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肿瘤研究与临床
肿瘤研究与临床

梁小波

月刊

1006-9801

zlyjylc@163.com

0351-4650389

030013

山西省太原市职工新街3号

肿瘤研究与临床/Journal Cancer Research and ClinicCSTPCD
查看更多>>中华医学会、山西省肿瘤研究所、山西省肿瘤医院主办。本刊是肿瘤学专业学术期刊。办刊宗旨：开展学术交流，推广科技成果，反映发展动态，引导研究方向。基础与临床并举，普及与提高兼顾，努力推动我国恶性肿瘤防治事业的发展。服务对象：从事肿瘤研究及临床工作的中高级医务人员及其他关注本领域发展动态的相关人员。主要栏目：专论、专家讲坛、论著、短篇论著、调查报告、讲座、会议速递、综述、短篇及个案报告等。编委会由国内外100多位著名肿瘤学专家组成。为中国科技论文统计源期刊（中国科技核心期刊）、中国生物医学核心期刊、中国肿瘤学类核心期刊。被美国《化学文摘》（CA）等国际著名检索期刊及国内各大检索数据库收录。
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    非小细胞肺癌患者术前血浆纤维蛋白原降解产物水平与临床病理特征的相关性

    车娟娟王婧胡牧甄洪超...
    1-5页
    查看更多>>摘要：目的 探讨接受完全切除的非小细胞肺癌（NSCLC）患者术前血浆纤维蛋白原降解产物（FDP）水平与临床病理特征的关系。 方法 回顾性病例系列研究。回顾性分析2016年1月至2017年12月首都医科大学附属北京友谊医院确诊的521例NSCLC患者资料，其中406例经术后病理证实无淋巴结及远处转移（无转移组），115例有淋巴结或远处转移（转移组）。比较两组患者术前血浆FDP水平、临床病理特征及不同FDP水平患者的临床病理特征；采用Spearman相关分析比较术前FDP水平与TNM分期的相关性。 结果 521例NSCLC患者中，女性266例，男性255例；年龄[M（Q1，Q3）]59岁（54岁，65岁）；腺癌441例，鳞状细胞癌70例。无转移组和转移组NSCLC患者术前FDP水平分别为2.78 mg/L（2.35 mg/L，3.13 mg/L）和2.99 mg/L（2.56 mg/L，4.16 mg/L），差异有统计学意义（Z＝6.13，P<0.001）。早期（Ⅰ～Ⅱ期）患者术前FDP水平为2.56 mg/L（2.35 mg/L，3.20 mg/L），晚期（Ⅲ～Ⅳ期）患者术前FDP水平为2.99 mg/L（2.56 mg/L，3.20 mg/L），差异具有统计学意义（Z＝8.42，P<0.001）。Spearman相关性分析结果显示，术前FDP水平与肿瘤长径呈正相关（r＝0.287，P<0.001）。115例患者有淋巴结转移，术前FDP水平与淋巴结转移数呈正相关（r＝0.679，P<0.001）。根据术前中位FDP水平（2.78 mg/L），将患者分为FDP≤2.78 mg/L组和FDP>2.78 mg/L组，两组NSCLC患者年龄、转移情况、肿瘤分期、肿瘤长径、淋巴结转移数和组织学类型比较，差异均有统计学意义（均P<0.05）。 结论 NSCLC患者术前血浆FDP水平升高可能与肿瘤的转移情况和肿瘤临床分期有关。 Objective To investigate the relationship between preoperative plasma fibrin degradation products (FDP) level and clinicopathological features of patients with completely resected non-small cell lung cancer (NSCLC). Methods A retrospective case series study was performed. The clinical data of 521 patients who were pathologically diagnosed with NSCLC in Beijing Friendship Hospital Affiliated to Capital Medical University from January 2016 to December 2017 were retrospectively analyzed. Among 521 cases, 406 cases were postoperatively pathologically confirmed as non-lymph node and non-distant metastasis (non-metastasis group) and 115 cases were postoperatively pathologically confirmed as lymph node or distant metastasis (metastasis group). The preoperative FDP level and clinicopathological characteristics as well as the clinicopathological characteristics of NSCLC patients with different FDP levels were compared between the two groups. The correlation between preoperative FDP level and TNM staging was analyzed by using Spearman correlation analysis. Results Among 521 NSCLC patients, 266 cases were female, 255 cases were male the age [M(Q1,Q3)] was 59 years (54 years, 65 years) 441 cases were adenocarcinoma and 70 cases were squamous cell carcinoma. The preoperative median FDP level was 2.78 mg/L (2.35 mg/L, 3.13 mg/L) and 2.99 mg/L (2.56 mg/L, 4.16 mg/L), respectively of NSCLC patients in non-metastasis group and metastasis group, and the difference was statistically significant (Z = 6.13, P < 0.001). The preoperative FDP level was 2.56 mg/L (2.35 mg/L, 3.20 mg/L) and 2.99 mg/L (2.56 mg/L, 3.20 mg/L), respectively in the early-stage NSCLC (stage Ⅰ-Ⅱ) and advanced NSCLC (stage Ⅲ-Ⅳ) patients, and the difference was statistically significant ( Z = 8.42, P < 0.001). Spearman correlation analysis showed that preoperative FDP level was positively correlated with tumor diameter ( r = 0.287, P < 0.001). There was a positive correlation between preoperative FDP level and the number of metastatic lymph nodes in 115 patients with lymph node metastasis ( r = 0.679, P < 0.001). According to the preoperative median FDP (2.78 mg/L), all patients were divided into FDP ≤2.78 mg/L group and FDP >2.78 mg/L, and there were statistically significant differences in age, metastasis, tumor staging, tumor diameter, the metastatic number of lymph node and histological types of NSCLC patients in both groups (all P < 0.05). Conclusions The increase of preoperative plasma FDP level may be related to the tumor metastasis and clinical stage of NSCLC patients

    癌,非小细胞肺纤维蛋白原肿瘤转移肿瘤分期

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    信迪利单抗联合紫杉醇、多西他赛二线治疗晚期非小细胞肺癌效果分析

