Primary Lung Cancer Patients Research Articles

Clinical evaluation of combination assay of tumor markers in primary lung cancer patients

Recently, the measurement of tumor markers, particularly for combined measurement, have been reported to be useful for the early diagnosis of cancer. In this study, the authors measured the serum levels of SLX, CA19-9, CA153, CA125, NCC-ST-439, CEA, SCC, NSE, TPA and IAP in 155 patients with primary lung cancer before treatment (76 adenocarcinomas, 40 squamous cell carcinomas, 36 small cell cancers, 3 large cell cancers). Seventy three benign lung disease cases were also studied as controls. The serum levels of CA19-9, CA153, CA125, NCC-ST-439, CEA, NSE and TPA were significantly higher in lung cancer patients than in benign lung disease patients. CA125 and CEA levels in adenocarcinoma, SCC levels in squamous cell carcinoma, NSE levels in small cell cancer and NCC-ST-439 in non-small cell cancer were significantly higher than those of other histological types of cancer. The level of each marker became higher, and was related with advance in stage. The probability of lung cancer was 90% when three markers were positive except for IAP, which was frequently false positive in benign lung disease. In conclusion, the simultaneous, combined measurement of at least three markers, including CEA and/or TPA was considered to be useful for the diagnosis of lung cancer.

Management of Multiple Primary Lung Cancer in Patients with Centrally Located Early Cancer Lesions

Patients with centrally located early lung cancer (CLELC) are often heavy smokers with a considerably high risk of multiple primary lung cancer (MPLC) lesions; treatment strategies for such patients must preserve the cardiopulmonary function. Between July 2004 and July 2008, patients with CLELC underwent photodynamic therapy (PDT) using NPe6, second-generation photosensitizer at Tokyo Medical University Hospital. Among these patients, we retrospectively analyzed MPLC, which was treated by surgery plus PDT or PDT alone and examined the effectiveness of PDT, and we propose a treatment strategy for patients with MPLC. A total of 64 patients with CLECL received NPe6-PDT, and MPLCs were found in 22 patients (34.4%) using sputum cytology and a bronchoscopical examination using autofluorescence bronchoscopy. Among these 22 patients, 10 patients underwent surgery for primary lung cancer and underwent NPe6-PDT for the treatment of secondary primary CLELC, one patient underwent PDT for CLELC as a primary lesion followed by an operation for peripheral-type lung cancer as a secondary primary lesion, and 11 patients underwent PDT alone for MPLC lesions (28 lesions) that were roentgenographically occult lung cancers. Among these 22 patients with MPLC including peripheral-type lung cancers, which were resected by surgery, all 39 CLELC lesions exhibited a complete response after PDT, and all patients were alive. For patients with lung cancer with a long-term history of smoking, careful follow-up examinations after surgical resection are needed considering the incidence of metachronous primary lung cancers. PDT can play an important role for the treatment strategy for MPLC.

Image-Guided Radiofrequency Ablation of Lung Neoplasm in 100 Consecutive Patients by a Thoracic Surgical Service

Surgical resection is the standard of care for patients with resectable non-small cell lung cancer or selected patients with pulmonary metastases. However, for high-risk patients radiofrequency ablation (RFA) may offer an alternative option. The objective of this study was to evaluate computed tomography-guided RFA for high-risk patients and report our initial experience in 100 consecutive patients by a thoracic surgical service. Medically inoperable patients were offered RFA. Thoracic surgeons evaluated and performed RFA under computed tomography guidance. Patients were followed in the thoracic surgery clinic. The primary end point evaluated was overall survival. One hundred patients underwent image-guided RFA for lung neoplasm (40 men, 60 women; median age, 73.5 years; range, 26 to 95 years). Forty-six patients (46%) with primary lung neoplasm, 25 patients (25%) with recurrent cancer, and 29 patients (29%) with pulmonary metastases underwent RFA. The mean follow-up for alive patients was 17 months. The median overall survival for the entire group of patients was 23 months. The probabilities of 2-year overall survival for the entire group, primary lung cancer patients, recurrent cancer patients, and metastatic cancer patients were 49% (95% confidence interval, 37 to 60), 50% (95% confidence interval, 33 to 65), 55% (95% confidence interval, 25 to 77), and 41% (95% confidence interval, 19 to 62), respectively. Our experience indicates that image-guided RFA done by the thoracic surgeons is feasible and safe in high-risk patients with lung neoplasm with reasonable results in patients who are not fit for surgery. Thoracic surgeons can perform RFA safely, and should continue to investigate this new image-guided modality that may offer an alternative option in medically inoperable patients.

