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Biomedical subjects

Junji Yoshida

Publications and source records attributed to Junji Yoshida.

At least 19 recordsLinked to original sources
PubMed2007

Differential impact of atorvastatin vs pravastatin on progressive insulin resistance and left ventricular diastolic dysfunction in a rat model of type II diabetes.

BACKGROUND: Controversy exists regarding the effects of statin therapy on progressive insulin resistance (IR) and its consequences, in the present study a rat model of spontaneously developing type II diabetes mellitus (DM) was used to examine the impact of atorvastatin (AS) vs pravastatin (PS). METHODS AND RESULTS: The Otsuka Long-Evans Tokushima Fatty rats were either untreated or treated with 100 mg/kg per day of AS or PS from 6 weeks of age for 24 weeks. AS achieved much greater lipid lowering than PS. Serial oral glucose tolerance tests revealed new-onset diabetes was delayed by PS only. The untreated rats exhibited a progressive decrease in plasma adiponectin, increases in plasma leptin and tumor necrosis factor-alpha, and reduction of plasma nitric oxide (NO), which were limited more by PS than AS. PS, but not AS, enhanced adiponectin mRNA expression in white adipose tissue at 30 weeks. Cardiac endothelial NO synthase expression was upregulated, and overexpression of both transforming growth factor-beta1 and monocyte chemoattractant protein-1 mRNA was limited more by PS than AS. Coronary perivascular fibrosis at 30 weeks was suppressed only by PS, which was accompanied by preserved left ventricular diastolic function assessed with Doppler echocardiography. CONCLUSIONS: The moderate lipid lowering by PS, but not the intensive lipid lowering by AS, prevented new-onset DM and diastolic dysfunction in a rat model of IR, and this was associated with preferable adipocytokine profiles and cardiac redox states.

Adiponectin↗
PubMed2006

Evaluation of extratumoral lymphatic permeation in non-small cell lung cancer as a means of predicting outcome.

BACKGROUND: Lymphatic permeation (ly) has been described as a potential prognostic factor for non-small cell lung cancer (NSCLC). METHODS: The purpose of this study was to analyze whether evaluation of the presence or absence of ly and its location (ly 0: absent, N=464; ly 1: intratumoral, N=42; ly 2: extratumoral, N=52) provides an appropriate means of predicting the outcome of NSCLC. We investigated the clinical implications of ly in 558 consecutive patients with surgically resected NSCLC. RESULTS: Evaluation according to ly status showed that the recurrence-free survival (RFS) time of the ly 2 patients was significantly shorter than that of the ly 0 patients (P<0.0001), the ly 1 patients (P=0.0028). A significant difference in RFS time was also observed between the ly 0 patients and the ly 1 patients (P=0.0025). RFS time of the ly 0 patients was significantly longer than that of the ly 1 plus ly 2 patients (P<0.0001). We also evaluated the patients with pathological stage I disease (N=378) separately. The RFS time of the ly 2 patients (N=9) was significantly shorter than that of the ly 0 plus ly 1 patients (P<0.0001). In the nine ly 2 patients, six developed a distant metastasis within 1 year. A multivariate analysis revealed that ly status (ly 0 plus ly 1 versus ly 2) was an independent prognostic factor (P=0.0116), demonstrating the significant prognostic value of extratumoral lymphatic permeation in NSCLC. CONCLUSIONS: These results indicate that ly status is a good prognostic marker of poorer outcome in patients with resected NSCLC.

Adenocarcinoma↗
PubMed2006

Carbonic anhydrase IX expression is associated with tumor progression and a poor prognosis of lung adenocarcinoma.

