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Lung cancer is one of the most prevalent malignancies with the highest morbidity and mortality rates worldwide. In recent years, with the development of immune-oncology research and several therapeutic antibodies have reach the clinic, many breakthroughs have been made in immunotherapy. The advent of immunotherapy has revolutionized the treatment of NSCLC, but the response and durable clinical benefit are only observed in a small subset of patients. Therefore, strategies to screen the potential beneficial population and improve the efficacy of immunotherapy remain an essential topic. In the current article, the author review the biomarkers that have potential to better predict responders to immunotherapy and to provide ideas for the clinical application of immunotherapy. .
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Humans , B7-H1 Antigen , Biomarkers, Tumor , Carcinoma, Non-Small-Cell Lung/therapy , Immunotherapy , Lung Neoplasms/therapyABSTRACT
Objective:To evaluate the clinical outcome of all arthroscopic autogenous tendon suspended fixation for Myerson type III chronic noninsertional achilles tendon rupture in elderly patients.Methods:Data of 18 patients with Myerson type III chronic noninsertional Achilles tendon rupture who had performed all arthroscopic autogenous tendon suspended fixation from February 2016 to February 2019 in Department of Hand and Foot Microsurgery, Xuzhou Central Hospital were retrospectively analyzed. There were 12 males and 6 females (right side, 10 cases and left side, 8 cases) aged from 60 to 79 years with a median of 65.3 years. The mean injury-to-surgery time was 12 weeks (range, 6-32 weeks). All the patients were treated by all arthroscopic autogenous tendon suspended fixation. The function of the ankle and the foot was assessed using visual analogue scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) foot and ankle score and the achilles tendon total rupture score (ATRS), and the excellent and good rate was evaluated according to Arner-Lindholm score.Results:All patients healed at the first stage without any complications such as infection, sural nerve injury or tend re-rupture. The mean follow-up period was 18.6 months (range, 12-50 months). At the latest follow-up, all achilles tendons were healed with the VAS score reduced from 4 (1, 7) preoperatively to 0 (0, 1) postoperatively ( Z=2.334, P< 0.05); the AOFAS ankle and hindfoot score was improved from 60.3±9.7 (range, 40-83) preoperatively to 92.6±4.3 (range, 86-100) postoperatively ( t=34.541, P< 0.05); the ATRS score was improved from 55.7±10.6 (range, 42-80) preoperatively to 93.1±3.2 (range, 88-100) postoperatively ( t=64.773, P< 0.05); one patient was unable to stand on tiptoe of the single injured limb, because he could stand it, no further treatment was given; another patient complained of mild pain after a long time walking,which was alleviated by stretching the achilles tendon consistently. According to the score of Arner-Lindholm, 14 cases were excellent, 4 cases were good, and the excellent and good rate was 100% (18/18). Conclusion:All arthroscopic autogenous tendon suspended fixation for Myerson type III chronic noninsertional achilles tendon rupture in elderly patients is an effective method, which has the advantages of less trauma, faster recovery and fewer complications.
