不吸烟女性肺癌危险因素病例-对照研究

目的：探讨不吸烟女性患肺癌的危险因素。方法：对沈阳市已确诊的126例不吸烟女性原发性肺癌进行1；1配对的病例对照研究。调查内容包括一般状况、家族史、疾病史、居住史、被动吸烟史、职业史、饮食史、烹饪史及室内微小环境等。结果：腺癌是女性肺癌的主要组织类型，占62．7％。生育次数越多，患肺癌的危险性越高（OR＝1．466，95％CI＝1．06－2．01）。肥胖指数（BMI）越小，肺癌的危险性越高（OR＝2．082，95％CI＝1．2－3．60）而且随着BMI的增加，肺癌的危险性降低。大量食用动物内脏（OR＝1．891，95％CI＝1．45－2．46）、玉米高梁（OR＝1．538，95％CI＝1．22－1．93）等能增加肺癌的危险性。使用液化石油作燃料（OR＝1．741，95％CI＝1．29－2．34）和室内燃煤（OR＝1．785，95％CI＝1．33－2．38）是不吸烟女性肺癌的危险因素。一级亲属中有肺癌患者，不吸烟女性的肺癌危险性增加（OR＝3．18，95％CI＝2．43－4．15）。结论：低BMI、多次生育、大量食用动物内脏及玉米高梁、室内燃煤、使用液化石油气作燃料均会增加不吸烟女性患肺癌的危险性。     

中老年女性家务劳动与恶性肿瘤关系的横断面研究

目的：探讨上海市区中老年妇女的家务劳动与恶性肿瘤的关系。方法：对上海市女性健康队列基线资料中共74942名中老年妇女的家务劳动进行了简单描述，并对家务劳动与恶性肿瘤的关系进行了logistic回归分析。结果：研究对象平均每周花费14h进行家务劳动，其中68．3％的对象表示担任家庭中大部分的家务劳动。家务劳动的活动量达到全部非职业性体力活动总量的1／4。家务劳动活动量与乳腺癌、直肠癌、卵巢癌和肺癌的患病率均呈负相关，OR分别为0．79（95％CI：0．73，0．87），0．53（95％CI：0．42，0．70），0．71（95％CI：0．55，0．95）和0．52（95％CI：0．36，0．73），根据活动量分层后显示有明显的剂量反应关系（趋势检验P≤0．05）。家务劳动与结肠癌和子宫内膜癌的OR分别为0．85（95％CI：0．68．1．05）和1．03（95％CI：0．79，1．33）。结论：家务劳动是中老年女性日常体力活动的主要组成部分，并与乳腺癌等一些常见恶性肿瘤的患病率呈负相关。     

2型糖尿病患者罹患生殖系统恶性肿瘤危险性的Meta分析

[目的]探讨2型糖尿病与生殖系统恶性肿瘤发生风险的关系。[方法]检索1979年1月至2012年10月Medline、Embase和Web of Science数据库公开发表的有关2型糖尿病与生殖系统恶性肿瘤关系的队列研究文献,按纳入和排除标准进行筛选,利用R软件及其Meta程序包对检索结果进行综合分析。[结果]共纳入39篇文献,包括10778543名观察对象。与非糖尿病人群相比,2型糖尿病患者发生生殖系统恶性肿瘤的合并相对危险度（RR）为1．15（95％CI：1．03～1．28）。2型糖尿病与女性生殖系统恶性肿瘤发生的相对危险度RR为l-39f95％CI：1．23－1．57）。2型糖尿病可以增加子宫内膜癌、宫颈癌和女性乳腺癌的发病风险,合并RR分别为1．83（95％CI：1．58-2．12）、2．13（95％CI：1．86－2．43）和1．16f95％CI：1．03-1.32）。卵巢癌风险的增加接近临界（RR=I．21,95％CI：0．99～1．48）;与前列腺癌的发病风险无关（RR=0．92,95％CI：0．78～1．09）。亚组分析提示,在欧美人群中2型糖尿病患者发生前列腺癌的风险降低．RR为0．80（95％CI：0．74－0．87）。[结论]2型糖尿病可能是子宫内膜癌、宫颈癌、乳腺癌的危险因素之一,可能是欧美人群前列腺癌保护因素。     

