洛铂联合足叶乙甙治疗晚期小细胞肺癌的临床研究

目的观察评价新一代铂类抗癌药物洛铂（LBP）联合足叶乙甙（VP-16）组成的LE方案治疗晚期小细胞肺癌（SCLC）的有效性和安全性。方法26例经病理组织学和／或细胞学检查确诊SCLC,均为初治患者,其中男性22例,女性4例;年龄42～74岁,中位年龄61岁,TNM分期：ⅢA11例,ⅢB6例,Ⅳ期9例。应用LE方案,即LBP30mg／m^2静滴d1;VP-16100mg静滴d1～5;21～28d为一周期,至少接受2个周期化疗。按照WHO标准评价客观疗效和毒性。结果26例患者中,可评价疗效的患者有25例。其中CR3／25,PR20／25,NC2／25,有效率（RR）92．0％。主要毒性反应为可逆性的骨髓抑制和胃肠道反应。结论LBP联合VP-16组成LE方案治疗SCLC疗效好,毒性反应可以耐受,值得进一步研究观察。     

An analysis of the outcomes of treatment of small cell lung cancer in the elderly

Abstract Background: Many cases of small cell lung cancer will occur in the elderly population but optimal management of the disease in this age group remains uncertain.
Aims: To evaluate treatment of small cell lung cancer in the elderly in Australia and to compare treatment received and outcomes with those of younger patients. To draw insights from these observations into the optimal management of small cell lung cancer in the elderly.
Methods: A retrospective review of treatment charts and case notes for 51 elderly patients and 102 younger patients was undertaken.
Results: Elderly patients had similar baseline parameters with respect to disease stage and performance status. Elderly patients were mostly treated uniformly with combination chemotherapy, but suffered more dose reductions than younger patients. Benefits of chemotherapy were seen even in patients with poor performance status. Despite the dose reductions, response rates and survival times for elderly patients were usually similar to younger patients.
Conclusions: Combination chemotherapy is beneficial to elderly patients with small cell lung cancer. Optimal therapy for the elderly may be different from that for younger patients and should be defined through prospective randomised clinical trials.     

Ghrelin and cancer

Ghrelin is a peptide hormone that was originally isolated from the stomach as the endogenous ligand for the growth hormone secretagogue receptor (GHSR). Ghrelin has many functions, including the regulation of appetite and gut motility, growth hormone release from the anterior pituitary and roles in the cardiovascular and immune systems. Ghrelin and its receptor are expressed in a number of cancers and cancer cell lines and may play a role in processes associated with cancer progression, including cell proliferation, apoptosis, and cell invasion and migration.     

紫杉醇+顺铂二线治疗小细胞肺癌38例临床观察

目的 研究紫杉醇+顺铂二线治疗复治小细胞肺癌患者的疗效和毒副反应.方法 纳入一线含铂方案(依托泊苷+卡铂)化疗失败患者38例,采用紫杉醇135 mg/m2,第1天;顺铂70 mg/m2,第1～3天,每3～4周为1个周期,连用2～4个周期.结果 部分缓解12例,稳定14例,进展12例,总有效率31.6％(12/38),疾病控制率68.4％(26/38),总生存期10.5个月,中位生存期6.8个月.化疗敏感者有效率39.3％(11/28);化疗耐药者有效率10.0％(1/10).本组38例均可评价毒副反应,Ⅲ度以上白细胞及中性粒细胞减少分别为47.4％(18/38)、57.9％(22/38).Ⅳ度中性粒细胞减少15.8％(6/38).中性粒细胞减少性发热10.5％(4/38).主要非血液学毒副反应是乏力、恶心呕吐、周围神经毒性,Ⅲ度以上毒性反应是乏力55.3％(21/38)、恶心呕吐31.6％(12/38).结论 紫杉醇+顺铂治疗复治小细胞肺癌有效且毒副反应可耐受.     

EARLY CROSSOVER OF INDUCTION CHEMOTHERAPY IN SMALL CELL LUNG CARCINOMA

The aim of this trial was to assess whether early crossover induction chemotherapy would improve the complete response rate in patients with small cell lung carcinoma. Tumour markers were defined in all 48 patients at diagnosis. The patients were reassessed after three and six cycles of chemotherapy and classified as having either complete, partial or non response of tumour on each occasion. Initial induction therapy consisted of cyclophosphamide, vincristine and adriamycin (T1). The therapy of the patients with no tumour response was changed to a regimen (T2) consisting of VP16-213, procarbazine, CCNU and high dose methotrexate with folinic acid rescue. The patients with partial tumour response were randomised to receive either T1 or T2, while patients with complete tumour response continued with T1. In those patients classified initially as having partial tumour response, crossover chemotherapy did not improve tumour response or survival. Similarly, in patients with no tumour response there was not an acceptable improvement. We conclude that non cross resistant crossover chemotherapy using these drug regimens confers no added benefit when compared with continuing the initial therapy.     

