Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 19 de 19
Filtrar
1.
Surg Oncol ; 37: 101514, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33429325

RESUMO

INTRODUCTION: The International Association for the Study of Lung Cancer has proposed a new classification of N descriptor based on the number of metastatic lymph nodes (LNs) stations, including skip metastasis. The aim of the study was to determine the effect of removed LNs on the adequacy of this new classification. MATERIALS AND METHODS: The material was collected retrospectively based on the database of the Polish Lung Cancer Group, including information on 8016 patients with non-small cell lung cancer operated in 23 thoracic surgery centers in Poland. The material covered the period from January 2005 to September 2015. We divided patients into two groups: ≤6LNs and >6LNs removed. RESULTS: In the whole group, an average of 13.4 nodes and 4.54 nodal stations were removed. 5-year survivals in the >6LNs group vs ≤ 6LNs group were: 62.3% and 55.1% (N0), 44.5% and 35.9% (N1a), 34.1% and 31,7% (N1b), 37.3% and 26.3% (N2a1), 32.4% and 26.7% (N2a2), 29.4% and 29.2% (N2b1), and 22.0% and 23.0% (N2b2), respectively. Comparing these groups, we detected significant differences at N0 (p < 0.001) and N2a1 (p = 0.022). In the ≤6LNs group, the survival curves for N2a1, N2a2, N2b1, and N2b2 overlapped (p > 0.05). In the >6LNs group, the survival curves were significantly different between grades, with survival for N2a1 better than N1b (p = 0.232). CONCLUSION: The proposed classification N descriptor is potentially better at differentiating patients into different stages. The accuracy of the classification depends on the number of lymph nodes removed. Therefore, the extent of lymphadenectomy has a significant impact on the staging of surgically-treated lung cancer.

2.
J Thorac Dis ; 12(10): 6042-6053, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33209438

RESUMO

The nodal status indicator in non-small cell lung cancer is one of the most crucial prognostic factors available. However, there are still many arguments among scientists regarding whether the currently used nodal status descriptor should be changed in the forthcoming editions of the Tumor Node Metastasis classification or whether it is precise enough and should be maintained as is. We reviewed studies concerning nodal factor classifications to evaluate their accuracy in non-small cell lung cancer patients and to address the previously mentioned challenge. We reviewed the PubMed database regarding the following classifications: ongoing 8th edition of the Tumor Node Metastasis classification, number of positive lymph nodes, number of negative lymph nodes, number of dissected lymph nodes, lymph node ratio, nodal chains, log odds of positive lymph nodes, zone-based classification and one that is based on the number of lymph node stations involved. Moreover, we analysed data regarding various combinations of these classifications. Our analysis showed that the present nodal staging may not accurately categorize every lung cancer patient. The number of positive lymph nodes and lymph node ratio or the log odds of positive lymph nodes (as the mathematical modification of lymph node ratio) are more legitimate, as they possess very robust data and should be considered initially as additional factors that can be incorporated in ongoing nodal staging systems. Forthcoming non-small cell lung cancer staging systems could benefit from the addition of quantitative-based parameters. Additionally, the minimal extent of lymphadenectomy should be established as staging benefits from it. International, prospective validation studies need to be performed to optimize the cut-off values and prognostic groups and to confirm the superiority of the newly suggested descriptors in non-small cell lung cancer nodal staging.

