晚期和复发子宫内膜癌的化疗

晚期和复发子宫内膜癌的化疗@章文华 @王桂香 @李洪君 @李晓光 @刘丽影 @李淑敏 @洪婉君~~子宫内膜肿瘤/药物疗法;;子宫内膜肿瘤/外科学;;子宫内膜肿瘤/放射疗法~~     

腹腔镜与开腹手术治疗早期子宫内膜癌的手术疗效及患者术后生活质量对比

目的 探讨腹腔镜与开腹手术治疗早期子宫内膜癌的手术疗效及患者术后生活质量.方法 根据患者意愿将60例早期子宫内膜癌患者分为腹腔镜手术组(n=35)和开腹手术组25例,分析2组患者围手术期指标、手术并发症、术后功能恢复情况.结果 腹腔镜组患者相较于开腹组患者术中出血量少、术后肛门排气时间短、镇痛药使用比例低、术后住院时间短以及盆腹腔引流量少,2组相比具统计学意义(P<0.05).腹腔镜手术组患者术中并发症发生率为2.9%,术后并发症发生率为11.4%;开腹组患者术中并发症发生率为12.0%,术后并发症发生率为36.0%.2组患者手术相应并发症发生率差异具统计学意义(P<0.05).腹腔镜组患者术后性功能评分降低较小,与术前相比较差异不具统计学意义(P>0.05);开腹组患者术后性功能评分降低显著,与术前相比较差异具统计学意义(P<0.05);术后性功能评分降低程度组间比较差异具统计学意义(P<0.05).腹腔镜组患者术中生活质量改善总有效率为88.6%,相较于开腹组总有效率为80.0%,差异具统计学意义(P<0.05).结论 腹腔镜应用于早期子宫内膜癌可显著降低术中出血量,术后患者恢复快,性功能及生活质量改善显著,临床疗效值得肯定.     

醋酸甲地孕酮对子宫内膜癌化疗的康复作用

[目的]观察国产醋酸甲地孕酮在子宫内膜癌化疗康复中的作用。[方法]将确诊为子宫内膜癌且具化疗适应证的患者60例。随机分为治疗组（化疗合用醋酸甲地孕酮）和对照组（单纯化疗），观察两组患者治疗期间及化疗后食欲和体重的变化、胃肠道反应等。[结果]治疗组患者56．7％食欲增加，60％体重增加，KPS评分增加〉10分者占63．3％；对照组仅6．7％食欲增加。13．3％体重增加，KPS评分增加〉10分者占10％，两组间有显著性差异（P〈0．01）。两组间胃肠道反应及骨髓抑制亦存在显著性差异（P〈0．01）。[结论]醋酸甲地孕酮可减轻化疗的副作用，提高食欲，增加体重。提高患者的生活质量。是晚期子宫内膜癌患者有效的辅助治疗药物。     

联合化疗治疗晚期子宫内膜癌的临床分析

本组应用卡铂.阿霉素.环磷酰胺治疗晚期子宫内膜癌9例。近期疗效尚好,近期总有效率为66.6％。毒付作用小。现介绍如下:临床资料病例来源:收集1990年～1992年7月晚期子宫内膜癌9例。均有病理诊断证实为腺癌,有明显的临床表现及明确的 B 超,X 线检查资料,观察指标可评价疗效。     

分层次个性化健康干预在子宫内膜癌术后化疗患者中应用效果

目的 探讨分层次个性化健康干预在子宫内膜癌术后化疗患者中应用效果.方法 依据干预方法将84例子宫内膜癌患者分为对照组(n=41)和研究组(n=43),对照组患者给予常规健康指导,观察组患者在此基础上给予分层次个性化健康干预.比较两组患者胃肠功能恢复时间、健康知识掌握程度、自我照护能力、生活质量、患者满意度及复发情况.结果 研究组患者的胃肠功能恢复时间明显短于对照组(P﹤0.01).干预后,两组患者知识测评、自护技能、自护责任感、自护概念评分及健康知识掌握程度评分均高于本组干预前(P﹤0.05),且研究组患者知识测评、自护技能、自护责任感、自护概念评分及健康知识掌握程度评分均高于对照组(P﹤0.05).干预后,研究组患者生理功能、社会功能及躯体功能评分均高于本组干预前和对照组(P﹤0.01).研究组患者健康指导、服务态度、基础干预、指导干预技术、患者安全评分均明显高于对照组(P﹤0.05).研究组患者的复发率为4.65％,低于对照组患者的24.39％(P﹤0.05).结论 分层次个性化健康干预可有效提高子宫内膜癌术后化疗患者的生活质量、自我照护能力,降低复发率,患者满意度高.     

