BACKGROUND:Breast cancer is notorious for its increasing incidence for decades. Ascending evidence has demonstrated that translocase of inner mitochondrial membrane (TIMM) proteins play vital roles in progression of several types of human cancer. However, the biological behaviors and molecular mechanisms of TIMM8A in breast cancer remain not fully illustrated.METHODS:Pan-cancer analysis was firstly performed for TIMM8A's expression and prognosis by Oncomine database. Subsequently, TIMM8A-related noncoding RNAs (ncRNAs) were identified by a series of bioinformatics analyses and dual-luciferase reporter assay, including expression analysis, correlation analysis, and survival analysis. Moreover, the effect of TIMM8A on breast cancer proliferation and apoptosis was evaluated in vitro by CCK-8 assays, EdU cell proliferation assays, JC-1 mitochondrial membrane potential detection assays and Western blot assays and the in vivo effect was revealed through a patient-derived xenograft mouse model.RESULTS:We found that TIMM8A showed higher expression level in breast cancer and the higher TIMM8A mRNA expression group had a poorer prognosis than the lower TIMM8A group. hsa-circ-0107314/hsa-circ-0021867/hsa-circ-0122013 might be the three most potential upstream circRNAs of hsa-miR-34c-5p/hsa-miR-449a-TIMM8A axis in breast cancer. TIMM8A promotes proliferation of breast cancer cells in vitro and tumor growth in vivo.CONCLUSION:Our results confirmed that ncRNAs-mediated upregulation of TIMM8A correlated with poor prognosis and act as an oncogene in breast cancer.

Background Icotinib has provided survival benefits for patients with advanced, epidermal growth factor receptor (EGFR)-mutant non-small-cell lung cancer (NSCLC). We aimed to compare icotinib with chemotherapy in patients with EGFR-mutant stage II-IIIA NSCLC after complete tumour resection. Here, we report the results from the preplanned interim analysis of the study. Methods In this multicentre, randomised, open-label, phase 3 trial done at 29 hospitals in China, eligible patients were aged 18-70 years, had histopathogically confirmed stage II-IIIA NSCLC, had complete resection up to 8 weeks before random assignment, were treatment-naive, and had confirmed activation mutation in exon 19 or exon 21 of the EGFR gene. Participants were randomly assigned (1:1) with an interactive web-based response system to receive either oral icotinib 125 mg thrice daily for 2 years or four 21-day cycles of intravenous chemotherapy (vinorelbine 25 mg/m(2) on days 1 and 8 of each cycle plus cisplatin 75 mg/m(2) on day 1 of each cycle for adenocarcinoma or squamous carcinoma; or pemetrexed 500 mg/m(2) plus cisplatin 75 mg/m(2) on day 1 every 3 weeks for non-squamous carcinoma). The primary endpoint was disease-free survival assessed in the full analysis set. Secondary endpoints were overall survival assessed in the full analysis set and safety assessed in all participants who received study drug. This trial is registered with ClinicalTrials.gov, NCT02448797. Findings Between June 8, 2015, and August 2, 2019, 322 patients were randomly assigned to icotinib (n=161) or chemotherapy (n=161); the full analysis set included 151 patients in the icotinib group and 132 in the chemotherapy group. Median follow-up in the full analysis set was 24.9 months (IQR 16.6-36.4). 40 (26%) of 151 patients in the icotinib group and 58 (44%) of 132 patients in the chemotherapy group had disease relapse or death. Median disease-free survival was 47.0 months (95% CI 36.4-not reached) in the icotinib group and 22.1 months (16.8-30.4) in the chemotherapy group (stratified hazard ratio [HR] 0.36 [95% CI 0.24-0.55]; p<0.0001). 3-year disease-free survival was 63.9% (95% CI 51.8-73.7) in the icotinib group and 32.5% (21.3-44.2) in the chemotherapy group. Overall survival data are immature with 14 (9%) deaths in the icotinib group and 14 (11%) deaths in the chemotherapy. The HR for overall survival was 0.91 (95% CI 0.42-1.94) in the full analysis set. Treatment-related serious adverse events occurred in two (1%) of 156 patients in the icotinib group and 19 (14%) of 139 patients in the chemotherapy group. No interstitial pneumonia or treatment-related death was observed in either group. Interpretation Our results suggest that compared with chemotherapy, icotinib significantly improves disease-free survival and has a better tolerability profile in patients with EGFR-mutant stage II-IIIA NSCLC after complete tumour resection. Copyright (C) 2021 Elsevier Ltd. All rights reserved.

