ADJUVANT CHEMOTHERAPY FOLLOWING RADICAL SURGERYFOR NON-SMALL CELL LUNG CANCER:A RANDOMIZED STUDY

Objective: To evaluate the efficacy of adjuvant chemotherapy after radical surgery for non-small cell lung cancer (NSCLC). Methods: Seventy patients with NSCLC (stage I–III) undergone radical surgery were randomized into two groups: 35 patients received adjuvant chemotherapy with cyclophosphamide (CTX) 300 mg/m2, vincristine (VCR) 1.4% mg/m2, adriamycin (ADM) 50 mg/m2, lomustine (CCNU) 50 mg/m2 dl, cisplatin (DDP) 20 mg/m2, d1–5, for 4 cycles, and followed by oral Ftorafur (FT-207) 600–900 mg/d for 1 year (adjuvant chemotherapy group). The other 35 patients received surgical treatment only (surgery group). Results: The overall 5-year survival rate was 48.6% in the adjuvant chemotherapy group, and 31.4% in the surgery group, respectively. The difference between the two groups was not statistically significant (P>0.05). The 5-year survival rate of patients in stage III was 44.0% and 20.8% received surgery with and without adjuvant chemotherapy, respectively. The difference between the two groups was statistically significant (P<0.025). The 5-year survival rate of patients in stage I–II in the two groups was 60.0% and 54.5%, respectively (P>0.75). Conclusion: Postoperative adjuvant chemotherapy in NSCLC can improve survival, for those patients in stage III, it suggests significantly 5-year survival rate in the adjuvant chemotherapy group was higher than that in the surgery alone group.

Synchronous multiple lung cancers with hilar lymph node metastasis of small cell carcinoma:A case report

BACKGROUND Synchronous multiple lung cancers are rare and refer to the simultaneous presence of two or more primary lung tumors,which present significant challenges in terms of diagnosis and treatment.CASE SUMMARY We report a case of multiple synchronous lung cancers with hilar lymph node metastasis of small cell carcinoma of unknown origin in a 73-year-old man.Transbronchial lung biopsy revealed squamous cell carcinoma.Although enlargement of lymph node 12u was detected,no distant metastases were observed.The patient was preoperatively diagnosed with T1cN0M0 and underwent thoracoscopic right upper lobectomy with nodal dissection(ND2a).Based on histopathological findings,the primary lesion was squamous cell carcinoma.A microinvasive adenocarcinoma was also observed on the cranial side of the primary lesion.Tumors were detected in two resected lymph nodes(#12u and#11s).Both tumors were pathologically diagnosed as small cell carcinomas.The primary lesion of the small cell carcinoma could not be identified even by whole-body imaging;however,chemotherapy was initiated for hilar lymph node metastasis of the small cell carcinoma of unknown origin.CONCLUSION Multiple synchronous lung cancers can be accompanied by hilar lymph node metastasis of small cell carcinomas of unknown origin.

Nedaplatin/Gemcitabine Versus Carboplatin/Gemcitabine in Treatment of Advanced Non-small Cell Lung Cancer: A Randomized Clinical Trial

Objective： To evaluate the efficacy and safety of nedaplatin/gemcitabine （NG） and carboplatin/gemcitabine （CG） in the management of untreated advanced non-small cell lung cancer （NSCLC）. Methods： Sixty-two patients with previously untreated advanced NSCLC were recruited between June 2006 and November 2007. Subjects were randomly assigned to the NG arm （n=30） and the CG arm （n=32）. Only patients （24 and 25 in the NG and CG arms, respectively） who completed 〉2 chemotherapy cycles were included in the data analysis. The primary outcome measure was the objective response rate （ORR）. The secondary outcome measures included progression-free survival （PFS）, overall survival （OS） and adverse events. Results： There were no statistically significant differences in the efficacy measures （ORR, P=0.305; median PFS, P=0.298, median OS, P=0.961） or in the major adverse events （grade 3/4 neutropenia, P=0.666; grade 3/4 anemia, P=0.263; grade 3/4 thrombocytopenia, P=0.222） between the two treatment arms. However, there was a trend towards higher ORR （37.5% vs. 24.0%）, longer PFS （6.0 vs. 5.0 months）, and less adverse events in the NG arm. Conclusion： NG regimen seems to be superior over CG regimen for advance NSCLS, but further investigation is needed to validate this superiority.

