CHOP或CHOP样方案一线治疗晚期血管免疫母细胞型T细胞淋巴瘤效果观察

目的 分析CHOP或CHOP样方案一线治疗血管免疫母细胞型T细胞淋巴瘤(AITL)的效果.方法 回顾性分析2006年8月至2014年2月收治的29例应用CHOP或CHOP样方案一线治疗的晚期AITL患者的临床资料,总结其临床特征,分析疗效及其预后因素.结果 患者中位发病年龄为59岁,全部为Ⅲ～Ⅳ期,17例(58.6％)伴B症状,26例(89.7％)IPI评分≥2分,20例(69.0％)起病时乳酸脱氢酶升高,9例(31.0％)出现≥2个结外器官受侵.中位随访20个月,总有效率为69.0％(20/29),其中17.2％(5/29)的患者初治达完全缓解或未确定完全缓解,51.7％(15/29)达部分缓解,20.7％(6/29)出现疾病进展,10.3％(3/29)稳定.中位无进展生存(PFS)期为6个月.1、2年PFS率分别为39.0％、20.0％.1、2、5年总生存(OS)率分别为76.8％、53.4％和17.1％.治疗有效患者PFS长于无效患者(P＜ 0.001),有效与无效患者OS差异无统计学意义(P＞0.05).结论 CHOP或CHOP样方案一线治疗AITL的总体疗效不满意,有待进一步探索新的治疗方法.     

含利妥昔单抗化疗方案治疗套细胞淋巴瘤效果分析

目的探讨含利妥昔单抗化疗方案治疗套细胞淋巴瘤(MCL)患者效果及预后影响因素。方法回顾性分析2007年6月至2018年11月苏州大学附属第一医院血液科收治的56例≤65岁MCL患者临床资料,化疗方案中均包括利妥昔单抗,观察临床特征、治疗方案及生物学指标对总生存(OS)和无进展生存(PFS)的影响。结果56例患者中位发病年龄57岁,男性43例,女性13例。24例接受R-CHOP方案化疗;29例接受含阿糖胞苷方案化疗,其中15例接受R-hyper CVAD/R-MA方案化疗,14例接受R-CHOP/R-DAHP交替治疗;3例接受其他方案化疗。19例接受自体造血干细胞移植(ASCT)巩固治疗。56例患者中位OS时间74个月,2年OS率83.8%,3年OS率70.9%,2年PFS率72.0%,3年PFS率49.7%。国际预后指数(IPI)评分和治疗中是否接受ASCT是MCL患者OS和PFS的独立影响因素。含阿糖胞苷治疗组总有效率(ORR)93.1%,优于R-CHOP方案组(83.3%),差异无统计学意义(χ²=0.465,P=0.495);两组间OS及PFS差异均无统计学意义(OS:χ²=0.291,P=0.590;PFS:χ²=0.912,P=0.339)。诱导化疗达缓解的MCL患者中,ASCT巩固治疗可延长中位OS时间(72个月比124个月,χ²=3.973,P=0.040)及中位PFS时间(34个月比90个月,χ²=3.984,P=0.046)。简化MCL国际预后指数(sMIPI)评分中高危组患者中接受ASCT巩固治疗患者OS和PFS优于未接受ASCT治疗者(OS:χ²=5.037,P=0.025;PFS:χ²=6.787,P=0.009),而sMIPI评分低危组患者中,是否接受ASCT组间OS、PFS差异均无统计学意义(均P>0.05)。结论含阿糖胞苷的化疗方案对改善MCL患者的预后和生存并不理想。对于诱导化疗达缓解及sMIPI评分中高危组的MCL患者,ASCT巩固治疗可改善其预后,可作为年轻患者的一线巩固治疗方案。     

Addition of rituximab is not associated with survival benefit compared with CHOP alone for patients with stage I diffuse large B-cell lymphoma

Background

The role of rituximab in combination with CHOP regimen in patients with stage I diffuse large B-cell lymphoma (DLBCL) remains to be defined. We aimed to compare CHOP plus rituximab (R-CHOP) with CHOP alone and determine the value of radiotherapy in these patients.

Methods

Between 2003 and 2009, 140 untreated patients with stage I DLBCL were retrospectively analyzed in this study.

