Outcomes and Prognostic Factors of Salvage Radiation for Postoperative Lymph Node Recurrence of Esophageal Squamous Cell Carcinoma.

Purpose: Recurrence of esophageal squamous cell carcinoma (ESCC) in regional lymph nodes (LNs) after surgical section can be treated with salvage resection, radiotherapy (RT) or chemoradiotherapy (CRT). RT or CRT is more widely used in clinic. This paper investigates the effects, toxicities and prognostic risk factors of salvage RT or CRT on patients with LN recurrence. Methods: We retrospectively analyzed the clinical outcomes of 103 patients receiving salvage RT or CRT for LN recurrence after ESCC resection. In total, 39 patients received RT alone and 64 received concurrent CRT. All the patients received intensity modulated radiation therapy (IMRT), administered with a median dose of 62 Gy (range, 50-70 Gy). Results: The median follow-up time was 44.5 months, and median survival was 22.5 months (5.5-99.5 months). One-, 3-, and 5-year overall survival (OS) were 80.6, 37.0, and 25.8%, respectively. One- and 2-year progression free survival (PFS) were 57.3 and 34.0%, respectively. Grade 3 or above toxicity was low (16.5%) and no treatment-related deaths occurred. In univariate analysis of OS, pN0 (p = 0.039), smaller LN volume (≤25 cm3, p = 0.019), combined chemotherapy (p = 0.041) and single LN recurrence (p = 0.001) were associated with prolonged OS. And pT1-2 (p = 0.044), pN0 (p = 0.042), irradiation dose (>60 Gy, p = 0.044), combined chemotherapy (p = 0.019) and single LN recurrence (p = 0.002) were associated with prolonged PFS. In multivariate analysis, the patients with only one recurrent node had a significant better OS (HR = 0.556, 95% CI 0.324-0.956, p = 0.034) and PFS (HR = 0.528, 95% CI 0.339-0.847, p = 0.008). Conclusions: Salvage RT or CRT for regional LN recurrence is effective and acceptable. Fewer recurrent nodes may indicate a better long-term survival.

Exosome-mediated transfer of miR-1260b promotes cell invasion through Wnt/ß-catenin signaling pathway in lung adenocarcinoma.

Increasing evidence confirms that exosome-mediated transfer of microRNAs can influence cancer progression including tumor cell invasion, cell proliferation, and drug resistance via cell-cell communication. However, the potential role of exosomal-miR-1260b in lung adenocarcinoma (LAC) remains poorly understood. Thus, this study focused on investigating the function of exosomal-miR-1260b on cell invasion. Exosomal-miR-1260b was found to be higher in plasma of patients with LAC than that of healthy persons via quantitative real-time polymerase chain reaction assay. The sensitivity and specificity of exosomal-miR-1260b (cutoff point: 2.027) were 72% and 86%, and area under the curve of 0.845 (95% CI = 0.772-0.922). Elevated expression of miR-1260b in LAC tissues was positively correlated with exosomal-miR-1260b in plasma (r = .642, p < .05). Furthermore, ceramide biosynthesis regulated exosomal-miR-1260b secretion. Exosome-mediated transfer of miR-1260b promoted A549 cell invasion and was still functional inside A549 cells. Moreover, exosomal-miR-1260b regulated Wnt/ß-catenin signaling pathway by inhibiting sFRP1 and Smad4. This study identified a new regulation mechanism involving in cell invasion by exosome-mediated tumor-cell-to-tumor-cell communication. Targeting exosome-microRNAs may provide new insights into the diagnosis and treatment of LAC.

Clinicopathologic predictors of metastasis of different regional lymph nodes in patients intraoperatively diagnosed with stage-I non-small cell lung cancer.

BACKGROUND: Selection of the best lymph node for dissection is a controversial topic in clinical stage-I non-small cell lung cancer (NSCLC). Here, we sought to identify the clinicopathologic predictors of regional lymph node metastasis in patients intraoperatively diagnosed with stage-I NSCLC. METHODS: A retrospective review of 595 patients intraoperatively diagnosed as stage I non-small-cell lung cancer who underwent lobectomy with complete lymph node dissection was performed. Univariate and multivariable logistic regression analysis was performed to determine the independent predictors of regional lymph node metastasis. RESULTS: Univariate logistic regression and multivariable analysis revealed three independent predictors of the presence of metastatic hilar lymph nodes, five independent predictors for lobe specific mediastinal lymph nodes, two independent predictors for lobe nonspecific mediastinal lymph nodes and two independent predictors for skipping mediastinal lymph nodes. CONCLUSIONS: A complete mediastinal lymph node dissection may be considered for patients suspected of nerve invasion and albumin (> 43.1 g/L) or nerve and vascular invasions. Lobe-specific lymph node dissection should probably be performed for patients suspected of pulmonary membrane invasion, vascular invasion, CEA (> 2.21 ng/mL), and tumor (> 1.6 cm) in the right lower lobe or mixed lobes. Hilar lymph node dissection should probably be performed for patients suspected of having bronchial mucosa and cartilage invasion, vascular invasion, and CEA (> 2.21 ng/mL).

