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Lymph Node Metastasis Diagnosis Using 18F-Fluorodeoxyglucose Coincidence PET/CT in Non-small Cell Lung Cancer

目的　探討18氟-脫氧葡萄糖（18F-FDG）雙探頭符合線路對非小細胞肺癌胸內淋巴結轉移的診斷價值，并分析其假陽性、假陰性診斷的原因。 方法　回顧性分析2010年12月－2012年6月非小細胞肺癌患者161例的臨床資料，其中腺癌122例，鱗癌23例，其他類型16例。分析患者術前18F-FDG雙探頭符合線路顯像對肺門、縱膈淋巴結的診斷結果（其中陽性53例，陰性108例），以術后病理診斷為金標準，評價其診斷價值。分析9例假陽性、26例假陰性診斷患者的吸煙史、慢性支氣管炎肺氣腫、肺結核病史、局限性肺炎、腫瘤標志物、淋巴結短徑、腫瘤原發灶T/N比值、外周血白細胞等指標。 結果　18F-FDG雙探頭符合線路單光子發射計算機斷層成像（SPECT）診斷非小細胞肺癌淋巴結轉移的靈敏度、特異性、準確性、陽性預測值、陰性預測值分別是62.9%、90.1%、78.3%、83%、75.9%。假陽性組患者慢支炎肺氣腫、局限性肺炎者高于真陽性組。假陰性組的淋巴結短徑、原發灶T/N比值小于真陽性組。 結論　18F-FDG雙探頭符合線路SPECT是術前診斷肺癌淋巴結轉移的有效手段；假陽性淋巴結與慢支炎肺氣腫、局限性肺炎有關；假陰性淋巴結與淋巴結短短徑小、原發腫瘤攝取18F-FDG低有關。

非小細胞肺癌跳躍性縱隔淋巴結轉移及其廓清的臨床探討

目的 探討非小細胞肺癌(NSCLC)跳躍性縱隔淋巴結轉移(跳躍性N2)的特點及轉移方式,為制定合理的縱隔淋巴結廓清范圍提供依據. 方法 回顧性總結121例(廣州軍區總醫院1996～1999年101例和北京大學深圳醫院1999～2000年20例)經系統性淋巴結廓清后病理證實為N2的NSCLC患者的臨床資料,將跳躍性N2與非跳躍性N2的數據進行比較. 結果 發現跳躍性N2 23例(19.0%),其中腺癌18例(78.3%).跳躍性N2患者中平均每例縱隔淋巴結轉移組為1.1組,明顯低于非跳躍性N2的3.1組.肺上葉腫瘤跳躍性N2多位于第4或第5組淋巴結,肺下葉腫瘤跳躍性N2多位于第7和第8組淋巴結. 結論 跳躍性N2是NSCLC縱隔淋巴結轉移的一個獨特亞群.在行肺上葉癌根治術時,應常規清掃第4或第5組淋巴結;在行肺下葉癌根治術時,應常規清掃第7和第8組淋巴結.

Surgical resection for synchronous multiple pulmonary nodules identified difficultly in clinics

