Analysis of failure patterns and survival after SBRT for 147 cases of T 1-2N 0M 0 stage non-small cell lung cancer / 中华放射肿瘤学杂志

Objective:To analyze the failure patterns and survival after stereotactic body radiotherapy (SBRT) in patients with T 1-2N 0M 0 non-small cell lung carcinoma (NSCLC). Methods:Clinical data of early-stage NSCLC patients who received SBRT at Zhejiang Cancer Hospital from January 2012 to September 2018 were retrospectively analyzed. The primary observed endpoint was the pattern of disease progression, which was divided into intra-field recurrence, regional lymph node recurrence and distant metastasis. Overall survival (OS) and progression-free survival (PFS) were calculated by Kaplan-Meier method. Univariate analysis was conducted by log-rank test, and multivariate analysis was performed by Cox's model.Results:A total of 147 patients with 156 lesions were included. The median follow-up time was 44.0 months (16.5-95.5 months). A total of 57 patients (38.8%) progressed: 14 patients (24.5%) had recurrence with the 1-, 3-, and 5-year local recurrence rates of 2.0%, 10.9%, and 14.3%, respectively; 36 patients (63.2%) had Distant metastasis with the 1-, 3- and 5-year distant metastasis rates of 12.2%, 22.4% and 28.6%, respectively; and 7 patients (12.3%) had recurrence complicated with distant metastasis. The 3-, 5- and 7-year OS rates were 80.5%, 64.2% and 49.9% for all patients, respectively. The median OS was 78.4 months. The 3-, 5- and 7-year PFS rates were 64.8%,49.5% and 41.5%, with a median PFS of 57.9 months (95% CI: 42.3-73.5 months). Univariate and multivariate analyses showed that biologically equivalent dose and age were the factors affecting the efficacy of SBRT (both P<0.05). Conclusion:Distant metastasis is the main failure pattern in patients with T 1-2N 0M 0 NSCLC after SBRT. High-risk population should be selected for further systematic treatment to improve the efficacy.

Failure mode and long-term survival after neoadjuvant therapy for locally advanced esophageal squamous cell carcinoma / 中华放射肿瘤学杂志

Objective:To analyze the fail mode of neoadjuvant therapy combined with surgery for locally advanced esophageal squamous cell carcinoma (ESCC) after long-term follow-up.Methods:Clinical data of consecutive 238 patients with locally advanced resectable ESCC who underwent neoadjuvant therapy combined with surgery in Zhejiang Cancer Hospital from September 2012 to October 2019 were retrospectively analyzed. The failure mode in the whole cohort was analyzed after long-term follow-up. The overall survival (OS) and disease free survival (DFS) rates were analyzed by Kaplan-Meier method. Survival differences were determined by log-rank test.Results:The pathological complete response (pCR) rate was 42.0% in 238 patients. After a median follow-up of 46.1 months, tumor progression occurred in 96 patients (40.3%), including 25 patients (10.5%) with local recurrence, 61 patients (25.6%) with distant metastases, and 10 patients (4.2%) with simultaneous local recurrence and distant metastases. The median OS and DFS were 64.7 months and 49.9 months. And the 3-, 5-, and 7-year OS and DFS rates were 70.0%, 52.8%, 36.4% and 63.5%, 42.5%, and 30.0%, respectively. The 3-, 5-, and 7-year locoregional recurrence-free survival rates and distant metastasis-free survival rates were 86.0%, 71.4%, 61.2% and 70.6%, 55.9%, 43.0%. Compared with non-pCR patients, the overall progression rate and distant metastasis rate of pCR patients were lower (26.0% vs. 50.7%, 16.0% vs. 32.6%, both P<0.05). And the 3-, 5-, and 7-year OS (83.0% vs. 60.2%, 69.7% vs. 41.7%, 50.4% vs. 27.7%, all P<0.001) and DFS rates (80.4% vs. 51.4%, 63.9% vs. 31.2%, 45.9% vs. 20.3%, all P<0.001) were significantly better in pCR patients. Conclusions:Distant metastasis is the main failure mode of patients with locally advanced ESCC after neoadjuvant therapy. Patients with postoperative pCR can achieve better long-term survival.

