目的 探讨血清乳酸脱氢酶（LDH）在中晚期肝癌患者接受靶向联合免疫治疗后的预后预测价值。方法 选取2022年1月—2024年8月在莆田学院附属医院肿瘤内科经病理和影像学检查确诊的中晚期肝癌患者作为研究对象。从医院的电子病历系统中收集患者的基线资料，随访截止2025年8月，并记录随访结果，包括患者的疾病缓解情况和死亡情况，以及无疾病进展生存期（PFS）、总生存期（OS）。采用Kaplan-Meier方法绘制不同基线LDH水平患者的OS生存曲线，并通过Log-rank检验比较生存曲线。同时，运用多因素Cox比例风险回归分析探讨影响中晚期肝癌患者在接受靶向联合免疫治疗后OS的相关因素。结果 结果显示，在50例肝癌患者中，基线LDH低于200 U/L的有15例，而高于200 U/L的有35例。与基线LDH＜200 U/L组相比，基线 LDH≥200 U/L患者PFS、OS更短，差异均有统计学意义（χ²分别为5.51、15.6，P值分别为0.019、0.017）。治疗8周后，与LDH降低患者相比，LDH升高患者OS更短，差异有统计学意义（χ²=13.2，P=0.04）。多因素Cox比例风险回归分析结果表明，基线LDH水平超过200 U/L是中晚期肝癌患者接受靶向联合免疫治疗后OS的影响因素［P=0.035，HR（95%CI）=5.03（1.12，22.54）］。结论 基线LDH水平较低的患者表现出更好的OS。基线LDH水平可以作为预测中晚期肝癌患者在接受靶向联合免疫治疗时预后的指标。 

   Objective To evaluate the prognostic significance of serum lactate dehydrogenase（LDH）levels in patients with advanced hepatocellular carcinoma（HCC）undergoing targeted therapy combined immunotherapy．Methods Patients diagnosed with advanced HCC were selected in Putian College Affiliated Hospital from January 2022 to August 2024，diagnosed with pathological and imaging examinations results．Patient baseline data were collected from the hospital’s electronic medical records，with follow-up extending until August 2025．We documented outcomes such as disease response and mortality，along with progression-free survival（PFS）and overall survival（OS）．Kaplan-Meier survival curves were constructed based on baseline LDH levels，and the Log-rank test was employed for comparison．Additionally，multivariate Cox proportional hazards regression analysis was conducted to identify factors influencing OS in patients receiving targeted therapy combined immunotherapy．Results Among the 50 patients，15 had baseline LDH levels below 200 U/L，while 35 had levels above．Patients with baseline LDH≥200 U/L had significantly shorter PFS and OS than those with baseline LDH ＜200 U/L（χ²=5.51 and 15.6 for PFS and OS，respectively；P=0.019 and 0.017，respectively）．After 8 weeks of treatment，patients with increased LDH had significantly shorter OS compared with patients with decreased LDH（χ²=13.2，P=0.04）．Multivariate Cox proportional hazards regression analysis indicated that a baseline LDH level exceeding 200 U/L is an independent prognostic factor for OS in patients with intermediate to advanced HCC receiving targeted therapy combined with immunotherapy（P=0.035，HR 5.03［1.12，22.54］）．Conclusions Patients with lower baseline LDH levels demonstrated better OS，suggesting that baseline LDH can serve as an important prognostic indicator for advanced HCC patients undergoing targeted combined immunotherapy．

晚期癌痛所带来的疼痛症状是持久且严重的，这十分影响患者的生活质量与身心健康，并阻碍肿瘤治疗方案的顺利实施，进而影响患者治疗效果。阿片类药物是治疗中重度癌痛的主要方式，具有明确的镇痛效果，但是，吗啡、芬太尼等具有代表性的传统阿片类药物也存在一定的应用局限性，其主要通过激活μ-阿片受体下游的G蛋白信号通路以发挥镇痛作用，这会在一定程度上激活β-arrestin通路，进而增加呼吸抑制、严重便秘、过度镇静等副作用的发生情况，因此，该类药物不具有临床广泛应用性[1-2]。在此背景下，奥赛利定作为新型阿片类药物应运而生，其可选择性激活G蛋白通路，且不会显著激动β-arrestin通路效应，能够在实现强效镇痛的同时，还可降低由β-arrestin通路激活所介导的不良反应发生率，这十分适合应用在无法耐受传统阿片镇痛药物副作用的患者群体之中[3-4]。基于此，本研究进一步探究奥赛利定注射液治疗晚期癌痛的临床疗效与安全性，如下。

