局部晚期非小细胞肺癌诱导化疗后同期放化疗与同期放化疗疗效及安全性Meta分析

目的 不可手术局部晚期非小细胞肺癌经诱导化疗后同期放化疗的获益情况尚缺乏证据.本研究通过对比不可切除局部晚期非小细胞肺癌经诱导化疗后同期放化疗与同期放化疗2种治疗模式下的疗效及安全性,望寻求对局部晚期非小细胞肺癌更有效的治疗方法,为临床治疗手段提供理论依据.方法 计算机检索The Cochrane Library、PubMed、Embase、Web of Science、CBM和CNKI,同时辅佐其他检索途径,搜集2016-06前所有关于局部晚期非小细胞肺癌诱导化疗后同期放化疗与同期放化疗治模式的随机对照试验(randomized controlled clinical study,RCT).质量评价参考2008年Cochrane质量评价标准,统计学分析应用Review Manager 5.2软件.结果 共纳入11个RCT.诱导化疗后同期放化疗与同期放化疗治模式总有效率差异无统计学意义,OR=1.30,95％CI为0.96～1.77,P=0.10;1(OR=1.51,95％CI为0.97～2.43,P=0.07)和2(OR=1.34,95％CI:1.00～1.79,P=0.05)年生存率差异无统计学意义,3年生存率差异有统计学意义,OR=1.43,95％CI:1.02～2.01,P=0.04;Ⅲ～Ⅳ级不良反应中,放射性食管炎(OR=1.96,95％CI:1.06～3.62,P-0.03)和白细胞降低(OR=1.84,95％CI:1.24～2.74,P=0.002)差异有统计学意义,放射性肺炎(OR=1.31,95％CI:0.62～2.77,P=0.48)和恶心呕吐(OR=1.46,95％CI:0.82～2.59,P=0.19)差异无统计学意义.结论 诱导化疗后同期放化疗组Ⅲ～Ⅳ级放射性食管炎、放射性肺炎及白细胞降低发生率较同期放化疗组增多,但无毒性相关死亡,而诱导化疗组3年生存率较同期放化疗组提高,可考虑为临床应用.     

多西他赛加顺铂诱导化疗联合同期放化疗局部晚期非小细胞肺癌的临床观察

目的 评价TP方案诱导化疗联合同期放化疗局部晚期非小细胞肺癌的近期疗效和不良反应。方法 病理证实的局部晚期非小细胞肺癌86例,随机分成同期放化疗联合TP方案诱导化疗(ICCRT) 组和单纯同期放化疗(CCRT) 组。放疗均采用调强放疗。治疗结束后比较两组疗效、生存率和不良反应。结果 86例患者的随访率为100%。ICCRT组和CCRT组的有效率分别为80%和70%(χ²=1.26,P=0.261),1、2、3年总生存率分别为85%和65%、50%和40%、44%和33%(χ²=3.90,P=0.048),主要不良反应白细胞减少(43例和32例,χ²=3.48,P=0.062)、放射性食管炎(26例和20例,χ²=0.12,P=0.730)、血红蛋白减低(26例和16例,χ²=2.34,P=0.126)和放射性肺炎(13例和9例,χ²=0.37,P=0.541)。结论 ICCRT能明显提高局部晚期非小细胞肺癌的总生存率,且与CCRT相比并不增加局部不良反应。     

局部晚期非小细胞肺癌同期放化疗研究进展

放化综合治疗是局部晚期非小细胞肺癌(NSCLC)的基本治疗策略.近期研究表明同期放化疗在生存率等方面优于序贯治疗,已成为局部晚期NSCLC的标准治疗模式,但是尚无具体放化结合模式指导临床治疗.为了进一步提高治疗疗效,目前临床研究主要集中于以下几个方面:同期放化治疗加入诱导或巩固化疗、同期放化疗中放疗分割方式的改变、同期放化疗中化疗方式及方案的选择、同期放化疗加入分子靶向治疗.     

