药物联合新辅助化疗(ET)对三阴乳腺癌患者生存状态的改善及其疗效评价

目的:观察表柔比星和多西紫杉醇联合新辅助化疗(ET)对三阴乳腺癌患者生存状态的改善及其疗效,评价该化疗方案在三阴乳腺癌的化疗中加入紫杉类化疗药物的可行性。方法:收集我院2011年1月至2011年12月收治的300例乳腺癌患者,将患者随机分为两组,研究组及对照组,每组各150例。对照组采用单纯表柔比星,研究组采用新辅助化疗的方案(ET方案),随访12个月,统计两组临床疗效并进行评价。结果:研究组完全缓解率(92.00%)明显高于对照组的78.00%,疾病无缓解率(1.33%)及疾病恶化率(0%)明显低于对照组的14.00%及1.33%,差异具有统计学意义(P0.01)。随访期间,对照组患者68例(45.3%)复发或转移,而研究组患者35例(23.3%)出现复发或远处转移,两者比较,差异显著(P0.001)。结论:在三阴乳腺癌的化疗中加入紫杉类化疗药物是可行的,效果显著。     

双歧杆菌三联活菌胶囊预防乳腺癌患者化疗后肠道菌群失调症的应用研究

目的探讨双歧杆菌三联活菌胶囊预防乳腺癌患者化疗后肠道菌群失调症的疗效。方法收集湖北医药学院附属东风医院2014年1月至2015年1月收治行乳腺癌改良根治术后化疗的患者128例,随机分为观察组和对照组,每组64例,观察两组患者的临床疗效。结果与对照组(29.7%,19/64;17.2%,11/64)相比,观察组患者化疗期间的腹泻发生率(9.4%,6/64)及肠道菌群失调发生率(4.7%,3/64)明显更低,差异有统计学意义(P0.05),而两组患者在化疗期间恶心、呕吐、发热等发生率比较差异无统计学意义(P0.05)。结论双歧杆菌三联活菌胶囊在预防乳腺癌患者化疗后肠道菌群失调症方面疗效明显,有利于提高患者的生活质量,值得临床进一步推广应用。     

新辅助化疗配合手术治疗中晚期乳腺癌的临床效果分析

目的:观察新辅助化疗配合手术治疗中晚期乳腺癌的临床效果,为临床研究提供参考。方法:选取我院2009年5月-2011年4月收治的中晚期乳腺癌患者107例,根据治疗方法的不同,将患者分为新辅助化疗组和对照组。新辅助化疗组采取术前辅助化疗,而对照组术前不接受化疗。观察新辅助化疗组患者的近期临床疗效、毒副反应发生率;比较两组患者的手术时间、术中出血量等;术后随访三年,记录两组患者的肿瘤局部复发率及远处转移率。结果:新辅助化疗组患者治疗的总有效率为79.66%,毒副反应的发生率为33.89%;新辅助化疗组的平均手术时间、术中出血量均低于对照组,差异具有统计学意义(P0.05)。新辅助化疗组患者的局部复发率为5.08%,远处转移率为6.78%;对照组患者局部复发率为12.50%,远处转移率为18.75%。新辅助化疗组患者的肿瘤复发转移率低于对照组,差异具有统计学意义(P0.05)。结论:在中晚期乳腺癌的临床治疗中,术前对患者实施新辅助化疗具有明显的效果,患者近期疗效良好,毒副反应可耐受,且手术后的复发转移率相对较低,值得推广应用。     

参附注射液联合TEC新辅助化疗治疗乳腺癌的临床疗效及安全性分析

目的:研究参附注射液联合TEC方案新辅助化疗治疗乳腺癌的临床疗效及安全性。方法:选取我院肿瘤科及乳腺外科2016年7月-2018年1月收治的120例乳腺癌患者,将其随机分为对照组和观察组。对照组50例给予TEC方案新辅助化疗;观察组70例给予TEC方案新辅助化疗联合参附注射液静脉滴注治疗。观察并比较两组患者治疗后的临床治疗效果,治疗前后白细胞、中性粒细胞、红细胞以及血小板计数、CD_4~+、CD_8~+和CD_4~+/CD_8~+的变化。结果:治疗后,对照组的总有效率为70%,观察组的总有效率为84.3%,观察组显著高于对照组(P0.05)。两组治疗后白细胞、中性粒细胞、红细胞、血小板板计数、CD_4~+、CD_8~+和CD_4~+/CD_8~+均较治疗前有不同程度减少,对照组以上指标均明显低于观察组(P0.05)。两组患者均发生口腔黏膜炎、呕吐、腹泻、便秘等不良反应,观察组不良反应发生率显著低于对照组(P0.05),且两组均未发生毒性反应致死事件。结论:TEC方案新辅助化疗联合参附注射液静脉滴注治疗乳腺癌患者能有效改善患者的细胞免疫功能,提高临床疗效,并且能有效抑制骨髓抑制和消化道反应,提高患者依从性。     

