Gastric metastasis of small cell lung carcinoma:Three case reports and review of literature

BACKGROUND Small cell lung carcinoma(SCLC)is highly susceptible to metastasis in the early stages of the disease.However,the stomach is an uncommon site of metastasis in SCLC,and only a few cases of this type of metastasis have been reported.Therefore,SCLC gastric metastases have not been systematically characterized and are easily missed and misdiagnosed.CASE SUMMARY We report three cases of gastric metastasis from SCLC in this article.The first patient presented primarily with cough,hemoptysis,and epigastric fullness.The other two patients presented primarily with abdominal discomfort,epigastric distension,and pain.All patients underwent gastroscopy and imaging examinations.Meanwhile,the immunohistochemical results of the lesions in three patients were suggestive of small cell carcinoma.Finally,the three patients were diagnosed with gastric metastasis of SCLC through a comprehensive analysis.The three patients did not receive appropriate treatment and died within a short time.CONCLUSION Here,we focused on summarizing the characteristics of gastric metastasis of SCLC to enhance clinicians'understanding of this disease.

TRIM21通过与ZSWIM1相互作用调节肺腺癌细胞的增殖和迁移

背景与目的 肺腺癌(lung adenocarcinoma, LUAD)是一种致病率和死亡率都极高的癌症,尽管现代医学的治疗手段在不断进步,但患者的5年生存率仍不高,因此我们想通过探究LUAD发生发展的分子机制进而鉴定新的治疗靶标。我们前期的研究报道了ZSWIM1(zinc finger SWIM-type containing 1)是一个促进LUAD细胞增殖、迁移、侵袭的新蛋白。本研究将着重探究E3泛素连接酶TRIM21(tripartite-motif protein 21)对ZSWIM1在LUAD细胞中促增殖、迁移功能的影响。方法 利用蛋白免疫共沉淀技术(co-immunoprecipitation,Co-IP)和免疫荧光技术(immunofluorescence, IF)验证TRIM21和ZSWIM1之间的相互作用和共定位;利用MTT和Transwell实验检测TRIM21及TRIM21、ZSWIM1协同对LUAD增殖、迁移的影响;利用蛋白印迹实验(Westernblot,WB)检测TRIM21和ZSWIM1对LUAD细胞上皮间充质转化(epithelial-mesenchymal transition, EMT)标志物表达的影响;利用Co-IP联合WB检测TRIM21对ZSWIM1泛素化的影响。结果 TRIM21与ZSWIM1存在相互作用和共定位。TRIM21的上调可以抑制LUAD细胞的增殖和迁移。过表达TRIM21能够降低ZSWIM1对LUAD细胞增殖、迁移和侵袭的促进作用,并逆转ZSWIM1对E-cadherin和Vimentin表达的影响。敲低TRIM21则可以增强ZSWIM1对LUAD细胞增殖和迁移的促进作用。机制方面,我们发现过表达TRIM21可明显增强ZSWIM1的泛素化水平,下调ZSWIM1的蛋白表达量。结论 TRIM21通过结合并促进ZSWIM1的泛素化,进而降低ZSWIM1的蛋白表达,这抑制了ZSWIM1对LUAD细胞增殖、迁移、侵袭表型的促进作用。

Primary pulmonary meningioma and minute pulmonary meningothelial-like nodules: Rare pulmonary nodular lesions requiring more awareness in clinical practice

In this editorial,we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case.Pulmonary meningothelial proliferative lesions,including primary pulmonary meningiomas,minute pulmonary meningothelial-like nodules,and metastatic pulmonary meningiomas are rare pulmonary lesions.These lesions are difficult to differentiate from lung cancers based on clinical and imaging manifestations.Herein,we briefly introduce the clinical,imaging,and pathological characteristics of these lesions and discuss their pathogenesis to strengthen the current understanding of pulmonary meningothelial proliferative lesions in clinical diagnosis and therapy.

