基于CT灌注成像的肺癌疗效评估方法初探

目的:快速有效地评估肺癌治疗效果。方法:采用肺部CT灌注图像的半自动分割方法和计算机辅助诊断方法对肺癌血管靶向治疗效果进行评估。首先读入肺部DICOM格式的CT灌注图像,然后采用改进的距离规则化水平集分割方法(modified distance regularized level set,MDRLS)对肺部肿瘤进行分割,将分割得到的区域逐层映射到其他CT灌注参数图像上,通过选取合适的阈值,分割出肿瘤的血管丰富区域,再分别计算肿瘤和内部血管丰富区域的体积。采用5例患者治疗前后的CT灌注参数图像,通过计算豪斯多夫距离,分析图像分割的效果;通过比较治疗前后肿瘤和血管丰富区域的体积,评估肺癌血管靶向治疗效果。结果:采用MDRLS可以得到较好的图像分割结果,疗效评估结果也与临床病理数据相吻合。结论:该研究提出的MDRLS方法有望对肺癌血管靶向治疗效果进行有效地评估,从而为肺癌的临床治疗提供重要参考。

基于CT灌注成像的肺癌疗效评估方法初探

为了快速有效地评估肺癌治疗效果，提出肺部计算机断层扫描（computed tomography，CT）灌注图像的半自动分割方法，并采用计算机辅助诊断方法对怖癌血管靶向治疗疗效进行评估。首先读入怖部DICOM格式的CT灌注图像，然后采用改进的距离规则化水平集分割方法对怖部肿瘤进行分割，将分割得到的区域逐层映射到其他CT灌注参数图像上，通过选取合适的阈值，分割出肿瘤的血管丰富区域，再分别计算肿瘤和内部血管丰富区域的体积。实验使用5例患者治疗前后的CT灌注参数图像，通过计算豪斯多夫距离，分析图像分割的效果；通过比较治疗前后肿瘤和血管丰富区域的体积，评估怖癌血管靶向治疗疗效。结果表明，本方法可以得到较好的图像分割结果，昕得的疗效评估结果也与临床病理数据相吻合。可见，该研究提出的方法有望对怖癌血管靶向治疗疗效做出有效评估，从而可为临床怖癌的治疗提供重要参考。

肺癌疗效评估新技术-磁共振肺部高分辨率扫描

目的探讨肺癌疗效评估新技术——磁共振肺部高分辨率扫描(HR-MRI)的临床应用。方法60例肺癌患者行常规磁共振成像(MRI)及HR-MRI扫描。按照“5分法”评价,测量计算信噪比(SNR)病灶,SNR肺组织及对比信噪比(CNR)。对比常规MRI与HR-MRI肺癌病灶扫描的图像评分,SNR病灶,SNR肺组织及CNR的差异。结果图像评分最高为HR-T_(1)WI:3.36分;SNR病灶最高为HR-T_(1)WI:73.27;SNR肺组织最高为HR-T_(1)WI:3.07;CNR最高为HR-T_(1)WI:172.32。HR-MRI与常规MRI各序列评分进行U检验分析,P值均<0.01。结论HR-MRI在图像评分,SNR,CNR均优于常规MRI,更适合肺癌疗效评价。

EP/PET方案序贯治疗小细胞肺癌疗效观察

目的观察EP/TEP方案序贯治疗小细胞肺癌的临床疗效。方法以顺铂+足叶乙苷方案及紫杉醇+顺铂+足叶乙苷方案各3个疗程序贯治疗治疗小细胞肺癌,评估疗效及不良反应。结果 EP/TEP方案序贯治疗小细胞肺癌有效率80%(40/50)。结论 EP/TEP方案序贯治疗小细胞肺癌提高了小细胞肺癌治疗缓解率,不良反应耐受性较好。

