Is thymectomy necessary in nonmyasthenic patients with early thymoma?

BACKGROUND: In thymoma patients without myasthenia gravis, it is debatable whether thymectomy should be performed in addition to thymomectomy, the procedure in which the thymoma alone is resected. In this study, we proposed to compare the surgical results in early-stage nonmyasthenic thymoma patients who underwent thymomectomy with and without extended thymectomy. METHODS: A total of 95 patients without clinical evidence of preoperative myasthenia gravis, who underwent surgery for early-stage thymoma (stages I and II), were selected for the study. Thymomectomy with extended thymectomy was performed through median sternotomy on 42 patients, whereas thymomectomy without thymectomy was carried out through video-assisted thoracoscopic surgery (VATS) or thoracotomy in 53 patients. Outcomes and surgical complications were compared between the two patient groups. RESULTS: The median duration of the follow-up was 57 months (6-121 months). Three patients, one in the thymomectomy group (1.9%) and two in the thymomectomy with thymectomy group (4.5%), developed tumor recurrences. Tumor recurrence rates between the two groups were not significantly different. During the follow-up period, we did not document the development of postoperative myasthenia gravis in any of the patients enrolled. Postoperative opioid use, the number of days of drainage, and hospitalization length were lower in patients undergoing thymomectomy through thoracotomy or VATS. CONCLUSIONS: In early-stage nonmyasthenic thymoma patients, thymomectomy without thymectomy through thoracotomy or VATS was associated with lower morbidity and shorter hospitalization, than thymomectomy with extended thymectomy. Postoperative myasthenia gravis did not develop in any of the patients enrolled in our study during the 57-month median follow-up period. Overall tumor recurrence rates were not significantly different between these two patient groups. On the basis of our results, we conclude that thymomectomy without thymectomy through thoracotomy or VATS is justified for early-stage nonmyasthenic thymoma patients, and longer follow-up is needed to investigate the necessity of thymectomy in this group.

Reconstruction after esophagectomy for esophageal cancer: retrosternal or posterior mediastinal route?

BACKGROUND: The aim of this study is to investigate which reconstructive route is most appropriate for patients undergoing an esophagectomy for esophageal cancer. METHODS: Clinical data on 110 patients were retrospectively collected by reviewing their medical charts. In order to evaluate the effects of adjuvant radiotherapy, patients were interviewed about the adverse side effects they experienced during and after treatment. RESULTS: The leakage rate was significantly lower in group that received posterior mediastinal reconstruction compared with the group that received retrosternal reconstruction (7.1% vs. 39%, p = 0.01). There were no significant differences between groups in terms of side effects related to adjuvant chemoradiotherapy or radiotherapy. The quality-of-life reports of patients who received adjuvant radiotherapy were not significantly different between the two study groups. CONCLUSION: For patients with esophageal cancer who undergo an esophagectomy followed by gastric conduit reconstruction, the posterior mediastinal route is superior to the retrosternal route in regard to anastomotic leakage and hospital mortality. Adjuvant radiotherapy did not influence the postoperative functions of the gastric conduit used for reconstruction in either route.

Small cell carcinoma of the esophagus: a report of 16 cases from a single institution and literature review.

BACKGROUND: The optimum treatment for small cell carcinoma of the esophagus (SCEC) has not been established. We reviewed our experience in the management of patients with SCEC. METHODS: The clinical data from 16 patients with SCEC were retrospectively collected with regard to demographics, use of tobacco or alcohol, presenting symptoms, tumor characteristics, staging, treatment, response, outcome, and survival. RESULTS: Of the 16 patients, 4 of 8 patients with limited disease underwent curative resection followed by adjuvant chemotherapy. Three patients are still alive at 221, 75, and 34 months after treatment with no evidence of disease. The other 4 patients with limited disease received chemotherapy with or without surgery, and all died of disease within 21 months after treatment. The other 8 patients had extensive disease at presentation. One of these patients had chemotherapy followed by surgery. The prognosis for this group of patients was poor. The median survival of all patients was 13.5 months (range, 4 days to 221 months). The median survival of patients with limited disease was 20.5 months (range, 5 to 221), whereas it was 4.5 months for patients with extensive disease (range, 4 days to 44 months). CONCLUSIONS: Small-cell carcinoma of the esophagus is a rare and highly malignant tumor with dismal prognosis. The treatment strategies for SCEC varied. Systemic chemotherapy should always be part of multimodality treatment. For patients with limited disease, curative resection followed by chemotherapy can provide long-term survival and can be considered as primary treatment for select patients.

