Objective:To investigate the efficacy and safety of sleeve pulmonary resection after neoadjuvant immunotherapy combined with chemotherapy in the treatment of non-small cell lung cancer.Methods:A retrospective cohort study was conducted. The clinical data of 61 patients with non-small cell lung cancer who underwent sleeve pulmonary resection surgery at Shanxi Province Cancer Hospital from January 2018 to December 2024 were retrospectively analyzed. According to the preoperative neoadjuvant therapy, the patients were divided into the immunotherapy combined with chemotherapy group (26 cases) and the chemotherapy group (35 cases). The efficacy and incidence of adverse reactions of neoadjuvant therapy between two groups of patients were compared.Results:The open surgery was the main surgical approach in both the immunotherapy combined with chemotherapy group and the chemotherapy group, accounting for 61.5% (16/26) and 74.3% (26/35), respectively. The surgical approach of 10 cases (38.5%, 10/26) in the immunotherapy combined with chemotherapy group and 9 cases (25.7%, 9/35) in the chemotherapy group was thoracoscopy, and the difference was not statistically significant ( χ2 = 1.13, P = 0.288); the most common postoperative complications were persistent pulmonary air leakage [30.8% (8/26) in the immunotherapy combined with chemotherapy group and 22.9% (8/35) in the chemotherapy group] and lung infection [19.2% (5/26) in the immunotherapy combined with chemotherapy group and 17.1% (6/35) in the chemotherapy group], with no statistically significant differences (both P > 0.05). Two cases (5.7%) in the chemotherapy group experienced worsening pulmonary infection leading to respiratory failure and died within 90 days after surgery, but there were no cases of death within 90 days in the immunotherapy combined with chemotherapy group ( P > 0.05). One patient in each group (3.8% of the immunotherapy combined chemotherapy group and 2.9% of the chemotherapy group) underwent the second surgery due to persistent hemoptysis after surgery, and further underwent pneumonectomy. After the second surgery, the patients recovered and were discharged. There was no statistically significant difference in intraoperative bleeding, surgical time, postoperative tubing time, and hospitalization time between the two groups of patients (all P > 0.05). Postoperative pathology showed that both groups achieved R 0 resection. The main pathological remission (MPR) rate in the immunotherapy combined chemotherapy group was 65.4% (17/26), while the MPR rate in the chemotherapy group was 20.0% (7/35), with a statistically significant difference ( χ2 = 12.89, P < 0.001); the pathological complete response (PCR) rate in the immunotherapy combined chemotherapy group was 30.8% (8/26), while the PCR rate in the chemotherapy group was 8.6% (3/35), with a statistically significant difference ( χ2 = 4.97, P = 0.026). During the period of neoadjuvant therapy, the incidence of adverse reactions in the immunotherapy combined with chemotherapy group was 80.8% (21/26), while in the chemotherapy group it was 62.9% (22/35); the incidence of ≥ grade 3 adverse reactions was 19.2% (5/26) and 20.0% (7/35), respectively, with no statistically significant differences (both P > 0.05). Conclusions:Patients with non-small cell lung cancer who undergo sleeve pulmonary resection after neoadjuvant immunotherapy combined with chemotherapy have controllable adverse reactions during neoadjuvant therapy, which does not increase the difficulty of surgery or the postoperative complications, and can improve the degree of postoperative pathological remission.

