Effect of histological subtype and treatment modalities on T1-2 N0-1 small cell lung cancer: A population-based study.

BACKGROUND: Combined small cell lung cancer (C-SCLC) is rare and its clinical features, appropriate treatment, and prognosis are poorly understood. Reports conflict over the prognosis of C-SCLCs compared to pure small cell lung cancer. METHODS: The records of patients diagnosed with primary SCLC from 1988 to 2014 were extracted from the Surveillance, Epidemiology, and End Results database. The general features of C-SCLCs were compared to those of SCLCs. T1-2 N0-1 data was extracted and the effects of the histological subtype, treatment modality, and other prognostic factors on lung cancer-specific survival (CSS) was analyzed in a 3:1 matched dataset. Analysis was performed using the 8th edition tumor node metastasis staging system and previous staging systems adjunctively. RESULTS: C-SCLCs comprised 1.5% of all SCLCs (1486/98 667); 184 cases of C-SCLCs and 2681 cases of non-combined SCLCs (NC-SCLCs) were included in this study. C-SCLCs were more likely to be of a higher grade and to occur in the upper lobe than NC-SCLCs. Before matching, C-SCLCs showed better CSS (hazard ratio 0.69; P < 0.001). However, stratified Cox proportional hazards analysis in the matched dataset revealed that only treatment modality and age at diagnosis were associated with CSS; the histological subtype had no effect on survival. Of all treatment modalities, surgery with chemoradiation showed the best CSS in T1-2 N0-1 SCLC. CONCLUSION: In early SCLC, surgery with chemoradiation shows the best CSS. C-SCLC patients might benefit more from multimodal treatments, including surgery, than SCLC patients.

The effect of thoracosopic thoracic sympathetomy on pulmonary function and bronchial hyperresponsiveness.

BACKGROUND: Endoscopic thoracic sympathectic denervation (ESD) is a procedure used in primary hyperhidrosis and upper extremity ischemia. Bronchial tone is affected by the sympathetic and parasympathetic nervous systems and bronchial asthma is associated with an imbalance between them. The aim of this study was to evaluate the effects of ESD on pulmonary function and bronchial hyperresponsiveness (BHR). PATIENTS AND METHODS: Fifty-eight patients with primary hyperhidrosis (n = 54) or upper limb ischemia (n = 4) were included. Spirometry and bronchial provocation test with methacholine was performed before and 4 weeks after ESD. RESULTS: Forced expiratory volume in 1 second (FEV(1)) and forced vital capacity (FVC) were significantly decreased early after ESD (from 4.67 +/- 0.84 L and 4.36 +/- 0.85 L to 4.12 +/- 0.78 L and 3.84 +/- 0.82 L, respectively), although no patient complained of an aggravation of respiratory symptoms. Twelve patients (21%) had a positive response to methacholine provocation preoperatively, and all remained positive post surgery. The provocative concentration of methacholine, which brought about a 20% decrease in the FEV(1) in the patients, was not significantly changed after surgery (from 5.1 +/- 4.3 to 4.6 +/- 4.6). Of 46 patients who had a negative result for methacholine challenge preoperatively, 12 (26%) became positive after surgery. In terms of the level of sympathectomy, T3 sympathectomy significantly increased the ratio of patients exhibiting a positive response to methacholine (from 19% to 34%, respectively) (p < 0.005). CONCLUSIONS: Thoracic sympathectomy can adversely affect lung function early after surgery, although the clinical significance is uncertain. It may also exert an influence on the development of bronchial hyperresponsiveness, especially when performed at the T3 level.

Clinical outcome after pulmonary metastasectomy from primary hepatocellular carcinoma: analysis of prognostic factors.

AIM: To review the surgical outcomes in terms of the surgical indications and relevant prognostic factors. METHODS: Sixteen patients underwent therapeutic lung surgery between March 1999 and May 2006. The observation period was terminated on May 31, 2007. The surgical outcomes and the clinicopathological factors were compared. RESULTS: There was no mortality or major morbidity encountered in this study. The mean follow-up period after metastasectomy was 26.7 +/- 28.2 (range: 1-99 mo), and the median survival time was 20 mo. The 1- and 5-year survival rates were 56% and 26%, respectively. At the end of the follow-up, 1 patient died from hepatic failure without recurrence, 6 died from hepatic failure with a recurrent hepatocellular carcinoma (HCC), and 4 died from recurrent HCC with cachexia. Among several clinical factors, Kaplan-Meier analysis revealed that liver transplantation as a treatment for the primary lesion, grade of cell differentiation, and negative evidence HBV infection were independent predictive factors. On Cox's proportional hazard model, there were no significant factors affecting survival after pulmonary metastasectomy in patients with HCC. CONCLUSION: A metastasectomy should be performed before other treatments in selected patients. Although not significant, patients with liver transplantation of a primary HCC survived longer. Liver transplantation might be the most beneficial modality that can offer patients better survival. A multi-institutional and collaborative study would be needed for identifying clinical prognostic factors predicting survival in patients with HCC and lung metastasis.