ABSTRACT: To compare the instructive value of the 6th and 7th editions of the UICC-AJCC staging system in prognosis of esophageal cancer (EC) patients.
The staging and prognosis of 1397 esophageal carcinoma patients undergoing curative resection from Jan. 2003 to Dec. 2006 in our hospital were retrospectively reviewed and analyzed according to the 6th AJCC staging system and the 7th UICC-AJCC staging system.
The 5-year overall survival (OS) of EC patients with curative resection was 38.5% (481/1250 cases), with a follow-up rate of 89.5% (1250/1397 case). In overall terms, both the editions were statistically significant discriminators of OS (P < 0.05). The 5-year OS of stages I, II and III patients were 64.9%, 43.5%, 25.2% according to the 6th edition, and 63.5%, 44.5%, 23.5% according to the 7th edition, respectively. Distinct differences in survival were present among patients categorized as stage Ia and Ib according to the 7th edition (P < 0.05), with a 5-year OS of 80.0% and 58.3%, respectively. Similarly, according to the 7th edition, the 5-year overall survivals (OS) of the stages IIIa, IIIb and IIIc patients were 28.2%, 18.4% and 16.7%, respectively, showing that the prognoses were significantly different (P < 0.05). In addition, according to the 7th edition, the prognoses of patients in stages N0, N1, N2 and N3 were also significantly different (P < 0.01), and the 5-year OS were 50.0%, 31.5%, 18.7% and 16.7%, respectively.
Both the 6th and 7th editions of UICC-AJCC staging system are significant discriminators for survival of esophageal cancer patients. The 7th edition is proved to be more accurate in prognosis. The number of lymph node metastases is an important predictor of prognosis.
Zhonghua zhong liu za zhi [Chinese journal of oncology] 06/2012; 34(6):461-4.
ABSTRACT: As a rare benign lung tumor, pulmonary sclerosing hemangioma (PSH) occurs predominantly in Asian women in their fifth and sixth decades of life. PSH is considered to be evolved from primitive undifferentiated respiratory epithelium. In this study, we summarized our experience in 89 cases of PSH.
There were a total of 89 patients who received surgical resection and were histopathologically diagnosed as PSH during the period January 2001 to December 2010 in department of thoracic surgery, Cancer Institute and Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences. The clinical data of these patients including symptoms, disease courses, image characteristics and surgical procedures were collected and reviewed retrospectively.
The PSHs were most frequently (50.6%) found in the patients aged 41 to 60 years with a median age of 51 years (range: 24 - 71), and the sex ratio (male/female) was approximately 1:7 in this series. In the 89 patients, 53 (59.6%) were asymptomatic while the other 36 (40.4%) had some non-special symptoms such as cough (30.3%), hemoptysis (24.7%). There were only 3 cases (3.4%) with multiple PSHs, 4 cases (4.5%) combined with synchronous primary lung cancer, and 13 cases (14.6%) with lesions located in the hilar region. The median diameter of the 92 lesions was 2.3 cm (range: 0.3 - 6.0 cm), of which 38% located in the right lower lobe and 26.1% in the right middle lobe, and only about 1/3 were assumed as PSHs preoperatively based on CT imaging. One of the five patients who underwent PET-CT scan had been misdiagnosed as malignant. Of the 92 lesions, 47 were resected by enucleation, 29 by wedge resection, 14 by lobectomy, and 2 by pneumonectomy.
PSH frequently occurs in the middle-aged women. Most individuals with PSH are asymptomatic or have some non-specific symptoms. Their lesions are usually found accidentally by chest imaging. Although PSH often shows typical imaging characteristics of benign neoplasm of the lung, it is difficult to establish a defined pathological diagnosis preoperatively. The significant error or deferred rate of intraoperative frozen-section evaluation for PSH may result in some unnecessarily extensive surgical procedures. The complete surgical resection is considered the only effective treatment for PSH, and the normal pulmonary tissue should be reserved as possible.
Zhonghua yi xue za zhi 05/2012; 92(17):1190-3.
ABSTRACT: ObjectiveTo evaluate the indication and short-term outcomes of video assisted thoracic surgery (VATS) for lung tumors.
MethodsData of 306 consecutive patients undergoing VATS pulmonary resection between January 2009 and August 2010 in Cancer Institute
& Hospital, Chinese Academy of Medical Sciences were retrospectively reviewed.
ResultsThere were 7 patients who underwent open thoracotomy, accounting for 2.29% (7/306). The overall morbidity rate of complications
and the mortality rate induced by VATS was 1.63% (5/306) and 0.33% (1/306), respectively. There were no significant differences
in morbidity and mortality rate between the patients receiving the VATS and the patients receiving the OT. The overall hospitalization,
postoperative length of stay (LOS) and chest tube duration in the VATS lobectomy group (n = 167) were shorter than those in the open thoracotomy (OT), but the operative time in the VATS group was longer than that
in the OT group (n = 124). There were no significant differences in the number of station of lymph nodal dissection (LND) and number of LND
in pathological stage I between VATS group and OT group, but significant differences were found in the number of station of
LND and the number of LND in pathological stage II and stage IIIA between the 2 groups. Compared with those who underwent
OT wedge resection (n = 72), the patients who underwent VATS wedge resection (n = 108) had shorter operative time, chest tube duration and hospital LOS, and there were no significant differences in morbidity
of the complications and mortality between the 2 groups.
