目的 分析三维（3D）重建技术联合解剖性肺段切除（SA）治疗非小细胞肺癌（NSCLC）患者对肿瘤标志物、炎症反应、血气指标及肺功能的影响。 方法 以2022年1月~2024年10月阜阳市人民医院收治的74例行胸腔镜下SA术（SA-VATS）治疗的NSCLC患者作为SA-VATS组，选取同期收治的31例行3D重建技术联合SA-VATS治疗的NSCLC患者作为3D组，观察至术后1个月。统计SA-VATS组和3D组手术相关指标、术后住院期间并发症发生情况，比较SA-VATS组和3D组术前及术后7 d血清肿瘤标志物、炎性因子水平、血气指标，术前及术后1个月肺功能。 结果 3D组手术相关指标改善情况优于SA-VATS组（P<0.05）。SA-VATS组和3D组术后7 d血清血管内皮生长因子、热休克蛋白90α、癌胚抗原、细胞角蛋白19片段水平与术前比较，降低，3D组低于SA-VATS组（P<0.05）。SA-VATS组和3D组术后7 d血清白介素-8、白介素-10、肿瘤坏死因子-α水平与术前比较，升高，但3D组低于SA-VATS组（P<0.05）。SA-VATS组和3D组术后7 d血气指标变化情况均改善，3D组优于SA-VATS组（P<0.05）。SA-VATS组和3D组术后1个月肺功能指标与术前比较，降低，但3D组高于SA-VATS组（P<0.05）。术后住院期间，3D组总并发症发生率与SA-VATS组组间比较，差异无统计学意义（P>0.05），但3D组低于SA-VATS组。 结论 3D重建技术联合SA治疗NSCLC患者可有效缩短手术时间、降低术中出血量，促进患者术后恢复，同时降低其血清肿瘤标志物水平，缓解机体炎症反应，改善其血气指标及肺功能，且可能有助于减少并发症的发生。
Abstract
Objective To analyze the effect of three-dimensional (3D) reconstruction technique combined with anatomical segmentectomy (SA) on tumor markers, inflammatory response, blood gas indexes, and lung function in patients with non-small cell lung cancer (NSCLC). Methods From January 2022 to October 2024,74 patients with NSCLC who video-assisted thoracoscopic surgery SA (SA-VATS) in Fuyang People's Hospital were selected as the SA-VATS group, and 31 patients with NSCLC who underwent 3D three-dimensional reconstruction combined with SA-VATS were selected as the 3D group. The operation-related indexes and postoperative complications during hospitalization were statistically analyzed. The levels of serum tumor markers, inflammatory factors, and blood gas indexes before and 7 d after operation, and lung function before and 1 month after operation were compared between SA-VATS group and 3D group. Results The improvement of operation related indexes in 3D group was better than that in SA-VATS group (P<0.05). The levels of serum vascular endothelial growth factor, heat shock protein 90α, carcinoembryonic antigen, and cytokeratin 19 fragment in SA-VATS group and 3D group at 7 d after operation were lower than those before operation, and those in 3D group were lower than those the SA-VATS group (P<0.05). The levels of serum interleukin-8, interleukin-10, and tumor necrosis factor-α in the SA-VATS group and 3D group at 7 d after operation were higher than those before operation, but those in 3D group were lower than those in SA-VATS group (P<0.05). The changes of blood gas indexes in SA-VATS group and 3D group were improved at 7 d after operation, and 3D group was better than SA-VATS group (P<0.05). The pulmonary function indexes of SA-VATS group and 3D group at 1 month after operation were lower than those before operation, but those in 3D group were higher than those in SA-VATS group (P<0.05). During hospitalization after operation, there was no significant difference in the incidence of total complications between 3D group and SA-VATS group (P>0.05), but 3D group was lower than SA-VATS group. Conclusions 3D reconstruction technique combined with SA-VATS in the treatment of patients with NSCLC could effectively shorten operation time, reduce intraoperative blood loss, promote postoperative recovery of patients, reduce the level of serum tumor markers, alleviate inflammatory response, improve blood gas index and lung function, and might help to reduce the occurrence of complications.
