OBJECTIVES
To assess the results of surgical treatment of T-ALI (adjacent lobe invasion) tumours in patients with non-small-cell lung carcinoma.
METHODS
Multicentric retrospective analysis of a ...prospectively maintained database of 13 065 patients, aged 32–89 years (mean 52.9, median 63 years), who underwent resection between January 2009 and September 2014.
RESULTS
In the whole study group, T-ALI was observed in 324 patients (2.5%): 201 patients (62.0%) with a tumour invading the pleura in the inter-lobar fissure (T-ALI-A), and 123 patients (38.0%) with a tumour in the adjacent lobe but without pleural invasion in the fissure (T-ALI-D). With regard to N0 patients, the 3- and 5-year survival rates in the T2 group were significantly higher than that of the T-ALI group (76.1 and 68.4%, P = 0.002 vs 58.3 and 51.0%, P = 0.008, respectively). On the other hand, when the N1 group was analysed, the 5-year survival rates were 54.3 and 48%, respectively (P = 0.041). In the N2 group, the 5-year survival rates in the T2 and T-ALI groups were 40.2 and 35.0%, respectively (P = 0.241). The comparison of the T-ALI and T3 groups for stages N0, N1 and N2 revealed differences in 5-year survival rates as follows: 68.4 vs 62.9% (P = 0.048), 48.0 vs 37.6% (P = 0.08) and 35.0 vs 27.6% (P = 0.121), respectively. In the whole group, the difference in survival rate between T-ALI N0 and T2N0 was statistically significant (P = 0.008) and statistically significant for the T3N0 group (P = 0.048). The 3-year survival rate in the T-ALI N0 group was statistically lower following pneumonectomy than following lobectomy (56.4 vs 61.3%, P = 0.03). The best survival rate was observed following bilobectomy (75.6%).
CONCLUSIONS
In our study, a tumour with ALI (T-ALI) represented a separate stage of cancer between T2 and T3. The survival rate in the T-ALI-A group was significantly poorer than that in the T-ALI-D group. Overall treatment results were similar for stage T3, suggesting that it may be necessary to divide this group into T3a and T3b. We would suggest that all tumours between 5 and 7 cm be classified as T3b, and any tumour smaller than 5 cm but with ALI be classified as T3a. Treatment of choice should include lobectomy or bilobectomy. Pneumonectomy should be performed only in a selected group of patients.
Abstract Objectives The paper aimed to compare the efficacy of log odds (LODDS) compared to a classification based on the distribution of involved lymph nodes (pN) and lymph node ratio (LNR). Methods ...Material was collected retrospectively from an online survey-based database of the Polish Lung Cancer Group and included a group of 17,369 patients who received radical surgical treatment (R0) due to lung cancer. Results In the whole group the median survival for N0, N1 and N2 was 76.1, 41.7 and 24.2 months, respectively. The median survival for individual LODDS categories (-6,-4, (-4,-3, (-3,-2, (-2,-1, (-1,0, (0,1 and (1,2 was 76.5, 76.3, 71.7, 45.4, 25.0, 19.1 and 17.7 months, respectively. The median survival for LNR in individual categories (0), (0,0.25, (0.25,05, (0.5075 and (0.75,1.0 was 75.6, 40.3, 24.1, 18.8 and 16.4 months, respectively. A multi-variant analysis demonstrated that each LODDS category is an independent prognostic factor: (-4,-3 (HR = 0.982; 95% CI 0.867–1.112; P = 0.775), (-3,-2 (HR = 1.114; 95% CI 0.984–1.262; P = 0.089), (-2,-1 (HR = 1.241; 95% CI 1.080–1.425; P = 0.002), (-1,0 (HR = 1.617; 95% CI 1.385–1.887; P < 0.0001), (0,1 (HR = 1.918; 95% CI 1.579–2.329; P < 0.0001) and (1,2 (HR = 2.016; 95% CI 1.579–2.573; P < 0.0001). Conclusions Based on LODDS it is possible to discriminate patients with regard to lung cancer stage more effectively compared to pN and LNR classification, and it is also a better classification system.
An analysis of subglottic stenosis (SGS) occurrence frequency in patients with granulomatosis with polyangiitis (GPA) based on the time of appearance of clinical symptoms, and an assessment of ...treatment effectiveness, in particular with the intratracheal dilation-injection technique (IDIT).
