基因导向的乳腺癌治疗进展研究

乳腺癌是我国妇女恶性肿瘤发病率排第一的癌症,根据WHO的数据显示,2008年,中国妇女乳腺癌的发病率为21.6/10万人,新增病例达16.9万例,死亡人数为4.5万例;根据现有研究报道,有5%¹0%的乳腺癌和10%10%的乳腺癌和10%¹5%的卵巢癌是由BRCA1/2突变引起的,而在乳腺癌和卵巢癌高发家族中,80%的患者BRCA1/2基因存在突变。该突变基因的携带者到50岁时乳腺癌发病率为33%15%的卵巢癌是由BRCA1/2突变引起的,而在乳腺癌和卵巢癌高发家族中,80%的患者BRCA1/2基因存在突变。该突变基因的携带者到50岁时乳腺癌发病率为33%⁵0%、到了70岁增长为56%50%、到了70岁增长为56%⁸7%。中国妇女卵巢癌的发病率为3.8/10万人,新增病例2.8万例,死亡人数为1.1万。而沿海发达地区的发病率明显高于内陆地区。中国是乳腺癌发病率增长最快的国家之一,中国抗癌协会公布的统计数字显示,我国近年来乳癌发病率正以每年3%的速度递增,成为城市中病死率增长最快的癌症,发病年龄也呈逐渐年轻化的趋势。乳腺癌的治疗方法有很多:手术治疗、放射治疗、分子靶向治疗以及内分泌治疗。本文主要根据现代治疗方法的新理念来进行研究。     

乳腺癌的药物治疗进展

乳腺癌是危害女性健康最常见的恶性肿瘤之一，全世界每年约有120万妇女发生乳腺癌，发病率为10％～15％，并以每年0．2％～8％的幅度上升。药物治疗是乳腺癌治疗的主要手段，包括细胞毒性化疗药物、内分泌治疗药物、分子靶向治疗药物。现将乳腺癌的药物治疗进展综述如下。     

玉溪市红塔区妇女乳腺疾病筛查结果分析

<正>乳腺疾病是妇女的常见病,特别是乳腺癌发病率高,危害性大,全球发病率逾100/10万人[1]。为了解红塔区妇女乳腺健康状况,我们对18 620例妇女进行乳腺疾病筛查,现将筛查结果报告如下。对象与方法红塔区筛查点持辖区户口和居住满3年以上,无乳腺恶性肿瘤史,自愿参加并能接受检查的35~69岁城区妇女10 000例、35~59     

某航天研究院2007年~2015年恶性肿瘤发病与死亡情况的分析

目的分析某航天研究院近9年来恶性肿瘤发病和死亡情况,以期有效的防治恶性肿瘤,减少其发生率及病死率。方法对2007年1月1日至2015年12月31日发病并确诊为恶性肿瘤的452例患者进行回顾性调查分析。结果 2007年~2015年该研究院恶性肿瘤发病率为179.96/10万~298.07/10万,平均252.37/10万;病死率为95.27/10万~146.45/10万,平均123.95/10万;40岁以上恶性肿瘤发病率增长较快,以肺癌发病率最高,其次为大肠癌、乳腺癌、胃癌及肝癌等。结论该研究院的恶性肿瘤发病率及病死率呈上升趋势,应加强40岁以上人群的筛查,并加强对肺癌、大肠癌、乳腺癌、胃癌、肝癌的健康教育及防控力度。     

81642例妇女宫颈癌和乳腺癌筛查结果的分析

目的掌握靖江市妇女宫颈癌和乳腺癌(简称"两癌")的发病率,早期发现,早期治疗,降低"两癌"的治疗成本,提高患病妇女的生存率。方法对2012年~2014年参加"两癌"免费筛查的81642例农村妇女的资料进行统计分析。结果 81642例妇女中,宫颈癌46例,患病率为56.34/10万(46/81642);宫颈上皮内瘤变(CIN)313例,患病率为383.38/10万(313/81642);乳腺癌29例,患病率为35.52/10万(29/81642)。结论农村妇女"两癌"筛查是有利于提高"两癌"的早诊早治率,降低病死率,值得全面推广,应逐步扩大筛查范围,更大程度的提高广大妇女的健康水平。     

艾素联合卡培他滨治疗晚期乳腺癌的疗效观察

<正>乳腺癌是人类最常见的一种恶性肿瘤,也是女性主要恶性肿瘤之一。近20年来乳腺癌的发病率和病死率逐年上升。每年全世界有120万妇女发生乳腺癌,约50万妇女死于乳腺癌。20世纪90年代后对于复发和转移的晚期乳腺癌患者,艾素与新一代的靶向性化疗药物卡培他滨的联合化疗是理想的选择。实验证明,此两药作用机制不同,但有协同作用,两毒性反应不重叠。我科近4年来采用艾素联合卡培他滨治疗晚期乳腺癌共18例,疗效满意,现报道如下:     

