Lung cancer cases reported in the annual of pathological autopsy cases in Japan (1958-1982), with special reference to the characteristics of lung cancer in Japan

There were 28,303 male and 9,540 female cases of lung cancer cases, comprising 8.5% and 4.4% of the total autopsies and 16.4% and 9.0% of all malignancies, respectively. The most frequent fatal malignant tumors were gastric cancer and lung cancer in both male and female. The relative incidence of gastric cancer was found to be decreasing, while that of lung cancer has increased. The major histological types of lung cancer in the male were adenocarcinoma (34%), sq. cell ca. (33%), small cell ca. (13%), and large cell ca. (9%). As for the female, they were adenocarcinoma (55%), sq. cell ca. (18%), small cell ca. (10%), and large cell ca. (7%). The peak age-group of cancer occurrence shifted from 60 years to 70 years for most of the major histological types in both sexes. The male/female ratio of lung cancer cases was 3.0 in total. This study has pointed out that the male/female ratio by age-group in each country is a very good reflection of histological distribution.     

Recent trends in different histological types of lung cancer in Tokyo based on pathological autopsy records

The recently increasing trend of lung cancer mortality in Japan was qualitatively analyzed. As the percentages of cases undergoing pathological autopsies in Tokyo were thirty for males and twenty-six for females during the period from 1979 to 1983, the histologically classified death rates in Tokyo could be estimated by combining the reported cases of death from lung cancer with the proportion of these of known histological type. The results indicated an increase in adenocarcinoma, and a decrease in squamous-cell carcinoma, except for the older age-group of men. The latter result suggested that the results were affected by the decreasing proportion of smokers and by the improvement in cigarette quality. The increase in small-cell and large-cell carcinoma, and the decrease in undifferentiated carcinomas, could be explained by problems associated with differing diagnostic standards. However, when these three different types of carcinoma were considered as a single type, the death rate was shown to be increased except in younger age-groups of women.     

Ecologic study of lung cancer risk factors in the U.S. and Japan, with special reference to smoking and diet.

Lung cancer mortality rates among United States and Japanese males were compared and related to smoking and dietary data. Mortality rates increased from 1950 to 1985 in both countries, but the absolute values are consistently lower in Japan (38.2 deaths/100,000 in 1985) than in the U.S. (72.2/100,000). The proportion of smokers is higher in Japan than in the U.S. since 1955. Japanese males start smoking considerably later than U.S. males, but smoke a higher quantity of cigarettes per day. Available information on inhalation practices and yield and type of cigarettes smoked showed no differences among the two countries large enough to account for the differences in mortality rates. Further data in this regard should be obtained. Dietary data show that fat consumption (as percentage of calories) is consistently higher in the U.S. than in Japan from 1950 (40% vs. 7.9%) through 1985 (43.5% vs. 24.5%). A linear relationship is observed between lung cancer mortality and fat intake. Our data support the hypothesis that dietary habits may modulate the carcinogenic effects of tobacco smoking.     

Gender-specific incidence trends in lung cancer by histological type in Sweden, 1958-1996.

We used the Swedish Family-Cancer Database to examine the time trends of lung cancer in Sweden by histological type, with special reference to gender. A total of 45,297 lung cancer cases were analysed. The overall age-adjusted incidence rates of squamous cell carcinoma (SCC) in men peaked in the 1980s and then slightly decreased, while corresponding rates in women increased steadily. The incidence of adenocarcinoma increased in both genders. The male-to-female incidence ratio for SCC was 12.4 in the 1960s and 3.6 in the 1990s. For adenocarcinoma the ratio was close to 1.5 throughout the period. Regression analysis indicated that the birth cohort of the 1940s was at the highest risk for adenocarcinoma in men and for all types of lung cancer in women. Lung cancer in parents was a risk factor for offspring. In conclusion, the data, particularly on women, suggest that modern cigarettes induce lung adenocarcinoma and SCC in a proportion of 1:0.6. This proportion was 1:3.7 among men diagnosed in the 1960s. The incidence ratio of 1.3 for adenocarcinoma between men and women in the 1990s is consistent with the smoking prevalence data a few decades ago, suggesting equal sensitivity of both genders to tobacco-induced lung cancer.     

Clinical study of asbestos‐related lung cancer in Japan with special reference to occupational history

A total of 152 patients with asbestos‐related lung cancer recognized by the criteria of Japanese compensation law for asbestos‐related diseases were examined and compared with 431 patients with non‐asbestos‐related lung cancer. Male comprised 96% of patients. Ages ranged from 50 to 91 years with a median of 72 years. Eighty‐nine percent were smokers or ex‐smokers. Almost all patients had occupational histories of asbestos exposure. The median duration of asbestos exposure was 31 years and the median latency period was 47 years. Thirty‐four percent of patients exhibited asbestosis and 81% exhibited pleural plaques by radiography. Regarding asbestos particles in the lung for 73 operated or autopsied patients, 62% had more than 5,000 particles per gram. On the other hand, 100% of non‐asbestos‐related lung cancer patients had <5000 particles per gram with a median of 554 particles. The number of asbestos bodies in the lung, male gender, absence of symptoms, smoking index, and early stage of cancer were significantly much more than those of non‐asbestos‐related lung cancer. In this study, a diagnosis of asbestos‐related lung cancer was made in 34% of patients by asbestosis, in 62% by presence of both pleural plaques and more than 10 years’ occupational asbestos exposure, and in 4% by more than 5000 asbestos particles per gram of lung tissue. Occupational histories, duration of asbestos exposure, and pleural plaques are common categories for the recognition of asbestos‐related lung cancer in Japan. (Cancer Sci 2010; 101: 1194–1198)     

A case-control study of lung cancer screening in Okayama Prefecture, Japan.

