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Hou Z, Liang X, Wang X, Zhou Z, Shi G. Myeloid-derived suppressor cells infiltration in non-small-cell lung cancer tumor and MAGE-A4 and NY-ESO-1 expression. Oncol Lett 2020; 19:3982-3992. [PMID: 32382343 PMCID: PMC7202317 DOI: 10.3892/ol.2020.11497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 01/14/2020] [Indexed: 12/22/2022] Open
Abstract
Cancer/testis antigens melanoma-associated antigen 4 (MAGE-A4) and New York esophageal squamous cell carcinoma-1 (NY-ESO-1) are of clinical interest as biomarkers and present valuable targets for immunotherapy; however, they are poor prognostic markers in non-small cell lung cancer (NSCLC). In addition, myeloid derived suppressor cells (MDSCs) are recognized as a key element in tumor escape and progression. The aim of the present study was to investigate the diagnostic and prognostic value of MAGE-A4 and NY-ESO-1, and their association with MDSCs in NSCLC samples. The expression levels of MAGE-A4 and NY-ESO-1, and the infiltration of MDSCs (CD33+), were analyzed by immunohistochemistry of 67 tissue samples from patients with NSCLC. Overall, 58.33% of the NSCLC squamous cell carcinoma tissues and 94.7% of adenocarcinoma tissues were positive for MAGE-A4. NY-ESO-1 expression was observed in 52.78% of the squamous cell carcinoma tissues and 80% of the adenocarcinoma tissues. In primary adenocarcinoma tumor tissues, MAGE-A4 and NY-ESO-1 demonstrated a higher intensity of expression compared with the squamous cell carcinoma tissues. A total of 33 (91.7%) squamous cell carcinoma and 19 (95.0%) adenocarcinoma specimens were positive for CD33. The expression of MAGE-A4 and NY-ESO-1 antigens and infiltration of MDSCs was associated with poor prognosis of patients with NSCLC. Further studies investigating the association between these findings and underlying molecular mechanisms are required.
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Affiliation(s)
- Zhenbo Hou
- Department of Pathology, Zibo Central Hospital, Zibo, Shandong 255000, P.R. China
| | - Xiao Liang
- Department of Thoracic Surgery, Zibo Central Hospital, Zibo, Shandong 255000, P.R. China
| | - Xinmei Wang
- Department of Pathology, Zibo Central Hospital, Zibo, Shandong 255000, P.R. China
| | - Ziqiang Zhou
- Department of Pathology, Zibo Central Hospital, Zibo, Shandong 255000, P.R. China
| | - Guilan Shi
- Department of Immunology, School of Nursing, Zibo Vocational Institute, Zibo, Shandong 255314, P.R. China.,Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA 23508, USA
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Evison M, Edwards J, McDonald F, Popat S. Stage III Non-small Cell Lung Cancer: A UK National Survey of Practice. Clin Oncol (R Coll Radiol) 2020; 32:527-536. [PMID: 32216979 DOI: 10.1016/j.clon.2020.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/02/2020] [Accepted: 02/08/2020] [Indexed: 12/25/2022]
Abstract
AIMS The optimal management of stage III non-small cell lung cancer (NSCLC) is widely debated and is a rapidly evolving area. However, less than one in five stage III patients in England receive optimal multimodality treatment. The aim of this study was to map commonalities and differences in clinician judgement as well as infrastructure and resources for managing stage III NSCLC. MATERIALS AND METHODS We carried out a national survey of practice in stage III NSCLC management in the UK using a 30-min web-based survey. Invitations were sent via e-mail to the British Thoracic Oncology Group and the Society of Cardiothoracic Surgery membership and a healthcare professional market research panel. RESULTS In total, 160 respondents completed the survey. Although opinion was variable, there was a preference for surgery and adjuvant chemotherapy in stage III N2 (single station) NSCLC that could be treated with lobectomy, but this preference switched to chemoradiotherapy in single-station N2 requiring a pneumonectomy or multi-station N2. The PD-L1 status influenced the treatment decision in 'potentially resectable' N2 for a number of clinicians who opted for concurrent chemoradiotherapy with adjuvant durvalumab when PD-L1 ≥ 1%. A joint clinic with surgeons and oncologists was considered the most important factor for shared decision making with patients. There are barriers to recommending trimodality treatment, e.g. concerns over the negative impact on quality of life. A proportion of clinicians favoured palliative treatment in certain clinical scenarios, including supraclavicular fossa lymph node metastases, patients with borderline fitness or high PD-L1 expressors >50%. DISCUSSION This survey has highlighted the need for infrastructure development, such as reflex PD-L1 testing and joint surgical and oncology clinics. Further research into the impact of multimodality treatment on quality of life and education to improve confidence in multimodality treatment could all drive improvements in stage III NSCLC management.
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Affiliation(s)
- M Evison
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
| | - J Edwards
- Department of Thoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - F McDonald
- Department of Thoracic Oncology, Royal Marsden Hospital, London, UK
| | - S Popat
- Department of Thoracic Oncology, Royal Marsden Hospital, London, UK
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Sugisaka J, Toi Y, Taguri M, Kawashima Y, Aiba T, Kawana S, Saito R, Aso M, Tsurumi K, Suzuki K, Shimizu H, Ono H, Domeki Y, Terayama K, Nakamura A, Yamanda S, Kimura Y, Honda Y, Sugawara S. Relationship between Programmed Cell Death Protein Ligand 1 Expression and Immune-related Adverse Events in Non-small-cell Lung Cancer Patients Treated with Pembrolizumab. JMA J 2020; 3:58-66. [PMID: 33324776 PMCID: PMC7733761 DOI: 10.31662/jmaj.2019-0005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 09/10/2019] [Indexed: 12/26/2022] Open
Abstract
Introduction: Immune checkpoint inhibitors (ICIs) can lead to immune-related adverse events (irAEs). A correlation between the development of irAEs and efficacy has been suggested; however, it is unclear whether there is a relationship between programmed death ligand 1 (PD-L1) expression and the development of these events. Methods: We performed a retrospective study of advanced or metastatic non-small cell lung cancer (NSCLC) patients who were treated with pembrolizumab monotherapy at our institution between May 2015 and April 2018 (n = 44). Patients were categorized into two groups, specifically those with irAEs (irAE group) or without (non-irAE group), and we evaluated the objective response rate (ORR), disease control rate (DCR), and progression-free survival (PFS). Predictors of irAEs were examined by multivariate analysis. Results: irAEs of any grade occurred in 31 (70.5%) patients. The median PFS was 10.9 months in the irAE group versus 3.7 months in the non-irAE group (P < 0.001). ORR and DCR were also higher in the irAE group than in the non-irAE group. Furthermore, high PD-L1 expression (≥50%) was a predictive factor of irAE based on logistic regression (P = 0.004). Conclusions: In patients with advanced NSCLC treated with pembrolizumab monotherapy, ORR, DCR, and PFS were significantly better in the irAE group than in the non-irAE group. High PD-L1 expression, at the time of pretreatment, was identified as an independent predictor of irAE development. We believe that more careful management of irAEs for individuals with high PD-L1 expression is needed to improve clinical benefits. Further, PD-L1 expression might be useful for ICI risk management.
