彩色超声联合X线钼靶诊断早期乳腺癌的价值分析

目的:探讨彩色超声联合X线钼靶诊断早期乳腺癌的价值,以期为临床提供一定指导.方法:回顾性分析本院2019年1月～2020年10月经病理学确诊的早期乳腺癌患者80例临床资料,所有患者均行X线钼靶检查和彩色超声检查,以病理穿刺活检结果作为金标准,比较X线钼靶检查、彩色超声检查及两者联合检查结果的诊断准确率、漏诊率及误诊率....     

乳腺癌患者免疫功能检测在评价新辅助化疗疗效中的临床应用价值

目的探讨乳腺癌患者新辅助化疗前后外周血免疫功能检测在评价新辅助化疗疗效中的应用价值。方法采用流式细胞术检测113例乳腺癌患者在新辅助化疗前后的静脉血免疫功能水平变化情况,评价新辅助化疗疗效,以病理学评价为金标准,与临床触诊、乳腺超声和乳腺钼靶评价标准进行比较。结果免疫功能法评价新辅助化疗疗效灵敏度、特异度和准确率(84%、60%和79%)均高于临床触诊及乳腺钼靶评价方式,与乳腺超声评价方式相似。结论检测乳腺癌患者新辅助化疗前后免疫功能水平可作为评价乳腺癌新辅助化疗疗效的一种有效方法。     

保乳手术与改良根治术在早期乳腺癌患者中的临床价值

目的 探析早期乳腺癌疾病的治疗中,保乳手术与改良根治术的临床疗效.方法 研究样本收录为早期乳腺癌患者,样本收录时间为2019年1月—2020年3月,以此阶段收治的60例患者为样本,其中接受改良根治术的30例患者纳入对照组,接受保乳手术治疗的30例患者纳入试验组,分析两组患者治疗结局.结果 试验组美容优良率96.67％,...     

Value of Information Analytical Methods: Report 2 of the ISPOR Value of Information Analysis Emerging Good Practices Task Force

The allocation of healthcare resources among competing priorities requires an assessment of the expected costs and health effects of investing resources in the activities and of the opportunity cost of the expenditure. To date, much effort has been devoted to assessing the expected costs and health effects, but there remains an important need to also reflect the consequences of uncertainty in resource allocation decisions and the value of further research to reduce uncertainty. Decision making with uncertainty may turn out to be suboptimal, resulting in health loss. Consequently, there may be value in reducing uncertainty, through the collection of new evidence, to better inform resource decisions. This value can be quantified using value of information (VOI) analysis. This report from the ISPOR VOI Task Force describes methods for computing 4 VOI measures: the expected value of perfect information, expected value of partial perfect information (EVPPI), expected value of sample information (EVSI), and expected net benefit of sampling (ENBS). Several methods exist for computing EVPPI and EVSI, and this report provides guidance on selecting the most appropriate method based on the features of the decision problem. The report provides a number of recommendations for good practice when planning, undertaking, or reviewing VOI analyses. The software needed to compute VOI is discussed, and areas for future research are highlighted.     

探讨超声检查联合乳腺钼靶在早期乳腺癌筛查中的应用价值

目的:总结超声、乳腺钼靶联合检查对早期乳腺癌的筛查价值。方法:纳入2018年3月~2019年4月在本院筛查的120例早期乳腺癌患者作为观察对象,回顾分析不同患者应用乳腺钼靶检查、超声检查以及病理诊断的相关资料。结果:所有患者均经病理证实确诊,超声检查联合乳腺钼靶检查诊断准确率为94.17%(113/120),联合诊断高于单一诊断准确率;在<15mm病灶直径对应的病灶检出率方面,超声检查联合乳腺钼靶检查高于单一诊断方法(P<0.05)。结论:早期乳腺癌筛查中,通过应用超声检查联合乳腺钼靶检查,既能够提高病灶检出率,同时也有利于更小病灶的检出,为乳腺癌患者的早期治疗干预提供依据。     

Value of Information and Value of Implementation: Application of an Analytic Framework to Inform Resource Allocation Decisions in Metastatic Hormone-Refractory Prostate Cancer

