肺母细胞瘤4例临床分析及文献复习

肺母细胞瘤少见，发病率仅占肺部原发肿瘤的0．25％~0．5％。我院胸外科自1964年4月至2000年2月共收治4例，占同期肺部恶性肿瘤的0．074％（4／5 421），现报告如下并进行有关文献复习。1 材料与方法1．1 一般资料 4例中男女各2例。年龄30~67岁 ，中位年龄48岁。临床症状有咳嗽、血丝痰、胸痛等。病程1个月～6个月，平均3．3个月。肿瘤位于左上叶2例，左下叶1例，右上叶1例。肿瘤直径5．5～16．0cm，平均9．3cm。1．2 诊断方法 胸部X线和CT表现：2例呈单个卵圆形肿块，密度欠均匀，边缘毛糙，有分叶和毛刺，其中1例肺门淋巴结肿大。1例…     

早期胆囊癌漏诊对策探讨

胆囊癌早期缺乏特异性症状，诊断困难，晚期疗效极差，我科1993年11月至1996年7月收治胆囊癌34例，现分析报道如下。1临床资料1．1一般资料男10例，女24例，男女之比1：2．4；年龄39～81岁，平均62．5岁。1．2临床表现急性胆囊炎4例；慢性胆囊炎13例；体检发现1例；胆囊外症状1例（肠梗阻）；黄疸、消瘦、乏力、腹部肿块等15例。手术证实伴有胆石症20例；伴有胆总管结石2例。1．3诊断准确率术前诊断胆囊癌15例（4％），疑诊3例；术中作快速切片检查3例。B超检查33例，准确率48％，CT检查16例，准确率75％，CT准确率高于B超的原因：1）病…     

多发性骨髓瘤12例误诊原因分析

多发性骨髓瘤（MM）是一种少见的骨髓浆细胞异常增生引起的恶性肿瘤，其临床表现多不典型。本组20例出现典型X线骨骼破坏7例，12例误诊，现就其12例误诊原因作一分析。亚临床资料1．！性别与年龄男性7例，女性5例，男女之比为＊．4。互，年龄19岁～75岁，平均年龄62．4岁，其中50岁以上9例占75％。1．2症状与体征头晕、无力6例（50％）、骨病8例（66．67％）、胸腹腔积液5例（41．61％）、骨折2例（16．67％）、肝脾肿大4例（33．33％）、鼻觑、少尿、关节病各1例。1．3实验室检查血常规血色素（Hb）＜1009／L12例（100％），其中＜60g／…     

238例骨肿瘤临床病理分析

收集我院1978年至1992年病理外检工作中骨肿瘤238例进行临床床病理分析，结果报道如下。l临床病理资料l·l一般信况238例中男132例、女106例，男女之比为1．25：1，年龄2岁～74岁，平均28．39岁。其中良性肿瘤177例（74．37％），平均年龄27．46岁，男女之比为1，30。1，恶性肿瘤附例（25．63％），平均年龄31．08岁，男女之比为1．4《：1，良恶性肿之比为2．90：1。本组骨肿瘤数占同时期病检数由1978年的0．26％增至1992年的0．57％，其中良性肿瘤由0．13％增至0．34％，恶性肿瘤由0．13％增至0．23％。1·2临床表现良性肿瘤主要表现，局部…     

666例骨肿瘤发病原因的统计分析

作者通过天津医院近10年经病理证实的666树五种常见骨肿瘤（骨肉瘤、软骨肉瘤、骨软骨瘤、骨巨细胞瘤、软骨瘤），按性别、年龄、部位分布结果分析发现，骨肿瘤发病与人体骨干错端骨结构所受压应力异常有一定关系。五种常见骨肿瘤：骨肉瘤163例，软骨肉瘤对例，骨软骨瘤2（）例，软骨癌31例。0无例骨肿瘤，男女之比为骨肉瘤1．7：1，软骨肉瘤1．扣：1，骨软骨瘤1．幻：1，骨巨细胞瘤1．18：1，软骨瘤1．田河。五种骨肿瘤合计为1．56：1。发病以11岁一30岁年龄组最高。于刀岁后随年龄增长发病呈递减趋势。发病部位显示：股骨下端占第一位，股…     

胆囊鳞癌和腺鳞癌9例临床分析

[目的]探讨原发性胆囊鳞癌和腺鳞癌的临床病理特征及手术治疗疗效。[方法]回顾性分析9例胆囊鳞癌（5例）和腺鳞癌（4例），采用Kaplan-Meier法计算生存率。[结果]T1和T4病变8例（88．9％），B病变1例（11．1％）。7例（77．8％）累及肝脏，淋巴结转移5例（55．6％）。凡切除5例，R1切除1例，R2切除3例。全组1年、3年及5年生存率分别为55．6％、29．6％和29．6％。R0切除的1年生存率为100％，R1／R2切除的1年生存率为0。[结论]胆囊鳞癌和腺鳞癌恶性程度高，易侵犯肝脏。即使局部晚期患者，R0切除可延长生存期。     

