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Overexpressions of PTTG and CMYC in Nonsmall Cell Lung Cancer and their Clinical Significances

摘要:目的:探討PTTG的表達在非小細胞肺癌發生、發展中的作用及其與CMYC蛋白表達的關系。方法:應用免疫組化SP法檢測PTTG、CMYC二種蛋白在44例非小細胞肺癌、20例肺良性病變組織和12例正常支氣管粘膜上皮組織中的表達。結果:PTTG和CMYC蛋白在非小細胞肺癌組織中的表達明顯高于肺良性病變組及癌旁組織,在TNM分期、淋巴結轉移組間差別有統計學意義。非小細胞肺癌組織中PTTG與CMYC表達呈顯著正相關。結論:提示PTTG和CMYC可能參與了非小細胞肺癌的發生和發展,可作為反映其生物學行為的指標。Abstract: Objective: To investigate the expression of PTTG and its relationship with expressions of CMYC protein in human nonsmall cell lung cancer (NSCLC).Methods: Immunohistochemical methods were applied to detect the expression of PTTG,CMYCproteins in 44 surgical specimens from NSCLC patients,20 pneumonic benign lesion and 19 normal bronchial epithelium. Results:There were high erexpressions of PTTG,CMYC in NSCLC tissues than inadjacent tissues and benign lesions.There were statistical relationships between their expressions and TNM stage,lymphnode metastasis.The expression of PTTG was positively correlated with CMYC. Conclusion: Overexpression of PTTG,CMYC may be related to human NSCLC,PTTG and CMYC play a cooperative role inthe process of NSCLC,all of them may be used as important indices for biologic behavior of NSCLC.

10 例老年性肺炎型肺癌診治體會

目的 探討老年性肺炎型肺癌( PTLC) 的臨床特征及影像學特點, 提高診斷率, 減少誤診。方法 回顧性分析麗水市第二人民醫院2009 年6 月至2011 年6 月經病理確診的10 例老年性 PTLC, 分析其臨床表現、實驗室檢查、胸部CT、支氣管鏡及病理資料, 總結其臨床特征。結果 老年性PTLC 影像學表現多見氣管充氣征、蜂窩狀透明影、小結節等, 缺乏特異性臨床表現, 抗感染及抗結核治療無效。結論 老年性PTLC 影像學表現與肺炎類似, 但臨床特點、實驗室檢查及對抗感染治療的反應性不符合感染性疾病的特征, 確診依賴于盡早獲得病理學診斷。

肺癌轉移至手部軟組織一例

The Inhibitory Effects of Dexamethasone on Cisplatin Induced Apoptosis of Human Lung Adenocarcinoma Cell SPC-A1 and Its Molecular Mechanism

The aim of this study is to investigate the apoptotic inhibition and its molecular mechanism of dexamethasone (DEX) acting on cisplatin (CDDP)-induced apoptosis of human lung adenocarcinoma cell SPC-A1. SPC-A1 cells were pre-cultured in vitro for 24 hours with DEX in different concentrations and then CDDP was added in different concentrations for culturing for further 48 hours. The survival rates of the cells were determined by MTT. The expression of serum/glucocorticoid-induced kinase (SGK-1) and mitogen-activated protein kinase phosphatase-1 (MKP-1) in SPC-A1 cells after being cultured by 1 μmol/L DEX at different time was detected by semi-quantitative RT-PCR technology. The expression of glucocorticoid receptor (GR) in SPC-A1 cells was measured by immunohistochemistry (IHC) with biotin-labeled anti-GR. The results of MTT showed that SPC-A1 cells had resistance to CDDP-induced apoptosis with pre-cultured DEX and the resistance intensity presented DEX concentration-dependent. The expressing quantity of SGK-1 in SPC-A1 cells stimulated by DEX could be elevated and increased with intention of time, but the express of MKP-1 was not detected. Up-regulated expression of GR in SPC-A1 cells stimulated by DEX was detected by IHC. The number of cells expressing GR in SPC-A1 cells was significantly higher than that in the control group. The results showed that DEX inhibited apoptosis of SPC-A1 cells induced by CDDP. The possible molecular mechanism is that elevated expression of GR induced by DEX up-regulates the expression of SGK-1 which locates at the downstream of anti-apoptosis pathway. The apoptosis resistance of SPC-A1 cells may account for all above the factors.

