肺癌化疗患者PICC置管相关性静脉血栓形成的危险因素

目的探讨肺癌化疗患者PICC置管相关性静脉血栓形成的危险因素。方法选择医院2016年1月—2019年10月收治的肺癌化疗患者176例,统计PICC置管相关性静脉血栓发生例数,采用单因素及多因素分析,筛选肺癌化疗PICC置管相关性静脉血栓形成的危险因素。结果根据PICC置管期间是否发生相关性静脉血栓分为病例组50例与对照组126例;单因素分析显示,年龄、BMI、吸烟史、合并高血压、穿刺次数、同步放疗、合并糖尿病、病理类型、置管前D-二聚体水平、置管肢体活动比较差异具有统计学意义(P<0.05)。多因素Logistic回归分析模型结果显示,肺癌化疗患者PICC置管相关性静脉血栓形成的危险因素有BMI≥25、合并糖尿病、腺癌、置管前D-二聚体>0.5 mg/L、置管肢体过度或缺失活动(P<0.05)。结论肺癌化疗患者PICC置管相关性静脉血栓形成受多因素影响,需强化预防护理干预。     

Incidence of venous thrombosis in a large cohort of 66 329 cancer patients: results of a record linkage study

BACKGROUND: The incidence of venous thrombosis (VT) for cancer patients is increased compared with patients without cancer, but estimations of the incidence for different types of cancer have rarely been made because of the low incidence of various types of cancer. Large registries offer an opportunity to study the risk of VT in large cohorts of cancer patients, which is essential in decisions on prophylactic anti-coagulant treatment. METHODS: This cohort study estimates the incidence of VT in cancer patients by using record linkage of a Cancer Registry and an Anticoagulation Clinic database in the Netherlands. Cumulative incidences in patients with different types of malignancies were estimated. We calculated relative risks (RRs) in relation to the presence of distant metastases and treatment. RESULTS: Tumors of the bone, ovary, brain, and pancreas are associated with the highest incidence of VT (37.7, 32.6, 32.1, and 22.7/1000/0.5 year). Patients with distant metastases had a 1.9-fold increased risk [RRadj: 1.9; 95% confidence interval (CI): 1.6-2.3]. Chemotherapy leads to a 2.2-fold increased risk (RR(adj): 2.2; 95% CI: 1.8-2.7) and hormonal therapy leads to a 1.6-fold increased risk (RRadj: 1.6; 95% CI: 1.3-2.1) compared with patients not using these treatment modalities. Patients with radiotherapy or surgery did not have an increased risk. CONCLUSIONS: We compared the overall incidences of VT in the first half year in our study to the risk of major bleeding as described in the literature. For patients with distant metastases, for several types of cancer, prophylactic anti-thrombotic treatment could be beneficial.     

Lung cancer: diagnosis and management

Lung cancer is the leading cause of cancer-related death in the United States, with an average five-year survival rate of 15 percent. Smoking remains the predominant risk factor for lung cancer. Lung cancers are categorized as small cell carcinoma or non-small cell carcinoma (e.g., adenocarcinoma, squamous cell carcinoma, large cell carcinoma). These categories are used for treatment decisions and determining prognosis. Signs and symptoms may vary depending on tumor type and extent of metastases. The diagnostic evaluation of patients with suspected lung cancer includes tissue diagnosis; a complete staging work-up, including evaluation of metastases; and a functional patient evaluation. Histologic diagnosis may be obtained with sputum cytology, thoracentesis, accessible lymph node biopsy, bronchoscopy, transthoracic needle aspiration, video-assisted thoracoscopy, or thoracotomy. Initial evaluation for metastatic disease relies on patient history and physical examination, laboratory tests, chest computed tomography, positron emission tomography, and tissue confirmation of mediastinal involvement. Further evaluation for metastases depends on the clinical presentation. Treatment and prognosis are closely tied to the type and stage of the tumor identified. For stages I through IIIA non-small cell carcinoma, surgical resection is preferred. Advanced non-small cell carcinoma is treated with a multimodality approach that may include radiotherapy, chemotherapy, and palliative care. Chemotherapy (combined with radiotherapy for limited disease) is the mainstay of treatment for small cell carcinoma. No major organization recommends screening for early detection of lung cancer, although screening has interested researchers and physicians. Smoking cessation remains the critical component of preventive primary care.     

