BackgroundWe aimed to investigate prevalence and prognostic role of SOX2, PIK3CA, FGFR1 and BRF2 gene gain in patients with surgically resected non-small cell lung cancer (NSCLC).Methods SOX2, PIK3CA, FGFR1 and BRF2 gene copy number was assessed by fluorescence in situ hybridization (FISH) in arrayed tissue cores from 447 resected NSCLCs.ResultsIncreased gene copy number (FISH+) for SOX2, PIK3CA, FGFR1 and BRF2 was observed in 23.6%, 29.2%, 16.6% and 14.9% of cases, respectively. FISH+ status for each gene was significantly associated with smoking history, squamous cell carcinoma (SCC) histology, and increased copy number of the other studied genes. Multivariate analysis of overall survival indicated increased SOX2 gene copy number (P = 0.008), stage I-II (P<0.001), and adenocarcinoma or SCC histology (P = 0.016) as independent, favorable prognostic factors. A statistically significant interaction was observed between stage and SOX2 gene status (P = 0.021), indicating that the prognostic impact of SOX2 gene gain differs across stages and is limited to patients with stage I-II disease (HR 0.44, 95% CI: 0.25–0.77; P = 0.004, adjusted for histology).ConclusionsIncreased SOX2 gene copy number is an independent and favorable prognostic factor in surgically resected, early stage NSCLC, regardless of histology. SOX2, PIK3CA, FGFR1 and BRF2 gene gains are likely to occur concurrently, with potentially relevant implications for the development of new therapeutic strategies.

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Cardiac SSFP sequences can be used for the resectability assessment of advanced mediastinal tumors: the presence of India Ink artifact between tumor and structures predicts tumor resectability.

The traditional approach to thymectomy requires median sternotomy based on the assumption that it is the best means to achieve adequate resection margins, complete removal of the thymus and clearance of the anterior mediastinal fat. However, in recent years, VATS thymectomy has been gaining acceptance as a means to achieve adequate oncologic results and symptomatic improvement of myasthenic symptoms with less impact on the patient. We have adopted a flexible approach based on the location of the tumor and on whether the patient has myasthenia gravis (MG) or not when planning minimally invasive VATS thymectomy. A preferential approach from the left side is chosen for clinical stage I-II thymomas located on the left side or on the midline in patients without MG, and a bilateral approach (uniportal VATS on the right side and three-portal VATS on the left side) for MG patients with or without thymoma in order to achieve complete clearance of the anterior mediastinal fat on both sides. Such techniques are herewith clearly illustrated in hope that surgeons wishing to endeavor in such an effort will be facilitated. patients, and on the hypothetical risk that a second primary thymoma may develop in the residual thymus gland (4,7). However, an increasing number of reports over the recent years have shown that thymectomy can be accomplished safely and effectively by VATS both for early-stage thymoma and for MG (8)(9)(10)(11)(12)(13)(14).A recently published propensity-matched study on patients undergoing either trans-sternal or minimally invasive thymectomy for stage I-II thymoma showed overall postoperative complications rates to be lower with VATS thymectomy, and suggested that in fact, the majority of complications in the open group were due the complications of median sternotomy (15).There are no randomized trials that compare minimally invasive and open thymectomy, but VATS thymectomy was compared to the traditional open approach in two recent large meta-analyses (16,17). Both such studies showed significantly reduced postoperative blood loss and blood products requirements, reduced postoperative pain scores, reduced overall complications rates and reduced postoperative hospital stay with VATS thymectomy compared with open thymectomy. Operating-room time was not significantly different between the two techniques.Most importantly, the probability of achieving microscopically complete resection (i.e., tumor free margins at pathologic examination) and loco-regional recurrence rates were similar with either approach.Over 50% of thymoma patients may suffer from a variety of autoimmune diseases, the most common of which are MG, erythroid aplasia and hypogammaglobinemia. Up to 25% of thymoma patients will have clinically overt MG and an additional 25% of clinically asymptomatic thymoma patients will have circulating anti-acetylcholinesterase receptor (anti-Ach-R) autoantibodies. Conversely, in 5-15% of the patients with MG, preoperative work up eventually demonstrates an unsuspected thymoma (18,19).Thymectomy in M...