Search

Hiroaki Kuroda,1 Shin Koyama,1 Mingyon Mun,2 Jun Nakajima,3 Kazuhito Funai,4 Ichiro Yoshino,5 Yoshikane Yamauchi,6 Masafumi Kawamura6 On behalf of the Metastatic Lung Tumor Study Group of Japan1Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan; 2Department of Thoracic Surgical Oncology, Cancer Institute Hospital Japanese Foundation for Cancer Research, Tokyo, Japan; 3Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan; 4First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan; 5Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan; 6Department of Surgery, Teikyo University School of Medicine, Tokyo, JapanCorrespondence: Hiroaki Kuroda, Department of Thoracic Surgery, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan, Tel +81-52-762-6111, Fax +81-52-763-5233, Email h-kuroda@aichi-cc.jpPurpose: Metastatic head and neck squamous cell carcinoma (HNSCC) is relatively poor; however, depending on the selected cases, pulmonary metastasectomy can be a practical therapeutic option. This study aimed to identify the outcomes of complete metastasectomy based on each primary site and to investigate unfavorable prognostic factors.Patients and Methods: We used the database from the Metastatic Lung Tumour Study Group of Japan. Between November 1980 and April 2017, 231 patients were deemed eligible. According to anatomy and the current epidemiology of HNSCC, the patients were divided into three groups: nasopharynx, oropharynx, and salivary gland (n = 40, Group 1), oral cavity, tongue, and paranasal sinuses (n = 69, Group 2), and larynx and hypopharynx (n = 122, Group 3).Results: The 5-year overall survival after complete pulmonary metastasectomy was 58.5%, 25.0%, and 46.9% in G1, 2, and 3, respectively (p < 0.01). Multivariate analyses revealed unfavourable prognostic factors to be G2, and pathological maximum diameter was > 20 mm. Therefore, on dividing group 1 and 3 with or without diameter, the 5-year overall survival was significantly worse in HNSCC with a diameter > 20 mm (n = 74) than that in the remnant (n = 88; 61.9% vs 35.5%; p < 0.01).Conclusion: According to the multi-institutional Japanese data, pulmonary metastasectomy from HNSCC indicates a potential survival benefit. Oral cavity, tongue, and paranasal sinuses cancer, and tumour size (> 20 mm) were poor prognostic factors for pulmonary metastasectomy from head and neck cancer.Keywords: pulmonary metastasectomy, head and neck squamous cell carcinoma, pulmonary metastasis, survival outcomes

Atsushi Hata,1,2 Yasuo Sekine,1 Ohashi Kota,1 Eitetsu Koh,1 Ichiro Yoshino2 1Department of Thoracic Surgery, Tokyo Women’s Medical University Yachiyo Medical Centre, Yachiyo, 2Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan Purpose: The outcome of radical surgery for lung cancer was investigated in patients with combined pulmonary fibrosis and emphysema (CPFE). Methods: A retrospective chart review involved 250 patients with lung cancer who underwent pulmonary resection at Tokyo Women’s Medical University Yachiyo Medical Center between 2008 and 2012. Based on the status of nontumor-bearing lung evaluated by preoperative computed tomography (CT), the patients were divided into normal, emphysema, interstitial pneumonia (IP), and CPFE groups, and their clinical characteristics and surgical outcome were analyzed. Results: The normal, emphysema, IP, and CPFE groups comprised 124 (49.6%), 108 (43.2%), seven (2.8%), and eleven (4.4%) patients, respectively. The 5-year survival rate of the CPFE group (18.7%) was significantly lower than that of the normal (77.5%) and emphysema groups (67.1%) (P

Terunaga Inage, Takahiro Nakajima, Ichiro Yoshino Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan Abstract: Accurate staging is the first step in the management of lung cancer. Nodal staging is quite important for physicians to be able to judge the primary operability of patients harboring no distant metastasis. For many years, mediastinoscopy has been considered a “gold standard” modality for nodal staging. Mediastinoscopy is known to be a highly sensitive procedure for mediastinal staging and has been performed worldwide, but is invasive. Because of this, clinicians have sought a less invasive modality for nodal staging. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive modality for diagnosis and staging of lung cancer. EBUS-TBNA is a needle biopsy procedure that has accessibility compatible with the reach of the convex-probe EBUS scope, so N1 nodes are also assessable. The diagnostic yield is similar to that of mediastinoscopy, and the core obtained by the dedicated needle biopsy can be used for histological assessment to determine the subtypes of lung cancer. The samples can also be used to test for various biomarkers using immunohistochemistry, polymerase chain reaction for DNA/complementary DNA, and in situ hybridization, and the technique is useful for selecting candidates for specific molecular-targeted therapeutic agents. According to the newly published American College of Chest Physicians guideline, EBUS-TBNA is now considered "the best first test" for nodal staging in patients with radiologically suspicious nodes. Appropriate training and thorough clinical experience is required to be able to perform correct nodal staging using this procedure. Keywords: lung cancer, staging, endobronchial ultrasound, transbronchial biopsy