鲁北地区子宫内膜癌发病因素病例对照研究

目的：了解子宫内膜癌发病情况及相关因素,为临床进行预防及治疗提供依据。方法：采用病例-对照流行病学分析方法,对鲁北地区6所三级医院2006-05-01-2011-10-01病理确诊的289例子宫内膜癌患者及174例对照进行统一问卷调查;采用单因素和多因素的Logistic回归分析,以OR和95%可信区间为评价指标,分析与子宫内膜癌有关联的危险性因素。结果：鲁北地区子宫内膜癌患者289例,其中子宫内膜样腺癌259例（90%）;非子宫内膜样腺癌（浆液性腺癌,透明细胞癌等）30例（10%）。Ⅰ期患者219例（76%）,Ⅱ期患者29例（10%）,Ⅲ~Ⅳ期患者共41例（14%）。子宫内膜癌的发病年龄为25~78岁,平均发病年龄为55.41岁,58~61岁为发病高峰。已绝经妇女占62%。单因素分析结果表明,高血压（OR=3.67,χ2=33.70,P=0.00）、糖尿病（OR=1.92,χ2=4.13,P=0.04）、肥胖（OR=4.63,χ2=50.62,P=0.00）、饮用茉莉花茶史（OR=2.63,χ2=19.84,P=0.00）、重体力劳动（OR=1.82,χ2=9.28,P=0.00）、月经不规律（OR=12.68,χ2=107.20,P=0.00）、口服中草药调经（OR=15.21,χ2=68.82,P=0.00）、绝经年龄（OR=1.10,χ2=11.56,P=0.00）、未产（OR=19.07,χ2=15.84,P=0.00）和一级亲属恶性肿瘤家族史（OR=2.91,χ2=12.22,P=0.00）等可增加子宫内膜癌发病风险;使用宫内节育器（intrauterine device,IUD）可降低子宫内膜癌发病风险,OR=0.29,χ2=37.21,P=0.00。多因素Logistic回归分析结果表明,高血压（OR=3.69,95%CI：1.89~7.22）、肥胖（OR=3.06,95%CI：1.62~5.75）、月经不规律（OR=4.53,95%CI：2.13~9.60）、口服中草药调经（OR=9.31,95%CI：2.91~29.76）、绝经年龄晚（OR=1.13,95%CI：1.06~1.20）和一级亲属恶性肿瘤家族史（OR=5.20,95%CI：2.13~12.73）是内膜癌发病的危险因素;使用IUD是内膜癌的保护性因素,OR=0.84,95%CI：0.79~0.88。结论：高血压、肥胖和绝经年龄等因素可影响子宫内膜癌的发生,应针对相关危险因素采取相应的预防措施。     

厦门市居民2005年－2014年结直肠癌死亡的流行病学分析

目的：探讨厦门市居民结直肠癌死亡变化趋势,为厦门市结直肠癌综合防治工作提供依据。方法：收集整理2005年－2014年厦门市居民结直肠癌死亡资料,计算死亡率等评价指标。多因素 Logistic 回归分析结直肠癌死亡的影响因素。结果：2005年－2014年,厦门市居民结直肠癌死亡率10．69／10万,年均上升9．35％,男性死亡率是女性的1．40倍。死亡率随着年龄的升高逐渐升高,死亡年龄中位数为70岁。男性（OR ＝1．67,95％CI：1．52～1．82）、生活在城市（OR ＝1．67,95％CI：1．50～1．85）和2010年－2014年时间段（OR ＝1．48,95％CI：1．35～1．63）、年龄越大（OR ＝1．52,95％CI：1．50～1．55）可能是结直肠癌死亡的危险因素。结论：厦门市居民结直肠癌死亡率呈上升趋势,应以城市、男性、老年人群作为重点关注对象,重视结直肠癌防治工作。     

