[Factors and Mechanisms of Pleural Dissemination in Surgically Treated Cases of Lung Metastasis Originated from Pancreatic Cancer].

Pancreatic cancer with distant metastasis typically results in a poor prognosis, but patients with only pulmonary metastasis are reported to have a relatively good prognosis. In this study, we investigated the clinicopathological data and prognosis of 15 patients who underwent surgery for lung metastasis of pancreatic cancer at our hospital between April 2010 and December 2021. The median disease-free interval after pancreatic cancer treatment was 24.5 (9.6-71.8) months. Ten of the 15 patients underwent successful radical resection, while the remaining 5 had pleural dissemination and underwent non-radical resection. The median follow-up duration was 13.5 months, with the median survival time for radical resection and non-radical resection cases being 49.5 months and 31.2 months, respectively. This indicates significantly worse prognosis for non-radical resection cases( p=0.010). Furthermore, the median CA19-9 levels before lung resection were 22 U/ml for radical resection and 2,181 U/ml for non-radical resection cases, significantly higher in the latter (p=0.049). Immunostaining of resected specimens revealed that MMP-2 was positive in 11 of 15 cases, particularly in 4 of 5 cases with pleural dissemination. CA19-9 levels before lung resection may be a predictive factor for pleural dissemination, and MMP-2 may play a role in the mechanism of pleural dissemination.

Changes in pedicle pericardial fat tissue around the anastomotic site after tracheobronchoplasty.

PURPOSE: Pericardial fat is appropriate tissue to cover the bronchial anastomotic site because its harvesting is minimally invasive. We investigated the changes in pericardial fat tissue around the anastomotic site after pulmonary resection with tracheobronchoplasty. METHODS: The subjects of this study were 43 lung cancer patients who underwent pulmonary resection with tracheobronchoplasty. We measured the maximum cross-sectional area and average computed tomography (CT) values of the pedicle pericardial fat pad around the anastomotic site 1 week and then 6 months after the operation. RESULTS: The average volume of the residual pedicle pericardial fat pad 6 months postoperatively was 61%. A body mass index (BMI) < 21.2 kg/m2 (P = 0.031) and a blood albumin level < 3.4 g/dl (P = 0.005) were significant predictors of pedicle flap shrinkage. Patients with fat tissue shrinkage had significantly elevated CT values 6 months postoperatively (P = 0.029), whereas those without shrinkage maintained low CT values. CONCLUSIONS: Preoperative nutritional conditions, reflected in high BMI and blood albumin levels, correlated with a high residual pedicle pericardial fat pad. Conversely, patients with pedicle flap shrinkage had significantly increased CT values, suggesting that the fat might have taken on another form such as scar tissue.

Artificial intelligence-supported lung cancer detection by multi-institutional readers with multi-vendor chest radiographs: a retrospective clinical validation study.

BACKGROUND: We investigated the performance improvement of physicians with varying levels of chest radiology experience when using a commercially available artificial intelligence (AI)-based computer-assisted detection (CAD) software to detect lung cancer nodules on chest radiographs from multiple vendors. METHODS: Chest radiographs and their corresponding chest CT were retrospectively collected from one institution between July 2017 and June 2018. Two author radiologists annotated pathologically proven lung cancer nodules on the chest radiographs while referencing CT. Eighteen readers (nine general physicians and nine radiologists) from nine institutions interpreted the chest radiographs. The readers interpreted the radiographs alone and then reinterpreted them referencing the CAD output. Suspected nodules were enclosed with a bounding box. These bounding boxes were judged correct if there was significant overlap with the ground truth, specifically, if the intersection over union was 0.3 or higher. The sensitivity, specificity, accuracy, PPV, and NPV of the readers' assessments were calculated. RESULTS: In total, 312 chest radiographs were collected as a test dataset, including 59 malignant images (59 nodules of lung cancer) and 253 normal images. The model provided a modest boost to the reader's sensitivity, particularly helping general physicians. The performance of general physicians was improved from 0.47 to 0.60 for sensitivity, from 0.96 to 0.97 for specificity, from 0.87 to 0.90 for accuracy, from 0.75 to 0.82 for PPV, and from 0.89 to 0.91 for NPV while the performance of radiologists was improved from 0.51 to 0.60 for sensitivity, from 0.96 to 0.96 for specificity, from 0.87 to 0.90 for accuracy, from 0.76 to 0.80 for PPV, and from 0.89 to 0.91 for NPV. The overall increase in the ratios of sensitivity, specificity, accuracy, PPV, and NPV were 1.22 (1.14-1.30), 1.00 (1.00-1.01), 1.03 (1.02-1.04), 1.07 (1.03-1.11), and 1.02 (1.01-1.03) by using the CAD, respectively. CONCLUSION: The AI-based CAD was able to improve the ability of physicians to detect nodules of lung cancer in chest radiographs. The use of a CAD model can indicate regions physicians may have overlooked during their initial assessment.

