Showing papers by "Toshio Onitsuka published in 2005"

Vascular endothelial growth factor expression in pN2 non-small cell lung cancer: lack of prognostic value.

Abstract: Objective: Although several previous studies have investigated the prognostic significance of vascular endothelial growth factor (VEGF) expression in non-small cell lung (NSCL) cancer, no previous study has concentrated on NSCL cancer with pathologically abnormal mediastinal nodes (pN2). Methodology: A total of 60 patients with pN2 NSCL cancer who had undergone a complete resection with a systematic mediastinal lymph node dissection were reviewed retrospectively. Immunohistochemical examination, using antibodies against VEGF, was conducted. The prognostic significance of VEGF expression and clinicopathological factors were analysed. Results: The overall 5-year survival rate was 21.7%. With respect to clinicopathological factors, single N2 involvement and skip metastasis were significantly associated with patients’ survival. Expression of VEGF was found in 35/60 (58.3%) patients. VEGF expression was not related to the clinicopathological parameters examined. There was no relationship between survival rates and patients positive and negative for VEGF. Multivariate analysis showed that single N2 disease was an independent prognostic factor, while VEGF expression was not. Conclusions: Although VEGF expression might be important for tumour development and maintenance, no prognostic significance of VEGF expression in pN2 NSCL cancer was found.

Serum carcinoembryonic antigen level in pN1 non-small cell lung cancer patients.

Abstract: Background: Although the prognostic significance of the serum carcinoembryonic antigen (CEA) level in non-small cell lung cancer has been reported in several studies, it is unknown whether the serum CEA level is a prognostic determinant for pN1 disease or not. Materials and Methods: Seventy patients with pN1 non- small cell lung cancer who received complete resection were reviewed. The preoperative serum CEA level was measured in all patients. Results: The pN1 patients with pT2-4 disease, hilar node involvement, multiple N1 station and elevated serum CEA level (>5 ng/mL) had a significantly unfavorable prognosis. Although a serum CEA level higher than 5 ng/mL was not an independent prognostic determinant, more than 10 ng/mL was an independent factor by multivariate analysis. In patients with pT1-2N1 disease, a serum CEA level more than 10 ng/mL was also a prognostic determinant. Conclusion: An elevated serum CEA level, especially higher than 10 ng/mL, is a significant prognostic determinant for pN1 lung cancer patients. The existence of regional lymph node metastasis is the most important prognostic factor for resectable non-small cell lung cancer (NSCLC). According to the accepted pathological Tumor-Node-Metastasis (pTNM) staging (1), the 5-year survival rate of pN1 disease was 47%, an intermediate value between those of pN0 (56%) and pN2 (20%) (1). The number of studies regarding the postoperative prognosis of pN1 NSCLC is small, probably because of the relatively small number of patients. In recent years, however, many studies about pN1 NSCLC have appeared (2-9), indicating that pN1 disease has become cynosure. The carcinoembryonic antigen (CEA) is one of the most commonly used serum markers to date for NSCLC patients. Several reports have indicated that elevated preoperative serum CEA levels are associated with more advanced disease and with very poor survival after surgical resection (10-16). Although measurement of the serum CEA level is a classic examination, many recent studies have re-evaluated the prognostic significance of serum CEA level (17-23). Despite several studies on the prognostic significance of the serum CEA level, to our knowledge, there have been no studies that focused on the serum CEA level in pN1 disease. The purpose of this study was to evaluate the significance of the serum CEA level in pN1 NSCLC patients.

Mid-Term Results of Entry Closure for Chronic Type B Dissecting Aortic Aneurysm

Abstract: B型解離性大動脈瘤に対して外科的またはステントグラフト留置によるエントリー閉鎖術を施行した症例について治療成績および術後の瘤径と偽腔の状態を検討した.対象は1996年より2003年までにエントリー閉鎖術を施行した8例(外科的閉鎖5例,ステントグラフト留置3例).全例慢性期症例で,DeBakey分類ではIII a型1例,III b型7例,男女比4:4,平均年齢63.8±10.9歳.エントリーは全例下行大動脈に存在した.術後観察期間40±29ヵ月で,在院死亡,脊髄および腹部臓器障害は認めなかった.初回手術後3例にリークを認め,手術群1例で下行大動脈置換術,ステント群1例でステントグラフト追加留置を施行した.遠隔期に瘤破裂症例や瘤径拡大に伴う追加手術症例は認めず,遠隔死亡は癌死を1例認めるのみであった.下行大動脈置換術を施行した症例を除く7例中6例で下行大動脈偽腔の血栓化が得られたが,血栓化後も縮小化しないものが存在し,縮小傾向はあるものの最大瘤径は術前後で有意差を認めなかった(術前68±8mm,術後59±17mm,p=0.22).エントリー閉鎖術では3例にリークを認めたが,ステントグラフト追加留置症例を含めると下行大動脈偽腔は高率に血栓化され,中期遠隔期の瘤破裂や瘤径拡大に伴う追加手術例は認めなかった.しかし,瘤径の縮小化が進まない症例も存在し,今後も慎重な経過観察を要する.

Chemotherapy and Surgical Resection for Solitary Bone Metastasis of Lung Cancer Resulting in Long-term Survival

Abstract: ━━ Background. Distant metastatic lesions of lung cancer are generally regarded as inoperable. This case report describes long-term survival achieved with surgical resection of primary and metastatic lesions in combination with perioperative chemotherapy. Case. A 62-year old man was referred to our institution with an irregularly shaped right upper lobe nodule in October 1999. Intraoperative frozen section of the nodule at the time of right upper lobectomy and mediastinal lymph node dissection confirmed adenocarcinoma of the lung. A left humeral head lesion identified by bone scintigraphy in January 2000 was confirmed to be metastatic adenocarcinoma by biopsy. Following 2 courses of chemotherapy(CDDP & TXT)the patient underwent left humeral head resection and reconstruction in April 2000. The final pathologic examination failed to demonstrate any malignant cells in the specimen, which was interpreted to indicate a complete histologic response to chemotherapy. Five years later, the patient is well without evidence of recurrence. Conclusion. Long term survival in a patient with primary lung cancer and a solitary bone metastasis was achieved through lobectomy, perioperative chemotherapy, and resection of the metastatic lesion. (JJLC. 2005;45:829832)