Nurses' knowledge of universal health coverage for inclusive and sustainable elderly care services / Conhecimento dos enfermeiros sobre a cobertura universal de saúde para serviços inclusivos e sustentáveis de cuidados a idosos / El conocimiento de las enfermeras sobre la cobertura universal de salud en servicios inclusivos y sostenibles para el cuidado de adultos mayores

Objectives: to explore nurses' knowledge of universal health coverage (UHC) for inclusive and sustainable development of elderly care services. Method: this was a cross-sectional survey. A convenience sample of 326 currently practicing enrolled nurses (EN) or registered nurses (RN) was recruited. Respondents completed a questionnaire which was based on the implementation strategies advocated by the WHO Global Forum for Governmental Chief Nursing Officers and Midwives (GCNOMs). Questions covered the government initiative, healthcare financing policy, human resources policy, and the respondents' perception of importance and contribution of nurses in achieving UHC in elderly care services. Results: the knowledge of nurses about UHC in elderly care services was fairly satisfactory. Nurses in both clinical practice and management perceived themselves as having more contribution and importance than those in education. They were relatively indifferent to healthcare policy and politics. Conclusion: the survey uncovered a considerable knowledge gap in nurses' knowledge of UHC in elderly care services, and shed light on the need for nurses to be more attuned to healthcare policy. The educational curriculum for nurses should be strengthened to include studies in public policy and advocacy. Nurses can make a difference through their participation in the development and implementation of UHC in healthcare services.

Objetivos: explorar o conhecimento dos enfermeiros sobre a cobertura universal de saúde (CUS) para o desenvolvimento inclusivo e sustentável de serviços de saúde a idosos. Método: estudo transversal. Foi recrutada uma amostra de conveniência de 326 enrolled nurses (EN) ou registered nurses (RN). Os entrevistados responderam a um questionário com base nas estratégias de implementação preconizadas pelo Fórum Global da OMS para Governmental Chief Nursing Officers and Midwives (GCNOMs). As perguntas abordavam iniciativas do governo, políticas de financiamento da saúde, políticas de recursos humanos e percepção dos entrevistados sobre a importância e contribuição do enfermeiro no alcance da CUS em serviços de cuidados a idosos. Resultado: o conhecimento de enfermeiros sobre a CUS em serviço de atenção ao idoso foi razoavelmente satisfatório. Enfermeiros tanto da prática clínica como da gestão perceberam-se contribuindo mais e tendo mais importância do que aqueles que trabalham na educação. Eles eram relativamente indiferentes à política de saúde e à política. Conclusão: a pesquisa revelou uma lacuna de conhecimento considerável no conhecimento da CUS pelos enfermeiros nos serviços de cuidados a idosos e evidenciou a necessidade de enfermeiros terem mais sintonia com a política de saúde. O currículo de formação para preparar os enfermeiros deve ser reforçado para incluir estudos em política pública e advocacia. Os enfermeiros podem fazer a diferença por meio de sua participação no desenvolvimento e implementação da CUS nos serviços de saúde.

Objetivos: explorar los conocimientos que tienen las enfermeras sobre la cobertura universal de salud (CUS) para el desarrollo inclusivo y sostenible de servicios para el cuidado de adultos mayores. Método: se utilizó una encuesta transversal. Se formó una muestra de conveniencia de 326 enrolled nurses (EN) o registered nurses (RN) que actualmente estuvieran ejerciendo. Los encuestados respondieron a un cuestionario basado en las estrategias de implementación apoyadas por el WHO Global Forum for Government Chief Nursing and Midwifery Officers (WGFGCNO). Las preguntas abarcaban la iniciativa del gobierno, políticas de financiamiento de la salud, las políticas de recursos humanos y la percepción de los encuestados sobre la importancia y la contribución de las enfermeras en el logro de la CUS en los servicios de cuidado para adultos mayores. Resultados: el conocimiento de las enfermeras sobre CUS en el servicio de cuidado para los adultos mayores fue bastante satisfactorio. Tanto las enfermeras de práctica clínica y como las de gestión perciben tener un mayor aporte e importancia que las de que están en educación. Tenían un punto de vista relativamente indiferente a la política sanitaria y la política. Conclusión: la encuesta descubrió una considerable brecha en el conocimiento de las enfermeras sobre CUS en los servicios de cuidado para adultos mayores y puso de manifiesto la necesidad de que las enfermeras estén más en sintonía con la política sanitaria. El plan de estudios para la preparación de las enfermeras debe fortalecerse para incluir estudios en las políticas públicas y promoción. Las enfermeras pueden hacer una diferencia a través de su participación en el desarrollo e implementación de CUS en los servicios de salud.

