Three-Field Versus Two-Field Lymphadenectomy in Minimally Invasive Esophagectomy: 3-Year Survival Outcomes of a Randomized Trial.

BACKGROUND: Minimally invasive esophagectomy (MIE) has been used widely for the treatment of esophageal cancer. However, the optimal extent of lymphadenectomy for esophagectomy in MIE remains unclear. This trial aimed to investigate the 3-year survival and recurrence outcomes in a randomized controlled trial comparing MIE with either three-field lymphadenectomy (3-FL) or two-field lymphadenectomy (2-FL). METHODS: Between June 2016 and May 2019, 76 patients with resectable thoracic esophageal cancer were enrolled in a single-center randomized controlled trial and randomly assigned to MIE that included either 3-FL or 2-FL at a 1:1 ratio (n = 38 patients each). The survival outcomes and recurrence patterns were compared between the two groups. RESULTS: The 3-year cumulative overall survival (OS) probability was 68.2 % (95 % confidence interval [CI], 52.72-83.68 %) for the 3-FL group and 68.6 % (95 % CI, 53.12-84.08 %) for the 2-FL group. The 3-year cumulative probability of disease-free survival (DFS) was 66.3 % (95 % CI, 50.03-82.57 %) for the 3-FL group and 67.1 % (95 % CI, 51.03-83.17 %) for the 2-FL group.. The OS and DFS differences in the two groups were comparable. The overall recurrence rate did not differ significantly between the two groups (P = 0.737). The incidence of cervical lymphatic recurrence in the 2-FL group was higher than in the 3-FL group (P = 0.051). CONCLUSIONS: Compared with 2-FL in MIE, 3-FL tended to prevent cervical lymphatic recurrence. However, it was not found to add survival benefit for the patients with thoracic esophageal cancer.

Short-term outcomes of neoadjuvant sintilimab with chemotherapy in stage III non-small cell lung cancer: a case series.

Background: Neoadjuvant chemoimmunotherapy seems to be a promising treatment option for stage III non-small cell lung cancer (NSCLC). Sintilimab, as a programmed death receptor-1 inhibitor, has exhibited a fine performance in treating NSCLC. However, the efficiency of sintilimab combined with chemotherapy for stage IIIA/IIIB NSCLC remains inconclusive. The purpose of this study was to share our experience on sintilimab in neoadjuvant chemoimmunotherapy for stage III NSCLC. Methods: This study retrospectively reviewed patients who received surgical resection following 1-3 cycles of neoadjuvant sintilimab (200 mg) with chemotherapy for stage III NSCLC between June 2020 and March 2022 in our center. Patients characteristics, surgical factors, surgery-related complications 30 days postoperatively, and treatment-related adverse events (TRAEs) before surgery were recorded through reviewing medical record data and telephone follow-up. Results: A total of eight patients were enrolled, including six cases of squamous cell carcinoma and two cases of adenocarcinoma. All of the patients received 1-3 cycles of neoadjuvant therapy. There were no treatment-related surgical delays. All patients underwent lobectomy, among which two underwent sleeve lobectomy and one received bronchoplasty. Five patients underwent open thoracotomy. Fibrosis of the primary tumor and lymph nodes was observed in all the cases. There were no surgery-related complications > grade 2 at 30 days postoperatively. According to the radiographic findings, one patient had stable disease and all of the others achieved a partial response. The median of maximum standardized uptake value change from baseline was a 52.75% reduction (range, 37.2-68.8%). Five patients achieved a major pathological response. R0 resection was achieved in all eight cases. One grade 4 event was observed. Neutropenia was the most common TRAE > grade 2 (3/8). There were no cases of treatment discontinuation or dose reduction due to TRAEs. Conclusions: The current study found that neoadjuvant sintilimab plus chemotherapy bring a high rate of major pathological response and acceptable TRAEs. Even though it increased the difficulties of surgery, there is still no evidence suggesting that it will brings additional surgical death. We believe that neoadjuvant sintilimab plus chemotherapy might be feasible for stage III NSCLC.

Three-Field Lymphadenectomy in Minimally Invasive Esophagectomy for Squamous Cell Carcinoma.

