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BACKGROUND@#Preliminary researches conformed that neoadjuvant immunotherapy combined with chemotherapy had a significant short-term effect in resectable non-small cell lung cancer (NSCLC), but there were few clinical trials about neoadjuvant chemoimmunotherapy in China. We aimed to assess retrospectively the antitumour activity and safety of neoadjuvant chemoimmunotherapy for resectable stage Ib-IIIb NSCLC.@*METHODS@#Twenty patients who had been diagnosed as stage Ib-IIIb NSCLC and received chemoimmunotherapy as neoadjuvant treatment between November 2019 and December 2020, in Beijing Chest Hospital, Capital Medical University were recruited. These patients received neoadjuvant treatment for 21 days as a cycle and antitumour activity and safety were evaluated every two cycles.@*RESULTS@#Of 20 patients received neoadjuvant chemoimmunotherapy, 17 patients underwent surgical resection. 16 patients had R0 resection (no residual tumor resection) and 1 patient had R1 resection (microscopic residual tumor resection). Radiographic objective response rate (ORR) was 85.0% (4 complete response, 13 partial response). 5.0% (1/20) of patients had stable disease, and 10.0% (2/20) of patients had progression disease. The major pathologic response (MPR) was 47.1% (8/17), and complete pathologic response (CPR) was 29.4% (5/17). 1 case developed grade IV immune-related pneumonia (IRP) and 9 (45.0%) cases had grade III hematologic toxicity.@*CONCLUSIONS@#Immunotherapy combined with chemotherapy as neoadjuvant therapy has a better efficiency and tolerable adverse effects for patients with resectable NSCLC in stage Ib-IIIb.
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Objective To evaluate the clinical significance of dissection of pulmonary ligament was operated on videoassisted thoracic surgery(VATS) with bullectomy for spontaneous pneumothorax.Methods From Jan 2012 to Dec 2013, 232 patients (188 males, 44 females) underwent VATS with bullectomy for spontaneous pneumothorax or hemopeumothorax, whose age were between 14 and 45 years and mean age was(26.4 ± 10.1) years.202 patients resulted from upper lobe spontaneous pneumothorax, 23 patients for lower lobe spontaneous pneumothorax, 7 patients for hemopeumothorax, and 18 cases because of recurrence after bullectomy (7.7 ％, 18/232).all the patients were accepted bullectomy with or without dissection of pulmonary ligament.Results Between 112 patients who underwent upper lobe bullectomy with dissection of pulmonary ligament, at 1 st postoperative day, it was found 92 patients whose pleural effusion were less than 300 ml (82.1％ ,92/112);20 patients whose pleural effusion were greater than or equal to 300 ml(17.9％, 20/112), and the mean drainage from thoracic cavity was(147.0 ± 61.0)ml.At 3 rd day, the mean drainage was(33.4 ± 20.0) ml.Within 23 cases who underwent lower lobe bullectomy with dissection of pulmonary ligament, the mean drainage from thoracic cavity, at 1 st postoperative day, was (155.2 ±41.1)ml,and the mean drainage, at the 3rd day, was(52.1 ± 21.3)ml.Also,within 90 patients who underwent bullectomywithout dissection of pulmonary ligament, 9 patients whose pleural effusion, at 1 st postoperative day, were less than 300ml(10％ ,9/90);81 patients whose pleural effusion were greater than or equal to 300ml (90％, 81/90);the mean drainage for 90 patients was(65.1 ± 28.0)ml.At the 3rd day, 40 patients' pleural effusion were greater than or equal to 300ml (44.4％,40/90) , and the mean drainage was(40.2 ± 25.5) ml.2 of 7 hemopeumothorax patients bled for the vessels injury during pulmonary ligament avulsion.Conclusion There was significant difference in clinical outcomes between two groups, and the dissection of pulmonary ligament was able to reduce the pooling of pleural effusion, facilitate the drainage of pleural effusion, and prevent pneumothorax recurrence, but there is no convincing evidence that dissection of pulmonary ligament can lead to bronchial deformation, stenosis, and reduce the free thoracic space.
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CD98 is a transmembrane heterodimer of cell surface.It regulates cell signaling pathway by activating some correlated proteins,and controls cell polarization,proliferation,adhesion and migration.CD98 plays an important role in the development of cancer and may be a novel tumor marker for diagnosis and prognosis in lung cancer.
