Prospects for chemoprevention of cancer

The recent progress in molecular biology and pharmacology has increased the likelihood that cancer prevention will rely increasingly on interventions collectively termed 'chemoprevention'. Cancer chemoprevention is the use of agents to inhibit, delay or reverse carcinogenesis. A number of potential targets for chemoprevention have recently been identified. Many classes of agents including antioestrogens, anti-inflammatories, antioxidants and other diet-derived agents have shown a great deal of promise. In this review, we will begin by describing the general classes of chemopreventive agents and the mechanisms by which these agents act. We will then describe the opportunities that presently exist for chemoprevention of specific cancers.     

肺癌患者肺功能检测

目的探讨肺癌患者的肺功能改变。方法通过对126例肺癌患者的肺功能进行检测,并与84例健康人进行对照。结果肺癌患者的肺通气及弥散功能指标明显低于正常,与对照组相比有显著性差异。结论肺癌患者存在肺功能的减退,肺癌患者手术前或化疗前应常规检测肺功能,以便确定最佳治疗方案。     

Prevention and chemoprevention of colorectal neoplasms

Main purpose of the review is to analyse the impact of the current approaches for colorectal cancer prevention, including chemoprevention. Available evidence does not support the contention that a more appropriate diet can be of great help in the prevention of these neoplasms, either because the scientific evidence is poor and highly controversial, or because changes in diet are difficult to implement, at least in many Western countries. Similarly, a preventive approach based on the modification of lifestyle remains improbable, either in the short --or in the long period of time. Secondary prevention--i.e., the systematic removal of adenomatous polyps--can hardly be applied in the general population, with the exception of individuals at risk because members of families with Adenomatosis coli or Lynch syndrome, or affected by inflammatory bowel diseases. Finally, chemoprevention (i.e., the attempt to prevent tumour development through the administration of drugs or natural compounds that interfere with various phases of carcinogenesis) is still in its infancy Though attractive, this approach requires well-designed studies which should be carried out for years before being evaluated and interpreted; so far most of these investigations gave inconsistent or controversial results. In conclusion, both primary and secondary prevention of colorectal malignancies appear difficult to apply in the general population, and chemoprevention is still at the beginning of a (presumably] long story. The final impression is that notwithstanding the remarkable advancements made in the last two decades in colorectal cancer research, the practical application of these new concepts remains difficult.     

肿瘤标志物联合检测在肺癌早期诊断中的应用

目的：探讨外周血肿瘤标志物癌胚抗原（CEA）、神经元特异性烯醇化酶（NSE）、细胞角质蛋白19片段（CYFRA21-1）、糖链抗原125（CA125）、糖链抗原19-9（CA19-9）、糖链抗原15-3（CA15-3）联合检测在肺癌早期诊断中的应用价值。方法：采用Elecsys2010电化学发光仪检测80例肺癌患者,55例肺部良性疾病患者,40例健康人血清中CEA、NSE、CYFRA21-1、CA125、CA19-9、CA153等肿瘤标志物的水平。结果：肺癌患者中CEA、NSE、CYFRA21-1、CA125、CA19-9、CA153等6种标志物显著高于正常对照组及肺部良性疾病组,差异有统计学意义（P〈0.01）。6项标志物不同组合对不同分期肺癌检出的敏感性均高于单项标志物。其中第6种CY-FRA21-1＋CA125＋NSE和第7种CYFRA21-1＋CA125＋NSE＋CEA组合的敏感性较其他组合均高,特别是对早期患者检出率明显提高,但第7种方式成本较高且6、7两种方式检出率差异无统计学意义。结论：CYFRA21-1＋CA125＋NSE联合检测能提高肺癌的早期诊断率。     

肺癌化学药物预防的研究进展

肺癌是世界范围内癌症致死的首要原因。近年来,针对肺癌的传统治疗手段虽不断发展和改善,但肺癌的病死率未明显改变。除了大力倡导戒烟,化学药物预防有望降低肺癌的发生及抑制肺癌的发展,从而成为近年来研究的热点。化学药物预防是应用饮食和／或药物来抑制或逆转肿瘤的形成,目前已成功用于某些恶性肿瘤的临床预防。虽然已有的研究未能找到有效预防肺癌的药物,但鉴于大部分肺癌的发生是支气管上皮经历正常分化、增生、化生、异常增生及癌变的过程,故找寻可以有效抑制或逆转癌前病变或癌前状态的药物就变得愈发重要。     

Serum retinoic acid, retinol and retinyl palmitate levels in patients with lung cancer

