病理类型不确定的晚期非小细胞肺癌的诊断、治疗及预后

The Diagnosis,Treatment and Prognosis of Advanced Non-small-cell Lung Cancer-Not Otherwise Specific

在个体化治疗来临时代,对存在驱动基因的晚期非小细胞肺癌(NSCLC)患者,靶向药物已成为目前的治疗趋势。而对于基因类型未明或野生型的患者,根据其病理类型指导治疗已是非小细胞肺癌治疗的共识。但在临床工作中,仍存在一群病理类型不确定的非小细胞肺癌(NSCLC-NOS)患者。NSCLC-NOS的诊断主要依靠形态学诊断及免疫组织化学染色方法。免疫组织化学染色方法的准确率相对较高,对NSCLC的分型更精确。关于NSCLC-NOS,目前靶向治疗的数据较少。对于NSCLC-NOS一线化疗方案研究较少,大多数试验在与其他病理类型的比较中,PFS及OS并不具有统计学意义。部分试验取得了PFS或OS数据上的获益,但均因样本量较小而无统计学差异。NSCLC-NOS是肺癌预后的独立不良因素。相较于其他病理类型的肺癌,NSCLC-NOS更具侵袭性。

In the era of personalized treatment,targeted therapy has become the most possible option for advanced NSCLC patients with gene mutations. While for patients with wild-type gene or unknown type gene,there＇s an agreement among the oncologists that the treatment should be established based on pathological results. However,in clinical work,there＇s a certain group of patients who are pathologically diagnosed as NSCLC-NOS. So far,effective therapies for this kind of patients are few. This review has systematically elaborated the diagnosis and prognosis of patients with NSCLC-NOS as well as the efficacy of different therapies. The diagnosis of NSCLC-NOS is mainly based on morphology and immunohistochemistry,the latter technology has a higher diagnostic yield and is more accurate with respect to NSCLC subtyping. So far,few clinical trials aiming at targeted therapies of NSCLC-NOS have gained meaningful clinical outcomes. There are few studies about first-line chemotherapy for NSCLC-NOS. Among them,most studies demonstrate patients with NSCLC-NOS don＇t gain extended OS or PFS comparing with other pathological types.Still,some clinical experiments show numerically superior in OS and PFS,but the results don＇t reach statistical difference because of the small sample size. NSCLC-NOS is an independent prognostic factor for lung cancer,which predicts the poor outcomes of the patient.