胸腔镜肺叶切除术与常规开胸手术治疗肺癌临床疗效及并发症发生率影响观察

目的探讨胸腔镜肺叶切除术与常规开胸手术治疗肺癌对临床疗效及并发症发生率的影响。方法选取2015年5月—2018年5月我院收治的80例肺癌患者为研究对象,随机将患者分为对照组和观察组。对照组患者行常规开胸手术治疗,观察组患者行胸腔镜肺叶切除术治疗,并对2组患者术后的治疗效果以及并发症发生率进行对比。结果观察组手术用时、术中出血量、下床时间、术后肺功能均优于对照组,差异显著(P<0.05),观察组并发症发生率为5%,显著低于对照组的25%,(P<0.05)。结论相较于开胸手术,对肺癌患者进行胸腔镜肺叶切除术治疗能提高疗效,降低并发症发生率值得在临床上推广应用。

PET/CT代谢参数与LMR在评估肺癌放化疗近期疗效的临床研究

目的研究PET/CT代谢参数与淋巴细胞/单核细胞比值(LMR)在评估肺癌放化疗近期疗效中的应用效果。方法将我院2017年1月至2018年12月间收治的32例行同步放化疗的肺癌患者纳为研究对象,分别于放化疗前、同步化疗1周期后2周(即放疗3周)进行全身PET/CT检查,放化疗结束后行胸部CT扫描;并于放化疗前24h、同步化疗1周期后2周采集空腹静脉血计算LMR,以RECIST客观疗效作为肺癌放化疗效果的“金标准”,评估PET/CT参数及LMR在肺癌放化疗近期疗效中的应用价值。结果同步化疗1周期后,32例肺癌患者SUVmax值较放化疗前下降;同步化疗1周期后,PET/CT参数提示代谢缓解率为53.13%,放化疗结束后,RECIST提示客观有效率为40.63%;以放化疗结束后RECIST客观有效率作为肺癌患者放化疗治疗效果“金标准”,同步化疗1周期后PET/CT参数在评估肺癌患者放化疗效果中的灵敏度、特异度及准确度分别为92.31%、73.68%及81.25%;代谢缓解组放化疗后LMR值较放化疗前显著降低(P<0.05),且其放化疗后LMR值显著低于无缓解组(P<0.05);RECIST客观有效组放化疗后LMR值较放化疗前显著下降(P<0.05),且其放化疗后LMR值显著低于无效组(P<0.05)。结论PET/CT参数SUVmax值及LMR值均可有效反映肺癌患者放化疗近期病灶代谢状况,在评估肺癌患者放化疗疗效中具有一定的价值。

多参数磁共振成像(mp-MRI)对NSCLC非手术疗效的评估和预测价值

目的探讨多参数磁共振成像对非小细胞肺癌非手术疗效的评估和预测价值。方法49例非手术NSCLC病例在治疗前、治疗1个疗程、治疗2个疗程行mp-MRI扫描。分析ADC改变与靶病灶最长径之和变化的相关性。按照RECIST1.1标准将病例分有效组和无效组,计算第1疗程SLD、ADC值、ADC值变化率、ADC值变化量及四组参数联合对第2疗程NSCLC疗效的ROC曲线下面积。结果第1疗程ADC值改变与第2疗程SLD变化之间呈正相关。第1疗程SLD较治疗前无统计学差异(t值0.177、P值0.859),第2疗程SLD改变较治疗前有显著统计学差异(t值7.410、P值<0.0001)。四组参数联合预测NSCLC疗效效能明显提高AUC为0.789。结论mp-MRI中SLD联合ADC值改变对NSCLC非手术疗效评价和预测效能较高,可以用于NSCLC非手术疗效的评估及预测。

血清HCY，CYFRA21-1和CEA在晚期NSCLC患者化疗疗效评估中的临床应用

目的研究NSCLC患者化疗前后血清Hey，cYFRA21—1和CEA水平的变化，探索其联合监测在NSCLC患者化疗疗效评价中的临床价值。方法选取汪油市第二人民医院NSCLC化疗病人37例，健康对照19例，其中鳞癌26例，腺癌11例，分别于化疗第一周期前和第二周期结束后，清晨空腹抽取静脉血检测Hcy，CYFRA21—1和CEA含量，对检测结果进行统计学分析。结果NSCLC患者化疗前后三项指标均明显高于健康对照组，差异有统计学意义（P〈0．05）；经两周期化疗后三项指标较化疗前均有所下降，化疗有效组三项指标分别为11．02±4．11μmol／L，6．41±3．52μmol／L和79．12±46．03ng／ml，与化疗前（19．61±5．74μmol／L，10．15±4．23μmol／I。和119．82±63．15ng／m1）相比差异均有统计学意义（P〈0．05），化疗无效组化疗后血清三项指标分别为17．94±7．25〉mol／L，9．53±4．85μmol／L和98．37±52．16ng／ml，与化疗前（19．23士6．32Lμmol／L,ll；57±5．06／μmol／LA和109．53土58．7ng／mI）相比有所下降，但差异无统计学意义（P〉0．05）；两组化疗前数据比较差异无统计学意义。结论NSCLC患者化疗过程中监测血清Hcy，CYFRA21—1和CEA水平的变化，可以评估NSCLC患者化疗疗效，观察息者病情动态变化。

