奥沙利铂与卡培他滨联合治疗晚期胃肠癌临床体会

目的：探讨对晚期胃癌以奥沙利铂与卡培他滨联合进行治疗所得到的临床效果。方法选择曾在我院进行治疗的晚期胃癌患者150例,将这些患者根据随机方式分为数量相等的两组,将这两组患者分别以观察组与对照组进行表示,观察组中患者以奥沙利铂与卡培他滨联合方法对其进行治疗,对照组中患者以顺铂联合5-氟尿嘧啶对其化疗,观察两组患者的临床治疗有效率及不良反应。结果在经过治疗之后,观察两组患者的临床治疗有效率,观察组中患者的临床治疗总有效率为95.4%,对照组中患者的临床治疗总有效率为76.9%,两组患者之间的差异较明显;观察两组患者在治疗过程中所出现的不良反应,观察组中患者的不良反应发生率为6.2%,对照组中患者的不良反应发生率为23.1%,两组患者之间的差异较明显。结论利用奥沙利铂与卡培他滨联合治疗晚期胃肠癌可得到较理想的临床效果,临床治疗有效率比较高,能够使患者的临床症状得到有效改善,并且在治疗过程中所出现的不良反应较少,是临床上治疗晚期胃癌的一种理想方法,可在临床上进行广泛应用。     

卡培他滨联合顺铂一线治疗HER2阴性的晚期胃癌后卡培他滨维持的疗效及安全性

目的:研究卡培他滨联合顺铂(XP方案)一线治疗HER2阴性的晚期胃癌后给予卡培他滨维持化疗的疗效及安全性.方法:82例初治的HER2阴性的晚期胃癌患者一线方案采用XP方案.每2周期化疗后进行疗效评价.最多6个周期化疗后疗效评价为无疾病进展的患者共59例,随机分为两组(A,B组),A组(n=30)给予卡培他滨单药维持化疗(1000 mg/m2,2次/d,d1～14,3周为1周期),持续至疾病进展或患者出现不能耐受的毒副作用为止.B组(n=29)仅接受定期随访观察.结果:82例患者共接收416周期的初始化疗,经初始化疗后均可评价疗效,总有效率(response rate,RR)为48.78％,疾病控制率(disease control rate,DCR)为71.95％.A组RR和DCR分别为26.67％,76.67％,均高于B组(RR和DCR分别为0.00％,37.93％,P<0.05).维持化疗组中位疾病进展时间(time to progress,TTP)7.9个月较B组5.3个月延长(P<0.05).A组和B组中位总生存期(overall survival,OS)分别为14.8,13.2个月,差异无统计学意义(P>0.05).维持化疗期间主要不良反应有骨髓抑制、恶心呕吐、腹泻、周围神经毒性、黏膜炎、手足综合征等,经对症治疗后均有好转,无治疗相关性死亡.结论:XP方案一线治疗HER2阴性的晚期胃癌后单药卡培他滨维持,可提高有效率、疾病控制率,延长疾病进展时间,且不良反应轻,值得进一步研究和临床推广应用.     

卡培他滨联合化疗双周方案研究进展

卡培他滨作为口服化疗药物,具有安全、有效和使用方便的特点,已经广泛应用于包括食管癌、胃癌、大肠癌、乳腺癌和卵巢癌等多种实体肿瘤的化疗。既往用药主要为3周方案,即每周期化疗口服卡培他滨14 d,停药7 d。作为对传统化疗方案的改良,卡培他滨双周方案显示出毒副反应降低、患者耐受性好、住院时间短等特点,值得临床应用推广。     

含卡培他滨方案一线或后线治疗晚期乳腺癌的效果对比

目的 对比观察含卡培他滨方案一线或后线治疗晚期乳腺癌的效果。方法 选取2013年1月~2016年2月我院收治的95例晚期乳腺癌患者作为研究对象,按照卡培他滨出现方案分为一线组（27例）、二线组（35例）、三线组（33例）,观察其疗效和安全性。结果 治疗效果方面,一线组的完全缓解（CR）、客观有效率（ORR）、临床获益率（CBR）均高于三线组（P＜0.05）,疾病进展（PD）低于三线组（P＜0.05）;二线组的PD低于三线组（P＜0.05）,CBR上高于三线组（P＜0.05）。三组安全性比较,差异无统计学意义（P＞0.05）。结论 相较于三线方案,一线或二线方案含卡培他滨治疗晚期乳腺癌患者,在控制和缓解患者癌细胞方面具有较好作用;而卡培他滨出现何种方案中并不会增加安全性事件;推荐临床应用一线或二线方案含卡培他滨。     

