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Predictive factors for the local recurrence and distant metastasis of phyllodes tumors of the breast: a retrospective analysis of 192 cases at a single center. 单中心192例乳腺叶状瘤局部复发和远处转移的预测因素分析
Q Medicine Pub Date : 2014-10-01 Epub Date: 2014-08-08 DOI: 10.5732/cjc.014.10048
Jing Wei, Yu-Ting Tan, Yu-Cen Cai, Zhong-Yu Yuan, Dong Yang, Shu-Sen Wang, Rou-Jun Peng, Xiao-Yu Teng, Dong-Geng Liu, Yan-Xia Shi

The local recurrence rate of phyllodes tumors of the breast varies widely among different subtypes, and distant metastasis is associated with poor survival. This study aimed to identify factors that are predictive of local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and overall survival (OS) in patients with phyllodes tumors of the breast. Clinical data of all patients with a phyllodes tumor of the breast (n = 192) treated at Sun Yat-sen University Cancer Center between March 1997 and December 2012 were reviewed. The Pearson Χ² test was used to investigate the relationship between clinical features of patients and histotypes of tumors. Univariate and multivariate Cox regression analyses were performed to identify factors that are predictive of LRFS, DMFS, and OS. In total, 31 (16.1%) patients developed local recurrence, and 12 (6.3%) developed distant metastasis. For the patients who developed local recurrence, the median age at the diagnosis of primary tumor was 33 years (range, 17-56 years), and the median size of primary tumor was 6.0 cm (range, 0.8-18 cm). For patients who developed distant metastasis, the median age at the diagnosis of primary tumor was 46 years (range, 24-68 years), and the median size of primary tumor was 5.0 cm (range, 0.8-18 cm). In univariate analysis, age, size, hemorrhage, and margin status were found to be predictive factors for LRFS (P = 0.009, 0.024, 0.004, and 0.001, respectively), whereas histotype, epithelial hyperplasia, margin status, and local recurrence were predictors of DMFS (P = 0.001, 0.007, 0.007, and < 0.001, respectively). In multivariate analysis, independent prognostic factors for LRFS included age [hazard ratio (HR) = 3.045, P = 0.005], tumor size (HR = 2.668, P = 0.013), histotype (HR = 1.715, P = 0.017), and margin status (HR = 4.530, P< 0.001). Histotype (DMFS: HR = 4.409, P = 0.002; OS: HR = 4.194, P = 0.003) and margin status (DMFS: HR = 2.581, P = 0.013; OS: HR = 2.507, P = 0.020) were independent predictors of both DMFS and OS. In this cohort, younger age, a larger tumor size, a higher tumor grade, and positive margins were associated with lower rates of LRFS. Histotype and margin status were found to be independent predictors of DMFS and OS.

