Metastatic renal cell carcinoma accounts for 20%-30% of newly diagnosed renal cell carcinoma and its prognosis is poor. It is not sensitive to radiotherapy or chemotherapy, and traditional cytokine therapy has limited efficacy in patient with metastatic renal cell carcinoma. In recent years, with the emergence of targeted drugs and immune checkpoint inhibitors, the survival of patients with metastatic renal cancer has been greatly improved. This article reviews treatment and research progress of metastatic renal cell carcinoma. It mainly introduces the medical treatment, including cytokine therapy, targeted therapy and emerging immunotherapy, and further analyzes the value of cytoreductive nephrectomy in the context of targeted therapy. The purpose of this article is to provide evidence for reasonable choices of treatment regimens in order to better guide clinical treatment.
Uveal melanoma is the most common primary intraocular malignancy in adults. Although it is relatively rare, it is extremely malignant, with poor treatment effect. The current treatment for primary lesions can achieve ideal local control, but there are still nearly half of the patients with distant metastasis. This article reviews the epidemiology, genetic status, diagnosis, treatment and prognosis of uveal melanoma in combination with recent advances in diagnostic and therapeutic techniques.
High-grade gliomas are the most common malignant primary central nervous system tumors with poor prognosis. The operation based on the principle of maximum safe resection of tumors, combined with radiation therapy and chemotherapy, is the primary treatment method. This treatment only delays the progression of high-grade gliomas, and almost all patients eventually develop disease progression or relapse. With the development of molecular biology, immunology, and genomics, people have a deeper understanding of the pathogenesis of gliomas. Targeted therapy, immunotherapy, and other comprehensive treatments are expected to become potential treatments for high-grade gliomas. This article reviews the current status of medical treatment of primary and recurrent high-grade gliomas, and the research progress of high-grade gliomas in targeted therapy and immunotherapy.
Objective To analyze the efficacy of breast-conserving surgery with adjuvant radiation therapy (BCS+RT) vs. mastectomy (MAST) for early breast cancer among young Chinese patients. Methods Young female breast cancer patients (≤40 years old) treated at West China Hospital of Sichuan University between January 1st, 2008, and December 31st, 2019 were analyzed for clinical staging, molecular subtypes, surgical techniques, and prognostic assessments using follow-up data. Results Of 974 eligible patients in this study, 211 underwent BCS+RT and 763 underwent MAST. The Kaplan-Meier analyses indicated that there was no significant difference in the 5-year locoregional recurrence-free survival rate (99.1% vs. 99.4%, P=0.299), distant metastasis-free survival rate (97.9% vs. 96.4%, P=0.309), breast cancer-specific survival rate (100.0% vs. 97.0%, P=0.209), or overall survival rate (99.4% vs. 96.8%, P=0.342) between patients who underwent BCS+RT and those who underwent MAST. The multiple Cox proportional hazards regression analyses revealed that the treatment approach (BCS+RT or MAST) did not significantly predict locoregional recurrence-free survival (P=0.427), distant metastasis-free survival (P=0.154), breast cancer-specific survival (P=0.155), or overall survival (P=0.263). Subgroup analyses showed that there was no statistically significant difference in survival outcomes between BCS+RT and MAST in different clinical stages or molecular subtypes. Clinical stage and molecular subtype should also not be regarded as independent factors in deciding the treatment approach. Conclusions Receiving BCS+RT or MAST treatment does not affect the survival outcomes of young early-stage breast cancer patients, showing similar efficacy across various clinical stages and molecular subtypes. Choosing BCS+RT is considered safe for early-stage young female breast cancer patients eligible for breast conservation.
