盐酸安罗替尼治疗晚期非小细胞肺癌的临床观察

目的:探讨盐酸安罗替尼治疗晚期非小细胞肺癌(non-small lung cancer,NSCLC)的临床疗效及不良反应。方法:回顾性分析2017年6月至2019年1月徐州医科大学附属医院收治的三线治疗及以上的晚期NSCLC,应用盐酸安罗替尼治疗的45例患者的临床资料,综合评价患者的疗效和无进展生存期(progression-free survival,PFS)以及不良反应情况。结果:共纳入45例患者,将患者分为安罗替尼单药组(24例)与安罗替尼联合用药组(21例),其中联合白蛋白结合型紫杉醇化疗17例,联合纳武单抗免疫治疗4例。在45例患者中,部分缓解(partial remission,PR)占4.4%(2/45),疾病稳定(stable disease,SD)占88.9%(40/45),疾病进展(progressive disease,PD)占6.7%(3/45),客观有效率(objective response rate,ORR)为4.4%,疾病控制率(disease control rate,DCR)为93.3%。45例患者的中位PFS为3.70个月,经log-rank检验结果显示不同治疗方案差异有统计学意义(P<0.05)。其中单药组患者中位PFS为3.30个月,联合用药组患者中位PFS为5.30个月,联合用药组PFS优于单药组。不良反应主要包括乏力、高血压、食欲不振、手足综合征等,其中3级不良事件包括高血压、手足综合征及骨髓抑制,未发现4级及以上的不良事件。结论:盐酸安罗替尼在三线治疗及以上的晚期NSCLC的治疗中,具有较好的疾病控制及生存获益,且不良反应相对可控。     

信迪利单抗联合盐酸安罗替尼用于晚期非小细胞肺癌疗效研究

目的 探讨信迪利单抗联合盐酸安罗替尼用于晚期非小细胞肺癌疗效研究.方法 回顾性选取2020年1月至2021年7月池州市人民医院收治晚期非小细胞肺癌患者56例作为研究对象,根据治疗方法不同将患者分为对照组(n=32)和观察组(n=24).对照组采用信迪利单抗+化疗,观察组采用信迪利单抗+盐酸安罗替尼治疗.观察两组患者治疗...     

培美曲塞联合顺铂治疗晚期卵巢癌的临床研究

目的探讨培美曲塞联合顺铂治疗晚期卵巢癌的临床疗效及安全性。方法 53例晚期卵巢癌患者,给予培美曲塞500 mg/m2,第1天,静脉滴注;同时给予顺铂30 mg/m2,第1~3天,静脉滴注〉2 h,28 d为1个周期,治疗2~4个周期。治疗满2个周期后评价临床疗效、不良反应、生存时间、疾病进展时间,同时进行生活质量评分及KPS评分。结果治疗有效率为49.06%,平均疾病进展时间为8.52个月,平均生存时间为15.01个月。治疗前KPS评分为（64.5±5.0）分,明显低于治疗后（78.2±6.6）分。治疗后功能评分、症状评分、整体生活质量评分较治疗前均有显著改善。结论培美曲塞联合顺铂是治疗晚期卵巢癌的有效治疗方案,不良反应耐受较好。     

晚期上皮性卵巢癌腹膜后淋巴结清扫的临床价值

目的评价腹膜后淋巴结清扫对晚期上皮性卵巢癌预后的影响。方法将67例晚期上皮性卵巢癌患者随机分为研究组32例及对照组35例。研究组行卵巢肿瘤细胞减灭术+术后规范化疗,对照组行卵巢肿瘤细胞减灭术+腹膜后淋巴结清扫术+术后规范化疗,对比2组手术时间、术中出血量、术后病率及术后1、3、5年生存率的差异。结果研究组术中出血量、手术时间、术后病率均显著小于对照组。2组1、3、5年生存率均无显著差异;而2组术后残留癌灶<1.0 cm的患者3、5年生存率均显著高于同组残留癌灶≥1.0 cm的患者。结论理想的肿瘤减灭术是影响晚期上皮性卵巢癌患者预后的重要因素,而腹膜后淋巴结清扫不能提高晚期上皮性卵巢癌的生存率,反而使围手术期的并发症显著提高。     

