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Volume 39, Issue 3
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[in Japanese], [in Japanese]1999 Volume 39 Issue 3 Pages 235-236
Published: June 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSDownload PDF (164K) -
[in Japanese], [in Japanese]1999 Volume 39 Issue 3 Pages 237-240
Published: June 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSDownload PDF (4809K) -
Bumpei Kimura, Tatsuo Kidokoro, Mitsuru Hashizume, Shouji Tokimitsu, K ...1999 Volume 39 Issue 3 Pages 241-250
Published: June 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSOn the 452 cases of primary lung cancer resected at local community hospitals in Tokyo from 1982 to the end of 1995, the outcome of treatment was examined according to the different reasons for detection. There were (1) 151 cases found by symptoms;(2) 137 found through health check-ups; and (3) 164 found during treatment of other diseases. Of these three groups, stage I A + I B were (1) 40%, (2) 60%, and (3) 63% respectively, and 72%, 62% and 98% of each group had preoperative complications.
Deaths within 5 years of operation were (1) 82, (2) 63 and (3) 83 cases, and out of each, (1) 13, (2) 13 and (3) 31 cases were deaths due to other diseases.
The survival rate after 5 years were (1) 41%, (2) 49% and (3) 44% and no significant difference was found.
During the three years since 1991, among all the lung cancer inpatients at our hospital, the rate of resection in each category was (1) 20%, (2) 68% and (3) 43%, and the 5-year survival rate was (1) 8%, (2) 33% and (3) 19% respectively.
Although no significant difference was found in the outcome of resection for each group, it can be presumed that among all lung cancer cases, including those without resection, the rate of survival seems better in cases that were found through check-ups or during the treatment for other diseases, than those found by symptoms. Therefore, to achieve higher survival rates in lung cancer patients, it is important to detect the cancer in the asymptomatic stage.View full abstractDownload PDF (1183K) -
Significance of Mass Surveys for Lung CancerHiroaki Nakamura, Atsushi Saitoh1999 Volume 39 Issue 3 Pages 251-260
Published: June 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSBecause of the changes in the medical environment, including reduction in the medical budget, and the problem of informed consent in the diagnosis and treatment of patients with lung cancer, how the allocated amount is spent for diagnosis and treatment is extremely important against such a background, we investigated the economic effect on the diagnosis and treatment of lung cancer. We studied 29 cases of lung cancer admitted in our hospital between January 1991 and November 1997. Of them, 14 cases were treated with chemotherapy and the other 15 cases were treated with best supportive care (BSC). We estimated the total cost in relation to overall hospitalization, mean survival time, and the cost required to survive for one day, and compared these variables, with operative cases (p-stage I) treated in the same period as the control group. Most patients in the control group were detected by mass surveys. The control group required significantly lower costs compared to the chemotherapy and BSC groups in relation to all of the above variables.
These results suggest that mass surveys for lung cancer might be promising from the viewpoint of cost effectiveness.View full abstractDownload PDF (1140K) -
Kazuma Kishi, Masateru Kawabata, Eiyasu Tsuboi, Koji Narui, Sakae Homm ...1999 Volume 39 Issue 3 Pages 261-266
Published: June 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSSixty-seven patients with malignant pleural effusions caused by lung cancer were treated by pleurodesis with a combination of OK-432 and adriamycin (ADM). All patients underwent tube thoracostomy drainage. After pleural effusion was drained as much as possible, 5 to 10 Klinische Einheit (KE) units of OK-432 and 10 to 30 mg of ADM were injected into the pleural cavity. Additionally, 5 to 10 KE of OK-432, with or without 10 to 30 mg ADM, were instilled until daily drainage of pleural effusion decreased to less than 200 ml. The median total dose of instilled OK-432 was 10 KE and that of ADM was 30 mg. The median duration of tube drainage was 10 days. Overall response rate was 85.1%. Overall median survival time (MST) was 18.1 weeks. Only 12% of patients required repeated pleural drainage. The main toxicity was fever, but there were no serious adverse reactions. These results suggested that pleurodesis with a combination of OK-432 and ADM is an effective treatment for malignant pleural effusions in patients with lung cancer.View full abstractDownload PDF (646K) -
Takashi Hirose, Kiyoshi Mori, Suguru Machida, Takeshi Yoshida, Munehid ...1999 Volume 39 Issue 3 Pages 267-273
