Objective To assess clinical efficacy and safety of Oxaliplatin plus Vinorelbine in the treatment of advanced non-small cell lung cancer (NSCLC). Methods We used the methods of Cochrane reviews, electronically searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3, 2008), MEDLINE (1966 to April 2008), EMbase (1984 to Dec. 2006), Cancerlit (1996 to Dec. 2005), CBM (1978 to April 2008), CNKI (1994 to April 2008), VIP (1989 to April 2008), and handsearched 15 Chinese medical core journals, to collect randomized controlled trials (RCTs) of Oxaliplatin combined with Vinorelbine in the treatment of advanced NSCLC. RCTs were included according to the inclusion and exclusion criteria, the quality of included trials was evaluated and RevMan 4.2.8 software was used for metaanalyses after the extraction of the data. Results Seventeen RCTs involving 1 399 patients with advanced NSCLC were included. All of them reported the use of a random method, but with no detailed reports of allocation concealment and whether the blind method was used. The results of meta-analyses showed that NO program (vinorelbine + oxaliplatin) and NP program (vinorelbine + cisplatin) were similar in efficient rate (RR=0.97, 95%CI 0.85 to 1.10) and 1-year survival rate (RR=0.82, 95%CI 0.66 to 1.03). Compared with NP program, NO program induced lower III-IV degree of nausea and vomiting response (RR=0.20, 95%CI 0.14 to 0.28), III-IV degree of leukopenia reaction (RR=0.64, 95%CI 0.52 to 0.79), and I-II degree of renal damage RR=0.27, 95%CI 0.11 to 0.60) after chemotherapy. No study reported treatmentrelated death. Conclusion Oxaliplatin and Cisplatin plus Vinorelbine are similar in efficacy in the treatment of advanced NSCLC. Oxaliplatin plus Vinorelbine could be used as a chemotherapy of advanced NSCLC because of its better tolerance and more liability to be accepted by patients. However, highly-potential selection bias and measurement bias would affect the demonstration level of the outcome, so more high-quality double-blind RCTs are needed.
Objective To investigate the primary peripheral non-small cell lung cancer (NSCLC) in stage T1 of TNM (UICC2011) (the tumor size≤3 cm) and to find out the lymphadenectomy way which will benefit patients most. Methods We retrospectively analyzed the clinical data of 60 patients with primary peripheral NSCLC in our hospital between November 2014 and May 2015. There were 26 males and 34 females at age of 34-76 (57.91±7.75) years. The lymph nodes dissection and metastasis were recorded. Results The total number of intrathoracic lymph nodes dissection is 1 208,with an average of 20.1, including 33 metastasis lymph nodes. The metastasis rate was 2.73%. A total of 51 patients were not found the mediastinum and hilum metastasis lymph node through the routine pathological detection method，while metastasis lymph node in section 12 and (or) 13 and (or) 14 group were found in 3 patients in our trial. The detection rate was 5.89%. For stage T1 primary peripheral NSCLC, with increasing tumor size, lymph node metastasis rate was gradually increased. The patients with solid lesions were more likely to have lymph node metastasis than those with non-solid lesions (pure ground-glass nodules or mixed ground-glass nodules) which generally did not find lymph node metastasis. Conclusion The lymph node metastasis rate in stage T1 primary peripheral NSCLC is related to the tumor size, nature, histological type, local pleural stretch in imaging. The dissection of lung lymph node (12+13+14 groups)may be able to find simple intrapulmonary lymph nodes metastasis. It is important to the selection of delineated staging and treatment program in stage T1 primary peripheral NSCLC.
