Risk stratification in gastric cancer lung metastasis: Utilizing an overall survival nomogram and comparing it with previous staging

BACKGROUND Gastric cancer(GC)is prevalent and aggressive,especially when patients have distant lung metastases,which often places patients into advanced stages.By identifying prognostic variables for lung metastasis in GC patients,it may be po-ssible to construct a good prediction model for both overall survival(OS)and the cumulative incidence prediction(CIP)plot of the tumour.AIM To investigate the predictors of GC with lung metastasis(GCLM)to produce nomograms for OS and generate CIP by using cancer-specific survival(CSS)data.METHODS Data from January 2000 to December 2020 involving 1652 patients with GCLM were obtained from the Surveillance,epidemiology,and end results program database.The major observational endpoint was OS;hence,patients were se-parated into training and validation groups.Correlation analysis determined va-rious connections.Univariate and multivariate Cox analyses validated the independent predictive factors.Nomogram distinction and calibration were performed with the time-dependent area under the curve(AUC)and calibration curves.To evaluate the accuracy and clinical usefulness of the nomograms,decision curve analysis(DCA)was performed.The clinical utility of the novel prognostic model was compared to that of the 7th edition of the American Joint Committee on Cancer(AJCC)staging system by utilizing Net Reclassification Improvement(NRI)and Integrated Discrimination Improvement(IDI).Finally,the OS prognostic model and Cox-AJCC risk stratification model modified for the AJCC system were compared.RESULTS For the purpose of creating the OS nomogram,a CIP plot based on CSS was generated.Cox multivariate regression analysis identified eleven significant prognostic factors(P<0.05)related to liver metastasis,bone metastasis,primary site,surgery,regional surgery,treatment sequence,chemotherapy,radiotherapy,positive lymph node count,N staging,and time from diagnosis to treatment.It was clear from the DCA(net benefit>0),time-de-pendent ROC curve(training/validation set AUC>0.7),and calibration curve(reliability slope closer to 45 degrees)results that the OS nomogram demonstrated a high level of predictive efficiency.The OS prediction model(New Model AUC=0.83)also performed much better than the old Cox-AJCC model(AUC difference between the new model and the old model greater than 0)in terms of risk stratification(P<0.0001)and verification using the IDI and NRI.CONCLUSION The OS nomogram for GCLM successfully predicts 1-and 3-year OS.Moreover,this approach can help to ap-propriately classify patients into high-risk and low-risk groups,thereby guiding treatment.

Recursive Partitioning Analysis Classification and Graded Prognostic Assessment for Non-Small Cell Lung Cancer Patients with Brain Metastasis:A Retrospective Cohort Study

Objective：To assess prognostic factors and validate the effectiveness of recursive partitioning analysis （RPA） classes and graded prognostic assessment （GPA） in 290 non-small cell lung cancer （NSCLC） patients with brain metastasis （BM）.Methods：From Jan 2008 to Dec 2009,the clinical data of 290 NSCLC cases with BM treated with multiple modalities including brain irradiation,systemic chemotherapy and tyrosine kinase inhibitors （TKIs） in two institutes were analyzed.Survival was estimated by Kaplan-Meier method.The differences of survival rates in subgroups were assayed using log-rank test.Multivariate Cox＇s regression method was used to analyze the impact of prognostic factors on survival.Two prognostic indexes models （RPA and GPA） were validated respectively.Results：All patients were followed up for 1-44 months,the median survival time after brain irradiation and its corresponding 95% confidence interval （95% CI） was 14 （12.3-15.8） months.1-,2-and 3-year survival rates in the whole group were 56.0%,28.3%,and 12.0%,respectively.The survival curves of subgroups,stratified by both RPA and GPA,were significantly different （P0.001）.In the multivariate analysis as RPA and GPA entered Cox＇s regression model,Karnofsky performance status （KPS） ≥ 70,adenocarcinoma subtype,longer administration of TKIs remained their prognostic significance,RPA classes and GPA also appeared in the prognostic model.Conclusion：KPS ≥70,adenocarcinoma subtype,longer treatment of molecular targeted drug,and RPA classes and GPA are the independent prognostic factors affecting the survival rates of NSCLC patients with BM.

