136例肺腺癌临床病例分析研究
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摘要
研究背景:
原发性支气管肺癌,又称为肺癌,是一种来源于支气管黏膜或腺体的恶性肺部肿瘤,是世界上最常见的致命的恶性肿瘤之一,占全部恶性肿瘤的16%,所有癌症死亡的28%。它的发病率最近50年来有明显上升趋势。在过去的10年,全球肺癌的发病率每年以22%的速度飞速上升,每年新增病例达110万,死亡达100万。在全世界范围内,无论男性还是女性,肺癌都已经成为癌症死亡的主要原因。目前我国肺癌发病率在农村占第3位,在城市里占恶性肿瘤的第一位,。1997年以来,肺癌已经在我国的肿瘤死因顺序中居第一位。肺癌中大约有80%为非小细胞肺癌(non-small cell lung cancer,NSCLC)。非小细胞肺癌主要分由肺鳞状细胞癌和肺腺癌组成,以往多以肺鳞癌为主,随着肺癌发病因素的变化以及环境社会等其他因素的变化,肺腺癌已经越来越多的出现在临床的实际病例之中,而且有其特殊的临床特点,不得不引起我们的重视。
研究目的
分析肺腺癌(adenocarcinoma of lung)的临床特点,病理分期及影响因素。
资料和方法
对广州医学院附属肿瘤医院自2009年2月至2010年12月连续收治的136例经病诊断为肺腺癌的患者的临床及病例资料进行回顾性分析,然后通过分析的结果,根据病理结果将136例肺腺癌患者分为I期肺癌和其他分期的肺癌两组,用统计学方法进行分析,研究和讨论年龄、性别、吸烟、临床症状、明确诊断的时间等对病理分期的影响,并对其中29例不能手术的肺腺癌患者进行液相芯片技术检测,达到对其个体化治疗的重要参考作用,并结合文献加以讨论。
结果
本组病例占我院同期肺癌的29.3% (136/464),其中男性35例,女性101例,男女之比为1:2. 89。肺腺癌的影像学表现不复杂,但是不容易与肺炎性病变及其他孤立肺结节病变鉴别,容易造成误诊。如果患者有咳嗽、咳痰或胸闷气短等症状,经正规抗炎或抗结核治疗无效,影像学检查示病灶为位于肺周边、圆形或者椭圆形分叶状肿块,应高度怀疑肺癌,特别是女性患者无吸烟史,高度怀疑是肺腺癌。液相芯片技术检测对于肺腺癌个体化治疗有重要意义,其他因素在肺腺癌中无统计学意义,性别在I期肺腺癌和其他分期肺腺癌患者所占比例的差异上具有统计学意义。
结论
肺腺癌与吸烟的关系不象其它非小细胞肺癌(non small-cell lung cancer,NSCLC)那样密切,以女性多,不一定有吸烟史,是一种常见的非小细胞肺癌;由于影像学上的变异性容易被误诊,导致耽搁治疗;性别在I期肺腺癌和其他分期肺腺癌患者所占比例的差异上具有统计学意义,女性患者中I期肺腺癌所占比例明显高于男性。肺腺癌的治疗以手术为主;对完全性切除术后的肺腺癌推荐辅助化疗。对于不能手术的肺腺癌患者应用液相芯片技术检测ERCC1、RRM1、TUBB3mRNA的表达水平,根据结果进行“个体化”化疗的,可以提高化疗疗效。
Background
Primary bronchus lung cancer, abbreviation lung cancer, is a kind of bronchial mucosa or gland from the malignant tumor, is the one of the most common malignancies in the word, accounting for 16% of all malignant tumor, 28% of all cancer deaths. Its incidence have clear ascendant trend in almost 50 years .In the past 10 years, the risk of lung cancer boost 22% speed in the world every year, 120 million new cases appear each year, about 110 million deaths. In the worldwide, whether male or female, lung cancer have become the main cause of cancer deaths. At present our country lung cancer rates in the city is the first place in malignant tumor, in rural accounted for third place. Since 1996, the cause of death in China has lung cancer tumors in the first draft. About 80 percent of lung cancer is non-small cell lung cancer (non - small, NSCLC) , Non-small cell lung cancer main points by lung squamous cell carcinoma and lung adenocarcinoma, rcomposed mainly by lung squamous cell carcinoma in the past, along with lung cancer in environment factors and social , other factors changes, lung adenocarcinoma have more and more appear in clinical cases, and has its special clinical characteristics, caused our attention.
