调强放射治疗在不可切除老年胃癌患者姑息治疗中的临床价值

目的:探讨调强放射治疗（intensity-modulated radiotherapy，IMRT）在老年不可切除胃癌患者中姑息减症治疗的临床价值。方法:回顾性分析23例老年病理确诊胃癌患者，手术无法切除，伴有出血(78.3%)、梗阻(52.2%)及疼痛(69.6%)症状；采用调强放射治疗为主的姑息治疗。观察治疗后症状缓解率、症状缓解时间以及中位生存时间（median overall survival，mOS）。结果: 全组患者男性16例，女性7例，年龄60~89岁(平均74岁)；Ⅲ期9例，Ⅳ期14例。全部采用6MV X线IMRT，常规分割，1.8~2.2 Gy/次，5次/周，总剂量35~50 Gy；同步放化5例，序贯化疗9例。出血、梗阻及疼痛症状缓解率分别为77.8%(14例)、58.3%(7例)和56.2%(9例)；中位症状缓解时间分别为101天、87天和99天。全组中位生存时间114天，症状缓解者中位生存时间较症状未缓解者明显延长(129天 vs 73天，P=0.01)。治疗期间出现Ⅲ级毒副反应者2例。结论:IMRT是一个有效的、可耐受的并能够缓解老年不可切除胃癌患者临床症状的治疗手段，可以改善患者生活质量，延长生存期。     

Comparison of Neoadjuvant and Adjuvant Chemotherapy in Muscle-invasive Bladder Cancer

BackgroundWe use observational methods to compare impact of perioperative chemotherapy timing (ie, neoadjuvant and adjuvant) on overall survival (OS) in muscle-invasive bladder cancer because there is no head-to-head randomized trial, and patient factors may influence decision-making.Patients and MethodsUsing Surveillance, Epidemiology, and End Results-Medicare data, we identified patients receiving cystectomy for muscle-invasive bladder cancer diagnosed between 2004 and 2013. Patients were classified as receiving neoadjuvant or adjuvant chemotherapy. Propensity of receiving neoadjuvant chemotherapy was determined using gradient boosted models. Inverse probability of treatment weighted survival curves were adjusted for 13 demographic, socioeconomic, temporal, and oncologic covariates.ResultsWe identified 1342 patients who received neoadjuvant (n = 676) or adjuvant chemotherapy (n = 666) with a median follow-up of 23 months (interquartile range, 9-55 months). Inverse probability of treatment weighted adjustment allows comparison of the groups head-to-head as well as counterfactual scenarios (eg, effect if those getting one treatment were to receive the other). The average treatment effect (ie, “head-to-head” comparison) of adjuvant compared with neoadjuvant on OS was not significant (hazard ratio, 1.14; 95% confidence interval, 0.99-1.31). However, the average treatment effect of the treated (ie, the effect if the neoadjuvant patients were to receive adjuvant instead) was associated with a 33% increase in risk of mortality if they were given adjuvant therapy instead (hazard ratio, 1.33; 95% confidence interval, 1.12-1.57).ConclusionSignificant treatment selection bias was noted in peri-cystectomy timing, which limits the ability to discriminate differential efficacy of these 2 approaches with observational data. However, patients with higher propensity to receive neoadjuvant therapy were predicted to have increased OS with approach, in keeping with existing paradigms from trial data.     

Nationwide treatment patterns and survival of older patients with prostate cancer

Objectives

To examine the clinical features, applied treatments, and survival of older patients with prostate cancer compared with younger patients.

