目的 探讨新辅助化疗联合手术对局部晚期非小细胞肺癌的疗效及生存率影响.方法 收集2010年5月~2014年9月间在本院接受治疗的局部晚期非小细胞肺癌患者100例,将入组患者分为:单纯手术治疗的对照组57例、新辅助化疗联合手术治疗的观察组43例,回顾性分析治疗经过、研究数据.分别于治疗前和治疗后3月,采用酶联免疫吸附法(ELISA)检测血清肿瘤标志物含量,采用放射免疫法检测血清血管新生指标含量.随访2年并记录两组患者的近期生存率.结果 治疗前,两组患者的血清肿瘤标志物含量、血管新生指标含量差异无统计学意义(P>0.05).治疗后3月,观察组血清肿瘤标志物Cyfra21-1、CA125、SCC含量低于对照组,血管新生指标VEGF、HIF-1、VE-cadherin含量低于对照组(P<0.05).观察组术后1年、2年生存率均高于对照组(P<0.05).结论 新辅助化疗联合手术可提高局部晚期非小细胞肺癌患者的近期疗效、降低肿瘤恶性程度,提高患者近期生存率.

BACKGROUND:Pulmonary complications are a major cause of mortality after operation for cancer of the gastric cardia or esophagus. Although the risk involved in gastric cardiectomy or esophagectomy associated with a concurrent major pulmonary operation is expected to be much higher, it has seldom been evaluated on the basis of clinical experience. The aim of this study was to investigate the possibility and feasibility of the gastric cardiectomy or esophagectomy associated with a major pulmonary operation.METHODS:From August 2003 to January 2011, 14 patients underwent concurrent gastric cardiectomy or esophagectomy and a major pulmonary operation in our hospital. This included eight for pulmonary invasion of esophageal carcinoma, and six for synchronous lung tumor. All patients underwent systematic lymph node dissection for cardiac or esophageal cancer. To prevent postoperative complications, the operative approach and dissection procedures for cardiac or esophageal carcinoma were modified according to the associated pulmonary operation and the extent of cancer invasion. All thoracotomies for cardiectomy or esophagectomy were performed on the same side as the major pulmonary operation.RESULTS:All patients underwent a curative operation. There were no deaths or postoperative complications in the six synchronous lung tumor patients. In the eight pulmonary invasion patients, one patient died of respiratory failure 11 days after operation, and postoperative complications developed in four of them, but none was fatal. Six patients were still alive.CONCLUSIONS:Curative gastric cardiectomy or esophagectomy associated with concurrent major pulmonary operation is not contraindicated in patients in good condition. In selected patients, when the operative procedures for cardiectomy or esophagectomy are appropriately modified to minimize the effect of the associated pulmonary operation, the treatment is associated with a low operative morbidity and mortality with an acceptable long-term survival.

【Objective】 Aim of this study was to investigate the expression of Pim-1 kinase in tissue of human lung cancer and its relationship to histological type,grade,differentiation and metastasis.【Methods】 Thirty-eight pathological primary lung cancer specimens and 12 cases of normal lung were observed by using immunohistochemical technique.【Result】 The positive expression of Pim-1 in lung cancer and normal lung was 55.26% and 17.00%,respectively.A significant difference was identified(P 0.05).Compared with those cases in different TNM staging,there was positive correlation.【Conclusion】 The high expression of Pim-1 is closely related with lung cancer,the expression of Pim-1 and TNM staging of lung cancer,tumor size are positively correlated.It is suggested that Pim-1 may be associated with the degree of malignancy and can be a new target point for lung cancer targeted therapy.

Background IIIb-T-4 non-small cell lung cancer (NSCLC) is commonly considered a contraindication to surgery, although chemo-radiotherapy also achieves a poor survival rate. We reviewed our experience with T-4 NSCLC patients who underwent surgery to explore the indications and prognostic factors of surgical treatment of lung cancer invading the left atrium and great vessels.Methods We investigated a cohort of 105 patients, 79 men and 26 women, who underwent surgery from May 1996 to July 2008. Their pathological staging was T4N0-M-2(0). The median age was 59 years, ranging from 36 to 75 years. Patients were grouped based on invading sites: tumors invading the left atrium (LA group), tumors invading the superior vena cava (SVC group), and tumors invading the intrapericardial pulmonary artery (PA group). Patients were further characterized based upon the type of operation, complete resection and incomplete resection groups, and on the lymph node pathological status, N-0, N-1 and N-2 groups. We calculated the overall five-year survival rate.Results All patients received resection of primary lesions, with partial resection of the left atrium in the LA group (n=25), angioplasty of superior vena cava in the SVC group (n=23) and intrapericardial ligation of the pulmonary artery in the PA group (n=57). Complete resection was possible in 77 patients (73.3%). The overall survival rate of the 105 patients was 41.0% at 5 years; 36.0% for the LA group, 34.8% for the SVC group and 45.6% for the PA group. Pathological N status significantly influenced the overall 5-year survival rate; 61.5% for N-0, 51.1% for the N-1 and 11.8% for the N-2 groups (N-2 group versus N-0 group, P < 0.0001, N-2 versus N-1 group, P < 0.0001). Surgical resection also influenced survival; 49.4% for the complete resection group and 17.9% for the incomplete resection group (P < 0.0001). Cox regression analysis demonstrated that pathological N status was a significant independent predictor of prognosis.Conclusions Pathological N status is a significant independent predictor for survival of patients with IIIb-T-4 lung cancer invading the left atrium and great vessels. The completeness of resection has a significant influence on the overall 5-year survival rate. Surgery for T-4 lung cancer may be effective in patients without mediastinal lymph node involvement. Chin Med J 2010;123(3)265-268

