甲磺酸阿帕替尼治疗晚期胃癌的疗效及安全性分析

目的:观察甲磺酸阿帕替尼治疗晚期胃癌的临床疗效和毒副反应。方法:回顾性分析2016年01月至2018年01月在我院接受二线或以上的单纯化疗或甲磺酸阿帕替尼单独治疗的晚期胃癌患者,单纯化疗组56例作为对照组,甲磺酸阿帕替尼组34例。收集两组患者的一般临床资料,分析其临床近期疗效、无进展生存期和毒副反应。结果:对照组和甲磺酸阿帕替尼组患者在性别、年龄、ECOG评分、肿瘤位置、分化程度和是否手术治疗方面差异无统计学意义（P＜0.05）。对照组患者近期疗效:达到CR、PR和SD的患者分别为0例、5例和10例,甲磺酸阿帕替尼组患者近期疗效:达到CR、PR和SD的患者分别为1例、7例和9例。对照组ORR（8.9%）与甲磺酸阿帕替尼组ORR（23.5%）相比,差异无统计学意义（P=0.056）;对照组DCR（26.8%）显著低于甲磺酸阿帕替尼组DCR（50.0%）（P=0.026）。对照组患者中位无进展生存期显著低于甲磺酸阿帕替尼组（P=0.020）。对照组出现乏力和骨髓抑制的比例显著高于甲磺酸阿帕替尼组（P=0.009,P=0.000）。结论:甲磺酸阿帕替尼二线治疗晚期胃癌与对照组相比近期疗效较好,无进展生存期较长,毒副反应较少,具有较好的疗效和安全性。     

紫杉醇联合阿帕替尼对比单药紫杉醇二线治疗胃癌的真实世界前瞻性研究

目的:观察紫杉醇联合阿帕替尼对比单药紫杉醇二线治疗胃癌的疗效及安全性。方法:选取2017年3月至2018年3月就诊于内蒙古医科大学赤峰临床医学院经一线(氟尿嘧啶类联合铂类)治疗后进展的HER-2阴性的晚期胃癌患者60例,分为单药组和联合组,每组30例。单药组给予单药紫杉醇化疗,联合组给予紫杉醇联合阿帕替尼治疗,观察的主要终点为两组患者的无进展生存期(progression-free survival,PFS),次要终点为疾病控制率(disease control rate,DCR)、客观缓解率(objective response rate,ORR)、安全性。结果:联合组患者的PFS优于单药组患者,两组相比差异有统计学意义(P<0.001)。联合组DCR、ORR均高于单药组,但差异均无统计学意义(均P>0.05);联合组高血压发生率高于单药组(P<0.05),其余不良反应发生率差异均无统计学意义(均P>0.05)。结论:紫杉醇联合甲磺酸阿帕替尼对比单药紫杉醇二线治疗胃癌,联合组PFS、DCR、ORR均优于单药组,虽然联合组DCR、ORR较单药组相比差异无统计学意...     

国产多西他赛联合顺铂治疗晚期非小细胞肺癌

目的评价国产多西他赛联合顺铂治疗晚期非小细胞肺癌(NSCLC)的疗效和毒副反应。方法 32例晚期NSCLC患者接受国产多西他赛联合顺铂化疗,21 d为1周期,2周期后评价疗效。结果 32例中,无CR病例,PR 10例,NC 20例,PD 2例,有效率31.25%(10/32),临床获益率93.75%(30/32)。主要毒副反应为骨髓抑制及胃肠道反应。结论国产多西他赛联合顺铂治疗晚期NSCLC疗效确切,毒副反应可耐受。     

培美曲塞联合顺铂与多西他赛联合顺铂二线方案治疗晚期肺腺癌的临床对比研究

为了比较培美曲塞联合顺铂与多西他赛联合顺铂二线治疗晚期肺腺癌的临床疗效,将符合入组标准的68例晚期肺腺癌患者随机分为观察组与对照组,每组34例.观察组以培美曲塞联合顺铂化疗,对照组多西他赛联合顺铂化疗.治疗后,CR两组均为0,两组相比差异无统计学意义,P>0.05.疾病控制率(DCR),观察组为23.53%,对照组为20.59%,两组相比差异无统计学意义,P>0.05.毒副反应Ⅱ～Ⅳ级发生率观察组低于对照组,差异有统计学意义,P<0.05.培美曲塞联合顺铂二线治疗肺腺癌临床疗效与多西他赛联合顺铂二线治疗晚期肺腺癌的临床疗效相当,但毒副反应发生率降低.     