紫杉醇联合表阿霉素新辅助化疗治疗三阴性乳腺癌的临床疗效评价及其对Ki-67、p53、P-gp和GST-π的影响

目的:研究紫杉醇联合表阿霉素新辅助化疗治疗三阴性乳腺癌的临床疗效及对Ki-67、p53、P-糖蛋白(P-gp)和谷胱甘肽转移酶(GST-π)的影响。方法:选取2010年6月~2012年6月我院收治的84例三阴乳腺癌患者,根据患者入院顺序分为观察组和对照组,42例每组。对照组使用表阿霉素联合环磷酰胺完成化疗,观察组使用紫杉醇联合表阿霉素完成新辅助化疗。比较两组患者临床疗效,治疗前后Ki-67、p53、P-gp和GST-π的表达情况。结果:治疗后,观察组总的缓解率显著高于对照组[76.19%(32/42)比45.24%(19/42)](P0.05)。化疗前,两组患者Ki-67、p53、P-gp和GST-π阳性表达率比较无统计学意义(P0.05);化疗后,观察组患者的Ki-67、p53、P-gp和GST-π阳性表达率较化疗前显著降低(P0.05),但对照组的Ki-67、p53、P-gp和GST-π阳性表达率和化疗前相比无明显变化(P0.05),观察组的Ki-67、p53、P-gp和GST-π阳性表达率显著低于对照组(P0.05)。观察组和对照组的不良反应率比较差异无统计学意义(P0.05)。结论:紫杉醇联合表阿霉素新辅助化疗治疗三阴性乳腺癌的疗效确切,其能有效降低Ki-67、p53、P-gp和GST-π的表达。     

术前新辅助放化疗联合全直肠系膜切除术治疗局部进展期直肠癌的疗效观察

目的:探讨应用术前新辅助放化疗和全直肠系膜切除术(TME)治疗局部进展期直肠癌的临床疗效。方法:选择2014年1月到2016年12月我院收治的80例中低位局部进展期直肠癌患者,按照随机数字表法分为实验组(n=40)和对照组(n=40)。实验组患者给予术前新辅助放化疗联合TME治疗,对照组患者仅给予TME治疗,两组患者均于术后给予辅助化疗4个疗程。比较两组患者治疗后的病理完全缓解率、病理降期情况、根治性切除率以及不良反应发生情况。结果:实验组患者的完全缓解率为22.50%(9/40),高于对照组的5.00%(2/40),差异具有统计学意义(P0.05)。实验组的降期率为91.89%(34/37),高于对照组的74.29%(26/35),差异具有统计学意义(P0.05)。两组患者的根治性切除率比较差异无统计学意义(P0.05)。治疗期间,两组不良反应发生率比较差异无统计学意义(P0.05)。结论:术前新辅助放化疗联合TME治疗局部进展期直肠癌安全有效,病理降期情况良好,完全缓解率较高。     

