BACKGROUNDLung cancer with intramedullary spinal cord metastasis(ISCM) is a rare event,which showes poor response to treatment.Its optimum treatment remains controversial.The objective of this study is to investigate the clinical features,diagnosis and treatment of lung cancer with ISCM.

METHODSThe diagnosis and treatment of two cases of lung cancer with ISCM in 2005 were reported retrospectively and some related literatures were reviewed.

RESULTSThe diseases of the two cases progressed fast,and their responses to treatment were poor.

CONCLUSIONSThe clinical feature of lung cancer with ISCM is untypical.Magnetic resonance imaging is now considered the most important method for diagnosis of ISCM.Radiotherapy is the major treatment.Its prognosis is still poor.

BACKGROUNDThe role of Traditional Chinese Medicine(TCM) is recognized in treatment of non-small cell lung cancer.The aim of this study is to evaluate the efficacy of TCM serving as consolidation treatment in patients with advanced non-small cell lung cancer.

METHODSOne hundred and sixty-two patients with advanced non-small cell lung cancer were divided into two arms.Arm A(observation arm):81 cases,TCM serving as consolidation treatment after conventional treatment;Arm B(control arm):81 cases,only conventional treatment,no TCM serving as consolidation treatment.The TCM was given according mainly to the syndrome differentiation.Four types were found in the arm A:lung and spleen-qi deficiency type,the lung heat and phlegm-dampness type,the lung-yin and stomach-yin deficiency type,and the qi stagnation with blood stasis type.

RESULTS1-,2-,3-and 5-year survival rate accounted for 70.3%,37.0%,20.9% and 8.6% in arm A,and 61.7%,20.9%,8.6% and 3.7% in arm B,respectively.Median survival time was 18 months in arm A and 12 months in arm B,respectively.Statistically,2-and 3-year survival rate of arm A and arm B had significant difference(P < 0.05).

CONCLUSIONSTCM serving as consolidation treatment in patients with advanced non-small cell lung cancer might be closely related to 2-and 3-year survival rate and median survival time improvement,but not to 5-year survival rate.

BACKGROUNDChemotherapy is the main treatment measure of advanced non-small cell lung cancer(NSCLC).The aim of this study is to explore the efficacy,toxicity,time to disease progression(TTP) and overall survival under the combined chemotherapy with gemcitabine(GEM) plus cisplatin(DDP) in the treatment of advanced NSCLC.

METHODSRetrospective review was conducted on 79 chemotherapy-naive cases of advanced NSCLC treated with GEM and DDP from October 1999 to November 2005.Among 79 patients,51 were male and 28 female;the median age was 53 years old(ranged from 21 to 74);there were 17 cases of squamous cell carcinoma,53 cases of adenocarcinoma,3 cases of large cell carcinoma,1 case of adeno-sqamous cell carcinoma,5 unidentified cases;there were 26 cases in IIIB stage and 53 cases in IV stage according to AJCC 1997 standard.All patients received GEM 800-1250 mg/m² on days 1 and 8 and DDP 75-80 mg/m² on day 1 or 30 mg/m² for three days by intravenous administration,with 21 days as one cycle.Each patient received 2-4 cycles chemotherapy.

RESULTSThe total clinical reponse rate(complete and partial response) was 31.6%,and clinical benefit rate(complete and partial response and stable disease) was 73.4%.1-year survival rate was 64.9%,2-year survival rate was 32%.After median follow-up of 2.33 years,median TTP was 5.06 months.The main toxicities were nausea,vomitting and hematological toxicities.The rates of grade III to IV leukopenia and thrombocytopenia were 25.4% and 31.6% respectively.Other toxicities were slight and tolerable.

CONCLUSIONSCombined chemotherapy with GEM plus DDP as first-line treatment to advanced NSCLC is an effective and feasible regimen,which is one of the standard regimens.For old patients,this regimen is a good choice.The fit dosage of GEM for Chinese is 1000 mg/m².

BACKGROUNDIt has been known that facilitative glucose transporter(GLUT) is the main carrier which intervenes the glucose uptake of cell,and there is a significant correlation between GLUT1 and cancer.The expression of GLUT1 in lung cancer has close relationship with the uptake of 18fluoro-2-deoxyglucose(FDG) of lung cancer,and the expression of GLUT1 is regulated by hypoxia inducible factor-1(HIF-1).The aim of this study is to investigate the relationship among expression of GLUT1,HIF-1α and the uptake of FDG in non-small cell lung cancer(NSCLC).

METHODSEighty-four patients with NSCLC were evaluated with FDG PET/CT before operation.The expression of GLUT1 and HIF-1α was detected immunohistochemically in lung cancer,and their expression level was assessed by the intensity of immunohistochemical staining.Correlation analysis was carried out among the expression level of GLUT1,HIF-1α and the value of standard uptake value(SUV) obtained from preoperative FDG PET/CT examination.

