中性粒细胞淋巴细胞比值和血小板淋巴细胞比值对调强放疗鼻咽癌患者的预后价值

目的 研究中性粒细胞淋巴细胞比值(NLR)与血小板淋巴细胞比值(PLR)对鼻咽癌(NPC)调强放疗患者的预后价值。 方法 回顾性收集2012年6月至2014年1月期间就诊的120例调强放疗鼻咽癌患者的一般临床信息及淋巴细胞、中性粒细胞、血小板计数和生存资料。选择相关性分析、K-M生存分析和Cox多因素回归分析、探讨NLR、PLR与患者总生存时间(OS)、无进展生存时间(PFS)、无远处转移生存时间(DMFS)、局部无复发生存时间(LRF)的关系。 结果 患者5年OS、PFS、LRF和DFS分别为86.8%、78.3%、94.2%和85.3%,NLR与T期、N期、肿瘤期相关,PLR与T期、肿瘤期相关。NLR是OS、PFS、DMF的独立预后指标。 结论 NLR是调强放疗鼻咽癌患者的独立预后因素。     

血小板与淋巴细胞比值对喉癌复发的预测价值

探讨术前外周血血小板与淋巴细胞比值(PLR)、中性粒细胞与淋巴细胞比值（NLR）、衍生中性粒细胞与淋巴细胞比值（dNLR）对喉鳞状细胞癌患者复发的影响和预测价值。     

NLR、LMR、PLR预测慢性鼻窦炎鼻内镜术后复发价值

目的 探讨中性粒细胞与淋巴细胞比值(NLR)、淋巴细胞与单核细胞比值(LMR)、血小板与淋巴细胞比值(PLR)预测慢性鼻窦炎鼻内镜术后复发价值。 方法 选取2016年3月至2018年3月收治的慢性鼻窦炎鼻内镜治疗患者60例。所有患者均术后随访6个月,并根据鼻窦炎是否复发分为术后复发组(n=21)和术后未复发组(n=39)。同期选取87例健康体检者作为对照组(n=87)。收集并分析所有患者NLR、LMR、PLR数值,并绘制上述指标受试者工作特征曲线(ROC)。 结果 CRS组NLR、PLR水平高于对照组,差异具有统计学意义(P<0.05);CRS组LMR水平低于对照组,差异具有统计学意义(P<0.01);术后未复发组NLR、LMR、PLR水平与对照组差异无统计学意义(P>0.05);术后复发组NLR、PLR水平高于术后未复发组,差异具有统计学意义(P<0.05);术后复发组LMR水平低于术后未复发组,差异具有统计学意义(P<0.01);NLR的敏感度、特异度分别为63.33%(19/30)、93.33%(28/30);LMR的敏感度、特异度分别为72.00%(18/25)、91.43%(32/35);PLR的敏感度、特异度分别为67.86%(19/28)、93.75%(30/32);ROC曲线显示:NLR、LMR、PLR曲线下面积分别为0.719(0.587~0.851)、0.922(0.853~0.991)、0.830(0.587~0.851)。 结论 NLR、LMR、PLR能较好地预测慢性鼻窦炎鼻内镜术后复发情况。     

尼妥珠单抗联合顺铂同步放化疗治疗中晚期鼻咽癌的疗效及安全性研究

目的 研究尼妥珠单抗联合顺铂同步放化疗治疗中晚期鼻咽癌的疗效及安全性。方法 选取2018年1月~2021年6月期间本院确诊中晚期鼻咽癌患者92例为研究对象,依据随机动态化分组法分为A组(n=47)、B组(n=45)。A组接受顺铂同步放化疗治疗,B组接受尼妥珠单抗联合顺铂同步放化疗治疗。分析患者治疗效果、血管内皮因子、转化治疗因子、肝功能、血常规指标。结果 (1)B组治疗后完全缓解(9.68%)、部分缓解(51.61%)患者占比升高,稳定(32.26%)、进展(6.45%)患者占比下降,较A组差异有统计学意义,P<0.05。(2)治疗后B组VEGF(187.65±18.95)pg/m、TGF-β1(20.08±4.15)μg/ml、ALT(42.08±5.49)U/L较A组差异有统计学意义,P<0.05;两组治疗后WBC、PLT指标及骨髓抑制发生率组间对比结果无统计学差异,P>0.05。结论 尼妥珠单抗联合顺铂同步放化疗治疗中晚期鼻咽癌效果确切,可在积极延缓患者病理机制进展同时,延长病情进展期及生存期,且具备治疗安全性。     

