Biomedical subjects

Yu-Chung Wu

Publications and source records attributed to Yu-Chung Wu.

25 records · Page 2Linked to original sources

PubMed2003

Long-term results of pathological stage I non-small cell lung cancer: validation of using the number of totally removed lymph nodes as a staging control.

OBJECTIVE: The number of totally removed lymph nodes during thoracotomy was used alternatively to represent the quality of lymphadenectomy in patients with pathologic stage I non-small cell lung cancer (NSCLC). We combined this new parameter with other well-established prognostic factors and performed multivariate survival analyses to validate its usage as a stage control. METHODS: Three hundred and twenty-one patients who underwent complete surgical resection for stage I NSCLC were reviewed retrospectively. Aside from the number of lymph nodes removed during thoracotomy, other well-known clinical and histopathological factors were also included as possible prognostic factors for analysis. Two survival analyses, overall death and cancer-related death as study end-point, were performed, using the Kaplan-Meier method and multivariable Cox's proportional hazard regression analysis. Stepwise method of variable selection was employed to choose the 'best' Cox proportional hazard model in each survival analysis. RESULTS: The overall 5- and 10-year survival rates were 48 and 35%, and the cancer-related 5- and 10-year survival rate was 63.3 and 58.3%, respectively. The number of totally removed lymph nodes during thoracotomy, tumor size and smoking history in multivariable analysis significantly affected both overall and cancer-related survival rates. Cell type of adenocarcinoma or large cell carcinoma was associated with a worse cancer-related survival compared with other histological types. CONCLUSIONS: The quality of lymphadenectomy, represented quantitatively by the number of totally removed lymph nodes during thoracotomy, may impact on a more accurate tumor stage, and will affect the survival rate for patients with stage I NSCLC as well as other well known clinical and histopathological factors.

Adult↗

PubMed2003

Sclerosing hemangioma of the lung: an analysis of 44 cases.

BACKGROUND: Sclerosing hemangioma is a rare benign lung tumor. Preoperative diagnosis of this tumor is difficult, and sometimes even intraoperative frozen sections cannot differentiate it from malignant tumors. Herein, we present our experiences in investigating its characteristics. METHODS: The medical records and pathological examinations of patients diagnosed with sclerosing hemangioma from 1982 to 2001 at the Division of Thoracic Surgery in Taipei-VGH were retrospectively reviewed. RESULTS: The incidence of sclerosing hemangioma in benign lung tumors resected during that period was 32.8%. There were 44 patients (7 male and 37 female) aged from 16 to 72 years, with a peak at fifth decade, and 72.7% of them were asymptomatic. Accurate preoperative diagnosis by chest CT could be achieved in only 20% (4/20) of patients, and malignancy could not be ruled out in 40% (8/20) of tumors. Histologically, this tumor exhibits four major patterns: solid, sclerotic, papillary and hemorrhagic. Five patients in this series had predominantly one pattern. At least two patterns existed in the remaining 39 patients, including eight patients who had tumors with all four patterns. There was no operative mortality or tumor recurrence despite that different operative methods were undertaken. CONCLUSIONS: Although rare, sclerosing hemangioma still accounts for the second common benign lung tumor in the current series. Chest CT and bronchoscopic examinations could not make accurate diagnosis preoperatively, and thoracotomy is usually indicated for definite diagnosis and treatment. Limited resection is warranted in view of uncommon tumor recurrence. In addition, multiple nodular lesions could not exclude the possibility of sclerosing hemangioma.

Adolescent↗

PubMed2003

The role of mediastinoscopy in the evaluation of thoracic disease and lung cancer.

