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Retrospective review of total neoadjuvant therapy

World Journal of Gastrointestinal Oncology 2019年第10期11卷 857-865页

作者： Laila Babar veli bakalov Stephen Abel Obaid Ashraf Gene Grant Finley Moses S Raj Kristina Lundeen Dulabh K Monga Alexander V Kirichenko Rodney E Wegner Department of Internal Medicine Allegheny General HospitalPittsburghPA 15212United States Department of Radiation Oncology Allegheny General HospitalPittsburghPA 15212United States Department of Medical Oncology Allegheny General HospitalPittsburghPA 15212United States

BACKGROUND Neoadjuvant chemoradiotherapy(nCRT)followed by resection and postoperative multi-agent chemotherapy(maChT)is the standard of care for locally advanced rectal cancer.Using this approach,maChT administration can be delayed for several months,leading to concern for distant metastases.To counteract this,a novel treatment approach known as total neoadjuvant therapy(TNT)has gained popularity,in which patients receive both maChT and nCRT prior to resection.We utilized the National Cancer Database to examine temporal trends in TNT usage,and any potential effect on survival.AIM To study the temporal trends in the usage of TNT and evaluate its efficacy compared to neoadjuvant chemoradiation.METHODS We queried the National Cancer Database for patients with locally advanced rectal cancer,Stage II-III,from 2004-2015 treated with nCRT or TNT.TNT was defined as maChT initiated≥90 d prior to nCRT initiation.Overall survival was calculated from the date of diagnosis to the date of last contact or death using Kaplan-Meier curves to present the cumulative probability of survival,with logrank statistics to assess significance.Multivariable cox regression was used to identify predictors of survival and propensity score analysis accounted for bias.RESULTS We identified 9066 eligible patients,with 8812 and 254 patients receiving neoadjuvant chemoradiation followed by maChT and TNT,respectively.Nodal involvement,stage III disease,and treatment in recent years were predictive of TNT use.There was greater use of TNT with more advanced stage,specifically>1 node involved(odds ratio[OR]=2.88,95%confidence interval[CI]:2.11-3.93,P<0.01)and stage III disease(OR=2.88,95%CI:2.11-3.93,P<0.01).From 2010 to 2012 the use of TNT increased(OR=2.41,95%CI:1.27-4.56,P<0.01)with a greater increase from 2013 to 2015(OR=6.62,95%CI:3.57-12.25,P<0.01).Both the TNT and neoadjuvant chemoradiation arms had a similar 5-year survival at 76%and 78%respectively.Multivariable analysis with propensity score demonstrated that increased age,high comorbidity s

关键词： Total neoadjuvant therapy Neoadjuvant chemoradiation Multi-agent chemotherapy Locally advanced rectal cancer National cancer database Colorectal cancer Retrospective review Gastrointestinal oncology Temporal trends Surgical excision

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特纳综合征患者血清转化生长因子β的变化

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北京大学学报（医学版） 2012年第5期44卷 720-724页

作者：周键 Sruthi AREPALLI Clara M.CHENG Vladimir K.bakalov Carolyn A.BONDY Section on Epigenetics&Development Program on Developmental Endocrinology and GeneticsNational Institute of Child Health and Human DevelopmentNational Institutes of HealthBethesda

目的:观察转化生长因子β(transforming growth factor-beta,TGFβ)在特纳综合征(Turner syndrome,TS)患者血清中的变化及其与内分泌和心血管参数的关系。方法:选择TS患者和健康志愿者妇女(对照组)各40例,采用酶联免疫方法测定血清中的... 详细信息

目的:观察转化生长因子β(transforming growth factor-beta,TGFβ)在特纳综合征(Turner syndrome,TS)患者血清中的变化及其与内分泌和心血管参数的关系。方法:选择TS患者和健康志愿者妇女(对照组)各40例,采用酶联免疫方法测定血清中的TGFβ1、TGFβ2及转化生长因子受体(endoglin)。所有TS患者均行心血管系统磁共振和超声检查。结果:TS患者血清中TGFβ1和endoglin水平均高于对照组(P<0.000 1),而TGFβ2的水平则低于对照组(P<0.000 1)。TGFβ的改变与年龄、血压、血小板、甲状腺功能、体重指数或心血管疾病的分型无关。结论:TS患者血清中TGFβ显著性改变对疾病的研究具有重要意义。

关键词：特纳综合征转化生长因子β 心血管疾病 X染色体主动脉

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Turner综合征大血管异常的发生率及磁共振血管造影特征

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世界核心医学期刊文摘（心脏病学分册） 2005年第3期1卷 28-29页

作者： Ho V.B. bakalov V.K. Cooley M. 王永兴 Dept. of Radiol./Radiological Sci. Uniformed Serv. Univ. Hlth. Sciences 4301 Jones Bridge Rd Bethesda MD 20814 United States Dr.

