ObjectiveTo explore the risk factors for lymph node metastasis in patients with T2 stage non-small cell lung cancer.MethodsThe clinical data of 271 patients with non-small cell lung cancer who underwent surgical treatment in our hospital from 2014 to 2017 were collected, including 179 males and 92 females, with an average age of 62.73±0.58 years. The patients were divided into N0, N1, and N2 groups according to the lymph node metastasis status. The clinical data of the patients in different groups were compared.ResultsThe body mass index (BMI, P=0.043), preoperative lymph node enlargement (P<0.001), and tumor diameter (P<0.001) were significantly different among groups. The BMI (OR=1.131, 95%CI 1.001-1.277, P=0.048) and preoperative lymph node enlargement (OR=3.498, 95%CI 1.666-7.342, P=0.001) were independent risk factors for N2 lymph node metastasis, and tumor diameter was an independent risk factor for both N1 (OR=1.538, 95%CI 1.067-2.218, P=0.021) and N2 (OR=1.814, 95%CI 1.196-2.752, P=0.005) lymph node metastasis.ConclusionPatients with high BMI or enlarged lymph nodes before surgery have a high risk for N2 lymph node metastasis, and those with large tumor diameter have a high risk for both N1 and N2 lymph node metastasis.
Abstract： Objective To evaluate the safety, feasibility, and clinical outcome of complete video-assisted thoracoscopic surgery （VATS） lobectomy for patients with early-stage non-small cell lung cancer （NSCLC）. Methods We retrospectively analyzed the clinical data of 160 consecutive patients（the VATS group, 83 males and 77 females with average age at 60.8 years）with early-stage NSCLC who underwent complete VATS lobectomy between January 2005 andDecember 2008 in Zhongshan Hospital of Fudan University，and compared them with 357 patients（the thoracotomy group, 222 males and 135 females with average age at 59.5 years）who underwent open thoracotomy in the same period. Results The conversion rate of the VATS group was 5.0%（8/160）. The operation time of the VATS group was significantly shorter than that of the thoracotomy group（113.0 min vs.125.0 min, P=0.039）. Length of postoperative hospital stay was not statistically different between the two groups（10.3±4.3 d vs.9.1±4.6 d，P=0.425）. The postoperative morbidity of the VATS lobectomy group and the thoracotomy group was 9.4%（15/160）and 10.1% （36/357） respectively，and the postoperative mortality of the two groups was 0.6%（1/160）and 2.0%（7/357）respectively. There was no statistical difference in the mean group of lymph node dissection （2.4±1.5 groups vs.2.4±1.7 groups，P=0.743） and the mean number of lymph node dissection （9.8±6.3 vs.10.1±6.4，P=0.626） between the two groups. The overall 5-year survival rate of the VATS group was significantly higher than that of the thoracotomy group （81.5% vs.67.8%, P=0.001）. Subgroup analysis showed that the 5-year survival rate of pⅠa stage, pⅠb stage, and pⅢa stage was 86.0%, 84.5%, and 58.8% respectively in the VATS group, and 92.9%, 76.4%, and 25.3% respectively in the thoracotomy group. Conclusion Complete VATS lobectomy is technically safe and feasible for patients with early-stage NSCLC. The lymph node dissection extension of complete VATS lobectomy is similar to that of open thoracotomy, and long-term outcome of complete VATS lobectomy is superior to that of open thoracotomy. Randomized controlled trials of large sample size are further needed to demonstrate superiority.
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.
ObjectiveTo investigate the effect of perioperative allogeneic blood transfusion on the prognosis of patients with non-small cell lung cancer (NSCLC).MethodsThe databases including PubMed, The Cochrane Library, EMbase, CNKI, Wanfang Data, VIP and CBM were searched for literature about the effects of perioperative allogeneic blood transfusion on the prognosis of patients with NSCLC from the inception to May 2020. Two authors independently screened the literature, extracted and cross-checked data, and negotiated to resolve differences in opinions. Review Manager V5.3 (Cochrane Collaboration, Oxford, UK) software was used for data analysis.ResultsA total of 15 articles were included, including 5 897 patients. There were 1 649 patients in the trial group and 4 248 patients in the control group. The results of meta-analysis showed that the overall survival of the control group was significantly higher than that of the trial group (OR=0.58, 95%CI 0.47-0.70, P<0.000 01). The disease-free survival of the control group was significantly higher than that of the trial group (OR=0.43, 95%CI 0.36-0.52, P<0.000 01). The recurrence rate of the control group was significantly lower than that of the trial group (OR=1.85, 95%CI 1.34-2.55, P=0.000 2).ConclusionPerioperative allogeneic blood transfusion has adverse effects on the recurrence and survival of patients with NSCLC.
