关注肿瘤患者的生存质量——Q-TWiST研究方法在转移性肾癌患者疗效评估中的应用

2017-09-05 佚名 中国医学论坛报

肿瘤患者最为关心的两个问题是:接受治疗能生存多久,以及治疗会对生活质量造成什么样的影响。为了更加客观地回答这个问题,专家们创造了一个新的概念:Q-TWiST (生存质量调整的无疾病或毒性症状时间(quality-adjusted time without symptoms of disease or toxicity),即整合了客观的疗效结果与患者的主观感受,来全面地评价一个药物。

专家简介



郭剑明教授,复旦大学泌尿外科研究所副所长,上海市医学会泌尿外科分会前列腺组副组长和医师协会委员 ,上海市激光学会激光医学泌尿外科专业委员会副主任委员,中华医学会泌尿外科学分会和上海市中西医结合学会泌尿外科分会委员,中国中西医结合学会和上海市中西医结合学会泌尿外科分会委员,上海市泌尿外科临床质控中心专家委员会委员。

肿瘤患者最为关心的两个问题是:接受治疗能生存多久,以及治疗会对生活质量造成什么样的影响。为了更加客观地回答这个问题,专家们创造了一个新的概念:Q-TWiST (生存质量调整的无疾病或毒性症状时间(quality-adjusted time without symptoms of disease or toxicity),即整合了客观的疗效结果与患者的主观感受,来全面地评价一个药物。

肾癌晚期一线的治疗已经有多种靶向药物,对这些药物的评估及合理应用则是临床实践中面临的新的挑战。为了全面评估这些药物给患者带来的综合获益,在COMPARZ研究中,研究者用Q-TWiST这一指标衡量了培唑帕尼与舒尼替尼两个药物。

COMPARZ研究是迄今为止晚期肾癌中纳入患者最多的非劣性临床研究,该研究证实,培唑帕尼与舒尼替尼一线治疗晚期/转移性肾癌的中位生存获益相当,而培唑帕尼组的ORR显着高于舒尼替尼组。同时,培唑帕尼在安全性以及对患者生存质量的影响上均优于舒尼替尼。在此基础上,研究者进一步进行了Q-TWiST分析。

Q-TWiST方法将治疗获益分成三个部分,评估治疗方案给患者带来的综合获益:

·肿瘤生长带来的症状

·治疗带来的不良反应

· 药物来到的生存获益



COMPARZ研究的Q-TWiST分析有何发现?

COMPARZ研究中位总随访时间约600天。可以看出,在此期间,舒尼替尼组3/4级毒性反应TOX的平均天数较培唑帕尼组更长,同时舒尼替尼组中代表无疾病复发和无不良反应的TWiST及REL时间更少(图)。用通俗的话来说,就是培唑帕尼组得患者生存时间更长,同时经历的不良反应更少,因此生存质量更高。




图 分区生存曲线图(分析显示,两组Q-TWiST中培唑帕尼更占优势)

Q-TWiST分析结果有何启示?

Q-TWIST在临床实践中具有极为重要的实际意义,而不仅仅只是一个学术概念。Q-TWiST 结合阈值分析法能够评价几乎所药物在疗效上带来的获益以及毒性或疾病进展带来的风险。COMPARZ研究中首次使用Q-TWiST分析评估了培唑帕尼与舒尼替尼对患者生存质量的综合影响。研究显示在药物的不良反应和疾病进展的效用权重组合中,培唑帕尼具有统计学意义的优势。且Q-TWiST积分显示培唑帕尼组患者临床获益优于舒尼替尼组患者,主要源于3/4级不良反应TOX的时间缩短。

COMPARZ研究中的Q-TWiST分析支持培唑帕尼组患者获益更多,这一分析结果随后被法国学者Escudier教授所进行的PICES研究再次证实。PICES研究的设计同样十分新颖,在双盲的情况下测试了医生与患者对于培唑帕尼和舒尼替尼两种药物的偏好程度。结果显示,约2/3的医生和患者均更愿意使用培唑帕尼治疗。这可能是因为培唑帕尼不仅能减少疲劳,手足综合征的发生,让患者享有更好的生活质量,同时还能显着减少急诊访视或电话咨询的次数,在临床上更加便于管理

在实际的治疗中,培唑帕尼在生活质量方面的优越性可能还能带来治疗依从性的提高。这在国际多个数据库及单中心治疗经验数据回顾中都得到了体现。正如同之前所说的那样,Q-TWIST不仅是一个学术上的创新概念,更是对我们临床用药的一种指导,一种对药物全面综合的考察与评价。相信在未来,会有更多的药物通过这样的考量,在给患者带来生存获益的同时,兼顾患者的生活质量,使患者活得更长,也更有尊严,更幸福。

