POS1196 SARS-CoV-2 VACCINE ACCEPTANCE AND ASSOCIATED PSYCHOLOGICAL FACTORS IN PATIENTS WITH RHEUMATIC AND MUSCULOSKELETAL DISEASES

Background

The mortality rate of coronavirus disease 2019 (COVID-19) in patients with rheumatic and musculoskeletal disease (RMD) is as high as approximately 10% [1]. Therefore, vaccination promotion is a critical issue. However, there are few reports on the psychological aspects of patient vaccine acceptance.

Objectives

To investigate the intention of patients with RMD to receive the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine and explore the psychological factors related to vaccine acceptance.

Methods

We conducted a questionnaire-based survey of 406 outpatients with RMD at Shiga General Hospital from July to October 2021. The questionnaire included the following sections: (1) vaccination status; (2) expectation of susceptibility to severe COVID-19; (3) expectation of vaccine efficacy; and (4) anxiety about the vaccine, which included concerns on I) the diminishing effect of the vaccine due to current treatment and II) the influence of vaccination on: i) primary disease status, ii) treatment, and iii) adverse reaction.

Results

There were 305 vaccinated and 101 unvaccinated individuals. Unvaccinated individuals were classified into the acceptance group (n=60) and hesitancy group (n=41) according to their vaccination status (Figure 1).

Figure 1.

SARS-CoV-2 vaccination status (n=406)

We compared the backgrounds and awareness of the patients on vaccination between the two groups. Univariate analysis did not show any difference in the backgrounds. The expectation of susceptibility to severe COVID-19 was similar in both groups. There were also no significant differences in the vaccine-related anxiety levels. However, the expectation of vaccine efficacy was higher in the acceptance group and significantly influenced vaccination intention as revealed by multivariate analyses (Table 1).

Table 1.

Awareness towards COVID-19 and SARS-CoV-2 vaccine associated with vaccination intention

Awareness towards COVID-19 and SARS-CoV-2 vaccineAcceptance(N=60)Hesitancy(N=41)UnivariateAnalysis§Multivariate Analysis||Median[IQR]Median[IQR]p-valuep-valueExpectation of susceptibility to severe COVID-19*2.0[1.0-3.0]2.0[1.5-2.5]0.84720.3440Expectation of vaccine efficacy†3.0[3.0-3.0]2.0[1.0-3.0]<0.0001¶<0.0001**Concerns about the diminishing effect of the vaccine due to current treatment‡2.0[1.0-3.0]3.0[2.0-3.0]0.04750.3600Concerns about the effect of vaccination on treatment‡3.0[1.0-3.0]3.0[2.0-4.0]0.01280.6232Concern about the effect of vaccination on primary disease status‡3.0[1.0-3.0]3.0[2.0-3.0]0.05760.7134Concern about the effect of vaccination on adverse reaction‡3.0[3.0-3.0]3.0[3.0-4.0]0.00930.8335

*0: Less likely to become severe~3: Very likely to become severe, †0: Not expected at all~4: Highly expected, ‡0: Not concerned at all ~4:Very concerned

§Pearson’s chi-square test or Wilcoxon test, ||Nominal logistic regression analysis, ¶ p<0.008 (after Bonferroni correction), ** p<0.05.

Conclusion

The perception of vaccine efficacy is strongly correlated with vaccine acceptance. In order to promote vaccination in patients with RMDs, this study suggests that emphasizing the efficacy of the vaccine may be more effective than alleviating anxiety about the adverse effects of the vaccine.

References

[1]Strangfeld, A. et al. Ann. Rheum. Dis. 2021; 80: 930–942.

Disclosure of Interests

Haruka Sugawara: None declared, Hiroshi Doi: None declared, Takeshi Iwasaki: None declared, Yoichi Nakayama: None declared, Yuri Nishida: None declared, Yoshie Gon: None declared, Masaki Kamakura: None declared, Kenshi Ohbori: None declared, Naoko Sakane: None declared, Naomi Nakamura: None declared, Takahiko Utsumi: None declared, Akio Morinobu Speakers bureau: Eli Lilly Japan K.K., Ono Pharmaceutical Co., Pfizer Inc., UCB Japan, AbbVie G.K., Asahi Kasei Pharma., and Chugai Pharmaceutical Co. Ltd., Grant/research support from: Eli Lilly Japan K.K., Ono Pharmaceutical Co., Pfizer Inc., UCB Japan, AbbVie G.K., Asahi Kasei Pharma., and Chugai Pharmaceutical Co. Ltd.