ObjectiveTo systematically review the prediction models of blood-based biomarkers for non-small cell lung cancer (NSCLC). MethodsThe PubMed, Embase, Cochrane Library, Web of Science, VIP, WanFang Data and CNKI databases were electronically searched to collect studies related to the objectives from inception to June, 2023. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.4.1 software. ResultsA total of 8 studies were included and all of them were retrospective cohort studies. The models were internally validated in 2 studies and externally validated in 4 studies. The performances of the eight predictive models were stable, which was measured by the area under the curve of receiver operating characteristic curve lying between 0.664 and 0.783. However, the risk of bias was high, which may mainly be reflected in data processing, model validation and performance adjustment. Meta-analysis showed that LDH (HR=1.86, 95%CI 41.32 to 2.63, P<0.01), dNLR (HR=2.15, 95%CI 1.56 to 2.96, P<0.01) and NLR (HR=1.71, 95%CI 1.08 to 2.69, P=0.02) were independent factors of prognosis for NSCLC patients. Conclusion Current evidence shows that the NSCLC prediction models based on peripheral blood biomarkers are still in the development stage, and the models have a high risk of bias.
Objective To explore the safety and feasibility of preferential manual bronchoplasty in single-port video-assisted thoracoscopic surgery (VATS) upper lobectomy. MethodsThe clinical data of 457 patients with non-small cell lung cancer who underwent single-port VATS lobectomy in the Department of Thoracic Surgery of Peking University First Hospital from March 2020 to March 2022 were retrospectively analyzed. The patients were divided into a preferential manual bronchoplasty group and a traditional single-port VATS lobectomy group with a 1 : 1 propensity score matching for further research. Results A total of 204 patients were matched, and there were 102 patients in each group. There were 50 males and 52 females aged 62.2±10.1 years in the preferential bronchoplasty group, and 49 males and 53 females aged 61.2±10.7 years in the traditional single-port VATS group. The preferential bronchoplasty group had shorter surgical time (154.4±37.0 min vs. 221.2±68.9 min, P<0.01), less bleeding (66.5±116.9 mL vs. 288.6±754.5 mL, P=0.02), more lymph node dissection (19.8±7.5 vs. 15.2±4.7, P<0.01), and a lower conversion rate to multi-port or open surgery (2.3% vs. 13.8%, P=0.04) in left upper lobe resection. In the right upper lobe resection surgery, there was no statistical difference in postoperative results between two groups. There was no perioperative death or occurrence of bronchopleural fistula in both groups. ConclusionCompared with traditional single-port VATS upper lobectomy, preferential bronchoplasty has similar safety and feasibility. In addition, priority bronchoplasty in left upper lobectomy has the advantages of shorter surgical time, less bleeding, more lymph node dissection, and lower conversion rate to multi-port or open surgery.
ObjectiveTo systematically review the economic evaluations of anaplastic lymphoma kinase (ALK)-tyrosine kinase inhibitors (TKIs) in the treatment of ALK-positive non-small cell lung cancer (NSCLC). MethodsPubMed, Web of Science, The Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect economic evaluations of ALK-TKIs in the treatment of ALK-positive NSCLC from inception to July 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, a systematic review was performed. ResultsA total of 20 studies were included. 18 of the included studies were cost-utility analyses based on the models. The method of survival data extrapolation involved the standard parameter model and the standard parameter model with a hazard ratio adjusting. 10 studies considered or included the disutility value of adverse events. 18 studies performed cost estimation on direct costs. In China, 45% of the included studies were first-line treatment, the results showed that ALK-TKIs were less economical than chemotherapy, and second-/third-generation ALK-TKIs were less economical than crizotinib. Only 1 studies were second-line treatment, the result showed that crizotinib was more economical than chemotherapy. ConclusionThe economic evaluation results of ALK-TKIs in ALK-positive NSCLC vary according to treatment stage and national scenario, and there is also room for optimization of methodological application in this field.
