恶性肿瘤并发急性下肢深静脉血栓形成的疗效分析

目的探讨溶栓、抗凝等常规疗法对恶性肿瘤并发的急性下肢深静脉血栓形成（DVT）的疗效。方法34例恶性肿瘤并发的DVT患者为观察组,选择34例创伤或手术后并发的DVT患者为对照组,两组均给予溶栓、抗凝等常规治疗,比较两组下肢深静脉再通情况和疗效。结果观察组下肢深静脉再通率、有效率均低于对照组（P〈0．05）。结论常规疗法对恶性肿瘤并发的急性下肢深静脉血栓形成的疗效较差。     

C反应蛋白与恶性肿瘤并发急性下肢深静脉血栓形成及预后的关系

 目的 探讨血清C反应蛋白(CRP)对恶性肿瘤并发急性下肢深静脉血栓（DVT）形成及疗效的影响。方法 34例恶性肿瘤并发的下肢DVT患者为观察组,选择34例创伤或手术后并发的下肢DVT患者为病例对照组,再选择34例健康者为正常对照组。观察组和病例对照组均给予溶栓、抗凝等常规治疗。检测观察组和病例对照组治疗前、治疗14 d血清CRP浓度和正常对照组CRP浓度,比较观察组和病例对照组治疗后下肢深静脉再通情况和疗效。结果 治疗前观察组血清CRP浓度为（47.72±29.88）mg/L,显著高于病例对照组和正常对照组[（30.04±15.84）mg/L、(6.19±2.99）mg/L],(F = 38.444,P < 0.01）;治疗14 d后观察组和病例对照组CRP浓度均显著下降[(32.77±19.68)mg/L、(7.76±7.52)mg/L],(P < 0.05）,但观察组CRP浓度仍显著高于病例对照组和正常对照组(F = 50.087,P < 0.01）,而病例对照组与正常对照组血清CRP浓度差异无统计学意义(F = 1.277,P = 0.263）;治疗后观察组肢体再通缓慢,显著低于病例对照组（ⅹ2 = 7.731a,P = 0.021）;治疗后观察组有效率显著低于病例对照组（ⅹ2 = 6.969a,P = 0.031）。结论 CRP在恶性肿瘤并发的下肢DVT发生、发展、疗效中起重要作用。     

阿加曲班对恶性肿瘤合并急性下肢深静脉血栓患者C反应蛋白及疗效的影响

目的 探讨阿加曲班对恶性肿瘤合并急性下肢深静脉血栓(DVT)患者血清C反应蛋白(CRP)及疗效的影响.方法 56例恶性肿瘤合并急性下肢DVT患者按随机数字表法分为观察组和对照组各28例,观察组给予阿加曲班抗凝治疗,对照组给予尿激酶溶栓、华法林抗凝等治疗.检测观察组和对照组在治疗前、治疗14 d血清CRP浓度,比较观察组和对照组治疗后下肢深静脉再通情况和疗效.结果 治疗前观察组与对照组血清CRP浓度分别为(46.44±28.82) mg/L、(45.96±29.40) mg/L,差异无统计学意义(F=0.004,P=0.951).治疗14d后观察组和对照组CRP浓度均下降,分别为(16.97±10.22) mg/L、(31.63±18.07)mg/L,与治疗前比较差异均有统计学意义(F=25.996,P＜ 0.05;F=4.828,P＜ 0.05),且治疗后观察组CRP浓度低于对照组(F=13.965,P＜ 0.01).治疗后观察组血管再通率(96.43％,27/28)高于对照组(67.86％,19/28)(x 2=8.204,P=0.017),治疗后观察组总有效率(96.43％,27/28)也高于对照组(75.00 ％,21/28)(x2=6.205,P=0.045).结论 阿加曲班可降低恶性肿瘤合并急性下肢DVT患者血清CRP浓度,提高疗效.     

妇科肿瘤术后并发下肢深静脉血栓21例分析

回顾性分析1984年1月至1999年12月间妇科肿瘤术后并发下肢深静脉血栓（DVT）21例患者的临床特点,诊断及治疗。认炽老年妇女,肥胖,经腹手术,手术时间长,术前及术中输血,术后应用止血药,妇科恶性肿瘤是DVT的高危因素,抗凝,祛聚,溶栓治疗对DVT有较好疗效。     

恶性肿瘤血栓形成的诊断和治疗(附31例)

目的：探讨恶性肿瘤患者静脉血栓形成的原因及治疗方法。方法：回顾分析31例恶性肿瘤患者并发静脉血栓形成的临床资料，结合文献进行分析。结果：恶性肿瘤患者并发静脉血栓以累及下肢深静脉多见，腺癌患者多见。化疗、手术、以及长时间大剂量使用止血药物可诱发血栓形成。及时抗凝、溶栓治疗疗效较好。本组31例中疗效好、有效分别为8例（25．0％）、11例（34．4％）。结论：恶性肿瘤患者，尤其是腺癌患者易并发血栓形成，可危及生命。一旦明确诊断要立即进行抗凝、溶栓治疗，可降低致残率、延长患者的生命及降低死亡率。     

