分化型甲状腺癌患者在进行131I治疗前必须忌碘,如何忌碘,笔者查阅资料后找到以下食物含碘量排行,在此贴上,仅供参考。以100g食物中的碘计算:1.裙带菜(干)(15878 微克) 2.紫菜(干)(4323 微克)3.海带(鲜)(923 微克) 4.鸡精(766.5 微克)5.海虹(346 微克) 6.虾皮(264.5 微克)7.虾酱(166.6 微克) 8.虾米(82.5 微克)9.可乐(68.4 微克) 10.叉烧肉(57.4 微克)11.豆腐干(46.2 微克) 12.开心果(37.9 微克)13.鹌鹑蛋(37.6 微克) 14.火鸡腿 (33.6 微克)15.牛肉辣瓣酱(32.5 微克) 16.鸡蛋(27.2 微克)17.牛腱子肉(24.5 微克) 18.菠菜(24 微克)19.黄酱(19.8 微克) 20.羊肝(19.1 微克)21.柳松茸(17.1 微克) 22.雏鸽(16.3 微克)23.金枪鱼(14 微克) 24.墨鱼(13.9 微克)25.花椒粉(13.7 微克) 26.鸡肉(12.4 微克)27.松子仁(12.3 微克) 28.南瓜子(炒)(11 微克)29.鱼翅(干)(10.9 微克) 30.核桃(10.4 微克)31.牛肉(瘦)(10.4 微克) 32.小白菜(10 微克)33.大豆(9.7 微克) 34.甜面酱(9.6 微克)35.青椒(9.6 微克) 36.杏仁(8.4 微克)37.方便面(8.4 微克) 38.杏仁(炒)(8.4 微克)39.甜杏仁(8.4 微克) 40.胡椒粉(8.2 微克)41.白胡椒(8.2 微克) 42.赤小豆(7.8 微克)43.冻豆腐(7.7 微克) 44.平鱼(7.7 微克)45.羊肉(瘦)(7.7 微克) 46.羊前腿肉(7.7 微克)47.松花蛋(鸭蛋)(6.8 微克) 48.黑鱼(6.5 微克)49.青鱼(6.5 微克) 50.柿子(6.3 微克)51.小黄鱼(5.8 微克) 52.榴莲(5.6 微克)53.带鱼(5.5 微克) 54.午餐肉(5.4 微克)55.杏仁露(5.3 微克) 56.橘子(5.3 微克)57.油皮(5 微克) 58.鸭蛋(5 微克)59.鲤鱼(4.7 微克) 60.芸豆(4.7 微克)61.榛子仁(炒)(4.4 微克) 62.羊肉(后 (4.1 微克)63.菠萝(4.1 微克) 64.鸡粉(3.9 微克)65.八宝菜(3.8 微克) 66.糯米(紫)(3.8 微克)67.小米(3.7 微克) 68.火腿(3.6 微克)69.野鸡(3.5 微克) 70.鲅鱼(3.5 微克)71.小麦面粉(2.9 微克) 72.老抽(2.9 微克)73.小麦富强粉(2.9 微克) 74.花生仁(生)(2.7微克)75.番茄(2.5 微克) 76.香蕉(2.5 微克)77.白酱油(2.4 微克) 78.酱油(2.4 微克)79.莲藕(2.4 微克) 80.稻米(2.3 微克)81.猪肉(瘦)(1.7 微克) 82.香菜(1.5 微克)83.鹿肉(1.5 微克) 84.乳黄瓜(1.3 微克)85.鸡肝(1.3 微克) 86.洋葱(1.2微克)87.土豆(黄皮)(1.2 微克) 88.酱牛肉(1.2 微克)89.茄子 (1.1 微克) 90.山竹(1.1 微克)91.豌豆(0.9 微克) 92.酸奶(0.9 微克)93.橙子(0.9 微克) 94.平菇(0.8 微克)95.四棱豆(0.7 微克) 96.芹菜(0.7 微克)97.梨(0.7 微克) 98.生抽(0.6 微克)99.牛里脊肉(0.5 微克) 100.西葫芦(0.4 微克)101.火龙果(0.4 微克) 102.甘薯(0.4 微克)103.空心菜(0.4 微克) 104.绿豆芽(0.2 微克)105.樱桃番茄(0.1 微克)
在我国,每年约有40万人死于肺癌,在各类癌症引起的死亡中高居榜首。肺腺癌是肺癌的各种亚类中最常见的类型,在每年全球确诊的新增肺癌病患中约占40%。研究肺癌中基因突变对肺癌的临床诊断和预后有着重要的意义。近日,国际肺癌研究协会举办的专业学术期刊Journal of Thoracic Oncology在线发表了生化与细胞所季红斌研究组与复旦大学肿瘤医院合作开展的最新研究成果,报道了中国肺腺癌人群中热点基因LKB1、EGFR和KRAS的突变谱。LKB1又名STK11 (serine threonine kinase 11),是丝氨酸苏氨酸激酶家族的成员,并且是家族性黑斑息肉综合症的致病基因。季红斌研究组此前的工作发现抑癌基因LKB1对肿瘤的转移有着重要的影响,其蛋白缺失可显著提高肿瘤细胞的转移。表皮生长因子EGFR是介导细胞生长信号的重要分子,并且在临床上携带该基因突的肺癌患者对抑制酪氨酸激酶的小分子化合物抑制剂(Tyrosine Kinase inhibitors,TKIs)有着很高的响应。KRAS是EGFR通路下游的重要信号分子,对MAPK通路有着直接的调节作用。上述三个基因在西方肺癌人群中有着相当比例的突变率,在亚洲包括韩国和日本肺癌人群中也有一定研究。我国的肺癌人群中LKB1,EGFR和KRAS突变的总体特征尚缺乏较为全面的认识。生化与细胞所季红斌课题组联合复旦大学肿瘤医院陈海泉主任领导的胸外科研究室对中国肺腺癌人群中重要的基因突变进行了筛查。他们筛查的结果发现LKB1在中国肺腺癌人群中的突变率为6.9%,而且LKB1突变主要来自吸烟患者。LKB1的F354L变异在肺腺癌人群中的比例约为10.5%且均为种系遗传(即从父母遗传而来),其中两例患者的肿瘤组织内F354L变异发生了杂合性缺失,提示该位点在肺癌的发生或发展中可能有着尚待探明的作用。与此同时,在中国肺腺癌人群中发现的EGFR突变率为66.3%,KRAS突变仅为2.3%。在EGFR突变中,较为引人注意的是女性非吸烟患者的突变率高达83.8%,提示该类肺腺癌人群具有高度的EGFR突变倾向,并且可能作为TKIs小分子药物治疗的重点人群。这些工作为全面而深入地揭示中国肺癌人群的基因突变谱奠定了一个良好的基础。J Thorac Oncol. 2010 Jun 16;:20559149 Spectrum of LKB1, EGFR, and KRAS Mutations in Chinese Lung Adenocarcinomas. Bin Gao, Yihua Sun, Junhua Zhang, Yan Ren, Rong Fang, Xiangkun Han, Lei Shen, Xin-Yuan Liu, William Pao, Haiquan Chen, Hongbin Ji
