长春瑞滨联合顺铂一线治疗晚期非小细胞肺癌疗效观察

目的观察长春瑞滨联合顺铂治疗Ⅲb或Ⅳ期初治非小细胞肺癌（NSCLC）的疗效和毒副作用。方法初治的Ⅲb或Ⅳ期初治非小细胞肺癌（NSCLC）23例,采用长春瑞滨（盖诺）25mg／m^2d,也静滴,顺铂30mg／m^2静滴第1-3d,21d为1个周期。结果23例患者中,CR病例1例,PR11例,SD9例,PD2例,客观有效率（CR＋PR）为52．16％中位生存期11．8个,1年生存率35％（8／23）中位肿瘤进展时间7个月,毒副作用为白细胞下降和消化道反应。结论长春瑞滨联合顺铂一线治疗晚期NSCLC有效率较高,有生存优势,毒副作用可耐受。     

125Ⅰ粒子植入联合化疗治疗非小细胞肺癌疗效观察

探讨125I粒子联合化疗治疗非小细胞肺癌(NSCLC)的临床疗效.采用CT引导下肿瘤内植入125I粒子,3 天后行长春瑞滨 (NVB)和 顺铂(DDP)静脉化疗,于2、4、6个月观察治疗效果(CR,PR,SD,PD).结果表明 125I粒子联合化疗组的有效率(CR+PR)分别为82.8%,90.6%,93.7%;单纯化...     

125Ⅰ粒子植入联合化疗治疗非小细胞肺癌疗效观察

探讨125I粒子联合化疗治疗非小细胞肺癌(NSCLC)的临床疗效。采用CT引导下肿瘤内植入125I粒子,3天后行长春瑞滨(NVB)和顺铂(DDP)静脉化疗,于2、4、6个月观察治疗效果(CR,PR,SD,PD)。结果表明125I粒子联合化疗组的有效率(CR+PR)分别为82.8%,90.6%,93.7%;单纯化疗组分别为44.3%,48.6%,52.9%,两组有显著性差异(P<0.05)。NSCLC行125I粒子联合化疗具有协同作用,有利于短期内减轻肿瘤负荷,提高肿瘤疗效。     

GP与NP两方案治疗晚期非小细胞肺癌的临床对比观察

目的评价吉西他滨联合顺铂(GP)方案与诺维本联合顺铂(NP)方案治疗晚期非小细胞肺癌的疗效及毒副反应。方法经病理组织学或细胞学证实的62例非小细胞肺癌患者,随机分为两组,吉西他滨联合顺铂组(A组)31例,以吉西他滨1200mg/m2静滴,第1、8、15天,顺铂80mg/m2静滴,第1天;诺维本联合顺铂组(B组)31例,以诺维本25mg/m2静滴,第1、8天,顺铂80mg/m2静滴,第1天,两方案均每3周重复,3周期以上评价疗效。结果A、B两组的有效率分虽为48.3%(15/31)、51.1%(16/31),组间无显著性差异(P>0.05);中位疾病进展时间分别为4.8个月和3.8个月,组间有显著性差异(P<0.05);中位生存期分别为11个月和10.6个月,无显著性差异(P>0.05);一年生存率A组为45.2%,B组为41.9%,组间无显著性差异(P>0.05)。A组血小板减少高于B组(P<0.01),但白细胞减少恶心呕吐及静脉炎明显低于B组(P<0.05)。结论A、B两组在有效率、中位生存期及一年生存率方面均较接近,但中位疾病进展时间吉西他滨组略占优势。     

