Background Non-small cell lung cancer (NSCLC) is one of the most common malignant tumors.Despite the advances in therapy over the years,its mortality remains high.The aim of this study was to evaluate the expression of small ubiquitin-like modifier (SUMO) proteases 1 (SENP1) in NSCLC tissues and its role in the regulation of vascular endothelial growth factor (VEGF) expression.We also investigated the association between the expression level of SENP1 and the clinicopathological features and survival of the patients.Methods A SENP1 small interfering RNA (siRNA) was constructed and transfected into the NSCLC cells.VEGF gene expression was analyzed by real-time polymerase chain reaction (RT-PCR).Immunohistochemistry staining was used to assess the expression of SENP1 in 100 NSCLC patients and its association with the clinicopathological features and survival was analyzed.Results VEGF expression was significantly higher in NSCLC tissues than in normal lung tissues.Inhibition of SENP1 by siRNA was associated with decreased VEGF expression.SENP1 was over-expressed in 55 of the 100 NSCLC samples (55％) and was associated with a moderate and low histological tumor grade (3.6％,38.2％,and 58.2％ in high,moderate and low differentiated tumors,respectively,P=0.046),higher T stage (10.9％ in T1,and 89.1％ in T2 and T3 tumor samples,P ＜0.001)and TNM stage (10.9％ in stage Ⅰ,and 89.1％ in stages Ⅱ and Ⅲ tumor samples,P ＜0.001).The rate of lymph node metastasis was significantly higher in the SENP1 over-expression group (76.4％) than that in the SENP1 low expression group (33.3％,P ＜0.001).Sixty three patients received postoperative chemotherapy,including 34 with SENP1 over-expression and 29 with SENP1 low expression.Among the 34 patients with SENP1 over-expression,22 (64.7％) patients developed recurrence or metastasis,significantly higher than those in the low expression group 27.6％ (8/29) (P=0.005).Multivariate Cox regression analysis showed that lymph node metastasis (P=0.015),TNM stage (P=-0.001),and SENP1 expression level (P=0.002) were independent prognostic factors for the survival of NSCLC patients.Conclusions SENP1 may be a promising predictor of survival,a predictive factor of chemo-sensitivity for NSCLC patients,and potentially a desirable drug target for lung carcinoma target therapy.

With the change of the spectrum of disease, the incidence and mortality of non-small cell lung cancer (NSCLC) has been high in global scale, since surgical intervention was applied to treat lung cancer, its status is increasing day by day, at present comprehensive treatment leaded by surgery has become the preferred scheme for NSCLC, there are many different kinds of surgical approaches and operation methods of disease, and the new technologies appear constantly, the paper aim to summarize the research progress of different operationmethods and surgical approach. With the development of software and hardware technology and the concept of minimally invasive thoracoscopic surgery was received by more people, minimally invasive thoracoscopic surgery has brought more benifit than traditional thoracotomy for lung cancer patients, minimally invasive thoracoscopic surgery reserve more lung tissue and improve the survival quality of patients due to better pulmonary function, we believe that minimally invasive thoracoscopic surgery can bring more benefits to people with surgical indications and surgical procedure further standardization.
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Carcinoma, Non-Small-Cell Lung ; surgery ; Humans ; Lung Neoplasms ; surgery ; Pneumonectomy ; Thoracic Surgery, Video-Assisted

OBJECTIVETo explore the relationship between the lymph node metastasis and clinicopathological features in patients with clinical stage T1a non-small cell lung cancer (NSCLC).

METHODSClinicopathological data of a total of 418 patients who underwent lobectomy and systematic lymph node dissection were retrospectively analyzed. Logistic regression was used to analyze the relationship between lymph node metastasis and clinicopathological features.

RESULTSLymph node metastasis was observed in 25 patients. There were 122 patients who were diagnosed as ground glass opacity with no lymph node metastasis. 399 patients had subcarinal dissection, among them 7 patients were found to have lymph node metastasis. Univariate analysis showed that gender, smoking history, diameter of lymph node, ground glass opacity (GGO), differentiation of the tumor and tumor site were the factors affecting lymph node metastasis (all P < 0.05). Logistic regression analysis showed that diameter of lymph node, differentiation of the tumor and the site of lesion were independent risk factors for lymph node metastasis of NSCLC.