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Affiliation(s)
- Jun Sugisaka
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Yukihiro Toi
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Masataka Taguri
- Department of Data Science, Yokohama City University school of Data Science, Yokohama, Japan
| | - Yosuke Kawashima
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Tomoiki Aiba
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Sachiko Kawana
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Ryohei Saito
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Mari Aso
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Kyoji Tsurumi
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Kana Suzuki
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Hisashi Shimizu
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Hirotaka Ono
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Yutaka Domeki
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Keisuke Terayama
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Atsushi Nakamura
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Shinsuke Yamanda
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Yuichiro Kimura
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Yoshihiro Honda
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Shunichi Sugawara
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
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Preoperative Staging by EBUS in cN0/N1 Lung Cancer: Systematic Review and Meta-Analysis. J Bronchology Interv Pulmonol 2020; 26:155-165. [PMID: 30119069 DOI: 10.1097/lbr.0000000000000545] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Performance of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for staging the radiologically normal mediastinum has been reported with inconsistent findings. We assessed the sensitivity of systematic staging using EBUS-TBNA for detection of radiologically occult mediastinal metastases in cN0/N1 lung cancer. METHODS Studies evaluating EBUS-TBNA for systematic mediastinal staging in cN0/N1 lung cancer were identified by systematic review. Data extracted included: participant age and sex; EBUS-TBNA protocol; stage determined by radiology, EBUS-TBNA and surgery; 2×2 tables. Primary outcome was diagnostic accuracy of EBUS-TBNA for detection of unsuspected N2/N3 disease. RESULTS We identified 1173 articles. In total, 13 were included in a qualitative review and 9 (1146 patients) in a quantitative meta-analysis. Mean prevalence of N2/N3 disease was 15% (6% to 24%). EBUS-TBNA had pooled sensitivity of 49% [95% confidence interval (CI), 41%-57%], pooled specificity of 100% (95% CI, 99%-100%), mean negative predictive value 91% (82% to 100%) for detection of unsuspected N2/N3 metastases. Number needed to test to detect occult N2/N3 disease was 14 (95% CI, 10.8-16.3), which halved with addition of per-esophageal endoscopic ultrasound. CONCLUSION Preoperative systematic staging by EBUS-TBNA of early lung cancer can reduce postoperative upstaging. Sensitivity for detection of radiologically occult mediastinal metastases seems lower than selective sampling of pathologic lymph nodes. Verification of negative results by mediastinoscopy in selected cases remains of value.
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MicroRNA Biomarker hsa-miR-195-5p for Detecting the Risk of Lung Cancer. Int J Genomics 2020; 2020:7415909. [PMID: 31976313 PMCID: PMC6961786 DOI: 10.1155/2020/7415909] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/14/2019] [Accepted: 12/03/2019] [Indexed: 12/24/2022] Open
Abstract
Background Lung cancer is one of the leading diagnosed cancers worldwide, and microRNAs could be used as biomarkers to diagnose lung cancer. hsa-miR-195 has been demonstrated to affect the prognosis of NSCLC (non-small-cell lung cancer) in a previous study. However, the diagnostic value of hsa-miR-195-5p in lung cancer has not been investigated. Methods To evaluate the ability of hsa-miR-195-5p to diagnose lung cancer, we compared the expression of hsa-miR-195-5p in lung cancer patients, COPD patients, and normal controls. Receiver operating characteristic (ROC) curve analysis was performed to investigate the sensitivity and specificity of hsa-miR-195-5p. Coexpression network and pathway analysis were carried out to explore the mechanism. Results We found that hsa-miR-195-5p had lower expression in lung cancer and COPD patients than in normal controls, and the AUC was 0.92 for diagnosing lung cancer. hsa-miR-143 correlated with hsa-miR-195-5p, and by combining these two microRNAs, the AUC was 0.97 for diagnosing lung cancer. Conclusions hsa-miR-195-5p may act as a biomarker that contributes to the diagnosis of lung cancer and the detection of its high-risk population.
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Zhang S, Wang L, Lu F, Pei Y, Yang Y. [Correlation between Lymph Node Ratio and Clinicopathological Features and Prognosis of IIIa-N2 Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:702-708. [PMID: 31771739 PMCID: PMC6885420 DOI: 10.3779/j.issn.1009-3419.2019.11.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND IIIa-N2 non-small cell lung cancer was significant different in survival, although N stage of lung cancer based on anatomic location of metastasis lymph node. Lymph node ratio considered of prognostic factor might be the evaluation index for IIIa-N2 non-small cell lung cancer prognosis. Therefore, the aim of the study was to evaluate the correlation between lymph node ratio and clinicopathological features and prognosis of IIIa-N2 non-small cell lung cancer prognosis. METHODS A total of 288 cases of pathological IIIa-N2 non-small cell lung cancer were enrolled who received radical resection at the Department of Thoracic Surgery II, Peking University Cancer Hospital from January 2006 to December 2016. The univariate analysis between clinicopathological variables and lymph node ratio used Pearson's chi-squared test. Cox regression was conducted to identify the independent prognosis factors for IIIa-N2 non-small cell lung cancer. RESULTS There were 139 cases in the lower lymph node ratio group, another 149 cases in the higher lymph node ratio group. Adenocarcinoma (χ²=5.924, P=0.015), highest mediastinal lymph node metastasis (χ²=46.136, P<0.001), multiple-number N2 metastasis (χ²=59.347, P<0.001), multiple-station N2 metastasis (χ²=77.387, P<0.001) and skip N2 lymph node metastasis (χ²=61.524, P<0.001) significantly impacted lymph node ratio. The total number of lymph node dissection was not correlated with the lymph node ratio (χ²=0.537, P=0.464). Cox regression analysis confirmed that adenocarcinoma (P=0.008), multiple-number N2 metastasis (P=0.025) and lymph node ratio (P=0.001) were the independent prognosis factors of disease free survival. The 5-year disease free survival was 18.1% in the higher lymph node ratio group, and 44.1% in the lower. Lymph node ratio was the independent prognosis factor of overall survival (P<0.001). The 5-year overall survival was 36.7% in the higher lymph node ratio group, and 64.1% in the lower. CONCLUSIONS Lymph node ratio was correlative with the pathology, highest mediastinal lymph node metastasis, multiple-number N2 metastasis, multiple-station N2 metastasis and skip N2 lymph node metastasis. Lymph node ratio was the independent prognosis factor for IIIa-N2 non-small cell lung cancer.