CPE和CE方案治疗小细胞肺癌的疗效比较

目的 评价CPE(卡铂、顺铂、足叶乙甙)和CE(卡铂、足叶乙甙)方案治疗小细胞肺癌(SCLC)的疗效和毒性。方法 应用CPE和CE方案治疗32例SCLC患者,每组16例,CPE组和CE组中的复治病例分别为10例和7例。结果 CPE组和CE组的有效率分别为81.3%(13/16)和87.5%(14/16)(P>0.05)。CPE组与CE组中的复治病例有效率分别为60%(6/10)和42.9%(3/7)(P<0.05)。CPE组与CE组的骨髓抑制率分别为71.9%和93.8%(P<0.05)。两组间其它毒性反应差异无显著性(P>0.05)。结论 CPE方案治疗SCLC的疗效与CE方案相近,但CPE的骨髓抑制明显较CE轻;CPE对复治病例的疗效优于CE。

电视胸腔镜下肺叶切除治疗肺癌临床疗效和安全性观察

目的探讨在电视胸腔镜下行肺叶切除术治疗肺癌的疗效及安全性。方法选取肺癌患者80例，将其随机分为观察组与对照组各40例。对照组采用传统的开胸手术；观察组在电视胸腔镜下行肺叶切除术。结果观察组术中出血量为（156.3±22）mL，明显少于对照组的（232.4±23）mL；观察组住院时间为（4.9±1.6）d，明显少于对照组的（8.5±1.4）d；观察组术后并发症发生率为12.50%，明显低于对照组的37.50%，差异均有统计学意义（P＜0.05）。结论在电视胸腔镜下行肺叶切除术安全、有效，极大程度地缩短了患者的恢复时间，值得临床推广使用。

Efficacy of pemetrexed combined with erlotinib/gefitinib in advanced non-small cell lung cancer patients during tyrosine kinase inhibitor treatment

Objective We aimed to evaluate the efficacy and safety of pemetrexed combined with erlotinib/gefitinib in advanced non-small cell lung cancer(NSCLC) patients during tyrosine kinase inhibitor(TKI) treatment. Methods Thirty-two patients with advanced NSCLC were divided into two groups. Patients in the control group received continuous daily epidermal growth factor receptor tyrosine kinase inhibitor(EGFRTKI) treatment, and patients in the experimental group received continuous daily EGFR-TKI along with pemetrexed treatment, which was administered on day 1 at 500 mg/m2. Erlotinib(150 mg) or gefitinib(250 mg) was administered daily from day 1 to day 21, with a cycle of every 21 days. Dexamethasone, folic acid, and vitamin B12 were also administered during the treatment. The endpoint of the primary study was the disease control rate. Results The objective response rate was 21.9%(95% CI: 7.6% to 36.3%) in the control group, whereas the disease control rate was 84.4%(95% CI: 71.8% to 97.0%) in the experimental group. The median progression-free survival was 6.2(95% CI: 2.4 to 10.0). Grades 3 or 4 adverse effects of leucopenia(15.6%), neutropenia(12.5%), anemia(3.1%), and nausea or vomiting(3.1%) were found in the experimental group.Conclusion The administration of pemetrexed combined with erlotinib or gefitinib showed a higher efficacy in TKI-resistant NSCLC patients. Further, the adverse effects of this drug combination were well tolerated by the patients. Pemetrexed combined with TKI treatment might provide a satisfactory therapeutic strategy for advanced NSCLC patients after TKI treatment.

