化疗交替靶向药物治疗对 EGFR 突变阳性的晚期 NSCLC 患者PFS及 OS的影响

目的：观察化疗交替靶向药物治疗对EGFR突变阳性的晚期非小细胞肺癌患者PFS及OS的影响。方法选取100例EGFR突变阳性的晚期NSCLC患者作为研究对象,将患者分为2组,A组为吉西他滨＋顺铂／卡铂化疗交替吉非替尼组,B组为单用吉非替尼组。比较患者治疗过程中的耐受情况、不良反应的发生率和总缓解率（ ORR）;对比A、B组患者的肿瘤无进展生存期（ PFS）、总生存期（ OS）和患者生活质量评分（ QoL）。结果2组患者的不良反应发生率无统计学差异（P＞0．05）,治疗期间A组5例患者因无法耐受不良反应而退出,B组4例患者退出。 A组患者ORR为68．89％,B组ORR为47．86％,差异具有统计学意义（P＜0．05）。 A组患者的PFS、OS和QoL高于B组,差异具有统计学意义（ P＜0．05）。结论化疗交替靶向药物在晚期EGFR突变阳性的NSCLC的治疗中具有显著的临床疗效,值得在临床上进行推广和应用。     

232例晚期黏膜黑色素瘤患者的一二线治疗疗效及预后影响因素

目的:探讨晚期黏膜黑色素瘤(mucosal melanoma,MM)患者的临床特征、治疗及预后影响因素.方法:收集2008年1月至2015年12月北京肿瘤医院肾癌黑色素瘤内科收治的232例晚期MM患者的临床资料,一二线治疗方案,对患者生存情况进行随访,并对影响总生存期的多因素预后进行分析统计.结果:本组晚期MM患者共232例(男101、女131例),中位年龄56.0岁;原发部位:直肠肛管29.3％,鼻腔25.0％,泌尿生殖道20.7％,口腔20.3％,食管4.7％;就诊时M分期:M1a 17.2％,M1b 21.6％,M1c 61.2％;多数患者存在多处转移,常见转移部位为肺50.4％、肝34.9％、骨23.3％.中位PFS:一线治疗方案患者4.5个月,二线治疗方案患者2.5个月.所有患者中位OS为11.0个月,其中M1a期16.0个月、M1b期14.0个月、M1c期10.0个月.预后分析发现,就诊时M分期和血清LDH与OS显著相关(P＜0.01),与原发灶部位、性别、年龄、基因突变状态等无显著相关性.结论:鼻腔、口腔是MM的好发部位,就诊时M分期、LDH水平是OS的独立预后因素.     

平消胶囊联合替吉奥加奥沙利铂方案治疗晚期胃癌的疗效分析

目的:探讨平消胶囊联合替吉奥(S-1)加奥沙利铂方案治疗晚期胃癌的疗效分析.方法:收集2016年09月至2019年09月郑州大学第一附属医院患者67例,分为治疗组33例和对照组34例,分别给予平消胶囊联合S-1加奥沙利铂化疗和单纯替吉奥加奥沙利铂化疗,连用2个周期.结果:两组患者治疗前后的PFS比较,治疗组明显高于对照...     

Perioperative blood transfusion is not an independent predictor for worse outcomes in retroperitoneal sarcoma surgery