目的 分析槐花散合桃花汤联合FP（顺铂、5-氟尿嘧啶）化疗方案治疗寒热错杂型晚期食管癌患者的效果。方法 选取我院2023年1月～2024年8月寒热错杂型晚期食管癌患者98例，依照随机数字表法分为两组，各49例。对照组接受FP化疗方案治疗，观察组接受槐花散合桃花汤联合FP化疗方案治疗。比较两组多维度疗效[西医疗效（疾病控制率）、中医疗效]、治疗前后中医证候积分（TCMSS）、肿瘤标志物[鳞状细胞癌抗原（SCC-Ag）、癌胚抗原（CEA）、细胞角蛋白19片段（CYFRA21-1）]、生活质量[食管癌生命质量测定量表（QLICP-ES）]、毒副反应、1年生存率。结果 观察组中医疗效（89.80%）较对照组（65.31%）高（P＜0.05），而两组疾病控制率比较无明显差异（P＞0.05）；观察组TCMSS低于对照组（P＜0.05）；治疗后，观察组CEA、CYFRA21-1、SCC-Ag水平低于对照组（P＜0.05）；治疗后，观察组QLICP-ES评分低于对照组（P＜0.05）；观察组恶心呕吐、消化系出血、脱发发生率较对照组低（P＜0.05）；两组1年生存率对比无明显差异（P＞0.05）。结论 槐花散合桃花汤联合FP化疗方案治疗寒热错杂型晚期食管癌，能提高中医疗效，降低患者肿瘤标志物水平，减轻毒副反应，改善中医症状，并有助于减轻化疗对生活质量的负面影响。

Objective To analyze the efficacy of Huaihua San and Taohua Decoction combined with FP (cisplatin, 5-fluorouracil) chemotherapy regimen in the treatment of patients with advanced esophageal cancer of intermingled cold-heat syndrome type. Methods A total of 98 patients with advanced esophageal cancer complicated with intermingled cold-heat syndrome admitted to our hospital from January 2023 to August 2024 were enrolled and divided into two groups by the random number table method, with 49 cases in each group. The control group was treated with FP chemotherapy regimen, and the observation group was treated with Huaihua San and Taohua Decoction combined with FP chemotherapy. Multi-dimensional efficacy indicators [western medicine efficacy (disease control rate) and traditional Chinese medicine (TCM) efficacy], as well as the TCM syndrome score (TCMSS), tumor markers [squamous cell carcinoma antigen (SCC-Ag), carcinoembryonic antigen (CEA), cytokeratin 19 fragment (CYFRA21-1)], quality of life [quality of life instrument for cancer patients-esophageal cancer scale (QLICP-ES)] before and after treatment, adverse reactions and 1-year survival rate were compared between the two groups. Results The TCM efficacy rate of the observation group was 89.80%, which was significantly higher than 65.31% of the control group (P<0.05), no significant difference was found in disease control rate between the two groups (P>0.05). The TCMSS of the observation group was lower than that of the control group (P<0.05). After treatment, the levels of CEA, CYFRA21-1 and SCC-Ag in the observation group were lower than those in the control group (P<0.05). The QLICP-ES score of the observation group was superior to the control group after treatment (P<0.05). The incidences of nausea and vomiting, digestive tract hemorrhage and alopecia in the observation group were markedly lower (P<0.05). There was no statistical difference in 1-year survival rate between the two groups (P>0.05). Conclusion The regimen of Huaihua San and Taohua Decoction combined with FP chemotherapy for advanced esophageal cancer of intermingled cold-heat syndrome can improve TCM therapeutic efficacy, reduce the levels of tumor markers, alleviate toxic and side effects, ameliorate TCM symptoms, and lessen the negative impact of chemotherapy on patients quality of life.