Clinical efficacy of oral enteral nutrition in lung cancer patients receiving chemotherapy and/or radiotherapy： a systematic review of randomized controlled trials

Background and Objectives： the effects of oral enteral nutrition （EN） in lung cancer patients receivingchemotherapy and/or radiotherapy were controversial, so we made a systematic review to analyze the clinicalefficacy of EN in lung cancer patients after chemotherapy and/or radiotherapy. Methods and Study Design：Pertinent studies were identified by searching in PubMed, Embase, Web of Science, Cochrane Library, ChinaNational Knowledge Infrastructure （CNKI）, WanFang Database, China Biomedical Literature database （CBM） andChinese Science and Technology Periodical Database （VIP）. Energy intake, protein intake, weight and other datawere extracted. Results： Finally, 5 randomized controlled trials （RCTs） were included in this systematic review.Patients in 3 studies received chemotherapy, in 1 with radiotherapy and in 1 with chemo-radiotherapy. Thecombined results showed that EN significantly increased energy and protein intake in lung cancer duringchemotherapy, while there was no significant effect on other results after patients had received chemotherapyand/or radiotherapy. Conclusions： Limited evidence is available to judge whether EN can improve clinical effect oflung cancer with or without chemotherapy and/or radiotherapy, as clinical heterogeneity and other potentialvariation existed in this review. Further studies are needed.

Efficacy of cetuximab combination with chemotherapy in non-small cell lung cancer first-line setting:the summary based on publications

Objective： The combination of cetuximab with standard chemotherapy was not widely studied though it was recommended by NCCN 2009 to apply in non-small cell lung cancer （NSCLC） first-line setting. The aim of this study was to summary the efficacy and safety profiles of all the NSCLC patients available in openly published papers treated with above mentioned regimens. Methods： The PubMed database was used to search all the papers on NSCLC associated with cetuximab treatment, and only the clinical trails applied cetuximab combined with doublets cytotoxic chemotherapy in first-line setting till to 30 November 2009 were collected. And the medians and their 95% CI of objective response rate （ORR）, progression free survival （PFS）, overall survival （OS）, and the common adverse events were calculated. Results： （1） Eight papers including 1032 patients were collected, and all cases were at advanced stage. （2） The ratio of male and female patients was 1.6, 50.1% patients were adenocarcinoma and 28.2% patients were squamous cell carcinoma （SCC）, 90.0% patients were PS = 0-1, and 78.2% patients were white ethnic. （3） The disease control rate （DCR）, ORR, PFS, and OS were 65.2% （95% CI： 60.7%-69.7%）, 33.2% （95% CI： 30.3%-36.1%）, 5.0 months （95% CI： 4.7-5.3） and 10.9 months （95% Cl： 9.6-12.2）, respectively. Conclusion： This is the first study to summarize the efficacy and safety profiles of cetuximab combined with chemotherapy in NSCLC first-line setting based on all available patients. The addition of cetuximab caused promising prognosis and acceptable side effects excepting higher incidence of neutropenia, and febrile neutropenia.

Effect of etoposide plus thalidomide as maintenance therapy on progression-free survival of elderly patients with advanced non-small cell lung cancer

Objective The aim of the study was to evaluate the efficacy and safety of etoposide plus thalidomide as maintenance therapy for elderly patients with advanced non-small cell lung cancer（NSCLC） without disease progression after first-line chemotherapy.Methods After four to six cycles of platinum-based first-line therapy, 64 elderly patients with advanced NSCLC without disease progression who were treated in the General Hospital of Shenyang Military Region（China） from 2014 to 2016 were enrolled in this study. According to the different maintenance treatment methods, patients were divided as having received etoposide plus thalidomide therapy（treatment group, n = 32） and best supportive care（control group, n = 32）. Disease control and progression-free survival（PFS） were compared between the two groups. Results The recent curative effect objective response rates of the treatment group and the control group were 31.3% and 3.1%, respectively, and the disease control rates were 71.9% and 31.3%, respectively. The Kaplan-Meier survival curves of the two groups were significantly different（χ2 = 26.532, P = 0.001）. The median PFS for the treatment group and control group was 6.0 months [95% confidence interval（CI） = 4.3–7.9 months] and 3.2 months（95% CI = 2.6–3.8 months）, respectively. The side effects in the treatment group included hematologic abnormalities, gastrointestinal toxicity, and impaired liver function, which were relieved after symptomatic support therapy and drug withdrawal.Conclusion Etoposide plus thalidomide as maintenance therapy is associated with a significantly longer PFS with tolerable toxicity for elderly patients with advanced NSCLC.AcknowledgementThe authors would like to thank Liu Zhongzheng for his technical assistance.

