摘要:目的:探讨血清CA153和BAKP在乳腺癌骨转移显像诊断中的应用。方法:对92例乳腺癌患者的核素骨显像结果、血清CA153和BAKP结果进行回顾性研究。结果:①血清CA15-3和B-AKP的值随着骨转移分期的增高而逐步升高,且差异显著(Plt;0. 01);②血清CA15-3和B-AKP与骨转移的数目呈正相关;③血清CA15-3gt;25 U/mL时,骨转移的阳性率为63.3%,血清CA15-3lt;25 U/mL时,骨转移的阴性预测值为94. 5%;血清B-AKPgt;20 U/L时,骨转移的阳性率为59. 6%时,骨转移的阴性预测值为73.5%;当血清CA15-3lt;25 U/mL同时B-AKPlt;20 U/L时,骨转移的阴性预测值为100%。结论:血清CA15-3和BAKP测定在乳腺癌骨显像诊断中具有重要的应用价值。Abstract: Objective: To evaluate the diagnosis value of serum CA153 and BAKP measurements for scanning bone metastatic images in patients with mammary Cancer. Methods: Retrospective study on the bone scan images and serum CA153 (with CLIA) and bone alkaline phosphatase (BAKP, with ELISA) levels were performed in 92 patients with confirmed mammary gland cancer. Results: ①The serum levels of CA153 and BAKP were increased step by step along with the advancement of bone metastatic grading from M0 to M3 with significant difference between values in successive gradings (Plt;0. 01).②The levels of CA153 and BAKP were significantly positively correlated. ③With serum CA153gt;25 U/mL the positive rate of bone metastasiswas 63.2%, with CA153lt;25 U/mL the negativepredictive value of bone metastasis was 94.5%, with BAKPgt;20 U/L,the positive rate of bone metastasis was 596%, with BAKPlt;20 U/L, the negative predictive value of bone metastasis was 73. 5%.However with Serum CA153lt;25 U/mL and BAKPlt;20 U/L, the negative predictive value of bone metastasis was100%. Conclusion: The combined measurement of the serum CA153 and BAKP levels would play an important role for diagnosis of bone scan images in patients with prostate cancer.
Objective To investigate the feasibil ity, safety and operative techniques of percutaneous vertebroplasty (PVP) in treating osteolytic bone metastasis of cervical vertebra and reconstructing the function of cervical vertebra. Methods From March 2005 to December 2007, 10 patients with osteolytic bone metastatic carcinoma in single cervical vertebral body received PVP, including 5 males and 5 females aged 38-75 years (mean 54.5 years). Among them, 5 patients had primary lung tumor, 1 primary renal tumor, 1 primary breast tumor, 1 primary cervical tumor and 2 unknown primary lesion. The course of disease was 2-4 years. All the patients suffered from obviously cervical pain and l imitation of activity, including 4 cases of metastatic tumor of the C2 vertebral body, 2 of C3, 2 of C6 and 2 of C7. The general condition of patients was stable before operation, and no blood coagulation dysfunction, radiculalgia and spinal cord compression were detected. Lateral PVP was performed on 6 cases, approaching between the vertebral artery and the carotid sheath under CT guidance and anterolateral PVP was performed on the rest 4 cases, approaching between the trachea and the internal carotid artery under continuously X-ray fluoroscopy. The amount of bone cement injected was 3-4 mL, and the fill ing rate was 50%-100%. Results Without obvious bleeding or organ injury, the puncture was performed successfully on all the patients. Without symptom of spinal cord compression, patients suffered from pain during operation (1 case) and such compl ications noted by immediate CT or X-rays examination after operation as paravertebral epidural cement leakage (2 ases),transverse foramen cement leakage (1 case) and pinhole reflux (3 cases). The pain of patients was improved to various degree postoperatively, the visual analogue scales score was (5.9 ± 1.2) points before operation, which was changed to (2.6 ± 1.2) points at 1 hour after PVP and (1.6 ± 1.3) points at 1 week after PVP, indicating there was a significant difference between pre- and postoperation (P lt; 0.05). During the regular follow-up at 1 week, 3 and 12 months after PVP, all patients had no dislocation of cervical vertebra body, spinal cord compression and paralysis. Five patients died from multiple organ failure due to primary tumor progression, including 3 cases at 6 months after PVP and 2 at 12 months after PVP, and the rest 5 patients’ cervical pain were under control, with sound functional recovery. Conclusion PVP can rel ieve pain quickly and reinforce the stabil ity of the vertebral body, and has sl ight compl ications; the lateral approach is safe and effective.
