Comparative study of systematic thoracoscopic lymphadenectomy and conventional thoracotomy in resectable non-small cell lung cancer

Objective

To assess the feasibility and safety of the video-assisted thoracoscopy surgery (VATS) systematic lymph node dissection in resectable non-small cell lung cancer (NSCLC).

Methods

The clinical data of patients with NSCLC who underwent VATS or thoracotomy combined with lobectomy and systematic lymphadenectomy from January 2001 to January 2008 were retrospectively analyzed to identify their demographic parameters, number of dissected lymph nodes and postoperative complications.

Results

A total of 5,620 patients were enrolled in this study, with 2,703 in the VATS group, including 1,742 men (64.4%), and 961 women (35.6%), aged 59.5±10.9 years; and 2,917 in the thoracotomy group, including 2,163 men (74.2%), and 754 women (25.8%), aged 58.5±10.4 years. Comparing the VATS with the thoracotomy groups, the mean operative time was 146 vs. 157 min, with a significant difference (P<0.001); and the average blood loss was 162 vs. 267 mL, with a significant difference (P<0.001). Comparing the two groups of patients data, the number of lymph node dissection: 18.03 in the VATS group and 15.07 in the thoracotomy group on average, with a significant difference (P<0.001); postoperative drainage time: 4.5 days in the VATS group and 6.37 days in the thoracotomy group on average, with a significant difference (P<0.001); postoperative hospital stay: 6.5 days in the VATS group and 8.37 days in the thoracotomy group on average, with a significant difference (P<0.001); proportion of postoperative chylothorax: 0.2% (4/2,579) in the VATS group and 0.4% (10/2,799) in the thoracotomy group, without significant difference (P>0.05).

Conclusions

For patients with resectable NSCLC, VATS systematic lymph node dissection is safe and effective with fewer postoperative complications, and significantly faster postoperative recovery compared with traditional open chest surgery.     

非小细胞肺癌纵隔淋巴结转移特点临床探讨

目的在可切除的非小细胞肺癌（non-small cell lung cancer,NSCLC）患者手术治疗中,对纵隔淋巴结的清扫范围国内外学者仍有较大争议。本研究目的在于总结NSCLC纵隔淋巴结转移特点,为手术治疗NSCLC时正确处理纵隔淋巴结提供理论依据。方法按Naruke等肺癌淋巴结分布图对168例NSCLC施行肺叶（全肺）切除加同侧纵隔淋巴结系统性廓清术,分析病理证实的纵隔淋巴结转移频度及分布情况。结果手术共清除纵隔淋巴结1143组,平均每例清扫6.8组,病理证实有纵膈淋巴结癌细胞转移（N2）的332组,N2转移率29.0％。最大径≤3cm（T1）肿瘤和最大径〉3cm（T2）肿瘤间淋巴结转移差异有统计学意义（P〈0.05）。鳞癌、腺癌发生3组或3组以上纵隔淋巴结转移者分别为33.3％、42.4％。N2跳跃式转移发生率为14.3％。结论在上叶癌以上纵隔淋巴结转移居多,中下叶癌则跨区域转移居多。淋巴结转移具有跳跃性、跨区域性和多发性特点。     

Predictive risk factors for lymph node metastasis in patients with small size non-small cell lung cancer

Background

Accurate clinical staging of non-small cell lung cancer (NSCLC) is essential for developing an optimal treatment strategy. This study aimed to determine the predictive risk factors for lymph node metastasis, including both N1 and N2 metastases, in clinical T1aN0 NSCLC patients.

Methods

We retrospectively evaluated clinical T1aN0M0 NSCLC patients who showed no radiologic evidence of lymph node metastasis, and who had undergone surgical pulmonary resection with systematic mediastinal node dissection or sampling at the First Affiliated Hospital of Zhejiang University between January 2011 and June 2013. Univariate and multivariate logistic regression analyses were performed to identify predictive factors for node metastasis.

Results

Pathologically positive lymph nodes were found in 16.2% (51/315) of the patients. Positive N1 nodes were found in 12.4% (39/315) of the patients, and positive N2 nodes were identified in 13.0% (41/315) of the patients. Some 9.2% (29/315) of the patients had both positive N1 and N2 nodes, and 3.8% (12/315) of the patients had nodal skip metastasis. Variables of preoperative radiographic tumor size, non-upper lobe located tumors, high carcinoembryonic antigen (CEA) levels and micropapillary predominant adenocarcinoma (AC) were identified as predictors for positive N1 or N2 node multivariate analysis.