The Association of Vacuum-Assisted Closure Therapy with Dynamic Volume Change of a Muscle Flap Transposed in an Empyema Cavity for Chronic Empyema: A Case Report

A 62-year-old woman with a history of lung resection for lung cancer was admitted to our hospital due to cough, which became progressively more severe. She was diagnosed with chronic empyema with bronchopleural fistula (BPF) of the right upper bronchial stump. Although a pedicled muscle flap was transposed to the empyema cavity, the fistula remained. We used a vacuum-assisted closure system after open-window thoracotomy and observed the cavity reduction with expansion of the transposed muscle flap. We quantitatively evaluated the dynamics of the cavity change using a three-dimensional image analysis system. A reduction of the volume of the muscle flap by prolonged empyema and expansion of the muscle flap was observed immediately after vacuum-assisted management. However, expansion of the right residual lung was not recognized. Pedicled muscle flap transposition followed by vacuum-assisted management after open-window thoracotomy may be effective for treating chronic empyema caused by BPF.

Adenocarcinoma with fetal features invading the right superior sulcus treated with neoadjuvant chemoradiotherapy followed by complete video-assisted thoracoscopic right upper lobectomy: a case report

BACKGROUND

Fetal adenocarcinoma of the lung is a rare lung neoplasm that accounts for only 0.5% of all primary lung cancers. Because of its rarity, effective treatments for the management of the tumor are poorly understood. We herein report a case of adenocarcinoma with fetal features of the lung with invasion of the right superior sulcus that was treated with neoadjuvant chemoradiotherapy followed by surgical resection.

CASE PRESENTATION

A 54-year-old man was referred to a medical institution due to right inner forearm pain. On computed tomography of the chest, a 56-mm mass with invasion of right superior sulcus was discovered. Bronchoscopic biopsy revealed non-small cell lung carcinoma. We performed concurrent chemotherapy (2 cycles of cisplatin and vinorelbine) and thoracic radiation therapy (40 Gy in 20 fractions). As the result of extreme tumor reduction after neoadjuvant chemoradiotherapy, we could perform right upper lobectomy by complete video-assisted thoracoscopic surgery. Since no viable cancer cells were detected from the pathological examination of the resected tissue, the specimen obtained by bronchoscopic biopsy was reexamined by immunohistochemistry. The analysis supported a pathologic diagnosis of adenocarcinoma with fetal features.

CONCLUSIONS

We experienced a case of adenocarcinoma with fetal features of the lung in which the patient showed a complete response to neoadjuvant chemoradiotherapy. In addition, the tumor invading the right superior sulcus was completely resected by video-assisted thoracoscopic lobectomy. Neoadjuvant chemoradiotherapy followed by surgery may be also an effective treatment for advanced-stage high-grade fetal adenocarcinoma of the lung, similarly to other subtypes of advanced-stage primary lung cancer.

Programmed Death-ligand 1 Expression With Clone 22C3 in Non-small Cell Lung Cancer: A Single Institution Experience

Background:

In recent years, the anti-programmed cell death 1 (PD-1) drug pembrolizumab (Keytruda) was approved for treatment of unresectable advanced non-small cell lung cancer (NSCLC) as first- or second-line therapy depending on the clone 22C3-programmed death-ligand 1 (PD-L1) immunohistochemical expression score by the companion diagnostic assay. We herein evaluated 22C3-PD-L1 expression of NSCLC in a single institution experience and compared it with clinicopathologic features.

Materials and methods:

We assessed 22C3-PD-L1 expressions of 411 patients with NSCLC from our institution, including in past specimens. Programmed death-ligand 1 immunohistochemistry (IHC) testing was performed using the PD-L1 clone 22C3 pharmDx kit (Agilent Technologies/Dako, Carpinteria, CA, USA). Patients were separated into 3 groups with <1% (no expression), 1% to 49% (low expression), or ⩾50% (high expression) positive tumor cells.

Results:

In all, 137 patients (33%) did not express PD-L1, 155 (38%) showed low expression, and 119 (29%) demonstrated high expression. Archival samples showed lower PD-L1 expression than that of recent samples, and the ratios of no expression case significantly increased by using paraffin blocks embedded particularly in more than 4 years ago. Programmed death-ligand 1 positivity was significantly associated with male sex, smoking, higher tumor grade, squamous cell carcinoma in histologic type, wild-type EGFR, and ALK rearrangement positive.