ObjectiveIn a budget-constrained health-care system, decisions about investing in strategies to promote implementation have to be made alongside decisions about health-care provision and research funding. Using a Bayesian decision-theoretic approach, an analytic framework has been developed to inform these separate but related decisions, establishing the expected value of both perfect information (EVPI) and perfect implementation (EVPIM). We applied this framework to inform decision-making about resource allocation to metastatic hormone-refractory prostate cancer (mHRPC) in the UK.MethodsBased on available evidence on the cost-effectiveness of all plausible treatments for mHRPC, we determined which treatment option(s) were cost-effective and explored the uncertainty surrounding this decision. Given the decision uncertainty and the variation in care provided by health-care professionals, we then determined the EVPI and EVPIM. Finally, we performed sensitivity analyses to explore the influence of alternative assumptions regarding various decision parameters on the efficiency of resource allocation.ResultsDepending on the cost-effectiveness threshold (λ), we identified mitoxantrone plus prednisone/prednisolone and docetaxel plus prednisone/prednisolone (3 weekly) as the optimal treatments for mHRPC. Given current clinical practice, there appears to be considerable scope for improving the efficiency of health-care provision: the EVPI (estimated to be over £13 million) indicates that acquiring further information could be cost-effective; and the EVPIM (estimated to be over £4 million) suggests that investing in strategies to implement the treatments regimens being identified as optimal is potentially worthwhile. Through sensitivity analyses, we found that the EVPI and EVPIM are mainly driven by λ, the number of treatment options being considered, the current level of implementation, and the size of the eligible patient population.ConclusionThe application demonstrates that the framework provides a simple and useful analytic tool for decision-makers to address resource allocation problems between health-care provision, further research, and implementation efforts.     

个性化护理模式在乳腺癌术后护理中的应用效果分析

目的探讨在乳腺癌术后护理中运用个性化护理模式的效果及对护理满意度的影响。方法将本科80例乳腺癌手术患者(2018年1月—2019年6月)纳入研究,用计算机实施随机分组,分为常规组(n=40)、个性化组(n=40),对常规组运用常规护理,对个性化组运用个性化护理模式,分析术后并发症、生活质量及护理满意度。结果个性化组术后并发症总发生率与常规组组间对比更低,差异有统计学意义(P<0.05)。个性化组护理2周后生活质量评分与常规组组间对比更高,差异有统计学意义(P<0.05)。个性化组护理满意度评分与常规组组间对比更高,差异有统计学意义(P<0.05)。结论在乳腺癌术后护理中运用个性化护理模式可减少术后并发症,改善生活质量,提升护理满意度。     

Cost-Effectiveness of Chemotherapy for Breast Cancer and Age Effect in Older Women

BackgroundPrevious economic evaluations compared specific chemotherapy agents using input parameters from clinical trials and resource utilization costs. Cost-effectiveness of treatment groups (drug classes) using community-level effectiveness and cost data, however, has not been assessed for elderly patients with breast cancer.ObjectiveTo assess the cost-effectiveness of chemotherapy regimens by age and disease stage under “real-world” conditions for patients with breast cancer.MethodsThe Surveillance Epidemiology and End Results-Medicare data were used to identify patients with breast cancer with American Joint Committee on Cancer stage I/II/IIIa, hormone receptor–negative (estrogen receptor–negative and progesterone receptor–negative) patients from 1992 to 2009. Patients were categorized into three adjuvant treatment groups: 1) no chemotherapy, 2) anthracycline, and 3) non–anthracycline-based chemotherapy. Median life-years and quality-adjusted life-years (QALYs) were measured using Kaplan-Meier analysis and were evaluated against average total health care costs (2013 US dollars).ResultsA total of 4575 patients (propensity score–matched) were included for the primary analysis. The anthracycline group experienced 12.05 QALYs and mean total health care costs of $119,055, resulting in an incremental cost-effectiveness ratio of $7,688 per QALY gained as compared with the no chemotherapy group (QALYs 7.81; average health care cost $86,383). The non–anthracycline-based group was dominated by the anthracycline group with lower QALYs (9.56) and higher health care costs ($122,791). Base-case results were found to be consistent with the best-case and worst-case scenarios for utility assignments. Incremental cost-effectiveness ratios varied by age group (range $3,790–$90,405 per QALY gained).ConclusionsAnthracycline-based chemotherapy was found cost-effective for elderly patients with early stage (stage I, II, IIIa) breast cancer considering the US threshold of $100,000 per QALY. Further research may be needed to characterize differential effects across age groups.     

上海市社区乳腺癌患者生命质量及影响因素研究

目的了解上海市社区乳腺癌患者生命质量,并探讨其影响因素。方法通过问卷调查影响因素,运用FACT-B量表对患者的生命质量进行测定,采用一般线性模型进行多因素分析。结果调查时发现,患者年龄、确诊时年龄、是否仍旧在职、家庭人均月收入、患病部位、手术距离发现时间、是否复发、有无并发症、患病后社会交往和家人的关心、与家庭成员关系、配偶和患者谈论病情情况、配偶自觉与患者的交流及是否参加俱乐部与患者生命质量有关。结论应当密切关注乳腺癌患者病情,及时手术,积极治疗并发症,预防复发;关注低收入、低年龄和自费医疗的患者;为在职患者提供良好的工作环境;关心乳腺癌患者,加强与患者的交流,开展“粉红丝带俱乐部”活动,重视多学科合作。     