Prognostic Analysis of NSCLC Based on the Tumor-associated Macrophages, Tumor Neo-vessels and PD-L1 Expression in Tumor Microenvironment / 中国肺癌杂志

BACKGROUND@#Tumor microenvironment is a complex and dynamic community, which plays a crucial role in tumor progression via the co-evolution of cancer cells and tumor stroma. Among them, tumor-associated macrophages (TAMs) and tumor neo-vessels are two key components in the tumor microenvironment during cancer invasion. In addition, programmed cell death ligand 1/programmed cell death ligand 1 (PD-1/PD-L1) also plays an important role in tumorigenesis and development, and the clinical strategies to block PD-1/PD-L1 pathway could have great benefits for cancer patients. This study was aimed at analyzing the quantitative expression and prognostic significance of TAMs, tumor neo-vessels and PD-L1 in tumor microenvironment and exploring the relations between the expression of above components with the patients' prognosis of non-small cell lung cancer (NSCLC).@*METHODS@#Clinico-pathological data and surgical specimens of 92 patients with NSCLC were collected, and immunohistochemistry was used to stain the expression of TAMs, tumor neo-vessels and PD-L1 on tumor tissue and peri-tumor tissues. The inverted microscopy was used to take pictures and Image-pro Plus 6.0 software was used for quantitative analysis. The clinicopathological characteristics and overall survival (OS) were analyzed.@*RESULTS@#The median OS of 92 NSCLC cases was 22.5 month. The expression of TAMs, tumor neo-vessels and PD-L1 in tumor tissue and peri-tumor tissues were not statistically significant (P>0.05). According to the cutoff of above key three components in tumor microenvironment, all the cases could be classified into high, middle and low expression groups. The survival analysis demonstrated that the OS in high expression group of TAMs (P=0.016) and PD-L1 (P=0.002) was shorter than the other two groups, respectively, with statistical significance. The OS in high tumor neo vessels group was shorter than the other two groups. However, there was no statistical significance between these three group (P=0.626). Combined with above the three components, all the cases could be classified into low, middle and high density groups. The survival analysis demonstrated that the median OS of combined high density group was shorter than the other two groups (P=0.001). Multivariate analysis by Cox regression indicated that pathological type, TAMs and PD-L1 expression were the independent prognostic factors.@*CONCLUSIONS@#The key components of TAMs and PD-L1 in tumor microenvironment are closely related to the prognosis of NSCLC patients.

Clinical efficacy of prophylactic cranial irradiation for patients with surgically resected small cell lung cancer / 中华放射肿瘤学杂志

Objective To evaluate the clinical efficacy of prophylactic cranial irradiation (PCI) in the treatment of surgically resected small cell lung cancer (SCLC).Methods Clinical data of SCLC patients undergoing radical resection surgery in Zhejiang Cancer Hospital from 2003 to 2015 were retrospectively analyzed.According to the treatment modality,all patients were allocated into the PCI and non-PCI groups.A total of 52 patients were finally included,including 19 patients in the PCI group (5 cases of stage Ⅰ,5 stage Ⅱ and 9 stage Ⅲ) and 33 in the non-PCI group (12 cases of stage Ⅰ,5 stage Ⅱ and 16 stage Ⅲ).Kaplan-Meier method was utilized for survival analysis.Cox proportional hazards model was adopted to analyze clinical prognosis.Results The median survival time was 32.9 months in the PCI group,and 20.4 months in the non-PCI group.The 2-year overall survival rate was 72％ in the PCI group,significantly higher than 38％ in the non-PCI group (P=0.023).The median brain metastasis-free survival (BMFS) was 32.5 months in the PCI group,and 17.1 months in the non-PCI group.In the PCI group,the 2-year BMFS rate was 89％,significantly better than 53％ in the non-PCI group (P=0.026).Subgroup analysis demonstrated that PCI could confer survival benefit to patients with p-stage Ⅲ (p=0.031) rather than p-stage Ⅰ (P=0.924) and Ⅱ (P=0.094) counterparts.Multivariate analysis revealed that PCI (HR=0.330,P=0.041) was an independent prognostic factor of the overall survival.Conclusions PCI can reduce thr risk of brain metastasis rate and improve the overall survival of patients with surgically resected SCLC.

