Long-term survival outcomes of duodenal adenocarcinoma:A cohort study with 15-year single-center experience

BACKGROUND Duodenal adenocarcinoma(DA),a rare gastrointestinal malignancy,lacks clear natural history and management strategies.This study aimed to investigate the long-term outcomes of patients with DA,focusing on long-term survival and the impact of tumor characteristics,surgery,and adjuvant therapy.AIM To bridge this knowledge gap,we conducted a hospital-based cohort study in our 15-year experience with DA aimed at investigating the long-term outcomes of the patients with DA,along with analyzing the impact of the tumor characteristics,operations and adjuvant therapy on survival outcomes.METHODS A retrospective analysis of 208 patients diagnosed with non-ampullary DA at a single institution between 2009 and 2023 was performed.This study used SPSS 26.0 software to make a comprehensive statistical analysis of demographic characteristics,clinical presentation,treatment modalities,and survival outcomes.The effectiveness of surgical resection and adjuvant therapy in 5-year oval survival(OS)and disease-free survival was evaluated using Kaplan-Meier survival curves,the Cox proportional hazards model,and statistical comparisons of survival distributions.RESULTS The median OS time for the cohort was 39 months,with 3-and 5-year OS rates of 51.2%and 43.6%,respectively.Radical resection was performed in 82.6%of cases,and was significantly associated with an improved 5-year OS,with a rate of 57.8%.Adjuvant therapy showed a survival benefit in the specific patient subsets,particularly in tumor stage Ⅱ or Ⅲ tumors,with an improved OS.Adjuvant therapy(hazard ratio=2.71,95%confidence interval:1.30-5.62,P=0.008),pancreatic invasion and advanced tumor stage were identified as significant predictors of OS in multivariate analyses.CONCLUSION Radical operation for DA is associated with a remarkable improvement in the 5-year OS.Importantly,postoperative adjuvant therapy can significantly prolong the OS time in patients with radical operation,especially in patients with stage III.It highlights the necessity for early diagnosis,tailored surgical approaches,and a nuanced understanding of the role of adjuvant therapy.

Maintaining clarity:Review of maintenance therapy in nonsmall cell lung cancer

The purpose of this article is to review the role of maintenance therapy in the treatment of advanced nonsmall cell lung cancer(NSCLC). A brief overview about induction chemotherapy and its primary function in NSCLC is provided to address the basis of maintenance therapies foundation. The development of how maintenance therapy is utilized in this population is discussed and current guidelines for maintenance therapy are reviewed. Benefits and potential pitfalls of maintenance therapy are addressed, allowing a comprehensive review of the achieved clinical benefit that maintenance therapy may or may not have on NSCLC patient population. A review of current literature was conducted and a table is provided comparing the results of various maintenance therapy clinical trials. The table includes geographical location of each study, the number of patients enrolled, progression free survival and overall survival statistics, post-treatment regimens and if molecular testing was conducted. The role of molecular testing in relation to therapeutic treatment options foradvanced NSCLC patients is discussed. A treatment algorithm clearly depicts first line and second line treatment for management of NSCLC and includes molecular testing, maintenance therapy and the role clinical trials have in treatment of NSCLC. This treatment algorithm has been specifically tailored and developed to assist clinicians in the management of advanced NSCLC.

Correlation of radiotherapy with prognosis of elderly patients with hormone receptor-positive breast cancer according to immunohistochemical subtyping

Objective: The present study examined the effect of radiotherapy on recurrence and survival in elderly patients with hormone receptor-positive early breast cancer.Methods: A retrospective analysis of 327 patients aged ≥65 years, with stage I-II, hormone receptor-positive breast cancer who underwent breast-conserving surgery and received endocrine therapy(ET) or radiotherapy plus endocrine therapy(ET+RT) was performed. Both groups were divided into luminal A type and luminal B type subgroups. Evaluation criteria were 5-year disease-free survival(DFS), local relapse rate(LRR), overall survival(OS), and distant metastasis rate(DMR).Results: There were significant differences in 5-year DFS [hazard ratio(HR)=1.59, 95% confidence interval(95% CI), 1.15-2.19;P=0.005] and LRR(HR=3.33, 95% CI, 1.51-7.34;P=0.003), whereas there were no significant differences in OS and DMR between ET group and ET+RT group. In luminal A type, there was no significant difference in 5-year DFS, LRR, OS and DMR between ET group and ET+RT group. In luminal B type,there were statistically significant differences in 5-year DFS(HR=2.19, 95% CI, 1.37-3.49;P=0.001), LRR(HR=5.45, 95% CI, 1.65-17.98;P=0.005), and OS(HR=1.75, 95% CI, 1.01-3.05;P=0.048) between ET group and ET+RT group. In the ET group, there were significant differences between luminal A type and luminal B type in5-year DFS(HR=1.84, 95% CI, 1.23-2.75;P=0.003) and OS(HR=1.76, 95% CI, 1.07-2.91;P=0.026).Conclusions: After breast-conserving surgery, radiotherapy can reduce the LRR and improve the DFS and OS of luminal B type elderly patients, whereas luminal A type elderly patients do not benefit from radiotherapy.Without radiotherapy, luminal A type patients have better DFS and OS than luminal B type patients.

