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Objectives: To investigate the clinical characteristics and prognoses of patients with anaplastic thyroid carcinoma(ATC), and to explore the value of multi-modality treatment in improving overall survival(OS) of ATC patients. Methods: Medical records including clinicopathological data of patients diagnosed with ATC at Cancer Hospital, Chinese Academy of Medical Sciences between 2001 and 2020 were retrospectively analyzed. The cohort were divided into surgery-only and multi-modality subgroups, and the latter included patients treated with surgery plus radiotherapy and/or medical therapy(including chemotherapy, target therapy and immunotherapy). Univariate survival analysis was conducted through Kaplan-Meier method, and multivariate survival analysis was performed using Cox proportional hazard model. Results: A total of 47 patients were included in the study, including 24 males and 23 females, with a median age of 63 years. After a median follow-up duration of 3.37 months, 42 patients died due to tumor recurrence or progression. The median OS of the cohort was 4.33 months. Univariate survival analysis demonstrated that symptoms of recurrent laryngeal nerve(RLN) involvement, distant metastasis, leukocyte elevation, and treatment modality were significantly associated with OS (P values all<0.05). Multivariate analysis showed that symptoms of RLN involvement(HR=2.49, 95%CI: 1.16-5.32, P=0.019), distant metastasis(HR=2.33, 95%CI: 1.06-5.16, P=0.036), and leukocyte elevation(HR=2.50, 95%CI: 1.16-5.40, P=0.020) were all independent risk factors for OS, while multi-modality therapy significantly prolonged OS compared with surgery alone(HR=0.22, 95%CI: 0.10-0.47, P<0.001). Conclusions: Among ATC patients, absence of symptoms of RLN invasion, normal leukocyte level and absence of distant metastasis at initial diagnosis are all independent protective factors for OS and multi-modality treatment can help to improve the prognosis.
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Female , Male , Humans , Middle Aged , Retrospective Studies , Thyroid Carcinoma, Anaplastic/therapy , Neoplasm Recurrence, Local , Prognosis , Thyroid Neoplasms/therapyABSTRACT
The incidence of thyroid cancer continues to increase, among which differentiated thyroid cancer occupies the main position. Development of molecular biology has facilitated early diagnosis and precise treatment of thyroid carcinoma, and hopefully provided potential options for certain subtypes with poor prognosis, such as radioactive iodine-refractory differentiated thyroid carcinoma. This review summarizes the gene variants of high frequency and the mechanism of such gene variants, application of molecular biological detection in clinical diagnosis, as well as the correlation of specific gene variants with clinicopathological characteristics and prognosis for differentiated thyroid carcinoma.
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Objective:To explore the effectiveness of the treatment modality among western localized extranodal NK/T-cell lymphoma (ENKTCL) patients based on the Surveillance, Epidemiology and End Result (SEER) database.Methods:A total of 448 cases of early stage ENKTCL, diagnosed from 2000 to 2016, were identified from the SEER database: 108 received chemotherapy alone, 100 received radiation alone, and 240 had combined chemoradiotherapy. Overall survival (OS) were compared between different modalities using univariate, multivariate and propensity-score matched (PSM) method.Results:The median overall survival (OS) and 5-year OS rate were 59.0 months and 49.0% for the whole cohort, respectively. Different treatment modalities were significantly associated with OS of patients with localized ENKTCL. Patients who received chemoradiotherapy had the highest 5-year OS rate followed by those who received radiation alone and chemotherapy alone (62.1% vs. 41.5% vs. 28.5%, χ2=41.727, P<0.001). Patients who received radiation with/without chemotherapy had significant superior survival outcome compared with those who received chemotherapy alone (5-year OS rate, 55.9% vs. 28.5%, χ2=10.823, P<0.001). Furthermore, compared with radiation alone, additional chemother-apy to radiation provided survival benefit and reduced death hazard for localized ENKTCL ( HR 0.578, 95% CI: 0.413~0.808, P=0.001). After baseline prognostic factors adjustment using PSM method, similar survival benefit was still observed among patients treated with chemoradiotherapy over those treated with radiation alone (5-year OS, 61.3% vs. 40.5%, HR 0.592, 95% CI: 0.369~0.885, P=0.012). Conclusions:These results based on SEER database indicate that compared with radiation or chemotherapy alone, chemoradiotherapy is more preferable treatment option for patients with early stage ENKTCL.
