Objective To evaluate the efficacy and adverse effects of gefitinib as the first line treatment in elderly patients with lung adenocarcinoma.Methods 81 elderly patients of previously untreated advanced lung adenocarcinoma,who were non-smokers and unsuitable for chemotherapy,received gefitinib treatment until disease progression or intolerable toxicities occurred.The curative effect performance status of improvement and adverse effects were observed.Results All of the patients were evaluable.Partial response rate and stable disease rate of gefifinib were 25.9 ％ (21/81) and 48.1％ (39/81),respectively.55.5 ％ (45/81)of patients had performance status improved after treatment.Conclusion Gefitinib has curative effect and is well tolerated in the treatment of elderly patients with previously untreated advanced lung adenocarcinoma.

Objective To improve the level of diagnosis and treatment of the sharp injury in the back. Methods 47 cases which were treated from Jan 1991 to May 2000 were reviewed. ResultsAmong 37 cases who underwent the exploration, 5 cases died. Among 10 cases who underwent conservative treatment, 2 cases died. ConclusionThe condition of sharp injury in the back is very complicated,it is easy to be misdiagnosed, the mortality is high. Saving should be equalled with the diagnosis and treatment. The application of wound exploration, abdominal puncture, ultrasound examination and X-ray checking is valuable to the diagnosis. The patients with operation indications should be operated at once,while the others should be observed for some time to prevent the delayed clinical manifestation.

Objective Under the guidance of CT and three dimensional reconstruction, we made therapeutic plan for lung cancer by radiofrequency ablation (RFA) and observed its effect. Methods From February 2007 to January 2009, we used RITA radiofrequency therapeutic equipment to treat lung cancer under the guidance of 64-slice spiral CT (Siemens) and three dimensional reconstruction of the image. The target temperature is 90℃. Results We performed 29 RFA on 25 patients. In the follow-up, 10 of them showed tumor shrinkage by CT scan. 23 showed lack of tumor-uptake value by SPECT scan and 2 showed lower tumor-uptake value. Conclusion CT-guided percutaneous RFA is safe and practical for lung cancer. It has satisfactory short-term effect to reduce tumor burden.

Objective The aim of the present study was to evaluate the clinical application of 2 μm thulium laser in pulmonary nodules resection under VATS.Methods 61 patients,undergoing thoracoscopic resection of pulmonary nodules in thoracic department of Xuanwu Hospital,were identified between January and December of 2016.Of those,30 underwent 2μm thulium laser dissection and 31 were treated with standard technique by using staplers.In terms of clinical characteristics,including gender,age and smoking history,there is no significant difference between the laser group and the stapler group,but the lesion size was slightly larger in the stapler group compared with the laser group.The lesions of the two groups were almost evenly distributed on the five lobes.Results All the procedures were performed successfully under VATS.The intraoperative evaluation of air leaks demonstrated that less than or equal to 2 grade air leaks were observed in 28 cases in the laser group and in 30 cases in the stapler group.Grade 3 air leaks requiring a rescue treatment were observed in 2 cases in the laser group and in 1 case in the stapler group.There were no significant differences in the postoperative hospital stay and total hospital stay between two groups.Chest tube duration was lower in the laser group compared with the stapler group even if it was not statistically significant (2.71 vs 3.55 days).Hospitalization costs was significantly lower for the laser group.Conclusion The use of 2um thulium laser to prevent intra-and postoperative air leaks and bleeding is effective and makes patients recover quickly,which allows a minimally invasive,accurate and safe application during thoracoscopic resection of pulmonary nodules.