甲状腺癌与外周静脉血炎性相关指标

包括甲状腺癌在内的多种恶性肿瘤,证据表明其预后与反应系统的炎症反应的血液学指标相关。越来越多地研究关注甲状腺癌和中性-淋巴细胞比、血小板-淋巴细胞计数比值、C反应蛋白的关系。就这些血液学相关指标与甲状腺癌的研究进展做一综述。     

新辅助化疗联合同期放化疗与同期放化疗单独治疗鼻咽癌疗效及安全性的Meta分析

目的 评价新辅助化疗联合同期放化疗（IC+CCRT）治疗局部进展期鼻咽癌的疗效及安全性。方法 计算机检索pubmed、embase、cochrane图书馆、CNKI等数据库有关IC+CCRT与CCRT治疗鼻咽癌的随机对照试验,按照事先设置的标准由两位研究者独立进行筛选、提取相关资料并用RevMan5.1.0软件进行分析。结果 10项RCT共921例患者纳入本研究。Meta分析结果显示,与CCRT相比: ① 近期疗效：IC+CCRT即期颈部淋巴结完全缓解率提高［OR=2.53,95%CI (1.44,4.44),P=0.001］,而鼻咽部肿瘤完全缓解率两者差异无统计学意义［OR=1.26,95%CI (0.66,2.40),P=0.16］;治疗结束3个月后IC+CCRT鼻咽部肿瘤及颈淋巴结完全缓解率均较前者有所提高［RR=1.07,95%CI(1.02,1.14),P=0.01］, ［RR=1.11,95%CI (1.02,1.21),P=0.01］;②远期疗效：2年总生存率两者差异无统计学意义［OR=1.04, 95%CI(0.97,1.12),P=0.25］;③安全性：IC+CCRT治疗过程中除Ⅲ°及以上白细胞下降情况明显外［RR=1.57,95%CI(1.24,1.98),P=0.0002］,其余Ⅲ°及以上皮肤反应［RR=1.57,95%CI (0.91,1.96),P=0.14］、口腔黏膜反应 ［RR=1.13,95%CI(0.95,1.34),P=0.18］和消化道不良反应［RR=0.99,95%CI (0.72,1.37),P=0.95］两者差异无统计学意义。结论 与CCRT相比,IC+CCRT可以提高近期疗效,但对2年远期总生存率无明显益处,且后者治疗期间白细胞下降更明显。     

外周血中性粒细胞与淋巴细胞比值以及血小板与淋巴细胞比值评估声门型喉癌患者预后的价值

目的 探讨外周血中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）与声门型喉鳞状细胞癌患者预后的关系。方法 收集115例有明确病理诊断的声门型喉鳞状细胞癌患者的临床病理及随访资料,通过建立受试者工作特征曲线（ROC曲线）,确定术前外周血NLR及PLR预测术后生存的最佳截点,以此将患者分为低NLR和高NLR组以及低PLR和高PLR组,分析NLR及PLR与患者的临床病理特征之间的关系,并通过单因素及多因素分析评估术前外周血NLR及PLR对患者术后生存的影响。结果 115例患者中获得随访107例,失访8例,随访率为93.0%。随访患者中27例死于喉鳞状细胞癌,80例生存。根据ROC曲线计算出PLR、NLR的临界值分别为139.79和2.83。107例声门型喉鳞状细胞癌患者的5年生存率为74.8%,其中低PLR组患者的5年生存率为82.7%;高PLR组患者的5年生存率为56.3%,差异具有统计学意义（P=0.004）。低NLR组患者的5年生存率为81.8%;高NLR组患者的5年生存率为56.7%,差异具有统计学意义（P=0.003）。单因素分析显示,声门型喉鳞状细胞癌患者的预后与患者的T分期、有无淋巴结转移、NLR水平和PLR水平有关（P均<0.05）。多因素分析显示,PLR水平以及NLR水平为影响声门型喉鳞状细胞癌患者预后的独立因素（P均<0.05）。结论 PLR和NLR可能是影响声门型喉鳞状细胞癌患者预后的独立因素。     