Circulating Tumor Cells in Pulmonary Venous Blood of Primary Lung Cancer Patients

Circulating tumor cells in peripheral blood (CTC) is a potential surrogate of distant metastasis, which is the critical factor influencing decision making regarding therapy and prognosis of primary lung cancer patients. After our preliminary study showing that CTCs were detected in peripheral blood in 29.4% of resectable lung cancer patients, we conducted a prospective study on CTC in pulmonary vein (PV) blood because tumor cells apart from the primary tumor may circulate after passing through the drainage PV. A total of 30 consecutive lung cancer patients who underwent thoracotomy were included. The CTCs in peripheral blood and in PV blood from the primary tumor site were quantitatively examined with the CellSearch system, and the numbers of CTCs per 7.5 mL peripheral and PV blood in each patient were represented as periCTC count and pvCTC count, respectively. Circulating tumor cell was detected in peripheral blood in 5 patients (16.7%; the periCTC count was 1 in 2 patients; and 2, 3, and 16 in 1 patient each), and the incidence of positive periCTC was higher in squamous carcinoma patients than in adenocarcinoma patients (p = 0.028). Circulating tumor cell was detected in PV blood in most patients (29 of 30, 96.7%), and the mean and median pvCTC counts were 1,195 and 81, respectively (range, 0 to 10,034). There was no significant correlation between pvCTC count and any other patient characteristic, including periCTC count. In resectable lung cancer, CTC was positive in peripheral blood of some patients and in PV blood of most patients. A long-term follow-up study to clarify the clinical significance of pvCTC status is warranted.

Longitudinal assessment of cognitive impairment among lung cancer survivors

9609 Background: Patients undergoing treatment for cancer often report problems with their cognitive function (CF), which is an essential component in maintaining Quality of Life (QoL). We conducted a longitudinal study of lung cancer (LC) patients to systematically evaluate changes in QOL including changes in CF, over time. Methods: Between 2005–2008, we followed 1757 primary LC patients who responded to CF questions at least once within 8 years of diagnosis. Overall QoL measured by LCSS and LASA (scores 0–100 from worst to best) were assessed among 1,604 of 1,757 (91%) who completed the questionnaire at one or both of two time periods: short-term (T1-within 3 years of diagnosis) and long-term follow-up (T2-beyond 5 years of diagnosis). Questions rated overall CF and problems in thinking clearly. Results: The median age at the time of LC diagnosis was 68 years in men (n=834) and 65 years in women (n=770), p<0.0001. At T1, the mean score of patients reporting problems with CF was 63.2 (±22.45) vs 74.4 (±20.38) who reported no problems (p<0.0001). At T2, the mean score was 62.2 (±24.18) for patients who reported CF problems and 78.1 (±18.28) who reported no changes with their CF (p<0.0001). At T1, the mean score of patients reporting problems thinking clearly was 66.1 (±21.65) vs 75.6 (±20.21) reporting no problems with their thinking (p<0.0001). At T2, the mean score was 70.4 (±20.95) for patients reporting problems thinking clearly vs 82.6 (±17.76) who reported no problems (p<0.0001). Conclusions: Self-reported QoL of lung cancer survivors showed substantial deficits with their cognitive function. Prospective and objective assessments are needed to determine if cancer treatments are positively associated with cognitive decline, to identify the patients at risk, and to test appropriate interventions. Funding Source: NIH grants: CA 115857, CA 84354, CA 80127 and CA 77118. No significant financial relationships to disclose.

