Lancet oncol:新辅助放化疗治疗食管癌后,内镜超声、活检、PET-CT等方法检测残余病灶的漏诊情况

2018-06-01 MedSci MedSci原创

对食管癌进行新辅助放化疗后,约有一半鳞状细胞癌患者的和1/4的腺癌患者在手术前获得病理性完全缓解。因此,对于对新辅助放化疗反应有效的患者,应重新考虑新辅助放化疗后进行标准食管切除术的必要性。近日,Lancet子刊上发表一篇文章,Bo Jan Noordman等人对比新辅助放化疗后,用不同的诊断方法检测残余病灶的准确性,并探究进行临床反应评估的诊断技术的最佳组合。SANO预试验是在荷兰的6个中心开展

对食管癌进行新辅助放化疗后,约有一半鳞状细胞癌患者的和1/4的腺癌患者在手术前获得病理性完全缓解。因此,对于对新辅助放化疗反应有效的患者,应重新考虑新辅助放化疗后进行标准食管切除术的必要性。近日,Lancet子刊上发表一篇文章,Bo Jan Noordman等人对比新辅助放化疗后,用不同的诊断方法检测残余病灶的准确性,并探究进行临床反应评估的诊断技术的最佳组合。

SANO预试验是在荷兰的6个中心开展的一前瞻性、多中心的诊断队列研究,招募年满18岁的组织学确诊的可切除的食管或胃食管交界鳞状细胞癌或腺癌患者,并可进行新辅助放化疗(5个疗程的卡铂+紫杉醇,联合41.4Gy的放疗),随后进行食管切除术。放化疗结束后4-6周,进行食管胃十二指肠镜活检和内镜超声检测肿瘤最大厚度。组织学证实有残余病灶或内镜检查未通过并且无远处转移的患者立即行手术切除。在其余患者中进行次要临床反应评估(PET-CT,食管胃镜活检、内镜超声检测最大肿瘤厚度和细针穿刺可疑淋巴结),然后在放化疗结束后12-14周进行手术。主要结点:在临床反应评估期间,临床反应与切除样本的最终病理反应之间的相关性,以临床反应评估期间忽略的肿瘤进展分期(TRG)3或4期(切除样本的残余癌>10%)的残留肿瘤比例表示。

2013年7月22日-2016年12月28日,共招募219位患者,其中207位纳入分析。以内镜常规活检检查漏诊8位(8/26,31%[95% CI 17-50])TRG3或TRG4期肿瘤患者。以点对点活检和细针穿刺淋巴结漏诊4例(4/41,10%[95% CI 4-23])TRG3或TRG4肿瘤。内镜超声测量最大肿瘤厚度漏诊11位(11/39,28% [95% CI 17–44])RG3或TRG4残余肿瘤患者。PET-CT漏诊6例(6/41,15% [95% CI 7–28])TRG3或TRG4肿瘤。PET-CT在190位患者中检测出18例(9%)经组织学证实的间隔转移癌(1例鳞状细胞癌、17例腺癌)。

对食管癌进行新辅助放化疗后,用内镜超声、点对点活检和细针穿刺可疑淋巴结进行临床反应评估足够检测出局部残余病灶,用PET-CT可检测间隔转移。3期临床随机对照试验正在评估如何组合这些检查方法。

原始出处:

Bo Jan Noordman,et al. Detection of residual disease after neoadjuvant chemoradiotherapy for oesophageal cancer (preSANO): a prospective multicentre, diagnostic cohort study.The Lancet Oncology.May 31,2018.https://doi.org/10.1016/S1470-2045(18)30201-8

