Risk factors of postoperative acute pain after thoracoscopic surgery for patients with early-stage lung adenocarcinoma / 中华胸心血管外科杂志

Objective:To improve the understanding of acute pain after thoracoscopic surgery in patients with early-stage lung adenocarcinoma, to analyze and screen out the independent risk factors that may induce acute postoperative pain. The patients' surgery experience may get improved through the corresponding timely and effective interventions.Methods:We retrospectively reviewed the clinical data of 204 patients with early-stage lung adenocarcinoma who were treated by a single medical team of our center from May 2021 to October 2021, and analyzed the assessment results of acute postoperative pain. Patients were grouped according to the general condition, past medical history, social and spiritual attributes, lesion characteristics, surgical approaches and anesthetic methods. Comparison of proportions of acute postoperative pain between the groups were made, and independent risk factors were identified.Results:A total of 84 males and 120 females were enrolled, with a mean age of(57.9±11.5)years old and a median operation time of 120(110, 145) min. No serious complication or perioperative death occurred in the whole group. Postoperative pain control failed in 76 cases(37.3%), 24 cases(11.8%) suffered from severe postoperative pain, and 33 cases(16.2%) required additional intramuscular injection of strong analgesics after surgery. Those who were younger than 60 years old, with a university degree or above, received two-incision surgery, operated for more than 2 h, received general anesthesia only, or in a state of depression, had significantly higher rates of postoperative acute pain, compared with their respective control groups( P<0.05). The independent risk factors for acute pain after thoracoscopic surgery included age( P=0.002), history of alcoholism( P=0.014), number of incisions( P=0.016), operation time( P=0.010), depression status( P=0.037) and enhanced anesthetic method( P=0.012). Conclusion:A large amount of patients with early-stage lung cancer suffered from acute pain after thoracoscopic surgery, which seriously affected their treatment experience and even quality of life. Young patients with a history of alcoholism and depression status were high-risk groups for postoperative acute pain. Applying Uniportal video-assisted thoracoscopic surgery, reducing the operation time as much as possible, and choosing enhanced analgesic anesthesia represented by epidural block combined with general anesthesia might be effective ways to reduce the probability of acute postoperative pain.

A comprehensive overview of RET fusion lung caner’s characters, diagnosis and treatment / 中华胸心血管外科杂志

The RET(REarranged during transfection) gene as a novel has broken the therapeutic deadlock in the last two years, whith is attributed to the rapid approval of targeted therapies and inclusion in treatment guidelines, bringing more hope for the survival of patients with non-small cell lung cancer(NSCLC). Usually, the main activation of the RET proto-oncogene contributes to the development of lung cancer via somatic rearrangements. Thus, this study reviews the biological characteristics of RET gene, the classification of RET fusion in lung cancer and the detection of RET fusion. Meanwhile the pathological and clinical features, targeted therapies, drug resistance, prognosis of lung cancer patients with RET fusion were further discussed.

Preliminary experience of neoadjuvant immunochemotherapy in resectable non-small cell lung cancer / 中华胸心血管外科杂志

Objective:The study aimed was to explore the safety and efficacy of neoadjuvant immunochemotherapy for non-small cell lung cancer (NSCLC).Methods:We retrospectively collected data of all patients who received neoadjuvant immunochemotherapy and chemotherapy for NSCLC followed by surgery in our unit between January 2019 to September 2021.Results:Forty-four patients were diagnosed with NSCLC in a stageⅠ(2 cases), ⅡA(7 cases), ⅡB(11 cases), ⅢA (15 cases), ⅢB (1 case). The average age was 63 years old(range 44-71 years old). Squamous cell carcinoma accounted for 65.91% of all patients. Central lung cancer accounted for the vast majority, with 39 patients (88.64%). There were 19 cases in the neoadjuvant immunochemotherapy group and 25 cases in the neoadjuvant chemotherapy group; the average interval between the end of neoadjuvant therapy and the day of operation was 34 days, including( 33.74±10.66 )days in the immunochemotherapy group and (33.88±11.9) days in the chemotherapy group, and there was no significant difference between the two groups. No grade 3 or more adverse events occurred in all patients. There were 13 cases (63.16%) reached PR (partial response)+ CR (complete response) according to the Response Evaluation Criteria in Solid Tumors (RECIST v. 1.1) in the neoadjuvant immunity group and 11 cases (44.00%) in the neoadjuvant chemotherapy group. There was no significant difference between the two groups. In the neoadjuvant immunochemotherapy group, 9 cases (47.37%) achieved down-staging, In the neoadjuvant chemotherapy group, 8 cases (32.00%) achieved down-staging, there was no significant difference between the two groups. Seven patients (36.84%) in neoadjuvant immunochemotherapy group showed pCR (pathologic complete remission), but there were no patients who reached pCR in the neoadjuvant chemotherapy group., the difference was statistically significant ( P=0.001). Four patients (21.05%) in the neoadjuvant immunochemotherapy group reached mPR (major pathologic response), 6 patients (24.00%) in the neoadjuvant chemotherapy group reached mPR, and the difference was no statistically significant( P= 0.817). Conclusion:The safety of neoadjuvant immunochemotherapy was satisfactory; Compared with neoadjuvant chemotherapy, neoadjuvant immunochemotherapy did not increase the preoperative grade 3 adverse events and prolong the waiting time before operation; neoadjuvant immunochemotherapy had obvious advantages in pCR, which provided the possibility for the cure of tumor.

