雾化吸入IL-2联合化疗对原发性非小细胞肺癌疗效观察

观察雾化吸入ＩＬ－２联合化疗对非小细胞肺癌的临床疗效并与静滴ＩＬ－２及单纯化疗进行对比。方法：ＩＬ－２的雾化１０万ｕ／次，２次／ｄ，连用１月，化疗后３ｄ开始用；ＩＬ－２静滴４０万ｕ／次，１次／ｄ，加入５００ｍｌ液体中静滴，连用１月；化疗采用动脉灌注或全身化疗，药物及剂量为环磷酰胺４００ｍｇ／ｍ２＋ＤＤＰ８０ｍｇ／ｍ２。结果：用ＩＬ－２的两组ＣＲ＋ＰＲ显著高于单纯化疗组（Ｐ＜０．０１）；雾化ＩＬ－２组ＣＲ＋ＰＲ与静滴ＩＬ－２差别无显著性（Ｐ＞０．０５），但不良反应的发生率显著低于后者，而与单纯化疗类似，结论：雾化吸入ＩＬ－２联合化疗对非小细胞肺癌有较好的疗效，且副作用小，值得扩大样本进一步验证其疗效。     

流式细胞术检测非小细胞肺癌患者骨髓微转移

目的　应用流式细胞术检测非小细胞肺癌患者骨髓中的微转移。方法　骨髓经Ficoll梯度离心分离单核细胞后,用细胞角蛋白 19(Cytokeratin, CK19)单克隆抗体染色,应用流式细胞仪检测。结果　检测了 96例肺癌患者骨髓,发现 25例患者骨髓中有微转移。20例肺良性病变患者、10例正常人骨髓均无微转移。肺癌患者阳性率与患者病理分期、分化程度和细胞组织学类型密切相关 (P<0. 05)。结论　应用流式细胞术检测非小细胞肺癌患者骨髓中的微转移,有助于肺癌的综合治疗。     

迪利单抗对肺癌患者嗜酸性气道炎症的研究

目的 探讨信迪利单抗对肺癌患者嗜酸性气道炎症的影响。方法 选取2019年4月—2020年4月于徐州医科大学附属宿迁医院就诊的60例IV期非鳞非小细胞肺癌患者,随机分为对照组(单纯化疗组)和试验组(信迪利单抗联合化疗组);对照组给予培美曲塞500 mg/m2联合顺铂75 mg/m2静脉注射;试验组在对照组治疗方案基础上联合免疫检查点抑制剂信迪利单抗200 mg静脉注射,均21天为1个周期。6个周期治疗后检测两组患者呼出气一氧化氮(Fractional exhaled nitric oxide,FeNO)、外周血嗜酸性粒细胞计数、肺功能及动脉血气;分析信迪利单抗治疗组严重不良事件(SAE)及免疫相关性肺炎(CIP)的发生率。结果 ⑴试验组在第2、4、6周期治疗后FeNO水平、外周血嗜酸性粒细胞计数相较于基线水平出现升高趋势,但差异无统计学意义(PFeNO=0.536; PEos=0.762)。⑵两组患者经6个周期治疗后,第1秒用力呼吸容积(FEV1)、用力肺活量(FVC)、FEV1/FVC、一氧化碳弥散量占预计值百分比(DLco%)较治疗前均无明显变化(PFEV1=0.615; PFVC=0.473; PFEV1/FVC=0.637; PDLco%=0.598);动脉血气分析中PH、PaO2、PaCO2水平较治疗前均无明显变化(PPH=0.457; PPaCO2=0.242; PPaO2=0.631)。⑶试验组免疫相关SAE发生率和CIP的发生率均为0。结论 6周期治疗后信迪利单抗对肺癌患者的嗜酸性气道炎症、肺功能、动脉血气分析无明显影响,未出现免疫相关SAE及CIP。     

High expression of nitric oxide synthases is a favorable prognostic sign in non-small cell lung carcinoma

