肺结节患者生活质量影响因素分析

<正>肺癌患病率居全球癌症第二,我国肺癌发病数占全球37%。肺癌早期症状不明显,多数确诊时已处于晚期,生存率相对较低^[1-2]。早期肺癌筛查、诊断和治疗是降低病死率的重要途径。肺结节影像学包括实性结节,磨玻璃影等,需定期复查肺部CT观察结节变化,判断是否需要接受手术^[3-4]。观察期3个月至2年,不断复查给肺结节患者带来许多不良情绪,如焦虑,恐惧等,影响生活质量。随着积极心理学的发展,人们将注意力放在以积极应对疾病方式和个体具备获取、处理和理解健康行为能力。     

人工智能在肺结节良恶性鉴别诊断中的价值分析

目的评价人工智能(artificial intelligence, AI)风险评估对肺结节良恶性鉴别诊断的价值。 方法收集2018年8月至2019年12月唐都医院行胸部CT检查，发现肺结节患者310例，将患者CT影像数据DICOM文件拷贝输入到"FACT人工智能"软件系统对结节进行分析，获得结节的部位、数量、特征(磨玻璃、亚实性、实性)、大小、密度、以及恶性风险概率AI值和Lung-rads分级；其中39例肺结节经过多学科讨论，建议采用外科手术、经皮肺穿刺或者支气管镜下活检等，271例患者进行随访。 结果31例肺结节病理诊断良性14例，分别为结核8例，隐球菌2例，炎性结节4例；恶性25例，分别肺鳞癌2例，腺癌23例。进一步分析，恶性病变的AI风险概率明显高于良性病变(P<0.05)；结节AI风险概率与肺结节特点(磨玻璃、亚实性、实性)显著相关(P<0.05)，而与数量及边缘毛刺征无显著相关性(P>0.05)；肺结节特点(磨玻璃、亚实性、实性)在良恶性之间存在显著性差异(P<0.05)，而密度和体积之间在在良恶性之间无显著性差异(P>0.05)。肺结节Lung-rads分级与AI风险概率之间具有显著的相关性(P<0.05)。 结论依据人工智能自动分析良恶性概率AI值对肺结节良恶性鉴别诊断具有一定的价值，值得临床借鉴。     

肺结节与肺癌全程智能管理云平台的构建及临床应用

目的 我国肺癌患病率、病死率稳居恶性肿瘤第一位。创建肺结节与肺癌全程管理模式,将肺结节纳入规范诊疗体系,以期实现肺癌早诊早治,提高患者复诊依从性。方法 构建肺结节与肺癌全程智能管理云平台,建立恶性肺结节队列、良性肺结节队列和未确诊肺结节规律随访队列。收集人口统计学、影像、病理、疗效等信息,通过全程管理后分析人群特征、诊治精准性与复诊率。结果 创建了基于重庆市肺结节管理工作室的肺结节与肺癌全程智能管理云平台。2019年1月至2021年12月期间,纳入全程管理的肺结节与肺癌患者共5 144例,确诊肺结节1 546例(30.05%),其中恶性1 194例,良性352例;Ia期肺癌占确诊肺癌的(80.80%);随访中肺结节3 598例(69.95%)。2019年进入平台登记管理后未确诊的肺结节,有≥1次复诊记录的患者652例(74.86%);2020年667例(65.67%);2021年245例(13.94%)。结论 建立肺结节与肺癌全程智能管理云平台有利于提高恶性肺结节早诊早治率与患者依从性,促进患者自我健康管理模式养成,改善肺癌预后,值得尝试。     