Accuracy of helical computed tomography in the detection of pulmonary colorectal metastases.

OBJECTIVE: This study assessed the sensitivity of helical computed tomography in the detection of pulmonary metastases in patients with colorectal cancer and the role of video-assisted thoracoscopic surgery in patients with pulmonary metastases. METHODS: A total of 120 operations for pulmonary metastases were performed in 91 patients with colorectal cancer. All patients received an open thoracotomy that allowed full operative inspection and palpation. Clinical data, including the size and number of pulmonary metastasis, were retrospectively collected. The difference in the number of pulmonary metastases as determined by computed tomography scan and surgical findings was determined and analyzed. RESULTS: Operative findings were consistent with the preoperative computed tomography scan reports in 64 of the 120 operations (53.3%). In 32 operations (26.7%), additional metastatic tumors were identified at open thoracotomy. The sensitivity of helical computed tomography in the detection of colorectal cancer metastatic lesions ranged from 35.5% to 95.5%. Unilateral solitary lesion demonstrated on computed tomography scan was an independent factor for the prediction of additional metastatic lesions (P = .023). CONCLUSIONS: The sensitivity of helical computed tomography scan in the detection of pulmonary metastases can reach 95.5% in patients with colorectal cancer with a solitary metastatic lesion. A unilateral solitary lesion demonstrated on preoperative computed tomography scan is an independent factor for prediction of additional metastatic lesions. If feasible, video-assisted thoracoscopic surgery may be justified in patients with colorectal cancer with solitary pulmonary metastases.

Persistently high serum carcinoembryonic antigen levels after surgery indicate poor prognosis in patients with stage I non-small-cell lung cancer.

BACKGROUND: The aim of this study is to evaluate the prognostic significance of preoperative and postoperative serum carcinoembryonic antigen (CEA) levels in patients with stage I non-small-cell lung cancer. MATERIAL AND METHODS: A retrospective review of the medical records of 257 patients with stage I lung cancer undergoing surgical resection was performed. The clinical data of each patient was collected for analysis including age, smoking habits, gender, preoperative and postoperative serum CEA levels, tumor diameter, histologic type, visceral pleural invasion, pathologic stage, and type of operation. RESULTS: Adenocarcinoma was more often associated with elevated preoperative CEA level compared with non-adenocarcinoma. Tumor histology, however, did not influence postoperative CEA levels. In the univariate analysis, age, serum CEA level, and pathologic stage were prognostic factors. Patients with normal preoperative serum CEA levels had better 5-y survival than patients with high preoperative serum CEA levels (71.1% versus 54.6%, P = 0.016). The patients with a persistently high serum CEA level after surgery had worst prognosis. Multivariate analysis demonstrated that older age (≥65) and persistently high serum CEA levels were independent significant prognostic factors in patients with stage I lung cancer. CONCLUSIONS: Age (≥65 years) and preoperative and postoperative serum CEA levels are independent prognostic factors in patients with stage I lung cancer. Patients with a persistently high serum CEA level after surgery had worst survival, and may be good candidates for adjuvant chemotherapy.

Surgical outcomes in resected non-small cell lung cancer < or = 1 cm in diameter.

BACKGROUND: The goal of this study was to investigate the prognostic factors and patterns of recurrence in patients with resected non-small cell lung cancer (NSCLC) < or = 1 cm in diameter. METHODS: We conducted a retrospective review of the clinicopathological characteristics of 71 patients with NSCLC < or = 1 cm in diameter in Taipei Veterans General Hospital between 1982 and 2007. Overall survival and its predictors were analyzed. RESULTS: Median follow-up time of the 71 patients was 33.3 months. Complete resection was performed in 68 patients (95.8%) with stage I disease. The 5- and 10-year overall survival rates of patients who underwent complete resections were 81.7% and 44.9%, respectively. There was tumor recurrence in 6 (8.8%) of these 68 patients. Five (9.3%) of 54 patients who underwent standard resection experienced tumor recurrence, but only 1 (7.1%) of 14 patients who received sublobar resection had recurrent disease. The difference was not statistically significant (p = 0.569). Multivariate analysis revealed that sublobar resection (hazard ratio, 5.00; 95% confidence interval, 1.28-20.00; p = 0.020) was a significant predictor for worse overall survival. CONCLUSION: Survival in patients with NSCLC pound 1 cm in diameter is satisfactory. Sublobar resection, performed in patients unfit for standard resection, is a poor prognostic factor for overall survival.