ConclusionVATS lobectomy can be performed for patients with clinical stage I lung cancer (with tumor diameter smaller than 5 cm, without
hilar and mediastinal lymph node enlargement). VATS lobectomy is superior to OT lobectomy in short-term outcomes, although
further studies exploring long-term outcomes through longer follow-up is needed to determine the oncologic equivalency between
the VATS and the open lobectomy. VATS is also superior to OT in pulmonary wedge resection.
Key Wordsthoracic surgery-video-assisted-lung neoplasms-thoracotomy
Clinical Oncology and Cancer Research 04/2012; 7(5):310-316.
ABSTRACT: To compare the short-term outcomes of surgical treatment for non-small cell lung cancer (NSCLC) by video-assisted thoracoscopic surgery (VATS) and open thoracotomy (OT).
Data of 737 consecutive NSCLC patients who underwent surgical treatment for non-small cell lung cancer by video-assisted thoracoscopic surgery and 630 patients who underwent pulmonary resection via open thoracotomy (as controls) in Cancer Institute & Hospital, Chinese Academy of Medical Sciences between January 2009 and August 2011 were retrospectively reviewed. The risk factors after lobectomy were also analyzed.
In the 506 NSCLC patients who received VATS lobectomy, postoperative complications occurred in 13 patients (2.6%) and one patient died of acute respiratory distress syndrome (0.2%). In the 521 patients who received open thoracotomy (OT) lobectomy, postoperative complications occurred in 21 patients (4.0%) and one patient died of pulmonary infection (0.2%). There was no significant difference in the morbidity rate (P > 0.05) and mortality rate (P > 0.05) between the VATS group and OT group. In the 190 patients who received VATS wedge resections, postoperative complications occurred in 3 patients (1.6%). One hundred and nine patients received OT wedge resections. Postoperative complications occurred in 4 patients (3.7%). There were no significant differences for morbidity rate (P = 0.262) between these two groups, and there was no perioperative death in these two groups. Univariate and multivariate analyses demonstrated that age (OR = 1.047, 95%CI: 1.004 - 1.091), history of smoking (OR = 6.374, 95%CI: 2.588 - 15.695) and operation time (OR = 1.418, 95%CI: 1.075 - 1.871) were independent risk factors of postoperative complications.
To compare with the NSCLC patients who should undergo lobectomy or wedge resection via open thoracotomy, a similar short-term outcome can be achieved via VATS approach.
Zhonghua zhong liu za zhi [Chinese journal of oncology] 04/2012; 34(4):301-5.
ABSTRACT: To evaluate the indication and safety of video assisted thoracic surgery (VATS) for chest tumors.
Data of 144 consecutive patients receiving VATS between January and November 2009 in Cancer hospital Chinese Academy of Medical Sciences were retrospectively reviewed.
There was no conversion to open thoracotomy. Overall morbidity rate was 2.08% (3/144) and mortality rate was 0.69% (1/144). There were no significant differences for operative time, number of nodal dissection, morbidity rate, mortality rate, overall hospitalization and postoperative length of stay between VATS lobectomy group and open thoracotomy (OT) lobectomy group. Chest tube duration was shorter in the VATS lobectomy group than OT lobectomy group and more early-stage lung cancer patients were found in VATS group. There were no significant differences for number of nodal dissection, chest tube duration, morbidity rate, mortality rate, and postoperative length of stay between VATS lung wedge resection group and OT lung wedge resection group. Operative time and overall hospitalization were shorter in the VATS wedge resection group than OT wedge resection group.
Morbidity and mortality rate of VATS were acceptable. VATS lobectomy can be used as an alternative surgical technique for early-stage lung cancer. For lung wedge resection, VATS was superior than OT.
Zhonghua yi xue za zhi 03/2010; 90(9):621-3.