Paclitaxel-etoposide-carboplatin/cisplatin versus etoposidecarboplatin/cisplatin as first-line treatment for combined small-cell lung cancer: a retrospective analysis of 62 cases

Objective: To compare the efficacy and adverse effects of paclitaxel-etoposide-carboplatin/cisplatin(TEP/TCE) regimen with those of etoposide-carboplatin/cisplatin(EP/CE) regimen as first-line treatment for combined small-cell lung cancer(CSCLC).Methods: A retrospective study was conducted on 62 CSCLC patients who were treated at Tianjin Medical University Cancer Institute and Hospital from July 2000 to April 2013 and administered with TEP/TCE regimen(n=19) or EP/CE regimen(n=43) as first-line CSCLC treatment. All patients received more than two cycles of chemotherapy, and the response was evaluated every two cycles. The primary endpoint was overall survival(OS), and the secondary endpoints were progression-free survival(PFS), objective response rate(ORR), disease control rate(DCR), and adverse effects. Results: ORR between the TEP/TCE and EP/CE groups showed a statistical difference(90% vs. 53%, P=0.033). Both groups failed to reach a statistical difference in DCR(100% vs. 86%, P=0.212). The median PFS and OS of the TEP/TCE group were slightly longer than those of the EP/CE group, although both groups failed to reach a statistical difference(10.5 vs. 8.9 months, P=0.484; 24.0 vs. 17.5 months, P=0.457). However, stratified analysis indicated that the PFS of patients with stages III and IV CSCLC showed marginally significant difference between the TEP/TCE and EP/CE groups(19.5 vs. 7.6 months; P=0.071). Both rates of grade IV bone marrow depression and termination of chemotherapy in the TEP/TCE group were significantly higher than those in the EP/CE group(26.3% vs. 7.0%, P=0.036; 31.6% vs. 14.7%, P=0.004). Conclusion: The TEP/TCE regimen may not be preferred for CSCLC, and this three-drug regimen requires further exploration and research. To date, the EP/CE regimen remains the standard treatment for CSCLC patients.

Advances in adjuvant systemic therapy for non-small-cell lung cancer

Non-small-cell lung cancer remains a leading cause of death around the world. For most cases, the only chance of cure comes from resection for localised disease, however relapse rates remain high following surgery. Data has emerged over recent years regarding the utility of adjuvant chemotherapy for improving disease-free and overall survival of patients following curative resection. This paper reviews the clinical trials that have been conducted in this area along with the studies integrating radiation therapy in the adjuvant setting. The role of prognostic gene signatures are reviewed as well as ongoing clinical trials including those incorporating biological or targeted therapies.

GOECP/SEOR radiotherapy guidelines for small-cell lung cancer

Small cell lung cancer(SCLC)accounts for approximately 20%of all lung cancers.The main treatment is chemotherapy(Ch).However,the addition of radiotherapy significantly improves overall survival(OS)in patients with non-metastatic SCLC and in those with metastatic SCLC who respond to Ch.Prophylactic cranial irradiation reduces the risk of brain metastases and improves OS in both metastatic and non-metastatic patients.The 5-year OS rate in patients with limited-stage disease(non-metastatic)is slightly higher than 30%,but less than 5%in patients with extensive-stage disease(metastatic).The present clinical guidelines were developed by Spanish radiation oncologists on behalf of the Oncologic Group for the Study of Lung Cancer/Spanish Society of Radiation Oncology to provide a current review of the diagnosis,planning,and treatment of SCLC.These guidelines emphasise treatment fields,radiation techniques,fractionation,concomitant treatment,and the optimal timing of Ch and radiotherapy.Finally,we discuss the main indications for reirradiation in local recurrence.

