Diagnosis and Treatment Evaluation of 48 Cases of Broncholithiasis.

Background Broncholithiasis is a rare disease with various clinical classifications. The aim of this study was to evaluate the imaging diagnosis and surgical treatment of broncholithiasis. Methods and Materials Forty-eight patients with broncholithiasis were enrolled in this retrospective study between January 1985 and December 2009. Patients were classified into intraluminal, transluminal, and extraluminal broncholith according to the anatomy between the calculus and the bronchial lumen confirmed by chest computed tomography (CT), bronchoscopy, and pathology after operation. Result Forty-eight patients were enrolled, with 33 males and 15 females. The sex ratio (male:female) was 2.2:1, and average age was 54.3 ± 13.6 years. There were 8, 19, and 21 patients in intraluminal, transluminal, and extraluminal broncholith group, respectively. Cough, hemoptysis, and chest pain were the most common symptoms. Four patients with intraluminal broncholith and two with transluminal broncholith underwent broncholith removal via bronchoscopy, and the other 42 patients underwent thoracotomy. Conclusion Bronchoscopy combined with CT examination is helpful in diagnosing and typing broncholithiasis. An optimal treatment method, either bronchoscopic removal of broncholithiasis or thoracotomy, according to the clinical typing and indications, is the key to improve the treatment effect.

Common genetic variants on 3q28 contribute to non-small cell lung cancer susceptibility: evidence from 10 case-control studies.

The association between common variations (rs10937405, rs4488809) on 3q28 and lung cancer has been widely evaluated in various ethnic groups, since it was first identified through genome-wide association approach. However, the results have been inconclusive. To derive a more precise estimation of the relationship and the effect of factors that might modify the risk, we performed this meta-analysis. The random-effects model was applied, addressing heterogeneity and publication bias. A total of 10 articles involving 36,221 cases and 58,108 controls were included. Overall, the summary per-allele OR of 1.19 (95 % CI 1.14-1.25, P < 10(-5)) and 1.17 (95 % CI 1.10-1.23, P < 10(-5)) was found for the rs10937405 and rs4488809 polymorphisms, respectively. Significant results were also observed in heterozygous and homozygous when compared with wild genotype for these polymorphisms. Significant results were found in East Asians when stratified by ethnicity, whereas no significant associations were found among Caucasians. After stratifying by sample size, study design, control source and sex, significant associations were also obtained. In addition, our data indicate that these polymorphisms are involved in lung cancer susceptibility and confer its effect primarily in lung adenocarcinoma when stratified by histological subtype. Furthermore, significant associations were also detected both never-smokers and smokers for these polymorphisms. In conclusion, this meta-analysis demonstrated that rs10937405 and rs4488809 are a risk factor associated with increased non-small cell lung cancer susceptibility, particularly for East Asian populations.

Association between CLPTM1L polymorphisms (rs402710 and rs401681) and lung cancer susceptibility: evidence from 27 case-control studies.

Genome-wide association studies have identified two SNPs (rs402710 and rs401681) of CLPTM1L at chromosome 5p15.33 as a new lung cancer (LC) susceptibility locus in populations of European descent. Since then, the relationship between these SNPs and LC has been reported in various ethnic groups; however, these studies have yielded inconsistent results. To investigate this inconsistency, we performed a meta-analysis of 27 studies involving a total of 60,828 cases and 109,135 controls for the two polymorphisms to evaluate its effect on genetic susceptibility for LC. An overall random-effects per-allele odds ratio of 1.14 (95% CI 1.11-1.16, P < 10(-5)) and 1.15 (95% CI 1.12-1.19, P < 10(-5)) was found for the rs401681 and rs402710 polymorphism, respectively. Significant results were also observed for under dominant and recessive genetic models. After stratified by ethnicity, significant associations were found among Caucasians and East Asians. In the subgroup analysis by sample size, significantly increased risks were found for these polymorphisms in all genetic models. In addition, we find both rs402710 and rs401681 conferred significantly greater risks for adenocarcinoma and squamous cell carcinoma when stratified by histological type of tumors. Furthermore, associations of these polymorphisms with LC risk were observed among current smokers and former smokers, as well as never smokers. Our findings demonstrated that rs402710 and rs401681 are risk-conferring factors for the development of lung cancer.

[Clinical analysis of 81 cases of pulmonary cryptococcosis].