多西他赛或紫杉醇联合奈达铂在宫颈癌辅助化疗中的疗效及安全性分析

目的:观察和比较多西他赛或紫杉醇联合奈达铂辅助化疗治疗宫颈癌患者的临床疗效及其安全性。方法:选择45例采用多西他赛联合奈达铂化疗的宫颈癌患者为观察组及45例同期采用紫杉醇联合奈达铂化疗的宫颈癌患者作为对照组,两组均行手术治疗,且术前接受辅助化疗。对比两组临床疗效、手术时间和术后病理状况及不良反应的发生情况。结果:化疗后,观察组临床有效率高于对照组(62.22%vs.55.56%),但组间比较差异无统计学意义(P0.05)。化疗期间,观察组恶心、呕吐、腹痛、腹泻、白细胞、中性粒细胞减少、血红蛋白和血小板减少的发生率均低于对照组,但组间比较差异均无统计学意义(P0.05);观察组神经毒性发生率明显低于对照组,组间比较差异有统计学意义(P0.05)。化疗后,行手术治疗,观察组手术时间低于对照组,但组间比较差异无统计学意义(P0.05);手术后,观察组盆腔淋巴结转移率和宫旁浸润率低于对照组,但组间比较差异无统计学意义(P0.05)。结论:多西他赛联合奈达铂辅助化疗宫颈癌的疗效与紫杉醇联合奈达铂相当,且神经毒性、骨髓抑制方面的发生率明显降低,是临床低毒性且有效的宫颈癌术前新辅助化疗方案。     

耳穴压豆配合穴位注射治疗神经性呕吐的效果观察

目的观察耳穴压豆配合穴位注射治疗神经性呕吐的疗效。方法将74例神经性呕吐患者随机分为对照组37例和研究组37例,对照组给予舒必利治疗,研究组在对照组治疗的基础上加用耳穴压豆配合穴位注射干预,观察比较两组每天呕吐次数、每次呕吐时间及控制呕吐的总有效率。结果两组呕吐次数及呕吐时间比较,研究组明显优于对照组(P0.05)。两组总有效率比较,研究组为94.6%明显优于对照组的75.7%,差异有统计学意义(P0.05)。结论耳穴压豆配合穴位注射可改善神经性呕吐患者的症状,止吐效果显著。     

紫杉醇联合洛铂治疗LACC患者的疗效评价

为了探讨紫杉醇联合洛铂在局部晚期宫颈癌(LACC)患者术前新辅助化疗中的效果以及对患者血清肿瘤标记物和预后的影响。本研究选取在我院实施新辅助化疗的58例LACC患者进行研究,其中29例患者采用紫杉醇联合洛铂新辅助化疗方案(A组)、29例患者采用紫杉醇联合顺铂治疗(B组),两组患者均实施根治性宫颈癌手术治疗,对比两组患者的近期疗效、血清肿瘤标记物、毒副反应发生率及远期预后。研究发现,A组患者的缓解率82.75%、总有效率100%,B组患者的缓解率68.97%、总有效率96.55%,两组间比较差异均不具有统计学意义(p0.05);化疗后,A组和B组患者的血清CYFRA21-1、SCCAg水平较化疗前均显著的降低(p0.05);化疗过程中,A组患者的恶心呕吐、腹泻发生率分别为17.24%、6.90%,B组患者的恶心呕吐、腹泻发生率分别为48.28%、62.07%,两组比较差异具有统计学意义(p0.05);36个月随访,A组总生存率为68.97%(20/29)、B组患者的总生存率为62.07%(18/29),两组比较差异无统计学意义(χ~2=0.305,p=0.5810.05);两组患者的生存函数曲线分析,生存时间比较差异无统计学意义(z=0.381,p=0.5370.05)。说明紫杉醇联合洛铂在LACC患者术前新辅助化疗中与紫杉醇联合顺铂的效果相当,但是紫杉醇联合洛铂相对毒副反应发生率更低,提高了患者的治疗依从性,可以成为目前LACC治疗的首选方案,但未来还需进一步研究来提高其治疗效果。     

新辅助化疗后保乳手术治疗三阴性乳腺癌的临床疗效分析

目的:探讨不同方案新辅助化疗后行保乳手术治疗三阴性乳腺癌的临床疗效及安全性。方法:收集2006年1月至2015年6月于我院确诊的可手术三阴性乳腺癌患者90例作为研究对象,按照随机数字表法分为观察组及对照组各45例。观察组患者在保乳手术前给予AC-T方案进行新辅助化疗,对照组患者在保乳手术前给予TAC方案进行新辅助化疗。观察并比较两组患者治疗效果、化疗相关不良反应发生情况、术后并发症发生情况以及生活质量的改善情况。结果:观察组总有效率为82.22%,对照组为73.33%;观察组控制率为95.56%,对照组为91.11%,两组总有效率及控制率比较差异无统计学意义(P0.05);观察组患者中性粒细胞减少、胃肠道不良反应及口腔溃疡发生率均低于对照组(P0.05),而两组脱发情况比较差异无统计学意义(P0.05)。两组术后并发症发生率分别为6.67%及11.11%,组间比较差异无统计学意义(P0.05)。观察组患者术后生活质量改善总有效率为86.67%,对照组总有效率为82.22%,两组相比差异无统计学意义(P0.05)。结论:在保乳手术前采用AC-T序贯化疗方案进行新辅助化疗治疗三阴性乳腺癌与TAC方案疗效相当,但不良反应明显减少,值得临床推广应用。     