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Affiliation(s)
- Shanyuan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Liang Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Fangliang Lu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Yuquan Pei
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Yue Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing 100142, China
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Citak N, Aksoy Y, Isgörücü Ö, Obuz C, Acikmese B, Buyukkale S, Metin M, Sayar A. A Comparison of the Currently Used Nodal Stage Classification with the Number of Metastatic Lymph Nodes and the Number of Metastatic Lymph Node Stations for Non-Small Cell Lung Cancer; Which of These Is the Best Prognostic Factor? Zentralbl Chir 2019; 145:565-573. [DOI: 10.1055/a-1008-9598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Abstract
Objectives We aimed to compare the currently used nodal staging system (pN) with the number of metastatic lymph node (LN) stations (sN) and the number of metastatic LNs (nN) on survival in patients with NSCLC.
Methods Between 2010 and 2017, 1038 patients resected for NSCLC were analyzed. We performed three-different stratifications of LN status assessment: pN-category (pN0, pN1 and pN2); sN-category (sN0, sN1; one station metastasis, sN2; two-three stations metastases, and sN3; ≥ 4 stations metastasis); nN-category (nN0, nN1; one-three LNs metastasis, nN2; four-six Lns metastasis, and nN3; ≥ 7 LNs metastasis).
Results Five-year survival rate was 70.1% for N0 in all classifications. It was 54.3% for pN1, and 26.4% for pN2 (p < 0.0001). Five-year survival rates for N1, N2, and N3 categories were 54.1%, 42.4% and 16.1% according to sN, and 51.4%, 36.1%, and 7.9% according to nN, respectively (p < 0.0001). In multivariate analysis, sN and nN were independent risk factors such as pN (p < 0.0001). Hazard ratios versus N0 for N1, N2, and N3 were more significant for sN and nN than pN (1.597, 2.176, and, 3.883 for sN, 1.645, 2.658, and, 4.118 for nN, and 1.576, 3.222 for pN, respectively). When the subcategories of sN and nN were divided into pN1 and pN2 subgroups, the anatomic location of the LN involvement lost importance as tumor burden and tumor spreading increased.
Conclusion The number of metastatic LN stations and the number of metastatic LNs are better prognostic factors than currently used nodal classification in NSCLC.
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Affiliation(s)
- Necati Citak
- Thoracic Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Yunus Aksoy
- Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Özgür Isgörücü
- Thoracic Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Cigdem Obuz
- Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Baris Acikmese
- Thoracic Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Songul Buyukkale
- Thoracic Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Muzaffer Metin
- Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Adnan Sayar
- Thoracic Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Eichhorn F, Klotz LV, Muley T, Kobinger S, Winter H, Eichhorn ME. Prognostic relevance of regional lymph-node distribution in patients with N1-positive non-small cell lung cancer: A retrospective single-center analysis. Lung Cancer 2019; 138:95-101. [PMID: 31678832 DOI: 10.1016/j.lungcan.2019.10.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/03/2019] [Accepted: 10/16/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Lymph node (LN) metastases predict survival in patients with non-small cell lung cancer (NSCLC) treated with curative surgery. Nevertheless, prognostic differences within the same nodal (N) status have been reported. Consequently, the International Association for the Study of Lung Cancer (IASLC) proposed to stratify patients with limited nodal disease (pN1) from low (pN1a) to high (pN1b) nodal tumor burden. This study aimed to validate the IASLC proposal in a large single-center surgical cohort of patients with pN1 NSCLC. MATERIAL AND METHODS Data from 317 patients with pN1 NSCLC treated between January 2012 and December 2016, were retrospectively analyzed. Associations between distribution of LN metastases and survival were analyzed for different classification models-toward nodal extension (pN1a: one station involved; pN1b: multiple stations involved) and toward location (pN1 in the hilar [LN#10/11] or peripheral zone [LN#12-14]). RESULTS Tumor-specific survival (TSS) in the entire pN1 cohort was 67.1% at five years. Five-year TSS rates for pN1a and pN1b patients were comparable (67.6% vs. 66.5%, p = 0.623). Significant survival differences from pN1a to pN1b were observed only in patients with adenocarcinoma histology and completed adjuvant chemotherapy (5-year TSS: pN1a, 80.4% vs. pN1b, 49.6%; p = 0.005). TSS for LN metastases in the hilar zone/peripheral zone or in both zones was 68.2% and 59.9%, respectively (p = 0.068). In multivariate analysis, adjuvant chemotherapy, squamous cell histology, and nodal disease limited to one zone nodal disease were identified as independent beneficial prognostic factors (p < 0.05). CONCLUSION pN1 in only one region (hilar or lobar) was associated with better outcome than metastatic affection of both regions after surgery and adjuvant therapy. A stratification towards single (pN1a) and multiple (pN1b) N1-metastases was found of prognostic relevance only in adenocarcinoma. Prospective multicenter analysis of prognostic subgroups in N1 NSCLC is required to evaluate its clinical impact for consideration in future TNM classification.
