Peripheral direct adjacent lobe invasion non-small cell lung cancer has a similar survival to that of parietal pleural invasion T3 disease.

INTRODUCTION: The postoperative prognosis of peripheral adjacent lobe invasion non-small cell lung cancer (NSCLC) is unclear. The purpose of this study was to determine the postoperative prognosis of NSCLC with direct adjacent lobe invasion by comparing it with that of visceral pleural invasion (primary lobe) T2 disease, and parietal pleural invasion T3 disease, and hence determine its most appropriate T category. METHODS: A retrospective analysis was conducted to assess the survival of patients with peripheral direct adjacent lobe invasion NSCLC (group A), and it was compared with that of patients with visceral pleural invasion of the primary lobe (group B) and parietal pleural invasion (group C). All patients were node-negative on pathologic examination. Kaplan-Meier method was used to compare the postoperative survival between groups. RESULTS: A total of 263 patients were analyzed. The overall survival rates in groups A (n = 28), B (n = 167), and C (n = 68) at 5 years were 40.7, 54.6, and 41.9%, respectively; corresponding median survival in three groups were 53, 71, and 40 months, respectively. The survival difference among three groups was statistically significant (p = 0.031). A similar survival was observed between groups A and C, whereas group B had a much better survival than other groups. CONCLUSIONS: Peripheral adjacent lobe invasion NSCLC has a similar survival prognosis with that of parietal pleural invasion T3 disease and hence should be classified as T3 rather than T2. However, further studies are warranted.

[Safety and long-term outcome of sleeve lobectomy for non-small cell lung cancer].

BACKGROUND AND OBJECTIVE: Pneumonectomy has been long term used as the standard surgical procedure for central type non-small cell lung cancer (NSCLC). Sleeve lobectomy has been performed in a small number of patients meeting the indications. This study was to compare the 5-year survival rate, operation related complications and mortality of sleeve lobectomy with pneumonectomy for NSCLC, and evaluate sleeve lobectomy in the surgical treatment for NSCLC. METHODS: Ninety-three patients with NSCLC undergoing sleeve lobectomy (group A) and 571 patients with NSCLC undergoing pneumonectomy (group B) from January 1997 to December 2007 in Sun Yat-sen University Cancer Center were reviewed. The 5-year survival rate, operation related complications and mortality between the two groups were analyzed. RESULTS: The overall 5-year survival for group A and group B were 42.0% and 31.5%, respectively (P=0.015). In the subgroup analysis, the 5-year survival of N0 (P=0.007) and N1 (P=0.025) patients were significant higher in group A than in group B, while the survival were not significantly different between N2 patients (P=0.073). The 5-year survival rates for bronchial and pulmonary arterial sleeve resection (the subset of group A) and pneumonectomy were not significantly different (P=0.092). There was no significant difference in local recurrences between the groups (P=0.821). The postoperative complication rates were 11.8% in group A and 20.7% in group B (P=0.046). There was no statistically significant difference in mortality between the two groups (P=0.259). CONCLUSION: The operative safety and long term efficacy of sleeve lobectomy are superior to pneumonectomy for NSCLC.

Expression of CXCL12/CXCR4 and its correlation to prognosis in esophageal squamous cell carcinoma.

BACKGROUND AND OBJECTIVE: CXCL12/CXCR4 is expressed in many kinds of tumors, which is associated with tumor proliferation and invasion. This study was to investigate the expression of CXCL12/CXCR4, and explore its correlation to prognosis and clinicopathologic factors of esophageal squamous cell carcinoma (ESCC). METHODS: The expression of CXCL12/CXCR4 protein in 186 specimens of ESCC was assessed by immunohistochemistry. RESULTS: The positive rates of CXCL4 and CXCR12 protein in ESCC tissues were 67.2% and 63.4%, respectively. CXCL4 and CXCR12 were not expressed in 20 specimens of normal esophageal epithelium. PTNM stage and positive expression of CXCR4 were independent prognostic factors of ESCC (p < 0.05). The five-year survival rates of CXCL12-positive and CXCL12-negative groups were not significantly different (21.0% vs. 18.8%, p > 0.05), while the five-year survival rate was significantly higher in CXCR4-negative group than in CXCR4-positive group (28.5% vs. 2.2%, p < 0.05). The expression of CXCR4 was higher in the group with lymph node metastasis and pathological T3 stage than in the group without lymph node metastasis and with pathological T1-T2 stages (p < 0.05). The expression of CXCR4 was not correlated with the expression of CXCL12 in ESCC. CONCLUSIONS: CXCL12/CXCR4 is intensively expressed in esophageal squamous cell carcinoma. The level of CXCR4 is positively correlated to progression and prognosis of ESCC.

