血清KL-6在肺癌放射性肺炎中的研究进展

血清KL-6是由上皮性黏蛋白1(MUCl)基因编码的一类糖蛋白,是较早被公认的间质性肺疾病的特异性标志物,而且KL-6亦高表达于部分恶性肿瘤患者.近年的研究发现,血清KL-6与放射性肺炎的发生相关,监测血清KL-6可预测放射性肺炎的发生并评估疾病的严重程度及预后.     

糖尿病与Ⅲ期非小细胞肺癌的放射性肺炎的相关性分析

目的 探讨Ⅲ期NSCLC糖尿病患者放射性肺炎的发生率.方法 回顾性分析完成放疗的Ⅲ期NSCLC患者的临床资料,将其分为糖尿病组(DM)(n=38)和对照组(NDM) (n=175),比较两组患者放射性肺炎的发生率.结果 糖尿病组放射性肺炎发病率为42.1％,对照组为21.7％,两组患者发生2级以上放射性肺炎的差异具有统计学意义(P＜0.05).糖尿病病程≥5年的患者放射性肺炎的发生率与糖尿病病程＜5年的患者相比,差异有统计学意义(P＜0.05).结论 糖尿病为Ⅲ期非小细胞肺癌患者发生放射性肺炎的易感因素.     

75例非小细胞肺癌患者同步放化疗致放射性肺炎的相关因素分析

目的:探讨非小细胞肺癌同步放化疗引起放射性肺炎的相关影响因素.方法:回顾性分析我中心75例非小细胞肺癌进行三维适形放疗同步化疗后出现放射性肺炎的患者的一般情况,基础肺功能及其放疗靶体积和放疗剂量的关系.结果:75例患者中肿瘤完全缓解(CR)6例,占8%;部分缓解(PR)41例,占54.67%;稳定(NC)17例,占22...     

非小细胞肺癌根治术后放射治疗价值的前瞻性研究

目的　评价术后放疗对根治术后N1与N2 非小细胞肺癌的作用。方法　 1982年 2月至 1995年12月收治的 36 6例小于 6 5岁的N1与N2 非小细胞肺癌病例 ,随机分为术后放疗组 (n =184)和单纯手术组 (n= 182 )。结果　术后放疗组和单纯手术组 5年生存率分别为 43 .4%± 5 .1%和 40 .5 %± 4.6 % (P =0 .5 6 ) ,5年无瘤生存率分别为 42 .9%± 5 .2 %和 38.3 %± 4.5 % (P =0 .2 8)。T3 4 N1M0 患者在术后放疗组的 5年生存率和5年无瘤生存率分别为 5 8.1%± 15 .5 %和 6 5 %± 12 % ,单纯手术组则分别为 39.9%± 10 .2 % (P =0 .0 92 )和40 %± 10 % (P =0 .0 5 7)。术后放疗可明显减少胸内复发 (P <0 .0 1)。结论　术后放疗可减少局部复发 ,对总的生存改善不明显 ,但对T3 4 或N1患者有望获得治疗益处     

非小细胞肺癌合并2型糖尿病患者发生放射性肺炎的分析

目的 探讨非小细胞肺癌合并2型糖尿病患者发生放射性肺炎的分析.方法 收集肺癌放疗的患者134例,对比分析肺癌合并糖尿病与未合并糖尿病患者放射性肺炎的发生情况.结果 单纯肺癌组与肺癌合并糖尿病组患者一般资料对比分析发现,2组患者在年龄、体质量以及是否合并高血压以及TNM分期方面差异具有统计学意义(P＜0.05),但在性别、癌症家族史以及病理类型方面差异不具统计学意义(P＞0.05).单纯肺癌组患者与肺癌合并糖尿病组患者相比照射面积差异无统计学意义(P＞0.05).放射性肺炎的总发生率单纯肺癌组为20.7％,与肺癌合并糖尿病组(40.4％)相比,差异具有统计学意义(P＜0.05).肺癌合并糖尿病患者放射性肺炎的发病危险是单纯肺癌组患者的2.43倍(95％CI为1.270 ～4.879),糖尿病为非小细胞肺癌患者发生放射性肺炎的危险因素.结论 肺癌合并2型糖尿病会增加患者发生放射性肺炎的危险性,值得临床上注意.     

