-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Pulmonary tuberculosis (TB) is associated with an increased risk of lung cancer. Our study investigated whether the coexistence of an old pulmonary TB lesion is an independent prognostic factor for lung cancer survival in Chinese non-small cell lung cancer patients. METHODS: We performed a retrospective review of 782 non-small cell lung cancer patients who underwent surgical resection as their primary treatment in 2006 and were followed for 5 years. The associations between lung cancer survival and the presence of old pulmonary TB lesions were assessed using Cox's proportional hazard regression analysis adjusted for WHO performance status (PS), age, sex, smoking-status, tumor stage, and surgical approach. RESULTS: Sixty-four of the patients had old pulmonary TB lesions. The median survival of squamous cell carcinoma patients with TB was significantly shorter than that of patients without TB (1.7 vs. 3.4 years, p < 0.01). The presence of an old pulmonary TB lesion is an independent predictor of poor survival with a hazard ratio (HR) of 1.72 (95% CI, 1.12--2.64) in the subgroup of squamous cell carcinoma patients studied. CONCLUSION: The presence of an old pulmonary TB lesion may be an important prognostic factor for predicting the survival of squamous cell carcinoma patients.
Journal of Cardiothoracic Surgery 05/2013; 8(1):123. · 1.19 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Pneumonectomy is associated with a significant incidence of postoperative complications. The purpose of this study is to identify the risk factors associated with adverse outcomes. METHODS: One hundred thirty-six patients with benign lung disease who underwent pneumonectomy were included in this retrospective analysis. Postoperative complications were observed during the 30-day follow-up. Univariate and multivariate analysis was performed to investigate the risk factors of pneumonectomy among the patients. RESULTS: Postoperative complications were observed in 33 patients (24.26%). The rate of bronchopleural fistula was 6.1% (9 of 136). Five perioperative deaths (3.68%) were noted. Univariate analysis and multivariate analysis indicated that type of disease (hazard ratio [HR], 3.158; 95% confidence interval [CI], 1.248 to 7.992; p = 0.015) and operation duration (HR, 2.508; 95% CI, 1.035 to 6.080; p = 0.042) were independent risk factors of postoperative complications, and that type of disease (HR, 6.409; 95% CI, 1.669 to 6.021; p = 0.011) and pulmonary function (HR, 6.159; 95% CI, 0.018 to 0.625; p = 0.013) were independent risk factors of bronchopleural fistula for patients with benign lung disease after pneumonectomy. CONCLUSIONS: A high incidence of complications was reported among patients with benign lung disease after pneumonectomy. The type of disease and operation duration were the best independent predictors of morbidity after this surgery. With careful patient selection and operative technique, morbidity and mortality rates could be comparable to those for pneumonectomy in cancer patients. Pneumonectomy is still a satisfactory treatment method for benign lung disease.
The Annals of thoracic surgery 05/2013; · 3.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We report the case of a 35-year old woman with a giant thymic carcinoid of the left hemithorax. Enhanced computed tomography showed marked vascularization of the tumour, with an enlarged drainage vein. Endovascular embolization of the major feeding arteries of the tumour was performed preoperatively with good angiographic results. A left thoracotomy was performed the following day. Minimal bleeding was observed due to prior embolization. The patient made a rapid postoperative recovery and was discharged 8 days later.
Interactive cardiovascular and thoracic surgery 12/2012;
-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: It has been technically challenging to perform simultaneous triple plasty on the superior vena cava (SVC), pulmonary artery (PA), and main bronchus for central-type lung cancers. In the present study, the authors describe a corresponding technique and clinical outcomes of this surgical manipulation. METHODS: Clinical data from 4 patients with non-small cell lung cancer (NSCLC) who underwent triple plastic resections and reconstructions were retrospectively reviewed. Three patients received neoadjuvant chemotherapy for pathologically proven locally advanced disease. For pulmonary arteries, sleeve resection with end-to-end anastomosis was performed in 2 patients; tangential resection was used in the other 2 patients. SVC resection with ringed polytetrafluoroethylene (PTFE) graft interposition was performed in 1 patient; the other 3 patients underwent tangential SVC resection. Sleeve resection of the bronchus was performed in all 4 patients. Systemic lymphadenectomy was accomplished in all patients. RESULTS: There was histologic confirmation of large cell carcinoma, adenocarcinoma, squamous cancer, and adenosquamous cancer, respectively, in these 4 patients. Stage pT4N2M0-IIIB was confirmed in 2 patients, and stage T4N1M0-IIIA and stage T2aN2M0-IIIA were confirmed in the other 2 patients. There were no perioperative deaths. Postoperative atrial fibrillation and prolonged air leakage occurred in 2 patients, respectively. Four patients underwent postoperative chemotherapy and 2 patients were administered radiotherapy. Patients were followed for 21 to 38 months: Two patients had disease-free survival at their 32-month and 38-month follow-ups, and the other 2 patients died 21 and 22 months, respectively, after operation because of remote metastasis. CONCLUSIONS: Triple plasty of bronchus, PA, and SVC is both practical and safe for patients with locally advanced NSCLC. For patients with strict indications, the long-term survival is favorable.
