The International Association for the Study of Lung Cancer (IASLC) has presented the details of the IASLC/International Union Against Cancer (UICC)/American Joint Committee on Cancer (AJCC) Revised Staging Classification for Lung Cancer. The IASLC is the largest world-wide professional organization solely dedicated to reduce the worldwide burden of lung cancer. The IASLC recognizes that the staging classification will be most valuable and accurate if it is based on the evaluation of outcomes of large numbers of cases carefully collected and analyzed in an extensive worldwide database. The analyses of the T, N and M descriptors as well as the stage groupings were performed in 67,725 non-small cell lung cancer (NSCLC)patients. Survival was the primary outcome, measured from the date of diagnosis or date of protocol registration for clinical staging, or the date of surgery for pathologic staging. The remarkable efforts of the IASLC Staging Committee have resulted in an evidence-based, validated and robust revision of the international staging system for NSCLC. This landmark contribution will improve our care of patients and lays a strong foundation for future refinements based on an expanding knowledge of lung cancer behavior and biology. This review outlines the changes in the tumor, node, metastasis (TNM) descriptors and stage groupings anticipated in the official new stage classification system for NSCLC.

The post-operative adjuvant chemotherapy(PAC) for non-small cell lung cancer(NSCLC) appeared on the 1970s of the 20th century. Along with the appearance of each kind of new drugs and new combined therapeutic regimen, PAC for NSCLC is also progressed gradually, and more and more evidence showed that PAC can improve the survival and quality of life of patients with NSCLC. The present situation of PAC for NSCLC and the prospects of its future development were introduced.

Surgical resection remains the cornerstone of therapy for early stage lung cancer. Five-year survival rates are reported as high as 92% for stage Ⅰ non-small cell lung cancer (NSCLC). However, many patients presenting with resectable early stage disease are unable to tolerate pulmonary resection, even sublobular resection, because of compromised cardiopulmonary functions or other comorbidities. Traditionally,patients deemed medically inoperable have been treated by external-beam radiation. But the results were poor with a mean survival of 20 months and a 5-years survival rate of 12%. In this scenario, we need to develop other non-surgical local therapies. One of these was image-guided percutaneous radiofrequency ablation(RFA).Many clinical trials show that RFA for lung tumors is a minimally invasive, feasible and safe technique with minor mortality and morbidity. Moreover, its efficacy seems to be promising, even in the long-term follow-up.Further experiences and comparison with other emerging minimally invasive local treatments are required to determine its rote in the treatment of medically inoperable early stage NSCLC.

Surgical resection (usually lobectomy) is considered the treatment option for individuals with stage Ⅰ and Ⅱ non-small cell lung cancer. The surgical treatment of stage Ⅰ and Ⅱ non-small cell lung cancer (NSCLC) continues to evolve in the areas of intraoperative lymph node staging (specifically the issue of lymph node dissection vs sampling), the role of sublobular resections instead of lobectomy for treatment of smaller tumors (especially peripheral carcinoma ≤2 cm in diameter), and the use of video-assisted techniques to perform anatomic lobectomy. Video-assisted thoracic surgery (VATS) lobectomy provides a minimally invasive approach for the management of early-stage lung cancer. Questions about the safety of VATS lobectomy and its adequacy as a cancer operation compared with open thoraeotomy have hindered its universal acceptance among thoracic surgeons. Evidence suggests that VATS lobectomy can be safely performed and is an adequate cancer operation for early-stage NSCLC. Recently, robots have been introduced into surgical procedures in an attempt to facilitate surgical performance. However, adequately powered well-balanced studies comparing VATS with open thoracotomy for lobectomy are lacking in the literature.

Objective To evaluate the efficacy of erlotinib on advanced NSCLC, and observe its adverse events. Methods An open labeled, expanded access program (EAP) was conducted on 19 pathologically confirmed advanced NSCLC patients who had received at least one regimen chemotherapy.Erlotinib (150 mg) was orally administered daily till disease progression or intolerable adverse events developed.The efficacy was evaluated according to RECIST criteria; the adverse events were evaluated according to NCI criteria.Results In 19 patients, the objective response rate was 21.1% (4/19), and the disease control rate was 84.2 % (16/19); the median progression-free survival time was 7.5 months (3-36 months), and the median survival time was 15.9 months (9-39 months).Adverse events were generally mild (grade Ⅰ or Ⅱ ), including skin rash (84.2 %) and diarrhea (57.9 %). One (5.3 %) patient developed grade Ⅲ elevation of serum glutamate pyruvate transaminase.No grade Ⅳ drug-related adverse event occurred.Conclusion Erlotinib is effective and safe for locally advanced or metastatic NSCLC patients who have failed previous chemotherapy.