目的 探讨靶向治疗前晚期非小细胞肺癌（NSCLC）患者血清肿瘤特异性生长因子（TSGF）、乳酸脱氢酶（LDH）、同型半胱氨酸（Hcy）水平与靶向治疗无效的相关性，并分析其对靶向治疗无效的预测价值。方法 选取2023年1月～2025年1月于本院就诊的晚期NSCLC患者108例作为研究组，另选取同期健康志愿者108例作为对照组。比较两组血清TSGF、LDH、Hcy水平。研究组予以靶向治疗（治疗3个疗程），依据靶向治疗无效将其分为无效亚组36例、有效亚组72例，比较其血清TSGF、LDH、Hcy水平。分析血清TSGF、LDH、Hcy与靶向治疗无效的相关性，并分析其对靶向治疗无效的预测价值。结果 研究组血清TSGF、LDH、Hcy水平高于对照组（P＜0.05）；无效亚组血清TSGF、LDH、Hcy水平高于有效亚组（P＜0.05）；校正吸烟史、分化程度、TNM分期后，治疗1个疗程后血清TSGF、LDH、Hcy水平仍与靶向治疗无效独立相关（P＜0.05）；靶向治疗前血清TSGF、LDH、Hcy水平预测靶向治疗无效的AUC值明显大于各指标单独预测（P＜0.05）。结论 晚期NSCLC患者血清TSGF、LDH、Hcy水平升高与靶向治疗无效独立相关，检测其水平对靶向治疗无效具有一定预测价值，且联合预测的效能更高，可指导临床制定及调整诊治方案。

       目的   探讨孕中晚期口腔二维轴向切面超声在产前诊断胎儿唇腭裂中的应用价值，评估其对唇裂、唇腭裂及继发腭裂的检出率和准确性。方法   本研究为前瞻性研究，共纳入2020年3月—2023年12月在我院超声科行产前超声诊断的3 666例孕中晚期胎儿，其中经超声检查诊断出111例唇腭裂，这些病例归为唇腭裂组，其余3 555例归入正常对照组。所有受试者均通过口腔二维轴向切面超声进行评估，诊断结果经产后随访确认。结果   在正常对照组中，上唇及上牙槽突的评估成功率为100%，软硬腭分界线显示率为99%，软腭显示率为85%。在唇腭裂组中，超声对唇裂、唇腭裂及继发腭裂的检出率分别为45%、48%和7%，且超声诊断的灵敏度、特异度和预测值均超过98%。结论   孕中晚期口腔二维轴向切面超声在产前诊断胎儿唇腭裂中具有较高的准确性和可靠性，为早期干预和临床管理提供了重要的影像学依据。

       Objective  To explore the application value of two-dimensional axial section ultrasound in prenatal diagnosis of fetal cleft lip and palate in the second and third trimesters of pregnancy，and to evaluate its detection rate and accuracy for cleft lip，cleft lip and palate，and secondary cleft palate．Methods  This study is a prospective study that included 3 666 fetuses in the second and third trimesters of pregnancy．Among them，111 cases of cleft lip and palate were diagnosed by ultrasound examination．These cases were classified as the cleft lip and palate group，and the remaining 3 555 cases were classified as the normal control group．All subjects were evaluated by oral two-dimensional axial section ultrasound，and the diagnostic  results were confirmed by postpartum follow-up．Results  In the normal control group，the success rates of evaluating the upper lip and upper alveolar process were 100%．The present rate of the soft hard palate boundary was 99%，and the present rate of the soft palate was 85%．In the cleft lip and palate group，the detection rates of cleft lip，cleft lip and palate，and secondary cleft palate by ultrasound were 45%，48% and 7% respectively，and the sensitivity，specificity，and predictive value of ultrasound diagnosis exceeded 98%．Conclusions  Two dimensional axial section ultrasound of the oral cavity in second and third trimesters of pregnancy has high accuracy and reliability in prenatal diagnosis of fetal cleft lip and palate，providing strong imaging evidence for early intervention and clinical management．

目的 分析贝伐珠单抗与化疗对晚期结直肠癌患者4种错配修复蛋白（MSH2、MLHI、MSH6、PMS2）水平影响。方法 选择2022年1月—2024年1月江苏省宿迁市中医院肿瘤科102例晚期结直肠癌患者,按抽签法分成两组,即化疗组及联合组,各51例。化疗组应用FOLFOX（亚叶酸钙+奥沙利铂+氟尿嘧啶）方案进行化疗,联合组采取贝伐珠单抗联合FOLFOX方案治疗。对比其肿瘤控制效果、免疫功能及MSH2、MLHI、MSH6和PMS2水平变化,并对比组间不良反应发生率。结果 联合组客观缓解率、疾病控制率高于化疗组（P<0.05）;治疗后联合组患者CD4⁺、CD3⁺、CD8⁺、和CD4⁺/CD8⁺数值高于化疗组,且两组治疗后均低于治疗前（P<0.05）;治疗后两组患者MSH2、MLHI、MSH6和PMS2缺失率对比无统计学意义（P>0.05）,但其阳性、阴性表达情况对比差异有统计学意义,联合组MSH2、MLHI、MSH6和PMS2阳性率低于化疗组（P<0.05）;两组不良反应发生率对比差异无统计学意义（P>0.05）。结论 对晚期结直肠癌在化疗基础上增加贝伐珠单抗抗肿瘤效果显著,改善其免疫功能,虽无法改善患者错配修复蛋白缺损,但可辅助降低其阳性率,且不影响安全性。

