Ergonomic effects of medical augmented reality glasses in video-assisted surgery.

BACKGROUND: The aim of this study was to objectively compare medical augmented reality glasses (ARG) and conventional monitors in video-assisted surgery and to systematically analyze its ergonomic benefits. METHODS: Three surgeons (thoracic, laparoscopic, and thyroid surgeons) participated in the study. Six thoracoscopic metastasectomies, six subtotal laparoscopic gastrectomies, and six thyroidectomies were performed with and without ARG. The subjective experience was evaluated using a questionnaire-based NASA-Task Load Index (NASA-TLX). Postures during surgeries were recorded. The risk of musculoskeletal disorders associated with video-assisted surgery was assessed using rapid entire body assessment (REBA). Surface electromyography (EMG) was recorded. Muscle fatigue was objectively measured. RESULTS: NASA-TLX scores of three surgeons were lower when ARG was used compared to those with conventional monitor (66.4 versus 82.7). Less workload during surgery was reported with ARG. The laparoscopic surgeon exhibited a substantial decrease in mental and physical demand [- 21.1 and 12.5%)] and the thyroid surgeon did (- 40.0 and - 66.7%).Total REBA scores decreased with ARG (8 to 3.6). The risk of musculoskeletal disorders was improved in regions of the neck and shoulders. Root mean square (RMS) of the EMG signal decreased from 0.347 ± 0.150 to 0.286 ± 0.130 (p = 0.010) with usage of ARG; a decrease was observed in all surgeons. The greatest RMS decrease was observed in trapezius and sternocleidomastoid muscles. The decrease in brachioradialis muscle was small. CONCLUSION: ARG assisted with correction of bad posture in surgeons during video-assisted surgery and reduced muscular fatigue of the upper body. This study highlights the superior ergonomic efficiency of ARG in video-assisted surgery.

The association of physical function and quality of life on physical activity for non-small cell lung cancer survivors.

PURPOSE: Our study aimed to assess the association between physical function and quality of life (QOL) with physical activity among non-small cell lung cancer (NSCLC) survivors. METHODS: Participants were 92 NSCLC survivors. Physical activity was assessed by a self-report with physiatrist's interview and the Korean version of the short form of the International Physical Activity Questionnaire (IPAQ-SF). All participants were required to perform three standardized fitness tests. The Korean version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) was used to assess QOL. Factors associated with physical functioning and QOL were determined using multiple linear regression. RESULTS: A significant correlation between metabolic equivalent task minutes per week (MET-min/wk) and aerobic fitness was found (r = 0.277, p = 0.008). Factors associated with aerobic fitness include gender, age, and MET-min/wk. The meeting physical activity guideline group was also a factor associated with aerobic fitness. In the QOL aspect, a significant correlation between MET-min/wk and some QOL score was found. The meeting physical activity guideline group was a factor associated with QOL (global health status, physical function, and role function), not total MET-min/wk. CONCLUSIONS: Increased physical activity was associated with higher aerobic fitness and QOL. Engagement in physical activity that met physical activity guidelines was a factor related to aerobic fitness and better QOL in some domains. To improve aspects of aerobic fitness and QOL, we may consider the pattern of physical activity, including regular participation and intensity, rather than total physical activity including basal activity.

Genetic Variant of Notch Regulator DTX1 Predicts Survival After Lung Cancer Surgery.