Expression of RRM1 and RRM2 as a novel prognostic marker in advanced non-small cell lung cancer receiving chemotherapy.

The aim of this study was to examine the prognostic value of BRCA1, RRM1, and RRM2 in patients with non-small cell lung cancer (NSCLC) who received adjuvant chemotherapy. A total of 418 patients who underwent curative pulmonary resection were obtained between January 2007 and November 2009. The relative cDNA quantification for BRCA1, RRM1, and RRM2 was conducted using a fluorescence-based, real-time detection method, and ß-actin was used as a reference gene. The low expression of RRM1 and RRM2 significantly increased the platinum-based chemotherapy response (For RRM1: odds ratio (OR) = 2.09, 95% confidence interval (CI) = 1.38-3.18; For RRM2: OR = 1.64, 95% CI = 1.09-2.48). The univariate analysis indicated that low expression of RRM1 attained a longer time to progression and overall survival time, with HR (95% CI) of 0.50 (0.33-0.77) and 0.60 (0.39-0.92), respectively. Similarly, low expression of RRM2 had a longer time to progression and overall survival, with HR (95% CI) of 0.57 (0.38-0.86) and 0.47 (0.31-0.71), respectively. In conclusion, low expression of RRM1 and RRM2 could be used to predict the treatment response to platinum-based chemotherapy and survival in NSCLC. The RRM1 and RRM2 could substantially contribute to the future design of individualized cancer treatment in NSCLC patients.

[The clinical application of videomediastinoscopy combined with the examination of CD(4)/CD(8) in the diagnosis of mediastinal tuberculosis and sarcoidosis].

OBJECTIVE: To evaluate the role of videomediastinoscopy combined with the examination of CD(4)/CD(8) in the diagnosis of tuberculosis and sarcoidosis of the mediastinum. METHODS: The clinical records of 90 patients who underwent videomediastinoscopy from February 2003 to September 2005 were retrospectively reviewed. The expression of CD(4)/CD(8) was studied using immunohistochemical method in the tissues from 57 cases with a diagnosis of tuberculosis or sarcoidosis and noncaseating granuloma without classical "sarcoid" pathology obtained by videomediastinoscopy. RESULTS: Sarcoidosis was diagnosed in 37 patients, tuberculosis in 14 patients, lymphoma in 15 patients, nodal metastasis in 18 patients, noncaseating granuloma without classical "sarcoid" in 6 patients. The diagnostic accuracy was 93.3% (84/90). The expression of CD(4) and CD(8) in sarcoidosis was (65 +/- 13)% and (9.4 +/- 2.6)%, respectively. While the expression of CD(4) and CD(8) in tuberculosis was (41 +/- 11)% and (11.8 +/- 3.4)%, respectively. The rate of CD(4)/CD(8) in sarcoidosis was higher than that in tuberculosis (7.3 +/- 1.8 and 3.6 +/- 1.1, respectively, t = 1.883, P = 0.000). The accuracy, specificity and sensitivity for diagnosis of sarcoidosis was 90.2%, 85.7% and 91.9%, respectively, if the cutoff value of CD(4)/CD(8) was 5. No complication or mortality was reported. CONCLUSION: Videomediastinoscopy is an effective procedure for the diagnosis of mediastinal diseases. The examination of CD(4)/CD(8) adds more information to the differentiation of tuberculosis from sarcoidosis.

[Clinical therapeutic effect of esophageal carcinoma with hand video assisted surgery].

