99mTc-MDP骨扫描和肿瘤标记物对非小细胞肺癌分期诊断的价值

目的：探讨99mTc-MDP全身核素骨扫描及肿瘤标记物对非小细胞肺癌分期诊断的价值。方法：对68例确诊为非小细胞肺癌患者进行全身核素骨扫描,采集68例非小细胞肺癌患者血清,应用酶联免疫法、放射免疫法、比色法、胶乳凝集法检测68例非小细胞肺癌病人（观察组）及40例健康体检者（对照组）血清CA125、CEA、TSGF、SGF、VEGF水平,比较各肿瘤标记物水平在非小细胞肺癌各期中的水平。结果：观察组患者血清肿瘤标记物含量均高于健康对照组,且随临床分期的逐渐升高,各肿瘤标记物水平逐步升高;99mTc-MDP骨扫描明确骨转移者有16例,Ⅰ期肺癌患者骨转移1例、Ⅱ期肺癌患者骨转移2例、Ⅲ期肺癌患者骨转移4例、Ⅳ期肺癌患者骨转移9例。结论：99mTc-MDP全身核素骨扫描可作为非小细胞肺癌分期检测的筛查手段,患者血清CA125、CEA、TSGF、SGF、VEGF水平随病程的进展而不断升高;99mTc-MDP骨扫描联合肿瘤标记物检测在非小细胞肺癌分期诊断中具有重要意义。     

PC和DC方案一线治疗晚期非小细胞肺癌的临床观察

目的比较培美曲塞（PEM）联合顺铂（DDP）与多西他赛（DOC）联合DDP治疗晚期非小细胞肺癌的临床疗效及不良反应。方法将30例晚期非小细胞肺癌（ⅢB～Ⅳ期）患者随机分为培美曲塞加顺铂组（PC组）和多西他赛加顺铂组（DC组）,每组15例。治疗2个周期后评价疗效及不良反应。结果 PC组疾病控制率为86.7%;DC组疾病控制率为80%。两组比较差异均无统计学意义（均P〉0.05）。PC组Ⅲ-Ⅳ度骨髓抑制及胃肠道反应显著低于DC组（P〈0.05）。结论培美曲塞联合顺铂治疗晚期非小细胞肺癌的疗效与多西他赛加顺铂的疗效相当,但不良反应发生率低,可作为晚期非小细胞肺癌患者的一线治疗。     

吉非替尼靶向疗法对Ⅲ、Ⅳ期非小细胞肺癌患者的疗效及安全性分析

目的探讨吉非替尼靶向疗法对Ⅲ、Ⅳ期非小细胞肺癌患者的疗效以及用药安全性。方法 74例晚期（Ⅲ、Ⅳ期）非小细胞肺癌患者,按照入院顺序,前37例患者采用GP方案治疗（GP组）,后37例患者采用吉非替尼治疗（吉非替尼组）,对比两组住院期间的治疗效果和安全性。结果 GP组有效率为29.73%（11/37）,低于吉非替尼组的37.84%（14/37）,但差异无统计学意义（P〉0.05）;GP组控制率为48.65%（18/37）,明显低于吉非替尼组的75.68%（28/37）,差异具有统计学意义（P〈0.05）;两组口腔溃疡以及转氨酶升高差异无统计学意义（P〉0.05）;吉非替尼组腹泻、便秘明显高于GP组,其余毒副反应的发生率显著低于GP组,差异有统计学意义（P〈0.05）。结论对于晚期非小细胞肺癌患者,采用吉非替尼靶向疗法能够保证患者在短期内获得较高的生活质量,减轻患者痛苦,且引起的毒副反应程度较轻,用药安全性相对较高。     

唑来膦酸治疗肺癌骨转移患者首次骨相关事件的临床分析

目的 探讨唑来膦酸对肺癌骨转移患者首次骨相关事件(SRE)的作用.方法 回顾性分析2007年1月至2010年6月期间106例肺癌骨转移患者的临床资料.A组为未使用唑来膦酸病例67例(63.2％);B组为骨转移后使用唑来膦酸治疗病例39例(36.8％),比较2组首次SRE的发生情况.结果 106例患者中50例(47.2％)患者发生首次SRE,A组的首次SRE发生率为56.7％ (38/67),明显高于B组[30.8％ (12/39)],2组比较差异有统计学意义(P＜0.05).其中,A组的骨放疗事件发生率明显高于B组[40.3％ (29/67)比20.5％ (8/39)],2组比较有统计学差异(P＜0.05).2组患者的中位无SRE生存时间分别为7.4和8.4个月.2组比较差异无统计学意义(P＞0.05).结论 唑来膦酸能减少肺癌骨转移患者的首次SRE发生率,尤其减少骨放疗事件的发生.     

