吉西他滨和奥沙利铂联合治疗复发难治性非霍奇金淋巴瘤疗效观察

目的探讨吉西他滨+奥沙利铂(GEMOX)方案治疗复发难治性非霍奇金淋巴瘤患者临床疗效及预后影响因素。方法选取2015年1月至2018年12月间营口市中心医院收治的86例复发难治性非霍奇金淋巴瘤患者,按照治疗方法进行分组,采用GEMOX方案治疗44例患者纳入GEMOX组,采用吉西他滨+顺铂+地塞米松(GDP方案)治疗的42例患者纳入GDP组,比较两组患者临床疗效、KPS评分及分析预后影响因素。结果 GEMOX组患者治疗总有效率为68. 2%,GDP组为57. 1%,但两组比较,差异无统计学意义(P> 0. 05)。治疗后,两组患者卡氏评分均提高,且GEMOX组患者高于GDP组,差异有统计学意义(P <0. 05)。随访1年,26例患者死亡(均为肿瘤源性死亡),1年生存率69. 8%。单因素分析显示,Ann Arbor分期、IPI指数、乳酸脱氢酶升高和β2微球蛋白升高与复发难治性非霍奇金淋巴瘤患者的预后有关,差异均有统计学意义(均P <0. 05)。Ann Arbor分期Ⅲ～Ⅳ期、IPI指数(高危)、乳酸脱氢酶升高和β2微球蛋白升高是影响复发难治性非霍奇金淋巴瘤患者预后的危险因素,差异均有统计学意义(均P <0. 05)。结论 GEMOX方案治疗复发难治性非霍奇金淋巴瘤患者,近期临床疗效与GDP方案相当,但功能状态改善较好; Ann Arbor分期、IPI指数、乳酸脱氢酶及β2微球蛋白水平是复发难治性非霍奇金淋巴瘤患者的预后影响因素。     

硼替佐米治疗复发难治性套细胞淋巴瘤的研究进展

 复发难治性套细胞淋巴瘤（MCL）的治疗是临床医师面临的严峻挑战。近年来,蛋白酶体抑制剂硼替佐米的应用给复发难治性MCL患者的治疗提供了新方法。就硼替佐米治疗复发难治性MCL的机制、临床疗效以及MCL细胞对硼替佐米耐药产生的机制和应对策略进行综述。     

我国复发难治性淋巴瘤治疗策略分析

对比分析国内外淋巴瘤权威指南中关于不同类型复发难治性淋巴瘤的诊治信息,并收集国内外复发难治性淋巴瘤诊治的循证医学证据.与国外指南相比,我国的复发难治性淋巴瘤治疗方案包括病种较少;内容相对简单,操作力不强;未注明循证医学研究证据,可参考性有待提高.我国复发难治性淋巴瘤的定义、诊断标准有待规范,临床实践指南内容有待扩充,应开展复发难治性淋巴瘤的高质量临床研究,充分收集循证医学研究证据,提高临床实践指南的可操作性,规范复发难治淋巴瘤诊治.     

胺苯吖啶联合治疗复发难治性白血病52例临床观察

复发难治性白血病的治疗是临床医生感到棘手的问题,肿瘤细胞耐药可能是白血病难治的主要原因之一［１］。近年来,有报道认为胺苯吖啶（ＡＭＳＡ）无论对初治还是复发、难治性白血病均有良效［２］。我们应用国产ＡＭＳＡ为主的联合化疗方案,对５２例复发难治性白血病进...     

霍奇金淋巴瘤复发、难治的相关因素分析

 目的　探讨霍奇金淋巴瘤（HL）复发、难治的相关因素,分析复发、难治性HL患者的生存情况。方法　对62例HL患者的临床资料进行回顾性分析,对其临床特征、治疗方法等与复发、难治的关系进行相关性分析。结果　62例HL患者中,12例（19.35 %）为复发、难治性。病理类型（P＝0.026）、淋巴结区≥3个（P＝0.030）和大包块（P＝0.006）与复发、难治有关。复发、难治性HL患者中位生存时间为69.5个月（27～129个月）,复发、难治性HL及其他HL患者的5年总生存（OS）率分别为66.7 %和88.8 %,二组差异无统计学意义（P＝0.117）,无事件生存（EFS）率分别为52.4 %和87.9 %,差异有统计学意义（P＝0.006）。结论　HL的病理类型、淋巴结区≥3个和大包块与复发、难治关系密切,同时,短期（<1年）内复发是复发、难治性HL患者的不良预后因素,值得关注。     