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<p><b>BACKGROUND AND OBJECTIVE</b>Adenoid cystic carcinoma is primary bronchopulmonary carcinoma with low malignancy, and 43 patients treated in the past 50 years in our hospital were retrospectively studied. The aim of this study is to discuss the clinical symptoms, pathologic characteristic and therapeutic method of primary tracheal or bronchuotracheal adenoid cystic carcinoma.</p><p><b>METHODS</b>This study summarized total 43 patients of primary tracheal or bronchus adenoid cystic carcinoma treated in our hospital from Jan. 1958 to Dec. 2007. Among them, 40 patients were treated by surgical resection, and 3 patients were treated by fiberoptic bronchoscope's interventional treatment.</p><p><b>RESULTS</b>The 1-yr, 3-yr, 5-yr survival rates of the 43 patients above were 100% (41/41), 89.5% (34/38), 87.1% (27/31), respectively.</p><p><b>CONCLUSION</b>Primary tracheal or bronchus adenoid cystic carcinoma are rare and low malignancy carcinoma. The clinical symptoms of them are not typical. The best treatment is early detection and taking measures of operation plus radiotherapy. The other palliative treatment is fiberoptic bronchoscope's interventional treatment.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Bronchial Neoplasms , Diagnosis , Mortality , General Surgery , Carcinoma, Adenoid Cystic , Diagnosis , Mortality , General Surgery , Prognosis , Tomography, X-Ray Computed , Tracheal Neoplasms , Diagnosis , Mortality , General SurgeryABSTRACT
Objective To study the relationship between monoeyte chemoattractant protein 1 (MCP-1)-2518A/G polymorphism and lung cancer in Han nationality of North China. Methods One hun-dred and thirty-four unrelated consecutive patients with lung cancer(112 with NSCLC, 22 with SCLC)and 82 healthy individuals were studied. The polymorphisms of MCP-1-2518A/G were detected with polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP). Results The distribution of AA, AG and GG genotypes of MCP-1-2518 was significantly different in lung cancer patients compared with controls (X~2=8. 486,P=0. 014). There was a significant increase in the frequency of the AA genotype (OR=2. 645, X~2=6. 532, P=0.011) and a significant decrease in the frequency of the GG genotype (OR=0.519, X~2=4.929, P=0. 026)in the lung cancer patients, compared with controls. In the NSCLC patients the fre-quency of the AA genotype was higher than controls(OR=3. 138, X~2=8. 905, P=0.003) and the frequency of the GG genotype was lower than controls(OR=0. 516 ,X~2=4. 613, P=0. 032). The frequencies of AA, AG and GG genotypes in SCLC patients and controls had no difference. Conclusion This preliminary study showed that MCP-1-2518A/G polymorphism was associated with NSCLC but not SCLC.
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<p><b>BACKGROUND</b>The latest studies have demonstrated that postoperative adjuvant chemotherapy may improve survival in patients with stage I non-small cell lung cancer (NSCLC), so it was a challenge for clinician to choose the patients who might benefit from adjuvant chemotherapy. The aim of this study is to evaluate the prognostic implications of angiogenesis and tumor blood vessel invasion (BVI) in stage I NSCLC patients who underwent complete resection.</p><p><b>METHODS</b>One hundred and eighteen stage I NSCLC patients undergoing complete resection from 1994-2002 were retrospectively reviewed. Angiogenesis was assessed by vascular endothelial growth factor (VEGF) and microvessel density (MVD), BVI was assessed by examining the direct invasion of tumor cells marked by CD34 within vessel lumen.</p><p><b>RESULTS</b>Low VEGF expression was seen in 44 patients (37.3%), high VEGF expression was in 74 patients (62.7%). The MVD of high VEGF expression cases was much higher than that of low VEGF expression ones (33.4±17.8 vs 24.7±14.8, P=0.010). There was a positive correlation between VEGF and MVD (r=0.216, P=0.019). The 5-year survival rate in patients with high VEGF expression was much lower than in those with low VEGF expression (36.48% vs 72.20%, P=0.003). The BVI was present in 32 patients (27.1%) and absent in 86 patients (72.9%). The 5-year survival rate in patients with presence of BVI was much lower than those with absence of BVI (34.38% vs 60.47%, P=0.018). Multivariate COX regression analysis showed that high VEGF expression and BVI were significantly independent predictive factors for overall survival. Finally, the presence of both risk factors, BVI and high VEGF expression was highly predictive of poor outcome (P= 0.001 ).</p><p><b>CONCLUSIONS</b>Tumor vessel invasion and high VEGF expression are independent prognostic factors for overall survival of postoperative stage I NSCLC. The assessment of these factors may improve prognostic stratification for adjuvant therapy or a targeted and specific treatment in stage I NSCLC.</p>