关键词
非小细胞肺癌； /
/
三维重建技术； /
/
解剖性肺段切除； /
/
肺功能
Key words
Non-small cell lung cancer; /
/
Three-dimensional reconstruction technology; /
/
Anatomical pneumonectomy; /
/
Lung function
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Remon J, Soria J C, Peters S. Early and locally advanced non-small-cell lung cancer: an update of the ESMO Clinical Practice Guidelines focusing on diagnosis, staging, systemic and local therapy[J]. Ann Oncol, 2021, 32(12): 1637-1642. DOI: 10.1016/j.annonc.2021.08.1994.
[2] Chua TH, Chuah KL. Concordance of Cytological Specimens with Histological Tissue for Detection of Epidermal Growth Factor Receptor Mutation in Non-Small Cell Lung Cancer: A Systematic Review[J]. Acta Cytol, 2022, 66(1): 61-71. DOI: 10.1159/000519380.
[3] Kato H. Thoracoscopic anatomical segmentectomy for early-stage non-small cell lung cancer: minimally invasive surgery involving various approaches[J]. J Thorac Dis, 2023, 15(2): 242-245. DOI: 10.21037/jtd-23-3.
[4] Tosi D, Nosotti M, Bonitta G, et al. Anatomical segmentectomy versus pulmonary lobectomy for stage I non-small-cell lung cancer: patients selection and outcomes from the European Society of Thoracic Surgeons database analysis[J]. Interact Cardiovasc Thorac Surg, 2021, 32(4): 546-551. DOI: 10.1093/icvts/ivaa298.
[5] Wu YJ, Shi QT, Zhang Y, et al. Thoracoscopic segmentectomy and lobectomy assisted by three-dimensional computed-tomography bronchography and angiography for the treatment of primary lung cancer[J]. World J Clin Cases, 2021, 9(34): 10494-10506. DOI: 10.12998/wjcc.v9.i34.10494.
[6] Mohammed KK, Hassanien AE, Afify HM. A 3D image segmentation for lung cancer using V.Net architecture based deep convolutional networks[J]. J Med Eng Technol, 2021, 45(5): 337-343. DOI: 10.1080/03091902.2021.1905895.
[7] Patil SM, Kunda NK. Nisin ZP, an Antimicrobial Peptide, Induces Cell Death and Inhibits Non-Small Cell Lung Cancer (NSCLC) Progression in vitro in 2D and 3D Cell Culture[J]. Pharm Res, 2022, 39(11): 2859-2870. DOI: 10.1007/s11095-022-03220-2.
[8] Bruggeman AR, Sarkar RR, Ahn GS, et al. Split course palliative radiotherapy for advanced lung cancer with 3D planning based analysis of outcome: a retrospective review[J]. Ann Palliat Med, 2022, 11(2): 423-430. DOI: 10.21037/apm-21-1589.
[9] Oncology Branch of Chinese Medical Association, Journal of Chinese Medical Association. Clinical diagnosis and treatment guidelines of lung cancer by oncology branch of Chinese Medical Association (2021 edition) [J]. Journal of Chinese Medicine, 2021, 101(23): 1725-1757.
[10] Mennecier B, Olland A, Mascaux C, et al. Re: Two centres' experience with lung cancer resection in patients with advanced non-small-cell lung cancer following treatment with immune checkpoint inhibitors: safety and clinical outcomes[J]. Eur J Cardiothorac Surg, 2021, 60(6): 1306-1307. DOI: 10.1093/ejcts/ezab399.
[11]Kamigaichi A, Hamada A, Tsuboi M, et al. A Multi-Institutional, Randomized, Phase III Trial Comparing Anatomical Segmentectomy and Lobectomy for Clinical Stage IA3 Pure-Solid Non-Small-Cell Lung Cancer: West Japan Oncology Group Study WJOG16923L (STEP UP Trial)[J]. Clin Lung Cancer, 2024, 25(4): 384-388. DOI: 10.1016/j.cllc.2024.01.004.
[12]Stamatis G, Leschber G, Schwarz B, et al. Survival outcomes in a prospective randomized multicenter Phase III trial comparing patients undergoing anatomical segmentectomy versus standard lobectomy for non-small cell lung cancer up to 2 cm[J]. Lung Cancer, 2022, 172(1): 108-116. DOI: 10.1016/j.lungcan.2022.08.013.
[13]Tao J, Liang C, Yin K, et al. 3D convolutional neural network model from contrast-enhanced CT to predict spread through air spaces in non-small cell lung cancer[J]. Diagn Interv Imaging, 2022, 103(11): 535-544. DOI: 10.1016/j.diii.2022.06.002.