    蔚晓勇李晓凤史婉婷杜家乐...
    6-10页
    查看更多>>摘要：目的 探讨信迪利单抗联合紫杉醇、多西他赛二线治疗晚期非小细胞肺癌（NSCLC）的效果。 方法 前瞻性队列研究。前瞻性选取包头市肿瘤医院2019年10月至2022年10月收治的90例二线治疗晚期NSCLC患者，采用随机数字表法分为研究组（信迪利单抗联合紫杉醇或多西他赛二线治疗，45例）和对照组（单纯紫杉醇或多西他赛二线治疗，45例）。比较两组患者的近期疗效、血清细胞因子水平、生命质量和T细胞亚群等；获取随访6个月内患者生存情况，采用Kaplan-Meier法分析两组总生存（OS），组间比较行log-rank检验。 结果 研究组和对照组患者年龄分别为（63±5）岁、（65±6）岁，分别有男性25例（55.56%）、28例（62.22%），两组性别、年龄、美国东部肿瘤协作组评分、体质量差异均无统计学意义（均P>0.05），具有可比性。研究组总有效率为88.89%（40/45），对照组为71.11%（32/45），差异有统计学意义（χ2＝4.44，P＝0.035）。两组治疗后血清血管内皮生长因子（VEGF）、糖类抗原125（CA125）水平均低于治疗前（均P<0.001），且治疗后研究组均低于对照组[VEGF：（223±15）pg/ml比（289±15）pg/ml，t＝20.82，P<0.001；CA125：（23±6）ng/ml比（75±4）ng/ml，t＝51.28，P<0.001]；两组治疗后生命质量量表评分、Karnofsky评分均高于治疗前（均P<0.05），且治疗后研究组均高于对照组[生命质量量表评分：（63±6）分比（51±5）分，t＝10.29，P<0.001；Karnofsky评分：（80.5±5.7）分比（78.8±3.7）分，t＝1.70，P＝0.041]；两组治疗后T细胞亚群相关指标均高于治疗前（均P<0.001），且治疗后研究组均高于对照组[CD3+细胞比例：（68±5）%比（65±5）%，t＝2.52，P＝0.014；CD4+细胞比例：（42.5±1.7）%比（36.5±3.7）%，t＝9.91，P<0.001；CD4+/CD8+：1.78±0.54比1.46±0.27，t＝3.56，P<0.001]。研究组和对照组不良反应总发生率差异无统计学意义[11.11%（5/45）比15.55%（7/45），χ2＝0.39，P＝0.534]。随访6个月，研究组OS优于对照组（χ2＝3.86，P＝0.044）。 结论 信迪利单抗联合紫杉类药物二线治疗晚期NSCLC有效，可改善患者免疫功能，安全性良好。 Objective To investigate the efficacy of sintilimab combined with paclitaxel and docetaxel in the treatment of advanced non-small cell lung cancer (NSCLC). Methods Prospective cohort study was performed. A total of 90 patients with advanced NSCLC receiving second-line treatment in Baotou Cancer Hospital from October 2019 to October 2022 were prospectively selected. All patients were divided into the study group (sintilimab combined with paclitaxel and docetaxel as second-line treatment, 45 cases) and the control group (paclitaxel or docetaxel alone, 45 cases) according to random number table method. The short-term efficacy, serum cytokine levels, quality of life and T-cell subsets of the two groups were compared. The survival of patients within 6 months was followed up. Kaplan-Meier method was used to analyze the overall survival (OS) of both groups, and log-rank test was used to make comparison among groups. Results There were 25 males (55.56%) in the study group with the age of (63±5) years and 28 males (62.22%) in the control group with the age of (65±6) years. There were no statistically significant differences in the gender, age, Eastern Cooperative Oncology Group scores, the body mass (all P>0.05). The total effective rate was 88.89% (40/45) in the study group and 71.11% (32/45) in the control group, and the difference was statistically significant (χ2 = 4.44, P = 0.035). The levels of serum vascular endothelial growth factor (VEGF) and carbohydrate antigen 125 (CA125) of both groups after treatment were lower than those before treatment (all P<0.001) the levels of VEGF and CA125 in the study group after treatment were lower than those in the control group [VEGF: (223±15) pg/ml vs. (289±15) pg/ml,t=20.82, P<0.001 CA125: (23±6) ng/ml vs. (75±4) ng/ml,t=51.28, P<0.001].Quality of life scale score, Karnofsky score of both groups after treatment were higher than those before treatment (allP<0.05) quality of life scale score and Karnofsky score in the study group after treatment were higher than those in the control group [quality of life scale score: (63±6) scores vs. (51±5) scores,t=10.29, P<0.001 Karnofsky score: (80.5±5.7) scores vs.(78.8±3.7) scores,t=1.70,P=0.041]. T-cell subsets indicators of both groups after treatment were higher than those before treatment (all P<0.001). T-cell subsets indicators in the study group after treatment were higher than those in the control group [CD3+ cell proportion: (68±5)% vs. (65±5)%, t=2.52, P = 0.014 CD4+ cell proportion:(42.5±1.7)% vs. (36.5±3.7)%, t=9.91, P<0.001 CD4+/CD8+: 1.78±0.54 vs. 1.46±0.27, t=3.56, P<0.001]. There was no significant difference in the incidence of adverse reactions between the two groups [11.11% (5/45) vs. 15.55% (7/45),χ2=0.39,P=0.534]. The follow-up time was 6 months. The OS in the study group was better than that in the control group (χ2=3.86, P = 0.044). Conclusions Sintilimab combined with taxoid chemotherapy drugs is effective in the second-line treatment of advanced NSCLC, and it improves immune function and shows a favorable safety.

    癌,非小细胞肺免疫检查点抑制剂紫杉烷类治疗结果

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    同期与分期电视辅助胸腔镜手术解剖性肺段切除治疗双侧双原发肺癌效果比较