ObjectiveTo compare and analyze clinical effects of video-assisted thoracoscopic surgery (VATS) lobectomy and systematic lymph node harvests for peripheral non-small cell lung cancer (PNSCLC) patients between single-port (SP) and multi-port (MP) with a propensity-matched analysis. MethodsWe retrospectively analyzed the clinical data of 324 patients presented with PNSCLC and admitted in the Affiliated Hospital of Qingdao University from January 2013 through December 2015. Six-eight patients underwent single-port thoracoscopic lobectomy were as a SP group and 256 patients with multi-port thoracoscopic lobectomy. Another 68 patients were produced by a propensity-matched analysis in these 256 patients, to match with SP group as a MP group. There were 26 males and 42 females at age of 54-62 (59.3±10.3) years in the SP group. There were 32 males and 36 females at age of 50-66 (61.5±9.4) years in the MP group. Perioperative outcomes were compared between the two groups. ResultsAll operations were accomplished successfully, without conversion to thoracotomy. Most postoperative outcomes were similar in intraoperative blood loss (136.3±22.7 ml vs. 142.2±20.3 ml), conversion (4.4% vs. 7.4%), lymph node dissection number (19.9±3.5 vs. 20.0±3.0), station (7.9±2.3 vs. 8.3±2.1), postoperative drainage volume (761.4±182.3 ml vs. 736.9±176.4 ml), chest drainage duration (5.2±1.5 d vs. 5.8±1.8 d), length of hospital stay (5.5±2.0 d vs. 5.0±2.5 d), and postoperative complications (2.9% vs. 7.4%) between the two groups (P > 0.05). There were statistical differences in operation time (138.2±20.3 min vs. 126.4±22.4 min), downtrend of pain scores (P=0.03), and patients' satisfaction level (8.8±1.4 vs. 7.3±2.3, P < 0.05). Concision Single-port thoracoscopic lobectomy is not inferior to multi-port and is a safe and feasible surgical procedure for the management of PNSCLC.
Objctive To explore the effect of positive lymph nodes ratio (LNR) on prognosis of patients with non-small cell lung cancer (NSCLC). Methods Clinical data of 432 NSCLC patients undergoing radical surgery for lung cancer and systemic lymph node dissection in our hospital from January 2010-2013 were retrospectively analyzed. There were 316 males and 116 females with age of 39-84 (57.59±9.16) years. Among 432 patients, 229 (53.0%) were classified as N0 based on pathological staging of lymph nodes, 104 (24.1%) as N1 and 99 (22.9%) as N2. Kaplan-Meier curve and COX multi-factor regression model were used to evaluate the correlation between the clinical data and patients' survival. Results Five lymph nodes on average (range, 1-52) were removed in each patient. Kaplan-Meier survival curves showed that the higher the staging of positive lymph nodes was, the shorter the patients' overall survival and disease-free survival were (P<0.001). Survival analysis showed that the LNR was closely associated with disease-free survival and overall survival (P<0.001). COX multivariate analysis revealed that the LNR staging was an independent risk factor of prognosis of NSCLC. Conclusion LNR is an independent prognostic factor of NSCLC, and can be used to improve lymph node staging in standards for NSCLC staging in the future.
Objective To evaluate the efficacy and safety of total thoracoscopic lobectomy for patients with stage Ⅰ/Ⅱ non-small cell lung cancer (NSCLC). Methods The clinical data of 138 NSCLC patients from January 2013 to June 2015 in Shaanxi People's Hospital were retrospectively analyzed. There were 88 males and 50 females with an average age of 57.4±8.8 years, ranging from 44 to 76 years. According to the operation methods, they were divided into a video-assisted thoracoscopic surgery (VATS) group (thoracoscopic lobectomy in 63 cases) and a thoracotomy group (conventional open chest surgery in 75 cases). The intra- and postoperative clinical data, surgical complications and pulmonary function were compared. Results There was no significant difference in the operation time, intraoperative lymph node dissection groups, intraoperative lymph node dissection number between two groups (P>0.05). The blood loss, postoperative drainage volume, duration of postoperative analgesia, Numeric Rating Scale for pain and hospital stay in the VATS group were significantly lower than those of the thoracotomy group (P<0.05). The pre- and postoperative FVC%pred and FEV1%pred in both groups were compared and there was no significant difference (P>0.05). However the postoperative FVC%pred and FEV1%pred in both groups significantly reduced compared with preoperative ones (P<0.05). Complication rate of thoracoscopic group was significantly less than that of the thoracotomy group (20.63%vs. 32.00%,χ2=3.974,P=0.046). Conclusion Thoracoscopic lobectomy for NSCLCⅠ/Ⅱpatients is reliable, and achieves rapid postoperative recovery as well as less complications.