The Annals of thoracic surgery 12/2012; · 3.74 Impact Factor
-
Yifeng Sun,
Bo Su,
Peng Zhang,
Huikang Xie,
Hui Zheng,
Yongjie Xu,
Qiaoling Du,
Huan Zeng,
Xiao Zhou, Chang Chen,
Wen Gao
[show abstract]
[hide abstract]
ABSTRACT: The present study investigated the expression of miR-150 and miR-3940-5p in non-small cell lung carcinoma (NSCLC) and its relationship with clinicopathologic features. Samples included tumor, tumor-adjacent and normal lung parenchyma tissues from 90 NSCLC patients and 17 cases of embryonic lung cDNA. The expression levels of miR-150, miR-18b-5p, miR-643 and miR-3940-5p were detected by real‑time PCR; p53, EGFR, Kras and Ki-67 expression in tumor tissues was determined by immunohistochemistry. p53 mRNA expression levels in NSCLC were examined by SYBR-Green real-time PCR. The relationship between the four miRNAs and clinicopathologic features of 90 cases was analyzed. The expression of miR-150 and miR-3940-5p was significantly downregulated in tumor tissues and embryonic lung tissues compared to normal lung tissues. The expression of miR-150 and miR-3940-5p in tumor tissues was also lower than that in the matched tumor-adjacent tissues. miR-150 was downregulated preferentially in subgroups of patients with a tumor diameter more than or equal to 3 cm, in smokers and in stage III and IV tumors. Specifically, miR-150 and miR-3940-5p expression was decreased in nuclear cell proliferation antigen Ki-67-positive NSCLC cases. miR-150 and miR-3940-5p were found to be significantly downregulated in p53 IHC-positive NSCLC cases and were negatively correlated with p53 mRNA. Reduced miR-150 and miR-3940-5p expression in tumor tissues and embryonic lung tissues suggests that these miRs may be involved in the tumorigenesis or de-differentiation of NSCLC. Due to this associaton with the Ki-67 proliferation index in NSCLC, downregulation of miR-150 and miR-3940-5p may contribute to tumor growth and proliferation. miR-150 and miR-3940-5p may affect p53 expression through a direct or indirect pathway.
Oncology Reports 11/2012; · 1.84 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Radical lung resection is the best chance for cure in patients with anatomically resectable non-small cell lung cancer. A retrospective study was performed in an attempt to investigate general rules of major lung resection for non-small cell lung cancer in patients with compromised pulmonary function.
Between June 2002 and December 2008, major lung resection was performed in 127 non-small cell lung cancer patients at our institution, who met the criteria of compromised pulmonary function defined as preoperative forced vital capacity < 50% of prediction or preoperative forced expiratory volume in one second < 50% of prediction. Clinical data of the patients were retrospectively reviewed.
The patients consisted of 108 males (85.0%) and 19 females (15.0%) with a mean age of 61.7 years. The morbidity rate was 44.1% (56/127) and the mortality rate was 4.7% (6/127). Multivariate analysis identified PaCO2 (P = 0.023, OR = 2.959, 95%CI 1.164 - 7.522), the percent predicted postoperative diffusing capacity of the lung for carbon monoxide (P = 0.001, OR = 0.176, 95%CI 0.064 - 0.480) and comprehensive preoperative preparation (P = 0.048, OR = 0.417, 95%CI 0.176 - 0.993) as the independent predictors of postoperative cardiopulmonary complications that were found in 45 cases. Overall 1-, 3- and 5-year survival rates were 90%, 55% and 37% respectively. For overall survival, multivariate analysis revealed that TNM staging (P = 0.004, OR = 1.585, 95%CI 1.154 - 2.178) was the only independent prognostic factor.
