目的 探讨舒尼替尼治疗伊马替尼耐药后胃肠间质瘤(GIST)患者的疗效、安全性及其疗效预测因素.方法 搜集舒尼替尼二线治疗的胃肠间质瘤患者32例,所有患者均为伊马替尼耐药或不能耐受后改为舒尼替尼37.5 mg/d持续给药,观察、统计其疗效及不良反应,并将32例患者分为2组,A组为出现治疗相关性高血压患者,B组为无治疗相关性高血压患者.分析总结其疗效差异.结果 32例患者的客观有效率(RR)为25％,疾病控制率(DCR)为69％,中位无进展生存期(PFS)为43周,中位总生存期(OS)为78周;A组及B组的中位PFS分别为74周、26周,中位OS分别为114周、69周,A组的PFS和OS均优于B组,差异有统计学意义(P＜0.05).结论 舒尼替尼二线治疗GIST患者安全有效,舒尼替尼治疗相关性高血压可作为评估疗效及预后的预测因素.

Objective: To study the expression of neuropilin-l (NRP-1) in non-small cell lung cancer (NSCLC) and the paracancerous normal lung tissues, and to investigate the association of NRP-1 expression with the clinicopathological characteristics and prognosis of NSCLC patients. Methods: Ninety-two patients with NSCLC who underwent complete resection and pathological diagnosis from June 2009 to June 2012 in Affiliated Hospital of Xuzhou Medical University were collected. The expression of NRP-1 in 92 NSCLC tissues and 88 paracancerous lung tissues was detected by immunohistochemistry. All patients were followed up by telephone after operation, the last followed-up time was June 2016. The correlations of NRP-1 expression with the clinicopathological features and prognosis of NSCLC patients were analyzed. Results: The high expression rate of NRP-1 in NSCLC was significantly higher than that in paracancerous normal lung tissues (P = 0.004). The expression of NRP-1 was significantly associated with tumor maximum diameter, lymph node metastasis, TNM stage and pathological grade (all P ＜ 0.05), but was not related to age, gender, histological type and smoking status (all P ＞ 0.05). The overall survival time of NSCLC patients with NRP-1 high expression was significantly shorter than that of patients with NRP-1 low expression (P ＜ 0.001). COX multivariate regression analysis indicated that NRP1 expression and TNM stage were independent prognostic markers for NSCLC patients (both P ＜ 0.05). Conclusion: The high expression of NRP-1 is associated with the poor clinicopathological characteristics and poor prognosis of NSCLC. NRP-1 may be a promising prognostic marker and potential therapeutic target for NSCLC patients (both P ＜ 0.05).

目的 探讨分析替吉奥胶囊联合贞芪扶正胶囊治疗老年非小细胞肺癌的临床疗效.方法 将我院从2014年2月至2016年3月收治的112例老年非小细胞肺癌患者选取为此次研究对象,将其随机分成对照组与观察组,对照组患者使用替吉奥胶囊治疗,观察组患者在此基础上联合贞芪扶正胶囊治疗,对比两组患者的治疗效果,并对患者进行随访1年,观察生存情况.结果 观察组患者的病情发展时间平均为(3.56±1.32)个月,对照组患者的病情发展时间平均为(0.74±0.51)个月;观察组患者的疾病控制率显著高于对照组,组间数据比较差异显著,均具有统计学意义(P<0.05).两组患者的不良反应发生率经过比较,无明显差异,不具有统计学意义(P>0.05).结论 在单独使用替吉奥胶囊治疗的基础上联合贞芪扶正胶囊治疗老年非小细胞肺癌,患者的病情发展能够有效控制,提高了患者1年内的存活率,同时治疗中的不良发应情况与单独用药治疗差异不大,但效果更好,值得在临床治疗中推广应用.

