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1.
目的 探讨脑胶质母细胞瘤术后同步放化疗患者预后的影响因素.方法 选取2015年6月30日至2017年12月13日在安徽省肿瘤医院完成同步放化疗的78例胶质母细胞瘤术后患者,回顾分析其一般临床特征、放疗剂量、辅助替莫唑胺化疗疗程、术中脑胶质母细胞瘤切除情况以及免疫组化相关指标对患者无进展生存期(PFS)及总生存期(OS)的影响.用生命表法绘制PFS及OS生存曲线;用Kaplan-Meier评估生存率的差异,Log-rank检验法进行单因素生存分析;将单因素分析中具有统计学意义的变量纳入多因素Cox比例风险模型筛选生存影响因素.结果 78例胶质母细胞瘤患者的单因素分析发现,患者放疗前KPS评分>60分、术中肿瘤全切、辅助替莫唑胺化疗疗程数>6个周期可能延长患者的PFS及OS,差异均有统计学意义(P<0.001);而患者的性别、年龄、放疗剂量、IDH1突变情况、MGMT状态、Ki-67表达情况对患者PFS、OS无明显影响(P>0.05);单因素分析中有统计学意义的3个变量,其生存曲线图均无明显相交满足PH假设.将3个变量纳入多因素Cox回归分析,KPS评分、术中是否全切、辅助替莫唑胺化疗周期数对延长患者的OS均有存在影响(P<0.05);KPS评分和术中是否全切对患者PFS的延长差异有统计学意义(P=0.005、0.003),而辅助替莫唑胺化疗周期数对延长PFS差异无统计学意义(P=0.109).结论 放疗前KPS评分、术中切除情况、辅助化疗周期数是胶质母细胞瘤患者术后独立预后影响因素,KPS评分越高、术中全切、辅助化疗周期延长可明显改善患者的OS.  相似文献   
2.
目的:探讨沙利度胺对食管癌同步放化疗疗效和不良反应的影响。方法:选取82例食管癌患者,随机分为研究组和观察组,研究组治疗方案为沙利度胺联合同步放化疗,观察组为同步放化疗,同步放化疗中放疗单次剂量180~200 cGy,每周5次,给予放疗总量6 000~6 120 cGy/30~34次,同步化疗方案为紫杉醇135 mg/m2 d1+顺铂25 mg/m2 d1~d3,28天为1个周期,同步放化疗期间化疗2个周期,放化疗结束后再全身化疗2个周期。实验组患者在放化疗的基础上每日口服沙利度胺100 mg。观察两组患者近期疗效、长期生存及毒副作用。结果:研究组有效率为77.5%,观察组有效率为71.4%,P=0.529。研究组患者OS为43个月,观察组患者OS为45个月,P=0.783,差异无统计学意义。研究组中有14例发生放射性肺炎,发生率35%,观察组有24例发生,发生率为57%,P=0.044,差异有统计学意义。在放射性食管炎、放射性皮肤损伤、放射性气管炎方面,两组比较均无统计学差异。结论:在食管癌同步放化疗中加用沙利度胺不能提高近期有效率和远期生存,但可以减少放射性肺炎发生率。  相似文献   
3.
目的 探讨同时性多发性骨髓瘤和结肠癌的病因、诊断及治疗方法。方法 对1例同时诊断为多发性骨髓瘤和结肠癌并继发肝转移患者的临床资料及相关文献进行回顾性分析。结果 患者以贫血为首发症状,骨髓穿刺术提示多发性骨髓瘤,荧光原位杂交检测示14q32 IgH基因重排阳性,肠镜及病理活检明确诊断结肠癌,数月后继发肝占位。给予VTD方案减轻骨髓负荷后行结肠癌切除术,术后采用VTD与XELOX联合方案化疗,肝占位行局部肝病损射频消融术,患者可耐受,肝转移灶较前明显缩小。 结论 同时性多发性骨髓瘤和结肠癌并伴肝转移罕见,需组织病理检查鉴别诊断原发癌与转移癌,治疗上尚无统一标准,需多学科评估制定治疗方案。  相似文献   
4.