化疗对肺癌患者生活质量的影响

背景与目的随着现代医学的发展,不仅要求医护人员要消除患者病痛和心理障碍,还要提高患者生活质量。本研究探讨化疗对肺癌患者生活质量的影响及其影响因素。方法随机抽取住院化疗的肺癌患者61例,分别于化疗前、化疗2周期后1周内、化疗4周期后1周内评估临床疗效,并进行肺癌患者生活质量量表(EORTC QLQ-30)问卷调查。结果化疗2周期后化疗有效率40%,患者社会功能下降,恶心、呕吐、失眠、厌食症状加重(P<0.05)。化疗4周期后化疗有效率23%,患者化疗后躯体、角色、情绪、社会功能降低,恶心呕吐、食欲减退、失眠症状加重,经济困难较化疗前加重(P<0.05)。生活质量影响因素分析:女性较男性易疲倦、食欲减退(P<0.05)。文化程度低者较文化程度高者易失眠、疲倦(P<0.05)。老年患者较中年人更易出现疲倦、食欲减退、恶心呕吐(P<0.05)。按体重指数分为消瘦、正常、超重三组,三组比较生活质量无明显统计学差异(P>0.05)。按血浆白蛋白水平分为低白蛋白组及正常白蛋白组,两组比较生活质量无明显统计学差异(P>0.05)。但前组症状及经济困难得分较高,后组功能领域及总体健康状况得分较高。结论化疗可使肺癌患者肿瘤减小,临床症状缓解,但化疗后患者易疲劳、纳差、恶心呕吐加重,患者情绪较差,生活质量降低,应注重患者化疗不良反应并及时予处理,加强对患者的心理疏导,增加患者的营养,提高患者的生活质量。     

认知行为干预对子宫内膜癌手术患者心理状态、自我效能及生活质量的影响

目的 探讨认知行为干预对子宫内膜癌(EC)手术患者心理状态、自我效能及生活质量的影响.方法 将接受手术治疗的127例子宫内膜癌患者根据干预方案不同分为对照组(n=66,接受常规干预)和观察组(n=61,接受常规干预+认知行为干预).比较两组患者干预前后的心理状态、自我效能、生活质量改善情况并分析干预效果的影响因素.结果 两组患者术中出血量、术后抗生素使用时间比较,差异均无统计学意义(P﹥0.05);观察组患者术后住院时间明显短于对照组(P﹤0.01).干预后,两组患者的焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分均明显低于本组干预前,自我效能感量表(GSES)评分明显高于本组干预前,差异均有统计学意义(P﹤0.01);且观察组患者的SAS、SDS评分均明显低于对照组,GSES评分明显高于对照组,差异均有统计学意义(P﹤0.01).干预后,两组患者生活质量(QOL)评分量表各维度评分均明显高于本组干预前(P﹤0.01),且观察组患者QOL量表各维度评分均明显高于对照组(P﹤0.01).Logistic回归模型分析结果显示,年龄≥65岁、文化程度为小学及以下、SAS评分≥50分、SDS评分≥53分、GSES评分﹤30分、QOL评分﹤76分均是EC患者不良干预效果的独立危险因素(P﹤0.05).结论 认知行为干预可改善EC手术患者负性情绪,提高患者的自我效能及生活质量,是一种具有应用前景的新干预模式,可在临床进行推广.     

改良DCF化疗方案与SOX化疗方案治疗晚期胃癌对患者生活质量的影响

目的 考察改良DCF方案与SOX方案对晚期胃癌患者的影响.方法 晚期胃癌患者分为DCF组和SOX组.DCF组给予改良DCF化疗方案化疗,SOX组给予SOX化疗方案化疗.对比2组患者短期治疗有效率、不良反应严重程度和生活质量差异.结果 2组患者短期治疗有效率差异无统计学意义(P>0.05).DCF组患者白细胞减少、血小板减少及恶心呕吐等不良反应较SOX组更为严重(P<0.05).SOX组患者治疗后生活质量显著优于DCF组(P<0.05).结论 对胃癌患者,SOX化疗能够明显缩小肿瘤病灶,改善生活质量,同时化疗中安全性好.     

