三种含铂化疗方案治疗晚期非小细胞肺癌的临床观察

目的 观察三种抗癌药(长春瑞滨、吉西他滨和多西紫杉醇)联合顺铂治疗晚期非小细胞肺癌(NSCLC)的近期疗效及毒性反应.方法 经病理组织学或细胞学证实的70例晚期NSCLC患者,随机按治疗方法 分为3组化疗,长春瑞滨联合顺铂(NP)组24例,吉西他滨联合顺铂(GP)组25例,多西紫杉醇联合顺铂(TP)组21例,3组患者资料具备可比性,3组患者采用对应药物进行治疗,均以21d为一周期,连续应用两周期后评价疗效及不良反应.结果 NP组总有效率29.2%(7/24),GP组总有效率40.0%(10/25),TP组总有效率33.3%(7/21),3组方案总有效率比较无统计学差异(P＞0.05);毒性反应方面,3组均以骨髓抑制为主,白细胞下降及贫血发生率相近.NP组Ⅰ～Ⅱ度静脉炎(14.6%)较其他两组多,GP组Ⅲ～Ⅳ度血小板降低(16%)较其他两组严重,TP组Ⅰ～Ⅱ度外周神经毒性(38.1%)较其他两组多.结论 用于晚期NSCLC一线化疗,NP、GP、TP三种方案近期疗效相似,但毒性存在差异,故应根据患者个体情况进行选择.     

冠心病患者住院期间焦虑抑郁状况调查

目的通过调查了解冠心病患者住院期间焦虑抑郁的状况,探究其影响因素,为临床护理干预提供依据。方法选择2013年8月-2014年1月收治于新疆石河子绿洲医院的冠心病患者150例,采用医院焦虑抑郁量表（HAD）进行调查。结果150例患者中,76例存在焦虑情绪,占50．67％;70例存在抑郁情绪,占46．67％。结论冠心病患者中,焦虑、抑郁是比较普遍的负性情绪,临床护士应注意识别患者心理问题。尽早给予护理干预。     

非小细胞肺癌预后相关评价标志物的筛选

目的利用生物芯片技术和非小细胞肺癌（non-small cell lung cancer,NSCLC）患者血清及随访结果,筛选出新型NSCLC高敏感性和特异性的血清自身免疫抗体作为分子标志物用于NSCLC的预后评价。方法（1）提取NSCLC组织总mRNA构建T7噬菌体cDNA文库;（2）用NSCLC预后良好和不良患者血清对T7文库进行生物淘洗;（3）构建蛋白芯片,分别用预后良好和不良患者血清孵育芯片进行CyS／Cy3双荧光标记并分析芯片结果;（4）对挑选出的标志物进行测序及分析。结果筛选得到最佳评价组合含6个NSCLC预后相关标志物,其联合诊断准确率80．7％,敏感性85．3％,特异性73．9％,AUC为0．825;测序及BLAST分析显示,abl—interactor 1、pleiotrophin、surfactantprotein B 3个标志物是已知癌细胞转移和预后相关分子。结论成功筛选得到1个含有6个标志物的最佳评价组合,可对NSCLC预后进行较准确诊断。     

外泌体miR-9-3p在非小细胞肺癌血清中表达及检测的临床意义

目的 分析外泌体miR-9-3p在非小细胞肺癌(non-small cell lung cancer,NSCLC)血清中的表达水平,探讨血清外泌体miR-9-3p检测在NSCLC诊断中的临床意义.方法 收集2016年1月至2017年12月在山东省青岛疗养院诊疗的80例NSCLC患者(NSCLC组)、50例肺部良性病变患...     

健择治疗非小细胞肺癌的护理

为探讨健择治疗晚期非小细胞肺癌的护理要点,笔通过对30例晚期非小细胞肺癌50次使用健择治疗的观察,提出护理重点在于掌握健择的配制,储存要求,调节滴注速度,加强对症护理,是防治不良反应的关键。     

Detecting psychological distress in cancer patients: validity of the Italian version of the Hospital Anxiety and Depression Scale

