肝癌中医证型与肝功能及肝脏储备功能的相关性

原发性肝癌的中医辨证分型,尚无一致性意见［１］。研究中晚期肝癌中医证型与肝功能、肝脏储备功能的关系,探讨中医证型的病机传变规律,有助于肝癌证型的诊断与规范化研究。１对象与方法１．１诊断标准 按《新编常见恶性肿瘤诊治规范》原发性肝癌的临床诊断标准;分期标准按我国１９７７年的三期分期标准［２］。１．２中医辨证分型方法 根据临床症状表现,分为肝热血瘀型、肝盛脾虚型、肝肾阴虚型［３］。１．３纳入标准 符合以上临床诊断标准的患者;全部为住院患者,年龄在１８岁－７０岁,估计生存期＞３个月;入院后第二天即经两位…     

90例胃癌患者营养不良状况及中医证型相关性

摘 要：［目的］ 了解不同中医证型胃癌患者的人体组成成分情况。［方法］ 选择90例胃癌患者,收集患者相关资料如中医证型、手术情况等,根据中医证型进行分组。利用人体组成分析仪测定患者人体组成成分(蛋白质、脂肪、水分、骨质、肌肉),运用PG-SGA量表和NRS 2002量表进行营养状况评估及营养风险筛查,统计分析上述各项指标与中医证型之间的关系。［结果］ 四组中医证型组均存在不同程度的脂肪、蛋白质降低（P<0.05）。其中气血亏虚组患者营养不良发生率显著性高于痰湿蕴结组及肝胃不和组（P<0.05）。气血亏虚组患者体内水分、肌肉、蛋白质等显著性低于痰湿蕴结组及肝胃不和组（P<0.05）。［结论 ］ 不同中医证型的胃癌患者,其人体组成成分存在差异。气血亏虚型胃癌患者营养不良发生率最高,并且与营养成分的下降程度相关。     

二代基因测序在胶质瘤治疗中的临床价值

摘 要：［目的］ 探讨二代基因测序（next generation sequencing，NGS）在胶质瘤治疗和预后中的临床意义。［方法］ 收集郑州大学第一附属医院2017年6月至2019年6月收治的88例胶质瘤患者。所有患者的术后组织标本均经过NGS，分析突变基因对肿瘤突变负荷（tumor mutation burden，TMB）的影响，并对2年无进展生存期（progression?鄄free survival，PFS）和2年总生存期（overall survival，OS）的影响因素进行单因素和多因素分析。［结果］ 每例患者均检测了520个基因，其中TP53基因突变、IDH1基因突变及CDKN2B基因突变是影响TMB的独立危险因素（P＜0.05）。IDH1基因突变、PTEN基因突变是影响2年PFS的独立因素（P＜0.05）。TMB和PTEN基因突变是影响2年OS的独立因素（P＜0.05）。［结论］ NGS增加了胶质瘤中有意义的突变基因的检出率，尤其是一些罕见基因，可以用于指导患者的治疗和预测患者的预后。     

中晚期非小细胞肺癌患者中医证型分布规律研究

[目的]探讨中晚期非小细胞肺癌（NSCLC）患者中医证型分布规律，为制定统一的辨证分型标准提供依据。[方法]根据预先设计的观察表和临床证候诊断标准，按八纲、气血及脏腑辨证的原则，对282例中晚期NSCLC患者进行详细的中医辨证分型并做统计学处理分析。[结果]282例患者证候数为568个，两个以上证候的病例为213个，占总病例数的75．53％。证候分型主要包括如下13种：气虚血瘀型，气虚型，气虚痰湿型，气虚兼痰湿、血瘀型，气阴两虚型，血瘀型，痰湿兼血瘀型，气虚兼气滞、血瘀型，气滞血瘀型，痰湿型，阴虚型，气虚兼气滞、阳虚型，气虚痰热型。以气虚为主的兼证多见，占总病例数的56．73％。[结论]中晚期NSCLC证候分布复杂．单证少。复证多。含两个以上证候的复证多见，多为虚实兼挟。     

