569例鼻咽癌生存率及其影响因素分析

目的通过对我院鼻咽癌患者生存率及其影响因素分析，以了解我院目前鼻咽癌的诊治水平，并为临床治疗提供参考依据。方法收集1999年1月至2001年12月在我院收治的、经病理确诊的初治鼻咽癌患者临床资料进行回顾分析，分析年龄、性别、临床分期、病理分类、治疗方法等与生存率的关系。生存率的计算采用Kaplan-Meier法，统计学检验采用Log-rank检验，采用Cox逐步回归模型进行多因素分析。结果全组1年、3年、5年生存率分别为82．8％、69．6％，60．2％。单因素分析显示年龄、临床分期、T分期、N分期、治疗方法、性别对生存的影响有统计学意义，病理分类对生存的影响无统计学意义。多因素分析显示仅年龄、临床分期、N分期与预后关系密切。结论我院鼻咽癌患者1年、3年、5年生存率与文献报道大致相同。要提高鼻咽癌患者生存率，首先必须提高早诊率，在提高早诊的基础上，进一步开展放化疗综合治疗的临床试验，确定化疗在鼻咽癌治疗中的地位，并加以规范化，以及采用现今先进的三维适形放疗和调强放疗技术，才能进一步提高鼻咽癌患者生存率。     

心理干预对鼻咽癌患者心理健康状况及生活质量的影响

目的 探讨心理干预对鼻咽癌患者心理健康状况及生活质量的影响.方法 将78例鼻咽癌患者随机分为研究组和对照组各39例.两组均予以肿瘤内科常规治疗,研究组在此基础上联合心理干预.观察6周.于心理干预前及干预2、4和6周末采用症状自评量表评定心理健康状况,焦虑自评量表、抑郁自评量表评定焦虑、抑郁情绪;于心理干预前后采用生活质量综合评定问卷评定生活质量.结果 心理干预6周末,研究组症状自评量表、焦虑自评量表、抑郁自评量表评分均较干预前有显著下降(P ＜0.05或P＜0.01),并显著低于对照组(P＜0.05或0.01),对照组干预前后则均无显著变化(P＞0.05).干预6周末,研究组GQOLI-74总分、躯体健康、心理健康、社会功能维度分较治疗前有显著提高(P＜0.01),并显著高于对照组(P＜0.01),对照组干预前后则无显著变化(P＞0.05).结论 心理干预能有效缓解鼻咽癌患者的焦虑、抑郁情绪,对提高患者的生活质量具有重要意义.     

放射治疗65例早期鼻咽癌的预后因素分析

目的:分析影响放疗后早期鼻咽癌预后的因素。方法:单纯放疗48例,新辅助化疗 放疗17例。放疗采用常规双耳前野及面颈联合野放疗技术。化疗采用放疗前给予PDD 50mg静滴连用2 d,5-Fu 750mg静滴连用4~5 d,化疗结束后即行放疗。采用KapLan-Meier及Cox回归方法进行统计分析。结果:全组1、3、5年生存率为96.92%、86.15%、71.15%。5年局控率为78.5%,远地转移率为26.2%。外周血红蛋白低于110 g/l者,5年生存率明显低于血红蛋白高于110 g/l者(P<0.05)。疗终肿瘤残留者,5年生存率亦明显低于肿瘤消退者(P<0.05)。Ⅱ期患者行新辅助化疗者,5年生存率和单纯放疗者无明显差异。结论:(1)血红蛋白水平低者,生存率差。(2)疗终肿瘤残留者,生存率差。(3)Ⅱ期患者行新辅助化疗并没改善生存率。     

健康信念模式教育对鼻咽癌患者放射治疗期间生存质量的影响

目的探讨健康信念模式教育对鼻咽癌患者放射治疗期间生存质量的影响,为临床健康教育和护理提供相应的依据。方法对2009年10月至2012年6月广州市2家医院收治的病理学诊断为鼻咽癌并接受放射治疗的患者120例作为研究对象,随机分为对照组60例,干预组60例,对照组应用传统的健康教育方式,干预组采用健康信念模式教育的健康教育方式,出院前一天进行生存质量问卷调查。结果应用健康信念模式教育以后,鼻咽癌放射治疗期间对照组与干预组的患者在生存质量上比较,生理机能、生理职能、躯体疼痛、一般健康状况、社会功能、精神健康6个方面得分的差异有统计学意义（P〈0．05）。结论依据健康信念模式建立的健康教育是一种有效的健康教育方法,能够提高鼻咽癌患者放射治疗期间的生存质量。     

Prognostic value of health-related quality of life in patients with metastatic pancreatic adenocarcinoma: a random forest methodology

Purpose

Eastern Cooperative Oncology Group Performance Status (ECOG-PS) is currently an important parameter in the choice of treatment strategy for metastatic pancreatic adenocarcinoma (mPA) patients. However, previous research has shown that patients’ self-reported health-related quality of life (HRQOL) scales provided additional prognostic information in homogeneous groups of patients with respect to ECOG-PS. The aim of this study was to identify HRQOL scales with independent prognostic value in mPA and to propose prognostic groups for these patients.

