Analysis of 30 patients with persistent or recurrent squamous cell carcinoma of the cervix within one year after concurrent chemoradiotherapy

Objective： To investigate the recurrence sites, risk factors, and prognosis of＇patients with persistent or recurrent squamous cell carcinoma （SCC） of the cervix within one year after undergoing concurrent chemoradiotherapy （CCRT）. Methods： Clinical data of 30 patients with persistent or recurrent SCC of the cervix within one year after CCRT between July 2006 and July 2011 were analyzed retrospectively： These data were compared with those of 35 SCC cases with no signs of recurrence after complete remission. These 35 patients were treated during the same period （between 2,006 and Z011） and selected randomly. Results： Among these 30 patients, 25 exhibited distant metastases of which 14 were observed within 6 months after CCRT. Univariate analysis showed higher incidence of pelvic or para-aortic lymphadenectasis and SCC-ag 〉 10 ng/mL in the group with persistent or recurrent disease before treatment （P〈0.01）. Multivariate analysis by logistic regression revealed that the pre-therapeutic pelvic or para-aortic lymph node enlargement and SCC-ag 〉 10 ng/mL were the independent risk factors. Palliative chemotherapy was the main treatment option for patients with persistent or recurrent disease. The 2-year survival rate was 21.7%, and the median survival time was 17 months. Conclusion： Patients with persistent or recurrent SCC of the cervix after CCRT exhibited a high rate of distant metastasis with poor prognosis. The pre-therapeutic pelvic or para-aortic lymph node enlargement and SCC-ag 〉10 ng/mL were identified as the independent risk factors for persistent or recurrent SCC within i year after CCRT.     

宫颈鳞状细胞癌预测指标的模型建立与分析

目的:通过检测HR-HPV感染、hTERC、c-myc基因扩增和MCM5蛋白在宫颈鳞状细胞癌及不同级别宫颈上皮内瘤变中的水平,筛选宫颈癌相关指标,建立回归模型用以预测宫颈鳞状细胞癌,并评估模型效果。方法:筛选初诊病理确诊宫颈鳞状细胞癌和CIN I、II、III级患者共200例作为研究对象,分别检测HR-HPV感染、hTERC、c-myc基因扩增及MCM5蛋白表达,用Logistic向后逐步回归的方法,筛选宫颈癌相关指标,建立回归模型预测宫颈鳞状细胞癌,并评估模型效果。结果:将HR-HPV负荷量及感染状况、hTERC、c-myc基因扩增和MCM5蛋白表达的检测数据绘制直方图,并进行Logistic向后逐步回归分析,得出hTERC、HR-HPV负荷量、MCM5回归系数分别为0.042、0.061和0.052,P值分别是0.024、0.005、0.005（P＜0.05）,HR-HPV感染状态和c-myc基因P值是0.856和0.682（P＞0.05）,被回归方程排除,提示hTERC（X1)、HR-HPV负荷量(X2)、MCM5(X5）与回归方程存在线性关系,即与宫颈鳞状细胞癌发生有关,由此建立回归模型Logit(P)=-66.283+0.042X1+0.061X2+0.052X5。评估模型拟合优度和预测准确度,H-L检验P值=1(P＞0.05),模型拟合效果好,Cox-Snell R2=0.643,Nagelkerke R2=0.958,模型预测准确度98.5%,模型预测准确性高。结论:由hTERC、HR-HPV负荷量和MCM5蛋白建立的回归模型拟合效果较好,对宫颈鳞状细胞癌的预测准确度较高,hTERC、HR-HPV负荷量和MCM5蛋白联合检测能够用于宫颈鳞状细胞癌的预测评估,对CIN患者的分流管理和预后评估、宫颈鳞癌患者的早期诊断均有较高临床价值。     