Clinical Course Of Patients with Small Cell Lung Cancer As Second Primary Malignancy

Objective： To evaluate the clinical course of patients with small cell lung cancer （SCLC） as second primary malignancy. Methods： Among the 355 patients diagnosed with SCLC at Helen and Harry Gray Cancer Center of Hartford Hospital Connecticut USA between 1988 and 1998, the records of 48 patients, which had been diagnosed with other malignancies before their diagnosis of SCLC, were retro- spectively reviewed. Results： Forty-eight patients （13.5%） were diagnosed with other malignancies prior to their SCLC among which 43 had documented smoking history and 93% of them （40/43） were current/former smokers. Of the 28-second primary SCLC patients who were treated with standard method, 11 （39.3%） achieved CR. 12 （42.8%） achieved PR, and the RR was 82.1%. The median survival of the 28 treated with standard method was 11.3 months （5.1-77.7 months）, while that of the rest 19 untreated patients （1 of 20 was lost to follow-up） was only 2.0 months （0.5 34.0 months）. There was no significant difference in the median survival and RR between 165 treated first primary SCLC （13.5 months and 77.6% respectively） and 28 treated secondary primary SCLC （11.3 months and 82.1% respectively） （P〉0.05）. The patients who had prostate cancer were older and subjected to less treatments than those with skin cancer, so their survival was shorter than the latter （3.5 months vs. 15 months, P〈0.05）. Conclusion： The response and survival of the treated patients with SCLC as a second malignancy showed no difference as compared to the treated ones with SCLC only. Therefore, an active medical treatment is important to relieve symptom and prolong survival of the second primary SCLC patients.

The 7th lung cancer TNM classification and staging system:Review of the changes and implications

Lung cancer is the most common cause of death from cancer in males,accounting for more than 1.4 million deaths in 2008.It is a growing concern in China,Asia and Africa as well.Accurate staging of the disease is an important part of the management as it provides estimation of patient’s prognosis and identifies treatment sterategies.It also helps to build a database for future staging projects.A major revision of lung cancer staging has been announced with effect from January 2010.The new classification is based on a larger surgical and non-surgical cohort of patients,and thus more accurate in terms of outcome prediction compared to the previous classification.There are several original papers regarding this new classification which give comprehensive description of the methodology,the changes in the staging and the statistical analysis.This overview is a simplified description of the changes in the new classification and their potential impact on patients’ treatment and prognosis.

Colonic metastasis after resection of primary squamous cell carcinoma of the lung:A case report and literature review

Lung cancer is a common malignancy in the world; however symptomatic colonic metastasis from primary lung cancer is rare. A 64-year-old man was originally found poorly differentiated squamous cell carcinoma of right lung and received right lower lobectomy and lymph node dissection. Three years later, the patient presented to our emergency room with the symptom of upper abdominal pain and weight loss. Abdominal palpation and computed tomography scan of the abdomen revealed a large mass measuring 7.6 cm × 8.5 cm in the ascending colon. Colonoscopy and biopsy revealed poorly differentiated squamous cell carcinoma with similar morphological pattern to that of the previous lung cancer. Chemotherapy was given and the patient died 5 mo later. Lung cancer metastatic to the colon confers a poor prognosis: overall survival ranged from 5 wk to 1 year, with a median survival of 3 mo after the diagnosis of the colonic metastasis.

The Clinical Usefulness of ^(99m)Tc-Tetrofosmin Scintigraphy in the Diagnosis of Lung Neoplasmas and Mediastinal Lymphoid Node Involvement

In order to investigate the clinical significance of 99mTc-Tetrofosmin （TF） scintigraphy in the evaluation of lung cancer and mediastinal lymphoid node involvement, 33 patients with pulmo- nary neoplasmas were subjected to both 99mTc-TF scintigraphies and CT scans in one week before their operations or puncturations. All the images were judged visually and the emission images were analyzed with semi-quantitative methods in addition. The results of each group were compared. There was marked difference in target/non-target （T/N） ratio between the lung cancer group and the benign lesion group （P〈0.001）. Moreover, in the lung cancer group, T/N ratio in tomographies was signifi- cantly higher than that in planar images （P〈0.01）. The sensitivity and accuracy of semi-quantitative analysis in 99mTc-TF SPECT were significantly higher than those of CT in the diagnosis of pulmonary neoplasmas （P〈0.05 and P〈0.01 respectively）, so was the sensitivity of 99mTc-TF SPECT vs CT in the diagnosis of mediastinal lymphoid node metastasis （P〈0.05）. It was also found that epidermoid squamous cell carcinomas and adenocarcinomas had a higher T/N ratio than in small cell carcinomas （P〈0.05）, and 2 h washout rate （WR） of adenocarcinomas was higher than that of epidermoid squamous cell carcinomas （P〈0.05）. In conclusion, 99mTc-TF scintigraphy showed a favorable diag- nostic accuracy in appraising lung cancers and mediastinal lymph node metastases. Furthermore semi-quantitative technology can improve the accuracy, and is potential to offer some information about histological type of the cancer tissue. Therefore, 99mTc-TF scintigraphy will be a useful tool in the diagnosis and staging of lung cancer.

