甲状腺癌并肺转移

教授:今天讨论的病例为甲状腺癌并肺转移。肺转移癌胸片的阴影有随病程逐渐增大、增多的特征,但本例自查出甲癌肺转移后,其胸片4年无改变,此现象应引起临床注意。现请先报告病历。主管医师:患者女,22岁。住院号298853。因颈部包块6年,气急1年余,于1986年7月5日入     

表现为双肺弥漫性病变的甲状腺癌肺转移一例

患者 ,男性 ,14岁。右颈部淋巴结肿大、进行性消瘦一年、双肺弥漫性病变 15ｄ入院。一年前发现右颈部一枚 1.5ｃｍ×2 .0ｃｍ大小的淋巴结 ,并逐渐消瘦 ,活动后稍气喘 ,口唇轻度紫绀。入院前胸片和胸部ＣＴ检查提示双肺弥漫性结节影。入院体检 :体温 3 7.6℃ ,脉搏 78次 /ｍｉｎ ,呼吸 18次 /ｍｉｎ ,血压 10 5 /70ｍｍＨｇ ,体重 41.5ｋｇ。右颈前部发现一枚 1.5ｃｍ× 2 .0ｃｍ大小的淋巴结 ,质地较硬 ,与周围组织界线清楚 ,活动度差 ,无压痛。口唇轻度紫绀。血气分析检查提示轻度低氧。肺功能检查提示轻度弥漫功能障碍。ＰＰＤ皮试阴性 ,…     

利用131 I治疗分化型甲状腺癌肺转移患者的疗效评价及相关因素分析

目的研究分析131 I治疗分化型甲状腺癌肺转移患者的疗效评价及相关因素。方法选取2005年1月至2015年1月在榆林市第一医院、北京协和医院及四川大学华西医院治疗的分化型甲状腺癌肺转移患者82例作为研究对象,在接受甲状腺癌手术后,采用131 I 对其进行治疗,观察治疗3个月后的短期疗效,并分析影响疗效的相关因素。结果随着治疗次数的增加,患者的缓解率呈逐渐下降的趋势。分析131 I 治疗效果的影响因素,与男性相比,女性患者的治疗缓解率较高(χ2=5.707,P<0.05),且治疗前血清甲状腺球蛋白水平较低的患者治疗缓解率明显高于水平较高的患者(χ2=3.934,P<0.05)。进一步分析可见,治疗前甲状腺球蛋白水平是影响患者治疗效果的主要因素之一,缓解组与未缓解组比较差异有统计学意义(t=8.462,P <0.05)。经多元 logistic 回归分析,131 I的治疗效果与患者治疗前甲状腺球蛋白呈明显负相关。结论131 I对分化型甲状腺癌肺转移患者有十分显著的疗效,且患者性别、治疗前血清甲状腺球蛋白水平是影响其疗效的相关因素。     

分化型甲状腺癌209例临床分析

对我院收治的209例分化型甲状腺癌(DTC)患者的临床资料进行回顾性分析,以探讨影响DTC长期预后及复发的因素.发现209例DTC患者的复发率为18.7%,其5、10 a生存率分别为93.3%、86.4%;多因素分析表明,年龄、浸润程度、远处转移、临床病理分期是影响DTC预后的独立因素.认为年龄、浸润程度、远处转移、临床病理分期是影响DTC长期预后及复发的重要因素.     