Different preoperative examinations could be considered for small lung adenocarcinoma with different CT findings / 中华胸心血管外科杂志

Objective:To analyze the law of distant metastasis in patients with small lung adenocarcinoma with different CT findings, and to explore the feasibility of different preoperative examination methods for small lung adenocarcinoma with different imaging characteristics.Methods:Clinicopathological data of cT1a-cN0 lung adenocarcinoma patients admitted to the respiratory center of China-Japan Hospital from January 2017 to December 2018 were retrospectively collected. A total number of 785 patients were included, including 289 males and 496 females. SPSS 22.0 was used for statistical analysis.Results:A total number of 785 patients were included in this study, including 287 pure ground-glass nodule (GGN) patients, 111 GGN predominant patients, 221 solid predominant patients and 166 solid nodule patients. Among the included patients, 8 had distant metastasis, including 6 with bone metastasis, 1 with brain metastasis and 1 with brain and adrenal metastasis. No distant metastasis was observed in the patients with pure GGN and GGN predominant nodule, while 1 solid predominant patients had distant metastasis, and 7 patients with solid nodules had distant metastasis. The probability of distant metastasis was 0.5% for the solid predominant patients and 4.2% for the solid nodule patients. Univariate analysis results showed that CEA level ( P=0.030), the largest diameter of the lung window tumor ( P=0.003), the largest diameter of the solid component of the lung window tumor ( P<0.001), the largest area of the lung window tumor ( P=0.002), mediastinal window tumor maximum area ( P<0.001), CTR ( P<0.001), TDR ( P<0.001), and pleural indentation sign ( P=0.037) were risk factors for distant metastases. Multivariate analysis showed that CEA ( OR=1.019, 95% CI: 1.002-1.037, P=0.028) and TDR ( OR=0.000, 95% CI: 0.000-0.310, P=0.001) were independent risk factors of distant metastasis. Conclusion:For patients with pure GGN and GGN predominant nodule, preoperative examination could not be required, but for pure solid nodules, it is necessary to perform relevant preoperative examination including skull MRI before surgery to exclude distant metastasis.

The predictive value of stair climbing test combined with arterial blood gas analysis on postoperative complications in lung cancer patients with limited pulmonary function / 中华胸心血管外科杂志

Objective:To evaluate the predictive value of stair climbing test combined with arterial blood gas analysis on postoperative complications in lung cancer patients with limited pulmonary function.Methods:A total of 1 231 hospitalized lung cancer patients with limited pulmonary function dating from August 2012 to August 2020 were retrospectively reviewed. Included in the cohort were 766 of patients who underwent stair climbing test(SCT) preoperatively and completed data collection. Patients were grouped according to their general condition, past medical history, surgical approach, pulmonary function test(PFT) and SCT results. Comparison of the postoperative cardiopulmonary complication rates were made between different groups, and independent risk factors were identified.Results:A total of 182 cardiopulmonary-related complications occurred in 144 cases, accounting for 18.8% of the entire cohort. Perioperative mortality rate was 0.9%(7/766). The rate of postoperative cardiopulmonary complications was significantly different between the groups stratified by gender, age, smoking index, PFT index(FEV1%, DLCO%), SCT results(height achieved, speed, changes in heart rate and oxygen saturation of the arteries before and after the test), ASA score, surgical approach(VATS/Open), resection range(Lobectomy/Sublobectomy), anesthetic duration, blood loss volume, etc. Logistic regression analysis showed that only height achieved( P<0.001), changes in heart rate( P<0.001), changes in oxygen saturation of the arteries( P=0.001), resection range( P=0.006) and anesthetic duration( P=0.025) were independent risk factors for cardiopulmonary-related complications in lung cancer patients with limited pulmonary function. Conclusion:The stair climbing test combined with arterial blood gas analysis could be used as a preoperative screening method for lung cancer patients with limited lung function and may have a predictive value for postoperative cardiopulmonary-related complications.

