Prognostic significance of urine N1, N12-diacetylspermine in patients with non-small cell lung cancer.

BACKGROUND: Recently N(1),N(12)-diacetylspermine, a diacetylated polyamine derivative, was recognized as a tumor marker in patients with several kinds of cancers. However, the significance of its levels in urine as a prognostic factor has not been elucidated. In the present study, we examined whether the urine N(1),N(12)-diacetylspermine levels can be used as a prognostic factor in patients with NSCLC. PATIENTS AND METHODS: Urine samples from 251 patients with NSCLC were collected prior to surgery and the urinary N(1),N(12)-diacetylspermine concentration was measured. Thereafter, all 251 patients underwent curative surgery and the analysis of prognosis was performed for over 10 years. Out of the 251 patients, 91 had recurrent disease. The significance of the urinary N(1),N(12)-diacetylspermine level as a prognostic factor among all 251 patients and among the 91 patients with recurrence was evaluated. RESULTS: Univariate analysis of all 251 patients showed that the level of urinary N(1),N(12)-diacetylspermine was a significant prognostic factor for disease-free survival and overall survival; however, multivariate analysis showed it had no significance. Conversely, the univariate and multivariate analyses of post-recurrent survival of the 91 patients with recurrence showed that urinary N(1),N(12)-diacetylspermine was an independent prognostic factor for post-recurrent survival. CONCLUSION: Patients with recurrence with positive urinary N(1),N(12)-diacetylspermine should undergo more intensive care and determination of urinary N(1),N(12)-diacetylspermine may contribute to improvement of prognosis of NSCLC.

Preoperative chemoradiotherapy using cisplatin plus S-1 can induce downstaging in patients with locally advanced (stage III) non-small-cell lung cancer.

BACKGROUND: About 30% of patients with non-small cell lung cancer (NSCLC) have locally advanced cancer (stage IIIA or IIIB) at the time of presentation. Many institutions have reported treatment with preoperative chemoradiotherapy (PCRT) followed by curative resection in patients with stage III NSCLC, but the optimal therapeutic protocol for this group has not been established. PATIENTS AND METHODS: Nineteen patients with stage III NSCLC were treated with PCRT, followed by surgery at the Hamanomachi Hospital, Fukuoka, Japan from May 2000 to November 2011. We evaluated the effectiveness of PCRT for inducing downstaging using mainly three chemoradiotherapy regimens; cisplatin plus Tegafur-Gimeracil-Oteracil Potassium (S-1), cisplatin plus Tegafur-Uracil (UFT), or 1,1'cyclobutanedicarboxylate (Carboplatin, CBDCA) plus paclitaxel, with concurrent radiation therapy in 19 patients with stage III NSCLC. RESULTS: The overall 5-year survival rate was 57.1%, which is higher than the average survival rate for patients with stage III NSCLC in Japan. Among the regimens used, only cisplatin plus S-1 with concurrent radiation therapy significantly induced downstaging. There was a significant difference in survival time between the downstaged and non-downstaged groups. However, there was no significant difference in survival time between the S-1 plus cisplatin group and the other groups combined, because of the short observation period for the S-1 plus cisplatin group. CONCLUSION: PCRT using cisplatin plus S-1 with concurrent radiation therapy is useful for inducing downstaging in patients with locally advanced stage III NSCLC.

[A case of disseminated actinomycosis which extended from the thoracic cavity].

A 74-year-old man was referred to our hospital with a high grade fever, a left abdominal tumor and bloody sputum since the beginning of April 2006. We made an incision of the abdominal tumor, and the Gram-stain smear demonstrated Gram-positive rods. Actinomycosis was diagnosed because tissue culture demonstrated Actinomyces israelii. Penicillin was administered, and his clinical features improved. It is difficult to distinguish actinomycosis from malignancy or tuberculosis, therefore actinomycosis should be considered in the differential diagnosis of a mass shadow, and it can be cured with penicillin.

[First case report of respiratory infection with Rothia aeria].

A 53-year-old woman was admitted to our hospital with dysbasia and forgetfulness. Her past history included uveitis at age 39. Medical examinations led to a diagnosis of neurosarcoidosis. Although she was treated with prednisolone, her symptoms remained, so she received steroid pulse therapy twice, and administration of azathioprine. In early January 2007, a chest X-ray film showed nodules in the right upper lung that rapidly increased in size and number. A CT scan revealed multiple nodules including cavitary lesions in both lung fields. Examination of bronchial lavage fluid and a transbronchial lung biopsy showed a mycelium-like gram-negative filament. After the treatment with benzylpenicillin for 1 month, her laboratory data and radiological abnormalities markedly ima proved. However, switching to oral administration of amoxicillin caused the regrowth of the nodules. She was retreated with intravenous benzylpenicillin for 8 weeks, followed by oral administration of amoxicillin for 5 months, and her condition completely resolved. The causative organism was identified as Rothia aeria (described in 2004) by 16S rRNA gene sequencing. This is the first report of a case of pulmonary infection with this species.