Elevated Circulating Levels of Osteopontin Are Associated with Metastasisin Advanced Non-Small Cell Lung Cancer

Objective：To investigate the relationship between postoperative metastasis and circulating levels of osteopontin in non-small cell lung cancer（NSCLC）.Methods：The expression of osteopontin mRNA were detected with RT-PCR technique.The circulating levels of osteopontin were measured through ELASA in 46 NSCLC cases that had not been received any anti-cancer treatment at the time of sampling.The tissues from fifteen patients with benign pulmonary diseases were studied as control group.Results：The overall median mRNA expression level of osteopontin was approximately 70-fold higher in tumor tissues than in matched normal lung tissues（P0.001）.Over-expression of osteopontin mRNA was significantly associated with clinical stage（P=0.009）.Advanced disease states had higher circulating level of osteopontin（stage I＋II versus stage III＋VI）.In multivariate analysis,stage was the only independent factor influencing circulating levels of osteopontin.All patients were followed up for 12 months,2 of the 46 patients with both osteopontin mRNA expression and elevated plasma osteopontin levels had local recurrence and 10 had distant metastasis.There was a significant difference in the osteopontin levels between metastasis group and non-metastasis group.Conclusion：Preoperative plasma levels of osteopontin are significantly associated with post-operative metastasis in advanced NSCLC.

Expression of Maspin in Non-small Cell Lung Cancer and Its Relationship to Vasculogenic Mimicry

Maspin belongs to the serine protease inhibitor （serpin） family and has been proven to be a suppressor of tumor growth and metastasis in many types of tumors. The purpose of this study was to investigate the expression of maspin in non-small cell lung cancer （NSCLC） and its relationship to vasculogenic mimicry （VM）. A total of 160 specimens of NSCLC were involved in this study and 20 specimens of normal lung tissue served as controls. VM, microvessel density （MVD） and the expression of maspin were detected by using immunohistochemical staining. The results showed that the positive rates of maspin and VM in the NSCLC group were 48.1% （77/160） and 36.9% （59/160）, respectively, which were significantly different from those in the control group with the positive rates of maspin and VM being 100% and 0% respectively （P〈0.05）. VM, MVD and the expression level of maspin were significantly related to tumor differentiation, lymph node metastasis, clinical stages and postoperative survival time （all P〈0.05）. The maspin expression in patients with squamous cell carcinoma was significantly higher than that in those with adenocarcinoma （P〈0.05）. The maspin expression was negatively correlated with VM and MVD, and there was a positive correlation between VM and MVD. Maspin-negative expression, VM and high MVD score were negatively related to the 5-year-survival rate. PTNM stages, VM, MVD and maspin expression were independent prognostic factors for NSCLC （P〈0.05）. It was suggested that the loss of expression of maspin may participate in the invasion and metastasis of NSCLC and it has a positive relationship to VM in NSCLC. Combined detection of maspin, VM and MVD may help predict the progression and prognosis of NSCLC.

Role of surgical intervention in managing gastrointestinal metastases from lung cancer

AIM:To investigate the clinicopathological characteristics of late-stage lung cancer patients with gastrointestinal(GI)-tract metastases,focusing on therapeutic options and outcomes.METHODS:Our institution(the National Taiwan University Hospital) diagnosed 8159 patients with lung cancer between 1987 and 2008,of which 21 developed symptomatic GI metastases.This study reviewed all of the patients' information,including survival data,pathological reports,and surgical notes.RESULTS:The most common histological type of lung cancer was adenocarcinoma,and 0.26% of patients with lung cancer developed GI metastases.The median duration from lung cancer diagnosis to GI metastases was three months(range,0-108 mo),and the average time from diagnosis of GI metastasis to death was 2.8 mo.Most patients with symptomatic gastric and/or duodenal metastases exhibited GI bleeding and were diagnosed by panendoscopy.In contrast,small bowel metastases typically presented as an acute abdomen and were not diagnosed until laparotomy.All patients with small bowel or colonic metastases underwent surgical intervention,and their perioperative mortality was 22%.Our data revealed a therapeutic effect in patients with solitary GI metastasis and a favorable palliative effect on survival when metastases were diagnosed preoperatively.In patients with multiple GI metastases,the presentation varied according to the locations of the metastases.CONCLUSION:Surgical treatment is worthwhile in a select group of patients with bowel perforation or obstruction.Physicians should be more alert to symptoms or signs indicating GI metastases.

