The value of tumor volume in surgically resected non-small cell lung cancer.

BACKGROUND: The aim of this study was to evaluate whether or not tumor volume (TV) has an impact on survival in non-small cell lung cancer. METHODS: In a retrospective analysis of 385 cases with NSCLC who underwent curative surgery between 1994 and 2003, we calculated the tumor volume by using an ellipsoidal formula. The patients were grouped according to TV as determined by histograms. Gender, age, histology, nodal involvement, size, and TV were analyzed. Multivariate analysis by Cox's proportional hazards regression model was performed to identify the prognosis. RESULTS: Cases of N0 showed a significantly lower TV than cases with other N statuses (p < 0.05). A significant difference was also observed between TV and histology or gender. The 189 patients belonging to the small volume group (SVG) (range, 0.105 to 9.265 cm3) had a significantly better overall survival rate than the other 196 patients in the large volume group (LVG) (9.266-366.522 cm3). With univariate analysis, gender, age, nodal involvement, size, and TV were significantly associated with prognosis. Multivariate analysis showed that only gender (p = 0.0184) and nodal involvement (p = 0.0001) were significantly independent prognostic factors. The size factor was not significant (p = 0.5285). However, TV was not an independent factor, but trending toward significance (p = 0.0801). CONCLUSIONS: Although TV provides no independent prognostic information with multivariate analysis, TV in NSCLC should be considered using volumetric measurement with a three-dimensional CT approach prior to surgery or treatment planning.

Prognostic significance of subcarinal station in non-small cell lung cancer with T1-3 N2 disease.

BACKGROUND: Surgical resection may continue to offer the best chance of long-term survival for patients with non-small cell lung cancer (NSCLC). Generally, patients with N2 NSCLC have a poor prognosis. However, the surgical treatment of patients with N2 remains controversial as in these patients, some N2 subgroups have better prognoses than others. The objective of the current study was to evaluate the factors associated with N2, and to determine whether such factors are reliable predictors of survival. METHODS: We retrospectively reviewed 142 non-small cell lung cancer patients with T1-3 N2 in whom a curative approach had been attempted between January 1994 and December 2003. The patients were consequently divided into four groups (NS-1, no subcarinal involvement and without N1; NS-2, no subcarinal involvement and with N1; SI-1, subcarinal involvement and without upper mediastinal site; SI-2, subcarinal involvement and with upper mediastinal site). We also evaluated two groups for N2 stations (single-station N2 versus multiple-station N2). Multivariate analysis by Cox's proportional hazards regression model was performed to identify the prognosis. RESULTS: Lobectomy was carried out in 105 of the patients; bilobectomy in 10, and pneumonectomy in 27. The patients with T1-3 N2 disease showed survival rates of 34.1 % at 3 years and 24.1 % at 5 years. The overall survival rates at 3 years and 5 years were as follows: NS-1, 56.3 % and 43.2 %; NS-2, 35.4 % and 29.5 %; SI-1, 16.7 % and 0 %; SI-2, 15.4 % and 0 %, respectively. The NS-1 group had better prognoses than the other groups. There was a significant difference in survival rates within each group ( p = 0.0005). In univariate analysis, the type of surgery, type of subcarinal involvement, and multiple-station N2 were significantly associated with prognosis. Multivariate analysis showed that NS-1 was only found to be an independent prognostic factor in cases of T1-3 N2 disease ( p = 0.0018). NS-2 was not an independent factor but tended toward significance ( p = 0.0681). But multiple-station N2 was not an independent factor ( p = 0.1549). CONCLUSIONS: Surgery for patients with T1-3 N2 NSCLC might be acceptable if subcarinal lymph node metastasis is predicted to be absent.

[Surgical treatment for primary non-small cell lung cancer with synchronous brain metastases].

The brain is one of the most common sites of metastasis from lung cancer. The strategies of treatment for non-small cell lung cancer patient with synchronous brain metastases (stage IV) is controversial. We evaluate retrospectively the effectiveness of surgical treatment for these patients. Forty patients were divided into 3 groups on the basis of surgical treatment, group A of patients received both lung and brain resection, group B of patients received lung resection plus gamma knife therapy, group C of patients received brain resection. Median survival from the date of diagnosis of brain metastasis was as follows: group A 331 days, group B 151 days and group C 92 days. Univariate analysis revealed that adenocarcinoma histology and serum LDH significantly affected survival. Multivariate analysis found that only adeocarcinoma histology also affected the survival. It is concluded that surgical treatment may acceptable in selected group of non-small cell lung cancer patients with synchronous brain metastases.