3.
J Thorac Dis ; 12(3): 383-393, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32274104

RESUMO

Background: Pulmonary veins (PVs) are important during segmentectomy. Many case reports prove that they may be the source of bleeding during surgery, especially when anatomical variants are present. We decided to describe venous variations and prepare a computed tomography based atlas of our observations. Methods: The study was conducted using 135 chest computed tomography studies with intra venous iodine contrast injection. The study population contained 86 females and 49 males, mean age was 60. Thirteen people had atrial fibrillation. Images were analysed using radiological workstation. Results: The variations were divided into three categories: atypical topography of the PV, atypical venous outflow to the left atrium (LA), atypical venous vascularization of the lung bronchopulmonary segment. Retrobronchial course of the vein of the posterior segment of the right upper lobe was observed in 8.15%. The most common variant of atrial venous outflow was the direct outflow of the middle lobe vein, observed in 25.19% of cases and the long common trunk of left PVs in 11.11%. The split drainage from the middle lobe into the right superior pulmonary vein (RSPV) and the right inferior pulmonary vein (RIPV) was observed in 9.63% as the full drainage into the RIPV in 2.96%. Conclusions: Long common trunk of left PVs and numerous variants of venous vascularisation of the middle lobe are the variations that may pose potential problems during thoracic surgeries. The frequency is high enough to justify the routine assessment of pulmonary vessels with computed tomography before surgery.

4.
Interact Cardiovasc Thorac Surg ; 30(4): 559-564, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32068846

RESUMO

OBJECTIVES: The American College of Chest Physicians guidelines recommend low-technology exercise tests in the functional evaluation of patients with lung cancer considered for resectional surgery. However, the 6-min walk test (6MWT) is not included, because the data on its clinical value are inconsistent. Our goal was to evaluate the 6MWT in assessing the risk of cardiopulmonary complications in candidates for lung resection. METHODS: We performed a retrospective assessment of clinical data and pulmonary function test results in 947 patients, mean age 65.3 (standard deviation 9.5) years, who underwent a single lobectomy for lung cancer. In 555 patients with predicted postoperative values ≤60%, the 6MWT was performed. The 6-min walking distance (6MWD) and the distance-saturation product (DSP), which is the product of the 6MWD in metres, and the lowest oxygen saturation registered during the test were assessed. RESULTS: A total of 363 patients with predicted postoperative values <60% and a 6MWT distance (6MWD) ≥400 m or DSP ≥ 350 m% had a lower rate of cardiopulmonary complications than patients with shorter 6MWD or lower DSP values [odds ratio (OR) 0.53, 95% confidence interval (CI) 0.35-0.81] and 0.47 (95% CI 0.30-0.73), respectively. This result was also true for patients with predicted postoperative values <40%, ORs 0.33 (95% CI 0.14-0.79) and 0.25 (95% CI 0.10-0.61), respectively. CONCLUSIONS: The 6MWT is useful in the assessment of operative risk in patients undergoing a single lobectomy for lung cancer. It helps to stratify the operative risk, which is lower in patients with 6MWD ≥400 m or DSP ≥350 m% than in patients with a shorter 6MWD or lower DSP values.


Assuntos
Tolerância ao Exercício/fisiologia , Neoplasias Pulmonares/fisiopatologia , Pneumonectomia/métodos , Teste de Caminhada/métodos , Caminhada/fisiologia , Idoso , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/cirurgia , Masculino , Modalidades de Fisioterapia , Valor Preditivo dos Testes , Testes de Função Respiratória , Estudos Retrospectivos
5.
Oncotarget ; 10(19): 1760-1774, 2019 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-30956756

