肺癌眼脉络膜转移的临床分析

目的探讨肺癌眼脉络膜转移的临床特点、诊断和治疗。方法采用回顾性研究的方法,对收治的21例肺癌眼脉络膜转移的临床资料进行总结、分析。结果 21例中,以肺部为首发症状的7例,以眼部为首发症状的14例;肺部病变位于左肺12例,右肺9例;中心型8例,周围型13例。眼部病变位于单眼20例,双眼1例,共22只眼受累,左眼13例,右眼9例;病变位置在后极14例,近视乳头5例,脉络膜周边3例。病理类型:肺腺癌13例,小细胞肺癌4例,鳞癌3例,大细胞肺癌1例。18例并发眼以外器官的转移。随访19例,中位生存期12.0月,1年生存率44.7%,2年生存率6.5%。结论肺癌眼脉络膜转移应对其重视及完善检查,使其尽早确诊。恰当的治疗可延长患者的生存期、缓解症状及提高生活质量。     

肺癌胰腺转移的临床特点及预后分析

背景与目的 由于缺乏特异的临床症状,70%的肺癌患者确诊时为局部晚期或晚期,多数患者伴有实性器官转移,不同部位转移患者的临床表现及预后不同.随着诊断技术的发展,肺癌伴胰腺转移似有逐渐增多趋势.本研究针对肺癌胰腺转移的临床特点、诊治、预后及生存情况进行统计分析,探讨肺癌胰腺转移的相关预后因素.方法 回顾性分析1996年7月-2017年6月于北京肿瘤医院胸部肿瘤内一科就诊的35例经病理确诊的肺癌并胰腺转移或在治疗过程中出现胰腺转移的患者,其中33例有完整随访资料.结果 35例患者中,小细胞肺癌28例(80%),腺癌3例(8.6%),鳞癌4例(11.4%).初治时即存在胰腺转移者21例(60%),14例治疗过程中出现胰腺转移(40%).在胰腺转移灶中,胰头转移者15例(42.9%),胰腺体尾部转移者20例(57.1%),单发转移23例(65.7%),多发转移12例(34.3%).肺癌胰腺转移患者多无明显临床症状,本组病例中,仅4例患者在病程中出现胰腺炎症状.病理类型是影响肺癌胰腺转移患者生存的独立预后因素.结论 部分晚期肺癌患者可以出现胰腺转移,多见于小细胞肺癌.肺癌患者出现胰腺转移,治疗原则以全身化疗为主的综合治疗.病理类型是影响肺癌胰腺转移患者生存的独立预后因素.     

320例老年肺癌电子支气管镜检查的临床分析

目的 探讨老年肺癌患者电子支气管镜下的特点,分析组织学类型与性别、镜下形态及病变部位的关系.方法 回顾性分析320例经电子支气管镜确诊肺癌的年龄≥65岁的患者.结果 320例肺癌患者中,中央型肺癌199例(62.2%),外周型肺癌121例(37.8%).病理类型最常见鳞癌176例(55.0%),其次是腺癌80例(25.0%),小细胞癌53例(16.6%).镜下表现:增殖型162例(50.6%),肿块伴浸润型85例(26.6%),管壁浸润型66例(20.6%),外压型7例(2.2%).男性鳞癌患病率显著高于女性(P=0.0000),而女性腺癌与小细胞癌患病率显著高于男性(P=0.0033,0.0035).4种镜下表现与不同病理类型之间差异有统计学意义(P=0.0000).在鳞癌、小细胞癌中,中央型肺癌发生率显著高于周围型肺癌(P=0.0476,0.0245).在腺癌中,周围型肺癌发生率显著高于中央型肺癌(P=0.0000).结论 老年肺癌以中央型肺癌多见,鳞癌和腺癌发生率较高,镜下表现以增殖型多见.电子支气管镜操作方便,患者耐受性较好,对老年肺癌患者的诊断具有重要意义.     