二代测序技术检测结外NK/T细胞淋巴瘤中高频突变基因及其临床意义

目的：采用二代测序技术检测结外NK/T细胞淋巴瘤（extranodal natural killer/T-cell lymphoma,ENKTL）目的基因突 变情况,分析其与疾病预后和临床特征的关系, 为ENKTL发病机制、临床诊断和靶向治疗提供依据。方法：根据以往文献报道 筛选其突变会影响淋巴瘤发生发展的基因作为本研究的目的基因。选择2010年8月至2018年10月期间在河北医科大学第四医 院初治的ENKTL患者29例,通过二代测序技术检测组织标本中目的基因突变情况。应用SPSS21.0统计软件分析临床特征、 疾 病预后和目的基因突变情况三者间的关系。结果：筛选得到9个目的基因,其中AT丰富结合域1A基因（AT-rich interactivedomain 1A,ARID1A）为突变率最高的基因,占 34.48%（10 例）,其次为赖氨酸甲基转移酶 2D（lysine methyltransferase 2D, KMT2D）（31.03%）、肿瘤蛋白P53（tumor protein P53,TP53）（24.13%）。Kaplan-Meier生存分析显示,KMT2D野生型患者总生存 优于伴有KMT2D基因突变型患者（P=0.006）。KMT2D基因突变情况与ENKTL患者临床资料分析发现,KMT2D基因突变型与 患者临床分期、CRP、白蛋白、淋巴细胞计数、Ki67水平密切相关,具有统计学意义（P<0.05）。通过COX回归多因素分析得出： KMT2D基因突变型为独立预后不良因素（P<0.05）。结论：KMT2D基因在ENKTL中高频突变,并与其预后相关,提示KMT2D 基因在ENKTL发生发展中起重要作用,可作为ENKTL临床治疗潜在的靶点。     

口腔恶性肿瘤术后患者中医辨证分型116例分析

[目的]探讨口腔颌面部恶性肿瘤术后患者的中医辨证分型。[方法]对116例口腔恶性肿瘤术后患者进行中医辨证分型，参照《中医证候规范》及《上海市中医病证诊疗常规》，分成气阴两虚型、气血亏虚型、睥虚痰湿型、气滞血瘀型、热毒壅阻型及其他证型。[结果]116例口腔恶性肿瘤患者术后出现气阴两虚型占50．86％（59／116），同时兼有脾虚痰湿型占64．65％（75／116）：颈部淋巴结转移患者与临床各证型关系无显著性相关（P〉0．05）；气阴两虚型患者病程为7．61±5．80个月，明显长于总病例数的平均病程7．56±5．95个月（P〈0．05）。[结论]口腔恶性肿瘤患者术后中医证型以气阴两虚型为主，脾虚痰湿型其次。     

胃癌与脾虚证关系的初步研究

采用组织化学、放射免疫和能量色散X射线分析方法在55例脾虚证胃病患者中研究4种不同类型的胃粘膜肠化生和胃粘膜cAMP和微量元素。肠化生率、结肠型肠化生率、不完全性结肠型肠化生率和胃癌率随着脾气虚证和脾虚气滞证的顺序而递增,胃粘膜cAMP和Zn含量则分别随着相同的脾虚证、完全性和不完全性小肠型和结肠型肠化生,良性胃病和胃癌的顺序而递减,统计学差异也有意义,P<0.05-0.001。所有这些发现提示胃粘膜cAMP和Zn的量变和不完全性结肠型肠化生与脾虚证胃癌密切相关。胃粘膜cAMP和Zn含量变化可能是脾虚证胃病演化过程中病理生理和病理组织反应的物质基础。测定cAMP和Zn含量及肠化生类型在估计病程和疗效上可有重要临床意义。     

胃癌胃粘膜形态、DNA、cAMP、微量元素改变的临床与实验研究

本文检测67例脾虚证胃病患者胃粘膜超微结构、肠化生亚型、DNA、cAMP、微量元素及其氧化物如~3H TdR LcT,发现不完全性结肠型肠化生率、非病灶处“背景病变”发生率随着脾气虚证至脾虚气滞证、良性胃病至胃癌的顺序递增.组间均有显著性差异.P<0.05～0.001。胃粘膜不完全性结肠型肠化生组织内DNA、cAMP、Zn、Cu、ZnO与CuO含量与胃癌组织间无显著性差异。认为脾虚气滞证胃病伴不完全性结肠型肠化生,及cAMP、Zn、Cu、ZnO与CuO含量降低,而DNA含量异常增高时,有癌变倾向。     

