研究者詳細 - 加勢田　馨

論文 - 加勢田　馨

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[Clinicopathological Features and Imaging Characteristics of Pulmonary Mucosa-associated Lymphoid Tissue Lymphoma].

Oka N, Masai K, Okubo Y, Kaseda K, Hishida T, Emoto K, Asakura K

Kyobu geka. The Japanese journal of thoracic surgery 76 （ 8 ） 623 - 628 2023年08月

ISSN 0021-5252

Feasibility and safety of percutaneous cryoablation under local anesthesia for the treatment of malignant lung tumors: a retrospective cohort study

Kaseda K., Asakura K., Nishida R., Okubo Y., Masai K., Hishida T., Inoue M., Yashiro H., Nakatsuka S., Jinzaki M., Asamura H.

Journal of Thoracic Disease （Journal of Thoracic Disease） 14 （ 11 ） 4297 - 4308 2022年11月

ISSN 20721439

Background: In our institution, computed tomography (CT)-guided percutaneous cryoablation has been performed in patients with malignant lung tumors under local anesthesia. This study aimed to examine the feasibility and safety of percutaneous cryoablation for the treatment of malignant lung tumors. Methods: From July 2002 to December 2016, 227 patients (56 with primary lung cancer and 171 with metastatic lung tumor) underwent percutaneous cryoablation for the treatment of malignant lung tumors using a cryosurgical unit at our institution. Demographic factors, duration of post-treatment hospitalization, and adverse event and mortality rates were retrospectively investigated in 366 treatment sessions targeting 609 lesions. Results: The median diameter of the targeted tumor was 1.3 cm. All the cryoablation procedures were completed under local anesthesia, and the median duration of post-treatment hospitalization was two days. Adverse events (grade 2 or higher) were observed in 79 sessions (21.6%), with pneumothorax being the most common. In five sessions (1.4%), patients had grade 3 adverse events. There was no 30-day mortality; however, there were two 60-day mortality (0.5%) due to acute exacerbation of interstitial pneumonia. In multivariate analysis, independent predictors of adverse events were comorbid interstitial pneumonia [odds ratio (OR) =2.20; 95% confidence interval (CI): 1.04–4.64] and no history of pulmonary resection on the treated side (OR =3.04; 95% CI: 1.65–5.62). Conclusions: Cryoablation is a feasible and safe treatment for malignant lung tumors with acceptable adverse event rates. However, the mortality risk in patients with comorbid interstitial pneumonia should be fully recognized.

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Safety and efficacy of salvage surgery for non-small cell lung cancer: a retrospective study of 46 patients from four Keio-affiliated hospitals

Suzuki S., Asakura K., Okui M., Sawafuji M., Shigenobu T., Tajima A., Kaseda K., Masai K., Hishida T., Asamura H.

General Thoracic and Cardiovascular Surgery （General Thoracic and Cardiovascular Surgery） 70 （ 10 ） 891 - 899 2022年10月

ISSN 18636705

Objectives: Advances in drug therapy and radiotherapy for non-small cell lung cancer resulted in an increased number of salvage surgeries for initially unresectable tumors. This study aimed to evaluate the safety and efficacy of salvage surgery for non-small cell lung cancer. Methods: We defined salvage surgery as (1) surgery for local recurrence/residual tumor after definitive chemoradiotherapy/radiotherapy (salvage surgery in a narrow sense) or (2) conversion surgery after non-surgical treatment. We retrospectively analyzed patients who underwent salvage surgery at four Keio University-affiliated hospitals. Results: Forty-six patients were included. The initial clinical stage was I in 4 patients (9%), III in 19 (41%), and IV in 23 (48%). Initial treatment before salvage surgery was chemoradiotherapy in 10 patients (24%), radiotherapy in 4 (9%), and drug therapy in 32 (67%). Pneumonectomy, lobectomy, segmentectomy, and wedge resection were performed in 2 (4%), 37 (80%), 3 (7%), and 4 (9%) patients, respectively. Complete resection was achieved in 41 patients (89%). Postoperative complications occurred in 11 patients (24%). Initial chemoradiotherapy/radiotherapy was an independent predictor of postoperative complications (odds ratio 10, p = 0.03). The 30- and 90-day mortality rates were 0 and 2%, respectively. The 5-year overall and progression-free survival rates were 66 and 30%, respectively. Conclusion: The safety and efficacy of salvage surgery for non-small cell lung cancer were acceptable. Salvage surgery was a viable treatment option for selected patients with recurrent/residual tumors after non-surgical treatments.