目的比较序贯放化疗与同步放化疗对ⅢA-N2期非小细胞肺癌的治疗效果。方法将40例ⅢA-N2期非小细胞肺癌患者按照随机数字表法分为序贯组(接受化疗序贯纵隔淋巴结放疗)与同步组(接受化疗同步纵隔淋巴结放疗),每组20例。比较两组患者的临床疗效、治疗前后的血清肿瘤标志物[糖类抗原125(CA125)、鳞状上皮细胞癌抗原(SCC-Ag)、细胞角质蛋白19片段抗原21-1(CYFRA21-1)]水平、治疗期间不良反应发生情况、无进展生存时间(PFS)和总生存时间(OS)。结果同步组患者的总有效率为75%(15/20),高于序贯组患者的35%(7/20),差异有统计学意义(P﹤0.05)。同步组患者的临床疗效优于序贯组患者,差异有统计学意义(P﹤0.05)。治疗后,同步组患者血清中的CEA、CYFRA21-1、SCC-Ag水平均低于序贯组患者,差异均有统计学意义(P﹤0.05)。两组患者的各不良反应发生率比较,差异均无统计学意义(P﹥0.05)。同步组患者的PFS、OS均长于序贯组患者,差异均有统计学意义(P﹤0.05)。结论与序贯放化疗相比,同步放化疗对于ⅢA-N2期非小细胞肺癌患者的临床疗效更优,能够有效延长患者的生存时间,且不会增加不良反应。  相似文献   
5.
目的:研究双特异性酪氨酸磷酸化调节激酶1b(dual specificity tyrosine phosphorylation regulated kinase 1b,Dyrk1b)蛋白在宫颈癌组织中的表达及其与放化疗治疗预后的关系。方法:选取2009年04月至2013年03月于我院就诊的宫颈癌患者80例,采用免疫组化法检测Dyrk1b蛋白表达水平。所有患者均接受三维适形放疗(3D-CRT)同步顺铂治疗。对患者进行为期5年的随访,并分析Dyrk1b蛋白表达与患者临床病理及预后之间的关系。结果:Dyrk1b低表达组有34例,高表达组有46例,Dyrk1b的高表达与年龄、病理类型无关,而与FIGO分期、分化程度、淋巴结转移和脉管浸润密切相关(P<0.05)。高、低Dyrk1b蛋白表达组近期疗效无统计学差异(P>0.05),而远期疗效经Kaplan-Meier曲线分析显示,Dyrk1b蛋白高表达组患者的中位生存时间少于低表达组(29月 vs 39月,Log-rank test P=0.012)。结论:Dyrk1b蛋白在宫颈癌组织中高度表达,且随着FIGO分期的升高、分化程度的降低、淋巴结的转移和浸润深度的增加而表达增加,并影响患者的长期预后。  相似文献   
6.
BackgroundThe coexistence of intracranial arteriovenous malformation (AVM) and meningioma in a single patient is seldom reported, so the clinical profile, optimal management, and outcomes of these patients are mostly unknown.MethodsWe performed a systematic review of the SCOPUS and PubMed databases for case reports and case series on patients with both intracranial AVMs and meningiomas. Data on demographics, clinical characteristics, surgical management, and outcomes were collected.ResultsA total of 18 cases were reported in the literature, including the present case. The mean age at presentation was 54 years (range of 15–70 years), with no gender predilection. Most of the meningiomas and AVMs were frontal in location, and more than half of the lesions were contiguous. The most common presenting symptoms were seizures (67%), headache (44%), and weakness (33%). Majority of the patients underwent single stage meningioma and AVM excision (44%), followed by staged meningioma excision then AVM excision (17%) and meningioma excision only (17%). In all, 94% (17/18) of the meningiomas were excised compared to 72% (13/18) of the AVMs. Outcomes were reported in 15 patients; 80% were favorable, but there were 2 deaths and 1 tumor recurrence after 5 years.ConclusionThe coexistence of an intracranial AVM with a meningioma is recognized but rarely reported in the literature. Individualized treatment should be employed in managing patients with concurrent lesions, and outcomes are generally favorable due to the benign nature of both these entities.  相似文献   
7.
