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Lancet Respir Med:免疫疗法,第三波肺癌治疗新潮流—呼吸病学2015年度总结专题

2015-12-03 MedSci MedSci原创

继1980年代化疗和2000年代的靶向治疗之后,免疫肿瘤学是改善非小细胞肺癌治疗效果的第三波潮流。免疫疗法对于肺癌患者有可能产生持久的治疗反应,这将是改善肺癌治疗效果的最大的潮流。

近50年来调动免疫系统对抗传染病是非常成功的创举。针对许多微生物开发的疫苗帮助人类有效减少疾病发病率,甚至清除了许多疾病。因为癌细胞可以被免疫系统视为异物,同样的调动免疫系统的方法也应该可以成功的治疗癌症。

然而迄今为止,正如有史以来最大的佐剂疫苗接种试验所示,试验证明疫苗接种治疗肺癌是无效的。

MAGRIT试验(NCT00480025),非小细胞肺癌患者常规治疗后接受黑素瘤相关抗原(MAGE-A3)疫苗注射。这次试验提前终止,没有任何亚组报告有效。一方面,试验可能是不成功的,因为免疫系统激活不足;另一方面,过度激活的免疫反应会造成灾难性后果,在2006年Ⅰ期临床试验6个健康受试者中观察到MAGE-A3疫苗(意外)通过CD28受体刺激免疫系统过度激活,受试者体内产生几近致命的的细胞因子风暴。

在肺癌治疗方案引入免疫检查点抑制剂后情况发生了实质性的变化。
 
特别是抑制PD-1受体及其配体PD-L1,参与免疫逃逸、防止自身免疫反应,展示了对肺癌生存的令人印象深刻的影响。
 
二线治疗272例晚期鳞状细胞非小细胞肺癌患者,PD-1抑制剂nivolumab与多西他赛相比,可使受试者平均总生存期增加(9.2个月,95%CI 7.3 -13.3 vs 6.0月,95%CI 5.1-7.3]),死亡风险降低(HR 0.59,95%CI 0.44-0.79,P<0.001),毒性降低(严重和危及生命的治疗相关事件(7% vs 55%)。
 
在非鳞状上皮非小细胞肺癌的姐妹试验中,nivolumab与多西他赛相比也显示出类似的优越性:92例接受nivolumab治疗的受试者中位总生存期是12.2个月(95%CI 9.7-15.0),相比之下,290例接受多西他赛治疗的患者中位总生存期是9.4个月(95%CI 8.1-10.7),HR 0.73(95%CI 0.59-0.89),P=0.002。
 
这个试验报道肺癌组织中nivolumab和PD-L1表达与患者生存受益之间的阳性关联。
 
另一个重要发现是治疗反应的持续时间。
 
在另外一项试验中129例非小细胞肺癌患者在强化治疗后接受nivolumab治疗(45.7%受试者接受1-2次常规治疗,54.3%受试者接受≥3次常规治疗),3年生存率高达18%(95%CI 11%- 25%)。
 
另一个PD-1抑制剂pembrolizumab也展示了令人印象深刻的结果:多队列研究(N=495,包括强化治疗患者)结果显示试验反应率为19.4%,中位总生存期是12.0个月。
 
肿瘤PD-L1表达也与治疗反应和患者生存相关:与表达PD-L1的肿瘤细胞比例较低的患者相比,表达PD-L1的肿瘤细胞超过50%的患者反应率较高(45.2%),平均无进展生存期更长(6.3个月),平均总生存期更长(试验无法计算)。
 
PD-L1抑制剂例如atezolizumab在非小细胞肺癌试验中也表现出令人欣喜的活性。atezolizumab作为二线治疗的Ⅱ期试验初步报告显示中位总生存期为12.6个月,而多西他赛为9.7个月(HR 0.73,95%CI 0.53-0.99,P=0.040)。
 
再一次着重强调,患者生存受益依赖于肿瘤组织和肿瘤间质中PD-L1表达。肿瘤组织或肿瘤间质PD-L1高表达组,atezolizumab中位总生存期是15.5个月,多西他赛中位总生存期是11.1个月(HR 0.49,95%CI 0.22-1.07,P=0.068)。
 
PD-1-PD-L1轴抑制剂的典型的副作用包括轻度疲劳、食欲下降和乏力。除了其他常见胃肠道不良事件以外,几种免疫相关副作用包括肝炎、皮肤反应、肺炎和内分泌功能失调如甲状腺功能减退,这些副作用程度较轻。
 
未来的研究方向是将这些抑制剂和其他药物例如ipilimumab(一种CTLA-4 免疫检查点抑制剂)联合使用。nivolumab与ipilimumab的组合在几个剂量方案试验中显示出可喜的成果,但毒性也有所增加。其他研究概念包括免疫治疗联合化疗(同时或后续)和靶向药物。
 