Quality control of robot-assisted segmentectomy for early-stage lung cancer

Recently, anatomical segmentectomy emerges as a hot spot in clinical research for surgical treatment of early-stage lung cancer. The techniques of segmentectomy are more elaborate and complicated than lobectomy, because of the considerable anatomic variations of segment blood vessels and bronchus. In a long term, video-assisted thoracic surgery is the mainly minimally invasive approach. As a new approach of minimally invasive surgery, da Vinci robot system possesses three-dimensional and high definition view, better dexterity mechanical wrist and tremor filtering system, which are the main advantages over video-assisted thoracic surgery. All the superiorities of robot system provide good supports for performing segmentectomy. Robot-assisted segmentectomy has been carried out in many medical centers in China and abroad until now. However, most surgery cases often lack adequate controls on quality.

Short-term and long-term outcomes of uniportal versus three portal thoracoscopic radical resection of non-small cell lung cancer: A retrospective cohort study

Objective To compare the short-term efficacy and long-term survival of patients with non-small cell lung cancer (NSCLC) treated by uniportal or three portal thoracoscopic radical resection. Methods A total of 388 patients who underwent uniportal or three portal thoracoscopic radical resection of lung cancer in the Department of Thoracic Surgery of Anhui Chest Hospital from 2015 to 2016 were analyzed retrospectively. The patients were divided into two groups including an uniportal group and a three portal group according to the procedure. The clinicopathological features, perioperative data and long-term survival of the two groups were compared. Results Finally, we included 205 patients with 105 males and 100 females at an average age of 58.73±10.93 years. There were 102 patients in the uniportal group and 103 patients in the three portal group. There was no statistical difference in clinicopathological features between the two groups (P>0.05). But compared with the three portal group, the uniportal group had less postoperative drainage, shorter postoperative catheterization time and postoperative hospital stay (P<0.05). There was no statistical difference in the number of lymph node dissection stations between the two groups (P=0.058). The pain score at 24 hours after operation in the uniportal group was significantly lower than that in the three portal group (P<0.001). There was no statistical difference in the total incidence of complications and the incidence of pulmonary complications between the two groups (P=0.161 and P=0.275). The median survival period and the 1st, 3rd, and 5th year survival rate in the uniportal group was 63.0 months and 95.0%, 75.2%, 51.5%, respectively. The median survival period and the 1st, 3rd, and 5th year survival rate in the three portal group was 61.0 months and 89.3%, 70.9%, 50.5%, respectively. There was no satistical difference in the survival results between the two groups (P=0.440). Conclusion Uniportal thoracoscopic radical resection of lung cancer is more minimally invasive and safe and effective in the treatment of NSCLC. It can make patients recover faster after operation.

隧道式胸腔引流管在惡性胸腔積液患者中的應用

摘要： 目的 介紹隧道式胸腔引流管（tunnelled pleural catheter，TPC)治療惡性胸腔積液（MPE）的方法，探討其臨床應用價值。 方法 分析美國西南醫學中心St.Paul醫院自2002年10月至2005年11月共對112例MPE患者植入TPC的臨床資料，其中男69例，女43例；年齡58.5±6.7歲。主要原發病為原發性肺癌、轉移性肺腫瘤（原發癌為淋巴瘤、乳腺癌、卵巢癌）、胸膜間皮瘤；分析MPE患者TPC植入的效果。 結果 在3年觀察期內，112例MPE患者共應用125例次TPC治療，其中10例為對側植入TPC，4例為同側再次植入TPC。隨訪2周后有48例次癥狀完全緩解，62例次癥狀部分緩解，5例次癥狀未緩解，有5例次植管失敗，5例次TPC植入術后2周內失去隨訪。 120例次成功植入TPC患者中有51例發生繼發性胸膜炎，僅5例在管道拔除后需要再次胸腔治療。隨訪2周中單胸腔積液量lt;20%。導管留置時間平均為56 d。所有TPC植入術后患者隨訪期的生存時間平均為144 d，隨訪1個月和1年的病死率分別為128%和836%。 結論 對具有門診治療條件、需要姑息治療的MPE患者,TPC是有效的方法之一。

