儿童脊髓室管膜瘤术后放射治疗的疗效和预后分析

  目的  研究儿童脊髓室管膜瘤的临床特点、治疗转归和预后。  方法  回顾性分析2011年1月至2018年12月首都医科大学附属北京世纪坛医院收治的经病理证实的11例儿童脊髓室管膜瘤放射治疗患者的临床资料,观察疗效并结合文献进行分析。  结果  中位随访59个月,7例发生术后复发、播散,1例患儿死于疾病进展。放疗剂量为36.0~55.8 Gy,5次/周,1.7~1.8 Gy/次,平均剂量45.0 Gy。所有患儿放疗过程中未发生严重不良反应。3、5、8年无进展生存率（progression free survival,PFS）分别为42.4%、28.3%、28.3%。3、5、8年总生存率（overall survival,OS）分别为100%、87.5%、87.5%。  结论  手术切除程度是影响儿童脊髓室管膜瘤预后最重要的因素,对于肿瘤残存或间变性室管瘤患儿,术后放射治疗能有效提高局部控制率。      

Second series by the Italian Association of Pediatric Hematology and Oncology of children and adolescents with intracranial ependymoma: an integrated molecular and clinical characterization with a long-term follow-up

BackgroundA prospective 2002–2014 study stratified 160 patients by resection extent and histological grade, reporting results in 2016. We re-analyzed the series after a median of 119 months, adding retrospectively patients’ molecular features.MethodsFollow-up of all patients was updated. DNA copy number analysis and gene-fusion detection could be completed for 94/160 patients, methylation classification for 68.ResultsProgression-free survival (PFS) and overall survival (OS) at 5/10 years were 66/58%, and 80/73%. Ten patients had late relapses (range 66–126 mo), surviving after relapse no longer than those relapsing earlier (0–5 y). On multivariable analysis a better PFS was associated with grade II tumor and complete surgery at diagnosis and/or at radiotherapy; female sex and complete resection showed a positive association with OS. Posterior fossa (PF) tumors scoring ≥0.80 on DNA methylation analysis were classified as PFA (n = 41) and PFB (n = 9). PFB patients had better PFS and OS. Eighteen/32 supratentorial tumors were classified as RELA, and 3 as other molecular entities (anaplastic PXA, LGG MYB, HGNET). RELA had no prognostic impact. Patients with 1q gain or cyclin-dependent kinase inhibitor 2A (CDKN2A) loss had worse outcomes, included significantly more patients >3 years old (P = 0.050) and cases of dissemination at relapse (P = 0.007).ConclusionsPreviously described prognostic factors were confirmed at 10-year follow-up. Late relapses occurred in 6.2% of patients. Specific molecular features may affect outcome: PFB patients had a very good prognosis; 1q gain and CDKN2A loss were associated with dissemination. To draw reliable conclusions, modern ependymoma trials need to combine diagnostics with molecular risk stratification and long-term follow-up.     

Efficacy of adjuvant radiotherapy in the intracranial hemangiopericytoma

We retrospectively evaluated an efficacy of adjuvant radiotherapy (RT) in the intracranial hemangiopericytoma (HPC) and analyzed prognostic factors influencing treatment outcomes. Among 49 patients diagnosed as localized intracranial HPC between 1995 and 2016, 31 patients received adjuvant RT after surgery; 26 with fractionated RT and 5 with stereotactic radiosurgery using Gamma Knife. After gross total resection (GTR) (n?=?32) and subtotal resection (STR) (n?=?17), histopathological grade was confirmed to be grade II (n?=?9) or grade III (n?=?40). The median follow-up period was 50 months (range 3–216 months). The local recurrence was defined as intracranial relapse within 15 mm and regional recurrence as beyond 15 mm from the margin of surgical bed. The 10-year overall survival (OS) and progression-free survival (PFS) were 69.9 and 34.4%, respectively. The 10-year local, regional, and distant failure-free rates were 56.6, 88.2, and 73.3%, respectively. Local tumor control was better with GTR followed by RT than GTR alone (p?=?0.056), while there was no difference in OS. Local tumor control and OS after STR plus RT were equivalent to those after GTR alone. There were no differences in distant metastasis-free survival (DMFS) among GTR plus RT, GTR alone, and STR plus RT. Tumor volume >?40 cm³ was associated with poor PFS (p?=?0.024). The local tumor recurrence was reduced by adjuvant RT after surgery. But OS or DMFS was not improved with adjuvant RT. PFS was better in the tumor with small volume at diagnosis.     

