Objective To investigate the significance of spread through air spaces (STAS) in early-stage non-small cell lung cancer (NSCLC) patients undergoing either sublobar resection or lobectomy by pooling evidence available, and to assess the accuracy of frozen sections in determining types of resection among patients with suspected presence of STAS. MethodsStudies were identified by searching databases including PubMed, EMbase, Web of Science, and The Cochrane Library from inception to July 2022. Two researchers independently searched, screened, evaluated literature, and extracted data. Statistical analysis was conducted using RevMan 5.4 and STATA 15.0. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the study. ResultsA total of 26 studies involving 23 surgical related studies (12 266 patients) were included, among which, 11 compared the outcomes of lobectomy with sublobar resection in the STAS-positive patients. NOS score≥6 points. Meta-analysis indicated that presence of STAS shortened patients' survival in both lobectomy group and sublobar resection group (RFS: HR=2.27, 95%CI 1.96-2.63, P＜0.01; OS: HR=2.08, 95%CI 1.74-2.49, P＜0.01). Moreover, lobectomy brought additional survival benefits to STAS-positive patients compared with sublobar resection (RFS: HR=1.97, 95%CI 1.59-2.44, P＜0.01; OS: HR=1.91, 95%CI 1.47-2.48, P＜0.01). Four studies were included to assess the accuracy of identifying presence of STAS on intraoperative frozen sections, of which the pooled sensitivity reached 55% (95%CI 45%-64%), the pooled specificity reached 92% (95%CI 77%-97%), and the pooled area under the curve was 0.68 (95%CI 0.64-0.72) based on the data available. Conclusion This study confirms that presence of STAS is a critical risk factor for patients with early-stage NSCLC. Lobectomy should be recommended as the first choice when presence of STAS is identified on frozen sections, as lobectomy can prolong patients' survival compared with sublobar resection in STAS-positive disease. The specificity of identifying STAS on frozen sections seems to be satisfactory, which may be helpful in determining types of resection. However, more robust methods are urgently in need to make up for the limited sensitivity and accuracy of frozen sections.
ObjectiveTo understand the development of clinical nutrition departments in western China, analyze the main problems and factors restricting its development, and provide a basis for promoting the construction and development of clinical nutrition departments in western China and formulating clinical nutrition management standards.MethodsQuestionnaires were used to investigate the development of clinical nutrition services in some hospitals in 11 provinces/municipalities/autonomous regions in western China (except Tibet) in March 2019. ResultsA total of 230 hospitals participated in the survey. Most clinical nutrition departments set up outpatient clinics (76.1%), with an average annual number of outpatients of 884; most of them carried out nutrition inspection visit/follow-up work (86.5%), and the average number of inspection visit/follow-ups was 3 876. Most hospitals had incomplete hardware and software facilities in the clinical nutrition departments. The charging items for diagnosis and treatment were complicated, and the charging standards were uneven. There were still 47.0% of the clinical nutrition departments of hospitals that did not offer diagnosis and treatment charging items. The surveyed hospitals believed that the talent team was the number one factor restricting the development of the clinical nutrition department, and regular skills training was the number one project that urgently needed the help of the Clinical Nutrition Discipline Alliance of West China Hospital of Sichuan University.ConclusionIn the future, the western region should increase the investment in hardware and software facilities, strive for policy support for maintaining department operations and formulate unified standards to regulate the development of disciplines.