BackgroundSurgery for retroperitoneal soft tissue sarcoma (RPS) is technically challenging, often requiring perioperative red blood cell transfusion (PBT). In other cancers, controversy exists regarding the association of PBT and oncologic outcomes. No study has assessed this association in primary RPS, or identified factors associated with PBT.MethodsData was collected on all resected primary RPS between 2006 and 2020 at The Ottawa Hospital (Canada) and University Hospital Birmingham (United Kingdom). ‘PBT’ denotes transfusion given one week before surgery until discharge. Multivariable regression (MVA) identified clinicopathologic factors associated with PBT and assessed PBT association with oncologic outcomes. Surgical complexity was measured using resected organ score (ROS) and patterns of resection.Results192 patients were included with 98 (50.8%) receiving PBT. Median follow-up was 38.2 months. High tumour grade (OR 2.20, P = 0.048), preoperative anemia (OR 2.78, P = 0.020), blood loss >1000 mL (OR 4.89, P = 0.004) and ROS >2 (OR 2.29, P = 0.026) were associated with PBT on MVA. A direct linear relationship was observed between higher ROS and increasing units of PBT (β = 0.586, P = 0.038). Increasingly complex patterns of resection were associated with increasing odds of PBT. PBT was associated with severe post-operative complications (P = 0.008) on MVA. Univariable association between PBT and 5-year disease-free or overall survival was lost upon MVA.ConclusionsSurgical complexity and high tumour grade are potentially related to PBT. Oncologic outcomes are not predicted by PBT but are better explained by tumour grade which subsequently may increase surgical complexity. Strategies to reduce PBT should be considered in primary RPS patients.     

骨肉瘤肺转移手术后的生存预测因素分析

目的：评估骨肉瘤患者肺部转移（ PM）完全切除（ CR）后的预后因素。方法回顾性分析62例转移性骨肉瘤患者接受治疗和随访的资料。单因素和多因素分析转移性骨肉瘤的人口统计学和疾病相关的特性对总体生存（ OS）的影响。结果总共有25例PM患者行完全切除,并纳入分析。5年OS和无病生存率分别为30％和21％。单变量分析较差的OS相关的因素包括软骨细胞亚型,后化疗原发肿瘤坏死＜90％,新辅助或辅助化疗期间检测到转移,病理识别肿瘤细胞达到任何切除结节的内脏胸膜表面。在多变量分析中,软骨细胞亚型是唯一的独立的不良预后因素（ HR＝4．6,95％CI：1．0～21．3,P＝0．044）。结论肿瘤生物学相关的因素,原发肿瘤坏死不彻底,化疗期间癌细胞转移,软骨细胞亚型和内脏胸膜受累都是手术预后差的相关因素。     

A multi-center phase II study of nintedanib as second-line therapy for patients with advanced non-small-cell lung cancer in China

Purpose: This study examined the efficacy and safety of using nintedanib as single-regimen in 2^nd-line chemotherapy for Chinese patients with advanced (beyond stage IIIB) non-small-cell lung cancer (NSCLC). Methods: Chinese patients were those with stage IIIB or IV NSCLC and had unsuccessful 1^st-line platinum based chemotherapy. Patients received two oral intakes of 200 mg nintedanib everyday from day 1 to day 21, on every 4-week cycle. Primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS) and disease control rate. Results: There were 62 eligible patients enrolled in the study. Half of the patients were male (n = 31, 50.0%). The median age was 64.2 years with youngest age of 33 years and oldest age of 83 years. Median PFS was 3.9 months (95% CI, 2.7-6.4 months). Median OS was 6.7 months (95% CI, 4.8-10.1 months). No patients (0.0%) had complete response. Thirty-one patients (50.0%) had stable disease and 23 patients (37.1%) had partial response. The most common severe adverse events (AEs), graded as 3 or 4, were heart failure (n = 12, 19.4%), hypertension (n = 7, 11.8%) and diarrhea (n = 6, 9.8%). Conclusion: NSCLC Patients in 2^nd-line chemotherapy reached similar PFS, as compared with other FDA-approved second-line regimens. Also, the toxicity of nintedanib was well tolerated. Thus, nintedanib may be used as a standard regimen for 2^nd-line chemotherapy for patients with advanced NSCLC.     