乳腺叶状瘤的局部复发率在不同亚型之间差异很大,远处转移与生存率低有关。本研究旨在确定预测乳腺叶状肿瘤患者局部无复发生存期(LRFS)、远处无转移生存期(DMFS)和总生存期(OS)的因素。回顾1997年3月至2012年12月中山大学肿瘤中心收治的所有乳腺叶状肿瘤患者(n = 192)的临床资料。采用Pearson Χ²检验探讨患者临床特征与肿瘤组织型的关系。进行单因素和多因素Cox回归分析,以确定预测LRFS、DMFS和OS的因素。其中31例(16.1%)局部复发,12例(6.3%)远处转移。局部复发的患者,原发肿瘤诊断时的中位年龄为33岁(范围17 ~ 56岁),原发肿瘤的中位大小为6.0 cm(范围0.8 ~ 18 cm)。对于发生远处转移的患者,原发肿瘤诊断时的中位年龄为46岁(范围24-68岁),原发肿瘤的中位大小为5.0 cm(范围0.8-18 cm)。在单因素分析中,年龄、大小、出血和边缘状态被发现是LRFS的预测因素(P分别为0.009、0.024、0.004和0.001),而组织类型、上皮增生、边缘状态和局部复发是DMFS的预测因素(P分别为0.001、0.007、0.007和< 0.001)。在多因素分析中,LRFS的独立预后因素包括年龄[危险比(HR) = 3.045, P = 0.005]、肿瘤大小(HR = 2.668, P = 0.013)、组织类型(HR = 1.715, P = 0.017)和切缘状态(HR = 4.530, P< 0.001)。组织类型(DMFS: HR = 4.409, P = 0.002;OS: HR = 4.194, P = 0.003)和边缘状态(DMFS: HR = 2.581, P = 0.013;OS: HR = 2.507, P = 0.020)是DMFS和OS的独立预测因子。在该队列中,年龄较小、肿瘤大小较大、肿瘤分级较高和阳性切缘与LRFS发生率较低相关。发现组织型和切缘状态是DMFS和OS的独立预测因子。
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引用次数: 66
James P. Allison received the 2014 Szent-Györgi Prize for Progress in Cancer Research. James P. Allison获得了2014年Szent-Györgi癌症研究进展奖。
Q Medicine Pub Date : 2014-09-01 DOI: 10.5732/cjc.014.10125
Jie Zhao, Peter Scully, Sujuan Ba

The Szent-Györgyi Prize for Progress in Cancer Research is a prestigious scientific award established by the National Foundation for Cancer Research (NFCR) -- a leading cancer research charitable organization in the United States that is committed to supporting innovative cancer research on the global scale that aims to cure cancer. Each year, the Szent-Györgyi Prize honors an outstanding researcher whose original discoveries have expanded our understanding of cancer and resulted in notable advances in cancer prevention, diagnosis, or treatment. The prize also promotes public awareness of the importance of basic cancer research and encourages the sustained investment needed to accelerate the translation of these research discoveries into new cancer treatments. This report highlights the history and mission of the Szent-Györgyi Prize, its role in promoting discovery-oriented cancer research, and the pioneering work led by the 2014 prize winner, Dr. James Allison. Dr. Allison's work in the area of cancer immunotherapy led to the successful development of immune checkpoint therapy, and the first drug approved by the United States Food and Drug Administration for the treatment of metastatic melanoma.

Szent-Györgyi癌症研究进步奖是由美国国家癌症研究基金会(NFCR)设立的一项享有声望的科学奖项。NFCR是美国领先的癌症研究慈善组织,致力于在全球范围内支持旨在治愈癌症的创新癌症研究。每年,Szent-Györgyi奖都会表彰一位杰出的研究人员,他们的原创发现扩大了我们对癌症的了解,并在癌症预防、诊断或治疗方面取得了显著进展。该奖项还促进公众对基础癌症研究重要性的认识,并鼓励持续投资,以加速将这些研究发现转化为新的癌症治疗方法。本报告重点介绍了Szent-Györgyi奖的历史和使命,它在促进以发现为导向的癌症研究方面的作用,以及2014年获奖者詹姆斯·艾利森博士领导的开创性工作。Allison博士在癌症免疫治疗领域的工作导致了免疫检查点疗法的成功开发,以及美国食品和药物管理局批准的第一种用于治疗转移性黑色素瘤的药物。
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引用次数: 3
Novel anti-melanoma treatment: focus on immunotherapy. 新型抗黑色素瘤治疗:以免疫疗法为重点。
Q Medicine Pub Date : 2014-09-01 DOI: 10.5732/cjc.014.10118
Meng-Ze Hao, Wen-Ya Zhou, Xiao-Ling Du, Ke-Xin Chen, Guo-Wen Wang, Yun Yang, Ji-Long Yang

Melanoma is an intractable cancer that is aggressive, lethal, and metastatic. The prognosis of advanced melanoma is very poor because it is insensitive to chemotherapy and radiotherapy. The incidence of melanoma has been ascending stably for years worldwide, accompanied by increasing mortality. New approaches to managing this deadly disease are much anticipated to enhance the cure rate and to extend clinical benefits to patients with metastatic melanoma. Due to its high degree of immunogenicity, melanoma could be a good target for immunotherapy, which has been developed for decades and has achieved certain progress. This article provides an overview of immunotherapy for melanoma.

