肿瘤标记物和肺癌

肺癌是最常见的恶性肿瘤之一,在世界范围内男性发病率、病死率均占全部恶性肿瘤的第1位,女性占第2位,且逐年升高.肺癌的预后与早期诊断和早期治疗有密切的关系.但因大多数早期肺癌缺乏典型的临床症状,其早期诊断目前尚无理想的方法.     

有机性挥发物在肺癌组织和癌细胞株中的检测和分析

目的:通过检测肺癌组织与肺癌细胞株代谢过程中产生的挥发性有机化合物(volatile organic compounds,VOCs),寻找肺癌特征性的气体标记物,为呼吸气体检测在肺癌早期诊断中的应用提供实验依据.方法:利用固相微萃取联合气相色谱质谱联用技术(solid-phase microextraction and gas chromatography-mass spectroscopy,SPME-GCMS)检测18例原发性肺癌患者的手术标本及A549、NCI-H446、SK-MES-1、BEAS-2B 4种细胞株培养液顶空气体中的VOCs,从中筛选与肺癌相关的特征性VOCs组分.结果:2-十五烷酮和十九烷在肺癌细胞株A549、NCI-H446、SK-MES-1中均有表达,2-十五烷酮的表达量分别为(1.382±0.171 )×10-5 mg/L、(1.681±0.190)×10-4 mg/L和(2.835±0.401)×10-6 mg/L;十九烷的表达量分别为(8.382±0.606 )×10-6 mg/L、(1.845±0.130)×10-5 mg/L和(6.220±0.362)×10-6 mg/L;二十烷在肺癌细胞株A549和NCI-H446中有表达,表达量分别为(8.313±1.130)×10-6 mg/L、(1.020±0.141)×10-5 mg/L;而此3种VOCs在对照组BEAS-2B中无表达.在18例肺癌组织中,癸烷、2-十五烷酮、十九烷、二十烷等12种VOCs高表达,其中2-十五烷酮的表达量为5.421×10-6 mg/L～3.621×10-5 mg/L,十九烷为5.805×10-6 mg/L～1.830×10-5 mg/L,二十烷为2.730×10-6 mg/L～2.343×10-5 mg/L;其表达水平与肿瘤分化程度无关(P>0.05).二十烷在非鳞癌中的表达高于鳞癌,此结果与肺癌细胞株的表达情况相符.结论:2-十五烷酮、十九烷、二十烷、癸烷等12种VOCs在肺癌组织中高表达,其中2-十五烷酮、十九烷、二十烷与肺癌细胞株结果相符,提示上述物质可能为肺癌潜在的特征性标志物.     

Risk of lung cancer among white and black relatives of individuals with early-onset lung cancer

Context  Evidence exists that lung cancer aggregates in families and recent findings of a chromosomal region linked to lung cancer susceptibility support a genetic component to risk. Family studies of early-onset lung cancer patients offer a unique opportunity to evaluate lifetime risk of lung cancer in relatives. Objective  To measure lung cancer aggregation and estimate lifetime risk among relatives of early-onset cases and population-based controls. Design and Setting  Familial aggregation and cumulative risk estimates from interview data of incident cases and concurrently ascertained controls between 1990 and 2003 in metropolitan Detroit, Mich. Participants  The study included 7576 biological mothers, fathers, and siblings of 692 early-onset cases and 773 frequency-matched controls. One third of the population was black. Main Outcome Measures  Cumulative lifetime risk of lung cancer, stratified by race and smoking behavior in relatives of early-onset cases and controls. Results  Smokers with a family history of early-onset lung cancer in a first-degree relative had a higher risk of developing lung cancer with increasing age than smokers without a family history. An increase in risk occurs after age 60 years in these individuals, with 17.1% (SE 2.4%) of white case relatives and 25.1% (SE 5.8%) of black case relatives diagnosed with lung cancer by age 70 years. Relatives of black cases were at statistically significant increased risk of lung cancer compared with relatives of white cases (odds ratio, 2.07, 95% confidence interval, 1.29-3.32) after adjusting for age, sex, pack-years, pneumonia, and chronic obstructive lung disease. Conclusions  First-degree relatives of black individuals with early-onset lung cancer have greater risk of lung cancer than their white counterparts, and these risks are further amplified by cigarette smoking. These data provide estimates of lung cancer risk that can be used to offer counseling to family members of patients with early-onset lung cancer.      