Expressions of FEZ1 and Survivin, and their significance in small cell lung cancer and squamous cell lung carcinoma

Objective： To detect the expressions of FEZ1 and Survivin in small cell lung cancer （SOLO） and poorly differentiated squamous cell carcinoma （PDSCC）, and to approach a theoretical basis for clinical diagnosis and treatment. Methods： Immunohistochemical and flow cytometry method were used to detect the expressions of FEZ1 and Survivin. Apoptosis ratio and cell proliferation index in normal lung tissue, SCLC and PDSCC were analyzed. Results： The expressions of FEZ1 and Survivin were significantly different between SCLC and PDSCC （P 〈 0.05）. The apoptosis ratio and proliferation index of normal lung tissue were lower than those of PDSCC and SOLO, with a significant difference （P 〈 0.05）. Conclusion： The expressions of FEZ1 and Survivin are significantly different between SCLC and PDSCC, indicating that detecting the expressions of the two indexes may be helpful for clinical diagnosis.

The effect of Supplementing Qi and Nourishing Yin combined with chemotherapy for lung cancer： a meta-analysis

Objective： To evaluate whether herbs of supplementing Qi and nourishing Yin combined with chemotherapy （versus chemotherapy alone） improve survival, increase tumor response, improve performance status or reduce chemotherapy toxicity in patients with lung cancer. Methods： Searching the randomized controlled trials （RCT） studies from the databases （China HowNet database, Wan Fang database, VIP database, Master Thesis and Pubmed） between January 2013 and January 2017. RevMan 5.3 software was used to evaluate the quality of these collected papers. Results： Of 48 potentially relevant publications, 10 randomized studies representing 691 patients met inclusion criteria with 369 cases in the supplementing Qi and nourishing Yin plus Chemotherapy group （Herbs ＋ Chem group） and 322 cases in Chemotherapy group （Chem only group）. There were significant differences between Herbs ＋ Chem group and Chem only group in improving the treatment efficacy and reducing the side effects of chemotherapy （P 〈 0.001 for all）. There were also significant differences between the two groups in tumor response and quality of life （P 〈 0.001 for all）. Conclusion： Herbs of supplementing Qi and nourishing Yin may increase chemotherapy effectiveness, reduce chemotherapy toxicity and improve the quality of life of patients with lung cancer when combined with chemotherapy.

Clinical Effects of Treatment for Lung Cancer with Double Points Cryoablation through Percutaneous Puncture Guided by Computed Tomography

OBJECTIVE To investigate the clinical effects of the application of double points cryoablation through percutaneous puncture for advanced lung cancer patients. METHODS Forty-one patients diagnosed with stage III-IV pulmonary carcinoma were selected for the study. The patients were found to have from 1 to 3 foci of carcinoma, and in each case the disease was limited to one lung. The study patients were divided randomly into 3 groups. There were 16 cases receiving routine chemotherapy and radiotherapy in group I, 13 cases treated with cryoablation at a single point in group II, and 12 cases treated with cryoablation at 2 points simultaneously in group III. The patients in the 2 cryoablation groups also received the same treatment as the patients did in group I. The clinical effects were evaluated within 6 months after treatment, and the survival rate was followed-up for 3 years. RESULTS The clinical effects were improved significantly after treatment in group II and in group III compared with those in group I （P 〈 0.05）, including an enhanced regressive rate of 21%, postponed tumor progression of 50.58% and a clinical benefit rate of 92%. The effective rate of regression in group III was higher than that in group II, 43.59% （P 〈 0.05）, and the 3-year survival rate was 37.25%. Significant differences in side effects were not found between the 2 cryoablation groups. CONCLUSION Cryosurgery ablation at 2 points, simultaneously, and directed at I foci might improve the effects of treatment and the prognosis of lung cancer patients, when used in combination with routine treatment.

