手术为主治疗卵巢上皮癌156例临床分析

目的探讨手术治疗对上皮性卵巢癌预后的影响.方法回顾性分析近10年来收治的有完整统计资料的上皮性卵巢癌156例患者的临床资料.结果随访至2002年12月,5年生存率为57.5%(46/80),3年生存率为75.5%(80/106);残余病灶＜2 cm者3年和5年生存率分别为50.0%和34.6%,残余病灶＞2 cm者分别为20.0%和0;在无手术残余灶的基础上不同术式之间3年和5年生存率相近.结论手术后有无残余病灶及残余灶大小是影响卵巢癌患者预后的主要因素,而手术方式的选择、腹膜后淋巴结清除对预后影响不显著;复发性晚期卵巢癌治疗应选择以二线化疗药物为基础的联合化疗.     

上皮性卵巢癌患者手术及化疗前后血清中人附睾蛋白4和糖类抗原125的变化

目的探讨上皮性卵巢癌患者手术及化疗前后血清中人附睾蛋白4(HE4)和糖类抗原125(CA125)的变化。方法选取2012年3月至2013年3月间收治的50例上皮性卵巢癌患者,采用酶联免疫吸附试验(ELISA)检测50例上皮性卵巢癌患者(研究组)手术及化疗前后、正常健康人群(健康组)及卵巢良性肿瘤患者(对照组)血清中HE4和CA125水平,探讨其在疾病预后的的价值。结果对照组患者CA125和HE4水平显著高于健康组,差异有统计学意义(P<0.05)。研究组患者术前CA125和HE4水平明显高于对照组和健康组,其中化疗3个疗程后血清CA125水平降至正常水平,化疗2个疗程后血清HE4水平降至正常水平。CA125阴转符合率为41.5%,HE4阴转符合率为75.6%,CA125+HE4联合检测阴转符合率则增至85.4%;联合检测阳转符合率高达100%。结论血清CA125和HE4联合检测对卵巢癌预后判断有重要指导意义,可作为卵巢癌病情检测指标之一。     

影响上皮性卵巢癌复发患者预后相关临床病理因素分析

目的分析影响上皮性卵巢癌(epithelial ovarian cancer,EOC)复发患者预后的相关临床病理因素。方法采用Kaplan-meier生存率曲线,Log rank检验和Cox模型多因素回归分析法对92例临床病理及随访资料完整的复发癌患者进行影响其预后的相关因素分析。结果(1)92例复发上皮性卵巢癌临床病例的总体中位生存时间是18月(95%CI:16.052~19.948);(2) Kaplan-Meier单因素分析提示,FIGO分期、复发距离末次化疗时间、复发部位、最大复发病灶、复发后伴有腹水、CA125升高、复发后二次肿瘤细胞减灭术、再次治疗化疗方案是影响复发EOC患者的重要预后因素(P<0.1)。而年龄、肿瘤细胞分级、初次治疗方案与预后无关(P>0.1);(3)Cox回归分析结果显独示,复发后再次治疗化疗方案、最大复发病灶大小、复发部位是影响患者预后的独立危险因素。结论 多个临床病理因素影响复发上皮性卵巢癌预后,其中复发后再次治疗化疗方案、最大复发病灶大小、复发部位是影响患者预后的独立危险因素。     

复发上皮性卵巢癌的综合治疗和预后因素

目的研究分析上皮性卵巢癌复发影响因素及其综合治疗,以期提高复发性卵巢癌的生存率.方法研究组为1998年1月-2000年12月收治的60例复发性卵巢上皮癌.研究组在二次细胞减灭术后,铂类敏感者选用TP方案(紫杉醇+顺铂)或CC方案(卡铂+环磷酰胺).铂类耐药者采用TM方案(紫杉醇+丝裂霉素)或VM方案(依托泊苷+丝裂霉素).获得缓解后采用原方案2/3剂量维持治疗,平均4-6次化疗.对盆腔有残存肿瘤病例进行盆腔大野外放射治疗.在化放疗期间穿插选用干扰素、白介素-2.将1986年1月-1997年12月收治的167例复发性卵巢上皮癌作为对照组,进行回顾性研究分析.对照组复发后采用以CAP为主的化疗配合中医中药治疗.结果研究组CR为43.33%、PR为45.00%,均高于对照组的2.99%、7.78%(P=0.000);研究组一年、二年、三年生存率为89.38%、79.69%、71.25%分别高于对照组的64.58%、40.39%、31.20%(P＜0.01);多因素分析结果显示,初次治疗因素中,首次细胞减灭术后残癌≥1cm、透明细胞癌患者预后较差,接受静脉化疗者预后较好.复发治疗因素中,术后接受放疗或二线化疗者预后较好.结论通过二次细胞减灭术、二线化疗、放疗及免疫治疗可提高疗效、延长生存期.和预后有关的因素有首次细胞减灭术后残癌大小、病理类型、静脉化疗,复发术后接受放疗或二线化疗.     

