目的探究孕妇孕期血清样本中血清十八碳一不饱和脂肪酸硬脂酰鞘氨醇(serum stearoyl sphingosine,C18∶1-Cer)和1-硬脂酰基-sn-甘油-3-磷酸胆碱(lysophosphatidyl choline,LPC18∶0)水平在预测孕妇患妊娠期糖尿病(gestational diabetes ...目的探究孕妇孕期血清样本中血清十八碳一不饱和脂肪酸硬脂酰鞘氨醇(serum stearoyl sphingosine,C18∶1-Cer)和1-硬脂酰基-sn-甘油-3-磷酸胆碱(lysophosphatidyl choline,LPC18∶0)水平在预测孕妇患妊娠期糖尿病(gestational diabetes mellitus,GDM)方面的价值。方法回顾性分析126例孕妇的临床资料和实验室指标,根据GDM诊断结果,将研究对象分为GDM组(n=66)和对照组(n=60)。采用质谱法检测研究对象孕早期和孕中期血清C18∶1-Cer和LPC18∶0水平,通过Logistic回归分析筛选出GDM的危险因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线评估C18∶1-Cer,LPC188∶0和两者联合对GDM的预测价值。结果与对照组相比,GDM组血清C18∶1-Cer和LPC18∶0水平在孕早期(18.92±2.77ng/ml vs 23.47±4.18ng/ml,41.32±17.55ng/ml vs 88.08±16.02ng/ml)和孕中期(23.14±4.10ng/ml vs 18.76±4.05ng/ml,84.60±14.53ng/ml vs 40.50±17.79ng/ml)均显著升高,差异具有统计学意义(t=7.127,15.637;-5.984,2.174,均P<0.05)。C18∶1-Cer与空腹血糖(fasting plasma glucose,FPG)、空腹胰岛素(fasting plasma insulin,FPI)、胰岛素抵抗指数(homeostasis model assessment of insulin resistance,HOMA-IR)、糖化血红蛋白(glycated hemoglobin,HbA1c)和三酰甘油(triglyceride,TG)呈正相关(r=0.458,0.209,0.317,0.223,0.219,均P<0.05)。LPC18∶0与FPG,FPI,HOMA-IR,HbA1c,总胆固醇(total cholesterol,TC)和TG呈正相关(r=0.715,0.426,0.580,0.465,0.232,0.372,均P<0.05)。Logistic回归分析结果显示,C18∶1-Cer[OR(95%CI):1.522(1.136~.039),P<0.05]和LPC18∶0[OR(95%CI):1.198(1.102~1.302),P<0.001]是GDM的独立危险因素。ROC曲线分析结果显示,血清C18∶1-Cer,LPC18∶0和两指标联合的曲线下面积(area under the curve,AUC)分别为0.819,0.971和0.986,两者联合检测的预测效能优于单独检测。结论妊娠早期血清中的C18∶1-Cer和LPC18∶0与GDM的发生密切相关,C18∶1-Cer联合LPC18∶0对GDM早期诊断有一定的预测价值。展开更多
以程序性死亡蛋白-1(programmed death protein-1,PD-1)抑制剂为代表的免疫检查点抑制剂在胃癌中显示良好疗效,逐步改变晚期胃癌的治疗格局。对于程序性死亡蛋白配体-1(programmed death-ligand 1,PD-L1)高表达的患者,PD-L1单抗的治疗...以程序性死亡蛋白-1(programmed death protein-1,PD-1)抑制剂为代表的免疫检查点抑制剂在胃癌中显示良好疗效,逐步改变晚期胃癌的治疗格局。对于程序性死亡蛋白配体-1(programmed death-ligand 1,PD-L1)高表达的患者,PD-L1单抗的治疗效果更为优异,且与PD-L1蛋白表达水平呈正相关。而对于PD-L1阴性或低表达这类免疫治疗非优势人群,以PD-1单抗为基础的用药方案疗效有限,尝试双特异性抗体、ADC等不同药物的联合也是一种趋势。为了精准指导临床实践,中国抗癌协会胃癌专业委员会组织国内胃癌领域专家进行多轮讨论,系统汇总国内外最新指南和循证证据,并结合我国临床实际,从病理检测、晚期治疗以及围术期治疗3个方面制订了本专家共识,旨在提高胃癌诊治的科学性和规范性,尤其是指导基层医生对免疫治疗的选择和应用。展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the compa...BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the comparative efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC remain unclear.AIM To compare the efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC.METHODS We retrospectively analyzed the hospitalized data of a total of 472 consecutive patients with cT1N0M0 EC treated at Sun Yat-sen University Cancer center between 2017-2019 and followed up until October 30th,2022.We analyzed demographic,medical recorded,histopathologic characteristics,imaging and endoscopic,and follow-up data.The Kaplan-Meier method and Cox proportional