Objective To analyze the effects of bevacizumab and chemotherapy on the levels of four mismatch repair proteins（MSH2,MLHI,MSH6,PMS2）in patients with advanced colorectal cancer. Methods A total of 102 patients with advanced colorectal cancer from the Oncology Department of Suqian Traditional Chinese Medicine Hospital in Jiangsu Province from January 2022 to January 2024 were selected,and were divided into two groups according to the drawing method,namely the chemotherapy group and the combination group,with 51 patients in each group．The chemotherapy group received FOLFOX（calcium folinate+oxaliplatin+fluorouracil）regimen for chemotherapy,while the combination group received bevacizumab combined with FOLFOX regimen for treatment．Tumor control effect,immune function,and changes in MSH2,MLHI,MSH6,and PMS2 levels,and its incidence of adverse reactions were compared．Results The objective remission rate and disease control rate of the combined group were higher than those of the chemotherapy group（P<0.05）．After treatment,the CD4⁺,CD3⁺,CD8⁺ and CD4⁺/CD8⁺ values in the combination group were higher than those in the chemotherapy group,and those after treatment were lower than those before treatment in both groups（P<0.05）．After treatment,there were no significant differences in the deletion rates of MSH2,MLHI,MSH6,and PMS2 between the two groups of patients（P>0.05）,but there was a significant difference in their positive and negative expression．The positive rates of MSH2,MLHI,MSH6,and PMS2 in the combination group were lower than those in the chemotherapy group（P<0.05）．There was no significant difference in the incidence of adverse reactions between the two groups（P>0.05）．Conclusions Adding bevacizumab on the basis of chemotherapy has a significant anti-tumor effect on advanced colorectal cancer,improving its immune function．Although it cannot improve the mismatch repair protein defect in patients,it can assist in reducing its positivity rate and has high safety．

目的 探讨免疫治疗联合化学治疗（化疗）对晚期非小细胞肺癌（NSCLC）患者淋巴免疫及生活质量的影响,为临床进一步治疗提供参考。方法 选择2021年6月—2023年6月天津市滨海新区大港医院收治的晚期NSCLC患者120例进行研究,按抽签法分为干预组及对照组,每组60例,对照组采取单纯化疗方案,干预组采取免疫联合化疗方案,对比两组临床疗效、药物不良反应,治疗前后免疫功能（CD3⁺、CD4⁺、CD8⁺）、糖类抗原199（CA199）、糖类抗原 125（CA125）、血清癌胚抗原（CEA）水平及健康状态调查表（QOL）评分。结果 干预组患者治疗总有效率高于对照组（68.33%>41.67%,P<0.05）;治疗后干预组患者CD3⁺、CD4⁺比例高于治疗前及对照组治疗后,CD8⁺比例低于治疗前及对照组治疗后（P<0.05）;治疗后干预组血清CA199、CA125、CEA水平均低于治疗前及对照组治疗后（P<0.05）;干预组药物不良反应发生率为16.67％,对照组为36.67％,干预组低于对照组（P<0.05）;治疗后干预组QOL各维度评分高于对照组及治疗前（P<0.05）。结论 与单纯化疗相比,免疫联合化疗治疗晚期NSCLC患者,能有效降低肿瘤标志物水平,改善患者免疫指标,减轻药物不良反应,提高患者疗效及生活质量。