OBJECTIVE: To clarify the clinical feature, diagnosis and therapy of the pulmonary cryptococcosis (PC). METHODS: A retrospective study of cases with PC who were diagnosed by pathological examinations between January 1996 and December 2010 was conducted. Eighty-one cases were enrolled in the study (58 male and 23 female patients; mean age of (51±11) years). Forty-one cases were asymptomatic at the time of diagnosis. There were single pulmonary lesions in 50 cases, and multiple lesions in 31 cases. Fourteen lesions (17.3%) were located in left upper lobe, 27 (33.3%) in left lower lobe, 21 (25.9%) in right upper lobe, 3 (3.7%) in right middle lobe, 28 (34.6%) in right lower lobe, and 3 (3.7%) diffusely involved bilateral lungs. The tumors ranged from 0.8 to 10.0 cm in diameter with a mean of (2.9±1.8) cm. All the cases were misdiagnosis prior to the surgical resection, and histologically confirmed by postoperative pathological specimens. RESULTS: All the cases received surgical treatment including complete resection in 69 cases, and palliative resection in 12 cases. Resections were performed by means of video-assisted thoracoscopy in 31 cases and thoracotomy in 50 cases. Surgical resections included pulmonary wedge excisions in 42 cases, and lobectomies in 39 cases. After histological confirmation, 63 cases (77.8%) were treated with antifungal agents, which consisted of fluconazole in 38 cases, itraconazole in 18 cases, amphotericin B in 6 cases, and flucytosine in 4 cases. There were no intraoperative death, but two cases died for cryptococcal meningoencephalitis in the postoperative period. Operative morbidity occurred in 7 (8.6%) cases. The median follow-up was 42.5 months (6 to 84 months). There were 2 local relapses of PC, and 9 cases with complications of anti-fungal agents. CONCLUSIONS: The clinical manifestations of PC are mild and non-specific, with no characteristic radiographic manifestations. Surgical resection is usually indicated for definite diagnosis and treatment. Antifungal drug therapy is indispensable even after complete resection.

[Surgery treatment for pulmonary sclerosing hemangioma].

OBJECTIVE: To investigate the clinicopathological features and surgical treatment of pulmonary sclerosing hemangioma (PSH). METHODS: Clinic data of PSH patients admitted by surgical resection from January 1985 to December 2010 was analyzed retrospectively. One hundred and sixty-five patients were enrolled in the study. There were 27 male and 138 female patients with a mean age of (48 ± 13) years. Seventy-nine patients were asymptomatic at the time of diagnosis. Eighty-nine tumors arose in the right lung (27 in right upper lobe, 24 in right middle lobe, 34 in right lower lobe, 2 in right upper lobe with invasion of right middle lobe, 1 in right middle lobe with invasion of right lower lobe, and 1 case with multiple lobe lesions), 75 in the left (33 in left upper lobe, 42 in left lower lobe), and 1 in the bilateral. There were huge mass lesions in 2 cases, endobronchial lesions in 2 cases, and multiple lesions in 6 cases. The mean size of the lesion was (2.6 ± 0.9) cm (ranging from 0.9 to 10.0 cm). Forty-eight cases (29.1%) were misdiagnosed as malignancies preoperatively, and 41 cases (24.8%) were misdiagnosed intraoperatively. RESULTS: Resections were performed by means of video-assisted thoracoscopy (n = 53) and thoracotomy (n = 112). Surgical resection included pulmonary wedge excision in 61 patients, lobectomy in 89 patients, right bilobectomy in 5 patients, anatomic segmentectomy in 2 patient, enucleation in 6 patients, and synchronous bilateral pulmonary wedge resection in 1 patient. Operative mortality and morbidity occurred in 0 and 2 (4.3%) patients, respectively. Mean follow-up was 34.7 months (ranging from 6 to 62 months). There was no local recurrence or death from PSH. CONCLUSIONS: PSH is a rare benign lung tumor. It is difficult to make accurate diagnosis preoperatively, and sometimes even intraoperative frozen sections can't differentiate it from malignant tumors. Surgical resection is usually indicated for definite diagnosis and treatment. Partial resection is a sufficient treatment in view of uncommon tumor recurrence. Thoracoscopic surgery is recommended for PSH.

[Cytokine responses after lobectomy for early non-small cell lung cancer: a prospective randomized comparison of video-assisted thoracic surgery and open thoracotomy].