lncRNARP5-1185K9.17在结直肠癌组织中的表达及其临床意义

目的:探讨lncRNA RP5-1185K9.17在结直肠癌组织中的表达及其临床意义.方法:实时荧光定量-PCR法检测2011年1月至2016年6月四川省人民医院收治的117例结直肠癌患者手术切除的癌组织及癌旁组织lncRNA RP5-1185K9.17的表达;使用Chi-Square检验、Kaplan-Meier法和Cox比例风险模型分别分析lncRNA RP5-1185K9.17表达与患者临床病理特征、生存时间及预后的关系和影响结直肠癌预后的因素.结果:lncRNA RP5-1185K9.17在结直肠癌组织中的表达明显较癌旁正常组织增高[(结肠癌:6.850±0.420;直肠癌:7.180±0.380) vs(癌旁组织:1.080±0.220;正常组织:0.980±0.140),P＜0.01],lncRNA RP5-1185K9.17的表达与疾病分期、淋巴结转移、远处转移、肿瘤分化和血清CEA水平及生存状态显著相关(均P,＜0.05);而与患者的性别、年龄及肿瘤部位无显著关系(均P＞0.05);lncRNA RP5-1185K9.17高表达患者的总生存(OS)时间及无进展生存(PFS)时间均较低表达患者明显缩短[OS:(25.45±4.28)月vs (42.69±3.72)月;PFS:(13.88±2.97)月vs (26.65±5.33)个月均P＜0.01];lncRNA RP5-1185K9.17的表达、远处转移,临床分期和血清CEA水平是结直肠癌独立的预后影响因素(均P＜0.05).结论:lncRNA RP5-1185K9.17可能参与调节结直肠癌的发生发展,可作为潜在的结直肠诊断和预后分子标志物.     

APRI评分对HBV相关肝细胞癌切除术患者预后的预测价值

目的:评估天冬氨酸转氨酶与血小板计数比值指数（APRI）对HBV相关肝细胞癌（HCC）切除术患者术后总生存率（OS）的预测价值。方法:采用回顾性队列研究方法,收集2012年1月至2016年12月期间在广西医科大学附属肿瘤医院行切除术治疗的1 031例HBV相关HCC患者的术前临床资料。通过Kaplan-Meier生存曲线确定APRI评分的cutoff值。采用Kaplan-Meier法绘制不同APRI组患者的生存曲线,并通过Log-rank检验评估两组人群的生存差异。运用逐步多因素Cox回归筛选患者OS独立影响因素。采用限制性立方条图（RCS)评价患者APRI与死亡风险的相关性。建立列线图模型评估APRI对OS的预测能力并内部验证。结果:RCS显示APRI与死亡风险呈非线性关联（非线性P＜0.001）。多因素Cox回归结果显示:APRI、BCLC分期、AFP、性别和肿瘤大小是OS独立影响因素,高APRI组死亡风险是低APRI组2.1倍。患者OS的列线图显示APRI对OS的预测能力仅次于BCLC分期。在建模组和验证组中预测OS列线图的C-index分别为0.71（95%CI:0.68~0.74）、0.69（95%CI:0.64~0.75）;1和5年OS校正曲线显示列线图具有良好的校准度;临床决策曲线（DCA）显示模型具有良好的临床应用价值。结论:APRI是HBV相关HCC切除术患者OS独立影响因素,基于APRI对患者预后进行分层,有利于进行个体化治疗和随访。     

The importance of actual tumor growth rate on disease free survival and overall survival in laryngeal squamous cell carcinoma

Background and purpose

Evaluation of the variation in tumor growth rate and the influence of tumor growth rate on disease free survival (DFS) and overall survival (OS) in laryngeal squamous cell carcinoma (LSCC).

Material and methods

We delineated tumor volume on a diagnostic and planning CT scan in 131 patients with laryngeal squamous cell carcinoma and calculated the tumor growth rate. Primary endpoint was DFS. Follow up data were collected retrospectively.

Results

A large variation in tumor growth rate was seen. When dichotomized with a cut-off point of −0.3 ln(cc/day), we found a significant association between high growth rate and worse DFS (p = 0.008) and OS (p = 0.013). After stepwise adjustment for potential confounders (age, differentiation and tumor volume) this significant association persisted. However, after adjustment of N-stage association disappeared. Exploratory analyses suggested a strong association between N-stage and tumor growth rate.

Conclusions

In laryngeal squamous cell carcinoma, there is a large variation in tumor growth rate. This tumor growth rate seems to be an important factor in disease free survival and OS. This tumor growth rate is independent of age, differentiation and tumor volume associated with DFS, but N-stage seems to be a more important risk factor.