共查询到19条相似文献,搜索用时 536 毫秒
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摘 要:[目的] 探讨对室管膜下区(subventricular zone,SVZ)受累的高级别胶质瘤(high-grade glioma,HGG)患者行全室管膜下区预防性放疗的安全性及疗效。[方法] 纳入2012年1月至2019年12月南京医科大学附属肿瘤医院放疗科收治的81例HGG患者,入组患者在初诊时影像学上均累及SVZ。入组患者根据放疗范围分为常规放疗+全SVZ放疗组24例及常规放疗组57例。采用Cox比例风险回归模型进行影响因素分析。采用Kaplan-Meier法统计分析常规放疗+全SVZ放疗组与常规放疗组的无进展生存期(progression free survival,PFS)和总生存期(overall survival,OS)。[结果] 单因素分析显示年龄、性别、病理分级、病灶位置、病灶数及是否联合SVZ放疗与HGG患者PFS和OS均无相关性(P均>0.05)。年龄分层分析结果显示,大于50岁的患者中,常规放疗+全SVZ放疗对比常规放疗中位PFS分别为37个月vs 19个月(P=0.033 ),中位OS分别为25个月vs 21个月(P=0.097);而年龄小于50岁的患者中,常规放疗+全SVZ放疗对比常规放疗中位PFS 分别为5个月vs 15个月(P=0.024 ),中位OS分别为15个月vs 32个月 (P=0.202)。[结论]对于年龄大于50岁伴SVZ受累的HGG患者行SVZ预防性放疗可带来生存获益。 相似文献
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摘 要:[目的] 评价中医药辨证治疗对年龄≥65岁老年晚期胃癌患者预后的影响。[方法]采用非随机同期对照研究,以老年晚期胃癌病例总生存期(OS)为主要疗效观察指标,并预设分层,化疗亚组(中医药辨证治疗+化疗组、化疗组)和非化疗亚组(单纯中药组、最佳支持治疗组),运用Cox比例风险回归模型分析影响各组老年晚期胃癌生存期的因素,在基线均衡的条件下应用Kaplan-Meier法估算中位生存期,组间差异采用Log-rank 进行显著性检验。两组的毒副反应发生率采用χ2检验进行比较。[结果] 共有255例老年晚期胃癌病例纳入本项研究,全组分析:中药组中位OS较非中药组延长(14.60个月 vs 8.68个月,P<0.001);Cox多因素分析显示腹膜转移(P=0.016)、放疗(P=0.031)、中医药辨证治疗(P<0.001)是老年晚期胃癌总生存期的独立影响因素。以化疗因素分层分析,化疗亚组中中医药辨证治疗+化疗组93例,化疗组81例,中医药辨证治疗+化疗组中位OS较化疗组延长(14.79个月vs 9.01个月,P<0.001);Cox多因素分析显示,转移部位数目(P=0.031)、中医药辨证治疗(P=0.001)是化疗亚组老年晚期胃癌总生存期的独立影响因素。中医药辨证治疗+化疗组白细胞减少(P=0.006)、中性粒细胞减少(P=0.010)、血小板减少(P=0.030)、出血(P=0.021)、恶心呕吐(P=0.036)、发热(P=0.020)的发生率均低于化疗组。非化疗亚组中单纯中药组32例,最佳支持治疗组36例,单纯中药组中位OS较最佳支持治疗组延长(11.11个月 vs 6.05个月,P=0.003)。Cox多因素分析显示,中医药辨证治疗(P=0.003)是非化疗亚组老年晚期胃癌总生存期的独立影响因素。[结论]中医药辨证治疗、放疗、腹膜转移、转移部位数目是影响老年晚期胃癌总生存期的独立预后因素。中医药辨证治疗可延长老年晚期胃癌患者的生存期,降低白细胞减少、中性粒细胞较少、血小板减少、恶心呕吐等毒副反应的发生率。 相似文献
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背景与目的放疗联合化疗或靶向治疗仍然是非小细胞肺癌脑转移患者的首选治疗。本研究旨在探讨脑放疗时机的选择及推迟脑放疗对于患者疗效和生存期的影响。方法2003年5月-2015年12月,就诊于我中心确诊为非小细胞肺癌脑转移且接受过脑放疗及全身治疗(包括化疗和靶向治疗)的患者共198例入组了本研究。127例接受了同时性的全身治疗和脑放疗(早放疗组)。71例患者接受了延迟性的脑放疗:完成至少2周期全身治疗后才接受脑放疗(晚放疗组)。早放疗组和晚放疗组患者治疗前的脑转移预后评分(DS-GPA评分)均衡无偏倚。结果早放疗组患者的中位生存时间(overall survival, OS)与晚放疗组相比明显延长(17.9个月vs 12.6个月,P=0.038),早放疗组患者的无进展生存期(progression-free survival, PFS)也优于晚放疗组(4.0个月vs 3.0个月,P<0.01)。3级-4级放化疗不良反应的发生率两组间无明显差异。确诊脑转移后,一线使用酪氨酸激酶抑制剂( tyrosine kinase inhibitor, TKI)药物可能延长患者的OS(17.9个月vs 15.2个月,P=0.289),但无明显统计学差异。在整个疾病进展过程中曾经使用TKI类药物与从未使用过TKI药物相比,患者的OS延长(20.0个月vs 10.7个月,P<0.01)。结论对于非小细胞肺癌脑转移患者,推迟脑放疗可能会影响患者的生存期。这一发现仍需要前瞻性多中心的随机对照研究来证实。 相似文献
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摘 要:[目的] 探讨在接受一线表皮生长因子受体(epidermal growth factor receptor,EGFR)酪氨酸激酶抑制剂(EGFR-TKI)全身治疗的基础上联合放疗能否延长EGFR基因敏感突变的同时性寡转移非小细胞肺癌(non-small cell lung cancer,NSCLC)患者生存期。[方法] 回顾性分析75例确诊为晚期NSCLC患者的临床资料,寡转移、EGFR基因敏感突变并且接受一线TKI治疗的患者纳入本研究,其中部分患者还接受原发灶和所有转移病灶的放疗。采用Kaplan-Meier法评估其无进展生存期(progression-free survival,PFS)和总生存期(overall survival,OS)。[结果] 75例患者中32例(42.7%)接受了全部病灶的放疗(放疗组),43例(57.3%)未接受放疗(未放疗组)。放疗组的PFS优于未放疗组(中位PFS:19.0个月 vs 13.0个月,P<0.001),放疗组的OS也优于未放疗组(中位OS:35.0个月 vs 26.0个月,P=0.009)。Cox多因素回归分析显示转移灶数目不超过2个、对原发及转移灶进行放疗为PFS和OS的独立预后因素。放疗引起的3级及以上不良反应包括放射性肺炎(6.3%)和放射性食管炎(12.5%)。[结论] 对于EGFR基因敏感突变的同时性寡转移NSCLC患者,在TKI一线治疗的基础上对所有病灶进行放疗是一种可行的选择,与未放疗的患者相比,可显著延长PFS和OS。 相似文献