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Clinicopathological Analyses for Predicting Recurrence After Complete Resection of Thymoma

Suzuki, T; Hishida, T; Yano, K; Imoto, T; Oka, N; Maeda, C; Okubo, Y; Masai, K; Kaseda, K; Asakura, K; Emoto, K; Asamura, H

JOURNAL OF THORACIC ONCOLOGY 17 （ 9 ） S333 - S333 2022年09月

ISSN 1556-0864

Separate evaluation of unilateral lung function using upright/supine CT in a patient with diaphragmatic paralysis

Suzuki T., Asakura K., Yamada Y., Yamada M., Yokoyama Y., Okubo Y., Masai K., Kaseda K., Hishida T., Asamura H., Jinzaki M.

Radiology Case Reports （Radiology Case Reports） 17 （ 8 ） 2826 - 2830 2022年08月

ISSN 1930-0433

Background: Unilateral diaphragmatic paralysis is a condition in which the unilateral diaphragm is paralyzed and elevated. Orthopnea due to lung compression by an elevated diaphragm in the supine position is common in patients with unilateral diaphragmatic paralysis. Although its symptom is posture-dependent, the effect of posture on lung function in unilateral diaphragmatic paralysis has not been studied. Computed tomography (CT) can be used to assess lung volume. However, conventional CT cannot be performed in the upright position. A pulmonary function test can be performed in both upright and supine positions. However, it cannot evaluate the function of each lung separately. Case presentation: We report a case of a 79-year-old man with unilateral diaphragmatic paralysis. He presented with difficulty in inspiration, specifically in the supine position, and underwent both conventional supine CT and newly developed upright CT to assess the effect of posture on the function of each lung. The difference between expiratory and inspiratory lung volumes on CT in the supine position was less than that in the upright position by 46% and 4% on affected and healthy sides, respectively. We previously reported that the difference between expiratory and inspiratory lung volumes on CT correlated with inspiratory capacity on the pulmonary function test. A 46% decline in inspiratory capacity on the affected side in the supine position likely caused orthopnea in this patient. Conclusions: Supine/upright CT is helpful to assess the influence of posture on unilateral lung function in patients with unilateral diaphragmatic paralysis.

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Ehlers-Danlos症候群を背景に発症した気胸に対する2手術例

西田梨紗, 菱田智之, 政井恭兵, 加勢田馨, 江本桂, 淺村尚生

日本呼吸器外科学会雑誌（特定非営利活動法人日本呼吸器外科学会） 36 （ 5 ） 554 - 561 2022年07月

ISSN 09190945

Ehlers-Danlos症候群（EDS）はコラーゲンやその修飾酵素の遺伝子異常により結合組織脆弱性を来す遺伝性疾患群である．我々はEDS合併の気胸手術を2例経験した．症例1は43歳女性，網膜剥離の既往と両肺多発空洞を有していた．左初発気胸に対し左肺下葉の空洞性病変を切除したが，staple lineおよび把持した肺実質から気漏を生じ修復を要した．既往，術前画像，術中所見からEDSを疑い，術後の遺伝子検査にて古典型EDSの診断に至った．症例2は38歳女性，下行結腸穿孔の既往があり血管型EDSと診断されていた．右気胸再発に対し右肺上葉の囊胞縫縮術を施行したが，把持した肺実質から気漏を認め，肺部分切除と壁側胸膜擦過を追加した．2例とも切除標本では組織中の弾性線維は維持されていたが肺実質は極めて脆弱であり，EDS合併が疑われる気胸手術では組織脆弱性に注意した愛護的な操作が肝要である．