OBJECTIVE: To explore the clinical therapeutic effect of esophageal carcinoma with hand video assisted surgery. METHODS: Forty cases which C TNM stage was T3N1M0 received hand video assisted surgery (HVATS group), 40 cases received routine operation (control group). Recurrence survival analysis of each group was analyzed with SPSS10.0 software according to the date of the stage and survival rate. RESULTS: All group have satisfied surgical result. All patients have good quality of life. The 3 year survival rate was 52.7% in HVATS group and 51.3% in control group. The difference of survival rate was no significance. CONCLUSION: Hand video assisted surgery for esophageal carcinoma had same result as routine thoracic operation. Short operation time, less trauma and fast recovery are the advantages of hand video assisted surgery.

[A prospective longitudinal study examining the impact on short term quality of life of hand video-assisted thoracoscopic surgical esophagectomy in patients with esophageal cancer].

OBJECTIVE: To evaluate the impact of hand video-assisted thoracoscopic surgery (HVATS) and Ivor-Lewis surgery on short term quality of life (QL) of patients with esophageal cancer. METHODS: Thirty-nine consecutive patients with esophageal cancer were classified into HVATS group (n = 21) and Ivor-Lewis group (n = 18) randomly, all patients completed the Chinese versions of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 and QLQ-OES18 before treatment and at regular intervals until 6 months after operation. MEAN scores were calculated for every patient. RESULTS: Baseline functional and symptom QL MEAN scores were similar in both groups. All patients reported worse functional, symptom and global QL scores (QOL) within 6 months after operation than before. HVATS group gained higher functional, global QL scores and lower symptom scores than Ivor-Lewis group, moreover, patients' QL scores of HVATS group returned to preoperative levels more quickly than those patients in Ivor-Lewis group. Significant differences were found in global health (QOL), physical functioning, fatigue and pain scales between groups. In both groups, QLQ-OES18 dysphagia scales were improved after surgery,but no significant differences were found at scales respect to esophageal cancer. CONCLUSIONS: HVATS esophagectomy is a safe procedure which has a low disturbance to patients' short term Quality of Life compared with Ivor-Lewis esophagectomy. It might seem reasonable to choose HVATS esophagectomy for patients with early stage esophageal cancer.

18F-FDG uptake as a biologic factor predicting outcome in patients with resected non-small-cell lung cancer.

BACKGROUND: The outcome of surgical treatment of non-small-cell lung cancer (NSCLC) remains poor. In many patients the biological behavior of NSCLC does not follow a definite pattern, and can not be accurately predicted before treatment. (18)F-fluoro-2-deoxy-glucose ((18)F-FDG) uptake on positron-emission tomography (PET) is associated with the aggressiveness of NSCLC. The present study focused on the role of (18)F-FDG uptake in predicting the outcome of surgically treated patients with NSCLC. METHODS: A retrospective analysis was made of 82 patients who underwent complete resection and preoperative FDG PET. The maximum standardized uptake value (SUV(max)), in addition to five clinicopathological factors and three biomolecular factors, which could possibly influence survival, was compared for possible association with patients' recurrence and survival, by the Log-rank test in univariate analysis and the Cox proportional hazards model in multivariate analysis. The association between SUV(max) and other factors was also analyzed. RESULTS: Patients with SUV(max) more than 11 had a disease-free survival and overall survival shorter than patients with SUV(max) less than 11 in univariate analyses (P < 0.001, P = 0.002). In the multivariate analysis, SUV(max) (dichotomized by 11) was the only significant predictor for tumor recurrence. TNM stage and SUV(max) (dichotomized by 11) were independent predictors for the overall survival. Associations of SUV(max) with p53 overexpression, proliferating cell nuclear antigen (PCNA) labeling index and microvascular density of the tumor were significant in the entire group. CONCLUSIONS: (18)F-FDG uptake on PET may be used to noninvasively assess biological aggressiveness of NSCLC in vivo, identifying the surgically-treated patients with poor prognosis who could benefit from additional therapy.

[The value of dual time point 11C-choline PET-CT in differentiating malignant from benign lesion of mediastinum].

