The prognostic significance of PD-1 and its ligands in non-small cell lung cancer.

Background: In this study, we aimed to investigate the prognostic value of programmed cell death protein 1 (PD-1), programmed cell death ligand 1 (PD-L1), and programmed cell death ligand 2 (PD-L2) expressions on immune and cancer cells in terms of survival in patients with lung adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. Methods: Between January 2000 and December 2012, a total of 191 patients (172 males, 19 females; mean age: 60.3±8.4 years; range, 38 to 78 years) who were diagnosed with non-small cell lung cancer and underwent anatomic resection and mediastinal lymph node dissection were retrospectively analyzed. The patients were evaluated in three groups including lung squamous cell carcinoma (n=61), adenocarcinoma (n=66), and large-cell carcinoma (n=64). The survival rates of all three groups were compared in terms of immunohistochemical expression levels of PD-1, PD-L1, and PD-L2. Results: The mean follow-up was 71.8±47.9 months. In all histological subtypes, PD-1 expressions on tumor and immune cells were observed in 33% (61/191) and in 53.1% (102/191) of the patients, respectively. Higher expression levels of PD-L1 and PD-L2 at any intensity on tumor and immune cells were defined only in lung adenocarcinomas, and PD-L1 and PD-L2 values were detected in 36.4% (22/64) of these patients. The PD-L1 expressions on tumor and immune cells were observed in 41.7% (10/24) and 25% (6/24) of the patients, respectively. The PD-L2 expressions on tumor and immune cells were detected in 16.7% (4/24) and 8.4% (2/24) of the patients, respectively. Univariate and multivariate analyses revealed that PD-1 expression in tumor cells was an independent prognostic factor in all histological subtypes. Conclusion: Our study results suggest that PD-1 expression is a poor prognostic factor for overall survival in patients with completely resected adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.

Surgical resection of a giant mass pushing the boundaries of the chest wall: An Askin's tumor.

Intrathoracic masses may arise from the chest wall, mediastinum, pleura, and pulmonary parenchyma. Primary malign tumors of the chest wall and pleura usually present with chest pain; however, the tumor may sometimes remain asymptomatic, until it grows large enough to cause compression-related symptoms. Herein, we present a 35-year-old female case with a giant intrathoracic mass. The patient was diagnosed with an Askin"s tumor and underwent extended surgical resection.

The Role of Sublobar Resection in T1 N0 Non-Small-Cell Pulmonary Carcinoma.

OBJECTIVES: In this study, we aimed to investigate the effect of resection type on survival in patients with stage IA non-small-cell lung cancer (NSCLC) and other factors affecting the prognosis. MATERIALS AND METHODS: Between January 2005 and December 2016, we retrospectively screened 269 patients who were resected and were having T1N0M0 non-small-cell pulmonary carcinoma. The survival time after surgery was obtained from the National Population Registration System (MERNIS) system. Patients were classified according to the extent of resection. Additionally, age, sex, smoking, concomitant disease, histological type, pathological stage (T1a-T1b-T1c), and the presence of postoperative complications were evaluated to determine whether they are prognostic factors or not. RESULTS: A lobectomy was performed in 257 cases (95.5%), and a sublobar resection was performed in 12 patients (4.5%). The 5-year survival was 62.5% for lobectomies and 73.3% for sublobar resections. Although 5-year survival was better in patients with a limited resection, it was not statistically significant (p=0.301). Histopathological evaluation revealed that 130 patients (48.3%) had adenocarcinoma, 113 (42.0%) had squamous cell carcinoma, and 26 (9.7%) had the other types. The 5-year survival rate was 69.9% in patients with adenocarcinoma and 53.2% in squamous cell carcinoma, and this was statistically significant (p=0.036). The overall 5- and 10-year survival rates in all patients were 65.0% and 47.2%, respectively. CONCLUSION: Although lobectomy is the standard type of resection in the early stage of lung cancer cases in the Thoracic Surgery Department of Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital patients who underwent sublobar resection were found to be having partially better survival, but it was not statistically significant. Owing to the small number of cases, we think that sublobar resections should be prospectively investigated with more extensive series in patients with T1 NSCLC.

The Initial Experience on Thoracoscopic Sleeve Lobectomy: Continuous Suturing Technique of the Bronchial Anastomosis in 12 Cases.