The effectiveness of lung cancer screening in reducing mortality still remains uncertain. In order to evaluate the efficacy of lung cancer screening, a case-control study was conducted in Okayama Prefecture, Japan. The study area consisted of 34 municipalities where a population-based lung cancer screening had been conducted. Chest X-ray examinations for all participants and sputum cytology for high-risk participants were offered annually. The cases analyzed in this study consisted of 412 individuals aged between 40 and 79 who died of lung cancer. A total of 3490 controls, two to ten for each case matched by gender, year of birth, and living district were randomly collected. Screening histories of cases were compared with those of and matched controls for the identical calendar period prio to diagnosis of the case. Smoking adjusted odds ratio (OR) of death from lung cancer for screened individuals versus unscreened, within 12 months before diagnosis, was calculated as 0.59 (95% confidence interval: 0.46-0.74; P=0.0001). The OR for women (0.39, 95% confidence interval: 0.24-0.64) was lower than that for men (0.67, 95% confidence interval: 0.51-0.87), although both were statistically significant. These results suggest that lung cancer screening contributes to reducing lung cancer mortality by 41%.     

A Joinpoint regression analysis of long-term trends in cancer mortality in Japan (1958-2004)

Cancer is one of the major targets of disease control programs in Japan. A Joinpoint regression model was used to analyze the long-term trends of mortality related to overall cancer and the 15 most common cancers based on published data from the National Vital Statistics of Japan between 1958 and 2004. Since 1996, a decline has been seen in overall cancer for both sexes in Japan. Most of the common sites, including cancers of the stomach, colon, liver, gallbladder and lung and leukemia in both sexes, cancer of esophagus in men and rectal and ovarian cancers in women showed a decreasing trend, and cancers of the rectum, pancreas, prostate and urinary bladder and malignant lymphoma in men and cancers of the esophagus and uterus in women leveled off during the most recent period. However, an increasing trend was confirmed for cancers of the pancreas, breast and urinary bladder and malignant lymphoma in women. An effective cancer control program including prevention, early detection and treatment should be implemented to further reduce the cancer mortality, particularly for cancer sites that show higher mortality rates or increasing trends.     

盐亭县1969～1997年肺癌死亡变化趋势分析

目的：了解盐亭县28年间肺癌死亡率的动态变化。方法：依照盐亭县居民全死因死亡资料，计算各年度肺癌死亡率、肺癌死亡率年平均变化速度和肺癌死亡在恶性肿瘤死亡中所占比例；对年龄与肺癌死亡率的关系进行出生队列分析。结果：盐亭县28年间肺癌死亡率逐年上升（x^2=457．51，P＝0．000）。肺癌死亡在恶性肿瘤死亡中所占比例也逐年显著上升（x^2＝273．29，P＝0．000）。无论男女，同一年代出生者肺癌死亡率均随年龄增长而上升，而不同年代出生者则表现为出生年代越晚肺癌死亡率上升越快。结论：盐亭县肺癌死亡率逐年显著上升，在今后的肿瘤防治工作中应把肺癌列入重点防治对象。     

A Statistical Study of Lung Cancer in the Annual of Pathological Autopsy Cases in Japan, from 1958 to 1997, with Reference to Time Trends of Lung Cancer in the World

Lung cancer cases (66 650 males and 20 890 females) registered in the Annual of Pathological Autopsy Cases in Japan, between 1958 and 1997, were analyzed with regard to sex, age and histology. They were subdivided into decades (periods I to IV), and compared with the Japanese mortality statistics, with which they were in good correspondence. Although the autopsy rate is decreasing, more than 10% of the total lung cancer deaths in Japan were registered by 1990. Among autopsied cases, the incidence of lung cancer cases increased from 6% to 12% in males and from 3% to 6% in females. From period III, lung cancer in males became the most frequent, and was the second most frequent cancer in females after gastric cancer. As for the histological distribution, adenocarcinoma was the most frequent and squamous cell carcinoma was the next most frequent in both sexes. Recently, a significant increase in adenocarcinoma and a significant decrease in squamous cell carcinoma have been observed in both sexes. The peak ages shifted from the 60s to the 70s and a significant rise in the mean ages were observed. The male-to-female ratios and the ratio curves by histological and age group were high for squamous cell carcinoma and small cell carcinoma, while they were low for the total and adenocarcinoma. With the recently acquired data on lung cancer in Asian countries, and from the male-to-female ratios and the status of smoking rates, lung cancer in the world at present was divided into three groups; North America, Europe and Asia. The possibility of one group changing to resemble another and of groups converging in the near future is suggested.     