彩色多普勒超声在乳腺癌早期诊断中的应用

目的探讨彩色多普勒超声在乳腺癌早期诊断中的价值。方法应用高频探头以乳头为中心向四周进行辐射状或环状连续扫查,对发现的占位性病变,仔细观察其外形、边界、有无包膜及同侧腋下淋巴结是否肿大。结果 7904例中,886例乳腺内探及囊性包块956个,553例乳腺内可及边界清楚的实性包块615个,其中29例可疑乳腺癌（占3.66‰）。26例已接受手术,病理诊断为乳腺癌。此26例乳腺癌病变都小于1cm。结论 与其他传统方法相比较,彩色多普勒超声在乳腺较小肿块的检出及良恶性的鉴别诊断中有很大优势,成为乳腺癌早期诊断的首选。     

保乳手术联合化疗治疗乳腺癌的临床疗效分析

目的观察保乳手术联合化疗药物治疗乳腺癌的疗效。方法收集100例乳腺癌患者,随机分为两组,A组50例,行乳腺癌根治手术治疗;B组50例,行保乳手术联合化疗药物治疗,比较两组患者临床疗效、生存质量评分、IL-17和IL-10水平变化。结果治疗后A组与B组临床总有效率比较差异无统计学意义(P>0.05);B组的术后美容评价效果优于A组,差异有统计学意义(P<0.05);两组治疗后IL-17、IL-10水平降低明显(P<0.05),B组IL-17、IL-10水平低于A组(P<0.05)。两组治疗后生存质量评分明显升高(P<0.05),B组高于A组(P<0.05)。结论保乳手术联合化疗治疗乳腺癌患者的临床美容效果更优,能够提高患者生存质量,能够显著下调IL-17和IL-10水平,起到治疗作用。     

Program-Specific Cost-Effectiveness Analysis: Breast Cancer Screening Policies for a Safety-Net Program

BackgroundEvery Woman Counts (EWC), a California breast cancer screening program, faced challenging budget cutbacks and policy choices.MethodsA microsimulation model evaluated costs, outcomes, and cost-effectiveness of EWC program mammography policy options on coverage for digital mammography (which has a higher cost than film mammography but recent legislation allowed reimbursement at the lower film rate); screening eligibility age; and screening frequency. Model inputs were based on analyses of program claims data linked to California Cancer Registry data, Surveillance, Epidemiology, and End Results data, and the Medi-Cal literature. Outcomes included number of procedures, cancers, cancer deaths, costs, and incremental cost per life-year.ResultsProjected model outcomes matched program data closely. With restrictions on the number of clients screened, strategies starting screening at age 40 years were dominated (not cost-effective). This finding was highly robust in sensitivity analyses. Compared with no screening, biennial film mammography for women aged 50 to 64 years was projected to reduce 15-year breast cancer mortality by nearly 7.8% at $18,999 per additional life-year, annual film mammography was $106,428 per additional life-year, and digital mammography $180,333 per additional life-year. This more effective, more expensive strategy was projected to reduce breast cancer mortality by 8.6%. Under equal mammography reimbursement, biennial digital mammography beginning at age 50 years was projected to decrease 15-year breast cancer mortality by 8.6% at an incremental cost per additional life-year of $17,050.ConclusionsFor the EWC program, biennial screening mammography starting at age 50 years was the most cost-effective strategy. The impact of digital mammography on life expectancy was small. Program-specific cost-effectiveness analysis can be completed in a policy-relevant time frame to assist policymakers faced with difficult program choices.     

Deterioration of Quality of Life of High-Risk Breast Cancer Patients Treated with High-Dose Chemotherapy: The PEGASE 01 Quality of Life Study

Objective:  The aim of this study was to compare the quality of life (QOL) of high-risk breast cancer patients included in a randomized clinical trial (PEGASE 01) comparing conventional chemotherapy versus adding an additional high-dose chemotherapy (HDC) cycle with blood stem cell support.
Methods:  A total of 314 patients were included in the clinical trial. QOL evaluations were available for 199 patients. QOL was assessed over a 1-year follow-up period, using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C-30. The results were analyzed using a linear mixed-effects model.
Results:  Toxicity of HDC has a strong negative impact on patients' QOL during the treatment phase. This negative impact tended to last longer in the HDC group, as for most of the QLQ-C30 scales, the QOL scores of HDC patients tend to improve at a slower rate than that of patients receiving standard chemotherapy. In particular, physical functioning remains deteriorated 1 year after inclusion for HDC patients comparatively to conventional chemotherapy patients (85.99 vs. 76.65, P  = 0.021), and the pain score was still higher in the HDC group at that time (28.32 vs. 15.97, P  = 0.004).
Conclusion:  HDC has a negative impact on QOL even after treatment phase. In the absence of an overall survival benefit of using HDC for high-risk breast cancer patients, QOL studies with a longer follow-up play an important role in informing the complex trade-off implied by HDC between higher toxicity, reduced risk of relapse, and QOL decrease after the active phase of treatment.     