RESULTSThe range of average SUV(SUVave) of the eighty-four patients was 3.6-13.2,and the average value was 7.8±3.0.There was no significant correlation between the SUVave and the maximum diameter of the tumors,the TNM stage,pathological classification and the degree of differentiation.The positive rate of GLUT1 in the eighty-four patients was 95.2%(80/84).The average intensity of immunohistochemical staining was 4.4±1.3.The positive rate of HIF-1α in the eighty-four patients was 96.4%(81/84).The average intensity of immunohistochemical staining was 4.4±1.4.A highly significant positive correlation was found between GLUT1 expression and the SUVave(r=0.78,P < 0.01),and also between HIF-1α expression and the SUVave(r=0.73,P < 0.01).There was also a highly significant positive correlation between GLUT1 expression and HIF-1α expression(r=0.93,P < 0.01).

CONCLUSIONSGLUT1 protein and HIF-1α expressions are general in NSCLC tissues.GLUT1 may paly an important role in the glucose and FDG uptake of lung cancer cell,and HIF-1α might be one of the most important regulative factors of GLUT1 expression,which up-regulates the expression of GLUT1.

BACKGROUNDRecently,mutations in the epidermal growth factor receptor(EGFR) gene were reported to correlate with EGFR tyrosine kinase inhibitor(TKI) response.In this study,relationship between mutations of EGFR in plasma and pleural effusion and responses to gefitinib was investigated in pretreated patients with advanced non-small cell lung cancer(NSCLC).

METHODSThe circulating free DNA was isolated from the plasma of 53 cases and pleural effusion of another 10 cases and analysed for EGFR mutations by LightCycle PCR method.Relationship between EGFR mutations and response to gefitinib was analysed with Chi-square test.

RESULTSEGFR mutations were found in 17 of 63 cases(27.0%).EGFR mutations were frequently present in females(P=0.024) and non-smokers(P=0.021).Patients with EGFR mutations had a significantly better response rate compared to that of the wild-type patients(P=0.000).

CONCLUSIONSThe EGFR mutations exist in the plasma and the pleural effusion from patients with advanced NSCLC.These mutations can be detected with LightCycle PCR method which is highly specific and sensitive and easy to perform compared with the direct sequencing.It will enable us to get a potential implication in the diagnosis and targeted therapy of NSCLC at late stage.

BACKGROUNDSmoking plays an important role in the development of carcinoma of human lung,but the mechanism is unknown.The objective of this study is to investigate the mutation in the coding region of mitochondrial DNA(mtDNA) in patients with squamous cell carcinoma of the lung and to explore its significance in carcinogenesis.

METHODSWhite blood cells,pericarcinomatous tissues and cancer tissues were obtained from 15 cases of lung squamous cell carcinoma and mtDNA was extracted by one step method.The part of coding region fragments was amplified by PCR.Mutations were determined by DNA sequencing.

RESULTSFifteen pairs of matched pericarcinomatous tissues and cancer tissues were screened for mutation in coding regions,18 mutations were detected in the coding region of mtDNA in 11 patients,of which 10 cases were smokers.

CONCLUSIONSThe mutations of the coding region of mtDNA in squamous cell carcinoma of the lung may be correlative with smoking.

BACKGROUNDNeoadjuvant chemotherapy is one of the hot points of lung cancer therapy,which has been proven to be able to improve resection rate and 5-year survival of patients.But its effect on operation safety is not clear yet.The aim of this study is to confirm the effect of neoadjuvant chemotherapy on pulmonary arterial wall so as to assess its safety for operation in patients with lung cancer.

METHODSThirty-two patients underwent lobectomy or pneumonectomy with mediastinal lymphadenectomy after a neoadjuvant chemotherapy,compared with 36 patients surgically treated only.During the operation,the changes of thoracic structure were observed.After the operation,the pulmonary artery specimens were detected pathologically.

RESULTSThe incidence of pleural fibrosis and thickening of pulmonary arterial tunica adventitia in neoadjuvant chemotherapy group was significantly higher than those of control group(59.38% vs 22.22%,P < 0.01;68.75% vs 19.44%,P < 0.01).The incidence of tunica intima,internal elastic membrane and tunica media damage in neoadjuvant chemotherapy group was also markedly higher than those of control group(65.62% vs 33.33%,P < 0.01;59.38% vs 19.44%,P < 0.01;71.88% vs 22.22%,P < 0.01).

CONCLUSIONSNeoadjuvant chemotherapy may lead to pleural fibrosis and thickening of pulmonary arterial tunica adventitia and increase crispness of pulmonary arterial wall,which may increase difficulty and risk of operation.

