Development and Application of Procedures for the Management of Skin Toxicity Related to Immune Checkpoint Inhibitors in Patients with Lung Cancer

Objective: To establish the procedures for the management of skin toxicity related to immune checkpoint inhibitors in patients with lung cancer and explore the effect of application. Methods: A total of 24 evidence-based evidences were collected from 7 aspects, including risk factors, baseline screening, ICIs monitoring, daily skin care, multidisciplinary management, symptom management and health education. A total of 157 lung cancer patients and 94 nurses from 8 wards of the Oncology department of our hospital from November 2022 to May 2023 were selected by convenience sampling. A total of 77 patients and 46 nurses from ward 1 - 4 were divided into the baseline group. There were 80 patients and 48 nurses in Ward 5 - 8 as the evidence-based practice group. In the baseline group, patients were treated with routine methods such as assessing skin symptoms, taking medication according to symptoms, guiding to keep skin clean and moist, eating a light diet, and avoiding scratching. The evidence-based practice group adopts an evidence-based continuous improvement model for nursing. The differences in the severity of symptoms of skin toxicity in the second cycle of medication and the knowledge and practice of self-care of skin toxicity were compared between the two groups before and after the use of the syndrome, as well as the differences in the implementation rate of review indicators, evidence-based ability and knowledge and practice of skin toxicity care before and after the use of the syndrome. Results: The incidence and severity of cutaneous toxicity were significantly lower after treatment than before treatment (P P < 0.05). Conclusion: The implementation of immune checkpoint inhibitor-related skin toxicity management procedures can effectively reduce the incidence and severity of skin toxicity symptoms, optimize the clinical pathway, and improve the quality of care.

Association between DNA mismatch repair gene polymorphisms and platinum-based chemotherapy toxicity in non-small cell lung cancer patients

Background:Chemotherapy toxicity is a serious problem from which non-small cell lung cancer(NSCLC) patients suffer.The mismatch repair(MMR) system is associated with platinum-based chemotherapy toxicity in NSCLC patients.In this study,we aimed to investigate the relationship between genetic polymorphisms in the MMR pathway and platinum-based chemotherapy toxicity in NSCLC patients.Methods:A total of 220 Chinese lung cancer patients who received at least two cycles of platinum-based chemotherapy were recruited for this study.Toxicity was evaluated in each patient after two cycles of chemotherapy.A total of 44 single nucleotide polymorphisms were selected to investigate their associations with platinum-based chemotherapy toxicity.Results:MutS homolog 2[MSH2) rs6544991[odds ratio(OR) 2.98,95%confidence interval(CI) 1.20-7.40,P = 0.019]was associated with gastrointestinal toxicity in the dominant model;MSH3 rs6151627(OR 2.38,95%CI 1.23-4.60,P = 0.010),rs6151670(OR 2.05,95%CI 1.07-3.93,P = 0.031),and rs7709909(OR 2.38,95%CI 1.23-4.64,P = 0.010)were associated with hematologic toxicity in the dominant model.Additionally,MSH5 rs805304 was significantly associated with overall toxicity(OR 2.21,95%CI 1.19-4.09,P = 0.012),and M5H5 rs707939 was significantly associated with both overall toxicity(OR 0.42,95%CI 0.23-0.76,P = 0.004) and gastrointestinal toxicity(OR 0.44,95%CI 0.20-0.96,P = 0.038) in the dominant model.Conclusion:Genetic polymorphisms in the MMR pathway are potential clinical markers for predicting chemotherapy toxicity in NSCLC patients.