Surgical outcomes of primary lung cancers following esophagectomy for primary esophageal carcinoma.

BACKGROUND: The aim of this retrospective study is to evaluate the perioperative complications and prognosis of patients with a history of resected esophageal carcinoma who subsequently underwent pulmonary resection of a primary lung cancer. METHODS: The study cohort comprised 23 patients who had undergone curative resection of a primary lung cancer following esophagectomy for a primary esophageal carcinoma. Clinical characteristics and surgical outcomes were analyzed. RESULTS: The initial treatment for esophageal carcinoma was esophagectomy by thoracotomy in 10 patients and video assisted thoracoscopic surgery in 13. The treatments for lung cancer comprised wedge resection in three patients, segmentectomy in seven and lobectomy in 13. The pulmonary resections were performed by thoracotomy in six and video assisted thoracoscopic surgery in 17. The average operating time for the lung cancer surgeries was 202 min and average blood loss 122 ml. There were no perioperative deaths or severe complications. Three- and Five-year overall survival rates were 78.0% and 68.2%. According to univariate survival analysis, age, restrictive ventilatory impairment and histology of lung cancer were significant predictors of poor prognosis (all P < 0.05). Significantly more of the patients with than without restrictive ventilatory impairment died of other diseases (P = 0.0036). CONCLUSIONS: Pulmonary resection for primary lung cancers following esophagectomy for esophageal carcinoma is acceptable in selected patients. Such surgery requires caution concerning intrathoracic adhesions and postoperative prolonged air leakage. Patients with restrictive ventilatory impairment had a poorer prognosis, and the indication for surgery in these patients should be carefully considered.

[Sleeve Lobectomy for Right Middle Lobe and S6 Segment Lung Cancer:Report of a Case].

A 76-year-old man showed an abnormal chest shadow at the follow-up of treated gastric cancer. Chest computed tomography revealed mass lesions in the right middle and left upper lobes, and bronchoscopy revealed a nodular lesion at the entrance of the right B6. The right middle lobe and B6 lesions were diagnosed as lung cancer, and sleeve resection for the right middle lobe and S6 segment was performed. On postoperative day 98, partial resection of the left lung lesion was performed, and the pathological diagnosis was also lung cancer.

Combined sleeve lobectomy for centrally located primary lung cancer and lung cancer with hilar lymph node metastasis.

BACKGROUND: Centrally located lung cancer or metastatic hilar lymph nodes can invade the airway and other hilar structures, and they must be removed to achieve complete resection. METHODS: We retrospectively assessed the clinical course of 47 patients with centrally located lung cancer or metastatic hilar lymph nodes who underwent sleeve lobectomy from January 2010 to December 2017. RESULTS: The invaded structure other than the airway was the pulmonary artery in 21 patients, chest wall in 3, esophageal muscular wall in 2, vagus nerve in 2, pericardium in 2, left atrium in 1, phrenic nerve in 1 and superior vena cava in 1. Twenty-four patients were treated with sleeve lobectomy alone (simple sleeve lobectomy), and 23 patients were treated with sleeve lobectomy with additional methods (combined sleeve lobectomy). Adverse events occurred in 10 patients (48%) in the simple sleeve lobectomy group and 7 patients (30%) in the combined sleeve lobectomy group. During the follow-up period, 15 patients developed recurrent disease and 12 patients died. Patients in the combined sleeve lobectomy group had significantly shorter overall survival (P = 0.004) and disease-free survival periods (P = 0.013). Combined sleeve lobectomy was a significantly poor prognostic factor in the univariate and multivariate analyses. Patients who underwent sleeve lobectomy with an additional method other than angioplasty had a significantly poorer prognosis. However, no patient developed recurrent disease in the hilar area. CONCLUSIONS: Combined sleeve lobectomy has acceptable adverse events and good local controllability. However, combined sleeve lobectomy is associated with a significantly poorer prognosis than simple sleeve lobectomy in terms of overall survival and disease-free survival.