Prophylactic lymph node dissection for papillary thyroid cancer less than 2 cm: implications for radioiodine treatment.J Clin Endocrinol Metab 2009Apr94(4) :1162-7 PMID:19116234OBJECTIVE: Prophylactic neck dissection for small papillary carcinoma remains controversial. Radioiodine ablation is not recommended for tumors less than 10 mm and depends on various factors for tumors between 10 and 20 mm. The aim was to determine the effect of lymph node (LN) staging on the indication for treatment with radioiodine. PATIENTS AND METHODS: We conducted a retrospective study of 115 patients presenting with papillary thyroid carcinoma less than 2 cm without ultrasonographically detectable cervical LN treated by total thyroidectomy and complete selective dissection of the central and lateral compartment. Radioiodine treatment was based on definitive pathology (tumor and LN). Follow-up was based on neck ultrasound and thyroglobulin levels. RESULTS: LN were found for 41.7% of cases. Radioiodine was not used for 42% of patients with tumors less than 20 mm and no metastatic LN. Fifty-eight percent of patients were treated with radioiodine due to LN metastasis, extracapsular thyroid invasion, or unfavorable histological subtype. LN status affected the indication for radioiodine in 30.5% of cases classified as T1, 12 cases with tumors less than 10 mm but with LN metastases (who received radioiodine), and 13 cases with tumors between 10 and 20 mm but without LN metastases (who did not receive radioiodine). Definitive vocal fold paralysis and hypoparathyroidism each occurred in 0.9% of cases. At 1 yr, ultrasound was normal in all patients, and recombinant human TSH-stimulated thyroglobulin was undetectable for 97% of the patients. CONCLUSION: Precise LN staging by prophylactic neck dissection for tumors initially staged T1N0 modified the indication for radioiodine ablation for 30% of patients.目前,对小的甲状腺乳头状癌是否行预防性颈淋巴结清扫术仍存在争议。我们不推荐对小于10 mm的甲状腺癌采用放射性碘治疗,对10-20 mm的甲状腺癌是否采用放射性碘治疗取决于其病理和其他各种因素。本研究的目的是根据淋巴结分级确定放射性碘疗法的适应症。病人和方法:我们对115例患者进行了回顾性研究,所有入选患者甲状腺乳头状癌均小于2cm,超声均未发现颈淋巴结转移的,且采用的术式为甲状腺全切,和甲状腺中央区和外侧区选择性颈淋巴结清扫术。放射性碘治疗的适应症主要由病理分期(肿瘤和淋巴结)来决定。依据颈部超声和甲状腺激素水平对患者进行随访。结果:发生淋巴结转移的患者占41.7%。未发生淋巴结转移,肿瘤小于20 mm,且未采用放射性碘治疗的患者占42%。58%的患者由于淋巴结转移、肿瘤侵出甲状腺组织,及不良的组织学分型而采用放射性碘治疗。放射性碘治疗的适应症取决于淋巴结的情况,T1期的患者为30.5%,12例患者肿瘤小于10 mm伴淋巴结转移(接受了放射性碘治疗),13例患者肿瘤10- 20 mm不伴淋巴结转移(未接受放射性碘治疗),0.9%的病例发生了声带麻痹和甲状旁腺机能减退术后并发症。在随访1年时,所有病人的超声检查正常,97%的患者未检测到重组人促甲状腺激素刺激。结论: T1N0期的甲状腺肿瘤预防性颈淋巴结清扫术可以使淋巴结分级更精确,30%的患者可以根据此分级调整放射性碘治疗的适应症。