新辅助化疗在Ⅲ期非小细胞肺癌术前的应用评价

目的 评价分析新辅助化疗在Ⅲ期非小细胞肺癌术前应用的效果和安全性。方法 选择本科收治的Ⅲ期非小细胞肺癌患者45例,术前进行2周期新辅助化疗后手术（观察组）和同时期的不同意行新辅助化疗而直接手术的Ⅲ期非小细胞肺癌患者45例为对照组,对两组手术切除率、3年生存率和并发症发生率进行比较。结果 观察组患者手术切除率显著高于对照组,比较差异具有统计学意义（P〈0.01）;观察组患者3年生存率高于对照组,比较差异具有统计学意义（P〈0.05）;观察组并发症发生率15.6%,对照组并发症发生率17.8%,比较差异无统计学意义（P〉0.05）。结论 Ⅲ期非小细胞肺癌术前应用新辅助化疗具有提高手术切除率和术后生存率的优势,同时是安全可靠的。     

康莱特联合全身化疗对老年晚期非小细胞肺癌的疗效观察

目的观察康莱特联合全身化疗对治疗老年晚期非小细胞肺癌（non small cell lung cancer,NSCLC）的治疗效果。方法将老年晚期非小细胞肺癌60例患者随机分为观察组30例,对照组30例。观察组采用康莱特联合化疗药物治疗,对照组单用化疗药物治疗,比较2组疗效。结果观察组临床总有效率明显高于对照组,二者差异有统计学意义（P〈0.05）。观察组Ⅱ～Ⅲ度不良反应率26.67%,明显低于对照组60.0%,差异有统计学意义（P〈0.01）。治疗前后Karnofsky（KPS）评分观察组明显高于对照组（P〈0.01）。结论康莱特联合化疗药物治疗老年晚期非小细胞肺癌优于单纯化疗药物治疗老年晚期非小细胞肺癌,值得临床推广应用。     

替吉奥联合多西他赛治疗晚期非小细胞肺癌效果观察

目的：观察替吉奥联合多西他赛治疗晚期非小细胞肺癌的疗效及其不良反应。方法将本院肿瘤科收治的100例Ⅲ/Ⅳ期非小细胞肺癌患者随机分为观察组和对照组。观察组用替吉奥联合多西他赛治疗,对照组仅采用替吉奥治疗,观察两组的临床疗效及不良反应。结果治疗后,观察组的有效率及疾病控制率分别为48.0%（24/50）、84.0%（42/50）,1年生存率为72.0%（36/50）;对照组的有效率及疾病控制率分别为22.0%（11/50）、60.0%（30/50）,1年生存率为48.0%（24/50）,组间差异有统计学意义。两组患者均出现轻度或中度不良反应,但不良反应发生率差异无统计学意义。结论替吉奥联合多西他赛治疗晚期非小细胞肺癌疗效较好,有助于延长患者的生存时间。     

三维适形放疗治疗晚期非小细胞肺癌的临床疗效观察

目的探讨三维适形放疗治疗晚期非小细胞肺癌的临床疗效。方法将我院2010年1月至2012年6月间收治的92例晚期非小细胞肺癌患者随机分为常规放射治疗组（对照组）和三维适形放射治疗组（观察组）,每组各46例,观察两组患者的近期疗效及毒副反应。结果观察组患者的临床疗效总有效率为76.1%,显著高于对照组患者的54.3%,组间差异有统计学意义（P＜0.05）。观察组患者治疗后毒副反应发生率为28.3%,显著低于对照组患者的63.0%,组间差异有统计学意义（P＜0.05）。结论采用三维适形放疗治疗晚期非小细胞肺癌临床疗效好,毒副反应发生率低,值得临床进一步推广使用。     

