No Survival Benefit for Patients with Treatment in Certified Breast Centers—A Population‐based Evaluation of German Cancer Registry Data

Much time and money has been spent on the establishment and preservation of certified breast centers (CBCs), but up to now there is almost no evidence for whether certification results in an improved outcome for breast cancer patients. The aim of this evaluation was to assess, whether the certification of specialized units had any influence on their patients’ outcomes and if a survival difference between CBC patients and non‐CBC patients can be shown. This population‐based analysis included cancer registry data from 32,789 operated breast cancer patients with no prior cancer diagnosis and with active follow‐up. They were diagnosed between 2004 and 2010 in four different regions in Germany. Survival was investigated using the Kaplan–Meier method and multivariate Cox regression analysis. A survival difference was found neither between patients with treatment before and after certification of specialized units nor between CBC patients and non‐CBC patients aged up to 75 years. Only for patients older than 75 years, an improved survival could be seen for CBC patients (adjusted hazard ratio 0.77; 95% confidence interval 0.68–0.87). The improved survival of elderly CBC patients is most likely caused by selection effects concerning health status differences and not by processes attributable to certification. Thus, this study found that as of yet, certification has not influenced survival of breast cancer patients.     

非小细胞肺癌K-ras突变小分子对吉非替尼耐药细胞的作用

目的 观察针对K-ras突变小分子NSC-741909是否可特异性杀伤吉非替尼原发耐药细胞,并探讨其机制.方法 选取吉非替尼耐药细胞;观察NSC-741909作用后细胞增殖与凋亡的变化;共聚焦显微镜观察细胞骨架改变;Western blot检测K-ras、JNK、P-JNK的改变.结果 NSC-741909可使耐药细胞在作用24 h后,在1 μmol/L和2 μmol/L时,FITC-A+/PE-A+细胞增加至(6.9±0.6)%和(21.1±3.2)%(P＜0.01);作用30 min后,K-ras表达在2 h下降达70%;p-JNK表达增加,并持续至少15 h,而总JNK蛋白表达无改变;细胞骨架蛋白F-actin呈稀疏、不规则、发散状排列.结论 针对K-ras突变的小分子NSC-741909可特异性杀伤吉非替尼原发耐药细胞,这是通过持续激活JNK途径从而导致细胞凋亡实现的.

Abstract：

Objective To study whether a recently identified novel anticancer agent NSC-741909 can suppresses the growth of non-small cell lung cancer cell line ( NSCLC) which has primary resistance to Gefitinib and explore its molecular mechanisms. Methods Select NSCLC cell line which is resistant to Gefitinib. Observe the cell growth supression effect of NSC-741909 to the cell line, apoptosis and actin cytoskeleton changement. Observe K-ras, JNK, p-JNK protein expression by Western blotting. Results NSC-741909 can induce apoptosis of Gefitinib resistant cell lines at 24 h. At that time point, FITC-A +/ PE-A + increased to (6. 9 ±0.6)% and (21. 1 ±3.2)% (P ＜0. 01) at 1 and 2 μmol/L;K-ras protein decreased to 70% at 2 h; p-JNK expression was increased and lasted for at least 15 h and total JNK remained the same. Cell cytoskeleton F-actin presented as loose, irregular and radiation arrangement. Conclusion NSC-741909 which supress the mutant K-ras expression can induce the apoptosis of the NSCLC which is primary resistant to Gefitinib. This inhibition was mediated by sustained JNK activation.     

非小细胞肺癌术后随访中国胸外科专家共识

外科手术是非小细胞肺癌的重要治疗手段,其术后定期随访是早期发现和治疗肿瘤复发转移或第二原发肿瘤的有效方法,可提高患者的生活质量,改善预后.本共识旨在完善我国非小细胞肺癌患者术后随访方案,为负责非小细胞肺癌患者术后随访的同道提供参考,进一步提高我国肺癌规范化诊疗水平.     