黑色素瘤是一种具有侵袭性、致命性和转移性的顽固性癌症。晚期黑色素瘤的预后非常差,因为它对化疗和放疗不敏感。近年来,黑素瘤的发病率在全球范围内稳步上升,死亡率也在不断上升。治疗这种致命疾病的新方法有望提高治愈率,并扩大转移性黑色素瘤患者的临床获益。黑色素瘤具有高度的免疫原性,是免疫治疗的一个很好的靶点,经过几十年的发展,已经取得了一定的进展。本文综述了黑色素瘤的免疫治疗。
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引用次数: 12
Immune checkpoint inhibitors in clinical trials. 临床试验中的免疫检查点抑制剂。
Q Medicine Pub Date : 2014-09-01 DOI: 10.5732/cjc.014.10122
Elad Sharon, Howard Streicher, Priscila Goncalves, Helen X Chen

Immunology-based therapy is rapidly developing into an effective treatment option for a surprising range of cancers. We have learned over the last decade that powerful immunologic effector cells may be blocked by inhibitory regulatory pathways controlled by specific molecules often called "immune checkpoints." These checkpoints serve to control or turn off the immune response when it is no longer needed to prevent tissue injury and autoimmunity. Cancer cells have learned or evolved to use these mechanisms to evade immune control and elimination. The development of a new therapeutic class of drugs that inhibit these inhibitory pathways has recently emerged as a potent strategy in oncology. Three sets of agents have emerged in clinical trials exploiting this strategy. These agents are antibody-based therapies targeting cytotoxic T-lymphocyte antigen 4 (CTLA4), programmed cell death 1 (PD-1), and programmed cell death ligand 1 (PD-L1). These inhibitors of immune inhibition have demonstrated extensive activity as single agents and in combinations. Clinical responses have been seen in melanoma, renal cell carcinoma, non-small cell lung cancer, and several other tumor types. Despite the autoimmune or inflammatory immune-mediated adverse effects which have been seen, the responses and overall survival benefits exhibited thus far warrant further clinical development.

基于免疫学的疗法正迅速发展成为治疗各种癌症的有效方法。在过去的十年中,我们已经了解到,强大的免疫效应细胞可能会被由特定分子(通常称为 "免疫检查点")控制的抑制性调节途径阻断。这些检查点的作用是在不再需要免疫反应时控制或关闭免疫反应,以防止组织损伤和自身免疫。癌细胞已经学会或进化出使用这些机制来逃避免疫控制和消灭。最近,开发一类新的治疗药物来抑制这些抑制途径已成为肿瘤学的一种有效策略。临床试验中出现了三组利用这一策略的药物。这些药物是针对细胞毒性 T 淋巴细胞抗原 4(CTLA4)、程序性细胞死亡 1(PD-1)和程序性细胞死亡配体 1(PD-L1)的抗体疗法。这些免疫抑制抑制剂作为单药和联合用药已显示出广泛的活性。黑色素瘤、肾细胞癌、非小细胞肺癌和其他几种肿瘤类型都出现了临床反应。尽管出现了自身免疫或炎症性免疫介导的不良反应,但迄今为止所表现出的反应和总体生存获益仍值得进一步临床开发。
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引用次数: 0
The human application of gene therapy to re-program T-cell specificity using chimeric antigen receptors. 利用嵌合抗原受体对t细胞特异性进行基因治疗的人类应用。
Q Medicine Pub Date : 2014-09-01 DOI: 10.5732/cjc.014.10100
Alan D Guerrero, Judy S Moyes, Laurence J N Cooper

The adoptive transfer of T cells is a promising approach to treat cancers. Primary human T cells can be modified using viral and non-viral vectors to promote the specific targeting of cancer cells via the introduction of exogenous T-cell receptors (TCRs) or chimeric antigen receptors (CARs). This gene transfer displays the potential to increase the specificity and potency of the anticancer response while decreasing the systemic adverse effects that arise from conventional treatments that target both cancerous and healthy cells. This review highlights the generation of clinical-grade T cells expressing CARs for immunotherapy, the use of these cells to target B-cell malignancies and, particularly, the first clinical trials deploying the Sleeping Beauty gene transfer system, which engineers T cells to target CD19+ leukemia and non-Hodgkin's lymphoma.