Comparison of Stereotactic Body Radiotherapy Delivery Techniques for Early-Stage Lung Cancer Using Lung Toxicity Modeling

Purpose: Lung toxicity is a primary side effect in stereotactic radiotherapy (SBRT) for early-stage non-small cell lung cancer (NSCLC). We aimed to use a set of radiobiological models to evaluate and compare modern IMRT delivery techniques with three-dimensional conformal techniques for SBRT treatment of NSCLC in terms of lung toxicity, and aimed to compare the results from different radiobiologcal models. Methods: Ten early-stage NSCLC patients treated with SBRT were retrospectively selected. Five treatment plans were generated to deliver 50 Gy in five fractions to the planning target volume for each case: a helical tomotherapy (HT) plan, two three-dimensional cofnromal radiotherapy (3D-CRT) plans using 6-MV and 10-MV photon beams respectively, and two volumetric modulated arc therapy (VMAT) plans using one and two arc fields respectively. The lung RDV was calculated with three parallel functional sub-unit (FSU) models and two normal tissue complication probability (NTCP) models. Results: Both the HT and VMAT plans showed significantly higher contralateral mean lung dose and lower ipsilateral mean lung dose compared to the 3D-CRT plans. There was no statistically significant difference in terms of lung toxicities between the IMRT and 3D-CRT techniques using either the FSU models or the NTCP models. Based on both the FSU and the NTCP models, there was strong correlation between lung toxicity and the mean lung dose in SBRT treatment plans. Conclusions: Based on both the NTCP and parallel FSU models, both IMRT and traditional 3D-CRT delivery techniques could achieve comparable lung sparing inn SBRT treatment of early-stage lung cancer. However, the validity of the radiobiological model results should be checked by clinical data.

Association between Subjective Evaluation of Skin Toxicities and Quality of Life in Patients with Lung Cancer Undergoing Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitor Treatment: A Pilot Study for Developing Skin Toxicity Assessment

Purposes: Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) exert satisfactory therapeutic effects in lung cancer patients. However, the resultant skin toxicity can deteriorate patients’ quality of life (QoL). Differences exist in skin toxicity evaluation between patients and clinicians. We aimed to clarify the association between the subjective evaluation of skin toxicities and QoL in lung cancer patients and to establish a document of scale development in the subjective evaluation of skin toxicity. Methods: We used self-administered questionnaires to evaluate 12 lung cancer patients receiving EGFR-TKI treatment. Indices of QoL were generated using the Functional Assessment of Cancer Therapy-Lung and Hospital Anxiety and Depression Scale, and a subjective evaluation questionnaire concerning skin toxicity was completed. The data were collected immediately before treatment initiation and at 4 weeks post treatment. Results: In the subjective evaluation of skin toxicity, four patients (33.3%) were classified as ≥Grade 2 (painful group), experiencing painful pruritus at the emergence site of the skin rash or xerosis. In this group, the QoL scores of physical and emotional aspects declined after treatment. Conversely, patients in the painless group (Grade 0 - 1) demonstrated an improved emotional QoL following treatment (p = 0.028). Conclusions: Lung cancer patients suffering from painful skin toxicity tended to show a decline in the physical and emotional aspects of QoL following EGFR-TKI treatment. The skin toxicity questionnaire was useful from the point of view of a subjective evaluation and could be a powerful assessment tool in future clinical settings with further modification.

Lung Single-Cell Transcriptomics Offers Insights into the Pulmonary Interstitial Toxicity Caused by Silica Nanoparticles

The adverse respiratory outcomes motivated by silica nanoparticles(SiNPs)exposure have received increasing attention.Herein,we aim to elucidate the interplay of diverse cell populations in the lungs and key contributors in triggering lung injuries caused by SiNPs.We conducted a subchronic respiratory exposure model of SiNPs via intratracheal instillation in Wistar rats,where rats were administered with 1.5,3.0,or 6.0 mg/kg body weight SiNPs once a week for 12 times in total.We revealed that SiNPs caused pulmonary interstitial injury in rats by histopatho-logical examination and pulmonary hydroxyproline determination.Further,a single-cell RNA-Seq via screening 10457 cells in the rat lungs disclosed cell-specific responses to SiNPs and cell-to-cell interactions within the alveolar macrophages,epithelial cells,and fibroblasts from rat lungs.These disturbed responses were principally related to the dysregulation of protein homeostasis(proteostasis),accompanied by an inflammatory response in macrophages,cell death in epithelial,proliferation,and extracellular matrix deposition in fibroblast.These cell-specific responses may serve a synergistic role in the pathogenesis of pulmonary interstitial disease triggered by SiNPs.In particular,the analyses of gene interaction networks and gene−disease associations filtered out heat shock proteins(Hsps)family genes crucial to the observed pulmonary lesions caused by SiNPs.Of note,both GEO database analysis and our experiments’validation indicated that Hsps,especially Hspd1,may be a key contributor to pulmonary interstitial injury,possibly through triggering oxidative stress,immune response,and disrupting protein homeostasis.Taken together,our study provides insights into pulmonary toxic effects and underlying molecular mechanisms of SiNPs from a single-cell perspective.

