Relevance of EGFR gene mutation with pathological features and prognosis in patients with non-small-cell lung carcinoma

Objective:To study the relevance of EGFR gene mutation with pathological features and prognosis in patients with non-small-cell lung carcinoma.Methods:A total of 297 patients from July 2009 to May 2013 were chosen as objects.EGFR gene mutation were detected with fluorescence quantitative PCR.Relevance of EGFR gene mutation with clinical and pathological features was analyzed,and the prognosis of EGFR- mutant-patients and that of EGFR- wide type-patients was compared.Results:In 297 patients.136(45.79%) showed EGFR gene mutation.EGFR gene mutation had no significant relevance with age.gender,smoking history,family history of cancer and clinical stage(P>0.05);there was significant relevance between EGFR gene mutation and blood type,pathologic types,differentiation and diameter of cancer(P<0.05).The difference between prognosis of EGFR- mutant-patients and that of EGFR- wide type-patients was statistical significance(P<0.05).Conclusions:EGFR gene mutation has significant relevance with pathological features,the prognosis of EGFRmutant-paticnts is better than that of EGFR- wide type-patients.

Inhibitory Effect of MiR-449b on Cancer Cell Growth and Invasion through LGR4 in Non-Small-Cell Lung Carcinoma

Non-small-cell lung carcinoma （NSCLC） is one of the most frequently diagnosed malignancies worldwide. Previous studies have shown that microRNA-449b （miR-449b） functions as a tumor suppressor in many cancers. However, the role of miR- 449b in NSCLC is still unknown. In the present study, miR-449b was significantly down- regulated in NSCLC samples and cell lines. Bioinformatics analysis revealed that 3＇-UTR region of leucine rich repeat containing G protein-coupled receptor 4 （LGR4） mRNA had putative complementary sequences to miR-449b, which was further confirmed by the luciferase assay. Western blotting showed that restoration of miR-449b in NSCLC cells decreased the expression of LGR4. Interestingly, over-expression of miR-449b inhibited growth and invasion of NSCLC cells in vitro. Furthermore, ectopic expression of LGR4 reversed miR-449b-suppressed proliferation and invasion of NSCLC cells. Therefore, the data of the present study demonstrate that miR-449b inhibits tumor cell growth and invasion by targeting LGR4 in NSCLC.

Pang Fuwan Uses Yao Medicine to Observe the Therapeutic Effects on the Physical and Mental Symptoms of Patients with Advanced Non-Small Cell Lung Cancer

Objective: Investigate the efficacy and safety of Yao Medicine in the treatment of advanced non-small-cell lung carcinoma, and explore the best therapeutic measure for clinical benefit. Methods: From July 2020 to July 2022, 84 patients with advanced non-small-cell lung carcinoma were selected and randomly divided into the Observation Group and control group, and the control group was treated with routine Western medicine, with 42 cases in each group. The activity of daily living (ADL) was assessed before and after treatment, meanwhile, the self-rating depression scale (SDS) and self-rating anxiety SAS (SAS) were used to assess the improvement of a bad mood, and quality of life SF-36 was used to assess the quality of life, to judge the efficacy and safety. Results: The effective rate of observation group was 91.67%. The effective rate of the control group was 76.19%. The effective rate of the observation group was significantly higher than that of the control group (P 0.05). There were no significant differences in the scores of SDS, SAS and quality of life between the two groups before treatment (P > 0.05), and after treatment, the scores of SDS, SAS and quality of life in the two groups were compared with those in the control group (P > 0.05), the scores of VAS, SDS and SAS decreased significantly, while ESCV, angle of straight leg elevation, ADL, physiological score, emotional score, social score and health status score increased significantly, the difference was statistically significant (P 0.05). Conclusion: Yao Medicine can improve the psychosomatic symptoms of patients with advanced non-small-cell lung carcinoma better, with better efficacy and higher safety.