Potential Increase in the Prognostic Value of p53 Mutation by Pro72 Allele in Stage I Non-Small-Cell Lung Cancer

Accumulated evidence suggests that p53 function altered by its gene mutation or genetic polymorphism contributes to tumor malignancy. Association of p53 mutation and its codon 72 polymorphism with lung cancer prognosis has been extensively studied. However, the joint effect of p53 mutation and p53 codon 72 polymorphism on lung cancer prognosis remains uncertain. In the present study, 266 primary lung cancer patients were included and overall survival was calculated. Genomic DNA prepared from adjacent normal lung and lung tumor tissues was used to determine p53 codon 72 genotype and p53 mutation by polymerase chain reaction (PCR) restriction fragment length polymorphism (RFLP) and direct sequencing, respectively. For all stages, neither p53 codon 72 genotype nor p53 mutation is associated with lung cancer prognosis. However, stage I patients with p53 mutation had a 1.79-fold hazard ratio [95% confidence interval (CI) 1.04-3.10] for overall survival when compared with p53 wild-type patients. Notably, stage I patients with p53 mutation and p53 codon 72 Pro/Pro genotype experienced a 2.66-fold hazard ratio (95% CI 1.21-5.85) for overall survival when compared with those with p53 wild-type and Arg/Arg genotype. An increased prognostic value was not observed in stage I patients with p53 wild-type and p53 Pro72 allele or in those with p53 mutation and p53 codon 72 Arg/Arg genotype. We therefore suggest that p53 codon 72 Pro allele potentially increases the prognostic value of p53 mutation in stage I non-small-cell lung cancer.

Risk Factors for Post-pneumonectomy Acute Lung Injury/Acute Respiratory Distress Syndrome in Primary Lung Cancer Patients

Acute lung injury/acute respiratory distress syndrome (ALI / ARDS) is the most serious pulmonary complication after lung resection. This study investigated the incidence and outcome of patients with ALI / ARDS who required mechanical ventilation within one week of undergoing pneumonectomy for primary lung cancer and analysed the risk factors. We retrospectively reviewed the medical records of 146 patients who underwent pneumonectomy for primary lung cancer between May 2001 and April 2006. Preoperative, perioperative and postoperative clinical data were analysed. Post-pneumonectomy ALI / ARDS developed within the first postoperative week in 18 (12%) patients. Patients who developed ALI / ARDS had a longer hospital duration of stay (median [interquartile range], 26 [18 to 75] vs. 8 [7 to 11] days; P < 0.001) and higher in-hospital mortality (12 [67%] vs. 0 [0%]; P < 0.001). In an univariate analysis, post-pneumonectomy ALI / ARDS was associated with larger tidal volume (V(T)) and higher airway pressure (P(aw)) during one-lung ventilation (V(T) 8.2 [7.5 to 9.0] vs. 7.7 [6.9 to 8.2] ml/kg predicted body weight, P = 0.016; P(aw), 28.9 [27.6 to 30.0] vs. 27.2 [25.6 to 28.5] cmH2O, P = 0.001). V(T) during two-lung ventilation was also greater in patients who developed ALI / ARDS (P = 0.014) than in those who did not, but P(aw) during two-lung ventilation did not differ (P = 0.950). In a multiple logistic regression analysis, post-pneumonectomy ALI / ARDS was independently associated with a larger V(T) (OR 3.37 per 1 ml/kg predicted body weight increase; 95% confidence interval 1.65 to 6.86) and higher P(aw) (OR 2.32 per 1 cmH2O increase; 95% confidence interval 1.46 to 3.67) during the period of one-lung ventilation. In conclusion, a large V(T) and high P(aw) during one-lung ventilation were associated with an increased risk of post-pneumonectomy ALI / ARDS in primary lung cancer patients.