Prognostic factors of postrecurrence survival in completely resected stage I non-small cell lung cancer with distant metastasis.

OBJECTIVE: Distant metastasis after surgical resection is the most frequent cause of death in patients with non-small cell lung cancer (NSCLC). This study aimed to investigate the patterns of distant metastasis and the prognostic factors of postrecurrence survival in patients with resected stage I NSCLC with distant metastases. METHODS: The clinicopathological characteristics of 166 patients with distant metastases after complete resection of stage I NSCLC at Taipei Veterans General Hospital between 1980 and 2000 were retrospectively reviewed. The patients were divided into two groups according to patterns of distant metastasis (single or multiple organ metastases). Predictors of postrecurrence survival were analysed. RESULTS: The patterns of distant metastasis included single organ metastasis in 106 (63.9%) and multiple organ metastases in 60 (36.1%) patients. The 1- and 2-year postrecurrence survival rates for those with single organ metastasis were 30.2% and 15.1%, respectively. The most common site of single organ metastasis was bone (32.1%), followed by the brain (29.2%). Multivariate analysis revealed that disease-free interval >16 months (HR 0.534; 95% CI 0.288 to 0.990; p=0.046) and treatment for distant metastasis (including re-operation, chemotherapy and/or radiotherapy) (HR 0.245; 95% CI 0.089 to 0.673; p=0.006) were significant predictors of better postrecurrence survival in resected stage I NSCLC with single organ metastasis. CONCLUSIONS: A longer disease-free interval is a favourable prognostic predictor for postrecurrence survival in resected stage I NSCLC with single organ metastasis. Treatment for distant metastasis significantly prolongs postrecurrence survival.

Race of the interviewer and the black-white test score gap.

Does the race of interviewers introduce a bias in estimating the test score gap between blacks and whites in the United States? To answer this question. I use an adult sample from the General Social Survey (GSS) in which vocabulary testing involves face-to-face and one-on-one interaction between the respondent and the interviewer. I find that black respondents perform better when tested by a black interviewer as opposed to a white interviewer. For white respondents, however, the race of the interviewer does not have a significant impact on test performance. Because most black respondents are tested by white interviewers in the GSS, the test performance of black respondents is downward biased, and the black-white test score gap is overestimated.

Reduced axin protein expression is associated with a poor prognosis in patients with squamous cell carcinoma of esophagus.

AIMS: Our study investigates the significance of the expression of Wnt pathway proteins including beta-catenin, Axin, beta-transducin-repeat-containing protein (beta-TrCP), and adenomatous polyposis coli (APC) in squamous cell carcinoma of the esophagus (ESCC). METHODS: Immunohistochemical analysis was performed on paraffin-embedded tissue specimens from 128 resected ESCC tumors to detect the expression of beta-catenin, Axin, beta-TrCP, and APC. Correlation between immunoexpression, clinicopathological parameters, and patient survival was analyzed. RESULTS: Increased beta-catenin expression was noted in 22 (18.2%) of 121 tumor specimens. Reduced expression of Axin, beta-TrCP, and APC was observed in 57 (46.0%) of 124, 29 (24.4%) of 119, and 54 (48.2%) of 119 specimens, respectively. No correlation was found among these protein expressions. Axin protein expression was inversely correlated with tumor invasion depth (P = 0.033). Reduced Axin protein expression, lymph node involvement, and distant metastasis were significant negative predictors for overall survival and disease-free survival on univariate analysis. In multivariate analysis, reduced Axin expression remained a significant prognostic factor for patients with ESCC (P = 0.005). CONCLUSIONS: Reduced Axin expression was observed in 46% of ESCC tumor specimens and was associated with poor prognosis in patients with ESCC. Further study is mandatory to elucidate the underlying mechanism responsible for loss of Axin expression and the role of Axin in ESCC tumorigenesis.

