• Journal of Chest Surgery
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• v.55 no.1
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• pp.20-29
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• 2022

Background: Patients with high-risk (HR) operable non-small cell lung cancer (NSCLC) may have unique prognostic factors. This study aimed to evaluate surgical outcomes in HR patients and to investigate prognostic factors in HR patients versus standard-risk (SR) patients. Methods: In total, 471 consecutive patients who underwent curative lung resection for NSCLC between January 2012 and December 2017 were identified and reviewed retrospectively. Patients were classified into HR (n=77) and SR (n=394) groups according to the American College of Surgeons Oncology Group criteria (Z4099 trial). Postoperative complications were defined as those of grade 2 or higher by the Clavien-Dindo classification. Results: The HR group comprised more men and older patients, had poorer lung function, and had more comorbidities than the SR group. The patients in the HR group also experienced more postoperative complications (p≤0.001). More HR patients died without disease recurrence. The postoperative complication rate was the only significant prognostic factor in multivariable Cox regression analysis for HR patients but not SR patients. HR patients without postoperative complications had a survival rate similar to that of SR patients. Conclusion: The overall postoperative survival of HR patients with NSCLC was more strongly affected by postoperative complications than by any other prognostic factor. Care should be taken to minimize postoperative complications, especially in HR patients.

• The Korean Journal of Cytopathology
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• v.8 no.2
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• pp.109-114
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• 1997

Transbronchial fine needle aspiration(TBNA) is one of the cytologic methods in diagnosing lung cancers. TBNA can be used in cases of hilar, mediastinal or lung masses adjacent to the bronchi. We analyzed and compaired the findings of 27 cases of TBNA and bronchial washing and brushing(BW/BB) in lung cancers confirmed by either biopsy or surgical resection between Jun, 1996 and May, 1997 in Asan Medical Center. They were 18 cases of non-small cell carcinomas(eight squamous cell carcinomas, nine adenocarcinomas, and one large cell undifferentiated carcinoma), eight cases of small cell carcinomas, and one case of metastatic hepatocellular carcinoma. The sensitivity of TBNA was 37%(10/27) and false negative was 63%(17/27). Although the sensitivity of BW/BB w3s 56%(15/27), it was not different statistically from that of TBNA(Chi square, p=0.38). Overall sensitivity of TBNA and BW/BB in this series was 70%(19/27). Forty-seven percent of false negative TBNA(8/17) were positive in BW/BB. The findings suggest that the addition of TBNA to the standard BW/BB increases diagnostic yield in cytologic diagnosis of lung cancer.

• The Korea Journal of Herbology
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• v.35 no.6
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• pp.35-41
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• 2020

Objectives : The object of this study was to observe anticancer and immunomodulatory effects of Formosa plum aqueous extracts (PLe) on non-small cell lung carcinoma (squamous epithelial carcinoma), NCI-H520, xenograft Balb/c nu-nu nude mice. Method : Three different dosages of PLe, 50, 100 and 200 mg/kg were orally administered once a day for 28 days from 11 days after tumor cell inoculation. Five groups, each of seven mice per group were used in the present study as follows. Tumor volume and weights, serum interferon (IFN)-γ levels, serum IL-6 were observed with tumor mass and lymphatic organ histopathology to detect anticancer and immunomodulatory effects. Result : Although no meaningful changes on the tumor weights and volumes were observed after treatment of all three different dosages of PLe, decreases of tumor cell volumes in tumor masses were dose-dependently decreased mediated by increases of apoptosis among tumor cells by treatment of PLe 100 and 200 mg/kg as compared with tumor-bearing control. In addition, decreases on the body weight and gains were also demonstrated in tumor-bearing control with increases of serum IL-6 levels. Conclusion : The results obtained in this study suggest that over 50 mg/kg of PLe showed favorable immunomodulatory and anticachexic effects with anticancer effects in 100 and 200 mg/kg of PLe treated groups on the NCI-H520 cell xenograft. However, detail mechanism studies should be conducted in future with the screening of the biological active compounds in this herb.

• Radiation Oncology Journal
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• v.8 no.1
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• pp.73-77
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• 1990

From January 1981 to December 1989, total 42 patients with atelectasis from lung cancer were treated with radiation therapy at the Department of Therapeutic Radiology in Kyung Hee University Hospital. The reexpansion of atelectasis after radiotherapy of the lung was evaluated retrospectively, utillzing treatment records and follow-up chest radiographs. Of the patients with non-small cell carcinoma of the lung, the response rate was $62\%$ (21/34). Patient with small cell carcinoma showed a $75\%$ (6/8) response rate. There appears to be some evidence of a relationship of total tumor dose versus response of atelectasis; radiation dose over 40 Gy (1337 ret), had a favorable effect on the rate of response compared with that below 40 Gy (1297 ret), $70\%$(21/30) and $50\%$ (6/12), respectively (p<0.01). Total response rate (partial and complete responses) of all patients was $64\%$ (27/42). Franction size was not contributed to the difference of response rates between small fraction ($180\~200$ cGy) and large fraction (300 cGy), $53\%$ (14/22) and $65\%$ (13/20), respectively. The results of this study suggest that radiation therapy has a definite positive role in management of atelectasis caused by lung cancer, especially in inoperable non-small cell carcinoma.

