Surgery has remained the cornerstone of lung cancer therapy. Sleeve lobectomy, which is featured by not only the maximal resection of tumors but also the maximal preservation of functional lung parenchyma, has been proved to be a valid therapeutic option for the treatment of some centrally located lung cancer . Evidence points toward equivalent oncologic outcomes with improved survival and quality of life after sleeve resections compared with pneumonectomy. However, the postoperative morbidities and the long-term results after sleeve lobectomy remain controversial, especially in relation to nodal involvement and after induction therapy. With the development of technology, minimally invasive procedures have been performed more and more widely.
ObjectiveTo evaluate the clinical efficacy and safety of artieral infusion chemotherapy combined with 125I seed implantation in treatment of non-small cell lung cancer (NSCLC). MethodsBetween February 2012 to June 2014, 34 patients with unresectable NSCLC received 125I seed implantation, in which 16 patients also received artieral infusion chemotherapy. All the patients were followed up and two months after 125I seed implantation the thoracic CT scanning was carried out in all patients. The response to treatment was evaluated in accordance with Response Evaluation Criteria in Solid Tumors and the accumulated survival rate was analyzed by means of Kaplan-Meier. ResultsThe operation successful rate was 100% and no severe complications were observed. Two months later the thoracic CT scanning showed that patients who only received 125I seed implantation with a total effective rate of 72.2% and those received artieral infusion chemotherapy combined with 125I seed implantation with an effective rate of 87.5%, with no significant difference between two groups in the effective rate (χ2=1.122, P>0.05). Median survival time of two groups was 361 days and 470 days (χ2=2.985, P < 0.05), respectively. Survival rate of 1 year was 43.5% and 83.5%(χ2=4.101, P < 0.05), respectively. ConclusionArtieral infusion chemotherapy combined with 125I seed implantation is safe, reliable and effective in treatment of unresectable NSCLC, which can prolong the patient's survival time.
ObjectiveTo explore the relationship between Beclin 1 level and lymph node metastasis in patients with non-small cell lung cancer.MethodA total of 204 surgical specimens of patients with non-small cell lung cancer from September 2011 to September 2016 were collected in our hospital. There were 116 males and 88 females . Beclin 1 levels were detected by Western blotting. There were 116 males and 88 females at average age of 55.3±11.2 years. The patients were divided into three groups including a group N0 (no lymph node metastasis), a group N1(intralobar and interlobar lymph node metastases, and no mediastinal lymph node metastasis), and a group N2 (mediastinal lymph node metastasis). The differences of Beclin 1 levels in tumor tissues and lymph nodes of patients with N0, N1 and N2 were statistically analyzed.ResultsAmong 204 patients of lung cancer, 36 patients were squamous cell carcinoma and 168 patients were adenocarcinoma. The levels of Beclin 1 in tumor tissues of N0, N1 and N2 groups decreased gradually with a statistical difference (P<0.05). In the three groups, the levels of Beclin 1 in the lung hilum and intrapulmonary lymph nodes (N1 Beclin 1) of N1 and N2 groups were less than that of N0 group with a statistical difference (P<0.01). In the three groups, the level of Beclin 1 in the mediastinal lymph nodes (N2 Beclin 1) of N2 group was less than that of the N0 and N1 groups with a statistical difference (P<0.01). In the N1 group, the level of N1 Beclin 1 was less than that of N2 group (P<0.01). In the N2 group, though the level of N1 Beclin 1 was less than N2 Beclin 1, there was no statistical difference (P>0.05). ConclusionBeclin 1 level can be used as a reference index to judge the benign and malignant lung masses, and lymph node Beclin 1 level can be used as an important reference index to help determine whether there is lymph node metastasis in lung cancer.
ObjectiveTo explore prognostic factors of non-small cell lung cancer(NSCLC)patients with preoperative clinical N0 staging but unexpected postoperative pathological N2 staging (cN0-pN2). MethodsClinical data of NSCLC patients with cN0-pN2 after radical lung cancer resection in Huashan Hospital Affiliated to Fudan University from January 2006 to December 2010 were retrospectively analyzed. Survival information was collected through followup, and follow-up expired on December 31, 2012. Prognostic factors of NSCLC patients with cN0-pN2 were analyzed using Cox proportional-hazard regression. ResultsA total of 263 patients were enrolled in this study. The followup rate was 91.63%. Overall 1-year, 3-year and 5-year survival rate was 94.6%, 55.2% and 26.3%, respectively. Videoassisted thoracoscopic surgery (VATS, P=0.017, RR=0.659, 95%CI 0.469-0.927), multiple stations of mediastinal lymph node metastases (P=0.003, RR=1.605, 95%CI 1.180-2.183), no adjuvant chemotherapy(P=0.012, RR=1.576, 95%CI 1.105-2.246) were independent predictive factors for NSCLC patients with cN0-pN2. For patients with single station N2, median survival after VATS was significantly longer than that after open thoracotomy (48.55 months vs. 37.34 months, P=0.018). For patients with multiple stations of mediastinal lymph node metastases, median survival without any adjuvant chemotherapy was significantly shorter than that after adjuvant chemotherapy (20.32 months vs. 31.55 months, P=0.001). ConclusionPrognosis of NSCLC patients with cN0-pN2 is related to operational methods, adjuvant chemotherapy and station number of mediastinal lymph node metastasis. Patients with single station of mediastinal lymph node metastasis are more likely to benefit from VATS while patients with multiple stations of mediastinal lymph node metastases are more likely to benefit from adjuvant chemotherapy.
