脏层胸膜受侵对Ⅰb期非小细胞肺癌预后的影响

目的 探讨脏层胸膜受侵对Ⅰ b期非小细胞肺癌预后的影响.方法 回顾性分析1994年1月至2003年12月间在我院接受手术切除的232例Ⅰ b期非小细胞肺癌(NSCLC)患者的临床和随访资料.根据肿瘤大小和脏层胸膜受侵情况,将患者分为3组,A组:肿瘤最大径＞3 cm且无脏层胸膜受侵;B组:肿瘤最大径≤3 cm且脏层胸膜受侵;C组:肿瘤最大径＞3 cm且脏层胸膜受侵.运用Kaplan-Meier生存分析和Cox比例风险模型,对影响NSCLC预后的因素进行分析.结果 A组45例,B组96例,C组91例,其5年生存率分别为70.1%、61.9%和56.2%,10年生存率分别为56.7%、50.6%和35.9%,3组生存率之间的差异有统计学意义(P＝0.018).脏层胸膜受侵者187例(80.6%), 5年和10年生存率分别为59.3%和42.6%;无脏层胸膜受侵者45例(19.4%), 5年和10年生存率分别为70.1%和56.7%,两组生存率之间的差异有统计学意义(P＝0.035).多因素分析显示,以肿瘤大小和脏层胸膜受侵情况分组为变量,是影响预后的因素(RR＝1.530,95%CI为1.132～2.067,P＝0.006).结论 Ⅰ b期NSCLC中,不同T状态患者生存率之间的差异有统计学意义,肿瘤最大径＞3 cm且脏层胸膜受侵的患者预后较差,这一T2状态是否需要修改有待进一步的研究.     

Prognostic value of visceral pleural invasion in the stage pT1-2N2M0 non-small cell lung cancer: A study based on the SEER registry

BackgroundVisceral pleural invasion (VPI) is considered an adverse prognostic factor in non-small cell lung cancer (NSCLC). However, the prognostic roles of VPI in Ⅲ/N2 NSCLC remain controversial. Therefore, this study aims to evaluate the prognostic value of VPI in patients with postoperative stage pT_1-2N₂M₀ NSCLC.MethodsUsing the Surveillance, Epidemiology, and End Results (SEER) database, we screened for patients with stage T1-2N2M0 NSCLC who received surgery from 2010 to 2015. To reduce baseline differences between Non-VPI group and VPI group, two-to-one propensity score matching (PSM) was performed. Cox proportional hazards regression was used to identify factors associated with survival. Overall survival (OS) was between the Non-VPI group and the VPI+ group by the Kaplan-Meier analysis.ResultsWe identified 1374 postoperative NSCLC patients with stage pT_1-2N₂M₀. The majority of cases (N = 1047, 76.8%) are Non-VPI patients. The factors associated with VPI+ group included white race (P < 0.0001), and adenocarcinoma (P < 0.0001).When analyzed in the total study population, VPI status remained a significant independent predictor of worse OS compared with the Non-VPI group (HR, 1.343; 95% CI, 1.083–1.665 [P=0.007]). Besides, in a subgroup analysis by VPI status, the results showed that patients without treatment exhibited a higher risk level in the Non-VPI group (P<0.0001). However, we did not find statistically significant differences among treatments in the VPI+ group (P=0.199). Mean survival time was 49.5 months (95% CI: 45.7–53.3 months) for chemotherapy alone in the Non-VPI group, compared with 41.2 months (95% CI: 35.8–46.6 months) in VPI+ groups. In both the VPI group and the non-VPI group, there is no statistical difference between adjuvant chemotherapy combined with PORT and chemotherapy alone.ConclusionThis study emphasizes that the presence of VPI is a poor prognostic factor, even in patients with Ⅲ/N2 NSCLC. As the study shows, chemotherapy significantly improved overall survival of patients with postoperative stage pT_1-2N₂M₀ NSCLC, especially for Non-VPI patients. However, the significance of PORT is still worth further exploration.     