B7-H3在小细胞肺癌中的表达及其与患者预后的关联性研究

［摘要］　目的　探讨B7-H3在小细胞肺癌（SCLC）中的表达水平及其与患者预后的关联性。方法　收集2010年1月至2019年7月于首都医科大学附属北京胸科医院经外科手术切除的SCLC组织标本34份,并收集标本来源患者的病历资料和随访资料。采用免疫组化方法检测SCLC组织B7-H3的表达情况,并分析其表达水平与患者临床特征的关联性。结果　B7-H3高表达14例（41.18%）,B7-H3低表达20例（58.82%）。B7-H3表达阳性26例（76.47%）,表达阴性8例（23.53%）。B7-H3高表达组淋巴结转移比例及淋巴结转移数目高于B7-H3低表达组,差异有统计学意义（P<0.05）,两组性别、年龄、吸烟比例比较差异无统计学意义（P>0.05）。B7-H3表达与微血管密度（MVD）评分之间存在一致性（Kappa=0.339,P=0.048）。B7-H3高表达组MVD评分高于B7-H3低表达组,差异有统计学意义（t=3.784,P=0.001）。B7-H3高表达组的中位总生存期短于B7-H3低表达组（13.8个月 vs 23.5个月）,两组生存预后比较差异有统计学意义（log-rank检验： χ²=3.873,P=0.049）。结论　B7-H3在SCLC组织中有不同程度表达,B7-H3高表达与淋巴结转移、不良预后相关,有可能成为SCLC治疗的潜在靶标。     

Biology and clinical use of GM-CSF in lung cancer

Administration of granulocyte macrophage colony-stimulating factor (GM-CSF) has been shown to induce an increase in production of neutrophils, monocytes, and eosinophils. This is reflected in an accelerated recovery of myelopoiesis following cytotoxic chemotherapy and radiation. Human trials completed so far have used patients with many tumor types. It was clearly demonstrated that the leukocyte responses are dose and schedule dependent and that the route of factor administration is important. The results of clinical trials suggest that the acute toxicity of cytotoxic chemotherapy may be decreased. This may result in a higher dose of drugs or in a reduction of treatment interval, and it may increase the rate of complete remissions and the number of patients with long-term disease free survival, particularly in small cell lung cancer. However, up to now a definitive statement as to the value of this supportive treatment in solid tumor chemotherapy is not possible.     

Combination therapy with carboplatin and paclitaxel for small cell lung cancer

Background

Although small cell lung cancer (SCLC) is an aggressive cancer, few useful treatment options exist after relapse. Information concerning the efficacy and safety of carboplatin plus paclitaxel in patients with SCLC is limited.

Long-term survival in small cell lung cancer patients is correlated with high interleukin-2 secretion at diagnosis

Purpose: We have previously reported significant impairment of IL-2 secretion in patients with small cell lung cancer (SCLC) at the time of diagnosis. Impairment of IL-2 secretion correlated with reduced survival in SCLC. This new prognostic factor was independent of other factors of prognostic relevance in SCLC. The prognostic value of IL-2 secretion was comparable to the most predominant prognostic factors for survival in SCLC identified so far. We now report long-term survival data from these patients. Methods: The significance of correlations between single parameters in the test groups was calculated by using linear regression analysis, the Wilcoxon rank sum test, and Fisher's exact test. Using the Kaplan-Meier method, the log-rank test and the Cox regression model, we analyzed the relation of IL-2 secretion in whole blood cell cultures from 52 patients with SCLC at the time of diagnosis to established prognostic factors relevant for survival in SCLC. Results: IL-2 secretion correlates with survival in SCLC. In addition, survival analysis according to tumor response and level of IL-2 secretion at the time of diagnosis demonstrates that long-term survival can only be observed after complete response to chemotherapy and high initial IL-2 secretion. Conclusions: IL-2 secretion at the time of diagnosis represents an independent prognostic factor for survival in SCLC. Moreover, long-term survival is only observed in patients with complete response upon chemotherapy that showed high IL-2 secretion at diagnosis. Therefore, IL-2 secretion may partially define long-term survival in this disease. These results have to be confirmed in a larger patient population. Received: 7 February 1999 / Accepted: 12 May 2000     

Prediction and prognostic factors of post-recurrence survival in recurred patients with early-stage NSCLC who underwent complete resection

Background

This study aimed to evaluate prognostic factors of post-recurrence survival (PRS) and to improve survival in recurred patients with early-stage non-small cell lung cancer (NSCLC).

