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| 1 | BCLC策略:预后预测和治疗推荐2022版更新显示文摘2018版BCLC预后和治疗推荐策略发布后,肝细胞癌(简称HCC)的研究又取得了重大进展。本次更新基于肝癌各领域的研究进展结果。重点关注影响策略的重要研究进展。虽然近年的研究结果成绩斐然,但将其引入为临床医生和研究者提供行动依据的循证模型指南来说证据效力依然不够确切。本文对该问题进行分析,阐述了为HCC患者制定个体化治疗临床决策所需的批判性思维和专业知识。 | Reig M Forner A Rimola J Ferrer-Fabrega J Burrel M Garcia-Criado A Kelley RK Galle PR Mazzaferro V Salem R Sangro B Singal AG Vogel A Fuster J Ayuso C Bruix J 刘永凡(摘译) 崔笑(摘译) 耿小平(审校) | 2022 | 肝胆外科杂志2022，30，5： | 80 |
| 2 | 脉冲电场治疗黑色素瘤可破坏肿瘤血供,导致肿瘤完全消退显示文摘A new pulsed electric field therapy for melanoma disrupts the tumor's blood supply and causes complete remission without recurrence. Nuccitelli R, Chen X, Pakhomov AG, et al. Int J Cancer, 2009, 125(2):438-445. | Nuccitelli R Chen X Pakhomov AG | 2009 | 中国口腔颌面外科杂志2009，7，4： | 32 |
| 3 | 直肠癌放化疗后观察等待与手术治疗的配对队列研究显示文摘目的近年对于直肠癌放化疗后临床完全缓解的患者出现了新的治疗模式。这类患者在新辅助治疗后不进行手术治疗而进行观察-等待(watch-and-wait)的随诊观察。本研究旨在通过对比放化疗后临床完全缓解的患者接受手术治疗和观察-等待方式两者的肿瘤学转归,研究观察-等待随诊方式的安全性。方法 On Co Re(直肠癌完全缓解病例肿瘤学转归)研究是在英国曼切斯特一所三级癌中心进行的配对队列研究。自2011年1月到2013年4月,收集所有年龄段、无远处转移且接受了术前化放疗(45Gy,25天,同期氟尿嘧啶化疗)的直肠腺癌病例。达到临床完全缓解的患者,进入观察-等待方式,而未获临床完全缓解的患者,在条件允许下接受手术治疗。本研究通过注册登记,同时纳入自2005年3月10日至2015年1月21日来自相邻区域的3所英国癌中心临床完全缓解而接受单纯等待-观察方式的直肠癌患者。研究采用采用1∶1配比队列,使用倾向得分匹配分析法(包括T分期、年龄和体力状态),比较患者接受单纯观察等待与手术切除的治疗转归。主要观察终点为自化放疗开始后无疾病进展生存,次要终点为总体生存以及结肠造口术后无瘤生存。本研究以更保守的P〈0.01视为差异具有统计学意义。结果共有259例患者来自曼彻斯特癌中心,228例接受手术治疗,而31例临床完全缓解患者单纯进行观察-等待。此外通过注册登记的98例患者也进入观察-等待组。观察-等待组共129位患者[中位随访33个月(IQR 19~43个月)],44例(34%)局部复发。41例无转移的局部复发患者中36例(88%)接受了补救性手术。配对分析显示(各109例),观察-等待组和手术组的3年无疾病进展生存无统计学差异[88%(95%CI 75~94)vs.78%(63~87),P=0.043]。同时3年总体生存也没有显著性差异(96%vs.87%,P=0.024)。观察-等待组的结肠造口率明显低于手术组,其3年结肠造口术后无瘤生存率为74%(95%CI 64~82),而手术组为47%(P〈0.0001)。风险比0.445(95%CI 0.31~0.63,P〈0.0001),观察-等待组较手术组的3年终生造口风险降低26%(95%CI 13~39)。结论本研究显示,确实存在一定比例的直肠癌患者可以通过观察-等待方式避免手术,免除终生造口,同时获得3年良好的肿瘤安全性。这结果提示,应从一开始就认真考虑直肠癌患者化放疗策略,观察-等待治疗作为标准治疗方式看来是可行的。研究者认为如果患者在化放疗开始后,少于14周内取得早期临床完全缓解,或者大于24周取得临床完全缓解,其复发的机会较少。此外,广泛使用45 Gy的放疗的患者的临床完全缓解率为10%~15%,更高剂量的放化疗能够将其提高到大于50%。如此高的临床完全缓解率如果能够在可接受的毒副作用范围内反复出现,那么以上两种策略就可以实现长期、持续的临床完全缓解。然而,这一观察结果还需要临床研究验证。 | Renehan AG Malcomson L Emsley R 张信华 | 2016 | 消化肿瘤杂志(电子版)2016，8，1： | 27 |
| 4 | Evaluation of quantitative contrast harmonic imaging to assess malignancy of liver tumors:A prospective controlled two-center study显示文摘AIM: To establish the extent to which contrast enhancement with SonoVue in combination with quantitative evaluation of contrast-medium dynamics facilitates the detection of hepatic tumors. METHODS: One hundred patients with histologically confirmed malignant or benign hepatic tumor (maximum size 5 cm) were analyzed. Contrast-enhanced ultrasound (bolus injection 2.5 mL SonoVue) was carried out with intermittent breath-holding technique using a multifrequency transducer (2.5-4 MHz). Native vascularization was analyzed with power Doppler. The contrast-enhanced dynamic ultrasound investigation was carried out with contrast harmonic imaging in true detection mode during the arterial,portal venous and late phases. Mechanical index was set at 0.15. Perfusion analysis was performed by post-processing of the raw data time intensity curve (TIC) analysis. The cut-off of the gray value differences between tumor and normal liver tissue was established using Receiver Operating Characteristic (ROC) analysis 64-line multi-slice computed tomography served as reference method in all cases. Magnetic resonance tomography was used additionally in 19 cases. RESULTS: One hundred patients with 59 malignant (43 colon,5 breast,2 endocrine metastases,7 hepatocellular carcinomas and 2 kidney cancers) and 41 benign (15 hemangiomas,7 focal nodular hyperplasias,5 complicated cysts,2 abscesses and 12 circumscribed fatty changes) tumors were included. The late venous phase proved to be the most sensitive for classification of the tumor type. Fifty-eight of the 59 malignant tumors were classified as true positive,and one as false negative. This resulted in a sensitivity of 98.3%. Of the 41 benign tumors,37 were classified as true negative and 4 as false negative,which corresponds to a specificity of 90.2%. Altogether,95.0% of the diagnoses were classified as correct on the basis of the histological classification. No investigator-dependency (P = 0.23) was noted. CONCLUSION: The results show the possibility of accurate prediction of malignancy of hepatic tumors with a positive prognostic value of 93.5% using advanced contrast-enhanced ultrasound. Contrast enhancement with SonoVue in combination with quantitative evaluation of contrast-medium dynamics is a valuable tool to discriminate hepatic tumors. | EM Jung DA Clevert AG Schreyer S Schmitt J Rennert R Kubale S Feuerbach F Jung | 2007 | World Journal of Gastroenterology2007，13，47： | 15 |
