Publications by authors named "Siyang Feng"

22 Publications

  • Page 1 of 1

Potentiating CD8 T cell antitumor activity by inhibiting PCSK9 to promote LDLR-mediated TCR recycling and signaling.

Protein Cell 2021 Feb 19. Epub 2021 Feb 19.

Center for Precision Medicine, Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510030, China.

Metabolic regulation has been proven to play a critical role in T cell antitumor immunity. However, cholesterol metabolism as a key component of this regulation remains largely unexplored. Herein, we found that the low-density lipoprotein receptor (LDLR), which has been previously identified as a transporter for cholesterol, plays a pivotal role in regulating CD8 T cell antitumor activity. Besides the involvement of cholesterol uptake which is mediated by LDLR in T cell priming and clonal expansion, we also found a non-canonical function of LDLR in CD8 T cells: LDLR interacts with the T-cell receptor (TCR) complex and regulates TCR recycling and signaling, thus facilitating the effector function of cytotoxic T-lymphocytes (CTLs). Furthermore, we found that the tumor microenvironment (TME) downregulates CD8 T cell LDLR level and TCR signaling via tumor cell-derived proprotein convertase subtilisin/kexin type 9 (PCSK9) which binds to LDLR and prevents the recycling of LDLR and TCR to the plasma membrane thus inhibits the effector function of CTLs. Moreover, genetic deletion or pharmacological inhibition of PCSK9 in tumor cells can enhance the antitumor activity of CD8 T cells by alleviating the suppressive effect on CD8 T cells and consequently inhibit tumor progression. While previously established as a hypercholesterolemia target, this study highlights PCSK9/LDLR as a potential target for cancer immunotherapy as well.
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http://dx.doi.org/10.1007/s13238-021-00821-2DOI Listing
February 2021

Machine Learning Models to Predict Primary Sites of Metastatic Cervical Carcinoma From Unknown Primary.

Front Genet 2020 21;11:614823. Epub 2020 Dec 21.

Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.

Metastatic cervical carcinoma from unknown primary (MCCUP) accounts for 1-4% of all head and neck tumors, and identifying the primary site in MCCUP is challenging. The most common histopathological type of MCCUP is squamous cell carcinoma (SCC), and it remains difficult to identify the primary site pathologically. Therefore, it seems necessary and urgent to develop novel and effective methods to determine the primary site in MCCUP. In the present study, the RNA sequencing data of four types of SCC and Pan-Cancer from the cancer genome atlas (TCGA) were obtained. And after data pre-processing, their differentially expressed genes (DEGs) were identified, respectively. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis indicated that these significantly changed genes of four types of SCC share lots of similar molecular functions and histological features. Then three machine learning models, [Random Forest (RF), support vector machine (SVM), and neural network (NN)] which consisted of ten genes to distinguish these four types of SCC were developed. Among the three models with prediction tests, the RF model worked best in the external validation set, with an overall predictive accuracy of 88.2%, sensitivity of 88.71%, and specificity of 95.42%. The NN model is the second in efficacy, with an overall accuracy of 82.02%, sensitivity of 81.23%, and specificity of 93.04%. The SVM model is the last, with an overall accuracy of 76.69%, sensitivity of 74.81%, and specificity of 90.84%. The present analysis of similarities and differences among the four types of SCC, and novel models developments for distinguishing four types of SCC with informatics methods shed lights on precision MCCUP diagnosis in the future.
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http://dx.doi.org/10.3389/fgene.2020.614823DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779672PMC
December 2020

Circular RNA circNELL2 Acts as the Sponge of miR-127-5p to Promote Esophageal Squamous Cell Carcinoma Progression.

Onco Targets Ther 2020 16;13:9245-9255. Epub 2020 Sep 16.

Department of Thoracic Surgery, Southern Medical University Nanfang Hospital, Guangzhou City, Guangdong Province 510515, People's Republic of China.

Introduction: Owing to its involvement in both the initiation and progression of various cancers, aberrant circular RNA (circRNA) expression has been researched extensively in the recent times. In the present study, we aim to investigate the effect of a novel circRNA has_circ_0025933 (circNELL2) in the progression of esophageal squamous cell carcinoma (ESCC).