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Affiliation(s)
- F Eichhorn
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, Heidelberg, Germany; Translational Lung Research Center (TLRC), Heidelberg, Member of the German Center for Lung Research (DZL), Germany.
| | - L V Klotz
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, Heidelberg, Germany; Translational Lung Research Center (TLRC), Heidelberg, Member of the German Center for Lung Research (DZL), Germany
| | - T Muley
- Section Translational Research (STF), Thoraxklinik, Heidelberg University, Heidelberg, Germany; Translational Lung Research Center (TLRC), Heidelberg, Member of the German Center for Lung Research (DZL), Germany
| | - S Kobinger
- Section Translational Research (STF), Thoraxklinik, Heidelberg University, Heidelberg, Germany
| | - H Winter
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, Heidelberg, Germany; Translational Lung Research Center (TLRC), Heidelberg, Member of the German Center for Lung Research (DZL), Germany
| | - M E Eichhorn
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, Heidelberg, Germany; Translational Lung Research Center (TLRC), Heidelberg, Member of the German Center for Lung Research (DZL), Germany
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González-Rivas D, Rami-Porta R. Reply from the authors: The quantification of nodal disease has prognostic relevance. J Thorac Cardiovasc Surg 2019; 159:e146-e147. [PMID: 31610966 DOI: 10.1016/j.jtcvs.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/11/2019] [Accepted: 09/11/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Diego González-Rivas
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China; Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit, Coruña Hospital, Coruña, Spain
| | - Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain; Network of Centers for Biomedical Research in Respiratory Diseases Lung Cancer Group, Terrassa, Spain
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Prognostic factor and treatment strategy for clinical N1 non-small cell lung cancer. Gen Thorac Cardiovasc Surg 2019; 68:261-265. [PMID: 31535276 DOI: 10.1007/s11748-019-01205-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 09/05/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim of this study is to evaluate the surgical results of clinical N1 disease and to clarify the high-risk clinical N1 subgroup. METHODS Between 1990 and 2012, 137 patients who were clinically diagnosed as having N1 disease were enrolled. Their medical records were reviewed to assess clinical characteristics, radiologic findings, pathologic results, postoperative outcomes, recurrence patterns, and survival. Logistic regression analysis was used to identify independent predictive factors for pathologic N2 upstaging. To determine which factors were significantly associated with survival, a multivariate analysis using a Cox proportional hazards model was performed. RESULTS More cases were pathological N2 in adenocarcinoma than squamous cell carcinoma (p = 0.039). The overall survival rates at 5 years were 54.9%, 36.7% in group upper lobe, middle and lower lobe, respectively (p = 0.013). Logistic regression analyses revealed that #10 positive (p = 0.002, HR 4.625) and adenocarcinoma (p = 0.029, HR 1.544) were significant predictor of pathologic N2 disease. Multivariate analyses revealed that pathologic N2 (p = 0.007, HR 4.186), middle and lower lobe (p = 0.009, HR 2.045) and presence of #10 (p = 0.024, HR 1.871) were independent prognostic factors. Patients with upper lobe and absence of #10 showed a significantly higher 5-year survival rate than patients with middle and lower lobe and presence of #10 (62.1 vs 25.9%: p < 0.0001). CONCLUSIONS Among patients with cN1, pathological N2 disease, tumor in middle and lower lobe and clinical #10 lymph node positive were high-risk subgroup. Further analyses using larger numbers of patients with N1 disease from multiple centers are necessary.
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Park BJ, Kim TH, Shin S, Kim HK, Choi YS, Kim J, Zo JI, Shim YM, Cho JH. Recommended Change in the N Descriptor Proposed by the International Association for the Study of Lung Cancer: A Validation Study. J Thorac Oncol 2019; 14:1962-1969. [PMID: 31442497 DOI: 10.1016/j.jtho.2019.07.034] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/15/2019] [Accepted: 07/26/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The International Association for the Study of Lung Cancer recently proposed a new N descriptor by combining the location of metastatic lymph nodes (LNs), nN (single-station versus multiple-station), and absence versus presence of skip metastasis as pN1a, pN1b, pN2a1, pN2a2 and pN2b. This study aimed to evaluate the discriminatory ability and prognostic performance of the proposed N descriptor in a large independent NSCLC cohort. METHODS We analyzed 1228 patients who underwent major pulmonary resection for pathological N1 or N2 NSCLC between 2004 and 2014. Survival analysis using the Cox proportional hazard model was performed to assess the prognostic significance of the N descriptor. RESULTS From 2004 to 2014, a total of 7437 patients were operated on for NSCLC. Patients pathologically confirmed as having N1 (n = 732) or N2 (n = 496) disease after surgery were included. The median total number of dissected LNs was 24 (range 10-83), and the median number of involved LNs was 2 (range 1-40). The 5-year overall survival rates were 62.6%, 57.0%, 64.7%, 48.4%, and 42.8% for stages N1a, N1b, N2a1, N2a2, and N2b, respectively. Analysis of overall and recurrence-free survival revealed that N2a1 is not sufficiently distinguished from N1a and N1b. In terms of overall survival, N1b is not sufficiently distinguished from N2a2. CONCLUSION On the basis of the N descriptor proposed by the International Association for the Study of Lung Cancer, some of the prognostic implications of the five groups overlapped. It would be better to classify similar prognostic groups into three or four groups to divide the group. A large-scale prospective study is needed to validate these N descriptors.
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Affiliation(s)
- Byung Jo Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Ho Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Ill Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Ito M, Miyata Y, Hirano S, Kimura S, Irisuna F, Ikeda K, Kushitani K, Kishi N, Tsutani Y, Takeshima Y, Okada M. Synchronicity of genetic variants between primary sites and metastatic lymph nodes, and prognostic impact in nodal metastatic lung adenocarcinoma. J Cancer Res Clin Oncol 2019; 145:2325-2333. [PMID: 31317326 DOI: 10.1007/s00432-019-02978-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/08/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE Nodal positive lung adenocarcinoma includes wide range of survival. Several methods for the classification of nodal-positive lung cancer have been proposed. However, classification considering the impact of targetable genetic variants are lacking. The possibility of genetic variants for the better stratification of nodal positive lung adenocarcinoma was estimated. METHODS Mutations of 36 genes between primary sites and metastatic lymph nodes (LNs) were compared using next-generation sequencing. Subsequently, mutations in EGFR and BRAF, rearrangements in ALK and ROS1 were evaluated in 69 resected pN1-2M0 adenocarcinoma cases. Recurrence-free survival (RFS), post-recurrence survival (PRS), and overall survival (OS) were evaluated with respect to targetable variants and tyrosine kinase inhibitor (TKI) therapy after recurrence. RESULTS About 90% of variants were shared and allele frequencies were similar between primary and metastatic sites. In 69 pN1-2M0 cases, EGFR/ALK were positive in primary sites of 39 cases and same EGFR/ALK variants were confirmed in metastatic LNs of 96.7% tissue-available cases. Multivariate analyses indicated positive EGFR/ALK status was associated with worse RFS (HR 2.366; 95% CI 1.244-4.500; P = 0.009), and PRS was prolonged in cases receiving TKI therapy (no post-recurrence TKI therapies, HR 3.740; 95% CI 1.449-9.650; P = 0.006). OS did not differ with respect to targetable variants or TKI therapy. CONCLUSIONS Cases harbouring targetable genetic variants had a higher risk of recurrence, but PRS was prolonged by TKI therapy. Classification according to the targetable genetic status provides a basis for predicting recurrence and determining treatment strategies after recurrence.
