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Objective:Immune checkpoint inhibitors have a high remission rate in the preoperative application of resectable and potentially resectable non-small cell lung cancer when combined with chemotherapy. For the unresectable stage Ⅲ non-small cell lung cancer, whether the transformation can be achieved through this regimen to provide opportunities for surgical resection is controversial. In this study, we evaluated the pattern of transformation therapy by reviewing the efficacy and safety of preoperative therapy and surgery of this group.Methods:A review of 23 patients undergoing surgical resection after transformation therapy by preoperative immunotherapy combined chemotherapy between November 2019 and November 2021 was performed. All patients must clarify the pathological diagnosis of non-small cell lung cancer by biopsy. After the multi-disciplinary treatment team and preoperative imaging assessment, the diagnosis should be consistent with unresectable stage III as described in the Expert Consensus on Multidisciplinary Management of Stage Ⅲ Non-Small Cell Lung Cancer, 2019 Edition. After 2 to 4 cycles of preoperative anti-PD-1 monoclonal antibody combined with chemotherapy, the surgical team assessed the chance of resection and performed surgery. Important indicators such as surgical resection rate, R0 resection rate, MPR, pCR, incidence of grade 3-5 adverse reactions and various other perioperative data were counted.Results:In the whole group, initial imaging evaluation was 10 of stage cⅢA and 13 of stage cⅢB.15 cases had multiple stations N2 lymph nodes metastasis, 9 had enlarged fused N2 lymph nodes metastasis, 6 had large vessel invasion(T4), and 1 had contralateral mediastinal lymph node metastasis(N3). After preoperative neoadjuvant therapy, 17 cases achieved PR, 3 achieved SD and 3 achieved PD. The surgical resection rate of the whole group was 91.3%(21/23, 1 lobectomy combined with superior vena cava reconstruction, 2 sleeve lobectomy, 5 pneumonectomy, 12 lobectomy/combined lobectomy, 1 wedge resection and 2 unresectable cases), R0 resection rate was 95.2%(20/21). MPR was achieved in 13 cases, 8 of them reached pCR. There were no perioperative deaths, median surgical time was 260(190-460) min, median bleeding volume was 100(50-750) ml, median drainage time was 5(3-9) days, and median hospitalization was 7(5-11) days. Two cases got immunotherapy-related grade 3 adverse reactions, one was interstitial pneumonia and the other was immune-related injury involving the eye, oral and genital mucosa. Two cases got surgical complications and one was persistent lung leakage, which stopped after 46 days of conservative treatment; The other was pleural effusion, which was relieved after drainage.Conclusion:For the unresectable stage Ⅲ NSCLC, immunotherapy combined chemotherapy is an effective preoperative downstage method. It can convert 91.3% cases to resectable ones while achieving a good degree of pathological remission. Its side reactions are generally controllable and safety.
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The morbidity and mortality of lung cancer are always at the forefront of malignant tumors. To improve the therapeutic effects and overall survival of lung cancer patients is one of the key areas both in clinical medicine and basic research. With the development of precision medicine, targeted treatment based on the characteristics of DNA mutation and immunotherapy targeting PD-1/PD-L1, CTLA-4 and other pathways have promoted the progress of the overall diagnosis and treatment level of lung cancer, which has been widely used in clinical practice. While making the continuous achievements in the above fields, the researchers committed to lung cancer research are gradually shifting their attention to the exploration of RNA level. Some results have been accumulated in the effects of RNA epigenetic modifications on the biological behavior of lung cancer. N6-methyladenosine(m6A) is the most abundant form of mRNA methylation. The dysfunction of m6A modification mediated by related regulatory proteins has been reported to play an important role in the development and progression of lung cancer. This paper focuses on the detection methods of m6A modification, related regulatory proteins and their mode of action, and reviews the effects on the onset, diagnosis, treatment and prognosis of lung cancer. The aim is not only to summarize the researchers' latest understanding of the epigenetic regulatory mechanism, but also to provide new perspectives for the early diagnosis, effective drug use and prognosis judgment of lung cancer.