培美曲塞对比吉西他滨治疗中国晚期非小细胞肺癌的meta分析

目的系统的评价培美曲塞联合顺铂(PP方案)与吉西他滨联合顺铂(GP方案)一线治疗中国晚期非小细胞肺癌患者的疗效与安全性。方法以"培美曲塞"、"吉西他滨"、"顺铂"、"非小细胞肺癌"为检索词,计算机检索中国期刊全文数据库(1995年~2014年),中文科技期刊全文数据库(1995年~2014年),万方数据库(1995年~2014年),Pubmed(1995年~2014年),同时检索可纳入文献的参考文献,并收集PP方案对比GP方案治疗中国晚期非小细胞肺癌患者的随机对照试验。两名评价者均独立按照纳入标准筛选文献,对纳入的文献作出评价后提取数据,用RevMan5.0软件进行统计学分析。结果纳入8项随机对照试验,共计851例患者。meta分析的结果显示,培美曲塞联合顺铂方案与吉西他滨联合顺铂方案一线治疗中国晚期非小细胞肺癌患者相比较,在疗效方面,其客观缓解率(OR=1.43,95%CI：1.03-1.97)的差异有统计学意义,而在1年生存率(OR=0.83,95%CI：0.62-1.11)方面的差异无统计学意义;在安全性方面,严重消化道反应(OR=0.33,95%CI：0.11-0.96),及严重血液学毒性方面的差异均有统计学意义。结论 PP方案与GP方案在客观缓解率及不良反应方面有差别,而在1年生存率方面的差异无统计学意义,PP方案能提高中国晚期非小细胞肺癌患者的客观缓解率,同时能减低化疗引起的不良反应。     

紫杉醇联合顺铂治疗晚期非小细胞肺癌临床观察

目的:探讨紫杉醇联合顺铂化疗对晚期非小细胞肺癌(NSCLC)患者的疗效,以及对机体免疫功能的影响。方法:回顾分析2009-01/2009-12采用紫杉醇联合顺铂的化疗方案治疗87例晚期NSCLC的临床资料。结果:观察组完全缓解(CR)20.69%,部分缓解(PR)25.29%,无变化(NC)31.03%,进展(PD)22.99%,总有效率45.98%。随访6～12月,缓解期为8.9个月,1年生存率为43.68%。全组在治疗中,未出现因化疗毒性而终止治疗者。但出现不同程度的毒副反应,恶心、呕吐7例,中性粒细胞减少5例,水肿4例,皮疹瘙痒2例,均对症治疗后好转。观察组治疗前化疗前CD4+、CD4+/CD8+阳性细胞比例低于对照组(P0.05),差异有统计学意义。化疗后CD4+、CD4+/CD8+阳性细胞比例较化疗前均显著升高(P0.05),差异有统计学意义。结论:紫杉醇联用顺铂是治疗非小细胞肺癌的有效方案,毒副反应可以耐受,使用安全,并且可减少化疗对非小细胞肺癌患者细胞免疫功能的影响。     

恩度联合TP方案治疗晚期小细胞肺癌的临床研究

目的研究恩度联合TP方案治疗晚期小细胞肺癌的近期疗效和耐受性。方法临床收集89例晚期小细胞肺癌患者,随机分成两组,对照组44例,予以拓扑替康联合顺铂（TP）方案化疗;观察组45例,在TP方案的基础上加用恩度。21 d为一个周期,以上两组患者均治疗2个周期,之后评价并比较两组方案的疗效性与安全性。结果恩度联合TP方案治疗晚期小细胞肺癌的近期有效率高达84.44%,与对照组TP化疗方案相比较相差显著（P〈0.05）,并且两组患者的化疗药物毒副作用情况无显著性差异（P〉0.05）。结论恩度联合TP方案治疗晚期小细胞肺癌具有较好的近期疗效和耐受性。     

培美曲塞、多西他赛分别联合顺铂治疗晚期非小细胞肺癌的临床疗效及安全性分析

目的:分析培美曲塞、多西他赛分别联合顺铂治疗晚期非小细胞肺癌的临床疗效及安全性.方法:选取2018年1月至2020年1月收治的晚期非小细胞肺癌患者74例,随机分为研究组和对照组(n=37),分别静脉滴注培美曲塞(500 mg·(m2)-1,Qd)+顺铂(75 mg·(m2)-1,Qd)以及多西他赛(75 mg·(m2)...     

