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The emergence of immune checkpoint inhibitors (ICIs) has dramatically changed the therapeutic outlook for patients with non-small cell lung cancer (NSCLC). Preoperative neoadjuvant immunotherapy has been paid more and more attention as an effective and safe treatment. Neoadjuvant immune therapy, however, the relevant research started late, relatively few research results and mainly focused on the small sample size of phase I and II studies, treatment itself exists many places it is not clear, also in benefit population screening, the respect such as the choice of treatment and curative effect prediction has not yet reached broad consensus. This paper reviews the important studies and recent achievements related to neoadjuvant immunotherapy, aiming to comprehensively discuss the procedures and existing problems of this kind of therapy from three aspects of beneficiary groups, treatment cycle and efficacy prediction. .
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Humans , Carcinoma, Non-Small-Cell Lung/drug therapy , Immune Checkpoint Inhibitors , Immunotherapy/methods , Lung Neoplasms/drug therapy , Neoadjuvant TherapyABSTRACT
@#Objective To analyze the correlation between folate receptor-positive circulating tumor cells (FR+CTC) and the benign or malignant lesions of the lung, and to establish a malignant prediction model for pulmonary neoplasm based on clinical data, imaging and FR+CTC tests. Methods A retrospective analysis was done on 1 277 patients admitted to the Affiliated Hospital of Qingdao University from September 2018 to December 2019, including 518 males and 759 females, with a median age of 57 (29-85) years. They underwent CTC examination of peripheral blood and had pathological results of pulmonary nodules and lung tumors. The patients were randomly divided into a trial group and a validation group. Univariate and multivariate analyses were performed on the data of the two groups. Then the nomogram prediction model was established and verified internally and externally. Receiver operating characteristic (ROC) curve was used to test the differentiation of the model and calibration curve was used to test the consistency of the model. Results Totally 925 patients suffered non-small cell lung cancer and 113 patients had benign diseases in the trial group; 219 patients suffered non-small cell lung cancer and 20 patients had benign diseases in the verification group. The FR+CTC in the peripheral blood of non-small cell lung cancer patients was higher than that found in the lungs of the patients who were in favorite conditions (P<0.001). Multivariate analysis showed that age≥60 years, female, FR+CTC value>8.7 FU/3 mL, positive pleural indenlation sign, nodule diameter, positive burr sign, consolidation/tumor ratio<1 were independent risk factors for benign and malignant lung tumors with a lesion diameter of ≤4 cm. Thereby, the nomogram prediction model was established. The area under the ROC curve (AUC) of the trial group was 0.918, the sensitivity was 86.36%, and the specificity was 83.19%. The AUC value of the verification group was 0.903, the sensitivity of the model was 79.45%, and the specificity was 90.00%, indicating nomogram model discrimination was efficient. The calibration curve also showed that the nomogram model calibration worked well. Conclusion FR+CTC in the peripheral blood of non-small cell lung cancer patients is higher than that found in the lungs of the patients who carry benign pulmonary diseases. The diagnostic model of clinical stage Ⅰ non-small cell lung cancer established in this study owns good accuracy and can provide a basis for clinical diagnosis.
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Tumor immunotherapy is a new therapy which developed in recent years, it has greatly changed the therapeutic schedules and brought new options for patients. However, not all patients can have obvious therapeutic effects after using immunotherapy. So selecting more suitable patients and raising immunotherapy effect are worthy to discuss. With the research of circular RNAs (circRNAs), circRNAs have been found that they not only play a significant role in the field of tumor markers, tumor progression and prognosis, but also can abnormally express in a variety of tumors and affect tumor immunity. Therefore, the circRNAs expression may not only can be used as a supplementary method for selecting patients, but also can be used to predict the efficacy of tumor immunotherapy. In this article, we summarize current knowledge on circRNAs abnormally expressed in many cancers, especially lung cancer which can affect tumor immunity, and discuss its potential effects in tumor immunotherapy, and we hope to provide more references for the clinical practice of circRNAs. .
