Xiangyang Chu

Survival benefit of neoadjuvant chemotherapy in non-small cell lung cancer: an updated meta-analysis of 13 randomized control trials

Introduction: The survival effectiveness of neoadjuvant chemotherapy in non-small cell lung cancer (NSCLC) is still unclear based on the study of most up-to-date literatures. This article contributes to this problem by conducting an updated meta-analysis. Methods: Based on Burdett et als (J Thorac Oncol 2006;1:611–621) systematic review, this meta-analysis was conducted. Articles were searched electrically. The possible survival benefit of neoadjuvant chemotherapy was assessed by hazard ratio (HR) in terms of overall survival. A subgroup meta-analysis with only stage III NSCLC was also conducted. The software of Review Manager was used for data management. Results: Thirteen randomized control trials, 6 of which were new ones, were included into this meta-analysis. The overall survival of NSCLC patients in neoadjuvant chemotherapy arm were improved significantly, comparing with those in surgery-alone arm (combined HR = 0.84; 95% confidence interval, 0.77–0.92; p = 0.0001). When only patients with stage III NSCLC were considered, the result was similar (combined HR = 0.84; 95% confidence interval, 0.75–0.95; p = 0.005). Conclusion: Neoadjuvant chemotherapy, as an addition of surgery, would significantly improve the overall survival of operable NSCLC patients, including patients with stage III NSCLC.

miR-143 inhibits NSCLC cell growth and metastasis by targeting Limk1

MicroRNAs (miRNAs) have essential roles in carcinogenesis and tumor progression. Here, we investigated the roles and mechanisms of miR-143 in non-small cell lung cancer (NSCLC). miR-143 was significantly decreased in NSCLC tissues and cell lines. Overexpression of miR-143 suppressed NSCLC cell proliferation, induced apoptosis, and inhibited migration and invasion in vitro. Integrated analysis identified LIM domain kinase 1 (Limk1) as a direct and functional target of miR-143. Overexpression of Limk1 attenuated the tumor suppressive effects of miR-143 in NSCLC cells. Moreover, miR-143 was inversely correlated with Limk1 expression in NSCLC tissues. Together, our results highlight the significance of miR-143 and Limk1 in the development and progression of NSCLC.

Congenital Bronchial Atresia: Diagnosis and Treatment

This study aimed to retrospectively summarize the clinical signs, diagnosis, and treatment of congenital bronchial atresia (CBA) in 12 patients. Chest radiographs and computed tomographic (CT) images of 12 patients with CBA treated in the Chinese Peoples Liberation Army General Hospital were reviewed. Analysis of chest radiographs revealed ten patients had hilar mass-like shadows and two had pneumonia-like shadows; most patients (n = 8) showed hyperlucency of the peripheral lung fields. CT revealed a mucocele in all the patients (n = 12); the mucoceles were round in four patients and club-like in eight. In 80% of the cases (n = 10), associated anomalies, including occlusions of the bronchus central to the mucocele, emphysematous changes of the peripheral lung fields, bronchogenic cyst, and anomalous branching of the bronchial tree and vascular structure were observed. CBA was detected in the right lobe in eight patients and the left lobe in the remaining four. No surgical intervention was performed in 5 CBA patients and the remaining 7 patients underwent surgery, including lobectomy in 5 patients and local resection in 2 patients. Among these 7 patients, 3 had a preoperative diagnosis of malignant disease, and the remaining 4 had severe clinical symptoms that could not be effectively treated by medicines. All patients were followed up, and none experienced obvious discomfort. CBA is a relatively rare and benign malformation disease. Chest CT is the procedure of choice for diagnosis. The presence of a bronchocele and surrounding emphysematous changes are typical radiologic findings in CBA. Surgery should be reserved only for patients with serious complications secondary to the atretic bronchus.

[Primary report of lobectomy with single utility port complete video-assisted thoracoscopic surgery].