Advances in adjuvant systemic therapy for non-small-cell lung cancer

Non-small-cell lung cancer remains a leading cause of death around the world. For most cases, the only chance of cure comes from resection for localised disease, however relapse rates remain high following surgery. Data has emerged over recent years regarding the utility of adjuvant chemotherapy for improving disease-free and overall survival of patients following curative resection. This paper reviews the clinical trials that have been conducted in this area along with the studies integrating radiation therapy in the adjuvant setting. The role of prognostic gene signatures are reviewed as well as ongoing clinical trials including those incorporating biological or targeted therapies.

Pembrolizumab-emerging treatment of pulmonary sarcomatoid carcinoma: A case report

BACKGROUND Few studies have addressed the efficacy of pembrolizumab in pulmonary sarcomatoid carcinoma(PSC),a rare,previously rapidly fatal subtype of nonsmall-cell lung cancer.CASE SUMMARY We report the case of a 69-year-old man presented with respiratory distress caused by a large left upper lung lobe mass diagnosed as PSC with programmed death-ligand 1 expressed on more than 50 percent of tumor cells.The patient was started on pembrolizumab and,after 5 cycles,there was a more than 80 percent decrease in the size of the tumor mass.Further decrease was seen at the end of 10 cycles.The patient has been tolerating pembrolizumab well,with no limiting side-effects.Fourteen months after first coming into the hospital,he remains asymptomatic.CONCLUSION Pembrolizumab appears as a viable emerging treatment for PSC.

Unresectable stage Ⅲ non-small-cell lung cancer: Have we made any progress?

Lung cancer is responsible for the most cancer deaths worldwide with an incidence that is still rising. One third of patients have unresectable stage ⅢA or stage ⅢB disease. The standard of care for locally advanceddisease in patients with good performance status consists of combined modality therapy in particular concurrent chemoradiotherapy. But despite a lot of efforts done in the past, local control and survival of patients with unresectable stage Ⅲ non-small-cell lung cancer(NSCLC) remains poor. Improving outcomes for patients with unresectable stage Ⅲ NSCLC has therefore been an area of ongoing research. Research has focused on improving systemic therapy, improving radiation therapy or adding a maintenance therapy to consolidate the initial therapy. Also implementation of newer targeted therapies and immunotherapy has been investigated as well as the option of prophylactic cranial irradiation. This article reviews the latest literature on improving local control and preventing distant metastases. It seems that we have reached a plateau with conventional chemotherapy. Radiotherapy dose escalation did not improve outcome although increasing radiation dose-intensity with new radiotherapy techniques and the use of newer agents, e.g., immunotherapy might be promising. In the future well-designed clinical trials are necessary to prove those promising results.

Epidermal growth factor receptor and K-Ras in non-small cell lung cancer-molecular pathways involved and targeted therapies

Lung cancer is currently the leading cause of cancer death in Western nations.Non-small cell lung cancer(NSCLC)represents 80%of all lung cancers,and adenocarcinoma is the predominant histological type.Despite the intensive research carried out on this field and therapeutic advances,the overall prognosis of these patients remains unsatisfactory,with a 5-year overall survival rate of less than 15%.Nowadays,pharmacogenetics and pharmacogenomics represent the key to successful treatment.Recent studies suggest the existence of two distinct molecular pathways in the carcinogenesis of lung adenocarcinoma:one associated with smoking and activation of the K-Ras oncogene and the other not associated with smoking and activation of the epidermal growth factor receptor(EGFR).The K-ras mutation is mainly responsible for primary resistance to new molecules which inhibit tyrosine kinase EGFR(erlotinib and gefitinib)and most of the EGFR mutations are responsible for increased tumor sensitivity to these drugs.This article aims to conduct a systematic review of the literature regarding the molecular pathways involving the EGFR,K-Ras and EGFR targeted therapies in NSCLC tumor behavior.