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Affiliation(s)
- Masaoki Ito
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yoshihiro Miyata
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shoko Hirano
- Analysis Center of Life Science, Natural Science Center for Basic Research and Development, Hiroshima University, Hiroshima, Japan
| | - Shingo Kimura
- Analysis Center of Life Science, Natural Science Center for Basic Research and Development, Hiroshima University, Hiroshima, Japan
| | - Fumiko Irisuna
- Analysis Center of Life Science, Natural Science Center for Basic Research and Development, Hiroshima University, Hiroshima, Japan
| | - Kyoko Ikeda
- Analysis Center of Life Science, Natural Science Center for Basic Research and Development, Hiroshima University, Hiroshima, Japan
| | - Kei Kushitani
- Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Naoto Kishi
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yasuhiro Tsutani
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yukio Takeshima
- Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
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Chen W, Zhang C, Wang G, Yu Z, Liu H. Feasibility of nodal classification for non-small cell lung cancer by merging current N categories with the number of involved lymph node stations. Thorac Cancer 2019; 10:1533-1543. [PMID: 31207184 PMCID: PMC6610263 DOI: 10.1111/1759-7714.13094] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/23/2019] [Accepted: 05/02/2019] [Indexed: 12/25/2022] Open
Abstract
Introduction The aim of this study was to assess the prognoses of patients with non‐small cell lung cancer (NSCLC) according to the current nodal (N) categories of the tumor, node and metastasis (TNM) classification and the number of involved lymph node stations. Methods Five hundred and seventy patients with NSCLC underwent surgery from 1 January 2005 to 31 December 2009 and were analysed retrospectively. Postoperative overall survival was analysed according to two nodal classifications: the current N0, N1, N2 and N3 categories and those based on the number of involved nodal stations: N0, N1a (single N1), N1b (multiple N1), N2a1 (single N2 without N1), N2a2 (single N2 with N1), N2b1 (multiple N2 without N1) and N2b2 (multiple N2 with N1). Results Five‐year survival rates were 76.1%, 53.4% and 26.3% for N0, N1 and N2, respectively (P < 0.001). When survival was analysed by the number of involved nodal stations, the groups with significant differences were maintained; otherwise, they were merged, and new codes were assigned as follows for exploratory analyses: NA (N0), NB (N1a), NC (N1b, N2a (i.e., N2a1 and N2a2) and N2b1) and ND (N2b2). Five‐year survival rates were 76.1%, 60.0%, 39.1%, and 11.4% for NA, NB, NC and ND, respectively, and there were significant differences among them. This N classification was an independent prognostic factor in multivariate analyses. Conclusion Pending prospective and international validation, it is practical to merge the current N categories with the number of involved lymph node stations when evaluating the postoperative prognosis of NSCLC patients.
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Affiliation(s)
- Wei Chen
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Chenlei Zhang
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Gebang Wang
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Zhanwu Yu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Hongxu Liu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
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Fan Y, Du Y, Sun W, Wang H. Including positive lymph node count in the AJCC N staging may be a better predictor of the prognosis of NSCLC patients, especially stage III patients: a large population-based study. Int J Clin Oncol 2019; 24:1359-1366. [PMID: 31183778 DOI: 10.1007/s10147-019-01483-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 06/02/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The study was designed to explore the value of including positive lymph node count in the TNM staging system of non-small cell lung cancer. PATIENTS AND METHODS The X-tile model was applied to determine the cutoff values of positive lymph node count. Survival curves were generated using the Kaplan-Meier method and differences in survival among subgroups were examined using the log-rank test. The influence of different variables on overall survival and lung cancer-specific survival was further evaluated using univariate and multivariate Cox proportional hazard models. All statistical analyses were performed using SPSS version 22.0 (SPSS, Chicago, IL, USA). All p values were 2-sided and p < 0.05 was considered statistically significant. RESULTS The overall survival and lung cancer-specific survival between stage IIIA and IIIB classified by the sixth edition TNM staging system show no statistically significant difference (p = 0.479 for overall survival; p = 0.081 for lung cancer specific survival). The X-tile model was used to screen three different cutoff values including nN = 0, nN1-3 and nN4-. The nN value is a significant independent prognostic factor that affects overall survival and lung cancer-specific survival of non-small cell lung cancer patients (all, p < 0.001). We obtained the hypothesized TNM sub-stages based on location and the number of PLN. There were significant differences between the hypothesized stage IIIA and IIIB regarding overall survival and lung cancer-specific survival (all, p < 0.001). CONCLUSIONS It needs to be considered that N stage in combination with positive lymph node count may be used to predict the prognosis of non-small cell lung cancer for stage III cases with increased accuracy than category location-based stage.
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Affiliation(s)
- Yanling Fan
- Department of Haematology and Oncology, Jinxiang People's Hospital, Jinxiang Hospital Affiliated to Jining Medical University, Jining, 272200, China
| | - Yanfang Du
- Department of Haematology and Oncology, Jinxiang People's Hospital, Jinxiang Hospital Affiliated to Jining Medical University, Jining, 272200, China
| | - Wenqu Sun
- Department of Cardiothoracic Surgery, Jinxiang HongDa Hospital Affiliated to Jining Medical University, Jining, 272200, China
| | - Haiyong Wang
- Department of Internal-Medicine Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated To Shandong University, Shandong Academy of Medical Sciences, Jinan, 250117, China.
