晚期非小细胞肺癌预后相关因素分析简

目的：探讨影响晚期非小细胞肺癌预后的相关因素。方法：对兰州军区乌鲁木齐总医院2007年1月1日至2010年6月30日所收住的201例晚期非小细胞肺癌患者的临床资料进行回顾性分析,用Kaplan—Meier法计算中位生存期并绘制生存曲线,对晚期非小细胞肺癌预后的相关因素进行Logistic回归分析,筛选影响晚期非小细胞肺癌预后的相关因素。结果：符合纳入标准的病例共201例,单因素结果显示性别、吸烟、治疗情况对晚期非小细胞肺癌预后有影响,多因素COX分析提示吸烟及治疗情况是晚期非小细胞肺癌预后的独立因素。结论：吸烟及治疗方案的选择是影响晚期非小细胞肺癌生存的独立预后因素。     

吉西他滨联合卡铂治疗37例晚期非小细胞肺癌的临床观察

吉西他滨作为非小细胞肺癌二线治疗药物疗效较好,其与铂类联合已广泛应用于晚期肺癌中,我科自2004年3月至2005年3月应用吉西他滨联合卡铂治疗晚期非小细胞肺癌37例,现报告如下。1临床资料与方法1.1临床资料37例晚期非小细胞肺癌患者均经病理学或细胞学诊断,有可测量的客观指标,     

康莱特注射液治疗老年晚期非小细胞肺癌102例疗效观察

目的:评价康莱特注射液治疗老年晚期非小细胞肺癌的临床疗效。方法:回顾分析采用康莱特注射液治疗102例老年晚期非小细胞肺癌患者的临床资料,观察肿瘤疾病控制率、治疗进展时间、生活质量、中医临床症状及毒副反应。结果:疾病控制率为65.69%,治疗进展时间2.91±0.51个月,可改善中医临床症状(P<0.01),无明显毒副反应。结论:康莱特注射液对老年晚期非小细胞肺癌患者具有较好的临床疗效。     

顺铂联合紫杉醇脂质体治疗晚期非小细胞肺癌的临床观察

目的探讨顺铂联合紫杉醇脂质体治疗晚期非小细胞肺癌的近期疗效及不良反应。方法顺铂联合紫杉醇脂质体对74例晚期非小细胞肺癌患者进行治疗。结果患者完全缓解4例、部分缓解30例、稳定28例、进展12例。所有患者均未发生过敏反应,发生不良反应的程度较轻。结论采用顺铂联合紫杉醇脂质体对晚期非小细胞肺癌进行治疗具有较好的疗效,不良反应较轻,值得临床进一步推广应用。     

培美曲塞单药或联合铂类三线及以上治疗晚期非鳞型非小细胞肺癌的临床观察

背景与目的培美曲塞联合铂类或单药在晚期非小细胞肺癌一、二线治疗中的疗效已得到验证,但其在三线及以上治疗中的地位还不明确。本文旨在观察培美曲塞单药或联合铂类三线及以上治疗晚期非鳞型非小细胞肺癌的临床疗效及安全性。方法 46例多线治疗失败的晚期非鳞型非小细胞肺癌患者接受培美曲塞单药或联合铂类药物治疗。结果 46例晚期非鳞型非小细胞肺癌患者中部分缓解7例,疾病稳定20例,疾病进展19例,客观缓解率为15.2%,疾病控制率为58.7%,中位无疾病进展时间为3.0个月。分析显示培美曲塞联合卡铂及顺铂较培美曲塞单药治疗的疾病控制率明显增高(P=0.043)。常见的不良反应主要有恶心、呕吐及骨髓抑制。结论应用培美曲塞单药或联合铂类治疗多线治疗失败的晚期非鳞型非小细胞肺癌患者仍可使其临床获益,且毒副反应可耐受。     