BACKGROUND: Minimally invasive esophagectomy (MIE) has been used widely for the treatment of esophageal cancer. However, there is still a lack of consensus on the extent of lymphadenectomy in MIE. The objective of this study was to investigate the safety and efficacy of three-field lymphadenectomy (3-FL) in MIE, compared with the standard two-field lymphadenectomy (2-FL). METHODS: A single-center randomized controlled trial was conducted, enrolling patients with resectable thoracic esophageal cancer (cT1-3,N0-3,M0) between June 2016 and May 2019. Eligible patients were randomized into two groups to receive either 3-FL or 2-FL during MIE procedures. Perioperative outcomes of the two groups were compared. The trial was registered in the Chinese Clinical Trial Registry (ChiCTR-INR-16007957). RESULTS: Seventy-six eligible patients were randomly assigned to the 3-FL group (n = 38) and the 2-FL group (n = 38). Compared with patients in the 2-FL group, patients in the 3-FL group had more lymph nodes harvested (54.7 ± 16.5vs 30.9 ± 9.6, P < .001) and more metastatic lymph nodes identified (3.5 ± 4.5 vs 1.7 ± 2.0, P = .027). Patients in the 3-FL group were diagnosed with a more advanced final pathologic TNM stage than patients in the 2-FL group. There was no significant difference between the two groups in blood loss, major postoperative complications, or duration of hospital stay, except that the operation time was longer in the 3-FL group than in the 2-FL group (270.5 ± 45.4 minutes vs 236.7 ± 47.0 minutes, P = .002). CONCLUSIONS: Three-field lymphadenectomy allowed harvesting of more lymph nodes and more accurate staging without increased surgical risks compared with 2-FL MIE for esophageal cancer.

Salvage surgery for advanced non-small cell lung cancer after targeted therapy: A case series.

BACKGROUND: Tumor recurrence or residual tumor after targeted therapy is common in patients with advanced non-small cell lung cancer (NSCLC). There is a lack of high-level evidence on which type of treatment should be employed for these patients and the role of salvage surgery has not been well reported in the literature. METHODS: A retrospective analysis of patients who underwent salvage surgery in our center between January 2016 and June 2019 for advanced NSCLC after targeted therapy was performed. RESULTS: A total number of nine patients were identified, including five males and four females, with a median age of 56 years (range, 40-65 years), all diagnosed with lung adenocarcinoma stage IIIa-IVb. All patients had received targeted therapy according to individual positive mutation of driver gene(s). Salvage surgery was performed for tumor recurrence or residual tumor after a duration of 2-46 months of targeted therapy. A negative surgical margin was achieved in all cases. Postoperative complication rate was 11.1% (1/9). All patients were alive at the time of this analysis and two patients had disease progression. After a median follow-up of 17 months (range: 5-44 months), the median event-free survival and postoperative survival was 14 months (range: 2-44 months) and 17 months (range: 5-44 months) respectively. CONCLUSIONS: Salvage surgery may be a feasible and promising therapeutic option for tumor recurrence or residual tumor in advanced NSCLC in selective patients after targeted therapy. KEY POINTS: Salvage surgery is feasible in selected patients with advanced NSCLC and provides promising survival outcomes after targeted therapy failure. Salvage surgery provides precise molecular and pathological information which is most important for subsequent therapy.

LINK-A lncRNA is upregulated in metastatic non-small cell lung cancer and is associated with poor prognosis.

Long intergenic non-coding RNA for kinase activation (LINK-A) has been characterized as an oncogenic long non-coding RNA (lncRNA) in triple-negative breast cancer. However, its involvement in non-small cell lung cancer (NSCLC) remains unknown. The aim of the present study was to investigate the involvement of LINK-A in NSCLC. Expression of LINK-A lncRNA in the plasma of patients with NSCLC collected on the day of admission and the day of discharge, and in the plasma of healthy controls, was detected by reverse transcription-quantitative PCR. Diagnostic values of plasma LINK-A for metastatic NSCLC were evaluated by receiver operating characteristic curve analysis. A LINK-A lncRNA expression vector was constructed and transfected into human NSCLC cell lines, and the effects on cell migration and invasion, and Akt activation were detected by Transwell and Matrigel assays, and western blotting, respectively. Plasma levels of LINK-A were found to be significantly higher in patients with different types of metastatic NSCLC than in patients with non-metastatic NSCLC and healthy controls. Plasma levels of LINK-A were lower in patients with metastatic NSCLC on the day of discharge than on the day of admission. Patients with high plasma LINK-A had a higher mortality rate and lower progression-free survival rate within 2 years of discharge. In conclusion, LINK-A is overexpressed in metastatic NSCLC, and may promote the migration and invasion of NSCLC by activating Akt signaling.