RESUMO

The development of cancer is driven by the accumulation of many oncogenesis-related genetic alterations and tumorigenesis is triggered by complex networks of involved genes rather than independent actions. To explore the epistasis existing among oncogenesis-related genes in lung cancer development, we conducted pairwise genetic interaction analyses among 35,031 SNPs from 2027 oncogenesis-related genes. The genotypes from three independent genome-wide association studies including a total of 24,037 lung cancer patients and 20,401 healthy controls with Caucasian ancestry were analyzed in the study. Using a two-stage study design including discovery and replication studies, and stringent Bonferroni correction for multiple statistical analysis, we identified significant genetic interactions between SNPs in RGL1:RAD51B (OR=0.44, p value=3.27x10-11 in overall lung cancer and OR=0.41, p value=9.71x10-11 in non-small cell lung cancer), SYNE1:RNF43 (OR=0.73, p value=1.01x10-12 in adenocarcinoma) and FHIT:TSPAN8 (OR=1.82, p value=7.62x10-11 in squamous cell carcinoma) in our analysis. None of these genes have been identified from previous main effect association studies in lung cancer. Further eQTL gene expression analysis in lung tissues provided information supporting the functional role of the identified epistasis in lung tumorigenesis. Gene set enrichment analysis revealed potential pathways and gene networks underlying molecular mechanisms in overall lung cancer as well as histology subtypes development. Our results provide evidence that genetic interactions between oncogenesis-related genes play an important role in lung tumorigenesis and epistasis analysis, combined with functional annotation, provides a valuable tool for uncovering functional novel susceptibility genes that contribute to lung cancer development by interacting with other modifier genes.

6.
Thorac Surg Clin ; 28(3): 305-313, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30054068

RESUMO

The carinal resection is still considered a real challenge, both for a thoracic surgeon and an anesthesiologist. Depending on the indications and the degree of local advancement of the neoplasm, there are 2 techniques of carinal resection and reconstruction. The first one consists of the isolated resection with formation of a new bifurcation, whereas the second one is a combination of anatomic resection of lung parenchyma together with the bifurcation and the subsequent reconstruction. Long-term outcomes after carinal resection procedures, with clear postoperative margins, depend to a large extent on the stage of advancement of the primary disease.


Assuntos
Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Traqueia/cirurgia , Humanos , Pulmão/cirurgia , Cuidados Pré-Operatórios , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Torácicos/métodos , Traqueia/anatomia & histologia
7.
Carcinogenesis ; 39(3): 336-346, 2018 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-29059373

RESUMO

Non-small cell lung cancer is the most common type of lung cancer. Both environmental and genetic risk factors contribute to lung carcinogenesis. We conducted a genome-wide interaction analysis between single nucleotide polymorphisms (SNPs) and smoking status (never- versus ever-smokers) in a European-descent population. We adopted a two-step analysis strategy in the discovery stage: we first conducted a case-only interaction analysis to assess the relationship between SNPs and smoking behavior using 13336 non-small cell lung cancer cases. Candidate SNPs with P-value <0.001 were further analyzed using a standard case-control interaction analysis including 13970 controls. The significant SNPs with P-value <3.5 × 10-5 (correcting for multiple tests) from the case-control analysis in the discovery stage were further validated using an independent replication dataset comprising 5377 controls and 3054 non-small cell lung cancer cases. We further stratified the analysis by histological subtypes. Two novel SNPs, rs6441286 and rs17723637, were identified for overall lung cancer risk. The interaction odds ratio and meta-analysis P-value for these two SNPs were 1.24 with 6.96 × 10-7 and 1.37 with 3.49 × 10-7, respectively. In addition, interaction of smoking with rs4751674 was identified in squamous cell lung carcinoma with an odds ratio of 0.58 and P-value of 8.12 × 10-7. This study is by far the largest genome-wide SNP-smoking interaction analysis reported for lung cancer. The three identified novel SNPs provide potential candidate biomarkers for lung cancer risk screening and intervention. The results from our study reinforce that gene-smoking interactions play important roles in the etiology of lung cancer and account for part of the missing heritability of this disease.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/etiologia , Carcinoma Pulmonar de Células não Pequenas/genética , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/genética , Fumar/efeitos adversos , Estudos de Casos e Controles , Grupo com Ancestrais do Continente Europeu , Interação Gene-Ambiente , Predisposição Genética para Doença/genética , Estudo de Associação Genômica Ampla , Genótipo , Humanos , Polimorfismo de Nucleotídeo Único
8.
Eur J Cardiothorac Surg ; 52(2): 363-369, 2017 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-28402455