外周血中性粒细胞与淋巴细胞比率及血小板与淋巴细胞比率对喉鳞状细胞癌预后价值的研究进展

喉鳞状细胞癌（LSCC）是头颈鳞状细胞癌最常见类型之一,由多种致癌因素共同影响所致且预后欠佳。LSCC预后因素包括个体状况、原发肿瘤大小、淋巴结受累情况、有无远处转移和人乳头状瘤病毒（HPV）感染等,均不能准确评估LSCC预后,因此,探寻新的指标显得尤为重要。在肿瘤的发生、发展、转移过程中,炎症因子起到了至关重要的作用,其中外周血中性粒细胞/淋巴细胞比率（NLR）、血小板/淋巴细胞比率（PLR）对LSCC预后价值较高且备受关注,因此本文将探讨NLR、PLR与LSCC预后价值的关系,为临床诊疗提供参考。     

阻塞性睡眠呼吸暂停低通气综合征与血液学指标相关性

目的　探讨血常规相关指标与阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的相关性,为OSAHS诊断评估提供新的理论依据。方法　回顾性分析2017年1月～2018年12月172例OSAHS患者相关临床资料,比较分析不同病情轻重的OSAHS患者间血常规相关指标的分布特征。结果  在不同病情的OSAHS患者中,血常规相关指标中血小板 平均体积、血小板分布宽度、中性粒细胞/淋巴细胞比值及血小板/淋巴细胞比值差异有统计学意义（P <0.05）;且重度患者水平明显高于轻度患者,血小板平均体积：重度患者为（12.72±0.69）fL,轻度患者为（10.34±2.28）fL;血小板分布宽度：重度患者为（18.08±2.38）fL,轻度患者为（13.25±1.79）fL;中性粒/淋巴细胞比值：重度患者为1.90±0.12,轻度患者为1.69±0.30;血小板/淋巴细胞比值：重度患者为117.94±6.04,轻度患者为108.46±18.26。结论  血常规相关指标在OSAHS的分型中具有重要的意义,可作为临床医师诊断、评估OSAHS病情轻重可靠指标。     

艾灸神阙穴联合耳穴压豆对鼻咽癌放化疗患者毒副反应及生存质量的影响

目的 探讨艾灸神阙穴联合耳穴压豆对鼻咽癌放化疗患者毒副反应及生存质量的影响。方法 选取2019年4月～2020年5月收治的80例鼻咽癌放化疗患者,根据治疗方案分为观察组及对照组各40例,对照组行常规护理,观察组在此基础上行艾灸神阙穴联合耳穴压豆,对两组干预效果进行比较。结果 观察组毒副反应发生率为10.00%,较对照组27.50%低(P<0.05);干预前,两组各领域生存质量评分差异不显著(P>0.05),干预后,观察组各领域生存质量评分均较对照组高(P<0.05)。结论 艾灸神阙穴联合耳穴压豆在鼻咽癌放化疗患者中应用价值较高,利于减少毒副反应,改善生存质量,值得应用。     

Concurrent chemoradiotherapy with adjuvant chemotherapy for high-risk nasopharyngeal carcinoma

Objectives

To evaluate the impact of invasion of the prevertebral or parapharyngeal spaces and large tumor volume on treatment outcomes in patients with nasopharyngeal carcinoma (NPC).