OBJECTIVES: Epidemiological studies have shown an inverse relationship between dietary vitamin A intake and the risk of developing lung cancer. The aim of this study was to investigate the vitamin A status in patients with lung cancer, by determining the serum levels of retinoic acid, retinol and retinyl palmitate. METHODS: In total, 36 patients with lung cancer and 27 controls were assessed. Of the patients 14 had squamous cell carcinoma, 3 adenocarcinoma, 15 non-small cell lung cancer and 4 small cell lung cancer. Serum retinoic acid, retinol and retinyl palmitate levels were determined with HPLC and UV detection, after liquid extraction. RESULTS: Serum retinol levels did not differ between patients (733.5 +/- 326.4 ng/mL) and controls (734.5 +/- 337.1 ng/mL). The retinyl palmitate concentration tended to be lower in patients (14.3 +/- 9.7 ng/mL) than in controls (16.7 +/- 13.7 ng/mL). The serum retinoic acid levels were significantly lower in patients (1.9 +/- 0.6 ng/mL) than in controls (2.5 +/- 1.1 ng/mL, P < 0.05). A positive correlation was observed between the retinol and retinoic acid levels and retinyl palmitate and retinoic acid levels. CONCLUSIONS: The lower levels of retinoic acid in patients with lung cancer suggest there may be a deficiency or impairment in retinol metabolism in these patients. Further studies with larger numbers of patients are needed to evaluate the possible relationship between serum retinoid levels and lung cancer.     

The value of positron emission tomography in early detection of lung cancer in high‐risk population: a systematic review

Background: Early detection trials with chest radiography and sputum cytology were ineffective in decreasing lung cancer mortality. The advent of low‐dose spiral chest computed tomography (LDCT) provided clinicians with a new tool that could be with early diagnosis; however, this also raised significant concerns regarding the systematic use of LDCT with its high false‐positive rate for benign nodules. At this time, there is limited information about the true role of PET (positron emission tomography) for early detection of lung cancer. Methods: We used systematic methods, including Preferred Reporting Items for Systematic reviews and Meta‐Analyses statement, to identify relevant studies, assess study eligibility, evaluate study methodological quality, and summarize findings regarding diagnostic accuracy and outcome. Results: In total, only seven eligible studies were selected from 82 potentially relevant studies. The sensitivity of 18F‐FDG‐PET for the detection of T1 lung cancers ranged between 68% and 95%. The rate of detection tended to be lower for carcinoid tumors, adenocarcinoma and bronchoalveolar cell carcinomas. FDG‐PET using SUV (standardized uptake value) level can predict the outcome of the screening detected lung cancer. A combination of FDG‐PET and LDCT may improve screening for lung cancer in high‐risk patients. Conclusions: PET or PET/CT may be used as a useful tool for early detection of lung cancer in high‐risk population based on the existing information. However, there is still limited information with regards to evidence of survival benefits from PET screening in high‐risk patients. Please cite this paper as: Chang C‐Y, Chang S‐J, Chang S‐C and Yuan M‐K. The value of positron emission tomography in early detection of lung cancer in high‐risk population: a systematic review. Clin Respir J 2013; 7: 1–6.     

晚期非小细胞肺癌患者肺功能检测的临床意义

目的探讨晚期非小细胞肺癌患者肺功能改变。方法通过对59例晚期非小细胞肺癌患者的肺功能进行检测,并与63例健康成人进行对照。结果晚期非小细胞肺癌患者的肺通气及弥散功能指标明显低于正常,与对照组相比有显著性差异。结论晚期非小细胞肺癌患者存在肺通气和弥散功能的减退,肺癌患者应常规检测肺功能。     

Early detection of pancreatic cancer: a possibility in some cases but not a reality in most

Pancreatic cancer is notoriously difficult to diagnose until a late stage when curative options are no longer available. Owing to its relatively low incidence and the lack of sensitivity of current diagnostic tool, screening of pancreatic cancer in the general population is not recommended. However, in high‐risk individuals, especially those with well‐described genetic syndromes and a strong family history of pancreatic cancer, screening can be carried out. Detection of a lesion of the diameter < 1 cm without lymph node involvements and subsequent removal of the tumor results in long‐term cure of the cancer. Endoscopic ultrasound (EUS) is the only diagnostic tool that is able to detect such small lesions. EUS is often combined with endoscopic retrograde cholangiography to augment the diagnostic yield. The conundrum in clinical practice is to differentiate between a malignant and a benign lesion. Resection of the pancreas constitutes major surgery with a high morbidity and mortality. The need continues, therefore, to find even more accurate imaging modalities to diagnose small pancreatic cancers with confidence.     