Objective To investigate the prognostic differences and decision-making role in postoperative radiotherapy of four molecular subtypes in pT1-2N1M0 stage breast cancer. Methods The clinicopathological data of 1526 patients with pT1-2N1M0 breast cancer treated at West China Hospital of Sichuan University between 2008 and 2018 were retrospectively analyzed. χ2 test was used to compare the clinicopathological features among patients with different molecular subtypes. Kaplan-Meier survival analysis and log-rank test were used to draw the survival curves and compare the overall survival (OS) and breast cancer-specific survival (BCSS) among patients with different molecular subtypes. Cox regression model was used to determine the influencing factors of OS of patients after radical mastectomy. Results Among the 1526 patients with pT1-2N1M0 breast cancer, there were 674 cases (44.2%) of Luminal A subtype, 530 cases (34.7%) of Luminal B subtype, 174 cases (11.4%) of human epidermal growth factor receptor 2 (Her-2) overexpression subtype, and 148 cases (9.7%) of triple-negative subtype. The 5-year OS rates of Luminal A, Luminal B, Her-2 overexpression and triple negative patients were 98.6%, 94.3%, 95.5% and 91.2%, respectively (χ2=11.712, P=0.001), and the 5-year BCSS rates were 99.3%, 94.6%, 95.5% and 92.5%, respectively (χ2=18.547, P<0.001). Multiple Cox regression analysis showed that menstrual status [hazard ratio (HR)=0.483, 95% confidence interval (CI) (0.253, 0.923), P=0.028] and whether endocrine therapy [HR=2.021, 95%CI (1.012, 4.034), P=0.046] were prognostic factors for the 5-year OS rate of breast cancer patients after radical mastectomy (P<0.05). However, it failed to reveal that Luminal subtypes and postoperative radiotherapy were prognostic factors for the 5-year OS rate (P>0.05). Conclusions In pT1-2N1M0 breast cancer patients, the 5-year OS rate and 5-year BCSS rate in triple-negative patients are the lowest. The relationship between Luminal classification, postoperative radiotherapy and survival in patients after radical mastectomy needs further study in the future.
目的 探讨不同诊断或分类标准在脊柱关节病患者之间诊断效能、临床特点。 方法 收集2000年2月－2012年8月141例脊柱关节病患者及197例类风湿关节炎、未分化关节炎患者资料。采用3种诊断标准下对141例患者分为纽约标准（NY）组、欧洲脊柱关节病研究（ESSG）组及脊柱关节病国际评估（ASAS）组，统计患者的临床表现、骶髂关节CT、MRI、实验室指标，并加入197例类风湿关节炎未分化关节炎患者，计算和比较3种诊断的敏感性、特异性。 结果 在141例脊柱关节病中，62例符合NY标准，34例符合ESSG标准，45例只符合ASAS标准。3组患者在性别、胸廓受限、附着点炎及跖（指）炎、非甾体抗炎药及慢作用药使用、炎症因子水平方面差异无统计学意义（P＞0.05）；ASAS组则较19 NY组及ESSG组患者更年轻、病程较短，且表现有外周关节炎明显高于其余两组（P＜0.05）；NY组炎性腰背痛、脊柱活动受限、HLA-B27阳性率明显高于其余两组，且使用生物制剂比例最高，达48.38；在骨盆X线、骶髂关节CT表现关节侵蚀上，NY组较其他两组更严重。NY、ESSG、ASAS分类标准敏感性依次为43.97%、47.51%、73.76%，特异性依次为100.00%、90.86%、84.26%。 结论 ASAS分类标准敏感性高，患者更年轻、病程更短，炎性腰背痛、外周关节炎是ASAS诊断中非常重要的指标；NY组脊柱活动受限及关节侵蚀最显著，HLA-B27阳性可能是预测AS很好的指标。NY标准特异性最高，敏感性最低，而ASAS标准敏感性最高，特异性最低。
Objective To explore the feasibility and safety of 2 μm thulium laser in thoracoscopic wedge resection. Methods The clinical data of 137 patients who underwent thoracoscopic wedge resection with thulium laser (as a thulium laser group, 64 patients, including 22 males, 42 females, average age of 58.39±10.40 years) and staplers (as a stapler group, 73 patients, including 33 males, 40 females, average age of 60.79±10.96 years) in thoracic Department of Xuanwu Hospital between April 2016 and August 2018 were retrospectively analyzed. In the study, the intraoperative blood loss, the operative time, chest tube duration, daily amount of fluid leak, hospital stay and hospitalization costs were compared between two groups. Results The intraoperative blood loss of the thulium laser group (16.05±23.67 mL) was significantly shorter or lower than that of the stapler group (28.56±32.09 mL) (P=0.011). Besides, the post operation hospital stay and hospitalization costs of the thulium laser group (4.72±2.49 d, 37 127.33±9 302.14 yuan) were also significantly shorter or lower than those of the stapler group (5.67±2.02 d, 49 545.76±13 831.93 yuan) (P=0.015, P=0.000). Furthermore, no statistical difference was found between the thulium laser group and the stapler group in the operative time (116.38±41.91 min vs. 108.36±47.25 min), total hospital stay (10.13±2.98 d vs. 11.05±3.26 d), daily amount of fluid leak (138.38±72.23 mL vs. 152.7±77.54 mL), chest tube duration (2.89±2.34 d vs. 3.52±1.48 d) and the frequency of postoperative fever (0.89±1.55 times vs. 1.23±1.70 times). Conclusion Applying 2 μm thulium laser to thorascopic wedge resection is safe and feasible. Besides, 2 μm thulium laser can achieve a similar result to that of the standard technique by using staplers.
