目的 评估总胆红素与直接胆红素及二者的比值对广泛期小细胞肺癌(ES-SCLC)患者预后的预测价值.方法 选取中国人民解放军联勤保障部队第九○一医院2018年1月至2020年7月收治的83例ES-SCLC患者为研究对象.收集患者入院时临床资料、生化检验、无进展生存期(PFS)和总生存期(OS)等.采用多因素Cox回归分析胆红素对ES-SCLC患者生存预后的影响,用Kaplan-Meier方法评估生存时间.结果 总胆红素和总胆红素/直接胆红素对ES-SCLC患者生存预后具有预测价值(P<0.05),最佳截断值分别是12.3μmol/L和2.8;与低总胆红素组(≤12.3μmol/L)患者比较,高总胆红素组(>12.3μmol/L)患者有更长的中位PFS和OS(P<0.05);与低总胆红素/直接胆红素组(≤2.8)患者比较,高总胆红素/直接胆红素组(>2.8)患者有更长的中位PFS和OS(P<0.05);总胆红素和总胆红素/直接胆红素是影响ES-SCLC患者独立预后因素(P<0.05).结论 总胆红素水平和总胆红素/直接胆红素水平可能是ES-SCLC的重要预后因素,有助于判断患者的预后.

Objective:To explore the clinical efficacy of different doses of apatinib combined with chemotherapy in patients with advanced non-small cell lung cancer (NSCLC) and the adverse reactions.Methods:A total of 69 patients with NSCLC diagnosed in the No. 901 Hospital of the Chinese People′s Liberation Army Joint Logistics Support Force were selected from January 2018 to June 2020, and were divided into chemotherapy alone group (docetaxel+ cisplatin was used), apatinib group A [apatinib (0.25 g)+ docetaxel+ cisplatin was used] and apatinib group B [apatinib (0.50 g)+ docetaxel+ cisplatin was used] according to random number table method, with 23 cases in each group. The objective response rate (ORR), disease control rate (DCR), median overall survival (OS), median progression-free survival (PFS), and incidences of adverse reactions were compared between the three groups of patients.Results:One patients in the apatinib group B withdrew from the study due to acute myocardial infarction. After 4 cycless of treatment, the ORR of the patients in the chemotherapy alone group, apatinib group A and apatinib group B were 17.39% (4/23), 47.83% (11/23) and 54.55% (12/22) respectively, with a statistically significant difference ( χ2=7.41, P=0.024). The ORR of the apatinib group B was higher than that of the chemotherapy alone group, with a statistically significant difference ( χ2=6.77, P=0.009). There were no statistically significant differences in ORR between the apatinib group A and chemotherapy alone group, the apatinib group A and apatinib group B ( χ2=4.85, P=0.028; χ2=0.20, P=0.652). The DCR of the patients in the three groups were 47.83% (11/23), 78.26% (18/23) and 86.36% (19/22) respectively, with a statistically significant difference ( χ2=9.03, P=0.011). The DCR of the apatinib group B was higher than that of the chemotherapy alone group, with a statistically significant difference ( χ2=7.52, P=0.006). There were no statistically significant differences in DCR between the apatinib group A and the chemotherapy alone group, the apatinib group A and apatinib group B ( χ2=4.57, P=0.033; χ2=0.51, P=0.477). The median OS of the patients in the three groups were 6.8, 9.2 and 9.9 months respectively, with a statistically significant different ( χ2=8.91, P=0.022). Compared with the chemotherapy alone group, the median OS of the apatinib group A and apatinib group B were significantly prolonged, with statistically significant differences ( χ2=7.25, P=0.036; χ2=8.60, P=0.029). Compared with the apatinib group A, the median OS of the apatinib group B was prolonged, but there was no statistically significant different ( χ2=1.54, P=0.201). The median PFS of the patients in the three groups were 5.2, 7.7 and 8.2 months respectively, with a statistically significant different ( χ2=8.79, P=0.026). Compared with the chemotherapy alone group, the median PFS of the apatinib group A and apatinib group B were significantly prolonged, with statistically significant differences ( χ2=7.01, P=0.039; χ2=8.36, P=0.031). Compared with the apatinib A group, the median PFS of the apatinib group B was prolonged, but there was no statistically significant different ( χ2=1.68, P=0.186). There were statistically significant differences in the incidences of fatigue [34.78% (8/23) vs. 65.22% (15/23) vs. 72.73% (16/22), χ2=7.50, P=0.024], hypertension [4.35% (1/23) vs. 34.78% (8/23) vs. 68.18% (15/22), χ2=20.07, P<0.001], hand-foot syndrome [4.35% (1/23) vs. 43.48% (10/23) vs. 72.73% (16/22), χ2=22.28, P<0.001] and oral mucositis [8.70% (2/23) vs. 39.13% (9/23) vs. 72.73% (16/22), χ2=19.26, P<0.001] among the three groups. Compared with the chemotherapy alone group, the incidences of hypertension and hand-foot syndrome in the apatinib group A and the incidences of fatigue, hypertension, hand-foot syndrome and oral mucositis in the apatinib group B were increased, with statistically significant differences ( χ2=6.77, P=0.009; χ2=9.68, P=0.002; χ2=6.51, P=0.011; χ2=20.00, P<0.001; χ2=22.37, P<0.001; χ2=19.21, P<0.001). Conclusion:Apatinib (0.50 g) combined with chemotherapy has better short-term efficacy than chemotherapy alone in advanced NSCLC. Apatinib (0.25 g) and apatinib (0.50 g) can prolong the survival of patients, but increasing the treatment dose can not achieve longer survival benefit.

目的 探讨晚期复发性铂耐药型卵巢癌脂质体阿霉素与依托泊苷的疗效对比.方法 选取2016年1月至2017年6月中国人民解放军联勤保障部队第901医院收治的晚期复发性铂耐药型卵巢癌患者60例,按照随机数字表法分为对照组和研究组,每组30例.对照组应用依托泊苷治疗,100mg/次,口服,每日1次,持续14d,每3周为1个周期,6个周期为1个疗程;研究组给予脂质体阿霉素治疗,40～50mg/m2,静脉滴注,每4周给药1次且为1个周期,6个周期为1个疗程.对所有患者每2个周期进行1次疗效评估.比较两组患者总有效率、无进展生存期以及不良反应发生情况.结果 治疗后,研究组总有效率(40.0％)与对照组(36.6％)比较差异无显著性(P>0.05);研究组患者无进展生存期[(7.4±0.5)个月]与对照组[(7.1±0.6)个月]比较差异无显著性(P>0.05);对照组患者粒细胞缺乏(20.0％)及胃肠道不良反应(26.6％)的发生率均高于研究组(6.0％、6.0％),差异有显著性(P<0.05),其他不良反应差异无显著性(P>0.05).结论 对于晚期复发性铂耐药型卵巢癌的治疗,脂质体阿霉素与依托泊苷的疗效均较为理想,脂质体阿霉素不良反应发生率较低,在临床中可根据患者的具体情况予以应用.