Conclusions:

The rate of 22C3-PD-L1 expression of NSCLC detected in this study was similar to the frequencies of the previous reports, although the ratio of expression case decreased when using old paraffin blocks.

A Phase II Study of Partial and Subtotal Thymectomy for Thymoma (JART02)

BACKGROUND

We believe the merit of preservation of a part of the thymus following surgery for thymoma. We evaluated the efficacy of partial or subtotal thymectomy for early-stage thymoma in the prospective study.

METHODS

The Japanese Association for Research on the Thymus conducted a multiple institutional study of thymectomy for thymoma localized in the thymus without total thymectomy. Patients without autoimmune disease who had an anterior mediastinal tumor that had been clinically diagnosed as an early-stage thymoma were enrolled in the study. Patients who were positive for anti-acetylcholine receptor antibodies were excluded.

RESULTS

Sixty-three patients were enrolled preoperatively; 27 patients were judged as being inappropriate based on the other thymic pathologies or tumor invasion. The remaining 36 cases were diagnosed as early-staged thymoma and analyzed. The mean age of the patients was 61 years. The mean maximal tumor diameter in the resected specimens was 3.6 cm. The most common pathological types of thymoma were AB (n = 10) and B1 (n = 10). The Masaoka stages were classified as stage I (n = 22) and II (n = 14). The mean observation period was 63 months. Two patients died due to respiratory dysfunction, which was not related to thymoma. One hundred percent of the patients remained recurrence-free.

CONCLUSIONS

This prospective study suggested the efficacy of partial or subtotal thymectomy for early-stage thymoma in patients without any apparent evidence of autoimmune disease. We can preserve a part of the thymus even following surgery for thymoma to prepare the possible second malignancies or diseases in future.

The Outcomes of a Limited Resection for Non-Small Cell Lung Cancer Based on Differences in Pathology

OBJECTIVE

A precise preoperative diagnosis of in situ or minimally invasive carcinoma may identify patients who can be treated by limited resection. Although some clinical trials of limited resection for lung cancer have started, it will take a long time before the results will be published. We have already reported a large-scale study of limited resection. We herein report the data for a subclass analysis according to differences in pathology.

METHODS

Data from multiple institutions were collected on 1710 patients who had undergone limited resection (segmentectomy or wedge resection) for cT1N0M0 non-small cell carcinoma. The disease-free survival (DFS) and recurrence-free proportion (RFP) were analyzed. Small cell carcinomas and carcinoid tumors were excluded from this analysis. Adenocarcinomas were sub-classified into four groups using two factors, the ratio of consolidation to the tumor diameter (C/T) and the tumor diameter alone.

RESULTS

The median patient age was 64 (20-75) years old. The mean maximal diameter of the tumors was 1.5 ± 0.5 cm. The DFS and RFP at 5 years based on the pathology were 92.2 and 94.7 % in adenocarcinoma (n = 1575), 76.3 and 82.4 % in squamous cell carcinoma (SqCC) (n = 100), and 73.6 and 75.9 % in patients with other tumors (n = 35). The prognosis of adenocarcinoma in both groups A (C/T ≤0.25 and tumor diameter ≤2.0 cm) and B (C/T ≤0.25 and tumor diameter >2.0 cm) was good. In SqCC, only segmentectomy was a favorable prognostic factor. In the groups with other pathologies, large cell carcinomas were worse in prognosis (the both DFS and RFP: 46.3 %).

CONCLUSION

Knowing the pathological diagnosis is important to determine the indications for limited resection. Measurement of the tumor diameter and C/T was useful to determine the indications for limited resection for adenocarcinoma. Limited resection for adenocarcinomas is similar with a larger resection, while the technique should be performed with caution in squamous cell carcinoma and other pathologies.

Differences in subtype distribution between screen-detected and symptomatic invasive breast cancer and their impact on survival

PURPOSE

Stage shift is considered a major reason for more favorable outcomes in patients with screen-detected breast cancer. However, even after adjusting for clinical stage, unresolved issues concerning the reasons for a survival benefit associated with screening programs remain. This study aims to evaluate differences in subtype distribution and outcomes among patients with screen-detected and symptomatic invasive breast cancer and assess whether variations in subtype distribution could explain differences in prognosis.