诱导化疗联合三维适形放射治疗对局部晚期非小细胞肺癌治疗的临床研究

目的:评价诱导化疗加三维适形放射治疗(3DCRT)治疗局部晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的疗效及并发症。方法:经病理细胞学确诊的35例局部晚期NSCLC患者,采用在3DCRT治疗前给予2~4个周期多西他赛75mg/(m2·d),21d为1个周期的化疗。结果:中位总生存期18个月,1年生存率为71·4%,2年生存率为37·1%。毒副反应患者能耐受。结论:诱导化疗加三维适形放疗治疗晚期NSCLC可延长生存期,但并不增加放射不良反应。     

三维适形放疗联合诱导化疗和紫杉醇同期化疗不能手术Ⅲ期非小细胞肺癌的疗效分析

目的 观察诱导化疗和三维适形放疗(3DCRT)联合每周紫杉醇治疗非小细胞肺癌(NSCLC)的疗效及毒性.方法 56例不能手术的Ⅲ期NSCLC患者予紫杉醇(175 mg/m2第1天)加卡铂(AUC=5～6第1天)诱导化疗2～4个疗程,化疗后3～4周内开始3DCRT,剂量在满足V20≤31%,脊髓≤50 Gy的条件下给予尽可能高(平均60.75 Gy),联合每周紫杉醇40 mg/m2同期化疗.结果 同期放化疗期间,3例因3+4级放射性肺炎,1例因3级心脏毒性终止治疗,2例因身体虚弱分别中断治疗7、12 d,其余均按计划完成治疗.白细胞下降发生率为58.9%(1例为3级,余为1、2级),3级淋巴细胞下降发生率达75.O%.主要急性毒性为放射性食管炎和放射性肺炎,≥2级发生率分别为38%和25%.放射性食管炎3级3例,放射性肺炎3级2例,4级1例.2、3、4级晚期食管损伤各1例,肺纤维化2级9例.肺原发灶总有效率为69.7%.1年生存率分别为72.3%,1年局部无进展生存率为62.7%.局部复发率为32.1%,远处转移率为39.3%,远处转移与局部复发仍是死亡的主要原因.结论 诱导化疗后3DCRT结合每周紫杉醇治疗局部晚期NSCLC耐受性较好,近期疗效好,远期疗效有待继续观察.     

氩氦刀联合放化疗方案治疗中晚期非小细胞肺癌的Meta分析

目的 评价氩氦刀联合放化疗治疗中晚期非小细胞肺癌（NSCLC）的有效性和安全性。方法 计算机全面检索The Cochrane Library、Pub Med、EMBASE、中国生物医学文献数据库、中国期刊全文数据库、维普中文科技期刊全文数据库和万方数字化期刊全文数据库中有关氩氦刀联合放化疗对比放化疗或单一疗法治疗中晚期NSCLC的随机对照试验（randomized controlled trials,RCTs）和对照试验,时间截止2014年7月16日。由2位研究者逐篇评价纳入研究的质量、提取数据并交叉核对,采用Rev Man 5.2软件进行数据处理。结果 共纳入6篇RCTs和10篇对照试验,共1 727例患者。Meta分析结果显示,与单纯氩氦刀方案比较,氩氦刀联合化疗方案在近期疗效和1、2、3年总体生存率上差异无统计学意义（P〉0.05）;与单纯化疗比较,氩氦刀联合化疗能提高中晚期NSCLC患者的近期疗效和临床受益率（OR=3.02,95%CI：1.91-4.77,P〈0.00001;OR=3.18,95%CI：1.72-5.89,P=0.0002）,可以提高中晚期NSCLC患者的1、2年总体生存率（OR=1.99,95%CI：1.23-3.20,P=0.005;OR=27.89,95%CI：1.57-494.62,P=0.02）;与单纯氩氦刀比较,氩氦刀联合放疗方案能有效提高中晚期NSCLC患者1年的总体生存率（OR=1.77,95%CI：1.03-3.06,P=0.04）;与放化疗方案比较,氩氦刀联合放化疗方案能使患者的生存质量得到改善（OR=3.34,95%CI：1.53-7.29,P=0.002）。结论 与单纯化疗比较,氩氦刀联合化疗能提高有效性并且安全性较好。与单纯氩氦刀比较,氩氦刀联合放疗能提高有效性。与放化疗比较,氩氦刀联合放化疗能改善患者的生活质量。     