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摘 要:[目的] 评估在晚期胸段食管鳞癌患者中放疗序贯免疫治疗和放疗同步免疫治疗的疗效及副反应。[方法] 回顾性分析2017年6月至2020年6月在南京医科大学附属肿瘤医院同时接受免疫治疗和放疗的晚期胸段食管鳞癌病例118例,根据联合治疗的时机及顺序将患者分为两组,序贯组为先放疗后序贯免疫治疗,同步组为放疗同步免疫治疗。分析比较两组患者的疗效及副反应差异。采用Log-rank法比较生存曲线。[结果] 中位随访时间9个月,中位无进展生存期(progression free survival,PFS)为6个月(1~39个月),中位总生存期(overall survival,OS)为 7个月(1~43个月)。放疗序贯免疫治疗和同步免疫治疗两组的1年PFS 及OS分别为26.8%、27.4%和51.6%、48.3%。亚组分析显示:放疗序贯免疫治疗组,二线使用对比三线使用的中位OS分别为17个月、10个月(1年OS分别为56.9%、44.4%,P=0.039;1年PFS为19.3%、14.7%,P=0.049)。但是,在二线治疗中,放疗序贯免疫治疗组、放疗同步免疫治疗组两组1年OS 分别为56.9%、56.0%(P=0.556);在三线治疗中,两组1年OS分别为43.5%、33.3%(P=0.744)。出现3级以上副反应5例(4.1%),1~2级副反应43例(35.5%),主要是肺炎29例(24.6%)。[结论] 免疫治疗联合放疗对于晚期胸段食管鳞癌患者疗效肯定;治疗时机放在一线、二线使用能带来更多生存获益;在治疗顺序上,二线或三线使用序贯或同步治疗无统计学意义生存差异;两组副反应差异无统计学意义。 相似文献
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目的 基于美国SEER数据库的资料,评估放疗对初诊转移性头颈鳞癌(HNSCC)患者预后的影响。方法 利用SEER数据库筛选2010—2015年初诊为转移性HNSCC的患者1226例,包括放疗组762例(62.1%),未放疗组464例(37.9%)。采用Kaplan‐Meier法计算癌症特异性生存(CSS)和总生存(OS),在全组患者中通过Cox多因素回归和倾向配比评分(PSM)评估放疗对预后的影响。依据多因素分析结果将患者分为低、中和高风险组,并在不同风险组中分析放疗对生存的影响。结果 全组患者中位CSS和OS时间分别为11.0个月和10.0个月;放疗组和未放疗组的中位CSS时间分别为13.0个月和6.0个月,中位OS时间分别为12.0个月和6.0个月。多因素分析显示年龄、原发灶部位、T分期、N分期、转移脏器个数、手术、放疗和化疗是独立的预后影响因素(CSS:P值为0.045、0.021、0.001、0.002、<0.001、<0.001、<0.001、<0.001;OS:P值为0.002、<0.001、0.002、<0.001、<0.001、<0.001、<0.001、<0.001)。PSM配对后,在低、中、高风险组中,放疗和未放疗患者3年CSS分别为:62.5%∶23.5%、22.4%∶15.7%和10.5%∶9.6%(P=0.008、0.001、0.203);3年OS分别为:58.0%∶20.8%、19.8%∶12.7%和7.0%∶6.1%(P=0.002、0.001、0.166)。结论 放疗显著提高低风险和中风险组患者的CSS和OS,但高风险组患者不能从放疗中生存获益。 相似文献
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目的 基于美国SEER数据库的资料,评估放疗对初诊转移性头颈鳞癌(HNSCC)患者预后的影响。方法 利用SEER数据库筛选2010—2015年初诊为转移性HNSCC的患者1226例,包括放疗组762例(62.1%),未放疗组464例(37.9%)。采用Kaplan‐Meier法计算癌症特异性生存(CSS)和总生存(OS),在全组患者中通过Cox多因素回归和倾向配比评分(PSM)评估放疗对预后的影响。依据多因素分析结果将患者分为低、中和高风险组,并在不同风险组中分析放疗对生存的影响。结果 全组患者中位CSS和OS时间分别为11.0个月和10.0个月;放疗组和未放疗组的中位CSS时间分别为13.0个月和6.0个月,中位OS时间分别为12.0个月和6.0个月。多因素分析显示年龄、原发灶部位、T分期、N分期、转移脏器个数、手术、放疗和化疗是独立的预后影响因素(CSS:P值为0.045、0.021、0.001、0.002、<0.001、<0.001、<0.001、<0.001;OS:P值为0.002、<0.001、0.002、<0.001、<0.001、<0.001、<0.001、<0.001)。PSM配对后,在低、中、高风险组中,放疗和未放疗患者3年CSS分别为:62.5%∶23.5%、22.4%∶15.7%和10.5%∶9.6%(P=0.008、0.001、0.203);3年OS分别为:58.0%∶20.8%、19.8%∶12.7%和7.0%∶6.1%(P=0.002、0.001、0.166)。结论 放疗显著提高低风险和中风险组患者的CSS和OS,但高风险组患者不能从放疗中生存获益。 相似文献
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BACKGROUND: Survival improvements have been demonstrated for patients with bronchioloalveolar (BAC) nonsmall cell lung cancer (NSCLC) with intrapulmonary satellite T4 nodules compared with other patients with stage IIIB disease, and for ipsilateral intrapulmonary M1 tumors versus contralateral or distant metastasis. However, it is not known whether these differences are observed in