Objective To explore the effect of immunotherapy combined with chemotherapy on lymphatic immunity and quality of life of patients with advanced non-small cell lung cancer（NSCLC）,and to provide reference for further clinical treatment. Methods A total of 120 patients with NSCLC from June 2021 to June 2023 were selected and divided into observation group and control group evenly according to the method of drawing lots,control group was treated with chemotherapy,the observation group was treated with immunotherapy combined with chemotherapy,and the clinical efficacy and adverse drug reactions were compared between the two groups．Before and after treatment,immune function（CD3⁺,CD4⁺,CD8⁺）,carbohydrate antigen 199（CA199）,carbohydrate antigen 125（CA125）,serum carcinoembryonic antigen（CEA）levels and health status questionnaire（QOL-RRB- scores）were measured．Results The total effective rate in the observation group was significantly higher than that in the control group（68.33%>41.67%,P<0.05）．After treatment,the ratios of CD3⁺ and CD4⁺ in the observation group were significantly higher than those before treatment and control group after treatment,and the ratio of CD8⁺ was significantly lower than that before and after treatment in the control group（P<0.05）．After treatment,the serum levels of CA199,CA125 and CEA in the observation group were lower than those before and after treatment in the control group（P<0.05）．The incidence of adverse drug reactions was 16.67% in the observation group and 36.67% in the control group,which was significantly lower in the observation group than in the control group（P<0.05）．After treatment,the QOL scores in the observation group were significantly higher than those in the control group and before treatment（P<0.05）．Conclusions Compared with chemotherapy alone,immunotherapy combined with chemotherapy can effectively reduce the levels of tumor markers,improve the immune indexes of patients,reduce the adverse drug reactions,and improve the efficacy and quality of life of patients with advanced NSCLC．

目的 探讨妊娠期糖尿病（GDM）患者孕24~28周的75 g 口服葡萄糖耐量试验（OGTT）血糖异常项数及妊娠晚期分娩前血糖值与妊娠结局的关系。方法 选择2019年11月—2020年5月在广州医科大学附属妇女儿童医疗中心进行产检并在孕24~28周确诊的167例GDM患者为研究对象,将孕24~28周75 g OGTT结果中仅其中1项时间点血糖异常的孕妇为GDMⅠ组（92例）,2项异常为GDMⅡ组（48例）,3项异常为GDMⅢ组（27例）,比较三组血糖异常项数GDM患者的人口学特点;并分析GDM患者一般人口学特征与妊娠晚期分娩前血糖监测均值的关系,及血糖值对不良妊娠结局的影响。结果 75 g OGTT血糖异常项数与孕前不同的体质指数（BMI）及妊娠晚期的糖化血红蛋白（HbA_1c）间比较差异均有统计学意义（P<0.05）。孕前BMI指数水平对妊娠晚期的空腹血糖、餐后1 h血糖、餐后2 h血糖比较差异均有统计学意义（P<0.05）;75 g OGTT血糖异常项数对空腹血糖及餐后2 h血糖比较差异有统计学意义（P<0.05）;③空腹血糖不同水平组在新生儿低血糖、胎膜早破、早产不良结局中比较,差异有统计学意义（P<0.05）。餐后2 h不同血糖水平间组在新生儿低血糖及胎膜早破中比较,差异有统计学意义（P<0.05）。结论 孕前BMI指数与妊娠中期75 g OGTT的血糖筛查结果有关,75 g OGTT试验中血糖异常项数越多不良妊娠结局的发生概率越大,妊娠期进行规范化的运动饮食干预和必要时的药物干预后可改善妊娠晚期的HbA_1c水平。

Objective To investigate the relationship between abnormal blood glucose items in the 75 g oral glucose tolerance test（OGTT）at 24-28 weeks of pregnancy and the blood glucose levels before delivery in the third trimester of pregnancy and pregnancy outcomes in gestational disbetes mellitus（GDM）patients. Methods All 167 GDM patients diagnosed at 24-28 weeks of gestation in Women and Children's Medical Center Affiliated to Guangzhou Medical University from November 2019 to May 2020 were enrolled as subjects．The pregnant women with only 1 abnormal blood glucose item among the 75 g OGTT results were classified as GDMⅠ group（92 cases）,with 2 abnormal items were GDMⅡ group（48 cases）,and with 3 abnormal items were GDM Ⅲ group（27 cases）．The demographic characteristics of the three groups of GDM patients were compared．The relationship between the general demographic characteristics of GDM patients and the mean value of blood glucose monitoring before delivery in the third trimester was analyzed,and the influence of blood glucose monitoring on adverse pregnancy outcomes was also analyzed．Results ①With different BMI and HbA_1c,there were significant differences in 75 g OGTT blood glucose items（P<0.05）．BMI level had statistically significant effects on fasting blood glucose,1-hour postprandial blood glucose and 2-hour postprandial blood glucose in the third gestational trimester（P<0.05）．②With different number of abnormal blood glucose items,there were significant in fasting blood glucose and 2 hours postprandial blood glucose（P<0.05）．③There were statistically significant differences in the outcomes of neonatal hypoglycemia,premature rupture of membranes and preterm delivery in different fasting blood glucose groups（P<0.05）．There were statistically significant differences in neonatal hypoglycemia and premature rupture of membranes between different 2 hours postprandial blood glucose（P<0.05）. Conclusions BMI can affect the blood glucose screening results of 75g OGTT in the second trimester．The more abnormal blood glucose items in the 75g OGTT test,the greater the probability of adverse pregnancy outcome．Standardized exercise diet intervention and necessary drug intervention during pregnancy can improve the HbA_1c level in the third trimester．