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BACKGROUND@#Lung cancer is the most common malignancy world-wide. There are a variety of immune infiltrating cells in tumor microenvironment, which is an important component of tumor immunity and has clinical significance for the prognosis of patients. CD45RO is a surface marker of memory T cells. The expression of CD45RO⁺ tumor infiltrating lymphocytes (TILs) is associated with the prognosis of many tumors. The purpose of this study was to evaluate the relationship between the density of CD45RO⁺ TILs in tumor and stromal area and the clinical characteristics of patients with non-small cell lung cancer (NSCLC) and its impact on the prognosis of patients. We aimed to explore the clinical value of CD45RO⁺ TILs and programmed cell death ligand 1 (PD-L1) as prognostic markers.@*METHODS@#Multiple fluorescent immunohistochemical staining was used to stain the tissue microarray chips of 167 patients with NSCLC, marking CD45RO, cytokeratin (CK) and PD-L1. Using artificial intelligence image recognition technology and tumor cell-specific CK staining, divide the tumor and stromal area in the tissue, evaluate the density of CD45RO⁺ TILs in the tumor and stromal area, and the expression level of PD-L1 in tumor cells. The non-parametric test was used to analyze the relationship between CD45RO⁺ TILs and the clinical characteristics of patients, and the Kaplan-Meier method and Cox risk ratio model were used to analyze the relationship between CD45RO⁺ TILs independently or in combination with PD-L1 and tumor prognosis.@*RESULTS@#The density of CD45RO⁺ TILs was significantly associated with patient age, smoking, tumor stage, and pathological type. Single-factor survival analysis showed that NSCLC (P=0.007) stromal region and lung adenocarcinoma (LUAD) (P<0.001) with CD45RO⁺ TILs high density had better OS. Multivariate survival analysis showed that the high density of CD45RO⁺ TILs in the stromal region of NSCLC (HR=0.559, 95%CI: 0.377-0.829, P=0.004) and lung adenocarcinoma (HR=0.352, 95%CI: 0.193-0.641, P=0.001) were independent prognostic factors for overall survival time (OS). Combined with PD-L1 score of tumor cells in tumor tissues and infiltration score of CD45RO⁺ TILs in all tumor tissues, the patients were divided into 4 groups: patients with PD-L1⁺/CD45RO⁺ had the longest disease-free survival (DFS) time, and patients with PD-L1⁺/CD45RO- had the shortest DFS time. Multivariate Cox regression analysis showed that PD-L1⁺/CD45RO- was an independent prognostic factor for DFS and had a higher risk of poor prognosis compared to the other three groups (HR=2.221, 95%CI: 1.258-3.919, P=0.006).@*CONCLUSIONS@#In tumor tissues, the density of CD45RO⁺ TILs, as well as the combination of CD45RO⁺ TILs and PD-L1 in tumor areas, significantly correlated with clinicopathological features and prognosis of NSCLC, which can be used as a new prognosis marker.
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BACKGROUND@#Targeted therapy for patients with driver genes positive and immunotherapy for patients with driver gene-negative but high programmed death ligand 1 (PD-L1) expression are the standards of first-line treatment for patients with advanced non-small cell lung cancer (NSCLC). The treatment options for patients with driver gene positive and high PD-L1 expression are still worth exploring.@*METHODS@#The characteristics of 315 patients with NSCLC were identified to analyze the clinicopathological characteristics of patients with driver gene positive and high PD-L1 expression, and the efficacy of targeted therapy.@*RESULTS@#Among the 315 patients, the total positive rate of driver genes was 62.2%, and the high PD-L1 expression rate (≥50.0%) was 11.2%. The proportion of patients with driver gene positive and high PD-L1 expression was 10.7%. PD-L1 was highly expressed in patients with epidermal growth factor receptor (EGFR) mutation, KRAS mutation, ALK fusion, BRAF mutation, and MET 14 exon skip mutation, the proportions were 7.8% (11/141), 18.2% (4/22), and 23.1%, (3/13), 50.0% (2/4) and 100.0% (1/1) respectively. EGFR mutation positive with PD-L1 high expression was mainly in patients with stage IV lung adenocarcinoma. KRAS mutation positive with PD-L1 high expression was mainly in patients with a history of smoking. Among them, two patients were followed in detail for targeted therapy, who with ALK fusion-positive and PD-L1 high expression (90.0%), EGFR L858R mutation and PD-L1 high expression (70.0%) respectively. The total OS of the patients was 5 months, 2 months.@*CONCLUSIONS@#The high PD-L1 expression rate in NSCLC patients with different driver gene mutations was variable, which maybe correlated with distinct clinicopathological characteristics. Patients with sensitive mutations and high PD-L1 expression may be less benefit from targeted therapy and have poor prognosis.