绝经前子宫内膜癌的危险因素分析

[目的]分析绝经前子宫内膜癌的危险因素,为临床诊治提供参考依据.[方法] 2006年1月至2010年12月间因阴道出血就诊的绝经前患者1 283例,其中子宫内膜正常1 239例,子宫内膜癌44例;收集两组病例的临床资料,采用Logistic回归分析危险因素的危险度.[结果]多因素Logistic回归分析显示多囊卵巢综合征(PCOS)患者患子宫内膜癌风险是非PCOS的28.594倍(95％CI为11.983～73.407).糖尿病者患有子宫内膜癌的风险是非糖尿病患者的43.965倍(95％CI为11.783～164.041).三苯氧胺(TAM)使用史者患子宫内膜癌的风险是无TAM使用史的65.074倍(95％CI为8.993～476.172).肿瘤家族史者患子宫内膜癌的风险是无肿瘤家族史患者的67.797倍(95％CI为9.622～377.687).[结论]PCOS、糖尿病、TAM使用史和肿瘤家族史是子宫内膜癌的危险因素.针对危险因素采取防治措施对预防子宫内膜癌发病有着一定的价值.     

2006－2013年江苏省昆山市居民结直肠癌发病与死亡趋势分析

目的：结直肠癌是影响居民健康的主要癌症之一,且发病率呈现明显上升趋势。本研究探讨江苏省昆山市2006－2013年结直肠癌发病与死亡趋势。方法江苏省昆山市2006－2013年结直肠癌发病和死亡病例来源于昆山市肿瘤登记报告;计算结直肠癌粗发病（死亡）率与发病（死亡）的年龄标化率（age standardized rate,ASR）;使用平均年度变化百分比（annual percent change,APC）及其95％CI,评价结直肠癌发病率和死亡率在年份之间变化趋势。结果江苏省昆山市2006－2013年结直肠癌发病 ASR 在女性人群中呈明显上升趋势,APC＝2．3％,95％CI 为0．5％～4．2％;结直肠癌发病率总体变化趋势（APC＝0．6％,95％ CI 为－0．8％～1．9％）与男性人群（APC＝－0．8％,95％ CI 为－3.5％～1．5％）差异无统计学意义。昆山市2006－2013年结直肠癌死亡 ASR 在总体（APC ＝－5．3％,95％CI 为－9．0％～－1．6％）和女性（APC ＝－9．1％,95％CI 为－16．2％～－2．0％）人群中呈下降趋势,差异有统计学意义;而男性人群中结直肠癌死亡 ASR 的变化差异无统计学意义,APC＝－2．1％,95％CI 为－6．2％～2．0％。结论虽然结直肠癌死亡率呈现下降趋势,但是结直肠癌发病数逐年增加。因结直肠癌造成的疾病负担逐年增加,在全人群中开展结直肠癌预防控制十分必要。     

CYP17 MspA1Ⅰ基因多态性和月经生育史与子宫内膜癌关系的病例对照研究

目的 研究细胞色素CYP17 MspA1 Ⅰ基因多态性与子宫内膜癌发生的关系。方法采用Taqmam特异性等位基因鉴别方法,对832例子宫内膜癌患者和781例正常对照者的CYP17MspA1 Ⅰ基因多态性进行分析。以非条件Logistic回归模型计算各种基因型发生子宫内膜癌的比数比（OR）及其95％置信区间（CI）。结果 在781例正常对照组中,CYP17 MspA1 Ⅰ位点A1／A1、A1／A2、A2／A2等3种基因型的频率分别为17．8％、49．3％和32．9％。无论绝经与否,CYP17MspA1 Ⅰ基因型与子宫内膜癌的发生均无关,但在携带A2等位基因且未绝经的女性中,怀孕次数多者发生子宫内膜癌的危险降低（OR=0．66,95％ CI 0．44～0．99）。在绝经后女性中,怀孕次数〉2或行经年数≤32年且具有A2等位基因者发生子宫内膜癌的危险降低（OR=0．68,95％CI 0．47～0．99;OR=0．54,95％CI 0．37～0．81）。结论CYP17MspA1 Ⅰ基因多态性单独存在可能与上海市区女性子宫内膜癌的发生无关。     