奈达铂联合多西紫杉醇治疗晚期非小细胞肺癌的临床观察

目的探讨奈达铂联合多西紫杉醇治疗晚期非小细胞肺癌的疗效和毒性。方法对23例晚期非小细胞肺癌应用奈达铂联合多西紫杉醇治疗,并对其疗效及毒性进行分析。结果奈达铂联合多西紫杉醇治疗晚期非小细胞肺癌的总有效率为39.3%,其中鳞癌有效率为38.5%,腺癌有效率为40.0%,主要不良反应为骨髓抑制、恶心、呕吐,绝大多数患者耐受性良好。结论奈达铂联合多西紫杉醇治疗晚期非小细胞肺癌安全,有效,值得临床推广应用。     

艾迪注射液治疗老年人晚期非小细胞肺癌152例

  目的　评价艾迪注射液治疗老年人晚期非小细胞肺癌的临床疗效。方法　152例老年晚期非小细胞肺癌患者采用静脉滴注艾迪注射液治疗,对肿瘤客观疗效、治疗进展时间（TTP）、生活质量、中医临床症状、不良反应等进行观察。结果　艾迪注射液治疗肿瘤的稳定率为68.42 %;TTP为（2.81±0.47）个月;并能提高患者的生活质量（P＜0.05）、改善中医临床症状（P＜0.01）,且无明显不良反应。结论　艾迪注射液对老年晚期非小细胞肺癌患者具有较好的临床疗效。     

培美曲塞在晚期非鳞非小细胞肺癌三线及以上治疗中的临床观察

目的：观察培美曲塞在晚期非鳞非小细胞肺癌三线及以上治疗中的临床疗效及安全性。方法：40例多线治疗失败的晚期非鳞非小细胞肺癌患者接受培美曲塞治疗。结果：40例晚期非鳞非小细胞肺癌患者中,三线治疗者30例（75%）,三线及以上治疗者10例（25%）,部分缓解5例,疾病稳定17例,疾病进展18例,客观缓解率12.5%,疾病控制率55.0%,中位无疾病进展时间3.1月。三线化疗的疾病控制率稍优于三线以上化疗,但无统计学差异。常见的毒副反应主要有恶心、呕吐、骨髓抑制及肝功能损害。结论：应用培美曲塞治疗既往治疗失败的晚期非鳞非小细胞肺癌的三线及以上患者仍有临床获益,毒副反应可耐受。     

晚期非小细胞肺癌患者射频毁损治疗的生存质量评价分析

目的　探讨射频毁损治疗晚期非小细胞肺癌患者的疗效及其临床应用价值。方法　对 73例中老年晚期非小细胞肺癌患者 ,分别给予射频毁损治疗和以铂类为主的联合化疗。结果　射频治疗组与化疗组比较 ,疼痛缓解程度、KPS评分及患者生存质量评分均有明显提高 ,体重也有明显变化 ,均有非常显著性差异 (P <0 .0 1)。结论　射频毁损治疗技术具有微创、疗程短、安全可靠、近期效果较好的优点 ,可明显提高晚期非小细胞肺癌患者的生存质量 ,有很好的临床应用价值     

分子靶向治疗在Ⅲb/Ⅳ期非小细胞肺癌一线治疗中的应用

Ⅲb/Ⅳ期非小细胞肺癌一线化疗的疗效已进入瓶颈期.分子靶向药物的出现,给晚期非小细胞肺癌的一线治疗带来了划时代的变革,极大地改善了晚期非小细胞肺癌患者的生活质量、提高了生存期.全文就分子靶向治疗在晚期非小细胞肺癌一线治疗中的应用作一综述.     