Longitudinal experience with WHO Grade III (anaplastic) meningiomas at a single institution

To retrospectively analyze and assess the outcomes and prognostic factors in patients with anaplastic meningioma (AM) (WHO Grade III). Clinical data and outcome [overall (OS) and progression-free (PFS) survival] from 18 patients with Grade III meningioma (AM, based on World Health Organization 2016 definition) initially treated between March 2000 and June 2015 were analyzed. Eleven patients (61%) were male, median age at diagnosis was 63 (range 48–86), and 55% (10/18 patients) had good performance status (KPS?≥?80). Eight patients (45%) had lower grade disease (Grade I—n?=?2; Grade II—n?=?6) prior to being upgraded to AM. Ten patients had fractionated radiation after primary surgery, eight patients had salvage fractionated RT, stereotactic radiosurgery (SRS) boost along with primary RT in 1 patient, and salvage SRS to 18 separate areas in 14 patients. Salvage chemotherapy was mainly considered in third or fourth recurrences. 13 (72%) patients recurred and 10 (56%) have died. Median PFS was 14.5 months (95% CI 6.9–22.2). The 5-year survival rate was 40?±?15% and median OS was 55.8 months (95% CI 27.7–80.3). Of all factors examined, only Karnofsky performance status (KPS) affected outcome (PFS p?=?0.0003; OS p?=?0.0003). With median OS of 55 months (4.6 years) our results are consistent with existing reports of the poor outcomes for AM patients. From the available data, surgical resection followed by RT and salvage radiosurgery and/or chemotherapy can lead to extended survival; however the benefit may decrease with successive treatments.     

BRAF基因V600E突变与Ⅰ～Ⅱ期乳头状甲状腺癌临床病理特征及预后的相关性分析

目的 探讨Ⅰ～Ⅱ期乳头状甲状腺癌（PTC）患者肿瘤组织中BRAF基因V600E突变情况,并分析其与临床病理特征及预后的关系。方法 采用RT-PCR法检测374例Ⅰ～Ⅱ期PTC患者组织样本中BRAF基因V600E突变,并分析其与临床病理特征及预后的关系。 结果 374例PTC患者标本中BRAF基因V600E的突变率为40.37％（151／374）。BRAF基因V600E突变与包膜侵犯、多灶、多次131I治疗相关（P＜0.05）。374例 PTC患者中31例复发,复发患者中有BRAF基因V600E突变的22例。31例复发病例中,BRAF基因V600E突变患者的中位生存期为5.3年（95％CI：3.9～6.7年）,未突变患者为7.0年（95％CI：5.1～8.9年）,差异无统计学意义（P＞0.05）。Logistic多因素回归分析显示,BRAF基因V600E突变及包膜侵犯是Ⅰ～Ⅱ期PTC患者复发的独立危险因素（P＜0.05）。 结论 BRAF基因V600E突变可能是Ⅰ～Ⅱ期PTC患者预后的一项重要预测指标。     