脏层胸膜侵犯和脉管癌栓对非小细胞肺癌术后初始复发部位及预后的影响

背景与目的：脏层胸膜侵犯(visceral pleural invasion,VPI)和脉管癌栓(vessel invasion,VI)是非小细胞肺癌(non-small cell lung cancer,NSCLC)患者预后的危险因素,前者的初始复发部位可能以局部复发为主,而后者可能以远处转移多见。本研究主要探讨VPI和VI对初始复发部位及术后生存率的影响。方法：回顾性分析广西医科大学附属肿瘤医院2007年1月—2013年12月期间住院的NSCLC手术治疗患者的完整资料共计290例。VPI患者51例,无VPI患者239例;有VI患者29例,无VI患者261例,分别比较其临床特征、总生存期(overall survival,OS)及无病生存期(disease-free survival,DFS)的差异。结果：VPI组与无VPI组的肿瘤大小、淋巴结转移、TNM病理分期和初始复发部位相比,差异有统计学意义(P<0.05)。VI组与无VI组的淋巴结转移和TNM病理分期相比,差异有统计学意义(P<0.05)。VPI组的1年、3年和5年生存率(88.2%、56.7%和52.7%)均低于无VPI组(95.8%、83.7%和74.0%),差异有统计学意义(P<0.001)。VI组的1年、3年和5年生存率(79.3%、56.8%和48.7%)均低于无VI组(96.1%、81.3%和72.3%),差异有统计学意义(P=0.001)。Cox多因素分析结果显示,TNM病理分期是患者DFS的独立影响因素(P<0.05)。淋巴结转移、VPI是患者OS的独立影响因素(P<0.05)。结论：VPI患者的初始复发部位以局部复发多见;VPI和VI的NSCLC患者预后均较差,需要更积极的术后治疗。     

Oestrogen potentiates topoisomerase-II-mediated cytotoxicity in an activated subpopulation of human breast cancer cells: implications for cytotoxic drug resistance in solid tumours

Primary resistance to chemotherapeutic agents is a major problem in the management of advanced cancer. By using oestrogen to modulate the topoisomerase II content of T-47D human breast cancer cells, we show here that cell subpopulations resistant to the topoisomerase-II-interactive drug VPI6 (etoposide) can be identified and quantified using single-cell analytical techniques. Immunohistochemical studies reveal topoisomerase II to be present in approximately 10% of control cells compared with 30% of oestrogen-stimulated cells, and this difference is reflected in the proportions of cells exhibiting VPI6-induced cell-cycle delay. This moderate increase in overall cell sensitivity is accompanied by massive enhancement of clonogenic cell kill, suggesting that oestrogen enhances VPI6 cytotoxicity by recruiting a clonogenic cell subpopulation characterized by increased topoisomerase II content. Flow cytometry confirms that the increase in topoisomerase II is localized to an activated G1-phase cell subset. We conclude that (i) single-cell analysis of cellular topoisomerase II content is predictive of VPI6 chemosensitivity; (ii) the existence of resistant tumour-cell subpopulations does not necessarily indicate the presence of phenotypically divergent subclones; and (iii) rational strategies for eliminating tumour resistance may be based on biological manipulation of specific cytotoxic drug targets.     

