Risk factors for occult nodal metastasis in patients with stage ⅠA peripheral non-small cell lung cancer

Objective To study the risk factors of mediastinal lymph node metastasis in patients with ≤3 cm peripheral non-small cell lung cancer.Methods From January 2000 to December 2010,a total of 281 patients with NSCLC[152 men and 129 women,aged ( 60.31±12.13) years;≤ 3 cm in diameter]underwent lobectomy or partial resection with systematic mediastinal lymphadenectomy in hospital .Clinical data included age,gender,symptoms,history and quantity of smoking history,history of tumor,family history of tumor,site,diameter,calcification,speculation,border,lobulation,traction of pleural,vascular convergence sign,cavity were collected compaired and analyzed.Single and multi-variate analysis was performed to determine the independent risk of occult N2 nodal involvement.Results Logistic regression analysis show seven clinical characteristics (fleshless( OR:22.262),history of tumor(OR:5.485),diameter( 0R:3.788),density( OR;5.850),traction of pleural (OR:1.371),border ( OR:8.259) and cavity (OR:7.124) were risk factors.Conclusion Fleshless,history of tumor,diameter,density,traction of pleural and the border and cavity were independent predictors of malignancy in patients with ≤3 cm peripheral non-small cell lung cancer.     

Prognostic effect of number of lymph nodes sampled in patients with stage Ⅰ non-small cell lung cancer

Objective To investigate the prognostic effect of quantity of lymph node(LN)resected in operations of patients with stage Ⅰ non-small cell lung cancer(NSCLC).Methods The clinical, pathological and follow-up data of 74 patients with stage Ⅰ NSCLC who were treated with surgery from January 1998 to December 2002 Beijing Friendship Hospital, Affiliated to Capital Medical University were reviewed retrospectively.Grouping the patients, according to the quantity of lymph node resected, the Kaplan-Meier method and Cox proportional hazards model was used for univariate analysis and multivariate analysis of factors with prognostic effect.Results The five year survival rate and disease-free survival(DFS)rate of these 74 patients were 64.9% and 47.3%.The univariate analysis showed that tumor size(P =0.016),T-staging (P =0.008)and extent of lymph node dissection(P =0.013)could influence the survival rate.The 5-year OS and DFS rates of patients with less than 6 LNs resected were less than the other group(more than 6 LNs)apparently.The multifactorial analysis indicated that other than staging, the quantity of lymph node resected was also an influence factor of prognosis.Conclusions The OS rate of patients has positive correlation with quantity of lymph node resected in operations.Six LNs must be resected leastways in operations of patients with stage Ⅰ NSCLC.     

临床ⅠA期周围型非小细胞肺癌纵隔淋巴结转移危险因素

目的 探讨临床Ⅰ A期周围型非小细胞肺癌(NSCLC)纵隔淋巴结转移情况,分析早期周围型NSCLC纵隔淋巴结转移的影响因素.方法 2000年1月至2010年12月治疗临床Ⅰ A期的周围型NSCLC 281例,男152例,女129例;年龄19～86岁,平均(60.31±12.13)岁.行肺叶切除或肺局限性切除加系统性纵隔...     

cⅠA期非小细胞肺癌纵隔淋巴结切除方式的临床研究

目的 探讨不同淋巴结切除方式在病理诊断为T1的cⅠA期非小细胞肺癌治疗中的作用.方法 根据淋巴结切除方式的不同,将1998年1月至2002年5月115例病理诊断为T1的cⅠA期非小细胞肺癌患者分为系统性纵隔淋巴结清扫组(清扫组)和纵隔淋巴结采样组(采样组),回顾性分析两组的并发症、N分期及预后之间的差异,评价各临床病理因素与预后的关系.结果 清扫组平均每例切除淋巴结(15.98±3.05)个,采样组平均每例切除淋巴结6.48±2.16个,两组差异有统计学意义(P＜0.01),但清扫组的手术时间、术后胸腔引流量及并发症发生率均多于采样组.两组在淋巴结分期的改变、总生存率与无病生存率等方面差异无统计学意义;进一步分析发现,当肿瘤直径＞2 cm时,清扫组与采样组的5年总生存率分别为78.2%和54.5%,无病生存率分别为75.1%和51.3%,清扫组均高于采样组(P＜0.05);当肿瘤直径≤2 cm时,两组的5年总生存率与无病生存率无明显差别.病理类型方面,大细胞癌和腺鳞癌5年总生存率低于腺癌和鳞状细胞癌(P＜0.05),有淋巴结转移的5年总生存率与无病生存率明显低于无淋巴结转移者(P均＜0.01).结论 对于术中确定为T1的cⅠA期非小细胞肺癌,当肿瘤直径≤2 cm时,选择纵隔淋巴结采样术可以相对减小创伤;当肿瘤直径＞2 cm时,选择系统性纵隔淋巴结清扫术可能更有助于长期生存.     