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Yun JK, Lee GD, Choi S, Kim HR, Kim YH, Kim DK, Park SI. Comparison between lymph node station- and zone-based classification for the future revision of node descriptors proposed by the International Association for the Study of Lung Cancer in surgically resected patients with non-small-cell lung cancer. Eur J Cardiothorac Surg 2019; 56:849-857. [DOI: 10.1093/ejcts/ezz147] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 03/25/2019] [Accepted: 04/16/2019] [Indexed: 01/01/2023] Open
Abstract
AbstractOBJECTIVESThe International Association for the Study of Lung Cancer (IASLC) proposed further subdivisions of pathological N1 (pN1) and pN2 by including the location and the number of involved lymph node (LN) stations. We adopted the subdivided N descriptors and reclassified them according to the involved LN zones or LN stations, and compared the discrimination abilities of the 2 classifications.METHODSA retrospective analysis was carried out on patients who underwent complete resection with systematic LN dissection for non-small cell lung cancer diagnosed as pathological stages I–III between 2006 and 2015. N classification was grouped into 6 categories: no LN involvement, single-station N1, multiple-station N1, single-station N2 without N1, single-station N2 with N1 and multiple-station N2. LN zones were defined by grouping the LN stations: peripheral or hilar for N1 nodes, and upper mediastinal, lower mediastinal, aortopulmonary and subcarinal for N2 nodes.RESULTSA total of 3971 patients (2451 men, median age: 63 years) were analysed. Median follow-up was 59 months. A multivariable analysis showed that the subdivided N descriptors based on LN station and zone were both independent prognostic factors in terms of both overall survival and freedom from recurrence. Whether multiple LN involvements were confined within a single LN zone was a significant prognostic factor in the multiple-station N2 group. A zone-based classification showed similar discrimination ability to the station-based classification.CONCLUSIONSBoth LN station- and zone-based classifications showed favourable prognostic discrimination abilities. The new N classifications could be considered for future revisions of tumour, node and metastasis (TNM) staging system for lung cancer.
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Affiliation(s)
- Jae Kwang Yun
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Sehoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
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Tumor Mutation Load: A Novel Independent Prognostic Factor in Stage IIIA-N2 Non-Small-Cell Lung Cancer. DISEASE MARKERS 2019; 2019:3837687. [PMID: 31182981 PMCID: PMC6515152 DOI: 10.1155/2019/3837687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 02/02/2019] [Accepted: 02/11/2019] [Indexed: 01/26/2023]
Abstract
This study is aimed at investigating the prognostic biomarkers of patients with stage IIIA-N2 non-small-cell lung cancer (NSCLC) and at analyzing the correlation between tumor mutation load (the frequency and number of tumor mutations) and prognosis. Clinical data of 35 patients with stage IIIA-N2 NSCLC were collected from Cancer Hospital, Chinese Academy of Medical Sciences. Whole blood samples from the peripheral vein were taken at different treatment periods, and the mutations of cell-free DNA (cfDNA) were detected. Multivariate analysis showed that smoking (P = 0.0308), mutation number > 2 (P = 0.0283), and max mutation frequency > 0.025 (P = 0.0450) were associated with improved progression-free survival (PFS). The overall survival (OS) of well-differentiated NSCLC patients was better than that of poorly differentiated ones (P = 0.0006). The rates of PFS, disease-free survival, local-regional recurrence-free survival, and local-regional progression-free survival were significantly higher in the group with a mutation number > 2 than in the group with a mutation number ≤ 2. The mutation number of the preoperation group was significantly higher than that of the postradiochemotherapy group (5 vs. 2.5, P = 0.023), and the max mutation frequency change was approximately significant in the postradiochemotherapy group compared with the postoperation group (2.6% vs. 1.85%, P = 0.067). The max mutation frequency is positively correlated with vascular invasion (21.13% vs. 3.62%, P = 0.04). Furthermore, Met, ALK, APC, PTEN, ERBB4, NF1, and other genes, involving multiple tumor suppressor genes and lung cancer-driven genes, did not mutate in recurrence-free patients when compared with recurrent patients. In conclusion, differentiation, smoking, mutation frequency > 0.025, and mutation number > 2 are prognostic factors. The frequency and number of gene mutations in cfDNA are expected to be prognostic predictors of NSCLC.
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Adegunsoye A, Oldham JM, Bonham C, Hrusch C, Nolan P, Klejch W, Bellam S, Mehta U, Thakrar K, Pugashetti JV, Husain AN, Montner SM, Straus CM, Vij R, Sperling AI, Noth I, Strek ME, Chung JH. Prognosticating Outcomes in Interstitial Lung Disease by Mediastinal Lymph Node Assessment. An Observational Cohort Study with Independent Validation. Am J Respir Crit Care Med 2019; 199:747-759. [PMID: 30216085 PMCID: PMC6423102 DOI: 10.1164/rccm.201804-0761oc] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 09/12/2018] [Indexed: 12/19/2022] Open
Abstract
RATIONALE Mediastinal lymph node (MLN) enlargement on chest computed tomography (CT) is prevalent in patients with interstitial lung disease (ILD) and may reflect immunologic activation and subsequent cytokine-mediated immune cell trafficking. OBJECTIVES We aimed to determine whether MLN enlargement on chest CT predicts clinical outcomes and circulating cytokine levels in ILD. METHODS MLN measurements were obtained from chest CT scans of patients with ILD at baseline evaluation over a 10-year period. Patients with sarcoidosis and drug toxicity-related ILD were excluded. MLN diameter and location were assessed. Plasma cytokine levels were analyzed in a subset of patients. The primary outcome was transplant-free survival (TFS). Secondary outcomes included all-cause and respiratory hospitalizations, lung function, and plasma cytokine concentrations. Cox regression was used to assess mortality risk. Outcomes were assessed in three independent ILD cohorts. MEASUREMENTS AND MAIN RESULTS Chest CT scans were assessed in 1,094 patients (mean age, 64 yr; 52% male). MLN enlargement (≥10 mm) was present in 66% (n = 726) and strongly predicted TFS (hazard ratio [HR], 1.53; 95% confidence interval [CI], 1.12-2.10; P = 0.008) and risk of all-cause and respiratory hospitalizations (internal rate of return [IRR], 1.52; 95% CI, 1.17-1.98; P = 0.002; and IRR, 1.71; 95% CI, 1.15-2.53; P = 0.008, respectively) when compared with subjects with MLN <10 mm. Patients with MLN enlargement had lower lung function and decreased plasma concentrations of soluble CD40L (376 pg/ml vs. 505 pg/ml, P = 0.001) compared with those without MLN enlargement. Plasma IL-10 concentration >45 pg/ml predicted mortality (HR, 4.21; 95% CI, 1.21-14.68; P = 0.024). Independent analysis of external datasets confirmed these findings. CONCLUSIONS MLN enlargement predicts TFS and hospitalization risk in ILD and is associated with decreased levels of a key circulating cytokine, soluble CD40L. Incorporating MLN and cytokine findings into current prediction models might improve ILD prognostication.
