Deep learning model based on primary tumor to predict lymph node status in clinical stage IA lung adenocarcinoma:a multicenter study

Objective:To develop a deep learning model to predict lymph node(LN)status in clinical stage IA lung adeno-carcinoma patients.Methods:This diagnostic study included 1,009 patients with pathologically confirmed clinical stage T1N0M0 lung adenocarcinoma from two independent datasets(699 from Cancer Hospital of Chinese Academy of Medical Sciences and 310 from PLA General Hospital)between January 2005 and December 2019.The Cancer Hospital dataset was randomly split into a training cohort(559 patients)and a validation cohort(140 patients)to train and tune a deep learning model based on a deep residual network(ResNet).The PLA Hospital dataset was used as a testing cohort to evaluate the generalization ability of the model.Thoracic radiologists manually segmented tumors and interpreted high-resolution computed tomography(HRCT)features for the model.The predictive performance was assessed by area under the curves(AUCs),accuracy,precision,recall,and F1 score.Subgroup analysis was performed to evaluate the potential bias of the study population.Results:A total of 1,009 patients were included in this study;409(40.5%)were male and 600(59.5%)were female.The median age was 57.0 years(inter-quartile range,IQR:50.0-64.0).The deep learning model achieved AUCs of 0.906(95%CI:0.873-0.938)and 0.893(95%CI:0.857-0.930)for predicting pN0 disease in the testing cohort and a non-pure ground glass nodule(non-pGGN)testing cohort,respectively.No significant difference was detected between the testing cohort and the non-pGGN testing cohort(P=0.622).The precisions of this model for predicting pN0 disease were 0.979(95%CI:0.963-0.995)and 0.983(95%CI:0.967-0.998)in the testing cohort and the non-pGGN testing cohort,respectively.The deep learning model achieved AUCs of 0.848(95%CI:0.798-0.898)and 0.831(95%CI:0.776-0.887)for predicting pN2 disease in the testing cohort and the non-pGGN testing cohort,respectively.No significant difference was detected between the testing cohort and the non-pGGN testing cohort(P=0.657).The recalls of this model for predicting pN2 disease were 0.903(95%CI:0.870-0.936)and 0.931(95%CI:0.901-0.961)in the testing cohort and the non-pGGN testing cohort,respectively.Conclusions:The superior performance of the deep learning model will help to target the extension of lymph node dissection and reduce the ineffective lymph node dissection in early-stage lung adenocarcinoma patients.

A novel recurrence-associated metabolic prognostic model for risk stratification and therapeutic response prediction in patients with stage Ⅰ lung adenocarcinoma

Objective:The proportion of patients with stageⅠlung adenocarcinoma(LUAD)has dramatically increased with the prevalence of low-dose computed tomography use for screening.Up to 30%of patients with stageⅠLUAD experience recurrence within 5 years after curative surgery.A robust risk stratification tool is urgently needed to identify patients who might benefit from adjuvant treatment.Methods:In this first investigation of the relationship between metabolic reprogramming and recurrence in stageⅠLUAD,we developed a recurrence-associated metabolic signature(RAMS).This RAMS was based on metabolism-associated genes to predict cancer relapse and overall prognoses of patients with stageⅠLUAD.The clinical significance and immune landscapes of the signature were comprehensively analyzed.Results:Based on a gene expression profile from the GSE31210 database,functional enrichment analysis revealed a significant difference in metabolic reprogramming that distinguished patients with stageⅠLUAD with relapse from those without relapse.We then identified a metabolic signature(i.e.,RAMS)represented by 2 genes(ACADM and RPS8)significantly related to recurrence-free survival and overall survival times of patients with stageⅠLUAD using transcriptome data analysis of a training set.The training set was well validated in a test set.The discriminatory power of the 2 gene metabolic signature was further validated using protein values in an additional independent cohort.The results indicated a clear association between a high risk score and a very poor patient prognosis.Stratification analysis and multivariate Cox regression analysis showed that the RAMS was an independent prognostic factor.We also found that the risk score was positively correlated with inflammatory response,the antigen-presenting process,and the expression levels of many immunosuppressive checkpoint molecules(e.g.,PD-L1,PD-L2,B7-H3,galectin-9,and FGL-1).These results suggested that high risk patients had immune response suppression.Further analysis revealed that anti-PD-1/PD-L1 immunotherapy did not have significant benefits for high risk patients.However,the patients could respond better to chemotherapy.Conclusions:This study is the first to highlight the relationship between metabolic reprogramming and recurrence in stageⅠLUAD,and is the first to also develop a clinically feasible signature.This signature may be a powerful prognostic tool and help further optimize the cancer therapy paradigm.