乳腺癌靶向治疗药物研究进展

乳腺癌是女性常见的恶性肿瘤之一,其发病率高居女性肿瘤疾病首位,全世界每年约有50万妇女死于乳腺癌。目前对于乳腺癌的治疗主要有手术、放疗、化疗和内分泌治疗等4种手段。近年来,随着对恶性肿瘤发病的基因和分子机制研究的不断深入,针对致癌基因的分子靶向治疗技术被应用于医学临床。分子靶向治疗是以肿瘤细胞中特有的基因片段为治疗位点,通过调节或阻断这些基     

乳腺癌药物治疗的研究概况和最新进展

乳腺癌是严重威胁妇女生命的恶性肿瘤，发病率呈逐年上升趋势。手术、放疗、化疗、内分泌治疗以及特异性靶向药物治疗已成为乳腺癌治疗的主要手段。本文就乳腺癌药物治疗的最新进展作一综述。     

乳腺癌的内科治疗进展

乳腺癌在全世界妇女中是第一位的恶性肿瘤,每年约有7.9万新病例,占全部女性恶性肿瘤总数21%.全世界乳腺癌年均发病率为30.30/10万.     

脾多肽联合卡培他滨+多西紫杉醇治疗晚期乳腺癌的临床探讨

<正>乳腺癌是目前我国致死率最高的女性恶性肿瘤,因社会经济的发展及生育模式的改变,乳腺癌发病率持续上升,50~60岁妇女为高发人群,临床防治形势严峻。当前,早期乳腺癌治疗效果较为理想,但晚期乳腺癌治疗难度仍然较多,患者生存时间较短。脾多肽注射液是细胞免疫缺陷病和改善肿瘤患者恶变质新型生物制剂,为进一步探讨脾多肽联合卡培他滨+多西紫杉醇治疗晚期乳腺癌的临床效果,本次研究选择2014年10月至2016年8月期间在本院行化学治疗的79例     

2014年—2018年湖南省肿瘤登记地区恶性肿瘤发病与死亡特征及变化趋势分析

目的 通过2014年—2018年湖南省肿瘤登记数据,分析湖南省恶性肿瘤发病与死亡特征及流行趋势,为制定肿瘤防控策略提供工作依据。方法 收集整理2014年—2018年湖南省32个肿瘤登记点报告的发病与死亡资料,统计分析恶性肿瘤的发病率、死亡率、中国人口标化率（中标率）、年龄别发病率与死亡率、累积发病率与死亡率及年度变化百分比（APC）等指标。结果 2014年—2018年湖南省肿瘤登记地区恶性肿瘤发病率为225.56/10万,中标发病率为156.41/10万;恶性肿瘤死亡率为147.32/10万,中标死亡率为95.78/10万。恶性肿瘤发病与死亡变化趋势显示：中标发病率由2014年的142.27/10万上升至2018年的172.28/10万,APC为5.1%,上升趋势有统计学意义（t=12.30, P=0.001）;中标死亡率由2014年的92.44/10万上升至2018年的99.16/10万,APC为2.1%（t=4.54, P=0.020）。男性恶性肿瘤中标发病率和中标死亡率均高于女性。恶性肿瘤年龄别发病率在0～39岁处于较低水平,55～59岁年龄组开始快速上升,75～79岁年龄组达到最高峰;年龄别死亡率在0～44岁处于较低水平,55～59岁年龄组开始快速上升,80～84岁年龄组升至峰值。2014年—2018年湖南省肿瘤登记地区恶性肿瘤发病率前5位依次为肺癌、女性乳腺癌、肝癌、子宫颈癌和结直肠肛门癌;死亡率前5位依次为肺癌、肝癌、结直肠肛门癌、胃癌和女性乳腺癌。结论 湖南省恶性肿瘤的发病和死亡均呈逐年上升趋势,应高度重视恶性肿瘤的防治,做好重点癌症的筛查与早诊早治工作。     

