Purpose:Postamputation neuropathic pain is a common disease in patients with malignant tumor amputation, seriously affecting amputees' quality of life and mental health. The objective of this study was to identify independent risk factors for phantom limb pain in patients with tumor amputation and to construct a risk prediction model.Methods:Patients who underwent amputation due to malignant tumors from 2013 to 2023 were retrospectively analyzed and divided into phantom limb pain group and non-phantom limb pain group. To determine which preoperative factors would affect the occurrence of phantom limb pain, we searched for candidate factors by univariate analysis and used multivariate logistic regression analysis to identify independent factors and construct a predictive model. The receiver operating characteristic curve (ROC) was drawn to further evaluate the accuracy of the prediction model in evaluating the phantom limb pain after amputation of bone and soft tissue tumors.Results:Multivariate analysis showed that age (OR, 1.054; 95% CI, 1.027 to 1.080), preoperative pain (OR, 5.773; 95% CI, 2.362 to 14.104), number of surgeries (OR, 3.425; 95% CI, 1.505 to 7.795), amputation site (OR, 5.848; 95% CI, 1.837 to 18.620), amputation level (OR, 8.031; 95% CI, 2.491 to 25.888) were independent risk factors for phantom limb pain for bone and soft tissue tumors. The the area under the curve (AUC) of this model was 0.834.Conclusion:Risk factors for postoperative phantom limb pain were the site of amputation, proximal amputation, preoperative pain, multiple amputations, and older age. These factors will help surgeons to individualize and stratify phantom limb pain and help patients with risk counseling. In particular, an informed clinical decision targeting those modifiable factors can be considered when needed.

RATIONALE:Malignant melanoma (MM) is notorious for its remarkable morphological variation and aberrant histopathological patterns. In addition, Malignant Periopheral Nerve Sheath Tumor (MPNST) is an uncommon but aggressive soft tissue sarcoma. Because of the common embryological origin of melanocytes and Schwann cells in the neural crest, discriminating between a particular type of MM and MPNST can be difficult, particularly when they are amelanotic. Our goal is to increase awareness among clinicians of the rare variations of MM and the importance of medical history in improving the accuracy of the final clinical diagnosis.PATIENT CONCERNS:A 68-year-old man was admitted to the hospital due to pain in his right ankle, which had persisted for 8 months, along with swelling for 4 months. Medical history revealed delayed healing of right plantar for 5 years after a traumatic injury.DIAGNOSES:The ankle mass was initially diagnosed as MPNST through biopsy. After reviewing the patient's medical history and receiving the final pathological report following amputation, we have revised the diagnosis to metastatic amelanotic desmoplastic melanoma in the ankle part and lentigo maligna melanoma in the plantar part. This is due to both lesions displaying positive markers or mutated genes in immunohistology and Gene Mutation Detection, indicating homology between the 2 tumors.INTERVENTIONS:Due to the malignant characteristics of the tumor and the patient's wishes, amputation of the right lower leg was carried out.OUTCOMES:Subsequently, the patient was treated with interferon-γ and immunosuppressant PD-1 inhibitor, and survived for 1 year after amputation.LESSONS:Clinical data, immunohistochemisty biomarkers and genes detection results can serve as valuable evidence for pathologists and clinicians in identifying the disease process. Collaborative efforts between clinicians and scientists are crucial in order to identify specific markers that can effectively differentiate between the 2 tumors, thereby enhancing the conclusiveness of the diagnosis.

目的 探讨CT引导下经皮粗针穿刺活检在上中胸椎病变诊断中的应用价值.方法 回顾性分析85例于2017年1月至2019年12月间在我科行CT引导下经皮粗针穿刺活检的上中胸椎病变患者的病例资料,其中男47例,女性38例;年龄10～77岁,平均(52.9±15.8)岁,并随访其后续的诊治情况.以手术大体病理结果或临床随访作为评价穿刺病理的标准,随访期至少为6个月.收集穿刺前后治疗方案的调整情况.结果 本研究纳入的85例患者,3例穿刺失败,穿刺成功率96％(82/85).82例穿刺成功的患者中,真阳性69例,假阳性0例,真阴性10例,假阴性3例.针吸活检诊断的敏感性、特异性、准确率、阳性预测值、阴性预测值分别为96％、100％、96％、100％、77％.有19例(23％)患者穿刺前后治疗方案发生了调整:由拟行手术改为非手术治疗者14例;由拟行手术和/或放疗改为靶向治疗者5例.结论 CT引导下经皮粗针穿刺活检在上中胸椎病变诊断中具有较高的敏感性、特异性及准确率,安全性好,可为制定正确的临床决策提供可靠的依据.

