乳腺癌新辅助化疗后腋窝淋巴结转移综合预测模型的建立

目的:建立乳腺癌新辅助化疗后淋巴结转移的综合预测模型，评估新辅助化疗后淋巴结转移情况，指导临床手术方案选择。方法:回顾分析2015年1月至2018年12月143例乳腺癌新辅助化疗患者的临床、病理及影像资料，并根据术后淋巴结病理分为转移组与无转移组。采用χ2/t检验对两组指标进行单因素分析；将P<0.05的指标纳入多因素Logistic回归分析。用多因素分析有统计学意义(P<0.05)的指标构建乳腺癌新辅助化疗后淋巴结转移综合预测模型的列线图，并应用受试者工作特征（receiver operation characteristic,ROC)曲线评价此模型的性能。结果:单因素分析表明化疗方案、化疗前淋巴结穿刺病理、术前查体、术前彩超、术前CT/MRI、RECIST分级对腋窝淋巴结转移有预测作用；多因素分析表明，化疗前淋巴结穿刺病理、术前彩超、RECIST分级是新辅助化疗后腋窝淋巴结转移的独立预测因素。乳腺癌新辅助化疗后淋巴结转移的预测模型的曲线下面积为0.785，特异度为85.4%，敏感度为59.8%。结论:乳腺癌新辅助化疗后淋巴结转移的综合预测模型对腋窝淋巴结有较好的预测能力，可为选择合适的手术方式提供临床指导。     

Cabozantinib for relapsed neuroblastoma: Single institution case series

Relapsed high‐risk neuroblastoma has few effective therapies currently available or in development. Cabozantinib is an Food and Drug Administration approved multitargeted tyrosine kinase inhibitor for select adult malignancies with preclinical data suggesting efficacy against neuroblastoma. A safe and tolerable dose has been identified for children, but its efficacy remains unknown. We describe four children with relapsed metastatic neuroblastoma treated with cabozantinib. All four patients had extended disease control (two complete responsesfor >12 months, 2 stable disease >6 months) with manageable predictable toxicities requiring dose reduction in two patients. We discuss the potential for the use of cabozantinib in neuroblastoma.     

Prevalence and clinical impact of TP53 germline mutations in Chinese women with breast cancer

The prevalence and clinical relevance of TP53 germline mutations in a large unselected breast cancer series are largely unknown. Here, we determined TP53 germline mutations in a large cohort of 10,053 unselected breast cancer patients through multigene panel-based next-generation and/or Sanger sequencing assays. We found that 0.5% of patients (50 cases) carried a pathogenic TP53 germline mutation in this large series of 10,053 unselected breast cancer patients, and the prevalence of TP53 germline mutation was 3.8% in very early onset breast cancer (age ≤30 years) in this large cohort. TP53 mutation carriers were significantly more likely to have early onset cancer (p < 0.001) and bilateral breast cancer (p = 0.03), they and were significantly more likely to respond to carboplatin-based neoadjuvant chemotherapy compared to anthracycline- or taxane-based regimen in terms of pathologic complete response (50% vs. 0%, p = 0.006). At the median follow-up of 54 months, TP53 mutation was an independent unfavorable factor for recurrence-free survival (RFS), distant recurrence-free survival (DRFS), and overall survival (OS) (RFS, adjusted hazard ratio [HR]: 2.24, 95% confidence interval [CI]: 1.15–4.33, p = 0.02; DRFS, adjusted HR: 2.73, 95% CI: 1.41–5.30, p = 0.003; OS, adjusted HR: 4.60, 95% CI: 2.26–9.41, p < 0.001) in multivariate analyses. Our study suggested that TP53 germline mutations occur more frequently in very early onset unselected breast cancer patients; and TP53 germline mutation carriers have a very poor survival and may benefit from carboplatin-based neoadjuvant chemotherapy in unselected breast cancer patients.     

Disappearing colorectal liver metastases: Strategies for the management of patients achieving a radiographic complete response after systemic chemotherapy

The mainstays of treatment for colorectal liver metastases (CRLMs) are surgery and chemotherapy. Chemotherapeutic benefits of tumor shrinkage and systemic control of micrometastases are in part counterbalanced by chemotoxicity that can modify the liver parenchyma, jeopardizing the detection of CRLM. This review addresses the clinical decision-making process in the context of radiographic and pathologic responses, the preoperative imaging workup, and the approaches to the liver for CRLM, which disappear after systemic chemotherapy.     

