Diagnostic value of negative enrichment and immune fluorescence in situ hybridization for intraperitoneal free cancer cells of gastric cancer

Objective:To explore the intraperitoneal free cancer cell(IFCC)detection value of negative enrichment and immune fluorescence in situ hybridization(NEimFISH)on chromosomes(CEN)8/17.Methods:To verify the reliability of NEimFISH,29 gastric cancer tumors,their adjacent tissues and greater omental tissues were tested.Our study then included 105 gastric cancer patients for IFCC.We defined patients as IFCC-positive if a signal was detected,regardless of the detailed cancer cell numbers.A comparison of clinicopathological features was conducted among IFCC groups.We also compared the diagnosis value and peritoneal recurrence predictive value among different detection methods.The comparison of IFCC number was also conducted among different groups.Results:A cutoff of 2.5 positive cells could distinguish all benign tissue samples and 97%of malignant tissue samples in our study.Compared to intestinal gastric cancer,patients with diffuse gastric cancer tended to have more IFCCs(6 vs.4,P=0.002).The IFCC counts were often higher in the lymphovascular invasion positive group than negative group(3 vs.1,P=0.022).All IFCC samples that were considered positive using conventional cytology were also found to be positive using NEimFISH.When compared to conventional cytology and paraffin pathology,NEimFISH had a higher IFCC positive rate(68.9%)and higher one-year peritoneal recurrence predictive value with area under the curve(AUC)of 0.922.Conclusions:Gastric cancer could be effectively diagnosed by NEimFISH.The IFCC number found using NEimFISH on CEN8/17 is closely associated with Lauren type and vascular invasion of cancer.NEimFISH is a reliable detection modality with a higher positive detection rate,higher one-year peritoneal recurrence predictive value and quantitative features for IFCC of gastric cancer.

Detection methods and clinical significance of free peritoneal tumor cells found during colorectal cancer surgery

Peritoneal washing is now part of the standard clinical practice in several abdominal and pelvic neoplasias. However, in colorectal cancer surgery, intra-peritoneal free cancer cells(IFCC) presence is not routinely investigated and their prognostic meaning is still unclear. When peritoneal washing results are positive for the presence of IFCC a worse outcome is usually expected in these colorectal cancer operated patients, but it what is not clear is whether it is associated with an increased risk of local recurrence. It is authors' belief that one of the main reasons why IFCC are not researched as integral part of the routine staging system for colon cancer is that there still isn't a diagnostic or detection method with enough sensibility and specificity. However, the potential clinical implications of a routine research for the presence IFCC in colon neoplasias are enormous: not only to obtain a more accurate clinical staging but also to offer different therapy protocols, based on the presence of IFCC. Based on this, adjuvant chemotherapy could be offered to those patients found to be positive for IFCC; also, protocols of proactive intraperitoneal chemotherapy could be applied. Although presence of IFCC appears to have a valid prognostic significance, further studies are needed to standardize detection and examination procedures, to determine if there are and which are the stages more likely to benefit from routine search for IFCC.

Liquid biopsy in patients with pancreatic cancer: Circulating tumor cells and cell-free nucleic acids

Despite recent advances in surgical techniques and perioperative management, the prognosis of pancreatic cancer(PCa) remains extremely poor. To provide optimal treatment for each patient with Pca, superior biomarkers are urgently needed in all phases of management from early detection to staging, treatment monitoring, and prognosis. In the blood of patients with cancer, circulating tumor cells(CTCs) and cell-free nucleic acids(cf NAs), such as DNA, m RNA, and noncoding RNA have been recognized. In the recent years, their presence in the blood has encouraged researchers to investigate their potential use as novel blood biomarkers, and numerous studies have demonstrated their potential clinical utility as a biomarker for certain types of cancer. This concept, called "liquid biopsy" has been focused on as a less invasive, alternative approach to cancer tissue biopsy for obtaining genetic and epigenetic aberrations that contribute to oncogenesis and cancer progression. In this article, we review the available literature on CTCs and cfN As in patients with cancer, particularly focusing on PCa, and discuss future perspectives in this field.