METHODS

Survival analysis was performed to estimate the likelihood of distant recurrence and death in 1132 patients. Subtypes were defined as luminal A [estrogen receptor (ER)+ and/or progesterone receptor (PR)+, human epidermal growth factor receptor 2 (HER2)-, and Ki67 low], luminal B (HER2-) (ER+ and/or PR+, HER2-, and Ki67 high), luminal B (HER2+) (ER+ and/or PR+ and HER2+), HER2 overexpressing (ER-, PR-, and HER2+), and triple negative (ER-, PR-, and HER2-).

RESULTS

Screen-detected cancers had favorable clinicopathological characteristics, such as smaller tumor size and a lower frequency of lymph node involvement. Women with screen-detected cancers had a survival advantage. Subtype distribution differed significantly among women with screen-detected and symptomatic cancer. Screen-detected cancers were more likely to be luminal A and less likely to be HER2 overexpressing or triple negative cancer compared with symptomatic cancers (luminal A 61.3 vs. 44.2%, HER2 overexpressing 4.0 vs. 8.0%, triple negative 8.0 vs. 15.9%). Node status, mode of detection, and subtype were independent prognostic factors in the multivariate analysis.

CONCLUSIONS

Differences in subtype distribution between screen-detected and symptomatic cancer could partially explain differences in outcomes.

A Case of Solitary Well-Differentiated Papillary Mesothelioma with Invasive Foci in the Pleura

Well-differentiated papillary mesothelioma (WDPM) is a rare, distinct tumor consisting of mesothelial cells with a papillary architecture, bland cytological features, and a tendency toward superficial spread without invasion. Rare cases with superficial invasion are termed WDPM with invasive foci. We report a case of solitary WDPM with invasive foci in the pleura. A 61-year-old woman presented with a lung adenocarcinoma. A small papillary lesion measuring 29 × 10 × 8 mm was incidentally found in the parietal pleura during a lobectomy for the lung adenocarcinoma. The fibrovascular core of the small papillary lesion was surrounded by a single layer of cuboidal cells with mild to moderate atypia and large nucleoli. Atypical mesothelial cells focally invaded the submesothelial layer. The cells of the papillary lesion were positive for cytokeratins and mesothelial markers. The Ki67 index was <1 %. The lesion did not show p16 loss on fluorescence in situ hybridization. We could not detect atypical mesothelial cells in the specimen from an extrapleural pneumonectomy. WDPM with invasive foci is prone to multifocality; however, our case represents a solitary case in the pleura.

A case of long-term survival after multimodal local treatments of intramedullary spinal cord metastasis of squamous cell lung cancer

Intramedullary spinal cord metastasis of non-small cell lung cancer is rare, and it has a short prognosis. We report a 53-year-old man diagnosed with cT4N0M0, stage IIIA squamous cell lung cancer. Ten months after left pneumonectomy (pT4N0M0), an intramedullary spinal cord tumor developed at the axis level. The intramedullary spinal cord tumor was resected, and he was diagnosed with metastatic squamous cell lung cancer. Radiotherapies and another tumor resection were conducted, as he had a good performance status and the discrete lesion was associated with the risk of brain stem compression. Multimodal local treatments for intramedullary spinal cord metastasis caused the tumor to shrink, and he lived for 25 months after the spinal metastasis occurred.

Early and late recurrence after intentional limited resection for cT1aN0M0, non-small cell lung cancer: from a multi-institutional, retrospective analysis in Japan

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.

Primary Marginal Zone Lymphoma in the Posterior Mediastinum with Pleural Involvement

We herein report a case of primary marginal zone lymphoma (MZL) of the posterior mediastinum in an 84-year-old woman. Computed tomography of the chest showed a posterior mediastinal mass in the right thoracic paravertebral region with right pleural effusion. Pathological findings of a surgical biopsy from the posterior mediastinum, along with immunohistochemical and flow cytometric results, indicated MZL. The patient was treated with chemotherapy and radiation therapy for the mediastinal lesion and achieved complete remission. A relapse occurred 3 months after the initial treatment regimen. However, a second relapse has not occurred more than 2 years after second-line chemotherapy. This is the first case of MZL originating in the posterior mediastinum.