术后辅助化疗对Ⅰ期非小细胞肺癌无瘤生存时间的影响

背景与目的 手术是早期肺癌的首选治疗方法,但早期肺癌术后的预后仍有很大差异,术后是否应用辅助化疗也有争议.本研究探讨术后辅助化疗在Ⅰ期非小细胞肺癌患者中的作用,尤其是在高危人群中的作用.方法 选择北京大学人民医院2009年1月-2013年6月接受手术的Ⅰa期、Ⅰb期肺癌患者,分别以是否行术后化疗分为两组,用Kaplan-Meier法进行生存分析,比较两组术后无瘤生存时间(disease-free survival,DFS)的差异;并按危险因素个数进行评分,分为0分、1分、≥2分三组,比较三组术后DFS的差异;单独比较术后化疗对≥2分的高危组患者的作用.结果 经过筛选后共有465例患者纳入研究,Ⅰa期284例,Ⅰb期181例.Ⅰa期化疗组和对照组术后DFS并无明显差异(P=0.171),但化疗组生存曲线位于对照组下方,Ⅰb期两组术后DFS也无明显差异(P=0.630).危险因素评分后的三组患者DFS有明显差异(P<0.001),危险因素越多,术后DFS越差,可看作是高危患者.但单独分析显示,术后化疗与否对这部分高危患者的DFS并无显著影响(P=0.763).结论 术后化疗对早期非小细胞肺癌的DFS并无积极作用,即使是对于具有多个高危因素的I期非小细胞肺癌患者,术后化疗也许也不适用.     

调强放疗对非小细胞肺癌患者生存情况、血清CA125水平及不良反应的影响

目的探讨调强放疗对非小细胞肺癌患者生存情况、血清CA125水平及不良反应的影响。方法选取非小细胞肺癌患者74例,将患者随机分为对照组和观察组,每组37例。对照组采用三维适形放疗(3D-CRT),观察组采用调强放疗(IMRT)。观察比较两组患者的近期治疗效果等情况。结果观察组和对照组患者总有效率分别为75.68%、72.97%,差异无统计学意义(P>0.05)。观察组和对照组患者的1年生存率为75.68%、67.56%,差异有统计学意义(P<0.05)。观察组患者的血清CA125水平为(76.32±8.25),低于对照组(101.38±15.24),差异有统计学意义(P<0.05)。观察组不良反应发生包括白细胞减少、血小板减少、消化道反应、放射性肺炎、放射性食管炎,明显较对照组低,差异有统计学意义(P<0.05)。观察组的CI值低于对照组,HI值高于对照组,差异有统计学意义(P<0.05)。结论调强放疗和三维适形放疗,对非小细胞肺癌患者的治疗疗效相近,调强放疗能够有效降低患者的血清CA125水平,减少不良反应的发生,并且靶区剂量分布更加合理。     

X刀立体定向放射治疗非小细胞肺癌的临床研究

目的观察X刀立体定向放射治疗非小细胞肺癌(NSCLC)的近期、远期疗效及其并发症,探讨X刀立体定向放疗在非小细胞肺癌治疗中的应用价值。方法75例符合条件的NSCLC患者随机分为两组,X刀治疗组38例,应用X刀立体定向放疗,剂量4~6Gy/次,每日或隔日1次,共治疗8~10次,使GTV边缘剂量达45~55Gy。常规放疗组37例,常规分割放疗,每次1.8~2.0Gy,每日1次,每周5次,总照射剂量60~65Gy。结果X刀组总有效率(CR PR)为86.8%,明显优于常规放疗组的62.1%,两组差异有非常显著性(P<0.05)。X刀组1,2,3年生存率分别为87.5%、60.0%和35.0%;常规放疗组分别为58.3%、27.8%和16.7%,两组间1,2,3年生存率比较差异均有显著性。结论与常规放疗相比,X刀立体定向放疗可以在较好保护周围正常组织的同时,提高肿瘤照射区的放射剂量,从而增加非小细胞肺癌的局部控制率,提高远期生存率。     