目的 探讨纵隔镜辅助手术治疗早期食管鳞状细胞癌的远期结局.方法 回顾性分析2005年12月～2014年12月180例早期食管鳞状细胞癌接受纵隔镜辅助食管癌切除术的临床资料,通过无进展生存期(progression-free survival,PFS)和总生存期(overall survival,OS)分析患者远期生存情况.结果 均无术后30、90 d内死亡发生.术后并发症发生率30.6％(55/180),按发生率由高到低分别为吻合口漏15.6％(28/180),肺不张7.8％(14/180),肺部感染5.0％(9/180),声带麻痹2.8％(5/180),切口裂开2.2％(4/180),肠梗阻1.1％(2/180),乳糜胸1.1％(2/180),膈疝0.6％(1/180).术后吻合口/残胃复发率10.6％(19/180),术后转移部位前2位分别为淋巴结转移率16.7％(30/180)、肺转移率5.6％(10/180).3年PFS为74.4％,OS为81.1％;5年PFS为70.6％,OS为71.7％.结论 纵隔镜辅助食管癌切除术是治疗早期食管癌的有效手段.

BACKGROUND:Studies in larger populations and long-term outcomes of Mediastinoscopic esophagectomy (ME) were needed. The aim of this study was to report the long-term survival and surgical process for reducing the postoperative complications after ME.METHODS:From December 2005 to March 2018, 269 patients diagnosed with esophageal squamous cell carcinoma were participated for ME in our center, while we improved the surgical process in November 1st 2014, clinical data was collected and analyzed.RESULTS:The overall survival rate after ME was 60.3% at 10-year and 69.2% at 5-year, and the survival curve was markedly associated with T and N stages. N2-3 stage resulted in lower survival time, while the median survival was 36 months. After Nov. 2014, the positive rate of lymph nodes around left recurrent laryngeal nerve (LRLN) was increased from 6.7% to 14.5% (P<0.05), and the morbidity of vocal cord paralysis decreased from 9.8% to 3.9% (P<0.05), while the incidence of anastomotic fistula decreased from 15% to 5.3% in ME (P<0.05), compared with the data before Nov. 2014.CONCLUSIONS:ME was an effective surgical method for esophageal cancer. The processes of isolating and marking the LRLN and reinforcing the posterior wall of anastomosis were proved valuable for improvement of postoperative complications.

目的 分析影响食管癌患者手术预后的因素.方法 回顾性分析行手术治疗的胸段食管癌患者197例,均行经右胸食管癌根治术,包括经右胸、上腹正中二切口食管癌切除术(Ivor-Lewis手术)和经左颈、右胸、上腹正中三切口食管癌切除术(McKeown手术).观察手术情况和术后病理诊断以及随访术后生存情况.分析食管鳞癌患者术后预后影响因素.结果 肿瘤位置、肿瘤直径、浸润深度、淋巴结转移、淋巴结转移区域、淋巴结转移率、脉管内瘤栓、细胞分化程度、TNM分期、神经侵犯、术前CRP/白蛋白(Alb)是影响食管癌患者术后预后的因素(P＜0.05).结论 肿瘤位置、肿瘤直径、浸润深度、淋巴结转移、淋巴结转移区域、淋巴结转移率、脉管内瘤栓、细胞分化程度、TNM分期、神经侵犯、术前CRP/Alb是评估食管鳞癌术后预后的重要影响因素.

Background The relationships between coagulation factors and non‐small cell lung cancer (NSCLC) prognosis have been intensively studied. However, no previous study has investigated the combined effects of preoperative platelet (PLT), fibrinogen (FIB), and D‐dimer (D‐D) levels on the prognosis of NSCLC. Methods A multicenter prospective study was conducted over seven hospitals. A total of 395 patients diagnosed with operable NSCLC for the first time were included and followed‐up until disease progression or the end of the study. Baseline demographic and clinicopathological information, and preoperative coagulation test results were collected for each patient. Univariate and multilevel survival analyses were conducted using Cox regression and shared frailty models. Results Multilevel analyses revealed that there was a marginally significant association between elevated PLT level (> 215 × 109/L) and unfavorable progression‐free survival (PFS) (hazard ratio 2.42, P = 0.05), whereas preoperative FIB and D‐D were not significant prognostic factors for PFS (P = 0.31 and 0.30, respectively). Compared to patients with one elevation of the three coagulation factors, patients with at least two elevations of the three factors had a significantly higher risk of cancer progression (hazard ratio 4.62, P = 0.02). Conclusion The number of elevated preoperative coagulation factors may have a significant effect on PFS and could be used to predict the prognosis of NSCLC patients after surgery. Future studies are warranted to further investigate the interactions between these three coagulation factors.

