Background. Surgical stress and general anesthesia can have detrimental effects on postoperative immune function. We sought to comparatively evaluate postoperative lymphocytes response in patients undergoing videoassisted thoracoscopic surgery (VATS) under thoracic epidural or general anesthesia.Methods. Between October 2008 and June 2009, 50 patients with nonmalignant pulmonary conditions were randomized to undergo VATS through either sole epidural anesthesia and spontaneous ventilation (awake group, n ؍ 25) or general anesthesia with one-lung ventilation (control group, n ؍ 25). In both groups, assessment of total lymphocytes count and changes in proportion of lymphocyte subsets including CD19؉, CD3؉, CD4؉, CD8؉, CD4؉:CD8؉ ratio, and CD16؉CD56؉ (natural-killer cell) were evaluated by two-way analysis of variance test for repeated measures at baseline and postoperative days 1, 2, and 3. The Mann-Whitney test was performed at each time point only for significant parameters at between-group analysis of variance.
This study confirms a relevant role for apoptosis-regulatory proteins in the pathogenesis of lung cancer, and highlights the possible role of Bcl-2 as a prognostic factor for this tumour.
Cardiovascular disease seems to have significant impact on survival and morbidity in patients undergone surgery for lung cancer, especially in presence of multifocal vascular disease and following major resections. The timing of vascular surgery and the extension of resection should rely on the severity of vascular disease, anaesthesiologist's and surgeon's final evaluation.
Background/Aims: Abnormalities of the proteins involved in cell cycle checkpoints are extremely common among almost all neoplasms. This study aimed to investigate the expression of four components of the cell cycle machinery-p21, p16, p53, and proliferating cell nuclear antigen (PCNA)-in non-small cell lung cancer (NSCLC). Methods: The expression of p21, p16, p53, and PCNA was examined in 68 well characterised NSCLC specimens using immunohistochemistry. The coregulation of these proteins and their influence on survival were analysed using both univariate and multivariate analyses. Results: By univariate analysis, the expression of all the proteins examined, except for PCNA, was significantly correlated with survival. In multivariate analysis, the only immunohistochemical parameter able to influence overall survival was p16, confirming the hypothesis that the RB-p16 tumour suppressor pathway is inactivated in most lung cancer samples. Finally, the group of patients with NSCLC who were negative for both p21 and p16 had a significantly shorter overall survival. Conclusions: These results suggest that loss of control of cell cycle checkpoints is a common occurrence in lung cancers, and support the idea that functional cooperation between different cell cycle inhibitor proteins constitutes another level of regulation in cell growth control and tumour suppression.
Although surgical resection is considered the adequate treatment in early stages of nonsmall cell lung cancer, long-term survival is not satisfactory and recurrence rate is high. We previously showed that postoperative chemotherapy at stage IB reduces recurrences and prolongs overall survival. We extended size and observation period of the study sample and performed a separate analysis for minimally resected patients. The trial was designed as a randomized, 2-armed study with postoperative adjuvant chemotherapy versus surgery alone as control group. All patients had stage IB disease (pT2N0) assessed after a radical surgical procedure (defined as anatomical or minimal). Chemotherapy consisted of cisplatin (100 mg/m 2 day 1) and etoposide (120 mg/m 2 days 1-3) for 6 cycles. The primary endpoint was overall survival; secondary endpoint was disease-free survival (DFS). One hundred and forty patients entered the study: 70 were assigned to the adjuvant chemotherapy group and 70 to the control group. Groups were homogeneous for conventional risk factors. There was no clinically significant morbidity associated to chemotherapy. Patients were followed for a mean period of 40.31 6 30.86 months. A significant difference in overall (p 5 0.02) and disease-free (p 5 0.0001) survival was observed between patients undergoing adjuvant chemotherapy vs. control group. Adjuvant chemotherapy significantly improved both overall (p 5 0.02) and DFS (p 5 0.003) of anatomically resected patients, but only the DFS (p 5 0.02) of minimally resected patients. Our results confirm that adjuvant chemotherapy may have a real impact on long-term survival in patients with stage IB nonsmall cell lung cancer being this effect especially evident for those anatomically resected. ' 2006 Wiley-Liss, Inc.Key words: adjuvant chemotherapy; NSCLC IB; long-term survival Radical surgical resection is considered the adequate treatment in providing survival benefits for early nonsmall cell lung cancer (NSCLC), especially for those patients without lymph node involvement.1 A variety of surgical procedures exist (e.g. standard, atypical, parenchyma-sparing or extended procedures) but all aim at the resection of NSCLC oncologically complete. Notwithstanding, long-term survival is not satisfactory and the recurrence rate is quite high 2-4 due to the presence of micrometastases 5-7 not detectable by conventional diagnostic procedures and, therefore, not eradicable by surgery. To prevent this occurrence, postoperative adjuvant systemic therapy was proposed even in the case of surgical procedures deemed radical. 8,9 A recent meta-analysis of all randomized trials with accrual from January 1965 to December 1991 showed that the absolute risk of death was reduced by 3% at 2 years and 5% at 5 years for patients who were treated with postoperative cisplatin-containing regimens.10 According to these evidences some institutions, 8,9,11,12 proposed adjuvant chemotherapy even after presumed radical surgery at stage I, despite discordant results presented by another multicentr...
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