Bronchogenic Carcinoma In Patients Research Articles

Usefulness of post-bronchoscopic sputum cytology with respect to bronchoalveolar lavage and brush cytology using fiber-optic bronchoscopy in suspected cases of lung cancer

Background: Bronchogenic cancer is the most common cause of cancer-related mortality in both sexes all over the world, especially across urban population. However, early diagnosis and timely intervention may minimize the mortality rate to a certain extent and increase the 5-year survival rate to 70–80%. Among the diagnostic modalities available, bronchoscopic biopsy, though gold standard, is less feasible in peripheral centers where we depend more on cytological techniques such as bronchoalveolar lavage (BAL) fluid and sputum cytology for quick diagnosis. Aims and Objectives: This study was conducted at a tertiary care center for studying usefulness of post-bronchoscopic sputum cytology and also to correlate sputum cytology with brushing and washing cytology taking biopsy as the gold standard in the diagnosis of lung cancer. Materials and Methods: A cross-sectional observational study was done in Nil Ratan Sircar Medical College, Kolkata, over a period of 18 months in clinically and radiologically suspected patients of bronchogenic carcinoma. Bronchoscopic samples using a fiber-optic bronchoscope were collected from 50 such patients. In every case, following sequence of events was performed: Pre-biopsy washing (BAL fluid), brushing, biopsy, post-biopsy washing (BAL), and post-bronchoscopy sputum. Cytological examination done and compared with bronchoscopic biopsy specimens of the same. Results: All the available information were meticulously documented in tables and charts along with other variables such as age, sex, morphological types, and cytological and histological diagnosis. SPSS software was used to calculate the efficacy and statistical significance, if any, of these different diagnostic tools and its correlation with the final histological diagnosis. Conclusion: We found that BAL cytology had higher sensitivity and positive predictive value in early and accurate diagnosis of lung malignancy. However, post-bronchoscopy sputum cytology had no additional benefit with respect to BAL and brush cytology (in addition to bronchial biopsy) in diagnosing the same.

Lobectomy versus sublobar resection in patients with non-small cell lung cancer: a systematic review.

Surgery is the gold standard treatment of lung cancer. The minimally invasive technique does not only concern access to the chest but also the limits of parenchymal resection. The study debates on the safety and oncological adequacy of sublobar resections in bronchogenic carcinoma patients. A systematic analysis of the data in the literature was carried out, comparing the outcomes of patients with resectable non-small lung cancer (NSCLC) who underwent lobectomy or sublobar resection. These last interventions include both segmentectomies and wedge resections taking into consideration the following parameters: complications, relapse rate and overall survival. The complication rate is higher in patients underwent lobectomy compared to sublobar resection, especially in presence of high comorbidity index or octogenarian patients (overall values respectively between 0 and 48% and 0 and 46.6%). Contrarily, the relapse rate (6.2% to 32% vs. 3.6% to 53.4%) and overall survival (50.2% to 93.8% vs. 38.6% to 100%) are more favorable in patients undergoing lobectomy. Sublobar resections are particularly indicated in elderly patients and in patients with high comorbidity index or reduced respiratory functional reserve. However, pulmonary lobectomy still remains the safest and oncologically correct method in patients with good performance status or higher risk of recurrence.

LUng CAncer focuS - Long-term Monitoring of Bronchogenic Carcinoma Patients (LUCAS)

LUng CAncer focuS - Long-term Monitoring of Bronchogenic Carcinoma Patients (LUCAS)

GAMBARAN STATUS, DERAJAT DAN PROFIL MEROKOK SERTA KETERGANTUNGAN NIKOTIN PADA PASIEN PEROKOK YANG DIRAWAT DI BANGSAL PARU RSUP DR. M. DJAMIL PADANG

