410 Abstracts/Lung Cancer 10 (1994) 395-430

levels havesignificantlyshortersurvival timea; (4)apositivecorrelatioo between pretreatment NSE and NCAM levels was found (n = 221, r = 0.60); and (5) a correlation between serum marker levels aod clinical status was found in follow-up studies of 19 patients. Conclusions. From these data, ir IS concluded that NCAM is. along with NSE. a pnlentlal Nmor marker for SCLC.

Cardiopulmonary Function after pulmonary lohectomy in patients with lung cancer Nisbimura H, Haniuda M. Morimoto M. Kubo K. Depunmenr of Surgery. Shitrrhu Universiv School of Med., 3-I-l Rcahi, Matswnoto 3!=w. ANI Thorac surg 1993% 1477-84.

The. effects of pulmonary lobectomy on cardiopulmonary function were investigated in 9 patients with lung cancer. Hemodynamic studies at restandduringexercisewerepertormedbeforeand4 to6moothsafter the operation. Differences in hemodynamics between before and after operation were observed with respect to heart rate, pulmonary artenal pressure, pulmonary vascular resistance index, and stroke volume index. Heart rate, pulmonary arterial pressure, and pulmonary vascular resistance index were significantly increased after operation, whereas stroke volume Index was significantly decreased. It is thought that cardiac index was preserved by the increase in heart rate despite a deccn;tse in stroke volume index associated with thedecreased pulmonary vascular bed atier the operation. When driving pressure and cardiac mdex were studied after operatton. the pressure at rest and during exerc,se was higher. and the pressure-flow curve increased more steeply. as compared with the preoperative values. These results suggest asib~iticantdeterioration in cardiopulmonary functiooafterlobectomy. As the patient characteristics were heterogeneous (live lobectomies and four bilobectomies), and thalr findings are limited. additional studies may be necessary in the future.

Lung cancer in young patients (aged lfss 40 years) Cangemi V, Volploo P. D’AndreaN, Tomassmj R, Grazani E. Fabrizi S et al. Via Syuarcialupo 19/A, 0162 Roma. Chirurgia (Turm) 1993;6: 134-9.

It is generally agreed that there is an increase mcideoce of lung cancer but its incidence in young people is very low. During 1987 65.078 patients were treated in Italy for primary lung cancer. The incidence of broochogeoic carcmoma in patients less than 40 years was 4.9 % . A total of 516 cases of histologically proven broochogeoic carcinoma were observedat lstSurgica1 ClimcoftheUniversityofRome ‘LaSapierua’. Eighteen of these cases (3.5 %) aged between 6 and 40 years. The male to female ratio was 2.6. 80% were habitual smokers; 78% had symptoms before diagnosis. The most common cell types were adroocarcinomas and large cell carcinomas (33.3 96 respectively) (five cases in stage I and II; 7 cases in stage III and IV). Squamous carcinomas and oat cell carcinomas were 16.7% respectively (all of them presented m stage III and IV were unresectable). Eight patients uodenvent resectton. XX of them for care. The actuarial survival, expressed by Kapla&Meler method, was 58% at five years for the surgical treated group and 0% at 2 years for the group that did not undergo surgical resection. Four of five patients wnh stage I and II disease are alive after 9- 10 years. Even Ihe patients surgically treated with stage III disease had a better survival (33% at 3 years) than rhe patients who were not suqlcally treatul.

Asbestos-related pleural plaques and hmg cancer Weiss W. 3912 &rhe@Xd Rood, Philadelphia. PA 19129. Chest 1993;103: 1854-9.

The English-language literature was reviewed to evaluate a possible relationship betweo asbestos- related pleural plaques and lung cancer

in the absence of pareochymal asbestosis. There were six cohort studies in which the comparison group was limited to unexposed persons or the general population, four lung cancer case-control studies, and three autopsy sNdies. Oftbe 13 investigations, only3 supported the hypothesis that lung cancer risk is elevated among parsons witb pleural plaques over the risk in unexposed people: 2 cohort studies from the same city in England with much the same data and 1 case-control study. These three studies had the most defects in design. The other ten sNdiu failed to confirm the hypothesis. Thus, the weight of the evidence favors the conclusion that persons with asbestos- related pleural plaques do not have an increased risk of lung cancer in Ihe absence of parenchymal asbestosis.

Terminal pulmonary infections in patients with lung cancer Nagata N, Nikaido Y, Kido M, Isbibasbi T, Sueisbi K. Division of RespimrotyDiseoses, Univ. OccupationaUEntiron Health, I-l Iseigaokn, Yaharanishiku, Kimkyuhu 807. Chest 1993:103:1739-42.