An Atypically Large, Free-Floating Thrombus Extending From the Lung to the Left Atrium via a Pulmonary Vein: A Case Report.

An atypically large, free-floating thrombus extending from primary pulmonary malignancy into the left atrium (LA) is a rare phenomenon. Here, we report a 61-year-old man presenting with a large mass in the lower lobe of the left lung, extending to LA via the left inferior pulmonary vein.The thrombus remained clinically silent and was detected by computed tomography (CT) and transthoracic echocardiography. To prevent life-threatening complications including systemic embolism and sudden death, the patient underwent surgical excision of the mass under cardiopulmonary bypass. Pathology of the tumor and the embolus was confirmed as moderately differentiated squamous cell carcinoma. Furthermore, immunohistochemical studies demonstrated consistency of the tumor cells in this pathological category.The patient tolerated the surgery well and his condition began to improve gradually after the operation.

[Inhibitory effect of endostar on lymphangiogenesis in non-small cell lung cancer and its effect on circulating tumor cells].

BACKGROUND AND OBJECTIVE: It is unclear how could endostatin effect tumor lymphangiogenesis? The aim of this study is to explore inhibitory effect of recombinant human endostatin injection (endostar) on lymphangiogenesis in non-small cell lung cancer (NSCLC) tissue and its effect on circulating tumor cells (CTC) in peripheral blood. METHODS: Tumor-bearing model nude mice were divided into eight groups randomly (n=7), including control group, cisplatin group, several concentration endostar groups and endostar plus cisplatin groups. Continuous administration of Endostar for two weeks, observed one week after the end of administration. Using HE staining and immunohistochemical staining to diagnose the tumor tissue and suspect metastasis lymph nodes, detected vascular endothelial growth factor (VEGF)-C, VEGF-D, VEGF receptor (VEGFR)-3 expression level and microlymphatic vessel density (MLVD) of tumor tissue. Enrichment of circulating tumor cells in peripheral blood used immunomagnetic negative selection strategy, used immunofluorescence staining to diagnose and count CTCs. RESULTS: Microlymphatic vessel density and the positive expression rate of VEGF-C, VEGF-D, VEGFR-3 in three endostar groups and three endostar plus cisplatin groups were significantly less than those in control group and cisplatin group. Microlymphatic vessel density and the positive expression rate of VEGF-C, VEGF-D, VEGFR-3 in endostar plus cisplatin group and endostar group with high endostar concentration were significantly less than those with low endostar concentration; There was a significant positive correlation between microlymphatic vessel density and the positive expression rate of VEGF-C, VEGF-D, VEGFR-3. The number of circulating tumor cells in endostar plus cisplatin groups were significantly less than that of endostar or cisplatin alone. CONCLUSIONS: Endostar could inhibit tumor lymphangiogenesis and reduce tumor cells into the bloodstream through the lymphatic. Inhibitory effect concerned with drug concentrationwith a dose-dependant.

Utility of squamous cell carcinoma antigen, carcinoembryonic antigen, Cyfra 21-1 and neuron specific enolase in lung cancer diagnosis: a prospective study from China.

BACKGROUND: Early detection and diagnosis is urgent for the sake of effective treatment strategy for lung cancer. However, a convenient, economical and relatively precise method is not available. We here report a prospective study to find the possible value of the combined use of four popular tumor markers in the early diagnosis of lung cancer among patients with suspicious nodules in the lung. METHODS: Six hundred and sixty inpatients with suspicious nodules in the lung were divided into a lung cancer group and a benign pulmonary tumor group according to post-operative histological examinations. Serum levels of four tumor markers including squamous cell carcinoma antigen (SCC), carcinoembryonic antigen (CEA), Cyfra 21-1 and neuron specific enolase (NSE) were assayed for each patient. Receiver operating characteristic (ROC) curves were constructed for each tumor marker. The power of lung cancer diagnosis of each tumor marker, as well as a combination of them were analyzed and compared. RESULTS: The serum levels (median, range) of SCC, CEA, Cyfra 21-1 and NSE were 0.44 (0.01 - 35.70) ng/ml, 2.49 (0.30 - 26.78) ng/ml, 2.30 (0.82 - 73.33) ng/ml and 10.54 (0.10 - 56.41) ng/ml respectively in lung cancer group, and were 0.32 (0.01 - 0.90) ng/ml, 1.60 (0.20 - 8.93) ng/ml, 1.41 (0.72 - 4.82) ng/ml and 9.36 (6.56 - 24.24) ng/ml respectively in the benign pulmonary tumor group. The difference in each tumor marker between the two groups was significant (P < 0.05). The ROCs of SCC, CEA, Cyfra 21-1 and NSE were 0.702 (95%CI, 0.654 - 0.751), 0.611 (95%CI, 0.563 - 0.659), 0.650 (95%CI, 0.601 - 0.700) and 0.598 (95%CI, 0.542 - 0.654) respectively, indicating very low power of these four tumor markers. When a combination of SCC, CEA, Cyfra 21-1 and NSE were employed, the diagnosis power was strengthened. CONCLUSION: SCC, CEA, Cyfra 21-1 and NSE are valuable in the early diagnosis of lung cancer among suspicious nodules in the lung, especially when they were assayed together for one patient.