Correlation of p53, MDM2 and p14(ARF) protein expression in human esophageal squamous cell carcinoma.

PURPOSE: To determine the interrelationships of p53, MDM2, and p14(ARF) protein expression in primary esophageal squamous cell carcinoma (ESCC) and their prognostic value in ESCC. METHODS: In total, 119 patients treated for ESCC with esophagectomy were enrolled in this study. Demographic and clinical data including gender, age, depth of tumor invasion, lymph node involvement, and 5-year survival rate were collected by chart review. p53, MDM2, and p14(ARF) were detected immunohistochemically in the resected tumors to evaluate their usefulness as biomarkers of clinical outcome. RESULTS: p53, MDM2, and p14(ARF) were expressed in 61 (51.3%), 34 (28.6%), and 22 (18.5%) of 119 tumor specimens, respectively. Overall, p53 protein expression was positively correlated with MDM2 (P = 0.024) and p14(ARF) expression (P = 0.026). In addition, p14(ARF) expression was most often found in specimens that were positive for both p53 and MDM2. Changes in the p53, MDM2, and p14(ARF) protein levels were not correlated with 5-year survival rate. CONCLUSIONS: Expression of p53 protein correlates with increased MDM2 and p14(ARF) protein levels in ESCC. In addition, status of p53 (wild-type versus mutant) rather than expression level of p53, MDM2, or p14(ARF) is likely to be the more critical determinant of clinical outcome.

Reduced membranous beta-catenin protein expression is associated with metastasis and poor prognosis in squamous cell carcinoma of the esophagus.

OBJECTIVES: The aim of this study was to evaluate, by immunohistochemical analysis, the protein expression of beta-catenin and p53 in resected esophageal squamous cell carcinoma specimens. The clinical relevance and prognostic significance of the expression of these proteins were also analyzed. METHODS: Immunohistochemistry was performed on paraffin-embedded tissue specimens from 68 resected esophageal squamous cell carcinoma tumor specimens to detect the expression of beta-catenin and p53. The correlation between the results of immunoexpression and the clinicopathologic parameters and patient survival was processed statistically. RESULTS: Reduced membranous beta-catenin expression was noted in 43 (63.2%) of 68 tumor specimens. Increased expression of p53 was observed in 43 (63.2%) of 68 specimens. Reduced membranous beta-catenin protein expression was associated with the presence of distant metastasis (P = .006). Patients with reduced membranous beta-catenin expression had a worse prognosis than patients with normal membranous beta-catenin expression (P = .005). Patients with combined increased p53 and reduced membranous beta-catenin protein expression had the worst prognosis (P = .012). In a multivariate survival analysis, reduced membranous beta-catenin expression and nodal involvement were independent prognostic factors (P = .004 and .019, respectively). CONCLUSIONS: Immunohistochemical analysis revealed that reduced membranous beta-catenin protein expression was associated with the presence of distant metastasis and a poor prognosis in patients with esophageal squamous cell carcinoma. Combined increased p53 and reduced membranous beta-catenin protein expression indicated a very poor prognosis in patients with esophageal squamous cell carcinoma. Further investigation is needed to understand the roles of beta-catenin and p53 in the tumorigenesis and metastasis of esophageal squamous cell carcinoma.

Effect of formalin fixation on tumor size determination in stage I non-small cell lung cancer.

BACKGROUND: Tumor size is an important prognostic factor in non-small cell lung cancer (NSCLC), but the American Joint Committee on Cancer staging system does not mandate a specific measurement method. Moreover, measuring fresh specimens and formalin-fixed specimens may yield disparate results. Our goal was to evaluate this disparity for stage I NSCLC. METHODS: We enrolled 401 patients with stage I NSCLC who underwent surgical interventions and follow-up in our hospital between 1993 and 2002. Tumors invading visceral pleura, involving the main bronchus, or associated with atelectasis or obstructive pneumonitis were excluded. Tumor size was measured immediately after resection by surgeons and after formalin fixation by pathologists. Patients were assigned to one of three groups. Group 1 included 201 patients with tumors of 3 cm or less as indicated by both operation notes and pathology reports. Group 2 included 160 patients with tumors larger than 3 cm by both records. Group 3 included 40 patients with tumors larger than 3 cm according to operation notes but 3 cm or less according to pathology reports. Survival rates were compared. RESULTS: Mean follow-up was 58 months. Five-year survival was 70.1% in group 1, 49.1% in group 2, and 51.1% in group 3. As expected, there was a significant survival difference between groups 1 and 2 (p < 0.001); however, there was also a difference between groups 1 and 3 (p = 0.006). CONCLUSIONS: Formalin fixation may cause tumor shrinkage and migration from T2 to T1. For accurate tumor staging, size measurements should be performed immediately after resection instead of after formalin fixation. TNM staging should specify how to measure tumor size and the specimen status to be measured.