不可手术的局部晚期非小细胞肺癌患者胸部放疗后脑转移特征及危险因素分析

目的 探讨不可手术的局部晚期非小细胞肺癌患者胸部放疗后脑转移特征及其危险因素.方法 选取经组织病理学检查或免疫组化检查证实的不可手术的局部晚期非小细胞肺癌患者72例.根据患者各项资料,分析不可手术的局部晚期非小细胞肺癌患者放疗后脑转移特征,使用多因素Logistic回归分析影响不可手术的局部晚期非小细胞肺癌患者放疗后脑转移的危险因素.结果 72例患者中,15例(20.83%)患者出现脑转移,其中腺癌14例,鳞癌1例;单纯脑转移2例,脑转移合并其他部位转移13例.患者出现脑转移的中位时间为8.5个月,1年、3年累积脑转移率分别为16.31%、29.94%.单因素分析结果显示:患者的年龄、吸烟史、CA125、NSE、CEA与局部晚期非小细胞肺癌患者胸部放疗后脑转移存在一定关系(P﹤0.05).多因素Logistic回归分析结果显示:年龄﹥60岁、有吸烟史、CA125升高、NSE升高、非鳞状细胞癌是影响局部晚期非小细胞肺癌患者胸部放疗后脑转移的危险因素.结论 年龄﹥60岁、有吸烟史、CA125升高、NSE升高、非鳞状细胞癌的局部晚期非小细胞肺癌患者胸部放疗后出现脑转移的危险性高.     

N2肺癌根治术后肿瘤复发模式的临床分析

目的:阐明纵隔淋巴结转移(N2)的非小细胞肺癌(NSCLC)患者根治术后肿瘤复发的模式,为手术后采取针对性的辅助治疗提供依据.方法:回顾96例根治性切除术后病理诊断为N2肺癌患者的临床资料.术后2年内每6个月对患者进行随访复查,监测肿瘤复发情况.应用x2检验比较手术后放疗及化疗对肿瘤复发模式的影响.结果:术后2年内肿瘤复发率为37.5%,复发模式以转移性复发为主(77.8%),多数为脑和肺转移(64.3%).手术后放疗患者的局部复发率为5.2%,而未施行放疗患者的局部复发率为23.7%,两者比较有显著性差异(OR=5.69,P＜0.05);手术后化疗者与未化疗者相比,局部复发和转移性复发的发生率的差别无显著性(P＞0.05).结论:转移性复发是N2非小细胞肺癌根治术后肿瘤复发的主要模式,手术后放疗可以减少N2肺癌根治术后肿瘤的局部复发.     

血清癌胚抗原鳞状细胞癌抗原神经特异型烯醇化酶糖类抗原125与肺癌病理分型及临床特征的关系

目的探讨血清癌胚抗原(CEA)、鳞状细胞癌抗原(s SCC-Ag)、神经特异型烯醇化酶(NSE)、糖类抗原(CA125)水平与肺癌病理分型和临床特征的关系。方法采用罗氏E-70型电化学发光及免疫分析仪检测107例肺癌患者血清中CEA、SCC-Ag、NSE和CA125的水平,并探讨其与肺癌患者临床特征及肿瘤-淋巴结-转移(TNM)分期的关系。结果腺癌患者中血清CEA水平显著高于鳞癌及小细胞癌(P<0.05),鳞癌患者血清SCC-Ag水平显著高于腺癌及小细胞癌(P<0.05),小细胞癌患者血清NSE水平显著高于腺癌及鳞癌,血清CEA在腺癌患者中的表达水平与是否有远处转移、转移部位数量、TNM分期有关(P<0.05),SCC-Ag与转移部位数量有关(P<0.05),CA125与是否有远处转移有关(P<0.05);血清SCC-Ag在鳞癌患者中的表达水平与TNM分期有关(P<0.05);血清NSE在小细胞肺癌中的表达与是否有远处转移及TNM分期有关(P<0.05),CA125仅与是否有远处转移有关(P<0.05)。血清CEA与腺癌患者远处转移、转移部位数量及TNM分期呈正相关(P<0.05),SCC-Ag与腺癌患者的转移部位数量及鳞癌患者的TNM分期呈正相关(P<0.05),NSE与小细胞癌患者的远处转移及TNM分期呈正相关(P<0.05),CA125与腺癌及小细胞肺癌患者的远处转移呈正相关(P<0.05)。结论血清CEA、SCC-Ag、NSE、CA125水平与肺癌的临床特征及病理分型有关,4种肿瘤标志物联合检测有利于更加全面地评价肺癌患者的病情,值得临床重视。     