中晚期宫颈鳞癌患者治疗前外周血Treg计数分析

背景与目的：中晚期宫颈鳞癌同期放化疗(concurrent chemoradiotherapy,CCRT)治疗前性价比高的疗效判断方法较有限,该研究拟通过检测治疗前外周血CD4⁺CD25⁺CD127^Low/-调节性T细胞(regulatory T cells,Tregs)亚群计数及血清鳞癌抗原(squamous cell carcinoma antigen,SCC-Ag)水平,评价两者预测临床疗效的可行性。方法：采集44例Ⅱ_B~Ⅳ_A期宫颈鳞癌患者行CCRT治疗前的外周血标本,分别利用流式细胞免疫表型分析和酶联免疫法检测外周血CD4⁺CD25⁺CD127^Low/- Treg计数及血清SCC-Ag水平。收集临床和病理资料,并统计检验2个指标对疗效的预测作用。结果：治疗前外周血CD4⁺CD25⁺CD127^Low/- Treg计数在临床有效组低于无效组［(8.78±2.80)% vs (10.95±2.56)%,P<0.05］,血清SCC-Ag在不同临床疗效组间差异无统计学意义,且这2个、指标之间未发现相关性(Spearman’rho=-0.093,P=0.540)。经受试者工作特征(receiver operating characteristic,ROC)曲线确定治疗前外周血CD4⁺CD25⁺CD127^Low/- Treg及血清SCC-Ag最佳界值分别为9.76%与9.50 ng/mL。单因素分析显示,治疗前外周血CD4⁺CD25⁺CD127^Low/- Treg计数(OR=1.901,95%CI：1.112~3.219,P=0.017)对CCRT疗效有预测作用,而血清SCC-Ag水平无预测作用(OR=0.998,95%CI：0.001~4.253,P=0.897)。多因素Logistic回归分析显示,治疗前外周血CD4⁺CD25⁺CD127^Low/- Treg为独立的临床疗效预测因子(OR=3.115,95%CI：1.253~7.742,P=0.014)。结论：治疗前外周血CD4⁺CD25⁺CD127^Low/- Treg计数用于中晚期宫颈鳞癌患者CCRT临床疗效预测具有可行性。     

基于TCGA数据库免疫基因表达谱构建253例宫颈鳞状细胞癌免疫亚组

目的 采用美国肿瘤基因组图谱(TCGA)数据库免疫基因表达谱构建宫颈鳞状细胞癌免疫亚型,并分析各免疫亚组特征,为宫颈鳞状细胞癌预后分析及治疗提供新指标.方法 TCGA数据库共下载253例宫颈鳞状细胞癌及3例癌旁正常组织的mRNA表达谱及临床数据.根据单样本基因集富集分析(ssGSEA)得分情况,将宫颈鳞状细胞癌分为高免...     

Contribution of DNA ploidy image cytometry to the management of ASC cervical lesions

BACKGROUND: The Bethesda system classifies smears that suggest an underlying cervical intraepithelial neoplasia (CIN) as ASC (atypical squamous cell) smears. ASC smears are subdivided into ASCUS (of undetermined significance) and ASCH (cannot exclude a high-grade lesion). Today the management of ASCUS is a triage with HR-HPV testing and colposcopy is recommended for ASCH. The aim was to conduct a study on ASC smears to determine DNA ploidy measurement for the detection of CIN2+. METHODS: The link between a suspect DNA ploidy assessed by image cytometry and/or a positive HR-HPV testing was analyzed on 69 ASCUS and 82 ASCH smears, and the presence of CIN2+ within 12 months after ASC diagnosis. The ploidy was suspect in case of aneuploidy, multiploidy, or in the presence of cells with a DNA content >5c or >9c. RESULTS: Every woman who had a CIN2+ had a suspect DNA profile in the ASCUS smears and every woman except 1 was HR-HPV-positive. The link between a positive HR-HPV test or a suspect DNA profile or both and a CIN2+ was high (P = .019, .023, and .008, respectively). The presence of >9c cells was particularly linked to CIN2+ (P = .0031). In all, 90.9% and 87.9% of the ASCH smears with CIN2+ were, respectively, HR-HPV positive or had a suspect ploidy (P = .0000 and P = .0043), and the presence of >9c cells was also linked to CIN2+ (P = .003). CONCLUSIONS: HR-HPV testing and determination of the ploidy profile with special attention to 9c-exceeding cells could be accurate for a better management of ASC smears.     

