非吸烟女性肺腺癌病因因素的病例对照研究

非吸烟女性肺腺癌病因因素的病例对照研究戴旭东，孙喜文，石于波，林春艳哈尔滨医科大学肿瘤研究所（哈尔滨１５００４０）肺腺癌在女性肺癌中占很大比重，而且大量研究证实与吸烟联系不密切。近年来随着肺癌发病率的上升，肺腺癌也有不同程度的增长。为了探讨除吸烟以外...     

代谢综合征与肺腺癌患者临床分期的相关性研究

目的:探讨代谢综合征（metabolic syndrome，MS）与肺腺癌临床分期的相关性。方法:2018年1月至2019年1月由华北理工大学附属医院首次确诊为肺腺癌的患者135例。57例被诊断为代谢综合征合并肺腺癌患者纳入病例组，78例为单纯肺腺癌患者纳入对照组。收集病例人口学信息、首次生化检查结果、临床症状及肺腺癌临床分期，SPSS 23.0用于数据分析。结果:经多元Logistic回归分析发现MS并不会导致肺腺癌临床症状的改变（P均大于0.05）,但是却与肺腺癌患者的临床分期相关（P=0.019），与单纯肺腺癌患者相比，MS合并肺腺癌的患者肿瘤临床分期为晚期的概率上升了51.8%。结论:MS与肺腺癌患者的肿瘤临床分期存在相关性，MS可能是导致肺腺癌临床分期严重程度的独立危险因素。     

榄香烯对人肺腺癌细胞A549作用机理的初步研究

目的：研究榄香烯对体外培养的人肺腺癌细胞株A549的作用及其机制。方法：采用MTTI地检测药物对细胞的抑制作用。流式细胞术检测细胞周期变化以及电镜观察细胞的形态变化，结果：榄香烯能明显抑制肺腺癌细胞A549的生长，其半数生长抑制剂量为124．61μg/ml，流式细胞术证实榄香烯能阻滞肺腺癌细胞从S期进入G2／M期；透射电镜超微结构可见细胞浆内脂滴增多和坏死细胞明显增多的形态变化。结论：榄香烯能抑制肺腺癌细胞的生长，并阻滞肺腺癌细胞从S期进入G2／M期。     

肺癌转化生长因β1的表达与预后的相关性研究

目的：检测各种肺癌组织中ＴＧＦβ１的表达情况,探讨ＴＧＦβ１的表达与肺腺癌患者预后的相关性。方法：免疫组织化学ＳＡＢＣ染色方法。结果：６３例女性肺腺癌中,ＴＧＦβ１阳性４０例（６３．５％）,对照绷带９例肺鳞癌ＴＧＦβ１阳性１例（１１．１％）,１５例肺小细胞癌ＴＧＦβ１仅１例弱阳性（６．７％）,２０例癌旁正常肺组织均阴性,肺腺癌与对照组有显著差异,ＴＧＦβ阳性术后生存期短,３ａ、５ａ生存率低,结论：     

谷胱甘肽S转移酶在人肺癌的表达

应用PAP免疫组化技术,观察了谷胱甘肽S转移酶(GST)在84例肺癌的表达,并与23例肺非癌病变对照.结果发现,碱性、中性、非酸性GST很少在肺癌及肺非癌病变表达.酸性GST在鳞癌、腺癌、腺鳞癌、小细胞癌及类癌的阳性率分别为93.5％、66.7％、83.3％、7.1％、18.2％,而极少在肺非癌病变表达.故酸性GST可能是肺鳞癌、腺癌、腺鳞癌的标志酶,在与肺非癌病变的鉴别上为有用指标.     