Isolation and Identification of Cancer Stem Cells from Human Osteosarcom by Serum-free Three-dimensional Culture Combined with Anticancer Drugs

The cancer stem cells(CSCs)from human osteosarcoma by serum-free three-dimensional culture combined with anticancer drugs were isolated and identified.The primary cells derived from human osteosarcoma were digested by trypsin to prepare a single-cell suspension,and mixed homogeneously into 1.2% alginate gel.Single-cell alginate gel was cultured with serum-free DMEM/F12 medium.Epirubicin(0.8μg/mL)was added to the medium to enrich CSCs.After cultured conventionally for 7 to 10 days,most of cells suspended in ...

Comparison of peritoneal free gastric cancer cells' detecting rates between laparoscopically assisted and open radical gastrectomy

Objective： To compare laparoscopic gastrectomy and conventional surgery on the dissemination and seeding of tumor cells. Methods：Intraoperative peritoneal lavage cytologic examination was performed in 65 patients with gastric cancer, during laparoscopic gastrectomy （n = 34） and conventional surgery （n = 31）. Cytology was examined twice, immediately after opening the peritoneal cavity and just before closing the abdomen. Saline was poured into the peritoneal cavity, and 100 ml fluid was retrieved after irrigation. Laparoscopic instruments were lavaged after surgery with 100 ml saline. Carbon dioxide （COz） was derived through the trocar side orifice after pneumoperitoneum during laparoscopic gastrectomy and filtered through 100 ml saline. Cytologic examination of the filtrate was performed after the filtration process. Results： The incidence of positive cytology during laparoscopic surgery was 32.26% in the preoperative lavage and 22.58% in the postoperative lavage. The incidence of positive cytology during conventional surgery was 41.18% before lavage and 26.47% after lavage. Only one positive cytology was detected in the CO2 filtrate gas. The incidence of positive cytology in the lavage of the instruments during laparoscopic surgery was 6.45 %. Conclusion： During gastric laparoscopic surgery, CO2 pneumoperitoneum does not affect tumor cell dissemination and seeding. In this study, laparoscopic techniques used in gastric cancer surgery were not associated with a higher risk for intraperitoneal dissemination of cancer cells than the conventional surgery.

THE RELATIONSHIP BETWEEN SEROSAL TYPES, PATHOLOGICAL CHARACTERISTICS AND FREE CANCER CELLS IN THE PERITONEAL CAVITY OF GASTRIC CANCER PATIENTS

The relationship between free cancer cells and the pathological characteristics of gastric cancer were studied. Of 100 cases of gastric cancer, free cancer cells in the peritoneal cavity were detected in 32 cases (32%). Free cancer cells were most often found in tendonoid (62.2%) and colour diffused (60.0%) serosal types. When the area of serosal invasion was over 20 cm, the positive free cancer cell rate was 56.6% and only 2.5% if below 20 cm. Free cancer cells were related to the depth of cancer infiltration, often found in the S2 and S3 invasion layers, as well as to the pathological characteristics of gastric cancer. Free cancer cells were often seen in infiltrated type cancer, histologically poorly differentiated or undifferentiated adenocarcinoma. and nest or diffused growth types. In patients without peritoneal metastasis (P0), the positive rate was 26.1%. This study proved that Chen's serosal classification is correct and useful in assessing whether the cancer cells have penetrated through the serosa or not during surgery. Different treatments should be used in the cases with different serosal types. In addition to surgery, destruction of free cancer cells should be considered in tendonoid and colour diffused serosal types, so as to prevent peritoneal metastasis.

Prognostic and predictive blood biomarkers in gastric cancer and the potential application of circulating tumor cells

Gastric cancer(GC), with its high incidence and mortality rates, is a highly fatal cancer that is common in East Asia particularly in China. Its recurrence and metastasis are the main causes of its poor prognosis. Circulating tumor cells(CTCs) or other blood biomarkers that are released into the circulating blood stream by tumors are thought to play a crucial role in the recurrence and metastasis of gastric cancer. Therefore, the detection of CTCs and other blood biomarkers has an important clinical significance; in fact, they can help predict the prognosis, assess the staging, monitor the therapeutic effects and determine the drug susceptibility. Recent research has identified many blood biomarkers in GC, such as various serum proteins, autoantibodies against tumor associated antigens, and cell-free DNAs. The analysis of CTCs and circulating cell-free tumor DNA(ctDNA) in the peripheral blood of patients with gastric cancer is called as liquid biopsy. These blood biomarkers provide the disease status for individuals and have clinical meaning. In this review, we focus on the recent scientific advances regarding CTCs and other blood biomarkers, and discuss their origins and clinical meaning.