回顾分析2000年1月至2015年12月诊治、病理确诊的5例不典型类癌患者的临床资料。5例中，男2例，女3例，年龄39～76岁；体检发现2例，刺激性干咳2例，胸痛1例，咯血1例，痰中带血1例，均无类癌综合征表现。血癌胚抗原水平偏高1例；CT 检查均提示占位病变；痰细胞学检查均阴性；4例行纤维支气管镜检查阳性。均行手术治疗，2例辅以化疗。术后随访24～58个月，1例术后1年发现前列腺癌骨转移，带瘤生存，4例无瘤生存。提示，肺不典型类癌临床少见，术前诊断较为困难，术后病理是确诊的主要方法，手术是治疗肺不典型类癌的有效方法，术后需要长期随访。

目的 总结手术治疗中央型非小细胞肺癌(NSCLC)的临床效果.方法 回顾性分析160例中央型NSCLC患者的临床资料.术前均经纤维支气管镜检查,病理确诊.其中,肿瘤位于主支气管11例,肿瘤侵及叶支气管开口35例.结果 常规肺叶切除术100例,支气管袖状肺叶切除29例,全肺切除31例.术后未发生支气管胸膜瘘的并发症.149例获得随访8～72个月;手术切除病例的1年生存率86.8％,3年生存率45.8％,5年生存率24.5％.结论 手术是治疗中央型NSCLC的主要手段.手术方式应依据支气管受肿瘤侵及的程度和患者肺功能情况选择常规肺叶切除、袖状肺叶切除或全肺切除术.

OBJECTIVE The purpose of this study was to detect the feasibility, safety, and effectiveness of mediastinoscopic esophagectomy for early esophageal cancer. METHODS The clinical data of 194 patients who underwent mediastinoscopic esophagectomy for early esophageal cancer in our center from December 2005 to October 2014 were retrospectively analyzed. RESULTS All the surgery was performed successfully. The average duration of thoracic surgery was 48.2±7.8 min and the average intra-operative blood loss was 128.1±34.5 mL. An average of 3.1±1.6 lymph node stations were dissected, with an average number of dissected lymph nodes being 9.38±6.2, among which 4.2±5.4 were mediastinal lymph nodes. No peri-operative mortality was noted, and the rate of peri-operative morbidity was 13.4%. The median duration of follow-up was 39 [3-108] months, and the overall survival was 72.73%. The overall survival rates significantly differed among different T stages; more specifically, the 5-year survival was 95.23% in patients with stage T1a esophageal cancer, 70.15% for T1b, and 55.56% for T2 (P<0.001). The overall survival was significantly better in patients with negative lymph nodes than those with lymph nodes metastasis (P=0.003); more specifically, the 5-year survival rate was 84.9% for N0, 62.5% for N1, and 50.0% for N2 + N3. CONCLUSIONS The mediastinoscopic esophagectomy can achieve a similar effectiveness as the conventional thoracoscopic surgery for patients with early stage esophageal cancer.

OBJECTIVEThe purpose of this study was to explore the indications of radical vedio-assisted mediastinoscopic resection for esophageal cancer.METHODSThe data of 109 patients with T1 esophageal cancer who underwent video-assisted mediastinoscopic resection (VAMS group) in Third Affiliated Hospital of Soochow University Hospital from December 2005 to December 2011 were collected in the study for comparison with the 58 patients with T1 esophageal cancer who underwent video-assisted thoracoscopic surgery (VATS group) in Zhongshan Hospital, Fudan University. The perioperative safety and survival were compared between the two groups.RESULTSAll operations were successful in both groups. One perioperative death was noted in the VATS group. The incidences of post-operative complications were not significantly different between these two groups, whereas the VAMS group was favorable in terms of operative time (P<0.001) and blood loss (P<0.001), and a significantly larger number of chest lymph nodes were dissected in the VATS group compared with the VAMS group (P<0.001). Long-term follow-up showed that the overall survival was not significantly different between these two groups (P=0.876).CONCLUSIONST1N0M0 esophageal cancer can be as the indication of VAMS radical resection. VAMS radical resection can be considered as the preferred option for patients with poor pulmonary and cardiac function or a history of pleural disease.

