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.

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.

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.

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

This paper discussed on current medical education situation in UK through introducing the concept,method and system.Medical education in UK takes students as the center of education,emphasizes humanistic education and cultivates medical students' eloquence,clinical skills and scientific research.Medical education in UK sheds light on how to mobilize students' subjective initiative,improve communication skills and clinical skills,which medical education in china can draw lessons from.

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 explore expression of the minichromosome maintenance 2 (MCM2)protein and the mucin-like cell surface adhesion molecule CD24 in non-small cell lung cancer (NSCLC) and their relationship with its prognosis. Methods Seventy-three patients of NSCLC diagnosed for the first time and received surgical treatment in Xuanwu Hospital, Beijing were selected for the study. Expression of the MCM2 and CD24 in pathological specimens of the patients was measured by immunohistochemistry and their relationship with its prognosis was analyzed retrospectively. Results High-level expression of the MCM2 and CD24 was seen in 42 and 54 of 73 NSCLC patients, accounting for 57. 5 percent and 74. 0 percent,respectively. Risk of death for the patients with high-level expression of the MCM2 or the CD4 was significantly higher as compared to those with low-level expression ( P ＜ 0. 05 ). Risk of death for patients with both high-level expression of the MCM2 and CD24 was significantly higher than that in those with only high-level expression of the MCM2 or the CD24 (HR =2. 59, 95%CI 1.40 -4. 80, P=0. 002) and in those with both low-level expression of them ( HR = 15.32, 95 % CI = 2.07 - 113.41, P = 0. 008 ). But there was no significant difference in risk of death between patients with high-level expression of the MCM2 or CD24 and those with low-level expression of both of them ( HR = 5. 60, 95% CI 0. 79 - 44. 82, P = 0. 083 ), and cumulative survival rate of patients with both high-level expression of the MCM2 and CD24 was significantly lower than those with only high-level expression of the MCM2 or the CD24 ( P = 0. 001 ). Conclusions Both expression of the MCM2 and the CD24 are independent prognostic factors for NSCLC and combined detection of the two markers have higher prognostic value for it.

Objective To investigate the expression of MCM2 and its prognostic significance in non-small cell lung cancer (NSCLC). Methods The expression of MCM2 was measured by immunohistochemistry in 73 cases of NSCLC and 10 cases of normal lung tissue. The correlations between the expression of MCM2 and clinic-opathological parameters and prognosis were investigated. Results There was no MCM2 expression in normal lung tissue and positive rate of MCM2 expression was 87.7% in NSCLC. The difference between the two groups was significant (P<0.001). The expression of MCM2 in poorly differentiated NSCLC patients was significantly higher than that in moderately- and well-differentiated NSCLC patients (P=0.008). The expression of MCM2 in patients with squamous carcinoma was higher than that in patients with adenocarcinoma (P=0.005). The hazard ratio was significantly higher(RR=3.389, 95 % CI=1.803-7.146,P<0.001), and the accumulated survival rate was significantly lower (P=0.001) in NSCLC patients with higher MCM2 expression than that of lower expression. MCM2 was independent prognostic factor of NSCLC patients (P=0.041). Conclusion MCM2 could reflect the reproductive activity of NSCLC and has some clinical significance for assessing the development and prognosis of NSCLC. MCM2 was a potential target for future treatment.