结语:继1980年代化疗和2000年代的靶向治疗之后,免疫肿瘤学是改善非小细胞肺癌治疗效果的第三波潮流。免疫疗法对于肺癌患者有可能产生持久的治疗反应,这将是改善肺癌治疗效果的最大的潮流。
 
David Felix Heigeneremail报告接受百时美施贵宝、罗氏、勃林格殷格翰和辉瑞的赞助。Martin Reck报告接受罗氏、礼来、百时美施贵宝、默沙东、阿斯利康、勃林格殷格翰、辉瑞和诺华的赞助。
 
原文出处:

David Felix Heigeneremail, Martin Reck. Immunotherapy: the third wave in lung cancer treatment. Lancet Respir Med. December 2015.

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    2016-05-26 howi
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  4. [GetPortalCommentsPageByObjectIdResponse(id=1663416, encodeId=064b166341643, content=<a href='/topic/show?id=2653396e53b' target=_blank style='color:#2F92EE;'>#呼吸病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39675, encryptionId=2653396e53b, topicName=呼吸病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ed5525610796, createdName=ms9833124466084992, createdTime=Thu Nov 17 18:31:00 CST 2016, time=2016-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1828335, encodeId=e09918283356a, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Thu May 26 01:31:00 CST 2016, time=2016-05-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1734850, encodeId=91701e3485052, content=<a href='/topic/show?id=eb82822328e' target=_blank style='color:#2F92EE;'>#肺癌治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82232, encryptionId=eb82822328e, topicName=肺癌治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=267533842346, createdName=马龙, createdTime=Wed Oct 12 07:31:00 CST 2016, time=2016-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1707393, encodeId=35c61e0739365, content=<a href='/topic/show?id=25df20e54dc' target=_blank style='color:#2F92EE;'>#专题#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20754, encryptionId=25df20e54dc, topicName=专题)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1f4231418733, createdName=108807375_62823137, createdTime=Sat Jan 02 20:31:00 CST 2016, time=2016-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1688039, encodeId=6c6016880395d, content=<a href='/topic/show?id=577a396e60f' target=_blank style='color:#2F92EE;'>#呼吸病学#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39676, encryptionId=577a396e60f, topicName=呼吸病学)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f99a28444895, createdName=ms306040998833292, createdTime=Sun Nov 13 12:31:00 CST 2016, time=2016-11-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=48950, encodeId=adec48950a3, content=好文章,值得收藏, beContent=null, objectType=article, channel=null, level=null, likeNumber=197, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sun Dec 27 08:38:00 CST 2015, time=2015-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=48951, encodeId=2f5248951b7, content=好文章,值得收藏, beContent=null, objectType=article, channel=null, level=null, likeNumber=143, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sun Dec 27 08:38:00 CST 2015, time=2015-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1606749, encodeId=33461606e49e5, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Sat Dec 05 14:31:00 CST 2015, time=2015-12-05, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1663416, encodeId=064b166341643, content=<a href='/topic/show?id=2653396e53b' target=_blank style='color:#2F92EE;'>#呼吸病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39675, encryptionId=2653396e53b, topicName=呼吸病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ed5525610796, createdName=ms9833124466084992, createdTime=Thu Nov 17 18:31:00 CST 2016, time=2016-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1828335, encodeId=e09918283356a, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Thu May 26 01:31:00 CST 2016, time=2016-05-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1734850, encodeId=91701e3485052, content=<a href='/topic/show?id=eb82822328e' target=_blank style='color:#2F92EE;'>#肺癌治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82232, encryptionId=eb82822328e, topicName=肺癌治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=267533842346, createdName=马龙, createdTime=Wed Oct 12 07:31:00 CST 2016, time=2016-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1707393, encodeId=35c61e0739365, content=<a href='/topic/show?id=25df20e54dc' target=_blank style='color:#2F92EE;'>#专题#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20754, encryptionId=25df20e54dc, topicName=专题)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1f4231418733, createdName=108807375_62823137, createdTime=Sat Jan 02 20:31:00 CST 2016, time=2016-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1688039, encodeId=6c6016880395d, content=<a href='/topic/show?id=577a396e60f' target=_blank style='color:#2F92EE;'>#呼吸病学#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39676, encryptionId=577a396e60f, topicName=呼吸病学)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f99a28444895, createdName=ms306040998833292, createdTime=Sun Nov 13 12:31:00 CST 2016, time=2016-11-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=48950, encodeId=adec48950a3, content=好文章,值得收藏, beContent=null, objectType=article, channel=null, level=null, likeNumber=197, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sun Dec 27 08:38:00 CST 2015, time=2015-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=48951, encodeId=2f5248951b7, content=好文章,值得收藏, beContent=null, objectType=article, channel=null, level=null, likeNumber=143, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sun Dec 27 08:38:00 CST 2015, time=2015-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1606749, encodeId=33461606e49e5, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Sat Dec 05 14:31:00 CST 2015, time=2015-12-05, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1663416, encodeId=064b166341643, content=<a href='/topic/show?id=2653396e53b' target=_blank style='color:#2F92EE;'>#呼吸病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39675, encryptionId=2653396e53b, topicName=呼吸病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ed5525610796, createdName=ms9833124466084992, createdTime=Thu Nov 17 18:31:00 CST 2016, time=2016-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1828335, encodeId=e09918283356a, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Thu May 26 01:31:00 CST 2016, time=2016-05-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1734850, encodeId=91701e3485052, content=<a href='/topic/show?id=eb82822328e' target=_blank style='color:#2F92EE;'>#肺癌治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82232, encryptionId=eb82822328e, topicName=肺癌治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=267533842346, createdName=马龙, createdTime=Wed Oct 12 07:31:00 CST 2016, time=2016-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1707393, encodeId=35c61e0739365, content=<a href='/topic/show?id=25df20e54dc' target=_blank style='color:#2F92EE;'>#专题#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20754, encryptionId=25df20e54dc, topicName=专题)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1f4231418733, createdName=108807375_62823137, createdTime=Sat Jan 02 20:31:00 CST 2016, time=2016-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1688039, encodeId=6c6016880395d, content=<a href='/topic/show?id=577a396e60f' target=_blank style='color:#2F92EE;'>#呼吸病学#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39676, encryptionId=577a396e60f, topicName=呼吸病学)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f99a28444895, createdName=ms306040998833292, createdTime=Sun Nov 13 12:31:00 CST 2016, time=2016-11-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=48950, encodeId=adec48950a3, content=好文章,值得收藏, beContent=null, objectType=article, channel=null, level=null, likeNumber=197, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sun Dec 27 08:38:00 CST 2015, time=2015-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=48951, encodeId=2f5248951b7, content=好文章,值得收藏, beContent=null, objectType=article, channel=null, level=null, likeNumber=143, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sun Dec 27 08:38:00 CST 2015, time=2015-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1606749, encodeId=33461606e49e5, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Sat Dec 05 14:31:00 CST 2015, time=2015-12-05, status=1, ipAttribution=)]
    2015-12-27 hixiaoluo