Smoking was still health major problem in the word that lead 7.1 million smoking related deaths annually. Prevalence smoking in Indonesia was fifth in the world. Based on Riskesdas in 2007 and 2010 showed an increase number of smokers from 29% - 34.7%. <strong>Methods: </strong>This is Descriptive-prospective study in 177 patients who were treated in pulmonary ward of Dr. M. Djamil Padang from November 2016 to January 31, 2017. Data were collected through interviews patients with closed questions and validated questioner. <strong>Results: </strong>This study found total 177 patients that consist of 128 (72.4%) males with an average age of 52.5 ± 15.57 SD years. History of smoking were 63 smokers (35.6%), 67 nonsmokers (37.8%) and former smokers 47 (26.5%). Smoker patients have been found most in bronchogenic carcinoma patients 24 (38%), with profile for stress 34 (54%), and the Brinkman index grade was severe. Former smokers were mostly in patients with pneumonia 11 (23.4%) and COPD 10 (21.2%). The nicotine dependence is low to moderate 13 (56.5%) in patients with bronchogenic carcinoma and low dependence 10 (53%) in TB patients. <strong>Conclusion: </strong>Patients that were treated in the pulmonary ward more than third were smokers. The most common profile was for pleasure and nicotine dependence mostly low to moderate could give opportunity for educational intervention.

EP1.16-10 Differentiation of Performance Status After Tumor Debulking in Malignant Central Airway Tumor via Rigid Bronchoscopy

Bronchogenic carcinoma patients have been suffered from cancer and its complications. The aim of cancer treatment is for prolonged survival and symptomatic control. Novel multimodality treatment can be relieving symptoms and improve patients’ performance status (PS). Malignant central airway obstruction is the most harmful complication that increases morbidity, mortality and decreases PS. Rigid bronchoscopy with tumor resection plays pivotal roles for resolve these problems Retrospective Observational study enrolled cancer patients who had been suffered from malignant central airway obstruction that undergo Rigid bronchoscopy with tumor debulking in Phramongkutklao Hospital during January 2014 – October 2018 64 cancer patients were included in this study. 37(60.7%) were older than sixty. 36 (59%) were male and 38 (62.3%) had primary lung cancer in origin. 30 (49.2%) had left main bronchial obstruction 24(39.3%) had right main bronchial obstruction and 15(24.6%) had the tracheal obstruction. Most of patients 43(70.5%) had intraluminal obstruction and degree of obstruction were grade 4 39(63.9%). Pre-intervention ECOG 2-4 group were 23(37.7%), 24(39.3%) and 14(23%) respectively. Mean pre- intervention ECOG was 2.9±0.8 After rigid bronchoscopy with tumor debulking mean ECOG was decreased to 1.8 ±1.0. 46 of 64 (90.2%) had clinical improvement after successful procedure. 37 (72.5%) had 6-month survival and 33(64.7%) had 1-year survival after successful procedure, compared with 2(20%) and 1(10%) in unsuccessful procedure. 43(95.6%) had opportunity to received other treatment such as chemotherapy, targeted therapy, etc. after ECOG status was improveView Large Image Figure ViewerDownload Hi-res image Download (PPT) Rigid bronchoscopy with tumor debulking improves performance status, increases survival and increases opportunity for other new multimodality treatment in cancer patients who had malignant central airway obstruction.

Role of PET/CT in Differentiating Bronchogenic Carcinoma from Inseparable Pseudo-Neoplastic Lesions

Background: Bronchogenic carcinoma is the single most important cause of cancer-related deaths with approximately 1.5 million cases worldwide every year. Computed tomography (CT) scanning can only estimate the proximal extent “with difficulty in visualization the real borders” of a tumor. The role of MRI in local staging of bronchogenic carcinoma is limited by the signal loss secondary to respiratory motion and heterogeneity of the magnetic field caused by the tissue/air interfaces. Positron Emission tomography combined with CT (PET/CT can accurately delineate the viable tumor from surrounding atelectasis and collapse/consolidation, this information cannot only demarcate the size and extent of the tumor for accurate T staging, but also provide guidance for biopsies if histological confirmation is required Purpose: It was to emphasize the role of PET/CT in differentiation the bronchogenic carcinoma from its inseparable pseudo-neoplastic lesions for better staging and increase the accuracy of follow up by ruling out the pseudo progression as well as pseudo regression. Patients and Methods: The study involved 32 patients proved histo-pathologically to have bronchogenic carcinoma and referred for PET/CT scanning. Each patient included in the study was subjected to full history taking, reviewing medical sheet and PET/CT examination. The study was done in private center (Techno-scan holding center, Heliopolis branch using PET-CT machine (GE Discovery VCT 64 PET/CT, USA); in which PET-CT examination was followed by diagnostic contrast enhanced CT examination and processed at Ain Shams University, Radiology department. Results: In this study we found presence of inseparable pseudo neoplastic lesions among 20 patients out of 32 patients and the mean diameter of the bronchogenic mass lesion was 6.89 +/- 3.65 SD as measured by CT, while it was 5.77 +/-3.38 SD as measured by PET/CT in centimeters. Conclusion: The combined PET/CT using 18F-FDG is the best oncologic imaging modality with valuable role in local staging and follows up in patients of bronchogenic carcinoma.