纵隔淋巴结清扫对Ⅰ期非小细胞肺癌预后的影响

目的探讨纵隔淋巴结清扫范围对I期非小细胞肺癌预后的影响。方法回顾性分析从1994年1月至2003年12月在我院接受手术切除的330例I期非小细胞肺癌患者的临床、病理和随访资料。根据纵隔淋巴结清扫范围将全组患者分为纵隔淋巴结清扫组（LND）和淋巴结取样组（LNS）。运用Kaplan—Meier生存分析和COX比例风险模型,对影响预后的因素进行单因素和多因素分析。结果本组患者男性233例,女性97例;中位年龄60岁。IA期98例,IB期232例。LND组140例,LNS组190例;平均每例患者淋巴结清扫个数两组分别为（13,3±4,7）个和（5,2±3,0）个（P〈0,01）;平均每例患者纵隔淋巴结清扫组数两组分别为（3．7±0,9）组和（1．3±1．1）组（P〈0．01）。LND组5年和10年生存率分别为72,0％和66,1％,LNS组为65,9％和43．0％（P〈0,05）。其他影响预后的因素包括诊断时是否出现症状、肿瘤分期、是否侵犯脏层胸膜和肿瘤大小。COX比例风险模型分析结果显示,淋巴结清扫范围和术前有无症状是影响预后的因素。结论纵隔淋巴结清扫可以提高I期非小细胞肺癌术后的生存率。     

肺癌跳跃性纵隔淋巴结转移及其廓清的临床研究

目的　总结肺癌跳跃性纵隔淋巴结转移的特点及转移方式 ,为制定合理的纵隔淋巴结廓清范围提供依据。方法　回顾性研究了 1988～ 1999年间 ,系统性纵隔淋巴结廓清术后 ,131例病理证实的非小细胞肺癌伴纵隔淋巴结转移病人的临床资料。结果　发现跳跃性纵隔淋巴结转移 2 3例 (17 5 % ) ,腺癌占绝大多 (82 6 % ) ,多数为周边型肺癌 (74 0 % ) ,T1 和T2 肿瘤占优势 (91 3% ) ,转移部位与原发肿瘤的位置密切相关 ,大多累及区域纵隔淋巴结。结论　肺上叶非小细胞肺癌跳跃性转移多发生在上纵隔 ,下叶肿瘤跳跃性转移多在下纵隔 ;因此 ,在无肺门淋巴结转移时可单独廓清区域性纵隔淋巴结     

Can tumor size be a guide for limited surgical intervention in patients with peripheral non-small cell lung cancer? Assessment from the point of view of nodal micrometastasis.