Carbonic anhydrase (CA) IX catalyzes the hydration of carbon dioxide into carbonic acid and participates in a variety of physiological and biological processes. The aim of this study was to evaluate the prognostic significance of CA IX expression in patients with lung adenocarcinoma. Standard immunohistochemical techniques were used to study CA IX expression in 134 patients who underwent curative resection for adenocarcinoma of the lung at our hospital between January 1995 and December 1996. We evaluated the correlations between CA IX expression levels on cancer cells and clinicopathological factors. CA IX expression was not observed in normal lung tissue or specimens from non-invasive adenocarcinomas. CA IX immunostaining was detected in 33 (24.6%) invasive adenocarcinoma cases. Poor differentiated histological phenotype (p=0.0015), pathological stage (p=0.0400), vascular invasion (p=0.0009) and lymphatic permeation (p=0.0050) were significantly related to CA IX expression. On univariate analysis, CA IX positive cases showed significantly shorter overall survival (p=0.0083) and disease-free survival (p=0.0122). In particular, the overall and disease-free survivals in stages I+II were significantly shorter in the CA IX positive than in the CA IX negative cases (p=0.0269 and 0.0011, respectively). Our results suggest that CA IX expression is strongly associated with tumor progression and indicates a poor prognosis for patients with stages I+II lung adenocarcinoma.

Adenocarcinoma↗
PubMed2006

Pleural lavage cytology before and after lung resection in non-small cell lung cancer patients.

BACKGROUND: The aim of this study was to analyze on a multivariate basis the prognostic significance of pre-resection and post-resection pleural lavage cytologies in surgically resected primary non-small cell lung cancer (NSCLC) patients, in relation to pathologic TNM factors in a large cohort of almost 1,200 patients. METHODS: From August 1992 through March 2001, pleural lavage cytology (PLC) was performed in 1,214 NSCLC patients without pleural effusion or dissemination undergoing pulmonary resection. The cytologic evaluation was classified into three categories: negative, suggestive, and positive. To investigate the impact on patient survival, PLC results were analyzed with conventional clinicopathologic factors. RESULTS: Definitive pre-resection PLC result was obtained in 1,194 patients and 38 had a positive result. The 5-year survival rates were 27% if pre-resection PLC was positive and 71% if negative. Of 1,198 patients 54 had a positive post-resection PLC result. The 5-year survival rates were 10% if post-resection PLC was positive and 73% if negative. On multivariate analysis, post-resection PLC was an independent prognostic factor as significant as established clinicopathologic factors. CONCLUSIONS: Pre-resection and post-resection PLC should be recognized as an essential prognostic factor and should be performed in NSCLC patients without pleural effusion and dissemination. Post-PLC, compared with pre-PLC, had a greater and independent impact on survival and needs to be incorporated in the pathologic staging of NSCLC in the future.

Adenocarcinoma↗
PubMed2006

Is surgical resection indicated for a solitary non-small cell lung cancer recurrence?

OBJECTIVES: Some investigators have reported long-term survival after surgical resection of a solitary non-small cell lung cancer recurrence in various sites. However, the role and indications of the second operation remain unclear. METHODS: We reviewed 28 patients with a solitary recurrence after successful initial resection of primary non-small cell lung cancer who underwent resection of the recurrent lesion. The clinicopathologic factors associated with outcome were analyzed. RESULTS: There were 17 men and 11 women. Recurrence resection was performed for the following sites: 16 in the lung, 5 in the brain, 2 in the adrenal gland, and 1 each in the chest wall, stomach, skin, pelvic lymph node, and malar bone. The median survival time was 25 months, and the 1-, 2-, and 5-year survival rates after recurrence were 89%, 59%, and 32%, respectively. Advanced p-stage (p-stage II and III, n = 14) of the primary tumor was the significant negative prognostic factor. Patients with p-stage II or III had survival equivalent to that of those who had multiple recurrences or were unfit for further surgical intervention. CONCLUSIONS: Resection of a solitary non-small cell lung cancer recurrence might provide long-term survival in highly selected patients. However, surgical resection might be contraindicated if the primary tumor is stage II or III.