Surgical treatment for lung cancer with COPD based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD).

OBJECTIVE: The surgical indications for non-small cell carcinoma (NSCLC) with chronic obstructive pulmonary disease (COPD) are not well known. A classification of severity in COPD has been newly recommended by the US National Heart, Lung, and Blood Institute (NHLBI) and the World Health Organization (WHO). Therefore, based on this new system of classification, we review here a series of NSCLC patients with COPD who underwent lung resection at our hospital and attempt to identify the survival and morbidity of such patients. METHODS: We retrospectively reviewed the patients with NSCLC treated at our hospital between January 1994 and December 2002. Among these 640 patients, a curative approach was attempted in 50 with COPD (31 lobectomies, 11 segmentectomies, 8 bilobectomies). The patients were consequently divided into two groups (moderate group and severe group) according to the Global Iinitiative for Chronic Obstructive Lung disease (GOLD). Lung function was evaluated by FEV1 and FVC, and the survival rates were analyzed at 5 years. Postoperative morbidity was also compared between the two groups. RESULTS: FEV1 was 1.527 +/- 0.311 L in the moderate group compared with 1.025 +/- 0.224 L in the severe group ( p < 0.001). Postoperative decrease in FEV1 was lower compared to the predicted data of patients who underwent surgery for NSCLC with COPD. Postoperative pulmonary support such as mechanical ventilation or tracheotomy were necessary more frequently in the severe group. A significant difference was observed between the two groups in respiratory support ( p = 0.0102). Overall 5-year survival rate for NSCLC with COPD was 73.9 %, although there was no statistically significant difference between the moderate and severe groups in terms of survival. Lobectomy and segmentectomy show a remarkable advantage for the patients with bilobectomy, although this difference was not statistically significant. On the other hand, gender, degree of COPD, and histological type were shown to be not significant factors. Survival rate of these NSCLC patients with COPD were demonstrated to be comparable to those of the NSCLC patients without COPD in stages I and II. CONCLUSION: Stringent selection of candidates among NSCLC patients with a severe grade of COPD based on GOLD could be an acceptable and valuable approach compared to conventional patients without COPD, although NSCLC with severe COPD patients more frequently needed respiratory support.

Micropapillary pattern: a distinct pathological marker to subclassify tumours with a significantly poor prognosis within small peripheral lung adenocarcinoma (

AIMS: A micropapillary pattern (MPP) in lung adenocarcinoma, characterized by papillary structures with epithelial tufts lacking a central fibrovascular core, has been reported to be a new pathological marker of poor prognosis. However, its clinicopathological and prognostic significance in small lung adenocarcinomas (

Results of surgical treatment for non-small cell lung cancer of 20 mm or less in diameter.

BACKGROUND: Surgical efficacy is still unsatisfactory for small lung cancer; accordingly, minimal resection has recently been the focus of increased study. The objective of the current study was to evaluate the factors associated with small lung cancer, and to determine whether such factors are reliable predictors of long-term survival. METHODS: We retrospectively investigated 130 patients with histologically confirmed non-small cell carcinoma, whose treatments were primarily surgical, with no chemotherapy or radiotherapy prior to surgery. All tumors were located peripherally and were less than 20 mm in diameter. Follow-up was performed for five-year and eight-year survivors and multivariate analysis with Cox's proportional hazards regression model was performed. RESULTS: Of all 130 patients, the 5-year survival rate among patients with tumors less than 15 mm was 82.5 %, vs. 57.4 % of patients with tumors with a diameter of 16 - 20 mm. The 5-year survival rate of patients who were node negative was 73.9 % while it was 28.5 % for node-positive patients. Status of nodal invasion was also significantly associated with survival in small-size tumors ( p < 0.0001). Furthermore, the 5-year survival rate among patients with pleural involvement was 55 % vs. 83.8 % for patients without pleural involvement. Using multivariate Cox analysis, lymph node involvement ( p = 0.0004), size ( p = 0.0475), and pleural invasion ( p = 0.0482) were found to be independent prognostic factors in cases of tumors 20 mm or less in diameter. CONCLUSIONS: The results of this study at least demonstrate that the optimal therapy for patients with nodal involvement or patients with tumors of 16 - 20 mm must be carefully determined even in cases of small lung cancer.