Tumor spread through air spaces (STAS) as a new pathological invasion mode is closely related to many clinicopathological factors. In lung adenocarcinoma, micropapillary and solid pathological subtypes are most related; STAS for early stage lung adenocarcinoma, surgical type of lobectomy seems to benefit better than sublobar resection, which may up-regulate the pathological stage of early lung cancer; Moreover, STAS is closely related to squamous cell carcinoma and other non-small cell lung cancer (NSCLC). In addition, intraoperative frozen-section pathological detection of STAS is difficult and controversial. STAS as an independent risk factor for tumor recurrence is also an important factor indicating poor prognosis. This paper reviews the research status and progress of STAS.
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Adenocarcinoma of Lung ; diagnosis ; pathology ; surgery ; Animals ; Humans ; Lung Neoplasms ; diagnosis ; pathology ; surgery ; Neoplasm Invasiveness ; Prognosis

BACKGROUND: Previous studies have shown that the neutrophil-to-lymphocyte ratio (NLR) has a significant impact on the prognosis of many malignant tumors such as gastric cancer, colorectal cancer and pancreatic cancer, but the study on the prognosis of patients with resectable lung adenocarcinoma is less. The aim of this study is to investigate the correlation between the NLR and the clinicopathologic features of adenocarcinoma of lung patients who underwent radical pneumonectomy. Furthermore, this study aimed to clarify the predictive and prognostic significance of NLR in patients who underwent pneumonectomy for lung adenocarcinoma. METHODS: This study reviewed the medical records of 163 patients with lung adenocarcinoma who underwent pneumonectomy. The receiver operating characteristic (ROC) curve and Youden index were used to determine the cut-off value of the NLR. Survival curves were described by Kaplan-Meier method and compared by Log-rank test. The univariate and multivariate analyses were performed with the Cox proportional hazard model to identify the prognostic factors. RESULTS: When the NLR value was 2.96, the Youden index was maximal, with a sensitivity of 77.5% and a specificity of 75.9%. The 5-year survival rate in the low NLR group was higher than that in the high NLR group (P<0.05). The univariate and multivariate analyses showed that TNM staging and NLR were independent factors in predicting survival rate. CONCLUSIONS The NLR value was a simple and useful tool to predict the prognosis of lung adenocarcinoma after radical pneumonectomy.
Adenocarcinoma ; diagnosis ; immunology ; pathology ; surgery ; Adenocarcinoma of Lung ; Aged ; Cell Count ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Lung Neoplasms ; diagnosis ; immunology ; pathology ; surgery ; Lymphocytes ; cytology ; Male ; Middle Aged ; Neoplasm Staging ; Neutrophils ; cytology ; Pneumonectomy ; Prognosis ; ROC Curve ; Retrospective Studies

BACKGROUNDLymph node status of patients with early-stage nonsmall cell lung cancer has an influence on the choice of surgery. To assess the lymph node status more correspondingly and accurately, we evaluated the relationship between the preoperative clinical variables and lymph node status and developed one model for predicting lymph node involvement.

METHODSWe collected clinical and dissected lymph node information of 474 patients with clinical stage T1aN0-2M0 nonsmall cell lung cancer (NSCLC). Logistic regression analysis of clinical characteristics was used to estimate independent predictors of lymph node metastasis. The prediction model was validated by another group.

RESULTSEighty-two patients were diagnosed with positive lymph nodes (17.3%), and four independent predictors of lymph node disease were identified: larger consolidation size (odds ratio [OR] = 2.356, 95% confidence interval [CI]: 1.517-3.658, P < 0.001,), central tumor location (OR = 2.810, 95% CI: 1.545-5.109, P = 0.001), abnormal status of tumor marker (OR = 3.190, 95% CI: 1.797-5.661, P < 0.001), and clinical N1-N2 stage (OR = 6.518, 95% CI: 3.242-11.697, P < 0.001). The model showed good calibration (Hosmer-Lemeshow goodness-of-fit, P < 0.766) with an area under the receiver operating characteristics curve (AUC) of 0.842 (95% [CI]: 0.797-0.886). For the validation group, the AUC was 0.810 (95% CI: 0.731-0.889).

CONCLUSIONSThe model can assess the lymph node status of patients with clinical stage T1aN0-2M0 NSCLC, enable surgeons perform an individualized prediction preoperatively, and assist the clinical decision-making procedure.