COMPARZ研究首次使用Q-TWiST分析靶向药物治疗后患者的生存时间和生活质量,该分析把患者用药后分成三个阶段,第一个阶段没有不良反应,第二个阶段有3~4级不良反应,最后一个阶段是疾病进展。实际上就是将我们以往关注的PFS分成了两段,一段是没有不良反应,另一段是有3~4级不良反应。这样就将患者的生存质量与总生存相结合,这是Q-TWiST分析的主要亮点。

COMPARZ研究表明,培唑帕尼和舒尼替尼两治疗组患者的总生存无显着差异,但培唑帕尼组的ORR高于舒尼替尼。通过Q-TWiST分析发现,培唑帕尼的不良反应发生率要低于舒尼替尼,这反映在Q-TWiST分析中的TOX,也就是使用药物后患者发生3或4级治疗相关毒性的持续时间,这一时间明显短于舒尼替尼。这提示,在OS相当的情况下,患者使用培唑帕尼后发生不良反应的时间缩短,在药物治疗过程中的生活质量高于舒尼替尼。

另一项PISCES研究也表明,无论是患者还是医生,对于培唑帕尼的偏好明显高于培唑帕尼,这其实也与患者用药后的自我感觉、不良反应及需要与医生联络的次数等相关。

此文章由诺华肿瘤中国资助推送

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createdBy=2f5a410, createdName=zxxiang, createdTime=Sat Mar 24 23:23:00 CST 2018, time=2018-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1951894, encodeId=97591951894d3, content=<a href='/topic/show?id=7ff1149416a' target=_blank style='color:#2F92EE;'>#Q-TWiST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14941, encryptionId=7ff1149416a, topicName=Q-TWiST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a9de34, createdName=zhangpaul93, createdTime=Mon Oct 23 22:23:00 CST 2017, time=2017-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=242680, encodeId=38bf242680a3, content=学习了谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Mon Sep 11 00:02:56 CST 2017, time=2017-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=241803, encodeId=1c0f241803b5, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Fri Sep 08 16:16:54 CST 2017, time=2017-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1386284, encodeId=357f138628461, content=<a href='/topic/show?id=f08293399f9' target=_blank style='color:#2F92EE;'>#转移性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93399, encryptionId=f08293399f9, topicName=转移性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ac22500003, createdName=1249842em09(暂无昵称), createdTime=Thu Sep 07 13:23:00 CST 2017, time=2017-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1424205, encodeId=4413142420542, content=<a href='/topic/show?id=94c182929d0' target=_blank style='color:#2F92EE;'>#肿瘤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82929, encryptionId=94c182929d0, topicName=肿瘤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=60943920553, createdName=lanyan20020087, createdTime=Thu Sep 07 13:23:00 CST 2017, time=2017-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240900, encodeId=a8de24090052, content=这个好.医学不应该只是延长病人的生存期.更应该为病人病人着想.提高病人生存质量.使病人活的有尊严.更幸福, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/DYAIOgq83eqcAwLDVlsWdkjRvWfuiaXKZuQc7wBCmHM5Go3OacaDkO3Mib3VbbTzuNZCHEjqeHShX4dqVequotTw/0, createdBy=933a1954585, createdName=xufang111, createdTime=Wed Sep 06 05:40:36 CST 2017, time=2017-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240885, encodeId=2b1324088573, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4KDsF1g1gUHzGM0LHxX5B5uhEMln8y8iagso9N4XBTQVPmHrCNoT3o8bw80Ds53TpTgcPnKUIfkyw/0, createdBy=bc101976400, createdName=suibian2007bbb, createdTime=Wed Sep 06 00:13:15 CST 2017, 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  4. 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content=这个好.医学不应该只是延长病人的生存期.更应该为病人病人着想.提高病人生存质量.使病人活的有尊严.更幸福, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/DYAIOgq83eqcAwLDVlsWdkjRvWfuiaXKZuQc7wBCmHM5Go3OacaDkO3Mib3VbbTzuNZCHEjqeHShX4dqVequotTw/0, createdBy=933a1954585, createdName=xufang111, createdTime=Wed Sep 06 05:40:36 CST 2017, time=2017-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240885, encodeId=2b1324088573, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4KDsF1g1gUHzGM0LHxX5B5uhEMln8y8iagso9N4XBTQVPmHrCNoT3o8bw80Ds53TpTgcPnKUIfkyw/0, createdBy=bc101976400, createdName=suibian2007bbb, createdTime=Wed Sep 06 00:13:15 CST 2017, time=2017-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240878, encodeId=1e982408e84e, content=好好看下.内容丰富, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Tue Sep 05 23:57:22 CST 2017, time=2017-09-05, status=1, ipAttribution=)]
    2017-09-11 1e145228m78(暂无匿称)

    学习了谢谢作者分享!