    王峰万子扬罗利华郎华...
    11-15页
    查看更多>>摘要：目的 探讨同期与分期电视辅助胸腔镜手术（VATS）解剖性肺段切除治疗双侧双原发肺癌（DPLC）的临床效果。 方法 回顾性队列研究。回顾性分析2020年2月至2022年8月泸州市中医医院76例行VATS解剖性肺段切除的双侧DPLC患者的临床资料，依据手术方式分为同期双侧胸腔镜手术组（同期组，44例）和分期胸腔镜手术组（分期组，32例）。比较两组术中情况、围术期指标和术后并发症发生情况等。 结果 两组患者性别、年龄、病理分型、术后TNM分期比较，差异均无统计学意义（均P>0.05）。分期组一、二期手术麻醉苏醒时间分别为（11±3）min、（13±4）min，均短于同期组的（16±4）min （t值分别为5.27、3.51，均P<0.05）。同期组放置引流管数量少于分期组两期叠加[（1.9±0.5）根比（2.2±0.5）根，t＝3.40，P＝0.001]。分期组一、二期手术胸腔引流管留置时长、术后总引流量、住院时间、术后首次下地时间和治疗总费用均低于同期组（均P<0.05），分期组两期叠加术后总引流量、住院时间和治疗总费用则均高于同期组（均P<0.05）。术后1个月同期组并发症总发生率高于分期组[18.18%（8/44）比3.13%（1/32）]，差异有统计学意义（χ2＝4.02，P＝0.045）。同期组日常活动能力评分、动脉血氧气分压、动脉血二氧化碳分压、血氧饱和度均低于分期组（均P<0.05）。 结论 分期VATS解剖性肺段切除治疗双侧DPLC并发症少，患者日常活动能力好，但同期双侧胸腔镜手术治疗费用低。临床医生在全面考虑患者身体及经济因素的情况下，可优先选择同期双侧胸腔镜手术。 Objective To explore the clinical efficacy of simultaneous or staged video-assisted thoracoscopic surgery (VATS) anatomic segmentectomy for bilateral double primary lung cancer (DPLC). Methods A retrospective cohort study was conducted. The clinical data of 76 patients with bilateral DPLC who underwent VATS anatomic segmentectomy in Luzhou Traditional Chinese Medicine Hospital from February 2020 to August 2022 were retrospectively analyzed, and they were classified into the simultaneous bilateral thoracoscopic surgery group (the simultaneous group, 44 cases) and the staged thoracoscopic surgery group (the staged group, 32 cases) on the basis of the surgical methods. The intraoperative conditions, perioperative indexes and postoperative complications of the two groups were compared. Results There were no statistically significant differences in the gender, age, pathological type,postoperative TNM staging of both groups (all P > 0.05). The anesthesia awakening time of the first and second stages of surgery in the staged group was (11±3) min and (13±4) min, which was shorter than that in the simultaneous group [(16±4) min] ( t values were 5.27 and 3.51, both P < 0.05). The number of drainage tubes placed in the simultaneous group was less than that in the sum of two stages of the staged group [(1.9±0.5) tubes vs. (2.2±0.5) tubes, t = 3.40, P = 0.001]. The duration of thoracic drainage tube retention, the postoperative total drainage flow, the days of hospitalization, the first postoperative landing time, and the total treatment cost in the first and second stages of surgery in the staged group were lower than those in the simultaneous group (all P < 0.05), while the postoperative total drainage flow, the days of hospitalization, and the total treatment cost in the sum of two stages of the staged group were higher than those in the simultaneous group (all P < 0.05). The total incidence of complications in the simultaneous group was higher than that in the staged group 1 month after surgery [18.18% (8/44) vs. 3.13% (1/32)], and the difference was statistically significant ( χ2 = 4.02, P = 0.045). The scores of activities of daily living, arterial partial pressure of oxygen, arterial partial pressure of carbon dioxide, and blood oxygen saturation in the simultaneous group were lower than those in the staged group (all P < 0.05). Conclusions Staged VATS anatomic segmentectomy for bilateral DPLC has few complications and good ability to perform activities of daily living, whereas the treatment cost of simultaneous bilateral thoracoscopic surgery is low. Clinicians may recommend prioritizing simultaneous bilateral thoracoscopic surgery after comprehensively considering the patients ' physical and economic conditions.

    肺肿瘤肿瘤,多原发性胸外科手术,电视辅助解剖性肺段切除同期手术分期手术

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    EGFR-TKI与化疗一线治疗EGFR少见突变非小细胞肺癌患者效果及预后比较

    郭燕蓉王静郭沁香赵畅...
    16-23页
    查看更多>>摘要：目的 探讨表皮生长因子受体（EGFR）少见突变非小细胞肺癌（NSCLC）患者一线接受EGFR酪氨酸激酶抑制剂（TKI）治疗与化疗的效果的差异。 方法 回顾性病例对照研究。回顾性收集2013年1月至2019年10月于山西省肿瘤医院接受治疗的伴EGFR少见突变的NSCLC患者资料。一线治疗前均采用扩增阻滞突变系统-聚合酶链反应（ARMS-PCR）检测活组织或血液EGFR突变情况。根据一线治疗方法将患者分为EGFR-TKI治疗组和化疗组。比较两组客观缓解率（ORR）、疾病控制率（DCR），采用Kaplan-Meier法绘制无进展生存（PFS）和总生存（OS）曲线，组间比较采用log-rank检验。采用单因素和多因素Cox比例风险模型分析PFS和OS的影响因素。 结果 169例EGFR少见突变患者纳入研究，年龄[M（IQR）]63岁（12岁），<65岁96例（56.8%），≥65岁73例（43.2%）；男性70例（41.4%），女性99例（58.6%）；EGFR G719X突变55例（32.5%），L861Q突变45例（26.6%），S768I突变17例（10.1%），复合突变52例（30.8%）；一线接受化疗55例（32.5%），一线接受EGFR-TKI治疗114例（67.5%）。化疗组患者ORR 36.4%（20/55），DCR 85.5%（47/55）；EGFR-TKI治疗组患者ORR 72.8%（83/114），DCR 90.4%（103/114）；EGFR-TKI治疗组ORR高于化疗组（χ2＝20.70，P＝0.001），DCR差异无统计学意义（χ2＝1.76，P＝0.184）。G719X、L861Q、复合突变的EGFR-TKI治疗组ORR均高于相应突变的化疗组，差异均有统计学意义（均P<0.05），但DCR差异均无统计学意义（均P>0.05）。EGFR-TKI治疗组中位PFS时间9.7个月（95%CI：6.0～13.4个月），化疗组中位PFS时间3.8个月（95%CI：3.1～7.1个月）；两组PFS差异有统计学意义（P<0.001）。EGFR-TKI治疗组中位OS时间25.6个月（95%CI：18.0～37.9个月），化疗组中位OS时间31.7个月（95%CI：18.0～42.8个月）；两组OS差异无统计学意义（P＝0.231）。多因素Cox回归分析显示，脑转移情况[有比无：HR＝2.306，95%CI：1.452～3.661，P<0.001]和一线治疗方式[EGFR-TKI治疗比化疗：HR＝0.457，95%CI：0.317～0.658，P<0.001]是EGFR少见突变NSCLC患者PFS的独立影响因素，脑转移情况（有比无：HR＝2.087，95%CI：1.102～3.953，P＝0.024；未知比无：HR＝2.118，95%CI：1.274～3.520，P＝0.004）为患者OS的独立影响因素。 结论 与一线化疗相比，一线EGFR-TKI治疗可改善EGFR少见突变NSCLC患者客观缓解及PFS，但未观察到OS获益。 Objective To investigate the therapeutic effect difference between first-line treatment with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKI) and chemotherapy in non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) rare mutation. Methods A retrospective case-control study was performed. Data of NSCLC patients with rare EGFR mutation who were treated in Shanxi Province Cancer Hospital from January 2013 to October 2019 were retrospectively analyzed. EGFR mutations in living tissues or blood were detected by using amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) before first-line treatment. According to first-line treatment methods,they were divided into EGFR-TKI treatment group and chemotherapy group. Objective remission rate (ORR) and disease control rate (DCR) of both groups were compared. Kaplan-Meier method was used to draw progression-free survival (PFS) and the overall survival (OS) curves. Log-rank test was used for comparison among groups. Single-factor and multi-factor Cox proportional risk models were used to analyze the influencing factors of PFS and OS. Results A total of 169 patients with EGFR rare mutations were included, and the age [M (IQR)] was 63 years (12 years) there were 96 cases (56.8%) < 65 years and 73 cases (43.2%) ≥65 years 70 (41.4%)males and 99 (58.6%) females 55 cases (32.5%) had EGFR G719X mutation,45 cases (26.6%) had L861Q mutation, 17 cases (10.1%) had S768I mutation, and 52 cases (30.8%) had complex mutation 55 cases (32.5%) received the first-line chemotherapy and 114 cases (67.5%) received the first-line EGFR-TKI treatment. In the chemotherapy group, ORR was 36.4% (20/55) and DCR was 85.5% (47/55) in EGFR-TKI treatment group, ORR was 72.8% (83/114) and DCR was 90.4% (103/114). The ORR of EGFR-TKI treatment group was higher than that of chemotherapy group ( χ2 = 20.70, P = 0.001), and there was no statistically significant difference in DCR between two groups (χ2 = 1.76, P = 0.184). Subgroup analysis showed that ORR in EGFR-TKI treatment group with G719X, L861Q and complex mutations was higher than that of the corresponding mutations in chemotherapy group, and the differences were statistically significant (all P < 0.05), while there were no significant differences in DCR among subgroups (all P > 0.05). The median PFS time was 9.7 months (95% CI: 6.0-13.4 months) and 3.8 months (95% CI: 3.1-7.1 months), respectively in EGFR-TKI treatment group and chemotherapy group, and there was a statistically significant difference in PFS between the two groups (P < 0.001). The median OS time was 25.6 months (95% CI: 18.0-37.9 months) and 31.7 months (95% CI: 18.0-42.8 months), respectively in EGFR-TKI treatment group and chemotherapy group, and there was no statistically significant difference in OS between the two groups (P = 0.231). Multivariate Cox regression analysis showed that brain metastasis [with vs. without: HR = 2.306, 95% CI: 1.452-3.661, P < 0.001] and the first-line treatment methods (EGFR-TKI vs. chemotherapy: HR = 0.457, 95% CI:0.317-0.658, P < 0.001) were independent influencing factors for PFS of NSCLC patients with EGFR rare mutation brain metastasis (with vs. without: HR = 2.087, 95% CI: 1.102-3.953, P = 0.024 unknown vs. without: HR = 2.118,95% CI: 1.274-3.520, P = 0.004) were independent influencing factors for OS of NSCLC patients with EGFR rare mutation. Conclusions Compared with the first-line chemotherapy, EGFR-TKI first-line treatment could improve objective remission and PFS of NSCLC patients with EGFR rare mutation, while no OS benefit is observed.