新辅助化疗对ⅠB2～ⅡB期宫颈癌近期疗效的观察

目的：探讨新辅助化疗对ⅠB2～ⅡB期宫颈癌的近期疗效。方法：对哈尔滨医科大学附属第二医院2005年9月-2007年1月间ⅠB2～ⅡB期宫颈癌82例进行前瞻性研究,其中42例在根治性手术前行新辅助化疗（Neoadjuvant Chemotherapy,NACT）2～3个疗程,为NACT组,40例在术前未行新辅助化疗,为直接手术组。评价NACT组化疗疗效及影响疗效的相关因素,比较两组手术后的病理结果。结果：NACT的总有效率为76．2％,化疗效果与临床分期和分化程度无关（P〉0．05）,与病理类型及肿瘤的大小有关,鳞癌的有效率明显高于非磷癌（P〈0．05）,肿瘤直径〉8cm的疗效明显低于≤8cm（P〈0．05）。两组术后盆腔淋巴结阳性率及宫旁侵润率之间的差异有统计学意义（P〈0．05）;在NACT组中化疗有效组与无效组术后盆腔淋巴结阳性率及宫旁侵润率之间的差异有统计学意义（P〈0．05）。结论：新辅助化疗可改善宫颈癌的临床分期,提高宫颈癌的手术疗效,成为治疗ⅠB2～ⅡB期宫颈癌一种新手段,有较大的临床应用价值。     

Late chronotypes are associated with neoadjuvant chemotherapy-induced nausea and vomiting in women with breast cancer

Neoadjuvant chemotherapy, that is, the administration of chemotherapy before surgery, has been commonly used for locally advanced breast cancer to improve the surgical outcomes and increase the opportunity for breast-conserving therapy. Women with breast cancer often receive an anthracycline-based regimen as the neoadjuvant chemotherapy, which is associated with a high risk of emesis. Despite the development of novel antiemetics, chemotherapy-induced nausea and vomiting (CINV) has been commonly reported as a major adverse effect, affecting the quality of life of the patients. However, the factors predicting CINV in women with breast cancer undergoing neoadjuvant chemotherapy remain unclear. In this single-institution, prospective, observational study conducted at an outpatient cancer centre in the Republic of Korea from November 2013 to March 2016, we analysed women with breast cancer who planned to be treated with neoadjuvant chemotherapy before surgery. Candidate factors associated with CINV were assessed before neoadjuvant chemotherapy using the Munich Chronotype Questionnaire, Pittsburgh Sleep Quality Index and Hospital Anxiety and Depression Scale. CINV was assessed after chemotherapy by using the Multinational Association of Supportive Care in Cancer Antiemesis Tool. Of a total of 143 participants, 7 patients were lost to follow-up and 2 patients were excluded due to changes in their treatment plan; thus, 134 patients were finally included in the analyses. Overall, 48.5% of the participants experienced CINV, with delayed CINV prevalence (42.5%) being more common than acute (39.6%). In the univariate analyses, overall CINV was significantly associated with late chronotypes (odds ratio [OR], 3.49; 95% confidence interval [CI], 1.37–8.87; p = 0.009), a history of nausea/vomiting (OR, 2.19; 95% CI, 1.10–4.37; p = 0.026) and anxiety (OR, 2.25; 95% CI, 1.05–4.81; p = 0.036). In the multivariate analyses, late chronotypes (OR, 3.53; 95% CI, 1.27–9.79; p = 0.015) and a history of nausea/vomiting (OR, 2.83; 95% CI, 1.31–6.13; p = 0.008) remained significantly associated with CINV. In conclusion, in women with breast cancer undergoing neoadjuvant chemotherapy before surgery, late chronotypes were found to have an increased risk of CINV; these data suggest that clinicians need to assess and consider the chronotype in the management of CINV.     

