Objective To systematically review the effectiveness and safety of radiotherapy combined with short-term or long-term hormonal therapy for prostate cancer. Methods Databases including EMbase, PubMed, Web of Science, CENTRAL and CBM were searched from inception to August 2012 to collect the randomized controlled trials (RCTs) on radiotherapy combined with short-term or long-term hormonal therapy for prostate cancer. According to the inclusion and exclusion criteria, data of the included studies were extracted, and the methodological quality was evaluated. Then meta-analysis was performed using RevMan 5.1, and the evidence qualities and recommendation levels were determined according to the GRADE System. Results A total of 6 RCTs involving 3157 patients were included. The results of meta-analysis showed that there were no significant differences in the overall survival rate (RR=0.95, 95%CI 0.91 to 1.00) and the disease-free survival rate (RR=0.73, 95%CI 0.46 to 1.13) between the radiotherapy plus short-term hormonal therapy group (the short-term group) and the radiotherapy plus long-term hormonal therapy group (the long-term group). The long-term group was superior to the short-term group in biochemical failure-free survival rate (RR=0.81, 95%CI 0.68 to 0.97), clinical progression rate (RR=1.61, 95%CI 1.44 to 1.80), and prostate cancer-specific mortality (RR=1.44, 95%CI 1.16 to 1.80). Based on the GRADE system, the evidence level of biochemical failure-free survival was moderate with a weak recommendation; the evidence level of disease-free survival was low with a weak recommendation; the evidence level of overall survival was high with a weak recommendation; and the evidence levels of clinical progression rate and prostate cancer-specific mortality were high with a b recommendation. Conclusion Currently, the limited evidence shows extending the length of hormone therapy is beneficial for patients with localized prostate cancer and locally advanced prostate cancer, especially for patients with high Gleason score, but it cannot raise overall survival rate and disease-free survival rate. This conclusion still needs to be further proved by more high-quality and large-scale RCTs.
Objective To investigate the postoperative biochemical changes and the strategy of steroid treatment for autoimmune pancreatitis （AIP）. Methods Six patients with AIP from January 2007 to October 2011 in this hospital were included in this study. Four patients received pancreaticoduodenectomy or distal pancreatectomy for being preoperatively misdiagnosed as malignant tumors. Two patients avoided the unnecessary resection and received the internal drainage for obstructive jaundice and postoperative steroid medication because of a confirmation of AIP by intraoperative frozen biopsy. All the patients underwent routine examinations， including liver function， CA19-9 level， and imaging data. Measurement of serum IgG or IgG4 was performed for fewer patients after operation. Results CA19-9 levels were normal or slightly elevated in six AIP patients. For five patients with AIP in the head of pancreas， preoperative serum γ-GT levels were elevated. For these patients， whether pancreaticoduodenectomy or the internal drainage were performed， TB/DB levels were transiently elevated on day 1 or 4 after operation but dropped to below preoperative levelsor normal levels on day 7 after operation， and serum γ-GT levels among them presented a downward. Serum γ-globulin levels exhibited a downward trend among four AIP patients after resection， while a upward trend was found in another two AIP patients receiving internal drainage. From the limited data， elevated serum level of IgG in the AIP patients were found. As to IgG4， the only case was tested on month 7 after operation， the serum IgG4 level was elevated. CT showed that the swollen status of pancreas obviously reduced on month 3 after operation as compared with before operation.Conclusions Postoperative steroid therapy of AIP should be based on the serum γ-globulin level and operation method. CT or MRI imaging is used to evaluate the response to steroid treatment for the AIP patients.
ObjectiveTo explore the clinical characteristics of idiopathic hypereosinophilic syndrome (IHES), and improve the early diagnosis and treatment of such diseases.MethodsThe clinical diagnosis and treatment data were retrospectively analyzed from the patients with confirmed IHES hospitalized in China-Japan Friendship Hospital between September 2010 to May 2018.ResultsFifteen patients were included. There were 3 women and 12 men in the study, with an average age of 53.7±21.3 years. Eleven patients had respiratory problems, with an average course of 7 months. Most lesions occurred in both lungs. Patchy distribution, ground glass opacity, pleural effusion and mediastinal lymph node enlargement were common in the chest computed tomography. Serum total IgE was significantly increased. Four patients had other systems involved rather than respiratory system. One of them had digestive problems and another 3 had skin diseases. There was a significant increase in eosinophils in peripheral blood, bone marrow and histopathology, the same as eosinophils in sputum, pleural effusion, and bronchoalveolar lavage fluid. Hypoxemia was common in patients with respiratory problems. The blood eosinophil and total IgE were reduced after glucocorticoid treatment, and the hypoxemia was significantly improved.ConclusionsThe clinical symptoms, signs and image of chest computed tomography are not specific in IHES, so the rate of misdiagnosis and wrong diagnosis is high. This disease involves many organs or systems, so the pathological examination should be completed as soon as possible to make a clear diagnosis to prevent further damage. Glucocorticoid treatment is effective in this disease.