AIM:To assess the effects of 3-field lymphadenectomy for esophageal carcinoma.METHODS:We conducted a computerized literature search of the Pub Med,Cochrane Controlled Trials Register,and EMBASE databases from their in...AIM:To assess the effects of 3-field lymphadenectomy for esophageal carcinoma.METHODS:We conducted a computerized literature search of the Pub Med,Cochrane Controlled Trials Register,and EMBASE databases from their inception to present.Randomized controlled trials(RCTs)or observational epidemiological studies(cohort studies)that compared the survival rates and/or postoperative complications between 2-field lymphadenectomy(2FL)and3-field lymphadenectomy(3FL)for esophageal carcinoma with R0 resection were included.Meta-analysis was conducted using published data on 3FL vs 2FL in esophageal carcinoma patients.End points were 1-,3-,and 5-year overall survival rates and postoperativecomplications,including recurrent nerve palsy,anastomosis leak,pulmonary complications,and chylothorax.Subgroup analysis was performed on the involvement of recurrent laryngeal lymph nodes.RESULTS:Two RCTs and 18 observational studies with over 7000 patients were included.There was a clear benefit for 3FL in the 1-(RR=1.16;95%CI:1.09-1.24;P<0.01),3-(RR=1.44;95%CI:1.19-1.75;P<0.01),and 5-year overall survival rates(RR=1.37;95%CI:1.18-1.59;P<0.01).For postoperative complications,3FL was associated with significantly more recurrent nerve palsy(RR=1.43;95%CI:1.28-1.60;P=0.02)and anastomosis leak(RR=1.26;95%CI:1.05-1.52;P=0.09).In contrast,there was no significant difference for pulmonary complications(RR=0.93;95%CI:0.75-1.16,random-effects model;P=0.27)or chylothorax(RR=0.77;95%CI:0.32-1.85;P=0.69).CONCLUSION:This meta-analysis shows that 3FL improves overall survival rate but has more complications.Because of the high heterogeneity among outcomes,definite conclusions are difficult to draw.展开更多
High expression of fibrinogen and platelets are often observed in non–small cell lung cancer(NSCLC) patients with local regional or distant metastasis. However, the role of these factors remains unclear. The aims of ...High expression of fibrinogen and platelets are often observed in non–small cell lung cancer(NSCLC) patients with local regional or distant metastasis. However, the role of these factors remains unclear. The aims of this study were to evaluate the prognostic significance of plasma fibrinogen concentration and platelet count, as well as to determine the overall survival of NSCLC patients with brain metastases. A total of 275 NSCLC patients with brain metastasis were enrolled into this study. Univariate analysis showed that high plasma fibrinogen concentration was associated with age ≥ 65 years(P = 0.011), smoking status(P = 0.009), intracranial symptoms(P = 0.022), clinical T category(P = 0.010), clinical N category(P = 0.003), increased partial thromboplastin time(P < 0.001), and platelet count(P < 0.001). Patients with low plasma fibrinogen concentration demonstrated longer overall survival compared with those with high plasma fibrinogen concentration(median, 17.3 months versus 11.1 months; P ≤ 0.001). A similar result was observed for platelet counts(median, 16.3 months versus 11.4 months; P = 0.004). Multivariate analysis showed that both plasma fibrinogen concentration and platelet count were independent prognostic factors for NSCLC with brain metastases(R2 = 1.698, P < 0.001 and R2 = 1.699, P < 0.001, respectively). Our results suggest that high plasma fibrinogen concentration and platelet count indicate poor prognosis for NSCLC patients with brain metastases. Thus, these two biomarkers might be independent prognostic predictors for this subgroup of NSCLC patients.展开更多
The presence of lymph node metastasis is an important prognostic factor for patients with esophageal cancer.Accurate assessment of lymph nodes in thoracic esophageal carcinoma is essential for selecting appropriate tr...The presence of lymph node metastasis is an important prognostic factor for patients with esophageal cancer.Accurate assessment of lymph nodes in thoracic esophageal carcinoma is essential for selecting appropriate treatment and forecasting disease progression.Positron emission tomography combined with computed tomography(PET/CT)is becoming an important tool in the workup of esophageal carcinoma.Here,we evaluated the effectiveness of the maximum standardized uptake value(SUVmax)in assessing lymph node metastasis in esophageal squamous cell carcinoma(ESCC)prior to surgery.Fifty-nine surgical patients with pathologically