T细胞的过继性转移是一种很有前途的治疗癌症的方法。通过引入外源性T细胞受体(tcr)或嵌合抗原受体(CARs),可以利用病毒和非病毒载体修饰人原代T细胞,促进对癌细胞的特异性靶向。这种基因转移显示出增加抗癌反应的特异性和效力的潜力,同时减少了针对癌细胞和健康细胞的常规治疗所产生的全身不良反应。这篇综述强调了用于免疫治疗的表达CARs的临床级T细胞的产生,使用这些细胞靶向b细胞恶性肿瘤,特别是首次临床试验部署睡美人基因转移系统,该系统设计T细胞靶向CD19+白血病和非霍奇金淋巴瘤。
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引用次数: 10
Cancer immunotherapy. 癌症免疫疗法。
Q Medicine Pub Date : 2014-09-01 DOI: 10.5732/cjc.014.10153
Li Yan, Helen X Chen
Authors′ Affiliations: US Chinese Anti-Cancer Association; Therapy Evaluation Program (CTEP) National Cancer Institute (NCI), Bethesda, MD 20892, USA. Corresponding Authors: Li Yan, US Chinese Anti-Cancer Association. Tel: +1-610-213-7025; Email: ynyinternational@yahoo.com. Helen X. Chen, Therapy Evaluation Program (CTEP) National Cancer Institute (NCI), 6130 Executive Blvd, EPN 7131, Bethesda, MD 20892, USA. Tel: +1-240-276-6106; Email: helen.chen@nih.gov. doi: 10.5732/cjc.014.10153 Li Yan and Helen X. Chen
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引用次数: 1
Cancer immunotherapy in clinical practice -- the past, present, and future. 癌症免疫治疗的临床实践——过去,现在和未来。
Q Medicine Pub Date : 2014-09-01 DOI: 10.5732/cjc.014.10123
Gaurav Goel, Weijing Sun

Considerable progress has been made in the field of cancer immunotherapy in recent years. This has been made possible in large part by the identification of new immune-based cellular targets and the development of novel approaches aimed at stimulating the immune system. The role played by the immunosuppressive microenvironment in the development of tumors has been established. The success of checkpoint-inhibiting antibodies and cancer vaccines has marked the beginning of a new era in cancer treatment. This review highlights the clinically relevant principles of cancer immunology and various immunotherapeutic approaches that have either already entered mainstream oncologic practice or are currently in the process of being evaluated in clinical trials. Furthermore, the current barriers to the development of effective immunotherapies and the potential strategies of overcoming them are also discussed.

近年来,肿瘤免疫治疗领域取得了长足的进展。这在很大程度上是由于新的基于免疫的细胞靶标的识别和旨在刺激免疫系统的新方法的发展而成为可能的。免疫抑制微环境在肿瘤发展中的作用已经确立。检查点抑制抗体和癌症疫苗的成功标志着癌症治疗新时代的开始。这篇综述强调了癌症免疫学的临床相关原则和各种免疫治疗方法,这些方法要么已经进入主流肿瘤学实践,要么正在临床试验中进行评估。此外,目前的障碍发展有效的免疫疗法和潜在的策略克服他们也进行了讨论。
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引用次数: 34
Epidemiologic studies of particulate matter and lung cancer. 颗粒物与肺癌的流行病学研究。
Q Medicine Pub Date : 2014-08-01 Epub Date: 2014-07-11 DOI: 10.5732/cjc.014.10063
Yin-Ge Li, Xiang Gao