Molecular analysis of human papillomavirus in never-smokers with non-small cell lung cancer

The causes of lung cancer in never-smokers remain unclear. The potential contribution of human papillomavirus (HPV) to the carcinogenesis of non-small cell lung cancer (NSCLC) has been reported. In 2008, a prospective registry of never-smokers with NSCLC was established at the Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan. Never-smokers with NSCLC were consecutively enrolled onto the registry. Of these patients, 114 with large tumor specimens, the majority of which were surgical tissues, were selected. In total, 23 of the most clinically relevant HPV types were assayed using polymerase chain reaction amplification of the viral genome. Following exclusion of samples with suboptimal quality, DNA was extracted from 96 formalin-fixed paraffin-embedded samples. These 96 cases consisted of 82 females (85.4%) and 14 males (14.6%), with a median age of 67 years (range, 29-83). Almost all cases (93.8%) were of the adenocarcinoma histological subtype. Despite confirmation of the quality and amount of DNA, HPV type 6 was detected in only one case (1.1%). Furthermore, no other samples examined were positive for any other HPV types. The results therefore suggest that HPV does not play a major role as the driving oncogenic event in never-smokers with NSCLC.

Survival of 1737 lobectomy-tolerable patients who underwent limited resection for cStage IA non-small-cell lung cancer

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.

Assessment of human papilloma virus in non-small cell lung cancer in never-smokers: A study from a prospective registry of never-smokers

e18126

Background: Driver mutations have been identified in most non-small cell lung cancers (NSCLC) from never-smokers. However, a small percentage of the tumors still have no its mutations detected. Human papillomavirus (HPV) has been hypothesized to contribute to lung carcinogenesis in East Asia. Methods: We started a prospective registry of never-smokers with NSCLC at the Kinki-chuo Chest Medical Center, Japan, in 2008. We consecutively enrolled all the never-smokers after obtaining written informed consent. Among these, we selected the 114 patients treated with surgery to obtain a large amount of DNA. After exclusion of samples with suboptimal quality, DNA was extracted from 93 formalin-fixed paraffin-embedded surgical tissues. HPV genotyping was performed using a PCR-based microarray system for detecting 23 HPV types, including high-risk (HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68) and low-risk or risk-unknown types (HPV types 6, 11, 30, 34, 40, 42, 53, 54, 61, and 66). Epidermal growth factor receptor (EGFR) and KRAS mutations were examined with real time PCR (genotyping), and EML4-ALK rearrangements were detected using immunohistochemical staining and fluorescence in-situ hybridization. Results: There were 80 female (86.0%) and 13 male patients (14.0%), with a median age of 67 years (range 29-83). Almost all cases were of the adenocarcinoma histological subtype (92.5%). Molecular analysis of these 93 patients detected 59 EGFR mutations (63.4%), 5 K-ras mutations ( 5.4% ) and 4 EML4-ALK rearrangements (4.3%). These abnormalities were mutually exclusive except for one case who had both EGFR and KRAS mutations. HPV 6 was detected in only one case (1.1%), a 49-year-old female who had an EGFR mutation with wild type KRAS and ALK. No others examined were positive for any HPV type. Conclusions: The three driver mutations accounted for 72.0% of NSCLC in never-smokers. Although a low-risk HPV type was evident in one case, no high-risk HPV types were detected in the tumors with or without the mutations. Our results suggest that HPV does not play a major role as the driving oncogenic event in adenocarcinoma in never-smokers in Osaka, the central area of Japan.

Lymphatic and venous malformation or "lymphangiohemangioma" of the anterior mediastinum: case report and literature review

Lymphatic and venous malformations (LVM) are tumor-like lesions combining dysplastic lymphatic and venous vessel structures. They are rarely found in the mediastinum. We present a case of mediastinal LVM, with review of the literature. An asymptomatic 60-yearold man presented for evaluation of an anterior mediastinal mass. On chest computed tomography (CT), the mass demonstrated contrast enhancement and its 7-mm vein draining directly into the left brachiocephalic vein. The tumor was resected completely using video-assisted thoracoscopic surgery. The surgical specimen revealed combined features of venous and lymphatic dysplasia, and was diagnosed it as LVM, so-called mediastinal lymphangiohemangioma. Management plans based on precise imaging studies using magnetic resonance imaging and multi-detector-row CT phlebography could be helpful in guiding both preoperative diagnosis and subsequent treatment decisions for mediastinal LVM.

