查看基于多柔比星的化疗对右心房肿块和心包积液狗的回顾性评估的源代码
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基于多柔比星的化疗对右心房肿块和心包积液狗的回顾性评估
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== Discussion == 这项研究的主要发现是,单独接受基于多柔比星的化疗方案的狗的中位生存时间为 139 ·5天。与单独接受心周穿刺术(少于 30 天)或单独接受 RA 肿块切除术(中位数 42 天)治疗的狗相比,生存时间更长(Kersetetter 等人,1997 年,Dunning 等人,1998 年,Stafford Johnson 等人,2004 年,Weisse 等人,2005 年,MacDonald 等人,2009 年)。它与接受 RA 肿块切除和辅助化疗的狗报告的 175 天的中位生存时间相当(Weisse 等人,2005 年)。因此,对于不希望进行手术干预的主人或RA肿块无法手术切除的狗来说,单独使用基于多柔比星的化疗似乎是一种可行的选择。 本研究中最常用的化疗方案是多柔比星和环磷酰胺,之前有报道称,多柔比星和环磷酰胺可提高早期 HSA 犬患者的生存率和可接受的发病率(Sorenmo 等人,1993 年)。兽医文献中已经报道了 HSA 的其他化疗方案,但只要包含多柔比星,就没有方案被认为优于另一种方案(Hammer 等人,1991 年,Sorenmo 等人,1993 年,Ogilvie 等人,1996 年,Clifford 等人,2000 年)。有必要进行具有标准化化疗方案和对照组的进一步前瞻性研究,以更好地评估对治疗的反应。 初步研究报告称,超声心动图检测心脏肿块的敏感性相对较差(Kersetetter 等人,1997 年,Weisse 等人,2005 年)。然而,最近的一项研究报告称,识别狗的心脏肿块,尤其是 RA 肿块具有很高的敏感性和特异性(MacDonald 等人,2009 年)。最近的另一项研究发现,基于超声心动图肿瘤位置的推定诊断与组织病理学诊断之间只有中等程度的一致性(Rajagopalan 等人,2013 年)。后两项研究在超声心动图诊断的敏感性和特异性方面的差异可能与评估的人群有关,因为前一项研究仅包括患有 PE 的狗,而后一项研究中只有不到一半的病例出现 PE。根据作者的经验,由于无声心包液的对比作用,PE 的存在通常能够更准确地定位心脏肿瘤。此外,Rajagopalan等人(2013)进行的研究是一项基于病理学的研究,因此可能反映了由于异常的超声心动图发现或无法定位肿块的起源而更有可能在尸检中评估的狗的选择偏倚。超声心动图识别 PE 狗心脏肿瘤位置的敏感性和特异性需要进一步评估。 本研究中的狗在随后的重新评估中重复进行了超声心动图检查,以确定 RA 质量尺寸是保持不变还是正在变化。在大多数情况下,质量尺寸似乎是静态的,尽管由于没有PE,很难确定质量是否一致。此外,进行复查评估的心脏病专家或心脏病学住院医师并不总是最初确定 RA 肿块的同一个人,因此可能存在一定程度的观察者间差异,可能会影响测量的一致性。 本研究的进一步局限性在于其回顾性设计和缺乏对照组所固有的。没有报告临床症状的严重程度,因此临床症状不太明显的动物可能会接受化疗,而临床症状更严重的狗则没有,这进一步影响了本研究的结果。治疗组中只有一只狗经组织学证实为 RA HSA。研究报告称,多达 88% 的具有超声心动图识别的 RA 肿块的狗随后被诊断为 HSA,但其他确定的肿瘤包括甲状腺癌、间皮瘤、淋巴瘤和神经内分泌肿瘤(Ware & Hopper 1999, MacDonald et al. 2009, Rajagopalan et al. 2013)。因此,虽然本研究中包含的大多数狗确实患有 RA HSA,但一小部分人没有,这将影响此处报告的狗的存活时间,具体取决于个体肿瘤对基于多柔比星的化疗方案的反应性。此外,大多数狗的分期很少,因此很难准确评估疑似心脏HSA的分期及其对生存的影响。最后一个限制是本研究中包含的狗数量相对较少,因此需要大量具有组织学证实的 HSA 的 RA 肿块的狗接受标准化化疗方案来验证此处报告的结果。 The primary finding of this study was that dogs receiving a doxorubicin-based chemotherapy protocol alone had a median survival time of 139 · 5 days. This is a longer survival time compared to dogs treated with periocardiocentesis alone (less than 30 days) or with RA mass resection alone (median of 42 days) (Kersetetter et al. 1997, Dunning et al. 1998, Stafford Johnson et al. 2004, Weisse et al. 2005, MacDonald et al. 2009). It is comparable to the median survival time of 175 days reported for dogs with RA mass resection and adjuvant chemotherapy (Weisse et al. 2005). Consequently, doxorubicin-based chemotherapy alone appears to be a viable alternative for owners who do not wish to pursue surgical intervention or for dogs whose RA mass is not surgically resectable. The most commonly used chemotherapy protocol in this study was doxorubicin and cyclophosphamide, which has been reported previously to improve survival with acceptable morbidity in canine patients with early-stage HSA (Sorenmo et al. 1993). Other chemotherapy protocols for HSA have been reported in the veterinary literature although no protocol is considered superior to another as long as doxorubicin is included (Hammer et al. 1991, Sorenmo et al. 1993, Ogilvie et al. 1996, Clifford et al. 2000). Further prospective studies with a standardised chemotherapy protocol and a control group are warranted to better evaluate response to therapy. Initial studies reported a relatively poor sensitivity for echocardiography at detecting cardiac masses (Kersetetter et al. 1997, Weisse et al. 2005). However, a more recent study reported a high sensitivity and specificity for identification of cardiac masses in dogs and RA masses in particular (MacDonald et al. 2009). Another recent study found only moderate agreement between presumptive diagnosis based on echocardiographic tumour location and