Particulate matter (PM) plays an important role in air pollution, especially in China. European and American researchers conducted several cohort-based studies to examine the potential relationship between PM and lung cancer and found a positive association between PM and lung cancer mortality. In contrast, the results regarding PM and lung cancer risk remain inconsistent. Most of the previous studies had limitations such as misclassification of PM exposure and residual confounders, diminishing the impact of their findings. In addition, prospective studies on this topic are very limited in Chinese populations. This is an important problem because China has one of the highest concentrations of PM in the world and has had an increased mortality risk due to lung cancer. In this context, more prospective studies in Chinese populations are warranted to investigate the relationship between PM and lung cancer.

颗粒物(PM)在空气污染中起着重要作用,尤其是在中国。欧洲和美国的研究人员进行了几项基于队列的研究,以检查PM与肺癌之间的潜在关系,并发现PM与肺癌死亡率之间存在正相关。相比之下,关于PM和肺癌风险的结果仍然不一致。以前的大多数研究都有局限性,例如PM暴露的错误分类和残留混杂因素,从而削弱了其研究结果的影响。此外,关于这一主题的前瞻性研究在中国人群中非常有限。这是一个重要的问题,因为中国是世界上颗粒物浓度最高的国家之一,肺癌导致的死亡风险也在增加。在此背景下,有必要在中国人群中进行更多的前瞻性研究,以调查PM与肺癌之间的关系。
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引用次数: 21
The clinical characteristics and treatment outcome of 57 children and adolescents with primary central nervous system germ cell tumors. 57例儿童青少年原发性中枢神经系统生殖细胞瘤的临床特点及治疗结果分析。
Q Medicine Pub Date : 2014-08-01 Epub Date: 2014-07-03 DOI: 10.5732/cjc.013.10112
Xiao-Fei Sun, Fei Zhang, Zi-Jun Zhen, Qun-Ying Yang, Yun-Fei Xia, Shao-Xiong Wu, Jia Zhu, Su-Ying Lu, Juan Wang, Fei-Fei Sun, Rui-Qing Cai, Yan Chen, Peng-Fei Li

Primary central nervous system germ cell tumors (CNS-GCTs) in children and adolescents have unique clinical features and methods of treatment compared with those in adults. There is little information about Chinese children and adolescents with CNS-GCTs. Therefore, in this study we retrospectively analyzed the clinical features and treatment outcome of Chinese children and adolescents with primary CNS-GCTs. Between January 2002 and December 2012, 57 untreated patients from a single institution were enrolled. They were diagnosed with CNS-GCTs after pathologic or clinical assessment. Of the 57 patients, 41 were males and 16 were females, with a median age of 12.8 years (range, 2.7 to 18.0 years) at diagnosis; 43 (75.4%) had non-germinomatous germ cell tumors (NGGCTs) and 14 (24.6%) had germinomas; 44 (77.2%) had localized disease and 13 (22.8%) had extensive lesions. Fifty-three patients completed the prescribed treatment, of which 18 underwent monotherapy of surgery, radiotherapy, or chemotherapy, and 35 underwent multimodality therapies that included radiotherapy combined with chemotherapy or surgery combined with chemotherapy and/or radiotherapy. PEB (cisplatin, etoposide, and bleomycin) protocol was the major chemotherapy regimen. The median follow-up time was 32.3 months (range, 1.2 to 139 months). Fourteen patients died of relapse or disease progression. The 3-year event-free survival (EFS) and overall survival rates for all patients were 72.2% and 73.8%, respectively. The 3-year EFS was 92.9% for germinomas and 64.8% for NGGCTs (P = 0.064). The 3-year EFS rates for patients with NGGCTs who underwent monotherapy and multimodality therapies were 50.6% and 73.5%, respectively (P = 0.042). Our results indicate that multimodality therapies including chemotherapy plus radiotherapy were better treatment option for children and adolescents with CNS-GCTs.