Results

Seventy-eight patients were treated in R-CHOP group and 62 in CHOP group. Ninety-one patients received additional radiotherapy at the end of chemotherapy. The different treatment groups were well-balanced with respect to baseline characteristics. Complete response (CR) rate was 77% both in R-CHOP and CHOP groups (P=0.945). After a median follow-up period of 56 months, patients received R-CHOP regimen had similar 5-year progression-free survival (PFS) (76% vs. 85%; log-rank P=0.215) and 5-year overall survival (OS) (90% vs. 96%; log-rank P=0.175) compared with those with CHOP alone. Patients with radiotherapy had significantly increased 5-year PFS compared with those who had chemotherapy alone (86% vs. 71%; log-rank P=0.005). At multivariate analysis, patients who had CR (P=0.008) and received radiotherapy (P=0.003) were significantly associated with superior PFS.

Conclusions

CHOP alone could be as effective as R-CHOP regimen and additional radiotherapy would be necessary for stage I or stage I non-bulky DLBCL patients.     

青少年或儿童原发系统性间变大细胞淋巴瘤CHOP为主化疗±放疗的远期疗效

目的 分析青少年儿童原发系统性间变大细胞淋巴瘤(ALCL)患者接受CHOP方案化疗 ±受累野放疗的疗效。方法 回顾分析本院1998—2010年收治的 28例青少年、儿童ALCL患者资料。Ⅰ、Ⅱ期 12例中单纯化疗 2例、综合治疗 10例,Ⅲ、Ⅳ期 16例中单纯化疗 14例、综合治疗 2例。CHOP方案 15例、CHOP联合其他高强度化疗 13例。化疗周期数 3~17个(中位数6个)。放疗多为受累野照射,剂量 39.6~50.0 Gy (中位数45 Gy)。结果 全组患者首程疗后达CR者 25例(89%),3例病变进展。中位随访时间45.3个月。全组 5年无事件生存率为80%,5年OS为93%。疗终达CR者 5年OS为100%,而未达CR者无 5年OS (P=0.000)。≥2个结外器官受侵者 5年无事件生存率为38%,而<2个结外器官受侵者的为85%(P=0.010)。结论 青少年、儿童原发系统性ALCL按成人方案治疗效果满意,但还需要长期随访。     

Combined chemoradiation for the management of nasal natural killer (NK)/T-cell lymphoma: elucidating the significance of systemic chemotherapy

The objective of this analysis was to evaluate the efficacy and treatment outcome of CHOP and CHOP combined with nitrosourea chemotherapy in natural killer (NK)/T-cell lymphoma of the nasal cavity. Sixty-three patients with NK/T-cell lymphoma of the nasal cavity were treated with CHOP or CHOP combined with oral nitrosourea chemotherapy between January 1997 and June 2005. By the Ann Arbor Lymphoma Staging Classification, 57 patients (90%) had Stage IE or IIE disease and six patients (10%) had Stage III or IV disease. All patients with Stage IE or IIE disease were intended to be treated curatively with combined chemoradiation; and patients who had Stage III or IV disease were treated with chemotherapy alone with curative intention. Chemotherapy consisted of: (1) up to six cycles of the standard CHOP based regimen, or (2) up to six cycles of the standard CHOP based regimen with oral Semustine dosed at 120 mg (or Lomustine dosed at 100mg) on day 1 of each chemotherapy cycle. External beam radiation therapy was delivered by daily conventional fractionation by Co-60 or 6MVx linear accelerator for patients with Stage IE or IIE disease. The radiation dose to the tumor bed was between 36 and 50 Gy with a median dose of 45 Gy. Fifty-three patients received chemotherapy prior to radiation, and four patients were treated with involved field radiation before chemotherapy. The median follow up for all 44 surviving patients was 31 months (range: 6-104 months). The 2-year progression-free survival (PFS) and overall survival (OS) rates were 60% and 70%, respectively. The PFS and OS of patients who were treated with or without oral nitrosourea in addition to CHOP were 73% vs. 44% (P=0.035) and 75% vs. 64% (P=0.276), respectively. Nine patients with Stage IE or IIE diseases developed disease progression during their planned treatment and died within 10 months after the initiation of treatment; Six patients who achieved complete response (CR) after planned chemoradiation developed systemic recurrence and died at 13-48 months despite salvage treatment; one patient died of Hemophagocytic Syndrome during radiotherapy after achieving CR from chemotherapy. Three patients with Stage III or IV disease died during chemotherapy or during salvage treatment at 2, 4, and 19 months, respectively. Among the 59 patients who received chemotherapy as their initial treatment, 29, 6, 12, and 12 patients had complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) respectively after chemotherapy. The 2-year overall survival rates for these four groups of patients were 100%, 75%, 60%, and 17%, respectively (P<0.0001). Multivariate analysis revealed that International Prognostic Index (IPI) for Lymphoma, perforation of nasal septum as a presenting symptom, "B" symptoms, ECOG performance, as well as response after chemotherapy, were significant independent prognostic factors for this group of patients. The extent of response after induction chemotherapy is significantly related to the treatment outcome of patients with nasal NK/T-cell lymphoma. CHOP based chemotherapy combined with oral nitrosourea followed by involved field radiotherapy may provide improved treatment results compared to conventional CHOP chemotherapy and radiation. This strategy needs to be optimized and tested in a prospective trial for its efficacy.     

