Expression of Six1 and Six4 in esophageal squamous cell carcinoma and their correlation with clinical prognosis / 中华病理学杂志

<p><b>OBJECTIVE</b>Six1 and Six4 are expressed in several tumors, and associated with tumor progress and poor prognosis. The aim of this study was to investigate the expression of Six1 and Six4 in esophageal squamous cell carcinoma (ESCC), and to evaluate their correlation with the clinicopathological factors and prognosis.</p><p><b>METHODS</b>Tissue microarray technology and immunohistochemical method (EnVision) were used to detect the expression of Six1 and Six4 in the tumor tissues and corresponding adjacent normal epithelium of esophagus from 292 ESCC patients.</p><p><b>RESULTS</b>Among the 292 ESCC patients, the positive rates of Six1 and Six4 protein expression in tumor tissues were 72.9% (213/292) and 56.2% (164/292), respectively, significantly higher than the expression rate of 33.2% (97/292) and 32.5% (95/292) in adjacent normal epithelium of esophagus (P < 0.05). Chi square test showed that the expression of Six1 protein was related to tumor size, depth of tumor invasion and patient survival status; higher Six4 protein expression level was related to poor differentiation and increased depth of invasion. Single factor Log-rank analysis revealed that gender, TNM stage, Six1 protein expression level were related to the overall survival of ESCC patients (P < 0.05), while the five-year survival rate was significantly higher in the Six1-negative group than the Six1-positive group [51.9% (41/79) vs. 43.7% (93/213)]. Multi-factor Cox proportional risk model analysis showed that TNM stage and positive expression of Six1 were independent prognostic factors for ESCC patients (P < 0.05).</p><p><b>CONCLUSIONS</b>Six1 and Six4 are highly expressed in ESCC. Their expression levels are closely related to the progress and prognosis of ESCC. Over-expression of Six1 is related to poor prognosis in ESCC patients. Thus, Six1 could be used as an important prognostic indicator for ESCC patients.</p>

Value of cytopathology in endobronchial ultrasound-guided transbronchial needle aspiration / 中华病理学杂志

<p><b>OBJECTIVE</b>To evaluate the role of cytopathology in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for lung tumor diagnosis and staging.</p><p><b>METHODS</b>Two-hundred consecutive cases of lung tumor with EBUS-TBNA performed during the period from April, 2009 to September, 2010 in Shanghai Cancer Hospital were retrospectively reviewed. The cytologic diagnoses were categorized as non-diagnostic, negative, suspicious and malignant. When available, cell block preparation and immunohistochemistry were performed. On the 22 positive cases diagnosed by on-site evaluation, epidermal growth factor receptor (EGFR) mutation study was carried out.</p><p><b>RESULTS</b>In the 200 cases of cytology specimens, 122 cases (69.3%) were diagnosed as malignant, 42 cases (23.9%) as benign and 12 cases (6.8%) as suspicious for malignancy. The non-diagnostic rate was 12.0% (24/200). Amongst the 200 cases studied, 140 cases (70.0%) had histologic correlation available (via core biopsy, mediastinoscopic biopsy or surgical excision). The sensitivity and specificity of EBUS-TBNA cytologic diagnoses were 94.4% and 100%, when using histopathologic findings and clinical follow-up data as gold standard. The cell block preparation and immunohistochemistry were useful in subtyping and diagnosis of extrathoracic malignancy. EGFR mutations were detected in 8 cytology samples (36.4%).</p><p><b>CONCLUSIONS</b>EBUS-TBNA is a sensitive and specific tool for diagnosis and staging of lung cancer. The cytology samples can be used for further ancillary investigations including cell block preparation, immunohistochemistry and molecular studies.</p>

Characteristics and risk factors of lymph node metastases in esophageal carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the status of lymph node metastases (LNM) of esophageal carcinoma and to identify the risk factors.</p><p><b>METHODS</b>Clinical data of 308 patients who underwent esophagectomy with three-field lymphadenectomy during January 2006 and December 2010 were reviewed. Characteristics of LNM were studied.</p><p><b>RESULTS</b>The average number of dissected lymph nodes was 35.6 ± 14.5 in 308 patients. There were 197 patients(64%) had LNM. Logistic regression analysis showed that lymphatic vessel invasion(P=0.019) and deep tumor invasion(P<0.001) were risk factors of LNM. The highest LNM site was paratracheal node(25.0%). The incidence of cervical LNM was 14.1% in the middle thoracic carcinoma, higher than that of upper thoracic (7.3%) and lower thoracic (8.3%). Rate of LNM was lower in upper thoracic carcinomas than that in middle or lower ones(P=0.001). No significant difference of LNM was found among upper, middle and lower thoracic carcinoma for cervical or thoracic nodes. Lymphatic vessel invasion(P<0.001) and metastases in paratracheal lymph nodes (P=0.014) were risk factors for cervical LNM.</p><p><b>CONCLUSIONS</b>LNM of esophageal carcinoma can be found in both directions vertically and skipped metastasis. Paratracheal lymph nodes involvement is an indicator for cervical lymphadenectomy in thoracic esophageal carcinoma.</p>

