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ABSTRACT: Intrathoracic anastomotic leakage following esophagectomy is extremely difficult to manage appropriately. The outcomes of conservative management strategies are often disappointing, particularly in patients who develop adhesions of the pleural cavity and multiloculated empyema. This study describes a novel approach using combined thoracoscopy and gastroscopy in two cases. Thoracoscopy under local anesthesia was used to dissect the septations within the multiloculated empyema and remove the infected focus by direct visualization, and gastroscopy was subsequently performed to place a nasogastric or sump tube around the leak. The outcomes of both procedures were satisfactory: the empyemas almost completely resolved, the anastomotic leak closed quickly and there was adequate lung re-expansion. Accordingly, the combination of thoracoscopy and gastroscopy for the treatment of intrathoracic anastomotic leak post-esophagectomy may be an effective, safe, minimally-invasive, simple and inexpensive procedure.
Oncology letters 01/2013; 5(1):198-200. · 0.11 Impact Factor
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ABSTRACT: High serum carcinoembryonic antigen (CEA) levels have been reported to be associated with poor prognosis in non-small cell lung cancer (NSCLC), while the prognostic role of tumor CEA expression remains to be defined. The present study investigated the expression of tumor CEA in stage IB NSCLC, and correlated it with clinicopathological features and prognosis.
Immunohistochemistry for tumor CEA was assessed in the specimens of 183 patients with stage IB NSCLC. Receiver-operating characteristic (ROC) curve analysis was used to determine the cut-off score for tumor positivity.
High CEA expression was detected more frequently in adenocarcinomas (72.2%) and other NSCLCs (69.0%) than in squamous cell carcinomas (25.4%, P<0.001). Both univariate and multivariate analysis indicated that tumor CEA was an independent prognostic factor for overall and disease-free survival (P<0.05).
Elevated expression of tumor CEA may be an adverse prognostic indicator in stages IB NSCLC.
Journal of thoracic disease. 10/2012; 4(5):490-6.
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ABSTRACT: Epidermal growth factor receptor (EGFR) gene mutation and copy number are useful predictive markers that guide the selection of non-small cell lung cancer (NSCLC) patients for EGFR-targeting therapy. This study aimed to investigate the correlation between EGFR gene mutation and copy number and clinicopathologic characteristics of Chinese patients with NSCLC. NSCLC specimens collected from 205 patients between November 2009 and January 2011 were selected to detect EGFR gene mutations with real-time polymerase chain reaction (RT-PCR) and to detect EGFR gene copy number with fluorescence in situ hybridization (FISH). EGFR mutations primarily occurred in females, non-smokers, and patients with adenocarinomas (all P < 0.001). Tissues from 128 (62%) patients were FISH-positive for EGFR, including 37 (18%) with gene amplification and 91 (44%) with high polysomy. EGFR gene mutation was correlated with FISH-positive status (R = 0.340, P < 0.001). Multivariate analysis showed that not smoking (OR = 5.910, 95% CI = 2.363-14.779, P < 0.001) and having adenocarcinoma (OR = 0.122, 95% CI = 0.026-0.581, P = 0.008) were favorable factors for EGFR gene mutation. These results show a high frequency of EGFR FISH positivity in NSCLC tissues from Chinese patients and a significant relevance between EGFR gene mutations and FISH-positive status. Among the FISH-positive samples, EGFR gene mutation occurred more frequently in samples with gene amplification compared to those with high polysomy, suggesting that EGFR mutation and gene amplification should be used as clinical decision parameters to predict response to EGFR-targeting therapy.
Chinese journal of cancer 05/2012; 31(10):491-9.
