答:目前肺癌临床分期分4期,Ⅰ期、Ⅱ期、Ⅲ期和Ⅳ期,而在Ⅰ期里又分ⅠA期、ⅠB期,Ⅱ期分ⅡA、ⅡB,Ⅲ期分ⅢA、ⅢB期。目前医学上临床分期是Ⅰ期和Ⅱ期 的病友可以通过手术获益,而ⅢB期和Ⅳ期一般不适合手术,ⅢA期的病人则有的可以直接手术,有的需要做新辅助化疗后再争取手术。充分完善的术前检查,可以判断是否可以手术并通过手术获益。
答:对于完全切除的I期患者,其中对于ⅠA期期的患者,现在没有证据证明术后辅助化疗能够延长患者的生存率。所以一般对此期是不做辅助化疗的。对IB期的患者,则是可做可不做,如果有高危因素,如肿瘤四公分以上,切缘有癌残留,或小血管/淋巴管内癌栓,也可以考虑化疗。对于II期和部分III期的能够完全切除的患者,术后疗能够延长患者的生存,毫无疑问的肯定要做术后辅助化疗。
工作中经常有病友及家属问还能活多久的问题,简要回答如下:肺癌是一种死亡率较高的恶性肿瘤,也是中国居民的主要死亡原因之一,那么肺癌的治疗效果如何呢?我们中山大学肿瘤医院的肺癌手术病例中, 抽样调查结果显示: IA期的5年生存率约为70%, IB期的5年生存率约为66%,ⅡA期的5年生存率约为35%, ⅡB期的5年生存率约为25%, IIIA期手术患者的5年生存率约为20%,Ⅳ期肺癌的5年生存率小于1%。(注:本组数据来源于我院抽样数据统计,如果与文献报道有差异,系不同抽样导致,但总体数据应该相差不大)5年生存率是什么?肺癌确诊以后还可以活多久? 简单的说就是病患确诊肺癌或经过治疗以后, 大体病人人群中经过5年时间还有多少人还活着, 比如IA期的5年生存率约为70%就是说经过系统的治疗IA期的肺癌病人100个里面会有70个可以活到5年, 同样IIIA期手术患者的5年生存率约为20%是指IIIA期手术患者100个里面会有20个可以活到5年。那有人要问那5年以后怎么办呢?有报道IIIA期手术患者的20年生存率约为7%,也就是说IIIA期手术患者100个里面也有7个左右的病友可以活到20年。病友及家属应该有怎么样的心理预期才比较好呢?这个我觉得的应该要看确诊时的分期是如何的。如果属于早期(I期,Ⅱ期)就应该积极手术及综合治疗,争取达到治愈。如果已经属于较晚期(例如Ⅳ期),也应该积极治疗,化疗,放疗,靶向药物等等,但是这时候治疗的主要目的应该是提高病人的生活质量为主要目的,比如改善呼吸困难,疼痛的控制等等。以上文稿由本人撰写,可以免费转载,但请注明出处,谢谢!具体病例请咨询医生。本文属于科普性质,肺癌治疗进展日新月异,如有雷同及错误,敬请原谅和批评指正,谢谢阅读。
答:肺癌只要治疗得当,病人获得长期生存甚至治愈都是可能的。我们建议,在征得患者家属同意的前提下,向患者开诚布公地交代病情并告知肺癌可治,绝大多数患者在短暂的慌乱后,能很快平静下来并积极面对,推动治疗向好的方向发展。而那些被瞒着的病人,医患之间难以建立信任,病人要么不配合治疗,要么胡乱猜测自己的病情,心理问题严重,最终对治疗不利。
检查项目简要说明检查楼层必做项目血液检查包括血常规、血型、凝血、生化(肝肾功能)、传染病、肿瘤标志物等术前常规检查。2层抽血处胸部增强CT观察病灶部位、大小、淋巴结及胸部隐蔽部位等。4层腹部增强CT帮助排除腹部脏器(如肝脏,肾上腺)等的转移。颅脑MRI 帮助排除颅脑转移。心电图帮助评价心脏能否承受手术或化放疗等的打击。5层肺功能和血气分析评价肺通气和换气功能,帮助决策手术的术式。10层肺功能室支气管镜检查手术前必须充分了解气管及支气管腔内情况。11层胸科内镜室视情况选做项目痰细胞学检查晨起漱口后反复轻咳,再用力咳出肺深部的痰,每次送检痰量1~2口,连续3天。3层胸部正侧位片观察病变的部位、大小、范围等。4层颅脑增强CT帮助排除颅脑转移。4层腹部彩色B 超帮助排除腹部脏器(如肝脏,肾上腺)等的转移。5层B超室心脏彩色B 超帮助评价心脏能否承受手术或化放疗等的打击。彩色B 超引导下肿物穿刺活检适用于因各种原因不能手术的患者,只有取得病理后,才能进行下一步的化放疗或靶向等治疗,有时需要多次穿刺活检才能取得病理。5层B超室预约胸部CT引导下肿物穿刺活检10层介入病区找值班医生预约气管镜超声引导针吸活检(EBUS-TBNA)可对纵隔肿大淋巴结进行定性病理诊断。2层内镜室全身骨ECT扫描了解全身骨骼有无癌转移。核医学科全身PET/CT对鉴别肺部孤立结节是否为恶性具有较高的敏感性和特异性。颈部及锁骨上淋巴结活检活检取得病理后,才能进行下一步的化放疗或靶向等治疗,争取最大获益。预约门诊小手术备注
答:体检发现肺部的结节或肿块,有一些可能是良性的,比如有糖尿病的朋友由于抵抗力下降,容易发生肺结核球,还有一些肺的炎性假瘤、隐球菌病、结节病、肺错构瘤等等。但是对于有家族史,长期吸烟史的朋友则要高度警惕肺癌的可能。目前手术是治疗早期肺癌的最有效,治疗效果最好的手段,也是国际广泛承认的标准治疗手段,要抓住时机,争取早做手术,达到最佳的治疗效果。
