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Yano M.,Nagoya City University | Yoshida J.,National Cancer Center Hospital East | Koike T.,Niigata University | Kameyama K.,Kurashiki Central Hospital | And 26 more authors.
European Journal of Cardio-thoracic Surgery | Year: 2014

OBJECTIVES: A precise preoperative diagnosis of 'very early' lung carcinoma may identify patients who can undergo curative surgery with limited resections. METHODS: Data from a multi-institutional project were collected on 1737 patients who had undergone limited resections (segmentectomy or wedge resection) for T1N0M0 non-small-cell carcinomas. As it was expected, this study was predominantly including ground glass nodules. Computed tomography was used to obtain the ratio of consolidation to the maximal tumour diameter to determine invasive potential of the tumours. Overall and disease-free survivals and recurrence-free proportions were analysed. RESULTS: Median age was 64 years. Mean maximal diameter of the tumours was 1.4 ± 0.5 cm. Overall and recurrence-free survivals after limited lung resection were 94.0 and 91.1% at 5 years, respectively. Recurrence-free proportions were 93.7% at 5 years. Unfavourable prognostic factors in overall survival were lymph node metastasis, interstitial pneumonia, male gender, older age, comorbidities (cardiac disease, diabetes etc.) and consolidation/tumour ratio (C/T) ≤ 0.25. C/T ≤ 0.25 predicted good outcomes especially in cT1aN0M0 disease. In a subclass analysis of cT1N0M0 squamous cell carcinomas, wedge resection was the only unfavourable prognostic factor in both overall and disease-free survivals. CONCLUSIONS: If the patient was 75 years old or younger and was judged fit for lobectomy, limited resection for cStage I non-small-cell lung cancer (NSCLC) showed excellent outcomes and was not inferior to the reported results of lobectomy for small-sized NSCLC. The carcinomas with C/T ≤ 0.25 rarely recur and are especially good candidates for limited resection. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.


Matsumura Y.,National Cancer Center Hospital East | Matsumura Y.,Fukushima Medical University | Yano M.,Nagoya City University | Yoshida J.,National Cancer Center Hospital East | And 25 more authors.
Interactive Cardiovascular and Thoracic Surgery | Year: 2016

OBJECTIVES In 2015, we reported the outcomes of patients undergoing intentional limited resection (ILR) for non-small-cell lung cancer (NSCLC) from a retrospective, multi-institutional large database in Japan. Here, we analyse the clinicopathological characteristics of the patients extracted from this database with late recurrence and compare them with those with early recurrence. METHODS Of 1538 patients in the database with cT1aN0M0 NSCLC, 92 (6%) had recurrence. In this study, early recurrence was defined as recurrence within 5 years and late recurrence as recurrence beyond 5 years after surgery. We compared the clinicopathological characteristics and post-recurrence survival (PRS) between patients with early and late recurrence. RESULTS Of the 92 patients with recurrence, 21 (23%) had late recurrence. Compared with the early recurrence group, there were significantly more adenocarcinomas and local recurrences in the late recurrence group (P = 0.04 for both). The 3- and 5-year PRS rates were 53 and 24%, respectively, and the median PRS period was 38 months. There were no significant differences in the PRS curves between patients with early and late recurrence (P = 0.12). Only 3 patients (0.2%) had recurrence more than 10 years after ILR. Of the 21 late-recurrence patients, 17 (81%) had tumours with a consolidation/tumour ratio (CTR) >0.25. CONCLUSIONS Late recurrence occurred in 21 (23%) of 92 patients with recurrence after ILR for cT1aN0M0 NSCLC. Late recurrence was more likely to involve adenocarcinoma and local recurrence. It is thus considered reasonable to follow patients with a CTR >0.25 for 10 years after ILR. © 2016 The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.


Goto T.,Guidelines Committees of Japanese Association for Chest Surgery | Goto T.,Keio University | Kadota Y.,Guidelines Committees of Japanese Association for Chest Surgery | Kadota Y.,Osaka Prefectural Medical Center for Respiratory and Allergic Diseases | And 10 more authors.
General Thoracic and Cardiovascular Surgery | Year: 2015

Objective: The purpose of this consensus conference was to determine whether video-assisted thoracic surgery (VATS) improves clinical outcomes compared with conventional thoracotomy in patients undergoing surgery for pneumothorax, and to outline evidence-based recommendations for the use of VATS. Methods: Before the consensus conference, the best available evidence was reviewed, with systematic reviews, randomized trials, and nonrandomized trials all taken into consideration in descending order of validity and importance. At the consensus conference, evidence-based interpretative statements were created, and consensus processes were used to determine the ensuing recommendations. The Medical Information Network Distribution Service in Japan (Minds) system was used to label the levels of evidence for the references and the classes of recommendations. Results and recommendations: The consensus panel agreed upon the following statements and recommendations for patients with pneumothorax undergoing surgery: 1. VATS is broadly indicated as surgery for pneumothorax. 2. VATS is judged to be less invasive, as it results in minimal postoperative pain, the periods of chest tube placement and hospitalization are short, and it shows a trend toward early realization of social integration. 3. There is no difference in terms of safety and complications between VATS and open thoracotomy. 4. As it is anticipated that VATS will result in a higher recurrence rate than open thoracotomy, it may be desirable to add a supplemental procedure during surgery. In summary, VATS can be recommended as pneumothorax surgery (Recommendation grade: Level B). © 2014, The Japanese Association for Thoracic Surgery.