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Lymphoma is the most common hematological malignancy, often accompanied by coagulation abnormalities. Coagulative dysfunction leads to thromboembolic and bleeding complications, which greatly increases mortality in patients with lymphoma. The mechanisms of abnormal coagulation system in lymphoma mainly include the direct coagulation mechanism of tumor cells secreting procoagulant factors and the indirect coagulation mechanism of tumor cells activating the procoagulant potential of host cells. Coagulative factors may be related to the prognosis of lymphoma.
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Medical treatment is an important strategy for patients with head and neck squamous cell carcinoma (HNSCC).Studies have shown that three-weekly cisplatin regimen is a promising treatment for patients with locally advanced HNSCC and cetuximab plus platinum and 5-fluorouracil can be the first-line therapy for patients with recurrent or metastatic HNSCC.Current results from immunotherapy trials have shown an improved response rate and overall survival in patients with recurrent or metastatic HNSCC while maintaining a safe and tolerable toxicity profile.Immunotherapy is becoming the fourth treatment strategy towards cancer.There is still insufficient evidence that patients with HNSCC can benefit from induction chemotherapy and further study is warranted.
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Objective To explore the therapeutic effect of endoscopic treatment for common bile duct stricture secondary to chronic pancreatitis.Methods The clinical data of 58 patients with common bile duct stricture secondary to chronic pancreatitis diagnosed between January 2007 and January 2014 were retrospectively analysed.Results A total of 58 patients with common bile duct stricture secondary to chronic pancreatitis underwent 157 endoscopic procedures with placement of 204 polyethylene stents.The mean time of stenting was 12.2 months(3-33 months).After treatment,stricture disappeared in 20 patients(34.5％),with a mean stenting period of 7.8 months(3-22 months).Treatment was successful in 37 patients(63.8％),with a mean stenting period of 9.5 months (3-22 months),and was incompletely successful in 12 patients (20.7％) with a mean stenting period of 19.8 months(12-33 months).Nine patients(15.5％) referred to surgery were considered a failure of endoscopic therapy.Conclusion The endoscopic treatment of common bile duct stricture due to pancreatic edema or pancreatic cyst is effective.Endoscopic treatment is a safe,effective and minimally invasive method for common bile duct stricture secondary to chronic pancreatitis,which can be the first option.
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The objective of study was to observe the efficacy and adverse events of modified CAG regimen in treating patients with relapsed acute myeloid leukemia. CAG regimen with prolongation of aclarubicin up to 7 days were used to treat 17 cases of relapsed acute myeloid. After 1 course of chemotherapy, the efficacy and adverse events were evaluated, patients who did not achieve remission were excluded from this regimen, patients who achieved remission were continuously given 1 course of CAG regimen. The results showed that out of 17 case 8 patients achieved complete remission (CR, 47.06%) and 5 patients achieved partial remission (PR, 29.14%). Most of these cases had slight adverse events which mainly were marrow suppression that could be tolerated, overall survival was 76.47%. In conclusion, treatment for relapsed acute myeloid leukemia with modified CAG regiment is safe and effective, and can provide conditions for allo-hematopoietic stem cell transplantation, but its long term efficacy needs to further study.
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Humans , Aclarubicin , Antineoplastic Combined Chemotherapy Protocols , Cytarabine , Granulocyte Colony-Stimulating Factor , Leukemia, Myeloid, Acute , Drug Therapy , Treatment OutcomeABSTRACT
To investigate the clinical features and outcome of severe pneumonia after allogeneic hematopoietic stem cell transplantation for malignant hematological disease, the clinical features of severe pneumonia, including symptoms, signs, blood-gas analysis and thoracic X-ray change were observed, the clinical therapeutical outcome is also evaluated. The results showed that after treatment with antibiotics or antibiotics + antiviral drugs or antibiotics + antiviral drugs + glucocorticosteroids, as well as mechanical ventilation, pulmonary changes in 17 patients with sever pneumonia completely disappeared, 1 case died. In conclusion, early diagnosis and proper treatment for complicated pneumonia after allogeneic hematopoietic stem cell transplantation can decrease the mortality.