在此之前,我们必须明白关于肺癌诊断的两个概念,这非常关键,因为不同的诊断直接导致不同的治疗手段的运用。肺癌的诊断包涵了“病理诊断和分期诊断”两个概念。肺癌病理诊断:简单的说临床上把肺癌分为 “小细胞肺癌和非小细胞肺癌”,其中非小细胞肺癌又可以简单的大概的分为1鳞癌2腺癌(包括细支气管肺泡癌,淋巴上皮样癌,粘液腺癌,乳头腺癌等等)4大细胞癌 5腺鳞癌6其他(包括混合成分的癌等等)。注释:这里为什么说是简单的分类呢?因为WHO的肺癌分类太复杂,那个太专业,临床上大部分时候用不着,就不细说了。肺癌分期诊断:临床上简单的把非小细胞肺癌分为Ⅰ期,Ⅱ期,Ⅲ期,Ⅳ期,进一步说Ⅰ期,Ⅱ期,Ⅲ期又可以分为ⅠA期,ⅡA期,ⅢA期和ⅠB期,ⅡB期,ⅢB期。Ⅰ期和Ⅱ期相当于老百姓常说的早期,Ⅲ期相当于中期,Ⅳ期相当于晚期。扩散到淋巴不一定是晚期啊!具体分期请咨询专科医生!不同的分期基本上决定了不同的治疗手段,具体见下。好了,明白了“病理诊断和分期诊断”两个概念以后,我们简单谈下肺癌有哪些治疗手段。上网一搜,乖乖,肺癌治疗手段五花八门,眼花缭乱,对于病人来说,到底哪些适合自己呢,一下子就糊涂了?目前总的来说:肺癌主要三大治疗手段,包括:1手术;2化学治疗,简称化疗;3放射治疗,简称放疗;其他还有没有呢?有!还有包括其他的手段:靶向药物治疗,介入,热疗,冷冻治疗,中医中药等等。有人问:肺癌生物治疗有吗?生物治疗有效吗?回答:目前还没有什么效果。“病理诊断和分期诊断”两个概念与肺癌的治疗手段的选择关系很大。简单的原则:1小细胞肺癌首先选择化疗2非小细胞肺癌则考虑:Ⅰ期,Ⅱ期,和部分ⅢA期病人适合手术;还有一部分ⅢA期适合先化疗再手术;还有一部分ⅢA期适合化疗+放疗;ⅢB期和Ⅳ期的病人大部分不适合手术只适合化疗+放疗,也有一些可以手术参与,例如孤立的单个脑转移等。3即使化疗,根据不同的病理类型,可以选择不同的化疗方案,例如腺癌用“铂类+培美曲赛”的方案就比较好,而鳞癌就不适用此方案等等。4靶向药物治疗,目前来说适合EGFR突变的病人,二线药物,一般适用ⅢB期和Ⅳ期的病人,在化疗无效时或者病人不能耐受化疗时使用。5介入,早期的肺癌病人可以做吗,如果病人有其他疾病或情况无法手术,可考虑介入6中医中药,有效吗?祖国医学博大精深,但中医中药目前还处于辅助治疗的地位!以上只是治疗基本的原则,实际治疗过程中还是要根据具体的情况进行处理,请咨询专科医生为佳。最后一个标准的肺癌的诊断的格式应该是这样的,例如:右上肺腺癌, pT1N2M0, ⅢA期以上文稿由本人撰写,可以免费转载,但请注明出处,谢谢!本文属于科普性质,肺癌治疗进展日新月异,如有雷同及错误,敬请原谅和批评指正,谢谢阅读。
Introduction to the inaugural issue of Annals of Palliative MedicineHoward S. Smith1, Zhi-hua Zhu2,31Department of Anesthesiology, Albany Medical College, New York, USA; 2State Key Laboratory of Oncology in South China, China; 3Department of Thoracic Oncology, Cancer Center of Sun Yat-Sen University, ChinaCorresponding to: Howard S. Smith, MD. Professor & Academic Director of Pain Management, Department of Anesthesiology, Albany Medical College, 47 New Scotland Avenue, MC-131 Albany, New York 12208, USA. Tel: 518-262-4461; Fax: 518-262-4462. Email: smithh@mail.amc.edu. Zhi-Hua Zhu, MD, PhD. State Key Laboratory of Oncology in South China; Department of Thoracic Oncology, Cancer Center of Sun Yat-Sen University, No. 651, East Dongfeng Rd, Guangzhou 510060, China.Tel/Fax: +86-20-87343571. Email: zhu-zh@hotmail.com.Ann Palliat Med 2012;1(1):1. DOI: 10.3978/j.issn.2224-5820.2012.03.01Although many "palliative medicine journals" currently exist, there remains "room" for a quality international journal; especially one with a translational focus. We are especially excited that this new journal is being published in China where palliative medicine is blossoming and world-wide leaders of "translational palliative medicine" exist. The editor-in-chiefs, editorial board members, and publisher take great pleasure in presenting the Annals