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Humans , Biomarkers, Tumor , Immunotherapy , Lung Neoplasms/therapy , Prognosis , RNA, CircularABSTRACT
BACKGROUND@#TRIM proteins are important members of E3 ubiquitin ligases, and many studies have confirmed that TRIM family members play an important role in the development of various tumors. We found that TRIM59 expression level in non-small cell lung cancer (NSCLC) was significantly increased through second-generation sequencing. The purpose of this study was to investigate the expression of TRIM59 in NSCLC and its relationship with the clinicopathological parameters as well as the prognosis of patients.@*METHODS@#The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) datasets were excavated to analyze the expression of TRIM59 mRNA in NSCLC and its relationship with the prognosis of patients; The expression of TRIM59 protein in 90 tumor tissues and adjacent tissues was detected by immunohistochemical staining, and the relationship between the expression of TRIM59 protein and clinicopathological parameters and prognosis was analyzed.@*RESULTS@#Overexpression of TRIM59 mRNA in tumor tissues predicted poor prognosis. The expression level of TRIM59 protein was significantly higher in tumor tissues than in adjacent tissues, and TRIM59 protein expression was correlated with tumor size (P=0.007), tumor differentiation (P=0.009), tumor-node-metastasis (TNM) stage (P=0.003) and lymph node metastasis (P=0.003). Multivariate Cox regression analyses showed that along with TNM stage, overexpression of TRIM59 could be considered an independent prognostic factor for NSCLC patients.@*CONCLUSIONS@#The expression of TRIM59 is closely related to the prognosis of NSCLC patients, and it is an independent risk factor for NSCLC patients.
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@# Robotic surgery system has been widely used in various types of pulmonary resections. With the unremitting efforts of Chinese thoracic surgeons, the quantity and quality of robotic pulmonary resections in China have reached a remarkable level. With the development and rapid promotion of this technology, the popularity of robotic surgery is also increasing. In order to standardize the clinical practice, guarantee the quality of treatment and promote the development of robotic pulmonary resections, the Committee of Thoracic Surgery, Doctor Society of Medical Robotics, Chinese Medical Doctor Association organized relevant domestic experts to formulate the consensus of Chinese clinical experts on robot-assisted lung cancer surgery.
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@#Objective To analyze the characteristics and risk factors of lymph node metastasis in thoracic esophageal squamous cell carcinoma (ESCC). Methods The clinical data of 407 patients with ESCC who underwent radical resection of esophageal carcinoma from December 2012 to October 2018 in our hospital were retrospectively analyzed. There were 390 males and 17 females with a median age of 63 (38-82) years. Esophageal lesions were found in 26 patients of upper thoracic segment, 190 patients of middle thoracic segment and 191 patients of lower thoracic segment. Results Among the patients, 232 (57.0%) were found to have cervical, thoracic and/or abdominal lymph node metastasis. The lymphatic metastasis rates of cervical, upper, middle, lower mediastinal nodes and abdominal nodes were 0.7%, 8.8%, 21.4%, 16.7% and 37.1%, respectively. The adjacent lymph node metastasis alone occurred in 50.0% patients, and the multistage or skip lymph node metastasis accounted for 29.3% and 20.7%, respectively. Multivariate analysis showed that the length of esophageal lesion, T stage, degree of tumor differentiation, vascular cancer embolus and nerve invasion were independent risk factors for lymph node metastasis. Conclusion The rates of lymph node metastasis are similar in the upper, middle and lower thoracic ESCC. The main pattern of lymph node metastasis is the adjacent lymph node metastasis, followed by multistage and skip lymph node metastases. The length of esophageal lesion, T stage, degree of tumor differentiation, vascular cancer embolus and nerve invasion are independent factors for lymph node metastasis. The operation and dissection range should be selected according to the location of tumor and the characteristics of the lesion.
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Objective:To compare the short-term outcomes between robotic completely portal surgery and robotic-assisted surgery used for lung cancer treatment.Methods:Lung cancer patients treated with robotic surgery in our institution from October 2014 to August 2018 were enrolled. Baseline information and postoperative outcomes were collected. All patients were divided into two approaches and abbreviated as 3-armed utility incision assisted lung surgery(RAL-3) and 4-armed completely portal lung surgery(RPL-4). Short-term outcomes of two approaches were compared after propensity score-matched(PSM) analysis.Results:A total of 471 patients were included in this study: 252 patients underwent robotic-assisted surgery with a utility incision and 219 patients underwent robotic completely portal surgery. After propensity score-matched( PSM) analysis, each group included 159 cases. The comparison of the two groups showed that there were no significant differences in chest tube duration( P=0.307), postoperative hospital stays( P=0.829), analgesics use( P=0.789), the postoperative visual analogue pain score(VAS)( P>0.05), the SF-12 score( P>0.05) and complications( P=0.265). However, RPL-4 caused less blood loss(52.11 ml vs. 70.00 ml, P<0.001) and shorter surgical time of RPL-4(122.74 min vs. 153.16 min, P<0.001). Conclusion:RPL-4 showed relatively shorter operative time and less intraoperative blood loss than RAL-3. Both RAL-3 and RPL-4 are safe and feasible for patients with lung.