Nomograms and risk score models for predicting survival in rectal cancer patients with neoadjuvant therapy

BACKGROUND Colorectal cancer is a common digestive cancer worldwide.As a comprehensive treatment for locally advanced rectal cancer(LARC),neoadjuvant therapy(NT)has been increasingly used as the standard treatment for clinical stage II/III rectal cancer.However,few patients achieve a complete pathological response,and most patients require surgical resection and adjuvant therapy.Therefore,identifying risk factors and developing accurate models to predict the prognosis of LARC patients are of great clinical significance.AIM To establish effective prognostic nomograms and risk score prediction models to predict overall survival(OS)and disease-free survival(DFS)for LARC treated with NT.METHODS Nomograms and risk factor score prediction models were based on patients who received NT at the Cancer Hospital from 2015 to 2017.The least absolute shrinkage and selection operator regression model were utilized to screen for prognostic risk factors,which were validated by the Cox regression method.Assessment of the performance of the two prediction models was conducted using receiver operating characteristic curves,and that of the two nomograms was conducted by calculating the concordance index(C-index)and calibration curves.The results were validated in a cohort of 65 patients from 2015 to 2017.RESULTS Seven features were significantly associated with OS and were included in the OS prediction nomogram and prediction model:Vascular_tumors_bolt,cancer nodules,yN,body mass index,matchmouth distance from the edge,nerve aggression and postoperative carcinoembryonic antigen.The nomogram showed good predictive value for OS,with a C-index of 0.91(95%CI:0.85,0.97)and good calibration.In the validation cohort,the C-index was 0.69(95%CI:0.53,0.84).The risk factor prediction model showed good predictive value.The areas under the curve for 3-and 5-year survival were 0.811 and 0.782.The nomogram for predicting DFS included ypTNM and nerve aggression and showed good calibration and a C-index of 0.77(95%CI:0.69,0.85).In the validation cohort,the C-index was 0.71(95%CI:0.61,0.81).The prediction model for DFS also had good predictive value,with an AUC for 3-year survival of 0.784 and an AUC for 5-year survival of 0.754.CONCLUSION We established accurate nomograms and prediction models for predicting OS and DFS in patients with LARC after undergoing NT.

Prognostic impact of at least 12 lymph nodes after neoadjuvant therapy in rectal cancer: A meta-analysis

BACKGROUND The number of dissected lymph nodes(LNs)in rectal cancer after neoadjuvant therapy has a controversial effect on the prognosis.AIM To investigate the prognostic impact of the number of LN dissected in rectal cancer patients after neoadjuvant therapy.METHODS We performed a systematic review and searched Pub Med,Embase(Ovid),MEDLINE(Ovid),Web of Science,and Cochrane Library from January 1,2000 until January 1,2020.Two reviewers examined all the publications independently and extracted the relevant data.Articles were eligible for inclusion if they compared the number of LNs in rectal cancer specimens resected after neoadjuvant treatment(LNs≥12 vs LNs<12).The primary endpoints were the overall survival(OS)and disease-free survival(DFS).RESULTS Nine articles were included in the meta-analyses.Statistical analysis revealed a statistically significant difference in OS[hazard ratio(HR)=0.76,95%confidence interval(CI):0.66-0.88,I2=12.2%,P=0.336],DFS(HR=0.76,95%CI:0.63-0.92,I2=68.4%,P=0.013),and distant recurrence(DR)(HR=0.63,95%CI:0.48-0.93,I2=30.5%,P=0.237)between the LNs≥12 and LNs<12 groups,but local recurrence(HR=0.67,95%CI:0.38-1.16,I2=0%,P=0.348)showed no statistical difference.Moreover,subgroup analysis of LN negative patients revealed a statistically significant difference in DFS(HR=0.67,95%CI:0.52-0.88,I2=0%,P=0.565)between the LNs≥12 and LNs<12 groups.CONCLUSION Although neoadjuvant therapy reduces LN production in rectal cancer,our data indicate that dissecting at least 12 LNs after neoadjuvant therapy may improve the patients’OS,DFS,and DR.