Sesamol Alleviates the Cytotoxic Effect of Cyclophosphamide on Normal Human Lung WI-38 Cells via Suppressing RAGE/NF-κB/Autophagy Signaling

Cyclophosphamide(CYL)is a chemotherapeutic medication commonly used in managing various malignancies like breast cancer or leukemia.Though,CYL has been documented to induce lung toxicity.Mechanism of CYL toxicity is through oxidative stress and the release of damage-associated molecular patterns(DAMPs).Sesamol(SES)is a natural antioxidant isolated from Sesamum indicum and its effect against CYL-induced lung toxicity is not studied yet.This study aims to inves-tigate whether SES could prevent any deleterious effects induced by CYL on lung using normal human lung cells,WI-38 cell line,without suppressing its efficacy.Cells were pretreated with SES and/or CYL for 24 h,then cell viability was estimated by MTS and trypan blue assays.The mode of cell death was determined by AO/EB staining.Additionally,caspase-3 level,oxidative stress,and inflammatory markers were evaluated by colorimetric and ELISA techniques.qRT-PCR was performed to evaluate RAGE,NF-κB,and Beclin-1 mRNA-expression.CYL-treated WI-38 cells developed a significantly increased cell death with enhanced oxidative and RAGE/NF-κb/Autophagy signaling,which were all attenuated after pretreatment with SES.Thus,we concluded that SES offered a protective role against CYL-induced lung injury via suppressing oxidative stress and RAGE/NF-κB/Autophagy signaling,which is a natural safe therapeutic option against CYL toxicities.

Successful treatment after toxic epidermal necrolysis induced by AZD-9291 in a patient with non-small cell lung cancer:A case report

BACKGROUND Toxic epidermal necrolysis and Stevens-Johnson syndrome are acute lifethreatening skin reactions.AZD9291 has been developed as a third-generation epidermal growth factor receptor(EGFR)-tyrosine kinase inhibitor(TKI)with activity against T790M mutation.CASE SUMMARY Herein we report a 68-year-old woman who developed a large area of skin necrosis and was diagnosed with toxic epidermal necrolysis after AZD-9291 ingestion.To the best of our knowledge,this is the first case reported in patients with EGFR T790M mutation in non-small cell lung cancer(NSCLC).Cabozantinib combined with erlotinib had clinically meaningful effectiveness,with additional toxicity that was generally manageable.CONCLUSION Treatment with AZD-9261 is effective in regressing the growth of the NSCLC and can bring some hope to despairing patients.We hope that more research will be carried out on the association between severe rashes and EGFR-TKIs,and more safe and effective drugs can be developed.

Sirolimus-related pulmonary toxicity mimicking 'asthma like' symptoms

Sirolimus is an immunosuppressant with expanding use in pediatric organ transplantation, dermatology and rheumatology. We report two cases of children who developed asthma like symptoms and were diagnosed with interstitial lung disease, which responded to discontinuation of sirolimus. Pediatricians should be aware about the pulmonary side effects of sirolimus.

Toxic epidermal necrolysis related to AP(pemetrexed plus cisplatin)and gefitinib combination therapy in a patient with metastatic non-small cell lung cancer

Toxic epidermal necrolysis(TEN) is a rare acute life-threatening mucocutaneous disorder that is mostly drug-related(80%-95%). It is clinically characterized as a widespread sloughing of the skin and mucosa. AP regimen(pemetrexed plus cisplatin) has been the preferred first-line chemotherapy for metastatic non-squamous non-small cell lung cancer(NSCLC). Gefitinib, a small-molecule epidermal growth factor receptor(EGFR) tyrosine kinase inhibitor(TKI), has already been recommended as a first-line treatment in EGFR-mutant metastatic NSCLC. We report rare presentation of TEN involving adverse effects of AP and gefitinib combination treatment in a 42-year-old woman diagnosed with metastatic NSCLC harboring an EGFR mutation. On the 21 st day after administration of the first cycle of AP regimen and the 8th day after the initiation of gefitinib treatment, she developed an acne-like rash, oral ulcer, and conjunctivitis, which later became blisters and ultimately denuded. The characteristic clinical courses were decisive for the diagnosis of TEN. Treatment with systemic steroids and immunoglobulin as well as supportive treatment led to an improvement of her general condition and a remarkable recovery.