NH与NP方案治疗非小细胞肺癌疗效比较分析

目的：设计异长春花碱（N）和羟基喜树碱（H）联合化疗（NH）方案治疗非小细胞肺癌，并与NP方案进行随机分组比较，评价NH方案治疗非小细胞肺癌的疗效和不良反应。方法：48例不能手术或术后复发转移的非小细胞肺癌患者随机分为NH方案组和NP方案组。结果：4周期后评价疗效，两组有效率比较差异无显著性（P〉0．05）；NH组Ⅲ～Ⅳ度血液毒性反应2例（8．4％），NP组10例（41．7％），两组比较差异有显著性（P〈0．01）；消化道反应两组发生率分别为，NH组Ⅲ～Ⅳ度2例（8．4％），NP组Ⅲ～Ⅳ度12例（50．0％），两组相比有显著差异（P〈0．01）。结论：NH方案是治疗非小细胞肺癌有效的方案，与NP方案相比，疗效略高而不良反应轻微，特别适合晚期、体弱、高龄患者．值得临床试用推广。     

培美曲塞、顺铂方案联合艾迪注射液治疗非小细胞肺癌的临床研究

目的观察培美曲塞＋顺铂联合艾迪注射液对非小细胞肺癌患者的疗效。方法观察组32例（肺鳞癌13例、肺腺癌19例,Ⅱ期7例,Ⅲa期8例,Ⅲb期11例,Ⅳ期6例）,对照组32例（肺鳞癌12例、肺腺癌20例,Ⅱ期7例,Ⅲa期8例,Ⅲb期10例,Ⅳ期7例）治疗结束对两组患者的有效率、疾病控制率、白细胞下降及Karnof-sky评分进行评价。结果观察组总有效率为62.5%,疾病控制率为84.3%;对照组总有效率为34.4%,疾病控制率为59.4%;治疗前后的白细胞总数下降在Ⅲ°以上发生率,观察组为12.5%;对照组为28.3%;Karnof sky评分：观察组改善者18例,稳定者8例,对照组改善者12例,稳定者7例;两组间差异有统计学意义（P〈0.05）。结论培美曲塞＋顺铂方案联合艾迪注射液对非小细胞肺癌患者有较良好的疗效。     

Brain metastases in metastatic non-small cell lung cancer responding to single-agent gefitinib: a case report

Brain metastases are a frequent finding in patients with non-small cell lung cancer (NSCLC). The present case reports the clinical course of a patient who was treated with gefitinib alone for progressive brain metastases after whole-brain irradiation treatment (WBRT). A 50-year-old women with primary stage IV NSCLC (bone metastases) developed brain metastases after 3 cycles of chemotherapy consisting of paclitaxel and carboplatin (CBDA). After completion of the WBRT, magnetic resonance imaging (MRI) indicated further progression. Two cycles of temozolomide and topotecan were applied; this was ineffective in preventing central nervous system progression. For symptomatic brain metastatic disease the patient received gefitinib as single-agent treatment. Within a few weeks of treatment there was an obvious clinical improvement. Follow-up of the brain 2 months after the start of treatment showed a decrease in both the size and number of brain metastases. Additional manifestations in the lungs and the skeletal system were re-assessed as stable disease during the treatment with gefitinib. Within 4 months of treatment there were no side-effects such as skin rash or any other systemic toxicity. Gefitinib may therefore have a role in the treatment of brain metastases from NSCLC.     

Targeting angiogenesis for treatment of NSCLC brain metastases

Lung cancer is the leading cause of cancer-related mortality worldwide, and non-small cell lung cancer (NSCLC) accounts for about 85% of all new lung cancer diagnosis. The majority of people with NSCLC are unsuitable for surgery since most patients have metastatic disease at diagnosis. About 60% of brain metastases arise from lung cancer. Therapeutic approaches to brain metastases include surgery, whole brain radiotherapy (WBRT), stereotactic radiosurgery, chemotherapy and new biologic agents. Angiogenesis is essential for the development and progression of cancer, and vascular endothelial growth factor (VEGF) is a critical mediator of tumour angiogenesis. One of the targeted approaches most widely studied in the treatment of NSCLC is the inhibition of angiogenesis. Bevacizumab, an anti-VEGF recombinant humanized monoclonal antibody, is the first targeted agent which, when combined with chemotherapy, has shown superior efficacy versus chemotherapy alone as first-line treatment of advanced non-squamous NSCLC patients. Patients with central nervous system (CNS) metastases have initially been excluded from bevacizumab trials for the risk of cerebral haemorrhage as a result of the treatment. Nevertheless, the available data suggest an equal risk of intracranial bleeding in patients with CNS metastases treated with or without bevacizumab therapy. Several other anti-angiogenetic drugs are being investigated in the treatment of advanced NSCLC patients, but results of their activity specifically in CNS metastases are still lacking. This review will focus on the potential role of bevacizumab and other anti-angiogenetic agents in the treatment of brain metastases from NSCLC.     