Breast cancer management: quality-of-life and cost considerations

The purpose of this article was to provide a literature-based extensive overview of the quality-of-life and cost issues posed by the management of breast cancer. Incidence and mortality rates vary widely in different countries. Breast cancer accounts approximately for one-fifth of all deaths in women aged 40-50 years. The 1994-1998 incidence rate in the US population was on average 114.3 per 100 000 women. Treatment options include surgery, radiotherapy and drug therapy (cytotoxic and endocrine drugs). All treatment options affect patients' health-related quality of life (HR-QOL) in various ways. The use of cytotoxic agents has a particularly large HR-QOL impact. HR-QOL questionnaires are complex tools, not routinely used in breast cancer trials.Worldwide, around 10 million individuals develop cancer each year; this figure is expected to increase to 15 million in 2020. For all cancers, the total economic burden of this disease worldwide was projected by the authors to be in the range of $US 300-400 billion in 2001 (about $US 100-140 billion as direct costs and the remainder as indirect costs [morbidity and mortality]). According to the National Institute of Health (NIH), the total cost of cancer was estimated at $US 156.7 billion in 2001 in US ($US 56.4 billion as direct costs, $US 15.6 as indirect morbidity costs, and $US 84.7 billion as indirect mortality costs). Based on limited information, in the US, breast cancer can be projected to account for about one-fifth/one-fourth of the total cost of cancer. Breast cancer treatment costs are higher in the US than in other developed countries. Both direct and indirect costs are dependent on disease stage. The per-patient costs for initial care in 1992 were estimated at $US 10 813, for continuing care at $US 1084 and for terminal care at $US 17 886. Stage-specific costs provide information for cost-effectiveness analyses of cancer-control initiatives, such as screening programmes. Economic studies on breast cancer are heterogeneous, and the cost estimates made are not easily generalisable. The cost of treatment for breast cancer in developing countries is < or =5% of that in developed regions.     

乳腺癌化疗相关中性粒细胞减少症预防用药的直接经济负担对比分析

目的：对比分析粒细胞刺激因子用于预防乳腺癌化疗相关中性粒细胞减少症的经济负担,为合理用药以及卫生资源的优化配置提供依据。方法：整群抽取郑州大学第一附属医院的住院病案系统,收集整理2016年11月1日至2019年11月30日临床诊断为乳腺癌的出院患者信息,进行描述性对比分析。结果：共纳入7 913名患者,采用粒细胞刺激因子预防的患者相较未预防的患者人群死亡率更低,2组患者整体住院费用增长较快,但医保报销比例逐年提高,预防组的平均报销比例比非预防组高约20%。成本-效果比率预防组为67 654.70元/周期,非预防组为52 804.31元/周期,增量成本-效果比率预防组为非预防组的1.28倍。结论：使用粒细胞刺激因子用于乳腺癌化疗相关的中性粒细胞减少症的预防在当前阈值范围内具有经济性,但整体医疗花费仍较高,建议进一步提高诊疗规范,合理减少住院次数、天数,建立预防管理临床路径,有效控制相关住院费用的增长,从而降低乳腺癌患者的经济负担。     

Comparing the economic burden of ischemic stroke patients with and without atrial fibrillation: a retrospective study in Beijing,China

Background: Little is known about the economic burden for ischemic stroke (IS) patients with atrial fibrillation (AF) in China.

Aim: We aimed to compare the economic burden of treatment-related costs in IS patients with AF vs. without AF in China.

Methods: This retrospective analysis used economic burden data from the Beijing urban health insurance database. Using a random sampling method, 10% of the patients diagnosed with IS from 1 January through 31 December 2012 were enrolled. First hospitalization was considered as the index event and hospital utilization after the index event was followed up until September 2013. Overall healthcare cost during the study period was analyzed.

Results: In 4061 patients with IS (mean?±?SD age, 68.45?±?13.95 years; AF: 992; without AF: 3069), the AF group had a higher percentage of patients with co-morbidities at baseline. Compared with the non-AF group, the AF group had significantly greater hospitalization at the index event (p?p?Conclusions: AF increased the use of healthcare resources, treatment cost, and economic burden in patients with IS. Therefore, prevention of cardio-embolic events in patients with AF by anticoagulants may decrease the economic burden in patients with IS.     

干扰素治疗慢性乙型肝炎病毒感染的经济效益

目的:评估慢性乙型肝炎及其并发症的经济负担和α-干扰素(IFN-α)治疗的临床效果与经济效益。方法:根据慢性乙型肝炎、代偿性肝硬化、失代偿性肝硬化和肝癌患者的年直接医疗费用、非直接医疗费用以及间接费用,计算其经济负担。同时,根据IFN-α+常规治疗和常规治疗2种方案所得的临床治疗结果,计算IFN-α治疗节省的费用。结果:不同肝病阶段的患者年直接医疗费用、年经济负担不同,慢性乙型肝炎为9000、11362元,代偿性肝硬化为13865、19412元,失代偿性肝硬化为25678、36979元,肝癌为26501、40264元。IFN-α+常规治疗方法治疗慢性乙型肝炎患者4mo,随访5y,与常规治疗比较,其直接医疗费用、总费用得到节省,节省金额分别为831元/人、2038元/人;其存活率可提高2·8%。结论:慢性乙型肝炎病毒感染者经济负担较重,而采用IFN-α治疗则可降低其经济负担。     