BACKGROUND: We evaluated the association between genetic variants in the Notch pathway and survival outcomes of patients with surgically resected NSCLC. METHODS: Sixty-four single nucleotide polymorphisms (SNPs) in the Notch pathway genes were evaluated in the discovery study (n = 354) and two sequential validation studies (n = 772 and n = 746, respectively). The association of genotype with overall survival (OS) and disease-free survival (DFS) was evaluated. RESULTS: Of the 64 SNPs analyzed in the discovery study, 9 were significantly associated with OS or DFS. Among them, the association remained significant only for Deltex-1 (DTX1) rs1732786A>G in the first validation study. The second validation study confirmed again the association between DTX1 rs1732786A>G and survival outcomes. In the combined analysis, rs1732786A>G was significantly associated with better OS and DFS (adjusted HR ·aHR· for OS, 0.75; 95% CI 0.64-0.87; P = 0.0002; aHR for DFS, 0.79; 95% CI 0.71-0.89; P = 0.0001). In vitro luciferase assay showed that the rs1732786G allele was associated with higher promoter activity compared to rs1732786A allele. Consistently, relative mRNA expression level of DTX1 showed significant positive correlation with rs1732786 A-to-G change (Ptrend = 0.02) in tumor tissues. CONCLUSIONS: These results suggest that DTX1 rs1732786 is a potential prognostic factor that may have clinical utility in the management of early stage NSCLC.

Prognostic significance of nuclear factor of activated T-cells 5 expression in non-small cell lung cancer patients who underwent surgical resection.

BACKGROUND: Nuclear factor of activated T-cells 5 (NFAT5) is known to be correlated with migration or invasion of tumor cells based on previous in vitro studies. The aim of this study was to analyze the relationship between NFAT5 expression and clinical prognosis in non-small cell lung cancer (NSCLC) patients who underwent surgical resection. MATERIALS AND METHODS: A total of 92 NSCLC patients who underwent surgical resection were enrolled. The tissue microarray core was obtained from surgically resected tumor specimens. NFAT5 expression was evaluated by immunohistochemistry. Relationships of NFAT5 expression with disease recurrence, overall survival, and disease-free survival (DFS) were analyzed. RESULTS: The mean age of 92 patients was 63.7 y. The median follow-up duration was 63.3 mo. Fifty-one (55%) patients exhibited positive expression of NFAT5. Disease recurrence in the NFAT5-positive group was significantly (P = 0.022) higher than that in the NFAT5-negative group. NFAT5-positive expression (odds ratio: 2.632, 95% confidence interval: 1.071-6.465, P = 0.035) and pathologic N stage (N1-2 versus N0; odds ratio: 3.174, 95% confidence interval: 1.241-8.123, P = 0.016) were independent and significant risk factors for disease recurrence. DFS of the NFAT5-positive group was significantly worse than that of the NFAT5-negative group (89.7 versus 48.7 mo, P = 0.011). A multivariate analysis identified NFAT5 expression (P < 0.029) as a significant independent risk factor for DFS of patients with postoperative pathologic T and N stages (P < 0.001 and P = 0.017, respectively). CONCLUSIONS: NFAT5 expression is a useful prognostic biomarker for NSCLC patients who underwent surgical resection.

Learning curve of single-incision thoracoscopic surgery for primary spontaneous pneumothorax.

BACKGROUND: Single-incision thoracoscopic surgery (SITS) requires extensive time and practice to achieve satisfactory technical skills. The aim of this study was to evaluate the learning curves of SITS for primary spontaneous pneumothorax (PSP). METHODS: This study included a total of 274 consecutive patients who underwent PSP surgery by a single operator between May 2011 and February 2014. During this period, SITS was applied as a routine approach. Learning curves were made by the cumulative sum (CUSUM) method using the number of cases and four surgical technique-related factors, including operation time, postoperative complication, non-SITS rate, and ipsilateral PSP recurrence. RESULTS: Among the 274 patients, 16 patients who were presented with a previous 3-port wound scar or inadequate chest tube site before surgery were not eligible for SITS. Hence, SITS was attempted on 258 patients and performed successfully in 251 patients. For these successful SITS patients, the mean age was 22.9 ± 8.1 years, the mean operation time was 65.6 ± 22.2 min, the mean chest tube indwelling time was 1.5 ± 1.1 days, and the mean postoperative hospital stay was 1.7 ± 1.1 days. The mean operation time decreased from 84.0 to 47.6 min when a comparison was made between patients operated in the initial 6 months and the last 6 months of the study period. As revealed by the CUSUM technique, more than 50 % of the cases experienced an operation time of <70 min after the first 92 cases. After 57 cases, the postoperative complication rate was maintained at <5 %. The non-SITS rate was achieved to be lower than 5 % after 112 cases. The ipsilateral PSP recurrence rate was maintained at below 8 % after 102 cases. CONCLUSIONS: Although PSP is the most applicable scenario for the beginner of SITS, at least 100 cases of experience are needed to achieve optimal technical level.