每周单药国产多西它赛方案与每周国产多西它赛联合铂类方案治疗晚期非小细胞肺癌的临床研究

目的 观察单药每周国产多西它赛方案与每周国产多西它赛联合顺铂方案治疗老年晚期非小细胞肺癌的客观疗效及毒副反应.方法 156例患者非随机分为两组,A组82例患者采用国产多西它赛每周21～29 mg/ m2(中位剂量为每周25 mg/ m2) ,静脉滴入,连用6 周休2周;B组74例患者使用国产多西它赛方法及剂量同上,同时于第1～3 天分别给予顺铂30 mg/m2,静脉滴入,所有患者均接受8 周以上的化疗.结果 156例患者可评价疗效,A组38例患者达PR,有效率为46.3%(38/82),中位生存期为13.1 个月,1 年生存率为48.0%;B组36例患者达PR,有效率为48.6%(36/74),中位生存期为12.6个月,1 年生存率为51.0%.两组主要毒副反应为恶心呕吐和腹泻、肝功能损害、骨髓抑制、皮疹等,A组患者毒副反应较B组轻,两组患者耐均受良好.经常规预防用药后,未观察到过敏反应、疲乏、浮肿现象.结论 每周单药国产多西它赛疗法与每周国产多西它赛联合铂类方案治疗非小细胞肺癌疗法疗效相当,且毒副反应轻,临床使用安全,值得临床进一步研究.     

阿帕替尼治疗化疗失败的转移性结直肠癌近期疗效及预后分析

  目的  评价阿帕替尼单药或联合化疗治疗转移性结直肠癌的近期疗效及耐受性。  方法  选取2016年1月至2017年12月唐山市人民医院收治的化疗失败的转移性结直肠癌患者23例,病理均经肠镜或手术证实,术后按结直肠癌诊疗规范行化疗,一线或二线化疗进展后进入阿帕替尼单药或联合化疗。单药阿帕替尼组16例,口服阿帕替尼联合化疗组7例,前3个月剂量250~500 mg,每个月评价可测量病灶,3个月以后每3个月应用CT评价疗效,评估阿帕替尼治疗的有效性及不良反应。  结果  所有患者中,无完全缓解（complete response,CR）,部分缓解（partial response,PR）9例,病情稳定（stable disease,SD）7例,疾病进展（progressive disease,PD）7例,客观缓解率（overall response rate,ORR）为39.13%,疾病控制率（disease control rate,DCR）为69.56%,疾病无进展生存时间（progressionfree survival,PFS）为1~19.0个月,中位PFS为5.0个月。单药阿帕替尼组无CR,PR 5例,SD 5例,PD 6例,ORR为31.25%,DCR为62.50%,中位PFS为4.5个月。阿帕替尼联合化疗组无CR,PR 4例,SD 2例,PD 1例,ORR为57.10%,DCR为85.70%,中位PFS为12.0个月。Log-Rank单因素分析显示,同步化疗、阿帕替尼剂量、LDH升高、低蛋白血症及疗效评价与PFS相关（均P < 0.05）;同步化疗、阿帕替尼剂量、血红蛋白降低、CD4+淋巴细胞下降及疗效评价与OS相关（均P < 0.05）。Cox回归多因素分析显示,LDH升高为PFS的独立影响因素,上述因素与OS差异无统计学意义（P>0.05）。两组患者不良反应以轻度高血压、蛋白尿、手足综合征为主,差异无统计学意义（均P>0.05）。  结论  阿帕替尼联合化疗可改善化疗失败的转移性结直肠癌患者PFS,可作为转移性结直肠癌治疗的一种有效方法。      