免疫组织化学在纤维支气管镜活检诊断及鉴别诊断中的应用

运用免疫组织化学技术对51例纤维支气管镜咬检组织中的角蛋白（KER）及癌胚抗原（CEA）进行检测，并设5例正常支气管粘膜肺组织作对照。结果正常支气管粘膜肺组织均呈CEA阴性，而癌组织的阳性率为62％；各型肺癌的可疑组与确诊组的阳性率及染色强度均无差异；鳞状细胞癌（鳞癌）KER染色的阳性率及染色强度均与腺癌有显著差异；小细胞癌KER染色阳性率为90％。作者认为在纤支镜咬检组织的诊断中CEA染色可用于肿瘤的定性诊断；而KER检测对鳞癌与腺癌的鉴别有一定帮助；小细胞癌KER染色的高阳性率支持其与其他非小细胞癌共同起源于干细胞的说法。     

38例肺源性脑转移瘤临床病理分析

目的 肺源性脑转移瘤临床病理特征。方法 研究38例肺源性脑转移瘤的临床和病理特点，男性27例，女性11例，年龄在30-74岁之间。其中5例转移性癌作免疫组织化学染色和电镜观察。结果 20例为腺癌，12/20为乳头状腺癌；5例为腺鳞癌，7例为鳞形细胞癌，4例为燕麦细胞癌，2例为不典型类癌；5例乳头状腺癌作免疫组织化学染色示CK（5/5）和CEA（4/5）为阳性；电镜显示转移性乳头状腺癌具有肺泡II型上皮细胞分化潜能。结论 肿癌中腺癌更易发生脑转移，免疫组织化学在鉴别诊断中有一定的辅助作用，转移性乳头状腺癌具有异质性。     

蛇床子素对肺腺癌、肺鳞癌生长抑制作用的实验研究

目的: 观察蛇床子素对人肺鳞癌和肺腺癌的抑制作用。方法:建立BALB/ C 裸鼠的人肺腺癌和肺鳞癌模型,给予蛇床子素,剂量为1. 5μg/ (g·d) ,观察瘤体的大小、重量和动物血清中肺癌标志物DR270 的水平,以此评价蛇床子素的抑癌作用。结果:蛇床子素对肺鳞癌的抑瘤率为69. 5 % ,对肺腺癌的抑瘤率为50. 0 % ,对DR270 也有显著降低作用。结论:蛇床子素对肺鳞癌和肺腺癌的瘤体生长有一定的抑制作用,尤其是肺鳞癌。     

肺癌危险因素的多元Logistic回归分析

基于全人群的病例对照研究揭示,上海市区男性肺癌的主要危险因素是吸烟,而20年内曾患肺结核与男性肺腺癌的关系甚为密切。女性肺癌除上述因素外,还与月经周期的长短及厨房小环境污染     

TP63 rs6790167多态性与海南汉族人肺癌的相关性研究

  目的  探讨TP63 rs6790167多态性与海南汉族人肺癌之间的相关性。  方法  收集2014年6月至2015年7月258例海南医学院第二附属医院就诊的肺癌患者和270例健康对照者的外周静脉血,采用病例对照研究的方法,提取血液基因组DNA,应用等位基因特异性聚合酶链反应（allele-specific PCR,AS-PCR）法检测肺癌组和对照组人群的TP63 rs6790167位点的多态基因型。  结果  肺癌组中TP63 rs6790167位点的G等位基因分布频率明显高于对照组（P=0.045）。进一步分层分析显示,在肺腺癌组中,非吸烟男性的GG基因型分布和G等位基因的分布频率均显著高于对照组（P < 0.001,P=0.001）,携带GG基因型的非吸烟男性的肺腺癌发病风险与AA基因型相比明显升高（OR=6.66,95%CI为2.16~20.41）,相对于TP63 rs6790167位点的A等位基因,携带G等位基因的非吸烟男性的肺腺癌发病风险显著增加（OR=2.54,95%CI为1.42~4.56）。  结论  TP63 rs6790167多态性与肺腺癌的发生有关,对非吸烟男性人群肺腺癌的发生可能具有预测作用。      