合并慢性阻塞性肺疾病对老年肺癌患者术后并发症及预后的影响

目的探讨合并慢性阻塞性肺疾病(COPD)对老年肺癌患者术后并发症及预后的影响。方法选择行手术治疗的老年肺癌患者156例,依据患者是否合并COPD分为对照组(未并发疾病)89例和观察组(有并发疾病)67例。统计并分析两组患者术后并发症发生情况,Spearman方法分析COPD与患者术后并发症的相关性,Kaplan-Meier方法分析肺癌患者术后12个月生存率。结果与对照组患者比较,观察组患者术后出现肺部感染、呼吸衰竭、心律失常和胸腔出血并发症发生率较高(P0.05)。合并COPD肺功能为Ⅲ级肺癌患者肺部感染和呼吸衰竭发生率显著高于肺功能为Ⅰ级和Ⅱ级的患者(P0.05),Spearman分析发现合并COPD与行手术治疗肺癌患者术后并发症发生率高呈正相关性(r=0.542,P0.01)。术后12个月肺癌患者总生存率为75.00%,合并COPD肺癌患者生存率低于对照组患者,且患者肺功能分级越高其术后12个生存率越低。结论合并COPD是行手术治疗老年肺癌患者术后并发症发生率高的独立危险因素,而且影响肺癌患者术后12个月生存率。     

肺结节人工智能判读与术后病理的对比分析

目的 评价人工智能对肺结节的良恶性鉴别能力及在临床上应用价值。方法 回顾性分析本院2019年—2021年经手术治疗且有术后病理的肺结节患者464人,包含485个结节;将所有患者的胸部CT图像导入人工智能(Artificial Intelligence, AI)系统,统计得到的肺结节相关参数,分析不同类型结节AI参数之间的关系。结果 恶性结节的AI恶性概率及准确率均明显高于良性结节,差异均具有显著统计学意义(P<0.01);恶性混杂磨玻璃结节的长径值越大,恶性概率越大;恶性混杂磨玻璃结节的AI准确率均明显高于纯磨玻璃及实性结节,差异有显著统计学意义(P<0.01);长径>1 cm的恶性结节中,混杂磨玻璃的恶性概率均要明显大于纯磨玻璃及实性结节,差异均具有统计学意义(P<0.05);术前穿刺活检准确率与AI比较,差异无统计学意义。结论 AI对良性结节的鉴别能力较低,对混杂磨玻璃结节良恶性鉴别有较高的临床应用价值,且长径对混杂磨玻璃结节的鉴别有一定的参考价值,但临床上AI是否可代替穿刺活检仍不确定。     

肺内孤立结节的CT鉴别诊断

肺内孤立结节是影像检查中常见的病变形态。肺内结节的ＣＴ诊断方法主要有ＣＴ平扫、增强扫描和ＣＴ导向经皮穿刺活检等。 2ｃｍ以下结节需高分辨ＣＴ(ＨＲＣＴ)检查。 2 0 0 3年第 1期刊出的两篇肺内病变的文章[1,2 ] 主要是依据ＣＴ对于结节病变进行鉴别诊断。充分认识各种方法的诊断价值对于准确地得出影像诊断结论是十分必要的。ＣＴ平扫主要用于观察结节的密度、轮廓与边缘及病灶周围的形态。结节的密度包括钙化、脂肪、磨玻璃密度和含气影像。肺内结节的钙化一般分为 4种形态 :(1)层状及同心圆状 ,(2 )中心巢状 ,(3)爆米花状 ,(4 )多…     

肺癌孤立性肺结节患者64排螺旋CT扫描影像特点分析

目的 研究64排螺旋CT对肺癌孤立性肺结节(SPN)的诊断价值.方法 选择2015年5月至2019年5月于我院收治的158例经病理证实伴SPN的肺癌患者为对象,按肺癌不同病理类型分为A组(腺癌,112例)、B组(鳞癌,34例)、C组(小细胞癌,12例),均接受64排螺旋CT扫描.比较三组SPN平扫及增强各序列(增强30...     

