微波消融术联合经导管动脉化疗栓塞对原发性肝癌患者免疫功能、肝功能与生存情况的影响

目的 探讨微波消融术联合经导管动脉化疗栓塞(TACE)对原发性肝癌患者免疫功能、肝功能与生存情况的影响.方法 依据治疗方法将100例原发性肝癌患者分为联合组和单纯组,每组50例,单纯组患者给予单纯TACE治疗,联合组患者给予微波消融术联合TACE治疗.治疗前和治疗后6个月,比较两组患者的肝功能指标[总胆红素(TBIL)、直接胆红素(DBIL)、丙氨酸氨基转移酶(ALT)和白蛋白]、免疫功能指标[补体C3、免疫球蛋白(Ig)A、IgG、IgM]、甲胎蛋白(AFP)和癌胚抗原(CEA)水平.随访3年,比较两组患者的生存情况.结果 治疗后,两组患者TBIL、DBIL、ALT水平均低于本组治疗前,白蛋白水平均高于本组治疗前,且联合组患者TBIL、DBIL、ALT水平均低于单纯组,白蛋白水平高于单纯组,差异均有统计学意义(P﹤0.05).治疗后,两组患者补体C3、IgA、IgG和IgM水平均高于本组治疗前,且联合组患者补体C3、IgA、IgG和IgM水平均高于单纯组,差异均有统计学意义(P﹤0.05).治疗后,两组患者AFP、CEA水平均低于本组治疗前(P﹤0.05),且联合组患者AFP、CEA水平均低于单纯组(P﹤0.05).随访3年,联合组患者的生存率高于单纯组(P﹤0.05).结论 微波消融术联合TACE可改善原发性肝癌患者的肝功能和免疫功能指标,抑制肿瘤标志物的表达,提高远期生存率.     

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.     

射频消融联合经导管动脉化疗栓塞术在原发性肝癌患者中的应用效果

目的 探讨射频消融联合经导管动脉化疗栓塞术(TACE)在原发性肝癌(PHC)患者中的应用效果.方法 选取2017年1月至2018年2月收治的42例中晚期PHC患者给予单纯TACE治疗,作为对照组,选取2018年3月至2019年6月收治的42例中晚期PHC患者给予TACE联合射频消融治疗,作为联合组.比较两组患者临床疗效、肝功能指标[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、白蛋白(ALB)、总胆红素(TBIL)]、血清肿瘤标志物[癌胚抗原(CEA)、表皮生长因子受体(EGFR)、甲胎蛋白(AFP)]、术后并发症发生情况、预后情况和生活质量.结果 联合组患者的临床疗效明显优于对照组(P﹤0.01),治疗总有效率为78.57％,明显高于对照组患者的50.00％(P﹤0.01).术后4周,两组患者血清ALT、AST、TBIL、CEA、AFP、EGFR水平均低于本组术前(P﹤0.05),ALB水平高于本组术前(P﹤0.05),且联合组患者血清ALT、AST、TBIL、CEA、AFP、EGFR水平均低于对照组(P﹤0.05),ALB高于对照组(P﹤0.05).联合组患者的并发症总发生率为7.14％,低于对照组患者的23.81％(P﹤0.05).随访1年,联合组患者的复发率为21.43％,明显低于对照组患者的54.76％(P﹤0.01),1年生存率为90.48％,明显高于对照组患者的66.67％(P﹤0.01).随访1年,两组患者简明健康状况调查问卷(SF-36)量表各维度评分均高于本组出院前(P﹤0.05),且联合组患者SF-36量表各维度评分均高于对照组(P﹤0.05).结论 射频消融联合TACE治疗中晚期PHC患者,能够改善临床疗效,减轻肝功能损伤,降低术后血清肿瘤标志物水平,改善预后和生活质量.     

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.     

超声引导下经皮射频消融术联合经导管动脉化疗栓塞术治疗原发性肝癌的临床价值研究

目的 探讨超声引导下经皮射频消融术(RFA)联合经导管动脉化疗栓塞术(TACE)治疗原发性肝癌的临床价值.方法 选取118例原发性肝癌患者,根据治疗方案不同分为对照组(n=61)和观察组(n=57),对照组采用TACE治疗,观察组采用TACE+RFA治疗.比较两组患者的近期疗效、肝功能指标及并发症发生情况.结果 观察组患者的总有效率为85.96％(49/57),高于对照组患者的68.85％(42/61),差异有统计学意义(P﹤0.05);观察组患者疾病控制率为92.98％(53/57),高于对照组患者的78.69％(48/61),差异有统计学意义(P﹤0.05).治疗后,两组患者丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)及总胆红素(TBIL)水平均明显低于本组治疗前,白蛋白(ALB)水平均明显高于本组治疗前,差异均有统计学意义(P﹤0.01);观察组患者ALT、AST及TBIL水平均明显低于对照组,ALB水平明显高于对照组,差异均有统计学意义(P﹤0.01).两组患者并发症总发生率比较,差异无统计学意义(P﹥0.05).结论 原发性肝癌患者采用TACE+RFA治疗有利于提高近期疗效,改善患者肝功能,且未增加严重不良反应,临床应用前景可观.     

