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.
Objective To summarize the diagnosis and treatment of synchronous multiple primary malignant tumors in lung. Methods The clinical and pathological data of 5 cases with intrapulmonary synchronous multiple primary cancer, who were diagnosed in recent 10 years in Xinhua Hospital, were retrospectively analyzed. Results The incidence of intrapulmonary synchronous multiple primary cancer was 0. 21%( 5 /2380) in all lung cancer cases diagnosed in respiratory department of Xinhua Hospital. There were 4 males and 1 female, with the average age of 60. 2 years old. Five patients were all treated with surgical operation. Four patients with bilateral synchronous multiple primary lung cancer underwent staging operation treatment( larger lesions on one side of lung underwent conventional thoraceotomy and lobectomy, and smaller lesions on another side underwent thoracoscopic lobectomy or wedge resection afer 1 month) . For 1 patients with ipsilateral synchronous multiple primary lung cancer, simultaneous operation was performed. There was no death during perioperative period or severe cardiopulmonary complications. They were followed up for 3 years. The survival rate was 80. 0%( 4 /5) at 1 year and 60. 0% ( 3/5) at 3 years, respectively. Conclusions With the development of medical science and awareness of pulmonary multiple primary cancer, early diagnosis improves continuously. Active treatment with operation can achieve better prognosis.
ObjectiveTo compare the current status of clinical studies regarding lung cancer between China and the United States in 2019, and to indicate the weakness, trend and future development direction of clinical studies drug treatment in China.MethodsThe data of lung cancer clinical studies from January 1st to November 30th, 2019 in China and the United States were retrieved and analyzed through Informa pharmaprojects database.ResultsThe United States was superior on the number of projects (128 vs. 156) and research institutions (743 vs. 2 250). Compared with the United State, there were more phase Ⅲ confirmatory researches (19.5% vs. 10.3%), bioequivalent drug researches (3.1% vs. 0%), and researches initiated by academic institutions (39.8% vs. 28.1%) in China. The United States exhibited advantages in phaseⅠ andⅠ/Ⅱstudies (25.8% vs. 60.3%), immunodrugs (49.2% vs. 60.3%), primary tested drug ratio (61.7% vs. 93.6%), targets abundance (32.9% vs. 69.6%), and chimeric antigen receptor-T (CAR-T, 0.7% vs. 7.1%).ConclusionCompared with the United States, China should pay more attention to innovative drug investigations in early phase of clinical studies, especially novel immune agents, vaccines, and CAR-T.
ObjectivesTo systematically review the correlation between NFKB1 gene, NFKBIA gene and lung cancer susceptibility.MethodsWeb of Science, PubMed, VIP, CNKI and WanFang Data databases were electronically searched to collect case-control studies on the correlation between NFKB1 gene rs4648127, rs28362491 polymorphisms and NFKBIA gene rs696 polymorphism and lung cancer susceptibility from inception to November, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 7 case-control studies were included. The results of meta-analysis showed that: no correlation was found between rs4648127 and lung cancer susceptibility (C vs. T: OR=1.065, 95%CI 0.323 to 3.512, P=0.918). A positive correlation was found in hospital population between rs28362491 (D vs. I: OR=1.290, 95%CI 1.117 to 1.489, P=0.001; DD vs. II: OR=1.707, 95%CI 1.273 to 2.289, P<0.001; DD vs. ID+II: OR=1.409, 95%CI 1.100 to 1.806, P=0.008) and lung cancer. Rs696 polymorphism (A vs. G: OR=1.215, 95%CI 1.105 to 1.336, P<0.001; AA vs. GG: OR=1.438, 95%CI 1.194 to 1.731, P<0.001; GG vs. AG+AA: OR=1.566, 95%CI 1.341 to 1.829, P<0.001) was correlated with lung cancer susceptibility.ConclusionsCurrent evidence shows that NFKB1 gene rs4648127 may not be associated with lung cancer. The rs28362491 pdymorphism of NFKB1 gene in hospital population and rs696 pdymorphism of NFKBIA gene may be positively correlated with lung cancer susceptibility. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Lymphangiogenesis plays an active role in lung cancer metastasis. Currently, it attracts more and more attention because of its role in tumor metastasis and become a hotspot in the field. Lymph node metastasis of lung cancer is the key factor for the unfavourable prognosis of the patient suffered lung cancer. But the correlation of lymphangiogenesis and lung cancer metastasis is yet unknown. Some development about it is reviewed.