BACKGROUND AND OBJECTIVE Video-assisted thoracoscopic surgery (VATS) has been widely used in the diagnosis and treatment of chest diseases. The aim of this study was to explore the feasibility and clinical value of lobectomy with single utility port complete VATS. METHODS From September 2009 to December 2009, 21 cases underwent lobectomy with single utility port complete VATS. Of 21 patients, right upper lobectomy was 12 cases, left lower lobectomy 5 cases, right lower lobectomy 2 cases, left upper lobectomy 1 case, right middle lobectomy 1 case. RESULTS The operation process were smooth in all patients and without conversion to thoracotomy. The mean operative time was (132.7 +/- 16.2) min and the mean intraoperative blood loss was (110.5 +/- 24.6) mL. The average chest tube drainage time was (3.1 +/- 1.3) d, and the mean hospitalization day was (5.2 +/- 3.2) d. All patients recovered smoothly and without severe complications. There were no post-operative deaths. CONCLUSION Lobectomy with single utility port VATS is technically feasible and has the advantages of minimal invasive and rapid recovery.

Lung cancer presenting as thin-walled cysts: An analysis of 15 cases and review of literature.

Lung cancer presenting as cysts is a rare entity in clinical practice. Differential diagnosis is difficult in the benign‐like cyst.

Video-assisted thoracoscopic surgery thymectomy versus open thymectomy in patients with myasthenia gravis: a meta-analysis

Abstract Background: Video-assisted thoracoscopic surgery (VATS) thymectomy has become a feasible treatment for myasthenia gravis (MG) in recent years. The objective of the present meta-analysis was to evaluate the perioperative characteristics, safety, and completely stable remission rate in patients with MG who received VATS or open thymectomy (OT). Methods: We searched PubMed, Embase, ScienceDirect, Web of Science, and CNKI for related articles using combinations of the search terms video-assisted thoracoscopic thymectomy, transsternal thymectomy, and MG. The inter-study heterogeneity was assessed by χ2-based Q statistics, and the extent of inconsistency was generated by I2 statistics. Results: A total of 12 studies with 1173 patients were included, and there was no difference in the operation time (p = 0.08) and ICU time (p = 0.14) between the two groups, but VATS thymectomy was associated with less intra-operation blood loss and hospital time (p < 0.00001). VATS was also associated with lower rates of total complication (OR =0.59; 95% CI, 0.37–0.94; p = 0.03) and myasthenic crisis (OR = 0.51; 95% CI, 0.28–0.92; p = 0.03), but the rates of pneumonia (OR = 0.59; 95% CI, 0.29–1.32; p = 0.21) and complete remission rate (CSR) (OR = 0.64; 95% CI, 0.38–1.09; p = 0.10) had no obvious differences between the VATS and OT groups. Conclusion: Patients with MG undergoing VATS thymectomy achieved better surgical outcomes and fewer complications than those who received OT.

Sternum bone giant cell tumor resection and chest wall reconstruction after the excision of breast cancer

Giant cell tumor (GCT) is generally treated with wide surgical excision, but the local bone tissue dysfunction is a major complication. Here, we report a sternum GCT patient who had previously undergone a mastectomy. The tumor was excised, and the patient accepted chest wall reconstruction. The patient recovered well and suffered no recurrence at the first year follow-up.

Small satellite pulmonary nodules in operable lung cancer: Diagnosis and therapeutic strategy

Objective: The use of high-resolution computed tomography (HRCT) has improved the management of non-small cell lung cancer (NSCLC), but has also increased the detection of indeterminate satellite nodules. Obtaining differential diagnosis of nodules less than 10 mm is difficult but essential for choosing optimal therapeutic strategies. Here, we evaluated the characteristics of small satellite nodules in patients with operable NSCLC and examined the optimal diagnostic and therapeutic approach in patients with small satellite nodules. Methods: Using data from a prospective database, all surgically treated patients diagnosed with NSCLC from 2008 to 2011 were retrospectively reviewed. Patients presenting with small pulmonary non-GGO nodule(s) were identified. Results: A total of 1206 patients underwent complete resection for NSCLC, out of which 45 patients presented with 60 nodules less than 10 mm on thoracic CT. Twenty-six nodules (43%) were malignant, 31 (52%) were benign, and 3 (5%) were of undetermined nature. Tumor histology (adenocarcinoma vs. nonadenocarcinoma), TNM stage (advanced stage vs. early stage), and nodule size (6–10 vs.  5 mm) were associated with nodule malignancy. The incidence of metastatic nodules in patients with stage III NSCLC was significantly higher than that in patients with stage I NSCLC. In contrast, the incidence of multiple primary lung cancers in patients with stage I NSCLC was significantly higher than that in patients with stage III NSCLC. Conclusion: Differential diagnosis of indeterminate satellite lesions in patients with operable NSCLC is critical. Surgery should be performed cautiously in patients with stage III NSCLC having nodules larger than 5 mm.