Materials And Methods: Sanger sequencing and the detection of circNELL2 level after RNase R or actinomycin D treatment were performed to identify the existence of cirNELL2 in ESCC cells. WST, EDU staining and colony-formation assay were used to assess the proliferation while transwell assay was used to evaluate the migration of ESCC cells. Luciferase assay, RNA pull down and the FISH assay were performed to verify the interaction between circNELL2 and miR-127-5p as well as miR-127-5p and CDC6. Xenograft model was carried out to evaluate the effect of circNELL2 in vivo.

Results: circNELL2 was proved to exist in ESCC cells. The up-regulated expression of circNELL2 in the clinical ESCC specimens was also verified. Next, function studies suggested that circNELL2 knockdown inhibited the proliferation of ESCC cells in vitro and in vivo, while circNELL2 overexpression promotes that of ESCC cells. Besides, this study mechanically predicted and verified the target miR of circNELL2, which is miR-127-5p. It was found that miR-127-5p was capable of reversing the effect of circNELL2 on ESCC cells. Moreover, miR-127-5p was also found to target CDC6 to participate in the regulation of cell phenotype.

Discussion: circNELL2 promoted the progression of ESCC cells via sponging miR-127-5p, and it has the potential to serve as a novel prognostic and therapeutic target for ESCC.
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http://dx.doi.org/10.2147/OTT.S247847DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7502390PMC
September 2020

Oligosilanyl-Bridged Biscarbazoles: Structure, Synthesis, and Spectroscopic Properties.

ACS Omega 2020 Aug 21;5(30):19181-19186. Epub 2020 Jul 21.

Key Laboratory of Organosilicon Chemistry and Material Technology of Ministry of Education, and Key Laboratory of Organosilicon Material of Zhejiang Province, Hangzhou Normal University, No. 2318, Yuhangtang Road, Hangzhou 311121, P. R. China.

Oligosilanyl-bridged systems are expected to give rise to unique optoelectronic properties because of σ-π conjugation between the Si-Si σ orbital and the aryl π orbital. Herein, we synthesized a small series of novel biscarbazoles bridged with permethylated oligosilanyl units (-[Si(CH)]-, = 1-4) and examined their spectroscopic properties in detail. In the target molecules , = 2-4, the efficient σ-π conjugation elevated the highest occupied molecular orbital energy level with no influence on the lowest unoccupied molecular orbital. In the solid state, the emission full width at half-maximum (fwhm) of all the compounds narrowed significantly, while the emission efficiency increased and the emission color of carbazole was retained. This research provided a very simple and general way of subtly manipulating the electronic properties of organic materials to construct an emissive color-retaining system for multifunctional applications.
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http://dx.doi.org/10.1021/acsomega.0c02559DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7409250PMC
August 2020

Clinicopathological features, survival outcomes, and appropriate surgical approaches for stage I acinar and papillary predominant lung adenocarcinoma.

Cancer Med 2020 05 24;9(10):3455-3462. Epub 2020 Mar 24.

Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.

Background: Whether prognosis differs between lung acinar predominant adenocarcinoma (ACN) and papillary predominant adenocarcinoma (PAP) patients remains controversial. Furthermore, the appropriate surgical plan for each subtype is undetermined.

Methods: Data of stage I ACN or PAP patients from 2004 to 2015 were retrospectively reviewed by SEER*Stat 8.3.5. The primary outcome was overall survival (OS) and lung cancer specific survival (LCSS).

Results: 1531 patients (PAP, 484; ACN, 1047) were included. ACN patients had better OS (P = .001) and LCSS (P = .003) than PAP patients. Among stage I ACN patients, lobectomy with mediastinal lymph node dissection (Lob) (P = .001) or segmentectomy (Seg) (P = .003) provided a better OS than wedge resection (Wed). And ACN patients who received Lob had a equivalent LCSS, compared to those who received Seg (P = .895). For patients with PAP in stage I, those who received Lob tended to have a better prognosis than that received Seg (HR of OS, 0.605, 95% CI: 0.263-1.393; HR of LCSS, 0.541, 95% CI: 0.194-1.504) or Wed (HR of OS, 0.735, 95% CI: 0.481-1.123; HR of LCSS, 0.688, 95% CI: 0.402-1.180).

Conclusions: Among patients with lung adenocarcinoma in stage I, those with ACN have a better OS and LCSS than that with PAP. For patients with stage I ACN, Seg and Lob, rather than Wed, seem to be an equivalent treatment choice; however, Seg is the prior option because it could preserve more lung function than Lob. For patients with PAP, Lob tends to be a better choice than Wed and Seg, although the prognostic difference between them is nonsignificant.
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http://dx.doi.org/10.1002/cam4.3012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7221422PMC
May 2020

IRGS: an immune-related gene classifier for lung adenocarcinoma prognosis.