非小细胞肺癌血清中CA125、CEA的浓度及意义

背景与目的CA125、CEA是最早被应用的肿瘤标志物,目前认为CEA在腺癌中有较高的表达,对近3年住院的非小细胞肺癌患者病历进行回顾性分析,发现CA125在非小细胞肺癌中的阳性率远高于以往文献报道。本文旨在讨论非小细胞肺癌血清中CA125、CEA的浓度及意义。方法应用化学发光法检测136例非小细胞肺癌患者,46例肺部良性病变患者及50例健康体检者血清中CA125、CEA含量。结果非小细胞肺癌患者血清CA125含量明显高于肺部良性病变(混合细胞癌除外),差异有统计学意义(P<0.0001),CEA在腺癌及鳞癌患者血清中的含量明显高于肺部良性病变,差异有统计学意义(P<0.0001),CA125、CEA含量在肺部良性病变患者与健康体检者之间无明显差异。CA125在大细胞癌、腺癌、鳞癌、混合细胞癌中的阳性率分别为92.3%、80.2%、54.8%、50%,CEA在腺癌、大细胞癌、鳞癌、混合细胞癌中的阳性率分别为67.4%、0、25.8%、0,CA125/CEA联合检测能提高腺癌的阳性率(90.7%)。进展期非小细胞肺癌CA125、CEA阳性率分别为86.9%、63.6%,CA125在进展期腺癌阳性率达90.9%。结论CA125在非小细胞肺癌中的阳性率较CEA高,在进展期大细胞癌和腺癌中敏感性在90%以上,在协助非小细胞肺癌的诊断中,检测CA125比CEA更有意义。     

晚期非小细胞肺癌免疫治疗与消融治疗的研究进展

肺癌为原发性支气管肺癌的简称,是起源于气管、支气管黏膜或腺体的最常见的肺部原发性恶性肿瘤。根据组织病理学特点分为非小细胞肺癌（non-small cell lung cancer,NSCLC）和小细胞肺癌。其中,NSCLC又包括鳞癌和腺癌。肺癌发病率高,早诊率低,预后较差。2018年全球统计数据显示,肺癌发病率高居所有癌症发病率的第一位（总病例数的11.6%）,是导致癌症死亡的主要原因（占癌症总死亡人数的18.4%）。高达55%的NSCLC患者诊断时已处于Ⅳ期,无法手术。目前全身治疗仍然是晚期NSCLC的主要治疗方式,免疫治疗俨然成为全身治疗中最重要的一环。但是越来越多的证据表明,对原发肿瘤部位进行局部消融治疗同样可以提高生存率,激活全身免疫系统,助力免疫治疗。自然而然,个体化微创消融治疗结合免疫治疗就成为了一种新兴的治疗策略。本文综述了NSCLC的免疫治疗、消融治疗以及两种方式联合治疗的研究进展。     

进展期非小细胞肺癌抗血管生成治疗进展

肺癌是中国发病率和死亡率最高的恶性肿瘤,其中非小细胞肺癌（non-small cell lung cancer,NSCLC）占肺癌总数的85%,大部分肺癌患者初诊时即为进展期。目前,细胞毒化疗在进展期NSCLC治疗的进步较为有限,多项研究中含铂二联方案化疗治疗下的中位总生存期（overall survival,OS）未超1年。抗血管生成治疗的出现打破现状,治疗策略由单纯的细胞毒化疗转换为抗血管生成与化疗、酪氨酸激酶抑制剂（tyrosine kinase inhibitors,TKI）和免疫检查点抑制剂联合的综合治疗模式。本文将对进展期NSCLC抗血管生成治疗的应用现状进行探讨。      

Adjuvant treatment of lung cancer: current status and potential applications of new regimens

Non-small-cell lung cancer (NSCLC) accounts for approximately 80% of lung cancers diagnosed worldwide. Surgical resection offers the best chance for cure for those patients diagnosed with early-stage disease; however, the vast majority of patients will eventually relapse. Despite complete surgical resection, recurrences are likely due to undetectable microscopic disease at diagnosis, making these patients potential candidates for effective adjuvant therapy. Postoperative radiation therapy may actually have a detrimental effect in patients with NO-N1 disease and has been shown to possibly prevent local recurrences in patients with N2 disease. Although results from a large meta-analysis of data on adjuvant chemotherapy suggested an absolute benefit of 5% at 5 years from cisplatin-based chemotherapy, a rate similar to that seen in breast and colon cancers where adjuvant chemotherapy is a standard of care, the use of adjuvant therapy in NSCLC remained controversial. In addition, results of the International Adjuvant Lung Cancer Trial (IALT), which compared adjuvant cisplatin-based chemotherapy to observation in patients with resected stage-I-IIIA NSCLC, suggested that adjuvant therapy had the potential to prevent a substantial number of deaths each year. Two recently reported landmark studies have demonstrated the survival advantages of adjuvant therapy for patients with early-stage NSCLC. Docetaxel, one of the most active agents for advanced NSCLC, is also regularly used for locally advanced disease as part of neoadjuvant or combined-modality regimens. As recent findings have established the value of adjuvant chemotherapy for early-stage NSCLC, agents such as docetaxel warrant rigorous evaluation in this setting.     

