近年来,肿瘤免疫治疗取得了重大的进步,目前以程序性细胞死亡蛋白1(programmed cell death protein-1,PD-1)/程序性细胞死亡蛋白-配体1(programmed cell death protein-ligand 1,PD-L1)抑制剂为代表的新型免疫治疗临床应用如火如荼进行中,但在PD-1/PD-L1抑制剂应用中,不同患者和不同肿瘤类型之间疗效差异显著.现有研究发现外泌体PD-L1能解释这种疗效差异,主要机制是外泌体PD-L1可代替细胞PD-L1,产生抑制T细胞活化作用,同时,还可将功能性PD-L1转移到其他细胞,产生免疫抵抗或免疫耐受,影响PD-1/PD-L1抑制剂治疗结局.本文将对外泌体PD-L1与肿瘤免疫治疗的关系进行简要介绍.

信号淋巴细胞活化分子受体(SLAMF)表达于众多免疫细胞中,通过共刺激参与免疫调节,在自身免疫性疾病、感染性疾病、造血系统疾病及恶性肿瘤中发挥重要作用,其通过调节肿瘤微环境及免疫细胞的功能,最终影响着免疫细胞的抗肿瘤作用.SLAMF在正常组织与肿瘤组织中的表达差异使其具有作为肿瘤诊断标志物的潜力,肿瘤免疫抑制剂通过逆转免疫检查点途径相关的"免疫逃逸"来使得肿瘤患者获益,其中许多抑制剂已在临床恶性肿瘤治疗中取得良好疗效,但仍有部分患者无法从中获益,寻求新的免疫治疗靶点已成为当下热门话题.本文将对SLAMF的作用机制及其在诊断与治疗中的研究进展进行综述.

Immunotherapy has recently become a new therapeutic method. Related cells and cytokines mediating tumor immunity play different roles in the process of tumor immunity, and they are correlated with tumor prognosis, which has a reference significance in the evaluation of tumor prognosis. In China, esophageal carcinoma is one of the common tumors of digestive system, and its 5-year overall survival rate is low. With the wide use of immunotherapy and introduction of precision medicine, the study on the relationship between tumor immune-related cells, cytokines and the prognosis of esophageal carcinoma can provide the guidance for the diagnosis and treatment of esophageal carcinoma.

免疫治疗是现今肿瘤治疗的重要方式,其中程序性死亡蛋白-1/程序性死亡蛋白配体-1抑制剂是目前应用较为成熟且患者生存获益较大的免疫制剂.程序性死亡蛋白-1/程序性死亡蛋白配体-1抑制剂给食管癌患者带来更好的临床获益,也为食管癌的治疗提供了更有利的选择.该文介绍了程序性死亡蛋白-1/程序性死亡蛋白配体-1抑制剂的作用机制、在食管癌中的应用以及疗效预测指标,旨在为程序性死亡蛋白-1/程序性死亡蛋白配体-1抑制剂更合理地用于食管癌提供一定理论基础.

目的:探讨影响老年弥漫大B细胞淋巴瘤治疗与预后的相关因素.方法:选取我院肿瘤科2008年7月至2014年7月收治的20例年龄大于65岁的弥漫大B细胞淋巴瘤病人,观察影响疗效及总生存率的各种变量,分析导致死亡的最主要因素.结果:16例病人接受治疗,4例病人未接受治疗.接受治疗的16例病人2年生存率为40％,中位生存时间为15个月.其中分期早、白蛋白高、IPI值2分以下、完成治疗的病人2年生存率高、预后好.利用COX比例风险回归模型分析感染、有无完成治疗是影响患者总生存期的因素.结论:感染是导致生存率下降的危险因素,也是导致死亡最主要的因素.