全肺切除治疗肺癌96例临床分析

目的：总结96例全肺切除术治疗肺癌的临床经验，探讨手术指征和术中、围术期处理要点。方法：左全肺切除63例．右全肺切除33例．其中49例行心包内处理血管全肺切除。病理类型：鳞癌51例，腺癌24例，小细胞癌14例．鳞腺癌6例．未分化大细胞癌1例。PTNM分期：Ⅱ期21例，Ⅲa期41例，Ⅲb期34例。结果：手术死亡1例(1．04％)，术后并发症8例(8.33％)；1、3、5年生存率分别为73．95％、31.42％、11．76％，14例未分化小细胞癌中1例生存3年以上。结论：全肺切除术可提高手术切除率，心包内处理血管是安全的，只要正确合理地选择患者，加强围手术期处理，配合化、放疗，在临床中仍有一定的疗效。     

IRESSA治疗晚期难治性非小细胞肺癌的临床研究

背景与目的 化疗是晚期非小细胞肺癌的主要治疗手段，但是非小细胞肺癌常常对化疗耐药，先天性耐药或获得性耐药是导致非小细胞肺癌化疗失败的主要原因之一，因此寻找理想的新的抗癌药物是临床肿瘤学家的共同目标。本文旨在观察IRESSA对晚期耐药非小细胞肺癌的疗效和不良反应。方法 应用口服IRESSA 250mg／d治疗晚期耐药非小细胞肺癌100天后观察疗效。结果 33例Ⅳ期耐药非小细胞肺癌患者中32例完成口服IRESSA 100天，可评价疗效，其中完全缓解1例（3．1％），部分缓解11例（34．4％），稳定9例（28．1％），进展11例（34．4％）。有效率为37．5％，疾病控制率为65．6％。全组中位肿瘤进展时间为5．7个月，总生存期为3．3～25．9个月（中位生存时间9．6个月），9例生存时间超过1年，1年生存率为28．1％，2例生存时间超过2年，2年生存率为6．3％，最长1例存活25．9个月。IRESSA的疗效与病理类型有一定关系，肺泡细胞癌效果最佳，其次为腺癌、鳞癌。主要不良反应包括：皮疹28例（84．8％），皮肤瘙痒31例（93．9％），四肢关节疼痛9例（27．3％），腹泻25例（75．8％），食欲减退29例（87．9％），恶心14例（42．4％），呕吐4例（12．1％），头晕5例（15．2％），头痛4例（12．1％），胸闷13例（39．4％），腹痛3例（9．1％），间质性肺炎1例（3．0％），大部分不良反应可以耐受，仅1例原有慢性肺部纤维化疾病者出现严重间质性肺炎，最终因为呼吸功能衰竭导致死亡。无心电图及肝肾功能改变。结论 IRESSA对晚期耐药非小细胞肺癌具有较好的疗效，不良反应轻微，可以耐受，可以考虑做为晚期非小细胞肺癌的三线治疗方案，并且可以考虑做为一些体质较差、不能耐受手术、放疗或化疗的非小细胞肺癌患者的一线治疗。     

恶性胸膜间皮瘤诊断方法探讨(附1024例分析)

恶性胸膜间皮瘤是一种不常见的肿瘤，误诊率高。为避免误诊，作者统计分析了国内1982~1995年间发表的恶性胸膜间皮瘤1024例，报告如下。男675例，女349例，男女比1．9：1。发病年龄15~82岁，其中45~60岁者占68．2％。发病至确诊时间为11~720天。28例有石棉接触史。本病常见症状为：胸痛（91．3％）、咳嗽（79．7％）、呼吸困难（20％）。发热（3．1％）、贫血（1．7％）、胞壁肿块（1．3％）、咽下困难（0．8％）。566例恶性胸膜间皮瘤误诊分析：误诊为结核性胸膜炎186例，占32．9％；肺癌105例，占18．6％；纵隔肿瘤34例，占6％；胸膜转移…     

儿童期甲状腺癌34例报道

甲状腺癌在儿童期发病较少见，而术后并发症发生率较高。本院自1963年～1990年内共收治儿童期甲状腺癌患者34例，占同期本院收治的1124例甲状腺癌患者的3．03％。现将34例患者发病及治疗情况分析报道如下。1临床资料1．1年龄、性别34例中男性15例，女性19例，男女之比为1：1．27。年龄最大为14周岁，最小为6周岁，中位年龄为12．8岁。1．2病史全部患者以颈部肿块为首发症状而就诊，病史最短2个月，最长为8年。其中1年以下为20例，占5882％。1．3病理类型34例病例均经病理证实。其中乳头状腺癌21例，滤泡型腺癌7例，髓样癌4例，未分化癌及腺…     

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.