Impact of oral anti-hepatitis B therapy on the survival of patients with hepatocellular carcinoma initially treated with chemoembolization

Introduction:Most hepatocellular carcinomas(HCC) develop in a background of underlying liver disease including chronic hepatitis B.However,the effect of antiviral therapy on the long-term outcome of patients with hepatitis B virus(HBV)-related HCC treated with chemoembolization is unclear.This study aimed to evaluate the survival benefits of anti-HBV therapy after chemoembolization for patients with HBV-related HCC.Methods:A total of 224 HCC patients who successfully underwent chemoembolization were identified,and their survival and other relevant clinical data were reviewed.Kaplan-Meier and Cox regression analyses were performed to validate possible effects of antiviral treatment on overall survival(OS).Results:The median survival time(MST) was 15.9(95%confidence interval[CI],9.5-27.7) months in the antiviral group and 9.6(95%CI,7.8-13.7) months in the non-antiviral group(log-rank test,P = 0.044).Cox multivariate analysis revealed that antiviral treatment was a prognostic factor for OS(P = 0.008).Additionally,a further analysis was based on the stratification of the TNM tumor stages.In the subgroup of early stages,MST was significantly longer in the antiviral-treatment group than in the non-antiviral group(61.8 months[95%CI,34.8 months to beyond the follow-up period]versus 26.2[95%CI,14.5-37.7]months,P= 0.012).Multivariate analysis identified antiviral treatment as a prognostic factor for OS in the early-stage subgroup(P = 0.006).However,in the subgroup of advanced stages,MST of the antiviral-treated group was comparable to that of the non-antiviral group(8.4[95%CI,5.2-13.5]months versus 7.4[95%CI,5.9-9.3]months,P = 0.219).Multivariate analysis did not indicate that antiviral treatment was a significant prognostic factor in this subgroup.Conclusion:Antiviral treatment is associated with prolonged OS time after chemoembolization for HCC,especially in patients with early-stage tumors.

Hypofractionated particle beam therapy for hepatocellular carcinoma–a brief review of clinical effectiveness

Hepatocellular carcinoma(HCC)is the fifth most common malignancy and the second leading cause of cancer mortality worldwide.The cornerstone to improving the prognosis of HCC patients has been the control of loco-regional disease progression and the lesser toxicities of local treatment.Although radiotherapy has not been considered a preferred treatment modality for HCC,charged particle therapy(CPT),including proton beam therapy(PBT)and carbon ion radiotherapy(CIRT),possesses advantages(for example,it allows ablative radiation doses to be applied to tumors but simultaneously spares the normal liver parenchyma from radiation)and has emerged as an alternative treatment option for HCC.With the technological advancements in CPT,various radiation dosages of CPT have been used for HCC treatment via CPT.However,the efficacy and safety of the evolving dosages remain uncertain.To assess the association between locoregional control of HCC and the dose and regimen of CPT,we provide a brief overview of selected literature on dose regimens from conventional to hypofractionated short-course CPT in the treatment of HCC and the subsequent determinants of clinical outcomes.Overall,CPT provides a better local control rate compared with photon beam therapy,ranging from 80%to 96%,and a 3-year overall survival ranging from 50%to 75%,and it results in rare grade 3 toxicities of the late gastrointestinal tract(including radiation-induced liver disease).Regarding CPT for the treatment of locoregional HCC,conventional CPT is preferred to treat central tumors of HCC to avoid late toxicities of the biliary tract.In contrast,the hypo-fractionation regimen of CPT is suggested for treatment of larger-sized tumors of HCC to overcome potential radio-resistance.

Any role for transarterial radioembolization in unresectable intrahepatic cholangiocarcinoma in the era of advanced systemic therapies?

