Long-Term Survival After Surgical Treatment of Thymic Carcinoma: A Retrospective Analysis from the Chinese Alliance for Research of Thymoma Database.

BACKGROUND: Thymic carcinoma is a type of rare and highly malignant tumor that originates from the thymic epithelium. Treatment and prognosis of thymic carcinoma remain controversial. We retrospectively analyzed survival data from a large-sample multicenter database in China. METHODS: The Chinese Alliance for Research of Thymoma constructed a retrospective database of patients with thymic epithelial tumors, which enrolled 1930 patients from January 1996 to August 2013, including 329 with thymic carcinomas. In this study, we analyzed clinical, pathologic, and treatment information, measured long-term survival rates, and identified relevant prognostic factors. RESULTS: Of 329 patients, R0 resection was performed in 211 (57.7 %), R1 in 34 (9.2 %), and R2 in 84 (22.5 %).The 3-, 5-, and 10-year survival rates were 78.3, 67.1, and 47.9 %, respectively. In univariate analysis, early Masaoka-Koga stage, R0 resection, and postoperative radiotherapy were associated with better overall survival.Early Masaoka-Koga stage and postoperative radiotherapy were also associated with disease-free survival. In multivariate analyses, R0 resection, Masaoka-Koga stage, and postoperative radiotherapy were significant prognostic factors of survival. CONCLUSIONS: Complete resection is the preferred primary treatment for thymic carcinoma. R0 resection, early Masaoka-Koga stage, and postoperative radiotherapy are significant predictors of improved survival.

The significance of MAGED4 expression in non-small cell lung cancer as analyzed by real-time fluorescence quantitative PCR.

The aim of this study was to detect differences in the expression levels of melanoma-associated antigen D4 (MAGED4) mRNA between non-small cell lung cancer (NSCLC) tissues and normal tissues, and to compare differences in the expression levels of MAGED4 in tumor patients. Patients were grouped according to age, gender, smoking history, tumor size, pathological classification, degree of lung cancer cell differentiation and presence of lymph node metastasis. The expression levels of MAGED4 were detected using real-time fluorescence quantitative PCR. MAGED4 expression was higher in squamous cell carcinomas compared to adenocarcinomas (P<0.05), in poorly differentiated tissues compared to well-differentiated tissues (P<0.05), and in patients with lymph node metastasis compared to patients without lymph node metastasis (P<0.05). MAGED4 may be used as a specific antigen for NSCLC to influence the improvement of diagnosis, prognosis and immunological therapy outcomes in lung cancer patients.

Tumour length is an independent prognostic factor of esophageal squamous cell carcinomas.

BACKGROUND: The latest version of the American Joint Committee on Cancer (AJCC) TNM staging system has not comprehensively evaluated the impact of tumour length on survival in patients with esophageal squamous cell carcinoma. Our study explored the relationship between tumour length and clinicopathological characteristics as well as long-term survival. METHODS: All 202 cases of esophageal resections done from January 1, 2004 to December 31, 2008 in Huashan Hospital, Fudan University were reviewed and followed up. RESULTS: Patients with tumour length = 3 cm were related to more advanced tumour stage (χ(2) = 55.9, P < 0.001), more metastatic lymph nodes (χ(2) = 14.6, P < 0.001), increased metastatic lymph node ratio χ(2) = 16.1, P < 0.001) and worse overall TNM stage (χ(2) = 48.1, P < 0.001). Univariate and multivariate analyses indicated that tumour length was a significant prognostic risk factor (95% CI 0.235 - 0.947, P = 0.035). Subgroup analyses disclosed that tumour length was a valuable prognostic predictor in patients with lower T stage, absence of metastatic lymph nodes and lower TNM stage. CONCLUSIONS: Esophageal tumour length is a predictive factor for long-term survival especially for lower tumour stage, absence of metastatic lymph nodes and lower TNM stage patients. Tumour length should be incorporated in the staging system as an important grouping factor for better prognostic evaluation.

Application of the titanium plate fixation system in sternum transverse incisions.

The purpose of this study was to review the application of the titanium plate fixation system in sternum transverse incisions and assess its advantages over the conventional methods of steel wire fixation. Sternal healing of 249 patients who underwent a thymectomy and/or excision of the thymoma with a transverse sternal incision was compared between patients who underwent titanium plate fixation or steel wire fixation. Short-term results: The stability of the sternum was significantly superior in the titanium plate group compared with the steel wire group (P < 0.01). Out-of-bed activities started earlier for patients in the titanium plate group compared with the steel wire group (P < 0.01). Long-term results: The sternal healing rate in the titanium plate group was significantly higher than the steel wire group (P < 0.05). Titanium plate fixation improves the postoperative sternal stability in patients with transverse sternal incisions for thymectomy and/or excision of a thymoma. Titanium plate fixation also reduces postoperative pain, enhances the patient's physical activity, and decreases the long-term nonunion rate of the sternum.

Deployment of self-expanding metallic stents under fluoroscopic guidance in patients with malignant esophagorespiratory fistula.

BACKGROUND/AIMS: Stent deployment for the treatment of ERFs is typically performed under endoscopic guidance. Our aim was to evaluate self-expanding metallic stent placement under fluoroscopic guidance. METHODOLOGY: The records of six patients who underwent self-expanding metallic stent placement under fluoroscopic guidance for the treatment of ERFs were reviewed. Technical data of the procedures, complications, and associated morbidity were recorded. The main outcome measures were dysphagia score, KPS, and survival. RESULTS: Stents were successfully inserted in all 6 patients without complications, and all procedures were completed within 15 minutes. The mean dysphagia score was 4 +/- 0 before treatment and 1.2 +/- 0.8 one week after stent placement. The mean KPS increased significantly from 28.0 +/- 9.8 before stent placement to 58.3 +/- 16.0 one week after placement (p = 0.001). For the patients who had KPS < or =50 one week after the surgery, the survival period was relatively short (mean, 37 days). For the patients who had KPS > or =60 one week after the surgery, the mean survival period was 192 days. CONCLUSIONS: Self-expanding metallic stent placement can be performed safely and quickly under fluoroscopic guidance alone.