Conclusions

Pathologically positive lymph nodes were common in small size NSCLC patients with clinical negative lymph nodes. Therefore, preoperative staging should be performed more thoroughly to increase accuracy, especially for patients who have the larger size, non-upper lobe located, high CEA level or micropapillary predominant ACs.     

Inflammatory cytokines in robot-assisted thoracic surgery versus video-assisted thoracic surgery

BackgroundCytokines play a crucial role in the inflammatory response and are essential modulators of injury repair mechanisms. While minimally invasive operations have been shown to induce lower levels of cytokines compared to open thoracotomy, the inflammatory cytokine profile difference between video-assisted (VATS) and robotic-assisted thoracic surgery (RATS) techniques has yet to be elucidated.MethodsIn this prospective observational study of 45 patients undergoing RATS (n=30) or VATS (n=15) lung resection for malignancy, plasma levels of interleukin (IL)-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, vascular endothelial growth factor (VEGF), interferon (IFN)-γ, tumor necrosis factor (TNF)-α, monocyte chemo-attractant protein (MCP)-1, and endothelial growth factor (EGF) were measured before and after surgery via immunoassay.ResultsLevels of IL-6 and MCP-1 were significantly higher in patients undergoing VATS than in patients undergoing RATS (P<0.001 and P=0.005, respectively) 2 hours following surgery. MCP-1 levels were also found to be significantly higher in the VATS group (P<0.001) 24 hours following surgery. IL-1α, IL-1β, IL-2, IL-4, IL-8, IL-10, IFN-γ, TNF-α, and EGF levels were not significantly different at any time-point comparing VATS to RATS.ConclusionsThe VATS approach is associated with a more robust pro-inflammatory cytokine response through the upregulation of MCP-1 and IL-6 when compared to the RATS approach in patients undergoing anatomic lung resection. Further studies are necessary to validate the clinical significance of this finding.     

Radical systematic mediastinal lymphadenectomy versus mediastinal lymph node sampling in patients with clinical stage IA and pathological stage T1 non-small cell lung cancer

Purpose  To explore the appropriate method of mediastinal lymph node dissection for selected clinical stage IA (cIA) non-small cell lung cancer (NSCLC). Methods  From 1998 through 2002, the curative-intent surgery was performed to 105 patients with cIA NSCLC who had been postoperatively identified as pathologic-stage T1. According to the method of intraoperative medistinal lymph node dissection, they were divided into radical systematic mediastinal lymphadenectomy (LA) group (n = 42) and mediastinal lymph-node sampling (LS) group (n = 63). The effects of LS and LA on morbidity, N staging, overall survival (OS) and disease-free survival (DFS) were investigated. Also, associations between clinicopathological parameters and survival were analyzed. Results  The mean numbers of dissected lymph nodes per patient in the LA group was significantly greater than that in the LS group (15.59 ± 3.08 vs. 6.46 ± 2.21, P < 0.001), and the postoperative overall morbidity rate was higher in the LA group than that in the LS group (26.2 vs. 11.1%, P = 0.045). There were no significant difference in migration of N staging, OS and DFS between two groups. However, for patients with lesions between 2 and 3 cm, the 5-year OS in LA group was significantly higher than that in LS group (81.6 vs. 55.8%, P = 0.041), and the 5-year DFS was also higher (77.9 vs. 52.5%, P = 0.038). For patients with lesions of 2 cm or less, 5-year OS and DFS were similar in both groups. Multivariate analysis showed that lymph node metastasis was the unique unfavorable prognostic factor (P < 0.001). Conclusions  After being intraoperatively identified as stage T1, patients with lesions between 2 and 3 cm in cIA NSCLC should be performed with LA to get a potentially better survival, and patients with lesions of 2 cm or less should be performed with LS to decrease invasion.     