Vascular proliferation is important for clinical progress of endometrial cancer

Angiogenesis is essential for tumor growth, invasion, and metastatic spread. Whereas microvessel density (MVD) has been widely used as a measure of tumor-associated angiogenesis, we now wanted to examine the significance of other angiogenic markers, especially vascular proliferation (by Ki-67/factor VIII staining) and the degree of pericyte coverage [by alpha-smooth muscle actin (alpha-SMA)/factor VIII staining], in a large and population-based series of endometrial carcinoma with complete follow-up. Due to limited information on the role of lymphangiogenesis in these tumors, lymphatic vessel density (LVD) by LYVE-1 staining was also determined, as well as selected angiogenic factors [vascular endothelial growth factor (VEGF)-A, VEGF-C, VEGF-D and basic fibroblast growth factor (bFGF)], which could possibly be related to vascular proliferation and lymphangiogenesis. The information on angiogenic phenotype was related to clinicopathologic features and disease progress. Median vascular proliferation, as estimated by vascular proliferation index (VPI), was 3.9% and high VPI was associated with features of aggressive tumors and decreased survival. The prognostic effect of VPI was superior to that of MVD. Presence of pericyte coverage, as estimated by the alpha-SMA index (SMAI), was 35% and low SMAI was significantly associated with vascular invasion by tumor cells and impaired prognosis. Peritumoral lymphatic vessels (LVD-pt) were found in 39.5% of the cases and high LVD-pt was significantly associated with aggressive tumor features and decreased survival. In multivariate survival analysis, only the extent of vascular proliferation had independent prognostic effect, in addition to well-known clinicopathologic factors, whereas MVD did not have significant prognostic value. In conclusion, our study indicates that vascular proliferation is a meaningful variable in assessing the angiogenic phenotype of endometrial carcinoma.     

A Histochemical Approach to the Diagnosis of Visceral Pleural Infiltration by Non-small Cell Lung Cancer

Introduction: Although invasion of the visceral pleura (VPI) by non-small cell lung cancer (NSCLC) is a TNM-relevant diagnostic criterion and is known to affect the patients′ prognoses, until recently there were no standardized or internationally accepted guidelines. This resulted in a diagnostic ambiguity leading to different tumor staging systems and to hardly comparable patient collectives in research studies world wide. The major problem in this issue is to exactly define what constitutes for the diagnosis of VPI with respect to anatomical landmarks. Methods: In order to address this problem we investigated the pleural infiltration depth of 173 NSCLC specimens without lymph node metastases and proven tumor-related death using elastic stains and a scoring system referring to prominent pleural elastic layers, the lamina elastica externa and interna, as anatomical landmarks. Results: Performing comparative Kaplan-Meier survival analyses for each patient collective we could not find any significant difference in the patients′ survival. This indicates that a differential evaluation of the tumor infiltration depth according to the elastic layers is not practicable. Conclusions: Our findings support the consequent application of the recently proposed, pragmatic approach of the international staging committee for lung cancer (IASLC) to define an internationally accepted and standardized staging system for VPI.     

Otitis Media with Effusion (OME) in Urban Pediatric Population in a Tertiary Care Centre: A Clinical Study

Otitis media with effusion (OME) is a common condition affecting children. It is one of the most common causes for reduced hearing in pediatric age group leading to various learning disabilities including delayed speech development. The aim of this study was to find out various epidemiological characteristics and risk factors for developing OME and various treatment modalities depending on the clinical features and their outcomes in urban pediatric population. A prospective comparative study was done in 100 children taken 50 as cases and 50 as controls for a period of 2 years. The risk factors, common presenting features and the examination and investigational findings (tympanometry) of the study condition were compared among the cases and controls. Among the 50 cases, 28 children were treated medically and 22 underwent surgical treatment in the form of Myringotomy and Grommet insertion. The patients were followed up-to 6 months in both groups.     

A brief review of voice restoration following total laryngectomy

Despite advances in conservative laryngeal surgery and radiotherapy, total laryngectomy still remains the procedure of choice for advanced-stage (UICC T3 and T4) laryngeal carcinoma, around the world. The functional rehabilitation of the laryngectomized patients has been a concern of head and neck surgeons and speech therapists. Significant developments in speech rehabilitation over the past three decades have led to substantial improvements in the quality of life of these patients. The tracheoesophageal (TE) voice prosthesis has become the gold standard in various centers for voice rehabilitation since its introduction in 1980. Successful tracheoesophageal voice restoration in laryngectomy patients can be very rewarding and patients no longer have to live in silence while they await the results of their cancer treatments. They can face the challenges of life with the knowledge that a near normal quality of life is very much possible.In this article, we present a brief review of voice restoration following laryngectomy.     

