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CXCLs play critical roles in antitumor immunity by activating tumor-specific immune responses and stimulating tumor proliferation, thus affecting patient outcomes. However, the expression and prognostic values of CXCLs in breast cancer have not been well clarified. The aim of this study was to investigate the impact of CXCLs transcriptional expression on breast cancer patients. Oncomine database, GEPIA (Gene Expression Profiling Interactive Analysis), UALCAN, Kaplan–Meier Plotter, TIMER (Tumor Immune Estimation Resource), and DAVID were used in our study. The transcriptional levels of CXCL9/10/11/13 in breast cancer tissues were significantly elevated while the transcriptional levels of CXCL1/2/3/12 were decreased based on intersections of Oncomine database and GEPIA. Among them, breast cancer patients with high transcriptional levels of CXCL2/9/10/12/13 and low transcriptional level of CXCL3 were associated with a better prognosis. We also found that most of CXCLs expressions are significantly correlated with known prognostic factors, such as patient’s age, major subclasses, individual cancer stages, and nodal metastasis status. In addition, the expression of CXCL9/10/12/13 was also indicated to be correlated with the infiltration of six types of immune cells (B cells, CD8+ T cells, CD4+ T cells, macrophages, neutrophils, and dendritic cells). The functions of differentially expressed CXCLs are primarily related to the immune response and cytokine-cytokine receptor interactions. Our results may provide novel evidence of new prognostic or predictive biomarkers for breast cancer patients.

Background This study detected programmed death-ligand 1 (PD-L1) expression in esophageal squamous cell carcinoma (ESCC) samples and investigated the association between the clinicopathological features of ESCC and PD-L1 expression. Furthermore, this study evaluated whether lymph node metastasis (LNM) status affected the prognosis of ESCC patients with diverse PD-L1 expression. Methods A total of 108 ESCC paraffin-embedded specimens were collected and further used to detect the expression of PD-L1 by immunohistochemistry. The correlation between PD-L1 expression and clinicopathological characteristics and its prognostic significance were evaluated. Finally, the clinical outcomes were investigated in the subgroup of patients with simultaneous high PD-L1 expression and LNM. Results PD-L1 expression was observed in 85.2% of ESCC cases, 43.5% of which showed high expression. Only N stage (P=0.038) was associated with high PD-L1 expression. Univariate and multivariate Cox regression analyses showed that T stage (P=0.012), N stage (P=0.029), and PD-L1 expression (P=0.044) were independent prognostic factors in ESCC patients. Moreover, further analysis of the N stage subgroup showed that skip LNM (P=0.286) or laryngeal nerve LNM (P=0.387) showed no prognostic significance, while two-field LNM was highly correlated with a worser 5-year overall survival (P=0.037). Conclusions High PD-L1 expression was significantly correlated with N stage and can be used as an independent prognostic biomarker in ESCC. Its expression level can also be used to guide appropriate lymph node dissection in ESCC.

Background Esophageal squamous cell carcinoma (ESCC) survival is mainly reported at the time of treatment. Conditional survival is another prognostic tool to evaluate ESCC patients who has survived more than one year since treatment. Methods We analyzed data from 705 ESCC patients who underwent minimally invasive surgery between 2013 and 2016. Using the Kaplan–Meier method, we computed a 5-year relative conditional survival. We also investigated the prognostic factors associated with survival using Cox proportional hazards models. Results Conditional survival improved over time for all cohorts of ESCC patients who survived a period after surgery. The greatest improve in conditional survival were observed in patients 2 years after surgery. In addition, the results of the Cox survival model from the time of surgery, T stage (p p p = 0.022), were significantly associated with survival. However, the results of the Cox survival model from 2 years after surgery, N stage (p p = 0.032) were significantly associated with survival. Conclusion For ESCC patients who survived a period after surgery, the largest increases in conditional survival were observed in patients 2 years after surgery. We suggest that patients with anastomotic leakage and higher T and N stages should be strictly screened according to various time, and that conditional survival should be used as a powerful prognostic tool for ESCC patients.

