青年人肺癌化疗加放射治疗的临床研究

目的　探讨化疗 放射治疗 (化放疗 ) <4 0岁青年人肺癌的临床病理及预后。方法　对化放疗的 70例肺癌患者 (<4 0岁 ,研究组 )进行回顾性研究 ,对照组是 82例随机选择同期患者 (≥4 0岁 )。比较两组临床病理特征和生存期。结果　研究组中位年龄 36 .5岁 ,对照组 6 2 .0岁。与对照组相比 ,研究组中女性多 (P =0 .0 39) ,中位症状持续时间长 (4个月 ,P <0 .0 0 1) ,误诊率高 (70 % ,P <0 .0 0 1)及中位误诊时间长 (4个月 ,P <0 .0 0 1) ,腺癌为主要病理类型 (6 4 .3% ,P <0 .0 0 1) ,诊断时晚期多 (90 % ,P <0 .0 0 1) ,放射治疗剂量高 (Ⅰ～Ⅲb期 ,中位剂量 6 2Gy ,P =0 .0 4 8;Ⅳ期 ,中位剂量 5 6Gy,P =0 .0 0 3) ,同期化放疗和早期放射治疗比例高 (77.1% ,P <0 .0 0 1和 5 5 .6 % ,P =0 .0 2 3) ,顺铂剂量高(90mg/m2 ,P <0 .0 0 1)以及化疗周期多 (6个周期 ,P <0 .0 0 1) ;两组在体重减轻、KPS、肿瘤家族史及吸烟史方面无差异。两个组总的中位生存时间及生存率比较差异无显著性意义 (χ2 =2 .88,P =0 .0 90 )。结论　化放疗的青年人肺癌临床病理特征明显不同于≥ 4 0岁人的肺癌 ,但生存情况一致。将青年人肺癌定义为”青年型肺癌”有一定临床实际意义。     

53 例青年人结肠癌临床病理分析

 目的　探讨青年人结肠癌的临床病理特点。方法　收集本院 1 980～ 1 994年间收治的53例青年人结肠癌与同期收治的 2 72例中老年结肠癌从临床、病理方面进行对比分析。结果　青年人结肠癌以粘液腺癌、低分化腺癌为主占 69.81 % ( 37/53) ,中老年组占 7.35% ( 2 0 /2 72 ) ,两组相比 ,P<0 .0 0 1。高、中分化腺癌则相反 ,中老年组占 91 .91 % ( 2 50 /2 72 ) ,青年组占 2 6.4% ( 1 4/53) ,P<0 .0 0 1。两组具显著显差异。生存率 :3、5年生存率中老年组明显高于青年组 ,62 .86%、1 9.85%对5.60 %、3.77% ,P<0 .0 0 1。两组差异显著。结论　青年结肠癌与中老年结肠癌相比具有分化程度低 ,恶性程度高、生存率低的特点.     

青年人与老年人肺癌的比较

目的 对青年人肺癌（年龄≤40岁）和老年人肺癌（年龄≥70岁）的病理类型、临床表现、性别比例、临床分期及对治疗的选择进行比较。方法 回顾性收集6年来在我院经病理学证实青年人组70例及老年人组135例肺癌患者的年龄、性别、组织学分类、起始症状、临床分期及治疗经过进行比较。结果 （1）青年人组中女性患者比例较老年人组明显增高（P＜0.01)。青年人组腺癌的比例亦较老年组高。（2）青年组中出现胸痛症状的比例明显高于老年人组（P＜0.01)。（3）青年人组中中晚、期比例略高于老年人组，但统计学上无显著性差异。（4）青年人组中手术治疗及放化疗的比例要明显高于老年人组（P＜0.01)，老年人组中更倾向于保守治疗。结论 青年人肺癌与老年人肺癌相比，女性患者比例明显增高，腺癌比例增高，疾病进展迅速，恶性度高，且易误诊。早期诊断，积极治疗能提高肺癌的生存期。     