Adjuvant treatment for triple-negative breast cancer: a retrospective study of immunotherapy with autologous cytokine-induced killer cells in 294 patients

Objective: To examine the efficacy and safety of a sequential combination of chemotherapy and autologous cytokine-induced killer(CIK) cell treatment in triple-negative breast cancer(TNBC) patients.Methods: A total of 294 post-surgery TNBC patients participated in the research from January 1, 2009 to January 1, 2015. After adjuvant chemotherapy, autologous CIK cells were introduced in 147 cases(CIK group), while adjuvant chemotherapy alone was used to treat the remaining 147 cases(control group). The major endpoints of the investigation were the disease-free survival(DFS) and overall survival(OS). Additionally, the side effects of the treatment were evaluated.Results: In the CIK group, the DFS and OS intervals of the patients were significantly longer than those of the control group(DFS:P = 0.047;OS: P = 0.007). The multivariate analysis demonstrated that the TNM(tumor-node-metastasis) stage and adjuvant CIK treatment were independent prognostic factors for both DFS [hazard ratio(HR)= 0.520, 95% confidence interval(CI):0.271-0.998, P = 0.049;HR = 1.449, 95% CI:1.118-1.877, P = 0.005, respectively] and OS(HR=0.414, 95% CI:0.190-0.903, P = 0.027;HR= 1.581, 95% CI:1.204-2.077, P = 0.001, respectively) in patients with TNBC. Additionally, longer DFS and OS intervals were associated with increased number of CIK treatment cycles(DFS: P = 0.020;OS: P = 0.040). The majority of the patients who benefitted from CIK cell therapy were relatively early-stage TNBC patients.Conclusion: Chemotherapy in combination with adjuvant CIK could be used to lower the relapse and metastasis rate, thus effectively extending the survival time of TNBC patients, especially those at early stages.

Prediction of peritoneal free cancer cells in gastric cancer patients by golden-angle radial sampling dynamic contrast-enhanced magnetic resonance imaging

Objectiveperitoneal free cancer cells can negatively impact disease progression and patient outcomes in gastric cancer. This study aimed to investigate the feasibility of using golden-angle radial sampling dynamic contrast-enhanced magnetic resonance imaging (GRASP DCE-MRI) to predict the presence of peritoneal free cancer cells in gastric cancer patients.MethodsAll enrolled patients were consecutively divided into analysis and validation groups. Preoperative magnetic resonance imaging (MRI) scans and perfusion were performed in patients with gastric cancer undergoing surgery, and peritoneal lavage specimens were collected for examination. Based on the peritoneal lavage cytology (PLC) results, patients were divided into negative and positive lavage fluid groups. The data collected included clinical and MR information. A nomogram prediction model was constructed to predict the positive rate of peritoneal lavage fluid, and the validity of the model was verified based on data from the verification group.ResultsThere was no statistical difference between the proportion of PLC-positive cases predicted by GRASP DCE-MR and the actual PLC test. MR tumor stage, tumor thickness, and perfusion parameter Tofts-Ketty model volume transfer constant (Ktrans) were independent predictors of positive peritoneal lavage fluid. The nomogram model featured a concordance index (C-index) of 0.785 and 0.742 for the modeling and validation groups, respectively.ConclusionsGRASP DCE-MR could effectively predict peritoneal free cancer cells in gastric cancer patients. The nomogram model constructed using these predictors may help clinicians to better predict the risk of peritoneal free cancer cells being present in gastric cancer patients.

Revolutionizing Non-Invasive Biomarker Discoveries: The Power of Methylation Screening Analysis in Cell-Free DNA Liquid Biopsy

Epigenetic changes of DNA, including methylation, have long been recognized as key indicators of various diseases, including aging, cancer, and neurological disorders. Biomarker discoveries based on distinct methylation patterns for both hypermethylation and hypomethylation lead the way in discovery of novel diagnosis and treatment targets. Many different approaches are present to detect the level of methylation in whole genome (whole genome bisulfite sequencing, microarray) as well as at specific loci (methylation specific PCR). Cell-free DNA (cf-DNA) found in body fluids like blood provides information about DNA methylation and serves as a less invasive approach for genetic screening. Cell-free DNA and methylation screening technologies, when combined, have the potential to transform the way we approach genetic screening and personalized therapy. These technologies can help enhance disease diagnostic accuracy and inform the development of targeted therapeutics by providing a non-invasive way for acquiring genomic information and identifying disease-associated methylation patterns. We highlight the clinical benefits of using cell-free DNA (cf-DNA) liquid biopsy analysis and available methylation screening technologies that have been crucial in identifying biomarkers for disease from patients using a non-invasive way. Powering such biomarker discoveries are various methods of cf-DNA methylation analysis such as Bisulfite Sequencing and most recently, Methylation-Specific Restriction Enzyme (MSRE-seq) Analysis, paving the way for novel epigenetic biomarker discoveries for more robust diagnosis such as early disease detection, prognosis, monitoring of disease progression and treatment response as well as discovery of novel drug targets.

