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The detection of micrometastases in patients with operable non-small cell lung carcinoma (NSCLC) could have a considerable influence on the choice of a proper treatment.The aim of the study was to evaluate the usefulness of microscopic examination and immunohistochemistry for the detection of micrometastases or single malignant cells in the bone marrow of patients undergoing surgery for NSCLC, as their late survival and recurrence-free time is dependent on immunohistochemical markers of cancer metastases in the bone marrow.Material and methods. Thirty-five patients were included in the study. Their age range was from 47 to 78 years old. Bone marrow was obtained from a rib during surgery for lung cancer. Both a resected tumour and bone marrow sample were tested for the presence of cytokeratins AE1/AE3, CAM 5.2, CK-7, and CK-18 and other indicators such as CD31 and CD34. The mean time of observation was 871.6 days.Results. Microscopic examination detected no malignant cells or micrometastases in the bone marrow in the analyzed group. Cytokeratin CAM 5.2 was detected in 33 cases (94.23%) in a lung tumour and in 21 cases (60%) in the bone marrow. Statistical analysis (chi2 NW), showed a statistically significant relationship between the presence of CAM 5.2 expression in a tumour and in the bone marrow. In all analysed cases, the expression of cytokeratin AE1/AE2 was found in a tumour, but was not detected in any bone marrow sample. Cytokeratin CK-7 and CK-18 were present in a tumour in 20 (57.14%) and 23 (65.71%) patients, respectively. In the bone marrow, the expression of cytokeratin CK-7 was found in one case (2.86%), and CK-18 was not found in any patients. Thirteen (37.14%) patients died during follow-up. Local recurrence was diagnosed in three patients (8.57%) and distant metastases in 15 patients (42.86%). Mean recurrence-free time was 687.7 days.Conclusions. On the basis of immunohistological tests, it was shown that a significant correlation existed between the presence of cytokeratin CAM 5.2 expression in a tumour and in the bone marrow. Its presence in the bone marrow was a good predictive factor for recurrence-free time. Mortality and the frequency of locoregional recurrence and distant metastases depend on pathological lung cancer staging.
The aim of the study was to investigate the influence of bacterial colonisation of a neoplastic lung tumour on the frequency of infectious complications after radical surgical treatment of the malignancy.Material and methods. 49 patients operated on for non-small cell lung cancer (NSCLC) from 23rd January to 2nd November 2006 were included into the study. The analyzed group consisted of 39 men and 10 women, they were from 45 to 79 years old. Material for microbiological tests was collected in an operating theatre under sterile conditions directly after the resection of a tumour. A sample (5x5x5 mm) of the tumour was cultured for facultative anaerobes, obligate anaerobes and fungi. After the homogenisation of tumour tissues quantitative culture was also performed.Results. Potentially pathogenic microbes were cultured from tumours in 14 patients (28.6%). The most frequent bacterium was Propionibacterium acnes. It was found in six out of 49 tumours (12.2%). In 13 cases (26.6%) postoperative infectious complications were observed. They were as follows: infection of the lower airways - 8 cases (16.3%), surgical wound infection - 3 cases (6.1%), pleurisy - 1 case (2%) and pleural empyema - 1 case (2%). In 12 patients (24.5%) pathogenic microbes were isolated from biological material obtained from other sources than a tumour. In remaining 36 patients (73.5%) no infectious postoperative complications were observed. In 13 patients in whom bacteria were cultured from a tumour there were no postoperative infectious complications. Only in one patient the same bacterium (Staphylococcus aureus) was identified in a tumour and 35 days later in pleural effusion where four other pathogenic bacteria were isolated, too. In 12 patients whose postoperative course was complicated by infections had no pathogenic microbes cultured from a resected tumour. Statistical analysis showed no significant relations between the presence of pathogenic microbes within a lung malignant tumour and postoperative infectious complications in patients.Conclusions. The most frequent microbe cultured from non-small cell lung carcinoma is Propionibacterium acnes. There is no relation between the colonisation of a malignant tumour by bacteria and postoperative complications in patients treated surgically for NSCLC.
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