影响胃恶性淋巴瘤患者预后的临床病理因素分析

目的探讨影响胃恶性淋巴瘤患者预后的临床病理因素。方法回顾分析73例胃恶性淋巴瘤患者的临床资料,观察临床病理因素与其预后的相关关系。结果本组73例患者的1年、3年、5年累积生存率为89.5%、78.6%和71.4%。经单因素分析显示,临床分期、病理分级、治疗方式是影响胃恶性淋巴瘤患者预后的危险因素(P<0.05);经多因素分析显示,病理分级、治疗方式是影响胃恶性淋巴瘤患者预后的独立危险因素(P<0.05)。结论胃恶性淋巴瘤临床表现缺乏特异性,容易造成漏诊和误诊,病理分级和治疗方式是影响胃恶性淋巴瘤患者预后的独立危险因素。     

吉西他滨组成方案挽救治疗非霍奇金淋巴瘤的疗效与安全性分析

目的:探讨GDP和GemOx方案治疗复发难治性非霍奇金淋巴瘤的早期疗效及安全性。方法:选取本院2016年1月至2017年8月收治的复发难治性弥漫大B细胞淋巴瘤及复发难治性NK/T细胞淋巴瘤患者共52例,其中25例接受 GDP方案化疗,27例接受GemOx方案化疗。观察两组患者早期临床疗效和毒副反应。结果:GDP方案组患者总有效率52.00%,GemOx方案组患者总有效率59.26%。两种方案的主要毒副反应均为轻度的消化道反应、血液学毒性及转氨酶升高。结论:以吉西他滨为基础的联合化疗方案可作为复发难治性非霍奇金淋巴瘤的治疗选择。     

复发难治性NK/T细胞淋巴瘤疗效及预后相关因素

目的 分析复发难治性NK/T细胞淋巴瘤患者的有效治疗方法和预后相关因素.方法 回顾性分析1999年1月至2007年6月中山大学肿瘤医院收治的复发及难治的NK/T细胞淋巴瘤24例,并进行单因素和多因素分析.结果 截至末次随访时间2007年6月,中位随访期7(1.5～38)个月,共生存5例,复发后中位生存期(MST)7(1.5～38)个月,预计1、2、3年总生存(OS)率分别为33.3%、4.2%、4.2%.多因素分析结果提示,复发后骨髓受累、复发后PS与全身性复发NK/T细胞淋巴瘤患者复发后OS率密切相关,是独立预后指标.2例接受自体外周血干细胞移植(AHSCT)患者无瘤生存期分别是19、38个月.结论复发后骨髓受累情况、PS是复发难治性NK/T细胞淋巴瘤独立预后因素,复发难治性NK/T细胞淋巴瘤患者预后较差,MST短,化疗敏感患者采用AHSCT,可能提高其生存.     

异环磷酰胺、VP－16、强的松和米托蒽醌联合化疗治疗复发和难治性非何杰金淋巴瘤

异环磷酰胺、ＶＰ－１６、强的松和米托蒽醌联合化疗治疗复发和难治性非何杰金淋巴瘤沈志祥赵亚麟曾晓颖李秀松上海第二医科大学附属瑞金医院血液科，上海血液学研究所（上海２０００２５）复发性或难治性恶性淋巴瘤的治疗往往是临床医师的一个棘手问题。最近，我科应用Ｖ...     

大剂量甲氨喋呤联合消瘤芥治疗复发难治性恶性淋巴瘤12例临床观察

目的观察大剂量甲氨喋呤(MTX)联合消瘤芥(AT-1258)治疗复发难治性恶性淋巴瘤的效果及毒副反应。方法观察12例复发难治性淋巴瘤患者,给予MTX 2~3 g/m2联合AT-1258 20~40 mg化疗,同时给予水化、碱化、利尿、保肝及营养支持治疗。结果4例霍奇金淋巴瘤近期有效率为75%,8例非霍奇金淋巴瘤近期有效率为62.5%,总有效率为66.7%,未发生严重的毒副反应。结论大剂量甲氨喋呤联合消瘤芥治疗复发难治性恶性淋巴瘤是一种安全有效的方案。     

头颈部恶性肿瘤嗜神经侵袭临床诊治现状

嗜神经侵袭是肿瘤通过神经扩散与转移的一种独特的生物学行为,与复发、转移、预后密切相关。随着研究的不断深入,人们普遍认识到嗜神经侵袭的临床意义。但由于头颈部肿瘤发病率相对较低,不同解剖部位、不同病理类型嗜神经发生率各不相同,故缺乏高级别的循证医学证据。目前嗜神经侵袭的病理学机制尚未完全阐明,也无针对神经侵犯的特异性治疗手段,因此头颈部肿瘤嗜神经侵袭的治疗对于临床医师是一个巨大的挑战。本文就头颈部恶性肿瘤中嗜神经侵袭的临床诊治现状做一综述。     