    癌,非小细胞肺受体,表皮生长因子突变酪氨酸激酶抑制剂药物疗法

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    深部热疗联合信迪利单抗及nab-PC方案治疗驱动基因阴性、PD-L1表达阳性晚期鳞状非小细胞肺癌效果及安全性

    肖敬李超张淑平程晓云...
    24-31页
    查看更多>>摘要：目的 探讨深部热疗联合信迪利单抗及nab-PC（白蛋白结合型紫杉醇+卡铂）方案治疗驱动基因阴性、程序性死亡受体配体1（PD-L1）表达阳性的晚期鳞状非小细胞肺癌（NSCLC）的临床效果及安全性。 方法 前瞻性病例对照研究。收集河北省第七人民医院2020年1月至2022年12月收治的84例驱动基因阴性、PD-L1表达阳性的晚期鳞状NSCLC患者。按随机数字表法分为观察组与对照组（各42例）。对照组给予信迪利单抗联合nab-PC方案治疗，观察组在对照组基础上联合深部热疗。连续治疗4个周期后比较两组患者近期疗效，比较两组治疗前后患者血清肿瘤标志物[癌胚抗原（CEA）、鳞状细胞癌抗原（SCCA）、细胞角蛋白片段19（CYFR21-1）]水平以及免疫组织化学标志物[p40、p63、细胞角蛋白5/6（CK5/6）]阳性表达率，比较两组癌症治疗功能评价系统-肺癌模块（FACT-L）评分、不良反应和远期生存情况。 结果 观察组男性26例，女性16例，年龄（59±11）岁；对照组男性22例，女性15例，年龄（58±11）岁。观察组客观缓解率、疾病控制率分别为71.43%（30/42）、90.48%（38/42），对照组客观缓解率、疾病控制率分别为50.00%（21/42）、80.95%（34/42）；观察组客观缓解率高于对照组，差异有统计学意义（χ2＝4.04，P＝0.044）；两组疾病控制率比较差异无统计学意义（χ2＝1.56，P＝0.212）。治疗后两组血清CEA、SCCA、CYFRA21-1水平以及p40、p63、CK5/6阳性表达率均较治疗前低（均P<0.05），FACT-L评分中生理状况、功能状况、附加关注情况维度评分及量表总分均较治疗前高（均P<0.05）。两组血小板减少、中性粒细胞减少、白细胞减少、贫血、发热等发生率比较差异均无统计学意义（均P>0.05）。观察组和对照组中位无进展生存时间分别为6.5个月（95%CI：3.82～12.75）、5.1个月（95% CI：3.14～12.26），组间比较差异有统计学意义（χ2＝4.21，P＝0.040）。观察组和对照组中位总生存时间分别为12.9个月（95% CI：6.25～15.46）、9.7个月（95% CI：4.74～13.02），组间比较差异有统计学意义（χ2＝4.43，P＝0.035）。 结论 深部热疗联合信迪利单抗及nab-PC方案治疗驱动基因阴性、PD-L1表达阳性的晚期鳞状NSCLC，能有效降低患者血清肿瘤标志物水平及免疫组织化学标志物阳性表达率，提高患者生命质量，提高疗效。 Objective To investigate the clinical efficacy and safety of deep hyperthermia combined with sintilimab and nab-PC (albumin-bound paclitaxel + carboplatin) regimen in the treatment of advanced squamous non-small cell lung cancer (NSCLC) with driver gene negative and programmed death-1 receptor ligand 1 (PD-L1) expression positive. Methods A prospective case-control study was performed. A total of 84 advanced squamous NSCLC patients with driver gene negative and PD-L1 expression positive in Hebei Seventh People's Hospital from January 2020 to December 2022 were collected, and all patients were divided into the observation group and the control group according to the random number table method, with 42 cases in each group. The control group was given the treatment of sintilimab combined with nab-PC regimen, and the observation group was given deep hyperthermia on the basis of the control group. After 4 consecutive cycles of treatment, the short-term efficacy of the two groups was compared. The levels of serum tumor markers [carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCCA), cytokeratin fragment 19 (CYFR21-1)], and the positive expression rates of immunohistochemistry markers [p40, p63, and cytokeratin 5/6 (CK5/6)] before and after treatment were compared between two groups. Functional Assessment of Cancer Therapy-Lung cancer module (FACT-L) scores, the adverse reactions and the long-term survival of the two groups were compared. Results There were 26 males and 16 females in the observation group, and the age was (59±11) years there were 22 males and 15 females in the control group, and the age was (58±11) years. The objective remission rate and the disease control rate were 71.43% (30/42), 90.48% (38/42), respectively in the observation group, and 50.00% (21/42), 80.95% (34/42), respectively in the control group the objective remission rate in the observation group was higher than that in the control group, and the difference was statistically significant (χ2 = 4.04, P = 0.044) and there was no statistically significant difference in the disease control rate of both groups (χ2 = 1.56, P = 0.212). The levels of serum CEA, SCCA and CYFRA21-1, and the positive expression rates of p40, p63, and CK5/6 in the two groups after treatment were lower than those before treatment (all P < 0.05) and the scores of physiological status, functional status, additional concern in FACT-L scores and the total score of the scale after treatment were higher than those before treatment (all P < 0.05). There were no statistically significant differences in the incidence of adverse reactions including thrombocytopenia, neutropenia, leukopenia, anemia, fever of the two groups (all P > 0.05). The median progression-free survival (PFS) time was 6.5 months (95% CI: 3.82-12.75), 5.1 months (95% CI: 3.14-12.26),respectively in the observation group and the control group, and the difference in the median PFS time was statistically significantly of both groups (χ2 = 4.21, P = 0.040). The median overall survival (OS) time was 12.9 months (95% CI: 6.25-15.46), 9.7 months (95% CI: 4.74-13.02), respectively in the observation group and the control group, and the difference in the median OS time was statistically significantly of both groups (χ2 = 4.43, P = 0.035). Conclusions Deep hyperthermia combined with sintilimab and nab-PC regimen in the treatment of advanced squamous NSCLC with driver gene negative and PD-L1 expression positive can effectively reduce the serum tumor markers levels and positive expression rate of immunohistochemical markers, improve the quality of life of patients, and increase the short-term and long-term efficacy.

