Objective:To comprehensively investigate the prognostic significance of nodal skip metastasis and lobe-specific me-tastasis for patients with IIIa-N2 non-small-cell lung cancer (NSCLC). Methods:A total of 218 completely resected pN2-NSCLC cases with systematic lymph node dissections from 2008 to 2009 at Tianjin Medical University Cancer Hospital were enrolled. Mediastinal lymph node metastasis was subdivided into continuous metastasis and skip metastasis according to whether N1 lymph nodes were in-volved. Mediastinal lymph node metastasis was also classified into extensive metastasis and lobe-specific metastasis on the basis of whether the lymph nodes involved were within or beyond lobe-specific regions. Overall survival (OS) and disease-free survival (DFS) were compared. Results:For the whole cohort, 5-year OS was 21.6%and 5-year DFS was 16.8%. The 5-year OS for patients with skip metastasis or continuous metastasis were 37.6%and 22.0%, respectively (P=0.008). The 5-year DFS of patients with skip metastasis or continuous metastasis were 29.1%and 15.0%, respectively (P=0.022). The 5-year OS of patients with lobe-specific metastasis and ex-tensive metastasis were 38.3%and 20.4%, respectively (P=0.005). The 5-year DFS of patients with lobe-specific metastasis and exten-sive metastasis were 28.4%and 15.1%, respectively (P=0.009). According to the two patterns, patients were subdivided into three sub-groups:Group A (presence of both skip metastasis and lobe-specific metastasis), Group B (presence of skip metastasis only or lobe-spe-cific metastasis only), and Group C (presence of non-skip metastasis and non-lobe-specific metastasis). The 5-year OS of the three sub-groups were 47.1%(Group A), 28.1%(Group B), and 16.6%(Group C) (P=0.001), and the 5-year DFS of these subgroups were 35.2%(Group A), 20.8%(Group B), and 11.2%(Group C), respectively (P=0.002). Multivariate analysis demonstrated that the combined pat-tern was an independent prognostic factor for both OS and DFS. Conclusion:This combined pattern of lymph node metastasis was a strong prognostic factor for IIIa-N2 NSCLC. This pattern should be considered when predicting prognoses and during the selection of patients that will receive postoperative treatments.

Objective To evaluate the efficacy and adverse effects of radical three-dimensional conformal radiotherapy (3DRT) alone or combined with chemotherapy in elderly patients (≥70 years) with esophageal cancer.Methods The clinical data of 116 esophageal cancer patients who were aged 70 years or older and received radical 3DRT ± chemotherapy from 2008 to 2013 were retrospectively analyzed.Of the 116 patients,32 received concurrent chemoradiotherapy,24 received sequential chemoradiotherapy,and 60 received radiotherapy alone.Overall survival (OS) and progression-free survival (PFS) rates were determined using the Kaplan-Meier method,and survival difference analysis and univariate prognostic analysis was performed using the log-rank test.Multivariate prognostic analyses were performed using the Cox proportional hazard model.Results The follow-up rate was 100％.The 2-and 3-year sample sizes were 102 and 77,respectively.The 1-,2-,and 3-year OS rates were 59.1％,38.4％,and 23.2％,respectively,and the PFS rates were 61.9％,37.9％,and 0％,respectively.The median OS for the patients treated with concurrent chemoradiotherapy,sequential chemoradiotherapy,and radiotherapy alone were 22.3,18.0,and 12.4 months,respectively (P =0.044).The median OS was significantly different between patients treated with 60 Gy and ＜60 Gy in radiotherapy (24.7 vs.10.9 months,P =0.036),but not significantly different between those treated with 60 Gy and ＞ 60 Gy (24.7 vs.18.7 months,P =0.938).Multivariate analysis indicated that sex,presence or absence of combined chemotherapy,and radiotherapy dose were independent influencing factors for OS (P=0.003,0.042,and 0.037,respectively).Conclusions Radical 3DRT ± chemotherapy are well tolerated in elderly patients with esophageal cancer and equally effective as in those younger than 70 years.Patients treated with radical concurrent chemoradiotherapy have a better prognosis than those treated with sequential chemoradiotherapy and radiotherapy alone.Radiotherapy with a dose of 60 Gy effectively improves the survival compared with doses less than 60 Gy,which suggests that 60 Gy is the optimal dose in radiotherapy.

