阿帕替尼辅助治疗晚期肺癌患者的临床疗效及其对血清基质金属蛋白酶9、自然杀伤细胞的影响

目的 探讨阿帕替尼辅助治疗晚期肺癌患者的疗效及其对血清基质金属蛋白酶9(MMP9)、自然杀伤(NK)细胞的影响.方法 将102例晚期肺癌患者根据不同治疗方法分为GP组(n=48,采用吉西他滨与顺铂联合化疗)和联合组(n=54,采用阿帕替尼联合GP方案治疗).比较两组患者免疫功能指标(CD4+、CD8+、CD4+/CD8+、NK)、血清学指标[MMP9、血管内皮生长因子(VEGF)]、临床疗效、生存情况及不良反应发生情况.结果联合组患者的客观缓解率(ORR)、疾病控制率均高于GP组(P﹤0.05).治疗后,两组患者CD4+、CD4+/CD8+及NK细胞水平均高于本组治疗前,CD8+水平均低于本组治疗前,且联合组患者CD4+、CD4+/CD8+及NK细胞水平均高于GP组,CD8+水平低于GP组,差异均有统计学意义(P﹤0.05).治疗后,两组患者MMP9、VEGF水平均明显低于本组治疗前,且联合组患者上述指标均明显低于GP组,差异均有统计学意义(P﹤0.01).联合组患者血小板减少、白细胞降低及肝功能损伤发生率均低于GP组,差异均有统计学意义(P﹤0.05),而两组患者心律不齐发生率比较,差异无统计学意义(P﹥0.05).联合组患者的生存率高于GP组,差异有统计学意义(P﹤0.05).结论阿帕替尼联合GP方案对晚期肺癌患者具有较好的治疗效果,可降低患者血清中MMP9、VEGF表达水平,改善患者免疫功能,提高患者的生存率,且不良反应发生率较低.     

扶正抗癌方联合安罗替尼治疗中晚期小细胞肺癌患者的临床疗效

目的 探究扶正抗癌方联合安罗替尼治疗中晚期小细胞肺癌(SCLC)的临床疗效.方法 将65例中晚期SCLC患者根据不同的治疗方式分为西药组(n=32,在常规治疗的基础上使用安罗替尼治疗)与联合组(n=33,在西药组的基础上联合扶正抗癌方治疗).比较两组患者的临床疗效,不良反应,治疗前及治疗4个周期后的肿瘤相关因子水平[基质金属蛋白酶2(MMP2)、血管内皮生长因子(VEGF)及多效生长因子(PTN)]、炎症因子水平[肿瘤坏死因子-α(TNF-α)、转化生长因子-β1(TGF-β1)及白细胞介素-6(IL-6)]、免疫功能指标(CD3+、CD4+、CD8+及CD4+/CD8+).结果 联合组患者的治疗总有效率为63.64％,与西药组的46.87％比较,差异无统计学意义(P﹥0.05).治疗后,联合组患者MMP2、VEGF及PTN水平均明显低于西药组(P﹤0.01);联合组患者的TNF-α、TGF-β1及IL-6水平均明显低于西药组(P﹤0.01);联合组患者CD3+、CD4+及CD4+/CD8+水平均高于西药组(P﹤0.05),CD8+水平低于西药组(P﹤0.05).联合组患者的不良反应总发生率为24.24％,明显低于西药组的56.25％(P﹤0.01).结论 扶正抗癌方联合安罗替尼治疗中晚期SCLC,可提高患者的免疫功能,降低其炎症反应及不良反应发生率,还可改善肿瘤相关因子水平,具有较好的临床应用价值.     

