BACKGROUNDTo investigate the indication, complication and efficacy of bronchial artery embolization for the management of lung cancer with massive hemoptysis.

METHODSThirty-eight cases of lung cancer with massive hemoptysis were retrospectively analyzed in our hospital from January 1996 to January 2003. All cases presented with acute hemoptysis from 220 to 980 ml daily, with a mean of 290 ml daily. A digital subtracted bronchial arteriogram was perfomed and bleeding arteries were embolized.

RESULTSHemoptysis decreased gradually in all cases and ceased in 3 or 4 days after embolization. Recurrence was found only in one case 2 months after embolization and second embolization was applied to control hemoptysis. No serious complications occured.

CONCLUSIONSBronchial artery embolization is safe and efficient for the management of lung cancer with massive hemoptysis.

BACKGROUNDTo investigate the efficacy of EP regimen combined with split-course hyperfractionated accelerated irradiation for locally advanced non-small cell lung cancer.

METHODSThe treatment was composed of 3 cycles of combined chemoradiotherapy at 4-week intervals. Chemotherapy with cisplatin ( 30 mg/m²) and etoposide (60 mg/m²) was administrated intravenously on days 1-3, followed by radiotherapy on days 4-8. A course of radiotherapy consisted of 1.5 Gy per fraction, twice a day (3 Gy per day) for 5 consecutive days, for a total dose of 15 Gy. In the third cycle, additional irradiotherapy consisted of 2 Gy once a day was performed on days 11-15, for a total dose up to 55 Gy during 10 weeks. After three cycles, patients were given 2 additional cycles of chemotherapy with MVP regimen.

RESULTSOf the 43 patients, 12 had a complete remission and 22 a partial response, resulting in an overall response rate of 79.1%. Of the 152 chemotherapeutic cycles administrated, there were 40 during which grade III-IV toxicities occurred, mainly consisting of leukopenia and vomiting. The 1- and 2-year survival rates were 66.7% and 57.2%, respectively.

CONCLUSIONSEP regimen combined with split-course hyperfractionated accelerated irradiation is effective and well tolerated for advanced locally non-small celll lung cancer. It should be investigated further.

BACKGROUNDTo evaluate the activity and toxicity of paclitaxel as second-line treatment for advanced non-small cell lung cancer (NSCLC).

METHODSForty patients with recurrent advanced NSCLC were enrolled. Thirty-six patients were managed with regular regimen. Paclitaxel 135 mg/m², 3 h, on day 1; DDP 75 mg/m² or carboplatin 300-350 mg/m² on day 2. Four patients were managed with weekly regimen. Paclitaxel 60 mg/m²,3 h, on days 1,8,15; DDP 75 mg/m² on day 2. It was repeated every three or four weeks, up to two to four cycles.

RESULTSThirty-six cases were evaluated for response and 27 for survival. The objective response rate was 13.9% (5/36). At least one tumor-related symptom relief was observed in 21 patients (58.3%). The median survival duration was 26.4 weeks and 1-year survival rate was 8% (4/36). The main toxicities included myelosuppression, fatigue and myalgia-arthralgia neuropathy.

CONCLUSIONSPaclitaxel has advantage to be well-tolerated and improve tumor-related symptom. Further studies with standardization of dose and regimen will be needed to clarify its role in the second-line treatment.

BACKGROUNDTo analyze the perioperative respiratory and circulatory features of overweighted patients with lung cancer.

METHODSThe perioperative respiratory and circulatory features of 221 overweighted lung cancer patients were compared with those of 715 normal-weighted patients, by means of Chi-square analysis and t analysis.

RESULTSThe abnormal incidence of MBB, Raw, SGaw, PEF, FEV₁, V₇₅ , and EEG, blood presure, serum cholesterol and glucose, was significantly higher in overweighted group than that in the normal weighted group ( P < 0.05), and FRC was significantly lower than that of the normal weighted group (3.46±0.87 vs 3.63±1.17, P < 0.01). There was no difference in D LCO, MMEF, V₅₀ , V₂₅ between the two groups. The odds of postoperative complication in respiratory or circulatory system was significantly increased in overweighted group than that in the normal weighted group.