Methods

A total of 105 patients with newly diagnosed NPC were enrolled in this study. TNM stage and presence of invasion of the prevertebral or parapharyngeal spaces were recorded. All patients received a total dose of 70–75 Gy.

Results

After controlling for age, sex, and chemotherapy status, invasion of the prevertebral or parapharyngeal spaces and large primary tumor volume produced a significantly increased hazard ratio for distant metastasis and recurrence. We defined patients with two or more such prognostic factors as high-risk patients, in whom the 3-year metastasis-free survival rate, with and without adjuvant chemotherapy, was 100% and 69.6%, respectively (P = 0.02). Their 3-year recurrence-free survival rate, with and without adjuvant chemotherapy, was 93.3% and 70.2% (P = 0.09). This benefit was not observed in low-risk NPC patients.

Conclusion

NPC patients with any two or more of the factors, involvement of the prevertebral space, large primary tumor volume, or advanced parapharyngeal space invasion, had more recurrence and poor survival rates and benefited from concurrent chemoradiotherapy followed by adjuvant chemotherapy.     

Treatment outcomes of concurrent chemoradiotherapy for locally advanced sinonasal squamous cell carcinoma: A single-institution study

Conclusions: CCRT is a potential treatment option for locally advanced sinonasal SCC in terms of organ preservation. Objectives: Concurrent chemoradiotherapy (CCRT) is increasingly used for patients with advanced head and neck cancer to preserve organ function and improve survival. In the present study, treatment outcomes were compared between surgery and post-operative radiotherapy (PORT) and CCRT in patients with locally advanced sinonasal squamous cell carcinoma (SCC). Methods: The records of 30 patients with non-metastatic stage III and IV sinonasal SCC were retrospectively reviewed. Fifteen patients were treated with CCRT and 15 patients underwent PORT. Results: The locoregional recurrence-free, distant metastasis-free, disease-free, disease-specific, and overall survival rates did not differ between PORT and CCRT groups. In addition, there were no significant differences in incidence rates of acute and chronic toxicities between the two groups.     

局部晚期鼻咽癌新辅助化疗联合同步放化疗

鼻咽癌是我国南部地区最常见恶性肿瘤之一,大部分患者被发现时已处于局部晚期.鼻咽癌对放、化疗比较敏感,过去认为同步放化疗方案是鼻咽癌的标准治疗方式;研究显示新辅助化疗联合同步放化疗对局部晚期鼻咽癌患者的治疗效果更佳.然而调强放疗与传统放疗技术相比,在保证原有治疗效果基础上可进一步降低患者的毒副反应.本文比较在传统放疗与调强放疗技术两种情况下,同步放化疗与同步放化疗联合新辅助化疗的两种方案对局部晚期鼻咽癌患者治疗效果做一综述.     

探讨同期放化疗对儿童青少年鼻咽癌患者生活质量的影响

目的 探讨同期放化疗对儿童青少年鼻咽癌患者生活质量(QOL)的影响及其不良反应。 方法 通过儿童生存质量普适性核心量表(Peds QL^TM4.0)和儿童生存质量癌症模块量表(Peds QL^TM3.0)对放化疗治疗的21例儿童青少年鼻咽癌患者进行调查与评估,并对患儿治疗期间的不良反应进行统计分析。 结果 一定周期的放化疗后,患儿的QOL较治疗前均呈下降趋势,Peds QL^TM4.0中,患儿的生理功能、情感功能、学校功能3个维度总分均下降(P<0.01),以学校功能影响较为显著,而Peds QL^TM3.0中,疼痛、恶心、操作焦虑、认知、交流5 个方面总分均下降,差异均有统计学意义(P<0.01)。放化疗的不良反应主要集中在皮肤损害、口腔黏膜损害、口干、恶心呕吐、白细胞下降等方面。 结论 儿童自我报告的生活质量应受到更多关注,儿童青少年鼻咽癌患者因放化疗而导致的不良反应,可显著影响其生活质量,对不良反应可采取相应措施积极预防。     

p53 expression in concurrent chemoradiotherapy with docetaxel for head and neck squamous cell carcinoma

Background

The current study aimed to evaluate the significance of an immunohistochemical assessment of tumor suppressor p53 as a prognostic marker in head and neck squamous cell carcinoma (HNSCC) patients treated with docetaxel and radiotherapy.