多西他赛与奥沙利铂联合氟尿嘧啶类药物治疗晚期胃癌的临床对比研究

目的对比分析多西他赛与奥沙利铂分别联合氟尿嘧啶类药物在晚期胃癌一线化疗中的疗效及毒副反应,评价2种不同化疗方案在晚期胃癌化疗中的应用价值。方法 57例晚期胃癌患者分为多西他赛联合氟尿嘧啶类化疗组(A组,26例)和奥沙利铂联合氟尿嘧啶类化疗组(B组,31例),所有患者均化疗至少4周期,按RECIST标准评价并比较2组的客观疗效,按NCI-CTC 3.0标准评价并比较毒副反应发生情况。结果A组有效率为38.4%,疾病控制率为76.9%,中位疾病进展时间5.8个月,中位总生存时间12.5个月;B组分别为38.7%、80.6%、5.3个月、14.0个月,比较差异均无统计学意义(P>0.05)。毒副反应方面,A组白细胞减少总发生率为88.5%,高于B组的61.3%(P<0.05);A组外周神经毒性发生率为30.8%,显著低于B组的67.7%(P<0.05)。结论多西他赛联合氟尿嘧啶类化疗方案与奥沙利铂联合氟尿嘧啶类化疗方案治疗晚期胃癌疗效相当,毒副反应有差异,但均属可耐受范围,2种方案均可作为晚期胃癌化疗方案,临床制定化疗方案需个体化选择。     

三维适形放疗联合多西他赛为主的化疗同步治疗局部晚期食管癌疗效观察

目的观察三维适形放疗(3DCRT)联合多西他赛为主的化疗同步治疗局部晚期食管癌的疗效及患者耐受性。方法 43例局部晚期食管癌患者均接受3DCRT和以多西他赛为主的化疗(多西他赛+顺铂),治疗结束后评价疗效和毒副反应。结果 43例患者均可评价疗效,其中CR 10例,PR 30例,NC 2例,PD 1例,有效率为93.0%。主要毒副反应是骨髓抑制、放射性肺炎和放射性食管炎。治疗后KPS评分提高者34例,不变者7例,下降者2例。结论 3DCRT联合多西他赛为主的化疗同步治疗局部晚期食管癌疗效较好,毒副反应可耐受。     

甲磺酸阿帕替尼联合多西他赛二线治疗晚期胃癌的临床研究

目的分析甲磺酸阿帕替尼联合多西他赛治疗一线化疗失败后晚期胃癌患者的近期疗效及安全性。方法收集2017年3月至2018年5月就诊于山西省肿瘤医院、采用一线化疗方案(非多西他赛或紫杉醇)治疗失败后的23例晚期胃癌患者的临床资料, 给予阿帕替尼联合多西他赛治疗, 分析患者的近期疗效和安全性。结果 23例患者中, 20例患者可评价疗效, 其中部分缓解4例, 稳定13例, 疾病进展3例;客观缓解率为20.0%, 疾病控制率为85.0%, 中位无进展生存时间为4.5个月。不良反应以高血压、呕吐和乏力为主。结论阿帕替尼联合多西他赛二线治疗晚期胃癌患者具有生存获益, 安全性良好。     

奥沙利铂或伊立替康联合希罗达治疗晚期胃癌的临床比较分析

目的 观察并比较奥沙利铂联合希罗达与伊立替康联合希罗达治疗晚期胃癌的近期疗效和毒副反应.方法 59例晚期胃癌随机分为两组,A组31例应用奥沙利铂联合希罗达,B组28例应用伊立替康联合希罗达.均化疗2个周期以上.结果 A组中CR 1例,PR 14例,有效率为48.39%,中位无进展生存期为6.3个月;B组中CR 0例,PR 13例,有效率为46.43%.中位无进展生存期为5.9个月.两组有效率及巾位无进展生存期比较差异均无统计学意义(P>0.05).两组主要毒副反应为骨髓抑制和胃肠道反应,A组神经毒性较重,B组腹泻较重;两组均无化疗相关性死亡.结论 两种方案对晚期胃癌均有较好的疗效,且疗效相当;毒副反应均可耐受.     

Bacteria and cancer--antagonisms and benefits

There is considerable historical and recent evidence concerning the antagonisms between acute bacterial infections or their toxins and cancer and allied diseases. These data provide renewed incentives to undertake clinical programmes with mixed bacterial vaccines in many countries at the present time.     

