Baidu
map

腺癌治疗所致骨丢失的治疗研究:无论是否联合运动,大剂量维生素D的疗效与安全性均优

2019-06-12 于世英教授 肿瘤资讯

大剂量维生素D补充联合运动治疗接受芳香化酶抑制剂的乳腺癌患者抗癌治疗所致骨丢失的II期随机对照临床研究 第一作者:Luke Joseph Peppone,纽约州罗切斯特市罗切斯特大学医学中心

大剂量维生素D补充联合运动治疗接受芳香化酶抑制剂的乳腺癌患者抗癌治疗所致骨丢失的II期随机对照临床研究 第一作者:Luke Joseph Peppone,纽约州罗切斯特市罗切斯特大学医学中心

背景

抗癌治疗所致的骨丢失(cancer treatment-induced bone loss,CTIBL)是芳香化酶抑制剂(AIs)的副作用,可导致骨质疏松性骨折。维生素D(VITD)可防止绝经后骨质流失,但尚不清楚目前VITD的每日推荐摄入量(recommended daily allowance,RDA:600 IU/d)是否足以预防 CTIBL。这一项II期随机对照研究旨在评估大剂量VITD补充(联合或不联合运动)与RDA相比在改善骨密度(bone mineral density ,BMD)上的可行性、安全性和初步疗效。

方法

入组人群为开始使用AIs的非转移性乳腺癌患者,入组时血清VITD为低水平(<32 ng/ml),按1:1:1随机分为3组:①安慰剂;②大剂量VITD补剂(50000 IU/w); ③大剂量VITD补剂+癌症患者运动项目(Exercise for Cancer Patients ,EXCAP:一项为期24周的个性化的在家步行和阻力带训练计划)。所有受试者均接受RDA剂量的VITD补剂600 IU/d。在基线期、第6周, 第12周, 第18周和第24周评估血清VITD和血清钙水平。在基线期和第24周通过DXA评估髋部BMD。

结果

在116例随机受试者中(平均年龄=60岁;94%为白人;平均基线血清VITD水平=24.6ng/ml),90例受试者提供了完全可评价的数据。3个组的依从性(完成≥80%的指导剂量)均超过95%,组间无差异。ANCOVA显示最终血清VITD水平有统计学差异(大剂量组=63.6ng/ml vs大剂量+EXCAP组=60.3ng/ml vs安慰剂组=32.0ng/ml;P<0.001),在最终血清钙水平上无显着性差异(大剂量组=9.4ng/ml vs大剂量+EXCAP组=9.5ng/ml vs安慰剂组=9.4ng/ml;P=0.78),三组均没有严重的钙中毒。与基线水平相比,安慰剂组出现显着的髋部BMD减少(-1.7%;p<0.01),而在大剂量组和大剂量+EXCAP组,髋部BMD下降很少,分别为(-0.1%;P=0.77)和(-0.2%;P=0.74),结果显示大剂量+EXCAP组与安慰剂组(P=0.04)和大剂量组与安慰剂组(P=0.05)之间存在显着性差异。

结论

这是第一批针对接受AIs治疗的乳腺癌患者使用新的大剂量VITD补剂干预研究之一,无论是否联合运动,大剂量VITD补剂都能显着降低患者髋部的骨密度丢失。此外,大剂量VITD补充是安全可行的。尚需III期随机对照研究来证实这些发现。资金:K07CA168911。临床试验信息:NCT0419730。

专家点评

绝经后乳腺癌患者年龄高,雌激素水平下降,骨质疏松和骨折风险均高于同龄健康女性。如果再使用芳香化酶抑制剂,会进一步降低雌激素水平,使得骨质疏松的情况“雪上加霜”。ATAC研究显示33个月的随访期内使用阿那曲唑骨折风险高于他莫昔芬(5.9% vs 3.7%,P<0.001)。BIG1-98研究显示在26个月的随访期内使用来曲唑的骨折风险高于他莫昔芬(5.7%vs 4.0%,P<0.001)。BMD是评价绝经后乳腺癌患者骨质丢失和骨质疏松的主要方法。低度风险是指BMD低于健康年轻女性平均BMD水平T值≥1.0,中度风险为-2.020%或髋骨骨折>3%。低度风险或中度风险不伴危险因素的可考虑补充钙剂和VITD,中度风险伴有2个及以上危险因素或高度风险者需加用双膦酸盐。危险因素包括①骨密度T值<-1.5;②年龄>65岁;③BMI<20kg/m2;④髋骨骨折家族史;⑤>50岁有脆性骨折史;⑥口服糖皮质激素>6个月;⑦吸烟(目前吸烟和有吸烟史)。

