今天说说骨转。
指南中推荐了PETCT作为复查影像之一，虽然说PET可以查骨转，但病人不可能将PET作为常规的检测方式，ECT也不能作为常规检查方式。怎么办？有没有敏感性、特异性都较高的生化指标用于判断骨转？
有
联合——尿1型胶原氨基末端肽 + 血清骨特异性碱性磷酸酶 ，即：uNTX+sBAP 。前者判断破骨、后者判断成骨，需要结合起来看。此指标用于监测骨转及骨转治疗效果，我一共查询了20多篇论文证实有效。
但是问题也来了，很多3甲医院都没有这两个检测项目，去北京协和医院、北大人民医院问过也没有。协和有“贝塔CTX”，但该项目特异性貌似一般。怎么办？各位看官有没有打听到哪个医院有以上2个检测项目。麻烦跟贴告诉一下。
林仲秋教授的观点——鳞癌不看分化。
证据找到了。http://www.syzlzz.com/Files/cmhj/MagazinePDF/1a14682e-1049-4fd1-b221-f77d1de6eb13.pdf
本帖最后由 独孤八戒 于 2017-11-13 10:37 编辑
随着PD1越来越火爆，跨癌肿使用也越来越多。但是对于宫颈癌，PD的有效率一直很低很低，前天看到一个很差的数据，O药联合某药，ORR14%，同时在PDL表达小于1%的队列中，ORR为0%。
从2015年时，根据CC病友的反馈PD对于CC的结果很不好，现在越来越多证据支持CC尽量不要用PD。
讲个题外话，2016年时江湖中传闻某CC病人用了一针PD，肿瘤缩小了一半，注意啊，是缩小了一半，听说这个消息后，我第一反应是有人为了在CC人群中卖药而编造的虚幻故事。但确实也看到几个用PD有效的。各位看官不喜勿喷:lol
在剂量扩展期研究中，考察了Opdivo联合BMS-986205对接受过深度治疗的膀胱癌（n=25）以及宫颈癌（n=22）患者的抗肿瘤活性。
在膀胱癌队列中，客观应答率（ORR）为32%，疾病控制率（DCR）为44%。在宫颈癌队列中，ORR为14%，DCR为64%。
研究还考察了PD-L1表达水平对ORR的影响。在PD-L1表达阳性患者（PD-L1≥1%）中，膀胱癌队列（n=13）的ORR为46%，宫颈癌队列（n=12）的ORR为25%。在PD-L1表达水平≤1%的患者中，膀胱癌队列（n=9）ORR为7%，宫颈癌队列无应答。
RESULTS:
A total of 133 patients were identified, of whom 107 (80%) had squamous cell carcinoma. Ninety patients (68%) had bulky disease and were treated primarily with chemoradiation and brachytherapy. Of patients whose disease recurred, 5 patients (42%) had tested positive for hr-HPV during their surveillance period, compared to 13 patients (11%) for whom disease did not recur (relative risk: 3.88, P = .002). On multivariate logistic regression, hr-HPV status remained significantly predictive of disease recurrence (odds ratio: 12.3, P = .02, 95% confidence interval: 1.5-99.6). Using 2 × 2 table analysis, we found that while cervicovaginal cytology has limited specificity (5.7%) in predicting recurrence, the combination of cytology with hr-HPV testing increases the specificity of testing to 89.3%.
CONCLUSIONS:
Persistence of hr-HPV is a risk factor for disease recurrence. High-risk-HPV testing is not routinely used during surveillance for cervical cancer, but this study suggests that large, prospective trials investigating the role of hr-HPV testing in cervical cancer surveillance are needed.
日常的HPV监控必须要重视。
独孤八戒 发表于 2017-11-15 18:33 static/image/common/back.gif
RESULTS:
A total of 133 patients were identified, of whom 107 (80%) had squamous cell carcinoma. Ni ...
谢谢分享！
星月梦语 发表于 2017-11-19 19:43
能介绍下这些抑制剂吗？怎么用的吗
查论文吧，一两句讲不清楚的。
Abstract
The expression of the immunomodulating enzyme indoleamine-2,3-dioxygenase (IDO) suppresses T-lymphocyte function, thus correlating with poor survival in a variety of cancer patients. IDO degrades the essential amino acid tryptophan leading to immunosuppressive kynurenines production. In the present study, concentrations of tryptophan, 3-hydroxykynurenine, and kynurenine were measured in pre-treatment serum samples of 251 cervical cancer patients by a mass-spectrometric method (XLC-MS/MS) and IDO activity determined by the kynurenine/tryptophan (Kyn/Trp) ratio. A low concentration of tryptophan was found to be significantly associated with tumors greater than 4 cm and lymph node metastatic spread. Furthermore, significant positive correlations were found between high concentrations of the tryptophan metabolites kynurenine and 3-hydroxykynurenine and advanced disease stage (FIGO >IIA) and lymph node metastases. High levels of kynurenine were further associated with parametrial invasion and tumor size. A high Kyn/Trp ratio was related to lymph node metastasis, FIGO stage, tumor size, parametrial invasion and poor disease-specific survival. These results suggest that IDO activation is linked to poor clinicopathological parameters and worse survival in cervical cancer, warranting the use of IDO inhibitors in future clinical trials.
这个很好的解释了前几天发的O药为什么要联合986205，因为IDO高表达。
IDO越高表达分期就越晚。但是IDO联合PD1后，数据还是相当一般。