Recurrence Risk-Scoring Model for Stage I Adenocarcinoma of the Lung.

PURPOSE: The aim of this retrospective, multicenter study was to develop a recurrence risk-scoring model in patients with curatively resected stage I lung adenocarcinoma (ADC). METHODS: Clinicopathologic and outcome data for a development cohort of 1,700 patients with pathologic stage I ADC from four institutions resected between January 2000 and December 2009 were evaluated. A phantom study was performed for correction of inter-institutional differences in positron emission tomography-standardized uptake value (PET-SUV). A nomogram for recurrence prediction was developed using Cox proportional hazards regression. This model was validated in a cohort of 460 patients in two other hospitals. The recurrence rate was 21.0 % for the development cohort and 22.1 % for the validation cohort. RESULTS: In multivariable analysis, three independent predictors for recurrence were identified: pathologic tumor size (hazard ratio [HR] 1.03, 95 % CI 1.017-1.048; p < 0.001), corrected PET-SUV (HR 1.08, 95 % CI 1.051-1.105; p < 0.001), and lymphovascular invasion (HR 1.65, 95 % CI 1.17-2.33; p = 0.004). The nomogram was made based on these factors and a calculated risk score was accorded to each patient. Kaplan-Meier analysis of the development cohort showed a 5-year recurrence-free survival (RFS) of 83 % (95 % CI 0.80-0.86) in low-risk patients and 59 % (95 % CI 0.54-0.66) in high-risk patients with the highest 30 percentile scores. The concordance index was 0.632 by external validation. CONCLUSIONS: This recurrence risk-scoring model can be used to predict the RFS for pathologic stage I ADC patients using the above three easily measurable factors. High-risk patients need close follow-up and can be candidates for adjuvant chemotherapy.

The Role of Maximum Standardized Uptake Value in PET/CT as a Prognostic Factor in Patients with Resected Esophageal Squamous Cell Carcinoma.

BACKGROUND: The aim of this study was to evaluate the role of the maximum standardized uptake value (mSUV) of the main mass as a risk factor for recurrence in patients with completely resected esophageal squamous cell carcinoma (ESCC). PATIENTS AND METHODS: Clinicopathologic factors including primary tumor location, tumor size, depth of tumor invasion, number of positive lymph nodes, angiolymphatic invasion, and mSUV were analyzed as risk factors for recurrence. The prognostic influence of variables on disease-free survival was analyzed using the log-rank test for univariate analysis and the Cox proportional hazards model for multivariate analysis. RESULTS: A total of 102 patients underwent complete resection of ESCC and positron emission tomography/computed tomography was performed. The median follow-up period was 35.0 months (range, 2-94). The average mSUV of the main mass was 5.5 ± 4.2. The tumor had recurred in 38 patients (37.3%). Univariate analysis identified that tumor size (> 3.5 cm), depth of tumor invasion (≥ T2), pathologic stage, and mSUV (> 5.1) were statistically significant prognostic factors for recurrence of ESCC. However, in multivariate analysis, only mSUV (> 5.1, HR = 4.222, p = 0.025) was the independent risk factor of recurrence. CONCLUSIONS: The mSUV of the main mass was an independent predictor for recurrence with a cutoff value of 5.1.

New TNM staging system for esophageal cancer: what chest radiologists need to know.