CONCLUSIONSTumor in the left lung, poor differentiation, and diameter of lymph nodes ≥ 1 cm on the preoperative CT image are independent risk factors for lymph node metastasis of NSCLC, hence we should pay attention before surgery and systematic lymph node dissection should be done. For patients with poor differentiation and lymph nodes ≥ 1 cm, subcarinal lymph nodes dissection is recommended for the sake of higher possibility of lymph node metastasis. For patients with ground glass opacity ≤ 2 cm, the lymph node metastasis is extremely rare, therefore, selective lymph node dissection is reconmmended.

Analysis of Variance ; Carcinoma, Non-Small-Cell Lung ; pathology ; secondary ; surgery ; Cell Differentiation ; Humans ; Logistic Models ; Lung Neoplasms ; pathology ; surgery ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Neoplasm Staging ; Retrospective Studies ; Risk Factors ; Sex Factors ; Smoking

Objective To explore the relationship between the lymph node metastasis and clinicopathological features in patients with clinical stage T1a non-small cell lung cancer ( NSCLC ) . Methods Clinicopathological data of a total of 418 patients who underwent lobectomy and systematic lymph node dissection were retrospectively analyzed.Logistic regression was used to analyze the relationship between lymph node metastasis and clinicopathological features.Resulst Lymph node metastasis was observed in 25 patients.There were 122 patients who were diagnosed as ground glass opacity with no lymph node metastasis.399 patients had subcarinal dissection, among them 7 patients were found to have lymph node metastasis.Univariate analysis showed that gender, smoking history, diameter of lymph node, ground glass opacity ( GGO ) , differentiation of the tumor and tumor site were the factors affecting lymph node metastasis ( all P<0.05) .Logistic regression analysis showed that diameter of lymph node, differentiation of the tumor and the site of lesion were independent risk factors for lymph node metastasis of NSCLC. Conclusions Tumor in the left lung, poor differentiation, and diameter of lymph nodes ≥1 cm on the preoperative CT image are independent risk factors for lymph node metastasis of NSCLC, hence we should pay attention before surgery and systematic lymph node dissection should be done.For patients with poor differentiation and lymph nodes≥1 cm, subcarinal lymph nodes dissection is recommended for the sake of higher possibility of lymph node metastasis.For patients with ground glass opacity≤2 cm, the lymph node metastasis is extremely rare, therefore, selective lymph node dissection is reconmmended.

Objective Video?assisted thoracoscopic ( VATS ) esophagectomy has been performed for more than 10 years in China. However, compared with the conventional esophagectomy via right thoracotomy, whether VATS esophagectomy has more advantages or not in the lymph node ( LN) dissection and prevention of perioperative complications is still controversial and deserves to be further investigated. The aim of this study was to explore whether there are significant differences in this issue between the two surgical modalities or not. Methods The results of lymph node dissection and perioperative complications as well as other parameters in the patients treated by VATS esophagectomy and those by conventional esophagectomy via right thoracotomy at our department from May 1,2009 to July 30,2013 were compared using SPSS 16.0 in order to investigate whether there was any significant difference between these two treatment modalities in the learning curve stage of VATS esophagectomy. Results One hundred and twenty?nine cases underwent VATS esophagectomy between May 1, 2009 and July 30, 2013, and another pared 129 cases with the same preoperative cTNM stage treated by conventional esopahgectomy via right thoracotomy were selected in order to compare the results of lymph node dissection and perioperative complications as well as other parameters between those two groups of patients. There were no significant differences in the sex, age, lesion locations and cTNM stage between these two groups. The total LN metastatic rate in the VATS esophagectomy group was 35.7% and that of the conventional esophagectomy group was 37.2% (P>0.05). The total average number of dissected lymph nodes was 12.1 vs. 16.2 ( P<0.001) . The average dissected LN stations was 3.2 vs. 3.6 ( P=0.038) . The total average number of dissected LN along the left recurrent laryngeal nerve was 2.0 vs. 3.7 ( P=0.012) . The total average number of dissected LN along the right recurrent laryngeal nerve was 2.9 vs. 3.4 (P=0.231). However, there was no significant difference in the total average number of dissected LN in the other thoracic LN stations, and in the perioperative complications between the two groups. The total postoperative complication rate was 41. 1% in the VATS group versus 42. 6% in the conventional group ( P=0.801) . The cardiopulmonary complication rate was 25.6% vs. 27.1% ( P=0.777) . The death rate was the same in the two groups (0.8%). The VATS group had less blood infusion (23.2% vs. 41.8%, P=0.001) and shorter hospital stay (15.9 days vs. 19.2 days, P=0.049) but longer operating time (161.3 min vs. 127.8 min, P<0.01). Conclusions In the learning curve stage of VATS esophagectomy, compared with the conventional esophagectomy, less LN number and stations can be dissected in the VATS group due to unskillful VATS manipulation, especially it is more difficult in the LN dissection along the left recurrent laryngeal nerve. Therefore, it is more suitable to select patients with early esophageal cancer without obvious enlarged lymph nodes for VATS esophagectomy in the learning curve stage.