头颈部恶性肿瘤嗜神经侵袭临床诊治现状

嗜神经侵袭是肿瘤通过神经扩散与转移的一种独特的生物学行为,与复发、转移、预后密切相关。随着研究的不断深入,人们普遍认识到嗜神经侵袭的临床意义。但由于头颈部肿瘤发病率相对较低,不同解剖部位、不同病理类型嗜神经发生率各不相同,故缺乏高级别的循证医学证据。目前嗜神经侵袭的病理学机制尚未完全阐明,也无针对神经侵犯的特异性治疗手段,因此头颈部肿瘤嗜神经侵袭的治疗对于临床医师是一个巨大的挑战。本文就头颈部恶性肿瘤中嗜神经侵袭的临床诊治现状做一综述。     

口腔癌的转化医学研究现状与思考

我国拥有世界上最大的疾病和生物样本资源，口腔癌亦不例外。但长期以来，由于临床医生与实验室科研工作者各自为政、埋头一隅的工作方式，临床医生往往找不到有价值的科研选题，基础研究者也往往以发表高质量文章漂亮为终点，二者无沟通、无合作，更无互动，转化更是无从谈起。因此，必须重视从临床中提炼课题，鼓励临床医生积极参与基础科学研究，认真思考如何将临床现象凝练为具体科研问题；基础研究者也需要掌握基本的临床知识，以临床需求为导向进行科研选题。基础研究者、临床医生交流合作，通过系统的实验研究获得临床可应用的生物标志物，将实验室研究成果转化为指导的临床诊治知识，并可通过大样本的随机临床试验对研究成果进一步验证和系统评价。      

真实世界中老年非小细胞肺癌的临床特征及预后分析

目的:探讨真实世界中老年非小细胞肺癌患者的临床特点及预后因素。方法:回顾性分析我院肿瘤科、胸外科、呼吸科及老年病科2015年6月至2017年6月出院的老年非小细胞肺癌患者的临床资料742例,利用SPSS 17.0软件进行统计学处理,K-M法进行单因素分析,Log-rank法评价生存差异,COX多因素回归模型对多个变量分析确定影响预后的因素,检验水准为α=0.05,分别探讨了性别、年龄、体能状态（ECOG）、临床分期、病理类型、合并症、治疗方式等7个因素对预后的影响。结果:我中心老年非小细胞肺癌男女性别比例为3.7∶1,单因素分析显示年龄、病理类型、ECOG评分、临床分期、治疗方式及合并症是影响预后的危险因素,多因素分析显示病理类型、ECOG评分、临床分期、治疗方式及合并症是影响预后的独立危险因素。结论:我中心老年非小细胞肺癌患者男女比例稍高,性别、年龄对生存期无显著影响,而病理为腺鳞癌、ECOG评分高、临床分期晚、合并症多及姑息治疗方式是预后不佳的独立危险因素。     

Patients With Positive Axillary Lymph Nodes: How to Use Genomic Assays

OPINION STATEMENT: The treatment of breast cancer is continually evolving. Standard treatment for early stage, node positive breast cancer has included adjuvant chemotherapy. As we learn more about differences in a tumor's genetic makeup that result in different patterns of recurrence and survival, we are starting to include gene expression in addition to the routine clinical and pathological factors when we make treatment recommendations. For lymph node negative, early stage breast cancer, there are two genomic assays in routine use to predict prognosis and benefit from adjuvant chemotherapy. There is emerging data to support that the same tests may also predict prognosis and chemotherapy benefit, or lack thereof, in lymph node positive tumors. Currently there are no standard of care and this is an area in which more research is being done. Given that the biology of breast tumors is independent of nodal status, there are certainly cases of node positive early stage breast cancer where clinicians can feel comfortable making treatment decisions based on genomic assays. These include women with micrometastases in the lymph nodes or those with one to three positive lymph nodes. Currently, the genomic assays are limited to use in tumors that are estrogen receptor positive. It is still clearly the standard of care to administer chemotherapy to estrogen receptor negative, lymph node positive tumors.     