CCR6通过上皮间质转化促进结直肠癌肝转移的机制研究

目的检测人趋化因子受体6(CCR6)、人趋化因子配体20(CCL20)、E-钙黏着蛋白和波形蛋白在结直肠癌及肝转移组织中的表达,探讨CCR6参与结直肠癌肝转移的可能机制。方法选取山西医科大学第一医院及山西省肿瘤医院2009至2017年资料齐全的62例原发性结直肠癌患者(结肠癌54例、直肠癌8例)手术切除存档蜡块,其中包含同期切除结直肠癌伴肝转移病灶的标本20例。采用免疫组织化学法检测结直肠癌及肝转移组织中CCR6、CCL20、E-钙黏着蛋白和波形蛋白的表达情况,分析CCR6、E-钙黏着蛋白和波形蛋白的表达与患者临床病理特征之间的关系,采用logistic多因素回归分析肝转移与患者临床病理特征及CCR6、E-钙黏着蛋白和波形蛋白表达的关系,采用Spearman相关分析CCR6与E-钙黏着蛋白和波形蛋白的相关性。结果CCR6在结直肠癌组织中的阳性表达率为66.1%(41/62);在伴有肝转移的结直肠癌组织中的阳性表达率为85.0%(17/20),在肝转移组织中的阳性表达率为70.0%(14/20)。CCL20在结直肠癌中的阳性表达率为83.9%(52/62);在伴有肝转移的结直肠癌组织中的阳性表达率为90.0%(18/20),在肝转移组织中的阳性表达率为90.0%(18/20)。E-钙黏着蛋白在结直肠癌中的阳性表达率为67.7%(42/62);在伴有肝转移的结直肠癌组织中的阳性表达率为50.0%(10/20),肝转移组织中的阳性表达率为65.0%(13/20)。波形蛋白在结直肠癌组织中阳性表达率为79.0%(49/62);在伴有肝转移的结直肠癌组织中的阳性表达率为85.0%(17/20),在肝转移组织中的阳性表达率为90.0%(18/20)。CCR6的表达与淋巴结转移(χ^2=11.142,P=0.001)、肝转移(χ^2=4.694,P=0.030)、TNM分期(χ^2=21.785,P<0.001)密切相关;E-钙黏着蛋白的表达与患者淋巴结转移(χ^2=4.694,P=0.030)、肝转移(χ^2=4.253,P=0.039)、TNM分期(χ^2=7.867,P=0.005)密切相关;波形蛋白的表达与患者淋巴结转移(χ^2=7.293,P=0.007)、TNM分期(χ^2=5.712,P=0.017)密切相关。CCR6、E-钙黏着蛋白、波形蛋白均与结直肠癌患者的性别、年龄、肿瘤部位、肿瘤大小及分化程度无关(均P>0.05)。logistic多因素回归分析发现,CCR6(OR=6.812,95%CI为1.206~38.474,P=0.030)、E-钙黏着蛋白(OR=0.256,95%CI为0.069~0.945,P=0.041)是结直肠癌患者肝转移的独立影响因素。Spearman相关分析显示,在20例晚期结直肠癌患者肝转移组织中,CCR6与E-钙黏着蛋白表达(r=0.454,P=0.044)、波形蛋白表达(r=0.509,P=0.022)相关。结论CCR6可能通过上皮间质转化机制促进结直肠癌的进展和肝转移。     

局部晚期鼻咽癌洛铂单周方案同期放疗初探

目的 探讨局部晚期鼻咽癌洛铂单药单周方案同期放疗中洛铂最大耐受剂量(MTD)。方法 选择18例Ⅲ-ⅣA期鼻咽癌初治患者,采用根治性IMRT同时进行洛铂剂量递增试验。洛铂初始剂量10 mg/m²,组间递增剂量为5 mg/m²,每个剂量组至少3位受试者。如无剂量限制性毒性反应则进入下一剂量组直至MTD,定期评价疗效及不良反应。结果 10、15 mg/m²剂量组各3例,20、25 mg/m²剂量组6例。25mg/m²组出现2例剂量限制性毒性反应,因此MTD确定为20 mg/m²。患者治疗结束后3个月,鼻咽部肿瘤和颈部阳性淋巴结临床缓解率为100%。主要毒性反应为骨髓抑制。结论 洛铂单药周方案同期放化疗治疗局部晚期鼻咽癌的MTD为20mg/m²,该方案疗效可靠安全性较好,值得开展进一步临床研究。