Immunohistochemical expression of neuronal (n), endothelial (e), and inducible (i) NOS and their association with the type, grade, apoptotic index, proliferation of tumors and the survival of patients were investigated in 89 biopsies of non-small cell lung carcinoma (NSCLC). In tumor cells, expression of iNOS was detected in 35/89 (40%) cases, while 79/89 (89%) and 72/89 (81%) cases showed weak to intense positivity for eNOS and nNOS, respectively. Strong eNOS staining was seen significantly more often in adenocarcinomas than in squamous cells carcinomas (p=0.016), and iNOS immunoreactivity was seen more often in grade I-II tumors than in grade III tumors (p=0.024). There was no significant difference between the low and high apoptotic indexes or between the low and high proliferation rates of tumors in any instance of NOS staining. The patients with tumors showing high nNOS expression tended to have better survival than the others (p=0.06, log-rank; p=0.04, Bresow; p=0.048, Tarone-Ware). Similarly, the patients with tumors showing high expression of iNOS, eNOS and nNOS, as determined by a combined sum index, had a better survival than those with a low sum index for these enzymes (p<0.05). The results show intense expression of eNOS and nNOS, and moderate expression of iNOS in tumor cells of non-small cell carcinoma. Intense NOSs expression seems to be a favorable prognostic sign in non-small cell lung carcinoma.     

非小细胞肺癌放疗期间外周血细胞数的变化

目的　研究胸部受电离辐射后外周血细胞的变化特点。方法　选取１９９７ ～１９９８ 年非小细胞肺癌患者３０ 例。按１∶２ 配比年龄相似,性别相同的非放疗慢性病患者作为对照组。观察胸部外照射对外周血白细胞、淋巴细胞、血小板数的影响。ＮＳＣＬＣ以医用直线加速器６ ＭＶ－ Ｘ 线,常规分割放射治疗。射野包括肿瘤及其周围１ ～２ｃｍ 正常肺组织,同侧肺门以及纵膈,有时包括锁骨上区ＦＳＺ（Ｆｉｅｌｄｓｑｕａｒｅｚｏｏｍ） ７２ ～２４６ｃｍ２ ,剂量率２Ｇｙ／ｍｉｎ ,ＳＳＤ１００ｃｍ 。采用ＳＷＧＥＡＢＡＣ－ ９２０ 型血液细胞自动分析仪检测外周血白细胞、淋巴细胞、血小板数,并严格质量控制。结果　当吸收剂量１０Ｇｙ／５ｆ／ Ｗ ,ＮＳＣＬＣ外周血细胞数量开始下降;至２０ ～３０Ｇｙ／１０ ～１５ｆ／２ ～３ Ｗ 时,其外周血细胞数量降至低谷。并且上述３ 种细胞数量较之放疗前和对照组具有显著差异（ｔ＞ ２．５８ ,Ｐ＜ ０．０１）。另外,局部照射野＞ １００ｃｍ２ 组外周血白细胞数显著低于照射野为＜ １００ｃｍ２ 组,（ Ｆ＝６ ．４６,Ｐ＜ ０ ．０１）。在缩野和改侧斜野,放疗第四周（Ｄｔ＝ ４０Ｇｙ） 后,局部受损骨髓开始修复,受照区内的毒性产物被迅速稀     

高剂量与常规剂量表阿霉素联合化疗初治非小细胞肺癌对比研究

目的本实验为一前瞻性随机化对照研究,以高剂量表阿霉素-丝裂霉素-顺铂,常规剂量表阿霉素-丝裂霉素-顺铂作比较,初治非小细胞肺癌(NSCLC),评价其疗效及毒副作用.方法治疗NSCLC共40例.分高剂量组和常规剂量组(A、B)各20例.男性25例,女性15例.病理类型以腺癌为主(26例),Ⅲa期4例,Ⅲb期17例,Ⅳ期19例.全部为初治病人.结果高剂量组(A)总有效率(65%)高于常规剂量组(B)(45%),中位缓解期A组3.1个月,B组2.2个月;中位生存期A组8.7个月,B组7.1个月.表阿霉素的剂量限制毒性为心脏毒性和骨髓抑制,心脏毒性发生率A、B两组均为5%(1例),骨髓抑制A组较B组稍高,白细胞下降率各为65.0%和55.0%.结论高剂量表阿霉素为主的联合化疗治疗NSCLC的有效率比常规剂量组高,毒性相似,可以耐受,是值得推荐的高效低毒的一种给药途径.     

Immunotherapeutic targets in non-small cell lung cancer

Non-small cell lung cancer (NSCLC) is one of the most common types of cancer in the world and has a 5-year survival rate of ~20%. Immunotherapies have shown promising results leading to durable responses, however, they are only effective for a subset of patients. To determine the best therapeutic approach, a thorough and in-depth profiling of the tumour microenvironment (TME) is required. The TME is a complex network of cell types that form an interconnected network, promoting tumour cell initiation, growth and dissemination. The stroma, immune cells and endothelial cells that comprise the TME generate a plethora of cytotoxic or cytoprotective signalling pathways. In this review, we discuss immunotherapeutic targets in NSCLC tumours and how the TME may influence patients' response to immunotherapy.