二代测序获得胰腺癌患者肿瘤相关基因变异图谱分析

摘 要：［目的］ 了解胰腺癌患者的基因变异情况,为胰腺癌的个体化治疗提供探索依据。［方法］ 收集58例原发胰腺恶性肿瘤患者,利用二代基因测序技术（NGS）检测肿瘤组织和体细胞的基因变异情况,绘制基因变异图谱,并结合临床资料进行分析。［结果］ 53例胰腺腺癌患者中最常见的突变基因是KRAS、TP53、CDKN2A、SMAD4、ARID1A、RNF43（突变发生频率在10%以上）等。原发灶和转移灶、不同性别的样本之间,基因变异基本相似。肿瘤相关重要通路,如 MAPK通路变异89.0%,G1/S通路变异84.9%,HRD相关通路变异17.0%,TGF-β信号通路变异35.8%,SWI/SNF复合物通路变异46.0%。其中54.7%的患者至少有1个潜在可用药靶点。免疫生物标志物方面高肿瘤突变负荷（TMB-H）占1/52（1.9%),可分析的52例患者全部为微卫星稳定（MSS）。［结论］该研究中胰腺癌患者的全肿瘤相关基因测序情况,在主要的突变基因和潜在可用药靶点基因上,与国外报道相似,少数低频率突变的基因差异有待扩大样本量进一步验证。超50%的患者存在潜在可用药靶点,为胰腺癌的靶向免疫治疗提供了个体化治疗依据。     

晚期胃癌患者血液ctDNA水平与组织学基因检测的一致性比较

目的:比较晚期胃癌患者外周血循环肿瘤DNA（circulating tumor DNA,ctDNA）与组织学基因检测的一致性,讨论ctDNA的临床应用价值。方法:根据纳排标准最终收集30例晚期初诊初治胃癌患者的实体组织标本及血浆标本,并用二代测序(next generationg sequencing,NGS)技术分别检测68个基因在其中的表达状况。对比ctDNA与组织学检测基因的检出一致性及差异,评估其用于诊断胃癌的敏感度、特异度。并按胃癌突变基因分层进一步评估ctDNA的检出率。结果:30例患者中检出的基因突变总共138个,其中组织学标本中总共检出71个,ctDNA中总共检出67个。ctDNA对比组织学检测基因诊断胃癌的灵敏度为31.5%,特异度为63.6%,一致率为43.3%。单基因检测分析突变最多的基因前三位为TP53、PIK3CA、HER-2。其中对PIK3CA的检测,组织学和ctDNA两种方法差异有统计学意义（P＜0.05）。TP53、PIK3CA、HER-2、EGFR、KRAS在组织学中检出丰度大于1,但在ctDNA中小于1。有PIK3CA突变的患者中,共存的其他致癌基因突变位点包括KRAS 2例、BRAF 2例、EGFR 4例。有HER-2突变的患者中,共存PIK3CA突变者4例,共存KRAS突变者3例。结论:ctDNA检测虽然在晚期胃癌患者的诊断中敏感度、特异度低于组织标本基因检测,但其标本易获、接受度高,可作为基因检测的补充、备选。实体组织检出相同基因的突变丰度总体高于ctDNA。TP53、PIK3CA、HER-2、EGFR等基因在ctDNA中的检出有利于指导胃癌治疗及预后评估,尤其PIK3CA在ctDNA中高于组织中的检出率。ctDNA检测可为胃癌患者的精准靶向治疗提供依据。     

Experience with Impedance Phlebography Compared with Venography

Venography is a particularly reliable method for the diagnosis of deep venous thrombosis but is not suitable as a screening test. Impedance phlebography represents another attempt to discover a simple, non-invasive and reliable method of detecting deep venous thrombosis. It does not, however, meet these criteria.     

Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours

PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.     

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer

BackgroundMethylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy.Patients and methodsPooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization.ResultsIn two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43–109 versus 56 days, 95% CI 43–69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59–177 versus 55 days, 95% CI 40–70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29–0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30–0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88).ConclusionThis unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy.Clinical trials numberNCT00401362, NCT00672477.     

Costs associated with complications are lower with capecitabine than with 5‐fluorouracil in patients with colorectal cancer

BACKGROUND:

Capecitabine, an oral alternative to 5‐fluorouracil (5‐FU) in patients with colorectal cancer (CRC), has equal clinical efficacy and a favorable safety profile; however, its use may be limited because of unit cost concerns. In this study, the authors measured the cost of chemotherapy‐related complications during treatment with capecitabine‐ and 5‐FU–based regimens.