BACKGROUND: Sleeve resection is a widely performed type of operation in the surgical treatment of non-small cell lung cancer. Video-assisted thoracoscopic surgery (VATS) is now used even in central tumor surgeries of the lung with the increasing technology and experience. Sleeve resection cases performed through VATS in our clinic in recent years were presented with demographic, surgical, pathologic, and survey characteristics. MATERIALS AND METHODS: Twelve patients who underwent sleeve resection with VATS in our clinic between November 2015 and August 2019 were included in the study. Operative, pathologic, and postoperative characteristics of the patients were examined. RESULTS: A total of 12 patients, 3 female and 9 male individuals, were included in the study. The mean age of the patients was 61.7±12.9 years. According to the localization of the tumors, left upper lobectomy was performed in 4 patients and 8 patients underwent right upper lobectomy. During the sleeve anastomosis of the patients, 3/0 prolene sutures were used in 5 patients (36%) and 4/0 prolene sutures in 4 patients (36%), whereas 3/0 polydioxanone suture (PDS) was used in 3 patients (28%). The mean operation time was 288.2±77.1 (205 to 460) minutes and the mean anastomosis time was 70±18.5 (55 to 110) minutes. In the postoperative period, 1 patient who had acute myocardial infarction died on the fourth postoperative day. The mean postoperative drainage duration of the patients was 5.5±1.9 (3 to 10) days and the mean length of hospital stay was 6.4±1.9 (4 to 11) days. When the pathologic features were examined, the mean tumor diameter was found to be 2.5±1.2 (1 to 5.5) cm. The mean follow-up period was calculated as 26.1±15.6 months (2 to 47). Other than 1 patient who died, the follow-up of 11 patients still proceeds. CONCLUSIONS: VATS approach of sleeve resections, which is performed cautiously even by thoracotomy, is becoming more common. These operations, which could be performed in experienced centers, offer a postoperative period of less morbidity to the patients with the advantage of reduced postoperative pain, drainage time, and hospital stay.

Prognostic Effects of Predominant Histologic Subtypes in Resected Pulmonary Adenocarcinomas

Background: Predominant histologic subtypes have been reported as predictors of survival of patients with pulmonary adenocarcinoma. Aims: To evaluate the predictive value of histologic classification in resected lung adenocarcinoma using the classification systems proposed by the International Association for the Study of Lung Cancer, American Thoracic Society, European Respiratory Society, and World Health Organization (2015). Study Design: Cross-sectional study. Methods: The histologic classification of a large cohort of 491 patients with resected lung adenocarcinoma (stages I-III) was retrospectively analyzed. The tumors were classified according to their predominant component (lepidic, acinar, papillary, solid, micropapillary, and mucinous), and their predictive values were assessed for clinicopathologic characteristics and overall survival. Results: The patient cohort comprised 158 (32.2%) patients with solid predominant, 150 (30.5%) with acinar predominant, 80 (16.3%) with papillary predominant, 75 (15.3%) with lepidic predominant, 22 (4.5%) with mucinous, and 5 (1.0%) with micropapillary subtype, and 1 (0.2%) with adenocarcinoma in situ. Overall 5-year survival of 491 patients was found to be 51.8%. Patients with lepidic, acinar, and mucinous adenocarcinoma had 70.9%, 59.0%, and 66.6% 5-year survival, respectively, and there was no statistically significant difference between them. Whereas patients with solid, papillary, and micropapillary predominant adenocarcinoma had 41.0%, 40.5%, and 0.0% 5-year survival, respectively. Compared to other histologic subtypes, patients with solid and papillary predominant adenocarcinoma had significantly lower survival than those with lepidic (p<0.001, p=0.002), acinar (p<0.001, p=0.008), and mucinous (p=0.048, p=0.048) subtypes, respectively. The survival difference between patients with solid subtype and those with papillary subtype was not statistically significant (p=0.67). Conclusion: Solid and papillary histologic subtypes are poor prognostic factors in resected invasive lung adenocarcinoma.

Papillary predominant histological subtype predicts poor survival in lung adenocarcinoma.

BACKGROUND: This study aims to investigate whether papillary predominant histological subtype can predict poor survival in lung adenocarcinoma. METHODS: Between January 2005 and December 2016, a total of 80 patients with papillary predominant subtype lung adenocarcinoma (70 males, 10 females; mean age 60.7 years; range, 42 to 79 years) operated in our clinic were included in the study. These patients were compared with those having lepidic, acinar, and mucinous subtypes. Overall and five-year survival rates were evaluated. RESULTS: Five-year survival was 40.5% in papillary predominant histological subtype, while this rate was 70.9%, 59.0%, and 66.6% in lepidic, acinar, and mucinous subtypes, respectively. Papillary subtype showed significantly poor survival compared to lepidic (p=0.002), acinar (p=0.008), and mucinous subtypes (p=0.048). In Stage 1 disease, it was more evident (papillary, 47.5%, lepidic 86.9% [p=0.001], acinar 69.3% [p=0.040], and mucinous 90.0% [p=0.050]). CONCLUSION: Our study results suggest that papillary predominant subtype predicts poor survival in lung adenocarcinoma and these cases may be candidates for adjuvant treatment modalities even in the earlier stages of disease.