OBJECTIVE: To evaluate the value of dual time point 11C-choline PET-CT in differentiating malignant from benign lesions of mediastinum. METHODS: Thirty-five patients with mediastinal diseases, including 8 non-small cell lung cancer or highly suspected lung cancer patients with mediastinal lymphadenectasis, were subject to CT, dual time point PET-CT and videomediastinoscopy within four weeks. 11C-choline was used as PET tracers to visualize various masses. The imaging protocol included the first PET scanning 5-10 min after the-injection of 370 MBq 11C-choline and then a second PET scanning 25-30 min later. The PET data were evaluated using the standardized uptake value (SUV) and the difference between the two point (DeltaSUV). Then the results were analyzed in accordance with the pathologic data. RESULTS: Eleven of the 35 patients with mediastinal diseases were diagnosed as with sarcoidosis, 6 with tuberculosis, 5 with lymphoma, 11 with nodal metastasis (8 had their modes from the lung and the primary lesions of the other 3 failed to be identified), and 2 with lung cancer with reactive hyperplasia lymph node. The SUV of the delayed images of the 16 malignant lesions was 6.48 (3.0-11.2), higher than that of the early images [6.17 (3.2-9.8)] with a DeltaSUV of 0.31 (-0.4-1.4). The value of SUV of delayed images of the 19 benign lesions was 4.99 (2.2-9.3), lower than that of early images [5.11 (2.9-8.3)] with a DeltaSUV of -0.12 (-0.9-1.0). The DeltaSUV of the benign lesions was significantly lower than that of the malignant lesions (F = 1.939, P = 0.04). The accuracy rates of diagnosis of mediastinal masses of CT, first-time PET-CT, dual time point PET-CT, and videomediastinoscopy were 54.3% (19/35), 74.3% (26/35), 82.9% (29/35), and 100% (35/35) respectively. Conclusion With a high diagnostic yield, videomediastinoscopy remains the gold standard in differentiation of malignant and benign lesions located in the middle mediastinum. Dual time point PET-CT may improve the accuracy.

[Clinical value of videomediastinoscopy in diagnosis of mediastinal disease].

OBJECTIVE: To evaluate the role of videomediastinoscopy in the diagnosis of disease of the mediastinum. METHODS: We retrospectively reviewed the clinical records of the 115 patients who underwent videomediastinoscopy. Local anesthesia or general anesthesia was employed. This operation consisted of cervical videomediastinoscopy in 102 patients, parasternal videomediastinoscopy in 13 patients, ninety-one patients had videomediastinoscopy for diagnosis of isolated mediastinal mass or lymphadenopathy, 25 patients with non small cell lung cancer or suspected lung cancer showed enlarged mediastinal lymph nodes radiographically in the chest. RESULTS: Among the patients with mediastinal disease, sarcoidosis was diagnosed in 37 patients, tuberculosis in 14 patients, lymphoma in 15 patients, nodal metastasis in 18 patients, noncaseating granulomata without classical "sarcoid" in 6 patients, with the accuracy of 93.3% (84/90); and staging of lung cancer in 25 patients, with the accuracy of 100% (25/25). The total accuracy of videomediastinoscoy and CT was 94.8% (109/115), 56.5% (65/115), respectively. Mean operative time was 26 min. There was neither complication nor mortality. CONCLUSION: videomediastinoscopy is a safe and effective procedure for the diagnosis of mediastinal disease and the staging of lung cancer.

[Resection for lung cancer invading the superior vena cava].

OBJECTIVE: To analyze the feasibility and the value of resection for lung cancer invading the superior vena cava (SVC). METHODS: Between 1988 and 2005 the data of 31 patients who underwent resection were analyzed retrospectively. The reconstruction was done using simple suture, pericardial patch or prosthetic replacement. Postoperative morbidity, long-term survival were examined using the Kaplan-Meier method (Log rank test) and the COX model for survival. RESULTS: Seventeen squamous cell carcinomas, 8 adenocarcinomas, and 6 undifferentiated small cell carcinomas were resected. There were 13 partial SVC resection, the reconstruction was done using a simple running in 5 patients, and a pericardial patch in 8 patients. Eighteen patients underwent complete resection of SVC with prosthetic replacement. The time of clamping the SVC system was from 8 to 35 minutes for complete resection patients, while the time was from 3 to 15 minutes for partial resection patients. One patient didn't clamp the SVC. Postoperative morbidity and mortality were 48% and 0%, respectively. One, 3 and 5-year survival rates were 61%, 33% and 21%, respectively, with median survival at 31 months. Survival rate of patients with N2 disease was obviously lower than those with localized (N0/N1) nodal disease (chi2 = 14.3, P = 0.000), the median survival was 42 and 13 months respectively. There were no significant effects on overall survival with pathologic features and surgery methods. Survival rate of patients with induction chemotherapy before operation or intraoperative chemotherapy was higher than those received direct surgery (chi2 = 5.0, P = 0.025), the median survival was 39 and 14 months respectively. CONCLUSIONS: The resection of the SVC for involvement by lung cancer can be performed in selected patients, especially for those with localized (N0/N1) nodal disease. Induction chemotherapy should be performed.