112例非小细胞肺癌淋巴结转移规律分析

目的分析112例非小细胞肺癌淋巴结的转移规律。方法对112例肺癌患者施行手术切除并行广泛肺门、叶间及纵隔淋巴结清扫术。术后病理资料进行统计分析。结果在共清除898组淋巴结中,单纯N1淋巴结转移率为24.1%,N2(包括N1+N2)淋巴结转移率30.4%。原发肺癌(T)分期T1、T2、T3间淋巴结转移率差异有统计学意义(P0.01)。跳跃式转移占N2转移的35.3%。结论非小细胞肺癌的淋巴结转移与T分期有关,具有较多的跳跃性纵隔淋巴结转移发生,肿瘤部位及肺癌的病理学类型与淋巴结的转移无明显关系。外科治疗中应注意广泛清扫肺内、同侧纵隔淋巴结才有可能达到根治目的。     

Positive nodal status is still a risk factor for long-term survivors of non-small cell lung cancer 5 years after complete resection

BackgroundLung cancer has a poor prognosis; the number of long-term survivors (LTSs) is small compared with that of other cancers. Few studies have focused on late recurrence in LTSs with lung cancer. The purpose of this study was to analyze the risk factors for survival and late recurrence in LTSs after disease-free period of 5 years.MethodsA retrospective analysis of patients with a disease-free survival of at least 5 years after surgical resection for non-small cell lung cancer (NSCLC) between January 1998 and December 2012 was conducted. Patients who underwent neo-adjuvant therapy, had an incomplete resection, or had advanced stage (stages IIIb and IV) cancer were excluded.ResultsA total of 1,254 (53.2%) of 2,357 patients were enrolled. Of these, 759 (60.5%) were men, and the mean patient age was 61.9±10.1 (range, 10–87 years) years. Pathologic N0 (997 patients, 79.5%) and stage I (860 patients, 68.6%) were the dominant stages. Late recurrence occurred in 22 patients (1.8%) 5 years postoperatively. On multivariate analysis, male sex, older age, node-positive status, and late recurrence were found to be independent risk factors for overall survival (OS), while a node-positive status was the only independent risk factor for disease-free survival [hazard ratio (HR) =3.824; P=0.002; 95% confidence interval (CI): 1.658–8.821].ConclusionsThe nodal stage at the time of surgical resection was found to be an independent risk factor for both OS and disease-free survival 5 years after initial treatment in patients with completely resected NSCLC.     

Preoperative inflammation-based scores predict early recurrence after lung cancer resection

BackgroundInflammation in the tumor microenvironment is hypothesized to have a major role in cancer invasiveness, progression, and metastases. The purpose of this study was to evaluate the prognostic value of preoperative inflammation-based scores in terms of estimating the timing of recurrence by hazard curves in a cohort of operable, early-stage non-small cell lung cancer (NSCLC) patients.MethodsA total of 387 patients with NSCLC who underwent complete pulmonary resection from 2010 to 2019 had their C-reactive protein-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), Glasgow prognostic score (GPS), modified GPS, systemic immune-inflammation index (SII), and advance lung cancer inflammation index (ALI) measurements taken before surgery. Hazard curves indicating changes in hazards over time were evaluated.ResultsMedian follow-up was 39.2 months. In total, 105 patients (27.1%) experienced recurrence. The resulting hazard curve with elevated CAR, SII, GPS, and mGPS, values displayed an initial high peak during the first year. Multivariate analyses showed that an elevated CAR [hazard ratio (HR), 1.987; 95% confidence interval (CI), 1.202–3.284] independently predicted the recurrence-free survival. Even in stage I disease, patients with elevated CAR and SII values showed an earlier peak of recurrence, which was about 12 to 16 months earlier than those with low values.ConclusionsEven after complete resection of stage I NSCLC, patients with elevated CAR and SII values retain a high risk of early recurrence. Preoperative inflammation-based scores can be an objective, simple, and cost-effective measurement for predicting early recurrence of NSCLC.     

