The Study Of The Diagnosis And Treatment In Lung Cancer Patients With Pleural Effusion Based On The Trapezoidal Spiral Separator

Background:Lung cancer is the second most common malignant tumor(11.4%)and the highest mortality rate in the world.The incidence of lung cancer in China will also increase in 2020 compared with the previous year,with an overall incidence of about 816,000 cases and about 715,000 deaths,while non-small cell lung cancer accounts for 85% of total lung cancer,with more than half of patients already in advanced stages(Phase III,Phase IV)40% of patients with advanced lung adenocarcinoma are accompanied by malignant thoracic fluid,but the current shedding cytology method has a low diagnosis rate(50%),so this paper explores whether the use of trapezoidal helix sorting technology has the advantage of pathological diagnosis.Treatments for advanced non-small cell lung cancer are mainly targeted therapy,radiotherapy,chemotherapy,immunotherapy,etc.Targeted therapy is adapted to drive gene-positive patients,while in Asian patients,40 percent of patients drive the base negatively,and this group of patients can only choose chemotherapy or immunotherapy.For immunotherapy,immunochecker inhibitors have become an effective treatment for advanced non-small cell lung cancer.The survival benefits of patients treated with immunocheckpoint inhibitors are associated with the expression of PD-L1 in tumor cells.At present,the clinical PD-L1 test method is tissue biopsy,but about 40% of people are difficult to successfully carry out tissue biopsy,and tissue biopsy is an invasive examination,to the patient has a certain harm,if there can be invasive,high detection rate method,will greatly improve clinical efficiency and the effectiveness of patient immunotherapy.Therefore,this paper explores the molecular diagnosis of malignant thoracic fluid compared with the advantages of traditional shedding cytology.For chemotherapy,patient resistance is the main reason for chemotherapy failure,because tumor cell heterogeneity is strong,not all patients are consistent with the sensitivity of the same drug,therefore,if 3D culture of patient tumor cells and in vitro drug sensitivity experiments,will effectively guide clinicians personalized drug use,to improve the life expectancy of patients.The purpose of this study is to explore whether the use of keyoidal helix sorting technology can improve the positive rate of pathological diagnosis,and to achieve molecular diagnosis of PD-L1 in patients with malignant thoracic fluid in the advanced stage of lung adenocarcinoma,as well as to carry out primary cell culture and apply to drug sensitivity experiments to achieve personalized treatment.Methods: 1.22 patients with advanced lung adenocarcinoma were selected at the University Hospital affiliated with Southeast University with malignant thoracic fluid,and the thoracic fluid cells were sorted by a trapezoidal helix sorter.2.after sorting for immunofluorescence staining,to determine whether it is tumor cells.3.through the original cell culture method to culture cells into 3D tumor balls,after the ball to select a first-line chemotherapy drugs for in vitro drug sensitivity experiments,after the ball of the original cells using CCK-8 method for conventional chemotherapy drug sensitivity experiments,the drugs are cisplatin(DDP),carplatin(CBP),Paclitaxel(PTX),Gisitabin(GEM),Pemetrexed(PEM),Vinorelbin(NVB).And use graph Pad prism 8.0 for data analysis.Results: Of the 22 patients selected in the experiment,14(64%)tested positive directly for pathological shedding cytology,21 were positive with trapezoidal helix sorters and 21 were positive by Pan-CK(95%),only 1 cell that did not find TTF-1 positive was significantly higher than the shedding cytology test,followed by 13 cases of PD-L1 expression positive,consistent with histopathological results,and finally,after the selection of tumor cells for primary culture,And the formation of the original 3D tumor cell ball.Different patients are sensitive to different first-line chemotherapy drugs,5 patients are sensitive to all chemotherapy drugs,one patient is resistant to drugs,in chemotherapy drug sensitivity patients,2 patients are most sensitive to NVB,2 patients are most sensitive to cisplatin,1 patient is most sensitive to carplatin.Conclusion: 1,from the pathological diagnosis of thoracic fluid in patients with advanced lung cancer,the positive rate of pleural effusion diagnosed as malignant thoracic fluid after the keyoid helix sorting technique is significantly higher than the traditional malignant shedding cytology test,which has certain clinical guidance significance.2,after the keyoid helix sorter sorting chest fluid cells can be used as a sample to detect PD-L1,the cell can be used to detect PD-L1 positive cell ratio,clinical immunotherapy has a certain guiding significance.3,after the keystone spiral sorter after the selection of chest fluid cells,is a better sample of primary cell culture,after successful transmission,can successfully carry out 3D primary cell culture and drug sensitivity test,determine the most suitable chemotherapy drugs.