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1.
EBioMedicine ; 2019 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-31767541

RESUMO

BACKGROUND: The spatial distributions of different types of cells could reveal a cancer cell's growth pattern, its relationships with the tumor microenvironment and the immune response of the body, all of which represent key "hallmarks of cancer". However, the process by which pathologists manually recognize and localize all the cells in pathology slides is extremely labor intensive and error prone. METHODS: In this study, we developed an automated cell type classification pipeline, ConvPath, which includes nuclei segmentation, convolutional neural network-based tumor cell, stromal cell, and lymphocyte classification, and extraction of tumor microenvironment-related features for lung cancer pathology images. To facilitate users in leveraging this pipeline for their research, all source scripts for ConvPath software are available at https://qbrc.swmed.edu/projects/cnn/. FINDINGS: The overall classification accuracy was 92.9% and 90.1% in training and independent testing datasets, respectively. By identifying cells and classifying cell types, this pipeline can convert a pathology image into a "spatial map" of tumor, stromal and lymphocyte cells. From this spatial map, we can extract features that characterize the tumor micro-environment. Based on these features, we developed an image feature-based prognostic model and validated the model in two independent cohorts. The predicted risk group serves as an independent prognostic factor, after adjusting for clinical variables that include age, gender, smoking status, and stage. INTERPRETATION: The analysis pipeline developed in this study could convert the pathology image into a "spatial map" of tumor cells, stromal cells and lymphocytes. This could greatly facilitate and empower comprehensive analysis of the spatial organization of cells, as well as their roles in tumor progression and metastasis.

2.
Int J Surg ; 72: 175-184, 2019 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-31715310

RESUMO

BACKGROUND: For early-stage lung adenocarcinoma, determining the extent of surgical resection and lymphadenectomy according to the invasion status of the tumour may be more reliable. Intraoperative frozen section (FS) is a potentially effective method to identify the invasion status while its accuracy is still unknown. This meta-analysis aimed to evaluate the accuracy of FS for the invasion status of lung adenocarcinoma. METHODS: We conducted a systematic search of PubMed, Embase, Scopus and Cochrane Library databases (from inception to October 26, 2018) to identify studies investigating the accuracy of FS for the invasion status of lung adenocarcinoma. The accuracy of FS was evaluated by calculating the pooled concordance rates (CCR) between FS and final pathology and the pooled sensitivity, specificity, and other parameters of FS for discriminating pre-/minimally invasive adenocarcinoma from invasive adenocarcinoma (IAC). The negative predictive value (NPV) of FS for diagnosing IAC was also calculated to evaluate the chance of underestimation. RESULTS: Six eligible studies were included. The pooled CCR for differentiating pre-invasive adenocarcinoma, minimally invasive adenocarcinoma and IAC was 88% (95% CI, 84%-93%). When pre-invasive adenocarcinoma and minimally invasive adenocarcinoma were classified as a group, the pooled CCR, sensitivity, specificity of FS for differentiating pre-/minimally invasive adenocarcinoma from IAC were 95% (95% CI, 94%-97%), 95% (95% CI, 92%-97%), 95% (95% CI, 80%-99%), respectively. The pooled NPV of FS for diagnosing IAC was 95% (95% CI, 92%-97%). CONCLUSIONS: Intraoperative FS is reliable for identifying the invasion status of lung adenocarcinoma, with high diagnostic accuracy for differentiating pre-/minimally invasive adenocarcinoma from IAC.

