Clinical patterns and treatment outcome in resected elderly lung cancer patients.

PURPOSE: Lung cancer is the leading cause of cancer related morbidity and mortality worldwide. The aim of this study was to determine the clinical patterns and their impact on surgical resection in patients with non-small cell lung cancer (NSCLC)> 70 years. METHODS: We reviewed the records of 2050 resected lung cancer patients in a 5-year period from 2002-2007, out of whom 93 were > 70 years. RESULTS: There were 73 males and 20 females with median age of 71 years (range 70-78). Nineteen (20.43%) patients underwent pneumonectomy, 6 (6.45%) extended pneumonectomy, 54 (58.06%) lobectomy, 8 (8.61%) extended lobectomy, and 3 (3.23%) bilobectomy and wedge resection each. There were 37 (39.8%) resected patients with locally advanced (IIIA, IIIB) or advanced stage (IV) of NSCLC. A total of 48 complications occurred. The 30-day mortality rate was 1.08% (one patient). Pathological stage (p<0.001) and application of adjuvant therapy (p<0.001) were predictors of long-term survival. The overall 3- and 5-year actuarial survival rates were 46% and 28%, respectively. CONCLUSION: Advanced age should not be considered as a contraindication for NSCLC resection. However, careful preoperative assessment must be undertaken. The presence of comorbidities and extent of resection predict increased operative risk. Pathological stage and application of adjuvant therapy were the only predictors of long-term survival.

Gender and age trends of histological types of lung cancer in a 20-year period: pathological perspective.

PURPOSE: To find out the trends of distribution in different histological types of lung cancer in both genders in a period of 20 years. METHODS: The most frequent histological types of lung cancer in tissue specimens obtained by bronchoscopy or percutaneous needle biopsy were analysed in terms of age and gender. The studied population included 6289 patients (16.6% females and 83.1% males). Statistical significance was established by x(2) test at the level p<0.05. RESULTS: Squamous cell carcinoma (SCC) prevailed in the total number of patients in all investigated years (58.0%), and separately in male (60.4%) and female (45.7%) patients. This histological type was predominant in all age groups in both genders (41.6% in males and 38.1% in females). CONCLUSION: SCC has the highest incidence in Serbia. Continuous campaign against smoking and helping its cessation, improving working and socioeconomic conditions is a strategy for decreasing all histological types of lung cancer patients.

[Radiologic manifestation of primary pleural tumors].

OBJECTIVES: To show the radiological manifestations of primary pleural tumors. PATIENTS AND METHODS: we carried out a retrospective analysis of radiological findings in 62 patients with primary malignant tumor of pleura. RESULTS: Study included 39 male and 23 female patients. Malignant tumors were present in 92.7% of the patients and benign ones in 7.2%. The most common malignant tumor was mesothelioma (85.4%), and solitary fibrous tumor prevailed among benign tumors (9.7%). Diffuse malignant mesothelioma manifested on computed tomography (CT) as a pleural thickening and effusion in 67.4% of the patients, tumors and effusion in 11.7%, and only as an effusion in 9.8% cases. Thickening of the pleura appeared diffuse in 54% of patients and most often it had nodular pattern. Both localized malignant and all benign tumors presented as tumor-like changes with the signs of necrosis in 50%. CONCLUSION: The imaging methods have a key role in the diagnosis of pleural tumors. CT shows different morphologic features of pleural lesions that have been established as a useful tool for differentiating malignant from benign disease. However, magnetic resonance is preferred imaging method for assessing the extent and resectability of pleural tumors.

Diagnostic procedures of pleural malignant mesothelioma: our experience.

PURPOSE: The morphology of the epithelioid malignant mesothelioma (MM) of the pleura is similar to lung adenocarcinoma involving pleura. The aim of this study was to evaluate the value of immunohistochemistry in the accurate diagnosis of MM, especially of the epithelioid type with needle biopsy of the pleura. MATERIALS AND METHODS: The diagnosis of MM was established with pleural needle biopsy and tumor immunophenotyping in 30 patients. A broad spectrum of monoclonal antibodies was applied: HBME-1, E-cadherin, calretinin, cytokeratin 5/6, vimentin, thyroid transcription factor (TTF-1) and surfactant apoprotein A (SP-A). RESULTS: We diagnosed 24 epithelioid, 2 biphasic and 4 sarcomatoid MM. HMBE-1 was the most sensitive tumor marker of the epithelioid type, being positive in 100% of the cases. Calretinin, E-cadherin and cytokeratin 5/6 were positive in 70%, 73%, and 50% of all tumors, respectively. TTF-1 and SP-A were negative in all MM. Vimentin was positive in spindle cells of all sarcomatoid and biphasic MM (20%). CONCLUSION: The accurate diagnosis of MM is mandatory for appropriate treatment decision (surgical or nonsurgical). Our results demonstrate that HMBE-1 is a most useful diagnostic antibody for epithelioid MM, and TTF-1 for lung adenocarcinoma (its thyroid origin excluded) involving pleura.