[Clinical analysis of 33 cases of primary esophageal small cell carcinoma].

BACKGROUND & OBJECTIVE: Esophagus is the most commonly involved site of extrapulmonary small cell carcinoma. However, no standard treatment has been established for primary esophageal small cell carcinoma. This study was to summarize the clinical characteristics, treatment, and prognosis of primary esophageal small cell carcinoma, and explore the impact of chemotherapy on the survival. METHODS: The records of 33 patients with primary esophageal small cell carcinoma, treated in Cancer Center of Sun Yat-sen University from Jan. 1985 to Dec. 2005, were reviewed to summarize the clinical characteristics and impact of therapy modality on the survival. Prognostic factors were analyzed by Kaplan-Meier and log-rank method. RESULTS: The median survival time of the 33 patients was 11.3 months; the 1-, 3-, and 5-year survival rates were 45.1%, 16.6%, and 3.5%, respectively. Clinical stage was the most important prognostic factor. The median survival time of the patients received local treatment (surgical operation or radiotherapy) was 6.3 months; the 1-, 2-, 3-year survival rates were 31.1%, 23.5%, and 8.2%, respectively. The median survival time of the patients received local treatment plus chemotherapy was 15.4 months; the 1-, 2-, 3-year survival rates were 69.3%, 34.6%, and 28.7%, respectively. CONCLUSION: Surgical operation plus chemotherapy can improve the survival of the patients with early stage primary esophageal small cell carcinoma.

[Evaluation of lymph node metastasis in the contralateral mediastinum or scalene through mediastinoscopy and para-mediastinal small incision in potentially operable non-small cell lung cancer].

OBJECTIVE: The purpose of this study was to investigate the clinical characteristics of lymph node metastasis in the contralateral mediastinum and scalene in patients with potentially operable nonsmall cell lung cancer (NSCLC). METHODS: Cervical mediastinoscopy was performed for 89 patients with clinical stage I-III A non-small cell lung cancer prior to thoracotomy. Of these, 12 underwent cervical medistinoscopy combined with right scalene lymph node biopsy and 10 with anterior para-mediastinal small incision. RESULTS: A total of 9 patients were found have N3 disease on mediastinosopy, with cancer-cell-positive lymph nodes in the contralateral mediastinum in 6 and 3 in the right scalene. Statistical analysis revealed that the incidence of N3 disease in adenocarcinoma group was higher than that in patients with nonadenocarcinoma (P < 0.05), which was also higher in the patients with serum CEA >5 ng/ml than that in the patients with CEA <5 ng/ml (P < 0.05), and it was higher in the patients with ipsilateral mediastinal multi-station lymph node metastasis than that in the patients with uni-station lymph node metastasis (P < 0.05). CONCLUSION: Biopsy of contralateral mediastinal lymph nodes or scalene lymph node should be performed in order to exclude N3 disease for potentially operable NSCLC patients with adenocarcinoma, serum CEA >5 ng/ml or ipsilateral multi-station mediastinal lymph node metastasis.

[Expression and clinical significance of apoptosis-related oncogenes in stage I-II non-small cell lung cancer].

