Mitsutoshi Shiba

Ki-67 immunostaining and other prognostic factors including tobacco smoking in patients with resected nonsmall cell lung carcinoma.

To estimate the effectiveness of expression of the tumor proliferative marker Ki‐67 antigen (Ki‐67) as a postoperative prognostic marker, the authors analyzed Ki‐67 expression and its correlation with postoperative survival and other clinicopathologic factors, including preoperative smoking habits, in patients with resected nonsmall cell lung carcinoma (NSCLC).

Evidence of neoangiogenesis and an increase in the number of proliferating cells within the bronchial epithelium of smokers.

Normal bronchial epithelium gradually acquires cellular and genetic changes that result in the formation of invasive tumors. The objective of this study was to evaluate the degree of proliferative change and the amount of neovascularization in both normal and preneoplastic lesions in smokers who were at high risk for developing lung carcinoma.

Successful resection of a primary liposarcoma in the anterior mediastinum in a child: report of a case.

Abstract Primary liposarcomas of the mediastinum are very rare. We report on a 13-year-old girl who presented with a huge mediastinal tumor. The tumor was extirpated by a median sternotomy with a right thoracotomy. The tumor included the superior vena cava in the anterior mediastinum. It therefore probably originated from the anterior mediastinal fat tissue, possibly from the thymus. A pathological examination revealed myxoid liposarcoma. At 35 months postoperatively, the patient has not shown any recurrence.

Prognostic implication of Ki-67 immunostaining in treating subclinical pleural cancer found at thoracotomy in lung cancer patients

BACKGROUND Therapeutic principles for managing subclinical pleural cancer found unexpectedly during intraoperative examination are unclear. We analyzed prognostic factors including the tumor proliferative marker Ki-67 in these circumstances. METHODS The cases of 65 surgically treated patients with lung cancer and subclinical T4 pleural cancer, microscopic in 25 and macroscopic in 40, were reviewed. RESULTS The overall 5-year survival rate of patients undergoing lobectomy was 14.3%. For patients with T4 NO disease, the 5-year survival rate was 46.7%. In patients with a low Ki-67 labeling index, the 5-year survival rate was 28.6%. The Ki-67 labeling index was a significant (p < 0.05) indicator of survival. Multivariate analysis demonstrated Ki-67 labeling index, lymph node involvement, and tumor differentiation to be the most influential prognostic factors for postoperative survival (p < 0.01). CONCLUSIONS In the treatment of lung cancer patients with subclinical pleural cancer found at thoracotomy, tumor resection is not necessarily contraindicated. Resection appears to be beneficial in patients with no nodal involvement or a low tumor Ki-67 labeling index. This index is a good therapeutic indicator for lung cancer patients.

Adjuvant immunotherapy of primary resected lung cancer with transfer factor.

One hundred seventy‐one patients were studied in order to evaluate the clinical efficacy of the transfer factor (TF) for primary resected lung cancers under a randomized controlled trial. Eligible cases for evaluation were randomly chosen at 75 and 74 patients in TF and control groups, respectively. The same long‐term intermittent adjuvant chemotherapy was administered to two groups as a standard therapy. The distribution of clinical features in both groups was very similar. The overall survival rates of the TF group at 2 and 4 years postoperatively were 69% and 53%, respectively, which was about 15% better than the control group, but this difference could not yet be considered statistically significant. The survival of the TF group was significantly better than that of the control group in patients with Stages I + II or curative resection (P < 0.05 by Cox‐Mantel test); however, there was no significant difference in patients with Stages III + IV, or noncurative resection. The recurrence rate of pulmonary and mediastinal regions was less in the TF group. In conclusion, TF seems to suppress postoperative recurrence and appears to be beneficial for primary resected lung cancer patients, especially at early stages, as postoperative adjuvant immunotherapy.

Surgical intervention for non-small-cell lung cancer patients with pleural carcinomatosis: Results from the Japanese lung cancer registry in 2004