Okuma Y.,Komagome Hospital | Okuma Y.,Jikei University School of Medicine | Hosomi Y.,Komagome Hospital | Takahashi S.,Komagome Hospital | And 3 more authors.
Clinical Lung Cancer | Year: 2015

Background Clinical efficacy of second- and later-line chemotherapy for patients with thymic carcinoma previously treated with chemotherapy remains uncertain; limited data are available about this carcinoma because of its rarity. The aim of this study was to investigate effective chemotherapy for patients with thymic carcinoma previously treated with chemotherapy using a retrospective analysis of responses and times to event. Patients and Methods We conducted a retrospective review of the medical records of 23 advanced thymic carcinoma patients previously treated with palliative-intent chemotherapy between 1980 and 2014 in our institution. Clinical demographic characteristics, agents, response, and time to treatment failure for each treatment line and overall survival were reviewed. Factors expected to be associated with survival rates were analyzed. Differences in survival were assessed using Kaplan-Meier analysis and univariate and multivariate Cox proportional hazards regression analyses. Results The study included 13 men (56.5%) and 10 women (43.5%). The median age at diagnosis was 58.5 years. The most common histological subtypes were squamous cell carcinoma (16 patients [69.6%]), followed by neuroendocrine carcinoma (4 patients [17.4%]). The objective response rates of first-, second-, third-, and fourth-line chemotherapy were 60.9%, 39.1%, 23.1%, and 25.0%, respectively. The median survival time was 18.8 months (95% confidence interval, 7.5-40.9 months). Uni- and multivariate analyses of all assessed variables failed to identify any statistically significant indicators of overall survival. Conclusion Patients with thymic carcinoma previously treated with palliative-intent chemotherapy might respond to second- or later-lines of cytotoxic chemotherapy. © 2015 Elsevier Inc.


Sakamaki H.,Tokyo Metropolitan Cancer and Infectious Diseases Center
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2013

Within the framework of the National Cancer Act, the Tokyo Metropolitan Government has executed a plan to promote the cancer control programs since 2008. The effort has resulted in substantial outcomes in the last 5 years. Or reviewing the past plan and in compliance with the National Basic Plan to Promote Cancer Control Program, which was initiated in 2012, the new Tokyo Plan will be launched this fiscal year. This plan focuses on cancer prevention, early detection, the provision of high-level and comprehensive cancer medical services, the identification of anxiety in patients cancer and their families, and the advancement of cancer registration and research activities.


Iwanaga T.,Tokyo Metropolitan Cancer and Infectious Diseases Center
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2012

CXCR4, one of the chemokine receptors, plays a major role in cell migration in metastasis and cancer dissemination. However, it is not known whether CXCR4 is associated with tumor growth in vivo. In the present study, we investigated the inhibitory effect of CXCR4 blockers on CXCR4-expressing gastric cancer in vivo. Cells of a CXCR4-expressing gastric cancer cell line, K-MK-2, were transplanted into nude mice. A CXCR4 blocker, AMD3100 (2 mg/kg), was injected and another blocker, KRH3955 (1 mg/kg or 10 mg/kg), was administered orally. Both drugs were administered for 5 days followed by 2 days of rest. The mice were sacrificed on the 35th day following transplantation and the weights of the tumors were measured. The mean weights of the tumors were 7.092±1.221 g in the control mice, 5.137±1.001 g in the ADM3100-injected mice, 3.895±2.120 g in mice treated with 1 mg/kg of KRH3955, and 4.257±1.169 g in mice treated with 10 mg/kg of KRH3955. The 2 CXCR4 blockers significantly inhibited the growth of gastric cancer cells transplanted into the nude mice. The CXCR4 blockers AMD3100 and KRH3955 inhibit tumor growth in vivo. These drugs are possible candidates for personalized therapy of gastric cancer.


PubMed | Tokyo Metropolitan Cancer and Infectious Diseases Center
Type: Journal Article | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2011

Chemotherapy-induced peripheral neuropathy(CIPN)is one of chemotherapys common and disabling adverse effects. It may be caused by many chemotherapeutic agents including the taxanes(paclitaxel, docetaxel), the vinca alkaloids(vincristine, vinorelbine, vinblastine), the platinum analogues(cisplatin, carboplatin, oxaliplatin), bortezomib and thalidomide, among others. Once the symptoms have developed, they may lead to compromising patients quality of life(QOL). For medical oncologists, the management of CIPN remains an important challenge. At the present time, no agent has shown enough solid beneficial evidence to be recommended for the treatment or/prophylaxis of CIPN. The standard of care for CIPN includes awareness and early detection of neuropathy, and dose reduction and/or discontinuation of the problematic agents.


Iwasaki Y.,Tokyo Metropolitan Cancer and Infectious Diseases Center
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2012

We evaluated the safety of preoperative chemotherapy against advanced gastric cancer with para-aortic lymph node metastasis. In this study, we compared 11 patients who received preoperative chemotherapy(PC group) to 56 patients who did not receive preoperative chemotherapy (NPC group). We performed 47 total gastrectomies and 2 distal gastrectomies in the PC group and 9 total gastrectomies and 9 distal gastrectomies in the NPC group. In the PC group, the mean operation time was 275 min for distal gastrectomy and 297 min for total gastrectomy. In the NPC group, the mean operation time was 265 min for distal gastrectomy and 296 min for total gastrectomy. Regarding blood loss during operation, in the PC group, the mean blood loss was 650 mL for distal gastrectomy and 760 mL for total gastrectomy. In the NPC group, the mean blood loss was 530 mL for distal gastrectomy and 825 mL for total gastrectomy. No significant differences were seen between the 2 groups. In conclusion, preoperative chemotherapy against advanced gastric cancer with para-aortic lymph node metastasis appears to be a safe treatment, but we need to conduct clinical trials for confirmation.

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