电视纵隔镜手术(VMS)广泛用于纵隔及肺部疾病治疗,适应证不断扩大[1].2010年3月至2013年5月,我们应用VMS引流治疗7例食管源性纵隔感染患者,现总结经验报道如下. 资料和方法 7例患者中男6例,女1例;年龄49 ～ 65岁,中位年龄57.8岁.食管胃吻合口瘘致纵隔感染5例,食管异物穿孔1例,不能手术切除的晚期食管癌穿孔1例.患者术前胸部CT检查情况见图1～图3.

电视纵隔镜下食管癌切除术的安全性及近期效果已报道[1-2],然而其远期预后尚无相关报道.现回顾性分析2006 ～ 2009年我院采用纵隔镜技术施行的70例食道癌切除术的长期预后情况. 资料和方法 本组中男46例,女24例;年龄48～83岁,中位数55.5岁,平均64.7岁.所有患者均接受详细的病史询问及全面体格检查,术前均经胃镜病理证实为食管癌,并常规行颈、胸、腹增强CT以及其他检查排除远处转移,其中有10例接受了PET-CT检查.接受新辅助化、放疗以及术前检查有远处转移的患者排除在外.手术采用左胸锁乳突肌前缘切口及上腹正中切口,以纵隔镜游离食管,上腹正中切口游离胃,食管胃左颈部手工吻合的术式[3].

OBJECTIVES Transthoracic oesophagectomy is associated with high morbidity and mortality. Some oesophageal cancer (OC) patients with serious comorbidities cannot tolerate transthoracic oesophagectomy. Therefore, we have adopted a minimally invasive approach to oesophagectomy for such patients. METHODS Eighty-five OC patients, who could not tolerate transthoracic oesophagectomy, received mediastinoscopy-assisted oesophagectomy (MAO) from January 2007 to January 2010 in our hospital. Seventy patients were confirmed to be in T1 stage by postoperative pathological diagnosis, and their complications and outcomes were retrospectively analysed in this study. The impact of invasion depth, tumour length and lymph node metastases on the 5-year survival rate of these patients was also analysed. RESULTS The operation time was 150.0 ± 15.0 min, and the perioperative bleeding volume was 202.0 ± 12.8 ml. Some patients had anastomotic leakage (5 cases), pneumonia (4 cases) and chylothorax (1 case). No patient died during hospitalization. The median postoperative hospital stay was 10 (7-22) days. The number of lymph nodes resected was 13.8 ± 4.4. The overall 5-year survival rate was 71%. Kaplan-Meier estimates revealed that tumour length (<2 vs ≥ 2 cm), lymph node metastasis (N0 vs N1) and depth of invasion (T1a vs T1b) could influence the 5-year survival rate (P <0.05). Multivariate analysis by Cox regression showed that lymph node metastasis and tumour length were independent prognostic factors for the 5-year survival rate (P <0.05). CONCLUSIONS MAO could be performed for T1 OC patients with serious comorbidities who cannot tolerate transthoracic oesophagectomy. Lymph node metastasis and tumour length were independent prognostic factors for these patients.

我们采用电视纵隔镜技术为47例早期食管癌患者进行了经纵隔径路食管切除手术.现将本组病例治疗经验总结报道如下. 资料和方法 2004年2月至2007年2月,在常州市第一人民医院接受治疗的早期食管癌患者中随机选择83例,入选标准:(1)通过胃镜确诊为食管鳞癌.(2)术前检查胸部增强CT及上腹部B超检查无明显转移.(3)术前经食管超声内镜(EUS)检查纵隔无明显肿大淋巴结,且食管癌浸润不超过T2.排除标准:(1)既往有颈椎疾病史,头颈不能后仰者.(2)有明确心肌梗死、脑梗死、肺梗塞病史.(3)胸部CT或超声内镜示纵隔淋巴结肿大超过1 cm.

