Jianjun Qin

A randomized clinical trial of preoperative neoadjuvant chemotherapy followed by surgery in the treatment of stage III non-small cell lung cancer

BACKGROUND To explore the feasibility and toxicity of preoperative neoadjuvant chemotherapy followed by surgery in the treatment of stage III NSCLC and to evaluate its effects on tumor response, resection rate, tumor downstaging, and survival rate. METHODS From Jan. 1990 to Jan. 2001, 624 patients were randomly devided into group A ( preoperative neoadjuvant chemotherapy group) and group B ( control group, without neoadjuvant chemotherapy) . Group A had 314 patients and group B had 310 cases. The patients in group A were give 2 cycles of neoadjuvant chemotherapy, and operations were performed in 4 weeks after finishing the last chemotherapy. Twenty-one patients were given bronchial artery intervensional chemotherapy. The other 293 cases were given intravenous chemotherapy. The regimens included MVP in 68 cases, CAP in 36 cases, EP in 67 cases, VIP in 20 cases, Gem+ DDP in 30 cases, NVB+ DDP in 32 cases, Taxol+ NVB in 30 cases, and Taxol+ DDP in 10 cases. The patients in group B were firstly operated. Thoracic radiation therapy of 50-55 Gy was g iven in the patients with N1 and N2 disease both in group A and group B. RESULTS The tumor response to induction chemotherapy was 73. 57%( 231/ 314) in group A. The tumor downstaging was 43. 63%( 137/ 314) . The histological complete response was 15. 92%( 50/ 314) . The resection rate was 97. 69% in group A, and 91. 94% in group B. No significant differences of blood loss, operative complications and mortality were observed between the group A and group B. The 1-, 3-, 5- and 10-year survival rates were 89. 35%, 67. 46% , 34. 39% and 29. 34% in group A, and 87. 53%, 51. 54%, 24. 19% and 21. 64% in group B respectively. The long-term survival rate in group A was remarkably higher than that in group B ( P < 0. 01) . CONCLUSIONS The results demonstrate that the preoperative neoadjuvant chemotherapy is safe and effective. It is helpful to decrease the tumor staging , to increase the resection rate of the tumor, and to improve the long-term survival rate and life qualities of patients with stage III NSCLC.

[Lobectomy or pneumonectomy combined with extended resection of the heart, great vessels in the treatment of locally advanced lung cancer].

BACKGROUND To summarize the results of extended resection of the heart, great vessels, or both in the treatment of 349 patients with locally advanced lung cancer. METHODS From February , 1983 to December, 2000, lobectomy or pneumonectomy combined with extended resection of the heart, great vessels or both were carried out in 349 patients with locally advanced lung cancer. The operations included bronchoplastic procedures and pulmonary artery reconstruction in 205 cases, extended resection of left atrium in 75 cases, superior vena cava resection and reconstruction in 65 cases ( 3 patients had carina resection and reconstruction simultaneously) , and aorta resection and reconstruction in 4 cases respectively. RESULTS There were two operative death. The operative mortality was 0. 6% in the series. Fifty-three patients had operative complications. The 1, 3, 5 and 10-year survival rates were 79. 36%, 59. 93%, 33. 14% and 23. 56% respectively. CONCLUSIONS Extended resection of the heart, great vessels or both can remarkably increase the long-term survival and improve the prognosis in patients with locally advanced lung cancer. Lobectomy or pneumonectomy combined with extended resection of the heart, great vessels in the treatment of locally advanced lung cancer.

Bronchoplastic procedures and pulmonary artery reconstruction in the treatment of stage III lung cancer invading pulmonary artery