Prognostic Significance of X-ray Cross-complementing Group 1 T-77C Polymorphism in Resected Non-small Cell Lung Cancer

A novel T-77C polymorphism in the promoter region of the DNA repair gene X-ray cross-complementing group 1 (XRCC1) may modulate its transcription to increase the risk of lung cancer. Here, we attempt to clarify: (i) whether the XRCC1 T-77C polymorphism was associated with lung cancer risk in Taiwanese and (ii) whether this polymorphism could act as a prognostic indicator to predict the clinical outcome of non-small-cell lung cancer (NSCLC) patients. A total of 294 primary lung cancer patients and 288 potential controls were recruited into our study. Clinical data were collected. The genotypes of XRCC1 T-77C were identified by polymerase chain reaction. Our case-control study showed that the XRCC1 T-77C polymorphism was not associated with the risk of lung cancer in Taiwanese patients. To verify the impact of the XRCC1 T-77C polymorphism on the clinical outcome of NSCLC, survival analysis showed that patients with TT had a lower survival rate than those with the TC + CC genotype (33.1% versus 48.8%, P = 0.031). The Cox regression analysis further indicated that patients with the TT genotype had a 1.84-fold risk compared with those with the TC + CC genotype (95% CI, 1.16-2.86, P = 0.008). Our results suggest that XRCC1 T-77C variants (TC + CC) may act as a favorable prognostic indicator of resected NSCLC.

The influence of behavior intervention therapy on primary lung cancer patient's psychology condition and life quality

目的 探讨行为干预疗法对原发性肺癌患者心理状况及生活质量的影响.方法 选择本院42例原发性肺癌住院患者并给予干预治疗,包括心理情绪干预、躯体功能干预和生活行为干预.采用症状自评量表(SCL-90)和肿瘤患者生活质量核心量表评定患者接受行为干预治疗1、2、3个月后的心理状况及生活质量,并与对照组30例患者进行比较.结果 实验组与对照组最终纳入分析的分别为35例和27例,实验组SCL-90总评分随时间显著降低,躯体化、强迫、人际关系、抑郁、焦虑、恐怖因子分值均低于同期对照组,差异有统计学意义.生活质量评定各项因子分值显著低于同期对照组.结论 行为干预疗法可显著改善肺癌患者的心理状况,提高患者生活质量。

Circulating tumor cells (CTCs) and endothelial cells (CECs) in malignant pleural mesothelioma (MPM) and primary lung cancer (LC)

11019 Backgrounds: CTC, a surrogate of distant metastasis, and CEC, a marker of angiogenesis, are potentially useful in diagnosis and decision-making of therapy of malignant tumors, and CTC evaluated by the “CellSearch” system has been established as a prognostic marker of metastatic breast cancer patients. The clinical significance, however, has not been examined in other malignant tumors. Methods: We quantitatively evaluated CTC/CECs in peripheral blood (7.5mL/4.0mL) taken from 36 malignant pleural mesothelioma (MPM; epithelioid-type, n=34) and 34 primary lung cancer (LC; adenocarcinoma, n=25) patients treated from October to December, 2007 by using the “CellSearch” system. In 10 patients (one with MPM and 9 with LC), CTCs in blood sampled during operation from a pulmonary vein of the primary tumor site (PV-CTC) were also examined. Results: CTC in peripheral blood was positive in 28% (10/36) of MPM and 47% (16/34) of LC patients, and CTC was not detected in any patient with non-malignant disease (n=11). The mean CTC number and the percentage of CTC-positive patients tended to increase along with advance in tumor-stage, whereas the difference did not reach a statistical significance in MPM or LC (Table). The percentage of CTC-positive patients was significantly higher in resectable-LC patients than in unresectable-LC patients (65% vs 29%; p<0.05).; among operated patients, the percentage was increased along with lymphatic and/or blood vessel invasion. Of noted, PV-CTC was positive in one stage-II MPM and two stage-I LC patients. The mean CEC number of LC patients was 100.9, which was significantly higher that of non-malignant patients (49.9; P<0.05) and was similar to that of MPM patients (86.2). The CEC number of MPM and LC patients tended to increase along with tumor progression (Table). Conclusions: CTC and CEC are potentially useful clinical marker in the diagnosis of MPM and LC. When CTC or PV-CTC is positive, adjuvant chemotherapy may be indicated even for early-stage patients. CTC/CEC in MPM and LC MPM (malignant pleural mesothelioma) LC (primary lung cancer) CTC-positive Pts Mean No. of CTCs Mean No. of CECs CTC-positive Pts Mean No. of CTCs Mean No. of CECs Stage I 50% (1/2) 0.5 (0-1) 42.0 33% (4/12) 0.7 (0-3) 48.8 Stage II 0% (0/4) 0.0 (-) 55.0 33% (1/3) 0.3 (0-1) 65.3 Stage III 31% (4/13) 2.5 (0-27) 61.0 33% (1/3) 2.3 (0-7) 180.0 Stage IV 27% (4/15) 0.4 (0-2) 100.4 63% (10/16) 5.5 (0-42) 129.0 All Pts 28% (10/36) 1.1 (0-27) 86.2 47% (16/34) 3.1 (0-42) 100.9 CTC, circulating tumor cell; CEC, circulating endothelial cell No significant financial relationships to disclose.