Esophageal cancer is a leading cause of cancer-related deaths worldwide, and the 5-year relative survival rate remains less than 20% in the United States. The treatment of esophageal cancer should be stage specific for better clinical outcomes. Recent treatment paradigms tend to involve a multimodality approach to management, which includes surgical resection and preoperative or definitive chemoradiation therapy. Accurate pretreatment staging of esophageal cancer is integral for assessing operability and determining a suitable treatment plan. The American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC) have published the seventh edition of the staging manual for cancer in the esophagus and esophagogastric junction. Unlike the sixth edition, the revised staging manual is data driven and harmonized with the staging of stomach cancer. Improvements include new definitions for the anatomic classifications Tis, T4, regional lymph node, N, and M and the addition of nonanatomic cancer characteristics (histopathologic cell type, histologic grade, and cancer location). Given the recent increase in the incidence of adenocarcinoma of the distal esophagus, esophagogastric junction, and gastric cardia, the staging of tumors in the esophagogastric junction has been addressed. Radiologists must understand the details of the seventh edition of the AJCC-UICC staging system for esophageal cancer and use appropriate imaging modalities, such as computed tomography (CT), endoscopic ultrasonography, and positron emission tomography/CT, for initial staging.

Preoperative thrombocytosis is a significant unfavorable prognostic factor for patients with resectable non-small cell lung cancer.

BACKGROUND: Previous studies have reported that pretreatment thrombocytosis is associated with poor outcomes in several cancer types. This study was designed to evaluate the prognostic significance of preoperative thrombocytosis in patients with non-small cell lung cancer (NSCLC) who undergo surgery. METHODS: We retrospectively reviewed the records of 199 patients who underwent R0 resection for NSCLC between May 2003 and July 2006 at Seoul National University Bundang Hospital, Seongnam, Korea. RESULTS: The frequency of preoperative thrombocytosis was 7.5% (15/199). Patients with preoperative thrombocytosis had shorter overall survival (OS, P = 0.003) and disease-free survival (DFS, P = 0.005) than those without thrombocytosis. In multivariable analysis, patients with preoperative thrombocytosis had a significantly greater risk of death and recurrence than those without preoperative thrombocytosis (risk of death: hazard ratio (HR) 2.98, 95% confidence interval (CI) 1.39 to 6.37, P = 0.005; risk of recurrence: HR 2.47, 95% CI 1.22 to 5.01, P = 0.012). A tendency towards a shorter OS and DFS was observed in three patients with persistent thrombocytosis during the follow-up period when compared with those of patients who recovered from thrombocytosis after surgery. CONCLUSIONS: Preoperative thrombocytosis was valuable for predicting the prognosis of patients with NSCLC. Special attention should be paid to patients with preoperative and postoperative thrombocytosis.

Single-incision thoracoscopic surgery for primary spontaneous pneumothorax using the SILS port compared with conventional three-port surgery.

BACKGROUND: Single-incision thoracoscopic surgery (SITS) is postulated to cause less incisional pain, less paresthesia, and less wound scarring than the conventional three-port approach. The difficulties performing the technique have prevented it from being widely accepted. This study shows how the authors overcame the difficulties by using the SILS port and proved it to be a safe and useful procedure for the treatment of primary spontaneous pneumothorax (PSP). METHODS: The same surgeon operated on all the patients using the three-port technique (n = 13) and SITS (n = 27) under the same procedural and management policy. The two groups were retrospectively compared in terms of operation time, postoperative complications, hospital stay, pain score, residual paresthesia, satisfaction regarding the wound scar, and surgical material cost. RESULTS: The mean age, sex ratio, and previous pneumothorax episodes were similar between the two groups. The uniport and three-port groups did not differ statistically in terms of mean operation time (74.6 ± 22.8 vs 72.4 ± 20.2 min; p = 0.77), hospital stay (2.3 ± 0.7 vs 2.5 ± 0.8 days; p = 0.72), visual analog pain scale (on the day of surgery: 4.1 ± 1.7 vs 4.8 ± 2.2, p = 0.26; on day 1: 3.2 ± 1.4 vs 2.8 ± 1.4, p = 0.33; on day 2: 2.7 ± 1.0 vs 2.6 ± 1.1, p = 0.61), or total surgical material cost (US$1,810 ± $320 vs $1,741 ± $329; p = 0.58). However, the uniport group had a lower incidence of paresthesia than the three-port group (33.3 vs 76.9%; p = 0.01) and showed a higher satisfaction rate regarding wound scarring (70.4 vs 30.7%; p = 0.03). CONCLUSIONS: Compared with the three-port approach, SITS using the SILS port in PSP patients proved to be a safe and feasible procedure that can be clinically implemented without additional economic burden or operation time. Additionally, SITS showed better cosmesis with minimized neurologic sequelae, which contributed to higher satisfaction among patients. Progress in uniport instruments and surgical experience will lead to wider applications of SITS.