Nodal involvement adversely affects prognosis in pulmonary carcinoid tumors.

BACKGROUND: This study aims to analyze the prognostic factors affecting survival in pulmonary carcinoid tumors. METHODS: Gender, age, smoking habit, comorbidity, localization of the tumor, T status, N status, histological type, and pathological stage of patients who had undergone resection of pulmonary carcinoid tumor between January 1, 2005 and December 31, 2016 were retrospectively reviewed. RESULTS: A total of 47 patients (18 male, 29 female; mean age 50.5 years; range, 23 to 74 years) consisting of 40 typical and 7 atypical carcinoid tumor cases were included in our study. Anatomical resection and systematic mediastinal lymph node dissection was performed on all patients. Pathological studies revealed lymphatic involvement in six patients (12.8%; 4 pN1 and 2 pN2). In the typical group (n=40), three patients were classified N1 (7.5%) and one patient N2 (2.5%). In the atypical group (n=7), one patient were classified N1 (14.3%) and one patient N2 (14.3%). Throughout the study, four patients with typical histology (10%) and two patients with atypical histology (28.6%) had nodal involvement. All six patients with nodal involvement underwent adjuvant radiotherapy. Atypical histology (p=0.005) and nodal involvement (p=0.008) were determined as negative prognostic factors in statistical analysis. CONCLUSION: Systematic hilar and mediastinal nodal dissection play a crucial role in the surgical treatment of pulmonary carcinoid tumors.

The role of the tissue culture in granulomatous mediastinal lymphadenitis: tuberculosis or not.

AIM: To evaluate the role of the tissue culture via mediastinoscopic biopsy in granulomatous mediastinal lymphadenitis. METHODS: The dossier data of 92 cases with mediastinal lymphadenitis showing granulomatous lymphadenitis features by cervical mediastinoscopy and whose clinical, radiological and bacteriological definitive diagnosis is tuberculosis and sarcoidosis were examined retrospectively. The rate of the positive tissue culture of mediastynoscopic biopsy in the diagnosis of granulomatous lymphadenitis was calculated. RESULTS: There were 65 (71%) females and 27 (29%) males. The mean age of the patients was 42.5 (range 15-75) years. Non necrotizing granulomatous lymphadenitis was detected in 58 (63 %) cases while necrotizing granulomatous lymphadenitis was seen in 34 (37%) cases. There were 29 cases diagnosed with tuberculosis. Acid resistant bacilli culture positive rate was 38% (in 11 cases). There were 21 (62%) cases of necrotizing granulomatous lymphadenitis and eight (14%) cases of non-necrotizing granulomatous lymphadenitis diagnosed with tuberculosis. Culture positivity was identified in two (25%) of eight cases whose differential diagnosis could not be made histopathologically as tuberculosis/sarcoidosis. CONCLUSIONS: In addition to clinical, radiological and histopathological diagnosis, the study aims to highlight the importance of tissue culture in definitive diagnosis, especially undetermined incidents.

Effect of diclofenac on experimental pleurodesis induced by tetracycline in rabbits.

BACKGROUND AND OBJECTIVE: Pleurodesis is a frequently preferred procedure in thoracic surgery, and many factors may affect the process. We aimed to determine whether the administration of systemic diclofenac sodium diminishes the effectiveness of the pleurodesis induced by intrapleural tetracycline in rabbits. METHODS: Twelve male New Zealand rabbits that received tetracycline 35 mg/kg intrapleurally were allocated into two groups. The first group (diclofenac group, n = 6) received 2 mg/kg diclofenac sodium intramuscularly for 10 days, and the second group (control group, n = 6) received acetaminophen 30 mg/kg orally for 10 days after the pleurodesis procedure. The rabbits were sacrificed after 28 days, and the pleural spaces were assessed grossly for evidence of pleurodesis and microscopically for evidence of fibrosis, inflammation, and collagenization. RESULTS: The mean macroscopic pleurodesis score of the diclofenac group was 2.16 +/- 0.40 compared with 2.83 +/- 0.40 in the control group (p = .027). The mean microscopic pleurodesis score of the diclofenac group was 2. 3 +/- 1.03, whereas it was 3.5 +/- 0.54 in the control group (p = .045). CONCLUSION: The administration of diclofenac sodium for 10 days following tetracycline pleurodesis reduces the effectiveness of pleurodesis in rabbits.