Adrenal Gland Neoplasms↗
PubMed2005

Treatment of ischemic limbs based on local recruitment of vascular endothelial growth factor-producing inflammatory cells with ultrasonic microbubble destruction.

OBJECTIVES: We sought to clarify the mechanism for neovascularization by ultrasonic microbubble destruction (US/MB) and its ability to improve the function of ischemic limbs. BACKGROUND: In tissue, US/MB can cause capillary rupture, leading to angiogenesis and arteriogenesis. METHODS: Seven days after removal of the femoral artery (day 0) in mice, microbubble/ultrasound treatment was performed by intermittent insonation (1.6 MHz, mechanical index 1.1) to the ischemic limbs after intravenous infusion of phospholipid-stabilized microbubbles BR14 (US/MB group). Effects were compared with those in untreated mice with ischemic limbs (control group). RESULTS: Immunostaining of the treated muscles revealed a greater leukocyte (CD45-positive cell) count in the US/MB group on days 3 and 7. These cells included F4/80-positive cells (macrophages) and CD3-positive cells (T-lymphocytes), both of which were immunoreactive to vascular endothelial growth factor (VEGF) antibody. Muscular VEGF content by Western blotting was elevated in the US/MB group on day 3, which declined but remained greater until day 21. The US/MB group showed a greater capillary density by alkaline phosphatase stain on day 7 without further increase at day 21. Surface vascularity of the muscles and blood flow were greater in the US/MB group on day 7, which further increased by day 21. Moreover, the US/MB group showed a two-fold longer treadmill time compared with the untreated control group on day 21. None of these favorable effects were observed in mice treated with ultrasound only or microbubbles only. CONCLUSIONS: Ultrasonic destruction of microbubbles delivered to the ischemic limbs can recruit inflammatory cells producing VEGF, which is followed by neovascularization and functional improvement, and thus has a therapeutic potential.

Animals↗
PubMed2005

Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) in the thymus: report of four cases.

Mucosa-associated lymphoid tissue (MALT) lymphoma in the thymus is extremely rare, and little is known about its clinicopathological features. In this study, we examined four cases of MALT lymphoma in the thymus at our institute in terms of clinicopathological features. Most patients had autoimmune disease or hyperglobulinemia, and they also had cysts in the tumors. Both elevated serum levels of autoantibodies and the polyclonal increase in serum Ig remained almost unchanged after total thymectomy in all patients. We recommend that MALT lymphoma in the thymus should be considered in the differential diagnosis when a cystic thymic mass is found and if the patient is Asian and/or has autoimmune disease or hyperglobulinemia.

Adult↗
PubMed2005

Histopathologic prognostic factors in resected colorectal lung metastases.

BACKGROUND: Pulmonary metastasectomy is a standard method of treatment for selective pulmonary metastases of colorectal cancer. However, the pathologic factors of metastatic lesions that affect survival and tumor recurrence after pulmonary resection are less well defined. The pathologic findings of colorectal pulmonary metastases have not been correlated with clinical outcome. The study was conducted to clarify the characteristics and identify the prognostic factors of the pulmonary metastases of colorectal cancer. METHODS: Between July 1992 and November 2002, 89 patients underwent the complete resection of pulmonary metastases of primary colorectal carcinoma, and we pathologically reviewed the surgical specimens of 136 metastatic lesions from these patients. RESULTS: There were no perioperative deaths. The overall 5-year survival rate was 61.4%. No clinical factors were associated with the outcome. The univariate analysis of pathologic factors revealed aerogenous spread with floating cancer cell clusters (ASFC) (p = 0.004), vascular invasion (p = 0.002), lymphatic invasion (p = 0.032), and pleural invasion (p = 0.037) to be prognostic factors. The multivariate analysis showed vascular invasion (p = 0.02) and ASFC (p = 0.02) to be independent prognostic factors. The 5-year survival rate of patients whose lesions were positive for both ASFC and vascular invasion was 24.7% and much poorer than in the patients with ASFC without vascular invasion (78.6%), vascular invasion but without ASFC (80.2%), and patients negative for both (93.3%) (p = 0.0002). CONCLUSIONS: The morphologic features of ASFC and vascular invasion at metastatic sites are prognostic factors for colorectal cancer patients who have undergone pulmonary metastasectomy.