METHODS:

Patients with CRC who received at least 1 administration of capecitabine or 5‐FU during 2004 and 2005 were identified from the Thomson MarketScan research databases. Monthly frequency and cost for 23 complications were recorded. Logistic regression was used to predict complication probability. General linear models were used to predict monthly complication cost and total monthly expenditure.

RESULTS:

In total, 4973 patients with CRC met the inclusion criteria for this analysis. Although the most frequently observed complications were the same between capecitabine and 5‐FU (nausea and vomiting, infection, anemia, neutropenia, diarrhea), each was observed with greater frequency in 5‐FU–based regimens. The mean predicted monthly complication cost was significantly higher (by 136%) with 5‐FU monotherapy than with capecitabine monotherapy (difference, $601; 95% confidence interval [95% CI], $469‐$737). In addition, the mean predicted monthly complication cost for 5‐FU+oxaliplatin was higher than the cost with capecitabine plus oxaliplatin (difference, $1165; 95% CI, $892‐$1595). When acquisition, administration, and complication costs were taken into consideration, there were no significant differences in the total cost between capecitabine regimens and 5‐FU regimens.

CONCLUSIONS:

Capecitabine compared well with 5‐FU–based therapy in patients with CRC and was associated with lower complication rates and associated costs. Cancer 2009. © 2009 American Cancer Society.     

Living with secondary breast cancer: coping with an uncertain future with unmet needs

JOHNSTON S.R.D. (2010) European Journal of Cancer Care 19 , 561–563 Living with secondary breast cancer: coping with an uncertain future with unmet needs     

奥沙利铂联合羟基喜树碱治疗晚期胃癌临床分析

背景与目的体外及体内的临床研究显示,奥沙利铂(L-OHP)对多种肿瘤有显著抑制作用并与绝大多数抗癌药物具有相加或协同细胞毒作用.本文旨在观察L-OHP联合羟基喜树碱(HCPT)治疗晚期胃癌的近期疗效和患者耐受性,并与传统的化疗方案进行对比.方法采用非随机的分组方法将43例晚期胃癌患者分为L-OHP+HCPT方案组(治疗组)与Vp-16+CF+5-FU(ELF)方案组(对照组),其中男性28例,女性15例,中位年龄59岁,KPS评分≥60,观察两组的近期疗效和患者耐受性.结果治疗组24例有效率58.3%(14/24),对照组19例有效率42.1%(8/19).治疗组有效率高于对照组,两组差异有显著性(P<0.05).两组不良反应主要是骨髓抑制、恶心、呕吐、口腔炎、周围神经炎、静脉炎、脱发等,均在Ⅰ、Ⅱ度范围内.结论L-OHP联合HCPT方案治疗晚期胃癌疗效较好,不良反应可以耐受.     

Varicella-Zoster Virus Prophylaxis with Low-Dose Acyclovir in Patients with Multiple Myeloma Treated with Bortezomib

BackgroundVaricella-zoster virus (VZV) reactivation is a common complication in patients with multiple myeloma (MM) treated with bortezomib, with an incidence rate of 10%-60%. The aim of our study was to analyze the effect of acyclovir prophylaxis in this patient population.Patients and MethodsWe studied 98 consecutive patients with relapsed MM treated with bortezomib. Bortezomib 1.3 mg/m² was given on days 1, 4, 8, and 11 of a 21-day cycle. At first, patients did not receive any VZV prophylaxis, but because of the high incidence of VZV reactivation, VZV prophylaxis with acyclovir was implemented subsequently.ResultsA total of 11 patients treated with bortezomib did not have any VZV prophylaxis, and 4 of these 11 patients (36%) developed VZV reactivation in the form of herpes zoster. No VZV reactivations were observed in the 32 patients who received acyclovir 400 mg 3 times daily or the 55 patients who received acyclovir in a dose reduced to 400 mg once daily during bortezomib treatment.ConclusionVaricellazoster virus reactivation is a common and serious adverse effect of bortezomib treatment. Acyclovir 400 mg once daily is sufficient to protect from VZV reactivation in patients with MM treated with bortezomib.