• Tuberculosis and Respiratory Diseases
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• v.39 no.6
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• pp.502-510
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• 1992

Background: Neuron specific enolase (NSE) is a neuronal form of the glycolytic enzyme enolase which was first found in extracts of brain tissue, and later in a variety of APUD cells and neurons of the diffuse endocrine system. SCLC shares many APUD properties with normal neuroendocrine cells. NSE immunostaining and serum NSE measurement may be a useful marker of neuroendocrine differentiation in lung tumors and diagnosis of small cell carcinoma. Methods: NSE immunohistochemical staining was done and at the same time serum NSE levels were measured in 22 small cell lung cancer and 21 non small cell lung cancer which were confirmed histologically. Results: 1) NSE immunoreactivity was detected in 9 of the 18 (50%) small cell lung cancer, in 5 of the 16 non small cell lung cancer. 2) Whereas the mean value in non-small cell lung cancer group was $11.79{\pm}4.47\;ng/ml$, the mean level of serum NSE in small cell lung cancer increased up to $59.3{\pm}77.8\;ng/ml$. In small cell lung cancer patients, mean value of limited disease group was $20.19{\pm}12.91\;ng/ml$, while mean value of extended disease group was $91.9{\pm}94.2\;ng/ml$ showing statistically significant difference. If serum levels above 20 ng/ml were tentatively defined as positive, 16 of 22 (73%) patients with SCLC had positive serum NSE level, but only one patient with NSCLC did. There was no correlation between serum NSE level and immunoreactivity of NSE. Conclusion: These studies indicate that serum NSE measurement may be a useful marker for the diagnosis and disease extent and NSE immunostaining can be used to demonstrate the neuroendocrine components of lung tumor.

• Tuberculosis and Respiratory Diseases
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• v.41 no.6
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• pp.616-623
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• 1994

Objectives: Careful evaluation about mediastinal involvement is important in the management of patients with non-small cell lung cancer. Invasive staging procedure such as mediastinoscopy is advocated because of the unreliability of noninvasive staging methods such as CT, MRI. We compared differences between pre- and postoperative staging in non-small cell lung cancer without lymphadenopathy on CT scan and investigated the methods for more accurate preoperative staging. Methods & Results: 1) Records of a total of 41 patients with preoperative $T_{1-3}N_0M_0$ non-small cell lung cancer were reviewed and the histologic types of tumors were squamous cell carcinoma in 32 cases, adenocarcinoma in 6 cases and large cell carcinoma in 3 cases. Twenty-four cases were central lesions and seventeen cases were peripheral lesions. 2) Among the 32 cases with preoperative $T_2$, 2 cases were identified postoperatively as $T_3$ with invasion of chest wall and among 6 cases with preoperative $T_3$, 1 case was identified postoperatively as $T_4$ with invasion of aorta and pulmonary arteries. 3) After the operation of 35 cases with $T_{1-2}$, 5 cases were $N_1$ and 3 cases were $N_2$ postoperatively. After the operation of 6 cases with $T_3$, 2 cases were $N_1$ and 3 cases were $N_2$ postoperatively. Preoperative $T_3$ showed more intrathoracic lymph node metastases and higher $N_2/N_1$ involvement ratio than preoperative $T_{1-2}$. 4) Complete surgical resections were done in 34 out of 41 cases. Incomplete resection were done in all postoperative $N_2$ tumors. Conclusion: Invasive staging procedures such as mediastinoscopy should be considered in the case of preoperative $T_3$ non-small cell lung cancer even though mediastinal lymphadenopathy is not recognized on the CT scan of the chest.

• Journal of Chest Surgery
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• v.30 no.3
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• pp.308-314
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• 1997

A retrospective review of the histopathology and clinical information of primary lung cancer was performed to investigate the trends in the histologic type related to sex, age, and smoking history. During January 1988 and July 1995, 541 pateints were diagnosed as primary lung cancer at the Korea Univeristy Anam Hospital. Male (423) to female(118) ratio was 3. 6:1. The most frequent histologic type of lung cancer in male patients was squamous cell carcinoma (223 patients, 52.7%) followed by adenocarcinoma (86, 20.3%) and small cell carcinoma (85, 20.1 %). In female patients, adenocarcinoma (64, 54.2%) wa most common, which was followed by squamous cell carcinoma (22, 18.6%) and small cell carcinoma (22, 18. 6%). The incidence of adenocarnimoma had an increased tendency recently (14.3% in 1988, 33.3% in 1995)(P=0.019). The predominant type in smokers was squamous cell carcinoma; whereas adenocarcinoma was the most frequent type in non-smokers. The proportion of patients aged less than 40 years (younger group) was 4. 0% (n=22). Of them, adenocarcinoma (7) and small cell carcinoma (7) were most common. In patients older than 40 years (older group, n=519), 243 (46.8%) patients had squamous cell carcinoma, and 143 (27.6%) adenocarcinoma. As age increased, the prevalence of squamous cell carcinoma was increased (P=0.0005), adenocarcinoma decreased (P=NS), and small cell carcinoma remained unchanged. We suggest above data as a clinical guidance for management of primary lung cancer.