Objective To investigate methylation of p16 gene in non-small cell lung cancer (NSCLC), and analyze the correlation between it and clinical and pathological data. Methods Specimens were taken from 61 NSCLC patients pathological conifrmed after surgical resection. Fresh tumor samples matched with corresponding adjacent normal tissue were taken during operation and frozen preserved. After extraction and Bisulifte treatment of DNA from the frozen tissues, we examined the methylation of p16 gene in NSCLC tissues and corresponding paracancerous tissues by using methylation-speciifc PCR (MSP) method. Then the result of experiment was ana-lyzed statistically combined with clinical and pathological data. Results The positive rate of the methylation of p16 gene was respectively 11.48%(7/61) in lung cancer tissues and 1.64%(1/61) in paracancerous tissues (P>0.05). No signiifcant difference was found in the methylation of p16 gene according to different pathologic classi-ifcation, differentiation of cancer, TNM stage, the extent of metastasis of lymph node and smoking index (P>0.05). Conclusion The methylation of p16 gene existed in NSCLC tissues.

目的分析纵隔镜辅助食管癌切除手术的术后并发症。方法回顾性分析128例纵隔镜辅助食管癌切除手术资料,探讨术中、术后并发症的原因、处理方法和结果。结果术中因出血中转开胸2例;气管损伤1例。术后发现喉返神经损伤4例;乳糜纵隔2例;纵隔血肿3例;血胸4例;吻合口瘘7例;呼吸衰竭2例;心律失常12例。结论纵隔镜辅助食管癌切除手术创伤小,术中、术后并发症较常规手术少。

<正>1临床资料例1,女,64岁。2006年初行左径食管癌切除术,早期恢复尚可,但1个月后出现剧烈咳嗽,无法平卧,并咳出消化液,诊断为食管气管瘘。禁食、抗炎、支持治疗2周后,病情未见好转,且体质愈来愈差。在气管镜、X线透视双重支持下在气管内放置覆膜支架(镜下见瘘口位于左主支气管),病情迅速好转,2周后痊愈出院。例2,男,65岁。2006年7月行右径食管癌

目的:探讨全电视胸腔镜(video-assisted thoraeic surgery,VATS)手术治疗早期肺癌行肺叶切除的安全性和早期疗效。方法:连续完成全电视胸腔镜肺叶切除36例中原发周围性肺癌30例,良性肿瘤6例。胸腔镜观察孔位于腋中线第7或第8肋间,第一操作孔(主操作孔)位于腋前第4肋间6cm(上、中叶)或第5肋间(下叶)、第二操作孔肩胛旁第6肋间1.5cm;不用胸撑开器。施行右肺上叶切除11例,右肺中叶切除5例,右肺下叶切除6例,左肺上叶切除6例,左肺下叶切除8例。恶性肿瘤同时施行标准淋巴结清扫。结果:2例患者术中出血施加小切口后完成手术。术后发生并发症2例,其中声音嘶哑1例,1个月后好转,肺不张1例,气管镜吸痰后好转;无二次手术,无围手术期死亡。随访1～17个月,1例T1N2M0术后11个月发生远处转移。结论:全电视胸腔镜(手术治疗早期肺癌行肺叶切除,手术创伤小、术中出血少、术后疼痛轻、恢复快,安全。

回顾我院2006～2009年住院手术并术后病理证实为非小细胞肺癌(NSCLC)患者,按照是否合并慢性阻塞性肺病(COPD)分为两组临床资料,进行临床特征分析和总结.

Objective To investigate the value of video-mediastinal endoscopy in the resection of esophageal cancer at the early stage.Methods From October 2005 to February 2009,89 patients with esophageal cancer underwent video-mediastinal endoscopic resection of esophageal cancer in our hospital.We isolated the esophageal by video-mediastinoscopy and then the stomach through an abdominal incision,afterwards the esophageal and gastric stump was anastomosed through the neck incision.ResultsExcept for one case who was converted to open surgery because of massive hemorrhage,video-mediastinal endoscopy was completed in all the patients.No patient died during perioperative period.Follow-up was achieved in 86 cases for 1 to 38 months(<6 months in 16 cases,7-12 months in 9 cases,13-18 months in 21 cases,and >24 months in 40 cases)with a median of 17 months.During the period,8 cases died,the mean survival time of this series was 17.8 months(8-29 months).Of the 8 death,5 died of recurrent tumor,and the other 3 died of unknown reasons.Conclusions Video-mediastinal endoscopic resection is safe and effective for esophageal cancer especially for patients with early stage esophageal cancer complicated with cardiovascular or pulmonary diseases.