中国女性乳腺癌危险因素的Meta分析

[目的]评价中国女性乳腺癌部分危险因素的作用,探讨乳腺癌的病因。[方法]运用Meta分析方法对我国1996～2006年间公开发表的有关乳腺癌危险因素病例对照研究的12篇文献资料进行定量综合分析。[结果]各因素合并OR值分别为：初潮年龄OR=1．5401（95％CI：1．3437～1．7654）;哺乳OR=0．6837（95％CI：0．4779—0．9782）;口服避孕药OR=1．3278（95％CI：1．0627—1．6589）;良性乳腺疾病史OR=2．6180（95％CI：2．0275—3．3804）;吸烟OR=1．8576（95％CI：1．5394—2．2415）;饮酒OR=0．8137（95％CI：0．6196～1．0686）;饮茶OR=0．8625（95％CI：0．7646～0．9728）。[结论]初潮年龄、口服避孕药、良性乳腺疾病史及吸烟是乳腺癌发生的危险因素,哺乳及饮茶则是乳腺癌的保护因素。     

山东省肥城市1998—2011年农村居民恶性肿瘤死亡趋势分析

目的：分析山东省肥城市农村居民1998—2011年恶性肿瘤死亡情况及趋势,为该市恶性肿瘤防治研究工作提供参考依据。方法：采用肥城市农村居民1998—2011年恶性肿瘤死亡登记资料,计算恶性肿瘤死亡率、标化死亡率、年龄别死亡率和死亡构成比等指标,采用Joinpoint软件估计死亡率的年度变化百分率（APC）,分析恶性肿瘤变化趋势。结果：1998—2011年肥城市农村恶性肿瘤粗死亡率为195．72／10万,标化死亡率为153．14／10万,恶性肿瘤死因顺位前5位依次为食管癌、胃癌、肺癌、肝癌和结直肠癌,农村恶性肿瘤标化死亡率、男性标化死亡率均呈上升趋势（P〈0．05）,平均年度增加百分率（AAPC）和95％CI分别为1．7％（0．6％～2．7％）和2．2％（1．0％～3．3％）。男性肺癌、男性结直肠癌、女性肺癌、结直肠癌和乳腺癌标化死亡率呈上升趋势（P〈0．05）,AAPC和95％CI分别为5．3％（3．6％～7．1％）,16．8％（10．3％～23．7％）,7．4％（4．4％～10．5％）,14．1％（4．8％～24．3％）,9．9％（5．1％～14．9％）,其余癌种标化死亡率无明显趋势变化。结论：1998—2011年肥城市农村居民恶性肿瘤死亡率呈不断上升趋势,消化系统肿瘤、肺癌和乳腺癌等主要恶性肿瘤的防治形势严峻。加强肿瘤登记质量控制,提高登记数据质量,有助于肿瘤防治工作的顺利开展。     

Impact of radiotherapy in the risk of esophageal cancer as subsequent primary cancer after breast cancer