Background Exosomes have emerged as critical mediators of intercellular communication. Hypoxia is widely recognized as a key regulator of tumor aggressiveness, and significantly affects exosome release by tumor cells. However, the effects of exosomes derived from hypoxic lung adenocarcinoma (LUAD) cells are poorly understood. Methods Samples of miRNA isolated from hypoxic LUAD cell-derived exosomes (HExo) and normoxic LUAD cell-derived exosomes (NExo) were sequenced to identify miRNAs that might mediate tumor progression. Exosomal miRNA was co-cultured with LUAD cells to assess its biological effects on cell migration and metastasis both in vitro and in vivo. The cellular target of exosomal miRNA was confirmed by dual-luciferase assays. Western blot studies showed that exosomal miRNA regulated the related pathway. The availability of circulating exosomal miRNA derived from plasma was also evaluated. Results We found that HExo could significantly enhance the migration and invasion of normoxic LUAD cells. MiRNA sequencing results suggested that miR-31-5p was largely internalized within HExo and could be taken up by normoxic LUAD cells. Exosomal miR-31-5p was found to directly target Special AT-Rich Sequence-Binding Protein 2 (SATB2)-revered epithelial mesenchymal transition and significantly increase activation of MEK/ERK signaling, thereby contributing to tumor progression both in vitro and in vivo. Furthermore, higher levels of circulating exosomal miR-31-5p were detected in LUAD patients, especially in patients with metastatic disease. Conclusions Our findings demonstrate that exosomal miR-31-5p exerts a crucial role in LUAD progression, and could serve as a diagnostic biomarker for LUAD.

Background Despite the improvements in radical surgery for esophageal squamous cell carcinoma (ESCC), a large number of patients still develop recurrence. This research sought to graphically depict patterns in ESCC recurrence following curative surgical treatment using event dynamics and clarify approaches to postsurgical follow-up on the basis of recurrence time. Methods This study included 717 individuals with ESCC who received radical surgery in the Thoracic Department at Fujian Medical University Union Hospital between 2013 and 2016. Event dynamics analysis was performed on the basis of hazard rates. An initial event was defined as the occurrence of local recurrence, distant metastasis, or both. Results After complete resection, patients were followed up for a median of 44 months (range, 2-83 months). A total of 223 (31.1%) patients developed recurrence, including 122 (17.0%) patients who developed only locoregional recurrence, and 101 (14.1%) patients who developed only distant metastasis or both locoregional recurrence and distant metastasis. Recurrences were concentrated mainly (98.2%) in the first 4 years of follow-up among all recurrences, with 100 cases (44.8%) in the first year, 69 cases (30.9%) in the second year, and 50 cases (22.4%) in the third and fourth years. Conclusions After curative surgery in a multimodal setting, a significant number of patients still experienced recurrence within 4 years after surgery, which suggests that current postoperative esophageal cancer follow-up strategies may need to be modified.

Zhiyuan Zheng,1,2,* Donghong Lin,2,* Qiaoqian Chen,2,* Bin Zheng,1 Mingqiang Liang,1 Chun Chen,1 Wei Zheng1 1Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, 350001, People’s Republic of China; 2Medical Technology and Engineering College of Fujian Medical University, Fuzhou, Fujian, 350004, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wei Zheng; Chun ChenDepartment of Thoracic Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, People’s Republic of ChinaTel +86 591-83357896Fax +86 591-87113828Email zwfjxh@fjmu.edu.cn; ccfjxh@fjmu.edu.cnBackground: We retrospectively analyzed the prognostic value of the albumin-to-fibrinogen ratio (AFR)–neutrophil-to-lymphocyte ratio (NLR) score, comprising preoperative AFR and NLR, in esophageal squamous cell carcinoma (ESCC) patients after radical resection.Patients and Methods: Overall, 215 patients were included. The optimal cutoff value was determined using the receiver operating characteristic (ROC) curve. Based on a low AFR (< 12.06) and high NLR (≥ 1.78), the AFR–NLR score was classified as 2 (both hematological abnormalities present), 1 (one abnormality present), or 0 (both abnormalities absent). Kaplan–Meier curves, Cox regression, and predicted nomogram were used to evaluate the prognostic value of the score.Results: The prognostic value of the AFR–NLR score was better than that of AFR or NLR alone (P < 0.05). Multivariate analysis showed that a high AFR–NLR score was an independent predictor of poor prognosis for overall survival (P < 0.001). Additionally, in the nomogram including the AFR–NLR score, the net reclassification improvement index increased by 35.5% (P < 0.001), and the integrated discrimination improvement index increased by 9.0% (P < 0.001). The predictive accuracy of the established nomogram model was proved using Harrell’s concordance index (0.811, 95% confidence interval: 0.765– 0.856) and calibration curve. Notably, the decision analysis curve showed that the nomogram had a higher net benefit within most of the threshold probability range, indicating better clinical applicability.Conclusion: The AFR–NLR score is a useful predictor of the prognosis of ESCC patients after radical resection, and the nomogram established on the basis of this score has a good prognostic value.Keywords: esophageal squamous cell cancer, AFR–NLR score, prognosis, nomogram

