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.

Related factors of N2 lymph node metastasis in non-small cell lung cancer and selection of lymph node dissection / 中国医师杂志

Objective To analyze the related factors of lymph node metastasis in N2 group of patients with non-small cell lung cancer,and found its meaning for lymph node dissection.Methods A retrospective analysis was made on 110 patients with non-small cell lung cancer from July 2014 to May 2016 in our thoracic surgery department.Potential related factors were collected,single factor analysis and variate analysis were carried out to find the relationship between N2 lymph node metastasis and potential related factors.Results Univariate analysis showed that the longest diameter of the tumor ＞ 2 cm (P =0.016),lymph node imaging (P =0.021),pleural involvement (P =0.002) were related factors of lymph node metastasis in N2 group,and these three factors were independent related factors of lymph node metastasis in N2 group.Conclusions The longest diameter of the tumor,lymph node imaging and pleural involvement are related factors of N2 lymph node metastasis.Systematic lymph node dissection is strongly recommended for patients with three related factors at the same time.

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.

Prognostic value of three different staging schemes based on pN, MLR and LODDS in patients with T3 esophageal cancer / 中华肿瘤杂志

Objective@#To evaluate the prognostic value of three different staging schemes based on positive lymph nodes (pN), metastatic lymph nodes ratio (MLR) and log odds of positive lymph nodes (LODDS) in patients with T3 esophageal cancer.@*Methods@#From 2007 to 2014, clinicopathological characteristics of 905 patients who were pathologically diagnosed as T3 esophageal cancer and underwent radical esophagectomy in Zhejiang Cancer Hospital were retrospectively analyzed. Kaplan-Meier curves and Multivariate Cox proportional hazards models were used to evaluate the independent prognostic factors. The values of three lymph node staging schemes for predicting 5-year survival were analyzed by using receiver operating characteristic (ROC) curves.@*Results@#The 1-, 3- and 5-year overall survival rates of patients with T3 esophageal cancer were 80.9%, 50.0% and 38.4%, respectively. Multivariate analysis showed that MLR stage, LODDS stage and differentiation were independent prognostic survival factors (P<0.05 for all). ROC curves showed that the area under the curve of pN stage, MLR stage, LODDS stage was 0.607, 0.613 and 0.618, respectively. However, the differences were not statistically significant (P>0.05).@*Conclusions@#LODDS is an independent prognostic factor for patients with T3 esophageal cancer. The value of LODDS staging system may be superior to pN staging system for evaluating the prognosis of these patients.

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.

Serous microcystic adenoma of pancreas: a clinicopathological study / 中华肝胆外科杂志

Objective To study the clinicopathological features in the diagnosis of serous microcystic adenoma of pancreas.Method A clinicopathological and immunohistochemical study was conducted on 7 patients with serous microcystic adenoma of pancreas.Results All the patients were female,with a mean age of 51 years.Clinical symptoms were present in 2(28.6％)patients.On microscopy,the tumor composed of variable-sized cysts.The cyst wall was covered by simple cuboidal epithelium.The cytoplasm was clear and glycogen-rich.The nucleus of the epithelial cells was small and round.In the center,there was no nucleolus and no nuclear division.There were bulky fibrous tissues between the cystic cavities.Immunohistochemical study showed AE1/AE3,CK7,CK8,CK19,CK/LMW,EMA were positive,and CEA,CD31,CD34,D2-40,Syn,CgA,Calretinin,Vim were negative.Conclusions Serous microcystic adenoma of pancreas is a rare tumor,which was common in old women.Serous microcystic adenoma of pancreas is a benign tumor with good prognosis.The diagnosis is made on histopathological and immunohistochemical study.

Prognosis analysis of esophageal carcinoma patients with tumor loco-regional recurrence after curative surgery / 中华放射医学与防护杂志

Objective To evaluate the outcome of radiotherapy for recurrent esophageal cancer after surgery and to determine the prognostic factors. Methods From Jan 2004 to Dec 2009, 93 patients of esophageal carcinoma with loco-regional recurrence as the first site of failure after surgery were retrospectively reviewed. Kaplan-Meier method was used to analyze the survival. Logrank test was used to evaluate the difference between the groups. Multivariate survival analysis was conducted using a Cox proportional hazard regression model with a backward stepwise procedure. Results The overall survival rates at 1, 2 and 3 years were 40. 9% , 10. 1% and 6. 7% ,respectively,but with a median survival time of 11.0 months(95% CI 9. 4-12. 6) . In univariate analysis, age,PS, radiation dose and retreatment methods were independent prognostic factors. In multivariate analysis, only radiation dose and retreatment methods were independent prognostic factors for overall survival. Conclusions The prognosis of patients with postoperative loco-regional recurrence of esophageal cancer is poor. However, a long-term survival maybe expected by definitive chemoradiotherapy.

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.