Effect of TCM Combined with Chemotherapy on Immune Function and Quality of Life of Patients with Non-small Cell Lung Cancer inStage Ⅲ-Ⅳ

Objective: To observe and compare the effect of traditional Chinese medicine (TCM) combined with chemotherapy (CT) on immune function and quality of life (QOL)of patients with non-small cell lung cancer (NSCLC) in stage Ⅲ-Ⅳ. Methods: One hundred cases with stage Ⅲ-Ⅳ NSCLC were randomly divided into two groups. The treated group (n=50) received CT combined with TCM, and the control group received CT alone. The percentage of T lymphocyte subset in peripheral blood and the change of natural killer (NK) cell count were observed after treatment. The QOL and tolerance of CT were also compared between the two groups after treatment. Results: In the treated group, CD3 cell count, CD4 cell count, CD4/ CDg ratio and NK cell activity were higher than those in control group, while CD8 cell count in the treated group was lower than that in the control group (P<0.05), and QOL and tolerance of CT in the treated group were also better (P<0.05). Conclusion: TCM combined with CT could raise the patients' ability in tolerating CT in stage Ⅲ-ⅣNSCLC.

Unresectable stage Ⅲ non-small-cell lung cancer: Have we made any progress?

Lung cancer is responsible for the most cancer deaths worldwide with an incidence that is still rising. One third of patients have unresectable stage ⅢA or stage ⅢB disease. The standard of care for locally advanceddisease in patients with good performance status consists of combined modality therapy in particular concurrent chemoradiotherapy. But despite a lot of efforts done in the past, local control and survival of patients with unresectable stage Ⅲ non-small-cell lung cancer(NSCLC) remains poor. Improving outcomes for patients with unresectable stage Ⅲ NSCLC has therefore been an area of ongoing research. Research has focused on improving systemic therapy, improving radiation therapy or adding a maintenance therapy to consolidate the initial therapy. Also implementation of newer targeted therapies and immunotherapy has been investigated as well as the option of prophylactic cranial irradiation. This article reviews the latest literature on improving local control and preventing distant metastases. It seems that we have reached a plateau with conventional chemotherapy. Radiotherapy dose escalation did not improve outcome although increasing radiation dose-intensity with new radiotherapy techniques and the use of newer agents, e.g., immunotherapy might be promising. In the future well-designed clinical trials are necessary to prove those promising results.

Number of involved nodal stations: a better lymph node classification for clinical stage IA lung adenocarcinoma

Background:With the popularization of lung cancer screening,more early-stage lung cancers are being detected.This study aims to compare three types of N classifications,including location-based N classification(pathologic nodal classification[pN]),the number of lymph node stations(nS)-based N classification(nS classification),and the combined approach proposed by the International Association for the Study of Lung Cancer(IASLC)which incorporates both pN and nS classification to determine if the nS classification is more appropriate for early-stage lung cancer.Methods:We retrospectively reviewed the clinical data of lung cancer patients treated at the Cancer Hospital,Chinese Academy of Medical Sciences between 2005 and 2018.Inclusion criteria was clinical stage IA lung adenocarcinoma patients who underwent resection during this period.Sub-analyses were performed for the three types of N classifications.The optimal cutoffvalues for nS classification were determined with X-tile software.Kaplan‒Meier and multivariate Cox analyses were performed to assess the prognostic significance of the different N classifications.The prediction performance among the three types of N classifications was compared using the concordance index(C-index)and decision curve analysis(DCA).Results:Of the 669 patients evaluated,534 had pathological stage N0 disease(79.8%),82 had N1 disease(12.3%)and 53 had N2 disease(7.9%).Multivariate Cox analysis indicated that all three types of N classifications were independent prognostic factors for prognosis(all P<0.001).However,the prognosis overlaps between pN(N1 and N2,P=0.052)and IASLC-proposed N classification(N1b and N2a1[P=0.407],N2a1 and N2a2[P=0.364],and N2a2 and N2b[P=0.779]),except for nS classification subgroups(nS0 and nS1[P<0.001]and nS1 and nS>1[P=0.006]).There was no significant difference in the C-index values between the three N classifications(P=0.370).The DCA results demonstrated that the nS classification provided greater clinical utility.Conclusion:The nS classification might be a better choice for nodal classification in clinical stage IA lung adeno-carcinoma.