OBJECTIVE:To explore the clinical features and surgical treatment of thoracic Castleman's disease.METHODS:The clinical symptoms, pathological, laboratory, CT findings and results of surgery in 32 patients with Castleman's disease from June 1996 to November 2008 were evaluated. Among the 32 patients, there were 14 male and 18 female, aged from 16 to 48 years old with a mean age of 34.2 years old. Thirteen cases had symptoms including short of breath, irritable cough, or chest pain, while 14 cases had no symptoms. Mediastinal or hilar tumors were found by CT examination.RESULTS:Tumor was surgically removed in all the 32 patients except one died with anesthetic accident. Castleman's disease was conformed by pathology. Five cases were diagnosed as with paraneoplastic pemphigus, 3 of them were attacked by bronchiolitis obliterans. All 5 cases were failed by the use of prednisone. The signs of PNP were dissolved after operation, but pulmonary lesions failed to improve. There was no recurrence in all cases.CONCLUSIONS:PNP and lung abnormalities are the rare and severe complications of thoracic Castleman's disease. Surgical resection of the tumor is the first choice for treatment.

Castleman病又称巨大淋巴结增生症或血管滤泡性淋巴结增生症,临床上绝大多数患者表现为无症状的局限性淋巴结肿大,手术切除肿瘤预后良好.但此病伴有副肿瘤性天疱疮(paraneoplastic pemphigus,PNP)者临床罕见,由于此类患者常以典型类天疱疮皮肤损害改变为首发和主要临床表现而贻误诊治,或因合并肺部损害而预后不良,故应引起临床医生的高度重视.北京大学第一医院自1999年确诊并成功治疗我国首例PNP以来,至今共收治胸部局限性Castleman病伴PNP的患者8例,现将其临床资料报道如下。

【Objective】To investigate the effects of lung protective strategy on lung function of patients after lung resection.【Methods】50 patients undergoing elective lung resection were randomly assigned to a trial group and a contrast group.The trial group received lung protective strategy:tidal volume of 5～6 mL/kg(predicted body weight,PBW) and FiO2 of 0.4～0.7 during one lung ventilation;mean infusion rate was maintained at 2.0～3.0 mL/kg·h(measured body weight,MBW) besides blood loss displaced.Ventilation and fluid input in contrast group were not restricted.Forced expiratory volume in one second(FEV 1.0),peak expiratory flow(PEF) and arterial blood gas were measured preoperatively and postoperatively at days 1,3,and 5.Oxygen tension-based indices(OI) were recorded.【Results】Patients who received lung protective strategy had significant higher level of FEV 1.0(P =0.002),PEF(P =0.004) and OI(P =0.002).【Conclusions】Lung protective strategy could improve lung function and OI of patients after lung resection,resulted in better postoperative recovery.

AIM:To observe the inhibitive effect of celecoxib,a selective inhibitor of cyclooxygenase-2(COX-2),in vitro and in vivo,on the proliferation of A549 cell line.METHODS:Antiproliferative effect was detected by MTT assay and flow cytometry was used to analyze the effect of celecoxib on cell cycles.Nude mice bearing lung cancer xenografts were treated with celecoxib and then the weight of implanted tumors was measured.The apoptotic cells in implanted tumors were stained by terminal deoxynucleotidyl transferasemediated dUTP nick-end labeling(TUNEL)technique.RESULTS:Celecoxib inhibited the cell proliferation of lung cancer cells in a dose-dependent manner and IC50 was 50 μmol/L.Celecoxib induced the cycle arrest at G0/G1 stage,inhibiting the transition of G1 cells to S phrase.The average weight of tumor nodules in control group was(2.16±0.98)g,while in the experimental group the average weight was(0.98±0.51)g,with the inhibitive rate of 54.6%(P<0.05).Apoptosis of tumor cells showed that apoptotic index(AI)was 1.6±0.6 in the control group and 9.5±2.5 in the experimental group,with significant differences(P<0.05).CONCLUSION:Celecoxib may exert its suppressive effect in vitro and in vivo on the proliferation of A549 cell line by inducing cell cycle arrest at G0/G1 stage of A549 cell and apoptosis of the tumor cells.