Role of PET/CT in Differentiating Bronchogenic Carcinoma from Inseparable Pseudo-Neoplastic Lesions

Background: Bronchogenic carcinoma is the single most important cause of cancer-related deaths with approximately 1.5 million cases worldwide every year. Computed tomography (CT) scanning can only estimate the proximal extent “with difficulty in visualization the real borders” of a tumor. The role of MRI in local staging of bronchogenic carcinoma is limited by the signal loss secondary to respiratory motion and heterogeneity of the magnetic field caused by the tissue/air interfaces. Positron Emission tomography combined with CT (PET/CT can accurately delineate the viable tumor from surrounding atelectasis and collapse/consolidation, this information cannot only demarcate the size and extent of the tumor for accurate T staging, but also provide guidance for biopsies if histological confirmation is required Purpose: It was to emphasize the role of PET/CT in differentiation the bronchogenic carcinoma from its inseparable pseudo-neoplastic lesions for better staging and increase the accuracy of follow up by ruling out the pseudo progression as well as pseudo regression. Patients and Methods: The study involved 32 patients proved histo-pathologically to have bronchogenic carcinoma and referred for PET/CT scanning. Each patient included in the study was subjected to full history taking, reviewing medical sheet and PET/CT examination. The study was done in private center (Techno-scan holding center, Heliopolis branch using PET-CT machine (GE Discovery VCT 64 PET/CT, USA); in which PET-CT examination was followed by diagnostic contrast enhanced CT examination and processed at Ain Shams University, Radiology department. Results: In this study we found presence of inseparable pseudo neoplastic lesions among 20 patients out of 32 patients and the mean diameter of the bronchogenic mass lesion was 6.89 +/- 3.65 SD as measured by CT, while it was 5.77 +/-3.38 SD as measured by PET/CT in centimeters. Conclusion: The combined PET/CT using 18F-FDG is the best oncologic imaging modality with valuable role in local staging and follows up in patients of bronchogenic carcinoma.

Computed tomography‐guided intraluminal brachytherapy in recurrent bronchogenic carcinoma: A clinical trial in a small group

AbstractObjectiveThe overall survival (OS) of lung cancer patients has been significantly extended as a consequence of chemotherapy and targeted drug utilization, which has resulted in an increase in local recurrences. The present study followed patients to evaluate the short‐term and long‐term efficacies and the safety of high‐dose rate intraluminal brachytherapy (ILBT) in recurrent bronchogenic carcinoma patients, and investigate the factors that influence prognosis.MethodsThe clinical records, treatment, curable effects, and adverse events of 15 patients treated in the First Affiliated Hospital of Soochow University, Suzhou, China, who were diagnosed with recurrent bronchogenic cancer between 1 June 2009 and 30 September 2015 were reviewed, and survival analysis was assessed by the Kaplan–Meier method.ResultsA total of 15 recurrent bronchogenic carcinoma patients received ILBT, and information on curable effects and safety was available. The group consisted of two complete response (2/15), 11 partial response (11/15), one stable disease (1/15) and one progression disease (1/15). The response rate was 86.7% (13/15), and disease control (complete response + partial response + stable disease) was 93.3% (14/15). The dyspnea indexes of the patients decreased significantly in weeks 1, 2, 4, and 8 after ILBT treatment (P < 0.001). The average post‐ILBT partial remission period was 5.27 ± 3.35 months, and the median partial remission period was 3.24 months. The combination therapy of ILBT and bronchofiberscope (P = 0.013), and a total ILBT dose of ≥20 Gy could produce a partial effective rate. The progress‐free survival of patients was 9.5 months (95% CI 12.2–16.5 months), average progress‐free survival was 15.8 ± 14.4 months, median OS was 32.0 months (95% CI 25.0–30.0 months), 1‐year OS was 93.3% (14/15), and 3‐year OS was 40.0% (6/15). The main adverse events were bronchospasm and hemoptysis (grade III); others were grade I–II.ConclusionComputed tomography‐guided ILBT is a safe, effective palliative treatment for recurrent bronchogenic carcinoma, but it requires further study in larger groups.