Scintigraphic detection of neural-cell-derived small-cell lung cancer using glioma-specific antibody

Radiolabeled GA-17, a murine monoclonal antibody that reacts specifically with glioma cells, bound to a small-cell lung cancer (SCLC) cell line NCI-H69 derived from neural cells, both in vitro and in vivo. The affinity constant of GA-17 F (ab)₂ fragment binding to NCI-H69 was 1.02×10⁸/M while that to the glioma cell line U87MG was 1.22×10⁸/M. Iodine-125-labeled GA-17 F (ab)₂ fragments injected i.v. localized well in NCI-H69 cells xenografted in nude mice. The percentage of the injected dose per gram accumulated in the xenografted tumor was 6.87±1.34%g^–1 (mean±SD,n=5) 24 h after injection. On the other hand, control monoclonal F (ab)₂ fragments accumulated in the xenografted tumor at 0.75±0.30%g^–1. The tumor-to-blood ratio was 1.8 for NCI-H69, while that of control F (ab)₂ was 0.60. In conclusion, the radiolabeled GA-17 F (ab)₂ fragment is expected to be useful clinically to visualize the small-cell lung cancer and in radioimmunotherapy.Abbreviations SCLC small-cell lung cancer - mAb monoclonal antibody     

在B型超声引导下穿刺活检对肺癌检出率的临床研究

目的探讨肺肿瘤患者在B型超声引导下肺穿刺活检对肺癌检出率的研究。方法选择769例肺部肿瘤患者,采用B超引导下穿刺活检,将穿刺吸出物涂片,用10％甲醛液固定,送病理科做细胞学检查。结果769例肺部肿瘤在B超引导下肺活检,确诊为肺癌患者685例,占89．1％,可疑癌14例,占1．8％。肺肿块活检确诊为非肺癌者61例,占7．9％,另有9例,占1．2％的患者肺肿块活检未能确诊。提示B超引导下肺活检对肺癌总检出率为90．9％（699／769）,而肺部疾病部总检出率为98．8％（760/769）。结论B超引导下肺肿瘤活检术,无X线辐射,操作简单,定位准确,并发症少,安全性好;检出率较高,值得临床推广使用。     

血清肿瘤分子标记物联合动态检测对肺癌诊疗的临床应用

目的探讨血清肿瘤分子标记物癌胚抗原(CEA)、鳞状上皮癌抗原(Scc-Ag)、胃泌素释放肽前体31-98(Pro-GRP31-98)联合动态监测在肺癌早期诊断和监控治疗中的临床应用价值。 方法选取156例肺癌患者(肺癌组)、50例肺部良性病变患者(良性对照组)及50例健康体检者(正常对照组)为研究对象,采用电化学发光法及酶联免疫法检测三组人群血清CEA、Scc-Ag、Pro-GRP31-98水平,分析血清肿瘤分子标记物CEA、Scc-Ag、Pro-GRP31-98在肺癌早期诊断、临床分期、病理组织学分型、监控复发转移及判断预后的相关性。 结果(1)肺癌组患者血清CEA、Scc-Ag、Pro-GRP31-98水平明显高于良性病变组及正常对照组,差异有统计学意义(P<0.01)。良性病变组与正常对照组血清CEA、Scc-Ag、Pro-GRP31-98水平比较无统计学差异(P>0.05);(2)肺癌患者血清CEA、Scc-Ag、Pro-GRP31-98水平与性别、年龄、肿瘤发生部位无明显相关性(均P>0.05);与肿瘤大小、临床分期、组织学类型、复发转移及治疗后明显相关,肺癌高分期(Ⅲ、Ⅳ期)组、转移组、复发组、治疗前与低分期(Ⅰ、Ⅱ期)组、无转移组、无复发组、治疗后血清CEA、Scc-Ag、Pro-GRP31-98水平相比较有明显增高(均P<0.01);(3)CEA、Scc-Ag、Pro-GRP31-98分别在肺腺癌、鳞癌、小细胞癌血清阳性检出率较高,与其它两种病理组织学类型比较差异有统计学意义(P<0.01);(4)CEA、Scc-Ag、Pro-GRP31-98诊断肺癌的敏感性分别为51.28%、48.72%、50.50%,特异性分别为96.00%、98.00%、94.00%,准确性分别为62.14%、60.68%、62.62%;两两组合CEA＋ Scc-Ag、CEA＋Pro-GRP31-98、Scc-Ag＋Pro-GRP31-98诊断肺癌的敏感性分别为61.54%、64.74%、62.18%,特异性分别为92.00%、90.00%、92.00%,准确性分别为69.27%、71.22%、69.76%;三项肿瘤分子标记物联合检测虽特异性有所降低(86.00%),但敏感性、准确性明显提高,分别为96.46%、93.17%,与各单项及部分组合检测比较差异有统计学意义(均P<0.01)。 结论肿瘤分子标记物CEA、Scc-Ag、Pro-GRP31-98与肺癌的发生发展密切相关,联合检测可以做到相互补充、相互印证,有利于早期诊断、临床早期干预;动态检测可以监控肿瘤复发、转移,指导治疗及评估预后。     

