Purpose:To evaluate the efficiency of mediastinal lymph nodes dissection (MLND) and to determine a reasonable extent of dissection in the treatment of patients with clinical stageⅠ A non small cell lung carcinoma (NSCLC). Methods:From January 1988 to June 1995, one hundred and forty seven patients with clinical stageⅠ A NSCLC were treated by surgery. All the patients were divided into three groups according to the type of procedure, that is, resection without MLND, resection with selective MLND and systematic MLND. According to their clinical characteristics patients in each group were matched and assigned once again, and 93 cases were enrolled. Survival rates were calculated by Kaplan meier method and survival curves were prepared and survival difference was compared by Log rank test. Results:Survival rates at 5 year of no MLND, selective MLND and systematic MLND groups were 22.6%, 48.4%, and 51.6%, respectively. Survival rates of two MLND groups were higher than that of no MLND group. Log rank test presented significantly statistical difference between them ( P

Objective: Our aims were to measure DNA content in primary lung cancer and to study the relationship between the DNA content and TNM stage, histological differentiation of tumor cell, cellular proliferation, and apoptosis. Methods: The DNA content and cellular proliferation were analyzed using flow cytometry. Tumor cell apoptosis was detected by using TUNEL method. Results: (1) The DNA index (DI) distribution ranged from 0.829 to 2.514. There were 41 cases (77.4%) of DNA aneuploid. The distribution of DI and DNA aneuploid was independent of histological subtypes（P>0.05）.(2) With the increase of TNM stage, the DI and the rate of DNA aneuploid increased（P<0.05）.(3) There was relationship between DI and histological differentiation of tumor cell. The DI was higher in tumors of poor differentiation than those in tumors of moderate and good differentiation（P<0.05 and P<0.01）. (4) The cellular proliferation index of aneuploid tumors was significantly higher than that of diploid tumors(P<0.01), while apoptosis index of aneuploid tumors was significantly lower than that of diploid tumors (P<0.01). Conclusion: Correlations exist between DNA content and TNM stage, hiological differentiation, cellular proliferation, and apoptosis.

BACKGROUNDTo elucidate the characteristics and metastastic pattern of skipping mediastinal lymph node metastasis (skipping N2) in non-small cell lung cancer (NSCLC), and investigate reasonable extent of lymph node dissection.

METHODSFrom 1990 to 1998, lobectomy combined with systematic mediastinal lymph node dissection was performed in 109 patients with NSCLC. A retrospective study was carried out to elucidate the characteristics of skipping N2 disease and to compare the difference between skipping N2 and non-skipping N2 diseases.

RESULTSTwenty-one patients (19%) had skipping N2 diseases. Of the skipping N2 group, 18 cases (86%) were adenocarcinoma. Skipping N2 disease was more common in T1 and T2 group than that in T3 and T4 group (P < 0.01). All skipping N2 diseases only involved one nodal station, and most of them were regional mediastinal nodal metastasis. Skipping N2 from upper lobe tumors mainly involved superior tracheobronchial or subaortic lymph nodes, and skipping N2 from lower lobe tumors involved subcarinal lymph nodes.

CONCLUSIONSSkipping N2 disease presents certain clinical characteristics and metastastic pattern, and mediastinal nodal dissection might be modified according to the pattern.

BACKGROUNDTo evaluate the diagnostic method of occult metastasis to mediastinal lymph nodes (MLNs) in patients with non-small cell lung cancer (NSCLC).

METHODSThe mRNA expression of mucin 1(MUC1) gene, an epithelial-tissue-specific gene, was detected in dissected mediastinal lymph nodes by RT-PCR assay. Seventy-eight MLNs which had no malignant evidence on routine histopathologic examination were assessed in 19 patients with stage pN0-1 disease. Five regional lymph nodes from 5 patients with benign pulmonary diseases and 5 MLNs proved malignant by histopathology from 5 patients with NSCLC were also studied as negative and positive control respectively.

RESULTSThe mRNA of MUC1 was not detected in any specimen of negative control group, whereas the mRNA was detected in all MLNs of positive control group. The mRNA in 6 out of 78 MLNs from 19 patients with pN0-1 disease was also detected, and occult metastasis was diagnosed.

CONCLUSIONSDetection of MUC1 mRNA expression might be helpful to diagnose occult metastasis in MLN in patients with lung cancer, and RT-PCR is superior to routine histopathologic examination in staging NSCLC.

OBJECTIVETo investigate gene diagnosis of occult micrometastasis in the mediastinal lymph node in patients with non-small cell lung carcinoma (NSCLC) and to evaluate its prognostic significance.

METHODSWith mRNA expression of mucoid1 (MUC1) gene examined by RT-PCR, 168 mediastinal lymph nodes taken from 37 pN(0) (negative lymph nodes) NSCLC patients (stage Ia approximately IIb) made up the experiment group. Thrity negative lymph nodes from 14 benign lesions and 30 positive lymph nodes from 15 NSCLC patients served as control. The survival difference between MUC1 mRNA-negative and MUC1 mRNA-positive groups was compared by the chi(2) test.

