Abstracts/Lung Cancer 12 (1995) 265-329

Additionally, no difference was found in the time to first recurrence between these groups, and the site of recurrence was independent of a negative preopexalive sce.n for that location. These data, using patient outcame as the basis of our conclusion, support a policy of reserving expensive preoperative metastatic evaluations only for those patients with clinical evidence of metsstatic disease.

Prediftkm of probability of pneumooectomy for lung caocer using Tc- 99m MAA perfusion lung imaging Chen C-Y, Kao C-H, Hsu N-Y, Chcn C-L, Hsu C-P, Wang P-Y Division of Thoracic Surgery, Deparbnent of Surgery. Taichung Veterans General Hospital, 160 Taichung Harbor Road, Taichung. Clin Nucl Med 1994,19:1094-7.

Pulmonary perfusion scintigraphy with Tc-99m MAA was performed on 182 patients, on whom either pneumonectomy or lobectomy was performed, because of primary nonsmallccll lung carcinoma. Among them, 76 underwent pncumoneetomy, and 106 underwent lobectomy. The mean value of the perfusion fraction (PF) of the affected lung of the patients undergoing pneurnonectomy ~88 32.3 * 13.6% (range, 4%-50%) and was less than that of the patients undergoing lobectomy, 43.5 f 4.5% (range, 27%-50%). The difference was statistically significant (t-test, t = 6.82; P < 0.001). Among the 28 patients whose PF of the affected lung was equal to or less than 30%, 26 underwent pncumonectomy and only 2 had a lobectomy. Among the I54 patients whose PF of the sffccted lung was more than 30%. 50 underwent pncumonectomy and 104 had a lobectomy. These result suggest that ‘30%’ can be a cutoff value (Yates correction X2 test, X’ = 33.09; P < 0.001).

Pmgnostic signifiiaoce of tissue polypeptidespecific antigen (‘I’PS) in patientswith advaoced non-small ceil lung cancer Van der Gaast A, Schoenmakers CHH, Kok TC, Blijcnberg BG, Hop WCJ, Splinter TAW. Deporbnent of Medical Oncology, Univ. Hospital Rotterdam- Dijkzigt, DrMolewaterplein 40, 3015 CD Rotterdam, Eur J Cancer Part A Gen Top 1994;30:1783-6.

In this study, we evaluated the prognostic value of the turnour marker, tissue polypeptidc-specific antigen (TPS), in 203 patients with non-small cell lung cancer (NSCLC), and related this to several other known prognostic factors. TPS was significantly correlated with lactate dchydrogcnasc (LDH), gamma- glutamyltmnspeptid and alkaline phosphatase, and the median level of TPS in patients with stage 4 disease was significantly higher as compared to stage 3A and 3B discaPc. In the univariate analysis, performance status, stage of disease, LDH, alkaline phosphatase, a histology of undiffmntiated large cell carcinoma and TPS all had a statistically signiticant ass&&ion with survival. Multivariate analysis showed that stage of disease, performance status, histology and TPS were the most important prognostic factors. TPS has prognostic significance for survival in patients with advanced NSCLC, independent from performance states and stage of disease.

ClinkA evaluation of serum tissue polypeptidespecitic antigen (Tps) in non-small cell lung cancer Pujol J-L, Cooper EH, Grenier J, Purvcs DA, Lehmann M, Ray P et al. Service des Maladies Respiratoires, Hopital Amnoud de C%lleneuw, 34059 Montpellier Cedex. Eur J Cancer Part A Gen Top 1994;30: 1768-74.

M3 is an cpitope of the tissue polypeptide antigen detectable in the serum by immunoradiometric assay. This cpitope is referred to as tissue polypeptide- specific antigen (TPS). We examined the pretreatment TPS level of 160 non- small cell lung cancer (NSCLC) patients and 71 patients who suffered from non-malignant pulmonary diseases. The upper limit of normal values was 140 U/ I. Using this cutoff, the sensitivity and specificity were 36 and 90%, respectively. The TPS was significantly higher in NSCLC patients with an advanced swe, B mediastinal lymph node involvement or a poor performance status. This level w.ss significantly higher in the group of patients for whom the disease proved to progress during chemotherapy. In univariate analysis, patients with a high TPS level proved to have a shorter survival than patients with a TPS % 140 U/l. In Cox’s model analysis, performance status, stegc of the disease and serum TPS were the only significant prognostic variables. The low sensitivity ofTPS precludes its use for diagnosis. However. the pretreatment TPS level adds information to the management of NSCLC inasmuch as it predicts a low sensitivity to chemotherapy and a poor prognosis.