confirmed thoracic ESCC were retrospectively studied.These patients underwent radical esophagectomy with pathologic evaluation of lymph nodes.They all had18F-FDG PET/CT scans in their preoperative staging procedures.None had a prior history of cancer.The pathologic status and PET/CT SUVmax of lymph nodes were collected to calculate the receiver operating characteristic(ROC)curve and to determine the best cutoff value of the PET/CT SUVmax to distinguish benign from malignant lymph nodes.Lymph node data from 27 others were used for the validation.A total of 323 lymph nodes including 39 metastatic lymph nodes were evaluated in the training cohort,and 117lymph nodes including 32 metastatic lymph nodes were evaluated in the validation cohort.The cutoff point of the SUVmax for lymph nodes was 4.1,as calculated by ROC curve(sensitivity,80%;specificity,92%;accuracy,90%).When this cutoff value was applied to the validation cohort,a sensitivity,a specificity,and an accuracy of 81%,88%,and 86%,respectively,were obtained.These results suggest that the SUVmax of lymph nodes predicts malignancy.Indeed,when an SUVmax of 4.1 was used instead of 2.5,FDG-PET/CT was more accurate in assessing nodal metastasis.展开更多
Epidermal growth factor receptor(EGFR) gene mutation and copy number are useful predictive markers that guide the selection of non-small cell lung cancer(NSCLC) patients for EGFR-targeting therapy.This study aimed to ...Epidermal growth factor receptor(EGFR) gene mutation and copy number are useful predictive markers that guide the selection of non-small cell lung cancer(NSCLC) patients for EGFR-targeting therapy.This study aimed to investigate the correlation between EGFR gene mutation and copy number and clinicopathologic characteristics of Chinese patients with NSCLC.NSCLC specimens collected from 205 patients between November 2009 and January 2011 were selected to detect EGFR gene mutations with real-time polymerase chain reaction(RT-PCR) and to detect EGFR gene copy number with fluorescence in situ hybridization(FISH).EGFR mutations primarily occurred in females,non-smokers,and patients with adenocarinomas(all P < 0.001).Tissues from 128(62%) patients were FISH-positive for EGFR,including 37(18%) with gene amplification and 91(44%) with high polysomy.EGFR gene mutation was correlated with FISH-positive status(R = 0.340,P < 0.001).Multivariate analysis showed that not smoking(OR = 5.910,95% CI = 2.363-14.779,P < 0.001) and having adenocarcinoma(OR = 0.122,95% CI = 0.026-0.581,P = 0.008) were favorable factors for EGFR gene mutation.These results show a high frequency of EGFR FISH positivity in NSCLC tissues from Chinese patients and a significant relevance between EGFR gene mutations and FISH-positive status.Among the FISH-positive samples,EGFR gene mutation occurred more frequently in samples with gene amplification compared to those with high polysomy,suggesting that EGFR mutation and gene amplification should be used as clinical decision parameters to predict response to EGFR-targeting therapy.展开更多
Response criteria remain controversial in therapeutic evaluation for locally advanced esophageal carcinoma treated with neoadjuvant chemotherapy.We aimed to identify the predictive value of tumor regression grading(TR...Response criteria remain controversial in therapeutic evaluation for locally advanced esophageal carcinoma treated with neoadjuvant chemotherapy.We aimed to identify the predictive value of tumor regression grading(TRG) in tumor response and prognosis.Fifty-two patients who underwent neoadjuvant chemotherapy followed by esophagectomy and radical 2-field lymphadenectomy between June 2007 and June 2011 were included in this study.All tissue specimens were reassessed according to the TRG scale.Potential prognostic factors,including clinicopathologic factors,were evaluated.Survival curves were generated by using the Kaplan-Meier method and compared with the log-rank test.Prognostic factors were determined with multivariate analysis by using the Cox regression model.Our results showed that of 52 cases,43(83%) were squamous cell carcinoma and 9(17%) were adenocarcinoma.TRG was correlated with pathologic T(P = 0.006) and N(P < 0.001) categories.Median overall survival for the entire cohort was 33 months.The 1-and 2-year overall survival rates were 71% and 44%,respectively.Univariate survival analysis results showed that favorable prognostic factors were histological subtype(P = 0.003),pathologic T category(P = 0.026),pathologic N category(P < 0.001),and TRG G0(P = 0.041).Multivariate analyses identified pathologic N category(P < 0.001) as a significant independent prognostic parameter.Our results indicate that histomorphologic TRG can be considered as an alternative option to predict the therapeutic efficacy and prognostic factor for patients with locally advanced esophageal carcinoma treated by neoadjuvant chemotherapy.展开更多