OBJECTIVE: To compare video-assisted thoracic surgery (VATS) and open thoracotomy (OT) on acute inflammatory responses and immunosuppression after lobectomy for early non-small cell lung cancer (NSCLC). METHODS: Present prospective randomized study. OT or VATS lobectomy was performed in patients who met enter criteria and clinical data was collected. Plasma concentration of IL-6, IL-8 and IL-10 were measured before surgery and at postoperative day (POD) 1 and POD 3. There were 271 patients underwent lobectomy for early NSCLC, including of 133 patients in group VATS and 138 patients in group OT from January 2007 to June 2008. There were 132 males and 139 females, aging from 19 ∼ 70 years with a mean of (56 ± 8) years. RESULTS: Compared with OT group, shorter postoperative hospital stay [(8.2 ± 2.5) d vs. (9.8 ± 6.2) d, P = 0.03], lower morbidity rate (11.3% vs. 21.7%, P = 0.02) and lower increase of plasma concentration of IL-6 at POD 1 [(35 ± 25)% vs. (65 ± 43)%, P = 0.00], IL-6 at POD 3 [(14 ± 22)% vs. (55 ± 44)%, P = 0.00] and IL-10 at POD 1 [(25 ± 20)% vs. (43 ± 35)%, P = 0.00] were observed in patients of VATS group. CONCLUSION: VATS lobectomy for early NSCLC is associated with less acute inflammatory responses and less immunosuppression when compared with OT.

The role of survivin on overall survival of non-small cell lung cancer, a meta-analysis of published literatures.

The prognostic value of survivin for survival of patients with non-small cell lung cancer (NSCLC) remains controversial. The authors performed a meta-analysis of the literatures in order to clarify its impact. Published studies were identified using an electronic search in order to aggregate the available survival results. To be eligible, a study had to have dealt with survivin assessment in NSCLC patients on the primary site and have analyzed survival according to survivin expression. There were 10 eligible studies and data from eight studies where non-location specific immunohistochemistry (IHC) definition system, in situ hybridization (ISH) and RT-PCR used were combined to present the impact of survivin on overall survival (OS) of NSCLC. The level of survivin expression correlated with the OS of NSCLC patients significant (RR 1.88, 95% CI 1.31-2.70, P=0.0006). Data of seven studies were combined to demonstrate that the level of survivin correlated with the OS of NSCLC patients who had received radical surgeries (RR 1.79, 95% CI 1.45-2.20, P<0.00001). Data from three studies were combined to find that the level of nuclear survivin did not have impact on OS of NSCLC patients (RR 1.58, 95% CI 0.87-2.85, P=0.13). Positive-survivin expression might be a prognostic factor for NSCLC patients, nuclear survivin positivity could not work as a prognostic factor for NSCLC patients based on current clinical data. Larger clinical trails with widely accepted assessment methods are necessary to define the precise prognostic significance for survivin in NSCLC patients.

[Surgical treatment of pulmonary tuberculosis combined with endobronchial tuberculosis].

OBJECTIVE: To evaluate the experience of surgical treatment of pulmonary tuberculosis with endobronchial tuberculosis. METHODS: The clinical data of 85 patients with pulmonary tuberculosis and endobronchial tuberculosis undergoing surgical resection from 1967 to 2004 were reviewed retrospectively. Forty-five cases were bronchial stenosis. Four cases were tracheal stenosis. Sixteen cases underwent right upper lobectomy. One case underwent right upper and middle lobectomy. Three cases underwent right middle lobectomy. Five cases underwent right middle and lower lobectomy. Two cases underwent right lower lobectomy. Twelve cases underwent left upper lobectomy. Four cases underwent left lower lobectomy. Eight cases were assisted with sleeve lobectomy. Six cases underwent right pneumonectomy (with partial tracheal resection and tracheal reconstruction in 3 cases). Thirty cases underwent left pneumonectomy. One case underwent left lower lobectomy who underwent left upper lobectomy 2 years ago. Four cases were assisted with sleeve pneumonectomy. Three cases underwent tracheal segment resection and tracheal reconstruction. One case underwent left upper bronchial and pulmonary artery sleeve resection. One case underwent biopsy. RESULTS: No surgical mortality occurred. There was 1 case of bronchopleural fistula and 1 case of empyema in the 35 cases (without sleeve lobectomy) who underwent lobectomy. There were 3 cases of bronchopleural fistula and 4 cases of empyema in the 33 cases (without sleeve pneumonectomy) who underwent pneumonectomy (P < 0.05). There were 5 cases of atelectasis in the 35 cases who underwent lobectomy and 3 cases of atelectasis in the 8 cases who underwent sleeve lobectomy (P < 0.01). In the follow-up of 3 to 10 years, 1 case died due to acute respiratory distress syndrome 7 years postoperatively. CONCLUSIONS: It is important to resect all the tissue which has been infected. With the routine anti-tuberculosis chemotherapy during the perioperative period, the effect of surgical treatment is superior to others. Fewer pneumonectomy is also important.

