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Background and purpose: Adenocarcinoma has become the most common histological type of lung cancer in recent years, and there is an increasing trend. This study aimed to investigate postoperative differences in clinical characteristics between adenocarcinoma and other types of non-small cell lung cancer (NSCLC) and prognostic factors of adenocarcinoma treated with surgery, and to provide a reference for the prevention and treatment of lung adenocarcinoma. Methods: The medical records of patients with NSCLC treated with surgery were selected from Jan. 2005 to Dec. 2014 at the Affiliated Tumor Hospital of Guangxi Medical University. This study compared the differences in clinical characteristics between adenocarcinoma and other types of NSCLC, and analyzed the influence of prognostic factors of lung adenocarcinoma with log-rank test and COX model. Results: With 451 cases of adenocarcinoma, the gender ratio was 1.29:1, the average age was 56.02 years old, the lymph node metastasis rate was 53.22% (240/451), and the median survival time was 44 months. There were statistical differences between adenocarcinoma and other types of NSCLC in gender ratio (P<0.001), average age (P=0.039), lymph node metastasis rate (P=0.012), and median survival time (P<0.001). In multivariate analysis, PTNM stage (P<0.001), gender (P=0.032), preoperative diabetes (P=0.019), subcarinal lymph node metastasis (P=0.013), number of lymph node metastasis (P<0.001), postoperative chemotherapy (P=0.040) or targeted therapy after surgery (P<0.001) were independent prognostic factors. Conclusion:Compared with other types of NSCLC, adenocarcinoma showed the characteristics of higher incidence of constituent ratio in women, lower average age, higher rate of lymph node metastasis and poor prognosis. PTNM stage, gender, pre-operative diabetes, subcarinal lymph node metastasis, number of lymph node metastasis, postoperative chemotherapy or targeted therapy are important influencing factors that can affect the prognosis of adenocarcinoma following the surgical procedure.
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Objective To provide the reference basis for reducing the occurrence of nutritional risk by analyzing possible risk factors for nutritional risk status and investigating the relationship between preoperative nutritional risk status and prognosis.Methods We retrospectively analyzed the clinical data of 894 patients(nutritional risk group of 491 cases,non-nutritional risk group of 403 cases) with esophageal cancer resection.The univariate analysis was used to analyze the relationships between nutritional risk status with postoperative complications and length of hospitalization.And the multiple Logistic regression model analysis was applied to analyze the risk factors of nutritional risk status.Results The nutritional risk group had a higher rate of postoperative complications (33.60 ％ vs.19.60 ％,U =-3.429,P =0.001),higher incidence of serious complications (23.01％ vs.8.68％,U =-3.611,P =0.000) and longer hospital stays [(37.20 ± 13.89) days vs.(31.69 ± 13.49) days,t =4.124,P =0.000] than that of non-nutritional risk group.The results of the multiple logistic regression analysis showed that the preoperative nutritional risk factors were associated with the patients' age (OR =1.58,95％ CI:1.101-2.268),number of symptoms entries(OR =7.97,95 ％ CI:6.071-10.463),symptom severity (OR =0.26,95％ CI:0.186 -0.385),and dietary intake (OR =0.62,95 ％ CI:0.482-0.813),P ＜ 0.05 for all.Conclusion The older patients with more severe symptoms and poor diet are more likely to suffer from nutritional risk.Prolonged hospital stay and postoperative complications easily happen in patients with nutritional risk.So patients with preoperative nutritional risk should be given timely and effective nutrition intervention measures,in order to reduce postoperative complications and length of hospitalization.
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Background and purpose:It is increasingly focused on that insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 4 (IGFBP-4) effect cell proliferation, differentiation and apoptosis of tumor cells, and pregnancy-associated plasma protein-A (PAPPA) plays an important role in IGF-1-dependent IGFBP-4 protease mechanism that regulats tumor cells' growth. This study aimed to investigate the serum levels and clinical signiifcance of IGF-1, IGFBP-4, and PAPPA in patients with non-small cell lung cancer (NSCLC). Methods:IGF-1, IGFBP-4, and PAPPA plasma levels were measured by enzyme-linked immunosorbent assay from 82 patients with NSCLC and 40 control subjects, then the correlations between variables were assessed by Spearman correlation analysis, and associations between the IGFs variables and lung cancer risk were calculated through the odds ratio (OR) and its 95%conifdence interval (CI) with the use of unconditional logistic regression analysis. Results:Serum levels of IGF-1, IGFBP-4 and PAPPA in NSCLC patients were signiifcantly higher than those in the control group(P<0.05). There was a signiifcant positive correlation between the serum IGF-1 levels and PAPPA levels (r=0.835,P=0.000), and a negative correlation with IGFBP-4 levels (r=-0.612,P=0.000). IGFBP-4 and PAPPA levels were negatively correlated(r=-0.673, P=0.000). High plasma levels of IGF-1(OR=2.28, 95%CI: 1.25-4.36,P=0.008) and PAPPA (OR=1.64, 95%CI: 0.89-3.01,P=0.046)were associated with an increased risk of lung cancer, however high plasma levels of IGFBP-4(OR=0.54, 95%CI:0.30-1.01,P=0.047)were associated with reduced risk of lung cancer. Conclusion:To detect IGF-1, IGFBP-4 and PAPPA in serum in NSCLC patients is meaningful for the clinical auxiliary diagnosis and biology behavior prediction of NSCLC. And further study of signal transduction pathways of IGFs with the occurrence and development of NSCLC is a meaningful research direction.
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ObjectiveSurgical radiofrequency (RF) ablation has recently been one of the most effective means to treat chronic atrial fibrillation(AF).However,about 20％ to 30％ patients have shown recurrence of AF during the follow-up period.This study retrospectively analyzed AF recurrence rate in those patients who underwent valve replacement procedures combined with RF ablation to treat AF in our department during the last three years.We compared the information and clinical date in the sinus rhythm(SR) group with in the AF recurrence group to analyze the relationship between various preoperative risk factors and operation failure.The aim of this study is to provide evidences to select patients who can benefit most from this type of surgery and to reduce their surgical risk and hospital charges.MethodsFrom June 2006 to June 2009,52 patients with rheumatic heart disease (RHD) and chronic AF underwent RF ablation concomitant with valve replacement in our department by a same surgeon with the same method.Preoperative and intraoperative data was retrospectively collected and all patients were followed up longer than six months to determine the type of heart rhythm.Operation failure was defined as showing any rhythm except normal sinus rhythm by electrocardiogram.We divided all patients to the SR grope and AF grope.Univariate and multivariate statistical analysis was used to compare the data between the two groups in pre-,intra- and postoperative period.Results There was only one case in-hospital mortality ( 1.9％ ).None mortality,re-exploration for bleeding and pacemaker implantation for malignant arrhythmia was shown during the mean follow-up period of 14 months (9-35 months).At the last follow-up,sinus rhythm was shown in 71.2％ (37/52) patients.In univariaye analysis,the left atrial diameter,AF duration,left ventricular end diastolic volume and aortic cross-clamp were predictors of recurrence of AF.Age,left ventricular ejection factor,cardiopulmonary bypass time showed no significant difference between the two gropes.Multivariate analysis showed that AF duration was the independent risk factor of recurrence of AF after the bipolar radiofrequency ablation procedure.ConclusionRF ablation concomitant with valve replacement is an effective way to treat AF for those patients who need open heart surgery at the same time.Patients with normal SR may gain a better life quality.Preoperative duration of AF was the independent risk factor of AF recurrence.The longer the duration of AF is,the worse the efficacy of this procedure to restore normal SR is.
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<p><b>BACKGROUND</b>To maximize the preservation of functional pulmonary parenchyma and improve the quality of life of patients with centrally located lung cancer, trachea-bronchoplasty has been used in clinical application with good efficacy. The aim of this study is to explore the appropriate admission and management of trachea-bronchoplasty and prevent complications of trachea-bronchial sleeve resection in the treatment of centrally located lung cancer.</p><p><b>METHODS</b>Seventy-six patients with central lung cancer, who were treated with trachea-bronchoplasty from June, 1988 to October, 2004, were analyzed. There were 49 cases of squamous cell carcinoma, 16 adenocarcinoma, 7 adenosquamous carcinoma, 3 small cell lung cancer and 1 adenoid cystic adenocarcinoma. Seventeen patients were in stage I, 39 in stage II, 17 in stage IIIA and 3 in stage IIIB. There were 55 cases of sleeve lobectomy, 12 lobectomy with wedge resection of the main bronchus, 8 big arc resection of superior lobar bronchus-main trachea-lateral wall of trachea, 1 resection of right upper lobe-right main bronchus-carina-lateral trachea and carinal reconstruction.</p><p><b>RESULTS</b>Postoperative complications happened in 7 patients. Pneumonia and atelectasis occurred in 6 cases, in which 1 died of heart and respiratory failure. Another one died of haemorrhage of upside alimentary canal. Seventy-one patients were followed up (93.4%). The 1-, 3-, 5-year survival rate was 82.4% (56/68), 57.8% (26/45) and 41.7% (15/36) respectively.</p><p><b>CONCLUSIONS</b>The trachea-bronchoplasty can not only preserve functional pulmonary parenchyma as much as possible and improve the quality of life of patients, but also provide an operative opportunity to those patients with poor pulmonary function in the treatment of centrally located lung cancer.</p>