周彩存教授团队:七种自身抗体分子谱在肺癌早筛早诊中的临床价值

2017-10-20 佚名 MedSci

肺癌居所有恶性肿瘤的病死率首位,总体5年生存率不超过15%,与之相对比,如肺癌患者在IA期发现并治疗,其五年生存率可达92%。令人遗憾的是,肺癌早期无明显临床症状,目前临床约80%的肺癌患者就诊时已属中晚期,失去手术治疗的机会。因此,为了有效改善整体肺癌患者的预后,开展肺癌筛查和早期诊段,刻不容缓。上海市肺科医院肿瘤科周彩存教授团队在肺癌早诊领域持续科研攻关。基于我国肺癌高发的区域,以上海市肺科医

肺癌居所有恶性肿瘤的病死率首位,总体5年生存率不超过15%,与之相对比,如肺癌患者在IA期发现并治疗,其五年生存率可达92%。令人遗憾的是,肺癌早期无明显临床症状,目前临床约80%的肺癌患者就诊时已属中晚期,失去手术治疗的机会。因此,为了有效改善整体肺癌患者的预后,开展肺癌筛查和早期诊段,刻不容缓。

上海市肺科医院肿瘤科周彩存教授团队在肺癌早诊领域持续科研攻关。基于我国肺癌高发的区域,以上海市肺科医院为牵头单位,全国相关专家共同努力,联合北京胸科医院张树才教授团队、河南省肿瘤医院马智勇教授团队、浙江省肿瘤医院徐笑红教授团队、武汉大学人民医院李艳教授团队和南京鼓楼医院蔡后荣教授团队六家单位,开展了前瞻性、多中心临床研究。本研究是国内第一次大规模的针对中国人群进行肺癌自身抗体分子谱筛查的临床研究,通过对2848例临床样本进行系统分析,首次确认肺癌血清七种自身抗体分子在肺癌早期诊断中的重要临床应用价值,并在502例I期肺癌中再次进行验证了早期肺癌诊断的敏感性。主要研究成果发表在国际顶尖肿瘤免疫学杂志“Oncolmmunology”,获得同行的高度评价。

1.总体研究思路

该研究着眼于目前美国低剂量螺旋CT肺癌筛查的利弊与英国NHS开展的肺癌自身抗体分子血液筛查进展,结合目前国内临床越来越多的肺小结节诊断难题,周彩存教授领衔的研究团队通过多年临床研究,试图回答以下临床面临的难题:如何合理应用影像学与血液分子标记物检查全面评估和诊断早期肺部肿瘤?目前在高度困惑临床的肺小结节诊断过程中这七个自身抗体分子指标究竟能提供什么样临床信息? 血液检查指标能否应用于中国肺癌筛查过程之中?

2.七种肺癌自身抗体谱在肺小结节分层管理的重要价值

随着胸部CT的广泛应用,临床遇到的肺内小结节越来越多,其病因复杂、病变小,临床表现缺乏特异性,肺小结节的诊治一直是临床上的难点。研究团队进一步开展了肺小结节前瞻性随防,结果表明,肺癌七种自身抗体谱对于8毫米以下肺部小结节与8毫米以上肺小结节,对于实性结节、半实性结节与磨玻璃结节都有90% 以上高特异性。数据表明,对于肺小结节人群如果七种肺癌自身抗体谱指标阳性,提示微小病灶有肿瘤侵袭的可能,建议纳入肺小结节高危(High risk)分层管理

3.CT联合肺癌七种自身抗体谱,更有效肺癌筛查

美国国立肺癌筛查试验研究结果表明:与X线胸片相比,采用低剂量螺旋CT(LDCT)对肺癌高危人群进行筛查可使肺癌死亡率降低20%。低剂量螺旋CT的里程碑的肺癌筛查价值得到越来越多人的认可。然而,低剂量螺旋CT针对肺小结节高达96%假阳性,持续的CT暴露可能诱发第二肿瘤等多种未知风险因素等不足,美国将胸部CT筛查限制在50岁以上重度男性吸烟的人群,50岁以下的重度男性吸烟者与美国女性如何开展肺癌早诊,美国肿瘤界也在持续关注血液检查的应用范围与模式。英国NHS在2012年开展了肺癌血液自身抗体筛查研究的探索。但是,美国与欧洲开展肺癌筛查的研究都是基于男性烟民肺癌高危人群的筛查,中国肺癌流行病学的特点有其自身规律,开展符合中国人群特征的肺癌筛查项目和管理策略是我们目前亟待解决的问题。