Six single-nucleotide polymorphisms in apoptotic genes and chemotherapy outcome in lung cancer patients

3598 Background: Identification of genetic polymorphisms which influence chemotherapy outcome may help towards individually optimised therapy. We therefore investigated the influence of six single nucleotide polymorphisms (SNPs) in four apoptosis relevant genes on chemotherapy outcome in lung cancer patients. FAS: rs2234767, rs1800682, rs2234768, BAX: rs4645878, BCL- 2: rs2279115 and BCL-x: rs6121172. All SNPs were chosen on the basis of a known or suspected phenotypic effect. Methods: Using RECIST criteria response of 424 Caucasian primary lung cancer patients was assessed after the second cycle of chemotherapy. 97 of these patients were evaluated by clinically indicated CT. DNA isolated from peripheral blood lymphocytes obtained before start of chemotherapy was genotyped using PCR followed by fluorescence-based melting curve and restriction fragment length polymorphism analysis. Genotype frequencies were compared in responders (complete or partial remission) and non-responders (stable or progressive disease). For variant allele carriers, odds ratios (ORs) and 95% confidence intervals (CI) for the risk of being a non-responder were calculated by logistic regression for all lung cancer patients and in the subgroups SCLC (n=192) and NSCLC (n=232). For survival analyses the median follow-up time was 324 days. Results: In the group of all lung cancer patients as well as the subgroups none of the polymorphisms above modified response statistically significant. For all lung cancer patients rs2234768 showed a non-significantly better chemotherapy response (OR 0.65; CI 0.41–1.04). This effect was more pronounced in SCLC patients (OR 0.37; CI 0.14–1.02) than in NSCLC patients (OR 0.72 CI 0.4–1.3). Rs2236767 showed improved response in SCLC (OR 0.45; CI 0.19–1.11) but reduced response in NSCLC (OR 1.29; CI 0.70–2.39). Conclusions: Our data suggest an effect of rs2234768 and rs2234767 on chemotherapy response in lung cancer patients. In contrast to its supposed effect rs2234768 variant allele carriers had better chemotherapy response. Interestingly, rs2236767 may exert its effects depending on lung cancer histology. Funded in part by the Deutsche Krebshilfe and an DKFZ- intramural grant to L.F.K. No significant financial relationships to disclose.