RESUMO

OBJECTIVES: Anatomical lobar resection and mediastinal lymphadenectomy remain the standard for the treatment of early stage non-small-cell lung cancer (NSCLC) and are preferred over procedures such as segmentectomy or wedge resection. However, there is an ongoing debate concerning the influence of the extent of the resection on overall survival. The aim of this article was to assess the overall survival for different types of resection for Stage I NSCLC. METHODS: We performed a retrospective analysis of the results of the surgical treatment of Stage I NSCLC. Between 1 January 2007 and 31 December 2013, the data from 6905 patients who underwent Stage I NSCLC operations were collected in the Polish National Lung Cancer Registry (PNLCR) and overall survival was assessed. A propensity score-matched analysis was used to compare 3 groups of patients, each consisting of 231 patients who underwent lobectomy, segmentectomy, or wedge resection. RESULTS: In the unmatched and matched patient groups, lobectomy and segmentectomy were associated with a significant benefit compared to wedge resection regarding overall survival (log-rank P < 0.001 and P = 0.001). The Cox proportional hazard ratio comparing segmentectomy and lobectomy to wedge resection was 0.54 [95% confidence interval (CI): 0.37-0.77) and 0.44 (95% CI: 0.38-0.50), respectively, indicating a significant improvement in survival. There was no difference in the 5-year survival of patients after lobectomy (79.1%; 95% CI: 77.7-80.4%) or segmentectomy (78.3%; 95% CI: 70.6-86.0%). The 30-day mortality rate was 1.6, 2.6 and 1.4% for lobectomy, segmentectomy and wedge resection, respectively. Wedge resection was associated with a significantly lower 5-year survival rate (58.1%; 95% CI: 53.6-62.5%) compared to segmentectomy (78.3%; 95% CI: 70.6-86.0%) and lobectomy (79.1%; 95% CI: 77.7-80.5%). The propensity score matched analysis confirmed most of the results of the comparisons of unmatched study groups. CONCLUSIONS: Wedge resection was associated with significantly lower 3-year and 5-year survival rates compared to the other methods of resection. There was no significant difference in 3-year or 5-year survival rates between lobectomy and segmentectomy. Segmentectomy, but not wedge resection, could be considered an alternative to lobectomy in the treatment of patients with Stage I NSCLC.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Pneumonectomia , Idoso , Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Pneumonectomia/métodos , Pneumonectomia/estatística & dados numéricos , Polônia/epidemiologia , Sistema de Registros , Estudos Retrospectivos
9.
Respiration ; 92(2): 65-71, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27428328

RESUMO

BACKGROUND: Impaired lung function (LF) is a well-known risk factor for perioperative complications in patients qualified for lung resection surgery. The recent European guidelines recommend using values below 80% predicted as indicating abnormal LF rather than the lower limit of normal (LLN). OBJECTIVES: To assess how the choice of a cut-off point (80% predicted vs. LLN at -1.645 SD) affects the incidence of functional disorders and postoperative complications in lung cancer patients referred for lung resection. METHODS: Preoperative spirometry and the transfer factor for carbon monoxide (TL,CO) were retrospectively analysed in 851 consecutive lung cancer patients after resectional surgery. RESULTS: Airway obstruction was diagnosed in 369 (43.4%), and a restrictive pattern in 41 patients (4.8%). The forced expiratory volume in 1 s (FEV1) or TL,CO was below the LLN in 503 patients (59.1%), whereas the FEV1 or TL,CO was <80% predicted in 620 patients (72.9%; χ2 test: p < 0.0001). In all, 117 out of 851 patients had LF indices <80% predicted but not below the LLN. Odds ratios (ORs) for perioperative complications were higher in patients with impaired LF indices defined as below the LLN (1.59, p = 0.0005) with the exception of large resections (>5 segments). In patients with test results above the LLN and <80% predicted, the OR for perioperative complications was not different (1.14, p = 0.5) from that in patients with normal LF. CONCLUSIONS: LF impairments are common in candidates for lung resection. Using the LLN instead of 80% predicted diminishes the prevalence of respiratory impairment by 14% and allows for safe resectional surgery without additional function testing.


