Prognostic assessment after surgical resection for non-small cell lung cancer: experiences in 2083 patients.

The importance of the TNM staging system for patient management, clinical research and communicating information about lung cancer is of international importance. Modifications of the TNM classification system is scheduled for the near future. A retrospective review of 2376 patients with primary non-small cell lung cancer treated in a monocentric institution between 1996 and 2005 was performed.

[Prognosis after complete surgical resection for non-small cell lung cancer based on the staging classification].

Background And Objective: The importance of accurate staging according to the international TNM staging system of non-small cell lung cancer (NSCLC) for patient management and ascertaining individual prognosis cannot be overemphasized. The TNM classification is scheduled to be revised in 2007. In a large single-center collective we investigated the prognosis for patients who had complete resection of a NSCLC.

Networking in shared care--first steps towards a shared electronic patient record for cancer patients.

Objectives: This paper aims at identifying the data protection and security requirements for a cross-institutional EPR. Three possible models and the first steps towards a cross-institutional EPR for the Thoraxklinik Heidelberg and the Department of Clinical Radiology of the University Medical Center of Heidelberg shall be discussed.

Methods: A comprehensive analysis of literature and legal documents supplied information for determining the data protection and security requirements.

Coping and survival in lung cancer: a 10-year follow-up.

Objective: Little evidence is available to clarify the influence of psychological variables on the outcome of cancer. The authors studied whether style of coping was predictive of survival in lung cancer.

Method: A cohort of 103 patients newly diagnosed with cancer was followed for 10 years.

Using the eXtensible Markup Language (XML) in a regional electronic patient record for patients with malignant diseases.

Communication between different institutions which are responsible for the treatment of the same patient is of outstanding significance, especially in the field of tumor diseases. Regional electronic patient records could support the co-operation of different institutions by providing ac-cess to all necessary information whether it belongs to the own institution or to a partner. The Department of Medical Informatics, University of Heidelberg is performing a project in co-operation with the Thoraxclinic-Heidelberg and the Department of Clinical Radiology, University of Heidelberg with the goal: to define an architectural concept for interlinking the electronic patient record of the two clinical institutions to build a common virtual electronic patient record and carry out an exemplary implementation, to examine composition, structure and content of medical documents for tumor patients with the aim of defining an XML-based markup language allowing summarizing overviews and suitable granularities, and to integrate clinical practice guidelines and other external knowledge with the electronic patient record using XML-technologies to support the physician in the daily decision process.

Long-term survival in small cell lung cancer patients is correlated with high interleukin-2 secretion at diagnosis.

Purpose: We have previously reported significant impairment of IL-2 secretion in patients with small cell lung cancer (SCLC) at the time of diagnosis. Impairment of IL-2 secretion correlated with reduced survival in SCLC. This new prognostic factor was independent of other factors of prognostic relevance in SCLC.

Immunochemical analysis of cathepsin B in lung tumours: an independent prognostic factor for squamous cell carcinoma patients.

In order to evaluate the possible role of the proteolytic enzyme cathepsin B (cath B) in human non-small cell lung cancer (NSCLC) we examined cath B concentrations (cath B(C)) and activities (cath B(A)) in homogenates of 127 pairs of lung tumour tissues and corresponding non-tumourous lung parenchyma. Total cath B activity (cath B(AT)) and enzymatic activity of the fraction of cath B, which is stable and active at pH 7.5 (cath B(A7.

Coping, distress, and survival among patients with lung cancer.

Background: This study addresses the question of whether coping and emotional state are predictors of survival among patients with lung cancer. The hypotheses were (1) active coping is linked with longer survival time and (2) depressive coping, emotional distress, and depression are linked with shorter survival.

Methods: The study was based on a sample of 103 patients who were investigated after their diagnosis and before the beginning of primary treatment.

Sequential hepatic and pulmonary resections for metastatic colorectal cancer.

Background: Resection of pulmonary or hepatic colorectal metastases is associated with a 5-year survival rate of 25-40 per cent. This report analyses outcome following sequential resection of colorectal metastases to both organs.

Methods: Seventeen patients with histologically confirmed colorectal adenocarcinoma and resection of liver and lung metastases were identified from a prospective database.

[Treatment strategy in pleural mesothelioma].

The development of diffuse malignant pleural mesothelioma is associated with exposure to asbestos. The surgical treatment comprises a radical pleuropneumonectomy with resection of the pericardium and diaphragm (P3D) or palliative pleurectomy/decortication of the tumor. The prognosis in general is poor.

[Incomplete resections in bronchial carcinoma: morbidity and prognosis].