3.
Genomics Proteomics Bioinformatics ; 17(3): 287-296, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31479759

RESUMO

T cells and T cell receptors (TCRs) play pivotal roles in adaptive immune responses against tumors. The development of next-generation sequencing technologies has enabled the analysis of the TCRß repertoire usage. Given the scarce investigations on the TCR repertoire in lung cancer tissues, in this study, we analyzed TCRß repertoires in lung cancer tissues and the matched distant non-tumor lung tissues (normal lung tissues) from 15 lung cancer patients. Based on our results, the general distribution of T cell clones was similar between cancer tissues and normal lung tissues; however, the proportion of highly expanded clones was significantly higher in normal lung tissues than in cancer tissues (0.021% ±â€¯0.002% vs. 0.016% ±â€¯0.001%, P = 0.0054, Wilcoxon signed rank test). In addition, a significantly higher TCR diversity was observed in cancer tissues than in normal lung tissues (431.37 ±â€¯305.96 vs. 166.20 ±â€¯101.58, P = 0.0075, Mann-Whitney U test). Moreover, younger patients had a significantly higher TCR diversity than older patients (640.7 ±â€¯295.3 vs. 291.8 ±â€¯233.6, P = 0.036, Mann-Whitney U test), and the higher TCR diversity in tumors was significantly associated with worse cancer outcomes. Thus, we provided a comprehensive comparison of the TCR repertoires between cancer tissues and matched normal lung tissues and demonstrated the presence of distinct T cell immune microenvironments in lung cancer patients.

6.
Ann Surg Oncol ; 26(9): 2890-2898, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31183641

RESUMO

BACKGROUND: Effective tools evaluating the prognosis for patients with esophageal cancer undergoing surgery is lacking. The current study aimed to develop a nomogram to predict overall survival (OS) and provide evidence for adjuvant therapy for patients with esophageal carcinoma after esophagectomy. METHODS: The study retrospectively reviewed patients with pathologic T1N +/T2-4aN0-3, M0 thoracic esophageal squamous cell carcinoma after radical esophagectomy, with or without adjuvant therapy, in one institution as the training cohort (n = 2281). A nomogram was established using Cox proportional hazard regression to identify prognostic factors for OS, which were validated in an independent validation cohort (n = 1437). Area under curve (AUC) values of receiver operating characteristic curves were calculated to evaluate prognostic efficacy. RESULTS: In the training cohort, the median OS was 50.46 months, and the 5-year OS rate was 47.08%. Adjuvant therapy, sex, tumor location, grade, lymphovascular invasion, removed lymph nodes, and T and N categories were identified as predictive factors for OS. The nomogram showed favorable prognostic efficacy in the training and validation cohorts (5-year OS AUC: 0.685 and 0.744, respectively), which was significantly higher than that of the American Joint Committee on Cancer (AJCC) staging system. The nomogram distinguished OS rates among six risk groups, whereas AJCC could not separate the OS of 2A and 1B, 3C and 3B, or 3A and 2B. Patients with a nomogram score of 72 to 227 were predicted to achieve a 5-year OS increase of 10% or more from adjuvant therapy. CONCLUSION: The nomogram could effectively predict OS and aided decision making in adjuvant therapy for patients with thoracic esophageal squamous cell carcinoma after esophagectomy.

7.
Sci Rep ; 9(1): 6886, 2019 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-31053738

RESUMO

Prediction of disease prognosis is essential for improving cancer patient care. Previously, we have demonstrated the feasibility of using quantitative morphological features of tumor pathology images to predict the prognosis of lung cancer patients in a single cohort. In this study, we developed and validated a pathology image-based predictive model for the prognosis of lung adenocarcinoma (ADC) patients across multiple independent cohorts. Using quantitative pathology image analysis, we extracted morphological features from H&E stained sections of formalin fixed paraffin embedded (FFPE) tumor tissues. A prediction model for patient prognosis was developed using tumor tissue pathology images from a cohort of 91 stage I lung ADC patients from the Chinese Academy of Medical Sciences (CAMS), and validated in ADC patients from the National Lung Screening Trial (NLST), and the UT Special Program of Research Excellence (SPORE) cohort. The morphological features that are associated with patient survival in the training dataset from the CAMS cohort were used to develop a prognostic model, which was independently validated in both the NLST (n = 185) and the SPORE (n = 111) cohorts. The association between predicted risk and overall survival was significant for both the NLST (Hazard Ratio (HR) = 2.20, pv = 0.01) and the SPORE cohorts (HR = 2.15 and pv = 0.044), respectively, after adjusting for key clinical variables. Furthermore, the model also predicted the prognosis of patients with stage I ADC in both the NLST (n = 123, pv = 0.0089) and SPORE (n = 68, pv = 0.032) cohorts. The results indicate that the pathology image-based model predicts the prognosis of ADC patients across independent cohorts.