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ABSTRACT: Response criteria remain controversial in therapeutic evaluation for locally advanced esophageal carcinoma treated with neoadjuvant chemotherapy. We aimed to identify the predictive value of tumor regression grading (TRG) in tumor response and prognosis. Fifty-two patients who underwent neoadjuvant chemotherapy followed by esophagectomy and radical 2-field lymphadenectomy between June 2007 and June 2011 were included in this study. All tissue specimens were reassessed according to the TRG scale. Potential prognostic factors, including clinicopathologic factors, were evaluated. Survival curves were generated by using the Kaplan-Meier method and compared with the log-rank test. Prognostic factors were determined with multivariate analysis by using the Cox regression model. Our results showed that of 52 cases, 43 (83%) were squamous cell carcinoma and 9 (17%) were adenocarcinoma. TRG was correlated with pathologic T(P = 0.006) and N (P < 0.001) categories. Median overall survival for the entire cohort was 33 months. The 1- and 2-year overall survival rates were 71% and 44%, respectively. Univariate survival analysis results showed that favorable prognostic factors were histological subtype (P = 0.003), pathologic T category (P = 0.026), pathologic N category (P < 0.001), and TRG G0 (P = 0.041). Multivariate analyses identified pathologic N category (P < 0.001) as a significant independent prognostic parameter. Our results indicate that histomorphologic TRG can be considered as an alternative option to predict the therapeutic efficacy and prognostic factor for patients with locally advanced esophageal carcinoma treated by neoadjuvant chemotherapy.
Chinese journal of cancer 05/2012; 31(8):399-408.
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ABSTRACT: ObjectiveTo explore the extent of lymphadenectomy deemed reasonable by analyzing the influence of the regular pattern and ratio of
lymph node metastasis on the prognosis of the patients with middle third thoracic esophageal squamous cell carcinoma.
MethodsClinical data from 129 patients with middle third thoracic esophageal squamous cell carcinoma who underwent curative esophagectomy
with modern two-field lymphadenectomy were retrospectively analyzed.
ResultsThe rate of lymphatic metastasis in EC patients was 56.6% in all groups, and the ratio of lymph node metastasis (RLNM, i.e.
positive nodes/total dissected nodes) was 11.3%, with a lymphatic metastasis rate of 43.4% in the superior mediastinum. The
most commonly involved regions included the sites around the esophagus, the right recurrent laryngeal nerve and the left-sided
blood vessels of stomach, as well as the cardia and the inferior tracheal protuberance. The main factors influencing lymphatic
metastasis were the depth of tumor infiltration, differentiation of tumor cells and the size of the tumor. The 5-year survival
rate for patients in the groups without lymphatic metastasis, with a RLNM ≤ 20%, and a metastasis ratio > 20% was 50.4%, 31.0%
and 6.8%, respectively. The differences were statistically significant among the groups (P = 0.000).
ConclusionThe RLNM is one of the key factors affecting the prognosis of EC patients. For conventional therapy for patients with middle
third thoracic esophageal carcinoma, modern 2-field lymphadenectomy, including node dissection in the bilateral superior mediastinum,
should be performed.
Key Wordsesophagus cancer-lymph nodes-metastasis-lymphadenectomy
Clinical Oncology and Cancer Research 04/2012; 7(1):33-38.
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ABSTRACT: The purpose of this study was to investigate the correlation between gene mutation and gene copy number and their association with the clinical profiles and pathological features in Chinese patients with non-small cell lung cancer (NSCLC).
Surgical specimens of cancer tissue were collected from 118 NSCLC patients. Gene mutations in exon 19 and exon 21 were detected by real-time PCR and gene copy number was detected by fluorescence in situ hybridization (FISH). Chi-square (χ(2)) test was performed to analyze the correlation between EGFR mutation and gene copy number, and explore their association with clinicopathological features in the NSCLC patients.
The mutation frequency in EGFR was 41.5% (49/118). EGFR mutations occured in 50.0% (48/96) of patients with adenocarinoma and 5.0% (1/20) of patients with squamous cell carcinoma. EGFR gene high copy number was detected in 70.3% (83/118)of the patients. The FISH-positive rate was 78.1% (75/96) in adenocarcinoma and 35.0% (7/20) in squamous cell carcinoma. EGFR mutation and high copy number mainly occurred in the adenocarcinoma, advanced stage, female gender, and non-smoking patients. There was a significant correlation between EGFR gene mutation and gene high copy number.