晚期肺癌患者血清CEA、CYFRA21-1、SCC、NSE水平变化的临床意义

目的探讨癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)、鳞状细胞癌相关抗原(SCC)和神经烯醇化酶(NSE)在晚期肺癌患者化疗疗效评估中的价值。方法选择136例晚期肺癌患者(肺癌组)和40例肺部良性疾病患者(对照组),对肺癌组进行至少2个疗程的化疗,比较化疗前肺癌组和对照组、肺癌组不同病理类型患者血清CEA、CYFRA21-1、SCC和NSE水平,并比较肺癌组不同疗效患者化疗前后上述肿瘤标志物水平的变化情况。结果化疗前肺癌组血清CEA、NSE、CYFRA21-1、SCC水平均高于对照组(P0.01);鳞癌患者血清CEA水平高于腺癌患者和小细胞癌患者(P0.01),小细胞癌患者血清NSE水平高于腺癌患者和鳞癌患者(P0.01),鳞癌患者血清CYFRA21-1、SCC水平均高于腺癌患者和小细胞患者(P0.01)。腺癌部分缓解(PR)患者化疗后血清CEA水平显著下降(P0.01),鳞癌PR患者化疗后血清CYFRA21-1、SCC水平显著下降(P0.05),小细胞癌PR患者化疗后血清NSE水平显著降低(P0.01),各组化疗后稳定的和有进展的患者化疗前后血清CEA、NSE、CYFRA21-1、SCC水平差异均无统计学意义(P0.05)。结论 CEA、CYFRA21-1、SCC、NSE可作为肺腺癌、肺鳞癌和小细胞癌化疗有效的评估指标,但对化疗无效患者检测意义不大。     

肺癌患者空腹血糖特点的回顾性临床研究

目的探讨肺癌患者与空腹血糖（FBG）的关系。方法选择入院前未经治疗、无糖尿病史的肺癌患者560例为研究组,根据细胞学类型分为2个亚组：小细胞肺癌组（70例）及非小细胞肺癌组（490例）。非小细胞肺癌组再根据病理分型分为鳞癌组（156例）、腺癌组（292例）和腺鳞癌组（42例）。另选取同期住院治疗的无糖尿病史的非恶性肿瘤患者500例为对照组。所有患者晨起采集空腹静脉血2 m L,采用葡萄糖氧化酶法进行FBG测定。对各组的FBG进行比较。结果除鳞癌组外,研究组及各亚组患者FBG明显高于对照组（均P〈0.05）。研究组、小细胞癌组、非小细胞肺癌组、腺癌组及腺鳞癌组6.1 mmol·L^-1〈FBG≤7．0mmol·L^-1。发生率高于对照组（P〈0．05）;研究组、小细胞肺癌组患者3．9mmol·L^-1≤FBG≤6．1mmol·L^-1发生率低于对照组（P〈0．05）。研究组各亚组患者的FBG比较差异均无统计学意义（均P〉0．05）。结论肺癌患者特别是小细胞癌、腺癌及腺鳞癌患者较容易发生FBG升高．且考虑与肺癌本身有关。     