    好文章,值得收藏

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1663416, encodeId=064b166341643, content=<a href='/topic/show?id=2653396e53b' target=_blank style='color:#2F92EE;'>#呼吸病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39675, encryptionId=2653396e53b, topicName=呼吸病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ed5525610796, createdName=ms9833124466084992, createdTime=Thu Nov 17 18:31:00 CST 2016, time=2016-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1828335, encodeId=e09918283356a, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Thu May 26 01:31:00 CST 2016, time=2016-05-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1734850, encodeId=91701e3485052, content=<a href='/topic/show?id=eb82822328e' target=_blank style='color:#2F92EE;'>#肺癌治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82232, encryptionId=eb82822328e, topicName=肺癌治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=267533842346, createdName=马龙, createdTime=Wed Oct 12 07:31:00 CST 2016, time=2016-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1707393, encodeId=35c61e0739365, content=<a href='/topic/show?id=25df20e54dc' target=_blank style='color:#2F92EE;'>#专题#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20754, encryptionId=25df20e54dc, topicName=专题)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1f4231418733, createdName=108807375_62823137, createdTime=Sat Jan 02 20:31:00 CST 2016, time=2016-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1688039, encodeId=6c6016880395d, content=<a href='/topic/show?id=577a396e60f' target=_blank style='color:#2F92EE;'>#呼吸病学#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39676, encryptionId=577a396e60f, topicName=呼吸病学)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f99a28444895, createdName=ms306040998833292, createdTime=Sun Nov 13 12:31:00 CST 2016, time=2016-11-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=48950, encodeId=adec48950a3, content=好文章,值得收藏, beContent=null, objectType=article, channel=null, level=null, likeNumber=197, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sun Dec 27 08:38:00 CST 2015, time=2015-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=48951, encodeId=2f5248951b7, content=好文章,值得收藏, beContent=null, objectType=article, channel=null, level=null, likeNumber=143, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sun Dec 27 08:38:00 CST 2015, time=2015-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1606749, encodeId=33461606e49e5, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Sat Dec 05 14:31:00 CST 2015, time=2015-12-05, status=1, ipAttribution=)]
    2015-12-27 hixiaoluo

    好文章,值得收藏

    0

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