Systemic therapy in breast cancer: efficacy and cost utility

Cancer treatment accounts for a large proportion of healthcare costs. Often, new treatment modalities provide benefits, but at high costs. The impression that cancer treatment is expensive is enhanced by publicity surrounding treatments like bone marrow transplantation. There is a need to evaluate costs of different treatment approaches and to address the cost utility of cancer treatment in general compared with therapies for other conditions. Breast cancer can serve as a good model for economic evaluation of cancer treatment because of the broad range of treatment options and objectives it encompasses, and also because well defined benefits can be achieved. The cost utility of contemporary adjuvant therapy strategies, specifically chemotherapy in premenopausal women and hormonal treatment in estrogen-receptor (ER) positive pre- as well as postmenopausal women, seems favourable. Cost-utility ratios {cost per quality-adjusted life-year (QALY) gained} range from $US4000 to $US10 000. However, hormonal treatment in ER-negative women may be associated with cost-per-QALY ratios of $US50 000 to $US200 000. So far there are no published cost-utility analyses of neo-adjuvant therapy or adjuvant bone marrow transplantation as the long term effects of these treatment options are undefined. Few data exist on cost utilities of systemic drug treatment in advanced breast cancer, although drugs may account for only a moderate part of the total treatment and caring costs. Bone marrow transplantation in patients with metastatic breast cancer costs about $US100 000 per QALY, which is expensive.     

Colorectal cancer incidence on the General Practice Research Database

PURPOSE: The General Practice Research Database (GPRD) contains longitudinal patient medical records collected within UK primary care. This study aimed to identify incident cases of colorectal cancer on the GPRD and to compare incidence rates for 2007 with those reported by the UK cancer registries. METHODS: Algorithms were created to identify incident cases of colorectal cancer on the GPRD and cases were required to have additional medical codes to support the diagnosis. Age-specific and sex-specific incidence rates for 2007 were calculated using the GPRD data and compared with those reported by the cancer registries. RESULTS: Trends in colorectal cancer by age and sex were similar for the two data sources; however, the incidence of colorectal cancer on the GPRD was lower than that of the registries, particularly when supporting evidence was required: 57.0 compared with 70.2 per 100?000 per year for men and 42.0 compared with 56.6 per 100?000 per year for women. Inclusion of cases without supporting evidence still resulted in lower rates but increased the GPRD rates to 63.7 and 48.4 for men and women, respectively. The largest discrepancy was observed in the older age groups. CONCLUSION: Colorectal cancer rates on the GPRD were lower than those reported by UK cancer registries, especially when requiring supporting evidence in addition to a diagnosis code. It appears that the requirement of supporting evidence on the GPRD for colorectal cancer identification may result in some true cases being excluded, particularly in the very elderly. Copyright ? 2012 John Wiley & Sons, Ltd.     

某三级甲等医院“医保”患者Ⅰ类切口手术预防用抗菌药物分析

目的：评价某三级甲等医院＂医保＂患者Ⅰ类切口手术预防用抗菌药物情况。方法：调查该院2011年7月-2012年6月出院的1334例＂医保＂患者Ⅰ类切口手术病历预防用抗菌药物的使用率、用药品种、用药时机和疗程、术后感染及费用情况。结果：各个评价周期相互间比较,该院＂医保＂患者Ⅰ类切口手术抗菌药物预防用药率渐次降低、给药时机渐趋合理、抗菌药物费用明显下降,而术后感染的发生率并未增加。结论：该院＂医保＂患者Ⅰ类切口手术围术期预防用抗菌药物的合理性有所提高,显著减少了抗菌药物费用,且没有增加术后感染的发生率,但仍存在一些问题,需引起重视。     

2012—2014年天津市肿瘤医院住院患者镇痛药物的使用情况分析

目的分析2012—2014年天津市肿瘤医院镇痛药物的使用情况,为临床合理使用镇痛药物提供依据。方法调取2012—2014年天津市肿瘤医院镇痛药物的相关信息,对药物剂型、销售金额、用药频度(DDDs)、日均费用(DDC)及药品排序比(B/A)进行统计分析。结果 2012—2014年镇痛药物的销售金额逐年增加,速释口服剂型及缓、控释制剂构成比远超注射剂,达到97%以上。各品种镇痛药物的DDDs变化较大但排序基本稳定,盐酸布桂嗪注射液、氨酚羟考酮片及芬太尼透皮贴剂的DDDs值分别位居各剂型的首位。大部分镇痛药物的DDC值各年份略有差异,15种药品的DDC值小于100,患者负担较轻。75%镇痛药物的B/A值接近于1,表明用药同步性较好。结论天津市肿瘤医院镇痛药品的使用日趋合理,但也存在个别药品日均费用较高、同步性较差的问题,需进一步加强管理。