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Value of a patient-reported-outcome measure of carcinoid syndrome symptoms.
患者报告的价值-类癌综合征症状的结果测量。
- 影响因子:0
- DOI:10.1530/EJE-20-1138
- 作者列表:"Maurel J","Guimbaud R","Lecomte T","Lièvre A","Hautefeuille V","Robinson P","Francois L","Lombard-Bohas C","Forestier J","Milot L","Subtil F","Walter T
- 发表时间:2021-05-01
Abstract
Objective:Literature on patient-reported outcomes (PRO) of carcinoid syndrome symptoms (CSS) is scarce. We used a patient-reported outcome measure (PROM) to evaluate CSS, the domains of daily life impacted by CSS, the main symptoms that affect daily life, its change according to clinical, biological and morphological evolution, and the risk factors for a poor PRO-CSS score. Methods:Patients completed the PRO-CSS, EORTC-QLQ30, and GI-NET21 questionnaires at the time of their clinical, laboratory, and morphological assessments in a multicentre French cohort study from February 2019 to May 2020. Results:In total, 147 patients with metastatic ileal (n =126), lung (n =20), or unknown primitive neuroendocrine tumour but high 5-hydroxyindole-3-acetic acid level (n =1) were included; 42 (32%) received an above-label dose of somatostatin analogues. Fifty-one (35%) patients had a poor PRO-CSS score. Travelling and food restriction were the two main domains affected. Diarrhoea (mean: 2.3/5 on Likert scale), imperiousness (mean of 2.5/5), fatigue (2.2/5), abdominal pain (1.7/5), and flushing episodes (1.5/5) were the main symptoms affecting daily life. The PRO-CSS score was not correlated to the clinical assessment performed by physicians at the baseline and during the follow-up. Patients with a poor PRO-CSS score had a higher tumour burden. Conclusions:PROM-CSS may help physicians make an objective assessment of CSS and its impact in daily practice; this tool could become a key evaluation criterion in clinical trials focusing on CSS.
摘要
目的: 关于类癌综合征症状 (CSS) 的患者报告结果 (PRO) 的文献很少。我们使用患者报告的结局指标 (PROM) 来评估CSS、受CSS影响的日常生活领域、影响日常生活的主要症状、根据临床、生物学和形态学演变的变化以及PRO-CSS评分不佳的风险因素。 方法: 患者在2019年2月至2020年5月的法国多中心队列研究中完成了PRO-CSS,EORTC-QLQ30和GI-NET21份问卷的临床,实验室和形态学评估。 结果: 共纳入147例转移性回肠 (n = 126),肺 (n = 20) 或未知的原始神经内分泌肿瘤但高5-羟基吲哚-3-乙酸水平 (n = 1) 的患者; 42例 (32%) 接受上述剂量的生长抑素类似物。51例 (35%) 患者的PRO-CSS评分较差。旅行和食物限制是受影响的两个主要领域。腹泻 (Likert量表平均值: 2.3/5) 、专横 (平均值2.5/5) 、疲劳 (2.2/5) 、腹痛 (1.7/5) 和潮红发作 (1.5/5) 是影响日常生活的主要症状。PRO-CSS评分与医生在基线和随访期间进行的临床评估不相关。PRO-CSS评分差的患者具有更高的肿瘤负荷。 结论: PROM-CSS可以帮助医生对CSS及其在日常实践中的影响进行客观评估; 该工具可能成为CSS临床试验中的关键评估标准。
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METHODS::The ATP binding-cassette superfamily corresponds the mostly transmembrane transporters family found in humans. These proteins actively transport endogenous and exogenous substrates through biological membranes in body tissues, so they have an important role in the regulation of many physiological functions necessary for human homeostasis, as well as in response regulation to several pharmacological substrates. The development of multidrug resistance has become one of the main troubles in conventional chemotherapy in different illnesses including cancer, being the increased efflux of antineoplastic drugs the main reason for this multidrug resistance, with a key role of the ABC superfamily. Likely, the interindividual variability in the pharmacological response among patients is well known, and may be due to intrinsically factors of the disease, genetic and environmental ones. Thus, the understanding of this variability, especially the genetic variability associated with the efficacy and toxicity of drugs, can provide a safer and more effective pharmacological treatment, so ABC genes are considered as important regulators due to their relationship with the reduction in pharmacological response. In this review, updated information about transporters belonging to this superfamily was collected, the possible role of these transporters in cancer, the role of genetic variability in their genes, as well as some therapeutic tools that have been tried to raise against main transporters associated with chemoresistance in cancer.
METHODS:BACKGROUND:Cholinergic neurotransmission regulates neuroinflammation in Parkinson disease (PD). RESEARCH DESIGN AND METHODS:The authors conducted a delayed-start study of donepezil for cognitive decline in non-demented PD patients. The study consisted of a 96-week randomized placebo-controlled double-blind phase 1, followed by a 24-week donepezil extension phase 2. The primary outcome measure was a change in the Mini-Mental State Examination (MMSE) at week 120. RESULTS:A total of 98 patients were randomly allocated to the early-start (donepezil-to-donepezil) and delayed-start (placebo-to-donepezil) groups. Mean (SD) of the baseline MMSE was 27.6 (2.0) and 28.0 (2.1), respectively. MMSE change at week 120 was better in the early-start group than in the delayed-start group, but the difference was not significant. The MMSE declined in apolipoprotein ε4 carriers, but not in non-carriers, and the factor interaction (intervention × ε4 genotype) was highly significant (P < 0.001). Analyzed with the interaction, the difference was significant (group difference 1.95 [0.33 to 3.57], P = 0.018). The MMSE decline slope in phase 1 was significantly better in the early-start group than in the delayed-start group (P = 0.048). CONCLUSIONS:Cognitive function deteriorated in ε4 carriers, but not in non-carriers, and early-start donepezil may postpone cognitive decline in the former.
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