康艾注射液对TACE联合MWA治疗后肝癌患者疗效影响的研究

目的 探究康艾注射液对肝动脉插管化疗栓塞(TACE)联合微波消融(MWA)治疗后肝癌患者疗效的影响.方法 对92例肝癌患者的病历资料进行回顾性分析.根据治疗方法不同将患者分为治疗组及对照组,每组各46例.对照组患者接受TACE联合MWA治疗方案进行治疗,治疗组患者在对照组治疗方案的基础上加用康艾注射液进行治疗.对两组患者治疗前后甲胎蛋白(AFP)水平、丙氨酸转移酶(ALT)水平、凝血功能、治疗总有效率以及不良反应发生情况进行比较.结果 治疗前,两组患者的AFP水平、ALT水平及凝血功能比较,差异均无统计学意义(P﹥0.05);治疗后,治疗组患者的ALT及AFP水平均低于对照组(P﹤0.05);治疗组患者的治疗总有效率高于对照组(P﹤0.05);治疗过程中,治疗组患者的白细胞下降、血红蛋白下降发生率均低于对照组(P﹤0.05).结论 康艾注射液可增强TACE联合MWA方案对肝癌的治疗总有效率,降低治疗用药对肝功能的不良影响及不良反应发生情况.     

雷替曲塞联合奥沙利铂经导管动脉化疗栓塞治疗原发性肝癌的疗效研究

目的 探讨雷替曲塞联合奥沙利铂经导管动脉化疗栓塞(TACE)治疗原发性肝癌的短期疗效及安全性.方法 收集75例原发性肝癌患者的临床资料,根据治疗方法的不同将患者分为研究组(n=39)和对照组(n=36),研究组患者接受雷替曲塞联合奥沙利铂栓塞化疗,对照组患者接受吡柔比星联合奥沙利铂栓塞化疗.比较两组患者的近期疗效、生存情况、甲胎蛋白(AFP)改变情况、不良反应发生率及血常规和肝肾功能指标.结果 两组患者的疾病控制率、生存情况和AFP下降率比较,差异均无统计学意义(P﹥0.05).术后3天研究组患者发热、肝区疼痛及恶心呕吐的发生率均明显低于对照组,差异均有统计学意义(P﹤0.01).治疗后研究组患者的总胆红素(TB)、直接胆红素(DB)、谷丙转氨酶(ALT)、谷草转氨酶(AST)水平均明显高于治疗前(P﹤0.01),血浆白蛋白水平低于治疗前(P﹤0.05);治疗后对照组患者的TB、DB、ALT、AST、白细胞计数(WBC)水平均高于治疗前(P﹤0.05),血浆白蛋白水平明显低于治疗前(P﹤0.01).治疗后研究组患者的血浆白蛋白水平高于对照组,差异有统计学意义(P﹤0.05);ALT、AST、γ-谷氨酰转移酶(γ-GT)、WBC水平均明显低于对照组,差异均有统计学意义(P﹤0.01).结论 雷替曲塞联合奥沙利铂TACE治疗原发性肝癌的不良反应较少,其近期疗效与吡柔比星联合奥沙利铂栓塞效果相当,远期疗效有待临床进一步研究.     

沙利度胺辅助治疗对转移性结肠癌患者血管生成、炎性反应和预后的影响

目的 探讨沙利度胺辅助治疗对转移性结肠癌患者血管生成、炎性反应和预后的影响.方法 依据治疗方法的不同将112例转移性结肠癌患者分为对照组和观察组,每组56例,对照组患者给予单纯放疗治疗,观察组患者给予沙利度胺辅助放疗治疗.比较两组患者的临床疗效、血管生成相关指标[血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)、微血管密度(MVD)]、炎性因子指标[肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6、IL-10]、不良反应发生情况和随访5年的生存情况.结果 观察组患者的治疗总缓解率为60.71％,明显高于对照组患者的33.93％(P﹤0.01).治疗后,两组患者血清VEGF、bFGF水平和MVD均低于本组治疗前(P﹤0.05),且观察组患者血清VEGF、bFGF水平和MVD均低于对照组(P﹤0.05).治疗后,两组患者的血清TNF-α、IL-6、IL-10水平均低于本组治疗前(P﹤0.05),且观察组患者血清TNF-α、IL-6、IL-10水平均低于对照组(P﹤0.05).观察组患者的不良反应发生率为7.14％,低于对照组患者的21.43％(P﹤0.05),5年生存率为61.08％,高于对照组患者的36.87％(P﹤0.05).结论 沙利度胺辅助治疗转移性结肠癌患者,能够通过抑制血管生成、减轻炎性反应来提高抗肿瘤效果,可提高患者的生存率且安全性较高.     