BACKGROUND: Mediastinoscopy is a widely used technique in the diagnosis of mediastinal disease and the staging of bronchogenic carcinoma. Its efficacy in the preoperative staging of lung cancer is well-established, with a procedural sensitivity of greater than 90% and specificity of 100%. Mediastinoscopy can also establish the diagnosis in greater than 90% of mediastinal disease. We conducted a retrospective study of mediastinoscopy performed at our institution between 1998 and 2001 to evaluate the safety and efficacy of mediastinoscopy. METHODS: We collected 100 consecutive mediastinoscopies performed in Thoracic Division of Taipei Veterans General Hospital between 1998 and 2001. The indications for mediastinoscopy included mediastinal mass or lymphadenopathy and the staging of lung cancer. Some patients had the undetermined lung mass with enlarged mediastinal lymph node. RESULTS: There were 69 men and 31 women aged from 13 to 87 (mean 60.9). Sixty-seven patients had mediastinoscopy for the staging of lung cancer, 29 patients for diagnosis of mediastinal mass or lymphadenopathy, and 4 patients for undetermined lung mass with mediastinal lymphadenopathy. Among the patients with mediastinal disease, sarcoidosis was diagnosed in 13 patients, and lymphoma in 5 patients. N2 or N3 nodal metastasis was revealed in 38 of 67 patients who had lung cancer. Fifteen patients with negative mediastinoscopy proceeded to thoracotomy for tumor resection. Seventeen patients received neoadjuvant chemotherapy followed by resection. There were three complications, all due to bleeding, and no mortality. CONCLUSIONS: Mediastinoscopy is a safe and effective procedure for the diagnosis of mediastinal disease and the staging of lung cancer. In cases of lung cancer, mediastinoscopy can provide more accurate evaluation of mediastinal lymph node metastasis than conventional diagnostic tools like computed scan or magnetic resonance image with low morbidity and mortality.

Adolescent↗

PubMed2003

Surgical results of squamous cell carcinoma of the esophagus in young patients.

BACKGROUND: Squamous cell carcinoma of the esophagus (ESCC) is one of the ten most common cancers in Taiwan. Surgical resection is the mainstay of the treatment. Young patients with ESCC are reported to have poor surgical outcome. This retrospective and comparative study is to evaluate the clinicopathologic difference and survival between young and elderly patients. METHODS: From January 1985 to December 2000, totally 797 patients with esophageal cancer received esophagectomy with reconstruction at our institution. Among them, 12 patients who received neoadjuvant concurrent chemo-radiotherapy followed by esophagectomy were excluded from this study. The other 785 patients were divided into two groups. Group I included 67 patients aged 50 or younger (8.5%) and group II included 718 patients aged over 50 years (91.5%). The clinical data were collected by chart review and follow-up data were collected through outpatient department record or telephone contact. These two groups were analyzed and compared regarding sex ratio, exposure to tobacco or alcohol, surgical mortality rate and 5-year survival rate. RESULTS: There was no difference in gender distribution between young and old patients groups. More patients in the young patients group had the habits of alcohol and tobacco consumption than in the elder patients group. The surgical (30-day) mortality was 2.98% in the young patient group, and 5.43% in the elder group. The 5-year survival rate was better in young patients group than in elder patients group but there was no statistical significance. Survival in young patients group was significantly related to TNM staging system. CONCLUSIONS: More young patients with ESCC had the habit of smoking and drinking. There was no statistical difference between the groups in clinical variables, surgical mortality and survival. The survival rate was significantly related to the TNM tumor stage.

Age Factors↗

PubMed2002

Primary thymic carcinoma.