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Affiliation(s)
| | - Justin M. Oldham
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California at Davis, Davis, California
| | | | - Cara Hrusch
- Section of Pulmonary and Critical Care, Department of Medicine
| | | | | | - Shashi Bellam
- Division of Pulmonary and Critical Care, Department of Medicine and
| | - Uday Mehta
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois; and
| | - Kiran Thakrar
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois; and
| | - Janelle Vu Pugashetti
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California at Davis, Davis, California
| | | | | | | | - Rekha Vij
- Section of Pulmonary and Critical Care, Department of Medicine
| | - Anne I. Sperling
- Section of Pulmonary and Critical Care, Department of Medicine
- Committee on Immunology, Biological Sciences Division, University of Chicago, Chicago, Illinois
| | - Imre Noth
- Division of Pulmonary and Critical Care and Sleep Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Mary E. Strek
- Section of Pulmonary and Critical Care, Department of Medicine
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Liu Y, Shen J, Liu L, Shan L, He J, He Q, Jiang L, Guo M, Chen X, Pan H, Peng G, Shi H, Ou L, Liang W, He J. Impact of examined lymph node counts on survival of patients with stage IA non-small cell lung cancer undergoing sublobar resection. J Thorac Dis 2018; 10:6569-6577. [PMID: 30746202 DOI: 10.21037/jtd.2018.11.49] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background The correlation between the number of examined lymph nodes (ELNs) and lung cancer-specific survival (LCSS) of stage IA non-small cell lung cancer (NSCLC) patients, who underwent sublobar resection in which lymph node (LN) sampling was relatively restricted as compared with standard lobectomy remains unclear. Methods Patients from the Surveillance, Epidemiology, and End Results database with stage IA NSCLC who underwent sublobar resection were categorized based on ELN count (1-6 vs. ≥7; the cut point 7 was identified by Cox model). Results Collectively, 3,219 patients with a median follow-up time of 37 months were included in this study (G1: 1-6 ELN, n=2,410; G2: ≥7 ELN, n=809). The 5-year LCSS rate of the G1 and G2 cohorts were 75% and 83%, respectively. Cox analysis suggested that the LCSS of G1 cohort patients was lower as compared with the G2 cohort [hazard ratio (HR) =1.530; 95% confidence interval (CI): 1.240-1.988, P<0.001). Propensity score analysis also showed decreased survival of the matched G1 cohort (HR =1.499; 95% CI: 1.176-1.911; P=0.001). Conclusions The data suggested the ELNs ≤6 were associated with poor prognoses. Adequate LN sampling is essential even for stage IA NSCLC patients undergoing sublobar resection.
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Affiliation(s)
- Yang Liu
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jianfei Shen
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou 317000, China
| | - Liping Liu
- The Translational Medicine Laboratory, State Key Laboratory of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Lanlan Shan
- Department of Health Management, Nanfang Hospital, Southern Medical University, Guangzhou 510120, China
| | - Jiaxi He
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Qihua He
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Long Jiang
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Minzhang Guo
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Xuewei Chen
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Hui Pan
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Guilin Peng
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Honghui Shi
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Limin Ou
- The Translational Medicine Laboratory, State Key Laboratory of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Wenhua Liang
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jianxing He
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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Evison M, McDonald F, Batchelor T. What is the role of surgery in potentially resectable N2 non-small cell lung cancer? Thorax 2018. [DOI: 10.1136/thoraxjnl-2018-212287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Molnar TF. Tuberculosis: mother of thoracic surgery then and now, past and prospectives: a review. J Thorac Dis 2018; 10:S2628-S2642. [PMID: 30345099 PMCID: PMC6178290 DOI: 10.21037/jtd.2018.04.131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 04/19/2018] [Indexed: 11/06/2022]
Abstract
Knowledge on ontogenesis of thoracic surgery is essential not only for understanding present concepts and debates on surgery for tuberculosis, but it also contributes to the further developments in operative treatment of lung cancer. Both diseases have been the leading cause of death in their respective ages. History of tuberculosis follows the classic algorithm: diagnostic, casuistic and therapeutical stages. Villemin followed by Virchow, and, finally, Koch revealed the pathoanatomy and the cause of tuberculosis. The therapeutic phase of lung cancer has been reached without identified cause of the disease. Chest surgery, eradication of the macroscopic focus by physical interference with the involved tissue mass, in both diseases preceded medical treatment. Identification of phenotypes of lung cancer-if it is a single disease at all-does not contravene the concept: the tumor mass should been eliminated. However, causation is not an absolute sine qua non of an effective treatment, as the tuberculosis-lung cancer analogy also proves. Surgical approach of both diseases suffered from the same paraoxon: eradication without direct interference with the causative factor. While lung cancer seems to be controlled by an emerging array of new drugs, tuberculosis poses a new challenge, as multidrug resistant and extensively drug resistant Koch bacteria are emerging and fragile societies' immunity is weakening. Thoracic surgery has a significant share in the fight against tuberculosis, when drugs and/or society fail. Palliative and radical adjuvant surgery multiplies the chance of cure in those cases, where not much hope is left. The jury is still out in a series of questions, but it is obvious, that surgery is only an option and not a panacea where medicines and their providers fail. Deeper understanding of our past and present failures with tuberculosis and its surgery might contribute to new concepts in coping with lung cancer as well.
