Xiayi Lv

Segmentectomy or lobectomy for early stage lung cancer: a meta-analysis

Early stage lung cancer is routinely treated by lobectomy whenever clinically feasible, whereas the role of segmentectomy is controversial. The purpose of this study was to investigate the benefits of segmentectomy vs lobectomy for early stage lung cancer through a meta-analysis of published data. Eligible studies were identified from MEDLINE through February 2013. The manual selection of relevant studies was based on the summary analysis. We used published hazard ratios (HRs) if available or estimates from the published survival data. Lobectomy was chosen as the reference in all HR calculations. We compared the effect of segmentectomy and lobectomy for Stage I, Stage IA, Stage IA with tumours larger than 2 cm but smaller than 3 cm in size and Stage IA with tumours of 2 cm or smaller in 22 observational studies. The HRs of overall and cancer-specific survival indicated significant benefits of lobectomy for Stage I, Stage IA and Stage IA with tumours larger than 2 cm but smaller than 3 cm at 1.20 (95% confidence interval [CI] 1.04-1.38; P = 0.011), 1.24 (95% CI 1.08-1.42; P = 0.002) and 1.41 (95% CI 1.14-1.71; P = 0.001), respectively. For tumours 2 cm or smaller, segmentectomy provided an effect equivalent to that of lobectomy (HR 1.05; 95% CI 0.89-1.24; P = 0.550). No significant publication bias was detected in any part of the analysis. These findings should be interpreted in the context of the inherent limitations of meta-analyses of retrospective studies, including the heterogeneity of patient characteristics.

Down-Regulation of MiR-1294 is Related to Dismal Prognosis of Patients with Esophageal Squamous Cell Carcinoma through Elevating C-MYC Expression

Aims: Changes in the expression of microRNAs (miRNAs) have been found in many cancers. This study aimed to investigate the expression of miR-1294 in patients with esophageal squamous cell carcinoma (ESCC) and its effect on prognosis. The underlying mechanism was explored as well. Methods: We examined the expression of miRNA in human ESCC cancer tissues and adjacent non-tumor controls using quantitative reverse transcription polymerase chain reaction (qRT-PCR). And the relationship between expressions of miR-1294 and ESCC prognosis was analyzed in this study. Over-expression and knock-down methods were used to investigate the biological functions of miRNA-1294. The effect of miRNA-1294 on cell proliferation was evaluated by MTT. Besides, the function of miR-1294 on cell migration and invasion were evaluated by transwell assays. Results: MiR-1294 was significantly down-regulated in human ESCC tissues compared with the non-tumor controls tissues (P=0.014). And patients with low miR-1294 expression had a significantly poorer prognosis than those with a high miR-1294 expression (P=0.040). Negative association was defined between the expression of miR-1294 and the c-MYC expression in ESCC patients (Pearson correlation, r=-0.299, P=0.0079). Additionally, it was found that miR-1294 suppress esophageal cancer cells proliferation, migration and invasion capacity through targeting c-MYC in vitro. Conclusions: Down-regulation of miR-1294 correlates with poor prognosis of ESCC. Its partially due to the reduced function of c-MYC. This study may give insight into the understanding of pathogenesis of esophageal cancer and provide evidence for diagnosis and treatment of esophageal cancer.

Bilateral thoracotomy for removal of uncommon postmediastinal multi‐schwannomas

Postmediastinal schwannoma is a kind of neurogenic tumor originating from the neuron sheath in the posterior mediastinum. In the majority of cases these tumors are located in the paravertebral sulcus and the incidence is similar in both sides of the thorax as single or multiple; however, multi‐schwannomas involved in the bilateral postmediastinum are rare. We report a case of postmediastinal multi‐schwannomas and discuss the clinical and surgical treatment. We are aware of no previously published reports on this rare condition.

Primary cardiac synovial sarcoma

Abstract  Synovial sarcomas are rare tumors and account for only 3% of cardiac malignancies. In this report, we present a case of a primary synovial sarcoma of the left ventricle. (J Card Surg 2010;25:288‐290)

Predictive risk factors for lymph node metastasis in patients with small size non-small cell lung cancer

