-
[show abstract]
[hide abstract]
ABSTRACT: To compare postoperative complications and prognosis of esophageal squamous cell carcinoma patients treated with different routes of reconstruction.
After obtaining approval from the Medical Ethics Committee of the Sun Yat-Sen University Cancer Center, we retrospectively reviewed data from 306 consecutive patients with histologically diagnosed esophageal squamous cell carcinoma who were treated between 2001 and 2011. All patients underwent radical McKeown-type esophagectomy with at least two-field lymphadenectomy. Regular follow-up was performed in our outpatient department. Postoperative complications and long-term survival were analyzed by treatment modality, baseline patient characteristics, and operative procedure. Data from patients treated via the retrosternal and posterior mediastinal routes were compared.
The posterior mediastinal and retrosternal reconstruction routes were employed in 120 and 186 patients, respectively. Pulmonary complications were the most common complications experienced during the postoperative period (46.1% of all patients; 141/306). Compared to the retrosternal route, the posterior mediastinal reconstruction route was associated with a lower incidence of anastomotic stricture (15.8% vs 27.4%, P = 0.018) and less surgical bleeding (242.8 ± 114.2 mL vs 308.2 ± 168.4 mL, P < 0.001). The median survival time was 26.8 mo (range: 1.6-116.1 mo). Upon uni/multivariate analysis, a lower preoperative albumin level (P = 0.009) and a more advanced pathological stage (pT; P = 0.006; pN; P < 0.001) were identified as independent factors predicting poor prognosis. The reconstruction route did not influence prognosis (P = 0.477).
The posterior mediastinal route of reconstruction reduces incidence of postoperative complications but does not affect survival. This route is recommended for resectable esophageal squamous cell carcinoma.
World Journal of Gastroenterology 10/2012; 18(39):5616-21. · 2.47 Impact Factor
-
Nan Ge,
Huan-Xin Lin,
Xiang-Sheng Xiao,
Ying Guo,
Ling Guo,
Hui-Min Xu, Xin Wang,
Ting Jin,
Xiu-Yu Cai,
Yi Liang,
Wei-Han Hu,
Tiebang Kang
[show abstract]
[hide abstract]
ABSTRACT: ABSTRACT: BACKGROUND: Oct4 and Sox2 are two major transcription factors related to the stem cell self-renewal and differentiation. The aim of this study was to examine the association between Oct4 and Sox2 expression levels with both the clinicopathological characteristics and prognoses of patients with hypopharyngeal squamous cell carcinoma. METHOD: Tumor tissue samples from 85 patients with hypopharyngeal squamous cell carcinoma were collected, and the clinical follow-up data of these patients were recorded, and expression status of Oct4 and Sox2 were examined in these tissue samples by immunohistochemistry (IHC). RESULTS: Oct4 expression was found to be an independent predictive factor for overall survival (p = 0.000) in patients with hypopharyngeal squamous cell carcinoma and was independently related to loco-regional control (p = 0.000). Although Sox2 expression status showed no significant association with overall survival (p = 0.166), disease-free survival (p = 0.680) or loco-regional control (p = 0.383), when using a subgroup analysis, the subgroup with both high Oct4 and Sox2 expression had the best prognosis (p = 0.000). Sox2 expression could be a potential prognostic predictor for patients with hypopharyngeal squamous cell carcinoma. Simultaneous analyses of Oct4 and Sox2 expression could be more effective in evaluating the prognoses of patients with hypopharyngeal squamous cell carcinoma. CONCLUSION: Oct4 expression is an independent predictive factor for patients with hypopharyngeal squamous cell carcinoma, suggesting that Oct4 expression may be a useful indicator for predicting the prognosis of hypopharyngeal squamous cell carcinoma.
Journal of Translational Medicine 10/2010; 8(1):94. · 3.41 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Nasopharyngeal carcinoma (NPC) is known for its propensity for distant metastases. Lung metastasis is one of the most important causes of death for patients with NPC. Solitary metastatic lung tumor from NPC is a distinctive group associated with a better survival. This study was to find a more effective treatment modality and prognostic factors for the group.