目的 观察雷替曲塞联合奥沙利铂方案二线治疗晚期结直肠癌的有效性和安全性.方法 入组经病理组织学确诊的晚期结直肠癌患者45例,其中23例(试验组)采用雷替曲塞联合奥沙利铂化疗,22例(对照组)采用5-Fu、甲酰四氢叶酸钙联合奥沙利铂化疗,比较观察2组疗效、毒副反应及生存情况.结果 试验组和对照组有效率分别为18.18％和14.29％ (P＞0.05);疾病控制率分别为63.64％和57.14％ (P＞0.05);中位疾病进展时间分别为6.8和5.5个月(P＞0.05),中位生存期分别为11.5和10.2个月,1 a生存率分别为54.55％和42.86％(P均＞0.05).2组最常见的毒副反应为骨髓抑制,以中性粒细胞减少、血小板减少为主;试验组转氨酶升高发生率高于对照组(47.83％ vs 31.82％,P＜0.05),而呕吐发生率低于对照组(39.13％vs59.09％,P＜0.05).结论 雷替曲塞联合奥沙利铂方案在晚期结直肠癌的二线治疗中安全有效,患者耐受性好,尤其适合老年患者.

目的 研究GEMOX方案(吉西他滨联合奥沙利铂)与FOLFOX4方案(亚叶酸钙、氟尿嘧啶联合奥沙利铂)治疗中晚期原发性肝癌(PHC)的近期疗效与不良反应.方法 45例中晚期PHC患者随机分为GEMOX方案组(A组,22例)和FOLFOX4方案组(B组,23例).比较两组总有效率(RR)、疾病控制率(DCR)、疾病进展时间(TTP)、总生存期(OS)、血清甲胎蛋白(AFP)水平以及不良反应.结果 A组和B组RR、DCR、中位TTP、中位OS、AFP分别为18.2％和17.4％、63.6％和60.9％、4.3个月和4.1个月、9.2个月和8.9个月、13.2％和12.7％,差异均无统计学意义(P＞0.05).两组主要不良反应为骨髓抑制、消化道反应及周围神经毒性.结论 GEMOX方案与FOLFOX4方案治疗中晚期PHC有效、安全.

Objective to explore the advanced gastric intraperitoneal chemotherapy clinical observation of 58 cases . Methods Patients with advanced gastric cancer from december 2010 to June 2013 in our hospital were 58 cases , they were randomly divided into the control group and the observation group , 29 cases each . all patients undergoing elective radical gastrectomy , the control group after intravenous chemotherapy , intraperitoneal chemotherapy in the observation group . treatment effects were observed , and the relapse rate , the transfer rate and mortality to assess the therapeutic effect. Results the effective rate of 58.62% was observed after the chemotherapy group , while the control group was 34.48% effective treatment , the observation group was significantly higher, the difference was statistically significant (P <0.05); recurrence rate in the observation group , the transfer rate and mortality rates were significantly lower than the control group, the difference was statistically significant (P <0.05); observation group incidence of gastrointestinal reactions and bone marrow suppression was significantly less than the control group, the difference was statistically significant (P <0.05). Conclusion advanced gastric cancer after radical resection , intraperitoneal chemotherapy had a higher overall efficiency, improved patient outcomes provide a strong guarantee .

ObjectiveWe observed the survival situation,efficacy and safety of irinotecan plus 5-Fu/LV after first-line chemotherapy failure with advanced or/and metastatic gastrointestinal cancer.MethodsTwenty nine patients with metastatic gastrointestinal cancer whose disease had progressed after treatment with first-line chemotherapy were included to receive weekly regimen(irinotecan 60 mg/m2,LV 100 mg/m2,5-Fu 500 mg/m2).Results25 colorectal cancers were assessable to observe the efficacy and safety.No case was CR.5 cases were PR,response rate was 20.0%(5 /25).9 cases were SD,rate was 36.0%(9 /25).11 cases were PD,rate was 44.0%(11/25).Median time to progression(TTP) was 4.0 months(2 to 10 months),median overall survival was 9.0 months(5 to 28 months).The majority of adverse reactions were nausea,vomiting,anorexia,diarrhea,leucopenia,alopecie.Most of them were Ⅰ/Ⅱ degree.ConclusionThe weekly regimen of irinotecan in combination with 5-Fu/LV results in significant and clinically meaningful improvement in survival and quality of life among patients with metastatic gastrointestinal cancer.Toxicity is manageable.