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BACKGROUND@#The patients with advanced lung adenocarcinoma should select targeted drugs based on the type of tumor epidermal growth factor receptor (EGFR) gene mutation. However, it is difficult to collect tumor tissue of advanced lung adenocarcinoma, and some experts agree that peripheral blood can be used as a substitute for tumor tissue as a test specimen. This paper aimed to investigate the clinical value of ddPCR and super-amplification refractory mutation system (ARMS) in detecting EGFR gene mutation in peripheral blood of patients with advanced lung adenocarcinoma.@*METHODS@#A total of 119 patients diagnosed in Beijing Chest Hospital Affiliated to Capital Medical University from February 2016 to February 2019 were collected, and the sensitivity and specificity of plasma ctDNA EGFR gene mutation detected by ddPCR and super-arms were compared. Some patients with positive EGFR gene mutations received oral treatment with first-line EGFR tyrosine kinase inhibitors (EGFR-TKI). The patients were divided into subgroups according to the test results. In group 1, both ddPCR and super-arms showed positive EGFR gene mutation results, with 21 cases. In group 2, ddPCR and super-arms detection of EGFR gene mutation were all negative, with 16 cases. In group 3, the ddPCR test was positive and the super-arms test was negative, with 5 cases. In group 4, the ddPCR test result was negative while the super-arms test result was positive. Since the number of patients in group 4 was 0, no statistics were included. Objective response rate (ORR) and disease control rate (DCR) were used to evaluate the short-term outcome, and progression-free survival (PFS) was compared with survival analysis to evaluate the long-term outcome.@*RESULTS@#EGFR mutations were detected in 58 (48.7%) of 119 patients with advanced lung adenocarcinoma. The coincidence rate between ddPCR and EGFR gene mutation in tumor tissues was 82.4% (Kappa=0.647, P0.05). Survival analysis showed that the PFS of the three groups was compared. The difference was not statistically significant (χ²=2.221, P=0.329).@*CONCLUSIONS@#ddPCR, as a high sensitivity and specificity liquid gene detection method, can be used as a reliable method to detect the mutation of plasma ctDNA EGFR gene in patients with advanced lung adenocarcinoma. The results of plasma genetic testing can also be used as the basis for predicting the efficacy of EGFR-TKIs in patients.
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Objective@#To analyze the clinical effects of all-inside arthroscopic treatment for the patients of avulsion fracture of tibial origin withⅠdegree supination and external rotation injury according to the Lauge-Hansen classification.@*Methods@#A retrospective analysis of 34 patients (34 feet) who had underwent all-inside arthroscopic for avulsion fracture of tibial origin with Ⅰ degree supination and external rotation injury from September 2015 to September 2017 in Department of Hand and Foot Microsurgery, Xuzhou Central Hospital. There were 20 males and 14 females, aged (24.7±11.3)years (range:14-43 years). The duration from injury to operation was (4.3±2.5) d (range: 6 h-7 d). The pro-operation visual analogue scale(VAS) of pain was 6.8±1.4(range: 4-8). All the patients were treated with the all-inside arthroscopic procedure by using the anterolateral and near-anterolateral portals and the fractures were fixed with cannulated screws. Main outcome measures included the pain, foot appearance, and patients were scored using the American Orthopaedic Foot & Ankle Society Lesser Toe Metatarsophalangeal-Interphalangeal Scale(AOFAS).@*Results@#Primarily healing of the wound was achieved in all cases without postoperative complications of nerve, vessel and tendon injury. The follow-up period was (16.9±6.6)months(range: 8-24 months). Postoperatively X-ray films showed complete fracture healing at (11.2±2.1)weeks after surgery.At the last follow-up, the ankle movement and appearance were good, and no ankle joint traumatic arthritis were found. The VAS and AOFAS was 0 and 95.7±9.4 respectively.@*Conclusion@#The all-inside arthroscopic treatment of Lauge-Hansen type avulsion fracture of tibial origin with Ⅰ degree supination and external rotation injury is an effective and precise method, with accurately outcomes, precise reduction and minimally postoperative complications.
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Seventy patients with advanced non-small-cell lung cancer (NSCLC) aged 65 or above were treated with epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) erlotinib or gefitinib from February 2006 to September 2010. The efficacy and toxicities of treatment were retrospectively analyzed.The overall response rate and disease control rate were 31.4％ and 84.3％,respectively. Themedian progression-free survival time and median survival time were 8.0 months and 13.5 months,respectively(P ＜ 0.05 ). One-year survival rate was 54.3％. Response rate ( CR + PR) ( 42.9％ ) anddisease control rate (94.3％ )in female patients were superior to males (20.0％ and 74.3％ ) (P ＜ 0.05 ).Non-smoking and PS score ＜ 2 were good predictors for survival.The side effects were generally mild and mainly were skin rash and diarrhea.