Biphasic pulmonary blastoma with metastasis to adjacent rib:one case report

Pulmonary blastoma （PB） is a relatively rare intrathoracic neoplasm that is composed of immature malignant epithelial and/or mesenchymal tissues whose features may resemble early embryological lung tissues . They have been divided into three subgroups - classic biphasic pulmonary blastoma （BPB）, well-differentiated fetal ad enocarcinoma （WDFA） and pleuropulmonary blastoma （PPB） , among which BPB is the most common subtype and its prognosis is fairly poor, especially in case of accompanying local infiltration or distant metastasis. There have been several case reports about BPB with distant metastasis to brain, lung, kidney, even to pancrea. Here we reported a case of biphasic pulmonary blastoma with metastasis to adjacent rib.

Clinical study of docetaxel-vinorelbine as second-line chemotherapy in advanced non-small cell lung cancer

Objective： To evaluate the efficacy and toxicity of docetaxel and vinorelbine as second-line chemotherapy in the treatment of advanced non-small cell lung cancer （NSCLC）. Methods： 48 histologically or cytologically confirmed NSCLC patients with progressive or recurrent disease after first-line treatment were treated with docetaxel and vinoretbine. The chemotherapy included vinorelbine （25 mg/m^2） on days 1,5 and docetaxel （60 mg/m^2） on day 1. The treatment was repeated every 3 weeks. Patients receiving at least two cycles were evaluated for efficacy and toxicity. Results： Of 48 patients, 1 patient achieved complete response and 16 achieved partial response. Overall response rate for all 48 patients was 35.4% （17/48）. Main hematologic toxicities included neutropenia （60.4%） and febrile neutropenia （29.2%） and non-hematologic toxicities were mild. Conclusion： The combination of docetaxel-vinorelbine as second-line chemotherapy is an effective regimen with manageable toxicity for the treatment of advanced NSCLC. Further studies may confirm these results.

The clinical effects of DC-CIK cells combined with chemotherapy in the treatment of advanced NSCLC

Objective: The aim of the study was to evaluate the safety and therapeutic effects of autologous dendritic cells co-cultured with cytokine-induced killer cells (DC-CIK) combined with chemotherapy in advanced non-small cell lung cancer (NSCLC) patients. Methods: Fifty patients with advanced NSCLC (stages III to IV), who had received therapies in our Center (Department of Biotherapy, Affiliated to Cancer Hospital of Shanxi Medical University, Taiyuan, China) from August 2008 to January 2010, were treated by DC-CIK + chemotherapy as the combined treatment group; fifty advanced NSCLC patients treated with chemotherapy at the same time served as controls. The immunologic function, short-term therapeutic effects, the 1-year survival rate, the life quality, the chemotherapy side effects were compared between the two groups, the safety and therapeutic effects of DC-CIK cells therapy were observed too. Results: There was no obvious change of subsets of T cells in peripheral blood before and after therapy in DC-CIK + chemotherapy group, and IFN-γ was improved after therapy in this group (P < 0.05); in chemotherapy alone group, the ratios of CD3+CD4+, CD3+CD8+, CD3-CD56+ cells and the secretion of IL-2, TNF-α decreased significantly after therapy (P < 0.05); the ratios of CD3+CD8+, CD3+CD56+ were improved after cell culture (P < 0.05). The disease control rate (DCR) of DC-CIK + chemotherapy group was higher than that in the chemotherapy alone group (78.0% vs 56.0%, P < 0.05); the 1-year survival rates of DC-CIK + chemotherapy group and chemotherapy alone group were 50% and 44% respectively, had no significant difference. Compared with chemotherapy alone group, the occurrence of chemotherapy side effects (including bone marrow suppression, nausea and vomiting, peripheral nerve toxicity) was less in the DC-CIK + chemotherapy group (P < 0.05). The physical and appetite were better in DC-CIK + chemotherapy group after therapy. Conclusion: To compare with simple chemotherapy, DC-CIK + chemotherapy for advanced NSCLC is safe and effective, and it can improve patients' life quality and remission rate, and prolong their survival time.