[14]Wu L, Lou X, Kong N, et al. Can quantitative peritumoral CT radiomics features predict the prognosis of patients with non-small cell lung cancer? A systematic review[J]. Eur Radiol, 2023, 33(3): 2105-2117. DOI: 10.1007/s00330-022-09174-8.
[15]Lee SY, Lee E, Lim JU, et al. U-Shape Pillar Strip for 3D Cell-Lumped Organoid Model (3D-COM) Mimicking Lung Cancer Hypoxia Conditions in High-Throughput Screening (HTS)[J]. Anal Chem, 2024, 96(25): 10246-10255. DOI: 10.1021/acs.analchem.4c00890.
[16]Yoon SH, Na KJ, Kang CH, et al. Remotely shared CT-derived presurgical understanding of lung cancer: A randomized trial[J]. Thorac Cancer, 2022, 13(19): 2823-2828. DOI: 10.1111/1759-7714.14637.
[17]Cui Z, Ding C, Li C, et al. Preoperative evaluation of the segmental artery by three-dimensional image reconstruction vs. thin-section multi-detector computed tomography[J]. J Thorac Dis, 2020, 12(8): 4196-4204. DOI: 10.21037/jtd-20-1014.
[18] Malmros K, Kirova N, Kotarsky H, et al. 3D cultivation of non-small-cell lung cancer cell lines using four different methods[J]. J Cancer Res Clin Oncol, 2024, 150(10): 472-472. DOI: 10.1007/s00432-024-06003-x.
[19]Hu W, Zhang K, Han X, et al. Three-dimensional computed tomography angiography and bronchography combined with three-dimensional printing for thoracoscopic pulmonary segmentectomy in stage IA non-small cell lung cancer[J]. J Thorac Dis, 2021, 13(2): 1187-1195. DOI: 10.21037/jtd-21-16.
[20]Ding Y, Feng H, Yang Y, et al. Deep-learning based fast and accurate 3D CT deformable image registration in lung cancer[J]. Med Phys, 2023, 50(11): 6864-6880.DOI: 10.1002/mp.16548.
[21]Mileham KF, Farhangfar CJ. Expanding the Multidisciplinary Team in Prediagnostic Care of Lung Cancer: How Else Can We Improve Time to Targeted Treatment in Metastatic Non-Small-Cell Lung Cancer?[J]. JCO Oncol Pract, 2023, 19(9): 694-696. DOI: 10.1200/OP.23.00416.
[22]Lanuti M. Commentary: Evolution of the preoperative space: Neoadjuvant targeted therapy in patients with operable non-small cell lung cancer with actionable mutations Surgeon equipoise?[J]. J Thorac Cardiovasc Surg,2023, 165(5): 1694-1695. DOI: 10.1016/j.jtcvs. 2022.12.020.
[23] Zhu Y, Lowe AC. Multiplexed fluorescence in situ hybridization-based detection of circulating tumor cells: A novel liquid-based technology to facilitate accurate and early identification of non-small cell lung cancer patients[J]. Cancer Cytopathol, 2020, 128(8): 518-519. DOI: 10.1002/cncy.22277.
[24]Terrones M, Deben C, Rodrigues-Fortes F, et al. CRISPR/Cas9-edited ROS1 + non-small cell lung cancer cell lines highlight differential drug sensitivity in 2D vs 3D cultures while reflecting established resistance profiles[J]. J Transl Med, 2024, 22(1): 234-234. DOI: 10.1186/s12967-024-04988-0.
[25]Wang H, Yuan Y, Qin L, et al. Tunable rigidity of PLGA shell-lipid core nanoparticles for enhanced pulmonary siRNA delivery in 2D and 3D lung cancer cell models[J]. J Control Release, 2024, 366(3): 746-760. DOI: 10.1016/j.jconrel.2024.01.029.
[26]Veiga M, Kuhweide R, Demaerel V, et al. Labyrinthine enhancement on 3D black blood MR images of the brain as an imaging biomarker for cisplatin ototoxicity in (lung) cancer patients[J]. Neuroradiology, 2021, 63(1): 81-90. DOI: 10.1007/s00234-020-02504-x.
基金
安徽省重点研究和开发计划项目（1804h08020267）
PDF(1761 KB)
京ICP备08002354号-3