Double stapling method for closure of intraoperative alveolar air leakage adjacent to the staple line: a randomized experimental study on ex vivo porcine lungs

Suzuki T., Asakura K., Egawa T., Kawauchi M., Okubo Y., Masai K., Kaseda K., Hishida T., Asamura H.

Journal of Thoracic Disease （Journal of Thoracic Disease） 14 （ 6 ） 2045 - 2052 2022年06月

ISSN 20721439

Background: Alveolar air leakage from a pleural defect around the staple line is one of the complications after wedge resection of the lung. An intraoperative closure of the pleural defect by suturing can cause additional pleural rupture due to tension of the pleura adjacent to staple lines. Therefore, we have introduced a novel closure method for pleural defect adjacent to the staple line, named the double stapling method. This study compared the efficacy of two closure methods; the double stapling method and conventional suturing method with pledgets using ex vivo porcine lungs. Methods: The double stapling method involves closing the pleural defect by suturing the two parallel staple lines at both sides of the pleural defect. This method was developed to distribute the pleural tension around the needle holes of suturing. As a model of pleural defect adjacent to the staple line after wedge resection, wedge resection of the caudal lobe of left porcine lungs was performed, and a superficial square pleural defect (10 mm × 10 mm) adjacent to the staple line was made by scalpel. The defect was closed using the following two methods: (I) suturing with pledgets (n=10); and (II) double stapling method (n=10). The lobe was inflated in water at an airway pressure of 20, 25, and 30 cmH2O; closure success or failure was judged by the absence or presence of air leakage. Results: The closure success was confirmed in 2 (20%) out of 10 cases in the suturing with pledgets group and 9 (90%) out of 10 in the double stapling method group (P=0.007). In 4 out of 10 cases in the suturing with pledgets group, new pleural clefts longer than 3 mm were created around the needle holes of suturing. Conclusions: Ex vivo experiments have suggested the superiority of the double stapling method for the intraoperative closure of alveolar air leakage adjacent to the staple line after wedge resection, compared to conventional suturing with the pledget method.

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Hemoptysis after coil embolization for pulmonary arteriovenous malformation: Histopathological confirmation of bronchial epithelium extension

Yanagihara T., Shimohira M., Inoue M., Nakayama K., Tamura M., Nakatsuka S., Hattori H., Emoto K., Yokota K., Okuda K., Nakanishi R., Kaseda K., Maeda C., Asakura K., Hiwatashi A.

Radiology Case Reports （Radiology Case Reports） 17 （ 6 ） 2101 - 2105 2022年06月

ISSN 1930-0433

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画像上肺癌との鑑別が困難であった潰瘍性大腸炎に合併した肺肉芽腫の切除例

岡直幸, 政井恭兵, 加勢田馨, 朝倉啓介, 菱田智之, 淺村尚生

日本呼吸器外科学会雑誌（特定非営利活動法人日本呼吸器外科学会） 36 （ 4 ） 382 - 388 2022年05月

ISSN 09190945

症例は51歳，女性．潰瘍性大腸炎に対して19年前より薬物療法が開始され，寛解が維持されていた．胸部CT検査で左肺下葉に内部に低吸収域を伴う腫瘤影を認めた．増大傾向を認め，原発性肺癌が疑われたため左肺下葉切除術を施行した．病理組織所見では悪性所見は認めず，高度な炎症性細胞浸潤，膿瘍形成，杯細胞減少など潰瘍性大腸炎活動期の腸管病変に類似した所見であったため，臨床経過と併せて潰瘍性大腸炎合併肺肉芽腫と診断した．潰瘍性大腸炎を含めた炎症性腸疾患はさまざまな臓器に腸管外合併症を認めることがあり，炎症性腸疾患に合併する肉芽腫は肺癌との画像診断は困難である．病理組織学的にも多彩な所見を示すため，少量の検体量では確定診断は困難な場合が多く，手術検体を用いた病理組織学的診断が必要となることがある．

Four cases of completion lobectomy for locally relapsed lung cancer after segmentectomy

Suzuki S., Asakura K., Masai K., Kaseda K., Hishida T., Asamura H.

World Journal of Surgical Oncology （World Journal of Surgical Oncology） 19 （ 1 ） 47 2021年12月

Background: Although completion lobectomy is the treatment of choice for local recurrence of non-small cell lung cancer after segmentectomy, few cases have been reported. We report four patients who underwent completion lobectomies for staple line recurrence after segmentectomy for stage I non-small cell lung cancer. Case presentation: Three women aged 65, 82, and 81 years underwent completion lower lobectomy after superior segmentectomy of the same lobe for local recurrence of stage I non-small cell lung cancer. A 67-year-old man, who had a tumor recurrence on the staple line after apical segmentectomy with superior mediastinal nodal dissection for stage I non-small cell lung cancer, underwent completion right upper lobectomy. These four patients underwent segmentectomy because of comorbidities or advanced age. Local recurrence was confirmed by computed tomography-guided needle biopsy. The interval between the two operations was 37, 39, 41, and 16 months, respectively. Although minimal hilar adhesion was seen for the three completion lower lobectomies, tight adhesions after apical segmentectomy made completion right upper lobectomy quite difficult to dissect, which led to injury of the superior pulmonary vein. No recurrence was recorded after completion lobectomies for 62, 70, 67, and 72 months, respectively. Conclusions: Although completion lobectomy is one of the most difficult modes of resection, among several completion lobectomies, completion lower lobectomy after superior segmentectomy without superior mediastinal nodal dissection was relatively easy to perform because of fewer hilar adhesions.

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Micronodular thymoma with lymphoid stromaの二切除例

大村征司, 政井恭兵, 加勢田馨, 朝倉啓介, 菱田智之, 淺村尚生

日本呼吸器外科学会雑誌（特定非営利活動法人日本呼吸器外科学会） 35 （ 6 ） 705 - 711 2021年09月

ISSN 09190945

Micronodular thymoma with lymphoid stroma（リンパ性間質を伴う小結節性胸腺腫，以下MNTLS）は胸腺腫の1.4%を占める比較的稀な胸腺腫の一型である．今回我々は二例のMNTLSを経験した．症例1．60歳女性．胸部CTで前縦隔に17 mm大の結節を指摘され，胸腔鏡下前縦隔腫瘍切除術を施行した．症例2．70歳女性．胸部CTで前縦隔に18 mm大の結節を指摘され，胸腔鏡下前縦隔腫瘍切除術を施行した．いずれの腫瘍もBリンパ球が豊富な間質を背景に，腫瘍細胞が敷石状に広がっており，MNTLSと診断した．MNTLSは，針生検や迅速診断ではAB型胸腺腫や胸腺リンパ濾胞過形成と誤診される可能性もあるが，過去の報告では予後は良い疾患であり症例1においては術後4年，症例2においては術後1年6ヵ月経過した現在も無再発生存中である．文献的考察を加えて報告する．

Debulking surgery for malignant tumors: The current status, evidence and future perspectives

Hishida T., Masai K., Kaseda K., Asakura K., Asamura H.