ObjectiveTo evaluate the role of surgical resection on synchronous multiple pulmonary nodules identified difficultly in clinics.MethodsThe clinical data of 97 patients with synchronous multiple pulmonary nodules who received surgical resection between 2012 and 2019 in Hunan Cancer Hospital were retrospectively analyzed. There were 72 males and 25 females, aged 58.1±9.0 years. Among these patients, there were 78 patients with ipsilateral and 19 patients with bilateral pulmonary nodules. Clinicopathological parameters between main nodules and secondary nodules were evaluated. Perioperative morbidity was also assessed.ResultsThe operation was successfully completed on all patients for the ipsilateral and bilateral lesions. Totally, 71.1% of mian lesions was mostly removed by lobectomy, and the completion rate of video-assisted thoracoscopic surgery (VATS) was 69.1% (67/97); 80.4% of secondary lesions were mostly removed by wedge resection, and the completion rate of VATS was 71.1% (69/97). The incidence of grade 3 or higher complications after unilateral or bilateral surgery was 12.8% and 5.3%, respectively. Postoperative pathology confirmed that the main lesions were malignant in 65 patients (67.0%), mainly adenocarcinoma (63.1%), of which 43.1% were in the stage Ⅰ; 32 patients were benign, mainly tuberculoma (56.3%). There were 29 patients of malignant secondary lesions, 67 benign, and 1 both benign and malignant; the pathological agreement rate of primary and secondary lesions was 54.6% (lung cancer metastases in the lung and all the benign). When the primary lesion was malignant with its diameters of <3 cm, 3-<5 cm, 5-7 cm, >7 cm, the metastatic rate of secondary lesions was 42.5%, 15.8%, 20.0%, 0, respectively. When the primary lesion was malignant with lymph node metastasis, the probability of the secondary lesion being a metastatic tumor was higher than that without lymph node metastasis (46.7% vs. 30.0%, P>0.05). When the primary lesion was malignant and the primary and secondary lesions were located in the same lobe, the secondary lesions were more likely to metastasize (54.5%), while when they were located on different lobes on the same side or different sides, the secondary lesions were more likely to be benign (58.1%, 72.7%), and the possibility of metastasis was small ( 32.6%, 9.1%). When the primary lesion was benign and clinical differential diagnosis was difficult, the secondary lesion was benign.ConclusionFor synchronous multiple pulmonary nodules, the diameter of the primary lesion is large, the metastatic rate of secondary lesions tends to decrease. In ipsilateral synchronous multiple pulmonary nodules, especially with node metastasis, the risk of metastatic nodule increases. Bilateral surgical resection does not significantly increase the perioperative morbidity.

同期手術治療同時性食管肺重復癌一例

Single Utility Port Complete Video-assisted Thoracoscopic Surgery Lobectomy for Patients with Early-stage Lung Cancer

Abstract：?Objective?To evaluate clinical outcomes of single utility port complete video-assisted thoracoscopic surgery （VATS） lobectomy for patients with early-stage lung cancer.?Methods?We retrospectively analyzed the clinical data of 162 consecutive patients with early-stage lung cancer who underwent single utility port complete VATS lobectomy from September 2009 to October 2011 in Chinese PLA General Hospital （single utility port group），and compared them with 221 patients with early-stage lung cancer who underwent video-assisted mini-thoracotomy （VAMT） lobectomy in the same period （VAMT group）. The clinical outcomes including operation time, intraoperative blood loss, lymph node dissection number, time to first activity out of bed, chest drainage duration and postoperative complications, were compared between the two groups.?Results?No perioperative death was observed in both groups. There were statistical differences in the intraoperative blood loss （162.8±75.6 ml vs. 231.4±62.8 ml）, time to first activity out of bed （2.2±0.3 d vs. 3.7±0.5 d） , and chest drainage duration （3.5±0.2 d vs. 4.6±0.4 d） between the two groups （P＜0.05）. There was no statistical difference in operation time （133.7±22.0 min vs. 124.9±25.7 min） , lymph node dissection number （11.7±1.9 vs. 12.5±2.7）， and incidence of serious postoperative complications （7.4% vs. 8.1%）between the two groups.?Conclusion?Single utility port complete VATS lobectomy and lymph node dissection are safe and reliable for patients with early-stage lung cancer with less injury and better postoperative recovery compared with VAMT.

Preparation and application of a PDGFRβ-targeted near-infrared fluorescent probe for molecular optical imaging of lung cancer

ObjectiveTo prepare platelet-derived growth factor receptor β (PDGFRβ)-targeted near-infrared molecular probe and evaluate its potential in optical molecular imaging of lung cancer.MethodsPDGFRβ-specific affibody Z-tri was recombinantly expressed in Escherichia coli (E. coli) and purified using affinity chromatography. In vitro cell-binding of Z-tri was analyzed by flow cytometry. Cellular distribution of Z-tri in tumor grafts was determined by protein-tracing. The molecular probe CF750-Z-tri was prepared by conjugating near-infrared fluorescent dye CF750 to Z-tri. The optical images of xenografts of lung cancer were obtained by using CF750-Z-tri combined with optical imaging system.ResultsPDGFRβ-specific affibody Z-tri was highly expressed in E. coli and purified to homogeneity. Z-tri could bind PDGFRβ-positive cells but not PDGFRβ-negative cells cultured in vitro. In the tumor xenografts of human lung cancer, intravenously injected Z-tri was predominantly distributed on cells overexpressing PDGFRβ. The near infrared fluorescent dye CF750 was efficiently conjugated to Z-tri. Optical images with high contrast of lung cancer xenografts were produced by using the near-infrared fluorescent probe CF750-Z-tri combined with optical imaging system.ConclusionThe near-infrared fluorescent probe CF750-Z-tri can be used for optical imaging of human lung cancer, which takes great potential in optical imaging-guided surgery of lung cancer.