PURPOSE: To assess the risk of esophageal cancer as second cancer among breast-cancer patients treated with radiotherapy. METHODS AND MATERIALS: The records of the Finnish Cancer Registry from 1953 to 2000 were used to assess the risk of esophageal cancer as second cancer among 75,849 breast-cancer patients. Patients were treated with surgery (n = 33,672), radiotherapy (n = 35,057), chemotherapy and radiotherapy (n = 4673), or chemotherapy (n = 2,447). The risk of a new primary cancer was expressed as standardized incidence ratio (SIR), defined as the ratio of observed to expected cases. RESULTS: By the end of 2000, the number of observed cases esophageal cancers was 80 vs. 72 expected cases (standardized incidence ratio (SIR) = 1.1, 95% Confidence Interval (CI) = 0.9 to 1.5). Among patients followed for 15 years and treated with radiotherapy, the SIR for esophageal cancer was 2.3 (95% CI = 1.4 to 5.4). No increase in risk was seen for patients treated without radiotherapy. The risk of esophageal cancer was increased among patients diagnosed during 1953 to 1974, although age at the treatment did not have marked effect on the risk estimate. CONCLUSION: Increased risk of second cancer in the esophagus was observed for breast-cancer patients in Finland, especially among patients with over 15 years of follow-up and treated in the earliest period, which may relate to the type of radiotherapy.     

Amiodarone and the risk of cancer

BACKGROUND:

In postmarketing surveillance, the US Food and Drug Administration has reported the development of lung masses, thyroid cancer, and skin cancer after amiodarone therapy.

METHODS:

Using the Taiwan National Health Insurance Research database, the authors conducted a population‐based cohort study. Patients who were treated with amiodarone between 1997 and 2008 were enrolled. Those with antecedent cancer were excluded. Standardized incidence ratios (SIRs) of cancers were calculated to compare the cancer incidence of the study cohort with that of the general population. A multivariate Cox regression model was used to evaluate the association between cumulative defined daily doses (cDDDs) of amiodarone and cancer occurrence.

RESULTS:

The study included 6418 subjects, with a median follow‐up of 2.57 years. A total of 280 patients developed cancer. The risk of cancer increased with borderline significance (SIR, 1.12; 95% confidence interval [95% CI], 0.99‐1.26 [P = .067]). Male patients had a higher risk (SIR, 1.18; 95% CI, 1.02‐1.36 [P = .022]). The total cohort of patients and the male patients with > 180 cDDDs within the first year were found to have SIRs of 1.28 (95% CI, 1.00‐1.61; P = .046) and 1.46 (95% CI, 1.11‐1.89; P = .008), respectively. After adjustment for age, sex, and comorbidities, the hazards ratio was 1.98 (95% CI, 1.22‐3.22; P = .006) for the high tertile of cDDDs compared with the low tertile.

CONCLUSIONS:

The results of the current study indicate that amiodarone may be associated with an increased risk of incident cancer, especially in males, with a dose‐dependent effect. Cancer 2013;119:1699–1705. © 2013 American Cancer Society.     

Trends in the management of breast cancer

Responses of general surgeons to a questionnaire on breast cancer were analyzed to determine the current trends in the management of this disease. A 21-item questionnaire was mailed to members of the New Jersey Chapter of the American College of Surgeons in 1982 and the responses, received on noncoded, anonymous answer sheets, were analyzed for frequency distribution. These responses were compared to previously recorded responses to the same questions for 1971 and 1977. Seventy-six percent of the respondents in 1982 performed needle aspirations often or always, compared to 36% in 1971 and 80% in 1977. The use of routine mammography has increased from 16% in 1971 and 20% in 1977 to 38% in 1982. Modified radical mastectomy is now the most common type of procedure employed in the management of stage I breast cancer, with 89% of respondents in favor of this approach compared to 15% in 1971 and 60% in 1977. Fifty-nine percent of the respondents are not opposed to breast reconstruction following mastectomy versus 14% in 1971 and 49% in 1977. For patients with axillary nodes, chemotherapy with multiple agents was recommended by 76% of general surgeons in 1982, compared to 58% in 1977. These results indicate a continuing trend towards increasing use of needle aspiration and routine mammography for diagnosis and for employment of chemotherapy with multiple agents in the adjuvant treatment of patients with positive axillary nodes. Furthermore, modified radical mastectomy is the operation of choice for stage I cancer of the breast for increasing numbers of surgeons.     

