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Objective: To investigate the prognostic value of white blood cells detected for the first time after adjuvant chemotherapy in primary operable non-small cell lung cancer. Methods: From January 2010 to May 2016, data from 208 patients who underwent surgery for non-small cell lung cancer were retrospectively analyzed. Results: A white blood cell count detected for the first time after adjuvant chemotherapy greater than 7.00 was an independent predictor of poor disease-free survival (Hazard ratio: 1.736, 95% confidence interval: 1.267-2.378; P = .001) and overall survival (Hazard ratio: 1.802, 95% confidence interval: 1.305-2.471; P = .000). In a further study, after myelosuppression, survival analysis indicated that the patients with white blood cell counts 7.00 and increased white blood cell after chemotherapy compared to pretreatment had a poorer prognosis than patients with white blood cell ≤7.00 and no increase in white blood cell, P = .000 and P = .002, respectively. We further evaluated the prognosis of the 2 groups in different levels of white blood cell. In the group of patients with white blood cell ≤4.0, patients with chemotherapy cycles ≤2, and >2 showed no differences (Hazard ratio: 2.346, 95% confidence interval: 0.288-19.073, P = .425). In the group of patients with white blood cell of 4.0 to 7.0, the prognosis of patients with chemotherapy cycles ≤2 and patients with chemotherapy cycles >2 showed no difference (Hazard ratio: 0.560, 95% confidence interval: 0.248-1.261, P = .161). In the group of patients with white blood cell >7.0, patients with >2 chemotherapy cycles had a better prognosis than patients with chemotherapy cycles ≤2 (Hazard ratio: 0.573, 95% confidence interval: 0.338-0.971, P = .037) Conclusions: The level of white blood cells detected for the first time after adjuvant chemotherapy is an independent risk factor for non-small cell lung cancer, especially for patients with nonadenocarcinoma. In addition, the level of white blood cells after postoperative adjuvant chemotherapy and its change compared with pretreatment might also provide useful information regarding the best choice of cycles of adjuvant chemotherapy.

To evaluate the results of chest wall reconstruction (CWR) in patients who underwent chest wall tumor resection accompanying huge chest wall defect.From Jan. 1998 to Mar. 2003, 31 patients underwent CWR. Among them, 20 were male and 11 female. The age ranged from 8 to 72 years. The indications for resection were primary chest wall tumor in 21 patients, lung cancer with invasion of chest wall 6, recurrence of breast cancer 2, radiation necrosis 1 and skin cancer 1. The number of rib resected was 2-7 ribs (3.6 in average). The defect was 20-220 cm2 (97.1 cm2 in average). Concomitant resection was done in 13 patients, including lobectomy or wedge resection of lung 10, partial resection of diaphragm 2, and partial sternotomy 1. Seven patients underwent soft tissue reconstruction alone (latissimus dorsi+greater omentum, latissimus dorsi myocutaneous flap, latissimus dorsi muscle flap), 5 patients bony reconstruction alone (Prolene web), and simultaneous BR and STR were performed in 19 patients (latissimus dorsi, pectoralis major, latissimus dorsi+fascia lata, and Prolene web).Three patients (9.7%) developed postoperative complications. Postoperative survival period was 6-57 months with a median of 22 months.A favorable clinical outcome can be achieved by CWR for the patients with huge chest wall defects that result from resection of chest wall tumors.