Clinical data of 105 cases of solitary metastatic lung tumor from NPC were retrospectively analyzed. Survival rate was calculated by the Kaplan-Meier method. The difference of survival between the patients treated by different modalities was evaluated by the log-rank test. The Cox univariate and multivariate analyses of gender, age, pathologic type, stage, adjuvant chemotherapy, evaluation of treatment for NPC, disease-free interval, size of metastatic tumor, pulmonary hilar and/or mediastinal lymph node metastasis, treatment modalities, recurrent distant metastases and/or relapse of NPC were conducted.
The local control rate was 53.8% in chemotherapy group, 88.0% in radiotherapy ± chemotherapy group, and 96.4% in operation ± chemotherapy group (P < 0.01). The most promising progression-free survival (PFS) and overall survival (OS) were obtained with operation ± chemotherapy and followed by radiotherapy ± chemotherapy. Both of them showed much better efficacy than chemotherapy (P < 0.001). The Cox multivariate analysis showed that recurrent distant metastases and/or relapse of NPC affected the survival (OR = 2.087, 95% CI = 1.277-3.410, P = 0.003). The T stage of NPC, size of metastatic tumor, hilar and/or mediastinal lymph node metastasis, and the treatment modality were independent prognostic factors.
Operation ± chemotherapy and radiotherapy ± chemotherapy are better treatment of solitary metastatic lung tumor from NPC, which could improve the local control and prolong the PFS and OS. Chemotherapy is recommended for patients with higher T stage of NPC, size of metastatic tumor ≥ 3 cm, pulmonary hilar and/or mediastinal lymph node metastasis.
Chinese journal of cancer 09/2010; 29(9):787-95.
-
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
[show abstract]
[hide abstract]
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.
-
[show abstract]
[hide abstract]
ABSTRACT: It is controversial for the irradiation level and dose of the regional prevention for naspharyngeal cancer (NPC) with one or both cervical lymph node-negative neck. The study was to analyze the proophylactic irradiation of cervical lymph nodes for Stage -N0 NPC patients.
From January 2002 and December 2004, 205 NPC patients with negative lymphadenopathy diagnosed by imaging, were retrospectively analyzed. Before treatment, each patient underwent CT or MRI. Facial-cervical portals and 6-8 MV photons were used in radiotherapy. Doses applied were 60-80 Gy to the nasopharynx and 46-64 Gy to the neck without lymphadenopathy. Consecutive radiotherapy was performed employing conventional fractionation of 2 Gy/fraction, once a day, for a total of five fractions per week. Chemotherapy was administered to 60 patients. Median follow-up was 44 months. The survival function was calculated according to the Kaplan-Meier method. A log-rank test was used to compare the differences in survival. The Cox proportional hazards model was used for multivariate analysis. A total of 205 patients with stage-N0 NPC were divided into an upper-neck irradiation group and an entire-neck group.
The 3-year overall survival rate (OS) was 92.9% and the 3-year disease-free survival rate (DFS) was 91.9%. A total of 88 patients received irradiation to the upper neck and 117 to the entire neck. The rate of regional failure for the upper-neck group and the entire-neck group were 2.27% and 0%, respectively (P>0.05). The rates of regional failure in patients with T1-, T2-, T3- and T4-stage disease were 0, 3.08%, 0, and 0, respectively (P>0.05). The rates of regional failure in the patients both without and with local failure were 1.03% and 0, respectively (P>0.05). The 1-and 3-year OS for the upper-neck group were 97.7% and 94.2%, and the 1- and 3-year OS for the entire-neck group were 97.4% and 91.9% (P=0.950). The 1- and 3-year DFS for the upper-neck group were 96.6% and 92.9%, and the 1- and 3-year DFS for the entire-neck group were 95.6% and 90.9% (P= 0.730). In multivariate analysis, sex (P=0.039) and T stage (P=0.004) were independent prognosis factors for patients with stage-N0 NPC.
Prophylactic irradiation to the upper neck does not influence regional failure or long-term survival in the patients with stage-N0 NPC. Radiotherapy to the upper neck (levels II, III, VA) is recommended for the patients with stage-N0 NPC. Involvement of the parapharyngeal space, T stage, and the rates of local failure do not influence regional failure in these patients. Sex and T stage were independent prognosis factors of stage-N0 NPC patients.
Chinese journal of cancer 01/2010; 29(1):106-10.
-
[show abstract]
[hide abstract]
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.
-
[show abstract]
[hide abstract]
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.