Adenocarcinoma↗
PubMed2005

Predictive factors for local recurrence of resected colorectal lung metastases.

BACKGROUND: Wedge resection or segmentectomy are the preferred treatments for pulmonary metastasis from colorectal cancer. However, local recurrence at the surgical margin is a problem with limited resections. This study attempted to identify predictive factors associated with local recurrences at the surgical margin after resection of pulmonary metastases. METHODS: A total of 96 lesions in 61 patients who had undergone a pulmonary wedge resection or segmentectomy for the treatment of pulmonary metastasis from colorectal cancer were investigated. Various clinical and pathologic factors were reviewed, and the risk of a local recurrence at the surgical margin was investigated. RESULTS: After pulmonary resection, 34 of the 61 patients (56%) experienced recurrences in their lungs. Local recurrences at the surgical margin were found in 17 patients (28%), even though 15 of these 17 cases had been histologically confirmed as completely resected cases. No clinical factors associated with local recurrence at the surgical margin were identified. Pathologically, lesions exhibiting 10 or more aerogenous spreads with floating cancer cell clusters around the main tumor (p = 0.02) and a malignant positive surgical margin (p = 0.04) had a significantly higher risk of local recurrence. CONCLUSIONS: The present study indicated that local recurrence may occur even in cases with a pathologically negative surgical margin. In cases with pulmonary metastases from colorectal cancer, lesions with 10 or more aerogenous spreads with floating cancer cell clusters around the main lesion and a malignant positive surgical margin in the resected specimens have a significantly higher risk of local recurrence at the surgical margin than those without.

Adult↗
PubMed2005

Limited resection trial for pulmonary ground-glass opacity nodules: fifty-case experience.

OBJECTIVE: This study was undertaken to determine the recurrence rate after limited resection of small lung carcinoma and to evaluate intraoperative frozen-section examination accuracy for Noguchi classification. METHODS: Enrollment requirements were as follows: pulmonary nodule 2 cm or smaller, diagnosed or suspected clinical T1 N0 M0 carcinoma in the lung periphery, and ground-glass opacity findings and lack of evident pleural indentations or vascular convergence on high-resolution computed tomographic scan. A wedge or segmental resection specimen, removed with custom stapler cartridges, was immediately reinflated and examined by frozen-section with hematoxylin-eosin and Victoria blue-van Gieson stains. If the tumor was confirmed as Noguchi type A or B with resection margins greater than 1 cm, the patient was closed and followed up on an outpatient basis. End points were 5-year disease-free survival and intraoperative classification accuracy. RESULTS: From August 1998 through October 2002, a total of 50 patients were enrolled (20 men and 30 women, ages 30-77 years). Tumor sizes ranged from 2 to 21 mm (11 mm average). There were 2 Noguchi type A tumors, 23 Noguchi type B tumors, 15 Noguchi type C tumors, 5 atypical adenomatous hyperplasias, 4 fibroses, and 1 granuloma. Frozen-section accuracy was approximately 98% (39/40). One intraoperative type B diagnosis was revised to type C after postoperative pathologic study. No morbidity, mortality, or recurrence has been seen with a median follow-up of 50 months. CONCLUSION: Noguchi type A and B tumors may well be in situ carcinomas, and frozen-section examination was highly accurate. Neither local recurrence nor distant metastases have been found to date. Limited resection initial results appear promising.

Adult↗
PubMed2005

Visceral pleural invasion is an invasive and aggressive indicator of non-small cell lung cancer.