Evaluation of decortication in patients with chronic tuberculous empyema by three-dimensional computed tomography densitometry.

BACKGROUND: Decortication for chronic pleural empyema (CPE) is to restore lung volume by removing empyema sac and thickened pleura. Extent of lung volume restoration after decortication has been undefined. This study aims to evaluate lung volume restoration using densitometry with three-dimensional reconstruction computed tomography (CT). METHODS: We studied 23 patients with CPE who underwent decortication and follow-up CT. CT and pulmonary function test (PFT) were evaluated at a median of 19.1 months postoperatively. The volumes of operated and nonoperated lung were measured by pre- and postoperative CT-densitometry. Preoperative and postoperative values of lung volumes, PFTs, and thoracic asymmetry rates were compared statistically. RESULTS: The mean preoperative volumes of operated and nonoperated lung were 1,239 and 2,094 mL, respectively and 1,848 and 2,311 mL postoperatively. The postoperative lung expansion rate was 71% on the operated side (p < 0.001) and 15% on the nonoperated side (p = 0.026). The mean improvement rate of total lung volume was 31%. The postoperative value of forced vital capacity, forced expiratory volume during 1 second and lung diffusion capacity of carbon monoxide improved 28.0%, 27.4% (p < 0.001), and 17.9% (p < 0.012), respectively. The thoracic asymmetry decreased from 4.3% before surgery to 2.8% after surgery (p = 0.026). CONCLUSIONS: With the use of CT-densitometry, we quantified the changes of each lung volume. Decortication for CPE can improve re-expansion of diseased and healthy lung. Improvement of nonoperated lung may be due to the overall improvement of chest wall elasticity. Coincidentally, we discovered that the improvement of total lung volume was positively associated with the improvement of PFT after decortication.

Transabdominal cardiophrenic lymph node dissection for cytoreductive surgery in advanced ovarian cancer.

OBJECTIVE: Minimizing residual tumors is one of the most important prognostic factors in the management of advanced ovarian cancer [1]. In ovarian cancer patients with cardiophrenic lymph node (LN) metastases, transabdominal cardiophrenic lymph node dissection (CPLND) has been performed along with the surgery on the primary site [2]. However, CPLND for the complicated locations in the thoracic cavity is still technically challenging. This video aims to share our surgical technique for the transabdominal CPLND. METHODS: A 60-year-old woman who presented with suspicious bilateral ovarian cancer was hospitalized for cytoreductive surgery. Preoperative CT demonstrated peritoneal seeding and multiple LN metastases including right anterior, lateral, posterior, and left anterior cardiophrenic LNs. The gynecology and general surgery team underwent hysterectomy, bilateral salpingo-oophorectomy, supracolic omentectomy, lower anterior resection, right diaphragmatic and bladder peritonectomy, pelvic and paraaortic LN dissection, and appendectomy. The thoracic surgeon took over the operation because the pelvic cavity was regarded as R0. CPLND was performed by transabdominal, subxiphoid approach. The procedure is narrated in the video. RESULTS: Complete clearance of CPLN leaving no gross residual disease was possible without complication. A long, transverse incision of the anterior diaphragm was closed with a 1-0 polypropylene in the way of double layered continuous running suture and 8 times ties for the final knot. CONCLUSION: Transabdominal CPLND can be used safely and effectively without change of patient's position and with minimal diaphragmatic injury. However, this approach may be unfeasible for metastatic internal mammary LN dissection and still needs meticulous surgical skills to avoid complications.