Free fatty acids receptors 2 and 3 control cell proliferation by regulating cellular glucose uptake

BACKGROUND Colorectal cancer(CRC)is a worldwide problem,which has been associated with changes in diet and lifestyle pattern.As a result of colonic fermentation of dietary fibres,short chain free fatty acids are generated which activate free fatty acid receptors(FFAR)2 and 3.FFAR2 and FFAR3 genes are abundantly expressed in colonic epithelium and play an important role in the metabolic homeostasis of colonic epithelial cells.Earlier studies point to the involvement of FFAR2 in colorectal carcinogenesis.AIM To understand the role of short chain FFARs in CRC.METHODS Transcriptome analysis console software was used to analyse microarray data from CRC patients and cell lines.We employed short-hairpin RNA mediated down regulation of FFAR2 and FFAR3 genes,which was validated using quantitative real time polymerase chain reaction.Assays for glucose uptake and cyclic adenosine monophosphate(cAMP)generation was done along with immunofluorescence studies to study the effects of FFAR2/FFAR3 knockdown.For measuring cell proliferation,we employed real time electrical impedancebased assay available from xCELLigence.RESULTS Microarray data analysis of CRC patient samples showed a significant down regulation of FFAR2 gene expression.This prompted us to study the FFAR2 in CRC.Since,FFAR3 shares significant structural and functional homology with FFAR2,we knocked down both these receptors in CRC cell line HCT 116.These modified cell lines exhibited higher proliferation rate and were found to have increased glucose uptake as well as increased level of glucose transporter 1.Since,FFAR2 and FFAR3 signal through G protein subunit(Gαi),knockdown of these receptors was associated with increased cAMP.Inhibition of protein kinase A(PKA)did not alter the growth and proliferation of these cells indicating a mechanism independent of cAMP/PKA pathway.CONCLUSION Our results suggest role of FFAR2/FFAR3 genes in increased proliferation of colon cancer cells via enhanced glucose uptake and exclude the role of PKA mediated cAMP signalling.Alternate pathways could be involved that would ultimately result in increased cell proliferation as a result of down regulated FFAR2/FFAR3 genes.This study paves the way to understand the mechanism of action of short chain FFARs in CRC.

Clinical benefit of COX-2 inhibitors in the adjuvant chemotherapy of advanced non-small cell lung cancer: A systematic review and metaanalysis

BACKGROUND Lung cancer is a major cause of death among patients,and non-small cell lung cancer(NSCLC)accounts for more than 80%of all lung cancers in many countries.AIM To evaluate the clinical benefit(CB)of COX-2 inhibitors in patients with advanced NSCLC using systematic review.METHODS We searched the six electronic databases up until December 9,2019 for studies that examined the efficacy and safety of the addition of COX-2 inhibitors to chemotherapy for NSCLC.Overall survival(OS),progression free survival(PFS),1-year survival rate(SR),overall response rate(ORR),CB,complete response(CR),partial response(PR),stable disease(SD),and toxicities were measured with more than one outcome as their endpoints.Fixed and random effects models were used to calculate risk estimates in a meta-analysis.Potential publication bias was calculated using Egger’s linear regression test.Data analysis was performed using R software.RESULTS The COX-2 inhibitors combined with chemotherapy were not found to be more effective than chemotherapy alone in OS,progression free survival,1-year SR,CB,CR,and SD.However,there was a difference in overall response rate for patients with advanced NSCLC.In a subgroup analysis,significantly increased ORR results were found for celecoxib,rofecoxib,first-line treatment,and PR.For adverse events,the increase in COX-2 inhibitor was positively correlated with the increase in grade 3 and 4 toxicity of leukopenia,thrombocytopenia,and cardiovascular events.CONCLUSION COX-2 inhibitor combined with chemotherapy increased the total effective rate of advanced NSCLC with the possible increased risk of blood toxicity and cardiovascular events and had no effect on survival index.