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In recent years,the incidence and mortality of advanced lung cancer in elderly patients have been increasing,but the number of elderly patients with lung cancer who receive active treatment is less than that of lung caner patients in other age stage.Molecular targeted therapies,such as the human epidermal growth factor receptor tyrosine kinase inhibitors,angiogenesis inhibitors,anti-tumor monoclonal antibodies and multitarget drugs,have prolonged the overall survival and improved the life quality of elderly patients with advanced non-small cell lung cancer.Targeted therapy has become the most promising treatment and can significantly improve the prognosis of elderly patients.
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Epithelial cell adhesion molecules (EpCAMs) play an important role in the process of gene expression and regulation by combining with nuclear receptor.Aberrant expression of EpCAMs has been detected in different types of cancers,such as breast cancer,lung cancer,gastric cancer,and etc.The research of EpCAMs in circulating tumor cells enrichment,tumor pathogenesis and prognosis will be conducive to achieve new breakthroughs in cancer targeted therapy.
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<p><b>BACKGROUND AND OBJECTIVE</b>Results of studies on genetic polymorphisms of ERCC1 gene in DNA repair pathway which may affect response to platinum-based chemotherapy and survival in patients with non-small cell lung cancer are conflicting. The aim of this study is to prospectively assess the association between single nucleotide polymorphisms of C8092A and codon118 in ERCC1 and drug response in 90 patients with advanced non-small cell lung cancer treated with cisplatin-based chemotherapy.</p><p><b>METHODS</b>All patients were treated with cisplatin-based chemotherapy. Genotypes of ERCC1 C8092A and codon118 were examined by sequencing, and the association between genotypes and response was evaluated.</p><p><b>RESULTS</b>Genotype frequencies of ERCC1 C8092A were CC 40.0% (36/90), CA 48.9% (44/90) and AA 11.1% (10/90), frequencies of codon118 were CC 58.9% (53/90), CT 34.4% (31/90) and TT 6.7% (6/90). There was no significant difference in response rate of patients carrying with CC, compared with CA plus AA in C8092A (33.3% vs 29.6%, P = 0.71). Response rate of patients carrying with CC in ERCC1 118 was 32.1%, 24.3% with CT plus CC (P = 0.43). There was no difference in progression free survival between patients carrying with CC and CT plus TT in C8092A (5.2 months vs 5.4 months, P = 0.62). There was no difference in progression free survival between patients carrying with CC and CA plus AA (5.5 months vs 5.3 months, P = 0.59).</p><p><b>CONCLUSION</b>The results suggest that there is no association between polymorphisms in ERCC1 C8092A and codon118 and response in patients with advanced non-small cell lung cancer receiving cisplatin-based chemotherapy.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Antineoplastic Agents , Therapeutic Uses , Carcinoma, Non-Small-Cell Lung , Drug Therapy , Genetics , Mortality , Cisplatin , Therapeutic Uses , DNA-Binding Proteins , Genetics , Disease-Free Survival , Endonucleases , Genetics , Genotype , Lung Neoplasms , Drug Therapy , Genetics , Mortality , Polymorphism, Genetic , Genetics , Prospective StudiesABSTRACT
<p><b>BACKGROUND AND OBJECTIVE</b>Serum tumor markers play important roles in diagnosis, response and prognosis monitoring for lung cancer. The clinical significance of serum level of tissue polypeptide specific antigen (TPS) was investigated in diagnosis, response monitoring and prognosis in patients with lung cancer, compared with carcinoembryonic antigen (CEA), precursor of gastrin-releasing peptide (Pro-GRP) and cytokeratin-19-fragments (CYFRA21-1).</p><p><b>METHODS</b>Blood samples of eighty-two patients with lung cancer before treatment and some after chemotherapy were measured by ELISA for four tumor markers.</p><p><b>RESULTS</b>Compared with lung benign diseases group and health control group, the positive rates and levels of TPS, CEA and Pro-GRP in patients with lung cancer were higher, with statistically significant difference. TPS in extensive-small cell lung cancer was significant higher than that in limited-small cell lung cancer. The positive rates and levels of TPS, CEA and Pro-GRP in patients after treatment had significant decreases compared with before treatment. TPS was an independent prognostic factor of non-small cell lung cancer.