China ; Humans ; Lung Neoplasms ; diagnosis ; therapy ; Practice Guidelines as Topic ; standards

Objective To investigate the changes and clinical significance of T-lymphocyte subsets in the treatment of advanced lung adenocarcinoma. Methods Ninety six patients with advanced lung adenocarcinoma who underwent treatment in Xuanwu Hospital Capital Medical University from October 2015 to May 2016 were selected as the subjects. There were 63 cases in the transferred group and 23 cases in the un-transferred group. The peripheral blood was taken, then flow cytometry was used to detect CD3+, CD3+CD4+, CD3+CD8+, CD4+/CD8+, CD3-CD16+CD56+(NK), CD8+CD28+, CD8+CD28-, Treg cells, CD3+γδ, and the results were analyzed statistically. Results The levels of CD3+γδand Treg cells in the transferred group were significantly higher than those in the un-transferred group (6.56±3.11 vs. 3.05±2.23; 25.83±6.22 vs. 20.81±9.03) (t=1.590, P=0.026; t=2.027, P=0.044). The level of CD45RA+in the effective group (52.15 ±7.99) was significantly lower than that in the untreated group (70.26 ±17.33) (t= 1.660, P= 0.024). Conclusion The detection of peripheral blood T-lymphocyte subsets in treatment of patients with advanced lung adenocarcinoma has a certain value in predicting the therapeutic effect and prognosis.

Objective To detect the expressions of interleukin-11 (IL-11) and interleukin-11 receptorα(IL-11Rα) in non-small cell lung cancer (NSCLC) cell lines, and explore their clinical significances. Methods The expressions of IL-11 and IL-11Rαin NSCLC cell lines A549, H2228, healthy lung small airway epithelial cell (SAEC) line cytoplasm, cell membrane and nucleus were detected by Western blot. Results The expressions of IL-11 and IL-11Rα were low in the cell membrance and nucleus (cell membrane: IL-110.04± 0.03, IL-11Rα0.05±0.03; nuclear: IL-110.45±0.19, IL-11Rα0.07±0.02;P<0.01); The expressions of IL-11 and IL-11Rα in A549 and H2228 cell lines were significantly increased compared with those of SAEC cell lines in the cell membrance and cytoplasm (P< 0.01); Among the A549 cell lines, the expressions of IL-11 and IL-11Rα in cell nucleus were much higher than those of the cell membrance and cytoplasm (P< 0.01). Among the H2228 cell lines, the expression of IL-11 in cytoplasm was the highest and the expression of IL-11Rα was the highest in the cell nucleus (P< 0.01). Conclusion The expressions of IL-11 and IL-11Rαare high in NSCLC cell lines, and it is good for the screening and early diagnosis of lung cancer by detecting the expressions of IL-11 and IL-11Rα.

Objective The purpose of this study is to evaluate Surgical Procedure and Prognosis for elderly stage 1NSCLC patients above 70 years old.Methods The patients who were stage Ⅰ non-small cell lung cancer from 2003 to 2007were enrolled ( n =71 ).The median age was 74 years ( ranged from 70 to 84 years).The median follow-up of patients was 30months( ranged from 2 to 81 months).Results The percentages of postoperative complications after sublobar resection and lobectomy patients were 36.4％ and 46.9％,respectively.The period in hospital were 11.36 days and 12.24 days.The 3 year survival was 85.9％ for patients undergoing sublobar resection and 78.8％ for lobectomy.The 5 year survival was 56.4％ and 56.9％ respectively.No significant difference was observed between two types of surgical procedure in the elderly.Staging is the independent factor of prognosis.Conclusion Lobectomy is still the main therapy method for elderly stage Ⅰ NSCLC patients.Especially,for those who can undergo radical resection.But sublobar resection also appears to be a viable surgical treatment for patients with cardiopulmonary physiologic impairment.

Objective To evaluate the therapeutic effects afer radiofrequency ablation(RFA) in 24 patients with pulmonary neoplasms through quantitative iodine-based and water-based material decomposition images with spectral computed tomography(CT) imaging.Methods 30 patients(19 male,11 female;age range,52-85 years;mean age,69 years;26 peripheral lung cancer,4 central lung cancer) underwent lung radiofrequency ablation on a GE Discovery CT750HD scanner from March 2012 to March 2013.We compared the volume,CT value,water-based value and iodine-based value of lung tumor before and after the RFA using spectral imaging mode.Results 22 of 30 tumors was bigger after the RFA,8 had no change.Through water-based material decomposition images,the water content in the tumors were increased from(1 014.76 ±6.83) mg/ml to (1 022.71 ± 10.16)mg/ml after RFA,and the difference was significant (t =-2.329,P ＜ 0.05).The iodine-based value in parenchyma of the tumor was 2.49 ± 0.74 mg/mL before the RFA.The tumor was most or completly necrosis after the RFA,the value of iodine in the area of necrosis was (0.45 ± 0.29) mg/mL,which was obviously reduced than before (t =11.072,P =0.000).Conclusion Through compared with the volume,CT value,water-based value and iodine-based value of the parenchyma of the tumors before and after the RFA with spectral computed tomography(CT) imaging,we can know the morphology and metabolism of the tumors to investigate the short term results.