Experience with aprepitant in the prevention of nausea and vomiting caused by highly emetic chemotherapy of lung cancer

Approximately one half of cancer patients experience nausea or vomiting during chemotherapy containing high-dose cisplatin, despite the use of a corticosteroid and 5-hydroxytryptamine(3) (5-HT(3)) receptor antagonists. The addition of aprepitant, a neurokinin 1 receptor antagonist, improves control of emesis by a further 15-20%, and improves late phase symptoms (>24 h after chemotherapy). The cornerstone of standard first line lung cancer chemotherapy is high-dose cisplatin. Our experience with aprepitant in the chemotherapy of 10 lung cancer patients is described, who reported more than one episode of vomiting caused by chemotherapy despite the use of ondansetron previously. Aprepitant prevented acute and late phase oncoming vomiting in all 10 patients and acute and late phase nausea in 9 of the 10 patients. According to our experience on a limited number of patients, aprepitant may be of clinical benefit in the supportive treatment of lung cancer, in achieving better quality of life during chemotherapeutic cycles in these patients.     

全反式维甲酸联合化疗治疗晚期结肠癌临床观察

目的:探讨全反式维甲酸联合化疗治疗晚期结肠癌的临床疗效和安全性。方法:将2009年4月至2012年3月我院收治的178例晚期结肠癌患者随机分入试验组(全反式维甲酸联合m FOLFOx6方案化疗)和对照组(单纯m FOLFOx6方案化疗),每组89例。治疗后,观察和比较两组患者的近期疗效、疾病进展时间、总生存期、KPS评分改善情况和不良反应的发生情况。结果:试验组的近期有效率为67.8%,对照组为50.6%,显著低于试验组(P=0.021);试验组患者的KPS评分改善率为79.3%,而对照组为57.4%,显著低于试验组(P=0.002)。试验组患者的中位生存期和中位疾病进展期分别为14.784、7.502个月;对照组患者分别为13.12、6.244个月,均较试验组显著缩短(P0.05)。试验组患者恶心呕吐的发生率显著低于对照组(P=0.016),两组其它不良反应如骨髓抑制、肝肾功能损害、心脏毒性等的发生率比较差异无统计学意义(P0.05)。结论:全反式维甲酸注射液联合化疗治疗晚期结肠癌可以提高其临床疗效,延长其生存期,改善其生存质量,且能减轻消化道不良反应。     

Psychological impact of adjuvant chemotherapy in the first two years after mastectomy.

Psychological symptoms were assessed over two years in a randomised trial of three forms of treatment given to women after mastectomy for stage II breast cancer. The treatments were: three weeks'' radiotherapy; one year''s adjuvant chemotherapy with cyclophosphamide, methotrexate, and 5-fluorouracil; and radiotherapy followed by chemotherapy. Analysis of the results on an intention to treat basis showed no substantial differences in depression or anxiety among groups at one, three, or six months after the operation. At 13 months, however, patients who had been allocated chemotherapy had significantly more symptoms, especially depression, than control patients treated with radiotherapy alone. Conditioned reflex nausea and vomiting increased considerably during the second six months of chemotherapy and persisted for up to a year afterwards. The psychological morbidity of adjuvant chemotherapy could be substantially reduced if courses of treatment were restricted to about six months.     

TAC方案治疗晚期术后乳腺癌疗效观察

目的探讨分析TAC方案治疗晚期术后乳腺癌的临床疗效。方法选取我院自2008年1月至2010年6月收治的76例晚期术后乳腺癌患者,所有患者按随机数法分为实验组与对照组,两组均为38例。实验组接受TAC化疗方案,对照组接受CTF化疗方案,治疗6个疗程后比较两组患者的临床疗效及不良反应发生情况。结果实验组的无进展生存期、总生存期及1—3年生存率均明显优于对照组（P〈0．05）;实验组中性粒细胞减少与恶性呕吐的发生率明显高于对照组（P〈0．05）,两组其余髓内及髓外毒性反应及心脏毒性反应发生率的差异比较均无统计学意义（P〉0．05）。结论TAC方案治疗晚期术后乳腺癌的临床疗效显著,延长了患者术后的生存时间,且不良反应少,值得推广。     

Sodium ditiocarb as adjuvant immunotherapy for high risk breast cancer: A randomized study