Comparison of efficacy between trimodality and chemoradiation therapy alone in treatment of locally advanced esophageal squamous cell carcinoma / 中华放射医学与防护杂志

Objective To compare the efficacy of trimodality therapy and chemoradiation therapy (CRT) alone in patients with locally advanced resectable esophageal squamous cell carcinoma (SCC).Methods A total of 124 cases with locally advanced resectable esophageal SCC were retrospectively analyzed and classified into 2 groups.Fifty-four cases in trimodality group were treated with surgery and preoperative chemoradiation,while 70 cases in CRT alone group only received radiation and chemotherapy.Local tumor control,3-year survival and treatment-related mortality were assessed.Results The local recurrent rate of the resected patients was 18.5％ in trimodality group and 35.7％ in CRT alone group,respectively(x2 =4.445,P ＜ 0.05).The 3-year progression-free survival (PFS) was 65.3％ (95％ CI 50.7-80.5) in trimodality group and31.9％ (95％CI 19.6-44.2) in CRT alone group (P＜0.05),while the overall survival (OS) 66.3％ (95％ CI43.0-89.6) and 34.4％ (95％ CI 21.1-47.7),respectively(P ＜ 0.05).Treatment-related mortality was 1.9％ in trimodality group and 2.9％ in CRT alone group (P ＞ 0.05).For CRT alone group,the sub-group analysis showed that there was no statistically significant difference in the 3-year OS between patients who received 50-50.4 Gy and those who received the dose over 50.4 Gy (39.9％ 95％ CI 18.5-61.3 vs.31.5％ 95％ CI 14.8-48.2,P ＞0.05).Conclusions Compared with CRT alone,trimodality therapy showed the superior local control,PFS and OS,with similar treatment-related mortality in the treatment of patients with SCC of esophagus.The role of surgery could not be replaced by CRT alone even with the augment of radiation dose.

Analysis of outcomes and prognostic factors after Ivor Lewis esophagectomy / 中国基层医药

Objective To explore the outcomes and prognostic effects of Ivor Lewis esophagectomy and evalue the N staging.Methods Participants comprised 1145 patients with ESCC from Jan.2004 to Dec.2013,who under-went Ivor Lewis esophagectomy.The clinicopathologic data were analyzed.Kaplan -Meier and Cox regression methods were used for survival analysis.Results The morbidity of postoperative complication was 9.15% and with 1.83% of motality.The 1 -,3 - and 5 -year survival rates were 84.2%,58.4%,47.9% respectively.The median survival time was 55 months and average survival time was (70.16 ±2.086)months.Cox model multivariate analysis was used for those of P <0.05 in single variate analysis.Univariate analysis revealed that gender(P =0.003),smoking history (P =0.013),alcohol history(P =0.017),tumor location(P =0.001),body mass index(P =0.008),tumor length (P =0.000),differentiation degree(P =0.000),numbers of metastic zones(P =0.000)of lymph node metastasis (P =0.000),depth of invasion (P =0.000),pathological staging(P =0.000),vascular tumor thrombus (P =0.000),nerve involvement(P =0.000)and postoperative adjuvant therapy(P =0.000)were influencing prognosis factors.And multivariate analysis revealed that differentiation degree(P =0.000),depth of invasion(P =0.000), numbers of metastic zones (P =0.013 )of lymph node metastasis (P =0.000)were independent risk factors. Conclusion Ivor Lewis esophagectomy was a safe and effective treatment,and tumor differentiation degree,depth of invasion,numbers and zones of lymph node metastasis were important prognostic factors.