The standard treatment for locally advanced non‐small cell lung cancer (NSCLC) is chemoradiotherapy (CRT) followed by anti‐programmed cell death‐ligand 1 (anti‐PD‐L1) treatment. BIM deletion polymorphism induces the suppression of apoptosis resulting from epidermal growth factor (EGFR)‐tyrosine kinase inhibitors in EGFR‐mutated NSCLC patients. We aimed to examine the effects of BIM polymorphism on CRT and anti‐PD‐L1/PD‐1 treatment in NSCLC patients. In this retrospective study of 1312 patients with unresectable NSCLC treated at Higashi‐Hiroshima Medical Center and Hiroshima University Hospital between April 1994 and October 2019, we enrolled those who underwent CRT or chemotherapy using carboplatin + paclitaxel or cisplatin + vinorelbine, or anti‐PD‐L1/PD‐1 treatment. Of 1312 patients, 88, 80, and 74 underwent CRT, chemotherapy, and anti‐PD‐L1/PD‐1 treatment, respectively, and 17.0%, 15.2% and 17.6% of these patients showed BIM polymorphism. Among patients receiving CRT, the progression‐free survival was significantly shorter in those with BIM deletion than in those without. In the multivariate analyses, BIM polymorphism was an independent factor of poor anti‐tumor effects. These results were not observed in the chemotherapy and anti‐PD‐L1/PD‐1 treatment groups. In in vitro experiments, BIM expression suppression using small interfering RNA in NSCLC cell lines showed a significantly suppressed anti‐tumor effect and apoptosis after irradiation but not chemotherapy. In conclusion, we showed that BIM polymorphism was a poor‐predictive factor for anti‐tumor effects in NSCLC patients who underwent CRT, specifically radiotherapy. In the implementation of CRT in patients with BIM polymorphism, we should consider subsequent treatment, keeping in mind that CRT may be insufficient.  相似文献   
8.
BackgroundIn rectal cancer, extramural vascular invasion (EMVI) is the presence of tumour cells in blood vessels outside the muscular layer, which is associated with poor prognosis. Regression of EMVI on MRI following neoadjuvant chemoradiotherapy or its persistence may have prognostic implications.MethodsThis retrospective study included 52 patients with rectal cancer who underwent total mesorectal excision following long-course neoadjuvant chemoradiotherapy (CRT). EMVI assessments were done on previous pelvic MRIs obtained before neoadjuvant CRT and eight weeks after the completion of neoadjuvant chemoradiotherapy in initially EMVI positive cases.ResultsPersistently EMVI positive patients had worse overall survival and disease-free survival compared to initially EMVI negative patients and patients who returned to negative (p < 0.001 for both). Multivariate analysis identified persistent EMVI positivity after neoadjuvant treatment (HR, 102.9; p = 0.003) as significant independent predictor of worse overall survival; and persistent EMVI positivity (HR, 17.0; p = 0.002), mesorectal fascia involvement after neoadjuvant treatment (HR, 8.0; p = 0.017), and poor differentiation (HR, 10.3, p = 0.012) as significant independent predictors of worse disease-free survival.ConclusionPersistent EMVI positivity after neoadjuvant therapy appears to be an independent factor for poor overall survival; and persistent EMVI positivity as well as mesorectal fascia involvement on post neoadjuvant therapy MRI and poor differentiation appears to be important predictors of poor disease-free survival in rectal cancer patients.  相似文献   
9.
BackgroundStandard Western management of rectal cancers with pre-treatment metastatic lateral lymph nodes (LLNs) is neoadjuvant (chemo)radiotherapy (nCRT) followed by total mesorectal excision (TME). In recent years, there is growing interest in performing an additional lateral lymph node dissection (LLND). The aim of this systematic review and meta-analysis was to investigate long-term oncological outcomes of nCRT followed by TME with or without LLND in patients with pre-treatment metastatic LLNs.MethodsPubMed, Ovid MEDLINE, Embase, Cochrane Library and Clinicaltrials.gov were searched to identify comparative studies reporting long-term oncological outcomes in pre-treatment metastatic LLNs of nCRT followed by TME and LLND (LLND+) vs. nCRT followed by TME only (LLND-). Newcastle-Ottawa risk-of-bias scale was used. Outcomes of interest included local recurrence (LR), disease-free survival (DFS), and overall survival (OS). Summary meta-analysis of aggregate outcomes was performed.ResultsSeven studies, including 946 patients, were analysed. One (1/7) study was of good-quality after risk-of-bias analysis. Five-year LR rates after LLND+ were reduced (range 3–15%) compared to LLND- (11–27%; RR = 0.40, 95%CI [0.25–0.62], p < 0.0001). Five-year DFS was not significantly different after LLND+ (range 61–78% vs. 46–79% for LLND-; RR = 0.72, 95%CI [0.51–1.02], p = 0.143), and neither was five-year OS (range 69–91% vs. 72–80%; RR = 0.72, 95%CI [0.45–1.14], p = 0.163).ConclusionIn rectal cancers with pre-treatment metastatic LLNs, nCRT followed by an additional LLND during TME reduces local recurrence risk, but does not impact disease-free or overall survival. Due to the low quality of current data, large prospective studies will be required to further determine the value of LLND.  相似文献   
10.
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