Research purpose
Analysis of lung adenocarcinoma (adenocarcinoma of the clinical characteristics, the company lung staging and influencing factors of pathology.
Material and method
Tumor hospital of guangzhou medical colleage since February 2009 to December 2010 , 136 patients with disease diagnosed with lung adenocarcinoma, patients for clinical and cases were analyzed retrospectively, based on pathology results . 136 patients with is adenocarcinoma, patients is divided into stage I lung cancer and other staging of lung cancer two groups, with statistical methods, this paper analyzes the age, sex, smoking, clinical symptoms, diagnosis of time on the influence of pathologic stage, in the case,29 lung adenocarcinoma patients who can't surgery use liquid chip technology testing, reach the indiidual therapy and the important reference. Finally discussed with other document.
The results
This period of our cases of lung cancer 29.3% (136/464), including male 35 patients, women, men and women than 101 cases for the 1:2. 89. Lung adenocarcinoma of radiological findings is not complicated, but not easy distinguish with pneumonia venereal change and other isolated pulmonary nodules lesions, easy cause the misdiagnosis identification. If patients have a cough, sputum chest distress, via regular short anti-inflammatory symptoms .antitubercular treatment is invalid, imaging examination reealed lesions in the lung, round for around or oval lobulated mass, should be highly suspected lung cancer, and especially women without smoking history, lung adenocarcinoma is highly suspected. Other factors in lung adenocarcinoma in no statistical significance, liquid chip technology test for lung adenocarcinoma is important indiidual therapy, gender in stage I lung adenocarcinoma and other staging patients with lung adenocarcinoma proportion are statistically significant differences.
conclusion
Lung adenocarcinoma relationed with smoking unlike other non-small cell lung cancer (non small - cancer cell, NSCLC) , the kind of this lung cancer , women is in common, and doesn't have a smoking history, is a common non-small cell lung cancer; Due to the variation on image, cause delayed treatment by misdiagnosis; Gender in stage I lung adenocarcinoma and other staging patients with lung adenocarcinoma proportion are statistically significant differences, women in patients with stage I lung adenocarcinoma is significantly higher than male proportion. The treatment of lung adenocarcinoma is operation for the Lord; After resection for completeness of lung adenocarcinoma recommend adjuvant chemotherapy. For not surgery patients with lung adenocarcinoma liquid chip technology applicat ERCC1, RRM1, TUBB3mRNA detection expression level, according to the results of the "individual" chemotherapy, can improve chemotherapy curative effect.
原发性支气管肺癌,又称为肺癌,是一种来源于支气管黏膜或腺体的恶性肺部肿瘤,是世界上最常见的致命的恶性肿瘤之一,占全部恶性肿瘤的16%,所有癌症死亡的28%。它的发病率最近50年来有明显上升趋势。在过去的10年,全球肺癌的发病率每年以22%的速度飞速上升,每年新增病例达110万,死亡达100万。在全世界范围内,无论男性还是女性,肺癌都已经成为癌症死亡的主要原因。目前我国肺癌发病率在农村占第3位,在城市里占恶性肿瘤的第一位,。1997年以来,肺癌已经在我国的肿瘤死因顺序中居第一位。肺癌中大约有80%为非小细胞肺癌(non-small cell lung cancer,NSCLC)。非小细胞肺癌主要分由肺鳞状细胞癌和肺腺癌组成,以往多以肺鳞癌为主,随着肺癌发病因素的变化以及环境社会等其他因素的变化,肺腺癌已经越来越多的出现在临床的实际病例之中,而且有其特殊的临床特点,不得不引起我们的重视。
研究目的
分析肺腺癌(adenocarcinoma of lung)的临床特点,病理分期及影响因素。
资料和方法
对广州医学院附属肿瘤医院自2009年2月至2010年12月连续收治的136例经病诊断为肺腺癌的患者的临床及病例资料进行回顾性分析,然后通过分析的结果,根据病理结果将136例肺腺癌患者分为I期肺癌和其他分期的肺癌两组,用统计学方法进行分析,研究和讨论年龄、性别、吸烟、临床症状、明确诊断的时间等对病理分期的影响,并对其中29例不能手术的肺腺癌患者进行液相芯片技术检测,达到对其个体化治疗的重要参考作用,并结合文献加以讨论。
结果
本组病例占我院同期肺癌的29.3% (136/464),其中男性35例,女性101例,男女之比为1:2. 89。肺腺癌的影像学表现不复杂,但是不容易与肺炎性病变及其他孤立肺结节病变鉴别,容易造成误诊。如果患者有咳嗽、咳痰或胸闷气短等症状,经正规抗炎或抗结核治疗无效,影像学检查示病灶为位于肺周边、圆形或者椭圆形分叶状肿块,应高度怀疑肺癌,特别是女性患者无吸烟史,高度怀疑是肺腺癌。液相芯片技术检测对于肺腺癌个体化治疗有重要意义,其他因素在肺腺癌中无统计学意义,性别在I期肺腺癌和其他分期肺腺癌患者所占比例的差异上具有统计学意义。
结论
肺腺癌与吸烟的关系不象其它非小细胞肺癌(non small-cell lung cancer,NSCLC)那样密切,以女性多,不一定有吸烟史,是一种常见的非小细胞肺癌;由于影像学上的变异性容易被误诊,导致耽搁治疗;性别在I期肺腺癌和其他分期肺腺癌患者所占比例的差异上具有统计学意义,女性患者中I期肺腺癌所占比例明显高于男性。肺腺癌的治疗以手术为主;对完全性切除术后的肺腺癌推荐辅助化疗。对于不能手术的肺腺癌患者应用液相芯片技术检测ERCC1、RRM1、TUBB3mRNA的表达水平,根据结果进行“个体化”化疗的,可以提高化疗疗效。
Background