以左旋门冬酰胺酶为基础的方案治疗结外鼻型NK/T细胞淋巴瘤36例

 【摘要】 目的 观察以左旋门冬酰胺酶（L-ASP）为基础的方案治疗结外鼻型NK／T细胞淋巴瘤（ENKTL）的近期疗效、远期生存和不良反应。 方法 2008年2月至2011年9月,采用以L-ASP为基础的方案治疗ENKTL 36例。20例Ⅰ、Ⅱ期患者采用VLD方案联合放化疗,16例III、IV期患者行改良SMILE方案化疗,其中4例化疗后接受序贯受累野放疗。 结果 36例患者中35例可评价疗效,完全缓解（CR）率为54.3 %（19／35）,总有效率为68.6 %（24／35）。中位随访13.5个月（3～31个月）,全部患者1年总生存率为82 %,1年无疾病进展生存率为65 %。近期疗效评价有效的患者1年生存率（93 %）和无疾病进展生存率（80 %）均优于对治疗无应答的患者（35 %、33 %）,差异有统计学意义（χ2＝13.909,P ＝ 0.000; χ2＝8.216,P＝ 0.004）。主要不良反应为骨髓抑制,无化疗相关性死亡。 结论 以L-ASP为基础的方案治疗ENKTL显示了较好的疗效,且耐受性好。L-ASP用于一线治疗ENKTL的大型前瞻性临床试验值得开展和深入研究。     

Fluorouracil, doxorubicin, and streptozocin in the treatment of patients with locally advanced and metastatic pancreatic endocrine carcinomas.

PURPOSE: The role of systemic chemotherapy in the management of pancreatic endocrine carcinoma (islet cell carcinoma; PEC) is an area of considerable controversy. Response rates ranging from 6% to 69% have been reported for streptozocin-based chemotherapy. We retrospectively studied 84 patients with locally advanced or metastatic PEC who had been treated with fluorouracil, doxorubicin, and streptozocin (FAS) to determine the objective response rate, duration of progression-free survival (PFS), and duration of overall survival (OS). PATIENTS AND METHODS: Eligible patients had histologic or cytologic confirmation of their tumor and measurable disease on computed tomography or magnetic resonance imaging scans. Response to treatment was evaluated in this study using the new international criteria proposed by the Response Evaluation Criteria in Solid Tumors Committee. RESULTS: Sixty-one of the patients were male and 23 were female, with a median age of 54 years (range, 24 to 78 years). The response rate (RR) to FAS was 39%, with a median response duration of 9.3 months. The 2-year PFS rate was 41%, and the 2-year OS rate was 74%. The extent of liver metastatic disease correlated with a worse PFS (P = .01 by log-rank test) and a worse OS (P < .0001 by log-rank test). Analyses showed that metastatic replacement of more than 75% of the liver and prior chemotherapy were independently associated with inferior PFS. CONCLUSION: Patients with locally advanced or metastatic PEC who are treated with FAS may have a reasonable RR, and responders may experience longer PFS and OS. The volume of metastases in the liver is the most important predictor of outcome.     