Background Depending on the pathological stage, patients with esophageal squamous cell carcinoma (ESCC) can experience poor prognosis after surgery. This study was designed to analyze the effect of various treatments on prognosis in pathologic node-positive esophageal cancer patients who undergo radical surgery. Methods We evaluated 210 pathologic stage IIb-IIIc patients (pT1-4aN + M0) who had undergone esophagectomy for thoracic ESCC from January 2013 to October 2015 at our institute. Surgery alone was applied in 65 patients, postoperative chemotherapy alone was applied in 112 patients, and postoperative adjuvant chemoradiotherapy was applied in 33 patients. Kaplan--Meier and Cox regression analysis were used to compare overall survival (OS) and disease-free survival (DFS). A nomogram was constructed to visualize the multivariate Cox regression analysis model. Results The median follow-up period was 49.4 months. The 3- and 5-year OS rates of the patients in the surgery group, postoperative chemotherapy group, postoperative chemoradiotherapy group were 55.4%, 61.6%, and 75.8%, and 30.1%, 44.0%, and 63.0% respectively. The 3- and 5-year DFS rates of the patients in the surgery group, postoperative chemotherapy group, postoperative chemoradiotherapy group were 44.6%, 52.7%, and 72.7%, and 20.0%, 24.1%, and 39.4%, respectively. Both the OS and DFS of the patients in the postoperative chemoradiotherapy group were better than those of the patients in the surgery and postoperative chemotherapy group. Among them, the OS of the postoperative radiotherapy group was longer than that of the surgery group (P=0.011) and the postoperative chemotherapy group (P=0.190), while the DFS of postoperative chemoradiotherapy group was longer than that of the surgery group and postoperative chemotherapy group, but the difference was not statistically significant (P>0.05). Conclusions This study showed that postoperative adjuvant chemoradiotherapy could improve 3-year OS and DFS compared with treatment using surgery alone or postoperative chemotherapy alone. However, an evaluation of long-term prognosis requires a longer follow-up.

Background The management of the intersegmental plane (ISP) is challenging during uniport video-assisted thoracoscopic (VATS) pulmonary segmentectomy. Staplers and electrocautery have been used extensively in ISP management. However, both of them have their respective drawbacks. Currently, we have provided a revised technique termed as "Combined Dimensional Reduction Method" (CDR method), for managing the ISP with combined application of ultrasonic scalpel and staplers. The study aimed to review the outcomes of patients who underwent uniport VATS segmentectomy with or without the CDR method in our institute and assess the feasibility and safety of the CDR method. Methods From March 2017 to February 2018, 220 patients who underwent uniport VATS segmentectomy were retrospectively reviewed. By using IQQA software, pulmonary structures were reconstructed as three-dimensional (3D) images, making the targeted structures could be identified preoperatively. For the management of the ISP, in the CDR group, we firstly used the ultrasonic scalpel to trim the 3D pulmonary structure along the intersegmental demarcation, making the remaining targeted parenchyma both sufficiently thin enough and located on a 2D plane; thus, enabling easy use of staplers in managing ISP. Whereas, in the non-CDR group, we only use the staplers to manage the ISPs. The clinical characteristics, complications, and postoperative pulmonary functions were compared between the two groups. Results Propensity score analysis generated 2 well-matched pairs of 71 patients in CDR and non-CDR groups. There was no 30-day postoperative death or readmission in either group. The CDR group was significantly associated with the shorter operative time (178.3±35.8 vs. 209.2±28.7 min) (P=0.031) and postoperative stay (4.5±2.3 vs. 5.7±4.2 days) (P=0.041), compared to the non-CDR group. Moreover, no significant difference was observed in blood loss, a period of chest tube drainage, a period of ultrafine tube drainage, and postoperative pulmonary complications between the two groups. Moreover, the recovery rate of postoperative forced expiratory volume in 1 second (FEV1) or vital capacity (VC) at 1 and 3 months after segmentectomy was comparable between them. Conclusions The CDR method could make segmentectomy easier and more accurate, and therefore has the potential to be a viable and effective technique for uniport VATS pulmonary segmentectomy.

