培美曲塞治疗晚期非小细胞肺癌近期疗效分析

Objective:The aim of our study was to observe the efficacy and toxicity of 50 cases of advanced non-small cell lung cancer (NSCLC) patients treated by pemetrexed.Methods:Fifty patients,including 29 females and 21 males,with a median age 62 years (35–82 years),13 of whom were treated with pemetrexed only and the left 37 cases were treated with pemetrexed combined with platinum in the Department of Oncology,Renmin Hospital of Wuhan University from June 2006 to March 2009.Single agent regimen:patients received pemetrexed 500 mg/m2 on day 1 with every 21 days.Combination regimen:patients received pemetrexed 500 mg/m2 on day 1 and carboplatin 300 mg/m2 on day 1 or cisplatin 35 mg/m2 on day 1 to day 3 or nedaplatin 80 mg/m2 on day 1 by intravenous infusion with 21 days as one cycle.RECIST 1.0 standard was used to evaluate the clinical efficiency,and the WHO toxicity standard was used to evaluate toxic reaction,and the QOL was used to evaluate the quality of life.Results:All patients were given 162 cycles (at least 2 cycles,at most 6 cycles) and the response rate of all the patients were evaluated.There were 2 complete remission (CR),7 partial remission (PR),22 stable disease (SD) and 19 progressive disease (PD) in the group,the overall response rate was (RR) was 18.0% and disease control rate (DCR) 62.0%.The quality of life improvement rate reaches 58.0%.The major toxic reaction included neutropenia,thrombocytopenia,hypemia,nausea,and vomiting.Most of the severity of these effects was grade I–II and well tolerated.Conclusion:Chemotherapy with pemetrexed or pemetrexed combined with platinum in the treatment of advanced non-small cell lung cancer is effective,safe and well-tolerable,which can improve quality of life of the patient.     

针对表皮生长因子受体的非小细胞肺癌靶向治疗

靶向治疗是特异性针对肿瘤发生、发展环节的新的一种药物治疗方法,近年来针对表皮生长因子受体的靶向治疗取得了长足的进展,为肺癌患者尤其是非小细胞肺癌患者的治疗带来了曙光.本文就表皮生长因子受体靶向治疗的作用机制及临床疗效、毒副作用做一综述.     

吉非替尼治疗晚期非小细胞肺癌不良反应的护理

目的 探讨晚期非小细胞肺癌患者应用吉非替尼治疗的疗效及不良反应.方法 选择30例晚期非小细胞肺癌患者,应用吉非替尼治疗90d后对其疗效及不良反应进行观察.结果 本组发生皮疹10例(33.33%),腹泻9例(30%),胃肠道反应5例(16.67%),肝功能异常4例(13.33%),间质性肺炎2例(6.67%).用药期间加强皮肤、口腔、胃肠道护理,密切监测生命体征、肝功能、呼吸功能,可提高疗效.结论 晚期非小细胞肺癌患者应用吉非替尼治疗出现不良反应时,及时进行护理干预和对症处理至关重要,有助于保证用药安全、提高治疗依从性和患者舒适度,能有效地提高患者的生存质量.     

Smac在非小细胞肺癌表达的临床意义

Objective:The aim of our study was to investigate the clinical significance of Smac (second mitochondria-derived activator of caspase) expression on non-small cell lung cancer (NSCLC). Methods:The expression of Smac was evaluated on RNA and protein level in tumor tissues. The expression of Smac mRNA was examined by RT-PCR in 59 samples of tumor tissues and matched normal lung tissues. The expression of Smac protein was examined by IHC in 213 cancer tissues. Results:The positive rate of Smac mRNA was found in 59.3% of cancer tissues, but only in 30.5% of matched normal tissues (P < 0.05). The positive rate of Smac protein was 76.5%. The expression of Smac in stage II disease was significantly higher than that in stage I disease (P = 0.001). The survival of patients with Smac overexpression was significantly shorter than those who were negative. Conclusion:Smac might be involved in the progression of NSCLC, the biologic significance of Smac in primary lung cancer needs further study.     