‘llte clinical signifhoce serum N-POMC level in lung cancer patients Li L, Luo W, Lu Z. Peking Union Medical College Hosp., Beijing 100730. Chin J Oncol 1994;16:2914.

Serum N-POMC level of 103 cases of lung cancer were measured in our hospital. The results were as follows: The lung cancer group, 50.5%. of paticnst has an N-PONC level above the normal upper limit. The percentages of the N- POMC levels above the normal limit in lung cancers, such as: squamous-cell carcinoma, adenocarcinoma, SCLC and undifferentiated carcinoma were 52.2%, 50.0%. 47.3% and 57.1%, respectively. There was no statistically significant difference of N-POMC levels among these kinds of lung cancers. Eleven of 18 eases of SCLC patients in stage W or IV. and 3 of 9 cases of SCLC patients in stage m had N-POMC levels above the upper normal limit. Could serum N- POMC be one of the indexes for assisting the diagnosis and prognosis of lung cancer needs further investigation. Cases with carcinoid, thymoma and ncumtibmma had higher N-POMC levelstoo Six pateints had Cushing syndrome.

Surriv~rarly~sofuntrePted~tieotsnithnoa-sm~ kmgcancer Vrdoljak E, Mist K, Sapunar D, Rozga A, Mnrusic M. School ojMedicinc, Clinical Hospital, Split and Zagreb Untiersily. Split. Chest 1994;106:1797- 1800.

The survival rate analysis of I30 patients with non-small-cell lung cancer who did not receive any specific anticancer therapy showed no statistically significant differences in the survival rates behuan various TNM combinations classified into stage groups II, III& IIIb. and IV, as proposed by Mountain in 1989 and adopted by the American Joint Committa on Cancer. Following these findings, based on survival probabilities, two distinctive staging groups could be distinguished. The tirst stage group we.8 composed of only the Tl , ZNO, MO combination, and the second of all other TNM combinations. In a purely biologic sense of tomor growth, the lymph node involvement appeared to be the crucial factor determining the length of survival.

Endoscopic criteliaofearly squamous cell carcinoma oftbe bronchus Akaogi E, Ogawe I, Mitsui K, Onizuka M, Ishikawa S, Yamamoto T et al. Institute of Clinical Medicine, Universi~ of Tsuhba. Tsukuba 305. Cancer 1994,74:3113-7.

Baclrground. Early lung cancer, not extending beyond the bronchial cartilaginous layer without regional lymph node involvement is considered curable by endoseopic laser therapy or limited surgery. The endoscopic criteria for early squamous cell carcinoma ofthe bronchus, however, have not yet been determined. Me&o&. For 44 resected lesions of roentgenographically occult bronchogcnic squamous cell carcinomas, the relationship between cndoscopic findings and the degree of histologic extent of tumor was examined. ResuL. The lesions were divided into three types: polypoid or nodular (PN), flatly spreading (FS), and mixed. Thirty-three lesions arising from the central bronchus included 7,19, and 7 of the PN, FS, and mixed types, respectively. In the central lesions, the degree of transmural invasion and the greatest dimension correlated, but the degree of intramural invasion of PN-type lesions was higher then that of the FS type. The PN-type lesions smaller than 10 mm and the FS type smaller than 15 mm in greatest dimension were found within the cartilaginous layer without regional lymph node involvement. All lesions of the mixed type were larger than 20 mm. Three of the lesions larger than 20 mm had regional lymph node involvement. All 1 I lesions originating in the Peripheral bronchus were of the FS type, and a lesion of only 5 mm in greatest dimension had extracartilaginous invasion. Conclusions. The ezdoscopic criteria of early squamous cell carcinoma ofthe bronchus may be applied to central PN lesions smaller than IO mm and central FS lesions less than 15 mm in greatest dimension. Any lesions of mixed type should be excluded from the criteria.