Background:Body mass index(BMI)has a U?shaped association with lung cancer risk.However,the effect of BMI on prognosis is controversial.This retrospective study aimed to investigate the effect of BMI on the survival o...Background:Body mass index(BMI)has a U?shaped association with lung cancer risk.However,the effect of BMI on prognosis is controversial.This retrospective study aimed to investigate the effect of BMI on the survival of patients with stage I non?small cell lung cancer(NSCLC)after surgical resection.Methods:In total,624 consecutive stage I NSCLC patients who underwent radical resection were classified into four groups according to their BMI:underweight(BMI<18.5 kg/m^2),normal weight(BMI obese(BMI>28.0 kg/m^2).The effect of BMI on progress=18.5–22.4 kg/m2),overweight(BMI=22.5–28.0 kg/m^2),andion?free survival(PFS)and over?all survival(OS)was estimated using the Kaplan–Meier method and Cox proportional hazards model.Postoperative complications in each group were analyzed using the Chi square test or Fisher’s exact test.Results:A univariate analysis showed that PFS and OS were longer in the overweight group than in other groups(both P<0.05).A multivariate analysis showed that OS was longer in the overweight group than in other groups(compared with the other three groups in combination:hazard ratio[HR]e underweight group:HR=1.87,95%confidence interval[CI]1.30–2.68,P=0.003;compared with th3,P=2.24,95%CI 1.18–4.25,P=0.013;compared with the normal weight group:HR 1.48–5.59,P=1.58,95%CI 1.07–2.3=0.022;compared with the obese group:HR=2.87,95%CIwe=0.002),but PFS was similar among the groups(HRd an association between being overweight and pro=1.28,95%CI 0.97–1.68,P longed OS in patients at sta=0.080).A subgroup analysis shoge T1a(P 0.001).Overweight=0.024),T1b(P=0.051),and T2a(P=0.02),as well as in patients with a non?smoking history(P=patients had lower rates of postoperative complications,such as respiratory failure(compared with the underweight and obese groups:P=0.014),myocardial infarction(compared with the obese group:P=0.033),and perioperative death(com?pared with the other three groups:P=0.016).Conclusions:Preoperative BMI is an independent prognostic factor for stage I NSCLC patients after resection,with overweight patients having a favorable prognosis.展开更多
基金Supported by Grants from the Science and Technology Planning Project of Guangdong Province,China,No.2010B31500010,No.2012B031800463 and No.2013B022000040the National High Technology Research and Development Program of China(863 Program),No.2009AA02Z421
文摘AIM:To assess the effects of 3-field lymphadenectomy for esophageal carcinoma.METHODS:We conducted a computerized literature search of the Pub Med,Cochrane Controlled Trials Register,and EMBASE databases from their inception to present.Randomized controlled trials(RCTs)or observational epidemiological studies(cohort studies)that compared the survival rates and/or postoperative complications between 2-field lymphadenectomy(2FL)and3-field lymphadenectomy(3FL)for esophageal carcinoma with R0 resection were included.Meta-analysis was conducted using published data on 3FL vs 2FL in esophageal carcinoma patients.End points were 1-,3-,and 5-year overall survival rates and postoperativecomplications,including recurrent nerve palsy,anastomosis leak,pulmonary complications,and chylothorax.Subgroup analysis was performed on the involvement of recurrent laryngeal lymph nodes.RESULTS:Two RCTs and 18 observational studies with over 7000 patients were included.There was a clear benefit for 3FL in the 1-(RR=1.16;95%CI:1.09-1.24;P<0.01),3-(RR=1.44;95%CI:1.19-1.75;P<0.01),and 5-year overall survival rates(RR=1.37;95%CI:1.18-1.59;P<0.01).For postoperative complications,3FL was associated with significantly more recurrent nerve palsy(RR=1.43;95%CI:1.28-1.60;P=0.02)and anastomosis leak(RR=1.26;95%CI:1.05-1.52;P=0.09).In contrast,there was no significant difference for pulmonary complications(RR=0.93;95%CI:0.75-1.16,random-effects model;P=0.27)or chylothorax(RR=0.77;95%CI:0.32-1.85;P=0.69).CONCLUSION:This meta-analysis shows that 3FL improves overall survival rate but has more complications.Because of the high heterogeneity among outcomes,definite conclusions are difficult to draw.