Hand-assisted laparoscopic versus laparoscopic-assisted radical gastrectomy in the treatment of advanced distal gastric cancer: final results of a single-center randomized study

ObjectiveTo compare the results and 5- and 8-year overall survival (OS) and disease-free survival (DFS) of hand-assisted laparoscopic surgery (HALS) and laparoscopic-assisted surgery (LAS) in radical gastrectomy for advanced distal gastric cancer.MethodsA total of 124 patients admitted to our institution from May 2009 to April 2013 were randomly divided into a HALS group (n = 62) and a LAS group (n = 62). Postoperatively, 110 patients were followed for 5 and 8 years, and 14 patients were lost to follow-up. The 5- and 8-year OS and DFS rates of the groups were compared and analyzed.ResultsThe 5- and 8-year OS rates, respectively, were 38.8% and 19.4% in the HALS group and 38.3% and 15.3% in the LAS group (log-rank test, χ² = 0.250). The 5- and 8-year DFS rates, respectively, were 23.1% and 10.6% in the HALS group and 19.3% and 11.6% in the LAS group (log-rank test, χ² = 0.109). No significant differences were found.ConclusionCompared with LAS, HALS radical gastrectomy for advanced distal gastric cancer had a lower conversion rate to open surgery, shorter surgical duration, and more thorough dissection of lymph nodes; 5- and 8-year OS and DFS rates were similar to those with LAS.     

晚期上皮性卵巢癌、输卵管癌、原发性腹膜癌患者新辅助化疗后Ki-67表达与预后的相关性分析

目的 分析晚期上皮性卵巢癌、输卵管癌、原发性腹膜癌患者新辅助化疗后Ki-67水平与患者预后的关系.方法 回顾性收集重庆医科大学附属第一医院2017年1月至2019年6月接受新辅助化疗联合间期肿瘤细胞减灭术的晚期上皮性卵巢癌、输卵管癌、原发性腹膜癌患者的病历资料,对其临床病理特征、术后病理标本中卵巢癌组织Ki-67表达情...     

Gingival metastasis from primary hepatocellular carcinoma: a case report

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide; however, cases with metastasis to the oral cavity are extremely rare. Herein, we report a 68-year-old man who was diagnosed with HCC. Ten months after surgical removal of the right half of his liver, the patient developed gingival metastasis. Unfortunately, the patient died 4 months after the diagnosis. We discuss treatment options, pathological results, and disease prognosis. When a mandibular gingival mass is found, metastatic tumors should be considered in the differential diagnosis. In this regard, the patient’s medical history and physical examination are valuable indicators for the diagnosis of mandibular gingival metastasis. This case provides a basis for the clinical diagnosis of metastatic HCC involving the oral cavity.     

对症支持护理在晚期卵巢癌患者中的应用效果

目的研究对症支持护理在晚期卵巢癌患者中的应用效果。方法选择2016年2月至2018年2月我院收治的120例晚期卵巢癌患者作为研究对象,以随机数字表法将其分为对照组和观察组,各60例。对照组在化疗期间给予常规性的护理,观察组在对照组的基础上进行对症支持护理。观察并记录两组患者的护理效果。结果观察组患者的焦虑和抑郁发生率均低于对照组(P<0.05)。护理后,两组患者的生活质量评分均升高,且观察组患者的生活质量评分高于对照组,差异具有统计学意义(P<0.05)。护理后,观察组患者的不良反应总发生率显著低于对照组(P<0.05)。护理干预后,观察组的护理满意度显著高于对照组(P<0.05)。结论将对症支持护理用于晚期卵巢癌患者,可以有效地缓解患者的焦虑以及抑郁情绪,提高其生活质量,降低不良反应发生率,提高患者的护理满意度,值得推广运用。     

