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肺癌切除术给早期肺癌患者提供了最佳的治愈机会,但是对于肺功能不全的肺癌患者行手术切除,可能会出现严重的术后并发症,甚至死亡,所以术前的评估很重要。应从年龄,一般情况,肺功能和运动能力这4个方面进行评估,以决定肺癌患者是否能耐受肺癌切除术。 相似文献
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Paola Ciriaco Alberto Briganti Annalisa Bernabei Giorgio Gandaglia Angelo Carretta Cristina Viola Francesco Montorsi Giampiero Negri 《European urology》2019,75(5):871-874
The introduction of novel imaging approaches for recurrent prostate cancer (PC) has paved the way for the use of nonsystemic approaches in patients with recurrent disease. While use of surgery or radiotherapy is standard for men with nodal or bone recurrence only, there are no significant data on the possible curative role of surgery for pulmonary metastases. We aimed to assess the efficacy of lung resection in patients with isolated pulmonary recurrence after radical prostatectomy (RP) for clinically localized PC. Overall, nine patients with biochemical recurrence after RP and either single (n = 4) or multiple (n = 5) pulmonary uptake spots on fluorodeoxyglugose, choline, or prostate-specific membrane antigen positron emission tomography/computed tomography underwent a total of 20 lung resections between 2011 and 2017 at our institution. No postoperative complications occurred. After lung resection, seven of the nine patients experienced a biochemical response (defined as prostate-specific antigen <0.2 ng/ml at 40 d after surgery). All patients except for one were free of clinical recurrence (CR) at median follow-up of 23 mo. One patient experienced CR and received androgen deprivation therapy at the time of bone recurrence. Although larger prospective studies are needed, our series demonstrates that surgical resection of isolated pulmonary metastases is safe and effective in selected PC patients with recurrent disease. 相似文献
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Alberto Briganti Niccolò Passoni Matteo Ferrari Umberto Capitanio Nazareno Suardi Andrea Gallina Luigi Filippo Da Pozzo Maria Picchio Valerio Di Girolamo Andrea Salonia Liugi Gianolli Cristina Messa Patrizio Rigatti Francesco Montorsi 《European urology》2010
Background
Several guidelines have indicated that in patients with well-differentiated or moderately well-differentiated prostate cancer (PCa), a staging bone scan may be omitted. However, the guidelines recommendations have not yet been externally validated.Objective
The aim of the study was to externally validate the available guidelines regarding the need for a staging bone scan in patients with newly diagnosed PCa. Moreover, we developed a novel risk stratification tool aimed at improving the accuracy of these guidelines.Design, setting, and participants
The study included 853 consecutive patients diagnosed with PCa between January 2003 and June 2008 at a single centre. All patients underwent bone scan using technetium Tc 99m methylene diphosphonate at diagnosis.Measurements
The area under the curve (AUC) of the criteria suggested by the guidelines (European Association of Urology, American Urological Association, National Comprehensive Cancer Network, and American Joint Committee on Cancer) to perform a baseline bone scan was assessed and compared with the accuracy of a classification and regression tree (CART) including prostate-specific antigen (PSA), clinical stage, and biopsy Gleason sum as covariates.Results and limitations
The AUC of the guidelines ranged between 79.7% and 82.6%. However, the novel CART model, which stratified patients into low risk (biopsy Gleason ≤7, cT1–T3, and PSA <10 ng/ml), intermediate risk (biopsy Gleason ≤7, cT2/T3, and PSA >10 ng/ml), and high risk (biopsy Gleason >7) was significantly more accurate (AUC: 88.0%) than all the guidelines (all p ≤ 0.002). The limitation of this study resides in its retrospective design. Moreover, the proposed risk stratification tool can be considered only for patients who are candidates for radical prostatectomy until validated in other clinical settings.Conclusions
This is the first study aimed at externally validating the available guidelines addressing the need for staging baseline bone scans in PCa patients. All guidelines showed high accuracy. However, their accuracy was significantly lower compared with the accuracy of the novel risk stratification tool. According to this tool, staging bone scans might be considered only for patients with a biopsy Gleason score >7 or with a PSA >10 ng/ml and palpable disease (cT2/T3) prior to treatment. However, before recommending its use in clinical practice, our model needs to be externally validated. 相似文献6.
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《The Journal of thoracic and cardiovascular surgery》2023,165(3):828-839.e5
ObjectiveMultimodality treatment for resectable non–small cell lung cancer has long remained at a therapeutic plateau. Immune checkpoint inhibitors are highly effective in advanced non–small cell lung cancer and promising preoperatively in small clinical trials for resectable non–small cell lung cancer. This large multicenter trial tested the safety and efficacy of neoadjuvant atezolizumab and surgery.MethodsPatients with stage IB to select IIIB resectable non–small cell lung cancer and Eastern Cooperative Oncology Group performance status 0/1 were eligible. Patients received atezolizumab 1200 mg intravenously every 3 weeks for 2 cycles or less followed by resection. The primary end point was major pathological response in patients without EGFR/ALK+ alterations. Pre- and post-treatment computed tomography, positron emission tomography, pulmonary function tests, and biospecimens were obtained. Adverse events were recorded by Common Terminology Criteria for Adverse Events v.4.0.ResultsFrom April 2017 to February 2020, 181 patients were entered in the study. Baseline characteristics were mean age, 65.1 years; female, 93 of 181 (51%); nonsquamous histology, 112 of 181 (62%); and clinical stages IIB to IIIB, 147 of 181 (81%). In patients without EGFR/ALK alterations who underwent surgery, the major pathological response rate was 20% (29/143; 95% confidence interval, 14-28) and the pathological complete response rate was 6% (8/143; 95% confidence interval, 2-11). There were no grade 4/5 treatment-related adverse events preoperatively. Of 159 patients (87.8%) undergoing surgery, 145 (91%) had pathologic complete resection. There were 5 (3%) intraoperative complications, no intraoperative deaths, and 2 postoperative deaths within 90 days, 1 treatment related. Median disease-free and overall survival have not been reached.ConclusionsNeoadjuvant atezolizumab in resectable stage IB to IIIB non–small cell lung cancer was well tolerated, yielded a 20% major pathological response rate, and allowed safe, complete surgical resection. These results strongly support the further development of immune checkpoint inhibitors as preoperative therapy in locally advanced non–small cell lung cancer. 相似文献