of Palliative Medicine (APM). The journal features a distinguished editorial board covering multiple disciples contributing to the field of palliative medicine. The journal will be an international, peer-reviewed publication with a focus on: Cutting edge solutions to challenging palliative medicine problems, the basic science of palliative medicine and its translation to the patient's bedside surgical approaches to palliation of distressing advanced clinical issues, as well as potential future targets for novel agents geared to control/ alleviate distressing symptoms. APM will also highlight current practical palliative medicine clinical care in efforts to lead to optimal patient outcomes. Specific areas of interest include, but not limited to, multimodality therapy, biomarkers, imaging, biology, pathology, and technical advances related to palliative medicine.The entire submission and review process of APM is managed online with Open Journal System (OJS) developed by Public Knowledge Project. This would greatly expedite the process from submission to editorial decision for an individual manuscript, and hence a rapid turnaround of publication. The open-access policy of APM will allow all readers from the medical science community to utilize all material published in this journal freely without obstacle. But importantly, all these benefits would by no means compromise quality of published studies in APM which are constantly subject to formal peer-review and are expected to meet the most rigorous standards of academic excellence.We are very thankful to all who supported the creation and maintenance of APM including clinicians, scientists, authors, editorial board members, staff, and publisher. It is our sincere hope that this journal will function as a forum for clinicians and basic scientists to share information, communicate, and collaborate in search of solutions to significant clinical issues as well as be an exciting addition to the existing palliative medicine literature.We believe that this journal will facilitate translation of outstanding basic science and clinical research, serve as a valuable resource for health care providers, and help to shape future basic science and clinical directions in the field of palliative medicine.