紫杉醇+DDP新辅助化疗治疗局部晚期乳腺癌疗效观察

目的:探讨新辅助化疗在局部晚期乳腺癌治疗中的应用。方法:回顾性分析32例局部晚期乳腺癌患者进行新辅 助化疗的临床资料。结果:32例患者中30例经辅助化疗后病情缓解,可以手术。结论:大多数局部晚期乳腺癌患者可以在2~3个 疗程的新辅助化疗后病情缓解便于手术治疗,从而改善预后。     

保乳手术治疗早期乳腺癌的疗效及安全性探究

目的 观察比较保乳手术与改良根治术治疗早期乳腺癌的疗效及安全性.方法 选取2008年3月至2014年1月期间在我院行手术治疗的101例早期乳腺癌患者为研究对象,将其按所行术式不同随机分为研究组（53例）和对照组（48例）.研究组施行保乳手术进行治疗,对照组施行改良根治术进行治疗.比较两种术式的临床疗效和安全性.结果 研究组患者的手术耗时、术中出血量、术后引流时间分别为（117.0±25.7） min, （142.4±35.0） mL, （8.2±4.6）d,对照组患者的手术耗时、术中出血量、术后引流时间分别（169.5±24.3） min, （217.5±43.1） mL, （13.1±5.3）d,研究组显著低于对照组,差异具有统计学意义（P＜0.01）;研究组随访期间出现局部复发、远处转移患者比例分别为7.55％和3.77％,对照组随访期间出现局部复发及远处转移患者比例分别为6.25％和8.33％,两组差异不显著,无统计学意义（P＞0.05）;研究组术后乳房美观效果的优良率为71.70％,对照组为0,研究组显著优于对照组,差异具有统计学意义（P＜0.01）.结论 保乳手术治疗早期乳腺癌在远期疗效方面与改良根治术相当,但在保持乳房美观效果方面明显优于改良根治术.     

乳腺癌影像设备检查对比分析

目的:探讨乳腺癌影像设备检查的优劣性,做到选择乳腺检查方法时有的放矢。方法:总结我院近年来128例乳腺癌术前检查方法进行分析。结果:钼靶X线检查确诊86例,超声检查确诊77例,CT检查确诊20例,MR检查确诊13例。钼靶X线和超声联合检查确诊105例。结论:钼靶X线检查为乳腺癌筛查的有效工具,超声成像能提高乳腺X线检查的敏感性和特异性,CT和MR是乳腺癌检查的重要补充手段。     

A Phase II Multicenter Trial on High-Dose Vitamin D Supplementation for the Correction of Vitamin D Insufficiency in Patients with Breast Cancer Receiving Adjuvant Chemotherapy

Breast cancer (BC) treatments induce vitamin D (VD) insufficiency and bone metabolism changes, resulting in osteoporosis and skeletal morbidity risk. We report the results of a bicentric phase II trial (ClinicalTrials.gov Identifier: {"type":"clinical-trial","attrs":{"text":"NCT04091178","term_id":"NCT04091178"}}NCT04091178) on the safety and efficacy of high-dose oral VD supplementation for VD deficiency correction in 44 patients with early BC treated with adjuvant chemotherapies. Patients received one dose of 100,000 IU 25-OH VD every 3 weeks from day 1 of cycle 1 to day 1 of cycle 5. The primary endpoint was the percentage of patients achieving serum 25-OH VD concentration normalization on day 1 of cycle 6 (D1C6). Secondary endpoints were safety, VD and calcium parameters at baseline and during chemotherapy, and identification of predictive biomarkers of VD normalization on D1C6. On D1C6, 21 patients (47.7%, 95% CI: 33.0–62.8) achieved VD normalization. No VD-related clinical toxicity was reported. However, 13 patients (29.5%) presented asymptomatic grade 1 hypercalciuria, leading to interruption of the high-dose oral VD supplementation in 10, followed by a rapid reduction in serum VD concentration. No baseline clinical factor was predictive of VD normalization on D1C6. This high-dose VD supplementation appears safe and efficient in patients with early BC receiving adjuvant chemotherapy.     

Cost-Effectiveness Analysis of Pertuzumab With Trastuzumab and Chemotherapy Compared to Trastuzumab and Chemotherapy in the Adjuvant Treatment of HER2-Positive Breast Cancer in the United States

Objective

The APHINITY trial assessed the effectiveness and the safety of adding pertuzumab to trastuzumab and chemotherapy (THP) compared to trastuzumab and chemotherapy (TH) in the adjuvant management of human epidermal growth factor 2-positive (HER2+) breast cancer. We performed a study to project the potential cost-effectiveness of THP vs. TH.