美国吸烟者与非吸烟者肺癌流行病学概况

人们已清楚知道，吸烟是肺癌的主要危险因素，也知道吸烟和职业暴露以外的因素在某些肺癌特别是腺癌中起作用。本文以医院病例为基础进行大样本的病冽对照研究来分析肺癌与吸烟因素（吸烟量，过滤咀烟，黑白人种的吸烟习惯）及非吸烟因素（ＥＴＳ暴露，原发性肿瘤和治疗，生殖和内分泌因素，躯体指数）的联系。虽然吸烟与所有主要细胞类型的肺癌都有剂量－效应关系，但与腺癌的联系强度较弱，提示吸烟以外的因素对腺癌的重要性。在白人和黑人中，无论男、女，肺癌的ＯＲ值均随香烟焦油摄入量的增加而增加，并随戒烟年限的延长而减少。是否吸含薄荷香烟，对肺癌的危险性影响不大。未见到ＥＴＳ与肺癌的联系，即使丈夫吸烟也未能使不吸烟妻子患肺癌的危险性增加。生殖系统原发性肿瘤和放射治疗，可使不吸烟女性患肺癌的危险性增加４倍。曾观察到身体瘦弱与现在吸烟、以前吸烟和从不吸烟的女性肺癌之间的联系。以上结果在本文中分别加以讨论。总的来说，人群中肺癌患病率的不同，可能由于：（１）香烟烟雾中的致癌物不同；（２）香烟烟雾的作用因素不同，包括受到机体敏感性及对致癌物的代谢的影响；（３）暴露于吸烟以外的其他各种危险因素     

40岁以下青年肺癌的临床特点与外科治疗

背景与目的 分析40岁以下青年肺癌的临床特点及治疗方法.方法 本文分析了1994-2007年间40岁以下肺癌患者41例.结果 41例患者男性28例,女性13例,男女之比为2.2:1,病理类型中腺癌为19例,鳞癌16例,小细胞肺癌5例,大细胞肺癌1例.误诊率为44%,多误诊为肺结核,肺炎,炎性假瘤及结核性胸膜炎等.结论 青年肺癌在病理类型上腺癌多见,故肿瘤生长快,转移率高.手术切除率(73.2%)低,预后差,5年生存率低.早期诊断和尽早根治切除是关键问题.     

238 例女性肺癌纤维支气管镜检查的早期诊断探讨

目的:分析女性肺癌的诊断方法和危险因素,探讨早期肺癌诊断的途径。方法:收集2005年1 月至2008年12月本院呼吸内科纤维支气管镜（纤支镜）检查病例238 例,结合临床资料分析比较纤支镜下肺癌表现与临床影像学表现、女性罹患肺癌的主要危险因素及病理类型的关系。两组资料比较采用χ2检验。结果:年龄49岁以下组腺癌为主要病理类型,60岁以上组鳞癌为主要病理类型。纤支镜下表现分为增生型、浸润型、外压型、正常型。其中增生型与鳞癌相关,影像学表现以肿块为主,主要危险因素为吸烟;浸润型与腺癌相关,影像学表现以胸腔积液为主,主要危险因素为室内油烟吸入。结论:对长期接触室内油烟和烟草暴露女性,尤其存在多项危险因素的女性应该定期进行低剂量CT（LDCT）筛查,发现异常及时行纤支镜检查和组织细胞学检查是确诊早期肺癌的有效途径。      

Lung cancer among Chinese women

A case-control study involving interviews with 672 female lung cancer patients and 735 population-based controls was conducted to investigate the high rates of lung cancer, notably adenocarcinoma, among women in Shanghai. Cigarette smoking was a strong risk factor, but accounted for only about one-fourth of all newly diagnosed cases of lung cancer. Most patients, particularly with adenocarcinoma, were life-long non-smokers. The risks of lung cancer were higher among women reporting tuberculosis and other pre-existing lung diseases. Hormonal factors were suggested by an increased risk associated with late menopause and by a gradient in the risk of adenocarcinoma with decreasing menstrual cycle length, with a 3-fold excess among women who had shorter cycles. Perhaps most intriguing were associations found between lung cancer and measures of exposure to cooking oil vapors. Risks increased with the numbers of meals cooked by either stir frying, deep frying or boiling; with the frequency of smokiness during cooking; and with the frequency of eye irritation during cooking. Use of rapeseed oil, whose volatiles following high-temperature cooking may be mutagenic, was also reported more often by the cancer patients. The findings thus confirm that factors other than smoking are responsible for the high risk of lung cancer among Chinese women and provide clues for further research, including the assessment of cooking practices.     