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createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTI5PdY90y5Jib8FnPhCXTR2d9v3K17epNSwB2eb0vmXUldNJl2e72S4unZTAHLAojicdVSialTDFHAxA/132, createdBy=78d82500042, createdName=ms7514935887898259, createdTime=Sun Jun 03 05:05:00 CST 2018, time=2018-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1407354, encodeId=999a140e3545c, content=<a href='/topic/show?id=144966640f8' target=_blank style='color:#2F92EE;'>#漏诊#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66640, encryptionId=144966640f8, topicName=漏诊)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2d362645427, createdName=makuansheng, createdTime=Sun Jun 03 05:05:00 CST 2018, time=2018-06-03, status=1, ipAttribution=)]
    2018-08-11 howi
  4. 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href='/topic/show?id=4d185e31825' target=_blank style='color:#2F92EE;'>#放化疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57318, encryptionId=4d185e31825, topicName=放化疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=310e209, createdName=yzh399, createdTime=Sun Jun 03 05:05:00 CST 2018, time=2018-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1331100, encodeId=fffe13311002b, content=<a href='/topic/show?id=15e2140e438' target=_blank style='color:#2F92EE;'>#PET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14074, encryptionId=15e2140e438, topicName=PET)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTI5PdY90y5Jib8FnPhCXTR2d9v3K17epNSwB2eb0vmXUldNJl2e72S4unZTAHLAojicdVSialTDFHAxA/132, createdBy=78d82500042, createdName=ms7514935887898259, createdTime=Sun Jun 03 05:05:00 CST 2018, time=2018-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1407354, encodeId=999a140e3545c, content=<a href='/topic/show?id=144966640f8' target=_blank style='color:#2F92EE;'>#漏诊#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66640, encryptionId=144966640f8, topicName=漏诊)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2d362645427, createdName=makuansheng, createdTime=Sun Jun 03 05:05:00 CST 2018, time=2018-06-03, status=1, ipAttribution=)]
    2018-08-28 minlingfeng
  5. [GetPortalCommentsPageByObjectIdResponse(id=1727341, encodeId=ca661e2734174, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Thu Feb 21 13:05:00 CST 2019, time=2019-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2059153, encodeId=3c9f205915340, content=<a href='/topic/show?id=a5ab936847a' target=_blank style='color:#2F92EE;'>#辅助放化疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93684, encryptionId=a5ab936847a, topicName=辅助放化疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c2b4297, createdName=徐岩, createdTime=Fri Jun 29 01:05:00 CST 2018, time=2018-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1829655, encodeId=8747182965522, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Sat Aug 11 06:05:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1865448, encodeId=dc5d1865448c9, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, 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createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTI5PdY90y5Jib8FnPhCXTR2d9v3K17epNSwB2eb0vmXUldNJl2e72S4unZTAHLAojicdVSialTDFHAxA/132, createdBy=78d82500042, createdName=ms7514935887898259, createdTime=Sun Jun 03 05:05:00 CST 2018, time=2018-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1407354, encodeId=999a140e3545c, content=<a href='/topic/show?id=144966640f8' target=_blank style='color:#2F92EE;'>#漏诊#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66640, encryptionId=144966640f8, topicName=漏诊)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2d362645427, createdName=makuansheng, createdTime=Sun Jun 03 05:05:00 CST 2018, time=2018-06-03, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1727341, encodeId=ca661e2734174, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Thu Feb 21 13:05:00 CST 2019, time=2019-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2059153, encodeId=3c9f205915340, content=<a href='/topic/show?id=a5ab936847a' target=_blank style='color:#2F92EE;'>#辅助放化疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93684, encryptionId=a5ab936847a, topicName=辅助放化疗)], attachment=null, authenticateStatus=null, createdAvatar=, 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href='/topic/show?id=4d185e31825' target=_blank style='color:#2F92EE;'>#放化疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57318, encryptionId=4d185e31825, topicName=放化疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=310e209, createdName=yzh399, createdTime=Sun Jun 03 05:05:00 CST 2018, time=2018-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1331100, encodeId=fffe13311002b, content=<a href='/topic/show?id=15e2140e438' target=_blank style='color:#2F92EE;'>#PET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14074, encryptionId=15e2140e438, topicName=PET)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTI5PdY90y5Jib8FnPhCXTR2d9v3K17epNSwB2eb0vmXUldNJl2e72S4unZTAHLAojicdVSialTDFHAxA/132, createdBy=78d82500042, createdName=ms7514935887898259, createdTime=Sun Jun 03 05:05:00 CST 2018, time=2018-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1407354, encodeId=999a140e3545c, content=<a href='/topic/show?id=144966640f8' target=_blank style='color:#2F92EE;'>#漏诊#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66640, encryptionId=144966640f8, topicName=漏诊)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2d362645427, createdName=makuansheng, createdTime=Sun Jun 03 05:05:00 CST 2018, time=2018-06-03, status=1, ipAttribution=)]
    2018-06-03 docwu2019
