Rie Nakahara

Chiba-East National Hospital, Tiba, Chiba, Japan

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Publications (26)50.37 Total impact

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    ABSTRACT: BACKGROUND: A greater proportion of ground-glass opacity (GGO) is well known to be strongly associated with less invasive lung adenocarcinoma. Recently, the solid area diameter has also been reported to be a simple and better marker for the same purpose compared with the whole nodule diameter. METHODS: From 1997 to 2009, 383 patients with clinical T1-2N0M0 non-small cell lung cancer (NSCLC) with a solid area of 3 cm or less underwent surgical resection, and their preoperative high-resolution computed tomographic images were preserved in Digital Imaging and Communications in Medicine format. Less invasive lung cancer was defined as having no vascular, lymphatic, or pleural invasion or lymph node metastasis. We compared the solid area and whole nodule diameters and proportion of GGO, with the objective of predicting less invasive lung cancer. RESULTS: Among the 383 patients, 187 were men, 335 had adenocarcinoma histologic type, 242 had less invasive lung cancer, and 43 experienced recurrence. Receiver operating characteristic (ROC) analysis to predict less invasive lung cancer showed that the area under the curve of proportion of GGO was the highest (0.848; 95% confidence interval [CI], 0.810-0.886), followed by the solid area diameter (0.785; 95% CI, 0.740-0.829), and then whole nodule diameter (0.621; 95% CI, 0.565-0.677). Multiple logistic regression analyses revealed that proportion of GGO was the only significant predictor of less invasive lung cancer. The proportion of GGO was also found to be a significant prognostic factor of disease-free survival (DFS) along with solid area diameter by multivariate analysis. Regardless of the solid area diameter, no patient with a greater proportion of GGO (> 50%) experienced recurrence. CONCLUSIONS: Proportion of GGO remains important for predicting less invasive lung cancer.
    The Annals of thoracic surgery 04/2013; · 3.45 Impact Factor
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    ABSTRACT: ABSTRACT OBJECTIVES: The positive results of screening computed tomography (CT) trial are likely to lead to an increase in the use of CT, and, consequently, an increase in the detection of subsolid nodules. Noninvasive methods including follow-up with CT, in order to determine which nodules require invasive diagnosis and surgical treatment, should be defined promptly. METHODS: Between 2000 and 2008, from our database of over 60,000 CT examinations, we identified 174 subsolid nodules, which showed a ground-glass opacity (GGO) area greater than 20% of the nodule and measured less than 2 cm in diameter, in 171 patients. We investigated the clinical characteristics and CT images of the subsolid nodules in relation to changes identified during the follow-up period. RESULTS: The nodule sizes ranged from 4 to 20 mm at the first presentation. Nonsolid nodules numbered 98. During the follow-up period, 18 nodules showed resolution or shrinkage, and 41 showed growth of 2 mm or more in diameter. The time to 2-mm nodule growth curves calculated by Kaplan-Meier methods indicated that the 2- and 5-year cumulative percentages of growing nodules were 13 and 23% in patients with nonsolid nodules and 38 and 55% in patients with part-solid nodules, respectively. Multivariate analysis disclosed that a large nodule size (>10 mm) and history of lung cancer were significant predictive factors of growth in nonsolid nodules. CONCLUSION: An effective schedule for follow-up with CT for subsolid nodules should be developed according to the type of subsolid nodule, initial nodule size, and history of lung cancer.