Early detection of lung cancer

The overall 5-year survival of lung cancer is only 10% in Europe and 15% in the United States, and progress in curative treatments during the last 20 years has been modest. Late diagnosis of extensive disease is the main reason of failure. Early detection with low-dose spiral computed tomography (CT) is one of the most promising development of clinical research, and continuous improvements in technology can make this instrument more effective than mammography in breast cancer detection. In order to prove the benefit of early detection by reduction of lung cancer mortality, we need to enroll large numbers of high-risk individuals in multicentric prospective randomized trials combining primary prevention by smoking cessation with diagnostic intervention with low-dose spiral CT, optimal management of cancer and minimum damage for healthy individuals. Molecular biology research within early detection trials, combining genomic and proteomic analysis of blood and sputum, may improve the differential diagnosis, define the individual risk of cancer incidence and failure, and help target therapies on the basis of biologic profile.     

Gefitinib-induced lung injury successfully treated with high-dose corticosteroids

A 55-year-old man was treated with gefitinib for disseminated pleural lesions, 1 year after resection of the left lower lobe for non-small cell lung cancer. After 6 weeks of continuous daily treatment with oral gefitinib, he developed dyspnoea on exertion and a non-productive cough. CXR and CT revealed focal areas of ground-glass opacity (GGO) in the right upper lobe. Despite gefitinib being discontinued, high-resolution CT revealed extension of GGO and restructuring of lung parenchyma, suggesting acute interstitial pneumonia. Transbronchial biopsy revealed acute-phase diffuse alveolar damage. After administration of methylprednisolone pulse therapy (1 g/day intravenously) for three consecutive days, the areas of GGO shrank on high-resolution CT and symptoms resolved. Diffuse alveolar damage caused by gefitinib can be successfully treated in the early phase with high-dose corticosteroids. Patients receiving gefitinib should be carefully examined for symptoms and undergo CT if their condition deteriorates.     

肺癌患者凝血常规指标检测的临床意义

目的探讨肺癌患者凝血功能相关指标与临床病理特征及预后的相关性。方法对60例肺癌患者及20例健康人的血浆凝血酶原时间（PT）、纤维蛋白原（FIB）、部分活化凝血活酶时间（APTT）分别进行测定。结果肺癌患者血浆纤维蛋白原水平显著高于健康对照组（P〈0.01）,血浆PT、APTT值与对照组相比无显著性差异。肺癌组中除PT值在性别上有显著性差异外（P〈0.05）,其余各指标与患者的年龄、性别、病理类型、肿瘤大小、TNM分期、有无远处转移等临床病理特征之间无明显关系。血浆纤维蛋白原与生存期之间有显著的负相关（r=-0.32,P〈0.01）。结论肺癌患者存在血浆纤维蛋白原水平增高,血浆纤维蛋白原水平与患者的生存期呈负相关,抗凝治疗对改善肺癌的预后可能有益。     

经支气管镜冷冻活检在中央型肺癌中的诊断价值

目的探讨经支气管镜冷冻活检在中央型肺癌中的诊断价值及安全性。方法回顾性分析65例中央型肺癌患者,每例均经支气管灌洗、针吸活检、活检钳活检、毛刷刷检、冷冻活检。对冷冻活检与活检钳活检两种方法取得的组织大小、组织结构的完整性进行比较分析,并对所有取材方法的病理结果进行比较分析。同时观察各种取材方式的出血情况。结果活检钳活检组织平均大小为5.68mm~2,冷冻活检组织平均大小为12.35mm~2,冷冻活检组织明显大于活检钳活检;组织结构的完整性差异性不明显。冷冻活检的阳性检出率为83.08%,显著高于活检钳活检(P0.05)。对增生型及混合型肺癌,冷冻活检联合活检钳活检阳性率为98.46%。冷冻活检在浸润型病变中出血风险较大。结论在中央型肺癌中,冷冻活检联合活检钳活检,对增生型及混合型肺癌阳性率高,建议采用浸润型病变冷冻活检出血风险大,慎用。     

肺癌和癌旁正常肺组织中5种肿瘤标志物比较研究

目的 探讨肺癌组织及癌旁正常肺组织中心钠素、分泌型IgA、铁蛋白、DNA聚合酶、血管内皮生长因子的含量。方法 应用放射免疫法测定39例肺癌和癌旁正常肺组织中心钠素、分泌型IgA、铁蛋白、DNA聚合酶、血管内皮生长因子5种肿瘤标志物含量。结果 5种肿瘤标志物在肺癌组织中的含量均高于癌旁正常肺组织，差异有统计学意义（P均〈0．001）。结论 肺癌细胞具有产生物质的作用。