</p><p><b>CONCLUSION</b>TPS is valuable to diagnosis, response monitoring for patients with lung cancer, moreover, it maybe a useful factor of prognosis of non-small cell lung cancer.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Antigens, Neoplasm , Blood , Biomarkers, Tumor , Blood , Carcinoembryonic Antigen , Blood , Enzyme-Linked Immunosorbent Assay , Keratin-19 , Blood , Lung Neoplasms , Blood , Diagnosis , Peptides , Blood , Prognosis , Protein Precursors , Blood , ROC CurveABSTRACT
<p><b>BACKGROUND AND OBJECTIVE</b>Promoter hypermethylation of the RASSF1A gene is among the most abundant epigenetic deregulations in human cancer. The aim of this study is to investigate the relationship between the methylation status of RASSF1A promoter and the prognoses of non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>The methylation status of RASSF1A promoter in 150 NSCLC and 25 non-malignant tissues was determined using a methylation-specific polymerase chain reaction (MSP).</p><p><b>RESULTS</b>RASSF1A promoter hypermethylation was detected in 38.7% (58/150) of NSCLC tissues, but in none of the non-malignant tissues. The patients with hypermethylation of RASSF1A had a poor survival rate, and the relationship between the survival rate and hypermethylation of RASSF1A was statistically significant (P = 0.004). Then by using stepwise Cox proportional hazard regression testing, methylation status of RASSF1A was an independent factor affecting the NSCLC patients' survival (RR = 1.584, 95% CI: 1.040-2.411, P = 0.032).</p><p><b>CONCLUSION</b>The hypermethylation of the RASSF1A promoter may be an independent prognostic factor of NSCLC after operation.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Carcinoma, Non-Small-Cell Lung , Genetics , Pathology , DNA Methylation , Genetics , Lung Neoplasms , Genetics , Pathology , Prognosis , Promoter Regions, Genetic , Genetics , Tumor Suppressor Proteins , GeneticsABSTRACT
<p><b>BACKGROUND</b>Topotecan is one of active agents for relapsed small cell lung can-cer (SCLC), some studies have shown that it is effective against SCLC as the first-line drug. This study is to assess the efficacy, toxicity and survival rate of topotecan plus cisplatin (TP) versus etoposide plus carboplatin (CE) in patients with previously untreated SCLC.</p><p><b>METHODS</b>Sixty-four patients with previously untreated SCLC were randomly assigned to receive either TP or CE. Topotecan 0.75 mg/(m²×d) via a 30-min intravenous infusion on days 1 to 5 and cisplatin 25 mg/(m²×d) on days 1 to 3 with hydration were given to patients in TP group. Carboplatin 300 mg/m² on day 1 and etoposide 100 mg/d on days 1 to 5 were given to patients in CE group. Treatment was repeated every 21 days. Responses and toxicities were evaluated in patients who received two cycles of chemotherapy. Patients with limited disease SCLC received thoracic irradiation or operation after the completion of chemotherapy.</p><p><b>RESULTS</b>Overall response rate was 75.0% in TP group and 68.8% in CE group. The median survival time was 10.5 months in TP group and 9.6 months in CE group. 1-, 2- and 3-year survival rate were 40.6%, 18.8% and 9.4% in TP group and 34.4%, 15.6% and 9.4% in CE group respectively. There were no significant differences in response rate, median survival time and survival rate between two groups (P > 0.05). Myelosuppression, nausea and vomiting, and alopecia were the most common toxicities, there was no significant difference in grade III and IV toxicities between two groups (P > 0.05).</p><p><b>CONCLUSIONS</b>TP has similar response rate and survivals with CE, and its toxicities are acceptable. TP regimen is an effective first-line treatment for SCLC.</p>