Intensive chemotherapy with whole blood stem-cell support and concurrent chest radiotherapy in small cell lung cancer: a phase I/II trial

Intensive chemotherapy combined with chest radiation may ameliorate survival in small cell lung cancer (SCLC). In a prospective study, we treated 18 patients with limited SCLC with an intensive sequential single agent (ifosfamide, carboplatin, etoposide and paclitaxel, (ICE-T)) chemotherapy with the support of unprocessed stem-cell enriched whole blood and G-CSF and concomitant bi-fractionated chest radiotherapy (60 Gy). The treatment was delivered in a short time of 10 weeks. The results were compared with an historical patient group treated with six cycles of standard chemotherapy of etoposide and cisplatin and concomitant chest radiotherapy. After a 3-year median follow up, the 2-year progression free (PFS) and overall survival (OS) are 54 and 63% in the ICE-T group, respectively. In the control group, median PFS and OS were 13 and 17 months and the 2-year PFS and OS were 32% (P=0.20) and 47% (P=0.25), respectively. This short and intensive chemo-radiotherapy regimen is well tolerated and induces promising survival results. The use of stem cell enriched whole blood should be investigated in larger randomized studies.     

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.     

31例血管免疫母T细胞淋巴瘤临床分析

  目的   探讨血管免疫母T细胞淋巴瘤（AITL）的发病情况、临床特点、诊断及治疗。   方法   回顾性分析哈尔滨医科大学附属肿瘤医院1995年1月至2008年1月哈尔滨医科大学附属肿瘤医院收治的31例AITL患者的临床及随访资料,分析其发病情况、临床特征、诊断及不同治疗方案对有效率的影响。   结果   31例完全缓解率（CR）为54.8%,部分缓解率为（PR）16.1%,总有效率为（70.9%）,中位生存时间27.3个月,5年总生存率为35%,CHOP（CTX VCR ADM PDN）组和COP（CTX VCR PDN）组有效率分别为76.5%和75%,无显著差异（P > 0.05）。   结论   AITL临床表现多样且无特异性,其首发部位广泛,化疗对本病有效率较高。COP化疗方案与CHOP疗效相似且不良反应小,值得推荐。      

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。     

CHOP or THP‐COP regimens in the treatment of newly diagnosed peripheral T‐cell lymphoma,not otherwise specified: a comparison of doxorubicin and pirarubicin

The CHOP regimen consisting of cyclophosphamide, doxorubicin (DOX), vincristine and prednisolone has been the most used regimen for peripheral T‐cell lymphoma, not otherwise specified (PTCL‐NOS). Pirarubicin [tetrahydropyranyladriamycin (THP)], a derivative of DOX, is an anthracycline with reportedly less cardiotoxicity than DOX. Here, we confirmed the efficacy of THP‐COP using THP instead of DOX in the treatment of PTCL‐NOS. The study protocol employed a retrospective, consecutive entry design. We retrospectively analysed 56 patients with PTCL‐NOS who had received THP‐COP or CHOP. These regimens were performed every 21 days. Twenty‐nine patients received THP‐COP, and 27 received CHOP. There were no significant differences in known prognostic factors, including in the International Prognostic Index (IPI) and the prognostic index for T‐cell lymphoma (PIT), between the two groups. Complete remission rates in patients with THP‐COP and CHOP were 52% in both groups; the 3‐year overall survival (OS) rates were 67% and 52% (p = 0.074), and the 3‐year progression‐free survival (PFS) rates were 51% and 29% (p = 0.070), respectively. In patients with low IPI (low or low‐intermediate), THP‐COP had significantly better 3‐year OS (100% vs. 64%; p < 0.001) and 3‐year PFS (75% vs. 33%; p < 0.05) than CHOP. Similar differences between THP‐COP and CHOP were observed in patients with a low PIT (groups 1 or 2). Our study showed that THP‐COP produced results equivalent to CHOP regarding efficacy and safety in patients with PTCL‐NOS. In patients with low IPI or PIT, THP‐COP resulted in significantly better prognosis. Copyright © 2015 John Wiley & Sons, Ltd.     