Mid-term effects of lung volume reduction surgery on pulmonary function in patients with chronic obstructive pulmonary disease.

BACKGROUND: Now lung volume reduction surgery (LVRS) has become one of the most effective methods for the management of some cases of severe chronic obstructive pulmonary disease (COPD). We evaluated the mid-term effects of LVRS on pulmonary function in patients with severe COPD. METHODS: Ten male patients with severe COPD aged 38 - 70 years underwent LVRS and their pulmonary function was assessed before, 3 months and 3 years after surgery. The spirometric and gas exchange parameters included residual volume, total lung capacity, inspiratory capacity, forced vital capacity, forced expiratory volume in one second, diffusion capacity for CO, and arterial blood gas. A 6-minute walk distance (6MWD) test was performed. RESULTS: As to preoperative assessment, most spirometric parameters and 6MWD were significantly improved after 3 months and slightly 3 years after LVRS. Gas exchange parameters were significantly improved 3 months after surgery, but returned to the preoperative levels after 3 years. CONCLUSIONS: LVRS may significantly improve pulmonary function in patients with severe COPD indicating for LVRS. Mid-term pulmonary function 3 years after surgery can be decreased to the level at 3 months after surgery. Three years after LVRS, lung volume and pulmonary ventilation function can be significantly improved, but the improvement in gas exchange function was not significant.

[Diffuse myxoid malignant fibrous histiocytoma of the pleura: a case report and review of the literature].

OBJECTIVE: To study the clinicopathologic characteristics of diffuse myxoid malignant fibrous histiocytoma (MFH) of pleura. METHODS: The clinical and pathological features of a patient with diffuse myxoid MFH of pleura from this hospital were analyzed, and the reported literature of 7 patients with MFH of pleura were reviewed. RESULTS: The patient was a 65-year-old male. The primary manifestations were cough, chest pain, breathlessness, and a great quantity of bloody pleural effusion. Chest CT scan showed diffuse masses on the visceral and parietal pleura. Exploratory thoracotomy exposed diffuse translucent gray-white masses on the surface of visceral and parietal pleura, with diameters of 1 - 8 cm. Microscopic findings showed that diffuse spindle-shaped and pleomorphic tumour cells were within the myxoid stroma. Tumor cells were positive for vimentin, CD(68), lysozyme, and negative for CK, EMA, and desmin. The patient died of obstruction of superior vena cava, and circulatory failure at 24th postoperative day. Different from cases with single or multiple MFH of pleura reported in the literature, this case of diffuse myxoid MFH had an abrupt onset, and progressed aggressively. CONCLUSION: Diffuse myxoid MFH of pleura is a very rare high-grade malignant tumor with very poor prognosis.

Nonintubated-Awake Anesthesia for Uniportal Video-Assisted Thoracic Surgery Procedures.

Nonintubated video-assisted thoracic surgery (VATS) strategies are gaining popularity. This review focuses on noninutbated VATS, and discusses advantages, indications, anesthetic techniques, and approaches to intraoperative crisis management. Advances in endoscopic, endovascular, and robotic techniques have expanded the range of surgical procedures that can be performed in a minimally invasive fashion. The nonintubated thoracoscopic approach has been adapted for use with major lung resections. The need for general anesthesia and endotracheal intubation has been reexamined, such that regional or epidural analgesia may be sufficient for cases where lung collapse can be accomplished with spontaneous ventilation and an open hemithorax.

[Detection of micrometastasis in mediastinal lymph nodes in operable non-small cell lung cancers].

OBJECTIVE: Using the LUNX-mRNA as a marker and RT-PCR technique to assess mediastinal lymph nodes in patients with operable NSCLC, to evaluate at gene level the feasibility of this method in detection of micrometastasis in NSCLC and the necessity of systematic mediastinal lymphadenectomy during surgery. METHODS: Twenty patients with operable NSCLC were involved in this study. The mediastinal lymph nodes were taken during operation. RT-PCR assay was carried out to detect the LUNX-mRNA. Ten cases with benign lung disease were assayed by the same method as control. RESULTS: Seventy one mediastinal lymph nodes were obtained from 20 patients, 8 (11.3%) of which showed histologically metastasis with HE staining, while 23 (32.4%) were LUNX-mRNA positive by RT-PCR, P < 0.001. Micrometastasis was detected in 25.4% of all lymph nodes. LUNX-mRNA was found to be positive in 23.6% of lymph nodes from 15 patients with stage I A-II B NSCLC compared with 62.5% from 5 patients with stage III NSCLC, with a significant difference (P = 0.003). CONCLUSION: About 25.4% of mediastinal lymph nodes are with micrometastasis in patients with operable NSCLC. Systematic mediastinal lymphadenectomy is necessary to deal with the regional lymph nodes during surgery.

