【摘要】 目的 分析交叉抗原表达的急性白血病的临床特征及缓解率。 方法 对2009年10月-2010年11月血液内科的210例交叉表达髓系和淋巴细胞系相关抗原的初治急性白血病患者的标本，采用流式细胞术检测白血病细胞的免疫表型，根据免疫标记和FAB（French、American、Britain）分型进行分组，分析其异质性的生物学特征和影响缓解率的相关因素。 结果 210例急性白血病的FAB分型以AML-M1/M2（82例）和ALL（78例）为主；免疫分型以B淋巴细胞系和髓系混合表达多见（116例），其中CD34表达率高达91.4%（192例）， CD7表达率为50.5%（106例），且与CD34相关（P=0.04）；出现CD34、CD7、CD19三者共表达的患者缓解率较低（9.09%）。 结论 交叉抗原表达的急性白血病的诊断有赖于免疫分型的判断，其分化抗原的表达类型是影响其缓解率的重要因素。【Abstract】 Objective To observe the clinical characters of acute leukemia with cross-lineage antigen expression and analyze the remission rate. Methods Between October 2009 and November 2010, 210 patients were diagnosed and classified by morphology. Cytochemistry and immunology were used to analyze the immunophenotype. According to the immunostaining relative factors and FAB (French, American, and Britain) phenotype standard, the samples were divided into several groups. The conical characters and relative factors of remission rate were analyzed. Results In 210 patients with cross-lineage antigen expression, AL, AML-M1/M2 (82 cases) and ALL (78 cases) were common in FAB phenotype,and cross-lineage of B lineage and myelolineage were common in immunotype (116 cases). CD34 got the highest expression frequency of all (192 cases),and had the most important effect on patients′ prognosis. CD7 was also positive commonly (106 cases) and related with CD34 (P=0.04). So it′s significant for the outcome. The patients who got co-expression of CD34, CD7 and CD19 had worse prognoses. Conclusions Acute leukemia with cross-lineage antigen expression is a special type and is confirmed by immunotype. Furthermore, expression types of differentiation antigen are critical for the prognosis.
ObjectiveTo explore clinical efficacy of Frey procedures for chronic pancreatitis. MethodsThirty two patients with chronic pancreatitis who underwent Frey procedures in our hospital from June 2000 to October 2009 were analyzed retrospectively. The rate of perioperative complications, pain relief, and especially endocrine and exocrine function of pancreas in longterm followup (mean 43 months) were analyzed. ResultsNo death occurred in all patients. Fat liquefaction of wound was found in two patients and pancreatic fistula was found in one patient, who was cured by conventional treatment. So the rate of perioperative complications was 9.4%(3/32). After Frey procedures, pain disappeared completely in sixteen patients (50.0%), pain relieved in fourteen patients (43.8%) and two cases were ineffective. Therefore, the rate of pain relief in longterm follow-up was 93.8%. The hospitalization was (11±2) d. After surgical treatment the illness of five patients with diabetes mellitus did not aggravate while new onset of diabetes mellitus was observed in three cases. For three cases who suffered from indigestion and steatorrhea, symptomatic relief was found in one patient treated by oral administration of pancreatin and inefficacy was observed in two cases. But four patients with new steatorrhea were found after operation. ConclusionUnder the strict surgical indications, Frey procedure is a safe and effective surgical method for the treatment of chronic pancreatitis.