新辅助化疗联合中间性肿瘤细胞减灭术治疗晚期上皮性卵巢癌的疗效及对HE4、VEGF、CA125水平的影响

目的 探讨新辅助化疗联合中间性肿瘤细胞减灭术治疗晚期上皮性卵巢癌的疗效及其对血清人附睾蛋白4(HE4)、血管内皮细胞生长因子(VEGF)、糖类抗原125(CA125)水平的影响.方法 回顾性分析68例晚期上皮性卵巢癌患者的病历资料,根据治疗方法不同将患者分为联合组与对照组,每组34例.联合组患者采用新辅助化疗联合中间性肿瘤细胞减灭术治疗,对照组患者仅接受卵巢肿瘤细胞减灭术治疗.观察并比较两组患者的近期疗效,手术相关指标,血清HE4、VEGF、CA125水平及预后情况.结果 联合组患者的治疗总有效率为79.4%,高于对照组的52.9%(P﹤0.05);联合组患者的手术时间明显短于对照组(P﹤0.01);联合组患者的术中失血量、腹腔积液量均明显低于对照组(P﹤0.01);治疗后,联合组患者的血清HE4、VEGF、CA125水平均明显低于对照组(P﹤0.01);治疗后,两组患者的1年、2年、3年生存率比较,差异均无统计学意义(P﹥0.05).联合组和对照组患者的中位生存时间分别为32.0个月(95%CI:25.3~35.6)和28.0个月(95%CI:22.1~33.9),两组患者的生存情况比较,差异无统计学意义(χ2=1.96,P﹥0.05).结论 新辅助化疗联合中间性肿瘤细胞减灭术治疗晚期上皮性卵巢癌可以缩短手术时间,减少术中出血量,降低血清肿瘤相关标志物水平,但该方法对改善患者的远期生存意义不大.     

miR-506和FGF2在上皮性卵巢癌中的表达及临床意义

目的:检测上皮性卵巢癌组织微小RNA-506（miR-506）和成纤维细胞生长因子2（FGF2）表达情况,并探究其临床意义。方法:选取2011年3月至2012年12月本院收治的上皮性卵巢癌患者56例,选择同期因子宫良性病变在平煤神马医疗集团总医院接受全子宫双附件切除的患者56例（对照组）;采用实时定量PCR（qRT-PCR）法检测miR-506表达水平,采用免疫组化法检测FGF2表达水平,采用全自动化学发光免疫分析仪检测血清糖类抗原125（CA125）水平。结果:上皮性卵巢癌组织miR-506表达水平较正常卵巢组织显著降低（P＜0.05）,FGF2表达量显著高于正常卵巢组织（P＜0.05）,FGF2蛋白表达阳性率较正常卵巢组织显著升高;上皮性卵巢癌组织中miR-506、FGF2表达与患者临床分期、有无淋巴结转移、血清CA125水平有关（P＜0.05）,与患者年龄、组织学类型无关（P＞0.05）;miR-506高表达上皮性卵巢癌患者术后5年总生存率显著高于低表达者（P＜0.05）,FGF2高表达上皮性卵巢癌患者术后5年总生存率显著低于低表达患者（P＜0.05）;Pearson检验结果显示,卵巢癌肿瘤组织miR-506与FGF2表达水平负相关。结论:miR-506在上皮性卵巢癌组织中低表达,FGF2高表达,与患者临床分期、淋巴结转移、血清CA125水平有关,可能作为上皮性卵巢癌患者病情监测及预后的生物指标。     