J Transl Med 2020 02 4;18(1):55. Epub 2020 Feb 4.

Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, No. 1838 of North Guangzhou Avenue, Guangzhou, 510515, People's Republic of China.

Background: Tumour cells interfere with normal immune functions by affecting the expression of some immune-related genes, which play roles in the prognosis of cancer patients. In recent years, immunotherapy for tumours has been widely studied, but a practical prognostic model based on immune-related genes in lung adenocarcinoma comparable to existing model has not been established and reported.

Methods: We first obtained publicly accessible lung adenocarcinoma RNA expression data from The Cancer Genome Atlas (TCGA) for differential gene expression analysis and then filtered immune-related genes based on the ImmPort database. By using the lasso algorithm and multivariate Cox Proportional-Hazards (CoxPH) regression analysis, we identified candidate genes for model development and validation. The robustness of the model was further examined by comparing the model with three established gene models.

Results: Gene expression data from a total of 524 lung adenocarcinoma patients from TCGA were used for model development. We identified four biomarkers (MAP3K8, CCL20, VEGFC, and ANGPTL4) that could predict overall survival in lung adenocarcinoma (HR = 1.98, 95% CI 1.48 to 2.64, P = 4.19e-06) and this model could be used as a classifier for the evaluation of low-risk and high-risk groups. This model was validated with independent microarray data and was highly comparable with previously reported gene expression signatures for lung adenocarcinoma prognosis.

Conclusions: In this study, we identified a practical and robust four-gene prognostic model based on an immune gene dataset with cross-platform compatibility. This model has potential value in improving TNM staging for survival predictions in patients with lung adenocarcinoma.

Impact: The study provides a method of immune relevant gene prognosis model and the identification of immune gene classifier for the prediction of lung adenocarcinoma prognosis with RNA sequencing and microarray compatibility.
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http://dx.doi.org/10.1186/s12967-020-02233-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001261PMC
February 2020

Digital health for sexually transmitted infection and HIV services: a global scoping review.

Curr Opin Infect Dis 2020 02;33(1):44-50

Dermatology Hospital of South Medical University.

Purpose Of Review: The current study aimed to review how digital health has been used for sexually transmitted infection (STI)/HIV prevention, testing, and treatment.

Recent Findings: A scoping review was conducted by searching five databases for peer-reviewed literature published between March 2018 to August 2019. 23 out of 258 studies met the inclusion criteria and were assessed. Six studies used digital platform to enhance STI/HIV prevention messaging; four studies found that digital health can provide vivid promotional information and has been instrumental in increasing the accessibility and acceptability of STI/HIV testing; three studies reported digital health provides a channel to understand and interpret the discourses on preexposure prophylaxis (PrEP) and increase PrEP uptake; three studies focused on refining big data algorithms for surveillance; four studies reported on how digital interventions could be used to optimize clinical interventions; and four studies found digital interventions can be used to assist mental health services.

Summary: Digital health is a powerful and versatile tool that can be utilized in the production of high-quality, innovative strategies on STIs and HIV services. Future studies should consider focusing on strategies and implementations that leverage digital platforms for network-based interventions, in addition to recognizing the norms of individual digital intervention platforms.
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http://dx.doi.org/10.1097/QCO.0000000000000619DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152691PMC
February 2020

Beyond T Cells: Understanding the Role of PD-1/PD-L1 in Tumor-Associated Macrophages.

J Immunol Res 2019 4;2019:1919082. Epub 2019 Nov 4.

Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.

Programmed cell death protein 1 (PD-1) and its ligand PD-L1 have attracted wide attention from researchers in the field of immunotherapy. PD-1/PD-L1 have been shown to exist in many types of cells in addition to T lymphocytes, and studies have accordingly extended from their suppressive effect on T cell activation and function to examining their role in other cells. In this review, we summarize recent research on PD-1/PD-L1 in macrophages, with the aim of furthering our understanding of PD-1/PD-L1 and their detailed roles in macrophages. This information may provide additional insights for researchers, enrich the basic theory of anti-PD-1/PD-L1 immunotherapy, and thus ultimately benefit more patients.
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http://dx.doi.org/10.1155/2019/1919082DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875348PMC
April 2020

The Current Situation of Esophageal Cancer Staging and Perioperative Strategies Determination in Central and Southern China: A Cross Sectional Survey.

