ObjectiveTo investigate the clinical characteristics and prognosis of resectable esophageal small cell carcinoma after surgical resection.MethodsA retrospective study of patients with resectable esophageal small cell carcinoma undergoing surgical resection from January 2009 to June 2015 in the Department of Thoracic Surgery, Sichuan Provincial Fourth People's Hospital and Department of Thoracic Surgery, West China Hospital of Sichuan University was performed. Survival analysis was conducted by Kaplan-Meier analysis and log-rank test. Cox regression model was used for identifying independent prognostic factors.ResultsA total of 53 patients with resectable esophageal small cell carcinoma were included for analysis. The mean age was 58.4 ± 8.3 years and there were 42 male patients and 11 female patients. Forty-two patients were diagnosed as pure esophageal small cell carcinoma while 11 patients were diagnosed with mixed esophageal small cell carcinoma, who were all mixed with squamous cell carcinoma. Most of the esophageal small cell carcinomas were located in the middle (58.5%) and lower (32.1%) segments of the esophagus. Thirty patients (56.6%) were found to have lymph node metastasis, and 7 patients (13.2%) were found to have lymphovascular invasion. According to the 2009 TNM staging criteria for esophageal squamous cell carcinoma, there were 12 patients with stage Ⅰ disease, 19 patients with stage Ⅱ disease, and 22 patients with stage Ⅲ disease. Most of the patients underwent left thoracotomy with two-field lymphadenectomy. Postoperatively, only twenty-two patients (41.5%) received adjuvant chemoradiotherapy. The median survival time of these patients was 20.1 months, and the 1- and 3-year survival rate was 75.5% and 33.1%, respectively. For prognosis, age, gender, pathological type, tumor location, and lymphovascular invasion had no significant impact on long-term survival of these patients. However, TNM stage (1 year survival rate: stage Ⅰ: 91.7%; stage Ⅱ: 78.9%; stage Ⅲ: 63.6%; P=0.004) and postoperative adjuvant therapy (1 year survival rate: 81.8% vs. 71.0%; P=0.005) had significant impact on the survival of patients with esophageal small cell carcinoma. In multivariate analysis, TNM stage and postoperative adjuvant therapy were independent prognostic factors for long-term prognosis of patients with esophageal small cell carcinoma.ConclusionEsophageal small cell carcinoma is very rare, with high malignancy and poor prognosis. For patients with resectable esophageal small cell carcinoma, the TNM staging system of esophageal squamous cell carcinoma can be used to direct the choice of treatment options. For early stage esophageal small cell carcinoma (stage Ⅰ/Ⅱ), surgery plus postoperative adjuvant chemoradiotherapy can be the prior therapeutic choice, while for locally advanced esophageal small cell carcinoma (stage Ⅲ), chemoradiotherapy should be the preferred treatment.
Esophageal cancer is one of the most common malignant cancers with a poor prognosis. For those non advanced stage patients, multi-disciplinary treatment based on surgery remains to be an important treatment strategy. Even though surgical techniques have developed rapidly, it still remains controversies in the surgical treatment of esophageal cancer. This review aimed to summarize and discuss those hot topics about the surgery of esophageal cancer, including surgical approaches of esophagectomy, anastomosis, lymphadenectomy, minimally invasive esophagectomy, and neoadjuvant therapy, hoping to provide evidence and perspectives in the surgical treatment for esophageal cancer.
The resistance of non-small cell lung cancer (NSCLC) to epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) has been brought into focus. COX-2 signal pathway was found to be closely related to EGFR signal pathway by recent researches, and there has been a growing interest to focus the researches on whether COX-2 pathway inhibition improves the efficacy of EGFR-TKIs in treating advanced NSCLC. In this review, we will illustrate recent advances of combined inhibition of EGFR and COX-2 signal pathways in NSCLC therapy.
ObjectiveTo systemically evaluate the efficacy and safety of cyclooxygenase-2 (COX-2) signal pathway inhibition in treating advanced non-small cell lung cancer (NSCLC). MethodsA systematic literature search in PubMed, EMbase, Cochrane Library, ASCO databases, CNKI and Wanfang database was conducted to identify relevant randomized controlled trials (RCTs) from the time of database establishment to June 2015. RCTs of COX-2 inhibitors treating advanced NSCLC were included. We assessed the methodology quality of the included studies by using Jadad's scale, and performed this meta-analysis by using stata12.0 software. ResultsTwelve RCTs involving three different COX-2 inhibitors with a total of 1 828 patients were identified including 8 studies of high quality and 4 studies of low quality. We found that COX-2 signal pathway inhibition could significantly increase overall response rate at RR=1.27 with 95%CI1.10 to 1.46 (P=0.001). While our present data could not confirm the efficacy of COX-2 inhibitors in improving progression-free survival (PFS) at HR=0.93 with 95%CI0.81 to 1.08 (P=0.334), overall survival (OS) at HR=0.95 with 95%CI0.84 to 1.08 (P=0.461), or one-year survival rate at RR=1.08 with 95%CI0.90 to 1.24 (P=0.29). As for toxicities, only increased risk of thrombocytopenia at RR=1.28 with 95%CI 1.03 to 1.85 (P=0.03) was observed in the patients treated with COX-2 inhibitors. ConclusionCOX-2 signal pathway inhibition is effective in improving the overall response rate of the patients with advanced NSCLC, and is well tolerated. Whether COX-2 signal pathway inhibition is effective in improving long-term survival of the patients with advanced NSCLC still needs to be confirmed via further clinical trials.
Lymph node metastasis in non-small cell lung cancer is an independent risk factor for poor prognosis. Resection of lymph nodes can improve the prognosis of patients. Although surgical techniques are progressing, there is still much controversy about the way of lymph node resection for non-small cell lung cancer. The research progress of hot topics such as the choice of lymph node resection methods for non-small cell lung cancer is discussed and summarized.
ObjectiveTo investigate the quality of life of family caregivers of patients with Alzheimer's disease (AD) and to explore the related factors. MethodsTwenty family caregivers of patients with Alzheimer's disease were surveyed with short form 36 health survey questionnaire between October 2013 and August 2014. ResultsThe subjects who were over 60 years old had lower scores in the dimensions of physical functioning, role limitations due to physical problem and role limitations due to emotional problem than those below 60 years old. Female subjects scored better than male subjects in the dimension of vitality. The sons and daughters had higher scores than the wives and husbands in the dimensions of physical functioning, role limitations due to physical problem and role limitations due to emotional problem. The subjects whose patients had medical insurance scored better than those whose patients with no insurance. The differences above were all statistically significant. The scores of caregivers with senior middle school edudation or above were higher than the caregivers with lower education level in the dimensions of mental health, vitality and general health perceptions. ConclusionThe quality of life of the family members of AD patients is obviously affected by many factors. It is very important to implement planned, targeted, reasonable and effective interventions to enhance the quality of life of these people.