-
[show abstract]
[hide abstract]
ABSTRACT: To retrospectively analyze the therapeutic effect on patients with tonsillar carcinoma and factors affecting their prognosis.
Clinical data of 61 patients pathologically confirmed with tonsillar carcinoma without distant metastasis were analyzed. All the patients were treated in Cancer Center of Sun Yat-sen University from April 1997 to April 2008. There were 2 patients with undifferentiated carcinoma, 26 with poorly differentiated squamous cell carcinoma and 33 with median-well differentiated squamous cell carcinoma. According to the AJCC 2002 staging criteria for head-neck cancers, there were 9 staged I cases, 7 staged II cases, 23 staged III cases and 22 staged IV cases. The treatment was radiotherapy alone in 27 cases, radiotherapy combined with chemotherapy in 23 cases, surgery combined with postoperative radiotherapy in 6 cases, neoadjuvant chemotherapy plus surgery combined with postoperative radiotherapy in 3 cases, radiotherapy with salvage surgery in 2 cases.
The overall 5-year survival rate was 50.2%. For 16 cases with staged I-II staged, there were 8 cases with radiotherapy alone, 5 years survival was 50.0%, 6 cases with surgery combined with postoperative radiotherapy, 5 years survival was 83.3%. The difference between the two treatments was not significant in statistics (P = 0.318). For III-IV staged 45 cases, there were 19 cases with simple radiotherapy, 5 years survival was 51.5%, 21 cases with radiotherapy combined with chemotherapy, 5 years survival was 36.4%, 5 cases with surgery combined with postoperative radiotherapy, 5 years survival was 75.0%. The difference among the three treatments was not significant in statistics (P = 0.239). According to T stages, the 5-year survival rates of stage T1-T4 cases were 91.8%, 46.8%, 29.1%, 0% respectively (chi(2) = 30.168, P < 0.001). Multivariate analysis demonstrated that T stage, therapeutic effect of primary site and cervical metastatic lymph node were the independent prognostic factors (P < 0.05).
T stage, the therapeutic effect of primary site and cervical metastatic lymph node were the independent prognostic factors. For I-II staged tonsillar tumor cases, based on organ preservation, were tendency to choice simple radiotherapy. For III-IV staged cases, yet the relationships between therapeutic mode and therapeutic effect still need further researches.
Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery 10/2009; 44(10):848-52.
-
[show abstract]
[hide abstract]
ABSTRACT: To explore the clinical indication of N3 lymph node biopsy during mediastinoscopy for non-small cell lung cancer (NSCLC).
Cervical mediastinoscopy was performed in 89 patients with clinical stage I-IIIA non-small cell lung cancer prior to thoracotomy. Of those, 12 underwent cervical medistinoscopy combined with right scalene lymph node biopsy and 10 with anterior mediastinotomy.
Nine patients were found to have lymph node metastasis (N3 disease) during mediastinosopy. Of those, 6 had contralateral mediastinal lymph node metastasis and 3 cases with right scalene lymph node metastasis. The incidence of N3 disease in the patients with adenocarcinoma, serum CEA > 5 ng/ml and multi-station mediastinal lymph node metastasis was significantly higher than that in those with non-adenocarcinoma, CEA < 5 ng/ml and ipsilateral uni-station mediastinal lymph nodes metastasis (P < 0.05).
Biopsy of scalene lymph node or contralateral mediastinal lymph node should be performed during mediastinoscopy in order to exclude N3 disease for potentially operable NSCLC patients with adenocarcinoma, serum CEA >5 ng/ml and ipsilateral multi-station mediastinal lymph nodes metastasis.
Zhonghua zhong liu za zhi [Chinese journal of oncology] 10/2009; 31(10):780-2.
-
[show abstract]
[hide abstract]
ABSTRACT: To discuss the strategy of mediastinoscopy for the evaluation of mediastinal lymph node status (metastasis or not) of non-small cell lung cancer (NSCLC) prior to surgery.
