目的 探讨混合磨玻璃结节的CT征象对肺腺癌病理亚型及分化程度的预测价值.方法 回顾性分析2021年5月-12月厦门大学附属第一医院胸外二科术后病理为浸润性腺癌(invasive adenocarcinoma,IAC)的混合磨玻璃结节66例患者的临床资料,其中男20例、女46例,年龄35～75岁.术前分析其CT表现,术后切开病灶剖面,区分其磨玻璃成分与实性成分并得出不同位置的病理结果,按术后病理结果将患者分为低危组(贴壁型为主且没有微乳头亚型和实体亚型成分)16例,中危组(乳头或腺泡型为主且没有微乳头亚型和实体亚型成分)38例,高危组(含有微乳头或实体亚型)12例,分析比较三组患者CT特征与病理亚型及分化程度的关系.结果 在66例IAC患者中,实性成分的浸润程度均大于磨玻璃成分,当实性成分比(consolidation tumor ratio,CTR)≥25％(敏感度为90.2％,特异度为64.0％,P=0.005),平均CT值＞-283.95 HU(敏感度为82.9％,特异度为64.0％,P=0.000)时组织学分级更倾向于中、低分化.具有中、高危组亚型的IAC,其CTR、Ki-67、平均CT值及组织学分级都高于低危组结节.结论 IAC混合磨玻璃结节中实性成分浸润程度高于磨玻璃成分,可根据其CT特征预测肺腺癌病理亚型、Ki-67表达程度及组织学分级,对于确定手术时机有重要的临床意义.

MicroRNA是一类非编码且在进化上高度保守的小分子RNA,通过与信使RNA(mRNA)的特异性结合,从而调控基因的表达.目前,关于microRNA的研究已引起全世界的高度重视,其中miR-139-5p表达在癌症的变化发展过程中起着重要作用.在相当一部分癌症中,如肺癌、食管癌、乳腺癌、口腔舌鳞状细胞癌、肝癌,具有抑制癌细胞增殖、转移、侵袭的作用.在癌症治疗中,miR-139-5p可联合部分抗癌药物,延缓抗癌药物的耐药性,以及增强肿瘤对放疗的敏感性,对癌症预后有积极的影响;且其在其它疾病的组织、细胞研究领域中分别起着不同作用,如神经细胞、炎症组织.本文对miR-139-5p的研究现状展开分析.

Abstract Background Lung cancers arising in never smokers have been suggested to be substantially different from lung cancers in smokers at an epidemiological, genetic and molecular level. Focusing on non-small cell lung cancer (NSCLC), we characterized lung cancer patients in China looking for demographic and clinical differences between the smoking and never-smoking subgroups. Methods In total, 891 patients with NSCLC, including 841 with adenocarcinoma and 50 with squamous cell carcinoma, were recruited in this study. Association of smoking status with demographic and clinical features of NSCLC was determined, and risk factors for lymph node metastasis and TNM stage were evaluated using Multivariate logistic regression analysis. Results In patients with adenocarcinoma, never smokers showed a younger age at diagnosis (54.2 ± 12.7vs. 59.3 ± 9.4, p adjusted <0.001), a lower risk for lymph node metastasis than smokers (7,6% vs. 19.5%, p adjusted <0.001) and less severe disease as indicated by lower percentages of patients with TNM stage of III or IV (5.5% vs. 14.7%, p adjusted <0.001 ). By contrast, these associations were not observed in 50 patients with squamous cell carcinoma. Multivariate logistic regression analysis showed that smoking status was a risk factor for lymph node metastasis (OR = 2.70, 95% CI: 1.39–5.31, p = 0.004) but not for TNM stage (OR = 1.18, 95% CI: 0.09–14.43, p = 0.896) in adenocarcinoma. Conclusion This study demonstrates that lung adenocarcinoma in never smokers significantly differ from those in smokers regarding both age at diagnosis and risk of lymph node metastasis, supporting the notion that they are distinct entries with different etiology and pathogenesis.

非小细胞肺癌是全球癌症死亡的主要原因,其发病率逐年升高,严重危害人类健康.早期的非小细胞肺癌依据症状体征一般难以被发现,因此准确的病理学诊断、精准的预后预测对于非小细胞肺癌患者制定最佳治疗计划、改善患者生存期至关重要.人工智能在非小细胞肺癌诊疗中的应用已显示出良好的性能和巨大的潜力,本文介绍了人工智能在预测非小细胞肺癌分型、分期、基因组学和预后方面的研究进展.