Objective To investigate the feasibility and safety of uniportal video-assisted thoracic surgery (VATS) for primary lung cancer. Methods We retrospectively analyzed the clinical data of 95 primary lung cancer patients in our hospital between January 2014 and January 2015. The patients were divided into an observation group (45 patients) and a control group (50 patients). Standard thoracoscopy lobectomy was used in the control group. Uniportal thoracoscopy lobectomy was used in the trial group. The parameters of the two groups were observed. Results The surgeries of the two groups were successfully completed. There was no statistical difference in operative time, intraoperative transit rate, blood loss, number of lymph node dissection, thoracic drainage and pathology Ⅰ, Ⅱ period (P>0.05). Postoperative drainage tube time, postoperative hospital stay, postoperative pain in the observation group were better than those in the control group (P<0.05). But postoperative drainage time in the observation group was longer than that in the control group (P<0.05). Also, the total hospital costs, especially on the use of expensive consumables, during surgery in the observation group was higher. And there was a higher risk of delayed incision healing or airway injury (P<0.05) in the observation group. One death in the control group during perioperative period occurred. Conclusion Uniportal VATS operation applied in radical operation for lung cancer is safe and feasible. It accelerates postoperative turnover, reduces postoperative pain. But there is a higher risk for airway injury or delayed wound healing, and an increase in use of medical consumptive stuff.
Objective To identify the short ( lt;30 days) and intermediate ( 30 days to 6 months) benefits and risks of tracheobronchial stents in patients with malignant airway stenosis. Methods 55 cases with malignant airway disease who underwent tracheobronchial stents placement from January 2006 to May 2008 were followed up for 6 months. The efficacy rate, complication rate, reintervention rate, and survival were analyzed. Results There were 61 self-expanding metal stents placed in 55 patients with malignant disease, with no intraoperative mortality. The immediate efficacy rate was 100% , the short-term( lt;30 days) efficacy rate was 94. 5% , and the survival rate in 6 months was 32. 7% . The complications included tumor ingrowth, excessive granulation tissue, stent migration, and restenosis. A total of 14 cases of complicationswere observed, in which two occurred during the short-term period ( lt; 30 days ) and the remaining complications occurred after 30 days. Conclusions Tracheobronchial stents can improve symptoms immediately for the patients with unresectable malignant central airway obstruction with fairly safety. The benefit of airway stents is particularly seen in the short-termperiod and the complications occur mainly after 30 days.
Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2022 edition) has been published this year. The 2022 edition has been updated in the aspects of lung cancer screening, pathology, standards of thoracic surgery, treatment of metastatic lung cancer. In this study, we tried to introduce those updated aspects in the guideline of 2022 edition.
Objective To explore the incidence and severity of symptoms of the lung cancer patients undergoing concurrent chemoradiation therapy, and reveal the influence of symptom clusters on the patients’ daily activities. Method From December 2016 to June 2017, a total of 150 patients with lung cancer who underwent concurrent chemoradiation therapy were investigated by using M. D. Anderson Symptom Inventory of Chinese Version and the revised lung cancer module. Results For the patients during the period of concurrent chemoradiation therapy, the symptoms with severity score >5 were fatigue, nausea, poor appetite, cough, distress, disturbed sleep, vomiting, expectoration, and grief; the symptoms with incidence >80% were fatigue, nausea, disturbed sleep, poor appetite, grief, and cough. Joy of life (87.33%), emotion (74.38%), and work (72.67%) were the top three in terms of high incidence of symptom distress. Exploratry factor analysis revealed 4 major symptom clusters, which were fatigue-related symptom cluster, gastrointestinal symptom cluster, emotion symptom cluster, and respiratory symptom cluster. Conclusions During the period of concurrent chemoradiation therapy, lung cancer patients suffer from multiple symptom clusters. Medical staff should assess symptoms timely, and provide effective interventions, to improve the patients’ quality of life.
ObjectiveTo evaluated the effect of the video-assisted thoracoscope surgery(VATS) for non-small cell lung cancer. MethodsWe searched EMbase, PubMed, OVID, Springer Link, Cochrane Library, CNKI, CBMdisc, and VIP to collect randomized controlled trials(RCTs) of VATS versus thoracotomy for non-small cell lung cancer. Each database was searched from establishment to October 2014. Two reviewers independently assessed the quality of the included studies and extracted relevant data, using RevMan5.3 meta-analysis software. ResultsWe finally identified 10 RCTs involving 1 529 patients. There were 453 patients in the VATS group and 1 076 patients in the thoracotomy group. The results of meta-analysis showed that there was no statistical difference in the number of lymph node dissection(P=0.41), operation time(P=0.14), operation bleeding volume(P=0.14), chest tube placement time(P=0.53), operation mortality(P=0.72), and the overall survival rate(P=0.39). While there were statistical differences in thoracic drainage(P=0.04), post-operation hospital stay(P=0.01), and postoperative complications(P=0.0001). ConclusionVATS is safe and effective in the treatment of non-small cell lung cancer.