The psychometric properties of the Italian version of the Hospital Anxiety and Depression Scale and its utility as a screening instrument for anxiety and depression in a non-psychiatric setting were evaluated. The questionnaire was administered twice to 197 breast cancer patients randomised in a phase III adjuvant clinical trial: before the start of chemotherapy and at the first follow-up visit. The presence of psychiatric disorders was evaluated at the follow-up visit using the Structured Clinical Interview for DSM-III-R in 132 patients. Factor analyses identified two strictly correlated factors. Crohnbach's alpha for the anxiety and depression scales ranged between 0.80 and 0.85. At follow-up, 50 patients (38%) were assigned a current DSM-III-R diagnosis, in most cases adjustment disorders (24%) or major depressive disorder (10%). Receiver operating characteristics (ROC) analysis was used to test the discriminant validity for both anxiety and depressive disorders. The comparison of the areas under the curve (AUC) between the two scales did not show any difference in identifying either anxiety (P=0.855) or depressive disorders (P=0.357). The 14-item total scale showed a high internal consistency (alpha=0.89 and 0.88) and a high discriminating power for all the psychiatric disorders (AUC=0.89; 95% CI=0.83–0.94). The cut-off point that maximised sensitivity (84%) and specificity (79%) was 10. These results suggest that the total score is a valid measure of emotional distress, so that the Italian version of HADS can be used as a screening questionnaire for psychiatric disorders. The use of the two subscales as a 'case identifier' or as an outcome measure should be considered with caution.     

非小细胞肺癌患者化疗前后生活质量及焦虑情绪的影响因素分析

目的 通过分析比较非小细胞肺癌患者化疗前后的生活质量及焦虑情绪的变化,探讨化疗对于肺癌患者生活质量及焦虑情绪的影响.方法 采用EORTC QLQ-C30及Zung焦虑自评量表(SAS)对64例非小细胞肺癌患者于化疗前、化疗2周期后、化疗4周期后进行临床疗效评估.结果 化疗前生活质量方面疲乏、呼吸困难项目得分较高,伴焦虑情绪的患者占58％,平均SAS得分为(49.7±5.8)分;焦虑症状与失眠有相关性;化疗2周期后,患者呼吸困难得分较前下降,食欲丧失、失眠得分升高,与化疗前比较有显著差异;化疗4周期后患者角色、躯体、情绪、社会功能得分明显下降,恶心呕吐、便秘、食欲不振及经济困难条目得分明显上升,与化疗前2周期相比有显著差异;焦虑症状与疲乏、便秘及失眠相关.结论 非小细胞肺癌在化疗过程中,部分患者躯体症状得到缓解,但焦虑情绪明显增加,生命质量有所下降,因此护理人员应当及时准确评价患者生活质量及情绪改变并针对性地加强护理措施,提高患者生活质量.     

An update on liquid biopsy analysis for diagnostic and monitoring applications in non-small cell lung cancer

Introduction: Collection of tumor samples is not always feasible in non-small cell lung cancer (NSCLC) patients, and circulating free DNA (cfDNA) extracted from blood represents a viable alternative. Different sensitive platforms have been developed for genetic cfDNA testing, some of which are already in clinical use. However, several difficulties remain, particularly the lack of standardization of these methodologies.

Areas covered: Here, the authors present a review of the literature to update the applicability of cfDNA for diagnosis and monitoring of NSCLC patients.

Expert commentary: Detection of somatic alterations in cfDNA is already in use in clinical practice and provides valuable information for patient management. Monitoring baseline alterations and emergence of resistance mutations is one of the most important clinical applications and can be used to non-invasively track disease evolution. Today, different technologies are available for cfDNA analysis, including whole-genome or exome sequencing and targeted methods that focus on a selection of genes of interest in a specific disease. In the case of Next Generation Sequencing (NGS) approaches, in depth coverage of candidate mutation loci can be achieved by selecting a limited number of targeted genes.     

EGFR mutations in non-small cell lung cancer: an audit from West China Hospital

Objectives: To discover the incidence and characteristics of EGFR mutations in non-small cell lung cancer (NSCLC) in a single, large cohort as a part of routine diagnostic investigations.

Methods: We reviewed EGFR mutations investigated by Amplification Refractory Mutation System (ARMS) PCR (covering 29 known mutations) using DNA samples from FFPE tissue or cell clot specimens in a total of 3894 cases of NSCLC analysed between 2012-2014.

Results: EGFR mutations are preferentially associated with adenocarcinomaand adenosquamous histology, particularly those well to moderately differentiated, and were significantly more common in female than male patients irrespective of histological subtypes. Exon 19 deletion (45.7%) and exon 21 L858R (45.6%) accounted for the vast majority of the EGFR mutations detected, with the remaining mutations being infrequent (<2%). Compound mutations were seen in 51 (3%) of the mutant cases, the combination of these compound mutations could be classified into three subgroups according to the potential impact of individual mutations on EGFR TKI therapy. Accordingly, 7 cases had both sensitive mutations, 4 cases harboured one sensitive and one less responsive /uncertain mutation, 19 cases contained one sensitive and one resistant change, and a further 21 cases had two less responsive /uncertain mutations.

Conclusion: Our data represents the largest EGFR mutation survey based on routine clinical diagnostic laboratory data from a single institution, it confirms the incidence and characteristics of EGFR mutations in NSCLC seen in Asian patients, and also unravels the combinatorial nature of rare compound EGFR mutations.     

