Analysis of clinical characteristics and prognosis of patients with anaplastic lymphoma kinase-positive and surgically resected lung adenocarcinoma.

BACKGROUND: Recent research into lung cancer-related driver genes has identified a distinctive molecular subtype of non-small cell lung cancer (NSCLC) - anaplastic lymphoma kinase (ALK)-positive NSCLC. We evaluated the clinical features and survival rates of ALK-positive lung adenocarcinoma patients who had undergone surgery but had not received ALK inhibitor therapy, along with the characteristics of patients with distant metastases. METHODS: Clinical data of 40 patients with ALK-positive, postsurgical lung adenocarcinoma were retrospectively analyzed. Relationships between the patients' clinical characteristics, distant metastases, and their disease-free survival (DFS) and overall survival (OS) rates were assessed. RESULTS: Most patients were relatively young, never-smokers, had peripheral tumors, and the tumors were either moderately or poorly differentiated. The most common organ of distant metastases was the brain. The median time from surgery to brain metastasis was 17.2 months. The median OS following brain metastasis was 9.4 months. DFS in patients with early stage disease, peripheral tumors, no lymph node metastases, and treated with adjuvant therapy was significantly longer than for those with late stage disease (P = 0.015), central tumors (P = 0.000), lymph node metastases (P = 0.026), and not treated with adjuvant therapy (P = 0.000). Patients with early stage disease, peripheral tumors, and treated with adjuvant therapy obtained markedly longer OS than those with late stage disease (P = 0.021), central tumors (P = 0.003), and not treated with adjuvant therapy (P = 0.006). CONCLUSION: Patients with ALK-positive surgically resected lung adenocarcinoma have distinctive clinical characteristics. The brain is the most common site of extrapulmonary metastasis. Survival is associated with stage, tumor location, and the administration of adjuvant therapy.

Surgical treatment efficacy in 172 cases of tuberculosis-destroyed lungs.

OBJECTIVES: Compared to the use of anti-TB drugs for the treatment of tuberculosis (TB), surgery is destructive and is associated with higher risk. Whether surgery is needed for the treatment of TB-destroyed lungs (for short: destroyed lungs) is still controversial and unresolved in the clinic. METHODS: Retrospective analysis of treatment efficacy was performed on 172 cases of destroyed lungs (176 surgeries) in the Thoracic Surgery Department of our hospital from April 1992 to June 2010. RESULTS: A total of 83 male and 89 female patients was analyzed. The youngest patient was 7 years old, and the oldest was 72 years old, with a mean age of 38.4 years. A total of 120 cases had a preoperative cough, 31 cases had fever, and 42 cases had hemoptysis. A total of 49 cases was positive for Mycobacterium tuberculosis by sputum test before surgery, yielding a positive TB rate of 28.5% (49/172). A total of 116 patients had a destroyed left lung and 56 cases had a destroyed right lung. In all, 110 cases underwent total pneumonectomy, 37 pleuropneumonectomy, one lobectomy, 10 residual lobectomy, two total pneumonectomy and tracheoplasty, 11 cases bronchopleural fistula (BPF) repair and other surgeries, and one case underwent thoracoplasty. A total of four patients underwent thoracoplasty 30 days after surgery due to a thoracic cavity infection or empyema. The overall perioperative mortality rate was 2.9% (5/172). The surgical complication rate was 18.6% (32/172). The sputum negative conversion rate was 87.8% (43/49), and the clinical cure rate was 91.9% (158/172). CONCLUSIONS: Our findings suggested that surgical treatment efficacy in destroyed lungs was satisfactory with strict surgical indications, standard preoperative anti-TB treatment, adequate preoperative preparation, and careful intraoperative operations.

[Management of short-term complications after pneumonectomy for pulmonary tuberculosis].

OBJECTIVE: To explore the diagnosis and management of short-term complications after pneumonectomy for pulmonary tuberculosis. METHODS: The clinical data and management of short-term complications in patients with pulmonary tuberculosis after pneumonectomy were retrospectively reviewed and analyzed. RESULTS: From September 2000 to September 2010, 206 patients with pulmonary tuberculosis underwent pneumonectomy, of whom 26 experienced complications shortly after the surgery. Postoperative acute type II respiratory failure occurred in 5 within 14 months post-operation, acute respiratory distress syndrome (ARDS) in 2 within 3 months post-operation, chest hemorrhage in 7 within 20 days post-operation, empyema in 8 within 4 years post-operation, and bronchopleural fistula in 4 cases within 50 days post-operation. Of the 7 cases with chest hemorrhage, 2 were cured and 5 dead. All the 8 cases with empyema were cured. Of the patients with bronchopleural fistula, 2 were cured, 1 failed, and 1 was dead. CONCLUSIONS: Pneumonectomy for pulmonary tuberculosis carries a higher risk of developing serious complications such as chest hemorrhage, acute type II respiratory failure and bronchopleural fistula. Most complications can be managed successfully if diagnosed and treated early.

[Clinical analysis of treating 174 cases with pulmonary tuberculosis by pneumonectomy].

