Toshio Kasugai

The relationship between the expression of thymidylate synthase, dihydropyrimidine dehydrogenase, orotate phosphoribosyltransferase, excision repair cross‑complementation group 1 and class III β‑tubulin, and the therapeutic effect of S‑1 or carboplatin plus paclitaxel in non‑small‑cell lung cancer

Previous studies have reported that the expressions of specific proteins may predict the efficacy of chemotherapy agents for non-small cell lung cancer (NSCLC) patients. The present study evaluated the expression of proteins hypothesized to be associated with the effect of chemotherapeutic agents in 38 NSCLC patients with pathological stage II and IIIA. The subjects received carboplatin plus paclitaxel (CP) or S-1 as adjuvant chemotherapy following complete resection. The protein expressions evaluated were those of thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD) and orotate phsphoribosyltransferase (OPRT), which were suspected to be associated with the effect of S-1 agents, excision repair cross-complementation group 1 (ERCC1), which was suspected to be associated with the effect of platinum-based agents, and class III β-tubulin (TUBB3), which was suspected to be associated with the effect of taxane-based agents. The positive rate of TS was 55.3% (n=21/38), DPD was 57.9% (n=22/38), OPRT was 42.1% (n=16/38), ERCC1 was 47.4% (n=18/38) and TUBB3 was 44.7% (n=17/38). Among the patients who received S-1 adjuvant chemotherapy, TS-negative cases demonstrated a significantly better disease-free survival than positive cases. Thus, TS protein expression may have been a factor that predicted the effect of S-1 agent as adjuvant chemotherapy.

S-1 vs. paclitaxel plus carboplatin as adjuvant chemotherapy for completely resected stage II/IIIA non‑small‑cell lung cancer

The majority of patients with completely resected stage II or IIIA non-small-cell lung cancer (NSCLC) require adjuvant chemotherapy to improve survival following surgery. In the present trial, the 2-year disease-free survival (DFS), and the feasibility and safety of S-1 as an adjuvant chemotherapy for advanced lung cancer were evaluated. A total of 40 patients with completely resected stage II or IIIA NSCLC were enrolled and randomized to receive postoperative chemotherapy with either up to 4 cycles of paclitaxel plus carboplatin (arm A) or with up to 1 year of S-1 (arm B). The primary endpoint was 2-year DFS. The secondary endpoints were feasibility and toxicity. A total of 40 patients were enrolled, but 3 were excluded in accordance with the exclusion criteria. The remaining 37 patients were analyzed. The 2-year DFS rate was 54.2% in arm A and 84.2% in arm B. Overall, 15/18 (83.3%) patients completed 4 cycles of paclitaxel plus carboplatin and 13/19 (68.4%) completed 1-year of S-1adjuvant chemotherapy. Of the 18 (16.7%) patients in arm A, 3 experienced grade 3 or 4 adverse events, while none in arm B experienced such events. Therefore, S-1 chemotherapy for patients with completely resected stage II or IIIA NSCLC was a feasible and safe regimen, and it may therefore be considered as a potential adjuvant chemotherapy option for advanced NSCLC.

10-Year Survivors after Resection of Lung Cancer.

1992年末までに名古屋市立大学第2外科学教室で施行した低悪性度の癌, 重複肺癌を除く原発性肺癌切除症例538例について検討した. 全切除例の10年生存率は25.9%であった. 組織型別の10年生存率は扁平上皮癌26.1%, 腺癌25.2%, 大細胞癌32.0%で, 腺扁平上皮癌, 小細胞癌では10年生存例はなく, 最長生存期間は各々術後9年, 9年4カ月であった. 病理学的な病期分類では10年生存率はstage I 41.3%, stage II 22.3%, stage IIIA 17.5%で, stage III B, stage IVでは10年生存例はなく, 最長生存期間は各々9年2カ月, 2年8カ月であった.さらに術後10年以上経過した1982年末までの切除症例のうち10年以上生存した27例について背景因子について検討した. 性別, 年齢, 組織型, 術式による10年生存率の有意な差は認めなかったが, 性別では男19%に対して女は37%と高率であった. 年齢別では50歳台が37%と最も高率であったが, 一定の傾向は認められず70歳台においても14%の生存が得られた.病理学的T因子, N因子, 根治度による生存率の差を認め, T4, N3, 絶対的非治癒切除術の症例では10年以上の生存は得られなかった.