From October 2000 to June 2007, 152 consecutive NSCLC cases pathologically proven and clinically staged I-III were enrolled in the study. Of the 152 cases, there were 118 males and 34 females. Age ranged 24-79 years old and the median age was 58. All cases underwent CT and mediastinoscopy for the evaluation of mediastinal lymph node status prior to surgery. Compared with the results of final pathology, the positive rate of mediastinoscopy and the prevalence of mediastinal lymph node metastasis were calculated in the NSCLC patients with negative mediastinal or hilar lymph nodes on CT scan (the shortest axis of mediastinal or hilar lymph nodes <1 cm). Clinical characteristics used as predictive factor including sex, age, cancer location, type of pathology, T status, cancer type (central or peripheral), size of mediastinal lymph nodes (the shortest axis <1 cm or >1 cm) on CT scan and serum CEA level were analyzed by univariate and multivariate analysis with Binary logistic regression model to identify risk factors of mediastinal metastasis.
The positive rate of mediastinoscopy was 11.6% (8/69) and the prevalence of mediastinal metastasis was 20.1% (14/69) in NSCLC with negative mediastinal or hilar lymph nodes on CT scan respectively. In clinical stage I (cT1-2N0M0) NSCLC the positive rate of mediastinoscopy was 11.3% (7/62), N2 accounting for 6.5% (4/62) and N3 4.8% (3/62), respectively; and the prevalence of mediastinal lymph node metastasis was 19.4% (12/62), N2 ccounting for 14.6% (9/62) and N3 4.8% (3/62), respectively. In the whole group both univariate and multivariate analysis showed that adenocarcinoma or mediastinal lymph nodes > or =1 cm in the shortest axis on CT scan was an independent risk factor to predict mediastinal lymph node metastasis. In NSCLC with negative mediastinal or hilar lymph nodes on CT scan both univariate and multivariate analysis showed that adenocarcinoma was a predictor of mediastinal lymph node metastasis. Conclusion We recommend the policy of routine mediastinoscopy in NSCLC prior to surgery if the mediastinal staging was only based on CT scan. Mediastinal lymph nodes > or =1 cm in the shortest axis on CT scan mandates preoperative mediastinoscopy. Adenocarcinoma also indicates mandatory mediastinoscopy even with negative mediastinal or hilar lymph nodes on CT scan.
Zhonghua zhong liu za zhi [Chinese journal of oncology] 06/2009; 31(6):456-9.
-
[show abstract]
[hide abstract]
ABSTRACT: With advances in mammographic equipment and techniques, more and more nonpalpable breast lesions have been detected. This study was to investigate the application of methylene blue dye for localized biopsy to diagnose nonpalpable breast lesions.
In total 138 patients with suspicious malignant, nonpalpable breast lesions between August 2002 and October 2006 were enrolled. A small dose of methylene blue was injected into the lesion under mammographic guidance. The dyed tissues were excised completely via an optimal incision, and radiographys was obtained to confirm the removal of the nonpalpable lesion. The specimen weight and incision length were measured.
Suspicious lesions in all 138 patients were accurately excised. Eighty-four (60.9%) patients were confirmed as breast cancer, and 54 (39.1) were diagnosed with benign lesions. The mean length of the incision was 4.6 cm (range 3.2-5.3 cm), and the mean weight of the resected specimen was 42 g (range18-86 g). All patients achieved stage I healing.
Excisional biopsy is recommended for nonpalpable breast lesions which are highly suggestive of malignancy by imaging examination. Methylene blue guided localization and excisional biopsy is a safe, relatively simply procedure with high diagnostic accuracy.
Ai zheng = Aizheng = Chinese journal of cancer 02/2009; 28(1):79-81.
-
Xin Wang,
Lie Zheng,
Li Ling,
Shi-yi Zhang,
Ze-ming Xie,
Hui Yu,
Xiao-dong Su,
Jun-ye Wang,
Zhi-fan Huang,
Ming-tian Yang,
Tie-hua Rong
[show abstract]
[hide abstract]
ABSTRACT: To compare the value of CT and mediastinoscopy in assessment of mediastinal lymph node status in potentially operable non-small cell lung cancer (NSCLC).
From Oct. 2000 to Jun. 2007, 152 consecutive patients with pathologically proven and stage I to approximately III NSCLC were enrolled into the study. Of the 152 cases, there were 118 males and 34 females, with a median age of 58 years (range, 24 to approximately 79 years). Compared with the final pathology, the sensitivity, specificity, positive and negative predictive values and accuracy of CT and mediastinoscopy for preoperative evaluation of mediastinal lymph node status were calculated, respectively. The accuracy and diagnostic efficacy of CT and mediastinoscopy was compared by Pearson chi(2) test and ROC curve, respectively.