Selective Mediastinal Lymph Node Dissection Strategy for Clinical T1N0 Invasive Lung Cancer: A Prospective,Multicenter, Clinical Trial

IntroductionWe aimed to prospectively evaluate our previously proposed selective mediastinal lymph node (LN) dissection strategy for peripheral clinical T1N0 invasive NSCLC.MethodsThis is a multicenter, prospective clinical trial in China. We set six criteria for predicting negative LN stations and finally guiding selective LN dissection. Consolidation tumor ratio less than or equal to 0.5, segment location, lepidic-predominant adenocarcinoma (LPA), negative hilar nodes (stations 10–12), and negative visceral pleural invasion (VPI) were used separately or in combination as predictors of negative LN status in the whole, superior, or inferior mediastinal zone. LPA, hilar node involvement, and VPI were diagnosed intraoperatively. All patients actually underwent systematic mediastinal LN dissection. The primary end point was the accuracy of the strategy in predicting LN involvement. If LN metastasis occurred in certain mediastinal zone that was predicted to be negative, it was considered as an “inaccurate” case.ResultsA total of 720 patients were enrolled. The median number of LN dissected was 15 (interquartile range: 11–20). All negative node status in certain mediastinal zone was correctly predicted by the strategy. Compared with final pathologic findings, the accuracy of frozen section to diagnose LPA, VPI, and hilar node metastasis was 94.0%, 98.9%, and 99.6%, respectively. Inaccurate intraoperative diagnosis of LPA, VPI, or hilar node metastasis did not lead to inaccurate prediction of node-negative status.ConclusionsThis is the first prospective trial validating the specific mediastinal LN metastasis pattern in cT1N0 invasive NSCLC, which provides important evidence for clinical applications of selective LN dissection strategy.     

Functional laryngeal surgery - critical determinants of successful rehabilitation

This study addresses the functional outcome and rehabilitative process in 30 partial laryngectomies carried out for laryngeal (22) und hypoorpharyngeal (8) cancers at the department of H/N Surgery, The kidwai Memorial Institute of Oncology. Bangalore, India from 1985–1995, Special emphasis is directed towards post-surgical convalescence after various partial laryngeetomy techniques which include 6 vertical laryngectomies (V L / VPL). 17 supraglottic laryngectomies (SG L), and 7 supracricoid laryngectomies with Cricohyoidepexy (CHP). Rehabilitative success was measured with respect to the ease of dccannulation, resumption of normal deglutition and speech analysis - both objectively using standard speech analytical equipment in a speech laboratory and subjectively using the services of blinded judges to score recorded speech of patients. The speech analysis indicate that past SGL speech was the superior most followed by V L and C H P in that order. Aspiration was deemed as minimal and inconsequential after V L/VPL followed by CHP;and SGL, in the order of severity;the extended modifications to resect the arytenoid and / or basE of tongue and / or piriform fossa faring worse than classic standard technique.     

