Survival Prognostic Value of Morphological and Metabolic variables in Patients with Stage I and II Non-Small Cell Lung Cancer

BACKGROUND

The prognosis of patients with non-small cell lung cancer (NSCLC) is important, as patients with resectable disease and poor prognostic variables might benefit from neoadjuvant therapy. The goal of this study is to evaluate SUVmax, SUVmax ratio, CT volume (CTvol), metabolic tumour volume (MTV) and total lesion glycolisis (TLG) as survival prognostic markers. In addition, we defined two variables; MTV x SUVmax (MTVmax) and CTvol x SUVmax (CTvolmax) and assessed whether they can be used as prognostic markers.

METHODS

Patients with stage I-II NSCLC who underwent 18 F FDG PET/CT and surgery were evaluated. Cox proportional-hazard model was used to determine the association between variables and survival. Similar analysis was performed in cases with no lymph node (LN) involvement.

RESULTS

One hundred and eighty-one patients were included (at the end of the study, 140 patients were alive). SUVmax with a cut-off value of 8.2 was significant survival prognostic factor regardless of LN involvement (P = 0.012). In cases with no LN involvement, SUVmax and CTvol (≥7.1 ml) were significant survival prognostic factors with P = 0.004 and 0.03, respectively.

CONCLUSIONS

SUVmax may be a useful prognostic variable in stage I-II NSCLC while morphologic tumour volume might be useful in cases with no lymph node involvement.

KEY POINTS

• Identifying variables that predict the prognosis of patients with NSCLC is important. • SUVmax in primary lung tumour is a useful independent prognostic variable. • (CTvol) is an independent prognostic variable if no lymph nodes are involved.

Harnessing soluble NK cell killer receptors for the generation of novel cancer immune therapy

The natural cytotoxic receptors (NCRs) are a unique set of activating proteins expressed mainly on the surface of natural killer (NK) cells. The NCRs, which include three members; NKp46, NKp44 and NKp30, are critically involved in NK cytotoxicity against different targets, including a wide range of tumor cells derived from various origins. Even though the tumor ligands of the NCRs have not been identified yet, the selective manner by which these receptors target tumor cells may provide an excellent basis for the development of novel anti-tumor therapies. To test the potential use of the NCRs as anti-tumor agents, we generated soluble NCR-Ig fusion proteins in which the constant region of human IgG1 was fused to the extracellular portion of the receptor. We demonstrate, using two different human prostate cancer cell lines, that treatment with NKp30-Ig, dramatically inhibits tumor growth in vivo. Activated macrophages were shown to mediate an ADCC response against the NKp30-Ig coated prostate cell lines. Finally, the Ig fusion proteins were also demonstrated to discriminate between benign prostate hyperplasia and prostate cancer. This may provide a novel diagnostic modality in the difficult task of differentiating between these highly common pathological conditions.

Haloperidol-induced neurotoxicity--possible implications for tardive dyskinesia

Tardive dyskinesia (TD) is one of the major side effects of long term neuroleptic treatment. The pathophysiology of this disabling and commonly irreversible movement disorder is still obscure. The traditional concept of supersensitivity of striatal dopamine receptors as the mechanism involved in the development of TD is not satisfying, and current studies have focused on the role of neuroleptic-induced neuronal toxicity in the development of TD. We performed a series of experiments to gain a better understanding on the mechanisms involved in induction of TD. We have evaluated the direct neurotoxic effect of haloperidol (HP), a widely--used neuroleptic drug, and its three metabolites, in mouse neuronal cultures and in PC-12 cells. We found that the features of HP-induced cell death were apoptotic rather than necrotic, as indicated by different DNA-staining methods and specific caspases inhibitors. Moreover, cotreatment with antioxidants such as vitamin E and N-acetylcysteine (NAC) significantly protected the cultures. Further studies on the mechanisms underlying HP-induced toxicity may lead to the development of new neuroprotective therapeutic strategies.

[Video-assisted thoracic surgery--experience with 586 patients]

Recent advances in optics, video systems and endoscopic operating instruments have led to increasing application of thoracoscopic surgery, as it has become easier to perform and more accurate. We performed 586 video-assisted thoracic surgical procedures for diagnosis and treatment (May 1992-Dec. 1998) 127 were for diagnostic thoracoscopy and 79 for pleurodesis. 380 cases of operative thoracoscopy included pulmonary wedge resection (for interstitial lung disease, benign and malignant pulmonary tumors and pulmonary metastases) bullectomy, management of empyema, pleural tumor biopsy, thoracic sympathectomy, pericardial window formation, thoracic spinal procedures and resection of posterior mediastinal cysts. Recently we have had good experience in evacuating blood and blood clots from the thorax which accumulated after cardiac and thoracic surgery. Patients were placed in the lateral thoracotomy position and were ventilated with a double-lumen endotracheal tube, enabling collapse of the operated lung. The operating approach was through 1-3 thoracic ports. Mean operation time was 55 minutes, chest-tubes remained for 2.2 days (mean) and mean hospitalization was 3.3 days. There were no wound infections or significant postoperative complications. 5 patients had air leaks longer than 7 days; none required further surgical intervention. There was intercostal neuralgia and Horner's syndrome after thoracic sympathectomy (1 each) In cases in-which localizing the parenchymal lesion was difficult, the lung was palpated directly by inserting a finger through a small incision or a mini-thoracotomy. Conversion to thoracotomy was performed when primary malignancy of lung was diagnosed by frozen section. Only 2 patients had thoracotomy for uncontrolled bleeding. Thoracoscopy is a minimally invasive surgical technique with very low morbidity and high diagnostic accuracy. Postoperative recovery is brief and uneventful.

[Videothorascopic sympathectomy (VATS) for palmar hyperhidriosis:summary of a clinical trial and surgical results]

Palmar hyperhidriosis is not a life-threatening disease but leads to loss in the quality of life. Conservative treatment is ineffective and major surgery involves perioperative complications and esthetic impairment. From 1992 to 1998 we treated 156 patients with palmar hyperhidriosis using a single port, drainless videothoracoscopic procedure with almost no complications.