tbuckley/cabot-search huggingface dataset:
Use of prophylactic cranial irradiation in patients with extensive-stage small cell lung cancer receiving immunotherapy.
Authors: Daniel X. Yang, Vikram Jairam, Henry S. Park, Roy H. Decker, Anne C. Chiang, Cary Philip Gross, James B. Yu
Journal: Journal of Clinical Oncology (2020)

e19309 Background: Prophylactic cranial irradiation (PCI) use is controversial in extensive-stage small cell lung cancer (ES-SCLC). In addition to lack of survival benefit of PCI compared to close MRI surveillance in a 2017 published trial, the role of PCI is being further challenged in the modern immune-oncology (IO) era. The IMpower133 trial reporting a survival benefit to atezolizumab for ES-SCLC published in 2018 did not require PCI use. Contemporary practice patterns of PCI in relation to immunotherapy are unknown. Methods: We performed a retrospective cohort analysis of patients with ES-SCLC diagnosed between January 1, 2013 to September 31, 2019 from the nationwide Flatiron Health electronic health record-derived de-identified database. First-line chemotherapy (Chemo) was defined as Chemo given alone, while first-line IO therapy was IO alone or combined with chemotherapy as initial systemic therapy. Results: The cohort included 3047 ES-SCLC patients who received first-line Chemo, and 324 patients who received first-line IO. For first-line IO patients, 268 (82.7%) received first-line atezolizumab. The use of first-line IO increased from 1.2% of patients diagnosed in 2013 to 11.3% of patients diagnosed in 2018 (p &lt; 0.001), and 54.5% of patients diagnosed in 2019 (p &lt; 0.001). Overall documented PCI for patients receiving either first-line IO or first-line Chemo decreased from 14.7% in 2013 to 7.0% in 2018-2019 (p &lt; 0.001). For first-line IO patients, 23 (7.1%) had documented PCI over our study period, with 5.3% of patients diagnosed in 2018-2019 having received PCI. In contrast, for first-line Chemo patients, 428 (14.0%) received PCI over our study period, and PCI use significantly decreased from 14.8% in 2013 to 7.9% in 2018-2019 (p = 0.001). In 2018-2019, use of PCI was not significantly different between patients receiving first-line IO compared to first-line Chemo (5.3% vs 7.9%, p = 0.163). Conclusions: The use of first-line IO has significantly increased in ES-SCLC. Overall PCI rates for ES-SCLC patients decreased significantly over the study period, although documented PCI use rates do not differ between patients receiving upfront IO or Chemo in 2018-2019. Further investigation is warranted regarding effectiveness of PCI in the modern IO era.
Prognostic impact of ESR1 mutations in ER+ HER2- MBC patients prior treated with first line AI and palbociclib: An exploratory analysis of the PADA-1 trial.
Authors: Francois Clement Bidard, Celine Callens, Florence Dalenc, Barbara Pistilli, Thibault De La Motte Rouge, Florian Clatot, Veronique D'hondt, Luis Teixeira, Helene Vegas, Sibille Everhard, Jerome Lemonnier, Ivan Bieche, Anne Pradines, Jean FranCois Paitel, Dominique Spaeth, Isabelle Moullet, Jean-Yves Pierga, Frederique Berger, Anne-Claire Hardy-Bessard, Thomas Bachelot
Journal: Journal of Clinical Oncology (2020)