外周血淋巴细胞亚群水平变化在鼻咽癌中的意义

目的 探究外周血淋巴细胞亚群水平变化在鼻咽癌(NPC)中的意义.方法 选取NPC患者60例为试验组,选取健康体检者30例为对照组.采用流式细胞仪检测试验组治疗前后和对照组的外周血中CD3+、CD4+、CD8+细胞亚群及自然杀伤细胞(NK)水平;采用免疫组化法和Western Blot检测试验组治疗前后肿瘤组织中白细胞介素-21(IL-21)蛋白表达水平.结果 治疗前,试验组外周血中CD3+、CD4+、CD4+/CD8+及NK细胞水平明显低于对照组(P﹤0.01),CD8+细胞水平明显高于对照组(P﹤0.01);治疗后,试验组外周血中CD4+、CD4+/CD8+和NK细胞水平均较本组治疗前明显上升(P﹤0.01),CD8+细胞水平较本组治疗前明显下降(P﹤0.01);治疗后,早期NPC患者的总缓解率高于晚期NPC患者(P﹤0.05);免疫组化法和Western Blot检测结果显示,治疗前,NPC患者肿瘤组织中IL-21蛋白的阳性表达率及表达水平均高于治疗后(P﹤0.05).结论 NPC患者外周血中淋巴细胞亚群及NK细胞的检测对鼻咽癌的早期诊断及疗效评判具有重要意义.     

贝伐珠单抗联合卡铂+多西他赛治疗卵巢癌和宫颈癌的临床疗效

目的 探讨贝伐珠单抗联合卡铂+多西他赛治疗卵巢癌和宫颈癌的临床疗效。方法 根据治疗方式的不同将90例卵巢癌和宫颈癌患者分为对照组和观察组,每组45例,对照组患者给予卡铂+多西他赛治疗,观察组患者给予贝伐珠单抗联合卡铂+多西他赛治疗。比较两组患者临床疗效、血清肿瘤标志物[糖类抗原125(CA125)、肿瘤特异性生长因子(TSGF)、转化生长因子-β1(TGF-β1)、人附睾蛋白4(HE4)]水平、免疫功能指标(CD3⁺、CD4⁺、CD8⁺,计算CD4⁺/CD8⁺)及不良反应发生情况。结果 观察组患者的治疗总有效率为82.22%,明显高于对照组患者的51.11%,差异有统计学意义(P﹤0.01)。治疗后,两组患者血清CA125、TGF-β1、TSGF、HE4水平均低于本组治疗前,且观察组患者CA125、TGF-β1、TSGF、HE4水平均低于对照组,差异均有统计学意义(P﹤0.05)。治疗后,两组患者CD3⁺、CD4⁺水平和CD4     

TACE和RFA对原发性肝癌的疗效及对细胞免疫、血清相关标志物水平的影响

目的 探讨经肝动脉化疗栓塞(TACE)联合射频消融术(RFA)治疗原发性肝癌患者的疗效及其对患者T淋巴细胞亚群、血清相关标志物水平的影响.方法 选取98例原发性肝癌患者,根据治疗方法的不同将其分为联合组和对照组,每组49例.联合组采用TACE+RFA方案进行治疗,对照组采用TACE方案进行治疗,比较两组患者的治疗效果、T淋巴细胞亚群、血清甲胎蛋白(AFP)、糖类抗原-199(CA-199)、谷氨酰转肽酶(GGT)及血管内皮细胞生长因子(VEGF)水平.结果 治疗后,联合组患者的有效率为71.43％,高于对照组患者的51.02％(P﹤0.05);联合组患者的疾病控制率为95.92％,与对照组患者的91.84％比较,差异无统计学意义(P﹥0.05);治疗前,联合组和对照组患者的CD3+、CD4+、CD8+、CD4+/CD8+水平比较,差异无统计学意义(P﹥0.05);治疗后,联合组患者的CD3+、CD4+、CD4+/CD8+水平明显高于对照组患者(P﹤0.01),CD8+水平明显低于对照组患者(P﹤0.01);治疗前,联合组和对照组患者的AFP、CA-199、GGT、VEGF水平比较,差异无统计学意义(P﹥0.05);治疗后,联合组患者的AFP、CA-199、GGT、VEGF水平明显低于对照组患者(P﹤0.01).结论 原发性肝癌患者采用TACE联合RFA治疗具有更好的临床效果,同时可以改善患者的免疫功能.     

