OBJECTIVETo review the experience of the diagnosis, surgical treatment and prognosis of metachronous second primary lung cancers.

METHODSBetween January 1983 and April 2004, 32 patients with metachronous second primary lung cancers were operated in our department. Clinical data of all these patients were reviewed retrospectively.

RESULTSThe initial procedures for their first primary lung cancers were lobectomy or pneumonectomy. Lobectomy or completion pneumonectomy for the second primary lung cancers were performed in 17 cases, limited pulmonary resection was done in 14 cases and exploration was in 1 case. The postoperative morbidity and mortality were 12% (4/32) and 3% (1/32), respectively. The 1-, 3-, and 5-year survival rate after second operation were 66% (19/29), 32% (9/28) and 19% (4/21), respectively.

CONCLUSIONSThe incidence of metachronous second primary lung cancers has been increasing gradually during recent years. The closely follow-up for patients undergoing resection for their first primary lung cancers is most important factor for improvement of the diagnosis of metachronous second primary lung cancers. Limited resection and incomplete lymph node dissection might be the factors contributing to the poor prognosis.

Adult ; Aged ; Female ; Humans ; Lung Neoplasms ; diagnosis ; mortality ; pathology ; surgery ; Lymph Node Excision ; Male ; Middle Aged ; Neoplasms, Second Primary ; diagnosis ; mortality ; pathology ; surgery ; Pneumonectomy ; methods ; Prognosis ; Retrospective Studies

BACKGROUND/AIMS: Although the lung is the most common site of extrahepatic spread from hepatocellular carcinoma (HCC), the role of surgery for pulmonary metastasis remains unclear. The aim of this study was to evaluate the efficacy of pulmonary resection in patients with pulmonary metastasis from HCC. METHODS: Between July 2000 and July 2004, a total of 6 patients with pulmonary metastasis from HCC underwent curative pulmonary resections. The patients were divided into two groups (Surgery group and Non-surgery group) according to the primary treatment modality of HCC. Medical records, imaging studies, and pathologic reports of the surgical specimens were reviewed. RESULTS: Three patients in the surgery group underwent pulmonary resections for a solitary metastasis after hepatectomy for HCC, and they are all still alive. One of the 3 patients developed a tumor recurrence in the chest wall after pulmonary resection. The survival time after diagnosis of HCC were 79, 122, and 54 months, respectively. The survival time after pulmonary metastatectomy were 49, 39, and 20 months in the three patients. Another 3 patients in the non-surgery group, received a pulmonary metastatectomy; they had either a complete response HCC or partial radiologic response. These 3 patients developed recurrent disease in the liver. One of 3 patients died. The survival time after diagnosis of HCC were 153, 83, 12 months. The survival time after pulmonary metastatectomy were 51, 4, 2 months. CONCLUSIONS: The surgical resections of a solitary pulmonary metastasis from HCC in highly selected patients might be an effective treatment modalities for prolonged survival.
Adult ; Carcinoma, Hepatocellular/diagnosis/mortality/*secondary/*surgery ; Humans ; Liver Neoplasms/*pathology ; Lung Neoplasms/diagnosis/mortality/*secondary/*surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; *Pneumonectomy/mortality ; Survival Rate ; Treatment Outcome

The demographics and prognosis of non-small cell lung cancer patients have changed during the last few decades. We conducted this study to assess the change in demographics and prognosis in resected non-small cell lung cancer patients during a 20-yr single-institution study in Korea. We retrospectively reviewed the medical records of 2,076 non-small cell lung cancer patients who underwent pulmonary resection between 1990 and 2009. Their clinical characteristics and survival were analyzed over a five-year period. With time, the proportions of female, adenocarcinoma, stage IA, and lobectomy patients increased, whereas the proportions of male, squamous cell carcinoma, stage IIIA, and pneumonectomy patients decreased. These demographic changes caused improved prognosis. The five-year survival rate of all patients was 53.9%. The five-year survival rate increased from 31.9% in 1990-1994, to 43.6% in 1995-1999, 51.3% in 2000-2004, and 69.7% in 2005-2009 (P < 0.001). In conclusion, among patients with resected non-small cell lung cancer, the proportions of female, adenocarcinoma, stage IA, and lobectomy patients have increased, and the five-year survival rate has gradually improved during the last 20 yr in Korea.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung/*diagnosis/mortality/surgery ; Child ; Demography ; Female ; Humans ; Lung Neoplasms/*diagnosis/mortality/surgery ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Republic of Korea ; Retrospective Studies ; Survival Rate ; Young Adult

OBJECTIVETo study the survival and prognostic factors of stage III N2 non-small cell lung cancer (NSCLC) after surgical treatment.

