Diagnosis and treatment progress of stage Ⅲ resectable/potentially resectable NSCLC / 中华胸心血管外科杂志

Treatment of stage Ⅲ NSCLC is challenging, and the best treatment strategy is still controversial. The emergence of new therapeutic agents and philosophy also continues to redefine the range of resectable/ potentially resectable NSCLC. Resectable N2-stage Ⅲ lymph nodes are usually scattered with well-defined margins and no adhesions to surrounding structures. Neoadjuvant therapy followed by surgery has lower local recurrence rate compared to radical radiotherapy. According to current guidelines, surgical treatment is not recommended for N3-stage Ⅲ NSCLC. However, for regional N3 disease with continuous response to chemotherapy, after careful selection, surgery may worth a try. The efficacy of immunotherapy in locally advanced lung cancer has been confirmed in many prospective clinical trials. Neoadjuvant immunotherapy significantly improves major pathological remission rates and pathological complete remission rates, which allows these downstaging patients have the chance to receive surgery and thus improve their long-term prognosis. For efficacy assessment of neoadjuvant immunotherapy, pathological biopsy is more reliable than CT. In conclusion, the progress in multimodality neoadjuvant therapy will provide more surgical opportunities and better long-term prognosis for patients with potentially resectable stage Ⅲ NSCLC.

Trends in clinicopathological characteristics of surgically-treated lung cancer: sex-based heterogeneity / 中华胸心血管外科杂志

Objective:To explore the sex-based heterogeneity in demographic and pathological trends of lung cancer during the past 30 years.Methods:Patients with primary lung cancer who received surgical treatment in the Department of thoracic surgery, Shanghai Pulmonary Hospital Tongji University from 1989 to 2018 were retrospectively analyzed. The differences between male and female patients in age, smoking history, pathological stage and type were compared. Mann- Kendall trend test was performed for trend analysis. Results:A total of 58 433 patients were included in this study, encompassing 30 729(52.6%) men and 27 , 704(47.4%) women. Compared with male patients, female patients were younger(56.0 years old vs. 59.7 years old), and had a higher proportion of non-smokers(98.3% vs. 52.3%), stage Ⅰ lung cancers(60.6% vs. 49.3%), and adenocarcinoma(93.7% vs. 56.1%, all P-values <0.001). Trend analyses revealed that the proportion of female patients increased year by year, and surpassed males in 2015, with the current ratio of male to female being 1∶1.5. After 2013, the age of onset in females was getting younger, and the average age decreased from 58.7 years old to 54.7 years old( P=0.02). The decrease in the proportion of smoking patients was mainly reflected by male patients(from 68.5% to 31.1%, P<0.01). Stage Ⅰ lung cancers in male and females outnumbered advanced stage in 2012 and 2010, respectively, with a much higher proportion in female patients. Among male patients, adenocarcinoma has replaced squamous cell carcinoma as the most common pathological type since 2012, while in female patients adenocarcinoma remained the most common pathological type of lung cancer, and its proportion continued to increase reaching over 98%. Conclusion:A dramatic change in gender distribution was noticed during the past 30 years. Female patients became the primary population in surgically-treated lung cancers, with a trend of getting younger. The proportion of smokers and squamous cell carcinoma decreased significantly in male patients, and adenocarcinoma has become the most common pathological type of lung cancer. The proportion of stage Ⅰ lung cancers was on a dramatic rise, with the popularization of CT screening for lung cancer.

Shanghai Pulmonary Hospital Experts Consensus on the Management of Ground-Glass Nodules Suspected as Lung Adenocarcinoma (Version 1) / 中国肺癌杂志

Background and objective As computed tomography (CT) screening for lung cancer becomes more common in China, so too does detection of pulmonary ground-glass nodules (GGNs). Although anumber of national or international guidelines about pulmonary GGNs have been published,most of these guidelines are produced by respiratory, oncology or radiology physicians, who might not fully understand the progress of modern minimal invasive thoracic surgery, and these current guidelines may overlook or underestimate the value of thoracic surgery in the management of pulmonary GGNs. In addition, the management for pre-invasive adenocarcinoma is still controversial. Based onthe available literature and experience from Shanghai Pulmonary Hospital, we composed this consensus about diagnosis and treatment of pulmonary GGNs. For lesions which are considered as adenocarcinoma in situ, chest thin layer CT scan follow-up is recommended and resection can only be adopt in some specific cases and excision should not exceed single segment resection. For lesions which are considered as minimal invasive adenocarcinoma, limited pulmonary resection or lobectomy is recommended. For lesions which are considered as early stage invasive adenocarcinoma, pulmonary resection is recommend and optimal surgical methods depend on whether ground glass component exist, location, volume and number of the lesions and physical status of patients. Principle of management of multiple pulmonary nodules is that primary lesions should be handled with priority, with secondary lesions taking into account.
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Pretreatment diagnosis and surgical management of minimally invasive adenocarcinoma / 中华胸心血管外科杂志

Objective In 2011's new IASLC-ATS-ERS(International Association for the Study of Lung Cancer,American Thoracic Society,and European Respiratory Society) lung adenocarcinoma classification,adenocarcinoma in situ and minimally invasive adenocarcinoma(MIA) substituted for bronchioloalveolar carcinoma.The excellent prognosis wins these two histologic types a lot of attention.With the development of image technology,more and more lung adenocarcinomas are detected in early stage.Tumors showing a ground-glass nature in preoperative CT scans are more likely to be minimally invasive adenocarcinoma.This review discusses from the following 6 aspects.Imaging characteristics of MIA,the diagnostic value of intraoperative frozen section,preoperative localization,selection of surgical approaches for ground-glass opacity(GGO) nodules,the extent of lymph nodes dissection and management of multiple primary lung adenocarcinoma.The clinical guideline for early-stage lung adenocarcinoma is still controversial,strong evidence and further studies are needed.

Pretreatment diagnosis and surgical management of minimally invasive adenocarcinoma / 中华胸心血管外科杂志

Objective In 2011's new IASLC-ATS-ERS(International Association for the Study of Lung Cancer,American Thoracic Society,and European Respiratory Society) lung adenocarcinoma classification,adenocarcinoma in situ and minimally invasive adenocarcinoma(MIA) substituted for bronchioloalveolar carcinoma.The excellent prognosis wins these two histologic types a lot of attention.With the development of image technology,more and more lung adenocarcinomas are detected in early stage.Tumors showing a ground-glass nature in preoperative CT scans are more likely to be minimally invasive adenocarcinoma.This review discusses from the following 6 aspects.Imaging characteristics of MIA,the diagnostic value of intraoperative frozen section,preoperative localization,selection of surgical approaches for ground-glass opacity(GGO) nodules,the extent of lymph nodes dissection and management of multiple primary lung adenocarcinoma.The clinical guideline for early-stage lung adenocarcinoma is still controversial,strong evidence and further studies are needed.