On the premise of integrated preoperative evaluation and comprehensive preoperative preparation, major lung resection provides an optimal therapeutic for selected non-small cell lung cancer patients with compromised pulmonary function. Hypercapnea and the percent predicted postoperative diffusing capacity of the lung for carbon monoxide < 40% could be considered as the independent predictive factors for operative risk in those patients.
Chinese medical journal 10/2012; 125(19):3465-71. · 0.86 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To clarify the clinical feature, diagnosis and therapy of the pulmonary cryptococcosis (PC).
A retrospective study of cases with PC who were diagnosed by pathological examinations between January 1996 and December 2010 was condected. 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.
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.
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.
Zhonghua wai ke za zhi [Chinese journal of surgery] 05/2012; 50(5):430-3.
-
[show abstract]
[hide abstract]
ABSTRACT: The prognostic significance of hilar structures invasion, which remains undefined for non-small cell lung cancer (NSCLC), may have potential application for cancer staging. Tumor extension along the bronchus and pulmonary vessels was examined for survival significance.
In all, 213 pathologically proved central-type stage I NSCLC cases were enrolled. Four study groups were assigned based on the extent of resections: standard lobectomy (group L, n=32), bronchoplastic procedures (group B, n=94), standard lobectomy combined with pulmonary angioplasty (group A, n=48), and bronchial sleeve resection combined with pulmonary artery angioplasty (group BA, n=39). Univariate and multivariate analysis were performed by the Kaplan-Meier method and the Cox regression model.
There were 2 postoperative deaths (pulmonary embolism and serious pulmonary infection). Complications were noted in 39 patients (18.3%). Among these patients, the overall 5-year survival rate was 60.2%±0.05%, with a median survival time of 75.0±7.5 months. The 5-year survival rates of subgroups were 79.5%, 59.7%, 59.0%, and 47.9%, respectively for groups L, B, A, and BA. Univariate analysis indicated tumor size, bronchial invasion, arterial involvement, and type of operation as closely associated with long-term survival. Multivariate analysis indicated that type of operation and tumor size were the most prominent prognostic factors of 5-year survival.
Proximal tumor extension into bronchus, invasions into extrapericardial pulmonary vessels, and tumor size were the most important risk factors for 5-year survival with central-type stage I NSCLC. Tumor extension in the hilum was highly related to prognosis and might provide pertinent information to accurately define a tumor ("T") subclass.
The Annals of thoracic surgery 12/2011; 93(2):389-96. · 3.74 Impact Factor
-
Asian cardiovascular & thoracic annals 10/2011; 19(5):370.
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the prognostic role of radical lymph node dissection in treatment for pulmonary Low Grade Malignant Tumors (LGMTs); specifically, on the extent of nodal removal and its impact on long-term survival.
A total of 93 LGMTs cases underwent surgical resection and were histopathologically confirmed. Overall survival rates and disease-free survival were respectively calculated according to the extent of lymph node resection and histopathological grades of tumors. Risk factors of nodal involvement and survival predictors were calculated via multivariate analysis. Life table, Kaplan-Meier, and Cox regression models were used for the statistical analysis.
Thirty-eight cases of carcinoid, 17 adenoid cystic carcinomas, and 38 mucoepidermoid carcinomas were included in the current study. Twenty-one cases were high-grade and 72 were low-grade. A total of 813 lymph nodes were removed, at an average of 8.7±5.4 nodes per patient. The numbers of harvested nodes were 11.8±4.5, in the study group via radical nodal removal and 4.0±2.4 nodes per patient in the nodal sampling group. Eleven cases showed lymph nodal involvement (5 mediastinal and 6 hilar lymph node metastasis). No significant differences of overall survival was found among the different histological types (p=0.939), or the extent of nodal removal (p=0.971). Meanwhile, there was a significant difference of disease-free survival (DFS) rates according to the extent of nodal removal (5-YS: 97% of radical nodal dissection vs. 78% of nodal sampling, p=0.038). Overall survival and disease-free survival were closely associated with histological grading (OS: 78% of high grade vs. 97% of low grade, p=0.001; DFS: 57% of high grade vs. 97% of low grade, p<0.0001).