[Treatment strategy for thymoma and thymic carcinoma]

Thymoma and thymic carcinoma are neoplasms originating from the epithelial cells of the thymus. Although these tumors should be treated according to the pathological diagnosis and the stage, they have distinct characteristics in the clinical behaviors, and therefore, should be treated separately. The standard treatment strategy has not been established because of the rarity of these tumors, but the recent accumulation of experiences provided some insights into therapeutic method for these tumors. In thymoma, Masaoka staging and completeness of surgical resection are important factors to determine the therapeutic method. Stage I and II thymomas are often good candidates for less invasive approach by endoscopic surgery. Highly invasive stage III thymoma, especially with involvement of the great vessel, is supposed to be treated with preoperative chemotherapy. Postoperative adjuvant therapy after complete resection has not been shown to have significant effect. Stage IVA thymoma patients with pleural dissemination sometimes achieve long-term survival after resection, and even subtotal resection has some value. In thymic carcinomas, patients often appear with advanced stage, and multimodality treatment is more frequently recommended than thymomas. Histological grade of aggressiveness is also an important factor for prognosis. Further study is still required for establishment of the universal approach to these tumors including TNM classification.

Clinical outcome of resected solid-type small-sized c-stage IA non-small cell lung cancer

BACKGROUND

The chances of pulmonary resection for small-sized lung cancer have increased because of the development of thin-slice computed tomography (CT). Though sublobar resection could be indicated for ground glass opacity (GGO)-dominant adenocarcinoma with low-grade behaviour, the malignant potential of solid-type, small-sized lung cancer has not been sufficiently assessed. We aimed to address the clinical outcomes of resected solid-type c-stage IA non-small cell lung cancer (NSCLC) smaller than 2 cm.

METHODS

A retrospective observational study involving 118 patients who had undergone a complete resection for lung cancer smaller than 2 cm with solid component more than 50% on CT was conducted, and their postoperative survival and recurrence pattern were analysed.

RESULTS

Thirty-five patients with solid component-dominant lesion (SCDL) and 83 patients with pure solid lesion (PSL) without GGO were enrolled. Lymph node involvement was found in 15 patients with PSL (18%). The 5-year disease-free survival (DFS) was 100% in SDCL patients and 83% in PSL patients. Multivariate analysis of PSL patients showed that lymph node metastasis and pleural invasion were independent negative prognostic predictors. The 5-year DFS was 88%, 80% and 46% in p-N0, p-N1 and p-N2 patients, respectively. The 5-year DFS was 33% for patients with pleural invasion, which was significantly worse than that for patients without pleural involvement. Postoperative recurrence was mainly observed as intrathoracic lesions within 3 years.

CONCLUSIONS

A proportion of solid-type NSCLC has malignant potential, even for tumours smaller than 2 cm. Periodic intrathoracic evaluation is required following complete resection.

Applicability of lectin histochemistry in a test system with in ovo treatment for detecting androgenic and antiandrogenic effects of chemicals in Japanese quail (Coturnix japonica)

The aim of the current study was to examine whether analysis of the appearance of specific lectin-positive substances in the quail embryonic cloacal gland would be useful for evaluating the androgenic and antiandrogenic effects of chemicals. Fertilized Japanese quail eggs were injected with 0 to 75 µg of cyproterone acetate (CA), an antiandrogenic compound, on d 12 of incubation (d 12), followed by injection of 0 to 300 µg of testosterone propionate (TP) on d 13. Experimental groups consisted of a control group (corn oil injections on d 12 and 13), a TP-L group [corn oil and a low dose (L; 30 µg) of TP], a TP-H group [corn oil and a high dose (H; 300 µg) of TP], a CA-L + TP-H group [a low dose (L;7.5 µg) of CA + TP-H], and a CA-H + TP-H group [a high dose (H; 75 µg) of CA + TP-H]. The cloacal tissues were collected on d 16, processed into paraffin sections, and stained using 14 different biotinylated lectins. The Vicia villosa (VVA) lectin most strongly stained the developing cloacal glandular cells in TP-H. Western blotting analysis showed 1 VVA-positive band of approximately 75 kDa. The ratio of VVA-positive areas per unit square examined microscopically by image analysis was significantly greater in the TP-H group than in the control group in both males and females. The ratio was significantly decreased in the CA-L + TP-H and CA-H + TP-H groups compared with the TP-H group in both males and females. Furthermore, the ratio was smaller in females than in males within a TP-L or TP-H treatment group. These results suggest that lectin histochemistry on quail embryonic cloaca using VVA is useful for evaluating the androgenic and antiandrogenic effects of chemical compounds.