Japanese Journal of Clinical Oncology （Japanese Journal of Clinical Oncology） 51 （ 9 ） 1349 - 1362 2021年09月

ISSN 03682811

Debulking surgery, also called cytoreductive surgery, is a resection of the tumor as much as possible and an intended incomplete resection for unresectable malignant tumors. Since the most important principle in surgical oncology is complete R0 resection, debulking surgery goes against the basic principle and obscures the concept of operability. However, debulking surgery has been advocated for various types of advanced malignant tumors, including gynecological cancers, urological cancers, gastrointestinal cancers, breast cancers and other malignancies, with or without adjuvant therapy. Positive data from randomized trials have been shown in subsets of ovarian cancer, renal cell carcinoma, colorectal cancer and breast cancer. However, recent trials for renal cell carcinoma, colorectal cancer and breast cancer have tended to show controversial results, mainly according to the survival improvement of nonsurgical systemic therapy alone. On the other hand, debulking surgery still has a therapeutic role for slow-growing and borderline malignant tumors, such as pseudomyxoma peritonei and thymomas. The recent understanding of tumor heterogeneity and clonal evolution responsible for malignancy and drug resistance indicates that select patients may obtain prolonged survival by the synergistic effect of debulking surgery and novel systemic therapy. This review aimed to describe the current status and evidence of debulking surgery in a cross-organ manner and to discuss future perspectives in the current era with advances in systemic therapy.

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内視鏡治療が奏効せず気管管状切除・再建術を要した挿管後気管狭窄の1例

田中浩登, 大塚崇, 菱田智之, 大村征司, 鈴木幹人, 政井恭兵, 加勢田馨, 朝倉啓介, 淺村尚生

気管支学（特定非営利活動法人日本呼吸器内視鏡学会） 43 （ 3 ） 231 - 236 2021年05月

ISSN 02872137

背景．挿管後気管狭窄に対する治療は，外科的な気管切除・再建術が長期開存性に優れるとされ推奨されてきた．一方，近年内視鏡機器・技術の進歩に伴い，内視鏡下拡張術の報告も増加しているが，その適応や長期成績は十分検討されていない．症例．患者は23歳，女性．1年前に交通外傷で他院に搬送され，意識障害に対して5日間の経口気管内挿管，人工呼吸管理が施行された．抜管40日後より，咳嗽と呼吸困難を自覚し，喘息として治療されたが軽快しないため，精査・加療目的に当院へ紹介受診となった．胸部CT画像および気管支鏡検査所見上，狭窄長2.1 cmの瘢痕性気管狭窄を認め，挿管後気管狭窄の診断の元，緊急で硬性気管支鏡による拡張術を施行した．しかし，その後に再狭窄が生じ，硬性鏡下に拡張術を再度行ったが再々狭窄を認めたため，気管管状切除・端々吻合術を施行した．術後2年6カ月経過した現在，再狭窄の徴候は認めていない．結論．瘢痕性の挿管後気管狭窄に対し，硬性鏡下での拡張術を複数回施行したものの再狭窄を繰り返したため，外科的気道再建術を行い良好な経過を得た1例を経験した．

Video-Assisted Thoracoscopic Surgery for Stage I Thymoma: Short-Term Outcomes and Appropriate Indications

Suzuki, T; Hishida, T; Maeda, C; Matsuda, K; Nakagomi, T; Omura, S; Tanaka, H; Masai, K; Kaseda, K; Asakura, K; Asamura, H

JOURNAL OF THORACIC ONCOLOGY 16 （ 3 ） S389 - S390 2021年03月

ISSN 1556-0864

A case of solitary pulmonary metastasis from thymoma resected 19 years after surgery

Suzuki M., Kaseda K., Masai K., Asakura K., Hishida T., Hayashi Y., Asamura H.