pAKT Expression and Response to Sorafenib in Differentiated Thyroid Cancer

Sorafenib has an antitumor activity in patients with radioactive iodine-refractory differentiated thyroid carcinoma (RAIR-DTC). Prior research has implicated signaling through the MAPK and AKT/PI3K pathways in the progression of DTC. To assess whether the activity of these pathways is predictive of response to sorafenib, we retrospectively studied molecular tumor markers from these two pathways from a phase 2 study of sorafenib in RAIR-DTC. Tumor samples from 40 of 53 DTC subjects obtained prior to initiation of sorafenib were immunostained with DAB-labeled antibodies to phospho-AKT (pAKT), phospho-ERK (pERK), and phospho-S6 (pS6). BRAFV600E genetic mutation analysis was performed on all samples. Expression levels and mutational status were compared to response and progression-free survival (PFS) for each patient. Low tumor expression of nuclear pAKT was associated with partial response to sorafenib (p?<?0.01). Patients with nuclear pAKT expression that was below the median for our sample were more than three times as likely to have a partial response as patients with equal to or above median expression. There was no correlation between tumor expression of nuclear pERK or pS6 and response. Endothelial cell and pericyte expression of pERK, pAKT, and pS6 were not predictive of response. There was no correlation between BRAFV600E mutation status and partial response. No correlation was observed between either the expression of pAKT, pERK, or pS6, or the presence of the BRAFV600E mutation, and PFS. In conclusion, lower tumor expression of nuclear pAKT was associated with higher rate of response to sorafenib. This observation justifies evaluation of combination therapy with sorafenib and an inhibitor of the PI3K/AKT signaling pathway in RAIR-DTC.     

P-Gemox方案联合调强放疗治疗早期结外NK/T细胞淋巴瘤的临床疗效

目的 探讨P-Gemox方案联合调强放疗治疗早期结外NK/T细胞淋巴瘤（extranodal NK/T-cell lymphoma,ENKTL）的疗效。方法 回顾性分析四川省肿瘤医院2012年3月至2017年10月初治的73例ENKTL患者的临床资料,根据治疗方案分为P-Gemox方案夹心放疗组（n=38）和P-Gemox方案序贯放疗组（n=35）,比较两组患者的近期和远期临床疗效。结果 73例ENKTL患者总有效率（ORR）为95.9%,3年无进展生存率（PFS）为73.5%,3年总生存率（OS）为81.9%。P-Gemox方案夹心放疗组ORR为97.4%,3年PFS和OS分别为74.2%和84.1%。P-Gemox方案序贯放疗组ORR为94.3%,3年PFS和OS分别为72.6%和79.2%。两组ORR、PFS和OS差异均无统计学意义（P＞0.05）。控制相关潜在混杂因素后,多因素Cox回归分析显示,P-Gemox方案夹心放疗组与P-Gemox方案序贯放疗组的PFS相当（HR=0.617,95%CI：0.353~1.081,P=0.091）,而P-Gemox方案夹心放疗组较P-Gemox方案序贯放疗组OS更好 （HR=0.556,95%CI：0.314~0.982,P=0.043）。两组化疗毒副反应以Ⅰ～Ⅱ级为主,其中P-Gemox方案夹心放疗组较P-Gemox方案序贯放疗组更容易发生Ⅰ～Ⅱ度转氨酶升高（P＜0.05）,血液学、胃肠道等毒副反应,发生率差异无统计学意义（P＞0.05）。结论 P-Gemox方案夹心放疗与P-Gemox方案序贯放疗的近期疗效和PFS相当,但P-Gemox方案夹心放疗较P-Gemox方案序贯放疗可提高患者OS。     

Angioimmunoblastic T-cell lymphoma: the effect of initial treatment and microvascular density in 31 patients

The objectives of this study are to explore the clinical features and treatment outcomes and to investigate the correlation between microvessel density (MVD) and survival in patients with angioimmunoblastic T-cell lymphoma (AITL). We retrospectively analyzed clinical and follow-up data of 31 patients treated in two hospitals during 1995-2009 histologically proven AITL. We also assessed MVD in the lump of 31 previously untreated patients using α-CD34 immunohistochemical staining. The median age of the 31 patients was 48?years, eighty percent of the patients were in an advanced stage. 67.7% of them had B symptoms, with the follow-up of 2-13?years, the 5-year overall survival rate was 25.8%. The response rates (RR) of CHOP group and COP (cyclophosphamide, vincristine and prednisolone) group are 76.5 and 75%, respectively, which is no significant difference (P?=?0.894). RR did not differ whether chemotherapy regimens contained anthracycline or not. The 3-year PFS rate for patients who received COP and CHOP regimen was 25.4 and 35.3% (P?=?0.562), while 5-year OS rates were 25.0 and 29.4%, respectively (P?=?0.667). The median PFS for patients with high MVD and low MVD were 15.1 and 30.0?months (P?=?0.048), while the median OS were 20 and 45?months, respectively (P?=?0.038). Patients who were sensitive to initial chemotherapy COP regimen have the similar therapeutic effect to CHOP regimen. Patients with high MVD measured in the microenvironment had worse PFS and OS than AITL patients with low expression.     

