Noboru Yanai

Prognosis of non-surgically treated, clinical stage I lung cancer patients in Japan

OBJECTIVE The optimal management of stage I lung cancer is surgical resection. However, some of these patients are not candidates for surgery because of several medical problems. We analyzed prognosis of non-surgically treated, clinical stage I lung cancer patients. METHODS AND RESULTS There were 21211 lung cancer patients registered from 1982 to 1991 in the data-base of the Japanese National Chest Hospital Study Group for Lung Cancer, and the number of non-surgically treated, clinical stage I lung cancer patients during the 10 years was 802. The 5- and 10-year survival rates of the 799 patients, exclusive of two carcinoid tumors and one adenid cystic carcinoma which have good prognosis, were 16.6 and 7.4%. We analyzed the 799 patients according to several prognostic factors. Sex, T factor of the tumor, histology, performance status and the method in which lung cancer was detected were prognostic factors, but age and treatment method were not associated with prognosis. Forty-nine patients survived for 5 years or more without surgical resection, but the survival rate continued to decrease even after 5 years, and the 7- and 10- year survival rates were 34.4 and 18.1% in the 49 patients. CONCLUSIONS It is a fact that there are long-term survivors in non-surgically treated, stage I lung cancer patients. However, the rate is low, and the survival curve continues to decrease even after 5 years. Long-term survivors might suggest the presence of a lung cancer in which the tumor growth is slow.

Japanese doctors' preferred treatment choices for their hypothetical non-small cell lung cancer: how they would wish to be treated

We conducted a trial to clarify what Japanese clinical doctors think about the present status of therapy for non-small cell lung cancer, as well as to clarify which problems are still unresolved. One-hundred five Japanese doctors who treat lung cancer patients were asked how they would choose to be treated, if they suffered from non-small cell lung cancer. Six scenarios were presented and the doctors had to choose one treatment method for each of the six scenarios. Adjuvant chemotherapy or radiotherapy after complete resection, increase with progression of the pathological stage. Ninety-three per cent of Japanese doctors wanted surgery, even if mediastinal lymph node metastases were present. In the scenario of only one distant metastasis to the brain, 44% of doctors wanted surgery while 39% wanted chemotherapy and/or radiotherapy. In the scenario of multiple bone metastases, 33% wanted chemotherapy, 77% did not. It was concluded therefore that Japanese doctors choose surgery as the number one treatment modality when all lesions are considered resectable.

Atypical Adenomatous Hyperplasia of the Lung Detected in a Thoracic CT Screening Program for Lung Cancer.

要旨: 低線量らせんCTを用いた肺癌検診で発見され, 病理組織学的に確認された異型腺腫様過形成 (atypical adenomatous hyperplasia, AAH) 5例について, その頻度, 画像所見について検討した. 検診対象者数は7,980人 (男性6,136名, 女性1,844名, 平均年齢57歳), うち初回受診者数は5,991名である. 肺癌疑いで病院へ紹介された49例のうち, 40例に病理組織学的検索がなされ, 5例がAAHと診断された. AAHの頻度は0.083%であった. AAHの画像所見は, HRCT上の大きさは7.9mm～12.4mm (平均9.8mm) で限局性のスリガラス濃度領域 (ground glass opacity; GGO) のみからなっていた.3 例は検出直後の精検の3カ月から12カ月の期間経過観察されていたが, 大きさの増大は見られなかった.