基于Cf DNA检测探索局部晚期食管鳞癌同期放化疗敏感性相关基因的初步研究

目的 探索局部晚期食管鳞癌同期放化疗敏感性相关基因及分子标志物。方法 收集2017—2018年间 31例在中国医学科学院肿瘤医院采用根治性同期放化疗的局部晚期食管鳞癌患者治疗前外周血并提取血浆Cf DNA,采用基于NovaSeq6000高通量测序平台的目标基因捕获测序技术检测靶基因与肿瘤突变负荷(TMB)变化。根据放化疗近期疗效将患者分为放化疗敏感组(CR+PR)和放化疗抗拒组(SD+PD),综合生物信息学和临床资料分析两组间的基因突变和TMB差异。结果 31例患者测序数据中突变频率>10%的肿瘤相关基因为Tp53、NOTCH1、BRAF、FGFR4、CDKN2A、ATRX和AXIN2,他们在放化疗敏感组和放化疗抗拒组均有分布且相近。高频突变基因主要与7条信号通路相关,主要涉及凋亡信号通路和细胞周期信号通路等,它们主要参与的是RTK-RAS信号通路。放化疗敏感组患者TMB值高于放化疗抵抗组(P=0.04),但GXYLT1和KRT18基因在放化疗抵抗组患者的突变率高于放化疗敏感组(P<0.05)。结论 Tp53、NOTCH1和CDKN2A可能是与食管鳞癌发生发展相关的高频突变基因,而KRT18、GXYLT1和TMB与局部晚期食管鳞癌患者同期放化疗敏感性密切相关。     

Foxp3+Treg和IDO+APC细胞在不同病变宫颈组织中的表达

目的:检测免疫抑制细胞Foxp3+Treg和免疫蛋白IDO在不同病变宫颈组织中的表达情况。方法:采用免疫细胞化学及蛋白印记（Western blot）检测Foxp3蛋白及IDO蛋白在宫颈癌细胞系HeLa、SiHa及C33A中的表达与分布;采用免疫组织化学法检测Foxp3和IDO在20例正常宫颈组织及45例不同程度宫颈病变组织中的表达情况。结果:Foxp3蛋白在HeLa、SiHa及C33A中无表达;IDO蛋白在HeLa、SiHa及C33A细胞的胞浆中均有表达。Foxp3蛋白在宫颈组织中表达于Treg,IDO蛋白在宫颈组织中表达于APC和/或异常细胞。宫颈病变组织中的Foxp3+Treg（H=43.211,P=0.000）和IDO蛋白的表达均明显高于正常组织（χ2=20.028,P=0.00;Z=226.600,P=0.00）。随着病理级别升高,Foxp3+Treg的侵袭性（H=28.307,P=0.000）增加,Foxp3+Treg与IDO+APC的数目显著正相关（rs=0.550,P=0.003）统计学正相关（rs=0.550,P=0.000）。结论:在宫颈癌进展的不同病理阶段,局部微环境中Foxp3+Treg数目随宫颈细胞恶性转化的进程而增多,IDO+APC细胞在早期宫颈病变组织中表达多于晚期病变。     

不同病理类型局部晚期(ⅠB2及ⅡA2期)宫颈癌的预后情况分析

目的探讨不同病理类型局部晚期(ⅠB2、ⅡA2期)宫颈癌的预后情况。方法选取169例ⅠB2、ⅡA2期宫颈癌(鳞状细胞癌149例,腺癌或腺鳞癌20例)患者,根据治疗模式的不同将其分为同期放化疗组、根治性手术组、新辅助化疗+根治性手术组。比较不同病理类型及不同治疗模式局部晚期宫颈癌患者的2年无复发生存率,分析120例接受过根治性手术的局部晚期宫颈癌患者的病理类型与其他临床特征的关系,并比较新辅助化疗+根治性手术组中不同病理类型局部晚期患者对新辅助化疗的反应。结果截至随访结束,随访超过2年者137例,2年无复发生存率为83.9%(115/137),其中,鳞状细胞癌患者的2年无复发生存率高于腺癌或腺鳞癌患者(P﹤0.05)。同期放化疗组、根治性手术组、新辅助化疗+根治性手术组患者的2年无复发生存率分别为77.3%、87.0%、87.2%。接受根治性手术或新辅助化疗后行根治性手术+术后辅助放疗和(或)化疗的120例宫颈癌患者中,肌层浸润情况与局部晚期宫颈癌患者的病理类型可能有关(P﹤0.05)。接受新辅助化疗+根治性手术+术后辅助放疗和(或)化疗的62例患者中,鳞状细胞癌患者58例,包括CR患者14例,PR患者40例,SD患者4例;腺癌/腺鳞癌患者4例,包括CR患者1例,PR患者3例。鳞状细胞癌患者与腺癌/腺鳞癌患者对新辅助化疗的反应比较,差异无统计学意义(P﹥0.05)。结论局部晚期宫颈癌患者的近期预后较好,腺癌或腺鳞癌患者的预后较鳞状细胞癌患者差。对于病理类型为腺癌/腺鳞癌的局部晚期宫颈癌,建议在治疗方式上较鳞状细胞癌更激进,不建议保留卵巢功能,更倾向于以根治性手术为主的综合治疗,可望改善患者预后。     