The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of detection of mediastinal metastasis was 73.8%, 70.1%, 64.9%, 78.2% and 71.7% by CT, respectively, versus 83.1%, 100.0%, 100.0%, 88.8% and 92.8% by mediastinoscopy, respectively. Both the accuracy and diagnostic efficacy of mediastinoscopy were superior to CT (Pearson chi(2) test, P < 0.001; Z test of the areas under the ROC curve, P < 0.001). The complication rate of mediastinoscopy was 4.6%, and the false negative rate was 7.2%.
Mediastinoscopy is safe and effective in preoperative assessment of mediastinal lymph node status in potentially operable NSCLC, while CT alone is inadequate.
Zhonghua zhong liu za zhi [Chinese journal of oncology] 01/2009; 31(1):42-4.
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the impact of visceral pleural invasion (VPI) on prognosis and staging in patients with stage Ib non-small cell lung cancer (NSCLC).
Clinical data of 232 patients with stage Ib NSCLC surgically treated by curative resection between January 1994 and December 2003 was retrospectively reviewed. Histopathological diagnosis was reviewed by an experienced pathologist. According to the tumor size and status of VPI, patients were stratified into three group: group A: tumor > 3 cm and VPI(-); group B: tumor < or = 3 cm and VPI (+); group C: tumor > 3 cm and VPI(+). There were 45 patients in group A, 96 in group B and 91 in group C. Kaplan-Meier method was used for survival analysis. Cox proportional hazards model was used for multivariate analysis.
187 (80.6%) patients had visceral plural invasion, while 45 (19.4%) had no. The 5-and 10-year survival rates of patients with VPI were 59.3% and 42.6%, while it was 70.1% and 56.7% for the patients without (P = 0.035), respectively. The 5-year survival rates of patients in group A, B and C were 70.1%, 61.9% and 56.2%; and 10-years survival rates were 56.7%, 50.6% and 35.9%, respectively (P = 0.018). VPI with large size of tumor was revealed by Cox multivariate analysis as an independent prognostic factor (RR = 1.530, 95% CI: 1.132-2.067, P = 0.006).
A significant difference in survival exists among the stage Ib NSCLC patients who have different T status, the patient with > 3 cm tumor and visceral plural invasion may have the worst prognosis. Further studies are still needed to assess whether it is necessary or not to modify the T2 statue of tumor > 3 cm with visceral plural invasion.
Zhonghua zhong liu za zhi [Chinese journal of oncology] 05/2008; 30(5):368-71.
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the prognostic effect of mediastinal lymph node dissection in patients with stage I non-small cell lung cancer (NSCLC).
The clinical data of 330 patients with stage I NSCLC who were treated with curative resection from January 1994 to December 2003 were reviewed retrospectively. According to the extent of mediastinal lymph node dissection and the pathology report, the patients were assigned to lung resection combined with mediastinal lymph node dissection (LND) group or with lymph node sampling (LNS) group. The Kaplan-Meier method was used for survival analysis. COX proportional hazards model was used for multivariate analysis.
There were 233 (70.6%) male patients and 97 (29.4%) female patients. The median age was 60 years old. Ninety-eight patients were in stage IA and 233 in stage IB. One hundred and forty patents were in group LND and 190 in group LNS. The mean number of removed lymph nodes in group LND and group LNS were (13.3 +/- 4.7) and (5.2 +/- 3.0) (P < 0.01), respectively. The mean of mediastinal lymph node station sampled in group LND and group LNS were (3.7 +/- 0.9) and (1.3 +/- 1.1) (P < 0.01), respectively. The 5-year and 10-year survival rates of patients in group LND were 72.0% and 66.1%, while in group LNS were 65.9% and 43.0% (P < 0.05), respectively. Other prognostic factors included symptom, staging, visceral pleura invasion and tumor size. LND was disclosed as a favourable prognostic factor at COX multivariate analysis, together with absence of symptom at diagnosis.
As compared with LNS, LND can improve survival in stage I NSCLC.
Zhonghua wai ke za zhi [Chinese journal of surgery] 12/2007; 45(22):1543-5.
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to investigate the clinical characteristics of lymph node metastasis in the contralateral mediastinum and scalene in patients with potentially operable nonsmall cell lung cancer (NSCLC).