Methods

We analysed data from 98 chemotherapy-naive patients with histologically proven mPA recruited from 2007 to 2011 in the FIRGEM phase II study which aimed to compare the effectiveness of two chemotherapy regimen. HRQOL data were assessed with the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire. A random survival forest methodology was used to impute missing data and to identify major prognostic factors for overall survival.

Results

Baseline HRQOL assessment was completed by 60 % of patients (59/98). Twelve prognostic variables were identified. The three most important prognostic variables were fatigue, appetite loss, and role functioning, followed by three laboratory variables. The model’s discriminative power assessed by Harrell’s C statistic was 0.65. Fatigue score explained almost all the survival variability.

Conclusion

HRQOL scores have prognostic value for mPA patients with good ECOG-PS. Moreover, the patient’s fatigue, appetite loss, and self-perception of daily activities were more reliable prognostic indicators than clinical and laboratory variables. These HRQOL scores, especially the fatigue symptom, should be urgently included for prognostic assessment of mPA patients (with good ECOG-PS).

     

The mediating role of optimism on post-radiation quality of life in nasopharyngeal carcinoma

Nasopharyngeal carcinoma (NPC) is prevalent in southern China. In non-welfare countries, eating difficulties after radiotherapy may hinder NPC patients' short-term quality of life (QoL) especially regarding work and finance. This study explored the positive mediating role of optimism on the relationship between eating ability and QoL of Chinese NPC patients who received radiotherapy in Hong Kong. A sample of 211 newly referred patients were recruited and followed-up face-to-face or by telephone at four (post-radiation 1) (FU 1) and eight (post-radiation 2) (FU 2) months from baseline. QoL was measured by the FACT-G (Chinese). Optimism and eating ability were measured by two 11-point self-rated items. Mediating effects were tested with a series of multiple regression models. After adjustment for pre-radiation QoL, socio-economic status and cancer stage, optimism significantly mediated the relationship between eating ability at FU 1 and overall QoL at FU 2, in particular physical and social/family well-being. This study is the first to underpin the mediating role of optimism on QoL of NPC patients. Faced with aversive side-effects of radiotherapy, facilitating positive thinking in Chinese NPC patients may accelerate their short-term post-radiation adjustment.     

宫颈癌患者治疗后生活质量的影响因素分析

目的 评估宫颈癌患者术后或放化疗后的生活质量(QOL)及其影响因素,以采用针对性治疗措施提高宫颈癌患者治疗后的生活质量.方法 采用欧洲癌症研究与治疗组织生活质量核心调查表(EORTC QLQ-C30)对术后或放化疗后的100例宫颈癌患者进行生活质量调查.结果 年龄对宫颈癌患者整体生活质量、角色功能、认知功能、疲乏和恶心、呕吐均有影响(t值分别为-0.3083、-2.114、-2.090、-2.495、2.619,均P<0.05).家庭收入是影响整体生活质量、社会功能、经济困难的因素(t值分别为2.631、-3.082、-6.385,均P<0.05).疾病分期是影响患者认知功能、情绪功能的因素(t值分别为-2.634、-4.861,均P<0.05).肌层浸润深度、组织学转移、淋巴结转移均与宫颈癌患者的生活质量水平呈负相关.治疗方式是整体生活质量、疲乏、食欲减弱、经济困难的影响因素(t值分别为-5.171、3.471、2.023、2.738,均P<0.05).结论 重视宫颈癌的早诊早治,选择合理的治疗方式,为患者及其家人提供有针对性的治疗措施,可以提高宫颈癌患者治疗后的生活质量.     

Advanced nasopharyngeal carcinoma: radiation treatment and chemotherapy approaches, and life table survival results.

Induction combination chemotherapy and radiotherapy was tried in 50 patients with T3-T4 nasopharyngeal carcinoma. The results were compared to another matching group of 50 patients given radical radiotherapy. The study showed preliminary improvement of local control rates of the tumour in patients treated by combination chemotherapy with radiation. The actuarial method of survival computation was applied, also the variance and standard error of the four years survival rates for both treatment groups was computed. Comparison of the survival rates showed no significant difference between group I (received combined chemo and radiotherapy) and group II (Radiation therapy) throughout the observation period.     