1010 Background: The question of which is the best endocrine partner to CDK4/6 inhibitors in first line for ER+ HER2- metastatic breast cancer (MBC) remains open. ESR1 mutations might be of paramount importance, as they confer resistance to AI but not to SERD. In pts treated with first line palbociclib-AI combination (PADA-1 trial, NCT03079011), we investigated ESR1mut detection rate at inclusion, prior to any therapy, and their prognostic impact. Methods: The PADA-1 phase 3 trial (NCT03079011, UCBG-GINECO) evaluates the utility of monitoring the onset of ESR1mut in cell-free DNA (with a ddPCR assay [Jeannot et al, Oncogene 2020]) of pts receiving AI-palbociclib in first line. Included pts had no prior therapy for MBC and no overt resistance to AI. Results: N = 1017 ER+ HER2- MBC pts were included in 22 months from 04/2017 and had their cfDNA tested for ESR1mut at inclusion and during therapy. N = 33/1017 pts had a detectable circulating ESR1mut at inclusion (3.2%, 95%CI [2.2;4.5]), ESR1mut positivity being associated with a prior exposure to AI in the adjuvant setting (p &lt; 0.01). N = 1 pt died after 1 month on treatment. In N = 25/32 evaluable pts (78%), ESR1mut became undetectable in cfDNA (AF &lt; 0.1%) within the first 5 months on treatment, with a median time to ESR1mut ‘clearance’ of 34 days. Among these 25 pts, 14 pts (56%) had ESR1mut detected again during therapy; 2 pts (8%) experienced a progression with no ESR1mut detected; the remaining 9 patients (36%) were still both ESR1mut -free and progression-free at time of analysis. With a median FU time of 12.4 months (range: 0-25.3m) under AI-palbociclib, the 33 ESR1mut-positive pts had a shorter PFS (median: 17.5mo, 95%CI[10.5-NR]) than the 984 ESR1mut-negative pts (median not reached), with an estimated HR = 2.8 [1.6;5.0]. Updated data will be presented at the meeting. Conclusions: ESR1mut are rarely detected in the cfDNA of ER+ HER2- MBC patients with no overt resistance to AI. The quick ‘clearance’ of ESR1mut under treatment and the observed 17.5 months-long median PFS both suggest that the AI-palbociclib combination retain a clinical activity in this population. ESR1mut-positivity prior was however associated with a significantly shorter PFS, suggesting that ESR1mut positivity at baseline could accelerate the onset of resistance to AI-palbociclib. These findings may put into perspective the incoming results of the PARSIFAL trial. Clinical trial information: NCT03079011 .
Interaction between CAF and CD8+ T cells in non-small cell lung cancer affects prognosis and efficacy of immunotherapy.
Authors: Xinlong Zheng, Dongqiang Zeng, Wenying Peng, Pansong Li, Lifeng Li, Xuan Gao, Zhipeng Zhou, Jing Bai, Junhui Li, Jianming Ding, Deqiang Wang, Suya Zheng, Qian Miao, Kan Jiang, Biao Wu, Feng Long, Chao Li, Haipeng Xu, Yi Yin, Lin Gen
Journal: Journal of Clinical Oncology (2020)

9536 Background: Cancer-related fibroblasts (CAFs) are important components of the tumor microenvironment (TME) and play a key role in tumor progression. There is growing evidence that CAF levels in tumors are highly correlated with treatment response and prognosis. However, the effect of CAFs on immunotherapy response remains unknown. Methods: RNA-seq and clinical data were downloaded from TCGA and GEO. The SVA package ComBat function was used to remove batch effects. The ssGSEA algorithm was used to assess the level of cell infiltration in each sample. OS (overall survival) and DFS (disease free survival) were analyzed using the Kaplan–Meier method. GO enrichment analysis was used to assess the biological processes of subgroup differential genes. The Tumor Immune Dysfunction and Exclusion (TIDE) algorithm and subclass mapping were used to predict the clinical response to immune checkpoint blockade. Results: We evaluated the infiltration abundance of 24 types of immune cells and fibroblasts in 1768 NSCLC samples and found that almost all IMFRs (immune cells / fibroblasts) are beneficial to the prognosis. This phenomenon is called “CAFs-mediated immune resistance pattern (CMIRP)”. We evaluated the infiltration abundance of 24 types of immune cells and fibroblasts in 1768 NSCLC samples and found that almost all IMFRs (immune cells / fibroblasts) are beneficial to the prognosis. This phenomenon is called “CAFs-mediated immune resistance pattern (CMIRP)”. The prognosis according to CD8+ T cells was not strong, but CD8+ T cells / fibroblasts (CFR) were significant protective prognostic factors [n = 1588; hazard ratio (HR), 0.66; 95% confidence interval (CI), 0.56–0.78; P &lt; 0.001]. Multivariate analysis revealed that the CFR was an independent prognostic biomarker. The TCGA pan-cancer cohort confirmed the widespread presence of CMIRP in cancer. We further defined the CFR high and CFR low subgroups. CFR high samples were enriched with immune activation pathways including T cell activation, cytolysis, and antigen presentation, while CFR low was associated with immunosuppression including activation of transforming growth factor β, epithelial-mesenchymal transition, and angiogenesis pathways. Finally, we combined TIDE and submap to speculate that CFR is a potential prognostic marker of immunotherapy for NSCLC. Conclusions: We proposed the term “CMIRP” to shed light on a more accurate assessment of immune status. CFR is a potential marker for prognosis and predictive efficacy of immunotherapy in NSCLC.
Impact of treatment line on outcomes with salvage ipilimumab + nivolumab in metastatic renal cell carcinoma (mRCC).
Authors: Ritesh Kotecha, Chung-Han Lee, Andrea Knezevic, Neil J. Shah, Maria Isabel Carlo, Darren R. Feldman, Sujata Patil, Robert J. Motzer, Martin H Voss
Journal: Journal of Clinical Oncology (2020)

