恩度联合化疗治疗老年晚期非小细胞肺癌25例临床护理

目的:探讨恩度(重组人血管内皮抑制素)联合含铂化疗方案治疗老年晚期非小细胞肺癌(NSCLC)的疗效和不良反应护理。方法:将老年晚期NSCLC患者50例随机分为两组各25例,对照组采用NP方案(长春瑞滨+顺铂)治疗,观察组采用NP方案+恩度治疗,21 d为1个周期,2个周期治疗结束后对其疗效、生活质量及不良反应进行评价,并随访至少1年统计生存率。结果:观察组有效率为80.0%,6个月、12个月生存率分别为96.0%、88.0%,生活质量提高率为76.0%;对照组有效率为44.0%,6个月、12个月生存率分别为44.0%、20.0%,生活质量提高率为20.0%。以上两组比较差异有统计学意义(P<0.05)。结论:恩度联合化疗治疗老年晚期NSCLC,可提高患者疗效,延长生存期,提高生活质量,不良反应少。     

The prognostic value of intraepithelial and stromal innate immune system cells in non-small cell lung carcinoma

Aims:  The major value of prognostic markers in potentially curable non-small cell lung carcinoma (NSCLC) should be to guide therapy after surgical resection. The prognostic significance of tumour-infiltrating macrophages, their growth factor, macrophage colony-stimulating factor (M-CSF), and its receptor, colony-stimulating factor-1 receptor (CSF-1R), as well as natural killer cells and dendritic cells, is controversial. The aim of this study was to elucidate the prognostic significance of these markers in the epithelial and stromal compartments of NSCLC.
Methods and results:  Tissue microarrays from 335 resected NSCLC, stage I–IIIA were constructed from duplicate cores of epithelial and stromal areas. Immunohistochemistry was used to evaluate epithelial and stromal areas for CD68, M-CSF, CSF-1R, CD56 and CD1a. On univariate analysis, increasing numbers of stromal CD1a+ ( P  = 0.011) and CD56+ cells ( P  = 0.014) correlated significantly with improved disease-specific survival (DSS). On multivariate analysis, stromal CD56+ cells were an independent prognostic factor for DSS (hazard ratio = 2.3, confidence interval = 1.1, 5.0, P  = 0.031).
Conclusions:  High density of stromal CD56+ cells is an independent factor associated with improved prognosis in resected NSCLC, suggesting that these cells mediate an antitumour immune response in the tumour stroma.     

伊立替康治疗晚期非小细胞肺癌临床观察

目的：观察伊立替康（开普拓）联合顺铂治疗晚期非小细胞肺癌（Non-Small cell lung cancer,NSCLC）的疗效以及不良反应。方法：经病理学或细胞学确诊的初治晚期NSCLC患者30例,男性18例,女性12例,中位年龄45岁（波动于33-56岁之间）,KPS评分〉70。接受顺铂60-80 mg.（m^2）^-1联合开普拓60 mg.（m^2）^-1第1d、8d、15d静脉滴注,每4周重复。至少2周期以上,可评价疗效及不良反应。结果：全组PR7例,SD21例,PD2例,总有效率为23%。中位生存时间10.5个月,1年生存为率57%（17/30）。主要不良反应为延迟性腹泻和粒细胞减少。结论：伊立替康联合顺铂治疗晚期NSCLC疗效确切,不良反应发生率低,耐受性较好。     

替加氟持续低剂量口服治疗晚期非小细胞肺癌的临床观察

目的：观察替加氟片（FT-207）持续低剂量口服治疗晚期非小细胞肺癌（NSCLC）的有效性和安全性。方法：32例ⅢB～Ⅳ期NSCLC复治患者，其中男性19例，女性13例；年龄56—74岁，服用FT-207片50mg，bid，持续服用至病情进展或毒性不能耐受。根据WHO标准评价疗效和毒性。结果：全组32例患者均可评价，获PR2例，SD16例，PD14例，有效率（RR）为6．3％，疾病控制率（DCR）为56．3％。疾病进展时间（TTP）为3．1个月。中位生存时间（MST）为7．9个月。KPS评分治疗前平均77．9分，治疗后平均85．1分。主要毒副反应为乏力、恶心和食欲减低，但均较轻微。骨髓抑制不常见，少数患者可有轻度的白细胞及血红蛋白减少。结论：替加氟片持续低剂量口服治疗晚期NSCLC，能延缓病情发展，毒副作用轻微，费用低廉，易为患者接受。     

吉西他滨耐药细胞系H460/Gem及其亲代细胞NCI-H460之间的不同

Objective: To discuss the difference between multi-drug resistant cell line H460/Gem and its parental cell NCI-H460 on the basis of establishment of human gemcitabine-resistant cell line H460/Gem so as to elaborate the possible mech-anisms of gemcitabine resistance. Methods: Human gemcitabine-resistant non-small cell lung cancer cell line H460/Gem was established by 2/3 clinical serous peak concentration gemcitabine intermittent selection from its parental cell human large cell lung carcinoma cell line NCI-H460 which was sensitive to gemcitabine. During the course of inducement, we had monitored their morphology, checked their resistance indexes and resistant pedigree by MTT method, gathered their growth curves and calculated their doubling time, examined their DNA contents and cell cycles by FCM; at the same time, we had measured its expressions of P53, EGFR, c-erb-B-2, PTEN, PCNA, c-myc, VEGF, MDR-1, Bcl-2, nm23, MMP-9, TIMP-1, CD44v6 proteins via immunocytochemistry staining, RRM1 and ERCC1 mRNA by real-time fluorescent quantitative-PCR. Results: The resis-tance index of H460/Gem' cells (the deputy of cells in the process of inducement) to gemcitabine was 1.201, and the cell line also exhibited cross-resistance to paclitaxol, fluorouraci, etoposide, cisplatin and oxaliplatin, but kept sensitivity to vinorelbine and taxotere. The doubling time of H460/Gem' cells was longer and figures in G0-G1 phase was decreased than that of NCI-H460 cells. Compared with NCI-H460 cells, H460/Gem' cells had achieved TIMP-1 protein expression emerged, nm23 protein expression enhanced, VEGF and MMP-9 protein expressions reduced, and CD44v6, P53 protein expressions van-ished, but expressions of EGFR, c-erb-B-2, PTEN, PCNA, c-myc, MDR-1, Bcl-2 proteins and RRM1, ERCC1 mRNA changed trivially. The resistance index of H460/Gem cells to gemcitabine was 1.644, and the cell line also exhibited cross-resistance to fluorouraci, cisplatin and oxaliplatin, but kept sensitivity to paclitaxol, vinorelbine, taxotere, and etoposide. The doubling time of H460/Gem cells was longer and figures in G0-G1 phase was decreased than those of NCI-H460 cells. The farther studies indicated that, compared with NCI-H460 cells, the expressions of MDR-1, nm23 and Bcl-2 proteins in H460/Gem cells had been enhanced, c-erb-B-2 protein expression emerged, P53, MMP-9 and VEGR protein expression had been weakened, but the changes of PTEN, PCNA, c-myc, TIMP-1, EGFR, CD44v6 protein, RRM1 mRNA and ERCC1 mRNA expressions were trivial. Furthermore, compared with its parental cells, H460/Gem cells were mixed with giant cells of different sizes that were larger and more irregular. Conclusion: The human gemcitabine-resistant non-small cell lung cancer cell line H460/Gem had achieved multi-drug resistance and great changes of biological characters compared with its parental cells. And these changes possibly participated in the formation of multidrug resistance.     

The effects on surgery and preoperative patients with non-small cell lung cancer by preoperative bronchial artery infusion chemotherapy

Objective: To study the efficiency, safety and feasibility of preoperative bronchial artery infusion (BAI) chemotherapy on operation in patients with locally advanced (stage Ⅲ) non-small cell lung cancer (NSCLC).Methods: 92 cases with locally advanced NSCLC patients were randomly divided into two groups: (1) BAI chemotherapy group: 39 cases were received BAI chemotherapy for 2 courses and followed surgery; (2) surgery alone group: 51 cases were treated by operation alone.The complete resection rate and preoperative complications were compared between these two groups.Results: In BAI chemotherapy group, the rate of clinical efficiency was 68.3% with slight toxicity.In BAI chemotherapy group the surgery complete resection rate was 89.7%, which was significantly higher than that in surgery alone group (72.5%, P＜0.05).No significant differences of blood loss, operative complications and mortality were observed between these two groups.Conclusion: BAI neoadjuvant chemotherapy was safe and effective, which can increase the complete resection rate of the tumor and did not increase the operative complications and mortality.     

654-2注射液在非小细胞肺癌动脉灌注化疗中的临床应用

目的：观察654—2注射液在非小细胞肺癌动脉灌注化疗中的增效反应与不良反应。方法：76例中晚期NSCLC随机分为两组。对照组42例，经支气管动脉推注化疗药物（MMC、VDS、DDP）；实验组34例，先经支气管动脉推注654—2注射液（10—20）mg，以后推注化疗药物；每月1次，连用3次为1疗程。结果：对照组有效率49．99％，实验组有效率61．76％，实验组疗效明显优于对照组（P=0．01）。不良反应率两组相似，无统计学差异（P〉0．05）。结论：654—2注射液在中晚期非小细胞肺癌支气管动脉灌注化疗中能提高化疗疗效，不良反应轻微，具有一定的临床应用价值。