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Objective To introduce our experience of 4L lymph node dissection in left lung cancer and to analyze the pattern of 4L LN metastasis. To investigate the prognostic impact of 4L lymph node dissection. Methods 171 patients with left lung cancer who underwent pulmonary resection andsystematic mediastinal lymph node dissection from March 2016 to March 2019 were collected retrospectively. There were 106 males and 65 females endolled, aged(64. 1 ± 7. 7) years. 54. 4％ had a historyofsmoking. Thediameterofthetumorswas(3.3±1.9)cm;Central-typetumorwere59cases(34.5％),peripheral 112 cases(65. 5％), upper lobe 95 cases(55. 6％) and lower lobe 76 cases(44. 4％). The clinical and perioperative data as well as the pattern of lymph node metastasis were analyzed. t test or Mann-Whiteney U test was used for continuous variables, and χ2 test or Fisher test was used for categorical variables. Multivariate analysis was performed using a logistic regression model to evaluate the risk factors. Results The metastasis rate of station 4L was 21. 6％. Tumor size, locations(central type/upper lobe),operative type, micropapillary/entity components and vascular invasion were risk factors for 4L LN metastasis in univari-ate analysis. Tumor size(OR=1. 611,P=0. 032) and location of upper lobe(OR=2. 823,P=0. 008) were independent risk factors in multivariate logistic analysis. Through the analysis of ROC curve, the optimal cutoff point of tumor size was 2. 5cm. The metastatic rate of 4L was 32. 6％ when tumor size larger than 2. 5 cm and 7. 9％ when tumor size smaller than 2. 5cm. Tumor located in upper lobe tended to metastasize to upper mediastinal lymph nodes, including station 4L, 5 and 6, while the one located in lower lobe tended to metastasize to station 7. Conclusion Station 4L LN involvement is commen in left lung cancer. The dissection of the 4L LN is important, especially for the tumor larger than 2. 5 cm or located at upper lobe.
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Objective@#To introduce our experience of 4L lymph node dissection in left lung cancer and to analyze the pattern of 4L LN metastasis. To investigate the prognostic impact of 4L lymph node dissection.@*Methods@#171 patients with left lung cancer who underwent pulmonary resection andsystematic mediastinal lymph node dissection from March 2016 to March 2019 were collected retrospectively. There were 106 males and 65 females endolled, aged(64.1±7.7) years. 54.4% had a history of smoking. The diameter of the tumors was(3.3±1.9) cm; Central-type tumor were 59 cases(34.5%), peripheral 112 cases(65.5%), upper lobe 95 cases(55.6%) and lower lobe 76 cases(44.4%). The clinical and perioperative data as well as the pattern of lymph node metastasis were analyzed. t test or Mann-Whiteney U test was used for continuous variables, and χ2 test or Fisher test was used for categorical variables. Multivariate analysis was performed using a logistic regression model to evaluate the risk factors.@*Results@#The metastasis rate of station 4L was 21.6%. Tumor size, locations(central type/upper lobe), operative type, micropapillary/entity components and vascular invasion were risk factors for 4L LN metastasis in univariate analysis. Tumor size(OR=1.611, P=0.032) and location of upper lobe(OR=2.823, P=0.008) were independent risk factors in multivariate logistic analysis. Through the analysis of ROC curve, the optimal cutoff point of tumor size was 2.5cm. The metastatic rate of 4L was 32.6% when tumor size larger than 2.5 cm and 7.9% when tumor size smaller than 2.5cm.Tumor located in upper lobe tended to metastasize to upper mediastinal lymph nodes, including station 4L, 5 and 6, while the one located in lower lobe tended to metastasize to station 7.@*Conclusion@#Station 4L LN involvement is commen in left lung cancer. The dissection of the 4L LN is important, especially for the tumor larger than 2.5 cm or located at upper lobe.