非小细胞肺癌发生脑转移的高危因素及生存分析

目的 探讨非小细胞肺癌发生脑转移的高危因素及对生存的影响.方法 回顾对比分析150例经病理确诊的ⅡA～Ⅳ期非小细胞肺癌患者,其中发生脑转移的100例,未发生脑转移者50例,比较两组之间临床特征及肿瘤特征的差异.结果 (1)单因素分析发现,年轻、非鳞状细胞癌、中央型肺癌、有淋巴结转移、肺内播散、合并其他部位转移及未接受治疗是非小细胞肺癌发生脑转移的可能危险因素;多因素分析发现,年龄与病理类型是非小细胞肺癌发生脑转移的高危因素.(2)性别、民族及肺内病变左右位置不是非小细胞肺癌发生脑转移瘤的危险因素.(3)脑转移组中位生存时间为(6.661±0.573)月,低于非脑转移组的(13.318±0.966)月(P=0.000);脑转移组的6月、12月生存率分别为32.0％、14.7％,明显低于非脑转移组的80.6％和62.4％ (P =0.000).结论 年龄＜60岁、非鳞状细胞癌是非小细胞肺癌发生脑转移的高危因素,中央型肺癌、肺内转移、淋巴结转移、其他部位远处转移及未接受治疗为非小细胞肺癌患者发生脑转移的可能高危因素.脑转移的发生影响非小细胞肺癌患者的预后.     

羟基喜树碱联合化疗治疗晚期非小细胞肺癌的临床观察

目的观察羟基喜树碱联合化疗治疗晚期非小细胞肺癌的疗效和毒副作用.方法 56例晚期非小细胞肺癌患者中,50例肺腺癌接受HEMe方案化疗,6例肺鳞癌接受HE方案化疗.结果总有效率为39.3%,肺腺癌有效率为42.0%,肺鳞癌有效率为16.7%.结论羟基喜树碱联合化疗治疗非小细胞肺癌疗效好,毒副作用小,费用低,值得临床推广应用.     

肺癌脑转移瘤的预后因素分析

脑转移瘤多以肺癌为原发灶,且肺癌的主要死因是脑转移。由于肺癌的发病率逐年增加,故肺癌脑转移的研究具有临床意义。为进一步提高肺癌脑转移瘤患者的生存期,现将1994年10月～2003年12月中国辐射防护研究院附属医院肿瘤科综合治疗的45例肺癌脑转移患者进行回顾性分析如下:1材料与方法1.1临床资料45例肺癌脑转移患者,均进行了放疗化疗为主的综合治疗,其中男32例,女13例,全组中位年龄57岁,32～79岁,其中肺癌原发灶和脑转移灶同时发现27例,肺癌原发灶治疗后出现脑转移18例。病理分型:腺癌27例,小细胞未分化癌7例,鳞癌9例,腺鳞癌2例。合并其他部…     

同时性多原发肺腺癌的外科治疗及预后

背景与目的 随着高分辨率计算机断层扫描(high-resolution computed tomography,HRCT)应用的普及,多原发肺癌(multiple primary lung cancers,MPLC)的检出率逐年上升,其中腺癌是最常见的病理类型.目前国内外对MPLC的研究已相对多见,但罕有单独分析同时性多原发肺腺癌(synchronous multiple primary lung adenocarcinomas,SMPLA)的报道.本研究探讨SMPLA患者的临床病理特点及预后,旨在提高对SMPLA的认识.方法 对2012年12月-2016年7月期间我科38例临床资料保存完整的SMPLA患者进行了回顾性分析.结果 38例SMPLA患者中,男性12例,女性26例,中位年龄为58岁(39岁-73岁).双原发肺腺癌29例,2个病灶以上9例.病灶位于同侧26例,双侧12例.同期手术34例(包括8例患者同期行双侧手术),分期手术4例.5例患者对每个病灶分别行基因检测,结果证实不同病灶的表皮生长因子受体(epidermal growth factor receptor,EGFR)基因突变类型不完全相同.1年和3年总生存率分别为96.6%和74.2%.肿瘤直径越大(P<0.001)、T分期越高(P=0.003)、淋巴结转移(P=0.001)、TNM分期越高(P=0.022)以及术后放、化疗(P=0.009)提示总生存预后较差.结论 对于多发的非小细胞肺癌,不能轻易地诊断为转移癌,应考虑多原发可能.EGFR基因检测可作为鉴别多原发肺腺癌与复发转移癌的临床参考.     

Clinical study on the metastasis to the eyes from breast cancer

In our hospital, 24 patients who underwent surgery for breast cancer during 1980 to 2001 were diagnosed with metastasis to the eye. Metastasis to the choroid was found most frequently, making the choroid the most common site of metastasis. A few patients had metastasis in the orbit. Decreased visual acuity and tunnel vision were frequently found in patients who had metastasis to the choroid, and ocular floaters and blurred vision were also found in a few patients. Patients with metastasis to the orbit showed diplopia caused by ocular dyskinesia and eyelid swelling. The mean postoperative period until the diagnosis with metastasis to the eye was 3 years and 2 months, with most cases diagnosed between 20 and 40 months postoperatively, a relatively long period. We performed radiotherapy in 21 of the 24 patients, and more than half of the patients showed improvement. The mean survival period after diagnosis with metastasis to the eye was 10 months, and most of them already had recurrence to other organs such as the bones or lungs. Examination with consideration of metastasis to the eyes is required to improve the quality of life of cancer patients.     