8.
Thorac Cancer ; 10(6): 1431-1440, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31102336

RESUMO

BACKGROUND: Whether postoperative radiotherapy is beneficial in the treatment of esophageal squamous cell carcinoma with one or two regional lymph node (LN) metastases (pN1) after esophagectomy is uncertain. This study aimed to explore the effect of postoperative radiotherapy (PORT) on survival. METHODS: Propensity score-matching (PSM) analysis was conducted to balance the two arms (surgery only [S] or surgery plus postoperative radiotherapy [PORT]). The survival rate was calculated by the Kaplan-Meier method and analyzed using the log-rank test. RESULTS: A total of 992 cases confirmed positive for one or two regional LN metastases were eligible. After PSM, 622 patients were reviewed. Each group consisted of 311 cases. The median follow-up was 80.7 months. For the overall cohort, the one-, three- and five-year overall survival (OS) were 90.6%, 51.9% and 38.2%, respectively. Disease-free survival (DFS) was 76.0%, 41.4% and 32.1%, respectively. The five-year OS and DFS were 45.0% and 39.8% for PORT, which was significantly higher than the S group (31.3% and 24.2%, both P < 0.001). On subgroup analysis, PORT was associated with improved OS and DFS for patients with pathological stage pT3-4N1M0, compared with S group (five-year OS 41.3% vs. 23.5%, P < 0.001; five-year DFS 35.8% vs. 18.8%, P < 0.001). However, for pT1-2N1M0 patients, PORT did not benefit OS and DFS compared with S (P = 0.063). CONCLUSIONS: In summary, the addition of PORT after esophagectomy was associated with a statistically significant improvement in OS and DFS for patients with pathological one or two lymph-node positive pathology, in particular for stage pT3-4N1M0 patients.

9.
Int J Surg ; 60: 88-100, 2018 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-30389537

RESUMO

BACKGROUND: Multimodality treatments including definitive chemoradiotherapy (dCRT) and neoadjuvant chemoradiotherapy (nCRT) or chemotherapy (nCT) followed by surgery (S) are frequently used to improve prognosis in locally advanced oesophageal squamous-cell carcinoma (LAESCC), while the optimal multimodality regimen has yet to be defined; therefore, this systematic review and meta-analysis aimed to find out the current best multimodality regimen for LAESCC. METHODS: We conducted a systematic search of PubMed, Embase, Ovid and Cochrane Library databases for studies comparing nCRT + S with nCT + S or dCRT. The primary outcome was overall survival. The secondary outcomes were the rates of R0 resection, pathologic complete response (pCR), tumor-free lymph nodes (pN0) and postoperative recurrence. RESULTS: Five studies comparing nCRT + S with nCT + S and fourteen studies comparing nCRT + S with dCRT were finally included. Meta-analysis showed that nCRT + S had higher rates of R0 resection (OR 1.84, 95% CI 1.03-3.29), pCR (OR: 2.90 95% CI 1.37-6.14) and pN0 (OR: 2.55 95% CI 1.54-4.24) with a significant survival advantage (HR 0.72; 95% CI 0.52-0.99) when compared with nCT + S in LAESCC. When nCRT + S was compared with dCRT, nCRT + S yielded a significant survival benefit (HR 0.65; 95% CI 0.56-0.76) and had a significantly lower rate of local recurrence (OR: 0.35 95% CI 0.22-0.57). CONCLUSION: Current evidence suggests that CRT + S may be the optimal potential curative treatment mode for patients with LAESCC as long as they are suitable for this multimodality regimen.