非小细胞肺癌伴对侧肺内结节的外科治疗

目的探讨非小细胞肺癌(non-small cell lung cancer,NSCLC)伴对侧肺结节的诊断及治疗。方法 24例获明确诊断的NSCLC患者伴对侧肺结节,均接受手术治疗,术后辅助放、化疗,并定期跟踪随访14～21个月。结果 24例患者中,其中6例有原发或转移癌;2例术后2年内死于心脑血管意外;16例良性病变;肺结节的大小,原发癌的病理类型和分期与结节性质之间无联系。结论 NSCLC患者伴对侧肺结节,若不能获得病理学诊断,并非手术禁忌证。     

Enhanced expression of FGF19 predicts poor prognosis in patients with non-small cell lung cancer

BackgroundLung cancer is one of the most common cancers and a leading cause of cancer-related death worldwide. Although many treatment options exist for lung cancer, some patients still suffer postoperative recurrence, and a consequent reduction of overall survival (OS). Our study aimed to investigate the correlation of FGF19 expression with the clinicopathological features and survival outcomes of non-small cell lung cancer (NSCLC) patients.MethodsBioinformatics analysis was conducted using the data from The Cancer Genome Atlas (TCGA) database to distinguish between the FGF19 levels of tumor and normal tissue and to determine their correlation with the OS. A total of 187 NSCLC patients who underwent radical resection of lung cancer were enrolled, and tissues were collected to determine FGF19 expression by immunohistochemistry (IHC) assay. Clinicopathological features including the survival date were collected for detailed research.ResultsAccording to the analysis based on the TCGA database, we found that the NSCLC tissues exhibited enhanced FGF19 messenger RNA (mRNA) expression and that the FGF19 mRNA levels correlated with shorter OS in NSCLC patients. IHC staining indicated that 88 (47.1%) patients had high FGF19 expression and 99 (52.9%) patients had low FGF19 expression. Meanwhile, survival data showed that high FGF19 expression was correlated with reduced OS (P<0.001). Moreover, both the univariate analysis and the forward stepwise multivariate Cox regression revealed that high FGF19 expression was an independent prognostic factor for decreased OS (P=0.001).ConclusionsThe expression of FGF19 is significantly upregulated in NSCLC, and the overexpression of FGF19 is correlated with poor OS, especially in lung adenocarcinoma (LUAD) cases. FGF19 might serve as a potential biomarker for predicting poor OS in NSCLC patients.     

化疗对行全肺切除的非小细胞肺癌患者预后的影响

目的探讨化疗对行全肺切除的非小细胞肺癌(NSCLC)患者预后的影响。方法本研究为队列研究, 采用非随机抽样方法选择美国SEER数据库2004-2016年收录的接受全肺切除术的NSCLC患者纳入研究, 其中单纯全肺切除术患者491例(全肺切除组), 全肺切除术联合化疗患者573例(联合化疗组)。分析化疗对行全肺切除术后的NSCLC患者预后的影响, 同时采用1∶1倾向性匹配方法分析2组患者预后情况。结果与全肺切除组比较, 联合化疗组累计生存率(30.1%比16.8%, χ²=79.30, P<0.001)和肿瘤特异性累计生存率(38.5%比34.3%, χ²=38.31, P<0.001)增高;通过倾向性匹配分析共获得329对单纯全肺切除术及联合化疗的NSCLC患者, 与单纯全肺切除的NSCLC患者比较, 联合化疗组的累计生存率(30.9%比17.7%, χ2=52.70, P<0.001)、肿瘤特异性累计生存率(39.8%比34.4%, χ²=27.38, P<0.001)均增高。通过多元逐步Cox回归模型分析显示, 不管是匹配前还是匹配后, 辅助化疗都是全肺切除术后患者总体生存或肿瘤特异性生存的独立影响因素。结论联合化疗有助于全肺切除术后NSCLC患者获得更好的预后。     

Correlation of clinicopathologic features and driver gene mutation in non-small cell lung cancer

<正>Objective To study the relationship between mutations of well-known driver genes and clinicopathologic characteristics of non-small cell lung cancers(NSCLC).Methods Scorpions amplification refractory mutation system(scorpions ARMS)fluorescence quantitative PCR was performed to investigate 205 driver gene mutation status in NSCLC in correlation with clinicopathological     

Correlation between survivin expression and prognosis in non-small cell lung cancer

