目的：采用Meta分析评估miR-17-92簇高表达在肿瘤患者预后中的价值。方法：检索Web of Science、Pub Med、EMBASE数据库从建库至2015年10月1日关于miR-17-92簇成员高表达与恶性肿瘤患者预后关系的英文文献,提取关键数据,计算合并风险比...目的：采用Meta分析评估miR-17-92簇高表达在肿瘤患者预后中的价值。方法：检索Web of Science、Pub Med、EMBASE数据库从建库至2015年10月1日关于miR-17-92簇成员高表达与恶性肿瘤患者预后关系的英文文献,提取关键数据,计算合并风险比（hazard ratio,HR）及其95%置信区间（confidence interval,CI）。结果：共纳入39篇文献,包含4 908例患者。miR-17-92簇的高表达与恶性肿瘤患者总生存率（HR=1.83,95%CI：1.58-2.12,P=0.000）低有关,并且miR-17-92簇高表达的肿瘤患者的无病生存率（HR=1.80,95%CI：1.43-2.26,P=0.000）、无进展生存率（HR=1.83,95%CI：1.11-3.02,P=0.018）及肿瘤特异性生存率（HR=1.59,95%CI：1.04-2.42,P=0.032）均降低;然而无复发生存率的合并风险比无统计学意义（P=0.539）。结论：miR-17-92簇高表达与恶性肿瘤患者的不良预后有关,有望成为新型肿瘤预后标志物。展开更多
患者,女,20岁,因发现外阴肿物4月,头皮肿物1周于2012年10月31个日入院。4个月前发现外阴肿物,未予特殊处理,肿物逐渐增大。1周前发现头皮肿物,伴头痛头晕入住我院颅脑外科。患者既往史、月经史及家族史均无特殊。入院体格检查：体温36.8...患者,女,20岁,因发现外阴肿物4月,头皮肿物1周于2012年10月31个日入院。4个月前发现外阴肿物,未予特殊处理,肿物逐渐增大。1周前发现头皮肿物,伴头痛头晕入住我院颅脑外科。患者既往史、月经史及家族史均无特殊。入院体格检查：体温36.8℃,脉搏79次/min,呼吸12次/min,血压120/73 mm Hg。意识清楚,双侧瞳孔等大等圆,对光反射灵敏,心肺腹检查未见异常,颌下及腋窝末触及肿大淋巴结。展开更多
目前免疫检查点抑制剂针对恶性肿瘤有较好的疗效,但其引起的重度免疫相关的不良反应较少。1例70岁的男性肺鳞癌患者经治1月后出现视物模糊,上眼睑提肌无力,眼球运动障碍,颈部肌肉无力,无法平卧等临床症状,结合实验室检查及临床症状考虑...目前免疫检查点抑制剂针对恶性肿瘤有较好的疗效,但其引起的重度免疫相关的不良反应较少。1例70岁的男性肺鳞癌患者经治1月后出现视物模糊,上眼睑提肌无力,眼球运动障碍,颈部肌肉无力,无法平卧等临床症状,结合实验室检查及临床症状考虑为重症肌无力合并免疫相关性心肌炎,立即予以甲强龙联合丙种球蛋白治疗等综合治疗,后患者症状明显改善。结合该患者的诊疗方案我们得出结论,在应用卡瑞利珠单抗等抗PD-1治疗时,应监测患者肝肾功能、心肌酶谱、神经系统功能等指标,一旦出现免疫相关不良反应累及神经系统及心脏时,应立即并永久停药,并给予足够的皮质类固醇和免疫球蛋白治疗,同时可联合溴吡斯的明减少后遗症的发生。我们报道此例卡瑞利珠单抗治疗后诱发重症肌无力合并免疫相关性心肌炎通过治疗好转的病例,同时进行文献回顾,以期为重度免疫相关不良反应诊治提供一些治疗策略参考。At present, immune checkpoint inhibitors have a good effect on malignant tumors, but they cause few severe immune-related adverse reactions. A 70-year-old male patient with lung squamous cell carcinoma developed blurred vision, weakness of the levator muscle of the upper eyelid, eye movement disorder, neck muscle weakness, and inability to lie down one month after treatment. Combined with laboratory tests and clinical symptoms, the patient was considered as myasthenia gravis combined with immune-related myocarditis. Based on the diagnosis and treatment plan of this patient, we conclude that liver and kidney function, myocardial enzyme spectrum, and nervous system function should be monitored during the application of anti-PD-1 therapy such as Camrelizumab. Once immune-related adverse reactions occur involving the nervous system and heart, the drug should be stopped immediately and permanently, and adequate corticosteroid and immunoglobulin should be given. It can be combined with pyridostigmine bromide to reduce the occurrence of sequelae. We report a case of myasthenia gravis complicated with immune-related myocarditis induced by Camrelizumab and review the literature in order to provide some treatment strategies for the diagnosis and treatment of severe immune-related adverse reactions.展开更多