e17092 Background: With the approval of ipilimumab plus nivolumab (I+N) and other immune checkpoint blockade (ICB) based combinations in the first-line setting, the role of I+N for salvage is of high interest for treatment sequencing, yet data is limited. Methods: We conducted a retrospective review of mRCC patients (pts) treated with I+N in the second-line (2L) and beyond settings at MSKCC between 2013-2019. Pt demographics, treatment history and toxicity were compiled. IMDC-risk status was calculated at I+N therapy start. Time to treatment failure (TTF) was defined as earliest date of clinical progression, therapy change or death, and overall survival (OS) was estimated by Kaplan-Meier method. Results: 36 pts received I+N in the 2+L setting, including 31/36 with clear-cell histology. Evaluable IMDC-risk at I+N start was favorable in 1/35 and intermediate-poor in 34/35 pts. The most common 1L therapies were anti-VEGF (22/36) and VEGF + ICB (6/36). 11/36 pts had ICB treatment exposure prior to I+N therapy. I+N therapy in the 2L, 3L and 4L was in 21/36, 8/36 and 7/36 pts, respectively, and 7/36 pts continue I+N at data cut-off. 8/36 pts discontinued I+N due to toxicity, 20/36 pts discontinued therapy due to disease progression, and 1 pt discontinued per pt preference. Cohort median OS was 14.8 months (95%CI: 4.2-44). Overall median TTF was 5.0 months (95%CI: 2.9-14.4), and TTF per 2L, 3L and 4+L was 8.3, 8.9 and 2.5 months, respectively. The number of patients who completed all 4 I+N induction cycles in the 2L, 3L, and 4+L was 11/21 (52%), 5/8 (63%), and 1/7 (14%). The number of patients who subsequently received nivolumab maintenance therapy after induction was 16/21 (76%) in the 2L, 1/8 (13%) in the 3L, and 0/7 (0%) in 4+L. Conclusions: With emerging treatment options for mRCC, this study reveals activity and safety for I+N in 2+L settings. In this limited cohort, completion of induction ipilimumab and use of maintenance nivolumab decline in later-line settings, suggesting limitations as salvage therapy. [Table: see text]
Covid-19: the ethics of clinical research in quarantine
Authors: Nicholas G Evans
Journal: BMJ (2020)

The ongoing covid-19 outbreak has resulted in more than 5.4 million cases and over 330 000 deaths worldwide.Governments responding to a serious disease pandemic might engage in liberty limiting measures including the use of quarantine, sometimes without sufficient legal 1 or ethical justification. 2 But quarantine offers an opportunity to develop an understanding of covid-19 that might otherwise not be possible, through the study of disease course and transmission.Research on individuals and groups in quarantine raises distinct ethical issues that require balancing the rights of confined people against the scientific and social value such research could produce.
Depatuxizumab mafodotin (Depatux-M) plus temozolomide (TMZ) in recurrent glioblastoma patients: Real-world experience from a multicenter study of Italian Association of Neuro-Oncology (AINO).
Authors: Mario Caccese, Marta Padovan, Marica Eoli, Alessia Pellerino, Simona Rizzato, Claudia Caserta, Matteo Simonelli, Maria Michiara, Vittorina Zagonel, Roberta Ruda, Giuseppe Lombardi
Journal: Journal of Clinical Oncology (2020)

