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Background: In patients with epidermal growth factor receptor (EGFR)-mutated advanced non-small-cell lung cancer (NSCLC), epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) treatment has shown a good response. Subsequent treatments jeopardize the ability to determine the effect of first-line chemotherapy on overall survival (OS). Therefore, using patient-level data, we aimed to study the associations of progression-free survival (PFS) and post-progression survival (PPS) with OS after first-line EGFR-TKI treatment in patients with EGFR-mutated NSCLC., Methods: Between November 2006 and December 2016, we analyzed 92 patients with EGFR-mutated NSCLC treated with first-line EGFR-TKI. The correlations of PFS and PPS with OS were analyzed for each patient., Results: Spearman's rank correlation and linear regression analyzes showed that PPS correlated highly with OS (r = 0.85, P < 0.05, R 2 = 0.75), whereas PFS correlated weakly with OS (r = 0.76, P < 0.05, R 2 = 0.50). The best responses after first-line and second-line treatments were significantly associated with PPS., Conclusions: PPS has a higher impact on OS than PFS in patients with EGFR-mutated NSCLC treated with first-line EGFR-TKIs. These outcomes suggest that the OS in this patient group may be affected by treatments following first-line chemotherapy; however, this remains to be verified in prospective trials., (© 2019 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.)

Two cases of bronchioloalveolar carcinomas are presented. In both cases, chest CT demonstrated widespread ground-glass shadows. The findings on CT revealed tumor tissue character with tumor cell proliferation along the alveolar wall and air in the alveoli.

A CT-pathologic correlative study concerning the nature of the tumor margin was performed in 22 lung cancer cases with solitary nodules in the peripheral lung field. Three of 14 adenocarcinoma cases showed an ill-defined margin and an adjacent subtle high attenuation area on CT, representing alveoli lined by tumor cells. In the other 11 cases, both ill- and well-defined margins were seen on CT. A well-defined margin of the mass represented alveoli filled entirely with mucinous material or tumor cells. In three of six squamous cell carcinomas an ill-defined margin in CT represented the infiltration of lymphatic cells surrounding the tumor and continuous spread of tumor cells from neighboring alveoli. A well-defined margin in the other cases and two small cell carcinoma cases represented alveoli filled entirely with tumor cells. CT was shown to be very useful in the assessment of the nature of the margin of the tumor.

Purpose: To evaluate the radiologic-pathologic relationship between the tumor edge of peripheral lung cancers and surrounding normal structures., Materials and Methods: Tissue samples from 16 lung cancers with diameters less than 2 cm were examined: 7 adenocarcinomas, 5 squamous cell carcinomas, 2 small cell carcinomas, 1 large cell carcinoma, and 1 that had metastasized to the lung. Inflation-fixed lung specimens containing tumor tissue were sliced to a thickness of 2 mm: The tumor edge of each section was traced under a stereomicroscope and its relationship to marginal structure, including bronchi, pulmonary arteries, and pulmonary veins containing interlobular septa, was analyzed. The tumor edge and marginal structures were classified into four types: Type 1, clear margin formed by marginal structures; Type 2, tumor involving the marginal structures; Types 3 and 4, marginal structures penetrating the tumor with and without a notch, respectively., Results: Type 1 was found in 23 of 47 pulmonary arteries (49%), 23 of 49 bronchi (47%), and 12 of 31 pulmonary veins or interlobular septa (39%). Type 2 was found in 11% (14/127), Type 3 in 15% (19/127) and Type 4 in 28% (36/127) of marginal structures. Type 1 was common in all histological types of carcinomas studied., Conclusion: In small peripheral lung cancers, the tumor edge sometimes has a clear margin formed by surrounding structures such as interlobular septa. This can make it difficult to differentiate benign from malignant lesions.

Three-Dimensional MR angiography (3D-MRA) of the lung was performed in 5 healthy volunteers and 14 patients with primary pulmonary cancer in the hilum, and compared with 2D-MRA. As 3D-MRA could be obtained with single breath holding after intravenous bolus injection of Gd-DTPA, pulmonary vessels of the hilum and peripheral zone were demonstrated more definitely than those of 2D-MRA. In all patients except one case, the relation between the tumor and pulmonary vessels was visualized more clearly by 3D-MRA than 2D-MRA. This technique is considered a non-invasive and effective method for evaluation of pulmonary vessels in the patient with hilar tumor.

We encountered three patients with synchronous double cancers in the lung and stomach. Although the gastric cancers were resected curatively in all three patients, the lung cancers were resected palliatively because they were too advanced for curative resection. In the Japanese literature we found 25 operated cases of synchronous double cancers and 24 operated cases of metachronous double cancers in the lung and stomach. Early diagnosis and curative resection of both cancers improve the survival rate of these primary double cancers.