Radical lymph node dissection improved disease-free survival for pulmonary low-grade malignant tumors, although no obvious improvement on overall survival was noticed. Histological grade was the most important prognostic factor in LGMTs.
Lung cancer (Amsterdam, Netherlands) 08/2011; 75(3):342-7. · 3.14 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The complete type of anomalous systemic arterial supply to normal basal lung segments is characterized by anomalous systemic artery supply to all or some of the normal basal segments with an absent corresponding pulmonary artery. Surgical intervention generally is required. This study reports on four patients with this anomaly with hemoptysis or a combination of other symptoms who underwent successful transarterial embolization using metallic coils or an Amplatzer vascular plug. To our knowledge, only six such cases treated with transarterial embolization have been reported previously in adult patients.
Chest 06/2011; 139(6):1506-13. · 5.25 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: N2 non-small-cell lung cancer (NSCLC) is a heterogeneous disease with an extremely wide range of 5-year survival rates. A composite method of sub-classification for N2 is likely to provide a more accurate method to more finely differentiate prognosis of N2 disease.
A total of 720 pN2 (T1-4N2M0) NSCLC cases were enrolled in our retrospective analysis of the proposed composite method. Survival rates were respectively calculated according to the N2 stratification methods: singly by "nodal stations", "nodal zones", or "nodal chains", or by combination of all three. Statistical analysis was carried out by Kaplan-Meier and Cox regression models.
A total of 10,199 lymph nodes (8059 mediastinal; 2140 hilar and intra-lobar) were removed. By nodal station, there were 173 cases of single-station involvement and 547 multi-stations. By nodal zone, there were 413 single-zone involvement and 307 with multiple zones. By nodal chain, there were 311 cases with single-chain and 409 multi-chain involvements. The overall 5-year survival was 20% and median survival time was 27.52 months. The 5-year survival was significantly better for cases of single-zone involvement, as compared to multi-zones (29% vs. 6%, p<0.0001). The 5-year survival rates of single- and multi-chains involvement were 36% and 8%, respectively (p<0.0001). When taking all of the above grouping methods into consideration, the N2 disease state could be further sub-classified into two subgroups with respective survival rates of 36% and 7% (p<0.0001). Subgroup I was composed of individuals with single-chain involvement and having either one or two station metastasis; individuals with any other metastasis combinations formed Subgroup II. Multivariate analysis revealed that the composite sub-classification method, number of positive lymph nodes, ratio of nodal metastasis, and pT information were the most important risk factors of 5-year survival.
By combining the three N2 stratification methods based on "stations", "zones", and "chains" into one composite method, prognosis prediction was more accurate for N2 NSCLC disease. Single nodal chain involvement, which may be either one or two nodal stations metastasis, is associated with best outcome for pN2 patients.
Lung cancer (Amsterdam, Netherlands) 04/2011; 74(3):497-503. · 3.14 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Aspiration via a congenital broncho-esophageal fistula in an adult thoracotomy patient has not been previously reported. Repeated aspiration and subsequent respiratory failure if the fistula is not recognized could be life-threatening in these postoperative patients. We describe one such critical case, in which a broncho-esophageal fistula was discovered weeks after aspiration and the onset of respiratory failure after left lower lobectomy. This unusual case suggests that repeated localized pulmonary infections can indicate a broncho-esophageal fistula and that further investigations should be performed, including detailed history.
Respiratory care 04/2011; 56(8):1195-7. · 2.01 Impact Factor
-
Wen-Xin He,
Ge-Ning Jiang,
Jia-An Ding,
Wen Gao,
Yu-Ming Zhu,
Xiao Zhou, Chang Chen,
Hao Wang,
Jiang Fan,
Peng Zhang,
Ming Liu
[show abstract]
[hide abstract]
ABSTRACT: Lung transplantation (LT) is a viable option for patients with end-stage lung diseases, but in China, the supply is limited, and the experience with LT is rare too. This study aimed to evaluate the survival and postoperative complications of recipients undergone LT.
From January 2003 to May 2010, all patients who underwent LT were included. The clinical data of recipients were analyzed retrospectively, including demographic characteristics, survival rate, and the occurrences of postoperative complications, acute rejection and bronchiolitis obliterans syndrome.