Prognosis associated with synchronous or metachronous multiple primary malignancies in patients with completely resected non-small cell lung cancer.

PURPOSE: To investigate the influence of multiple primary malignancies (MPMs) on the prognosis of patients with completely resected non-small cell lung cancer (NSCLC). METHODS: The subjects of this retrospective study were 521 patients who underwent complete curative pulmonary resection for NSCLC. Patients were divided into two groups: those with and those without MPMs. RESULTS: The 521 NSCLC patients included 184 patients (35.3%) with MPMs and 337 patients without MPMs. The overall 5-year survival rates for patients with vs those without MPMs were 66.1 and 75.6%, respectively (p = 0.0061). According to multivariate analysis, MPMs, age, gender, pathological stage, and interstitial pneumonia were independent predictors of prognosis. The 47 patients with synchronous MPMs and the 82 patients with metachronous MPMs found within the last 5 years had significantly poorer prognoses than patients without MPMs (p = 0.0048 and p = 0.0051, respectively). However, the prognoses of the 55 patients with metachronous MPMs that had been present for over 5 years did not differ from those of the patients without MPMs. CONCLUSIONS: NSCLC patients with synchronous MPMs or metachronous MPMs diagnosed within the last 5 years had poor prognoses. Decisions about the best therapeutic strategies require comprehensive consideration of the organ location, malignant potential, recurrence, and prognosis of the MPMs. In contrast, decisions about the best therapeutic strategies for NSCLC patients with metachronous MPMs present for over 5 years should be based solely on the NSCLC.

Surgical outcome of patients with lung cancer involving the left atrium.

BACKGROUND: Pulmonary and left atrial resection is not yet an established treatment for patients with primary lung cancer involving the left atrium. We investigated the clinical course of patients with primary lung cancer involving the left atrium who were treated with pulmonary resection and partial atrial resection. METHODS: From January 1996 to December 2013, 51 patients underwent extended resection for lung cancer that invaded the surrounding organs. Of these, we focused on 12 patients who underwent surgical treatment for lung cancer involving the left atrium. The clinical course of each of these patients was investigated retrospectively. RESULTS: The most common histological subtype was squamous cell carcinoma. Pneumonectomy was performed in nine patients, and right middle and lower lobectomy was performed in three patients. Complete resection was performed in 11 patients (92 %). Postoperative complications were observed in four patients (33 %)-prolonged air leakage in two patients, broncho-pleural fistula in one patient, and empyema in one patient. There were no surgical deaths. This study involved seven patients with pathological N0-1 disease and five patients with pathological N2 disease. The postoperative 5-year survival rate was 46 % in all patients. The 5-year survival rates in patients with pathological N0-1 disease and N2 disease were 67 and 20 %, respectively. CONCLUSION: Because treatment-related death was not observed and outcome was fair in patients with N0-1 disease, surgical resection for primary lung cancer involving the left atrium may be acceptable in selected patients. Further investigations are required to improve the outcome of surgical treatment for patients with primary lung cancer involving the left atrium.

Clinical Significance of Perioperative Blood Coagulation Factor XIII in Pulmonary Resections.