NRG oncology RTOG 9006: a phase III randomized trial of hyperfractionated radiotherapy (RT) and BCNU versus standard RT and BCNU for malignant glioma patients

From 1990 to 1994, patients with newly diagnosed malignant gliomas were enrolled and randomized between hyperfractionated radiation (HFX) of 72.0 Gy in 60 fractions given twice daily and 60.0 Gy in 30 fractions given once daily. All patients received 80 mg/m² of 1,3 bis(2 chloroethyl)-1 nitrosourea on days 1–3 q8 weeks for 1 year. Patients were stratified by age, KPS, and histology. The primary endpoint was overall survival (OS), with secondary endpoints including progression-free survival (PFS) and toxicity. Out of the 712 patients accrued, 694 (97.5%) were analyzable cases (350 HFX, 344 standard arm). There was no significant difference between the arms on overall acute or late treatment-related toxicity. No statistically significant effect for HFX, as compared to standard therapy, was found on either OS, with a median survival time (MST) of 11.3 versus 13.1 months (p?=?0.20) or PFS, with a median PFS time of 5.7 versus 6.9 months (p?=?0.18). The treatment effect on OS remained insignificant based on the multivariate analysis (hazard ratio 1.16; p?=?0.0682). When OS was analyzed by histology subgroup there was also no significant difference between the two arms for patients with glioblastoma multiforme (MST: 10.3 vs. 11.2 months; p?=?0.34), anaplastic astrocytoma (MST: 69.8 vs. 50.0 months; p?=?0.91) or anaplastic oligodendroglioma (MST: 92.1 vs. 66.5 months; p?=?0.33). Though this trial provided many invaluable secondary analyses, there was no trend or indication of a benefit to HFX radiation to 72.0 Gy in any subset of malignant glioma patients.     

Comparative volumetric analysis of the extent of resection of molecularly and histologically distinct low grade gliomas and its role on survival

The authors investigate the role of extent of resection (EOR) and genetic markers on patient outcome and survival for LGGs. We conducted a retrospective cohort between 2005 and 2015, of 109 adult patients who underwent surgery for a LGG by a single surgeon. Volumetric computations of MRI studies were conducted to evaluate the EOR, and genetic markers (IDH1, 1p/19q co-deletion, and p53) were assessed and their effects on survival and neurological outcome were evaluated. The median EOR was 88.1%. Permanent postoperative neurological deficits were seen in 4.6% of patients. EOR was a significant predictor for both overall survival (OS) (hazard ratio [HR]?=?0.979, 95% CI 0.961–0.980, p?=?0.029) and progression free survival (PFS) (HR?=?0.982, 95% CI 0.968–0.997, p?=?0.018). Malignant progression free survival (MPFS) was predicted by the 1p/19q co-deletion (HR?=?0.148, 95% CI 0.019–1.148, p?=?0.048). Patients with EOR of 100% had a significantly better OS than EOR less than 90% (p?=?0.038). Patients with an EOR of at least 76% had a better OS than EOR less than 76% (p?=?0.025). Patients with an EOR of at least 71% had a better PFS than EOR less than 71% (p?=?0.030). Preoperative tumor volume was found to have significant association with EOR (R²?=?0.049, p?=?0.031). Increased EOR is associated with improved OS and PFS survival outcomes, while 1p/19q co-deletion provides improved MPFS. Understanding both surgical resections and molecular markers of the tumor are important for effective management of LGG patients.     

Viable malignant cells after primary chemotherapy for disseminated nonseminomatous germ cell tumors: prognostic factors and role of postsurgery chemotherapy--results from an international study group.