BACKGROUND & OBJECTIVE: The prognosis of stage I-II non-small cell lung cancer (NSCLC) after operation is related to many factors. Apoptosis-related oncogenes play an important role in occurrence and development of tumors. This study was to investigate the expression and prognostic significance of representative apoptosis-related oncogenes (Survivin, Bcl-2, Bax, and Fas) in stage I-II NSCLC. METHODS: The expression of Survivin, Bcl-2, Bax, and Fas in 115 specimens of stage I-II NSCLC and 20 specimens of non-tumor lung tissue were detected by SP immunohistochemistry. RESULTS: The positive rates of Survivin and Bcl-2 were significantly higher in NSCLC than in non-tumor lung tissues (62.61% vs. 10.00%, P<0.001; 49.57% vs. 15.00%, P<0.05); the positive rates of Bax and Fas were significantly lower in NSCLC than in non-tumor lung tissues (31.30% vs. 65.00%, P<0.05; 46.96% vs. 80.00%, P<0.05). TNM stage and positive expression of Survivin were independent prognostic factors of stage I-II NSCLC (P<0.01). The survival time of patients was significantly shorter in Survivin-positive group than in Survivin-negative group [(33+/-7) months vs. (52+/-9) months, P<0.05]. CONCLUSIONS: Apoptosis-related oncogenes may have some impacts on the occurrence and development of stage I-II NSCLC. TNM stage and positive expression of Survivin are independent prognostic factors.

[Expression and significance of C-kit and platelet-derived growth factor receptor-beta (PDGFRbeta) in esophageal carcinoma].

BACKGROUND & OBJECTIVE: Some researches have showed that STI-571 could inhibit tyrosine kinase of Bcr-Abl, C-kit, and platelet-derived growth factor receptor-beta (PDGFRbeta), therefore, inhibit cell differentiation and proliferation and accelerate cell apoptosis. This study was to examine the expression of tyrosine kinase receptor C-kit and PDGFRbeta, which is correlated to STI-571, in esophageal carcinoma. METHODS: The expression of C-kit and PDGFRbeta in tumor tissue, para-tumor tissue, and normal tissue of 50 specimens of esophageal carcinoma was examined by immunohistochemistry. RESULTS: The strong expression rate of C-kit was low in tumor, para-tumor, and normal tissues (4%, 4%, and 12%, respectively), with no significant difference (P=0.220). The strong expression rate of PDGFRbeta was significantly higher in tumor tissues than in para-tumor and normal tissues (68% vs. 28% and 28%, P=0.001). Logistic regression analysis revealed that the strong expression rate of C-kit and PDGFRbeta had no correlation to sex, age, differentiation degree, infiltrative depth, position, lymph node metastasis, and stage of esophageal carcinoma. CONCLUSIONS: The strong expression rate of PDGFRbeta is significantly higher in tumor tissues than in para-tumor and normal tissues. The strong expression rate of C-kit in normal esophageal tissues is low, and it is lower in para-tumor and tumor tissues.

[Vascular endothelial growth factor expression and microvessel density in stage I-II non-small cell lung cancer and their prognostic significances].

BACKGROUND & OBJECTIVE: TNM staging system is used widely to predict prognosis of non-small cell lung carcinoma (NSCLC) patients, but patients with the same stage may have very different survivals; better prognostic index is needed. Angiogenesis is considered to be essential for tumor development, progression, and metastasis, but the prognostic impacts of vascular endothelial growth factor (VEGF) and microvessel density (MVD) in NSCLC is controversial. This study was to evaluate the prognostic value of VEGF and MVD in NSCLC. METHODS: VEGF and MVD in 214 specimens of stageI-II NSCLC (20 in stage IA, 137 in stage IB, and 57 in stage IIB) were detected by tissue chip and SP immunohistochemistry. No patient underwent postoperative antitumor treatment. RESULTS: VEGF expression didn't relate to gender, age, blood type, pathologic type, and TNM stage (P0.05). MVD correlated with age and pathologic type (P0.05), but did not relate to gender, blood type, and TNM stage (P0.05). The mean value of MVD was 65.8+/-5.2 in VEGF-low patients, and 67.5+/-2.5 in VEGF-high patients (P0.05). The 5-year survival rate was significantly lower in MVD-high patients than in MVD-low patients (34.5% vs. 60.0%, P=0.013). Furthermore, multivariate Cox regression analysis showed that MVD (P=0.000) was an independent prognostic factor of NSCLC. CONCLUSION: High MVD closely relates to poor prognosis of stageI-II NSCLC.

