Survival and prognostic factors of non-small cell lung cancer patients with postoperative locoregional recurrence treated with radical radiotherapy

Background: Locoregional recurrence remains the challenge for long-term survival of non-small cell lung cancer(NSCLC) patients after radical surgery, and curative-intent radiotherapy could be a treatment choice. This study aimed to assess the survival and prognostic factors of patients with postoperative locoregionally recurrent NSCLC treated with radical radiotherapy.Methods: We reviewed medical records of 74 NSCLC patients with postoperative locoregional recurrence who received radical radiotherapy between April 2012 and February 2016 at Sun Yat-sen University Cancer Center(Guangzhou, China). The efficacy and safety of radical radiotherapy were analyzed. The probability of survival was estimated using the Kaplan-Meier method and compared using the log-rank test. The Cox proportional hazards model was used to identify prognostic factors.Results: Grade 3/4 adverse events included neutropenia(8 cases, 10.8%), esophagitis(7 cases, 9.5%), pneumonitis(1 case, 1.4%), and vomiting(1 case, 1.4%).The 2-year overall survival, progression-free survival, local recurrencefree survival(LRFS), and distant metastasis-free survival(DMFS) rates of all patients were 84.2,42.5,70.0, and 50.9%,respectively. Univariate and multivariate analyses showed that a higher biological effective dose(BED) of radiation was associated with longer LRFS [hazard ratios(HR)=0.317,95% confidence interval(CI) = 0.112-0.899, P = 0.016] and that wild-type epidermal growth factor receptor(EGFR) was associated with longer DMFS compared with EGFR mutation(HR = 0.383,95% CI=0.171-0.855, P = 0.019).Conclusions: Radical radiotherapy is effective and well-tolerated in NSCLC patients with postoperative locoregional recurrence. High BED is a predictor for long LRFS, and the presence of wild-type EGFR is a predictor for long DMFS.

Therapeutic strategy for postoperative recurrence in patients with non-small cell lung cancer

Postoperative recurrence occurs in approximately half of patients with non-small cell lung cancer(NSCLC), even after complete resection. Disease recurrence after surgical resection reduces the patient's life expectancy sharply. The prognosis after postoperative recurrence is considered to largely depend on both the mode of first recurrence(distant, locoregional or combined) and the treatment modality:(1) The majority of cases of postoperative recurrence involve distant metastasis with or without locoregional recurrence. Platinum-based systemic chemotherapy is practically accepted as the treatment for these diseases on the basis of evidence for original stage Ⅳ disease. The advent of both pemetrexed and molecular-targeted drugs has improved the survival of nonsquamous NSCLC and changed the chemotherapeutic algorithm for NSCLC;(2) Among patients with distant metastatic recurrence without locoregional recurrence at the primary tumor site, the metastasis is often limited in both organ and number. Such metastases are referred to as oligometastases. Local therapy, such as surgical resection and radiotherapy, has been suggested to be the first-line treatment of choice foroligometastatic recurrence; and(3) While locoregional recurrence is likely to cause troublesome symptoms, it is a potentially limited disease. Therefore, providing local control is important, and radiation is usually beneficial for treating local recurrence. In order to obtain better control of the disease and provide treatment with curative intent in patients with limited disease, the administration of concurrent platinum-based chemoradiotherapy is recommended according to the results of originally nonresectable stage ⅢA and ⅢB disease.

Determination of Carboplatin Dose by Area Under the Curve in Combination Chemotherapy for Senile Non-small Cell Lung Cancer

To preliminarily determine the appropriate dosage of carboplatin （CBP） at AUC of 5 mg-M1^-1·min^-1 in the combination chemotherapy for Chinese senile patients with non-small cell lung cancer （NSCLC）. Thirty-five Chinese senile patients with NSCLC in advanced stage （Ⅲ/Ⅳ） were given 96 cycles of combination chemotherapy. Chemotherapy schedules included Taxol＋CBP, Gemzar＋CBP and NVB＋CBE The dose of CBP was at 5 mg.mL^-1·min^-1 of area under the concentration-time curve （AUC）. Side effects and quality of life were observed before and after the chemotherapy. Myelosuppression was severe and commonly observed. Grade 3/4 of granulocytopenia was found in 47.9% （46/96） of the patients and grade 3/4 of thrombocytopenia was noted in 28.1% （27/96） of the subjects. However, other side effects were slight. The mean score of quality of life （QOL）, according to the criteria of QOL for Chinese cancer patients had reduced 6.8. At 5 mg.mL^-1·min^-1 by AUC, the hematological toxicity of CBP was severe and it had some negative effects on the QOL. The administration of CBP at 5 mg.mL^-1·min^-1 by AUC may be too high for Chinese senile patients with non-small cell lung cancer.