Objective To explore the clinical characteristics of patients with bilateral synchronous multiple primary non?small cell lung cancer ( NSCLC) and identify the prognostic indicators associated with survival. Methods From January 2010 to December 2014, clinicopathological data of 96 patients with bilateral synchronous multiple primary NSCLC, who met the modified Martini?Melamed criteria and underwent radical surgical resection, were retrospectively reviewed. Survival was estimated using the Kaplan?Meier method, and the clinical parameters associated with survival were analyzed using a log?rank test. Cox proportional hazards regression models were used to identify the risk factors for this cancer. Results Of the 96 patients, two patients who died of severe postoperative complications were excluded, and 94 patients were analyzed. Of the 94 cases, a two?stage operation was performed in 93 patients, while a single?stage bilateral surgery was performed in only one patient using video?assisted thoracic surgery ( VATS) . 79 patients had 2 tumors and the other 15 patients had 3 or more tumors. There were 82 patients with synchronous tumors located in different lobes and 12 patients had at least two tumors located in the same lobe. Seventy?six patients were found to have multiple lung adenocarcinoma and 12 patients had multiple squamous cell
carcinoma ( SCCs) . Five patients had adenocarcinoma and SCC, and one patient had adenocarcinoma and adenosquamous carcinoma simultaneously. Univariate analysis showed that the large maximum tumor diameter, highest pT stage and lymph node involvement were associated with an unfavorable DFS ( P<0.01 for all ) , while female gender, small maximum tumor diameter, early highest pT stage and pN0 were associated with a better overall survival ( OS) . Multivariate analysis showed that highest pT stage and lymph node metastasis were independent prognostic factors for DFS and OS. Patients with a lower highest pT stage and negative lymph node metastasis had longer DFS and OS ( P<0. 05 for both ) . Conclusions The diagnosis for patients with bilateral synchronous multiple primary NSCLCs should be made very carefully. Two stage surgical treatment is safe, reasonable and effective for patients with bilateral synchronous multiple primary NSCLCs in a relatively early stage. The highest pT stage and pN status are important predictors for long?term survival. Adequate pulmonary tissue resection with complete resection of multiple nodules and systematic lymphadenectomy are suggested.