Primary bronchus lung cancer, abbreviation lung cancer, is a kind of bronchial mucosa or gland from the malignant tumor, is the one of the most common malignancies in the word, accounting for 16% of all malignant tumor, 28% of all cancer deaths. Its incidence have clear ascendant trend in almost 50 years .In the past 10 years, the risk of lung cancer boost 22% speed in the world every year, 120 million new cases appear each year, about 110 million deaths. In the worldwide, whether male or female, lung cancer have become the main cause of cancer deaths. At present our country lung cancer rates in the city is the first place in malignant tumor, in rural accounted for third place. Since 1996, the cause of death in China has lung cancer tumors in the first draft. About 80 percent of lung cancer is non-small cell lung cancer (non - small, NSCLC) , Non-small cell lung cancer main points by lung squamous cell carcinoma and lung adenocarcinoma, rcomposed mainly by lung squamous cell carcinoma in the past, along with lung cancer in environment factors and social , other factors changes, lung adenocarcinoma have more and more appear in clinical cases, and has its special clinical characteristics, caused our attention.
Research purpose
Analysis of lung adenocarcinoma (adenocarcinoma of the clinical characteristics, the company lung staging and influencing factors of pathology.
Material and method
Tumor hospital of guangzhou medical colleage since February 2009 to December 2010 , 136 patients with disease diagnosed with lung adenocarcinoma, patients for clinical and cases were analyzed retrospectively, based on pathology results . 136 patients with is adenocarcinoma, patients is divided into stage I lung cancer and other staging of lung cancer two groups, with statistical methods, this paper analyzes the age, sex, smoking, clinical symptoms, diagnosis of time on the influence of pathologic stage, in the case,29 lung adenocarcinoma patients who can't surgery use liquid chip technology testing, reach the indiidual therapy and the important reference. Finally discussed with other document.
The results
This period of our cases of lung cancer 29.3% (136/464), including male 35 patients, women, men and women than 101 cases for the 1:2. 89. Lung adenocarcinoma of radiological findings is not complicated, but not easy distinguish with pneumonia venereal change and other isolated pulmonary nodules lesions, easy cause the misdiagnosis identification. If patients have a cough, sputum chest distress, via regular short anti-inflammatory symptoms .antitubercular treatment is invalid, imaging examination reealed lesions in the lung, round for around or oval lobulated mass, should be highly suspected lung cancer, and especially women without smoking history, lung adenocarcinoma is highly suspected. Other factors in lung adenocarcinoma in no statistical significance, liquid chip technology test for lung adenocarcinoma is important indiidual therapy, gender in stage I lung adenocarcinoma and other staging patients with lung adenocarcinoma proportion are statistically significant differences.
conclusion
Lung adenocarcinoma relationed with smoking unlike other non-small cell lung cancer (non small - cancer cell, NSCLC) , the kind of this lung cancer , women is in common, and doesn't have a smoking history, is a common non-small cell lung cancer; Due to the variation on image, cause delayed treatment by misdiagnosis; Gender in stage I lung adenocarcinoma and other staging patients with lung adenocarcinoma proportion are statistically significant differences, women in patients with stage I lung adenocarcinoma is significantly higher than male proportion. The treatment of lung adenocarcinoma is operation for the Lord; After resection for completeness of lung adenocarcinoma recommend adjuvant chemotherapy. For not surgery patients with lung adenocarcinoma liquid chip technology applicat ERCC1, RRM1, TUBB3mRNA detection expression level, according to the results of the "individual" chemotherapy, can improve chemotherapy curative effect.