Objective:To investigate the efficacy and safety of sleeve pulmonary resection after neoadjuvant immunotherapy combined with chemotherapy in the treatment of non-small cell lung cancer.Methods:A retrospective cohort study was conducted. The clinical data of 61 patients with non-small cell lung cancer who underwent sleeve pulmonary resection surgery at Shanxi Province Cancer Hospital from January 2018 to December 2024 were retrospectively analyzed. According to the preoperative neoadjuvant therapy, the patients were divided into the immunotherapy combined with chemotherapy group (26 cases) and the chemotherapy group (35 cases). The efficacy and incidence of adverse reactions of neoadjuvant therapy between two groups of patients were compared.Results:The open surgery was the main surgical approach in both the immunotherapy combined with chemotherapy group and the chemotherapy group, accounting for 61.5% (16/26) and 74.3% (26/35), respectively. The surgical approach of 10 cases (38.5%, 10/26) in the immunotherapy combined with chemotherapy group and 9 cases (25.7%, 9/35) in the chemotherapy group was thoracoscopy, and the difference was not statistically significant ( χ2 = 1.13, P = 0.288); the most common postoperative complications were persistent pulmonary air leakage [30.8% (8/26) in the immunotherapy combined with chemotherapy group and 22.9% (8/35) in the chemotherapy group] and lung infection [19.2% (5/26) in the immunotherapy combined with chemotherapy group and 17.1% (6/35) in the chemotherapy group], with no statistically significant differences (both P > 0.05). Two cases (5.7%) in the chemotherapy group experienced worsening pulmonary infection leading to respiratory failure and died within 90 days after surgery, but there were no cases of death within 90 days in the immunotherapy combined with chemotherapy group ( P > 0.05). One patient in each group (3.8% of the immunotherapy combined chemotherapy group and 2.9% of the chemotherapy group) underwent the second surgery due to persistent hemoptysis after surgery, and further underwent pneumonectomy. After the second surgery, the patients recovered and were discharged. There was no statistically significant difference in intraoperative bleeding, surgical time, postoperative tubing time, and hospitalization time between the two groups of patients (all P > 0.05). Postoperative pathology showed that both groups achieved R 0 resection. The main pathological remission (MPR) rate in the immunotherapy combined chemotherapy group was 65.4% (17/26), while the MPR rate in the chemotherapy group was 20.0% (7/35), with a statistically significant difference ( χ2 = 12.89, P < 0.001); the pathological complete response (PCR) rate in the immunotherapy combined chemotherapy group was 30.8% (8/26), while the PCR rate in the chemotherapy group was 8.6% (3/35), with a statistically significant difference ( χ2 = 4.97, P = 0.026). During the period of neoadjuvant therapy, the incidence of adverse reactions in the immunotherapy combined with chemotherapy group was 80.8% (21/26), while in the chemotherapy group it was 62.9% (22/35); the incidence of ≥ grade 3 adverse reactions was 19.2% (5/26) and 20.0% (7/35), respectively, with no statistically significant differences (both P > 0.05). Conclusions:Patients with non-small cell lung cancer who undergo sleeve pulmonary resection after neoadjuvant immunotherapy combined with chemotherapy have controllable adverse reactions during neoadjuvant therapy, which does not increase the difficulty of surgery or the postoperative complications, and can improve the degree of postoperative pathological remission.

Objective:To explore the clinical value of CT identification of vascular variations in the dorsal side of right middle segmental bronchus before thoracoscopic lobectomy.Methods:A retrospective analysis was conducted on the clinical data of 3 patients who underwent thoracoscopic lobectomy at Shanxi Province Cancer Hospital from July 2022 to March 2024 and had a variant blood vessel on the dorsal side of the right middle segmental bronchus. Relevant literature was also reviewed.Results:Among the 3 patients, 2 were female and 1 was male, with ages of 66, 50 and 69 years old, respectively. Prior to admission, imaging examinations revealed space-occupying lesions or nodes in the right lung, and all patients underwent thoracoscopic right lobectomy and systematic lymph node dissection. Postoperative pathology diagnosed adenocarcinoma in the lower lobe of the right lung, cystic adenoma in the upper lobe of the right lung and invasive adenocarcinoma in the lower lobe of the right lung. Preoperative chest CT scans revealed an abnormal blood vessel on the dorsal side of the right middle segmental bronchus, and its direction and confluence with the right lower pulmonary vein or left atrium were observed on the downward CT imaging. This was confirmed and treated accordingly during surgery. All 3 patients had no postoperative complications and recovered smoothly. Follow-up showed good health status.Conclusions:The vascular variation on the dorsal side of the right middle segmental bronchus has obvious characteristic manifestations on chest CT. Identifying the variation by CT before thoracoscopic lobectomy can effectively ensure surgical safety and reduce the occurrence of postoperative complications.

Objective:To investigate the clinical effect of intranasal drainage in treatment of anastomotic fistula accompanied with abscess in thoracic cavity or mediastinum after esophageal cancer surgery.Methods:A retrospective case cohort study was conducted. The clinical data of 32 patients with anastomotic fistula and abscess in thoracic cavity or mediastinum after esophageal cancer surgery in Shanxi Province Cancer Hospital from January 2017 to December 2022 were analyzed. Among them, 15 cases were treated with traditional closed thoracic drainage (the traditional group), and 17 cases were treated with intranasal drainage (the intranasal drainage group). The time of abnormal body temperature, antibiotic usage time, anastomotic fistula healing time, hospitalization stay and the incidence of anastomotic stenosis were compared between the both groups.Results:There were no statistically significant differences in age, gender, tumor staging, surgical method, and fistula diameter between the 2 groups (all P>0.05). The time of abnormal body temperature in the intranasal drainage group was shorter than that in the traditional group [(6.1±1.5) d vs. (9.1±1.9) d], and the difference was statistically significant ( t = 5.02, P < 0.001). The usage time of antibiotic in the intranasal drainage group was shorter than that in the traditional group [(11.5±1.9) d vs. (14.2±2.7) d], and the difference was statistically significant ( t = 3.30, P < 0.001). Anastomotic fistula healing time in the intranasal drainage group was shorter than that in the traditional group [(20±4) d vs. (24±6) d], and the difference was statistically significant ( t = 2.32, P < 0.05). The hospitalization stay in the intranasal drainage group was shorter than that in the traditional group [(27±3) d vs. (36±7) d],and the difference was statistically significant ( t = 5.20, P < 0.001). There was no statistically significant difference in the incidence of anastomotic stenosis between the 2 groups after treatment ( P > 0.05). Conclusions:Intranasal drainage is a simple and effective treatment method for patients with anastomotic fistula and abscesses that are not easily drained in thoracic cavity or mediastinum after resection surgery of esophageal cancer.