Background-Turner syndrome(TS) is associated with aortic coarctation and dissection; hence, echocardiographic evaluation of all patients is currently recommended. X-ray angiography in clinically symptomatic patients has suggested a range of other vascular anomalies, but the true prevalence of such lesions in TS is unknown. To better understand the prevalence and pathogenesis of cardiovascular defects in TS, we prospectively evaluated a group of asymptomatic adult volunteers with TS using magnetic resonance(MR) angiography. Methods and Results-A total of 85 adults with TS and 27 normal female adult volunteers underwent gadolinium-enhanced 3D MR angiography. A high prevalence of aortic anomalies was seen in women with TS, including elongation of the transverse arch(49%), aortic coarctation(12%), and aberrant right subclavian artery(8%). Venous anomalies were also prominent, including persistent left superior vena cava (13%) and partial anomalous pulmonary venous return(13%). None of these anomalies were found in healthy female controls. The constellation of elongation of the transverse arch, aortic coarctation, and persistent left superior vena cava was significantly associated with women with TS. Neck webbing and increased thoracic anterior-to-posterior dimension diameters were strong predictors for arterial and venous anomalies. Conclusions-Thoracic vascular anomalies are common in TS, occurring in ≈50%of a group not preselected for cardiovascular disease. The highly significant association between neck webbing, increased chest diameter, and these vascular anomalies suggests that in utero, centrally localized lymphatic obstruction may contribute to these cardiovascular deformities in TS. Improved recognition of these often-undetected vascular lesions may be important for identification of patients in need of closer cardiovascular monitoring.

关键词： Turner综合征磁共振血管造影主动脉弓延长锁骨下动脉超声心动图心血管病变左上腔静脉血管造影检查静脉畸形无症状

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自身免疫性卵巢炎是染色体核型为46XX的自发性卵巢功能早衰患者卵泡功能障碍的原因

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世界核心医学期刊文摘（妇产科学分册） 2006年第2期2卷 32-33页

作者： bakalov V.K. Anasti J.N. Calis K.A. L.M. Nelson 张剑萍 Dr. National Institutes of Health CRC 1-3330 MSC-1103 10 Center Drive Bethesda MD 20892-1103 United States

Objective: To assess the association between serum adrenal cortex autoantibodies and histologically confirmed autoimmune lymphocytic oophoritis. Design: Controlled, prospective. Setting: Tertiary research center. Patient(s): Two hundred sixty-six women with 46,XX spontaneous premature ovarian failure. Intervention(s): Ovarian biopsy in 10 women. Main Outcome Measure(s): Serum adrenal cortex autoantibodies assessed by indirect immunofluorescence and autoimmune oophoritis assessed by immunohistochemical lymphocyte markers. Result(s): We obtained a histologic diagnosis of autoimmune oophoritis in four women who tested positive for adrenal cortex autoantibodies and excluded this diagnosis in ovarian biopsies from six women who tested negative for adrenal cortex autoantibodies (4/4 vs 0/6). Women with histologically confirmed autoimmune oophoritis had a greater total ovarian volume as assessed by transvaginal sonography (11.4 ±5.6 mL vs 1.5 ±0.4 mL) (mean ±SEM). They were also more likely to have subclinical adrenal insufficiency and clinical signs of androgen deficiency (3/4 vs 0/6). Overall, 10/266 women tested positive for adrenal cortex autoantibodies (3.8%, 95%confidence interval: 1.8%-6.5%). Conclusion(s): In women who present with 46,XX spontaneous premature ovarian failure as their primary concern there is a clear association between serum adrenal cortex autoantibodies and the presence of histologically confirmed autoimmune oophoritis.

关键词： XX 卵巢功能早衰染色体核型自身免疫抗体功能障碍免疫抗体检测卵巢炎雄激素分泌肾上腺皮质

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