Predictive value of radiological features on spread through air spaces in stage cⅠA lung adenocarcinoma with predominant ground-glass opacity / 中国胸心血管外科临床杂志

@#Objective    To investigate the predictive value of preoperative radiological features on spread through air spaces (STAS) in stage cⅠA lung adenocarcinoma with predominant ground-glass opacity, and to provide a basis for the selection of surgical methods for these patients. Methods    The clinical data of 768 patients with stage cⅠA lung adenocarcinoma undergoing operation in our hospital from 2017 to 2018 were reviewed, and 333 early stage lung adenocarcinoma patients with predominant ground-glass opacity were selected. There were 92 males and 241 females, with an average age of 57.0±10.0 years. Statistical analysis was performed using SPSS 22.0. Results    STAS-positive patients were mostly invasive adenocarcinoma (P=0.037), and had more micropapillary component (P<0.001) and more  epidermal growth factor receptor (EGFR) gene mutations (P=0.020). There were no statistically significant differences between the STAS-positive and STAS-negative patients in other clinicopathological features. Univariate analysis showed that the maximum diameter of tumor in lung window (P=0.029), roundness (P=0.035), maximum diameter of solid tumor component in lung window (P<0.001), consolidation/tumor ratio (CTR, P<0.001), maximum area of the tumor in mediastinum window (P=0.001), tumor disappearance ratio (TDR, P<0.001), average CT value (P=0.001) and lobulation sign (P=0.038) were risk factors for STAS positive. Multivariate logistic regression analysis showed that the CTR was an independent predictor of STAS (OR=1.05, 95%CI 1.02 to 1.07, P<0.001), and the area under the receiver operating characteristic (ROC) curve was 0.71 (95%CI 0.58 to 0.85, P=0.002). When the cutoff value was 19%, the sensitivity of predicting STAS was 66.7%, and the specificity was 75.2%. Conclusion    CTR is a good radiological feature to predict the occurrence of STAS in early lung adenocarcinoma with predominant ground-glass opacity. For the stage cⅠA lung adenocarcinoma with predominant ground-glass opacity and CTR ≥19%, the possibility of STAS positive is greater, and sublobar resection needs to be carefully considered.

Clinical Recommendations for Perioperative Immunotherapy-induced Adverse Events in Patients with Non-small Cell Lung Cancer / 中国肺癌杂志

BACKGROUND@#Perioperative treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancelation of surgery, additional illness, and even death, and have therefore attracted much attention. The purpose of the clinical recommendations is to form a diagnosis and treatment plan suitable for the current domestic medical situation for the immune-related adverse event (irAE).@*METHODS@#This recommendation is composed of experts in thoracic surgery, oncologists, thoracic medicine and irAE related departments (gastroenterology, respirology, cardiology, infectious medicine, hematology, endocrinology, rheumatology, neurology, dermatology, emergency section) to jointly complete the formulation. Experts make full reference to the irAE guidelines, large-scale clinical research data published by thoracic surgery, and the clinical experience of domestic doctors and publicly published cases, and repeated discussions in multiple disciplines to form this recommendation for perioperative irAE.@*RESULTS@#This clinical recommendation covers the whole process of prevention, evaluation, examination, treatment and monitoring related to irAE, so as to guide the clinical work comprehensively and effectively.@*CONCLUSIONS@#Perioperative irAE management is an important part of immune perioperative treatment of lung cancer. With the continuous development of immune perioperative treatment, more research is needed in the future to optimize the diagnosis and treatment of perioperative irAE.

The 5-year survival rate of 11 958 postoperative non-small cell lung cancer patients in stage Ⅰ-ⅢA by two different follow-up patterns: A multi-center, real-world study / 中国胸心血管外科临床杂志

@#Objective    To compare the 5-year survival rates between two different follow-up patterns of postoperative stage Ⅰ-ⅢA non-small cell lung cancer (NSCLC) patients. Methods    Pathological stage Ⅰ-ⅢA NSCLC 11 958 patients who underwent surgical resection and received follow-up within 6 months after initial diagnosis through telephone follow-up system were included in nine hospitals from July 2014 to July 2020. The patients were divided into two groups including a proactive follow-up group (n=3 825) and a passive follow-up group (n=8 133) according to the way of following-up. There were 6 939 males and 5 019 females aged 59.8±9.5 years. The Kaplan-Meier and Cox proportional hazards regression model were used. Results    The median follow-up frequency was 8.0 times in the proactive follow-up group and 7.0 times in the passive follow-up group. The median call duration was 3.77 minutes in the proactive follow-up group and 3.58 minutes in the passive follow-up group. The 5-year survival rate was 81.8% and 74.2% (HR=0.60, 95CI 0.53-0.67, P<0.001) in the proactive follow-up group and the passive follow-up group, respectively. Multivariate analysis showed that follow-up pattern, age, gender and operation mode were independent prognostic factors, and the results were consistent in all subgroups stratified by clinical stages. Conclusion    The proactive follow-up leads to better overall survival for resected stage Ⅰ-ⅢA NSCLC patients, especially in the stage ⅢA.