在2010年7月最新出版的影响因子为87.92(MedSci 各细分学科影响因子TOP10查询)的著名学术刊物CA:A Cancer Journal for Clinicians上,美国癌症学会(American Cancer Society)公布了美国癌症的最新统计数据。报告的主要要点如下:2010年,美国查出1529560新发癌症病例,也就是说每天新发4190人。新发癌症中,男性789620例,前三位是前列腺癌(28%)、肺癌(15%)和直肠癌(9%),女性739940例, 前三位是乳腺癌(28%),肺癌(14%)和直肠癌(10%);2010年,全美有569490人死于癌症,其中男性299200例,女性270290例, 也就是说每天死亡1560人。在2010年7月最新出版的影响因子为87.92(MedSci 各细分学科影响因子TOP10查询)的著名学术刊物CA:A Cancer Journal for Clinicians上,美国癌症学会(American Cancer Society)公布了美国癌症的最新统计数据。报告的主要要点如下:2010年,美国查出1529560新发癌症病例,也就是说每天新发4190人。新发癌症中,男性789620例,前三位是前列腺癌(28%)、肺癌(15%)和直肠癌(9%),女性739940例, 前三位是乳腺癌(28%),肺癌(14%)和直肠癌(10%);2010年,全美有569490人死于癌症,其中男性299200例,女性270290例, 也就是说每天死亡1560人。2000年到2006年间,男性癌症发病率每年下降1.3%;从1998年到2006年,女性癌症发病率每年下降0.5%。男性癌症发病率下降较多是因为肺癌、前列腺癌和直肠癌发病率明显下降。女性癌症死亡率下降主要因为乳腺癌和直肠癌发病率明显下降; 由于在癌症预防、检测和治疗方面的进步,从1990年到2006年,美国男性癌症死亡率下降21%,其中女性患者死亡率下降12.3%,期间被癌症夺去生命者减少76.7万。在所有癌症中,男性的三大杀手是肺癌(29%)、前列腺癌(11%)和直肠癌(9%);女性的三大杀手是肺癌(26%)、乳腺癌(15%)和直肠癌(9%)
Thyroid cancer survival in the United States: observational data from 1973 to 2005. OBJECTIVE: To compare the survival rate of people with papillary thyroid cancer limited to the thyroid gland who have not had immediate, definitive treatment for their thyroid cancer with the survival rate of those who have had such treatment. DESIGN: Cohort study of incident cancer cases and initial treatment data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. Data on cause of death was taken from the National Vital Statistics System. PATIENTS: Patients with papillary thyroid cancer limited to the thyroid gland. MAIN OUTCOME MEASURE: Cancer-specific survival. RESULTS: Of all eligible people in the data (n = 35,663), 1.2% did not undergo immediate, definitive treatment (n = 440). The life table estimate of their 20-year cancer-specific survival rate was 97% (95% confidence interval [CI], 96%-100%). The corresponding estimate for the patients who did receive treatment was 99% (95% CI, 93%-100%). Among those who did not receive immediate, definitive treatment, 6 died from their cancer. This number is not statistically different from the number of thyroid cancer deaths in the treated group over the same period (n = 161) (P = .09). CONCLUSION: Papillary thyroid cancers of any size that are limited to the thyroid gland (no extraglandular extension or lymph node metastases at presentation) have favorable outcomes whether or not they are treated in the first year after diagnosis and whether they are treated by hemithyroidectomy or total thyroidectomy.结论:局限于甲状腺体内的甲状腺乳头状癌(不论肿瘤大小,未侵出包膜,无淋巴结转移),不论是否在确诊一年内治疗,不论是行甲状腺全切还是甲状腺腺叶切除,都有着较好的预后。