In total, 37 patients underwent LT. The early mortality (≤ 30 days) was 14% (5/37). Cumulative survival rate was 78%, 70%, 70% and 42% at 1, 3, 5 and 6 years, respectively. In 37 patients, 5 (14%) developed fungal infections, 9 (24%) pulmonary bacterial infections, and 6 (16%) had bronchial anastomosis complications after LT. At three months post-transplantation, a significant improvement was observed in lung function (P < 0.05). Fifteen recipients (41%) developed acute rejection within the first year. Freedom from bronchiolitis obliterans syndrome was 89%, 85% and 80% at 1, 2 and 3 years after transplantation.
Despite the limited number of cases, the survival and occurrences of complications after LT were comparable to the international experience. Single LT may be a reasonable option for some patients with end-stage pulmonary diseases.
Chinese medical journal 04/2011; 124(7):978-82. · 0.86 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Present research aimed to explore the rationale of defining RIR operations by metastatic status of highest nodes.
549 surgical patients, bearing pN2-NSCLCs, were enrolled in the current study. R1/R2 nodes on the right side and L4 nodes on the left were taken as the highest mediastinal lymph nodes. The operations were defined "Complete Resection (CR)" if the highest nodes were negative. Operations were otherwise "Relative Incomplete Resections (RIR)" if the nodes were positive. Exclusion criteria included: metastatic carcinomas or small cell lung cancer, prior history of induction therapy, exploratory thoracotomy, palliative resection, and massive pleural dissemination, as well as cases without "highest" mediastinal nodal pathology. The survival rate was calculated using the life-table and Kaplan-Meier method. Comparisons between groups were calculated using the Log-rank test.
A total of 6865 lymph nodes (5705 mediastinal and 1160 regional, average 12.6±6.4 nodes for each patient) were removed. Total cases included 246 RIR (100 left and 146 right side) and 303 CR (108 left and 195 right). The overall 5-year survival rate was 22% and the median survival time was 28.29 months. Five-year survival rates of the CR and RIR group were statistically significant (29% and 13%, respectively p<0.0001). L4 and R1/R2 lymph nodes had similar position for defining RIR; no obvious survival difference was indicated between either side (p=0.464 in CR groups, p=0.647 in RIR groups). N2 subcategories and skip-metastasis were closely associated with highest nodal involvement (p<0.0001). Multivariate analysis showed CR/RIR assignment, tumor size, N2 disease stratification, pathological T status, and number of positive mediastinal nodes were risk factors for 5-year survival in the present case series.
Involvement of the highest mediastinal lymph nodes is highly predictive of poor prognosis and indicates an advanced stage of the disease. Therefore, it may be appropriate to assign R1/R2 or L4 as criterion for defining RIR or CR cases in surgical NSCLC cases.
Lung cancer (Amsterdam, Netherlands) 11/2010; 72(3):348-54. · 3.14 Impact Factor
-
Yi Zhang,
Ge-ning Jiang,
Qun Wang,
Yu-ming Zhu,
Jia-an Ding, Chang Chen,
Xiao-feng Chen,
Hao Wang,
Bo-xiong Xie,
Wen-tao Li,
Wen-pu Tong
[show abstract]
[hide abstract]
ABSTRACT: 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).
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.
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.
VATS lobectomy for early NSCLC is associated with less acute inflammatory responses and less immunosuppression when compared with OT.
Zhonghua wai ke za zhi [Chinese journal of surgery] 09/2010; 48(17):1285-8.
-
Chinese medical journal 06/2010; 123(11):1477-8. · 0.86 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: There are few reports discussing the surgical pathological characteristics of superficial endobronchial lung cancer (SELC) defined as cancer growth limited to the bronchial wall. Its prognosis and corresponding TNM staging have not been fully clarified. Little is known as to whether T status is impacted by the existence of associated atelectasis or pneumonia (which might be controversial, indicating either T1 or T2), and circumstantial invasion depth.
Between 1988 and 2007, 81 out of 8817 surgically treated patients met SELC criteria; there was no detectable invasion beyond the bronchial wall. A retrospective review was performed and follow-up information was collected.