白蛋白结合型紫杉醇治疗复发性上皮性卵巢癌及原发性腹膜癌的回顾性研究

目的 探讨白蛋白结合型紫杉醇（ABX）治疗复发性上皮性卵巢癌及原发性腹膜癌患者的疗效及耐受性。方法 对2010年1月至2012年11月在我院接受ABX为基础化疗方案的31例复发性卵巢癌及1例原发性腹膜癌患者进行回顾性分析。采用GCIG CA125反应评价标准或RECIST标准评估疗效;通过治疗方案的延后、减量及中断情况评估ABX方案的耐受性。结果32例卵巢癌及原发性腹膜癌患者中,铂类敏感者占15.6％（5／32）,铂类耐药／难治者占84.4％（27／32）。 ABX方案治疗前, CA125为（477.5±654.9）U／ml,CA125升高者26例（81.3％）。32例患者接受ABX为基础方案的总反应率为28.0％（9／32）,CA125完全缓解率为15.6％（5／32）。铂类敏感者的反应率为60.0％（3／5）,铂类耐药／难治者的反应率为22.2％（6／27）,两者差异无统计学意义（P＞0.05）。5例患者6个周期的化疗延后＞1周。治疗过程中未记录到剂量减少或治疗中断,亦未记录到ABX超敏反应的发生。结论 ABX为基础的方案在铂类敏感及铂类耐药／难治卵巢癌及原发性腹膜癌患者中均能产生临床疗效。在接受过多线化疗的卵巢癌及原发性腹膜癌患者中,ABX方案的总体耐受性较好。     

晚期上皮性卵巢癌新辅助化疗的疗效分析

目的 探讨新辅助化疗治疗晚期上皮性卵巢癌的临床疗效.方法 回顾性分析2006年5月至2010年3月山西医科大学附属肿瘤医院收治的60例Ⅲ～Ⅳ期上皮性卵巢癌患者,按治疗方法的不同将其分为观察组与对照组各30例,观察组采用新辅助化疗,对照组不采用新辅助化疗.通过观察疗效、残留灶大小、手术时间、术中出血量、血清糖类抗原125(CA125)水平等,评价新辅助化疗在上皮性卵巢癌中的疗效.结果 观察组的总有效率为60.0％,最佳减灭数21例(70.0％),显著高于对照组(x2=5.455,P＜0.05).观察组CA125水平[(165.26±43.27) U/ml∶(339.13±51.86) U/ml,t=14.100,P＜0.05]、手术时间[(127.21 ±27.62) min∶(189.33 ±45.87) min,t=10.113,P＜0.05]、术中平均出血量[(408.50±112.62) ml∶(590.60±162.41)ml,t =5.047,P＜0.05]均低于对照组.观察组的5年生存率为36.7％,显著高于对照组5年生存率(26.7％),差异有统计学意义(x2=8.492,P=0.036).结论 新辅助化疗能够改善晚期上皮性卵巢癌的治疗效果.     

上皮性卵巢癌Ⅲ期的综合治疗及预后分析

目的:探讨细胞减灭术及化疗对Ⅲ期卵巢上皮性癌的治疗效果及影响因素。方法:回顾性分析1997年11月~2002年11月在我院治疗的35例Ⅲ期卵巢上皮性癌的临床治疗,其中术后无残留灶者33例,有残留灶>2cm者2例,术后均采用PCA方案(顺铂、表柔比星、环磷酰胺)或TP方案(顺铂、紫杉醇)行腹腔、静脉联合化疗。结果:Ⅲ期卵巢上皮性癌总的5年生存率为11%。化疗疗程数<4次的1年、3年、5年生存率均显著小于化疗疗程数≥6次者,而复发率均分别高于化疗疗效数≥6次者;TP方案化疗组的1年、3年、5年生存率均显著高于CAP组,复发率显著低于CAP组。结论:经细胞减灭术后,有无肿瘤残留灶、术后化疗疗程数、方案均与预后有关,对复发性卵巢癌再次或多次手术切除孤立病灶对生存期延长有影响。     

血清CA125水平动态变化对卵巢上皮癌疗效的预测价值

目的 探讨血清CA125动态变化对卵巢上皮癌疗效的预测价值.方法 采用微粒子捕捉免疫发光技术(MEIA)测定75例卵巢上皮癌患者治疗前、每疗程化疗后3周、手术前及手术后7～14天血清中CA125浓度.计算CA125半衰期、第一疗程化疗后血清CA125下降率,分析CA125半衰期、第一疗程化疗后血清CA125下降率与近期治疗缓解率、长期生存率的关系.结果 75例患者治疗前CA125大于35 ku/l 72例.半衰期≤15天组完全缓解率高于半衰期>15天组(P=0.000);第一疗程化疗后血清CA125下降率≥50%组完全缓解率高于下降率<50%组(P=0.000);晚期卵巢癌CA125半衰期≤15天组生存率、中位生存时间高于半衰期>15天组(P=0.013);晚期卵巢癌第一疗程化疗后血清CA125下降率≥50%组与<50%组生存率、中位生存时间无显著差异;多因素生存分析表明晚期卵巢癌术后残留灶大小和术后疗程数是独立预后因素.结论 CA125半衰期、第一疗程化疗后血清CA125下降率可作为反映化疗敏感性的临床指标.     

