[目的]探讨术后复发三阴性乳腺癌(triple-negative breast cancer,TNBC)临床流行病学特征。[方法]本研究是一项基于医院的、全国多中心、3年(2012—2014年)临床流行病学回顾性研究。纳入术后复发乳腺癌患者病例资料,收集并分析其人口统...[目的]探讨术后复发三阴性乳腺癌(triple-negative breast cancer,TNBC)临床流行病学特征。[方法]本研究是一项基于医院的、全国多中心、3年(2012—2014年)临床流行病学回顾性研究。纳入术后复发乳腺癌患者病例资料,收集并分析其人口统计学信息、潜在危险因素、临床诊疗特点及预后信息。[结果]共纳入术后复发TNBC患者455例,平均年龄46岁,中位无病生存时间20个月。相较非TNBC,TNBC在无病生存时间、肝转移、肺转移、骨转移、辅助化疗和分布地区上均有统计学差异(P均<0.05)。多因素分析显示,淋巴结转移数目大于2(OR=0.817,95%CI:0.678~0.985,P=0.034)和新辅助化疗未达病理完全缓解(OR=0.757,95%CI:0.609~0.942,P=0.012)是术后复发TNBC无病生存时间的独立影响因素。[结论]淋巴结转移数大于2和新辅助化疗未达病理完全缓解的TNBC患者,术后应进行密切随访。展开更多
目的探讨CT导向下^125I粒子植入治疗复发／转移性盆腔恶性肿瘤的近中期临床疗效。方法接受手术、化疗或放疗等综合治疗后盆腔复发／转移恶性肿瘤患者30例，男10例、女20例，年龄31～85岁，中位年龄为55岁。可评价病灶32个，病灶最大径3...目的探讨CT导向下^125I粒子植入治疗复发／转移性盆腔恶性肿瘤的近中期临床疗效。方法接受手术、化疗或放疗等综合治疗后盆腔复发／转移恶性肿瘤患者30例，男10例、女20例，年龄31～85岁，中位年龄为55岁。可评价病灶32个，病灶最大径3．0～12．2cm，平均值4．8cm。病例采用计算机立体定位系统（treatment plan system，TPS）计算布源，肿瘤周边匹配剂量（MPG）为100～160Gy，局部麻醉CT导向下采用2．96×10^7Bq活度的^125I粒子相隔0．5～1．0cm植入盆腔病灶内，随访观察局部控制率，总体生存率，疼痛缓解情况及并发症。结果随访2～40个月，中位随访时间28个月，随访结束32个局部病灶评价CR10／32，PR13／32，SD5／32，PD4／32，临床受益率87．5％（CR＋PR＋SD），1年累计局部控制率为83．3％，2年累积局部控制率为62．5％；总体1年生存率87．7％，2年生存率73．1％，3年生存率45．7％，中位生存时间28个月；疼痛缓解率21／23（91．3％）。近期副反应轻微，远期副反应主要表现为3例Ⅰ-Ⅱ级放射性肠炎，1例Ⅰ级放射性膀胱炎，1例下肢长期麻木感，未见大出血、急性肺栓塞、盆腔脓肿、肠瘘、肠穿孔、窦道等严重并发症。结论CT导向下放射性粒子植入复发／转移性盆腔恶性肿瘤，并发症发生率低，患者生活质量改善明显，临床疗效确切，是一种治疗复发／转移性盆腔恶性肿瘤简单、安全、有效的方法。展开更多
Unresectable recurrent or metastatic head and neck cancer is an incurable disease with survival of approximately 12 months. Head and neck tumors exhibit numerous derangements in the tumor microenvironment that aid in ...Unresectable recurrent or metastatic head and neck cancer is an incurable disease with survival of approximately 12 months. Head and neck tumors exhibit numerous derangements in the tumor microenvironment that aid in immune evasion and may serve as targets for future therapies. Pembrolizumab is now approved as a first line therapy. Despite the promise of currently approved immunotherapies there continues to be low response rates and additional strategies are needed. Here, alterations in the immune microenvironment and current therapeutic strategies are reviewed with a focus on novel immunologic approaches.展开更多
BACKGROUND The outcomes of patients diagnosed with head and neck squamous cell carcinoma(HNSCC)who are not candidates for local salvage therapy and of those diagnosed with recurrent or metastatic disease are dismal.A ...BACKGROUND The outcomes of patients diagnosed with head and neck squamous cell carcinoma(HNSCC)who are not candidates for local salvage therapy and of those diagnosed with recurrent or metastatic disease are dismal.A relatively new systemic therapy option that emerged in recent years in the treatment of advanced HNSCC is immunotherapy using immune checkpoint inhibitors(ICIs).The safety profile and anti-tumor activity of these agents demonstrated in early phase clinical trials paved the way to the initiation of several promising phase-3 trials in the field.AIM To evaluate the evidence on the effectiveness of ICIs in HNSCC,based on published phase-3 clinical trials.METHODS We searched PubMed,Cochrane Library,Embase,and Scopus to identify published literature evaluating immunotherapy using ICIs in recurrent or metastatic