Background: Many non-small cell lung cancer (NSCLC) tumors present complex histology with various components. The effects of the lepidic growth component (LGC) on the prognosis of NSCLC have not been investigated. Here, we investigated whether an LGC is a relevant prognostic factor for NSCLC. Methods: This study retrospectively investigated the clinicopathologic characteristics of 379 patients with NSCLC ≤3 cm who underwent complete surgical resection between 2004 and 2016 at the University of Yamanashi Hospital. The histologic subtypes were classified into NSCLC with or without an LGC. We evaluated the effect of an LGC on the clinicopathologic features and 5-year overall survival of patients with NSCLC. Results: On final pathology, 214 (56%) of 379 patients had an LGC, and 165 (44%) did not. Sex, smoking history, ground-glass opacity component, pathologic invasive size, lymph node metastasis, pleural invasion, vessel invasion, pathologic stage, and histologic type were significantly different between the groups. Multivariate analysis of 5-year overall survival, identified age (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.035-1.105; p < 0.001), pathologic invasive size (HR, 1.548; 95% CI, 1.088-2.202; p = 0.015) and LGC (HR, 2.11; 95% CI, 1.099-4.051; p = 0.025) as independent prognostic factors. When the pathologic invasive size was matched, the 5-year overall survival of the LGC and non-LGC groups was 93% and 77%, respectively (p = 0.006). Conclusions:LGC is a significantly favorable prognostic factor for NSCLC with a pathologic invasive size of ≤3 cm.

Background The role of various serum tumor markers (TMs) has been reported in non‐small cell lung cancer (NSCLC). However, the prognosis of patients with multiple TM‐negative NSCLC remain unclear. Aims This study aimed to describe the characteristics and outcomes of patients with NSCLC undergoing surgery and to investigate their prognostic association with preoperative serum TM‐negative cases. Methods and results We retrospectively evaluated 442 patients who underwent complete resection of stage I NSCLC between January 2004 and December 2019. These 442 patients were classified into a group whose preoperative serum levels of carcinoembryonic antigen (CEA), cytokeratin‐19 fragment (CYFRA21‐1), carbohydrate antigen 19‐9 (CA19‐9), and squamous cell carcinoma antigen (SCC Ag) were all negative (TM‐negative group; n = 249, 56%) and a group with at least one positive marker (TM‐positive group; n = 193, 44%). Among all patients, the TM‐negative group showed higher 5‐year recurrence‐free survival (RFS) (92.6% vs. 79.1%; p < .01), and overall survival (OS) rates (86.3% vs. 68.6%; p < .01). After propensity score matching, patients in the TM‐negative group still exhibited good 5‐year RFS (92.1% vs. 81.4%; p = .01) and OS rates (87.6% vs. 72.6%; p < .01). Conclusion Our study suggests that NSCLC patients who are preoperatively negative for all serum TMs, such as CEA, CYFRA21‐1, CA19‐9, and SCC Ag, represent a subgroup with a particularly good prognosis.

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A desmoplastic small round cell tumor (DSRCT) is an extremely rare high-grade tumor that frequently develops in the abdominal cavity of young men. Herein, we report a case of pericardial DSRCT. A woman in her thirties underwent pericardial drainage for congestive heart failure due to cardiac tamponade at a hospital. The pericardial effusion was bloody, and atypical cells were detected on cytology. She was referred to our hospital for a detailed examination. Chest computed tomography revealed a thickened pericardium and large amount of pericardial effusion; however, there was no evidence of the primary lesion. Thoracoscopic pericardial fenestration was performed for tissue collection and drainage of the pericardial effusion. She was histopathologically diagnosed with DSRCT. Although DSRCT has been reported to occur extra-abdominally, this is the first reported case of DSRCT showing pericardial involvement in Japan. There are few atypical cases of DSRCT.

A 69-year-old man with non-small cell lung cancer presenting with pericardial effusion and rapid progression of dyspnea achieved long-term disease stabilization after radiation therapy and immunotherapy. This case shows that pembrolizumab may improve prognosis in advanced lung cancer, even when complicated by cardiac tamponade.