“A Study to Assess Socio Clinical profile of Lung Cancer Patients in a Tertiary Care Hospital of India”

INTRODUCTION: - Lung cancer is among the five main types of cancer leading to overall cancer mortality contributing about 1.3 million deaths/year globally. There are only few Indian studies on bronchogenic carcinoma in patients below 40 years, describing its pattern and epidemiology. Hence we planned this study to evaluate the profile of lung cancer in patients of age less than 40 years and elderly patients MATERIAL AND METHODS: This was a cross-sectional descriptive study (including retrospective secondary and prospective primary data) using data base of patients of primary lung cancer diagnosed between 1 st January 2006 to 31 st December 2012 in indoor and outdoor of department of Respiratory Medicine, J.L.N. Medical College, Ajmer, a tertiary level hospital and teaching center. RESULTS: - In the present study there were 1418 male and 352 female patients with male: female ratio of 4.03 suggesting that the disease was more common in males.The maximum number of cases (46.89%) were from the 41-60 year age group followed by (39.21%) in 61-80 years. 9.03% patient were below the age of 40 year.

A Study to Assess Treatment response and Pattern among Lung Cancer Patients in a Tertiary Care Hospital of India

Introduction: Lung cancer is among the five main types of cancer leading to overall cancer mortality contributing about 1.3 million deaths/year globally. There are only few Indian studies on bronchogenic carcinoma in patients below 40 years, describing its pattern and epidemiology. Hence we planned this study to assess treatment response and Pattern among Lung Cancer Patients of age less than 40 years and elderly patients. Material and Methods: This was a cross-sectional descriptive study (including retrospective secondary and prospective primary data) using data base of patients of primary lung cancer diagnosed between 1 st January 2006 to 31 st December 2012 in indoor and outdoor of department of Respiratory Medicine, J.L.N. Medical College, Ajmer, a tertiary level hospital and teaching center. Results: In the present study there were 1418 male and 352 female patients with male: female ratio of 4.03 suggesting that the disease was more common in males. The maximum number of cases (46.89%) were from the 41-60 year age group followed by (39.21%) in 61-80 years. 9.03% patient were below the age of 40 year. Maximum patients (50%) benefited with partial relief of symptoms and radiological regression after treatment.

Early operative mortality of bronchogenic carcinoma

Introduction: Lung cancer is the most common cancer in the world operative mortality rates for resection of lung cancer varies with type of resection carried out. Aim: The aim was to study the various causes of 30-day mortality, difference in the 30-day operative mortality between pneumonectomy, lobectomy and lesser resections and overall 30-day operative mortality following lung resection surgery of bronchogenic carcinoma. Materials and Methods: All those patients of bronchogenic carcinoma who were planned for lung resection surgery, from May 2008 to October 2010 in the department of cardiovascular and thoracic surgery, were included in the study protocol prospectively. Results: Lung carcinoma is predominantly a disease of males. The most common finding on X-ray chest is evidence of mass lesion. 91.1% had positive findings on bronchoscopic examination. Squamous cell carcinoma was present in the majority of patients (74.4%). Majority of patients underwent lobectomy (55.6%). Overall 30-day operative mortality was 4.4%. Mortality was more in patients who underwent pneumonectomy. Advanced age was associated with significant mortality. The most common postoperative complication was pneumonia followed by bronchopleural fistula. Conclusion: Surgery for bronchogenic carcinoma is associated with low mortality and morbidity and a good outcome, especially in patients with early stage disease.

Human papillomavirus type-16 positive endobronchial metastasis from uterine cervical cancer.

