“…Mediastinal downstaging occurred in 48% of patients with trimodality treatment, but only 15% had a pathological CR. Multivariate analysis revealed that three factors were associated with improved outcome: lobectomy, pathological downstaging, and completeness of resection …”
BackgroundIn spite of the progress made in neoadjuvant therapy for operable non small‐cell lung cancer (NSCLC), many issues remain unsolved, especially in locally advanced stage IIIA.MethodsRetrospective data of 163 patients diagnosed with stage IIIA NSCLC after surgery was analyzed. The patients were divided into two groups: a preoperative chemotherapy group including 59 patients who received platinum‐etoposide doublet treatment before surgery, and an upfront surgery group including 104 patients for whom surgical resection was the first treatment step. Adjuvant chemotherapy or/and radiotherapy was administered to 139 patients (85.3%), while 24 patients (14.7%) were followed‐up only.ResultsThe rate of N2 disease was significantly higher in the upfront surgery group (P < 0.001). The one‐year relapse rate was 49.5% in the preoperative chemotherapy group compared to 65.4% in the upfront surgery group. There was a significant difference in relapse rate in relation to adjuvant chemotheraphy treatment (P = 0.007). The probability of relapse was equal whether radiotherapy was applied or not (P = 0.142). There was no statistically significant difference in two‐year mortality (P = 0.577). The median survival duration after two years of follow‐up was 19.6 months in the preoperative chemotherapy group versus 18.8 months in the upfront surgery group (P = 0.608 > 0.05).ConclusionThere was significant difference in preoperative chemotherapy group regarding relapse rate and treatment outcomes related to the lymph node status comparing to the upfront surgery group. Neoadjuvant/adjuvant chemo‐therapy is a part of treatment for patients with stage IIIA NSCLC, but further investigation is required to determine optimal treatment.
“…Generally, patients with pectus excavatum are healthy, nearly asymptomatic, and are not known to show any specific laboratory findings so that laboratory study is considered unnecessary (1,6). However, we showed that pectus excavatum has various effects on the whole body, such as body growth and spinal scoliosis (2,12,13). In addition, some severe cases of pectus excavatum present with jaundice and right heart failure (1,5).…”
Background: In previous study, we found elevated serum total lactate dehydrogenase (LDH) before correction of pectus excavatum and a decrease in total LDH after the deformity correction. In the present study, we analyzed total LDH activity and its isoenzyme patterns to investigate the causes of these laboratory findings in patients with pectus excavatum.Methods: Between March 2014 to December 2018, 85 patients with pectus excavatum who had undergone the Nuss procedure (NP) and bar removal (BR) were included into this study. We analyzed (I) total LDH and its isoenzyme patterns before the correction, (II) relationships of total LDH and its isoenzymes with age at time of NP, sex, severity of pectus excavatum, and pectus morphology types, and (III) post-corrective changes.Results: The mean age of the patients was 13.6 (±6.5) years at the age of NP and the mean interval between NP and BR was 2.2 (±0.42) years. Seventy-one males and 14 females were included. The pectus types included 54 symmetric and 31 asymmetric cases. The mean Haller index before NP and BR were 3.8±1.45 and 2.7±0.4, respectively. The mean of total LDH before NP (pre-correction) and BR (post-correction) were 404.2±80.8 and 369.2±79.3 IU/L, respectively. Before correction, total LDH was significantly higher than normal values, irrespective of age [the young group (<10 years old), P=0.006, and the old group (≥10 years old), P<0.001]. The proportion of LDH5 was significantly higher than that of LDH4 (P<0.001). Total serum LDH was significantly associated with age at time of NP and Haller index (P<0.001 and P=0.030). There was no significant correlation between severity and total LDH. However, the value of only LDH5 among all isoenzymes had a significant positive correlation with severity (P=0.006) and the proportion of only LDH5 in the severe group was significantly higher (P=0.003). After correction, proportions of each isoenzyme were all within the reference range, however, there were significant decreases in values of LDH1-LDH4, except LDH5 (P=0.020, P<0.001, P<0.001, and P=0.029). Conclusions: This study shows that pectus excavatum is a muscular disease entity and that laboratory findings are associated with compression of internal organs, which was explained by post-corrective changes in LDH activity and its isoenzyme patterns. This study will provide a deeper and wider comprehension of pectus excavatum.
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