ObjectiveTo evaluate the prognostic significance of visceral pleural invasion in diameter 3-5 cm nonsmall cell lung cancer(NSCLC). MethodsA total of 112 patients who underwent lobectomy and pathologically diagnosed with NSCLC(3-5 cm) were included in our hospital between January 2006 and December 2010.There were 72 males and 40 females at average age of 61(28-72) years. There were 62 patients diagnosed as adenocarcinoma and 44 as squamous cell lung cancer. Viceral pleural invasion(VPI) was identified in 63 patients as a VPI group. The other 49 patients without VPI were as a NVPI group. All patients were performed with lobectomy and mediastinal lymph node dissection. ResultsThere was no perioperative mortality. More smokers were included in the VPI group when compared with the NVPI group(53.9% vs. 28.6%, P=0.007). More squamous cell cancers were included in the VPI group, while more adenocarcinoma were included in the NVPI group with a statistical difference(P=0.003). The average follow-up duration was 52 months. A total of 32 death occurred at the endpoint. The overall survival(OS) of all included patients was 71.4%. The average follow-up duration was 51 months in the VPI group and 54 months in the NVPI group(P=0.441). There was no statistical difference in OS between the VPI group and the NVPI group(61.7% vs. 83.7%, P=0.017). Cox regression showed age less than 65 years(P=0.007), TNM stage(P=0.013), and VPI(P=0.035) were significant prognostic factors for NSCLC. ConclusionWe identified the presence of VPI as an independent poor prognostic factor in NSCLC patients with diameter at 3-5 cm.
Abstract： Objective To analyze the modes and rules of subcarinal lymph node metastasis in non-small cell lung cancer patients， and explore appropriate surgical dissection strategy of subcarinal lymph nodes for patients with non-small cell lung cancer. Methods The clinical data of 608 patients with non-small cell lung cancer who underwent lung resection and systematic lymph node dissection in Henan Cancer Hospital from September 2002 to October 2011 were analyzed retrospectively. There were 388 males and 220 females with an average age of 62.3 （45-78） years. There were 122 patients with left upper lobe tumor， 119 patients with left lower lobe tumor， 158 patients with right upper lobe tumor， 40 patients with right middle lobe tumor and 169 patients with right lower lobe tumor. Subcarinal lymph node metastasis was observed in 118 patients （19.4%）. There were 244 patients with squamous carcinoma， 285 patients with adenocarcinoma and 79 patients with other types of carcinoma. The relationship of subcarinal lymph node metastasis with tumor location， pathological types and clinicopathological characteristics were analyzed. Results There was statistical difference in subcarinal lymph node metastasis rate among different tumor locations （P=0.000）. Subcarinal lymph node metastasis rate was the highest ［45.8% （54/118）］ in patients with right lower lobe tumor. For patients with different pathological types， subcarinal lymph node metastasis rate was the highest ［55.9% （66/118）］ in patients with adenocarcinoma， and then squamous carcinoma （P=0.034）. Subcarinal lymph node metastasis rate increased with the increase in T staging， and patients with tumors located in the middle or lower lobe of the left or right lung had a significantly higher subcarinal lymph node metastasis rate than patients with upper lobe tumor. Conclusion Subcarinal lymph node metastasis rate are lower in patients with left or right upper lobe tumor， patients with squamous carcinoma whose clinical T staging is within cT 1 .
Objective To systematically review the clinical response and partial adverse effects of endostar plus chemotherapy for patients with unresected non small cell lung cancer. Methods The clinical trials of endostar plus chemotherapy for unresected non small cell lung cancers published before March 2, 2010 were searched in The Cochrane Library, Medline, EMbase, Pubmed, CBM, CNKI, VIP and so on. According to the Cochrane handbook for systematic reviews for interventions, the quality of clinical trials was evaluated by two reviewers independently, and the meta-analysis was conducted by using Revman 5.0 software. Results The endostar as an endostatin was developed by our country, so the relevant RCTs were not found in foreign databases. Fourteen studies involving 1 219 patients were included. All studies adopted random method but no blind method was mentioned in detail. The results of meta-analysis indicated that the rate of clinical response and clinical benefit of the endostar plus chemotherapy group was significantly higher than that of the chemotherapy alone group (RR=1.76, 95%CI 1.47 to 2.09; RR=1.43, 95%CI 1.10 to1.86; respectively). The incidence rate of thrombocytopenia was significantly lower of the endostar plus chemotherapy group than that of the chemotherapy alone group (RR=0.77, 95%CI 0.62 to 0.96). The incidence rates of hypoleukemia, anaemia, nausea and vomiting and hepatic and renal function damage were not significantly different between the two groups (RR=0.94, 95%CI 0.83 to 1.06; RR=0.94, 95%CI 0.79 to 1.13; RR=1.04, 95%CI 0.91 to 1.18; RR=0.63, 95%CI 0.25 to 1.60; respectively). Conclusion Endostar plus chemotherapy can improve the rate of clinical response and clinical benefit, and can relieve partial adverse effects of chemotherapy.