EGFR gene mutation and gene high copy number are more common in Chinese NSCLC patients with adenocarcinomas, advanced stage, non-smokers and females. There is a significant correlation between gene mutation and gene high copy number. Combined analysis of EGFR mutation and gene copy number by FISH may provide a superior approach in selecting patients who may benefit from anti-EGFR target therapy.
Zhonghua zhong liu za zhi [Chinese journal of oncology] 09/2011; 33(9):666-70.
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ABSTRACT: More data are essential to test the efficacy of the American Joint Committee on Cancer (AJCC) system for staging esophageal squamous cell carcinoma. We tested the classifiers used in the AJCC staging system and propose a modification to this system to better represent the survival characteristics of esophageal squamous cell carcinoma in the Chinese population.
We used data from two centers, which established the training (n=1,006) and validation (n=783) cohorts. All the patients underwent curative surgical treatment. Survival was compared using AJCC classifiers to test the efficacy of this staging system. Martingale residuals from a Cox proportional hazards regression model were used to modify the nodal categories. The results obtained from the training cohort were validated with the validation cohort at each step.
The evaluation of the patients' overall survival allowed only poor discrimination between AJCC IIIb and IIIc cancers in both cohorts. Also, in both cohorts, N2 and N3 classification cancers could not be well discriminated in terms of survival when AJCC nodal categories were used. Nevertheless, the survival rate could easily be distinguished when using the four modified categories: 0, 1, 2 to 3, and 4 or more positive nodes. The survival difference between IIIb and IIIc obtained using the modified nodal categories could easily be discriminated in both cohorts.
Esophageal squamous cell carcinoma nodal staging for the Chinese population was more accurately classified using the following four categories: no positive node, 1 positive node, 2 to 3 positive nodes, and 4 or more positive nodes. Further studies are required to confirm these results.
The Annals of thoracic surgery 07/2011; 92(1):216-24. · 3.74 Impact Factor
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ABSTRACT: To evaluate a new method for chest wall reconstruction using porcine-derived artificial rib and pleura in an animal experiment. Further, the clinical application was performed in five patients with large defects in the chest wall as a preliminary observation.
In animal experiments, a full-thickness chest wall defect of 7 cm × 8 cm was created in 12 adult mongrel dogs. Six dogs underwent reconstruction with porcine-derived artificial ribs and pleura (test group), and six with methylmethacrylate and double polyester mesh in the form of traditional Marlex sandwich technique (control group). At follow-up of each for 3, 6, and 12 months postoperatively, a general performance assessment and thoracic radiography were performed. Gross and histopathological examinations were carried out following humane euthanasia at the time of last follow-up. In clinical application, five patients with wide tumor resection in the chest wall underwent reconstruction with porcine-derived artificial ribs and pleura as well.
In animal experiment, no perioperative death or hyperpyrexia occurred and no difference in either infection or dyspnea was noted between the two groups. Postoperative radiography revealed good thoracic integrity with no evidence of collapse, deformation, or abnormal movement in the test group. In the control group, similar results were observed, except that two dogs had abnormal movement in the chest wall associated with respiration. Severe adhesions between the 'sandwich' complex and the host tissues were identified in the control group, but by contrast, only mild adhesions were noted in the test group. The non-degradable polyester mesh induced fibrous proliferation and rejection, whereas the artificial pleura was absorbed with mild fibrous hyperplasia after 12 months. In clinical application, no thoracic deformity, chronic pain, or respiratory discomfort were observed at 1 or 12 postoperative months.
Porcine-derived ribs and pleura can be employed safely to create an artificial chest wall to repair bony chest defects. The clinical results corresponded well with those of animal experiments, and thus confirmed the safety and feasibility of this new alternative of chest wall reconstruction. However, a long-term study in a large number is needed due to the small number of animals in this study.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 02/2011; 40(4):939-47. · 2.40 Impact Factor
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ABSTRACT: To study the expression of β-catenin in esophageal squamous cell carcinoma (ESCC) at stage T2-3N0M0 and its relation with the prognosis of ESCC patients.