Zoledronic acid: a review of its use in the management of bone metastases and hypercalcaemia of malignancy

Zoledronic acid (Zometa) is an effective inhibitor of osteoclast-mediated bone resorption. Zoledronic acid demonstrated efficacy in the reduction of skeletalrelated events (SREs) in patients with multiple myeloma or bone metastases secondary to breast cancer, prostate cancer or other solid tumours, or hypercalcaemia of malignancy. Zoledronic acid was effective in patients with multiple myeloma or metastatic breast cancer with osteolytic or mixed bone lesions. The proportion of patients who experienced an SRE was similar during 12 months of treatment with zoledronic acid 4mg or pamidronic acid 90mg, but significantly fewer patients receiving zoledronic acid required radiotherapy to bone. Furthermore, in patients with breast cancer and osteolytic lesions, median time to a first SRE was more than 4 months longer with zoledronic acid than with pamidronic acid. In the multiple event analysis in a 12-month extension study (total study duration was 25 months) in patients with breast cancer, zoledronic acid was superior to pamidronic acid, with an 18% reduction in the risk of experiencing an SRE. Both drugs were associated with a slight reduction in pain. Zoledronic acid 4mg, compared with placebo, significantly reduced the proportion of patients with prostate cancer bone metastases experiencing an SRE, particularly pathological fractures after 15 months' treatment. The drug also significantly delayed the onset of skeletal complications compared with placebo in patients with prostate cancer and other solid tumours including non-small cell lung cancer. When administered as a single 15-minute intravenous infusion, zoledronic acid 4mg was significantly more effective than pamidronic acid administered as a 2-hour infusion in the treatment of severe hypercalcaemia of malignancy, as assessed by complete responses measuring normalised serum calcium concentrations at day 10 after a single dose. Furthermore, zoledronic acid normalised serum calcium concentrations significantly faster than pamidronic acid, and the duration of response and median time to relapse were approximately twice as long in zoledronic acid recipients than in pamidronic acid recipients. Zoledronic acid is well tolerated and has a similar tolerability profile to pamidronic acid. The most commonly reported adverse events included flu-like symptoms (fever, arthralgias, myalgias and bone pain), fatigue, gastrointestinal reactions, anaemia, weakness, dyspnoea and oedema. CONCLUSION: In conjunction with antitumour therapy, zoledronic acid should be considered for routine use to reduce skeletal complications in patients with advanced malignancies involving bone. In patients with hypercalcaemia of malignancy, zoledronic acid is expected to become the treatment of choice.     

Assessing pharmacological interventions for bone metastases: the need for more patient-centered outcomes

Bone metastases are associated with a broad spectrum of clinical sequelae. Pain, reduced mobility, skeletal complications and treatment-related events reduce quality of life. Numerous randomized controlled trials have evaluated pharmacological interventions to treat bone metastases. The primary outcomes used have evolved over the past 25 years; from improvement in pain to time to first skeletal-related event (SRE). In the current definition, a SRE consists of pathological fracture, spinal cord compression or the need for radiotherapy or surgery to the bone. Currently used outcomes can detect small differences between interventions. However, there are several limitations to SRE-related outcomes. In this article we illustrate the evolution of outcomes used in randomized controlled trials, critically appraising current outcomes used and proposing that more patient-centered outcomes are needed.     