A systematic review and meta-analysis of stereotactic body radiation therapy versus surgery for patients with non–small cell lung cancer

Objective

Stereotactic body radiation therapy is the preferred treatment modality for patients with inoperable early-stage non–small cell lung cancer. However, comparative outcomes between stereotactic body radiation therapy and surgery for high-risk patients remain controversial. The primary aim of the present meta-analysis was to assess overall survival in matched and unmatched patient cohorts undergoing stereotactic body radiation therapy or surgery. Secondary end points included cancer-specific survival, disease-free survival, disease recurrence, and perioperative outcomes.

不同手术方式下应用RATS和VATS治疗非小细胞肺癌的研究进展

机器人辅助胸腔外科手术(Robot-assisted thoracic surgery,RATS)近几年来逐渐开始用于早期非小细胞肺癌(Non-small cell lung cancer,NSCLC)患者的手术治疗,但其与已经发展较为成熟的视频辅助胸腔外科手术(Video-assisted thoracic surgery,VATS)相比,优劣对比仍存争议。近期研究发现,在解剖性肺叶切除术中,相较于VATS,虽然RATS的手术时间延长、成本明显增加,但由于RATS具有更好的术中稳定性和安全性,患者依旧可以从中获益,包括术中出血少、中转开胸率低和淋巴结清扫多,患者30d死亡率、住院时间等也明显减少。在袖式肺叶切除术中,RATS在支气管吻合、气道重建和术后并发症等方面也展现了独特的优势。本文就近几年RATS与VATS在不同手术方式下治疗NSCLC中的研究进展进行综述。     

八珍汤加减联合化疗对小细胞肺癌患者 CD细胞及不良反应的影响

目的:探讨化疗联合或不联合八珍汤加减治疗小细胞肺癌(SCLC)的有效性、安全性。方法:选取2020年1月—2021年6月河北中医学院附属沧州中西医结合医院收治的SCLC患者120例,按随机数字表法分两组,对照组(n=60)予EP化疗方案(依托泊苷+顺铂),研究组(n=60)在对照组基础上联合八珍汤加减。对比两组疗效、CD细胞、生活质量、不良反应。结果:研究组客观缓解率(ORR)高于对照组(P＜0.05)。治疗后,对照组CD3+、CD4+、CD4+/CD8+均低于治疗前(P＜0.05),CD8+高于治疗前(P＜0.05),研究组CD3+、CD4+、CD4+/CD8+均高于治疗前(P＜0.05),CD8+低于治疗前(P＜0.05),且治疗后研究组CD3+、CD4+、CD4+/CD8+均高于对照组(P＜0.05),CD8+低于对照组(P＜0.05)。治疗后,两组EORTC-QLQ-C30量表各维度得分均高于治疗前(P＜0.05),且治疗后研究组EORTC-QLQ-C30量表各维度得分均高于对照组(P＜0.05)。研究组各不良反应的总发生率均低于对照组(P＜0.05)。结论:八珍汤加减联合化疗能提高SCLC患者疗效,改善患者免疫功能与生活质量,减轻化疗所致不良反应。     

机器人与胸腔镜肺叶切除对非小细胞肺癌患者机体创伤及淋巴细胞亚群的影响

目的 探讨机器人与胸腔镜肺叶切除对非小细胞肺癌患者机体创伤及淋巴细胞亚群的影响.方法 收集本中心同时期同一手术组进行肺叶切除120例非小细胞肺癌患者的临床资料.根据手术方式不同,将患者分为机器人组(n=60)和胸腔镜组(n=60).记录两组患者手术时间、术中出血量、术后引流时间、引流量、术后住院时间、并发症发生率、疼痛...     

基于患者健康参与模型的肺癌手术患者运动康复方案构建和初步应用

目的 探讨基于患者健康参与模型的运动方案对肺癌微创手术患者康复的影响.方法 按住院时间将拟进行肺癌微创手术的42例患者分为对照组22例和干预组20例,对照组实施常规护理,干预组构建与实施基于患者健康参与模型的运动康复方案.结果 两组均未发生运动康复相关不良反应和并发症.干预组胸腔引流管留置时间、住院时间显著短于对照组,...     