Apoptosis of Lewis Lung Carcinoma Cells Induced by Microwave via p53 and Proapoptotic Proteins In vivo

Background： Microwave therapy is a minimal invasive procedure and has been employed in clinical practice for the treatment of various types of cancers. However, its therapeutic application in non-small-cell lung cancer and the underlying mechanism remains to be investigated. This study aimed to investigate its effect on Lewis lung carcinoma （LLC） tumor in vivo. Methods： Fifty LLC tumor-bearing C57BL/6 mice were adopted to assess the effect of microwave radiation on the growth and apoptosis of LLC tumor in vivo. These mice were randomly assigned to 10 groups with 5 mice in each group. Five groups were treated by single pulse microwave at different doses for different time, and the other five groups were radiated by multiple-pulse treatment of a single dose. Apoptosis of cancer cells was determined by terminal deoxynucleotidyl transferase dUTP nick-end labeling assay. Western blotting was applied to detect the expression of proteins. Results： Single pulse of microwave radiation for 5 min had little effect on the mice. Only 15-min microwave radiation at 30 mW/cm2 significantly increased the mice body temperature （2.20 ± 0.82）℃ as compared with the other groups （0.78 ± 0.29 ℃, 1.24 ± 0.52 ℃, 0.78 ± 0.42 ℃, respectively）, but it did not affect the apoptosis of LLC tumor cells significantly. Continous microwave radiation exposure, single dose microwave radiation once per day for up to seven days, inhibited cell division and induced apoptosis of LLC tumor cells in a dose- and duration-dependent manner. It upregulated the protein levels of p53, Caspase 3, Bax and downregulated Bcl-2 protein. Conclusions： Multiple exposures of LLC-bearing mice to microwave radiation effectively induced tumor cell apoptosis at least partly by upregulating proapoptotic proteins and downregulating antiapoptotic proteins. Continuous radiation at low microwave intensity Ibr a short time per day is promising in treating non-small-cell lung cancer.

KRAS Exon 3 and PTEN Exon 7 Mutations in Small-cell Lung Cancer

Small cell lung cancer (SCLC) is recognized as one of the most aggressive and fatal malignant tumors. No significant improvement has been made to prolong the survival of SCLC patients. This study aimed to examine the mutation status of K-Ras (KRAS) and phosphatase and tensin homolog (PTEN) in SCLC patients in order to identify potential therapeutic targets for SCLC. Nineteen primary SCLC tumor specimens were enrolled in the study. Direct sequencing was perfonned to detect the mutations of KRAS exon 3 and PTEN exon 7 in the specimens. Kaplan- Meier and Cox regression analysis was performed to determine the overall survival (OS) of these SCLC patients. KRAS exon 3 mutation was found in 4 (21%) SCLC patients, and PTEN exon 7 mutation in only 1 (5%) SCLC patient. Kaplan Meier analysis showed that clinical stage and brain metastasis were significantly associated with OS (both P<0.05), but neither KRAS exon 3 mutation nor PTEN exon 7 mutation was significantly associated with OS (P>0.05). Cox proportional hazards regression model indicated that extensive stage of disease was the only independent negative prognostic factor for OS in SCLC patients. In conclusion, KRAS exon 3 and PTEN exon 7 mutations had no significant impact on OS of SCLC patients. Further study is still necessary to validate the molecular profiles of SCLC.

Role of positron emission tomography-computed tomography in non-small cell lung cancer

Lung cancer is the leading cause of cancer-related mortality worldwide. Non-small cell carcinoma and small cell carcinoma are the main histological subtypes and constitutes around 85% and 15% of all lung cancer respectively. Multimodality treatment plays a key role in the successful management of lung cancer depending upon the histological subtype, stage of disease, and performance status. Imaging modalities play an important role in the diagnosis and accurate staging of the disease, in assessing the response to neoadjuvant therapy, and in the follow-up of the patients. Last decade has witnessed voluminous upsurge in the use of positron emission tomography-computed tomography(PET-CT); role of PET-CT has widened exponentially in the management of lung cancer. The present article reviews the role of 18-fluoro-deoxyglucose PET-CT in the management of non small cell lung cancer with emphasis on staging of the disease and the assessment of response to neoadjuvant therapy based on available literature.

