肿瘤患者营养问题不容小觑

肿瘤患者营养不良的发生率高得超出你的想象.流行病学研究显示,大约有1/3的肿瘤发生与营养因素有关,57％的肿瘤患者存在营养不良, 20％患者直接死于营养不良.尤其是头颈、消化道肿瘤患者,营养不良发生率更是远高于其他部位的患者.那种让肿瘤患者少吃饭、低营养从而"饿死肿瘤细胞"的说法,如果不是恶意的"谋杀",也是一种愚蠢的反智行为.     

胎盘部位滋养细胞肿瘤及其诊治

胎盘部位滋养细胞肿瘤(placental site trophoblastic tumor,PSTT)是妊娠滋养细胞肿瘤(gestational trophoblastic neoplasm,GTN)中最为少见的类型,其发生率约为1/10万次妊娠,占所有GTN的1%～2%.Kurman等于1976年首次用"胎盘部位假瘤"描述了这种疾病,当时认为该病为一种良性疾病.1981年,Scully和Young提出该病有恶性潜能,并将其易名为PSTT.     

癌症患者可以“进补”吗?

肿瘤会"饿"死吗?吃补药是否会促进肿瘤生长?许多患者和家属担心吃多了补品或者营养丰富后会为肿瘤的生长提供更多的养分,会使肿瘤细胞疯长,甚至还有人让患者饥饿,想把肿瘤细胞"饿死"。到底癌症患者可不可以"补"呢?让我们听听专家的意见吧。     

乳头内陷多不祥溢液湿疹有文章

张工的儿子在一家医院的辅助科室工作.受儿子工作的影响,她对医学知识较为关注.这不,一个人在家的她正一边看着电视中徐光炜教授的科普讲解,一边同步进行着乳腺自检.她非常仔细,对讲解的任何一个细节都不放过.进行到乳头视诊时,她发现自己左侧的乳头有轻度的内陷.按电视上所讲,这可能是乳腺癌的早期征象.于是她让儿子带她到肿瘤医院检查,最后发现了一个直径只有0.6cm、无法摸到的早期癌.     

专栏寄语

上世纪70年代,美国精神病学和内科学教授O.L.Engel在《科学》杂志上批评当时流行的生物医学模式"仅关注疾病","不能解释并解决所有的医学问题",提出了建立"生物-心理-社会医学模式"的构想。这一观点启发肿瘤界的有识之士对"医学究竟是什么、医学的目的是什么、现代医学技术的发展是否真正改善了肿瘤患者的生存状态"等问题进行了深入的反思。"生物-心理-社会医学模式"使医生们对癌症疼痛及其治疗有了全新的认识,并在世界各地进行了广泛     

胃镜检查救了我一命

提起做胃镜,很多人都是望而却步,我就是如此,觉得那根黑管子从口腔插入是多么难受呀!因此,胃不舒服时只是吃药,不敢检查.当时胃也不疼,只是感觉有点儿"别扭",就是觉得胃里有点儿"揪的慌"(肿瘤在胃壁上没法待着,我认为是"瘤子的根"抓住了胃壁),那个劲儿很特别,反正是胃不太舒服.     

消化道肿瘤——新视角

日前,在北京召开的一次"消化系统肿瘤诊治质量控制"研讨会上,层出不穷的精彩报告从不同角度让人们看到了消化系统肿瘤诊治的新希望。     

质子技术儿童肿瘤治疗的前沿

"现代肿瘤治疗强调的是靶向治疗、个性化治疗、综合治疗,这已经成为肿瘤治疗的三大原则。"在几乎所有的肿瘤高层论坛研讨会上,都可以听到这样的呼吁,而其中,综合治疗又成为了重中之重。确实,对任何一种肿瘤的治疗方法都不应该单兵作战,多兵种的集团军"协作"才能让肿瘤这个强大的"敌人"完败。如今在临床中,医生还是更愿意把目     