10.
J Thorac Dis ; 10(9): 5308-5317, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30416778

RESUMO

Background: The aim of this study was to evaluate the significance of spread through air spaces (STAS) in early lung adenocarcinomas after radical lobectomy and lymphadenectomy. Methods: A total of 242 patients with lung adenocarcinomas less than 4 cm (8th pStage I) were selected from the lung cancer patients surgically treated from January, 2009 to September, 2011. Pathological review focused on STAS as well as histological subtypes, blood vessel & neural invasion, pathological tumor size etc. Recurrence or disease-free survival (DFS) and overall survival (OS) were compared between patients as stratified by STAS and tumor size. Results: STAS was observed in 33.47% (81/242) patients, which was significantly correlated with histological predominant subtype (χ2=25.903, P=0.093×10-3) and differentiation grade (χ2=23.986, P=0.025×10-3). Patients with STAS (+) showed a comparable PFS (P=0.268) and OS rates (P=0.100) in all stage I cases, but a significant lower PFS (P=0.029) and OS (P=0.013) in tumors within 2< tumors ≤4 cm. Multivariate analysis revealed STAS to be an independent worse prognostic factor in lung adenocarcinomas within 2< tumors ≤4 cm, both for PFS (P=0.004) and OS (P=0.002), while no significant difference was found in patients with tumors ≤2 cm (PFS, P=0.537; OS, P=0.448), after adjusting by other clinicopathological parameters as age, gender, smoking etc. Conclusions: Presence of STAS was a significant worse predictor for pStage I patients with lung adenocarcinoma >2 cm who underwent radical lobectomy, while it is not significant in patients with tumor ≤2 cm. These findings may be helpful in assessing postoperative therapy stratified by tumor size and STAS status.

11.
Thorac Cancer ; 9(12): 1763-1769, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30414313

RESUMO

BACKGROUND: This study explored the clinicopathological features, predictive factors of malignancy, effectiveness of video assisted thoracic surgery (VATS), and prognosis of solitary fibrous tumor of the pleura (SFTP). METHODS: A single-center retrospective study of the data of 82 patients with SFTP who were surgically treated in our department between January 2003 and December 2015 was conducted. RESULTS: A total of 82 SFTPs (70 benign, 12 malignant) were included and all patients underwent complete en bloc resection. SFTPs originated from the visceral pleura in 47 (57%) and the parietal pleura in 35 (43%) patients. In our cohort, malignant tumors were often symptomatically large, and the patients with malignant SFTPs (mSFTPs) often had a family history of neoplasms. Patients in the VATS group (n = 22) had tumors with significantly smaller diameters, required a shorter surgical duration and shorter hospital stay, and experienced less intraoperative blood loss and less postoperative chest tube drainage compared to the thoracotomy group (n = 60). No tumor recurrence was found in benign SFTP (bSFTP) patients. The long term survival and disease-free survival rates of mSFTP patients were 76% and 53%, respectively. CONCLUSION: Larger tumor diameter and a family history of neoplasm may be predictive factors for mSFTP; however, this conclusion needs to be verified in large cohort. VATS is safe and reliable for treating selected SFTP patients. Local recurrence is associated with mSFTP patient death, thus close follow-up of such patients is crucial.

12.
Zhonghua Wei Chang Wai Ke Za Zhi ; 21(9): 987-994, 2018 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-30269317

RESUMO

Esophageal squamous cancer is a malignancy with high incidence and mortality. Surgery currently remains the most important part of the comprehensive treatments. The number of metastatic lymph node has great influence on the prognosis of esophageal cancer, so thorough lymphadenectomy also becomes a key factor. Meanwhile, the choice of lymphadenectomy procedure during surgery has always been controversial. In current article, we summarized the pattern in lymph node metastasis in thoracic esophageal squamous cell carcinoma by analyzing relevant literatures, and discovered that the longitudinal lymphatic network of the submucosa and the horizontal lymphatic pathways of the muscularis propria are the anatomical foundation of the lymph node metastasis of esophageal cancer. Then, we evaluated the impact of lymph node metastasis on the prognosis in terms of number of metastatic lymph node, distant metastasis, positive lymph node ratio, solitary metastasis, micrometastasis and extracapsular lymph node involvement. During surgery, should we choose two-field lymphadenectomy (2-FL) or three-field lymphadenectomy (3-FL)? The clinical efficacy was compared between 2-FL and 3-FL in this paper. The results showed that compared with patients who underwent 2-FL, those who underwent 3-FL had significantly higher 5-year survival rate, significantly longer operative time, and more dissected lymph nodes, while blood loss during surgery was not significantly different. As for complication, some studies indicated that patients after 3-FL had a significantly higher risk of anastomotic leakage, recurrent laryngeal nerve paralysis, and tracheal ischemia, while no significant differences in pulmonary infection and chylothorax were found. At last, we introduced the application of sentinel lymph node technique and relevant research evidence of recurrent laryngeal nerve lymph node as predictive markers for cervical lymph node metastasis.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia , Excisão de Linfonodo , Humanos , Linfonodos , Estadiamento de Neoplasias , Estudos Retrospectivos
13.
J Thorac Dis ; 10(7): 4061-4068, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30174849

