ObjectivesTo construct a symptom assessment system suitable for surgical lung cancer patients, and to objectively evaluate the types and severity of postoperative symptoms in patients so as to provide evidence-based basis for the treatment of postoperative symptoms of lung cancer patients.MethodsPostoperative symptom items of lung cancer were formed according to previous researches, literature review, the current lung cancer symptom assessment tools, and expert interviews. The Delphi method was used to conduct two rounds of expert consultation and a postoperative symptom inventory was established for lung cancer patients.ResultsNine first-level symptom items were eventually formed: cough, pain, shortness of breath, fatigue, dizziness, nausea or vomiting, subcutaneous emphysema, insomnia, and constipation. The first round of active coefficient and authority coefficient of experts were 85.0% and 0.88, and the second round were 88.2% and 0.87. The Kendall coordination coefficients of the nine first-level symptom items were 0.47 (P<0.001) and 0.43 (P<0.001), respectively.ConclusionsThe evaluation system of postoperative symptom items for lung cancer patients is highly recognized by experts and has good consistency.
MicroRNA (miRNA) is a noncoding RNA and protein involved in regulating gene expression in the transcription level. Epidermal growth factor receptor (EGFR) is a protein tyrosine kinase receptor and its mutations have been confirmed in non-small cell lung cancer (NSCLC) by a large number of studies in recent years. EGFR tyrosine kinase inhibitor (EGFR-TKI) is widely used for treatment of NSCLC patients with EGFR mutation. In recent years, miRNA is more and more important in tumor metastasis. The role of EGFR mutations in NSCLC has become a hot spot as well. New researches report that the relationship between miRNA and EGFR mutations plays an important role in NSCLC metastasis. Therefore, we write this review to discuss the mechanisms of miRNA and EGFR mutations in metastasis of NSCLC.
ObjectiveTo review and analyze the treatment of chylothorax after video-assisted thoracoscopic lung cancer surgery and to discuss the best clinical treatment methods and effects.MethodsA total of 400 patients diagnosed with chylothorax at the Department of Thoracic Surgery, West China Hospital, Sichuan University from January 2012 to January 2020 were continuously collected. According to the inclusion and exclusion criteria, 37 patients were finally included. There were 20 males and 17 females with an average age of 55.55±10.49 years. Chylothorax was diagnosed primarily by triglyceride levels (above 110 mg/dL) or the Sudan triple stain test. Treatment included surgical and non-surgical treatment. The overall incidence, high risk factors and treatment methods of chylothorax after radical thoracoscopic surgery for lung cancer were analyzed. According to the treatment methods, the patients were divided into a surgical treatment group and a non-surgical treatment group. The average daily drainage volume and average hospital stay of the patients between the two groups were analyzed.ResultsIncluded patients accounted for 0.3% (37/12 515) of lung cancer thoracoscopic surgery in our hospital during the same period. The incidence of postoperative chylothorax in patients with right lung surgery (0.2%, 29/12 515) was higher than that of patients with left lung surgery (0.1%, 8/12 515). Of 37 patients with chylothorax after lung cancer surgery, 32 patients were in the non-surgical treatment group (86.5%, 32/37), and the rate was higher compared with the surgical treatment group (13.5%, 5/37, P=0.000). The average daily drainage in the surgical treatment group was 777 mL more than that in the non-surgical treatment group (95%CI 588.58 to 965.55, P<0.001). The total drainage volume of the surgical treatment group was more than that of the non-surgical treatment group (8 609.2±4 680.3 mL vs. 4 911.2±3 925.5 mL, P=0.055). The postoperative hospital stay and total hospital stay in the surgical treatment group were shorter than those in the non-surgical treatment group (P=0.162, P=0.118). The tube indwelling time (8.2±2.7 d) was shorter than that of the non-surgical treatment group (12.3±6.8 d, P=0.204).ConclusionThe treatment of chylothorax after radical resection of VATS lung cancer is still mainly non-surgical treatment. Surgical treatment should be initiated as early as possible when the drainage volume is too large 72 hours after chylothorax surgery after radical resection of VATS lung cancer.