To determine the factors that predispose the patient with lung cancer to develop terminal pulmonary infections, we reviewed the case records and autopsy data of 304 patients who died of lung cancer in the Kyushu University Hospital between 1976 and 1990. The incidence of mycobacterial infection was signiticandy higher among those treated with antineoplastic therapy and corticosteroids (group 3) than io those who received antineoplastic therapy alone (group 2). The incidence of nonbacterial infection did not differ significantly between the two groups. IO some ymup 3 patients, the administration of corticosteroids forrelativclyshortperiods(Iessthanooemooth) ledtofatalmycobacterial infection. Among those pauentswith lymphocytopenia, the incidenceof fatal mycobacterial iofe&ioo was significantly higher in group 3 than in group 2, whereas the incidence of fatal nonbacterial infection was not. In group 3, the incidence of fatal mycobacterial and nonbacterial infrrtions did not differ s@ficantly among those with and wlthout lymphocytopenia. Thus, in pauentswitb lungcancerwho were receiving antinmplastic treatment, corticosteroids were more cloxly associated with the development and exacerbation of mycobactenal infection than was Iymphocytopeoia. The influence of corticosteroids on the development ofnonbacterial infection was not more marked than that of lymphocytopenia. The incidence ofcommon bacterial infectloos was no higheramong thosepatients who receivednoantineopiastic treatment or corticosteroid (group I), group 2. and group 3. Therefore, the local and systemic cffocts of the lung cancer itself are likely more important in predisposing the patient to bacterial infections than arz either antineoplastic agents or corucosteroids.

Phenotypes and lymphokineactivated killer activity of pleural cavity lymphocytes of lung cancer patienti without millignant effusion Takabashi K, Sooe S. Kimura S, Ogura T, Moodeo Y. 2nd Deponmenf of Surgery, Tokushima Univ. School of Medicine, Tokushima 770. Chest 1993: 103: 1732-8.

We examined the phenotypes of lymphocytes in the pleural cavity of 23 lung cancer patients without malignant effusion. The ability of those lymphocytes to develop lymphokioe-activated killer (LAK) activity and the regulation of LAK by pleural cavity macrophages were also compared with theircounlerparts in the peripheral blood. Mooonuclzar cells(MNC)wereobtamedsimultaneouslyfromthebloodand bylavage of the pleural cavity of patients with lung cancer. The proportion of the T-cell subset of HLA-DR’ cells was signiticantly higher in the pleural cavity than in the peripheral blood. but the proportions of CD3’ and CD8’ cells in the pleural cavity were similar to the corresponding proportions in the blood. The proport~oos of CD4’ and CD 16’ cells were lower in the pleural cavity than in the blood. The LAK activity could be developed by MNC from the pleural cavity following incubation with

Abstracts/Lung Cancer IO (1994) 395-430 411

interleukin 2 (IL-2). but the LAK activity of pleural cavity MNC was si~ficandyI~thanthatofperipbemlMNC.Pleurslcavitylymphocytes alone also developed LAK activity following incubation with IL- 2. Pleural macrophages from the patients were regulated to augment in vitro induction of LAK activity by IL-2 from autologous blood lymphocytes and pleural cavity lymphocytes. Lymphocytes in the pleural cavity without malignant pleural effusion could be developed by LAK activity and this activity was augmented by pleural cavity macrophages. The LAK activity developed by pleural cavity lymphocytes was significantly lower than that developed by peripheral blood lymphocytes. However, they can change their population to include cells with higher activities on exposure to IL-2 against the invasion of lung cancer cells into the pleural cavity. Thus, the population of lymphocytes in the pleunl cavity of patients with lung cancer without malignant pleural effusion was different from that in malignant pleural effusion.

Clinical evaluation of serum tumour marker CA 242 in non-small cell hmg cancer Pujoi J-L, Cooper EH, Lehmann M, Purves DA, Da~-Ao~ta M. Midander J et al. Service des Maladitv Respimtoires. Universite de Montpellier, Hopital Amud de Villeneuve, 34059 Montpellier Ceder Br J Cancer 1993;67:1423-9.

CA 242, a novel turnour carbohydrate antigen present in serum (upper limit of normal values: 20.0 U ml-‘), has been measured in a group of 102 pathologically confirmed non-small cell lung cancer patients. The aim of the pent prospective study was to identify any relationship between pre-treatment serum CA 242 level and different features of lung cancer including prognosis. Serum CA 242 was measured using the delayed eumpium lanthanide fluoroimmunometric assay. Sensitivity and specificity were 28.5% and 95.6% respectively. ItsIevelwassignilicantlylowerinsquamouscellcan5nomaincomparison with non-squamous histologies (adenocarcinoma and large cell carcinoma). The CA 242 level was higher in metastatic disease (median: 15.3 U &‘) in comparison with non-me&static (median: 7.9 IJ n$‘; Mann Whitney U test; P < 0.003). and increased significantly from stage I to stage IV. In 50 patients who underwent chemotherapy, the serum CA 242 level was higher in non-responder patients when compared with responders (median: 16.8 U ml-’ and 9.5 U ml-’ respectively; Mann Wkimey; P < 0.02). Univariate analysis of the entire population showed serum CA 242 levels were not related to survival. However, patients with unresectable non-small cell lung cancer and elevated CA 242 level proved to have a significantly shorter survival than those with a CA 242 < 20 U ml-‘. In Cox’s model analysis, stage of the disease and performance status were the only significant determinantsofsurvival. Wecoacludethatahigh levelofserumCA242 (I) is significantly related to the stage of disease. (2) predictive of no response to chemotherapy but seems to add weak prognostic information to stage of disease and performance status, the main prognostic determinants of non-small cell lung cancer.