Objective To explore the effect of microRNA-613 (miR-613)/Wee1 axis on the radiosensitivity of colorectal cancer cells.Methods A total of 20 patients with radiosensitive colorectal cancer and 20 patients with radioresistance were selected from Yan'an Hospital Affiliated to Kunming Medical University from November 2016 to May 2017.Human colorectal cancer cell lines LoVo and HCT116 were selected and the radioresistant cell lines LoVo/R and HCT116/R were established for subsequent experiments.Real-time fluorescence quantitative PCR (qRT-PCR) was used to detect the expression of miR-613 and Wee1 in colorectal cancer tissues and cell lines.The radioresistant cells were transfected by miR-613 mimic,and non-transfected cells were used as control group.The effects of miR-613 overexpression on the proliferation,invasion and cell cycle of radiation resistance of colorectal cancer cells at different radiation doses were evaluated by CCK-8 assay,Transwell assay and Western blotting,respectively.Furthermore,dual-luciferase reporter gene assay was used to verify whether Wee1 was a target gene of miR-613.si-Wee1 was transfected into radioresistant cells of colorectal cancer,or co-transfected with si-Wee1 and miR-613 inhibitor,and non-transfected cells were used as control group.The effects of miR-613/Wee1 axis on cell proliferation,invasion and cell cycle were detected by CCK-8,Transwell and Western blotting at different radiation doses.Results The expression of miR-613 was downregulated in the radiation resistance group of patients (1.54 ± 0.25 vs.2.64 ± 0.45;t =3.140,P =0.009) and radiation resistance cell lines (LoVo/R vs.LoVo:1.03 ± 0.12 vs.3.05 ± 0.15;t =8.944,P =0.006;HCT116/R vs.HCT116:1.01 ±0.11 vs.2.85 ±0.16;t =8.050,P =0.008).Overexpression of miR-613 was significantly inhibited the proliferation (LoVo/R:t6 Gy =6.018,P =0.013;HCT116/R:t6Gy =5.634,P =0.015) and invasion (LoVo/R:45.00 ± 8.95 vs.180.15 ± 6.95,t6 Gy =11.93,P =0.003;HCT116/R:49.97 ±6.21 vs.170.20 ±7.03,t6 Gy =12.82,P =0.006) of LoVo/R and HCT116/R cells and decreased the expression levels of G2-M phase cell cycle correlated proteins (CDK1 and cyclin B).Moreover,dual-luciferase reporter gene assay confirmed that Wee1 was a target of miR-613.Mechanistically,overexpression of miR-613 promoted the radiosensitivity of LoVo/R and HCT116/R cells through inhibiting cell proliferation (compared with si-Wee1 group,co-transfected with si-Wee1 and miR-613 inhibitor,and control group,LoVo/R:F8 Gy =40.742,P =0.007;HCT116/R:F8 Gy =28.958,P =0.011),invasion (LoVo/R:F8 Gy =55.413,P =0.004;HCT116/R:F8 Gy =65.634,P =0.003) and arresting cell at G2-M phase via downregulating Wee1.Conclusion miR-613/Wee1 axis plays a certain role in regulating the radiation resistance of colorectal cancer cells,overexpression of miR-613 may reverse the radiation resistance of colorectal cancer cells.