晚期非小细胞肺癌的中医维持治疗

晚期非小细胞肺癌（ＮＳＣＬＣ）维持治疗是肿瘤学专家在化疗疗效达到“瓶颈”后为延长患者生存时间所提出的一种新型治疗模式,主要包括化疗维持和靶向维持,目前维持治疗尚存在较多的争议,临床上尚未完全推行。本文通过论述中医药治疗晚期ＮＳＣＬＣ的现状及优势,分析中医药进行维持治疗的优势及可行性,并对维持治疗的发展进行探索,希望中医药在晚期ＮＳＣＬＣ维持治疗中能有新的突破和进展。     

Clinical study of adenoviral mediated p53 gene therapy for non-small cell lung cancer in Japan

The prognosis in case of non-small cell lung cancer (NSCLC) remains poor, and novel treatment modalities are urgently needed for advanced NSCLC. Backed by advances in the understanding of cancer biology, gene therapy has been developed in recent years. The p53 gene is altered in over 50% of cancers and has been extensively studied as a tumor suppressor gene. Adenoviral-mediated p53 gene transfer is currently under clinical evaluation worldwide for the treatment of cancer. We are now conducting a phase I study of Ad-p53 for advanced NSCLC patients in Japan. As an interim report, we provide a brief summary of the current status of this study, highlighting the safety and clinical efficacy of Ad-p53. As of September 2002, 13 patients were enrolled to this study, and safety and antitumor effects have been noted.     

晚期非小细胞肺癌吉非替尼二线和三线治疗的疗效比较

目的:探讨吉非替尼用于晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)二线或三线治疗对患者生存期的影响。方法:回顾性分析106例晚期NSCLC患者的病历和随访资料,其中62例患者接受吉非替尼二线治疗,44例患者接受吉非替尼三线治疗。应用Kaplan-Meier法进行生存分析。结果:两组患者的性别(P=0.51)、年龄(P=0.91)、体能状况评分(P=0.42)、临床分期(P=0.18)、吸烟史(P=0.95)和病理类型(P=0.99)的差异无统计学意义。吉非替尼二线治疗和三线治疗患者的中位无进展生存期分别分别为2.9和3.2个月(P=0.757),有效率分别为17.7%和11.4%(P=0.665),疾病控制率分别为48.4%和54.5%(P=0.822)。吉非替尼二线治疗和三线治疗患者的中位总生存期分别为24.0和21.0个月(P=0.524)。二线治疗获得疾病控制的30例患者以及三线治疗获得疾病控制的24例患者的中位总生存期分别为29.7和22.2个月(P=0.611)。吉非替尼二线治疗与三线治疗的不良反应相似。结论:吉非替尼用于晚期NSCLC二线治疗和三线治疗的缓解率和生存获益无明显差异。     