BACKGROUND To summarize the clinical results of bronchoplastic procedures and pulmonary artery reconstruction or combined with other resection and plasty of heart, great vessels in the treatment of 304 patients with locally advanced lung cancer. METHODS From February, 1983 to December, 2001, double sleeve resection and reconstruction of bronchus and pulmonary artery, or combined with other resection of heart, great vessels were carried out in 304 patients with locally advanced lung cancer. The operations included double sleeve left upper lobectomy in 199 cases; double sleeve right upper lobectomy in 21 cases; double sleeve right upper middle lobectomy in 14 cases; double sleeve left upper lobectomy combined with resection of left atrium in 8 cases; double sleeve right upper lobectomy combined with superior vena cava (SVC) resection and reconstruction with Gortex graft in 29 cases; double sleeve right upper middle lobectomy combined with SVC resection and reconstruction in 21 cases; double sleeve right upper middle lobectomy, carinal and SVC resection and reconstruction in 11 cases; left pneumonectomy combined right main pulmonary artery and pulmonary artery trunk resection and reconstruction with Gortex graft in 1 case. RESULTS There were 3 operative deaths. The operative mortality was 1% in this series. Sixty four patients had operative complications. The operative complication rate was 21.05% (64/304). The 1-, 3-, 5- and 10 year survival rates were 81.75%, 60.14%, 37.21% and 24.39% respectively. CONCLUSIONS Double sleeve lobectomy or comblined with other resection and reconstruction of heart, great vessels can significantly improve the prognosis and increase the curative rate and long term survival in patients with locally advanced lung cancer.

A study on the allelic deletion and mutation of FHIT gene in human non-small cell lung cancer

BACKGROUND To explore the role of the allelic deletion and mutation of FHIT gene on the carcinogenesis and development of lung cancer. METHODS The allelic alterations of FHIT gene and microsatellites D3S1300, D3S1312,D3S1313 were detected in 35 cancer samples of NSCLC, their corresponding normal tissues, and 4 lung cancer cell lines, and 10 lung tissues of benign pulmonary lesions as control by PCR-SSCP and DNA sequence. RESULTS Loss of heterozygosity (LOH) affecting at least one locus of FHIT gene was observed in 22 out of 35 tumors, with a LOH rate of 62.86%. LOH of FHIT gene in squamous cell carcinoma (88.24%) was significantly higher than that in adenocarcinoma (38.89%) (P<0.01). The LOH rate of FHIT gene in smoking patients (76.19%) was also significantly higher than that in non-smoking patients (42.86%)(P<0.05).No significant relationship was found among the LOH of FHIT and cell differentiation, P-TNM stages, size of primary tumor, location of cancer and age of the patients (P>0.05). LOH of FHIT was also detected in Lewis lung cancer and A549 cell lines. Mutation of microsatellite D3S1312 was observed in 4 lung cancer tissues. DNA sequence showed that C->T mutation occurred in the 87 codon of microsatellite D3S1312. CONCLUSIONS The alteration of FHIT gene is mainly allelic loss and the frequency of allelic mutation is rare. FHIT gene alterations preferentially occur in squamous cell carcinoma patients and smokers, and FHIT gene may be a candidate molecular target of carcinogenesis in tobacco smoker. Allelic deletion of FHIT gene might be an early molecular event in smoking-related lung cancer.

Construction of adenoviral vector carrying Smad3D or Smad7

BACKGROUND To construct recombinant adenoviral vector carrying Smad3D or Smad7 by a simplified means. METHODS Based on AdEasy System, adenoviral backbone plasmid vector and shuttle vector carrying the gene of interest were transferred into E.coli BJ5183 by chemical transformation methods in special order. The homologous recombination was performed. RESULTS Recombinant adenoviral vector pAd-Smad3D and pAd-Smad7 were constructed successfully, which were confirmed by restriction enzyme digesting. CONCLUSIONS Recombinant adenoviral vector may be constructed quickly and efficiently in E.coli by sequential chemical transformation methods.

Reduction of FHIT gene expression in primary lung cancer

BACKGROUND To investigate the role of FHIT (fragile histidine triad) gene in oncogenesis and progression of human lung cancer. METHODS The expression of FHIT gene was detected in 166 lung cancer samples and 37 benign pulmonary lesion tissues as control by immunohistochemistry. RESULTS The positive rate of FHIT expression in lung cancer tissues was 63.03%±26.41%, which was significantly lower than that in tisssues adjacent to cancer (83.74%±17.46%) (P < 0.01 ), and both positive rates in cancer tissues and tissues adjacent to cancer were significantly lower than that in benign lesion tissues (92.98%±5.56%)(P < 0.01). The expression level of FHIT gene was closely related to histological classification, cancer cell differentiation, P TNM stages and lymph node involvement in lung cancer patients (P < 0.05). The positive rate of FHIT expression in smoking lung cancer patients was remarkably lower than that in non smoking ones ( 55.14% ±27.55% vs 71.93%±22.05%, P < 0.01). The postoperative survival time in patients with high FHIT expression was significantly longer than those with low expression (P < 0.05). CONCLUSIONS Reduction of FHIT gene expression might be associated with the oncogenesis and progression of human lung cancer; Smoking may be one of the important reasons of reduction of FHIT gene expression in lung cancer patients.

