Abstract: Objective To observe the expression of integrinlinked kinase (ILK) and matrix metalloproteinases9 (MMP9) in human nonsmall cell lung cancer (NSCLC) and investigate the correlation of ILK and MMP9 expression with the prognosis of NSCLC. Methods The expression of ILK and MMP9 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 MMP9 was determined, and the relationship of survival time with clinical features including expression of ILK and MMP-9 was compared by Logrank 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, Plt;0.05). Patients with lower expression of ILK and MMP9 had a significantly longer survival time than those with higher expression of ILK and MMP-9 in the postoperative followup (χ2=15.067,14301,Plt;0.05). The survival time was not correlated with sex,age,smoking history or pathological type(χ2=0450,0078, 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 MMP9 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 MMP9 may play an important role in the evaluation of prognosis for patients with NSCLC.
ObjectiveTo evaluate the survival results of surgical resection (SR) and CT-guided percutaneous ablation (PA) for stageⅠnon-small cell lung cancer (NSCLC).MethodsThe PubMed, Web of Science, EMbase, The Cochrane Library, CNKI, VIP, Wanfang databases from inception to June 2021 were searched to collect comparative studies on the survival results between SR and CT-guided PA treatment for stageⅠNSCLC. RevMan 5.3 software was used for statistical analysis of data.ResultsA total of 3 114 patients were included in 11 studies. The results of meta-analysis showed that compared with the PA group, the SR group had a higher 2-year postoperative overall survival (OS) rate (OR=1.44, 95%CI 1.00-2.06, P=0.05), 3-year postoperative OS rate (OR=2.37, 95%CI 1.47-3.81, P<0.001), 5-year OS rate (OR=1.64, 95%CI 1.19-2.28, P<0.01), 5-year progression-free survival rate after operation (OR=2.43, 95%CI 1.54-3.82, P<0.001) and lower local recurrence rate (OR=0.26, 95%CI 0.13-0.54, P<0.001). There were no statistical differences between the two groups in terms of 1-year postoperative OS rate, 1-year, 2-year, and 3-year tumor-related survival rates, 1-year, 2-year tumor-free survival rates, or distant postoperative recurrence rate (P>0.05).ConclusionFor patients with stageⅠNSCLC with optimal basic conditions, surgery is a more appropriate treatment. For patients who cannot withstand surgical injuries or refuse surgery, CT-guided PA is also a potential alternative treatment. However, this conclusion needs to be verified by prospective controlled trials with larger sample sizes and a more rigorous design.
Treatment of Non-small Cell Lung Cancer by Single-direction Four-hole Complete Video-assisted Thoracoscopic Lobectomy HUANG Jia, ZHAO Xiao-jing, LIN Hao, TAN Qiang, DING Zheng-ping, LUO Qing-quan. (Shanghai Lung Tumor Clinical Medical Center, Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai 200030, P. R. China) Corresponding author：LUO Qing-quan, Email：luoqingquan@hotmail. com Abstract： Objective To explore the feasibility and safety of single-direction four-hole video-assisted thoracoscopic lobectomy in the treatment of non-small cell lung cancer (NSCLC). Methods Between January 2007 and December 2010, 428 patients with NSCLC were surgically treated by single-direction complete video-assisted thoracoscopic lobectomy in Shanghai Chest Hospital. There were 186 males and 242 females; aged 33 to 78 years. All the patients were diagnosed as primary NSCLC at early clinical stage. Among the 428 patients, 134 patients underwent right upper lobectomy, 48 patients underwent right middle lobectomy, 98 patients underwent right lower lobectomy, 4 patients underwent right middle and lower lobectomy, 72 patients underwent left upper lobectomy, and 72 patients underwent left lower lobectomy. All the 428 patients were divided into two groups according to their surgical approach：a three-hole group (300 patients) and a four-hole group (128 patients).The clinical results of the two groups were analyzed. Results A total of 412 patients underwent complete video-assisted thoracoscopic lobectomy, and 16 patients (3.7%) underwent conversion to open