肿瘤化疗患者输液港相关性血栓的简易风险评分构建及验证

目的:了解肿瘤化疗患者输液港相关性血栓的临床发生情况和影响因素,并构建和验证简易风险评分系统,为肿瘤化疗患者的临床护理提供参考。方法:应用自行设计的患者资料调查表回顾性收集2015年1月至2018年12月在广州医科大学附属第一医院呼吸健康研究院留置输液港的肿瘤化疗患者资料,数据应用SPSS 22.0软件进行统计分析。结果:620例患者的输液港相关性血栓发生率为6.5%(40/620),训练样本和验证样本的发生率依次为6.7%(25/372)和6.1%(15/248);通过logistic回归分析可构建包含化疗次数、癌症分期、血栓病史、D-二聚体、同侧中心静脉置管史5个因子的简易评分系统,模型的评分在0~28,可以将其划分为低危(<9分)、中危(9~19分)和高危(>19分)3个风险等级,并且训练样本和验证样本在不同风险等级的血栓发生率差异无统计学意义(P>0.05)。ROC结果示:训练样本和验证样本的曲线下面积分别为0.748(0.707~0.873)和0.837(0.749~0.925),差异均具有统计学意义(P<0.05)。结论:肿瘤化疗患者输液港相关性血栓的临床发生率相对较高,新建的简易评分系统具有一定的预测能力,适用于肿瘤化疗患者输液港相关性血栓的筛查和预防。     

Prognostic significance of febrile episodes in lung cancer patients receiving chemotherapy

The prognostic significance of neutropenic fever in lung cancer patients receiving chemotherapy with or without radiotherapy was investigated. Male patients and patients with squamous cell lung cancer had a higher incidence of febrile episodes than female patients and patients with other cell types, but the differences were not significant. Patients with a poor performance status had a significantly higher incidence of febrile episodes. An indwelling central venous catheter was an important risk factor for febrile episodes, indicating that bacteremia was one of the major causes of fever. The median survival time of the patients who developed febrile episodes during chemotherapy was significantly shorter than that of patients without fever (6.1 vs 12.0 months), whether or not cases of early death within 3 months were excluded (8.9 vs 13.1 months). The prevention of infectious complications during anticancer treatment by the use of rh G-CSF and the early initiation of antimicrobial chemotherapy, although the results are inconclusive, may be worthwhile.     

肺癌患者血清NSE，SCC，CA125及 CYFRA21-1水平检测在不同病理类型早期诊断和化疗疗效评价中的应用价值

目的　研究肺癌患者血清神经元特异性烯醇化酶（ neuron speci.c enolase,NSE）、鳞状上皮细胞癌抗原（ squamous cell carcinoma antigen,SCC）、糖类癌抗原 125（carbohydratte cancer antigen 125,CA125）及细胞角蛋白 -19片断抗原（cytokeratin-19 fragment antigen,CYFRA21-1）检测在不同病理类型早期诊断和化疗疗效评估中的作用。方法　纳入宝鸡市中心医院放射治疗科 78例肺癌患者作为研究对象,采用免疫电化学发光法检测血清 NSE,SCC,CA125及 CYFRA21-1水平,记录病理分型检测结果。比较腺癌、鳞癌及小细胞肺癌（ small cell lung cancer,SCLC）不同病理分型患者血清 NSE,SCC,CA125及 CYFRA21-1水平。分析血清 NSE,SCC,CA125及 CYFRA21-1对诊断不同病理分型患者及判断化疗近期疗效的准确性。结果　穿刺病理结果显示腺癌 38例,鳞癌 30例,SCLC 10例。三组不同病理分型肺癌患者血清 NSE,SCC,CA125及血清 CYFRA21-1水平差异均有统计学意义（ F=8.627,44.832,31.864,11.480,均 P<0.05）。受试者工作曲线（ receiver operating characteristic,ROC）分析显示血清 CYFRA21-1和 CA125诊断肺腺癌的 AUC分别为 0.690和 0.691（95%CI=0.546~0.807,0.533~0.781,P<0.05）。ROC分析显示血清 CYFRA21-1,SCC及 CA125诊断鳞癌的 AUC分别为 0.681,0.675及 0.670（95%CI=0.561~0.801,0.557~0.794,0.550~0.791,P<0.05）。ROC分析显示血清 NSE,CYFRA21-1及 SCC诊断 SCLC的 AUC为 0.717,0.743及 0.699（95%CI=0.493~0.941,0.602~0.884,0.531~0.867, P<0.05）。血清 CYFRA21-1+CA125诊断肺腺癌的敏感度和特异度分别为 0.873和 0.756,血清 CYFRA21-1+SCC诊断肺鳞癌敏感度和特异度分别为 0.893和 0.822,血清 CYFRA21-1+SCC+CA125诊断肺鳞癌的敏感度和特异度分别为 0.915和 0.716。血清 NSE+CYFRA21-1诊断 SCLC的敏感度和特异度分别为 0.914和 0.786,血清 NSE+SCC+CYFRA21-1诊断 SCLC的敏感度和特异度分别为 0.920和 0.702。血清 CYFRA21-1+CA125,血清 CYFRA21-1+SCC及血清 CYFRA21-1+NSE对判断肺腺癌、肺鳞癌及 SCLC化疗疗效的 AUC分别为 0.822,0.804及 0.772（95%CI=0.708~0.936,0.697~0.911,0.641~0.903,均 P<0.05）。结论　不同病理类型肺癌患者血清 NSE,SCC,CA125及 CYFRA21-1水平表达各异,血清 NSE,SCC, CA125及 CYFRA21-1的检测有助于不同病理类型肺癌患者的诊断和化疗近期疗效的判断。     

