Advance in Perioperative Physical Therapy for Esophageal Cancer (review) / 中国康复理论与实践

Esophageal cancer is the most common malignant tumor of the digestive tract in China. At present, surgical resection is the main method to cure esophageal cancer. With the population and implementation of the enhanced recovery after surgery, perioperative physical therapy plays a more and more important role. This review discussed the necessity of preoperative cardiopulmonary function assessment in patients with esophageal cancer, the effects of preoperative respiratory training and aerobic exercise on optimizing physical fitness and reducing postoperative complications, and the content of early postoperative physical therapy. Preoperative cardiopulmonary function of esophageal cancer patients is not strongly related with the outcome, which may be related to the complexity of esophageal cancer surgery and the high incidence of postoperative complications. Preoperative inspiratory muscle exercise can improve the pulmonary function of patients to some extent, but still lack of large sample size research. Preoperative aerobic exercise for esophageal cancer can improve the patient's physical reserve and should be valued. Postoperative physiotherapy priorities includes pain management, chest physical therapy and early mobilization. Exercise prescriptions such as intensity and time for early mobilization are yet to be further studied.

Value of positron emission tomography-computed tomography in the diagnosis of mediastinal lymph node metastasis of non-small cell lung cancer / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the value of positron emission tomographic-computed tomographic scanning (PET/CT) in the diagnosis of mediastinal lymph node metastasis in patients with non-small cell lung cancer and the application of PET/CT in the clinical staging of NSCLC.</p><p><b>METHODS</b>A hundred and fifty-eight patients with NSCLC undergoing surgical resection and mediastinoscopy received preoperative examinations with PET/CT. All the patients underwent mediastinal lymph node dissection or sampling, and the pathological results were compared with the imaging findings. The diagnostic sensitivity, specificity, positive and negative predictive values, and accuracy of CT and PET/CT were compared.</p><p><b>RESULTS</b>Final histology was available for 937 lymph node samples (N1, N2, and N3) from 158 patients during mediastinoscopy or surgical resection. The sensitivity, specificity, and positive and negative predictive values of CT for identifying mediastinal lymph node involvement were 51.0%, 76.1%, 49.0%, and 77.6%, respectively, with an diagnostic accuracy of 68.4%. The sensitivity, specificity, and positive and negative predictive values of PET/CT were 83.7%, 89.0%, 77.4%, and 92.4%, respectively, with a diagnostic accuracy of 87.3%.</p><p><b>CONCLUSION</b>Mediastinoscopy is essential for patients with positive findings of mediastinal lymph node involvement by PET/CT, but might not be necessary in negative patients.</p>

Surgical treatment of ipsilateral multi-focal non-small cell lung cancer / 中华外科杂志

<p><b>OBJECTIVES</b>The staging and treatment of multi-focal non-small cell lung cancer (NSCLC) are controversial. This study evaluated the effectiveness of surgical treatment for the ipsilateral multi-focal NSCLC.</p><p><b>METHODS</b>Sixty-eight patients with multi-focal NSCLC underwent complete resection from December 1999 to December 2006. This series included 44 males and 24 females, with a mean age of 60.3 years old (range from 33 to 81 years old). Fifty-four patients had multiple nodules in primary lobe (T4) and 13 patients had additional nodules in non-primary lobe (M1), and a patient was proved to have synchronous primary NSCLC lesions. Surgical treatments included lobectomy in 53 cases, bilobectomy in 4 cases, pneumonectomy in 2 cases, and lobectomy combined with wedge resection in 9 cases.</p><p><b>RESULTS</b>The median overall survival time of this series was 30 months. Prognostic study demonstrated that mediastinal lymph node metastasis and bronchioloalveolar carcinoma histology had significant impact on overall survival. The median survival times were 39 months for patients with N0 and N1, and 14 months for patients with N2, respectively, and there was significant difference between the groups (P < 0.01). The difference in survival was significant between patients with bronchioloalveolar carcinoma components and other NSCLC histologic types (P < 0.01), and the median survival times were 46 months and 20 months, respectively.</p><p><b>CONCLUSION</b>Surgery could provide choice for multi-focal NSCLC patients (T4 and M1), especially for patients with bronchioloalveolar carcinoma components and without mediastinal lymph node metastasis.</p>