hazards modeling were used to analyze the difference of survival outcome by treatments.Inverse probability of treatment weighting(IPTW)was used to minimize potential confounding factors.RESULTS We retrospectively analyzed patients who underwent ESD(n=99)or surgery(n=220)or d-CRT(n=16)at the Sun Yat-sen University Cancer Center from 2017 to 2019.The median follow-up time for the ESD group,the surgery group,and the d-CRT group was 42.0 mo(95%CI:35.0-60.2),45.0 mo(95%CI:34.0-61.75)and 32.5 mo(95%CI:28.3-40.0),respectively.After adjusting for background factors using IPTW,the highest 3-year overall survival(OS)rate and 3-year recurrence-free survival(RFS)rate were observed in the ESD group(3-year OS:99.7% and 94.7% and 79.1%;and 3-year RFS:98.3%,87.4% and 79.1%,in the ESD,surgical,and d-CRT groups,respectively).There was no difference of severe complications occurring between the three groups(P≥0.05).Multivariate analysis showed that treatment method,histology and depth of infiltration were independently associated with OS and RFS.CONCLUSION For cT1N0M0 EC,ESD had better long-term survival and lower hospitalization costs than those who underwent d-CRT and surgery,with a similar rate of severe complications occurring.展开更多
背景:pT1N1M0分期胃癌术后辅助治疗目前各大指南无统一共识。本研究的目的是确定辅助放化疗对pT1N1M0胃癌根治术后患者有无生存获益,分析影响pT1N1M0胃癌患者预后的危险因素。方法:从SEER数据库中选择2004年至2019年胃切除术后pT1N1M0 G...背景:pT1N1M0分期胃癌术后辅助治疗目前各大指南无统一共识。本研究的目的是确定辅助放化疗对pT1N1M0胃癌根治术后患者有无生存获益,分析影响pT1N1M0胃癌患者预后的危险因素。方法:从SEER数据库中选择2004年至2019年胃切除术后pT1N1M0 GC患者319例。采用Kaplan-Meier法和log-rank检验分析总生存率。采用Cox比例风险回归模型对影响pT1N1M0胃癌根治性切除患者预后的因素进行单变量和多变量分析。结果:生存分析显示术后辅助化疗(5年OS:52.4% vs. 75.8%,p 0.05)。结论:术后辅助化疗及辅助放疗能够改善pT1N1M0 GC患者OS,年龄、辅助化疗、肿瘤部位、ELNC是pT1N1M0胃癌预后的独立影响因素。Background: Currently, there is no consensus on postoperative adjuvant therapy for pT1N1M0 gastric cancer in major guidelines. The aim of this study is to determine the survival benefit of adjuvant chemoradiotherapy in patients with pT1N1M0 gastric cancer after radical gastrectomy, and to analyze the risk factors affecting the prognosis of patients with pT1N1M0 gastric cancer. Methods: A total of 319 patients with pT1N1M0 GC after gastrectomy from 2004 to 2019 were selected from the SEER database. Kaplan-Meier method and log-rank test were used to analyze the overall survival rate. Univariate and multivariate analyses of prognostic factors of patients with pT1N1M0 gastric cancer after radical resection were performed using Cox proportional hazards regression model. Results: Survival analysis showed that postoperative adjuvant chemotherapy (5-year OS: 52.4% vs. 75.8%, p 0.05). Conclusions: Postoperative adjuvant chemotherapy and radiotherapy can improve the OS of patients with pT1N1M0 GC. Age, adjuvant chemotherapy, tumor location, and ELNC are independent prognostic factors for pT1N1M0 gastric cancer.展开更多