207例淋巴结阴性的早期非小细胞肺癌的临床病理特征及预后分析

目的:对行手术切除的淋巴结阴性的早期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者的临床病理特征及影响术后生存预后因素进行分析.方法:纳入2008年1月至2013年12月于四川大学华西医院诊治,行手术切除且经病理确诊为非小细胞肺癌,肿瘤直径≤7cm,且无淋巴结及远处转移的患者,回顾性分析其一般临床特征以及术后生存预后的影响因素.结果:共纳入207例非小细胞肺癌患者,其中男性137例(66.2％),女性70例(33.8％);平均年龄60.1岁(38 ～ 80岁);有吸烟史患者113例(54.6％);病理类型以腺癌121例(58.5％)为主;病变部位主要位于肺上叶(右肺上叶65例,左肺上叶39例);有脏层胸膜浸润的肺癌患者101例(48.8％).肿瘤直径≤3cm、＞3～5cm和＞5～ 7cm的患者五年生存率分别为80.0％、63.6％、41.5％.多因素分析提示年龄＞65岁(HR:1.071,95％ CI:1.026 ～1.118,P=0.001)、肿瘤直径≤3cm(HR:0.767,95％ CI:0.630 ～ 0.930,P=0.007)及有脏层胸膜浸润(HR:2.058,95％CI:1.134～3.735,P=0.018)是影响淋巴结阴性的早期非小细胞肺癌患者生存预后的独立危险因素.结论:淋巴结阴性的早期非小细胞肺癌患者以男性居多,腺癌为主;肿瘤直径、患者年龄和脏层胸膜浸润是影响早期无淋巴结转移的肺癌患者的独立危险因素.     

The current status of cochlear implants

In the University of Sydney cochlear implant programmes, 109 adults and teenagers have received a 22 electrode cochlear implant (Cochlear? implant) since 1984; and 127 children have received a Cochlear? implant since 1987. The results were analysed when all patients were still using the MSP speech processors rather than the newer SPEAK processors. Seventy five percent of adults and teenagers deafened after learning speech for a period of less than 15 years were able to recognise some words by audition alone. Only 30 percent of adults and teenagers deafened for over 15 years regaining hearing were able to recognise any words by audition alone but most found the device very helpful in aiding lipreading. None of adults and teenagers who were born deaf who received a cochlear implant found they could recognise any sounds and half of them abandoned using the device. Children who were deafened after learning speech usually did extremely well with a cochlear implant and could remain in their regular school situation. Children who had done well with hearing aids were also very likely to succeed with a cochlear implant. Children who had learnt to communicate by gestures or signs who had reached an age of over 6 years did poorly with the cochlear implant with 73 percent unable to recognise speech by listening alone and unable to improve their speech production to an intelligible level. Children born deaf who received the implant early in life and were taught primarily through audition could be very successful with 52% recognising words by audition alone and gaining intelligible speech. Preliminary studies suggested that the younger the child received the cochlear implant the greater the possibility of success. Neural plasticity or the ability to the brain to learn or relearn tasks appear to be the most important factor affecting the selection of candidates for a cochlear implant. It appeared that after the age of 6 years, if a child had not utilised the auditory and motor areas of spech production within the brain, the neural plasticity remaining was insufficient to allow effective use of a cochlear implant. The cochlear implant is a device which can restore when a person is too deaf to be able to use a conventional hearing aid. The cochlear implant does not provide normal hearing but may provide sufficient information for the recipient to distinguish several words without the need for lipreading. Evidence will be presented which shows that the device can enable children suffering from congenital deafness to gain excellent speech and listening providing it is fitted at an early age and there is an appropriate training programme to teach the child.     

The spouse as facilitator for esophageal speech: a research perspective.

The role of the spouse in relation to the quality of esophageal speech of laryngectomized patients was investigated using psychodiagnostic instruments and speech ratings and through an assessment of the verbal interactions between the patient and spouse. Analysis of the results indicates that those speakers who were objectively judged to have higher quality speech and learned esophageal speech rapidly had spouses who were more likely to disagree verbally with them, addressed them in a way that encouraged long answers, and evidenced reciprocal compatibility for meeting affectional needs.     

