Abstract ： Objective To evaluate the clinical validity of Physiological and Operative Severity Score for theenUmeration of Mortality and Morbidity (POSSUM) in primary lung cancer patients undergoing surgery in order to get clinical treatment reference. Methods A total of 179 patients，with 124 males and 55 females，with primary lung cancer surgery between January 2007 and October 2010 were included in the First Affiliated Hospital of Xinjiang Medical University. Their age was 59.2±11.4 years．Before the surgery，POSSUM was used to each patient to rate the results and substituted the results into Copeland equation to calculate the predicted postoperative mortality and morbidity. The actual number of complications and death were calculated after surgery and the patients were divided into one group with postoperative complications and another group without postoperative complications. The physiological score and the operative risk score were compared between the two groups. Actual number of complications and death were compared with thenumber predicted by POSSUM respectively. The clinical factors related to the actual number of complications and death were analyzed. Results Among 179 patients， there were postoperative complications in 78 patients. The physiological score and the operative severity score were significantly higher in the group in whose complications occurred compared with those without complications (16.11±2.53 points versus 14.88±1.86 points for physiological score，P=0.000 ； 13.47±2.83 points versus 12.88±2.57 points for operative severity score，P=0.000). There was no statistical difference in complication between the predicted and actual number (65/179 versus 78/179，χ2=1.968，P=0.161). There was statistical difference in death between the predicted and actual number(12/179 versus 3/179，χ2=5.636，P=0.018).Univariable analysis revealed that 5 single factors were related to the complications， only hemoglobin was related to the death. Conclusion The POSSUM gives satisfactory prediction in morbidity rate but overrates the mortality rate in primary lung cancer patients undergoing surgery， and 5 single clinical factors show a better clinical value.
Primary bronchopulmonary carcinoma occurs in the bronchial mucosa epithelium, also called lung cancer (LC), and has currently become the first cause of death of malignant tumors in China. With constant efforts of Chinese physicians, the diagnosis and management of LC has made certain progress, but standardized surgery for LC still varies to a great extent due to difference regions, nature of medical centers, and technical levels. Complete and standardized surgical resection can provide good long-term survival for patients with stageⅠ, Ⅱand partly ⅢA LC, and cannot be a substitute for other treatment, which shows the importance of standardized surgery. As the most solid member, surgery plays a decisive role in comprehensive multidisciplinary treatment of LC. Today's medical development requires thoracic surgeons to provide most standardized and individualized treatment with principles of evidence-based medicine. This review focuses on progress of standardized surgery for stage Ⅰto ⅢA LC.
ObjectiveTo investigate the expression of autophagy-related genes and proteins in the lung tissues of patients with non-small cell lung cancer (NSCLC).MethodsPulmonary tissues were obtained from the surgically resected lung tissues of patients with NSCLC who were clinical diagnosed. The lung cancer tissues were derived from the pathologically diagnosed NSCLC and the normal tissues were from lung tissues 5 cm away from the lung lesions (29 cases in the lung cancer group and 32 cases in the normal group). The expression of autophagy-related proteins ATG5, LC3B, and p62 in lung tissues were measured by Western blot, and mRNA expression of ATG5 and p62 in the lung tissues were measured by real-time PCR.ResultsWestern blot analysis showed that the expression of ATG5 and p62 in lung cancer group were significantly higher than those in normal group (P<0.05). However, the expression of LC3B in lung cancer group was significantly lower than that in normal group (P<0.05). Real-time PCR analysis found that the mRNA expression of ATG5 and p62 in lung cancer group were significantly higher than those in normal group (P<0.05). The expression of ATG5, LC3B and p62 had no relationship with gender, age, smoking history, tumor location, tumor size, clinicopathological classification, differentiation or TNM stage. The expression of ATG5 had statistical significance in lymph node metastasis (P<0.05), but there was no difference for LC3B or p62 in lymph node metastasis (P>0.05).ConclusionsAutophagy plays a role in the tumorigenesis of lung cancer. If it’s possible to regulate and control autophagy-related genes and proteins effectively, it may supply new insights or targets into treatment for lung cancer patients.