Front Oncol 2019 22;9:1098. Epub 2019 Oct 22.

Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.

We aim to investigate the current esophageal cancer staging according to the 7th edition TNM classification for esophageal carcinoma proposed by American Joint Committee on Cancer (AJCC) among oncology-related physicians in China. A specifically-designed 14-item questionnaire was distributed to 366 doctors who were working with esophageal cancer patients. We collected and analyzed the feedbacks and explored the possible associations within different departments, including thoracic surgery, the internal medicine of gastroenterology, oncology, and/ radiotherapy in eight different hospitals from central and southern China. Among all the responses, 31.42% of them were from thoracic surgery department, 40.44% were from oncology and/or radiation therapy and 28.14% were from the internal medicine of gastroenterology, respectively. Surprisingly, in total 66.12% of all the physicians were unaware that the 7th edition of esophageal carcinoma TNM classification was released in 2009; only 21.86 and 16.67% of physicians recognized cervical nodes and celiac nodes as regional lymph nodes. Furthermore, 67.21% physicians didn't know that tumor location, histologic grade, and histopathology were accepted as new prognostic factors in the latest TNM system; and 51.37% physicians could not determine the correct TNM classification of esophagogastric junction cancers. Intriguingly, over 50% of them could still design appropriate perioperative strategies. The 7th edition of the TNM classification for esophageal carcinoma is poorly recognized and understood in central and southern China, which might contribute to the relatively low rates of appropriate perioperative procedures applied for esophageal cancer patients.
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http://dx.doi.org/10.3389/fonc.2019.01098DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6817579PMC
October 2019

Survival-related risk score of lung adenocarcinoma identified by weight gene co-expression network analysis.

Oncol Lett 2019 Nov 4;18(5):4441-4448. Epub 2019 Sep 4.

Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China.

The present study aimed to identify the novel biomarkers and underlying molecular mechanisms of lung adenocarcinoma (LAC) to aid in its diagnosis, prognosis, prediction, disease monitoring and emerging therapies. Data from a total of 498 LAC samples were collected from The Cancer Genome Atlas and divided into two sets by stratified randomization based on pathological Tumor-Node-Metastasis stage. The training set was comprised of 348 samples and the validation set was comprised of 150 samples. A total of 123 samples from the training set for patients who completed follow-up were analyzed by weighted gene co-expression network analysis. A module was identified that contained 113 protein-coding genes that were positively associated with overall survival (OS). A least absolute shrinkage and selection operator (LASSO) Cox regression model was constructed and four survival-associated genes (OPN3, GALNT2, FAM83A and KYNU) were retained. Risk score, calculated by the linear combination of each gene expression multiplied by the LASSO coefficient, could successfully discriminate between patients with LAC exhibiting low and high OS time in both sets. The results from the present study indicate that this risk score may contribute to potential diagnostic and therapeutic strategies for LAC management.
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http://dx.doi.org/10.3892/ol.2019.10795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6781564PMC
November 2019

The impact of angiogenesis inhibitors on survival of patients with small cell lung cancer.

Cancer Med 2019 10 21;8(13):5930-5938. Epub 2019 Aug 21.

Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, P. R. China.

Background: Small cell lung cancer (SCLC) is a highly invasive and lethal neuroendocrine tumor. Antiangiogenic drugs have been reported in the treatment of SCLC. We aimed to provide a comprehensive evaluation of the impact of angiogenic inhibitors on SCLC survival using network meta-analysis.

Methods: The impact of five angiogenesis inhibitors, that is, vandetanib (Van), bevacizumab (Bev), Rh-endostatin (End), sunitinib (Sun), and thalidomide (Tha), on progression-free survival (PFS) and overall survival (OS) was evaluated by conducting a network meta-analysis. RNA sequencing data were downloaded from publicly available databases.

Results: Nine phase II and III randomized controlled trials (RCTs), that involved 1599 participants, that investigated angiogenesis inhibitors in the treatment of SCLC were included in this meta-analysis. Sun and Bev achieved better PFS than Tha (Bev VS. Tha, HR = 0.88, 95% CI: 0.79-0.98, Sun VS. Tha, HR = 0.80, 95% CI: 0.65-1.00). Moreover, Sun and Bev were superior to placebo in terms of PFS (Bev VS. Placebo, HR = 0.89, 95%CI: 0.81-0.97, Sun VS. Placebo, HR = 0.81, 95% CI: 0.66-1.00). Based on this study, we found no significant difference of OS of SCLC. The angiogenesis pathway and expression of target genes were globally deactivated in SCLC tissue.