histopathological diagnosis (Rajagopalan et al. 2013). The discrepancy in the sensitivity and specificity of echocardiographic diagnosis between these latter two studies is likely related to the population evaluated as the former study included only dogs with PE whereas less than half the cases in the latter study presented with PE. In the authors’ experience, the presence of PE typically enables more accurate anatomic localisation of the cardiac tumour owing to the contrasting effect of anechoic pericardial fluid. Furthermore, the study performed by Rajagopalan et al. (2013) was a pathology-based study and therefore likely to reflect a selection bias for dogs that were more likely to be evaluated at necropsy owing to unusual echocardiographic findings or inability to localise the origin of the mass. The sensitivity and specificity of echocardiography for identifying cardiac tumour location in dogs with PE requires further evaluation. The dogs in this study had repeat echocardiograms performed in subsequent re-evaluations to determine if the RA mass dimensions remained static or were changing. In most instances, the mass dimensions appeared static although it was difficult to determine if the masses were measured consistently because of the absence of PE. Furthermore, the cardiologist or cardiology resident performing the recheck evaluation was not always the same person who had identified the RA mass initially, and therefore there was likely some degree of interobserver variation that could affect the consistency of the measurements. Further limitations to this study are inherent to its retrospective design and lack of a control group. Severity of clinical signs was not reported, and therefore it is possible that animals with less significant clinical signs pursued chemotherapy while dogs with more severe clinical signs did not, further affecting the results of this study. Only one of the dogs in the treatment group had histologically confirmed RA HSA. Studies have reported that as many as 88% of dogs with echocardiographically identified RA masses are subsequently diagnosed as HSA, but other tumours identified include thyroid carcinomas, mesothelioma, lymphoma and neuroendocrine tumours (Ware & Hopper 1999, MacDonald et al. 2009, Rajagopalan et al. 2013). As such it is likely that while the majority of dogs included in this study did have RA HSA, a small population did not, which would affect the survival times of the dogs reported here depending on the responsiveness of the individual tumour to a doxorubicin-based chemotherapy protocol. In addition, most dogs had minimal staging performed and therefore it is difficult to accurately assess the stage of the suspected cardiac HSA and its impact on survival. A final limitation was the relatively small number of dogs included in this study, and therefore larger populations of dogs with RA masses with histologically confirmed HSA receiving a standardised chemotherapy protocol are required to validate the results reported here. 总之,与之前仅进行心包穿刺或手术的报道相比,对患有 RA 肿块和 PE 的狗进行基于多柔比星的化疗可缩短生存时间,这与接受 RA 肿块切除术和辅助化疗的狗相当。有必要进行更大规模的前瞻性研究,包括标准化化疗方案和对照组的疾病组织病理学确认,以调查和验证这些初步结果。 In conclusion, doxorubicin-based chemotherapy for dogs with RA masses and PE resulted in an improved survival time compared with previous reports for pericardiocentesis or surgery alone, and that was comparable to dogs treated with RA mass resection and adjuvant chemotherapy. Larger prospective studies with standardised chemotherapy protocols and histopathological confirmation of disease with a control group are warranted to investigate and validate these initial results. <br>
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