ABSTRACT: Castleman's disease (CD) is a rare disorder characterized by non-cancerous tumor growth that may develop in the lymph node tissue at a single site or throughout the body (Castleman et al. in Cancer 9:822-830, 1956). It involves hyperproliferation of specific B cells that produce the cytokine IL-6. This disorder is often undiagnosed or misdiagnosed. For this reason, only very few patients have been reported, and little information is available in the literature. In hopes of providing a better understanding of this rare disease, this report examines 52 patients with Unicentric Castleman's disease (UCD) and Multicentric Castleman's disease (MCD) treated from 1999-2008 at a single institution. Fifty-two patients with CD, along with their histological diagnoses, were collected. Patients were divided into two groups--the more common UCD and the less common MCD. Relevant clinical, pathological, and laboratory data were examined in order to evaluate treatment responses, with symptom onsets and survival period serving as the endpoints of the assessment. Each of the 48 patients with UCD exhibited benign symptoms and underwent a curative surgical resection with excellent prognosis. All of the four patients with MCD received surgical resection. Three of the four patients relapsed and received radiotherapy and/or chemotherapy. Only one of the three post-treatment patients survived. UCD is manifested in the form of benign, painless, slow lymph node enlargement that is generally asymptomatic. Complete surgical removal is recommended as a course of curative treatment. The multicentric form of CD exhibits a progressive clinical course with potential for malignancy. There is currently no standard therapy for MCD.
Medical Oncology 11/2009; 27(4):1171-8. · 2.14 Impact Factor
ABSTRACT: To study the feasibility of interphase fluorescence in situ hybridization (FISH) in detection of chromosomal aneuploidy in touch preparations of lung carcinoma and its clinic significance.
We examined 46 touch preparations of lung carcinomas by FISH with DNA specific for chromosomes 7, 8, 9 and 12 to detect chromosomal aneuploidy.
Aneuploidy, mainly featured in gains of chromosomes 7, 8 and 12 and loss of chromosome 9 were observed in all of the touch preparations of the 46 cases with lung cancer. The rates of chromosomal aneuploidy detected by FISH were 67.4% (31/46), 60.9% (28/46), 28.3% (13/46) and 56.5% (26/31) respectively.
Interphase FISH is feasible in detecting aneuploidy in touch preparations of lung cancer. These alterations may be applied to early diagnosis and predicting prognosis of lung cancer.
Zhonghua yi xue za zhi 07/2007; 87(24):1701-3.
ABSTRACT: To investigate the classification, incidence, clinical characteristics, diagnosis and surgical treatment of pulmonary sequestration.
The clinical data of 23 patients with pulmonary sequestration, 13 males and 10 females, aged 39 (12 - 71), with a course of 3 days to 9 years, hospitalized during the period from May 1974 to November 2006, were reviewed retrospectively.
The cases of sequestration were presents which were resected and confirmed by pathology in our department. The incident rate of pulmonary sequestration was 0.29% among the patients who underwent operation during that period. Nineteen (83%) of the 23 patients suffered from interloper pulmonary sequestration and 4 suffered from extralobar pulmonary sequestration. Eighteen of the 23 patients had recurrent pneumonia with the clinical manifestations of cough, fever, and hemoptysis. Fourteen cases got confirmed diagnosis before operation.
The diagnosis of pulmonary sequestration mainly depends on X-ray, CT and MRI. The sequestration should be removed whenever it is diagnosed.
Zhonghua yi xue za zhi 07/2007; 87(23):1616-7.
ABSTRACT: An accurate clinical TNM staging of lung cancer is essential for the precise determination of the extent of the disease in order that an optimal therapeutic strategy can be planned. This is especially true in patients with marginally resectable tumors. Clinical over-staging of the disease may deny a patient the benefit of surgery, whereas under-staging may oblige a patient to accept a fruitless or even harmful surgery. We aimed to analyze preoperative clinical (c-TNM) and postoperative surgico-pathologic staging (p-TNM) of lung cancer patients in order to evaluate the accuracy of our clinical staging and its implications on the surgical strategy for lung cancer.
We did a retrospective comparison of c-TNM and p-TNM staging of 2007 patients with lung cancer surgically treated from January 1999 to May 2003. Preoperative evaluation and c-TNM staging of all patients were based on physical examination, laboratory studies, routine chest X-ray and CT scan of the chest and upper abdomen. Other examinations included sputum cytology, bronchoscopy, abdominal ultrasonography, bone scintiscan, brain CT/MRI, and mediastinoscopy whenever indicated.
In the present study the comparison of c-TNM and p-TNM staging of 2007 patients with lung cancer revealed an overall concurrence rate of only 39.0%. In the entire series the extent of disease was clinically underestimated in 45.2% and overestimated in 15.8% of the patients. Among all c-TNM stages the c-IA/B stage of 1105 patients gave the highest rate (55.2%) of underestimating the extent of disease. Clinical staging of T subsets was relatively easy with an overall accuracy rate of 72.9%, while that of N subsets was relatively more difficult with an overall accuracy rate of 53.5%. Analysis also showed that c-IV stage may not be an absolute contraindication to surgery, because in half of the patients, c-M1 turned out to be p-M0, providing the possibility of resectional surgery depending on the status of T and N.
For reasons to be further determined, the present preoperative clinical TNM staging of lung cancer remains a crude evaluation. Further efforts to improve its accuracy are needed.
Zhonghua zhong liu za zhi [Chinese journal of oncology] 10/2005; 27(9):551-3.