预防性脑照射在小细胞肺癌治疗中的应用进展

<正>目前,小细胞肺癌(small cell lung cancer,SCLC)在肺癌中占12.95%,其生长速度快、转移播散时间早、对放化疗的初始敏感度高[1]。然而,SCLC的治疗依然是是医学上的一个难题。在过去10年里,SCLC患者的生存率并没有显著提高,5年生存率最高仅为20%²5%。脑转移是SCLC转移的最常见部位之一,也是治疗失败的常见原因[2]。随着患者生存期的延长,脑转移的发生率还有增高的趋势。     

PD-L1与PD-1在宫颈鳞癌与宫颈良性病变组织及外周血中的表达及其预后价值

目的:通过分别对宫颈鳞癌、宫颈良性疾病组织和配对血液标本检测,了解外周血程序性死亡受体1(PD-1)与肿瘤组织程序性死亡受体-配体1(PD-L1)表达的一致性,初步评价其与宫颈鳞癌预后的关系。方法:收集宫颈鳞癌及宫颈良性病变组织标本各70例,并收集配对的外周血标本鳞癌24例,良性病变30例。免疫组化法检测组织PD-L1,流式细胞术检测外周血T细胞表面PD-1+亚群的比例,并结合生存资料做统计分析。结果:宫颈鳞癌患者外周血PD-1与组织PD-L1表达呈正相关（r2=0.734,P=0.000;r2=0.66,P=0.000）,宫颈良性病变者外周与组织的表达不相关（r2=0.138,P=0.043;r2=0.174,P=0.022）。宫颈癌患者血CD8+PD-1+细胞百分比、组织PD-L1+的细胞数大于宫颈良性病变组（P=0.000,P=0.002）。宫颈癌患者随肿瘤直径增大、分期升高,肿瘤组织PD-L1表达量也相应升高,外周T细胞表面PD-1表达也有类似趋势。但是外周T细胞表面PD-1表达程度与肿瘤大小、分化程度、深肌层侵犯均无关。单因素分析提示外周CD4+T细胞低表达PD-1的、组织低表达PD-L1的患者生存期较长。多因素分析结果显示,PD-L1表达对患者生存有影响（B=1.844,P=0.019）。结论:宫颈鳞癌患者外周血PD-1、组织PD-L1表达与肿瘤的分级、预后有关,组织PD-L1表达是患者的独立预后因素。     

免疫磁珠分选的口腔鳞状细胞癌干细胞诱导分化及成瘤活性研究

目的 探讨口腔鳞状细胞癌干细胞的诱导分化及成瘤活性。方法 采用免疫磁珠分选法从6例原代培养的口腔鳞状细胞癌细胞中分选出CD133⁺、CD44⁺细胞，以流式细胞术检测其纯度及细胞周期，并绘制CD133⁺细胞生长曲线。将分选出的细胞经诱导向成骨肪细胞及成脂肪细胞分化，将原代鳞癌细胞、分选所得的CD44⁺细胞及CD133⁺细胞进行体内成瘤实验。 结果 经免疫磁珠分选法成功获得CD44⁺细胞、CD133⁺细胞，其纯度经检测均在94%以上，且主要处于G0/G1期。CD133⁺细胞在接种后第2天进入对数期，细胞倍增时间为3.22 d。经诱导后CD44⁺、CD133⁺细胞成功分化为成骨细胞及成脂肪细胞。皮下注射后第3天可触及新生肿物，在3种细胞成瘤实验中CD133⁺细胞组瘤体体积最大，HE染色显示符合低分化口腔鳞状细胞癌病理表现。结论 免疫磁珠分选法可高效获得高纯度的口腔鳞状细胞癌干细胞。CD44⁺、CD133⁺细胞均具有较强的多向分化能力，CD133⁺细胞成瘤性较强。     