Aged ; Carcinoma, Non-Small-Cell Lung ; pathology ; surgery ; Female ; Humans ; Lung Neoplasms ; pathology ; surgery ; Lymph Node Excision ; Lymphatic Metastasis ; diagnosis ; pathology ; Male ; Middle Aged ; Models, Theoretical ; Multivariate Analysis ; Neoplasm Staging ; methods ; Retrospective Studies

No abstract available.
Adult ; Antineoplastic Agents/*adverse effects ; Antitubercular Agents/therapeutic use ; Biopsy ; Female ; Gastrointestinal Stromal Tumors/*drug therapy/pathology/surgery ; Humans ; Imatinib Mesylate/*adverse effects ; Lung Diseases, Interstitial/*chemically induced/diagnosis ; Mycobacterium tuberculosis/*isolation & purification ; Protein Kinase Inhibitors/*adverse effects ; Rectal Neoplasms/*drug therapy/pathology/surgery ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary/diagnosis/drug therapy/*microbiology

This study was aimed to characterize clinicopathological features and prognosis of patients with adenosquamous lung carcinoma (ASC). Among the 2531 patients with lung cancer who underwent surgery between January 2000 and June 2012 in our hospital, 59 were histologically diagnosed as having ASC. The clinicopathological features and follow-up data of ASC patients were collected and analyzed statistically. Superior lobectomy was accomplished in 40 patients, middle and inferior lobectomy in 3, lobectomy plus partial resection of contralateral lung in 5, partial lung resection in 4, and pneumonectomy in 7. Moreover, 22 cases were found to be adenocarcinoma-predominant, and 18 to be squamous cell carcinoma-predominant. The median survival time was 13.6 months, and the 1-, 3-, and 5-year survival rates were 59.9%, 36.4% and 31.2%, respectively. Of the 52 cases with tissue specimens available, 11 had an EGFR mutation (21.2%) and 2 had a KRAS mutation (3.8%). Multivariate analysis showed that histology subtype, pleural invasion, TNM stage, and postoperative treatment were all independent prognostic factors. The data from the current study demonstrated that SCC-predominant histology represents a better prognosis of ASC. Histology subtype, pleural invasion, TNM stage, and postoperative treatment are independent prognostic factors for ASC and adjuvant therapy may help control the disease.
Adult ; Aged ; Carcinoma, Adenosquamous ; genetics ; pathology ; surgery ; Diagnosis, Differential ; Female ; Humans ; Lung Neoplasms ; genetics ; pathology ; surgery ; Male ; Middle Aged ; Mutation ; Prognosis ; Proto-Oncogene Proteins p21(ras) ; genetics ; Receptor, Epidermal Growth Factor ; genetics ; Retrospective Studies ; Survival Analysis

The incidence of ground-glass opacity (GGO)-dominant lung cancer is rising in China. The review is focused on the diagnosis and therapy for GGO-dominant lung cancer. CT screening in high-risk groups is recommended for early diagnosis of GGO-dominant lung cancer. The early diagnosis of GGO-dominant lung cancer depends on dynamic observation on the chest CT. Non-surgical biopsy or PET/CT has limited diagnostic value in GGO-dominant lung cancer. Video-assisted Thoracoscopic resection (VATS) is the mainstream treatment for GGO-dominant lung cancer. Single-port VATS, VATS segmentectomy, robot-assisted VATS, and subxiphoid VATS are the new directions of minimally invasive surgery. GGO intraoperative localization can be integrated using a variety of models. Sublobectomy could be used in the therapy for adenocarcinoma in situ, minimally invasive adenocarcinoma or pure GGO with 2.0 cm or less in diameter. Surgery for multiple GGO need an individualized strategy.
Adenocarcinoma ; surgery ; China ; Humans ; Lung ; pathology ; Lung Neoplasms ; diagnosis ; surgery ; Positron-Emission Tomography ; Thoracic Surgery, Video-Assisted ; Tomography, X-Ray Computed

OBJECTIVETo analyze the clinical characteristics and follow up record of patients with synchronous multiple lung cancers (SMLC).

METHODSThe medical records of 1 868 lung cancer patients who underwent surgical treatments From January 2007 to December 2014 were reviewed, in which 103 patients were diagnosed SMLC by Martini and American College of Chest Physicians modified guideline. The average age was 60.5 years, including 34 male and 69 female patients. According to consolidation/tumor ratio (CTR) on thin-section computed tomography, 103 cases were classified into three groups: group A (multiple ground-glass opacities, CTR ≤ 50%), group B (with one solid dominant nodules, CTR > 50%), group C (with two solid dominant nodules). The surgical procedure was determined according to CT findings and respiratory function. The Kaplan-Meier method was used to analyze the duration of recurrence-free survival (RFS) and over-all survival (OS), and differences were assessed using the Log-rank test. Multivariate analysis using the Cox proportional hazards models was used to assess the potential independent effects on RFS or OS.

