Clinicopathological and statistical studies on 214 lung cancers in Niigata University were categorized according to the histological classification of lung cancer, newly established by the Japan Lung Cancer Society.
1. Histologically there were 84 adenocarcinomas, 48 epidermoid carcinomas, 39 small cell carcinomas, 15 adenosquamous carcinomas, 3 carcinoids, 2 mucoepidermoid carcinomas, 1 carcinosarcoma and 1 unclassified carcinoma.
2. Although the autopsy rate of lung cancer has not increased in the last twenty years, adenocarcinoma has tended to decrease and epidermoid, small cell and adenosquamous carcinomas have tended to increase. In the last five years epidermoid carcinoma slightly predominates over adenocarcinoma.
3. The most common age is the sixth decade in male and female, without any differences among histological types.
4. Male to female ratio of all lung cancers is 3.65, and the ratio is largest in epidermoid and large cell carcinomas, the smallest in adenocarcinoma which constitutes 5 8.7% of female lung cancers.
5. Small cell and epidermoid carcinomas usually arise in the hilar regions, and others in the periphery (p<0.025). More than 75% of bronchiolo-alveolar carcinoma show diffuse distribution (p<0.025).
6. Epidermoid carcinoma metastasizes least to lymph nodes and other organs. Small cell carcinoma metastasizes most frequently especially to the pancreas (p<0.05).
7. The total course of epidermoid carcinoma is longer than adenocarcinoma and small cell carcinoma (p<0.05). Moreover well differentiated epidermoid carcinoma has a longer course than the poorly differentiated type (p<0.01).
8. Frequencies of organ metastasis according to the subtype classification:
1) Adenocarcinoma; poorly differentiated type more frequently metastasizes to distant lymph nodes than the bronchiolo-alveolar type (p<0.025), and to the liver and cerebrum than the well differentiated type (p<0.05). Additionally moderately differentiated type metastasizes more frequently to the digestive tract than poorly differentiated and bronchiolo-alveolar types (p<0.05).
2) Epidermoid carcinoma; poorly differentiated type metastasizes more often to the adrenal glands than other types (p<0.025).
3) Small cell carcinoma; oat cell type shows more frequent metastasis to distant lymph nodes than the intermediate cell type (P<0.025).

View full abstract

Previously untreated 31 patients with adenocarcinomai of the lung were placedon one of the following therapeutic modalities. Group A, 10 patients, AFX therapy; ADR 40 mg. iv. 1 /w, 5-FU 250 mg. iv. daily, and MTX 15 mg. iv. 1 /w. Group B, 14patients, LDC-AFX therapy; AFX therapy with low dose concurrent irradiation (LDC-RT). Group C, 7 patients, LDC-CFVX therapy; CTX 20 mg./kg. iv. 11w, 5-FU 250 mg. iv. daily, VCR 1 mg. iv. Ow, and MTX 15 mg. iv. 1/w, with LDC-RT. In groups B andC, patients were given 200 rads irradiation immediately before intravenous administration of chemotherapeutic agents. Radiotherapy was performed only once a week with a total tumor dose of less than 1000 rads, Tumor response rates of group A, B and C were 10%, 14%, and 57% respectably. Toxicity associated with concurrent irradiation wasnot observed. The LDC-CFVX therapy was less myelosuppressive than either AFX therapy or LDC-AFX therapy. LDC-RT is an effective treatment modality in patients with adenocarcinoma, and combination chemotherapy involving CTX is highly recommended.

View full abstract

Incidence rates for squamous cell carcinoma and adenocarcinoma of the lung in Japan were estimated by sex based on the data from regional cancer registries, 1976, and the Japanese Committee of the TNM Classification for Lung Cancer, 1972-74. These rates were compared to those in whites in Los Angeles County, California, U.S.A., 1972-1976. The proportions of squamous cell carcinoma to all lung cancers were 48% for males and 24% for females in Japan, and 48% and 30% respectively in Los Angeles County, while the incidence rates (per 100, 000 population) were 11.9 for males 1.8 for females in Japan, and 25.2 and 5.7 respectively in Los Angeles County. Those proportions for adenocarcinoma were 32% for males and 59% for females in Japan, and 21% for males and 32% for females in Los Angeles County, while the incidence rates were 8.0, 4.5, 11.3 and 6.4 respectively. It was also showed that in Japan males had higher incidence rates for lung cancer than females in both hilar and peripheral regions. It was suggested that category-specific incidence rates instead of proportions of categories be used when the frequency of a disease is compared by category.

View full abstract

We experienced three cases of bilateral bronchogenic carcinoma among chromate factory workers. The multiple occurrence was diagnosed clinically in two patients, one of which was confirmed by bilateral surgery and the other by autopsy. The last case was recognized only by autopsy. Cell type was bilateral squamous cell carcinoma in two and a combination of squamous cell and small cell carcinoma in one. Until April 1981, 21 cancer patients were found among 303 chromate workers.
The facts that a high incidence of bronchogenic carcinoma is seen among chromate workers and that these three cases showed multiple occurrence strongly suggest the strong carcinogenicity of chromate compounds.

