Virtual Library

Start Your Search

K. Yoshida



Author of

  • +

    P1.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 233)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Biology, Pathology, and Molecular Testing
    • Presentations: 1
    • +

      P1.04-013 - Clinicopathological Characteristics of Lung Cancer with Combined Pulmonary Fibrosis and Emphysema (ID 1082)

      09:30 - 17:00  |  Author(s): K. Yoshida

      • Abstract
      • Slides

      Background:
      Combined pulmonary fibrosis and emphysema (CPFE) is a clinical syndrome that is diagnosed with computed tomography (CT), sometimes in conjunction with histopathology. Mostly all patients with CPFE are smokers, and thus, they are at high risk of developing lung cancer (LC). The histological and clinical characteristics of coexisting LC and CPFE syndrome remain unclear. Therefore, we conducted a retrospective study to explore the clinicopathological characteristics of LC along with CPFE (LC-CPFE).

      Methods:
      We retrospectively reviewed the data of 1647 patients who underwent lung resection for pulmonary masses at Shinshu University Hospital between December 1995 and December 2013. After excluding patients without CT images, patients with metastatic tumors, and patients without sufficient clinical and histological information, the remaining patients were divided into four groups based on chest CT findings: LC-CPFE, LC along with pulmonary fibrosis (LC-PF), LC along with emphysema (LC-Emp), and LC in normal lungs (LC-Norm). The clinicopathological characteristics of patients with LC-CPFE were compared to those of the patients in the other groups.

      Results:
      After excluding patients for the reasons described above, 985 patients were enrolled in this study. Of these 985 patients, there were 72, 28, 84, and 801 cases of LC-CPFE, LC-PF, LC-Emp, and LC-Norm, respectively. Patients with LC-CPFE were all smokers, with a mean Brinkman index of 1158. Compared with the other groups, patients with LC-CPFE were predominantly men (n = 67, 93.0%) and were older (a mean age of 70.5); LC-CPFE was also associated with a larger tumor size (a mean tumor size of 29.5 mm), the presence of multiple tumors (n = 13, 18.0%), higher stage, squamous cell carcinoma-predominant histology (n = 46, 63.9%), and higher tumor grade (n = 45, 62.5%). Patients with LC-CPFE showed a significantly worse outcome than did patients with LC-Emp and LC-Norm, with a 5-year disease-free survival (DFS) rate of 63.5% and a 5-year overall survival (OS) rate of 53.5%. The OS rate of patients with LC-CPFE was worse than that of patients with LC-PF, although the statistical difference was not significant (p = 0.06), whereas the DFS rates between the LC-CPFE group and the LC-PF group were not significantly different (p = 0.664). In the LC-CPFE group, the tumors were mostly found in associated fibrotic areas (n = 56, 77.7%), followed by emphysematous areas (n = 9) and normal lung areas (n = 7). The pattern of the fibrotic area was as follows: 31 unclassified, 19 UIP, and 6 NSIP. In situ carcinomatous lesions were found in fibrotic areas of more than half of the LC-CPFE cases (n = 30, 53.5%).

      Conclusion:
      This study indicates that LCs in patients with CPFE syndrome developed in heterogeneous tumorigenic backgrounds. However, because patients with LC-CPFE showed significantly poorer outcomes compared with the other groups, CPFE should be considered an important background disease for patients after resection of lung cancer.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

  • +

    P3.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 214)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Locoregional Disease – NSCLC
    • Presentations: 1
    • +

      P3.03-010 - Usefulness of Vessel Sealing Devices in Thoracoscopic Lobectomy for Lung Cancer (ID 825)

      09:30 - 17:00  |  Author(s): K. Yoshida

      • Abstract

      Background:
      Vessel sealing devices (VSD) are widely used for various surgical procedures. They are regarded as useful in thoracoscopic surgery, but few reports have substantiated this belief by comparison with non-use of VSD in human thoracoscopic lobectomy. Aiming to establish a simpler and safer thoracoscopic lobectomy, we examined the usefulness of VSDs.

      Methods:
      Primary lung cancer patients for whom a thoracoscopic lobectomy involving mediastinal lymph node dissection was planned in our department from April 2011 to June 2013 were recruited for the study. Patients were randomly allocated to a control group (n=15) or a VSD group (n=46), which constituted of three subgroups, namely, EnSeal (n=17), LigaSure (n=15), and Harmonic (n=14). The control group comprised of patients undergoing surgery solely with ligation and conventional electrocautery. EnSeal, LigaSure, and Harmonic were chosen because they are the 3 most popular disposable VSDs used in Japan. Primary endpoints were burst pressure of the pulmonary artery stump (measured using resected specimens), operative time, intraoperative blood loss, instances of endostapler use, intraoperative surgeon stress (assessed by visual analog scale), and postoperative drainage volume and duration. As a secondary objective, the individual VSD groups were also compared with each other.