Introduction: A subset of non–small-cell lung cancer (NSCLC) patients with malignant pleural effusion and/or malignant pleural nodules is now classified as stage IV and is generally considered a contraindication to surgery. However, several reports have demonstrated that the prognosis of patients with pleural carcinomatosis first detected at thoracotomy is relatively favorable. The aim of this study was to describe the results of surgical intervention in NSCLC patients with pleural carcinomatosis in Japan. Methods: In 2010, the Japanese Joint Committee of Lung Cancer Registry conducted a nationwide registration of lung cancer patients who underwent surgery in 2004. Using this database, we performed a retrospective study focused on pleural carcinomatosis. We examined the clinicopathological features, the current status of therapy, and surgical outcomes in patients with pleural carcinomatosis. Results: Among the 11,420 registered NSCLC patients, 329 (2.9%) patients had pleural carcinomatosis. The median survival time and 5-year survival rate of 313 patients without other metastatic disease were 34.0 months and 29.3%, respectively. Primary tumor resection was performed in 256 (81.8%) patients, and macroscopic complete resection was achieved in 152 (48.6%) patients, with 5-year survival rates of 33.1% and 37.1%, respectively. Multivariate analysis revealed that Eastern Cooperative Oncology Group performance status (p < 0.001), best stage nodal status (p = 0.002), and the presence or absence of gross residual tumor (p = 0.013) were independent predictors of survival. Conclusion: In our surgical registry for NSCLC, patients with pleural carcinomatosis accounted for 2.9%, and macroscopic complete resection for them was associated with better survival.

Pulmonary blastoma: report of a case.

A 30-year-old woman was admitted to our hospital for investigation of an abnormal shadow in the right pulmonary hilus on a chest X-ray film. A percutaneous needle biopsy was performed, which revealed pulmonary blastoma. A right upper lobectomy was performed and the pathological stage was confirmed to be IIIa (T3N0M0). An analysis of preoperative cytological specimens showed that epithelial tumor cells with thin cytoplasm were either tubular or papillary, while some mesenchymal tumor cells with elliptic and spindle-shaped nuclei were also found in the necrotic background. Thus, pulmonary blastoma should be considered when a two-cell pattern consisting of both epithelial and mesenchymal components is observed. DNA analysis was performed on previously identified areas of the epithelial or sarcomatous components, using a microdissection method. An analysis of the p53 gene by the single-strand conformation polymorphysm method showed an abnormal band with shifted mobility of exon 8 in only the sarcomatous component.

Randomized controlled trial of transfer factor immunochemotherapy as an adjunct to surgical treatment for primary adenocarcinoma of the lung

A total of 102 patients were studied in a randomized controlled trial to evaluate the clinical effect of transfer factor (TF) for primary resected adenocarcinoma of the lung. The TF and Control groups consisted of 50 and 52 randomly chosen patients, respectively. However, 6 and 5 patients were excluded from both groups for various reasons, therefore the total of cases eligible for evaluation were 44 and 47 in the TF and Control groups, respectively. The clinical features of both groups were similar. The survival of the TF group was significantly better than that of Controls in Stage I cases (p<0.05), however, there was no significant difference in patients in Stages II, III and IV. Significant differences were found between the TF and Control groups in curative resection cases (p<0.05), however, no significant difference was seen in either the relatively curative resection or noncurative resection groups. TF seems to inhibit postoperative recurrence and appears to be an effective postoperative adjuvant immunotherapeutic for primary resected adenocarcinoma of the lung, especially at the relatively early stages.

Diffuse malignant pleural mesothelioma: A multi-institutional clinicopathological study

PurposeThe relative rarity of malignant pleural mesothelioma (MPM) in Japan makes it difficult to perform a large-scale clinicopathological study of this tumor at a single institute. Thus, we performed a multiinstitutional study to evaluate the current status of diagnosis and treatment in Japan.MethodsWe analyzed the records of 65 patients with MPM, obtained from the 13 institutions comprising the Japanese Chiba Multicenter Study Group.ResultsIn 56 patients, the tumor was detected after a visit to a medical facility for subjective symptoms such as chest pain, shortness of breath, and cough. It took a median period of 2 months from the initial visit to establish the diagnosis. The overall survival rates of 33 patients with unresectable MPM 1, 2, and 3 years after the diagnosis were 40.5%, 10.8%, and 0%, respectively, whereas those of 32 patients who underwent surgery were 67.9%, 35.0% and 10.9%, respectively (P = 0.0035). According to multivariate analysis, histological type, International Mesothelioma Interest Group clinical stage, sex, and the presenting symptom of shortness of breath were significant prognostic factors.ConclusionsThe definitive diagnosis of early MPM is difficult, but establishing the best diagnostic modality would improve survival rates, since radical surgery is likely to be effective for resectable disease.

Changes in diagnostic strategies for hilar-type castleman’s disease: Report of two cases

Castleman’s disease (CD) is rare and difficult to diagnose preoperatively. We report two similar cases of hyaline vascular type CD diagnosed preoperatively using different modalities. In the first case, a biopsy specimen taken during diagnostic thoracoscopy revealed lymphatic structure suggestive of CD. In the second case, endobronchial ultrasound-guided transbronchial needle aspiration enabled sampling of histological cores for histological diagnosis. In both cases, the final diagnosis was established by surgical resection.