Ⅲb～Ⅳ期非小细胞肺癌同期放化疗临床因素与放射性肺炎相关性研究

目的 探讨非小细胞肺癌化疗同期三维适形或调强放疗中位剂量70 Gy时临床因素与放射性肺炎(RP)的相关性.方法 采用三维适形或调强后程加速超分割放疗经病理或细胞学证实初治的非小细胞肺癌患者84例,同期化疗78例,化疗采用紫杉醇或多西紫杉醇或长春瑞滨+顺铂或卡铂一线方案.单因素分析病理类型、治疗方式、年龄、性别、临床分期、卡氏评分、吸烟、糖尿病、慢性阻塞性肺病(COPD)与RP相关性,对其中P＜0.10因素代入Logistic回归模型进行多因素分析.结果 84例患者中≥1级RP发生率为63%,≥2级为33%.单因素分析显示糖尿病与≥1级RP(x2=4.03,P=0.045)及≥2级RP相关(x2=15.59,P=0.000),卡氏评分与≥1级RP(x2=3.98,P=0.046)及≥2级RP相关(x2=5.21,P=0.023).多因素分析显示糖尿病与≥1级RP(x2=5.50,P=0.019)及≥2级(x2=12.92,P=0.000)RP发生相关,卡氏评分与≥1级RP(x2=6.29,P=0.012)及≥2级RP(x2=6.61,P=0.010)发生相关.结论 糖尿病、卡氏评分是非小细胞肺癌患者发生RP的危险因素,制定放疗计划时充分考虑可减少RP发生机会.

Abstract：

Objective To evaluate clinical factors as predictors of radiation pneumonitis(RP)in advanced stage non-small cell lung cancer(NSCLC)patients treated with concurrent radiochemotherapy when gross tumor volume is 70 Gy. Methods Data of 84 patients with histologically proved NSCLC treated with 3DCRT or IMRT were collected. To evaluate the correlation between clinical parameters and radiation pneumonitis(RP). The clinical parameters were considered: pathological type, therapy agents, age,gender, stage, karnofsky performance status(KPS), smoking status, diabetes, chronic obstructive pulmonary disease(COPD). Results The occurrence of grade 1,2 RP was 63%, 33%, respectively. In univariate analysis, diabetes was significantly associated with RP of ≥ grade 1(x2 =4.03, P = 0.045)and ≥grade 2(x2 = 15.59 ,P =0.000). KPS was significantly associated with RP of ≥grade 1(x2 =3.98 ,P = 0.046)and ≥grade 2(x2 = 5.21, P = 0.023). In logistic multivariate analysis, diabetes was significantly associated with RP of ≥grade 1(x2 =5.50,P =0.019)and ≥grade 2(x2 = 12.92,P =0.000). KPS was significantly associated with RP of ≥ grade 1(x2 = 6.29, P = 0.012)and ≥ grade 2(x2 = 6.61, P =0.010). Conclusion The definite statistical significant risk factors of RP are diabetes and KPS.     

非小细胞肺癌低分割放疗后放射性肺炎的影响因素分析

目的 探讨非小细胞肺癌低分割放疗后放射性肺炎的影响因素.方法 收集120例接受低分割放疗的非小细胞肺癌患者的临床资料,对术后3个月内发生放射性肺炎的危险因素进行Logistic回归分析.结果120例患者中,37例(30.83%)患者发生放射性肺炎,83例(69.17%)患者未发生放射性肺炎.有肺部疾病史、肿瘤体积≥40 cm3、V20≥12%、患肺最大受照剂量≥54 Gy、有化疗史是影响非小细胞肺癌低分割放疗后放射性肺炎的独立危险因素(P﹤0.05).结论 非小细胞肺癌低分割放疗后放射性肺炎的发生是各项指标相互作用的结果,在制定放疗计划时需综合考虑各项指标,及时调整治疗方案以降低放射性肺炎的发生率.     