The discinid brachiopod from the Lower Triassic Osawa Formation in the Southern Kitakami Terrane, Japan, exhibited a unique morphological combination of a narrow pedicle track (listrium) and a V-shaped large depressed area, thereby suggesting an intermediate form between the Palaeozoic Orbiculoidea and the extant Discinisca. Based on these characteristics, we propose Bronzoria recta gen. et sp. nov., a genus that appeared in the late Permian and was widely distributed during the Triassic period. Morphological analysis of extant discinids revealed that the pedicle area showed an arrowhead-shaped median plate and a pair of semilunar plates, equivalent to the inner and outer listrial plates of Palaeozoic-type discinids, respectively. Consequently, there are great differences in the development of the pedicle area, i.e., the large pedicle area of extant discinids is suitable for robust pedicle attachment, whereas the narrow pedicle area of Bronzoria gen. nov. suggests a free-lying mode of life. Given the relationship between pedicle-related structures and the mode of life, we hypothesised that the evolution of the large depressed area preceded the development of the pedicle area. Subsequently, the large depressed area accommodated a larger pedicle, facilitating an autecological innovation for pedicle attachment, as observed in extant species.

Abstract Introduction The study aimed to determine the efficacy and safety of biological disease-modifying antirheumatic drugs (bDMARDs) in the treatment of polymyalgia rheumatica (PMR) complicated by rheumatoid arthritis (RA). Methods Patients with PMR which could be classified as RA and who were treated with bDMARDs were included in the analysis. The primary endpoint was the clinical Polymyalgia Rheumatica Activity Score (Clin-PMR-AS) after 26 weeks of treatment, and the secondary endpoint was adverse events during the observation period. Results A total of 203 patients with PMR which was resistant or intolerant to glucocorticoids and could be classified as RA were receiving bDMARDs and were enrolled in the study. There were 83, 82, and 38 patients in the tumor necrosis factor inhibitor (TNFi), interleukin-6 receptor inhibitor (IL-6Ri), and cytotoxic T lymphocyte-associated antigen-4-immunoglobulin (CTLA4-Ig) groups, respectively. Twenty-six weeks after bDMARD initiation, Clin-PMR-AS levels were significantly lower in the IL-6Ri group as compared to other groups. Multiple regression analysis was performed with Clin-PMR-AS as the objective variable. Body mass index (BMI), history of bDMARDs, and IL-6Ri use were identified as factors involved in Clin-PMR-AS. After adjustment for group characteristics using inverse probability of treatment weighting with propensity scores, the Clin-PMR-AS score at 26 weeks was significantly lower in the IL-6Ri group (9.0) than in both the TNFi (12.4, p = 0.004) and CTLA4-Ig (15.9, p = 0.003) group. Conclusion IL-6Ri may potentially improve the disease activity of PMR compared to other bDMARDs.

Background and purpose: Thymectomy is an effective treatment for myasthenia gravis (MG) with anti‐acetylcholine receptor (AChR) antibodies. We rarely encounter patients who develop MG after surgery for thymic tumors. This study aimed to investigate the characteristics and frequency of post‐thymectomy onset (PostTx) MG. Methods: We reviewed the clinical information of thymoma‐associated MG in 158 patients. Of these, 18 (11%) patients with PostTx MG were identified. Results: The presence of anti‐AChR antibodies (82%) and electrophysiological abnormalities (50%) was confirmed before thymectomy in patients with PostTx MG. The clinical characteristics of PostTx MG were similar to those of pre‐thymectomy onset (PreTx) MG. In PostTx MG, the duration between thymectomy and MG onset were distributed as < 6 months (early‐onset PostTx MG) and ≥ 6 months (late‐onset PostTx MG). Notably, some patients with late‐onset PostTx MG were associated with thymoma relapse. Conclusion: Our results suggest that approximately 11% of patients with thymoma‐associated MG were PostTx MG and pre‐surgical assessment of anti‐AChR antibody titer or electrophysiological testing may predict PostTx MG development. However, no difference in clinical manifestation and prognosis was observed between PreTx MG and PostTx MG. [ABSTRACT FROM AUTHOR]