Social perception of speech in individuals with oropharyngeal reconstruction

Oral cancer affects approximately 5% of the Canadian population every year. One option for treatment of oropharyngeal cancer includes resection of the diseased tissue with primary reconstruction of the defect using a microvascular free flap, followed by post-operative adjuvant radiation therapy. The aim of reconstructive surgery is to maintain functional speech and swallowing. While the literature provides support for the maintenance of speech intelligibility following reconstructive procedures, certain aspects of resonance may be altered when the palatal structures are involved. Little is known about the effect of such alterations on the perception of speakers who have been treated with microvascular free flap reconstruction. Social perception is a process in which we infer attributes of others, with the speech signal playing an integral part in attribution. The purpose of this study was to explore the social perceptions formed about speakers both before and after surgery for oropharyngeal cancer. The results of this study revealed that positive perceptions of speakers significantly diminished as a result of surgery and negative perceptions increased. Certain variables, such as degree of resection of the soft palate and base of tongue, and sex of the speaker, had influence on the results. This research suggests that intelligibility measurements of speech, although useful, do not provide a complete indication of the social impact of reconstructive surgery on patients with oropharyngeal resections.     

Survival with Parenchymal and Pleural Invasion of Non–Small Cell Lung Cancers Less than 30 mm

Objective

To determine long-term survival of visceral pleural invasion (VPI) and parenchymal invasion (PAI) (angiolymphatic and/or vascular) on survival of NSCLCs less than 30 mm in maximum diameter.

Evaluation of speech outcomes following treatment of oral and oropharyngeal cancers

Oral and oropharyngeal cancers are amongst the commonest cancers worldwide and present a major health problem. Owing to their critical anatomical location and complex physiologic functions, the treatment of oral and oropharyngeal cancers often affects important functions, including speech. The importance of speech in a patient’s life can not be overemphasized, as its loss is often associated with severe functional and psychosocial problems and a poor quality of life. A thorough understanding of the speech problems that are faced by these patients and their timely management is the key to providing a better functional quality of life, which must be one of the major goals of modern oncologic practice. This review summarises key methods of evaluation and outcome of speech functions in the literature on oral and oropharyngeal cancer published between January 2000 and December 2008. Speech has been generally overlooked and poorly investigated in this group of patients. This review is an attempt to fill this gap by conducting the first speech-specific review for oral and oropharyngeal cancer patients. We have proposed guidelines for better understanding and management of speech problems faced by these patients in their day-to-day life.     

Provox voice prosthesis — The Indian experience

Following Total Laryngectomy, Tracheo-oesophageal speech prosthesis offers the most reliable form of voice rehabilitation. Of the various prostheses currently available. The Provox voice prosthesis developed by the Netherlands Cancer Institute has been the most popular due to its superior design and in-dwelling nature. At the Apollo Cancer Hospital, Hyderabad, 17 patients underwent speech rehabilitation with the Provox voice prosthesis between February 1999 and July 2000. Speech rehabilitation was successful in all patients with the majority (82%) developing Good—Excellent speech. Two patients required replacement and one patient discontinued use of the prosthesis. There were no complications in any of the other patients.     

Unusual case of coin in larynx (glottic chink) presenting as Dysphagia

Foreign body larynx is a rare condition in adults — inhalation of coin and impaction of the coin in the glottic chink is more rare finding. But this patient presented with difficulty in swallowing and speech, without any respiratory trouble — Hence the case is reported.     

Speech Recognition Performance in Children with Cochlear Implants Using Bimodal Stimulation

Cochlear implantees have considerably good speech understanding abilities in quiet surroundings. But, ambient noise poses significant difficulties in understanding speech for these individuals. Bimodal stimulation is still not used by many Indian implantees in spite of reports that bimodal stimulation is beneficial for speech understanding in noise as compared to cochlear implant alone and also prevents auditory deprivation in the un-implanted ear. The aim of the study is to evaluate the benefits of bimodal stimulation in children in an Indian cochlear implant clinic. A group of 14 children who have been using cochlear implants served as subjects in this study. They were fitted with advanced digital hearing aids in their un-implanted ears to provide bimodal stimulation. Results revealed that bimodal stimulation did not bring greater change in speech scores in quiet surroundings but have shown a noticeable improvement in noisy ambience. Hence the present study suggests that bimodal stimulation would benefit children with cochlear implants especially in adverse listening conditions.