Objective To explore the clinical significance of estrogen receptor α( ERα) , estrogen receptor β( ERβ) in non-small cell lung cancer( NSCLC) .Methods EnVision method was used to detect the expressions of ERα, ERβ, vascular endothelial growth factor( VEGF) , and microvessel density( MVD) in 54 NSCLC patients, 10 patients with lung benign lesions, and 10 normal controls. The interrelation between ERα, ERβ, VEGF, and MVD was analyzed. Results No obvious expressions of ERα and ERβwere observed in the normal lung tissues and lung benign lesions. The positive expression rates of ERα, ERβ, and VEGF in NSCLC were 20. 4% ( 11/54) , 64. 8% ( 35/54) , and 64. 8% ( 35/54) , respectively. There were no significant differences between ERαin regard to clinical parameters of NSCLC. But the expression of ERβwas dependent on pathological classification and differentiation of NSCLC. The expression of ERβ was significantly higher in adenocarcinoma than in squamous cell carcinoma( P lt; 0. 05) . The expression rate of ERβin well differentiated group was significantly higher than that in low, moderately differentiated group( P lt;0. 05) . There were significant differences between VEGF in regard to lymph node metastasis and TNM stage. The expression of ERαinterrelated with VEGF and MVD with r value of 0. 4 and 0. 685 respectively ( P lt;0. 05) . There was little correlation between ERβ and VEGF, MVD( P gt; 0. 05) . Conclusion Theexpression of ERβ correlates with pathological classification and differentiation of NSCLC, suggesting its significance in evaluating the pathological classification and malignant degree of NSCLC. The expression of ERαcorrelates with VEGF and MVD, suggesting that ERαpossibly promote micro-angiogenesis of NSCLC by VEGF pathway.
This study reports a case of a 56-year-old female patient with BRAF-mutated non-small cell lung cancer (NSCLC) who successfully underwent curative surgery after neoadjuvant targeted therapy with the BRAF inhibitor dabrafenib combined with the MEK inhibitor trametinib. The chest drainage tube was removed 2 days postoperatively, and the patient was discharged smoothly. Postoperative pathology indicated invasive adenocarcinoma, moderately to highly differentiated, with 80% being lepidic type, and the maximum tumor diameter was 4 cm. No vascular invasion, nerve invasion, air cavity dissemination, pleural invasion, or lymph node metastasis were observed. The postoperative staging was ypT2aN0M0. The patient continued with adjuvant treatment with dabrafenib combined with trametinib postoperatively, and no signs of recurrence were found in the follow-up examination six months after surgery.
ObjectiveTo compare the effect on postoperative immune function between da Vinci robot-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) , and to provide clinical support for more effective surgical procedures.MethodsA total of 90 patients undergoing radical resection of pulmonary carcinoma in our hospital from June to November 2019 were included. There were 49 males and 41 females with an average age of 62.67 (37-84) years. Among them, 50 patients underwent da Vinci robot-assisted thoracoscopic surgery (a RATS group) and 40 patients underwent video-assisted thoracoscopic surgery (a VATS group). The perioperative indexes as well as postoperative inflammatory factors and immune level effects between the two groups were compared.ResultsCompared with the VATS, RATS could significantly shorten the operation time and decrease intraoperative blood loss (P<0.05). RATS also effectively reduced the increase of postoperative inflammatory factor level (P<0.05). But there was no significant difference in postoperative immune function between the RATS group and the VATS group (P>0.05).ConclusionRATS is superior to VATS in the treatment of non-small cell lung cancer in perioperative indicators and inflammatory factors.