本研究开展的基于中国人种进行肿瘤免疫抗体分子谱的临床研究表明,肺部七种自身抗体谱对吸烟与不吸烟人群、男性与女性、肺癌不同分期与亚型都有很好的敏感性与特异性。总体来说,单独使用七种抗体谱诊断肺癌的敏感性61%,特异性90%。胸部CT与肺癌七种身抗体谱联合,诊断肺癌的阳性预测值可达95.0%。对肺部小结节患者的前瞻性队列研究发现,肺癌七种自身抗体谱联合胸部低剂量螺旋CT可以显着降低低剂量螺旋CT的假阳性率,并提高其阳性预测值。以上结果说明,肺癌七种自身抗体在肺癌的临床诊断和肺部小结节的辅助诊断(联合低剂量螺旋CT)中具有很好的临床应用价值。



4.研究展望

临床中肺癌患者确诊时多已失去手术治愈的机会,这是肺癌长期生存率低的主要原因。早期筛查是提高肺癌总体生存率的关键。目前,CFDA批准肺癌七种自身抗体分子谱产品用于肺癌的辅助诊断。随着我们的不断探索和研究,以肺癌七种自身抗体为主的血液检查手段,将会被越来越多的应用到肺癌的早期诊断和筛查策略中。进而帮助临床医生发现更多早期肺癌,挽救更多肺癌患者生命与家庭!

专家简介:

周彩存教授


主任医师,教授,博士生导师;

同济大学附属上海市肺科医院,同济大学医学院肿瘤研究所;

中国临床肿瘤学会常务理事;

中国医促会胸部肿瘤分会主委;

中国抗癌协会肺癌专业委员会常委;

上海市抗癌协会肺癌分子靶向和免疫治疗专委会主委

中国抗癌协会肿瘤药物临床研究专业委员会副主任委员。

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    2017-10-30 1e145228m78(暂无匿称)

    学习了谢谢作者分享!

    0

  3. 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22 05:58:00 CST 2017, time=2017-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=254844, encodeId=e30e25484409, content=已经学习.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/be4YlKNv3rT6se8HUMWmAyS3eywXjKkf3TaeJkKrgAdTM1l1WesYwgkw2VAOVEWicdb6rCiaRbttqjb9ozpjCkGQ/0, createdBy=2d322139779, createdName=欧阳星月dora, createdTime=Sat Oct 21 10:00:34 CST 2017, time=2017-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=254681, encodeId=7bc5254681e3, content=学习了谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Fri Oct 20 23:21:03 CST 2017, time=2017-10-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=254674, encodeId=b6bc2546e414, content=学习了.很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/19/d82a4430fd2fae93a9bdc99fee8b8f09.jpg, createdBy=f4b663579, createdName=jiafeng76, createdTime=Fri Oct 20 22:10:17 CST 2017, time=2017-10-20, status=1, ipAttribution=)]
    2017-10-26 1e145228m78(暂无匿称)

    学习了谢谢作者分享!学习了谢谢作者分享!

    0

  4. 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createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Fri Oct 20 23:21:03 CST 2017, time=2017-10-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=254674, encodeId=b6bc2546e414, content=学习了.很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/19/d82a4430fd2fae93a9bdc99fee8b8f09.jpg, createdBy=f4b663579, createdName=jiafeng76, createdTime=Fri Oct 20 22:10:17 CST 2017, time=2017-10-20, status=1, ipAttribution=)]
    2017-10-25 情途末路

    学习了.获益匪浅!感谢分享

    0

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createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Fri Oct 20 23:21:03 CST 2017, time=2017-10-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=254674, encodeId=b6bc2546e414, content=学习了.很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/19/d82a4430fd2fae93a9bdc99fee8b8f09.jpg, createdBy=f4b663579, createdName=jiafeng76, createdTime=Fri Oct 20 22:10:17 CST 2017, time=2017-10-20, status=1, ipAttribution=)]
    2017-10-22 1e145228m78(暂无匿称)

    学习了谢谢作者分享!学习了谢谢作者分享!