初露端倪——演绎ALK阳性非小细胞肺癌的中国故事

记得1999年第一次去美国亚特兰大参加美国临床肿瘤学会(American Society of Clinical Oncology,ASCO)年会,当时将"分子靶向治疗"这个还觉陌生的名词仅仅与细胞和动物联系在了一起,感觉"服一片药代替化疗能够治疗肿瘤"就像"天方夜谭"或"美丽的童话"般遥远。而现实是时隔三年的2002年,第一个肺癌分子靶向治疗药物吉非替尼进入临床实践,此后更多分子靶向药物如雨后春笋般     

第八届肿瘤精准放化疗规范暨全球肿瘤放疗进展论坛(2017)第一轮通知

由北京医学会放射治疗学分会、北京抗癌协会肿瘤放疗专业委员会、北京医师协会放射治疗专科医师(技师)分会、北京大学放射肿瘤学系联合主办,北京大学肿瘤医院承办的2017年国家继续医学教育项目"第八届肿瘤精准放化疗规范暨全球肿瘤放疗进展论坛(2017)定于2017年10月13~15日在北京举办.会议将邀请国内外著名肿瘤专家全面评述2017年度美国放疗年会、美国肿瘤年会、欧洲放疗年会、世界肺癌大会有关肿瘤放疗和综合治疗最新进展,力争让每一位参会者达到"来一次北肿,晓全年进展".会议还将邀请国内外放疗专家共同探讨"胃癌靶区勾画共识".     

Anti-angiogenic therapy for osteosarcoma

Even in tumor centers using established protocols, the survival rate of patients with osteosarcoma has not improved significantly in recent years. Novel therapies are urgently needed as an adjunct to conventional treatment modalities, to reduce the dose and subsequent toxicity associated with current chemotherapy, improve local disease control, prevent development of metastases, and offer an alternative treatment for those tumors that are poorly responsive to chemotherapy. Anti-angiogenic therapy currently holds great potential in conjunction with conventional treatment modalities for osteosarcoma. Specifically, anti-angiogenic factors derived from cartilage, a natural barrier to osteosarcoma invasion, may have important therapeutic applications in osteosarcoma.     

Primary bone osteosarcoma in the pediatric age: state of the art

The current combination treatment, chemotherapy and surgery, has significantly improved the cure rate and the survival rate of primary bone osteosarcoma. The 5-year survival rate has increased in the last 30 years from 10% to 70%. Even in patients with poor prognosis, such as those with metastases at diagnosis, the 5-year survival rate has reached 20-30% due to chemotherapy and the surgical removal of metastases and primary tumor. However, the most effective drugs are still the same as those employed over the last 20 years as front line neoadjuvant or adjuvant chemotherapy: Doxorubicin, Cisplatin, Methotrexate, Ifosfamide. No standard, second line therapy exists for those who relapse. At relapse, due to the lack of new non-cross-resistant drugs, surgery is still the main option when feasible. Other drugs have been employed in relapsed patients with poor results. This article reviews the state of the art of treatment for bone osteosarcoma in the pediatric age.     

microRNA 与骨肉瘤的研究进展

骨肉瘤是好发于儿童和青少年的骨恶性肿瘤,它的第二个好发高峰是在70～80岁的老年人[1]。在美国,每年新发的骨肉瘤患者约为900例[2]。美国癌症中心的数据显示,骨肉瘤患者的5年生存率约为53.9%[3]。新辅助化疗的应用使得骨肉瘤的5年生存率有了明显提高,但是仍有一部分患者对化疗不敏感,同时肿瘤的复发和转移一直是治疗的难题。虽然骨肉瘤相对于其它肿瘤而言较为少见,但是由于它的高致死率和致残率,有关骨肉瘤的基础研究和临床治疗策略一直是医学界的研究热点。之前的研究已经发现骨肉瘤细胞中存在多种遗传学改变,包括染色体结构的异常、缺失等以及肿瘤抑制基因的突变。DNA 的甲基化等表观遗传学的改变也会导致骨肉瘤的发生。尽管有关骨肉瘤的基础研究层出不穷,但是有关microRNAs （ miRNAs ）在骨肉瘤的发生和发展过程中所起的作用仍不是十分明确[4]。     