Radiation-induced osteosarcoma 17 years after mediastinal irradiation following surgical removal of thymoma

Radiation-induced osteosarcoma is a rare complication after irradiation of primary malignancies. In the chest wall, it is usually secondary to radiotherapy for breast cancer or lymphoma. We report a rare case of radiation-induced osteosarcoma of the sternum after mediastinal irradiation of a thymoma. A 49-year-old woman presented with a sternal tumor 17 years after surgery plus mediastinal irradiation (50 Gy) for a stage III thymoma. On biopsy, this second tumor was diagnosed as a radiation-induced osteosarcoma. Systemic survey revealed additional metastatic spread to vertebrae and pelvis. Despite intensive combination chemotherapy that initially stabilized her disease, the patient died 2 years after the diagnosis was made. Because thymoma patients receiving mediastinal irradiation are thus at additional risk of radiation-induced secondary malignancy, long-term follow-up is advisable.

Abstract P5-14-01: The Influence on Upper Limb Function after Sentinel Lymph Node Biopsy or Axillary Lymph Node Dissection

Background

Sentinel lymph node biopsy (SLNB) is accepted as a method in patients with clinically negative axillary lymph nodes because it was assumed to be associated with improvement of upper limb morbidity. The purpose of this study was to investigate that SLNB reduces upper limb morbidity of patients with breast cancer compared with axillary lymph node dissection (ALND). Methods

The study comprised 362 patients with breast cancer who underwent measuring the upper limb mobility before and after surgery (at discharge, 1 month and 3 months after surgery). 241 patients underwent SLNB, 121 patients underwent ALND. In the SLNB group, 148 patients (48.1%) underwent breast conserving surgery (BCS), 67 patients (18.5%) underwent mastectomy. In the ALND group, 68 patients (18.8%) underwent BCS, 53 patients (14.6%) underwent mastectomy. Upper limb mobility was measured by the difference of the angle of the flexion and the angle of abduction between before and after surgery. The recovery defined that the difference of the angle between before and after surgery, is within 10 degree. The recovery rate was investigated by Kaplan-Meier method, and comparisons were evaluated using the log-rank test. Results

The recovery rate of patients in the SLNB group was 85% in measuring flexion, 90% in measuring abduction 3 month after surgery. The recovery rate of patients in the ALND group was 52% in measuring flexion, 58% in measuring abduction. The recovery rate of upper limb function increase by SLNB than by ALND (P&lt;0.001).’

Conclusions

SLNB reduces upper limb morbidity of patients with breast cancer compared with ALND. SLNB can improve activity of daily life (ADL) by improving of the upper limb function.

Bombyx mori Ras proteins BmRas1, BmRas2 and BmRas3 are neither farnesylated nor palmitoylated but are geranylgeranylated

The lipid modifications which occur on Bombyx mori Ras proteins BmRas1, BmRas2 and BmRas3 were studied by metabolic labelling in an insect cell-free protein synthesis system and in a baculovirus expression system, using specific inhibitors of protein prenylation and protein palmitoylation. In addition, the subcellular localization of BmRas proteins was examined using EGFP fusion proteins of constitutively active forms of BmRas proteins transiently expressed in Sf9 cells. As a result, it was revealed that the three B. mori Ras proteins BmRas1, BmRas2 and BmRas3 are neither farnesylated nor palmitoylated but are geranylgeranylated for localization to the plasma membrane of insect cells. Thus, the mechanism of membrane binding of insect Ras proteins is quite different from that reported for mammalian Ras proteins.

Recovery of the Upper Limb Function after Sentinel Lymph Node Biopsy or Axillary Dissection