[Surgical treatment of multi-drug resistant pulmonary tuberculosis in 188 cases].

OBJECTIVE: Multi-drug resistant pulmonary tuberculosis (MDR-PTB) is a major cause of morbidity and mortality throughout the world currently. Optimal therapy for patients infected with MDR-PTB often requires surgical intervention to eradicate the infection. METHODS: During a 15-year period from 1990 to 2005, of the 906 cases receiving surgical treatment for pulmonary tuberculosis in Shanghai Pulmonary Disease Hospital, 188 patients with MDR-PTB underwent 200 surgical procedures. All the patients of MDR-PTB had received individualized multiple-drug chemotherapy at least 2 - 3 months before surgery, as determined by drug susceptibility studies. Of the surgical procedures, 85 lobectomies, 48 pneumonectomies and other complicated surgical techniques were performed respectively. Twelve patients underwent repeated operation. Muscle flaps and omentum in some cases were used to avoid residual space and bronchial stump problems. RESULTS: Operative mortality was 0.5% (1/200). Postoperative mortality was 3.2% (6/187). Significant morbidity was 13.9% (26/187). All of the patients had positive sputum at the time of surgery. After the operation, the sputum remained positive in only 2 patients. Mean length of follow-up was 6.7 years (range 3 - 180 months). All of the patients after surgery continued their individualized multiple-drug chemotherapy for 3 - 18 months. CONCLUSION: Surgery remains an important adjunct to medical therapy for the treatment of MDR-PTB. Surgical treatment should be considered for localized diseases, persistent sputum positivity, or intolerance of medical therapy.

[The clinical features of postoperative ventilator-associated pneumonia after lung surgery].

OBJECTIVE: To investigate the clinical features of postoperative ventilator-associated pneumonia (VAP) after lung surgery. METHODS: Of 104 patients who had undergone lung surgery and been treated with ventilator in our surgical intensive care unit between January 2003 and March 2005, 35 patients met with the criteria of both VAP and postoperative pneumonia (POP), and 41 cases had no evidences of pneumonia. The clinical and laboratory data of all 76 cases were recorded and analyzed by a statistical software package (SPSS). RESULTS: The diagnosis of postoperative VAP was established clinically in 35 patients (46.1%), and etiologically in 33 cases. Compared to the patients without postoperative VAP, the patients with postoperative VAP had a significantly longer mean interval between intubation and operation [(2.7 +/- 2.9) days vs. (1.6 +/- 1.7) days, P = 0.039], a longer duration of mechanical ventilation [(32.2 +/- 37.7) days vs. (4.2 +/- 2.9) days, P < 0.001], and higher morbidity (20.0% vs. 2.4%, P = 0.013). There was a significant difference in mean duration of mechanical ventilation between the 15 cases of early-onset VAP and 20 cases of late-onset VAP (17 +/- 15 days vs. 43 +/- 46 days, P = 0.042). Among the initially detected pathogen, Staphylococcus aureus remains the most common Gram-positive coccus whereas Acinetobacter Baumannii took the place of Pseudomonas aeruginosa as the top Gram-negative rod. CONCLUSION: Postoperative VAP after lung surgery has different clinical features from VAP in medical ICU.

Subxiphoid uniportal video-assisted thoracoscopic surgery (VATS) for lobectomy: a report of 105 cases.

BACKGROUND: To address the feasibility and advantages of subxiphoid uniportal video-assisted thoracoscopic surgery (VATS) for lobectomy. METHODS: Since August 2014, 105 cases of subxiphoid uniportal VATS lobectomy were successfully performed. The clinical information was retrospectively analyzed. RESULTS: 96 cases underwent unilateral operation and 9 underwent bilateral operations. Surgeries were successfully performed with a complication rate of 10.5%. The average pain scores 8 hours, day 1, 2 and 3 after surgery, as well as the day before discharge were 2.39±0.99, 2.06±0.85, 1.68±0.87, 1.29±0.78, and 0.48±0.51, respectively, which were significantly lower than those in the control group (standard intercostal uniportal VATS) (P<0.001). CONCLUSIONS: The subxiphoid uniportal VATS lobectomy is safe and reliable, which is appropriate for bilateral lung diseases, and significantly relieves postoperative incision pain.

[Surgical management for pulmonary metastasis].

OBJECTIVE: To investigate the indications of resection for lung metastasis, the surgical procedure and factors affecting the survival based on our experience accumulated for 37 years. METHODS: A total of 108 patients with pulmonary metastasis was treated by surgery. Pathology showed 93 carcinoma (86.1%) and 15 (13.9%) sarcoma. Totally 122 operations were performed: partial lung resection 51, segmental lobectomy 7, lobectomy 40, pneumonectomy 15. RESULTS: After surgery, the cumulative 1-, 3-, 5-, 7- and 10-year post-thoracotomy survivals were 87.9%, 47.3%, 31.7%, 23.7% and 13.9%, with an overall median survival of 34.8 months. Solitary lesions, disease-free interval (DFI) > 36 months, absence of extrathoracic disease and "open" thoracotomy were predictors of a longer survival whereas age, gender, symptom and pathology of the primary tumor were found statistically insignificant prognostic factors. CONCLUSION: Surgery should be undertaken for patients who do fulfill these criteria, and "open" thoracotomy is a better choice. Surgical treatment for patients with short DFI and multiple lesions should be attempted with prudence.

[Skip metastasis to mediastinal lymph nodes: clinical significance and prognosis in stage III non-small cell lung cancer].

OBJECTIVE: To analyze the significance and prognosis of skip metastasis to mediastinal lymph nodes in stage III non-small cell lung cancer (NSCLC). METHODS: The data of 65 patients who underwent resection for NSCLC with a pN(2)-stage were analyzed retrospectively. Twenty-one of these patients (32.3%), showing no metastatic involvement of hilar (N(1)) lymph nodes, were compared to the remaining 44 patients with infiltration of hilar nodes (N(1)) as well as N(2) nodes. Software SPSS 10.0 was used for statistical analysis. RESULTS: Multivariate analysis showed no statistically significant difference between the skip metastasis and the continuous N(2) group regarding sex, age, histology, location, and T-or M-status. In the skip metastasis group, mediastinal node metastasis was found in >or=2 region in 16 patients (36.4%) and in continuous N(2) group in 2 patients (9.5%, chi(2) = 8.571, P = 0.036). The 5-year survival rate of pN(2) patients with skip metastasis was 41% compared to 21% in patients with involvement of N(1) and N(2) nodes (P = 0.022 6), and the mean survival time was 44 months and 26 months respectively. CONCLUSIONS: pN(2) patients with mediastinal lymph node skip metastasis have a more favorable prognosis compared to pN(2) patients with continuous infiltration of the regional lymph nodes. Skip metastasis is an independent prognostic factor for survival. Skip metastasis may represent a subgroup of pN(2) classification.

[Cooccurrence of pulmonary tuberculosis and carcinoma: diagnosis and the prognostic factors for surgical effects].

OBJECTIVE: To study the association, clinical diagnosis and treatment of the coexistence of lung cancer and tuberculosis. METHODS: Sixty-five patients with coexistence of lung cancer and tuberculosis underwent surgical treatment in our hospital between 1954.1 and 2004.3. Twelve factors possibly influencing the survival were selected. A multivariate analysis of these individual variables was performed using the cumulative survival rate by the computer' COX proportional hazard model. RESULTS: Histologically, there were 41 cases of squamous cell carcinoma, 15 adenocarcinoma, 3 small cell carcinoma and 6 mixed carcinoma. Chest radiological study showed infiltrative tuberculosis in 41, military tuberculosis in 2, and chronic fibrocavitary tuberculosis in 22 cases. Of these, wedge excision was performed in 4, lobectomy in 38, bilobectomy in 4, pneumonectomy in 17 and palliative resection in 2 patients. There was no operative mortality. Follow-up showed that 1-, 3- and 5-year survival was 67.7% (44/65), 35.4% (23/65), and 23.1% (15/65) respectively. Clinical analysis showed that the major significant prognostic factors influencing survival were malignancy occurred in local tuberculosis, the operation procedures for lung cancer, and the stage of lung cancer (P < 0.01). CONCLUSIONS: The occurrence of lung cancer is highly correlated to the site of tuberculosis. The recognize of this can facilitate the early diagnosis and resection of malignancy as well as the initiation of regular medical therapy.