云南省曲靖市631例肺癌患者临床特征分析

目的分析肺癌患者的临床特征,为肺癌的相关预防、诊治提供依据。方法选择云南省曲靖市第二人民医院2015年1月-2018年6月收治的631例肺癌患者作为研究对象,分析所有患者的性别、年龄、地域分布、吸烟史、肺部疾病史、病理类型等临床资料。结果 631例肺癌患者中,有腺癌378例(占59.91%),鳞癌197例(占31.22%),小细胞肺癌44例(占6.97%),其他12例(占1.90%)。肺癌患者男女比例为1.84:1。在鳞癌和小细胞肺癌中,男性所占比例均明显高于女性〔鳞癌:94.42%(186/197)比5.58%(11/197),小细胞肺癌:75.00%(33/44)比25.00%(11/44)〕,差异均有统计学意义(均P<0.01),在腺癌和其他病理分型中,男性和女性所占比例差异均无统计学意义(均P>0.05)。肺癌患者平均发病年龄为(61.95±10.98)岁,男性平均(62.56±10.97)岁,女性平均(60.57±11.66)岁,高发年龄为51~70岁。肺癌患者地域分布为麒麟区(216例)、宣威市(115例)、富源县(98例)、沾益区(81例)最为高发。肺癌患者的吸烟率为46.28%,其中鳞癌、小细胞肺癌患者的吸烟率较高,分别为69.04%、56.82%,腺癌患者吸烟率相对较低,为34.13%。既往有慢性肺部疾病史的肺癌患者共101例,占16.01%。结论云南省曲靖市是云南省肺癌高发地区,分析肺癌患者的临床特征对控制危险因素和促进高风险人群的早期发现具有重要意义。     

肺癌脑转移78例临床分析

目的：探讨肺癌脑转移的临床特点以提高对肺癌的诊治水平。方法：对我院199101－2002－01住院的78例肺癌脑转移患的临床资料进行回顾性分析，结果：肺癌脑转移发生率为8．5％，60例病理确诊中以腺癌最多见，占46．7％（28例），依次是小细胞癌33．3％（20例），鳞癌16．7％（10例），大细胞癌3．3％（2例），以神经系统症状为首发表现易误诊占肺癌脑转移的38．5％，肺癌脑转移常为多发病灶，以额叶、顶叶及颞叶多见，综合治疗（化疗，放疗和手术）后神经系统症状减轻或消失，可延长生存2－8个月，结论：肺癌脑转移预后差，及时发现及合理治疗可减轻神经系统症状，改善患的生存期和生活质量。     

214例肺癌CT征象与病理诊断结果对照研究

目的：探讨肺癌cT征象与病理结果间的相关性。材料与方法：回顾性分析临床确诊为肺癌患者214例,所有患者均行cT检查,将肺癌病理类型与cT征象相对照,判断其病理类型与cT征象的一致性。结果：腺癌的胸膜凹陷征发生率高于鳞状细胞癌、小细胞癌、大细胞癌,小细胞癌纵隔淋巴结转移率高于鳞状细胞癌、腺癌、大细胞癌,鳞状细胞癌、小细胞癌、大细胞癌合并肺炎及肺不张发生率高于腺癌。结论：cT检查可在术前对肺癌的组织分型做出初步判断。     

