肺癌早期诊断方法的研究进展

目的 肺癌是全球发病率及死亡率最高的恶性肿瘤，患者5年生存率仍低于20%，提高早期诊断及筛查至关重要，本文对肺癌早期诊断方法进行文献综述。方法 检索PubMed、知网、万方、维普等数据库，选择与肺癌筛查相关的文献，进一步选择如CT、核磁共振、MiRNA、自身抗体等文献，提炼其相关结果结论。结果 肺癌早期诊断方法较多，每一种诊断方法均有其优缺点。结论 目前尚无任何一种技术被证实能独立完成早期肺癌的筛查，需要将目前早期诊断技术加以优化组合，以提高早期肺癌的诊断率。     

肺癌相关基因的研究进展及其意义

肺癌是目前人类发病率和死亡率最高的恶性肿瘤,其发病与基因多态性及遗传易感性之间可能存在联系,尤其是癌基因和抑癌基因的突变在肺癌的发生、发展和预后中具有重要意义。其中,p53r、as基因频发点突变,在肺癌基因诊断中具有非常重要的作用。由此,肺癌基因与防癌抑癌基因的发现、研究和分析将大大地有助于临床对肺癌的诊断、治疗及预防。     

LUNX mRNA在恶性胸腔积液中表达及其诊断价值

目的 检测LUNX mRNA在非小细胞肺癌胸腔积液中的表达,并分析其诊断价值.方法 采用实时荧光定量PCR方法检测非小细胞肺癌和肺良性病变患者胸腔积液中LUNX mRNA的表达情况,分析其表达和临床病理组织学特征的关系.结果 LUNX基因在非小细胞肺癌患者胸腔积液中阳性表达率为76.92％,而在肺良性患者胸腔积液中无表达.LUNX mRNA表达与非小细胞肺癌病理类型无关,但与其临床分期有密切关系.结论 LUNX基因可用于非小细胞肺癌早期诊断,治疗及预后.     

环境因素甲基化效应对肺癌发病影响的研究进展

肺癌是肿瘤致死的主要原因,其发病率与死亡率均位于疾病谱的前列。引起肺癌发生的最主要危险因素是吸烟,同时,还发现其他一些环境危险因素,包括放射性物质、石棉、金属和营养因素。肺癌中异常的DNA甲基化效应阐明了环境因素和肿瘤抑制关键基因相互作用的机制及其影响肺癌的方式。随着对肺癌发生机制的不断深入研究,环境因素诱发的DNA异常甲基化有望成为肺癌有潜力优势的诊断或预后标记物。某些特异基因的甲基化和肺癌密切相关,是肺癌发生常见的早期事件,这对于肺癌的早期诊断有十分重要的意义。     

微小染色体维持蛋白研究进展

微小染节体维持（mini chromosome maintenfdnce，Mcm）基因是影响微染色体有丝分裂稳定性的主要基因，其编码的MCM蛋白家族是一组与启动DIP,复制密切相关的蛋白质；Mcm蛋白的过度表达可以作为检测肿瘤细胞的指标，在肺癌和食管癌的诊断、预后评价、临床治疗等方面具有重要的应用前景；本研究对Mcm蛋白的组成、作用、相互关系、调控及其在正常和胸部肿瘤组织中表达的意义方面进行综述。     

热休克蛋白60和膜粘连蛋白-2在肺癌中的诊断意义

目的:评估热休克蛋白60(HSP60)和膜粘连蛋白-2(annexin-2)在非小细胞肺癌中的诊断意义。方法:100名诊断肺恶性肿瘤患者分为早期肺癌组和晚期肺癌组,每组中再次分为鳞癌亚组和腺癌亚组。由肿瘤病灶处和对应的正常组织处提取新鲜组织测定蛋白表达水平并进行比较。结果:在进展期肺腺癌组中,将肿瘤组织中HSP60和annexin-2的表达量与正常组织进行对比。HSP60的表达量具有统计学差异(P0.05)。annexin-2的表达量具有统计学意义(P0.05)。结论:在早期肺癌的诊断中,HSP60和annexin-2是鳞癌和腺癌的重要标记物。     

非小细胞肺癌遗传与表遗传研究若干进展

非小细胞肺癌是恶性肿瘤中导致死亡的主要癌症。非小细胞肺癌早期诊断可及时发现病人,及时治疗,以获得较好的治疗效果。因此,很有必要开发一种能够在癌症早期准确诊断非小细胞肺癌的方法。目前来说,肺癌分子标志物检测在非小细胞肺癌的诊断中有一定的价值。大量分子生物学研究表明,基因多态性是肺癌发生的重要因素。此外,在肺癌发展过程中表遗传改变的重要性也逐渐被认识到。在未来非小细胞肺癌研究中,一种结合流行病学、遗传学和表遗传学的综合的研究方法会显得非常重要。     