放射性131Ⅰ治疗分化型甲状腺癌肺转移的疗效及其主要预后因素的系统评价

目的 对放射性131Ⅰ治疗分化型甲状腺癌肺转移的疗效及其主要预后因素进行系统评价.方法 计算机枪索了5个数据库.检出有关放射性131Ⅰ治疗分化型甲状腺癌肺转移疗效及其预后因素的文献,从中提取与131Ⅰ治疗及主要预后因素有关的患者的5年和(或)10年生存率,并用RevMan4.2软件进行统计分析.结果 共纳入11个回顾性队列研究.统计分析结果提示:接受131Ⅰ治疗与未接受131Ⅰ治疗患者的5年生存率分别为74.9%和27.1%.二组患者的10年生存率分别为60.8%和12.2%,二者之间的差异有统计学意义(P<0.01);仅肺转移患者的5年及10年生存率均高于合并多处转移的患者(P<0.01);乳头状甲状腺癌患者的5年及10年生存率均高于滤泡状甲状腺癌患者的5年(P=0.01)及10年生存率(P=0.002);男性与女性患者的5年及10年牛存率没有差异(P>0.05).结论 131Ⅰ治疗能明显提高分化型甲状腺癌肺转移患者的生存率;转移范围和组织学类型是分化型甲状腺癌肺转移患者的两个重要预后因素;患者的预后不受性别的影响.     

放射性131Ⅰ治疗分化型甲状腺癌肺转移的疗效及其主要预后因素的系统评价

Objective To assess the effect of radioiodine-131 (131Ⅰ) on treatment of pulmonary metastases from differentiated thyroid carcinoma and the main prognostic factors. Methods Five databases were retrieved and all published studies which analyzed the effect of 131Ⅰ on pulmonary metastases from differentiated thyroid carcinoma and the main prognostic factors were systematically reviewed. The data about the impact of 131Ⅰ treatment and the main prognostic factors on the 5-yr and 10-yr survival rates of the patients were abstracted. RevMan 4.2 software was used to statistically analyze. Results Eleven retrospective cohort studies were included. The pooled results suggested that the 5-yr survival rates of the patients who received 131Ⅰ therapy and who did not received 131Ⅰl therapy were 74.9% and 27.1% , respectively ;The lO-yr survival rates(P<0.01)of the two groups were 60.8% % 12.2% , respectively;The difference between them had statistical significance (P<0.01). The 5-yr and 10-yr survival rates of the patients only with pulmonary metastases were higher than those of the patients with multiple metastases (P<0.01). The 5-yr (P = 0.01) and 10-yr (P = 0. 002)surviv10al rates of the patients only with papillary thyroid carcinoma were higher than those of the patients with follicular thyroid carcinoma. The 5-yr and 10-yr survival rates of male and female patients were similar(P>0.05). Conclusions 131Ⅰ treatment increases the 5-yr and 10-yr survival rates of patients with pulmonary metastases from differentiated thyroid carcinoma. The extent of metastases and the histologie type of differentiated thyroid carcinoma are two main predicting factors of prognosis. The 5-yr and 10-yr survival rates of patients are not influenced by gender.     

放射性131Ⅰ治疗分化型甲状腺癌肺转移的疗效及其主要预后因素的系统评价

Objective To assess the effect of radioiodine-131 (131Ⅰ) on treatment of pulmonary metastases from differentiated thyroid carcinoma and the main prognostic factors. Methods Five databases were retrieved and all published studies which analyzed the effect of 131Ⅰ on pulmonary metastases from differentiated thyroid carcinoma and the main prognostic factors were systematically reviewed. The data about the impact of 131Ⅰ treatment and the main prognostic factors on the 5-yr and 10-yr survival rates of the patients were abstracted. RevMan 4.2 software was used to statistically analyze. Results Eleven retrospective cohort studies were included. The pooled results suggested that the 5-yr survival rates of the patients who received 131Ⅰ therapy and who did not received 131Ⅰl therapy were 74.9% and 27.1% , respectively ;The lO-yr survival rates(P<0.01)of the two groups were 60.8% % 12.2% , respectively;The difference between them had statistical significance (P<0.01). The 5-yr and 10-yr survival rates of the patients only with pulmonary metastases were higher than those of the patients with multiple metastases (P<0.01). The 5-yr (P = 0.01) and 10-yr (P = 0. 002)surviv10al rates of the patients only with papillary thyroid carcinoma were higher than those of the patients with follicular thyroid carcinoma. The 5-yr and 10-yr survival rates of male and female patients were similar(P>0.05). Conclusions 131Ⅰ treatment increases the 5-yr and 10-yr survival rates of patients with pulmonary metastases from differentiated thyroid carcinoma. The extent of metastases and the histologie type of differentiated thyroid carcinoma are two main predicting factors of prognosis. The 5-yr and 10-yr survival rates of patients are not influenced by gender.     