Introduction:Sentinel lymph node biopsy (SLNB) is widely accepted as an excellent method in the management of early breast cancer in patients with clinically negative axillary lymph nodes. The aim of this study was to evaluate the relationship between the type of breast cancer surgery and early postoperative arm mobility.Materials and methods:The study group consisted of 290 consecutive patients aged 30 to 86 years (median age 58) with breast cancer, operated upon in the Department of Breast Surgery and evaluated in Department of Rehabilitation Medicine afterward, between February 2005 and December 2008. Out of the 290 patients, 126 (43.4% - group 1) underwent breast conserving therapy with SLNB, 65 (22.4% - group 2) simple mastectomy with SLNB, 41 (14.1% - group 3) breast conserving therapy with axillary lymph node dissection (ALND) and 58 (20% - group 4) modified radical mastectomy. Shoulder mobility was evaluated after 1month and after 3 months.Results:After 1 month, patients in the ALND group (group 3 and 4) had more limitations in shoulder mobility than patients in the SLNB group (group1 and 2).After 3 months, shoulder mobility was not different between the ALND group (n=52) and the SLNB group (n=32) (shoulder flexion: 161.6±22.5 degree vs. 167.8±19.5 degree, abduction: 165.2±27.5 degree vs. 164.4±28.9 degree, respectively).Conclusion:In terms of upper limb functional status, the benefits of SLNB over ALND was observed at the early postoperative time. However, long-term effects have to be confirmed by further, larger series.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3118.

Expression Levels of Enzymes Related to In Situ Estrogen Synthesis and Clinicopathological Parameters in Breast Cancer Patients

Background: Local estrogen synthesis may play an important role of progression of breast cancer with hormone receptors. Local progression of breast cancer may depend on high concentration of estrogens and estrogen receptor status. To clarify correlation between expression levels of enzymes in breast cancer and clinicopathological parameters, we analyzed expression of steroid sulfatase(STS), estrogen sulfatase(EST), 17b-hydroxyl steroid dehydrogenase type I & II(17b-HSDI & II) and aromatase. In addition, mRNA expression of estrogens receptor alpha(ERa), estrogen receptor beta(ERb), cycline D1 and erbB2 were measured. Material and Methods: The mRNA expression levels of genes in 196 breast cancer tissues removed from surgery were assayed by RT-PCR. Results: The level of STS were significantly higher in patients with clinical stage. STS expressed none in stage 0 or I, 0.011 in stage II, and 0.013 amol/1 amol b-actin in stage 3 or 4. In addition, EST expressed 58.5 amol/1 amol b-actin in stage 2 and 36.8 in stage 3 or 4, otherwise, the expression level of EST in stage 0 or 1 revealed 15.3 amol/1 amol b-actin. There were no correlation between clinical stage and aromatase expression. Expression levels of ERa and cyclineD1 significantly correlated with protein levels of ER, and there were significant correlation between erbB2 expression and prognosis of patients. Conclusion: Up-regulation of STS play an important role in tumor progression of breast cancer.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4155.

Optimal sampling methods for margin cytology examination following lung excision

Local recurrence of the tumor after lung excision often occurs in cases with positive cytology results at the surgical stump. Some reports have described the efficacy of margin cytology examinations with various sampling procedures, though an optimum method has not been established. In the period between 2005 and 2008, 58 patients underwent a lung excision followed by a margin cytology examination at our hospital, of whom 49 were finally diagnosed with malignancy. Cytology samples were obtained by scratching the staple lines of both resected and residual lungs, and collecting lavage from washed stapler cartridges used in the procedure, with the results compared. Of the 49 cases with malignancy, 44 underwent both sampling techniques, of which four had positive results, three detected in lavage samples and one by the scratching method. Since neither technique detected all positive cases, it is recommended that samples be obtained using both techniques to avoid missing malignancy.

Castleman's disease arising from an intrapulmonary lymph node

A 23-year-old woman was admitted to our hospital because of an intrapulmonary mass that had been observed for 7 years. Chest computed tomography revealed a 3.5-cm well-defined mass with enhancement in the left lower lobe. During the 7 years of observation, she had been asymptomatic and the tumor size was unchanged. She underwent surgical resection for diagnosis and treatment. Histological examination revealed Castleman's disease of the hyaline vascular type. We present this rare case of solitary Castleman's disease arising from an intrapulmonary lymph node.

Successful factor XIII administration for persistent chylothorax after lung transplantation for lymphangioleiomyomatosis

Lung transplantation has emerged as a viable treatment option for patients with end-stage lymphangioleiomyomatosis (LAM), and therapeutic outcome results reported thus far have been satisfactory. However, persisting chylothorax after transplantation for LAM remains a challenging problem, and the optimal management has not been decided. We present the case with persistent chylothorax after lung transplantation for LAM, in which the intravenous administration of a tissue repair factor (human factor XIII) resulted in complete resolution of chylous effusion without performing additional invasive treatments, leading to a successful transplant outcome.