吉西他滨联合卡铂治疗非小细胞肺癌64例的临床观察

目的：探讨吉西他滨联合卡铂治疗中晚期非小细胞肺癌的临床疗效和不良反应。方法选取我院收治的中晚期非小细胞肺癌病例64例,采用吉西他滨联合卡铂化疗方案进行化疗,分析其临床治疗效果及不良反应。64例患者给予吉西他滨与卡铂联合治疗,吉西他滨1000mg/m2,第1、8、15d;卡铂200~400mg/m2,第2d,28d为1个周期。化疗2个周期后评价。结果64例患者中10例达到CR,26例PR,另外20例SD,8例PD。出现的毒副反应主要为骨髓抑制、恶心呕吐及脱发,多为I~I 度,均可耐受。结论吉西他滨联合卡铂治疗中晚期非小细胞肺癌疗效较好,不良反应可以耐受,在胃肠道反应及外周神经毒性方面具有一定的优势。     

晚期非小细胞肺癌ERCC1基因表达量的临界值研究及验证

目的 检测200例非小细胞肺癌FFPE样本中ERCC1的相对表达量,确定判别ERCC1表达量等级的临界值并对其进行回顾性验证.方法 采用实时荧光定量PCR技术检测FFPE样本中ERCC1和内参基因的表达量,并通过2-ΔCt法计算ERCC1的相对表达量.以其中位值为判别ERCC1表达量等级的临界值,并通过患者应用铂类化疗药物的短期、长期疗效进行回顾性验证.结果 200例FFPE样本中,ERCC1和内参基因均可检出的检出率为89.0％.ERCC1相对表达量与患者年龄、性别、分型、分期及有无吸烟史等差异均无显著性(P＞0.05).高表达、低表达ERCC1患者在应用药物后的客观有效率分别为22.0％、53.7％ (P ＜0.05).采用COX模型进行多因素回归分析,发现ERCC1表达量是影响患者无进展生存、总体生存的独立因素(P＜0.05).ERCC1高表达、低表达患者接受铂类化疗药物治疗的中位无进展生存时间分别为8个月、14个月,差异有显著性(P=0.018);ERCC1高表达、低表达患者中位总体生存时间分别为10个月、15个月,差异有显著性(P =0.028).结论 判定非小细胞肺癌ERCC1表达量等级的临界值适合进行后续验证,为相关检测标准的制定提供依据.     

纳米复合材料GO@AgPt对非小细胞肺癌的放射增敏作用

目的:制备新型纳米复合材料GO@AgPt,探究其对非小细胞肺癌的放射增敏效果。方法:通过改进型的水热法合成纳米复合材料GO@AgPt,通过透射电子显微镜、原子力显微镜、X射线光电子能谱分析、傅里叶红外光谱仪等方法对材料进行形貌及组分分析。应用细胞活性检测试剂盒CCK-8检测材料对肺癌细胞A549和人肺微血管细胞HPMEC的细胞活性的影响;然后通过流式检测及细胞克隆形成实验探究材料对于A549细胞的放射增敏效果。结果:成功制备出粒径大小均匀、化学成分稳定的纳米复合材料GO@AgPt。在一定浓度范围内该材料对肺癌细胞A549有毒性而对正常细胞HPMEC没有明显毒性。该材料能促进癌细胞产生活性氧,与X射线联合作用能促进细胞的凋亡。细胞克隆形成的结果也显示该材料对肺癌细胞具有放射增敏效果。结论:成功制备了纳米复合材料GO@AgPt,证明了该材料对于非小细胞肺癌有明显的放疗增敏效果。     

Weekly intravenous nanoparticle albumin-bound paclitaxel for elderly patients with stage IV non-small-cell lung cancer:a series of 20 cases