晚期非小细胞肺癌患者肿瘤突变负荷与靶向治疗疗效相关性

目的:探讨晚期非小细胞肺癌肿瘤突变负荷(TMB)与肿瘤靶向治疗疗效的相关性。方法:纳入2016年1月至2018年1月在复旦大学附属中山医院行靶向治疗的51例晚期非小细胞肺癌患者,采用靶向二代测序技术检测其肿瘤组织标本的TMB水平,并分析TMB与靶向治疗疗效的相关性。结果:51例非小细胞肺癌患者的中位TMB水平为6.2个突变/Mb,其中吸烟患者的TMB水平较不吸烟患者升高(P=0.046)。将所有入组患者分为高TMB组和中低TMB组,生存分析显示:与高TMB组相比,中低TMB组患者的无进展生存期(PFS)更长(410 d vs 217 d, HR=0.331, 95%CI 0.165～0.665,P=0.001 2)。亚组分析显示:在男女性、有无吸烟史、合并TP53基因突变与否患者中,中低TMB组者的中位PFS均长于高TMB组患者(P0.05);在腺癌、表皮生长因子受体(EGFR)突变、EGFR 19外显子缺失、EGFR L858R患者中,中低TMB组患者的中位PFS也长于高TMB组患者(P0.05)。结论:对于具有驱动突变的晚期非小细胞肺癌患者,肿瘤组织TMB水平对靶向治疗疗效具有预测作用,高TMB水平提示靶向治疗患者的PFS更短。     

Case report of penile cancer recurrence treated with cetuximab combined with anlotinib

Penile squamous cell carcinoma with pelvic lymph node metastases/recurrence has a poor prognosis. We reported a case with recurrent pSCC was administered cetuximab and anlotinib after failure of first‐line treatment and achieved an effective response. Cetuximab combined with anlotinib may be a new choice for relapsed pSCC.     

The rise of genomic profiling in ovarian cancer

Introduction: Next-generation sequencing and advances in ‘omics technology have rapidly increased our understanding of the molecular landscape of epithelial ovarian cancers.

Areas covered: Once characterized only by histologic appearance and clinical behavior, we now understand many of the molecular phenotypes that underlie the different ovarian cancer subtypes. While the current approach to treatment involves standard cytotoxic therapies after cytoreductive surgery for all ovarian cancers regardless of histologic or molecular characteristics, focus has shifted beyond a ‘one size fits all’ approach to ovarian cancer.

Expert commentary: Genomic profiling offers potentially ‘actionable’ opportunities for development of targeted therapies and a more individualized approach to treatment with concomitant improved outcomes and decreased toxicity.     

The association between allogeneic perioperative blood transfusion on tumour recurrence and survival in patients with advanced ovarian cancer

Objective: To evaluate the association between perioperative blood transfusion on the recurrence and survival of patient with advanced ovarian cancer. Background: Cytoreductive surgery for ovarian cancer can be an extensive procedure often requiring allogeneic blood transfusions. Blood transfusions can have detrimental effects on immune function which can lead to a decrease in the organism ability to detect and destroy metastasis. Methods: The study was a retrospective cohort investigation. Patients with advanced ovarian cancer (stage III) undergoing cytoreductive surgery were stratified by the need for perioperative blood transfusion. Allogeneic transfusions were non‐leucodepleted. Primary outcome included time to recurrence and survival. Data were extracted from the gynaecology oncology database at Northwestern University. Times to event outcomes were evaluated by constructing Kaplan–Meyer curves and Cox regression. Results: The charts of 136 subjects were evaluated. Seventy‐six received blood transfusion. Median [95% confidence interval (CI)] time to recurrence for the non‐transfusion group was longer, i.e. 17 (6–27) months, compared to 11 (8–14) months for the transfused group (P = 0·03). Median (95% CI) survival following surgery was longer in the non‐transfused group, i.e. 58 (43–73) months, compared to 36 (28–44) months for the transfused group (P = 0·04). Cox regression showed that transfused subjects had shorter median times to recurrence and mortality after adjusting for age and tumour grade. Conclusions: There is an association between ovarian cancer recurrence and allogeneic perioperative blood transfusion in patients with advanced ovarian cancer undergoing cytoreductive surgery. These findings may have important implications in the perioperative management of those patients.     