引文
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[16] Dienstmann R, Felip E.Necitumumab in the treatment of advanced non-small cell lung cancer: translation from preclinical to clinical development.N Eng I J Med, 2004, 350 (21) 2129-2139
[17] Zhang J, Li Y, Hao X, Zhang Q, Recent Progress in Therapeutic and Diagnostic Applications of Lanthanides.Clin Cancer Res 2005,11(15):5481
[18] Glimelius I, Rubin J, Fischer M,Effect of eosinophil cationic protein (ECP) on Hodgkin lymphoma cell lines. Am J Clin Pathol , 2004, 122 (3) , 421-427
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[16] Dienstmann R, Felip E.Necitumumab in the treatment of advanced non-small cell lung cancer: translation from preclinical to clinical development.N Eng I J Med, 2004, 350 (21) 2129-2139
[17] Zhang J, Li Y, Hao X, Zhang Q, Recent Progress in Therapeutic and Diagnostic Applications of Lanthanides.Clin Cancer Res 2005,11(15):5481
[18] Glimelius I, Rubin J, Fischer M,Effect of eosinophil cationic protein (ECP) on Hodgkin lymphoma cell lines. Am J Clin Pathol , 2004, 122 (3) , 421-427
[19] Robinson PJ,et al. Pediatr Pulmonnol,1996;22:248-254
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[21] Ueda K, Tanaka T, Hayashi M,Compensation of pulmonary function after upper lobectomy versus lower lobectomy.J Thorac Cardiovasc Surg,2001, 116 (3) , 319-325
[22] Hidaka N,Nagao K. Chest,1996;110:281-282
[23]蔡祖友,赵绍宏.肺腺癌的影像学.中国医学计算机成像杂志,2001,7:24-29
[24] Hulse RE , Kunkler PE , Fedynyshyn J P , et al. Optimization of multiplexed bead-based cytokine immunoassays for rat serum and brain tissue. J Neurosci Method ,2004 ,136 :87-98.
[25] Gervais R, Hainsworth JD, Blais N,Phase II study of sunitinib as maintenance therapy in patients with locally advanced or metastatic non-small cell lung cancer. Lung Cancer,2004,23:301-304
[26] Lee H, Kim JM, Huang SM. Lee H, Kim JM, Huang SM, Differential expression of DUSP6 with expression of ERK and Ki-67 in non-small cell lung carcinoma. Eur J Cardiothorac Surg,2006,30:160-163
[27] Feng Y, Hu J, Ma J, Feng K,RNAi-mediated silencing of VEGF-C inhibits non-small cell lung cancer progression by simultaneously down-regulating the CXCR4, CCR7, VEGFR-2 and VEGFR-3-dependent axes-induced ERK, p38 and AKT signalling pathways.Ann Thorac Surg,2006,82:1508-1510
[28] Puma F, Capozzi R, Experience with the autologous pulmonary vein for pulmonary arterioplasty.Daddi N, Eur J Cardiothorac Surg,2003,14:17-20
[29] Biagini RE ,Sammons DL , Smith J P ,et al.Comparison of a multiplexed fluorescent covalent microsphere immunoassay and an enzyme-linked immunosorbent assay for measurement of human immunoglobulin G anti-bodies to anthrax toxins. Clin Diagn Lab Immunol ,2004 ,11 :50-55.
[30] Blanco M,Villarroya I.Trac-Trends Anal.Chem,2002,21(4):240.
[31] Macho S,Rius A,Callao M P,et al.Anal.Chim. Acta,2001,445(2):213.
[32] YANG Nan-lin,CHENG Yi-yu,QU Hai-bin (杨南林,程翼宇,瞿海斌).Acta Chimica Sinica (化学学报),2003,61 (5):742.