OBJECTIVE: We sought to determine the critical diameter of a peripheral non-small cell lung cancer tumor less than which no evidence of nodal micrometastasis is present. METHODS: Samples of 3081 lymph nodes from 181 patients with stage I peripheral lung cancer (155 with adenocarcinoma and 26 with squamous cell carcinoma) who had undergone complete resection with systematic lymphadenectomy were used in the study. In the samples immunohistochemical staining for cytokeratin was performed. The expression of vascular endothelial growth factor (VEGF) at primary sites was also immunohistochemically assessed. RESULTS: Nodal micrometastasis was detected in 44 patients. The mean tumor sizes were 2.2 +/- 1.3 cm (range, 1.0-7.0 cm) in nodal micrometastasis-positive adenocarcinoma, 2.1 +/- 0.9 cm (range, 0.5-6.0 cm) in nodal micrometastasis-negative adenocarcinoma, 4.8 +/- 2.3 cm (range, 2.2-10.0 cm) in nodal micrometastasis-positive squamous cell carcinoma, and 3.2 +/- 2.1 cm (range, 0-9.0 cm) in nodal micrometastasis-negative squamous cell carcinoma. The tumor size in the nodal micrometastasis-positive group tended to be greater than that in the nodal micrometastasis-negative group in squamous cell carcinomas, but there was no significant difference in adenocarcinomas. Nodal micrometastasis was not found in patients with squamous cell carcinoma of 2.0 cm or less in diameter. However, nodal micrometastasis was found in 20% (19/95) of the patients with adenocarcinoma of 1.1 to 2.0 cm in diameter and even in 4 of 11 patients with adenocarcinoma of 1.0 cm or less. Among the patients with nodal micrometastasis, survival of patients with vascular endothelial growth factor overexpression was worse than that of patients without it. The survival of patients with nodal micrometastasis without vascular endothelial growth factor overexpression was comparable with that of patients without nodal micrometastasis. CONCLUSION: A limited surgical intervention without lymphadenectomy is validated for squamous cell carcinoma of 2.0 cm or less without pleural involvement. In adenocarcinoma the tumor size itself is not a reliable guide for nodal micrometastasis status. In patients with nodal micrometastasis with vascular endothelial growth factor overexpression, the risk of systemic disease should be considered.     

Impact of number of retrieved lymph nodes and lymph node ratio on the prognosis in patients with stage Ⅱ and Ⅲ colorectal cancer

Objective To discuss the impact of number of retrieved lymph nodes and lymph node ratio (LNR) on the prognosis in patients with stage Ⅱ and Ⅲ colorectal cancer.Methods Clinicopathological data of 507 patients with stage Ⅱ and Ⅲ colorectal cancer were analyzed retrospectively. Follow-up was available in all the patients. Results The total number of retrieved lymph nodes was 5801, of which 1122 had metastasis. There was a positive correlation between metastatic lymph nodes and retrieved lymph nodes (r=0. 171, P＜0.01). In stage Ⅱ colorectal cancer there was a significant difference in 5-year survival rate between patients with more than 12 lymph nodes retrieved and those with less than 12 lymph nodes retrieved (P＜0.01). LNR also affected the 5-year survival rate of patients with stage Ⅱ and Ⅲ colorectal cancer (P＜0.05). In patients with similar LNR, the 5-year survival rate differed significantly among different regions of lymph node metastasis(P＜0.05). LNR influenced the prognosis independent of the number of lymph nodes retrieved. Conclusions The number of retrieved lymph nodes is a prognostic factor for stage Ⅱ and Ⅲ colorectal cancer. More than 12 lymph nodes should be retrieved for better staging and prognosis. LNR is also a prognostic factor in stage Ⅱ and Ⅲ colorectal cancer. Regions of lymph nodes metastasis should be considered when evaluating the prognosis of patients using LNR.     

Is radiofrequency ablation more effective than stereotactic ablative radiotherapy in patients with early stage medically inoperable non-small cell lung cancer?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'is radiofrequency ablation more effective than stereotactic ablative radiotherapy in patients with early stage medically inoperable non-small cell lung cancer?' Altogether, over 219 papers were found, of which 16 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Radiofrequency ablation (RFA) and stereotactic ablative radiotherapy (SABR) offer a clear survival benefit compared with conventional radiotherapy in the treatment of early stage non-small cell lung cancer (NSCLC) in medically inoperable patients. Overall survival at 1 year (68.2-95% vs. 81-85.7%) and 3 years (36-87.5% vs. 42.7-56%) was similar between patients treated with RFA and SABR. However, 5-year survival was higher in SABR (47%) than RFA (20.1-27%). Local progression rates were lower in patients treated with SABR (3.5-14.5% vs. 23.7-43%). Both treatments were associated with complications. Pneumothorax (19.1-63%) was the most common complication following RFA. Fatigue (31-32.6%), pneumonitis (2.1-12.5%) and chest wall pain (3.1-12%) were common following SABR. Although tumours ≤ 5 cm in size can be effectively treated with RFA, results are better for tumours ≤ 3 cm. One study documented increased recurrence rates with larger tumours and advanced disease stage following RFA. Another study found increasing age, tumour size, previous systemic chemotherapy, previous external beam radiotherapy and emphysema increased the risk of toxicity following SABR and suggested that risk factors should be used to stratify patients. RFA can be performed in one session, whereas SABR is more effective if larger doses of radiation are given over two to three fractions. RFA is not recommended for centrally based tumours. Patients with small apical tumours, posteriorly positioned tumours, peripheral tumours and tumours close to the scapula where it may be difficult to position an active electrode are more optimally treated with SABR. Treatment for early stage inoperable NSCLC should be tailored to individual patients, and under certain circumstances, a combined approach may be beneficial.     

