Masaya Yotsukura

Value of the Glasgow Prognostic Score as a Prognostic Factor in Resectable Non–Small Cell Lung Cancer

Background: Over the past decade, the Glasgow prognostic score (GPS), which is based on serum C‐reactive protein and albumin levels, has been reported to be associated with the prognosis of patients with several types of inoperable and operable cancers. However, its applicability to operable non–small cell lung cancer (NSCLC) has not yet been established. Methods: We retrospectively collected data from patients with pathological stage I or II NSCLC who underwent complete resection. A total of 1048 patients were categorized as either GPS‐0 (n = 817 [78.0%]), GPS‐1 (184 [17.6%]), or GPS‐2 (47 [4.5%]). Survival curves were estimated using the Kaplan‐Meier method, and the Cox proportional hazard model was used to analyze the relationship between prognosis and GPS status. Results: The 5‐year overall survival (OS) rates were 91.2%, 78.3%, and 75.8% for GPS‐0, GPS‐1, and GPS‐2, respectively. There were significant differences in OS between GPS‐0 and GPS‐1 (p < 0.001) and between GPS‐0 and GPS‐2 (p < 0.001). Ten variables demonstrated to be associated with OS in a univariate analysis were subjected to a multivariate analysis. The results showed that male sex (p = 0.031), vascular invasion (p < 0.001), lymph node metastasis (p < 0.001), and GPS (p = 0.025) were significantly associated with OS. Conclusions: A high GPS is significantly associated with poor OS. Although the biological mechanism that underlies this association is not clear, this inflammation‐based score may be a useful indicator of the prognosis in patients with resectable NSCLC.

Original ArticleNon–Small Cell Lung CancerValue of the Glasgow Prognostic Score as a Prognostic Factor in Resectable Non–Small Cell Lung Cancer

Background: Over the past decade, the Glasgow prognostic score (GPS), which is based on serum C‐reactive protein and albumin levels, has been reported to be associated with the prognosis of patients with several types of inoperable and operable cancers. However, its applicability to operable non–small cell lung cancer (NSCLC) has not yet been established. Methods: We retrospectively collected data from patients with pathological stage I or II NSCLC who underwent complete resection. A total of 1048 patients were categorized as either GPS‐0 (n = 817 [78.0%]), GPS‐1 (184 [17.6%]), or GPS‐2 (47 [4.5%]). Survival curves were estimated using the Kaplan‐Meier method, and the Cox proportional hazard model was used to analyze the relationship between prognosis and GPS status. Results: The 5‐year overall survival (OS) rates were 91.2%, 78.3%, and 75.8% for GPS‐0, GPS‐1, and GPS‐2, respectively. There were significant differences in OS between GPS‐0 and GPS‐1 (p < 0.001) and between GPS‐0 and GPS‐2 (p < 0.001). Ten variables demonstrated to be associated with OS in a univariate analysis were subjected to a multivariate analysis. The results showed that male sex (p = 0.031), vascular invasion (p < 0.001), lymph node metastasis (p < 0.001), and GPS (p = 0.025) were significantly associated with OS. Conclusions: A high GPS is significantly associated with poor OS. Although the biological mechanism that underlies this association is not clear, this inflammation‐based score may be a useful indicator of the prognosis in patients with resectable NSCLC.

Prognostic Impact of Preoperative Tumor Marker Levels and Lymphovascular Invasion in Pathological Stage I Adenocarcinoma and Squamous Cell Carcinoma of the Lung

Introduction: Some unfavorable prognostic factors for stage I non–small-cell lung cancers have been reported; however, they are not reflected in the current Tumor–Node–Metastasis classification. Methods: We retrospectively reviewed 629 patients who underwent complete resection of pathological stage I adenocarcinomas (ADs) or squamous cell carcinomas (SQs) at two institutes between 1996 and 2011. The correlation between clinicopathological characteristics and survival rates was analyzed to identify prognostic factors. Results: Multivariate analysis indicated that among ADs, high serum carcinoembryonic antigen levels (p = 0.04 for overall survival [OS]; p < 0.01 for recurrence-free survival [RFS]; p = 0.02 for disease-specific survival [DSS]), lymphatic permeation (p < 0.01 for RFS and DSS), and vascular invasion (p < 0.01 for OS and RFS; p = 0.03 for DSS) were independent prognostic factors. Among SQs, high squamous cell carcinoma antigen (SCC) (p < 0.05 for OS), and vascular invasion (p < 0.05 for RFS and DSS) were independently prognostic. We suggest that among completely resected tumors less than or equal to 5 cm without lymph node metastasis, the current stages IA and IB AD with high serum carcinoembryonic antigen levels, lymphatic permeation, or vascular invasion should be upgraded to stage IB and IIA, respectively. The current stage IA SQ with high SCC antigen levels or vascular invasion should be upgraded to stage IB. These reclassifications accurately reflect survival status (p < 0.04 in all comparisons). Conclusions: Some important differences in prognostic factors were observed between AD and SQ. High preoperative serum tumor marker levels and lymphovascular invasion should be included as additional criteria in the forthcoming Tumor–Node–Metastasis staging.