自噬相关蛋白在卡培他滨联合奥沙利铂治疗晚期乳腺癌中的相关机制研究

目的:探讨自噬相关蛋白在卡培他滨联合奥沙利铂治疗晚期乳腺癌中的表达及其主要作用机制,并分析卡培他滨联合奥沙利铂对乳腺癌患者抗肿瘤免疫功能的影响。方法:选取本院2015 年1 月~2017 年1 月收治的60 例女性原发性乳腺癌晚期患者,接受卡培他滨联合奥沙利铂化疗2 疗程后评价疗效。采用免疫组织化学法检测乳腺癌患者癌组织中mTOR 和LC3-Ⅱ蛋白的表达;采用Real-Time PCR 法和Western blot 法检测乳腺癌组织中mTOR、LC3-II、Beclin-1、p62 和Atg5mRNA 和蛋白的表达;流式细胞仪检测患者在卡培他滨联合奥沙利铂治疗前后CD3+ 、CD4+ 、CD8+ 、CD4+ / CD8+ 及CD16+ /CD56+ 水平。结果:卡培他滨联合奥沙利铂化疗总有效率56.67%。卡培他滨联合奥沙利铂化疗后乳腺癌血清中CD3+ 、CD4+ 、CD4+ / CD8+ 、CD16+ / CD56+表达量显著升高,CD8+含量显著降低,差异有统计学意义(P<0.05)。与化疗前乳腺癌组织相比,卡培他滨联合奥沙利铂化疗后乳腺癌组织中mTOR 和p62 mRNA 表达和蛋白含量显著降低,LC3-II、Beclin-1 和Atg5 mRNA 表达和蛋白含量显著上升,差异有统计学意义(P<0.05)。结论:卡培他滨联合奥沙利铂对晚期乳腺癌具有较好的疗效,且自噬相关蛋白介导的mTOR 信号通路在此过程中发挥重要的作用。     

卡培他滨维持化疗治疗晚期胃癌的效果观察

目的：观察分析卡培他滨维持化疗治疗晚期胃癌的临床效果与应用价值。方法根据相关案例进行回顾性分析,我院选取了98例胃癌患者进行研究,并将其随机分成了对照组与观察组。对照组仅采取常规对症治疗,观察组在此基础上给予患者卡培他滨治疗。我院对两组的治疗效果与毒副反应进行了比较和分析。结果观察组治疗的总有效率高于对照组(P<0.05);两组的毒副反应发生率无明显差异(P>0.05)。结论在治疗晚期胃癌中应用卡培他滨维持化疗,可使治疗的有效率得到提高,且具有一定的安全性。     

多西紫杉醇联合卡培他滨与FOLFOX4方案治疗晚期胃癌疗效对比

目的比较多西紫杉醇联合卡培他滨或FOLFOX4方案治疗晚期胃癌的近期疗效及毒副反应。方法52例晚期胃癌的患者随机分为2组,实验组即多西紫杉醇联合卡培他滨治疗组,多西紫杉醇40mg／（m^2,w）d1．d8静脉输注,卡培他滨片每日口服2000mg／m^2每日二次d1—14,21d为1周期：对照组即FOLFOX4方案组,奥沙利铂85mg／m2dl静脉输注,亚叶酸钙200mg／m^2d1-2静脉输注2h,5-Fu400mg／m^2 d1-2快速静点。5-Fu600mg／m2d1-2持续静脉泵入22h,每14d重复,28d为1周期。均化疗2个周期以上,观察2纽药物的近期疗效及毒副反应。结果实验组CR2例．PR12例,有效率53．8％;对照组CR1例,PR12例,有效率50％,两组疗效无显著性差异。实验组与对照组的骨髓抑制及胃肠道反应发生率均较为常见．两组之间发生率无统计学差异。手足综合征发生率实验组明显高于对照组,但其多为Ⅰ-Ⅱ度,患者多能耐受,对生活质量影响轻微。对照组的毒副反应主要是外周神经毒性及腹泻,发生率显著高于实验组,两组数据比较在统计学上有显著性差异。结论多西紫杉醇联合卡培他滨治疗晚期胃癌的疗效确切,毒性反应发生程度轻,对晚期胃癌治疗有着积极的意义。     

伊立替康联合卡培他滨二线治疗42例晚期结直肠癌疗效分析

目的：探讨分析伊立替康联合卡培他滨二线治疗晚期结直肠癌的临床效果。方法回顾性分析2010年6月~2014年在我院进行治疗的84例结直肠癌患者的临床记录资料。结果治疗后,治疗组的总有效率为64.29%,高于对照组的40.48%,具有显著性差异(<0.05)。治疗组的疾病进展时间、平均生存时间均明显多于对照组,均具有显著性差异(<0.05)。两组的各项不良反应发生率相比均无显著性差异(>0.05)。结论伊立替康联合卡培他滨二线治疗晚期结直肠癌的临床效果显著,值得临床推广应用。     