Effects of microvascular density on primary pulmonary non-Hodgkin’s lymphoma (PPL)

This study aims to analyze 30 cases of primary pulmonary lymphoma (PPL) including treatment as well as follow-up information during the past 10?years and to investigate the correlation between microvessel density (MVD) and survival in patients with PPL. We reviewed all patients from October 2000 to October 2010. Patient demographics such as survival, recurrence, time to follow-up, and treatment mode were recorded. We also assessed MVD in the pretreated pulmonary lymphoma tissues of 30 previously untreated patients using ??-CD34 immunohistochemical staining. The median age of the 30 patients was 46.9?years. With a median follow-up of 4.3?years (range, 2 to 10?years), the 5-year overall survival (OS) rate was 57?% and progression-free survival (PFS) was 44?%. High MVD, elevated serum lactate dehydrogenase (LDH), and B symptoms was significantly correlated with clinical features and shorter PFS (P _MVD?=?0.021, P _LDH?=?0.023, and P _{B symptoms}?=?0.005) and OS (P _MVD?=?0.028, P _LDH?=?0.032, and P _{B symptoms}?=?0.001). Application of surgical treatment improved the PFS (P?=?0.024) and OS (P?=?0.028) of patients with stage IE disease (patients who were nodal negative). The patient??s stage predicted the outcome and guides the use of treatments. Patients with high MVD measured in the microenvironment had worse PFS/OS than those with low MVD expression. Patients who had B symptoms or elevated serum LDH had poor prognosis. Patients with lymph node involvement (stage IIE or greater) had poor prognosis.     

307例Ⅱ—Ⅲ期食管癌同期放化疗预后分析

目的 分析食管癌同期放化疗的疗效和影响因素。方法 2006—2014年间接受3DRT食管癌患者 307例,其中Ⅱ期 73例、Ⅲ期 234例。中位放疗剂量60 Gy,同期化疗方案为PF (166例)、TP (82例)、单药P (59例)。采用Kaplan-Meier法计算OS、PFS率并Logrank法检验和单因素预后分析,Cox模型多因素预后分析。结果 3、5年样本量分别为130、45例,1、3、5年OS和PFS率分别为85.6%、53.8%、36.9%和74.6%、43.7%、33.1%,中位OS、PFS期分别为41.6、29.8个月。单因素分析显示影响OS和PFS因素为T分期、N分期、临床分期、病变部位、病变长度和化疗方案(P=0.007和0.013、0.000和0.000、0.000和0.000、0.002和0.000、0.141和0.005、0.018和0.165)。多因素分析显示T分期、N分期、病变部位、化疗方案是影响OS因素(P=0.024、0.000、0.007、0.028),病变部位、病变长度、N分期是影响PFS因素(P=0.004、0.033、0.035)。放疗剂量 50~60、>60~70 Gy的中位OS期和PFS期分别为47.4、37.8个月(P=0.469)和34.1、25.1个月(P=0.233)。结论 Ⅱ—Ⅲ期食管癌同期放化疗可获得较好的生存,联合用药优于单药,低剂量与高剂量放疗疗效相近,不良反应可耐受。     

贝伐珠单抗联合FOLFOX或FOLFIRI方案治疗转移性结直肠癌的临床研究

目的 观察贝伐珠单抗联合FOLFOX或FOLFIRI方案用于转移性结直肠癌一线及二线治疗的临床疗效和毒副反应。方法 回顾性分析2005年11月至2012年8月接受贝伐珠单抗联合FOLFOX或FOLFIRI方案作为一线及二线治疗的57例转移性结直肠癌患者的临床资料。采用RECIST 1.1版评价疗效,用NCI-CTC 3.0版评价不良反应,用Kaplan-Meier法进行生存分析。结果 57例结直肠癌患者中,19例（33.3％）获PR,28例（49.2％）获SD,有效率（RR）为33.3％,疾病控制率（DCR）为82.5％。贝伐珠单抗联合化疗用于一线与二线治疗患者的RR或DCR差异均无统计学意义（P＞0.05）;贝伐珠单抗联合FOLFOX方案与FOLFIRI方案的RR或DCR差异均无统计学意义（P＞0.05）。57例患者的无进展生存期（PFS）及总生存期（OS）分别为8.83个月及14.80个月。一线与二线治疗及贝伐珠单抗联合FOLFOX方案与FOLFIRI方案的中位PFS或OS差异均无统计学意义（P＞0.05）。主要不良反应包括白细胞减少、血小板减少及恶心呕吐。贝伐珠单抗相关的不良反应主要包括高血压3例,蛋白尿1例,鼻衄2例,均为1～2级,药物可以控制。结论 贝伐珠单抗联合化疗治疗转移性结直肠癌能够提高治疗疗效,不良反应可以耐受。     