Analysis of mediastinal lymph node metastasis of stage cT1a-cN0M0 lung adenocarcinoma / 中国胸心血管外科临床杂志

@#Objective    To investigate the mediastinal lymph node metastasis of cT1a-cN0M0 lung adenocarcinoma, so as to provide a theoretical basis for intraoperative lymph node dissection in patients with early stage lung adenocarcinoma. Methods    Clinicopathological features of lung adenocarcinoma patients who received operation in our hospital from 2017 to 2018 were collected. A total of 667 patients including 241 male and 426 female patients at age of 59 (16, 87) years were included. There were 234 patients with pure ground glass nodules, 98 patients with ground glass-predominant tumor, 199 patients with consolidation-predominant tumor and 136 patinets with solid tumor in the study. Postoperative N1 lymph node metastasis occurred in 30 patients and N2 lymph node metastasis occurred in 52 patients. Results    The result of univariate analysis showed that male (P=0.014), higher carcino-embryonic antigen levels (P<0.001), larger nodal diameter (P<0.001), larger consolidation tumor ratio (P<0.001), smaller tumor disappearance ratio (P<0.001), solid nodules (P<0.001), cavitary sign (P=0.005), lobulation sign (P=0.002), spicule sign (P=0.003), pleural indentation sign (P=0.001), bronchus sign (P=0.025) were risk factors for mediastinal lymph node metastasis. In terms of pathology, the N2 positive group had larger size of pathological tissue (P<0.001), more N1 lymph node metastasis (P<0.001), higher pathology T stage (P<0.001), more spread through air space (P=0.001), more pleural invasion (P<0.001), and more lymphovascular invasion (P<0.001). Multivariate analysis showed that lymphovascular invasion (OR=6.9, 95%CI 2.3-20.7, P=0.001), larger consolidation tumor ratio (OR=109.6, 95%CI 3.8-3 124.3, P=0.006), cavitary sign (OR=3.1, 95%CI 1.1-8.3, P=0.028) and N1 lymph node metastasis (OR=15.7, 95%CI 6.7-36.4, P<0.001) were independent risk factors for mediastinal lymph node metastasis. Conclusion    For lung adenocarcinoma, mediastinal lymph node metastasis will not occur in ground glass nodule and ground glass-predominant tumor patients. The probability of mediastinal lymph node metastasis increases with the increase of solid components and presence of cavitary sign. Therefore, different types of lymph node resection can be considered for patients with different imaging findings.

Impact of interstitial lung disease on postoperative morbidity and 60 day mortality after pulmonary resection for lung cancer / 中华胸心血管外科杂志

Objective:To evaluate the effect of interstitial lung disease(ILD) on postoperative morbidity and mortality in pulmonary resection for lung cancer patients.Methods:We retrospectively analyzed 971 patients undergoing pulmonary operation from January 2010 to January 2018 in our hospital. Clinical data including age, sex, history of chronic obstructive pulmonary disease(COPD), smoking history, smoking index, American Society of Anesthesiologists(ASA) classification, forced expiratory volume in 1 s(FEV1) % predict, surgical procedure, video assisted thoracoscopic surgery(VATS) or not, intraoperative blood transfusion, anesthesia time, operation time/one-lung ventilation time, blood loss, histology, postoperative morbidity, 60-days mortality, onset of acute exacerbation of interstitial lung disease(AE-ILD), drainage, extubation time, and postoperative stay were collected and analyzed.Results:There were 80(8.2%) and 891(91.8%) patients in ILD and non-ILD group, respectively. AE-ILD occurred in 5 patients, with a 60-day mortality of 80%. A multivariate regression analysis identified that the sex( P=0.023), ILD( P=0.001), COPD( P=0.027) were independent risk factors for postoperative morbidity. ILD( P=0.023) and postoperative morbidity( P=0.001) were independent risk factors for 60-day mortality in multivariate analysis. Conclusion:Patients with ILD had a higher incidence of postoperative morbidity and 60-day mortality. Based on the obvious postoperative morbidity and mortality, special attention and management should be taken in ILD patients.

Establishment and Verification of A Novel Predictive Model of Malignancy for Non-solid Pulmonary Nodules / 中国肺癌杂志

BACKGROUND@#Mathematical predictive model is an effective method for preliminarily identifying the malignant pulmonary nodules. As the epidemiological trend of lung cancer changes, the detection rate of ground-glass-opacity (GGO) like early stage lung cancer is increasing rapidly, timely and proper clinical management can effectively improve the patients' prognosis. Our study aims to establish a novel predictive model of malignancy for non-solid pulmonary nodules, which would provide an objective evidence for invasive procedure and avoid unnecessary operation and the consequences.@*METHODS@#We retrospectively analyzed the basic demographics, serum tumor markers and imaging features of 362 cases of non-solid pulmonary nodule from January 2013 to April 2018. All nodules received biopsy or surgical resection, and got pathological diagnosis. Cases were randomly divided into two groups. The modeling group was used for univariate analysis and logistic regression to determine independent risk factors and establish the predictive model. Data of the validation group was used to validate the predictive value and make a comparison with other models.@*RESULTS@#Of the 362 cases with non-solid pulmonary nodule, 313 (86.5%) cases were diagnosed as AAH/AIS, MIA or invasive adenocarcinoma, 49 cases were diagnosed as benign lesions. Age, serum tumor markers CEA and Cyfra21-1, consolidation tumor ratio value, lobulation and calcification were identified as independent risk factors. The AUC value of the ROC curve was 0.894, the predictive sensitivity and specificity were 87.6%, 69.7%, the positive and negative predictive value were 94.8%, 46.9%. The validated predictive value is significantly better than that of the VA, Brock and GMUFH models.@*CONCLUSIONS@#Proved with high predictive sensitivity and positive predictive value, this novel model could help enable preliminarily screening of "high-risk" non-solid pulmonary nodules before biopsy or surgical excision, and minimize unnecessary invasive procedure. This model achieved preferable predictive value, might have great potential for clinical application.