Neuroimaging for central nervous system tumors

Advances in neuroimaging techniques have now provided clinicians with the ability to detect CNS neoplasms at an earlier stage and to measure responses to therapy. However, errors in performing or interpreting these studies can lead to erroneous conclusions that may subsequently influence therapeutic decisions. The exact delineation of areas of tumor involvement in the brain has improved with newer imaging techniques, but this too is problematic in some patients. Evaluations of response to treatment can also be complicated by technical artifacts that can lead to inadequate differentiation of tumor from non-neoplastic tissues. Nevertheless, MRI and CT have helped clinicians to redefine the natural history of CNS tumors, reach earlier diagnoses, improve the accuracy of radiotherapy, explain adverse treatment responses, and exclude conditions that are not related directly to the tumor but that can be responsible for clinical deterioration. Newer tests that have the ability to assess tumor metabolism will further increase our understanding of these pathological processes.     

Clinical Utility of Multigene Profiling Assays in Early-Stage Invasive Breast Cancer: An Ontario Health (Cancer Care Ontario) Clinical Practice Guideline

Objective: The purpose of this guideline is to determine the clinical utility of multigene profiling assays in individuals with early-stage invasive breast cancer. Methods: This guideline was developed by Ontario Health (Cancer Care Ontario)’s Program in Evidence-Based Care (PEBC) through a systematic review of relevant literature, patient- and caregiver-specific consultation and internal and external reviews. Recommendation 1: In patients with early-stage estrogen receptor (ER)-positive/human epidermal growth factor 2 (HER2)-negative breast cancer, clinicians should consider using multigene profiling assays (i.e., Oncotype DX, MammaPrint, Prosigna, EndoPredict, and the Breast Cancer Index) to help guide the use of systemic therapy. Recommendation 2: In patients with early-stage node-negative ER-positive/HER2-negative disease, clinicians may use a low-risk result from Oncotype DX, MammaPrint, Prosigna, EndoPredict/EPclin, or Breast Cancer Index assays to support a decision not to use adjuvant chemotherapy. Recommendation 3: In patients with node-negative ER-positive/HER2-negative disease, clinicians may use a high-risk result from Oncotype DX to support a decision to offer chemotherapy. A high Oncotype DX recurrence score is capable of predicting adjuvant chemotherapy benefit. Recommendation 4: In postmenopausal patients with ER-positive/HER2-negative tumours and one to three nodes involved (N1a disease), clinicians may withhold chemotherapy based on a low-risk Oncotype DX or MammaPrint score if the decision is supported by other clinical, pathological, or patient-related factors. Recommendation 5: The evidence to support the use of molecular profiling to select the duration of endocrine therapy is evolving. In patients with ER-positive disease, clinicians may consider using a Breast Cancer Index (H/I) high assay result to support a decision to extend adjuvant endocrine therapy if the decision is supported by other clinical, pathological, or patient-related factors.     

抗肿瘤药物诱导的手足综合征的诊疗进展

手足综合征(hand-foot syndrome,HFS)通常是由一些特殊抗肿瘤药物诱导的一种皮肤毒性反应,虽很少带来生命危险,但在严重的情况下常导致患者无法正常从事日常活动,甚至改变剂量或者中断治疗,从而影响治疗的效果。具体病因目前仍然不清,病理表现为皮肤基底角质细胞空泡变性、皮肤血管周围淋巴细胞浸润,值得注意的是显微镜下观察到皮下血管舒张、水肿。最新的国外临床研究荟萃分析发现维生素B6对于卡培他滨诱导的HFS并没有预防和治疗效果,这值得国内临床工作者参考。此外,针对HFS采用合理的预防策略和治疗可以改善患者的HFS症状,达到继续当前抗肿瘤治疗方案并改善患者预后的目的。本文介绍了 HFS可能的病因及导致HFS的常见药物、临床特点、毒性分级、预防和治疗措施等。     

Prognostic and predictive factors in prostate cancer.

Prostate cancer is a major public health problem in the Western world, and the second most common male malignancies in the European Union. Detection of the disease is possible at an early stage, using serum prostate specific antigen measurement and prostatic biopsies. To date, however, screening for prostate cancer has not been shown to be of benefit to patients in improving outcome. This is compounded by uncertainties surrounding treatment efficacy, as more men appear to die with prostate cancer than from it. Studies addressing these issues are underway in Europe and the U.S.A.Clinicians are currently unable to advise their patients with any degree of certainty as to the appropriateness of treatment for prostate cancer, because of their inability to differentiate tumours that will progress from those that will remain quiescent. This article reviews the various clinical, pathological and experimental markers available, and their value in providing prognostic information, which may assist clinicians and patients in making management decisions. Further research is still required to understand the biological behaviour of prostate cancer and to assess the value of screening and treatment efficacy in order to advise patients, clinicians and health care systems accordingly.