非小细胞肺癌放射增敏的研究进展

肺癌是目前对人类威胁最大的肿瘤之一,在所有的肺癌患者中,非小细胞肺癌(non-small cell lung cancer,NSCLC)占75%~80%,70%的患者在确诊时已错过了根治性手术的机会,只能采取放化疗、靶向治疗的手段,但效果却不尽人意。因此,如何提高NSCLC的放疗敏感性是亟待解决的问题。该文就NSCLC放射增敏的研究进展作一综述。     

Comparison of surgical difficulty in patients with resectable non-small cell lung cancer under different neoadjuvant treatment modes: a retrospective cohort study

BackgroundPrevious studies have reported on the efficacy and safety of neoadjuvant use of a programmed cell death 1 (PD-1) antibody, sintilimab, in patients with non-small cell lung cancer (NSCLC). This study aimed to further evaluate the difficulty of this surgery and the postoperative complication rates in patients with NSCLC receiving neoadjuvant sintilimab.MethodsPatients who received neoadjuvant sintilimab (200 mg) in the Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital from March 2018 to March 2019 were enrolled in the neoadjuvant immunotherapy group (NI group). Another two cohorts who did not receive sintilimab were retrospectively selected by propensity score matching (PSM) at a ratio of 1:1 in the upfront surgery (M-US) and neoadjuvant chemotherapy (M-NC) groups. The postoperative complication rate, postoperative days (PODs), and other detailed objective indicators were compared by t-test or χ² test.ResultsThirty-seven patients were enrolled in each group. Postoperative complications were greater in the NI group (37.8%) than in the M-US (10.8%; P=0.013) or in the M-NC group (16.2%; P=0.036). The number of PODs (7) was greater in the NI group than in the M-US group (P=0.005). The total number of dissected lymph nodes was lower in the NI group than in the M-US group (P<0.001) or in the M-NC group (P<0.001). Lymph node dissection (LND) in the NI group was more difficult than in the M-US group (P=0.015), but intrathoracic adhesion, tumor invasion, and whole procedure difficulty were similar.ConclusionsThe administration of neoadjuvant sintilimab increased complications but did not increase the difficulty of surgery. Fewer lymph nodes were dissected in the NI group.     

Video-assisted thoracic surgery left S1+2+3 segmentectomy for lung cancer

A 49-year-old female presented with a solitary pulmonary nodule on the chest screening computed tomography (CT) scan. The nodule was 1.3 cm in diameter and located in the apical segment of left upper lobe. The lesion was considered to be cT1aN0M0 non-small cell lung cancer (NSCLC) and a 3-port video-assisted thoracic surgery (VATS) wedge resection was performed. Intraoperative frozen sections revealed a lung adenocarcinoma. Therefore, sequential S1+2+3 segmentectomy of the left upper lobe was performed, also systematic lymph node dissection was carried out. The final pathological stage was pT1aN0M0 (Ia).     

The impact of an N1 lymph node examination in patients with early-stage non-small cell lung cancer: a retrospective cohort study

BackgroundThe examination of lymph nodes (LNs) is critical for accurate node staging in patients with non-small cell lung cancer (NSCLC), but a consensus on the examinations of hilar and intrapulmonary (N1 station) LNs has not been reached. This study aimed to evaluate the role of LN dissection and pathological examination of N1 LN stations and their effects on survival in patients with stage IA-IIA NSCLC.MethodsData from patients pathologically staged as IA-IIA who underwent radical surgery and confirmed as lacking LN metastases from January 2008 to March 2018 were retrospectively reviewed. The Kaplan-Meier method was used to determine the overall survival (OS) and disease-free survival (DFS). After propensity score matching (PSM), a Cox model was used to determine the prognostic factors.ResultsOf the 1,935 patients investigated, the median number of N1 stations examined was 3. Patients with at least 2 N1 stations examined had apparently better OS (P=0.002) and DFS (P=0.001). All patients were divided into patients with 0–1 N1 station examined and patients with 2–5 N1 stations examined. After PSM, the number of N1 stations examined was an independent prognostic factor for DFS (P=0.004). Patients with 2–5 N1 stations examined experienced prolonged DFS (P=0.010). Patients in group 12 experienced prolonged OS (P=0.021) and DFS (P=0.026). Patients in group 13 or 14 experienced prolonged OS (P=0.028).ConclusionsA larger extent of N1 station examination was associated with prolonged DFS in patients with stage IA-IIA NSCLC after lobectomy. The dissection and examination of at least 2 N1 stations included LNs from the lobar and segmental drainage fields.     