Analysis of endobronchial ultrasound-guided transbronchial needle aspiration's efficiency in the early diagnosis of non-central small cell lung cancer / 中华胸心血管外科杂志

Objective To evaluate the value of endobronchial ultrasound-guided transbronchial needle aspiration in the early diagnosis of non-central small cell lung cancer.Methods 141 patients wereselected from July 1999 to June 2017,who were diagnosed with small cell lung cancer (stage N2 and N3).They were divided into two groups according to the approach of obtaining histopathological tissuefor diagnosis.49 cases in the experimental group were obtained by EBUS-TBNA,92 cases in the control group were done by video assisted thoracic surgery (40 cases,43.5％),mediastinoscopy (1 case,1.1％),and open procedure (51 case,55.4％).Survival outcome,time of waiting for the treatment and lengthof stay were analyzed.Results There werel09 males,32 females,the range of age is from 16 to 79 years old [(56.21 ± 11.48) years].62 lesions located in the upper lobe,12 in the middle lobe,56 in the lower lobe,11 in the middle-lower/-upper lobes.Considering the T stage,there are 7 cases of T1,61 cases of T2,45 cases of T3,and 26cases of T4,2 patients with Tx stage.Compared with conventional approach,EBUS-TBNA saved 10.78 days from admission to the time of receiving treatment [(4.62 ± 0.66)days vs.(15.40 ± 1.61) days,P ＜ 0.05],and saved 18.13 days of length of stay [(5.30 ± 0.76) days vs.(23.43 ± 2.44) days,P ＜0.05].5-year survival rate was 31.0％ for traditional group and 27.5％ for EBUS-TBNA group,there was no significant difference between two groups(P =0.308).Conclusion EBUS-TBNA couldsave the waiting days from admission to the time of receiving treatment,and also shorten the total length of stay.EBUS-TBNA was more efficient than conventional approaches (VATS,mediastinoscopy or open procedure) for diagnosing non-central small cell lung cancer with enlarged mediastinal lymph nodes.

Research progress on correlation between CT features of pulmonary ground glass opacity and histopathology of lung adenocarcinoma / 中华胸心血管外科杂志

With the widespread use of multi-slice spiral computed tomography(CT) and the increasing level of diagnosis and treatment,the incidence of pulmonary ground glass opacity(GGO) is increasing.The etiology of GGO is complex and the pathological types are diverse.In addition to benign lesions,GGO can be a specific type of lung adenocarcinoma or its invasive lesions.Some scholars think it is closely related to early lung adenocarcinoma.Histopathology of lung cancer is crucial for the prognosis and treatment of lung cancer.However,under normal circumstances,the pathology of the patient can be known by surgery,bronchoscopy or puncture.However,many patients may not have the pathological conditions for obtaining the pathological specimen.CT as the primary method of diagnosis of lung adenocarcinoma,lung adenocarcinoma in the new classification,based on the lung GGO CT findings to determine its ability to provide a characteristic indicator of tumor histopathology in order to help GGO diagnosis and guidance of clinical treatment.

Surgical Procedures and Perioperative Management for Non-small Cell Lung Cancer Complicated with Left Atrial Tumor Thrombus / 中国肺癌杂志