PURPOSE: To assess the value of postsurgery chemotherapy in patients with disseminated nonseminomatous germ-cell tumors (NSGCTs) and viable residual disease after first-line cisplatin-based chemotherapy. PATIENTS AND METHODS: The outcome of 238 patients was reviewed. Tumor markers had normalized in all patients before resection. A multivariate analysis of survival was performed on 146 patients. RESULTS: The 5-year progression-free survival (PFS) rate was 64% and the 5-year overall survival (OS) rate was 73%. Three factors were independently associated with both PFS and OS: complete resection (P <.001), < 10% of viable malignant cells (P =.001), and a good International Germ Cell Consensus Classification (IGCCC) group (P =.01). Patients were assigned to one of three risk groups: those with no risk factors (favorable group), those with one risk factor (intermediate group), and those with two or three risk factors (poor-risk group). The 5-year OS rate was 100%, 83%, and 51%, respectively (P <.001). The 5-year PFS rate was 69% (95% confidence interval [CI], 62% to 76%) and 52% (95% CI, 40% to 64%) in postoperative chemotherapy recipients and nonrecipients, respectively (P <.001). No significant difference was detected in 5-year OS rates. After adjustment on the three prognostic factors, postoperative chemotherapy was associated with a significantly better PFS (P <.001) but not with better OS. Patients in the favorable risk group had a 100% 5-year OS, with or without postoperative chemotherapy. Postoperative chemotherapy appeared beneficial in both PFS (P <.001) and OS (P =.02) in the intermediate-risk group but was not statistically beneficial in the poor-risk group. CONCLUSION: A complete resection may be more critical than recourse to postoperative chemotherapy in the setting of postchemotherapy viable malignant NSGCT. Immediate postoperative chemotherapy or surveillance alone with chemotherapy at relapse may be reasonable options depending on the completeness of resection, IGCCC group, and percent of viable cells. Validation is necessary.     

BRAFV600E基因突变与甲状腺微小乳头状癌淋巴结转移的相关性研究

目的:探讨甲状腺微小乳头状癌（papillary thyroid microcarcinoma，PTMC）发生淋巴结转移是否与BRAFV600E基因突变相关。方法:回顾性分析行手术治疗的55例甲状腺微小乳头状癌有淋巴结转移（A组）和70例甲状腺微小乳头状癌无淋巴结转移（B组）的患者，用免疫组化对其肿瘤组织及转移性的淋巴结进行BRAFV600E基因突变蛋白检测并通过统计学分析甲状腺微小乳头状癌淋巴结转移与BRAFV600E基因突变的相关性。结果:A组总的BRAFV600E基因突变率（69.1%）、右侧PTMC（78.3%）、双侧PTMC的突变率(83.3%)要分别高于B组(37.1%、26.7%、42.9%)（P值均＜0.05），但强阳性率（23.6%）和左侧PTMC的突变率（50.0%）与B组（11.4%、46.2%）相比无统计学差异（P值均＞0.05）。A组组内淋巴结转移灶BRAFV600E基因突变率无论PTMC在左侧（72.2%）、右侧（92.0%）或双侧（91.7%）的阳性率和强阳性率（30.9%）上与原发灶（50.0%、78.3%、83.3%、23.6%）均无差异（P＞0.05），但总的突变率，前者（85.5%）要高于后者（69.1%）（P＜0.05）。结论:BRAFV600E突变是导致PTMC早期发生淋巴结转移的重要因素之一，术前或术后通过各种方法测得的BRAFV600E突变阳性预示着淋巴结转移的高风险。     