patients with non-BAC NSCLC. METHODS: A case-only analysis of the U.S. Surveillance, Epidemiology, and End Results (SEER) data (1999-2003) was conducted. Overall survival (OS) and lung cancer-specific survival (LCSS) univariate analyses were conducted using the Kaplan-Meier method. Multivariate survival analyses were performed using Cox proportional hazards ratios. RESULTS: A total of 27,435 incident cases of histologically confirmed, advanced stage NSCLC were identified. Cases with stage IIIB NSCLC due to multiple lesions in the same lobe (n = 633) had a significantly improved median OS (21 months) and LCSS (31 months) compared with other cases with stage IIIB NSCLC (n = 7695), with an OS of 7 months and an LCSS of 9 months (P < .0001 for both comparisons). Among cases with stage IV NSCLC, those with intrapulmonary nodules (n = 3010) had a significantly improved median OS (9 months) and LCSS (10 months) compared with those with distant metastasis (n = 16,097), with an OS of 4 months and an LCSS of 5 months (P < .0001 for both comparisons). These survival differences persisted after adjustment for age, sex, ethnicity, surgery, and radiotherapy. Among cases with stage IV NSCLC, those with ipsilateral intrapulmonary nodules (n = 1120) had improved OS (12 months) compared with those with bilateral intrapulmonary nodules (n = 1890), with an OS of 7 months (P < .0001). CONCLUSIONS: Cases with stage IIIB and IV NSCLC with ipsilateral intrapulmonary nodules were found to have improved survival outcomes compared with other cases with stage IIIB and IV disease. The results of the current study add additional support for modifications to the current NSCLC staging system. 相似文献
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《Clinical lung cancer》2023,24(1):18-28
IntroductionNo consensus has been achieved on the benefit of radiotherapy for resected stage IIIA NSCLC patients. The division of stage IIIA has changed significantly in 2017. This study aims to explore the effects of radiotherapy on the survival of patients with resectable stage IIIA NSCLC in the new era.Patients and MethodsPatients diagnosed with NSCLC between 2010 and 2018 were identified in the 8th edition TNM classification from the Surveillance, Epidemiology, and End Results database. A nomogram was developed by integrating all independent predictors for lung cancer-specific survival (LCSS). The Propensity Score Matching (PSM) and subgroup analysis were applied to mitigate potential bias. Survival analyses were conducted using the Kaplan Meier curves and Cox proportional hazards regression.ResultsA total of 2632 stage IIIA NSCLC patients were enrolled. The C-index of the nomogram for the prediction of LCSS was 0.636 (95% CI, 0.616-0.656). In the group of patients with N2 stage who featured more than 5 positive regional lymph nodes, compared with non-PORT, PORT did prolong