吉西他滨与培美曲塞联合卡铂治疗晚期肺腺癌的临床观察

目的 探讨吉西他滨与培美曲塞联合卡铂治疗晚期肺腺癌的疗效及其对血癌胚抗原的影响。方法 选取2013年6月~2016年9月中山大学附属东华医院收治的晚期肺腺癌患者85例作为研究对象,随机分为对照组42例和观察组43例。在常规治疗基础上,对照组采用吉西他滨联合卡铂的化疗方案,观察组则采用培美曲塞联合卡铂的化疗方案。观察比较两组患者的治疗有效率,治疗前后的血清CEA以及不良反应的发生情况。结果 治疗后观察组治疗有效率为37.21%,对照组治疗有效率为30.95%,两组比较差异无统计学意义(P＞0．05)。治疗前两组 CEA水平对比,差异无统计学意义(P＞0．05),治疗后观察组血CEA为（32.35±4.73）ng/ml,低于对照组（46.63±5.12）ng/ml,组间差异有统计学意义（P＜0.05）。此外,观察组中性粒细胞减少、贫血以及血小板减少发生率低于对照组,差异有统计学意义(P＜0．05)。结论 培美曲塞联合卡铂与吉西他滨联合卡铂治疗晚期肺腺癌患者的临床疗效相当,但培美曲塞组可明显降低血CEA水平,且不良反应发生率低,安全性好。     

TA方案和NP方案治疗晚期乳腺癌临床研究

目的：观察比较紫衫醇＋表阿霉素（TA）和长春瑞滨＋顺铂（NP）两种化疗方案治疗晚期乳腺癌的疗效和毒性.方法：46例晚期乳腺癌患者随机分为TA组和NP组,每组23例.TA组紫杉醇135 mg/m^2,第1天;表阿霉素25 mg/m^2 ,第2～3天.NP组长春瑞滨40 mg/m^2,第1天、第8天;顺铂25 mg/m^2, 第1～4天. 结果：疗效按WHO标准,TA组总有效率65.2%,NP组总有效率为56.5%,两组间比较差异无统计学意义（P＞0.05）.主要毒副反应中,骨髓抑制、恶心呕吐、脱发,两组间差异无统计学意义（P＞0.05）;TA组的关节肌肉酸痛发生率（39.1%）高于NP组（4.3%）,NP组的静脉炎发生率（43.5%）,明显高于TA组（8.7%）,组间比较均有统计学意义 （P＜0.05）.结论：TA和NP两组方案治疗复发转移性乳腺癌疗效高且无统计学差别,均可作为治疗晚期乳腺癌的有效方案.     

长春瑞滨联合顺铂治疗中晚期乳腺癌的临床观察

目的 观察长春瑞滨(盖诺)联合顺铂方案治疗中晚期乳腺癌的临床疗效.方法 运用盖诺(25mg/m2IVD d1,d8)加顺铂(DDP 80mg/m2IV d1)治疗中晚期乳腺癌36例.结果 总有效率达66.7%.主要不良反应为骨髓抑制.胃肠道反应和静脉炎.白细胞减少的发生率100%.其中Ⅲ-Ⅳ度达55.6%.恶心、呕吐的发生率92.3%,Ⅲ-Ⅳ度达11.1%.静脉炎的发生率11.1%.结论 国产长春瑞滨联合顺铂对中晚期乳腺癌疗效确切,且毒性可以耐受,可以作为对蒽环类药物治疗后复发,中晚期乳腺癌患者的第二线治疗方案.     

乳腺癌生物学因子与新辅助化疗疗效的相关性分析

目的:评价不同生物学因素在预测紫杉醇加蒽环类方案治疗乳腺癌疗效中的作用.方法:68个接受了4个周期紫杉醇加蒽环类新辅助化疗的病人被纳入这项回顾性研究.用免疫组化法检测化疗前乳腺癌组织中ER、PR、HER-2、Bcl-2和p53的表达情况,分析生物学标记物与临床、病理完全缓解之间的关系.结果:有效率84%,其中临床完全缓解34%,临床部分缓解50%.病理完全缓解仅18%.ER、PR阴性和HER-2过表达对病理完全缓解有预测价值(P<0.05、0.05、0.05).Bcl-2和p53与病理完全缓解之间元相关性.结论:HER-2过表达和激素受体阴性的病人对紫杉醇加蒽环类新辅助化疗可能更为敏感,可能作为预测该方案疗效的生物学标记物.     