临床ⅠA期肺腺癌发生淋巴结转移的危险因素分析

目的探讨临床ⅠA期肺腺癌发生淋巴结转移的危险因素。方法分析新疆医科大学第一附属医院胸外科2021年12月至2022年8月完成解剖性肺叶切除+系统性淋巴结清扫手术的199例临床ⅠA期肺腺癌患者的临床资料。根据病理结果分为淋巴结转移组46例, 非淋巴结转移组153例。采用单因素分析和二元Logistic回归分析临床ⅠA期肺腺癌发生淋巴结转移的危险因素。结果纳入199例临床ⅠA期肺腺癌患者中男86例(43.2%), 女113例(56.8%), 中位年龄57(52, 64)岁。单因素分析结果显示, 淋巴结转移组在术前癌胚抗原(CEA)水平(2.5 ng/ml比1.6 ng/ml, Z=-4.446, P<0.01)、CT肿瘤直径(2.38 cm比1.57 cm, Z=-6.952, P<0.01)、实性成分比例(CTR)(1.00比0.00, Z=-9.542, P<0.01)方面高于非淋巴结转移组, 两组之间在分化程度(χ2=38.271)、病理亚型(χ2=105.757)、经肺泡腔内气道播散(STAS)(χ2=47.276)、脉管瘤栓(χ2=16.358), 肿瘤部位(χ...     

非小细胞肺癌脊柱转移治疗现状及进展

目前,肺癌仍是全球肿瘤相关死亡的首要原因,在发达国家,肺癌的发生率占男性恶性肿瘤的首位,而非小细胞肺癌(non-small-cell lung cancer,NSCLC)占肺癌总数的80%～85%[1]。肺癌是最容易发生骨转移的恶性肿瘤之一,据报道30%～40%的晚期肺癌会发生骨转移,而脊柱转移最为常     

非小细胞肺癌淋巴结微转移的临床病理研究

目的 探讨免疫组化染色检测非小细胞肺癌淋巴结微转移的可行性。方法 将25例肺癌患者术中获取的淋巴结标本进行石蜡包埋,然后连续切片,6～10张不等,切片厚为5μm。选择第1和倒数第2张切片进行苏木精伊红染色,剩余切片用于免疫组化染色。免疫组化所选抗体为鼠抗人细胞角蛋白19单克隆抗体。结果 195枚淋巴结接受了苏木精伊红染色检查。9例患者共30枚淋巴结中发现有显性转移,无一例患者的淋巴结中检测出微转移。135枚苏木精伊红染色阴性的淋巴结又进行了免疫组化染色检查,有31枚淋巴结病理切片中显现出了癌微转移。16例常规病理PN0期患者中,5例患者肺门淋巴结出现了微转移;另9例常规病理PN1期患者中,4例出现了纵隔淋巴结的微转移,差异有统计学意义（x^2=52．900,P=0．0193）。结论 普通苏木精伊红染色能准确地检测出非小细胞肺癌淋巴结中的显性转移灶,而不易发现隐匿性微转移灶。免疫组化染色能提高非小细胞肺癌淋巴结微转移的检出率,并可对部分Ⅰ、Ⅱ期患者重新进行TNN分期。     