Assuntos
Neoplasias Pulmonares/cirurgia , Seleção de Pacientes , Pneumonectomia , Complicações Pós-Operatórias/epidemiologia , Transtornos Respiratórios/epidemiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polônia/epidemiologia , Prevalência , Testes de Função Respiratória , Estudos Retrospectivos
10.
J Clin Oncol ; 30(2): 172-8, 2012 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-22124104

RESUMO

PURPOSE: This study aimed to determine whether three preoperative cycles of gemcitabine plus cisplatin followed by radical surgery provides a reduction in the risk of progression compared with surgery alone in patients with stages IB to IIIA non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Patients with chemotherapy-naive NSCLC (stages IB, II, or IIIA) were randomly assigned to receive either three cycles of gemcitabine 1,250 mg/m(2) days 1 and 8 every 3 weeks plus cisplatin 75 mg/m(2) day 1 every 3 weeks followed by surgery, or surgery alone. Randomization was stratified by center and disease stage (IB/IIA v IIB/IIIA). The primary end point was progression-free survival (PFS). Results The study was prematurely closed after the random assignment of 270 patients: 129 to chemotherapy plus surgery and 141 to surgery alone. Median age was 61.8 years and 83.3% were male. Slightly more patients in the surgery alone arm had disease stage IB/IIA (55.3% v 48.8%). The chemotherapy response rate was 35.4%. The hazard ratios for PFS and overall survival were 0.70 (95% CI, 0.50 to 0.97; P = .003) and 0.63 (95% CI, 0.43 to 0.92; P = .02), respectively, both in favor of chemotherapy plus surgery. A statistically significant impact of preoperative chemotherapy on outcomes was observed in the stage IIB/IIIA subgroup (3-year PFS rate: 36.1% v 55.4%; P = .002). The most common grade 3 or 4 chemotherapy-related adverse events were neutropenia and thrombocytopenia. No treatment-by-histology interaction effect was apparent. CONCLUSION: Although the study was terminated early, preoperative gemcitabine plus cisplatin followed by radical surgery improved survival in patients with clinical stage IIB/IIIA NSCLC.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/cirurgia , Adulto , Idoso , Carcinoma Pulmonar de Células não Pequenas/patologia , Quimioterapia Adjuvante , Cisplatino/administração & dosagem , Desoxicitidina/administração & dosagem , Desoxicitidina/análogos & derivados , Esquema de Medicação , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias
11.
Pneumonol Alergol Pol ; 79(2): 127-31, 2011.
Artigo em Polonês | MEDLINE | ID: mdl-21351064

RESUMO

We present a case of 26 years old man with large spontaneous pneumothorax of about 5 days duration. Application of suction drainage was complicated by unilateral reexpansion pulmonary edema (REPE) and hemothorax developed during first 24 hours of treatment. On thoracotomy multifocal superficial pleural bleeding was seen which was probably attributed to the pathomechanisms similar to suggested in reexpansion pulmonary edema. The patient received supplemental oxygen therapy and completely recovered during next few days. The patient presented typical risk factors of REPE including: young age, large and prolonged pneumothorax. In such cases chest tube should be initially left off suction to prevent REPE.