Objective: To investigate the value of the folate receptor (FR)-positive circulating tumor cell (CTC) detection in the diagnosis of benign and malignant subcentimeter pulmonary nodules(the maximum diameter ≤10 mm). Methods: Thirty-seven patients with subcentimeter pulmonary nodules (the chest CT showed the maximum diameter was ≤10 mm) in the Xuanwu Hospital of Capital Medical University from July to December 2018 were collected. Among them, 22 cases were diagnosed with early stage lung adenocarcinoma by postoperative pathological diagnosis and another 15 cases were benign lung lesion. Venous blood samples from these patients were collected before surgery and then utilized to detect FR⁺ CTC level (defined unit as FU/3 ml) by novel ligand-targeted polymerase chain reaction (LT-PCR), and the enzyme-linked immunosorbent assay was used to detect the levels of tumor markers, including carcinoembryonic antigen (CEA), neuron-specific enolase(NSE), cytokeratin 19 fragment CYFRA21-1, carbohydrate antigen 125 (CA125), CA199, pro-gastrin releasing peptide (pro-GRP), etc. The t-test was used to compare the measurement values between the groups. The CTC value 8.70 FU/3 ml described in the detection kit instruction was used as the threshold. The binary logistic regression was used to analyze the risk factors of malignant pulmonary nodules. The kappa consistency test was used to identify the consistency of the diagnosis results obtained by the FR⁺ CTC level and the pathological results of surgically resected specimens. The receiver operating characteristic curve (ROC) was drawn to evaluate the efficiency of each index for the diagnosis of benign and malignant subcentimeter pulmonary nodules. Results: The level of FR⁺ CTC in patients with early stage lung cancer was higher than that in patients with benign lung lesion, and the difference was statistically significant [(11.0±3.0) FU/3 ml vs. (7.0±3.7) FU/3 ml, t=-3.327, P = 0.001]. The level of FR⁺ CTC was not related to the age, gender and smoking history of patients (all P>0.05). Logistic regression analysis indicated that high-level FR⁺ CTC was one of the risk factors for malignant pulmonary nodules (OR = 37.333, 95% CI 3.994-349.010, P = 0.002). The kappa consistency test indicated that the level of FR⁺ CTC used for the diagnosis of lung subcentimeter nodules presented a certain accuracy (κ = 0.627, P < 0.01). ROC illustrated that the FR⁺ CTC was better than CEA, NSE and CYFRA21-1 when it was used as an indicator for the diagnosis of malignant pulmonary nodules. The area under the curve(AUC) of FR⁺ CTC was 0.830 (95% CI 0.639-0.968), and the diagnostic sensitivity and specificity were 72.7% (95% CI 49.6%-88.4%) and 93.3% (95% CI 66.0%-99.7%), respectively. When FR⁺ CTC, CEA, NSE and CYFRA21-1 were combined for lung cancer diagnosis, the AUC, sensitivity and specificity were 0.776 (95% CI 0.614-0.938), 86.4% and 73.3%, respectively. Conclusion The detection of FR⁺ CTC has a high value in the diagnosis of benign and malignant subcentimeter pulmonary nodules.

Background and objective This study compared the efficacy and safety of icotinib with standard second-line chemotherapy (single-agent docetaxel or pemetrexed) in previously treated advanced non-small cell lung cancer (NSCLC).Methods hTirty-two consecutive patients treated with icotinib and 33 consecutive patients treated with standard second-line chemotherapy in Xuanwu Hospital from January 2012 to July 2013 were enrolled in our retrospective research. hTe Response Evaluation Criteria in Solid Tumors were used to evaluate the tumor responses, and the progression-free survival (PFS) was evaluated byKaplan-Meiermethod.Results Icotinib was comparable with standard second-line chemotherapy for advanced NSCLC in terms of overall response rate (ORR) (28.1%vs18.2%,P=0.341), disease control rate (DFS)(43.8%vs 45.5%,P=0.890), and PFS (4.3 monthsvs 3.8 months,P=0.506). In the icotinib group, the ORR of epidermal growth factor receptor (EGFR) mutant was signiifcantly higher than that of EGFR unknown or wild type (P=0.017). In multivariate analysis, age, gender, histology, and the optimum ifrst-line treatment response were dependent prognostic factors based on the PFS of the icotinib group. hTe incidence of adverse events was signiifcantly fewer in the icotinib group than in the chemotherapy group (P=0.001).Conclusion Compared with the standard second-line chemotherapy, icotinib is active in the treatment of advanced NSCLC patients, especially with EGFR unknown in the second line, with an acceptable adverse event proifle.

Background and objective Epidermal growth factor receptor tyrosine kinase in hibitors (EGFR-TKIs) is one of the foundamental treatment for non-small cell lung cancer (NSCLC) with EGFR mutation, however some patients might develop locally progression in primary site. The aim of this study is to assess the clinical application of radi of requency ablation atfer locally progression of NSCLC while receving EGFR-TKIs.Methods Twenty-eight eligible NSCLC patients were enrolled. Effcacy and Safety data of radiofrequency ablation followed by EGFR-TKIs or chemotherapy were collected.Results None of patients had died during peri-operation period. hTe average follow-up time was 17.25 months. Locally progression rate was 10.7% (3/28), and locally progression time was 16.6 months. hTe average progression-free survival was (24.55±5.36) (95%CI:14.04-35.05), and the average overall survival was (25.57±5.45)(95%CI:14.88-36.27). Patients were divided into EGFR-TKIs group and chemotherapy group atfer radi of requency ablation. The average progression-free survival of the two groups were (27.82±7.58)(95%CI:12.97-42.68) and (17.88±3.76)(95%CI:10.52-25.25)(P>0.05) respectively. hTe average OS (overall survival) was (29.42±7.68)(95%CI:14.36-44.48) and (18.44±3.87)(95% CI:14.89-36.27)(P>0.05) in two groups. Conclusion Radi of requency ablation combined with EGFR-TKIs or chemotherapy could prolong progression-free survival and overall survival of EGFR mutant NSCLC patients who had developed locally progression in primary site during EGFR-TKIs treatment.