    癌,非小细胞肺抗肿瘤联合化疗方案免疫检查点抑制剂透热疗法

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    基于SEER数据库老年晚期肺腺癌术后患者预后预测模型的构建

    陈琳俪张阿润卜文璐刘传波...
    32-40页
    查看更多>>摘要：目的 基于监测、流行病学和最终结果（SEER）数据库大样本数据，构建并分析可视化预测老年晚期肺腺癌术后患者预后的列线图模型。 方法 使用SEER*Stat8.4.0.1软件筛选2000年至2019年SEER数据库中来自17个注册点的数据，纳入4 453例经美国癌症联合会（AJCC）第7版分期标准诊断为Ⅲ期和Ⅳ期接受手术治疗、年龄≥65岁的肺腺癌患者，按7∶3比例随机分为训练集（3 117例）和验证集（1 336例），比较两组的流行病学资料和临床病理特征。采用LASSO回归进行数据降维，从患者预后因素中选择最佳预测因子。采用Cox比例风险模型对筛选出来的变量进行单因素和多因素分析，采用R软件rms包根据预后独立危险因素构建列线图，预测患者1、3、5年肿瘤特异性生存（CSS）率。采用Bootstrap法对验证集进行1 000次等量有放回重复采样验证，采用C指数、受试者工作特征（ROC）曲线及校正曲线验证列线图模型的准确性。 结果 训练集、验证集患者年龄、性别、种族、肿瘤位置、Grade分级、手术方式、淋巴结清扫数目、放疗方式、肿瘤长径、肿瘤转移、婚姻、居住环境、TNM分期、放化疗等比较，差异均无统计学意义（均P>0.05）。将训练集中18个变量纳入LASSO回归分析，对变量进行降维，共筛选出11个最优预测变量，年龄≥85岁（HR＝2.34，95% CI：1.803～3.037，P<0.01）、男性（HR＝1.326，95% CI：1.228～1.432，P<0.01），Grade分级Ⅲ～Ⅳ级（HR＝1.333，95% CI：0.844～2.105，P<0.01）、未清扫淋巴结（HR＝2.261，95% CI：2.023～2.527，P<0.01），肿瘤长径≥3.7 cm（HR＝1.445，95% CI：1.333～1.566，P<0.01），发生骨转移（HR＝1.535，95% CI：1.294～1.819，P<0.01）、脑转移（HR＝1.308，95% CI：1.117～1.532，P<0.01）、肺转移（HR＝1.229，95% CI：1.056～1.431，P＝0.01），居住于农村（HR＝1.215，95% CI：1.084～1.363，P<0.01）、TNM分期Ⅳ期（HR＝1.155，95% CI：1.044～1.278，P＝0.01）、术后放疗（HR＝1.148，95% CI：1.054～1.250，P<0.01）的肺腺癌患者预后更差。根据以上变量构建列线图预测模型，预测老年晚期肺腺癌术后患者1、3、5年CSS率。采用Bootstrap法重复抽样1 000次验证列线图的建模效果，模型组训练集的C指数为0.654（95%CI：0.641～0.668），验证集为0.666（95% CI：0.646～0.685）。分别绘制老年晚期肺腺癌术后患者训练集和验证集1、3、5年CSS率的ROC曲线，曲线下面积（AUC）分别为0.730（95% CI：0.708～0.754）和0.689（95% CI：0.672～0.710）、0.687（95% CI 0.668～0.711）和0.731（95% CI：0.697，0.765）、0.712（95% CI：0.684～0.740）、0.714（95% CI：0.683～0.745）。校准曲线显示模型预测概率与真实概率具有较高的一致性。 结论 根据最优预测变量构建的老年晚期肺腺癌术后患者预后预测列线图模型，可能是患者生存预测的一个简便工具。 Objective To construct and analyze the visual nomogram predictive model for the prognosis of elderly advanced lung adenocarcinoma patients after surgery based on the Surveillance, Epidemiology, and End Results (SEER) database. Methods SEER*Stat8.4.0.1 software was used to screen out the data from 17 register in SEER database between 2000 and 2019, and finally 4 453 lung adenocarcinoma patients aged ≥ 65 years who underwent surgical treatment and were diagnosed as stage Ⅲ and Ⅳ according to the 7th edition of the American Joint Committee on Cancer (AJCC) staging criteria were enrolled. The data were randomly divided into the training set (3 117 cases) and the validation set (1 336 cases) in a 7:3 ratio the epidemilogical data and clinicopathological characteristics of the two groups were compared. LASSO regression was used for data dimensionality reduction to select the best predictors from the prognostic factors of patients. Cox proportional risk model was used to perform univariate and multivariate analyses of the screened variables, and based on R software rms package and the prognostic independent risk factors, the nomogram was constructed to predict the 1-, 3-, and 5-year cancer-specific survival (CSS) rates of the patients. The validation set was validated by using Bootstrap method with 1 000 equal repeated samples with playback, and the accuracy of the nomogram model was verified by using the C-index, receiving operating characteristic (ROC) curves and calibration curves. Results There were no statistically significant differences in age, gender, race, tumor location, Grade grading, surgery methods, the number of lymph node dissection, radiotherapy, tumor diameter, tumor metastasis, marriage, living condition, TNM staging, radiochemotherapy of training set and validation set (all P > 0.05). In training set, 18 variables were included into LASSO regression analysis and were performed with dimensionality reduction ultimately, 11 optimal predictive variables were selected, including age ≥ 85 years ( HR = 2.34, 95% CI: 1.803-3.037, P < 0.01), male ( HR = 1.326, 95% CI: 1.228-1.432, P < 0.01), Grade grading Ⅲ-Ⅳ ( HR = 1.333, 95% CI: 0.844-2.105, P < 0.01), undissected lymph nodes ( HR = 2.261, 95% CI: 2.023-2.527, P < 0.01), tumor diameter ≥3.7 cm ( HR = 1.445, 95% CI: 1.333-1.566, P < 0.01), bone metastasis ( HR = 1.535, 95% CI: 1.294-1.819, P < 0.01), brain metastasis ( HR = 1.308, 95%CI: 1.117-1.532, P < 0.01), lung metastasis ( HR = 1.229, 95% CI: 1.056-1.431, P = 0.01), living in rural areas (HR = 1.215, 95% CI: 1.084-1.363, P < 0.01), TNM staging Ⅳ ( HR = 1.155, 95% CI: 1.044-1.278, P = 0.01), postoperative radiotherapy (HR = 1.148, 95% CI: 1.054-1.250, P < 0.01) lung adenocarcinoma