Expression of β-catenin in 227 ESCC specimens was detected by immunohistochemistry (IHC). A reproducible semi-quantitative method which takes both staining percentage and intensity into account was applied in IHC scoring, and receiver operating characteristic curve analysis was used to select the cut-off score for high or low IHC reactivity. Then, correlation of β-catenin expression with clinicopathological features and prognosis of ESCC patients was determined.
No significant correlation was observed between β-catenin expression and clinicopathological parameters in terms of gender, age, tumor size, tumor grade, tumor location, depth of invasion and pathological stage. The Kaplan-Meier survival curve showed that the up-regulated expression of β-catenin indicated a poorer post-operative survival rate of ESCC patients at stage T2-3N0M0 (P = 0.004), especially of those with T3 lesions (P = 0.014) or with stage IIB diseases (P = 0.007). Multivariate analysis also confirmed that β-catenin was an independent prognostic factor for the overall survival rate of ESCC patients at stage T2-3N0M0 (relative risk = 1.642, 95% CI: 1.159-2.327, P = 0.005).
Elevated β-catenin expression level may be an adverse indicator for the prognosis of ESCC patients at stage T2-3N0M0, especially for those with T3 lesions or stage IIB diseases.
World Journal of Gastroenterology 11/2010; 16(41):5195-202. · 2.47 Impact Factor
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ABSTRACT: Surgical resection remains the cornerstone of treatment for esophageal carcinoma. Mediastinal lymphadenectomy including subcarinal nodes has always been considered to be a reasonable extent, because of close anatomical relationship between subcarinal nodes and tracheobronchial tree. Metastatic involvement of subcarinal nodes alone is rare in esophageal carcinoma. In view of special anatomical features of subcarinal lymph nodes, it is worth exploring and discussing whether or not subcarinal lymph nodes dissection shall be routinely performed for thoracic esophageal carcinoma.
The data from a cohort of 676 patients with thoracic esophagus carcinoma who underwent esophagectomy with lymphadenectomy were analyzed retrospectively with respect to the impact of subcarinal lymph nodes dissection or non-dissection on the incidence of postoperative complications and patient survival.
The rate of subcarinal lymph nodes metastasis was 10.4%. The metastasis rates in upper, middle and lower esophageal carcinoma were 0%, 13.2% and 6.8% respectively (P = 0.001); for Tis, T1, T2, T3 and T4, they were 0%, 0%, 6.5%, 13.3% and 28.6% respectively (P = 0.008). The overall incidence of postoperative complications with and without subcarinal lymph nodes dissection was 36.8% versus 26.6% (P = 0.013). And the incidence of pulmonary complications were 22.2% versus 14.1% (P = 0.020). Survival analysis showed that: the 5-year survival rates were 50.9% versus 62.8% in the groups A and B of N0 patients (P = 0.083); 14.7% versus 29.3% in N1 patients (P = 0.112). In the group with metastasis of subcarinal lymph nodes, the 5-year survival rate was 22.6% versus 31.7% in those without metastasis (P = 0.142).
It may be unnecessary to dissect the subcarinal lymph nodes routinely for upper thoracic esophageal carcinoma. Elective subcarinal lymph nodes dissection can be planned for middle, lower, T3 or T4 thoracic esophageal carcinoma, or highly suspected subcarinal metastasis based on radiological imaging.
Zhonghua yi xue za zhi 10/2010; 90(37):2636-9.
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ABSTRACT: The aim of this study was to evaluate if factors associated with dissected lymph nodes affect the outcome of completely resected stage II (T1-2N1) non-small cell lung cancer (NSCLC).
Clinical data of 121 patients with complete resection of stage II NSCLC in Sun Yat-sen University Cancer center from January 1998 to December 2004 were reviewed retrospectively and the effect of factors of dissected lymph nodes on overall survival (OS) and disease-free survival (DFS) of NSCLC was analyzed.