Evaluation of the value of EBUS-TBNA in diagnosis of mediastinal lesions / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in diagnosis of mediastinal lesions and to discuss its optimal indication.</p><p><b>METHODS</b>One hundred and twenty three patients with mediastinal lesions who underwent EBUS-TBNA were included in this study. The accuracy, sensitivity, specificity, positive and negative predictive value of EBUS-TBNA in diagnosis of mediastinal lesions were analyzed according to the final diagnosis and evaluate its value and the optimal indication.</p><p><b>RESULTS</b>In the 123 patients, EBUS-TBNA was successfully performed to obtain samples from 286 stations of lymph nodes (2.33 stations/per patient). The puncture success rate was 100%. The procedure was uneventful without complications. Final diagnosis indicated that there were 83 positive and 40 negative patients. EBUS-TBNA had a sensitivity of 95.2%, specificity of 100%, positive predictive value of 100%, negative predictive value of 90.0%, and overall accuracy of 96.8%. For diagnosis of the epithelial cancer, EBUS-TBNA had an accuracy of 98.8%, sensitivity of 98.8%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 100%. EBUS-TBNA failed to reveal three lymphomas. For diagnosis of benign mediastinal diseases, EBUS-TBNA had a diagnosis rate of 47.2% which had a confirmed clinical application value.</p><p><b>CONCLUSIONS</b>EBUS-TBNA may be expected to replace the mediastinoscopy as a superior choice for diagnosis of mediastinal epithelial cancers. EBUS-TBNA can not replace mediastinoscopy but being a promising tool for diagnosis of benign mediastinal lesions including granulomas. For certain special diseases such as lymphoma, mediastinoscopy cannot be replaced. However, EBUS-TBNA can be a potentially favorite choice for early stage screening.</p>

CT-guided hookwire localization of small solitary pulmonary nodules in video-assisted thoracoscopic surgery / 中华肿瘤杂志

<p><b>OBJECTIVE</b>Video-assisted thoracoscopic surgery (VATS) provides a minimally invasive approach to resect small solitary pulmonary nodules (SSPN). The aim of this study is to evaluate the efficacy and safety of preoperative CT-guided hookwire localization for SSPN in VATS.</p><p><b>METHODS</b>Hookwire was used to localize 26 SSPN under CT guidance in 24 patients (14 male, 10 female, age range 21-61 years, mean 52.3 years), preoperatively, and wedge resection was performed through VATS. The lesion size, distance from the lesion to parietal pleura, the time of localization and complications were evaluated.</p><p><b>RESULTS</b>All the 26 pulmonary nodules were preoperatively detected and localized with hookwire under CT-guidance. The mean lesion size was 10.05 +/- 3.08 mm in diameter, and the mean distance from lesion to parietal pleura was 10.09 +/- 2.62 mm. The mean localization time was 20.18 +/- 7.16 min, and then the nodules were removed by VATS within 18 +/- 6.65 min. The major complication of CT-guided hookwire localization was mild pneumothorax in 6 patients (25.0%), but no one needed chest tube drainage. The dislodgment of hookwire was found in only one patient (4.2%) during the operation, but the lesion was still successfully resected under VATS. Of those patients, 8 were confirmed to have a primary NSCLC by rapid pathologic diagnosis during VATS wedge resection, and then VATS lobectomies were performed.</p><p><b>CONCLUSION</b>The preoperative CT-guided hookwire localization for small solitary pulmonary nodules is an effective and safe technique to assist VATS resection of the nodules.</p>

Serum proteomic patterns may assist the diagnosis of solitary pulmonary nodules / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To screen relatively specific biomarkers in serum from lung adenocarcinoma patients by surface-enhanced laser desorption and ionization time of flight mass spectrometry (SELDI-TOFMS), and to investigate the clinical value of SELDI-TOF-MS in differentiation of benign from malignant solitary pulmonary nodules (SPN).</p><p><b>METHODS</b>Serum samples from 71 lung adenocarcinoma patients and 71 healthy volunteers with matched gender, age and history of smoking were analyzed using WCX2 ProteinChip to screen potential biomarkers. 28 patients received surgical treatment among total 53 patients with SPN. The clinical value of SELDI-TOF-MS in differentiation of benign from malignant solitary pulmonary nodules was evaluated by pathological diagnosis.</p><p><b>RESULTS</b>Five highly expressed potential biomarkers were identified with the relative molecular weights of 4047.79 Da, 4203.99 Da, 4959. 81 Da, 5329. 30 Da and 7760.12 Da. The postoperative pathologic diagnosis was lung adenocarcinoma in 24 patients with SPN, validating the clinical value of the 5 potential biomarkers.</p><p><b>CONCLUSION</b>SELDI-TOF-MS technology is a quick, easy, convenient, and high-throughput analyzing method capable of screening several relatively specific potential biomarkers from the serum of lung adenocarcinoma patients and may have attractive clinic value in differentiation of solitary pulmonary nodules.</p>

Advance in the study on the clinical characteristics,diagnosis and therapy for primary lung cancer in young patients / 中国癌症杂志

Lung cancer is one of the commonest of malignant tumor in the world.It is a major threat to human health in China with highest morbidity and mortality.Steady increase in incidence rates have been observed worldwide in the last few decades in young patients,but previous studies have provided conflicting data about the clinical characteristics and prognoses of young patients with lung cancer.Consequently,we have difficulty in comparing their results with each other,as the cutoff ages defining"young"were different in each study.Therefore,this article focuses on the clinical characteristics and the different results of researches for the young patients with primary lung cancer.