1635例肺癌术后患者电话随访结果及预后分析

目的:分析肺癌患者术后的电话随访结果及影响肺癌预后的因素,探讨提高电话随访成功率的方法。方法:2011年11月至2012年1月对2002年1月至2011年8月期间1635例本院肺癌手术患者进行电话随访。随访结果及临床资料汇总后进行统计分析,在其中116例临床资料完整的病例中,进一步探讨肺癌转移和长期生存率的影响因素。结果:平均随访成功率为36.1%,电话随访成功率与术后随访间隔时间相关,随访时间与手术间隔时间越近,随访成功率越高。女性患者随访成功率要明显高于男性患者(P<0.001)。40岁以下患者的随访成功率(56%)明显高于50~59岁及60岁以上患者(分别为39%和24%,P<0.001),城镇和农村的随访成功率差异无明显统计学意义(P=0.844)。在116例临床资料完整的病例中,统计验证了转移和高淋巴结分期增加术后死亡的风险(OR值分别为0.212和1.818),腺癌、淋巴结高分期、高龄与术后肿瘤转移相关(OR值分别为2.353,2.181和2.908)。结论:电话随访成功率受时间、年龄及性别等因素影响。在小样本的病例分析中验证了远处转移、淋巴结转移、病理类型及高龄与肺癌预后的关系。     

探讨肺癌与肺癌合并肺部感染患者血常规指标、血清炎性因子差异性

目的 探究肺癌与肺癌合并肺部感染患者血常规指标、血清炎性因子差异性。方法 选取我院2017年11月～2019年11月进行诊断治疗的肺癌与肺癌合并肺部感染患者各36例,按照不同疾病情况分为观察组及对照组。单纯肺癌患者为对照组,肺癌合并肺部感染患者为观察组。对比两组血清炎性因子的水平、血常规指标及凝血指标情况,对比分析检测的结果。结果 观察组患者的PLT、APTT、PT、TT、FIB、D-dimer凝血指标水平均高于对照组,差异有统计学意义(P0.05);观察组患者的的LYM水平低于对照组,WBC、MONO及NEU血常规指标水平均高于对照组,差异有统计学意义(P0.05);观察组患者的IL-6、TNF-α、IL-1β血清炎性因子水平指标均高于对照组,差异有统计学意义(P0.05)。结论 针对肺癌与肺癌合并肺部感染患者,血清炎性因子、凝血指标、血常规指标均存在较大差异,相较于对照组,观察组的凝血功能紊乱、肺部的炎症反应症状更严重,具有临床应用价值。     

MicroRNA与非小细胞肺癌

肺癌已经成为全球范围内因癌症导致死亡的首要原因,当今由于缺乏有效的指导临床诊断和治疗的肿瘤分子标志物,所以非小细胞肺癌患者的疗效不佳。Micro RNA(以下简称miRNA)是真核生物中一类长度约为22个核苷酸的参与基因转录后水平调控的小分子非编码RNA。miRNA在肺癌中发挥原癌基因及抑癌基因的作用,在肺癌的发生、发展过程中均发挥着重要作用。miRNA不仅可以在石蜡包埋组织和体液中保持稳定,而且在血清和血浆中也可以稳定存在,这个特性使循环miRNA有望成为一种新型分子标志物,为肺癌的早期分子诊断、预测预后及治疗效果开辟了一个新的研究领域。     

Dietary phytoestrogens and lung cancer risk

Context  Despite lung-specific in vitro and in vivo studies that support a chemopreventive role for phytoestrogens, there has been little epidemiologic research focused on dietary intake of phytoestrogens and risk of lung cancer. Objective  To examine the relationship between dietary intake of phytoestrogens and risk of lung cancer. Design, Setting, and Participants  Ongoing US case-control study of 1674 patients with lung cancer (cases) and 1735 matched healthy controls. From July 1995 through October 2003, participants were personally interviewed with epidemiologic and food frequency questionnaires to collect demographic information and to quantify dietary intake of 12 individual phytoestrogens. Main Outcome Measure  Risk of lung cancer, estimated using unconditional multivariable logistic regression analyses stratified by sex and smoking status and adjusted for established and putative lung cancer risk factors. Results  Reductions in risk of lung cancer tended to increase with each increasing quartile of phytoestrogen intake. The highest quartiles of total phytosterols, isoflavones, lignans, and phytoestrogens were each associated with reductions in risk of lung cancer ranging from 21% for phytosterols (odds ratio [OR], 0.79; 95% confidence interval [CI], 0.64-0.97; P = .03 for trend) to 46% for total phytoestrogens from food sources only (OR, 0.54; 95% CI, 0.42-0.70; P<.001 for trend). Sex-specific effects were also apparent. For men, statistically significant trends for decreasing risk with increasing intake were noted for each phytoestrogen group, with protective effects for the highest quartile of intake ranging from 24% for phytosterols (OR, 0.76; 95% CI, 0.56-1.02; P = .04 for trend) to 44% for isoflavones (OR, 0.56; 95% CI, 0.41-0.76; P<.001 for trend), while in women, significant trends were only present for intake of total phytoestrogens from food sources only, with a 34% (OR, 0.66; 95% CI, 0.46-0.96; P = .01 for trend) protective effect for the highest quartile of intake. The apparent benefits of high phytoestrogen intake were evident in both never and current smokers but less apparent in former smokers. In women, statistically significant joint effects were evident between hormone therapy use and phytoestrogen intake. Specifically, high intake of the lignans enterolactone and enterodiol and use of hormone therapy were associated with a 50% (OR, 0.50; 95% CI, 0.31-0.68; P = .04 for interaction) reduction in risk of lung cancer. Conclusions  While there are limitations and concerns regarding case-control studies of diet and cancer, these data provide further support for the limited but growing epidemiologic evidence that phytoestrogens are associated with a decrease in risk of lung cancer. Confirmation of these findings is still required in large-scale, hypothesis-driven, prospective studies.      