patients with the above 11 factors had worse prognosis. Based on the variables, the nomogram predictive model was constructed to predict 1-, 3-, and 5-year CSS rates of elderly advanced lung adenocarcinoma patients. Bootstrap method was used for repeated sampling for 1 000 times to verify the modeling effect of nomogram. In the model group, C-index was 0.654 (95% CI: 0.641-0.668), 0.666 (95% CI: 0.646-0.685), respectively in the training set and the validation set. The nomogram was drawn to predict ROC curves of 1-, 3-, and 5-year CSS rates for elderly advanced lung adenocarcinoma patients after operation in the training set and validation set the area under the curve (AUC) of 1-year, 3-year, and 5-year CSS rates was 0.730 (95% CI: 0.708-0.754) and 0.689 (95% CI: 0.672-0.710), 0.687 (95% CI: 0.668-0.711) and 0.731 (95% CI: 0.697-0.765), 0.712 (95% CI:0.684-0.740) and 0.714 (95% CI: 0.683-0.745), respectively in the training and validation sets. The calibration curve showed a high consistency between the predicted probability of the model and the actual probability. Conclusions The nomogram model constructed by optimal predictive variables for predicting the prognosis of elderly advanced lung adenocarcinoma patients after surgery may be a convenient tool for survival prediction of these patients.

    肺腺癌老年人列线图预后

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    基于SEER数据库的喉癌合并同时性肺癌患者预后影响因素分析

    苏宏艳李红卫杨尚铭郎华...
    41-46页
    查看更多>>摘要：目的 探讨喉癌合并同时性肺癌患者的预后影响因素以及首诊病种与造成死亡病种之间的关系。 方法 回顾性分析监测、流行病学和最终结果（SEER）数据库中2004年1月至2015年12月被诊断为喉癌合并同时性肺癌240例患者的临床病理资料。采用χ2检验评估患者首诊病种与造成死亡病种之间的关系；采用Kaplan-Meier法行生存分析；采用Cox比例风险模型对患者总生存的影响因素进行单因素和多因素分析。 结果 共纳入240例喉癌合并同时性肺癌患者，其中年龄≥65岁141例；男性222例，女性18例。患者首诊的病种与造成死亡的病种无关（χ2＝3.31，P＝0.191）。患者1、3、5年总生存率分别为62.1%、31.5%、16.4%。单因素分析显示，喉癌原发灶位置、肺癌原发灶位置、肺癌组织学分级、病理学类型、临床分期、手术情况、放疗情况对患者总生存均有影响（均P<0.05）；多因素分析显示，喉癌原发灶位置、肺癌原发灶位置、肺癌组织学分级、病理学类型、临床分期、手术情况是患者总生存的独立影响因素（均P<0.05）。 结论 喉癌合并同时性肺癌患者预后的独立影响因素包括喉癌原发灶位置、肺癌原发灶位置、肺癌组织学分级、病理学类型、临床分期、手术情况。患者首诊病种与造成死亡病种之间不具有相关性。 Objective To explore the prognostic factors and the relationship between the disease type at initial diagnosis and the disease type causing death in patients with laryngeal cancer combined with simultaneous lung cancer. Methods The clinicopathological data of 240 patients diagnosed with laryngeal cancer combined with simultaneous lung cancer between January 2004 and December 2015 in the Surveillance, Epidemiology and End Results (SEER) database were retrospectively analyzed. Chi-square test was used to evaluate the relationship between the disease type at initial diagnosis and the disease type causing death in patients with laryngeal cancer combined with simultaneous lung cancer. Kaplan-Meier method was used for survival analysis, and Cox proportional risk model was used to make univariate and multivariate analysis of the factors influencing the overall survival of patients. Results A total of 240 cases with laryngeal cancer combined with simultaneous lung cancer included 222 males and 18 females, and there were 141 cases aged over 65 years. The disease type at initial diagnosis was not correlated with the disease type causing death of patients (χ2 = 3.31, P = 0.191). The 1-year, 3-year, and 5-year overall survival rates of these patients were 62.1%, 31.5%, and 16.4%, respectively. Univariate analysis showed that the primary location of laryngeal cancer, primary location of lung cancer, histological grade of lung cancer, pathological type, clinical staging, surgical condition, and radiotherapy influenced the overall survival of patients (all P < 0.05) multivariate analysis showed that the primary location of laryngeal cancer, primary location of lung cancer, histological grade of lung cancer, pathological type, clinical stage, and surgical condition were independent influencing factors for overall survival of patients with laryngeal cancer combined with simultaneous lung cancer (all P < 0.05). Conclusions The independent factors influencing the prognosis of laryngeal cancer with simultaneous lung cancer patients include the primary focus of laryngeal cancer, the primary focus of lung cancer, the histological grade of lung cancer, the pathological type, the clinical stage, and the surgical condition. And there is no correlation between the disease type at initial diagnosis and the disease type causing death.