RESULTSThere were 38 patients in group A (36.9%), 40 patients in group B (38.8%) and 25 patients (24.3%) in group C. More female (73.7% vs. 48.0%, χ² = 4.291, P = 0.038), less smoker (21.1% vs. 44.0%, 2 = 3.770, P = 0.052), younger (56.2 years old vs. 65.9 years old, t = -4.172, P = 0.000) and less tumor size (1.24 cm vs. 2.31 cm, t = -4.573, P = 0.000) patients in group A than in group C. The 3, 5-year RFS were 80.3% and 64.9% for all patients, respectively. The 3, 5-year OS were 87.3% and 68.6% for all patients, respectively. The 3, 5-year RFS were 100% and 100% in group A, 77.7% and 51.8% in group B, 59.6% and 44.7% in group C (P = 0.029). No significance were found in OS between the three groups (P = 0.214). Multivariate Cox analysis demonstrated that size of dominant nodule larger than 2 cm (HR = 4.475, 95% CI: 1.138 to 17.604, P = 0.032) is associated with poor prognosis, whereas postoperative chemotherapy did not affect RFS.

CONCLUSIONSMultifocal ground-glass opacities and multiple solid lung cancers are different in nature. RFS of patients with SMLC is strongly affected tumor size. Surgical resection is effective and should be performed specifically to patients.

Female ; Humans ; Lung ; pathology ; surgery ; Lung Neoplasms ; diagnosis ; pathology ; surgery ; Male ; Middle Aged ; Multivariate Analysis ; Proportional Hazards Models ; Tomography, X-Ray Computed ; Treatment Outcome

Although hematogenous metastasis of cancer to the gastrointestinal track is rare, it sometime has been reported in patients with malignant melanoma and breast cancer. However, it is extremely rare for lung cancer to metastasize to the stomach, not to mention solitary gastric metastasis. Herein, the authors report a case of a 69-year-old man who was initially diagnosed with lung cancer with synchronous primary gastric cancer which proved to be lung cancer with solitary gastric metastasis after the operation.
Adenocarcinoma/*diagnosis/pathology ; Aged ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Diagnosis, Differential ; Endoscopy, Digestive System ; Humans ; Lung Neoplasms/*diagnosis/drug therapy/pathology ; Male ; Stomach Neoplasms/*diagnosis/secondary/surgery ; Tomography, X-Ray Computed

Biopsy ; Bronchial Neoplasms ; diagnosis ; pathology ; surgery ; Bronchoscopy ; Child ; Diagnosis, Differential ; Fatal Outcome ; Female ; Humans ; Lung ; diagnostic imaging ; surgery ; Lung Neoplasms ; diagnosis ; pathology ; surgery ; Neoplasm Metastasis ; Rhabdomyosarcoma, Embryonal ; diagnosis ; pathology ; surgery ; Tomography, X-Ray Computed

PURPOSE: The purpose of this study was to identify the effects of a Progressive Walking program (PW) on physical activity, exercise tolerance, recovery, and post-operative complications for patients with a lung resection. METHODS: A nonequivalent control group non-synchronized design was utilized and 37 participants with a lung resection (22 for control group, 15 for experimental group) were recruited at A university hospital from December 2012 to August 2013. The PW consisted of preoperative education, goal setting, and feedback, provided to the experimental group, and usual care to the control group. Data were analyzed using the SPSS WIN 18.0. RESULTS: A higher proportion of patients in the experimental group showed adequate levels of physical activity (p=.001), shorter period of chest tube retention (< or = 7 days; p=.011), and shorter stay in the hospital (< or = 10 days; p=.036) than patients in the control group. Patients in the experimental group reported longer 6-minute walking distance (p=.032) and lower levels of dyspnea (p=.049) than patients in the control group. The PW did not influence the occurrence of pulmonary complications. CONCLUSION: The findings of this study suggest that the PW could be a useful strategy for improving patients' post-operative health and reducing cost after lung resection.
Aged ; Dyspnea/diagnosis ; Exercise Tolerance ; Female ; Humans ; Length of Stay ; Lung Neoplasms/pathology/*surgery ; Male ; Middle Aged ; Postoperative Care ; Postoperative Complications ; Questionnaires ; Treatment Outcome ; *Walking