OBJECTIVEThe aim of this study was to investigate the prognostic value of combined expression of Aurora A, Ki-67, p53 and p21 WAF1 in patients after curative resection of non-small cell lung cancer (NSCLC).

METHODSExpressions of Aurora A, Ki-67, p53 and p21 WAF1 in 58 tumor samples from resected primary NSCLCs were detected by immunohistochemistry. The correlation of proteins, survival and clinicopathological characteristics was analyzed.

RESULTSThe positive rates of Aurora A, Ki-67, p53 and p21 WAF1 expression were 89.7% (52/58), 53.4% (31/58), 46.6% (27/58) and 34.5% (20/58), respectively. Aurora A expression was positively correlated with nodal metastasis (69.2% vs. 37.8%, P = 0.045). The univariable analysis showed that the overall survival (OS) was 75.0%in patients with low Aurora A expression and 46.0% in patients with high Aurora A expression (P = 0.039). The 3-year survival rate was 40.0% in patients with positive expression of Aurora A and p53, 65.0% in the patients with positive expression of Aurora A or p53, and 82.1% in the patients with negative expression of Aurora A and p53 (P = 0.039). The Cox regression model showed that combined expression of Aurora and p53 is an independent factor affecting the prognosis of NSCLC patients (P = 0.015).

CONCLUSIONSOur findings suggest that the positive expression of Aurora A, Ki-67 and p53 proteins is an unfavorable factor affecting the prognosis for NSCLC patients, and the overexpression of Aurora A is an independent unfavorable factor association with shorter OS in NSCLC patients. Detection of positive Aurora A and p53 expression may be a useful predictive prognostic indicator for NSCLC patients.

Aurora Kinase A ; metabolism ; Carcinoma, Non-Small-Cell Lung ; metabolism ; mortality ; surgery ; Cyclin-Dependent Kinase Inhibitor p21 ; metabolism ; Humans ; Immunohistochemistry ; Ki-67 Antigen ; metabolism ; Lung Neoplasms ; metabolism ; mortality ; surgery ; Prognosis ; Survival Analysis ; Survival Rate ; Tumor Suppressor Protein p53 ; metabolism

Objective The aim of this study was to investigate the prognostic value of combined expression of Aurora A, Ki?67, p53 and p21 WAF1 in patients after curative resection of non?small cell lung cancer(NSCLC). Methods Expressions of Aurora A, Ki?67, p53 and p21 WAF1 in 58 tumor samples from resected primary NSCLCs were detected by immunohistochemistry. The correlation of proteins, survival and clinicopathological characteristics was analyzed. Results The positive rates of Aurora A, Ki?67, p53 and p21 WAF1 expression were 89.7% (52/58), 53.4% (31/58), 46.6% (27/58) and 34.5% (20/58), respectively. Aurora A expression was positively correlated with nodal metastasis(69.2% vs. 37.8% , P=0.045). The univariable analysis showed that the overall survival ( OS) was 75. 0%in patients with low Aurora A expression and 46.0% in patients with high Aurora A expression ( P=0.039) . The 3?year survival rate was 40.0% in patients with positive expression of Aurora A and p53, 65.0% in the patients with positive expression of Aurora A or p53, and 82. 1% in the patients with negative expression of Aurora A and p53 ( P=0. 039 ) . The Cox regression model showed that combined expression of Aurora and p53 is an independent factor affecting the prognosis of NSCLC patients ( P=0. 015 ) . Conclusions Our findings suggest that the positive expression of Aurora A, Ki?67 and p53 proteins is an unfavorable factor affecting the prognosis for NSCLC patients, and the overexpression of Aurora A is an independent unfavorable factor association with shorter OS in NSCLC patients. Detection of positive Aurora A and p53 expression may be a useful predictive prognostic indicator for NSCLC patients.

Epithelial to mesenchymal transition (EMT) has an important role in the development of embryo, as well as that in the metastasis of non-small cell lung cancer (NSCLC). Recent researches have demonstrated that both morpho-logical and phenotypic conversions emerge in cells undergoing EMT. As most of relevant studies were on other cancers, it is es-sential to uncover whether it is the similar mechanisms accounting for EMT in NSCLC. With the progress of the studies, EMT-related basic researches are gradually applied to predicting the prognosis of NSCLC. hTe aim of this article was to discuss the mechanisms related to EMT emerging in NSCLC.