Lateral Lymph Nodes in Rectal Cancer: Do we all Think the Same? A Review of Multidisciplinary Obstacles and Treatment Recommendations

Lateral lymph nodes in low, locally advanced, rectal cancer have proven implications for local recurrence rates, which increase drastically in the presence of persistently enlarged lateral lymph nodes. These clinical implications warrant a thorough understanding of lateral nodal disease with awareness and knowledge from all three specialties involved – radiology, radiation oncology, and surgery – to ensure proper treatment. Relevant literature for each specialty, including all current guidelines and perspectives, were examined. Variations in definitions and treatment paradigms were evaluated. There is still no consensus for the standardized treatment of lateral nodal disease. Each discipline works according to their own available evidence, but relevant data are scarce. Current international guidelines and standard recommendations for the diagnostics and treatment of lateral lymph nodes are lacking. This results in differing perspectives and interpretations between the disciplines which can lead to challenging communication in an area where multidisciplinary collaboration is essential. This review addresses this by presenting the current evidence, perspectives and practices of each specialty and makes suggestions for each phase of the diagnostic and treatment process for patients with lateral nodal disease. By doing this, steps are taken toward achieving international consensus, and multidisciplinary collaboration.     

探究培美曲塞与多西他赛在晚期非小细胞肺癌靶向治疗失败后挽救化疗中的临床疗效

目的 研究培美曲塞与多西他赛在晚期非小细胞肺癌靶向治疗失败后挽救化疗中的应用效果。方法 筛选2018 年1 月～2020 年1 月本院的60 例晚期非小细胞肺癌靶向治疗失败后挽救化疗的患者作为研究对象，依据患者选择的药物种类分为观察组和对照组，每组各30 例，对照组采用多西他赛治疗，观察组予以培美曲塞治疗，对比分析两组的近期治疗效果、生存质量评分和毒副反应发生情况。结果 观察组病症控制率为66.67%，对照组病症控制率为36.67%，观察组病症控制效果更好；观察组生存质量评分为（65.2±3.4）分，对照组生存质量评分为（51.7±4.6）分，两组比较差异有统计学意义（t=12.926，P=0.000）；观察组各项毒副反应发生率均低于对照组，差异有统计学意义（P＜0.05）。结论 在晚期非小细胞肺癌靶向治疗失败后进行挽救化疗中选用培美曲塞有更好的治疗效果，可以较好的进行临床治疗，改善患者的生活质量，且产生的毒副反应较少，在实际临床中的应用价值较高。     

Liver Transplantation Following Life-threatening Abdominal Trauma: A Case Series of 5 Patients at a Single Institution

Managing traumatic liver injury (TLI) is always challenging and demands precise clinical judgment. Currently, treatment of TLI in most circumstances is non-operative; however, surgical therapy might be required for severe TLI, particularly those that result in extensive blood loss. In the current institutional study carried out from June 1995 to April 2017, we describe our experience with 5 patients who received an orthotopic liver transplant for severe TLI. One patient passed away postoperatively from cerebral edema; 1 patient died of renal failure 4 years after the liver transplantation, and 3 patients are still alive. Based on our experience, we conclude that in patients with TLI, especially those with uncontrollable bleeding or those who develop liver failure, liver transplantation should be taken into consideration.     

吉非替尼联合顺铂治疗晚期非小细胞肺癌的临床研究

目的 回顾性分析吉非替尼联合顺铂治疗晚期非小细胞肺癌的临床疗效。方法 选取2017年2月-2020年4月淮南东方医院集团总医院收治的60例晚期非小细胞肺癌,根据用药方案不同分为对照组和治疗组,每组各30例。对照组化疗第1天静脉滴注注射用培美曲塞二钠,500 mg/m²,注射时间大于10 min,化疗第1~3天静脉滴注顺铂注射液,75 mg/m²,给药前2~16 h和给药后至少6 h内必需进行充分的水化治疗。治疗组从化疗第1天开始口服吉非替尼片,250 mg/d,同时化疗第1~3天静脉滴注顺铂注射液,用法用量同对照组。两组均以3周为1个疗程,治疗2个疗程。观察两组的临床疗效,比较两组治疗前后生活质量相关评分、免疫功能指标、肿瘤标志物、血清细胞因子水平的变化情况。结果 治疗后,治疗组客观缓解率(ORR)、疾病控制率(DCR)分别是60.0%、90.0%,显著高于对照组的33.3%、70.0%(P<0.01)。治疗后,对照组躯体、心理、社会、总分均显著低于治疗前(P<0.05),两组KPS评分显著高于治疗前(P<0.05);治疗后治疗组患者躯体、心理、社会、总分及KPS评分均显著高于对照组(P<0.05)。治疗后,治疗组CD4⁺和CD4⁺/CD8⁺均显著上升,CD8⁺下降(P<0.05);对照组CD4⁺和CD4⁺/CD8⁺均显著下降(P<0.05),CD8⁺有上升趋势但无统计学意义。治疗后,治疗组患者CD4⁺和CD4⁺/CD8⁺显著高于对照组,CD8⁺低于对照组(P<0.05)。治疗后,两组癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)、血管内皮生长因子(VEGF)均显著下降(P<0.05);且治疗后治疗组CEA、NSE、VEGF水平显著低于对照组(P<0.05)。治疗后,两组患者白细胞介素-2(IL-2)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、干扰素-γ(INF-γ)显著升高,而白细胞介素-4(IL-4)显著降低(P<0.01);且治疗后,治疗组IL-6和INF-γ显著高于对照组(P<0.05)。随访发现,治疗组总生存率(OS)、无进展生存率(PFS)中位生存时间分别为20.6、28个月,对照组为16、19个月。Log-rank (Mantel-Cox) test结果显示,治疗组PFS显著优于对照组(P<0.05),而OS虽有一定趋势但无显著性差异。结论 吉非替尼联合顺铂可有效治疗晚期非小细胞肺癌患者,提高ORR、DCR,改善患者携瘤生活质量,提高无进展生存率,且无显著不良反应。