VITD可促进肠黏膜钙吸收, 促使其从肠腔黏膜细胞膜往内部转运, 增加肠黏膜细胞内钙结合蛋白表达, 有利于钙浓度的提升和骨骼矿化, 具有明显的骨重建作用,从而有效地降低骨质疏松的发生。VITD缺乏可导致继发性甲状旁腺功能亢进,增加骨吸收,引发或加重骨质疏松程度。美国医学会修订的指南强调VITD的每日需求量一般要满足大多数人的需求,使得血清VITD水平保持在20ng/ml的水平。血清VITD<20ng/ml,诊断为VITD缺乏症,20ng/ml≤血清VITD<30ng/ml,诊断为VITD不足症,VITD≥30ng/ml对于一般人群是足够的,40~60ng/ml是理想范围,VITD的安全上限一般认为是<150ng/ml。我国成年人VITD的RDA是200 IU/d,老年人400~800 IU/d,在治疗骨质疏松时800~1200 IU/d,目前并没有针对绝经后乳腺癌患者预防骨质疏松剂量进行推荐。美国推荐的RDA为600 IU/d。

本研究是第一项对于接受AIs的乳腺癌患者骨质疏松进行大剂量VITD补充的研究。VITD的剂量为50000 IU/w,大大超出目前的RDA。这项研究值得关注的地方首先是它的安全性,大剂量VITD补剂第24周的血清VITD水平为63.6ng/ml,低于安全上限。VITD中毒是通过血钙浓度升高影响机体功能的。3个试验组血清钙水平无显着性差异,进一步证实了大剂量VITD的安全性。这项研究第二个值得关注的地方是对于骨质疏松的预防,大剂量组优于RDA,且与运动无关。这提示我们大剂量组对于预防接受AIs的乳腺癌患者骨质疏松的有效性。

接受AIs的乳腺癌患者预防和治疗骨质疏松的药物治疗除了钙剂和VITD,还有双膦酸盐。当VITD和钙剂与双膦酸盐合用时,推荐VITD剂量为400~800 IU/d。在能够使用双膦酸盐的情况下,大剂量VITD的必要性需要进一步审慎考虑。此外,地诺单抗等一系列预防和治疗骨质疏松的新药联合使用VITD的剂量需要进一步研究。

于世英主任医师、博士生导师,华中科技大学同济医学院附属同济医院肿瘤中心,中国抗癌协会癌症康复与姑息治疗专业委员会荣誉主任委员,,湖北省医师协会肿瘤医师分会主任委员,《Oncology and Translational Medicine》主编,《全球肿瘤快讯》总编。

程熠主治医师,华中科技大学同济医学院中国医疗保健国际交流促进会肿瘤姑息治疗与人文关怀分会 秘书 委员,《全球肿瘤快讯》 青年编委,《全球肿瘤快讯》 社外编辑,《JCO中文版》 青年审稿专家,《医师报》菁英记者。研究方向:宫颈癌放化疗,乳腺癌、肺癌消化系统肿瘤等常见恶性肿瘤的综合治疗,恶性肿瘤姑息与对症支持治疗