晚期非小细胞肺癌放化疗疗效观察

目的探讨同步放化疗与序贯化放疗治疗晚期非小细胞肺癌临床疗效及毒副反应。方法60例经病理或细胞学证实为非小细胞肺癌患者,鳞癌31例,腺癌23例,大细胞癌2例,未定型癌4例。经CT或MRI可测值病灶分期Ⅲa15例,Ⅲb30例,Ⅳ15例;年龄在21—86岁;Kamofsky评分／〉70;被随机分为A、B两组。A组30例为：序贯方法,即化疗＋放疗＋化疗;B组30例为：同步化放疗（周一-五放疗,周六化疗）＋化疗。结果近期疗效：PR＋CR：B组明显好于A组,差异有显著性。毒副作用：胃肠反应B组高于A组,骨髓抑制A组高于B组,差异有统计学意义。结论晚期非小细胞肺癌同步化放疗近期疗效明显优于序贯化放疗,而毒副作用没明显增加,更远期疗效尚待进一步观察。     

非小细胞肺癌合并孤立脑转移灶的手术疗效观察

目的探讨非小细胞肺癌合并孤立性脑转移灶的手术治疗效果,分析影响患者生存期的因素。方法回顾性分析2005年1月-2011年5月46例接受手术治疗的非小细胞肺癌合并孤立性脑转移灶患者的临床资料,其中男35例,女11例;年龄35～67岁,平均53.2岁;所有患者均行肺部原发肿瘤及脑部转移肿瘤切除术,其中肺叶切除术42例,全肺切除术4例,术后全部患者行全脑放射治疗,部分患者行系统化学疗法3～6周期。对随访患者的生存时间采用对数秩检验,分析影响生存率的因素。结果术后病理检查提示腺癌27例,鳞癌15例,大细胞癌2例,其他类型2例。患者1年生存率80%,2年生存率41%,3年生存率14%,中位生存期23个月,平均生存期（27.8±4.5）个月（乘积极限法）。对数秩检验结果提示N0与N1患者比N2患者生存率高（P=0.024）,腺癌患者生存期比非腺癌患者生存期长（P=0.002）。结论外科手术治疗非小细胞肺癌合并孤立性脑转移灶的患者可以取得良好的治疗效果,腺癌患者及无纵隔淋巴结转移的患者生存期长。     

肺癌肝转移瘤二维超声表现与组织病理类型的相关性研究

目的:探讨肺癌肝转移瘤的二维超声表现与组织病理类型的相关性。方法:回顾分析102例肺癌肝转移患者的临床资料,并分析肺癌肝转移瘤的不同病理分型与二维超声图像特性之间的相关性。结果:102例肺癌肝转移瘤中,小细胞癌24例,鳞癌16例,腺癌55例,腺鳞癌5例,大细胞癌1例,腺样囊性癌1例。小细胞癌、鳞癌、腺癌、腺鳞癌肝转移瘤的回声强度不同,组间比较差异有统计学意义(P=0.0169)。小细胞癌以低回声多见,占52.6%;高回声占26.3%。鳞癌以高回声多见,占84.6%;低回声占7.7%。腺癌低回声占31.9%,高回声占38.3%。腺鳞癌以高回声多见,占75.0%;低回声占25.0%。结论:肺癌肝转移瘤的二维超声表现与其病理组织类型有一定的相关性。     