CONCLUSIONSThe obstruction of main airway, partial alveolar collapse and impotency of respiratory muscle may result in respiratory complication in overweighted patients, and increased cardiac burden and some pre-existing diseases in overweighted patients might be the cause of increased incidence of circulatory complication.

BACKGROUNDTo explore predictors of mediastinal and intrapulmonary pathologic lymph node involvement in clinical stage I non-small cell lung cancer.

METHODSFrom July 1999 to April 2001, 159 patients with clinical stage I non-small cell lung cancer underwent lobectomy and complete mediastinal or intrapulmonary lymph node dissection. All the resected lymph nodes were pathologically analyzed to find out pathologic involvement. Univariate and multivariate analyses were used to clarify predictors of lymph node metastasis.

RESULTSOf all 159 patients, 37 (23%) had pathologic lymph node metastasis. According to logistic regression analysis, tumor size, grade of cell differentiation, and pleural invasion were the significant predictors of lymphatic metastasis ( P=0.003, P=0.004, P =0.005). Patients with 2 or more factors were more liable to have lymph node metastasis than those with less than 2 factors ( P < 0.001).

CONCLUSIONSWhen patients with clinical stage I non-small cell lung cancer have such clinical factors as tumor diameter > 2.0 cm, moderate or poor differentiation, or pleural invasion, they will be more liable to have lymph node metastasis. Therefore, it should be more prudent to select therapeutic way and judge their prognosis.

BACKGROUNDTo explore the perioperative changes of T subsets and NK cell and analyze the related factors in patients with lung cancer.

METHODSThe T subsets and NK cell from peripheral blood of 60 patients with lung cancer, 15 patients with lung benign tumor and 15 healthy people were detected by immunofluorescence. These indexes of the patients with lung cancer were detected also at postoperative 2nd, 7th, 14th and 28th days.

RESULTS1.There were significant differences in the indexes between the lung cancer group and the groups of lung benign tumor and normal people except for CD8+ (P < 0.05). 2.At postoperative 2nd day CD3+, CD4+, CD4+/CD8+ and NK cell of the patients with lung cancer were decreased and CD8+ was increased significantly than those before operation (P < 0.05). During postoperative 1 to 2 weeks, all indexes had recovered basically to the preoperative level. At postoperative 28th day, CD3+, CD4+ , CD4+/CD8+ and NK cell were increased and CD8+ was decreased than those before operation (P < 0.05). 3. There was significant difference in the indexes among preoperative stage IIIA, IIIB and IB, and between preoperative N2 diseases and N0 group (P < 0.05). There was significant difference between the groups of radical and palliative operation and the group of thoracic exploration at postoperative 28th day (P < 0.05). There was significant difference in T subsets between the groups of blood transfusion and non-transfusion at postoperative 14th day (P < 0.05).

CONCLUSIONSThe cellular immune function of the patients with lung cancer was lower than that of the patients with lung benign tumor and normal people. The perioperative immunity of patients with lung cancer decreases after operation and increases later. TNM stage and lymph node metastasis are relative to preoperative but not postoperative immunity. There is no significant correlation between cellular immune function and pathological type of the tumor. Radical and palliative operations can both significantly increase the patients' cellular immune function. Therefore the palliative operation is better than thoracic exploration. Blood transfusion can depress the immune function of the patients, so it is better to avoid perioperative blood transfusion.

BACKGROUNDTo study the prognostic factors in patients with lung cancer after curative resection.

METHODSA retrospective study was conducted on 210 cases of clinicopathological survival data of lung cancer patients who underwent surgical resection from January 1987 to December 1999. Nine conventional prognostic factors were analyzed by COX model.

RESULTSThe overall 3-, 5- and 10-year survival rates were 37.4%, 30.1% and 23.5% respectively. Univariate analysis showed that regional lymph nodes status (N), primary tumor status (T), histological type of lung cancer, the type of operation and curability of surgical resection were significantly related to disease specific survival. Multivariate analysis showed that regional lymph nodes status, primary tumor status and curability of surgical resection were the three independent predictors of long term outcome. The hazard ratio of death was 2.42 for patients with N2-3 vs N0-1( P =0.000 1), 3.50 for patients with T2-4 vs T1( P =0.033 0) and 1.77 for patients with incomplete resection vs complete resection ( P =0.022 4).