• Radiation Oncology Journal
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• v.35 no.1
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• pp.55-64
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• 2017

Purpose: The outcomes and toxicities of locoregionally recurrent non-small-cell lung cancer (NSCLC) patients treated with curative radiotherapy were evaluated in the modern era. Materials and Methods: Fifty-seven patients receiving radical radiotherapy for locoregionally recurrent NSCLC without distant metastasis after surgery from 2004 to 2014 were reviewed. Forty-two patients were treated with concurrent chemoradiotherapy (CCRT), and 15 patients with radiotherapy alone. The median radiation dose was 66 Gy (range, 45 to 70 Gy). Lung function change after radiotherapy was evaluated by comparing pulmonary function tests before and at 1, 6, and 12 months after radiotherapy. Results: Median follow-up was 53.6 months (range, 12.0 to 107.5 months) among the survivors. The median overall survival (OS) and progression-free survival (PFS) were 54.8 months (range, 3.0 to 116.9 months) and 12.2 months (range, 0.8 to 100.2 months), respectively. Multivariate analyses revealed that single locoregional recurrence focus and use of concurrent chemotherapy were significant prognostic factors for OS (p = 0.048 and p = 0.001, respectively) and PFS (p = 0.002 and p = 0.026, respectively). There was no significant change in predicted forced expiratory volume in one second after radiotherapy. Although diffusing lung capacity for carbon monoxide decreased significantly at 1 month after radiotherapy (p < 0.001), it recovered to pretreatment levels within 12 months. Acute grade 3 radiation pneumonitis and esophagitis were observed in 3 and 2 patients, respectively. There was no chronic complication observed in all patients. Conclusion: Salvage radiotherapy showed good survival outcomes without severe complications in postoperative locoregionally recurrent NSCLC patients. A single locoregional recurrent focus and the use of CCRT chemotherapy were associated with improved survival. CCRT should be considered as a salvage treatment in patients with good prognostic factors.

• Radiation Oncology Journal
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• v.31 no.1
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• pp.34-40
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• 2013

Purpose: To evaluate the predictive factors of radiation pneumonitis (RP) and associated changes in pulmonary function after definitive concurrent chemoradiotherapy (CCRT) in patients with non-small cell lung cancer (NSCLC). Materials and Methods: Medical records of 60 patients with NSCLC who received definitive CCRT were retrospectively reviewed. Dose volumetric (DV) parameters, clinical factors, and pulmonary function test (PFT) data were analyzed. RP was graded according to the CTCAE ver. 4.0. Percentage of lung volume that received a dose of threshold (Vdose) and mean lung dose (MLD) were analyzed for potential DV predictors. PFT changes were calculated as the difference between pre-RT and post-RT values at 3, 6, and 12 months after RT. Results: Twenty-two patients (37%) developed grade ${\geq}2$ RP. Among clinical factors, tumor location in lower lobe was associated with RP. Among the DV parameters, only MLD >15 Gy was associated with grade ${\geq}2$ RP. There were statistically significant decreases in PFT at all points compared with pre-RT values in grade ${\geq}2$ RP group. MLD was associated with forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) changes at 6 and 12 months. V10 was associated with FVC changes at 12 months. V20 and V30 were associated with FEV1 changes at 6 months and FVC changes at 12 months. Conclusion: After definitive CCRT in patients with NSCLC, MLD >15 Gy and lower lobe tumor location were predictors of grade ${\geq}2$ RP. Pulmonary functions were decreased after CCRT and the magnitude of changes was associated with DV parameters.

• Journal of Chest Surgery
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• v.52 no.3
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• pp.131-140
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• 2019

Background: The purposes of this study were to evaluate the appropriateness of the stage migration of stage IIA non-small cell lung cancer (NSCLC) in the seventh edition of the tumor, node, and metastasis classification for lung cancer to stage IIB lung cancer in the eighth edition, and to identify prognostic factors in patients with eighth-edition stage IIB disease. Methods: Patients with eighth-edition stage IIB disease were subclassified into those with seventh-edition stage IIA disease and those with seventh-edition stage IIB disease, and their recurrence-free survival and disease-specific survival rates were compared. Risk factors for recurrence after curative resection were identified in all included patients. Results: Of 122 patients with eighth-edition stage IIB NSCLC, 101 (82.8%) had seventh-edition stage IIA disease and 21 (17.2%) had seventh-edition stage IIB disease. Nonsignificant differences were observed in the 5-year recurrence-free survival rate and the 5-year disease-specific survival rate between the patients with seventh-edition stage IIA disease and those with seventh-edition stage IIB disease. Visceral pleural invasion was a significant risk factor for recurrence in patients with eighth-edition stage IIB NSCLC. Conclusion: The stage migration from seventh-edition stage IIA NSCLC to eighth-edition stage IIB NSCLC was appropriate in terms of oncological outcomes. Visceral pleural invasion was the only prognostic factor in patients with eighth-edition stage IIB NSCLC.