Comparison of Charlson comorbidity index and Kaplan-Feinstein index in patients with stage I lung cancer after surgical resection.

OBJECTIVE: We sought to determine whether Charlson comorbidity index (CCI) or Kaplan-Feinstein index (KFI) is a better predictor of prognosis in patients with stage I NSCLC after surgical resection. METHODS: A retrospective study of medical records of 426 patients with stage I lung cancer having complete surgical resection from 1995 to 2000 was performed. Data collected included age, gender, smoking history, resection type, pleural invasion status, and tumor type and size. Comorbidity score was determined using Charlson comorbidity index and Kaplan-Feinstein index. Both univariate and multivariate analyses were used to evaluate prognostic factors. RESULTS: Three hundred and twenty-eight male (76.99%) and 98 female (23.01%) patients had a mean age of 67.07 years (range 19-88 years). Median duration of follow-up was 60.32 months. Total follow-up rate was 95.1%. Distribution of CCI score was: 0, 236 (55.40%); 1, 112 (26.29%); >or=2, 78 (18.31%). Overall KFI score was: none, 247 (57.98%); mild, 126 (29.58%); moderate, 43 (10.09%); and severe, 10 (2.35%). In univariate analyses, patients aged>or=65 years, male, smokers, CCI score>or=2, extensive resection and pathological stage IB cancer had poorer 5-year survival. In multivariate logistic regression analysis, age>or=65 years, pneumonectomy, CCI score>or=2, and stage IB cancer were independent prognostic factors for poorer 5-year survival. CONCLUSIONS: Patients with CCI>or=2 had higher perioperative mortality and death from non-cancer causes after surgery compared to patients with CCI<2. However, KFI score had no impact on operative mortality and non-cancer death during follow-up.

Prognostic factors in resected stage I non-small cell lung cancer with a diameter of 3 cm or less: visceral pleural invasion did not influence overall and disease-free survival.

OBJECTIVE: Resection is the treatment of choice for patients with stage I non-small cell lung cancer. Stage I non-small cell lung cancer has been further subdivided into IA (T1N0M0, tumor size < or = 3 cm without visceral pleural invasion) and IB (T2N0M0, tumor size > 3 cm or any size with visceral pleural invasion). The aim of this study was to evaluate the prognostic factors in patients with resected stage I non-small cell lung cancer with a diameter of 3 cm or less. METHODS: We retrospectively reviewed the clinicopathologic characteristics of 445 patients with resected stage I non-small cell lung cancer with a diameter of 3 cm or less who were treated at Taipei Veterans General Hospital between 1980 and 2000. Disease-free survival, overall survival, and their predictors were analyzed. RESULTS: The 5- and 10-year overall survivals were 61.4% and 40.0%, respectively. The 5- and 10-year disease-free survivals were 74.5% and 73.4%, respectively. Tumor size, smoking index, and number of mediastinal lymph nodes dissected were significant predictors for both disease-free survival (P = .009, P = .002, and P = .006, respectively) and overall survival (P = .004, P < .001, and P = .001, respectively) in multivariate analyses. Visceral pleural invasion did not influence overall survival or disease-free survival. CONCLUSIONS: Tumor size, smoking index, and number of mediastinal lymph nodes dissected were prognostic factors for both overall survival and disease-free survival in resected stage I non-small cell lung cancer with a diameter of 3 cm or less. Small tumors (<3 cm) of stage IB (T2N0M0) non-small cell lung cancer with visceral pleural invasion should be treated as T1 disease and not T2 disease.