BACKGROUND@#Non-small cell lung cancer with left atrial tumor thrombus accounts for a small proportion of local advanced lung cancer. Whether surgery could bring benefits, as well as surgical options are still controversial, and have always been hot spots in surgical research. We report a single center experience of surgical treatment to non-small cell lung cancer with left atrial tumor thrombus, aim to figure out more reasonable treatment strategy.@*METHODS@#From August 2006 to July 2017, a total of 11 cases of non-small cell lung cancer with left atrial tumor thrombus underwent surgery in Thoracic Surgery Department of China-Japan Friendship Hospital. Clinical data, treatment options, pathological types and prognosis of these patients were collected to perform a retrospective study.@*RESULTS@#Of the 11 patients (mean age of 57.9), 7 were men and 4 were women. Six of them received neoadjuvant radiotherapy and/or chemotherapy. All patients underwent smooth operation, including 3 cases with cardiopulmonary bypass, 1 case of posterolateral approach under extracorporeal membrane oxygenation, 6 cases of conventional posterolateral approach and 1 case of video-assisted minithoracotomy. Nine patients were evaluated as R0 resection while 2 cases were evaluated as R1 resection. The Surgeries cost an average of 292 min (210 min-380 min), with an average of 436 mL (100 mL-1,600 mL) blood loss. One patient (9.1%) died within 90 days after surgery, and another 4 cases (36.4%) suffered postoperative complications such as arrhythmia, cerebral infarction or hypoxemia. Six cases of squamous cell carcinoma, 4 cases of adenocarcinoma and 1 case of sarcomatoid carcinoma were identified by pathology. Seven cases were staged as pT4N0M0 while 4 cases were staged as pT4N1M0. Nine patients underwent adjuvant chemotherapy, and two patients underwent radiotherapy during follow-up. The overall follow-up time was 2 to 53 months, the 3-year disease-free survival rate was 30.7%, the median disease-free survival time was 31 months, the 3-year overall survival rate was 49.1% and the median overall survival time was 33 months.@*CONCLUSIONS@#For selected patients of non-small cell lung cancer complicated with left atrial tumor thrombus, choose a reasonable surgical approach to resect both the tumor and the thrombus, strengthen the perioperative management and apply neoadjuvant/adjuvant radiotherapy and/or chemotherapy, might obtain satisfying prognosis.

Impact of Chronic Obstructive Pulmonary Disease on Risk of Recurrence in Patients with Resected Non-small Cell Lung Cancer / 中国肺癌杂志

BACKGROUND@#Lung cancer and chronic obstructive pulmonary disease (COPD) are both common diseases in respiratory system and the leading causes of deaths worldwide. The purpose of this study was to determine whether the severity of COPD affects long-term survival in non-small cell lung cancer (NSCLC) patients after surgical resection.@*METHODS@#A retrospective research was performed on 421 consecutive patients who had undergone lobectomy for NSCLC. Classification of COPD severity was based on guidelines of the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Characteristics among the three subgroups were compared and recurrence-free survivals were analyzed.@*RESULTS@#A total of 172 patients were diagnosed with COPD, 124 as mild (GOLD-1), 46 as moderate(GOLD-2), and 2 as severe (GOLD-3). The frequencies of recurrence were significantly higher in higher COPD grades group (P<0.001). Recurrence-free survival at five years were 78.1%, 70.4%, and 46.4% in Non-COPD, GOLD-1 COPD, and GOLD-2/3 COPD groups, respectively (P<0.001). In univariate analysis, age, gender, smoking history, COPD severity, tumor size, histology and pathological stage were associated with recurrence-free survival. Multivariate analyses showed that older age, male, GOLD-2/3 COPD, and advanced stage were independent risk factors associated with recurrence-free survival.@*CONCLUSIONS@#NSCLC patients with COPD are at higher risk for postoperative recurrence, and moderate/severe COPD is an independent unfavorable prognostic factor. The severity of COPD based on pulmonary function test can be a useful indicator to identify patients at high risk for recurrence. Therefore, it can contribute to adequate selection of the appropriate individualized treatment.

The regularity and clinical significance of intrapulmonary lobar and segmental lymph nodes metastasis in patients with cT1N0M0 stage lung adenocarcinoma / 中华胸心血管外科杂志

Objective To investigate the regularity of intrapulnonary lobar and segmental lymph nodes metastasis in patients with cT1N0M0 stage lung adenocarcinoma.To provide a basis for more accurate determination of N stage and indication for pulmonary segmental resection.Methods A prospective study was performed from March 2014 to December 2015.103 cases of cT1 N0M0 stage lung adenocarcinoma received lobectomy and mediastinal lymph node dissection in the thoracic surgery department of China-Japan Friendship Hospital.Intrapulmonary lobar and segmental lymph nodes were dissected and sorted carefully then sent to the pathological department with the corresponding lung specimen and other lymph nodes.Statistical analysis was carried out considering size of the lesion,imaging features,serum CEA levels,pathological subtypes and so on.Results In total 103 cases,pN0 was confirmed in 82 cases,pN1 in 15 cases,pN1 + N2 in 5 cases,and skipping-pN2 in 1 case.14 cases(93.3％) in pN1 group were detected with station 12-14 lymph node metastasis,while only 5 cases (33.3％) were detected with station 12-14 LSNs metastasis.4 cases(66.7％) in pN2 group were detected with station 12-14 lymph node metastasis,while only 1 case(16.7％) with station 13 and station 7 lymph node metastasis.If LSNs were not detected,the false negative rate of N staging could be as high as 6.1％ (5/82),The rate of missed diagnosis of lymph node metastasis might be 30％ (6/20) to N1 stations alone.41.2％ (7/17)cases with metastasis to the adjacent LSNs had been proved with metastasis to the isolated LSNs.The metastasis rate of the isolated LSNs was significantly lower(P =0.049) in pure GGNs compared with those part-solid/solid nodules.Invasive adenocarcinoma had higher metastasis rate of isolated LSNs,compared with preinvasive lesions or minimally invasive adenocarcinomas,with no statistical difference between groups (P =0.055).No significant difference in isolated LSNs metastasis rate was found between groups with different serum CEA levels(P =0.251) or tumor size(P =0.197).Conclusion Dissection of intrapulmonary lobar and segmental lymph nodes might facilitate a more accurate N stage,reduce the false negative rate of lymph node metastasis,and provide basis for more accurate assessment of prognosis and postoperative adjuvant treatment.The sampling area of lymph nodes during segmental resection should include the adjacent LSNs of the target segment.The isolated LSNs metastasis rate of cT1N0M0 stage lung adenocarcinoma with pureGGN as imaging feature is relative low,which might be suitable for segmentectomy when meeting other criteria.