The overall five-year survival rate of 81 patients was 85.6%; for N0M0 (n = 67), N1M0 (n = 7) and N2M0 (n = 7) patients, they were 89.3%, 75.0% and 60.0%, respectively. Intraluminal tumor size measured from 0.4 to 3.0 cm; obstructive atelectasis or pneumonia was noted in 14 patients. The presence of tumor-associated obstructive atelectasis or pneumonia did not have a significant impact upon prognosis (P = 0.96), nor did the greatest diameter of the tumor (P = 0.70). Histology showed carcinoma in situ (level one) in 13 cases; invasion of the submucosal layer (level two) in 12, involvement of the muscular layer (level three) in 20, invasion into the space between the muscular layer and cartilage (level four) in 21, and bronchial cartilage infiltration in 15 (level five). In cases without lymphnode metastases, five-year survival was 100% for the first three levels and 84.0% and 61.3% for the level four and level five.
Relative to TNM-based prognostic data, superficial endobronchial lung cancer exhibits increased five-year survival rates, and therefore should be placed at the forefront among tumors in the T1 class, regardless of tumor size or the presence of secondary obstructive atelectasis or pneumonia. Lymphnode metastasis is associated with a worse prognosis. Survival is negatively impacted by tumor infiltration depth into the bronchial wall.
Chinese medical journal 06/2010; 123(12):1505-9. · 0.86 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We retrospectively analyzed risk factors for late bronchopleural fistula after non-small cell lung cancer (NSCLC) surgery and compared with those for early bronchopleural fistula.
In all, 6,239 patients with NSCLC who underwent surgery were studied, and clinical risk factors were examined by univariate and multivariate analysis. This study included 23 patients (0.38%) with late bronchopleural fistula and 43 patients (0.65%) with early bronchopleural fistula among all 6,239 patients. Follow-up data were recorded until December 2005 or until death. Statistical significance was calculated using the log rank test.
By univariate analysis, patients with radiotherapy after operation, pneumonia after operation, pneumonectomy, and advanced age were related to higher risk of bronchopleural fistula. In the multiple logistic regression models, both pneumonia and operative procedure were among the independent risk factors of early and late bronchopleural fistula. Early bronchopleural fistula was observed primarily in the aged. Late bronchopleural fistula was associated with postoperative radiotherapy. The average intervals of bronchopleural fistula between pneumonectomy and lobectomy were significantly different. Compared with the mortality rate of late bronchopleural fistula (0%), the mortality rate of early bronchopleural fistula (11.6%) was significantly higher.
There are both similarities and differences between the risk factors for early and late bronchopleural fistula. We should analyze the different reasons for the occurrence of bronchopleural fistula, and adopt different preventive measures. Different follow-up should be provided for the different operations.
The Annals of thoracic surgery 11/2009; 88(5):1589-93. · 3.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Obliterative airway disease (OAD) has been a major obstacle to long-term survival after lung or tracheal transplantations, but the role of airflow has not been examined in the orthotopic or the heterotopic tracheal transplantation models.
Sixty mice were assigned to two experimental groups. Two C57BL/6 tracheal segments were surgically prepared and then orthotopically transplanted into allogeneic BALB/c recipients. In group A mice, both segments were left patent, whereas in group B mice, one of the donor tracheas was occluded with a silk knot to obstruct airflow. Histology, quantitative OAD measurements, electron microscopy, immunohistochemical staining, and apoptosis measurement of the epithelium were performed.
Gross examination at harvest showed patent lumens of all tracheal segments. Group A allografts (ventilating tracheas) showed a markedly higher proportion of ciliated epitheliums and less lymphocyte infiltration in the lamina propria, whereas the epithelium appeared metaplastic in group B, with a higher proportion of flattened attenuated epithelium and loss of the normal ciliate architecture. Quantitative morphometric measurements suggested more prominent OAD manifestations in the nonventilating allografts of group B than were present in group A, although recipient-derived epithelium was observed in all allografts under immunohistochemical staining. The apoptotic indexes of the epithelium were 12.1% in allografts with adequate ventilation (group A) and 66.2% in ventilation-occluded allotracheas (group B).
OAD severity and the epithelial repopulation process are closely related to the physiologic environment of airflow. Further research is warranted to explore the underlying mechanisms of this phenomenon.
Transplantation 07/2009; 87(12):1762-8. · 4.00 Impact Factor