We report a 50-year-old man with mediastinal tumor. The patient received the thoracoscopic resection for mediastinal tumor with the operative time of 1 h and intraoperative blood loss of 10 mL. The final diagnosis after surgical excision was an ectopic papillary thyroid carcinoma. The patient recovered well without surgery-related complications, and was discharged on the 2nd day after the operation. No recurrence was found during the follow-up. We also reviewed relevant literature to explore the clinical features, diagnosis, and treatment of ectopic thyroid carcinoma.
Objective To assess the safety and effectiveness of direct stenting (DS) versus conventional stenting (CS) with predilation in clinical practice. Methods Such databases as PubMed, EMbase, The Cochrane Library (Issue 3, 2011), CBM, VIP and CNKI were searched from the date of their establishment to April 2011, to collect the randomized controlled trials (RCTs) on DS vs. CS. The quality of RCTs was critically appraised, and the data were extracted and cross-checked by two reviewers independently. Meta-analyses were conducted using RevMan 5.0 software. Results A total of 24 RCTs involving 6 666 patients were included. The results of Meta-analyses showed that DS took shorter operative time compared with CS (MD=–3.36, 95%CI –4.41 to –2.30, Plt;0.000 01) with acute gain (luminal diameter) during operation (MD=–0.01, 95%CI –0.04 to 0.02, P=0.64). But there were no significant differences in the incidence of major adverse cardiac events during six-month follow-up (OR=0.89, 95%CI 0.69 to 1.14, P=0.35) and restenosis (OR=1.02, 95%CI 0.82 to 1.26, P=0.88). Conclusion Current evidence shows that DS is not superior to CS. This conclusion still needs to be further proved by well-designed and large scale RCTs with longer follow-up duration.
ObjectiveTo explore and analyze the related influencing factors for common intraoperative complications during CT-guided percutaneous radiofrequency ablation of pulmonary tumor. MethodsWe retrospectively analyzed the clinical data of the patients who underwent CT-guided percutaneous radiofrequency ablation of pulmonary tumor in our hospital from December 2018 to December 2019, and analyzed the influencing factors for complications. ResultsA total of 106 patients were enrolled. There were 58 (54.7%) males and 48 (45.3%) females aged 46-81 (68.05±8.05) years. All patients successfully completed the operation. The operation time was 47.67±16.47 min, and the hospital stay time was 2.45±1.35 d. The main intraoperative complications were pneumothorax (16.0%, 17/106) and intrapulmonary hemorrhage (22.6%, 24/106). Univariate analysis showed that the number of pleural punctures had an impact on the occurrence of pneumothorax (P=0.00). The length of the puncture path (P=0.00), ablation range (P=0.03) and ablation time (P=0.00) had an impact on the occurrence of intrapulmonary hemorrhage. Multivariate logistic regression analysis showed that the size of the lesion (OR=17.85, 95%CI 3.41-93.28, P=0.00) and the number of pleural punctures (OR=0.02, 95%CI 0.00-0.11, P=0.00) were independent influencing factors for the occurrence of pneumothorax. The length of the puncture path (OR=15.76, 95%CI 5.34-46.57, P=0.00) was the independent influencing factor for the occurrence of intrapulmonary hemorrhage. ConclusionPercutaneous radiofrequency ablation of pulmonary tumor is safe and with a high success rate, but intraoperative complications are affected by many factors, so the surgeons should be proficient in operating skills to avoid complications.