ObjectiveTo systematically review the efficacy and safety of cisplatin combined with etoposide versus other platinum combined with etoposide in the treatment of small cell lung cancer (SCLC).
MethodsWe searched PubMed, The Cochrane Library (Issue 8, 2013), MEDLINE (Ovid), CNKI, VIP and WanFang Data to collect randomized controlled trials (RCTs) concerning the efficacy and safety of cisplatin combined with etoposide (the cisplatin group) versus other platinum combined with etoposide (the control group) for SCLC. The search was up to August 2013. Two reviewers screened literatures according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. And then, meta-analysis was performed by using RevMan 5.2 software.
ResultsA total of 6 RCTs involving 684 patients were included. The results of meta-analysis showed that there were no significant differences in disease control rate (DCR) (RR=1.03, 95%CI 0.91 to 1.17, P=0.63), overall response rate (ORR) (RR=1.04, 95%CI 0.97 to 1.11, P=0.33), occurrence of leukocytopenia (RR=0.97, 95%CI 0.81 to 1.17, P=0.77), decreased hemoglobin (RR=0.89, 95%CI 0.61 to 1.31, P=0.56) between the cisplatin group and the control group. Occurrence of thrombocytopenia was lower (RR=0.49, 95%CI 0.38 to 0.63, P<0.000 01) while occurrence of nausea and vomiting was higher (RR=1.80, 95%CI 1.40 to 2.31, P<0.000 01) in the cisplatin group.
ConclusionCurrent evidence shows that the clinical efficacy of cisplatin combined with etoposide for SCLC is equal to other platinum combined with etoposide, but it has a certain advantage in decreasing the aggregative rate of platelets, while the gastrointesnial reaction patients should avoid using cisplatin combined with etoposide.
目的 探討肺癌患者采用電視胸腔鏡輔助肺葉切除及系統性淋巴結清掃術的臨床操作方法、技術要點和適應證等。 方法 2007年2月至2008年2月我科收治了60例周圍型原發性支氣管肺癌患者，男36例，女24例；年齡34～79歲，平均年齡55歲。根據采用的手術術式不同，將60例患者分為兩組，電視胸腔鏡輔助（VAMT）組（n=30）：行電視胸腔鏡輔助肺葉切除及系統性肺門、縱隔淋巴結清掃術；傳統開胸組（n=30）：采用傳統手術方法行肺葉切除及系統性肺門、縱隔淋巴結清掃術。 結果 兩組患者均無死亡。 VAMT組患者切口長度（6.8±1.1 cm vs. 21.5±3.4 cm）、術后杜冷丁用量（52.5±10.2 mg vs. 228.3±32.6 mg）、術后胸腔引流時間（3.2±0.8 d vs. 5.7±1.5 d）和術后住院時間（6.3±1.4 d vs. 8.5±1.8 d）短于或少于傳統開胸組（Plt;0.05）; 而清掃淋巴結數、術中出血量和術后胸腔引流量兩組差異無統計學意義（Pgt;0.05）。 結論 對可手術的原發性肺癌患者行電視胸腔鏡輔助下系統性淋巴結清掃術是可行的，在淋巴結清掃的徹底性方面能達到常規開胸手術的效果，并且創傷小、術后并發癥少。
ObjectiveTo investigate the clinical significancy of K-ras gene mutation in peripheral blood free DNA in patients with non-small cell lung cancer (NSCLC).
MethodsA total of 242 patients pathologically diagnosed with NSCLC in the Third People's Hospital of Chengdu were recruited between January 2013 and August 2015. Both tumor tissues and peripheral blood free DNA were collected for detection of K-ras gene mutation by mutant-enriched liquidchip technology. The detection rate was compared between these two kinds of samples.
ResultsIn tumor tissues, the K-ras gene mutation was detected in 12 cases with a positive rate of 4.96%. While in peripheral blood samples, the K-ras gene mutation was detected in 10 cases with a positive rate of 4.13%. The detection yield of K-ras gene mutation in peripheral blood had a good consistency with that of lung cancer tissues (Kappa value=0.81).