Published: June 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSFrom January 1987 to April 1998, a total of 103 patients with small cell lung cancer received treatment with combination chemotherapy, with or without radiotherapy, with a variety of regimens. Of them, 85 patients who achieved complete or partial responses were studied. We retrospectively studied the patterns of relapse, procedures for detecting relapse, and whether the relapse was diagnosed at the time of routine follow-up or between scheduled follow-up evaluations. Relapse developed in 60 patients. The chest was the most frequent site of relapse (46%, 42%) followed by the brain (33%, 25%) in patients with both limited disease and extensive disease. Relapses were detected by radiographic imaging in 51% of the patients, by clinical histories in 41%, by physical examinations in 4%, and by blood testing in 4%. Fifty-one percent of relapses in the chest were detected by plain chest X ray film, 38% of relapses in the brain were detected by computed tomography (CT) or magnetic resonance imaging (MRI). Most relapses except those in the brain were detected at the time of routine follow-up. The median relapse-free survival was 17.5 months (2-125 months), and all relapses occurred within 2 years. We recommend follow-up including plain chest X ray and brain CT or MRI for 2 years.View full abstractDownload PDF (717K) -
Yoshihiro Kobashi, Kazue Fujita, Takayuki Karino, Tatsutoshi Yano, Jun ...1999 Volume 39 Issue 3 Pages 275-281
Published: June 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSOf 530 unresectable non-small cell lung cancer cases observed between 1985 and 1997 at Kawasaki Medical School and Kawasaki Medical School Kawasaki Hospital, 15 cases (2.9%) surviving more than 3 years were analysed clinically. These longterm survival cases showed the following characteristics.
The average age of 15 cases (male 13 cases, female 2 cases) was 69.9 years old and the histological diagnosis was adenocarcinoma in 7 cases, squamous cell carcinoma in 7 cases and large cell carcinoma in 1 case. The performance status of almost all cases was sustained and the efficacy rate was 33%(5 of 15 cases). Of clinical stage IV cases, metastatic lesions were in the bone or lung, or both and their range was restricted.
The predicting factors related to long-term survival cases were analyzed in 530 patients. Univariate analyses showed significant differences in survival according to sex, age, performance status, histological differentiation, serum protein and serum albumin. The results of multivariate analyses revealed that performance status, serum albumin, serum protein, histological differentiation, age and sex were significant predicting factors.View full abstractDownload PDF (757K) -
Akio Yamazaki, Sadahiko Masuda, Yoshio Oose, Minoru Tahara, Kazuki Nak ...1999 Volume 39 Issue 3 Pages 283-288
Published: June 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA clinical study was conducted on 22 patients aged less than 40 years old who underwent resection for lung cancer in our department. They were 14 men and 8 women. Their mean age was 34.2 years old and the youngest patient was a 23-year-old woman. There were 12 (55%) asymptomatic cases and 10 (45%) symptomatic cases. Histological types were adenocarcinoma in 12 cases, squamous cell carcinoma in 2 cases, large cell carcinoma in 1 case, small cell carcinoma in 4 cases and carcinoid in 3 cases. Small cell carcinoma and carcinoid were more commonly found than in the over 40-yearold resected group. There were 9 stage I cases, 4 stage II, 7 stage IIIA, 1 stage IIIB and 1 stage IV, according to pathological examinations, thus 90% of the patients were in stage I + II + IIIA. All cases detected by mass screening were stage I + II + IIIA. The prognosis of patients less than 40 years old did not differ significantly from that of the over 40-year old resected group with a 5-year survival rate.View full abstractDownload PDF (597K) -
Mayumi Seto, Keiko Kuriyama, Masahiko Higashiyama, Shoji Kido, Hideoki ...1999 Volume 39 Issue 3 Pages 289-293
Published: June 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSWe reviewed computed tomographic scans of five patients of lung cancer with sarcoid-like reaction. Four were men and one was a woman. The ages ranged from 65 to 75. All patients were found to have mediastinal lymph node enlargement, and the presumptive diagnosis was metastatic disease. The histological examination of the resected lymph nodes revealed non-caseating epithelial cell granulomas and no cancer metastasis. In 3 of the 5 patients, superior mediastinal lymph nodes were enlarged, and in 3 of 5, pretracheal mediastinal lymph nodes were enlarged. Ten enlarged mediastinal lymph nodes were seen, and 7 of 10 nodes were measured 10×10mm. Our results show that radiographic patterns do not necessarily indicate metastatic disease. The assumption of metastatic disease can lead to inaccurate staging of the disease and inaccurate treatment and prognosis determination. Analysis of a larger series is needed. Furthermore, in operable cases, a mediastinoscopic biopsy should be performed to adequately exclude metastatic disease.View full abstractDownload PDF (5576K) -
Hidenori Hara, Kazuya Yamashita, Satomi Suzuki, Jun Shinada, Hirokuni ...1999 Volume 39 Issue 3 Pages 295-302