558例维吾尔族肺癌患者的临床病理特征及预后分析

目的 分析新疆本地维吾尔族肺癌患者的临床病理特征,了解该民族肺癌的分布特点及差异。方法 收集新疆医科大学附属肿瘤医院2005年1月1日至2014年12月31日就诊的558例维吾尔族肺癌患者,对患者的临床分期、病理类型、驱动基因等临床资料进行对比分析及随访。结果 男女比例1.37:1,女性和城市维吾尔族肿瘤患者中腺癌最多,而男性、有吸烟史和乡镇患者中鳞癌和小细胞肺癌居多;小细胞肺癌患者3年生存率最低,腺癌最高;21.8%（65/298）患者存在EGFR基因突变,多见于不吸烟、腺癌、女性患者;6.9%（11/159）患者存在EML4-AL基因融合,多表达于腺癌、不吸烟或既往有吸烟史,同时无EGFR突变患者;Ⅳ期EGFR基因突变患者与EGFR野生型患者总生存期（OS）差异无统计学意义（P=0.597）。Ⅳ期EML4-ALK基因融合患者与EML4-ALK基因未融合患者总生存期差异无统计学意义（P=0.941）。结论 维吾尔族肺癌患者在临床特征、病理类型、流行病学分布及驱动基因方面有其特点。病理类型和分期是影响维吾尔族NSCLC患者预后的独立因素。     

上海市区非吸烟女性肺癌病例对照研究的多因素分析

目的：为了进一步探索、验证上海市区非吸烟女性肺癌的危险因素。方法：1992年2月－1993年12月在上海市区进行女性肺癌的病例对照研究,共调查非吸烟女性肺癌病例498例及人群对照595例。结果：烹调油烟、腌制品摄入、工作环境烟草烟雾和肺癌家族史增加上海市区非吸烟女性肺癌的危险性,而饮茶,尤其是饮绿茶和新鲜瓜果,蔬菜的摄入和非吸烟女性肺癌呈负相关关系。结论：烹调油烟、腌制品、工作环境烟草烟雾和肺癌家族史可能是上海市区非吸烟女性肺癌的主要危险因素,而饮茶、多吃新鲜瓜果蔬菜对非吸烟女性肺有保护作用。     

烹调引起的室内空气污染与女性非吸烟者肺癌关系的病例─对照研究

在上海市区进行的一次女性肺癌病例一对照研究共调查５０４名不吸烟的肺癌新病例和按年龄、性别及吸烟状态配对的人群对照６０１例。结果揭示：１．厨房通风差，或与卧室分隔不好，或在卧室内烧饭，肺癌危险性增加；２．烹调时眼睛经常有受抽烟烟雾刺激之感觉和／或室内充满烟雾，肺癌危险性上升；３．烹调中经常使用菜油或经常烹调油炸食品，肺癌危险性亦会增加；４．肺癌危险性随居室通风面积的增加而降低，线性趋势在调整年龄、家庭人均月收入、居室面积后有显著性；５．烹调所用燃料类型与肺癌危险性无显著联系。     