ObjectiveTo analyze the clinical efficacy of decitabine contained chemotherapy regimens in the treatment of relapsed or refractory acute myeloid leukemia (AML) patients.MethodsA total of 101 patients with relapsed or refractory AML from May 2014 to December 2017 were collected retrospectively. Three schemes with a relatively larger number of users were included: 15 cases were treated with decitabine monotherapy (DAC regime); 37 cases were treated with decitabine, anthracycline antibiotic, and cytarabine (D-DA regime); and 49 cases were treated with decitabine, cytarabine, aclarubicin, and granulocyte colony-stimulatingfactor (G-CSF) (D-CAG regimen). The remission rate, blood products support strength, degree and duration of bone marrow suppression, adverse reaction, and survival time were compared.ResultsThe complete remission (CR) rates of DAC, D-DA and D-CAG regimen group were 40.0%, 48.6%, and 71.4%, respectively; the overall respond rates (ORR) were 46.7%, 54.1%, and 79.6%, respectively. The ORR in D-CAG regimen group was higher than those in the other two groups (P<0.017). The dosage of G-CSF in D-CAG regimen group were lower than those in DAC regimen group [ (1 363.0±1 037.9) vs. (2 517.0±1 163.4) μg, P<0.05]; the mean number of erythrocyte transfusion and the dosage of G-CSF were lower than those in D-DA regimen group [(6.7±4.0) vs. (14.8±10.1) U, P<0.05; (1 363.0±1 037.9) vs. (2 786.0±1474.0) μg, P<0.05]; the time to the suppression of hemoglobin and platelet in D-CAG regimen group were later than those in D-DA regimen group [(11.5±2.6) vs. (8.8±2.5) days, P=0.007; (10.9±2.6) vs. (7.6±2.5) days, P=0.002]; the time to the suppression of platelet was later than that in DAC regimen group [(10.9±2.6) vs. (7.6±1.6) days, P=0.003]. There was no statistically significant difference in the incidence of adverse reations among the three group (P>0.05). The median overall survival of D-CAG regimen group was longer than that in DAC regimen group (11.6 vs. 8.8 months, P=0.013).ConclusionAmong the three chemotherapy regimens containing decitabine, the CR and ORR of D-CAG regimen are higher, the tolerance is better, and further promotion can be attempted in qualified medical institutions.
ObjectiveTo systematically review the value of autoantibodies to serum M-type phospholipase A2 receptor (PLA2R) in predicting spontaneous and therapeutic remission rates of idiopathic membranous nephropathy (IMN).MethodsPubMed, Embase, Clinical Trails, China National Knowledge Infrastructure, China Biology Medicine, Wanfang, and CQVIP databases were searched for studies on remission of IMN associated with PLA2R antibody published from inception to December 2020. Binary variables were extracted according to PLA2R antibody positive and negative groups. Newcastle-Ottawa Scale was used to evaluate the literature quality. Meta analyses were performed in RevMan 5.3 software, and relative risk (RR) and its 95% confidence interval (CI) were calculated. Publication bias was analyzed by Stata 15.0 software.ResultsA total of 15 articles were included in the meta-analysis, all of which were cohort studies (erther retrospective or prospective). A total of 1 452 patients with IMN were enrolled in the study. Among them, the spontaneous remission rate of IMN patients without immunosuppressive therapy was observed in 6 articles, and the therapeutic remission rate of IMN patients receiving immunosuppressive therapy was observed in 13 articles (both spontaneous remission rate and therapeutic remission rate were observed in 4 articles). Meta-analysis results showed that the spontaneous remission rate in the PLA2R antibody positive group was significantly lower than that in the PLA2R antibody negative group [RR=0.73, 95%CI (0.55, 0.97), P=0.03]. For IMN patients receiving immunosuppressive therapy, the remission rate in the PLA2R antibody positive group was significantly lower than that in the PLA2R antibody negative group at diagnosis [RR=0.81, 95%CI (0.72, 0.92), P=0.000 9].ConclusionsThe spontaneous remission rate of IMN with PLA2R antibody positive at diagnosis and the remission rate under the immunosuppressive therapy are significantly lower than those with PLA2R antibody negative. For IMN patients with negative PLA2R antibody, non-immunosuppressive therapy may be preferred to reduce the risk of adverse reactions due to its relatively high spontaneous remission rate. For IMN patients with PLA2R antibody positive, a more aggressive, longer-term immunosuppressive therapy may be required, given its lower spontaneous and therapeutic remission rates.