CONCLUSIONSPrimary tumor status, regional lymph nodes status and curability of surgical resection are the three important prognostic factors of lung cancer. In order to improve long-term survival of lung cancer patients, it is very important to operate in the earlier stage of tumor, to extensively dissect intra-pulmonary and ipsilateral mediastinal lymph nodes and to avoid incomplete resection.

BACKGROUNDTo investigate pathologically the characteristics of proximal bronchial invasion of lung cancer, and to provide the theoretic basis for the selection of a proper operation mode.

METHODSA total of 398 patients with lung carcinoma underwent radical pulmonectomy and systematic lymphadenectomy. The proximal bronchi and the hilar and mediastinal lymph nodes of their operatively resected specimens were selected for pathological study.

RESULTS(1)The direct invasion of cancerous cells through mucous, submucous or multiple layers was the most frequent way during lung cancer spread, rating 9.3%, 21.8% and 68.9% respectively. 96.4% of the cancerous invasion occurred at the proximal bronchial wall less than 1.5 cm apart from the cancer margin. The extension of invasion correlated with the histopathologic type of cancer, mode of invasion and TNM classification. (2)The cancer infiltration by the nodes metastasizing into the bronchus wall (bronchial external tunica or cartilage) was also an important way for the cancer to spread, especially in adenocarcinoma. The poor differentiated adenocarcinoma has significantly higher metastatic rate and infiltration rate than the well differentiated ( P < 0.01, P < 0.01). There were 22 such cases, including 3 of lobar bronchus wall invaded by N1 metastasis and 19 of main bronchus wall by N2 metastasis.

CONCLUSIONSFor radical removal of tumor, the key point for selecting a rational operation mode is to keep a distance of 1.5 cm or more between the excision margin of the bronchus and the tumor, to pay attention to the bronchial wall invasion caused by the metastatic lymph nodes, even in peripheral adenocarcinoma, and to dissect extensively and completely the lymph nodes of the hilar and upper and lower mediastinum at the homolateral thoracic cavity.

BACKGROUNDTo investigate immunoexpression of P14ARF protein in non-small cell lung cancer (NSCLC) and to evaluate the prognostic significance.

METHODSThirty-nine tumor specimens were immunohistochemically examined with FL-132 antibody against P14ARF protein.

RESULTSP14 nuclei immunoexpression was found in 25 tumor specimens (64.1%). The patients in stage I and II had a much higher P14 expression rate than the patients in stage III and IV [78.0%(18/23) vs 43.8%(7/16) P =0.043]. The P14 expression rate in patients with and without metastasis was 78.3%(18/23) and 43.8%(7/16) respectively (P=0.043). The mean survival time of patients without P14-immunopositive staining was significantly shorter than that of patients with P14-immunopositive staining (17 months vs 45 months, P=0.023 5).

CONCLUSIONSPatients with the expression of P14ARF protein have a better prognosis. Detection of P14ARF protein in lung cancer tissues may be helpful to predict the prognosis of NSCLC.

BACKGROUNDTo determine the expression of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) in lung cancer specimens, and to find out the possible roles of MMPs and TIMPs in the infiltration and metastasis of lung cancer.

METHODSThe expression of MMP-1, MMP-2, MMP-9, MMP-13, TIMP-1, TIMP-2 were detected in 104 lung cancer tissues by immunohistochemical method.

RESULTSThe expressions of MMPs and TIMPs were up-regulated in lung cancer tissues. The expression of MMP-2 was related to differentiated degree of tumor cells. MMP-9 correlated with lymph node metastasis of lung cancer. The positive rate of TIMP-1 was related to TNM stage and lymph node metastasis. In lung cancer tissues, there was positive correlation between MMP-2 and TIMP-2, and between MMP-9 and TIMP-2.

CONCLUSIONSMMPs and TIMPs may play the important roles in the development of lung cancer. MMP-9 and TIMP-1 might promote the infiltration and metastasis of lung cancer.