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<p><b>BACKGROUND</b>Cytochrome P450 2A6 (CYP2A6) plays an important role in oxidation of nicotine and in activation of tobacco-related carcinogens. It has been suggested that individuals with defective CYP2A6 allele are at a lower risk of developing lung cancer. This study is to investigate the frequency of CYP2A6 gene deletion and the relationship of CYP2A6 genetic polymorphism with lung cancer risk in Chinese.</p><p><b>METHODS</b>A case-control study which detected CYP2A6 genotype of 180 patients with lung cancer and 224 controls by PCR-based genotype assay was conducted.</p><p><b>RESULTS</b>No relationship was found between the frequency of CYP2A6 gene deletion and lung cancer risk. There was only one case of CYP2A6 del/del genotype in the controls. The frequency of CYP2A6 del allele was 13.8% in the controls, and 12.8% in lung cancer cases. The CYP2A6 del/del genotype was not found in lung cancer cases.</p><p><b>CONCLUSIONS</b>There is no difference in frequency of CYP2A6 gene deletion between lung cancer cases and controls.</p>
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<p><b>BACKGROUND</b>Cisplatin has remarkable anti-tumor effects against various malignancies. Of its severe adverse reactions, nausea and vomiting are considered to be dose-limiting factors in cisplatin therapy. The anti-emetic properties of 5-HT₃ receptor antiagonists, such as ramosetron, can reduce nausea/vomiting. In order to evaluate the clinical efficacy of ramosetron injection against nausea and vomiting in treatment of cisplatin, a randomized control study was performed to compare the efficacy of anti-nausea and vomiting between ramosetron and ondansetron.</p><p><b>METHODS</b>A randomized parallel control trial was carried out. One hundred patients were randomized divided into 2 groups: ramosetron group (n=50) and ondansetron group (n=50). Ramosetron was given intravenously 30 minutes before chemotherapy in a dose of 0.3mg. Ondansetron was given intravenously 15 minutes before chemotherapy and after chemotherapy in a dose of 8mg .</p><p><b>RESULTS</b>The effective rate of nausea by ramosetron was 82%, 72% and 84% for the first three days. The effective rate of nausea by ondansetron in a 3-day period was 84%, 70% and 76% for the first three days. Ramosetron and ondansetron were equally effective in the control of nausea induced by cisplatin. The control rate of vomiting by ramosetron was 88%, 86% and 90% for the first three days. The control rate of vomiting by ondansetron was 80%, 76% and 86% for the first three days. Ramosetron was more effective than ondansetron in controlling vomiting, but without statistical difference between the two groups. The side effects of ramosetron and ondansetron were similar.</p><p><b>CONCLUSIONS</b>Ramosetron can effectively prevent the nausea and vomiting induced by cisplatin chemotherapy. The efficacy of ramosetron in controlling nausea and vomiting is better than that of ondansetron.</p>
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<p><b>BACKGROUND</b>To investigate the relations between metabolizing enzymes' genetic polymorphism and lung cancer risk in Chinese, especially in heavy smokers.</p><p><b>METHODS</b>CYP1A1, 2D6, 2E1 and GSTM1 genotypes were detected in 180 patients with lung cancer and 224 controls by PCR-based genotype assays.</p><p><b>RESULTS</b>CYP1A1 variant allele, CYP2D6 wild allele, CYP2E1 A genotype, GSTM1-null genotype were found to be associated with lung cancer. The individuals who carried GSTM1-null genotype and one of the CYP1A1, CYP2D6, CYP2E1 'in risk' genotypes had a 2.24-2.69 fold increased risk of lung cancer. The heavy smokers had a significantly increased risk of lung cancer than the non-smokers who carried the same genotype of metabolizing enzymes. The heavy smoker who carried all the four 'in risk' genotypes of metabolizing enzymes had an obviously increased risk of lung cancer (OR=9.85, 95%CI=2.30-45.71).</p><p><b>CONCLUSIONS</b>The individuals who carry the 'in risk' genotype of metabolizing enzymes have an increased risk of lung cancer. It is positively associated with tobacco carcinogen dose.</p>