Intratracheally Administered Liposomal α-Tocopherol Protects the Lung against Long-Term Toxic Effects of Paraquat

Paraquat is a broad-spectrum herbicide known to produce lung injury via oxidative stress-mediated mechanisms. Different pharmacological strategies have been explored to reduce the formation of these reactive oxygen species and/or prevent their toxic effects in the treatment of paraquat poisoning. The present study was carried out to investigate whether the antioxidant (L-tocopherol, incorporated into liposomes and delivered directly to the lungs of rats, could protect the organ against the long-term toxic effects of paraquat.Plain liposomes (composed of dipalmitoylphosphatidylcholine, DPPC) or α-tocopherol liposomes (8 mg α-tocopherol/kg body weight) were administered intratracheally to animals 24 h prior to an intraperitoneal injection of paraquat dichloride (20 mg/kg) and rats wefe killed 0, 1, 4, 6, 8, 10, 12, 16, 19 or 24 days after paraquat treatment. Results of this study showed that lungs of animals treated with paraquat were extensively damaged,as evidenced by significant increases in lung weight and decreases in lung angiotensin converting enzyme (ACE) and alkaline phosphatase enzyme (AKP) activities. Moreover,paraquat treatme; resulted in a significant reduction in the number of neutrophils in the blood of rats with a concurrent increase in the pulmonary myeloperoxidase activity,suggestive of neutrophil infiltration in the lungs of treated animals. Pretreatment of rats with liposomes alone did not significantly alter the paraquat-induced changes of all parameters examined. On the other hand, pretreatment of rats with (t-tocopherol liposomes,24 h prior to paraquat challenge, attenuated paraquat-induced changes in ACE, AKP and myeloperoxidase activities but failed to prevent increases in lung weight. Thus, pretreatment of rats with liposome-associated α-tocopherol appears to protect the lung against some of the toxic effects of paraquat

Predictive Factors of Severe Toxicities of Pemetrexed-Containing Chemotherapy in Patients with Non-Squamous Non-Small Cell Lung Cancer

Background: Pemetrexed (PEM) is an efficacious multi-targeted antifolate with acceptable toxicities for non-squamous non-small cell lung cancer (non-Sq NSCLC). However, in the clinical setting, PEM has more severe adverse effects than those reported. The aim of this study was to identify the factors for the toxicities of PEM-containing chemotherapy in non-Sq NSCLC patients in the clinical setting. Patients and Methods: We retrospectively evaluated the factors related to PEM toxicities in chemotherapy-naive patients with non-Sq NSCLC from September 2009 to July 2013 at our hospital. Logistic regression model was used in the univariate and multivariate analyses. Results: In total, 104 patients were analyzed. Grades 3 to 5 hematologic toxicities were frequent and included neutropenia (42%), febrile neutropenia (7%), anemia (18%), thrombocytopenia (17%), and disseminated intravascular coagulation (2%). On multivariate analyses, the predictors were poor performance status (PS) [odds ratio (OR): 4.89, 95% confidence interval (CI): 1.22 - 19.4] and low body mass index (OR: 1.44, 95% CI: 1.05 - 1.98) for febrile neutropenia;concomitant chronic infectious disease (OR: 6.63, 95% CI: 1.59 - 27.5) and bevacizumab use (OR: 3.57, 95% CI: 1.36 - 9.32) for neutropenia;poor PS (OR: 3.02, 95% CI: 1.33 - 6.85) for thrombocytopenia;and low serum albumin level (OR: 0.22, 95% CI: 0.08 - 0.63) for non-hematologic toxicities. Conclusions: In addition to the previously reported predictors of PEM toxicities, the presence of concomitant chronic infectious disease was associated with hematologic toxicities. Patient groups who are not sufficiently evaluated in clinical trials should be carefully monitored for the development of more toxicities than expected.