Seven-year quality of life assessment in lung cancer

9531 Background: After decades of efforts on reducing lung cancer incidence and mortality, we are now challenged by the lack of understanding of the health conditions and quality of life (QOL) among the survivors. Methods: We evaluated 2,005 consecutive primary lung cancer patients diagnosed 1999- 2006. Two validated patient-reported assessments, the Lung Cancer Symptom Scale and Linear Analogue Self-Assessment, were used to measure overall QOL, pain, fatigue, appetite, symptoms, physical-, emotional-, mental-, and spiritual well-being, social activity/support, and financial/legal concerns. Cross-sectional and longitudinal analyses were performed. Assessments were translated onto a 0–100 (worst to best) scale, and a normative range was defined as 80.0±10.0 established in healthy individuals. Four QOL groups were defined: norm (70.0–90.0), above-norm (>90), below-norm (60.0–70.0), and poor (<60). Adjusted QOL was calculated by multiple regression models with variables at baseline (age, sex, ethnicity, marital status, years of education, employment status, smoking history, body weight, histology and stage, and comorbidities) and at each time a QOL questionnaire was answered (performance status, surgery, chemotherapy, and radiotherapy, weight change, and current tobacco use). Results: A total of 5,289 QOL questionnaires were answered by 2,005 patients from 6-month to 7-year post diagnosis. The mean (SD) overall QOL was 73.0 (23.2), ranging 70.8–76.0 across the 7 years, with and without covariates. Frequent pain and physical well-being were consistently below norm, fatigue scored as poor for all years, and shortness of breath was below norm between 6 months and year-4 and declined to poor thereafter. Longitudinally following patients in the four groups based on their initial overall QOL score, survivors stayed in the same QOL group throughout years, except those who started in the poor group (mean score 41.2) improved gradually to a mean score of 64.7 at year-5 although still below norm. Conclusions: This study describes health-related QOL by prospectively following a large lung cancer cohort. Modifiable contributors to poor QOL need to be identified and interventions should be designed to improve patients’ QOL in conjunction with prolonged survival. Supported by NIH grants CA77118, CA80127, and CA84354. No significant financial relationships to disclose.

Activation of Placenta-Specific Transcription FactorDistal-lessHomeobox 5 Predicts Clinical Outcome in Primary Lung Cancer Patients

To identify novel biomarkers and therapeutic targets for lung cancers, we screened for genes that were highly transactivated in lung cancers using a cDNA microarray representing 27,648 genes. DLX5 gene, a member of the human distal-less homeobox transcriptional factor family that is expressed during early embryonic development, was found to be overexpressed in the great majority of lung cancers. Tissue microarray consisting of archival non-small cell lung cancer samples from 369 patients was applied to examine the clinicopathologic significance of DLX5 protein. A role of DLX5 in cancer cell growth and/or survival was investigated through small interfering RNA experiments. Northern blot and immunohistochemical analyses detected expression of DLX5 only in placenta among 23 normal tissues examined. Immunohistochemical analysis showed that positive immunostaining of DLX5 was correlated with tumor size (pT classification; P = 0.0053) and poorer prognosis of non-small cell lung cancer patients (P = 0.0045). It was also shown to be an independent prognostic factor (P = 0.0415). Treatment of lung cancer cells with small interfering RNAs for DLX5 effectively knocked down its expression and suppressed cell growth. These data implied that DLX5 is useful as a target for the development of anticancer drugs and cancer vaccines as well as for a prognostic biomarker in clinic.

The relationship between genetic polymorphism of GSTM1 and the outcome of chemotherapy in Chinese patients with primary lung cancer.