      Results:
      The burst pressure of ligation-treated pulmonary artery stumps was higher than that of VSD-treated stumps (P<0.0001). The burst pressure of < 5-mm wide VSD-treated stumps was higher than that of ≥ 5 mm wide stumps (P=0.0359). However, burst pressure for all groups and all vessel diameters was sufficient to withstand physiological pulmonary artery pressure. The VSD group demonstrated reduced intraoperative blood loss (P=0.0174), surgeon stress (P=0.0001), postoperative drainage volume (P=0.0270), and shortened postoperative drainage duration (P=0.0330). Operative time and the instances of endostapler use did not significantly differ. Comparison between each of the VSD groups revealed no significant differences. None of the patients experienced serious perioperative complications or died because of surgery.

      Conclusion:
      VSD is simple and safe to use in thoracoscopic lobectomy involving mediastinal lymph node dissection for primary lung cancer. Further, none of the VSDs used in this study presented any observable differences in quality that could lead to clinical problems.

  • +

    P3.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 235)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Biology, Pathology, and Molecular Testing
    • Presentations: 1
    • +

      P3.04-118 - Expression of TS and DPD in Primary Lung Cancer (ID 287)

      09:30 - 17:00  |  Author(s): K. Yoshida

      • Abstract
      • Slides

      Background:
      Chemotherapy with 5-fluorouracil (5-FU) preparations is widely used to treat gastrointestinal cancer, head and neck cancer, and breast cancer. 5-FU acts by inhibiting thymidylate synthase (TS), the rate-controlling enzyme of pyrimidine synthesis, and its anticancer activity is related to the rate of TS inhibition in gastrointestinal cancer and other tumors. Dihydropyrimidine dehydrogenase (DPD) is the rate-limiting enzyme for the catabolism and inactivation 5-FU. As one biochemical modulation strategy, uracil–tegafur (UFT) has been developed to improve the bioavailability of 5-FU by inhibiting DPD. Expression levels of TS and DPD in resected lung cancer samples are generally determined quantitatively by reverse-transcription polymerase chain reaction (RT-PCR) or qualitatively by immunohistochemical analysis. However, no study has employed enzyme-linked immunosorbent assay (ELISA) to measure TS and DPD expression in lung cancer, although this technique is often used for gastrointestinal, colorectal, and breast cancers.

      Methods:
      From April 2004 through December 2007, we studied tissue samples from 168 of 280 patients with primary lung cancer in which both TS and DPD could be measured. TS and DPD in normal and tumor tissues were quantified by ELISA and compared according to expression level, gender, histological type, and clinicopathological characteristics. Patient Characteristics: Of the 168 patients, 110 were men (65.4%), and 58 were women (34.6%). The median age was 69.6 (range, 35-89) years; 107 patients were former or current smokers and 61 were nonsmokers.The pathologic disease stage was IA in 59 patients, IB in 34, IIA in 8, IIB in 23, IIIA in 33, IIIB in 7, and IV in 4. The patients with stage IV disease had brain metastasis. The most common histological type was adenocarcinoma (107 cases), followed by squamous cell carcinoma (39), adenosquamous carcinoma (2), large cell carcinoma (9), small cell carcinoma (5), pleomorphic carcinoma (3), and carcinoid (3).

      Results:
      Expression levels of TS and DPD were significantly higher in lung cancer tissue than in noncancerous tissue. As for patient characteristics, TS expression in tumors was significantly lower in women and nonsmokers. According to histological type, tumor TS expression was significantly lower in adenocarcinoma and squamous cell carcinoma than in other types of lung cancer, whereas DPD expression did not differ significantly among histological types. Median tumor TS expression was significantly lower in well-differentiated tumors than in moderately/poorly-differentiated tumors. Among patients with adenocarcinoma (n=107), median tumor TS expression was significantly lower in women and nonsmokers.

      Conclusion:
      The present study suggested that tumor TS and DPD levels are useful predictors of chemosensitivity to UFT in patients with primary lung cancer who receive postoperative adjuvant chemotherapy. The expression level of TS in tumors may be useful for selecting postoperative treatment for individual patients with lung cancer, particularly those who are women or nonsmokers or who have adenocarcinoma.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.