postoperative survival time (50 vs. 31 months; P= .005). N2 patients with visceral pleural invasion (VPI), older (age >65), or had a larger tumor (size >3 cm) could also benefit from adjuvant radiotherapy.ConclusionTreatment protocol for stage IIIA NSCLC patients should be individualized. Based on our findings, N2 patients with more than 5 positive regional lymph nodes, VPI, larger tumor size (greater than 3 cm), and older (age above 65) could benefit from adjuvant radiotherapy. Further well-designed randomized trials are warranted. 相似文献
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《European journal of surgical oncology》2023,49(4):780-787
BackgroundThis study aimed to evaluate the prognostic value of lymph node dissection (LND) in node-negative intrahepatic cholangiocarcinoma (ICC) and identify the appropriately total number of lymph nodes examined (TNLE).MethodsData from node-negative ICC patients who underwent curative intent resection in ten Chinese hepatobiliary centers from January 2010 to December 2018 were collected. Overall survival (OS), relapse-free survival (RFS) and postoperative complications were analyzed. Propensity score matching (PSM) was performed to reduce the bias due to confounding variables in LND group and non-lymph node dissection (NLND) group. The optimal TNLE was determined by survival analysis performed by the X-tile program using the enumeration method.ResultsA total of 637 clinically node-negative ICC patients were included in this study, 74 cases were found lymph node (LN) positive after operation. Among the remaining 563 node-negative ICC patients, LND was associated with longer OS but not RFS before PSM (OS: 35.4 vs 26.0 months, p = 0.047; RFS: 15.0 vs 15.4 months, p = 0.992). After PSM, patients in LND group had better prognosis on both OS and RFS (OS: 38.0 vs 23.0 months, p < 0.001; RFS: 15.0 vs 13.0 months, p = 0.029). There were no statistically differences in postoperative complications. When TNLE was greater than 8, OS (48.5 vs 31.1 months, p = 0.025) and RFS (21.0 vs 13.0 months, p = 0.043) were longer in the group with more dissected LNs.ConclusionRoutinely LND for node-negative ICC patients is recommended for it helps accurate tumor staging and associates with better prognosis. The optimal TNLE is more than 8. 相似文献
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Jie Ren Ying-Mu Tong Rui-Xia Cui Zi Wang Qing-Lin Li Wei Liu Kai Qu Jing-Yao Zhang Chang Liu Yong Wan 《World journal of gastrointestinal oncology》2020,12(12):1394-1406
