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闋牳閮細鑵﹁啘鏃佸崁(q奴)RMS鍗犻牠闋搁儴RMS鐨�50%锛屾棭鏈熶笉鏄撶櫦(f膩)鐝�(xi脿n)锛岃€屼笖寰堥洠瀹屽叏鍒囬櫎?锛熸潃鎲〧(xi脿n)鐐洪蓟鑵旀垨鑰呭鑰抽亾鍑虹従(xi脿n)鑶胯鎬у垎娉岀墿锛岃€抽亾鎴栭蓟鑵旈樆濉烇紝鎴栬€呭悶鍜藉洶闆�銆傜櫏鐙€鍙兘鏈冭瑾よ獚(r猫n)鐐烘槸涓婂懠鍚搁亾鎱㈡€х値鐧�銆�
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(浜�)鐥呯悊鍒嗗瀷
姗磱鑲岃倝鐦ゆ槸鐢变笉鍚屽垎鍖栭殠娈电殑姗磱鑲屾瘝绱�(x矛)鑳炵祫鎴愭儭鎬ц叓鐦�锛屽爆浜庡皬鍦撹棈(l谩n)绱�(x矛)鑳炶叓鐦�锛岃叓鐦ょ敱灏忕窗(x矛)鑳炵祫鎴�锛屾湁澶х殑銆佸湏鐨勬繁鏌撶殑绱�(x矛)鑳炴牳锛岄彙涓嬪彲瑕嬮楠艰倢鎺掑垪銆傚厤鐤祫鍖栭’绀哄瓨鍦╠esmin銆乵yogenin銆乵yoglobin銆乤ctin銆乿imentin绛夐楠艰倢妯�(bi膩o)瑷�銆俉HO灏嘡MS鍒嗙偤浠ヤ笅涓夌ó鍩烘湰鐥呯悊椤炲瀷銆�
1.鑳氳儙鍨�(ERMS)锛氬寘鎷憽钀勭媭(botryoidcell)鍜屾褰㈢窗(x矛)鑳炲瀷(spindlecell)銆傜窗(x矛)鑳為伜鍌冲(xu茅)鍙婂垎瀛愮敓鐗╁(xu茅)鐮旂┒鎻愮ず锛岄儴鍒嗚儦鑳庡瀷瀛樺湪11铏熸煋鑹查珨闆滃悎缂哄け銆�
2.鑵烘场鍨�(ARMS)锛氶儴鍒咥RMS涓瓨鍦ㄦ煋鑹查珨鏄撲綅t(2;13)(q35;q14)鎴杢(1;13)(q36;q14)銆傞€欏叐绋槗浣嶅垎鍒ュ舰鎴愪簡鐩告噳(y墨ng)鐨勮瀺鍚堝熀鍥燩AX3-FKHR鍜孭AX7-FKHR銆傚叾涓�锛孭AX3-FKHR铻嶅悎铔嬬櫧鑸囬爯(y霉)鍚庝笉鑹浉闂�(gu膩n)銆�
3.澶氬舰鍨嬫垨闁撹畩鍨�(pleomorphicoranaplasticRMS)锛氬厭绔ョ綍瑕�锛岀梾鐞嗕簽鍨嬬偤闁撹畩鑰呴爯(y霉)鍚庝笉浣炽€�
(涓�)杓斿姪妾㈡煡
1.琛€甯歌(gu墨)銆佸翱甯歌(gu墨)銆佽鐢熷寲銆佸嚌琛€妾㈡煡
(1)琛€甯歌(gu墨)妾㈡煡锛氭偅鍏掑彲琛ㄧ従(xi脿n)鐐鸿钵琛€;鏈夐楂撴蹈娼よ€呭彲鍑虹従(xi脿n)鍏ㄨ绱�(x矛)鑳炴笡灏�銆�
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(3)琛€鐢熷寲妾㈡煡锛氳倽鑵庡姛鑳�銆丩DH銆侀浕瑙h唱(zh矛)鏄繀鏌ラ爡鐩�銆傝叓鐦よ矤(f霉)鑽峰ぇ鐨勬偅鑰呭彲鍑虹従(xi脿n)琛€灏块吀鍙婁钩閰歌劔姘叾澧為珮銆�
(4)鍑濊鍔熻兘锛氬寘鎷琍T銆丄PTT銆乀T銆丗IB銆丏-浜岃仛楂�銆丗DP銆傛湁楠ㄩ珦娴告饯銆侀珮鑵槫璨�(f霉)鑽�銆佸法澶х槫鐏跺悎骞惰叓鐦ょ牬瑁傚嚭琛€鑰呭彲鍑虹従(xi脿n)FIB涓嬮檷锛孌-浜岃仛楂斿崌楂樼瓑銆�
2.褰卞儚瀛�(xu茅)妾㈡煡
(1)X绶氬钩鐗囨鏌ワ細鍘熺櫦(f膩)閮ㄤ綅鐨刋绶氭鏌ュ彲浠ョ櫦(f膩)鐝�(xi脿n)鑵槫閳e寲銆侀渚电姱绛�?锛熸ⅱ鏆俹鍔╄ê鏂疯叓鐦よ偤閮ㄨ綁(zhu菐n)绉�銆�
(2)CT鎺冩弿锛氳叓鐦ゅ師鐧�(f膩)閮ㄤ綅閫氬父琛屽寮�(qi谩ng)CT鎺冩弿渚嗚紨鍔╄ê鏂风槫鐏跺ぇ灏忓強灞€閮ㄨ粺绲勭箶銆侀楠间镜鐘儏娉�锛屼互鍙婄敤渚嗚⿻浼版不鐧傚弽鎳�(y墨ng)銆傝兏閮–T鍙婅吂閮–T骞虫巸鍙敤渚嗗垽瀹氭湁鐒¤偤閮ㄥ強鑲濊嚐鐨勮綁(zhu菐n)绉汇€�
(3)纾佸叡鎸巸鎻忥細鍙⒑瀹氬師鐧�(f膩)鐦ょ伓浠ュ強灏嶅懆鍦嶉劙杩戠祫绻斿櫒瀹樼殑渚电姱鎯呮硜锛屽挨鍏堕仼鐢ㄤ簬鐪跺懆銆佽叇鑶滄梺鍙婅剨鏌辨梺鍗€(q奴)鍩熺殑鑵槫銆�
(4)楠ㄦ巸鎻忥細鐢ㄤ簬瑭曚及楠ㄩ杞�(zhu菐n)绉荤殑鎯呮硜銆�
(5)PET/CT妾㈡煡锛氭湁姊濅欢鐨勫柈浣嶅彲鑰冩叜琛屽叏韬闆诲瓙鐧�(f膩)灏勮▓绠楁(j墨)鏂峰堡椤儚锛屾湁鍔╀簬鍏ㄩ潰瑭曚及鐦ょ伓鍙婅綁(zhu菐n)绉婚儴浣�銆�
(6)B瓒呮鏌ワ細鍙敤浜庡師鐧�(f膩)鐦ょ伓鍙婅綁(zhu菐n)绉荤槫鐏剁殑瑭曚及鍙婃不鐧傚弽鎳�(y墨ng)鐨勭洠(ji膩n)娓€�
(7)蹇冭嚐褰╄壊瓒呰伈锛氱敤浜庡寲鐧傚墠蹇冭嚐鍔熻兘鐨勮⿻浼�銆�
3.鏈夊壍(chu脿ng)鎿嶄綔妾㈡煡
(1)娲绘锛氶€氬父鎵嬭(sh霉)娲绘鍙嵅鍙栬冻澶犵殑妯�(bi膩o)鏈敤浜庣祫绻旂梾鐞嗗強鍒嗗瓙鐢熺墿瀛�(xu茅)妾㈡煡銆傝嫢鍒濊ê鏅備笉鑳借鏍规不鎬ф墜琛�(sh霉)鍒囬櫎锛屽彲鍏堜簣杓斿姪鍖栫檪锛屽緟鑵槫绺皬鍚庢搰鏈熸墜琛�(sh霉)娌荤檪銆傛浠跺厑瑷辩殑鎯呮硜涓嬪彲琛岀┛鍒烘椿妾€€�
(2)楠ㄩ珦绌垮埡鎴栨椿妾細鐢ㄤ簬瑭曚及鏈夌劇楠ㄩ珦娴告饯銆�
(3)鑵﹁剨娑叉鏌ワ細鐥呰畩浣嶄簬鑵﹁啘鏃佸崁(q奴)鑰咃紝寤鸿琛岃叇鑴婃恫妾㈡煡锛屽寘鎷彙涓嬫壘鐦ょ窗(x矛)鑳�锛屾湁姊濅欢鐨勫柈浣嶅彲琛屾祦寮忕窗(x矛)鑳炶(sh霉)妾㈡煡銆�
4.鍏朵粬妾㈡煡
(1)鑱藉姏妾㈡煡锛氱敤浜庢不鐧傚墠鑱藉姏鐨勮⿻浼帮紝浠ュ強閴戦钘ョ墿鑱藉姏姣掓€х殑鐩�(ji膩n)娓�銆�
(2)UGTIAI鍩哄洜澶氭厠(t脿i)鎬х殑妾㈡脯锛歎GTIAI鏄紛绔嬫浛搴风殑涓昏浠h瑵閰�锛屾湁姊濅欢鐨勫柈浣嶆噳(y墨ng)琛孶GTIAI鍩哄洜澶氭厠(t脿i)鎬ф娓�銆俇GTIAI*6鍩哄洜鐨勭獊璁婂瀷鍙檷浣嶶GTIAI娲绘€э紝澧炲姞鑵搁亾榛忚啘鎼嶅偡锛屽嚭鐝�(xi脿n)鑵圭€夐ⅷ(f膿ng)闅�;UGTIAI*28鍩哄洜澶氭厠(t脿i)鎬ф槸闋�(y霉)娓寲鐧傚悗鐧�(f膩)鐢熷毚(y谩n)閲嶇矑绱�(x矛)鑳炴笡灏戝拰鑵圭€夐ⅷ(f膿ng)闅殑鍒嗗瓙妯�(bi膩o)瑷�銆�
(3)鐔掑厜鍘熶綅闆滀氦妾㈡煡(FISH)锛氬皪浜庤吅娉″瀷RMS锛岄€欓爡妾㈡煡鐢ㄤ締妾㈡脯鏄惁鏈塼(1:13)鎴杢(2:13)鏄撲綅锛屽嵆鏄惁瀛樺湪PAX7-FKHR鍜孭AX3-FKHR铻嶅悎鍩哄洜銆�
(鍥�)閼掑垾瑷烘柗
1.灏ゆ枃鑲夌槫锛氶€氬父琛ㄧ従(xi脿n)鐐鸿粺绲勭箶鍖呭锛岀壒鍒ユ槸鐧�(f膩)鐢熶簬闋牳閮�銆佸洓鑲㈢殑RMS闇€娉ㄦ剰鑸囧挨鏂囪倝鐦ら憭鍒�锛岀祫绻旂梾鐞嗘鏌ュ強FISH妾㈡煡鏈夊姪浜庨憭鍒ヨê鏂�銆�
2.绁炵稉(j墨ng)姣嶇窗(x矛)鑳炵槫锛氱櫦(f膩)鐢熶簬鑵圭泦鑵斻€侀牳閮ㄧ殑RMS闇€娉ㄦ剰鑸囩缍�(j墨ng)姣嶇窗(x矛)鑳炵槫閼掑垾锛屽彲绲�(ji茅)鍚堣叓鐦ゆ(bi膩o)瑷樼墿绁炵稉(j墨ng)鍏冪壒鐣版€х儻閱囧寲閰�(NSE)銆佸翱3-鐢叉哀鍩�4-缇ュ熀鑻︽潖浠侀吀/棣欒崏鎵佹閰�(HVA/VMA)杓斿姪瑷烘柗銆�
3.鐧借鐥咃細鏈夐楂撲镜鐘殑RMS闇€娉ㄦ剰鑸囩櫧琛€鐥呯浉閼掑垾锛岄楂撹叓鐦ょ窗(x矛)鑳炲厤鐤垎鍨嬨€侀楂撴椿妾㈢梾鐞嗘鏌ユ湁鍔╀簬瑷烘柗銆�
4.娣嬪反鐦わ細鐗瑰垾鏄吅娉″瀷姗磱鑲岃倝鐦ゆ湁鏅傚彲瑾よê鐐烘穻宸寸槫锛岄渶瑕佺梾鐞嗘渻瑷烘槑纰鸿ê鏂枫€�
5.鍏朵粬杌熺祫绻旇倝鐦わ細濡傜簴缍倝鐦�銆佸钩婊戣倢鑲夌槫銆佹儭鎬у鍛ㄧ缍�(j墨ng)闉樼槫銆侀鑲夌槫銆佹粦鑶滆倝鐦ょ瓑锛岄渶瑕侀€氶亷鐥呯悊瑷烘柗閼掑垾銆�
鍥�銆佽嚚搴婂垎鏈熷強鍗遍毆搴﹀垎绲�
(涓€)鑷ㄥ簥鍒嗘湡
鍏掔鑵槫鐮旂┒鍦嬮殯鍗�(xi茅)鏈冿紝鏍规摎(j霉)娌荤檪鍓嶅熀浜庡奖鍍忓(xu茅)鍒跺畾鐨勮嚚搴婂垎鏈熺郴绲�(t菕ng)(TNM-UICC锛岃〃1)锛屼互鍙婃┇绱嬭倢鑲夌槫鐮旂┒缇庡湅鍗�(xi茅)浣滅祫(IRS)鐨勮(sh霉)鍚�-鐥呯悊鑷ㄥ簥鍒嗙祫绯荤当(t菕ng)(琛�2)锛屽叐绋垎鏈熸柟娉曠浉绲�(ji茅)鍚�銆�
(浜�)鍗遍毆搴﹀垎绲�
渚濇摎(j霉)鐥呯悊浜炲瀷銆佽(sh霉)鍚庣梾鐞嗗垎鏈熷拰TNM鍒嗘湡锛屽皣鍗遍毆搴﹀垎鐐轰綆鍗辩祫銆佷腑鍗辩祫銆侀珮鍗辩祫(琛�3)锛屼互渚垮垎灞ゆ不鐧�銆�
浜斻€佺檪鏁堣⿻浼�
(涓€)鐦ょ伓瑭曚及妯�(bi膩o)婧�(zh菙n)
1.瀹屽叏绶╄В(CR)锛氭墍鏈夌梾鐏跺畬鍏ㄦ秷澶卞ぇ浜�4鍛�锛岄楂撹綁(zhu菐n)绉昏€呯窗(x矛)鑳炴秱鐗囨鏌ラ櫚鎬�銆�
2.閮ㄥ垎绶╄В(PR)锛氬師鐧�(f膩)鑵槫绺皬≥64%锛岃綁(zhu菐n)绉荤槫鐏剁府灏�≥30%锛屾矑鏈夋柊鐨勭梾鐏�銆�
3.鐤剧梾閫�(j矛n)灞�(PD)锛氬師鐧�(f膩)鑵槫杓冨垵瑷烘檪澧炲ぇ≥40%锛岃綁(zhu菐n)绉荤槫鐏�≥20%锛屾垨鍑虹従(xi脿n)鏂扮梾鐏�銆�
4.鐤剧梾绌�(w臎n)瀹�(SD)锛氳叓鐦ら珨绌嶄粙浜嶱D鍜孭R涔嬮枔銆�
(浜�)绺介珨鐧傛晥瑭曞児妯�(bi膩o)婧�(zh菙n)
1.CR锛氬師鐧�(f膩)鐦ょ伓鍜岃綁(zhu菐n)绉荤槫鐏跺潎CR锛岀劇鏂扮櫦(f膩)鐥呯伓銆�
2.PR锛氬師鐧�(f膩)鐦ょ伓CR锛岃綁(zhu菐n)绉荤槫鐏禤R/SD锛岀劇鏂扮櫦(f膩)鐥呯伓;鎴栧師鐧�(f膩)鐦ょ伓PR锛岃綁(zhu菐n)绉荤槫CR/PR/SD锛岀劇鏂扮櫦(f膩)鐥呯伓銆�
3.SD锛氬師鐧�(f膩)鐦ょ伓SD锛岃綁(zhu菐n)绉荤槫CR/PR/SD锛岀劇鏂扮櫦(f膩)鐥呯伓銆�
4.PD锛氬師鐧�(f膩)鐦ょ伓銆佽綁(zhu菐n)绉荤槫鐏朵换浣曡檿閫�(j矛n)灞昉D銆傞”楠�1.5鍘樼背浠ュ収(n猫i)鐥呯伓銆�
(涓�)娌荤檪涓⿻浼�
1.鎵嬭(sh霉)鍓嶆鏌ャ€傚叏韬鏌�锛屽寘鎷偤CT銆侀牠椤盡RI銆佸師鐧�(f膩)鐦ょ伓B瓒呭拰灞€閮ㄥ寮�(qi谩ng)CT鎴朚RI銆�
2.鍖栫檪姣忛枔闅�2鐧傜▼銆傝⿻浼板師鐧�(f膩)鐦ょ伓鍙婅綁(zhu菐n)绉荤槫鐏跺ぇ灏�锛屽嵆寰�(f霉)鏌ュ眬閮˙瓒�锛岄伕鎿囨€у寮�(qi谩ng)MRI銆�
3.寰�(f霉)鐧�(f膩)瑭曚及銆傚京(f霉)鐧�(f膩)鏄寚鑵槫瀹屽叏娑堝け1鍊嬫湀鍚�锛屽啀娆″嚭鐝�(xi脿n)灞€閮ㄦ垨杞�(zhu菐n)绉绘€ц叓鐦ょ梾鐏躲€傛鑵槫鏄撳師浣嶅京(f霉)鐧�(f膩)锛屽鏋滃京(f霉)鏌ヤ腑鐧�(f膩)鐝�(xi脿n)鍘熶綅鎴栫梾鍒濊綁(zhu菐n)绉荤伓寰�(f霉)鐧�(f膩)锛屾垨鑰呭嚭鐝�(xi脿n)鐩告噳(y墨ng)鐨勭櫏鐙€銆侀珨寰�锛屽墖闇€閫�(j矛n)涓€姝ュ啀鑰冩叜鑲篊T銆侀牠椤盡RI绛夊鏄撹綁(zhu菐n)绉婚儴浣嶇殑妾㈡煡銆�
4.娌荤檪涓娆¤⿻鍍圭偤CR銆丳R鍜孭D鐨勬偅鍏掞紝闁撻殧6锝�8鍛ㄥ啀瑭曞児浠ョ⒑瑾�(r猫n)銆�
5.娌荤檪绲�(ji茅)鏉熷墠瑭曚及銆傚師鐧�(f膩)鐦ょ伓B瓒�銆佸寮�(qi谩ng)纾佸叡鎸垨CT銆佽兏閮–T銆侀牠椤盡RI锛屽繀瑕佹檪琛岄鎺冩弿銆傛不鐧備腑棣栨瑭曞児鐐篊R銆丳R鍜孭D鐨勬偅鍏�锛岄枔闅�6锝�8鍛ㄥ啀瑭曞児浠ョ⒑瑾�(r猫n)銆傛不鐧傜祼(ji茅)鏉熷悗閲濆皪绺介珨鐨勬不鐧傛晥鏋滃啀娆¤⿻鍍瑰拰纰鸿獚(r猫n)銆�
鍏�銆佹不鐧�
RMS娌荤檪鍘熷墖鍜岀窗(x矛)鍓囬噸榛炲弮鐓с€婄編鍦嬪厭绔ユ┇绱嬭倢鑲夌槫鐮旂┒鍗�(xi茅)浣滅祫(IRSG)娌荤檪鏂规銆嬪拰銆婁腑鍦嬪厭绔ュ強闈掑皯骞存┇绱嬭倢鑲夌槫瑷虹檪寤鸿CCCG-RMS-2016鍜岃В璁€銆嬨€愪腑鑿厭绉戦洔蹇�2017绗�55鍗风10鏈熴€�銆傛彁渚涚殑浠ヤ笅娌荤檪鏂规鍚勯啱(y墨)闄㈡牴鎿�(j霉)鍚勮嚜鎯呮硜閬告搰鎳�(y墨ng)鐢紝閮ㄥ垎鐥呬汉鍙祼(ji茅)鍚堟墍鍦ㄩ啱(y墨)闄㈠闅涙儏娉侀仼鐣�(d膩ng)鏀硅壇銆�
(涓€)鎵嬭(sh霉)
鏈€濂借兘鍋氬畬鏁寸殑鑵槫鍒囬櫎鎴栧儏鏈夐彙涓嬫畼鐣�銆傚鏋滀笉鑳藉畬鍏ㄥ垏闄ゆ垨鑰呯梾璁婄疮鍙婄溂鐪躲€侀櫚閬�銆佽唨鑳辨垨鑶介亾锛岀偤浜嗕繚瀛樺櫒瀹樺強鍏跺姛鑳�锛屽彲鍏堢敤鍖栫檪鎴栧姞鏀剧檪锛屼娇鑵槫绺皬锛屽啀閫�(j矛n)琛屾墜琛�(sh霉)銆�
濡傜涓€娆℃墜琛�(sh霉)鍍呭仛鑵槫閮ㄥ垎鍒囬櫎锛屽彲缍�(j墨ng)鍖栫檪鍜�(鎴�)鏀剧檪3锝�6鍊嬫湀(4锝�8鍊嬬檪绋�)鍚庡啀鎵嬭(sh霉)銆傜偤浜嗛仈(d谩)鍒板畬鏁村垏闄よ叓鐦ょ殑鍘熺櫦(f膩)鐥呯伓锛屽彲浠ラ€�(j矛n)琛屼簩娆℃墜琛�(sh霉)锛屽垏闄ゅ師閬虹暀涓嬬殑闄芥€ч倞绶f垨鍘熷儏鍋氭椿妾㈤儴浣嶃€�
(浜�)鏀剧檪
1.鏀剧檪鎸囧緛锛歊MS鑳氳儙鍨婭RS-鈪犳湡涓嶅仛鏀剧檪锛屸叀锝炩叄鏈熷墖闋堟斁鐧�銆傝吅娉″瀷鏄撴湁灞€閮ㄥ京(f霉)鐧�(f膩)锛屾晠鈪犳湡涔熷仛鏀剧檪銆�
2.鏀剧檪鍔戦噺锛氬父瑕�(gu墨)鍒嗗壊鏀剧檪鑸囪秴鍒嗗壊鏀剧檪鐒″崁(q奴)鍒�銆傜偤娓涘皯鏅氭湡鎼嶅偡锛屾斁鐧傞渶閲囩敤澶氬垎娆$収灏�锛屽柈娆″姂閲忎笉瓒呴亷180cGy銆傚缓璀伴噰鐢ㄤ笁缍仼褰㈡垨瑾�(di脿o)寮�(qi谩ng)鏀剧檪鎶€琛�(sh霉)銆俁MS鍘熺櫦(f膩)鍜岃綁(zhu菐n)绉荤槫鐏剁殑鎺ㄨ枽鏀剧檪鍔戦噺(琛�4)銆�
3.鏀剧檪鏅傛(j墨)锛氭墜琛�(sh霉)宸茬稉(j墨ng)瀹屽叏鍒囬櫎鐦ょ伓鑰咃紝鍙簬琛�(sh霉)鍚�1鍛ㄥ収(n猫i)鏀剧檪;浼撮”搴曚镜鐘殑鎮e厭锛屾湁鏄庨’澹撹揩鐧ョ媭锛岄渶瑕佺穵鎬ユ斁鐧傝€�锛屽彲浜庡寲鐧傚墠鍏堟斁鐧�銆傝叓鐦よ純澶х劇娉曟墜琛�(sh霉)鑰�锛屽缓璀版斁鐧傛檪闁撳湪鍘熺櫦(f膩)鐦ょ伓鍖栫檪绗�13鍛�锛岃綁(zhu菐n)绉荤槫鐏跺彲寤堕伈鍒板寲鐧傜25鍛�銆傚湪鏈夋浠剁殑鎯呮硜涓�锛屽彲浠ヨ€冩叜閲囩敤璩�(zh矛)瀛愭斁鐧�锛岃兘鏇撮珮鐨勪繚璀�(h霉)闈跺崁(q奴)鍛ㄥ湇鐨勬甯哥祫绻斿拰鍣ㄥ畼銆�
(涓�)鍖栫檪
1.绺界窗(x矛)鍓�
(1)鏍规摎(j霉)褰卞儚瀛�(xu茅)鍙婂叾浠栨鏌�锛屼及瑷堣叓鐦よ兘鍩烘湰瀹屽叏鍒囬櫎鑰呭厛鎵嬭(sh霉);瀹屽叏鍒囬櫎鍥伴洠鑰呭儏娲绘锛屾槑纰鸿ê鏂峰悗鍏堝寲鐧傚啀鎵嬭(sh霉)銆傚閬告搰鎵嬭(sh霉)锛屽墖鍖栫檪鍦ㄨ(sh霉)鍚�7d鍏�(n猫i)闁嬪銆傜1娆″寲鐧傛檪娉ㄦ剰鐥呯悊鏈冭ê绲�(ji茅)鏋滐紝濡傛灉鐐鸿吅娉″瀷寤鸿鍋氳瀺鍚堝熀鍥燩AX3-FKHR鍜孭AX7-FKHR锛岄渶淇鍗遍毆搴﹀垎绲�銆�
(2)鏀剧檪鏈熼枔閬垮厤鎳�(y墨ng)鐢ㄦ斁绶氳弻绱燚(ACTD)鍜岄樋闇夌礌(ADR)锛屽寲鐧傚姂閲忔笡鐐哄崐閲�銆�
(3)鍚勬湡鍧囨湁蹇呰鍖栫檪銆傛牴鎿�(j霉)鍗遍毆搴﹀垎绲�锛岄噰鐢ㄤ笉鍚屽挤(qi谩ng)搴︾殑鍖栫檪銆�
(4)鍔戦噺鍙婂寲鐧傚墠瑕佹眰锛氶暦鏄ユ柊鍫挎渶澶ч噺2.0mg锛屾斁绶氳弻绱燚鏈€澶ч噺2.5mg銆傚湪瀹屽叏绶╄В鍚�4锝�6鍊嬬檪绋嬪彲鑰冩叜鍋滆棩锛岀附鐧傜▼鏁�(sh霉)>12鍊嬫檪鑰冩叜鍊嬮珨鍖栬(di脿o)鏁存柟妗�銆傚寲鐧�12鍛ㄧ槫鐏惰⿻浼拌檿浜嶱D(鑵槫澧炲ぇ鎴栧嚭鐝�(xi脿n)鏂扮梾鐏�)鍓囧嚭绲�銆�
骞撮健<12鍊嬫湀鍖栫檪鍔戦噺娓涘崐鎴栭珨閲�≤12kg鎸夐珨閲嶈▓绠楋紝鍔戦噺=楂旇〃闈㈢⿳鍔戦噺/30×楂旈噸(kg)銆傛瘡鐧傜▼闁撻殧21d銆傛瘡鐧傜▼鍖栫檪鍓嶄腑鎬х矑绱�(x矛)鑳�(ANC)>0.75×10⁹/L锛岃灏忔澘(PLT)>100×10⁹/L?锛涱嚖鐔僘(ji茅)鏉�24锝�48h锛岄枊濮嬫敞灏勭矑绱�(x矛)鑳炲埡婵€鍥犲瓙(G-CSF)鎴栫矑-宸ㄥ櫖绱�(x矛)鑳炲埡婵€鍥犲瓙(GM-CSF)銆傞楂撴姂鍒舵湡>28澶╄€呬笅涓€鐧傜▼娓涢噺25%銆�
(5)鍖栫檪钘ョ墿姣掑壇鍙嶆噳(y墨ng)鐨勫垽瀹氭(bi膩o)婧�(zh菙n)锛氫互NCI涓嶈壇鍙嶆噳(y墨ng)鐨勫垎绱氭(bi膩o)婧�(zh菙n)(CTCAEversion5.0锛岃〃5)鐐轰緷鎿�(j霉)?锛涱嚖鐔愭槀缂额嫗姘夆拋閳緕娓績銆佽倽銆佽厧鍔熻兘鍜岃伣鍔涖€備笝姘ㄩ吀杞�(zhu菐n)姘ㄩ叾(ALT)闇€灏忎簬姝e父鍊�2鍊�锛岀附鑶界磪绱犲皬浜庢甯稿€�1.5鍊�銆傝厧鍔熻兘涓嶅叏鏅傛寜鑲岄厫娓呴櫎鐜�(Ccr)闄嶄綆姣斾緥鐩告噳(y墨ng)娓涢噺銆�
(6)甯歌(gu墨)鍙f湇寰�(f霉)鏂规柊璜炬槑25mg/(kg·d),2娆�/d锛屾渶澶ч噺0.48g/娆�锛�2娆�/澶�锛屾湇3d/鍛�锛屽寲鐧傞枊濮嬬洿鍒板寲鐧傜祼(ji茅)鏉熷悗3鍊嬫湀銆�
2.鍚勫嵄闅害鍒嗙祫鏂规
(1)浣庡嵄绲勬柟妗堬細
VAC鏂规(V锛氶暦鏄ユ柊鍫�+A锛氭斁绶氳弻绱燚+C锛氱挵(hu谩n)纾烽叞鑳�);VA鏂规(V锛氶暦鏄ユ柊鍫�+A锛氭斁绶氳弻绱燚);闀锋槬鏂板牽锛�1.5mg/m²,闈滆剤婊存敞,d1,d8,d15;鏀剧窔鑿岀礌D锛�0.045mg/(kg·娆�)+鐢熺悊楣芥按5min,d1;鐠�(hu谩n)纾烽叞鑳猴細1.2g/m²,1h,闈滆剤婊存敞锛宒1銆�2-宸板熀涔欏熀纾洪吀閳�(Mesna)360mg/(m²·娆�)+鐢熺悊楣芥按20锝�30min锛屼簬鐠�(hu谩n)纾烽叞鑳�0銆�3銆�6銆�9h,闈滆剤鎺ㄦ敞锛宒1銆�
娉細骞撮健灏忎簬12鍊嬫湀锛屾斁绶氳弻绱燚鍔戦噺娓涘崐鎴�≤12kg鎸夐珨閲嶈▓绠�锛屽姂閲�=楂旇〃闈㈢⿳鍔戦噺/30×楂旈噸(kg)?锛涱嚖?鐧傜▼鍚庡叏闈㈣⿻浼帮紝濡傛灉瀹屽叏绶╄В锛�4鐧傜▼鍚庡彲鑰冩叜鍋滆棩锛岀附鐧傜▼涓嶈秴閬�10娆�銆�
(2)涓嵄绲勬柟妗堬細
VAC鏂规锛氬悓浣庡嵄绲�锛�≤12kg鎸夐珨閲嶈▓绠�锛屽姂閲�=楂旇〃闈㈢⿳鍔戦噺/30×楂旈噸(kg)銆俈I鏂规(V锛氶暦鏄ユ柊鍫�+I锛氫紛绔嬫浛搴�)闀锋槬鏂板牽鍚屼綆鍗辩祫锛屼紛绔嬫浛搴凤細50mg/m²锛宒1锝瀌5锛孷CR鍚庨潨鑴堟淮娉�90min;鍠鏈€澶ч噺≤100mg/d锛屼紛绔嬫浛搴锋湁鍤�(y谩n)閲嶇矑绱�(x矛)鑳炴笡灏戝拰鑵圭€夌瓑涓嶈壇鍙嶆噳(y墨ng)锛屾湁姊濅欢鑰呭湪鍖栫檪鍓嶆浠惰€呭彲鍋歎GT1A1鍩哄洜妾㈡脯銆�
娉細VAC鍜孷I鏂规鍙氦鏇块€�(j矛n)琛屻€傚叏閮ㄥ寲鐧傚湪瀹屽叏绶╄В鍚�4锝�6鍊嬬檪绋嬪彲鑰冩叜鍋滆棩锛岀附鐧傜▼鏁�(sh霉)鏈€澶氱偤13鍊嬬檪绋�(42鍛�)锛岃秴閬�12鍊嬬檪绋嬫檪鑰冩叜鍊嬮珨鍖栬(di脿o)鏁存柟妗�?锛涱嚖?2鍛ㄧ槫鐏惰⿻浼拌檿浜嶱D(鑵槫澧炲ぇ鎴栧嚭鐝�(xi脿n)鏂扮梾鐏�)鍓囧嚭绲�锛屽彲鑰冩叜閫犺骞茬窗(x矛)鑳炵Щ妞�銆�
(3)楂樺嵄绲勬柟妗堬細
