Surgical Outcomes of Patients With Stage III Thymoma in the Japanese Nationwide Database.

BACKGROUND: To investigate the clinical characteristics and therapeutic outcomes of patients who underwent surgery for stage III thymoma in Japan. METHODS: Using the Japanese nationwide database, which contains the records of 2,835 patients with thymic epithelial tumors who underwent treatment between 1991 and 2010, we extracted and analyzed the records of those who underwent surgery for stage III thymoma. RESULTS: A total of 310 patients (170 males, 140 females; median age, 58 years) were analyzed. Involved sites were the lung in 194 (62.6%), the pericardium in 151 (48.7%), the great vessels in 126 (40.6%), the phrenic nerve in 84 (27.1%), and the chest wall in 7 (2.3%). Complete resection (R0) was achieved in 247 (79.7%) cases. Induction therapies were administered to 42 (13.5%) patients, and postoperative therapies were administered to 147 (47.4%). In R0 cases, 68 (27.5%) experienced recurrence. The pleural space was the most frequent site of recurrence (46; 18.6%). The 10-year overall and disease-free (in R0) survival rates were 80.2% and 51.6%, respectively. Multivariate analyses revealed that age (p = 0.002), male sex (p = 0.017), induction therapy (p < 0.001), and type B histology (p = 0.037) were independent adverse predictors for overall survival. Chest wall invasion was the only independent adverse predictor for disease-free survival, although the factor analysis was marginal for overall survival. CONCLUSIONS: The outcomes of surgery for patients with stage III thymoma were favorable unless chest wall invasion was present; however, the role of complete resection and appropriate multimodal treatment plan require further investigation.

Proposal of a new prognostic staging system for pulmonary metastases from colorectal cancer.

PURPOSE: The aim of this retrospective study was to establish a new prognostic staging system for pulmonary metastases from colorectal carcinoma (CRC). METHODS: The baseline characteristics and outcomes on 352 CRC patients who underwent complete pulmonary resection were collected from 19 institutions by the Japanese Society for Cancer of the Colon and Rectum (JSCCR) Study Group (group A). The clinical and pathological factors were entered into a multivariate analysis to identify independent variables that were helpful for accurately predicting the long-term prognosis after pulmonary resection. Using the selected variables in group A, we developed a new prognostic staging system (PSS). The new PSS was examined in a validation study in a series of 841 patients from 110 institutions of the JSCCR by the 78th society of the JSCCR (group B). RESULTS: We evaluated four variables selected in the multivariate analysis: the number of pulmonary metastases, the distribution, the disease-free interval and the lymph node metastases of primary cancer in group A. Using these four variables, we developed a new PSS. This PSS was found to significantly predict the prognosis in group B. CONCLUSIONS: Our new PSS was useful for the selection of patients suitable for pulmonary resection.

Prognostic factors in patients undergoing complete resection of pulmonary metastases of colorectal cancer: a multi-institutional cumulative follow-up study.

PURPOSE: The aim of this retrospective study was to establish the prognostic factors for overall survival after pulmonary resection for lung metastases of colorectal carcinoma (CRC). METHODS: The baseline characteristics and outcomes of 266 CRC patients undergoing complete pulmonary resection were collected from 19 institutions by the Japanese Society for Cancer of the Colon and Rectum (JSCCR) Study Group. We used the Cox proportional hazard regression to identify independent prognostic factors for OS. RESULTS: The 5-year overall survival rate of patients undergoing complete resection of isolated pulmonary metastases was 56.5 %. The independent unfavorable prognostic factors after pulmonary resection included stage T4 (p = 0.0004) and N2 (p = 0.0082) as primary cancer-related factors, and more than three metastases (p = 0.0342), bilateral distribution (p = 0.0450), metastatic disease-free interval (DFI) of less than 2 years (p = 0.0257), and a preoperative carcinoembryonic antigen (CEA) level greater than 5.0 ng/mL (p = 0.0209) as pulmonary metastases-related factors. CONCLUSIONS: This retrospective analysis suggested that the indications for pulmonary resection of CRC metastases should be decided not only by the status of lung metastases, but also by pulmonary-related factors such as the T and N stage of the primary lesion, preoperative CEA level, and the DFI.

[Case of loxoprofen sodium-induced eosinophilic pneumonia that occurred ipsilaterally after VATS lobectomy for lung cancer].

A 76-year-old man was admitted because of dry cough and dyspnea two weeks after VATS lobectomy for lung cancer. Chest radiographs and computed tomography showed interstitial shadows in the only operative lung side. Although antibiotic drugs were given because we believed it to be postoperative pneumonia, abnormal shadows on chest radiographs increased. A bronchoalveolar lavage fluid (BALF) study performed on the 21" day after operation showed that the proportions of eosinophils, basophils and mast cells had increased, and the CD4/CD8 ratio was 4.42. The drug lymphocyte stimulation test for loxoprofen sodium was positive. Based on the clinical course, laboratory data and BALF study, we arrived at a diagnosis of drug-induced pneumonia caused by loxoprofen sodium. Treatment with corticosteroid resulted in marked improvement of the chest radiographs and clinical findings. Drug-induced pneumonia usually occurs bilaterally, but it occurred only on the operative side in this case. Although rare, it is important to recognize that unilateral drug-induced pneumonia is one of the differential diagnose of postoperative pneumonia.