MiR-191靶向调控TIMP3促进肺癌细胞恶性转化进程的研究

目的探索miR-191靶向调控基质金属蛋白酶抑制剂3(TIMP3)对肺癌细胞增殖、迁移、侵袭影响及相关机制,为深入了解肺癌发生发展机制及寻找新的诊断和治疗靶标提供新思路。方法 Target Scan软件预测miR-191的潜在靶基因;双荧光素酶报告实验检测miR-191对TIMP3调控作用; Western blot和实时定量聚合酶链式反应(qPCR)检测正常肺细胞CCD-19Lu和肺癌细胞A549中TIMP3、miR-191表达水平;肺癌细胞A549中转染anti-miR-191后检测TIMP3蛋白表达变化;噻唑蓝(MTT)检测细胞增殖能力; Transwell检测细胞迁移、侵袭能力; Western blot检测细胞中MMP2、JNK、p-JNK、β-actin蛋白表达水平。结果 Target Scan预测软件发现TIMP3是miR-191的潜在靶基因;双荧光素酶报告实验证实TIMP3是miR-191的靶标;正常肺细胞CCD-19Lu中miR-191表达较低,TIMP3 mRNA表达较高;肺癌细胞A549中miR-191表达较高,TIMP3 mRNA表达较低;肺癌细胞A549中转染anti-miR-191可显著增加TIMP3蛋白表达;MTT结果显示肺癌细胞增殖未受明显影响; Transwell实验结果表明anti-miR-191可抑制细胞迁移和侵袭; Western blot结果显示TIMP3下游癌蛋白MMP2、p-JNK显著下调。结论 TIMP3是miR-191的一个靶标,肺癌中高表达的miR-191可靶向抑制TIMP3激活MMP2、JNK等癌基因促使肺癌细胞发生恶性转化; miR-191/TIMP3信号轴在肺癌恶性病变过程中可能起重要作用,可成为肺癌早期诊断与靶向治疗的分子靶标。     

Survivin蛋白在肺癌中的表达及意义

目的探讨Survivin蛋白在肺癌中的表达及其临床病理学意义。方法应用免疫组织化学方法检测65例肺癌组织、10例癌旁肺组织、8例肺良性病变组织中Survivin蛋白表达情况。结果Survivin蛋白在肺癌中的阳性表达率为70.77%,在癌旁肺组织及肺良性病变组织中表达阴性。非小细胞肺癌Survivin蛋白阳性表达率为78.85%,小细胞肺癌为38.46%,二者之间比较差异有统计学意义(P<0.01)。Survivin蛋白表达与肺癌淋巴结转移有关。结论Survivin蛋白的过度表达在肺癌发生中可能起重要作用,Survivin有可能成为肺癌早期诊断和预后判断的参考指标。     

蛋白质组学在肺癌相关标志物挖掘中的应用

肺癌是全球发病率和死亡率最高的恶性肿瘤,其5年生存率仅为15%,但早期诊断出的肺癌患者5年生存率可达52%。缺乏早期诊断及有效治疗手段使得肺癌的死亡率很高。因此,寻找新的早期诊断和预后标志物为治疗打开新途径迫在眉睫。蛋白质组学技术具有足够的灵敏度,特异性和可重复性,它正成为肺癌生物标志物和治疗靶点研究的一个重要工具。本文就近年来肺癌的蛋白质组学研究进展包括肺癌的预防、早期诊断和治疗方法等进行综述。     

基于机器学习的肺癌图像辅助诊断应用研究

目的:为满足肺癌临床早期筛查需求,拟在CT图像分析及病理细胞学诊断中建立智能化辅助筛查工具,提高图像分析效率,降低医生工作量。方法:在对肺癌临床早期诊断技术研究基础上,提出基于机器学习建立肺癌CT及病理切片图像辅助分析工具的方案;基于人工智能辅助诊断理念,采用图像模式增强、分割及机器学习分类模型等方法构建肺癌图像辅助诊断系统,以解决肺癌早筛的推广及应用范围受区域医疗资源分布限制的问题。结果:通过构建肺癌图像辅助诊断系统,实现了CT图像肺结节分割、数字病理细胞及细胞核分割、CT肺结节辅助筛查及细胞及细胞核辅助筛查等功能;系统阳性病例的辅助诊断准确率接近临床低年资医生的诊断水平,平均筛查时间缩短58%,为肺癌早期筛查创造条件。结论:通过构建肺癌图像辅助诊断系统,提高了图像分析效率,降低医生工作量,将一定程度上缓解区域医疗资源不平衡,为临床诊断提供辅助筛查支持,有助于提高肺癌早期筛查在临床的应用范围。     

肺癌患者血清脂蛋白Lp（a）与CEA水平分析

[目的]探讨血清脂蛋白（a）[Lp（a）]、癌胚抗原（CEA）联合检测对肺癌的意义。[方法]测定82例肺癌患者的CEA、血清脂蛋白Lp（a）的水平并和健康对照组比较。[结果]肺癌组Lp（a）、CEA的水平分别为（362±141）mg/L和（34.92±15.6）ng/ml,明显高于对照组（P〈0.01）。二者检测对肺癌早期诊断有一定意义,二者联合检测使肺癌诊断准确性、敏感性、特异性均有很大提高。[结论]二项血清学指标联合检测对肺癌的辅助诊断有重要临床意义。     