BACKGROUNDDue to the special clinical features and biologic characteristics of adolescent and young adult (AYA) cancers, AYA cancers are different from cancers in children and elderly individuals. However, there are few reports on AYA hepatocellular carcinoma (HCC).AIMTo investigate the overall survival (OS) of AYA (15-39 years) and elderly (40-74 years) patients with HCC.METHODSThe data of all the HCC cases were extracted from the Surveillance, Epidemiology, and End Results database from 2004 to 2015 and were then divided into two groups based on age: AYA group (15-39 years) and older group (40-74 years). Kaplan-Meier curves and log-rank tests were used to compare the OS of the two groups. Propensity score matching (PSM) was employed to analyze the OS difference between the two groups. The Cox proportional hazards regression model was used to perform multivariate analysis to explore the risk factors for OS of HCC patients.RESULTSCompared to elderly cancer patients, AYA patients with HCC had a worse Surveillance, Epidemiology, and End Results stage, including the distant stage (22.1% vs 15.4%, P < 0.001), and a more advanced American Joint Committee on Cancer (AJCC) stage, including AJCC III and IV (49.2% vs 38.3%, P < 0.001), and were more likely to receive surgery (64.5% vs 47.5%, P < 0.001). Before PSM, the AYA group had a longer survival in months (median: 20.00, interquartile range [IQR]: 5.00-62.50) than the older group (median: 15.00, IQR: 4.00-40.00) (P < 0.001). After PSM, the AYA group still had a longer survival in months (median: 21.00, IQR: 5.00-64.50) than the older group (median: 18.00, IQR: 6.00-53.00) (P < 0.001). The Cox proportional hazards regression model showed that advanced age (hazard ratio [HR] = 1.405, 95%CI: 1.218-1.621, P < 0.001) was a risk factor for OS of HCC patients. In the subgroup analysis, the Cox proportional hazards regression model showed that in AJCC I/II HCC patients, advanced age (HR = 1.749, 95%CI: 1.352-2.263, P < 0.001) was a risk factor for OS, while it was not a risk factor in AJCC III/IV HCC patients (HR = 1.186, 95%CI: 0.997-1.410, P = 0.054) before PSM. After PSM, advanced age (HR = 1.891, 95%CI: 1.356-2.637, P < 0.001) was still a risk factor for OS in AJCC I/II HCC patients, but was not a risk factor for OS in AJCC III/IV HCC patients (HR = 1.192, 95%CI: 0.934-1.521, P = 0.157) after PSM.CONCLUSIONAYA patients with HCC have different clinical characteristics from older adults. In different AJCC stages, the two groups of patients have different OS: In AJCC I/II HCC patients, advanced age is a risk factor for OS, but it is not a risk factor for OS in the AJCC III/IV HCC patient group. 相似文献
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目的 探讨在ⅣB期食管鳞状细胞癌(ESCC)患者全身治疗中增加放疗的生存获益情况。方法 根据纳入及排除标准,收集郑州大学附属肿瘤医院2016年1月至2021年2月期间入院的298例初诊为ⅣB期ESCC患者的治疗信息。根据治疗情况将这些患者分为早期放疗干预组(CRT组/197例)、挽救性放疗干预或不干预组(CT组/101例)。通过使用倾向评分匹配使两组患者之间的基线特征保持均衡,使用Kaplan‐Meier法计算生存率并行log‐rank检验差异,采用Cox模型行多因素预后分析。结果 两组患者的肿瘤客观缓解率(ORR)和疾病控制率(DCR)分别为52.8%∶31.5%(P=0.006)、98.9%∶85.4%(P=0.001)。两组患者1、2、3年生存率分别为74.2%∶52.8%、31.5%∶10.1%、15.7%∶2.2%。中位无进展生存(PFS)期分别为8.5个月(95%CI为6.7~10.3个月)∶4.4个月(95%CI为3.5~5.3个月)(P<0.001)。中位总生存(OS)期分别为17.1个月(95%CI为14.9~19.3个月)∶12.7个月(95%CI为8.0~17.4个月)(P<0.001)。不良反应的差异主要表现在血液学上。结论 初诊ⅣB期ESCC患者,应尽早在全身治疗中联合放疗,无进展生存期和总生存期更长,且能有效改善吞咽困难,不良反应可耐受。应在较大的前瞻性研究中进一步验证。 相似文献