文摘目的探究孕妇孕期血清样本中血清十八碳一不饱和脂肪酸硬脂酰鞘氨醇(serum stearoyl sphingosine,C18∶1-Cer)和1-硬脂酰基-sn-甘油-3-磷酸胆碱(lysophosphatidyl choline,LPC18∶0)水平在预测孕妇患妊娠期糖尿病(gestational diabetes mellitus,GDM)方面的价值。方法回顾性分析126例孕妇的临床资料和实验室指标,根据GDM诊断结果,将研究对象分为GDM组(n=66)和对照组(n=60)。采用质谱法检测研究对象孕早期和孕中期血清C18∶1-Cer和LPC18∶0水平,通过Logistic回归分析筛选出GDM的危险因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线评估C18∶1-Cer,LPC188∶0和两者联合对GDM的预测价值。结果与对照组相比,GDM组血清C18∶1-Cer和LPC18∶0水平在孕早期(18.92±2.77ng/ml vs 23.47±4.18ng/ml,41.32±17.55ng/ml vs 88.08±16.02ng/ml)和孕中期(23.14±4.10ng/ml vs 18.76±4.05ng/ml,84.60±14.53ng/ml vs 40.50±17.79ng/ml)均显著升高,差异具有统计学意义(t=7.127,15.637;-5.984,2.174,均P<0.05)。C18∶1-Cer与空腹血糖(fasting plasma glucose,FPG)、空腹胰岛素(fasting plasma insulin,FPI)、胰岛素抵抗指数(homeostasis model assessment of insulin resistance,HOMA-IR)、糖化血红蛋白(glycated hemoglobin,HbA1c)和三酰甘油(triglyceride,TG)呈正相关(r=0.458,0.209,0.317,0.223,0.219,均P<0.05)。LPC18∶0与FPG,FPI,HOMA-IR,HbA1c,总胆固醇(total cholesterol,TC)和TG呈正相关(r=0.715,0.426,0.580,0.465,0.232,0.372,均P<0.05)。Logistic回归分析结果显示,C18∶1-Cer[OR(95%CI):1.522(1.136~.039),P<0.05]和LPC18∶0[OR(95%CI):1.198(1.102~1.302),P<0.001]是GDM的独立危险因素。ROC曲线分析结果显示,血清C18∶1-Cer,LPC18∶0和两指标联合的曲线下面积(area under the curve,AUC)分别为0.819,0.971和0.986,两者联合检测的预测效能优于单独检测。结论妊娠早期血清中的C18∶1-Cer和LPC18∶0与GDM的发生密切相关,C18∶1-Cer联合LPC18∶0对GDM早期诊断有一定的预测价值。
文摘以程序性死亡蛋白-1(programmed death protein-1,PD-1)抑制剂为代表的免疫检查点抑制剂在胃癌中显示良好疗效,逐步改变晚期胃癌的治疗格局。对于程序性死亡蛋白配体-1(programmed death-ligand 1,PD-L1)高表达的患者,PD-L1单抗的治疗效果更为优异,且与PD-L1蛋白表达水平呈正相关。而对于PD-L1阴性或低表达这类免疫治疗非优势人群,以PD-1单抗为基础的用药方案疗效有限,尝试双特异性抗体、ADC等不同药物的联合也是一种趋势。为了精准指导临床实践,中国抗癌协会胃癌专业委员会组织国内胃癌领域专家进行多轮讨论,系统汇总国内外最新指南和循证证据,并结合我国临床实际,从病理检测、晚期治疗以及围术期治疗3个方面制订了本专家共识,旨在提高胃癌诊治的科学性和规范性,尤其是指导基层医生对免疫治疗的选择和应用。
基金Supported by the Guangdong Esophageal Cancer Institute Science and Technology Program,No.M202013Guangdong Medical Research Foundation,No.A2021369.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the comparative efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC remain unclear.AIM To compare the efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC.METHODS We retrospectively analyzed the hospitalized data of a total of 472 consecutive patients with cT1N0M0 EC treated at Sun Yat-sen University Cancer center between 2017-2019 and followed up until October 30th,2022.We analyzed demographic,medical recorded,histopathologic characteristics,imaging and endoscopic,and follow-up data.The Kaplan-Meier method and Cox proportional hazards modeling were used to analyze the