Correlation between mitochondrial TRAP-1 expression and lymph node metastasis in colorectal cancer

AIM:To evaluate the effect of mitochondrial tumor necrosis factor receptor-associated protein-1(TRAP-1) on the lymph node metastasis(LNM) in Chinese colorectal cancer(CRC) patients,and develop potential LNMassociated biomarkers for CRC using quantitative realtime polymerase chain reaction(RT-PCR) analysis.METHODS:Differences in mitochondrial TRAP-1 gene expression between primary CRC with LNM(LNM CRC) and without LNM(non-LNM CRC) were assessed in 96 Chinese colorectal carcinoma samples using quantitative RT-PCR analysis,Western blotting,and confirmed with immunohistochemical assay.The relationship between clinicopathological parameters and potential diagnostic biomarkers was also examined.RESULTS:TRAP-1 was significantly upregulated in LNM CRC compared with non-LNM CRC,which was confirmed by RT-PCR,Western blotting and immunohistochemical assay.The expression of TRAP-1 in two different metastatic potential human colorectal cancer cell lines,LoVo and HT29,was analyzed with Western blotting.The expression level of TRAP-1 was dramatically higher in LoVo than in HT29.Overexpression of TRAP-1 was significantly associated with LNM(90.2% in LNM group vs 22% in non-LNM group,P < 0.001),the advanced tumor node metastasis stage(89.1% in LNM group vs 26.9% in non-LNM group,P < 0.001),the increased 5-year recurrence rate(82.7% in LNM group vs 22.6% in non-LNM group,P < 0.001) and the decreased 5-year overall survival rate(48.4% in LNM vs 83.2% in non-LNM group,P < 0.001).Univariate and multivariate analyses indicated that TRAP-1 expression was an independent prognostic factor for recurrence and survival of CRC patients(Hazard ratio of 2.445 in recurrence,P = 0.017;2.867 in survival,P = 0.028).CONCLUSION:Mitochondria TRAP-1 affects the lymph node metastasis in CRC,and may be a potential biomarker for LNM and a prognostic factor in CRC.Overexpression of TRAP-1 is a predictive factor for the poor outcome of colorectal cancer patients.

Prognostic factors in patients with stage IV non-small cell lung cancer

Objective: To investigate the prognostic factors for stage IV non-small cell lung cancer (NSCLC) with distant metas- tasis and establish a reliable model of clinical prognostic index. Methods: From January 1990 to April 2005, 313 primary NSCLC patients with metastasis, who had been treated in Shanghai Chest Hospital, were reviewed. Survival time was estimated accord- ing to the Kaplan-Meier method. Cox proportional hazard regression model was used for multivariate analysis. Results: Among the 313 cases of non-small cell lung cancer (NSCLC) at stage IV, there were 218 and 95 patients with metastasis to single and different organs, respectively. The overall median survival time for all 313 cases of NSCLC patients was 10.8 (9.00, 12.30) months and the overall 1-, 2-, 3-, 4- and 5-year survival rate was 45%, 18%, 12%, 4% and 0%. There were 63, 174, 127, 36, 18, 11 and 5 patients with metastasis to brain (20.13%), bone (55.59%), lung (40.58%), liver (11.50%), adrenal gland (5.75%), subcutaneous (3.51%) and others, respectively. The survival time was shortest in subcutaneous metastasis (4.6 months), and liver 7.0 months, brain 8.0 months, adrenal gland 8.6 months, bone 10.6 months, lung 11.8 months. Kaplan-Meier estimation showed that patients anatomic typing, KPS, numbers of organ with metastasis, appetite, liver, adrenal gland and subcutane- ous metastasis, body weight loss, smoking, index of smoking, chemotherapy, cycles of chemotherapy were the predictors of survival. Multivariate analysis showed survival statistically significant correlation with anatomic typing, KPS, appetite, liver and subcutaneous metastasis, body weight loss, cycles of chemotherapy. The relative risk (RR) was 1.51, 1.97, 1.55, 1.67, 2.56, and 2.56 respectively. Conclusion: Survival time decreases distinctly in patients who had distant metastasis to more than two different organs (P<0.01). Bone is the commonest organ for distant metastasis in lung cancer. The prognosis is poor when lung cancer appears subcutaneous metastasis and liver metastasis. Independent prognostic factors in patient with stage IV non-small cell lung cancer were liver and subcutaneous metastasis, anatomic typing, KPS, appetite, body weight loss, cycles of chemotherapy.