目的 探讨肿瘤患者中心静脉穿刺(CVC)/外周静脉穿刺(PICC)置管术后静脉血栓发生的影响因素.方法 纳入我院肿瘤中心2016年1月～2018年1月行CVC/PICC置管术的住院化疗患者234例,分为血栓组(66例)和无血栓组(113例),回顾性分析其年龄、性别、肿瘤类型(血液系统肿瘤和非血液系统肿瘤)、化疗次数、凝血酶原时间(PT)、置管时间、随访时间及随访方式、活动频率及强度等与静脉血栓发生的相关性.结果 所有纳入者中静脉血栓发生率为26.92％;单因素分析结果显示肿瘤类型、凝血酶原时间(PT)、化疗次数、置管时间、随访方式及活动与静脉血栓的发生有相关性(P＜0.05);多因素分析提示置管时间和随访方式是静脉置管术后血栓形成的独立危险因素(P＜0.05);置管时间大于14天会显著升高静脉血栓发生率(P＜0.05),规律门诊随访的患者静脉血栓发生率低于电话及其它方式随访者(P＜0.05),且门诊随访更易在血栓形成早期发现.结论 CVC/PICC静脉置管术患者肿瘤类型、PT、化疗次数、置管时间、随访方式及时间、活动频率及强度与静脉血栓形成相关.医护人员日常护理中应及时识别血栓形成高风险因素,加强对患者的宣教,嘱其按时门诊随访并及时拔出导管,从而降低CVC/PICC置管术后静脉血栓的发生率,提高肿瘤患者护理质量,降低置管术后静脉血栓的形成风险.

目的 探究还原型谷胱甘肽(GSH)联合抗病毒肝动脉化疗栓塞(TACE)治疗乙肝相关性肝癌的治疗效果.方法按随机数字表法将68例乙肝相关性肝癌患者分为观察组与对照组,每组34例.两组患者均行TACE联合抗病毒药物治疗,对照组患者给予常规保肝治疗,观察组在对照组基础上给予还原型谷胱甘肽治疗,观察两组患者临床疗效及不良反应,测定治疗前后患者丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)水平及血清中乙肝病毒(HBV-DNA)载量.结果观察组总有效率为97.06％,显著高于对照组(P<0.05);两组患者接受治疗后HBV-DNA载量均显著减少(P<0.05),观察组患者血清HBV-DNA载量显著低于对照组(P<0.05);治疗后两组患者ALT、AST、TBIL、DBIL水平均显著升高(P<0.05),观察组患者肝功能指标显著低于对照组,差异显著(P<0.05).结论GSH联合抗病毒TACE疗法能显著降低乙肝相关性肝癌患者的HBV-DNA载量,有效减轻肝功能损伤,效果显著.

Objective:To evaluate the effectiveness and safety of CPT-11 combined with DDP and PTX combined with DDP for second-line treatment of SCLC.Methods:Four databases were searched, including The Cochrane Library, Pubmed, Embase, CBM, CNKI, VIP, Wanfang Database, and the methodological quality assessment of RCTs included was conducted according to the methods of Cochrane collaboration.The Meta-analysis were performed by using the RevMan 5.3 software.Results:4 RCTs containing 307 patients were finally included.In the second-line treatment of SCLC, there were no significant differences in the rate of CR, PR, and the effective rate between the two groups (P ＞ 0.05).There were also no significant differences in the Ⅲ-Ⅳ grade side reaction between the two groups (P ＞ 0.05).Conclusion:Current evidence shows that there is no differences in the second-line treatment of SCLC between the IP and TP regimen in the short-term clinical efficacy.There was also no significant differences in the grade Ⅲ-Ⅳ side reactions between the two groups.For the quality of included study, the conclusion needs more high-quality clinical researchs to support.