| 5 | Quality of life, work productivity impairment and healthcare resources in inflammatory bowel diseases in Brazil显示文摘BACKGROUND Inflammatory bowel diseases(IBD)have been associated with a low quality of life(QoL)and a negative impact on work productivity compared to the general population.Information about disease control,patient-reported outcomes(PROs),treatment patterns and use of healthcare resources is relevant to optimizing IBD management.AIM To describe QoL and work productivity and activity impairment(WPAI),treatment patterns and use of healthcare resources among IBD patients in Brazil.METHODS A multicenter cross-sectional study included adult outpatients who were previously diagnosed with moderate to severe Crohn’s disease(CD)or ulcerative colitis(UC).At enrolment,active CD and UC were defined as having a Harvey Bradshaw Index≥8 or a CD Activity Index≥220 or calprotectin>200μg/g or previous colonoscopy results suggestive of inadequate control(per investigator criteria)and a 9-point partial Mayo score≥5,respectively.The PRO assessment included the QoL questionnaires SF-36 and EQ-5D-5L,the Inflammatory Bowel Disease Questionnaire(IBDQ),and the WPAI questionnaire.Information about healthcare resources and treatment during the previous 3 years was collected from medical records.Chi-square,Fisher’s exact and Student’s t-/Mann-Whitney U tests were used to compare PROs,treatment patterns and the use of healthcare resources by disease activity(α=0.05).RESULTS Of the 407 patients in this study(CD/UC:64.9%/35.1%,mean age 42.9/45.9 years,54.2%/56.6%female,38.3%/37.1%employed),44.7%/25.2%presented moderate-to-severe CD/UC activity,respectively,at baseline.Expressed in median values for CD/UC,respectively,the SF-36 physical component was 46.6/44.7 and the mental component was 45.2/44.2,the EQ-visual analog scale score was 80.0/70.0,and the IBDQ overall score was 164.0/165.0.Moderate to severe activity,female gender,being unemployed,a lower educational level and lower income were associated with lower QoL(P<0.05).Median work productivity impairment was 20%and 5%for CD and UC patients,respectively,and activity impairment was 30%,the latter being higher among patients with moderate to severe disease activity compared to patients with mild or no disease activity(75.0%vs 10.0%,P<0.001).For CD/UC patients,respectively,25.4%/2.8%had at least one surgery,38.3%/19.6%were hospitalized,and 70.7%/77.6%changed IBD treatment at least once during the last 3 years.The most common treatments at baseline were biologics(75.3%)and immunosuppressants(70.9%)for CD patients and 5-ASA compounds(77.5%)for UC patients.CONCLUSION Moderate to severe IBD activity,especially among CD patients,is associated with a substantial impact on QoL,work productivity impairment and an increased number of IBD surgeries and hospitalizations in Brazil. | Rogerio Serafim Parra Julio MF Chebli Heda MBS Amarante Cristina Flores Jose ML Parente Odery Ramos Milene Fernandes Jose JR Rocha Marley R Feitosa Omar Feres Antonio S Scotton Rodrigo B Nones Murilo M Lima Cyrla Zaltman Carolina D Goncalves Isabella M Guimaraes Genoile O Santana Ligia Y Sassaki Rogerio S Hossne Mauro Bafutto Roberto LK Junior Mikaell AG Faria Sender J Miszputen Tarcia NF Gomes Wilson R Catapani Anderson A Faria Stella CS Souza Rosana F Caratin Juliana T Senra Maria LA Ferrari | 2019 | World Journal of Gastroenterology2019，25，38： | 2 |
| 6 | 接受心脏手术的成人患者的体质量指数与死亡率:全国研究的系统评价和荟萃分析显示文摘接受心脏手术的肥胖患者的发病率和死亡率较低,该现象显然不合理,相关机制不明。该研究试图确定在心脏手术中观察到的这个肥胖悖论是否归因于逆流行病学、偏倚或混杂因素。方法:从英国国家成人心脏外科登记处提取自2002年4月至2013年3月期间进行的所有心脏外科手术数据。同时对至2015年6月Medline,Embase,Scopus, | 刘莉 叶鹏 Mariscalco G Wozniak MJ Dawson AG Serraino GF Porter R Nath M Klersy C Kumar T Murphy GJ | 2017 | 中华高血压杂志2017，25，2： | 2 |
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