Recent advances in thoracoscopic surgery have made it possible to perform esophagectomy with conventional lymphadenectomy (paraesophageal and subcarinal lymph node dissection) using minimally invasive techniques. However, minimally invasive esophagectomy (MIE) combined with extensive lymphadenectomy along the recurrent laryngeal nerves (RLN) has remained technically challenging for thoracic surgeons. The aim of this study was to examine the safety and efficacy of extensive lymphadenectomy when compared to conventional lymphadenectomy during MIE.We retrospectively reviewed data from a cohort of 147 consecutive patients who underwent MIE for esophageal cancer (EC) over a 3-year period at our institution. During thoracoscopic esophagectomy, extensive lymphadenectomy along the RLN was performed on 76 patients from June 2009 to December 2010 (group A), while 71 patients underwent conventional lymphadenectomy from June 2008 to May 2009 (group B) and were enrolled as historical controls. Clinical characteristics including patient demographics, operation features, and the rate and type of complications were recorded for both groups. The number of dissected lymph nodes and the number of patients with nodes positive for cancer on histological examination were determined for both groups. Statistical analysis was used to identify differences between the two groups.All patients underwent thoracoscopic esophagectomy without conversion to open thoracotomy. Patient demographics and operation features were similar between the two groups. Of the 76 patients that underwent extensive lymphadenectomy there were 13 patients (17.11%) who were RLN positive, which resulted in upstaging of TNM in 5 patients (6.58%). The overall incidence of postoperative complications (42.10% versus 39.47%, p = 0.742) and permanent recurrent laryngeal nerve palsy (1.32% versus 0%, p = 0.517) was similar between the two groups.Extensive mediastinal lymphadenectomy during minimally invasive esophagectomy is a feasible procedure for EC patients. It is technically safe and oncologically adequate in experienced hands, and improves the accuracy of tumor staging. Further study is required to discuss its long-term prognostic value for esophagus cancer patients.

We describe herein a case of single-port thoracoscopic right main bronchial tumor sleeve resection and secondary carinal reconstruction. A 66-year-old male patient had a right main bronchial tumor longer than 12 months, who had been received endobronchial cryosurgery twice before. However, the tumor relapsed quickly. Then the patient transferred to our department. He was underwent a single-port complete thoracoscopic right main bronchial tumor sleeve resection and secondary carinal reconstruction. He recovered smoothly, without any perioperative complications. On the 5th postoperative day (POD), he was discharged in good condition.

To compare the feasibility and safety of single-port vs. triple-port complete thoracoscopic lobectomy for non-small cell lung cancer (NSCLC).A retrospective study was conducted on 82 patients with NSCLC who underwent complete thoracoscopic lobectomy from August 2014 to October 2014 in Department of Thoracic Surgery, Fujian Medical University Union Hospital. There were 33 cases in single-port complete thoracoscopic lobectomy group (single-port group) and the other 49 ones in triple-port complete thoracoscopic lobectomy group (triple-port group). Total lymph node harvest, mediastinal lymph node harvest, dissection of mediastinal lymph node groups, operation time, intraoperative blood loss, chest drainage duration, postoperative hospital stay, postoperative one-day pain visual analogue scale (POP-VAS), and the complications were thoroughly compared between the two groups.There were no significant differences in total lymph node harvest, mediastinal lymph node harvest, dissection of mediastinal lymph node groups, intraoperative blood loss, chest drainage duration, postoperative hospital stay, and complications between the two groups (P0.05). However, the operation time of single-port group was significantly longer than that of triple-port group (181.3±27.5 vs. 149.5±30.9 min, P0.05). POP-VAS in single-port group was significantly lower than that in triple-port group (3.6±0.7 vs. 5.5±1.0, P0.05).For NSCLC, the feasibility and safety of single-port complete thoracoscopic lobectomy is similar to triple-port complete thoracoscopic lobectomy. Compared with triple-port complete thoracoscopic lobectomy, the operation time of single-port complete thoracoscopic lobectomy is longer, but its postoperative pain is gentler. As the experience accumulating, single-port complete thoracoscopic lobectomy should be popularized with its merits of minimal invasiveness.

We describe herein a case of thyrotoxic crisis after esophagectomy in a 64-year-old woman with esophageal carcinoma and well-controlled hyperthyroidism. On the fourth postoperative day, she had palpitations, abdominal pain, fever, and tachycardia, which were similar to the symptoms of an anastomotic leak. There was no evidence to indicate the existence of an anastomotic leak after examination. We were confused at first. After turning to Burch and Wartofsky's scoring system, we finally diagnosed thyrotoxic crisis and then prescribed several agents for emergency treatment, including propylthiouracil, metoprolol tartrate, and hydrocortisone. Afterward, she recovered and was discharged safely.