血液生物标志物在免疫检查点抑制剂治疗非小细胞肺癌中的研究进展

<正>2020全球癌症统计数据显示，肺癌为全世界发病率第二、死亡率第一的恶性肿瘤^[1]。肺癌主要有两种病理类型：非小细胞肺癌(NSCLC)(约占85%)和小细胞肺癌 (SCLC)(约占15%)^[2]。肺癌早期症状不典型，确诊时患者多处于疾病中晚期，已无手术机会。在过去十年中，免疫检查点抑制剂 (ICI)疗法改变了NSCLC的治疗格局^[3]。ICI已成为NSCLC患者一线和二线的标准治疗方法。     

骨膜蛋白与非小细胞肺癌相关性研究进展

<正>非小细胞肺癌(non-small cell lung cancer, NSCLC)占所有肺癌比例的80%～85%^[1],鳞状细胞癌和腺癌是最常见的组织学类型^[2],NSCLC患者5年生存率仍然非常低，约为16%^[3],是癌症特异性死亡率的主要原因^[4]。临床上，大部分NSCLC诊断时已为晚期疾病^[5],故对参与NSCLC发生发展相关分子及其功能意义认识的提高，可能影响肺癌的预后及治疗。     

非小细胞肺癌脑转移治疗进展

<正>肺癌是威胁人类健康的主要疾病之一,发病率死亡率较高[1]。非小细胞肺癌(non-small-cell lung cancer,NSCLC)占了肺癌的80%～85%[2]。80%左右的肺癌患者死于肿瘤的远处转移扩散[3-4]。晚期NSCL脑转移发生率高达30%～40%左右,一旦出现预后极差,未经治疗的中位总生存期(median overall survival,m OS)约1～3个月[5],1年生存率约10%～20%[6]。影响脑转移预后的因素有很多,如年龄、体力状态(performance status,PS)评分、脑转移个数、原发灶是否控制、中枢外是否转移等;因此,如何对肺癌脑转移患者进行及时有效的诊治具有重要意义。本文对NSCLC脑转移综合诊治的最新进展做一综述。     

EGFR突变非小细胞肺癌胸腔积液与外周血ctDNA丰度及EGFR-TKI疗效分析

<正>肺癌是位居全球第一的恶性肿瘤,是恶性肿瘤相关死亡首要因素^[1]。非小细胞肺癌(NSCLC)是肺癌主要病理类型,约80%～85%确诊时多为晚期,5年生存率低于5%^[2]。表皮生长因子受体(EGFR)是NSCLC突变频率最高的驱动基因,EGFR酪氨酸激酶抑制剂(EGFR-TKI)为晚期EGFR突变NSCLC一线用药,提升了患者生存时长与生存质量^[3]。EGFR突变状态是决定EGFR-TKI疗效关键,常规组织活检样本不易获取,无法克服遗传学的空间异质性,液体活检有效弥补上述不足^[4]。循环肿瘤DNA(ct DNA)由肿瘤细胞直接分泌,NSCLC EGFR突变与循环肿瘤DNA(ct DNA)丰度有关^[5]。晚期NSCLC常伴恶性胸腔积液,采集简便,为组织活检替代标本^[6]。本文对我院收治的98例晚期EGFR突变NSCLC患者进行分析,报道如下。     

老年肺癌靶向治疗的疗效与安全性

<正>我国肺癌发病率处于上升趋势，以老年患者为主，其中80%～85%为非小细胞肺癌(non-small cell lung cancer, NSCLC),大多数患者确诊时已至晚期，预后差^[1]。近年来，在肿瘤分子分型指导下的小分子靶向药物显著改善驱动基因突变肺癌患者的预后，患者总体生存时间(overall survival, OS)显著延长，已成为治疗驱动基因阳性晚期肺癌的基石^[2-3]。     

寡转移状态下的非小细胞肺癌合并脑转移治疗

<正>据统计,中国每年有75万新发肺癌病例,其中约70%在诊断时已为晚期肺癌[1]。肺癌患者一旦存在远处转移即被划分为晚期肺癌,肝、肾上腺、脑、骨等器官为常见的远处转移部位,其中脑部转移占30%～50%,且脑转移约有50%为单发脑转移。未接受任何治疗的非小细胞肺癌(NSCLC)合并脑转移患者中位生存期仅为1～2个月[2]。传统观点认为晚期肺癌应采取姑息治疗而非积极的手术治疗,近年来越来越多的研究[2～5]证实寡转移状态下的NSCLC患者发生远     

肺鳞癌行免疫联合化疗的新辅助治疗获得病理完全缓解1例报告

<正>肺癌的发病率和病死率在恶性肿瘤中排首位，其中非小细胞肺癌(non-small-cell lung cancer,NSCLC)占所有肺癌的85%左右^[1]。肺癌的5年生存率与分期密切相关，手术治疗是一些早期NSCLC的主要治疗手段。但即使肿瘤被完全切除，局部和远处复发率仍较高。含铂类药物的辅助化疗已成为可手术切除的NSCLC患者的首选治疗。     

CircRNA影响NSCLC增殖、侵袭相关信号通路研究进展

<正>肺癌(LC)患病率和病死率在全球范围内呈逐年递增趋势。2018年全球癌症协会统计全球新增病例约有209万和死亡病例约有176万^[1]。LC现在已经成为全球最常见的恶性肿瘤和致死原因之一^[2]。依据组织病理学可以将LC分为占80%～85%非小细胞肺癌(NSCLC)及占15%～20%小细胞肺癌(SCLC)^[3]。虽然近代医学在诊断技术及治疗手段 (包括手术、放疗和化疗)方面不断进步，但大部分LC患者就诊时已进入晚期^[4]。     

HER2/neu靶向治疗与非小细胞肺癌

在世界范围内,肺癌是发病率最高的肿瘤之一,同时也是病死率最高的肿瘤。人们估计,在美国2001年新诊断了169500例肺癌患者,死亡157400例[1]。根据临床表现和细胞学类型,肺癌分为小细胞肺癌(SCLC)和非小细胞肺癌(NSCLC),85%肺癌患者的病理类型为NSCLC。绝大部分NSCLC患者就诊时已处于晚期(ⅢB期或Ⅳ期)。这些晚期患者已经失去手术和放疗的机会,临床上只能采用全身化疗的方法进行治疗。目前对于晚期肺癌,最好的化疗方案的有效率也只有15%～21%,患者的中位生存期为7～8个月。因此,近些年来人们根据肿瘤细胞的分子生物学特征,开发了针对…     

肺癌靶向治疗全程中医证候的研究进展

<正>肺癌是我国乃至世界死亡率最高的恶性肿瘤,非小细胞肺癌(NSCLC)是其中最主要的病理分型^[1]。表皮生长因子受体(EGFR)酪氨酸激酶抑制剂(TKIs)可有效延长EGFR阳性NSCLC患者的生存期,已广泛应用于早期肺癌新辅助治疗、术后辅助治疗及晚期NSCLC维持治疗^[2]。长期广泛的基础和临床研究证实,中医药在肺癌靶向治疗不同阶段可发挥“增效”“减毒”双重疗效。     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.