维得利珠单抗相关肺毒性1例并文献分析

目的介绍1例维得利珠单抗(VDZ)致间质性肺炎的病例,汇总分析该药相关肺毒性的发生特点,为临床安全用药提供参考。方法从临床药师角度出发,回顾性分析1例VDZ致间质性肺炎患者的诊治过程,并进行不良反应相关性分析;检索中国知网、维普网、PubMed、Web of Science等中英文数据库,对VDZ相关肺毒性的病例报道进行汇总分析。结果该患者在使用VDZ期间发生间质性肺炎,予抗菌药物经验性抗感染治疗无改善;停用VDZ并予甲泼尼龙治疗后,患者的症状及影像学检查均有改善但仍提示间质性肺炎。经Naranjo's不良反应评估量表评估并根据我国《药品不良反应报告和监测工作手册》判断,VDZ与间质性肺炎的关联性均为“很可能”。文献分析结果显示,纳入的29例患者(含本文报道的患者)中,男性19例、女性10例,平均年龄(49.24±17.06)岁;肺毒性主要包括VDZ相关性肺炎、嗜酸性粒细胞肺炎、肺肉芽肿或坏死性结节、间质性肺损伤等,多发生在用药后24周以内(58.62%),主要临床表现为咳嗽、呼吸困难、发热等;绝大多数患者经停药和/或给予糖皮质激素等治疗后好转或康复,1例患者因呼吸衰竭死亡。结论肺毒性为VDZ较罕见的不良反应,起病隐匿且症状无特异性。一旦患者出现咳嗽、呼吸困难等症状,临床应早期判断、及时停药,并给予糖皮质激素等对症治疗,以保障患者用药安全。

经支气管等动脉化疗栓塞对70岁以上非手术老年肺癌患者的效果

目的:探讨经支气管等动脉化疗栓塞对70岁以上非手术老年肺癌患者的效果。方法:回顾性分析2021年11月—2023年6月海军安庆医院介入与血管外科收治的84例70岁以上非手术老年肺癌患者的临床资料,根据患者的治疗方式分为对照组40例和试验组44例。对照组患者接受静脉化疗,试验组患者接受经支气管等动脉化疗栓塞治疗。比较两组患者治疗效果、治疗前后肺功能、肿瘤因子水平及毒副反应发生情况。结果:试验组患者疾病控制率(DCR)高于对照组,差异有统计学意义(P<0.05)。治疗后,试验组患者肺功能情况优于对照组,差异有统计学意义(P<0.05)。治疗后,试验组患者癌胚抗原(CEA)、糖类抗原125(CA125)及细胞角蛋白19的可溶性片段(CYFRA21-1)水平低于对照组,差异有统计学意义(P<0.05)。试验组患者毒副反应发生率低于对照组,差异有统计学意义(P<0.05)。结论:经支气管等动脉化疗栓塞治疗70岁以上非手术老年肺癌的疗效优于静脉化疗,可使患者的肺功能得到有效改善,降低患者机体肿瘤因子水平,同时可减轻治疗产生的毒副反应。

清火消痈汤治疗心肝火旺及热毒内蕴型肺痈临床观察

目的研究清火消痈汤治疗心肝火旺及热毒内蕴型肺痈的临床价值。方法以2021年1月—2021年12月为研究周期,抽取研究对象72例,采用随机数字表法分为研究组、对照组,各36例;对照组予西药治疗,研究组予清火消痈汤治疗,对比两组呼吸功能指标和中医证候积分。结果治疗后,研究组二氧化碳分压(PaCO_(2))水平为(41.42±3.75)mm Hg(1 mm Hg≈0.133 kPa),低于对照组的(47.59±5.88)mm Hg(P<0.05);氧分压(PaO_(2))水平为(82.99±6.75)mm Hg,高于对照组的(73.26±2.48)mm Hg(P<0.05)。治疗后,研究组主证积分为(2.44±0.68)分、次证积分为(0.65±0.11)分、总积分为(3.12±0.64)分,均低于对照组的(5.29±1.05)分、(1.89±0.62)分、(7.28±1.75)分(P<0.05)。结论清火消痈汤治疗肺痈效果显著。