乳腺癌全乳房切除术后单纯区域复发的放疗和预后分析

目的 分析乳腺癌全乳房切除术后单纯区域复发(RR)患者的预后,探讨放疗的价值和靶区。方法 回顾性分析2001-2018年间 144例全乳房切除术后无辅助放疗、首次孤立性RR的乳腺癌患者,主要研究终点为再次局部区域复发(sLRR)、远处转移(DM)、无进展生存(PFS)和总生存(OS)。结果 RR后中位随访82.5个月,全组患者 5年sLRR、DM、PFS和OS分别为42.1%、71.9%、22.9%和62.6%。局部治疗+全身治疗是sLRR (P<0.001)和PFS (P=0.013)的独立影响因素。局部治疗时手术+放疗组的sLRR率最低(P<0.001)。手术+放疗组的 5年原RR部位再次复发率最低(P<0.001)。做和不做胸壁放疗患者的 5年胸壁复发率分别为12.1%和14.8%(P=0.873)。非锁骨上复发者,做和不做锁骨上放疗的 5年锁骨上复发率分别为9.9%和23.8%(P=0.206)。非腋窝或内乳复发者,无论放疗与否,腋窝或内乳的 5年复发率均<10%。结论 单纯RR患者有较高的 5年OS,推荐对复发部位行手术+放疗的局部治疗联合全身治疗。不建议常规对所有患者行胸壁、腋窝或内乳的预防放疗。锁骨上预防性放疗的价值需要进一步探讨。     

592例食管癌3DRT的预后分析

目的 分析食管癌3DRT (3DCRT、IMRT)疗效和预后影响因素。方法 2002—2012年间本院接受3DRT食管癌患者592例,其中3DCRT者123例、IMRT 者469例,单纯放疗360例、放化疗232例。中位放疗剂量60 Gy。Kaplan-Meier法计算OS、PFS并Logrank法检验和单因素预后分析,Cox法多因素预后分析。结果 3、5年样本数分别为142、53例。1、3、5年OS和PFS率分别为65.3%、34.0%、23.5%和52.1%、28.0%、19.6%。中位OS时间20个月(95%CI为17.9~22.1个月),中位PFS时间14个月(95%CI为11.8~16.2个月)。单因素分析显示影响OS和PFS因素有性别、N分期、M分期、TNM分期、放疗剂量、治疗前体重下降、吸烟和饮酒(P=0.002和0.000、0.000和0.000、0.001和0.000、0.000和0.000、0.000和0.000、0.024和0.026、0.009和0.005、0.000和0.000)。多因素分析显示TNM分期、放疗剂量和性别是影响OS、PFS因素(P=0.000和0.000、0.000和0.001、0.036和0.027)。结论 食管癌3DRT的生存有所提高,临床TNM分期、放疗剂量和性别是影响生存的因素。     

179例甲状腺乳头状癌患者BRAFV600E基因突变回顾性分析

目的:检测BRAFV600E基因突变在甲状腺乳头状癌(papillary thyroid carcinoma,PTC)中的发生情况,分析BRAFV600E基因突变与临床参数、合并桥本氏甲状腺炎和结节性甲状腺肿的关系.方法:回顾性分析第四军医大学西京医院核医学科2015年6月1日至2016年5月31日所收治的甲状腺乳头状癌患者179例,由病理科检测BRAFV600E突变情况.结果:179例患者病理结果显示BRAFV600E基因突变率为61.5％.BRAFV600E基因突变率与年龄和淋巴结转移个数相关(P＜0.05),且随着年龄增大,突变的风险略有增高(OR=1.064).合并结节性甲状腺肿的甲状腺乳头状癌患者48例,突变率75％;未合并结节性甲状腺肿的甲状腺乳头状癌患者131例,突变率56.5％,差异有统计学意义(P=0.024),且合并结节性甲状腺肿是BRAFV600E基因突变的危险因素(OR=2.349).结论:甲状腺乳头状癌患者的BRAFV600E基因突变率与患者年龄、颈部淋巴结转移个数以及是否合并结节性甲状腺肿具有相关性.     