Prophylactic cranial irradiation for patients with lung cancer

The central nervous system is a common site of metastasis in patients with small cell lung cancer (SCLC) and non-small-cell lung cancer. Despite advances in combined modality therapy, intracranial relapse continues to be a common site of recurrence and a major cause of morbidity for patients with lung cancer. Prophylactic cranial irradiation (PCI) has proven to be effective in reducing the incidence of brain metastases in patients with lung cancer. Based upon results of a metaanalysis demonstrating a small improvement in overall survival, PCI is now routinely offered to patients with limited-stage SCLC after a complete or near-complete response to initial treatment. However, many questions remain unanswered regarding the optimal dose, fractionation, and toxicity of PCI in patients with limited-stage SCLC. Additionally, the role of PCI in patients with extensive-stage SCLC and locally advanced non-small-cell lung cancer is unclear. Several important collaborative group trials are under way in an attempt to further define the role of PCI in patients with lung cancer.     

Choroidal metastasis in a patient with small cell lung cancer discovered during treatment with chemotherapy

A 56-year-old male patient complaining of productive cough, hoarseness, and fatigue was found to have extensive disease of small cell lung cancer (ED-SCLC), with staging of cT4N3M1(PUL). He was treated with chemotherapy. While undergoing treatment with chemotherapy, he complained of a right visual disturbance, and choroidal metastasis was diagnosed. Because the primary site responded well to chemotherapy alone and the visual disturbance did not worsen, the patient refused radiotherapy to the choroidal metastasis. Two months after the first diagnosis of the choroidal metastasis, while he was receiving the first treatment regimen for SCLC, the visual disturbance suddenly worsened; emergent radiotherapy was started, with a total dose of 40 Gy, given as 2.0 Gy/fraction per day. The visual disturbance never improved, and the patient lost 80% of his right visual field. Within 6 months of diagnosis, the patient became blind in his right eye. The patient died of septic shock related to treatment received during his third chemotherapy regimen. Choroidal metastasis is very rare with extraocular malignant tumors, though it is common with intraocular malignant tumors. Choroidal metastasis secondary to SCLC has a poor prognosis, but in order to maintain quality of life during the patients’ remaining lifespan, aggressive treatment would appear appropriate for these patients, because SCLC is a chemo-sensitive cancer.     

先进诊疗技术下小细胞肺癌脑预防照射临床价值与研究进展

小细胞肺癌（SCLC）恶性程度高,侵袭性强,易发生颅脑转移。现有指南均推荐脑预防照射（PCI）作为初始系统性治疗后达到完全缓解的SCLC患者的标准治疗方案。但在MRI广泛应用于颅脑转移诊断的今天,放疗同时免疫治疗及分子靶向治疗的联合治疗方案广泛应用于肺癌,PCI在SCLC治疗中的价值受到质疑并面临挑战。而应用海马保护技术及相关药物减少PCI后神经认知功能损伤成为研究热点。本文将近期文献报道的PCI相关研究结果进行综述,为SCLC患者选择最适合的PCI个体化治疗方案提供参考。     

先进诊疗技术下小细胞肺癌脑预防照射临床价值与研究进展

小细胞肺癌（SCLC）恶性程度高,侵袭性强,易发生颅脑转移。现有指南均推荐脑预防照射（PCI）作为初始系统性治疗后达到完全缓解的SCLC患者的标准治疗方案。但在MRI广泛应用于颅脑转移诊断的今天,放疗同时免疫治疗及分子靶向治疗的联合治疗方案广泛应用于肺癌,PCI在SCLC治疗中的价值受到质疑并面临挑战。而应用海马保护技术及相关药物减少PCI后神经认知功能损伤成为研究热点。本文将近期文献报道的PCI相关研究结果进行综述,为SCLC患者选择最适合的PCI个体化治疗方案提供参考。     