经尿道电切术联合膀胱灌注化疗在老年膀胱癌患者中的应用研究

目的 探讨经尿道电切术(TUR)联合膀胱灌注化疗在老年膀胱癌患者中的应用效果.方法 选择老年膀胱癌患者118例,根据医师介绍、患者自愿的原则将患者分为观察组与对照组,每组59例,观察组患者行TUR联合膀胱灌注化疗,对照组患者行根治性膀胱切除术.观察并比较两组患者术前及术后1周血清血管内皮细胞生长因子(VEGF)、血清胰岛素样生长因子-1(IGF-1)、尿液膀胱癌特异性核基质蛋白-4(BLCA-4)、炎性因子、免疫因子水平的差值,并对两组患者的术后不良反应发生率及1~2年生存情况进行比较.结果 两组患者术前与术后1周血清VEGF、血清IGF-1、尿液BLCA-4水平的差值比较,差异均无统计学意义(P﹥0.05).观察组患者术前与术后1周CRP、IL-6、TNF-α水平的差值均明显低于对照组(P﹤0.01).观察组患者术前与术后1周CD3+CD4+、CD3+CD8+、CD4+/CD8+水平的差值均明显高于对照组(P﹤0.01).观察组患者的术后总不良反应发生率明显低于对照组(P﹤0.01);观察组患者的术后1年、2年无瘤生存率和总生存率均高于对照组(P﹤0.05).结论 TUR联合膀胱灌注化疗治疗老年膀胱癌可有效清除恶性肿瘤细胞,纠正免疫失衡,且创伤小,有利于患者转归.     

肿瘤标志物及T淋巴细胞亚群在肺癌化疗患者中的变化及临床意义

目的 探讨肿瘤标志物及T淋巴细胞亚群在肺癌化疗患者中的变化及临床意义.方法 选取135例肺癌患者,检测化疗前后血清细胞角质蛋白19片段抗原21-1(CYFRA21-1)、癌胚抗原(CEA)水平和T淋巴细胞(CD4+、CD8+、CD4+/CD8+)水平,依据实体瘤疗效评价标准(RECIST)1.1版评估所有患者的化疗疗效,将完全缓解和部分缓解患者纳入有效组,疾病稳定+疾病进展患者纳入无效组.结果 135例患者完成一线化疗方案后完全缓解28例,部分缓解66例,疾病稳定34例,疾病进展7例,依据RECIST分为有效组94例,无效组41例.化疗6、12周,有效组患者CYFRA21-1、CEA水平均明显低于本组化疗前和无效组(P﹤0.01).化疗6周,有效组患者CD8+水平低于无效组,CD4+/CD8+高于无效组(P﹤0.05);化疗12周,有效组患者CD4+水平及CD4+/CD8+均高于无效组,CD8+水平低于无效组(P﹤0.05).94例化疗有效组患者中,小细胞肺癌(SCLC)患者18例,非小细胞肺癌(NSCLC)患者76例,分别作为SCLC组和NSCLC组.化疗12周,SCLC组和NSCLC组患者CYFRA21-1、CEA水平均低于本组化疗前(P﹤0.05),且SCLC组患者CYFRA21-1、CEA水平均低于NSCLC组(P﹤0.05);SCLC组患者CD4+水平及CD4+/CD8+均高于本组化疗前(P﹤0.05),且SCLC组患者血清CD4+水平及CD4+/CD8+均高于NSCLC组(P﹤0.05).化疗期间,135例患者不良反应总发生率为20.00％(27/135),未发生严重不良反应.结论 有效化疗可以降低肺癌患者血清肿瘤标志物水平,改善患者机体免疫功能,有助于促进患者康复,且有效化疗对SCLC患者的影响更大.     