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Objective To evaluate the effect of recurrent laryngeal nerve detector on the operation of upper or middle-thoracic esophageal carcinoma. Methods A total of 60 patients with resectable esophageal carcinoma in Beijing Tsinghua Changgung Hospital from January 2015 to December 2017 were recruited. These patients were randomly divided into experimental group and control group by using random number table method.The experimental group used recurrent laryngeal nerve detector to assist in the nerve exploration and separation. The control group was treated by routine operation method, and the operation effect of the two groups was compared. Results In the experimental group, the time spent on the confirmation of recurrent laryngeal nerve was significantly shorter than that in the control group [right side: 1.50 min (1.00, 1.63 min) vs. 5.50 min(4.88, 6.50 min), Z= -6.715, P < 0.05; left side: 1.75 min (1.50, 2.00 min) vs. 7.85 min (6.50, 9.00 min), Z= -6.726, P< 0.05]. The rate of recurrent laryngeal nerve injury in the experimental group was significantly lower than that in the control group [3.3 % (1/30) vs. 20.0 % (6/30), χ 2= 4.043, P < 0.05]. Conclusion The use of recurrent laryngeal nerve detector in the neck anastomosis of upper or middle-thoracic esophageal carcinoma can significantly shorten the time spent on confirming of the recurrent laryngeal nerve and reduce the rate of recurrent laryngeal nerve injury.
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Objective Lung cancer has been the most common cause of cancer death worldwide.More than three quarters is diagnosed at advanced stage.Nearly one half has distant metastases outside the chest cavity.It has been recognized that oligometastatic state exists in natural history of malignant tumors,which has significantly better prognosis than those with polymetastases.The eighth edition of TNM staging system defined NSCLC with a single metastasis as a new separated stage(M1 b).Long-term survival of oligometastatic NSCLC patients treated with local control methods has been reported in literatures.But whether surgical resection of liver metastasis has benefit or not remains unknown.We performed a systematic review of surgical therapy for NSCLC with limited liver metastases.
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<p><b>OBJECTIVE</b>To evaluate the ovarian response and pregnancy outcomes in patients with excessive ovarian response receiving long-protocol pituitary down-regulation during repeated in vitro fertilization and embryo transfer (IVF-ET).</p><p><b>METHODS</b>Sixty IVF-ET cycles from January 2008 to December 2011 were analyzed retrospectively. The clinical characteristics were compared between the various treatment cycles.</p><p><b>RESULTS</b>Compared with those with the first treatment cycle, the patients receiving repeated cycles had a significantly older age (P<0.001), reduced initial doses of Gn (P=0.049), and moderately lowered estrogen level on the day of hCG administration (E₂) (P=0.027) and the number of oocytes retrieved (P=0.030). The high-quality embryo formation rate (P<0.001) and clinical pregnancy rate (P=0.009) were both significantly higher in patients with repeated cycles. The dose for down-regulation, total Gn dose, duration of Gn stimulation, number of two pronuclei (PN), number of fertilized oocyte, and the cancellation rate for a high risk of ovarian hyperstimulation syndrome (OHSS) were all comparable between the two groups (P>0.05). The recurrence rate of ovarian excessive respond was 40% (12/30).</p><p><b>CONCLUSIONS</b>For patients receiving repeated IVF treatment cycle with a high ovarian response, a smaller initial dose of Gn should be used to minimize the risk of hyper-response and improve the outcome of assisted reproductive treatment.</p>
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Femenino , Humanos , Embarazo , Regulación hacia Abajo , Transferencia de Embrión , Fertilización In Vitro , Gonadotropinas , Usos Terapéuticos , Oocitos , Síndrome de Hiperestimulación Ovárica , Resultado del Embarazo , Índice de Embarazo , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Objective To analyze the types and risk factors of community-acquired infections (CAI)in diabetic patients by system analysis method of evidence-based medicine.Methods China National Knowledge Infrastructure (CNKI),Wanfang database,VIP database were searched by computer,domestic published researches on CAI and related risk factors in dia-betic patients were aggregated,Meta-analysis was conducted by stata 1 1 .0 software.Results A total of 1 2 literatures were included in the study .The average rate of CAI in diabetic patients was 39.55% (22.12%-55.86%).The major infec-tions were respiratory system infection(40.74%),urinary tract infection(27.35%),tuberculosis(10.80%),skin and soft tissue infection(9.19%),and hepatobiliary system infection (5.57%).Stratified analysis on risk factors revealed that OR and OR95%CI of chronic complication,age,disease course,glycemic control,gender,type of diabetes,subtype of ketoac-idosis was 1.63(1.45,1.82),1.30(1.19,1.42),1.47(1.35,1.61),0.68(0.61,0.76),0.69(0.64,0.75),1.37 (1.13,1.66 )and 0.87(0.62,1.23),respectively.There was no publication bias and combined results were stable. Conclusion The main CAI in diabetic patients are respiratory system infection,urinary tract infection,tuberculo-sis,skin and soft tissue infection,and so on ;several factors,such as female,older age,long-term disease course, poor glycemic control,and complication,can contribute to the increase of CAI in diabetic patients.