Evaluation of a Smart After-Care Program for Patients with Lung Cancer: A Prospective, Single-Arm Pilot Study.

BACKGROUND: The efficacy of telemedicine among cancer survivors is uncertain. The Smart After-Care Program (SAP), which is an interactive, smartphone-based remote health monitoring system, was developed to help patients manage their health after leaving the hospital. This study was designed to evaluate the efficacy of our remote health care program for lung cancer patients. METHODS: We enrolled 50 patients with lung cancer. Self-monitoring devices were supplied to all patients, who were instructed to enter their daily vital signs and subjective symptoms to the Smart After-Care app. The app also provided information about rehabilitation exercises and a healthy diet for lung cancer patients. All patients received health counseling via telephone once a week and visited an outpatient clinic during weeks 6 and 12 to assess satisfaction with the SAP and changes in quality of life and physical performance. RESULTS: Overall satisfaction with the SAP was very high (very good, 61.9%; good, 26.2%). In the multivariate analysis to identify factors affecting satisfaction, the distance between the patient's residence and the hospital was the only significant independent factor (p=0.013). Quality of life improved along all functional scales (p<0.05). Muscle strength significantly improved in the lower limbs (p=0.012). Two-minute walk distance also significantly improved (p=0.028). CONCLUSION: This study demonstrated that the SAP was acceptable for and supportive of patients with reduced pulmonary function after lung cancer treatment. The SAP was found to be particularly useful for patients living far from the hospital.

Trend of lung cancer surgery, hospital selection, and survival between 2005 and 2016 in South Korea.

BACKGROUND: Studies on the clinical implication of hospital selection for patients with lung cancer are few. Therefore, this study aimed to analyze 2005-2016 data from the Korean national database to assess annual trends of lung cancer surgery and clinical outcomes according to hospital selection. METHODS: Data of 212 554 patients with lung cancer who underwent upfront surgery were screened. Trends according to sex, age, residence, and income were examined. Descriptive statistics were performed, and ptrend values were estimated. The association between survival and hospital selection was assessed using the log-rank test. A multivariate Cox regression analysis was also performed. RESULTS: A total of 49 021 patients were included in this study. Surgery was prevalent among men, patients aged 61-75 years, capital area residents, and high-income patients. However, with the increasing rate of surgery among women, patients aged ≥76 years, city residents, and middle-income patients, the current distribution of lung cancer surgery could change. The rate of lobectomy among these groups increased. All patients, except those in capital areas, preferred a hospital outside their area of residence (HOR); the number of patients with this tendency also increased. However, this trend was not observed among low-income patients and those aged ≥76 years. There were significant differences in survival according to hospital selection. CONCLUSIONS: The trend of lung cancer surgery is changing. The current medical system is effective in providing lobectomy for patients including women, aged ≥76 years, city residents, and middle-income. Increasing tendency to choose an HOR requires further study.

Vincristine, Irinotecan, and Temozolomide as a Salvage Regimen for Relapsed or Refractory Sarcoma in Children and Young Adults.

PURPOSE: No standard salvage regimen is available for relapsed or refractory sarcoma. We investigated the efficacy and toxicity of the vincristine, irinotecan, and temozolomide combination (VIT) for relapsed or refractory sarcomas of variable histology in children and young adults. MATERIALS AND METHODS: We retrospectively reviewed data from the relapsed or refractory sarcoma patients who were treated with VIT. The VIT protocol was given every 3 weeks as follows: vincristine, 1.5 mg/m2 intravenously on day 1, irinotecan, 50 mg/m2/day intravenously on days 1-5, and temozolomide, 100 mg/m2/day orally on days 1-5. RESULTS: A total of 26 patients (12 males) with various sarcoma histology were included in the study. Most common diagnosis was rhabdomyosarcoma (n=8) followed by osteosarcoma (n=7). Median age at the start of VIT was 18.5 years (range, 2.0 to 39.9). VIT was delivered as 2nd to 7th line of treatment, with 4th line most common (9/26, 34.6%). Median number of VIT courses given was 3 (range, 1 to 18). Of the 25 evaluable patients, there was two partial response (PR) and 11 stable disease (SD) with an overall control rate (complete remission+PR+SD) of 52%. PR was seen in one (50%) of the two evaluable patients with Ewing sarcoma and one (14.3%) of the seven patients with osteosarcoma. Overall survival and progression-free survival rates were 79.3% and 33.9% at 1 year, and 45.5% and 25.4% at 2 years, respectively. There was no treatment-related mortality. CONCLUSION: The VIT regimen was effective and relatively safe in our cohort of sarcoma patients.