The univariate analysis demonstrated that the total number of removed lymph nodes, the number of involved N1 lymph nodes, the ratio of involved N1 lymph nodes and the total number of removed N2 lymph nodes were significant prognostic factors for OS. In the multivariate analysis, the total number of removed lymph nodes and the number of involved N1 lymph nodes were independent prognostic factors for OS. In both of univariate and multivariate analyses, tumor size, the total number of removed lymph nodes and the number of involved N1 lymph nodes were independent prognostic factors for DFS.
For patients with completely resectable stage II NSCLC, 10 or more lymph nodes should be removed at the surgical resection. Total number of removed lymph nodes >or= 10 is a favorable prognostic factor and involved N1 >or= 3 is an adverse one.
Zhonghua zhong liu za zhi [Chinese journal of oncology] 06/2010; 32(6):436-40.
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ABSTRACT: To evaluate the role of endoscopic ultrasonography (EUS) and CT in the prediction of the resectability of esophageal carcinoma.
A retrospective study was carried out in 746 patients with esophageal carcinoma. These patients were divided into CT group (480 cases), EUS group (151 cases) and EUS+CT group (115 cases). Images of EUS and CT were double-blindly reviewed by radiologists. Relationship of EUS and CT images with surgical and pathological findings was examined.
Resection rates in the EUS group, CT group and EUS+CT group were 93.4%, 91.0% and 93.9%, respectively (chi(2)=1.551, P=0.484). Accuracy, sensitivity, specificity, positive predictive value and negative predictive value in the CT group were 81.7%, 87.4%, 23.3%, 92.0% and 15.4%, respectively; 94.7%, 98.6%, 40.0%, 95.9% and 66.7% in the EUS group; and 96.5%, 99.1%, 57.1%, 97.3% and 80.0% in the EUS+CT group, respectively. When assessing aortic invasion, accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 91.3%, 33.3%, 93.1%, 13.5% and 97.7%, in the CT group, respectively; 98.7%, 87.5%, 99.3%, 87.5% and 99.3% in the EUS group, respectively,and 98.3%, 85.7%, 99.1%, 85.7% and 99.1% in the EUS+CT group, respectively. In assessing tracheobronchial invasion, accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 91.3%, 20.8%, 95.0%, 17.9% and 95.8% in the CT group, respectively; 96.0%, 20.0%, 98.6%, 33.3% and 97.3% in the EUS group, respectively; and 98.3%, 66.7%, 99.1%, 66.7% and 99.1% in the EUS+CT group. Differences in assessing resectability were significant between CT group and EUS group (chi(2)=15.131, P=0.000), between CT group and EUS+CT group (chi(2)=15.662, P=0.000), and between EUS group and EUS+CT group (chi(2)=0.502, P=0.346). Differences in assessing aortic invasion were significant between CT group and EUS group (chi(2)=9.764, P=0.000), and between CT group and EUS+CT group (chi(2)=6.659, P=0.004), but were not significant between EUS group and EUS+CT group (chi(2)=0.076, P=0.581). Differences in assessing tracheobronchial invasion were significant between CT group and EUS+CT group (chi(2)=6.659, P=0.004), but were not significant between CT group and EUS group (chi(2)=3.729, P=0.034) and between EUS group and EUS+CT group (chi(2)=1.117, P=0.248).
EUS is a better procedure than CT in the prediction of the resectability and aortic invasion in esophageal carcinoma. There is limited value for EUS and CT in assessing tracheobronchial invasion. Combination of CT and EUS does not improve the prediction of resectability significantly.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 05/2010; 13(3):205-9.