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Objective To evaluate the clinical effects of long-term domiciliary oxygen therapy (LDOT)in accompany with pummonary rehabilization program on the patients with chronic obstructive pulmonary disease (COPD).Methods Seventy two COPD cases receiving LDOT treatment were randomized into treatment group and control group.The patients in control group were given LDOT alone,while the treatment group was given pulmonary rehabilization besides LDOT.Lung functions,arterial blood gas parameters and blood rheological parameters were compared between the two groups 2 years after the observation.Results The follow-up period lasted for 1 - 2 years.The frequency of acute exageration in the treatment group ( 3.0 ± 1.3 ) was significantly lower than that of control group (4.0 ± 1.6) ( t =1.893,P ＜ 0.05 ).Compared with that of control group,the FEV1([1.59±0.08]L vs.[1.41 ±0.13]L,t =-3.966,P ＜0.01),FVC ([2.47 ±0.20]L vs.[2.27 ±0.17]L,t=-2.788,P＜0.05),FEV1％ ([2.47±0.20]％ vs.[2.27±0.17]L,t=-4.402,P＜0.01) and PaO2 ( [79.1 ± 8.9 ] kPa vs.[ 60.0 ± 6.6 ] kPa,t =- 4.622,P ＜ 0.01 ) were significantly increased,while plasma viscosity ( [ 2.14 ± 0.31] mPa · s vs.[ 2.44 ± 0.45 ] mPa · s,t =1.985,P ＜ 0.05 ),Low shear blood viscosity ( [ 13.48 ± 1.97 ] mPa · s vs.[ 14.33 ± 1.87 ] mPa · s,t =2.126,P ＜ 0.05 ),median shear whole blood viscosity( [ 6.33 ± 0.66 ] mPa · s vs.(7.92 ± 0.98 ) mPa · s,t =4.238,P ＜ 0.01 ),high shear whole blood viscosity ([4.58 ±0.59] mPa · s vs.[5.33 ±0.68]mPa · s,t =0.3890,P ＜0.01) and erythrocyte sedimentation rate ( [ 30.63 ± 5.76 ] mm/1 h vs.[ 35.63 ± 6.925 ] mm/1 h,t =2.230,P ＜ 0.05 ) was greatly decrease.Conclusion Long-term domiciliary oxygen therapy in company with pulmonary rehabilization program is helpful to improve the lung function,arterial blood gas parameters and rheological status of COPD patients.