A study on transcript a bnormalities of FHIT gene in human non-small cell lung cancer

Objective To explore the role of abnormalities in RNA transcript of FHIT gene in human non-small cell lung cancer(NSCLC) . Methods Transcript abnormalities of FHIT gene were detected in 35 cancer samples and their corresponding paracancer tissues and normal tissues, four lung cancer cell lines, and 10 lung tissues of benign pulmonary lesions as control by nested RT-PCR. Results Fourteen of 35 cancer tissues ( 40%) had abnormalities in RNA transcripts of FHIT. There were 5 paracancer tissues with transcript abnormalities of FHIT gene out of the 14 lung cancers with transcript abnormalities of FHIT gene, with an abnormality rate of 35. 71%. All of 4 lung cancer cell lines had transcript abnormalities of FHIT gene. The aberrant rate of FHIT gene in squamous cell carcinoma tissues ( 58. 82%) was significantly higher than that in adenocarcinoma tissues ( 22. 22%) ( P 0. 05) . Conclusion The results show that there are transcript abnormalities of FHIT gene in NSCLC. FHIT transcript abnormality preferentially occur in squamous cell carcinomas, and it might be the earlymolecular phenomenon of lung cancer. DOI: 10.3779/j.issn.1009-3419.2000.04.02

Detection of micro-vascular density(MVD) and its clinical significance in lung cancer

BACKGROUND To study the relationship between MVD of lung cancer tissues and the pathophysiological characteristics and prognosis in patients with lung cancer. METHODS The MVD was detected in 114 lung cancer tissues, 30 benign pulmonary tissues by immunohistochemical staining (LSAB method). RESULTS MVD in lung cancer tissues (30.47+/-10.56) was significantly higher than that in benign pulmonary tissues (10.23+/-6.92)(P<0.01); The MVD was closely related to the size of primary cancer, lymph node status, P-TNM stages, grade of cell differentiation of lung cancer (P<0.01), but not to the histological classification and site of the cancer, and age, sex and smoking or not in the patients with lung cancer (P<0.05); The 5-year survival rate in patients (17.27%) with high MVD (>=30) was significantly lower than that in patients (52.74%) with low MVD (<30)(P<0.01); The survival time of patients with lung cancer was negatively related to MVD (r=-0.521,P<0.01); The results of multivariable COX model showed that the P-TNM and MVD were the most significant variables for predicting prognosis among the all related factors in lung cancer. CONCLUSIONS Increase of MVD may play an important role in the oncogenesis, development, metastasis of lung cancer and might be served as a tumor marker to evaluate the biological behavior of lung cancer. Detection of MVD might be helpful to predict prognosis and guide the postoperative multi-modality therapy in patients with lung cancer.

Risky factors of post-operative respiratory failure in patients with lung cancer

BACKGROUND To analyze the risky factors of post-operative respiratory failure in patients with lung cancer. METHODS Thirty-six cases of lung cancer with post-operative respiratory failure and 72 controls were analyzed by Chi-Square analysis and Logistic Regression. RESULTS MVV , RV/ TLC , FEV1 , BR , V25 , MMEF and DLCO in respiratory failure group were all significantly lower than those in control group ( P < 0. 05) . The post-operative chest drainage and perioperative intravenous perfussion in respiratory failure group were significantly more than those in control group ( P < 0. 05) . The odds of respiratory failure was much lower in sleeve resection and lobectomy group than in pneumonectomy group. CONCLUSIONS Severe obstruction of small airway , diffusion capacity and large amount perioperative intravenous infusion are the risky factors of post-operative respiratory failure in lung cancer patients , and bronchoplastic or/ and pulmonary artery reconstruction as a curative operation can significantly prevent the post-operative respiratory failure.