[Advances in Lymph Node Metastasis and the Modes of Lymph Node Dissection in Early Stage Non-small Cell Lung Caner]

Determining Association between Lung Cancer Mortality Worldwide and Risk Factors Using Fuzzy Inference Modeling and Random Forest Modeling

Lung cancer remains the leading cause for cancer mortality worldwide. While it is well-known that smoking is an avoidable high-risk factor for lung cancer, it is necessary to identify the extent to which other modified risk factors might further affect the cell's genetic predisposition for lung cancer susceptibility, and the spreading of carcinogens in various geographical zones. This study aims to examine the association between lung cancer mortality (LCM) and major risk factors. We used Fuzzy Inference Modeling (FIM) and Random Forest Modeling (RFM) approaches to analyze LCM and its possible links to 30 risk factors in 100 countries over the period from 2006 to 2016. Analysis results suggest that in addition to smoking, low physical activity, child wasting, low birth weight due to short gestation, iron deficiency, diet low in nuts and seeds, vitamin A deficiency, low bone mineral density, air pollution, and a diet high in sodium are potential risk factors associated with LCM. This study demonstrates the usefulness of two approaches for multi-factor analysis of determining risk factors associated with cancer mortality.

The clinical value of a new method of functional lymph node dissection in video-assisted thoracic surgery right non-small cell lung cancer radical resection

Background

To evaluate the safety, thoroughness and feasibility of "tunnel-type en bloc mediastinal lymph node dissection" in video-assisted thoracic surgery (VATS) for right non-small cell lung cancer (NSCLC) radical resection, which functionally dissected the lymph nodes of station 2R/4R/7.

Methods

A retrospective study was performed in the clinical data of 196 patients with VATS right NSCLC radical resection. According to the different methods of lymph node dissection of station 2R, 4R and 7, they were divided into the tunnel-type group (n=102) and the routine group (n=94). The clinical data of two group were compared.

Results

The analyses of the baselines of the two groups are comparable. For lymph nodes dissection of station 2R/4R/7, operation time, the total number, positive number and metastasis incidence shown no significant difference between two groups (P>0.05). However, the amount of bleeding, postoperative thoracic drainage volume, extubation time, hospitalization days, the incidence of postoperative pulmonary infection and chronic cough were significantly lower in the tunnel-type group (P<0.05). There was no significant difference in 3-year recurrence and metastasis and in 3-year survival between tunnel-type group and routine group.

Conclusions

The tunnel-type group has more advantages, such as less surgical trauma, shorter hospitalization time, faster postoperative rehabilitation, even less postoperative chronic cough compared with the routine group. Therefore, we believe that the tunnel-type en bloc mediastinal lymph node dissection is a safe, thorough and feasible surgical method, which is worthy of being popularized and applied in the VATS right NSCLC radical resection.

Clinical analysis on 113 patients with lung cancer treated by percutaneous CT-guided microwave ablation

BACKGROUND

Lung Cancer is a primary tumor with poor prognosis. For early stage lung cancer, treatment options include surgical resection and microwave techniques. Percutaneous ablative techniques emerged as best therapeutic options for nonsurgical patients.

METHODS

The aim of this study was to retrospectively analyze the clinical effect of CT-guided microwave ablation (MWA) treatment for patients with lung cancer who were not eligible for surgical resection. MWA was used to treat the tumor lesion of 113 patients with lung cancer who were in our hospital from Jan, 2013 to Jun, 2015. The median diameter of tumors was 3.1 cm (0.7-6 cm). Follow-up were paid to all the patients who received MWA therapy. The average follow-up was 22.1±8.6 months, and the median follow-up was 18 (7-40) months.

RESULTS

All of 113 cases of patients with lung cancer experienced MWA therapy, and their tumors were found to have vacuolization, lower density and much smaller distinct shrinkage of tumor size with varying degrees. The local progression rate or relapse rate of the whole group was 15.9%. The counterpart of patients in the early-stage group was 5.7% (2/35), and the diameter of tumors in the two patients was more than 3 cm. The local progression rate or relapse rate of patients in advanced-stage group was 20.5%, wherein, 81.3% of local progression or relapse occurred to the patients with a tumorous diameter of more than 3 cm. The results indicated that the patients in advanced-stage group were vulnerable to local progression or relapse, the tumorous with greater diameter had higher incidence of local relapse. No mortality occurred within 30 days after surgery, the survival rate of patients in early-stage group at first, second, third year was respectively 97.1%, 94.1% and 84.7%. The counterpart of patients in advanced-stage group was respectively 93.6%, 87.7% and 71.7%. The difference of survival rate between both groups was not statistically significant (P=0.576). No perioperative deaths occurred, and the main complications i.e., fever, pneumothorax, pleural effusion, hemoptysis, pneumonia, and pain were slight and tolerable.

CONCLUSIONS

MWA is an effective, safe and minimally invasive treatment for the patients with lung cancer who cannot be tolerated by surgical resection.