Expressions of Livin and Smac Proteins in Non-Small Cell Lung Cancer

Objective： To investigate the expression characteristics of Livin and second mitochondrial activator of Caspase （Smac） proteins in non-small cell lung cancer （NSCLC）, and analyze their effect on patients＇ prognosis. Methods： The expressions of Livin and Smac proteins were detected in 89 NSCLC tissue samples and 25 normal lung tissue samples by immunohistochemical technique. Results： The positive expression rates of Livin and Smac proteins in NSCLC tissues were 53.9%, and 58.4% respectively, higher than that in normal lung tissues（P〈0.01）. Livin protein expression correlated with Smac protein significantly（Χ^2=1 8.451, P=0.000, r=0.455）. The expression level of Livin protein was closely related to lymph node metastasis, TNM stage and histological type （P〈0.05）, but not to sex, age, differentiation grade （P〉0.05）. The expression level of Smac protein was closely related to lymph node metastasis, TNM stage （P〈0.01）, but not to sex, age, histological types （P〉0.05）. Kaplan-Meier analysis revealed a significant impact on survival by Livin protein in NSCLC （P〈0.01）, but not by Smac protein （P〉0.05）. Conclusion： Overexpression of Livin protein may play a promoting role in the occurrence and progression of NSCLC. Moreover, it may bring an adverse effect on patients＇ prognosis. Although overexpression of Smac protein affects the occurrence and progression of NSCLC, it has no relationship with the prognosis. Livin protein may be helpful to evaluate the progression of NSCLC, and to predict the prognosis.

Different types of tumor microvessels in stageⅠ-ⅢA squamous cell lung cancer and their clinical significance

BACKGROUND Lung cancer(LC)is the leading cause of morbidity and mortality among malignant neoplasms.Improving the diagnosis and treatment of LC remains an urgent task of modern oncology.Previously,we established that in gastric,breast and cervical cancer,tumor microvessels(MVs)differ in morphology and have different prognostic significance.The connection between different types of tumor MVs and the progression of LC is not well understood.AIM To evaluate the morphological features and clinical significance of tumor MVs in lung squamous cell carcinoma(LUSC).METHODS A single-center retrospective cohort study examined medical records and archival paraffin blocks of 62 and 180 patients with stage I-IIIA LUSC in the training and main cohorts,respectively.All patients underwent radical surgery(R0)at the Orenburg Regional Cancer Clinic from May/20/2009 to December/14/2021.Tumor sections were routinely processed,and routine Mayer's hematoxylin and eosin staining and immunohistochemical staining for cluster of differentiation 34(CD34),podoplanin,Snail and hypoxia-inducible factor-1 alpha were performed.The morphological features of different types of tumor MVs,tumor parenchyma and stroma were studied according to clinicopathological characteristics and LUSC prognosis.Statistical analysis was performed using Statistica 10.0 software.Univariate and multivariate logistic regression analyses were performed to identify potential risk factors for LUSC metastasis to regional lymph nodes(RLNs)and disease recurrence.Receiver operating characteristic curves were constructed to discriminate between patients with and without metastases in RLNs and those with and without disease recurrence.The effectiveness of the predictive models was assessed by the area under the curve.Survival was analyzed using the Kaplan-Meier method.The log-rank test was used to compare survival curves between patient subgroups.A value of P<0.05 was considered to indicate statistical significance.RESULTS Depending on the morphology,we classified tumor vessels into the following types:normal MVs,dilated capillaries(DCs),atypical DCs,DCs with weak expression of CD34,"contact-type"DCs,structures with partial endothelial linings,capillaries in the tumor solid component and lymphatic vessels in lymphoid and polymorphocellular infiltrates.We also evaluated the presence of loose,fine fibrous connective tissue(LFFCT)and retraction clefts in the tumor stroma,tumor spread into the alveolar air spaces(AASs)and fragmentation of the tumor solid component.According to multivariate analysis,the independent predictors of LUSC metastasis in RLNs were central tumor location(P<0.00001),the presence of retraction clefts(P=0.003),capillaries in the tumor solid component(P=0.023)and fragmentation in the tumor solid component(P=0.009),whereas the independent predictors of LUSC recurrence were tumor grade 3(G3)(P=0.001),stage N2(P=0.016),the presence of LFFCT in the tumor stroma(P<0.00001),fragmentation of the tumor solid component(P=0.0001),and the absence of tumor spread through the AASs(P=0.0083).CONCLUSION The results obtained confirm the correctness of our previously proposed classification of different types of tumor vessels and may contribute to improving the diagnosis and treatment of LUSC.