RESUMO

Background: The pathologic stages of lymph nodes usually differ from preoperatively predicted in lung cancers and it is difficult to predict the metastasis of lymph nodes for the patients diagnosed as clinical stage IA non-small cell lung cancers (NSCLC). This study aimed to investigate the patterns of lymph node metastasis and the risk factors predicting lymph node metastasis in the patients with clinical stage IA NSCLCs. Methods: All patients diagnosed as clinical stage IA NSCLC from July 2013 to June 2017 in our center were retrospectively reviewed, and a total number of 1,543 patients who underwent anatomical lobectomy with systematic lymph node dissection were enrolled in this study. Multivariate logistic regression analysis was performed to identify the risk factors predicting lymph node metastasis, and Fisher's exact test was used to confirm the lymph node spread mode according to the locations of primary tumors. Results: Totally, lymph node metastases presented in 131 patients (8.5%) in this series. Sixty-three patients presented N1 diseases, 17 patients showed only skipped N2 diseases, and 51 patients had simultaneous N1 and N2 positive lymph nodes. No lymph node metastasis was found in the patients with pure ground grass opacity (GGO). When patients were arbitrarily divided into six groups by the longest tumor diameter of ≤0.5, 0.6-1, 1.1-1.5, 1.6-2.0, 2.1-2.5, 2.6-3 cm, the lymph node metastasis rates of each group were 0% (0/20), 1.5% (4/264), 4.7% (20/429), 8.6% (29/336), 13.1% (38/290), 19.6% (40/204), respectively. When the patients with pure GGO were excluded, the lymph node metastasis rates in the patients with partial or total solid tumors were 0% (0/10), 2.4% (4/164), 6.6% (20/303), 11.7% (29/249), 16.0% (38/238) and 23.1% (40/173). The cut off value showed by receiver operating characteristic (ROC) curve for tumor size was 1.95 cm, and the area under the curve (AUC) was measured as 0.681 (P<0.001, 95% CI: 0.630-0.726). Multivariate logistic regression analysis indicated that male patients [odds ratio (OR) =3.34, P=0.012], smoking history (OR =14.12, P<0.001), solid components (OR =3.34, P=0.01), large tumor size (OR =1.9, P<0.001), poor differentiation (OR =2.25, P=0.013), lymphovascular invasion (OR =58.45, P<0.001), visceral pleural invasion (OR =48.37, P<0.001) were significantly associated with lymph node metastasis in clinical stage IA NSCLC. The rate of non-lobe specific lymph node metastasis was 15.8-40.0% when any of the lobe specific lymph nodes was positive, while it was only 0-2.2% when all lobe specific lymph nodes were negative. Conclusions: Tumor size, solid components, poor differentiation, lymphovascular invasion, visceral pleural invasion and smoking history were significant factors predicting lymph node metastasis of clinical stage IA NSCLC. Patients with negative lobe-specific lymph node have very low risk of metastasis to the non-lobe specific lymph nodes. Lobe-specific lymph node dissection may become an alternative lymph node dissection mode for clinical stage IA NSCLC, especially for tumors ≤2 cm.