A prediction model for lymph node metastases using pathologic features in patients intraoperatively diagnosed as stage I non-small cell lung cancer.

BACKGROUND: There is little information on which pattern should be chosen to perform lymph node dissection for stage I non-small-cell lung cancer. This study aimed to develop a model for predicting lymph node metastasis using pathologic features of patients intraoperatively diagnosed as stage I non-small-cell lung cancer. METHODS: We collected pathology data from 284 patients intraoperatively diagnosed as stage I non-small-cell lung cancer who underwent lobectomy with complete lymph node dissection from 2013 through 2014, assessing various factors for an association with metastasis to lymph nodes (age, gender, pathology, tumour location, tumour differentiation, tumour size, pleural invasion, bronchus invasion, multicentric invasion and angiolymphatic invasion). After analysing these variables, we developed a multivariable logistic model to estimate risk of metastasis to lymph nodes. RESULTS: Univariate logistic regression identified tumour size >2.65 cm (p < 0.001), tumour differentiation (p < 0.001), pleural invasion (p = 0.034) and bronchus invasion (p < 0.001) to be risk factors significantly associated with the presence of metastatic lymph nodes. On multivariable analysis, only tumour size >2.65 cm (p < 0.001), tumour differentiation (p = 0.006) and bronchus invasion (p = 0.017) were independent predictors for lymph node metastasis. We developed a model based on these three pathologic factors that determined that the risk of metastasis ranged from 3% to 44% for patients intraoperatively diagnosed as stage I non-small-cell lung cancer. By applying the model, we found that the values y > 0.80, 0.43 < y ≤ 0.80, y ≤ 0.43 plus tumour size >2 cm and y ≤0.43 plus tumour size ≤2 cm yielded positive lymph node metastasis predictive values of 44%, 18%, 14% and 0%, respectively. CONCLUSIONS: A non-invasive prediction model including tumour size, tumour differentiation and bronchus invasion may be useful to give thoracic surgeons recommendations on lymph node dissection for patients intraoperatively diagnosed as Stage I non-small cell lung cancer.

[Clinical effect of off-pump epicardial microwave ablation of atrial fibrillation].

OBJECTIVE: To apply the off-pump epicardial microwave ablation (MW) to treat the permanent atrial fibrillation (PAF) and evaluate the clinical effect. METHODS: From April 2003 to April 2005, a total of 46 patients with PAF underwent off-pump epicardial MW, including the patients with mitral valve disease (28 cases), mitral and aortic valve disease (5 cases), coronary artery disease (8 cases) and lone PAF (5 cases). FLEX 10 probe was placed around four pulmonary orifices and the access orifice of the inferior vena cava to tricuspid annulus. The microwave application was set 65 W, 90 s and a continuous ablation line was finished encircling the pulmonary veins. Subsequently, patients underwent either off-pump coronary artery bypass graft or valve surgery on-pump. Mean left atrial diameter was (52.5 +/- 15.3) mm, LVEF 42% - 70% before operation. All patients were followed up in the discharge, 3, 6, 12 months after surgery by standard 12-lead ECG, 24 h Holter, UCG and clinical examination. RESULTS: All procedures were completed successful on the off-pump cardiac surgery and 46 patients were converted sinus rhythm when the operations were performed. Mean ablation time was (37.7 +/- 7.8) min, without any related complications. At discharge, 3, 6 and 12 months follow-up, 63.0%, 66.7%, 72.7% and 80.6% of the patients kept sinus rhythm and left atrial diameter of < 50 mm. CONCLUSIONS: Using MW, electrical isolation of the pulmonary veins can be achieved epicardially without cardiopulmonary bypass support. Off-pump epicardial microwave ablation is an efficient option with an excellent benefit/risk ratio for the treatment of PAF with or without other cardio-surgical disease.

[Clinical efficacy of endoscopic epicardial microwave ablation for isolated atrial fibrillation].

OBJECTIVE: To assess the efficacy of endoscopic epicardial microwave ablation, a new completely endoscopic technique, for isolated atrial fibrillation (AF). METHODS: From July to October of 2004, 5 patients with isolated permanent AF underwent this procedure. We performed epicardial microwave ablation using FLEX10 probe under the guide of VasoView 5 endoscope. The probe was placed around left and right pulmonary vein orifices, the microwave application was set 65 W/90 s, and a continuous ablation line was obtained encircling the pulmonary veins. Echocardiography and electrocardiography were carried out in all patients before and after operation. RESULTS: Five patients received electrical conversion after ablation. Average ablation time was 35.0 min and average procedure time was 2.5 h without any procedure-related complications. At the 3-month, 6-month and 12-month follow-up, 4 patients (80%) were in sinus rhythm, associated with a reduced left atrial diameter and an improved cardiac function. CONCLUSION: Endoscopic epicardial microwave ablation for isolated atrial fibrillation appears to be safe and effective.