Mechanisms of Lung Cancer Caused By Cooking Fumes Exposure： A Minor Review

Cooking fumes （CFs） are mixtures of many toxic components, such as aldehydes, heterocyclic amines, polycyclic aromatic hydrocarbons, fat aerosols and particulate matters. CFs exposure has been proven to be associated with many diseases. Lung cancer takes the leading place among the diseases being reported caused by CFs exposure. Molecular and biochemical studies have found that CFs exposure may lead to lung cancer by gene damage, formation of reactive oxygen species, blockage of related proteins’ function, and even cell death. However, reviews about the mechanisms of how CFs exposure leads to lung cancer are still lacking. Elucidation of the mechanisms of lung cancer caused by CFs exposure may provide a new insight into the prevention of lung cancer caused by CFs exposure, as well as laying the foundation for the toxicity study of CFs. In this minor review, the mechanisms of how CFs exposure leads to lung cancer were summarized and discussed.

宣肺败毒方治疗新冠病毒感染的中医学理论探讨及现代药理研究进展

目的探讨宣肺败毒方治疗新型冠状病毒感染的中医学理论,归纳该方的药理实验研究进展,为扩展该方的临床应用和进一步的实验研究提供参考。方法采用理论研究与文献调研相结合的方法,探讨宣肺败毒方的中医学理论和药理学进展,归纳该方的实验研究。结果宣肺败毒方适用于湿毒郁肺的患者,宣肺败毒方可通过PD-1/IL17A、IL-6/STAT3及CXCL2/CXCR2等通路改善肺损伤,以及NF-κB通路减轻肠道疾病。结论宣肺败毒方是中药和科技结合的产物,既有充分的中医药理论支撑,亦有足够的现代药理实验研究证据支持。

替雷利珠联合化疗治疗非小细胞肺癌手术患者的效果

目的评价替雷利珠单抗在含铂双药化疗治疗的非小细胞肺癌手术患者中的应用效果。方法选取2022年1月—2023年12月收治的100例拟行手术治疗的非小细胞肺癌患者,根据随机数字表法将其分成两组。对照组50例患者在术前给予含铂双药治疗,观察组50例患者在其治疗基础上加用替雷利珠单抗治疗。比较两组临床疗效、无事件及无疾病生存率、生活质量改善情况、不良反应。结果观察组临床疗效(完全缓解率:20.00%vs.10.00%)及病理评估(主要病理学缓解率:46.00%vs.20.00%)优于对照组(Z=3.484,P<0.001;χ^(2)=7.664,P=0.006);Kaplan-Meier生存分析显示,观察组无事件生存率(84.00%vs.60.00%)及无疾病生存率(78.00%vs.60.00%)均高于对照组(χ^(2)=4.298,P=0.038;χ^(2)=4.783,P=0.029);在生活质量改善率方面,观察组(64.00%)较对照组高(42.00%),差异有统计学意义(χ^(2)=4.857,P=0.028);两组不良反应发生率(18.00%vs.22.00%)比较,差异无统计学意义(χ^(2)=0.250,P=0.617)。结论在含铂双药化疗治疗非小细胞肺癌手术患者中的实施替雷利珠单抗治疗可提高治疗效果,促进生活质量改善,且不会增加不良反应发生风险。