Maintaining clarity:Review of maintenance therapy in nonsmall cell lung cancer

The purpose of this article is to review the role of maintenance therapy in the treatment of advanced nonsmall cell lung cancer(NSCLC). A brief overview about induction chemotherapy and its primary function in NSCLC is provided to address the basis of maintenance therapies foundation. The development of how maintenance therapy is utilized in this population is discussed and current guidelines for maintenance therapy are reviewed. Benefits and potential pitfalls of maintenance therapy are addressed, allowing a comprehensive review of the achieved clinical benefit that maintenance therapy may or may not have on NSCLC patient population. A review of current literature was conducted and a table is provided comparing the results of various maintenance therapy clinical trials. The table includes geographical location of each study, the number of patients enrolled, progression free survival and overall survival statistics, post-treatment regimens and if molecular testing was conducted. The role of molecular testing in relation to therapeutic treatment options foradvanced NSCLC patients is discussed. A treatment algorithm clearly depicts first line and second line treatment for management of NSCLC and includes molecular testing, maintenance therapy and the role clinical trials have in treatment of NSCLC. This treatment algorithm has been specifically tailored and developed to assist clinicians in the management of advanced NSCLC.

Is there an optimal time to initiate adjuvant chemotherapy to predict benefit of survival in non-small cell lung cancer?

Objective: Adjuvant chemotherapy (AC) after curative resection is known to improve the survival of patients with non-small cell lung cancer (NSCLC); however, few studies have reported the correlation between the time to initiation of AC (TTAC) and survival in NSCLC patients. Methods: The clinical data of 925 NSCLC patients who received curative resection and post-operative AC at the Cancer Hospital of Chinese Academy of Medical Sciences between 2003 and 2013 were retrospectively analyzed. TTAC was measured from the date of surgery to the initiation of AC. Disease-free survival (DFS) was defined as the duration from surgery to the time of tumor recurrence or last follow-up evaluation. The optimal cut-off value of TTAC was determined by maximally selected log-rank statistics. The DFS curve was estimated using the Kaplan-Meier method, and the Cox proportional hazards regression model was used to identify risk factors independently associated with DFS. Propensity score matching (PSM) was performed for survival analysis using the match data. Results: The optimal discriminating cut-off value of TTAC was set at d 35 after curative resection based on which the patients were assigned into two groups: group A (<= 35 d) and group B (> 35 d). There was no significant difference in the DFS between the two groups (P=0.246), indicating that the TTAC is not an independent prognostic factor for DFS. A further comparison continued to show no significant difference in the DFS among 258 PSM pairs (P=0.283). Conclusions: There was no significant correlation between the TTAC and DFS in NSCLC patients. Studies with larger samples are needed to further verify this conclusion.

Emerging role of non-invasive and liquid biopsy biomarkers in pancreatic cancer

A global increase in the incidence of pancreatic cancer(PanCa)presents a major concern and health burden.The traditional tissue-based diagnostic techniques provided a major way forward for molecular diagnostics;however,they face limitations based on diagnosis-associated difficulties and concerns surrounding tissue availability in the clinical setting.Late disease development with asymptomatic behavior is a drawback in the case of existing diagnostic procedures.The capability of cell free markers in discriminating PanCa from autoimmune pancreatitis and chronic pancreatitis along with other precancerous lesions can be a boon to clinicians.Early-stage diagnosis of PanCa can be achieved only if these biomarkers specifically discriminate the non-carcinogenic disease stage from malignancy with respect to tumor stages.In this review,we comprehensively described the non-invasive disease detection approaches and why these approaches are gaining popularity for their early-stage diagnostic capability and associated clinical feasibility.