PTEN expression is associated with prognosis for patients with advanced endometrial carcinoma undergoing postoperative chemotherapy

The prognostic significance of PTEN expression in endometrial carcinoma has not been clear. We conducted the present study to clarify the relationship between PTEN expression and prognosis in advanced endometrial carcinoma. Of 784 patients with endometrial carcinoma who underwent primary treatment between 1985 and 2000 at 5 institutions, 98 pure endometrioid carcinomas with retroperitoneal lymph node metastasis were provided for our study. PTEN expression was determined by immunohistochemic staining. Negative or mixed PTEN staining was observed in 64 (65.3%) patients. The survival rate for PTEN-positive patients was significantly higher than that for PTEN-negative or -mixed patients. PTEN-staining status was not associated with patient age, International Federation of Gynecology and Obstetrics (FIGO) stage, myometrial invasion or histologic grade. Of the 98 patients, 87 received radiation therapy (n = 25) or chemotherapy (n = 62) after surgery. PTEN expression did not relate to survival for patients receiving radiation therapy. In contrast, the survival rate for PTEN-positive cases was significantly higher than that for PTEN-negative or -mixed cases when patients underwent chemotherapy (62.4% vs. 11.8%). Subsequent multivariate analysis revealed that PTEN staining was an independent prognostic factor for patients undergoing chemotherapy. PTEN-positive staining was a significant prognostic indicator of favorable survival for patients with advanced endometrial carcinoma who underwent postoperative chemotherapy.     

局部晚期鼻咽癌同期放化疗患者营养状况与生活质量的相关性研究

目的分析局部晚期鼻咽癌患者治疗期间营养状况,探讨营养状况与生活质量的相关性。方法采用调查问卷对136例局部晚期鼻咽癌同期放化疗患者分别在治疗前及治疗第14天、第28天、第42天、第56天、治疗后3、6个月进行营养状况、生活质量评价,并分析营养状况与生活质量之间的相关性。结果患者在治疗期间均发生不同程度的营养不良,且持续到治疗结束后6个月。多因素分析显示,患者的总体健康状况、认知功能、止痛药物、情绪功能、疲劳、腹泻、口干、唾液黏稠、食欲丧失和失眠等因素与营养状况密切相关（P〈0．01）。结论局部晚期鼻咽癌同期放化疗患者治疗期间普遍存在不同程度的营养不良,并与生活质量中的多个维度密切相关。     

索拉非尼对中晚期肝细胞癌患者的影响

目的：观察中晚期肝细胞癌患者索拉非尼治疗后药物相关性不良反应的发生率,并评价服药后6个月的疗效及对患者生活质量的影响。方法：对36例服用索拉非尼的肝细胞癌患者所发生的药物相关性不良反应进行分级、记录与统计分析。按照RECIST标准评价服药6个月后的疗效。EORTC QLQ-C30量表评估索拉非尼治疗前与治疗后6个月患者的生活质量。结果：患者服用索拉非尼后出现手足皮肤反应、腹泻、皮疹、高血压等不良反应。患者服药6个月后总反应率为75％。经索拉非尼治疗后患者在躯体、角色、认知、情绪及社会功能评分有所上升,有统计学差异（ P＜0.05）。除腹泻外其他症状评分均有下降,有统计学差异（ P     

长春瑞滨联合铂类治疗中晚期子宫内膜癌

目的：比较长春瑞滨和紫杉醇分别与铂类联合治疗中晚期子宫内膜癌的近期疗效及毒副反应。方法：33例晚期子宫内膜癌，治疗组（NP方案组）21例，长春瑞滨＋顺铂或卡铂化疗，长春瑞滨25mg／m^2，静注d1、8；顺铂25mg／m^2，静注d1～3，或卡铂（300mg／m^2或者AUC4～5）静脉滴注d1。对照组（TP方案组）12例：紫杉醇135～150mg／m^2，静注d1；顺铂或卡铂用法同前。结果：全组均完成2周期以上化疗，其中CR4例．PR14例，NC10例，PD5例。有效率（CR＋PR）54．54％。NP方案组，CR2例，PR9例，有效率（CR＋PR）52．38％；TP方案组，CR2例，PR5例，有效率（CR＋PR）58．33％，两组间无统计学差异（P〉0．05）。副反应主要为骨髓抑制、白细胞、血小板减少，Ⅲ～Ⅳ度发生率，NP组为71．43％，TP组为75．0％（P〉0．05）。结论：长春瑞滨＋铂类联合与紫杉醇＋铂类联合化疗治疗中晚期子宫内膜癌有相同的疗效且毒副反应可以耐受。     

The effect of chemotherapy on health-related quality of life in mesothelioma: results from the SWAMP trial

Background:

The effect of chemotherapy on health-related quality of life (HRQoL) in malignant pleural mesothelioma (MPM) is poorly understood. Patient-individualised prognostication and prediction of treatment response from chemotherapy is useful but little evidence exists to guide practice.