Intrahepatic cholangiocarcinoma(iCCA)is recognized as the second most frequently diagnosed liver malignancy,following closely after hepatocellular carcinoma.Its incidence has seen a global upsurge in the past several years.Unfortunately,due to the lack of well-defined risk factors and limited diagnostic tools,iCCA is often diagnosed at an advanced stage,resulting in a poor prognosis.While surgery is the only potentially curative option,it is rarely feasible.Currently,there are ongoing investigations into various treatment approaches for unresectable iCCA,including conventional chemotherapies,targeted therapies,immunotherapies,and locoregional treatments.This study aims to explore the role of transarterial radioembolization(TARE)in the treatment of unresectable iCCA and provide a comprehensive review.The findings suggest that TARE is a safe and effective treatment option for unresectable iCCA,with a median overall survival(OS)of 14.9 months in the study cohort.Studies on TARE for unresectable iCCA,both as a first-line treatment(as a neo-adjuvant down-staging strategy)and as adjuvant therapy,have reported varying median response rates(ranging from 34%to 86%)and median OS(12-16 mo).These differences can be attributed to the heterogeneity of the patient population and the limited number of participants in the studies.Most studies have identified tumor burden,portal vein involvement,and the patient’s performance status as key prognostic factors.Furthermore,a phase 2 trial evaluated the combination of TARE and chemotherapy(cisplatin-gemcitabine)as a first-line therapy for locally advanced unresectable iCCA.The results showed promising outcomes,including a median OS of 22 mo and a 22%achievement in down-staging the tumor.In conclusion,TARE represents a viable treatment option for unresectable iCCA,and its combination with systemic chemotherapy has shown promising results.However,it is important to consider treatment-independent factors that can influence prognosis.Further research is necessary to identify optimal treatment combinations and predictive factors for a favorable response in iCCA patients.

二氧化锆髓腔固位冠修复低牙合龈距磨牙的临床效果

目的 评估二氧化锆髓腔固位冠修复低牙合龈距磨牙的临床效果。方法 对2020年1月—2022年1月就诊的46例(50颗)根管治疗后的低牙合龈距磨牙采用二氧化锆髓腔固位冠修复。分别于修复完成后1、6、12个月复查,对修复体完整性、邻接紧密度、边缘密合情况、基牙情况、牙周状况及修复体松动或脱落情况进行评估。结果 1个月复查,50颗磨牙修复后各项评价指标均达到临床可接受水平。6个月复查,6颗患牙牙龈轻度充血,修复体及基牙牙体无异常。12个月复查,仅2颗患牙修复体邻接关系欠佳;2颗患牙牙龈轻度充血,未发现修复体及基牙牙体问题。结论 对根管治疗后的低牙合龈距磨牙采用二氧化锆髓腔固位冠修复既可保护牙体避免折裂,又可提升黏结效果且兼具美观,临床应用效果良好。

去甲基化药物在慢性粒单核细胞白血病中的临床疗效观察

目的:观察去甲基化药物在慢性粒单核细胞白血病(CMML)中的临床疗效及安全性。方法:回顾性分析2014年2月至2021年6月在河北医科大学第二医院确诊为CMML并应用去甲基化药物治疗的患者的临床资料、疗效指标、生存期及安全性。结果:共有25例CMML患者接受去甲基化药物治疗,18例以地西他滨为基础治疗,7例以阿扎胞苷为基础治疗。其中20例获得应答,7例获得完全缓解(CR),CR患者均以地西他滨为基础治疗,5例CR发生于治疗的前4个疗程。中位随访16.4(9.4-20.5)个月后,4例CR患者进展为急性髓系白血病。25例CMML患者的中位总生存期为17.4个月(95%CI:12.437-22.363)。按照MDAPS、CPSS、CPSS-mol、MMM预后积分系统分别对患者进行危险度分层,仅发现MDAPS预后积分系统不同危险度分层与生存期之间的差异有统计学意义。CMML患者应用去甲基化药物的常见不良反应包括感染、胃肠道反应、血液学毒性、皮肤过敏和肝功能损伤。所有患者给予相应的治疗后,症状均得到改善。结论:去甲基化药物对CMML患者治疗有效,且安全性良好。CR多发生于治疗的前4个疗程,对于无应答的患者,可应用去甲基化药物联合小剂量化疗。去甲基化药物可以延缓病情但并不能阻止CMML的疾病进展。