BACKGROUND Accurate clinical staging of non-small cell lung cancer (NSCLC) is essential for developing an optimal treatment strategy. This study aimed to determine the predictive risk factors for lymph node metastasis, including both N1 and N2 metastases, in clinical T1aN0 NSCLC patients. METHODS We retrospectively evaluated clinical T1aN0M0 NSCLC patients who showed no radiologic evidence of lymph node metastasis, and who had undergone surgical pulmonary resection with systematic mediastinal node dissection or sampling at the First Affiliated Hospital of Zhejiang University between January 2011 and June 2013. Univariate and multivariate logistic regression analyses were performed to identify predictive factors for node metastasis. RESULTS Pathologically positive lymph nodes were found in 16.2% (51/315) of the patients. Positive N1 nodes were found in 12.4% (39/315) of the patients, and positive N2 nodes were identified in 13.0% (41/315) of the patients. Some 9.2% (29/315) of the patients had both positive N1 and N2 nodes, and 3.8% (12/315) of the patients had nodal skip metastasis. Variables of preoperative radiographic tumor size, non-upper lobe located tumors, high carcinoembryonic antigen (CEA) levels and micropapillary predominant adenocarcinoma (AC) were identified as predictors for positive N1 or N2 node multivariate analysis. CONCLUSIONS Pathologically positive lymph nodes were common in small size NSCLC patients with clinical negative lymph nodes. Therefore, preoperative staging should be performed more thoroughly to increase accuracy, especially for patients who have the larger size, non-upper lobe located, high CEA level or micropapillary predominant ACs.

Distribution and prognosis of mediastinal lymph node metastases of nonsmall cell lung cancer

BACKGROUND AND OBJECTIVE With the popularity of minimally invasive techniques, preoperatively determining whether mediastinal lymph node dissection (MLD) is necessary for patients with cN1/2 nonsmall cell lung cancer (NSCLC) has sparked controversy once again. This study aims to analyze whether different primary sites are associated with the distribution of mediastinal lymph node metastases and to investigate the necessity of lymph node dissection and the factors influencing prognosis. MATERIALS AND METHODS One hundred and thirteen patients with pathologically confirmed NSCLC with N2 lymph node metastases were included in the study and were grouped according to the lung lobes, in which primary lesions were located for statistically analyzing the metastatic rates of different mediastinal lymph node stations. Through a 3-year follow-up survey, risk factors influencing the 3-year postoperative survival were analyzed. RESULTS N2 stations with the highest metastasis rate for different pulmonary lobes were Station 2/4 of the right upper lobe (100%), Station 7 of the right middle/lower lobes (80.0%/88.9%), Station 5 of the left upper lobe (84.4%), and Station 7 of the left lower lobe (78.6%). Three-year survival rate of the cross-regional N2 group was lower than the total N2 group (47.8% vs. 75.3%), P = 0.009 (<0.01). Three-year survival rates for preoperative stages T1 and T2 were superior to stages T3 and T4, showing significant differences (P < 0.05). CONCLUSION Station 7 is likely the most frequently metastases sites in all mediastinal lymph node stations. Cross-regional metastasis of N2 and staging of T3 and T4 were the risk factors for 3-year survival rate, whereas poor differentiation was not the risk factor. Due to the presence of micrometastases and skip metastases, MLD was first recommended for patients with preoperative stage cN1/2.

Resection of an Invasive Thymoma Extending into the Superior Vena Cava and Right Atrium

Abstract  Although invasive thymoma commonly infiltrates mediastinal structures, intracardiac extension from intracaval growth is rare. We present a case of invasive thymoma with intravascular invasion of the superior vena cava extending into the right atrium. (J Card Surg 2010;25:515‐517)

Clinical Application of CT-guided Preoperative Pulmonary Nodule Localization Technique

BACKGROUND AND OBJECTIVE Its difficult to localize the accurate position for some pulmonary nodules in video-assisted thoracoscopic surgery (VATS) wedge resection. The aim of this study is to retrospectively analyze the clinical significance of CT-guided preoperative pulmonary nodule localization technique. METHODS Between Jan 2010 and Apr 2011, 20 patients of the First Affiliated Hospital of Medical School of Zhejiang University underwent preoperative pulmonary nodule localization technique before performing VATS wedge resection of the pulmonary nodule. Diameter of the lesion ranges from 0.5 cm to 2 cm (average 9.8 cm±5.3 cm). It was evaluated with the success rate in localization technique, rate of localization related complications, and rate of transferring thoracotomy. RESULTS Eighteen patients underwent successful CT-guided Hookwire localization, with the average time of 14.5 minutes. There was no serious complications. CONCLUSION CT-guided preoperative pulmonary nodule localization is a promising technique for small solitary pulmonary nodules. It could play an important role in accurate localization of small pulmonary nodules, and it is a safe technique with less postoperative complications.

Is thymomectomy sufficient for non-myasthenic early stage thymoma patients? A retrospective, single center experience

Thymic complete resection is considered the standard treatment for all thymic tumors; however, the ideal resection for non‐myasthenic early stage thymic tumors has not yet been determined. We conducted a retrospective study to examine this unique scenario.

Survival rates after lobectomy versus sublobar resection for early-stage right middle lobe non-small cell lung cancer: Surgery for middle lobe lung cancer

Lung cancer in the right middle lobe has a poorer prognosis than tumors located in other lobes. The optimal surgical procedure for early‐stage non‐small cell lung cancer (NSCLC) in the right middle lobe has not yet been elucidated. The aim of this study was to compare survival rates after lobectomy and sublobar resection for early‐stage right middle lobe NSCLC.