Delayed Gastric Emptying after Esophagectomy: Management and Prevention.

The quality of life associated with eating is becoming an increasingly significant problem for patients who undergo esophagectomy as a result of the improved survival rate after esophageal cancer surgery. Delayed gastric emptying (DGE) is a common complication after esophagectomy. Although several strategies have been proposed for the management and prevention of DGE, no clear consensus exists. The purpose of this review is to present a brief overview of DGE and to help clinicians choose the most appropriate treatment through an analysis of DGE by cause. Furthermore, we would like to suggest some tips to prevent DGE based on our experience.

Size and extranodal extension of metastatic lymph nodes in lung adenocarcinoma.

BACKGROUND: This study assessed the prognostic significance of metastatic lymph node size (MLNS) and extranodal extension (EN) in patients with node-positive lung adenocarcinoma (ADC). METHODS: Prognostic factors influencing survival were analyzed, including age, sex, extent of operation, T- and N-stage, size of tumor, postoperative chemotherapy, presence of EN, and MLNS (>7.0 vs. ≤7.0 mm). RESULTS: Three hundred seventy-five patients met the inclusion criteria were enrolled (mean age: 59.8±10.5 years). Increasing MLNS was significantly correlated with large tumor size (P=0.015), advanced N status (P<0.001), and presence of EN (P<0.001). In multivariable analysis, large tumor size [hazard ratio (HR) 1.135, 95% confidence interval (CI): 1.050 to 1.228, P<0.001], adjuvant chemotherapy (HR 0.582, 95% CI: 0.430 to 0.787, P<0.001), EN (HR 1.454, 95% CI: 1.029 to 2.055, P=0.034), and MLNS greater than 7 mm (HR 1.741, 95% CI: 1.238 to 2.447, P<0.001) were significant prognostic factors for survival. Patients were classified into 3 groups: Group A, MLNS ≤7.0 mm/EN (-); Group B, MLNS ≤7.0 mm/EN (+) or MLNS >7.0 mm/EN (-); and Group C, MLNS >7.0 mm/EN (+). The 5-year overall survival (OS) was 72.2%, 59.0%, and 38.5% in Groups A, B and C, respectively (P<0.001). CONCLUSIONS: The MLNS and presence of EN could provide an important prognostic implication for patients with node-positive lung ADC.

Comparative Analysis of Lung Perfusion Scan and SPECT/CT for the Evaluation of Functional Lung Capacity.

PURPOSE: This study aimed to compare lung perfusion scan with single photon emission computed tomography/computed tomography (SPECT/CT) for the evaluation of lung function and to elucidate the most appropriate modality for the prediction of postoperative lung function in patients with lung cancer. METHODS: A total of 181 patients underwent Tc-99m macroaggregated albumin lung perfusion scan and SPECT/CT to examine the ratio of diseased lung and diseased lobe. Forty-one patients with lung cancer underwent both preoperative and postoperative pulmonary function tests within 1 month to predict postoperative pulmonary function. Predicted postoperative forced expiratory volume in 1 s (ppoFEV1) was calculated by the % radioactivity of lung perfusion scan and SPECT, and the % volume of the residual lung, assessed on CT. RESULTS: The ratios of diseased lung as seen on lung perfusion scan and SPECT showed significant correlation, but neither modality correlated with CT. The ratios of the diseased lung and diseased lobe based on CT were higher than the ratios based on either perfusion scan or SPECT, because CT overestimated the function of the diseased area. The lobar ratio of both upper lobes was lower based on the perfusion scan than on SPECT but was higher for both lower lobes. Actual postoperative FEV1 showed significant correlation with ppoFEV1 based on lung perfusion SPECT and perfusion scan. CONCLUSIONS: We suggest SPECT/CT as the primary modality of choice for the assessment of the ratio of diseased lung area. Both perfusion scan and SPECT/CT can be used for the prediction of postoperative lung function.

