Abstracts/Lung Cancer 13 (1995) 185-232 207

selected cases, by a direct video-assisted approach. We report our experience of 155 patients submitted to videothoracoscopic operative staging between October 1991 and January 1994. Videothomcoscopic operative staging showed unresectability in 13 patients (8.3%) due to preoperatively unexpected (10 patients) or suspected conditions (3 patients). The remaining 142 patients were divided by staging of the lesion and general conditions into three groups. Group A consisted of 13 elderly patients with small peripheral tumor who could not tolerate lobsctomy and who underwent thoracoscopic wedge resection. Group B consisted of 63 patients with peripheral clinical Tl NO or T2 NO tumor. Fii-two lobectomies and 4 pneumonectomies were carried out thoracoscopically. Seven conversions to thoracotomy were necessary due to technical problems. The postoperative course was uneventful in 5 1.5 had prolonged air leakage, and a bronchial fistula developed in 1 because ofpositive-pressure postoperative ventilation. Group C consisted of 66 patients with stage II or IIIa neoplasm. Thoracotomy after thoracoscopy proved unresectability in 4, whereas 62 were submitted to a radical pulmonary resection. In the literature the incidence of exploratory thoracotomies for conditions missed by preoperative staging still remains high. After adoption of videothoracoswpic operative staging we reported a 2.6% exploratory thoracotomy rate. This is sufficient to justify routine performing of videothoracoscopic operative staging as the first step of operation for lung cancer. Furthermore, videothoracoscopic operative staging permits confirmation of resectability of the lesion and, in selected patients, even direzt video- excision. In our experience videothorawscopic treatment proved a safe and concrete opportunity.

Second primary lung cancer Antakli T, Schaefer RF, Rutherford JE, Read RC. Sufgicol Service, John L. McClellan Memorial VetHosp., Univ. o/Arkansas/or Medical &is., 4300 W 7th St, Little Rock, AR 72205. Ann Thorac Surg 1995;59:863-7.

We reviewed our experience with second primary lung cancer (SPLC) at the Little Rock kterans Atfairs Medical Center from 1966 to 1993. Fifty-four patients were found to have 65 such lesions after 1,572 ‘curative’ resections for lung cancer (4.1%). Eleven patients had at least a third primary tumor (3 having more). Metachronous SPLCs comprised 60% (39/65) and synchronous 40% (26/65). The mean interval between first and second tumors was 54.63 f 8 (standard error) months (range, 5 to 218 months), and that between second and third was 26.1 * 7.4 (standard error) (range, 5.5 to 51 months). Squamous cell carcinoma comprised 58.4% (38/65), adenocarcinoma 30.8% (201 65). and small cell carcinoma 10.8% (l/65). Histology of the SPLC was the same as that of the first tumor in 50.7% (33/65). Stage I primary tumors comprised 76% (41/54) of index tumors, 61.1% (33/54) of SPLCs, and 72.2% (S/11) of third primary tumors. Second primary lung cancer followed minimal resection in 44% (24/54), lobectomy in 37% (20/54), and pneumonectomy in 13% (l/54) of cases. There was no evidence that minimal resection for the first primary tumor predisposed to SPLC. After 1983 the majority of SPLCs were diagnosed with computed tomographic scanning. After resection of SPLCs, survival rates at 3 and 5 years were 26% and la%, metachronous 39% and 23.4%, and synchronous 12.25% and 12.25%.

Studies on cliiicopathologicai features of lung cancer patients with K-rrslpS3 gene alterations: Comparison between younger and older groups Kashii T, Mizushima Y, Lima CEQ, Noto H, Sato H, Saito H et al. Firsr Demnt In&tral Medicine, Topmo Med Phannaceurical Universi& 2630 Sugitani, Toyama 930-01. Onwlogy (Switzerland) 1995;52:219- 25.

In order to define the roles of the K-ras and ~53 genes in the

development of lung cancer, especially in young adults, we compared the cliniwpathological features of the patients between younger (‘/ 45 years, n = 47) and older (> 55 years, n = 50) groups. The gene alterations were examined by the polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) method. The K-ras gene alterations were detected only in adenocarcinomas, and the ~53 gene alterations in all histologic types of lung cancer. There were no significant differences in the frequency of both K-ras and ~53 gene alterations between the younger and older groups (9 vs. ll%, 36 vs. 32%). In the younger group, but not in the older one, the percentage for smokers was significantly higher in the ~53 gene alteration-positive group than for the negative group (65 vs. 30%). As to the prognosis, there were no significant differences between the p53 gene alteration- positive and -negative cases in both the younger and older groups as well as in all subjects, while a tendency of poorer prognosis was observed in K-ras gene alteration-positive cases than for the -negative ones with adenocarcinomas. These results suggest that (1) the K-ms and ~53 gene alterations would have no special roles in terms of the lung carcinogenesis in young adults; (2) a positive relationship between smoking and ~53 gene alteration would exist in young adults with lung cancer, and (3) K-ras gene alteration would become a prognostic factor in lung cancer.

CYFRA 21-1 as a tumour marker for bronchogenic carcinoma Rapellino M, Niklinski J, Pecchio F, Furman M, Bakli S, Chyczewski L et al. Srxz. Fisiopatologia Respiraloria, Ospedale Molinette. Via Geneva 3, 10126 Torino. Eur Respir J 1995;8:407-10.

Despite extensive research, the role of the commonly employed hunour markers in the diagnosis of lung carcinoma is yet to be clarified. The utility of a new marker, CYFRA 2 l-1, in the preoperative evaluation of patients with bronchogenic carcinoma was investigated. CYFR4 2 I- 1 was determined with a radiometric assay in serum of 280 patients with lung cancer and 208 patients with various nonmalignant lung diseases. The levels of the marker were significantly higher in lung cancer patients. Among benign lung diseases, elevated CYFRA 2 l- 1 levels were found in pulmonary fibrosis. Using a cut-off of 3.2 ng ” ml ’ (95th percentile of levels obtained in benign lung disease), the total sensitivity of the marker was 48%. The best sensitivity was obtained in squamous cell lung cancer (60%). The highest values of CYFRA 2 l-l were found in metastatic lung cancer, and the marker sensitivity was more elevated in stage IIIh and IV. On the other hand, 40 % of patients with surgically resectable lung cancer had CYFRA 2 1-I levels above the cut-off. We conclude that CYFRA 21-l may be satisfactorily employed in the differential diagnosis between malignant and benign lung diseases in association with other clinical and radiological data.

Lung surfactant protein-A and carcinoembryonic antigen in pleural effusions due to lung adenocarcinoma and malignant mesothelioma Shijubo N, Honda Y, Fujishima T, Takahashi H, Kodama T, Kuroki Y et al. Third Depr of internal Medicine. Sappom Med. Univ. Sch. of Medicine, South-l West-16, Chuo-ku. Sappom 060. Eur Respir J 1995;8:403-6.

Lung surfactant protein-A (SP-A) is a major phospholipid-astiated glycoprotein in surfactant, and is a usetid immunohistochemical marker for lung adenocarcinoma. Carcinoembryonic antigen (CEA) has not been immunohistochemically detected in mesothelioma. In pleural effusions due to malignant mesothelioma, very low concentrations of SP-A and CEA can be expected. We studied the value of combined daenninations of CEA and SP-A in pleural fluid to distinguish between lung adenazarcinoma and mesothelioma SP-A and CEA concentrations