[Clinical analysis of resectable breast cancer: a report of 6 263 cases].

BACKGROUND & OBJECTIVE: In Europe and America, breast cancer commonly occurs in women of middle and old age, the median age of patients is about 57 years old. Modified radical mastectomy has taken the place of traditional radical mastectomy, and is called standard radical mastectomy. Patients with breast cancer of early stage commonly receive breast conservative therapy. TNM stage (especially the lymph node status) affects the prognosis, and adjuvant therapy can improve the survival. In China, just a few clinical researches of large amounts of breast cancer patients have been reported. This study was to analyze clinical feature, surgical patterns, treatment outcome of resectable breast cancer, and explore prognostic factors and the effect of adjuvant therapy, for the sake of improving the levels of diagnosis and treatment. METHODS: Records of 6 263 patients with resectable breast cancer, admitted in our hospital from Jun. 1963 to Jun. 2003, were analyzed retrospectively. RESULTS: Of the 6 263 patients, 98.8% were women. Breast cancer occurred most frequently in patients of 40-49 years old (41.0%), especially in patients of 45-49 years old (25.2%). Breast lump was the main clinical manifestation, and occurred in 96.2% of the patients. The 5-, and 10-year survival rates of all patients were 75.2%, and 40.4%. Of the patients in TNM stages 0-I,II, and III, the 5-year survival rates were 96.8%, 73.7%, and 46.4%, respectively the 10-year survival rates were 78.7%, 64.6%, and 33.5%, respectively. The 5-, and 10-year survival rates were higher in lymph node negative group than in lymph node positive group (80.3% vs. 55.6%, and 59.2% vs. 31.9%, P<0.01). There was no significant difference in survival rates of patients received radical mastectomy and modified radical mastectomy since 1980's (P>0.05). Of the 73 patients received breast conservative therapy, no local recurrence or metastasis occurred, with the maximal follow-up of 17 years. Of the patients in stage T2 -T4, the 5-, and 10-year survival rates were significantly higher in adjuvant chemotherapy group than in non-chemotherapy group (78.2% vs. 60.1%, and 48.9% vs. 30.7%, P<0.01). CONCLUSIONS: According to our data, breast cancer most frequently occurred in patients of 45-49 years old. TNM stage (especially the axillary lymph node status)relates to prognosis of breast cancer. The prognosis was worse in the patients with positive lymph node than in the patients with negative Lymph node. The efficacy of modified radical mastectomy equals to that of radical mastectomy, breast conservative therapy can be applied to patients in early stage. Adjuvant chemotherapy and endocrine therapy can improve the survival of resectable breast cancer patients.

[Predictive value of detection of sentinel lymph nodes on lymphatic metastasis of non-small cell lung cancer].

BACKGROUND & OBJECTIVE: The metastasis status of regional lymph node is an important prognostic factor of non-small cell lung cancer (NSCLC). Sentinel lymph node (SLN) mapping and biopsy is a quick and high efficient technique to intraoperatively detect occult micrometastatic disease, however, its application in NSCLC is immature. This study was designed to investigate the feasibility of detecting SLN in patients with NSCLC during radical surgery, and to evaluate its accuracy of predicting metastasis status of regional lymph node. METHODS: Fifty patients with NSCLC underwent SLN detection. During radical operation, 4 ml of 1% isosulfan blue was injected into the lung tissue around the tumor at 3, 6, 9, and 12 o'clock sites. Location and number of blue dyed SLNs were recorded, and compared with pathologic results to calculate the accuracy and false negative rate of SLN detection. RESULTS: Blue dyed SLNs were seen in 33 patients with a detection rate of 66.0%. SLNs located in N1 lymph node of 24 patients (72.7%), in N2 lymph node of 6 patients (18.2%), in both N1 and N2 lymph nodes of 3 patients (9.1%). Approved by pathology, the accuracy of SLN detection was 87.9% (29/33), the sensibility was 73.3% (11/15), the false negative rate was 26.7% (4/15). CONCLUSION: SLN detection is valuable for predicting hilar and mediastinal lymph nodes metastases in NSCLC.

