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in stage 1, the five-year actuarial survival was 60.8%. The correspond- ing values were2.68 yearsand 1.6% respectively in stage II.compared to 1.14 years and 13.4% respectively in stage IIIa. The differences between tumor stages are statistically significant. The nature of the resection treatment within the tumor stages did not have any effect on the survival times. Tendency to keratinize, lymphangiosis carcinoma- tosa, and infiltration of tumor cells into vessels also had no prognostic significance. It was also analysed to what degree tumor size and extent as well as lymph-node involvement influence the prognosis after potentially curative operation. In the absence of lymph-node involve- ment,thepmgnosis ofpatients withT1 andT2 tumors was significantly better than that of patients with T3 tumors. However, when metastatic spreading into bmnchopulmonary lymph nodes was present (Nl). the prognoses of patients with Tl, T2 and T3 tumors no longer differed significantly from each other. In mediastinal lymph-node involvement (N2) and Tl tumor, the survival times were significantly better than in mediastinal lymph-node involvement and T2 or T3 tumor. The pmgno- sis of the patients with T2 tumors proved to be significantly dependent on lymph-node stage, whereas this was not the case in Tl tumors, possibly because tbe number of the cases was too small. Whereas the mean survival times of patients with T3 tumors were independent of the N stage, significant differences were shown in the five-year actuarial survival (T3NO: 30%. T3Nl: 281, T3N2: 0%). The analysis of the deciding features for the T and N classification under the tumor stages I, 11 and IIIa showed that the stage IIIa is not an homogeneous group in prognostic terms and that in stage II differentiation of true metastatic spreading into bqnchopulmonary lymph nodes and infiltration of the lymph nodes is of prognostic importance.

Reevaluation of pulmonary neoplasms resected as small cell carci- nomas. Significance of distinguishing between well-differentiated and small cell neuroendocrine carcinomas Warren WH, Memoli VA, Jordan AG, Gould VE. Department of Cardiovascular-Thoracic Surgery, Rash Medical College. Chicago,lL. Cancer 1990;65:lCO3-10.

The clinicopathologic features of 50 cases of surgically resected small cell carcinoma were reevaluated (doubly blinded). Two pulmo- nary carcinomas were excluded because neuroendocrine features could not be demonstrated, two additional cases also were excluded because tbe tumors grossly invaded the chest wall and their pulmonary origin was not substantiated. Thirty-four tumors were confirmed to be small cell neuroendocrine carcinoma (SCNC). Only seven of 11 (64%) patients with TlNO,TPNO tumors survived more than 1 year; one of 11 (9%) patients survived more than 2 years. In 12 cases, the diagnosis was changed to well-differentiated neuroendocrinecarcinoma (WDNC). Of these, nine of nine (100%) patients with TlNO,T2NO tumors survived more than 1 year; sixofeight(75%) patients survivedmoretban2 years. These observations strongly indicate that a significant number of long- term survivors with the diagnosis of small cell carcinoma may, in fact, have a distinctly less aggressive type of pulmonary neuroendocrine carcinoma. It wasconcluded that thedistinctionbetween small cell and well-differentiated types of neuroendocrine carcinomas has significant prognostic and therapeutic implications.

A specilic tracheobroncbial stem Dumon IF. Service d’Endoscopie Thoracique. Hopital Saint+Margae- rite, 270 Boulevard de Sainte-Marguerite. F-13009 Marseille. Presse Med 1989;18:2055-8.

A tracheobronchial stent specifically designed for the treatment of main airway external compression is presented. The stent is made of moulded silicone. Its outside surface bears regularly located studs to prevent displacement. The fmtresults are encouraging: 154 stunts have been placed in 86 patients. They were well tolerated and complications were rare. Migration occurred on 15 occasions; in 7 cam a poorly designed early prototype had been used. Obstruction was noted in 5 cases without major problems. Granulomas were found in 28 cases and were treated by endoscopic resection. At the time of writing the mean follow-up period is 3 months and the longest is 22 months.

Socio-occupational activity of lung cancer patients following radi- cal treatment ArtemkinaNI,BlinovNN,ChulkovaVA,Shipovnikov NB,DeminEV. N.N. Petrov Research Institute of Oncology of the USSR Ministry of Health, Leningrad. Vopr Gnkol 1989;35:1348-52.

One hundred and twenty-six radically treated patients with lung cancer showed a decrease in the majority of parameters of socio- occupational activity. A comparative study in two groups of patients (lobectomy - 95 and pneumonectomy - 31) established a correlation between tbe extent of surgery and degree of socio-occupational activity rehabilitation which was most pronounced in terms of patients’ inter- course, resumption of occupational activity and duration of rehabilita- tion and invalidity periods. Psycho-emotional status of lobectomized patients proved better than that in cases having undergone pneumonec- tomy.

Long term survivors with palliative resection for non-small cell lung cancer Oka T, Ishida T, Nishino T et al. SecondDepartment ofSurgey. Faculty of Medicine. Kyashu University. 3-l-l Maidashi. Higashi-ku. Fukaoka 812. Surg Res Commun 1990:7:219-23.

Forty-seven patienu with non-small cell lung cancer, excluding distant metastasis and malignant pleurisy, underwent palliative resec- tion in our department from April, 1974, through March, 1987. In 30 patients with residual tumor at tbe resection margin, 4-year survivors were 4 patients. Seventeen patients with residual tumor in the mediasti- nal lymph nodes died within 2 years after resection. In 30 patients with residual tumor at the resection margin, 24 underwent known palliative resection.Theother6patientsunderwentaputativelycurableresection, but residual tumor was microscopically evident at the resection margin. These 6 patients were prescribed adjuvant therapy, and 4 survived over 4 years without any clinical evidence of a local recurrence or distant metastasis. In light of this evidence, we propose that patients with an advanced lung cancer involving adjacent structures should be consid- ered for ‘intraoperatively complete’ resection.

The significance of ipsilateral mediastinal lymph node metastasis (N2 disease) in non-small cell carcinoma of the lung. A commentary Shields TW. Northwestern University Medical School, 250 East Sape- rior Street, Chicago, IL 60611. J Thorac Cardiovasc Surg 1990;99:48- 53.

The significance of the presence of N2 disease in patients with non- small cell cancer of the lung is widely misunderstood. long-term survival rates from 15% to more than 30% after surgical resection are frequently reported in the literature. However, these percentages repre- sent only the surgical results in a highly selected and unfortunately small proportion of the entire number of patients with N2 disease. In those patients in whom N2 disease is readily clinically recognizable or is identified by standard roentgenographic or bmnchoscopic study and proved by biopsy or is discovered by pretboracotomy mediastinal exploration, a 5-year survival rate of only approximately 2% for the entire group can be expected, even when aggressive surgical resection is performed when appropriate. In those patients in whom the N2 disease isonly initially recognized at thoracotomy, theresectability rate is higher and 5-year survival rates as noted are in the range of 15% to 30%. Although surgical resection continues to be the primary choice of therapy in this small group (less than 20% of patients with N2 disease), surgical resection can be expected to salvage only 3% to 6% of all patients with N2 disease. Thus, with presently available therapy, the vast majority of patients proved to have N2 disease will die of their lung cancer. It must be concluded that N2 disease is a significant poor prognostic factor in patients with lung cancer.

Carcinoma of the lung: who will benelit from surgery? Landreneau RI. Division of Cardiothoracic Surgery, MA 312, Univer- siry of Missouri, Columbia School of Medicine, Columbia, MO 65212. Postgrad Med 1990;87:117-35.