Method:

Consecutive patients with MPM who were fit for first-line chemotherapy with pemetrexed and cisplatin\carboplatin were recruited and followed up for a minimum of 12 months. This study focussed on the HRQoL outcomes of these patients using the EQ-5D, EORTC QLQ-C30 and LC13.

Results:

Seventy-three patients were recruited of which 58 received chemotherapy and 15 opted for best supportive care (BSC). Compliance with HRQoL questionnaires was 98% at baseline. The chemotherapy group maintained HRQoL compared with the BSC group whose overall HRQoL fell (P=0.006) with worsening dyspnoea and pain. The impact of chemotherapy was irrespective of histological subtype although those with non-epithelioid disease had worse HRQoL at later time points (P=0.012). Additionally, those with a falling mesothelin or improvement on modified-RECIST CT at early follow-up had a better HRQoL at 16 weeks.

Conclusions:

HRQoL was maintained following chemotherapy compared with a self-selected BSC group. Once chemotherapy is initiated, a falling mesothelin or improved RECIST CT findings infer a quality-of-life advantage.     

Assessment of long-term quality of life in patients with anal carcinomas treated by radiotherapy with or without chemotherapy.

This study was conducted to assess long-term Quality of Life (QOL) in patients treated by radiotherapy with or without chemotherapy for anal carcinomas. Patients with a maximum age of 80 years, and who were alive at least 3 years following completion of treatment with a functioning anal sphincter and without active disease, were selected for this study. Of 52 such patients identified, 41 (79%) were evaluable. There were 35 females and six males with a median age of 71 years (55-80). The median follow-up interval was 116 months (range 37-218). QOL was assessed using two self-rating questionnaires developed by the European Organization for Research and Treatment of Cancer: one for cancer-specific QOL (EORTC QLQ-C30) and one for site-specific QOL (EORTC QLQ-CR38). For the function scales a higher score represents a higher level of functioning (100 being the best score), whereas for the symptom scales a higher score indicates a higher level of symptomatology/problems (0 being the best score). For the QLQ-C30, the functional scale scores ranged from 71 (global quality of life) to 85 (role function) and the symptom scale scores from 6 (nausea-vomiting) to 28 (diarrhoea). For the QLQ-CR38 module the functional scale scores ranged from 13 (sexual functioning) to 74 (body image) and for the symptom scale scores from 5 (weight loss) to 66 (sexual dysfunction in males). None of the functional and symptom scale scores seemed to be better in patients with longer follow-up. In patients treated with sphincter conservation for anal carcinomas, long-term QOL as measured by the EORTC QLQ-C30 and QLQ-CR38 appears to be acceptable, with the exception of diarrhoea and perhaps sexual function. Moreover, the subset of patients who presented with severe complications and/or anal dysfunction showed poorer scores in most scales.     

Effect of Intermittent Androgen Blockade on the Quality of Life of Patients with Advanced Prostate Carcinoma

OBJECTIVE To investigate the effect of intermittent androgen blockade (IAB)on the quality of life(QOL)of patients with advanced prostatic carcinoma(APC). METHODS Investigations on the QOL of 51 APC patients receiving IAB treatment,totaling 3 times,i.e.6 months before and after,and 12 months after treatment,were perform using the EORTC QLQ-C30 measuring scale and QLQ-PR25 scale. RESULTS Although IAB became an economic burden for the families,it was lessened during the intermission(P<0.05).The overall health status significantly improved 6 months after IAB treatment(P<0.01),especially during the intermission(P<0.05),with a total or local easement of pain(P<0.01)and an improvement of urinary function(P<0.01).Although there was impairment, to various degrees,in many functions of the patients on the 6th month of treatment,such as the physical function(P<0.05),role function(P<0.05),the emotional(P<0.01)and the social functions(P<0.01),with an enhancement of fatigue(P<0.01),these functions gradual y recovered by the 12th month as the intermission started.Treatment-related symptoms such as flushing and mammary swel ing significantly emerged on the 6th treatment month (P<0.01),and lessened on the 12th(P<0.01).During the treatment period, there was an notable drop in sexual interest(P<0.01),with a deprivation of sex life,but revived to various degrees during the intermission(P<0.01). CONCLUSION Although IAB treatment of APC patients did impair the physiologic and psychologic status of patients to varying degrees,these were improved and restored during the intermission.     