甲状腺癌中PTEN蛋白表达与BRAFV600E突变的相关性研究

目的：探讨PTEN蛋白在甲状腺乳头状癌（PTC）中的表达情况,并进一步分析此蛋白的表达量与BRAFV600E基因突变的相关性及临床意义,初步揭示两者在PTC发生、发展中的致癌作用。方法：采用免疫组化EnVision两步法检测70例PTC 中PTEN 蛋白的表达水平;采用 PCR法及 DNA 测序法检测上述标本中BRAFV600E突变情况,分析PTEN蛋白表达与BRAFV600E突变的相关性及其与PTC临床病理特征的关系。结果：70例PTC中PTEN阴性率为78．6％（55／70）,与癌旁组织18．6％（13／70）比较,差异有统计学意义（P＜0．05）。PTEN表达下调与性别、肿瘤淋巴结转移、临床分期有关（P＜0．05）;与BRAFV600E突变、年龄、肿瘤直径无关（P＞0．05）。70例PTC中BRAFV600E突变率为60％,BRAFV600E突变与肿瘤淋巴结转移、临床分期密切相关（P＜0．05）;与患者年龄、性别、肿瘤大小无关（P＞0．05）。结论：PTEN蛋白表达与BRAFV600E突变无相关性。两者可能是PTC生物侵袭高的独立危险因素,可能作为评估PTC预后不良的不同肿瘤标记物。两者对甲状腺癌的临床个体化治疗及判定预后有指导意义。     

91例儿童髓母细胞瘤术后放射治疗的临床预后及相关因素分析

目的:探讨儿童髓母细胞瘤(medulloblastoma, MB)的术后放疗效果,分析影响其预后的相关因素。方法:回顾性分析2011年01月至2015年12月我院收治的91例儿童MB病历资料。对性别、年龄、肿瘤部位、手术切除程度、放疗前肿瘤M分期、危险度分组、放疗剂量、靶区范围、术后是否化疗、放疗与手术的时间间隔进行分析。采用Kaplan-Meier法进行生存分析,Log-rank检验进行单因素分析,采用Cox回归模型进行多因素分析。结果:本组患儿9例失访,失访率9.9%,其余82例随访满5年或死亡。随访期间,25例患儿出现局部复发或转移,经治疗后仍有16例死亡,9例带瘤生存,本组患儿3年、5年无进展生存率(progression-free survival, PFS)分别为79.3%、70.8%,3年、5年总生存率(overall survival, OS)分别为84.9%、81.3%。63例标危组的5年PFS和OS为77.5%、89.6%,其中11例行低剂量全中枢放疗的5年OS为76.2%。单因素分析显示,手术切除程度、放疗前肿瘤M分期、危险度分组对PFS(P=0.015,P=0....     

甲状腺乳头状癌BRAFV600E突变分析

  目的  检测BRAFV600E突变在甲状腺乳头状癌(PTC)中的发生情况, 分析BRAFV600E突变与临床各病理参数以及与合并桥本氏甲状腺炎(HT)和结节性甲状腺肿的关系。  方法  天津医科大学附属肿瘤医院2011年3月至2011年8月所收治的临床考虑甲状腺癌患者112例, 术中取部分新鲜肿瘤组织, 送基因诊断室检测BRAFV600E突变情况, 其中30例患者同时取部分正常甲状腺组织进行检测对照。  结果  112例患者病理结果显示110例为PTC, 2例为结节性甲状腺肿。其中BRAFV600E突变在110例PTC的突变率为62.7%, 不存在于结节性甲状腺肿及正常甲状腺组织。年龄≤30岁PTC患者8例, 突变率为25.0%;30~60岁患者86例, 突变率为62.8%;≥60岁患者16例, 突变率为81.2%, 差异有统计学意义(P=0.027)。、BRAFV600E突变与其他临床病理参数间的差异无统计学意义。合并HT的PTC患者40例, 突变率42.5%;未合并HT的PTC患者70例, 突变率74.3%, 差异有统计学意义(P=0.001)。合并结节性甲状腺肿的PTC患者61例, 突变率72.1%;未合并结节性甲状腺肿的PTC患者49例, 突变率51.0%, 差异有统计学意义(P=0.023)。  结论  PTC的BRAFV600E突变率可能与种族差异有关。BRAFV600E突变率可能与患者年龄构成比有一定的相关性。合并HT的PTC BRAFV600E突变率低, 而合并结节性甲状腺肿的PTC BRAFV600E突变率高。      