Although the lung is the most common site of metastasis from extrapulmonary malignancies, endobronchial metastases (EBM) are relatively rare. EBM typically originate from breast, colorectal, or kidney cancer. EBM from uterine cervical cancer is relatively rare and is difficult to confirm. In this study, we report a case of EBM in a patient with previously treated uterine cervical cancer. In this case, differentiation of the EBM from primary bronchogenic carcinoma with clinical, radiological, and pathologic findings was difficult. As identical human papillomavirus (HPV)-16 DNA was detected in both the EBM and in previously resected tissues from the prior uterine cervical cancer, the patient was diagnosed with EBM from uterine cervical cancer. HPV genotyping may aid in discriminating EBM from primary bronchogenic carcinoma in patients with uterine cervical cancer.

Aspergillus colonization in patients with bronchogenic carcinoma.

Aspergillus antigens such as galactomannan antigen, a cell wall polysaccharide, can be detected in patient's serum or bronchoalveolar lavage. To study the prevalence of Aspergillus infection in patients with bronchogenic carcinoma, we measured galactomannan antigen in serum and bronchoalveolar lavage samples of patients with bronchogenic carcinoma. The study was conducted on 45 bronchogenic carcinoma patients. The diagnosis of lung cancer was confirmed by bronchoscopy, histopathological and radiological examinations. Bronchoalveolar lavage fluid collected from each patient by fiberoptic bronchoscopy was subjected to direct microscopy and culture on Sabouraud's dextrose agar and Czapek-Dox agar, and Aspergillus galactomannan antigen was measured in serum and bronchoalveolar lavage samples. The majority of patients were male (93.3%) in the age group 51-60 years, 88.9% were addicted to gutka chewing, and 82.1% were addicted to smoking. Most patients complained of cough (73%) and shortness of breath (51.1%). Squamous cell carcinoma (64.4%) was the most common malignancy, followed by adenocarcinoma (13.3%). On culture of bronchoalveolar lavage samples, 35.5% showed growth of Aspergillus spp. (Aspergillus fumigatus in 17.8%, Aspergillus flavus in 13.3%, and Aspergillus niger in 4.4%). Galactomannan antigen was detected in 58.3% of bronchoalveolar lavage samples and 47.2% of serum samples. There is a high prevalence of aspergillosis in patients with lung carcinoma, especially among smokers and gutka chewers.

Hypercoagulability in different respiratory diseases

BackgroundThe risk of venous thromboembolism (VTE) is equally high in medical patients admitted to the hospital and those treated in the surgery wards. Patients who are immobilized due to heart failure, severe respiratory disease, cerebrovascular stroke and cancer are at a high risk of venous thrombosis. Aim of the workThe aim of the study was to assess the impact of different respiratory insults on blood coagulation for early detection and prevention of thrombosis to open the way for thromboprophylaxis in such cases. Patients and methodsThe study included 25 apparently normal healthy control subjects and 141 patients with different respiratory disorders. All patients were subjected to full medical history taking, full clinical examination, and radiological evaluation. Computed tomography (CT) pulmonary angiography was done for all cases and lower limb duplex ultrasonography for all patients, at day 1 and day 5 of admission. The following coagulation markers were evaluated for all patients at day 1, 2,3,4, and 5 of admission including: Soluble fibrin complex, D dimer, thrombin antithrombin complex, antithrombin, protein C, protein S, and fibrinogen. ResultsIt was found that, the mean values of soluble fibrin complex, D dimer and thrombin antithrombin complex were higher in patients with positive duplex ultrasonograghy and positive CT angiography than patients with negative duplex ultrasonograghy and CT angiography and the difference was statistically highly significant. The higher mean values for soluble fibrin complex was on the third day of admission, while the higher mean values for D dimer, thrombin antithrombin complex and fibrinogen were on the fifth day. Whereas, there are no detectable variations in levels of antithrombin, protein C and protein S on all 5days there were highly statistically significant differences in soluble fibrin complex, D dimer and fibrinogen levels between all disease groups and the control subjects. The mean values of soluble fibrin complex, D dimer, thrombin antithrombin complex and fibrinogen were higher in severe COPD patients than in moderate COPD patients and the difference was statistically significant while there was no statistically significant difference in coagulation marker levels between moderate and severe asthmatic patients and also, between bronchogenic carcinoma and mesothelioma patients. ConclusionsEstimation of soluble fibrin complex, D dimer, thrombin antithrombin complex and fibrinogen may be useful for early identification of the prethrombotic state which may help to prevent the onset of thrombotic disorders and thereby improve the outcome of various respiratory diseases. Common respiratory disorders especially, COPD exacerbation, pneumonia, interstitial pulmonary fibrosis, and lung cancer are considered to be hypercoagulable states which carry high risks for the development of venous thromboembolism.