Preoperative serum carcinoembryonic antigen level is a prognostic factor in women with early non-small-cell lung cancer.

BACKGROUND: Carcinoembryonic antigen (CEA) is one of the markers evaluated in patients with non-small cell lung cancer (NSCLC). The significance of the preoperative serum CEA level in female patients with NSCLC is seldom discussed. In this study, we conducted a retrospective review to investigate the prognostic significance of the preoperative CEA level in female patients with stage I NSCLC. METHODS: In this study, we looked at 163 female patients with stage I NSCLC. Patient charts were reviewed to collect patient data, including the age of the patient, tumor location, tumor size, visceral pleural invasion, the stage of disease, and the preoperative serum CEA level. The cutoff value of serum CEA level was 6.0 ng/mL. The significance of preoperative CEA level in the prognosis of female patients with stage I NSCLC was evaluated. RESULTS: Among the 163 female patients with stage I NSCLC, 47 patients (28.8%) had abnormal preoperative serum CEA level (>6 ng/mL). Diagnosis of adenocarcinoma and bronchoalveolar carcinoma accounted for 83.4% of these 163 female patients. In-hospital mortality was encountered in 1 patient. Univariate analysis of survival in the other 162 female patients with stage I NSCLC showed that age, stage, tumor size, and preoperative CEA level were prognostic factors. Visceral pleural invasion had no impact on the prognosis of these patients. Multivariate analysis revealed that tumor size and preoperative CEA level were independent prognostic factors in female patients with stage I NSCLC. CONCLUSIONS: Preoperative serum CEA level and tumor size are independent prognostic factors in female patients with stage I NSCLC. In contrast, visceral pleural invasion was not associated with the prognosis. Importantly, these results suggest that female patients with abnormally high preoperative CEA level and tumor size larger than 3 cm may need a thorough preoperative evaluation and careful postoperative follow-up to rule out occult metastasis of early NSCLC.

Management of primary chest wall tumors: 14 years' clinical experience.

BACKGROUND: Primary chest wall tumor is rare but it encompasses tumors of various origins. We analyzed our experience with primary chest wall tumors with emphasis on its demographic presentation and management. METHODS: From 1991 to 2004, 62 patients with the diagnosis of primary chest wall tumors were enrolled. Lipoma, chest wall metastasis, direct invasion from nearby malignancy, infection, and inflammation of chest wall were excluded. The clinical features, management, and the outcome of these patients were retrospectively reviewed. RESULTS: There were 37 males and 25 females. Malignant and benign tumors were equally distributed. Chondrosarcoma and lymphoma were the 2 most common types of malignant chest wall tumors. The most common clinical symptoms were palpable mass (54.8%) and pain (40.3%). Nine of 31 patients (29.0%) with benign chest wall tumors were free of symptoms whereas patients with malignant chest wall tumors were all symptomatic (p = 0.002). A definite diagnosis was obtained in 21 of 26 patients (80.7%) who received nonexcision biopsy. All patients with primary chest wall tumors, except 6 who had medical treatment only, underwent surgical resection. Patients with malignant chest wall tumors were older than those with benign tumors (p < 0.001). The mean largest diameter of tumors was also larger in malignant tumors than in benign tumors (p = 0.04). CONCLUSION: Patients with primary malignant chest wall neoplasm were older than those with benign tumors. The mean size of malignant tumors was larger than that of benign tumors. Adequate surgical resection remains the treatment of choice for patients with primary chest wall tumors. Nonexcision biopsy should be reserved for patients with a past history of malignancy, suspicion of hematologic disease, and with high operative risk. For patients with isolated chest wall lymphoma, surgical resection followed by chemotherapy can be considered to obtain a better outcome.

En bloc resection for lung cancer with chest wall invasion.