Evaluation of local aggressive lung therapy versus systemic therapy in oligometastatic non-small cell lung cancer: a systematic review and meta-analysis

BackgroundPrevious studies have shown the feasibility and effectiveness of local aggressive thoracic therapy (surgery and radiotherapy) for oligometastatic non-small cell lung cancer compared with systemic therapy, but with small sample. This study aims to perform a pooled analysis to explore whether LT could improve outcomes of oligometastatic patients with non-small cell lung cancer.MethodsProtocol of present study was registered on PROSPERO as number: CRD42021233095. PubMed, Embase and Web of knowledge were searched, and eligible studies investigating local therapy for non-small cell lung cancer with 1–5 metastases regardless of organs were included. Linear regression between survival and clinical characteristics were conducted. Hazard ratios of survival and adverse effects were merged. Pooled survival curves were carried out.ResultsThree randomized controlled trials and 5 cohort studies enrolling 499 patients were included. There was a trend that median overall survival declined with the increasing proportion of N2–3 positive patients in local therapy group, but with no statistical difference (P=0.09, R²=0.98). Undergoing local therapy for oligometastatic non-small cell lung cancer achieved reduction of 47% and 60% in the risk of death and cancer progression (P<0.001), respectively. In subgroup analysis, patients receiving local therapy including surgery showed hazard ratio of 0.33 on progression-free survival and 0.55 of these excluding surgery. Patients receiving consolidative local therapy (local therapy after systemic therapy) obtained hazard ratios 0.33 and 0.45 on progression-free and overall survival vs. systemic therapy, respectively. Hazard ratios of those receiving upfront local therapy (local therapy first) were 0.62 and 0.68 on progression-free and overall survival vs. systemic therapy. Pooled survival analysis showed median overall and progression-free survival of local therapy (21.6 and 14 months) group were both longer than systemic one (14.3 and 6.5 months). Odds ratio of adverse effects were no difference between 2 groups (P=0.16).ConclusionsLocal aggressive thoracic therapy could prolong 7 months overall and progression-free survival compared with systemic therapy in patients with oligometastatic non-small cell lung cancer. Consolidative local therapy might be a more favorable choice of local therapy. Benefits of local therapy for N2–3 positive patients should explored further.     

Risk factors for postoperative complications after lung resection for non-small cell lung cancer in elderly patients at a single institution in China

Objective

The purpose of this study was to assess the postoperative complications after lung resection for non-small cell lung cancer (NSCLC) in elderly patients and to identify possible associated risk factors.

Methods

All patients aged 70 years or older who underwent pulmonary resection for NSCLC by either an open approach or by a thoracoscopic approach between January 2003 and December 2013 at our institution were reviewed. Postoperative events were divided into minor and major complications. Risk factors for complications were assessed by univariate and multivariate logistic regression analysis. A matched case-control study was performed to determine if the utilization of video-assisted thoracic surgery (VATS) for lung resection for NSCLC in elderly patients’ results in decreased complications compared with thoracotomy.

Results

During the study period, 476 consecutive patients (410 thoracotomy, 66 thoracoscopy) older than 70 years underwent resection for NSCLC. Postoperative complications occurred in 169 patients (35.5%) and the overall operative mortality was 2.3% (11 patients). Univariate predictors of complications included history of smoking (P=0.032), CCI scores ≥3 (P<0.001), pneumonectomy (P=0.016), as well as the duration of surgery (P=0.003). After multiple logistic regression analysis, CCI scores ≥3 [odds ratio (OR) =29.95, P<0.001], pneumonectomy (OR =2.26, P=0.029) and prolonged surgery (≥180 min) (OR =1.93, P=0.003) remained the only independent risk factors. After matching based on age, gender, the Charlson Comorbidity Index (CCI), pathologic stage, and the type of resection, there were 60 patients in each group. Patients had similar preoperative characteristics. A VATS approach resulted in a significantly lower rate of complications (25.0% vs. 43.3%, P=0.034) and a shorter median length of stay (19 days, range, 12 to 35 vs. 21 days, range, 13 to 38, P=0.013) compared with thoracotomy.

Conclusions

Pulmonary resection for NSCLC in patients older than 70 years shows acceptable morbidity and mortality. Postoperative complications are more likely to develop in patients with CCI scores ≥3, those who undergo pneumonectomy, and those with a prolonged surgery. Thoracoscopic minimally invasive surgery for NSCLC in elderly patients is associated with fewer complications as well as a shorter hospital stay compared with thoracotomy.     