The purpose of this study was to evaluate the efficacy and safety of nanoparticle albumin-bound paclitaxel as a rescue regimen in the treatment of patients with advanced non-small-cell lung cancer.We retrospectively reviewed the medical records of 20 patients with stage IV non-small-cell lung cancer.The patients had progressive disease after standard antitumor therapy and subsequently received intravenous albumin-bound paclitaxel at the dose of 100 mg/m2 in weekly schedule.Cumulative findings showed that the overall response rate was 30.0%,the disease control rate amounted to 40%,and the 1 year survival rate was 30%.In addition,the median time to progression and the median survival time reached 5 and 10 months,respectively.Meanwhile,no severe hypersensitivity reactions and grade 4 adverse effects were reported.In summary,weekly-administered albumin-bound paclitaxel seems to be an effective and safe regimen for elderly patients with stage IV non-small-cell lung cancer who were refractory to conventional therapy.     

The influence of different culture microenvironments on the generation of dendritic cells from non-small-cell lung cancer patients

Introduction: Monocyte-derived dendritic cells (DCs) are currently under extensive evaluation as cell vaccines for cancer treatment. Many protocols regarding DCs generation in vitro with different protein components, especially autologous proteins, have been described. On the other hand, active tumor-derived factors in patients’ serum could impair monocytes, which might result in their abrogated differentiation into DCs in vitro. Materials and Methods: Autologous DCs from non-small-cell lung cancer (NSCLC)-bearing patients were generated in different culture microenvironments. Peripheral blood mononuclear cells (PBMCs) were cultured in the presence of interleukin-4 and granulocyte-monocyte-stimulating factor with supplementation of 10% autologous serum, 10% allogenic serum, or 2% human albumin. The course of apoptosis, phagocytic ability, and the immunophenotype of the generated DCs were analyzed using flow cytometric methods. Results: After 48 h of culture, we found a lower percentage of CD1a⁺/CD14⁺ and a higher percentage of CD1a⁺/CD14⁻ cells in the culture supplemented with human albumin than in the cultures supplemented with serums. The lowest CD14 antigen expression was found in the human albumin-supplemented 48-h cultures. After 48 h in the cultures carried out with human albumin we found significantly higher percentages of AV⁺/PI⁺ cells and AV⁻/PI⁺ cells than in cultures supplemented with autologous or allogenic serum. We also noted that the expression of FITC-dextran after 4 and 24 h of incubation was significantly higher in the cultures supplemented with both serums than in the HA-SC. The percentage of semi-mature DCs and of CD83 expression was lowest in the culture supplemented with 2% human albumin. Conclusions: The kind of culture supplementation had a great impact on the apoptosis of cultured PBMCs. It could also influence the yield of monocyte-derived DCs. It was also confirmed that autologous and allogenic serums provide suitable microenvironments for the generation of autologous DCs from NSCLC patients. The choice of culture supplementation for DC generation is still unsolved and further studies should be undertaken.     

埃克替尼对非小细胞肺癌EGFR 21外显子少见突变的临床疗效

目的:探讨埃克替尼对非小细胞肺癌(non-small cell lung cancer,NSCLC)EGFR 21外显子L861Q/L833F突变的临床疗效.方法:回顾性分析17例埃克替尼治疗EGFR 21外显子少见突变的NSCLC,服用至病情进展或出现不可耐受的毒副作用,并观察疗效.结果:17例L861Q/L833F突变患者中L861Q突变17例,中位生存时间2.2个月,L833F突变1例,中位生存时间4.2个月.L833F突变患者生存时间稍长.复合突变与单纯突变相比,复合突变中位生存时间更长(L861Q突变2.1个月vs.5.6个月,P=0.065).结论:埃克替尼在EGFR基因21外显子少见突变的疗效上比传统敏感突变未见明显优势,但复合突变比单纯突变临床获益更多.     

bcl-2 and c-erbB-2 proteins are involved in the regulation of VEGF and of thymidine phosphorylase angiogenic activity in non-small-cell lung cancer