基金supported by grants from Ministry of Science and Technology Projects of China(No.2012AA021502)Provincial Science and Technology Projects of Guangdong(No.2012B031800295)
文摘High expression of fibrinogen and platelets are often observed in non–small cell lung cancer(NSCLC) patients with local regional or distant metastasis. However, the role of these factors remains unclear. The aims of this study were to evaluate the prognostic significance of plasma fibrinogen concentration and platelet count, as well as to determine the overall survival of NSCLC patients with brain metastases. A total of 275 NSCLC patients with brain metastasis were enrolled into this study. Univariate analysis showed that high plasma fibrinogen concentration was associated with age ≥ 65 years(P = 0.011), smoking status(P = 0.009), intracranial symptoms(P = 0.022), clinical T category(P = 0.010), clinical N category(P = 0.003), increased partial thromboplastin time(P < 0.001), and platelet count(P < 0.001). Patients with low plasma fibrinogen concentration demonstrated longer overall survival compared with those with high plasma fibrinogen concentration(median, 17.3 months versus 11.1 months; P ≤ 0.001). A similar result was observed for platelet counts(median, 16.3 months versus 11.4 months; P = 0.004). Multivariate analysis showed that both plasma fibrinogen concentration and platelet count were independent prognostic factors for NSCLC with brain metastases(R2 = 1.698, P < 0.001 and R2 = 1.699, P < 0.001, respectively). Our results suggest that high plasma fibrinogen concentration and platelet count indicate poor prognosis for NSCLC patients with brain metastases. Thus, these two biomarkers might be independent prognostic predictors for this subgroup of NSCLC patients.
文摘The presence of lymph node metastasis is an important prognostic factor for patients with esophageal cancer.Accurate assessment of lymph nodes in thoracic esophageal carcinoma is essential for selecting appropriate treatment and forecasting disease progression.Positron emission tomography combined with computed tomography(PET/CT)is becoming an important tool in the workup of esophageal carcinoma.Here,we evaluated the effectiveness of the maximum standardized uptake value(SUVmax)in assessing lymph node metastasis in esophageal squamous cell carcinoma(ESCC)prior to surgery.Fifty-nine surgical patients with pathologically confirmed thoracic ESCC were retrospectively studied.These patients underwent radical esophagectomy with pathologic evaluation of lymph nodes.They all had18F-FDG PET/CT scans in their preoperative staging procedures.None had a prior history of cancer.The pathologic status and PET/CT SUVmax of lymph nodes were collected to calculate the receiver operating characteristic(ROC)curve and to determine the best cutoff value of the PET/CT SUVmax to distinguish benign from malignant lymph nodes.Lymph node data from 27 others were used for the validation.A total of 323 lymph nodes including 39 metastatic lymph nodes were evaluated in the training cohort,and 117lymph nodes including 32 metastatic lymph nodes were evaluated in the validation cohort.The cutoff point of the SUVmax for lymph nodes was 4.1,as calculated by ROC curve(sensitivity,80%;specificity,92%;accuracy,90%).When this cutoff value was applied to the validation cohort,a sensitivity,a specificity,and an accuracy of 81%,88%,and 86%,respectively,were obtained.These results suggest that the SUVmax of lymph nodes predicts malignancy.Indeed,when an SUVmax of 4.1 was used instead of 2.5,FDG-PET/CT was more accurate in assessing nodal metastasis.
基金supported by grants from the Ministry of Science and Technology of China (No.2006AA02A401)
文摘Epidermal growth factor receptor(EGFR) gene mutation and copy number are useful predictive markers that guide the selection of non-small cell lung cancer(NSCLC) patients for EGFR-targeting therapy.This study aimed to investigate the correlation between EGFR gene mutation and copy number and clinicopathologic characteristics of Chinese patients with NSCLC.NSCLC specimens collected from 205 patients between November 2009 and January 2011 were selected to detect EGFR gene mutations with real-time polymerase chain reaction(RT-PCR) and to detect EGFR gene copy number with fluorescence in situ hybridization(FISH).EGFR mutations primarily occurred in females,non-smokers,and patients with adenocarinomas(all P < 0.001).Tissues from 128(62%) patients were FISH-positive for EGFR,including 37(18%) with gene amplification and 91(44%) with high polysomy.EGFR gene mutation was correlated with FISH-positive status(R = 0.340,P < 0.001).Multivariate analysis showed that not smoking(OR = 5.910,95% CI = 2.363-14.779,P < 0.001) and having adenocarcinoma(OR = 0.122,95% CI = 0.026-0.581,P = 0.008) were favorable factors for EGFR gene mutation.These results show a high frequency of EGFR FISH positivity in NSCLC tissues from Chinese patients and a significant relevance between EGFR gene mutations and FISH-positive status.Among the FISH-positive samples,EGFR gene mutation occurred more frequently in samples with gene amplification compared to those with high polysomy,suggesting that EGFR mutation and gene amplification should be used as clinical decision parameters to predict response to EGFR-targeting therapy.