Ⅲ_a期非小细胞肺癌术后辅助放疗开始时间对远期生存的影响

目的:分析Ⅲ_a期非小细胞肺癌术后辅助放疗开始时间与手术间隔的时间对患者远期生存的影响。方法:回顾性分析我院收治的42例Ⅲ_a期非小细胞肺癌术后放疗患者的临床资料,其中卡氏评分60～90分;男性22例,女性20例;年龄30～74岁,中位年龄55岁;鳞癌13例,腺癌23例,其它6例;切缘阳性17例,阴性25例;术后放疗开始时间与手术间隔的时间13～120天,放射治疗采用常规放疗或三维适形放疗,放疗剂量40～66 Gy,所有患者均行2～6疗程以铂类为主的双药联合化疗。结果:术后放疗开始时间与手术间隔时间长者(43～120天) 5年生存率好于间隔时间短者(13～42天)(P=0. 040),手术与术后放疗开始时间的间隔对手术切缘阳性者的5年生存率影响差异无统计学意义(P=0. 067)。结论:对Ⅲ_a期非小细胞肺癌患者,术后早放疗并不能提高患者的生存,若术后计划行放化疗,放疗在手术后1个半月后开始可能效果更好。

165例Ⅲ_a期非小细胞肺癌以手术为主的综合治疗

目的 探讨晚期肺癌的疗效。 方法 165例Ⅲa期非小细胞肺癌以手术为主,配合化疗、放疗的综合治疗。 结果 165例以手术为主的综合治疗组与98例非手术组一、三、五年生存率比较,分别为679%、385%、238%和408%、125%、62%,前者明显高于后者,以手术为主的综合治疗组与非手术组一、三、五年生存率之间差异有显著性(P<0025)。 结论 Ⅲa期非小细胞肺癌病人应不失时机选择以手术为主的综合治疗。

Low-depth whole genome sequencing reveals copy number variations associated with higher pathologic grading and more aggressive subtypes of lung non-mucinous adenocarcinoma

Objective:Histology grade,subtypes and TNM stage of lung adenocarcinomas are useful predictors of prognosis and survival.The aim of the study was to investigate the relationship between chromosomal instability,morphological subtypes and the grading system used in lung non-mucinous adenocarcinoma(LNMA).Methods:We developed a whole genome copy number variation(WGCNV)scoring system and applied next generation sequencing to evaluate CNVs present in 91 LNMA tumor samples.Results:Higher histological grades,aggressive subtypes and more advanced TNM staging were associated with an increased WGCNV score,particularly in CNV regions enriched for tumor suppressor genes and oncogenes.In addition,we demonstrate that 24-chromosome CNV profiling can be performed reliably from specific cell types(<100 cells)isolated by sample laser capture microdissection.Conclusions:Our findings suggest that the WGCNV scoring system we developed may have potential value as an adjunct test for predicting the prognosis of patients diagnosed with LNMA.

