The Diagnostic And Therapeutic Issues In The Surgical Management Of Locally Advanced NSCLC Surgical Diagnosis And Treatment

PART Ⅰ The Effect Of Tumor Location On The Prognosis Of Patients With Locally Advanced Lung CancerBACKGROUND: Lung cancer is one of the most common malignant tumors in morbidity and mortality in China.Currently,even with standard lung surgery along with systemic mediastinal lymph node dissection,the prognosis of patients with locally advanced lung cancer is still unsatisfactory,and the 5-year survival rate of patients with locally advanced lung cancer is only 40%.Therefore,to find an effective predictive model of locally advanced lung cancer prognosis and postoperative management measures for high-risk patients is of great significance for improving the long-term survival of locally advanced lung cancer patients.The eighth edition of TNM staging has been launched in January 2017.This article focuses on the relationship between central lung cancer and the prognosis of peripheral lung cancer in locally advanced lung cancer patients.METHODS: This study included 801 locally advanced lung cancer patients diagnosed by postoperative pathology in Shanghai Chest Hospital between January 2012 and December 2013.According to the postoperative pathological report,the specific location of the tumor was determined.Lung cancer from within the tertiary bronchus was central lung cancer,and peripheral lung cancer was the exception.The primary endpoints were disease-free survival(DFS)and overall survival(OS).The Kaplan-Meier method was used to compare the differences in survival curves of lung cancer patients at different anatomical locations.Cox multivariate analysis model was used to analyze the risk factors that affected the prognosis of patients.RESULTS: The median follow-up time for all enrolled patients was 44(2-74)months.The analysis showed that in patients with locally advanced lung cancer,patients with central lung cancer had significantly worse DFS and OS than peripheral patients.Compared with lung adenocarcinoma patients,DFS and OS in lung squamous cell carcinoma were better than lung adenocarcinoma under the same conditions.PART Ⅱ Effect Of Surgical Approach On Prognosis Of Locally Advanced Lung Cancer PatientsBACKGROUND: Lung cancer is one of the highest mortality rates in the world.Lung cancer is one of the highest malignant tumors in morbidity and mortality in China.Nowadays,for patients with locally advanced lung cancer that can be resected,many doctors and patients are the first to consider surgery,and those who are able to undergo surgery are treated as soon as possible,combined with radiotherapy and chemotherapy.Currently,even with standard lung surgery along with systemic mediastinal lymph node dissection,the prognosis of patients with locally advanced lung cancer is still unsatisfactory,and the 5-year survival rate of patients with locally advanced lung cancer is only 40%.Especially for central lung cancer,the range of surgical resection is often larger due to the anatomical location,resulting in unsatisfactory recovery after surgery.Therefore,the choice of surgery to ensure the complete resection of the tumor as possible,reduce the incidence of postoperative complications and death has become an important factor to ensure the survival time of patients.The eighth edition of TNM staging was started in January 2017.This article focuses on the effect of surgery on the prognosis of patients with locally advanced lung cancer.METHODS: This study included 801 locally advanced lung cancer patients diagnosed by postoperative pathology in Shanghai Chest Hospital between January 2012 and December 2013.According to the different surgical methods the patients received,they were grouped to study the effect of different surgical methods on the prognosis of the patients.Kaplan-Meier method was used to compare the difference between Disease-Free survival(DFS)and Overall Survival(OS).Cox multivariate analysis model was used to analyze the risk factors that affected the prognosis of patients.RESULTS: In patients with locally advanced lung cancer,lobectomy compared with pneumonectomy and sleeve lobectomy,the patient’s DFS has no relationship with the type of surgery,but different operations can still determine the quality of life of patients after surgery There is a length of life.And when the degree of tumor progression is relatively low,these differences will be relatively weak.At the same time,we also found that in addition to the N-staging that researchers often care about,the tumor’s T-stage also largely influences the patient’s disease recurrence,regardless of the choice of surgery.Since sleeve lobectomy of the lobe can retain more normal lung tissue,this type of surgery has better long-term outcomes.Sputum resection of the lobe can be performed as long as the anatomy is appropriate and the postoperative complications can be controlled.As a priority for central lung cancer patients.CONCLUSION: According to the eighth edition of TNM staging standard,through this study,we found that lobar sleeve lobectomy can protect postoperative lung function of patients,and it can be used as a surgical choice for central non-small cell lung cancer patients.PART Ⅲ The Correlation Analysis Of Postoperative Adjuvant Chemotherapy In Patients With Locally Advanced Lung CancerBACKGROUND: Lung cancer is one of the most common malignant tumors in morbidity and mortality in China.Currently,even with standard lung surgery plus systemic mediastinal lymph node dissection,the prognosis of patients with locally advanced lung cancer is still unsatisfactory,and the 5-year survival rate of locally advanced lung cancer patients is less than 40%.With the official implementation of the eighth edition of lung cancer TNM staging,how to effectively combine surgery and various types of postoperative treatment to extend the survival of patients as much as possible has become an important topic.This article focuses on the correlation between the benefits of postoperative adjuvant chemotherapy in patients with locally advanced lung cancer.METHODS: This study included 801 locally advanced lung cancer patients diagnosed by postoperative pathology in Shanghai Chest Hospital between January 2012 and December 2013.According to different surgical methods,different pathological types,and whether or not to receive chemotherapy after treatment,patients were divided into different groups to study the prognosis of postoperative chemotherapy.Kaplan-Meier method was used to compare the difference between Disease-Free survival(DFS)and Overall Survival(OS).Cox multivariate analysis model was used to analyze the risk factors that affected the prognosis of patients.RESULTS: According to our research,overall,combined with adjuvant chemotherapy after surgery can effectively prolong the survival time of patients.The 5-year survival rate of the patients was 49.4% and 56.8%,respectively,and the median survival time was 43 months.47 months.However,as far as the recurrence of the disease is concerned,there is no significant difference between the two.When we compared the pathology and staging of these patients with locally advanced non-small cell lung cancer,we found that,in most cases,the OS of patients undergoing adjuvant chemotherapy after surgery was significantly improved,and the changes in DFS were not obvious.Through multivariate analysis,we can see that for patients with squamous cell carcinoma,chemotherapy can effectively improve the patient’s survival time,but it can not stop the recurrence of the disease.For patients with lung adenocarcinoma,postoperative adjuvant chemotherapy has a relatively small impact on long-term survival,but it can delay or reduce the recurrence of the disease.CONCLUSION: According to the eighth edition of TNM staging criteria,patients with locally advanced non-small cell lung cancer can benefit from postoperative adjuvant chemotherapy,and postoperative adjuvant chemotherapy is recommended.For patients with squamous cell carcinoma,chemotherapy can effectively improve the patient’s survival time,but it can not stop the recurrence of the disease.For patients with lung adenocarcinoma,postoperative adjuvant chemotherapy has a relatively small impact on long-term survival,but it can delay or reduce the recurrence of the disease.