FOLFOX4、SOX化疗方案治疗晚期胃癌的疗效及对血清生物活性因子及预后的影响

目的探讨奥沙利铂+亚叶酸钙+5-氟尿嘧啶(FOLFOX4)、奥沙利铂+替吉奥(SOX)化疗方案治疗晚期胃癌的疗效及对血清基质金属蛋白酶9(MMP9)、CD44v6、血管内皮细胞生长因子C(VEGFC)、转化生长因子-β1(TGF-β1)水平和预后的影响。方法根据治疗方法不同将112例晚期胃癌患者分为对照组与观察组,每组56例。对照组患者采用FOLFOX4方案化疗,观察组患者采用SOX方案化疗。比较两组患者的近期疗效、远期生存情况、不良反应发生情况,并对两组患者治疗前后的血清MMP9、CD44v6、VEGFC、TGF-β1水平进行比较。结果治疗结束后,两组患者的疾病控制率、客观缓解率比较,差异均无统计学意义(P﹥0.05)。化疗过程中,两组患者白细胞减少、血小板减少、乏力、恶心、呕吐、口腔黏膜炎、肝肾功能不全、神经功能异常的发生率比较,差异均无统计学意义(P﹥0.05)。两组患者治疗后的血清MMP9、CD44v6、VEGFC、TGF-β1水平均明显低于本组治疗前(P﹤0.01);观察组患者治疗后的血清MMP9、CD44v6、VEGFC、TGF-β1水平均低于对照组治疗后(P﹤0.05)。观察组患者的2年生存率高于对照组(P﹤0.05)。结论SOX化疗方案治疗晚期胃癌的远期疗效优于FOLFOX4方案,可能与降低血清MMP9、CD44v6、VEGFC、TGF-β1水平有关。     

盐酸安罗替尼联合信迪利单抗注射液治疗对微卫星稳定型结直肠癌患者血管内皮生长因子、转化生长因子-β水平及免疫功能的影响

目的探讨盐酸安罗替尼联合信迪利单抗注射液治疗对微卫星稳定型(MSS)结直肠癌患者血管内皮生长因子(VEGF)、转化生长因子-β(TGF-β)及免疫功能的影响。方法根据治疗方法的不同将经临床标准治疗失败的36例MSS型结直肠癌患者分为单一组(n=16,接受盐酸安罗替尼治疗)和联合组(n=20,接受盐酸安罗替尼联合信迪利单抗治疗)。比较两组患者的临床疗效、不良反应发生情况、VEGF水平、TGF-β水平、T淋巴细胞亚群指标(CD8⁺、CD4⁺、CD4⁺/CD8⁺)及免疫分子含量。结果治疗后,联合组患者的有效率及CD4⁺水平、CD4⁺/CD8⁺均高于单一组患者,血清VEGF、TGF-β水平均低于单一组患者(P﹤0.05)。治疗后,联合组患者肿瘤促进分子CD168、CD133、CD151的含量均明显低于单一组,肿瘤抑制分子CD9、CD63的含量均明显高于单一组患者(P﹤0.01)。结论盐酸安罗替尼联合信迪利单抗对经临床标准治疗失败的MSS型结直肠癌患者具有较好的治疗效果,可降低VEGF、TGF-β水平,抑制肿瘤生长,并提高患者的免疫功能。     

槐耳颗粒联合索拉非尼对晚期肝癌患者免疫功能及生活质量的影响

目的 探究槐耳颗粒联合索拉非尼对晚期肝癌患者免疫功能及生活质量的影响.方法 将80例晚期肝癌患者按治疗方法不同分为对照组和观察组,每组40例.对照组予以甲苯磺酸索拉非尼片口服(每次0.4 g),观察组在对照组用药基础上加用槐耳颗粒口服(每次20 g).比较两组患者治疗总有效率、免疫功能指标[CD3+、CD4+、CD8+、CD4+/CD8+、自然杀伤(NK)细胞]水平、不良反应发生率及肝胆肿瘤治疗功能评定量表(FACT-hep)评分差异.结果 观察组患者总有效率为92.50％(37/40),高于对照组的72.50％(29/40),差异有统计学意义(P﹤0.05).治疗后,两组患者CD3+、CD4+、CD4+/CD8+、NK细胞水平均升高,CD8+水平均降低,差异均有统计学意义(P﹤0.05);治疗后,观察组患者CD3+、CD4+、CD4+/CD8+、NK细胞水平均高于对照组,CD8+水平低于对照组,差异均有统计学意义(P﹤0.05).观察组患者不良反应总发生率为17.50％(7/40),低于对照组的40.00％(16/40),差异有统计学意义(P﹤0.05).治疗后,两组患者FACT-hep量表生理、心理、社会、功能及症状领域评分均较治疗前升高,且观察组患者生理、心理、社会、功能及症状领域评分均高于对照组,差异均有统计学意义(P﹤0.05).结论 槐耳颗粒联合索拉非尼可显著提高晚期肝癌临床疗效,改善患者免疫功能,降低不良反应发生率,提升患者生活质量.     