The impact of bilateral breast cancer on the prognosis of breast cancer: a comparative study with unilateral breast cancer

BACKGROUND: The clinical significance of bilateral breast cancer is unclear and its influence on prognosis is controversial. We assessed the impact of synchronous and metachronous bilateral breast cancer on the prognosis compared with unilateral breast cancer. METHODS: Between January 1, 1960 and December 31, 2001, 1,214 women were treated for primary operable breast cancers. Thirteen (1.1%) had synchronous bilateral breast cancer; 33 (2.7%) had a metachronous contralateral breast cancer. We compared age at operation, menopausal status, clinical stage, tumor size and histology, lymph node status, hormone receptor status, and use of adjuvant chemotherapy or hormone therapy, and we analyzed the impact of these factors on recurrence and survival in the 46 patients with bilateral breast cancer and the 1,168 patients with unilateral breast cancer. RESULTS: The 5-and 10-year disease-free survival rates, respectively, were 65% and 65% in metachronous cases, 85.7% and 64.3% in synchronous cases, and 77.9% and 72.1% in unilateral cases. There was no significant difference in overall survival among the three groups. On multivariate analysis, metachronous bilaterality, tumor size, lymph node status and adjuvant hormone therapy were each independent risk factors for recurrence, whereas bilaterality of breast cancer did not influence overall survival. CONCLUSIONS: Our data suggest that metachronous bilateral breast cancer is associated with shorter disease-free survival than synchronous bilateral or unilateral breast cancer, although overall survival does not differ among the 3 groups. Patients with metachronous bilateral breast cancer should be followed particularly closely in order to detect recurrence early and maximize quality of life.     

右半结肠癌与直肠癌的临床特征变化研究

目的近年来中国结直肠癌发病率明显上升, 其构成比和临床特点发生了显著变化。本文针对近15年哈尔滨医科大学附属肿瘤医院收治的右半结肠癌与直肠癌临床特点进行研究。方法 对1992年-2006年在哈尔滨医科大学附属肿瘤医院接受治疗的2552例右半结肠癌与直肠癌的临床病理特点, 以5年为一阶段进行回顾性分析, 所有病例均有病理确诊。结果 2002年-2006年段与1992年-1997年段比较, 右半结肠癌与直肠癌收治率每年分别同比增长6.7%和6.0%;发病平均年龄从53.1岁和52.8岁分别上升至60.5岁和57.6岁;男女比例右半结肠癌由1.38∶1下降至1.19∶1, 直肠癌无明显变化;全部结直肠癌构成中右半结肠癌无明显变化, 直肠癌构成从67.4%下降到61.8%;Dukes A期构成分别上升3.8%和2.6%, Dukes D期分别下降2.8%和3.7%。结论 近年来, 结直肠癌的发病率不断上升, 发病中位年龄上升, 直肠癌构成比下降, 右半结肠癌无明显变化, Dukes A期构成比增多, Dukes D期下降。     

Medullary cancer of the breast revisited

Common as well as unusual, heretofore unmentioned histopathologic features observed in 336 typical and 273 atypical medullary breast cancers from 6404 patients enrolled in various stage I and II protocols of the National Surgical Adjuvant Breast and Bowel Projects (NSABP) are presented. Both medullary types exhibited comparable pathologic findings, except for the infiltrative border and/or slight or absent tumor lymphoid infiltrate which by definition characterize the atypical form. Both also demonstrated a similar, high proclivity to be aneuploid, and to lack estrogen and progesterone receptors and nodal metastases. After appropriate statistical adjustments, survival (analyzed for 198 patients with typical and 149 with atypical medullary cancers) was found to be better for untreated, node-negative and node-positive patients treated with L-PAM + 5 Fu who had typical medullary cancers than those with the NOS histologic type. The magnitude of this difference was 6% at 5 and 17% at 10 years post-operatively (cumulative odds = 1.81 with a 95% confidence interval of 1.08 – 3.3) for the former group, and 4% at 5 and 16% at 10 years (cumulative odds = 1.56 with a 95% confidence interval of 1.08 – 2.23) for the latter. Survival was comparable for patients with atypical medullary and NOS types in both situations. No clear difference in survival was found in untreated, positive node patients with the 3 histologic types examined, although the sample sizes in this subset were relatively small. This information as well as other pertinent considerations indicate that the prognosis of typical medullary cancer is not as good as previously perceived. It is also concluded that there is insufficient evidence at present to exclude the atypical medullary variant as a histologic type of breast cancer.     

