發(fā)布時間：2018-05-30 05:13

  本文選題：非小細(xì)胞肺癌 + 血漿血管內(nèi)皮生長因子�。� 參考：《皖南醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:肺癌是全球范圍內(nèi)患病率和病死率最高的惡性腫瘤之一,盡管當(dāng)代醫(yī)學(xué)發(fā)展迅速,然而如何提高早期肺癌的診療技術(shù),能否尋找到一種方法或生物標(biāo)志物更好地評估治療反應(yīng)和預(yù)測疾病進展,怎樣才能更好地管理肺癌患者。本文就上述問題作一探討。方法:我們研究了49名確診的、主要是未經(jīng)治療的原發(fā)性非小細(xì)胞肺癌(NSCLC)的患者,并收集10名對照組的資料(主要包括:診斷、癌胚抗原、細(xì)胞角蛋白19片段等)。49名NSCLC患者接受以鉑劑為主的一線化療。然后分別在第1周期化療前、第3周期化療前和第5周期化療前采集并量化血漿血管內(nèi)皮生長因子(VEGF)水平,根據(jù)評估結(jié)果進行相關(guān)分析。結(jié)果:我們觀察到:(1)肺腺癌患者血漿VEGF水平高于肺鱗癌,P0.05;(2)血漿VEGF水平作為肺腺癌、肺鱗癌生物標(biāo)志物的受試者工作特征曲線(ROC曲線)下面積(AUC)分別是0.910、0.723,95%置信區(qū)間(CI)分別為0.813-1.000、0.537-0.909,各自敏感度為76%、87.5%,各自特異度為90%、50%,且P均0.05;(3)第3次化療前、第5次化療前評估時,緩解期、穩(wěn)定期、進展期的血漿VEGF水平是不同的,P0.05;(4)第3次化療前、第5次化療前血漿VEGF水平反應(yīng)疾病進展的AUC分別為0.857、0.856,各自敏感度為88.9%、77.8%,特異度為73.3%、83.3%,95%CI分別為0.735-0.980、0.729-0.983,P=0.001;(5)對于治療反應(yīng)方面,血漿VEGF水平評估治療反應(yīng)良好,第3次化療前、第5次化療前的AUC分別為0.218,0.146;血漿VEGF水平評估治療反應(yīng)欠佳,第3次化療前、第5次化療前的AUC分別為0.782、0.854;95%CI分別為0.617-0.947,0.730-0.978,且敏感度很高,達(dá)90%以上,P均0.05。結(jié)論:血漿VEGF作為中晚期NSCLC特異性的生物標(biāo)志物有潛在價值,在一線化療過程中監(jiān)測血漿VEGF水平,能在早期階段識別哪些患者可能存在治療反應(yīng)欠佳或者是有疾病進展,這對我們是否需要更換治療方案提供重要信息,有助于個體化治療,對中晚期非小細(xì)胞肺癌的患者有更好的管理。
[Abstract]:Objective: lung cancer is one of the malignant tumors with the highest morbidity and mortality in the world. Despite the rapid development of modern medicine, how to improve the diagnosis and treatment of early lung cancer, Can we find a better method or biomarker to evaluate the therapeutic response and predict the progress of the disease, and how to better manage the lung cancer patients. This paper discusses the above problems. Methods: we studied 49 patients with untreated primary non-small cell lung cancer (NSCLC) and 10 controls (including diagnosis, carcinoembryonic antigen, carcinoembryonic antigen). A total of 49 NSCLC patients with cytokeratin 19 fragment were treated with platinum-based first-line chemotherapy. Then before the first cycle of chemotherapy, before the third cycle of chemotherapy and before the fifth cycle of chemotherapy, the plasma levels of vascular endothelial growth factor (VEGF) were collected and quantified, and the correlation analysis was carried out according to the evaluation results. Results: we observed that the plasma VEGF level of lung adenocarcinoma was higher than that of lung squamous cell carcinoma (P0.05 / 2) the plasma VEGF level was regarded as lung adenocarcinoma. The area under the operating characteristic curve (ROC curve) of patients with lung squamous cell carcinoma (ROC curve) was 0.91010 / 0.72395% confidence interval (CI) 0.813-1.000 / 0.537-0.909, respectively. The sensitivity of the two groups was 760.87.5%, and the specificity of each part was 90% (P 0.053) before the third chemotherapy, when the fifth time of chemotherapy was evaluated, The plasma VEGF levels in remission, stable and advanced stages were different (P0.05 / 4) before the third time of chemotherapy, before the fifth time of chemotherapy, the levels of plasma VEGF were 0.8570.8056, respectively, the sensitivity was 88.97.88.The specificity was 73.395CI (0.735-0.980,0.729-983P0. 001Ci, respectively) in response to the treatment, the plasma VEGF level was 0.857-0.856, and the specificity was 83.395CI (0.735-0.980) before the third time of chemotherapy, and before the fifth time of chemotherapy, the level of plasma VEGF reflected the progression of the disease, and the specificity was 0.735-0.980 (0.729-983P = 0.001), respectively. The response of plasma VEGF was good, the AUC before the 5th chemotherapy was 0.2180.146, the plasma VEGF level was poor, before the 3rd chemotherapy, the AUC before the 5th chemotherapy was 0.617-0.9470.730-0.978, and the AUC before the 5th chemotherapy was 0.617-0.9470.730-0.978. More than 90% (P < 0.05). Conclusion: plasma VEGF has potential value as a specific biomarker of NSCLC in middle and late stage. Monitoring plasma VEGF level during first-line chemotherapy can identify which patients may have poor therapeutic response or disease progression in the early stage. This provides important information on whether or not we need to change treatment protocols, contribute to individualized treatment and better manage patients with advanced non-small cell lung cancer (NSCLC).
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R734.2

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