AIMS AND BACKGROUND: Survivin is a recently identified protein as an inhibitor of apoptosis, which supresses programmed cell death and regulates cell division. In this study, we investigated the prognostic significance of both nuclear and cytoplasmic survivin expression in non-small cell lung cancer (NSCLC) and examined the association with clinicopathological parameters. METHODS: The study comprised 58 male patients diagnosed NSCLC with a mean age of 57.29+/-8.82 years; range 40-76 years. Patients underwent lobectomy (64%) or pneumonectomy (36%) with hilar and mediastinal lymph node sampling. Paraffin embedded tumor sections were retrieved for evaluation of nuclear and cytoplasmic staining of survivin. Clinicopathological data, stage and survival of patients were all determined. RESULTS: Cytoplasmic staining was found significantly increased in squamous cell carcinoma (P=0.003), whereas there was no association between nuclear staining and histopathological type (P=0.837). Also, both nuclear and cytoplasmic staining did not show any association with tumor stage (P>0.05). In univariate analysis there was significant correlation between nuclear survivin and short survival (P=0.0002). In multivariate survival analysis using Cox regression, only nuclear staining of survivin was determined as an independent prognostic factor (P=0.004). CONCLUSIONS: Localization of survivin expression might have an important regulatory mechanism in carcinogenesis and tumor progression. Nuclear survivin expression in tumor tissues might predict the prognosis in NSCLC, whereas cytoplasmic survivin has no prognostic significance.     

Cytoplasmic expression of G protein-coupled estrogen receptor 1 correlates with poor postoperative prognosis in non-small cell lung cancer

BackgroundA hormonal role in the development of non-small cell lung cancer (NSCLC) has been well documented, and the classic estrogen receptors (ERs)—ERα and ERβ have been extensively investigated over the past decade. The expression of ERβ was found to be high and display biological activity in NSCLC, but anti-estrogen therapy targeting this receptor has shown limited efficacy for the disease. The third estrogen receptor, G protein-coupled estrogen receptor 1 (GPER1/GPR30), was recently found to be highly expressed in NSCLC. Herein, we aimed to investigate the expression profile of GPER1 and correlate it with clinicopathological factors as well as postoperative prognosis in NSCLC.MethodsWe examined GPER1 and ERβ expression using immunohistochemistry among 183 NSCLC cases, including 132 lung adenocarcinoma (LUAD) with identified epidermal growth factor receptor (EGFR) mutation status and 51 squamous cell carcinoma (SCC) patients. We then conducted correlation analysis between the expression of GPER1 and clinicopathological factors and patients’ postoperative prognosis.ResultsPositive expression of GPER1 was categorized into 2 main classes: nuclei-GPER1 (nGPER1) and concurrent nuclei-and cytoplasm-GPER1 (n/cGPER1), according to its subcellular localization. The LUAD with wild-type EGFR (wt-EGFR) had a higher frequency of n/cGPER1 (50%) but a lower frequency of nGPER1 (31%) when compared with those with mutated EGFR (n/cGPER1: 31%, nGPER1: 41%, respectively). The expression of GPER1, regardless of subcellular localization, was positively correlated with tumor stage and lymph node metastasis. The median recurrence-free survival (mRFS) and overall survival (OS) were significantly worse in participants with n/cGPER1 expression than in those with nGPER1 or without GPER1 expression.ConclusionsThis study revealed that GPER1 is aberrantly highly expressed and presents a unique GPER1 expression profile in NSCLC. The n/cGPER1 expression was significantly associated with EGFR mutation status, tumor stage, lymph node metastasis, and poor postoperative prognosis in NSCLC.     

非小细胞肺癌组织可替代标本的驱动基因检测现状及进展

肺癌已成为世界范围内发病率和病死率居首位的恶性肿瘤.分子靶向治疗是针对晚期/复发非小细胞肺癌患者的一线治疗,在敏感基因突变的患者中,通常具有显著的临床疗效.靶向治疗的基础是基因突变检测,病理组织是最佳标本来源.但相当部分的非小细胞肺癌患者不能耐受有创检查而无法获得组织学标本.因此,寻找能够有效替代组织标本、创伤小、可多次获取的检测方法成为研究热点.本文对组织标本可替代检测样本的驱动基因检测研究进展进行综述.     