SBRT对比手术治疗Ⅰ期可手术切除NSCLC系统评价

目的 系统评价SBRT对Ⅰ期可手术切除NSCLC患者的有效性和安全性。方法 计算机检索Cochrane图书馆、MEDLINE、EMbase、中国生物医学文献数据库、中国期刊全文数据库和万方数据库,收集SBRT与手术治疗Ⅰ期可手术切除NSCLC的临床试验,由2名评价员按照纳入与排除标准选择文献、评价质量和提取资料,对符合纳入标准的研究用 RevMan 5.3软件进行 Meta分析。结果 共纳入4个临床试验,410例患者。Meta分析结果显示SBRT与手术治疗3年OS率差异无统计学意义(RR=1.13,95%CI为0.66~1.94,P=0.66);两组LC率差异也无统计学意义(RR=0.71,95%CI为0.26~1.93,P=0.50);两组3—4级不良反应差异有统计学意义(RR=0.29,95%CI为0.16~0.53,P=0.000),SBRT组3—4级不良反应较手术组少。结论 SBRT已显示出其治疗Ⅰ期可手术切除NSCLC患者的手术等效性,但该系统评价存在一定局限性,尚需进一步大样本临床随机对照试验进行证明。     

同步放化疗与序贯放化疗治疗67例局部晚期非小细胞肺癌的疗效比较

[目的]探讨同步放化疗及序贯放化疗治疗局部晚期非小细胞肺癌（NSCLC）的疗效及不良反应。[方法]67例局部晚期NSCLC患者分为同步放化疗组（35例）及序贯放化疗组（32例）。同步放化疗组采用紫杉醇40mg/m2,卡铂AUC=2,d1;3DCRT与化疗同时开始,每周1次。序贯放化疗组先行2个周期全身化疗：紫杉醇150mg/m2,卡铂AUC=6,d1,21d为1个周期;第42d开始行3DCRT。[结果]同步放化疗组及序贯放化疗组有效率分别为77%及56%,1年生存率分别为76%和66%,2年生存率分别为39%和32%,差异均无统计学意义（P〉0.05）。两组不良反应差异无显著性（P〉0.05）。同步放化疗组、序贯放化疗组局部复发率分别为20%（7/35）和31%（10/32）,差异有统计学意义（χ2=4.521,P=0.033）。[结论]同步放化疗治疗局部晚期NSCLC疗效较好,但有增加不良反应的可能。     

放疗联合长春瑞滨加顺铂同步或序贯化疗治疗Ⅲ期非小细胞肺癌的临床研究

为了比较放射治疗联合长春瑞滨（NVB）加顺铂（DDP）同步与序贯放化疗治疗Ⅲ期非小细胞肺癌（non-small cell lung cancer,NSCLC）的疗效及毒副反应,将55例Ⅲ期NSCLC患者随机分成2组,同步放化疗组（26例）：放疗第1天起即同时开始化疗。序贯放化疗组（29例）：入组后先予化疗2个疗程,再单独予放疗。结果：近期有效率（CR＋PR）同步放化疗组为76.9%（20/26）,序贯放化疗组为51.7%（15/29）,P=0.0456。1、2年生存率同步放化疗组为69.2%（18/26）、42.3%（11/26）,序贯放化疗组为51.7%（15/29）、17.2%（5/29）。2年生存率差异有统计学意义,P=0.041。同步放化疗组白细胞下降与放射性食管炎较序贯放化疗组严重,P〈0.05;但经治疗后,患者大多能耐受。初步研究结果提示,放射治疗联合NVB加DDP同步放化疗治疗Ⅲ期NSCLC的疗效优于序贯放化疗,不良反应增大但可耐受,值得进一步研究。     

