老年肿瘤患者综合评估的现状

肿瘤与年龄密切相关，近60％的肿瘤发生于65岁及以上人群，80％的肿瘤死亡发生于这一年龄组。65岁及以上人群肿瘤的发病率比65岁以下人群高近10倍，其肿瘤死亡率是65岁以下人群的16倍。这与老年肿瘤患者的生理特点及治疗的复杂性有关，因此如何更好地治疗老年肿瘤患者已经成为肿瘤学领域和老年病学领域共同关心的内容。     

老年肿瘤患者营养评估及影响因素研究进展

我国人口老龄化形势严峻,罹患肿瘤的老年患者不断增加,伴随而来的老年肿瘤住院患者逐年上升,老年肿瘤患者作为特殊群体获得临床学者的广泛关注。肿瘤作为一种慢性消耗性疾病, 其本身及其治疗的不良反应,会持续大量的消耗肌肉、脂肪组织。老年肿瘤患者合并症多、病情比较复杂, 治疗周期相对较长, 营养风险及营养不良的发生概率较高。营养不良会增加老年肿瘤患者并发症发生风险、延长住院时间、增加医疗费用,对患者的生存质量造成严重不良影响。了解老年肿瘤患者营养评估内容,采取合适的营养筛查和评估方法,同时了解引起老年肿瘤患者营养风险和营养不良的影响因素,对老年肿瘤患者具有重要意义。 本文从老年肿瘤患者营养评估内容、营养筛查与评估方法的选择、营养不良影响因素等方面进行讨论。以期全面提高对老年肿瘤患者营养情况的认识,选择合适的营养评估内容,筛选最佳的营养评估工具,根据影响因素采取针对性措施,更好地提高老年肿瘤患者的营养状况,提高预后和生活质量。     

老年综合评估在老年肿瘤患者中应用的研究进展

年龄超过65岁的老年人恶性肿瘤的发病率及死亡率近年来明显升高。老年人是一个异质性群体,自然年龄与其生理状态不一致。为了确保对老年肿瘤患者采取的治疗措施安全有效,肿瘤科医生应全面了解老年患者的生理及功能状态。老年综合评估是一项多学科多维度的有关老年患者健康和功能状态的评估系统。现已证明它对发现老年肿瘤患者潜在的健康问题、预测治疗相关不良反应、评估预后及治疗效果,帮助制定肿瘤治疗决策有重要意义。     

老年肿瘤患者应该知道自己的病情么?

究竟要不要告知肿瘤患者真实的病情?一直是家属和医护人员所面临的难题和困境。人们通常会担心告诉肿瘤患者真实病情可能引发患者本人产生心理问题,进而拒绝接受治疗。有的患者家属甚至认为,告诉真相会对患者造成伤害和打击。肿瘤'长在患者自己的身上',患者有权知道自己的真实病情,这是国际上对患者基本权力的普遍共识。经验证明,绝大多数患者都希望知道他们所患疾病的全部信息,都不愿人们对他们隐瞒真相。     

老年综合评估在老年血液系统肿瘤患者中的研究进展

随着老年人血液系统肿瘤发病率的逐年升高,如何更好地评估老年血液肿瘤患者对化疗的耐受性是困扰临床医师的问题.最近老年综合评估开始用于老年血液肿瘤患者,研究发现老年综合评估可以判断患者预后,预测患者对治疗的耐受性,并有可能指导治疗决策.文章对国内外老年综合评估在血液肿瘤的研究现状进行综述.     

744 例住院老年肿瘤患者营养不良状况调查及分析

目的 调查本院住院老年恶性肿瘤患者营养不良的发生情况,进一步分析其与不同临床因素的相关性。方法  采 用横断面调查法,应用PG-SGA对我院住院老年恶性肿瘤患者进行营养不良筛查与评估,分析营养状况与年龄、肿瘤分期、 治疗手段、住院时间及费用等临床因素的相关性。结果（1）老年恶性肿瘤患者744例,营养不良发生率高达67.9%;（2） 老年胃肠道恶性肿瘤患者发生轻/ 中度营养不良及重度营养不良比率均明显高于非胃肠道恶性肿瘤患者,分别为81.9% vs 58.2%,40.5% vs 22.7%,P 值均＜0.001;（3）老年胃肠道恶性肿瘤患者营养状况与临床因素相关性分析：①年龄：营养 不良发生率与年龄因素无明显相关性,P=0.462;②临床分期：Ⅰ+Ⅱ期患者营养不良发生率为79.3%（88/111）,Ⅲ期为 88.8%（103/116）,Ⅳ期为87.5%（42/48）,P=0.595,无统计学差异;③治疗手段：接受化疗患者（236 例）营养不良发 生比率明显高于仅接受手术患者（37 例）,86.0% vs 64.9%,P=0.001;④住院费用：无营养不良、轻/ 中度营养不良和重 度营养不良患者中位住院费分别为12,420.15 元、15,384.20 元、20,672.70 元,P=0.004,重度营养不良患者住院费用明显高 于前两者;⑤住院时间：无营养不良、轻/中度营养不良和重度营养不良患者中位住院时间分别为6.50天、7.50天和14.00天, P=0.002,重度营养不良患者住院天数明显多于前两者。结论 ①老年肿瘤患者营养不良现象普遍存在,尤以胃肠道肿瘤为著; ②老年肿瘤患者合并营养不良会明显增加住院费用、延长住院时间;③不同治疗手段对营养状态存在不同程度的影响,应 权衡利弊,合理应用;④关注老年肿瘤患者的营养状况,及早筛查、及时干预。     