GSTM1 takes part in the metabolism of environmental pollutants such as benzopyrene, other polycyclic aromatic hydrocarbons and anticancer drugs and so on. The study aims to investigate the relationship between the gene polymorphism of GSTM1 and chemotherapy as well as to study the effect to survival of Chinese patients with lung cancer. The genotypes of GSTM1 were examined with polymerase chain reaction in 137 primary lung cancer patients accepted chemotherapy. GSTM1 -null genotype frequency was 58.4%(80/137). The frequency of non-null GSTM1 genotype was 41.6%(57/137). The frequency of GSTM1-null genotype was 69.05%(58/84) in the response group of chemotherapy and 41.51%(22/53) in the non-response group of chemotherapy. They were significantly different (P=0.001). In the patients with platinum chemotherapy, the frequency of GSTM1-null genotype was 65.43%(53/81) in the response group of chemotherapy and 42%(21/50) in the non-response group. There werestastically differences in them (P=0.0025). For the advanced cases, GSTM1 -null genotype frequency was 70.13% (54/77) in the response group of chemotherapy, 41.51% (22/53) in the non-response group of chemotherapy respectively and they were significantly different(P=0.001). When the chemotherapy was effective, the survival time of patients in squamous carcinoma and small cell carcinoma with non-null GSTM1 genotype (the median survival times were 42 months and 14 months respectively) were longer than those with null GSTM1 genotype (the median survival times were 6 months and 7 months respectively)(P<0.05). The survival time of adencarcinoma with non-null GSTM1 genotype and null GSTM1 genotype (the median survival times were 13 months and 11 months respectively) were comparative (P>0.05). When chemotherapy was not effective, the median survival time were not significantly different (P>0.05). The effect of chemotherapy of GSTM1-null genotype patients was better than that of GSTM1-postive genotype patients. The chemotherapy effect of the cases with null GSTM1 type was better than those with non-null GSTM1 type when the patients accepted platinum chemotherapy. When the chemotherapy was effective, the survival time may be related to the histological types and GSTM1 genotypes.

Multiple Primary Malignancies Involving Lung: An Analysis of 40 Cases

We aimed to assess the incidence of multiple primary malignancies in primary lung cancer patients. We retrospectively evaluated the clinical files of 1038 primary lung cancer patients diagnosed in 2004. Forty patients (3.9 %) had multiple primary malignancies. There were 34 men (85 %) and 6 women (15 %). Their mean age was 62.4 ± 8.6 years. While 35 cases were smokers, 5 cases were nonsmokers. Tumour pathology of the lung was squamous cell carcinoma in 15 cases, adenocarcinoma in 10 cases, small cell carcinoma in 3 cases and non-small cell carcinoma in 12 cases. There were 2 primary tumours in 37 cases and 3 primary tumours in 3 cases. The first detected tumour was located in larynx in 11 cases, in genitourinary system in 9 cases, in intestine in 5 cases, in lung in 3 cases and in other organs in 12 cases. The mean interval between the first and the second tumour was 77 months with a range of 1 months to 32 years. This interval was shorter than 6 months in 4 cases. Treatment modality for the first detected tumour was surgery in 35 cases. The last primary tumour was treated with surgery in 12 cases. In conclusion, the development of multiple primary tumours is not a rare phenomenon. Patients with a malignancy should be followed for development of a second primary malignancy. The treatment of lung cancer in patients with a previous malignancy should be the same as for lung cancers presenting as the first cancer.

Exposure to Mosquito Coil Smoke May be a Risk Factor for Lung Cancer in Taiwan

BackgroundAbout 50% of lung cancer deaths in Taiwan are not related to cigarette smoking. Environmental exposure may play a role in lung cancer risk. Taiwanese households frequently burn mosquito coil at home to repel mosquitoes. The aim of this hospital-based case-control study was to determine whether exposure to mosquito coil smoke is a risk for lung cancer.MethodsQuestionnaires were administered to 147 primary lung cancer patients and 400 potential controls to ascertain demographic data, occupation, lifestyle data, indoor environmental exposures (including habits of cigarette smoking, cooking methods, incense burning at home, and exposure to mosquito coil smoke ), as well as family history of cancer and detailed medical history.ResultsMosquito coil smoke exposure was more frequent in lung cancer patients than controls (38.1% vs.17.8%; p<0.01). Risk of lung cancer was significantly higher in frequent burners of mosquito coils (more than 3 times [days] per week) than nonburners (adjusted odds ratio = 3.78; 95% confidence interval: 1.55-6.90). Those who seldom burned mosquito coils (less than 3 times per week) also had a significantly higher risk of lung cancer (adjusted odds ratio = 2.67; 95% confidence interval: 1.60-4.50).ConclusionExposure to mosquito coil smoke may be a risk factor for development of lung cancer.