Published: June 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSActivation of telomerase, the enzyme that synthesizes the telomere ends of linear chromosomes, has been implicated in many cancer tissues. Within the last two years, the expression of human telomerase reverse transcriptase (h-TERM), a telomerase catalytic subunit, has been found to be highly correlated with telomerase activity, which is usually detected by TRAP assay. Non-small cell lung cancer tissues (22 samples from 22 patients) and the adjacent non-cancerous tissues (22 samples from 22 patients) were examined for telomerase activity and h-TER Tgene mRNA. In analysis of telomerase activity and the expression of h-TERT gene mRNA in non-small cell lung cancer tissues, we compared the relationship between the activity and the expression with two other factors, the histological type and the pathological stage, in 22 surgically resected primary lung cancer tissues and adjacent non-cancerous tissues. Among the 22 primary lung cancer tissues, telomerase activities were detected in 17 specimens (77.2%), and h-TER Tgene mRNA in 18 specimens (81.8%). On the other hand, telomerase activity was not detected (0%) in any 22 adjacent non-cancerous tissues, and h-TERT gene mRNA was detected in one specimen alone (4.5%). Therefore, both methods of telomerase identification can distinguish between cancer and non-cancer in most instances. However, there is no correlation between histological type or pathological stage and positivity for both assays of telomerase.View full abstractDownload PDF (5144K) -
Takashi Seto, Hiroshi Semba, Mayumi Seto, Yuki Nishida, Yuji Fukai1999 Volume 39 Issue 3 Pages 303-308
Published: June 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSPrognostic factors in 70 patients with non-small cell lung cancer (NSCLC) with malignant pleural effusion at initial treatment were examined retrospectively. They constituted 11% of the patients with NSCLC, diagnosed at our hospital from 1990 to 1997. Although 9 of the patients had negative in effusion cytology findings, malignant effusion was diagnosed by thoracoscopic pleural biopsy under local anesthesia. Of the patients with malignant pleural effusion 89% were adenocarcinoma of the lung. Using nonparametorical method analyses, N-factor (p=0.0105), clinical stage (0.0247), ECOG performance status (0.001), protein value of effusion (0.0095), and effusion volume/day (0.0019) were recognized as prognostic factors. Furthermore, N-factor and low protein value of effusion were poor predictive factors for survival, and intra-pleural chemotherapy and systemic chemotherapy were related to good survival in multivariate analysis. In clinical trail for patients with malignant pleural effusion, we must carefully compare these pre-treatment factors.View full abstractDownload PDF (591K) -
Computed Tomography and Pathological FindingsShingo Kakeda, Takatoshi Aoki, Hideyuki Watanabe, Keiko Hirakata, Haji ...1999 Volume 39 Issue 3 Pages 309-316
Published: June 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSCT and pathological findings were analysed concerning 28 nodules detected in lobes other than those with primary lung cancers. As for solid type nodules on CT, their margins were irregular in all 5 malignant nodules, while they were smooth in 8 of 10 benign nodules. However as for the type of air-containing /mixed attenuations, most benign and malignant nodules showed irregular margins and it was difficult to distinguish between them. Although 7 of 12 lesions with identical histologies showed similar growth patterns suggesting metastases, the possibility of multiple primary lung cancers could not be excluded in some of them. When other nodules are detected on preoperative CT in lobe other than that containing the primary lung cancer, a histological confirmation is recommended in most cases with regard to the possibility of multiple metastasis.View full abstractDownload PDF (5999K) -
Makoto Suzuki, Chikabumi Kadoyama, Taro Irie, Kenzo Hiroshima, Hidemi ...1999 Volume 39 Issue 3 Pages 317-321
Published: June 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSThe patient, a 53-year-old man, was referred to us with a complaint of bloody sputum by a general practitioner in March 1998. A nodular tumor was observed in the right main bronchus by bronchoscopy, and malignant cells suggesting adenocarcinoma were detected on biopsy. Since the mucosa of the right upper bronchus and truncus intermedius showed no abnormality, and also severe extramucosal invasion was not seen, a limited operation consisting of right main bronchus wedge resection and lymph node dissection was performed. Histologically, the tumor was diagnosed as a mucoepidermoid carcinoma of the salivary gland showing pleomorphism. There was no involvement of lymph nodes, and the tumor was classified as pT1N0M0, stage I A. This case is considered interesting because of difficulties in establishing the histopathological diagnosis and because of the operative technique for mucoepidermoid carcinoma of main bronchus origin.View full abstractDownload PDF (6144K) -
Michiko Tanaka, Megumi Sawada, Naohiko Inase, Masahiko Ichioka, Yutaka ...1999 Volume 39 Issue 3 Pages 323-329
Published: June 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSCase 1: A 82-year old man was admitted with cough and bloody sputum. Chest roentgenogram showed a mass in the right upper lobe and bilateral pleural effusion. Cytology from right pleural effusion revealed adenocarcinoma. A left gingival tumor emerged 1.5 months after his discharge, and he died two and a half months later. Autopsy revealed a metastatic tumor to the left upper gingiva from lung carcinoma.
