目的 探讨TACE联合靶向免疫药物治疗晚期肝细胞癌(HCC)的疗效和安全性.方法 回顾性分析 2019 年 1 月至 2021 年 9 月苏州大学附属第一医院收治的 37 例晚期HCC患者的临床资料.采用TACE联合靶向免疫药物治疗(联合组)16 例,单纯靶向免疫治疗(单纯组)21 例.Kaplan-Meier法绘制生存曲线,比较两组的中位无进展生存期(mPFS)、中位总生存期(mOS).根据mRECIST标准进行疗效评估,比较两组的客观缓解率(ORR)、疾病控制率(DCR).观察两组患者的不良反应发生情况.结果 联合组的mOS和mPFS分别为 14.0 个月(95％CI:4.59～23.41)和 6.0 个月(95％CI:4.04～7.96),单纯组分别为11.6个月(95％CI:4.53～18.67)和 4.5个月(95％CI:3.38～6.63),差异有统计学意义(P=0.047、0.045).联合组的ORR和DCR分别为 68.75％和 87.5％,较单纯组(4.76％和 33.3％)均明显提高(P＜0.01).两组患者严重不良事件的发生差异无统计学意义(P=0.634).结论 与单纯靶向免疫治疗相比,TACE联合靶向免疫药物治疗晚期HCC的疗效明显提高,且不会增加严重不良反应的发生.

Objective To investigate CT and MRI characteristics of lateral ventricular tumors to improve the diagnostic accuracy.Methods CT and MRI findings were analyzed retrospectively in 46 cases of tumors in the lateral ventricle proved by surgery and pathology,imaging features were concluded in comparison with the pathological findings.Results Ependymoma (n=5),astrocytoma (n=8),glioblastoma (n=2),central neurocytoma (n=4),meningioma (n=7),metastatic tumor (n=4),lymphoma (n=4),cavernous hemangioma (n=7),hemangiopericytoma (n=l),subependymoma (n=2),subependymal giant cell astrocytoma (n=l) and neuroepithelial cyst (n=1) were included in 46 patients.Central neurocytoma was mostly found in young men compared to metastatic tumor.Predilection site of subependymoma,subependymal giant cell astrocytoma,central neurocytoma was cornu anterius and interventricular foramen in common,while meningioma and neuroepithelial cyst were located in ventricular trigone.The density and signal of meningioma,neuroepithelial cyst,lymphoma were relatively homogeneous.Cystic area were showed in most astrocytoma,glioblastoma,central neurocytoma,ependymoma and hemangiopericytoma.Conclusion Lateral ventricular tumors have some characteristics using CT and MRI,combining image features with the patient's age and the specific tumor location would contribute to the diagnosis and differential diagnosis of lateral ventricular tumors.

Objective To identify the rates of breast cancer-related lymphedema( BCRL) induced by radiotherapy in patients after breast surgery and to analyze the relative risk factors contributing to BCRL. Methods A total of 92 patients with breast cancer were treated with lumpectomy or modified radical mastectomy and afterwards conformal radiotherapy in our hospital. The determination of BCRL was based on subjective symptoms felt by patients and objective signs viewed by medical personnels. FCAT-B + 4 scoring system was introduced to comment patients' symptoms and circumference measurement was taken at 15 cm below the acromion process and15 cm below the olecranon in both arms. Then the actuarial rates of BCRL were calculated. Univariate analysis was performed by ChiSquare test,and multivariable analysis was undertaken by binary logistic regression. Results The actuarial rate of complaint and positive physical finding of BCRL was respectively 53. 3% and 32. 6%,among which BCRL was more likely to develop in patients with advanced nodal status( 41. 5% vs. 11. 1%,P = 0. 005),patients with stage Ⅲ( 52. 5% vs. 17. 3%,P = 0. 000),and patients receiving supraclavicular irradiation( 37. 8% vs. 11. 1%,P = 0. 030). TNM stage was the independent risk factor leading to lymphedema after multivariable analysis. Conclusion BCRL is the common complication with high morbidity induced by postoperative radiotherapy. The risk factors of BCRL include advanced nodal status,late stage and supraclavicular irradiation.