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Objectives According to our previous study, the concurrent detection of p53 and epidermal growth factor receptor mutations significantly improves the clonality assessment and impact management of patients with multiple primary lung cancer. Nevertheless, the treatment, outcome, and safety of patients with this complex disease remain controversial. This series of cases detail our experiences with surgical resections in 92 patients during the past 16 years. Methods A database of 1651 patients was evaluated for unilateral and bilateral synchronous multiple primary lung cancers. The relationships among the location of tumors, number of tumors, tumor size, tumor histology, vascular invasion, regional lymph node metastasis, extranodal extension, type of surgery, mortality, and survival were analyzed. Results The 5-year survival for all synchronous multiple primary lung cancers was 35.3%. The overall surgical mortality was 1.1%. Notably, lymph node metastasis, extranodal extension, vascular invasion, tumors with adenosquamous carcinoma or different histology, and poor survival were observed. Multivariate analysis showed that only the occurrence of lymph node metastasis remained a statistically significant prognostic factor. The 5-year survivals were 52.5% and 15.5% for patients with and without lymph node metastasis, respectively ( P Conclusion An aggressive surgical approach is safe and justified in patients with synchronous multiple primary lung cancers and node-negative diseases. The status of this particular form of non–small cell lung cancers might be considered in the conventional TNM staging system for more accurate prediction of patient prognosis.

Objective Estrogen receptor expression in lung cancer has been understudied, particularly in light of its potential biologic importance in the epidemic of lung cancer in women. The expression of estrogen receptors was investigated to better understand the possible role of sex hormones in lung cancer. Methods A total of 301 patients with surgically resected non–small cell lung cancers of stages I to III were explored. Sections of paraffin-embedded tumor samples were stained with estrogen receptor α and estrogen receptor β antibodies. Tumors with moderate-to-strong nuclear staining in at least 50% of the tumor cells were scored as positive for overexpression. Results The overall frequency of overexpression for estrogen receptor β was 45.8% (138/301). It was detected most frequently in female patients (in 54.3% of 127 tumors vs 39.7% of 174 tumors in men, P = .012). However, there was no estrogen receptor α nuclear staining detectable in non–small cell lung cancers. Interestingly, a significant correlation between estrogen receptor β expression, stage of disease, grade of differentiation, smoking status, vascular invasion, and survival in patients with stage II and III disease was found. By using multivariate analysis of survival among patients with stage II and III disease, estrogen receptor β overexpression, stage II tumor, well differentiation, nonsmoking status, and lack of vascular invasion were significantly favorable prognostic factors. Conclusions The results presented here show for the first time that immunohistochemical expression of estrogen receptor β can be used as a prognostic indicator in patients with surgically resected stage II and III non–small cell lung cancers. These observations might offer a possibility for hormonal therapy in patients with lung cancer.

ObjectiveSurgical lung biopsy is considered the final method of diagnostic modality in patients with undiagnosed diffuse pulmonary disease. Nevertheless, the effect of surgical lung biopsy on the diagnosis, treatment, and outcome of the patient still remains controversial. This study reviewed the experiences of surgical lung biopsies in 196 consecutive patients during the past 7 years.MethodsSurgical lung biopsy was performed after achievement of general anesthesia through video-assisted thoracoscopic surgery or a 7-cm minithoracotomy. Biopsy specimens were swabbed for aerobic and anaerobic bacterial, fungal, and mycobacterial cultures. The sections of specimens were routinely stained with hematoxylin and eosin, and acid-fast, Gomori methenamine silver, Gram stain, or other special stains were added if necessary.ResultsThe pathologic diagnosis after surgical lung biopsy included infection (30.6%), interstitial pneumonia or fibrosis (21.9%), diffuse alveolar damage (17.3%), neoplasm (13.3%), autoimmune diseases (8.2%), and others (8.2%). After surgical lung biopsy, 165 (84.2%) patients had changes in their therapy, 124 (63.3%) patients had clinical improvement of their conditions, and 119 (60.7%) patients survived to hospital discharge. Comparison between immunocompromised and immunocompetent patients showed that diagnosis of infection was significantly higher (P < .01) in the former group (41.2% vs 20.2%). In addition, there was no significant difference in the distribution of diagnosis and rate of change in therapy between the respiratory failure and nonrespiratory failure groups. However, the rates of response to therapy and patient survival were significantly lower in the respiratory failure group (51.2% and 41.5%) than in the nonrespiratory failure group (71.9% and 78.1%, P < .05). There was no surgical mortality directly related to the procedure. The surgical morbidity rate was 6.6%.ConclusionSurgical lung biopsy is a safe and accurate diagnostic tool for diffuse pulmonary disease. For a large proportion of the patients, change of therapy and then clinical improvement can be achieved after surgical lung biopsy. Surgical lung biopsy should be considered earlier in patients with undiagnosed diffuse pulmonary disease, especially when the respiratory condition is deteriorating.

Objectives: Expression of the cell-cell adhesion molecules E-cadherin and α-, β-, and γ-catenin seems closely related to tumor invasiveness. The relationship between the expression and clinicopathologic characteristics in surgically resected non–small cell lung cancers of 3 cm or less in size was studied. The relationship to patient survival was analyzed. Methods: A total of 115 patients with surgically resected lung cancers of 3 cm or less in size were enrolled in this study. Expression of E-cadherin and α-, β-, and γ-catenin was immunohistochemically measured. The χ 2 test was used to correlate this expression with clinicopathologic parameters. Their influence on patient survival was evaluated with the Cox proportional hazards model. Results: There was a positive correlation between E-cadherin and catenin expression in lung cancers. In general, E-cadherin and catenin expression were greater in tumors that were either bronchioloalveolar carcinomas or adenocarcinomas, well differentiated, early stage, peripheral, and without vascular or pleural invasion. By using multicovariate analysis of patient survival, only early-stage and peripheral tumors were significantly favorable prognostic factors. Further analysis of the group of patients with early-stage disease showed that higher α-, β-, or γ-catenin expression was a favorable prognostic indicator. Conclusion: Expression of α-, β-, or γ-catenin can be used as a prognostic indicator in patients with surgically resected stage I non–small cell lung cancers of 3 cm or less in size. J Thorac Cardiovasc Surg 2002;123:502-7