OBJECTIVE: Although visceral pleural invasion by non-small cell lung cancer is considered a poor-prognostic factor, further information is lacking, especially in relation to other clinicopathologic prognostic factors. We assessed the relationship between visceral pleural invasion and other clinicopathologic characteristics and evaluated its significance as a prognostic factor. METHODS: We reviewed 1074 patients with surgically resected T1/2 non-small cell lung cancer for their clinicopathologic characteristics and prognoses. The patients were divided into 2 groups according to visceral pleural invasion status (visceral pleural invasion group and non-visceral pleural invasion group). Both groups were compared with regard to age, sex, histology, tumor size, tumor differentiation, lymph node involvement, lymphatic invasion, vascular invasion, scar grade, nuclear atypia, mitotic index, serum carcinoembryonic antigen level, and survival. Univariate and multivariate analyses were conducted. RESULTS: Visceral pleural invasion was identified in 288 (26.8%) of the resected specimens. Survival was 76.0% at 5 years and 53.2% at 10 years in the non-visceral pleural invasion group and was 49.8% at 5 years and 37.0% at 10 years in the visceral pleural invasion group. The difference between groups was highly significant ( P < .0001). Visceral pleural invasion was also significantly associated with a higher frequency of lymph node involvement. However, regardless of N status (N0 or N1/2), there was a significant difference in survival when the visceral pleura was invaded. Visceral pleural invasion was observed significantly more frequently in tumors with factors indicative of tumor aggressiveness/invasiveness: moderate/poor differentiation, lymphatic invasion, vascular invasion, high scar grade, high nuclear atypia grade, high mitotic index, and high serum carcinoembryonic antigen level. By multivariate analysis, visceral pleural invasion proved to be a significant independent predictor of poor prognosis in non-small-cell lung cancer patients with or without lymph node involvement. CONCLUSIONS: Visceral pleural invasion is a significant poor-prognostic factor, regardless of N status. Our analyses indicated that visceral pleural invasion is an independent indicator of non-small cell lung cancer invasiveness and aggressiveness.

Aged↗
PubMed2005

Pitfalls in lymph node staging with positron emission tomography in non-small cell lung cancer patients.

BACKGROUND: The evidence of clinical value of positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose (FDG) in lymph node (LN) staging in non-small cell lung cancer (NSCLC) has been shown in numerous papers. However, few studies have assessed its limitations. The aim of the present study is to clarify clinico-pathologic factors responsible for false PET results. METHODS: From July 2000 through December 2001, 71 NSCLC patients underwent both FDG PET and surgical intervention at the National Cancer Center Hospital East, Chiba. Clinical records, computed tomographic (CT) scan findings, PET findings, and histologic findings were retrospectively reviewed. RESULTS: Sensitivity, specificity, accuracy in nodal staging for CT were 29, 83, and 65% and for PET were 39, 79, and 66%, respectively. There were 10 (14%) false-positive PET scans and 14 (20%) false-negative PET scans. The causative factors for false-positive PET scan were: (1) inflammatory conditions in seven patients; (2) PET mis-localization of an interlobar LN as a mediastinal LN in one patient; (3) inability to distinguish the endobronchial polypoid growth of a primary tumor from a lobar LN in one patient; (4) unknown in one patient. All false-positive LNs due to inflammatory conditions showed reactive lymphoid hyperplasia histologically. The causative factors for false-negative PET scan were: (1) limitation of spatial resolution of the PET scanner in 12 patients (maximum tumor focus dimensions in false-negative LNs ranging from 1 to 7.5 mm, with an average of 3.4 mm); (2) PET mis-localization of a mediastinal LN as a hilar LN in one patient; (3) weak FDG uptake by microscopic tumor foci due to necrosis with massive bleeding in a metastatic LN in one patient. CONCLUSIONS: Inflammatory conditions were most responsible for false-positive PET scans, and spatial resolution limitation of FDG PET was the causative factor of false-negative PET scans. Recognizing these factors in advance would be clinically helpful in accurate nodal staging with FDG PET.

