分子靶向时代胰腺癌综合诊治的现状与展望

胰腺癌发病率呈上升趋势,以早期诊断困难、手术切除率低及预后差为特点,临床诊治极具挑战性。由于其遗传异质性显著,不同患者之间在疾病进展、临床疗效、放化疗敏感性及预后等方面差异巨大,深入探讨胰腺癌分子生物学特征及其与临床表现、放化疗敏感性的相关性,研发相应的靶向药物,是胰腺癌从传统形态学分型转变到分子分型的重要基础,也是实现从"异病同治"到"同病异治"精准治疗模式转变的前提。在分子靶向时代,胰腺癌的治疗模式转变为综合诊治,有望成为胰腺癌治疗的突破口。     

表皮生长因子受体单抗在胰腺癌分子靶向治疗中的作用及机制

胰腺癌早期诊断困难，恶性程度高，预后差，总的5年生存率不足1％。手术治疗是目前胰腺癌获得根治的惟一手段，不幸的是确诊时约80％的病人淋巴结受累，半数有脏器转移，仅有10％～25％的病人可行根治术，且根治术后5年生存率仍不足25％。传统的放、化疗效果有限，迫使人们寻找新的治疗手段，分子靶向治疗是近年来研究的热点之一，本文针对表皮生长因子受体（epiderrnal glowth factor receptor, EGFR） 的单克隆抗体在胰腺癌辅助治疗中的作用及机制进行综述。     

胰腺癌新辅助化疗进展

胰腺癌目前仍然是临床非常棘手的问题,但在一些胰腺外科中心通过手术切除改善了胰腺癌的预后.目前已有结果提示新辅助治疗对胰腺癌患者安全,且能够显著提高手术切除率.但新辅助治疗与手术治疗、术后辅助治疗及姑息治疗相比较其疗效如何,到目前为止,尚缺少高质量的循证医学证据,也没有关于胰腺癌新辅助化疗或放化疗与外科手术后系统化疗间比较的随机对照研究.需要设计完善的随机对照研究对比新辅助化疗和手术治疗,以此来评价新辅助化疗在胰腺癌多种治疗方案中的价值.     

胰腺癌miRNA靶向药物研究现状

胰腺癌是目前恶性程度较高的肿瘤之一,20年来,其药物治疗方案更新缓慢.许多miRNA都被证实与胰腺癌的发生、转移、化疗敏感性密切相关,具有良好的临床应用前景.miRNA对正常组织的毒性作用,以及组织或细胞特异的递送系统的缺乏是基于miRNA的胰腺癌靶向药物研究领域的最大瓶颈.     

胰腺癌的辅助治疗新进展

胰腺癌是一种极难治疗的恶性肿瘤 ,其发病率有逐年增高的趋势 ,在英国、美国[1 ] 和日本[2 ] ,每年可分别导致 70 0 0、2 80 0 0和 14 0 0 0人死亡 ,目前已成为西方国家第 4或第 5大恶性肿瘤死亡原因。在我国[3 ] ,发病率也有逐年上升的趋势。由于胰腺癌发病隐匿 ,临床症状不明显 ,手术切除率为 10 %～2 4%;远期疗效不令人满意 ,综合 5年生存率仅为 0 .4%。近年来的研究表明 ,以手术为主 ,以其他治疗为辅的综合治疗策略 ,对提高胰腺癌患者生存率及生存质量是有效的。现就胰腺癌的辅助治疗作一概述。1　化学治疗1.1　全身化疗1.1.1　晚期胰腺…     

胰腺癌病人如何选择辅助治疗

二十多年前，主流观点认为胰腺癌术后辅助治疗不能改善病人的生存期。第一个术后辅助治疗的前瞻性对照研究是1985年的GITSG研究，此后欧洲和美国先后组织了一系列临床研究，包括EORTC、ESPAC-1、RTOG-9704、CONCO-001等．今年的ASCO年会上发布了最新的ESPAC-3研究结果。上述研究均证实．胰腺癌切除术后辅助治疗可改善胰腺癌病人的生存期。但对于胰腺癌术后最佳的辅助治疗方案．跨大西洋两岸的观点始终不一致，美国倾向于先予联合放化疗，随后化疗；欧洲则以化疗为主。     

Ⅱ期和Ⅲ期直肠癌术后辅助治疗随机试验对放化疗最佳顺序的界定:10年随访

为了确定Ⅱ期和Ⅲ期直肠癌患者术后辅助放化疗的最佳顺序,Kim TW、Lee JH、Lee JH等人进行了长达10年的随访研究。研究分为两组,一组实施早期术后辅助放化疗(早期组),另一组实施晚期术后辅助放化疗(晚期组)。两组的术后放化疗均包括8个化疗周期,并在间隔4周之后进行放射治疗。研究发现,较晚进行术后辅助放化疗的患者复发率相比于早期组较     

IFNα-2b结合辅助放化疗不能改善胰腺癌切除患者存活期

术前放化疗（新辅助）治疗是胰腺癌综合治疗的一大进步,通过该治疗,肿瘤体积可有所缩小,提高了手术切除率,另外也可以评估患者对化疗及放疗方案的敏感性,继而指导术后的辅助治疗。胰腺癌辅助治疗的作用至今不明确。德国黑尔福德医院JanSchmidt博士等研究者对2004年至2007年间的132例R0／R1胰腺癌切除患者进行了一项临床Ⅲ期研究。     

胰腺癌物理治疗的进展及评价

胰腺癌是困扰当今世界医学界的难题，其早期诊断困难，而且治疗效果也令人失望。目前胰腺癌的治疗方法仍以手术为主，配合化疗及放射疗法，但仅有10％的病人可以行手术治疗，而术后的5年生存率通常不及10％。因此，寻找手术治疗以外的多种辅助治疗方法成为提高胰腺癌治疗效果的希望。本文通过对胰腺癌的物理疗法进行系统性回顾，评价这些疗法的临床价值。     

人源性肿瘤组织异种移植模型在胰腺癌综合治疗中的应用及展望

胰腺癌预后欠佳,以化疗及分子靶向治疗为代表的全身综合治疗是改善胰腺癌术后预后的关键,也是延长晚期胰腺癌生存时间的重要手段。但是由于胰腺癌细胞的耐药性、异质性等原因,目前的全身综合治疗方案仍未达到理想效果,基于精准医学的个体化胰腺诊疗模式将是解决这个问题的重要途径。随着人源性肿瘤组织异种移植(PDX)模型的应用,胰腺癌的...     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.