OBJECTIVE:To explore the clinical manifestations and treatment of pulmonary sequestration.METHODS:Thirty-five patients with pulmonary sequestration confirmed by pathological studies were analyzed.RESULTS:Among these patients, 29 were of intralobar type and 6 of extralobar type. All patients of intralobar type had symptoms of cough, expectoration, fever and hemoptysis while 6 cases of extralobar type were asymptomatic. Twenty-three cases were diagnosed preoperatively by enhanced CT scan, CT angiography or selective arteriography. Success of operation had been achieved in all cases.CONCLUSION:The clinical manifestations of pulmonary sequestration are non-specific. Though invasive, selective arteriography plays a decisive role in the diagnosis. Such non-invasive angiographies as enhanced CT scan and CT angiography have become important supplements to it. Once the diagnosis is confirmed, operation should be performed.

Objective To study the value of video-assisted minithoracotomy (VAMT) in treatment of unsymmetrical severe emphysema with extensive pleural adhesion. Methods From January 2002 to November 2002,11 patients of unsymmetrical severe emphysema with extensive pleural adhesion underwent lung volume reduction surgery (LVRS) with video-assisted minithoracotomy. Result There was no perioperative death. Persistent air-leak occurred in 8 cases (72.7%). All the paitients left hospital in 7~67 days after operation. When leaving hospital,the respiratory difficulty index decreased from Ⅳ to 0~Ⅱ. Analysis showed that PaO2 increased and PaCO2 decreased (P 0.01). Conclusion LVRS with VAMT in treatment of severe emphysema with extensive pleural adhesion is effective and safe.

[Objective] To investigate the RNA interference-mediated inhibition of survivin gene on the proliferation and chemosensitivity to cisplatin of EC109 cells in vitro. [Methods] siRNA-survivin eukaryotic expression vector was constructed to transfect EC109 cells which were furtherly screened and evaluated to select stable cell clones. Meanwhile, empty vector and non-specific siRNA vector transfection were prepared as controls. Proliferation in vitro of all groups of cells were measured and their sensitivity to cisplatin, a chemotherapy drug, compared by means of MTT assay. Cell cycles of all groups of cells were detected by flow cytometer. [Results] Proliferation in vitro of siRNA-survivin transfected EC109 cells was suppressed. Cisplatin with different density can inhibit the proliferation of all groups of cells in a dose-dependent manner. IC50 of siRNA-survivin transfected EC109 cells was 1.0188 μg/mL, lower than that of control groups with a marked difference (P 0.05). Cell cycle of the experimental group was obviously blocked in G0/G1 phase (P 0.05), and the proportion of S period of this group was also lower than that of control groups (P 0.05). [Conclusions] RNAi-mediated survivin gene can inhibit proliferation in vitro of human esophageal cancer EC109 cells, and improve the sensitivity of cells to cisplatin, a chemotherapy drug. Induction of G0/G1 cell cycle arrest might be its important mechanism.

OBJECTIVE:To compare video-assisted thoracis surgery (VATS) and mini-incision thoracotomy for the treatment of benign esophageal diseases.METHODS:The clinical data of 52 patients with benign esophageal diseases underwent minimally invasive surgical treatment from January 1995 to January 2007 were analyzed retrospectively. VATS were performed in 25 cases and mini-incision thoracotomy were performed in 27 cases.RESULTS:There was no operative death or major perioperative complications in both groups. There were no significant difference between them according to operation time, postoperative thoracic drainage time, postoperative gastric drainage time and postoperative hospital stay time.CONCLUSIONS:For the treatment of benign esophageal diseases, both VATS and mini-incision thoracotomy are safe and effective. VATS can be performed in suitable cases with more minimal incision and decreased operative trauma, mini-incision thoracotomy can be performed in almost all cases, preferring the sophisticated cases.