慢性乙型肝炎患者抗病毒治疗后的生活质量测评

目的 评价慢性乙型肝炎患者抗病毒治疗后心理健康的状况,为临床疗效评价提供参考.方法 应用健康状况调查问卷SF-36量表,对我院2009年1月至2011年11月收治的82例慢性乙型肝炎患者(患者组)及30名健康者(对照组)进行生活质量的研究,比较两组生活质量的状况,并分析患者抗病毒治疗前后的临床客观指标和生活质量主观指标变化.结果 治疗前患者生活质量评分较健康对照组低,患者组SF-36总分为(65.1±10.7),对照组总分为(79.8±12.8),两组比较差异有统计学意义(t=6.3,P＜0.01);治疗后,患者组生活质量有明显改善,SF-36总分为(76.3±12.5),与治疗前相比,差异有统计学意义(t=4.7,P＜0.01).患者治疗前后ALT和HBV DNA有不同程度的改善,随着临床指标的好转,患者生活质量评分也上升,提示临床指标的变化与生活质量分值的相关性.结论 慢性乙型肝炎患者的生活质量评分低于健康对照组,抗病毒治疗后生活质量的评价有助于临床疗效分析,对临床治疗的选择和决策有指导意义.     

治疗鼻咽癌放射治疗后鼻窦炎的临床观察

目的 观察鼻内窥镜手术在治疗鼻咽癌放疗后鼻窦炎的疗效。方法 对28例经药物保守治疗一年后无效的鼻咽癌放疗后鼻窦炎患者行鼻内窥镜直视下手术治疗。结果 随访2～4．5年，经过鼻内窥镜直视下手术治疗后，鼻窦炎患者获治愈者12例，有效16例，有效率为（100％）。结论 在治疗鼻咽癌放疗后鼻窦炎中，择期应用鼻内窥镜手术具有重要的临床治疗价值。     

鼻咽癌患者放疗后真菌感染的危险因素分析

目的探讨鼻咽癌患者经放疗后真菌感染的危险因素及相应的处理对策,以降低鼻咽癌放疗后真菌感染的发生率。方法选取2005年1月-2013年12月接受治疗的鼻咽癌放疗患者378例,对真菌感染的各可能危险因素进行统计分析,数据采用SPSS 17.0软件进行统计分析。结果 378例鼻咽癌患者放疗后发生真菌感染82例,感染率为21.69%;培养出真菌88株,以白色假丝酵母菌和热带假丝酵母菌为主,分别占56.82%、21.59%;当患者年龄>60岁、≥2种并发症、使用免疫抑制剂、伴皮肤或黏膜溃烂、住院时间>50d、口腔感染时真菌感染率明显上升,差异有统计学意义(P<0.05);鼻咽癌放疗后患者抗菌药物使用率为80.42%;使用抗菌药物≥35d、品种≥3种及选用头孢菌素类抗菌药物抗感染时,真菌感染率明显增加,差异有统计学意义(P<0.05)。结论高龄、≥2种并发症、使用免疫抑制剂、伴皮肤或黏膜溃烂、住院时间>50d、不合理使用抗菌药物是鼻咽癌放疗后发生真菌感染的危险因素,医院应继续加强监管力度,降低鼻咽癌放疗后真菌感染的发生。     

放疗对食管癌患者生活质量的影响

目的评价食管癌放疗患者的短期生活质量。方法在放疗前及放疗后3个月的特定时间,对放疗患者进行EORTC QLQ-C30问卷调查,并计算出放疗后存活3个月以上患者的平均得分（n=38）。结果适形调强放疗组情绪功能、经济困难领域比常规放疗组好,食欲丧失领域较常规放疗组差,差异有统计学意义。与放疗前相比,放疗后生活质量下降但在放疗后3个月内恢复。放疗结束后1天功能及总体生活质量显著性下降,放疗结束后3个月大部分症状及单项项目显著改善。结论放疗对患者生活质量的负性影响是暂时的,QLQ-C30为测量食管癌治疗后生活质量的变化提供了选择。     

18F-FDG SPECT/CT符合线路显像在鼻咽癌放疗后随访中的价值

目的 评价18F-FDG SPECT/CT符合线路显像在鼻咽癌放疗后病人临床随访中的应用价值. 方法 43例鼻咽癌(NPC)病人行放疗或放化疗后.随访中行18F-FDG SPECT/CT显像检查50人/次,结果与同期CT/MRI显像结果和3～6个月的临床追踪结果比较. 结果 18F-FDG SPECT/CT符合线路显像发现鼻咽癌放疗后的复发和转移阳性25例、阴性18例,其敏感度、特异度和准确率分别为92.0%(23/25)、83.3%(15/18)和88.40/0(38/43). 结论 18F-FDG SPECT/CT符合线路显像对NPC治疗后的病人能有效地评价治疗效果,及时发现复发和转移病灶,值得临床推广.     