Trend of lung cancers in the National Cancer Center of Japan and comparison with that of Japanese pathological autopsy records

Trends in the histologic types of lung cancers during 1966-1985 by 5-year intervals were analyzed by using 4,419 cases in the National Cancer Center Hospital, Japan. Histologically confirmed cases increased to 76.6% in the last 5-year interval. The proportions of histological types in males have remained relatively unchanged; about 40% squamous cell carcinoma, one-third adenocarcinoma, and about 10% each of large cell carcinoma, small cell carcinoma and other types. In females, an increase of adenocarcinoma from 52% to 69.1% and a decrease of squamous cell carcinoma from 21% to 11.4% were noteworthy, and the other three types amounted to less than 10% each. These trends were compared with those obtained from the Annals of Pathological Autopsy Records in Japan during 1974-1983, which contained 26,844 lung cancer cases; the results were similar except for an increase of small cell carcinoma. The recent increase of small cell carcinoma was considered to be due to a change in diagnostic categorization, associated with a decreased rate of undifferentiated carcinoma. However, the increase of small cell carcinoma as well as adenocarcinoma in younger patients requires further study from both demographic and etiological viewpoints.     

Primary gastrointestinal lymphoma in Japan: a clinicopathologic analysis of 455 patients with special reference to its time trends

BACKGROUND: An optimal treatment modality for patients with primary gastrointestinal lymphoma has not yet been established. This study aimed to elucidate the clinicopathologic features of this disease and the influence of therapeutic modalities on the prognosis in Japanese patients METHODS: The clinicopathologic features of 455 patients with primary gastrointestinal lymphoma were investigated retrospectively regarding treatment modalities and time trends. RESULTS: This study comprised 342 patients (75%) with gastric lymphoma, 96 patients (22%) with intestinal lymphoma, and 17 patients (4%) with both gastric and intestinal lymphoma. Two hundred thirty-one (51%) patients were classified as having low-grade B-cell lymphoma including 200 marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) type, 185 (41%) patients were classified as having high-grade B-cell lymphoma including 76 diffuse large cell lymphoma plus MALT lymphoma, and 39 (9%) patients were classified as having T-cell lymphoma. The frequency of nonsurgical treatment, including Helicobacter pylori eradication, chemotherapy, and radiation, increased during the latest decade. Patients who received nonsurgical treatment showed a better overall survival than those treated by surgery, but event-free survival did not differ between two groups. Cox multivariate analysis revealed that early stage, younger age, gastric localization, B-cell phenotype, and absence of B symptoms were independent prognostic factors for better overall and event-free survivals. Mucosa-associated lymphoid tissue-derived lymphoma was also an independent prognostic factor for event-free survival, but not for overall survival. CONCLUSIONS: Nonsurgical treatment may be an optimal therapeutic modality for patients with primary gastrointestinal lymphoma.     

Concordance of histological classification of lung cancer with special reference to adenocarcinoma in Osaka, Japan, and the North-West Region of England

In routinely collected data adenocarcinoma of the lung appeared to be 3 times more frequent in Osaka, Japan, than in the North-Western (NW) Region of England (Manchester). Before embarking on comparative epidemiological studies, it was decided to investigate the comparability of histological diagnosis. Specimens from 60 NW Region lung cancer patients and 52 Osaka patients were exchanged and reviewed. The entire material was then independently assessed by the WHO Collaborating Centre for Histological Classification of Tumours. The interpretation of the WHO Classification (WHO, 1981) by the NW Region and by Osaka was upheld by the WHO Collaborating Centre in 89% and 93% of all cases and in 97% and 100% of adenocarcinoma cases respectively. Agreement between the 2 centres was 88% for the main cell types. Differences in the frequency of adenocarcinoma of lung between the NW Region and Osaka are thus not due to diagnostic artefact and require further exploration. The aetiological implications of the finding that many Chinese and Japanese women with lung adenocarcinoma do not smoke (77% in Osaka) are discussed.     

An autopsy case of triple primary cancers consisting of glioblastoma multiforme of the pons, colon cancer and rectal carcinoid--a statistical analysis of cases of brain tumor combined with other primary cancers in Japan autopsy annuals

An autopsy case of glioblastoma multiforms of the pons with a colon cancer, a rectal carcinoid, a renal adenoma and three gastric leiomyomas in a 81-year-old-woman is reported with a statistical analysis on multiple primary cancers associated with primary brain tumors as reported in the Japan autopsy annuals. Out of 329, 705 autopsy cases from 1975 to 1984 in the Japan autopsy registry, double cancers and triple cancers that included a primary brain tumor amounted to 123 cases (0.037%) and 12 cases (0.0036%), respectively. Other sites for primary cancers were the thyroid (23%), the stomach (15%), the lungs (12%), and the colon (10%) in that order of frequency.