Indium-lll pentetmotide in tbe diagnostic work-up of patients witb broncho&c caniooma Kirsch C-M, Wn Pawel J, Gmu I, Tats& K. Nukiearmedtzinische Klinik Kltiikwm Groshadem, D-81366 Munchen. Eur J Nucl Med 1994;21:1318-25

In a prospective study we examined 38 patients with primary bronchogenic carcinoma to validate the use of iridium-I I I pcntetreotide (IPT) as a diagnostic tool. Ofthese 38 patients, 25 had small ccl1 lung cancer (SCLC) end 13, non-small cell lung cancer (NSCLC). The aim of the tidy was to investigate whether (a)

Abstracts/Lung Cancer I2 (1995) 265-329

the disease can be reliably detected, (b) IPT sllows differentiation between SCLC and NSCLC and (c) IPT provides further information on mctaststic disease. AtIer giving their informed consent the patients were injected and imaged 4 and 24 h later using a planar whol&ody tcehniqw. In addition single-photon emission tomography of the thorax and, if necessary, other sress of the body wss performed at 24 h. In the 25 patients with SCLC 22 sites of primsly turnour were comctly identified (true-positive, TP); one wss falsenegative (FN) and two were true- negative (TN), the patients being in full remission. Metastascs were correctly identified in ten instances (lung, bone and brain), while the findings were FN in five cases. An additional six FN findings resulted in the sres of the upper abdomen due to the physiological uptake in the liver. spleen and kidneys. In the 13 patients with NSCLC, ten findings were TP and 3 FN with respect to the primary tumour. Two FNs were squamous cell carcinoma, and one, edcnocareinoma. Mcbxtsses were TP in nine csses and FN in one. We therefore conclude: (1) IPT is s highly sensitive method for the detection of primary bronchogcnic carcinoma, and in particular for SCLC, (2) different&ion between SCLC and NSCLC cannot be achieved and (3) the method is of limited use in the sesrch for metnstntic disessc. Compared with the conventional imaging modalities like X-my, CT and bone scintigrsphy, IPT provides only s small amount of additional diagnostic information.

‘l%erokofCTandMRIiostagingoftbemediaslinum Grover FL. Colorado Univ. Health Sciences Cti, Denver VA Medical Cenfer Derrwr CO. Ch&,1994:106:Supp1:391S-5S.

Lung Cancer Study Group (LCSG) Protocol 883, the comparative study of the results of magnetic resonance imaging (MRI) and eomputexized tomography (CT) for staging of tumor, nodal, and selected mctsststic sights in patients with surgically staged lung cancer wss activated in August 1988 but wea not completed because of termination of LCSG funding. A literature review wss therefore undertaken to determine the nsults ofother studies that were performed to evaluate the relative efficacy of MRI and CT in the staging of patients with lung center. Thcsc studies detmnined that CT and MRI are approximately equal in the stsging of N2 disease with s sensitivity of 70 to 90%, s specificity of 60 to 90%. snd sn accuracy of66 to 90% depending on the criteria used for determining positive nodes and the compulsiveness of surgical staging. Magnetic resonance imsging is probably better in the assessment of superior suleus tumors, tumors involving the aorta-pulmonary window, hilsr nodes, in assessing chest wall or diaphragmstic invasion, end in evaluating patients whose CT findings sre equivocal Computed tomography and MRI reveal adrenal abnormalities in 10 to 20% of patients but only one third of these have metsstsses. Mediastinoscopy has s sensitivity of 85 to 90%, II specificity of 100%. and sn accuracy of about 95% and is therefore the gold standard forN2 stsging. Ifthc CT examination rwcals no N2 discesc, one can proceed directly to thorscotomy with approximately s 15% chance of finding N2 discasc. It wss concluded that because CT is much chesper, it should therefore be used for the noninvasive stsging of patients with lung cancer unless the abovanoted special circumstsnccs sre present that have teen shown to favor MRI. Because of the limited accuracy of CT and MRI however, positive findings must be eonfirmed by biopsy specimens and psthologic study.

lEeearlydete&nofsecondphmaryhmgcancersbysputumimmuoo- staining To&man MS, Erozan YS, Gupts P, F’isntsdosi S, Mulshine JL, Ruckdeschel JC. JHSHPH, 61s N. War/c. Baltimo~ MD 21205-2179 Chest 1994$06:Suppl:385S- 90s.