difference of survival outcome by treatments.Inverse probability of treatment weighting(IPTW)was used to minimize potential confounding factors.RESULTS We retrospectively analyzed patients who underwent ESD(n=99)or surgery(n=220)or d-CRT(n=16)at the Sun Yat-sen University Cancer Center from 2017 to 2019.The median follow-up time for the ESD group,the surgery group,and the d-CRT group was 42.0 mo(95%CI:35.0-60.2),45.0 mo(95%CI:34.0-61.75)and 32.5 mo(95%CI:28.3-40.0),respectively.After adjusting for background factors using IPTW,the highest 3-year overall survival(OS)rate and 3-year recurrence-free survival(RFS)rate were observed in the ESD group(3-year OS:99.7% and 94.7% and 79.1%;and 3-year RFS:98.3%,87.4% and 79.1%,in the ESD,surgical,and d-CRT groups,respectively).There was no difference of severe complications occurring between the three groups(P≥0.05).Multivariate analysis showed that treatment method,histology and depth of infiltration were independently associated with OS and RFS.CONCLUSION For cT1N0M0 EC,ESD had better long-term survival and lower hospitalization costs than those who underwent d-CRT and surgery,with a similar rate of severe complications occurring.
文摘背景:pT1N1M0分期胃癌术后辅助治疗目前各大指南无统一共识。本研究的目的是确定辅助放化疗对pT1N1M0胃癌根治术后患者有无生存获益,分析影响pT1N1M0胃癌患者预后的危险因素。方法:从SEER数据库中选择2004年至2019年胃切除术后pT1N1M0 GC患者319例。采用Kaplan-Meier法和log-rank检验分析总生存率。采用Cox比例风险回归模型对影响pT1N1M0胃癌根治性切除患者预后的因素进行单变量和多变量分析。结果:生存分析显示术后辅助化疗(5年OS:52.4% vs. 75.8%,p 0.05)。结论:术后辅助化疗及辅助放疗能够改善pT1N1M0 GC患者OS,年龄、辅助化疗、肿瘤部位、ELNC是pT1N1M0胃癌预后的独立影响因素。Background: Currently, there is no consensus on postoperative adjuvant therapy for pT1N1M0 gastric cancer in major guidelines. The aim of this study is to determine the survival benefit of adjuvant chemoradiotherapy in patients with pT1N1M0 gastric cancer after radical gastrectomy, and to analyze the risk factors affecting the prognosis of patients with pT1N1M0 gastric cancer. Methods: A total of 319 patients with pT1N1M0 GC after gastrectomy from 2004 to 2019 were selected from the SEER database. Kaplan-Meier method and log-rank test were used to analyze the overall survival rate. Univariate and multivariate analyses of prognostic factors of patients with pT1N1M0 gastric cancer after radical resection were performed using Cox proportional hazards regression model. Results: Survival analysis showed that postoperative adjuvant chemotherapy (5-year OS: 52.4% vs. 75.8%, p 0.05). Conclusions: Postoperative adjuvant chemotherapy and radiotherapy can improve the OS of patients with pT1N1M0 GC. Age, adjuvant chemotherapy, tumor location, and ELNC are independent prognostic factors for pT1N1M0 gastric cancer.