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[34] Ibeas P, Cantos B, Gasent JM,PET-CT in the staging and treatment of non-small-cell lung cancer.ChesI;,1998,114(1)::5-7
[35] Gómez-AldaravíL, González-Larriba JL, Massuti B, Phase II clinical trial with gemcitabine and paclitaxel sequential monotherapy as first-line treatment for advanced non-small-cell lung cancer (SLCG 01-04).Clin Transl Oncol,1999,86(7):1165-ll73
[36] Zhou H, Zha Z, Liu Y,Structural insights into the down-regulation of over-expressed p185her2/neu of transformed cells by the antibody chA21.J Biol Chem,2001,42(2):261-267
[37] Bortolin S , Black M, Modi H ,et al . Analytical validation of the Tagit high2throughput microsphere-based universal array genotyping platform: application to the multiplex detection of a panel of thrombophilia-associated single-nucleotide polymorphisms [ J ] . Clin Chem,2004 ,50( 11) :2028-2036.
[38] Bonomo L, Storto ML, Ciccotosto C, et al. Bronchi loalveolar carcinoma of the lung. Eur Radiol,1998,8(6):996-1001
[39] Imanishi Y, Hu B, Xiao G, ANGIOPOIETIN-2 PROMOTES INITIAL GROWTH AND SURVIVAL OF BREAST CANCER METASTASES TO THE LUNG THROUGH THEINTEGRIN-LINKED KINASE (ILK)-AKT-B CELL LYMPHOMA 2 (BCL-2) PATHWAY.J Biol Chem, 1996,14(8):2377-2386
[40] Das SK, Eder S, Schauer S, Adipose Triglyceride Lipase Contributes to Cancer-Associated Cachexia.Hoefler G.Science. 1999,118:702-709
[41] Prabhakar UE , Eirikis M , Reddy E , et al.Validation and comparative analysis of a multiplexed assay for the simultaneous quantitative measurement of Th1/ Th2 cy2 tokines in human serum and human periph-eral blood mononuclear cell culture supernatants. J Immunol Methods,2004,291:27-38.
[42] Serkova NJ, Standiford TJ, Stringer KA.The Emerging Field of Quantitative Blood Metabolomics for Biomarker Discovery in Critical Illnesses.Am J Respir Crit Care Med.,2001,121:42-47
[43] Satoh H, Inoue A, Kobayashi K, Low-Dose Gefitinib Treatment for Patients with Advanced Non-small Cell Lung Cancer Harboring Sensitive Epidermal Growth Factor Receptor Mutations.Ann Thorac Surg,2001,71:971-974
[44] Yoshimasu T, Oura S, Ohta F, Epidermal Growth Factor Receptor Mutations Are Associated with Docetaxel Sensitivity in Lung Cancer.J Thorac Oncol,2002,73:1545-1550
[45] Li ZL, Shao SH, Xie SY, Yue Z, Ma Y. [Anti-sense nucleic acid of CyclinD1 induces apoptosis of lung adenocarcinoma cancer cell A549.]Sheng Li Xue Bao,2004,22:l4S.
[46] Zhong R, Teng J, Han B, Zhong H.Dendritic cells combining with cytokine-induced killer cells synergize chemotherapy in patients with late-stage non-small cell lung cancer.Cancer Immunol Immunother,2004,22:145.
[47] Li H, Zhao H, Yu J, Increased prevalence of regulatory T cells in the lung cancer microenvironment: a role of thymic stromal lymphopoietin. Cancer Immunol Immunother 2001,30:56.
[48] Forget MA, Reuben A, Turcotte S,Polyfunctionality of a DKK1 self-antigen-specific CD8(+) T lymphocyte clone in lung cancer. Cancer Immunol Immunother. 2003,40:55.
[49] Martínez-Girón R, van Woerden HC.Clinical and immunological characteristics associated with the presence of protozoa in sputum smears.Diagn Cytopathol. 2011 ;40(2):320-329.
[50] Wang N, Zhou R, Wang C, Guo X, -251 T/A polymorphism of the interleukin-8 gene and cancer risk: a HuGE review and meta-analysis based on 42 case-control studies.,Mol Biol Rep. 2010,75, 150-154
[51] Togashi Y, Masago K, Fukudo M, Efficacy of increased-dose erlotinib for central nervous system metastases in non-small cell lung cancer patients with epidermal growth factor receptor mutation.,Cancer Chemother Pharmacol. 2011,47:135-140