Irinotecan and platinums in the treatment of non small-cell lung cancer

Lung cancer is the leading cause of cancer death in the United States and in the world. In the United States, lung cancer ranks first in cancer deaths for both men and women. The 5-year survival rate is only 15%, but this has improved considerably from the 5% rate in the early 1960s. For many years, the standard therapy for patients with advanced, stage IIIB and IV non small-cell lung cancer (NSCLC) was best supportive care, which consisted of palliative radiotherapy, pain management, and other symptom management. The median survival for these patients was only 4 months, and more than 85% died in the first year after diagnosis. Cisplatin was the first drug that was shown to prolong the survival of patients with advanced lung cancer. Meta-analyses of randomized trials showed that cisplatin reduced the hazard rate of death by 26%, increased median survival from 4 to 6 months, and increased 1-year survival from 15% to 25%. Cisplatin-based therapy also relieved symptoms in the majority of patients and improved the quality of life as assessed by patients themselves. Still, further advances are desperately needed, as three fourths of the cisplatin-treated patients die within a year of diagnosis. Topoisomerase I inhibitors are a new class of chemotherapeutic agents introduced into lung cancer therapy during the 1990s. Irinotecan (CPT-11) was shown to be active in patients with both small-cell and non small-cell lung cancers. The activity of irinotecan in advanced NSCLC made it logical to combine irinotecan with the two platinums, cisplatin and carboplatin. The combination of irinotecan with cisplatin produced response rates of about 40% in phase II trials conducted in previously un-treated patients with advanced NSCLC. The median survival in these studies ranged from 6-8 months, and the 1-year survival rates ranged from 40%-60%. Because carboplatin is more convenient and better tolerated than cisplatin, a number of more recent phase II trials have evaluated the combination of irinotecan and carboplatin in patients with advanced NSCLC. These trials produced results similar to those achieved with irinotecan/cisplatin and with other two-drug combinations such as paclitaxel/carboplatin and gemcitabine/ cisplatin. The excellent activity of the two-drug combination or irinotecan and a platinum led to trials of three-drug combinations, such as irinotecan/carboplatin/paclitaxel. Preliminary results from these studies showed excellent survival, although the toxicity required some dosage reductions. Randomized trials will be necessary to determine whether such three-drug combinations will be preferred over standard two-drug combinations.     

The new era of immune checkpoint inhibition and target therapy in early-stage non-small cell lung cancer. A review of the literature

Surgery is the best option for patients with early stage non-small cell lung cancer (NSCLC). However, the rate of local and metastatic recurrences following surgery alone is high, especially in NSCLC patients with N2 lymph node involvement. A recent American study showed that 60% of lung cancers are diagnosed in an advanced stage, and less than 20% are diagnosed in an early, resectable stage. The same study reported the 5 year survival of patients with stage IV NSCLC was 6% compared to 50% in patients with resectable NSCLC depending by stage. The addition of adjuvant or neoadjuvant chemotherapy only improves 5 year survival by 5%-10%. Recently, immunotherapy with or without chemotherapy and novel targeted therapies have yielded excellent results, in terms of both progression-free survival and overall survival, in advanced NSCLC. Published studies have shown a benefit in using immunotherapy and targeted therapy in both the adjuvant and neoadjuvant settings with many further studies still ongoing. Here we review the published data on immunotherapy and targeted therapy in the adjuvant and neoadjuvant settings in patients with operable NSCLC.     

Targeted therapies for advanced non-small-cell lung cancer: current status and future implications

Lung cancer remains the leading cause of malignancy-related mortality worldwide, with over one million cases diagnosed yearly. Non-small-cell lung cancer (NSCLC) accounts for >80% of all lung cancers. Because lung cancer is typically diagnosed at an advanced stage, chemotherapy (CT) is the mainstay of management. Conventional treatment of NSCLC has apparently reached a plateau of effectiveness in improving survival of patients, and treatment outcomes must still be considered disappointing. Hence, considerable efforts have been made in order to identify novel targeted agents that interfere with other dysregulated pathways in advanced NSCLC patients. In order to further improve the results of targeted therapy, we should not forget that lung cancer is a heterogeneous disease with multiple mutations, and it is unlikely that any single signaling pathway drives the oncogenic behaviour of all tumours. The relative failure of some targeted therapies may be a result of multilevel cross-stimulation among the targets of the new biological agents along several pathways of signal transduction that lead to neoplastic events. Thus, blocking only one of these pathways allows others to act as salvage or escape mechanisms for cancer cells. We summarize the most promising research approaches to the treatment of NSCLC, with particular attention to drugs with multiple targets or combining targeted therapies.