4项肿瘤标志物在肺癌诊断中的应用价值

目的探讨肿瘤标志物胃泌素释放肽前体(ProGRP)、神经元特异性烯醇化酶(NSE)、细胞角蛋白19的可溶性片段(CYFRA21-1)和鳞状细胞癌抗原(SCC)在肺癌诊断中的临床价值。方法选择151例肺癌及肺部良性病变患者为研究对象,其中小细胞肺癌(SCLC)43例,非小细胞肺癌(NSCLC)68例(包括腺癌35例、鳞癌33例),肺部良性病变患者40例,另选取健康体检者40例纳入健康对照组。采用罗氏电化学发光仪E601检测所有研究对象血清中的ProGRP、NSE、CYFRA21-1和SCC水平。结果 SCLC组的ProGRP和NSE水平均明显高于NSCLC-腺癌组、NSCLC-鳞癌组及肺部良性病变组,而NSCLC-腺癌组和NSCLC-鳞癌组的CYFRA21-1和SCC水平均明显高于SCLC组及肺部良性病变组,差异均有统计学意义(P<0.05)。在单项指标中,ProGRP在SCLC中的灵敏度和特异度最高,分别为77.2%和91.1%;CYFRA21-1在NSCLC-腺癌和NSCLC-鳞癌中的灵敏度和特异度较高,分别为65.9%和90.1%,以及71.5%和91.2%;在联合检测中,ProGRP+NSE在SCLC中的灵敏度和特异度分别为92.5%和83.6%;CYFRA21-1+SCC对NSCLC-腺癌和NSCLC-鳞癌的灵敏度在83.0%以上,特异度在85.0%以上。结论 ProGRP与NSE联合检测诊断SCLC的价值优于单项肿瘤标志物的检测;CYFRA21-1与SCC联合检测对NSCLC-腺癌和NSCLC-鳞癌有较高的灵敏度和特异度,这些肿瘤标志物诊断和筛查肺癌的潜力值得进一步研究。     

原发性支气管肺癌1345例统计分析

目的:探讨不同年龄段肺癌的病理及临床特征。方法:回顾性查阅新桥医院2001年1月至2007年12月间共1345例确诊原发性支气管肺癌患者的临床病理资料,以Statistica6.0及Excel2003进行统计分析。结果:在全部1345例肺癌患者中,男性所占比重较大,男女比例约为4:1(78.07%:21.93%),其发病高峰年龄段均于50～59岁,分别占男性和女性患者的36.00%及31.53%,病理类型总体分布为腺癌:鳞癌:小细胞癌=37.99%:35.99%:15.61%,其中女性患者以肺腺癌(62.03%)居多,男性以肺鳞癌(42.38%)居首位,不同病理类型及性别构成比例分布在不同年份之间差异无显著性,肺腺癌所占比例随年龄增大呈现下降趋势。结论:肺癌发病率与患者年龄相关,男女比例约为4:1,腺癌居于首位,但随年龄增大所占比例减小。     

Non-small cell lung cancer: epidemiology, risk factors, treatment, and survivorship

Lung cancer is the leading cause of cancer-related mortality not only in the United States but also around the world. In North America, lung cancer has become more predominant among former than current smokers. Yet in some countries, such as China, which has experienced a dramatic increase in the cigarette smoking rate during the past 2 decades, a peak in lung cancer incidence is still expected. Approximately two-thirds of adult Chinese men are smokers, representing one-third of all smokers worldwide. Non-small cell lung cancer accounts for 85% of all lung cancer cases in the United States. After the initial diagnosis, accurate staging of non-small cell lung cancer using computed tomography or positron emission tomography is crucial for determining appropriate therapy. When feasible, surgical resection remains the single most consistent and successful option for cure. However, close to 70% of patients with lung cancer present with locally advanced or metastatic disease at the time of diagnosis. Chemotherapy is beneficial for patients with metastatic disease, and the administration of concurrent chemotherapy and radiation is indicated for stage III lung cancer. The introduction of angiogenesis, epidermal growth factor receptor inhibitors, and other new anti-cancer agents is changing the present and future of this disease and will certainly increase the number of lung cancer survivors. We identified studies for this review by searching the MEDLINE and PubMed databases for English-language articles published from January 1, 1980, through January 31, 2008. Key terms used for this search included non-small cell lung cancer, adenocarcinoma, squamous cell carcinoma, bronchioalveolar cell carcinoma, large cell carcinoma, lung cancer epidemiology, genetics, survivorship, surgery, radiation therapy, chemotherapy, targeted therapy, bevacizumab, erlotinib, and epidermal growth factor receptor.     