Experience with Impedance Phlebography Compared with Venography

Venography is a particularly reliable method for the diagnosis of deep venous thrombosis but is not suitable as a screening test. Impedance phlebography represents another attempt to discover a simple, non-invasive and reliable method of detecting deep venous thrombosis. It does not, however, meet these criteria.     

Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours

PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.     

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer

BackgroundMethylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy.Patients and methodsPooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization.ResultsIn two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43–109 versus 56 days, 95% CI 43–69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59–177 versus 55 days, 95% CI 40–70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29–0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30–0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88).ConclusionThis unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy.Clinical trials numberNCT00401362, NCT00672477.     

Living with secondary breast cancer: coping with an uncertain future with unmet needs

JOHNSTON S.R.D. (2010) European Journal of Cancer Care 19 , 561–563 Living with secondary breast cancer: coping with an uncertain future with unmet needs     

奥沙利铂联合羟基喜树碱治疗晚期胃癌临床分析

背景与目的体外及体内的临床研究显示,奥沙利铂(L-OHP)对多种肿瘤有显著抑制作用并与绝大多数抗癌药物具有相加或协同细胞毒作用.本文旨在观察L-OHP联合羟基喜树碱(HCPT)治疗晚期胃癌的近期疗效和患者耐受性,并与传统的化疗方案进行对比.方法采用非随机的分组方法将43例晚期胃癌患者分为L-OHP+HCPT方案组(治疗组)与Vp-16+CF+5-FU(ELF)方案组(对照组),其中男性28例,女性15例,中位年龄59岁,KPS评分≥60,观察两组的近期疗效和患者耐受性.结果治疗组24例有效率58.3%(14/24),对照组19例有效率42.1%(8/19).治疗组有效率高于对照组,两组差异有显著性(P<0.05).两组不良反应主要是骨髓抑制、恶心、呕吐、口腔炎、周围神经炎、静脉炎、脱发等,均在Ⅰ、Ⅱ度范围内.结论L-OHP联合HCPT方案治疗晚期胃癌疗效较好,不良反应可以耐受.     

Varicella-Zoster Virus Prophylaxis with Low-Dose Acyclovir in Patients with Multiple Myeloma Treated with Bortezomib

BackgroundVaricella-zoster virus (VZV) reactivation is a common complication in patients with multiple myeloma (MM) treated with bortezomib, with an incidence rate of 10%-60%. The aim of our study was to analyze the effect of acyclovir prophylaxis in this patient population.Patients and MethodsWe studied 98 consecutive patients with relapsed MM treated with bortezomib. Bortezomib 1.3 mg/m² was given on days 1, 4, 8, and 11 of a 21-day cycle. At first, patients did not receive any VZV prophylaxis, but because of the high incidence of VZV reactivation, VZV prophylaxis with acyclovir was implemented subsequently.ResultsA total of 11 patients treated with bortezomib did not have any VZV prophylaxis, and 4 of these 11 patients (36%) developed VZV reactivation in the form of herpes zoster. No VZV reactivations were observed in the 32 patients who received acyclovir 400 mg 3 times daily or the 55 patients who received acyclovir in a dose reduced to 400 mg once daily during bortezomib treatment.ConclusionVaricellazoster virus reactivation is a common and serious adverse effect of bortezomib treatment. Acyclovir 400 mg once daily is sufficient to protect from VZV reactivation in patients with MM treated with bortezomib.     

Pseudomembranous colitis associated with chemotherapy with 5-fluorouracil

Pseudomembranous colitis is frequently associated with antibiotics and more rarely with chemotherapeutic agents such as 5-fluorouracil. The objective of this study is to show that it is possible to confuse this infection with chemotherapy associated toxicity. We present a 54 year old woman who underwent surgery for colorectal cancer and in the first cycle of chemotherapy with 5-fluorouracil developed pseudomembranous colitis. We detected the toxin B of Clostridium difficile in stools and we began early antibiotic treatment. Thus, in patients with post chemotherapy neutropenia and diarrhoea that develop negatively, we have to rule out this infection.