Objective To compare lymph node sampling (LN-S) and lobe-specific lymph node dissection (L-SLD) in the clinical efficacy and safety for early-stage non-small cell lung cancer (NSCLC). Methods PubMed, Medline, EMbase, Web of Science and The Cochrane Library databases were searched up to March 2017 for English language studies. We collected randomized controlled trials (RCTs) and cohort studies (CS) which used the systematic mediastinal lymph node dissection (SMLD) and LN-S or L-SLD for the treatment of NSCLC. Direct meta-analysis was performed using RevMan 5.3 software and indirect meta-analysis with ITC software after two researchers screened the literature, extracted the data and evaluated the risk of bias independently. Results A total of 18 articles were included (4 RCTs and 14 CS, and 10 714 patients). Meta-analysis results showed that in the CS, compared with the the SMLD group, overall survival increased in the L-SLD group (HR=0.99, 95%CI 0.78 to 1.25, P=0.92), and overall survival decreased in the LN-S group with significant difference in CS (HR=1.43, 95%CI 1.17 to 1.75, P=0.000 4), but was not statistically significant in RCT (P=0.35). In terms of disease-free survival, there was no significant difference between the SMLD group and the LN-S group (HR=1.25, 95%CI 0.90, 1.62, P=0.10) as well as the L-SLD group (HR=1.15, 95%CI 0.92 to 1.43, P=0.23) in the CS. There was no significant difference in the local recurrence rate or distant metastasis rate between the non-systematic lymph node dissection (NSMLD) and SMLD in CS and RCTs (CS: P=0.43, P=0.39; RCT: P=0.43, P=0.10). There was no significant difference in the postoperative complications between NSMLD and SMLD in the CS (OR=0.79, 95%CI0.58 to 1.09, P=0.15) and RCTs (OR=0.36, 95%CI 0.09 to 1.45, P=0.15). Indirect meta-analysis showed that risk of death decreased by 31% and risk of recurrence by 35% in the L-SLD group compared with the LN-S group (HR=0.69, 95% CI 0.51 to 0.95, P=0.46; HR=0.65, 95% CI 0.65 to 1.30, P=0.72), but the difference was not statistically significant. Conclusion For early-stage NSCLC, L-SLD is not statistically different from SMLD in terms of survival; however, the overall survival of LN-S is lower than that of systematic lymphadenectomy. Indirect meta-analysis shows that L-SLD reduces the risk of death and recurrence risk compared with LN-S. There is no evidence to support both direct comparison of the prognosis of LN-S and L-SLD, therefore further prospective studies are still needed to verify.
ObjectiveTo analyze the correlation between the molecular biological information of SMARCA4-deficient non-small cell lung cancer (SMARCA4-dNSCLC) and its clinical prognosis, and to explore the spatial features and molecular mechanisms of interactions between cells in the tumor microenvironment (TME) of SMARCA4-dNSCLC. MethodsUsing data from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO), this study conducted functional enrichment analysis on differentially expressed genes (DEGs) in SMARCA4-dNSCLC and depicted its genomic variation landscape. Through weighted gene co-expression network analysis (WGCNA) and a combination of 10 different machine learning algorithms, patients in the training group were divided into a low-risk group and a high-risk group based on a median risk score (RiskScore). A corresponding prognostic prediction model was established, and on this basis, a nomogram was constructed to predict the 1, 3, and 5-year survival rates of patients. K-M survival curves, receiver operating characteristic (ROC) curves, and time-dependent ROC curves were drawn to evaluate the predictive ability of the model. External datasets from GEO further validated the prognostic value of the prediction model. In addition, we also evaluated the immunological characteristics of the TME of the prognostic model. Finally, using single-cell RNA sequencing (scRNA-seq) and spatial transcriptome (ST), we explored the spatial features of interactions between cells in the TME of SMARCA4-dNSCLC, intercellular communication, and molecular mechanisms. ResultsA total of 56 patients were included in the training group, including 38 males and 18 females, with a median age of 62 (56-70) years. There were 28 patients in both the low-risk and high-risk groups. A total of 474 patients were included in the training group, including 265 males and 209 females, with a median age of 65 (58-70) years. A risk score model composed of 8 prognostic feature genes (ELANE, FSIP2, GFI1B, GPR37, KRT81, RHOV, RP1, SPIC) was established. Compared with patients in the low-risk group, those in the high-risk group showed a more unfavorable prognostic outcome. Immunological feature analysis revealed differences in the infiltration of various immune cells between the low-risk and high-risk groups. ScRNA-seq and ST analyses found that interactions between cells were mainly through macrophage migration inhibitory factor (MIF) signaling pathways (MIF-CD74+CXCR4 and MIF-CD74+CD44) via ligand-receptor pairs, while also describing the niche interactions of the MIF signaling pathway in tissue regions. ConclusionThe 8-gene prognostic model constructed in this study has certain predictive accuracy in predicting the survival of SMARCA4-dNSCLC. Combining the ScRNA-seq and ST analyses, cell-to-cell crosstalk and spatial niche interaction may occur between cells in the TME via the MIF signaling pathway (MIF-CD74+CXCR4 and MIF-CD74+CD44).
Lung cancer is one of the most malignant common tumor worldwidely and it's the most popular cancer in China. Both the prevalence and mortality of it are higher than other cancers. And its 5-year survival rate is 15%. Non-small cell lung cancer(NSCLC) accounts for about 85% lung cancer and its pathogenesis has not been elucidated. Therefore, early prediction and detection are very important for improving the effect of treatment and prognosis. Recently, dysregulation and excessive activity of the C4.4A as a member of the LY6/uPAR family of membrane proteins has been shown to associate with multiple cancer types. And previous studies suggest that the C4.4A participates in the invasion and metastasis of NSCLC. At the same time, circumstantial evidence proves that C4.4A and liver kinase B1(LKB1) tumor suppressor gene have a negative regulatory relationship. This article will briefly summarize the recent research progresses of C4.4A in NSCLC.