焦磷酸测序技术检测63例晚期NSCLC患者血浆KRAS基因突变

目的探讨应用焦磷酸测序技术检测血浆KRAS基因突变的实用性,了解晚期非小细胞肺癌(NSCLC)血浆KRAS基因突变率和突变特征。方法收集63例晚期NSCLC患者的外周血标本,分离血浆并提取DNA,采用巢式PCR结合焦磷酸测序分析KRAS基因12和13号密码子突变。结果在63例晚期NSCLC患者中,3例存在血浆KRAS基因突变(4.76%),突变率较低,与亚裔组织KRAS突变率一致,低于西方人KRAS突变率,其突变类型均为单碱基替换突变。其中2例为12密码子突变,1例为13密码子突变。统计学分析未发现血浆KRAS突变与性别、吸烟史、年龄、病理类型、肿瘤分期、体力状况(PS)评分存在相关性。结论焦磷酸测序技术操作简便,可以快速、高通量地进行外周血循环KRAS基因突变检测,可广泛用于筛选对酪氨酸激酶抑制剂耐药的NSCLC患者,更有利于指导患者的个体化分子靶向治疗。

肺癌患者RASSF1A启动子甲基化状态及其基因表达水平

目的探讨肺癌RAS相关区域家族1A(RASSF1A)启动子CpG岛甲基化状态和基因表达水平与肺癌发生的关系。方法用甲基化特异性PCR检测RASSF1A启动子CpG岛甲基化状态,实时定量PCR检测RASSF1A mRNA的表达水平。结果在肺癌组织中RASSF1A启动子甲基化频率为53.33%(24/45),在正常肺组织中发生甲基化的频率为13.04%(3/23)(P<0.05)。正常肺组织中RASSF1A mRNA全部表达,肺癌组织中表达缺失率为28.89%(13/45),且表达量低于正常肺组织(P<0.05);不同年龄、性别、肿瘤大小、恶性程度、肿瘤分类中其表达量无显著差异;RASSF1A甲基化与其mRNA表达水平下降密切相关。结论肺癌中RASSF1A基因启动子甲基化频率明显升高,其表达普遍下调或缺失,提示RASSF1A启动子甲基化在肺癌发生、发展中起一定作用。

非小细胞肺癌患者肿瘤组织中EGFR、K-Ras和BRAF基因突变的分子病理检测分析

目的探讨非小细胞肺癌(NSCLC)患者肿瘤组织中EGFR、K-Ras和BRAF基因各亚型突变情况。方法应用直接测序方法检测550例NSCLC石蜡组织中EGFR基因、K-Ras基因和BRAF基因突变情况。结果 NSCLC肿瘤组织中EGFR基因总突变率为37.09%(204/550),外显子18、19、20和21的突变率分别为1.45%(8/550)、21.09%(116/550)、3.64%(20/550)和11.09%(61/550);EGFR基因各外显子之间双重突变共13例(2.36%),EGFR基因各外显子内双重突变共12例(2.18%)。K-Ras基因总突变率为2.00%(11/550)。BRAF基因总突变率为0.36%(2/550)。结论 NSCLC患者中EGFR基因存在较高的突变率,尤其为19和21外显子突变,其基因突变亚型分类能指导EGFR-TKI的肿瘤靶向治疗,K-Ras和BRAF基因突变率虽低但不容忽视。

Chemotherapy in conjunction with traditional Chinese medicine for survival of elderly patients with advanced non-small-cell lung cancer:protocol for a randomized double-blind controlled trial

BACKGROUND： Traditional Chinese medicine （TCM） is considered an important complementary therapy with beneficial effects for cancer patients. Elderly patients with non-small-cell lung cancer （NSCLC） are a complex patient group with increasing co-morbidity and shrinking physiological reserve, and may derive substantial benefit from the supportive aspects of TCM Researchers from Shanghai Longhua Hospital found that qi and yin deficiency is a common syndrome in patients with stage III or IV lung cancer. This project was designed to study the combination of single-agent chemotherapy with TCM methods of benefiting qi and yin in elderly patients with advanced NSCLC. METHODS AND DESIGN： This is a double-blind controlled, multi-center, and prospective study with randomly selected participants from elderly NSCLC patients in China. Seventy-six patients who meet the inclusion criteria will be allocated into two groups, which will receive treatments of 3-week single-agent chemotherapy with TCM or placebo for four cycles Progression-free survival （PFS） is the primary end point, and the secondary end points are overall survival, objective response rate, time-to-progression, and quality of life （EORTC QLQ-LC43, and TCM syndrome score） Meanwhile, other end points such as toxicity, side effects and safety of the treatments will be assessed. DISCUSSION： Results from this study may provide evidence on the effectiveness, and parameters for the usage of single-agent chemotherapy combined with or without TCM on PFS of elderly patients with NSCLC.

Effect of scar-producing moxibustion at the acupoints Zusanli(ST 36) and Feishu(BL 13) on neutrophil-to-lymphocyte ratio and quality of life in patients with non-small-cell lung cancer: A randomized,controlled trial

OBJECTIVE: To evaluate the effect of heat stimulation via scar-producing moxibustion at the acupoints Zusanli(ST 36) and Feishu(BL 13) on the neutrophil-to-lymphocyte ratio(NLR) and quality of life in patients with non-small-cell lung cancer(NSCLC).METHODS: Seventy patients with NSCLC were randomly assigned into two groups: group A received scar-producing moxibustion at the acupoints Zusanli(ST 36) and Feishu(BL 13) every day for 6 weeks, while group B received no intervention(control group). Outcome measures were the NLR and the scores from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire(EORTC QLQ-C30). The NLR and the EORTC QLQ-C30 were assessed at baseline and at the end of 6 weeks.RESULTS: Five participants dropped out, leaving afinal total of 65 participants who completed the trial. Groups A and B had a similar mean NLR at baseline. After the treatment course, the NLR in group A was significantly lower than that in group B(P <0.001). Compared with group B, the EORTC QLQ-C30 scores in group A were significantly greater in terms of global health status or quality of life(P < 0.001) and function(P < 0.05), and significantly lower in terms of symptoms(P < 0.05).CONCLUSION: The present study suggests that performing scar-producing moxibustion by heat-stimulating the acupoints Zusanli(ST 36) and Feishu(BL13) effectively decreases the NLR and improves the quality of life in patients with NSCLC.

ras P_(21)在原发性肺癌中的表达及其意义

用ras P_(21)单克隆抗体免疫组织化学半定量方法检测了P_(21)在51例原发性肺癌的表达,人肺癌部分呈阳性及异质性表达,总阳性率为68.6％;其表达与肺癌的病理类型及分化程度有关。非小细胞肺癌高于小细胞肺癌(P<0.01);腺癌高于鳞癌(P<0.05);分化较好的腺癌高于分化较差的腺癌(P<0.05)。

Rac1和NF-κBp65的表达与非小细胞肺癌转移及预后的关系

目的探讨非小细胞肺癌(NSCLC)中Ras相关的C3肉毒素底物1(Rac1)和核转录因子(NF)-κBp65的表达及其临床意义。方法采用免疫组化Super Pic TureTM Polymer二步法,检测112例石蜡包埋的NSCLC组织及112例相同患者石蜡包埋的正常余肺组织Rac1和NF-κBp65的表达。结果 NSCLC组织中Rac1及NF-κBp65的表达明显高于正常余肺组织,且两者的表达强度在NSCLC组织中呈正相关(r=0.549,P<0.001)。在肿瘤不同分化程度、TNM分期及淋巴结转移情况的NSCLC患者的Rac1的表达强度差异有统计学意义;在不同TNM分期及淋巴结转移情况的NSCLC患者的NF-κBp65的表达强度差异有统计学意义;而在低分化、高分期及有淋巴结转移的NSCLC患者组织中,2种指标协同表达的现象更容易出现,且差异有统计学意义(P<0.05)。Rac1高表达组的3年生存率(35.29%)低于低表达组(79.07%);NF-κBp65高表达组的3年生存率(40.28%)低于低表达组(74.36%);Rac1与NF-κBp65共同高表达组的3年生存率(37.70%)低于仅1种蛋白高表达(61.11%)及共同低表达者(81.25%)。Rac1和NF-κBp65共同高表达及淋巴结转移是预后的不良因素(P<0.05)。结论在NSCLC组织中,Rac1和NF-κBp65的表达呈现较好的相关性,检测两者的表达会对NSCLC患者的临床病理学特征及预后起一定的提示作用。

非小细胞肺癌K-ras基因点突变的研究

目的研究肿瘤组织中K-ras基因点突变在非小细胞肺癌(NSCLC)发生中的作用。方法采用聚合酶链反应—单链构象多态性结合银染技术检测31例NSCLC患者肿瘤组织标本中K-ras基因第12、13、61位密码子的突变情况。结果肺癌组织中K-ras突变率与癌旁正常对照组织比较有显著差异(P<0.01);K-ras基因突变与NSCLC患者年龄、性别、吸烟与否、临床分期及肿瘤细胞分化程度无关,但与病理组织学类型相关。结论K-ras基因突变参与了NSCLC的发病过程,可能是NSCLC发生的早期事件。

吸烟者肺肿瘤ras原癌基因活化的检测

从有长期吸烟嗜好的肺癌患者的手术标本（鳞状上皮癌）提取高分子量的癌细胞基因组DNA，对小鼠成纤维细胞（NIH／3T3）进行转染，获二轮转化细胞，发现二轮转化率是一轮的3倍．证实在转染过程中转化灶出现的多少，与所用DNA的量有关，二轮转化细胞可在软琼脂上培养存活，接种裸鼠（BALB／c）于注射部位长出肿瘤。表明该二轮转化细胞具有肿瘤细胞的特性，用32P标记的人Alu重复序列和ras癌基因家族探针分别与一轮、二轮转化细胞和裸鼠肿瘤细胞的DNA进行Southern印迹转移和分子杂交。结果在三者细胞的DNA中都见有与Alu杂交的阳性条带，从而证明在转染过程中人体特有的Alu重复序列已整合到转化细胞的基因组中，并确定了转化细胞中的转化基因之一的属性为Ha－ras癌基因，本工作提示吸烟可能是人体原癌基因（C－Ha－ras）活化和肺鳞癌发生的重要原因。

RASSF1A基因甲基化和SCC联合检测在非小细胞肺癌转移监测中的应用

目的探讨Ras相关结构域蛋白家族1A(ras association domain family 1A,RASSF1A)基因甲基化和鳞状上皮细胞癌抗原(squamous cell carcinoma antigen,SCC)联合检测对非小细胞肺癌(non-small cell lung cancer,NSCLC)患者术后转移评价的价值。方法选择2014年1月至2015年6月在龙岩市第二医院就诊的57例NSCLC患者,测定患者术前血浆RASSF1A基因甲基化、血清SCC水平,同时检测患者术后肿瘤组织RASSF1A基因甲基化水平。出院后随访12个月,根据随访结果分为转移组和非转移组,分析两组血浆及组织RASSF1A基因甲基化阳性率、术前血清SCC水平与术后转移的关系。结果发生转移的患者术前血清SCC水平、术后组织和术前血浆RASSF1A甲基化阳性率均高于未发生转移的患者,差异有统计学意义(P<0.05)。根据肿瘤组织RASSF1A基因甲基化、术前血清SCC水平对NSCLC患者术后转移判定的ROC曲线,NSCLC患者肿瘤组织RASSF1A基因甲基化、术前血清SCC水平符合预测NSCLC术后转移的条件。将SCC水平4.05 ng/m L、RASSF1A甲基化阳性作为危险分层界值,绘制Kaplan-Meier生存曲线显示,高危组与低危组两组术后转移比较差异具有统计学意义(P<0.05)。结论 NSCLC患者肿瘤组织RASSF1A基因甲基化、术前血清SCC水平越高,发生术后转移的风险越高,检测NSCLC患者肿瘤组织RASSF1A基因甲基化、术前血清SCC水平对NSCLC患者危险分层及术后转移评估具有一定的临床价值。