ObjectiveTo analyze the relation between age and postoperative pathological features of patients with colorectal cancer from Database from Colorectal Cancerr （DACCA）. MethodsThe data in DACCA were updated on January 5, 2022. The patients were selected from DACCA according to the established screening conditions, then were divided into ≤35, 35–59, and ≥60 years old groups. The differences of postoperative pathological （p） TNM （pTNM）, pT, pN, pM stages, perineural invasion （PNI）, high-risk factors grade, and tumor regression grade （TRG） among the three age groups were analyzed, and the correlation between them was analyzed. ResultsAfter screening, 5 628 data rows were enrolled, of whom 196 patients were <35 years old, 2 382 patients were 35–59 years old, and 3 050 patients were >59 years old. Statistical analysis showed that: ① There were statistical differences in the proportions of pN stage, PNI, and high-risk factors grade in the patients of different age groups （H=27.867, P<0.001; H=6.248, P=0.044; H=19.712, P<0.001, respectively）; However, it was not found that there were statistical differences in the proportions of pTNM, pT, pM stages, and TRG after neoadjuvant therapy among different age patients （H=0.920, P=0.631; H=4.923, P=0.085; H=2.272, P=0.321; H=2.337, P=0.311, respectively）. The Spearman correlation analysis results showed that there was a weakly negative correlation between the age and pN stage or grade of high-risk factors （rs=–0.070, P<0.001; rs=–0.067, P<0.001, respectively） and a weakly positive correlation between age and TRG after neoadjuvant therapy （rs=0.100, P=0.009）. ConclusionDACCA data analysis finds that patients of different age groups shows a negative correlation trend with pN stage or grade of high-risk factors and a positive correlation trend with TRG, which needs to be further verified.
ObjectiveTo investigate the short-term therapeutic effect of neoadjuvant immunotherapy combined with chemotherapy in the locally advanced esophageal squamous cell carcinoma. MethodsThe clinical data of patients with esophageal squamous cell carcinoma treated with neoadjuvant treatment in Gaozhou People's Hospital from August 2019 to October 2020 were retrospectively analyzed. According to the different treatments, the patients were divided into two groups: a neoadjuvant immunotherapy combined with chemotherapy group (NIC group) and a neoadjuvant chemoradiotherapy group (NC group). The baseline data, incidence of adverse events during treatment, perioperative indicators, postoperative pathological remission rate and incidence of postoperative complications were compared between the two groups. ResultsTotally 33 patients were enrolled, including 15 males and 18 females, with an average age of 62.37±7.99 years. There were 17 patients in the NIC group and 16 patients in the NC group. In the NIC group, the carcinoma was mainly located in the middle and lower esophagus, with 5 paitents in stage Ⅱ, 9 patients in stage Ⅲ, and 3 patients in stage Ⅳa. In the NC group, the carcinoma was mainly located in the upper-middle esophagus, with 1 patient in stage Ⅱ and 15 patients in stage Ⅲ. During the neoadjuvant treatment, there was no significant difference in the occurrence of bone marrow suppression or gastrointestinal reactions between the two groups (P>0.05). There were 4 immune-related rashes in the NIC group and 1 esophageal perforation in the NC group. Fourteen (82.35%) patients in the NIC group and 12 (75.00%) patients in the NC group completed the operation on schedule. The postoperative ICU stay time and chest tube indwelling time in the NIC group were shorter than those in the NC group (P<0.05). There were 5 patients of complete remission in the NIC group, and 6 patients in the NC group. There was no significant difference in the pathological regression grade or residual tumor cells between the two groups (P>0.05). There was no significant difference in the incidence of anastomotic fistula, thoracic gastric fistula, bronchial mediastinal fistula, abdominal distension, pulmonary infection, stroke, or hoarseness during the perioperative period between the two groups of patients who completed the operation (P>0.05). In the NC group, 2 patients died during the perioperative period because of thoracic gastric fistula complicated by severe infection. ConclusionNeoadjuvant immunotherapy combined with chemotherapy dose not significantly increase the occurrence of adverse events and shows a good rate of pathological remission, which indicates that the neoadjuvant immunotherapy combined with chemotherapy is a safe, feasible and potential new treatment model.