Objective To explore the relationship between the lymph node metastasis and clinicopathological features in patients with clinical stage T1a non-small cell lung cancer ( NSCLC ) . Methods Clinicopathological data of a total of 418 patients who underwent lobectomy and systematic lymph node dissection were retrospectively analyzed.Logistic regression was used to analyze the relationship between lymph node metastasis and clinicopathological features.Resulst Lymph node metastasis was observed in 25 patients.There were 122 patients who were diagnosed as ground glass opacity with no lymph node metastasis.399 patients had subcarinal dissection, among them 7 patients were found to have lymph node metastasis.Univariate analysis showed that gender, smoking history, diameter of lymph node, ground glass opacity ( GGO ) , differentiation of the tumor and tumor site were the factors affecting lymph node metastasis ( all P<0.05) .Logistic regression analysis showed that diameter of lymph node, differentiation of the tumor and the site of lesion were independent risk factors for lymph node metastasis of NSCLC. Conclusions Tumor in the left lung, poor differentiation, and diameter of lymph nodes ≥1 cm on the preoperative CT image are independent risk factors for lymph node metastasis of NSCLC, hence we should pay attention before surgery and systematic lymph node dissection should be done.For patients with poor differentiation and lymph nodes≥1 cm, subcarinal lymph nodes dissection is recommended for the sake of higher possibility of lymph node metastasis.For patients with ground glass opacity≤2 cm, the lymph node metastasis is extremely rare, therefore, selective lymph node dissection is reconmmended.

Objective Video?assisted thoracoscopic ( VATS ) esophagectomy has been performed for more than 10 years in China. However, compared with the conventional esophagectomy via right thoracotomy, whether VATS esophagectomy has more advantages or not in the lymph node ( LN) dissection and prevention of perioperative complications is still controversial and deserves to be further investigated. The aim of this study was to explore whether there are significant differences in this issue between the two surgical modalities or not. Methods The results of lymph node dissection and perioperative complications as well as other parameters in the patients treated by VATS esophagectomy and those by conventional esophagectomy via right thoracotomy at our department from May 1,2009 to July 30,2013 were compared using SPSS 16.0 in order to investigate whether there was any significant difference between these two treatment modalities in the learning curve stage of VATS esophagectomy. Results One hundred and twenty?nine cases underwent VATS esophagectomy between May 1, 2009 and July 30, 2013, and another pared 129 cases with the same preoperative cTNM stage treated by conventional esopahgectomy via right thoracotomy were selected in order to compare the results of lymph node dissection and perioperative complications as well as other parameters between those two groups of patients. There were no significant differences in the sex, age, lesion locations and cTNM stage between these two groups. The total LN metastatic rate in the VATS esophagectomy group was 35.7% and that of the conventional esophagectomy group was 37.2% (P>0.05). The total average number of dissected lymph nodes was 12.1 vs. 16.2 ( P<0.001) . The average dissected LN stations was 3.2 vs. 3.6 ( P=0.038) . The total average number of dissected LN along the left recurrent laryngeal nerve was 2.0 vs. 3.7 ( P=0.012) . The total average number of dissected LN along the right recurrent laryngeal nerve was 2.9 vs. 3.4 (P=0.231). However, there was no significant difference in the total average number of dissected LN in the other thoracic LN stations, and in the perioperative complications between the two groups. The total postoperative complication rate was 41. 1% in the VATS group versus 42. 6% in the conventional group ( P=0.801) . The cardiopulmonary complication rate was 25.6% vs. 27.1% ( P=0.777) . The death rate was the same in the two groups (0.8%). The VATS group had less blood infusion (23.2% vs. 41.8%, P=0.001) and shorter hospital stay (15.9 days vs. 19.2 days, P=0.049) but longer operating time (161.3 min vs. 127.8 min, P<0.01). Conclusions In the learning curve stage of VATS esophagectomy, compared with the conventional esophagectomy, less LN number and stations can be dissected in the VATS group due to unskillful VATS manipulation, especially it is more difficult in the LN dissection along the left recurrent laryngeal nerve. Therefore, it is more suitable to select patients with early esophageal cancer without obvious enlarged lymph nodes for VATS esophagectomy in the learning curve stage.