Objective To contrast the curative effect,safety and life span of treatment for second-line nonsmall cell lung cancer with combination of Nedaplantin and Docetaxel to Docetaxel only.Methods The samples are the advanced non-small cell lung cancer patients who failed first-line chemotherapy.The combination group:the first day,Nedaplantin of?80 mg/m~2 was diluted with 500 mL saline water,iv.for 2 hours.The second day,Docetaxel was given at 75 mg/m~2,iv.The time of each cycle was 21 days.Single-drug group:Docetaxel was given at?75 mg/m~2,iv.in the first day.The time of each cycle was 21 days.Every patient was treated through chemotherapy treatment for 2 cycles at least and 6 cycles at most.Results The response of 28 cases of combination group in overall was 25.0%and disease control rate was 71.4%,CR:0,PR:7 cases. The overall response rate in 23 cases of single-drug group was 13.0%and disease control rate was 60.9%, CR:0,PR:4 cases.The median time to progress was 5.2 months for combination group and 4.4 months for single-drug group.There was no significant difference between two groups.In combination group,the rate of neutropenia was 85.7%in 24 cases.And the rate of Ⅲ/Ⅳ was 28.5%,the decrease of platelet and hematin were 21.4%and 42.8%respectively,2 cases of platelet decrease at Ⅲ degree.In single-drug group,the rate of neutropenia was 47.8%in 11 cases.And the rate of Ⅲ/Ⅳ was 4.35%,the decrease of platelet and hematin were 17.4%and 13.0%respectively,the platelet decrease of all atⅠdegree.Remarkable differences were shown in the toxicity of hematology between the two groups.Conclusions A good curative effect and controlled toxic reactions were shown in the use of Nedaplantin and Docetaxel in second-line advanced non-small cell lung cancer.

Objective To observe the clinical efficacy,adverse effects and quality of life in patients trrated with best supportive care(BSC),single gemcitabine(GEM) and gemcitabine plus carboplatin(CBP) for advanced non-small-cell lung cancer(NSCLC) in the aged.Methods Patients who refused chemotherapy joined the BSC group,and patients receiving chemotherapy were randomly divided into single-agent GEM group and gemcitabine plus carboplatin(GME+CBP) group.Those in single-agent group were given GEM 1 000 mg/m2 on the first day and eighth day,and those in combined group received GEM 1 000 mg/m2 on the first day and eighth day and CBP AUB=4 on the first day.All the drugs were given intravenously for 30 minutes.A cycle is 21 days and each case completed at least two cycles of treatment.Results In short-term effect,the response rate of BSC group was 0,GEM group was 30.3% and GEM+CBP group was 46.7%.The difference was significant(P0.05).The major toxic reaction was bone marrow depression and digestive tract reaction.Although Ⅲ+Ⅳ degree of adverse effects rate of GEM+CBP group was significantly higher than that the GEM group(P0.05),the two groups were well tolerant.The clinical benefit rate of BSC group was 13.2%,GEM group was 48.5% and GEM+CBP group was 50.0%.Two chemotherapy group was superior to BSC Group(P0.05),but the difference was insignificant between the two chemotherapy groups(P0.05).Conclusion Chemotherapy is superior to symptomatic supportive care for advanced non-small-cell lung cancer(NSCLC) in the aged.Gemcitabine plus carboplatin is superior to single gemcitabine,but increases adverse effects and clinical benefit response rate is insignificant.clinical practice,should pay attention to individual treatment.