The clinical impact of family history of cancer in female never-smoker lung adenocarcinoma.

OBJECTIVES: Accumulating evidence reveals the association between the risk of never-smoker lung cancer and family history of cancer. However, the clinicogenomic effect of family history of cancer in never-smoker lung cancer remains unknown. MATERIAL AND METHODS: We screened 3,241 lung cancer patients who (a) underwent curative resection at National Cancer Center (Goyang, Korea) between 2001-2014, and (b) completed a pre-designed interview about family/smoking history at the time of diagnosis and identified 604 female never smoker lung adenocarcinoma. A positive family history of cancer [categorized as pulmonary cancer (FH-PC) or non-pulmonary cancer (FH-NPC)] was defined as a self-reported history of cancer in first-degree relatives. Survival data were followed up until January 2017. Multiplexed targeted next-generation sequencing was performed for genetic profiling. RESULTS: Of 604 patients, 29.1% (n = 176) had a FH, including 132 (21.9%) with FH-NPC and 44 (7.3%) with FH-PC. Patients with the FH-NPC had a higher proportion of young patients (≤45 years) than those without the FH-NPC (FH-NPC, FH-PC, and no FH; 13.6%, 2.3%, and 8.2%, respectively; P = 0.032). Patients with the FH-NPC had an increased risk of recurrence (hazard ratio [HR]: 1.90; 95% confidence interval [CI]: 1.40-2.56; P<0.001) and death (HR: 1.67; 95% CI: 1.18-2.37; P=0.004). In contrast, the FH-PC had no prognostic effect on recurrence (HR: 1.23; 95% CI: 0.71-2.15; P = 0.456) and death (HR: 0.93; 95% CI: 0.45-1.91; P=0.838). Among three driver oncogene alterations, EGFR mutation was significantly associated with the FH-PC (53.8%, 84.1%, and 65.8%, respectively; P = 0.016), ALK/ROS1/RET fusions was significantly associated with the FH-NPC (13.7%, 0.0%, and 5.0%, respectively; P = 0.004), but KRAS mutation was not associated with any type of the FH (13.8% vs. 6.0% vs. 7.8%, respectively; P = 0.288). CONCLUSION: The type of family history of cancer was associated with distinct clinocogenomic subtypes and prognosis of never-smoker lung adenocarcinoma.

Destruction of chlorobenzene and carbon tetrachloride in a two-stage molten salt oxidation reactor system.

Molten salt oxidation (MSO) is one of the promising alternative destruction technologies for chlorinated organics, because it is capable of trapping chlorine during organic destruction. This study investigated the characteristics of a two-stage MSO reactor system for the destruction of CCl(4) and C(6)H(5)Cl. Investigated parameters were the MSO reactor temperature (from 1023 K to 1223 K) and the excess oxidizing air feed rate (50% and 100%). The destruction of chlorinated solvents is substantial in the Li(2)CO(3)-Na(2)CO(3) eutectic molten salt, irrespective of the tested condition. However, further oxidation of CO, which is found to be the major destruction product, is not substantial due to the limited temperature and gas residence time in the MSO reactor. Increases in the reactor temperature as well as those in the oxidizing air feed rate consistently lead to decreased emissions of carbon monoxide. No significant influence of the MSO reactor operating condition on the chlorine capturing efficiency was found. Over 99.95% and 99.997% of the chlorine was captured in the hot MSO reactors during the C(6)H(5)Cl and CCl(4) destructions, respectively. This result suggests a relatively low potential of the MSO system in the recombination of chlorinated organics, when compared to a conventional incineration system.