目的 探讨影响乳腺癌骨转移发生、发展的因素及治疗方法。 方法 对106例乳腺癌骨转移患者的临床特点及近期疗效进行回顾性总结。 结果 乳腺癌骨转移的发生及发生早晚与腋窝淋巴结的转移数目相关。治疗以全身治疗为主，包括化疗、内分泌治疗、放疗、放射性同位素内照射及二磷酸盐的综合治疗。 结论 乳腺癌患者，特别是伴有较多数目腋窝淋巴结转移者，应进行同位素骨扫描检查，一旦出现骨转移，应积极进行全身治疗，转移局限者，可进行局部外放射治疗。
Objective To determine the efficacy of radioisotopes to control metastasic pain in patients with tumor bone metastases and complications due to bone metastases (hypercalcaemia, bone fracture and spinal cord compression). The effectiveness of radioisotopes in relation to patient survival and adverse effects were also assessed. Methods MEDLINE (1966 to April 2005),EMBASE (1966 to April 2005), The Cochrane Library (Issue 1, 2005) and CBMdisc (1979 to April 2005) were searched for randomized controlled trials (RCTs). Data were extracted by two reviewers using a designed extraction form. The quality of included RCTs was critically assessed. RevMan 4.2 software was used for data analysis. Results Four RCTs were included. The results of meta-analysis showed that small dose of radioisotopes couldn’t control metastatic pain in short term(2 months) with relative risk (RR) 1.13, 95%confidence interval (CI) 0.34 to 3.76, but large dose can significantly control metastatic pain in medium term(6 month) with RR 1.90, 95％CI 1.23 to 2.92; no evidence was available to assess long term(≥12 months) effects. No study provided data on quality of life, mortality, bone metastatic complications (hypercalcaemia, bone fracture) and analgesic use etc. Leukocytopenia and thrombocytopenia were secondary effects associated with the administration of radioisotopes. The incidences of leukocytopenia and thrombocytopenia were significantly greater in patients treated by radioisotopes with RR 8.28, 95％CI 2.24 to 30.67, and RR 3.70, 95％CI 1.59 to 9.04, respectively. Conclusions There is some evidence indicating that large dose of radioisotopes can relieve metastatic bone pain over one to six months, but adverse effects, particularly leukocytopenia and thrombocytopenia, have also been experienced.