射频联合紫衫醇＋卡铂方案治疗晚期非小细胞肺癌的临床观察

目的：观察多极射频消融（RFA）联合紫衫醇＋卡铂方案（PC）治疗晚期非小细胞肺癌（NSCLC）的临床效果。方法：30例晚期NSCLC（Ⅲ、Ⅳ期）采用RFA联合PC方案治疗,并与28例单纯PC方案化疗进行比较。结果：以疗效、生活质量评分及生存时间等指标评价,RFA联合PC方案治疗组明显优于单纯PC方案化疗组,疗效差异有显著意义,P〈0.01。结论：RFA联合PC方案化疗明显提高晚期NSCLC治疗效果,可作为晚期NSCLC的综合治疗方法。     

非小细胞肺癌中E-CD、CD44v6的表达和IMVD临床病理意义

目的：探讨非小细胞肺癌中E-CD、CD44v6表达与CD105标记瘤内微血管密度（IMVD）的关系及意义.方法：用免疫组化技术Envision方法检测E-CD、CD44v6与CD105在60例非小细胞肺癌中的表达水平,并用CD105测量IMVD.结果：E-CD和CD44v6与肺癌的TNM分期和淋巴结转移均密切相关（均P＜0.05或P＜0.01）.E-CD与其血管转移密切相关（P＜0.05）.E-CD和CD44v6有相关性（P＜0.01,Pearson列联系数r=0.66）.CD105-IMVD与肺癌的淋巴结和血管转移均密切相关（均P＜0.01）.E-CD正常表达患者的CD105-IMVD小于其异常表达者（P＜0.01）,CD44v6正常表达患者的CD105-IMVD明显大于其异常表达者（P＜0.01）.结论：E-CD、CD44v6的表达程度和CD105-IMVD均与非小细胞肺癌的生物学特性密切相关,对判断预后和指导治疗具有实用价值.     

磷酸丝氨酸转氨酶1在非小细胞肺癌中的表达水平和预后关系分析

目的 探讨磷酸丝氨酸转氨酶1 (phosphoserine aminotransferase 1,PSATl)在非小细胞肺癌组织中的表达水平,并分析PSAT1表达与非小细胞肺癌预后的相关性.方法 选择2013年12月-2015年10月确诊的非小细胞肺癌患者89例为观察组,同期25例肺良性病变患者为对照组.分别采用实时荧光定量PCR和免疫组织化学法检测和比较两组PSAT1 mRNA表达水平和蛋白阳性表达率;并分析PSAT1表达与患者病理特征的关系.结果 观察组PSAT1 mRNA和蛋白阳性表达率显著高于对照组(P＜0.05).PSAT1蛋白表达与肿瘤分化程度、TNM分期以及是否淋巴结转移有相关性(P＜0.05);而与患者的性别、年龄和肿瘤大小无相关性(P＞0.05).结论 PSAT1在非小细胞肺癌组织中呈过表达状态,检测PSAT1的水平对预测非小细胞肺癌进程及患者预后有重要意义.     

非小细胞肺癌患者ERCC1蛋白表达及与预后的关系

目的探讨DNA切除修复交叉互补组1（ERCC1）蛋白在非小细胞肺癌（NSCLC）中的表达与临床预后的关系。方法采用免疫组织化学Envision法检测90例NSCLC组织中ERCC1表达。结果 NSCLC组织ERCC1总阳性率为45.55%（41/90）,与癌旁组织比较的差异有统计学意义（P〈0.003）。ERCC1表达及强度与患者年龄、性别、肿瘤大小、组织学类型、淋巴结转移和临床分期无明显关系（P〉0.05）。临床Ⅱ期以上ERCC1阳性表达者生存率低于阴性表达者（P=0.004）。临床Ⅰ期ERCC1阳性表达者生存率高于阴性表达者,但差异无统计学意义。结论 ERCC1蛋白表达可作为临床Ⅱ期以上NSCLC患者预后的评估指标。     

流式细胞技术检测非小细胞肺癌肋骨骨髓微转移

目的 流式细胞技术检测非小细胞肺癌骨髓微转移,研究其与病理学因素及术后转移率的关系,探讨非小细胞肋骨骨髓微转移临床检测的价值。方法 选取2004年3月至2007年5月手术治疗的患者非小细胞肺癌病例158例,术中抽取肋骨骨髓,应用流式细胞技术,检测骨髓中阳性细胞表达率。结果 158例非小细胞肺癌患者59例出现骨髓微转移,...