Assuntos
Hemotórax/etiologia , Edema Pulmonar/etiologia , Sucção/efeitos adversos , Adulto , Humanos , Masculino , Pneumotórax/terapia , Resultado do Tratamento
13.
Radiother Oncol ; 98(2): 238-43, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20951453

RESUMO

AIM: To prospectively assess the cardiopulmonary morbidity and quality of life in patients with non-small cell lung cancer (NSCLC) treated with postoperative radiotherapy (PORT) in comparison to those not receiving PORT. MATERIALS AND METHODS: From 2003 to 2007, 291 patients entered the study; 171 pN2 patients received 3D-planned PORT (PORT group), 120 pN1 patients (non-PORT group) did not. One month after surgery, all patients completed EORTC QLQ C-30 questionnaire and had pulmonary function tests (PFT); cardiopulmonary symptoms were assessed by modified LENT-SOM scale. Two years later, disease-free patients repeated the same examinations. The differences between baseline values and values recorded at two years in QLQ, LENT-SOM and the PFT of the two groups were compared. RESULTS: In the whole cohort, the rate of non-cancer related deaths was 5.3% and 5.0% in PORT and non-PORT group, respectively. Ninety-five patients (47 - PORT group, 48 - non-PORT group) were included into the final analysis. The differences in the QLQ and cardiopulmonary function (LENT/SOM, PFT) between both groups were insignificant. The forced expiratory volume in one second was on average 12.2% and 1.3% better in the PORT and the non-PORT group, respectively, p=0.2. CONCLUSIONS: Our findings support the hypothesis about insignificant morbidity of 3D-planned PORT.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/radioterapia , Coração/efeitos da radiação , Neoplasias Pulmonares/radioterapia , Pulmão/efeitos da radiação , Qualidade de Vida , Adulto , Idoso , Carcinoma Pulmonar de Células não Pequenas/psicologia , Terapia Combinada , Feminino , Humanos , Neoplasias Pulmonares/psicologia , Masculino , Pessoa de Meia-Idade , Morbidade , Estudos Prospectivos , Planejamento da Radioterapia Assistida por Computador
14.
Pneumonol Alergol Pol ; 76(1): 1-10, 2008.
Artigo em Polonês | MEDLINE | ID: mdl-18283649

RESUMO

INTRODUCTION: Surgical resection is the mainstay of curative treatment for non-small cell lung cancer. MATERIAL AND METHODS: A retrospective analysis of the efficacy of this treatment, based on 431 patients operated from 1998 to 1999 in the Department of Surgery of the National Tuberculosis and Lung Diseases Research Institute, was accomplished. In 218 cases (51%) lobectomy was performed, in 21 cases (5%) - bilobectomy, in 188 cases (44%) - pneumonectomy and in 4 cases (1%) - wedge resection. The pIA stage was diagnosed in 70 cases (16%), pIB - in 112 (26%), pIIA - in 22 (5%), pIIB - in 110 (26%), pIIIA - in 88 (20%), pIIIB - in 13 (3%) and pIV - in 16 (4%). RESULTS: The five-year survival rate for the whole group was 49.1%. Statistical analysis revealed better survival in patients younger than 50 (p = 0.03), in women (p = 0.01, HR = 0.63) and in cases with less extensive surgery, i.e. lobectomy, (p < 0.05). Long-term survival was significantly dependent on the disease stage (p < 0.005). Five-year survival of patients in stage IA was 81.7%, IB - 62.2%, IIA - 59.1%, IIB - 38%, IIIA - 21.3%, IIIB - 8.3% and IV - 8.3%. Tumour status (p < 0.005) and histological subtype (p < 0.005) had a significant influence on long-term survival. Five-year survival of patients with squamous cell carcinoma was 53.4%, with adenocarcinoma - 38.3%, with large cell carcinoma - 37.5%, with carcinoid - 94.7% and with other types of cancer - 39.1%. The decreased preoperative Hb level (p < 0.005, HR = 1.52), as well as blood transfusion in postoperative period (p = 0.03), were negative prognostic factors. Significantly worse prognosis was observed in the cases of R1 or R2 categories (p = 0.01) and M1 category (p < 0.005). Additionally, in multivariate Cox analysis, a decreased FEV1 lower than 80% (HR = 1.46) was a negative prognostic factor, and lack of symptoms, except cough (HR = 0.73), was a positive one. CONCLUSIONS: Univariate analysis revealed several factors worsening prognosis: male sex, age older than 50 years, lowered preoperative Hb concentration, extended surgery, advanced stage, adenocarcinoma and large cell carcinoma, T status, N status, R status, M status and blood transfusion in postoperative period. In multivariate Cox analysis lowered preoperative Hb concentration, decreased FEV1 lower than 80% pred., extended surgery (pneumonectomy), advanced stage and adenocarcinoma were negative prognostic factors. Female sex and lack of symptoms, except coughing were positive prognostic factors.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/cirurgia , Pneumonectomia/mortalidade , Adulto , Idoso , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Pneumonectomia/métodos , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
15.
Pneumonol Alergol Pol ; 74(2): 171-8, 2006.
Artigo em Polonês | MEDLINE | ID: mdl-17269365