The role of 11C-choline positron emission tomography-computed tomography and videomediastinoscopy in the evaluation of diseases of middle mediastinum.

BACKGROUND: Middle mediastinal masses comprise a wide variety of tumors but may also reflect lymphadenopathy, and thus remain an interesting diagnostic challenge. We performed positron emission tomography (PET) of mediastinal masses in order to evaluate the ability of PET to predict the malignancy of these tumors. We compared histologic findings, videomediastinoscopy, computed tomography (CT), and PET-CT in patients with mediastinal disease. METHODS: Thirty-two patients were evaluated with CT, PET-CT and videomediastionoscopy, and all studies were performed within four weeks in each patient. (11)C-choline as a PET tracer was used to visualize masses. PET data were evaluated using the standardized uptake value (SUV) and were compared with pathologic data. RESULTS: There were 13 men and 19 women aged from 21 to 74 (mean 45.2) years. Among the patients with mediastinal diseases, sarcoidosis was diagnosed in 12 patients, tuberculosis in 5 patients, lymphoma in 5 patients, and noncaseating granulomata without classical "sarcoid" finding in 3 patients. N2 or N3 nodal metastasis was revealed in 6 of 7 patients who had non-small cell lung cancer or suspected lung cancer, and one was negative (the pathological diagnosis was reactive hyperplasia). The accuracies for correctly diagnosing mediastinal masses for CT, PET-CT and videomediastinoscopy were 38% (12/32), 63% (20/32), and 91% (29/32) respectively. The diagnostic accuracy of videomediastinoscopy was superior to that of PET-CT (chi(2) = 11.130, P < 0.001). The SUVs were similar among these diseases. On the other hand, if the diagnostic classification was benign vs malignancy, the accuracies for CT, PET-CT and videomediastinoscopy were 53% (17/32), 75% (24/32), 100% (32/32) respectively. The diagnostic accuracy of videomediastinoscopy was superior to that of PET-CT (chi(2) = 22.042, P < 0.001). The SUV of malignant lesions (6.9, 3.2 - 9.8; n = 11) appeared to be higher than that of benign lesions (4.9, 2.9 - 8.3; n = 21), however, this difference was not statistically significant (P = 0.054). CONCLUSIONS: To diagnose lesions located in the middle mediastinum, videomediastinoscopy possesses the highest diagnostic accuracy, and therefore remains the gold standard. PET-CT is valuable for differential diagnosis of benign vs malignant lesions, CT alone or PET alone (SUV) may provide misdiagnosis in a substantial proportion of patients with mediastinal masses.

[Hand-assisted video-thoracoscopy for resection of esophageal cancer].