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Yun Dai,
Xiao-Dong Su,
Hao Long,
Peng Lin,
Jian-Hua Fu,
Lan-Jun Zhang,
Xin Wang,
Zhe-Sheng Wen,
Zhi-Hua Zhu,
Xu Zhang, Tie-Hua Rong
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ABSTRACT: BACKGROUND AND OBJECTIVE: Surgery is the main therapy for patients with stage II non small cell lung cancer (NSCLC), but patients still have an unsatisfactory prognosis even though complete resection is usually possible. Adjuvant chemotherapy provides low rates of clinical benefit as well. We retrospectively analyzed prognostic factors of patients with completely resected stage II NSCLC to find patients with unfavorable factors for proper management. METHODS: Clinical data of 220 patients with complete resections of stage II NSCLC at the Sun Yat sen University Cancer Center between January 1998 and December 2004 were retrospectively analyzed. Cumulative survival was analyzed by the Kaplan Meier method and compared by log rank test. Prognosis was analyzed by the Cox proportional hazards model. Results: The overall 3 and 5 year survival rates were 58.8% and 47.9%, respectively. The 3 and 5 year disease free survival rates were 45.8% and 37.0%, respectively. Of the 220 patients, 86 (39.1%) had recurrence or metastasis. A univariate analysis demonstrated that age (> 55 years), blood type, the presence of symptoms, chest pain, tumor volume (> 20 cm3), total number of removed lymph nodes (> or = 10), number of involved N1 lymph nodes (> or =3 ), total number of removed N2 lymph nodes (> 6), and the ratio of involved N1 lymph nodes (> or = 35%) were significant prognostic factors for 5 year survival. In the multivariate analysis, age (> 55 years), chest pain, tumor volume (> 20 cm3), total number of removed lymph nodes (> or = 10), and number of involved N1 lymph nodes (> or = 3) were independent prognostic factors for 5 year survival. Conclusions: For patients with completely resectable stage II NSCLC, having > 55 years, presenting chest pain, tumor volumes > 20 cm3, and > or = 3 involved N1 lymph nodes were adverse prognostic factors, and > or = 10 removed lymph nodes was a favorable one. Patients with poor prognoses might be treated by individual adjuvant therapy for better survival.
Chinese journal of cancer 05/2010; 29(5):538-44.
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ABSTRACT: Most patients with esophageal carcinoma have disease in the locally late stage (stage III) when first diagnosed, with surgery as the first treatment of choice. This study analyzed the clinical data of patients with esophageal squamous carcinoma after radical esophagectomy and investigated prognostic factors.
The data of 361 patients with esophageal squamous carcinoma who underwent radical esophagectomy and were hospitalized at Sun Yat-sen University Cancer Center between January 1997 and March 2004 were analyzed. The Kaplan-Meier method was used to analyze prognosis, log-rank test was used to compare the groups, and the Cox proportional hazards model was used for multivariate analysis.
The 1-, 2-, 3-, 4-, and 5-year survival rates were 67.7%, 40.6%, 27.5%, 23.4%, and 20.1%, respectively. Based on univariate analysis, the degree of invasion, rate of lymph node metastasis, number of metastatic regions, number of metastatic lymph nodes, postoperative complications, and duration of surgery were prognostic factors. Based on multivariate analysis, the degree of invasion, rate of lymph node metastasis, and postoperative complications were independent factors for the prognosis.
Of all clinical and pathologic factors, the degree of invasion, rate of lymph node metastasis, and postoperative complications were independent prognostic factors for the patients with stage-III esophageal squamous carcinoma after radical esophagectomy.
Chinese journal of cancer 02/2010; 29(2):178-83.
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ABSTRACT: The current American Joint Committee on Cancer (AJCC) staging system for esophageal cancer does not define the minimum number of lymph nodes (LNs) necessary for accurate nodal staging. This study aimed to seek the minimum number of LNs examined for adequate nodal staging of patients with node-negative esophageal cancer.
We conducted a retrospective review of 592 patients undergoing R0 resection with node-negative esophageal carcinoma between December 1996 and December 2004. The relationship between the total number of examined LNs and death from esophageal cancer was investigated by means of a scatterplot of this variable versus Martingale residuals from a Cox proportional hazard regression model without the variable of interest. A smoothed line fit of the scatterplot was applied to detect the reasonable cutoff point.
The patients were classified into four categories according to the number of examined LNs: < or =5, 6 to 9, 10 to 17, and > or =18. A reduced hazard ratio of death was observed with an increasing number of LNs examined. The 5-year cancer-specific survival rate was 42.8% among patients with < or =5 LNs examined, compared with 52.6, 56.8, and 75% for those with 6-9 LNs, 10-17 LNs, and > or =18 LNs, respectively. Multivariate Cox regression analysis suggested that female sex, lower grade of cell differentiation, lower T category and increasing number of examined LNs were independent factors favoring cancer-specific survival.