肺癌合并肺动脉栓塞症的CTA表现

探讨肺癌患者合并肺动脉栓塞（PE）的临床表现及CT血管成像（CTA）特点,提高对肺癌并发肺动脉栓塞的防治认识,并研究两者在临床上诊断上的相关性。方法：回顾性分析763例原发性肺癌患者的临床及影像资料,9例确诊肺动脉栓塞,同时分析其诊断及治疗相关性。结果：肺癌患者急性肺动脉栓塞的发生率约1.2%（9/763）。9例患者均静脉应用肝素和口服华法林抗凝治疗,其中2例采用了尿激酶溶栓治疗,经积极溶栓及抗凝治疗后效果良好。结论：重视肺癌合并肺栓塞的及早期诊断与治疗,CTA对肺血栓栓塞症的诊断简便、安全、准确率高,敏感性和特异性较高,是诊断肺癌合并肺动脉栓塞症的理想检查方法。     

Role of positron emission tomography-computed tomography in non-small cell lung cancer

Lung cancer is the leading cause of cancer-related mortality worldwide. Non-small cell carcinoma and small cell carcinoma are the main histological subtypes and constitutes around 85% and 15% of all lung cancer respectively. Multimodality treatment plays a key role in the successful management of lung cancer depending upon the histological subtype, stage of disease, and performance status. Imaging modalities play an important role in the diagnosis and accurate staging of the disease, in assessing the response to neoadjuvant therapy, and in the follow-up of the patients. Last decade has witnessed voluminous upsurge in the use of positron emission tomography-computed tomography (PET-CT); role of PET-CT has widened exponentially in the management of lung cancer. The present article reviews the role of 18-fluoro-deoxyglucose PET-CT in the management of non small cell lung cancer with emphasis on staging of the disease and the assessment of response to neoadjuvant therapy based on available literature.     

Our experience using autofluorescence bronchoscopy

INTRODUCTION: Lung cancer is responsible for most cancer deaths in the world. The main reason for the poor prognosis is late diagnosis. Many patients could be successfully treated in early stage. AIMS: The authors performed 369 bronchological examination on 336 patients using autofluorescence bronchoscopy between 1998 and 2003 to detect preinvasive lesions and early forms of lung cancer. METHODS: Storz D-Light autofluorescence system has been used to perform the examinations. RESULTS: In one third of these patients invasive lung cancer developed during follow-up. Combining traditional white light and autofluorescence technique 50% more intraepithelial lesions have been observed and sensitivity has been increased by 69% compared to the lone use of white light bronchoscopy. CONCLUSIONS: Supported by most international studies these results emphasise that autofluorescence bronchoscopy has a major role in the early diagnosis of preinvasive bronchial lesions and may help in the prevention and early therapy of lung cancer.     

Generalizability of results from the National Lung Screening Trial

Lung cancer is the major cause of cancer-related death worldwide, with a 5-year survival of only 16?%. Most lung cancer cases are diagnosed at an advanced incurable stage. As earlier stages have a better prognosis, the key to reducing mortality could be early diagnosis of the disease. At present, low-dose computed tomographic (CT) screening has shown promising data. Lung cancer death rates were reduced by 20?% when CT screening is compared to chest radiography in a high-risk group. There are many advantages of CT screening in lung cancer, however there are also some important issues that should be taken into account. Therefore, the applicability of the results to clinical practice is not clear yet. In this Commentary we discuss different aspects that play important roles in the balance between harms and benefits of screening, including overdiagnosis, availability of treatment options worldwide, ethical considerations, costs, and prolonged life expectancy. We conclude that clinicians should be cautious in generalizing findings to the total population of smokers and take into account that the use of lung cancer screening in clinical practice may have limitations.     

Familial aggregation of breast cancer with early onset lung cancer.

Site-specific familial aggregation and evidence supporting Mendelian codominant inheritance have been shown in lung cancer. In characterizing lung cancer families, a number of other cancers have been observed. The current study evaluates whether first-degree relatives of early onset lung cancer cases are at increased risk of breast cancer. Families were identified through population-based lung cancer cases and controls under 40 years of age. Cases were ascertained through the Metropolitan Detroit SEER registry; controls through random-digit dialing. Data were available for 384 female relatives of 118 cases and 465 female relatives of 161 controls. Breast cancer in relatives was evaluated after adjusting for age, race, sex, and smoking status of each family member and the sex and age of the probands. A positive family history of early onset lung cancer increased breast cancer risk among first-degree relatives 5. 1-fold (95% CI, 1.7-15.1). Relatives of cases with adenocarcinoma of the lung were at highest risk (RR = 6.3, 95% CI 2.0-20). Mean age of breast cancer diagnosis among relatives of cases was 52.2 years and not statistically different from relatives of controls. Three case families also reported early ovarian cancers (mean age of diagnosis of 35 years). These findings suggest that shared susceptibility genes may act to increase risk of early onset lung and breast cancer in families.     

多基因表达与非小细胞肺癌术后复发的预测

尽管近年来医学生物科技水平不断进步,诊断和治疗水平不断提高,但是肺癌的早期发现,诊断和治疗,以及对于术后是否有复发的预测仍然是有待进一步努力和提高的关键部分。