化放疗治疗青年和中老年肺癌患者预后的比较研究

目的　探讨化放疗治疗 <4 0岁的青年和中老年肺癌患者的预后及其影响因素。方法　对化放疗治疗的 70例青年肺癌患者 (研究组 )和随机选择化放疗治疗的 82例≥ 4 0岁中老年肺癌患者 (对照组 )的临床资料进行统计分析。生存分析采用Kaplan Meier方法 ,单因素分析采用Logrank检验 ,多因素分析采用Cox模型回归分析。结果　研究组的中位生存期为 10个月 ,2年和 5年生存率分别为 11.1%和 3.1% ;对照组中位生存期为 12个月 ,2年和 5年生存率分别为 2 3.1%和 5 .4 % (P =0 .0 898)。单因素分析显示 ,症状持续时间、误诊持续时间、临床分期、化放疗联合模式、放疗剂量、顺铂 (DDP)剂量、体重减轻和卡氏评分与研究组预后有关 ;而症状持续时间、临床分期、放疗剂量、体重减轻和卡氏评分与对照组预后有关。多因素分析显示 ,临床分期、体重减轻和卡氏评分是两组的独立预后指标 ,而DDP剂量仅是研究组独立预后指标。结论　青年肺癌患者预后与中老年人肺癌患者相似 ,青年肺癌患者的预后指标与中老年肺癌患者有所不同。DDP剂量仅是青年肺癌患者预后指标 ,提示DDP治疗青年人肺癌时有剂量 反应关系。     

新辅助同步放化疗后青年中低位直肠癌患者的临床病理特征及预后

目的探讨新辅助同步放化疗后青年中低位直肠癌患者的临床病理特征及预后特点。方法新辅助同步放化疗后, 于2004年1月至2016年12月在中国医学科学院肿瘤医院接受根治性手术的原发性中低位直肠癌患者441例。根据患者的发病年龄分为青年组(51例)和中老年组(390例), 比较两组患者的临床病理特征及生存情况。结果青年组中68.6%的患者在放疗结束后7周内接受根治性手术, 高于中老年组(52.8%, P=0.047);青年组ypTNM分期为Ⅲ期患者的比例为51.0%, 高于中老年组(34.1%, P=0.027);青年组ypN分期为ypN+期患者的比例为51.0%, 高于中老年组(34.1%, P=0.047)。青年组和中老年组的疾病进展发生率分别为39.2%和25.1%, 远处转移发生率分别为35.3%和21.5%, 青年组均高于中老年组(P值分别为0.049和0.044)。青年组患者疾病进展大多发生在术后前3年内, 尤其在术后第2年, 青年组患者的疾病进展发生率高于中老年组(分别为55.0%和26.5%, P=0.025)。青年组患者3、5年无进展生存率分别为63.7%和58.2%, 中...     

血管内皮生长因子在非小细胞肺癌中的表达及临床意义

目的　研究血管内皮生长因子的表达与非小细胞肺癌临床病理特征及预后的关系 ,探讨血管内皮生长因子的作用机制。方法　采用超敏过氧化酶免疫组织化学法 ,检测手术切除的 96例非小细胞肺癌组织标本中微血管密度和血管内皮生长因子的表达。结果　 96例非小细胞肺癌组织标本中血管内皮生长因子的阳性表达率为 64 .6% ( 62 /96) ,主要分布于癌细胞的胞浆内 ,细胞核内无表达。VEGF表达与临床分期有密切关系 (P =0 .0 41) ,与其他各项临床病理特征无明显统计学相关性 (P >0 .0 5 )。微血管高密度组血管内皮生长因子阳性表达率为 80 .4% ,明显高于微血管低密度组 ( 4 6.7% ) (P =0 .0 0 1)。血管内皮生长因子阳性表达患者生存期明显短于阴性表达患者 (P <0 .0 1)。Cox风险比例模型分析显示血管内皮生长因子表达和病理分期可作为判断非小细胞肺癌患者预后的独立指标。结论　血管内皮生长因子可引起瘤内微血管密度增加 ,在非小细胞肺癌血管形成中起重要作用 ,并有助于预测肺癌患者预后。     