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (5)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1807701, encodeId=0167180e7012e, content=<a href='/topic/show?id=cbbd80e28e8' target=_blank style='color:#2F92EE;'>#联合运动#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80728, encryptionId=cbbd80e28e8, topicName=联合运动)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1a5a149, createdName=gongliu, createdTime=Fri Apr 03 02:33:00 CST 2020, time=2020-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1688626, encodeId=5a761688626e1, content=<a href='/topic/show?id=d661e039969' target=_blank style='color:#2F92EE;'>#疗效与安全性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70399, encryptionId=d661e039969, topicName=疗效与安全性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1a6a28606469, createdName=1179102698_36768935, createdTime=Sat Aug 03 08:33:00 CST 2019, time=2019-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1991242, encodeId=153319912422d, content=<a href='/topic/show?id=0e971015e4bd' target=_blank style='color:#2F92EE;'>#骨丢失#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101574, encryptionId=0e971015e4bd, topicName=骨丢失)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d4b7363, createdName=pandamao2010, createdTime=Mon Apr 27 00:33:00 CST 2020, time=2020-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578684, encodeId=902415e8684f1, content=<a href='/topic/show?id=fbf0436148a' target=_blank style='color:#2F92EE;'>#大剂量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43614, encryptionId=fbf0436148a, topicName=大剂量)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cd6a16418535, createdName=ms7899726347904398, createdTime=Fri Jun 14 01:33:00 CST 2019, time=2019-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032189, encodeId=9cf81032189a0, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Wed Jun 12 13:33:00 CST 2019, time=2019-06-12, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1807701, encodeId=0167180e7012e, content=<a href='/topic/show?id=cbbd80e28e8' target=_blank style='color:#2F92EE;'>#联合运动#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80728, encryptionId=cbbd80e28e8, topicName=联合运动)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1a5a149, createdName=gongliu, createdTime=Fri Apr 03 02:33:00 CST 2020, time=2020-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1688626, encodeId=5a761688626e1, content=<a href='/topic/show?id=d661e039969' target=_blank style='color:#2F92EE;'>#疗效与安全性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70399, encryptionId=d661e039969, topicName=疗效与安全性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1a6a28606469, createdName=1179102698_36768935, createdTime=Sat Aug 03 08:33:00 CST 2019, time=2019-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1991242, encodeId=153319912422d, content=<a href='/topic/show?id=0e971015e4bd' target=_blank style='color:#2F92EE;'>#骨丢失#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101574, encryptionId=0e971015e4bd, topicName=骨丢失)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d4b7363, createdName=pandamao2010, createdTime=Mon Apr 27 00:33:00 CST 2020, time=2020-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578684, encodeId=902415e8684f1, content=<a href='/topic/show?id=fbf0436148a' target=_blank style='color:#2F92EE;'>#大剂量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43614, encryptionId=fbf0436148a, topicName=大剂量)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cd6a16418535, createdName=ms7899726347904398, createdTime=Fri Jun 14 01:33:00 CST 2019, time=2019-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032189, encodeId=9cf81032189a0, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Wed Jun 12 13:33:00 CST 2019, time=2019-06-12, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1807701, encodeId=0167180e7012e, content=<a href='/topic/show?id=cbbd80e28e8' target=_blank style='color:#2F92EE;'>#联合运动#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80728, encryptionId=cbbd80e28e8, topicName=联合运动)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1a5a149, createdName=gongliu, createdTime=Fri Apr 03 02:33:00 CST 2020, time=2020-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1688626, encodeId=5a761688626e1, content=<a href='/topic/show?id=d661e039969' target=_blank style='color:#2F92EE;'>#疗效与安全性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70399, encryptionId=d661e039969, topicName=疗效与安全性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1a6a28606469, createdName=1179102698_36768935, createdTime=Sat Aug 03 08:33:00 CST 2019, time=2019-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1991242, encodeId=153319912422d, content=<a href='/topic/show?id=0e971015e4bd' target=_blank style='color:#2F92EE;'>#骨丢失#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101574, encryptionId=0e971015e4bd, topicName=骨丢失)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d4b7363, createdName=pandamao2010, createdTime=Mon Apr 27 00:33:00 CST 2020, time=2020-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578684, encodeId=902415e8684f1, content=<a href='/topic/show?id=fbf0436148a' target=_blank style='color:#2F92EE;'>#大剂量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43614, encryptionId=fbf0436148a, topicName=大剂量)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cd6a16418535, createdName=ms7899726347904398, createdTime=Fri Jun 14 01:33:00 CST 2019, time=2019-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032189, encodeId=9cf81032189a0, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Wed Jun 12 13:33:00 CST 2019, time=2019-06-12, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1807701, encodeId=0167180e7012e, content=<a href='/topic/show?id=cbbd80e28e8' target=_blank style='color:#2F92EE;'>#联合运动#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80728, encryptionId=cbbd80e28e8, topicName=联合运动)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1a5a149, createdName=gongliu, createdTime=Fri Apr 03 02:33:00 CST 2020, time=2020-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1688626, encodeId=5a761688626e1, content=<a href='/topic/show?id=d661e039969' target=_blank style='color:#2F92EE;'>#疗效与安全性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70399, encryptionId=d661e039969, topicName=疗效与安全性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1a6a28606469, createdName=1179102698_36768935, createdTime=Sat Aug 03 08:33:00 CST 2019, time=2019-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1991242, encodeId=153319912422d, content=<a href='/topic/show?id=0e971015e4bd' target=_blank style='color:#2F92EE;'>#骨丢失#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101574, encryptionId=0e971015e4bd, topicName=骨丢失)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d4b7363, createdName=pandamao2010, createdTime=Mon Apr 27 00:33:00 CST 2020, time=2020-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578684, encodeId=902415e8684f1, content=<a href='/topic/show?id=fbf0436148a' target=_blank style='color:#2F92EE;'>#大剂量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43614, encryptionId=fbf0436148a, topicName=大剂量)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cd6a16418535, createdName=ms7899726347904398, createdTime=Fri Jun 14 01:33:00 CST 2019, time=2019-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032189, encodeId=9cf81032189a0, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Wed Jun 12 13:33:00 CST 2019, time=2019-06-12, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1807701, encodeId=0167180e7012e, content=<a href='/topic/show?id=cbbd80e28e8' target=_blank style='color:#2F92EE;'>#联合运动#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80728, encryptionId=cbbd80e28e8, topicName=联合运动)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1a5a149, createdName=gongliu, createdTime=Fri Apr 03 02:33:00 CST 2020, time=2020-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1688626, encodeId=5a761688626e1, content=<a href='/topic/show?id=d661e039969' target=_blank style='color:#2F92EE;'>#疗效与安全性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70399, encryptionId=d661e039969, topicName=疗效与安全性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1a6a28606469, createdName=1179102698_36768935, createdTime=Sat Aug 03 08:33:00 CST 2019, time=2019-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1991242, encodeId=153319912422d, content=<a href='/topic/show?id=0e971015e4bd' target=_blank style='color:#2F92EE;'>#骨丢失#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101574, encryptionId=0e971015e4bd, topicName=骨丢失)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d4b7363, createdName=pandamao2010, createdTime=Mon Apr 27 00:33:00 CST 2020, time=2020-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578684, encodeId=902415e8684f1, content=<a href='/topic/show?id=fbf0436148a' target=_blank style='color:#2F92EE;'>#大剂量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43614, encryptionId=fbf0436148a, topicName=大剂量)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cd6a16418535, createdName=ms7899726347904398, createdTime=Fri Jun 14 01:33:00 CST 2019, time=2019-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032189, encodeId=9cf81032189a0, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Wed Jun 12 13:33:00 CST 2019, time=2019-06-12, status=1, ipAttribution=)]
    2019-06-12 内科新手