surgery. The average operation time was 132.1 (120-180) min, average length of incision was 3.7 (3-5) cm, and average blood loss was 150.0 (50-800) ml. There was no statistical difference in extubation time, intraoperative blood loss, and postoperative hospital stay between the two groups. But the operation time of the four-hole group is significantly shorter than that of the three-hole group （P＜0.05）. The 16 patients who underwent conversion to open surgery received intraoperative blood transfusion. Five patients died of severe pulmonary infection, pulmonary embolism, and acute cerebral infarction. Fifty two patients had squamous cancer, 340 patients had adenocarcinoma, 20 patients had adenosquamous carcinoma, 8 patients had poorly differentiated carcinoma, 6 patients had big cell lung cancer, and 2 patients had carcinoid. Postoperative persistent lung air leak occurred in 4 patients, thoracic empyema in 2 patients, pulmonary infection in 4 patients, arrhythmia in 26 patients, pulmonary embolism in 2 patients, chylothorax in 2 patients, and acute cerebral infarction in 2 patients. The overall 3-year survival rate was 83.6%（358/428）. Conclusion Single-direction four-hole complete video-assisted thoracoscopic lobectomy is feasible, safe and consistent with the operation standard in the surgical treatment for NSCLC patient. It is also helpful to reduce the operation time and facilitate lymph node dissection. Key words： Video-assisted thoracoscopic surgery； Lobectomy； Single-direction； Four-hole； Non-small cell lung cancer
Based on new clinical evidence, the National Comprehensive Cancer Network (NCCN) annually updates and releases the "NCCN Guidelines for the Clinical Diagnosis and Treatment of Non-Small Cell Lung Cancer" which has become the reference for clinical diagnosis and treatment approved and complied by clinicians worldwide. On November 25, 2020, the latest 2021 V1 version of "NCCN Clinical Diagnosis and Treatment Guidelines for Non-Small Cell Lung Cancer" (hereinafter referred to as "Guidelines") was released. Compared with the 8th edition of the "Guidelines" in 2020, many updates focused on the progress of targeted and immunotherapy. This article will provide the interpretations of the updated therapy content of this edition of the guidelines.
MicroRNA (miRNA) is a noncoding RNA and protein involved in regulating gene expression in the transcription level. Epidermal growth factor receptor (EGFR) is a protein tyrosine kinase receptor and its mutations have been confirmed in non-small cell lung cancer (NSCLC) by a large number of studies in recent years. EGFR tyrosine kinase inhibitor (EGFR-TKI) is widely used for treatment of NSCLC patients with EGFR mutation. In recent years, miRNA is more and more important in tumor metastasis. The role of EGFR mutations in NSCLC has become a hot spot as well. New researches report that the relationship between miRNA and EGFR mutations plays an important role in NSCLC metastasis. Therefore, we write this review to discuss the mechanisms of miRNA and EGFR mutations in metastasis of NSCLC.
Objective To investigate the clinical significance of serum cystatin C ( Cys C) in patients with non-small cell lung cancer ( NSCLC) .Methods The serumlevel of cystatin C was determined by enzyme linked immunosorbent assay ( ELISA) in patients with NSCLC, patients with benign lung diseases, and normal controls. Results The serum level of Cys C in the NSCLC patients was much higher than those in the patients with benign lung diseases and the normal control subjects [ ( 1.47 ±0.78) mg/L vs. ( 1.04 ±0.51) mg/L and ( 1.06 ±0.36) mg/L, Plt;0.01] . The level of Cys C in the NSCLC patients was significantly related to clinical stage [ TNM stage -Ⅱ vs. Ⅲ-Ⅳ: ( 1.38 ±0.88) mg/L vs. ( 1.57 ± 0.79) mg/L] , lymph node metastasis [ metastatic vs. non-metastatic: ( 1.83 ±0.97) mg/L vs. ( 1.06 ± 0.39) mg/L] , and differentiation degree [ medium-high differentiation vs. low differentiation: ( 1.63 ± 0.73) mg/L vs. ( 1.26 ±0.48) mg/L] ( all Plt;0.05) . However no correlation of Cys C with gender, age, and histological type was revealed ( Pgt;0.05) . Conclusion Cys C may contribute to the occurrence and development of NSCLC.