Sixty-four patients with non metastatic high risk breast cancer were randomized in a double blind trial of adjuvant immunotherapy with sodium ditiocarb (DDC) versus placebo. All patients underwent prior surgery (mammectomy according to Patey) then adjuvant FAC chemotherapy +/- DDC. With a median follow-up of 5 years we observed 6 relapses and 5 deaths in DDC group; 13 relapses and 12 deaths in control group. At 6 years, overall survival is 81% in DDC group versus 55%. Disease free survival (DFS) is 76% in DDC group versus 55%. DDC associated to chemotherapy and locoregional treatment can improve survival and probably DFS in this high risk breast cancer subgroup.Abbreviations DDC sodium ditiocarb - DFS disease free survival - OS overall survival - N node - FAC 5 Fluorouracil, Adrianycin, Cyclopho-pharmide     

Nanomedicines in the treatment of emesis during chemotherapy: focus on aprepitant

Aprepitant, a selective high-affinity antagonist of human substance P/neurokinin 1 (NK1) receptors, is the active ingredient of EMEND which has recently been approved by the FDA for the prevention of chemotherapy-induced nausea and vomiting (CINV). Aprepitant undergoes extensive metabolism, primarily via CYP3A4 mediated oxidation. It is eliminated primarily by metabolism and is not renally excreted. The apparent terminal half-life in humans ranged from 9 to 13 hours. Early development studies led to the development of a nanoparticle formulation to enhance exposure and minimize food effects. Two large randomized trials accruing 1099 patients studied the effect in patients receiving cisplatin of adding aprepitant to ondansetron and dexamethasone on day 1 then to dexamethasone on days 2 and 3 to control delayed emesis. The complete response of no vomiting and no rescue medication overall from days 1 to 5 improved from 48% to 68% (p<0.001), a 13% improvement in acute emesis but a 21% improvement in delayed emesis with the improvement from 51% to 72% (p<0.001). Similarly, 866 patients treated with cyclophosphamide plus either doxorubicin or epirubicin, received either ondansetron, dexamethasone, and aprepitant on day 1 followed by aprepitant on days 2 and 3 or ondansetron and dexamethasone on day 1 and dexamethasone on days 2 and 3. The overall complete response rate over 5 days was better for the aprepitant group 50.8% vs 42.5% (p=0.015). Complete responses were reported in more patients taking aprepitant in both the acute (76% vs 69%, p=0.034) and delayed (55% vs 49%, p=0.064) phases of vomiting. There were no clinically relevant differences in toxicity by adding aprepitant and improvements in the quality of life of patients on chemotherapy were recorded.     

DC-CIK细胞免疫治疗晚期结直肠癌患者的远期疗效及其影响因素分析

目的:探讨树突状细胞(DC)联合细胞因子诱导的杀伤(CIK)细胞免疫治疗晚期结直肠癌(CRC)患者的远期疗效及其影响因素分析。方法:收集我院2011年1月至2014年1月收治的112例晚期结直肠癌患者,依据是否接受DC-CIK细胞免疫治疗将患者分为对照组(n=47)和观察组(n=65),分别给予一般化疗方案治疗和化疗联合DC-CIK细胞免疫方案治疗,比较两组患者治疗前后血清肿瘤标志物癌胚抗原(CEA)、淋巴细胞亚群,治疗有效率(RR)、疾病控制率(DCR)、无进展生存期(PFS)和安全性改变,并分析影响疗效的危险因素。结果:两组治疗后CEA水平均显著低于治疗前(P0.05),治疗后对照组CD3+T细胞、CD4+T细胞、CD8+T细胞和NK细胞均显著减少(P0.05),观察组治疗后CD3+T细胞和CD8+T细胞数量显著高于治疗前和同期对照组(均P0.05);对照组RR、DCR和PFS分别为44.68%、65.96%、6.5个月,观察组治疗对应指标分别为46.15%、86.15%、9个月,观察组DCR和FPS均显著高于对照组(P0.05);多因素分析发现TNM分期达到Ⅳ级(P=0.023)和年龄超过60岁(P=0.006)是影响疗效的独立危险因素。结论:DC-CIK细胞免疫治疗晚期结直肠癌安全可靠,能显著改善患者免疫功能控制肿瘤进展,延长生存期,提高生存质量,值得临床推广。