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Abstract: Objective: To explore the diagnostic value of joint detection of soluble B7‐H4 (sB7‐H4) and carcinoembryonic antigen (CEA) in identifying malignant pleural effusion (MPE) from benign pleural effusion (BPE). Methods: A total of 97 patients with pleural effusion specimens were enrolled from The First Affiliated Hospital of Zhengzhou University between June 2014 and December 2015. All cases were categorized into malignant pleural effusion group (n = 55) and benign pleural effusion group (n = 42) according to etiologies. Enzyme‐linked immunosorbent assay was applied to examine the levels of sB7‐H4 in pleural effusion and meanwhile CEA concentrations were detected by electro‐chemiluminescence immunoassays. Receiver operating characteristic (ROC) curve was established to assess the diagnostic value of sB7‐H4 and CEA in pleural effusion. The correlation between sB7‐H4 and CEA levels was analyzed by Pearson's product‐moment. Results: The concentrations of sB7‐H4 and CEA in MPE exhibited obviously higher than those of BPE ([60.08 ± 35.04] vs. [27.26 ± 9.55] ng/ml, P = .000; [41.49 ± 37.16] vs. [2.41 ± 0.94] ng/ml, P = .000). The AUC area under ROC curve of sB7‐H4 and CEA was 0.884 and 0.954, respectively. Two cutoff values by ROC curve analysis of sB7‐H4 36.5 ng/ml and CEA 4.18 ng/ml were obtained, with a corresponding sensitivity (81.82%, 87.28%), specificity (90.48%, 95.24%), accuracy (85.57%, 90.72%), positive predictive value (PPV) (91.84%, 96.0%), negative predictive value (NPV) (79.17%, 85.11%), positive likelihood ratio (PLR) (8.614, 18.327), and negative likelihood ratio (NLR) (0.201, 0.134). When sB7‐H4 and CEA were combined to detect pleural effusion, it obtained a higher sensitivity 90.91% and specificity 97.62%. Furthermore, correlation analysis result showed that the level of sB7‐H4 was correlated with CEA level (r = .770, P = .000). Conclusions: sB7‐H4 was a potentially valuable tumor marker in the differentiation between BPE and MPE. The combined detection of sB7‐H4 and CEA could improve the diagnostic sensitivity and specificity for MPE. [ABSTRACT FROM AUTHOR]

Purpose: Delaying adjuvant chemotherapy initiation >8 weeks after radical lobectomy for non-small cell lung cancer (NSCLC) adversely affects overall survival. The effect of video-assisted thoracoscopic lobectomy (VATS) on adjuvant chemotherapy initiation is yet unclear. This study aimed to determine if using VATS for NSCLC resection affected the timing of adjuvant chemotherapy and oncological outcomes., Methods: Patients who underwent radical lobectomy for pathological stage II or IIIA NSCLC and received adjuvant chemotherapy between January 2009 and January 2016 were identified from a prospectively maintained lung cancer database. Patients were categorized according to surgical approach: open lobectomy or VATS. Patient demographics, clinicopathological data, postoperative complications, time from radical lobectomy to adjuvant chemotherapy initiation, and long-term survival outcomes were compared., Results: Age, gender, American Society of Anesthesiologists (ASA) class, comorbidity, TNM stage, and postoperative complications were similar between VATS and open cases; however, length of stay was shorter in VATS cases. No difference was observed in the proportion of patients who received adjuvant chemotherapy >8 weeks after radical lobectomy between the two groups. In the open group, a delay in adjuvant chemotherapy after radical lobectomy was associated with decreased overall survival (OS) and disease-free survival (DFS). However, delay in chemotherapy did not affect OS or DFS in the VATS group., Conclusions: The benefits of quicker recovery after VATS did not result in earlier adjuvant chemotherapy initiation in this retrospective study. However, VATS negated the inferior oncologic outcomes associated with delayed adjuvant chemotherapy initiation.