METHODS266 patients with stage III N2 NSCLC underwent operation from 1982 to 1996, with the 5-year survival rate compared with those of stage N0 and N1 patients who received operation in the same period. Histological classification, number of positive nodes, location and extent of mediastinal lymph node involvement, T primary tumor status, complete or incomplete operation, the procedure of operation were univariately and multivariately analyzed to determine their impact on the 5-year survival.

RESULTSThe 5-year survival rate of patients with stage III N2 non-small lung cancer after surgical treatment was 17.3%, which was significant lower than those with N0 (51.4%) and N1 (30.4%). Four prognostic factors significantly influenced the outcome: number of positive nodes, location and extent of mediastinal lymph node involvement, T primary tumor status and complete resection of the tumor.

CONCLUSIONPatients with stage III N2 NSCLC are candidates for surgical treatment if they have evidence of limited mediastinal lymph node metastasis and prospects of complete resection.

Aged ; Carcinoma, Non-Small-Cell Lung ; diagnosis ; mortality ; secondary ; surgery ; Female ; Humans ; Lung Neoplasms ; diagnosis ; mortality ; pathology ; surgery ; Lymph Nodes ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Survival Rate

OBJECTIVETo study the clinical characteristics, the principles of diagnosis and surgical treatment for primary pulmonary lymphoma.

METHODTen patients with primary pulmonary lymphoma were treated surgically and their clinical characteristics, the experiences of clinical diagnosis and surgical treatment were analyzed. The tumors located in left upper lobe in 2, left lower lobe in 1, right upper lobe in 3, right middle lobe in 3 and right lower lobe in 1. The main symptoms were cough and (or) hemoptysis. Imageological representations (X-ray and CT scanning of thorax) were similar to primary pulmonary carcinoma. Broncho-fibroscopic examination was performed on all cases with negative findings. Eight cases were mistakenly diagnosed as primary pulmonary carcinoma by imageological representations. Only 2 cases were diagnosed as primary pulmonary lymphoma by percutaneous needle biopsy and pathologic examination. All cases received pneumonectomy, ipsilateral hilar and mediastinal lymphadenectomy. All cases with non-Hodgkin's lymphoma received regular chemotherapy (MOPP and ABVD scheme for 1 case with Hodgkin's disease respectively, CHOP for 8 cases with non-Hodgkin's lymphoma), and 3 cases received radiotherapy postoperatively.

RESULTSEight cases were non-Hodgkin's lymphoma (B-type) and 2 cases were Hodgkin's disease (mixed type) confirmed by pathological examination. Six cases with non-Hodgkin's lymphoma (3 cases for stage IE, 2 cases for stage II 1E, and 1 case for stage II 2E W) had been surviving for 18-42 months until the follow-up. Two cases with non-Hodgkin's lymphoma (stage II 2E, B-cell, low-grade) and 2 cases with Hodgkin's disease (stage IE and II 2E, mixed type) died in 24, 32, 8 and 17 months postoperatively respectively.

CONCLUSIONSPrimary pulmonary lymphoma is a rare type of malignant lung neoplasm without special clinical features. The preoperative diagnosis is difficult. Treatment modalities include surgical treatment, radiotherapy and regular chemotherapy postoperatively.

Adult ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Humans ; Lung Neoplasms ; diagnosis ; drug therapy ; mortality ; surgery ; Lymph Node Excision ; Lymphoma ; diagnosis ; drug therapy ; mortality ; surgery ; Male ; Middle Aged ; Pneumonectomy ; methods ; Retrospective Studies

We present a recurrence prediction model using multiple clinical parameters in patients surgically treated for non-small cell lung cancer. Among 1,578 lung cancer patients who underwent complete resection, we compared the early-recurrence group with the 3-yr non-recurrence group for evaluating those factors that influence early recurrence within one year after surgery. Adenocarcinoma and squamous cell carcinoma were analyzed independently. We used multiple logistic regression analysis to identify the independent clinical predictors of recurrence and Cox's proportional hazard regression method to develop a clinical prediction model. We randomly divided our patients into the training and test subsets. The pathologic stages, tumor cell type, differentiation of tumor, neoadjuvant therapy and age were significant factors on the multivariable analysis. We constructed the model for the training set with adenocarcinoma (n=236) and squamous cell carcinoma (n=305), and we applied it to the test set with adenocarcinoma (n=110) and squamous cell carcinoma (n=154). It was predictive for the in adenocarcinoma (P<0.001) and the squamous cell carcinoma (P=0.037), respectively. Our results showed that our recurrence prediction model based on the clinical parameters could significantly predict the individual patients who were at high risk or low risk for recurrence.
Adenocarcinoma/mortality/pathology/surgery ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung/mortality/pathology/*surgery ; Carcinoma, Squamous Cell/mortality/pathology/surgery ; Disease-Free Survival ; Female ; Humans ; Lung Neoplasms/mortality/pathology/*surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local/*diagnosis ; Neoplasm Staging ; Predictive Value of Tests ; Prognosis ; Regression Analysis ; Risk Factors ; Survival Rate