Objective:To clarify the mechanism of Fat1 on the proliferation of esophageal squamous cell carcinoma (ESCC).Methods:KYSE450 cells were transfected with Plko.1-puro-GFP-shRNA-Fat1 plasmid and real time polymerase chain reaction (PCR) was used to verify the efficiency of Fat1 knockdown. The effects of Fat1 and extracellular regulated protein kinase (ERK) pathway inhibitor U0126 on the proliferation of ESCC cells were detected by methyl thiazolyl tetrazolium (MTT). Colony formation assay was used to detect the colony formation ability. Cell cycle was detected by live cell imaging. Western blot was used to observe the level of target protein. Mouse xenograft assay was applied to detect the effect of Fat1 knockdown on KYSE450 cell tumor growth. Immunohistochemistry was used to detect the expressions of related proteins in tumor sections.Results:The efficiency of Fat1 knockdown was (77.1±6.9)% in Fat1 sh1 group and (77.7±7.1)% in Fat1sh2 group. Compared with the control group, the cell proliferation and the expression of p-ERK1/2 were significantly increased in Fat1 sh1 and Fat1sh2 group ( P<0.05). After U0126 treatment, the effect of Fat1 knockdown on the proliferation of KYSE450 cells disappeared, and the expression of p-ERK1/2 in KYSE450 cells decreased to a level similar to that in the control group. The number of cell clones in the control group was (72±8), lower than (155±28) and (193±9) in the Fat1sh1 and Fat1sh2 groups, respectively ( P<0.05). In KYSE450 cell, division time was shortened from 1 622±32 min in control group to 1 408±29 min in Fat1 sh1 group, the difference was statistically significant ( P<0.05). Compared with the control group, the tumor volume of Fat1 knockdown group increased significantly. The tumor weight of control group and Fat1 knockdown group were (0.224±0.028) g and (1.532±0.196) g, respectively, at 4 weeks after inoculation, and the difference was statistically significant ( P<0.05). Conclusion:Fat1 inhibits cell proliferation via ERK signaling in ESCC.

Objective:To clarify the mechanism of Fat1 on the proliferation of esophageal squamous cell carcinoma (ESCC).Methods:KYSE450 cells were transfected with Plko.1-puro-GFP-shRNA-Fat1 plasmid and real time polymerase chain reaction (PCR) was used to verify the efficiency of Fat1 knockdown. The effects of Fat1 and extracellular regulated protein kinase (ERK) pathway inhibitor U0126 on the proliferation of ESCC cells were detected by methyl thiazolyl tetrazolium (MTT). Colony formation assay was used to detect the colony formation ability. Cell cycle was detected by live cell imaging. Western blot was used to observe the level of target protein. Mouse xenograft assay was applied to detect the effect of Fat1 knockdown on KYSE450 cell tumor growth. Immunohistochemistry was used to detect the expressions of related proteins in tumor sections.Results:The efficiency of Fat1 knockdown was (77.1±6.9)% in Fat1 sh1 group and (77.7±7.1)% in Fat1sh2 group. Compared with the control group, the cell proliferation and the expression of p-ERK1/2 were significantly increased in Fat1 sh1 and Fat1sh2 group ( P<0.05). After U0126 treatment, the effect of Fat1 knockdown on the proliferation of KYSE450 cells disappeared, and the expression of p-ERK1/2 in KYSE450 cells decreased to a level similar to that in the control group. The number of cell clones in the control group was (72±8), lower than (155±28) and (193±9) in the Fat1sh1 and Fat1sh2 groups, respectively ( P<0.05). In KYSE450 cell, division time was shortened from 1 622±32 min in control group to 1 408±29 min in Fat1 sh1 group, the difference was statistically significant ( P<0.05). Compared with the control group, the tumor volume of Fat1 knockdown group increased significantly. The tumor weight of control group and Fat1 knockdown group were (0.224±0.028) g and (1.532±0.196) g, respectively, at 4 weeks after inoculation, and the difference was statistically significant ( P<0.05). Conclusion:Fat1 inhibits cell proliferation via ERK signaling in ESCC.