Background This study evaluated the clinical significance of perioperative levels of plasma blood coagulation factor XlII in patients undergoing pulmonary resection. Methods The study involved 27 patients with ≥2day prolonged air leakage after pulmonary resection. The 27 pulmonary resection procedures comprised 25 lobectomies, 1 segmentectomy, and 1 partial resection. The preoperative and 5-day postoperative blood coagulation factor XIII levels were measured. Results Perioperative changes in the blood coagulation factor XlII levels showed no significant correlation with the preoperative hemoglobin Aic levels. The mean postoperative blood coagulation factor XIII level was 78.2±15.7% in patients with postoperative total protein levels of <6.6 g/dL, and 102.1±19.7% in patients with postoperative total protein levels of ≥6.6 g/dL (p=0.018). The mean drainage duration was 8.3 ±2.7 days in patients with postoperative blood coagulation factor XIII levels of ≤70% and 5.3 2.3 days in patients with levels of >70% (p=0.017). Conclusions Low blood coagulation factor XIII levels may be associated with prolonged air leakage and thereby exogenous blood coagulation factor XIII may lead to shorter drain placement durations in patients undergoing thoracic surgery, particularly patients with a poor nutritional status.

Clinical value of exogenous factor XIII for prolonged air leak following pulmonary lobectomy: a case control study.

BACKGROUND: We examined the effect of exogenous factor XIII (FXIII) concentrate in patients with prolonged air leak (PAL) after pulmonary lobectomy for non-small cell lung cancer. METHODS: We performed a retrospective analysis of 297 patients who underwent pulmonary lobectomy between July 2007 and March 2014: 90 had an air leak on the first postoperative day, which resolved spontaneously within 5 days in 53 cases (SR group). FXIII concentrate was administered to the remaining 37 patients (PAL group) for 5 days. This group was subdivided into those in whom the air leak resolved during FXIII treatment (EF group) and those who needed additional intervention (inEF group). The clinical and perioperative characteristics of the groups were compared. RESULTS: Although plasma FXIII activity did not differ significantly between the SR and PAL groups before surgery or on the fifth postoperative day, the proportional perioperative fall in FXIII activity was significantly greater in the SR group (33%) than the PAL group (22%, p = 0.044) and inEF group (14%, p = 0.048). On the fifth postoperative day, FXIII activity was significantly lower in the EF group than in the inEF group (74% versus 91%, p = 0.030). The optimal cut-off point for postoperative plasma FXIII activity to distinguish between the EF and inEF groups was 86%. CONCLUSIONS: Insufficient plasma FXIII consumption and lower postoperative FXIII activity may play a role in the resolution of PAL, and exogenous FXIII concentrate may be an effective, safe and non-invasive treatment.

Right Lower Sleeve Lobectomy: Detailed Technique and Perioperative Patient Management.

PURPOSE: This report reviews our experience with right lower sleeve lobectomy and describes our technique and approach to perioperative patient management. METHODS: We retrospectively reviewed 11 patients who underwent right lower sleeve lobectomy for lung cancer. Surgical techniques and perioperative management were also investigated. RESULTS: Bronchoplasty was performed using 4-0 absorbable monofilament sutures. The deepest portion was anastomosed using continuous sutures; interrupted sutures were used for the more superficial portions. The truncus intermedius and right middle lobe bronchus should be anastomosed in a natural position. Anastomosis patency was confirmed using intraoperative bronchoscopy. Separation of the right upper and middle lobes and pericardiotomy at the inferior edge of the superior pulmonary vein are useful for mobilizing the right middle lobe. Death during hospitalization and treatment-related death did not occur. One patient developed pneumonia, and another developed a bronchopleural fistula. CONCLUSION: We reported our technique of right lower sleeve lobectomy and our approach to perioperative patient management. Sharing knowledge is essential to completing this rare surgery.

Sialyl Lewis X as a predictor of skip N2 metastasis in clinical stage IA non-small cell lung cancer.