Prognostic value of ground glass opacity on computed tomography in pathological stage I pulmonary adenocarcinoma: A meta-analysis

BACKGROUND The clinical role of ground glass opacity(GGO)on computed tomography(CT)in stage I pulmonary adenocarcinoma patients currently remains unclear.AIM To explore the prognostic value of GGO on CT in lung adenocarcinoma patients who were pathologically diagnosed with tumor-node-metastasis stage I.METHODS A comprehensive and systematic search was conducted through the PubMed,EMBASE and Web of Science databases up to April 3,2021.The hazard ratio(HR)and corresponding 95%confidence interval(CI)were combined to assess the association between the presence of GGO and prognosis,representing overall survival and disease-free survival.Subgroup analysis based on the ratio of GGO was also conducted.STATA 12.0 software was used for statistical analysis.RESULTS A total of 12 studies involving 4467 patients were included.The pooled results indicated that the GGO predicted favorable overall survival(HR=0.44,95%CI:0.34-0.59,P<0.001)and disease-free survival(HR=0.35,95%CI:0.18-0.70,P=0.003).Subgroup analysis based on the ratio of GGO further demonstrated that the proportion of GGO was a good prognostic indicator in pathological stage I pulmonary adenocarcinoma patients,and patients with a higher ratio of GGO showed better prognosis than patients with a lower GGO ratio did.CONCLUSION This meta-analysis manifested that the presence of GGO on CT predicted favorable prognosis in tumor-node-metastasis stage I lung adenocarcinoma.Patients with a higher GGO ratio were more likely to have a better prognosis than patients with a lower GGO ratio.

血清TAP、proGRP、cyfra21-1与Ⅲ~Ⅳ期NSCLC新辅助化疗疗效及预后的关系

目的探讨血清肿瘤异常蛋白(TAP)、胃泌素释放肽前体(proGRP)、细胞角蛋白19片段(cyfra21-1)与Ⅲ~Ⅳ期非小细胞肺癌(NSCLC)新辅助化疗(NCT)疗效及预后的关系。方法选取100例Ⅲ~Ⅳ期NSCLC患者为研究对象,所有患者均采用NCT治疗,根据疗效将患者分为有效组和无效组,比较不同疗效患者化疗前后TAP、proGRP、cyfra21-1水平,分析化疗后TAP、proGRP、cyfra21-1水平对NSCLC患者NCT疗效的评估价值。所有患者均随访1年,分析化疗后TAP、proGRP、cyfra21-1表达水平与预后的关系。结果化疗后,有效组TAP、proGRP、cyfra21-1水平低于无效组(P<0.05)。ROC曲线结果显示,TAP评估NSCLC患者NCT疗效的AUC和截点值分别为0.739、178.18μm 2,proGRP评估NSCLC患者NCT疗效的AUC和截点值分别为0.810、52.21 ng/L,cyfra21-1评估NSCLC患者NCT疗效的AUC和截点值分别为0.775、7.70μmol/L,联合评估NSCLC患者NCT疗效的AUC为0.913,高于单项诊断(P<0.05)。TAP、proGRP、cyfra21-1高表达患者的1年生存率均低于低表达患者(P<0.05)。结论TAP、proGRP、cyfra21-1联合评估Ⅲ~Ⅳ期NSCLC患者NCT疗效具有较高价值,且其均与NSCLC患者预后密切相关。

姜黄素Ⅲ对A549裸鼠移植瘤VEGF蛋白表达的影响

目的 研究中药姜黄的主要活性单体成分双脱甲氧基姜黄素(姜黄素Ⅲ)抗肿瘤血管生成作用的可能机制。方法 将15只荷人A5 49肺腺癌的裸小鼠随机分成3个组:①阴性对照组;②TNP 470组(3 0mg/kg ,隔日注射1次,共8次) ;③姜黄素Ⅲ组(10 0mg/kg ,隔日注射1次,共8次)。治疗结束后取移植瘤组织及荷瘤鼠血清,免疫组化染色检测移植瘤组织中VEGF的表达,ELISA检测血清中VEGF的含量。结果 姜黄素Ⅲ组VEGF表达的阳性组织RGV值为1 63±0 13 ,血清中VEGF含量为(65 18±11 62 ) pg/ml,显著低于阴性对照组[2 49±0 15 ,(10 0 5 2±13 17)pg/ml ,P <0 0 1]。结论 姜黄素Ⅲ抗人肺腺癌细胞系A5 49裸鼠移植瘤血管生成作用的机制可能与其抑制移植瘤中肿瘤细胞VEGF的表达有关。