At least 18 LNs should be resected for accurate staging of operable esophageal carcinoma. However, a validation from other institute is warranted.
Annals of Surgical Oncology 02/2010; 17(7):1901-11. · 4.17 Impact Factor
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ABSTRACT: Background and Objective: For squamous cell carcinoma of the middle thoracic esophagus, surgical resection of left or right transthoracic approach has its advantages and disadvantages, respectively. This study was to compare the outcomes between the two approaches. Methods: A total of 482 consecutive patients with middle thoracic esophageal squamous cell carcinoma (ESCC) underwent transthoracic esophagectomy between January 1999 and June 2005. These patients were divided into left transthoracic approach group (n=350) and right transthoracic approach group (n=132). Surgical resection rate, postoperative complications, lymphadenectomy, recurrence pattern, disease-free survival, and overall survival of the two groups were compared retrospectively. Results: The surgical resection rate was 92.0% in left approach group and 92.4% in right approach group (P=0.878). The incidence of postoperative complications was higher in right approach group than in left approach group (57.6% vs. 35.4%, P<0.001). The average number of lymph nodes resected was 11.8+/-6.6 in left approach group and 16.3+/-8.0 in right approach group (P<0.001). Lymphatic recurrence rate was lower in right approach group than in left approach group (51.1% vs. 69.6%,P=0.028), especially occurring to mediastinal lymph nodes (15.6% vs. 38.4%,P=0.005). Three-year disease-free survival was higher in right approach group than in left approach group(22.92+/-0.74 vs. 25.09+/-1.22, P=0.039). Conclusion: Although left transthoracic resection reduced the incidence of postoperative complications, esophagectomy of right transthoracic approach was more effective in survival improvement.
Ai zheng = Aizheng = Chinese journal of cancer 12/2009; 28(12):1260-4.
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ABSTRACT: To evaluate the value of mediastinoscopy in preoperative staging of non-small cell lung cancer (NSCLC) based on survival analysis.
152 cases of potentially operable NSCLC were enrolled in this study. All cases underwent CT scan and mediastinoscopy for assessment of the mediastinal lymph node status before initial treatment. The definitive treatment was decided on the basis of mediastinoscopy and the survival rate was analyzed with a median follow-up of 30.5 months. Survival analysis was conducted by comparing the lymph node status which was determined by final pathology (groups pN0, pN1, pN2, pN3), CT scan (group cN0-1, cN2-3) and mediastinoscopy (group mN0-1, mN2, mN3).
The 5-year survival rates in group pN0, pN1, pN2 and pN3 were 61.7%, 75.0%, 32.4% and 16.1%, respectively. Both groups pN0 and pN1 had significantly higher survival rates than those in groups pN2 and pN3 (P < 0.05). There were not significant differences between survival rates in groups cN0-1 and cN2-3 (P = 0.670), while the survival rate in group mN0-1 was significantly higher than that in groups mN2 and mN3 (P < 0.05).
Mediastinoscopy is of great value in preoperative staging of NSCLC. Not only does it detect lymph node metastasis more precisely but also better predict the prognosis than CT scan.
Zhonghua zhong liu za zhi [Chinese journal of oncology] 12/2009; 31(12):929-32.
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ABSTRACT: This study was to compare the 5-year survival rate, the surgical resection rate, the post-operative complications and mortality of patients who underwent surgical resection for carcinoma of esophagus with or without neoadjuvant chemotherapy. To evaluate neoadjuvant chemotherapy in the treatment of esophageal carcinoma.
Forty-two patients with locally advanced esophageal carcinoma undergoing neoadjuvant chemotherapy and surgical resection (CS group), and 75 patients with the same phase undergoing surgical resection alone (S group) from August 2003 to March 2009 in Sun Yat-sen University Cancer Center were reviewed. The 5-year survival rate, the surgical resection rate, the post-operative complications and mortality between the two groups were analyzed.