PROXIMAL BRONCHIAL INVASION OF LUNG CANCER: ACLINICOPATHOLOGICAL STUDY

Objective: To investigate the characteristics of proximal bronchial invasion of lung cancer for different types. Methods: Proximal bronchus of 151 operatively resected specimens of hilar type lung cancer were selected for cross-sectional pathological study. Forty-one specimens were obtained from total pulmonectomy, and 110 from pulmonary lobectomy. Results: Evidence showed that the direct invasion of tumor cells through the submucosal layer or multiple layers was the major form of lung cancer spread; 96.6% of the cancerous invasion occurred at the proximal bronchial wall less than 1.5 cm apart from the margin of the cancer. The extension of invasion was correlated with the histopathologic type of cancer, mode of invasion and TNM classification (pT, pN). Besides, the invasion in the bronchial wall by metastatic lymph nodes was also an important way for the cancer to spread. Conclusion: In order to achieve the radical removal of a tumor, it is imperative to keep a distance of 1.5 cm or more between the excision margin of the bronchus and the tumor, and to completely resect the hilar and mediastinal lymph nodes.

A Controlled Study on Comparing Differences in CT Perfusion Imaging between Rabbits inoculated with VX2 Lung Tumor and Patients with Squamous Cell Carcinoma of the Lung