伽玛刀立体定向放射治疗肺癌脑转移瘤患者预后不良的影响因素

目的:分析伽玛刀立体定向放射治疗肺癌脑转移瘤患者预后不良的影响因素。方法:回顾性分析2022年1月至2023年1月在该院接受伽马刀立体定向放射治疗的121例肺癌脑转移瘤患者的临床资料。统计伽玛刀立体定向放射治疗肺癌脑转移瘤患者的预后情况,采用Logistic回归分析伽玛刀立体定向放射治疗肺癌脑转移瘤患者预后不良的影响因素。结果:121例伽马刀立体定向放射治疗肺癌脑转移瘤患者预后不良40例,设为预后不良组,预后良好81例,设为预后良好组;预后不良组脑转移瘤最大直径≥3 cm、血清鳞状细胞癌抗原(SCC-Ag)≥3.80 ng/mL、血清细胞角蛋白19片段(CYFRA21-1)≥7.52 ng/mL、血清神经元特异性烯醇化酶(NSE)≥50.81μg/L占比均高于预后良好组,差异有统计学意义(P<0.05);Logistic回归分析结果显示,血清SCC-Ag≥3.80 ng/mL、血清NSE≥50.81μg/L均为伽玛刀立体定向放射治疗肺癌脑转移瘤患者预后不良的危险因素(OR>1,P<0.05)。结论:血清SCC-Ag≥3.80 ng/mL、血清NSE≥50.81μg/L均为伽玛刀立体定向放射治疗肺癌脑转移瘤患者预后不良的危险因素。

Tis~T1期非小细胞肺癌脏层胸膜受累与淋巴结转移的相关性

目的探讨Tis~T1期非小细胞肺癌(NSCLC)脏层胸膜受累情况与淋巴结转移的相关性。方法回顾性分析84例Tis~T1期NSCLC患者的临床资料。所有患者均行肺叶切除术+系统性淋巴结清扫术治疗,术后将病理标本送检,明确患者胸膜脏层浸润(VPI)状态,依据VPI分为分为PL0组与PL1/PL2组。收集两组患者年龄、性别、体质量指数、基础疾病、肿瘤大小、病理类型、肿瘤位置、脉管瘤栓、术前癌胚抗原(CEA)水平、基础疾病及淋巴结转移情况等资料。分析VPI与临床病理特征及淋巴结转移的关系。结果84例患者中18例合并VPI,脏层胸膜受累率为21.43%(18/84);PL1/PL2组肿瘤大小2~3 cm、术前CEA水平≥3.5 ng/L占比高于PL0组,差异有统计学意义(P<0.05);PL1/PL2组淋巴结转移率、N2比率高于PL0组,差异有统计学意义(P<0.05)。结论Tis~T1期NSCLC患者VPI与淋巴结转移存在密切关系,当合并VPI时则需考虑存在淋巴结转移,术中应予以广泛淋巴结清扫,避免术后复发转移。