BACKGROUND: Radical segmentectomy has been performed for small-sized non-small cell lung cancer (NSCLC). However, underestimation of mediastinal lymph node metastasis in the absence of hilar or interlobar metastasis (skip N2) affects surgical strategy. Our aim was to investigate preoperative and intraoperative predictors of skip N2 in clinical stage (c-stage) IA NSCLC. METHODS: From 1998 to 2011, 279 patients (155 men and 124 women) with c-stage IA NSCLC (230 pN0, 17 pN1, 12 skip N2, 20 non-skip N2) underwent systematic lobectomy (R0 resection) at our institute. We compared preoperative serum concentrations of carcinoembryonic antigen, cytokeratin 19 fragment, sialyl Lewis X (SLX), and pre- and intraoperative clinicopathological features of pN0 and skip N2 patients. Receiver operator characteristic (ROC) curve analysis was performed to distinguish between the two patient groups. RESULTS: The 5-year survival rate of skip N2 patients was 78.6%, higher than that of non-skip N2 patients (44.9%), and not significantly different than that of pN0 (86.7%) or pN1 patients (82.4%). The mean serum SLX concentration in skip N2 patients (28.0 U/ml) was elevated compared to that in pN0 patients (22.9 U/ml). In ROC analysis of SLX, the area under the curve was 0.710, and the optimal cut-off value was 21.4 U/ml (sensitivity, 91.7%; specificity, 51.7%). In multivariate analysis, SLX was an independent predictor of skip N2 in patients with c-stage IA NSCLC (odds ratio, 9.43; p = 0.006). CONCLUSIONS: Skip N2 metastasis is common in patients with c-stage IA NSCLC with high serum SLX, and lobectomy with complete dissection of hilar and mediastinal lymph nodes should remain the standard surgical procedure for these cases.

Clinicopathological significance of combined analysis of cytokeratin19 expression and preoperative serum CYFRA21-1 levels in human lung squamous cell carcinoma.

BACKGROUND: To identify a useful biomarker for human lung squamous cell carcinoma (SCC), the expression of cytokeratin19 (CK19) in human SCC tissue was investigated. In addition, we examined the significance of CK19 expression levels by immunostaining and CYFRA21-1 levels in preoperative serum, and their correlation with the clinicopathologic features of human lung SCC. METHODS: To identify proteins in cancerous and non-cancerous tissues for the diagnosis and prognosis of SCC, QSTAR Elite LC-MS/MS was used. Immunostaining for CK19 was classified as either "CK19-strong" or "CK19-weak". Correlations between prognosis and both CK19 expression in tumor tissues and serum concentrations of CYFRA 21-1 were analyzed in 107 cases of lung SCC. RESULTS: The upregulation of CK19 in human squamous cell carcinoma tissues was observed by LCMS/MS. The weak expression of CK19, as determined by immunostaining intensity, was a significant predictor of poorer disease-specific survival (p = 0.032). The prognosis was significantly poorer for patients with weak CK19 immunostaining in tumor tissues and a high serum concentration of CYFRA21-1 compared with the other groups (p = 0.003). CONCLUSIONS: The combination of weak CK19 expression and high serum CYFRA21-1 levels is a predictor of poorer prognosis for patients with human lung SCC.

GLUT1 and PKM2 may be useful prognostic predictors in patients with non­small cell lung cancer following curative R0 resection.

Lung cancer has a poor prognosis despite recent progresses being made regarding its treatment. In addition, there is a paucity of reliable and independent prognostic predictors for non-small cell lung cancer (NSCLC) following curative resection. Glycolysis is associated with the malignancy and proliferation of cancer cells. Glucose transporter 1 (GLUT1) promotes glucose uptake, whereas pyruvate kinase M2 (PKM2) promotes anaerobic glycolysis. The present study aimed to evaluate the relationship between the expression of GLUT1 and PKM2 and the clinicopathological features of patients with NSCLC, and to identify a reliable prognostic factor for NSCLC following curative resection. Patients with NSCLC who underwent curative surgery were retrospectively enrolled to the present study. GLUT1 and PKM2 expression was assessed using immunohistochemistry. Subsequently, the association between the clinicopathological features of patients with NSCLC and the expression of GLUT1 and PKM2 was assessed. Of the 445 patients with NSCLC included in the present study, 65 (15%) were positive for both GLUT1 and PKM2 expression (G+/P+ group). GLUT1 and PKM2 positivity was significantly associated with sex, absence of adenocarcinoma, lymphatic invasion and pleural invasion. Furthermore, patients with NSCLC in the G+/P+ group presented significantly poorer survival rates than those expressing other markers. G+/P+ expression was significantly associated with poor disease-free survival. In conclusion, the findings of the present study indicated that the combination of GLUT1 and PKM2 may be considered a reliable prognostic factor for patients with NSCLC following curative resection, especially in patients with stage I NSCLC.