  7. [GetPortalCommentsPageByObjectIdResponse(id=1727341, encodeId=ca661e2734174, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Thu Feb 21 13:05:00 CST 2019, time=2019-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2059153, encodeId=3c9f205915340, content=<a href='/topic/show?id=a5ab936847a' target=_blank style='color:#2F92EE;'>#辅助放化疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93684, encryptionId=a5ab936847a, topicName=辅助放化疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c2b4297, createdName=徐岩, createdTime=Fri Jun 29 01:05:00 CST 2018, time=2018-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1829655, encodeId=8747182965522, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Sat Aug 11 06:05:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1865448, encodeId=dc5d1865448c9, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Tue Aug 28 04:05:00 CST 2018, time=2018-08-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1678569, encodeId=e27316e8569c0, content=<a href='/topic/show?id=110c5869153' target=_blank style='color:#2F92EE;'>#新辅助#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58691, encryptionId=110c5869153, topicName=新辅助)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=941f27706894, createdName=charl1234576, createdTime=Tue Jul 03 17:05:00 CST 2018, time=2018-07-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1261983, encodeId=03eb1261983fc, content=<a href='/topic/show?id=0ceb30545e0' target=_blank style='color:#2F92EE;'>#内镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30545, encryptionId=0ceb30545e0, topicName=内镜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=docwu2019, createdTime=Sun Jun 03 05:05:00 CST 2018, time=2018-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1278091, encodeId=0b1c12e809151, content=<a href='/topic/show?id=d34e6523544' target=_blank style='color:#2F92EE;'>#活检#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65235, encryptionId=d34e6523544, topicName=活检)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c39f145, createdName=smlt2008, createdTime=Sun Jun 03 05:05:00 CST 2018, time=2018-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1287920, encodeId=03cd128e9207d, content=<a href='/topic/show?id=4d185e31825' target=_blank style='color:#2F92EE;'>#放化疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57318, encryptionId=4d185e31825, topicName=放化疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=310e209, createdName=yzh399, createdTime=Sun Jun 03 05:05:00 CST 2018, time=2018-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1331100, encodeId=fffe13311002b, content=<a href='/topic/show?id=15e2140e438' target=_blank style='color:#2F92EE;'>#PET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14074, encryptionId=15e2140e438, topicName=PET)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTI5PdY90y5Jib8FnPhCXTR2d9v3K17epNSwB2eb0vmXUldNJl2e72S4unZTAHLAojicdVSialTDFHAxA/132, createdBy=78d82500042, createdName=ms7514935887898259, createdTime=Sun Jun 03 05:05:00 CST 2018, time=2018-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1407354, encodeId=999a140e3545c, content=<a href='/topic/show?id=144966640f8' target=_blank style='color:#2F92EE;'>#漏诊#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66640, encryptionId=144966640f8, topicName=漏诊)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2d362645427, createdName=makuansheng, createdTime=Sun Jun 03 05:05:00 CST 2018, time=2018-06-03, status=1, ipAttribution=)]
    2018-06-03 smlt2008
  8. [GetPortalCommentsPageByObjectIdResponse(id=1727341, encodeId=ca661e2734174, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Thu Feb 21 13:05:00 CST 2019, time=2019-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2059153, encodeId=3c9f205915340, content=<a href='/topic/show?id=a5ab936847a' target=_blank style='color:#2F92EE;'>#辅助放化疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93684, encryptionId=a5ab936847a, topicName=辅助放化疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c2b4297, createdName=徐岩, createdTime=Fri Jun 29 01:05:00 CST 2018, time=2018-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1829655, encodeId=8747182965522, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Sat Aug 11 06:05:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1865448, encodeId=dc5d1865448c9, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, 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channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30545, encryptionId=0ceb30545e0, topicName=内镜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=docwu2019, createdTime=Sun Jun 03 05:05:00 CST 2018, time=2018-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1278091, encodeId=0b1c12e809151, content=<a href='/topic/show?id=d34e6523544' target=_blank style='color:#2F92EE;'>#活检#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65235, encryptionId=d34e6523544, topicName=活检)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c39f145, createdName=smlt2008, createdTime=Sun Jun 03 05:05:00 CST 2018, time=2018-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1287920, encodeId=03cd128e9207d, content=<a 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createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTI5PdY90y5Jib8FnPhCXTR2d9v3K17epNSwB2eb0vmXUldNJl2e72S4unZTAHLAojicdVSialTDFHAxA/132, createdBy=78d82500042, createdName=ms7514935887898259, createdTime=Sun Jun 03 05:05:00 CST 2018, time=2018-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1407354, encodeId=999a140e3545c, content=<a href='/topic/show?id=144966640f8' target=_blank style='color:#2F92EE;'>#漏诊#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66640, encryptionId=144966640f8, topicName=漏诊)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2d362645427, createdName=makuansheng, createdTime=Sun Jun 03 05:05:00 CST 2018, time=2018-06-03, status=1, ipAttribution=)]
    2018-06-03 yzh399
  9. 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createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTI5PdY90y5Jib8FnPhCXTR2d9v3K17epNSwB2eb0vmXUldNJl2e72S4unZTAHLAojicdVSialTDFHAxA/132, createdBy=78d82500042, createdName=ms7514935887898259, createdTime=Sun Jun 03 05:05:00 CST 2018, time=2018-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1407354, encodeId=999a140e3545c, content=<a href='/topic/show?id=144966640f8' target=_blank style='color:#2F92EE;'>#漏诊#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66640, encryptionId=144966640f8, topicName=漏诊)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2d362645427, createdName=makuansheng, createdTime=Sun Jun 03 05:05:00 CST 2018, time=2018-06-03, status=1, ipAttribution=)]
  10. 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