    喉肿瘤肺肿瘤肿瘤,多原发性预后

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    光学表面监测系统容积漫游技术体表影像在胸部肿瘤调强放疗中的应用价值

    肖志平李定宇付秀根李君超...
    47-51页
    查看更多>>摘要：目的 探讨光学表面监测系统（OSMS）容积漫游技术（VRT）体表影像在胸部肿瘤调强放疗中的应用价值。 方法 回顾性病例系列研究。回顾性分析2021年9月至2022年10月华中科技大学同济医学院附属同济医院收治的65例行调强放疗的胸部肿瘤患者的临床资料。患者首次治疗行锥形束CT（CBCT）扫描并校正后利用OSMS获取VRT体表影像，后续治疗以VRT影像为基准，利用OSMS的六维床自动移动功能摆位，记录六维方向移床值，再行CBCT扫描并记录左右方向（X轴）、头脚方向（Y轴）和腹背方向（Z轴）平移误差和旋转误差。六维自动移床校正后，再记录此时的医学数字成像和通信（DICOM）体表影像实时δ（RTD）值，并获取新的VRT影像。CBCT配准误差值为VRT影像引导摆位误差，CBCT配准误差值与移床移动值之和为体表标记线引导摆位误差，CBCT配准误差值与记录的DICOM影像的RTD值之和为DICOM影像引导摆位的理论误差。对比分析VRT影像与体表标记线、DICOM影像引导摆位的优劣。 结果 65例患者包括男性42例，女性23例；年龄[M（Q1，Q3）]58岁（51岁，64岁）。VRT影像引导摆位在X、Y、Z轴上的线性误差[M（Q1，Q3）]分别为0.6 mm（0.3 mm，1.2 mm）、1.2 mm（0.5 mm，2.4 mm）、1.1 mm（0.5 mm，1.9 mm），旋转误差分别为0.4°（0.1°，0.7°）、0.4°（0.1°，0.6°）、0.4°（0.2°，0.6°）；标记线引导摆位的线性误差分别为1.6 mm（0.9 mm，2.6 mm）、2.2 mm（1.1 mm，3.8 mm）、1.0 mm（0.4 mm，1.8 mm），旋转误差分别为0.7°（0.3°，1.2°）、0.5°（0.2°，0.8°）、0.5°（0.2°，0.8°）；DICOM影像引导摆位的线性误差分别为1.1 mm（0.6 mm，1.9 mm）、2.1 mm（1.0 mm，3.4 mm）、1.3 mm（0.6 mm，3.1 mm），旋转误差分别为0.6°（0.2°，1.1°）、0.7°（0.3°，1.1°）、0.7°（0.2°，1.1°）。与标记线引导摆位相比，除Z轴线性误差（P＝0.218）外，VRT影像引导摆位其余误差均低（均P<0.001）；与DICOM影像引导摆位比较，VRT影像引导摆位X、Y、Z轴线性误差和旋转误差均低（均P<0.01）。 结论 VRT影像引导摆位优于传统的体表标记摆位和DICOM影像摆位，OSMS VRT体表影像可有效提高胸部肿瘤调强放疗的摆位精度和稳定性，减少摆位误差。 Objective To explore the application value of optical surface monitoring system (OSMS) volume rendering technique (VRT) body surface imaging in intensity-modulated radiotherapy for thoracic tumors. Methods A retrospective case series study was performed. The clinical data of 65 patients with thoracic tumors treated with intensity-modulated radiotherapy at Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from September 2021 to October 2022 were retrospectively analyzed. In the first treatment,after cone-beam computed tomography (CBCT) scan and correction, VRT body surface images were obtained by using OSMS. In subsequent treatment, the VRT image was used as the benchmark and the 6-dimensional bed was automatically positioned to record the 6-dimensional bed positioning value. The CBCT scan was performed to record the translation and rotation errors of left-right direction (X-axis), head-foot direction (Y-axis) and front-rear direction (Z-axis). After the calibration of the 6-dimensional automatic bed shifting, the new real-time deltas (RTD) value of digital imaging and communications in medicine (DICOM) body surface image was recorded, and the new VRT image was obtained. CBCT registration error value was defined as VRT image-guided setup error. The sum of CBCT registration error value and moving bed movement value was defined as the body surface marker line-guided setup error. The sum of CBCT registration error value and the recorded DICOM image RTD value was defined as the theoretical error of DICOM image-guided setup. The advantages and disadvantages of VRT image, body surface marker line and DICOM image-guided setup were compared and analyzed. Results There were 42 males and 23 females in 65 patients with thoracic tumors, and the age [M (Q1, Q3)] was 58 years (51 years, 64 years). The linear errors [M (Q1, Q3)] of VRT image-guided setup in X, Y and Z axes were 0.6 mm (0.3 mm, 1.2 mm), 1.2 mm (0.5 mm, 2.4 mm) and 1.1 mm (0.5 mm, 1.9 mm) and the rotational errors were 0.4° (0.1°, 0.7°), 0.4° (0.1°, 0.6°) and 0.4° (0.2°, 0.6°). The linear errors of the marker line-guided setup were 1.6 mm (0.9 mm, 2.6 mm), 2.2 mm (1.1 mm, 3.8 mm) and 1.0 mm (0.4 mm, 1.8 mm) and the rotational errors were 0.7° (0.3°, 1.2°), 0.5° (0.2°, 0.8°) and 0.5° (0.2°, 0.8°). The linear errors of the DICOM image-guided positioning were 1.1 mm (0.6 mm, 1.9 mm), 2.1 mm (1.0 mm, 3.4 mm) and 1.3 mm (0.6 mm, 3.1 mm), and the rotational errors were 0.6° (0.2°, 1.1°), 0.7° (0.3°, 1.1°), 0.7° (0.2°, 1.1°). Compared with the marker line-guided setup, except for Z-axis linear error (P = 0.218), the VRT-guided setup errors were low (all P < 0.001). Compared with the DICOM imaging-guided setup, the VRT image-guided setup linear error and rotational error in X-, Y- and Z-axis were low (all P < 0.01). Conclusions VRT image-guided setup is superior to traditional body surface marker setup and DICOM imaging setup OSMS VRT body surface imaging can effectively improve the setup accuracy and stability of intensity-modulated radiotherapy for thoracic tumors, and reduce the setup errors.