姜黄素Ⅲ抑制A549裸小鼠移植瘤生长及其血管生成的实验研究

目的 初步探讨中药姜黄的主要活性单体成分双脱甲氧基姜黄素 (姜黄素Ⅲ )对人肺腺癌细胞系A5 49裸小鼠移植瘤的生长及其血管生成的影响。方法 选用人肺腺癌细胞株A5 49建立裸小鼠皮下移植瘤模型 ,腹腔注射姜黄素Ⅲ ,测量移植瘤的重量、体积 ,同时应用CD3 4免疫组化染色 ,观测瘤组织内的微血管密度。结果 姜黄素Ⅲ具有较好的抗人肺腺癌细胞系A5 49裸小鼠移植瘤生长作用 ,移植瘤重量及体积显著低于阴性对照组 (P <0 0 1) ;瘤组织内可见微血管形态不规则 ,并可见无明显管腔形成的新生血管 ,姜黄素Ⅲ组微血管密度明显低于阴性对照组 (P <0 0 1)。结论 姜黄素Ⅲ能明显抑制人肺腺癌细胞系A5 49裸小鼠移植瘤的生长 ,其机制之一可能与其抑制瘤组织内血管生成有关。

Ⅲ期肺癌手术治疗生存率的分析

全组共1055例Ⅲ期肺癌手术切除,5、10年生存率分别为22.1％和15.3％,T_3N_0M_0预后好,5、10年生存率分别为41％和29.9％,虽N_2组预后较差,但是5,10年生存率仍有15.7％和9.1％,优于其它疗法。我们认为对纵隔淋巴结转移数少,及手术技术允许的N_2可以切除,但对食道旁、肺下韧带及隆突下淋巴结转移的手术应从严。Ⅲ期小细胞肺癌的长期生存率虽低,但和以往相比有所提高,可能和近年开展多方法学治疗有关,生存3年无病,可望根除。腺癌术后3年生存率仍不断下降,10年生存率仅为5年之半数,提示重视于血道、淋巴道内微转移灶之存在的重要性。

术前支气管动脉灌注化疗治疗Ⅲa(N_2)期非小细胞肺癌

目的探讨术前支气管动脉灌注(BAI)化疗在Ⅲa(N2)期非小细胞肺癌(NSCLC)治疗中的临床应用价值。方法临床确诊的Ⅲa(N2)期非小细胞肺癌186例,随机分为观察组和对照组,每组93例。观察组患者在接受2次BAI后手术,对照组确诊后直接手术,观察BAI疗效,比较两组患者的手术情况和术后生存率。结果观察组的临床和组织学有效率分别为80.6%和83.9%,TNM分期下降50.53%,不良反应轻微;观察组根治性手术切除率为93.4%,显著高于对照组的72.0%,差异有统计学意义(P<0.05);术中出血量和术后并发症两组间无差别;观察组与对照组1、3、5年生存率分别为97.8%、64.8%、36.3%和89.3%、50.5%、18.3%,两组间差异有显著统计学意义(P<0.01)。结论术前BAI可获得较好的临床和组织学疗效,并能提高Ⅲa(N2)期NSCLC的根治性手术切除率和术后生存率,值得临床推广应用。