Objective To explore the clinical characteristics of patients with bilateral synchronous multiple primary non?small cell lung cancer ( NSCLC) and identify the prognostic indicators associated with survival. Methods From January 2010 to December 2014, clinicopathological data of 96 patients with bilateral synchronous multiple primary NSCLC, who met the modified Martini?Melamed criteria and underwent radical surgical resection, were retrospectively reviewed. Survival was estimated using the Kaplan?Meier method, and the clinical parameters associated with survival were analyzed using a log?rank test. Cox proportional hazards regression models were used to identify the risk factors for this cancer. Results Of the 96 patients, two patients who died of severe postoperative complications were excluded, and 94 patients were analyzed. Of the 94 cases, a two?stage operation was performed in 93 patients, while a single?stage bilateral surgery was performed in only one patient using video?assisted thoracic surgery ( VATS) . 79 patients had 2 tumors and the other 15 patients had 3 or more tumors. There were 82 patients with synchronous tumors located in different lobes and 12 patients had at least two tumors located in the same lobe. Seventy?six patients were found to have multiple lung adenocarcinoma and 12 patients had multiple squamous cell
carcinoma ( SCCs) . Five patients had adenocarcinoma and SCC, and one patient had adenocarcinoma and adenosquamous carcinoma simultaneously. Univariate analysis showed that the large maximum tumor diameter, highest pT stage and lymph node involvement were associated with an unfavorable DFS ( P<0.01 for all ) , while female gender, small maximum tumor diameter, early highest pT stage and pN0 were associated with a better overall survival ( OS) . Multivariate analysis showed that highest pT stage and lymph node metastasis were independent prognostic factors for DFS and OS. Patients with a lower highest pT stage and negative lymph node metastasis had longer DFS and OS ( P<0. 05 for both ) . Conclusions The diagnosis for patients with bilateral synchronous multiple primary NSCLCs should be made very carefully. Two stage surgical treatment is safe, reasonable and effective for patients with bilateral synchronous multiple primary NSCLCs in a relatively early stage. The highest pT stage and pN status are important predictors for long?term survival. Adequate pulmonary tissue resection with complete resection of multiple nodules and systematic lymphadenectomy are suggested.

Objective The role of planned neoadjuvant radiotherapy or chemoradiotherapy in the non?radical resection of esophageal squamous cell carcinoma was unclear. The study aimed to evaluate their therapeutic effect and analyze the prognostic factors. Methods We retrospectively analyzed the clinical data of locally advanced esophageal squamous cell carcinoma who received neoadjuvant radio therapy ( 33 patients) and concurrent chemoradiotherapy (119 patients) from January 2004 to December 2016 in our single?institution database.The survival rates were calculated by Kaplan?Meier method. The prognostic factors were analyzed by using Log rank test and Cox proportional hazards model. Results The median follow?up was 29.8 months. One hundred and one patients survived more than 3 years. The rates of overall survival (OS) and disease?free survival ( DFS) at 3 years were 63.9% and 55.6%, respectively.The rates of complete, partial and minimal pathological response of the primary tumor were 50.3%, 38.4%, 11.3%, the corresponding 3?year OS were 75.5%, 57.4%, 27.3%( P＜0.001) and 3?year DFS were 72.0%, 44.7%, 17.6%(P＜0.001), respectively.The postoperative lymph node metastasis rate was 27.0%. The 3?year OS and DFS of the lymph node positive group was 45.6% and 32.8%, significantly lower than 70.8% and 63.7%of the negative group (both P＜0.001).The 3?year OS and DFS of pathologic stage Ⅰ,Ⅱ,ⅢA,ⅢB andⅥ A were 76.2%, 57.4%, 64.7%, 35.0%, 33.3%( P＜0.001) and 70.1%, 49.3%, 41.2%, 22.1%, 33.3%(P＜0.001), respectively.The operation?related mortality was 3.3%. Multivariate analysis showed that chest pain, postoperative respiratory failure, pathological differentiation, more than 15 lymph node dissection and ypTNM stage were the independent prognostic factors of OS ( P＜0.05 for all). Conclusions The planned neoadjuvant radiotherapy or chemoradiotherapy for the non?radical resection of advanced esophageal squamous cell carcinoma could result in favorable survival. The chest pain, postoperative respiratory failure, pathological differentiation, the number of lymph node resection and ypTNM stage are the independent prognostic factors of the prognosis of these patients.