Clinical and pathological characteristics of EGFR mutation in operable early-stage lung adenocarcinoma

OBJECTIVES Over the past decade, the biological and clinical characteristics of lung cancer with epidermal growth factor receptor (EGFR) mutation have been well studied. However, most studies have focused on advanced inoperable cancer, and not on resected early-stage lung adenocarcinoma. We aimed to elucidate the differences in the clinicopathological characteristics and postoperative prognosis according to the EGFR mutation status in early-stage lung adenocarcinoma. MATERIALS AND METHODS We retrospectively collected clinical and pathological data from 369 patients with pathological stage I or II lung adenocarcinoma who underwent complete resection. Clinicopathological characteristics and postoperative prognosis were compared depending on the EGFR mutation status, using the Chi-squared test and the log-rank test, respectively. RESULTS AND CONCLUSION Of the 369 patients, 160 (43.3%) had EGFR mutation, of which 64 (40.0%) were exon 19 deletion (Del-19) and 90 (56.3%) were exon 21 point mutation L858R. Although there was no difference in overall survival (OS) between patients with and without EGFR mutation (p=0.086), tumors with EGFR mutation were associated with a lower consolidation to tumor ratio (CTR) (p <0.001) and a higher incidence of a lepidic growth pattern by pathological evaluation (p <0.001) compared to those without EGFR mutation. Among tumors with EGFR mutation, there was no difference in OS (p=0.140) between Del-19 and L858R. Tumors with L858R were associated with a lower CTR (p=0.046), and tended to have a higher incidence of a lepidic growth pattern by pathological evaluation (p=0.073) compared to those with Del-19. In conclusion, although EGFR mutation status was not a prognostic indicator after surgery in early-stage lung adenocarcinoma, L858R and Del-19 had different radiological and pathological features.

Survival predictors after resection of lung metastases of head or neck cancers

Pulmonary metastasectomies are performed for a variety of cancers, though few reports have examined their merit for head and neck cancers. This study examined the relationship between clinical and pathological characteristics and survival after resection of lung metastases of these cancers.

Ectopic Adrenocorticotropic Hormone-Secreting Bronchial Carcinoid Diagnosed by Balloon-Occluded Pulmonary Arterial Sampling.

We present the case of a 50-year-old man with Cushing syndrome caused by an ectopic adrenocorticotropic hormone (ACTH)-secreting tumor. A small nodule was located in close association with the lateral segmental branch of the pulmonary artery in the left upper lobe. Blood samples were obtained from various branches of the pulmonary artery by balloon-occluded retrograde sampling for the measurement of location-specific serum ACTH levels. After confirmation that the pulmonary nodule was responsible for the increased ACTH secretion, lobectomy was performed. This report demonstrates the usefulness of balloon-occluded retrograde pulmonary arterial sampling for the preoperative diagnosis of an ACTH-producing tumor whose diagnosis is difficult to confirm.

Clinical Features of Ground Glass Opacity–Dominant Lung Cancer Exceeding 3.0 cm in the Whole Tumor Size

BACKGROUND Ground glass opacity (GGO)-dominant lung adenocarcinoma sized 3.0 cm or less in the whole tumor size is widely known to have an excellent prognosis and is regarded as early lung cancer. However, the characteristics and prognosis of lung cancer showing GGO exceeding 3.0 cm remains unclear. METHODS From 2002 through 2012, we reviewed 3,735 lung cancers that underwent complete resection at our institution. We identified 160 lung cancers (4.3%) showing GGO exceeding 3.0 cm on thin-section computed tomography and divided them into three types by the consolidation/tumor ratio (CTR) using cutoff values of 0.25 and 0.5. We compared the characteristics and prognosis among these types. RESULTS Type A (CTR, 0 to ≤0.25), type B (CTR, >0.25 to ≤0.5), and type C (CTR, >0.5 to <1.0) were found in 16 (10%), 37 (23%), and 107 lesions (67%), respectively. No lymph node metastasis was found in types A and B. Recurrence was not observed in types A and B. The 5-year overall survival and disease-free survival rates were both 100% in type A, both 97.2% in type B, and 88.4% and 66.7% in type C, respectively. Patients with type C had a significantly worse prognosis than those with the other types with respect to overall survival and disease-free survival. CONCLUSIONS A patient with GGO-dominant lung cancer exceeding 3.0 cm can be considered to be in a group of patients with nodal-negative disease and an excellent prognosis.

Temporary extravascular shunt for reconstruction of a superior vena cava invaded by a lung tumor

Advanced central lung cancers can invade the superior vena cava (SVC). Although the indications for resection of the vessel remain controversial, it has been suggested that it increases the long-term survival of selected patients; however, little consensus has been reached regarding the optimal method of vascular reconstruction. While the SVC is often replaced during unprotected cross-clamp, the placement of a temporary venous shunt with a view to preserve the periprocedural safety and facilitate the postoperative management seems preferable. We describe an SVC reconstruction procedure using an autologous pericardial patch and placement of a temporary extravascular shunt via a lateral thoracotomy.