双特异性抗体研究进展

抗体药物具有特异性高、不良反应少的特点，已成为肿瘤治疗的热点。双特异性抗体（双抗）是指同时结合2个不同抗原或同一抗原2个表位的抗体。与单特异性抗体相比，双抗具有高度特异性，增强了治疗有效性和安全性，同时减少了不良反应。已有多种双抗药物获批上市，进入临床研究的双抗药物数量不断增加。双抗药物的形式持续在更新，应用范围也在扩大，在未来具有非常好的应用前景。此文就目前已有的双抗类型、作用机制及目前双抗制备上面临的困难等进行概述。     

非小细胞肺癌脑转移放射治疗进展

肺癌是目前世界上发病率第二、死亡率第一的恶性肿瘤。非小细胞肺癌（NSCLC）是其主要病理类型,且易发生脑转移。目前,NSCLC脑转移的主要治疗方式包括手术、放疗、化疗、分子靶向治疗和免疫治疗等。放疗是脑转移局部治疗的常用方法,随着技术和药物的不断发展更新,放疗与其他治疗手段如何联合是目前临床研究热点。本文将对NSCLC脑转移放射治疗进展进行综述,从而为临床工作中治疗方案的选择提供参考。     

血清鸢尾素、血小板因子4及低氧诱导因子-1α水平在膀胱癌中的作用

目的 探讨血清鸢尾素、血小板因子4（PF4）及低氧诱导因子-1α（HIF-1α）水平在膀胱癌中的诊断及预后作用。方法 选择2018年10月至2020年6月于本院确诊并行膀胱癌根治术治疗的膀胱癌患者75例（疾病组），并随机选择同时期健康体检者72例（健康组）。收集受试者的一般资料、手术相关情况及血清鸢尾素、PF4、HIF-1α水平，对血清鸢尾素、PF4及HIF-1α水平与膀胱癌发生及预后的相关性进行分析。结果 疾病组患者的血清鸢尾素、PF4及HIF-1α水平均高于健康组（均P<0.05）。血清鸢尾素、PF4及HIF-1α在膀胱癌诊断方面具有较高的灵敏度（63.25%、78.30%、84.96%）和特异度（88.52%、87.45%、91.02%）（均P<0.05）。75例膀胱癌患者中39例患者预后良好、36例患者预后不良。单因素结果显示，两组年龄、肿瘤直径、病理分级、临床分期、肿瘤转移、血清鸢尾素、PF4、HIF-1α水平比较，差异具有统计学意义（P<0.05）；肿瘤转移、血清鸢尾素、PF4、HIF-1α水平是膀胱癌预后的独立影响因素（P<0.05）；多元线性逐步回归分析结果显示，血清鸢尾素、HIF-1α水平是影响膀胱癌患者预后的影响因子（P<0.05）。血清鸢尾素、PF4及HIF-1α在膀胱癌预后评估中具有较高灵敏度（70.12%、89.11%、86.52%）和特异度（78.96%、82.23%、91.07%）（均P<0.05）。结论 血清鸢尾素、HIF-1α、PF4水平在膀胱癌患者中上调，高水平的血清鸢尾素、HIF-1α及PF4与膀胱癌术后的预后不良相关，可作为患者预后的预测因子。     

Choosing the net survival method for cancer survival estimation

BackgroundA new net survival method has been introduced by Pohar Perme et al. (2012 [4]) and recommended to substitute the relative survival methods in current use for evaluating population-based cancer survival.MethodsThe new method is based on the use of continuous follow-up time, and is unbiased only under non-informative censoring of the observed survival. However, the population-based cancer survival is often evaluated based on annually or monthly tabulated follow-up intervals. An empirical investigation based on data from the Finnish Cancer Registry was made into the practical importance of the censoring and the level of data tabulation. A systematic comparison was made against the earlier recommended Ederer II method of relative survival using the two currently available computer programs (Pohar Perme (2013) [10] and Dickman et al. (2013) [11]).ResultsWith exact or monthly tabulated data, the Pohar-Perme and the Ederer II methods give, on average, results that are at five years of follow-up less than 0.5% units and at 10 and 14 years 1–2% units apart from each other. The Pohar-Perme net survival estimator is prone to random variation and may result in biased estimates when exact follow-up times are not available or follow-up is incomplete. With annually tabulated follow-up times, estimates can deviate substantially from those based on more accurate observations, if the actuarial approach is not used.ConclusionAt 5 years, both the methods perform well. In longer follow-up, the Pohar-Perme estimates should be interpreted with caution using error margins. The actuarial approach should be preferred, if data are annually tabulated.     