Objective To observe the short-term efficacy and safety of neoadjuvant sintilimab combined with chemotherapy in the treatment of patients with locally advanced resectable esophageal squamous cell carcinoma (ESCC). MethodsClinical data were collected from patients with locally advanced resectable ESCC who received neoadjuvant immunotherapy combined with chemotherapy followed by surgical treatment at the Department of Thoracic Surgery of Jining First People's Hospital from April 2020 to April 2022. The endpoints included major pathological response (MPR), pathological complete response (pCR), R0 resection rate, safety, and postoperative survival. Results A total of 43 patients with ESCC who received at least one cycle of neoadjuvant immunotherapy before surgery were included. Among them, there were 31 males and 12 females, aged from 46 to 77 years, with a median age of 65 years. All patients successfully completed the surgery without any surgical delays. The pCR rate was 14.0% (6/43), the MPR rate was 58.1% (25/43), and the R0 resection rate was 97.7% (42/43). Patients exhibited reliable safety during neoadjuvant therapy and postoperatively. The 2-year overall survival and disease-free survival rates were 90.7% and 81.4%, respectively. Kaplan-Meier survival analysis and log-rank test revealed lower recurrence rates and better survival in the MPR group compared to the non-MPR group. Conclusion The combination of neoadjuvant sintilimab and chemotherapy in the treatment of patients with locally advanced resectable ESCC has demonstrated significant clinical efficacy, while also being safe and reliable.
ObjectiveTo investigate the effect of Yttrium-90 selective internal radiotherapy (90Y-SIRT) on tumor control and compensatory hyperplasia of left hepatic lobe in the treatment of right hepatic malignant tumor. MethodsThe clinical data of 134 patients with liver malignant tumor (primary or secondary) who were treated with 90Y-SIRT in the Department of Hepatobiliary and Pancreatic Surgery, Beijing Tsinghua Changgung Hospital from September 2022 to November 2023 were collected, and 29 patients who met the inclusion and exclusion criteria were analyzed retrospectively. The liver volume, tumor volume, postoperative future liver remnant (FLR) and the percentage of FLR proliferation before and after treatment were measured by CT or MRI, and the surgical resection rate and pathological necrosis rate of tumor focus after 90Y-SIRT treatment were analyzed. The liver volume, tumor volume, postoperative future liver remnant (FLR) and the percentage of FLR hyperplasia were measured by CT or MRI before and 1 and 3 months after 90Y-SIRT, and the surgical resection rate and pathological necrosis rate of tumor lesions after 90Y-SIRT treatment were analyzed. ResultsOf the 29 patients, 22 patients with hepatocellular carcinoma, 2 patients with cholangiocarcinoma and 5 patients with liver metastases from colorectal cancer received 90Y-SIRT of the right liver. At 1 and 3 months after treatment, the tumor volume average decreased by 149.2 mL (P=0.124) and 228.2 mL (P=0.012), the right liver volume was average reduced by 197.4 mL (P=0.026) and 318.6 mL (P=0.023), the left liver volume average increased by 64.9 mL (P=0.261) and 144.7 mL (P=0.124), and the percentage of FLR increased by 6.6% (P=0.018) and 13.4% (P＜0.001) of 29 patients, respectively. Three months after operation, mRECIST standard was used to evaluate the curative effect of tumor imaging. The results showed that the objective response rate of tumor was 79.3% and the disease control rate was 93.1%. Conclusions90Y-SIRT can effectively control the growth of malignant tumors in the right lobe of the liver and induce compensatory hyperplasia of the left liver. At the same time, high objective response rate and pathological necrosis rate of tumor lesions can be obtained.