食管癌、贲门癌患者外周血CD+8 NKT细胞活化受体NKG2D及其分泌性配体sMICA检测的临床意义

 目的 　探讨外周血CD+8 NKT细胞活化受体NKG2D及其分泌性配体sMICA检测在食管癌、贲门癌诊断及术后疗效评价中的临床意义。方法　对53例患者确诊后（29例手术患者术前14 d及术后14 d）及30名健康对照组采用流式细胞术对外周血CD+8 NKT细胞中活化受体NKG2D阳性细胞百分比测定,应用酶联免疫吸附法进行sMICA含量测定,并各自进行差异性分析,同时对两者进行依从性分析。结果　患者外周血CD+8 NKT细胞中NKG2D阳性细胞百分比为（77.632±8.972）%,明显低于对照组的（89.053±6.515）%（t＝-6.113,P＜0.05）;TNM分期Ⅱ、Ⅲ、Ⅳ期患者依次降低（F＝99.251,P＜0.01）;有区域淋巴结转移者均低于无区域淋巴结转移者（t＝-10.384,P＜0.01）;鳞状细胞癌高于腺癌（t＝9.899,P＜0.01）;术前均低于术后（t＝-4.319,P＜0.01）。患者血清sMICA的含量为（326.28±85.407）pg／ml,明显高于对照组的（210.00±22.560）pg／ml（t＝7.292,P＜0.01）;Ⅱ、Ⅲ、Ⅳ期患者依次增高（F＝63.355,P＜0.01）;有区域淋巴结转移者均高于无区域淋巴结转移者（t＝7.770,P＜0.01）;鳞状细胞癌低于腺癌（t＝-7.593,P＜0.01）;术前均高于术后（t＝7.027,P＜0.01）。血清sMICA对外周血CD+8 NKT细胞活化受体NKG2D有抑制作用（F＝142.773,P＜0.05）,决定系数R2＝0.7368。结论　外周血CD+8 NKT细胞活化受体NKG2D及其分泌性配体sMICA含量的测定有助于食管癌、贲门癌分期的临床辅助诊断,对判断其生物学行为及预后有重要临床意义,并可作为患者手术治疗效果指标。     

Combination chemotherapy with nedaplatin (CDGP) and 5-FU for oral cancer

Chemotherapy using CDGP plus 5-FU was evaluated in patients with oral cancer. The subjects were patients with squamous cell carcinoma of the oral cavity who had not received any therapy, comprising 7 patients with carcinoma of the tongue, 2 with buccal carcinoma, 2 with maxillary gingival carcinoma, and 1 with carcinoma of the oral floor. There were 4 patients in Stage II, 3 patients in Stage III and 5 patients in Stage IV. Patients with a PS < or = 1, WBC > or = 4,000/mm3, Hb > or = 10 g/dl, platelet count > or = 10 x 10/mm3, and normal liver, kidney, and heart function at baseline were selected for this study. In all patients, 5-FU was administered at a dose of 600 mg/m2/day for 5 days (day 1 to day 5) by continuous infusion, for a total dose of 3,000 mg/m2. CDGP was administered on day 1 at a dose of 80 mg/m2 in 8 patients and at 100 mg/m2 in 4 patients. This treatment was one course of therapy, and patients received 1 or 2 courses. Of 12 patients who were evaluable, there were 9 partial responses and 3 no changes, for a major response rate of 75%. Toxicities experienced by patients were mild (grade 2 or lower) gastrointestinal disorders (including nausea/vomiting) and renal impairment, while grade 3 leukopenia and thrombocytopenia developed in 1 patient each and grade 4 thrombocytopenia occurred in another patient. Thus, patients receiving CDGP + 5-FU therapy should be closely monitored for hematologic toxicity. Since CDGP + 5-FU therapy achieved a good response rate (75%) in the treatment of squamous cell carcinoma of the oral cavity, we plan to use this therapy in the future and assess its benefit in a larger number of patients.     