非小细胞肺癌患者经帕博利珠单抗治疗后发生内分泌毒性的影响因素研究

目的探讨帕博利珠单抗治疗非小细胞肺癌(non-small cell lung cancer,NSCLC)患者后发生内分泌毒性的影响因素。方法选择2020年1月1日~2022年12月31日期间于晋城市第二人民医院住院,并接受过至少1个疗程帕博利珠单抗治疗的原发性NSCLC的连续病例作为研究对象,收集患者临床资料,以是否发生帕博利珠单抗相关内分泌毒性的患者进行分组,发生内分泌毒性的作为病例组,以未发生内分泌毒性的患者作为对照组,采用单因素和多因素Logistic回归分析评估帕博利珠单抗治疗NSCLC患者后发生内分泌毒性的危险因素。结果本研究共纳入了153例,其中72例(47.06%)出现不同级别的内分泌毒性,单因素分析结果显示两组在年龄、治疗前PD-L1表达、疗程、化疗、靶向药物治疗、化疗+靶向药物方面有显著差异(P<0.05)。多因素Logistic回归分析显示,疗程、治疗前PD-L1低表达、靶向药物、化疗及化疗+靶向药物是发生帕博利珠单抗内分泌毒性的危险因素。结论患者疗程、治疗前PD-L1低表达、靶向药物、化疗及化疗+靶向药物是NSCLC患者接受帕博利珠单抗治疗后发生内分泌毒性的危险因素。

经济毒性在晚期肺癌病人症状负担与失志综合征中的中介效应

目的:探讨经济毒性在晚期肺癌病人症状负担与失志综合征中的中介作用。方法:采用便利抽样法选取2022年2月-2023年2月在郑州市某三级甲等医院住院的292例晚期肺癌病人作为研究对象,采用一般资料调查表、癌症病人报告结局的经济毒性量表、安德森症状量表、简化版失志量表进行问卷调查。应用SPSS 26.0软件及AMOS 28.0软件进行统计分析。结果:晚期肺癌病人经济毒性总分为(11.66±4.35)分,症状严重程度总分为(123.14±14.23)分,症状困扰程度总分为(37.96±6.31)分,失志综合征总分为(18.73±5.11)分;Pearson相关分析显示,经济毒性总分与症状严重程度、症状困扰程度及失志综合征得分均呈负相关(r值分别为-0.601,-0.537,-0.578,P<0.01),失志综合征得分与症状严重程度及症状困扰程度得分均呈正相关(r值分别为0.502,0.538,P<0.01)。Bootstrap法显示,经济毒性在症状负担与失志综合征间起部分中介作用,经济毒性在症状严重程度与失志综合征间的间接效应占总效应的33.15%。经济毒性在症状困扰程度与失志综合征间的间接效应占总效应的35.26%。结论:晚期肺癌病人经济毒性在症状负担与失志综合征间起部分中介作用,医护人员应为病人提供全面支持,降低其经济毒性,进而降低其失志水平。

信迪利单抗注射液辅助化疗治疗非小细胞肺癌的疗效观察

目的 研究信迪利单抗注射液辅助化疗治疗非小细胞肺癌对血清肿瘤标志物和外周血Th17/Treg的影响。方法 选取天长市中医院肿瘤二科2020年1月至2023年1月收治的60例非小细胞肺癌患者,采用随机数字表法将患者分为接受常规化疗的对照组(30例)与接受信迪利单抗注射液辅助化疗治疗的观察组(30例)。比较两组疗效、血清肿瘤标志物、外周血Th17、Treg细胞水平以及毒副反应。结果 观察组总有效率高于对照组,差异有统计学意义(t=4.286,P<0.05)。治疗后两组癌胚抗原(CEA)、糖类抗原125(CA125)以及细胞角蛋白19片段抗原(CYFRA21-1)水平均显著低于治疗前,且治疗后观察组CEA、CA125及CYFRA21-1水平均显著低于对照组,差异有统计学意义(t=6.042、25.734、7.842,P<0.05)。治疗后两组Th17、Treg水平显著低于治疗前,且治疗后观察组Th17、Treg水平显著低于对照组,差异有统计学意义(t=7.216、4.426,P<0.05)。观察组各项发生率均高于对照组,但其中骨髓抑制、发热、肝功能异常以及腹泻差异均无统计学意义(t=0.659、0.884、1.832、0.480,P>0.05),观察组皮疹发生率显著高于对照组,差异有统计学意义(t=4.800,P<0.05)。结论 采用信迪利单抗注射液辅助化疗治疗非小细胞肺癌效果确切,可调节患者肿瘤标志物以及T淋巴细胞功能,但其毒副反应情况还需进一步研究。