View full abstract

A major concern of physicians in the treatment of advanced lung cancer (Stage III and IV in UICC classification) should be to improve the quality of the patients limited remaining life. For this purpose, treatment for local lesions such as metastasis to the central nervous system, bone, pericardium and pleural space are indispensable in conjunction with systemic therapy such as chemotherapy and immunotherapy.
We studied the effects of local injection of small dose Bleomycin and Pepleomycin into endobronchial cancer lesions under fiberoptic bronchoscopy, because these lesions may induce obstructive pneumonia, lung abscess and empyema in cases of very advanced lung cancer and frequently impair their quality of life.
25 patients were selected for this study. Bleomycin (dose ranging from 5 to 6.6mg) or Pepleomycin (from 3.3 to 4.4 mg) was injected once or twice weekly for as long as possible (maximum, 11 times over 3 months) via fiberoptic bronchoscopy. In 22 patients, the effects of treatment were repeatedly evaluated by fiberoptic bronchoscopy. In 20 patients, a decrease in size of the endobronchial lesions was observed and patency of the airway was maintained.
Side effects of the treatment included massive hemoptysis in one patient, but it was not fatal. No Bleomycin pneumonitis was observed. The blood gas range were within normal limite throughout the treatment. Bleomycin was not detectable in the blood and the concentration of Pepleomycin was less than 0.4μg/ml after local injection and these levels were far less than in systematic administration of these drugs.
The result suggests that local injection of small doses of Bleomycin through the fiberoptic bronchoscopy is the treatment of choice especially when the endobronchial cancer lesions threaten patency.

View full abstract

Thirty-eight of 89 patients with advanced non-small cell carcinoma of the lung were treated by a combination chemotherapy with cyclophosphamide (CPA) (500 mg/m²), vincristine (VCR) (1mg), and methotrexate (MTX) (20mg/m²), and the remaining fifty-one patients with adriamycin (ADR) (35 mg/m²), CPA (400mg/m²), . VRC (mg) and MTX (20/m²).
Response rates were 13%(CR; 2, PR; 2) in the COM group and 13.7%(CR; O, PR; 7) in the ACOM group. Eleven out of 12 patients complaining of severe pain due to multiple bone metastases were afforded. great relief by the ACOM regimen. The median survival time was 10 months in the COM group and 11 months in the ACOM group. There was no statistically significant difference between the two groups (p<0.3). Severe side effects were not observed in either groups but nausea, vomiting, alopecia and myelosuppression were noted more frequently in the ACOM group.

View full abstract

Serial measurements of serum carcinoembryonic antigen (CEA)[Sandwich method] and immunosuppressive acidic protein (IAP) levels were studied in 104 lung cancer patients in order to assess their value and to determine the extent of the disease and prognosis. When a patient with adenocarcinoma had CEA levels above 10 ng/ml, he was considered to have a lymphatic node metastasis of N₁ or N₂-factor, whereas when a patient had CEA levels above 15 ng/ml, he was considered to have a metastasis of up to N₂. In squamous cell carcinoma cases, when CEA levels were above 10 ng/ml, the patient was considered to have a metastasis of up to N₂. The studies indicate that serum CEA levels are of prognostic value only in patients whose tumors had a high production of CEA (over 5 ng/ml).
Patients with serum IAP levels of above 1, 000μg/ml were considered to have a markedly decreased immunity against advanced lung cancer. There is a probability that the patient will survive for longer than 6 months in cases where IAP levels decrease below 600 g/ml after the beginning of treatment.
The changes of serum CEA and IAP levels did not always correlate, but serial measurements of CEA and IAP during radio-and/or chemotherapy showed that the assay might be useful in evaluating the effects of therapy.

View full abstract

The possible association of 23 HLA specificities with susceptibility to lung cancer was investigated in 41 patients and 200 healty individuals. In a series of 41 lung cancer patients, the frequency of AW 16 was markedly decreased. However, no change was found in antigen frequencies in groups of patients with adenocarcinoma or squamous cell carcinoma.

View full abstract

Syrian golden hamsters were injected with UICC chrysotile asbestos intratracheally once a week for 12 weeks, and the lungs were examined at 2 days, 1, 2, 4, 6, 8, 12, 22, 32 weeks after injection. Asbestotic lesions were observed at first in peripheral bronchioles with acute inflammation and the lesions expanded into the surrounding alveoli as time progresses. In the lung at six weeks there were many large mononuclear cells in the alveoli and also there was also thickened alveolar wall containing inflammatory exudate. The exudate in alveolar walls was replaced gradually by argylophilic fibers, and at 32 weeks collagen fibers were also found in thickened alveolar wall. These changes suggest that asbestotic fibrosis is progressive. Slightly emphysematous changes were found in 22 and 32 weeks.
Hyperplastic epithelia with slight atypia were observed among these lesions, one at six weeks, three in 22 weeks, and two in 32 weeks respectively. Asbestos bodies were frequently found in hamster lungs as in men and guinea pigs.

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract