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Background and objective It has been known that the volume doubling time (VDT) of different lung nodule types is different. At present, there is still a lack of studies about the volume doubling time of lung cancer with different pathological types. The purpose of the study is to explore the factors influencing the progression of the early-stage adenocarcinoma, and provide some reference for the follow-up strategy of lung nodules by retrospective analysis of the image data of 143 early-stage adenocarcinoma. Methods 143 cases of the early adenocarcinoma were classified according to the 2015 World Health Organization Classification of Lung Tumors and the Eighth edition of the tumor-node-metastasis (TNM) classification of lung cancer. The volume doubling time was calculated with reference to the revised Schwartz formula. Results Among the 143 cases of the early adenocarcinoma, 50 cases (34.97%) were in progression. By multivarIate analysis, there were several factors associated with the progression of the early adenocarcinoma: the follow-up time, the dimension of nodule, the pathological type, the nodule type and the pathological stage. The VDT of lepidic predominant adenocarcinoma (LPA) is (594±272) d. The VDT of the invasive adenocarcinoma with lepidic part, but not predominant, is (520±285) d. The VDT of the invasive adenocarcinoma without lepidic part is (371±183) d. Conclusion About 35% of the early adenocarcinoma is in progress. Whether with the lepidic component is a positive factor to the speed of tumor progression.

Adenocarcinoma in situ (AIS) is a new concept which was introduced to the 2011 The International Association for the Study of Cancer (IASLC)/ American Thoracic Society (ATS)/ European Respiratory Society (ERS) International Multidisciplinary Classification of Lung Adenocarcinoma firstly and an important supplement of The 2015 World Health Organization Classification of Lung Tumors. Because AIS is at an early stage of development of lung adenocarcinoma, the deepening understanding of its pathology, differential diagnosis, treatment strategies, has an important significance for the improvement of the prognosis of lung adenocarcinoma. This review will provide a systematic review of the main progress of occurrence and development, pathological characteristics, differential diagnosis and treatment strategy of AIS, in order to provide theoretical basis for the further research of AIS.

Background and objective Synchronous multiple primary lung cancer (sMPLC) is a sparse disease in the past, but there has been a gradual increase in the morbidity of sMPLC recently. However, studies on large sample have never been undertaken. The purpose of this study is to investigate the diagnosis, treatment and prognosis of sMPLC through analyzing the clinical data, and provide supports for the management of sMPLC. Methods According to Martini-Melamed criteria, 357 patients were diagnosed sMPLC. The pathological staging is on the basis of the 8th edition tumor-node-metastasis (TNM) staging from International Association for the Study of Lung Cancer (IASLC). Results There were 269 patients with double primary lung cancer, 65 patients with triple primary lung cancer and 23 patients with four or more primary lung cancer. Lesions (68.55%, 571/833) were frequently in upper lobe, especially the right upper lobe. Adenocarcinoma (95.56%, 796/833) was the mainly pathological type, followed by squamous cell carcinoma (2.40%, 20/833). The acinar predominant subtype was the main part (70.81%, 313/442) of the all adenocarcinoma specimens. Most of the lesions (68.35%, 244/357) were stage Ib or low. Among the initial lesion and the following lesions ,patients who had the same pathological type (92.72%, 331/357) were more than the different (7.28%, 26/357), of which adenocarcinoma-adenocarcinoma occupied the major proportion (99.40%, 329/331). The 3-year overall survival (OS) and 5-year overall survival were respective 91.93% and 84.37%. Multivariate analysis found that smoking history (P=0.012), the diameter of the maximum lesion (P=0.027), lymph node metastasis (P=0.015) and pleural invasion (P

Background and objective With the extensively application of HRCT (high resolution CT) and the popularization of early lung cancer screening, the proportion of small nodullar lung cancer to be operated increases rapidly. Identifying the focus lesions quickly and accurately in operation has shown to be a challenge. We carried out this research trying to make use of and evaluate a new method that localizaes and extracts small peripheral pulmonary nodules by way of simulating radiaotherapy combining methylene blue staining. Methods From February 2012 to January 2015, 97 patients with 100 peripheral pulmonary nodules ≤10 mm in size were simulated puncturing using a radiotherapy planning. When the anaesthesia came into use, methylene blue dye was injected to the virtually identified point corresponding to the surface point, according to the angle and depth previously computed by the radiotherapy planning. The video-assisted thoracoscopic surgery (VATS) wedge resections of the marked lesions were undertaken and the specimens were sent for frozen pathologic examination. The interval time from anesthesia-completing to puncture and injection, The interval time from methylene blue injection to identifying the stained area and the distances between the centre point of the stains and edge of coloured lesion were recorded. Results Our preoperative localization procedure was successful in 96 of 100 (96%) nodules. The interval time from anesthesia-completing to puncture and injection of methylene blue were (4.85±1.25) min. The interval time from methylene blue injection to identifying the stained area was (16.36±2.36) min. The distances between the centre point of the stains and edge of coloured lesion were (4.78±2.51) mm. No complication was observed in all participants. Conclusion The new method of locating peripheral pulmonary nodules by simulating simulating radiaotherapy combining methylene blue staining has a high success rate and no complication for localizing small peripheral pulmonary lesions, avoiding the fear and pain of the patients untaken puncture without anaesthesia reducing radial damage.

Although the morbidity of multiple primary lung cancer (MPLC) has been increasing year by year, it is still controversial about pathogenesis, differential diagnosis and management strategies of MPLC. This review provides a snapshot of the main progress of pathogenesis, differential diagnosis and management strategies of MPLC.

Background and objective Concept of treatment for pulmonary metastatic tumor has been changed. The aim of this study is to analysis of the choice of operation mode and prognosis factors of patients with tumors of the lung metastasis. Methods The clinical data of 57 patients with pulmonary metastases who underwent operations from January 2006 to December 2009 were retrospectively analyzed. Difference of conventional open thoracic surgery and thoracoscope surgery was compared. The relationship between gender, age, type of surgery, disease-free interval (DFI), the number of metastatic tumor, the size of tumor, chemotherapy and prognosis was explored. Results Among the patients, there was no perioperative mortality. Postoperative 1-, 3-, 5-year survival rates were 81.3%, 46.5% and 29.2%, the median survival time was 33.8 months. Multivariate analysis showed that DFI, the number and diameter of metastasis tumor were independent prognostic factors. Conclusions Reasonable choice of surgical treatment can improve the survival of pulmonary metastatic tumor patient. Thoracoscopic surgery method is preferred. Operation effect of patients with tumor diameter less than 4 cm in solitary pulmonary metastasis has better effect.

Background and objective This study aims to explore the effect of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKIs) on the lymphangiogenesis of lung cancer with EGFR mutation, as well as to determine the function of EGFR targeted therapy in relation to the inhibition of lymphangiogenesis during lung cancer treatment. Methods The EGFR double mutant lung cancer cell line NCI-H1975 is used to construct lung cancer xenograft models. The models are divided into two groups: the solvent control group and the EGFR-TKI treatment group. Each group includes five mice. The inhibitory effect of EGFR-TKI on the growth of transplanted tumors was observed. Immunohistochemical method and lymphatic endothelium specific antibody D2-40 were used in the experiment to observe the influence of EGFR-TKI on lymphangiogenesis in lung cancer. Results The weight and relative volume of tumors in the EGFR-TKI treated group were less than those in the solvent control group. The average lymphatic vessel density of EGFR-TKI-treated mice was 6.44 per case. This value was 10.70 per case in the solvent control group. Lower density of lymphangiogenesis was found in the EGFR-TKI treated group (P=0.023). The area and longest diameter of neonatal lymphatic vessel of the EGFR-TKI treated group were less than those of the solvent control group. Moreover, EGFR-TKI exhibited no significant effect on the invasion of tumor cells into the lymphatic vessel (P=0.519). Conclusion EGFR-TKI can inhibit lymphangiogenesis in EGFR mutant lung cancer while suppressing vessel diameter and expansion area.

Background and objective More than 35% Ib stage lung cancers have metastasised or recurrenced after operation, whose prognosis still remain poor. There’re much controversy over the necessity of adjuvant chemotherapy to them. This aim of this study is investigated the clinical and pathological characters influencing prognosis of the stage Ib non-small cell lung cancer (NSCLC) and to explore the indication of postoperative chemotherapy. Methods NSCLC patients (281 cases) who underwent lobectomy were examined. Cox proportional-hazards ratios were used to identify independent prognostic factors for survival. Kaplan-Meier survival curves were calculated to estimate survival rates. Results Kaplan-Meier analysis show that, cancerous embolus in the blood vessel or lymphatic vessel, histologic grade and tumor location were remarkerbly associated with mortality risk (P

Background and objective To discuss the clinical application of mediastinoscopy in the differential diagnosis and preoperative staging on lung cancer. Methods A total of 361 cases of patients were included in the study, of which 162 cases were undiagnosed mediastinal tumor patients before operation, and 199 patients were suspected or diagnosed with lung cancer or mediastinal lymph nodes enlargment(short diameter ≥1.0 cm). All patients underwent surgery, including 308 cases standard cervical mediastinoscopy (SCM) , 53 cases parasternal mediastinoscopy (PM). Results Taking pathology diagnosis as the gold standard, the mediastinoscopy diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value are 98.11%, 97.62%, 100%, 100%, 91.67% and 98.28%, 98.03%, a 100%, 100%, 100% to mediastinal masses and mediastinal lymph node metastasis of lung cancer. Total seven cases suffered from complications of surgery-related, the complication rate was 1.93 percent (P

Background and objective Lymphatic metastasis is the most important way for the spread of lung cancer and is one of the important factors affecting the prognosis. Existing studies showed that compared to middle or lower lobe NSCLC, upper lobe non-small cell lung cancer (NSCLC) has a higher probability of occurring regional mediastinal lymph node metastasis. The purpose of this study is to research the prognostic factors and lymphadenectomy of stage Ib upper lobe NSCLC. Methods A retrospective study of 147 consecutive subjects (76 and 71 for right and left upper lobe NSCLC respectively) who had undergone curative resection for stage Ib upper lobe NSCLC was performed. A total of 925 lymph nodes were removed during the surgery in all enrolled patients and a total of 491 mediastinal lymph nodes (266 and 225 for superior and inferior mediastinal lymph nodes respectively) were removed. Kaplan-Meier product method and Log-rank test were used for univariate survival analysis and Cox regression model was used for multivariate survival analysis. Results ①Both univariate and multivariate analysis showed that age, tumor size and number of removed superior mediastinal lymph node stations were the important prognostic factors of stage Ib upper lobe NSCLC; ②For stage Ib right upper lobe NSCLC, station 4 lymph node was of statistical significance to the prognosis (P=0.021); while for stage Ib left upper lobe NSCLC, station 5 lymph node was of statistical significance to the prognosis (P=0.024). Conclusion In surgically treated stage Ib upper lobe NSCLC patients, age, tumor size and number of removed superior mediastinal lymph node stations are the important prognostic factors. And in this kind of patients, lobe-specific systematic lymph node dissection may be a more efficient procedure during the surgery.

Background and objective Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been gradually universal application, but its value in the preoperative staging of lung cancer and mediastinal mass biopsy remains to be explored. The aim of this study is to evaluate the value of clinical application between mediastinoscopy and EBUS-TBNA, desiring to provide an objective basis for the rational choice applications. Methods Between July 2009 and December 2012, mediastinoscopy patients with 361 cases accepted biopsy, including 199 cases of lung cancer and 162 cases of mediastinal mass of unknown origin, EBUS-TBNA patients with 348 cases accepted biopsy, including 216 cases of lung cancer and 132 cases of mediastinal mass. Comparing the diagnostic results and related indicators of two methods, this article analyzed the clinical value both the preoperative staging of lung cancer and the diagnosis of mediastinal mass. Results Taking pathology diagnosis as the gold standard, the accuracy, sensitivity and specificity of mediastinoscopy and EBUS-TBNA are 98.33%, 98.17%, 100% and 90.80%, 90.00%, 100%. Two techniques in the diagnosis and staging of lung cancer have not statistically significant (P>0.05), but in the diagnosis of mediastinal mass have statistical significance (P

Background and objective Treatment of pulmonary carcinoid is a comprehensive modality focusing on surgery. Thus, accurate and timely preoperative and intraoperative pathological diagnoses are very crucial. The aim of this study is to retrospectively analyze the pathological characteristics of pulmonary carcinoid, its natural history, and patterns of disease progression to obtain evidence for clinical decision making. Methods Clinical and pathological data of 32 patients with pulmonary carcinoid were retrieved and retrospectively analyzed. The pathological characteristics and their relationship with clinical diagnosis and treatment effect were systematically studied. Results Among the 32 patients, 18 had typical carcinoid and 14 had atypical carcinoid. The male-to-female ratio was 2.2:1, and the average age was (44±15) years. Almost half of the patients were discovered by accident. The average maximum diameter was (3.1±1.3) cm. About 27 of all 32 cases (84.4%) were stage I, 2 were stage IIa, 2 were stage IIIa, and 1 was stage IV. The follow-up time was 5.2-9.7 years. The 5-year progression free survival of 15 typical carcinoid patients and 12 atypical carcinoid patients were 100% and 92.9%, respectively. The characteristic neuroendocrine morphology and variable expression levels of cytokeratin, chromogranin A, synaptophysin, CD56, and index of Ki-67 were important factors that differentiated pulmonary carcinoid from other tumors. Conclusion Pathological diagnosis of pulmonary carcinoid must combine morphology with immunohistochemistry. Early-stage patients can also achieve good effect after surgery.

Background and objective Studies have shown that tumor metastasis in a variety of tumors is associated with lymphangiogenesis and lymphatic vessel invasion (LVI). Tumor metastasis is an important factor that affects the prognosis of patients. The aim of this study is to determine the prognostic value of lymphangiogenesis and LVI in non-small cell lung cancer (NSCLC). Methods We marked the endothelial cells of lymph vessels in lymphangiogenesis with specific monoclonal antibody D2-40. Immunohistochemistry was used to detect the expression of lymphangiogenesis and LVI in 79 cases of stage I-III NSCLC. Results The intratumoral lymphatic vessel density (ITLVD) was significantly higher in patients with N2 disease than those with N0 disease (P=0.015). The ITLVD was significantly higher in patients with LVI+ than that in those with LVI- (P=0.009). The ITLVD was also remarkably higher in poorly differentiated tumors than that in highly differentiated ones (P=0.007). The ITLVD was remarkably higher in adenocarcinoma than that in squamous cell carcinomas (P=0.025). Kaplan-Meier revealed that the survival rates of patients with higher ITLVD were remarkably poorer than those with lower ITLVD (P=0.007). Thus, the ITLVD is an important prognostic factor of NSCLC. The peritumoral lymphatic vessel density is not correlated with the prognosis. Conclusion The ITLVD level is an important prognostic factor of NSCLC.

Background and objective The aim of this study is to explore the effects of different modes of lymph node dissection in early-stage non-small cell lung cancer (NSCLC) on the survival rate, to study the prognostic factors, and to discuss the clinical application of lobe-specific lymph node dissection. Methods A total of 379 patients with completely resected pathological stage I NSCLC between the years 1998 and 2005 at Shanghai Chest Hospital were retrospectively analyzed. Among the patients, 148 were placed in the systematic lymph node dissection group and 150 in the lobe-specific lymph node dissection group. All of them were in pathological stage I (T1a-2aN0M0). The differences between the two groups were compared. Results No statistical difference was found between the two sets of data in terms of the clinical and pathological features of distribution (P>0.05). The overall survival distribution between the two groups had no statistical difference (P>0.05). The pathological stage, pathological type, and tumor size significantly differed between the two groups. The duration of surgery, blood loss, blood transfusion, drain secretion, duration of drainage, and duration of hospital stay also significantly differed between the two groups (P

Pulmonary peripheral tiny lesions are difficult to be localized during operation. The current each preoperative localization methods still exist defects and limited to application which can not adapt to urgent need for increasing numbers of the clinical pulmonary tiny lesions. This paper intends to summarize the present relevant progress, and introduce our recent attempt to explore a new method.

Background and objective Vascular endothelial growth factor-C (VEGF-C), a member of the VEGF family, has been proven to be a relatively special VEGF. When binding to its receptor VEGFR-3, it activates lymphangiogenesis, which likely induces lymph node metastasis in tumors. The aim of this study is to characterize the expression and prognostic value of VEGF-C and lymphangiogenesis in lung adenocarcinoma and squamous cell carcinoma. Methods Through immunohistochemistry, the lymph vessel endothelial cells undergoing lymphangiogenesis were stained with podoplanin to detect the expression of VEGF-C and lymphangiogenesis in 98 cases with stage IIIa (N2) lung adenocarcinoma and squamous cell carcinoma. Results The expression rate of the VEGF-C was positively correlated with the lymphatic microvessel density (LMVD; r=0.783, P

Background and objective The acute inflammatory, as manifest by alterations in white cell count and circulating concentrations of acute-phase proteins, C-reactive protein (CRP), and albumin, has been shown to be an independent prognostic factor in various cancers including non-small cell lung cancer (NSCLC). The aim of this study is to observe the relation between CRP level before operation and clinical characteristics of NSCLC stage I, and its prognostic value. Methods Data of ninety-six NSCLC stage I cases under total operational excision from Jan 2000 to Jan 2004 were reviewed. The difference of CRP level in different characteristics was analyzed by ANOVA. Distributions and comparisons of survival according to CRP level were analyzed by Kaplan-Meier and Log-rank test. COX regression model was used to analyze prognostic factors of NSCLC. Results Sixty-six cases had a CRP level of ≤5 mg/L. The level of CRP in patient with squamous cell carcinoma was remarkably higher than that with nonsquamous cell carcinoma (P3 cm was significantly higher than that in tumor diameter < 3 cm (P5 mg/L group than that in CRP≤5 mg/L group (54.1% vs 78.2%, P=0.021). COX model found CRP level was an independent prognostic factor of stage I NSCLC. Conclusion The pre-operational CRP level of stage I NSCLC is positively related to the maximum diameter of tumor. CRP level is probably a poor prognostic factor for stage I NSCLC.

Systematic nodes dissection be the standard procedure for lung cancer during operation. While Surgery for early lung cancer lymph node removal method has been controversial, particularly for clinical early stage non-small cell lung cancer that has presenced several methods of lymph node dissection. In this article, methods of lymph node dissection in the stage I non-small cell lung cancer, especially lobe-specific lymph node dissection of the way, are summarized.

Background and objective The new edition of the TNM staging for lung and pleural tumours has been finished, which put weight on the extent of primary tumor as one of the important prognosises. But little study has performed on the primary tumor extent ≤2 cm. The aim of this study is to explore the prognosis of patients with tumor extent ≤2 cm in stage I of non-small cell lung cancer, which helps us to choose the best treatment for these patients. Methods Retrospective study on the clinical response and survival time of whom underwent complete surgical resection and diagnosed as T1a of stage I NSCLC from 1998 to 2004 was analyzed. Data was analyzed by SPSS 17.0 software. Results Overall survival rate was 80.8%. By the study, age (P=0.241), gender (P=0.175), history of smoking (P=0.845), pathologic type (P=0.265), and systematic mediastinal lymphadenectomy (SML)(P=0.918) or not, postoperative adjuvant chemotherapy or not (P=0.616) and visceral pleural invasion (P=0.827) were not the prognosises of these patients. Only the tumor differentiation such as poorly differentiated was the important prognosis (P=0.01). Conclusion In the tumor extent ≤2 cm of stage I non-small cell lung cancer, the visceral pleural invasion maybe not influence the patients survival. The tumor differentiation is one of the important prognostic factors.

Background and objective The new edition of the TNM staging for lung and pleural tumours has been finished, which put weight on the extent of primary tumor as one of the important prognosises. But little study has performed on the primary tumor extent ≤2 cm. The aim of this study is to explore the prognosis of patients with tumor extent ≤2 cm in stage I of non-small cell lung cancer, which helps us to choose the best treatment for these patients. Methods Retrospective study on the clinical response and survival time of whom underwent complete surgical resection and diagnosed as T1a of stage I NSCLC from 1998 to 2004 was analyzed. Data was analyzed by SPSS 17.0 software. Results Overall survival rate was 80.8%. By the study, age (P=0.241), gender (P=0.175), history of smoking (P=0.845), pathologic type (P=0.265), and systematic mediastinal lymphadenectomy (SML)(P=0.918) or not, postoperative adjuvant chemotherapy or not (P=0.616) and visceral pleural invasion (P=0.827) were not the prognosises of these patients. Only the tumor differentiation such as poorly differentiated was the important prognosis (P=0.01). Conclusion In the tumor extent ≤2 cm of stage I non-small cell lung cancer, the visceral pleural invasion maybe not influence the patients survival. The tumor differentiation is one of the important prognostic factors. [ABSTRACT FROM AUTHOR]

Background and objective The aim of this study is to analyze the impact on the cough after radical systematic mediastinal lymphadenectomy and prevention of refractory cough with medialstinal fat to fill the residual cavity after radical systematic mediastinal lymphadenectomy. Methods Sixty patients clinically diagnosed of lung cancer were selected according to the adopt standardization, from January 2008 to December 2008. All of the patients were divided into two groups randomly: the filling-fat group and the non-fillling-fat group. The surgical information such as operation duration time bleeding volume during operation, post-operation bleeding volume were recorded. After one month, FACT-L and LCQ were completed. Results There are no remarkably differences between the operation duration time, bleeding volume in operation and 1st postoperation day’s drainage volume of the two groups. There’s significant difference in the scores of cough at night after taking off the chest tube, as well as in the scores of LCQ after one month and in the scores of last items of FACT-L. Conclusion Filling the fat of the mediastinal to cover the residual cavity left by completely systematic mediastinal lymphadenectomy can reduce the refractory cough after surgery, and can also improve the quality of the life. It has no effect on the the operation duration time, bleeding volume in operation and 1st post-operation day’s drainage volume of the patients.

Lymphatic metastasis is the main metastatic route for lung cancer, and is also one of the most important prognostic factors. Therefore, lymph node dissection has been an important procedure in standard lung cancer surgery. But so far, the mode and the extent of lymph node dissection during surgery are controversial for lung cancer in different pathological types, stages, or in different lobes. In this review, we summarize advances on the clinical significance, modes and extents of lymph node dissection during lung cancer surgery.

Background and objective The aim of this study is the clinical value of preoperative routine surgical staging to mediastinal lymph nodes on lung cancer. Methods Seventy-six cases underwent lymph nodes biopsy with mediastinoscopy. The diagnostic efficacy of thoracic CT scan and mediastinoscopy on mediastinal lymph nodes metastasis were compared. Results The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of thoracic CT scan and mediastinoscopy on diagnosing mediastinal lymph nodes metastasis were 68.5%, 66.7%, 68.4%, 84.6%, 16.7% and 87.5%, 100%, 84.2%, 100%, 60%, respectively. Conclusion Routine preoperative mediastinoscopy had obvious advantage compared with thoracic CT scan on mediastinal lymph nodes staging. The routine preoperative surgical staging of mediastinal lymph nodes on lung cancer had high clinical value.

Background and objective There is still lack of special prognostic factor on lung cancer, this study will explore the prognostic value of serum VEGF-C level and lymphangiogenesis of primary cancer and mediastinal lymph nodes in the patients with lung cancer. Methods Thirty patients with NSCLC would accept operation (new group) and 30cases followed up three years postoperative (history group) were chosen respectively. The serum VEGF-C level of new group was tested. The VEGF-C and LYVE-1 expression in the mediastinal lymph nodes were put in practice between two groups. The relationship was analyzed for the serum VEGF-C level, VEGF-C and LYVE-1 expression of primary cancerand mediastinal lymph nodes, mediastinal lymph nodes metastasis and the 3-year survival rate of the patients. Results ①In new group, the serum VEGF-C level of N2 patients was significantly higher than that of non-N2 patients. ②In new group, the serum VEGF-C level was closely correlated with VEGF-C expression of primary cancer. ③In two groups, the primary cancer and mediastinal metastasis lymph nodes had high VEGF-C expression. ④VEGF-C expression of primary cancer and mediastinal lymph nodes was closely correlated with LYVE-1 expression between the two groups. ⑤VEGF-C and LYVE-1 expression of N2 patients was significantly higher than that of non-N2 patients between two groups. ⑥The patients' 3-year-survival rate was closely correlated with VEGF-C expression of primary cancer and mediastinal lymphnodes metastasis. Conclusion Serum VEGF-C level has close correlation with VEGF-C expression of primary cancer, lymphangiogenesis of primary cancer/mediastinal lymph nodes, mediastinal lymph nodes metastasis status and patient's survival rate. Serum VEGF-C level is possible to be used as prognostic factor on lung cancer.

Background and objective It is needed to explore the effects of operation on stress statue, myocardial damage and arrhythmia to lung cancer. This study would compare the effects of two ligation styles of pulmonary vein on lung cancer patients' stress and cardiac postoperative. Methods 54 cases were divided into two groups randomly:the pulmonary vein trunk-ligation group (trunk group, 27 cases) and the pulmonary vein branch-ligation group (branch group, 27 cases). The blood concentrations of hydrocortisone (HC), blood glucose (BG) and cardial troponin-I (cTnI) were determined at different time point. The surgical data, the quantum of pain and ECG also recorded. Results ① There were no significance difference of the operation time, blood loss during operation and drainage volume in first day after operation between two groups. ② There're no differences of the quantum of pain between two groups. ③ The HC of the two groups' ascend obviously on the end of operation and descend during postoperative. ④ The BG of the two groups' rise on the 1st day obviously, maintain high level on the 2nd day, descend on the 3rd day but still higher than that of preoperation.⑤ The BG and HC show a direct positive correlation postoperative. ⑥ The cTnIs of the trunk group ascend immediatelyafter operation, but there's no statistically significance between two groups. ⑦ The arrhythmia incidence is higher in the trunk group, but the arrhythmia incidences classified by the date after operation of the two groups' show no distinction. Conclusion ① The effects of two pulmonary vein ligation styles on postoperative stress show no significance differences.② The style of pulmonary vein trunk-ligation has a more obvious tendency to do harm to heart than that of branch-ligation. ③ The style of pulmonary vein branch-ligation may reduce the arrhythmia incidence after operation.

Background and objective Preoperative chemotherapy increases the difficulty and risk of patients爷operation. The aim of this study is to analyze the change of thoracic tissue, study the influence ofchemotherapy to operation, discuss the special aspects of surgical management and observe the pathological change of focus after chemotherapy. Methods 100 patients were chosen and randomly divided into two groups(operation first group, 50 cases; chemotherapy first group, 50 cases) . Some patient爷s pathological sections were observed to investigate focus morphological influence of preoperative chemotherapy and the clinical response rate were compared with pathological response rate. Results It was showed that preoperative chemotherapy conduced different degree thoracic tissue fibrosis. Data statistics demonstrated that there were no significance difference of the operation time, blood loss during operation and drainage volume in first day after operation between two groups. The preoperativechemotherapy increased the difficulty of operation because of tissue fibrosis and scarification, but the risk could be avoided by skillful operation. In first operation group, there were various pathological changes in tumor tissue and the pathological response rate was not completely accordance with the clinical response rate. The focus pathological response rate of two cycles chemotherapy was more higher than that of one cycle chemotherapy. Conclusion Chemotherapy increases the risks of operation. Surgeons carefulness and better skills during operation are the key points to avoid the hazards of surgery. Two preoperative chemotherapy cycles are more suitable for the patients.