Adult↗
PubMed2005

Multiple sclerosing hemangiomas with a 10-year history.

We report a case of multiple sclerosing hemangiomas arising in a 38-year-old woman. Computed tomography (CT) scans of the chest showed multiple small nodules in all lobes of the right lung. The nodule sizes ranged from a few millimeters to the largest of 3.1 cm, which was located in the right middle lobe. She underwent right middle lobectomy to confirm the histological diagnosis. The resected specimen revealed multiple sclerosing hemangiomas. We followed this patient by annual chest CT scans for 10 years and demonstrated that all residual nodules remained unchanged. This is the first report of stable multiple pulmonary sclerosing hemangiomas observed for such a long period.

Adult↗
PubMed2004

Leukocyte-targeted myocardial contrast echocardiography can assess the degree of acute allograft rejection in a rat cardiac transplantation model.

BACKGROUND: Repetitive endomyocardial biopsies are necessary to monitor the effects of immunosuppressants after cardiac transplantation. Contrast ultrasound with microbubble targeting of leukocytes detects acute leukocyte infiltration. We examined whether leukocyte-targeted myocardial contrast echocardiography (MCE) could provide for the quantitative assessment of acute cardiac rejection. METHODS AND RESULTS: Hearts from Brown Norway rats or Lewis rats were transplanted into other Brown Norway rats. Isografts and groups of allografts either untreated or treated with cyclosporin A (CsA) at a low dose (3 mg x kg(-1) x d(-1)) or high dose (10 mg x kg(-1) x d(-1)) from 3 days before transplantation were compared at posttransplantation day 3. Echocardiography-derived left ventricular wall thickening was comparable among the 4 groups. Myocardial blood flow assessed with MCE, relating pulsing intervals with signal intensity (SI), was slightly decreased only in untreated allografts. However, myocardial SI (in gray levels) obtained after a 10-minute period allowing microbubble-leukocyte interactions after contrast injection exhibited a clear gradient in these groups (12+/-2 in untreated allografts, 9+/-5 in allografts treated with low-dose CsA, 6+/-3 in allografts treated with high-dose CsA, and 2+/-1 in isografts, P<0.001). The pattern of difference in SI among the groups agreed well with that in ED-1-positive cell (macrophage) count (25+/-7, 12+/-4, 5+/-3, and 1+/-0 cells per high-power field, respectively, P<0.001), which correlated with CD3-positive cell (T lymphocyte) count (33+/-5, 22+/-5, 9+/-4, and 1+/-0 cells per high-power field, respectively, P<0.001). CONCLUSIONS: Leukocyte-targeted MCE can noninvasively assess the degree of rejection in transplanted hearts by directly revealing the magnitude of intramyocardial infiltration of macrophages and T lymphocytes.

Acute Disease↗
PubMed2004

Interaction with leukocytes: phospholipid-stabilized versus albumin-shell microbubbles.

PURPOSE: To confirm that BR14 microbubbles (MBs) can be phagocytosed by activated leukocytes, to determine their stability after phagocytosis, and to evaluate how such characteristics influence the fate of neutrophils containing MBs after insonation. MATERIALS AND METHODS: BR14 and human albumin MBs (2 x 10(7)/mL) were incubated with activated human neutrophils (2 x 10(6)/mL) to allow phagocytosis. Deflation rate of the phagocytosed MBs after pulsed insonation (one burst per second for 5 seconds) at 1.8 MHz with peak negative pressure of -540 kPa or -1,340 kPa, lactate dehydrogenase (LDH) leakage, and terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling stain-positive cell count after insonation were compared between the two agents. RESULTS: At -540 kPa, phagocytosed MBs remained nearly unchanged for both agents after insonation. At -1,340 kPa, although human albumin MBs were disrupted on the first or second burst, BR14 MBs remained undisrupted. After -540-kPa insonation, a similar number of apoptotic cells appeared in neutrophils containing human albumin and BR14 MBs. At -540 kPa, LDH leakage was limited in human albumin MBs and BR14 MBs. At -1,340 kPa, LDH leakage was significantly increased in human albumin MBs and BR14 MBs (P <.01, both vs -540 kPa). Apoptotic cells were significantly decreased in human albumin MBs and BR14 MBs (P <.01, both vs -540 kPa). LDH leakage was lower and apoptotic cell count was greater in BR14 MB-containing neutrophils than in human albumin MB-containing neutrophils (both P <.01). CONCLUSION: Compared with human albumin MBs, BR14 MBs were more stable after phagocytosis with insonation. This stability is associated with less disruption and greater induction of apoptosis in leukocytes after relatively high-pressure insonation in the range for diagnostic use.