2544 Background: Precision medicine is a promising tool in oncology. Depatux-M is a new antibody-drug conjugate, consisting of a specific antibody against activated EGFR and a cytotoxic agent with antimicrotubule activity. The Intellance2/EORTC 1410 phase II trial, showed interesting results for Depatux-M and TMZ combination in EGFR-amplified glioblastoma (GBM) patients (PTS) at first recurrence after RT and TMZ. In our study, we investigated clinical outcome and safety of this combination used in recurrent GBM PTS as “compassionate use”. Methods: In this prospective observational study, PTS were enrolled from 7 centres of AINO. Major inclusion criteria were: histologically confirmed diagnosis of GBM, 1 or more prior systemic therapies, ECOG PS ≤ 2 and EGFR-amplified (analyzed by FISH). According to original schedule, patients received Depatux-M 1.25 mg/kg every two weeks combined with TMZ until disease progression or unacceptable toxicity. Kaplan-Meier method was used to estimate the survival curves, RANO criteria for radiological assessment, CTCAE v5.0 for drug related adverse events. Results: From October 2018 to June 2019, we enrolled 36 PTS: median age was 57, ECOG PS 0-1 in 88% of PTS, MGMTmet in 64%, 42% received the treatment as second-line therapy and 27% underwent further chemotherapy at progression. At the time of analysis, 13 PTS (36%) had died and 27 PTS (75%) had progressed. Median OS was 8.7ms (95%CI not available), 6ms OS was 68%; median PFS was 2.3ms (95% CI 1.8 – 2.8), 6ms PFS was 37%. All PTS were evaluable for response: disease control rate was 47%: stable disease was reported in 36% and partial response in 11% of PTS. Drug-related adverse events led to dose reductions of Depatux-M in 17% of PTS, in 28% was delayed and in 8% was permanently discontinued. The most frequent grade 3-4 adverse events were ocular toxicity in 67% and haematological toxicity in 17% of PTS; no death was considered drug-related. Conclusions: We report the first “real world” experience of Depatux-M plus TMZ in recurrent GBM. We showed encouraging clinical benefit, despite most patients were treated beyond the second-line of therapy. Overall the results are closed to those reported in previous phase II trial. Although toxicity was higher than expected, it was manageable and only a small group of patients discontinued the treatment due to serious adverse events
Design-based bone marrow biopsy training.
Authors: Sam Brondfield, Derek Harmon, Dylan Romero, Jenny Tai, Gerald Hsu
Journal: Journal of Clinical Oncology (2020)

11007 Background: Hematology/oncology fellows must achieve bone marrow biopsy proficiency. However, a cost-effective, high-fidelity system to practice these procedures has not been described. Other specialties utilize 3D printing to practice procedures. Using design thinking, we developed, implemented, and evaluated a bone marrow biopsy training session with 3D pelvis models. Methods: We printed two models using an NIH template and optimized them through iterative prototyping. We covered a hole at the intended biopsy site with a replaceable cap simulating cortical bone, used cork as medullary bone, and used sand and water as marrow. Caps of two densities simulated softer and harder bone. Fellows could lift silicone skin pads to view anatomy. A flat base minimized movement. In July 2019, we conducted a one-hour practice session (“3D session”) with eight fellows during orientation. After an anatomy review, fellows practiced biopsies using the models with faculty feedback. Fellows also attended a one-hour session with a hematologist demonstrating a biopsy on a patient (“patient session”), the only session offered in previous years. We used a t-test to compare course ratings and pre/post-orientation self-assessed comfort with biopsies (5-point scales). Six months later, we surveyed attendings about fellow biopsy skill and success rate compared to prior years. S.B. conducted a content analysis of a focus group with four fellows and email feedback from one fellow. Results: Fellows rated the 3D and patient sessions highly (4.50 vs 4.75, p = 0.51). Procedural comfort improved significantly after orientation (2.13 to 3.63, p = 0.03). Attendings noted no difference between the 2019 fellows and prior years. Fellows called the 3D session “helpful” and “high-yield.” They praised the opportunity to practice repeatedly with high-fidelity anatomy, rehearse mechanics, receive feedback, and internalize anatomy and muscle memory for later recall. Fellows noted that the model did not allow for patient positioning practice and that the denser cap was too hard. Fellows suggested incorporating a female pelvis and more soft tissue. Conclusions: We developed, implemented, and evaluated a design-based bone marrow biopsy training session. Though we did not find outcome differences compared to traditional training, 3D printing represents a feasible, cost-effective, and high-fidelity educational tool. 3D sessions, in conjunction with patient sessions, may augment understanding of anatomy and provide opportunities for practice and feedback. Future iterations should incorporate user feedback to optimize model fidelity and utility.
Analysis of perioperative hemorrhage in percutanous nephrolithotomy via standard nephrostomy tract
Authors: Bo Song, Peishan Wu, Xin Li
Journal: BMJ (2018)