非含铂双药和非含铂单药治疗老年和/或PS差的非小细胞肺癌病人疗效:荟萃分析

Objective:The aim of the study was to compare the efficacies and toxicities of non-platinum doublets (doublets group) with a non-platinum single agent (single-agent group) in previously untreated advanced non-small cell lung cancer (NSCLC) patients with elderly age and/or poor performance status (PS).Methods:The PubMed database was screened.Subsequently,the hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS),relative risks (RRs) for overall response rate (ORR) and one-year survival,and odds ratios (ORs) for the different types of toxicities were pooled using the Review Manager 5.0 package.Results:This study comprised of 1427 patients enrolled in four randomized controlled trials.The pooled HR showed that the doublet group could increase ORR (P = 0.002) with no heterogeneity (P = 0.64),and might improve OS (P = 0.01 / P = 0.06) with heterogeneity (P < 0.001).There was no significant difference in PFS (P = 0.16) and one-year survival (P = 0.25) between two treatment groups.The doublet group led to more grade 3/4 neutropenia and thrombocytopenia than the single-agent group (P = 0.02 and P = 0.000,respectively).The incidences of grade 3/4 anemia,vomiting,mucositis,constipation,diarrhea,neurotoxicity,allergy,and fatigue between the two treatment groups were insignificant.Conclusion:Except for neutropenia and thrombocytopenia,the non-platinum doublets could increase ORR,and might improve OS for NSCLC patients with elderly age and/or poor PS without addition of more side effects;however,the doublets showed an increased rate of neutropenia and thrombocytopenia.The addition of doublets may not improve PFS and one-year survival.     

晚期非小细胞肺癌化学治疗毒副反应的观察及护理

目的 探讨采用NP与GP方案治疗晚期非小细胞肺癌(NSCLC),患者化疗期间常见的毒副反应及护理对策.方法将78例经细胞学或病理学确诊的晚期NSCLC患者随机分为2组,其中40例使用NP方案(NP组),38例使用GP方案(GP组).观察化疗中出现的毒副反应并采取相应的护理措施,比较2组患者的毒副反应发生情况.结果 2组临床疗效相当,化疗期间出现的毒副反应均主要为骨髓抑制、胃肠道反应和发热;GP方案对患者的骨髓抑制较NP方案明显(P<0.05),而2组在其他毒副反应的发生率比较差异无统计学意义(P>0.05).结论 NP方案与GP方案均是治疗晚期NSCLC的较好方案,通过有效的护理干预,可减轻药物毒性反应引起的损害,使化疗如期进行.     

吉西他滨联合顺铂治疗局部晚期非小细胞肺癌疗效观察

目的:探讨吉西他滨联合顺铂治疗局部晚期非小细胞肺癌(NSCLC)的方法和临床疗效.方法:将2006年6月至2010年6月我院收治的60例NSCLC的患者随机分为观察组40例和对照组20例,观察组采用吉西他滨联合顺铂治疗,对照组采用长春地辛、异环磷酰胺、顺铂方案化疗,比较两组患者的临床疗效及不良反应.结果:观察组的近期总有效率为82.5%(33/40)显著高于对照组的近期总有效率45.0%(9/20),P<0.05.观察组与对照组的不良反应物显著性差异,P>0.05.结论:吉西他滨联合顺铂治疗NSCLC有较好的近期疗效,不良反应可耐受,有利于改善患者的生存质量.     

多西他赛联合顺铂治疗晚期非小细胞肺癌36例临床观察

近年来肺癌在世界上发病率和死亡率迅速上升，每年新发病例接近120万。而肺癌中非小细胞肺癌（non—small cell lung cancer，NSCLC）约占80％，未经治疗的转移性非小细胞肺癌患者中位生存期仅4个月。以铂类为主的联合用药方案仍是目前国际公认的晚期非小细胞肺癌的标准方案。     

骨转换标志物在非小细胞肺癌骨转移临床应用价值的研究

Objective:The purpose of this study was to assess the clinical application value of bone turnover markers in non-small-cell lung cancer (NSCLC) patients with bone metastases. Including diagnosing bone metastases, detecting bone metastatic spread. Methods: Alkaline phosphatase (AKP), p-C-terminal telopeptide of type I collagen (B-CTx), osteocalcin (OST) and bone alkaline phosphatase (BALP) were measured in 76 patients with bone metastases from NSCLC and 44 normal people. Results: The level of AKP, B-CTx and BALP in patients with bone metastasis was significantly higher than in the normal people. Significant correlation was observed among bone turnover markers. The levels of BALP and OST were significantly correlated with the extent of bone metastasis. The patients with high-level CTx and low-level BALP had higher risk of pathologic fracture. Conclusion: In NSCLC patients with bone metastases, bone turnover markers can help to make diagnosis and evaluate the severity. It will have a wide range of use in clinical practice.     