Accuracy of PET for diagnosis of solid pulmonary lesions with 18F-FDG uptake below the standardized uptake value of 2.5.

UNLABELLED: Benign and malignant pulmonary lesions usually are differentiated by 18F-FDG PET with a semiquantitative 18F-FDG standardized uptake value (SUV) of 2.5. However, the frequency of malignancies with an SUV of <2.5 is significant, and pulmonary nodules with low 18F-FDG uptake often present diagnostic challenges. METHODS: Among 360 consecutive patients who underwent 18F-FDG PET to evaluate pulmonary nodules found on CT, we retrospectively analyzed 43 who had solid pulmonary lesions (excluding lesions with ground-glass opacity, infiltration, or benign calcification) with an SUV of <2.5. The uptake of 18F-FDG was graded by a visual method (absent, faint, moderate, or intense) and 2 semiquantitative methods (SUV and contrast ratio [CR]). Final classification was based on histopathologic findings or at least 6 mo of clinical follow-up. RESULTS: We found 16 malignant (diameter, 8-32 mm) and 27 benign (7-36 mm) lesions. When faint visual uptake was the cutoff for positive 18F-FDG PET results, the receiver-operating-characteristic (ROC) analysis correctly identified all 16 malignancies and yielded false-positive results for 10 of 27 benign lesions. Sensitivity was 100%, specificity was 63%, and the positive and negative predictive values were 62% and 100%, respectively. When an SUV of 1.59 was the cutoff for positive 18F-FDG PET results, the ROC analysis revealed 81% sensitivity, 85% specificity, and positive and negative predictive values of 77% and 89%, respectively. At a cutoff for positive 18F-FDG PET results of a CR of 0.29, the ROC analysis revealed 75% sensitivity, 82% specificity, and positive and negative predictive values of 71% and 85%, respectively. The areas under the curve in ROC analyses did not differ significantly among the 3 analyses (visual, 0.84; SUV, 0.81; and CR, 0.82). Analyses of intra- and interobserver variabilities indicated that visual and SUV analyses were quite reproducible, whereas CR analysis was poorly reproducible. CONCLUSION: These results suggested that for solid pulmonary lesions with low 18F-FDG uptake, semiquantitative approaches do not improve the accuracy of 18F-FDG PET over that obtained with visual analysis. Pulmonary lesions with visually absent uptake indicate that the probability of malignancies is very low. In contrast, the probability of malignancy in any visually evident lesion is about 60%.

Increased thymocyte CD4+CD8+ cells and T-cell receptor beta gene rearrangements in thymoma.

Epithelial cells in thymoma and thymic carcinoma may influence T-cell development in the tumor. In this study, we investigated the cell surface phenotype and T-cell receptor (TCR) gene rearrangement of thymocytes in thymic tumors. TCR rearrangement was observed in all cases of thymoma (A, AB, B1-2). A faint band in each digestion suggested the deletion between D1 to C1 or D1 to J2, and an additional rearrangement band with BamHI suggested the rearrangement between D1 to J1. High percentages of CD1+ cells and CD4+CD8+ (DP) cells were detected in all cases of thymoma (A, AB, B1-2). There are two kinds of cell surface phenotypes increased in populations of thymoma; one is increased DP cells and the other is a relatively low percentage of DP cells accompanied by a relatively high percentage of CD3+CD69+ cells. These findings suggest that thymocytes in thymoma are derived from immature T-cell expansion.

[A case of Paragonimus miyazakii with migrating infiltrates: use of ELISA in diagnosis and treatment].

A 47-year-old man was referred to our clinic with abnormal chest radiographs. He was free of symptoms, but his chest CT demonstrated transient migrating infiltrates. Peripheral blood revealed eosinophilia and eosinophilic pneumonia was suspected. However, the bronchoalveolar lavage fluid showed no increase in eosinophils. Later, the patient's pleural effusion did contain eosinophils. His total IgE level was continuously elevated despite the absence of allergic disease, and so parasitic infection was suspected. Ouchterlony's double diffusion test after absorption of Paragonimus westermanii antigen was positive for Paragonimus miyazakii antigen. The ELISA values of both serum sample and pleural effusion were increased. As the ELISA value of the pleural effusion was higher than the serum one, we realised that pleural effusion was caused by Paragonimus miyazakii. Treatment with praziquantel for 3 days resulted in disappearance of the abnormal chest radiographic findings, and a reduced blood eosinophil level, IgE level and ELISA titre for Paragonimus miyazakii. We concluded that ELISA was useful in the diagnosis and assessment for treatment in Paragonimus miyazakii infections although there was no clearly relevant history.