Along with the popularity of low-dose computed tomography lung cancer screening, an increasing number of lung ground-glass opacity (GGO) lesions are detected. The pathology of GGO could be benign, but persistent GGO indicates early-stage lung cancer. Distinct from traditional lung cancer, GGO-featured lung cancer is more common in the young, nonsmokers and females. GGO-featured lung cancer represents an indolent type of malignancy with a long time to intervene. However, there is still no consensus on the screening, pathology, surgical procedure, and postoperative surveillance of GGO-featured lung cancer. Therefore, we proposed a personalized treatment strategy for GGO-featured lung cancer. The screening for GGO-featured lung cancer should be conducted at young age and low frequency. Adenocarcinoma in situ, minimally invasive adenocarcinoma, lepidic, and non-lepidic growth patterns could present as GGO. The following issues should be taken into consideration while determining the treatment of GGO-featured lung cancer: avoiding treating benign disease as malignancies, avoiding treating early-stage disease as advanced-stage disease, avoiding treating indolent malignancy as aggressive malignancy, and choosing appropriate timing to receive surgery without affecting life tracks and career developments. Bronchoscope and bone scan are not necessary for preoperative examinations of GGO-featured lung adenocarcinoma. For selected patients, sublobar resection without mediastinal lymph node dissection might be sufficient. Intraoperative frozen section is an effective method to guide resection strategy. Given the excellent survival of GGO-featured lung cancer, a less intensive postoperative surveillance strategy may be sufficient.
【Abstract】ObjectiveTo explore the effect of surgical treatment of metastatic hepatic cancer. MethodsTwo hundred and eight patients with metastatic hepatic cancer received surgical treatment in our department during the past seven years, and their information were analyzed retrospectively in this paper. The ages of these patients ranged from 19 years to 82 years, and 133 of them were male, 75 of them were female. Two of them were complicated with hepatocirrhosis, and 5 with polycystic liver. The metastatic cancer originated from gastrointestinal tract in 121 cases (58.2%), and from other parts of the body in 87 cases (41.8%). One hundred and sixteen of the patients received resection treatment (resection group), and 92 of them received nonresecton treatment (nonresection group). The survival rates of the two groups were compared through Chi square test.ResultsThe 1, 3 and 5year survival rates for all patients were 56.3%,23.1% and 13.0%, respectively. The 1, 3 and 5year survival rates were 74.1%,39.7% and 23.3% in the resection group respectively and 33.7%， 2.2% and 0 in the nonresection group， respectively. Resection group had a higher survival rate than that of the nonresection group (P＜0.05). The main postoperative complications include pulmonary infection (6 cases), subphrenic infection (2 cases), incisional infection (4 cases).ConclusionSurgical resection is an effective treatment method for the patients with metastatic hepatic cancer. Resection should be conducted as long as they could withstand the surgery.
目的 探讨手术切除联合液氮冷冻治疗结膜鳞状细胞癌的临床效果。 方法 分析1998年-2008年收治的21例眼睑结膜鳞癌患者的临床资料。对肿瘤局限在眼球结膜和部分穹窿结膜受侵犯者行单纯手术切除联合液氮冷冻治疗；部分或全部结膜及眼睑受侵犯者行局部肿瘤切除联合眼睑重建及液氮冷冻治疗；眼睑和球结膜广泛受累，无法进行眼睑重建者行眼眶内容物剜除术。 结果 21例中，7例行单纯肿瘤切除合并冷冻治疗，其中5例痊愈，2例复发；10例行局部肿瘤切除并进行眼睑重建，其中7例痊愈，3例复发，复发病例作眶内容摘除；4例肿瘤侵犯范围较宽而无法保留眼球者行眼眶内容物摘除。术手3例死于肝肺转移。 结论 眼睑结膜鳞状细胞瘤的外科手术切除是唯一有效的方法，眼睑重建视肿瘤侵犯范围而定，冷冻治疗作为辅助治疗可提高疾病的治愈率。
ObjectiveTo systematically review the efficacy and safety of neoadjuvant chemotherapy containing tegafur gimeracil oteracil potassium (S-1) combined with surgery in the treatment of advanced gastric cancer.MethodsWe searched EMbase, PubMed, The Cochrane Library, Web of Science, CBM, CNKI and WanFang Data from inception to February 2017, to collect randomized controlled trials (RCTs) about neoadjuvant chemotherapy containing S-1 combined with surgery in the treatment of advanced gastric cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 11 RCTs involving 971 advanced gastric cancer patients were included. The results of meta-analysis showed that the neoadjuvant