Conclusion: Results of this network meta-analysis indicate that the PFS outcome of SCLC with Sun or Bev drugs is superior to that of Tha. The improved therapeutic impact of angiogenesis inhibitors on SCLC needs more evidence, such as long-term observation in clinical trials, to be validated.
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http://dx.doi.org/10.1002/cam4.2462DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6792507PMC
October 2019

Differential effects of adjuvant EGFR tyrosine kinase inhibitors in patients with different stages of non-small-cell lung cancer after radical resection: an updated meta-analysis.

Cancer Manag Res 2019 2;11:2677-2690. Epub 2019 Apr 2.

Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China,

Purpose: A survival improvement was achieved with adjuvant chemotherapy in non-small-cell lung cancer (NSCLC) patients, but its differential effects among patients with different stages remained controversial. This study aimed to compare the beneficial effects of adjuvant tyrosine kinase inhibitor (TKI) therapy with those of traditional therapy on NSCLC patients, specifically on EGFR-mutant and stage II-IIIA patients, who might benefit most from such treatment.

Methods: MEDLINE, Embase, and the Cochrane Library were searched, and the results were screened independently according to certain criteria by two authors. Disease-free survival (DFS) and overall survival (OS) with HRs were used as the summary statistics.

Results: A total of 2,915 publications were identified and screened. Six randomized control trials and three retrospective cohort studies of 2,467 patients with acceptable quality were included. The overall EGFR mutation rate was 48.62%. DFS was significantly improved in all the patients (HR, 0.77; 95% CI, 0.68-0.88) and in the subgroup of EGFR-mutant patients (HR, 0.49; 95% CI, 0.40-0.61). The difference of 5-year OS in the subgroup of EGFR-mutant patients (HR, 0.48; 95% CI, 0.31-0.72) was statistically significant, while in all the patients (HR, 1.01; 95% CI, 0.85-1.19), the difference was not significant. In the subgroups of studies in which <50% of patients were in stage I (HR, 0.46; 95% CI, 0.35-0.60) and >30% of patients were in stage IIIA (HR, 0.46; 95% CI, 0.35-0.60), DFS was significantly improved, while in the subgroups of studies in which <30% of patients were in stage IIIA (HR, 0.90; 95% CI, 0.77-1.04) and >50% of patients were in stage I (HR, 0.90; 95% CI, 0.77-1.04), DFS was not significantly improved.

Conclusion: Stage IIIA NSCLC patients might benefit more from adjuvant TKIs than stage I NSCLC patients after radical resection.
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http://dx.doi.org/10.2147/CMAR.S187940DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6450185PMC
April 2019

TUSC3 accelerates cancer growth and induces epithelial-mesenchymal transition by upregulating claudin-1 in non-small-cell lung cancer cells.

Exp Cell Res 2018 12 9;373(1-2):44-56. Epub 2018 Aug 9.

Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, PR China. Electronic address:

Lung cancer is the most frequent cause of cancer-related deaths worldwide, but its molecular pathogenesis is poorly understood. The tumor suppressor candidate 3 (TUSC3) gene is located on chromosome 8p22 and is universally acknowledged as a cancer suppressor. However, our research has demonstrated that TUSC3 expression is significantly upregulated in non-small-cell lung cancer compared to benign controls. In this study, we analyzed the consequences of TUSC3 knockdown or overexpression on the biological functions of non-small-cell lung cancer cell lines. To identify the molecules and signaling pathways with which TUSC3 might interact, we completed immunoblotting, quantitative polymerase chain reaction, microarray, co-immunoprecipitation, and immunofluorescence assays. We demonstrated that TUSC3 knockdown leads to decreased proliferation, migration, and invasion, and reduced xenograft tumor growth of non-small-cell lung cancer cell lines, whereas opposite results were observed with overexpression of TUSC3. In addition, TUSC3 knockdown suppressed epithelial-mesenchymal transition by downregulating the expression of claudin-1, which plays an indispensable role in EMT progress. On the contrary, overexpression of TUSC3 significantly enhanced EMT progress by upregulating claudin-1 expression. Overall, our observations suggest that TUSC3 accelerates cancer growth and induces the epithelial-mesenchymal transition in non-small-cell lung cancer cells; we also identified claudin-1 as a target of TUSC3.
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http://dx.doi.org/10.1016/j.yexcr.2018.08.012DOI Listing
December 2018

3D-printing aided resection of intratracheal adenoid cystic carcinoma and mediastinal mature cystic teratoma in a 26-year-old female: a case report.