Methods

The expression of tumor suppressor p53 and its phosphorylated form at the Ser392 residue was retrospectively evaluated by immunohistochemistry in 51 Stage T1-3N0-2M0 (except T1N0 glottis) HNSCC patients who were treated with 10 mg/m²/week docetaxel four to six times and received concurrent chemoradiotherapy.

Results

Kaplan–Meier univariate analysis revealed that no difference in rates for overall and disease-free survival (DFS) between patients with p53-positive and -negative tumors (p = 0.786 and p = 0.924, respectively). The prognostic significance of phosphorylated p53 at the Ser392 residue was neither observed.

Conclusions

An immunohistochemical assessment of the expression of p53 and its phosphorylated form might not be of clinical use in defining subgroups of patients with poor prognosis.     

Efficacy of fluoro-2-deoxy-D-glucose positron emission tomography to evaluate responses to concurrent chemoradiotherapy for head and neck squamous cell carcinoma

Objective

This study evaluates the utility of fluorodeoxyglucose-positron emission tomography (FDG-PET) in patients with head and neck squamous cell carcinoma (HNSCC) who received concurrent chemoradiotherapy (CCRT).

Methods

Sixty-five patients were recruited for this study between November 2002 and April 2007. The FDG-PET scan was performed before treatment and 4–6 weeks after treatment.

Results

The mean of maximum standardized uptake value (SUVmax) before treatment at the primary tumor site was 8.1 (range, 2–22). The sensitivity of FDG-PET for the diagnosis of primary tumor site was 98%. The mean of SUVmax after treatment was 2.6 (range, 2–5). The sensitivity, specificity, and accuracy of FDG-PET for the diagnosis of primary tumor site after treatment were 100%, 40%, and 46%, respectively.The mean of SUVmax before treatment at the nodal site was 4.7 (range, 2–16). The mean of SUVmax after treatment was 2.0 (range, 2–6.7). The pre-treatment SUVmax of T2, T3, and T4 stages were significantly higher than that of the T1 stage. The N stage had no correlation in terms of the pre-treatment nodal site SUVmax.

Conclusion

Our results indicate that FDG-PET is a useful imaging method for evaluating the response of CCRT in patients with HNSCC. However, performing FDG-PET 4–6 weeks after treatment may be too early as it may give false-positive results due to fibrosis and scarring.     

Early assessment of clinical response to concurrent chemoradiotherapy in head and neck carcinoma using fluoro-2-deoxy-d-glucose positron emission tomography

OBJECTIVES: The aim of this study is to assess the utility of FDG-PET in the evaluation of therapeutic effects at 4 weeks after the completion of the concurrent chemoradiotherapy (CCR) in patients with head and neck squamous cell carcinoma (HNSCC). METHODS: Thirty-one patients with previously untreated HNSCC were retrospectively investigated about FDG-PET, CT, MRI and biopsies of the carcinoma before and 4 weeks after the treatment. RESULTS: The results of pathological examinations after CCR showed 6 residual cases and 25 ones with a pathologically complete response (pCR). The specificity of FDG-PET was 80%, although the sensitivity was limited to 67%. CONCLUSIONS: FDG-PET has a high specificity but limited sensitivity to discriminate residual cancer from fibrosis or scar at 4 weeks after CCR. FDG-PET at 4 weeks after CCR was too early to perform because of limited sensitivity.