卡瑞利珠单抗联合阿帕替尼治疗晚期原发性肝癌患者效果研究

目的探讨应用卡瑞利珠单抗联合阿帕替尼治疗晚期原发性肝癌(PLC)患者的效果。方法2018年8月~2021年8月我院诊治的晚期PLC患者62例,被随机分为对照组31例和观察组31例,分别给予阿帕替尼治疗或卡瑞利珠单抗联合阿帕替尼治疗3个疗程。使用流式细胞仪检测外周血T淋巴细胞亚群CD3^(+)、CD4^(+)、CD8^(+)细胞百分比,计算CD4^(+)/CD8^(+)细胞比值,采用电化学发光法检测血清甲胎蛋白(AFP)、热休克蛋白90α(HSP90α)和癌胚抗原(CEA)水平。结果在治疗3个月末,观察组和对照组客观缓解率分别为58.1%和32.3%,差异有统计学意义(P<0.05);观察组外周血CD4^(+)细胞百分比和CD4^(+)/CD8^(+)细胞比值分别为(38.3±2.6)%和(1.3±0.2),均显著高于对照组【分别为(34.5±2.9)%和(1.1±0.2),P<0.05】;观察组血清AFP、HSP90α和CEA水平分别为(143.6±26.5)μg/L、(93.2±22.4)ng/mL和(13.2±4.3)ng/mL,均显著低于对照组【分别为(204.5±29.6)μg/L、(129.1±23.5)ng/mL和(28.6±4.8)ng/mL,P<0.05】;经随访,观察组和对照组中位总生存期分别为14个月和10个月,差异有统计学意义(Log Rank x^(2)=5.033,P=0.025)。结论卡瑞利珠单抗联合阿帕替尼治疗晚期PLC患者有一定的临床疗效,可延长患者生存时间。

整合心理行为治疗配合放化疗对乳腺癌术后患者整体心身变化及睡眠质量的影响

目的探讨整合心理行为治疗配合放化疗对乳腺癌术后患者整体心身变化及睡眠质量的影响。方法选取2019年1月至2023年1月河南科技大学第一附属医院收治的289例乳腺癌术后患者作为研究对象,按随机数表法分为研究组145例和常规组144例。两组患者均给予4~8个周期的化疗,每个周期3周(21 d),化疗完成后放疗。期间常规组患者给予常规心理治疗,研究组患者在常规组基础上给予整合心理行为治疗。靶向维持及内分泌治疗期间不进行心理治疗。比较两组患者治疗前后的整体心身变化、90项症状自评量表(SCL-90)评分和睡眠质量[匹兹堡睡眠治疗指数(PSQI)]。结果研究组患者治疗期间脱落率为2.76%(4/145),明显低于常规组的14.58%(21/144),差异有统计学意义(P<0.05);治疗后,研究组患者的压力指数、疲劳指数分别为(45.20±5.24)分、(78.52±4.39)分,明显低于常规组的(52.61±6.08)分、(83.44±4.58)分,放松指数、稳定指数分别为(67.82±3.92)分、(88.54±3.16)分,明显高于常规组的(63.10±4.75)分、(85.17±3.04)分,差异均有统计学意义(P<0.05);治疗后,研究组患者的躯体化、精神病性、人际关系敏感、强迫症状、焦虑、抑郁、偏执、恐怖、敌对及SCL-90总分明显低于常规组,差异均有统计学意义(P<0.05);治疗后,研究组患者的主观睡眠质量、睡眠潜伏期、睡眠时间、睡眠效率、睡眠障碍、日间功能障碍、夜间功能障碍维度评分及PSQI总分分别为(0.95±0.10)分、(0.83±0.14)分、(0.76±0.23)分、(0.85±0.19)分、(0.93±0.20)分、(0.65±0.11)分、(0.72±0.14)分、(5.69±1.13)分,明显低于常规组(1.10±0.11)分、(0.96±0.17)分、(1.04±0.26)分、(1.06±0.22)分、(1.12±0.25)分、(0.81±0.13)分、(0.93±0.18)分、(7.02±1.25)分,差异均有统计学意义(P<0.05)。结论整合心理行为治疗配合放化疗应用于乳腺癌术后患者能减少治疗期间脱落病例,改善患者整体心身状况,提高睡眠质量。

新生儿黄疸护理中运用整体护理干预的效果

目的分析在新生儿黄疸护理中运用整体护理干预的效果。方法选取本院2021年1月—2023年6月收治的131例接受蓝光治疗的黄疸新生儿为研究对象,将患儿以信封法随机分成两组,其中对照组(n=65)行常规护理,观察组(n=66)行整体护理。比较两组患儿的黄疸康复情况、不良事件发生率、满意度。结果观察组黄疸消退时间、蓝光照射时间、住院时间均短于对照组(P<0.05);观察组患儿呕吐、高热、腹泻等不良事件总发生率低于对照组(P<0.05);观察组对护理的满意度为98.48%,高于对照组的87.69%(P<0.05)。结论整体护理在接受蓝光治疗的黄疸新生儿护理中应用效果令人满意,可缩短患儿病程,并减少不良事件的发生,得到家属的认可。