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目的探讨在ⅣB期食管鳞状细胞癌(ESCC)患者全身治疗中增加放疗的生存获益情况。方法根据纳入及排除标准,收集郑州大学附属肿瘤医院2016年1月至2021年2月期间入院的298例初诊为ⅣB期ESCC患者的治疗信息。根据治疗情况将这些患者分为早期放疗干预组(CRT组/197例)、挽救性放疗干预或不干预组(CT组/101例)。通过使用倾向评分匹配使两组患者之间的基线特征保持均衡,使用Kaplan-Meier法计算生存率并行log-rank检验差异,采用Cox模型行多因素预后分析。结果两组患者的肿瘤客观缓解率(ORR)和疾病控制率(DCR)分别为52.8%∶31.5%(P=0.006)、98.9%∶85.4%(P=0.001)。两组患者1、2、3年生存率分别为74.2%∶52.8%、31.5%∶10.1%、15.7%∶2.2%。中位无进展生存(PFS)期分别为8.5个月(95%CI为6.7~10.3个月)∶4.4个月(95%CI为3.5~5.3个月)(P<0.001)。中位总生存(OS)期分别为17.1个月(95%CI为14.9~19.3个月)∶12.7个月(95%CI为8.0~17.4个月)(P<0.001)。不良反应的差异主要表现在血液学上。结论初诊ⅣB期ESCC患者,应尽早在全身治疗中联合放疗,无进展生存期和总生存期更长,且能有效改善吞咽困难,不良反应可耐受。应在较大的前瞻性研究中进一步验证。 相似文献
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Ovarian Transposition for Stage Ib Squamous Cell Cervical Cancer - Lack of Effects on Survival Rates? 下载免费PDF全文
《Asian Pacific journal of cancer prevention》2013,14(1):133-137
Background: To investigate the impact of ovarian transposition (OT) on survival rates of the patients withstage Ib squamous cell cervical cancer. Materials and Methods: Ninety-two subjects who underwent a radicalhysterectomy including oophorectomy were evaluated. For nineteen (20.7%) , OT was performed. Patients weredivided into two groups, OT versus oophorectomy alone. The primary end-point of this study was to investigatethe impact of OT on tumor recurrence rate and time, 5-year disease-free survival (DFS) and overall survival(OS) . These comparisons were performed for subgroups including patients who received radiotherapy versuswho did not. Statistical analyses were conducted using the Chi-square test, T-test and Mann-Whitney test. OSwas examined using the Kaplan-Meier method. P≤0.05 was considered to be statistically significant. Results:The median follow-up period was 89 months for OT and 81 months for the oophorectomy group (p>0.05). Bothgroups experienced similar recurrence rates (31.6% vs. 26.4%, p=0.181). The median duration from surgery torecurrence, and surgery to death were also similar between the groups (p>0.05). The 5-year DFS and OS rateswere both 68.4% for the OT group, and 73.6% and 77.8% for the oophorectomy group (p=0.457 and p=0.307,respectively). While the 5-year DFS rate was not statistically significant between the OT and oophorectomy groupswho did not receive radiotherapy (p=0.148), the 5-year OS rate was significantly higher in the oophorectomy group(95.4% vs 66.7%, respectively) without radiotherapy (p=0.05). The 5-year DFS and OS rates were statisticallysimilar between the groups who received adjuvant radiotherapy (p>0.05). Conclusions: Ovarian transpositionhas not significantly negative effect on the survival rates when adjuvant radiotherapy will be applied, while5-year OS may be less in OT group if radiotherapy is not mandatory. 相似文献