Application of six-minute walk test in preoperative evaluation of patients undergoing pulmonary lobectomy / 中国康复理论与实践

@#Objective To analyze the feasibility of six-minute walk test (6MWT) before pulmonary lobectomy and prediction for postoperative outcome. Methods A total of 580 patients who were hospitalized in the department of lung surgery from May, 2017 to May, 2019 were reviewed, and 274 eligible patients were selected, who underwent first surgery and the surgical method was pulmonary lobectomy. They were divided into two groups based on the results of 6MWT before operation. The cut-off value of six-minute walk distance (6MWD) was obtained by receiver operating characteristic curve (ROC) area under curve (AUC). The postoperative outcome and the occurrence of cardiopulmonary complications in the two groups were analyzed. Results Compared to patients with 6MWD > 449 meters, the age was significantly older (P < 0.001), the forced expiratory volume in the first second (FEV1) was poor in patients with 6MWD ≤ 449 meters (P < 0.05), and other factors such as surgical resection site, pathological stage, gender, etc., were not significantly different (P > 0.05). The incidence of postoperative cardiopulmonary complications was significantly higher (OR = 2.672, 95%CI 1.488 to 4.798, P = 0.002), and the postoperative extubation time and hospital stay was longer in patients with 6MWD ≤ 449 meters than in patients with 6MWD > 449 meters (P < 0.05). 6MWD ≤ 449 meters was an independent risk factor for postoperative cardiopulmonary complications (OR = 2.395, 95%CI 1.299 to 4.415, P = 0.005). Conclusion As a simple function test, 6MWT can be routinely used to assess the physiological function of patients undergoing pulmonary lobectomy. Patients with 6MWD ≤ 449 meters may be in higher risks of postoperative cardiopulmonary complications.

Observation - An Favorable Option Forthoracic Dissemination Patients with Lung Adenocarcinoma or Squamous Carcinoma / 中国肺癌杂志

BACKGROUND@#Surgery was not standard-of-care of patients with advanced lung cancer. However, a serial of retrospective studies demonstrated that thoracic dissemination (M1a) patients could benefit from contraindicated surgery. After non-standard treatment, how should these patients choose following treatment approaches? Herein, we conducted this retrospective study to explore subsequent optimal treatment approaches.@*METHODS@#Different therapeutic approaches were evaluated by comparing progression-free survival (PFS), overall survival (OS), time to treatment interval (TTI) using the Kaplan-Meier method and Log-rank test. A Cox proportional hazards regression model was used for multivariate analysis.@*RESULTS@#141 eligible were enrolled. The median PFS of chemotherapy group, targeted therapy group and observation group were 14.7, 41.0 and 31.0 months, respectively (95%CI: 19.01-26.01; P<0.001). There was no significantly statistically difference between median PFS of targeted group and observation group (P=0.006). The median OS were 39.0, 42.6 and 38.1 months (95%CI: 32.47-45.33; P=0.478). The median PFS and OS of TTI<3 months and TTI ≥3 months were 15.2 months versus 31.0 months (95%CI: 19.01-26.06; P<0.001) and 41.7 months versus 38.7 months (95%CI: 32.47-45.33; P=0.714). Multivariate analyses revealed gender (P=0.027), lymph node status (P=0.036) and initial therapy (P<0.001) were independent prognostic factors for PFS.@*CONCLUSIONS@#Observation did not shorten survival of thoracic dissemination patients with lung adenocarcinoma or squamous carcinoma, therefore, it could be an favorable option. But prospective randomized controlled study was needed to confirm its validity.

Optimizing the methods of whole lung cancer RNA-loaded dendritic cells / 中国肺癌杂志

<p><b>BACKGROUND</b>Dendritic cells (DCs) are the unique antigen-presenting cells that can activate naive T lymphocytes. This function is critical for inducing specific immune response. DCs-based vaccines have been used broadly in immunotherapy for many carcinomas. Constructing vaccines by transfecting total tumor RNA into DCs can be done with a few tumor tissues and need not to identify tumor antigens, so it is especially suitable for lung cancer which lacks tumor-specific antigens but has great heterogenicity and weak immunogenicity. Currently, the best transfection stage and method are still indefinite. So, the objective of this study is to explore the best condition of transfecting total RNA extracted from lung cancer tissues into DCs.</p><p><b>METHODS</b>Ten patients with lung cancer were enrolled whose tumor tissues were CEA and MUC1 positive in immunohistochemical staining. Total tumor RNA were extracted by one-step method. Then DCs and T cells were separated and cultured from peripheral blood monocytes and the RNA was transfected into the DCs in different stages with different methods. CEA and MUC1 expression in the transfected DCs were measured by flow cytometry analysis and T cells' proliferation was examined by mixed lymphocyte reaction (MLR).</p><p><b>RESULTS</b>The expression of CEA and MUC1 protein in immature DCs (11.33±2.64, 39.68±7.25) was remarkably higher than that in mature DCs (5.46±1.63, 27.17±4.16) after transfection with total RNA of lung cancer tissues (P < 0.01), and the DCs presented more powerful effects on T cell proliferation. The CEA and MUC1 expression on DCs were significantly higher in electroporation transfection group (20.53±3.64, 65.39± 9.33) than that in lipofection group (11.33±2.64, 39.68±7.25) and passive pulsing transfection group ( 0.91±0.27,18.53±3.26)(P < 0.01), and the DCs in electroporation transfection group presented more powerful effects on stimulating T cell proliferation than the other two groups did.</p><p><b>CONCLUSIONS</b>Transfecting total tumor RNA into immature DCs by using electroporation is a good way to construct DCs-based vaccines for lung cancer and to achieve a higher activity to stimulate T cell proliferation.</p>

Gefitinib molecular target therapy for Chinese patients with non-small cell lung cancer / 中国肺癌杂志

<p><b>BACKGROUND</b>To explore the experience of gefitinib molecular target therapy for Chinese patients with non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>The unpublished data of gefitinib for advanced NSCLC in 7 hospitals were collected. The detailed data from Guangdong Provincial People's Hospital were analyzed.</p><p><b>RESULTS</b>A total of 282 patients with advanced NSCLC was treated with gefitinib from July 2001 to December 2003. Response rate was 22.2%-47.7%, disease control rate 62.6%-81.8%. No severe side effects were surveyed.</p><p><b>CONCLUSIONS</b>Gefitinib can be used safely and effectively in Chinese patients with advanced NSCLC.</p>

Guideline of surgical practice for non-small cell lung cancer based staging / 中国肺癌杂志

The clinical evidences of the guideline came from clinical trials based evidence-based medicine. Applied principle of the evidence was: systematic reviews, RCTs, the results from multiple factors ana-lysis, consensus, especially combined with Chinese experience and some lung cancer guidelines used in USA or Europe. All doctors who use the guideline in making therapeutic strategy must combine patients' conditions with the knowledge of biological behavior, dynamic change and response to treatment of lung cancer.

A randomized clinical trial on adjuvant interferon-alpha for completely resected stage I-II non-small cell lung cancer / 中国肺癌杂志

<p><b>BACKGROUND</b>To investigate the role of interferon-alpha (IFN-α) in completely resected stage I and II non-small cell lung cancer (NSCLC) patients.</p><p><b>METHODS</b>Forty-four stageIand II NSCLC patients were randomized to two groups. Study group (surgery+IFN-α) received IFN-α injection, 3 million unit, every two days, with a period of treatment of 90 days. Control group (surgery only) received no adjuvant therapy until relapse or metastasis were detected. pTNM stage, histological types, relapse or metastasis, survival time were observed and evaluated.</p><p><b>RESULTS</b>Median follow-up was 49.9 months. The 1-, 2-, 3-, 4-year survival rates were 90.5%, 80.9%, 52.4%, 52.4% in the study group and 95.2%, 80.9%, 66.0%, 50.8% in the control group respectively. No significant statistic difference was found between the two groups ( P = 0.663 9 ). Kaplan-Meier and Cox Model analysis showed pTNM stage ( P =0.010 2), N status ( P =0.015) and weight loss ( P =0.030) were prognostic factors in completely resected stage I and II NSCLC.</p><p><b>CONCLUSIONS</b>Postoperative low-dose IFN-α short-term therapy cannot significantly improve 3- and 4-year survival rates of patients with stage I and II completely resected NSCLC.</p>

Study on clonal expression of T cells bearing dominant TCR Vβ in non-small-cell lung cancers / 中国肺癌杂志

<p><b>BACKGROUND</b>To investigate the distribution of TCR Vβ subfamily T clonal cells in peripheral blood lymphocytes (PBL), tumor infiltrating lymphocytes (TIL) and lymphocytes in non-cancerous lung tissues of patients with non-small-cell lung cancer (NSCLC) and to see the inclination of the T cell antigen receptor (TCR) Vβ subfamilies' expression.</p><p><b>METHODS</b>Complimentarily determining region 3 (CDR3) of TCR 24 variable region genes was analyzed in PBL, TIL and lymphocytes in non cancerous lung tissues from 24 NSCLC cases with reverse transcriptase-polymerase chain reaction (RT-PCR) and gene scan techniques to identify the distribution and clonality of TCR Vβ subfamily T cells.</p><p><b>RESULTS</b>Only a portion of Vβ T cells were found in patients with NSCLC, whereas 24 TCR Vβ subfamily T cells were detected in 10 healthy controls. Vβ5 subfamily was expressed mostly in TIL and the frequency of Vβ5 in TIL (6/18, 33.3%) was much higher than that of PBL (1/24, 4.2%) and T cells infiltrating non-cancerous lung tissues (0/12) (P < 0.05). Oligoc lonal T cells were found in 2 cases with Vβ5 subfamily and polyclonal T cells in 4 cases.</p><p><b>CONCLUSIONS</b>There are dominant and clonal TCR Vβ subfamilies expressed in TIL of NSCLC patients, which may be the tumor associated antigens (TAA) specific.</p>

The relationship between microvessel density and structure in cancer tissues and prognosis in patients with non-small cell lung cancer / 中国肺癌杂志

<p><b>BACKGROUND</b>To explore the correlation of microvessel density (MVD) and microvessel structure (MVS) features with the patients' prognosis in non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>Anti-Von Willebrand factor antibody was used to stain microvessel endothelia by means of LsAB immunohistochemical technique, then the microvessel count and structure features were observed microscopically in 49 primary NSCLC tissues. MVS pattern A had scattered microvessels with relatively integral or thick wall and with relatively regular morphology and MVS pattern B had plexiform or network like microvessels with unintegral or thin wall and with irregular morphology.</p><p><b>RESULTS</b>MVD in primary NSCLC tissues was closely correlated with pTNM stage or lymph node involvement, P=0.043 and P=0.038, respectively. MVS in primary NSCLC tissues was closely correlated with the size of primary carcinoma, P=0.002. The survival of patients (23.2± 18.4 months) with MVD > 52/200× was significantly shorter than that of patients (35.9±20.9 months) with MVD < 52/200× in primary NSCLC tisssues, P=0.01. The survival of patients with MVS pattern A (39.4±17.2 months) was significantly longer than that of patients with MVS pattern B (23.5±20.3 months) in primary NSCLC tisssues, P=0.008. The survival of patients with MVD < 52/200× and MVS pattern A (42.9±19.3 months) was significantly longer than that of patients with MVD > 52/200× and MVS pattern B (15.7±16.8 months) in primary NSCLC tissues, P=0.002.</p><p><b>CONCLUSIONS</b>MVD and MVS are closely associated with prognosis of NSCLC patients and might be served as parameters estimating patients' prognosis and planning assistant therapy after operation.</p>

Prognostic factor analysis of pneumonectomy for non-small cell lung cancer / 中华外科杂志

<p><b>OBJECTIVES</b>To identify predictors of survival following pneumonectomy for non-small cell lung cancer (NSCLC) and provide evidence for the revision of patient selection criteria.</p><p><b>METHODS</b>81 cases of pneumonectomy for NSCLC from January 1990 to May 1996 at our hospital were reviewed retrospectively. There were 65 men (80.2%) and 16 women (19.8%), with a mean age 53.4 +/- 9.4 years (range 20 - 68 years). Predominant histological types included squamous cell carcinoma (54.3%), adenocarcinoma (24.7%), and squamoadenocarcinoma (17.3%). After follow-up for more than 5 years, data were examined using the chi-square test, Kaplan-Meier method, and Cox-mantel test. The possible factors affecting survival were tested with univariate and multivariate analysis.</p><p><b>RESULTS</b>The 5-year survival of N(0), N(1) and N(2) disease of NSCLC following pneumonectomy was (20.8 +/- 9.9)%, (15.4 +/- 10.0)% and (4.0 +/- 2.8)%, respectively. There was no perioperative death. The operative complications morbidity was 22.2%. Factors adversely affecting survival with univariate analysis included age over 60 years for right pneumonectomy, cardiopulmonary complications, adenocarcinoma, peripheral location, tumor greatest dimension more than 10 cm, chest wall involvement and N(2) disease. Factors adversely affecting survival with multivariate analysis included cardiopulmonary complications, greatest tumor dimension more than 10 cm, chest wall involvement and N(2) disease.</p><p><b>CONCLUSIONS</b>Pneumonectomy provides survival benefit with a high operative complications morbidity. Old age (>/= 60 years) for right pneumonectomy, cardiopulmonary complications, adenocarcinoma, and N(2) disease may be negative prognostic factors of long-term survival. Patient selection should be based on cardiopulmonary evaluation and the stage of disease.</p>

cDNA microarray screening biomarkers which simultaneously participate in different carcinogenesis progression in lung adenocarcinoma / 肿瘤研究与临床

Objective To study the genes which simultaneously participate in different carcinogenesis progression in lung adenocarcinoma for biomarkers identification. Methods 10 lung adenocarcinoma samples including pathologic stage Ⅰ,Ⅱ,Ⅲ were chosen for experiment and their matched normal tissues for control. After hybridization on 20 slides of microarray with 13824 genes, we analyze the expression profiles combined with pathologic stage and clinical prognosis by data mining. The genes differentially coexpressed in different stage and different prognosis samples were the target. Results 119 genes were identified. Among these targets, 26 genes have known to be related to lung cancer, 46 genes were unreported and 47 gene were new. Conclusions The 119 genes were very important during cancer occurrence and development and were the candidate biomarkers in lung adenocarcinoma.