http://www.sysucc.org.cn/news.asp?selectclassid=001004&id=2822(中心办报道) 近日,我中心胸外科朱志华教授参与的,包括美国旧金山加利福尼亚大学胸外科,美国Kaiser Permanente 研究中心、美国Pinpoint Genomics实验室、广州医学院附属第一医院、上海肺科医院、北京首都医科大学等多中心在内的一项肺癌预后预测研究,取得了新进展,研究论著《A practical molecular assay to predict survival in resected non-squamous, non-small-cell lung cancer: development and international validation studies》作为封面论文发表于世界著名医学期刊《The Lancet》。 此次的多中心合作研究利用定量PCR方法寻找并建立了一个包括14个基因的分子标记物群,分别成功的对包括361位,433位及1006位早期肺癌术后病人的预后进行了预测和验证。通过这种方法可以将术后的此类病人,区分成高危、中危和低危的三组,三组的5年生存率分别49.2%、58.3%和71.4%。肺癌的个体化预后预测,即如何准确找到预后差的病人予以干预治疗,同时避免对预后好病人的过度治疗,本研究进一步为早期肺癌患者术后的个体化治疗的选择提供科学依据。 朱志华教授在多家单位中排名第三(前两名为共同第一作者),这是我院首次在《The Lancet》主杂志发表文章,也是继朱志华教授肺癌研究在国际肿瘤学顶级杂志《Journal of Clinical Oncology》发表高影响因子论文后的一次新突破。此次合作扩大了我院在该领域的国际影响,为进一步的国际合作奠定了良好基础。The Lancet, Early Online Publication, 27 January 2012doi:10.1016/S0140-6736(11)61941-7Cite or Link Using DOIA practical molecular assay to predict survival in resected non-squamous, non-small-cell lung cancer: development and international validation studiesJohannes R Kratz MD a , Prof Jianxing He MD b , Stephen K Van Den Eeden PhD c, Prof Zhi-Hua Zhu MD d, Prof Wen Gao MD e, Patrick T Pham BS a, Michael S Mulvihill BS a, Fatemeh Ziaei BS f, Huanrong Zhang MD b, Bo Su MD e, Prof Xiuyi Zhi MD g, Charles P Quesenberry PhD c, Laurel A Habel BS c, Qiuhua Deng BS b, Zongfei Wang BS b, Jiangfen Zhou BS b, Huiling Li PhD b, Mei-Chun Huang PhD f, Che-Chung Yeh PhD a, Prof Mark R Segal PhD a, M Roshni Ray BS a, Prof Kirk D Jones MD a, Dan J Raz MD a, Zhidong Xu MD a, Thierry M Jahan MD a, David Berryman PharmD f, Biao He PhD a, Dr Michael J Mann MD a , Prof David M Jablons MD aSummaryBackgroundThe frequent recurrence of early-stage non-small-cell lung cancer (NSCLC) is generally attributable to metastatic disease undetected at complete resection. Management of such patients depends on prognostic staging to identify the individuals most likely to have occult disease. We aimed to develop and validate a practical, reliable assay that improves risk stratification compared with conventional staging.MethodsA 14-gene expression assay that uses quantitative PCR, runs on formalin-fixed paraffin-embedded tissue samples, and differentiates patients with heterogeneous statistical prognoses was developed in a cohort of 361 patients with non-squamous NSCLC resected at the University of California, San Francisco. The assay was then independently validated by the Kaiser Permanente Division of Research in a masked cohort of 433 patients with stage I non-squamous NSCLC resected at Kaiser Permanente Northern California hospitals, and on a cohort of 1006 patients with stage I—III non-squamous NSCLC resected in several leading Chinese cancer centres that are part of the China Clinical Trials Consortium (CCTC).FindingsKaplan-Meier analysis of the Kaiser validation cohort showed 5 year overall survival of 71·4% (95% CI 