Cervical mediastinoscopy was performed for 89 patients with clinical stage I-III A non-small cell lung cancer prior to thoracotomy. Of these, 12 underwent cervical medistinoscopy combined with right scalene lymph node biopsy and 10 with anterior para-mediastinal small incision.
A total of 9 patients were found have N3 disease on mediastinosopy, with cancer-cell-positive lymph nodes in the contralateral mediastinum in 6 and 3 in the right scalene. Statistical analysis revealed that the incidence of N3 disease in adenocarcinoma group was higher than that in patients with nonadenocarcinoma (P < 0.05), which was also higher in the patients with serum CEA >5 ng/ml than that in the patients with CEA <5 ng/ml (P < 0.05), and it was higher in the patients with ipsilateral mediastinal multi-station lymph node metastasis than that in the patients with uni-station lymph node metastasis (P < 0.05).
Biopsy of contralateral mediastinal lymph nodes or scalene lymph node should be performed in order to exclude N3 disease for potentially operable NSCLC patients with adenocarcinoma, serum CEA >5 ng/ml or ipsilateral multi-station mediastinal lymph node metastasis.
Zhonghua zhong liu za zhi [Chinese journal of oncology] 09/2007; 29(8):629-31.
-
Jun-Ye Wang,
Guo-Wei Ma,
Shu-Qin Dai,
Tie-Hua Rong, Xin Wang,
Peng Lin,
Wen-Feng Ye,
Lan-Jun Zhang,
Xiao-Dong Li,
Xu Zhang,
Guang-Yu Yao
[show abstract]
[hide abstract]
ABSTRACT: Cellular immunity suppression is marked in patients with esophageal carcinoma, which may be resulted temporarily from surgical injury. This study was to evaluate the effect of cellular immune supportive treatment on cellular immunity of patients with esophageal carcinoma.
A total of 60 patients with thoracic esophageal carcinoma, received two-field dissection, were randomized into control group and trial (immune supportive treatment) group. The patients in trial group were injected with Shenqi injection after operation; the patients in control group received no immune supportive treatment. Peripheral blood samples were obtained before operation, and 3 and 9 days after operation. AgNOR (argyrophilic nucleolar organizer regions) activity in peripheral blood T lymphocytes was measured by tumor immune microphotometry. T cell subsets were measured by flow cytometry.
The proportions of CD3+CD4+ and CD4+/CD8+ cells were significantly higher in trial group than in control group at 3 days after operation (P < 0.05). The amount of AgNOR and proportions of CD3+, CD3+CD4+, CD4+/CD8+, and CD4+CD25+ cells were significantly higher in trial group than in control group at 9 days after operation (P < 0.05). There was no significant difference in 1-year survival rate between the 2 groups (P > 0.05).
Shenqi injection could obviously improve cellular immunity of the esophageal carcinoma patients after modern two-field dissection.
Ai zheng = Aizheng = Chinese journal of cancer 08/2007; 26(7):778-81.
-
[show abstract]
[hide abstract]
ABSTRACT: Mediastinal lymph node staging in non-small cell lung cancer (NSCLC) is important to choose standard treatment plan and estimating prognosis. This study was to evaluate the clinical value of spiral CT in staging mediastinal lymph node in NSCLC through comparing spiral CT findings with corresponding pathology.
A total of 89 patients with pathologically proven NSCLC received spiral CT and mediastinoscopic biopsy. The spiral CT findings and corresponding pathologic findings in staging mediastinal lymph node were compared. The sensitivity, specificity, and accuracy of diagnosing mediastinal lymph node metastasis were calculated.
Compared with corresponding pathologic results, the overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of mediastinal lymph node staging with spiral CT were 58.9%, 70.0%, 60.5%, 68.6%, and 65.2%, respectively. The accuracy and specificity of spiral CT was relatively low in staging 4R, 5, 6, 7 lymph node groups; the false negative and false positive rates were relatively high in staging 4R, 7 lymph node groups.
Spiral CT is a non-invasive clinical examination which may be used in staging mediastinal lymph node in NSCLC; however, there exists false negative and false positive rates. It should be combined with other investigations, such as mediastinoscopy, to assess a more accurate mediastinal lymph node staging.
Ai zheng = Aizheng = Chinese journal of cancer 12/2006; 25(11):1384-8.