~(18)F-FDG SPECT/CT符合线路显像在鼻咽癌放疗后随访中的价值

目的评价18F-FDG SPECT/CT符合线路显像在鼻咽癌放疗后病人临床随访中的应用价值。方法43例鼻咽癌(NPC)病人行放疗或放化疗后,随访中行18F-FDG SPECT/CT显像检查50人/次,结果与同期CT/MRI显像结果和3～6个月的临床追踪结果比较。结果18F-FDG SPECT/CT符合线路显像发现鼻咽癌放疗后的复发和转移阳性25例、阴性18例,其敏感度、特异度和准确率分别为92.0%(23/25)、83.3%(15/18)和88.4%(38/43)。结论18F-FDG SPECT/CT符合线路显像对NPC治疗后的病人能有效地评价治疗效果,及时发现复发和转移病灶,值得临床推广。     

鼻咽癌放疗前后动态CT对比观察的临床应用价值

目的对比鼻咽癌放疗前后各阶段CT变化特点,掌握其变化规律,鉴别早期复发、改进治疗手段、改善预后。方法通过回顾性分析120例病理证实为鼻咽癌的患者进行放射治疗前后影像表现对比,观察和分析鼻咽癌放射治疗后CT变化规律。结果放疗后因肿瘤的病理分化程度、肿瘤对放疗的敏感性及随诊时间的不同,原发灶治疗后可完全消退、缩小及增大恶化等表现,本组病例肿块消失81例(57.5%),肿瘤较放疗前缩小19例(15.8%);增大外侵6例(5%);鼻咽部纤维化26例(21.7%)。结论鼻咽癌放疗前后动态CT对比观察,对提高CT随访诊断水平、鉴别早期复发、改进治疗手段、改善预后具有重要意义。     

品管圈在鼻咽癌患者放疗中张口锻炼的作用研究

目的:探讨品管圈活动对提高鼻咽癌放疗患者张口锻炼作用效果.方法:成立"品管圈"组织,对鼻咽癌患者张口锻炼依从性低的现象进行原因分析,制定相应的措施并组织实施.结果:提高了鼻咽癌放疗患者张口锻炼依从性.结论:品管圈活动在提高鼻咽癌放疗患者张口锻炼依从性方面有较好的效果.     

Health-related quality of life predicted subsequent health care resource utilization in patients with active cancer

Quality of Life Research - The objective of this study was to estimate the association between SF-12v2® Health Survey (SF-12v2) scores and subsequent health care resource utilization (HCRU)...     

纤维支气管镜联合振动排痰治疗鼻咽癌放疗后吸入性肺炎的效果

目的 探讨纤维支气管镜联合振动排痰治疗对鼻咽癌放疗后吸入性肺炎患者临床症状及呼吸功能的影响.方法 选择我院2016年3月-2019年1月收治的鼻咽癌放疗后吸入性肺炎患者56例,随机分为对照组和观察组,各28例,对照组采用振动排痰治疗,观察组采用纤维支气管镜吸痰灌洗联合振动排痰法,比较两组临床肺部感染评分(CPIS)、急...     

Prognostic factors correlated with survival in AIDS patients

The authors present the AIDS cases (CDC '93) observed in Brescia from 1983 to 1994. They observed 1189 subjects (M 84%, F 16%) with a mean age of 32.7 years (intra-venous drug users 75.1%, heterosexuals 14%, homosexuals 9.6%). The mean survival observed was 56.7 weeks from the diagnosis of AIDS (mortality per year 78%). The most frequent AIDS-defining events were Visceral Candidiasis, P.carinii Pneumonia (PCP) and Neurotoxoplasmosis, while the longest and shortest mean survival was for Kaposi's Sarcoma (89 weeks) and Wasting Syndrome (8.4). The mean value of CD4+ lymphocyte counts on AIDS diagnosis was 72.6/l (1166 cases) and the highest and lowest were in non-Hodgkin's Lymphoma (NHL; 147.6/l) and Cryptosporidiosis (18.8/l). Antiretroviral therapy had been given for at least a month in 41.4% subjects (mean treatment duration of 74.8 weeks). The Cox model has demonstrated the favourable effect on survival of high CD4+ lymphocyte counts on diagnosis, antiretroviral therapy, the diagnosis of Tuberculosis (TBC) and PCP as initial markers and the diagnosis of TBC, PCP or Cytomegalovirus infection (CMV) during the entire clinical evolution. Moreover, the unfavourable effect of high age, diagnosis of Progressive Multifocal Leucoencephalopathy (PML), Wasting Syndrome and NHL as initial markers and diagnosis of PML or NHL in any moment of the disease has been demonstrated.