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<p><b>BACKGROUND</b>Hepatoma-derived growth factor (HDGF), a novel growth factor, has a widely expression in many normal cells and tumor cells. It plays an important role in cell proliferation, differentiation and angiogenesis. It is considered as a promising marker for predicting the invasion, matastasis and prognosis of carcinomas in clinical researches. The aim of this study is to evaluate the expression of HDGF and its clinical implication in patients who undergone complete resection for stage I non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>Immunohistochemical technology was applied to detect the expression of HDGF in 118 lung cancer tissues and 30 normal lung tissues as control.</p><p><b>RESULTS</b>HDGF staining was observed in nuclear as well as in cytoplasm. HDGF positively staining was seen in all patients, and remarkably higher than that in normal lung tissues (52.23±10.35 vs 156.73±70.95, P < 0.01). Expresson of HDGF was closely related to histological classification, but not to other clinicopathological factors, and the expression of HDGF in adenocarcinoma was much stronger than that in squamous cancers (P=0.001). Univariate analysis and multivariate Cox regression analysis showed that the patients with high HDGF expression had a shorter overall survival and HDGF was a significantly independent predictive factor for patients with stage I NSCLC (RR=1.011, P=0.002).</p><p><b>CONCLUSIONS</b>HDGF may be a promising predictive factor for stage I NSCLC, and the assessment of HDGF may provide new insight on carcinogenesis and development of stage I NSCLC .</p>
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<p><b>BACKGROUND</b>With the development of social industrialization and aging of the population, patients with lung cancer have the tendency of becoming youthful and elderly, therefore the way of treatment should be also changed. In resent years, lung cancer in young and elderly patients have been reported respectively, but simultaneous contrast analysis of clinical feature and prognosis in elderly, normal and youthful patients have been rarely reported. Based on the clinic data in the patients, the clinical feature and prognosis of patients with non-small cell lung cancer at different ages were analyzed.</p><p><b>METHODS</b>From January 1996 to January 2003, 1380 patients with NSCLC were treated surgically in thoracic department in our hospital, the patients were divided into three group based on their age, group 1 (G1) (range ≤40), group 2 (G2) (range 41-69), group 3 (G3) (range ≥70). The clinical feature and prognosis were analyzed in each group.</p><p><b>RESULTS</b>The mean age in the whole group was 58.16±0.26, and 35.76±0.57 (range 12-40) in G1, 58.00±0.22 (range 41-69) in G2, 72.30±0.21 (range 70-80) in G3. The ratio of lung cancer in female between G1 and G3 was significant different (P=0.024). The coexisting diseases in G3 were more common than those of other groups (P=0.000). Squamous cell carcinoma was the main type in histology, accounting for 41.79% (28/67), 54.12% (644/1190) and 58.54% (72/123) in each group respectively (P=0.080), but the ratio of adenocarcinoma, higher than that of other groups, were 43.28% (29/67), 29.50% (351/1190) and 26.82% (33/123) (P=0.036). Lobectomy and pneumonectomy were the main surgical procedures, accounting for 58.21%, 65.29%, 78.86% (P=0.004) and 34.33%, 26.22%, 12.20% (P=0.001), respectively. The ratio of stage III were 43.28% (29/67), 38.82% (462/1190), and 26.02% (32/123) in each groups (P=0.015). 55.22% (37/67) in G1 received adjuvant chemotherapy, 47.48% (565/1190) in G2, and 29.27% (36/123) in G3 (P=0.000). 5-year survival rate was 38.96% in the whole group, 29.99% in G1, 39.61% in G2, and 37.99% in G3 (P=0.494).</p><p><b>CONCLUSIONS</b>In young patients with non-small cell lung cancer, female and adenocarcinoma make up the majority of the number, and a lot of patients are in advanced stage and likely to adopt adjuvant chemotherapy. While in elderly, squamous cell carcinoma accounts for the majority of the number, and more coexisting diseases are accompanied, much more complications occur after surgical procedure. Nevertheless, their prognosis has no significant difference.</p>
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<p><b>BACKGROUND</b>There are many factors that affect the prognosis of non-small cell lung cancer (NSCLC). This study aims to analyze the influential factors and prognosis in patients with NSCLC following operation.</p><p><b>METHODS</b>From January 1996 to January 2003, 1380 patients with NSCLC treated surgically were retrospectively studied. The correlation between clinicopathological characteristics and prognosis was evaluated by univariate and multivariate analyses.</p><p><b>RESULTS</b>In the whole group, 1-, 3- and 5-year survival rate was 78.85%, 49.78% and 38.96% respectively, and median survival time (MST) was 38.77 months. According to univariate analysis, tumor size, pathologic type, clinical type (central or peripheral), TNM stages, lymph node involvement, surgical procedure, postoperative chemotherapy, and cycles of chemotherapy were significantly related to the survival of patients. By multivariate analysis, tumor size, TNM stages, lymph node status and postoperative chemotherapy were independent prognostic factors.</p><p><b>CONCLUSIONS</b>Tumor size, TNM stages, lymph node involvement and postoperative chemotherapy are independent prognostic factors for NSCLC following the surgical procedure.</p>