New perspectives in the management of small cell lung cancer

The treatment of small cell lung cancer(SCLC)is a challenge for all specialists involved.New treatments have been added to the therapeutic armamentarium in recent months,but efforts must continue to improve both survival and quality of life.Advances in surgery and radiotherapy have resulted in prolonged survival times and fewer complications,while more careful patient selection has led to increased staging accuracy.Developments in the field of systemic therapy have resulted in changes to clinical guidelines and the management of patients with advanced disease,mainly with the introduction of immunotherapy.In this article,we describe recent improvements in the management of patients with SCLC,review current treatments,and discuss future lines of research.

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.

Quality assurance and safety of hippocampal avoidance prophylactic cranial irradiation in the multicenter randomized phase III trial(NCT01780675)

Objective:NCT01780675,a multicenter randomized phase III trial of prophylactic cranial irradiation(PCI)versus PCI with hippocampal sparing in small cell lung cancer(SCLC)investigated neurocognitive decline and safety.As part of quality assurance,we evaluated if hippocampal avoidance(HA)-PCI was performed according to the NCT01780675 trial protocol instructions,and performed a safety analysis to study the incidence and location of brain metastases for patients treated with HA-PCI.Methods:This retrospective analysis evaluated the quality of the irradiation given in the randomized controlled trial(RCT)comparing SCLC patients receiving PCI with or without hippocampal avoidance,using intensity mod-ulated radiotherapy(IMRT)or volumetric modulated arc therapy(VMAT).The dose distribution for each patient receiving HA-PCI was retrieved and analyzed to evaluate if the treatment dose constraints were met.A ques-tionnaire was sent out to all participating sites,and data on radiotherapy technique,pre-treatment dummy runs,phantom measurements and treatment electronic portal imaging device(EPID)dosimetry were collected and analyzed.As part of the safety analysis,the follow-up magnetic resonance imaging(MRI)or computerized to-mography(CT)scans on which cranial disease progression was first diagnosed were collected and matched to the radiotherapy planning dose distribution.The matched scans were reviewed to analyze the location of the brain metastases in relation to the prescribed dose.Results:A total of 168 patients were randomized in the NCT01780675 trial in 10 centers in the Netherlands and Belgium from April 2013 until March 2018.Eighty two patients receiving HA-PCI without evidence of brain metastases were analyzed.All patients were treated with 25 Gy in 10 fractions.Dummy runs and phantom measurements were performed in all institutions prior to enrolling patients into the study.The radiotherapy(RT)plans showed a median mean bilateral hippocampal dose of 8.0 Gy,range 5.4-11.4(constraint≤8.5 Gy).In six patients(7.3%)there was a protocol violation of the mean dose in one or both hippocampi.In four of these six patients(4.9%)the mean dose to both hippocampi exceeded the constraint,in 1 patient(1.2%)only the left and in 1 patient(1.2%)only the right hippocampal mean dose was violated(average median dose left and right 8.9 Gy).All patients met the trial dose constraint of V 115%PTV≤1%;however the D max PTV constraint of≤28.75 Gy was violated in 22.0%of the patients.The safety analysis showed that 14 patients(17.1%)developed cranial progression.No solitary brain metastases in the underdosed region were found.Two out of 11 patients with multiple brain metastasis developed metastasis in the underdosed region(s).Conclusions:The radiotherapy quality within the HA-PCI trial is performed according to the protocol guidelines.The dose constraints to the hippocampi are met in the vast majority of cases.In all patients,the volume of the brain for which a higher dose was accepted,is according to the trial.However,within this volume there are small areas with higher doses than advised.

