Type of lymph node involvement and survival in pathologic N1 stage III non-small cell lung carcinoma.

BACKGROUND: Survival of patients with stage II non-small lung cancer by the 1986 classification depends on the type of lymph node involvement (by direct extension or by metastases in lobar or hilar lymph nodes). The influence of these types of lymph node involvement on survival was investigated in pathologic N1 stage III patients. METHODS: Of 2,009 patients having operation from 1977 through 1993, the cases of 123 patients with pathologic N1 stage III disease (80 T3 N1 and 43 T4 N1) were reviewed. The N1 status was refined by the specific type of lymph node involvement. RESULTS: The cumulative 5-year survival rate of all hospital survivors (n = 111) was 27.2%. A significant difference in mean 5-year survival rate was observed between patients who underwent complete resection and those with incomplete resection (34.4% versus 11.4%; p = 0.0001). Further analysis was performed with hospital survivors having complete resection only (n = 76). The cumulative 5-year survival rate was 34.4%. Type of lymph node involvement did not relate to survival for the group as a whole or for the T3 and T4 subsets. Survival was not related to age, histology, type of resection, or tumor size. CONCLUSIONS: Moderately good results can be obtained with surgical resection for stage III patients with pathologic N1 disease. In contrast with stage II, complete resection of pathologic N1 higher-stage non-small cell lung carcinoma is not influenced by type of lymph node involvement.

Survival in resected stage I lung cancer with residual tumor at the bronchial resection margin.

BACKGROUND: Sometimes microscopic residual tumor is found at the bronchial resection margin despite an apparently complete resection of lung cancer. This may adversely affect the patient's prognosis. Its impact on survival is unclear. METHODS: The records of 834 patients with resected stage I non-small cell lung cancer were studied. Patients with complete resection were assigned to the complete resection group (n = 802); patients with microscopic residual tumor at the bronchial resection margin that was accepted were assigned to the residual tumor group (n = 23). Residual tumor was classified as carcinoma in situ, mucosal residual disease, or peribronchial residual disease. RESULTS: The 5-year survival in the patients in the complete resection group was 54%; it was 58% in the residual tumor group with carcinoma in situ and 27.3% in the residual tumor group with invasive tumor (mucosal residual disease or peribronchial residual disease). The difference in survival between patients in the complete resection group and patients in the residual tumor group with invasive tumor was significant (p = 0.03). CONCLUSIONS: The presence of mucosal or peribronchial residual disease, but not carcinoma in situ, at the bronchial resection margin in patients with stage I non-small cell lung cancer has an adverse effect on survival.

Type of lymph node involvement influences survival rates in T1N1M0 non-small cell lung carcinoma. Lymph node involvement by direct extension compared with lobar and hilar node metastases.

Stage II non-small cell lung cancer represents a group of patients with varying 5-year survival rates. Of 2,009 patients, we reviewed 58 patients with pT1N1M0 disease operated on from 1977 through 1994. The N1 status was refined into lymph node involvement by direct extension and/or involvement by metastases (lobar or hilar). The cumulative 5-year survival of all hospital survivors (n = 57) was 45.7%. The 5-year survival of patients with N1 direct extension was superior to survival of patients with N1 metastases (68.6% vs 31.2%; p = 0.0038). Survival of patients with N1 direct extension was better then survival of patients with N1 hilar metastases (p = 0.0006), but did not differ from survival of patients with lobar metastases. Survival was not related to histologic features, sex, and type of resection. Recurrence of malignancy occurred less in patients with N1 direct extension. In patients with N1 hilar nodes, the most common pattern was distant metastases. Survival differs according to the type of lymph node involvement: "direct extension" seems to be an early stage of the disease, while lymph node metastases represent a more advanced form.

Campylobacter-associated appendicitis: prevalence and clinicopathologic features.

To determine the prevalence of Campylobacter fetus subspecies jejuni-associated appendicitis, we studied, retrospectively, by means of immunohistochemistry, the appendectomy specimens of 116 consecutive patients, operated upon because of suspected acute appendicitis. We found immunohistochemical evidence of Campylobacter fetus subspecies jejuni infection in three patients. These findings were confirmed by electron microscopy. Based upon these three cases and five additional appendectomy specimens from patients with Campylobacter enteritis diagnosed by stool cultures, the clinical and histologic picture of Campylobacter-associated appendicitis is described. It is concluded that Campylobacter infection may present with an acute appendicitis-like clinical picture. In contrast with acute phlegmonous appendicitis, the histologic abnormalities in Campylobacter-associated appendicitis are limited to the appendiceal mucosa.