单操作孔电视胸腔镜下非小细胞肺癌根治术的临床疗效分析

目的:总结单操作孔电视胸腔镜治疗非小细胞肺癌的临床效果。方法:选择单一治疗组2013年1月至2016年12月非小细胞肺癌手术患者536例,手术方式均为电视胸腔镜肺癌根治术。其中,167例行三孔术式(三孔组),369例行单操作孔术式(二孔组),比较两组临床疗效。结果:两组间手术时间、术中出血量、清扫淋巴结数目、中转开胸率、术后第1天引流量、术后拔管时间、术后住院时间、术后并发症差异均无统计学意义;二孔组术后第1天、第5天、第30天视觉模拟评分(visual analogue score,VAS)明显低于三孔组(P0.05)。结论:单操作孔电视胸腔镜肺癌根治术的安全性及有效性与三孔电视胸腔镜肺癌根治术无明显差别,但术后疼痛较轻,值得临床推广。     

非小细胞肺癌患者p53基因突变检测的临床意义

目的探讨非小细胞肺癌（NSCLC）患者呼出气冷凝液（EBC）中p53基因突变检测的临床意义。方法采用巢式PCR结合DNA测序法,检测53例NSCLC患者EBC中p53基因第5～8外显子的突变情况,并以32例健康体检者EBC标本作为对照。结果肺癌组53例EBC标本中扩增到1）53基因26例,其中10例检测到p53基因突变,突变率为38．5％（10／26）;正常对照组32例EBC标本中扩增到p53基因15例,但未检测到p53基因突变。结论p53基因突变可能参与NSCLC的发生发展,检测EBC中p53基因的突变对肺癌的早期诊断有一定的价值。     

An Analysis of the Validity of the Hospital Anxiety and Depression Scale as a Screening Tool in Patients with Advanced Metastatic Cancer

Depression is difficult to diagnose in the terminally ill patient. As a result, it frequently is not treated. This has can have an adverse effect on quality of life and make the palliation of physical symptoms more difficult. In an effort to improve the detection of depression, many palliative care teams are using the Hospital Anxiety and Depression (HAD) scale as a screening tool. The HAD was devised for use in general medical settings and has not been validated for use in palliative care patients. One hundred patients receiving palliative care with an estimated prognosis of 6 months or less were invited to complete the HAD and a semi-structured psychiatric interview, the Present State Examination. The depression and anxiety subscales of the HAD showed poor efficacy for screening when used alone. The optimum threshold was at a combined cut-off of 19, which had a sensitivity of 68% and specificity of 67%. The major construct of the HAD is anhedonia, which may be present at the end of life due to increasing physical illness and may not be pathognomic of a depressive illness in this population. We recommend, therefore, that if the HAD is used as a screening tool in palliative care, it should be as a combined scale, but low sensitivity and specificity may lead to poor efficacy as a screening tool.     

Effect of gefitinib challenge to initial treatment with non-small cell lung cancer

Purposes

This study was conducted to assess the efficacy and toxicity of gefitinib as first line treatment in patients with advanced non-small-cell lung cancer (NSCLC).

Methods

Tumor tissue, derived from either the original tumor or the metastatic or recurrent site was taken from chemo-naïve patients with advanced (stage IIIB, IV and recurrent) NSCLC. Tumor genomic DNA underwent direct sequencing for EGFR exons 18, 19, 20 and 21. Sixty-one patients received 250 mg of gefitinib daily until disease progression or unacceptable toxicity.

Results

Out of 61 patients, 26 patients (42.6%) were EGFR mutations and 11 patients were wild type, 24 patients were status unknown. One patient achieved complete remission (CR). While 17 patients achieved partial remission (PR) and 23 experienced stable disease (SD). There were 20 patients developed progressive disease (PD). The tumor response rate and disease control rate was 29.5 and 67.2%, respectively, and symptom remission rate was 66.7% as well. Median remission time was 9 days. Median over survival time was 13.0 months. Median progression-free survival time was 5.0 months. The MST of patients with EGFR mutation was 17.0 months, while the MST of patients with EGFR status unknown or wild type was 11.0 months. The PFS of patients with EGFR mutation was 9.0 months and it in EGFR status unknown or wild type was 2.5 months .The most common toxicity included rash (54.1%) and diarrhea (31.1%). Dehydration and pruritus of skin was observed in 31.1 and 26.2% of the patients respectively. Hepatic toxicity occurred in 8.2% of patients and oral ulceration occurred in six patients (9.8%).

Conclusion

Single agent treatment with gefitinib is effective in patients with advanced NSCLC, especially in patients with EGFR mutation, and well tolerated in Chinese patients.     