    Chest 07/2012; · 5.85 Impact Factor
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    ABSTRACT: The study aimed to evaluate the effectiveness of two new nodal classifications based on the number of metastatic lymph nodes (LNs) or ratio of metastatic to examined LNs (LNR) in making a prognosis, compared with the current nodal classification based on the location of metastatic LNs. We analyzed 651 non-small-cell lung cancer patients who had undergone complete resection with the removal of more than five LNs between 1986 and 2003, excluding preoperative treatment cases, and a Tis, T4, N3, and M1 status, along with limited resection and operative death cases. The cutoff numbers for each category in the two new nodal classifications (number of metastatic LNs (nN0-2): 0, 1-2, and >3, and LNR (rN0-2): 0, 1-12, and >12%) were defined so that the numbers corresponded with paired categories within the current nodal classification. The 5-year survival rate was 75.4% for patients with the N0 categories in all three classifications. The 5-year survival rates for patients with N1 and N2 categories were 52.2% and 42.6% according to the current nodal classification, 54.3% and 39.8% according to the number of metastatic LNs, and 58.8% and 35.0% according to the LNR, respectively. Although all three nodal classifications were independent prognostic factors along with the age and pathological T status, when the three nodal classifications were entered into multivariate analysis individually, the hazard ratio of rN2 was the highest, at 3.15, followed by that of nN2 at 2.96. The LNR followed by the number of metastatic LNs may be more effective prognostic indicators than the current nodal classification based on the location of metastatic LNs. For the future revision, the number of metastatic LNs and LNR should be evaluated as indicators for the nodal classification of lung cancer.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 05/2011; 41(1):19-24. · 2.40 Impact Factor
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    ABSTRACT: In the surgical treatment of lung cancers invading the superior vena cava (SVC), primary closure is preferred for reconstruction when the resected area is small, but the repaired vessel can become constricted. A novel method for SVC repair with azygos flap, which is a longitudinally opened azygos arch, is a facile and effective treatment, and may prevent a reduction in the lumen if the area of tumor invasion is small and close to the azygos arch. When the azygos arch is not invaded by the tumor, this procedure should therefore be considered as one alternative method for SVC reconstruction.
    Interactive Cardiovascular and Thoracic Surgery 11/2010; 11(5):519-21. · 1.11 Impact Factor
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    ABSTRACT: Standard treatment for lung cancer presenting as a superior sulcus tumor is induction chemoradiotherapy followed by surgery, which yields rates of about 70% complete resection and 50% 5-year survival rate. However, the surgical technique to achieve complete resection for superior sulcus tumor invading major anatomical sites including the subclavian artery is challenging. The anterior transcervical thoracic approach applied by Dartevelle and colleagues provides excellent exposure of the subclavian vessels. Grunenwald and associates have improved on this approach to preserve the clavicle and sternoclavicular joint. We applied the transmanubrial osteomuscular-sparing approach in two patients. In both cases, exposure of the subclavian vessels was excellent. In one case, the subclavian artery was resected and reconstructed with a polytetrafl uoroethylene graft. This patient has continued to show recurrence-free survival for more than 5 years. We outline our experience and review the literature on the surgical approach for superior sulcus tumor invading the anterior part of the thoracic inlet.
    General Thoracic and Cardiovascular Surgery 03/2010; 58(3):149-54.
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    ABSTRACT: The surgical technique to achieve complete resection for superior sulcus tumor invading major anatomical sites including the subclavian vessels is challenging. The anterior transcervical-thoracic approach applied by Dartevelle and colleagues provides excellent exposure of the subclavian vessels. Grunenwald and associates have improved on this approach to preserve the clavicle and sternoclavicular joint. This paper describes the merits of this approach and details how to perform this surgical procedure.
    Kyobu geka. The Japanese journal of thoracic surgery 01/2010; 63(1):23-7.