    胸部肿瘤锥束计算机体层摄影术图像处理,计算机辅助放射治疗,图像引导放射治疗摆位误差容积漫游技术

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    气管镜窄带成像联合血清HSP70、Ntn1对支气管肺癌的临床诊断价值

    刘冠华郑康郎华
    52-56页
    查看更多>>摘要：目的 探讨气管镜窄带成像联合血清热休克蛋白70（HSP70）、神经轴突导向因子1（Ntn1）对支气管肺癌的临床诊断价值。 方法 回顾性队列研究。回顾性分析2021年1月至2022年1月山西省肿瘤医院收治的96例疑似中央型肺癌合并气道阻塞患者的临床资料，所有患者均采用支气管光镜检查及窄带成像进行分析，采用酶联免疫吸附试验（ELISA）检测血清HSP70、Ntn1水平。以病理活组织检查结果为金标准，采用受试者工作特征（ROC）曲线分析气管镜窄带成像联合血清HSP70、Ntn1水平对支气管肺癌的诊断价值。 结果 96例疑似患者中，男性70例，女性26例，年龄（46±5）岁；经病理确诊中央型肺癌72例，其中鳞状细胞癌43例，腺癌24例，小细胞癌3例，未分化2例，肺部良性病变24例。气管镜窄带成像诊断支气管肺癌的灵敏度、特异度、准确度分别为90.3%、79.2%、87.5%。肺癌患者血清HSP70、Ntn1水平均高于良性患者（均P<0.05）。ROC曲线显示，HSP70、Ntn1诊断支气管肺癌的最佳临界值分别为10.08 ng/ml、562.82 pg/ml，血清指标（HSP70+Ntn1）诊断支气管肺癌的灵敏度、特异度、准确度分别为93.1%、58.3%、84.4%；气管镜窄带成像联合血清指标诊断支气管肺癌的灵敏度、特异度、准确度分别为98.6%、87.5%、95.8%，其准确度高于单独气管镜窄带成像或血清指标（χ2值分别为4.36、7.07，均P<0.05）。 结论 气管镜窄带成像对支气管肺癌具有较好的诊断价值，而联合血清HSP70、Ntn1能进一步提高临床诊断效能。 Objective To investigate the clinical value of bronchoscopic narrow band imaging combined with serum heat shock protein family 70 (HSP70) and netrin-1 (Ntn1) in the diagnosis of bronchogenic carcinoma. Methods A retrospective cohort study was conducted. A total of 96 patients with suspected central lung cancer combined with airway obstruction admitted to Shanxi Province Cancer Hospital from January 2021 to January 2022 were retrospectively analyzed. Bronchoscopy and narrow band imaging were performed in all patients. Serum HSP70 and Ntn1 levels were measured by using enzyme-linked immunosorbent assay (ELISA). Pathological biopsy was taken as the gold standard. Receiver operating characteristic (ROC) curves were used to analyze the value of bronchoscopic narrow band imaging combined with serum HSP70 and Ntn1 in the diagnosis of bronchogenic carcinoma. Results There were 70 males and 26 females in 96 suspected patients, with the age of (46±5) years. According to the pathological results, 72 were diagnosed with central lung cancer, including 43 cases of squamous cell carcinoma, 24 cases of adenocarcinoma, 3 cases of small cell carcinoma, 2 undifferentiated cases,and 24 cases of benign lesions in lung. The sensitivity, specificity, and accuracy of bronchoscopic narrow band imaging in the diagnosis of bronchogenic carcinoma were 90.3%, 79.2% and 87.5%, respectively. The serum HSP70 and Ntn1 levels in patients with lung cancer were higher than those in benign patients (all P < 0.05). ROC curves showed that the optimal cut-off values of HSP70 and Ntn1 in the diagnosis of bronchogenic carcinoma were 10.08 ng/ml and 562.82 pg/ml, respectively. The sensitivity, specificity, and accuracy of serum markers (HSP70 + Ntn1) in the detection of bronchogenic carcinoma were 93.1%, 58.3% and 84.4%, respectively. The sensitivity, specificity, and accuracy of bronchoscopic narrow band imaging combined with serum markers in the diagnosis of bronchogenic carcinoma were 98.6%, 87.5% and 95.8%, respectively and the diagnostic accuracy of the combined method was higher than that of a single detection method such as bronchoscopic narrow band imaging or serum indexes ( χ2 values were 4.36, 7.07, all P < 0.05). Conclusions Bronchoscopic narrow band imaging has a good diagnostic value for bronchogenic carcinoma, and the combination of serum HSP70 and Ntn1 can further improve the clinical diagnostic efficacy.

    肺肿瘤气管镜窄带成像热休克蛋白家族70神经轴突导向因子诊断

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    肺肿瘤血栓性微血管病1例并文献复习

    于洋赵利宏蒋荣娜许力彬...
    57-60页
    查看更多>>摘要：目的 探讨肺肿瘤血栓性微血管病（PTTM）的诊治要点。 方法 回顾性分析吉林省肿瘤医院2022年11月收治的1例PTTM患者的临床及影像学检查资料，并复习文献。 结果 患者为34岁女性，确诊胃腺癌晚期1年半，本次入院主要临床表现为进行性加重的呼吸困难，胸部CT可见左肺下叶磨玻璃密度影，肺动脉增宽，实验室检查D-二聚体水平异常升高，CT下肺动脉造影检查无明显异常表现。给予糖皮质激素及低分子肝素钙抗凝等治疗，入院后第5天临床死亡。 结论 PTTM在临床中少见且预后极差。当肿瘤患者出现不明原因的呼吸困难伴肺动脉高压及血液高凝状态时，应当警惕PTTM的可能，应采取对症支持治疗，并针对原发肿瘤的化疗和靶向治疗。

    肺肿瘤血栓性微血管病肺动脉高压肿瘤转移

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