We retrospectively reviewed the clinical data of 7 patients with intraoperative or postoperative hemorrhage, who underwent percutanous nephrolithotomy (PCNL) in Beijing Luhe Hospital between 2010 and 2016.There are 5 males and 2 females with a mean age 50.7 year (30-75 years). There were 4 cases of multiple stones in kidney, 2 cases of mold stones and 1 case of stone in upper ureter.Digital subtraction angiography (DSA) showed 5 cases of false aneurysms after operation: on lower pole arterial branches in 3 cases and on middle pole arterial branches in 2 cases.Two patients with hemorrhage during operation underwent immediate digital subtraction angiography with negative result and the bleeding disappeared 1 week later with conservative therapy.False aneurysms and arteriovenous fistula caused by the procedure may lead to hemorrhage during and after PCNL.Hyperselective renal arteriolar embolization is an effective and safe method to treat delayed hemorrhage after PCNL.


Key words: 
Lithotripsy; Nephrostomy, percutaneous; Postoperative hemorrhage; Hyperselective renal arteriolar embolization
心尖球形综合征一例
Authors: 李建明, 刘挺松, 张海燕
Journal: BMJ (2010)

患者女,43岁,因突发胸闷、胸痛12 h就诊.病前在棋牌室持续打麻将超过6 h.既往体健.体检:血压85/50 mmHg(11.3/6.7 kPa),急性面容,两肺呼吸音粗,未闻及干湿性啰音.心率65次/min,第一心音低钝,可闻及频发早搏,各瓣膜听诊区未闻及杂音。
Comprehensive molecular analysis of microsatellite-stable (MSS) tumors with high mutational burden in gastrointestinal (GI) cancers.
Authors: Jingyuan Wang, Joanne Xiu, Anthony Frank Shields, Axel Grothey, Benjamin Adam Weinberg, John Marshall, Emil Lou, Moh'd M. Khushman, Davendra Sohal, Michael J. Hall, Francesca Battaglin, Hiroyuki Arai, Shivani Soni, Wu Zhang, Wolfgang Michael Korn, Heinz-Josef Lenz
Journal: Journal of Clinical Oncology (2020)

3631 Background: Mutational signatures contributing to high tumor mutation burden (TMB-H) independent from microsatellite instability-high (MSI-H) status are not well-studied. We aimed to characterize specific molecular features of a large cohort of GI tumors with TMB-H &amp; MSS. Methods: We sequenced23392 GI tumors, including 2707 gastroesophageal (GE), 11616 colorectal (CRC), and 9069 others. Samples were analyzed using Next-generation sequencing (NGS) and immunohistochemistry (IHC) (Caris Life Sciences, Phoenix, AZ). MMR/MSI status was evaluated by a combination of IHC, Fragment Analysis and NGS. Tumors with TMB ≥ 17 mutations/Mb were defined as TMB-H. PD-L1 was tested by IHC [22C3 (CPS score, positivity: CPS ≥ 1%) in GE tumors and SP142 (Positivity: TPS ≥ 5%) in other cancers]. Findings were compared in four groups (TMB-H/L &amp; MSI-H/MSS) using Fisher-Exact or Chi-square and adjusted for multiple comparison by Benjamini-Hochberg. Significance was determined by adjusted (adj) p &lt; .05. Results: Overall, TMB-H &amp; MSS was observed in 1% of patients (pts) (n = 237, including 45 GE, 124 CRC, 68 others), while TMB-H &amp; MSI-H, TMB-L &amp; MSS, TMB-L &amp; MSI-H were observed in 4% (n = 936), 94.4% (n = 22089) and 0.6% (n = 130) respectively. Compared to other groups, TMB-H &amp; MSS showed the most prevalent amplifications (AMPs), including CCND1 (5.6%), FGF3/4/19 (4.9%, 4.3%, 4.4%) , MYC (4.3%) (Top 5, adj p &lt; .05), and the highest mutation rates in POLE (21.6%), RB1 (13.1%), CDC73 (10.3%), RUNX1 (6.5%), and genes involved in PI3K &amp; MAPK ( PIK3R1 17%, mTOR 3.4%, MAP2K1 3.8% , MAP2K4 5.6%) and Wnt ( APC 48.5% , SMAD2 6.5% , TCF7L2 3.8%) pathways (adj p &lt; .05). The rates of HER2 AMP and high-expression (IHC) were the highest in TMB-H &amp; MSS, followed by TMB-L &amp; MSS, TMB-H &amp; MSI-H, TMB-L &amp; MSI-H (adj p&lt; .0001); PD-L1 positive rate was similar between TMB-H &amp; MSS and TMB-L &amp; MSI-H, while the highest and lowest in TMB-H &amp; MSI-H and TMB-L &amp; MSS respectively in GE and other GI cancers (adj p &lt; .01) (Table). Conclusions: This is the largest study to investigate the special molecular landscape of pts with TMB-H &amp; MSS in GI cancers. Our data may provide novel insights for pt selection and more effective targeted combination immunotherapies (e.g. HER2, PI3K inhibitors) in GI cancers. [Table: see text]
小儿输液不当所致高钠血症及后遗症
Authors: 吴明昌
Journal: BMJ (2005)