贝伐珠单抗联合长春瑞滨二线治疗复发转移性宫颈癌患者的近期疗效

目的:观察贝伐珠单抗联合长春瑞滨治疗复发转移性宫颈癌的近期疗效及不良反应。方法:回顾性分析2014年1月至2016年12月贵州省人民医院收治的34例复发转移性宫颈癌患者的临床资料，所有患者均使用贝伐珠单抗联合长春瑞滨，21天为1个周期，行4～6个周期治疗，评价疗效及评定不良反应级别。结果:34例宫颈癌患者中无完全缓解患者，部分缓解7例（20.6%）、疾病稳定20例（58.8%）、疾病进展7例(20.6%），总有效率为 20.6%（7/34），疾病控制率为79.4%（27/34）。34例患者常见不良反应程度均较轻，可以耐受。结论:贝伐珠单抗联合长春瑞滨方案治疗复发转移性宫颈癌患者近期疗效好，其不良反应患者可耐受，远期疗效有待进一步的研究。     

腹腔穿刺与腹腔输液港在卵巢癌患者腹腔化疗中的应用比较

目的:探讨腹腔穿刺与腹腔输液港在卵巢癌患者腹腔化疗中的应用效果。方法:选择2017年1月至2018年12月住院行腹腔化疗的卵巢癌患者90例，其中腹腔穿刺组患者45例，腹腔输液港组患者45例。对比2组患者的治疗效果、导管相关并发症发生情况、穿刺时疼痛评分、一次性穿刺成功率以及疗程完成情况。结果:两组患者治疗效果比较差异无统计学意义（P>0.05）；导管相关并发症发生情况，两组比较差异无统计学意义（P>0.05）；腹腔输液港组患者穿刺疼痛评分低于腹腔穿刺组，两组M(P25，P75)评分分别为2.00（1.40，2.50）和5.33（5.00，5.67），差异具有统计学意义（P<0.05），腹腔输液港组患者有18例主诉在留置期间存在腹部异物感；腹腔穿刺组患者一次性穿刺成功率为87.44%（181/207），腹腔输液港组患者为95.04%（249/262），两组比较差异具有统计学意义（P<0.05）；腹腔穿刺组患者疗程完成率为82.22%（37/45），腹腔输液港组为95.56%（43/45），差异具有统计学意义（P<0.05）。结论:腹腔输液港相较于腹腔穿刺应用于腹腔化疗中，其一次性穿刺成功率更高，疗程完成度更好，故在经济条件允许且化疗周期较长、腹部穿刺困难或对疼痛不耐受的患者可考虑置入腹腔输液港。     

Response to chemoradiotherapy and lymph node involvement in locally advanced rectal cancer

AIM: To establish the association between lymph node involvement and the response to neoadjuvant therapy in locally advanced rectal cancer.METHODS: Data of 130 patients with mid and low locally advanced rectal adenocarcinoma treated with neoadjuvant chemoradiation followed by radical surgery over a 5-year period were reviewed. Tumor staging was done by endorectal ultrasound and/or magnetic resonance imaging. Tumor response to neoadjuvant therapy was determined by T-downstaging and tumor regression grading (TRG). Pathologic complete response (pCR) is defined as the absence of tumor cells in the surgical specimen (ypT0N0). The varying degrees TRG were classified according to Mandard’s scoring system. The evaluation of the response is based on the comparison between previous clinico-radiological staging and the results of pathological evaluation. χ² and Spearman’s correlation tests were used for the comparison of variables.RESULTS: Pathologic complete response (pCR, ypT0N0, TRG1) was observed in 19 cases (14.6%), and other 18 (13.8%) had only very few residual malignant cells in the rectal wall (TRG2). T-downstaging was found in 63 (48.5%). Mean lymph node retrieval was 9.4 (range 0-38). In 37 cases (28.5%) more than 12 nodes were identified in the surgical specimen. Preoperative lymph node involvement was seen in 77 patients (59.2%), 71 N1 and 6 N2. Postoperative lymph node involvement was observed in 41 patients (31.5%), 29 N1 and 12 N2, while the remaining 89 were N0 (68.5%). In relation to ypT stage, we found nodal involvement of 9.4% in ypT0-1, 22.2% in ypT2 and 43.7% in ypT3-4. Of the 37 patients considered “responders” to neoadjuvant therapy (TRG1 and 2), there were only 4 N+ (10.8%) and the remainder N0 (89.2%). In the “non responders” group (TRG 3, 4 and 5), 37 cases were N+ (39.8%) and 56 (60.2%) were N0 (P < 0.001).CONCLUSION: Response to neoadjuvant chemoradiation in rectal cancer is associated with lymph node involvement.     

Risk based neoadjuvant chemotherapy in muscle invasive bladder cancer

Muscle invasive bladder cancer (MIBC) is an aggressive disease that frequently requires radical cystectomy (RC) to achieve durable cure rates. Surgery is most effective when performed in organ-confined disease, with the best outcomes for those patients with a pT0 result. The goals of neoadjuvant chemotherapy (NC) are to optimize surgical outcomes for a malignancy with limited adjuvant therapies and a lack of effective salvage treatments. Despite level 1 evidence demonstrating a survival benefit, the utilization of NC has been hampered by several issues, including, the inability to predict responders and the perception that NC may delay curative surgery. In this article, we review the current efforts to identify patients that are most likely to derive a benefit from NC, in order to create a risk-adapted paradigm that reserves NC for those who need it.     

miRNA失控表达在乳腺癌耐药中研究进展

近年来，乳腺癌耐药的研究取得了显著的进步。microRNA ( miRNA)作为乳腺癌耐药相关的分子标志物及治疗靶点，可能通过药物转运、DNA修复、细胞凋亡、上皮间质转化、乳腺癌干细胞等方面调控乳腺癌耐药。靶向调节miRNA的异常表达，恢复miRNA正常的调控功能，可能为治疗乳腺癌的提供新方向。