目的 探讨表皮生长因子受体酪氨酸酶抑制剂（EGFR-TKIs）一线治疗耐药后,二线化学治疗（化疗）联合程序性死亡蛋白1及其配体（PD-1/L1）免疫检查点抑制剂方案对晚期非小细胞肺癌（NSCLC）的疗效。方法 选取2018年 6月—2022年10月期间就诊于南通大学附属肿瘤医院院的80例有完整临床资料、应用EGFR-TKIs耐药后晚期NSCLC患者进行回顾性分析,依照不同治疗方式将患者分为观察组与对照组,均为40例。对照组一线EGFR-TKIs治疗耐药后进行二线化疗,观察组一线EGFR-TKIs治疗耐药后进行二线化疗联合PD-1/L1免疫检查点抑制剂治疗。对比两组临床疗效及无进展生存期（PFS）,化疗前后血清中人细胞角蛋白21-1片段（Cyfra21-1）、糖类抗原125（CA125）、碱性成纤维细胞生长因子（bFGF）、血管内皮生长因子（VEGF）水平变化,不良反应发生率及生存质量。结果 观察组客观缓解率与疾病控制率高于对照组（P<0.05）,对照组PFS为10（2.38,24.13）个月,观察组PFS为14（5.27~,5.27）个月,观察组高于对照组（χ²=4.536,P=0.041）;化疗后两组bFGF、VEGF,CA125、Cyfra21-1肿瘤标志物水平均比化疗前降低,且观察组[（17.85±3.32）ng/L、（310.51±88.37）ng/L、（51.62±13.66）U/mL、（10.26±3.37）ng/mL]低于对照组[（19.62±3.24）ng/L、（366.26±49.42）ng/L、（59.26±9.35）U/mL、（12.62±2.73）ng/mL],对比差异有统计学意义（t₁=2.413,P₁=0.018;t₂=3.482,P₂<0.001;t₃=2.919,P₃=0.005;t₄=3.442,P₄<0.001）;两组不良反应发生率对比差异无统计学意义（P>0.05）;化疗后两组世界卫生组织生存质量量表简表评分均升高,观察组[（98.62±8.24）、（101.53±12.62）、（95.28±11.15）、（97.79±10.47）分]高于对照组[（84.25±7.32）、（93.58±15.75）、（82.24±9.34）、（83.47±8.38）]分,对比差异有统计学意义（t₁=8.246,P₁<0.001;t₂=2.491,P₂=0.015;t₃=5.670,P₃<0.001;t₄=6.753,P₄<0.001）。结论 对EGFR-TKIs耐药后晚期非小细胞肺癌患者采取二线化疗联合PD-1/L1免疫检查点抑制剂可提升其临床疗效及生存期,改善血清相关肿瘤标志物表达水平,提升患者生存质量。