Successful Video-assisted Thoracic Surgery Lobectomy in a Single-lung Patient

In terms of perioperative management, it is extremely difficult to perform a video-assisted thoracic surgery lobectomy for primary lung cancer in patients previously undergoing a contralateral pneumonectomy. We herein describe the successful video-assisted thoracic surgery lobectomy with systematic mediastinal lymph node dissection in a single-lung patient with clinical stage IA nonsmall cell lung cancer. Our experience indicates surgeons may consider the procedure if the following conditions are met: (1) satisfactory pulmonary function, (2) the selective bronchial blockade of the lobe to be resected, and (3) the effective retraction of the inflated lung.

Outcome of Lung Cancer Patients Admitted to the Intensive Care Unit

In Brief We investigate the outcome of lung cancer patients admitted to the medical intensive care unit (MICU) and examine potential predictors of mortality. A retrospective quality assurance study of primary lung cancer patients admitted to the MICUs at 2 local tertiary care university hospitals from January 1, 1994 to May 12, 2004 was conducted (n = 69). Data on demographics and tumor-related data were collected using the hospital records of all patients admitted to MICU with a diagnosis of lung cancer. Statistical analysis was performed to determine the prognostic factors associated with MICU and hospital mortality as well as MICU and hospital lengths of stay. The MICU mortality rate was 50.7% and the mean MICU length of stay was 3.0 days. Multivariate analysis determined that Acute Physiology and Chronic Health Evaluation (APACHE II) scores, Therapeutic Intervention Scoring System scores, and non-small cell lung cancer were significantly associated with MICU mortality, whereas age and APACHE II scores were associated with hospital mortality. Respiratory failure upon admission and use of a Swan Ganz monitor were predictors of increased MICU length of stay, and chemotherapy administration and mechanical ventilation predicted increased hospital length of stay. The 50.7% mortality rate for patients with previously or newly diagnosed primary lung cancer admitted to the MICU is lower than the previously reported mortality rate of 66.7% for a period of 1986. Although the mortality remains high, an improvement over the previous decade has occurred and is comparable to that for patients requiring MICU admission for other indications. There is a high mortality rate associated with medical intensive care unit (MICU) admission for patients with previously or newly diagnosed primary lung cancer. However, it has improved over the previous decade and is comparable to that among patients requiring MICU admission for other illness such as pneumonia, adult respiratory distress syndrome, sepsis, and cardiopulmonary resuscitation.

P3-270: An analysis of surgical skills in pleuro-pneumonectomy of lung cancer with malignant pleural effusion

To evaluate the surgical skills in pleuro-pneumonectomy of lung cancer with effusion and the effect of the operation, from Jan.1988 to Jan.2003, 21 patients of primary lung cancer with dissemination and malignant pleural effusion were treated chiefly by operation. The surgical procedures included left pleuro-pneumonectomy in 8 and right pleuro-pneumonectomy in 13 patients. The operative skills include plural dissec-tion en bloc, management of big vessel in hilar, paying attention to disposal of dissemination on pericardium, big vessels and diaphragm, etc. All patients recovered postoperatively. There were no severe surgical complications such as bronchopleural fistula, empyema and hemorrhage. Fol-low-up showed that 16 patients have died at 5 to 34 months after the operation. Other patients were still alive at 24 to 29 months. Mid-lifetime was 18 months. Pleuro-pneumonectomy selectively performed in lung cancer with malignant pleural effusion (IIIb) is safe and manipulatable. Improvement of the surgical skills may reduce the perioperative complications, decrease recurrence of the tumor and so gain a better re-sult.

P3-271: Clinical investigation of surgical treatment for primary lung cancer in patients with idiopathic interstitial pneumonia

P3-271: Clinical investigation of surgical treatment for primary lung cancer in patients with idiopathic interstitial pneumonia