厄洛替尼与化疗治疗晚期非小细胞肺癌的临床观察

目的观察厄洛替尼与含铂化疗方案治疗晚期非小细胞肺癌的疗效和安全性。方法对我院晚期NSCLC给予化疗组30例,服用厄洛替尼组27例定期随访,观察疗效与不良反应。结果 57例可评价疗效的患者中,化疗组30例:CR:0例,PR:6例,SD:10例,PD:14例;缓解率6/30(20%),疾病控制率16/30(53.3%);服用厄洛替尼组27例:CR:2例,PR:8例,SD:14例,PD:3例;缓解率:10/27(37.1%),疾病控制率24/27(88.9%);不良反应主要表现在骨髓抑制、胃肠道反应以及皮疹,发生率在化疗组和厄洛替尼组分别为76.7%、80%、13.3%及3.71%、40.7%、66.7%,三者之间均有显著性差异。结论厄洛替尼治疗晚期NSCLC患者的疗效较化疗组好,且安全性高。     

Anatomical location and number of metastatic lymph nodes for prognosis of non-small cell lung cancer

BackgroundThe nodal classification of lung cancer is determined by the anatomical location of metastatic lymph nodes (mLNs). However, prognosis can be heterogeneous at the same nodal stage, and the current classification system requires improvement. Therefore, we investigated the correlation between the number of mLNs and prognosis in patients with non-small cell lung cancer.MethodsUsing a multicenter database in Japan, we retrospectively reviewed the records of patients who underwent complete resection for lung cancer between 2010 and 2016. Kaplan-Meier curves were used to determine recurrence-free and overall survival. Multivariate analyses were performed using the Cox proportional hazards model.ResultsWe included 1,567 patients in this study. We could show a statistically significant difference in recurrence-free survival between pN2 patients with 1 mLN and pN2 patients with ≥2 mLNs (P=0.016). Patients with a combination of pN1 (≥4 mLNs) plus pN2 (1 mLN) had a poorer prognosis than pN1 patients (1-3 mLNs) (P=0.061) and a better prognosis than pN2 patients (≥2 mLNs) patients (P=0.007). Multivariate analysis showed that the number of mLNs was independently associated with cancer recurrence in patients with pN1 and pN2 disease (P=0.034 and 0.018, respectively).ConclusionsNodal classification that combines anatomical location and the number of mLNs may predict prognosis more accurately than the current classification system. Our study provides the concept that supports the subdivision of nodal classification in the upcoming revision of the tumor, node, and metastasis staging system.     

The significance of systematic lymph node dissection in surgery for early-stage non-small cell lung cancer patients aged ≤40 years

BackgroundSurgery remains the best option for treating early-stage non-small cell lung cancer (NSCLC), and lymph node dissection (LND) is an important step in this approach. However, the extent of LND in the general age population, especially in young patients, is controversial. This retrospective study aimed to investigate the correlation between systematic lymph node dissection (SLND) and prognosis in young (≤40 years) patients with stage IA NSCLC.MethodsClinicopathological data of 191 patients aged ≤40 years who underwent surgical pulmonary resection for stage IA NSCLC between January 2010 and December 2016 were retrospectively collected. Of the patients, 104 received SLND (SLND group), while the other 87 patients underwent sampling or no LND (non-SLND group). The disease-free survival (DFS) and overall survival (OS) curves of the patients from each group were plotted using the Kaplan-Meier method, and the correlations of the patients’ clinical factors with prognosis were also analyzed.ResultsThe median follow-up period was 55 months. During follow-up, 7 patients died, and recurrence or metastasis was detected in 16 patients. Kaplan-Meier analysis revealed no difference in DFS (P=0.132) between the SLND and non-SLND group, but a significant difference was found between the groups in OS (P=0.022). Additionally, there was no statistically pronounced difference in OS or DFS between male and female patients. Multivariate survival analysis showed that the type of SLND, as well as tumor size, is an independent prognostic factor for DFS (HR, 3.530; 95% CI, 1.120–11.119; P=0.031) and OS (HR, 13.076; 95% CI, 1.209–141.443; P=0.034).ConclusionsFor young (age ≤40) stage IA NSCLC patients with pathological invasive adenocarcinoma, intraoperative SLND can improve the DFS and OS. Further studies are needed to verify the most optimal degree of LND in young patients.     