Srudy objective: To determine whether monoclonal antibody (Mab) detection of tumor-associsted antigen expressed on sputum epithclird cells precedes clinical p~ntstion of second primary lung cancer. Design SeftingParticiponLs: Eleven oncology centers collaborate in the accrual of I ,ooO patients with stage I non- small celllungcanccr(NSCLC) whohsd undergone resection. ThcMsbscxamined in this study (624H12, 703D4) detect two promising oncofe.taVdifferentiation markers (ie, II difucosylatcd Lewis X and s 31-Kd glycoprolein antigen). Interventions: Induced sputum specimens sre evaluated for quality, then sre Papsnicolaou and immunostaincd by independent central laboratories at enrollment and annually thcresftcr. The predictive value of Mab markers is compared with routine morphologic shady for detection of second primary lung cancer during sn anticipated 3 years of accrual and I year of follow-up. Meosurcnrenr~ and resulti Five hundred eighty of an anticipated 1,000 patients have ban accrued on schedule. Patients are primarily white (88.6%), former

smokers (75.9%). men (55.6%), with s median age of 66.7, and joined the study at an 8~ragc of 3.7 years following resection of s stage I NSCLC (34.4% squamous, 43.6% adenocarcinoma). Central laboratories found less dysplasia end more unsstisfsctory specimens (27.3%) than do the accrual institution laboratories. Immunoslaining identifies more suspicious cells than does morphologic study. However, only two second primary lung cancers (eight total deaths) have occurred lo date. Conclusionx Halfway through the accrul, we describe the study design and preliminary observations. This study illustretes rations1 selection of carcinogenesis markers by linkage of marker expression on preneoplsstic specimens with subsequent expression on tumor tissue.

‘Ibe adverse effect of perioperative blood transfosioo ia lung cancer Piantadosi S, Moores DWO, MoKneally MF, Oncology Eiosfotisfics, 550 N Broadway. Baltimore. MD 21205. Chest 1994;106:Suppl:382S4S.

Perioperstivc blood trsnsfusion appears to increase the risk of recurrence end death in patients with surgically resected lung cancer. This finding is consistent with that in other cancers and several studies in lung cancer report similar risk elevations. WC have reanalyzed the Lung Cancer Study Group data relevant to this question, assessing the potential confounding effects of some prognostic factors not examined previously. The results are nearly identical lo those reported esrlier. suggesting that increased risk is sttributsblc lo blood transfusion and not to confounding by known prognostic factors.

pS3 Immunostaining positivity is associated with redoced survival and is imperfectly correlated with gene mutations in resected non-small cell long cancer: A preliminary report of LCSG 871 Carbone DP, Mitsudomi T, Chibs H, Piantsdosi S, Rusch V, Nowsk JA et al. VT Sarfhwes~em Med Ce 5323 Hany Hines, Do/Ins, TX 75235-8593. Chest 1994;106:Suppl:377S-81s.

WC investigated the correlation of ~53 abnormalities with survival in 85 patients with non-small cell lung cancer (NSCLC) who had undergone resection with curative intent ss part of Lung Cancer Study Group (LCSG) 871. Our previous studies showed that only s subset of ~53 mutations in lung csncers result in overexpression. In addition, protein overexpression has been described in the absence of mutation. Therefore, we determined both ~53 protein overexpression (by irnmunostsining) and ~53 and rss gene mutations (by single- strand conformation polymorphism end DNA sequencing) in this set of resected tumor specimens. Clinicsl follow-up data were available for 75 cases. Of the studied patients, 64% showed p53 overexpression and 51% had mutant p53 sequences; however. the concordance rate wss only 67%. There was s negative survival correlation with positive ~53 immunostsining (p=O.OS), but not with the presence of gene mutations (6.62) in this group of patients. Overexpression of p53 protein determined by immunostaining may contribute to adverse outcome due to the ability of ~53 to ect ss s dominant oncogene, or alternatively, overexpression msy reflect ongoing DNA damage in the tumor as B marker for B moreaggressive behavior. Whenadjusted for stage,sge,and gendcrby multivariate analysis, however, there wss no independent impact of ~53 overexpression on survival.

Role of mediastinal staging of long cancer Thomas PA Jr. Wesf Side Veterans Admin. Med. Ck, Chicago, IL. Chest 1994;106:Suppl:331S-3s.

The Lung Cancer Study Group (LCSG) assured objective surgicaVpsthologic staging of clinical trial patients by requiring histologic examination of lymph nodes from anatomically idcnlified specific mcdiestinal locations. Therefore, within the larger population of heterogeneous patients with lung cancer, subsets of more homogeneous patients were identified. The addition of medisstinal exploration and removal of lymph nodes to the intmoperstivc procedure did not increase patient morbidity or mortality. The clinical trials designed using surgical pathologic medisstinsl lymph node staging provided definitive answers to severs1 important questions relative to sdjuvant and neosdjuvant treatment of patients with non-small cell lung cancer. The LCSG recommended that objective histopsthologic medisstinal lymph node staging be acc+pted 8s the standard of csre for patients with lung csncer.