非小细胞肺癌中VEGF、MVD及PCNA的表达

目的 :探讨VEGF、MVD和PCNA在非小细胞肺癌 (NSCLC)中的表达及其生物学行为的关系。方法 :采用免疫组织化学方法 ,对病理确诊的 5 9例非小细胞肺癌组织进行VEGF、MVD和PCNA表达的检测。结果 :5 9例非小细胞肺癌的VEGF阳性表达率 6 4 4 % (38/5 9) ,其表达与NSCLC的组织分化程度、生存期有相关性 (P <0 0 5 ) ,与组织学类型、有无淋巴结转移、临床病理分期无关。PCNA阳性表达率 6 1 0 % (36 /5 9) ,表达与肿瘤组织类型、TNM分期、有无淋巴结转移无关 ,与组织分化程度及生存期有关 (P <0 0 5 )。 5 9例NSCLC的MVD值为 3～ 2 0 (M =9) ,与生存期有关 (P <0 0 5 )。结论 :VEGF、MVD和PC NA可以作为评价非小细胞肺癌预后的重要指标。     

青年人胃癌临床与病理分析

目的探讨青年人胃癌临床病理特点与意义.方法收集1995年～2004年青年人胃癌39例,作光镜观察,并行胶原纤维(VG)和网状纤维(GS)染色,同时运用免疫组化方法对青年组胃癌39例、中老年组胃癌100例进行p53与PCNA检测.结果青年组胃癌临床分期以中晚期为主;组织分型以低分化腺癌、粘液细胞癌为主;VG和GS染色见低分化腺癌、粘液细胞癌周围胶原纤维、网状纤维明显减少,高-中分化腺癌则见周围纤维组织反应性增生;免疫组织p53与PCNA阳性表达率青年组明显高于中老年组.结论青年人胃癌发现多已属中晚期,且组织分化差,恶性程度高.对比中老年人,青年人胃癌预后差.因此,临床医生应提高对青年人胃癌的认识,旨在对青年人胃癌进行早期诊断与早期治疗,以提高青年人胃癌的生存率.     

射频消融联合放化疗治疗局部晚期非小细胞肺癌

 目的　探讨射频消融联合放化疗治疗局部晚期非小细胞肺癌的疗效。方法　 2 0 0 0年 2月至2 0 0 3月 10月采用射频消融联合放化疗治疗局部晚期非小细胞肺癌 4 2例 (综合组 ) ,选择同期条件相同采用常规放化疗局部晚期非小细胞肺癌 38例作对照 (常规组 ) ;比较两组病人的KPS、局部复发率、中位生存期、生存率。结果　综合组和常规组的KPS改善率分别为 2 8.5 7%和 10 .5 2 % ,稳定率分别为4 2 .86 %和 36 .84 %恶化率 2 8.5 7%和 5 2 .6 3% ;综合组KPS评分优于常规组 ( χ2 =6 .32 ,P <0 .0 5 )。原发灶局部复发率综合组显著低于常规组 ( 2 8.5 7%v 5 0 .0 0 % ;χ2 =3.86 ,P <0 .0 5 ) ;中位生存期综合组 16个月 ,常规组 14个月 ;1、2、3年生存率综合组稍高于常规组 6 3.5 3%v 5 3.5 0 % ,31.99%v 2 9.13% ,2 1.33%v 16 .18%。但两组间生存曲线比较无统计学意义 ( χ2 =0 .33,P >0 .0 5 )。结论　射频消融联合放化疗...     