Non-small cell lung cancer (NSCLC) accounts for more than 80% of lung cancer. Nowadays, gemcitabine and cisplatin in combination have been adopted as the first-line chemotherapy for patients with NSCLC. This study aimed to monitor early response to combined chemotherapy of gemcitabine plus cisplatin in a mouse model of NSCLC by using 18F-fluorodeoxyglucose and 18F-fluorothymidine small animal positron emission tomography (PET). Lewis lung carcinoma-bearing C57BL/6 mice were treated with gemcitabine-cisplatin or saline. Small animal PET with 18F-FDG and 18F-FLT was performed before (baseline) and after treatment (on Day 3), respectively. Imaging results were confirmed by histopathological studies (hematoxylin and eosin staining, Ki67 staining). Compared to the results in the control group, gemcitabine-cisplatin in the treated group significantly inhibited tumor growth (P<0.05). In the treated group, the maximum standardized uptake value (SUVmax) of 18F-FLT decreased significantly from 0.59±0.05 (baseline) to 0.28±0.05 (Day 3) (P<0.05). There was no significant difference between baseline (4.35±0.46) and that on Day 3 (4.02±0.47) on 18F-FDG SUVmax (P>0.05). The proliferation of tumor assessed by Ki67 staining decreased significantly after treatment of one dose of gemicitabine-cisplatin (P<0.05). The staining of HE showed an increase in necrotic and inflam- matory cells after the treatment. This study demonstrated that the uptake of 18F-FLT reduced more rapidly and signi-ficantly than that of 18F-FDG and was less disturbed by the increase of inflammatory cells after chemotherapy.
ObjectiveTo systematically review the postoperative recovery of lung function in patients with early stage non-small cell lung cancer (NSCLC) after different operation, such as lobectomy versus segmentectomy and video-assisted thoracoscopic surgery (VATS) versus traditional open chest surgery.MethodsClinical studies about effect of different surgical methods on lung function in patients with early NSCLC were searched from PubMed, EMbase, The Cochrane Library, CBM and CNKI databases from inception to October 1st, 2016. Two researchers independently screened literature, extracted data and evaluated the risk of bias of included studies, and then meta-analysis was conducted by RevMan 5.3 and MetaAnalyst software.ResultsA total of 25 studies involving 2 924 patients were included. The results of meta-analysis showed that: compared with lobectomy group, one-second rate difference (ΔFEV1%) (MD=–0.03, 95%CI –0.03 to –0.03, P<0.001) and predictive value of forced vital capacity difference (ΔFVC%) (MD=–0.09, 95%CI –0.11 to –0.06, P<0.001) of preoperative to postoperative in segmentectomy group were higher. However, there was no significant difference between two groups in first second forced expiratory volume difference (ΔFEV1) (MD=0.01, 95%CI –0.10 to 0.11, P=0.92). Compared with thoracotomy group, VATS group had lower ΔFEV1 (MD=–0.19, 95%CI –0.27 to –0.10, P<0.0001), ΔFVC (MD=–0.20, 95%CI –0.37 to –0.03, P=0.02), ΔFEV1% (MD=–0.03, 95%CI –0.06 to –0.01, P<0.001) of preoperative to postoperative (≤3 months), and maximum minute ventilation (ΔMVV) (MD=–5.59, 95%CI –10.38 to –1.52, P=0.008) of preoperative to postoperative (≥6 months). However, there were no statistically significant differences in difference of carbon monoxide diffusion rate (ΔDLCO%) (MD=–0.04, 95%CI –0.09 to 0.02, P=0.16), ΔFEV1% (MD=–0.02, 95%CI –0.06 to 0.02, P=0.32) and ΔFEV1 (MD=1.13, 95%CI –0.92 to 3.18, P=0.28).ConclusionThe protective effect of segmentectomy on postoperative pulmonary function is better than that of lobectomy. VATS has a protective effect on the ventilation function within 3 months and 6 months after surgery. Due to limited quantity and quality of included studies, the above conclusions are needed to be validated by more high quality studies.
