Clinical and prognostic assessment of patients with resected small peripheral lung cancer lesions
Article Abstract:
The incidence of lung cancer is increasing in Japan, and is likely to edge stomach cancer from the number one spot in that country. For this reason, Japanese health officials initiated a program to evaluate the usefulness of mass screening for lung cancer. This mass screening resulted in the identification of numerous individuals with small lung cancers; researchers now report on the cases of 115 individuals with small lung cancers, and review the factors that seem to influence survival. Due to the criteria for inclusion in the study, all 115 patients had cancers equal to or less than two centimeters in diameter. The overall five-year survival in this patient group was found to be 70 percent. However, tumor size was determined to only indirectly predict survival. When the survival of these patients was compared with that of patients with lung cancers between 2.1 and 3 centimeters, the results revealed that survival of the two groups was the same if only patients without metastatic spread to the lymph nodes were considered. Therefore, the decreased survival seen among patients with larger tumors is a result of the far greater likelihood that the cancer has already spread, and not a result of the size of the tumor itself. Even among the patients with small cancers, a significant proportion had already begun to spread; only 76 percent of the patients had Stage I disease, and 13 percent were already in Stage III or Stage IV at the time of screening. The findings also confirmed some previous studies which indicated that the prognosis for lung cancer is better for women than for men. Although the primary purpose of the present study was to examine factors that affect survival, the authors note that the mass screening did not significantly affect the survival of the patients. Most mass screenings exhibit what has been called lead time bias. At first glance, the screening program seems to confer improved survival. However, if a patient is diagnosed a year earlier than might be expected, a year longer apparent survival indicates that the patient died according to the same schedule as other patients and did not benefit from early diagnosis. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1990
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Transfusion-induced graft-versus-host disease in patients with malignant lymphoma
Article Abstract:
In graft-versus-host disease, immune cells within grafted tissue attack the body components of their new host. While the condition is of great concern in bone marrow transplantation, the immune cells contained within transfused blood are rarely a problem unless the transfusion recipient is immunocompromised. However, this is precisely the case with many patients with malignant lymphoma. The success rate in the treatment of lymphoma has greatly improved in recent years, but the strength of the chemotherapeutic drugs used also exposed the patient to a period of immunosuppression during which infections pose a great threat. The case is present of a patient receiving transfused blood who died of complications resulting from graft-versus-host disease. The patient, a 31-year-old woman, had nodular sclerosing Hodgkin's disease. Over a period of almost a year, she was given eight full cycles of chemotherapy. During the ninth cycle, she developed fever and experienced a reduction in red and white blood cells as well as platelets; a transfusion was indicated. The woman received a total of 14 units of platelets and three units of red blood cells. The transfused materials were not irradiated. Seven days after the first infusion of platelets the patient developed a rapidly progressive rash; skin biopsy revealed signs of graft-versus-host disease. The patient had persistent signs of bone marrow aplasia (the bone marrow was failing to produce an adequate supply of fresh blood cells). A bone marrow transplantation was performed, but the patient died of complications involving the heart, systemic infection with Candida krusei, and lung infarction due to infection with Aspergillus and Pneumocystis carinii. A review of the medical literature revealed 20 reports of lymphoma patients who developed graft-versus-host disease after transfusion; only one of these patients survived. While the irradiation of blood adds additional cost to a transfusion, irradiated blood does not cause graft-versus-host disease, and the added expense may be life-saving for immunosuppressed patients. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1990
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