J Thorac Dis 2018 Feb;10(2):E134-E137

Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.

Complete resection remains the ideal treatment for most patients with primary intratracheal tumors. Due to the limit in the resection length, the localization of the tumor during the surgery could be rather difficult if it hasn't invaded out of the trachea, which might be more difficult when there's another tumor in the anterior mediastinum. A 26-year-old woman with intratracheal adenoid cystic carcinoma (ACC) presented with dyspnea. CT scan revealed not only an ACC without extension out of trachea, but also a mediastinal teratoma (MT) near aorta, making the operation much more complicated than usual. To solve this problem, 3D-printing was applied for facilitating surgery plan making and intraoperative locating of ACC. And as we expected, the operation went successfully and the patient achieved full recovery without complications. To the best of our knowledge, the case of both intratracheal ACC and MT in one patient has not been previously reported.
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http://dx.doi.org/10.21037/jtd.2018.01.62DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5864643PMC
February 2018

Unidirectionally progressive resection of lower left lung carcinoma under video-associated thoracoscopy.

J Thorac Dis 2015 Dec;7(12):2371-5

Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.

General anesthesia is adopted through double-lumen endotracheal intubation, one-lung ventilation on the contralateral, and intravenous injection. The patient took a 90 degree decubitus on his contralateral side. The operative incisions: the observation port was made in the mid-axillary line of the 7(th) intercostal section, a second horizontal incision of 4 cm as the main operation port at the 4(th) intercostal space between the anterior axillary line and the midclavicular line, and a 3(rd) incision of 1.5 cm as the secondary operation hole at the 9(th) intercostal space between the axillary line and the bottom scapular line. The surgeons were on the ventral side of the patient, and operated with endoscope apparatus in front of the monitor screen.
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http://dx.doi.org/10.3978/j.issn.2072-1439.2015.12.49DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4703662PMC
December 2015

Randomized Adjuvant Chemotherapy of EGFR-Mutated Non-Small Cell Lung Cancer Patients with or without Icotinib Consolidation Therapy.

PLoS One 2015 16;10(10):e0140794. Epub 2015 Oct 16.

Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.

Background: Epidermal growth factor receptor (EGFR) mutations occur in up to 50% of Asian patients with non-small cell lung cancer (NSCLC). Treatment of advanced NSCLC patients with EGFR-tyrosine kinase inhibitor (EGFR-TKI) confers a significant survival benefit. This study assessed the efficacy and safety of chemotherapy with or without icotinib in patients undergoing resection of stage IB to ⅢA EGFR-mutated NSCLC.

Methods: Patients with surgically resected stage IB (with high risk factors) to ⅢA EGFR-mutated NSCLC were randomly assigned (1:1) to one of two treatment plans. One group received four cycles of platinum-based doublet chemotherapy every three weeks, and the other group received platinum-based chemotherapy supplemented with consolidation therapy of orally administered icotinib (125 mg thrice daily) two weeks after chemotherapy. The icotinib treatment continued for four to eight months, or until the occurrence of disease relapse, metastasis or unacceptable icotinib or chemotherapy toxicity. The primary endpoint was disease-free survival (DFS).

Results: 41 patients were enrolled between Feb 9, 2011 and Dec 17, 2012. 21 patients were assigned to the combined chemotherapy plus icotinib treatment group, while 20 patients received chemotherapy only. DFS at 12 months was 100% for icotinib-treated patients and 88.9% for chemotherapy-only patients (p = 0. 122). At 18 months DFS for icotinib-treated vs. chemotherapy-only patients was 95.2% vs. 83.3% (p = 0. 225), respectively, and at 24 months DFS was 90.5% vs. 66.7% (p = 0. 066). The adverse chemotherapy effects predominantly presented as gastrointestinal reactions and marrow suppression, and there was no significant difference between the two treatment groups. Patients in the chemotherapy plus icotinib treatment group showed favorable tolerance to oral icotinib.