肺癌组织中GALNT7的表达变化及其临床意义

目的 探讨N-乙酰氨基半乳糖转移酶7(GALNT7)在肺癌组织中的表达及其与临床病理特征和预后的关系。方法 收集2016年2月至2018年2月深圳市龙华区人民医院90例接受手术切除的肺癌患者癌组织及配对癌旁正常组织标本。采用免疫组织化学法检测肺癌组织及癌旁正常组织中GALNT7蛋白表达;采用实时荧光定量PCR(qPCR)检测肺癌组织及癌旁正常组织中GALNT7 mRNA的相对表达水平;分析GALNT7 mRNA表达与肺癌患者的临床病理特征及预后的关系。Kaplan-Meier法分析GALNT7表达与患者生存率之间的关系;Cox比例风险回归模型分析影响患者预后的独立因素。结果 GALNT7蛋白在肺癌组织中的高表达率为55.56%(50/90),显著高于癌旁正常组织中的11.11%(10/90),差异有统计学意义(P<0.05)。肺癌组织的GALNT7 mRNA表达水平为1.51±0.25,显著高于癌旁正常组织(1.02±0.18),差异有统计学意义(P<0.05)。GALNT7 mRNA表达与肿瘤大小、吸烟史、TNM分期、分化程度及淋巴结转移有关(P<0.05)。Kaplan-Meier生存分析显示,GALNT7低表达组患者的5年生存率显著高于高表达组(P<0.05);多因素Cox回归分析显示,淋巴结转移、GALNT7水平是影响肺癌患者预后的独立因素(P<0.05)。结论 GALNT7异常高表达参与肺癌的发生,且有作为肺癌患者预后预测分子标志物的潜力。

血清LncRNA MALAT1和microRNA-124水平检测对非小细胞肺癌患者预后的评估价值

目的:探究长链非编码RNA-转移相关肺腺癌转录本1(LncRNA MALAT1)和微小RNA-124(microRNA-124)对非小细胞肺癌(NSCLC)患者预后的预测效能。方法:选取2020年06月至2022年06月我院收治的124例NSCLC患者作为研究对象,入院后,收集患者的病历资料,检测入院时外周血LncRNA MALAT1、microRNA-124的相对表达量。电话随访12个月记录患者的死亡率,分为生存组和死亡组,分析NSCLC患者预后的影响因素,评估血清LncRNA MALAT1、microRNA-124对NSCLC患者预后的预测效能。结果:死亡组患者的IV期占比及LncRNA MALAT1相对表达量高于生存组,microRNA-124相对表达量低于生存组。Logistic遂步分析显示,病理分期IV期(OR=12.342,95%CI:4.295~36.765)、LncRNA MALAT1(OR=5.371,95%CI:1.836~15.714)及microRNA-124(OR=0.257,95%CI:0.089~0.752)是NSCLC患者死亡的影响因素(P<0.05)。LncRNA MALAT1与microRNA-124呈负相关(P<0.05)。受试者工作特性曲线(ROC)分析显示,LncRNA MALAT1及microRNA-124单一及联合预测NSCLC患者预后的灵敏度分别为0.741(95%CI:0.601~0.846)、0.759(95%CI:0.621~0.861)、0.815(95%CI:0.682~0.903),特异度分别为0.825(95%CI:0.705~0.906)、0.762(95%CI:0.635~0.856)、0.841(95%CI:0.723~0.917),曲线下面积(AUC)分别为0.781、0.760、0.839。联合预测效能更高(P<0.05)。结论:LncRNA MALAT1及microRNA-124可用于预测NSCLC患者的预后,且预测效能良好。

血清钠水平与小细胞肺癌患者的预后关系分析

目的探讨血清钠水平与小细胞肺癌(small cell lung cancer,SCLC)患者预后关系。方法对广西医科大学附属肿瘤医院呼吸肿瘤内科2010年12月~2018年10月收治的166例SCLC患者进行回顾性队列研究。结果单因素Cox比例风险模型显示不同血钠水平、ECOG评分、疾病临床分期、转移灶数目、骨转移、肝转移、疾病缓解是SCLC的不良预后指标(P<0.05)。在完全调整模型中,低钠血症组SCLC患者发生死亡的风险是正常水平组的1.03倍(HR:2.03,95%CI:1.050~3.911,P=0.0347)。结论低钠血症是SCLC患者的独立不良预后因素。

放射治疗在小细胞肺癌卵巢转移中的应用价值

目的探讨放射治疗在小细胞肺癌卵巢转移中的治疗价值。方法回顾报道2例小细胞肺癌卵巢转移进行放射治疗的患者资料,并结合文献报道分析在小细胞肺癌卵巢转移治疗中介入放射治疗的价值。结果2例患者卵巢转移灶经局部放疗均得到持续控制,其中一例完全缓解,局部PFS已达到21月,目前仍处于持续缓解中,较既往文献报道的小细胞肺癌卵巢转移的病例生存期明显延长。结论尽管小细胞肺癌卵巢转移的预后仍然很差,放疗可能是改善这些患者生存时间的系统治疗策略之一。