Elderly patients with squamous lung carcinoma: faring better or worse?

Introduction Nonsmall cell lung cancer is increasingly diagnosed at an advanced age and squamous cell carcinoma is the commonest histological type encountered in older patients. The clinical course, management, and outcome of squamous lung cancer in the elderly have not been thoroughly studied to date.Patients and Methods We retrospectively analyzed 236 squamous cell lung cancer patients diagnosed in two reference hospitals and compared key epidemiological, clinical, and management features between elderly (>70 years) and younger patients. Sixty-four were aged more than 70 years at diagnosis while 172 were up to 70 years of age.Results There were no differences between the two groups in gender or stage distribution. No differences were observed in the nature or duration of presenting symptoms, the appearance of pleurisy, atelectasis or vascular invasion, the incidence of distant metastatic spread, or the response to combination chemotherapy. Elderly patients were less fit (performance status 2/3 30 vs 20%, p=0.03), developed hemoptysis more often (56 vs 42%, p=0.04), and presented with smaller tumor primaries (median 4 vs 8 cm, p=0.004). When metastases were present, older patients exhibited a tropism for bony (64 vs 29%, p=0.03) and rarity of brain (5 vs 14%, p=0.03) deposits. Though elderly subjects received chemotherapy (63 vs 82%, p=0.003) or radiotherapy (29 vs 48%, p=0.009) less often than their younger counterparts, they tolerated it well and achieved comparable median time to treatment failure and overall survival (median 17 vs 18 months, log-rank p=0.22). Platinum-based chemotherapy and potentially curative management were applied less often in older patients.Conclusions Older patients are less fit, develop bony but not brain metastases, receive antineoplastic treatment less often, and survive as long as younger patients. Squamous lung carcinoma may follow a more indolent clinical course in the elderly, a hypothesis worth validating by case-cohort studies and molecular profiling, with the hope to rationally individualize patient treatment.     

宫颈癌卵巢转移的临床病理分析

目的探讨宫颈癌卵巢转移的发生率、临床病理特征及影响因素。方法对中山大学肿瘤防治中心妇科1980年1月至2002年12月手术治疗中切除卵巢的宫颈癌病例907例进行回顾性研究。结果本组Ⅰ～Ⅱ期宫颈癌的卵巢转移率为0.8%,其中鳞癌为0.4%,腺癌为2.1%,腺鳞癌为5.0%（P〈0.001）。7例卵巢转移以单侧为主,均为镜下转移,转移灶主要位于卵巢门。单因素分析显示,卵巢转移与组织学类型、颈管深肌层浸润、宫体侵犯、宫旁侵犯有关（均P〈0.05）。多因素分析显示,组织学类型（P=0.039）、颈管深肌层浸润（P=0.048）、宫旁侵犯（P=0.001）是宫颈癌卵巢转移的独立危险因素。结论Ⅰ～Ⅱ期宫颈癌中,腺癌、腺鳞癌的卵巢转移率明显高于鳞癌。血行转移可能是卵巢转移的主要途径之一。对年轻的早期宫颈癌患者,若组织学类型为腺癌或腺鳞癌、颈管肌层浸润≥1/2或宫旁侵犯,保留卵巢须慎重。     

921例经支气管镜确诊肺癌的临床特点分析

目的 对921例经支气管镜确诊肺癌的临床特点进行分析。方法 采用常规支气管镜检查，镜下直视、盲目活检组织病理检查和刷检细胞学检查的方法，确定诊断和病理类型。结果 肺癌的发病率在40岁以下显著增加，50-69岁为发病高峰，70岁以下开始下降。921例肺癌中，鳞癌占38．5％，腺癌和低分化癌分别占27．4％和21．9％，小细胞癌占8．7％，其他占3．5％。男性鳞癌的发病率最高，女性腺癌发病率最高。结论 50-69岁是肺癌的高发年龄段，发病率最高的是鳞癌，其次是腺癌、低分化癌和小细胞癌。男女性别的病理类型分布有差别。重视支气管镜检查和提高活检技术，可显著提高诊断率。为临床治疗提供依据。