VAC銆乂I鏂规锛氬悓涓嵄绲�锛�≤12kg鎸夐珨閲嶈▓绠�锛屽姂閲�=楂旇〃闈㈢⿳鍔戦噺/30×楂旈噸(kg)銆俈DC(V锛氶暦鏄ユ柊鍫�+D锛氶樋闇夌礌+C锛氱挵(hu谩n)纾烽叞鑳�)/IE(I锛氱暟鐠�(hu谩n)纾烽叞鑳�+E:渚濇墭娉婅嫹)鏂规銆傞暦鏄ユ柊鍫匡細鍚屼綆鍗辩祫;闃块湁绱狅細30mg/m²锛宒1锝瀌2;鐠�(hu谩n)纾烽叞鑳猴細1.2g/銕★紝1h锛宒1;鐣扮挵(hu谩n)纾烽叞鑳�1.8g/m²锛宒1锝瀌5;渚濇墭娉婅嫹锛�100mg/m²锛宒1锝瀌5;2-宸板熀涔欏熀纾洪吀閳�(Mesna)360mg/(銕�·娆�)+鐢熺悊楣芥按20锝�30min锛岀挵(hu谩n)纾烽叞鑳�/鐣扮挵(hu谩n)纾烽叞鑳�0銆�3銆�6銆�9h,d1銆�
娉細浠ヤ笂鍖栫檪鏂规寤鸿琛�(sh霉)鍓嶄互VAC鍜孷I浜ゆ浛鐐轰富銆傝(sh霉)鍚庝互VDC鍜孖E浜ゆ浛鐐轰富銆傛斁鐧傛湡闁撳缓璀版噳(y墨ng)鐢╒I鏂规銆傚叏閮ㄥ寲鐧傚湪54鍛ㄥ畬鎴�锛岀附鐧傜▼鏁�(sh霉)瓒呴亷12鍊嬬檪绋嬫檪鍙€冩叜鍊嬮珨鍖栬(di脿o)鏁存柟妗�?锛涱嚖?2鍛ㄥ悗瑭曚及铏曚簬PD(鑵槫澧炲ぇ鎴栧嚭鐝�(xi脿n)鏂扮梾鐏�)鍓囧嚭绲�锛屽彲鑰冩叜骞茬窗(x矛)鑳炵Щ妞嶃€�
涓�銆佹不鐧傜浉闂�(gu膩n)姣掑壇鍙嶆噳(y墨ng)鐩�(ji膩n)娓強杓斿姪娌荤檪
(涓€)钘ョ墿杩戞湡姣掓€х洠(ji膩n)娓強杓斿姪娌荤檪
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涓€鏃﹀績鍔熻兘妾㈡脯鎻愮ず蹇冭嚐灏勮鍒�?j菒n)?sh霉)<55%鎴栬桓绺煭鍒�?j菒n)?sh霉)<28%锛岃嫢鑳借瓑鏄庡乏蹇冨姛鑳界暟甯稿拰绱�(x矛)鑿屾劅鏌撴湁闂�(gu膩n)锛屽彲浠ョ辜绾�(x霉)浣跨敤钂界挵(hu谩n)椤炴姉鐢熺礌锛屽惁鍓囨噳(y墨ng)瑭叉毇鍋滐紝鐩村埌灏勮鍒�?j菒n)?sh霉)≥55%鎴栬桓绺煭鍒�?j菒n)?sh霉)≥28%銆傛牴鎿�(j霉)钂界挵(hu谩n)椤炶棩鐗╀娇鐢ㄥ姂閲忔垨蹇冭倢鎼嶅偡绋嬪害閬告搰鍙充笝浜炶兒(Zinecard)銆佸乏鏃嬭倝鍫裤€佽兘閲忓悎鍔戠瓑钘ョ墿銆�
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鍑虹従(xi脿n)鐩茶吀鐐庤€呮噳(y墨ng)鍋滆棩銆傞憭浜庣洰鍓嶇劇闀锋槬鍦拌緵鑸囬暦鏄ユ柊鍫垮湪娌荤檪鐧傛晥鐨勯毃姗�(j墨)灏嶇収鍫卞憡锛岄櫎浠ヤ笂鎯呮硜澶栧缓璀伴閬稿湅闅涘叕瑾�(r猫n)钘ョ墿闀锋槬鏂板牽銆�
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