吉西他滨增敏同期放疗局部晚期非小细胞肺癌的临床观察

目的：评价吉西他滨作为放疗增敏剂联合同期放疗治疗局部晚期非小细胞肺癌（NSCLC）的近期疗效和急性毒副反应.方法：同期放化组：42例采用吉西他滨化疗增敏同期联合放疗治疗不能手术切除的局部晚期（Ⅲ期）NSCLC患者,放疗同期第1、8、15、22、29、36天在放疗前4 h给予400 mg/m^2吉西他滨化疗,放射治疗采用6/15 MV X线,每次2 Gy/ d,5次/周,原发灶50 Gy后缩野加量,DT 60～70 Gy;有锁骨上淋巴结转移者,给予X线和电子线混合照射至DT 60～66 Gy.单纯放疗组：40例放射治疗方法与同期放化组相同.结果：同期放化组与单纯放疗组肺原发灶有效率分别为90.5%（38/42）和70.0%（28/40）,P=0.039;纵隔淋巴结转移灶有效率分别为90.5%（38/42）和82.5%（33/40）,P＞0.05;中位生存期分别为12.6和10.3个月,两组急性毒副反应主要为骨髓抑制、胃肠道反应、放射性食管炎、放射性肺炎和肝功能受损等,经处理后均可耐受.结论：吉西他滨化疗同期联合放疗局部晚期NSCLC与单纯放疗的比较,近期疗效有提高,急性毒副反应增加不明显,可耐受,吉西他滨有放疗增敏作用.     

大分割同期放化疗对局限期SCLC临床价值的Meta分析

目的:应用Meta分析评估大分割同期放化疗在局限期小细胞肺癌(limited disease small-cell lung cancer,LD-SCLC)中的价值。方法:检索中国生物医学文献数据库、中国学术期刊全文数据库、Cochrane Library、PubMed、Medline、Web of science、Embase 国内外数据库有关局部局限期SCLC患者大分割同期放化疗与常规分割/超分割同期放化疗对比的文献,依据入选和排除标准收集各项研究的近期疗效及生存情况，应用Meta分析方法评价大分割同期放化疗的临床疗效。结果:纳入符合标准的国内外文献5篇，共包括837例患者。大分割放疗与常规或超分割放疗相比，无进展生存时间相似(P=0.95)；大分割放疗可延长局限期小细胞肺癌患者的总生存期(P=0.03)；同时，大分割放疗不增加急性放射性食管炎和肺炎的发生率（RR=0.95，95%CI:0.63~1.42，P=0.79；RR=0.77，95%CI:0.39~1.51，P=0.44）。结论:大分割较常规分割/超分割同步放化疗延长总生存时间，不增加毒性，可作为局限期小细胞肺癌治疗的选择模式。     

βV-tubulin expression is associated with outcome following taxane-based chemotherapy in non-small cell lung cancer