Application of neoadjuvant chemotherapy combined with anlotinib in occult breast cancer: A case report and review of literature

BACKGROUNDOccult breast cancer (OBC) is a special type of breast cancer presenting as axillary lymph node metastasis with undetectable primary lesions in the breast. Due to its low incidence and unique clinical manifestations, there is a lack of consensus on the diagnosis and treatment of OBC. We report a case of OBC treated with neoadjuvant chemotherapy combined with anlotinib. The treatment was well tolerated, and the patient achieved a pathologic complete response.CASE SUMMARYA 53-year-old woman presented with a lump in her right axillary area with no primary lesions in the breast. Pathological biopsy confirmed right axillary metastatic carcinoma. Immunohistochemical staining results were positive for progesterone receptor, cytokeratin 7, specific breast markers GATA3 and gross cystic disease fluid protein-15. Tumor cells were negative for estrogen receptor, human epidermal growth factor receptor-2, cytokeratin 5/6, cytokeratin 20, and villin. The patient was diagnosed with OBC, and she underwent neoadjuvant chemotherapy combined with anlotinib. Mastectomy plus axillary lymph node dissection was performed. The patient achieved pathologic complete response with no residual invasive tumor cells in the breast or axillary lymph nodes. Postoperatively, she received adjuvant radiotherapy and endocrine therapy.CONCLUSIONNeoadjuvant chemotherapy and anlotinib had good efficacy and safety in the treatment of OBC and may be a new therapeutic option.     

Dementia with non-convulsive seizures: a case report

Non-convulsive seizures (NCSs) are highly treatable, but appropriate management is usually delayed because of inaccurate diagnoses as a result of variable clinical presentations, including an altered mental state. It is difficult to detect NCSs in patients with dementia. We report a case of NCS superimposed on cognitive decline caused by Alzheimer’s dementia. The patient’s history was carefully recorded. An electroencephalogram was recorded with sphenoidal electrodes, which showed epileptiform discharges in the right mesial temporal lobe and focal, sharply contoured, slow wave activity in the left fronto-temporal area, suggesting an epileptic origin contributing to the patient’s cognitive decline. After treatment with antiepileptic drugs, the patient’s cognitive functioning gradually improved. An accurate diagnosis of NCS relies on performing a detailed inventory of a patient’s history, thorough physical and neurological examinations, and electroencephalogram recordings. In patients with cognitive decline, testing for NCS should always be included in the differential diagnosis of cognitive impairment, even in the case of dementia. Early administration of antiepileptic drug therapy is the mainstay treatment for reversing the condition and for preventing prolonged insults from neurological sequelae.     

Long-term follow-up and successful treatment of pulmonary alveolar proteinosis without hypercholesterolemia with statin therapy: a case report

Pulmonary alveolar proteinosis (PAP) is a rare disorder characterized by the accumulation of excessive surfactant lipids and proteins in alveolar macrophages and alveoli. Oral statin therapy is a novel treatment for PAP with hypercholesterolemia. However, this treatment has never been described in a patient without hypercholesterolemia. Here, we present a case of successful treatment with atorvastatin for a patient with possibly unclassified PAP without hypercholesterolemia who responded poorly to whole lung lavage therapy and inhaled granulocyte-macrophage colony-stimulating factor. After 18 months of atorvastatin treatment, the patient experienced improvements in dyspnea, radiographic abnormalities and pulmonary function. The present case study supports the feasibility of statin therapy for PAP regardless of the level of cholesterol.     

安罗替尼联合多西他赛二线治疗晚期非小细胞肺癌疗效观察

目的 观察晚期非小细胞肺癌患者应用安罗替尼联合多西他赛二线治疗后血清癌胚抗原(carcino-embryonic antigen,CEA)、血管内皮细胞生长因子(vascular endothelial growth factor,VEGF)水平变化,探讨其治疗效果及安全性.方法 60例晚期非小细胞肺癌患者依据治疗方法...     