60·5—80·0) in low-risk, 58·3% (48·9—66·6) in intermediate-risk, and 49·2% (42·2—55·8) in high-risk patients (ptrend=0·0003). Similar analysis of the CCTC cohort indicated 5 year overall survivals of 74·1% (66·0—80·6) in low-risk, 57·4% (48·3—65·5) in intermediate-risk, and 44·6% (40·2—48·9) in high-risk patients (ptrend<0·0001). Multivariate analysis in both cohorts indicated that no standard clinical risk factors could account for, or provide, the prognostic information derived from tumour gene expression. The assay improved prognostic accuracy beyond National Comprehensive Cancer Network criteria for stage I high-risk tumours (p<0·0001), and differentiated low-risk, intermediate-risk, and high-risk patients within all disease stages.InterpretationOur practical, quantitative-PCR-based assay reliably identified patients with early-stage non-squamous NSCLC at high risk for mortality after surgical resection.FundingUCSF Thoracic Oncology Laboratory and Pinpoint Genomics.
朱志华副教授作为共同第一作者文章再次发表于美国顶级肿瘤学研究杂志《JOURNAL OF CLINICAL ONCOLOGY》(影响因子 18.970),这是继2009年朱志华副教授作为第一作者发表的早期肺癌论文后的第二篇高水平论文。链接如下:http://jco.ascopubs.org/content/29/34/4516.abstracthttp://jco.ascopubs.org/content/27/7/1091.abstract?sid=c046931e-17d6-47aa-a0f7-734bfba3b690论文摘要如下:Eight-Signature Classifier for Prediction of Nasopharnyngeal Carcinoma SurvivalAbstractPurpose Currently, nasopharyngeal carcinoma (NPC) prognosis evaluation is based primarily on the TNM staging system. This study aims to identify prognostic markers for NPC.Patients and Methods We detected expression of 18 biomarkers by immunohistochemistry in NPC tumors from 209 patients and evaluated the association between gene expression level and disease-specific survival (DSS). We used support vector machine (SVM) –based methods to develop a prognostic classifier for NPC (NPC-SVM classifier). Further validation of the NPC-SVM classifier was performed in an independent cohort of 1,059 patients.Results The NPC-SVM classifier integrated patient sex and the protein expression level of seven genes, including Epstein-Barr virus latency membrane protein 1, CD147, caveolin-1, phospho-P70S6 kinase, matrix metalloproteinase 11, survivin, and secreted protein acidic and rich in cysteine. The NPC-SVM classifier distinguished patients with NPC into low- and high-risk groups with significant differences in 5-year DSS in the evaluated patients (87% v 37.7%; P < .001) in the validation cohort. In multivariate analysis adjusted for age, TNM stage, and histologic subtype, the NPC-SVM classifier was an independent predictor of 5-year DSS in the evaluated patients (hazard ratio, 4.9; 95% CI, 3.0 to 7.9) in the validation cohort.Conclusion As a powerful predictor of 5-year DSS among patients with NPC, the newly developed NPC-SVM classifier based on tumor-associated biomarkers will facilitate patient counseling and individualize management of patients with NPC.