Improving the reproducibility of lateral therapy portal placement.

Lateral therapy treatment portals are vulnerable to significant placement errors when the beam axis position is based on skin marks or measurements from the anterior abdominal wall. Direct measurements from the treatment table top are shown to have an anatomic basis for reliability. An inexpensive simulator accessory is described which greatly simplifies the process of determining distances from the treatment table to structures of interest.     

Results of a Prospective Non-Interventional Post-Authorization Safety Study of Idelalisib in Germany

BackgroundIn pivotal studies, idelalisib demonstrated remarkable efficacy and manageable tolerability in patients with chronic lymphocytic leukemia (CLL) and follicular lymphoma (FL). This prospective, multicenter, non-interventional post-authorization study assessed the characteristics, clinical management, and outcome of CLL and FL patients receiving idelalisib in routine clinical practice in Germany.PatientsObservational study in CLL and FL patients treated with idelalisib between September 2015 and December 2020.ResultsA total of 147 patients with CLL and FL were included with a median age of 75 and 71 years, respectively. More than 80% of patients presented with comorbidity and many CLL patients with documented high-risk genetic features, including del(17p)/TP53 mutation or unmutated IGHV. The median progression-free survival (PFS) and overall survival (OS) were not reached in the CLL cohort irrespective of del(17p)/TP53 or unmutated IGHV. The estimated 6-month PFS and OS rates in CLL were 82% and 92%. The estimated 6-month PFS and OS rates for FL were 32.2% and 77.2%. Overall response rates in the CLL and FL cohorts were 70.4% and 36.4%, with the presence of high-risk genetics having no negative impact. No unexpected adverse events were observed. Most frequently reported adverse drug reactions (ADRs) were diarrhea, nausea, pneumonia, rash, and fatigue.ConclusionThis real-world study shows that idelalisib is an effective therapy for CLL and FL, regardless of age and high-risk genetic features, consistent with results from previous clinical trials. Collected safety data and the pattern of ADRs reflect those from previous studies.     

Biomarkers in Locally Advanced Rectal Cancer: A Review

Locally advanced rectal cancers (LARC) are the subject of a rapidly evolving treatment paradigm. The critical timepoints where management decisions are required during the care of the LARC patient are: prior to the institution of any treatment, post neoadjuvant therapy and post-surgery. This article reviews the clinical, imaging, blood-based, tissue-based, and molecular biomarkers that can assist clinicians at these timepoints in the patient's management, in prognosticating for their LARC patients or in predicting responses to therapy in the multi-modality neoadjuvant treatment era.     

Evaluation of Provider Preferences in First-Line Metastatic Renal Cell Carcinoma: Comparison Between Dual Immunotherapy vs. Immunotherapy/Tyrosine Kinase Inhibitors

IntroductionDual immunotherapy (ipilimumab/nivolumab, IO/IO) and immunotherapy/tyrosine kinase inhibitor (IO/TKI) combinations (e.g. pembrolizumab/axitinib) are approved for the first-line treatment of intermediate/poor risk metastatic renal cell carcinoma (RCC), but there is limited comparative data between these two options. We sought to understand how oncologists decide between IO/IO vs. IO/TKI.MethodsWe sent a 10-question electronic survey centered on a patient scenario of intermediate/poor risk metastatic RCC to 294 academic/disease-focused and general oncologists in the US.ResultsWe received 105 responses (36% response rate): 61% (64) of providers chose IO/IO, 39% (41) chose IO/TKI. 78% (82) of oncologists were academic or disease-focused, 22% (23) were general. Academic/disease-focused oncologists were significantly more likely to choose IO/IO (56/82, 68%) than general oncologists (8/23, 35%), P = .004.Among those who chose IO/IO, the perceived main issue with IO/TKI was: long-term toxicities - 31% (20), short-term toxicities - 28% (18), less effective - 28% (18), less convenient - 8% (5). Among those who chose IO/TKI, the perceived main issue with IO/IO was: short-term toxicities - 43% (17), less effective - 28% (11), long-term toxicities - 15% (6), and risk of death - 10% (4).88% (92) of providers would be comfortable enrolling patients into a phase III trial comparing IO/IO vs. IO/TKI. We found no associations between therapy chosen by a provider and participation as PI in a trial of IO/IO or IO/TKI, or receipt of outside funding from an IO/IO or IO/TKI company.ConclusionIn response to a patient scenario of intermediate/poor risk metastatic RCC, 61% of providers chose IO/IO, 39% chose IO/TKI. There was a significant association between type of practice and choice of therapy, with academic/disease-focused oncologists more likely to choose IO/IO. The majority of oncologists would be comfortable enrolling patients into a phase III trial comparing IO/IO vs. IO/TKI.     