Japanese Journal of Lung Cancer （Japanese Journal of Lung Cancer） 60 （ 5 ） 401 - 406 2020年10月

ISSN 03869628

© 2020 The Japan Lung Cancer Society. Background. Thymoma is a low-grade malignant epithelial tumor arising in the thymus and rarely metastasizes to distant sites after complete resection. We herein report a rare case of solitary pulmonary metastasis of type Bl thymoma. Case. A woman in her 70s underwent thymectomy with partial resection of the pericardium and right upper lobe for type Bl thymoma 19 years ago. The pathological stage was T3N0M0 Stage III with invasion to the right lung. She received postoperative radiotherapy of 50 Gy with 25 Fr and had no evidence of recurrence until the detection of a 0.8-cm solitary pulmonary nodule in the right lower lobe on follow-up computed tomography (CT) performed 13 years after surgery. The pulmonary nodule gradually grew over the next seven-year follow-up, so we performed wedge resection of the right lower lobe for the diagnosis and treatment. Pathologically, the nodule consisted of epithelial cells with slightly large nuclei and inconspicuous atypia surrounded by a lot of lymphocytes. Immunohistochemically, the epithelial cells were positive for AE1/AE3 and CK19, while the lymphocytes were positive for CD3 and TdT. These findings were similar to those shown in the initial thymoma specimen, and the diagnosis of pulmonary metastasis of type Bl thymoma was made. The patient is doing well 23 months after pulmonary metastasectomy with no evidence of re-recurrence of thymoma. Conclusion. We herein report a resected case of slow-growing pulmonary metastasis from type Bl thymoma with a review of the literature. In cases of type A-Bl thymoma, we should consider the possibility of late recurrence and perform long-term follow-up.

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Recent and current advances in FDG-PET imaging within the field of clinical oncology in NSCLC: A review of the literature

Kaseda K.

Diagnostics （Diagnostics） 10 （ 8 ） 2020年08月

© 2020 by the author. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). Lung cancer is the leading cause of cancer-related deaths around the world, the most common type of which is non-small-cell lung cancer (NSCLC). Computed tomography (CT) is required for patients with NSCLC, but often involves diagnostic issues and large intra- and interobserver variability. The anatomic data obtained using CT can be supplemented by the metabolic data obtained using fluorodeoxyglucose F 18 (FDG) positron emission tomography (PET); therefore, the use of FDG-PET/CT for staging NSCLC is recommended, as it provides more accuracy than either modality alone. Furthermore, FDG-PET/magnetic resonance imaging (MRI) provides useful information on metabolic activity and tumor cellularity, and has become increasingly popular. A number of studies have described FDG-PET/MRI as having a high diagnostic performance in NSCLC staging. Therefore, multidimensional functional imaging using FDG-PET/MRI is promising for evaluating the activity of the intratumoral environment. Radiomics is the quantitative extraction of imaging features from medical scans. The chief advantages of FDG-PET/CT radiomics are the ability to capture information beyond the capabilities of the human eye, non-invasiveness, the (virtually) real-time response, and full-field analysis of the lesion. This review summarizes the recent advances in FDG-PET imaging within the field of clinical oncology in NSCLC, with a focus on surgery and prognostication, and investigates the site-specific strengths and limitations of FDG-PET/CT. Overall, the goal of treatment for NSCLC is to provide the best opportunity for long-term survival; therefore, FDG-PET/CT is expected to play an increasingly important role in deciding the appropriate treatment for such patients.

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Clinicopathological and prognostic features of operable non-small cell lung cancer patients with diabetes mellitus

Kaseda K., Hishida T., Masai K., Asakura K., Hayashi Y., Asamura H.

Journal of Surgical Oncology （Journal of Surgical Oncology） 123 （ 1 ） 332 - 341 2020年