OBJECTIVE By analysis and evaluation of the perfusion images and perfusion parameters of the rabbits with VX2 lung tumor, the association between the perfusion parameters and tumor angiogenesis of patients with squamous cell carcinoma of the lung has been studied in order to establish a non-invasive and effective way to detect tumor blood supply, which is be able to exhibit hemodynamic data in tumors during cancer treatments. METHODS Fifteen Netherlands rabbits inoculated with VX2 lung tumor （rabbit group） and 25 patients with squamous cell carcinoma of the lung （patient group） received a multi-slice spiral CT perfusion imaging test using the Netherlands PHILIPS Brilliance 16-slice spiral CT and a U.S. MEDRAD binocular highpressure syringe. Image postprocessing was done using the special perfusion software and EBW 4.0 Workstation. Perfusion volume （PV）, peak enhanced increment （PEI）, transit time peak （TTP）, and blood volume （BV） were measured and analyzed. RESULTS In the rabbit group, the values of the PV, PEI, TTP, and BV of the tumor margin were （53.89 ± 13.38） mL/（min.mL）, （45.71 ± 15.52） Hu, （39.29 ± 10.10） sec, and （31.45 ± 18.19） mL/100 g, respectively; these values of the tumor center were （36.57 ± 14.17） mL/（min.mL）, （28.64 ± 11.74） Hu, （39.00 ＋ 9.78） sec, and （19.76 ± 13.95） mL/100 g, respectively; the values of the muscles were （12.45± 4.38） mL/（min.mL）, （10.98 ± 5.03） Hu, （38.86 ± 10.04） sec, and （5.38 ±2.87） mL/100 g, respectively. The values of the relative perfusion volume （RPV）, relative peak enhanced increment （RPEI）, and relative blood volume （RBV） of the tumor margin were 4.38 ± 1.45, 3.96± 1.45, 9.99 ± 11.7, respectively; these values of the tumor center were 2.14 ± 1.08, 1.83±1.45, 4.17 ±3.39, respectively. The values of the PV, PEL BV of the tumor margin vs. the values of the muscles developed t-values, which were 15.028, 10.79, and 5.88, respectively （P ≤ 0.01）, with statistical significance; the values of the PV, PEI, BV of the tumor center vs. the values of the muscles produced t-values, which were 8.67, 7.49, and 4.55, respectively （P 〈 0.01）, with statistical significance. The values of the TTP of the tumor margin vs. TTP values of the muscles, and the TTP values of the tumor center vs. TTP values of the muscles developed t-values, which were 1.7 and 0.806, respectively （P ≥ 0.05）, without statistical significance. In the patient group, the values of the PV, PE, TTP, and BV of the tumor margin were （88.95 ± 30.89） mL/（min.mL）, （61.87 ± 27.31） Hu, （37.72 ± 12.53） sec, and （18.38 ± 7.2） mL/100 g, respectively; these values of the tumor center were （39.77 ± 18.29） mL/（min.mL）, （14.57 ± 8.1） Hu, （35.64 ± 12.41） sec, and （11.22 ± 6.02） mL/100 g, respectively; these values of the muscles were （12.45 ± 6.5） mL/（min.mL）, （6.14 ± 2.66） Hu, （35.68± 12.35） sec, and （2.23 ± 1.11） mL/100 g, respectively. The values of the RPV, RPEI, and RBV of the tumor margin were 8.05 ± 5.04, 8.87 ± 4.32, and 12.16 ± 8.49, respectively; these values of the tumor center were 2.39 ± 1.68, 2.97 ± 2.1, 3.53 ± 2.82, respectively. The values of the PV, PEI, BV of the tumor margin in the patient group vs. the values of the muscles produced t-values, which were 13.8, 10.85, and 12.22, respectively （P 〈 0.01）, with significant differences; these values of the tumor center vs. the values of the muscles developed t-values, which were 9.158, 6.26, 8.654, respectively （P 〈 0.01）, with significant differences. The TTP value of the tumor margin vs. that of the muscles produced t-value, which was 0.371, and the TTP value of the tumor center vs. that of the muscles developed t-value, which was 1 （P 〉 0.05）, without statistical difference. CONCLUSION CT perfusion imaging technics demonstrates directly dynamic changes of blood flow to tumors, which assists in identifying tumor growth and necrosis, therefore, this research provides an evidence-based guidelines for the treatment of human lung squamous cell carcinoma and has far-reaching clinical significance.

Detection of circulating tumor cells (CTCs) in patients with lung carcinoma by real-time fluorescent quantitative-PCR approach before and after chemotherapy

Circulating tumour cells (CTCs) are referred to the tumour cells that disseminated from the primary tumour and survive in circulating during the pro-ceeding of tumour growth. As surgical treatment evolves and local control has improved, the failure of cancer treatment has largely remained the re-sult of systemic metastasis. Selection of patients most likely to benefit from adjuvant strategies remains problematic. In order to develop a new standard of curative effect, this study was de-signed to track the number of CTCs in patients with lung cancer during chemotherapy. Methods: Samples of peripheral blood was taken from each lung cancer patients (n=32) on the day before chemotherapy as well as the third week after the chemotherapy cycle. The samples were subjected to real-time fluorescent quantitative reverse-tran- scriptase polymerase chain reaction (fqRT-PCR). Meanwhile the tumour size was determined by chest X-ray or computed tomograghy. Results Compared to that of pre-chemotherapy, the ex-pression level of cytokeratin (CK) 19 in the pa-tients significantly declined after chemotherapy (t=4.659,P=0.000). The level of CK19 mRNA in pa-tients with small cell lung cancer (SCLC) was higher than that of patients with non-small cell lung cancer (NSCLC) (t=1.944, P=0.061). The de-crease of CK19 mRNA level correlated well with the type during the treatment. Relatively the de-crease of SCLC is more obvious (t=6.073,P=0.000). The variation of CK19 mRNA level before and after chemotherapy was positively related to the dis-parity of tumour burden (r=0.593). There was also a significant association between the type (NSCLC vs. SCLC) and the change of tumour size (t=3.686, P=0.001).The positive rate before chemotherapy Supported by grant from the Natural Science Foundation in China (No.30972961). was 71.9% (23/32), while that after chemotherapy was 37.5% (12/32), indicating that 11 patients con- verted into negative after chemotherapy. Of the 16 patients which were in Ⅳ-stage, 11 cases were po- sitive (11/16,68.8%). Surprisingly, of the remaining 16 patients which were Ⅱ/Ⅲ stage, 12 cases were regarded as positive according to the criteria (12/6,75%). Conclusions: The real-time flu- ores-cent quantitative-PCR approach is useful for mea- suring the relative number of CTCs in a patients’ peripheral blood to monitor the effectiveness of treatment, and for designing more comprehensive and reasonable therapeutic regimes at earlier dates for patients. The treatment response can be immediately assessed by serial quantitation of CTCs after chemotherapy, and therefore this method highlights an alternative approach to rapidly access the patient’s response to treatment.