Long-term results of prophylactic cranial irradiation for limited-stage small-cell lung cancer in complete remission

Background Brain metastasis is one of the most important causes of treatment failure in patients with small cell lung cancer （SCLC）. This study was conducted to evaluate the effects of prophylactic cranial irradiation （PCI） on survival and brain metastases for patients with limited stage small cell lung cancer in complete remission. Methods Fifty one patients with limited stage SCLC in complete remission after chemoradiotherapy were randomly divided into PCI group （n = 26） and control group （n = 25 ）. Patients in the PCI group received PCI at a dose of 25.2 to 30. 6 Gy in 1.8 to 2.0 Gy per fraction. The Kaplan-Meier method and Log rank test were used to analyse and compare survival rates, and X^2 test was used to compare the incidences of cranial metastases in two groups. Results There was no significant difference in clinical characteristics of patients such as age, sex, effect of treatment before PCI between the two groups. The incidence of brain metastases was 3.8% in the PCI group in contrast to 32. 0% in the control group （X^2 =5.15, P =0. 02）. The 1, 3, 5-year survival rates were 84. 6%, 42. 3%, 34. 6% respectively in the PCI group and 72.0%, 32. 0%, 24. 0% respectively in the control group, with no difference between the two groups （X^2 = 2. 25, P = 0. 13 ）. No serious sequelae were observed in patients receiving PCI. Conclusion For patients with limited stage SCLC responding completely to chemotherapy plus radiotherapy, PCI can decrease the incidence of brain metastases and improve survival rate.

卡瑞利珠单抗联合化疗治疗晚期NSCLC疗效及其对血清SCC-Ag、TIMP-1、D-二聚体、miR-206水平的影响

目的探讨卡瑞利珠单抗联合化疗治疗晚期非小细胞肺癌(NSCLC)的疗效及其对血清鳞状细胞癌抗原(SCC-Ag)、基质金属蛋白酶组织抑制剂-1(TIMP-1)、D-二聚体(D-D)、微小核糖核酸-206(miR-206)水平的影响。方法选取2022年4月—2023年10月保定市第二中心医院肿瘤科收治的晚期NSCLC患者110例为研究对象,按照随机数字表法分为对照组55例和观察组55例。对照组采用一线化疗方案,观察组在对照组基础上加用卡瑞利珠单抗治疗,21 d为1个周期,共治疗4~6个周期。采用酶联免疫吸附法(ELISA)检测血清SCC-Ag、TIMP-1、D-D水平,实时荧光定量PCR(qPCR)检测miR-206表达水平。比较2组患者临床疗效、治疗前后血清学指标、T淋巴细胞亚群水平及不良反应。结果观察组临床总有效率高于对照组(78.18%vs.60.00%,χ^(2)/P=4.257/0.039);与治疗前比较,治疗4~6个周期后2组血清SCC-Ag、TIMP-1、D-D水平均降低,miR-206表达升高,且观察组各指标降低/升高幅度大于对照组(t/P=38.360/<0.001、4.156/<0.001、9.567/<0.001、4.857/<0.001);与治疗前比较,治疗4~6个周期后2组CD4^(+)T淋巴细胞、CD4^(+)/CD8^(+)升高,CD8^(+)T淋巴细胞降低,且观察组各指标降低/升高幅度大于对照组(t/P=6.241/<0.001、6.879/<0.001、5.631/<0.001);治疗期间,观察组不良反应总发生率低于对照组(5.45%vs.21.82%,χ^(2)/P=6.253/0.012)。结论卡瑞利珠单抗联合化疗治疗晚期NSCLC患者的疗效确切,可有效改善机体免疫功能,降低血清SCC-Ag、TIMP-1、D-二聚体水平,提高miR-206水平。

Chemotherapy in conjunction with traditional Chinese medicine for survival of elderly patients with advanced non-small-cell lung cancer:protocol for a randomized double-blind controlled trial