Coexpression of cyclooxygenase-2 and thymidine phosphorylase as a prognostic indicator in patients with FIGO stage IIB squamous cell carcinoma of uterine cervix treated with radiotherapy and concurrent chemotherapy

PURPOSE: To evaluate the prognostic significance of thymidine phosphorylase (TP) and coexpression of cyclooxygenase-2 (COX-2)/TP, and to investigate the relationship between COX-2 and TP expression in squamous cell carcinoma of the uterine cervix. METHODS AND MATERIALS: Cancer specimens from 75 patients with International Federation of Gynecology and Obstetrics Stage IIB squamous cell carcinoma of the uterine cervix who had undergone radiotherapy and concurrent chemotherapy were immunohistochemically stained with COX-2 and TP antibodies and scored. The prognostic significance of their expression status, and the relationship between COX-2 and TP was investigated. RESULTS: TP predominantly stained cytoplasm and the cell membrane of the tumor cells mainly in a diffuse and intense manner. TP was negative (<10% distribution) in 17%, 1+ (10-50%) in 25%, and 2+ (>50%) in 57% of patients. TP overexpression was related to a marginal prognostic significance of a poor 5-year overall survival (p = 0.082, log-rank test) and a high locoregional recurrence rate (p < 0.1, chi-square test). COX-2 and TP coexpression was observed in 24% of patients and was significantly related to poor 5-year disease-free and overall survival rates (p = 0.0083 and p = 0.025, respectively), a high pelvic lymph node involvement rate, a poor response to treatment, and a greater incidence of locoregional recurrence (p < 0.05). By multivariate analyses, only COX-2, TP, and coexpression of COX-2/TP were significant independent prognostic indicators of patient survival. All tumors showed 1+ or 2+ TP expression when COX-2 was positive, and no tumor expressed COX-2 when TP was negative (p = 0.03). In contrast, 77% of tumors expressed 1+ or 2+ TP without the synchronous expression of COX-2. CONCLUSIONS: Thymidine phosphorylase expression or COX-2/TP coexpression may be used as a molecular prognostic marker for squamous cell carcinoma of the uterine cervix. TP appears to be an important downstream molecule of COX-2 during angiogenesis and may be a new target for the treatment of uterine cervical cancer.     

Phase II study of rhizoxin in squamous cell head and neck cancer. The EORTC Early Clinical Trials Group.

To test the anti-tumour activity of rhizoxin in recurrent and/or metastatic squamous cell head and neck cancer, we performed a phase II study. Eligibility required histologically proven squamous cell head and neck cancer. Patients could only have received one prior chemotherapy. Patients were entered if WHO PS was < or = 2 and organ functions were normal. Treatment consisted of rhizoxin 1.5-2.0 mg m-2 i.v. bolus injection once every 3 weeks. Thirty-two patients entered the study. All were eligible, 31 were evaluable for toxicity and 25 for response. Toxicity mainly consisted of pain at the tumour site and leucocytopenia. Mild asthenia and stomatitis were also observed. Two objective partial responses, lasting 7.5 and 3.5 months, were seen. Rhizoxin at this dose and schedule has minor activity in recurrent and/or metastatic squamous cell head and neck cancer.     

CD1a标记树突细胞在声门型喉鳞癌中的表达及其临床意义

背景与目的:树突细胞(dendriticcell,DC)是最重要的抗原呈递细胞(antigenpresentingcell,APC),而CD1a作为未成熟DC的标记物,在肿瘤的发生及发展过程中有一定的影响。本文旨在探讨CD1a DC与声门型喉癌病理分级、T分期及局部复发的关系,从而间接了解它与预后的关系。方法:收集111例有完整病理资料及临床随诊资料的声门型喉鳞癌病例,并取17例非肿瘤组织做对照。用免疫组化技术检测CD1a DC在癌组织中的表达,分析癌组织中CD1a DC在不同病理分级、T分期及局部复发组织中的表达,间接了解其与声门型喉鳞癌预后的关系。结果:111例声门型喉鳞癌病例中,CD1a阳性率为59.46%(66/111);高分化组阳性率为71.43%(55/77),中低分化组阳性率为28.57%(11/34);T1 T2组阳性率为67.16%(45/67),T3 T4组阳性率为47.73%(21/44)。局部复发组阳性率为42.86%(12/28),局部无复发组阳性率为65.06%(54/83)。17例非肿瘤组织中CD1a均为阴性。结论:声门型喉鳞癌中,肿瘤细胞分化越差,T分期越高,则CD1a标记树突细胞阳性率越低。局部复发者CD1a DC阳性率低。CD1a可作为预测声门型喉鳞癌预后的参考指标之一。     