Objective: To evaluate the survival of patients with locally advanced nasopharyngeal carcinoma treated with neoadjuvant chemotherapy followed by concurrent chemoradiotherapy compared with concurrent chemoradiotherapy alone.Methods: Seven databases were searched,including the Cochrane Library(Issue 2,2016),Pubmed,Embase,CBM,CNKI,VIP and Wanfang Database.The methodological quality assessment of eligible researches was conducted according to the Jadad scale and The Newcastal-Ottawa Scale.The Meta-analysis was performed by the Revman 5.3 software.Results: Eleven researches containing 1 521 patients were finally included.The 5-year distant metastasis-free survival of patients treated with neoadjuvant chemotherapy followed by concurrent chemoradiotherapy was significantly higher than that of those treated with concurrent chemoradiotherapy alone.There were no significant difference in 3-year overall survival,3-year distant metastasis-free survival,3-year progression-free survival,3-year recurrence free survival,5-year overall survival,5-year progression-free survival and 5-year recurrence free survival (P>0.05) respectively between these two regimens.Conclusion: Current evidence shows that compared with concurrent chemoradiotherapy alone,neoadjuvant chemotherapy followed by concurrent chemoradiotherapy could improve distant metastasis-free survival in locally advanced nasopharyngeal carcinoma,while no difference was found of the total survival between these two regimens.

目的探讨卡培他滨维持化疗治疗晚期胃癌和术后复发转移胃癌的效果和安全性。方法将44例经6周期全身化疗后取得完全缓解(CR)、部分缓解(PR)和稳定(SD)的胃癌患者随机分为维持化疗组和对照组各22例,两组均行常规对症支持治疗,在此基础上维持化疗组口服卡培他滨1.0 g/d,每周服5 d,用药至疾病进展或患者不能耐受。观察两组中位生存期及1、2年生存率;评定卡培他滨毒性反应及不同受累器官病灶对维持化疗的反应性。结果维持化疗组中位生存期显著长于对照组(P<0.05),1年生存率与对照组无显著差异(P>0.05),2年生存率显著高于对照组(P<0.05);维持化疗组最主要的Ⅲ～Ⅳ度毒性反应为白细胞降低、疲乏、手足综合征,无化疗相关性死亡;受累器官中对化疗反应性最好的是肝脏转移病灶,反应性最差的是肺转移病灶。结论对诱导化疗取得CR、PR、SD的无手术指征晚期胃癌和术后复发转移的胃癌患者(尤其是仅有肝转移灶者),卡培他滨维持化疗能延长生存期及疾病进展时间,提高2年生存率,且毒副反应可耐受;远期效果有待于扩大样本量进行更深入的分层研究。

目的观察三维适形放疗联用鸦胆子油乳注射液治疗放疗后复发食管癌患者的疗效及不良反应。方法将56例经病理检查确诊的放疗后复发食管癌患者随机分为研究组和对照组,研究组予三维适形放疗同时用10%鸦胆子油乳注射液30 mL和生理盐水250 mL,静脉滴注,每天1次,21 d为1个疗程;对照组采用单纯三维适形放疗。两组患者均采用加速器6 MV-X线,体外等中心三维适形放疗,每次4.2～4.8 Gy,3次/周,共7～9次,总照射剂量[转换为常规等效生物剂量(BED)]50～60 Gy。比较两组近期疗效、生存率及不良反应。结果近期有效率[完全缓解(CR)加部分缓解(PR)]:研究组为71.4%,对照组为42.9%(P<0.05)。两组患者1、2、3、5年生存率分别为78.6%、46.4%、32.1%、21.4%和53.6%、21.4%、7.1%、3.6%(P<0.05)。结论鸦胆子油乳注射液对放疗后复发食管癌再程放疗有明显的增效作用,三维适形放疗联用鸦胆子油乳注射液是根治性放疗后复发食管癌的一种有效治疗手段。

目的探讨和比较两种不同放疗方法对非小细胞肺癌(NSCLC)的疗效.方法将28例NSCLC随机分为两组,每组14例,A组连续放疗,B组后程加速度分割放疗.结果A组总有效率57.1%,B组总有效率78.6%.两组比较差异有统计学意义(P＜0.05).结论后程加速超分割放疗提高了非小细胞肺癌的局部控制率.