放射性131Ⅰ治疗分化型甲状腺癌肺转移的疗效及其主要预后因素的系统评价

Objective To assess the effect of radioiodine-131 (131Ⅰ) on treatment of pulmonary metastases from differentiated thyroid carcinoma and the main prognostic factors. Methods Five databases were retrieved and all published studies which analyzed the effect of 131Ⅰ on pulmonary metastases from differentiated thyroid carcinoma and the main prognostic factors were systematically reviewed. The data about the impact of 131Ⅰ treatment and the main prognostic factors on the 5-yr and 10-yr survival rates of the patients were abstracted. RevMan 4.2 software was used to statistically analyze. Results Eleven retrospective cohort studies were included. The pooled results suggested that the 5-yr survival rates of the patients who received 131Ⅰ therapy and who did not received 131Ⅰl therapy were 74.9% and 27.1% , respectively ;The lO-yr survival rates(P<0.01)of the two groups were 60.8% % 12.2% , respectively;The difference between them had statistical significance (P<0.01). The 5-yr and 10-yr survival rates of the patients only with pulmonary metastases were higher than those of the patients with multiple metastases (P<0.01). The 5-yr (P = 0.01) and 10-yr (P = 0. 002)surviv10al rates of the patients only with papillary thyroid carcinoma were higher than those of the patients with follicular thyroid carcinoma. The 5-yr and 10-yr survival rates of male and female patients were similar(P>0.05). Conclusions 131Ⅰ treatment increases the 5-yr and 10-yr survival rates of patients with pulmonary metastases from differentiated thyroid carcinoma. The extent of metastases and the histologie type of differentiated thyroid carcinoma are two main predicting factors of prognosis. The 5-yr and 10-yr survival rates of patients are not influenced by gender.     

放射性131Ⅰ治疗分化型甲状腺癌肺转移的疗效及其主要预后因素的系统评价

Objective To assess the effect of radioiodine-131 (131Ⅰ) on treatment of pulmonary metastases from differentiated thyroid carcinoma and the main prognostic factors. Methods Five databases were retrieved and all published studies which analyzed the effect of 131Ⅰ on pulmonary metastases from differentiated thyroid carcinoma and the main prognostic factors were systematically reviewed. The data about the impact of 131Ⅰ treatment and the main prognostic factors on the 5-yr and 10-yr survival rates of the patients were abstracted. RevMan 4.2 software was used to statistically analyze. Results Eleven retrospective cohort studies were included. The pooled results suggested that the 5-yr survival rates of the patients who received 131Ⅰ therapy and who did not received 131Ⅰl therapy were 74.9% and 27.1% , respectively ;The lO-yr survival rates(P<0.01)of the two groups were 60.8% % 12.2% , respectively;The difference between them had statistical significance (P<0.01). The 5-yr and 10-yr survival rates of the patients only with pulmonary metastases were higher than those of the patients with multiple metastases (P<0.01). The 5-yr (P = 0.01) and 10-yr (P = 0. 002)surviv10al rates of the patients only with papillary thyroid carcinoma were higher than those of the patients with follicular thyroid carcinoma. The 5-yr and 10-yr survival rates of male and female patients were similar(P>0.05). Conclusions 131Ⅰ treatment increases the 5-yr and 10-yr survival rates of patients with pulmonary metastases from differentiated thyroid carcinoma. The extent of metastases and the histologie type of differentiated thyroid carcinoma are two main predicting factors of prognosis. The 5-yr and 10-yr survival rates of patients are not influenced by gender.     