-
[show abstract]
[hide abstract]
ABSTRACT: Axillary lymph node dissection (ALND) is routinely performed during surgery for breast cancer, but whether ALND could increase survival rate of early stage breast cancer patients remains controversial. Recently, replacing ALND with sentinel lymph node (SLN) biopsy has became a hotspot in breast cancer research. This study aimed to evaluate the reliability and accuracy of SLN biopsy for early stage breast cancer, and to discover the significance of multiple step section level cytokeratin immunohistochemistry in identifying micrometastatic disease.
SLN biopsy was performed on 121 patients with T1 or T2 breast cancer: methylene blue-labeling was used in 38 patients (methylene blue group), double-labeling of (99m)Tc sulfur colloid and methylene blue was used in 83 patients (combination group). Lymphoscintigraphy and hand-hold gamma detector were used to localize SLNs before operation. All SLNs and ALND lymph nodes were pathologically examined. The tumor-negative SLNs were cut at three levels, and detected by immunohistochemistry.
Success rates were 81.6% in methylene blue group, and 95.2% in combination group; accurate detection rates of axillary lymph nodes were 93.5% in methylene blue group, and 97.5% in combination group. SLNs were found in 19 patients (23%) by lymphoscintigraphy, and 76 patients (92%) by hand-hold gamma detector, respectively (P=0.04). A total of 194 negative SLNs, detected by routine pathologic examination, were re-examined by multiple step section level cytokeratin immunohistochemistry; micrometastatic diseases were identified in 21 SLNs of 13 patients. The accuracy rate of combined examinations was 98.7%, and the false-negative rate was 3.2%.
The axillary node status can be predicted by SLN biopsy; double-staining is better than methylene blue-labeling. The role of lymphoscintigraphy in SLN biopsy needs further explore. Multiple step section level cytokeratin immunohistochemistry can improve detection rate of micrometastatic diseases.
Ai zheng = Aizheng = Chinese journal of cancer 10/2005; 24(9):1111-4.
-
[show abstract]
[hide abstract]
ABSTRACT: To study the methods and the clinical value of preserving intercostobrachial nerve during the axillary lymph nodes excision in breast cancer operations.
One hundred and sixty-two cases of stages I, II, IIIa breast cancer patients were divided into experimental group and control group respectively. The intercostobrachial nerves were preserved in experimental group and not in control group. Both groups were treated following the practice guideline of breast cancer, and found no recurrence during 4 to 36 months following up.
The postoperative arm sensory disturbance was 22.2% in the experimental group, which was significantly different from that of the control group 73.3% (chi(2) = 41.80, P < 0.01), the incidence of pain is 12.5% in experimental group, which was also significantly different from that of control group 31.1% (chi(2) = 7.86, P < 0.01).
Preserving intercostobrachial nerves may significantly decrease the postoperative morbidity of arm sensory disturbance and pain during axillary excision of stage I, II, IIIa breast cancer patients.
Zhonghua wai ke za zhi [Chinese journal of surgery] 09/2005; 43(17):1136-8.
-
[show abstract]
[hide abstract]
ABSTRACT: With the development of surgery treatment for lung cancer, the importance of preoperative pulmonary function assessment evoked more and more attention. This research was set to analyze postoperative complications of lung cancer patients with moderate pulmonary hypofunction, and explore associated factors.
Statistic t test and Chi(2) test were used to compare postoperative complications of 31 patients with moderate pulmonary hypofunction and 62 patients with normal pulmonary function (control group), logistic regression was performed to find associated factors.
In the 31 patients with moderate pulmonary hypofunction, hypoxemia (41.9%), arrhythmia or cardiac dysfunction (25.8%), pulmonary inflammation (25.8%) were common postoperative complications; incidence of severe complications, such as respiratory failure, and cardiac failure, was 9.2%; in-hospital mortality was 3.2%. In control group, the occurrence rates were 16.1%, 8.1%, 9.6%, and 3.2%, accordingly, no in-hospital death occurred. Regression analysis showed that age and resection range associated with the occurrence of postoperative complications.
compared with control group, incidences of common postoperative complications in patients with moderate pulmonary hypofunction are remarkably increased, but severe complications and in-hospital mortality are not significantly high. Patients with older age and larger resection range have a high risk of develop complications.
Ai zheng = Aizheng = Chinese journal of cancer 03/2005; 24(3):353-6.