Diagnostic values of SCC, CEA, Cyfra21-1 and NSE for lung cancer in patients with suspicious pulmonary masses: a single center analysis.

We recruited 805 patients with suspicious pulmonary masses that were identified finally as lung cancer or benign pulmonary masses. The serum levels of four tumor markers, including squamous cell carcinoma antigen (SCC), carcinoembryonic antigen (CEA), cytokeratin 19 fragment antigen 21-1 (Cyfra21-1) and neuron specific enolase (NSE) were tested for every patient. Though receiver operating characteristic (ROC) curves indicated unsatisfactory diagnostic power of those four tumor markers for lung cancer, 37.3% of early-staged lung cancer could be diagnosed just on the combination assays of the four tumor markers, under adjusted cut-off values through our statistical analysis retrospectively.

Survival benefit of neoadjuvant chemotherapy in non-small cell lung cancer: an updated meta-analysis of 13 randomized control trials.

INTRODUCTION: The survival effectiveness of neoadjuvant chemotherapy in non-small cell lung cancer (NSCLC) is still unclear based on the study of most up-to-date literatures. This article contributes to this problem by conducting an updated meta-analysis. METHODS: Based on Burdett et al's (J Thorac Oncol 2006;1:611-621) systematic review, this meta-analysis was conducted. Articles were searched electrically. The possible survival benefit of neoadjuvant chemotherapy was assessed by hazard ratio (HR) in terms of overall survival. A subgroup meta-analysis with only stage III NSCLC was also conducted. The software of Review Manager was used for data management. RESULTS: Thirteen randomized control trials, 6 of which were new ones, were included into this meta-analysis. The overall survival of NSCLC patients in neoadjuvant chemotherapy arm were improved significantly, comparing with those in surgery-alone arm (combined HR = 0.84; 95% confidence interval, 0.77-0.92; p = 0.0001). When only patients with stage III NSCLC were considered, the result was similar (combined HR = 0.84; 95% confidence interval, 0.75-0.95; p = 0.005). CONCLUSION: Neoadjuvant chemotherapy, as an addition of surgery, would significantly improve the overall survival of operable NSCLC patients, including patients with stage III NSCLC.

[Efficacy of docetaxel plus carboplatin combination chemotherapy for advanced non-small cell lung cancer].

BACKGROUND: Chemotherapy is one of the important treatment methods for advanced non-small cell lung cancer (NSCLC). The aim of this study is to evaluate the efficacy of docetaxel combined with carboplatin in treatment of advanced NSCLC. METHODS: Sixty-four stage IIIB/IV NSCLC patients were treated with docetaxel (75 mg/m² intravenously, on day 1) and carboplatin (AUC=5 intravenously, on day 2). RESULTS: The overall response rate (RR) was 42.6%, median survival time (MST) was 14 months, and 1-year survival rate was 45.23%. In initial treatment group, 1-year survial rate was 48.84% and MST was 14 months, and 37.89% and 12 months respectively in retreatment group (P=0.0233). The 1-year survial rate and MST of stage IIIB patients were 44.86% and 15 months, and 39.75% and 12 months respectively in stage IV patients (P=0.0354). There was no significant difference in efficacy between squamous cell carcinoma and adenocarcinoma patients. The major adverse effects were granulopenia, fatigue, nausea, vomiting and alopecia. CONCLUSIONS: The combination of docetaxel and carboplatin has a high response rate and tolerable side effects in treatment of advanced NSCLC, which can be adopted as both the first-line and second-line treatment.

[Effect of thymectomy in treatment of myasthenia gravis: analysis of 67 cases].