放射性131Ⅰ治疗分化型甲状腺癌肺转移的疗效及其主要预后因素的系统评价

Objective To assess the effect of radioiodine-131 (131Ⅰ) on treatment of pulmonary metastases from differentiated thyroid carcinoma and the main prognostic factors. Methods Five databases were retrieved and all published studies which analyzed the effect of 131Ⅰ on pulmonary metastases from differentiated thyroid carcinoma and the main prognostic factors were systematically reviewed. The data about the impact of 131Ⅰ treatment and the main prognostic factors on the 5-yr and 10-yr survival rates of the patients were abstracted. RevMan 4.2 software was used to statistically analyze. Results Eleven retrospective cohort studies were included. The pooled results suggested that the 5-yr survival rates of the patients who received 131Ⅰ therapy and who did not received 131Ⅰl therapy were 74.9% and 27.1% , respectively ;The lO-yr survival rates(P<0.01)of the two groups were 60.8% % 12.2% , respectively;The difference between them had statistical significance (P<0.01). The 5-yr and 10-yr survival rates of the patients only with pulmonary metastases were higher than those of the patients with multiple metastases (P<0.01). The 5-yr (P = 0.01) and 10-yr (P = 0. 002)surviv10al rates of the patients only with papillary thyroid carcinoma were higher than those of the patients with follicular thyroid carcinoma. The 5-yr and 10-yr survival rates of male and female patients were similar(P>0.05). Conclusions 131Ⅰ treatment increases the 5-yr and 10-yr survival rates of patients with pulmonary metastases from differentiated thyroid carcinoma. The extent of metastases and the histologie type of differentiated thyroid carcinoma are two main predicting factors of prognosis. The 5-yr and 10-yr survival rates of patients are not influenced by gender.     

Bone metastases from differentiated thyroid carcinoma

The presence of distant metastases from differentiated thyroid carcinoma decreases the 10-year survival of patients by 50%. Bone metastases represent a frequent complication especially of follicular thyroid cancer and severely reduce the quality of life causing pain, fractures, and spinal cord compression. Diagnosis is established by correlating clinical suspicion with imaging. Imaging is essential to detect, localize, and assess the extension of the lesions and should be used in conjunction with clinical evidence. Bone metastases are typically associated with elevated markers of bone turnover, but these markers have not been evaluated in differentiated thyroid cancer. Skeletal and whole-body magnetic resonance imaging and fusion 2-deoxy-2-[18F]fluoro-D-glucose whole-body positron emission tomography/computed tomography (PET/CT) are the best anatomic and functional imaging techniques available in specialized centers. For well-differentiated lesions, iodine-PET scan combined (124)I-PET/CT is the newest imaging development and (131)I is the first line of treatment. Bisphosphonates reduce the complications rate and pain, alone or in combination with radioiodine, radionuclides, or external beam radiotherapy and should be employed. Surgery and novel minimally invasive consolidation techniques demand an appropriate patient selection for best results on a multimodal approach. Basic research on interactions between tumor cells and bone microenvironment are identifying potential novel targets for future more effective therapeutic interventions for less differentiated tumors.     

非小细胞肺癌脑转移患者预后多因素Cox回归分析

目的探讨影响非小细胞肺癌(non-small cell lung cancer,NSCLC)脑转移患者生存时间的因素。方法回顾性分析我院收治的NSCLC脑转移并行头颅放疗患者302例,其中资料完整者171例进行分析。采用SPSS13.0统计软件行影响生存期的单因素及多因素Cox风险比例模型回归分析。探讨患者的临床特征及放疗方式等因素对患者生存期的影响。结果全组患者中位生存期为8.8(95%CI:7.2~10.3)个月;单因素分析显示:PS评分(P=0.002)、脑转移数量(P=0.023)、脑转移时间(P=0.031)、放疗方式(P=0.041)和肺癌是否切除(P=0.002)与患者预后有关;Cox多元回归分析显示:PS评分(P=0.04)和肺癌是否手术切除(P=0.04)为脑转移患者独立预后因素而与脑转移数量(P=0.65)、脑转移时间(P=0.71)、放疗方式(P=0.91)等因素无关。结论 NSCLC脑转移整体预后较差,手术切除肺部肿瘤且体力评分较好患者预后相对较好。     