Liver metastasis at the time of initial diagnosis of lung cancer

In order to evaluate clinicopathological features associated with liver metastases from lung cancer, we reviewed our experience of lung cancer patients seen in our division. Of the 1073 lung cancer patients diagnosed between October 1976 and May 2002, 62 (5.8%) patients had liver metastasis. The incidence of liver metastasis was 17.5% in small-cell lung cancer (SCLC) patients, whereas the incidence in non-small-cell lung cancer patients was 3.8%. Of the 62 patients, 17 had sole liver metastasis, and the remaining 45 had synchronous spread to the liver and one or more other organs. Six of 12 squamous cell carcinoma patients and 10 of 28 SCLC patients had sole liver metastasis. However, 19 of 20 adenocarcinoma patients showed liver metastasis with one or more other organs. In morphological liver metastasis, 26 of the 28 SCLC patients had multiple nodules, whereas 16 of the 34 non-small-cell lung cancer patients had a solitary liver nodule (p = 0.0006). Liver is a possible site of extrathoracic spread of disease for some patients with lung cancer, especially with SCLC. When the histological types are squamous cell carcinoma or SCLC, it would also be considered likely that an isolated liver mass represents a metastasis even though there is no metastatic disease elsewhere.     

不同转移部位对广泛期小细胞肺癌患者治疗 预后的影响

背景与目的:小细胞肺癌(small cell lung cancer,SCLC)是肺癌中恶性程度最高的病理学类型,易发生远处转移,转移部位及肿瘤负荷对患者的预后有一定预测作用.比较不同远处转移部位及转移器官个数对广泛期SCLC患者预后的影响,以期为临床决策提供参考.方法:收集2014年5月—2019年2月在同济大学附属...     

Uveal metastatic disease: current and new treatment options (review)

Choroidal metastasis represents the most common form of intraocular malignancies. It may occur in up to 10% of patients with systemic metastasis with almost half of the patients developing central nervous system disease. The most common primary sites of ocular metastasis are breast cancer in women and lung cancer in men. In most cases, these lesions tend to be asymptomatic and are not evaluated by an ophthalmologist. The diagnosis is generally made by the history of present or prior malignancies and an ophthalmological examination with slit-lamp biomicroscopy and indirect ophthalmoscopy. As with other malignancies, management may vary with each patient. Small tumors, that do not compromise the vision and that have responded previously to systemic treatment, may be closely observed. For larger lesions and for symptomatic ones, external beam radiation offers an excellent alternative to save the eye and stabilize vision. Bevacizumab (Avastin), a potent monoclonal antibody that has also been employed for the treatment of ocular vaso-proliferative diseases, has been used in the treatment of choroidal metastasis and has shown promising results.     

Radiation therapy for metastatic disease involving the orbit

A series of 47 patients with clinically demonstrated metastatic disease to the eye were evaluated for treatment with radiation therapy. Of the 37 patients who completed treatment, 88.9% responded with demonstrated tumor regression and improvement of symptoms. The breast and lung remain the two most common sites of origin for metastatic disease involving the orbit although the reason for this remains undetermined. The most common site of orbital involvement is the posterior choroid and no predilection for involvement of either the right or left eye could be determined. Radiation doses in the range of 3000-4000 rad delivered over a 3- to 4-week period of time, with care being taken to spare the lens, is recommended. Aggressive radiation therapy is indicated when the eye metastasis occurs without systemic disease or with stable systemic disease. The median survival in this group of patients was 8.5 months in those patients in whom adequate follow-up information was available.     

孤立性肺结节体素内不相干运动扩散加权磁共振成像研究

目的:探讨体素内不相干运动扩散加权磁共振成像（intravoxel incoherent motion diffusion weighted imaging,IVIM-DWI）在孤立性肺结节(solitary pulmonary nodules,SPN)中的应用价值。方法:对57例有明确病理诊断的孤立性肺结节分为良性结节组（n=16）与恶性结节组（n=41）,恶性结节分为小细胞肺癌（small cell lung cancer,SCLC）组（n=10）和非小细胞肺癌（non-small cell lung cancer,NSCLC）组（n=28）。对不同组扩散加权成像（diffusion weighted imaging,DWI）和IVIM-DWI图像进行分析,测量其ADC值、D值、D*值和f值。分析不同组之间各参数的差异性,评估各衍生参数的诊断效能。结果:ADC、D和f值在良恶性结节间差异有显著性。ADC值和D值在SCLC与NSCLC之间差异有显著性。良性结节与恶性结节,ADC、D及f值受试者工作特征（receiver operating characteristic,ROC）曲线下面积分别为0.822、0.864、0.736,D值显示出最高的诊断效能。SCLC与NSCLC,ADC、D值ROC曲线下面积分别为0.843、0.814,ADC值有最高的诊断效能。结论:IVIM-DWI可以对SPN良恶性作鉴别诊断,不仅能反映组织的扩散信息,还能反映其灌注信息,对孤立性肺结节的评估有重要指导意义。