Objective To investigate the perioperative outcome of robot-assisted pulmonary lobectomy in treating pathological stage Ⅰ non-small cell lung cancer (NSCLC). Methods We retrospectively analyzed the clinical data of 333 consecutive p-T1 NSCLC patients who underwent robotic-assisted pulmonary lobectomy in our hospital between May 2013 and April 2016. There were 231 females (69.4%) and 102 males (30.6%) aged from 20–76 (55.01±10.46) years. Cancer was located in the left upper lobectomy in 37 (11.1%) patients, left lower lobectomy in 71 (21.3%) patients, right upper lobectomy in 105 (31.5%) patients, right middle lobectomy in 32 (9.6%) patients, right lower lobectomy in 88 (26.4%) patients. Adenocarcinoma was confirmed in 330 (99.1%) patients and squamous cell cancer was confirmed in 3 (0.9%) patients. Results Total operative time was 46–300 (91.51±30.80) min. Estimated intraoperative blood loss was 0–100 ml in 319 patients (95.8%), 101–400 ml in 12 patients (3.6%), >400 ml in 2 patients (0.6%). Four patients were converted to thoracotomy, including 2 patients due to pulmonary artery branch bleeding and 2 due to pleural adhesion.No patient died within 30 days after surgery. And no perioperative blood transfusion occurred. Postoperative day 1 drain was 0–960 (231.39±141.87) ml. Chest drain time was 2–12 (3.96±1.52) d.And no patient was discharged with chest tube. Length of hospital stay after surgery was 2–12 (4.96±1.51) d. Persistent air leak was in 12 patients over 7 days. No readmission happened within 30 days. All patients underwent lymph node sampling or dissection with 2–9 (5.69±1.46) groups and 3–21 (9.80±3.43) lymph nodes harvested. Total intraoperative cost was 60 389.66–134 401.65 (93 809.23±13 371.26) yuan. Conclusion Robot-assisted pulmonary lobectomy is safe and effective in treating p-Stage Ⅰ NSCLC, and could be an important supplement to conventional VATS. Regarding to cost, it is relatively more expensive compared with conventional VATS. RATS will be widely used and make a great change in pulmonary surgery with the progressive development of surgical robot.
ObjectiveTo investigate the characteristics and influencing factors of N1 in T2 stage of the 8th TNM stage of The International Association for the Study of Lung Cancer (IASLC) (3 cm <tumor size≤5 cm) non-small cell lung cancer (NSCLC), to provide the basis for dissecting intrapulmonary lymph node more accurately during the operation.MethodsWe collected the clinical information of patients who underwent the pulmonary malignant tumor surgery in Dalian Central Hospital between October 2011 and November 2016. Through the inclusion and exclusion criteria, a total of 68 patients were obtained, including 48 males and 20 females, aged 48–81 (63.1±7.6) years. According to the pathological results, we invesigated the characteristics and influencing factors of N1 in T2 stage non-small cell lung cancer.ResultsThe results showed that the highest positive rate of lymph node was 14.8% in the 12th group, 14.3% in the 13th group, and 13.9% in the 6th group, respectively. In the single factor analysis, it showed that male, T2b stage, poorly differentiated degree were the risk factors for intrapulmonary lymph node metastasis in T2 stage (P<0.05). But the intrapulmonary lymph nodes metastasis was no significant correlation with above factors according to the multivariate analysis.ConclusionIt is necessary to extract the intrapulmonary lymph node of T2 stage NSCLC at utmost, especially for the No.12 and No.13 high-risk areas. T2b stage with odd ratio (OR) at 3.038 and poorly differentiated degree (OR=1.945) may be the risk factors for the intrapulmonary lymph nodes metastasis of NSCLC in T2 stage. But they are not determining factors.
Objective To study the short-term outcome and safety of radiofrequency ablation (RFA) combined with recombinant human endostatin (endostar) for non-small cell lung cancer (NSCLC) patients. Methods Between December 2013 and December 2014, 80 consecutive patients (50 males, 30 females) with biopsy-proved NSCLC were divided into two groups: a RFA combined treatment group (RFA combined with endostar, 60 patients, 38 males, 22 females, mean age at 67.77±10.43 years) and a RFA alone group (20 patients, 12 males, 8 females, mean age at 67.35±9.82 years). The RFA combined treatment group was divided into three groups according to vascular normalization window of endostar and 20 patients in each group: a combined treatment group 1 (transfusion of endostar after RFA), a combined treatment group 2 (transfusion of endostar for 1 to 3 d before RFA) and a combined treatment group 3 (transfusion of endostar for 4 to 7 d before RFA). The CT scan of the chest was followed up after the treatment, local recurrence and safety was observed. Results There was a statistical difference in local recurrence time among groups (χ2 = 11.05, P = 0.011). The effect of the combined treatment group is better than that of the radiofrequency ablation therapy alone group. And in the recombinant human endostatin of tumor vascular normalization time best combination therapy was observed in the near future effect compared with the radiofrequency ablation therapy alone. In this study common complications were associated with radiofrequency ablation. No recombinant human endostatin related complication was found. There was no satistical difference in safety between the combined treatment group and the radiofrequency ablation therapy group (χ2= 0.889, P > 0.05). Conclusion RFA combined with endostar is safe and effective for non-small cell lung cancer.