    谢谢梅斯提供这么好的信息,学到很多

    0

相关资讯

JCO:EGFR突变腺癌转化为非小细胞肺癌和其他神经内分泌肿瘤

大约3%至10%的EGFR突变的非小细胞肺癌(NSCLC)会转化为小细胞肺癌(SCLC),但其临床过程尚不明确。JCO近期发表了一篇文章研究这一问题。

Sci Rep:癌抗原-125对肺腺癌伴脑转移患者的预后价值

对于肺腺癌伴脑转移患者,验证后的预后列线图(KPS、吸烟、EGFR-20和Ca125)能够更准确地预测患者的1年和2年生存率。

JAMA Oncology:Pembrolizumab为晚期胃或胃食管交界部腺癌三线治疗带来新希望

晚期胃癌目前缺乏标准的三线治疗方案。KEYNOTE-059研究评估了Pembrolizumab单药用于经治的晚期胃癌或胃食管交界部癌三线或以上治疗的疗效和安全性。目前研究的初步结果发表在《JAMA Oncology》杂志。

原发性子宫内膜样腺癌合并卵巢腺鳞癌1例

患者,48岁,因不规则阴道流血、流液3年余,加重2天于2016年5月7日急诊入我院。

2019 CAP指南:乳腺癌人表皮生长因子受体2免疫组化定量分析

基因组学、计算机以及影像学技术的进步催生了将定量图像温习用于诊断检测的新的机会。本文主要针对乳腺癌人表皮生长因子受体2免疫组化定量分析的相关内容提出了指导建议。

Radiology:那些CT征象能够提示肺腺癌经气道播散?

本研究旨在识别能够预测与手术切除肺腺癌经气道播散(STAS)的CT征象。

Baidu
map
Baidu
map
Baidu
map