Conclusions: The results suggest that chemotherapy plus orally icotinib displayed better DFS compared with chemotherapy only, yet the difference in DFS was not significant. We would think the preliminary result here was promising, and further trials with larger sample sizes might confirm the efficiency of adjuvant TKI in selected patients.

Trial Registration: ClinicalTrials.gov NCT02430974.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0140794PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4608803PMC
June 2016

Unidirectionally progressive resection of left upper pulmonary lobe under video-assisted thoracoscopy.

J Thorac Dis 2014 Dec;6(12):1843-7

Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.

The case is a nodule in the upper left lobe, and intraoperative frozen section pathological diagnosis on the removed nodule confirmed well differentiated mucinous adenocarcinoma. Unidirectionally progressive resection of the left upper pulmonary lobe under video-assisted thoracoscopy is selected as the surgical method. Right below the operation hole, surgeons gradually advanced in one direction, and dissociated and divided in such order: the upper left pulmonary vein, the upper left lobe bronchus, the upper left pulmonary arterial branches and the fissures. Endoscopic linear cutters and hem-o-lok clip applicator were used to deal with the blood vessels, bronchus, and under-differentiated fissures. At last, the removed upper left lobe was put into a size eight sterile glove and taken out through the main operation hole. General anesthesia with double-lumen endotracheal intubation is used. The patient took a 90 degree decubitus on his contralateral side. The surgeons were on the ventral side of the patient, and operated with endoscope apparatus under the monitor.
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http://dx.doi.org/10.3978/j.issn.2072-1439.2014.12.26DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4283315PMC
December 2014

Unidirectionally thoracoscopic resection of lingual segment of the left upper pulmonary lobe.

J Thorac Dis 2014 Sep;6(9):1358-63

1 Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China ; 2 Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.

A patient with adenocarcinoma in situ was reported to undergo unidirectionally thoracoscopic resection of lingual segment of the left upper pulmonary lobe and lymphadenectomy in the order of the lingual segmental vein, the lingual segmental bronchus, the lingual segmental artery, and the pulmonary tissues of the lingual segment in turn. As the concepts of adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) are defined in the latest international classification of lung adenocarcinoma, pulmonary segmentectomy has been initially used in some multi-center clinical studies to treat these early lung cancer lesions. Pulmonary segmentectomy is currently one of the most minimally invasive lung surgeries, with its unique technical essentials different from those of pulmonary lobectomy. Some studies have shown that pulmonary segmentectomy for early lung cancer, especially for tumors with a diameter of less than 2 cm can achieve a similar long-term survival rate as pulmonary lobectomy, yet its effectiveness and safety should be confirmed in further large-scale prospective studies.
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http://dx.doi.org/10.3978/j.issn.2072-1439.2014.08.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4178103PMC
September 2014

Unidirectionally progressive left pneumonectomy & mediastinal lymph node dissection.

J Thorac Dis 2013 Dec;5(6):886-91

Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.

The patient has lower left lung tumor and adenocarcinoma at the openings of both upper and lower left lung. Preoperative bronchoscopic biopsy has confirmed the diagnosis. The surgical approach is unidirectionally progressive left pneumonectomy + mediastinal lymph node dissection. The layers of structure are treated one after another until the fissure from a single direction through the working port. Hence, the resecting order should be left superior pulmonary vein-left lower pulmonary vein-left main bronchus-left pulmonary artery. The vessels and bronchi are cut using an endoscopic linear stapler or the Hemolock clips. The resected lobe is placed into a large-size specimen bag and retrieved through the working port to prevent contamination of the chest incision by any tumor tissue. Mediastinal lymph node dissection is performed at the end. The surgery is performed under general anesthesia with double-lumen endotracheal intubation. The patient is placed in a 90-degree position lying on the unaffected side. Similar to traditional resection of left lung lobes, an approximately 1.5-cm observation port is created in the 7th intercostal space between the middle and anterior axillary lines, an approximately 4-cm working port in the 4th intercostal space between the anterior axillary line and the midclavicular line, and an approximately 1.5-cm auxiliary port in the 9th intercostal space between the posterior axillary line and the subscapular line. The operator stands in front of the patient, manipulating the endoscopic instruments while watching the monitor.
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http://dx.doi.org/10.3978/j.issn.2072-1439.2013.11.36DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3886847PMC
December 2013