    0

  6. 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level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/07/17/0ed05bbc4eb124766d2a39104932ec4e.jpg, createdBy=5afd2091871, createdName=情途末路, createdTime=Wed Oct 25 17:24:41 CST 2017, time=2017-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=255155, encodeId=9343255155a9, content=学习了谢谢作者分享!学习了谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Sun Oct 22 20:06:38 CST 2017, time=2017-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1420911, 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22 05:58:00 CST 2017, time=2017-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=254844, encodeId=e30e25484409, content=已经学习.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/be4YlKNv3rT6se8HUMWmAyS3eywXjKkf3TaeJkKrgAdTM1l1WesYwgkw2VAOVEWicdb6rCiaRbttqjb9ozpjCkGQ/0, createdBy=2d322139779, createdName=欧阳星月dora, createdTime=Sat Oct 21 10:00:34 CST 2017, time=2017-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=254681, encodeId=7bc5254681e3, content=学习了谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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  7. 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level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/07/17/0ed05bbc4eb124766d2a39104932ec4e.jpg, createdBy=5afd2091871, createdName=情途末路, createdTime=Wed Oct 25 17:24:41 CST 2017, time=2017-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=255155, encodeId=9343255155a9, content=学习了谢谢作者分享!学习了谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Sun Oct 22 20:06:38 CST 2017, time=2017-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1420911, 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22 05:58:00 CST 2017, time=2017-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=254844, encodeId=e30e25484409, content=已经学习.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/be4YlKNv3rT6se8HUMWmAyS3eywXjKkf3TaeJkKrgAdTM1l1WesYwgkw2VAOVEWicdb6rCiaRbttqjb9ozpjCkGQ/0, createdBy=2d322139779, createdName=欧阳星月dora, createdTime=Sat Oct 21 10:00:34 CST 2017, time=2017-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=254681, encodeId=7bc5254681e3, content=学习了谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Fri Oct 20 23:21:03 CST 2017, time=2017-10-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=254674, encodeId=b6bc2546e414, content=学习了.很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/19/d82a4430fd2fae93a9bdc99fee8b8f09.jpg, createdBy=f4b663579, createdName=jiafeng76, createdTime=Fri Oct 20 22:10:17 CST 2017, time=2017-10-20, status=1, ipAttribution=)]
    2017-10-22 nakerunner
  8. 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22 05:58:00 CST 2017, time=2017-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=254844, encodeId=e30e25484409, content=已经学习.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/be4YlKNv3rT6se8HUMWmAyS3eywXjKkf3TaeJkKrgAdTM1l1WesYwgkw2VAOVEWicdb6rCiaRbttqjb9ozpjCkGQ/0, createdBy=2d322139779, createdName=欧阳星月dora, createdTime=Sat Oct 21 10:00:34 CST 2017, time=2017-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=254681, encodeId=7bc5254681e3, content=学习了谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Fri Oct 20 23:21:03 CST 2017, time=2017-10-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=254674, encodeId=b6bc2546e414, content=学习了.很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/19/d82a4430fd2fae93a9bdc99fee8b8f09.jpg, createdBy=f4b663579, createdName=jiafeng76, createdTime=Fri Oct 20 22:10:17 CST 2017, time=2017-10-20, status=1, ipAttribution=)]
    2017-10-21 欧阳星月dora

    已经学习.谢谢分享

    0

  9. 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level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/07/17/0ed05bbc4eb124766d2a39104932ec4e.jpg, createdBy=5afd2091871, createdName=情途末路, createdTime=Wed Oct 25 17:24:41 CST 2017, time=2017-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=255155, encodeId=9343255155a9, content=学习了谢谢作者分享!学习了谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Sun Oct 22 20:06:38 CST 2017, time=2017-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1420911, 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22 05:58:00 CST 2017, time=2017-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=254844, encodeId=e30e25484409, content=已经学习.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/be4YlKNv3rT6se8HUMWmAyS3eywXjKkf3TaeJkKrgAdTM1l1WesYwgkw2VAOVEWicdb6rCiaRbttqjb9ozpjCkGQ/0, createdBy=2d322139779, createdName=欧阳星月dora, createdTime=Sat Oct 21 10:00:34 CST 2017, time=2017-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=254681, encodeId=7bc5254681e3, content=学习了谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Fri Oct 20 23:21:03 CST 2017, time=2017-10-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=254674, encodeId=b6bc2546e414, content=学习了.很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/19/d82a4430fd2fae93a9bdc99fee8b8f09.jpg, createdBy=f4b663579, createdName=jiafeng76, createdTime=Fri Oct 20 22:10:17 CST 2017, time=2017-10-20, status=1, ipAttribution=)]
    2017-10-20 1e145228m78(暂无匿称)

    学习了谢谢作者分享!

    0

  10. 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    2017-10-20 jiafeng76

    学习了.很好

    0

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