非黏液型肺腺癌中β-Tubulin-Ⅲ作为早期浸润灶标志物的应用

目的探讨β-Tubulin-Ⅲ在肺原位腺癌(adenocarcinoma in situ,AIS)、微浸润性腺癌(minimally invasive adenocarcinoma,MIA)的原位癌成分和早期浸润灶中的表达。方法应用免疫组化Eli Vision法检测51例AIS、88例MIA、40例不典型腺瘤样增生(atypical adenomatous hyperplasia,AAH)及54例浸润性腺癌(invasive adenocarcinoma,IA)组织中β-Tubulin-Ⅲ、CD34、CD31、FⅧRAg和CollagenⅣ-Laminin的表达。结果β-Tubulin-Ⅲ在IA(包括腺泡状腺癌、乳头状腺癌、微乳头状腺癌以及实性腺癌)中均强阳性;在AAH、AIS及MIA的原位癌成分中均阴性;在原位及浸润性黏液腺癌中均阴性。AAH、AIS及MIA原位癌成分的基膜和间质细胞中CD34均呈阳性,原位黏液腺癌及各类IA中无CD34阳性的间质细胞和基膜。AAH、AIS及MIA的原位癌成分有CollagenⅣ-Laminin阳性的基膜围绕,后两者基膜显著增厚;各类IA成分无基膜围绕。结论β-Tubulin-Ⅲ可作为非黏液型肺腺癌早期浸润灶的标志物。

姜黄素Ⅲ和顺铂联用抑制A549裸小鼠移植瘤生长作用研究

目的 观察中药姜黄的主要活性单体成分双脱甲氧基姜黄素(姜黄素Ⅲ)和顺铂联用对抑制人肺腺癌细胞系A5 49裸小鼠移植瘤生长有无增效作用。方法 将2 0只荷人A5 49肺腺癌的裸小鼠随机分成4组:①阴性对照组;②姜黄素Ⅲ组(10 0mg kg ,隔日1次×8次) ;③顺铂组(5mg kg ,每周2次×4次) ;④联合用药组(姜黄素Ⅲ10 0mg kg ,隔日1次×8次+顺铂5mg kg ,每周2次×4次)分别测量瘤质量、瘤体积和微血管密度,并观察各组移植瘤组织的病理形态结构。结果 4个组瘤质量分别为(1 15±0 18)、(0 5 7±0 10 )、(0 49±0 0 8)、(0 2 4±0 0 5 )g ;瘤体积分别为(14 13 4±2 66 3 3 )、(699 40±118 0 3 )、(5 90 88±114 0 5 )、(3 5 4 72±12 3 72 )mm3。统计学分析表明:在瘤质量及瘤体积方面,姜黄素Ⅲ组、顺铂组和阴性对照组比较差异具有显著性(P <0 0 1) ,联合用药组和其他3组比较均有显著性差异(P <0 0 1)。结论 姜黄素Ⅲ、顺铂对A5 49裸小鼠移植瘤生长都有明显的抑制作用;姜黄素Ⅲ和顺铂联用能起增效作用。

Ⅲ期非小细胞肺癌同步放化疗后的外科手术治疗

背景与目的：目前，对Ⅲ期非小细胞肺癌的治疗存在许多争论，手术、化疗和放疗的治疗次序组合，是否会影响手术的疗效和结果。本课题研究同步放化疗后再手术的手术指征、适应症、手术技巧和术后并发症的临床处理。方法：回顾性分析44例Ⅲ期非小细胞肺癌，其中同步放化疗组22例术前同步放化疗，另对照组22例选择先手术后辅助化疗，比较两组的手术结果；放疗总剂量小于45Gy；化疗方案为顺铂（DDP）15～20mg／m^2，第1～3天，或75mg／m^2，第1天；长春瑞滨（NVB）25mg／m^2，第1～3天；化疗放疗结束后3～4周后，血象正常，即予手术治疗。结果：同步放化疗组中3例左全肺切除，10右下叶切除，3例右上叶切除，5例左下叶切除，1例左上叶切除，术后化疔4个疗程。鳞癌16例，腺癌4例，腺鳞癌2例；Ⅲa期18例，Ⅲb期4例，手术成功率100％，术中出血量平均200ml；术后无严重并发症发生。对照组中4例左全肺切除，9右下叶切除，4例右上叶切除，4例左下叶切除，1例左上叶切除；鳞癌15例，腺癌4例，腺鳞癌3例；Ⅲa期20例，Ⅲb期2例。手术成功率100％，术中出血量平均150ml；术后无严重并发症发生。随访：同步放化疗组1例术后4个月全身皮下转移及骨转移死亡，1年成活率93．3％。对照组1例术后10个月出现对侧肺转移，1年成活率100％。结论：同步放化疗后再手术，在外科技术上是可行的，并不增加手术难度和手术并发症，长期生存情况有待进一步研究随访。