Methods

The 141 patients with recurrence after complete resection of stage I and II NSCLC between 1995 and 2012 was retrospectively reviewed. Overall PRS and PRS of the patient groups stratified according to the sum of their own risk scores were analyzed.

Results

The patterns of recurrence of 141 patients included local only in 40(28.4%), distant only in 86 (61%) and both in 15 (10.6%) patients. Of 141 patients, 110 patients received post-recurrence therapy. The overall 1- and 3-year PRS rates were 50.7% and 28.4%, respectively. Extensive pulmonary resection (P=0.001), poor histologic differentiation (P=0.009), symptom at initial recurrence (P=0.000), no pulmonary metastasis (P=0.006), no post-recurrence therapy (P=0.001) were significant risk factors in univariate analysis. Multivariate analysis revealed that extent of pulmonary resection [hazard ratio (HR), 2.039; 95% confidence interval (CI), 1.281 to 3.244; P=0.003; risk score 1.0], histologic differentiation HR, 3.125; 95% CI, 1.976 to 4.941; P=0.000; risk score 1.5), symptom (HR, 3.154; 95% CI, 2.000 to 4.972; P=0.000; risk score 1.5) and post-recurrence therapy (HR, 2.330; 95% CI, 1.393 to 3.899; P=0.001; risk score 1.1) were significant prognostic factors. The recurred patients whose risk score sums were 1.1 or less were assigned to Group I; between 1.5 and 2.1, to Group II; and more than 2.5, to Group III. Significant differences in their PRS rates were confirmed (P=0.000).

Conclusions

Extent of pulmonary resection, histologic differentiation, symptom and post-recurrence therapy are a prognostic factor for PRS. Based on the hazard ratios of each factors, the risk scores were yielded. And the recurred patients were stratified according to the sum of their risk scores based on their PRS rates. Therefore, these results may help advancements in making predictions for their prognosis and the improvement of PRS.     

164例小细胞肺癌术后预后分析

目的探讨术后小细胞肺癌（SCLC）生存率的影响因素。方法对经手术治疗后确诊为小细胞肺癌的164例患者进行长期随访,并对患者术后生存率有影响的因素进行分析。结果Ⅰ、Ⅱ与Ⅲ期1年、3年、5年生存率间差异有显著统计学意义（P〈0.05）;手术切除＋术后化疗组和单纯手术组比较,1年、3年生存率间差异有显著统计学意义（P〈0.01）,两组在TNM分期下Ⅰ、Ⅱ、Ⅲa期1年、3年、5年生存率间差异有显著统计学意义（P〈0.05）;术式（肺全切和肺叶切）、年龄（〈60岁和≥60岁）和性别（男性和女性）1年、3年、5年生存率间差异无显著意义（P〉0.05）。结论 TNM分期、术后有无化疗对患者术后生存率有明显影响。     

肿瘤标志物动态变化在肺癌疗效判断与随访中的意义

目的探讨癌胚抗原(carcino-embryonic antigen,CEA)、铁蛋白(ferritin,FRT)、糖类抗原125(carbohydrate antigen 125,CA125)、神经元特异性烯醇化酶(neuron specific enolase,NSE)和细胞角蛋19片段(cytokeratin19 fragment,CYFRA21-1)等5种血清学肿瘤标志物(tumor markers,TM)的动态变化在肺癌疗效判断与随访中的意义。方法选择唐都医院呼吸内科经治的170例中晚期肺癌患者,采用电化学发光免疫分析法检测CEA、FRT、CA125、NSE和CYFRA21-1等5种血清学TM,观察不同TM在肺癌治疗过程中的动态变化水平。结果治疗2周期后,CA125在各肺癌组、CYFRA21-1在鳞癌和腺癌及未分类癌、NSE在小细胞癌及神经内分泌癌、CEA在腺癌和未分类癌及神经内分泌癌、FRT在鳞癌治疗中呈下降趋势。结论血清TM水平的动态变化,在一定程度上反映肿瘤的活动情况及疗效,可用于肺癌疗效判断与随访。     

非小细胞肺癌患者EGFR、ALK基因突变及临床病理特征与预后的相关性研究

目的 探讨非小细胞肺癌(NSCLC)患者EGFR、ALK基因突变状态及病理特征,分析二者与患者预后情况相关性.方法 收集2015年1月至2018年1月苏州大学附属第一医院病理确诊的NSCLC病例262例,记录患者临床病理特征及转归,采用突变增阻滞系统(ARMS)-Taqman探针法及RT-PCR检测患者肿瘤样本的EGF...