Comparison of clinical characteristics and prognostic factors in two site-specific categories of ampullary cancer

BACKGROUND Ampullary cancer is a relatively rare malignant tumor in the digestive system.Its incidence has increased in recent years.As for now,its biological characteristics have not been fully clarified.Recent studies have primarily focused on the histological classification and genetic changes,but there are fewer investigations into the differences among site-specific subgroups.The clinicopathological charac-teristics of ampullary cancer occurring in different positions have not been elucidated.Furthermore,the role of adjuvant therapy in the treatment of patients with ampullary cancer remains controversial.ampullary cancer and explore the factors affecting prognosis.METHODS A total of 356 patients who met the inclusion and exclusion criteria were enrolled.Patients were divided into ampulla of Vater cancer(AVC)and duodenal papilla cancer(DPC)based on the gross and microscopic findings.Baseline data,admission examination results,and perioperative outcomes were collected and analyzed.The Kaplan-Meier curve was used for survival analysis.Univariate and multivariate analysis was performed to explore the independent risk factors affecting the overall survival(OS)of both groups.RESULTS The preoperative total bilirubin level in patients with AVC was significantly higher than those with DPC(P=0.04).The OS for patients with DPC was 58.90±38.74 months,significantly longer than 44.31±35.90 months for patients with AVC(P<0.01).The independent risk factors affecting the OS of AVC included:Preoperative albumin level(P=0.009),total bilirubin level(P=0.017),and number of positive lymph nodes(P=0.005).For DPC,risk factors included:Age(P=0.004),tumor size(P=0.023),number of positive lymph nodes(P=0.010)and adjuvant treatment(P=0.020).Adjuvant therapy significantly improved the OS rate of patients with DPC,but not for those with AVC.CONCLUSION Patients with AVC had a shorter OS compared to those with DPC.The prognosis factors and the role of adjuvant therapy of two groups were different.

New First-line Immunotherapy-based Therapies for Unresectable Hepatocellular Carcinoma: A Living Network Meta-analysis

Background and Aims:Several first-line immune checkpoint inhibitor(ICI)-based combination therapies have been identified for unresectable hepatocellular carcinoma(uHCC).This network meta-analysis(NMA)aimed to provide the most updated evidence about the preferred first-line ICI-based regimens for uHCC.Methods:A comprehensive literature search was performed in various databases from database inception to May 2022.The phase 3 trials evaluating first-line single-agent ICIs,molecular-target agents(MTAs),or their combinations in uHCC were included.The main endpoints were overall survival(OS)and progression-free survival(PFS).Pooled effect estimates were calculated using a random effects model within the frequentist framework.Subgroup analyses based on etiology were also conducted.Results:Twelve trials at low risk of bias with 8,275 patients comparing 13 treatments were included.OS with atezolizumab plus bevacizumab was comparable to sintilimab plus IBI305[hazard ratio(HR):1.16;95%confidence interval(CI):0.80–1.68]and camrelizumab plus apatinib(HR:1.06;95%CI:0.75–1.51).The combination therapies,apart from atezolizumab plus cabozantinib in OS and durvalumab plus tremelimumab in PFS,had higher P-score than single-agent MTAs or ICIs.The survival benefits were associated with a high risk of adverse events leading to treatment discontinuation.The proportion of patients with hepatitis B virus-related HCC receiving ICIs combinations might positively correlate with survival advantages(R2=0.8039,p=0.0155).Conclusion:This NMA demonstrated that atezolizumab plus bevacizumab remains the stand of care and confers comparable survival benefits to sintilimab plus IBI305 and camrelizumab plus apatinib in first-line therapy for uHCC.The optimal treatment algorithms should consider efficacy,safety,and etiology.