Lung Cancer Survival Improvement through Surgical Intervention in PUMCH Hospital

Objective： To investigate and evaluate improvement of lung cancer survival after surgical intervention in PUMC hospital during the last 15 years. Methods： From January 1989 to December 2003, 1574 lung cancer cases underwent surgical treatment and followed up. All cases in this series were divided into two groups according to time period： group A （1999-2003） and group B （1989-1998）. The difference in the survival rate between groups A and B was compared. Results： The morbidity and mortality in group A was decreased significantly in comparison to group B （11.2% vs. 19.2%, 1.06% vs. 1.93%, respectively）. However, the 3-year and 5-year survival rate was increased from 42.35% to 56.07%, and from 28.46% to 38.99%, respectively. A significant improvement in survival was observed in patients with stage Ⅰ, Ⅱ and ⅢA, but not in those with stage ⅢB and Ⅳ. Also, patients with lobectomy had more satisfactory results than those receiving exploratory thoracotomy, limited resection, pneumonectomy and sleeve resection. Conclusion： Lobectomy plus systematic mediastinal lymph nodes dissection has become the standard mode for resectable lung cancer. Combination of complete resection along with lymph nodal dissection, and postoperative adjuvant chemotherapy based on platinum/3^rd generation chemotherapy medicine, has preliminarily been justified, proving an important approach for effective improvement in long-term survival of non-small cell lung carcinoma.

SIGNIFICANCE OF ELECTRON MICROSCOPIC EXAMINATION IN THE DIAGNOSIS OF PULMONARY NEOPLASMS

The significance of electronic microscopc examination(EM) in the diagnosis of pulmonary neoplasms was evaIuated in 40 cases of Patients with different kinds of Pulmonary neoplasms.In 27 of the 40 cases,final diagnoses were made by light microscope(LM) examination,while in the remaining 13 cases,LM faded to reach definite diagnoses which were established with the help of EM.By analyzing our data,we conclude that in the following situations,EM helps meet in the diagnosis of pulmonary neoplasm:1.diagnosis of neuroendocrinal carcinomas of the lung;2.diagnosis of some rare pulmonary neoplasm;3.documentation of the histologic origins of the matastatic pulmonary neoplasms and 4.differentiation of malignant mesothelioma with pleural metastasis of Pulmonary adenocarcinoma.

Expression and Clinical Implication of HIF-1α and VEGF-C in Non-small Cell Lung Cancer

To study the expression and implication of HIF-1α and VEGF-C in non-small cell lung cancer （NSCLC） and its relationship with clinical pathological features of NSCLC, immunohisto-chemical SP was used to detect the expression of HIF-1α and VEGF-C proteins in 48 NSCLC tissues and the same para-cancerous tissues. The positive rates of HIF-1α and VEGF-C were 70.8% （34/48） and 68.8% （33/48） respectively. The expression of HIF-1α protein was detected in a significantly greater proportion in NSCLC carcinoma tissues than that in para-cancerous tissues （12.5% and 16.7%, P〈0.05）. The positive rates of HIF-1α and VEGF-C were correlated with lymph node metastasis and TNM stage. No relationship was found between the two factors and age, sex, pathological subtypes and histological grades. The positive rates between HIF-1α and VEGF-C were correlated （P〈0.05）. HIF-1α and VEGF-C were over-expressed in NSCLC. They may be involved in the carcinogenesis of NSCLC, and play an important role in invasion and metastasis of NSCLC. HIF-1α and VEGF-C work synergically in the process of NSCLC.