HNSCC(R/M HNSCC)and locally advanced head and neck squamous cell carcinoma(LAHNSCC).We used a combination of standardized search terms and keywords including head and neck squamous cell carcinoma,recurrent,metastatic,locally advanced,immunotherapy,immune checkpoint inhibitors,monoclonal antibodies,programmed cell death protein-1(PD-1),programmed death-ligand 1(PD-L1),cytotoxic T-lymphocyte associated protein-4(CTLA-4),and phase-3 clinical trial.A sensitive search filter was used to limit our results to randomized controlled trials.RESULTS Five phase-3 clinical trials have reported the data on the effectiveness of immunotherapy in HNSCC so far:Four in R/M HNSCC and one in LAHNSCC.In patients with R/M HNSCC,anti-PD-1 agents nivolumab and pembrolizumab demonstrated improved survival benefits in the second-line treatment setting compared to the standard of care(standard singleagent systemic therapy).While the net gain in overall survival(OS)with nivolumab was 2.4 mo[hazard ratio(HR)=0.69,P=0.01],that with pembrolizumab was 1.5 mo(HR=0.80 nominal P=0.0161).The anti-PD-L1 agent durvalumab with or without the anti-cytotoxic T-lymphocyte associated protein-4 agent tremelimumab did not result in any benefici展开更多
To summarize the progress of surgical treatment of hepatocellular carcinoma (HCC) and related basic research at the Liver Cancer Institute of Shanghai Medical University in the recent years, with special reference to ...To summarize the progress of surgical treatment of hepatocellular carcinoma (HCC) and related basic research at the Liver Cancer Institute of Shanghai Medical University in the recent years, with special reference to recurrence and metastasis Methods Published and unpublished update clinical and experimental data in the above mentioned areas are summarized Results Surgical resection has played an important role in improving prognosis of HCC, the 5 year survival were 63 4% for small HCC resection (n=806), 39 6% for large HCC resection (n=1061), 64 7% for cytoreduction (using hepatic artery cannulation and ligation) and sequential resection of initially unresectable HCC (n=93), 56 0% for cytoreduction using transcatheter arterial chemoembolization (TACE) and followed by resection (n=65), and 22 4% for hepatic resection with removal of tumor thrombi in portal vein (n=103) Unfortunately, the 5 year recurrent rate after curative resection of HCC was up to 61 5%, which was mainly a result of intrahepatic “metastasis” and multicentric origin of HCC Clinically, re resection of subclinical recurrence yielded 56% of 5 year survival (n=202); prevention of recurrence by transcatheter arterial chemoembolization (TACE)+Interferon, or LAK/IL 2 therapy have decreased 3 year recurrent rate from 33% to 11%-18% In experimental aspect, metastatic human HCC model in nude mice (LCI D20) and HCC cell line with metastatic potential (MHCC97) have been established; studies on HCC invasiveness in the molecular level revealed similar results that reported in other solid cancers, and small HCC showed slightly better biological characteristics as compared with large HCC; microvessel density (MVD) that reflecting angiogenesis adversely correlated with 5 year survival of small HCC; experimental interventions using antisense H ras, bispecific antibody, BB94, as well as anti angiogenic agents (TNP470, suramin, CAI, heparin, antisense VEGF, etc ) have been demonstrated to inhibit tumor growth and lung metastasis in展开更多