Medullary thyroid cancer: management guidelines of the American Thyroid Association.Thyroid 2009Jun19(6) :565-612 PMID:19469690BACKGROUND: Inherited and sporadic medullary thyroid cancer (MTC) is an uncommon and challenging malignancy. The American Thyroid association (ATA) chose to create specific MTC Clinical Guidelines that would bring together and update the diverse MTC literature and combine it with evidence-based medicine and the knowledge and experience of a panel of expert clinicians. METHODS: Relevant articles were identified using a systematic PubMed search and supplemented with additional published materials. Evidence-based recommendations were created and then categorized using criteria adapted from the United States Preventive Services Task Force, Agency for Healthcare Research and Quality. RESULTS: Clinical topics addressed in this scholarly dialog included: initial diagnosis and therapy of preclinical disease (including RET oncogene testing and the timing of prophylactic thyroidectomy), initial diagnosis and therapy of clinically apparent disease (including preoperative testing and imaging, extent of surgery, and handling of devascularized parathyroid glands), initial evaluation and treatment of postoperative patients (including the role of completion thyroidectomy), management of persistent or recurrent MTC (including the role of tumor marker doubling times, and treatment of patients with distant metastases and hormonally active metastases), long-term follow-up and management (including the frequency of follow-up and imaging), and directions for future research. CONCLUSIONS: One hundred twenty-two evidence-based recommendations were created to assist in the clinical care of MTC patients and to share what we believe is current, rational, and optimal medical practice.背景:遗传和散发性甲状腺髓样癌(MTC)是一个不常见且具有挑战性的恶性肿瘤。美国甲状腺协会(ATA)决定建立一个专门的MTC临床指南,它将集合和更新不同的MTC文献,并用循证医学以及临床专家的知识和经验将它整合起来。方法:通过系统的PubMed搜索和另外发行的增刊来遴选相关文章。建立基于循证学的推荐,并根据适合美国预防医学工作组和美国医疗保健研究与质量管理署的标准进行分类。结果:在学术交流中的临床热点包括:临床前期病变的的早期诊断和治疗(包括RET致癌基因的检测和预防性甲状腺切除的时限)、对有临床表现疾病的初步诊断和治疗(包括术前测试和成像、手术范围和甲状旁腺血行阻断的处理)、术后病人的初始评价和治疗(包括甲状腺完全切除术的作用)、持久性的或再发MTC的处理(包括肿瘤标记物倍增时间的作用、对有远端转移和激素活性转移灶的患者的治疗)、长期随访和处理(包括随访和影像检查的频率)、未来的研究方向。结果:建立了122个循证学推荐,以助于对MTC患者的临床护理并分享我们认为是通用、合理和最佳的医疗实践。
原癌基因RET突变和血管内皮细胞生长因子受体(VEGFR)的活性,在甲状腺髓样癌的发病机制中起关键作用。索拉非尼(一种靶向RET和VEGFR的多激酶抑制剂)在临床前甲状腺髓样癌(MTC)研究中显示出有抗肿瘤活性。这项索拉非尼治疗晚期MTC患者的Ⅱ临床试验,主要终点是客观反应;次要终点包括毒性评估与肿瘤标志相关反应、功能性影像,以及RET突变。患者进入A组(遗传组)和B组(散发组),口服索拉非尼400mg,每日2次。结果显示,在散发组16例患者中,1例获部分缓解(PR,6.3%),14例稳定(SD,87.5%),1例不可评估。析因分析表明,散发组10例患者在入组前疾病进展(PD),1例PR>21个月,4例SD>15个月,4例SD<6个月,1例有临床PD。中位无进展生存期为17.9个月。遗传组因获益慢而提前终止。大部分患者的肿瘤标志物下降,散发组10/12例患者检出RET突变。常见的不良事件包括腹泻、手足皮肤反应、皮疹和高血压。尽管严重不良事件罕见,但有1例患者死亡。研究者认为,因存在潜在与索拉非尼相关的罕见致命毒性反应,还应谨慎用药。