BACKGROUND: Thymic carcinoma is a malignancy of the anterior mediastinum, always with poor prognosis. Up to the present, very few articles have discussed and evaluated either the clinical or pathologic features or treatments of this tumor. Therefore, we are in a position to analyze our research data to support our belief as follows. METHODS: From January 1977 until December 1997, we received 614 patients who were diagnosed with anterior mediastinal tumors. Of the 614 patients, 38 patients (6.2%) were diagnosed with thymic carcinoma, including 26 men and 12 women. Data were collected from clinical records and personal interviews with the patients. Classification of these patients' tumor stages was based on the Masaoka staging system. RESULTS: We proceeded with surgery for 15 of the 38 patients to remove their tumors. Complete resection was done in 8 of these 15 patients (21.0%), whereas debulking was done in the other 7 (18.4%) patients. The mean survival time of all the patients in this study (excluding 3 patients who were lost to follow-up) was 53.0 months, with a median of 24.1 months. The overall cumulative survival rate was 38.6% at 3 years and 27.5% at 5 years. The data in this research show that tumor grading (p = 0.01), resectability (p = 0.02), and stage (p = 0.04) have statistically significant influence on patients' survival. CONCLUSIONS: The grade, stage, and resectability of the tumor are decisive factors of the effectiveness of either surgery or chemo/radiotherapies in the treatment of thymic carcinoma.

Adult↗

PubMed2002

Adenoid cystic carcinoma of the trachea and bronchus--a clinicopathologic study with DNA flow cytometric analysis and oncogene expression.

OBJECTIVE: Adenoid cystic carcinoma (ACC) of the tracheobronchial tree is quite uncommon. The clinicopathologic analysis and the therapeutic outcomes of tracheobronchial ACC have been reported earlier. However, their biological behavior should differ from other tracheal neoplasms. Thus, DNA flow cytometric analysis and biomarkers of p53, HER-2/neu and COX-2 for tracheobronchial ACC were investigated in order to evaluate their clinicopathological significance. METHODS: Between 1985 and 1999, nine patients with tracheobronchial ACC were included for the study. All the patients had pathologically confirmed ACC. Five were male and four were female. Eight patients underwent surgical resections. Seven paraffin embedded tumors from six patients were available for DNA flow cytomeric analysis and immunohistochemical staining of p53, HER-2/neu and COX-2. RESULTS: Histologically, nine pathologic specimens from eight surgical patients (including one patient received operation twice) showed one grade I, five grade II and three grade III. The mitotic activity, lymphatic invasion and vascular invasion were more frequent in advanced grading tumor. The higher grade tumors seemed to be associated with a higher synthetic phase fraction (SPF). Immunohistochemically, except for one grade II tumor showing positive expression of HER-2/neu, all the seven tumorous samples revealed negative expressions of p53, COX-2 and HER-2/neu. The patient with positive HER-2/neu tumor had distant metastases 4 years after surgery. CONCLUSIONS: Complete surgical resection may provide best survival for tracheobronchial ACC. The DNA ploidy and SPF may correlate with tumor grading or metastasis. The overexpressions of HER-2/neu, p53 and COX-2 may impact the prognosis in patients with stage I non-small cell lung cancer, but did not express difference in our patients.

Adult↗

PubMed2002

Pulmonary resection for metastases from colorectal adenocarcinomas.

BACKGROUND: Colorectal cancer is one of the most common cancers in Taiwan, as in the other part of the world. Surgical intervention is the best treatment of choice, yet some patients still developed distant metastasis after primary lesions were controlled. Metastasectomy is reported to improve the survival. This retrospective study was carried out to evaluate the relationship between the prognostic factors of lung metastasectomy and patient survival. METHODS: From 1981 to 2000, 68 patients undergoing complete lung metastasectomy in our section were studied. The prognostic factors influencing survival were analyzed, and the survival analysis was made with Kaplan-Meier method and compared by log-rank test. RESULTS: There was no surgical mortality in our series. The 5-year survival was 36.1%. None of parameters such as age, sex, stage of primary colorectal cancer, surgical method, size, number of metastatic deposits and disease free interval showed to relate with the survival. CONCLUSIONS: We concluded that lung metastasectomy for colorectal cancer is safe and effective to improve the survival. Since there were no significant factors influencing the survival, there should be no absolute contraindication against resectable pulmonary metastasis after primary lesions were adequately controlled.

Adenocarcinoma↗