RESUMO

THE AIMS: 1) comparison of NSCLC stages according to bronchoscopic and radiological findings with pathological outcome (mediastinoscopy), 2) efficacy of the neoadjuvant ChT by means of nodal involvement and primary tumour (downstaging), 3) influence of ChT on the surgical procedures' extension and its morbidity MATERIAL AND METHODS: 100 consecutive patients with resectable NSCLC in stages IIB (13 pts) or IIIA (57 pts), who were qualified to neoadjuvant ChT, participated in this study (77 men and 23 women, aged 42-73). Tumour and lymph nodes (mediastinal and hilar) were measured in CT scan. Mediastinoscopy was performed in 70 pts (70%). Majority of patients (87%) received two cycles of neoadjuvant ChT (cisplatin 80 mg/m(2) iv on day 1 and vinorelbine 25 mg/m(2) on day 1 and 5) administered every 21 days. After ChT 85 patients were qualified to surgery. THE RESULTS: The metastases in mediastinoscopy were excluded in 32 out of 45 patients (71%), whose lymph nodes were enlarged in CT scan (radiological false positive). Metastases were confirmed in 4 out of 25 patients (16%), whose lymph nodes were normal in CT scan (radiological false negative). After ChT the regression of the disease (PR+CR) was noted in 37% of patients. Pneumonectomy was performed in 23 (27%) pts, bilobectomy in 11 (13%) pts, lobectomy in 39 (46%) pts and "extended" (sleeve) lobectomy in 12 (14%) pts. Resected material was examined microscopically very exactly in patients, in whom mediastinoscopy was performed before treatment. Down-staging was confirmed in 6 out of 15 patients (40%). CONCLUSIONS: Neoadjuvant ChT was effective in 37% of patients and allowed us to perform less extensive surgery in these patients. 22 (64,7%) out of 34 patients who responded to ChT underwent lobectomy. Only 17 (36%) out of 51 patients who did not respond to ChT had lobectomy performed. Generally, 85 pts were operated with postroperative complications in 22.3% patients and 2.3% mortality rate. Pneumonol. Alergol. Pol. 2006, 74, 171:178


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/cirurgia , Adulto , Idoso , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/secundário , Quimioterapia Adjuvante , Cisplatino/administração & dosagem , Feminino , Humanos , Neoplasias Pulmonares/patologia , Excisão de Linfonodo , Metástase Linfática , Masculino , Mediastinoscopia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Vimblastina/administração & dosagem , Vimblastina/análogos & derivados , Vinorelbina
16.
Arch Immunol Ther Exp (Warsz) ; 53(2): 180-4, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-15928588