Patient-Reported Outcomes of Surgery of Non-Small Cell Lung Cancer: Evaluation Based on the Questionnaires of Anti-Aging Quality of Life and the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire

Background: Patient-reported outcomes of the quality of life (QOL) after an open thoracotomy have not been studied. To determine the physical and mental changes in surgical patients is very important for medical staffs. The surgical patient’s satisfaction and overall healthy changes were evaluated by the patient-self assessment questionnaires. Materials and Methods: From July 2007 to April 2008, 26 patients with non-small cell lung cancer (NSCLC) underwent surgical resection. The outcome of the QOL was evaluated by using two kinds of questionnaire surveys from the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the anti-aging QOL assessment (AA-QOL). The EORTC QLQ-C30 consisted of five domains (physical, role, cognitive, emotional, and social functionings) and global QOL. The AA-QOL contained 51 items;30 physical and 21 mental symptoms regarding the elderly and the aging population. The patients replied to the two questionnaires at two different times, i.e., at pre-surgery (baseline) and at post-surgery (2 weeks after the operation). The obtained data of these scores were averaged and compared between the two points of the pre-surgery and post-surgery. Results: Regarding the outcomes of the EORTC QLQ-C30, the physical and social functioning became significantly worse after the surgery. In contrast, the global QOL significantly became better after the surgery. For the symptom at post-surgery, three of which were “nausea and vomiting”, “pain”, and “appetite loss”, became significantly worse compared to those at pre-surgery. Regarding the outcomes of the AA-QOL, the physical symptoms (muscular pain/stiffness, palpitations, dyspnea, no feeling of good health, anorexia, and coughing and sputum) became significantly worse after the surgery. Regarding the mental symptoms, there were no significant differences. Conclusions: Regarding the outcomes based on the changes in the QOL after surgery, the physical symptoms became worse compared to the mental symptoms. To clarify the perioperative healthy changes of the QOL reported by patients with lung cancers is very important for multidisciplinary teamwork, which should play a role in providing the appropriate care and treatment and useful information for a preoperative patient’s decision making of receiving surgical treatment.

Perioperative considerations in patients with non small cell lung cancer and metastases in mediastinal lymph nodes

Since the latest revision of the TNM system reclassified T3N0 tumours into the ⅡB stage, N2 lesions became the major determinant of the ⅢA stage. Concerning the minority of patients with T3N1 tumours in this stage,

Protein Profiles Correlated with Recurrence of Early Stage Non-Small Cell Lung Cancer

Objective： To elucidate protein markers that differentiate stage I non-small cell lung cancer （NSCLC） that subsequently develop metastatic disease to those that do not develop metastasis by protein expression profiles. Methods： Matrix assisted laser desorption/ionization time-of-flight mass spectrometry （MALDI-TOF MS） and two dimensional difference gel electrophoresis （2D-DIGE） platforms were used to separate proteins in whole tumor specimens. Quantitating mRNA expression was used for validation. Results： Twelve proteins were identified as expressed differentially between two groups from protein expression platforms. But from gene expression platform no marker could distinguish patients with recurrent vs. nonrecurrent disease. Conclusion： Analysis of multiple protein markers may be more informative to predict prognosis of early stage lung cancer.

Are the data on quality of life and patient reported outcomes from clinical trials of metastatic non-small-cell lung cancer important?

Majority of the patients with advanced non-small-cell lung cancer(NSCLC)experience two or more disease related symptoms,which may have a negative impact on their health-related quality of life(HR QOL).These patients prefer a therapy that would improve disease related symptoms,as opposed or treatment that slightly prolongs their survival without improving symptoms.The improvements of the symptoms augment the significance of improved response rates or progression free survivals.The choice of the questionnaires to evaluate patients-reported outcomes(PROs)and HRQOL benefits and methods of collecting the data and their interpretations are very important and are discussed in this manuscript.PROs and HR QOL outcomes are important in patients with advanced NSCLC only when the data are collected and analyzed correctly.Then they can be viewed as components of the total value of a treatment,providing a comprehensive picture of the benefits and risks of anticancer therapies.Enabling the patients to feel during the last months of their lives more comfortable and not be dependent on their loved ones is a very important task in the treatment of advanced NSCLC.

Patient-Reported Outcomes of Chemotherapy Involving Non-Small Cell Lung Cancer: Evaluation by Questionnaires of Quality of Life Regarding Anti-Aging and Anti-Cancer Drugs

Background: Patient-reported outcomes (PROs) of quality of life (QOL) during chemotherapy involving lung cancer are very important for the medical staffs. Patients’ satisfaction and healthy changes were evaluated by the patient-self assessment. Materials and Methods: From July 2007 to April 2008, a total of 19 patients received chemotherapy. The QOL data were collected by using the QOL questionnaire for cancer patients treated with anticancer drugs (QOL-ACD) and the anti-aging QOL assessment (AA-QOL). The AA-QOL contained 51 items: 30 of physical and 21 of mental symptoms of the elderly and the aging population. The patients replied to the questions at two different times, i.e., at pre-chemotherapy (baseline) and at post-chemotherapy (2 weeks after the chemotherapy). Results: Regarding the hematological toxicities, for the grade 3/4 toxicities, there were 12 neutropenia (12/19, 63.2%) and 3 thrombocytopenia (3/19, 15.8%). For the grade 3 febrile neutropenia, there were 5 cases (5/19, 26.3%). Regarding the non-hematological toxicities, there was no grade 3 and grade 4 toxicities. Based on the outcomes of the QOL-ACD, the three items (“physical condition”, “social attitude”, and “overall QOL”) at post-chemotherapy became significantly worse compared to the baseline. Regarding the outcomes of the AA-QOL, 4 items of physical symptoms (“thirst”, “anorexia”, “early satiety”, and “diarrhea”) became significantly worse compared to the baseline. Regarding the mental symptoms, 2 items (“nothing to look forward in life” and “a sense of uselessness”) became significantly worse compared to the baseline. Conclusion: Regarding the PROs of the QOL during the chemotherapy term, both the physical and mental symptoms had become worse. To clarify the changes in the QOL during chemotherapy is very important for multidisciplinary teamwork, which should play the role of providing the appropriate cares and treatment as patient-support.

Over-expression of small ubiquitin-like modifier proteases 1 predicts chemo-sensitivity and poor survival in non-small cell lung cancer

Background Non-small cell lung cancer （NSCLC） is one of the most common malignant tumors.Despite the advances in therapy over the years,its mortality remains high.The aim of this study was to evaluate the expression of small ubiquitin-like modifier （SUMO） proteases 1 （SENP1） in NSCLC tissues and its role in the regulation of vascular endothelial growth factor （VEGF） expression.We also investigated the association between the expression level of SENP1 and the clinicopathological features and survival of the patients.Methods A SENP1 small interfering RNA （siRNA） was constructed and transfected into the NSCLC cells.VEGF gene expression was analyzed by real-time polymerase chain reaction （RT-PCR）.Immunohistochemistry staining was used to assess the expression of SENP1 in 100 NSCLC patients and its association with the clinicopathological features and survival was analyzed.Results VEGF expression was significantly higher in NSCLC tissues than in normal lung tissues.Inhibition of SENP1 by siRNA was associated with decreased VEGF expression.SENP1 was over-expressed in 55 of the 100 NSCLC samples （55％） and was associated with a moderate and low histological tumor grade （3.6％,38.2％,and 58.2％ in high,moderate and low differentiated tumors,respectively,P=0.046）,higher T stage （10.9％ in T1,and 89.1％ in T2 and T3 tumor samples,P ＜0.001）and TNM stage （10.9％ in stage Ⅰ,and 89.1％ in stages Ⅱ and Ⅲ tumor samples,P ＜0.001）.The rate of lymph node metastasis was significantly higher in the SENP1 over-expression group （76.4％） than that in the SENP1 low expression group （33.3％,P ＜0.001）.Sixty three patients received postoperative chemotherapy,including 34 with SENP1 over-expression and 29 with SENP1 low expression.Among the 34 patients with SENP1 over-expression,22 （64.7％） patients developed recurrence or metastasis,significantly higher than those in the low expression group 27.6％ （8/29） （P=0.005）.Multivariate Cox regression analysis showed that lymph node metastasis （P=0.015）,TNM stage （P=-0.001）,and SENP1 expression level （P=0.002） were independent prognostic factors for the survival of NSCLC patients.Conclusions SENP1 may be a promising predictor of survival,a predictive factor of chemo-sensitivity for NSCLC patients,and potentially a desirable drug target for lung carcinoma target therapy.

Recurrence patterns of advanced non-small cell lung cancer treated with gefitinib

Background Gefitinib is widely used in the treatment of advanced non-small cell lung cancer （NSCLC）.However,only a small number of reports have described initial failure sites in patients treated with gefitinib.The aim of this study was to investigate survival,recurrence sites,and treatment after recurrence in these patients.Methods A retrospective review was conducted of all patients with stage Ⅲ/Ⅳ NSCLC treated with gefitinib in Peking Union Medical College Hospital from October 2002 to September 2011.Patient characteristics,initial failure sites,associated clinical factors,and subsequent therapy were included in the analysis of prognostic factors.Results A total of 316 patients were identified The median progress free survival （PFS） and overall survival （OS） times were 238 days and 468 days,respectively.The median survival time after progression was 145 days.The sites of initial failure were lung （62.34%）,bone （17.72%）,central nerve system （CNS,16.14%）,liver （9.49%）,and others （7.19%）.Patients with single-site progression or multi-site progression were 81.01% and 18.99%,respectively.Progression-free survival time was associated with lung and bone failure.Additionally,the median survival time after progression was lower in patients with multi-site progression and liver progression.Other initial failure sites displayed no relationship with survival,including CNS failure.Subsequent therapy may affect survival after progression.In patients receiving continuous epidermal growth factor receptor tyrosine kinase inhibitor （EGFR-TKI） therapy,chemotherapy,radiotherapy,and retreatment with EGFR-TKIs,survival time after progression was prolonged compared with the best supportive care.Conclusions Our data suggest that patients receiving gefltinib should be closely monitored regarding lung metastasis during follow-up.Liver metastases and multi-site progression were poor prognostic factors.After failure with gefltinib,patients may benefit from radiotherapy,chemotherapy,continuous EGFR-TKI therapy and re-treatment with EGFR-TKIs.

PD-1/PD-L1抑制剂免疫治疗对晚期非小细胞肺癌二线及以上患者预后转归的影响

目的探究真实世界中程序性死亡蛋白1(Programmed Death Protein 1,PD-1)/程序性死亡蛋白配体1(Programmed Death Protein Ligand 1,PD-L1)抑制剂治疗对晚期非小细胞肺癌(Non-Small Cell Lung Cancer,NSCLC)二线及以上患者预后转归的影响。方法选取2019年1月—2023年7月涟水县人民医院就诊的112例晚期NSCLC二线及以上患者为研究对象,依据治疗方法分为两组,每组56例,对照组接受二线及以上单药化疗,观察组接受PD-1/PD-L1抑制剂免疫治疗,对比两组生存质量、无进展生存期、总生存期及不良反应发生率。结果化疗4个周期后,观察组生存质量评分显著高于对照组,差异有统计学意义(P<0.05)。观察组无进展生存期、总生存期显著优于对照组,差异有统计学意义(P均<0.05)。观察组不良反应发生率显著低于对照组,且观察组高血压发生人数显著少于对照组,差异有统计学意义(P均<0.05)。结论晚期NSCLC患者二线治疗中PD-1/PD-L1抑制剂免疫治疗能提升患者生存质量,降低其不良反应发生率。

Survival without common toxicity criteria grade 3/4 toxicity following second-line treatment with pemetrexed for nonsquamous non-small cell lung cancer in Chinese patients

Background The efficacy of pemetrexed in the second-line treatment of Chinese patients with advanced non-small cell lung cancer （NSCLC） has been shown to be similar to that of docetaxel in a recent study; additionally, pemetrexed was associated with much better safety and toxicity profiles. Here, the survival without common toxicity criteria grade 3/4 toxicity （SWT） data from a post hoc analysis of this recent prospective NSCLC study in Chinese patients is reported. This post hoc analysis differs from the main study; it focuses on the nonsquamous population to align with the current approval for pemetrexed in China. Methods A total of 154 patients with nonsquamous NSCLC received either pemetrexed （500 mg/m2 intravenously （IV）） or docetaxel （75 mg/m2 IV） on day 1 of 21-day cycles. SWT was analyzed using Kaplan-Meier and univariate Cox methods. Results Patients treated with pemetrexed had a longer median SWT than patients treated with docetaxel （7.4 months versus 1.2 months; unadjusted hazard ratio =0.59, 95% confidence interval CCI}： 0.41-0.84; P=0.003）. At 12 and 18months, the SWT event-free probability for pemetrexed patients （18 months： 24.5%, 95%C/ 13.9%-36.6%, vs. 12.3%, 95% CI 4.8%-23.6%） was greater than that for docexatel patients （12 months： 37.3%, 95% CI 26.5%- 48.0%, vs. 23.3%, 95% CI 14.4-33.4）. The progression- free survival without common toxicity criteria grade 3/4 toxicity （PFS-WT） was also statistically significantly longer for patients treated with pemetrexed than patients treated with docetaxel （1.9 months vs. 1.1 months, P=0.002）. Conclusions Chinese patients with nonsquamous NSCLC disease treated with pemetrexed had improved SWT beyond 6 months than those receiving docetaxel. This analysis supports a benefit-to-risk profile that favors pemetrexed over docetaxel in the second-line treatment of Chinese nonsquamous NSCLC patients.

能谱CT定量参数联合NLR、CAR检测对非小细胞肺癌根治术后复发转移的预测价值

目的:探讨能谱CT定量参数联合NLR、CAR检测对非小细胞肺癌(NSCLC)根治术后复发转移的预测价值。方法:选择2018年1月至2021年6月于我院就诊并接受根治性切除术的114例NSCLC患者作为研究对象,术前对患者行胸部平扫及双期增强扫描,记录平扫有效原子序数(Eff-Z)、病灶处动脉期标准化碘浓度(NICVP)和静脉期标准化碘浓度(NICAP)、碘浓度差值(ICD)。术前采用全自动血细胞分析仪检测中性粒细胞、淋巴细胞计数,采用免疫比浊法测定血清C反应蛋白水平,溴甲酚绿法测定血清白蛋白水平,计算并记录中性粒细胞/淋巴细胞比值(NLR)、C反应蛋白水平/白蛋白比值(CAR)。患者术后门诊随访2年,观察是否发生复发转移。结果:术后复发转移与未复发转移NSCLC患者的性别、年龄、BMI、家族肿瘤史、吸烟史和病理类型比较差异均无统计学意义(P均>0.05);术后复发转移组患者中临床分期为Ⅱ期和有淋巴结转移的比例显著高于术后无复发转移组(P<0.05)。术后复发转移患者的Eff-Z、NICVP、NICAP、ICD均低于未复发转移组(P<0.05),NLR、CAR均高于未复发转移组(P<0.05)。多因素Logistic回归分析结果显示,TNM分期、淋巴结转移、Eff-Z、NICAP、NLR、CAR水平是NSCLC患者术后复发转移的独立影响因素(P<0.05)。建立Logistic回归方程如下:Logit(P)=-0.179+1.211×TNM分期+1.161×淋巴结转移+(-0.209)×Eff-Z+(-0.368)×NICAP+0.842×NLR+0.934×CAR。ROC曲线分析结果显示,建立的模型预测NSCLC患者术后复发转移的曲线下面积为0.958(95%CI:0.920~0.997,P<0.001),敏感度和特异度分别为92.0%和85.4%,优于各指标的单独预测效能。结论:联合应用临床病理特征、能谱CT定量参数及NLR、CAR检测对非小细胞肺癌根治术后复发转移的预测效能较好,具有一定临床应用价值。

卡瑞利珠单抗联合化疗在EGFR/ALK野生型的晚期非鳞状非小细胞肺癌老年患者中的临床观察

目的:观察表皮生长因子受体/间变性淋巴瘤激酶(EGFR/ALK)野生型的晚期非鳞状非小细胞肺癌(NSCLC)老年患者接受卡瑞利珠单抗联合化疗的疗效和安全性。方法:选取2021年8月至2023年2月重庆医科大学附属第一医院133例接受卡瑞利珠单抗联合化疗的EGFR/ALK野生型的晚期非鳞状NSCLC患者,按照年龄分为老年组(≥65岁)和非老年组(<65岁),对两组患者的治疗效果和安全性进行回顾性分析。结果:老年组患者的中位无进展生存期长于非老年组(44.14周vs.37.71周),两组患者生存曲线经Log-rank法检验比较,差异无统计学意义(P>0.05)。老年组患者的客观缓解率和疾病控制率低于非老年组[客观缓解率:5.33%(4/75)vs.6.90%(4/58);疾病控制率:74.67%(56/75)vs.75.86%(44/58)],但差异均无统计学意义(P>0.05)。老年组患者所有级别治疗相关不良事件(TRAE)发生率为97.33%(73/75),高于非老年组的84.48%(49/58),差异有统计学意义(P<0.05)。老年组和非老年组患者3级以上治疗相关不良事件发生率分别为10.67%(8/75)和5.17%(3/58),差异无统计学意义(P>0.05)。结论:卡瑞利珠单抗联合化疗用于EGFR/ALK野生型的晚期非鳞状NSCLC老年患者的治疗效果与用于非老年患者相当;老年患者的TRAE发生率更高;初步判断老年患者接受治疗时不需要对卡瑞利珠单抗的剂量进行调整。

中医药干预早期非小细胞肺癌的临床效果研究

目的:分析早期非小细胞肺癌(NSCLC)患者根治术后无瘤生存期的影响因素,观察中医药干预对于早期NSCLC患者的影响。方法:采用单臂、单中心数据回顾性研究,分析415例接受中医药干预的早期NSCLC患者的临床资料,运用Kaplan-Meier法对可能影响早期NSCLC预后的因素进行单因素分析,并将经显著性检验后有意义的可疑影响因素纳入Cox回归分析,建立Cox风险比例模型。结果:415例早期NSCLC患者的1年、2年、3年、5年、10年无瘤生存率为96.1%、87.5%、84.0%、76.5%、67.4%。2)单因素分析显示,性别、年龄、吸烟史、手术方式、病理类型、临床分期、中医辨证分型、中医药物及非药物治疗疗程、中医干预空白期、中医综合治疗持续时间为预后相关影响因素(P<0.05)。Cox回归分析显示,性别、临床分期、中医辨证分型、中成药疗程、中医综合治疗持续时间是影响患者预后的独立危险因素。结论:中医药干预可以提高早期NSCLC患者的无瘤生存率,改善预后。2)早期NSCLC患者中,女性、年轻、不吸烟、行电视胸腔镜辅助手术、肺腺癌(贴壁型为主)、临床分期早、气阴两虚及肺脾气虚型患者预后佳。术后中医药干预空白期短且长期中医综合辨证治疗可以提高患者无病生存率。

双源CT定量参数在非小细胞肺癌术后随访中的应用及其与复发因子的相关性

目的探讨双源CT定量参数在非小细胞肺癌(NSCLC)术后随访中应用及与复发因子相关性。方法回顾性分析2019年6月至2021年6月新乡医学院第一附属医院收治的126例NSCLC患者的临床资料,所有患者均行肺癌根治术,根据术后2年内是否复发分为复发组(n=50)和未复发组(n=76)。比较两组患者的一般资料、双源CT定量参数和复发因子[血管内皮生长因子(VEGF)、可溶性CD105(sCD105)]的表达水平,采用Logistic回归方程分析NSCLC患者术后复发的影响因素,采用Pearson相关系数分析双源CT定量参数与复发因子相关性,绘制受检者工作特征曲线(ROC)分析双源CT定量参数对NSCLC患者术后复发的预测效能。结果复发组患者临床分期Ⅱ期占比、中分化占比和吸烟史占比分别为62.00%、66.00%、56.00%,明显高于未复发组的43.42%、40.79%、28.95%,差异均具有统计学意义(P<0.05);复发组患者术后3个月的血清VEGF、sCD105表达分别为(14.35±4.00)ng/mL、(4.72±1.36)ng/m,明显高于未复发组的(6.88±2.00)ng/mL、(3.50±1.05)ng/mL,差异均有统计学意义(P<0.05);复发组患者术后3个月的血清动脉期标准化碘浓度(NIC_(AP))、动脉期病灶碘覆盖值(CT_(AP))分别为(13.66±4.10)%、(24.23±6.60)HU,明显高于未复发组的(6.62±1.98)%、(15.11±3.63)HU,差异圴有统计学意义(P<0.05);经Logistic回归方程分析结果显示,吸烟史、术后3个月VEGF、sCD105、NIC_(AP)、CT_(AP)均是NSCLC术后复发影响因素(P<0.05);复发患者术后3个月的NIC_(AP)、CT_(AP)与VEGF、sCD105呈显著正相关(r=0.500、0.436、0.511、0.455,P<0.05);术后3个月NIC_(AP)、CT_(AP)联合预测NSCLC术后复发的AUC为0.883(95%CI:0.814~0.934),与术后3个月血清VEGF、sCD105联合预测效能的AUC接近[AUC为0.888(95%CI:0.819~0.937)]。结论NSCLC术后复发患者双源CT定量参数与复发因子VEGF、sCD105密切相关,且双源CT定量参数联合预测患者术后复发的价值与VEGF、sCD105联合预测效能接近。

Cofilin1及其Ser3位点磷酸化与老年非小细胞肺癌患者放疗敏感性的相关性研究

目的探讨Cofilin1及其Ser3位点磷酸化水平与老年非小细胞肺癌(NSCLC)患者放疗敏感性的相关性。方法选取2013年6月—2015年4月于我院行手术切除、经病理确诊并接受术后放疗的老年NSCLC患者102例,根据疗效分为放疗敏感组(55例)和放疗抵抗组(47例),检测Cofilin1及其Ser3位点磷酸化蛋白Cofilin1(phos‐pho S3)的表达,并记录患者的生存时间和生存率。结果放疗抵抗组Cofilin1阳性表达组织的TNM分期和淋巴结转移率均显著升高,而Cofilin1(phospho S3)阳性表达组织显著降低(P<0.05)。放疗抵抗组的Cofilin1阳性表达率显著高于放疗敏感组,而放疗敏感组的Cofilin1(phospho S3)阳性表达率显著高于放疗抵抗组(P<0.05)。淋巴结转移、Cofilin1高表达、Cofilin1(phospho S3)低表达是放疗抵抗的独立预测因素(P<0.05)。放疗敏感组、Cofilin1阴性患者、Cofilin1(phospho S3)阳性患者的无进展生存时间(PFS)较长、5年生存率较高(P<0.05);放疗敏感组中,Cofilin1阴性和Cofilin1(phospho S3)阳性患者PFS最长、5年生存率最高(P<0.05);放疗抵抗组中,Cofilin1阳性和Cofilin1(phospho S3)阴性患者PFS最短、5年生存率最低(P<0.05)。结论老年NSCLC患者的放疗敏感性与Co‐filin1表达呈明显负相关,与Cofilin1的Ser3位点磷酸化水平呈显著正相关。Cofilin1及其Ser3位点磷酸化是放疗敏感性的独立预测因素,对老年NSCLC患者的预后评估具有重要意义。

老年非小细胞肺癌放化疗患者下呼吸道感染病原菌分布及危险因素分析

目的分析老年非小细胞肺癌(non-small cell lung cancer,NSCLC)放化疗患者发生下呼吸道感染的病原菌分布及危险因素。方法采用回顾性分析,将我院108例行放化疗的老年NSCLC患者根据是否发生下呼吸道感染分为感染组(40例)和未感染组(68例),取分泌物作病原菌培养,同时对发生下呼吸道感染的相关因素进行单因素和多因素Logistic回归分析。结果NSCLC患者下呼吸道感染发生率37.04%,感染率高于我院近年来医院感染平均水平(2019—2022年平均感染率分别为8.39%、8.05%、8.17%、7.04%)。共培养分离出病原菌44株,革兰阴性菌占56.82%,革兰阳性菌占38.64%,真菌占4.55%。病原菌构成与我院总体病原菌构成无明显差异。感染组年龄≥70岁、合并糖尿病、TNM分期Ⅲ、Ⅳ期、住院时间>15 d、CD4^(+)/CD8^(+)比值≤1患者的比例均高于未感染组,差异有统计学意义(P均<0.05)。年龄≥70岁、CD4^(+)/CD8^(+)比值≤1、住院时间>15 d、TNM分期Ⅲ、Ⅳ期为老年NSCLC放化疗患者发生下呼吸道感染的危险因素(OR=1.574、2.416、3.995、2.186,P<0.05)。结论我院老年NSCLC放化疗患者发生下呼吸道感染的病原菌谱近年来无明显变化,肺炎克雷伯菌和金黄色葡萄球菌占比较高。高龄、CD4^(+)/CD8^(+)比值降低、住院时间长及TNM分期高是患者发生下呼吸道感染的危险因素。

安罗替尼联合IP方案治疗进展/复发小细胞肺癌临床研究

目的探讨安罗替尼联合IP方案(伊立替康+顺铂)治疗进展/复发小细胞肺癌(SCLC)的临床效果及其作用机制。方法选取医院2019年6月至2021年6月收治的进展/复发SCLC患者97例,按随机数字表法分为对照组(48例)和观察组(49例),两组患者均予IP方案治疗,观察组患者加服盐酸安罗替尼胶囊。两组均以28 d为1个周期,连续治疗2个周期,随访20个月。结果观察组患者的疾病控制率显著高于对照组(P<0.05);观察组患者治疗后的血清癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)、细胞角蛋白19片段(Cyfra21-1)水平及肿瘤代谢体积(MTV)、血容量(BV)、血流量(BF)均显著低于对照组(P<0.05);观察组患者中位无进展生存期(PFS)显著长于对照组(7.5个月比5.5个月,P<0.05);两组患者的不同等级不良反应发生率、生存率均无显著差异(P>0.05)。结论安罗替尼联合IP方案治疗进展/复发SCLC,可降低患者的肿瘤负荷,延长PFS,机制可能与调节肿瘤标志物和改善血流灌注指标有关。

血清微小RNA-184、微小RNA-451a表达对Ⅰ~ⅡA期非小细胞肺癌根治术后复发转移的预测价值

目的探讨血清微小核糖核酸(miRNA)-184、miR-451a表达对Ⅰ~ⅡA期非小细胞肺癌(NSCLC)根治术后复发转移的预测价值。方法选取2020年1月—2021年10月在本院行根治性切除术的203例Ⅰ~ⅡA期NSCLC患者为NSCLC组,随访2年根据复发转移情况分为复发转移组30例和无复发转移组173例;另选取同期87名体检健康志愿者为对照组。采用实时荧光定量聚合酶链式反应检测血清miR-184、miR-451a表达。采用多因素Logistic回归模型分析影响Ⅰ~ⅡA期NSCLC根治术后复发转移的因素;采用受试者工作特征(ROC)曲线分析血清miR-184、miR-451a表达对复发转移的预测价值。结果与对照组比较,NSCLC组血清miR-184、miR-451a表达降低,差异有统计学意义(P<0.05)。随访2年,203例Ⅰ~ⅡA期NSCLC患者术后复发转移率为14.78%(30/203)。与无复发转移组比较,复发转移组血清miR-184、miR-451a表达降低,差异有统计学意义(P<0.05)。Ⅰ~ⅡA期NSCLC根治术后复发转移的独立危险因素为ⅡA期、低分化、术后辅助化疗,独立保护因素为miR-184升高、miR-451a升高(P<0.05)。血清miR-184、miR-451a表达联合预测Ⅰ~ⅡA期NSCLC根治术后复发转移的曲线下面积为0.868,大于血清miR-184、miR-451a表达单独预测的0.784、0.781,差异有统计学意义(P<0.05)。结论Ⅰ~ⅡA期NSCLC患者血清miR-184、miR-451a呈低表达,与根治术后复发转移密切相关,血清miR-184、miR-451a联合检测对Ⅰ~ⅡA期NSCLC根治术后复发转移有较高的预测价值。