吉西他滨联合卡铂作为诱导方案治疗老年不可手术的非小细胞肺癌

Objective:The purpose of this study was to evaluate the efficacy and safety of gemcitabine (GEM) and carboplatin (CBP) used as induction regimen in the treatment of elderly patients with locally advanced unresectable non-small cell lung cancer (NSCLC). Methods: Seventy-eight cases of elderly patients have been cytologically and pathologically confirmed with locally advanced unresectable NSCLC, the age of the patients ranged from 65 to 75 years. The patients were treated with the combined regimen of gemcitabine and cisplatin. GEM 1000 mg/m2 intravenously injected by drip on the 1st, 8th day and the dosage of CBP was AUC 4 that was used on the 1st day, 21 days apart to each cycle, most patients received 2 cycles. Treatment response was evaluated according to the criteria of RECIST (Response Evaluation Criteria in Solid Tumor), the side effect of the regimen was judged based on WHO criteria. Results: Seventy-eight patients were evaluated and received a total of 156 cycles chemotherapy. There were no complete regression that could be observed, but 32 cases had partial regression (PR), 37 cases with no change (NC) and 9 cases with progression disease (PD). The overall response rate was 41.0%. The main side effects were hematological toxicity. Conclusion: The GC regimen could be used as induction treatment for elderly patients with locally advanced unresectable NSCLC, and the regimen could be well tolerated and is safe in terms of side effects.     

多西他赛与吉西他滨分别顺泊治疗晚期非小细胞肺癌的临床研究

Objective: The aim of this study was to evaluate the clinical efficacy and side effects of docetaxel/cisplatin regiment and gemcitabine/cisplatin regiment in the patients with advanced non-small-cell lung cancer (NSCLC). Methods: Seventy six patients with advanced NSCLC who were chemotherapy-naive were enrolled in two groups. In docetaxel group (DP group) the patients received docetaxel 75 mg/m2 and cisplatin 60 mg/m2 on day 1. In gemcitabine group (GP group) the patients received gemcitabine 1000 mg/m2 on day 1 and day 8. The dosage of cisplatin was the same as DP group. The two regiments were administrated intravenously every 21 days as a cycle, each patient received 2-4 cycles. All patients were followed up until disease progressed or patients died. Results: The overall response rates were 43.5% in DP group and 45.9% in GP group. The response rate was significantly different between the initial treated group and retreated group in both two groups (53.8% vs 23.0% in DP group and 56% vs 25% in GP group, P < 0.05, respectively). The main side effects were bone marrow suppression and thrombocytopenia. Conclusion: Docetaxel/cisplatin regiment and gemcitabine/cisplatin regiment for the patients with advanced NSCLC were efficient and well-tolerated chemotherapeutic approachs with low toxicity levels. The efficacy and major toxicity in two groups were similar.     

p-Stat3、VEGF-C和MMP-2在非小细胞肺癌中的表达及其与淋巴结转移的关系

目的:检测非小细胞肺癌组织中磷酸化信号转导和转录激活子-3(p-Stat3)、血管内皮生长因子C(VEGF-C)和基质金属蛋白酶2(MMP-2)的表达情况,探讨p-Stat3与VEGF-C、MMP-2之间,以及这三者与临床病理指标之间的相关性.方法:采用免疫组织化学SP法,检测53例非小细胞肺癌组织和10例正常肺组织中p-Star3、VEGF-C和MMP-2的表达情况,并对p-Star3、VEGF-C和MMP-2的表达情况进行相关性分析.结果:在53例非小细胞肺癌病例中,P-Stat3、VEGF-C和MMP-2的阳性表达率分别为45.2%(24/53)、77.3%(41/53)和58.4%(31/53).其中,p-Stat3的表达在腺癌中最显著,阳性表达率为75%(9/12),且在低分化肺癌组织中的表达明显高于高分化肺癌组织(P<0.01),在有淋巴结转移的肺癌组织中高于无淋巴结转移的肺癌组织(P<0.05),而阳性表达率与患者的年龄、性别和肿瘤的大小无明显相关(P>0.05).VEGF-C和MMP-2在有淋巴结转移的非小细胞肺癌组织中的阳性表达率高于无淋巴结转移的肺癌组织(P<0.05),且VEGF-C、MMP-2的表达与p-Stat3的表达呈正相关(依次为r=0.427和0.345,P均<0.05).结论:在非小细胞肺癌组织中,p-Stat3、VEGF-C和MMP-2表达均上调,高表达的p-Stat3与肺癌的发生、发展及淋巴结转移密切相关,其机制可能与VEGF-C和MMP-2有关.     