14.
J Thorac Dis ; 10(5): 2648-2655, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29997926

RESUMO

Background: Esophageal cancer is one of the most prevalent malignancies with a high incidence and mortality in China, the main treatment for esophageal cancer at present is still surgery-based multimodality treatment, and surgery is still the most effective measure. However, the modes of surgical treatment for esophageal cancer have been diverse. The surgical approaches can be mainly divided into the left thoracic approach and right thoracic approach in China. The long-term survival of the patients treated through right approach was reported better than that through left thoracic approach, but until now no statistically significant difference was found between two approaches, especially, for those with middle and lower thoracic esophageal cancer without suspected upper mediastinal lymph node metastasis in preoperative examinations, no definite conclusion have been made on selection of the approach, therefore, this studies try to compare the long-term survival between two approaches . Methods: The data of 402 cases with complete resection and two-field lymph node dissection from January, 2011 to December, 2011 in the Cancer Hospital, Chinese Academy of Medical Sciences was retrospectively reviewed and analyzed. Propensity score matching (PSM) analysis and life-table in SPSS 22.0 and Stata 14.0 were used to analyze the survival. Results: Totally, 402 cases were surgically treated either via left or right thoracic approach. The overall 5-year survival rate of this series was 38%, it was 37% in 281 cases surgically treated through left approach, and 39% in 121 cases through right approach (P=0.908). The 5-year survival of 256 patients without suspected lymph node metastasis in the upper mediastinum based on the preoperative examinations surgically treated through left approach was 38% versus 43% of 88 cases through right approach (P=0.404). After PSM, the 5-year survival of 110 cases surgically treated through left approach was 32% versus 40% of another matched 110 cases through right approach (P=0.146). for the patients without suspected lymph node metastasis in the upper mediastinum based on preoperative examinations, the 5-year survival of 88 surgically treated through left approach was 33% versus 44% of another matched 88 cases through right approach (P=0.239). Conclusions: For the middle and lower thoracic esophageal cancer patients, whether or not who has suspected lymph node metastasis in the upper mediastinum based on preoperative CT and EUS, the surgical treatment through right thoracic approach can achieve better but not significantly better overall survival than that through left thoracic approach. Further prospective randomized clinical trials are still needed to verify this disputed issue on approach selection.

16.
Zhongguo Fei Ai Za Zhi ; 21(6): 493-497, 2018 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-29945709

RESUMO

Superior sulcus tumor of the lung is a bronchogenic tumor occurred in the apex of the upper lobe of the lung and is a unique clinical subtype of non-small cell lung cancer (NSCLC), which account for less than 5% of all bronchogenic carcinomas. It often involves the first rib, brachial plexus, subclavian vessels, sympathetic chain, stellate ganglion or vertebra. A lot of progress has been achieved in the treatment of superior sulcus tumor over the past decades. Several clinical trials reported in recent years have confirmed that concurrent chemoradiotherapy followed by surgical resection can improve the rate of complete resection, local control and pathological remission of the tumor, and prolong the total-survival time. It has become the most effective treatment mode for the superior sulcus tumor, and recommended as a standard treatment mode for superior sulcus tumor by National Comprehensive Cancer Network (NCCN) and American College of Chest Physicians (ACCP) guidelines. This article reviews relevant literatures at home and abroad, and briefly introduces the advances in surgical treatment and comprehensive treatment of superior sulcus tumor.
.


Assuntos
Neoplasias Pulmonares/terapia , Costelas , Terapia Combinada , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/cirurgia , Terapia de Alvo Molecular , Resultado do Tratamento
18.
Zhongguo Fei Ai Za Zhi ; 21(2): 104-109, 2018 Feb 20.
Artigo em Chinês | MEDLINE | ID: mdl-29526177

RESUMO

BACKGROUND: Surgeons are the direct decision-makers and performers in the surgical treatment of patients with lung cancer. Whether the differences among doctors affect the survival of patients is unclear. This study analyzed the five-year survival rates of different thoracic surgeries in patients undergoing surgery to assess the physician's impact and impact. METHODS: A retrospective analysis of five years between 2002-2007 in the Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, for surgical treatment of lung cancer patients. According to different surgeons grouping doctors to compare the basic information of patients, surgical methods, short-term results and long-term survival differences. RESULTS: A total of 712 patients treated by 11 experienced thoracic surgeons were included in this study. The patients have nosignificant difference with gender, age, smoking, pathological type between groups. There were significant differences in clinical staging, surgery type, operation time, blood transfusion rate, number of lymph node dissection, palliative resection rate, postoperative complications and perioperative mortality. There was a significant difference in five-year survival rates among patients treated by different doctors. This difference can be seen in all clinical stage analyzes with consistency. In the multivariate analysis, it was suggested that surgeon was an independent factor influencing the prognosis of patients. CONCLUSIONS: Thoracic surgeon has a significant effect on the therapeutic effect of lung cancer patients.