Residual tumor (R1) was proven at the proximal bronchial resection margin in 88 (3.6%) of 2464 cases of lung cancer following lung resection and standard lymph node dissection. Postoperative complications (8%) were: fistula of the bronchial suture line (n = 7), bleeding (n = 2) and heart luxation (n = 1).

[Do psychological factors modify survival of cancer patients? II: Results of an empirical study with bronchial carcinoma patients].

The present prospective test study of hypotheses addressed the question whether psychological factors are predictive of survival time in lung cancer patients. The hypotheses were: Emotional distress, depression and depressive coping are associated with shorter survival; hope and active coping with longer survival. The study was based on a sample of n = 103 patients who were investigated post-diagnosis and before the beginning of primary treatment.

Decrease of interleukin-2 secretion is a new independent prognostic factor associated with poor survival in patients with small-cell lung cancer.

Background: We have previously shown that suppression of interleukin-2 (IL-2) secretion was mediated by transforming growth factor (TGF) beta 1 secreted by small-cell lung cancer (SCLC) tumor cells. We have also shown that IL-2 secretion was significantly impaired in patients with SCLC at the time of diagnosis. Reconstitution of cytokine secretion correlated with reduction of tumor load.

[Surgical information systems as instruments in quality assurance].

In various aspects, it is important to document medical procedures performed in surgical management. These records have become even more relevant because, in realizing the German health structure law, new forms of remuneration have been established, which are correlated with defined services. This means that data from medical documentation records today "rule" on financial compensation and, consequently, on the total economy of a hospital.

[Radical surgery and lymph node dissection in bronchial carcinoma].

Lymphatic spread of bronchial carcinoma can involve each position in the mediastinum. Localisation of the primary tumor has no influence. Metastatic skipping of topographical lymph node positions is not calculable.

[Surgical therapy of lung metastases. An interdisciplinary responsibility].

Surgical therapy of lung metastases is now an established procedure. The operation's purpose is radical, and therefore potentially curative, resection. There are also diagnostic and palliative indications.

Induction chemotherapy with and without recombinant human granulocyte colony-stimulating factor support in locally advanced stage IIIA/B non-small cell lung cancer.

Patients with non-small cell lung cancer (NSCLC) in stage IIIA with more than minimal N2 involvement or in stage IIIB are considered unresectable. Response rates to chemotherapy for these patients are in the range of 40%. Reduction of tumor mass by induction chemotherapy may lead to resectability and to improved survival.

Surgery for pulmonary metastases. The Heidelberg experience.

The surgical treatment of pulmonary metastases is now an established technique in the interdisciplinary concept of oncologic therapy. The authors' finding of a 5-year actuarial survival rate of 33% corresponds with the international standard. Unfortunately, data are only rarely provided as to whether the operations were curative or noncurative.

[Surgery for bronchial carcinoma with mediastinal lymph node involvement].

Or the 3000 patients analyzed in the prospective bronchial carcinoma field study, 1086 were operated between 1984 and 1989. Complete systematic mediastinal lymphadenectomy was performed in 661 patients to assess the PTNM stage as exactly as possible, and to improve prognosis. Lymphadenectomy removes all hylarand mediastinal lymph nodes.

New aspects in the staging of lung cancer. Prospective validation of the International Union Against Cancer TNM classification.

Background And Methods: To validate the new TNM definitions for lung cancer (International Union Against Cancer [UICC] TNM classification, 4th edition, 1987), the data of 3823 patients were analyzed prospectively in terms of concordance between clinical (TNM) and pathologically confirmed classification (pTNM), the value of the various diagnostic techniques in estimating the pathologically confirmed classification, and the prognostic relevance of the new TNM definitions.

Results: With regard to the primary tumor (T), clinical and pathologic classifications were identical in 63%; with regard to lymph node involvement (N), the agreement was 47%; for distant metastasis agreement occurred in 91% of cases and for the stages it occurred in 56%. As to the primary tumor (T), the accuracy of radiography (59%) was nearly identical to that of computed tomography (CT) (58%).

[Extended resection in tumor surgery of the lung].

Out of 3823 prospectively followed patients with bronchial carcinoma, 1404 were operated upon. After radical resection, prognoses for 5-year survival in T3 and T4 tumors was 22% and 10%, respectively. Resection was carried out in 190 T3 tumors and 202 T4 tumors.

Results in surgery of pulmonary metastases.

Nowadays surgical treatment of pulmonary metastases is a generally accepted therapeutic concept. Between 1973 and 1991 surgical resection was indicated in 655 patients, and 752 thoracotomies were carried out including 65 laser resections. Median sternotomy has become the preferred access, as the preoperative staging is not exact enough concerning the number of the metastases.