Building of the evaluation index system of clinical key disciplines at county level hospitals in Chengdu city / 中华医院管理杂志

Objective To build a clinical key disciplines evaluation index system for county level hospitals in Chengdu city.Methods Literature meta analysis, focus group discussion, expert consultation method, boundary value method, brainstorming and hierarchy analysis method were comprehensively used.Results The clinical key disciplines evaluation index system for county level hospitals in Chengdu city comprises 5 level-1 indexes,1 6 level-2 indexes,47 level-3 indexes.Among the level-1 indexes,service capacity,medical quality,technical personnel,scientific research and education, and foundation of specialty was 0.474 6,0.202 7,0.148 2,0.097 7,0.076 8 respectively.Conclusion The clinical key disciplines evaluation index system for county level hospitals in Chengdu city is scientific, guiding and practical,which can be used to evaluate the status of the clinical key disciplines for county level hospitals in Chengdu city.

Analysis of risk factors for postoperative pulmonary complications In elderly patients with esophageal cancer aged 70 years and over / 中华老年医学杂志

Objective To analyze the risk factors for postoperative pulmonary complications (PPCs) in elderly patients with esophageal cancer aged 70 years and over. Methods 185 elderly patients aged 70 years and over after esophagectomy were retrospectively analyzed. Univariate and multivariate logistic regression analysis were used to examine the risk factors for PPCs and related mortality. Results In 185 elderly patients from 70 to 86 years of age with a median age of 72 years, PPCs occurred in 36 patients(19.5%) including pneumonia in 23(63.8%) cases, atelectasis in 3 (8.3%) cases, adult respiratory distress syndrome (ARDS) in 2(5.5%) cases, pulmonary embolism in 1(2.7%) case and respiratory failure in 7(19.4%) cases. The related mortality was 5.9% (11cases) and the causes of death were pneumonia (4 cases), ARDS (1 case), pulmonary embolism (1case) and respiratory failure (5 cases). There were 43 (23.2%) cases with the forced expiratory volume in one second (FEV1%)< 65% before operation. The bleeding volume during operation ranged from 200ml～2000 ml, with a mean volume of about 350ml, and was above 800ml in 8(4.3%) cases. Injury of recurrent laryngeal nerve during operation occurred in 13(7.0%) cases. Univariate and multivariate logistic regression analysis indicated that smoking, obesity, poor preoperative pulmonary function (FEV1 % < 65%), bleeding volume over 800ml during operation and injury of recurrent laryngeal nerve were the independent risk factors for PPCs in elderly patients with esophageal cancer aged 70 years and over. Poor preoperative pulmonary function (FEV1% < 65%)(OR=29.49, P=0.023), bleeding volume over 800ml during operation(OR=32.93, P=0.011) and injury of recurrent laryngeal nerve(OR= 10.14, P= 0.034) were also the independent risk factors for related mortality of PPCs. Conclusions The high risks of PPCs and related mortality in elderly patients with esophageal cancer are not only due to the physiological and pathological characteristics of elderly people, but also due to the operative manipulation.

Clinical study of cervical esophagogastrostomy with mechanical stapler in treatment of esophageal cancer / 肿瘤研究与临床

Objective To contrast the efficacy of mechanical stapler and hand suture for cervical esophagogastrostomy in the treatment of esophayeal cancer.Methods From January 2001 to August 2007,217 cases of cervical esophagogastrostomy were done in esophageal carcinoma.Among them.136 cases were treated by mechanical stapler and 81 cases by hand.Results The incidence of anastomotic fistula was 2.2%(3/136)in mechanical stapler group and 11.1%(9/81)in the group by hand.There was significant difference between the two groups(P＜0.95).The incidence of cervical incision infection was 2.9%(4/136)in mechanical stapler group and 14.8%(12/81)in the group by hand.There was significant difference between these two groups(P＜0.05).There was no significant difference between these two groups about pulmonary infection,arrhythmia,chylothorax and laryngeal nerve injury.Conclusion The incidence of anastomotic fistula and cervical incision infection was reduced by mechanical stapler which was displayed to advantage in esophagogastrostomy.