患儿男,5岁,体重17 kg,不慎被开水烫伤左臂,经治疗,但烫伤继发感染,出现发热,食欲不振.在农村输液治疗,每日输葡萄糖生理盐水500～1 000 ml及抗生素(不详),共14 d,虽感染好转,但患儿烦躁,口渴,变得不活泼、不爱说话,好像变傻了,遂来京治疗.入院时查体:患儿反应迟钝,木呆状,肌张力增高,反射亢进.血生化:血钠165mmol/L,血氯增高,血钾正常.经输维持液治疗,血钠逐渐下降,第3天至正常高限,住院1周出院,肌张力恢复正常,但智力仍差。
社区需要引进便捷高效经济的即时检验技术
Authors: 刘俊玲
Journal: BMJ (2010)

现代医学重科学证据的特征贯穿于日常诊疗实践活动中,各种高科技技术层出不穷. 全科医生的工作是提供基础的一线服务,每天接触众多患者,并不能像在大医院里那样方便地利用各种检验设备,只是靠自己的临床经验进行疾病判断或开具处方.为了不贻误病情,不少医生习惯于在证据不清楚的情况下积极用药,例如对于呼吸道感染或其他炎症患者均使用抗生素,不管其病情是否严重或是否为细菌感染.这种习惯性做法似应予以纠正,因为它不符合循证医学原则,不利于合理使用药物,也不利于扭转社会和医疗保险界有关社区卫生服务不科学、问病拿药,不值得信任的偏见。
系统性红斑狼疮继发抗磷脂综合征伴蛋白S缺乏症一例
Authors: 刘润荣, 李梦涛, 赵永强, 曾小峰
Journal: BMJ (2011)

系统性红斑狼疮(SLE)继发性抗磷脂综合征(APS)在临床上常见,有血栓形成倾向,易出现反复自发性流产、血小板减少,这些表现均与抗磷脂抗体(APL)密切相关.临床上常检测的APL包括狼疮抗凝物(LA)、抗心磷脂抗体(ACL)和抗β2-糖蛋白Ⅰ(抗β2-GPⅠ)抗体.而SLE继发APS合并蛋白S缺乏症在国内报道较少.现报道一例如下。
取股骨外髁骨植骨治疗胫骨平台II、III型骨折25例分析
Authors: 齐春贵, 郭岩风, 张笑
Journal: BMJ (2008)

胫骨平台骨折由于局部解剖复杂,特别是严重创伤后可出现极其复杂的骨折形式,常出现关节面塌陷及骨缺损,处理不当容易出现膝关节僵直、创伤性关节炎等并发症,严重影响患者的膝关节功能.本院自2002年1月至2006年12月对此类患者行内同定和植骨治疗,膝关节功能恢复良好。
骨髓转移癌40例临床及血液学分析
Authors: 孔令环, 肖中平, 付堃, 黄淑英, 曲耿辉
Journal: BMJ (2005)

骨髓转移癌是原发于身体其他部位的肿瘤通过血液或淋巴循环,扩散侵犯到人体的造血组织--骨髓.骨髓穿刺涂片检查是诊断骨髓转移癌的简单而实用的方法.检出的肿瘤类型多种多样,可以来自肝脏、肺、胃肠、前列腺、乳腺、子宫、附件等器官.有的肿瘤在疾病晚期才发生转移,有的在疾病早期原发灶不明显的情况下已经发生转移.骨髓受累对肿瘤分期、治疗方案选择及判断预后有重要意义.现将我院近年来收集的40例骨髓转移癌病例分析如下。