Surgical treatment for bronchioloalveolar carcinoma with ipsilateral intrapulmonary metastatic nodules / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The staging and treatment of bronchioloalveolar carcinoma (BAC) with pulmonary metastasis are still controversial. This study aimed at evaluating the current staging of BAC with ipsilateral intrapulmonary metastatic nodules and the therapeutic effectiveness of surgical resection.</p><p><b>METHODS</b>The clinicopathological data of 729 completely and surgically resected patients with non-small cell lung cancer (NSCLC) from December 1999 to December 2006 were retrospectively reviewed. Prognostic factors affecting the overall survival were analyzed by the Kaplan-Meier method and compared by the log rank test.</p><p><b>RESULTS</b>Among 67 NSCLC patients with ipsilateral intrapulmonary metastatic nodules, 54 had multiple nodules in the lobe with primary lesion (T4, PM1) and 13 had additional nodules in the other ipsilateral lobes (M1, PM2). This series consisted of 40 males and 27 females, with a median age of 60.0 years. Of those, 28 had the lesions containing pure or some bronchioloalveolar carcinoma component, while the other 39 had a NSCLC lesions containing non-bronchioloalveolar carcinoma components. The median overall survival time of this series was 24.0 months. Prognostic study demonstrated that bronchioloalveolar carcinoma histology and mediastinal lymph node metastasis had significant adverse impact on the overall survival. The median survival time of the patients with bronchioloalveolar carcinoma was 58.0 months versus 27.0 months in patients with other subtypes of NSCLC (P < 0.01). The median survival times were 39.0 months for the patients with N0 or N1 versus 14.0 months for patients with N2, with a significant difference between the two groups (P < 0.01). There was no significant difference in the survival time between the patients with PM1 (36 months) and those with PM2 (24 months) (P > 0.05).</p><p><b>CONCLUSION</b>Surgical resection is effective for NSCLC patients with ipsilateral intra-pulmonary metastasis, especially for those with bronchioloalveolar carcinoma components. Our results suggest that the current TNM classification system may be inappropriate for the NSCLC patients with ipsilateral intrapulmonary metastatic nodules, and may need a modification.</p>

Expressions of E-cadherin in non-small cell lung cancer and it correlation with prognosis / 中华外科杂志

<p><b>OBJECTIVE</b>This study was to clarify E-cadherin expressions in non-small cell lung cancer (NSCLC) and its correlation with patients' prognosis.</p><p><b>METHODS</b>Tissue microarrays (TMAs) containing specimens from 365 different NSCLC were constructed, covering all stages and almost all histological types of this disease. Slides were immunohistochemically stained with antibodies against E-cadherin. Expression pattern of the protein was analyzed with relation to the clinicopathological. Correlations of the results with patients' overall survival were also examined.</p><p><b>RESULTS</b>Immunohistochemical staining revealed that E-cadherin protein was localized mainly on membranes and the cytoplasm of NSCLC tumors cells. Reduced E-cadherin expression was evident in 32.1%. Reduced E-cadherin expression significantly correlated with lymph nodes metastasis (chi(2) = 16.430, P = 0.001), histological dedifferentiation (chi(2) = 9.243, P = 0.010) and advanced clinical stage (chi(2) = 9.421, P = 0.024). There was no significant difference in E-cadherin expression between squamous cell carcinoma and adenocarcinoma. E-cadherin reduced expression correlated with a poor prognosis (P < 0.0001) in univariate analysis. Multivariate analysis showed a significantly lower survival probability for patients with reduced E-cadherin (P < 0.001), and E-cadherin was an independent prognostic factor for survival of NSCLC patients.</p><p><b>CONCLUSIONS</b>It suggests that dysfunction of E-cadherin has an important impact in the progression of lung cancer. As an independent prognostic factor, expression of E-cadherin can predict outcome of different group, together with conventional prognostic factors, and subsequently make appropriate management.</p>