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@#Objective To investigate the changes in pulmonary function after video-assisted thoracic surgery (VATS) and robot-assisted thoracic surgery (RATS) segmentectomy. Methods A total of 59 patients (30 males and 29 females) who underwent segmentectomy in the Affiliated Hospital of Qingdao University from July to October 2017 were included. There were 33 patients (18 males and 15 females) in the VATS group and 26 patients (12 males and 14 females) in the RATS group. Lung function tests were performed before surgery, 1 month, 6 months, and 12 months after surgery. Intra- and inter-group comparisons of lung function retention values were performed between the two groups of patients to analyze differences in lung function retention after VATS and RATS segmentectomy. Results The forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) in the VATS group and the RATS group were significantly lower than those before surgery (P<0.05), and they increased significantly within 6 months after surgery (P<0.05). The recovery was not obvious after 6 months (P>0.05), and they were still lower than those before surgery. In addition, the retentions of FEV1 and FVC in the VATS group and the RATS group were similar in 1 month, 6 months, and 12 months after operation with no statistical difference(P>0.05). Conclusion Pulmonary function decreases significantly in 1 month after minimally invasive segmentectomy, and the recovery is obvious in 6 months after the operation, then the pulmonary function recovery gradually stabilizes 12 months after surgery. FEV1 of the patients in the two groups recovers to 93% and 94%, respectively. There is no statistical difference in pulmonary function retention after VATS and RATS segmentectomy.
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BACKGROUND@#Lung segmentectomy is increasingly used to resect lung nodules. Video-assisted thoracic surgery (VATS) is widely chosen to performing lung segmentectomy, while robotic assisted thoracoscopic (RATS) was also one useful and practical method. There article was intended to compared the short-time outcomes of RATS and VATS in lung segmentectomy.@*METHODS@#The patients with lung nodules underwent segmentectomy by either RATS or VATS from January 2016 to April 2017 were studied. Baseline characteristics and short-time outcomes (dissected lymph nodes, postoperative duration of drainage, postoperative hospital stay, incidence of pro-longed air leak, atrial fibrillation and pneumonia) were compared.@*RESULTS@#166 patients were included in this study: 81 patients underwent RATS segmentectomy while 85 underwent VATS segmentectomy. The number of lymph nodes dissected in RATS group was more than in VATS group ［(13.07±5.08) vs (10.81±5.74), P=0.010］. The incidence of some postoperative complications such as pro-longed air leak, atrial fibrillation was not significant different between the two approaches.@*CONCLUSIONS@#Compared with VATS, RATS has similar safety and operability, and the number of lymphadenectomy is significantly more than that of VATS.
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In recent years, the incidence and detection rate of lung cancer have gradually increased, and segmentectomy has been increasingly used to treat early non-small cell lung cancer. Some scholars believe that segmentectomy is more conducive to the preservation of postoperative lung function than lobectomy. Some studies have found that the two surgical methods have little difference in postoperative cost retention. This article deals with segmentectomy and lobectomy. A review of related studies on postoperative pulmonary function changes. .
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Humans , Lung , General Surgery , Lung Neoplasms , General Surgery , Pneumonectomy , Methods , Recovery of FunctionABSTRACT
Lung cancer is the most common cancer and the leading cause of cancer death. Non-small cell lung cancer (NSCLC) represents over 85% of all lung cancers, and up to 50% of Asian NSCLC patients harboring epidermal growth factor receptor (EGFR) gene mutations. A number of studies have consistently demonstrated that uncommon EGFR-mutated NSCLC patients treated with EGFR-tyrosine kinase inhibitors (EGFR-TKIs) can achieve better survival outcomes. However, because uncommon EGFR mutations are generally associated with reduced sensitivity to EGFR-TKIs, which will bring a negative impact on the result of the study, the majority of clinical trials investigating the efficacy of EGFR-TKIs have included only patients with common EGFR mutations. In addition, uncommon EGFR mutations are rare in themselves, leading to the small number of such patients enrolled in these trials. Due to the small number and highly heterogeneous sensitivity of uncommon EGFR mutations, the efficacy of EGFR-TKIs in patients harboring uncommon EGFR mutations remains elusive. This article reviews the efficacy of EGFR-TKIs in patients with uncommon EGFR mutations, and give some reasonable advice about the selection of treatments for patients with NSCLC who harbor uncommon EGFR mutations.
