Dongrong Situ

Fish Oil-Supplemented Parenteral Nutrition in Patients Following Esophageal Cancer Surgery: Effect on Inflammation and Immune Function

Our aim was to investigate whether adding ω-3 polyunsaturated fatty acids (PUFAs) to parenteral nutrition (PN) could reduce inflammation and improve immune function in patients following esophageal cancer surgery. In this pilot study, 60 patients with esophageal cancer were divided into 2 groups (30 patients in each group). All patients had total scores of more than or equal to 3 on the nutritional risk screening (NRS2002) test recommended by the European Society of Parenteral Enteral Nutrition, which showed that all patients had nutritional risk and should receive nutritional support. Both groups received isocaloric and isonitrogenous PN. One group received a ω-3 PUFAs supplement. Key indicators of inflammation [serum procalcitonin (PCT) level and the ratio of CD4+ to CD8+ (CD4+/CD8+ ratio)] were determined intraoperatively and 24, 72, and 144 h postoperatively. PCT level was notably lower and CD4+/CD8+ ratio was markedly higher in the ω-3 PUFAs group (P = 0.007 for PCT level and P = 0.012 for CD4+/CD8+ ratio) on postoperative day 6 but not on postoperative days 1 and 3. ω-3 PUFAs supplemented PN can reduce inflammation and improve immune function in patients following esophageal cancer surgery. A larger trial is required to see whether ω-3 PUFAs supplementation of PN improves the clinical outcomes of patients following esophageal cancer surgery.

Prognostic impact of pattern-based grading system by the new IASLC/ATS/ERS classification in Asian patients with stage I lung adenocarcinoma

OBJECTIVES We examined the prognostic effect of the grading system based on the new IASLC/ATS/ERS classification in an Asian cohort of patients with early-stage lung adenocarcinoma. MATERIALS AND METHODS Patients with a lung adenocarcinoma less than 3cm in diameter that had undergone complete anatomic resection, diagnosed with pT1a-2aN0M0 consecutively from 2004 to 2013, were enrolled. All specimens were reviewed according to the new IASLC/ATS/ERS classification. The growth patterns were divided into three major categories: grade 1 for lepidic growth, grade 2 for acinar and papillary patterns, and grade 3 for solid and micropapillary patterns. Each tumor was then graded according to the modified grading system, the final score being the sum of the two most predominant grades. The correlations of clinical and pathological factors with disease-free survival (DFS) and overall survival (OS) were evaluated. RESULTS In total, 201 adenocarcinomas were eligible for score grading. Only 37 (18.4%) patients had a pure pathological growth pattern. Higher stage, greater tumor diameter, positive lymphovascular invasion, and a higher score were associated with shorter DFS. In contrast, stage no longer had a significant impact on OS in a multivariable analysis. Acinar/papillary-predominant tumors with a score of 3 or 4 were associated with better survival than those with a score of 5 (5-year DFS rate: 64.68 vs. 44.18%, HR=2.19, 95% CI: 1.24-3.87; 5-year OS rate: 85.61 vs. 68.59%, HR=3.03, 95% CI: 1.25-7.32). CONCLUSION The architectural scores may help to stratify survival differences among certain predominant growth subtypes of adenocarcinoma.

Surgical treatment for limited-stage primary small cell cancer of the esophagus.

BACKGROUND Primary small cell cancer of the esophagus (PSCCE) is a rare, aggressive, and highly metastatic disease. Surgical intervention, radiotherapy, and chemotherapy have been used alone or in combination to improve survival. This retrospective study tried to evaluate the significance of surgical procedures for the treatment of limited-stage PSCCE. METHODS We retrospectively evaluated 44 patients with limited-stage PSCCE who received esophagectomy with lymphadenectomy in our center between 1994 and 2011. The clinical and pathologic characteristics, median survival time (MST), overall survival (OS), and relevant prognostic factors were analyzed. RESULTS The MST in our cohort was 18.0 months (95% confidence interval [CI], 9.6-26.4 months), and the 6-, 12-, 24-, 36-, and 60-month OS rates were 73%, 58%, 39%, 30%, and 18%, respectively. The MST of patients with positive lymph nodes was significantly shorter than that of those with negative lymph nodes (14 months versus 47 months; p = 0.031). Survival analysis confirmed that regional lymph node involvement (relative risk [RR], 5.287; 95% CI, 1.036-26.978; p = 0.045) was an independent prognostic factor. CONCLUSIONS Although the standard treatment protocol for PSCCE has not been established, the results of our study indicated that radical esophagectomy with extended lymphadenectomy should be considered as the primary treatment for patients with limited-stage PSCCE, particularly for those without regional lymph node involvement.

Stage migration and therapy modification after thoracoscopic internal mammary lymph node dissection in breast cancer patients

Although internal mammary lymph node (IMN) status is a major prognostic factor in breast cancer, it is not routinely assessed. To evaluate the impact of IMN status on staging and treatment of breast cancer, we enrolled 50 consecutive patients with inner or central tumors who received IMN dissection by video-assisted thoracoscopic surgery (VATS) after breast surgery. Of the 50 patients, 20 (40%) had IMN metastases. Of the 20 patients, 6 (12%) were upstaged from N0 to N2b and 5 (10%), 3 (6%) and 6 patients (12%) were upstaged from N1a, N2a, and N3a, respectively, to N3b. Because of the upstaging, 6 patients (12%) with only IMN metastases received more aggressive adjuvant chemotherapy. Because the whole IMN chain was removed in all patients, radiotherapy on IMN field was not required in our cohort independent of IMN status. In conclusion, VATS IMN dissection might lead to stage migration and therapy modification.