Assuntos
Neoplasias Pulmonares/cirurgia , Cirurgiões/estatística & dados numéricos , Cirurgia Torácica , Procedimentos Cirúrgicos Torácicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Análise de Sobrevida , Procedimentos Cirúrgicos Torácicos/efeitos adversos
19.
Zhonghua Wei Chang Wai Ke Za Zhi ; 21(1): 112-117, 2018 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-29354905

RESUMO

Esophageal cancer is one of the most common malignant digestive system cancers in China, which has high incidence and mortality. Nowadays, surgery remains the most important part of the comprehensive treatments. Conventional open esophagectomies are highly traumatic with high morbidity, while minimally invasive esophagectomy has been increasingly used with the development of surgical instruments and techniques in recent years. Compared with conventional open esophagectomy(OE), what are the advantages of minimally invasive esophagectomy (MIE) and which is preferable? This review briefly introduces the developing history of MIE and common procedures. Then we review large amounts of relevant literatures, comparing MIE with OE in perioperative rehabilitation, lymph node dissection and long-term survival. Results showed that compared with OE, MIE had less blood loss during operation, less postoperative pulmonary complications, shorter hospital stay and ICU time, meanwhile, there were no significant differences in the incidence of anastomotic leak, perioperative mortality, R0 resection and total number of resected lymph nodes. However, there are still no clear results of comparisons on operative time, recurrent laryngeal nerve palsy, and long-term survival, thus, more supportive evidences from prospective large-sample observation studies or randomized controlled trials are still needed. Furthermore, this review also presents the application and the progress of robotic-assisted MIE(RAMIE), demonstrates the current use of robotic technology during esophagectomies, meanwhile forecasts the future advancements of RAMIE. For the moment, the limitations of RAMIE to be widely used mainly include the cost and controlling of surgical indications, and we hope these can be settled in the coming years.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos , China , Humanos , Laparoscopia , Tempo de Internação , Estudos Prospectivos , Resultado do Tratamento
20.
Int J Mol Med ; 41(3): 1659-1664, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29286089

RESUMO

Breast cancer-specific gene 1 (BCSG1), also referred to as γ-synuclein (SNCG), is highly expressed in human infiltrating breast carcinomas, but not in normal or benign breast tissue. The present study aimed to evaluate the effects of BCSG1 siRNA delivered by lentiviral vector on breast cancer cells and investigate the underlying mechanisms. BCSG1 RNAi lentiviral vector was constructed and transfected into MDA-MB-231 cells. BCSG1 mRNA levels were determined by quantitative polymerase chain reaction analysis. Cell proliferation, migration and apoptosis were evaluated by using the cell counting kit­8, Transwell assay and flow cytometry, respectively, followed by western blotting to determine the relative levels of AKT, extracellular signal­regulated kinase (ERK), p-AKT and p-ERK expression. BCSG1 mRNA levels were significantly reduced in MDA-MB­231 cells following transfection of BCSG1 siRNA delivered by lentiviral vector. Cell migration and proliferation were significantly decreased and the cell cycle was arrested. Western blot analysis indicated that the protein levels of p-AKT and p-ERK were significantly lower in the BCSG1 siRNA-treated groups compared with the control and negative control groups. Therefore, BCSG1 siRNA delivered by lentiviral vector was able to significantly reduce BCSG1 expression, suppress cell migration and proliferation, possibly through the reduction of the protein levels of p-AKT and p-ERK.


Assuntos
Movimento Celular , Vetores Genéticos/metabolismo , Lentivirus/genética , Proteínas de Neoplasias/metabolismo , RNA Interferente Pequeno/metabolismo , gama-Sinucleína/metabolismo , Apoptose , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Ciclo Celular , Linhagem Celular Tumoral , Proliferação de Células/genética , MAP Quinases Reguladas por Sinal Extracelular/metabolismo , Feminino , Humanos , Proteínas de Neoplasias/genética , Fosforilação , Proteínas Proto-Oncogênicas c-akt/metabolismo , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , gama-Sinucleína/genética
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