    0

  5. 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createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Mon Sep 11 00:02:56 CST 2017, time=2017-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=241803, encodeId=1c0f241803b5, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Fri Sep 08 16:16:54 CST 2017, time=2017-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1386284, encodeId=357f138628461, content=<a href='/topic/show?id=f08293399f9' target=_blank style='color:#2F92EE;'>#转移性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93399, encryptionId=f08293399f9, topicName=转移性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ac22500003, createdName=1249842em09(暂无昵称), createdTime=Thu Sep 07 13:23:00 CST 2017, time=2017-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1424205, encodeId=4413142420542, content=<a href='/topic/show?id=94c182929d0' target=_blank style='color:#2F92EE;'>#肿瘤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82929, encryptionId=94c182929d0, topicName=肿瘤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=60943920553, createdName=lanyan20020087, createdTime=Thu Sep 07 13:23:00 CST 2017, time=2017-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240900, encodeId=a8de24090052, content=这个好.医学不应该只是延长病人的生存期.更应该为病人病人着想.提高病人生存质量.使病人活的有尊严.更幸福, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/DYAIOgq83eqcAwLDVlsWdkjRvWfuiaXKZuQc7wBCmHM5Go3OacaDkO3Mib3VbbTzuNZCHEjqeHShX4dqVequotTw/0, createdBy=933a1954585, createdName=xufang111, createdTime=Wed Sep 06 05:40:36 CST 2017, time=2017-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240885, encodeId=2b1324088573, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4KDsF1g1gUHzGM0LHxX5B5uhEMln8y8iagso9N4XBTQVPmHrCNoT3o8bw80Ds53TpTgcPnKUIfkyw/0, createdBy=bc101976400, createdName=suibian2007bbb, createdTime=Wed Sep 06 00:13:15 CST 2017, time=2017-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240878, encodeId=1e982408e84e, content=好好看下.内容丰富, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Tue Sep 05 23:57:22 CST 2017, time=2017-09-05, status=1, ipAttribution=)]
    2017-09-08 大爰

    学习了谢谢分享!!