恶性肿瘤合并血栓栓塞性疾病22例临床分析

[目的]探讨恶性肿瘤合并血栓栓塞性疾病的特点。[方法]回顾性分析22例经病理学证实的恶性肿瘤合并血栓栓塞性疾病患者的临床资料。[结果]22例恶性肿瘤合并血栓栓塞性疾病中,并发颈内静脉血栓形成4例,单纯下肢深静脉血栓形成（DVT）10例,单纯肺血栓栓塞（PTE）3例,DVT合并PTE5例。5例合并PTE患者中3例有较典型的临床症状,多有低氧血症、血D-二聚体明显升高。心电图仅1例有典型SIQIIITIII表现。[结论]恶性肿瘤并发血栓栓塞性疾病临床常见,对手术、化疗、放疗、PICC置管或疾病进展可能导致血液高凝状态患者应及早进行抗凝治疗,预防血栓栓塞性疾病的发生。     

恶性肿瘤伴发下肢深静脉血栓形成的机制及治疗对策探讨

 目的　探讨恶性肿瘤伴发下肢深静脉血栓形成的机制及其治疗对策。方法　对 2 5例恶性肿瘤伴发下肢深静脉血栓形成的患者与随机选取的 2 5例健康成人进行血液流变学比较 ,并对此类患者的治疗过程进行回顾分析。结果　恶性肿瘤组的 ηb、ηp、Fib、HCT、ESR等五项指标均高于对照组 ,具有显著的统计学差异 (P <0 .0 1或 0 .0 5 ) ;在近期疗效上 ,经抗凝、溶栓、祛聚集治疗 3天后 ,病情好转率为 6 0 %。病情加重或无变化的患者 ,立即给予化疗 ,病情得到明显改善者占 90 %。结论　恶性肿瘤患者存在血液流变学变化 ,所导致的高凝状态易诱发下肢深静脉血栓的形成 ;在通过常规溶栓、抗凝、祛聚集等治疗无明显效果时 ,应考虑有癌栓的可能 ,应果断给予化疗。     

35例妇科盆腔手术后下肢深静脉血栓临床分析

[目的]探讨妇科盆腔手术后并发下肢深静脉血栓（LDVT）的病因、诊治方法及预防措施。[方法]回顾分析妇科盆腔手术后发生LDVT的35例患者的临床特点及诊断、治疗的方法。[结果]临床诊断LDVT的首选方法为血管多普勒超声（82.86%）。全部病例确诊后即进行抬高患肢,给予抗凝、溶栓、祛聚等综合治疗及手术治疗,症状均明显改善,无肺栓塞发生。[结论]老年、手术时间长、特别是妇科恶性肿瘤患者是LDVT形成的高危人群;术前纠正贫血、术中操作精细、术后鼓励患者早期下床活动是预防深静脉血栓形成的主要方法;早期诊断、及时进行抗凝治疗能有效地降低LDVT的发病率。     

盆腔恶性肿瘤并发急性下肢深静脉血栓形成的腔内介入治疗（附32例）

目的:探讨盆腔恶性肿瘤并发急性下肢深静脉血栓形成（DVT）原因及腔内治疗经验。方法:对2009年1月至2015年3月收治经导管接触性溶栓（CDT）及球囊扩张（PTA）或联合支架植入（髂静脉狭窄≥50%时）治疗32例盆腔恶性肿瘤并发急性下肢DVT患者临床资料进行回顾性分析。结果:32例患者CDT前均置入腔静脉滤器（VCF）,溶栓时间为（5.3±2.6） d,尿激酶用量（320±130）万U,溶栓后下肢深静脉平均通畅率为（83.7±16.9）%,溶栓期间仅3例出现轻度出血,调整用药后消失。13例髂静脉狭窄≥50%行支架植入治疗,共植入支架17枚;11例髂静脉狭窄在30%～49%之间仅行PTA;8例髂静脉狭窄＜30%未行球囊扩张及支架植入。治疗期间无症状性肺栓塞（PE）发生。30例患者获得随访,随访（13.6±5.4）个月,6例下肢深静脉血栓复发,其中1 例支架内血栓复发,4例血栓复发原髂静脉狭窄在30%～49%之间,1例血栓复发原髂静脉狭窄＜30%。均再次CDT联合PTA及支架植入治疗成功。结论:盆腔恶性肿瘤及放疗是发生急性下肢DVT、血栓复发的危险因素,血管腔内介入治疗是积极有效的治疗方法;当髂静脉狭窄超过30%时,我们建议支架植入治疗。     

低分子肝素预防直肠癌根治术后下肢深静脉血栓形成的研究

 目的　对比观察采用低分子肝素预防直肠癌术后下肢深静脉血栓形成 (DVT)的临床效果。方法　将 1999年 10月～ 2 0 0 2年 12月施行直肠癌根治术的患者随机分为对照组和用药组。对照组 37例未预防性使用低分子肝素抗凝 ,用药组共 33例围手术期给予低分子肝素 ,两组患者均于术后行下肢静脉彩色超声检查。结果　用药组DVT发生率为 9.1% ,对照组DVT发生率为 2 7.0 % ,两组相比差异有显著性意义 (P <0 .0 1)。用药组未发现术中及术后出血增多等现象和不良反应。结论　低分子肝素可显著降低直肠癌根治术后下肢深静脉血栓的发生率 ,且具有良好的安全性。     

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.