Evolving Approaches to Metastatic Breast Cancer Patients Pre-treated with Anthracycline and Taxane

Metastatic breast cancer is currently incurable and the goals of therapy focus on prolonging survival and maintaining quality of life by controlling symptoms and minimizing toxicity. Treatments for metastatic breast cancer include chemotherapeutic agents from various classes, such as taxanes, vinca alkaloids, anthracyclines and antimetabolites. This review provides an overview of chemotherapeutic agents for the treatment of metastatic breast cancer patients previously treated with anthracyclines and taxanes, focusing on a clinical evaluation of eribulin, the most recently approved agent for the treatment of metastatic breast cancer. Eribulin is a synthetic derivative of halichondrin B, a tumour growth inhibitor found in marine sponges, which prevents microtubule growth and sequesters the tubulin molecules into unusual aggregates, initiating apoptosis. Studies of eribulin have shown that the drug is effective in the treatment of previously treated metastatic breast cancer, and has an acceptable toxicity profile. Importantly, in the phase III EMBRACE study, eribulin treatment resulted in a survival advantage, a difficult endpoint to achieve with a single chemotherapeutic agent. An additional phase III study showed that eribulin has similar efficacy to capecitabine in women treated with no more than three prior therapies. Furthermore, pre-specified exploratory analyses suggest that particular patient subgroups may have greater therapeutic benefit with eribulin and may warrant further study to explore the potential mechanisms.     

乳腺癌患者血清Leptin水平检测及其临床意义

目的:研究瘦素(Leptin)对乳腺癌诊断的价值,为乳腺癌与乳腺良性病变的鉴别诊断提供实验依据。方法:应用放射免疫分析(RIA)分别检测46例乳腺癌、28例乳腺良性病变患者及41例正常对照组外周血中Leptin含量。结果:乳腺癌组病人血中Leptin含量(21.97±9.13ng/ml)明显高于乳腺良性病变组(16.78±5.13ng/ml)及正常对照组(12.25±2.39ng/ml),差别有显著性(P<0.01)。随着乳腺癌病情的进展,从乳腺癌Ⅰ期至Ⅳ期,Leptin水平逐渐升高,有显著性差异(P<0.01)。乳腺癌淋巴有转移组Leptin水平(26.29±8.83ng/ml),明显高于乳腺癌无淋巴转移组(16.35±6ng/ml),差异有显著性(P<0.01)。结论:Leptin的检测可作为乳腺癌诊断的实验室指标,对乳腺癌的分期和预后的评价有重要价值,对治疗方案的选择有重要的指导意义。     

A Mobile App to Stabilize Daily Functional Activity of Breast Cancer Patients in Collaboration With the Physician: A Randomized Controlled Clinical Trial

BackgroundThe well-being of breast cancer patients and reporting of adverse events require close monitoring. Mobile apps allow continuous recording of disease- and medication-related symptoms in patients undergoing chemotherapy.ObjectiveThe aim of the study was to evaluate the effects of a mobile app on patient-reported daily functional activity in a supervised and unsupervised setting.MethodsWe conducted a randomized controlled study of 139 breast cancer patients undergoing chemotherapy. Patient status was self-measured using Eastern Cooperative Oncology Group scoring and Common Terminology Criteria for Adverse Events. Participants were randomly assigned to a control group, an unsupervised group that used a mobile app to record data, or a supervised group that used the app and reviewed data with a physician. Primary outcome variables were change in daily functional activity and symptoms over three outpatient visits.ResultsFunctional activity scores declined in all groups from the first to second visit. However, from the second to third visit, only the supervised group improved, whereas the others continued to decline. Overall, the supervised group showed no significant difference from the first (median 90.85, IQR 30.67) to third visit (median 84.76, IQR 18.29, P=.72). Both app-using groups reported more distinct adverse events in the app than in the questionnaire (supervised: n=1033 vs n=656; unsupervised: n=852 vs n=823), although the unsupervised group reported more symptoms overall (n=4808) in the app than the supervised group (n=4463).ConclusionsThe mobile app was associated with stabilized daily functional activity when used under collaborative review. App-using participants could more frequently report adverse events, and those under supervision made fewer and more precise entries than unsupervised participants. Our findings suggest that patient well-being and awareness of chemotherapy adverse effects can be improved by using a mobile app in collaboration with the treating physician.ClinicalTrialClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT02004496","term_id":"NCT02004496"}}NCT02004496; https://clinicaltrials.gov/ct2/show/{"type":"clinical-trial","attrs":{"text":"NCT02004496","term_id":"NCT02004496"}}NCT02004496 (Archived by WebCite at http://www.webcitation.org/6k68FZHo2)     