环氧化酶-2在非小细胞肺癌的表达及与肿瘤血管生成的研究

目的　为探讨COX 2对非小细胞肺癌发生发展的影响 ,我们对肺癌患者与肺部良性疾病患者肺组织中COX 2表达情况进行了比较 ,并研究了COX 2与肺癌临床病理特征的关系及对肿瘤血管生成的影响。方法　免疫组化检测非小细胞肺癌COX 2表达、血管内皮生长因子 (VEGF)表达 ,并测定肿瘤微血管密度 (MVD)。结果　非小细胞肺癌组织COX 2蛋白阳性表达率为 69.2 % (5 4/78) ,显著高于良性对照组织的14 .3 % (2 /14 ) (χ2 =15 .0 44 ,P <0 .0 1)。COX 2表达阳性组MVD计数 (19.41± 8.5 6)显著高于COX 2表达阴性组 (12 .0 0± 5 .3 7) (t=3 .90 6,P <0 .0 1)。COX 2表达与肺癌患者性别、年龄、吸烟史及TNM分期无明显关系 (P >0 .0 5 ) ;在不同肿瘤的病理类型中 ,腺癌组织COX 2表达率为 88.9% (3 2 /3 6) ,显著高于鳞癌的5 0 .0 % (2 0 /4 0 ) (χ2 =13 .2 62 ,P <0 .0 1) ;鳞癌组织中低分化癌组织表达率为 81.0 % (17/2 1) ,显著高于中高分化癌组织的 15 .8% (3 /19) (χ2 =16.942 ,P <0 .0 1) ;腺癌组织中低分化癌组织表达率为 10 0 .0 % (18/18) ,显著高于中高分化癌组织的 77.8% (14 /18) (χ2 =6.0 46,P <0 .0 5 )。相关关系分析显示肺癌COX 2表达与VEGF表达呈显著正相关 (r =0 .5 0 9,P <0 .0 1) ;VEGF表达与MVD呈     

Ovarian cancer in younger vs older women: a population-based analysis

To compare the clinico-pathologic prognostic factors and survival of younger vs older women diagnosed with epithelial ovarian cancer. Demographic, clinico-pathologic, treatment, and surgery information were obtained from patients with ovarian cancer from the Surveillance, Epidemiology, and End Results Program from 1988 to 2001 and analysed using Kaplan-Meier estimates. Of 28 165 patients, 400 were <30 years (very young), 11 601 were 30-60 (young), and 16 164 were >60 (older) years of age. Of the very young, young, and older patients, 261 (65.3%), 4664 (40.2%), and 3643 (22.5%) had stage I-II disease, respectively (P<0.001). Across all stages, very young women had a significant survival advantage over the young and older groups with 5-year disease-specific survival estimates at 78.8% vs 58.8 and 35.3%, respectively (P<0.001). This survival difference between the age groups persists even after adjusting for race, stage, grade, and surgical treatment. Reproductive age (16-40 years) women with stage I-II epithelial ovarian cancer who received uterine-sparing procedures had similar survivals compared to those who underwent standard surgery (93.3% vs 91.5%, P=0.26). Younger women with epithelial ovarian cancer have a survival advantage compared to older patients.     

Comparison between young and old patients with bronchogenic carcinoma

The aim of this study was to compare the clinical characteristics, histological type, stage at diagnosis, treatment and survival of young (< or = 45 years) and older patients with bronchogenic carcinoma. The study was designed as a retrospective review of all lung cancer patients referred to the Kuwait Cancer Control Center over a 10-year period from 1985 to 1994. The study comprised 590 patients with primary bronchogenic carcinoma, of whom 72 (12%) were < or = 45 years of age at the time of diagnosis. Median (range) duration of symptoms, percentage of smokers and male to female ratios for the younger and older patients were 8 (2-48) weeks vs. 8 (1-52) weeks (p = 0.9), 74% vs. 83% (p = 0.06) and 5.5 vs. 5.3, respectively. The majority of patients had advanced stage disease at presentation; 91% of the younger patients had stage III or IV compared with 88% of the older patients (p = 0.1). The histological types for the younger and older patients were 32% vs. 20% for adenocarcinoma (p = 0.01) and 33% vs. 45% for squamous cell carcinoma (p = 0.1). There were more patients in the younger group who had surgery (21% vs. 7.5%) than in the older group (p = 0.001). Follow-up data were available for 177 patients out of 190 Kuwaiti national patients (93%). The median (range) survival rates for young and old patients were 8 (3-62) months and 7 (1-174) months, respectively (p = 0.09). Only 6 patients survived for more than 5 years, one (7.6%) from the younger group and 5 (3%) from the older group. Our study shows a relatively high percentage of young patients in our population of lung cancer patients. Apart from the higher incidence of adenocarcinoma in the young group and the fact that these patients had more surgery than the older group, there were no other significant differences between the two groups.     

Lung cancer in patients younger than 40 years of age.