Relationship between Angiogenic Squamous Dysplasia and Bronchogenic Carcinoma in Patients Undergoing White Light Bronchoscopy

To better understand the characteristic morphology of angiogenic squamous dysplasia (ASD) and its association with different types of common bronchogenic carcinomas using routine white light bronchoscopy. Using a case-control design, 186 formalin-fixed paraffin-embedded blocks of bronchial tissue (136 cases, 50 controls) obtained from patients who underwent routine nonfluorescence bronchoscopy between 2004 and 2005 were studied. ASD occurred at a higher frequency in patients with neoplastic lesions compared with those without neoplastic lesions (28 of 136 versus one of 50). ASD was also more prevalent in patients with squamous cell carcinoma compared with other neoplasms. Seventy six per cent of the ASD patients (22 of 29) smoked cigarettes. The morphology of ASD on hematoxylin and eosin- and CD31-stained sections was characterized by prominent microvasculature and capillary projections closely juxtaposed to variable degrees of dysplasia in all of the bronchogenic carcinoma specimens, and to metaplasia in one case in the control group. ASD is a unique morphological entity that should be considered by pathologists even on bronchoscopic biopsies from patients who undergo white light bronchoscopy. The presence of ASD may represent a risk biomarker of bronchogenic carcinoma in screening programs and in chemoprevention of lung cancer.

Increasing secondary bacterial infections with Enterobacteriaceae harboring blaCTX–M–15 and blaCMY-6 in patients with bronchogenic carcinoma: an emerging point of concern

Objective To look for secondary bacterial infections in bronchogenic carcinoma (BC A) with resistant organisms harboring bla genes considering the paucity of relevant studies. Methods A total of 137 confirmed cases of BC A and 34 healthy volunteers were studied for the occurrence and prevalence of bla CTX-M and and bla AmpC harboring–enterobacteriaceae. A subset of these patients ( n=69) was previously reported for the secondary infection with the Aspergillus species. Bronchoalveolar lavages (BAL) were subjected for bacterial and fungal cultures and the bacterial isolates were screened by multiplex PCRs for the presence of bla CTX–M and bla AmpC. The isolates were also screened for the association of insertion sequence (IS26) by PCR and characterized by RAPD for any clonal relatedness. Results A total of 143 bacterial isolates were obtained from 137 BAL specimens of BC A patients. The Enterobacteriaceae–isolates were multidrug-resistant showing concomitant resistance to fluoroquinolones and aminoglycosides. Both bla CTX-M and bla AmpC of CIT family were detected in 77.4% and 27.4% isolates, respectively. Sequencing revealed the presence of bla CTX–M–15 and bla CMY-6. Twenty one percent of the isolates were simultaneously harboring bla ampC and bla CTX–M–15. IS26 PCR and RAPD typing revealed the presence of diverse bacterial population but no predominant clone was identified. The present study also suggests strong association of aspergillosis with lung cancer and further strengthens the potential use of non-validated serological tests suggested earlier. Conclusions We emphasize that all patients of bronchogenic carcinoma should also be screened for secondary bacterial infections, along with secondary fungal infections, so as to introduce early and specific antimicrobial therapy and to prevent unwanted deaths.

A case-control study of bidi smoking and bronchogenic carcinoma

OBJECTIVE:To evaluate the risks imposed by tobacco smoking, in particular, bidi smoking, in the development of lung cancer.METHODS:Two hundred eighty-four histologically confirmed patients of bronchogenic carcinoma and 852 controls matched for age, sex, and socioeconomic status were interviewed according to a predesigned questionnaire. Effects of individual variables defining the various aspects of tobacco smoking, in particular, bidi smoking, were assessed using logistic regression models.RESULTS:81.3% cases of bronchogenic carcinoma were ever smokers as compared with 42.2% among controls. The odd ratios for ever smoking, bidi smoking, and cigarette smoking were 5.9 (confidence interval [CI] 4.3, 8.4), 6.1 (CI 4.3, 8.7), and 5.3 (CI 2.7, 10.4), respectively.CONCLUSION:Bidi smoking poses a very high risk for lung cancer even more than that of cigarette smoking.