基于Label-free技术的非小细胞肺癌蛋白质差异研究

目的 基于非小细胞肺癌(non-small-cell lung cancer,NSCLC)及与其配对的非癌性邻近组织(non-cancerous adjacent tissues,NATs)的蛋白质组学分析,寻找NSCLC诊断相关蛋白标志物。方法 应用非标记定量蛋白组学(LFP)技术,以NSCLC患者配对的NATs为对照,对5例NSCLC患者进行癌组织蛋白质组学分析。以差异倍数>1.5(上调)或<0.67(下调)且P<0.05为标准筛选差异蛋白。应用String网站和R语言对差异蛋白进行基因本体论(gene ontology,GO)分析、京都基因和基因组百科全书(Kyoto Encyclopedia of Genes and Genomes,KEGG)分析,为进一步研究提供良好基础。结果 本研究发现差异蛋白共644个,其中339个蛋白表达上调,305个蛋白表达下调。PCA结果显示,差异蛋白可明显区分NSCLC与NATs。GO分析结果表明,差异蛋白大多以细胞外泌体的形式存在且主要富集于调节胞外分泌、胞外分泌、骨髓细胞激活参与免疫反应等的生物学过程以及钙粘着蛋白绑定、细胞外基质绑定等的分子功能。KEGG分析结果显示,差异蛋白主要富集在抗坏血酸和醛酸代谢、组氨酸代谢、蛋白质消化吸收、丙酮酸代谢等通路(P<0.05)。结论 NSCLC与NATs存在明显差异,可为发现NSCLC新型标志物提供线索。

腹腔镜下D2根治术联合CME对局部进展期胃癌术后腹腔游离癌细胞检出率及预后的影响

目的:探讨腹腔镜下D2根治术联合完整系膜切除术(complete mesocolic excision,CME)对局部进展期胃癌腹腔游离癌细胞及预后的影响。方法:回顾性分析2021年06月至2022年06月于医院住院治疗的128例局部进展期胃癌患者临床资料,将64例实施腹腔镜下D2根治术的患者纳入对照组,64例实施腹腔镜下D2根治术联合CME的患者纳入研究组。记录两组手术、住院及并发症情况,采用生活质量综合评定问卷-74(GQOLI-74)评定生活质量。分别于腹腔镜探查后和肿瘤切除后收集腹腔冲洗液,应用细胞学检查检测腹腔游离癌细胞。术后随访1年,记录总生存期(OS)及无进展生存期(PFS)情况。结果:研究组淋巴结清扫总数及阳性淋巴结数量显著大于对照组(P<0.05)。与术前比较,研究组术后腹腔游离癌细胞阳性率显著降低(P<0.05)。与术前比较,两组术后GQOLI-74评分均显著增加,且研究组高于对照组(P<0.05)。两组腹腔感染/积液、胃排空障碍、肠梗阻、吻合口瘘、胰瘘、淋巴漏发生率及不良反应总发生率比较,差异均无统计学意义(P>0.05)。研究组术后1年PFS率和OS率均显著高于对照组(P<0.05)。结论:腹腔镜下D2根治术联合CME有利于彻底清除局部进展期胃癌淋巴结,减少术后复发,促进术后康复,且不增加腹腔游离癌细胞脱落和手术并发症风险,具有临床推广价值。

复方红豆杉胶囊维持治疗气虚痰瘀证晚期非小细胞肺癌的多中心、大样本、前瞻性队列研究

目的:探讨复方红豆杉胶囊维持治疗气虚痰瘀证晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的临床疗效和安全性。方法:采用多中心、大样本、前瞻性队列研究方法,纳入一线化疗4~6周期后疗效评价疾病稳定以上进入维持治疗阶段患者,根据患者意愿分为治疗组160例,对照组109例。对照组根据鳞癌和非鳞癌分别给予吉西他滨和培美曲塞单药化疗维持治疗,治疗组给予复方红豆杉胶囊维持治疗。均以21天为1个疗程,两组干预至少2个疗程,每周期进行生活质量评价,每2疗程进行影像学疗效评价。比较两组疾病无进展生存时间(progression-free survival time,PFS)、生活质量,同时进行药物安全性评价。结果:269例入组患者中,246例患者出现PFS终点事件(91.45%),其中治疗组145例,中位PFS为106天,对照组101例,中位PFS为120天,两组PFS比较差异无统计学意义(P>0.05)。采用美国肺癌生存质量量表(FACT-L4.0版)和欧洲五维健康量表中视觉模拟量表(EQ-5D-VAS)对两组患者生活质量评分进行比较,两种生活质量评价量表均提示治疗组较对照组在提高生活质量方面存在优势(P<0.05)。治疗期间两组共有19例患者出现ADR,治疗组7例(占治疗组人数4.38%),对照组12例(占对照组人数11.01%),ADR发生率在治疗组中更低,尤其表现在骨髓抑制不良反应的发生率方面。结论:在延长PFS方面,复方红豆杉胶囊维持治疗气虚痰瘀证晚期NSCLC的疗效非劣于现代医学单药维持化疗,且在高生活质量、低不良反应方面,复方红豆杉胶囊更具有一定优势。