Background:Tubulin-binding agents (TBAs) are effective in non-small cell lung cancer (NSCLC) treatment. Both βIII- and βV-tubulins are expressed by cancer cells and may lead to resistance against TBAs.Methods:Pre-treatment samples from 65 locally advanced or oligometastatic NSCLC patients, who underwent uniform induction chemotherapy with paclitaxel and platinum followed by radiochemotherapy with vinorelbine and platinum were retrospectively analysed by immunohistochemistry. Protein expression of βIII- and βV-tubulin was morphometrically quantified.Results:Median pre-treatment H-score for βIII-tubulin was 110 (range: 0-290), and 160 for βV-tubulin (range: 0-290). Low βIII-tubulin expression was associated with improved overall survival (OS) (P=0.0127, hazard ratio (HR): 0.328). An association between high βV-tubulin expression and prolonged progression-free survival (PFS, median 19.2 vs 9.4 months in high vs low expressors; P=0.0315, HR: 1.899) was found. Further, high βV-tubulin expression was associated with objective response (median H-score 172.5 for CR+PR vs 120 for SD+PD patients, P=0.0104) or disease control following induction chemotherapy (170 for CR+PR+SD vs 100 for PD patients, P=0.0081), but not radiochemotherapy.Conclusion:Expression of βV-tubulin was associated with treatment response and PFS following paclitaxel-based chemotherapy of locally advanced and oligometastatic NSCLC patients. Prolonged OS was associated with low levels of βIII-tubulin. Prospective evaluation of βIII/βV-tubulin expression in NSCLC is warranted.     

Efficacy and safety of camrelizumab (a PD-1 inhibitor) combined with chemotherapy as a neoadjuvant regimen in patients with locally advanced non-small cell lung cancer

Camrelizumab is a novel programmed cell death protein 1 (PD-1) inhibitor developed in China that exhibits good efficacy in several advanced cancer types, including non-small cell lung cancer (NSCLC); however, its utility as a neoadjuvant regimen in NSCLC remains unclear. Thus, the present study aimed to explore the efficacy and safety of neoadjuvant camrelizumab plus chemotherapy in patients with locally advanced NSCLC. A total of 56 patients with stage IIIA/IIIB resectable NSCLC were analyzed in the present prospective observational study. Amongst the cohort, 31 patients underwent neoadjuvant camrelizumab (200 mg every 2 weeks) plus paclitaxel and carboplatin (PC) chemotherapy, while another 25 cases underwent neoadjuvant PC chemotherapy alone. The pathological response, disease-free survival (DFS) time, overall survival (OS) time and adverse events (AEs) were analyzed. The complete pathological response (25.8 vs. 8.3%; P=0.159) and major pathological response (MPR) (61.3 vs. 37.5%; P=0.080) rates were higher in the camrelizumab plus PC group compared with the findings in the PC group, although the results were not statistically significant. DFS time was significantly prolonged in the camrelizumab plus PC group compared with that in the PC group (P=0.030); however, there was no difference in OS time between these two groups (P=0.251). Following adjustment by multivariate analysis, the camrelizumab plus PC regimen versus the PC regimen alone was independently associated with higher MPR [odds ratio, 5.216; 95% confidence interval (CI), 1.178-23.086; P=0.030], and favorable DFS [hazard ratio (HR), 0.055; 95% CI, 0.007-0.442; P=0.006] and OS (HR, 0.025; 95% CI, 0.002-0.416; P=0.010) times. The most common AEs of the neoadjuvant camrelizumab plus PC regimen were alopecia (51.6%), nausea and vomiting (45.2%), anemia (41.9%) and fatigue (41.9%), the majority of which occurred in patients with grade 1–2 disease. The present results indicated that neoadjuvant camrelizumab plus PC chemotherapy exhibited a superior pathological response and survival profile to PC chemotherapy alone, and was well tolerated in patients with locally advanced NSCLC.     

XPG is Predictive Gene of Clinical Outcome in Advanced Nonsmall-cell Lung Cancer with Platinum Drug Therapy