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    ABSTRACT: The optimal treatment method for thymoma with pleural dissemination remains controversial. We analyzed our experience with a multimodality approach and evaluated the role of extrapleural pneumonectomy (EPP) in the treatment of disseminated thymoma. Multimodality therapy was used to treat 11 consecutive patients with invasive thymoma disseminated into the pleural cavity. Disease was stage IVa in 9 and stage IVb disease with lymph node metastasis in 2. Our treatment strategy for those patients was induction chemotherapy with cisplatin, doxorubicin, and methylprednisolone (CAMP therapy), followed by thymectomy combined with resection of the visible disseminated nodules and postoperative radiotherapy. EPP was applied for 4 patients who had chemoresistant tumors or pleural refractory recurrence. Eight patients underwent induction chemotherapy. The response rate to CAMP was 85%. Thymectomy with or without the resection of disseminated pleural tumors was performed in 7 patients and EPP in 3. Postoperative radiotherapy was administered in 6. All patients except 1 with EPP had recurrence: pleural recurrence in 7, lung in 1, and multiple organs in 2. Nine patients were retreated with chemotherapy, radiotherapy, pulmonary metastasectomy, or pleurectomy. One underwent EPP for pleural recurrence. Consequently, among the 7 patients without EPP, only 1 was alive without disease and 4 were alive with pleural recurrence. In contrast, 3 of the 4 patients with EPP had no local failure and were alive without recurrence. In multimodality therapy for thymoma with pleural dissemination, EPP offers good local control and may lead to cure.
    The Annals of thoracic surgery 10/2009; 88(3):952-7. · 3.45 Impact Factor
  • The Annals of thoracic surgery 06/2009; 87(5):1622. · 3.45 Impact Factor
  • Ejc Supplements - EJC SUPPL. 01/2009; 7(2):514-514.
  • Ejc Supplements - EJC SUPPL. 01/2009; 7(2):517-517.
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    ABSTRACT: Amyloidosis is an unusual cause of mediastinal lymphadenopathy. A localized form of amyloidosis manifesting solely in the intrathoracic lymphnode is extremely rare. We describe a case of intrathoracic lymphadenopathy caused by a localized form of amyloidosis. Calcification has been reported in amyloidosis; however, it has been considered as non-specific. In our case, serial CT carried out over a period of 3 years and 3 months showed an unusual and unsynchronized pattern of enlargement and calcification.
    The British journal of radiology 10/2008; 81(969):e228-30. · 2.11 Impact Factor
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    ABSTRACT: Postoperative radiotherapy (PORT), especially using modern technology, for patients with stage IIIA-N2 non-small cell lung cancer (NSCLC) is controversial. We retrospectively investigated 112 patients with stage IIIA-N2 NSCLC who underwent complete resection of the lung tumor in our institution from 1986 through 2003. Among the 91 patients determined suitable candidates for PORT postoperatively, 45 patients received PORT (PORT group) and 46 did not (non-PORT group). We analyzed the correlation between PORT use and clinicopathological characteristics, number of involved mediastinal lymph node stations, recurrence, and survival. Five-year and 10-year survival rates of PORT group were 53.2% and 40.0%, which were superior, however, not statistically different, to those (39.3% and 27.5%) of non-PORT group (P=0.6284). According to the number of mediastinal lymph node stations, PORT was more effective for multiple station metastasis than single station metastasis. The disease-free survival of PORT group was significantly better than that of non-PORT group among the patients with multiple station metastasis. Five-year disease-free survival rate of PORT group and non-PORT group were 41% and 5.9%, respectively (P=0.0220). PORT using modern techniques can reduce local recurrence and improve overall survival especially for patients with multiple station N2. Prospective randomized control trials are warranted.