RESULTSUC1 mRNA was not identified in the negative-control group (specificity = 100%), but it was identified in 26 of 30 positive-control samples (sensitivity = 86.7%). MUC1 mRNA was identified in 16 (9.5%) of the experiment group from 12 patients whose TNM stage was up-regulated to stage IIIa. The 3-year survival rate (58.3%) of MUC1 mRNA positive group patients with occult micrometastasis in mediastinal lymph node was lower than the 88.0% of MUC1 mRNA negative group (P < 0.05).

CONCLUSIONOccult micrometastasis in the mediastinal lymph node in NSCLC patients can be diagnosed by MUC1 mRNA expression through RT-PCR. Poor prognosis in some pN(0) NSCLC patients may be associated with nodal occult micrometastasis.

Adult ; Aged ; Carcinoma, Non-Small-Cell Lung ; diagnosis ; secondary ; Female ; Genetic Markers ; genetics ; Humans ; Lung Neoplasms ; diagnosis ; pathology ; Lymphatic Metastasis ; diagnosis ; Male ; Middle Aged ; Mucin-1 ; analysis ; genetics ; Prognosis ; RNA, Messenger ; analysis

Objectives To investigate the frequency, distribution and features of lymph nodes metastasis in T1/T2 squamous carcinoma and adenocarcinoma of lung, and to provide evidence for extensive dissection of lymph nodes．Methods 254 patients with T1/T2 squamous caroinoma and adenocarcinoma of lung underwent R2 surgery plus extensive dissection of hilar, interlobular and mediastinal lymph nodes according to the grouping system proposed by Naruke．Results A total of 1685 groups of lymph nodes were dissected． The metastatic rates of N1 and N2 were 20．0% and 10．2%． The differerce was very significant between T1 and T2 (P<0．01)． No, N2 metastasis was found in T1 squamous carcinoma． N2 metastatic rates were 22．0% in squamous carcinoma and 40．9% in adenocarcinoma (P<0．01)． 64．3% of squamous carcinomas spread to only one group of N2 nodes,and over 3 groups of lymph nodes were positive in 46．2% of adenocarcinonmas． Saltatory metastasis accounted for 57．5% of N2 metastasis． 13．6% of N2-positive tumors in the upper lobes metastasized to the lower mediastinum, whereas 51．6% of N2-positive tumors in the lower lobes spread to the upper mediastinum．Conclusions The frequency of lymph node metastasis increases with the growth of tumors． Metastasis occurs more frequently in adenocarcinoma than in squamous carcinoma． Tumor at any site can metastasize to the distant mediastinum． Except for T1 squamous carcinoma, radical surgery can be achieved only by extensive dissection of ipsilateral intrapulmonary and mediastinal lymph nodes．

Objective To evaluate the diagnosis and management of bronchial rupture from blunt thoracic trauma. Methods A group of 31 patients with bronchial rupture was involved. Chest roentgenography, tornography and bronchoscopy were performed on all patients. The surgical technique and complications were described.Results Diagnosis was confirmed by tomography and bronchoscopy in all the patients. End to end anastomosis was used in 26 patients. Four patients were operated with total pneurnonectomy. One patient was repaired with an intercostal muscle and rib flap with blood supply. Of the 31 patients, one died of adult respiratory distress syndrome after operation. Most patients had excellent surgical outcomes. 81％ (25/31)of the bronchial rupture were delayed in diagnosis and treatment. The classic symptoms and signs of bronchial rupture included subcutaneous emphysema, dyspnea and an intermediate coma interval. The roentgenogram showed mediastinal emphysema, pneumothorax, “drop lung” sign and marked radiodensity of hilum widened mediastinum.Conclusion Bronchoscopy is a useful and accurate method to diagnose and treat the bronchial rupture, with which surgeons can easily locate the rupture site during surgery. Surgical treatment could restore pulmonary function in most patients.

Objectives To investigate the frequency, distribution and features of lymph nodes metastasis in T1/T2 squamous carcinoma and adenocarcinoma of lung, and to provide evidence for extensive dissection of lymph nodes．Methods 254 patients with T1/T2 squamous caroinoma and adenocarcinoma of lung underwent R2 surgery plus extensive dissection of hilar, interlobular and mediastinal lymph nodes according to the grouping system proposed by Naruke．Results A total of 1685 groups of lymph nodes were dissected． The metastatic rates of N1 and N2 were 20．0% and 10．2%． The differerce was very significant between T1 and T2 (P<0．01)． No, N2 metastasis was found in T1 squamous carcinoma． N2 metastatic rates were 22．0% in squamous carcinoma and 40．9% in adenocarcinoma (P<0．01)． 64．3% of squamous carcinomas spread to only one group of N2 nodes,and over 3 groups of lymph nodes were positive in 46．2% of adenocarcinonmas． Saltatory metastasis accounted for 57．5% of N2 metastasis． 13．6% of N2-positive tumors in the upper lobes metastasized to the lower mediastinum, whereas 51．6% of N2-positive tumors in the lower lobes spread to the upper mediastinum．Conclusions The frequency of lymph node metastasis increases with the growth of tumors． Metastasis occurs more frequently in adenocarcinoma than in squamous carcinoma． Tumor at any site can metastasize to the distant mediastinum． Except for T1 squamous carcinoma, radical surgery can be achieved only by extensive dissection of ipsilateral intrapulmonary and mediastinal lymph nodes．