直径≤3 cm浸润性肺腺癌脉管侵犯的危险因素分析

目的探讨直径≤3 cm浸润性肺腺癌脉管侵犯的危险因素。方法回顾性研究2017年2月至2018年6月于安徽省胸科医院行手术切除的257例直径≤3 cm浸润性肺腺癌患者,分析脉管侵犯组及非脉管侵犯组的临床资料、术前薄层CT及病理学资料的差异。结果单因素分析结果表明,直径≤3 cm浸润性肺腺癌脉管侵犯与患者术前CEA水平、毛刺征、肿瘤直径、胸膜侵犯及淋巴结转移有关(P<0.05),与患者年龄、性别、吸烟史、肿瘤家族史、分叶征、胸膜凹陷征、空泡征或支气管充气征、血管集束征、肿瘤位置及分化程度无关(P>0.05)。多因素分析结果表明,毛刺征、肿瘤直径及淋巴结转移是直径≤3 cm浸润性肺腺癌脉管侵犯的独立危险因素。结论毛刺征、肿瘤直径及淋巴结转移是直径≤3 cm浸润性肺腺癌的脉管侵犯的独立危险因素,对脉管侵犯的诊断具有重要的价值。     

Cluster Analysis Evaluating PM2.5, Occupation Risk and Mode of Transportation as Surrogates for Air-pollution and the Impact on Lung Cancer Diagnosis and 1-Year Mortality

Objective: Epidemiological studies have reported the close relationship between risk for lung cancers and air pollutionin particular, for non-smoking related lung cancers. However, most studies used residential address as proxies which maynot estimate accurately an individual’s air pollution exposure. Therefore, the aim of this study was to identify risk factorssuch as occupation and mode of transportation associated with lung cancer diagnosis and death. Methods: Subjectswith lung cancer (n=514) were evaluated both by chart reviews for clinical data and interviews to determine residentialaddress for ten years, main occupation and main mode of transportation. Annual particulate matter with diameter sizeless than 2.5 micrometre (PM2.5) concentration were calculated based on particulate matter with diameter size less than10 micrometre (PM10) data recorded by Malaysian Department of Environment. Logistic regression analysis, clusteranalysis and the Cox regression analysis were performed to the studied variables. Results: This study concurred withprevious studies that lung adenocarcinoma were diagnosed in predominantly younger, female non-smokers comparedto the other types of lung cancers. Lung adenocarcinoma subjects had annual PM2.5 that was almost twice higher thansquamous cell carcinoma, small cell carcinoma and other histological subtypes (p=0.024). Independent of smoking,the κ -means cluster analysis revealed two clusters in which the high risk cluster involves occupation risk with airpollution of more than four hours per day, main transportation involving motorcycle and trucks and mean annual PM2.5concentration of more than 30 based on residential address for more than ten years. The increased risk for the high-riskcluster was more than five times for the diagnosis of lung adenocarcinoma (OR=5.69, 95% CI=3.14-7.21, p<0.001).The hazard ratio for the high-risk cluster was 3.89 (95% CI=2.12-4.56, p=0.02) for lung adenocarcinoma mortality at1 year. Conclusion: High-risk cluster including PM2.5, occupation risk and mode of transportation as surrogates forair-pollution exposure was identified and highly associated with lung adenocarcinoma diagnosis and 1-year mortality.     

Dietary Habits and Risk of Lung Cancer Death in a Large-scale Cohort Study (JACC Study) in Japan by Sex and Smoking Habit

Lung cancer has increased and is the leading cause of cancer death among Japanese males. The associations of dietary habits with the risk of lung cancer death were evaluated by sex and smoking habits in this study. In the Japan Collaborative Cohort (JACC) Study, a cohort established in 1988–90 and consisting of 42 940 males and 55 308 females was observed for lung cancer deaths up to the end of 1997. During the observation period, 446 males and 126 females died of lung cancer. A self-administered food frequency questionnaire was used as the baseline survey. Hazard ratios for dietary factors were calculated by Cox's proportional hazards model. Among males, a high intake of ham and sausages, cheese, green-leafy vegetables, oranges, and other fruits significantly and dose-dependently decreased the risk of lung cancer death. Among females, a high intake of miso-soup, ham and sausages, and liver significantly and almost dose-dependently increased the risk. Vegetables and fruits rich in antioxidative and carcinogenic agents reduced the risk of lung cancer deaths among male smokers more than among female nonsmokers. The results among female nonsmokers were partially consistent with the hypothesis that high fat consumption increases the risk of lung cancer, especially that of adenocarcinoma.