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Objective To explore the clinical characteristics of bronchial carcinoma in elder patients and determine the operative indication, surgical technique, and management in the perioperative period. Methods 16 patients with bronchial carcinoma aged 80 and over received major pulmonary resection through muscle sparing mini-thoracotomy. The operative procedures were lobectomy(8 cases), bilobectomy (3 cases), sleeve lobectomy (2 cases), pneumonectomy (1 case), and lobectomy plus wedge resection (2 cases). Clinical data were analyzed retrospectively. Results Of the 16 patients, 6 with stage Ⅰ disease, 3 with stage Ⅱ and 7 with stage Ⅲdisease. There were no perioperative death occurred. The most popular postoperative complications were cardiac arrhythmia, pulmonary infection and hypoxemia. Conclusion Major pulmonary resection is a rational choice for part of the octogenarian patients with lung cancer.
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Objective To compare the results of surgical treatment of cardiac carcinoma through left thoracic approach and abdominal approach.Methods After finished cardiac carcinoma resection and gastroesophagus anastomosis in thorax through left thoracic approach,standard D2 regional lymph nodes dissection or/and combined pancreas and spleen resection were performed immediately through abdominal approach in 19 patients.Two surgical specimens were examined individually.Results 122 lymph nodes were founded in the abdominal surgical specimens,in which 23 were metastasis lymph nodes founded in 7 patients (7/19,37 %).Conclusion Left thoracotomy alone can no achieve complete resection for advanced gastric cardiac carcinoma.It should be treated through the combined abdominal and thoracic approach.
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<p><b>BACKGROUND AND OBJECTIVE</b>Positron emission tomography (PET) is used increasingly in staging of non-small cell lung cancer (NSCLC) as a non-invasive tool. However, the role of PET in mediastinal lymphatic staging of NSCLC is not clear. The aim of this study was to demonstrate the efficacy of mediastinoscopy in determining mediastinal lymphatic metastasis in cases of positive PET finding.</p><p><b>METHODS</b>We performed PET preoperatively in 68 patients with clinically operable NSCLC between 2003 and 2008. Mediastinal lymphatic defined as metastasis by PET (SUV(max) > 2.5) was recorded. Mediastinoscopy being performed initially in all patients. Involvement of mediastinal lymph nodes was verified to compare the sensitivity and specificity of mediastinoscopy and the related PET results.</p><p><b>RESULTS</b>From 2003 to 2008, 61 mediastinoscopy were performed. There were 38 men and 23 women, aged from 41 to 81 years (mean 60 years). Localization of the tumor was right lung in 41 patients and left lung in 20 patients. After the operation, 45 patients were demonstrated to have N2 or N3 disease. Ten patients with N3 mediastinal metastasis for chemotherapy, 38 patients with N2 mediastinal metastasis for neuadjuvant chemotherapy while lung resection and systemic mediastinal lymphatic dissection through thoracotomy was performed in the remaining 16 patients with no mediastinal metastasis. The positive prediction value of PET scan was 73.8% (45/61). The sensitivity, specificity, accuracy, positive prediction value and negative prediction value in diagnosis of metastasis of mediastinal lymph nodes were 93.8% (45/48), 100% (13/13), 95.1% (58/61), 100% (45/45), 81.3% (13/16) for mediastinoscopy, respectively.</p><p><b>CONCLUSION</b>PET results do not provide acceptable accuracy rates. Mediastinoscopy still remains the gold standard for mediastinal staging of NSCLC.</p>
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Pulmonares , Patología , Ganglios Linfáticos , Patología , Metástasis Linfática , Patología , Mediastinoscopía , Tomografía de Emisión de PositronesRESUMEN
The International Association for the Study of Lung Cancer (IASLC) has presented the details of the IASLC/International Union Against Cancer (UICC)/American Joint Committee on Cancer (AJCC) Revised Staging Classification for Lung Cancer. The IASLC is the largest world-wide professional organization solely dedicated to reduce the worldwide burden of lung cancer. The IASLC recognizes that the staging classification will be most valuable and accurate if it is based on the evaluation of outcomes of large numbers of cases carefully collected and analyzed in an extensive worldwide database. The analyses of the T, N and M descriptors as well as the stage groupings were performed in 67,725 non-small cell lung cancer (NSCLC)patients. Survival was the primary outcome, measured from the date of diagnosis or date of protocol registration for clinical staging, or the date of surgery for pathologic staging. The remarkable efforts of the IASLC Staging Committee have resulted in an evidence-based, validated and robust revision of the international staging system for NSCLC. This landmark contribution will improve our care of patients and lays a strong foundation for future refinements based on an expanding knowledge of lung cancer behavior and biology. This review outlines the changes in the tumor, node, metastasis (TNM) descriptors and stage groupings anticipated in the official new stage classification system for NSCLC.