头颈部鳞状细胞癌(squamous cell carcinoma of the head and neck,SCCHN)是头颈部肿瘤最为常见的一种类型,其疾病负担较重。SCCHN患者中,90%以上高表达表皮生长因子受体(epidermal growth factor receptor,EGFR),因此通过单克隆抗体特...头颈部鳞状细胞癌(squamous cell carcinoma of the head and neck,SCCHN)是头颈部肿瘤最为常见的一种类型,其疾病负担较重。SCCHN患者中,90%以上高表达表皮生长因子受体(epidermal growth factor receptor,EGFR),因此通过单克隆抗体特异性地与EGFR结合,是抑制EGFR信号转导的一种重要方法。目前多种基于EGFR受体及其通路相关的靶向药物中,西妥昔单抗是唯一疗效确切的药物,已于2020年2月在中国获批用于一线治疗复发/转移性SCCHN(recurrent/metastatic SCCHN,R/M SCCHN),随着西妥昔单抗逐步应用于临床,中国晚期SCCHN患者整体的治疗模式将不断得到优化和提升。值得注意的是,虽然靶向和免疫药物在SCCHN的治疗中取得了很大的进展,但仍然存在很多挑战,其中西妥昔单抗治疗R/M SCCHN在EGFR检测、药物应用时机、联合方案和应用剂量以及不良反应管理等方面尚未达成共识。本共识就西妥昔单抗用于R/M SCCHN一线、二线以及联合免疫治疗时的疗效和安全性,结合文献及中国临床实践进行阐述,并对相关治疗方案予以推荐,希望对西妥昔单抗规范化治疗SCCHN患者及优化临床实践提供指导。经过多轮商议和探讨,共识小组的专家汇总出以下推荐意见。在分子检测方面,R/M SCCHN患者无需常规检测EGFR以指导临床实践,抗EGFR单克隆抗体通过抑制EGFR信号转导起到抗肿瘤作用。一线治疗中,对于铂类药物耐受患者,建议6个周期的西妥昔单抗联合顺铂75 mg/m^(2),5-FU 750 mg/m^(2)治疗,疾病缓解或稳定后继续接受西妥昔单抗单药维持治疗至疾病进展;对于有5-FU治疗禁忌证、持续静脉输液不方便、二氢嘧啶脱氢酶(dihydropyrimidine dehydrogenase,DPD)缺乏症及治疗依从性差的患者,建议4个周期的西妥昔单抗联合铂类药物(顺铂75 mg/m^(2),每3周1次)+多西他赛(75 mg/m^(2),每3周1次)治疗,疾病缓解或稳定后继续接受西妥昔单抗单药维持治疗至疾病�展开更多
文摘[目的]探讨术后复发三阴性乳腺癌(triple-negative breast cancer,TNBC)临床流行病学特征。[方法]本研究是一项基于医院的、全国多中心、3年(2012—2014年)临床流行病学回顾性研究。纳入术后复发乳腺癌患者病例资料,收集并分析其人口统计学信息、潜在危险因素、临床诊疗特点及预后信息。[结果]共纳入术后复发TNBC患者455例,平均年龄46岁,中位无病生存时间20个月。相较非TNBC,TNBC在无病生存时间、肝转移、肺转移、骨转移、辅助化疗和分布地区上均有统计学差异(P均<0.05)。多因素分析显示,淋巴结转移数目大于2(OR=0.817,95%CI:0.678~0.985,P=0.034)和新辅助化疗未达病理完全缓解(OR=0.757,95%CI:0.609~0.942,P=0.012)是术后复发TNBC无病生存时间的独立影响因素。[结论]淋巴结转移数大于2和新辅助化疗未达病理完全缓解的TNBC患者,术后应进行密切随访。
文摘目的探讨CT导向下^125I粒子植入治疗复发／转移性盆腔恶性肿瘤的近中期临床疗效。方法接受手术、化疗或放疗等综合治疗后盆腔复发／转移恶性肿瘤患者30例，男10例、女20例，年龄31～85岁，中位年龄为55岁。可评价病灶32个，病灶最大径3．0～12．2cm，平均值4．8cm。病例采用计算机立体定位系统（treatment plan system，TPS）计算布源，肿瘤周边匹配剂量（MPG）为100～160Gy，局部麻醉CT导向下采用2．96×10^7Bq活度的^125I粒子相隔0．5～1．0cm植入盆腔病灶内，随访观察局部控制率，总体生存率，疼痛缓解情况及并发症。结果随访2～40个月，中位随访时间28个月，随访结束32个局部病灶评价CR10／32，PR13／32，SD5／32，PD4／32，临床受益率87．5％（CR＋PR＋SD），1年累计局部控制率为83．3％，2年累积局部控制率为62．5％；总体1年生存率87．7％，2年生存率73．1％，3年生存率45．7％，中位生存时间28个月；疼痛缓解率21／23（91．3％）。近期副反应轻微，远期副反应主要表现为3例Ⅰ-Ⅱ级放射性肠炎，1例Ⅰ级放射性膀胱炎，1例下肢长期麻木感，未见大出血、急性肺栓塞、盆腔脓肿、肠瘘、肠穿孔、窦道等严重并发症。结论CT导向下放射性粒子植入复发／转移性盆腔恶性肿瘤，并发症发生率低，患者生活质量改善明显，临床疗效确切，是一种治疗复发／转移性盆腔恶性肿瘤简单、安全、有效的方法。
基金Heft Neal ME was supported in part by the NIH Grant(T32 DC005356).Brenner JC was supported in part by American Cancer Society Grant:132034-RSG-18-062-01-TBG.Brenner JC was supported by F31:DE-027600-01
文摘Unresectable recurrent or metastatic head and neck cancer is an incurable disease with survival of approximately 12 months. Head and neck tumors exhibit numerous derangements in the tumor microenvironment that aid in immune evasion and may serve as targets for future therapies. Pembrolizumab is now approved as a first line therapy. Despite the promise of currently approved immunotherapies there continues to be low response rates and additional strategies are needed. Here, alterations in the immune microenvironment and current therapeutic strategies are reviewed with a focus on novel immunologic approaches.