Synchronous primary cancer of the rectum and lung:a case report

Multiple primary cancers refer to the condition where more than two cancers occur independently in an individual. The incidence of lung cancer in cases of colorectal cancer is rare and synchronous rectal cancer and lung cancer is even rare. A 61-year-old man was referred to our hospital with a 2-month history of blood in his stool, tenesmus, and mucous discharge in July 2010. Colonoscopy showed an irregular ulcerated rectal mass and histological examination of biopsy material showed a poorly differentiated adenocarcinoma. Computed tomography （CT） scan of the chest and abdomen showed a mass in the posterior segment of the right upper lobe of the lung and a mass in the right rectal wall of upper rectum. The rectal tumor was diagnosed as primary cancer based on the findings of immunohistochemical stain. An anterior resection （AR） and video assisted thoracoscopic （VAT） wedge resection were performed and histological findings of resected rectal and lung tumor specimen showed synchronous primary rectal cancer and lung cancer. A combination chemotherapy regimen with docetaxel and Iobaplatin was used and the patient was successfully discharged from hospital in August 2010. Although the incidence of synchronous multiple primary cancers is very low, we need to remain suspicious, when faced with two or even multiple organ lesions, and employ the necessary examination methods to confirm the diagnosis. For synchronous multiple primary cancers, if conditions allow, surgical resection for all the cancers can be performed in a single operation.

Initial Progression-Free Survival after Non-First Line TKIs Therapy Potentially Guides Immediate Treatment after Its Failure in Advanced Non-Small Cell Lung Cancer

Objective The standard therapy alter failure of the initial non-first line epidermal growth factor receptor tyrosine kinase inhibitor （EGFR-TK1） treatment in advanced non-small cell lung cancer （NSCLC） has not yet been established. The aim of the current study was to identify whether the 2nd TKI treatment or chemotherapy （paclitaxel-containing or non-paclitaxel regimen） is the appropriate treatment for patients with NSCLC based on the efficacy of the initial TKls. Methods Seventy-two advanced NSCLC patients who had accepted 2nd TKIs or chemotherapy immediately alter failure of the initial TKIs in non-first line setting from May 1, 2004 to January 31, 2010 at the Sun Yat-sen University Cancer Center were enrolled. The primary endpoint [2nd progression-free survival （PFS）] and the second endpoint loverall survival （OS）] were compared among the 2＇＇d TKI and chemotherapy groups as well as their subgroups. Results （1） Twenty-one patients were treated with 2 TKIs, and 51 patients were administered chemotherapy after failure of the initial non-first line TKI treatment. There was nonsignificant difference in the responses （P=0.900） [2nd PFS （P=0.833） and OS （P=0.369）] between the 2nd TKI and chemotherapy groups. （2） In tile 2nd TKI group, 9 patients exhibited PFS_〉7 months. The initial TKI treatment group exhibited a longer 2＂d PFS than the other 12 patients with an initial PFS〈7 months （7 months vs. 2 months, P=0.019）. However, these groups had nonsignificantly different OS （P=0.369）. （3） In the chemotherapy group, patients with PFS〈5 months exhibited longer 2＇1~ PFS than those with PFS 〉 5 months in the initial TKI treatment （3 months vs. 2 months, P=0.039）. （4） In the chemotherapy group, nd patients treated with paclitaxel-containing regimen showed longer 2 PFS than those treated with non-paclitaxel regimen （, months t,s. 2.3 months, P=0.043）. Conclusions Patients with PFS_〉7 months or 〈5 months under the initial TKI treatment potentially benefit from the 2nd TK1 treatment or chemotherapy immediately after failure of the non-first line TKIs. The paclitaxel-containing regimen may improve the 2na PFS. However, more patient samples are urgently needed to validate these findings.