Usefulness of pyruvate dehydrogenase-E1α expression to determine SUVmax cut-off value of [18F]FDG-PET for predicting lymph node metastasis in lung cancer.

A more accurate cut-off value of maximum standardized uptake value (SUVmax) in [18F]fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG-PET/CT) is necessary to improve preoperative nodal staging in patients with lung cancer. Overall, 223 patients with lung cancer who had undergone [18F]FDG-PET/CT within 2 months before surgery were enrolled. The expression of glucose transporter-1, pyruvate kinase-M2, pyruvate dehydrogenase-E1α (PDH-E1α), and carbonic anhydrase-9 was evaluated by immunohistochemistry. Clinicopathological background was retrospectively investigated. According to PDH-E1α expression in primary lesion, a significant difference (p = 0.021) in SUVmax of metastatic lymph nodes (3.0 with PDH-positive vs 4.5 with PDH-negative) was found, but not of other enzymes. When the cut-off value of SUVmax was set to 2.5, the sensitivity and specificity were 0.529 and 0.562, respectively, and the positive and negative predictive values were 0.505 and 0.586, respectively. However, when the cut-off value of SUVmax was set according to PDH-E1α expression (2.7 with PDH-positive and 3.2 with PDH-negative), the sensitivity and specificity were 0.441 and 0.868, respectively, and the positive and negative predictive values were 0.738 and 0.648, respectively. The SUVmax cut-off value for metastatic lymph nodes depends on PDH-E1α expression in primary lung cancer. The new SUVmax cut-off value according to PDH-E1α expression showed higher specificity for [18F]FDG-PET in the diagnosis of lymph node metastasis.

Restrictive Ventilatory Impairment as a Poor Prognostic Factor in Patients Who Undergo Surgical Resection for Metachronous Second Primary Lung Cancer.

PURPOSE: To evaluate the prognostic impact of restrictive ventilatory impairment in patients who undergo pulmonary resection of metachronous second primary lung cancer. METHODS: The clinical characteristics and surgical outcomes of 70 patients with metachronous second primary lung cancer were analyzed. RESULTS: The surgical procedures consisted of wedge resection in 40 patients, segmentectomy in 17, lobectomy in 12, and completion pneumonectomy in one. Patients who underwent ipsilateral pulmonary resection developed more perioperative complications (p = 0.0339). Three-year and 5-year overall survival rates were 78.2% and 69.2%, respectively. In univariate analysis, sex, restrictive ventilatory impairment, and histology of second primary lung cancer were significantly poor prognostic factors (all p <0.05). Multivariate analysis identified restrictive ventilatory impairment to be an independent predictor of a poor prognosis (p = 0.0193). In the 22 patients who died, the cause of death was lung cancer in 11 and other diseases, including pneumonia and respiratory failure, in 11. Death from another disease was significantly more common in patients with restrictive ventilatory impairment (p = 0.0216). CONCLUSION: Restrictive ventilatory impairment was an independent predictor of a poor prognosis in patients with a second primary lung cancer. Restrictive ventilatory impairment as a result of repeated thoracic surgery may increase the likelihood of death from another disease.

Elevation of the Neutrophil-to-Lymphocyte Ratio Is a Significant Postoperative Poor Prognostic Factor in Patients With Clinical T3-4 Centrally Located Primary Lung Cancer.

BACKGROUND/AIM: In centrally located non-small cell lung cancer (CLNSCLC) surgery, large tumors and extension to neighboring structures prevent the attainment of adequate surgical fields and make operations more difficult, and some patients have extremely poor outcomes. This study aimed to identify novel postoperative prognostic factors in patients with advanced CLNSCLC. PATIENTS AND METHODS: CLNSCLC was defined as a tumor requiring pneumonectomy or sleeve lobectomy for complete removal. We retrospectively investigated the clinical courses of 35 patients with cT3-4 CLNSCLC. RESULTS: This study included 21 patients with cT3 and 14 with cT4 lung cancer. Nine patients underwent pneumonectomy and 26 underwent sleeve lobectomy. Univariate analysis revealed that a high neutrophil-to-lymphocyte ratio (NLR, p=0.005) and carcinoembryonic antigen (CEA) positivity (p=0.028) were significant poor prognostic factors. Only high NLR (p=0.020) was a significant independent predictor in multivariate analysis. Nine of 16 patients with high NLR (56%) experienced disease recurrence, whereas 6 of 19 patients without high NLR (32%) had recurrent disease. CONCLUSION: High NLR and CEA positivity were significant poor prognostic factors in patients with cT3-4 CLNSCLC, and only high NLR was an independent predictor. Our findings may be helpful in selecting optimal treatments for advanced CLNSCLC.

