Icotinib, an EGFR tyrosine kinase inhibitor, as adjuvant therapy for patients with stage IIA-IIIA EGFR-mutant non-small-cell lung adenocarcinoma: a multicenter, open-label, single-arm, phase II study (ICAPE).

The survival benefit of icotinib (an oral epidermal growth factor receptor [EGFR] tyrosine kinase inhibitor) in patients with advanced lung cancer has been confirmed in several studies. This study (ICAPE) evaluated the efficacy of icotinib as adjuvant therapy for patients with stage IIA-IIIA EGFR-mutant non-small-cell lung adenocarcinoma. Patients with stage IIA-IIIA EGFR-mutant non-small-cell lung adenocarcinoma were enrolled in the multicenter, open-label, single-arm, phase II study. Eligible patients received oral icotinib 125 mg thrice daily for 1.5 years after complete surgical resection. The primary endpoint was disease-free survival (DFS). Between March 2014 and January 2018, 79 patients were enrolled. The median follow-up time was 39.7 months with a median DFS and overall survival (OS) of 41.4 months (95% CI: 33.6-51.8) and 67.0 months (95% CI: 21.2-not reached [NR]), respectively. The 1-year, 3-year, and 5-year OS rates were 100%, 83.3%, and 61.7%, respectively. No significant difference was found in the median DFS between patients with Bcl-2 interacting mediator of cell death (BIM) mutant-type and wild-type (NR vs. 41.7 months; p = 0.75). No significant difference was found in the median DFS according to EGFR mutation types. Icotinib as adjuvant therapy demonstrated a favorable survival benefit in patients with stage IIA-IIIA EGFR-mutant non-small-cell lung adenocarcinoma, indicating that icotinib might be a promising treatment option for this patient population. The optimal adjuvant duration of icotinib is still not clear and needs more incoming data to answer.

Placental transmogrification of the lung: Case report and systematic review of the literature.

OBJECTIVE: Placental transmogrification of the lung (PTL) is rare cystic lesion. Thus, we summarized the characteristics of PTL to explore the strategy of diagnosis and treatment. METHODS: Two patients pathologically confirmed PTL were treated in our hospital. Retrospectively analysis was performed on such 2 cases and 34 cases of PTL reported in abroad. The basic information and clinical characteristics from each patient were gathered and analyzed. RESULTS: The imaging findings of 2 patients were the pulmonary solid mass with peripheral multiple pulmonary bullae. After the improvement of preoperative examination and the multidisciplinary discussion of thoracic surgery, respiration, imaging, and anesthesia, the possibility of benign pulmonary lesions was improved in all cases. Thoracoscopic lobectomy was carried out under general anesthesia, and the intraoperative frozen pathology showed bullae of lung. Ultimately, PTL was confirmed by paraffin pathological diagnosis. Both 2 PTL patients had satisfied recovery without obvious complications or imaging abnormalities. In addition, the literature review of 34 PTL cases from PubMed database was summarized between 1995 and 2015. A total of 36 patients were retrospectively analyzed in our study. The age of 34 cases ranged from 24 to 72 years (an average age of 45.6 ±â€Š13.5 years). Among these, 8 cases were no obvious symptoms. In addition, the other 25 cases had respiratory symptoms such as chest tightness, cough, and chest pain. Moreover, the mean size of pulmonary bulla was 6.5 ±â€Š5.5 cm. The size of the solid lesions in 23 cases was 3.3 ±â€Š3.4 cm (ranging from 0.5 to 15). The follow-up period was 2 to 96 months (average 27.3 ±â€Š29.8 months). CONCLUSION: Early diagnosis and surgical operation of PTL should be performed as soon as possible. These lesions are best treated by minimally invasive surgery, so as to preserve more normal lung tissue and avoid the pneumonectomy.

[The effects of general anesthesia combined with epidural anesthesia on the stress response in thoracic surgery].