多西他赛联合顺铂治疗老年晚期非小细胞肺癌的疗效观察

<正>目前,我国肺癌发病率与死亡率居高不下,其中非小细胞肺癌(NSCLC)约占肺癌总数的80%以上,死亡率也高达85%左右[1]。由于非小细胞肺癌在初诊时,约有50%左右的患者已出现胸腔外转移,10%¹5%的患者初诊时已属局部晚期,错过手术时机[2]。我们观察并探讨了多西他赛联合顺铂治疗老年晚期NSCLC患者的临床疗效及安全性,现将结果报告如下。一、资料与方法1.一般资料:选取2010年1月至2012年12月间确诊     

生物标志物在非小细胞肺癌中的研究进展

<正>肺癌是世界范围内常见的癌症且是导致癌症患者死亡的主要原因之一[1],非小细胞肺癌(non-small cell lung cancer,NSCLC)占肺癌的80%⁸5%,总体而言,晚期非小细胞肺癌的预后仍然较差,5年生存率不到15%[2]。因此,寻求NSCLC新的治疗手段以及个体化治疗至关重要。当今,NSCLC患者个体化治疗中,利用分子标志物判断预后和指导治疗成为研究热点。通过检测分子标志物指导个体化治疗,能够选择最有效的治疗策略,使疗效最大化,最大程度降低毒性。然而,影响肺癌发病机制的分子生物学机制十分复     

CYP2D6遗传多态性与肺癌易感性关系的研究

目的探讨CYP2D6Ch基因多态性的频率分布,以及与肺癌的遗传易感性关系.方法应用病例-对照研究及PCR-RFLP等技术,检测肺癌及正常对照各50例的CYP2D6Ch基因型,并应用Logistic回归分析基因多态性与肺癌易感性的关系.结果(1)CYP2D6Ch T/T型(突变型)频率在病例组中为36.0%,在对照组中为50.0%;非T/T型(即C/C合并C/T基因型)与肺癌风险临界升高相关(OR=3.06;95%CI=0.94～9.92).(2)对病例组进行相关变量的分层分析后发现,在肺鳞癌,或轻度吸烟组中,CYP2D6Ch非T/T型与肺癌风险升高显著相关(分别为:OR=3.20,CI=1.04～9.85;OR=7.07,CI=1.16～42.85).结论本文提示CYP2D6Ch基因型分布规律与欧美人群差异较大,且T/T型在肺鳞癌或轻度吸烟者中可作为保护因素而降低肺癌的易感性.     

奈达铂联合吉西他滨与顺铂联合吉西他滨一线治疗晚期肺鳞状细胞癌随机对照临床研究

目的：与一线标准方案顺铂联合吉西他滨（DDP＋GEM）进行比较,评价奈达铂联合吉西他滨（NDP＋GEM）治疗晚期肺鳞状细胞癌的疗效与不良反应。方法2012年9月至2013年12月,依照入组标准入组101例ⅢB及Ⅳ期肺鳞状细胞癌初治患者,按随机数字表法分为两组：研究组69例患者接受NDP＋GEM治疗,对照组32例患者接受DDP＋GEM治疗。评价两组患者的近期有效率（RR）、疾病控制率（DCR）、无进展生存期（PFS）和不良反应。结果研究组和对照组 RR分别为28．6％（18／63）和15．6％（5／32）,DCR分别为81．0％（51／63）和68．8％（22／32）,差异均无统计学意义（χ2＝1．36,P＝0．24;χ2＝1．67,P＝0．20）,中位PFS分别为4．52个月和4．01个月,差异无统计学意义（χ2＝0．09,P＝0．73）。不良反应主要为骨髓抑制,两组发生率差异无统计学意义（33．3％∶37．5％,χ2＝0．17, P＝0．68）,研究组Ⅲ～Ⅳ级恶心呕吐发生率低于对照组,差异有统计学意义（14．5％∶56．3％,χ2＝19．02,P＝0．05）。结论 NDP＋GEM方案治疗晚期肺鳞状细胞癌的有效率与DDP＋GEM方案相当,但不良反应明显降低,提示NDP＋GEM可作为肺鳞状细胞癌的一线治疗方案,值得进一步开展研究。