Background and objective The aim of this study is to explore roles of thyroid transcription factor-1 (TTF-1), CD56, P40 expression and other clinical characteristics predicting response and survival in patients with small cell lung cancer (SCLC).Methods Formalin-fixed, paraffin-embedded biopsy tissues were retrospectively obtained from 198 SCLC patients who were diagnosed first in Xuanwu Hospital. The expressions of TTF-1, CD56 and P40 were detected by im-munohistochemistry. The clinical data including age, gender, cancer stage, Eastern Cooperative Oncology Group (ECOG) score, smoking or not, superior vena cava syndrome (SVCS) due to lung cancer or not were collected.Cox proportional hazard model was used to analyze the relationship between the overall survival (OS) and factors.Results Immunohistochemical staining results showed the positive rate of TTF-1, CD56, P40 were 73.2%, 88.4% and 7.1% respectively. TTF-1 expression (OR=0.665, 95%CI: 0.472-0.937), smoking index ≤400 (OR=1.72, 95%CI: 1.061-2.789) and ECOG=2 (OR=3.551, 95%CI: 2.133-5.914), extensive-stage (OR=2.487, 95%CI: 1.793-3.451) and SVCS due to lung cancer (OR=2.394, 95%CI: 1.49-3.846) were independent prognostic factors for SCLC patients.Conclusion Prognosis of SCLC was related to TTF-1 expression independently after adjusting smoking, ECOG score, stage and SVCS due to lung cancer. Detection of TTF-1, CD56 and P40 expression level might be helpful for predict the prognosis of SCLC.

BACKGROUND AND OBJECTIVEPositron emission tomography (PET) is used increasingly in staging of non-small cell lung cancer (NSCLC) as a non-invasive tool. However, the role of PET in mediastinal lymphatic staging of NSCLC is not clear. The aim of this study was to demonstrate the efficacy of mediastinoscopy in determining mediastinal lymphatic metastasis in cases of positive PET finding.

METHODSWe performed PET preoperatively in 68 patients with clinically operable NSCLC between 2003 and 2008. Mediastinal lymphatic defined as metastasis by PET (SUV(max) > 2.5) was recorded. Mediastinoscopy being performed initially in all patients. Involvement of mediastinal lymph nodes was verified to compare the sensitivity and specificity of mediastinoscopy and the related PET results.

RESULTSFrom 2003 to 2008, 61 mediastinoscopy were performed. There were 38 men and 23 women, aged from 41 to 81 years (mean 60 years). Localization of the tumor was right lung in 41 patients and left lung in 20 patients. After the operation, 45 patients were demonstrated to have N2 or N3 disease. Ten patients with N3 mediastinal metastasis for chemotherapy, 38 patients with N2 mediastinal metastasis for neuadjuvant chemotherapy while lung resection and systemic mediastinal lymphatic dissection through thoracotomy was performed in the remaining 16 patients with no mediastinal metastasis. The positive prediction value of PET scan was 73.8% (45/61). The sensitivity, specificity, accuracy, positive prediction value and negative prediction value in diagnosis of metastasis of mediastinal lymph nodes were 93.8% (45/48), 100% (13/13), 95.1% (58/61), 100% (45/45), 81.3% (13/16) for mediastinoscopy, respectively.

CONCLUSIONPET results do not provide acceptable accuracy rates. Mediastinoscopy still remains the gold standard for mediastinal staging of NSCLC.

Adult ; Aged ; Female ; Humans ; Lung Neoplasms ; pathology ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; pathology ; Male ; Mediastinoscopy ; Middle Aged ; Positron-Emission Tomography