Objective To systematically review the prognostic and clinicopathological value of FOXM1 expression in non-small cell lung cancer (NSCLC). Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 1, 2016), CNKI, WanFang Data and CBM were searched to collect cohort studies about the prognostic value of FOXM1 expression in NSCLC from inception to May 30th 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. Results A total of 8 cohort studies, involving 781 patients were included. The results of meta-analysis showed that FOXM1 expression was higher in tumor stage Ⅲ to Ⅳ than stageⅠtoⅡ(OR=2.24, 95%CI 1.25 to 4.01,P=0.007). Higher FOXM1 expression group had a shorter overall survival (HR=1.77, 95%CI 1.42 to 2.22,P<0.000 01) and disease-free survival (HR=1.96, 95%CI 1.04 to 3.17,P=0.04) than those of the lower FOXM1 expression group. Conclusion Current evidence shows that FOXM1 expression is associated with NSCLC stage. Furthermore, FOXM1 overexpression may be prognosis biomarker for NSCLC patients. Due to the limited quantity and quality of included studies, the above conclusions are needed to be verified by more high quality studies.
Objective To examine the clinical utility of postoperation symptom inventory. Methods According to the current cancer symptom assessment tools, clinical guidelines and expert interviews, we preliminarily selected 10 common symptoms as an alternative item. Postoperative symptom assessment scale of lung cancer patients was formulated through expert evaluation. And 383 patients in eight hospitals were evaluated and validated using the scale to analyze the reliability and validity. Results Postoperation symptom inventory was easy to operate and evaluate for postoperative lung cancer patients in 8 symptoms (pain, shortness of breath, fatigue, cough, insomnia, throat pain, sweating and constipation). The scale was with high reliability. Cronbach' s α was 0.888. This scale was also with reliable validity. Content validity index was 0.900. There were two common factors with high cumulative proportion in variance(47.70% and 57.46%). And each question had high factor load and communality (>0.40) in the exploratory factor analysis. Conclusion The postoperation symptom inventory has excellent reliability and validity in patients with lung cancer surgery.
ObjectiveTo investigate the preoperative psychological state of patients with pulmonary nodules in order to make the content of the education more "individualized and humanized".MethodsWe conducted a consecutive questionnaire study for 107 patients who were planning to undergo pulmonary resection surgery from May 2018 to July 2018 in our department. There were 54 males and 53 females with an average age of 56.8±11.2 years. The questionnaire content included two parts: personal basic information and 20 questions about surgery, complications, follow-up and hospitalization expense.ResultsThere were 60.7% of the patients diagnosed with pulmonary nodules by CT scan during physical examination, and 52.3% of the patients had strong will to undergo pulmonary surgery to resect nodules; 64.5% of patients wanted doctors to tell them the extent of the disease and whether the tumor could be cured by surgery, and 30.0% of patients concerned whether chief surgeon would complete the whole surgery. The surgery risk and postoperative complications were ignored by patients easily (5.6% and 14.9% respectively). The hospital expenses were not the primary concern of patients. Only 1.9% of patients believed that doctors used nonessentials which deliberately led to increased costs. Network follow-up was accepted by most patients (94.4%).ConclusionIt will contribute to improve preoperative education rationality and effectiveness by understanding true psychological state of patients.
ObjectiveTo explore the safety of day surgery program of video-assisted thoracoscopy surgery in the treatment of pulmonary nodules.MethodsWe retrospectively analyzed the clinical features of the patients who received video-assisted thoracoscopy surgery between June and November 2019 in Day Surgery Center of West China Hospital, Sichuan University. The basic conditions, surgery duration, intraoperative blood loss, placement time of thoracic drainage, postoperative pain score, hospitalization expenses, and postoperative complications were observed. Postoperative telephone follow-up was conducted on the 2nd, 3rd, and 30th day after operation. The 1st day after operation means the next day after operation.ResultsA total of 29 patients were included with 5 males and 24 females. Surgeries were successfully performed on these 29 patients and they were all discharged as planned. The mean surgery duration was (78.14±16.37) min, the mean intraoperative blood loss was (38.15±23.04) mL, and the mean placement time of thoracic drainage was (577.45±233.70) min. Intraoperative open chest surgery and massive hemorrhage were not occurred. The Pain Numerical Rating Scale score at the 6th hour after surgery was 2.10±0.56, and the average hospitalization expense was (33 600±4 611) yuan. In the 29 patients, the postoperative complications included pneumothorax in 2, urinary retention in 1, tachycardia in 1, and persistent cough in 9. No recurrence of the listed complications was reported on the 30th day of telephone follow-up. No severe complications or postoperative death occurred.ConclusionDay surgery program of video-assisted thoracoscopy surgery is safe and effective in the treatment of pulmonary nodules.