Predictors of conversion to thoracotomy during video-assisted thoracoscopic surgery lobectomy in lung cancer: additional predictive value of FDG-PET/CT in a tuberculosis endemic region.

BACKGROUND: To evaluate the added clinical value of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scans to chest CT imaging in predicting the conversion to thoracotomy during video-assisted thoracoscopic surgery (VATS) lobectomy in patients with lung cancer. METHODS: This is a retrospective study of 235 consecutive patients who underwent planned VATS lobectomy for primary lung cancer between 2011 and 2015. CT images were interpreted in terms of the presence and the attenuation of peribronchial lymph nodes (PLN) and peribronchial cuffs of soft (PCS) tissue, pleural calcification, and parenchymal calcified nodule. On FDG PET/CT images, anthracofibrotic lymph node was considered present when high FDG uptake (SUVmax >3.5) was observed on PET/CT images corresponded to PLN or PCS on chest CT. RESULTS: Among the 235 patients undergoing attempted VATS lobectomy, 55 (23.4%) underwent conversion to thoracotomy. Multivariate logistic regression analysis revealed that the attenuation of PLN or PCS on chest CT (OR, 2.57; 95% CI, 1.328-4.380, 0.005) was an only independent predictor of conversion. The ROC curve showed that combined FDG PET/CT and chest CT reading [areas under curve (AUC), 0.847 (95% CI, 0.795-0.891)] was significantly better than that of chest CT scans alone [AUC, 0.655 (95% CI, 0.50-0.751)] in predicting conversion (P=0.024). CONCLUSIONS: The addition of FDG PET/CT scanning to chest CT imaging provides better performance for predicting conversion to thoracotomy during VATS lobectomy in lung cancer patients. Therefore, in lung cancer patients undergoing surgical resection, FDG PET/CT can provide additional reliable information in selecting the appropriate surgical approach for a lobectomy.

Aberrant DNA methylation profiles of non-small cell lung cancers in a Korean population.

We performed this study to investigate the aberrant methylation profile of the cancer-related genes in Korean non-small cell lung cancer (NSCLC) that previously exhibited high frequencies of methylation in Western populations. The aberrant promoter methylation of eight genes (GSTP1, p16, FHIT, APC, RASSF1A, hMLH1, hMSH2, AGT) was determined by MSP in 99 surgically resected NSCLCs and their corresponding nonmalignant lung tissues. Methylation in the tumor samples was detected at 15% for GSTP1, 22% for p16, 34% for FHIT1, 48% for APC, 40% for RASSF1A, 18% for hMLH1, 8% for hMSH2 and 21% for AGT, whereas it occurred at lower frequencies in the corresponding nonmalignant lung tissues, particularly in the p16 (1%) and RASSF1A (1%) genes. These results suggest that the methylation profiles of NSCLCs in a Korean population are similar to those in Western populations.

[Factors affecting re-smoking in male workers].

OBJECTIVES: This study was performed to examine the factors affecting re-smoking in male workers. METHODS: A self-administrated questionnaire survey was conducted during April 2003 to examine the smoking state of 1,154 employees of a company that launched a smoking cessation campaign in 1998. Five hundred and eighty seven persons, who had stopped smoking for at least one week, were selected as the final study subjects. This study collected data on smoking cessation success or failure for 6 months, and looked at the factors having an effect on resmoking within this period. This study employed the Health Belief Model as its theoretical basis. RESULTS: The re-smoking rate of the 587 study subjects who had stopped smoking for at least one week was 44.8% within the 6 month period. In a simple analysis, the resmoking rates were higher in workers with a low age, on day and night shifts, blue collar, of a low rank, where this was their second attempt at smoking cessation and for those with a shorter job duration (p<0.05). Of the cues to action variables in the Heath Belief Model, re-smoking was significantly related with the perceived susceptibility factor, economic advantages of smoking cessation among the perceived benefits factor, the degree of cessation trial's barrier of the perceived barriers factor, smoking symptom experience, recognition of the degree of harmfulness of environmental tobacco smoke and the existence of chronic disease due to smoking (p<0.05). In the multiple logistic regression analysis for re-smoking, the significant variables were age, perceived susceptibility for disease, economic advantages due to smoking cessation, the perceived barrier for smoking cessation, recognition on the degree of harmfulness of environmental tobacco smoke, the existence of chronic disease due to smoking and the number of attempts at smoking cessation (p<0.05). CONCLUSION: From the result of this study, for an effective smoking ban policy within the work place, health education that improves the knowledge of the adverse health effects of smoking and the harmfulness of environmental tobacco smoke will be required, as well as counter plans to reduce the barriers for smoking cessation.

[The association between serum GGT level within normal range and risk factors of cardiovascular diseases].

OBJECTIVES: We conducted this study to examine the association between serum GGT levels within the normal range and the risk factors of cardiovascular diseases METHODS: We examined the cross-sectional association between serum GGT and the systolic and diastolic blood pressure, fasting blood glucose, total cholesterol, triglyceride, high density lipoprotein cholesterol (HDL-cholesterol), and uric acid among 975 subjects that participated in the health examination of a university hospital located in Daegu city. All the patients' GGT levels were within the normal range. RESULTS: After adjustment were made for age, body mass index (BMI), smoking status, drinking frequency, exercise frequency and coffee intake, the serum GGT level was positively associated with fasting blood glucose (p < 0.01), total cholesterol (p < 0.01), and triglyceride (p < 0.01) in men, and it was positively associated with fasting blood glucose (p < 0.01), total cholesterol (p < 0.05), triglyceride (p < 0.01), and uric acid (p < 0.01) in women. The associations were not significantly different depending on the status of alcohol drinking or obesity, except for the associations of serum GGT with diastolic blood pressure (P for interaction = 0.04) and uric acid (P for interaction = 0.04) between the lean and obese subjects. CONCLUSIONS: Serum GGT levels within the normal range were positively associated with fasting blood glucose, triglyceride and uric acid in most subgroups irrespective of the drinking or obesity status. These results suggest that GGT has important clinical implications as being more than just a marker of alcohol consumption and hepatobiliary disease.

Is serum gamma-glutamyltransferase inversely associated with serum antioxidants as a marker of oxidative stress?

A series of studies in black and white women and men have suggested that serum gamma-glutamyltransferase (GGT) within its normal range might be an early marker of oxidative stress. If serum GGT is a marker of oxidative stress, it might have important implications both clinically and epidemiologically because measurement of serum GGT is easy, reliable, and not expensive. We examined the cross-sectional association between deciles of serum GGT and concentrations of serum antioxidants among 9083 adult participants in the third U.S. National Health and Nutrition Examination Survey. After adjustment for race, sex, age, and total cholesterol, serum concentration of GGT across all deciles was inversely associated with serum concentrations of alpha-carotene, beta-carotene, beta-cryptoxanthin, zeaxanthin/lutein, lycopene, and vitamin C (p for trend <.01, respectively). Vitamin E was not associated with serum GGT. All these associations were not materially different after additional adjustment for total energy intake, body mass index, smoking status, smoking amount, alcohol intake, and exercise. These associations were similarly observed among most subgroups. In conclusion, the current and previous studies strongly suggest that serum GGT level within its normal range may be an early marker of oxidative stress.