艾灸联合免疫检查点抑制剂与化疗治疗晚期非鳞非小细胞肺癌临床研究

目的:观察艾灸联合免疫检查点抑制剂与化疗治疗肺脾气虚型晚期非鳞非小细胞肺癌的临床疗效。方法:选取62例肺脾气虚型晚期非鳞非小细胞肺癌患者,按照随机数字表法分成对照组与试验组各31例。对照组予免疫检查点抑制剂与化疗治疗,直至疾病进展或发生不可耐受的毒性反应,化疗期间予常规抑酸护胃、止吐、护肝等对症支持治疗。试验组在对照组基础上给予艾灸治疗。比较2组中医证候积分,中医证候疗效,实体瘤疗效,无进展生存时间(PFS),CD3^(+)、CD4^(+)、CD8^(+)T淋巴细胞百分比,CD4^(+)/CD8^(+)值,以及药物不良反应。结果:治疗后,对照组中医证候积分与同组治疗前比较,差异无统计学意义(P>0.05);试验组中医证候分较治疗前降低,且低于对照组(P<0.05)。试验组与对照组中医证候改善率分别为77.42%、41.94%,2组比较,差异有统计学意义(P<0.05)。试验组与对照组肿瘤总缓解率(ORR)分别为58.06%、51.61%,疾病控制率(DCR)分别为83.87%、77.41%,2组ORR、DCR比较,差异均无统计学意义(P>0.05)。试验组PFS长于对照组(Log Rank P<0.05)。治疗方式为影响晚期非鳞非小细胞肺癌PFS的独立因素,与对照组比较,试验组疾病进展风险较低[HR=0.57 (95%CI 0.33~0.99)]。治疗后,试验组CD3^(+)、CD4^(+)T淋巴细胞百分比及CD4^(+)/CD8^(+)值均较治疗前升高,CD8^(+)T淋巴细胞百分比均较治疗前下降,差异均有统计学意义(P<0.05);对照组CD3^(+)、CD8^(+)T淋巴细胞百分比均较治疗前下降,差异均有统计学意义(P<0.05);对照组CD4^(+)T淋巴细胞百分比及CD4^(+)/CD8^(+)值治疗前后比较,差异均无统计学意义(P>0.05);试验组CD3^(+)、CD4^(+)T淋巴细胞百分比及CD4^(+)/CD8^(+)值均高于对照组(P<0.05)。2组白细胞减少、中性粒细胞减少、贫血、血小板减少、肝功能异常、肾功能异常、恶心呕吐、反应性毛细血管增生、乏力、食欲下降、免疫性肺炎总发生率及上述不良反应程度≥3级发生率比较,差异均无统计学意义(P>0.05)。结论:艾灸联合免疫检查点抑制剂与化疗治疗能改善肺脾气虚型晚期非鳞非小细胞肺癌的临床症状,提高其免疫功能和延长PFS。

系统免疫炎症指数对根治性放疗Ⅲ期肺鳞癌患者长期生存的预测价值

目的探讨系统免疫炎症指数(SII)对接受根治性放疗的Ⅲ期肺鳞癌患者长期生存的预测价值。方法回顾性收集接受根治性放疗的Ⅲ期肺鳞癌患者的临床资料。计算患者放疗前1周内的SII及相关炎症指标,同时应用X-Tile软件确定最佳截断值。分析患者的生存情况以及SII对患者总生存(OS)及无进展生存(PFS)的影响。结果共纳入了453例患者,低SII组336例(<1277.3),高SII组117例(≥1277.3)。高SII组的中位OS和中位PFS均较低SII组缩短(OS:20.8个月vs.31.0个月,Log-rankχ2=18.015,P<0.01;PFS:13.0个月vs.21.0个月,Log-rankχ2=15.062,P<0.01)。多因素Cox回归分析显示,高SII是患者OS(HR=1.628,95%CI:1.294~2.047,P<0.001)和PFS(HR=1.559,95%CI:1.240~1.961,P<0.001)的独立危险因素,其他的影响因素包括较晚的TNM分期、放疗疗效欠佳,HALP评分下降。结论SII可作为接受根治性放疗Ⅲ期肺鳞癌患者长期生存的评价指标,SII升高提示预后较差。