Polymorphisms in XPG are considered to contribute to the clinical outcome of patients receiving platinumdrug chemotherapy. We aimed to investigate the role of five potential SNPs of XPG gene on the responseto platinum-based chemotherapy in advanced Chinese NSCLC patients. A total of 451 patients with newlydiagnosed and histopathologically confirmed primary NSCLC were consecutively collected. XPG rs2296147,rs4150261, rs17655, rs1047768 and rs2094258 were genotyped by the Taqman real-time polymerase chain reaction(PCR). In our study, we found patients carrying rs1057768 TT genotype had a significantly lower treatmentresponse when compared with the CC genotype (OR=0.38, 95% CI=0.18-0.78). Patients carrying rs1047768 TTgenotype showed a significantly short median PFS (11.2 months) and OS (13.6 months) than CC genotype, andthe hazard ratios (HR) for PFS and OS were 2.06 (1.01-4.50) and 2.29 (1.21-2.49), respectively. Moreover, wefound a significant decreased risk of death from NSCLC among patients carrying the rs2296147 TT genotypewhen compared with the CC genotype, the HR (95% CI) for OS being 0.50 (0.27-0.95). In conclusion, our studyfound that polymorphisms in rs1047768 C/T and rs2296147 C/T are associated with response to platinum-basedchemotherapy in advanced NSCLC, and XPG polymorphisms could be predictive of prognosis.     

非小细胞肺癌调强放化疗的近期疗效观察

目的:分析调强放疗(IMRT)联合化疗治疗局部晚期非小细胞肺癌(NSCLC)的近期疗效和毒副反应.方法:48例局部晚期不能手术或不愿手术的NSCLC患者,采用IMRT同步联合化疗综合治疗.放疗采用5～7野IMRT技术,单次剂量2.0～2,2 Gy,每周5次,中位总剂量60 Gy(54～66 Gy).所有患者均接受2个周期长春瑞滨加顺铂方案同步化疗,放疗结束后辅助2～4个周期化疗.结果:所有患者均顺利完成同步放化疗计划.放疗结束3个月后评价疗效,CR为21％(10/48),PR为60％(29/48),SD为13％(6/48),PD为6％(3/48),有效率为81％(39/48).中位随访时间为11个月(7～30个月),中位生存时间为25个月,1和2年总生存率分别为73％和39％.按RTOG标准评价放疗毒副反应,放射性食管炎Ⅰ级15例,Ⅱ级11例,Ⅲ级1例;放射性气管炎Ⅰ级14例,Ⅱ级8例,Ⅲ级3例;放射性肺炎Ⅰ级6例,Ⅱ级4例,Ⅲ级1例.结论:IMRT联合化疗对局部晚期NSCLC患者有较好的疗效,毒副反应可以被绝大多数患者耐受,对生存率的提高有待进一步研究.     

Combined modality trials of the Cancer and Leukemia Group B in stage III non-small-cell lung cancer: analysis of factors influencing survival and toxicity.

BACKGROUND: Combined modality therapy (CMT) is the standard of care for patients with unresectable stage III non-small-cell lung cancer (NSCLC); however, insufficient data are available regarding prognostic factors in this disease setting. PATIENTS AND METHODS: Six hundred and ninety-four patients included in five trials conducted by the Cancer and Leukemia Group B evaluating CMT in stage III NSCLC were included in this analysis. The primary objective was to identify factors that were predictors of survival and selected radiation-related toxicities using Cox regression models and logistic regression analysis. RESULTS: The Cox model shows that performance status (PS) 1 [hazard ratio (HR) 1.24; 95% confidence interval (CI) 1.06-1.45; P=0.009] and thoracic radiation therapy (TRT) only (HR 1.58; 95% CI 1.22-2.05; P=0.001) predicted for poorer survival, while baseline hemoglobin >/=12 g/dl predicted for improved survival (HR 0.67; 95% CI 0.55-0.81; P 5% weight loss (OR 2.9; 95% CI 1.3-6.6; P=0.008) and patients receiving concurrent chemoradiation (OR 7.3; 95% CI 3.4-15.6; P=0.0001). CONCLUSIONS: Baseline hemoglobin and PS, as well as the use of CMT, have the greatest effect on survival in unresectable stage III NSCLC. The use of concurrent chemoradiation increases the risk of esophagitis, which remains the primary radiation-related toxicity.     