非小细胞肺癌肝转移预后的列线图构建

目的 分析非小细胞肺癌(NSCLC)肝转移患者的临床特征及预后因素,并构建生存率列线图。方法 收集监测、流行病学和最终结果(SEER)数据库具有完整临床信息的NSCLC患者79 977例,分为肝转移组和非肝转移组,并将肝转移组随机分为训练集与验证集。采用χ^(2)检验比较肝转移组的临床特征;采用Cox回归分析筛选独立预后因素,并用于构建预测1、3年总生存率(OS)和癌症特异性生存率(CSS)的列线图。结果 性别、年龄、原发部位、组织学分类、病理分级、肿瘤直径、T分期、N分期、远处转移、手术、化疗、放疗与肝转移相关(P<0.001)。多因素分析发现,性别、年龄、肿瘤直径、组织学类型、病理分级、原发部位手术、化疗、骨转移、脑转移均是OS和CSS影响的独立危险因素(P<0.05)。受试者工作特征(ROC)曲线和校准曲线显示列线图具有良好的预测性能。基于建立的列线图对患者进行风险分层,低风险组的预后优于高风险组。结论 本研究构建的列线图能较为准确地预测NSCLC肝转移患者的预后情况。

头部伽马刀治疗非小细胞肺癌脑转移的临床效果及预后情况分析

目的 探讨头部伽马刀治疗非小细胞肺癌(NSCLC)脑转移的临床效果及预后相关影响因素。方法 回顾性分析82例NSCLC脑转移患者临床资料。所有患者均行头部伽马刀治疗,术后评价近期疗效,并随访1年,依据患者存活情况分为存活组与死亡组,收集2组年龄、性别、体质量指数、病理类型、原发癌部位、卡氏功能状态(KPS)评分、肺癌分级预后评估系统(GPA)评分、颅外转移、脑转移数目、脑转移瘤最大直径、胸部手术等资料,先开展单因素分析,得到有差异的项目后再行Logistic回归分析,获取影响头部伽马刀治疗NSCLC脑转移预后的独立危险因素。结果 82例NSCLC脑转移患者治疗后完全缓解13例,部分缓解48例,稳定14例,进展7例,总控制率为91.46%(75/82)。随访1年,82例NSCLC脑转移患者共存活39例,存活率为47.56%(39/82);单因素分析显示,年龄、KPS评分、GPA评分、颅外转移、脑转移数目、脑转移瘤最大直径、脑转移位置与头部伽马刀治疗NSCLC脑转移的预后相关,差异有统计学意义(P<0.05);多因素分析显示,≥65岁、KPS评分<70分、GPA评分≤1.5分、有颅外转移、脑转移数目>3个、脑转移瘤最大直径>2 cm为影响头部伽马刀治疗NSCLC脑转移预后的高危因素(P<0.05且OR>1)。结论 头部伽马刀治疗NSCLC脑转移可取得较为理想的近期疗效,但≥65岁、KPS评分<70分、GPA评分≤1.5分、有颅外转移、脑转移数目>3个、脑转移瘤最大直径>2 cm等的NSCLC脑转移患者预后欠佳,临床需针对性开展干预措施,提高整体生存率。