胸部放疗放射性肺炎病因学相关因素分析

目的:评价在胸部恶性肿瘤的放射治疗中各流行病学因素、治疗因素、放射剂量学因素与放射性肺炎发生的相关性.方法:回顾性分析2007-01-2010-12本中心接受胸部放射治疗的肺癌及食管癌患者共143例.使用CTCAE 3.0标准定义放射性肺炎及其分级,分别记录各患者的性别、年龄、既往手术史、化疗史、放疗史、同步放化疗、长期激素使用史、PTV体积、肺体积、放疗靶区、总剂量、单次剂量、肺平均受量、V5、V10、V20、V30及V40诸因素.分别使用x2检验、t检验及Logistic回归分析评价各因素与放射性肺炎间的相关性.结果:在143例患者中,共发生放射性肺炎26例(18.18％),其中1、2、3、4级放射性肺炎分别为13例(9.09％)、8例(5.59％)、3例(2.10％)和2例(1.40％).Logistic 回归分析的结果表明既往化疗史、放疗史、同步化疗、ECOG评分、放疗靶区、单次剂量、肺平均受量、V20、V30及V40均与放射性肺炎的发生相关.结论:既往有化疗史者、既往有放疗史者、同步放化疗者、ECOG评分、放疗靶区、单词剂量、肺平均受量、V20、V30或V40均是放射性肺炎发生率显著升高的相关因素.在临床工作中应充分评估需接受胸部放疗患者所具有的相关高危因素,预测可能发生放射性肺炎的风险.     

Thoracic radiation therapy improves the overall survival of patients with extensive-stage small cell lung cancer with distant metastasis

BACKGROUND:

The authors conducted a retrospective study to evaluate the effects of thoracic radiation therapy (TRT) for patients with extensive‐stage small cell lung cancer (ED‐SCLC).

METHODS:

Between January 2003 and December 2006, the records of 119 patients who were diagnosed with ED‐SCLC (all with distant metastasis [M1]) were included in the study. Sixty patients received chemotherapy (ChT) and TRT (ChT/TRT), and 59 patients received ChT alone. The ChT regimens consisted of either carboplatin and etoposide (CE) or cisplatin and etoposide (PE). The total dose of TRT ranged from 40 to 60 grays (Gy) at 1.8 to 2.0 Gy per fraction.

RESULTS:

For the entire group, the median survival was 13 months, and the 2‐year and 5‐year overall survival (OS) rates were 26.1% and 6.5%, respectively. The median survival and the 2‐year and 5‐year OS rates were 17 months, 35%, and 7.1%, respectively, in the ChT/TRT group and 9.3 months, 17%, and 5.1%, respectively, in the ChT group (P = .014). However, this improvement was achieved at the expense of low toxicity. Multivariate analysis revealed that receiving ≥4 cycles of ChT (P = .032) and TRT (P = .005) were favorable prognostic factors for OS. Of all toxicities, only high‐grade leucopenia (grade >3) was more frequent in the ChT/TRT group.

CONCLUSIONS:

The addition of TRT to ChT improved the OS of patients with ED‐SCLC. Furthermore, receiving ≥4 cycles of ChT and TRT were independent, favorable prognostic factors for OS. Cancer 2011;. © 2011 American Cancer Society.     

Nivolumab-induced radiation recall pneumonitis in non-small-cell lung cancer patients with thoracic radiation therapy

The role of previous thoracic radiation therapy as a risk factor of immune-related pneumonitis is unclear. Furthermore, some patients develop radiation recall pneumonitis, which is characterized by a radiation pneumonitis-like imaging pattern with consolidation progressing within a previous radiation field. In this multicenter retrospective study, we analyzed the relationship of previous thoracic radiation therapy with immune-related pneumonitis and the characteristics of radiation recall pneumonitis. The medical records of patients with non-small-cell lung cancer who had received nivolumab between December 2015 and March 2017 at five institutions were retrospectively reviewed. Incidence, imaging patterns, clinical course, and risk factors of immune-related pneumonitis and radiation recall pneumonitis were evaluated. A total of 669 patients were evaluated, and the incidences of all-grade and grade 3 or higher immune-related pneumonitis were 8.8% and 2.6%, respectively. The incidences of immune-related pneumonitis were 13.2% (34/257) and 6.1% (25/412) in patients with and those without previous thoracic radiation therapy, respectively. A history of previous thoracic radiation therapy was associated with immune-related pneumonitis (odds ratio, 2.11; 95% confidence interval, 1.21–3.69 in multivariate analysis). Among the patients with previous thoracic radiation therapy, 6.2% (16/257) showed radiation recall pattern. This study found an increased risk of nivolumab-induced immune-related pneumonitis associated with a history of thoracic radiation therapy. Radiation recall pattern was one of the major patterns of immune-related pneumonitis among the patients with previous thoracic radiation therapy. Incidence, risk factors, and clinical outcome of radiation recall pneumonitis were elucidated.     