BACKGROUNDProto-oncogene Pokemon is the special transcription inhibitor of ARF,which can regulate cell growth and differentiation by ARF-P53 path.It may be the important monitoring target of tumor because of being upstream region of many tumor suppressor genes and proto-oncogenes.The aim of this study is to explore the clinical significance of Pokemon gene in non-small cell lung cancer(NSCLC).

METHODSImmunohistochemistry was applied to detect the expression of Pokemon protein in 92 cases of NSCLC and 20 cases of paracancerous lung tissues.Correlation between abnormal expression of Pokemon with pathologic characteristics and prognosis of NSCLC was analyzed.

RESULTSPokemon was not expressed in paracancerous lung tissues and was found in 66 of 92(71.7%) cases of lung cancer tissues.Expression of Pokemon was closely related to TNM stages(P=0.011).Survival rate of patients with negative Pokemon expression was significantly higher than that of those with positive Pokemon expression(P=0.0015).Pokemon expression was demonstrated as independent prognostic factor of NSCLC.

CONCLUSIONSPokemon is expressed in NSCLC and it may be identified as a new diagnostic marker.High expression of Pokemon may indicate poor prognosis of patients with NSCLC.

BACKGROUNDLivin is a novel inhibitor of apoptosis protein(IAP),recent studies showed that it overexpressed in many carcinomas including lung cancer and contributed much to the cancerous development.The objective of this study is to explore the expression of the two isoforms of livin in lung cancer tissues and their relationship with histological types and chemotherapy,and to explore their relationship to the expression of caspase-3 as well.

METHODSExpression of livin α,livin β and caspase-3 mRNAs were detected by reverse transcription polymerase chain reaction(RT-PCR) assay in lung cancer tissues as well as in controls.

RESULTSLivin α and livin β were expressed in 12 of 27 and 19 of 27 lung cancer tissues respectively,much higher than those in lung para-cancerous(0/6,0/6) or benign disease lung tissues(0/12,1/12)(both P < 0.01).Moreover,the positive rate was 7/14 and 9/14 in lung adenocarcinoma and 4/12 and 9/12 in squamous and large cell carcinoma respectively,and both of them were detected in one small cell carcinoma.The levels of these two isoforms in lung cancer were significantly higher than those in controls by Gel Imaging System(both P < 0.05),the level of livin α was remarkably higher in adenocarcinoma than that in squamous cell carcinoma(P < 0.05),while the level of livin β was similar in both carcinomas(P > 0.05).Meanwhile,the level of caspase-3 in lung cancer was significantly lower than that in controls,the levels of either each of two isoforms or their sum were negatively associated with that of caspase-3(P < 0.05,P < 0.01,P < 0.01).Two isoforms of livin mRNA expression seemed to increase after chemotherapy but not related to clinical stages(P > 0.05).

CONCLUSIONSTwo isoforms of livin are differently expressed in different histological types of lung cancer and may contribute to corresponding cancerous development;the levels of livin are negatively associated with those of caspase-3,this may due to the fact that livin could resist against apoptosis;high expression of livin seems to be related to chemotherapy but not clinical stage.

BACKGROUNDVascular endothelial growth factor-C(VEGF-C) plays a critical role in tumor-induced lymphangiogenesis and contributes to lymph node metastasis.Human antigen R(HuR) is one of the firstly identified RNA-binding proteins.It can increase the stability of a variety of growth factors and cytokines and upregulate protein expression.The aim of this study is to investigate the expression of HuR and VEGF-C protein in non-small cell lung cancer(NSCLC),and explore the relationship between the expression of HuR and VEGF-C and clinicopathological factors.

METHODSHuR and VEGF-C protein levels were detected in 81 NSCLC tissues and 15 control benign pulmonary lesion tissues by immunohistochemistry method(SP method).

RESULTSIn NSCLC tissues,positive rate of cytoplasmic HuR,nuclear HuR and VEGF-C was 45.7%(37/81),82.7%(67/81) and 70.4%(57/81),respectively.There was a significant difference in positive expression of HuR and VEGF-C between NSCLC and benign pulmonary lesion tissues(P < 0.05).The expression of cytoplasmic HuR was closely related to pTNM stages,differentiation degree and lymph node metastasis(P < 0.05),but not correlated with sex,age and histological classification(P > 0.05).Furthermore,cytoplasmic immunoreactivity for HuR protein(P < 0.05) but not nuclear HuR expression(P > 0.05) was associated with high VEGF-C expression.

CONCLUSIONSCytoplasmic HuR and VEGF-C are overexpressed in NSCLC,and are related to tumor development.HuR may mediate the modulation of VEGF-C gene expression in NSCLC.