Adult↗
PubMed2004

Long-term survival achieved by repeated resections of metachronous pulmonary and adrenal metastases of alpha-fetoprotein-producing gastric cancer: report of a case.

We report a case of long-term survival achieved by repeated resections of metastases from alpha-fetoprotein (AFP)-producing gastric cancer. A 59-year-old man initially underwent total gastrectomy with lymph node dissection and resection of the spleen and left adrenal gland, for an advanced AFP-producing gastric cancer. A solitary pulmonary metastasis was resected 2 years later, and then a right adrenal gland metastasis, an inferior vena cava thrombus, and another pulmonary metastasis were resected 6 months, 1 year, and 8 months after each other, respectively. Thus, the patient has survived for 7 years and no further evidence of disease was found at his last follow-up examination. To the best of our knowledge, this is the first case of AFP-producing gastric cancer resulting in metachronous solitary pulmonary and adrenal gland metastases, but not liver metastasis. We report this case to show that for selected cases, surgical resection of these metastases is feasible and may extend survival.

Adrenal Gland Neoplasms↗
PubMed2004

Prognosis and histologic features of small pulmonary adenocarcinoma based on serum carcinoembryonic antigen level and computed tomographic findings.

OBJECTIVES: In 2001, we proposed the criteria for combined evaluation of the serum carcinoembryonic antigen (CEA) level and the tumor shadow disappearance rate (TDR) to predict pathologic N0 (pN0) disease in pulmonary adenocarcinomas. The objective of the present study was to determine the prognosis and histologic features in small-sized pulmonary adenocarcinomas according to serum CEA level and TDR. METHODS: We reviewed clinical records of 189 consecutive patients with peripheral pulmonary adenocarcinoma 3.0 cm or smaller who underwent major lung resection and systematic lymph node dissection: 50 patients with TDR 0.8 or more and normal CEA level (group I) and 139 patients with TDR <0.8 and/or elevated CEA level (group II). Among them, we investigated histologic features of 177 adenocarcinomas according to serum CEA level and TDR. RESULTS: The 5-year survival rates were 95% for group I and 75% for group II (P = 0.002) and for pN0 patients, 97% in group I and 87% in group II (P = 0.04). In univariate analyses, TDR, preoperative serum CEA level, and the maximum tumor dimension on computed tomographic (CT) scan were significantly associated with prognosis. Multivariate analysis showed that only preoperative serum CEA level and TDR were significant independent prognostic factors, and the maximum tumor dimension was not significant. Group I patients developed no local recurrence, including lymph node metastases. In 25 group I adenocarcinomas 2.0 cm or smaller, no lymph node involvement, two lymphatic permeation, two vascular invasion, and one pleural involvement tumors were observed. These signs of local invasiveness were less frequent than the remaining adenocarcinomas. CT findings correlated well with histologic findings in small-sized adenocarcinomas. CONCLUSIONS: Combined evaluation of preoperative serum CEA level and TDR may enable us to identify minimally invasive adenocarcinomas with good prognosis. Candidates for limited lung resection without systematic lymph node dissection could be selected based on these findings.

Adenocarcinoma↗