硼替佐米联合CHOP方案治疗血管免疫母细胞性T细胞淋巴瘤14例

目的 探讨硼替佐米联合CHOP方案治疗血管免疫母细胞性T细胞淋巴瘤(AITL)的有效性及安全性.方法 14例AITL患者应用硼替佐米(2mg/m2第1天)联合CHOP方案治疗,每21 d为1个疗程,对疗效、安全性及生存情况进行分析.结果 14例患者中初治12例,难治2例.12例患者治疗有效,其中完全缓解6例,部分缓解6例.14例患者3年预计生存率为55％,中位无进展生存时间9.4个月,3年预计无进展生存率为38％.Ⅲ～Ⅳ级中性粒细胞减少(6例)为最常见的血液学毒性;非血液学毒性均为Ⅰ～Ⅱ级,主要包括周围神经毒性(8例),恶心、呕吐(6例),腹泻(4例),感染(4例).结论 硼替佐米联合CHOP方案治疗AITL可在不增加治疗相关不良反应的同时,提高治疗缓解率,改善预后,可用于AITL的诱导及挽救治疗.     

Microvessel Density and Status of p53 Protein as Potential Prognostic Factors for Adjuvant Anthracycline Chemotherapy in Retrospective Analysis of Early Breast Cancer Patients Group

A considerable subgroup of patients with early breast cancer does not address benefits of anthracycline based chemotherapy. The aim of this retrospective study was to investigate the effect of microvessel density (MVD) and status of p53 protein on 5-year disease free survival (DFS) in the group of breast cancer patients treated with anthracyclines in adjuvant setting. Correlations between MVD, p53 status and other clinicopathological parameters were also assessed. MVD and p53 status were analyzed immunohistochemically in the group of 172 women with breast cancer in clinical stage T1-2, N1-N2, M0. There were 123 tumors (71.5?%) with lower MVD (≤214.8 microvesells/mm(2)) and 49 (28.5?%) with higher MVD (>214.8 microvesells/mm(2)). The proportion of higher MVD tumors significantly increased in N2 (P?=?0.000) and in estrogen (P?=?0.046) or progesterone receptors (P?=?0.029) negative tumors. p53 positivity was indicated in 50 cancers (29.1?%) and was significantly associated with higher grade (P?=?0.000), steroid receptors negativity (P?=?0.000), cytokeratin5/6 positivity (P?=?0.026), topoisomerase IIα overexpression (P?=?0.005) and higher proliferation rate (P?=?0.001). In univariate analysis, higher MVD (P?=?0.016) and p53 negativity (P?=?0.023) were significantly related with longer DFS (median follow-up 36?months). In multivariate Cox regression analysis MVD was independently associated with DFS. These data suggest that higher MVD is favourable prognostic factors for early advanced breast cancer patients after adjuvant anthracycline based chemotherapy.     