Surgical Outcomes After Pulmonary Resection With Typical or Atypical Bronchoplasty in Patients With Primary Lung Cancer.

BACKGROUND/AIM: Atypical bronchoplasty is essential for complete tumor removal and preservation of peripheral lung tissue. This study compared surgical outcomes after atypical or typical bronchoplasty in patients who underwent pulmonary sleeve resection with bronchoplasty. PATIENTS AND METHODS: Typical bronchoplasty was defined as that after one-lobe sleeve resection; atypical bronchoplasty was defined as that after sleeve bilobectomy or sleeve removal of one lobe plus segments. Double-barreled bronchoplasty was also included in the atypical group. Surgical outcomes were retrospectively investigated according to type of bronchoplasty. RESULTS: Fifty-one patients underwent typical bronchoplasty and 20 atypical bronchoplasty. Recurrence was seen in 17 out of 51 (33%) patients after typical bronchoplasty and 10 out of 20 patients (50%) after atypical bronchoplasty. The recurrence-free survival rate was significantly poorer in the atypical bronchoplasty group (p=0.038). However, patients in the atypical bronchoplasty group were able to receive anticancer treatment for tumor recurrence, and there was no significant difference in overall survival rates between the groups. CONCLUSION: Preservation of pulmonary function by atypical bronchoplasty might contribute to tolerability of anticancer treatment for tumor recurrence. Pulmonary resection with atypical bronchoplasty is reliably beneficial for overall survival.

Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue type arising in the pleura with pleural fibrous plaques in a lathe worker.

Our patient was an 86-year-old man who had worked as a lathe operator for 40 years. He had no history of tuberculosis, pyothorax, or autoimmune disease. He had not been exposed to asbestos. He was asymptomatic, but an imaging study showed gradually increasing pleural plaques. A biopsy specimen of a pleural lesion showed sclerosis of the pleura and diffuse infiltration of small- to medium-sized B lymphocytes. Polymerase chain reaction-based analysis detected monoclonal rearrangement of immunoglobulin heavy-chain genes. Histologic diagnosis was extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue type (MALT lymphoma). The lymphoma was negative for Epstein-Barr virus. We report a rare case of a metal worker with MALT lymphoma arising in the pleura with pleural fibrous plaques. It is speculated that MALT lymphoma might develop in the background of pneumoconiosis. Inflammatory and/or immunologic reactions to metal particles might contribute to the oncogenesis of this tumor.

Large Tumor Size and High Neutrophil-to-lymphocyte Ratio Predicts Poor Prognosis After Pneumonectomy or Sleeve Lobectomy in Patients With Non-small-cell Lung Cancer.

BACKGROUND/AIM: The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are useful biomarkers in non-small cell lung cancer (NSCLC). The aim of this study was to identify novel prognostic factors after pneumonectomy or sleeve lobectomy. PATIENTS AND METHODS: The clinical courses of 68 patients with NSCLC who underwent pneumonectomy or sleeve lobectomy were retrospectively investigated. RESULTS: High NLR (p=0.002) and PLR (p=0.006), and large tumor (>40 mm) (p=0.024) were indicative of poor prognosis in univariate analysis. High NLR (p=0.021) and large tumor (>40 mm) (p=0.017) remained independent factors indicating poor prognosis in multivariate analysis. Eighteen patients with both high NLR and large tumor (>40 mm) had significantly poorer prognoses than the remaining patients, 10 of them having recurrences within a short time after surgery. CONCLUSION: A high NLR and large tumor size indicate a poor prognosis after pneumonectomy or sleeve lobectomy. Our findings may be helpful in selecting optimal treatments for this subgroup of patients.