目的 探讨β-榄香烯在骨肉瘤中诱导自噬发生的信号通路及其对肿瘤细胞增殖及凋亡的影响.方法 以不同浓度(0、10、20、50、100、150μg/ml)的β-榄香烯处理人骨肉瘤143B细胞24、48 h后,应用CCK-8法检测细胞存活率;用0、20、50μg/mlβ-榄香烯处理143B细胞48 h后,应用流式细胞仪使用AnnexinⅤ-FITC/PI双染法检测细胞凋亡率,并通过荧光显微镜及蛋白印迹法(Western blotting)检测细胞自噬相关蛋白微管相关蛋白1轻链3(LC3B)的分布及表达,Western blotting检测143B细胞中丝氨酸/苏氨酸激酶(AKT)、磷酸化丝氨酸/苏氨酸激酶(p-AKT)、哺乳动物雷帕霉素靶蛋白(mTOR)及磷酸化哺乳动物雷帕霉素靶蛋白(p-mTOR)蛋白表达水平.结果 β-榄香烯呈浓度依赖性地显著抑制骨肉瘤143B细胞的增殖,其对143B细胞24 h和48 h时的半数抑制浓度(IC50)分别为58.89μg/ml和18.48μg/ml;143B细胞经20、50μg/mlβ-榄香烯处理48 h后,细胞凋亡率分别为(15.43±0.99)％和(19.21±0.82)％,明显高于0μg/mlβ-榄香烯组(6.87±1.02)％;且其细胞Cleaved caspase-3蛋白表达水平亦明显高于0μg/mlβ-榄香烯组,差异均有统计学意义(P<0.05);经20、50μg/mlβ-榄香烯处理骨肉瘤143B细胞48 h后,细胞质内的自噬体数量明显增多,其LC3-Ⅱ/LC3-Ⅰ表达水平较0μg/mlβ-榄香烯组均明显增高,差异均有统计学意义(P<0.05),β-榄香烯可以抑制骨肉瘤细胞p-AKT和p-mTOR的表达,且呈时间及剂量依赖性.结论 β-榄香烯可以诱导人骨肉瘤143B细胞增殖抑制及凋亡,还可以通过抑制AKT/mTOR通路激活细胞自噬.

目的 评估聚乙二醇重组人粒细胞刺激因子(polyethylene glycolated recombinant human gran-ulocyte stimulating factor,PEG-rhG-CSF)预防骨肉瘤患者初次吡柔比星联合顺铂方案化疗后引起的中性粒细胞绝对数(absolute neutrophil count,ANC)减少的临床效果.方法 纳入初诊为骨肉瘤的患者77例为研究对象.根据化疗后是否预防性应用PEG-rhG-CSF将其分为对照组(rhG-CSF组)25例、观察组(PEG-rhG-CSF联合rhG-CSF组)52例.患者初次化疗方案均为AP方案.通过定期观测血常规评估化疗后ANC减少及预防性应用PEG-rhG-CSF的效果.结果 预防性应用PEG-rhG-CSF可以显著缩短ANC减少的持续时间,降低Ⅲ-Ⅳ级ANC减少和粒细胞减少性发热(febrile neutropenia,FN)的发生率,减少补充使用rhG-CSF的使用剂量和时间,同时减少了抗生素的使用时间(P<0.05).结论 预防性应用PEG-rhG-CSF可以有效的降低吡柔比星联合顺铂方案化疗后ANC减少的发生,且安全性良好.有益于保证骨肉瘤患者后续大剂量、高强度化疗的顺利进行.