ISSN 00224790

© 2020 Wiley Periodicals LLC Background: The aim of this study was to investigate the clinicopathological and prognostic features of operable non-small cell lung cancer (NSCLC) patients with diabetes mellitus (DM). Methods: A total of 1231 surgically resected NSCLC patients were retrospectively reviewed. Clinicopathological characteristics were compared between patients with DM (DM group, n = 139) and those without DM (non-DM group, n = 1092). The clinical factors associated with postoperative complications and prognostic factors were identified. Results: The DM group had distinct clinicopathological features. No significant differences in histological invasiveness or stage were found. The presence and control status of DM were independent predictors of postoperative complications. No significant differences in recurrence-free survival or cancer-specific survival were observed; however, the DM group had worse overall survival (OS). The DM group had a higher number of deaths from other diseases than the non-DM group, and these patients had significantly higher postoperative hemoglobin A1c levels than patients with cancer-related death. Conclusion: The presence and control status of preoperative DM are useful predictors of both postoperative complications and OS in operable NSCLC patients. Concomitant diabetes-related complications have a negative effect on long-term survival in diabetic NSCLC patients, and long-term glycemic control is important to prolong OS.

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A case of lipofibroadenoma of the thymus

Hamada K., Kaseda K., Omura S., Suzuki M., Tanaka H., Suzuki Y., Kuriyama S., Sakamaki H., Shima T., Yotsukura M., Masai K., Hashimoto K., Takahashi Y., Hishida T., Ohtsuka T., Hayashi Y., Nakatani Y., Asamura H.

Japanese Journal of Lung Cancer （Japanese Journal of Lung Cancer） 58 （ 3 ） 237 - 238 2018年06月

ISSN 03869628

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Role of Surgery in Multimodality Treatment for Non-small Cell Lung Cancer;Current Status and Future Perspectives

Shima T., Masai K., Hishida T., Kaseda K., Hashimoto K., Takahashi Y., Otsuka T., Asamura H.

Kyobu geka. The Japanese journal of thoracic surgery （Kyobu geka. The Japanese journal of thoracic surgery） 71 （ 4 ） 244 - 248 2018年04月

ISSN 00215252

Recent improvement of outcomes for resected non-small cell lung cancer (NSCLC) has been contributed not only by increased detection of early-stage disease and improvement of preoperative diagnosis/perioperative management but also by improvement of multimodality treatment. The introduction of newly developed systemic therapies including molecular targeted agents and immune checkpoint inhibitors dramatically changed clinical outcomes of advanced NSCLC. Accordingly, the role of surgery during the multimodality treatment will be changed more than ever. In this article, we overviewed the current status of the multimodality treatment for clinical stageⅢ (N2)disease and postoperative adjuvant therapy and discussed the role of surgery during these situations. We also discussed the future perspectives of the role of surgery during the multimodality treatment for advanced NSCLC.

Prognostic significance of preoperative plasma D-dimer level in patients with surgically resected clinical stage I non-small cell lung cancer: a retrospective cohort study.

Kaseda K, Asakura K, Kazama A, Ozawa Y.

J Cardiothorac Surg （Springer） 28 （ 12 ） 102 2017年11月

研究論文（学術雑誌）, 査読有り, ISSN 1749-8090

BACKGROUND: Plasma D-dimer level, a marker of hypercoagulation, has been reported to be associated with survival in several types of cancers. The present study aimed to evaluate the prognostic significance of preoperative D-dimer levels in patients with surgically resected clinical stage I non-small cell lung cancer (NSCLC). METHODS: Participants comprised 237 patients with surgically resected clinical stage I NSCLC. In addition to factors such as age, sex, and smoking status, the association between preoperative D-dimer level and survival was explored. RESULTS: Patients were divided into two groups according to D-dimer level: Group A, </= 1.0 mug/ml (n = 170); and Group B, > 1.0 mug/ml (n = 67). The 5-year recurrence-free survival rate was 81.6% for Group A and 66.6% for Group B (p < 0.001). The 5-year overall survival rate was 93.6% for Group A and 84.7% for Group B (p = 0.002). Multivariate survival analysis identified D-dimer level as an independent prognostic factor, along with age, maximum standardized uptake value of the primary tumor, and pathological stage. CONCLUSIONS: Preoperative D-dimer level is an independent prognostic factor in patients with surgically resected clinical stage I NSCLC.

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