BACKGROUND AND OBJECTIVES: We investigated whether the clinicopathologic characteristics and prognosis of lung cancer in younger patients differ from those of older patients. METHODS: Among 2,763 lung cancer patients treated during the period from April of 1972 to April of 1997, we retrospectively investigated the clinical features and prognosis of 53 patients under 40 years of age (young group) and compared them with the findings of 1,886 patients with 60 years of age or older (elderly group). RESULTS: The proportion of female patients in the younger group was significantly higher than that in the elderly group (39.6% vs. 24.1%). The young group had a significantly higher proportion of adenocarcinoma (75.5% vs. 44.8%) and stage III-IV disease (73.6% vs. 59.2%) and a significantly lower proportion of squamous cell carcinoma (3.8% vs. 32.1%). Regarding the selection of therapy, in the young group, a significantly lower proportion of patients underwent surgical therapy (35.8% vs. 41.5%) and a significantly higher proportion of those (37.7% vs. 16.4%) received chemotherapy. The overall survival between the young and elderly groups was not significantly different. Moreover, the 5-year survival rate of the patients undergoing a surgical resection was 56.1% in the young group and 44.8% in the elderly group (P = 0.0615). CONCLUSIONS: This study suggests that the prognosis of young patients with lung cancer is at least equivalent to that of older patients; therefore, they should be managed according to the general therapeutic guidelines.     

Lung Cancer in Patients under 50 Years Old

A long-term retrospective study was carried out on 790 cases of lung cancer to determine if the clinicopathologic characteristics and survival rates of lung cancer patients under the age of 50 differ from those of patients 50 years of age or older at diagnosis by analyzing data on patients registered at Tochigi Cancer Center Hospital. Of the 790 patients, 77 (9.7%) were under the age of 50 at diagnosis. The percentage of women in the younger patient group was significantly higher than that in the older patient group (39.0% vs. 27.5%; P =0.034). Tumor histology revealed a significant preponderance of adenocarcinomas (60 patients, 77.9%) and a paucity of squamous cell carcinomas (8 patients, 10.4%) in the younger age group ( P <0.001). The preponderance of adenocarcinoma was significant in both males and females (male: P =0.004, female: P =0.004). Smoking rates and rate of detection by cancer screening did not differ between the two age groups. Because of the paucity of smokers among the younger female patients, causes of lung cancer other than smoking should be sought in younger patients. No difference was found in the stage of the disease at presentation, treatment methods and survival rates between the two age groups. It is suggested that the prognosis for patients with lung cancer under the age of 50 is not significantly worse than for those aged 50 years or older, as has been shown by several investigators.     

COMPARISON BETWEEN YOUNG AND OLD PATIENTS WITH LUNG CANCER

Lung cancer is a common malignancy in China. The majority of cases of lung cancer were diagnosed inpatients more than 40 years old. There are few datacomparing clinical characteristics, disease status,treatment modality of very young (≤40 years) vs very old (≥70 years) patients in China. This study was designed as retrospective review of all lung cancer patients referred to the Sir Run Run Shaw Hospital (SRRSH) over a 6-year period to compare demographic data, disease status, or treatme…     

非小细胞肺癌的减量性手术治疗

目的探讨非小细胞肺癌减量性手术的疗效和影响因素。方法用ＳＰＳＳ统计软件包的Ｋａｐｌａｎ－Ｍｅｉｅｒ和Ｃｏｘ模型,分析比较２４４例肺癌减量术及同期３６４例剖胸探查术的累积生存率和影响生存率因素。结果非小细胞肺癌减量术的１,３,５年累积生存率分别为５６．９％、２０．６％和１７．５％;探查术为４１．１％、７．８％和５．３％。两者比较,Ｂｒｅｓｌｏｗ＝２７．５５,Ｐ＜０．０００１。多因素分析显示,影响生存的主要因素为手术性质（减量术或探查术,Ｂ＝－０．４６００,Ｐ＜０．０００１）和有否后续治疗（Ｂ＝－０．１０５９,Ｐ＝０．０２１６）。结论肿瘤减量性手术是Ⅲ、Ⅳ期非小细胞肺癌的重要治疗手段之一,术后行放疗、化疗能有效地提高患者的生存率。     