Objective The purpose of this retrospective study was to evaluate the clinical and oncological results of combination treatment of short‐term preoperative denosumab (the receptor activator of nuclear factor kappa‐B ligand inhibitor) with surgery in unresectable or recurrent cases of giant cell tumor of the bone (GCTB). Methods Between 2016 and 2018, 11 eligible patients (1 man, 10 women, mean age 38.1 years) with grade 3 GCTB were treated with a combination of short‐term (six doses) preoperative denosumab and surgery in a single institution. The clinical, radiological, and pathological alteration after the denosumab treatment were compared. The oncological results of the combination therapy were also recorded. Meanwhile, adverse effects or complications of denosumab, if any, were reported. Results The median follow‐up time after surgical procedure was 30 months (range 13–45 months). After 3–4 denosumab injections, pain relief was observed in all patients. In two spine patients, the neurological status improved after four doses of treatment. Intraoperatively, the margin of the tumor became clear and the intensity of the tumor increased while the blood supply around and within the lesion decreased. Within the lesion, the typically soft and loose tissue were replaced by the tough and dense fibro‐osseous tissue. The mean diameter of the lesion before and after treatment was 61.55 ± 22.49 mm and 51.81 ± 21.12 mm, respectively, and the T‐score was 1.02 (P = 0.32). Variable calcification was observed at the periphery and within the lesion. A total of three patients experienced local recurrence in this study. In the resection group, only one extremity patient had soft tissue recurrence that was treated with en‐bloc excision. In the curettage group, two of three sacral tumor patients had local occurrence. Both refused re‐operation and restarted the monthly denosumab injection thereafter, and the lesions remained stable at the final follow up. Finally, no adverse effects or complications related to denosumab treatment were found. Conclusion For the unresectable or recurrent GCTB cases, short‐term (six doses) preoperative use of denosumab improved clinical symptoms, decreased the tumor size, and increased the tumor density. The changes in tumors, in turn, simplified the tumor removal manipulation and, subsequently, decreased the local recurrence for the resection surgery. For the curettage, the denosumab‐induced changes had mixed impacts, and shorter term (fewer than six doses) usage may be more appropriate. Our six‐dose regime was deemed safe, while the safety of long‐term use remains unknown.

目的 观察地舒单抗在治疗骨巨细胞瘤 ( giant cell tumor of bone,GCTB ) 中发挥的作用.方法2016 年 1 月至 2018 年 12 月,14 例难治性 GCTB 应用地舒单抗,包括脊柱 6 例、骨盆 2 例、骶骨 3 例、四肢复发性 GCT 3 例.6 例脊柱 GCTB 中 5 例为手术前应用 ( 胸椎、腰椎 ),1 例为两次手术后复发性难以切除同时发生肺转移病例;2 例骨盆分别是 1 区+4 区、2 区+3 区;3 例骶骨中 2 例为 S1～3,1 例为 S2～4;3 例四肢分别为肱骨近端、桡骨远端、胫骨远端,均为囊内刮除术后复发,肿瘤体积巨大,边界不清.男 2 例,女12 例,年龄 ( 34.79±16.89 ) 岁.手术前应用方法为:地舒单抗 120 mg,第 1、8、15、31、61、91 天行皮下注射.最后一次用药后 2 周作 CT 和 MRI,用作于用药后测量.对比用药前后肿瘤最大径、病变的 CT 值,并作统计学分析.疼痛程度通过 VAS 评分衡量.2 例骨盆肿瘤患者和 3 例四肢肿瘤患者均行整块切除术,骶骨肿瘤患者均行囊内刮除;5 例脊柱肿瘤患者,2 例行术前用药,已应用 4 mg×120 mg,尚未手术,另外 3 例均行 en-bloc 切除,并分析术中大体标本及术后病理结果.同时,对手术后＞6 个月病例随访结果进行分析.结果 用药前肿瘤最大径为 ( 62.58±21.88 ) cm,用药后为 ( 54.17±22.65 ) cm,P＝0.000.用药前病变中心及边缘平均 CT 值为 ( 43.30±19.71 ) HU 和 ( 97.15±42.68 ) HU,用药后为 ( 97.97±54.37 ) HU 和 ( 223.95± 116.63 ) HU,P 值分别为 0.027 和 0.010 ( P＜0.05 ).用药后 VAS 评分平均 1 分.手术后随访时间＞6 个月的8 例,平均随访 26.5 ( 16～35 ) 个月,分别为 3 例脊柱 0 复发,1 例骨盆 0 复发,3 例骶骨 2 例复发,1 例肱骨近端出现可切除的软组织复发.结论 地舒单抗治疗四肢长骨复发、边界不清的 III 级及中轴骨 GCTB,可明显使患者临床症状减轻,使肿瘤钙化、缩小.推荐骶骨或四肢肿瘤需要囊内切除者减少用量.