Impact of laparoscopic surgery on the long‐term outcomes for patients with rectal cancer

Background: This 20‐year retrospective study compared the results of laparoscopic surgery with open surgery for patients with rectal cancer to evaluate the impact of laparoscopic surgery on long‐term oncological outcomes for rectal cancer. Methods: We analysed survival data collected over 20 years for patients with rectal cancer (n= 407) according to surgical methods and tumour stage between those treated with laparoscopic surgery (n= 272) and those with open surgery (n= 135). Clinical factors were analysed to ascertain possible risk factors that might have been associated with survival from and recurrence of rectal cancer. A multivariate analysis was applied by using Cox's regression model to determine the impact of laparoscopic surgery on long‐term oncological outcomes. Results: Overall survival, disease‐specific survival and disease‐free survival rates were statistically higher in the laparoscopic group than in the open‐surgery group. The incidence of local recurrence in the laparoscopic group (7.9%; 95% confidence intervals (CI), 4.2–11.5) was significantly lower than that for the open‐surgery group (30.2%; 95% CI, 21.0–39.3; P < 0.001). By using a multivariate analysis, laparoscopic surgery for rectal cancer appeared not to be an independent factor for disease‐specific survival or disease‐free survival. However, the laparoscopic surgery was an independent factor associated with reduced local recurrence (Hazard ratio (HR), 3.408; 95% CI, 1.890–6.149; P < 0.001). Conclusion: Laparoscopic surgery did not adversely affect the long‐term oncological outcome for patients with rectal cancer.     

人参养荣汤对小细胞肺癌化疗后骨髓抑制患者疗效的影响

目的:探讨人参养荣汤对小细胞肺癌化疗后骨髓抑制患者疗效的影响。方法:选取本院2019年5月—2020年12月收治的小细胞肺癌化疗后骨髓抑制患者120例,按照随机数字表法分为治疗组(60例)和对照组(60例),对照组给予西药治疗,治疗组在对照组基础上加用人参养荣汤治疗,比较两组患者免疫指标[肿瘤坏死因子-α(TNF-α)、可溶性白细胞介素-2受体(sIL-2R)]、卡氏量表(KPS)及健康调查简表(SF-36)评分、血清白蛋白水平、白细胞计数、中性粒细胞计数、血小板计数、毒副反应发生率及临床疗效。结果:与治疗前比较,治疗后,两组患者KPS评分、SF-36评分、TNF-α、血清白蛋白水平、白细胞计数、中性粒细胞计数、血小板计数均升高(P＜0.05),且治疗组高于对照组(P＜0.05);sIL-2R水平降低(P＜0.05),且治疗组低于对照组(P＜0.05)。治疗组毒副反应发生率为31.67%,对照组毒副反应发生率为73.33%,治疗组低于对照组(P＜0.05);治疗组总有效率(76.67%)高于对照组(50.00%)(P＜0.05)。结论:人参养荣汤用于小细胞肺癌化疗后骨髓抑制患者,能够改善患者免疫功能及临床症状,提高生活质量,降低毒副反应发生率,增强疗效。     

基于加速康复外科理念的肺癌患者围术期气道管理方案构建与应用

目的 提高肺癌患者围术期气道管理效果。 方法 将256例行胸腔镜下肺部切除术肺癌患者按入院时间分为对照组115例、观察组141例。对照组行常规气道护理管理,观察组构建并实施基于加速康复外科理念的肺癌患者围术期气道管理方案。 结果 干预后,观察组潮气量、分钟通气量、动脉血氧分压显著高于对照组（均P＜0.05）,痰液黏稠度及主动咳嗽力量显著优于对照组（均P＜0.05）;肺部并发症发生率、机械通气时间与住院时间显著少于对照组（均P＜0.05）。 结论 基于加速康复外科理念的肺癌患者围术期气道管理方案应用于肺癌手术患者,能改善术后呼吸功能,降低并发症,缩短住院时间。