基于SEER数据库分析直肠癌外放疗后第二原发膀胱癌的发生风险与预后

目的分析直肠癌(RC)患者围手术期外放疗(EBRT)对第二原发膀胱癌(SPBC)发病风险及预后的影响。方法通过监测、流行病学和最终结果(SEER)数据库回顾性筛选1973年1月1日至2015年12月31日期间病理确诊RC患者51649例。利用SEER*Stat软件,采用泊松回归计算标准化发病率(SIR)。使用R软件,采用Fine-Gray竞争风险回归分析评估RC患者发生SPBC的累积发生率。最后使用倾向评分匹配Kaplan-Meier法评估SPBC患者的生存结局。结果在51649例RC患者中,15612例患者同时了接受手术和EBRT,而36037例患者仅接受手术治疗。总计随访30年,放疗组(RT组)SPBC的累计发病率为4.50%,无放疗组(NRT组)为2.20%。RT组的SIR高于普通人群(SIR=1.43,95%CI:1.24~1.64,P<0.050)。竞争风险回归分析显示,接受放疗与更高的SPBC发生风险相关(HR=1.49,95%CI:1.13~1.95,P=0.004)。RT组和NRT组经倾向评分匹配后合并的SPBC患者的生存分析结果显示,两组患者10年总生存期的差异有统计学意义(62.8%vs 72.7%,P=0.010)。此外,RT组(27.7%vs 40.4%,P=0.005)和NRT组(24.2%vs 35.1%,P<0.001)合并SPBC患者的10年总生存期均显著低于仅诊断原发膀胱癌患者。结论放疗是RC长期生存患者发生SPBC的重要危险因素,且可能与合并SPBC患者的不良预后有关。

Survival Rate and Factors Influencing It in Triptorelin-Castrated Metastatic Prostate Cancer Patients

Background: Most newly diagnosed prostate cancers in Benin are metastatic diseases and patients are reluctant to undergo orchiectomy. Still, chemical androgen deprivation therapy is not always available and not every patient can afford it. Thus, it will be interesting to evaluate the results of that therapy in the country. Objective: To analyze the survival rate and factors influencing it in metastatic prostate cancer patients who underwent triptorelin-based androgen deprivation therapy at the former Military Teaching Hospital of Cotonou from January 1, 2012, to December 31, 2022. Patients and Method: Metastatic prostate cancer patients received intragluteal injections of triptorelin 11.25 mg every 3 months. We retrospectively collected follow-up data from the patients’ medical records. By means of the software StataTM version 15, we performed a descriptive analysis of qualitative data. We used Kaplan-Meir method to estimate the overall survival rate in the whole cohort and in specific subgroups of patients. We compared survival rates by using the log-rank test. Results: 68 metastatic prostate cancer patients aged 47-86 years (mean = 69.9) with initial PSA ranging from 24.25 to 6334 ng/mL (mean = 666.1) started triptorelin-based castration. The tumor grade in 21 (33.3%), 14 (22.2%), 15 (23.8), 8 (12.7%), and 5 (7.9%) patients was respectively ISUP grade groups 5, 4, 3, 2, and 1. 15 (22.1%), 4 (5.9%), 2 (2.9%), 1 (1.5%), 11 (16.2%), and 7 (10.3%) patients respectively had hypertension, diabetes mellitus, peptic ulcer, asthma, unilateral or bilateral hydronephrosis, and paralysis. The mean nadir PSA level was 22.5 ng/mL (range: 0.01-220.25). The mean time to nadir PSA level was 8.9 months (range: 3-57). The overall survival rate was 42.6%. There was no significant survival difference between age groups (p = 0.475), relating to the presence of diabetes or hypertension (p = 0.757) or to the presence of paralysis or hydronephrosis (p = 0.090). The initial PSA level exerted no significant impact on patients’ survival (p = 0.461). Neither did the time to PSA nadir (p = 0.263). The PSA nadir less than 4 ng/mL (p = 0.005) and the PSA nadir less than 4 ng/mL achieved in 12 months or less (p = 0.002) were predictive of longer survival rate. The difference in survival rate through the ISUP grade groups was not significant (p = 0.061). Conclusion: The overall survival rate was 42.6% at 5 years. Achieving PSA nadir of less than 4 ng/mL in less than 12 months of castration was predictive of longer survival rate in triptorelin-castrated metastatic prostate cancer patients.