儿童和青少年原发性中枢神经系统生殖细胞肿瘤(cns - gct)与成人相比具有独特的临床特征和治疗方法。关于中国儿童和青少年cns - gct的资料很少。因此,在本研究中,我们回顾性分析了中国儿童和青少年原发性cns - gct的临床特征和治疗结果。在2002年1月至2012年12月期间,来自单一机构的57名未经治疗的患者入组。经病理或临床评估诊断为cns - gct。57例患者中,男性41例,女性16例,诊断时的中位年龄为12.8岁(范围2.7 - 18.0岁);非生殖细胞瘤(NGGCTs) 43例(75.4%),生殖细胞瘤14例(24.6%);局限性病变44例(77.2%),广泛性病变13例(22.8%)。53例患者完成了规定的治疗,其中18例接受了手术、放疗或化疗的单一治疗,35例接受了多模式治疗,包括放疗联合化疗或手术联合化疗和/或放疗。PEB(顺铂、依托泊苷和博来霉素)方案是主要的化疗方案。中位随访时间为32.3个月(1.2 ~ 139个月)。14例患者死于复发或疾病进展。所有患者的3年无事件生存率(EFS)和总生存率分别为72.2%和73.8%。生殖细胞瘤的3年EFS为92.9%,nggct为64.8% (P = 0.064)。nggct患者接受单一治疗和多模式治疗的3年EFS发生率分别为50.6%和73.5% (P = 0.042)。我们的研究结果表明,包括化疗和放疗在内的多模式治疗是儿童和青少年cns - gct更好的治疗选择。
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引用次数: 7
Genomics in personalized cancer medicine and its impact on early drug development in China: report from the 6th Annual Meeting of the US Chinese Anti-Cancer Association (USCACA) at the 50th ASCO Annual Meeting. 基因组学在个体化癌症治疗中的应用及其对中国早期药物开发的影响:来自第50届ASCO年会上美中抗癌协会(USCACA)第6届年会上的报告
Q Medicine Pub Date : 2014-08-01 DOI: 10.5732/cjc.014.10110
Wei Zhang, Shi-Yuan Cheng, Li-Fang Hou, Li Yan, Yun-Guang Tong

The 6th Annual Meeting of the United States Chinese Anti-Cancer Association (USCACA) was held in conjunction with the 50th Annual Meeting of American Society of Clinical Oncology (ASCO) on May 30, 2014 in Chicago, Illinois, the United States of America. With a focus on personalized medicine, the conference featured novel approaches to investigate genomic aberrations in cancer cells and innovative clinical trial designs to expedite cancer drug development in biomarker-defined patient populations. A panel discussion further provided in-depth advice on advancing development of personalized cancer medicines in China. The conference also summarized USCACA key initiatives and accomplishments, including two awards designated to recognize young investigators from China for their achievements and to support their training in the United States. As an effort to promote international collaboration, USCACA will team up with Chinese Society of Clinical Oncology (CSCO) to host a joint session on "Breakthrough Cancer Medicines" at the upcoming CSCO Annual Meeting on September 20th, 2014 in Xiamen, China.

2014年5月30日,美国华人抗癌协会(USCACA)第六届年会暨美国临床肿瘤学会(ASCO)第50届年会在美国伊利诺伊州芝加哥市召开。会议重点关注个性化医疗,重点介绍了研究癌细胞基因组畸变的新方法和创新的临床试验设计,以加快生物标志物定义的患者群体的癌症药物开发。小组讨论进一步就推进中国个体化癌症药物的发展提供了深入的建议。会议还总结了USCACA的主要举措和成就,包括设立两个奖项,表彰中国的年轻研究人员取得的成就,并支持他们在美国接受培训。为促进国际合作,USCACA将与中国临床肿瘤学会(CSCO)合作,在即将于2014年9月20日在中国厦门举行的CSCO年会上共同举办“癌症药物突破”专题会议。
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引用次数: 2
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