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<p><b>BACKGROUND</b>The influence of tumor size on prognosis has been determined in different stages of lung cancer, but it is not clear yet within the same stage of lung cancer, especially for those less than 3cm in diameter. The aim of this study is to explore the impact of tumor size on prognosis in stage IA non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>A total of 142 consecutive, surgically treated patients with pathologic stage IA NSCLC were analysed retrospectively. Kaplan-Meier survival curve was performed to estimate the survival of patients with different tumor size. And a COX proportional hazard regression model was used to make multivariate analysis about age, gender, pathologic type, tumor size and chemoradiotherapy or not.</p><p><b>RESULTS</b>There were 60 patients with tumor diameter less than 2.0cm, and 82 between 2.1 to 3.0cm. The overall 3-and 5-year survival rate was 84.41% and 70.89% respectively, in which tumor diameter less than 2.0cm group was 94.91% and 81.40%, tumor diameter between 2.1 to 3.0cm group was 82.18% and 64.91% (P=0.0353), respectively. In both univariate and multivariate analyses, the tumor size was an independent prognostic factor for survival.</p><p><b>CONCLUSIONS</b>Since the tumor size is an independent prognostic factor for NSCLC, it is necessary to improve the level of imageological diagnosis so as to treat the patients much earlier.</p>
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Objective To investigate the proliferation and apoptosis in stage-ⅠNSCLC and their prognostic implications.Methods Immunohistochemical technology and TUNEL assay was applied to detect proliferation and apoptosis in 118 lung cancer tissues and 30 normal lung tissues as controls.Results Proliferation Index(PI)was up-regulated in lung cancer tissues compared with that in normal lung tissues and was closely related to T-staging,differentiation and smoking.Apoptotic Index(AI)was up-regulated in lung cancer tissues compared with that in normal lung tissues and was closely related to T-staging.PI was not related to AI in stage-ⅠNSCLC.The patients with high PI had a shorter 5-year survival than those with low PI(33.57% and 73.12%,P=0.0001),and the patients with low AI had a shorter 5-year survival than those with high AI(41.48% and 68.80%,P=0.008).Multivariate analysis showed that PI was a significantly independently predictive factor for patients with stage-ⅠNSCLC(RR=2.473,95%CI:1.278~4.784,P=0.007).Conclusion Stage-ⅠNSCLC is a subgroup with high proliferation and apoptosis.Proliferation plays a more important role in stage-ⅠNSCLC.The assessment of proliferation and apoptosis may provide new insight into prognosis and adjuvant treatment for stage-Ⅰ NSCLC.
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<p><b>BACKGROUND</b>To summarize the operative indication, surgical technique and perioperative ma-nagement of resection and reconstruction of carina for advanced lung cancer involving the carina.</p><p><b>METHODS</b>There were 67 patients with lung cancer invaded the carina, right central lung cancer in 46 cases, peripheral lung cancer in 4 cases, involved superior vena cava (SVC) or with bilateral anonymous veins in 11 cases, left central lung cancer in 17 cases, respectively. Surgical procedure included carinal right pneumonectomy or lobectomy in 50 cases, concomitant replacement of SVC or with bilateral anonymous veins with vascular prosthesis in 11 cases, carinal left pneumonectomy in 17 cases. Follow-up was performed in long-term.</p><p><b>RESULTS</b>Perioperative death occured in 8 cases (11.94%), circulatory failure in 6 cases (8.96%), and respiratory failure in 2 cases (2.99%). The overall 1-, 3- and 5-survival rate was 77.21%, 48.23% and 32.54% respectively.</p><p><b>CONCLUSIONS</b>Complete resection and reconstruction of carina, SVC or bilateral anonymous veins combined with postoperatively multiple modality therapy can get good prognosis for the patients with advanced lung cancer.</p>
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This paper summerized the surgical treatment of primary bronchogenic carcinoma in 3568 cases between 1957-1991. The resectability rate was 90. 3%, postoperative morbidity rate 8.32% and operative mortality 0. 89%. Pathological diagnoses of the resected specimens included squa-mous cell carcinoma for 48.7%, adenocarcinoma 22.9%, small cell cancer 15. 4%, large cell cancer 1. 3% and squa-mous-adenocarcinoma in 10.1%. The follow-up rate was 93%. The 5-and 10-year survival rates were 34.6% and 22.79% respectively. Analyses of the data demonstratad that the histologic type, pathological stage and metastasis of mediastinal lymph node are the important factors affecting the prognosis. According to UICC P-TNM,42. 6% of the patients in this group were in stage III. The 5 year survival rate was 19% in IIIa patients and 6% in IIIb. According to authors experience, it is recommended that in IIIa patients with nonsmall cell cardinoma, active surgical treatment should be adopted; in patients with small cell carcinoma, chemotherapy and radiotherapy should be given pre-and postoperatively, in IIIb patients with small cell carcinoma, surgical treatment is generally not indicated.