临床上巨大胸腺瘤案例罕见,对于IVa期巨大胸腺瘤治疗方法尚无共识,且可供选择的治疗方法又尤为缺乏。本文介绍一例35岁Masaoka IVa期巨大胸腺瘤的患者,行手术切除后联合化疗及免疫治疗,获得无复发生存时间(Recurrence Free Survival, R...临床上巨大胸腺瘤案例罕见,对于IVa期巨大胸腺瘤治疗方法尚无共识,且可供选择的治疗方法又尤为缺乏。本文介绍一例35岁Masaoka IVa期巨大胸腺瘤的患者,行手术切除后联合化疗及免疫治疗,获得无复发生存时间(Recurrence Free Survival, RFS)为13个月,复发后又通过局部放疗联合化疗、免疫治疗后基本达到完全缓解(Complete Response, CR)。临床上对于Masaoka IVa期巨大胸腺瘤患者应采取多学科诊疗模式,即以手术为主,全身及局部治疗为辅的治疗模式下进行。随着免疫治疗在胸腺瘤中的机制及疗效正不断被披露,本例患者加用免疫治疗后取得不错的疗效,且未见明显副作用,这也提示我们免疫治疗的加入或可使难治性胸腺瘤从治疗中获益,或为临床决策提供了更多的选择。Giant thymoma cases are rare in clinical practice, and there remains a lack of consensus regarding treatment approaches for stage IVa giant thymomas. Furthermore, the available treatment options are limited. The present study reports on a case of a 35-year-old patient diagnosed with Masaoka stage IVa thymoma, who underwent surgical resection followed by combined chemotherapy and immunotherapy, achieving a recurrence-free survival time (RFS) of 13 months. Furthermore, upon relapse, the patient attained near-complete response (CR) through local radiotherapy in combination with chemotherapy and immunotherapy. In clinical practice, a multidisciplinary approach is recommended for patients with Masaoka stage IVa thymoma, wherein surgery serves as the primary treatment of giant thymoma treatment and systemic and local therapies are employed as adjunctive treatments. With an increasing comprehension of the mechanisms and efficacy of immunotherapy in thymomas, this case demonstrates favorable therapeutic effects without significant adverse reactions upon the addition of immunotherapy. This implies that incorporating immunotherapy may confer benefits to patients with refractory thymoma while offering additional options for clinical decision-making.展开更多
文摘患者,女,20岁,因发现外阴肿物4月,头皮肿物1周于2012年10月31个日入院。4个月前发现外阴肿物,未予特殊处理,肿物逐渐增大。1周前发现头皮肿物,伴头痛头晕入住我院颅脑外科。患者既往史、月经史及家族史均无特殊。入院体格检查：体温36.8℃,脉搏79次/min,呼吸12次/min,血压120/73 mm Hg。意识清楚,双侧瞳孔等大等圆,对光反射灵敏,心肺腹检查未见异常,颌下及腋窝末触及肿大淋巴结。
文摘目前免疫检查点抑制剂针对恶性肿瘤有较好的疗效,但其引起的重度免疫相关的不良反应较少。1例70岁的男性肺鳞癌患者经治1月后出现视物模糊,上眼睑提肌无力,眼球运动障碍,颈部肌肉无力,无法平卧等临床症状,结合实验室检查及临床症状考虑为重症肌无力合并免疫相关性心肌炎,立即予以甲强龙联合丙种球蛋白治疗等综合治疗,后患者症状明显改善。结合该患者的诊疗方案我们得出结论,在应用卡瑞利珠单抗等抗PD-1治疗时,应监测患者肝肾功能、心肌酶谱、神经系统功能等指标,一旦出现免疫相关不良反应累及神经系统及心脏时,应立即并永久停药,并给予足够的皮质类固醇和免疫球蛋白治疗,同时可联合溴吡斯的明减少后遗症的发生。我们报道此例卡瑞利珠单抗治疗后诱发重症肌无力合并免疫相关性心肌炎通过治疗好转的病例,同时进行文献回顾,以期为重度免疫相关不良反应诊治提供一些治疗策略参考。