    Interactive Cardiovascular and Thoracic Surgery 05/2008; 7(4):573-7. · 1.11 Impact Factor
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    ABSTRACT: Surgery alone remains the standard therapy for patients with stage I non-small cell lung cancer. Although the preoperative serum level of carcinoembryonic antigen has been shown to be an independent prognostic factor, it has not yet been included in the staging system and does not alter the treatment strategy, especially in the selection of patients for adjuvant chemotherapy. From 1986 to 2003, preoperative and postoperative serum carcinoembryonic antigen levels were measured in 455 patients with completely resected pathologic stage I non-small cell lung cancer. We compared the clinicopathologic characteristics and outcomes among patients who had preoperative serum carcinoembryonic antigen levels within the normal range (N group, n = 323), patients who had high carcinoembryonic antigen levels before surgery but normal levels after surgery (HN group, n = 112), and patients who had high carcinoembryonic antigen levels before and after surgery (HH group, n = 20). The significant characteristics of the HN group included the male sex, greater age, smoking, squamous cell histology, T2 status, lymphatic invasion, vascular invasion, and pleural invasion. Adenocarcinomas in patients of the HN group were more likely to be moderately to poorly differentiated. The 5-year survivals in the HN and HH groups were significantly lower (56.2% and 43.1%, respectively) than those in the N group (85.9%). Multivariate analysis revealed that greater age, non-adenocarcinoma histology, pleural invasion, and the carcinoembryonic antigen in the HN and HH groups were independent prognostic factors. Patients with resected pathologic stage I non-small cell lung cancer and high preoperative serum carcinoembryonic antigen levels are a subgroup with a distinctly poor prognosis who display smoking-related clinicopathologic characteristics.
    The Journal of thoracic and cardiovascular surgery 02/2008; 135(1):44-9. · 3.41 Impact Factor
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    ABSTRACT: Desmoid tumor, also referred to as aggressive fibromatosis, is a relatively rare, locally infiltrative, histologically benign tumor. This report details a case of desmoid tumor presented as a superior sulcus tumor, which showed a unique manifestation in the vertebral bodies on computed tomography.
    The Annals of thoracic surgery 12/2007; 84(5):1752-4. · 3.45 Impact Factor
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    ABSTRACT: Advanced invasive thymomas are not usually manageable by surgical resection and radiotherapy. We reviewed our experience with a multidisciplinary approach and evaluated chemotherapy in the treatment of invasive thymoma. Seventeen consecutive patients with invasive thymoma were treated with multimodality therapy consisting of chemotherapy, surgery, and/or radiotherapy. Four patients had stage III disease with superior vena cava invasion, nine had stage IVa disease, and four had stage IVb disease. The chemotherapy regimen consisted of cisplatin, doxorubicin, and methylprednisolone (CAMP). Chemotherapy was administered in a neoadjuvant setting to the 14 patients and in an adjuvant setting to the remaining three patients. Surgical resection was intended in all patients. After those treatments, chemotherapy and/or radiation therapy were performed. All but one of the 14 patients with induction chemotherapy responded to the CAMP therapy, and the response rate was 92.9%. Seven of these patients underwent complete remission after surgical resection and chemoradiotherapy, and the others underwent partial remission. All three patients treated with surgical resection and then chemotherapy with or without radiotherapy also achieved complete remission. Tumor progression after multimodality therapy occurred in 10 patients. After retreatment, eight of these patients were alive at the time of analysis, with a median survival time after recurrence of 30 months. The 5- and 10-year overall survival rates for all patients were both 80.7%. The major side effect of CAMP therapy was acceptable neutropenia. CAMP therapy was highly effective for invasive thymomas, and the multimodality therapy containing this chemotherapy brought about good disease control in the majority of patients. We believe that this multidisciplinary treatment with CAMP therapy, surgery, and radiotherapy is a justifiable initial treatment for patients with advanced invasive thymoma. Furthermore, appropriate treatments are essential for the long-term survival of patients with recurrences after multimodality therapy.
    Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 02/2007; 2(1):73-8. · 4.55 Impact Factor
  • Journal of Thoracic Oncology - J THORAC ONCOL. 01/2007; 2.
  • Journal of Thoracic Oncology - J THORAC ONCOL. 01/2007; 2.