BACKGROUND： Traditional Chinese medicine （TCM） is considered an important complementary therapy with beneficial effects for cancer patients. Elderly patients with non-small-cell lung cancer （NSCLC） are a complex patient group with increasing co-morbidity and shrinking physiological reserve, and may derive substantial benefit from the supportive aspects of TCM Researchers from Shanghai Longhua Hospital found that qi and yin deficiency is a common syndrome in patients with stage III or IV lung cancer. This project was designed to study the combination of single-agent chemotherapy with TCM methods of benefiting qi and yin in elderly patients with advanced NSCLC. METHODS AND DESIGN： This is a double-blind controlled, multi-center, and prospective study with randomly selected participants from elderly NSCLC patients in China. Seventy-six patients who meet the inclusion criteria will be allocated into two groups, which will receive treatments of 3-week single-agent chemotherapy with TCM or placebo for four cycles Progression-free survival （PFS） is the primary end point, and the secondary end points are overall survival, objective response rate, time-to-progression, and quality of life （EORTC QLQ-LC43, and TCM syndrome score） Meanwhile, other end points such as toxicity, side effects and safety of the treatments will be assessed. DISCUSSION： Results from this study may provide evidence on the effectiveness, and parameters for the usage of single-agent chemotherapy combined with or without TCM on PFS of elderly patients with NSCLC.

Pembrolizumab-emerging treatment of pulmonary sarcomatoid carcinoma: A case report

BACKGROUND Few studies have addressed the efficacy of pembrolizumab in pulmonary sarcomatoid carcinoma(PSC),a rare,previously rapidly fatal subtype of nonsmall-cell lung cancer.CASE SUMMARY We report the case of a 69-year-old man presented with respiratory distress caused by a large left upper lung lobe mass diagnosed as PSC with programmed death-ligand 1 expressed on more than 50 percent of tumor cells.The patient was started on pembrolizumab and,after 5 cycles,there was a more than 80 percent decrease in the size of the tumor mass.Further decrease was seen at the end of 10 cycles.The patient has been tolerating pembrolizumab well,with no limiting side-effects.Fourteen months after first coming into the hospital,he remains asymptomatic.CONCLUSION Pembrolizumab appears as a viable emerging treatment for PSC.

Exploration of Kras Mutations and Their Potential for Being a Target Molecule in Cancer Chemotherapy

The Rat sarcoma virus (RAS) family of proteins, which includes the Kristen Rat sarcoma virus (KRAS), is linked to nearly one-fourth of all human cancers. KRAS mutations, in particular, are associated with Non-Small Cell Lung Carcinoma (NSCLC), colorectal cancer, adenocarcinomas, ovarian carcinoma, and endometrial tumors. KRAS activates 80 different signaling pathways, including Mitogen-activated protein kinases (MAPK) and Phosphoinositide 3-kinase (PI3K), and up-regulates transcription factors such as ETS like Protein (ELK), Jun Proto-Oncogene (JUN), and Myelocytomatosis (MYC), which are involved in cell differentiation, proliferation, transformation, and survival. KRAS mutations are also known to cause autocrine function, which further exacerbates the situation. In NSCLC, KRAS mutations have a strong positive correlation with the disease, particularly in patients with a smoking history. In pancreatic cancer, KRAS mutations are a dominant pathological basis, with most mutations being G12D, G12V, G13D, G13C, G13S, and G13R. These mutations serve as initial markers in tumorigenesis and are associated with poor prognosis and high mortality rates. In colorectal cancer, KRAS mutations contribute to 4/5 of cases, with cellular mechanisms involving the MAPK pathway, which resists anti-epidermal growth factor antibodies. In Low-grade Serous Ovarian Cancer (LGSOC), KRAS mutations are associated with altered signaling in the MAPK pathway and drug resistance. However, treatments such as Selumetinib, a down regulator of RAS/Rapidly Accelerated Fibrosarcoma (RAF)/Mitogen-activated protein kinase (MEK) pathways, and a combination of trametinib and buparlisib have shown promise in managing LGSOC when diagnosed early through KRAS mutation markers. Although KRAS mutations are commonly associated with many types of cancer, their use in clinical practice is limited due to the lack of accurate methods to identify them. It is needed to further isolate the KRAS mutation products and correlate the cancer-causing genes to make it a promising approach for cancer chemotherapy.