Tumour angiogenesis has been recently recognised as one of the most important prognostic factors in lung cancer. Although a variety of angiogenic factors have been identified, the angiogenesis process remains poorly understood. Bcl-2, c-erbB-2 and p53 are well-known oncogenes involved in non-small-cell lung cancer pathogenesis. A direct correlation of thymidine phosphorylase (TP) and of vascular endothelial growth factor (VEGF) with intratumoural angiogenesis has been reported. In the present study we investigated the possible regulatory role if bcl-2, c-erB-2 proteins in angiogenesis and in VEGF and TP expression in non-small-cell lung cancer. Two hundred sixteen specimens from T1,2-N0,1 staged patients treated with surgery alone were immunohistochemically examined. Bcl-2 and c-erbB-2 were significantly inversely related to each other (P=0.04) and both were inversely associated with microvessel density (P<0.02). High TP and VEGF reactivity was statistically related to loss of bcl-2 expression (P<0.01). A significant co-expression of c-erbB-2 with TP was noted (P=0.01). However, TP expression was related to high angiogenesis only in cases with absence of c-erB-2 expression (P<0.0001). c-erbB-2 expression in poorly vascularised tumours was linked with poor outcome (P=0.03). The present study provides strong evidence that the bcl-2 gene has a suppressive function over genes involved in both angiogenesis (VEGF and TP) and cell migration (c-erbB-2) in NSCLC. TP and c-erbB-2 proteins are significantly, and often simultaneously, expressed in bcl-2 negative cases. However, expression of the c-erbB-2 abolishes the TP-related angiogenic activity. Whether this is a result of a direct activity of the c-erbB-2 protein or a consequence of a c-erbB-2-related immune response remains to be further investigated. This revised version was published online in July 2006 with corrections to the Cover Date.     

基于18F-FDG PET/CT影像组学的非小细胞肺癌病理亚型分类

目的：旨在建立一种基于¹⁸F-FDG PET/CT的临床—影像组学相结合的综合模型用于区分非小细胞肺癌中的腺癌和鳞癌。方法：回顾性收集上海交通大学附属胸科医院120例经病理学验证为腺癌(65例)和鳞癌(55例)的患者,从预处理的CT图像和PET图像中分别提取1218、108个影像组学特征,并纳入10个临床特征因素;卡方检验和Wilcoxon检验用于对临床特征进行筛选,并使用Relief算法和最小绝对收缩和选择算子(LASSO)对影像组学特征进行筛选;通过6种机器学习分类器分别建立临床、影像组学、综合模型。通过受试者工作特征(ROC)曲线及曲线下面积(AUC)来评价模型的分类能力。结果：综合模型在训练集和测试集中均表现出最高的AUC值和准确率,其中随机森林(RF)和Bagging分类器表现出的分类效果最佳。经五折交叉验证后,训练集中RF和Bagging的AUC值和准确率分别为0.92±0.03、0.86±0.06和0.92±0.02、0.83±0.02;测试集中RF和Bagging的AUC值和准确率分别为0.92、0.81和0.91、0.86。结论：结合^1...     

