Predicting Postoperative Complications and Long-Term Survival After Lung Cancer Surgery Using Eurolung Risk Score

Background@#This study aimed to assess the clinical relevance of the parsimonious Eurolung risk scoring system for predicting postoperative morbidity, mortality, and long-term survival in Korean patients with surgically resected non-small cell lung cancer. @*Methods@#This retrospective analysis used the data of patients who underwent anatomical resection for non-small cell lung cancer between 2004 and 2018 at a single institution. The parsimonious aggregate Eurolung score was calculated for each patient. The Cox regression model was used to determine the ability of the Eurolung scoring system for predicting longterm outcomes. @*Results@#Of the 7,278 patients in the study, cardiopulmonary complications and mortality occurred in 687 (9.4%) and 53 (0.7%) patients, respectively. The rate of cardiopulmonary complications and mortality gradually increased with the increase in the Eurolung risk scores (all P < 0.001). When risk scores were grouped into four categories, the Eurolung scoring system showed a stepwise deterioration of overall survival with the increase in risk scores, and this association was statistically significant (P < 0.001). Multivariate Cox analysis showed that the Eurolung scoring system, classified into four categories, was a significant prognostic factor of overall survival even after adjusting for covariates such as tumor histology and pathological stage (P < 0.001). @*Conclusion@#Stratification based on the parsimonious Eurolung scoring system showed good discriminatory ability for predicting postoperative morbidity, mortality, and long-term survival in South Korean patients with surgically resected non-small cell lung cancer. This might help clinicians to provide a detailed prognosis and decide the appropriate treatment option for high-risk patients with non-small cell lung cancer.

Prognostic Significance of Cigarette Smoking in Association with Histologic Subtypes of Resected Lung Adenocarcinoma / 대한흉부외과학회지

BACKGROUND: Smokers with lung adenocarcinoma have a worse prognosis than those who have never smoked; the reasons for this are unclear. We aimed to elucidate the impact of smoking on patients’ prognosis and the association between smoking and clinicopathologic factors, particularly histologic subtypes. METHODS: We reviewed the records of 233 patients with pathologic stage T1-4N0-2M0 lung adenocarcinomas who underwent surgery between January 2004 and July 2015. The histologic subtypes of tumors were reassessed according to the 2015 World Health Organization classification. RESULTS: In total, 114 patients had a history of smoking. The overall survival probabilities differed between never-smokers and ever-smokers (80.8% and 65.1%, respectively; p=0.003). In multivariate analyses, the predominant histologic subtype was an independent poor prognostic factor. Smoking history and tumor size >3 cm were independent predictors of solid or micropapillary (SOL/MIP)-predominance in the logistic regression analysis. Smoking quantity (pack-years) in patients with SOL/MIP-predominant tumors was greater than in those with lepidic-predominant tumors (p=0.000). However, there was no significant difference in smoking quantity between patients with SOL/MIP-predominant tumors and those whose tumors had non-predominant SOL/MIP components (p=0.150). CONCLUSION: Smoking was found to be closely associated with SOL/MIP-predominance in lung adenocarcinoma. Greater smoking quantity was related to the presence of a SOL/MIP component.

Lymph Node Metastasis after Spontaneous Regression of Non-Small Cell Lung Cancer / 대한흉부외과학회지

Spontaneous regression of lung cancer is a very rare and poorly understood phenomenon. A 64-year-old man presented to Dong-A University Hospital with a shrunken nodule in the right lower lobe. Although the nodule showed a high likelihood of malignancy on needle aspiration biopsy, the patient refused surgery. The nodule spontaneously regressed completely in the next 17 months. However, the subcarinal lymph node was found to be enlarged 16 months after complete regression was observed. We pathologically confirmed metastasis of squamous cell carcinoma and performed neoadjuvant chemotherapy, surgery, and adjuvant chemoradiation. Regardless of tumor size reduction, it is preferable to perform surgery aggressively in cases of operable lung cancer.