AIM2炎性小体在早期非小细胞肺癌组织中的表达及其作用探讨

目的:观察黑素瘤缺乏因子2(AIM2)炎性小体在早期非小细胞肺癌(NSCLC)组织中的表达及其与临床病理特征的关系,探讨AIM2炎性小体在早期NSCLC发病中的作用及潜在机制。方法:收集57例早期NSCLC的癌组织及其癌旁组织石蜡标本,其中腺癌33例,鳞癌24例,采用免疫组织化学法检测肺癌及癌旁组织中AIM2炎性小体组分AIM2、凋亡相关斑点样蛋白(ASC)、caspase-1的蛋白表达,并检测其下游细胞因子白细胞介素(IL)-1β和IL-18的蛋白表达,分析其与临床病理特征的关系,探讨各蛋白表达之间的相关性。结果:NSCLC癌组织中炎性小体组分AIM2、ASC、caspase-1及IL-1β、IL-18的阳性表达率均明显高于癌旁组织(P<0.01)。AIM2、ASC、caspase-1、IL-1β、IL-18在腺癌中的阳性表达率均高于鳞癌(P<0.05~P<0.01);在低分化、伴有淋巴结转移癌组织中的阳性表达率均分别高于高中分化、无淋巴结转移的癌组织(P<0.05~P<0.01);不同性别、年龄、肿瘤直径癌组织中AIM2、ASC、caspase-1、IL-1β、IL-18的蛋白表达差异均无统计学意义(P>0.05)。在NSCLC癌组织中,AIM2的表达水平与ASC、caspase-1、IL-1β、IL-18的表达水平均呈正相关关系(P<0.05~P<0.01);ASC的表达水平与caspase-1、IL-1β、IL-18的表达水平均呈正相关关系(P<0.05~P<0.01);caspase-1的表达水平与IL-1β、IL-18的表达水平均呈正相关关系(P<0.01和P<0.05)。结论:早期NSCLC癌组织中AIM2炎性小体组分及IL-1β、IL-18表达均上调,且腺癌中AIM2炎性小体的表达高于鳞癌,其表达水平与肿瘤分化程度及有无淋巴结转移有关。

Mediastinal lymphadenectomy influences postoperative immune response after lung cancer surgery

The aim of the study was to calculate the amount of surgical injury caused by systematic lymphadenectomy of mediastinum in patients operated on due to non-small cell lung cancer,with uneventful postoperative course.The study group consisted of 11 patients with cancer of the right lung(Group 1).The control group consisted of 12 patients with left lung cancer(Group 2).In patients with right lung cancer systematic lymphadenectomy,while in patients with left lung cancer systematic sampling was performed.Serum IL-6 and IL-1ra concentration was measured before and after surgery,and on postoperative day 1,3,and 7,as well as in sputum at the end of surgery and in pleural fluid on postoperative day 1,by ELISA test.Peripheral blood lymphocyte(PBL) count was measured with flow cytometry.Time of surgery was higher in patients with right than left lung cancer(154.1±31.29) vs(119.6±24.81) min;P=0.008) .The number of resected mediastinal lymph nodes was higher in patients with right than left lung cancer(27.6±7.6) vs(11.1 ±8.1);P=0.00006) .Postoperative decrease of PBL was significantly higher in group 1 than 2(1.25±0.37) vs(1.75 ±0.64) ×103/μL;P=0.04) .No significant differences were found in serum,pleural fluid and sputum concentration of IL-6 and IL -1ra between groups.Negative correlation between concentration of these cytokines in pleural fluid and number of resected mediastinal lymph nodes was found(Spearman test for IL-6:r=-0.723;P<0.001;for IL-1ra:r=-0.768;P<0.001).Number of "positive" N2 lymph nodes did not correlate with pleural fluid concentration of cytokines.Systematic lymphadenectomy of the mediastinum causes immunosuppression,as measured by decreased count of PBL and a negative correlation between number of resected mediastinal lymph nodes and concentration of cytokines in pleural fluid.