BAD與腫瘤關系的研究

【摘要】　腫瘤的發病率呈逐年攀升趨勢，但其發生、發展機制仍不明確。細胞凋亡抑制可能是導致腫瘤發生、發展的重要機制。因此與凋亡通路相關的蛋白有可能成為腫瘤治療的靶點。BAD是Bcl-2家族中的一員，屬于促凋亡蛋白，現就BAD與腫瘤關系的研究作一綜述。

The Correlation of Integrinlinked Kinase and Matrix Metalloproteinases9 Expression with Prognosis of Nonsmall Cell Lung Cancer

 Abstract: Objective To observe the expression of integrinlinked kinase (ILK) and matrix metalloproteinases9 (MMP9) in human nonsmall cell lung cancer (NSCLC) and investigate the correlation of ILK and MMP9 expression with the prognosis of NSCLC. Methods The expression of ILK and MMP9 in 75 specimens of NSCLC resected from January 2002 to January 2004 were detected by immunohistochemistry. According to the median of integral optical density (IOD), all patients were divided into the high or low ILK expression group and the high or low MMP-9 expression group. The relativity of ILK and MMP9 was determined, and the relationship of survival time with clinical features including expression of ILK and MMP-9 was compared by Logrank test. Results Both ILK and MMP-9 were expressed in NSCLC specimens. The expression between ILK and MMP-9 was positively correlated in 75 patients of our group (r=0.79, Plt;0.05). Patients with lower expression of ILK and MMP9 had a significantly longer survival time than those with higher expression of ILK and MMP-9 in the postoperative followup (χ2=15.067,14301,Plt;0.05). The survival time was not correlated with sex,age,smoking history or pathological type(χ2=0450,0078, 1.460, 1.623，Pgt;0.05), while tumor diameter, lymph node metastasis, TNM stage, the expression of ILK and MMP-9 significantly influenced the survival time (χ2=3.963, 15.169,20.529, 15.067，14.301，Plt;0.05). Conclusion  The expression of ILK and MMP9 affects the prognosis of NSCLC. MMP-9 may advance infiltration and metastasis of tumor cells through ILK pathway. In summary, the expression of ILK and MMP9 may play an important role in the evaluation of prognosis for patients with NSCLC.

Advance in microsatellite alterations and microRNA in blood of lung cancer

The early detection, diagnosis and treatment of lung cancer are the key points to reduce mortality and improve the prognosis. Detecting tumor markers in blood is a minimally-invasive, cost-effective, easy to administer and approachable test. A microsatellite consists of a tract of tenderly repeated DNA motifs that range in length from two to five nucleotides. Microsatellite alterations (MA) have been described as two types: loss of heterozygosity (LOH) and microsatellite instability (MSI). MicroRNA (miRNA) is a noncoding RNA and protein involved in regulating gene expression in the transcription level. In recent years, some miRNA markers and microsatellite alterations show significant tumor association, tissue specific and stability. Therefore, we write this review to discuss the microsatellite alterations and microRNA in blood of lung cancer.

Current Status and Progress of Lymphadenectomy in Lung Cancer Operation

Lymph node metastasis is the main and frequent metastatic way of lung cancer, it is also the reason of postoperative carcinoma residue which results in relapse and metastasis. It is vital to clean mediastinal lymph nodes and hilar lymph nodes in lung cancer operation. However, the patterns of lymphadenectomy are not yet uniform. There are complete mediastinal lymph node dissection(CMLND), radical lymph node dissection(RLND), lymph node sampling(LS), systematic lymph node sampling(SS) and sentinel lymph node navigation(SLN). And with the development of minimal invasive surgery, the thoracoscopic lymphadenectomy gets mature day by day. It is very necessary to find a more standardized and perfect patten of lymphadenectomy. This paper reviews the clinical significance, the pattens and the extent of mediastinal lymph node dissection and hilar lymph node dissection, and also reviews the current status and prospect of thoracoscopic lymphadenectomy