RESUMO

INTRODUCTION: The aim of this study was to determine the influence activating of the recipient immune system on the function of microencapsulated islet xenografts. MATERIAL/METHODS: The skin of WAG or Fisher rats and WAG free or encapsulated (APA) Langerhans islets were transplanted to healthy or to streptozotocin diabetic BALB/c mice. Skin grafts were performed following the method of Billingham and Medawar. Rat islets were isolated from pancreas by the Lacy and Kostianovsy method and encapsulated with calcium alginate-poly-L-lysine-alginate according to the 3-step coating method of Sun. RESULTS: The transplantation of encapsulated WAG islets, despite activation of the host immune system, restored euglycemia for over 180 +/-100 days. A subsequent skin graft taken from the same donor was rejected in the second set mode, but euglycemia persisted. In diabetic recipients, impaired immune response was corrected by successful encapsulated islet transplantation. In diabetic mice, strong stimulation with 2-fold skin transplantation induced primary non-function of grafted islets despite their encapsulation. CONCLUSIONS: The survival of an islet xenograft depends on the level of activation of the recipient immune system. The immune response of diabetic mice was impaired, but increased after post-transplant restitution of euglycemia. Microencapsulation sufficiently protected grafted islets, and remission of diabetes was preserved. However, after strong specific or non-specific stimulation of the host immune system, non-function of xenografted islets developed despite their encapsulation. Therefore, islet graft recipients should avoid procedures which could stimulate their immune systems. If absolutely necessary, the graft should be protected by exogenous insulin therapy at that time.


Assuntos
Transplante das Ilhotas Pancreáticas/imunologia , Animais , Glicemia/metabolismo , Diabetes Mellitus Experimental/sangue , Diabetes Mellitus Experimental/imunologia , Diabetes Mellitus Experimental/cirurgia , Composição de Medicamentos , Sobrevivência de Enxerto/imunologia , Transplante das Ilhotas Pancreáticas/métodos , Transplante das Ilhotas Pancreáticas/fisiologia , Camundongos , Camundongos Endogâmicos BALB C , Ratos , Ratos Endogâmicos F344 , Ratos Wistar , Transplante de Pele/imunologia , Transplante Heterólogo
17.
Pneumonol Alergol Pol ; 73(3): 281-4, 2005.
Artigo em Polonês | MEDLINE | ID: mdl-16989167

RESUMO

Malignant mesothelioma of the pleura is a rare neoplasm with a poor prognosis. The most often symptoms of this disease are dyspnoe and chest wall pain, which is often associated with pleural effusion. We present 35-years old woman with 5 epizodes of pneumothorax during 3 years (4 of right side and 1-bilateral) in whom bilateral pleurodesis was performed. Specimens of lung and pleurae were examinated. Result of microscopic and immunohistochemical examination was: mesothelioma epithelioides pleurae (mesothelium +, calretyninaa +, EMA+ membrane reaction, desmine +/-).


Assuntos
Mesotelioma/diagnóstico , Mesotelioma/cirurgia , Neoplasias Pleurais/diagnóstico , Neoplasias Pleurais/cirurgia , Pneumotórax/etiologia , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Mesotelioma/complicações , Neoplasias Pleurais/complicações , Pneumotórax/diagnóstico , Pneumotórax/cirurgia , Radiografia Torácica , Tomografia Computadorizada por Raios X
18.
Pol Merkur Lekarski ; 17(100): 345-8, 2004 Oct.
Artigo em Polonês | MEDLINE | ID: mdl-15690698

RESUMO

There is still controversy regarding the effective treatment of the patients with non-small cell lung cancer (NSCLC) in stage IIIA (pN2). The radical surgical resection with subsequent adjuvant radiotherapy remains a routine procedure. This research concentrates on the evaluation of the role of adjuvant radiotherapy. The retrospective analysis comprises 162 patients with NSCLC in stage IIIA (pN2) treated in the Department of Surgery, the Institute of Tuberculosis and Lung Diseases, Warsaw, Poland, in years 1988-1993. We conclude that adjuvant radiotherapy in patients with NSCLC stage IIIA (pN2) seems to improve the 5-year survival rate.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/radioterapia , Neoplasias Pulmonares/radioterapia , Adulto , Idoso , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Polônia , Radioterapia Adjuvante , Estudos Retrospectivos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA