ABSTRACT
OBJECTIVE: A solitary pulmonary lesion in patients with a history of malignancy may be either primary lung cancer or a metastatic lung tumor or benign nodule. We retrospectively examined the preoperative predictive factors for determining the type of pathology. METHODS: We used an exact logistic regression analysis to identify radiological and clinical predictors of primary lung cancer. The study included 187 patients who underwent pulmonary resection for a solitary pulmonary lesion and had received previous treatment for a malignancy. RESULTS: There were 107 patients with primary lung cancer, 74 with metastatic lung tumors, and 6 with benign lesions. The previous malignancy included colorectal cancer in 71 patients. A disease-free interval exceeding 5 years and ground-glass opacity were found in 27.0% (20/74) and 1.4% (1/74) of metastatic lung tumors, respectively. Multivariate logistic regression analysis demonstrated that spiculation [adjusted odds ratio (a-OR), 1.74; 95% confidence interval (CI), 1.09-2.86], pleural indentation (a-OR 1.99, 95% CI 1.24-3.29), and ground-glass opacity (a-OR 5.28, 95% CI 2.61-13.1) on high-resolution computed tomography, maximum standardized uptake value (a-OR 1.14, 95% CI 1.02-1.29), current and former smokers (a-OR 1.96, 95% CI 1.21-3.30), and previous malignancy other than colorectal cancer (a-OR 2.02, 95% CI 1.26-3.37) were associated with primary lung cancer. CONCLUSIONS: A combination of radiological findings, smoking history, and type of previous malignancy can improve the ability to predict primary lung cancer in the presence of a solitary pulmonary lesion that appears after previous treatment for a malignancy.
Subject(s)
Colorectal Neoplasms/pathology , Lung Neoplasms/diagnosis , Lung/diagnostic imaging , Neoplasm Staging , Neoplasms, Multiple Primary/diagnosis , Positron Emission Tomography Computed Tomography/methods , Solitary Pulmonary Nodule/diagnosis , Aged , Biopsy , Diagnosis, Differential , Female , Humans , Lung Neoplasms/secondary , Lung Neoplasms/surgery , Male , Neoplasm Metastasis , Pneumonectomy , Prognosis , Retrospective Studies , Solitary Pulmonary Nodule/surgeryABSTRACT
OBJECTIVE: To identify the predictors for the resumption of oral feeding at discharge among tube feeding-dependent stroke patients admitted to rehabilitation wards. MATERIALS AND METHODS: This study was a retrospective analysis of 107 stroke patients (mean age, 72.1 years) dependent on tube feeds at admission to a rehabilitation ward. Data analyzed included demographic information, severity of impairments, functional independence, body mass index, nutritional and inflammatory laboratory markers at admission, and videofluoroscopic examination findings, if conducted. The variables were compared between the groups with and without resumption of oral intake. The predictive factors for resumption of oral intake were analyzed by using a stepwise multiple logistic regression model. RESULTS: At discharge, 69.2% (74 of 107) of the patients resumed oral intake. There were significant differences in age, the Functional Independence Measure, body mass index, serum albumin, C-reactive protein, white blood cell count, and duration of stroke onset at admission between the 2 groups. Multiple logistic regression analysis identified age (odds ratio [OR] .55; 95% confidence interval [CI] .31-.95), body mass index (OR 1.34; 95% CI 1.12-1.60), and white blood cell count (OR .76; 95% CI .60-.97) as significant predictors for the resumption of oral intake in these patients. CONCLUSION: Older age, lower body mass index, and higher white blood cell count were significant independent negative predictors for the resumption of oral feeding among stroke patients dependent on tube feeding at admission to rehabilitation wards.