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Surgical resection (usually lobectomy) is considered the treatment option for individuals with stage Ⅰ and Ⅱ non-small cell lung cancer. The surgical treatment of stage Ⅰ and Ⅱ non-small cell lung cancer (NSCLC) continues to evolve in the areas of intraoperative lymph node staging (specifically the issue of lymph node dissection vs sampling), the role of sublobular resections instead of lobectomy for treatment of smaller tumors (especially peripheral carcinoma ≤2 cm in diameter), and the use of video-assisted techniques to perform anatomic lobectomy. Video-assisted thoracic surgery (VATS) lobectomy provides a minimally invasive approach for the management of early-stage lung cancer. Questions about the safety of VATS lobectomy and its adequacy as a cancer operation compared with open thoraeotomy have hindered its universal acceptance among thoracic surgeons. Evidence suggests that VATS lobectomy can be safely performed and is an adequate cancer operation for early-stage NSCLC. Recently, robots have been introduced into surgical procedures in an attempt to facilitate surgical performance. However, adequately powered well-balanced studies comparing VATS with open thoracotomy for lobectomy are lacking in the literature.
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Objective Under the guidance of CT and three dimensional reconstruction, we made therapeutic plan for lung cancer by radiofrequency ablation (RFA) and observed its effect. Methods From February 2007 to January 2009, we used RITA radiofrequency therapeutic equipment to treat lung cancer under the guidance of 64-slice spiral CT (Siemens) and three dimensional reconstruction of the image. The target temperature is 90℃. Results We performed 29 RFA on 25 patients. In the follow-up, 10 of them showed tumor shrinkage by CT scan. 23 showed lack of tumor-uptake value by SPECT scan and 2 showed lower tumor-uptake value. Conclusion CT-guided percutaneous RFA is safe and practical for lung cancer. It has satisfactory short-term effect to reduce tumor burden.
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Objective To survey the prevalence of greenhouse farmer's lung and related risk factors in part of rural areas of Liaoning Province.Methods Using uniform scheme,procedures and questionnaire,a survey for 5420 farmers(2660 men and 2760 women)with complete data who work inside greenhouses was performed in Shenyang,Xinmin,Chaoyang,and Jinzhou between August 2006 and June 2009.Pulmonary function tests was performed for every active farmer.Results Greenhouse farmer's lung was diagnosed in 308 cases,205 men(66.55%,205/308)and 103 women(33.44%,103/308),a prevalence of 5.7%(308/5420).The prevalence rate of greenhouse farmer's lung in males was significantly higher than that in females(?2=39.93,P0.05).In the 308 cases,the number of patiernts presented with fever chill,cough/sputum,chest tightness/shortness of breath were 180(58.44%),192(62.34%),160(51.95%)respectively,and the number of crepitations,radiological changes,spirometry abnormalities and serum IgE antibodies(+)was 164(53.25%),153(49.68%),147(47.73%)and 136(44.16%)at the time of the study.62.34%(192/308)of patients with greenhouse farmer's lung were mild and 38.66%(116/308)were severe.Conclusion The total prevalence rate of greenhouse farmer's lung in part of rural areas of Liaoning Province was 5.7% and multiple risk factors were associated with the disease.
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Objective:To observe the lens zonule infrastructure changes in experimental myopia. Methods; The eye lids were sutured to induce the myopia in guinea pigs and the zonule ultrastructure changes were observed. Results: There were significant differences in the eye axial length and diopter between lid-sutured eyes and controls(P