早期结外NK/T细胞淋巴瘤的预后分析

目的 分析早期上呼吸消化道结外NK/T细胞淋巴瘤(UADT ENKTCL)放疗联合以门冬酰胺酶/培门冬酶为主的化疗疗效及预后因素。方法 收集2003—2020年间贵州省肿瘤医院收治的 267例早期UADT ENKTCL患者,其中放疗或联合门冬酰胺酶/培门冬酶为主要方案化疗的 229例,单纯放疗或化疗的 38例。Kaplan-Meier计算总生存(OS)、无进展生存(PFS)并log-rank法检验和单因素分析,Cox模型多因素分析。结果 全组 5年OS、PFS分别为67.2%、61.5%;放化综合治疗、单纯放疗、单纯化疗的 5年OS分别为71.7%、35%、49%(P<0.001),5年PFS分别为66%、35%、28%(P<0.001)。放化疗患者基于NRI危险分层分为预后良好、预后不良组,5年OS分别为93.3%、64.3%(P<0.001),5年PFS分别为91.1%、56.7%(P<0.001);放疗剂量≥50Gy、<50Gy组 5年OS分别为72.4%、55.7%(P<0.001),5年PFS分别为68.3%、36.5%(P<0.001)。预后不良组化疗周期数≥4个、<4个的 5年OS分别为65.5%、59.2%(P=0.049),5年PFS分别为60.7%、50.6%(P=0.018)。单因素分析显示Ⅱ期、ECOG≥2分、超腔、单纯放疗、NRI≥1分、EB病毒-DNA≥2750 copies/ml、放疗剂量<50Gy,化疗周期数<4个为 5年OS及PFS的预后不良因素(均 P<0.05);CHOP类化疗方案仅为PFS的预后不良因素(P<0.05)。多因素分析显示超腔、ECOG≥2分、放疗剂量<50Gy均为OS和PFS的预后不良因素(均 P<0.05),Ⅱ期为OS的预后不良因素(P<0.05)。结论 早期低危UADT ENKTCL预后良好;足够剂量的扩大受累野放疗是早期UADT ENKTCL根治性手段;综合治疗较单纯放疗能改善早期预后不良组患者的预后;足疗程化疗能显著改善预后不良组的远期生存,门冬酰胺酶为基础的化疗均能较好的改善早期UADT ENKTCL的预后。     

Endostar,an Antiangiogenesis Inhibitor,Combined With Chemoradiotherapy for Locally Advanced Cervical Cancer

This phase II randomized clinical trial aimed to assess the efficacy and toxicity of Endostar, an antiangiogenesis inhibitor, combined with concurrent chemoradiotherapy (CCRT) for locally advanced cervical cancer (LACC). Patients with LACC were randomly assigned to either CCRT plus Endostar (CCRT+E arm) or CCRT alone (CCRT arm). All patients received pelvic intensity-modulated radiation therapy (IMRT) and brachytherapy. Weekly cisplatin was administered concurrently with IMRT. Patients in the CCRT+E arm also received concurrent Endostar every 3 weeks for two cycles. The primary endpoint was progression-free survival (PFS) and acute toxicities. The exploratory endpoint was the impact of vascular endothelial growth factor receptor-2 (VEGFR2) expression on long-term survival. A total of 116 patients were enrolled. Patients in the CCRT+E arm and in the CCRT arm had similar acute and late toxicity profile. The 1- and 2-year PFS were 91.4% versus 82.1% and 80.8% versus 63.5% (p=0.091), respectively. The 1- and 2-year distance metastasis-free survival (DMFS) were 92.7% versus 81.1% and 86.0% versus 65.1% (p=0.031), respectively. Patients with positive VEGFR2 expression had significant longer PFS and overall survival (OS) compared with those with negative VEGFR2 expression. Patients in the CCRT+E arm had significantly longer PFS, OS, and DMFS than those in the CCRT arm when VEGFR2 expression was positive. In conclusion, CCRT plus Endostar significantly improved DMFS but not PFS over CCRT alone. The addition of Endostar could significantly improve survival for patients with positive VEGFR2 expression.