老年肿瘤患者合并心血管疾病的研究概况

0 引言 目前关于老年人的定义尚未完全统一.WHO规定:60～74岁为年轻老人;75～89岁为老年人;90岁以上为非常老的老年人或长寿老年人.中华医学会老年学会根据我国实际情况于1982年将老年人年龄标准划分为60岁以上.     

老年肿瘤患者如何推动肿瘤学创新

<正>全球人口老龄化问题正在对包括经济、就业、福利和医疗保健等许多社会领域造成新的挑战。对于肿瘤学家而言,大多数国家人口老龄化问题造成的主要影响是患者人数的增加。肿瘤学家观察到的大多数年龄超过75岁的患者都是从年龄或生物学角度所称的老年人(这里定义为"年迈的老年人")。这些患者往往身体虚弱,有多种非癌症合并症和/或由于其他原因导致的与癌症不相关的相对有限的预期寿命。对于这些"年迈的老年"患者而     

综合老年评估在老年肿瘤中的临床应用

随着社会老龄化,老年肿瘤的处理成为一个主要的社会健康问题.然而,有关老年肿瘤的治疗耐受、疗效与预后的相关资料仍十分缺乏.综合老年评估是近年来发展起来的一项多学科、多维的老年肿瘤寿命及发病风险的评估系统,其对老年肿瘤患者制定合理的治疗方案,提出降低发病和死亡风险的干预措施等都有重要的意义.     

合并症对老年肿瘤患者二线化疗的影响

目的评估不同功能损害的合并症对老年肿瘤患者二线化疗的影响。方法回顾性分析了86例住院接受二线化疗老年肿瘤患者的疗效、生存期和副作用。将患者根据合并症所致功能损害程度分为无合并症（N）、一般合并症（G）和严重合并症（S）三组。结果 N组20例,G组47例,S组19例,三组患者的疾病控制率分别为77.7%、57.5%和42.8%（P〉0.1）,中位无进展生存期（mPFS）分别为9.8个月、5.1个月和3.7个月（P=0.05）,中位总生存期（mOS）分别为23.7个月、13.1个月和10.5个月（P〈0.05）。与其他两组相比,S组患者mPFS的下降程度接近统计学意义,mOS的下降程度有统计学意义。N组、G组、S组的3级以上血液学毒性分别为45%、31.9%和36.8%,3级以上非血液学毒性分别为20%、23.4%、42.1%,各组差异无统计学意义。结论大多数伴有不同合并症的老年肿瘤患者可耐受二线化疗,并有不同程度的获益;但应注意调整剂量和控制毒副作用。     

Cognitive dysfunctions in elderly cancer patients: A new challenge for oncologists

While chemotherapy is more commonly proposed to the elderly population with cancer, little is known about the impact of therapy on cognitive functions and the way of managing such dysfunctions in clinical practice among this population. Aging by itself is associated with cognitive modifications, comorbidities and functional decline, which may have a significant impact on the autonomy. In elderly patients with cancer, several factors like the biologic processes underlying the disease and therapies will contribute to favor the cognitive decline. The chemobrain phenomenon, referring to the chemotherapy-induced impairment of memory, executive function or information processing speed has been extensively described in patients with breast cancer, and the few studies available in older patients suggest that the impact could be more pronounced in patients with pre-existing troubles.     