Bioinformatics Identification of ZNFs/LINC00520/miR-181d/BCL2 Axis as a Novel Network in Cisplatin-Resistant Lung Adenocarcinoma Cells

Background: Resistance to cisplatin (DDP) leads to poor prognosis in patients with Lung Adenocarcinoma (LUAD) and limits its clinical application. It has been confirmed that autophagy promotes chemoresistance and, therefore, novel strategies to reverse chemoresistance by regulating autophagy are desperately needed. Methods: The differentially expressed lncRNAs (DElncRNAs), miRNAs (DEmiRNAs), and mRNAs (DEmRNAs) between A549 and A549/DDP cell lines were identified using the limma package in R, after gene expression profiles were obtained from Gene Expression Omnibus (GEO) database. By combining Autophagy-Related Genes (ARGs) from Human Autophagy Database (HADb), the interactions lncRNA-miRNAs and the interactions miRNAs-mRNAs respectively predicted by miRcode and miRDB/Targetscan database, the autophagy-related ceRNA network was constructed. Then, extraction of ceRNA subnetwork and Cox regression analyses were performed. A prognosis-related ceRNA subnetwork was constructed, and the upstream Transcription Factors (TFs) regulating lncRNAs were predicted by the JASPAR database. Finally, the expression patterns of candidate genes were further verified by quantitative real-time polymerase chain reaction (qRT-PCR) experiments. Results: A total of 3179 DEmRNAs, 180 DEmiRNAs, and 160 DElncRNAs were identified, and 35 DEmRNAs were contained in the HADb. Based on the ceRNA hypothesis, we established a ceRNA network, including 10 autophagy-related DEmRNAs, 9 DEmiRNAs, and 14 DElncRNAs. Then, LINC00520, miR-181d, and BCL2 were identified to construct a risk score model, which was confirmed to be a well-predicting prognostic factor. Furthermore, 5 TF ZNF family members were predicted to regulate LINC00520, whereas the RT-PCR results showed that the 5 ZNFs were consistent with the bioinformatics analysis. Finally, a ZNF regulatory LINC00520/miR-181d/BCL2 ceRNA subnetwork was constructed. Conclusions: An ZNFs/LINC00520/miR-181d/BCL2 axis as a novel network in DDP-resistant LUAD has been constructed successfully, which may provide potential therapeutic targets for LUAD.

Expert Consensus on Prevention and Treatment of COVID-19 Infection in Patients with Lung Cancer

Corona virus disease 2019(COVID-19)infection has become a major public health issue affecting human health.The main goal of epidemic prevention and control at the current stage in China is to“protect people’s health and prevent severe cases”.Patients with lung cancer who receive antitumor therapy have low immunity,and the risk of severe illness and death once infected is much higher than healthy people,so they are vulnerable to COVID-19 infection.At present,less attention has been paid to the prevention and treatment of COVID-19 infection in patients with lung cancer in domestic guidelines and consensus.Based on the published data in China and abroad,we proposed recommendations and formed expert consensus on the vaccination of COVID-19,the use of neutralizing antibodies and small molecule antiviral drugs for patients with lung cancer,for physician’s reference.

Intraoperative photodynamic therapy for tracheal mass in non-small cell lung cancer:A case report

BACKGROUND Tracheal neoplasms represent less than 0.1%of all malignancies and have no established treatment guidelines.Surgical resection with reconstruction is the primary treatment.This study demonstrates successful treatment of concurrent lung and tracheal tumors using surgical excision and intraoperative photodynamic therapy(PDT),highlighting the effectiveness and safety of this approach.CASE SUMMARY A 74-year-old male with a history of smoking and chronic obstructive pulmonary disease was diagnosed with tracheal squamous cell carcinoma and right lower lobe adenocarcinoma.A multidisciplinary team created a treatment plan involving tumor resection and PDT.The tracheal tumor was removed through a tracheal incision and this was followed by intraluminal PDT.The trachea was repaired and a right lower lobectomy was performed.The patient received a second PDT treatment postoperatively and was discharged 10 d after the tracheal surgery,without complications.He then underwent platinum-based chemotherapy for lymphovascular invasion of lung cancer.Three-month postoperative bronchoscopy revealed normal tracheal mucosa with a scar at the resection site and no evidence of tumor recurrence in the trachea or lung.CONCLUSION Our case of concurrent tracheal and lung cancers was successfully treated with surgical excision and intraoperative PDT which proved safe and effective in this patient.