chemotherapy containing S-1 combined with surgery group was superior to the control group in R0 resection rate (OR=2.75, 95%CI 1.91 to 3.95, P<0.000 01), 2 year survival rate (OR=1.72, 95%CI 1.01 to 2.93, P=0.05) and 3 year survival rate (OR=1.64, 95%CI 1.12 to 2.41, P=0.01), while there were no statistical differences in response rate (OR=1.33, 95%CI 0.70 to 2.51, P=0.39), 1 year survival rate (OR=1.50, 95%CI 0.64 to 3.53, P=0.35) and the incidence of postoperative complications (OR=1.00, 95%CI 0.66 to 1.51, P=0.98).ConclusionNeoadjuvant chemotherapy containing S-1 combined with surgery can improve the R0 resection rate, 2-year survival rate and 3-year survival rate without increase postoperative complications rate. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
目的 探讨脑胶质瘤术后不同时期的MRI增强表现，客观分析其术后的手术切除程度。 方法 2009年2月－2012年10月32例脑胶质瘤患者均在术后1 d～2周进行第1次MRI平扫及增强扫描（其中21例在术后3 d内进行检查），术后1～3个月随访复查21例，术后6～12个月随访复查18例，术后1～3年MRI随访16例。分析不同时期的MRI平扫及增强表现，以期发现正确评价手术切除程度的指标。 结果 术后3 d内行MRI增强检查仅有4例出现反应性强化，肿瘤残余有7例，结合其影像学表现可较准确地区分术后反应性强化及肿瘤残余。 结论 胶质瘤术后早期（3 d内）进行MRI增强检查可准确评价肿瘤术后切除程度，便于制订下一步治疗计划。
ObjectiveTo investigate the effect of the interval between neoadjuvant chemoradiotherapy (nCRT) and surgery on the clinical outcome of esophageal cancer.MethodsPubMed and EMbase databases from inception to March 2018 were retrieved by computer. A random-effect model was used for all meta-analyses irrespective of heterogeneity. The meta-analysis was performed by RevMan5.3 software. The primary outcomes were operative mortality, incidence of anastomotic leakage, and overall survival; secondary outcomes were pathologic complete remission rate, R0 resection rate, and positive resection margin rate.ResultsA total of 17 studies with 18 173 patients were included. Among them, 13 were original studies with 2 950 patients, and 4 were database-based studies with a total of 15 223 patients. The results showed a significant positive correlation between the interval and operative mortality (Spearman coefficient=0.360, P=0.027). Dose-response meta-analysis revealed that there was a relatively better time window for surgery after nCRT. Further analysis for primary outcomes at different time cut-offs found the following results: (1) when the time cut-off point within 30-70 days, the shorter interval was associated with a reduced operative mortality (7-8 weeks: RR=0.67, 95% CI 0.55-0.81, P<0.05; 30-46 days: RR=0.63, 95%CI 0.47-0.85, P<0.05; 60-70 days: RR=0.64, 95%CI 0.48-0.85, P<0.05); (2) when the time cut-off point within 30-46 days, the shorter interval correlated with a reduced incidence of anastomotic leakage (RR=0.39, 95%CI 0.21-0.72, P<0.05); when the time cut-off point within 7-8 weeks, the shorter interval could achieve a critical-level effect of reducing the incidence of anastomotic leakage (RR=0.73, 95%CI 0.52-1.03, P>0.05); (3) when the time cut-off point within 7-8 weeks, increased interval significantly was associated with the poor overall survival (HR=1.17, 95% CI 1.00-1.36, P<0.05). Secondary outcomes found that the shorter interval could significantly reduce the positive resection margin rate (RR=0.53, 95% CI 0.38-0.75, P<0.05) when time cut-off point within 56-60 days.ConclusionShortening the interval between nCRT and surgery can reduce the operative mortality, the incidence of anastomotic leakage, long-term mortality risk, and positive resection margin rate. It is recommended that surgery should be performed as soon as possible after the patient's physical recovery, preferably no more than 7-8 weeks, which supports the current study recommendation (within 3-8 weeks after nCRT).
ObjectiveTo understand the biological behavior of primary squamous cell carcinoma of thyroid (PSCCT), and provide references for its clinical diagnosis and treatment.MethodThe latest domestic and foreign reports of PSCCT were collected and analyzed.ResultsIn the diagnosis of PSCCT, the possibility of metastasis of squamous cell carcinoma to thyroid should be excluded. It often presented with hoarseness, local obstruction, and the median survival time was about 12 months. The treatment mainly relies on complete surgical resection.ConclusionPrimary squamous cell carcinoma of thyroid is a rare disease with rapid disease progression, poor overall prognosis and limited therapeutic options.