The prognostic impact of preoperative PET-CT on postoperative recurrence for completely resected stage I non-small cell lung cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the prognostic impact of preoperative (18)F-fluorodeoxyglucose (FDG) PET-CT on postoperative recurrence in patients with completely resected stage I non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>The clinic data of 182 patients with stage I NSCLC who underwent (18)F-FDG PET-CT scan before surgical resection between June 2005 and June 2012 were reviewed retrospectively. There were 121 male and 61 female patients, with an average age of 68 years (range from 34 to 85 years). The pathological stage was I A in 98 patients, I B in 84 patients; the histology were adenocarcinoma in 137 patients, squamous cell carcinoma in 35 patients, and others in 10 patients. Clinicopathological factors including gender, age, smoking history, SUV(max), surgical procedure, pathological features and adjuvant chemotherapy were evaluated to identify the independent factors predicting postoperative recurrences by univariate and multivariate analysis. The survivals were calculated by the Kaplan-Meier method and differences in variables were analyzed by the Log-rank test.</p><p><b>RESULTS</b>The postoperative recurrence rate was 15.9%. The univariate analysis identified that the SUV(max) (t=3.278, P<0.001), p-stage (χ² =5.204, P=0.026), blood vessel invasion (χ² =5.333, P=0.027) and visceral pleural invasion (χ² =7.697, P=0.009) are factors for predicting postoperative recurrence. Only SUV(max) was found to be a significant independent factor according to multivariate analysis (HR=1.068, 95%CI: 1.015 to 1.123, P=0.001). The study population was stratified into three groups by SUV(max), patients with SUV(max) > 5.0 had significantly higher risk of recurrence (23.9%) than those with 2.5 < SUV(max) ≤ 5.0 (15.0%) and SUV(max) ≤ 2.5 (7.3%) (P=0.043); patients with SUV(max) ≤ 2.5 had significantly better 5-year recurrence-free survival rate (90.9%) than those with 2.5 < SUV(max) ≤ 5.0 (82.7%) and SUV(max) ≤ 2.5 (71.0%) (P=0.030). There was a trend toward higher probability of blood vessel invasion (χ² =20.267, P < 0.001), visceral pleural invasion (χ² =6.185, P=0.045) and pathological stage I B (χ² =13.589, P=0.001) with increased SUV(max).</p><p><b>CONCLUSIONS</b>Preoperative SUV(max) of primary tumor is a predictor of postoperative relapse for stage I NSCLC after surgical resection. Therefore, it can contribute to the risk stratification for patients with the same pathological stage and selecting the optimal postoperative follow-up and therapeutic strategy.</p>

Surgical therapeutic strategy for non-small cell lung cancer with mediastinal lymph node metastasis (N2) / 中国肺癌杂志