Objective: To explore the value of the constructed prognostic prediction model of resectable lung cancer in predicting the survival and prognosis of patients. Methods: A total of 2 267 patients with primary lung cancer in Shanxi Provincial Cancer Hospital from January 2007 to September 2018 were selected. All patients underwent primary lung cancer surgery without a second primary tumor. Gender, age, occupation, tumor site, pathological type, surgical path, surgical method, tumor stage and treatment were selected as the prognostic factors. A Cox proportional hazard model was used to construct a prognostic index (PI) equation to calculate the PI value of each patient. According to the different ranges of PI values, the low-, intermediate- and high-risk prognosis groups were divided, and the survival status of three groups were evaluated. Results: Gender (RR= 0.684, P= 0.001), age (RR= 0.591, P < 0.01), occupation (RR= 1.439, P= 0.001), pathological type (RR= 3.694, P < 0.01), surgical path (RR= 0.734, P= 0.001), tumor stage (RR= 0.352, P= 0.007) were independent factors affecting the prognosis of patients with resectable lung cancer. Female, ≤65 years old, thoracoscopic surgery, and tumor stage Ⅰ were prognostic protective factors, and their risks of poor prognosis were reduced by 31.6%, 40.9%, 26.6%, and 64.8%, respectively. Farmer and adenosquamous carcinoma were prognostic risk factors, and their risks of poor prognosis were increased by 43.9% and 269.4%, respectively. The PI equation was ∑β_ix_i=-0.380 X₁-0.526 X₂+0.364 X₃₁+1.307 X₅₅-0.309 X₆-1.045 X₈₁ (X₁ was the gender, X₂ was the age, X₃₁ was the occupation as a farmer, X₅₅ was the pathological type of adenosquamous carcinoma, X₆ was the surgical path, X₈₁ was the tumor stage Ⅰ). PI <-1 was the low-risk group, PI ≥-1 and ≤-0.5 was the intermediate-risk group, PI >-0.5 was the high-risk group, and the differences of their survival rates were statistically significant (P < 0.05). The 1-, 3-, and 5-year survival rates for the low-, risk groups were 96.8%, 87.0% and 77.9%; the intermediate-risk group were 91.8%, 82.2% and 61.7%; the high-risk group were 86.5%, 61.7% and 50.3%. respectively. Conclusion The prognostic prediction model of resectable lung cancer can predict the prognosis risk and the corresponding survival rate of patients with resectable lung cancer, and it can help clinicians to evaluate the prognosis and formulate subsequent treatment plans.

Background and objective Surgical resection is the best choice for early lung cancer, but the prognosis of early postoperative lung cancer is still very different, whether or not to apply adjuvant chemotherapy is controversial. This study examines the role of postoperative adjuvant chemotherapy in patients with stage Ⅰ non-small cell lung cancer (NSCLC),particularly in high-risk groups. Methods Patients with pathologic stage Ⅰa and stage Ⅰb NSCLC who underwent complete (R0) resection between January 2009 and June 2013 were identified from Peking University People's Hospital and classified into two groups based on postoperative chemotherapy or not. Kaplan-Meier and Log-rank tests were used to compare disease free survival (DFS). Scored according to the number of risk factors, all patients were divided into three groups. Kaplan-Meier and Log-rank tests were used to compare DFS between them. The effect of postoperative chemotherapy on high-risk group was observed individually. Results A total of 465 patients including 284 cases of stage Ⅰa and 181 cases of stage Ⅰb were enrolled in this study.For stage Ⅰa there was no significant difference between the chemotherapy group and the control group in DFS (P=0.171),but the survival curve of the chemotherapy group was located below the control group. For stage Ⅰb there was no significant difference between the two groups either (P=0.630). But there were significant differences on DFS between the three groups according to the number of risk factors (P<0.001). The more risk factors mean the worse DFS. However, independent analyses showed no significant effect of postoperative chemotherapy on DFS in the high-risk group patients (P=0.763). Conclusion Postoperative chemotherapy does not have a positive effect on DFS in early stage non-small cell lung cancer, and chemotherapy may not be appropriate even for patients with multiple risk factors.

Objective To explore the effect of macrophage colony stimulating factor (M-CSF) on lung cancer cell line A549. Methods After M-CSF at 0.1, 1 and 10 ng/ml was given to cultured A549 cells for 0, 24, 48, 72 and 92 h respectively, their morphological changes were observed with inverted microscopy, proliferation was measured by MTT assay, and cell cycles were determined by flow cytometry. RT-PCR was used to detect the change of expression of M-CSF receptor. Result The growth of A549 was significantly inhibited by M-CSF in a concentration- and time- dependent manner. The maximum response was obtained at 10 ng/ml of M-CSF. Flow cytometric analysis revealed that the treated A549 cells arrested at the G0/G1 phase of the cell cycle. RT-PCR showed that the mRNA expression of M-CSF receptor was reduced after the M-CSF treatment. Conclusion M-CSF has an anti-tumour activity on lung cancer cell A549.