目的:观察阿霉素持续静脉输注联合国产长春瑞滨(盖诺 NVB)治疗晚期乳腺癌的疗效及毒副反应,探讨治疗方式改变在化疗中的价值。方法:32例晚期乳腺癌患者,用NA方案:NVB 25 mg/m2 ivgtt d1,8、ADM 50 mg/ m2 civ 96h d1~4。每28天为一周期,至少2周期后评价疗效。观察疗效及毒副反应。结果:32例患者均随访。总共用药170周期,平均5.3周期。CR 5例,PR 18例,RR(CR+PR)71.9% 。初治、复治有效率分别为73.3%、70.6%,二者间无显著性差异(Pgt;0.05)。中位缓解期8.2个月。主要毒副反应为白细胞降低,发生率100%(32/32),32例中Ⅲ～Ⅳ度下降15例(46.9%);恶心、呕吐23例(71.9%),Ⅲ～Ⅳ度4例(12.5%);均发生脱发,Ⅲ～Ⅳ度5例(156%);口腔炎16例(50.0%),Ⅲ～Ⅳ度4例(12.5%);静脉炎2例(6.2%),均为Ⅰ度;心脏毒性发生3例(9.4%),为Ⅰ、Ⅱ度不等。无治疗相关性死亡。结论:阿霉素持续静脉输注与盖诺联合治疗晚期转移性乳腺癌疗效明确,毒副反应可以耐受,远期疗效值得进一步研究。
Objective To summarize the effect of lenvatinib + transarterial chemoembolization (TACE) + programmed cell death protein-1 (PD-1) antibody in the treatment of hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation. Methods In this study, we reported the clinical data of four patients with hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation who received conversion therapy with lenvatinib combined with TACE and PD-1 antibody in West China Hospital. Results Among the four patients, two patients achieved complete response and two achieved partial response; tumor markers were significantly decreased after combination treatment. However, all four patients failed to undergo hepatectomy. ConclusionsLenvatinib + TACE + PD-1 antibody is effective for hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation. However, there are still many problems worthy of further discussion.
ObjectiveTo investigate the association between the stress-induced hyperglycemia ratio (SHR) and all-cause, cardiovascular, and diabetes-related mortality in patients with advanced cardiovascular-kidney-metabolic (CKM) syndrome, and to evaluate the value of SHR as an independent prognostic marker. MethodsThis retrospective cohort study used data from the 1999–2018 U.S. National Health and Nutrition Examination Survey (NHANES). A total of 2 135 patients with advanced CKM (stages 3 and 4) were included. Kaplan-Meier analysis and multivariable Cox regression models were applied to assess the relationship between SHR and mortality outcomes. Restricted cubic spline (RCS) analysis was employed to explore potential non-linear associations. Subgroup analyses were conducted to identify possible effect modifiers. ResultsOver a mean follow-up of 248 months, 674 all-cause, 198 cardiovascular, and 31 diabetes-related deaths occurred. Elevated SHR was significantly associated with diabetes-related mortality (HR=3.48, P<0.001) in a dose-response manner. SHR exhibited a U-shaped relationship with both all-cause and cardiovascular mortality (non-linearity P<0.001), indicating increased risk at both low and high SHR levels. Subgroup analyses revealed that sex, BMI, and hyperlipidemia significantly modified the association between SHR and diabetes-related death. ConclusionSHR is an independent predictor of mortality risk in patients with advanced CKM syndrome, particularly for diabetes-related death. These findings support the integration of SHR into risk stratification of high-risk CKM populations and provide a basis for metabolic stress-targeted interventions.