精准医学时代骨肉瘤诊疗的研究进展

随着组学技术和大数据技术的不断发展和成熟,精准医学在肿瘤领域取得了许多引人注目的成果。骨肉瘤多发于儿童和青少年,是最常见的骨骼系统原发性恶性肿瘤。自20世纪70年代至今,手术切除和药物化疗一直是骨肉瘤的主要治疗手段,高度基因异质性是其生存率停滞的主要原因。精准医学以组学等技术为基础,根据患者的生物学特征进行精确的诊断和治疗方案的定制。精准医学的实践有望为骨肉瘤研究及患者生存率提高提供新的契机。本文拟对精准医学在骨肉瘤治疗中的研究进展作一系统综述,并进一步探讨骨肉瘤精准治疗的前景和方向。      

基因芯片技术及其在骨肉瘤耐药机制研究中的应用

基因芯片技术打破了以往陈旧的研究模式,从系统宏观地研究生物整体基因的表达及功能。骨肉瘤患者化疗过程中肿瘤细胞对化疗药物产生耐药性是引起化疗失败的重要原因之一,其机制复杂,由肿瘤的综合特性决定,对药物的摄取减少和外排增多、DNA损伤修复能力的增强、抗调亡潜能的提高、细胞膜通透性的降低和相关酶活性的变化等都会导致骨肉瘤细胞对化疗药物产生耐药性。利用基因芯片技术从基因水平对骨肉瘤耐药机制进行研究,可以快速检测大量耐药相关基因,作为深入研究骨肉瘤化疗耐药机制有效手段。本文分别对基因芯片的原理、分类和特点,骨肉瘤耐药机制和基因芯片技术在其中的应用进行综述。      

Adjuvant and neoadjuvant chemotherapy for osteosarcoma of the extremities: 27 year experience at Rizzoli Institute, Italy

Around 1148 patients with non-metastatic osteosarcoma of the extremity were treated in a single institution between 1972 and 1999 with 4 different protocol of adjuvant and 7 different protocols of neoadjuvant chemotherapy. The rate of limb salvage increased from 20% to 71%. The 5-year event-free survival (EFS) and overall survival (OS) were 57% and 66%, respectively. The 10-year EFS and OS were 52% and 57%, respectively, and the results significantly correlated with serum alkaline phosphatase levels; the type of chemotherapy (adjuvant vs neoadjuvant); and with histologic response to pre-operative treatment. Aggressive chemotherapy and surgery could cure about the 60% of patients with osteosarcoma of the extremity. However, since local or systemic relapses, myocardiopathies and a second malignancy are possible even 5 or more years since the beginning of treatment, a long-term follow-up is recommended.     

AP化疗方案联合手术治疗原发性骨肉瘤的临床观察

目的探讨AP化疗方案联合手术治疗四肢原发性骨肉瘤的临床效果。方法回顾2008年1月至2011年11月,收治的四肢原发性骨肉瘤30例,病例资料及随访完整的20例患者纳人本研究,男12例,女8例;年龄9～38岁,平均19岁。发病部位：股骨远端10例,胫骨近端7例,肱骨近端3例。根据Enneking外科分期均为IIB期,术前穿刺活检病理亚型：成骨细胞型8例,成软骨细胞型6例,成纤维细胞型2例,小细胞性2例,毛细血管扩张型2例。20例患者均采用AP化疗方案联合手术治疗。结果随访时间12～55个月,平均35．6个月。20例中,保肢手术病例18例,截肢手术病例2例,手术即时保肢率为90％。7例因肺转移而死亡,其中5例死于术后2年内;2例分别在术后10、12个月复发,复发率为10％,末次随访时1例死亡,1例带瘤生存。Kaplan—Meier分析患者3年总生存率为66％。末次随访时规范化疗组12例中死亡3例,生存率为75％（9／12）;不规范化疗组8例中死亡4例,生存率为50％（4／8）。13例存活并保留肢体的患者末次随访时MSTS评分为23～27分,平均25．3分。结论AP化疗方案联合手术治疗四肢原发性骨肉瘤患者生存率和保肢率尚可,可以作为一种选择性应用的骨肉瘤化疗方案。     