基于MSCT灌注参数的非小细胞肺癌纵隔淋巴结转移的列线图模型的构建与验证

目的:探究基于多层螺旋CT(MSCT)灌注参数构建列线图模型预测非小细胞肺癌(NSCLC)纵隔淋巴结转移的预测价值。方法:纳入2010年1月至2020年1月我院380例NSCLC患者作为建模组,其中纵隔淋巴结转移患者159例,未转移患者221例;另于2020年2月至2023年2月多中心选取120例NSCLC患者作为验证组。比较两组临床资料及MSCT灌注参数,采用Logistic回归分析筛选NSCLC纵隔淋巴结转移的影响因素,构建列线图模型;通过校准曲线、受试者工作特征(ROC)曲线分析该模型的一致性与诊断效能,并进行外部验证。结果:Logistic回归分析结果显示,病理类型(OR=0.730,95%CI=0.567~0.941)、肿瘤直径(OR=12.195,95%CI=3.145~47.289)、肿瘤同侧纵隔淋巴结短径(OR=14.125,95%CI=2.857~69.832)、血清癌胚抗原(CEA)水平(OR=9.814,95%CI=2.415~39.882)、病灶区域血流量(BF)(OR=11.348,95%CI=3.074~41.892)、血容量(BV)(OR=11.456,95%CI=2.895~45.337)、平均通过时间(MTT)(OR=0.456,95%CI=0.274~0.759)、表面通透性(PS)(OR=10.475,95%CI=2.419~45.363)是NSCLC患者纵隔淋巴结转移的独立影响因素(P<0.05);对列线图预测模型进行内部验证与外部验证,模型的一致性指数(C-index)在建模组与验证组分别为0.921、0.918;校准曲线显示该列线图模型预测建模组与验证组NSCLC患者纵隔淋巴结转移风险均具有良好的区分度与精准度;应用ROC曲线分析该列线图模型预测建模组与验证组NSCLC患者纵隔淋巴结转移风险的效率,建模组曲线下面积(AUC)为0.956(95%CI=0.942~0.978),验证组AUC为0.950(95%CI=0.934~0.991)。结论:基于MSCT灌注参数构建NSCLC纵隔淋巴结转移的列线图模型区分度及校准度良好,可实现对NSCLC患者纵隔淋巴结转移的个体化评估。

趋化因子CCL5在非小细胞肺癌中的表达及生物学功能探究

目的探讨CC基序趋化因子配体5(CCL5)在非小细胞肺癌(NSCLC)中的表达情况及临床应用价值。方法收集在徐州医科大学附属宿迁医院首次就诊确诊为NSCLC并行手术治疗的72例患者癌组织、癌旁组织及其临床资料,用免疫组化法检测癌组织及癌旁组织CCL5表达情况;用Realtime PCR检测CCL5mRNA在NSCLC和健康对照者血清中的表达;分析CCL5表达情况与患者临床、病理特征之间的相关性及其对预后影响。体外培养肺腺癌A549细胞,siRNA-CCL5转染细胞,观察下调CCL5表达后细胞增殖、迁移、侵袭能力的变化。结果TCGA数据分析结果显示CCL5mRNA表达水平在肺腺癌和鳞癌中明显增加;免疫组化结果显示CCL5在NSCLC组织表达较癌旁组织明显上调,并且CCL5高表达与NSCLC患者淋巴结转移情况、TNM分期存在正相关(P=0.019,P=0.033);而与患者性别、年龄、病理类型无明显相关性;NSCLC血清中高表达CCL5mRNA,K-M分析结果显示血清CCL5 mRNA表达的上调与患者无进展生存率(PFS)存在明显的相关性;Cox多因素比例风险模型评估提示组织中CCL5高表达与患者预后有相关性;下调CCL5表达后A549细胞增殖受到抑制,侵袭、迁移能力下降。结论CCL5在NSCLC患者中表达水平上调,与淋巴结转移及肿瘤分期存在一定相关性,与NSCLC患者的预后相关,体外干扰CCL5可降低肺腺癌细胞增殖、迁移功能。CCL5可能成为NSCLC治疗的一个靶点。

肺癌脑转移中强调放疗方案及使用剂量对患者预后影响的研究

目的分析肺癌脑转移患者采用不同放疗方案及使用剂量的疗效及其预后不良的影响因素。方法回顾性分析2018年1月至2021年1月衡阳市第三人民医院放疗后61例肺癌脑转移患者临床资料,按照放疗方案不同分为研究组(n=31)与对照组(n=30);对照组采用同期推量放疗,治疗组采用全脑照射,后续辅以三维适形放疗。比较两组临床疗效、住院时间、中位生存期及分析预后不良的影响因素。结果研究组治疗总有效率(93.54%)高于对照组(70.00%),差异有统计学意义(P<0.05)。研究组住院时间短于对照组,且中位生存期长于对照组,差异有统计学意义(P<0.05)。Logistic回归分析显示,脑转移瘤数目、大体肿瘤体积(GTV)体积、合并其他部位转移、放疗方法选择、放疗具体剂量是死亡的影响因素(P<0.05)。结论同期推量放疗法根据对应控制剂量可提高肺癌脑转移患者治疗总有效率、降低患者住院时间,可为患者构建一个治疗周期短、疗效显著的放疗方案,同时,临床应根据预后不良影响因素制订相应措施,以改善预后。