Comparison of the Efficacy and Safety of EFGR TyrosineKinase Inhibitor Monotherapy with Standard Second-line Chemotherapy in Previously Treated Advanced Non-small-cell Lung Cancer: a Systematic Review and Meta-analysis

Purpose: To compare the efficacy and safety of epidermal growth factor receptor tyrosine kinaseinhibitormonotherapy (EFGR-TKIs: gefitinib or erlotinib) with standard second-line chemotherapy (single agentdocetaxel or pemetrexed) in previously treated advanced non-small-cell lung cancer (NSCLC). Methods: Wesystematically searched for randomized clinical trials that compared EGFR-TKI monotherapy with standardsecond-line chemotherapy in previously treated advanced NSCLC. The end points were overall survival (OS),progression-free survival (PFS), overall response rate (ORR), 1-year survival rate (1-year SR) and grade 3 or 4toxicities. The pooled hazard ratio (HR) or risk ratio (RR), with their corresponding 95% confidence intervals(CI) were calculated employing fixed- or random-effects models depending on the heterogeneity of the includedtrials. Results: Eight randomized controlled trials (totally 3218 patients) were eligible. Our meta-analysis resultsshowed that EGFR-TKIs were comparable to standard second-line chemotherapy for advanced NSCLC interms of overall survival (HR 1.00, 95%CI 0.92-1.10; p=0.943), progression-free survival (HR 0.90, 95%CI0.75-1.08, P=0.258) and 1-year-survival rate (RR 0.97, 95%CI 0.87-1.08, P=0.619), and the overall responserate was higher in patients who receiving EGFR-TKIs(RR 1.50, 95%CI 1.22-1.83, P=0.000). Sub-group analysisdemonstrated that EGFR-TKI monotherapy significantly improved PFS (HR 0.73, 95%CI: 0.55-0.97, p=0.03)and ORR (RR 1.96, 95%CI: 1.46-2.63, p=0.000) in East Asian patients, but it did not translate into increase in OSand 1-year SR. Furthermore, there were fewer incidences of grade 3 or 4 neutropenia, febrile neutropenia andneutrotoxicity in EGFR-TKI monotherapy group, excluding grade 3 or 4 rash. Conclusion: Both interventions hadcomparable efficacy as second-line treatments for patients with advanced NSCLC, and EGFR-TKI monotherapywas associated with less toxicity and better tolerability. Moreover, our data also demonstrated that EGFRTKImonotherapytended to be more effective in East Asian patients in terms of PFS and ORR compared withstandard second-line chemotherapy. These results should help inform decisions about patient management anddesign of future trials.     

Serum IL-33 as a Diagnostic and Prognostic Marker in Nonsmall Cell Lung Cancer

Background: Interleukin-33 (IL-33) has recently been implicated in tumor immunity. The aim of this studywas to explore the clinical role of serum IL-33 in patients with non-small-cell lung cancer (NSCLC). Methods:Sera collected from 250 healthy volunteers (HV), 256 patients with benign lung diseases (BLD) and 262 NSCLCcases were subjected to IL-33 ELISA and relationships between serum IL-33 and clinical characteristics wereevaluated. Results: Circulating IL-33 levels were higher in the NSCLC group in comparison with the HV andBLD groups (p<0.001). Using a cut-off level 68 pg/ml (95% specificity in the HV group), IL-33 showed a gooddiagnostic performance for NSCLC. Multivariate survival analysis indicated that serum IL-33 was an independentprognostic factor in the entire NSCLC group [hazards ratio (HR) = 0.64 for low versus high IL-33 levels, 95%confidence interval (CI) 0.50–0.82; p<0.001] and in 165 selected patients with locally advanced or metastaticdisease receiving chemoradiotherapy or chemotherapy (HR 0.70, 95% CI 0.52–0.94; p=0.013). Conclusions:IL-33 is a promising potential diagnostic and prognostic marker in NSCLC, independent of the therapeuticintervention.