Clinicopathologic correlates of postoperative N1 or N2 nodal upstaging in non-small cell lung cancer

Background

Clinical and pathologic determinations of lymph node staging are critical in the treatment of lung cancer. However, up- or downstaging of nodal status frequently is necessitated by postsurgical findings. This study was conducted to evaluate clinicopathologic features that impact nodal upstaging in patients staged primarily via positron emission tomography/computed tomography (PET/CT) and chest CT prior to surgery.

Methods

Between years 2011 and 2014, 634 patients underwent surgical treatment for non-small cell lung cancer (NSCLC) at our institution. Excluding 37 patients (given induction chemotherapy), 103 patients pathologically staged as N1 or N2 NSCLC. Nodal upstaging patients were classified into group A and non-upstaging patients into group B. We compared clinical characteristics and pathological results of group A with group B.

Results

Ultimately, 59 patients (57.3%) were assigned to group A and 44 patients (42.7%) to group B. Patients in group A (vs. group B) were significantly younger (61.6 vs. 68.4 years; P<0.001) and more often were female (47.5% vs. 15.9%; P=0.001), with shorter smoking histories (12.2 vs. 28.8 pack years; P<0.001) and lower maximum standardized uptake values (SUVmax) (7.3 vs. 10.4; P=0.001). Most upstaged (group A) tumors (50/59, 84.7%) were adenocarcinomas, displaying micropapillary (MPC; n=36) and lepidic (n=35) component positivity with significantly greater frequency (both, P<0.001); and the frequency of epidermal growth factor receptor (EGFR) mutation (n=36) was significantly greater in this subset (P=0.001). Multivariate analysis (logistic regression) indicated a significant correlation between MPC positivity and nodal upstaging (P=0.013).

Conclusions

In patients upstaged postoperatively to N1 or N2 stage of NSCLC, occult lymph node metastasis and MPC positivity were significantly related.     

Retreatment with pemetrexed chemotherapy in advanced non-small cell lung cancer patient

Objective

The aim of this study was to evaluate the feasibility and safety of retreatment the pemetrexed after the failure prior pemetrexed-based chemotherapy in non-small cell lung cancer (NSCLC) from our institute.

Patients and methods

Patients with advanced NSCLC who were admitted to Zhejiang Cancer Hospital from Dec 2009 to Dec 2012 were retrospectively analyzed. All of the patients were given pemetrexed chemotherapy after the prior pemetrexed-based treatment. Survival analysis was evaluated by Kaplan-Meier method.

Results

Twenty-five patients were included in current study. Initial pemetrexed-based therapy was given as first-line treatment in all patients. Nine patients retreated with pemetrexed as the fourth-line treatment, and sixteen as further-line. One patient (4%) achieved partial response (PR), 9 (36%) with stable disease (SD), and 15 (60%) had progressive disease (PD). The disease control rate (DCR) was 40% and the median progression-free survival (PFS) was 1.5 months (95% CI: 0.8-2.4 months). Patients with an initial PFS >6 months had a median PFS after retreatment of 2.2 months, while patients with an initial pemetrexed PFS ≤6 months had a median PFS after retreatment of 1.1 months (P=0.036). The toxicities associated with the 2nd pemetrexed were generally acceptable.

Conclusions

Retreatment of pemetrexed seems to be a potential therapeutic option for treatment of selected advanced NSCLC patients after failure of initial pemetrexed therapy, especially for the patients with a PFS more than 6 months in the initial pemetrexed treatment.     

Left lower lobectomy and systematic lymph node dissection by complete video-assisted thoracic surgery

A 50-year-old female was administered with left lower lobe lesion for 10 days. A preoperative chest computed tomography (CT) revealed a mass in the left basilar segment of the lung, about 2.1 cm × 1.7 cm in size. Therefore, video-assisted thoracic surgery (VATS) left lower lobectomy was performed. The operation takes 60 minutes. During the operation, the estimated blood loss was 15 mL. The patient was discharged on postoperative day (POD) 6 with no complications. And the pathological results confirmed the diagnosis of adenocarcinoma with no lymph nodes metastasis.