Religiosity and physical and emotional functioning among African American and White colorectal and lung cancer patients

The literature suggests that religiosity helps cope with illness. The present study examined the role of religiosity in functioning among African Americans and Whites with a cancer diagnosis. Patients were recruited from an existing study and mailed a religiosity survey. Participants (N = 269; 36% African American, 56% women) completed the mail survey, and interview data from the larger cohort was utilized in the analysis. Multivariate analyses indicated that in the overall sample religious behaviors were marginally and positively associated with mental health and negatively with depressive symptoms. Among women, religious behaviors were positively associated with mental health and negatively with depressive symptoms. Religiosity was not a predictor of study outcomes for men. Among African Americans, religious behaviors were positively associated with mental health and vitality. Among Whites, religious behaviors were negatively associated with depressive symptoms. These findings suggest a mixed role of religious involvement in cancer outcomes. The current findings may have applied potential in the areas of emotional functioning and depression.     

VEGF及KDR在大肠腺瘤和腺癌中的表达及意义

目的：探讨VEGF和KDR在大肠腺瘤和大肠腺癌中的表达及临床病理特征的关系。方法：大肠腺瘤和大肠腺癌组织标本各100例,采用免疫组织化学染色法检测VEGF和KDR在标本中的表达情况。结果：VEGF和KDR在大肠腺癌组中的阳性表达明显高于大肠腺瘤组（P〈0.05）;在正常大肠黏膜均未见VEGF和KDR表达的阳性染色;VEGF阳性表达组中KDR的阳性表达率为70%,显著高于VEGF阴性表达组中KDR的阳性表达率16%,两组比较有统计学意义（P〈0.01）。结论：大肠腺癌组织中KDR的表达与肿瘤大小、转移情况、浸润深度密切相关;VEGF和KDR在大肠腺瘤中的表达与患者的年龄、性别及分型均无相关性,而与增生程度相关（P〈0.05）。在大肠腺癌患者中VEGF及KDR表达更高,二者具有协同效应。     

Renal irradiation and the pharmacology and toxicity of methotrexate and cisplatinum

We used a rat model to study the effects of renal irradiation on the pharmacology of methotrexate (MTX) and cisplatinum (cis-Pt). Unanesthetized rats were given bilateral kidney irradiation (20 Gy in 9 fractions). At 9 months after irradiation, 3% of the animals had died and survivors showed moderately impaired renal function. At 15 months, 30% of the animals had died and survivors showed severely impaired renal function. Some animals were given i.v. MTX 1 week to 15 months after irradiation. In irradiated rats, the area under the MTX plasma clearance curve equaled that of controls through 6 months, and was significantly above controls from 9 months on. Other animals were given i.p. cis-Pt 1 week to 9 months after irradiation. The acute toxicity of cis-Pt was the same in control and irradiated rats when cis-Pt was given immediately before or after irradiation. Beginning 3 months after irradiation there was a progressive increase in cis-Pt toxicity and a simultaneous decrease in urinary platinum excretion. Irradiated animals that survived cis-Pt treatment showed increased radiation nephritis; the greatest effect occurred when cis-Pt was given 3 months or more after irradiation. MTX and cis-Pt clearance decreased when renal dysfunction was first observed and changes in renal function preceded changes in drug clearance and toxicity.     

Morphine and tumor growth and metastasis

Morphine is an analgesic widely used to alleviate cancer pain. In addition, the perioperative management of pain in cancer surgery patients most often includes opioids. However, there are reports that these drugs may alter cancer recurrence or metastasis. Several mechanisms have been proposed, such as the modulation of the immune response or cellular pathways that control the survival and migratory behavior of cancer cells. The published literature, however, presents some discrepancies, with reports suggesting that opioids may either promote or prevent the spread of cancer. It is of great importance to determine whether opioids, in particular the most widely used, morphine, may increase the risk of metastasis when used in cancer surgery. This review examines the available data on the effects of morphine which influence cancer metastasis or recurrence, including immunomodulation, tumor cell aggressiveness, and angiogenesis, with special emphasis on recently published clinical and laboratory based studies. We further discuss the parameters that may explain the difference between reports on the effects of morphine on cancer.     

肾上腺素能β受体与肿瘤生长及转移

大量研究表明肿瘤细胞可表达β受体，而一些神经递质、药物和社会心理因素可能通过β受体影响肿瘤的生长和转移，β受体激动剂、β受体阻滞剂以及抑郁等社会心理因素可加强或削弱这种作用。这为表达β受体肿瘤的治疗开辟了新的道路，提供了新的治疗靶点。