复方苦参注射液辅助程序性死亡受体1抑制剂联合多西他赛+顺铂方案化疗治疗非小细胞肺癌的疗效观察

目的:探讨复方苦参注射液辅助程序性死亡受体1(PD-1)抑制剂联合多西他赛+顺铂方案化疗治疗非小细胞肺癌的临床疗效。方法:回顾性选取2020年10月~2023年5月某院收治的84例非小细胞肺癌患者为研究对象,根据不同的治疗方案分为对照组和观察组,每组42例。对照组给予PD-1抑制剂联合多西他赛+顺铂方案,观察组在对照组基础上加用复方苦参注射液。评估两组患者临床疗效;应用流式细胞仪测定治疗前后患者血清肿瘤标记物[癌胚抗原(CEA)、异常糖链糖蛋白(TAP)]水平;评估两组患者治疗后的生活能力[卡诺夫斯凯计分(KPS)];比较治疗期间两组患者的不良反应发生情况以评估药物安全性。结果:治疗后,观察组的客观缓解率和疾病控制率分别为69.05%和95.23%,高于对照组的47.62%和76.19%,组间存在统计学差异(P<0.05)。治疗前,患者的血清CEA和TAP水平组间比较无统计学差异(P>0.05);治疗后,观察组CEA和TAP水平均低于对照组(P<0.05);治疗后,观察组患者的KPS评分高于对照组(P<0.05)。此外,在不良反应发生情况方面,观察组的骨髓抑制率(30.95%)低于对照组(80.95%,P<0.05),且观察组总不良反应发生率(33.33%)也低于对照组(92.86%,P<0.05)。结论:与PD-1抑制剂联合多西他赛+顺铂方案相比,采用复方苦参注射液辅助PD-1抑制剂联合多西他赛+顺铂方案化疗治疗非小细胞肺癌的临床疗效较佳,患者生活质量提升更明显,安全性更高,推荐临床广泛应用。

子午流注择时揿针疗法预防非小细胞肺癌患者化疗后骨髓抑制的效果研究

背景骨髓抑制是肺癌化疗常见的不良反应之一,针对化疗相关性骨髓抑制,现代医学多采用对症治疗,但存在一定局限性。目的探讨“子午流注”理论指导下择时揿针疗法预防肺癌化疗后骨髓抑制的效果。方法选择2020年7月—2022年6月在江苏省苏北人民医院呼吸科住院的142例首次行化疗的非小细胞肺癌(NSCLC)患者,按事先电脑生成的随机数字表和制订的分配方案,根据入院时间将研究对象随机分为对照组(47例)、揿针组(48例)及择时组(47例)。对照组给予肺癌化疗常规护理措施,揿针组在对照组措施基础上加用膈俞穴、脾俞穴、胃俞穴等穴位揿针疗法,择时组在对照组遵循子午流注纳子法于当日辰时(7:00—9:00)至巳时(9:00—11:00)实施择时揿针疗法。检测分析三组化疗前1 d及化疗第3、7、14、21天反映骨髓抑制情况的血常规指标及舒适度评分的变化情况。结果白细胞计数、中性粒细胞计数:揿针组和择时组化疗第7、14天均高于对照组(P<0.05),择时组均高于揿针组(P<0.05);血小板计数:化疗第7、14天揿针组和择时组均高于对照组(P<0.05)。舒适度评分:化疗第7、14天揿针组和择时组均高于对照组(P<0.05),化疗第14天择时组高于揿针组(P<0.05)。结论子午流注择时揿针疗法能有效预防NSCLC患者化疗后骨髓抑制,提高白细胞计数、中性粒细胞计数和血小板计数等部分血常规指标,提升患者的舒适度。