<p><b>BACKGROUND AND OBJECTIVE</b>Approximately 30% of patients who are diagnosed with non-small cell lung cancer (NSCLC) are classified as N2 on the basis of metastasis to the mediastinal lymph nodes. The effectiveness of surgery for these patients remains controversial. Although surgeries in recent years are proved to be effective to some extent, yet due to many reasons, 5-year survival rate after surgery varies greatly from patient to patient. Thus it is necessary to select patients who have a high probability of being be cured through an operation, who are suitable to receive surgery and the best surgical methods so as to figure out the conditions under which surgical treatment can be chosen and the factors that may influence prognosis.</p><p><b>METHODS</b>165 out of 173 patients with N2 NSCLC were treated with surgery in our department from January 1999 to May 2003, among whom 130 were male, 43 female and the sex ratio was 3:1, average age 53, ranging from 29 to 79. The database covers the patients' complete medical history including the information of their age, sex, location and size of tumor, date of operation, surgical methods, histologic diagnosis, clinical stage, post-operative TNM stage, neoadjuvant treatment and chemoradiotherapy. The methods of clinical stage verification include chest X-ray, chest CT, PET, mediastinoscopy, bronchoscope (+?), brain CT or MRI, abdominal B ultrasound (or CT), and bone ECT. The pathological classification was based on the international standard for lung cancer (UICC 1997). Survival time was analyzed from the operation date to May 2008 with the aid of SPSS (Statistical Package for the Social Sciences) program. Kaplan-Meier survival analysis, Log-rank test and Cox multiplicity were adopted respectively to obtain patients' survival curve, survival rate and the impact possible factors may have on their survival rate.</p><p><b>RESULTS</b>The median survival time was 22 months, with 3-year survival rate reaching 28.1% and 5-year survival rate reaching 19.0%. Age, sex, different histological classification and postoperative chemoradiotherapy seem to have no correlation with 5-year survival rate. In all N2 subtypes, 5-year survival rate is remarkably higher for unexpected N2 discovered at thoractomy and proven N2 stage before preoperative work-up and receive a mediastinal down-staging after induction therapy (P < 0.01), reaching 30.4% and 27.3% respectively. 5-year survival rate for single station lymph node metastasis were 27.8%, much higher compared with 9.3% for multiple stations (P < 0.001). Induction therapy which downstages proven N2 in 73.3% patients gains them the opportunity of surgery. The 5-year survival rate were 23.6% and 13.0% for patients who had complete resection and those who had incomplete resection (P < 0.001). Patients who underwent lobectomy (23.2%) have higher survival rate, less incidence rate of complication and mortality rate, compared with pneumonectomy (14.8%) (P < 0.01). T4 patients has a 5-year survival rate as low as 11.1%, much less than T1 (31.5%) and T2 (24.3%) patients (P = 0.01). It is noted through Cox analysis that completeness of resection, number of positive lymph node stations and primary T status have significant correlativity with 5-year survival rate.</p><p><b>CONCLUSION</b>It is suggested that surgery (lobectomy preferentially) is the best solution for T1 and T2 with primary tumor have not invaded pleura or the distance to carina of trachea no less than 2 cm, unexpected N2 discovered at thoractomy when a complete resection can be applied, and proven N2 discovered during preoperative work-up and is down-staged after induction therapy. Surgical treatment is the best option, lobectomy should be prioritized in operational methods since ise rate of complication and morality are lower than that of pneumonectomy. Patients' survival time will not benefit from surgery if they are with lymph nodes metastasis of multiple stations (Bulky N2 included) and T4 which can be partially removed. Neoadjuvant chemotherapy increases long-term survival rate of those with N2 proven prior to surgery. However, postoperative radiotherapy decreases local recurrence rate but does not contribute to patients' long-term survival rate.</p>

Tracheal carinal reconstruction and bronchovasculoplasty in central type bronchogenic carcinoma / 中国肺癌杂志

<p><b>BACKGROUND AND OBJECTIVE</b>Because radical resection for lung cancer invading the initial borderline of different lobes and carina is difficult, we tried to analyse the variables of successful tracheal carinoplasty and bronchovasculoplasty to discover a proper approach for appropriate early and long-term results.</p><p><b>METHODS</b>Of 1 399 lung resections for primary lung cancer performed in our hospital from April 1985 to December 2006, 133 underwent bronchoplastic surgeries, including 15 carinoplasty cases and 118 sleeve lobectomy (SL) cases, and 118 pneumoectomy (PN) cases were compared at the same time.</p><p><b>RESULTS</b>Complications occurred in 18 cases, with no operative related mortality. For all patients, the 1 year, 3 year, and 5 year survival rates were 79.8%, 56.7% and 31.2%, respectively. The 5 year survival rate by cancer stage was 69.2% for Ib, 40.6% for IIb, 19.6% for IIIa, and 16.6% for IIIa (N2).</p><p><b>CONCLUSION</b>Selection of cases, clearance of lymph nodes, disposal of the bronchus and pulmonary vessel and replacement or restoration of the superior vena cava are the main factors influencing prognosis.</p>

Sequential bilateral lobar transplantation A case report / 中国组织工程研究

BACKGROUND: Lung transplantation can improve quality of life of patients who get terminal pulmonary disease and also it can help to get better survival.Now it has become one of the best therapeutic methods for terminal pulmonary disease.However,limited donors leave the development of lung transplantation in dilemma.The emergence of living lobar transplantation and cadeveric lobar transplantation let this procedure much easier.OBJECTIVE: To evaluate the clinical probability of bilateral lobar transplantation.METHODS: Sequential bilateral lobar transplantation was performed for one 26 years old cystic fibrosis female.Cardiac pulmonary bypass was used during operation.Anti-rejection(Tacrolimus,mycophenolate,etc)and anti-infection was used postoperatively.RESULTS AND CONCLUSION: The recovery course postoperatively was smooth,and the recipient got out of hospital 7weeks later.Bilateral lobar transplantation could offer satisfied short-term pulmonary function.The long term results should be further evaluated.