Bronchogenic carcinoma in patients under 50 years old

Lung cancer in young patients is increasing in frequency. Its clinical course seems to be more aggressive than in the elderly. Our objective is to assess the clinicopathologic characteristics and survival of patients with bronchogenic carcinoma who underwent surgery at our department, comparing people younger than 50 years to older patients. We present a retrospective study of 610 patients diagnosed with non-small-cell lung cancer operated on between 1997 and 2006. They were classified into two groups: under 50 (n=60) and equal to or over 50 (n=550). The proportion of women, smokers and adenocarcinoma were significantly higher in young patients. There were no significant differences in survival rate between the two groups. In our series, despite the differences in sex, smoking history and histology, the behaviour of the disease is similar in both age groups.

Bronchogenic carcinoma in patients undergoing solid organ transplant. The role of surgery

BackgroundThe incidence of neoplastic diseases is higher in patients undergoing solid organ transplant. However, the incidence of bronchogenic carcinoma (BC) is controversial. The objective of our study was to determine the incidence of BC in a large cohort of transplant patients and the role of surgery. Material and methodsUntil December 2006, 3596 patients underwent solid organ transplant at our institution; 24 (0.7%) patients subsequently developed BC, of which 6 (24%) were classified as clinical stage I and submitted to surgical treatment. Survival was estimated by the Kaplan-Meier method. ResultsThree patients received a liver transplant, 2 a kidney transplant and 1 a heart transplant. All were male and all had a smoking history. Mean age was 58.6 years. Two patients had cough, one accompanied by bloody expectoration, and BC was an incidental finding in the remaining cases. The interval between transplant and diagnosis of BC was 38.1 months. Epidermoid carcinoma was the most frequent histological type. Mean tumour size was 3.6cm (range, 1.3–6). One tumour was classified as pathological stage IA, 4 as stage IB, and 1 as IIB due to parietal pleural invasion. No patient died during the perioperative period and only one had a haemothorax which resolved with chest tube drainage. Mean hospital stay was 8.5 days (range, 7–11). The immunosuppression regimen was maintained continuously. In subsequent follow-up, 1 patient died from BC metastasis, 1 from sepsis, 1 from chronic renal failure, and 3 remained alive. The probability of survival at 5 years was 40%, and median survival was established at 5 years. ConclusionsThe incidence of BC in patients undergoing solid organ transplant and the proportion of patients diagnosed in early stages does not differ from non-transplant patients diagnosed with BC, which questions the role of immunosuppression in the genesis and aggressiveness of BC in transplant patients. Surgery may offer acceptable results in early stages, with acceptable rates of perioperative morbidity and mortality.

Alveolar macrophages from patients with bronchogenic carcinoma and sarcoidosis similarly express monocyte antigens

It has been shown that bronchoalveolar lavages (BALs) from patients with sarcoidosis and other interstitial lung diseases contain abnormally increased numbers of alveolar macrophages (AM) expressing antigens found on monocytes. The aim of this study was to compare the phenotype of AM from patients with sarcoidosis with those from patients with non-interstitial lung disease, namely carcinoma. Using a panel of monoclonal antibodies against cells of the mononuclear phagocytic series and immunohistochemical staining, we have compared the expression of antigens on AM recovered at BAL and peripheral blood monocytes from patients with sarcoidosis, with similar cell preparations from bronchogenic carcinoma patients and normal volunteers. We have shown that CD14, CR1 (CD35) and CR3 (CD11b, CD18) are expressed on the majority of monocytes from all subjects, but on only a minority of normal AM. In both patients with sarcoidosis and patients with bronchogenic carcinoma increased proportions of AM expressed these monocyte-associated antigens. Since BALs from the carcinoma patients were derived from lung lobes which were radiologically free of tumour, the accumulation of AM expressing monocytic antigens is not a local response to the tumour. We conclude that infiltration of the lung with monocytes is a more general response to lung disease than has hitherto been reported.