EGFR突变在Ⅰ期非小细胞肺癌患者中的分布趋势

目的 检测Ⅰ期非小细胞肺癌(NSCLC)患者表皮生长因子受体(EGFR)的突变情况,初步探讨EGFR突变的分布特征.方法 收集272例术后病理为Ⅰ期非小细胞肺癌患者肿瘤组织标本,提取DNA,采用ARMS法对EGFR基因的第18、19、20及21外显子片段进行检测,根据阳性质控、阴性质控和DNA质控对EGFR突变类型分析判断.结果 272例Ⅰ期NSCLC患者肺癌组织中,154例(56.62％)存在EGFR的体细胞突变.其中,2例(1.3％)18号外显子上发生替代突变(G719S),53例(34.4％) 19号外显子上发生缺失突变(19-del),6例(3.9％)20号外显子上发生插入突变(20-ins),97例(63.9％) 21号外显子上发生替代突变(L858R).2个外显子同时突变11例.21外显子突变(敏药突变)合并20外显子突变(耐药突变)率(4/11,36.3％)显著高于19外显子突变(敏药突变)合并20外显子突变(耐药突变)率(1/11,9.1％),P＜0.05;肺腺癌的突变率(148/223,66.4％)显著高于肺鳞癌突变率(2/40,5％);肺腺鳞癌突变率(4/4,100％)显著高于肺腺癌、鳞癌和大细胞癌(0/5,0％)的突变率.结论 Ⅰ期NSCLC患者EGFR突变率56.62％,肺腺鳞癌、腺癌提示突变的高发性,EGFR突变多集中在19和21号外显子,21外显子突变比19外显子突变更易合并20外显子突变(耐药突变).     

Ⅰ期肺腺癌中病理学亚型判断预后的价值分析

目的:探讨2021年WHO肺腺癌分类判断Ⅰ期肺腺癌预后的价值。方法:回顾性分析2015年1月至2016年9月于复旦大学附属中山医院接受手术,且术后病理学检查确诊为Ⅰ期肺腺癌的829例患者资料。男性389例,女性440例,年龄（60±11）岁（范围：32~90岁）。术前CT表现为实性结节570例,磨玻璃结节259例。采用...     

ⅢA-N2期非小细胞肺癌切除术后影响预后的因素分析

目的 分析ⅢA-N2期非小细胞肺癌患者的临床情况和影响预后的相关因素,探讨手术及辅助治疗对预后的影响.方法 回顾性分析2000年1月至2005年12月经手术治疗的657例ⅢA-N2期非小细胞肺癌患者的临床资料,应用Kaplan-Meier法进行生存分析.单因素分析各变量与预后的关系采用Log-rank检验,多因素分析采用Cox模型.结果 术后全组患者的l、3和5年累计生存率分别为64.4%、26.0%和17.9%,中位生存期18个月.单因素分析中,影响生存期的不利因素为:肿瘤最大径>3 cm,高T分期,N2淋巴结无跳跃转移,纵隔淋巴结阳性数>4个,隆突下淋巴结阳性,治疗方式(单纯手术预后差,患者术后联合放化疗优于术后单纯化疗),术后未放疗、化疗,化疗周期小于4个.多因素分析显示,肿瘤直径(P=0.001),隆突下淋巴结阳性(P=0.019),纵隔淋巴结转移个数(P=0.006),术后化疗周期(P=0.007),术后放疗(P=0.055)和术后放化疗(P=0.026)对预后有明显影响.结论 ⅢA-N2期非小细胞肺癌患者5年生存率低,肿瘤直径、隆突下淋巴结阳性、纵隔淋巴结转移个数、术后化疗周期、术后联合放化疗是影响预后的独立因素.术后单站和多站纵隔淋巴结转移的预后相似,影响预后的主要是纵隔淋巴结的阳性个数,术后联合放化疗优于术后单纯化疗.     

MiR-34b在非小细胞肺癌中的表达及其在HGF-Met信号通路中的作用

目的 microRNAs (miRNAs)是内源性非编码小RNA,肿瘤细胞中大多数miRNAs表达降低,探讨miRNAs抑制肿瘤的机制.方法 应用实时定量PCR检测非小细胞肺癌组织miR-34b的表达,并且分析其与临床病理参数之间的关系.应用细胞转染技术获得miR-34b高表达细胞,并检测细胞凋亡与细胞增殖.运用免疫组织化学方法探索miR-34b表达与下游蛋白c-Met、p53以及Mdm2之间的相关性.结果 miR-34b在非小细胞肺癌中低表达,并与淋巴结转移负相关(P=O.031).miR-34b通过诱导凋亡抑制肿瘤增殖.非小细胞肺癌中miR-34b表达与c-Met负相关(P=0.012).结论 HGF-Met信号通路中p53磷酸化并增强转录活性,上调miR-34b,反馈抑制c-Met;miR-34b影响肿瘤细胞凋亡、增殖、转移,在肿瘤发展过程中发挥抑制肿瘤的作用.