Completeness and accuracy of registration of ovarian cancer in the cancer registry of Norway

Completeness of reporting and accuracy of the diagnosis of ovarian cancer from one health region in Norway to the Cancer Registry were examined. Data kept by the Cancer Registry were evaluated against discharge diagnosis data from all 8 hospitals in the health region during the period of 1987-1996. The assessment of the accuracy of the diagnosis recorded in the Cancer Registry was based on review of all medical records in the hospital setting and on slide review of all histologic diagnoses. The overall completeness of reporting ovarian cancer to the Cancer Registry was 99.6%. The organ specific completeness of registration of histologic verified ovarian cancer within the Cancer Registry was 95.3%; 0.9% was erroneously coded and 3.5% had their diagnosis changed to ovarian cancer at re-evaluation. Of all ovarian cancer cases registered at the Cancer Registry, 91% had a primary histologic diagnosis. Among 591 cases identified with a histologic diagnosis in the Cancer Registry, the accuracy of the diagnosis was estimated at 92%. Coding errors were found in 2% of these cases, while in 6% of the cases it was not possible to reproduce the original diagnosis of ovarian cancer at re-evaluation. In order to provide data of high quality for cancer surveillance a cancer registry needs several data providers, such as histopathologic laboratory reports and clinical reports. In addition, assessment of reported data through stringent quality assurance procedures within the registry are necessary for reaching a nearly 100% completeness of registration as found for ovarian cancer in the Cancer Registry of Norway.     

中国人群肿瘤家族史与鼻咽癌关系Meta分析

目的系统评价中国人群肿瘤家族史及与鼻咽癌之间的关系及相关强度,为我国鼻咽癌的防治策略提供依据。方法系统检索CNKI、万方和维普3个中文数据库及PudMed、ScienceDirect和SpringerLink 3个英文数据库2013-03之前发表的鼻咽癌病例对照研究及队列研究。文献检索、选取、信息提取及质量评价(NOS评分)均由2人独立进行。采用基于方差倒数加权的随机效应模型合并研究结果。结果纳入合格研究文献16篇,鼻咽癌患者7 478例,对照8 456例。肿瘤家族史与鼻咽癌患病的合并OR=2.63,95%CI为1.56~4.01;I2=49.2%,P=0.023;N=13;鼻咽癌家族史与鼻咽癌患病的合并OR=3.12,95%CI为2.47~3.78;I2=0,P=0.700;N=8。结合漏斗图及发表偏倚检验的结果,尚不能排除潜在的发表偏倚对结果的影响。结论在中国,肿瘤家族史,尤其是鼻咽癌家族史,会显著增加鼻咽癌的患病风险。     

Sorafenib in the treatment of thyroid cancer

Sorafenib has been evaluated in several Phase II and III studies in patients with locally advanced/metastatic radioactive iodine–refractory differentiated thyroid carcinomas (DTCs), reporting partial responses, stabilization of the disease and improvement of progression-free survival. Best responses were observed in lung metastases and minimal responses in bone lesions. On the basis of these studies, sorafenib was approved for the treatment of metastatic DTC in November 2013. Few studies suggested that reduction of thyroglobulin levels, or of average standardized uptake value at the fluorodeoxyglucose-PET, could be helpful for the identification of responding patients; but further studies are needed to confirm these results. Tumor genetic marker levels did not have any prognostic or predictive role in DTC patients.The most common adverse events observed included skin toxicity and gastrointestinal and constitutional symptoms. Encouraging results have also been observed in patients with medullary thyroid cancer. Many studies are ongoing to evaluate the long-term efficacy and tolerability of sorafenib in DTC patients.