ConclusionK-ras in peripheral blood plasma free DNA can be a surrogate marker for tumor tissues' K-ras gene mutation in screening patients with NSCLC.
Objective To evaluate the reporting quality and influencing factors of patient-reported outcome (PRO) data in randomized controlled trials (RCTs) of lung cancer. Methods RCTs of lung cancer with PRO as either primary or secondary endpoints were searched from PubMed, EMbase, Medline, CNKI, Wanfang Data, and VIP databases between January 1, 2010 and April 20, 2024. Reporting quality of included RCTs were assessed based on the CONSORT-PRO extension. Descriptive statistics and bivariate regression analysis were used to describe the reporting quality and analyze the factors influencing the reporting quality. Results A total of 740 articles were retrieved. After screening, 53 eligible RCTs of lung cancer with 22 780 patients were included. The patients were mainly with non-small cell lung cancer (84.91%), with the median sample size of the included studies was 364.0 (160.5, 599.5) patients. The primary PRO tool used was the EORTC QLQ-C30 (60.38%). There were 52 (98.11%) studies whose PRO measured the domain of "symptom management of cough, dyspnea, fatigue, pain, etc.", and 45 (84.91%) studies measured "health-related quality of life". Multicenter studies accounted for 84.91%, and randomized non-blind trials accounted for 62.26%. PRO was used as the primary endpoint in 33.96% of the studies and as secondary endpoints in 66.04%. The reliability and validity of the PRO tools were explicitly mentioned in 11.32% and 7.55% of the studies, respectively. The average completeness of reporting according to the CONSORT-PRO guidelines was 60.00%, ranging from 25.00% to 93.00%. The main factors affecting the completeness of CONSORT-PRO reporting included sample size and publication year. For every increment in sample size, the completeness of reporting increased by 27.5% (SE=0.00, t=2.040, P=0.046). Additionally, studies published after 2018 had a 67.2% higher completeness of reporting compared to those published in or before 2018 (SE=17.8, t=–3.273, P=0.006). Conclusion The study reveals that the overall reporting quality of PRO in lung cancer RCTs is poor. Particularly, the reporting of PRO measures reliability and validity, PRO assumptions, applicability, and handling of missing data need further improvement. Future research should emphasize comprehensive adherence to the CONSORT-PRO guidelines.
Objective To investigate the serum levels of endostatin and vascular endothelial growth factor ( VEGF) at different therapy stages of mouse Lewis lung carcinoma, and elucidate the relation to the progress and prognosis of tumor. Methods Forty-four Lewis lung carcinoma-bearing C57BL/6 mice were randomly divided into 4 groups, ie. a non-therapy group, a chemotherapy group, a gene therapy group, and a combination therapy group ( chemotherapy plus gene therapy) . Eleven healthy mice were included as normal control group. Serum was collected on the 0th, 5th, 19th day after therapy for measurement of endostatin and VEGF by ELISA. The correlations were analysed between endostatin and VEGF levels in each group. Results ( 1) The serum endostatin levels had no significant difference in all groups on the 0th day,but increased significantly on the 5th day in the gene and combination therapy groups than those in other three groups ( all P lt;0. 01) . Then the endostatin level decreased on the 19th day in the gene and combination therapy groups, but still higher than those in the chemotherapy group and the normal group. ( 2 ) On the contrary, serum VEGF levels of the gene and combination therapy groups decreased significantly on the 5th day and increased little on the 19th day, which were both significant lower than those in chemotherapy group on the 5th and 19th day( all P lt; 0. 05) . There were significant diferences between the three therapy groups and the non-therapy group( all P lt;0. 05) . ( 3) Negative correlations between VEGF and endostatin levels were revealed in the gene and combination therapy groups ( r = - 0. 77 and - 0. 761 respectively) .Correlation was not found in the non-therapy and chemotherapy groups. Conclusion The serum levels of endostatin and VEGF might be used as monitoring indices of antiangiogenesis therapy.