呼吸功能训练对Ⅲa期肺癌患者肺功能的影响

目的探讨呼吸功能训练对未化疗仅给予支持疗法的Ⅲa肺癌患者肺功能的影响。方法选取本院呼吸内科门诊及住院确诊未化疗的Ⅲa期肺癌患者79例,按随机数字法分为实验组40例和对照组39例。对照组仅给予Ⅲa期肺癌患者常规疾病治疗与护理及出院后跟踪护理指导,实验组在此基础上同时进行呼吸功能训练,2组均在常规支持治疗第6周末进行6 min步行试验,采用Brog量表进行呼吸困难分级和疲劳分级评分,并计算心率变化分数和血氧变化分数。结果治疗后,实验组患者6 min步行距离、呼吸困难评分、疲劳评分、心率变化分数和血氧饱和度变化分数均优于对照组,差异有统计学意义(P<0.05)。结论 6 min步行试验可反映Ⅲa期肺癌患者的肺功能状态,在常规治疗基础上配合呼吸功能训练,可进一步改善患者的肺功能及运动耐力,从而提高患者的生活质量。

Ⅲ期非小细胞肺癌三维适形放疗所致放射性肺炎的影响因素

目的回顾性分析Ⅲ期非小细胞肺癌(NSCLC)三维适形放疗(3D-CRT)引起放射性肺炎(RP)发生的相关物理参数及临床影响因素。方法 2001年1月至2008年12月接受根治性3D-CRT的203例NSCLC临床资料,其中男163例、女40例;中位年龄63岁(30~83岁);21例有慢性阻塞性肺疾病(COPD)病史;ⅢA期79例、ⅢB期124例。70例单纯放疗、133例放化联合治疗,中位等效照射剂量6 200 c Gy(5 000~7 800 c Gy);RP评价采用RTOG标准,剂量体积直方图(DVH)评价物理参数与≥2级和≥3级RP的关系。统计分析采用SPSS13.0统计软件。结果 203例放疗后发生≥2级RP者32%(65/203),≥3级RP者20.7%(42/203)。Spearman相关和Logistic单因素分析显示,物理参数中肺平均剂量、双肺V5~V40,临床因素中COPD病史、分割方式(常规分割/大分割)、放疗剂量、GTV和GTV/肺体积均与≥2级和≥3级RP相关(P<0.05);而性别、年龄、吸烟、病变部位(中央型/周围型、肺上叶/肺中下叶)、化疗与否等均与≥2级和≥3级RP无明显关系(P>0.05)。Logistic多因素回归分析显示,肺V25是≥2级和≥3级RP的独立危险因素,ROC曲线显示肺V25分界值为29%;COPD是≥2级RP的独立危险因素。结论 DVH参数可用于预测和评价放射性肺炎,肺V25可能是最有效预测≥2级RP和≥3级RP的指标,合并COPD增加≥2级RP的发生率。

Ⅲ期非小细胞肺癌综合治疗的探讨

目的 探讨Ⅲ期非小细胞肺癌综合治疗方法。方法 对治疗组 5 0例患者行介入诱导化疗加手术治疗和放射治疗 ,分析并观察疗效 ,并与对照组 42例病例进行比较。结果 治疗组通过介入诱导化疗 ,手术切除率为 94.0 % ,且 84.0 %的患者达到肉眼下的手术根治。治疗组 1、3、5年生存率分别为 44 .0 %、36.0 %和 2 2 .0 % ,而对照组 1、3、5年生存率分别为 2 3.8%、16.7%和 7.1% ,两组间比较差异均有显著性 (P <0 .0 5 )。结论 规范的综合治疗方法有助于提高Ⅲ期非小细胞肺癌的疗效 ,值得临床继续探讨。