ObjectiveTo investigate expression levels of thymidylate synthase (TS), excision repair cross-comple-menting gene 1 (ERCC1), β-tubulin 3 (TUBB3), ribonucleotide reductase subunit 1 (RRM1)in different pathological types of non-small cell lung cancer (NSCLC), and evaluate detection strategies of above genes for individualized chemotherapy of NSCLC.
MethodsWe retrospectively analyzed clinical data of 94 NSCLC patients who underwent radical resection in Department of Thoracic Surgery of Beijing Friendship Hospital from February 2010 to October 2012. Messenger ribonu-cleic acid (mRNA)expression levels of TS, ERCC1, TUBB3 and RRM1 were examined by immunohistochemistry.
ResultsThere were 91 patients (96.81%)with low mRNA expression of TS, 90 patients (95.74%)with low mRNA expression of ERCC1, 59 patients (62.77%)with low mRNA expression of TUBB3, and 48 patients (51.06%)with low mRNA expression of RRM1. There was no statistical difference in mRNA expression levels of TS, ERCC1, TUBB3 or RRM1 between adenocarcinoma and non-adenocarcinomas (P > 0.05). The percentage of low mRNA expression of TUBB3 in adenocarcinoma was significantly lower than that in non-adenocarcinomas (58.21% vs. 74.07%). Among patients with same pathological types of NSCLC, mRNA expression levels of TS, ERCC1 and TUBB3 were all positively correlated with mRNA expression of RRM1 (correlation coefficient all greater than 0.80).
ConclusionFor individualized chemotherapy of NSCLC, when selecting gene detection, mRNA expression levels of ERCC1 and TS need not be detected and can be considered as low expression by experience, mRNA expression levels of TUBB3 in adenocarcinoma and RRM1 in all pathological types of NSCLC should be routinely examined. For non-adenocarcinoma patients, whether or not to examine mRNA expression level of TUBB3 can be decided in a comprehensive manner.
Objective To investigate the clinical value of using videoassisted thoracoscopic lobectomy（VATS lobectomy） to treat primary nonsmall cell lung cancer(NSCLC) so that the videoassisted thoracoscopic surgery(VATS) can be better used in clinic. Methods From September 2007 to December 2008, seventysix NSCLC patients were collected. Thirtyseven patients underwent VATS lobectomy(VATS group), 21 male and 16 female with an average age of 60.4 years. Among them 20 underwent videoassisted minithoracotomy lobectomy, and 17 underwent total thoracoscopic lobectomy. Thirtynine patients underwent conventional thoractomy(conventional thoracotomy group), 32 male and 7 female with an average age of 58.7 years. Perioperative clinical and laboratory parameters of the two groups were compared. Results There was no severe complication and perioperative mortality in both groups. There were statistical significances between VATS group and conventional thoracotomy group in incision length (7.6±1.9 cm vs. 28.5±3.6 cm, t=-31.390,P=0.000), postoperative dosage of dolantin(160±125 mg vs.232±101 mg，t=-2.789,P=0.007), postoperative chest tube time(chest tube output＞100ml,4.8±2.5 d vs. 8.1±3.2 d，t=-4.944,P=0.000） and postoperative hospitalization time(12.1±3.0 d vs. 15.7±4.7 d，t=-3.945,P=0.000). There was no statistical significance between two groups in operation time（t=1.732，P=0.087）, intraoperative blood loss（t=-1.645，P=0.105） and the number of lymph node dissection（t=-0.088，P=0.930）. The total hospitalization expenses in VATS group were higher than that in conventional thoracotomy group, but there was no statistical significance（t=1.303，P=0.197）. The serum levels of glucose at 1st day after operation（7.2±1.2 mmol/L vs. 8.4±2.2 mmol/L, t=5.603,P=0.000）and the total count of white blood cell (12.7±3.8×10.9/L vs. 15.1±5.9×10.9/L,t=5.082,P=0.004) in VATS group were significantly lower than that in conventional thoracotomy group. The prealbumin(PA) level in VATS group was significantly higher than that in conventional thoracotomy group（215.0±45.5 mg/L vs.147.3+50.8 mg/L,t=-7.931,P=0.000). Conclusion VATS lobectomy could clean lymph node completely. Its advantages include less postoperative trauma, lower acute phase response, mild pain, rapid recovery, shorter hospitalization time and less economic burden. It could be an operation approach for early NSCLC patients who have been strictly selected.