OBJECTIVE: To explore the feasibility and advantages of hand-assisted video-thoracoscopy for resection of esophageal cancer. METHODS: Forty-five patients with esophageal cancer received hand-assisted video-thoracoscopic esophagectomy (group I). 45 patients underwent esophagectomy through routine open thoracotomy during the same period as control (group II). The data of lymph node resection, operating time and blood loss were compared. RESULTS: There were no operative mortality in 2 groups. In group I, the number of dissected paraesophageal lymph nodes, cardiac lymph nodes and left gastric nodes were (3.6 +/- 1.0), (1.3 +/- 1.1) and (4.3 +/- 1.4), respectively. While for group II the dissected lymph nodes were (3.3 +/- 1.5), (1.6 +/- 1.1) and (4.7 +/- 2.1), respectively. There was no significant difference between two groups (P > 0.05). However, the number of dissected mediastinal nodes was (6.6 +/- 3.7) for group I and (3.8 +/- 2.5) for group II (chi(2) = 2.95, P < 0.05). The mean operating time was (29 +/- 5) minutes for group I and (60 +/- 6) minutes for group II. The mean blood loss was (93 +/- 19) ml for group I and (145 +/- 35) ml for group II. The mean chest tube drainage was (201 +/- 45) ml for group I and (295 +/- 57) ml for group II in the first postoperative day. The difference in above parameters between 2 groups was significant (chi(2) = 18.69, 6.13, 6.08, P < 0.001). CONCLUSIONS: It is suggested that hand-assisted video-thoracoscopic esophagectomy is a safer, minimal invasive procedure in the resection of esophagus carcinoma.

[The clinical significance of vascular endothelial growth factor and intercellular adhesion molecule-1 expression in non-small cell lung cancer].

OBJECTIVE: To investigate the expression of vascular endothelial growth factor (VEGF) and intercellular adhesion molecule-1 (ICAM-1), and their relationship to behaviors of the non-small-cell lung cancer. METHODS: The study included 86 patients with non-small-cell lung cancer. A rapid immunohistochemical method (streptoavidin-peroxidase, SP) was used to detect VEGF and ICAM-1 expression. All patients were treated surgically and without preoperative radio- or chemotherapy. RESULTS: The positive expression of VEGF was significantly correlated with the lymph node metastasis, TNM stage, prognosis and hematogenous tumor metastasis positively, but ICAM-1 was negatively. For patients with positive expression of VEGF and negative expression of ICAM-1, the 5-year survival rate was the lowest in all patients. CONCLUSIONS: The expression of VEGF and ICAM-1 correlates with the malignant behavior of non-small-cell lung cancer. Examination of VEGF and ICAM-1 in non-small-cell lung cancer may help to evaluate its intensity of lymph node metastasis, TNM stage and prognosis. VEGF and ICAM-1 may play an important role in the development and metastasis of non-small-cell lung cancer.

[Predictive value of drug resistance-related genes expression in neoadjuvant chemotherapy in patients with non-small cell lung cancer of stage III].

BACKGROUND & OBJECTIVE: P-glycoprotein (P-gp), multidrug resistance-associated protein (MRP), and lung resistant protein (LRP) play important roles in multidrug resistance (MDR). This study was to determine P-gp, MRP, and LRP expression in patients with non-small cell lung cancer (NSCLC) of stage III, and evaluate their predictive value in neoadjuvant chemotherapy. METHODS: Immunohistochemical analyses were performed on 31 patients with NSCLC of stage III before, and after neoadjuvant chemotherapy. RESULTS: The frequency of P-gp, MRP, and LRP expression were 29.0% (9/31), 45.2% (14/31), and 38.7% (12/31) before chemotherapy, and were 61.3% (19/31), 51.6% (16/31), and 41.9% (13/31) after chemotherapy. Of 31 patients, 10 (10/31, 32.3%) expressed both MRP and LRP before chemotherapy, which indicated significant positive correlation between MRP and LRP expression (r=0.061, P< 0.001). In patients with P-gp, MRP, or LRP expression before chemotherapy, the response rates towards chemotherapy were 44.4% (4/9), 28.6% (4/14), and 16.7% (2/12). Of 10 patients with both MRP and LRP expression, only 1 (1/10, 10.0%) responded to chemotherapy. The median survival time of patients who responded to chemotherapy was 31 months, while that of patients who did not responded to chemotherapy was 15 months, that of patients who didn't receive neoadjuvant chemotherapy before surgery was 18 months. CONCLUSION: Patients with both MRP and LRP expression are probably resistant to chemotherapy, the value of neoadjuvant chemotherapy is limit in such patients.

[The effect of postoperative chemotherapy after esophagectomy on the survival rate to patients with original squamous cell carcinoma of esophagus].