    0

  6. 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createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Mon Sep 11 00:02:56 CST 2017, time=2017-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=241803, encodeId=1c0f241803b5, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Fri Sep 08 16:16:54 CST 2017, time=2017-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1386284, encodeId=357f138628461, content=<a href='/topic/show?id=f08293399f9' target=_blank style='color:#2F92EE;'>#转移性#</a>, beContent=null, objectType=article, 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content=这个好.医学不应该只是延长病人的生存期.更应该为病人病人着想.提高病人生存质量.使病人活的有尊严.更幸福, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/DYAIOgq83eqcAwLDVlsWdkjRvWfuiaXKZuQc7wBCmHM5Go3OacaDkO3Mib3VbbTzuNZCHEjqeHShX4dqVequotTw/0, createdBy=933a1954585, createdName=xufang111, createdTime=Wed Sep 06 05:40:36 CST 2017, time=2017-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240885, encodeId=2b1324088573, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4KDsF1g1gUHzGM0LHxX5B5uhEMln8y8iagso9N4XBTQVPmHrCNoT3o8bw80Ds53TpTgcPnKUIfkyw/0, createdBy=bc101976400, createdName=suibian2007bbb, createdTime=Wed Sep 06 00:13:15 CST 2017, time=2017-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240878, encodeId=1e982408e84e, content=好好看下.内容丰富, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Tue Sep 05 23:57:22 CST 2017, time=2017-09-05, status=1, ipAttribution=)]
  7. 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createdBy=2f5a410, createdName=zxxiang, createdTime=Sat Mar 24 23:23:00 CST 2018, time=2018-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1951894, encodeId=97591951894d3, content=<a href='/topic/show?id=7ff1149416a' target=_blank style='color:#2F92EE;'>#Q-TWiST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14941, encryptionId=7ff1149416a, topicName=Q-TWiST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a9de34, createdName=zhangpaul93, createdTime=Mon Oct 23 22:23:00 CST 2017, time=2017-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=242680, encodeId=38bf242680a3, content=学习了谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Mon Sep 11 00:02:56 CST 2017, time=2017-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=241803, encodeId=1c0f241803b5, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Fri Sep 08 16:16:54 CST 2017, time=2017-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1386284, encodeId=357f138628461, content=<a href='/topic/show?id=f08293399f9' target=_blank style='color:#2F92EE;'>#转移性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93399, encryptionId=f08293399f9, topicName=转移性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ac22500003, createdName=1249842em09(暂无昵称), createdTime=Thu Sep 07 13:23:00 CST 2017, time=2017-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1424205, encodeId=4413142420542, content=<a href='/topic/show?id=94c182929d0' target=_blank style='color:#2F92EE;'>#肿瘤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82929, encryptionId=94c182929d0, topicName=肿瘤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=60943920553, createdName=lanyan20020087, createdTime=Thu Sep 07 13:23:00 CST 2017, time=2017-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240900, encodeId=a8de24090052, content=这个好.医学不应该只是延长病人的生存期.更应该为病人病人着想.提高病人生存质量.使病人活的有尊严.更幸福, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/DYAIOgq83eqcAwLDVlsWdkjRvWfuiaXKZuQc7wBCmHM5Go3OacaDkO3Mib3VbbTzuNZCHEjqeHShX4dqVequotTw/0, createdBy=933a1954585, createdName=xufang111, createdTime=Wed Sep 06 05:40:36 CST 2017, time=2017-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240885, encodeId=2b1324088573, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4KDsF1g1gUHzGM0LHxX5B5uhEMln8y8iagso9N4XBTQVPmHrCNoT3o8bw80Ds53TpTgcPnKUIfkyw/0, createdBy=bc101976400, createdName=suibian2007bbb, createdTime=Wed Sep 06 00:13:15 CST 2017, time=2017-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240878, encodeId=1e982408e84e, content=好好看下.内容丰富, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Tue Sep 05 23:57:22 CST 2017, time=2017-09-05, status=1, ipAttribution=)]
  8. 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createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Mon Sep 11 00:02:56 CST 2017, time=2017-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=241803, encodeId=1c0f241803b5, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Fri Sep 08 16:16:54 CST 2017, time=2017-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1386284, encodeId=357f138628461, content=<a href='/topic/show?id=f08293399f9' target=_blank style='color:#2F92EE;'>#转移性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93399, encryptionId=f08293399f9, topicName=转移性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ac22500003, createdName=1249842em09(暂无昵称), createdTime=Thu Sep 07 13:23:00 CST 2017, time=2017-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1424205, encodeId=4413142420542, content=<a href='/topic/show?id=94c182929d0' target=_blank style='color:#2F92EE;'>#肿瘤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82929, encryptionId=94c182929d0, topicName=肿瘤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=60943920553, createdName=lanyan20020087, createdTime=Thu Sep 07 13:23:00 CST 2017, time=2017-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240900, encodeId=a8de24090052, content=这个好.医学不应该只是延长病人的生存期.更应该为病人病人着想.提高病人生存质量.使病人活的有尊严.更幸福, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/DYAIOgq83eqcAwLDVlsWdkjRvWfuiaXKZuQc7wBCmHM5Go3OacaDkO3Mib3VbbTzuNZCHEjqeHShX4dqVequotTw/0, createdBy=933a1954585, createdName=xufang111, createdTime=Wed Sep 06 05:40:36 CST 2017, time=2017-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240885, encodeId=2b1324088573, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4KDsF1g1gUHzGM0LHxX5B5uhEMln8y8iagso9N4XBTQVPmHrCNoT3o8bw80Ds53TpTgcPnKUIfkyw/0, createdBy=bc101976400, createdName=suibian2007bbb, createdTime=Wed Sep 06 00:13:15 CST 2017, time=2017-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240878, encodeId=1e982408e84e, content=好好看下.内容丰富, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Tue Sep 05 23:57:22 CST 2017, time=2017-09-05, status=1, ipAttribution=)]
    2017-09-06 xufang111