分析低剂量CT肺癌筛查效果及肺癌相关危险因素

目的分析低剂量CT肺癌筛查效果及肺癌相关危险因素。方法选取2017年1月至2020年5月于本院进行低剂量CT肺癌筛查的500例无症状受检者作为研究对象,分析500例受检者的筛查结果,并依据筛查结果分为阳性组(低剂量CT阳性,n=50)和阴性组(低剂量CT阴性,n=450),比较两组临床资料,并采用多因素Logistic回归分析肺癌相关危险因素。结果500例无症状受检者中低剂量CT筛查结果阳性者50例,阳性率为10.00%;阴性者450例,阴性率为90.00%;50例阳性患者经病理活检证实45例为肺癌。经多因素Logistic回归分析显示,年龄≥50岁、受教育程度低和有吸烟史是肺癌的独立危险因素(P<0.05)。结论低剂量CT能有效筛查肺癌,而年龄≥50岁、受教育程度低和有吸烟史是肺癌的独立危险因素,可将此类人群作为肺癌的高危人群,以更好地指导低剂量CT肺癌筛查工作的开展。     

循证医学与肺癌治疗

中医在肺癌治疗中十分重视证候。证是证据,候是外观,是病人的临床表现。从四诊获取信息、证据后,进行辨证治疗。中医学还十分重视肿瘤医学文献的收集和整理,也注重名著、医案在临床中的指导作用。中医学在这些方面和循证医学强调从文献所获取的系统信息指导临床有异曲同工之妙。中医肿瘤学与循证医学关系源远流长。中医中药治疗肺癌已有许多取得较好疗效的临床报道,其成绩是可喜的,但或多或少存在方法学方面的问题。例如随机方法过于随便,两组基线缺少可比性;缺乏大样本、多中心、双盲随机化对照的临床试验;在对照物的选择上也存在一些问题,如有些阳性对照物本身的临床疗效就是个问题;还存在着对病例近期疗效判定不太严格的问题,所统计的近期疗效(CR PR)存在样本误差。当然中医中药治疗肺癌有它的优势和特色,其主要特点是能控制病灶生长或使病灶生长缓慢,与此同时,患者的体征、症状有明显的改善,生活质量有明显的提高,生存期有明显的延长。“生存率作为金标准”,这对中医中药来说有其特定的价值。只有按照循证医学的规律,选择多个中心(中医医院、西医医院共同参与),采用公认的西医治疗方案以及按照盲法、严格随机化对照原则,探索出一套适合中国国情,中西合璧,治疗控制晚期非小细胞肺癌(NSCLC)的生长和转移,防止早中期NSCLC术后复发和转移的新的治疗策略,这样的科研结论才具有更高的科学性,中医中药才能进一步走向世界。     

长链非编码RNA与肺癌

长链非编码RNA(1ong noncoding RNA,lncRNA)是一类长度超过200个核苷酸的非编码RNA分子,其数量众多,但缺少蛋白质编码功能。研究发现,lncRNA能在表观遗传学、转录及转录后等多种水平调控基因表达,在各类生物过程中起重要的调节作用,并与多种肿瘤等疾病相关,已经成为现代遗传学的研究热点。近期研究证据显示,肺癌中有多种lncRNA的表达水平发生了变化,并在肺癌的发生、发展及预后中起着重要的调控作用,本文就lncRNA的定义、分类、功能机制及与肺癌的相关性研究作一综述。     

肺癌肺叶切除支气管成形术

本文介绍了12例肺癌肺叶切除支气管成形术的经验,本组病例按PTNM分期,Ⅰ期4例;Ⅱ期1例;Ⅲ期7例。均治愈出院。讨论了手术适应症的选择,支气管吻合时的注意事项以及并发症的予防和处理方法。对吻合口肉芽的处理,采用纤维支气管镜观察下,应用激光治疗,较用器械咬出为好。