腹腔微环境与卵巢上皮性癌腹腔转移关系的研究

目的：探讨腹腔微环境与卵巢上皮性癌腹腔转移关系的研究。方法采用 RT-PCR 法及免疫组化法检测卵巢上皮性癌组织相应趋化因子受体及其配体的表达情况,腹膜组织相应配体的表达情况,以揭示趋化因子介导上皮性卵巢癌腹腔内转移机制。结果趋化因子受体 CXCR4在卵巢上皮性癌组织中表达明显高于其他趋化因子受体表达（P ＜0．01）;趋化因子受体 CX-CR4的配体 SDF-1在上皮性卵巢癌组织和腹膜中均高表达。结论趋化因子 SDF-1及其受体 CXCR4在卵巢癌组织中高表达,通过自分泌作用,可能刺激卵巢癌细胞的过度生长;SDF-1在腹膜组织高表达,通过旁分泌作用,可能介导表达 CXCR4的卵巢癌细胞向腹腔内转移。     

尊严疗法在晚期癌症患者中应用的研究进展

随着医学技术的发展,癌症患者的生命终末期可能延长,但并未明显成功提高癌症的治愈率[1]。晚期癌症患者生命的延长,患者身体机能日益衰退,生存质量日益下降,对照顾者的生活依赖程度愈加强烈。同时患者的隐私不受保护,自我价值逐渐丧失,从而使患者的自尊心下降、尊严受损[2]。研究报道[3],我国晚期癌症患者的尊严丧失率53.3%~63.3%,较CHOCHINOV等[4]报道的5.3%~7.5%高。尊严作为安宁疗护的哲学基础,是患者心理健康的重要组成部分[5],但我国安宁疗护重在改善患者的躯体症状和疼痛控制,对心理支持方面相对欠缺[6]。CHOCHINOV等[7]于2005年在尊严模型为理论框架的基础上提出尊严疗法。尊严疗法作为安宁疗护中一种较新颖的心理干预方法,在改善尊严感、心理健康和整体生化质量方面显示出较好的效果[8]。国外对尊严疗法的研究已较成熟,但在我国还处于初级探索阶段,因此本研究对尊严疗法展开综述,以期为临床护理提供参考,现报道如下。     

Uniportal video-assisted thoracic surgery and perioperative pirfenidone for lung cancer and idiopathic pulmonary fibrosis: a case report

Patients with idiopathic pulmonary fibrosis (IPF) occasionally experience acute exacerbations after surgery for lung cancer. Several recent studies have revealed a prophylactic effect of perioperative pirfenidone treatment on postoperative acute exacerbations of IPF in patients with lung cancer. A 75-year-old woman consulted with her pulmonologist because of an IPF shadow detected by follow-up chest computed tomography 2 months after surgical treatment of biliary cancer. Another 7 months later, chest computed tomography showed a 23- × 14-mm nodule located in the right lower lobe with high accumulation of fluorodeoxyglucose detected by positron emission tomography, resulting in a radiological diagnosis of primary lung cancer with IPF. We administered perioperative pirfenidone treatment followed by right lower lobectomy using uniportal video-assisted thoracoscopic surgery after attaining a pathological diagnosis of adenocarcinoma. The patient developed no acute exacerbations of IPF during the postoperative period, and she had no recurrence of lung cancer for 15 months after surgery. We successfully used a combination of perioperative antifibrotic medication and minimally invasive surgery after lung cancer surgery in a patient with IPF.     

降期转化联合手术治疗卵巢癌肝转移1例并文献复习

目的 探讨降期转化联合手术治疗方案对卵巢癌肝转移患者的有效性和可行性.方法 回顾1例67岁卵巢癌肝转移患者的诊疗经过,患者2018年12月就诊于广州中医药大学第一附属医院妇科中心,经妇科、肝胆外科、肿瘤科等多学科联合会诊拟定具体治疗方案.结果 经"新辅助化疗-原始肿瘤减灭术-辅助化疗-靶向药物-肝转移灶切除术"一系列治...