立体适形放疗与常规放疗对老年非小细胞肺癌的疗效比较

比较立体适形放疗与常规放疗对老年非小细胞肺癌的疗效,结果表明:立体适形放疗的治疗效果更有优势。     

65例患者结肠肝曲癌侵犯十二指肠的外科治疗及预后

Objective:The aim of the study was to discuss surgical treatment of right colon carcinoma of hepatic flexure invading the duodenum.Methods:The 65 patients with right colon carcinoma of hepatic flexure invading the duodenum,treated in our department from 1987 to 2007,were included in this study.Their clinicopathological data were retrospectively reviewed and analyzed.All the cases were divided into three types (local invasion,regional invasion,and cancer with internal fistula) according to duodenal defect,including local invasion (< 2.0 cm),wide invasion (> 2.0 cm) and the presence of internal fistula.Results:The 25 patients with local invasion underwent en bloc resection of the duodenal wall.Pedicled ileal flap was used to cover the large duodenal defect measuring 2.0–3.0 cm in 5 patients.Dudenojejunostomy was used to reconstruct the large defect measuring more than 5 cm in 3 patients.Conservative resection of right-sided colon was performed in 18 patients with wide invasion.Four patients underwent pancreaticoduodenectomy combined with right hemicolectomy for colon cancer involving the pancreatic head.Ten cases underwent duodenal diverticularization.One patient with anastomotic leak-age healed within 3 weeks.Other patients were cured without postoperative complications.The total 3- and 5-year survival rates after surgery were 53.8% and 9.2%,respectively.Conclusion:The surgical procedure to be performed is usually de-cided according to the cancer location,extent,and duodenal defect and invasion,which are important for prolonging life time,improving of quality of life and prognosis in these patients.     

钢液/（N2、H2）过饱和体系中气泡生长的数值分析

采用水/CO₂体系模拟研究钢液/(N₂、H₂)过饱和体系中气泡生长动力学行为,分别建立水溶液和钢液中气泡形核长大机理模型.基于三种不同的气泡生长数学模型,分别研究水/CO₂和钢液/(N₂、H₂)体系数学模型中气泡生长动力学,并采用水模型实验数据对数学模型进行验证.分析钢液/(N₂、H₂)体系前期和后期处理压力以及钢液深度等因素对气泡生长的影响.研究表明:采用气泡浮选去除夹杂物技术时,前期处理压力对气泡生长有显著促进作用;后期处理压力对气泡生长有阻碍作用,随着后期处理压力的升高影响逐渐加强;钢液深度对气泡生长有阻碍作用,随着钢液深度的增加影响逐渐减弱;相比氮气,钢液中氢气气泡析出长大更快.      

为提高肺癌患者主观幸福感和生活质量的非创伤性干预方案效果分析

本文讨论了非创伤性心理干预方案对改善肺癌患者主观幸福感和生活质量所起的作用,并总结了非创伤性心理干预方案的特点,为肺癌患者的心理干预提供了适合的手段.     

小干扰RNA逆转三氧化二砷耐药的白血病K562/AS2细胞Topo Ⅱ基因表达的实验研究

目的 研究小干扰RNA片段(shRNA)对三氧化二砷(ATO)耐药的白血病细胞株K562/AS2细胞的Topo Ⅱα、TopoⅡβ基因表达及其功能的影响.方法 设计并合成针对Topo Ⅱα和TopoⅡβ基因序列的shRNA各3对,在脂质体的介导下转染K562/AS2细胞;用荧光实时定量聚合酶链反应(PCR)分析Topo Ⅱα、TopoⅡβmRNA的表达水平;流式细胞术检测Topo Ⅱα、TopoⅡβ蛋白表达.结果 针对Topo Ⅱα-shRNA、TopoⅡβ的shRNA作用于K562/AS2细胞24 h后,Topo ⅡαmRNA水平和蛋白水平最大下调为(78.22±0.01)%、(31.17±1.27)%(P<0.05),TopoⅡβmRNA水平和蛋白水平最大下调为(57.36 ±0.01)%、(23.98 ± 1.22)%(P<0.05).结论 转染24 h后针对TopoⅡ的shRNA可抑制对ATO耐药的白血病细胞株K562/AS2细胞TopoⅡ基因的表达.