文摘BACKGROUND The outcomes of patients diagnosed with head and neck squamous cell carcinoma(HNSCC)who are not candidates for local salvage therapy and of those diagnosed with recurrent or metastatic disease are dismal.A relatively new systemic therapy option that emerged in recent years in the treatment of advanced HNSCC is immunotherapy using immune checkpoint inhibitors(ICIs).The safety profile and anti-tumor activity of these agents demonstrated in early phase clinical trials paved the way to the initiation of several promising phase-3 trials in the field.AIM To evaluate the evidence on the effectiveness of ICIs in HNSCC,based on published phase-3 clinical trials.METHODS We searched PubMed,Cochrane Library,Embase,and Scopus to identify published literature evaluating immunotherapy using ICIs in recurrent or metastatic HNSCC(R/M HNSCC)and locally advanced head and neck squamous cell carcinoma(LAHNSCC).We used a combination of standardized search terms and keywords including head and neck squamous cell carcinoma,recurrent,metastatic,locally advanced,immunotherapy,immune checkpoint inhibitors,monoclonal antibodies,programmed cell death protein-1(PD-1),programmed death-ligand 1(PD-L1),cytotoxic T-lymphocyte associated protein-4(CTLA-4),and phase-3 clinical trial.A sensitive search filter was used to limit our results to randomized controlled trials.RESULTS Five phase-3 clinical trials have reported the data on the effectiveness of immunotherapy in HNSCC so far:Four in R/M HNSCC and one in LAHNSCC.In patients with R/M HNSCC,anti-PD-1 agents nivolumab and pembrolizumab demonstrated improved survival benefits in the second-line treatment setting compared to the standard of care(standard singleagent systemic therapy).While the net gain in overall survival(OS)with nivolumab was 2.4 mo[hazard ratio(HR)=0.69,P=0.01],that with pembrolizumab was 1.5 mo(HR=0.80 nominal P=0.0161).The anti-PD-L1 agent durvalumab with or without the anti-cytotoxic T-lymphocyte associated protein-4 agent tremelimumab did not result in any benefici
文摘To summarize the progress of surgical treatment of hepatocellular carcinoma (HCC) and related basic research at the Liver Cancer Institute of Shanghai Medical University in the recent years, with special reference to recurrence and metastasis Methods Published and unpublished update clinical and experimental data in the above mentioned areas are summarized Results Surgical resection has played an important role in improving prognosis of HCC, the 5 year survival were 63 4% for small HCC resection (n=806), 39 6% for large HCC resection (n=1061), 64 7% for cytoreduction (using hepatic artery cannulation and ligation) and sequential resection of initially unresectable HCC (n=93), 56 0% for cytoreduction using transcatheter arterial chemoembolization (TACE) and followed by resection (n=65), and 22 4% for hepatic resection with removal of tumor thrombi in portal vein (n=103) Unfortunately, the 5 year recurrent rate after curative resection of HCC was up to 61 5%, which was mainly a result of intrahepatic “metastasis” and multicentric origin of HCC Clinically, re resection of subclinical recurrence yielded 56% of 5 year survival (n=202); prevention of recurrence by transcatheter arterial chemoembolization (TACE)+Interferon, or LAK/IL 2 therapy have decreased 3 year recurrent rate from 33% to 11%-18% In experimental aspect, metastatic human HCC model in nude mice (LCI D20) and HCC cell line with metastatic potential (MHCC97) have been established; studies on HCC invasiveness in the molecular level revealed similar results that reported in other solid cancers, and small HCC showed slightly better biological characteristics as compared with large HCC; microvessel density (MVD) that reflecting angiogenesis adversely correlated with 5 year survival of small HCC; experimental interventions using antisense H ras, bispecific antibody, BB94, as well as anti angiogenic agents (TNP470, suramin, CAI, heparin, antisense VEGF, etc ) have been demonstrated to inhibit tumor growth and lung metastasis in