螺旋型鼻肠管肠内营养在非小细胞肺癌化疗中的临床应用研究

目的探讨经螺旋型鼻肠管行肠内营养(EN)支持在非小细胞肺癌化疗中的应用。方法将70例营养不良的非小细胞肺癌患者随机分为EN组和TPN组,采用NP化疗方案,分别测定两组患者化疗期间体重指数、营养指标、免疫机能、胃肠道反应程度、住院时间、住院费用、院内感染率。结果两组患者化疗后体重指数、各营养指标、CD4+/CD8+比较,差异无显著意义(P0.05);T细胞亚群CD3+、CD4+、CD8+及血清免疫球蛋白IgG、IgA、IgM、化疗胃肠道反应程度、平均住院时间、住院费用、院内感染率比较,差异有显著意义(P0.05)。结论EN对改善非小细胞肺癌患者化疗期间营养状况、完成后续化疗、提高生活质量具有一定的临床意义和实用价值。     

术前纵隔镜检查对非小细胞肺癌纵隔淋巴结转移的预测价值分析

目的 探讨非小细胞肺癌纵隔淋巴结转移特点及术前行纵隔镜检查的重要性。方法 89例临床诊断Ⅰ-Ⅲa期非小细胞肺癌患者接受纵隔镜检查；纵隔镜检查阴性者行开胸手术肺叶切除、系统纵隔淋巴结清扫，纵隔镜检查病灶同侧纵隔淋巴结转移（N2）者行新辅助化疗，病灶对侧纵隔或斜角肌淋巴结转移（N3）者行放化疗。结果 纵隔镜检查共发现23例N2、9例N3患者。右肺癌主要转移至右侧第2（R2）、第4（R4）、第7（R7）、右斜角肌（RS）站淋巴结，左肺癌主要转移至5、6、7站淋巴结，但左下肺癌也可转移至R2、R4和RS站。本组左、右肺癌对侧纵隔淋巴结转移率比较差异无统计学意义（P=0．219）。多因素分析结果显示CT扫描纵隔淋巴结短径≥1cm是预测纵隔淋巴结转移的一个独立因素。结论 可手术非小细胞肺癌患者术前行纵隔镜检查可提高分期准确性，减少不必要的开胸手术。     

原发性肝癌患者抑郁症状的调查分析

目的 了解原发性肝癌(Primary Liver Cancer，PLc)患者的抑郁症状水平及特点。方法 采用CES—D调查KPS≥60分的PLC患者及对照组(乙肝组和健康组)各100例。结果 (1)49％的PLC患者可能或肯定有抑郁症状．其中肯定有抑郁症状的PLC患者占23％；(2)PLC组的CES—D总分(T20)高于乙肝组和健康组，乙肝组的T20高于健康组；(3)PLC患者的抑郁症状以躯体症状为首要表现，但T20≥20的PLC患者则以情绪低沉为首要表现。结论 抑郁症状是PLC患者常见的负性情绪．医护人员不要因患者的躯体感受而忽视了对抑郁症状的评估，一旦发现患者情绪低沉，应采用简单有效的心理评定量表如CES—D对患者进行筛查，为可能有抑郁症状的患者提供进一步的检查和心理治疗，提高患者的生活质量。     

非小细胞肺癌p16基因甲基化及其临床诊断意义

目的 研究非小细胞肺癌癌组织p16基因甲基化及其临床诊断意义.方法 选择47例非小细胞肺癌患者,用MSP技术检测肺癌组织和癌旁正常组织p16基因甲基化.结果 肺癌组织p16基因甲基化率44.7%,高于癌旁组织的17.0%(P＜0.01);肺癌组织甲基化检出率与临床分期、临床病理分型和临床分类之间差异无统计学意义(均P＞0.05).结论 提示肺癌有关组织或样本的p16基因甲基化,可能成为各种临床类型的非小细胞肺癌早期诊断的一个有效指标.但特异性、灵敏性和可行性等有待进一步研究.     

非小细胞肺癌GP方案化疗前后肿瘤标志物变化临床意义分析

目的评估非小细胞肺癌(NSCLC)化疗前后血清癌胚抗原(CEA)、糖类抗原125(CA-125)、血清细胞角质素片段抗原21-1(CYFRA 21-1)变化的临床意义。方法 40例NSCLC患者行吉西他滨+顺铂(GP方案)化疗,根据疗效分为稳定组(26例)和进展组(14例)。在化疗前后,全部清晨空腹采集血清样本,冷冻保存。用电化学发光免疫测定法检测血清CEA、CA-125、CYFRA 21-1的含量水平。结果稳定组化疗后NSCLC患者血清中CEA、CA-125、CYFRA 21-1水平明显低于治疗前(P<0.05)。而进展组化疗前后此3项指标变化无统计学意义(P>0.05)。结论血清CEA、CA-125、CYFRA 21-1联合检测可作为NSCLC化疗疗效的评价指标。