OBJECTIVE: To study the effects of general anesthesia combined with epidural anesthesia (GEA) and pure general anesthesia (GA) on the surgical stress response and cytokines in pulmonary surgery. METHODS: Twenty patients submitted to elective pulmonary surgery were randomly divided into 2 groups of 10 patients: GEA group receiving general anesthesia combined with thoracic epidural analgesia and GA group receiving only general anesthesia. Blood samples were taken before induction, at incision, 2 h, 4 h, 6 h following the incision, and in the 1st and 3rd postoperative day. IL-6, ACTH and cortisol were detected with radioimmunoassay. RESULTS: (1). The concentration of ACTH was similar in the 2 groups before operation, was remarkably increased 2 hours postoperatively (P < 0.05), reached the peak values 2 approximately 4 hours after the incision in most patients (P < 0.01), and returned to the preoperative levels one day after operation without a significant difference at every time point between the two groups. (2). The concentration of cortisol decreased transiently during incision in the GEA group (P < 0.05), then increased gradually, was significantly higher than the preoperative level (P < 0.01), and remained at the high level till the morning of the 1st day after operation (P < 0.01). In the GA group the cortisol concentration was higher than that before operation 2 hours after incision (P < 0.01), and remained at the level higher than that before operation 4 h and 6 h after incision (P < 0.01), and returned to the normal level by the morning of the 3rd day. The cortisol concentration 2 hours after incision in GEA group was significantly lower than that in GA group (P < 0.05), however, the peak concentrations of these 2 groups were not significantly different (P > 0.05). In the GA group the IL-6 concentration began to increase after operation, became significantly different from that before operation 4 hours after operation (P < 0.01), reached the peak level in the morning of the first postoperative day (P < 0.05), and returned to the preoperative level in the third day. In the GEA group the IL-6 concentration began to increase 2 hours after operation (P < 0.05), and returned to the preoperative level in the morning of the first postoperative day. The concentration of IL-6 was positively correlated with that of cortisol (r = 0.231). CONCLUSION: Pulmonary surgery performed with two different anesthetic techniques causes inflammatory cytokine responses. The additional epidural anesthesia doesn't influence cytokine production. It incompletely inhibits the stress response in the early phase. IL-6 and cortisol may have some effects on each other.

[Early postoperative pulmonary function study: changing curve and influencing factors analysis].

OBJECTIVE: To investigate the changes and influence factors for early postoperative pulmonary function of thoracotomy. METHODS: Pre- and early postoperative pulmonary function was detected in 64 consecutive cases with optimal thoracotomy. Pain assessment was conducted before pulmonary function test, and the chief complaints of patients were recorded after the procedure. The changing curves of pulmonary function were made and the differences associated with groups, surgical styles, pain assessment, epidural analgesia, chief complaint and preoperative conditions were analyzed using SPSS10.0 medical statistic software. RESULTS: Pulmonary function was severely lowered to (39 +/- 14)% of the base line on the first day. It was rehabilitated gradually, and recovered to (62 +/- 10)% of the base line on the 8th day. Epidural analgesia could improve pain relaxation and pulmonary function in some degree. Single-factor analysis showed that postoperative pain, postoperative day and surgical style were the significant influence factors for early postoperative pulmonary function. Multiple-factor analysis showed that preoperative pulmonary function, age and postoperative pain were the main factors, while surgical style had only weak effect on it. CONCLUSIONS: Early postoperative pulmonary function is severely impaired by thoracotomy. It rehabilitate gradually with time. Improvement of preoperative pulmonary function, reducing surgical procedure injuries, especially injury to respiratory muscle system, and enough postoperative pain relief are the most important means that will reduce pulmonary function impairment and consequently reduce postoperative pulmonary complications.

Surgical resection of sternal tumors and reconstruction with titanium mesh / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the use of titanium mesh reconstruction after sternal tumor resection.</p><p><b>METHODS</b>From January 2007 to January 2011, 14 patients with sternal tumors were admitted into Peking Union Medical Hospital. The clinical characteristics, surgical resection, and technique of reconstruction were reviewed.</p><p><b>RESULTS</b>Of the 14 patients, 3 had a metastatic sternal tumor, the primary sites of which were as follows: hepatic carcinoma in one case (metastasis 19 years after operation), breast carcinoma in another case (metastasis 5 years after operation), and renal carcinoma in the other case (found simultaneously). Two patients showed local involvement of the sternum: 1 had thymic carcinoma, and the other had myofibrosarcoma. The remaining 9 patients had primary tumors: 4 were osteochondroma, 3 chondrosarcoma, 1 eosinophilic granuloma, 1 non-Hodgekin's lymphoma. En bloc resection of the sternal tumor was performed in all the 14 patients. The defect was repaired with the titanium mesh adjusted to the shape of the defect and fixed with the stainless steel wire. Eleven patients were followed up for a period from 2 months to 4 years, during which no translocation or broken of the titanium mesh was observed.</p><p><b>CONCLUSIONS</b>Radical en bloc excision remains the treatment of choice for sternal tumors. Sternum defect reconstruction using titanium mesh as a rigid replacement proves appropriate and effective.</p>