Plasma proteome predicts chemotherapy response in osteosarcoma patients

Osteosarcoma is the most common malignant bone tumor that affects hundreds of children and young adults every year. The major prognostic factor in patients with localized osteosarcoma is the development of resistance towards pre-operative chemotherapy. However, modifications of post-operative chemotherapy based on the histological response have not significantly improved the outcome of patients. Thus, it would be of tremendous clinical value if the poor responders could be identified at the time of diagnosis, so that ineffective therapy can be prevented and intensified or alternative therapy could be provided to improve their outcome. We hypothesized that plasma proteomic profiles could be used to distinguish good from poor responders prior to the start of treatment. In order to test this hypothesis, we analyzed the proteomic profiles in two sets of plasma samples (n=54) from osteosarcoma patients collected before (n=27) and after (n=27) pre-operative chemotherapy. Using a linear support vector machine algorithm and external leave-one-out cross validation, we developed two classifiers that classified good and poor responders with an equal accuracy of 85% (p<0.01 after 5000 permutations) in both sets of plasma samples. In order to understand the biological basis of the classifiers, we further identified and validated two plasma proteins, serum amyloid protein A and transthyretin, in the classifiers. Our results suggest that plasma proteomic profiles can predict chemotherapy response before treatment as accurately as after treatment. Our study could lead to the development of a simple blood test that can predict chemotherapy response in osteosarcoma patients. Since the two identified proteins are involved in innate immunity, our findings are corroborated by the notion that boosting the innate immunity in conjunction with chemotherapy, achieves a better anti-tumor activity, thus improving the overall survival of osteosarcoma patients.     

Bortezomib sensitizes human osteosarcoma cells to adriamycin‐induced apoptosis through ROS‐dependent activation of p‐eIF2α/ATF4/CHOP axis

Osteosarcoma is the most common bone cancer, and chemotherapy is currently indispensable for its treatment. Adriamycin has been claimed to be the most effective agent for osteosarcoma, however, the outcome of adriamycin chemotherapy remains unsatisfactory. Here, we reported a potent combination therapy that bortezomib, a proteasome inhibitor, enhances adriamycin‐induced apoptosis to eliminate osteosarcoma cells and we revealed that the activation of p‐eIF2α/ATF4/CHOP axis is the underlying associated mechanisms. First, we observed that bortezomib enhances adriamycin‐mediated inhibition of cell proliferation and enhances the apoptosis in osteosarcoma cell lines. Moreover, this drug combination produced more potent tumor‐growth inhibitory effects in human osteosarcoma cell line KHOS/NP xenografts. Our study showed that reactive oxygen species (ROS) plays an important role in apoptosis induced by adriamycin plus bortezomib, whereas ROS scavenger NAC could almost completely block the apoptosis induced by the combination treatment. Meanwhile, p‐eIF2α is remarkably elevated in the combination group. As a result, ATF4 exhibits strong activation which consequently induces the activation of CHOP and leads to the cell death. Finally, 13 primary osteosarcoma cells demonstrated potent response to the combination treatment. In a human osteosarcoma patient‐derived xenograft (PDX) model, our finding suggests that when combined with bortezomib, a relatively low dose of adriamycin produced more potent tumor‐growth inhibitory effects without increased toxicity. Thus, our findings not only provide a promising combination strategy to overcome osteosarcoma but also shed new light on the strategy of combining increased ROS and inhibited proteasome to open up new opportunities for the clinical development of chemotherapy regimens.     

Combined multimodal therapy for osteosarcoma--neoadjuvant chemotherapy]

Until the 1970s, the survival rate of osteosarcoma patients was less than 20%. By the 1990s, this had improved to 60% to 70%, and limb-sparing procedures have replaced amputation in many patients thanks to effective combination therapy. Neoadjuvant chemotherapy has become an accepted practice in the majority of institutions using protocols which include MTX, ADR, BCD and CDDP as the most active agents against this disease. Newer agents, particularly IFM and ETP, are increasingly incorporated into complex regimens. While several studies have reported multivariate analyses to identify prognostic factors, the histologic response to preoperative chemotherapy remains the most important prognostic factor. Pulmonary metastases are the primary cause of death in patients with osteosarcoma. Although current treatment regimens allow effective salvage therapy for the patients with pulmonary metastases, the actuarial survival rate is 30%. A more effective systemic treatment for those patients is needed. The current management of osteosarcoma is critically reviewed and a treatment strategy is proposed for discussion.