Review and treatment with IDIT of 34 patients with SGS associated with GPA.
SGS developed in 34 of 250 patients with GPA (13.6%) and was not reflective of disease activity in the organs in 15 of 34 patients (44%): 11 cases after and 4 cases during immunosuppressive therapy (IST) when patients did not have organ symptoms. All patients underwent IDIT and in total, the treatment resulted in immediate improvement. In addition, in 21 cases, IST was applied because of other organ involvement or of the lack of longterm efficacy of IDIT. The median time of response was 37 months and the median interval between sessions was 5 months. None of the patients required tracheostomy after beginning IDIT in our hospital.
SGS often occurs independently of other features of active GPA. IDIT is a safe and effective technique in the treatment of GPA-related SGS. It should be performed in all patients with GPA who develop significant SGS and in those with multiorgan disease concomitantly with IST. In patients with isolated SGS, IDIT also makes IST and tracheostomy unnecessary.
The aim of the study was to compare the presence of regulatory T cells (Tregs) in the local lung cancer environment versus systemic immune response based on the examination of bronchoalveolar lavage ...fluid (BALf) and peripheral blood (PB) from the same patient. 35 patients with lung cancer were investigated. Flow cytometry method with panel of antibodies: anti CD4/CD25/FoxP3/CD127 for Tregs identification was used. We observed significantly higher proportion of Tregs in the BALF than in PB (median 9.4 vs. 5.4%, p<0.05). The increased proportion of Tregs in patients with advanced disease and in adenocarcinoma was found. This study confirmed the usefulness of BALF analysis in evaluation of immune response in lung cancer. Detection of Tregs in the local tumour environment may have therapeutic relevance in individual indication for anti-cancer immune-therapies.
Mucopolysaccharidoses (MPS) are severe inherited metabolic disorders from the group of lysosomal storage diseases. They are caused by deficiency in the activity of enzymes involved in the degradation ...of glycosaminoglycans (GAGs) and resultant accumulation of these compounds in the cells of patients. Although enzyme replacement therapy has become available for some MPS types (MPS I, MPS II and MPS VI), this treatment is not efficient when neurological symptoms occur, especially in MPS III (Sanfilippo disease). Recent studies indicated that substrate reduction therapy (SRT) may be an effective option for the treatment of neurodegenerative lysosomal storage diseases, including MPS III. However, previous attempts to SRT for MPS III focused on the use of non-specific inhibitors of GAG synthesis. Thus, we aimed to use the small interfering RNA (siRNA) procedure to control expression of particular genes, whose products are involved in GAG synthesis. In this report we show that, in MPS IIIA fibroblasts, we were able to reduce mRNA levels of four genes, XYLT1, XYLT2, GALTI and GALTII, whose products are involved in GAG synthesis. This decrease in levels of transcripts corresponded to a decrease in levels of proteins encoded by them. Moreover, efficiency of GAG production in these fibroblasts was considerably reduced after treatment of the cells with siRNA. These results indicate that efficient reduction of GAG synthesis may be achieved by the use of siRNA.
Shot wounds become a growing clinical concern in the civilian setting, due to increasing popularity of air guns among minors. We present a pediatric case of a shot wound to the orbit with sparing of ...the eyeball and retention of airgun pellet in the retrobulbar space. The pellet was removed 3 months after injury via lateral orbitotomy. Pathophysiology and ballistics of shot wounds are briefly reviewed and current views on the management strategy of shot wounds with retained projectile are discussed.
Abstract The aim of the study was to compare the presence of regulatory T cells (Tregs) in the local lung cancer environment versus systemic immune response based on the examination of ...bronchoalveolar lavage fluid (BALf) and peripheral blood (PB) from the same patient. 35 patients with lung cancer were investigated. Flow cytometry method with panel of antibodies: anti CD4/CD25/FoxP3/CD127 for Tregs identification was used. We observed significantly higher proportion of Tregs in the BALF than in PB (median 9.4 vs. 5.4%, p<0.05). The increased proportion of Tregs in patients with advanced disease and in adenocarcinoma was found. This study confirmed the usefulness of BALF analysis in evaluation of immune response in lung cancer. Detection of Tregs in the local tumour environment may have therapeutic relevance in individual indication for anti-cancer immune- therapies.
PDF