Systemic Evaluation of Gefitinib in the Treatment of Non-small-cell Lung Cancer

Objective　To evaluate the efficacy of Gefitinib for patients with non-small-cell lung cancer (NSCLC). Methods　We searched several databases, including MEDLINE (1991 to June 2008), The Cochrane Library (Issue 4, 2008) and CBMDisc (1978 to Feb. 2008). Randomized controlled trials (RCTs) were included in the meta-analyses, which were done using The Cochrane Collaboration’s RevMan 4.2 software. We also included retrospective case reports published in Chinese journals. Results　Eight RCTs and 36 uncontrolled case reports were analyzed. The results of the RCTs showed that 250 mg/d Gefitinib had similar efficacy to 500 mg/d, but the side effect was significantly less for the lower dose. When used as a combined first-line treatment or a third-line treatment, Gefitinib was not superior to placebo on response rate, survival rate and life span. When used as second-line treatment, it did not prolong median survival, though it gave a higher response rate than placebo. Gefitinib caused many more side effects than placebo. Gefitinib exhibited similar efficacy to docetaxel in objective response rate [OR 1.18, 95%CI (0.84, 1.67), P=0.35], but was better for symptom and quality-of-life improvement [OR 1.58, 95%CI (1.33, 1.89), Plt;0.00001]. The overall uncontrolled clinical studies showed the following results: complete response rate was 2.2%, partial response rate was 25.8%, disease stable rate was 40.0% and progressive disease rate was 32.0%. The average median survival time was 8.9 months; the average time to progressive disease was 5.2 months, and the 1-year survival rate was 44.2%. The average median survival from EAP studies (6.9 months) was shorter than that for all the studies as well as the registered clinical trials (10.0 months). The average periods to progressive disease for registered clinical trials (3.2 months) and EAP studies (4.4 months) were somewhat shorter than that found for all studies combined, though response rate and 1-year survival rate were similar. Since there was no controlled clinical study, it was hard to conclude from the results whether Gefitinib brought any clinical benefit to NSCLC patients in China. Conclusion　 Gifitinib is not suitable as a combined first-line treatment or a third-line treatment for NSCLC. The clinical favor from gefitinib in the second-line treatment remains uncertain. There is not enough evidence to show whether Chinese people are more sensitive to Gefitinib, and its use in the second-line treatment of NSCLC needs to be tested further.

A machine learning-based risk prediction model of chronic obstructive pulmonary disease with lung cancer

Objective To establish a machine learning-based risk prediction model of combined chronic obstructive pulmonary disease (COPD) with lung cancer, so as to explore the high risk factors for COPD patients with lung cancer and to lay the foundation for early detection of lung cancer risk in COPD patients. Methods A total of 154 patients from the Second Hospital of Dalian Medical University from 2010 to 2021 were retrospectively analyzed, including 99 patients in the COPD group and 55 patients in the COPD with lung cancer group. the chest high resolution computed tomography (HRCT) scans and pulmonary function test of each patient were acquired. The main analyses were as follow: (1) to valid the statistically differences of the basic information (such as age, body mass index, smoking index), laboratory test results, pulmonary function parameters and quantitative parameters of chest HRCT between the two groups; (2) to analyze the indicators of high risk factors for lung cancer in COPD patients using univariate and binary logistic regression (LR) methods; and (3) to establish the machine learning model (such as LR and Gaussian process) for COPD with lung cancer patients. Results Based on the statistical analysis and LR methods, decreased BMI, increased whole lung emphysema index, increased whole lung mean density, and increased percentage activity of exertional spirometry and prothrombin time were risk factors for COPD with lung cancer patients. Based on the machine learning prediction model for COPD with lung cancer patients, the area under the receiver operating characteristic curve for LR and Gaussian process were obtained as 0.88 using the soluble fragments of prothrombin time percentage activity, whole lung emphysema index, whole lung mean density, and forced vital capacity combined with neuron-specific enolase and cytokeratin 19 as features. Conclusion The prediction model of COPD with lung cancer patients using a machine learning approach can be used for early detection of lung cancer risk in COPD patients.

Single-direction video-assisted thoracoscopic surgery anatomic basal segmentectomy in 352 patients: A retrospective study in a single center

Objective To share the clinical experience of video-assisted thoracoscopic surgery (VATS) anatomic basal segmentectomy by single-direction method. Methods The clinical data of 352 patients who underwent VATS anatomic basal segmentectomy in West China Hospital between April 2015 and April 2021 were retrospectively reviewed, including 96 males and 256 females with a median age of 50 (range, 26-81) years. All basal segmentectomies were performed under thoracoscopy, through the interlobar fissure or inferior pulmonary ligament approach, and following the strategy of single-direction and the method of "stem-branch". ResultsAll patients underwent basal segmentectomy successfully (49 patients of uniportal procedure, 3 patients of biportal procedure and 300 patients of triportal procedure) without addition of incisions or conversion to thoracotomy and lobectomy. The median operation time was 118 (range, 45-340) min, median intraoperative blood loss was 20 (range, 5-500) mL, median drainage time was 2 (range, 1-22) d and median postoperative hospital stay was 4 (range, 2-24) d. The postoperative complications included pneumonia in 6 patients, prolonged drainage (air leakage duration＞5 d or drainage duration＞7 d) in 18 patients, cerebral infarction in 1 patient and other complications in 2 patients. All patients were treated well and discharged without main complaints. No perioperative death happened. ConclusionVATS anatomic basal segmentectomy is feasible and safe. It can be performed in a simple manner following the strategy of single-direction.