Objective:To observe the clinical efficacy and adverse drug reactions of apatinib combined with tegio in the second-line treatment of advanced esophageal cancer.Methods:Seventy-two patients with advanced esophageal cancer from January 2018 to December 2019 in the Tumor Center of the No. 901 Hospital of Chinese People′s Liberation Army Joint Logistics Support Force were selected as research objects. According to the random number table method, the patients were divided into control group ( n=36) and observation group ( n=36). Patients in the control group were given irinotecan combined with tegio regimen chemotherapy, irinotecan 160 mg/m 2, intravenous drip on the first day; tegio 50-60 mg orally each time, twice a day, oral administration for 2 weeks, discontinuation for 1 week, 3 weeks for 1 cycle. Patients in the observation group were given tegio with the same administration method and dosage as the control group, and apatinib 0.5 g orally each time, once a day, continuous oral administration, 3 weeks for 1 cycle. Patients of the two groups were treated for 4 cycles. The primary study endpoints were objective response rate (ORR) and disease control rate (DCR). The secondary study endpoints were median overall survival (mOS), median progression-free survival (mPFS), quality of life scores and incidences of adverse drug reactions. Results:After 4 cycles of treatment, the ORR and DCR in the observation group were 38.89% (14/36) and 63.89% (23/36) respectively, which were higher than those in the control group [16.67% (6/36) and 38.89% (14/36)], and there were statistically significant differences ( χ2=4.431, P=0.035; χ2=4.503, P=0.034). The Karnofsky performance status score and special scale for esophageal cancer QLQ-OES24 score in the observation group were 75.23±10.65 and 76.55±9.12 respectively, which were higher than those in the control group (66.15±10.31 and 65.36±9.01), and there were statistically significant differences ( t=7.285, P=0.018; t=7.613, P=0.015). The incidences of oral mucositis, hand-foot syndrome, hypertension, proteinuria and rash in the observation group were 38.89% (14/36), 50.00% (18/36), 25.00% (9/36), 11.11% (4/36) and 33.33% (12/36) respectively, which were higher than those in the control group [11.11% (4/36), 13.89% (5/36), 0 (0/36), 0 (0/36), 2.78% (1/36)], and there were statistically significant differences ( χ2=7.407, P=0.007; χ2=10.797, P=0.001; χ2=10.286, P=0.001; χ2=4.235, P=0.040; χ2=11.359, P=0.001). The incidences of gastrointestinal reactions and bone marrow suppression in the observation group were 41.67% (15/36) and 30.56% (11/36) respectively, which were lower than those in the control group [66.67% (24/36) and 55.56% (20/36)], and there were statistically significant differences ( χ2=4.531, P=0.033; χ2=4.589, P=0.032). There were no patients who withdrew due to severe adverse reactions.The mOS and mPFS of the patients in the observation group were 11.6 months and 8.1 months respectively, which were longer than those in the control group (8.9 months and 5.6 months), and there were statistically significant differences ( χ2=8.015, P=0.012; χ2=8.721, P=0.007). Conclusion:Apatinib combined with tegio in the second-line treatment of patients with advanced esophageal cancer can effectively prolong the survival time of patients, improve patients′ quality of life, and the adverse reactions are tolerable.

目的 探讨多西他赛联合卡培他滨姑息治疗在晚期乳腺癌患者中的疗效及对患者生存期的影响.方法 选取我院收治的晚期乳腺癌女性患者74例,随机分为对照组和研究组,对照组采用多西他赛姑息治疗,研究组采用多西他赛联合卡培他滨姑息治疗,对比观察两组患者的治疗效果、不良反应及生存情况.结果 研究组患者缓解率为75.7％、对照组为45.9％,研究组明显高于对照组(P<0.05);两组患者恶心呕吐、口腔溃疡、骨髓抑制、脱发等不良反应的发生率无显著差异(P>0.05);研究组患者生存时间、无疾病进展生存期以及1年生存率均明显高于对照组(P<0.05).结论 多西他赛联合卡培他滨姑息治疗晚期乳腺癌可缓解临床症状,提高临床疗效,延长生存期且副反应未明显增加.

上皮-肌上皮癌又称腺肌上皮瘤,透明细胞腺瘤;透明细胞癌;恶性肌上皮瘤;管状实性腺瘤等,是一种低度恶性肿瘤,发病率很低,老年男性多发,主要发生于大小涎腺,80％发生于腮腺,小涎腺发生率在1％ -2％ [1] ,支气管的上皮-肌上皮癌发生率更低,原发于支气管的上皮-肌上皮癌发源于支气管黏膜下层腺体,大部分起源于大支气管内,多数有气道阻塞症状,支气管的上皮-肌上皮癌国内外少有报道. 现将我科收治的1例气管上皮-上皮癌治疗报道如下,探讨其发病情况、病理特征及免疫组化特点、临床表现、诊断及鉴别诊断、治疗及预后.