OBJECTIVE: To study the prognostic factors affecting the survival rate after extended radical esophagectomy with three-field lymph node dissection for squamous cell carcinoma and the effect of postoperative chemotherapy. METHODS: Out of 126 patients with original squamous cell carcinoma of esophagus who accepted extended radical esophagectomy with three-field lymph node dissection from 1987 - 1992 in a hospital, 97 of them were included in this study. Data on the clinical/pathological characters and post surgery survival records of the subjects' were collected. Survival analysis methods included Kaplan-Meier, Log-rank test and Cox multivariable model and the effects of postoperative chemotherapy were analyzed for patients in early and late stages. RESULTS: There was no significant difference in clinical and pathological character between those patients only undergone surgery and patients accepting postoperative chemotherapy. The size of tumor, grade of differentiation of the tumor cells, infiltration deepness, with or without lymph node metastasis, expression of nm23 and EGFR and treatment after surgery etc. were correlated with the survival rate. For patients in early tumor stage, postoperative chemotherapy with cisplatin and 5-FU after surgery seemed to be a risk factor. For patients in late stage, postoperative chemotherapy with cisplatin and 5-FU after surgery did not seem to improve survival rate. CONCLUSION: It is imperative to study on the effect of adjuvant postoperative chemotherapy to patients, especially those at early stage with squamous cell carcinoma of esophagus. Doctors must be scrupulous when making decisions.

[A study of correlation between early postoperative relapse with lymph node micrometastasis in patients with N0 esophageal cancer].

OBJECTIVE: To explore the correlation between early postoperative tumor relapse with lymph node micrometastasis in the patients with pN(0) esophageal cancer. METHODS: Using reverse transcriptase-polymerase chain reaction (RT-PCR), one hundred and sixty-six regional lymph nodes obtained from forty-three patients with esophagus cancer without invasion of the tumor confirmed by histopathologic analysis (pN(0)) were studied for further detecting mRNA of Mucin1 (MUC1) gene and determining nodal micrometastasis. All the patients underwent radical resection and regional lymph node dissection. Patients were followed up for one year to detect early tumor relapse. Difference in relapse was compared by chi(2) test. RESULTS: MUC1 mRNA expression was identified for twenty-six lymph nodes (15.7%), in eighteen patients (42%) who were diagnosed as having nodal micrometastasis. TNM staging for these patients was up-regulated from stages I-II(A) to stages II(B)-III. Relapse disease was found in nine patients with lymph nodes micrometastasis and three patients without nodal micrometastasis (P < 0.05). CONCLUSION: Early tumor relapse after radical surgery in the patients with pN(0) esophageal cancer might be correlated with nodal micrometastasis.

Lymph node occult micrometastasis in patients with non-small cell lung carcinoma: genetic diagnosis and its impact on prognosis.

BACKGROUND & OBJECTIVE: Occult micrometastasis to mediastinal lymph node, which could not be detected by routinely histopathologic examination, might be correlated with the prognosis of patients with non-small cell lung carcinoma (NSCLC). The aim of this stud y was to diagnose occult micrometastasis of mediastinal lymph node in NSCLC patients and evaluate its prognostic significance. METHODS: Using reverse transcription-polymerase chain reaction (RT-PCR), 242 stations of mediastinal lymph nodes, which were free of tumor determined by histopathologic examination(pN0), from 58 patients were examined for MUC1 gene mRNA and to diagnose occult micrometastasis. All the patients were followed-up for three years. The survival rate was calculated by Kaplan-Meier method and the survival was compared with log-rank test between the patients with and without occult nodal micrometastasis. RESULTS: The MUC1 gene mRNA was identified in 23 stations of lymph nodes from 16 patients, and nodal occult micrometastasis was diagnosed in the 27.6% of the patients. TNM staging for these patients was up-regulated from stageI(A)-II(B) to stage III(A). The 3-year survival rate in the patients with nodal occult micrometastasis (43.7%) was lower than that in the patients without nodal occult micrometastasis (73.8%) (P< 0.05). CONCLUSION: The expression of MUC1 gene mRNA in mediastinal lymph node is associated with poor prognosis of NSCLC patients with pN0 disease, suggesting that it may be an indicator of poor prognosis.