化疗对老年肿瘤患者生活质量的影响

目的研究化疗对65岁以上的老年肿瘤患者生活质量的影响。方法采用欧洲癌症研究和治疗组织的生命质量测定量表QLQ-C30（V3．0）中文版对我院94例≥65岁的老年肿瘤患者进行问卷调查,同时进行卡氏行为状态评分。其中辅助组38例,姑息组56例。在化疗前、化疗第3个周期后分别进行测定并进行比较。结果全体患者化疗3个周期后生活质量评分显示：恶心呕吐、便秘的症状较治疗前有显著性加重评分增高,但疼痛减轻评分下降（P〈0．05）;5项功能（躯体功能、角色功能、认知功能、情绪功能、社会功能）、其他症状（疲乏、睡眠、食欲下降、呼吸困难、腹泻、经济困难）和整体生活质量在治疗前后均无显著变化。与化疗前相比,辅助组患者化疗后恶心呕吐、食欲减退、便秘的症状加重（P〈0．05）。姑息组患者化疗后恶心呕吐的症状明显加重、但疼痛减轻（P〈0．05）。在化疗前后卡氏行为状态评分均未显示出明显的差别。化疗后辅助化疗组与姑息化疗组相比,姑息组在疼痛、便秘症状和经济困难的评分明显高于辅助组,姑息组的总体生活质量评分明显低于辅助组,均有统计学意义（P〈0．05）。结论老年肿瘤患者的躯体、角色、认知、情绪、社会功能受化疗的影响较小,化疗后会出现消化道症状加重,疼痛减轻,总体生活质量下降不明显。卡氏行为状态评分不能全面反映患者化疗时的生活质量,QLQ-C30（V3．0）中文版评估量表对中国老年肿瘤患者测评生活质量优于卡氏行为状态评分。     

甲孕酮改善晚期肿瘤病人化疗期生活质量

目的　观察病人服用甲孕酮后改善化疗引起的厌食、体重下降、Kps评分下降、骨髓抑制及胃肠道反应的作用。方法　 117例接受化疗的晚期肿瘤患者 ,采用单盲随机分成化疗 +甲孕酮组共 5 8例 ,单用化疗组 5 9例作为对照。结果　在化疗 +甲孕酮治疗的 15 6个周期中有 5 5 .1%食量增加 ;42 .3 %体重增加 ;平均每周期体重增加 1.46± 0 .82kg ;血浆白蛋白升高 2 .1± 3 .3 0 g/L ;2 6.9%Kps评分改善。按WHO抗癌药物急性毒性分级标准 ,3 1.4%出现Ⅱ度以上的白细胞下降、血红蛋白下降 2 3 .7%、胃肠道反应 17.9% ,平均恢复时间分别为 5 .8± 5 .5天、5 .9± 3 .8天及 1.8± 1.4天。上述各项指标与对照组比较均有显著性差异。结论　甲孕酮如能正确合理地应用于晚期肿瘤病人的辅助治疗 ,可以全面改善化疗期癌症患者的生活质量。     

鼻咽癌放疗后长期存活者生活质量的自我评价

目的　以病人自评的方式调查分析经放疗后能长期生存的鼻咽癌患者的生活状况及由于放疗给病人带来的不良影响。方法　以随访信的方式 ,填表调查生存十年以上的患者的生活情况 ,其中包括张口困难 ,听力障碍 ,视力障碍 ,口咽干燥 ,龋齿情况 ,语音情况 ,性生活状况等及其是否影响生活 ,由病人自我评价其生活质量。结果　可供分析的10 8例生存十年以上的病人均存在不同程度的放射损害 ,其中发生率最高的是龋齿增加 ,达 73 .15 % ,其次是口干。对自己的生活质量满意和比较满意的占 99.1%。结论　放疗后长期生存的鼻咽患者大多数对自己的生活质量满意 ,由放疗引起的后遗症确实影响着一部分病人的生活质量 ,值得放疗工作者进一步研究。