剂量网格分辨率大小对非小细胞肺癌立体定向放射治疗的剂量学影响

目的:定量分析剂量网格分辨率的大小对非小细胞肺癌（NSCLC）立体定向放射治疗（SBRT）计划剂量分布的影响,指导临床选用合适的剂量网格分辨率用于肺癌SBRT计划设计。 方法:选取10例NSCLC患者,采用容积旋转调强技术,使用0.20 cm的剂量网格分辨率设计SBRT计划,将治疗计划结果再分别用0.40、0.30、0.25、0.15、0.10 cm 的剂量网格分辨率计算最终剂量。比较6种不同剂量网格分辨率下的计划靶区（PTV）:D2%、Dmean、D98%、均匀性指数（HI）、适形度指数（CI）和危及器官:全肺、胸壁、食管、心脏、脊髓、主动脉、气管树等的相关剂量学参数的差异。 结果:与0.20 cm剂量网格分辨率组计划相比较,0.40、0.30、0.25、0.15、0.10 cm剂量网格分辨率计算得到的计划的靶区D2%、Dmean、CI均具有统计学意义（P<0.05）;HI除0.15 cm剂量网格分辨率组以外,均具有统计学意义（P<0.05）。在危及器官受照剂量方面,与0.20 cm剂量网格分辨率组计划相比较,大于0.20 cm（0.40、0.30、0.25 cm）组计划全肺、胸壁、食管、心脏、脊髓、主动脉、气管树等的相关剂量学参数差异均有统计学意义（P<0.05）;小于0.20 cm（0.15、0.10 cm）组计划除全肺[V10]、[V20]、[V12.5]和[V13.5]有影响以外（P<0.05）,胸壁、食管、心脏、脊髓、主动脉、气管树等的相关剂量学参数差异较小（P>0.05）。 结论:剂量网格分辨率的大小会影响剂量计算的准确性,在NSCLC患者SBRT计划设计时,建议使用0.20 cm或更小的剂量网格分辨率。     

Comparability of PD-L1 immunohistochemistry assays for non-small-cell lung cancer: a systematic review

Programmed cell death ligand 1 (PD-L1) immunohistochemistry is used to determine which patients with advanced non-small-cell lung cancer (NSCLC) respond best to treatment with PD-L1 inhibitors. For each inhibitor, a unique immunohistochemical assay was developed. This systematic review gives an up-to-date insight into the comparability of standardised immunohistochemical assays and laboratory-developed tests (LDTs), focusing specifically on tumour cell (TC) staining and scoring. A systematic search was performed identifying publications that assessed interassay, interobserver and/or interlaboratory concordance of PD-L1 assays and LDTs in tissue of NSCLC patients. Of 4294 publications identified through the systematic search, 27 fulfilled the inclusion criteria and were of sufficient methodological quality. Studies assessing interassay concordance found high agreement between assays 22C3, 28-8 and SP263 and properly validated LDTs, and lower concordance for comparisons involving SP142. A decrease in concordance, however, is seen with use of cut-offs, which hampers interchangeability of PD-L1 immunohistochemistry assays and LDTs. Studies assessing interobserver concordance found high agreement for all assays and LDTs, but lower agreement with use of a 1% cut-off. This may be problematic in clinical practice, as discordance between pathologists at this cut-off may result in some patients being denied valuable treatment options. Finally, five studies assessed interlaboratory concordance and found moderate to high agreement levels for various assays and LDTs. However, to assess the actual existence of interlaboratory variation in PD-L1 testing and PD-L1 positivity in clinical practice, studies using real-world clinical pathology data are needed.     

18F-FDG PET/CT影像组学预测非小细胞肺癌亚型的研究

目的:探究基于治疗前18F-FDG PET/CT影像组学特征预测非小细胞肺癌（NSCLC）病理亚型的可行性。方法:回顾性分析100例NSCLC患者治疗前的18F-FDG PET/CT图像,其中腺癌60例,鳞癌40例。首先在PET图像上勾画大体肿瘤靶区（GTV）,从GTV内提取肿瘤代谢参数和纹理参数。使用Pearson相关系数和ROC曲线评估特征预测NSCLC病理亚型的效能,并计算其敏感性、特异性和最佳阈值。结果:共提取107个特征,有87个特征在鳞癌与腺癌之间差异有统计学意义（P<0.05）。其中,有8个特征与病理类型具有相关性（r>0.4）,AUC均高于0.7。逆差矩、同质性、短区域因子作为预测因子,其ROC曲线下面积分别达到0.770、0.768和0.754,其敏感性和特异性分别为0.949和0.475、0.795和0.607、0.821和0.639。结论:腺癌、鳞癌的部分影像组学特征反应的肿瘤异质性有望为病理诊断提供一种高效、无创的检测方法。