CAPOX与CAPOX序贯多西他赛方案应用于Ⅲ期胃癌辅助治疗的疗效对比

背景Ⅲ期胃癌患者术后复发率较高,术后辅助化疗可以使患者生存获益,但部分患者无法耐受多周期化疗。在乳腺癌的辅助治疗模式中,不同药物的序贯化疗可减少化疗的不良反应且不影响疗效,但该治疗模式在胃癌治疗中尚未得到验证。目的比较Ⅲ期胃癌患者术后接受8周期卡培他滨联合奥沙利铂(CAPOX)方案辅助化疗与4周期CAPOX序贯4周期多西他赛(CAPOX→D)方案的疗效。方法回顾性分析2009年1月1日—2020年12月30日在解放军总医院行术后辅助化疗的141例Ⅲ期胃癌患者的临床数据。比较CAPOX与CAPOX→D方案化疗患者的无病生存期(disease-free survival,DFS)、总生存期(overall survival,OS)和化疗不良反应,并进行不同预后因素的单因素和多因素分析。结果CAPOX方案组95例,其中男性75例,女性20例,≥60岁36例,<60岁59例;CAPOX→D方案组46例,其中男性39例,女性7例,≥60岁16例,<60岁30例,两组间性别和年龄的差异无统计学意义(P>0.05)。CAPOX组中位DFS为23.2(95%CI:15.6~30.8)个月,CAPOX→D组中位DFS为23.0(95%CI:11.7~34.3)个月,差异无统计学意义(P=0.074)。CAPOX组中位OS为38.2(95%CI:27.8~48.6)个月,CAPOX→D组中位OS为46.2(95%CI:30.6~61.8)个月,差异有统计学意义(P=0.026)。预后因素分析显示,女性较男性有更高的进展风险(HR=1.649,95%CI:1.066~2.552,P=0.025);女性(HR=1.645,95%CI:1.094~2.607,P=0.030)、肿瘤位于胃体区(HR=1.751,95%CI:1.110~2.761,P=0.016)及幽门区(相较于贲门区;HR=1.889,95%CI:1.129~2.960,P=0.005)死亡风险较高,CAPOX→D方案辅助化疗的死亡风险较CAPOX方案下降(HR=0.663,95%CI:0.445~0.989,P=0.044)。CAPOX组的骨髓抑制(76.8%vs 41.3%,P=0.005)、消化道反应(84.2%vs 60.7%,P=0.010)和周围神经毒性(51.6%vs 32.6%,P=0.030)不良反应发生率较CAPOX→D组更高。结论相比CAPOX方案,Ⅲ期胃癌患者术后选择CAPOX→D方案辅助化疗生存获益更大,安全性更高。

去甲氧柔红霉素诱导治疗急性髓系白血病的效果

目的比较吡柔比星联合阿糖胞苷(TA方案)与去甲氧柔红霉素联合阿糖胞苷(IA方案)治疗初治急性髓系白血病(AML)的效果与不良反应。方法回顾性分析IA、TA方案诱导治疗初治AML患者91例,随访至2013年9月,比较两方案的疗效、不良反应。结果 IA与TA方案诱导化疗的完全缓解率、总反应率、不良反应的差异无统计学意义(P>0.05)。IA方案中位无复发生存比TA方案明显延长(分别14.14和9.36个月),差异有统计学意义(P=0.010);IA方案患者超过6个月的疾病复发率明显低于TA方案(15.8%vs 48.6%,P=0.002);总生存时间和3年生存率的差异无统计学意义(P>0.05)。结论在初治AML诱导治疗方案中,与TA方案相比,IA方案明显减少患者>6个月疾病复发率,延长无复发生存。

关于晚期胰腺癌的Meta分析:吉西他滨联合化疗与吉西他滨单药

目的通过Meta分析,探讨吉西他滨联合化疗和吉西他滨单药化疗在治疗晚期胰腺癌病人中的意义。方法通过MEDLINE、EMBASE、ASCO论文集等数据库检索国内外已发表和未发表的相关文献。选择治疗组为吉西他滨联合化疗,对照组为吉西他滨单药化疗的晚期胰腺癌的随机对照试验。由2位评价者分别收集资料,按纳入标准入选,主要对总生存率进行Meta分析,其次是客观缓解率、临床受益率、肿瘤进展时间/无进展生存、毒副反应。结果共纳入19个随机对照试验。在治疗晚期胰腺癌方面,吉西他滨联合化疗与吉西他滨单药化疗比较,半年生存率提高4%(P=0.02),1年生存率提高3%(P=0.05),客观缓解率提高5%(P=0.01),半年肿瘤进展时间/无进展生存提高10%(P<0.00001),临床受益率提高7%(P=0.06),但毒副反应增加(只统计WHO3～4度毒性),例如中性粒细胞减少症增加7%(P=0.04)、血小板减少症增加6%(P=0.002)、恶心/呕吐增加3%(P=0.04)。结论在晚期胰腺癌的治疗上,吉西他滨联合化疗与吉西他滨单药化疗对比,能提高总生存期(半年生存率)、客观缓解率和半年肿瘤进展时间/无进展生存,差异有统计学意义,但其副作用也增加。吉西他滨联合化疗在晚期胰腺癌治疗上有很好的前景。