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<p><b>BACKGROUND</b>To evaluate the efficacy and toxicity of combined chemotherapy of domestic paclitaxel and vinorelbine plus cisplatin and carboplatin in the treatment of advanced non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>A total of 181 initially treated patients with advanced NSCLC were enrolled in this study and treated by NP (vinorelbine plus cisplatin), TC (domestic paclitaxel plus carboplatin) and TP (domestic paclitaxel plus cisplatin). The efficacy and side effects were analysed after at least two cycles of chemotherapy.</p><p><b>RESULTS</b>The overall response rates (CR+PR) were 42.4% in the NP arm, 40.3% in the TC arm and 43.3% in the TP arm respectively. No significant statistical difference was found among the three groups ( Chi-square= 0.108 6 , P > 0.05). The median survival times were 8.4 months, 9.4 months and 8.9 months respectively in the NP, TC and TP groups ( P > 0.05). The 1-, 2-, 3-year survival rates were 39.0%, 16.9%, 5.1% in the NP group and 41.9%, 21.0%, 6.5% in the TC group and 40.0%, 18.3%, 5.0% in the TP group respectively. No significant statistical difference was found among the three groups ( Chi-square=0.140 4, P > 0.05). The major side effects were myelosuppression, alopecia and nausea/vomiting in the three groups. There were no chemotherapy-related death among the three groups.</p><p><b>CONCLUSIONS</b>The combined regimens of NP, TC and TP are effective and well-tolerated regimens for advanced NSCLC.</p>
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<p><b>BACKGROUND</b>To evaluate the values of a new tumor marker carbohydrate antigen (CA242) and combined determination of CA242, tissue polypeptide antigen (TPA), neuron-specific enolase (NSE) and carcinoembryonic antigen (CEA) in the diagnosis of malignant pleural effusion associated with lung cancer.</p><p><b>METHODS</b>The concentration of CA242, TPA, NSE and CEA in the serum and the pleural effusion was measured in 57 patients with malignant pleural effusion associated with primary lung cancer and 30 patients with tuberculous pleural effusion by enzyme-linked immunosorbent assay.</p><p><b>RESULTS</b>The levels of the four tumor markers in the serum and pleural effusion from patients with lung cancer were significantly higher than those with tuberculous pleural effusion (P < 0.01). The sensitivity of CA242 in the serum and the pleural effusion for lung cancer was 53.6% (31/57) and 61.4% (35/57) respectively; the sensitivity of CA242 for lung adenocarcinoma was 65.7% (23/36) and 66.7% (24/36) respectively. The specificity was 90.0%. Combined determination of the four tumor markers in serum and pleural effusion: If two or more of them were positive for evidence for diagnosis of lung cancer, the specificity for the serum and the pleural effusion was 96.7% (29/30) and 100.0% (30/30) respectively, with the sensitivity of 75.4% (43/57) and 77.2% (44/57) respectively.</p><p><b>CONCLUSIONS</b>The determination of the new tumor marker CA242 in serum and pleural effusion might be useful for the diagnosis of malignant pleural effusion associated with lung cancer, especially for adenocarcinoma. The combined determination of the four tumor markers can increase the specificity and the sensitivity in the diagnosis of malignant pleural effusion.</p>
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<p><b>OBJECTIVE</b>To evaluate Amifostin's effect on protecting kidney from cisplatinum (DDP) injury and its adverse reactions and safety.</p><p><b>METHODS</b>193 Patients were divided into two groups randomly: 102 in group A (treatment group) and 91 in group B (control group). Indexes such as blood routine, blood calcium, liver function, blood urea nitrogen (BUN), cretinine (C), and urinary N-acetyl-beta-D-glucosaminidase (NAG)/C and micro-albumin (MAB/C) were monitored at different intervals before or after treatment.</p><p><b>RESULTS</b>In the two courses of treatment in both groups, the deviation (D) values of MAB/C before treatment and on D2 in group A were lower than those in grop B (P < 0.05), so were those before treatment and on D4, D6, D10 and D14 (P < 0.01). The D-values of NAG/C before treatment and on D4, D6, D10 and D14 in the first course of group A were obviously lower than those on the corresponding days in group B (P < 0.01), so were those before treatment and on D2, D4, D6, D10 and D14 in the second course (P < 0.01).</p><p><b>CONCLUSION</b>The reduction of MAB/C and NAG/C by Amifostin in group A demonstrates that: Amifostin is able to effectively protect the renal function, regardless of the type of tumor. In contrast with group B, Amifostin in group A shows no protection for tumor in lung cancer and ovarian cancer. The main side effects of Amifostin are mild hypotension, nausea, vomiting and hypocalcemia in some patients.</p>