At present, immune checkpoint inhibitors have a good effect on malignant tumors, but they cause few severe immune-related adverse reactions. A 70-year-old male patient with lung squamous cell carcinoma developed blurred vision, weakness of the levator muscle of the upper eyelid, eye movement disorder, neck muscle weakness, and inability to lie down one month after treatment. Combined with laboratory tests and clinical symptoms, the patient was considered as myasthenia gravis combined with immune-related myocarditis. Based on the diagnosis and treatment plan of this patient, we conclude that liver and kidney function, myocardial enzyme spectrum, and nervous system function should be monitored during the application of anti-PD-1 therapy such as Camrelizumab. Once immune-related adverse reactions occur involving the nervous system and heart, the drug should be stopped immediately and permanently, and adequate corticosteroid and immunoglobulin should be given. It can be combined with pyridostigmine bromide to reduce the occurrence of sequelae. We report a case of myasthenia gravis complicated with immune-related myocarditis induced by Camrelizumab and review the literature in order to provide some treatment strategies for the diagnosis and treatment of severe immune-related adverse reactions.
文摘临床上巨大胸腺瘤案例罕见,对于IVa期巨大胸腺瘤治疗方法尚无共识,且可供选择的治疗方法又尤为缺乏。本文介绍一例35岁Masaoka IVa期巨大胸腺瘤的患者,行手术切除后联合化疗及免疫治疗,获得无复发生存时间(Recurrence Free Survival, RFS)为13个月,复发后又通过局部放疗联合化疗、免疫治疗后基本达到完全缓解(Complete Response, CR)。临床上对于Masaoka IVa期巨大胸腺瘤患者应采取多学科诊疗模式,即以手术为主,全身及局部治疗为辅的治疗模式下进行。随着免疫治疗在胸腺瘤中的机制及疗效正不断被披露,本例患者加用免疫治疗后取得不错的疗效,且未见明显副作用,这也提示我们免疫治疗的加入或可使难治性胸腺瘤从治疗中获益,或为临床决策提供了更多的选择。Giant thymoma cases are rare in clinical practice, and there remains a lack of consensus regarding treatment approaches for stage IVa giant thymomas. Furthermore, the available treatment options are limited. The present study reports on a case of a 35-year-old patient diagnosed with Masaoka stage IVa thymoma, who underwent surgical resection followed by combined chemotherapy and immunotherapy, achieving a recurrence-free survival time (RFS) of 13 months. Furthermore, upon relapse, the patient attained near-complete response (CR) through local radiotherapy in combination with chemotherapy and immunotherapy. In clinical practice, a multidisciplinary approach is recommended for patients with Masaoka stage IVa thymoma, wherein surgery serves as the primary treatment of giant thymoma treatment and systemic and local therapies are employed as adjunctive treatments. With an increasing comprehension of the mechanisms and efficacy of immunotherapy in thymomas, this case demonstrates favorable therapeutic effects without significant adverse reactions upon the addition of immunotherapy. This implies that incorporating immunotherapy may confer benefits to patients with refractory thymoma while offering additional options for clinical decision-making.