老年肿瘤患者发生心律失常的危险因素分析

目的:分析老年肿瘤患者发生心律失常的危险因素。方法:回顾性分析2015年8月至2018年9月我院诊治的324例老年肿瘤患者临床资料,发生心律失常者纳入观察组,未发生心律失常者纳入对照组,对比两组临床相关资料,分析影响老年肿瘤患者发生心律失常的因素。结果:324例患者中98例于住院期间发生心律失常,心律失常发生率为30.25%（98/324）;单因素及多因素Logistic回归分析发现,年龄、心血管病史、心律失常史、其他疾病的并发症、酸碱平衡、慢阻肺、甲状腺功能减退、脑损伤、低钾血症、新辅助化疗为老年肿瘤患者发生心律失常的危险因素（OR=1.166,95%CI 1.005～1.354;OR=1.279,95%CI 1.027～1.593;OR=1.359,95%CI 1.100～1.680;OR=1.324,95%CI 1.080～1.624;OR=1.405,95%CI 1.033～1.911;OR=1.507,95%CI 1.229～1.848;OR=1.443,95%CI1.072～1.944;OR=1.361, 95%CI 1.076～1.722;OR=1.581,95%CI 1.041～2.400;OR=1.293,95%CI 1.110～1.507,P＜0.05）,而术后镇痛为保护因素（OR=0.662,95%CI 0.548～0.799,P＜0.05）。结论:引起老年肿瘤患者心律失常的因素较多,应加强心律失常的监控,重视危险因素,及早预防及治疗,提高其晚期生活质量。     

uPA-uPAR系统在肿瘤评估与治疗中的研究进展

尿激酶型纤溶酶原激活剂-尿激酶型纤溶酶原激活剂受体(uPA-uPAR)系统是一种细胞外蛋白水解酶系统,该系统可激活纤溶酶,进而引发一系列蛋白水解级联反应,在肿瘤细胞的侵袭与转移中发挥重要作用。这为uPA-uPAR系统各组分成为多种恶性肿瘤的潜在预后生物标志物和治疗靶点提供了可能,本文主要介绍了近年来基于uPA-uPAR系统的恶性肿瘤诊断、治疗及预后评价策略。     

A new model of active specific immunotherapy using interleukin-1 and sonicated tumor supernatant in murine tumor system

The possibility of active specific immunotherapy using interleukin-1 (IL-1) plus sonicated tumor supernatant (SS) was examined in a murine tumor model. The growth of intraperitoneally or subcutaneously inoculated plasmacytoma MOPC104E, which is syngeneic to BALB/c mice, was significantly suppressed by intraperitoneal pretreatment with IL-1 and SS from MOPC104E cells (MOPC-SS), on days 10, 7, and 4 before tumor inoculation. Pretreatment with IL-1 plus MOPC-SS or MethA-SS (SS from MethA cells) suppressed the growth of subcutaneous tumor of only the corresponding tumor cells, indicating the development of tumor-specific immunity in vivo. The splenic cells of immunized mice with IL-1 and MOPC-SS showed tumor neutralizing activity. However, their tumor neutralizing activity was abrogated when they were treated in vitro with anti-Thy1.2 or anti-L3T4 plus complement. Moreover, when combined with indomethacin per oral, IL-1 plus MOPC-SS significantly suppressed the growth of established subcutaneous tumor and prolonged survival of postoperative mice. These results suggest that this new type of active specific immunotherapy could be a useful method for cancer immunotherapy, especially when combined with oral indomethacin. © 1996 Wiley-Liss, Inc.     

泌尿系统恶性肿瘤的CT诊断及其病理对照研究

目的探讨CT检查对泌尿系统恶性肿瘤的诊断价值及其病理对照研究。方法回顾性分析2010年至2013年间接受治疗的有CT影像学资料的肾癌患者78例,肾盂癌患者35例,膀胱癌患者79例,对比分析CT征象与病理结果的关系。结果肾癌的CT检查显示显著强化及中度强化者占92.3%,局限外凸型者占70.5%,CT与病理诊断的符合率为91.0%,术后病理分期与CT分期呈正相关。肾盂癌CT扫描显示病灶强化程度上呈现为明显的不一致,CT分型上有半数分型为局限肾盂型,CT与病理诊断的呈符合率为71.4%。膀胱癌CT增强后扫描显示病灶大多呈现为中等的均匀强化,CT与病理诊断的检测结果符合率为88.6%,病理分期与CT分期呈正相关。结论 CT对肾癌的定性诊断准确率最高,肾癌、膀胱癌的病理分期与CT分期呈正相关,肾盂癌的恶性程度与CT的分期级别呈正相关。     