以脑转移症状为首发表现的老年肺癌36例临床分析

目的探讨以脑转移为首发表现的老年肺癌的临床特点。方法分析１９８６～１９９６年收治的以脑转移症状为首发表现的３６例老年肺癌患者。结果腺癌、小细胞肺癌较鳞癌多，外周型肺癌远多于中央型，非手术组中位生存期５个月，手术组中位生存期１４个月，误诊率达７７．８％。结论本形式肺癌误诊率高，预后差，放疗、化疗有一定帮助，脑转移病灶能手术切除的患者预后相对较好     

Melena： A rare complication of duodenal metastases from primary carcinoma of the lung

Small bowel metastases from primary carcinoma of the lung are very uncommon and occur usually in patients with terminal stage disease. These metastases are usually asymptomatic, but may present as perforation, obstruction, malabsorption, or hemorrhage. Hemorrhage as a first presentation of small bowel metastases is extremely rare and is related to very poor patient survival. We describe a case of a 61- year old patient with primary adenocarcinoma of the lung, presenting with melena as the first manifestation of small bowel metastasis. Both primary tumor and metastatic lesions were diagnosed almost simultaneously. Upper gastrointestinal endoscopy performed with a colonoscope revealed active bleeding from a metastatic tumor involving the duodenum and the proximal jejunum. Histological examination and immunohistochemical staining of the biopsy specimen strongly supported the diagnosis of metastatic lung adenocarcinoma, suggesting that small bowel metastases from primary carcinoma of the lung occur usually in patients with terminal disease and rarely produce symptoms. Gastrointestinal bleeding from metastatic small intestinal lesions should be included in the differential diagnosis of gastrointestinal blood loss in a patient with a known bronchogenic tumor.     

Supportive care for patients with brain metastases from lung cancer

Lung cancer is the most common cause of intracranial metastases (ICM). Metastases in the brain can result in a broad range of uncomfortable symptoms and significant morbidity secondary to neurological disability. Treatment options can range from surgical resection of solitary metastases to radiotherapy and more recently systemic targeted therapies and immunotherapy. Patient survival continues to improve with innovations made in treatments for this condition, but each of these treatments carry their own adverse effects that must be appropriately managed. These patients can benefit greatly from multidisciplinary care throughout the course of their disease. Clinicians involved in their care must be equipped with the ability to communicate skillfully and compassionately and set expectations for the road ahead, including symptoms, treatment plans, and prognosis. Involvement of a palliative care team can be very helpful, especially for patients who are nearing the terminal stages of the disease. Palliative care skills may be invaluable in the management of symptoms and can ease suffering for patients and their caregivers, thus allowing for maximum quality of life for as long as possible. End of life may bring its own complications and challenges; and opinion of an experienced and knowledgeable clinician can alleviate the pain and distress of the patient and also bring peace to the caregivers and loved ones.     