Do tumor location and grade affect survival in pT2N0M0 esophageal squamous cell carcinoma

BACKGROUND The TNM staging system for esophageal cancer in the seventh edition of the AJCC Cancer Staging Manual incorporates tumor grade and location for staging pT2-3N0M0 esophageal squamous cell carcinoma. Patients with pT2N0M0, classified as stage IIA according to the sixth edition of the AJCC Cancer Staging Manual, can now be classified as stage IB, IIA, or IIB. We discuss whether these changes lead to a better prediction of the prognosis of these patients and aimed to find out other factors to forecast patient prognosis. METHODS We retrospectively analyzed 317 patients with postoperative pathologic stage T2N0M0 who underwent esophagectomy between 1990 and 2005 at Sun Yat-sen University Cancer Center. We performed univariate and multivariate analyses to identify prognostic factors for survival and used the Kaplan-Meier method to demonstrate the prognostic efficacy of each prognostic factor, including tumor grade and location. RESULTS The 5-year overall survival was 57%, with a median survival of 84.5 months (6.94 years). Univariate analysis indicated that age, alcohol consumption, and tumor grade were associated with survival. Multivariate Cox proportional hazard regression analysis revealed that alcohol consumption and tumor grade were independent prognostic factors. Survival analysis using the Kaplan-Meier method demonstrated age, cigarette smoking, alcohol consumption, tumor grade, and location as prognostic factors. CONCLUSIONS For pT2N0M0 esophageal squamous cell carcinoma, the seventh edition of the AJCC Cancer Staging Manual does not provide a more distinguishable prediction of prognosis compared with the sixth edition. Tumor grade is an independent prognostic factor in patients with pT2N0M0 esophageal squamous cell carcinoma, whereas tumor location is not. Furthermore, alcohol consumption is an independent prognostic factor that may imply a worse prognosis.

Assessment and treatment of cancer pain: from Western to Eastern

Satisfactory control of the cancer pain remains the single most important element in palliative care, as failure of pain relief is a major threat to the quality of life. Inadequate classification and assessment would unavoidably lead to inappropriate and impractical treatment of cancer pain, which has been a striking challenge in cancer clinical practice for the past several decades. While the cancer pain characteristics are influenced by physiological, psychological, pathological, cultural and even social factors, a comprehensive assessment and an individualized plan of care should be provided throughout the course of illness. This review attempted to describe the framework, illustrate the present evidence supporting current classification methodologies and assessment approaches, and demonstrate the advance in multidisciplinary interventions for cancer pain syndrome, including Western and Traditional Chinese medicine.

Analysis of differently expressed proteins involved in metastatic niche of lung

The “seed and soil” hypothesis for metastasis was a pivotal milestone in the study of malignant disease. Recently, growing studies have focused on the tumor secretory factors that may mediate preparation of the “metastatic soil.” A suitable environment for the metastatic lesions was created by many inflammatory cytokines in the lung, whichwas verified by in vivo experimental models. In 2005, a pre‐metastatic niche and metastatic niche modelwere suggested by David Lyden and Bethan Psaila, to delineate the interactions between malignant cells and their microenvironment at the metastatic site, whichsoon became the most importanthypothesis. However, the evidence is limited to animal models. More clinical evidence is needed to support this hypothesis.

Thoracoscopic Internal Mammary Lymph Node Dissection: A Video Demonstration

BackgroundInternal mammary lymph node (IMN) metastasis in breast cancer is a well-established prognostic factor of similar importance to axillary lymph node status. Although randomized controlled trials in the 1970s failed to show a survival benefit of IMN dissection during extended radical mastectomy, they did demonstrate diminished survival of patients with IMN metastasis.1,2 The 2011 National Comprehensive Cancer Network Clinical Practice Guidelines recommend radiotherapy to the IMN chain that is clinically or pathologically positive. However, the direct contribution of IMN irradiation to improved survival is still controversial, while it may contribute to the increased risk of relevant cardiac mortality.3–5MethodsThoracoscopic internal mammary node dissection is a novel minimally invasive technique to assess and treat IMN metastasis. It ensures that the whole IMN chain is excised for histological evaluation, and therefore, no further irradiation of these regional nodes is needed.ResultsThis procedure is indicated in the following instances: operable invasive breast cancer; all medial or central tumors; lateral tumors with involved axillary lymph nodes; primary internal mammary lymphatic drainage detected by lymphoscintigraphy; and no contraindications to thoracoscopic surgery, including the inability to tolerate single-lung ventilation and extensive pleural adhesion.ConclusionsThoracoscopic internal mammary node dissection is a feasible procedure designed to provide simultaneous assessment and management of IMN metastasis. However, a larger study cohort with long-term follow-up is required to verify its safety and clinical significance.

Characterization of a stem cell population in lung cancer cell line Glc-82

Objectives:  A side population (SP) of cells can be separated from diverse cancer cell lines by a fluorescence‐activated cell sorter (FACS) and show stem cell‐like characteristics. To gain more information about SP phenotypes, we performed a series of characterizations of SP cells.

Clinical model to estimate the pretest probability of malignancy in patients with pulmonary focal Ground-glass Opacity

Effective strategies for managing patients with pulmonary focal Ground‐glass Opacity (fGGO) depend on the pretest probability of malignancy. Estimating a clinical probability of malignancy in patients with fGGOs can facilitate the selection and interpretation of subsequent diagnostic tests.