OBJECTIVE: To evaluate the clinical effects of thymectomy in treatment of myasthenia gravis: (MG). METHODS: The clinical data of 67 patients, 29 males and 38 females, aged 10.5 - 68, who underwent thymectomy were analyzed. RESULTS: According to the Monden's standard the overall effective rate of thymectomy was 71.6%. The remission rate was 32.8% (22/6), the improvement rate was 38.8% (26/67), 14 patients showed no change (20.9%), and deterioration was seen in 5 patients (7.5%). CONCLUSION: An effective method to treat MG, thymectomy should be performed on most of the MG patients early and actively.

[Clinical study of post-operative adjuvant chemotherapy in non-small cell lung cancer].

BACKGROUND: Post-operative adjuvant chemotherapy in non-small cell lung can- cer (NSCLC) has been a highlight around the world. The aim of this study is to investigate the efficacy of adjuvant chemotherapy on the survival of patients with NSCLC after complete resection. METHODS: From June 2000 to December 2003, 64 patients with stage IB-IIIA NSCLC were divided into the chemotherapy group, who accepted adjuvant chemotherapy with navelbine+cisplatin (NP) or taxol+carboplatin (TP), and the observation group, who did not accept adjuvant chemotherapy after operation. The 1-, 2-, 3- and 4-year survival rate (SR), median survival time (MST) and disease-free time (DFT) were analyzed by Kaplan-Meier method. RESULTS: The 1-, 2-, 3- and 4-year cumulated SR in the chemotherapy group was 93.9%, 84.6%, 71.4% and 58.4%, and 93.6%, 83.1%, 63.5% and 43.1% in the observation group respectively. There were statistically significant differences in both the 3- and 4-year survival between the two groups (P < 0.05). The MST was 52 months in the chemotherapy group and 47 months in the observation group respectively (P < 0.05), and the DFT was 19 months and 16 months respectively (P < 0.05). CONCLUSIONS: The cisplatin- or carboplatin-based adjuvant chemotherapy can improve the survival of NSCLC patients after complete resection.

[Clinical analysis of operation combined chemotherapy for stage IIIa non-small cell lung cancer].

OBJECTIVE: To study the therapeutic result of operation combined chemotherapy for stage IIIa non-small cell lung cancer. METHODS: From January 2000 to December 2003, the data of 83 cases with stage IIIa non-small cell lung cancer undergoing operation combined chemotherapy and 33 cases with stage IIIa non-small cell lung cancer undergoing non-operative therapy were retrospectively analyzed. The median survival time and the 1-, 2-, 3- year survival rates of the two groups were compared by the Kaplan-Meier method. RESULTS: The median survival time of the operation group was 20.3 months, and the 1-, 2-, 3- year survival rates were 85%, 70%, and 35% respectively. The median survival time of the non-operation group was 14.5 months and the 1-, 2-, 3- year survival rates were 75%, 33%, and 15% respectively. CONCLUSION: The therapeutic result of the operation combined chemotherapy for the stage IIIa non-small cell lung cancer is better than that of the non-operative therapy obviously.

[Expression of vascular endothelial growth factor and its significance in pulmonary bronchoalveolar carcinoma].

BACKGROUND: To study the relationship between the vascular endothelial growth factor (VEGF) and the clinicopathological characteristics of the patients with pulmonary bronchoalveolar carcinoma, and to research the possible role of VEGF in the malignant growth of pulmonary bronchoalveolar carcinoma. METHODS: The expression of VEGF and MVD were detected in 38 pulmonary bronchoalveolar carcinoma and 20 normal lung tissues by immunohistochemical method. RESULTS: The positive rate of VEGF expression (73.68%,28/38) and MVD (63.81±19.26) in pulmonary bronchoalveolar carcinoma tissues were both remarkably higher than those in normal lung tissues (0, 18.44±6.53)( P < 0.005,P < 0.001). The positive rate of VEGF expression was significantly related to the size of tumor ( P < 0.05), lymphatic metastasis ( P < 0.025) and TNM stage ( P < 0.05), and so did the MVD ( P < 0.05, P < 0.05, P < 0.05). MVD was remarkably higher in VEGF (+) carcinoma tissues than that in VEGF (-) carcinoma tissues ( P < 0.05). CONCLUSIONS: VEGF correlates with the clinicopathological characteristics of pulmonary bronchoalveolar carcinoma. It may play an important role in the development of pulmonary bronchoalveolar carcinoma.