Management of brain metastases in elderly patients with lung cancer

The incidence of brain metastases (BM) is continuing to grow in the elderly population with lung cancer, but these patients are seriously under-represented in clinical trials. Thus, their treatment is not based on the evidence from randomized prospective studies. Age is a well recognized poor prognostic factor for survival in patients with BM from lung cancer, which is reflected in prognostic scales, but its impact on the patients'' prognosis reflected by its value in gradually updated grading indices seems to decrease. The reason for poorer outcomes in the elderly is unknown—it may result from the influence of the age per se, simplified staging work-up and suboptimal treatment in this patient subgroup or the excess toxicity of the aggressive anticancer treatment secondary to the impaired physiological regulation mechanisms and comorbidities. The main goal of treatment of BM is to ameliorate neurological symptoms and delay neurological progression, with the focus on the improvement and maintenance of the patients’ quality of life. The possible treatment options for BM from lung cancer are whole-brain radiotherapy, stereotactic radiosurgery, surgery, chemotherapy, targeted therapies and best supportive care. The aim of this review is to summarize the problems related to the management of BM in elderly patients with lung cancer, to analyze the value of the above mentioned treatment options, and to provide an insight into the influence of age-related clinical factors on the patients’ outcomes.     

肺炎型肺癌10例临床分析

目的探讨肺炎型肺癌的临床特征,提高认识,减少误诊。方法通过对10例经病理确诊肺炎型肺癌患者的临床表现,实验室、胸部X线、支气管镜及病理资料的回顾性分析,总结其临床特征。结果肺炎型肺癌的X线表现为渗出性病变,但缺乏肺部感染的常见临床特征,抗感染、抗结核治疗无效。结论 ：肺炎型肺癌胸部X线表现大片状或斑片状阴影,但其临床特点、血常规、细菌学检查及对治疗反应不符合一般感染性疾病特征,应积极获取病理诊断。     

Upper gastrointestinal bleeding due to duodenal metastasis from primary lung carcinoma

Metastatic dissemination of lung carcinoma may involve virtually all organs, however, symptomatic spread to the small bowel is a rare occurrence. Herein, we report a case of duodenal metastatic involvement leading to severe upper gastrointestinal bleeding in the absence of symptoms referable to the primary tumour.     

老年非小细胞肺癌多发脑转移患者不同放疗模式下的疗效和剂量学特点

【摘 要】目的 探讨老年非小细胞肺癌多发脑转移患者不同放疗模式下的疗效及剂量学特点,为临床确定老年非小细胞肺癌多发脑转移的放疗模式提供依据。 方法 回顾分析2018年8月至2021年8月青岛大学附属青岛市中心医院收治的老年非小细胞肺癌多发脑转移患者115例,根据放疗模式的不同分为全脑放疗组、序贯加量组及同步加量组,采用SPSS 26.0统计软件进行数据分析。根据数据类型,分别采用方差分析、c2检验进行组间分析。 结果 全脑放疗组、序贯加量组和同步加量组的有效率分别为47.5%（19/40）、60.6%（20/33）和76.2%（32/42）;局部控制率分别为72.5%（29/40）、87.9%（29/33）和95.2%（40/42）。同步加量组的有效率和局部控制率高于全脑放疗组,差异均有统计学意义（均P＜0.05）。全脑放疗组、序贯加量组和同步加量组1年的IPFS率分别为25.0%（10/40）、69.7%（23/33）和73.8%（31/42）;1年的OS率分别为47.5%（19/40）、75.8%（25/33）和78.6%（33/42）。同步加量组1年的IPFS率和OS率较全脑放疗组高,差异均有统计学意义（均P＜0.05）。同步加量组PTV的CN、PITV优于全脑放疗组和序贯加量组,全脑放疗组PTV的CN、PITV优于序贯加量组,差异均有统计学意义（均P＜0.01）。序贯加量组PTV的TC优于全脑放疗组和同步加量组,差异有统计学意义（P=0.041）。全脑放疗组PTV的HI优于序贯加量组和同步加量组,同步加量组PTV的HI优于序贯加量组,差异均有统计学意义（均P＜0.01）。同步加量组PGTV的CN、PITV优于序贯加量组,差异均有统计学意义（均P＜0.01）。3组均未发生3级及以上不良反应。 结论 全脑放疗联合同步加量可作为老年非小细胞肺癌多发脑转移患者的优选治疗方案。