    这个好.医学不应该只是延长病人的生存期.更应该为病人病人着想.提高病人生存质量.使病人活的有尊严.更幸福

    0

  9. 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createdBy=2f5a410, createdName=zxxiang, createdTime=Sat Mar 24 23:23:00 CST 2018, time=2018-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1951894, encodeId=97591951894d3, content=<a href='/topic/show?id=7ff1149416a' target=_blank style='color:#2F92EE;'>#Q-TWiST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14941, encryptionId=7ff1149416a, topicName=Q-TWiST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a9de34, createdName=zhangpaul93, createdTime=Mon Oct 23 22:23:00 CST 2017, time=2017-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=242680, encodeId=38bf242680a3, content=学习了谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Mon Sep 11 00:02:56 CST 2017, time=2017-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=241803, encodeId=1c0f241803b5, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Fri Sep 08 16:16:54 CST 2017, time=2017-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1386284, encodeId=357f138628461, content=<a href='/topic/show?id=f08293399f9' target=_blank style='color:#2F92EE;'>#转移性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93399, encryptionId=f08293399f9, topicName=转移性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ac22500003, createdName=1249842em09(暂无昵称), createdTime=Thu Sep 07 13:23:00 CST 2017, time=2017-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1424205, encodeId=4413142420542, content=<a href='/topic/show?id=94c182929d0' target=_blank style='color:#2F92EE;'>#肿瘤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82929, encryptionId=94c182929d0, topicName=肿瘤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=60943920553, createdName=lanyan20020087, createdTime=Thu Sep 07 13:23:00 CST 2017, time=2017-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240900, encodeId=a8de24090052, content=这个好.医学不应该只是延长病人的生存期.更应该为病人病人着想.提高病人生存质量.使病人活的有尊严.更幸福, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/DYAIOgq83eqcAwLDVlsWdkjRvWfuiaXKZuQc7wBCmHM5Go3OacaDkO3Mib3VbbTzuNZCHEjqeHShX4dqVequotTw/0, createdBy=933a1954585, createdName=xufang111, createdTime=Wed Sep 06 05:40:36 CST 2017, time=2017-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240885, encodeId=2b1324088573, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4KDsF1g1gUHzGM0LHxX5B5uhEMln8y8iagso9N4XBTQVPmHrCNoT3o8bw80Ds53TpTgcPnKUIfkyw/0, createdBy=bc101976400, createdName=suibian2007bbb, createdTime=Wed Sep 06 00:13:15 CST 2017, time=2017-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240878, encodeId=1e982408e84e, content=好好看下.内容丰富, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Tue Sep 05 23:57:22 CST 2017, time=2017-09-05, status=1, ipAttribution=)]
    2017-09-06 suibian2007bbb

    学习

    0

  10. 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createdBy=2f5a410, createdName=zxxiang, createdTime=Sat Mar 24 23:23:00 CST 2018, time=2018-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1951894, encodeId=97591951894d3, content=<a href='/topic/show?id=7ff1149416a' target=_blank style='color:#2F92EE;'>#Q-TWiST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14941, encryptionId=7ff1149416a, topicName=Q-TWiST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a9de34, createdName=zhangpaul93, createdTime=Mon Oct 23 22:23:00 CST 2017, time=2017-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=242680, encodeId=38bf242680a3, content=学习了谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Mon Sep 11 00:02:56 CST 2017, time=2017-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=241803, encodeId=1c0f241803b5, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Fri Sep 08 16:16:54 CST 2017, time=2017-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1386284, encodeId=357f138628461, content=<a href='/topic/show?id=f08293399f9' target=_blank style='color:#2F92EE;'>#转移性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93399, encryptionId=f08293399f9, topicName=转移性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ac22500003, createdName=1249842em09(暂无昵称), createdTime=Thu Sep 07 13:23:00 CST 2017, time=2017-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1424205, encodeId=4413142420542, content=<a href='/topic/show?id=94c182929d0' target=_blank style='color:#2F92EE;'>#肿瘤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82929, encryptionId=94c182929d0, topicName=肿瘤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=60943920553, createdName=lanyan20020087, createdTime=Thu Sep 07 13:23:00 CST 2017, time=2017-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240900, encodeId=a8de24090052, content=这个好.医学不应该只是延长病人的生存期.更应该为病人病人着想.提高病人生存质量.使病人活的有尊严.更幸福, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/DYAIOgq83eqcAwLDVlsWdkjRvWfuiaXKZuQc7wBCmHM5Go3OacaDkO3Mib3VbbTzuNZCHEjqeHShX4dqVequotTw/0, createdBy=933a1954585, createdName=xufang111, createdTime=Wed Sep 06 05:40:36 CST 2017, time=2017-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240885, encodeId=2b1324088573, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4KDsF1g1gUHzGM0LHxX5B5uhEMln8y8iagso9N4XBTQVPmHrCNoT3o8bw80Ds53TpTgcPnKUIfkyw/0, createdBy=bc101976400, createdName=suibian2007bbb, createdTime=Wed Sep 06 00:13:15 CST 2017, time=2017-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240878, encodeId=1e982408e84e, content=好好看下.内容丰富, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Tue Sep 05 23:57:22 CST 2017, time=2017-09-05, status=1, ipAttribution=)]
    2017-09-05 忠诚向上

    好好看下.内容丰富

    0

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