A critical assessment on the role of sentinel node mapping in endometrial cancer

Endometrial cancer is the most common gynecologic malignancy in the developed countries. Although the high incidence of this occurrence no consensus, about the role of retroperitoneal staging, still exists. Growing evidence support the safety and efficacy of sentinel lymph node mapping. This technique is emerging as a new standard for endometrial cancer staging procedures. In the present paper, we discuss the role of sentinel lymph node mapping in endometrial cancer, highlighting the most controversies features.     

Are we ready to predict late effects? A systematic review of clinically useful prediction models

BackgroundAfter completing treatment for cancer, survivors may experience late effects: consequences of treatment that persist or arise after a latent period.PurposeTo identify and describe all models that predict the risk of late effects and could be used in clinical practice.Data sourcesWe searched Medline through April 2014.Study selectionStudies describing models that (1) predicted the absolute risk of a late effect present at least 1 year post-treatment, and (2) could be used in a clinical setting.Data extractionThree authors independently extracted data pertaining to patient characteristics, late effects, the prediction model and model evaluation.Data synthesisAcross 14 studies identified for review, nine late effects were predicted: erectile dysfunction and urinary incontinence after prostate cancer; arm lymphoedema, psychological morbidity, cardiomyopathy or heart failure and cardiac event after breast cancer; swallowing dysfunction after head and neck cancer; breast cancer after Hodgkin lymphoma and thyroid cancer after childhood cancer. Of these, four late effects are persistent effects of treatment and five appear after a latent period. Two studies were externally validated. Six studies were designed to inform decisions about treatment rather than survivorship care. Nomograms were the most common clinical output.ConclusionDespite the call among survivorship experts for risk stratification, few published models are useful for risk-stratifying prevention, early detection or management of late effects. Few models address serious, modifiable late effects, limiting their utility. Cancer survivors would benefit from models focused on long-term, modifiable and serious late effects to inform the management of survivorship care.     

正常小肠血管与小肠腺癌血管对比研究

目的：建立正常小肠血管形态及小肠腺癌血管形态。材料与方法：对１０例正常小肠标本、１６例经病理证实的手术切除标本，其中８例术前已作肠系膜上动脉造影，分别采用血管铸型、血管造影、解剖镜观察及图像分析。结果：正常小肠血管的形态、分布与传统观点不尽相同。血管密度以十二指肠球部最低、在空、回肠呈由低增高，继而降低的变化规律。小肠腺癌术前血管造影确诊率较低（３／８）例，血管造影呈现：供血动脉增粗、杵状中断、狭窄，癌体内造影剂池，癌周血管增多、扭曲，肿块实质血管减少等特征。与正常组比，小肠腺癌血管面密度（目标总面积／统计场总面积）显著性减少（Ｐ＜０．０５）。结论：认识正常小肠血管分布规律，有助于小肠肿瘤的介入诊断和治疗。小肠腺癌癌周血管增多、变形，癌体内血管少、常见造影剂池征。     

Insulin-like growth factor (IgF)-I,IgF binding protein-3, and prostate cancer: correlation with gleason score

Introduction

Non-androgenic growth factors are involved in the growth regulation of prostate cancer (PCa).

Objective

This is the first Brazilian study to correlate, in a population of patients operated for PCa, PSA, total testosterone, insulin-like growth factor-I (IGF-I) and insulin-like growth factor-binding protein-3 (IGFBP-3) with Gleason score and to compare with a control group with benign prostate hyperplasia (BPH).

Materials and Methods

This retrospective single-center study included 49 men with previously diagnosed PCa and 45 with previously diagnosed BPH. PSA, testosterone, IGF-I, IGFBP-3 were determined in both groups.

Results

PSA and IGFBP-3 levels were significantly higher in the PCa group as compared to the BPH group (p<0.001 and p=0.004, respectively). There was a significant difference when we compared the PSA before surgery (p<0.001) and at the inclusion in the study (p<0.001) and IGFBP3 (0.016) among patients with Gleason <7, ≥7 and BPH. In the PCa group, PSA, testosterone, IGF-I and IGFBP-3 levels were comparable between Gleason <7 and ≥7.

Conclusions

Our data suggest that in localized PCa, the quantification of PSA and, not of IGF-1, may provide independent significant information in the aggressiveness. IGFBP-3 could be a biochemical marker of disease control in PCa patients.     

淋巴管在肿瘤转移中的作用

恶性肿瘤的局部及远处转移是导致患者死亡的根本原因,淋巴管形成以及结构改变的作用与淋巴转移途径密不可分.本文主要针对淋巴管在肿瘤转移过程中发挥的作用进行讨论,并且主要从近几年国际上关于淋巴管上皮细胞分子水平上的机制研究进展作一综述.