Prognostic Significance of Cigarette Smoking in Association with Histologic Subtypes of Resected Lung Adenocarcinoma

BACKGROUND@#Smokers with lung adenocarcinoma have a worse prognosis than those who have never smoked; the reasons for this are unclear. We aimed to elucidate the impact of smoking on patients’ prognosis and the association between smoking and clinicopathologic factors, particularly histologic subtypes.@*METHODS@#We reviewed the records of 233 patients with pathologic stage T1-4N0-2M0 lung adenocarcinomas who underwent surgery between January 2004 and July 2015. The histologic subtypes of tumors were reassessed according to the 2015 World Health Organization classification.@*RESULTS@#In total, 114 patients had a history of smoking. The overall survival probabilities differed between never-smokers and ever-smokers (80.8% and 65.1%, respectively; p=0.003). In multivariate analyses, the predominant histologic subtype was an independent poor prognostic factor. Smoking history and tumor size >3 cm were independent predictors of solid or micropapillary (SOL/MIP)-predominance in the logistic regression analysis. Smoking quantity (pack-years) in patients with SOL/MIP-predominant tumors was greater than in those with lepidic-predominant tumors (p=0.000). However, there was no significant difference in smoking quantity between patients with SOL/MIP-predominant tumors and those whose tumors had non-predominant SOL/MIP components (p=0.150).@*CONCLUSION@#Smoking was found to be closely associated with SOL/MIP-predominance in lung adenocarcinoma. Greater smoking quantity was related to the presence of a SOL/MIP component.

Lymph Node Metastasis after Spontaneous Regression of Non-Small Cell Lung Cancer

Spontaneous regression of lung cancer is a very rare and poorly understood phenomenon. A 64-year-old man presented to Dong-A University Hospital with a shrunken nodule in the right lower lobe. Although the nodule showed a high likelihood of malignancy on needle aspiration biopsy, the patient refused surgery. The nodule spontaneously regressed completely in the next 17 months. However, the subcarinal lymph node was found to be enlarged 16 months after complete regression was observed. We pathologically confirmed metastasis of squamous cell carcinoma and performed neoadjuvant chemotherapy, surgery, and adjuvant chemoradiation. Regardless of tumor size reduction, it is preferable to perform surgery aggressively in cases of operable lung cancer.

Risk Factors of On-Pump Conversion during Off-Pump Coronary Artery Bypass Graft

BACKGROUND: Off-pump coronary artery bypass grafting (OPCABG) procedures can avoid the complications of an on-pump bypass. However, some cases unexpectedly require conversion to cardiopulmonary bypass during OPCABG. The risk factors associated with a sudden need for cardiopulmonary bypass were analyzed. METHODS: This retrospective study included 283 subjects scheduled for OPCABG from 2001 to 2010. These were divided into an OPCABG group and an on-pump conversion group. Preoperative, operative, and postoperative variables were compared between the 2 groups. RESULTS: Of the 283 patients scheduled for OPCABG, 47 (16%) were switched to on-pump coronary artery bypass grafting (CABG). The mortality of the both the OPCABG and on-pump conversion groups was not significantly different. The major risk factors for conversion to on-pump CABG were congestive heart failure (CHF) (odds ratio [OR], 3.5; p=0.029), ejection fraction (EF) <35% (OR, 4.4; p=0.012), and preoperative beta-blocker (BB) administration (OR, 0.3; p=0.007). The use of intraoperative (p=0.007) and postoperative (p=0.021) inotropics was significantly higher in the conversion group. The amount of postoperative drainage (p<0.001) and transfusion (p<0.001) also was significantly higher in the conversion group. There were no significant differences in stroke or cardiovascular complications between the groups over the course of short-term and long-term follow-up. CONCLUSION: Patients who undergo OPCABG and have CHF or a lower EF (<35%) are more likely to undergo on-pump conversion, while preoperative BB administration could help prevent conversions from OPCABG to on-pump CABG.

Malignant ameloblastoma of mandible with lymph node metastasis

Ameloblastomas are generally considered to be benign tumors of odontogenic epithelial origin with high local recurrence. Rarely ameloblastomas exhibit malignant behavior with development of metastases. In this report, we present a 19-year-old woman with ameloblastoma in the right ascending ramus and multiple recurrences. Eleven years after first therapy, ameloblastoma metastasized to ipsilateral submandibular lymph node. We also review literature about cause, treatment and work-up of malignant ameloblastoma.