摘要:目的:评价塞来昔布(Celecoxib)联合希罗达(Xeloda)节拍化疗(metronomic chemotherapy)治疗老年晚期胃癌的客观疗效及毒副反应,探讨老年晚期胃癌高缓解率、低毒性的治疗方法。方法:45例患者随机分为两组。治疗组23例,采用塞来昔布与希罗达节拍化疗, Celecoxib 200 mg Bid, Xeloda 500 mg Bid,连续服药,直至病情进展。4周为一周期,至少1周期后评定疗效。对照组22例,采用FOLFOX4方案化疗:LOHP 85 mg/m2 iv gtt 2h d1,CF 200 mg/m2 iv gtt 2h d1、d2,5FU 400 mg/m2 iv bolus d1、d2,5FU 600 mg/m2 civ 22h d1、d2。每2周重复,4周为1周期,至少1周期后评定疗效。结果: 45例患者均获得随访。治疗组与对照组总有效率(RR)、疾病控制率(DCR)、生活质量改善率(QOL)分别为47.8%(11/23)、50.0%(11/22);91.3%(21/23)、63.6%(14/22);826%(19/23)、54.5%(12 /22)。 两组患者中位疾病进展时间(mTTP)、中位生存期(MST)分别为9.5个月、5.5个月;13.5个月、9个月。治疗组与对照组1年生存率分别为56.5％(13/23)、27.3％(6/22)。两组总有效率差异无统计学意(Pgt;0.05),生活质量改善率、疾病控制率、1年生存率差异有统计学意义(Plt;0.05)。治疗组毒副反应轻微。结论:塞来昔布联合希罗达节拍化疗治疗老年晚期胃癌安全、有效,患者得到生存受益,依从性好,效价比高,值得临床进一步研究。
ObjectiveTo systematically review the efficacy and safety of CDK4/6 inhibitors combined with endocrine therapy for advanced breast cancer.MethodsPubMed, EMBase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) of CDK4/6 inhibitors combined with endocrine therapy for advanced breast cancer from inception to October 13th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 4 RCTs involving 2 524 patients were included. The results of meta-analysis showed that: compared with placebo combined with endocrine therapy, CDK4/6 inhibitors combined with endocrine therapy could improve the median progression free survival rate (RR=0.53, 95%CI 0.47 to 0.60, P<0.000 01) and the objective response rate (RR=1.67, 95%CI 1.47 to 1.91,P<0.000 01). While there was no statistical difference in clinical benefit rate (RR=0.59, 95%CI 0.75 to 1.19,P=0.64). In terms of adverse reactions, CDK4/6 inhibitors combined with endocrine therapy had higher rates of neutropenia (RR=49.76, 95%CI 26.85 to 90.21, P<0.000 01), leukopenia (RR=48.69, 95%CI 18.74 to 133.61,P<0.000 01), fatigue (RR=3.11, 95%CI 1.37 to 7.08,P=0.007) and anemia (RR=2.96, 95%CI 1.61 to 5.42, P=0.000 3). There were no significant differences between two groups in nausea, diarrhea and decreased appetite.ConclusionCDK4/6 inhibitors combined with endocrine therapy for the patients with advanced breast cancer can improve median progression free survival and objective response rate, while increase the incidence of adverse events such as neutropenia, leukopenia, fatigue and anemia. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
Objective To study the long-term effect of neoadjuvant chemotherapy on advanced breast cancer. Methods The CAF neoadjuvant chemotherapy 〔CTX 500 mg/m2（1st day, 8th day), 5-FU 500 mg/m2（1st day, 8th day), and ADM 30 mg/m2 (1st day) every 3 weeks〕 was carried out in 31 breast cancer patients (stageⅢ,Ⅳ) for 2 cycles before operation, compared with 30 patients (stage Ⅲa) whose therapies were never done and operations could be feasible. Results The overall response rate was 87.1%(27/31). The stages of 19 patients among 31 (61.3%) declined (6 patients to stage Ⅲa, 8 to stageⅡb, 4 to stageⅡa, 1 to stage 0, 1 to complete response and none to pathological complete response). The diseasefree survival time of the patients was 56.3 months which was obviously longer than that of the patients without neoadjuvant chemotherapy (43.5 months, P＜0.05). The 5-year diseasefree survival rate of the patients with neoadjuvant chemotherapy was 38.7% which was a little higher than that (33.3%) of the patients without the chemotherapy, and the two groups had no significant difference. Conclusion The neoadjuvant chemotherapy can reduce the stages of patients with advanced breast cancer, obviously prolong the diseasefree survival time of patients, and reduce or delay recurrence or metastasis.
Objective To assess the efficacy, safety and dosage regimen of docetaxel in patients with non small cell lung cancer (NSCLC). Methods We searched The Cochrane Library, MEDLINE, EMBASE, CBM, CNKI, VIP and etc to collect controlled trials which involved docetaxel as the second-line treatment of NSCLC. Two reviewers evaluated the quality of included trials independently. The Cochrane Collaboration’s software RevMan 4.2 was used for meta-analyses. Results Eight randomized controlled trials were included, all of which didn’t mention the blinding methods. Compared with best supportive care (BSC), the docetaxel group showed longer time to progression (10.6 vs. 6.7 weeks, Plt;0.001) and longer median survival (7.0 vs. 4.6 months, P=0.047), as well as greater 1-year survival (37% vs. 11%, P=0.003). Patients treated with docetaxel showed higher incidence of hematologic toxicity than those treated with BSC. Meta-analyses of different docetaxel dosage regimens (1-week vs. 3-week) showed that there were no statistical differences in terms of disease control rate, response rate or 1-year survival; but the incidence of hematologic toxicity of 1-week regimen was lower than that of 3-week regimen, and no statistical difference was noted in the incidence of non-hematologic toxicity between the two regimens. Conclusion Docetaxel as the second-line chemotherapy for NSCLC significantly improved survival compared with BSC. Two dosage regimens of docetaxel had no difference in efficacy, but some differences in hematologic toxicity. Thus, if serious hematologic toxicity occurs, the 3-week treatment regimen of docetaxel could be replaced by 1-week treatment regimen.