老年颅内肿瘤术中并发非手术区域血肿的危险因素分析

目的:分析老年颅内肿瘤术中并发非手术区域血肿的危险因素。方法:选择2010年3月至2017年3月在我院行开颅切除手术且并发非手术区域血肿的老年颅内肿瘤患者31例作为血肿组，随机抽取同期在我院行开颅切除手术无血肿的老年颅内肿瘤患者107例作为对照组。对两组老年患者临床资料进行回顾性分析，采用单因素及多因素Logistic回归分析可能造成非手术区域血肿的危险因素。结果:单因素及多因素Logistic回归分析显示，术前合并脑积水、血浆凝血酶时间、术前合并脑萎缩、患者年龄以及肿瘤大小进入回归模型（P＜0.05）。对照组患者GOS评分显著优于血肿组（P＜0.05）。结论:老年颅内肿瘤术中并发非手术区域血肿对患者术后预后造成不良影响，术前合并脑积水、血浆凝血酶时间、术前合并脑萎缩、高龄以及肿瘤大小是影响患者血肿发生的独立危险因素，针对上述危险因素应采取积极的预防救治措施，以提高治疗效果。     

A new paradigm for mechanobiological mechanisms in tumor metastasis

Tumor metastases and epithelial to mesenchymal transition (EMT) involve tumor cell invasion and migration through the dense collagen-rich extracellular matrix surrounding the tumor. Little is neither known about the mechanobiological mechanisms involved in this process, nor the role of the mechanical forces generated by the cells in their effort to invade and migrate through the stroma. In this paper we propose a new fundamental mechanobiological mechanism involved in cancer growth and metastasis, which can be both protective or destructive depending on the magnitude of the forces generated by the cells. This new mechanobiological mechanism directly challenges current paradigms that are focused mainly on biological and biochemical mechanisms associated with tumor metastasis. Our new mechanobiological mechanism describes how tumor expansion generates mechanical forces within the stroma to not only resist tumor expansion but also inhibit or enhance tumor invasion by, respectively, inhibiting or enhancing matrix metalloproteinase (MMP) degradation of the tensed interstitial collagen. While this mechanobiological mechanism has not been previously applied to the study of tumor metastasis and EMT, it may have the potential to broaden our understanding of the tumor invasive process and assist in developing new strategies for preventing or treating cancer metastasis.     

Retrospective validation of a new staging system for Wilms' tumor

Prognostic significance has been ascribed to certain clinicopathological features of the Wilms' tumor. Examples are size, vascular invasion, histologic characteristics, tumor rupture, and lymph nodal involvement. Several of these were arranged into a grouping system, and used in a cooperative clinical trial, the first National Wilms' Tumor Study (NWTS). Detailed clinicopathologic information was accumulated for each patient entered in the study, and these data were analyzed with respect to their prognostic import. Factors found to be of significance were rearranged into a proposed staging system, believed more likely to be predictive of outcome for patients with tumor spread beyond the kidney confines, but without distant metastases (Groups II and III). The postulated discriminatory superiority was tested using Group II and III patients entered in the second NWTS. The same children were reassigned retrospectively to Stages II and III, and the outcomes compared. Statistically significant differences were noted between Stages II and III, but not for Groups II and III. These results encourage the use of the new staging system in the third NWTS.     

Exosomes: a new delivery system for tumor antigens in cancer immunotherapy

Exosomes are small membrane vesicles that are released into the extracellular environment during fusion of multivesicular bodies with plasma membrane. Exosomes are secreted by various cell types including hematopoietic cells, normal epithelial cells and even some tumor cells. They are known to carry MHC class I, various costimulatory molecules and some tetraspanins. Recent studies have shown the potential of using native exosomes as immunologic stimulants. Here, we demonstrate a novel means of using exosomes engineered to express a specific tumor antigen to generate an immune response against tumors. We expressed a target tumor antigen, human MUC1 (hMUC1), in 2 MHC type-distinct mouse cell lines, CT26 and TA3HA. Analysis of exosomes purified from these cells revealed that exosomes contained the target MUC1 antigen on their surfaces as well as other well-described exosomal proteins, including Hsc70 and MHC class I molecules. In addition, both autologous and allogenic exosomes were able to stimulate the activation of immune cells and suppress hMUC1-expressing tumor growth in a MUC1-specific and dose-related manner. Therefore, these data suggest that exosomes can be engineered from tumor cell lines to deliver a target immunogen capable of inducing an effective immune response and that they may represent a new cell-free tumor vaccine.     

A new mouse tumor model system (RIF-1) for comparison of end-point studies

A new tumor model system (RIF-1) was developed that is very suitable for studies in which clonogenic survival is compared with growth delay and control probability following various forms of treatment. The tumor was a radiation-induced sarcoma in the inbred female C3H/Km mouse. It had a low median tumor dose, had a satisfactory plating efficiency direct from in vivo to in vitro, was nonimmunogenic or minimally immunogenic, and metastasized only at a relatively advanced stage of growth. The cell line grew either as a monolayer on plastic dishes, as tumor spheroids in spinner culture, as lung nodules following injection of a single-cell suspension into the tail veins of syngeneic mice, or as a solid tumor. Both diploid and tetraploid clonogenic cells were found in monolayer cultures of the RIF-1 line.