贝伐珠单抗与GC化疗方案联合治疗晚期非小细胞肺癌的效果及药物经济学评价

目的 探究贝伐珠单抗联合GC化疗方案(顺铂+吉西他滨)治疗晚期非小细胞肺癌(NSCLC)的效果及药物经济学价值。方法 选取2020年7月—2022年7月收治的86例晚期NSCLC,依据治疗方案分为对照组和观察组,每组43例。对照组给予GC化疗方案,观察组给予贝伐珠单抗联合GC化疗方案。对比2组疗效、毒副反应发生情况以及治疗前后血生化指标,并进行成本-效果分析。结果 观察组客观缓解率58.14%(25/43)、疾病控制率93.02%(40/43)均高于对照组的32.56%(14/43)、72.09%(31/43)(P<0.05)。治疗2、4个疗程,观察组血清癌胚抗原、糖类抗原125、神经元特异性烯醇化酶、血管内皮生长因子、碱性成纤维细胞生长因子均低于对照组(P<0.05)。2组各项毒副反应总发生率比较无显著差异(P>0.05)。观察组总成本高于对照组(P<0.05)。观察组成本-效果比为790.67低于对照组的901.31,且敏感性分析显示,成本-效果分析稳定可靠。结论 贝伐珠单抗联合GC化疗方案治疗晚期NSCLC患者,可下调肿瘤标志物及血管内皮因子水平,提升疗效,且成本-效果优势明显。

血清SCCA、ProGRP、NSE与老年非小细胞肺癌患者病理特征及化疗客观疗效的相关性分析

目的 分析血清鳞状细胞癌抗原(SCCA)、胃泌素释放肽前体(ProGRP)、神经元特异性烯醇化酶(NSE)与老年非小细胞肺癌(NSCLC)患者病理特征及化疗客观疗效的相关性。方法 选取临泉县人民医院2020年10月~2023年5月收治的80例老年NSCLC患者,均接受规范化疗,根据化疗客观疗效分为部分缓解(PR)组、病情稳定(SD)组与疾病进展(PD)组,比较不同病理特征患者及不同化疗客观疗效组患者血清SCCA、ProGRP、NSE水平,并进行相关性分析。结果 Ⅳ分期、有淋巴结转移患者血清SCCA、ProGRP、NSE水平高于Ⅲ分期、无淋巴结转移患者,差异有统计学意义(P<0.05)。血清SCCA、ProGRP、NSE与患者TNM分期、淋巴结转移呈显著正相关(P<0.05)。PR组化疗后SCCA、ProGRP、NSE水平低于SD组、PD组;SD组化疗后SCCA、NSE水平低于PD组,差异均有统计学意义(P<0.05)。化疗后,SCCA、ProGRP、NSE与化疗客观疗效呈显著负相关(P<0.05)。结论 血清SCCA、ProGRP、NSE与老年NSCLC患者TNM分期、淋巴结转移情况及化疗客观疗效密切相关。