Case 2: A 71-year old man was admitted with bloody sputum. Although chest roentgenogram showed a mass in the right lower lobe, neither transbronchial biopsy nor percutaneous biopsy yielded a definitive diagnosis. A right lower gingival tumor appeared, and the biopsy was interpreted as rhabdomyosarcoma. He died 5 months later due to metastatic brain tumors and respiratory failure. Autopsy revealed primary lung carcinoma (pleomorphic (spindle/giant cell) carcinoma) with gingival metastasis.
Case 3: A 63-year old man was admitted with a right upper gingival tumor. Chest roentgenogram showed a mass in the right lower lobe. Primary lung carcinoma was diagnosed (poorly differentiated adenocarcinoma) with gingival metastasis. He died of respiratory failure due to uncontrolled malignant pleural effusion 1.5 months later.
A literature survey of gingival metastases from lung cancer revealed that most cases were poorly differentiated lung cancer and prognosis was very poor. In several cases, irradiation and chemotherapy were effective. Therefore, those treatment regimens should be considered for gingival metastases in early stage cases.View full abstractDownload PDF (9437K) -
Yoshiki Demura, Yoshitaka Totani, Seiji Tsubosaka, Shingo Ameshima, Ta ...1999 Volume 39 Issue 3 Pages 331-337
Published: June 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA 48-year-old woman with primary lung cancer was admitted to our hospital complaining of finger clubbing and progressive polyarthralgia. Pulmonary hypertrophic osteoarthropathy (PHO) associated with primary lung cancer was diagnosed based on a bone scintigram showing abnormal uptakes and a thermogram showing an increased blood flow in all distal digits. Resection was performed. The histological diagnosis was well differentiated adenocarcinoma. Her symptoms rapidly improved after the operation. The abnormal findings of the bone scintigram and thermogram synchronously improved until 4 months after surgery. The thermogram was valuable in the diagnosis and follow-up of PHO.View full abstractDownload PDF (10054K) -
Hirotoshi Kubokura, Kazunori Nishida, Hitoshi Nishimura, Mitsunobu Yam ...1999 Volume 39 Issue 3 Pages 339-344
Published: June 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSThe patient was a 45-year-old woman with a 2 cm-sized abnormal shadow on the chest x-ray. The nature of the tumor, benign or malignant, could not be defined by CT scan or bronchoscopy. Exploratory thoracotomy was performed, and enucleation of the tumor was tried, because it was considered to be benign from examination by palpation.
However, as the diagnosis on the frozen section was adenocarcinoma, a left lower lobectomy was performed. The final pathological diagnosis was “biphasic pulmonary blastoma.” The clinicopathological characteristics of this case were: no clinical symptoms, a small tumor and, histologically, embryonal carcinoma-like features.View full abstractDownload PDF (8126K) -
Kazuhiro Sakamoto, Satoshi Hirokawa, Yasunobu Yamazaki, Takashi Suda, ...1999 Volume 39 Issue 3 Pages 345-350
Published: June 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA 50-year-old man was admitted to our hospital with an abnormal shadow on chest X-ray. Chest CT scan showed a 2.4×1.5 cm tumor adjacent to a bulla in the right upper lobe. Transbronchial lung biopsy failed to obtain a definitive diagnosis. We performed tumorectomy. The tumor was located in the lateral wall of the bulla and lung cancer was diagnosed. Right upper lobectomy with mediastinal lymph node dissection (R2a) was then performed. Histologically, the tumor cells were medium to large in size, and had a trabecular growth pattern. Mitoses were frequently observed and focal necroses were also seen in the tumor. Because the immunohistochemical staining of the tumor was positive for synaptophysin and Leu-7, the tumor was pathologically diagnosed as large cell neuroendocrine carcinoma (LCNEC).View full abstractDownload PDF (5723K) -
1999 Volume 39 Issue 3 Pages 351-357
Published: June 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSDownload PDF (1010K)
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