目的 探讨宫颈癌骨转移相关因素。 方法 回顾分析2008年6月－2011年8月收治的352例宫颈癌患者的临床资料，其中鳞癌326例，腺癌26例；临床分期Ⅰ期60例、Ⅱ期184例、Ⅲ期90例、Ⅳ期18例。比较不同期别、不同病理类型、不同组织分级患者的骨转移情况。 结果 352例宫颈癌中有18例发现骨转移，转移率为5.1%；转移时间为3～48个月，2例于骨转移后1年内死亡。鳞癌326例，骨转移率为5.2%；腺癌26例，骨转移率为3.8%。Ⅰ、Ⅱ、Ⅲ和Ⅳ期患者的骨转移率分别为0.0%、3.8%、5.6%和33.3%，晚期与早期相比有统计学意义（P＜0.05）；高、中和低分化患者骨转移率分别为3.1%、3.1%和6.3%，高分化与中分化相比，差异无统计学意义（P＞0.05），低分化与高中分化相比差异有统计学意义(P＜0.05)。 结论 宫颈癌骨转移与宫颈癌临床分期、病理类型、细胞分级密切相关。在宫颈癌的治疗过程中，做到早发现、早治疗，可提高患者的治疗效果，延长生存时间。
Objective To predict the patients who can benefit from local surgery for bone-only metastatic breast cancer (bMBC). Methods Patients newly diagnosed with bMBC between 2010 and 2019 in SEER database were randomly divided into a training set and a validation set at a ratio of 7∶3. The Cox proportional hazards model was used to analyze the independent prognostic factors of overall survival in the training set, and the variables were screened and the prognostic prediction model was constructed. The concordance index (C-index), time-dependent clinical receiver operating characteristic curve and area under the curve (AUC), calibration curve and decision curve analysis (DCA) were used to evaluate the discrimination, calibration and clinical applicability of the model in the training set and validation set, respectively. The model was used to calculate the patient risk score and classify the patients into low-, medium- and high-risk groups. Survival analysis was used to compare the survival difference between surgical and non-surgical patients in different risk groups. Results A total of 2057 patients were enrolled with a median age of 45 years (interquartile range 47-62 years) and a median follow-up of 32 months (interquartile range 16-53 months). Totally 865 patients (42.1%) died. Multivariate Cox proportional hazards model analysis showed that the overall survival of patients with surgery was better than that of patients without surgery [hazard ratio=0.51, 95% confidence interval (0.43, 0.60), P<0.001]. Chemotherapy, marital status, molecular subtype, age, pathological type and histological grade were independent prognostic factors for overall survival (P<0.05), and a prognostic prediction model was constructed based on the independent prognostic factors. The C-index was 0.702 in the training set and 0.703 in the validation set. The 1-, 3-, and 5-year AUCs of the training set and validation set were 0.734, 0.727, 0.731 and 0.755, 0.737, 0.708, respectively. The calibration curve showed that the predicted survival rates of 1, 3, and 5 years in the training set and the validation set were highly consistent with the actual survival rates. DCA showed that the prediction model had certain clinical applicability in the training set and the validation set. Patients were divided into low-, medium- and high-risk subgroups according to their risk scores. The results of log-rank test showed that local surgery improved overall survival in the low-risk group (training set: P=0.013; validation set: P=0.024), but local surgery did not improve overall survival in the medium-risk group (training set: P=0.45; validation set: P=0.77) or high-risk group (training set: P=0.56; validation set: P=0.94). Conclusions Local surgery can improve the overall survival of some patients with newly diagnosed bMBC. The prognostic stratification model based on clinicopathological features can evaluate the benefit of local surgery in patients with newly diagnosed bMBC.
Objective To systematically evaluate the effectiveness and safety of zoledronic acid combined with radiotherapy in treating bone metastasis of malignant tumor. Methods Such databases as PubMed, EMbase, The Cochrane Library (Issue 10, 2012), CBM, CNKI, VIP and WanFang Data were searched to collect randomized clinical trials (RCTs) on bone metastasis of malignant tumor from inception to October, 2012. References of included studies were also retrieved. Two reviewers independently screened studies according to exclusion and inclusion criteria, extracted data, and assessed the methodological quality. Then, meta-analysis was performed using RevMan 5.1 software. Results Twenty nine trials were included involving 2 021 patients. The results of meta-analysis showed that, compared with the radiotherapy alone group, zoledronic acid combined with radiotherapy improved the effectiveness rate of pain relieving at the end of treatment (OR=3.08, 95%CI 2.30 to 4.12, Plt;0.000 01), the effectiveness rate of pain relieving two weeks after treatment (OR=3.39, 95%CI 2.52 to 4.56, Plt;0.000 01), the quality of life (OR=2.74, 95%CI 1.66 to 4.52, Plt;0.000 01) and the ability of movement (OR=2.96, 95%CI 2.16 to 4.05, Plt;0.000 01). Zoledronic acid combined with radiotherapy also reduced the incidence of new bone metastasis (OR=0.21, 95%CI 0.10 to 0.45, Plt;0.000 1) and the incidence rate of bone-related events (OR=0.17, 95%CI 0.03 to 0.92, P=0.04). The adverse reactions of zoledronic acid combined with radiotherapy such as fever (OR=11.92, 95%CI 6.31 to 22.48, Plt;0.000 01) and hypocalcaemia (OR=8.82, 95%CI 1.61 to 48.36, P=0.01), significantly increased. Conclusion Compared with radiotherapy alone, zoledronic acid combined with radiotherapy can relieve bone metastatic pain, effectively enhance patients’ ability of movement, improve quality of life, and decrease new bone metastasis and the occurrence of bone-related events.
【摘要】 目的 评价伴骨转移的非小细胞肺癌（non-small cell lung cancer，NSCLC）患者在接受帕米膦酸二钠和唑来膦酸治疗后的有效性和安全性。 方法 2007年6月-2008年12月，74例伴骨转移的NSCLC，患者接受了双膦酸盐治疗，其中50例接受帕米膦酸二钠治疗，24例接受唑来膦酸治疗。帕米膦酸二钠90 mg，静脉滴注3 h，每4周重复1次；唑来膦酸4 mg，静脉滴注15 min，每4周重复1次。对可能影响其骨相关事件发生时间及生存率的各种临床﹑病理、治疗方法等因素进行分析，用Kaplan-Meier曲线及Log rank检验生存率差异，对不良反应的发生率等采用χ2检验。 结果 18个月无骨相关事件生存率和总体生存率在帕米膦酸二钠及唑来膦酸组分别为19.3%、28.9%（P=0.253）和33.4%、38.2%（P=0.745），两组比较，差异均无统计学意义。两组患者不良反应中帕米膦酸二钠组8例（16.0%），唑来膦酸组6例（25.0%），两组比较差异无统计学意义（χ2=0.200，P=0.655）。7例患者用帕米膦酸二钠治疗失败后再用唑来膦酸治疗，其中位无骨相关事件生存时间为2个月（95%CI：0~4.6）。 结论 唑来膦酸和帕米膦酸二钠在缓解延迟骨相关事件发生时间疗效和不良反应发生率相当。用帕米膦酸二钠治疗失败后再用唑来膦酸可延缓骨相关事件发生时间。【Abstract】 Objective To retrospectively evaluate the efficacy and safety of pamidronate disoclium and zoledronic acid in treating non-small-cell lung cancer (NSCLC) patients with bone metastasis. Methods This study included 74 patients who were treated with bisphosphonate between June 2007 and December 2008. Fifty were treated with pamidronate disodium, and 24 with zoledronic acid. Pamidronate disodium was administered intravenously once for 3 hours every 4 weeks at a dose of 90 mg. Zoledronic acid was given intravenously once for 15 minutes every 4 weeks at a dose of 4 mg. Various clinical, pathological factors and treatment methods related to the occurring time of skeletal related events (SRE) and survival rate were analyzed. Kaplan-Meier curve and Log rank were adopted to detect the difference in survival rate between patients treated with different medicine, and we used χ2 test to discover the rate of adverse events of the patients. Results Eighteen-month SRE-free survival and overall survival rate in the pamidronate disodium and zoledronic acid group were 19.3% vs. 28.9% (P=0.253), and 33.4% vs. 38.2% (P=0.745) respectively. There were 8 (8/50) cases of adverse events in the pamidronate disodium group, and 6 (6/24) in the zoledronic acid group (χ2=0.200, P=0.655). The SRE-free survival time for seven patients who were treated with zoledronic acid after pamidronate disodium failed was 2 months (95%CI: 0-4.6). Conclusions Compared with zoledronic acid, pamidronate has equal efficacy in delaying SRE and incidence of adverse effects. Administering zoledronic acid after pamidronate failed can also delay the occurring time of SRE.