神经母细胞瘤57例临床分析

目的：讨论小儿神经母细胞瘤（NB）诊断、治疗与预后特点。方法：分析1994－1999年间收治小儿NB57例，以骨髓细胞形态学、X线、B超、CT及病理检查确诊。结果：57例男性39例，女性18例，各年龄段均可发病，5岁以下尤甚。临床以不规则发热、贫血、腹痛、腹部肿块为主要表现。NB好发于腹部，其次为后纵隔。确诊后49例予Apec方案化疗，其后手术。结论：骨髓细胞形态学和X线检查是诊断X线检查是诊断NB的较好方法，B超、CT可提高肿瘤检出率。NB经确诊首次化疗效果明显，其后延期手术。血清LDH明显增高化疗敏感性差，提示预后差。     

Reviewing RECIST in the Era of Prolonged and Targeted Therapy

Accurate assessment of disease response is the foundation of therapeutic trails, which is why the Response Evaluation Criteria in Solid Tumors (RECIST) serve as an international standard that investigators can utilize when examining patient outcomes. Nine years after the initial RECIST criteria were released, an update, RECIST 1.1, was published to improve on the initial criteria and address technologic advancements in imaging. Since then, advancements in both standard clinical and trial practices, combined with improvements in our understanding of cancer biology, have resulted in the identification of a number of limitations of the current RECIST 1.1, either in lack of clear guidance with regard to its best application or in potential benefit of capturing imaging-related data beyond standard categorical response details. As several of these situations reflect the consequences of prolonged control of metastatic disease by using targeted therapies, thoracic oncology has generated many of the key scenarios requiring elucidation and/or improvements. This article specifically examines current controversies in the interpretation and/or optimal utilization of RECIST 1.1, focusing on examples from thoracic oncology, and makes proposals, where possible, on how best to address these issues. These situations include addressing central nervous system versus extra–central nervous system response and progression, depth of response, oligoprogression versus polyprogression, continuation of systemic therapy after use of a local ablative therapy, and the impact of fluctuations in measurements bridging partial response and stable disease categories during prolonged therapy.     

髓母细胞瘤治疗进展

髓母细胞瘤多发生于青少年和儿童,约占儿童脑肿瘤的30%,成人中枢神经系统肿瘤的3%;髓母细胞瘤恶性程度较高,单纯手术不易完全切除;同时髓母细胞瘤对放化疗多比较敏感,目前标准治疗方案是进行手术,然后接受放疗和化疗。近年来,许多研究者对术后放化疗的方案进行了大量的研究,希望能够在保证较好的疗效的前提下,减少患者的副反应。本文对近年来术后放化疗方案的研究进展进行综述。     

胸腺肿瘤诊断和治疗的有关问题 (附73例报告)

目的：探讨良性胸腺瘤复发原因及胸瘤新的分类方法、恶性胸肿瘤的影像学诊断特点、手术方式、合并重症肌无力患者的处理、胸腺肿瘤术后治疗等。方法：１９７５年１月－１９９５年１２月手术治疗的７３例胸腺肿瘤和囊肿。结果：总结了恶性胸腺瘤的ＣＴ特征,恶性胸腺肿瘤应争取全胸腺及用脂肪组织切除,重视合并重症肌无力的围手术期 和潜在恶笥胸腺瘤术后应放疗,复发病例再手术仍能获得较好疗效。结论：提出了一种胸腺瘤新的分类方     

肾母细胞瘤的预后与治疗探讨

对３６例肾母细胞瘤患儿进行随访，生存２年以上者１８例（５０％）。结合文献探讨了影响预后的因素及改善预后的措施。