Objective To explore the therapeutic effect of second-line chemotherapy combined with PD-1/L1 immune checkpoint inhibitor regimen on advanced non-small cell lung cancer（NSCLC） after epidermal growth factor receptor-tyrosine kinase inhibitors（EGFR-TKIs）resistance in first-line chemotherapy．Methods Retrospectively selected 80 patients with advanced NSCLC EGFR TKIs resistance,who were admitted to the Affiliated Cancer Hospital of Nantong University from June 2018 to October 2022．Patients were divided into an observation group and a control group according to different treatment methods,with 40 cases in each group．The control group received second-line chemotherapy after first-line EGFR-TKIs therapy resistance,while the observation group received second-line chemotherapy and PD-1/L1 inhibitor after first-line EGFR-TKIs therapy reactions and quality of live．Clinical efficacy and PFS,changes in serum levels of human Cyfra21-1,CA125,bFGF,VEGF,incidence of adverse chemotherapy of two groups were compared．Results The ORR and DCR of the observation group were significantly higher than those of the control group（P<0.05）．The mean PFS of the control group was 10（2.38-24.13）months,while the mean PFS of the observation group was 14（5.27-35.27）months．The observation group was higher than the control group（χ²=4.536,P=0.041）．After chemotherapy,levels of bFGF,VEGF,CA125 and Cyfra21-1 tumor markers decreased in both groups,and the observation group [（17.85±3.32）ng/L,（310.51±88.37）ng/L,（51.62±13.66）U/mL,（10.26±3.37）ng/mL] was lower than the control group [（19.62±3.24）ng/L,（366.26±49.42）ng/L,（59.26±9.35）U/mL,（12.62±2.73）ng/mL],which showed statistically significant difference in the comparison（t₁=2.413,P₁=0.018;t₂=3.482,P₂<0.001;t₃=2.919,P₃=0.005;t₄=3.442,P₄<0.001）．There was no significant difference in the incidence of adverse reactions between the two groups（P>0.05）．After treatment,the WHO QOL-BREF scores increased in both patient groups and the observation group scores[（98.62±8.24）,（101.53±12.62）,（95.28±11.15）,（97.79±10.47）] were higher than the control group scores[（84.25±7.32）,（93.58±15.75）,（82.24±9.34）,（83.47±8.38）],which showed statistically significant difference．（t₁=8.246,P₁<0.001;t₂=2.491,P₂=0.015;t₃=5.670,P₃<0.001;t₄=6.753,P₄<0.001）．Conclusions The combination of second-line chemotherapy with PD-1/L1 immune checkpoint inhibitors can improve the clinical efficacy and survival of advanced NSCLC patients who are resistant to EGFR-TKIs,improve the expression levels of serum related tumor markers,and enhance the quality of life of patients．

目的 探析化疗联合调强放疗（IMRT）治疗老年（≥65岁）局部晚期鼻咽癌的临床效果。方法 选取2018年1月—2019年1月我院诊治的90例老年局部晚期鼻咽癌患者为研究对象,使用随机数表法将此90例患者分为观察组及对照组,各45例。观察组行IMRT,对照组行化疗联合IMRT,对比2组的效果。结果 2组的治疗总有效率均为100%,组间差异不显著（P<0.05）。观察组的生活质量改善率（93.33%）高于对照组（77.78%）（P<0.05）。对照组出现3~4级白细胞减少、呕吐、黏膜炎人数明显高于观察组（P<0.05）,两者其他毒副反应比较无显著差异（P>0.05）。观察组的1年总体生存率（91.11%）及3年总体生存率（75.56%）均高于对照组（86.67%、68.89%）（P<0.05）。结论 对于老年局部晚期鼻咽癌,化疗联合IMRT相比单纯IMRT降低了远期生存率,增加了毒副反应并影响疗后生活质量的改善,不宜常规应用,单纯IMRT可能是更合适的治疗选择。

Objective To explore the clinical effect of chemotherapy combined with intensity modulated radiation therapy（IMRT）in the treatment of elderly（≥65 years old）locally advanced nasopharyngeal carcinoma．Methods The study was carried out from January 2018 to January 2019．During this period,90 elderly patients with locally advanced nasopharyngeal carcinoma who were diagnosed and treated in our hospital were selected as the research objects．The random number table method was used to divide the 90 patients into observation groups,and the control group,each with 45 cases．The observation group was treated with IMRT,and the control group was treated with chemotherapy combined with IMRT．The effects of the two groups were compared．Results The total effective rate of the two groups was 100%,and there was no significant difference between the two groups（P<0.05）．The improvement rate of quality of life in the observation group（93.33%）was higher than that in the control group（77.78%,P<0.05）．The number of grade 3-4 leukopenia,vomiting and mucositis in the control group was significantly higher than that in the observation group（P<0.05）,and there was no significant difference in other side effects between the two groups（P>0.05）．The 1-year overall survival rate（91.11%）and 3-year overall survival rate（75.56%）of the observation group were higher than those of the control group（86.67%,68.89%,P<0.05）．Conclusions For locally advanced nasopharyngeal carcinoma in the elderly,chemotherapy combined with IMRT reduces the long-term survival rate,increases the toxic and side effects and affects the improvement of the quality of life after treatment．It is not suitable for routine application,and IMRT alone may be a more appropriate treatment choice.