目的:基于Ras-Raf-MAP-ERK信号和血管内皮生长因子(VEGF)在乳头状甲状腺癌(PTC)中的重要作用,研究人员通过索拉非尼II期临床试验来考察其对PTC患者RAF和VEGF受体激酶的作用。试验对象与方法:研究的主要评价指标为客观缓解率,其次包括血清甲状腺球蛋白(Tg)情况、功能状况、肿瘤基因型及肿瘤切片检查中的信号抑制情况。采用Simon最大最小双平台设计,A组纳入16或25名未接受过化疗的转移性PTC患者(接受肿瘤切片检查);B组纳入其他亚型甲状腺癌患者或之前接受过化疗的患者,不需进行肿瘤切片。患者口服索拉非尼治疗,一日两次,共400mg。每两个月通过RECIST(实体瘤疗效评价标准)评价疗效。结果:结果发现,41名PTC患者中,其中6名部分缓解(PR; 15%; 95% 可信区间, 6-29),23名患者(56%; 95% 可信区间, 40-72)的肿瘤稳定期超过6个月。PR中位持续期为7.5个月(范围:6-14)。中位无进展存活期为15个月(95% 可信区间, 10 -27.5)。18名可检测到Tg的PTC患者中有14名(78%)Tg下降超过25%。常见的3级不良反应包括手脚皮肤反应、肌肉骨骼疼痛及疲劳。22名接受检测的PTC患者中有17位(77%)存在BRAF基因变异。从PTC患者获得的10对肿瘤切片其中4对显示血管内皮生长因子受体磷酸化水平、ERK磷酸化水平及索拉非尼治疗期间的VEGF表达均下降。而非PTC患者未见症状缓解。结论:因此研究人员得出结论,索拉非尼对转移性PTC有临床及生物学抗肿瘤活性,且耐受良好。PURPOSE: Based on the pivotal role of Ras-Raf-MAP-ERK signaling and vascular endothelial growth factor (VEGF) in papillary thyroid cancer (PTC), we conducted a phase II clinical trial of sorafenib targeting RAF and VEGF receptor kinases in PTC. PATIENTS AND METHODS: The primary end point was the objective response rate. Secondary end points included response correlation with serum thyroglobulin (Tg); functional imaging; tumor genotype; and signaling inhibition in tumor biopsies. Using a Simon minimax two-stage design, 16 or 25 chemotherapy-naive metastatic PTC patients were to be enrolled in arm A (accessible tumor for biopsy). Arm B patients had other subtypes of thyroid carcinoma or prior chemotherapy, and did not require tumor biopsies. Patients received 400 mg orally twice per day of sorafenib. Response was assessed every 2 months using RECIST (Response Evaluation Criteria in Solid Tumors). RESULTS: Of 41 PTC patients, six patients had a partial response (PR; 15%; 95% CI, 6 to 29) and 23 patients (56%; 95% CI, 40 to 72) had stable disease longer than 6 months. Median duration of PR was 7.5 months (range, 6 to 14). Median progression-free survival was 15 months (95% CI, 10 to 27.5). In 14 (78%) of 18 Tg-assessable PTC patients, Tg declined more than 25%. Common grade 3 adverse events included hand-foot skin reaction, musculoskeletal pain, and fatigue. BRAF mutation was detected in 17 (77%) of 22 PTCs analyzed. Four of 10 paired tumor biopsies from PTC patients showed a reduction in levels of vascular endothelial growth factor receptor phosphorylation, ERK phosphorylation, and in VEGF expression during sorafenib therapy. No PRs were noted among non-PTC patients. CONCLUSION: Sorafenib is reasonably well-tolerated therapy with clinical and biologic antitumor activity in metastatic PTC.
甲状腺癌是头颈部常见的恶性肿瘤之一,占全身恶性肿瘤的1%~2%,多见于女性。目前国际上将甲状腺癌的治疗分为高危和低危两组,分别采用不同的处理对策。高危组的主要特征包括年龄大于45岁、男性、肿瘤有转移、