白蛋白结合型紫杉醇对比紫杉醇二线治疗晚期肺鳞癌回顾性分析

目的:回顾性分析白蛋白结合型紫杉醇(Nab-PTX)对比紫杉醇(PTX)作为二线化疗方案对晚期肺鳞癌的疗效及安全性。方法:选取于2016年03月至2018年06月在我院行二线单药化疗的肺鳞癌患者（方案为:Nab-PTX或PTX）的资料,根据其治疗情况分为Nab-PTX组和PTX组。分析符合入组条件患者的临床特征,比较两组患者的近期疗效、生存情况及毒副反应。结果:共有52例患者符合入组条件（每组各26例）,两组患者的临床特征比较差异无统计学意义。Nab-PTX组RR为38.5%,PTX组为34.6%,两组比较差异无统计学意义(P＞0.05);Nab-PTX组DCR为73.1%,PTX组为57.7%,两组比较差异具有统计学意义(P＜0.05)。Nab-PTX组患者中位PFS为6个月、中位OS为11个月;PTX组患者中位PFS为4.5个月、中位OS为8个月。两组的PFS及OS比较,差异均有统计学意义(P＜0.05)。血液毒性主要是白细胞减少、中性粒细胞减少和贫血,Nab-PTX组与PTX组在Ⅲ-Ⅳ级白细胞减少（23.1% vs 46.2%）和贫血（11.5% vs 26.9%）方面比较,差异具有统计学意义(P＜0.05);Ⅲ-Ⅳ级非血液学毒副反应分别为:疲劳(7.7% vs 11.5%)、周围神经病变(3.8% vs 15.4%)、肌痛/关节痛(7.7% vs 15.4%),差异均无统计学意义(P＞0.05)。结论:Nab-PTX较PTX更是一种治疗晚期肺鳞癌患者有效且耐受性良好的二线治疗方案。     

基于GELOX方案诱导化疗的Ⅰ—Ⅱ期结外鼻型K/T细胞淋巴瘤根治性放疗的预后分析

目的 探讨早期结外鼻型NK/T细胞淋巴瘤(ENKTL)接受GELOX (吉西他滨、奥沙利铂、左旋门冬酰胺酶)方案化疗和放疗疗效及影响因素。方法 回顾分析2007—2013年间收治的74例Ⅰ_E—Ⅱ_E期ENKTL患者,根据化疗方案及有无放疗分为3个组,A组47例为首选GELOX化疗后根治性放疗,B组10例为其他方案化疗改用GELOX挽救后放疗,C组17例为接受GELOX方案化疗后未放疗。全组化疗中位3周期,放疗中位剂量54.6 Gy分20~30次。结果 全组化疗后CR率33.8%(其中放疗后为90%),2年OS和PFS分别为88%和79%。A+C组的疗后CR率、2年OS和PFS分别为73%、92%和84%。A组的2年OS和PFS (96%和84%)均高于B组(50%和45%)和C组(47%和40%,P均<0.05)。单因素分析显示疗前LDH水平升高和化疗后无缓解是OS和PFS的不良预后因素,局部广泛侵犯也是OS的不良预后因素;多因素分析显示化疗后无缓解是OS及PFS的不良预后因素。结论 早期ENKTL患者接受GELOX诱导化疗结合根治性放疗可获得良好疗效,但该方案用于单纯化疗和挽救化疗的疗效仍不理想。     

晚期十二指肠癌肝转移一线化疗方案的临床观察

目的:探讨晚期十二指肠癌肝转移患者一线化疗方案的疗效和安全性。方法:回顾分析本院2008年6月至2016年1月收治的晚期十二指肠癌肝转移患者23例,6例未化疗,17例化疗,其中GEMOX方案8例、FOLFOX方案9例。采用Log-rank法进行生存分析。采用RECIST 1.1版与NCI-CTC 4.0版标准评价近期疗效和不良反应。结果:17例化疗患者均可评价疗效和不良反应,共完成化疗83个周期,中位化疗4个周期(2~12个周期)。GEMOX组获PR 1例、SD 5例、PD 2例,DCR为75.0%。FOLFOX组获SD 5例、PD 4例,DCR为55.6%。两组均无CR病例。23例肝转移患者的中位OS为9.8个月。17例化疗患者的中位OS为13.2个月,6例未化疗患者的中位OS为4.4个月,差异有统计学意义(P=0.032)。GEMOX组的中位OS为13.2个月,FOLFOX组的中位OS为10.3个月,差异无统计学意义(P=0.816)。GEMOX组的中位PFS为4.9个月,FOLFOX组的中位PFS为2.5个月,差异无统计学意义(P=0.468)。常见不良反应多为1-2级,主要为白细胞减少、中性粒细胞减少、贫血、乏力及恶心等。结论:肝转移影响晚期十二指肠癌患者的预后。化疗可延长晚期十二指肠癌肝转移患者的生存。GEMOX方案和FOLFOX方案均对晚期十二指肠癌肝转移一线治疗有效,且耐受性良好。GEMOX方案可能有更好的生存获益。