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BACKGROUND@#More patients with pulmonary nodules are being referred to thoracic surgeons under the increasing use of computed tomography scans (CT). Impalpable peripheral subpleural solitary pulmonary nodules are difficult to be localized by video assisted thoracic surgery. Although some common techniques including CT-guided puncture positioning and electromagnetic navigation bronchoscopy (ENB)-guided methylene blue staining positioning, can bring good results in positioning, there are still some complications such as pneumothorax, hemorrhage and inaccurate positioning. Vectorial localization guided by electromagnetic navigational bronchoscopy followed by thoracoscopic resection is a novel alternative technique by us firstly for definitive diagnosis, which can avoid the possible injury of pleural or enlargement of the location area, providing some guidance for ENB-guided location technology. The main objective of this study was to evaluate the feasibility and our initial experience of vectorial localization guided by electromagnetic navigation followed by video-assisted thoracoscopic pulmonary solitary nodules resection.@*METHODS@#We retrospectively analyzed 22 cases who undergoing vectorial localization of peripheral pulmonary lesion guided by electromagnetic navigation prior to video assisted lung resection, and characteristics and intraoperative outcomes were explored.@*RESULTS@#Twenty-two nodules of twenty-two patients were all localized by this method successfully with an average location time (17.5±4.2) min. The average nodule size was (11.0±3.6) mm. The distance between the locatable guide probe (LG) and lesion on the electromagnetic navigation bronchoscopy screen was (14.5±10.1) mm. The distance between the lesion and probe mark on the dissected specimen was (15.3±11.0) mm. There was no displacement of any case. No conversion to thoracotomy was found. And there were no adverse events during the localization and operation procedure. Length of hospital stay was (3.8±1.2) d and the operative mortality was 0.0%. Malignant lesions were found in 19 patients and they were all completely resected with negative microscopic margins.@*CONCLUSIONS@#Our initial experience with vectorial localization of peripheral pulmonary lesion guided by electromagnetic navigation and minimally invasive resection proved that this technique was an alternative accurate and safe way for small pulmonary nodules. Thoracic surgeons should further investigate this method and apply it to clinical practice.
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BACKGROUND@#In clinical Ia (cT1N0M0) patients, some may have poor prognosis, for it might occur pathologic N1 (pN1) or N2 (pN2) postoperatively. The aim of this study is to determine the radiologicaland pathological factors related to clinical Ia adenocarcinoma.@*METHODS@#The retrospective study was conducted on 297 clinical Ia adenocarcinoma patients resected at our hospital between May 2012 to December 2016. The clinical profiles, radiological and pathological features were analyzed between nodal upstaging group and non-upstaging group.@*RESULTS@#Of 297 patients treated for cN0 tumors, 250 cases (84.2%) were confirmed postoperatively as having pN0 tumors, and 47 (15.8%) were confirmed as having pN1 or pN2 tumors. Female, low smoking index, micropapillary predominant and solid predominant adenocarcinoma, puresolid tumor and large tumor size were all more frequently seen in the nodal upstaging group than in the pN0 group (P<0.05). Logistic regression indicate that radiological solid tumor, micropapillary predominant and solid predominant adenocarcinoma and vessel invasionare the risk factors of nodal upstaging in clinical Ia adenocarcinoma.@*CONCLUSIONS@#Radiological solid tumors, micropapillary predominant and solid predominant adenocarcinoma andvessel invasion are risk factors for nodal upstaging for early stage lung cancer. Radiological solid tumors should perform SLND in Ia adenocarcinomas.
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Female , Humans , Male , Middle Aged , Adenocarcinoma , Diagnosis , Pathology , Adenocarcinoma of Lung , Lung Neoplasms , Diagnosis , Pathology , Neoplasm Staging , Prognosis , Retrospective Studies , Risk FactorsABSTRACT
WHO 2015 Lung Tumor Histologic Typology presents spread through air spaces (STAS).Before,some scholars have realized this pathological feature.STAS is considered associated with the prognosis of lung cancer patients.This article reviews the progress of STAS and prognosis of patients with lung cancer.
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Objective To explore the relationship between the ET-1 and the oncogenesis, development of human esophageal cancer. Methods RT-PCR and Western blotting were employed to detect the expression of ET-1 and ETAR in the tissues of esophageal cancer and normal esophageal mucous membrane from 76 esophageal cancer patients admitted by our hospital from March to December in 2002. Results There was positive ET-1 mRNA expression in 82.7% (62/75) of the specimens of esophageal cancer and in 60% (45/75) of normal tissue and the ET-1 mRNA expression had a relation with histological grade, lymph node metastasis and clinical staging of esophageal cancer (P
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3 cm in diameter was 65.6%, while the rate in those