Forty-two patients after neoadjuvant chemotherapy, the complete response rate was 11.9%, the partial response was 47.6%, the total clinical response rate was 59.5%. The surgical resection rate of CS group and S group were 100% and 89.5% (P = 0.029). There was no statistically difference in the post-operative complications and mortality between two groups. The overall 5-year survival for CS group and S group were 31.7% and 26.4%, respectively (P = 0.266). In the subgroup analysis, the 5-year survival of patients with clinical response was significant higher than S group (P = 0.010).
The neoadjuvant chemotherapy can improve surgical resection rate and long-term survival of esophageal carcinoma patients with clinical response without increasing the post-operative complications and mortality.
Zhonghua yi xue za zhi 11/2009; 89(41):2906-9.
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ABSTRACT: The postoperative prognosis of peripheral adjacent lobe invasion non-small cell lung cancer (NSCLC) is unclear. The purpose of this study was to determine the postoperative prognosis of NSCLC with direct adjacent lobe invasion by comparing it with that of visceral pleural invasion (primary lobe) T2 disease, and parietal pleural invasion T3 disease, and hence determine its most appropriate T category.
A retrospective analysis was conducted to assess the survival of patients with peripheral direct adjacent lobe invasion NSCLC (group A), and it was compared with that of patients with visceral pleural invasion of the primary lobe (group B) and parietal pleural invasion (group C). All patients were node-negative on pathologic examination. Kaplan-Meier method was used to compare the postoperative survival between groups.
A total of 263 patients were analyzed. The overall survival rates in groups A (n = 28), B (n = 167), and C (n = 68) at 5 years were 40.7, 54.6, and 41.9%, respectively; corresponding median survival in three groups were 53, 71, and 40 months, respectively. The survival difference among three groups was statistically significant (p = 0.031). A similar survival was observed between groups A and C, whereas group B had a much better survival than other groups.
Peripheral adjacent lobe invasion NSCLC has a similar survival prognosis with that of parietal pleural invasion T3 disease and hence should be classified as T3 rather than T2. However, further studies are warranted.
Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 11/2009; 4(11):1342-6. · 4.55 Impact Factor
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Xu Zhang,
Peng Lin,
Zhi-Hua Zhu,
Hao Long,
Jing Wen,
Hong Yang,
Xing Zhang,
Dao-Feng Wang,
Jian-Hua Fu,
Yan Fang, Tie-Hua Rong
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ABSTRACT: An effective way to decrease the mortality rate in esophageal cancer (EC) is to provide diagnosis and treatment for early EC patients. Identification of molecular markers would be helpful for early diagnosis. In this study, we obtained the gene expression profile of early esophageal squamous cell carcinoma (ESCC) and further screened molecular markers that might be useful in early diagnosis and treatment. RNA extracted from EC cancer tissues and matched normal esophageal epithelium of four EC patients were analyzed using whole-genome microarrays. Welch's t-test was applied to normalized data to identify genes expressed differently between cancer and normal tissues. Significantly differentially expressed genes were classified according to gene ontology. Gene mapping software was used to identify pathways involving the genes that were significantly changed. Among the 54,613 gene transcripts and variants analyzed, 367 were differentially expressed between early ESCC and normal esophageal epithelium (Welch's t-test, P<0.01). Specifically, 104 genes were significantly upregulated and 263 were downregulated in early ESCC, compared with normal esophageal epithelium. Functional gene sets expressed differentially between ESCC cancer and normal tissues included those involved in gene transcription, cell proliferation, motility, apoptosis, and metabolism (specifically, pathways of cell apoptosis, the cell cycle, G protein, and TGF-beta signal transduction). We conclude that a large number of genes are involved in the occurrence and development of early ESCC and take part in various cell processes and pathways. The present findings contribute theoretical information for further screening of genes related to early ESCC.
Cancer genetics and cytogenetics 10/2009; 194(1):23-9. · 1.54 Impact Factor