[Objective] To retrospectively analyze and compare the impacts on stage IIIa NSCLC patients′ survival time of non-surgical, single surgical treatment, and post-operative adjuvant treatment, and to simplistically analyze factors that may impact the prognosis of stage IIIa NSCLC. [Methods] Following relevant criteria, 87 stage IIIa NSCLC patients were selected from 856 patients who received in-patient treatments at the Department of Thoracic Surgery of the Peking University First Hospital from 1/1/1997 to 12/31/2004. Then patients′ post-operative treatment information, survival time, and quality of living from 50 patients were available and the percentage of availability was 57.48%. For these patients, Post-operative 1, 3, and 5 year-survival rates were summarized by using SPSS (version 10.0); Patients who received surgery were further classified into those who received just surgery and those who also received post-operative adjuvant treatment which were differentiated by the Kaplan-Meier approach; The survival curves of the only-surgery and non-surgical group were also compared. [Results] The 1, 3, 5-year survival rates of the selected patients were 80.49%,34.62%, and 29.67%; Statistically significant result was not obtained from the comparison between the survival curves of the only-surgery and post-operative adjuvant treatment group (P =0.0722) while the small p-value may indicate higher survival rates of patients who received post-operative adjuvant treatment; Patients who received single surgery treatment had higher survival rates than those who didn′t receive surgery and the different is statistically significant (P =0.0073). [Conclusions] Surgery is the basic treatment for stage IIIa NSCLC which could be surgically removed; It′s likely that post-operative adjuvant treatment could increase the survival rates of patients with surgically removable stage IIIa NSCLC.

[Objective] To find out the time course and the independent risk factors of hypoxemia after lung resection.[Methods] 112 consecutive patients who underwent selected lung resection were studied by continuous pulse oximetry(SpO2) measurement,while perioperative data was collected and analysed by a multi-factors logistic regression test.[Result] Hypoxemia after lung resection had a very high incidence of 50%;in the first day after surgery,hypoxemia occurred most seriously,but it recovered soon,especially from the postoperative 3rd day to the 5th day.And to the 7th day,87.5% of the patients had recovered their SpO2 above 94%.Four independent risk factors for hypoxemia after lung resection were identified:old age,overweight,the higher average Prince Henry pain scale scores and systematic mediastinal lymphnode dissection.[Conclusion] The incidence of hypoxemia is high after lung resection,and the time course of hypoxemia indicated some characteristics.Old age,overweight,the higher average Prince Henry pain scale scores and systematic mediastinal lymphnode dissection were the independent risk factors of hypoxemia after lung resection.

Objective To investigate the expression of survivin and its subcellular localization in non-small cell lung cancer, as well as its relationship with p53, CD44 and lymph node metastasis. Methods The expressions of survivin, p53 and CD44 were assessed by immunohistochemical staining in postoperative samples from 28 patients with the diagnosis of non-small cell lung cancer. The data was analyzed with SPSS software. Results Survivin positive rate was 60.7%(17/28), with single plasma positive accounting for 25.0%(7/28), single nuclear positive accounting for 10.7%(3/28), both plasma and nuclear positive accounting for 25.0%(7/28), and the overall nuclear positive rate was 35.7%(10/28). The mean score of survivin was 2.00±2.92, which differed from that of normal tissue (scored 0.10±0.32). p53, CD44 and lymph node metastasis rate in survivin positive group had no difference compared with that in negative one (P>0.05); while in nuclear positive group, the positive rate of p53 was significantly higher than that in nuclear negative one (P<0.005). Conclusion The expression of survivin was up-regulated in non-small cell lung cancer, which may collaborate with p53 in the development of non-small cell lung cancer.

[Objective] To construct the recombinant plasmid vector containing human survivin-1,and transfect it into A549 cells.[Methods] Full length survivin-1 cDNA was obtained from A549 by RT-PCR.The PCR product was double-digested with restriction endonucleases BamHⅠand XhoⅠ,and inserted orientationally into pcDNA3.0.The plasmid of pcDNA-svv-1 was reproduced,and the fragment containing survivin-1 was reclaimed and transfected into E.coli JM109.After having been screened,the extracted plasmid containing surviving-1was transfected into A549 cells with liposome,and the expression of surviving-1 was proved by Western blot analysis and immunohistochemistry.[Results] The recombined plasmid pcDNA-survivin-1 was constructed successfully and expressed in adenocarcinoma A549 cells was observed by Western boltting.[Conclusion] A recombinant plasmid vector containing human surviving-1 was constructed successfully,and the survivin-1 protein was expressed highly in A549 cells.

目的探讨外科治疗支气管源性囊肿的必要性和方法.方法对20例支气管源性囊肿患者的临床资料进行回顾分析.结果手术标本均经病理证实为支气管源性囊肿,有症状者术后症状均得到缓解.术后并发症包括胸腔包裹性积液、低热等,无手术死亡病例.结论支气管源性囊肿临床表现多样,且有恶变可能,术前确诊有一定困难,因此我们提倡积极手术治疗.