血清癌胚抗原细胞角蛋白19的可溶性片段纤维蛋白原D-二聚体和前白蛋白与非小细胞肺癌化疗患者预后的相关性分析

目的分析血清癌胚抗原(CEA)、细胞角蛋白19的可溶性片段(CYFRA21-1)、纤维蛋白原(FIB)、D-二聚体(D-D)和前白蛋白(PAB)与非小细胞肺癌(NSCLC)化疗患者预后的相关性。方法采取回顾性研究,选择2021年6月至2023年6月医院收治120例行化疗治疗的NSCLC患者临床资料作为研究对象。均接受顺铂+吉西他滨(GD)方案化疗,随访12个月,根据随访期间存活情况进行分组,将存活患者临床资料纳入预后良好组,将病死患者临床资料纳入预后不良组。患者入院时均接受血清CEA、CYFRA21-1、FIB、D-D和PAB检测,统计患者基线资料。采用双变量相关性Pearson(N)分析,血清CEA、CYFRA21-1、FIB、D-D、PAB水平与NSCLC化疗患者生存期的关系;二元Logistic回归分析血清CEA、CYFRA21-1、FIB、D-D、PAB水平与NSCLC化疗患者预后不良之间的相关性;绘制受试者工作特征(ROC)曲线结果显示,血清CEA、CYFRA21-1、FIB、D-D、PAB水平预测NSCLC化疗患者预后不良的价值;采用样条函数与Logistics回归相结合的限制性立方样条法分析血清CEA、CYFRA21-1、FIB、D-D、PAB水平与NSCLC化疗患者预后不良的剂量反应关系。结果预后不良组分化程度为低分化、临床分期为Ⅲ~Ⅳ期患者占比高于预后良好组,CEA、CYFRA21-1、FIB、D-D高于预后良好组,PAB低于预后良好组(P<0.05);采用双变量相关性Pearson(N)分析显示,血清CEA、CYFRA21-1、FIB、D-D水平与NSCLC化疗患者生存期呈负相关(P<0.05),血清PAB水平与NSCLC化疗患者生存期呈正相关(P<0.05);二元Logistic回归分析结果显示,血清CEA、CYFRA21-1、FIB、D-D高表达是NSCLC化疗患者预后不良的危险因素(OR>1,P<0.05),血清PAB高表达是NSCLC化疗患者预后不良的保护因素(OR<1,P<0.05);绘制ROC曲线结果显示,血清CEA、CYFRA21-1、FIB、D-D、PAB水平预测NSCLC化疗患者预后情况的曲线下面积(AUC)均>0.70,有一定预测价值;NSCLC化疗患者血清CEA、CYFRA21-1、FIB、D-D水平与NSCLC化疗患者预后不良呈正相关,特别当血清CEA>24.53μg/ml、CYFRA21-1>7.82μg/ml、FIB>3.99 g/L、D-D>1.05μg/ml时,NSCLC化疗患者预后不良风险随血清CEA、CYFRA21-1、FIB、D-D水平升高而升高,NSCLC化疗患者PAB水平与NSCLC化疗患者预后不良呈负相关,当血清PAB<209.76 g/L时,NSCLC化疗患者预后不良风险随PAB水平降低而升高。结论血清CEA、CYFRA21-1、FIB、D-D和PAB水平与NSCLC化疗患者预后关系密切,上述指标可有效预测NSCLC化疗患者预后不良风险。

益气化瘀补肺汤对中晚期非小细胞肺癌化疗患者免疫功能及远期生存的影响

目的:观察益气化瘀补肺汤对中晚期非小细胞肺癌(NSCLC)化疗患者免疫功能及远期生存的影响。方法:选取136例中晚期NSCLC患者,按照随机数字表法分为观察组、对照组各68例。治疗期间,观察组剔除1例,对照组剔除4例,最终纳入研究观察组67例、对照组64例。对照组给予多西他赛联合顺铂方案化疗,观察组在对照组基础上给予益气化瘀补肺汤治疗。比较2组近期疗效,化疗前后肿瘤患者生活质量评分量表(QOL)评分、免疫功能指标水平,治疗期间不良反应发生率,以及中位生存时间。结果:化疗后,观察组总缓解率59.70%,高于对照组42.19%(P<0.05)。化疗后,2组社会功能、躯体功能、心理功能评分均较化疗前升高(P<0.05),观察组社会功能、躯体功能、心理功能评分均高于对照组(P<0.05)。化疗后,2组CD4^(+)水平均较化疗前降低(P<0.05),CD8^(+)水平均较化疗前升高(P<0.05);观察组CD3^(+)、CD4^(+)水平及CD4^(+)/CD8^(+)值均高于对照组(P<0.05),CD8^(+)水平低于对照组(P<0.05)。化疗期间,观察组不良反应总发生率4.48%,低于对照组17.19%(P<0.05)。观察组中位生存时间25个月,95%CI 15.223~34.777,对照组中位生存时间16个月,95%CI 17.684~24.316,2组比较,差异有统计学意义(Log Rank P<0.05)。结论:益气化瘀补肺汤可有效提高中晚期NSCLC化疗患者的近期疗效,有助于保护免疫功能,减少化疗期间严重不良反应发生,提高生活质量,延长患者的生存期。