多波束超声技术治疗乳腺癌临床效果的研究

研究多波束超声技术对乳腺癌患者的治疗方案,通过光镜和透射电镜评估治疗效果。采用束波刀-E10设备进行临床试验,对22名早期乳腺癌患者进行多波束超声治疗,并对治疗区域的癌细胞进行光镜和电镜检测。实验结果表明,22名患者接受治疗后,在超声影像下可见肿瘤组织局部回声增强;在光镜下21名患者(95.5%)病灶处显示大片坏死,1名患者(4.5%)可见部分病灶坏死;在电镜下21名患者(95.5%)病灶处显示全部癌细胞破裂死亡,1名患者病灶处部分癌细胞结构尚存。多束超声汇聚焦点作用于病灶,可使乳腺癌细胞发生崩解性坏死。     

Artemin在三阴性乳腺癌中的表达及其临床意义

目的 初步分析和探讨三阴性乳腺癌患者artemin表达情况,及其对疾病预后的价值.方法 选取我院肿瘤科2005年7月至2009年7月收治的149例浸润性乳腺癌患者为研究对象,根据ER、PR和HER-2免疫组化检测结果,将其分成三阴性乳腺癌组和非三阴性乳腺癌组,采用RT-PCR和免疫组织化学方法检测artemin在两组患者肿瘤组织中的表达情况,并分析artemin在不同组织学分级、临床分期和N分期三阴乳腺癌组患者中表达情况.结果 三阴性乳腺癌组免疫组化artemin阳性表达率为79.22％ (61/77),高于非三阴性乳腺癌组患者25.00％ (18/72),差异有统计学意义(x2=5.170,P =0.006);三阴性乳腺癌组artemin mRNA表达量为(3.36±0.04)×103 copies/mL,非三阴性乳腺癌组患者为(2.52±0.06)×103copies/mL,两组差异有统计学意义(x2=3.416,P=0.04);三阴性乳腺癌患者中artemin表达率与组织学分级、临床分期和N分期相关,差异具有统计学意义(P＜0.05),而与就诊年龄、恶性肿瘤家族史、肿瘤长径以及绝经状态无关(P＞0.05).结论 三阴性乳腺癌患者的artemin表达率显著高于非三阴性乳腺癌患者,artemin在三阴性乳腺癌组织中的表达与组织学分级、临床分期和N分期密切相关,临床检测artemin可以对患者疾病的发展和预后判断提供重要的依据.     

Depression Screening Using Daily Mental-Health Ratings from a Smartphone Application for Breast Cancer Patients

BackgroundMobile mental-health trackers are mobile phone apps that gather self-reported mental-health ratings from users. They have received great attention from clinicians as tools to screen for depression in individual patients. While several apps that ask simple questions using face emoticons have been developed, there has been no study examining the validity of their screening performance.ObjectiveIn this study, we (1) evaluate the potential of a mobile mental-health tracker that uses three daily mental-health ratings (sleep satisfaction, mood, and anxiety) as indicators for depression, (2) discuss three approaches to data processing (ratio, average, and frequency) for generating indicator variables, and (3) examine the impact of adherence on reporting using a mobile mental-health tracker and accuracy in depression screening.MethodsWe analyzed 5792 sets of daily mental-health ratings collected from 78 breast cancer patients over a 48-week period. Using the Patient Health Questionnaire-9 (PHQ-9) as the measure of true depression status, we conducted a random-effect logistic panel regression and receiver operating characteristic (ROC) analysis to evaluate the screening performance of the mobile mental-health tracker. In addition, we classified patients into two subgroups based on their adherence level (higher adherence and lower adherence) using a k-means clustering algorithm and compared the screening accuracy between the two groups.ResultsWith the ratio approach, the area under the ROC curve (AUC) is 0.8012, indicating that the performance of depression screening using daily mental-health ratings gathered via mobile mental-health trackers is comparable to the results of PHQ-9 tests. Also, the AUC is significantly higher (P=.002) for the higher adherence group (AUC=0.8524) than for the lower adherence group (AUC=0.7234). This result shows that adherence to self-reporting is associated with a higher accuracy of depression screening.ConclusionsOur results support the potential of a mobile mental-health tracker as a tool for screening for depression in practice. Also, this study provides clinicians with a guideline for generating indicator variables from daily mental-health ratings. Furthermore, our results provide empirical evidence for the critical role of adherence to self-reporting, which represents crucial information for both doctors and patients.