年轻肺癌患者的临床特征和分子特征的回顾性研究

目的:探究年轻肺癌患者（≤40岁）的临床特征、分子特征和预后。方法:此回顾性研究纳入了我院2010年至2020年间279例临床资料完整的年轻肺癌患者分析其临床特征。此研究纳入我院2010年至2020年间419例进行下一代测序检测（next-generation sequencing,NGS）的年老肺癌患者（>40岁）来比较年轻组和年老组肺癌患者分子特征的差异,探讨了年龄依赖性突变频率。单变量和多变量分析用于发现晚期年轻患者的预后因素。结果:腺癌是年轻肺癌患者的主要病理亚型;大多数我国年轻患者被诊断为早期肺癌,且TNM分期与体检显著相关（P＜0.001）。年轻组的EGFR突变频率明显低于年老组（P=0.047）。年轻组ALK（P＜0.001）、ROS1（P＜0.001）和ERBB2（P=0.001）的变异率显著高于年老组。单变量和多变量分析显示女性（HR,0.541;95%CI:0.308~0.950）（P=0.032）、吸烟史（HR,2.829;95%CI:1.083~7.389）（P=0.034）、单纯化疗（HR,3.242;95%CI:1.390~7.565）（P=0.007）和单纯分子靶向治疗（HR,2.227;95%CI:1.077~4.607）（P=0.031）是影响晚期年轻肺癌患者PFS的独立因素。结论:我国年轻肺癌患者以腺癌和早期肺癌为主。具有独特的分子特征,因此检测其分子特征并积极治疗更为有益。     

青年人与老年人直肠癌的临床病理与预后对比

目的探讨青年人与老年人直肠癌的临床病理特征及预后的差异。方法回顾1996年1月至2006年1月可手术的85例青年人（≤40岁）直肠癌与155例老年人（≥65岁）直肠癌患者的临床病理资料和随访资料,进行生存分析和预后多因素分析。结果青年人直肠癌发生在腹膜返折下占69.41％,高于老年组的52．90％（P=0．013）;低分化腺癌及黏液、印戒细胞癌比例分别为31．76％及22．35％,也分别高于老年组的18．71％及8．39％（P=0．023,P=0．007）;青年组有淋巴结转移者为63．53％,高于老年组的47．10％（P=0．015）;青年组与老年组的5生存率分别为48．2％、55．7％,两组差异无统计学意义（P=0．176）;多因素分析结果显示,手术性质、肿瘤侵犯深度、淋巴结转移、TNM分期是影响预后最重要的独立因素。结论与老年患者相比,青年患者直肠癌恶性度较高,发现较晚,但若能及早发现并通过根治手术为主联合放化疗,预后可与老年患者无差异。     

1,742例Ⅳ期非小细胞肺癌的预后分析

背景与目的目前非小细胞肺癌(non-small cell lung cancer,NSCLC)仍是导致癌症死亡的首要原因,本研究旨在探讨影响晚期NSCLC预后的重要因素。方法收集2000年1月4日-2008年12月25日1,742例IV期NSCLC临床资料,所有病例经细胞学或组织病理学确诊。分析性别、年龄、吸烟史、病理类型、分型、临床TN分期、转移器官数目、治疗方法对预后的影响,应用Kaplan-Meire方法计算生存率,Log-rank检验生存率差别,采用Cox多因素回归对预后因素进行分析。结果本组1,742例患者的中位生存期为10.0个月(9.5个月-10.5个月),1年、2年、3年、4年、5年生存率分别为44%、22%、13%、9%、6%。单器官发生转移与多器官转移中位生存期分别为11个月vs7个月(P<0.001)。不同器官发生转移后生存期不同,中位生存期分别为肺12个月(11.0个月-12.9个月),骨9个月(8.3个月-9.6个月),脑8个月(6.8个月-9.1个月),肝、肾上腺、远处淋巴结转移均为5个月(3.8个月-6.1个月),皮下3个月(1.7个月-4.3个月)。腺癌患者1,086例(62%),鳞癌305例(17.5%),中位生存期分别为12个月vs8个月(P<0.001)。化疗与最佳支持治疗者中位生存期分别为11个月vs6个月(P<0.001)。放疗与否的中位生存期分别为11个月vs9个月(P=0.017)。结论性别、年龄、大体分型、病理类型、临床T分期、N分期、转移器官数目、吸烟史、治疗方法是晚期NSCLC预后的独立影响因素。