异环磷酰胺联合多西紫杉醇+顺铂治疗复发难治性骨肉瘤的效果及安全性

目的 探讨异环磷酰胺联合多西紫杉醇+顺铂(DP)方案治疗复发难治性骨肉瘤的效果及安全性.方法 根据治疗方式将98例复发难治性骨肉瘤患者分为一般化疗组和异环磷酰胺组,每组49例,一般化疗组患者给予DP方案化疗,异环磷酰胺组患者在此基础上联合异环磷酰胺化疗.比较两组患者肿瘤标志物[肿瘤特异性生长因子(TSGF)、血管内皮生长因子(VEGF)、大鼠肉瘤癌基因(RAS)及erb-b2受体酪氨酸激酶3(ERBB3)]、肢体功能、睡眠质量、临床疗效和不良反应发生情况.结果 治疗后,两组患者TSGF、VEGF、RAS、ERBB3水平均低于本组治疗前(P﹤0.05),且异环磷酰胺组患者TSGF、VEGF、RAS、ERBB3水平均低于一般化疗组(P﹤0.05).治疗后,两组患者的Harris量表评分均明显高于本组治疗前(P﹤0.01),匹兹堡睡眠质量指数(PSQI)均明显低于本组治疗前(P﹤0.01);且异环磷酰胺组患者的Harris量表评分明显高于一般化疗组(P﹤0.01),PSQI评分明显低于一般化疗组(P﹤0.01).异环磷酰胺组患者的治疗有效率为46.94％,高于一般化疗组患者的22.45％(P﹤0.05),不良反应总发生率为6.12％,明显低于一般化疗组患者的28.57％(P﹤0.01).结论 异环磷酰胺联合DP方案治疗复发难治性骨肉瘤,可有效抑制肿瘤细胞发展,控制病情,促进肢体功能恢复,改善睡眠质量.     

贝伐珠单抗联合化疗对晚期肺癌患者血清肿瘤标志物及免疫功能的影响

目的 探讨贝伐珠单抗联合化疗对晚期肺癌患者血清肿瘤标志物及免疫功能的影响.方法 将80例晚期肺癌患者根据不同治疗方式分为观察组及对照组,每组40例.对照组采用顺铂联合紫杉醇(TP)化疗,观察组在对照组基础上联合贝伐珠单抗治疗,比较两组患者血清肿瘤标志物水平、免疫功能指标水平、临床疗效及不良反应.结果 治疗后,两组患者糖类抗原125(CA125)、细胞角蛋白19片段抗原21-1(CYFRA21-1)、血清癌胚抗原(CEA)水平均明显低于本组治疗前,且观察组均明显低于对照组,差异均有统计学意义(P﹤0.01).治疗后,两组患者免疫功能指标CD3+、CD4+、CD8+水平均明显低于本组干预前,但观察组均明显高于对照组,差异均有统计学意义(P﹤0.01).观察组患者疾病控制率为92.50％(37/40),高于对照组的72.50％(29/40),差异有统计学意义(χ2=5.541,P=0.019).两组患者不良反应发生率比较,差异均无统计学意义(P﹥0.05).结论 贝伐珠单抗联合TP化疗治疗晚期肺癌可有效降低血清肿瘤标志物水平,抑制疾病进展,同时控制化疗对机体免疫功能产生的影响,提升临床效果,应用价值较高.     

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.     

Costs associated with complications are lower with capecitabine than with 5‐fluorouracil in patients with colorectal cancer

BACKGROUND:

Capecitabine, an oral alternative to 5‐fluorouracil (5‐FU) in patients with colorectal cancer (CRC), has equal clinical efficacy and a favorable safety profile; however, its use may be limited because of unit cost concerns. In this study, the authors measured the cost of chemotherapy‐related complications during treatment with capecitabine‐ and 5‐FU–based regimens.

METHODS:

Patients with CRC who received at least 1 administration of capecitabine or 5‐FU during 2004 and 2005 were identified from the Thomson MarketScan research databases. Monthly frequency and cost for 23 complications were recorded. Logistic regression was used to predict complication probability. General linear models were used to predict monthly complication cost and total monthly expenditure.

RESULTS:

In total, 4973 patients with CRC met the inclusion criteria for this analysis. Although the most frequently observed complications were the same between capecitabine and 5‐FU (nausea and vomiting, infection, anemia, neutropenia, diarrhea), each was observed with greater frequency in 5‐FU–based regimens. The mean predicted monthly complication cost was significantly higher (by 136%) with 5‐FU monotherapy than with capecitabine monotherapy (difference, $601; 95% confidence interval [95% CI], $469‐$737). In addition, the mean predicted monthly complication cost for 5‐FU+oxaliplatin was higher than the cost with capecitabine plus oxaliplatin (difference, $1165; 95% CI, $892‐$1595). When acquisition, administration, and complication costs were taken into consideration, there were no significant differences in the total cost between capecitabine regimens and 5‐FU regimens.

CONCLUSIONS:

Capecitabine compared well with 5‐FU–based therapy in patients with CRC and was associated with lower complication rates and associated costs. Cancer 2009. © 2009 American Cancer Society.     

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.