1.Prognosis Of Locally Advanced Non-small Cell Lung Cancer Treated With Radiotherapy Or Chemoradiotherapy 2.The Prognostic Value Of MicroRNAs In Small Cell Lung Cancer

PartⅠ:3 DCRT improved overall survival for locally advanced non-small-cell lung cancer patients comparing to conventional radiotherapyPurpose To compare treatment results of three-dimensional(3D)conformal radiotherapy and conventional radiotherapy(2D)for patients with locally advanced non-small-cell lung cancer(NSCLC).Methods and Materials Between Jan 2000 and Dec 2006,527 patients with stageⅢNSCLC were reviewed.253 cases were treated with 3D conformal radiotherapy,274 with conventional radiotherapy.In the 3D group,62.8%patients with chemoradiotherapy,30.4%with total radiotherapy dose of＞60Gy,19.4%with 50～60Gy;In the 2D group,46.4%patients with chemoradiotherapy,17.5%with total radiotherapy dose of＞60Gy,27.4%with 50～60Gy.Toxicity was scored accorcing to CTC 3.0.The observed endpoints were overall survival(OS)and cancer-specific survival(CSS).Kaplan-Meier estimation and Cox regression models were used for survival analyses.Results 1-,3-,5-year overall survival rates(OS)and median survival time for patients who received 3D were 73.3%,26.1%,14.4%and 20.1 months respectively;61.0%,13.8%,8.0%and 15.6 months in patients who received 2D radiotherapy(P=0.002).1-,3-,5-year cancer-special survival rates(CSS)were 79.0%, 33.3%,20.8%for the 3D group and 65.1%,16.7%,11.2%for the 2D group, respectively(P=0.000).Locoregional control rates at 1-,3-,and 5-year were 71.6%, 34.3%and 31.0%for patients who received 3D radiotherapy and 57.3%,22.1%and 19.2%in patients who received 2D treatment,respectively(P=0.002).On multivariate analysis,3D radiotherapy was independently associated with increased OS and CSS.In addition,KPS,clinical tumor response and pretreatment haemoglobin level also were independently associated with OS and CSS.No statistically differences of radiation complication were found in the two groups.Conclusion This study demonstrates that 3D conformal radiotherapy improves survival rate in patients with stageⅢNSCLC compared with 2D treatment. PartⅡ:Treatment results of 3DCRT for locally advanced non-small cell lung cancerPurpose To retrospectively analyze treatment results of Three-Dimensional conformal Radiotherapy(3 DCRT)for locally advanced non-small cell lung cancer(LD NSCLC) patents.Methods and Materials Between Jan 2000 and Dec 2006,253 patients with locally advanced NSCLC were reviewed.Among them,82 with stageⅢA,171 with stageⅢB.Patents were treated with radiotherapy alone(n=96),concurrent chemoradiotherapy(n=93),Sequential chemoradiotherapy(n=64).The median total radiotherapy dose were 60(range,50～76)Gy.The observed endpoints were overall survival(OS)and cancer-specific survival(CSS).KapIan-Meier estimation and Cox regression models were used for survival analyses.Results The 1-,3-,5-year overall OS and the median survival time were 73.3%,26.1%,14.4%and 20.1 months for the whole group,respectively;79.0%,33.3%,20.8%for CSS.Tumor volume of 80cm~3 was selected as the cutoff point which optimally predict the prognosis.In univariate analysis,the following variables were significantly associated with OS and CSS:gross tumor volume(＞80 vs≤80cm),performance status(≥80 vs＜80)and clinical tumor response(CR+PR vs SD+PD).In multivariate analysis,gross tumor volume, performance status and clinical tumor response were independently associated factors on OS and CSS.Failure sites included the local recurrence(49.0%)and distant metastasis (48.6%).Radiation pneumonitis and esophagitis of GradeⅡor higher were 26.5%and 35.2%,respectively.Conclusion Gross tumor volume,performance status and clinical tumor response were the independent factors on OS and CSS.Tumor volume of 80cm~3 was the cutoff point which optimally predict the prognosis for patients with LD NSCLC. PartⅢ:The prognostic value of serum tumor markers(CEA,NSE,CA-125 and Cyfra 21-1)in patients with non-small cell lung cancer undergoing radiotherapy alone or chemoradiotherapyPurpose To study the prognostic value of serum tumor markers(CEA,CA-125,NSE and Cyfra 21-1)in patients with stageⅠ-Ⅲnon-small cell lung cancer(NSCLC)undergoing radiotherapy alone or chemoradiotherapy.Methods and Materials Between Jan,2001 and Dec,2006,190 patients were analyzed who met the following criteria:histologically or cytologically NSCLC,clinical stageⅠ-Ⅲ,definitive thoracic radiotherapy alone or chemoradiotherapy and a total dose of≥50 Gy;completed medical data of pretreatment biological markers.All assays were measured by ELISA.Serum levels of CEA,CA-125, NSE and Cyfra 21-1 less than 5.0 ng/ml,35 U/ml,12 ng/ml and 3.3 ng/ml,respectively, were considered as normal.The observed endpoints were overall survival(OS)and diease free survival(DFS).Kaplan-Meier estimation and Cox regression models were used for survival analyses.Results The overall 1,3,5-year survival rate(OS)and the median survival time were 70.1%,25.3%,19.2%and 19.4 months for the whole group, respectively,and 48.4%,18.2%,15.5%for disease free survival(DFS).In univariate analysis,Cyfra 21-1(≥3.3 vs＜3.3 ng/ml),CA-125(≥35 vs＜35 ng/ml),radiotherapy technique(2D vs 3D)and total dose(＜60 vs≥60Gy)were correlated with OS. Multivariate analysis demonstrated that Cyfra 21-1≥3.3 ng/ml(HR=1.708,1.176-2.478), CA-125≥35 ng/ml(HR=1.444,1.024-2.035),Three-Dimensional conformal radiotherapy(HR=0.657,0.454-0.952)and total dose≥60Gy(HR=0.664, 0.451-0.978)were independent prognostic factors.Conclusion Cyfra 21-1,CA-125 are independent prognostic factors for patients with NSCLC treated with radiotherapy alone or chemoradiotherapy.. PartⅣ:The prognostic value of microRNAs in small cell lung cancerPurpose To study the association between microRNAs and prognosis for small cell lung cancer.Methods and Materials MicroRNA microarray expression profiling of Archived formalin-fixed,paraffin-embedded tumor tissues was performed on a cohort of 42 patients with SCLC receiving surgery±chemotherapy±radiotherapy.Association between the level of each microRNA expression and survival was evaluated by cox regression analysis.A model was developed according to a linear combination of the expression level of the microRNAs,weighted by the regression coefficients for the prediction of the outcome of treatment of SCLC.We validated the model in another cohort of 40 patients,using quantitative reverse transcription polymerase chain reaction assays(qRT-PCR).Results In the microchip group,MicroRNA1 and microRNA2 that significantly correlated with survival among patients with SCLC were identified. According to the median risk score computed by model,high risk and low risk group were divided.The low risk group had higher 3-year progression free(76.2%vs 42.9%, P=0.045)and overall survival rate(76.3%vs 47.6%,P=0.02)than high risk group.The model was validated in the qRT-PCR group,3-year progression free survival rates were 64.3%,40.0%(P=0.017),3-year overall survival rates were 74.1%,40.0% (P=0.005).Conclusion Two-mcroRNA signature is closely associated with progression free and overall survival among patients with small cell lung cancer.