肺癌患者放射性肺炎诊治回顾性分析

目的:回顾性分析肺癌患者接受胸部放疗后并发放射性肺炎的发生率,了解其发生的相关因素及诊治情况。方法:选取接受胸部放疗的Ⅱ～Ⅳ期肺癌患者968例,研究照射剂量、面积等14个因素对放射性肺炎发生的影响。应用SPSS 13.0进行χ2检验的单因素分析。结果:113例患者均发生不同程度的放射性肺炎,发生率11.7%(113/968)。单因素分析显示,放疗剂量、射野面积、辐照体积V30及合并胸腔积液、肺部感染、有肺慢性疾病病史是放射性肺炎的主要影响因素;肿瘤病理类型、临床分期、性别、合并化疗、糖尿病与放射性肺炎无关。放射性肺炎的治疗除吸氧、支气管扩张剂等一般处理外,抗生素加激素治疗是关键。结论:照射野面积大和剂量高的患者放射性肺炎的发生率明显增高,在肺癌放疗中正确设计放疗靶区,全面了解患者的肺部并发症,可明显减少放射性肺炎的发生机会。     

Syntenin在非小细胞肺癌中的表达及其与患者总生存期的关系

目的：检测Syntenin在非小细胞肺癌（NSCLC）组织中的蛋白表达水平并探讨其临床意义。方法：采用组织芯片和免疫组织化学染色法,检测Syntenin在147例NSCLC及相应癌旁组织中的表达水平,并分析Syntenin的表达与NSCLC患者临床病理指标及预后的关系。结果：Syntenin在NSCLC组织中的阳性表达率（49.7%）显著高于癌旁组织（4.1%）（P < 0.01）。Syntenin的表达与NSCLC的淋巴结转移、临床分期和病理类型显著相关（P值分别为0.039、0.038、0.024）,与患者的性别和年龄无显著相关（P > 0.05）。Kaplan-Meier分析表明,Syntenin的表达与NSCLC患者的总生存期显著相关（P=0.028）。结论：Syntenin在NSCLC组织中高表达,并且其高表达预示了患者的不良预后。     

Serum amyloid A is elevated in the serum of lung cancer patients with poor prognosis

Background:

Lung cancer is known as the top cancer killer in most developed countries. However, there is currently no promising diagnostic or prognostic biomarker for lung cancer. This study aims to discover non-invasive differential markers in the serum of lung cancer patients, to determine the protein identity of the candidate biomarker(s), and to investigate any clinical implication of the biomarker(s) concerned.

Methods:

Blood specimens were collected from 154 pre-operative patients with lung cancer and 35 healthy blood donors with no evidence of lung cancer. Fractionated serum samples were processed by surface-enhanced laser desorption/ionisation time-of-flight mass spectrometry (MS). Candidate biomarker was identified using sodium dodecyl sulphate polyacrylamide gel electrophoresis and tryptic digestion followed by tandem MS fragmentation analysis, which was subsequently validated with immunoassay.

Results:

A differential protein with m/z 11.6 kDa was detected and identified as an isoform of human serum amyloid A (SAA). It was significantly increased by 1822% in lung cancer patients when compared with the healthy controls, which gave an area under the receiver operator characteristic curve of 0.88. In addition, the protein was also significantly elevated by 77% in lung cancer patients with survival <5 years when compared with patients with survival ⩾5 years.

Conclusion:

There are several functions of the SAA protein, described in the context of inflammation, that are compatible with the mechanism of tumour invasion and metastasis. Our study not only detected increased SAA level in the serum of lung cancer patients but also identified that elevated SAA level may be a non-invasive biomarker useful for the prediction of lung cancer prognosis.     

Exhaled nitric oxide predicts radiation pneumonitis in esophageal and lung cancer patients receiving thoracic radiation

Background and purpose

Radiation pneumonitis is a significant toxicity following thoracic radiotherapy with no method to predict individual risk.

Materials and methods

Sixty-five patients receiving thoracic radiation for lung or esophageal cancer were enrolled in a phase II study. Each patient received respiratory surveys and exhaled nitric oxide measurements before, on the last day of, and 30-60 days after completing radiotherapy (RT). Pneumonitis toxicity was scored using the common terminology criteria for adverse events, version 4.0. The demographics, dosimetric factors, and nitric oxide ratio (NOR) of end RT/pre-RT were evaluated for correlation with symptomatic patients (Grade ?2).

Results

Fifty patients completed the trial. The pneumonitis toxicity score was: Grade 3 for 1 patient, Grade 2 for 6 patients, Grade 1 for 18 patients, and Grade 0 for 25 patients. Dosimetric factors were not predictive of symptoms. The NOR was 3.0 ± 1.8 (range 1.47-6.73) for the symptomatic and 0.78 ± 0.29 (range 0.33-1.37) for the asymptomatic patients (p = 0.006). A threshold NOR of 1.4 separated symptomatic and asymptomatic patients (p < 0.001). The average error was 4%.

Conclusions

Elevation in eNO on the last day of radiotherapy predicted subsequent symptomatic radiation pneumonitis weeks to months after treatment.     

Long-term survival outcomes of video-assisted thoracic surgery for patients with non-small cell lung cancer

Background： Video-assisted thoracic surgery （VATS） has been shown to be a safe alternative to conventional thoracotomy for patients with non-small cell lung cancer （NSCLC）. However, popularization of this relatively novel technique has been slow, partly due to concerns about its long-term outcomes. The present study aimed to evaluate the long-term survival outcomes of patients with NSCLC after VATS, and to determine the significant prognostic factors on overall survival. Methods： Consecutive patients diagnosed with NSCLC referred to one institution for VATS were identified from a central database. Patients were treated by either complete-VATS or assisted-VATS, as described in previous studies. A number of baseline patient characteristics, clinicopathologic data and treatment-related factors were analyzed as potential prognostic factors on overall survival. Results： Between January 2000 and December 2007, 1,139 patients with NSCLC who underwent VATS and fulfilled a set of predetermined inclusion criteria were included for analysis. The median age of the entire group was 60 years, with 791 male patients （69%）. The median 5-year overall survival for Stage Ⅰ, Ⅱ, Ⅲ and Ⅳ disease according to the recently updated TNM classification system were 72.2%, 47.5%, 29.8% and 28.6%, respectively. Female gender, TNM stage, pT status, and type of resection were found to be significant prognostic factors on multivariate analysis. Conclusions： VATS offers a viable alternative to conventional open thoracotomy for selected patients with clinically resectableNSCLC     

糖尿病与放射性肺炎发生的相关危险性分析

目的 探讨伴有糖尿病的肺癌患者在接受放射治疗后放射性肺炎的发生情况.方法 156例非小细胞肺癌(NSCLC)患者均接受三维适形放射治疗,其中伴有糖尿病者52例,无糖尿病的对照组104例,随访观察1年,比较两组患者放射性肺炎的发生情况,并分析血糖控制水平和糖尿病病史与放射性肺炎的发病相关性.结果 糖尿病组和对照组患者放射性肺炎的发病率分别为40.4%和21.2%.(P<0.05),伴有糖尿病的肺癌患者放射性肺炎的发病危险是对照组患者的2.05倍(95%CI为1.17～3.58).糖尿病组和对照组患者放射性肺炎的严重程度无明显差异.血糖控制较好的NSCLC患者放射性肺炎的发病率(30.6%)低于血糖控制欠佳者(62.5%,P<0.05).糖尿病病史较长的NSCLC患者与糖尿病病史较短者比较,放射性肺炎的发病率差异无统计学意义(P0.05).结论 糖尿病为NSCLC患者发生放射性肺炎的易感因素,其易感程度与血糖控制水平有关.