[Clinical value of cervical mediastinoscopy in non-small cell lung cancer of stage I].

BACKGROUND & OBJECTIVE: Whether to apply routine mediastinoscopy to non-small cell lung cancer (NSCLC) of stage I remains controversial. This study was to evaluate application of cervical mediastinoscopy in detecting mediastinal lymph nodes status of NSCLC of stage I. METHODS: The cervical mediastinoscopy was performed in 31 patients with NSCLC of stage I prior to thoracotomy from Oct. 2000 to Feb. 2004. Mediastinoscopy-positive (stage N2) patients received neoadjuvant chemotherapy. RESULTS: Of the 31 patients, 2 had disease of stage N2, and 1 had disease of stage N3 (right scalenus lymph node metastasis); positive rate of mediastinosopy was 10% (3/31), sensitivity, specificity, and accuracy of mediastinoscopy were 75%, 100%, and 97%, respectively. CONCLUSION: Mediastinoscopy might be a routine examination for patients with NSCLC of stage I.

[Shrinkage of resected specimens of esophageal carcinoma].

BACKGROUND & OBJECTIVE: There are some kinds of shrinkage in resected specimens of esophageal carcinoma; however,there were few reports on its regularity. This study was designed to investigate the degree of shrinkage in resected specimens of esophageal carcinoma. METHODS: Specimens of seventy patients with esophageal squamous cell carcinoma who underwent resections in Cancer Center, Sun Yat-Sen University were collected. The length of the upper margin,the tumor,and the lower margin were measured with a ruler during operation before the esophagus was removed (in situ). After the esophagus was removed, the specimens were cut longitudinally on the side opposite the tumor, then the length of the upper margin, the tumor, and the lower margin were measured again without retraction. After 48 h fixation of 10% formalin (fixed), the length of the upper margin, the tumor, and the lower margin were measured again. RESULTS: After resection,the shrinkage rates of the upper margin, the tumor,and the lower margin were (40.71+/-10.02)%,(83.59+/-16.57)%, and (58.41+/-12.03)% of their in situ length; after 48 h fixation of 10% formalin, the shrinkage rates of the upper margin,the tumor, and the lower margin were (40.06+/-10.50)%, (80.92+/-15.88)%, and (54.83+/-11.29)% of their in situ length (P< 0.05). CONCLUSION: The specimens of esophageal carcinoma shrink remarkably after removed and after formalin fixation.

[Giant pathologic section in the study of optimal length of surgical resection for esophageal carcinoma].

OBJECTIVE: To study the optimal surgical resection length for esophageal carcinoma. METHODS: Specimens of seventy patients with esophageal squamous cell carcinoma resected and collected in our hospital were made into pathologic giant sections. Direct intramural infiltration, multicentric carcinogenic lesion and leaping metastasis were observed in the large slice by microscope. The actual length during the operation was calculated by the ratio of shrinkage. RESULTS: Direct intramural infiltration was found in 51 (72.9%) patients, 39 proximal and 36 distal to the tumor. The mean length of direct intramural infiltration was 0.9 +/- 0.8 cm (4.0 cm maximum) proximally and 0.5 +/- 0.3 cm (2.0 cm maximum) distally. Multicentric carcinogenic lesion was found in 11 (15.7%) patients, 5 proximally, 8 distally and 2 on both sides. Proximal to the tumor, the mean distance between the multicentric carcinogenic lesion and the main lesion plus the length of the multiple carcinogenic lesion was 3.2 +/- 1.5 cm (4.7 cm maximum). Distal to the tumor, it was 3.6 +/- 2.4 cm (9.1 cm maximum). Leaping metastasis was found in 9 (12.9%) patients, 7 proximally and 4 distally. The mean distance between the leaping metastasis and the main lesion plus the length of the leaping metastatic lesion was 1.9 +/- 0.6 cm (2.9 cm maximum) proximally and 1.4 +/- 1.0 cm (2.7 cm in maximum) distally. CONCLUSION: The optimal surgical resection length for esophageal carcinoma should be at least 5 cm proximal to the tumor and total length on the distal side.