基金supported by a grant from the National Key Technology Research and Development Program of China (No.2006AA02A403)
文摘Response criteria remain controversial in therapeutic evaluation for locally advanced esophageal carcinoma treated with neoadjuvant chemotherapy.We aimed to identify the predictive value of tumor regression grading(TRG) in tumor response and prognosis.Fifty-two patients who underwent neoadjuvant chemotherapy followed by esophagectomy and radical 2-field lymphadenectomy between June 2007 and June 2011 were included in this study.All tissue specimens were reassessed according to the TRG scale.Potential prognostic factors,including clinicopathologic factors,were evaluated.Survival curves were generated by using the Kaplan-Meier method and compared with the log-rank test.Prognostic factors were determined with multivariate analysis by using the Cox regression model.Our results showed that of 52 cases,43(83%) were squamous cell carcinoma and 9(17%) were adenocarcinoma.TRG was correlated with pathologic T(P = 0.006) and N(P < 0.001) categories.Median overall survival for the entire cohort was 33 months.The 1-and 2-year overall survival rates were 71% and 44%,respectively.Univariate survival analysis results showed that favorable prognostic factors were histological subtype(P = 0.003),pathologic T category(P = 0.026),pathologic N category(P < 0.001),and TRG G0(P = 0.041).Multivariate analyses identified pathologic N category(P < 0.001) as a significant independent prognostic parameter.Our results indicate that histomorphologic TRG can be considered as an alternative option to predict the therapeutic efficacy and prognostic factor for patients with locally advanced esophageal carcinoma treated by neoadjuvant chemotherapy.
基金supported by Science and Technology Planning Projects of Guangdong Province (No. 01578040171810021)
文摘Background:Body mass index(BMI)has a U?shaped association with lung cancer risk.However,the effect of BMI on prognosis is controversial.This retrospective study aimed to investigate the effect of BMI on the survival of patients with stage I non?small cell lung cancer(NSCLC)after surgical resection.Methods:In total,624 consecutive stage I NSCLC patients who underwent radical resection were classified into four groups according to their BMI:underweight(BMI<18.5 kg/m^2),normal weight(BMI obese(BMI>28.0 kg/m^2).The effect of BMI on progress=18.5–22.4 kg/m2),overweight(BMI=22.5–28.0 kg/m^2),andion?free survival(PFS)and over?all survival(OS)was estimated using the Kaplan–Meier method and Cox proportional hazards model.Postoperative complications in each group were analyzed using the Chi square test or Fisher’s exact test.Results:A univariate analysis showed that PFS and OS were longer in the overweight group than in other groups(both P<0.05).A multivariate analysis showed that OS was longer in the overweight group than in other groups(compared with the other three groups in combination:hazard ratio[HR]e underweight group:HR=1.87,95%confidence interval[CI]1.30–2.68,P=0.003;compared with th3,P=2.24,95%CI 1.18–4.25,P=0.013;compared with the normal weight group:HR 1.48–5.59,P=1.58,95%CI 1.07–2.3=0.022;compared with the obese group:HR=2.87,95%CIwe=0.002),but PFS was similar among the groups(HRd an association between being overweight and pro=1.28,95%CI 0.97–1.68,P longed OS in patients at sta=0.080).A subgroup analysis shoge T1a(P 0.001).Overweight=0.024),T1b(P=0.051),and T2a(P=0.02),as well as in patients with a non?smoking history(P=patients had lower rates of postoperative complications,such as respiratory failure(compared with the underweight and obese groups:P=0.014),myocardial infarction(compared with the obese group:P=0.033),and perioperative death(com?pared with the other three groups:P=0.016).Conclusions:Preoperative BMI is an independent prognostic factor for stage I NSCLC patients after resection,with overweight patients having a favorable prognosis.