Immtmoscintigntphy of small-ceil lung cancer: A study using technetium and indium labelled anti-carcinoeanbryonic antigen monoclonal antibody preparutions Macmillan CH. Perkins AC, Wastie ML, Leach IH. Morgan DAL. Depanmenr of Clinical Oncology. General Hospital. Nottingham NGI 6HA. Br J Cancer 1993:67:1391-t.

lmmunoscintigraphy with radiolabelled anti-carcinoembryonic antigen monoclonal antibody was performed on 21 patients with active small-cell lung cancer. Patients received either In-1 I l-labelled Mab F6 F(ab’), fragments or Tc-99m-labelled BW 431/26 intact antibody. Tumour was imaged in I3 patients (62%). Of 38 known sitesof disease, I8 sites were positively detected. Serum CEA levels were known in 19

patiarts and were abnormally elevated in three (hunour beiig detected in all three patients). Eight of 15 patieota with normal serum CEA had positive imaging. Using the In-l I I-labelled antibody seven out of ten patients (nine out of 18 sites) gave positive scans; with the Tc-99m- laballedantibody thesewereobtainedinnineoutof I8 patients(nineout of 20 sites).

The value and liiitations of u’TI scintigraphy in the evaluation of lung lesions and post-therapy follow-up of primary lung carcinoma Duman Y, Bunk Z. Erdem S, Tufan M, Unlu M, Haydarogullari A et al. DepartmentofNw!earMedicinc; Egc UniwrsityFaculryofMedicine, &nova. Nucl Med Commun 1993;14:446-53.

In this study lDITl planar scintigraphy and single photon emission computed tomogtaphy (SPECl’) were performed in 92 patients with solitary lung lesions in order to distinguish maligmmt versus benign and metastatic masses and to evaluate the radiotherapy response of IS primary lung carcinomas. Semiquantitative and quantitative analyses were carried out and the results were compared with histopathological diagnosis. The overall sensitivity, specificity and accuracy of semiquantitative analysis were 56, 71 and 58%. and quantitative evaluations were 88.8, IO0 and 92%. respectively. Retention indexes (RI) derived from the early and delayed images were 2.9 f 1.3 for primary lung carcinomas. -2.78 5 0.9 for benign conditions and -2.3 * I .5 for me&static pulmonary lesions. mm scintigraphy seems to be a sensitive modality for differentiating malignancies from benign conditions since the diffierence between those two pathologies is significant. However,thisprocedurehasalimitedvalueindistinguishing metastatic pulmonary lesions fmm benign pathologies, and in tissue characterization ofprimary lung carcinomas. On the otberbaod, a good correlation was observed between “Tl lung scintigraphy and clinical diagnostic examination during postradiotherapy follow-up of inoperable pulmonary neoplasia.

Comparison of the Wang 19-gauge and U-gauge needles in the mediastinai staging of lung cancer Schenk DA, Chambers SL, Derdak S. Komadii KH, Pickard JS, Stmllo PJ et al. 2200 Bergquirr Driw. L.acklandAFI?. Ix 78236-5300. Am Rev Respir Dis 1993;147: 1251-g.

Transbronchial needle aspiration (TBNA) offers the unique opportunity lo pathologically stage patients with lung cancer at the time of diagnostic bronchoscopy. The purpose of this study was to compare thestagingsensitivitiesoftheWang22-gaugeaod 19-gaugeneedles. We studied 64 patients with bronchogenic carcinoma and mediastinal adenopathy. Before bmnchoscopy each patient underwent chest CT.

sitesadjacent toparatracheallymphadenopathy. ln47patientamalignant mediastinal adenopathy was confirmed by the 19~gauge needle. A total of 29 panents had malignant 22- gauge needle as+Gates. Of the 64 patients, 9 had berogn. reactive mediastinal lymph nodes. There were 20 patients in whom only the 19-gauge needle demonstrated malignancy and 2 patients with malignant 22-gauge needle aspirates as the sole identifier of paratracheal malignancy. As a staging tool. the 19-gauge needle was significantly more sensitive than the 22-gauge needle, 85.5 versus52.716 (p = 0.0001). Overall, in49 of55 patients(89.146) with malignant mediastinal lymphadenopathy paratracheal tumor was confirmed by TBNA. The 19-gaugeTBNA staging of the media&urn is an effective. safe, and cost-saving alternative to surgical mediastinal tixploration that can be performed during initial diagnostic bmnchoaopy.

Oral verupumil with chemotherapy for advanced non-small cell lung cancer: a randomised study Millward MJ, Cantwell BMJ, Munro NC, Robiio A. Corris PA,