Objective To explore the value of preoperative detection of soluble fragments of cytokeratin-19 (CYFRA21-1), carcinoembryonic antigen (CEA), and postoperative detection of nuclear proliferation associated antigen Ki67 in prognostic evaluation of non-small cell lung cancer patients. Methods The clinicopathological data and follow-up results of patients with non-small cell lung cancer treated in the Department of Thoracic Surgery of the First Affiliated Hospital of Xiamen University in 2017 were collected. CYFRA21-1>3.39 ng/mL was defined as positive, and CEA>5 ng/mL was defined as positive. The receiver operating characteristic curve (ROC curve) of Ki67 expression level was drawn. The maximum area under the curve (AUC) was the cutoff value of Ki67 expression level, and the Ki67 expression level greater than its cutoff value was defined as positive. Cox regression analysis was used to determine the independent risk factors for poor prognosis in patients with non-small cell lung cancer. Results Finally 248 patients were collected, including 125 males and 123 females, with a median age of 61 years (ranging from 30 to 81 years) at the time of surgery. Univariate analysis showed that positive CYFRA21-1, high expression of Ki67, positive CEA, age≥60 years at operation, distant metastasis, lymph node metastasis, maximum tumor diameter>3 cm, and TNM stage Ⅲ were associated with poor prognosis in patients with non-small cell lung cancer. When combined detection of preoperative tumor markers and postoperative Ki67, the prognosis of all negative patients was the best, and that of all positive patients was the worst. Cox regression analysis showed that positive CEA+positive CYFRA21-1+high expression of Ki67 was an independent risk factor for poor prognosis in patients with non-small cell lung cancer (P<0.05). Conclusion The combined detection of preoperative serum CYFRA21-1, CEA, and postoperative Ki67 has important value in evaluating the prognosis of non-small cell lung cancer patients.
Objective To determine whether the basal characteristics and survival of young patients undergoing surgical resection of nonsmall cell lung cancer (NSCLC) differ from those of elderly patients. And, we would discuss the special perioperative management in elderly patients with NSCLC. Methods 178 NSCLC patients who underwent surgery in our hospital between Jan. to Dec. in 2002 were divided into two groups according to age. Young group comprised 89 patients aged 50 years or younger and elderly group comprised 89 patients aged 70 years or older. The patients’ clinical data, operative style,postoperative complications and survival results were reviewed and analysed. Results The proportion of the elderly group squamous cell carcinoma patients was higher than that of the younger group （χ2=9.281,P=0.000.）,but there was no significant difference between the gender, smoking, histology, TNM stage, type of resection, post operation chemotherapy or radiotherapy（χ2≤5.569，Pgt;0.05）. The incidence of the preoperative cardiovascular disease, chronic bronchitis in the elderly group patients were higher than those of younger group（χ2=14.053，P=0.000;χ2=13.044，P=0.000）.The incidence of postoperative complications was significantly higher in elderly group than those of younger group（χ2=12842，P=0.000）. The 1, 3 and 5year survival rates were 71.43％，33.53％ and 27.83％ in elderly group, and 77.78％，46.67％ and 44.07％ in young group, respectively. However, the 1, 3 and 5year survival rates for patients in two groups showed no difference between two groups（Pgt;0.05）. Conclusion The elderly patients have higher operative risk than that of young patients. We should pay more attention to the perioperative management of elderly patients. The elderly patients could get acceptable long term survival rates through surgical treatment. Operation is still the first choice for elderly patients with NSCLC.