OBJECTIVE: To evaluate the efficacy and indication of pneumonectomy in patients with pulmonary tuberculosis. METHODS: From January 1992 to the end of 2008, 174 patients with pulmonary tuberculosis underwent pneumonectomy. According to the classification of pulmonary tuberculosis, there were tuberculous destroyed lungs (n = 106), chronic fibro-cavernous pulmonary tuberculosis (n = 27), cavernous pulmonary tuberculosis with aspergilloma (n = 5), tuberculous tracheobronchial stenosis (n = 16), pulmonary tuberculosis with encapsulated empyema (n = 5), tuberculous empyema with broncho pleural fistula (n = 4) and massive hemoptysis (n = 11). RESULTS: The surgical approaches were pneumonectomy (n = 146), pleuropneumonectomy (n = 21), chlorine pneumonectomy (n = 3), pneumonectomy with thoracoplasty (n = 1) and pneumonectomy with tracheoplasty (n = 3). The overall clinical cure rate was 93.0%, the rate of complications 11.5% and the operative mortality 2.3%. There were 3 dead cases resulting from operations in six months. CONCLUSION: Tuberculosis chemotherapy is an important modality for pulmonary tuberculosis, but surgical therapy remains essential for some patients. Pneumonectomy may increase the cure rates of severe pulmonary and multiple drug resistant tuberculosis.

[Long-term results of surgical plus chemotherapy for stage I lung adenocarcinoma].

OBJECTIVE: Observe the effect of operation plus post-operative chemotherapy for long-term results of stage I lung adenocarcinoma. METHODS: From January 1994 to January 2005, 427 patients with stage I lung adenocarcinoma underwent surgical resection therapy. The comparison of long-term survival rates was made between post-chemotherapy and surgical resection alone. RESULTS: The analyses disclosed that the stage I a 1, 3, 5 and 10-year survival rate of post-chemotherapy was 100.00%, 92.34%, 86.17% and 74.82%, respectively, while in surgical resection alone was 96.63%, 88.11%, 79.52% and 65.85%, respectively. The stage I b 1, 3, 5 and 10-year survival rate of post-chemotherapy was 96.84%, 77.99%, 69.56% and 64.36%, respectively, while in surgical resection alone was 85.65%, 67.11%, 59.56% and 53.06%, respectively. There was statistically significant difference between 1 year survival rate of stage I a patients with post-chemotherapy and those with surgical resection alone (P < 0.05); 1 year survival rate of stage I b patients with post-chemotherapy and those with surgical resection alone (P < 0.01). CONCLUSION: The operation plus post-operative chemotherapy is better than surgical resection alone in stage I a and I b. Surgical plus post-operative chemotherapy mode is indispensable for better prognosis of stage I a and I b lung adenocarcinoma.

[Impact of TNM staging and treatment mode on the prognosis of non-small cell lung cancer].

OBJECTIVE: To study the impact of TNM staging and combined treatment mode on the survival of non-small cell lung cancer (NSCLC) patients. METHODS: From January 1997 to December 2002, 987 NSCLC patients were surgically treated in this hospital. Of those, 574 received combined modality therapy (surgery + chemotherapy/radiotherapy), while 413 underwent operation alone. Their clinicopathological data were retrospectively analyzed. RESULTS: The 1-, 3-, 5-, and 10-year overall survival rates were 87.7%, 57.5%, 54.6% and 54.5%, respectively, for the whole group, which were 90.6%, 57.5%, 54.3% and 54.1% for the combined therapy group versus 83.8%, 57.6%, 55.2% and 55.2% for the group treated by surgical resection alone. The 1-year survival rate of the combined therapy group was significantly higher than that of the surgical resection alone group (90.6% vs. 83.8%) (P<0.01). With regard to the T factor, 5-year survival rate of the combined therapy group (surgery + radiotherapy) was higher than that of surgery alone group, especially in T4 cases (43.6% vs. 12.7%), with a significant difference between them (P<0. 05). As for the N factor, the 1-year survival rate of NO patients in the combined therapy group (surgery + chemotherapy/radiotherapy) was significantly higher than that of surgery alone group (94.4%, 97.9% vs. 90.0%) (P<0.05). The 1-year survival rate of N1 patients in the combined therapy group (surgery + chemotherapy or + chemotherapy and radiotherapy) was 91.7% and 100% versus 82.9% in the surgery alone group (P<0.01); The 1- and 3-year survival rates of N2 patients in the combined modality therapy group (surgery + chemotherapy) were 82.1% and 37.3%, while those of the surgery alone group were 69.4% and 26.5%, respectively, with a significant difference (P<0.05, P<0.01). All the severity of primary tumor, distance of lymph node involvement, and distant tumor metastasis significantly worsen the prognosis of the patients. CONCLUSION: The prognosis in NSCLC patients treated with combined modality therapy (surgery + chemotherapy/radiotherapy) is better than that with surgery alone. The larger the original tumor and the farther the lymph node and tumor metastases, the worse the prognosis is for NSCLC patients.

[Preoperative chemotherapy for long-term results of small cell lung cancer].

OBJECTIVE: To reveal the pre-operative chemotherapy for long-term of small cell lung cancer. METHODS: From January 1994 to January 2005, 263 patients with small cell lung cancer underwent combined therapy. The comparison of long-term survival rates was made between pre-operative chemotherapy group (n = 111) (group A) and post-operative chemotherapy (n = 96) (group B). RESULTS: The analyses disclosed that the overall 5-year survival rate was 42.16%. The 5-year survival rate of group A was 38.25% while in group B it was 46.57%. 5-year survival rate of group A for N0-1 and N2 was 40.12% and 39.22%, that for stage I, II, IIIa, IIIb, IV was 60.15%, 35.70%, 40.16%, 14.29% and 0 respectively. 5-year survival rate of group B for N0-1 and N2 was 51.91% and 42.69%, that for stage I, II, IIIa, IIIb, IV was 61.1%, 50.23%, 42.32%, 26.47% and 0 respectively. CONCLUSION: The comparison of the survival rate between patients with the pre-operative chemotherapy and those with chemotherapy post-operatively revealed trend of variation. Operation plus post-operative chemotherapy mode is indispensable for better prognosis of small cell lung cancer.