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    ABSTRACT: Concerning the complications resulting from percutaneous needle biopsy (PNB), although cases of tumor seeding into the needle track have occasionally been reported, there were only two cases of pleural recurrences to date. The aim of this study was to elucidate the real risk of pleural recurrence after needle biopsy in patients with resected early stage lung cancer. Between 1986 and 2000, 335 patients with stage I nonsmall cell lung cancer underwent complete resection of the lung tumor. We retrospectively reviewed their medical records and investigated the relationship between the diagnostic methods used and the cancer recurrence patterns. Preoperative diagnoses were obtained for 290 patients; 220 were diagnosed by bronchoscopy and 66 by PNB. Among the patients without a preoperative diagnosis, 27 were diagnosed by intraoperative needle biopsy and 14 by wedge resection of the lung. Tumors diagnosed by needle biopsy including PNB and intraoperative needle biopsy were smaller and showed less vessel invasion than those diagnosed by other methods (p < 0.01). After surgical resection, 9 patients had pleural recurrence and 1 patient, needle track implantation. Seven of these 10 patients were diagnosed by needle biopsy using 18G cutting type needle. Pleural recurrence or needle track implantation was observed for 8.6% of the patients who underwent a needle biopsy, whereas it was 0.9% for patients who were examined using other diagnostic modalities (p = 0.0009). Needle biopsy especially using a cutting-type biopsy needle can cause a pleural recurrence in addition to needle track implantation.
    The Annals of thoracic surgery 12/2005; 80(6):2026-31. · 3.45 Impact Factor
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    ABSTRACT: Matrix metalloproteinases (MMPs) are believed to play an essential role in cancer invasion, although detailed differences between noninvasive and invasive lung carcinomas are still unclear. To elucidate the expression and activity patterns of MMPs in noninvasive and invasive carcinoma of the lung, we performed in situ hybridization and real-time reverse transcription-polymerase chain reaction to detect messenger RNAs (mRNAs) of MMPs and their tissue inhibitors (TIMPs). The basement membrane was evaluated by immunohistochemistry for type IV collagen. Gelatinase activity was examined by zymography and in situ zymography. A total of 14 surgically resected primary pulmonary adenocarcinomas were used for this study. All the tumors were adenocarcinoma mixed bronchioloalveolar carcinomas according to the 1999 WHO classification. MMP and TIMP2 mRNAs were detected by in situ hybridization in all samples, in both noninvasive and invasive carcinoma components. Signals for MMP mRNAs were significantly higher in both noninvasive and invasive carcinomas than in tumor-free lung tissue. However, the differences were small between noninvasive and invasive carcinomas, not only in the amount of mRNA but also in the activity of the MMPs. In most carcinomas, stromal fibroblast-type cells tended to express levels of MMP and TIMP2 mRNAs that were higher than or at least similar to those expressed in epithelial cells. Our data on mixed adenocarcinoma suggest that noninvasive carcinoma areas already express a molecular mechanism involving MMPs similar to that expressed by invasive carcinoma areas. Stromal fibroblast-type cells seem to be the most important source of MMPs, from the earliest event of tumor invasion by pulmonary adenocarcinomas.
    Modern Pathology 07/2005; 18(6):828-37. · 5.25 Impact Factor
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    ABSTRACT: A 67-year-old female was referred to our hospital because of bronchoesophageal fistula detected by upper gastro-intestinal series for cancer screening. The patient has had a history of coughing on liquid ingestion since childhood and she has been hospitalized 4 times for treatment of pneumonia during the past 20 years. While waiting the treatment, she was emergently admitted to the hospital because of massive hemoptysis. Transcatheter embolization of feeding arteries including the right inferior phrenic artery successfully controlled her hemoptysis. After reembolization of the feeding arteries for preventing massive hemorrhage during operation, posterolateral thoracotomy was performed. Surgical findings disclosed the bronchoesophageal fistula without inflammatory changes. She underwent fistulectomy combined resection of the middle and lower lobes which were destroyed by the repeated pneumonia. This case was considered type I congenital bronchoesophageal fistula according to Braimbridge and Keith classification because of the presence of diverticular projection which connected to the bronchus. Early diagnosis and rapid treatment are thought to be important for treating this disease.
    Kyobu geka. The Japanese journal of thoracic surgery 01/2005; 57(13):1241-4.