BACKGROUND: The aim of this study was to retrospectively assess the results of en bloc chest wall plus lung resection for patients with non-small cell lung cancer (NSCLC) invading the chest wall. METHODS: From January 1986 to December 2000, of 1,820 patients having surgery for NSCLC, 42 (2.3%) patients with neoplasms involving the chest wall underwent en bloc chest wall and lung resection. Patient demographics, preoperative symptoms, operative procedures, tumor cell type and size, removed nodal status, and pathologic stage were summarized. The 5-year survival rates of the groups were compared. RESULTS: Postoperative staging revealed 28 were T3N0M0, 4 were T3N1M0, and 10 were T3N2M0. The in-hospital mortality rate was 11.9% (5/42). The mean age was 79.0 +/- 2.8 years in the patients who died of complications, which was significantly older than the mean age of 67.9 +/- 8.1 years in the patients who survived the surgery (p = 0.005). The overall 5-year survival was 28.4%. The 5-year survival was significantly longer in the patients with negative (N0) nodal metastasis than in those with N1 and/or N2 nodal metastasis (39.6% versus 7.1%, p = 0.01). Eleven patients had tumor involvement of the parietal pleura. Thirty-one patients had tumor involvement of the soft tissue and/or bone. There was no significant difference of 5-year survival rate between the patients with involvement of the parietal pleura only and the patients with involvement of the parietal pleura and the soft tissue and/or bone (10.9% versus 33.5%, p = 0.94). CONCLUSION: En bloc resection for bronchogenic carcinoma invading the chest wall provides a favorable prognosis in cases without nodal metastasis. Significant postoperative mortality is associated with old age (> 80 years). The 5-year survival rate is not significantly different between the patients with involvement of the parietal pleura only and the patients with involvement of the parietal pleura and the soft tissue and/or bone.

Non-Hodgkin's lymphoma presenting as a large chest wall mass.

BACKGROUND: Malignant lymphoma presenting as a solitary chest wall mass is not frequently seen. Only a few case reports have been found in the English literature. The treatment for primary chest wall lymphoma remains unclear. METHODS: From 1991 to 2004, of 157 patients with initial presentation of isolated chest wall mass, non-Hodgkin's lymphoma was diagnosed in 7 of them. Patients with tumors arising from axillary lymph nodes or mediastinal lymphadenopathy with chest wall extension were excluded in the study. The clinical manifestation, management, and outcome of these patients were reviewed. RESULTS: There were 1 female and 6 male patients with a mean age of 66.5 years. The mean largest diameter of the mass was 10.3 cm. Four of these 7 patients had the chest wall lymphoma as the only site of disease. The other 3 patients had other organ involvement including lung, bone, or liver. The pathologic diagnoses were malignant lymphoma in 2 patients and diffuse large B-cell lymphoma in 5 patients. Three patients with chest wall lymphoma as the only site of disease had tumor excision followed by adjuvant chemotherapy. No recurrence or metastasis was noted for these 3 patients. The mean follow-up period was 102 months. The other patient with chest wall lymphoma as the only site of disease, who had chemotherapy as the initial treatment, remained free of disease for 6 months after treatment. The other 3 patients with other organ involvement who were managed with chemotherapy with or without radiotherapy died of disease after a mean survival of 20 months. CONCLUSIONS: Malignant lymphoma presenting as a large chest wall mass is not common. Although the primary treatment of choice for lymphoma with or without chest wall involvement is chemotherapy, surgery followed by adjuvant chemotherapy can provide satisfactory outcome for some patients in whom the chest wall lymphoma was the only site of disease.

Thymoma is associated with relapse of symptoms after transsternal thymectomy for myasthenia gravis.

Thymectomy is considered a therapeutic option for patients with myasthenia gravis. A myasthenic patient who has not received any treatment for years and shows no signs or symptoms of the disease after operation is still susceptible to a recurrence of myasthenic symptoms. To investigate which factors are related to relapse of symptoms in patients having thymectomy, we conduct a retrospective review in the patients who had experienced complete remission after thymectomy. Complete remission was achieved in 92 of 154 patients who received extended transsternal thymectomy for myasthenia gravis. Among these 92 patients, 20 patients had relapse of symptoms and needed medication again after complete remission was achieved (21.7%). Ten of 22 patients in the thymomatous group had relapse of symptom after complete remission was achieved, while only 10 of 70 patients in the nonthymomatous group had relapse of symptom (P=0.006). Multivariate Cox regression analysis revealed that thymoma was an independent factor for the development of relapse of symptoms. In conclusion, thymoma is an adverse prognostic factor for the MG patients who have experienced complete remission after thymectomy. The patients with thymoma had a greater possibility to develop relapse of symptoms than the patients without thymoma.