非小细胞肺癌新辅助化疗后的光镜和电镜观察

The light microscopic and the electron microscopic observation of non small cell lung cancer after induction chemotherapy

目的 :评价非小细胞肺癌 ( NSCL C)术前化疗后的疗效和观察其病理学的表现。方法 :随机选择 2 2例 NSCL C病人 ,其中 11例术前行 MVP方案化疗 1～ 2个周期 ,外科手术切除标本进行光镜和电镜的观察并评定其疗效 ,与临床评价进行比较。结果 :化疗组有不同程度的病理变化 ,原发灶的肿瘤细胞显示不同程度的变性和坏死 ,化疗反应率 、 和 级分别为 0 .0 %、63.6%和 36.4 % ,总有效率 ( 级和 级 )为 63.6% ( 7/11) ,低分化肿瘤患者的有效率占总有效率的 85.7% ( 6/7) ,临床评价与病理学评价的符合率为 72 .7% ,两种评价方法之间无显著性差异 ( P>0 .0 5) ,在非化疗组没有明显的肿瘤细胞的消失。结论 :对非小细胞肺癌术前行 MVP方案辅助化疗与单纯手术相比有更好的治疗效果 ,伴有纤维化的变性和坏死是原发灶化疗后的主要表现形式 。

Purpose:To evaluation the pathologic finding and the curative effects of induction chemotherapy of MVP(MMC+VDS+DDP)regimen on NSCLC. Patients and Methods:From August 1998 to June 1999,11 cases of NSCLC were treated with chemotherapy of MVP regimen before operation, and the other 11 cases were not treated with induction chemotherapy before operation. Treatment evaluation were conduced by pathologic findings of resected specimens under light microscope (LM)and electron microscope(EM). Results :There were various types of pathologic findings in the primary lesion of trial group, and the tumor cells showed various degrees of degeneration and necrosis. The overall response rate (grade Ⅰand Ⅱ) in the trial group was 63.6%(7/11), and that in patients with poorly differentiated NSCLC 85.7% (6/7).The response rate was consisting with the clinical assessment .There were no statistically significant differences in the evaluation of response rate between the pathology and clinic (P>0.05). There were no changes or obvious remissions of tumor cells in the control group. Conclusion: This study showed that induction chemotherapy with MVP regimen had better results than without adjuvant chemotherapy in the treatment of patients with NSCLC. Necrosis with fibrosis was a feature of the primary lesion after chemotherapy.