PAK4 expression is associated with the prognosis in non-small cell lung cancer

This study attempted to determine the expression of p21-activated kinase 4 (PAK4) in non-small cell lung cancer (NSCLC) tissues and the normal lung tissues. The correlation between PAK4 expression and prognosis of NSCLC patients was also evaluated in the present study. The expression level of PAK4 was measured by high-performance liquid chromatography method. Chi-square test was adopted to explore the relationship of PAK4 expression and clinical features. Kaplan-Meier survival curves were plotted to delineate the overall survival rate of NSCLC patients. Cox regression analysis was performed to evaluate the prognostic significance of PAK4 expression in NSCLC. The PAK4 expression in NSCLC tissue samples was significantly higher than that in normal lung tissues (P<0.001) and shared significant correlation with Eastern Cooperative Oncology Group score, histological type, and distant metastasis (P<0.05). Survival curve revealed that NSCLC patients with high PAK4 expression had relatively higher mortality than those with low PAK4 expression (P = .001). Cox regression analysis explained that PAK4 expression was associated with the prognosis of NSCLC patients (P = .024; HR, 3.104; 95% CI, 1.164–8.278). In a word, PAK4 was highly expressed in NSCLC tissues and could act as a prognostic factor for NSCLC patients.     

非小细胞肺癌患者EGFR、ALK基因突变及临床病理特征与预后的相关性研究

目的探讨非小细胞肺癌(NSCLC)患者EGFR、ALK基因突变状态及病理特征,分析二者与患者预后情况相关性。方法收集2015年1月至2018年1月苏州大学附属第一医院病理确诊的NSCLC病例262例,记录患者临床病理特征及转归,采用突变增阻滞系统(ARMS)-Taqman探针法及RT-PCR检测患者肿瘤样本的EGFR和ALK基因外显子突变情况,采用Kaplan-Meier法和Cox风险回归考察不同基因突变情况的预后、临床病理特征与临床结局的相关性。结果262例NSCLC患者中,168例为野生型,ALK突变12例,突变率4.6%;EGFR突变82例,突变率31.30%,其中18号外显子突变2例,19号外显子突变37例,20号外显子突变9例,21号外显子突变31例;各组间年龄、病理类型比较差异有统计学意义,P<0.05;Wild type组中位OS时间11.6月,ALK组中位OS时间15.0月,EGFR组中位OS时间36.8月,EGFR组OS明显优于ALK组OS时间及Wild type组OS时间,P<0.05;EGFR19号外显子突变组、21号外显子突变组OS生存时间显著高于18号外显子突变组和20号外显子突变组,P<0.05;EGFR阴性(RR=15.751,95%CI:9.252~26.816)、鳞癌(RR=18.344,95%CI:6.187~54.388)为OS的危险因素。结论EGFR突变状态、病理类型对非小细胞肺癌预后具有良好的预测价值,鳞癌和EGFR阴性患者生存期短。EGFR基因少见突变(18号外显子、20号外显子)患者的中位OS时间更短。     

非小细胞肺癌患者纤维蛋白原状态与预后的相关性探讨简

目的 研究一线化疗前晚期非小细胞肺癌患者纤维蛋白原状态与预后的相关性.方法 选择我院收治的120例晚期非小细胞肺癌患者和45名健康体检者进行试验研究.晚期非小细胞肺癌患者为实验组,健康体检者对照组.对两组对象的FIB水平进行比较分析.结果 实验组患者纤维蛋白原状态于对照组更高（P〈0.05）,实验组中FIB水平在非小细胞肺癌病理类型上差异无统计学意义（P〉0.05）,其病情分期与其FIB水平之间的关系差异无统计学意义（P〉0.05）.结论对肺癌患者或疑似肺癌患者的FIB水平进行检查有助于临床诊断和治疗预后.