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Affiliation(s)
- Tamas F. Molnar
- Department of Operational Medicine, Medical Humanities Unit, University of Pécs, Pécs, Hungary
- Department Surgery, St Sebastian Thoracic Surgery Unit, Petz A University Teaching Hospital, Győr, Hungary
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Bertoglio P, Ricciardi S, Alì G, Aprile V, Korasidis S, Palmiero G, Fontanini G, Mussi A, Lucchi M. N2 lung cancer is not all the same: an analysis of different prognostic groups†. Interact Cardiovasc Thorac Surg 2018; 27:720-726. [DOI: 10.1093/icvts/ivy171] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 04/17/2018] [Indexed: 12/25/2022] Open
Affiliation(s)
- Pietro Bertoglio
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
- Division of Thoracic Surgery, Sacro Cuore-Don Calabria Research Hospital and Cancer Care Centre, Negrar, Verona, Italy
| | - Sara Ricciardi
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Greta Alì
- Division of Pathological Anatomy, University Hospital of Pisa, Pisa, Italy
| | - Vittorio Aprile
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | | | - Gerardo Palmiero
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | | | - Alfredo Mussi
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Marco Lucchi
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
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Rami-Porta R, Call S, Dooms C, Obiols C, Sánchez M, Travis WD, Vollmer I. Lung cancer staging: a concise update. Eur Respir J 2018; 51:13993003.00190-2018. [PMID: 29700105 DOI: 10.1183/13993003.00190-2018] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/04/2018] [Indexed: 12/13/2022]
Abstract
Diagnosis and clinical staging of lung cancer are fundamental to planning therapy. The techniques for clinical staging, i.e anatomic and metabolic imaging, endoscopies and minimally invasive surgical procedures, should be performed sequentially and with an increasing degree of invasiveness. Intraoperative staging, assessing the magnitude of the primary tumour, the involved structures, and the loco-regional lymphatic spread by means of systematic nodal dissection, is essential in order to achieve a complete resection. In resected tumours, pathological staging, with the systematic study of the resected specimens, is the strongest prognostic indicator and is essential to make further decisions on therapy. In the present decade, the guidelines on lung cancer staging of the American College of Chest Physicians and the European Society of Thoracic Surgeons are based on the best available evidence and are widely followed. Recent advances in the classification of the adenocarcinoma of the lung, with the definition of adenocarcinoma in situ, minimally invasive adenocarcinoma and lepidic predominant adenocarcinoma, and the publication of the eighth edition of the tumour, node and metastasis classification of lung cancer, have to be integrated into the staging process. The present review complements the latest guidelines on lung cancer staging by providing an update of all these issues.
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Affiliation(s)
- Ramón Rami-Porta
- Dept of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Barcelona, Spain.,Network of Centres for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Barcelona, Spain
| | - Sergi Call
- Dept of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Barcelona, Spain.,Dept of Morphological Sciences, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Christophe Dooms
- Dept of Respiratory Diseases, University Hospitals, KU Leuven, Leuven, Belgium
| | - Carme Obiols
- Dept of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Barcelona, Spain
| | - Marcelo Sánchez
- Centre of Imaging Diagnosis, Radiology Dept, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - William D Travis
- Dept of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ivan Vollmer
- Centre of Imaging Diagnosis, Radiology Dept, Hospital Clínic, University of Barcelona, Barcelona, Spain
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73
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Wang Z, Li M, Huang Y, Ma L, Zhu H, Kong L, Yu J. Clinical and radiological characteristics of central pulmonary adenocarcinoma: a comparison with central squamous cell carcinoma and small cell lung cancer and the impact on treatment response. Onco Targets Ther 2018; 11:2509-2517. [PMID: 29765230 PMCID: PMC5942174 DOI: 10.2147/ott.s154385] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose The proportion of central pulmonary adenocarcinoma (ADC) in central-type lung cancer has been gradually increasing due to the overall increasing incidence of pulmonary ADC. But the clinical and radiological characteristics of central ADCs remain unclear. In this study, we compared the clinical and radiological characteristics of central ADCs with those of small cell lung cancers (SCLCs) and squamous cell carcinomas (SQCCs) and investigated the impact of these characteristics on patients’ treatment response. Patients and methods The medical records of 302 consecutive patients with central lung cancer from July 2014 to September 2016 were retrospectively reviewed. There were 99 patients with ADC, 95 with SQCC and 108 with SCLC. Computed tomography images were interpreted by two radiologists. Treatment response was determined by Response Evaluation Criteria In Solid Tumors 1.1. Results Univariate analyses found that younger age, female sex, no history of smoking, higher levels of carcinoembryonic antigen (CEA), contralateral hilum lymphadenopathy, contralateral lung metastasis, pleural nodules and pleural metastasis to the interlobular fissure were significantly correlated with central ADC. Multivariate logistic regression analyses revealed that compared with central SQCC, female sex, younger age, no history of smoking, higher levels of CEA and contralateral hilum lymphadenopathy were the significantly independent indicators of central pulmonary ADC. Furthermore, compared with central SCLC, younger age, higher levels of CEA and cytokeratin 19 fragment (Cyfra21-1), lower levels of neuron-specific enolase, pleural nodules and lack of vascular involvement were significantly associated with central ADC. In 85 central ADC patients who received first-line platinum-based chemotherapy, both univariate and multivariate logistic regression analyses revealed that pulmonary emphysema had a negative correlation with treatment response (odds ratio=8.04, p=0.02). Conclusion Our study revealed that central pulmonary ADCs exhibited more aggressive clinical and radiological characteristics. Pulmonary emphysema was an independent and negative indicator for treatment response of central ADC.
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Affiliation(s)
- Zhe Wang
- School of Medicine, Shandong University, Jinan, Shandong, China.,Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Minghuan Li
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Yong Huang
- Department of Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Li Ma
- Department of Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Hui Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Li Kong
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China
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Shafique MR, Robinson LA, Antonia S. Durvalumab: a potential maintenance therapy in surgery-ineligible non-small-cell lung cancer. Cancer Manag Res 2018; 10:931-940. [PMID: 29760563 PMCID: PMC5937504 DOI: 10.2147/cmar.s148009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Lung cancer is the most common cancer worldwide and the most common cause of cancer-related death. Non-small-cell lung cancer comprises ~87% of newly diagnosed cases of lung cancer, and nearly one-third of these patients have stage III disease. Despite improvements in the treatment of stage IV lung cancer, particularly with the introduction and dissemination of checkpoint inhibitors, very little progress has been made in the treatment of stage III lung cancer. In this article, we discuss the general staging criteria and treatment options for stage III lung cancer. We review how concurrent radiation and chemotherapy can have immunomodulatory effects, supporting the rationale for incorporating immunotherapy into existing treatment paradigms. Finally, we discuss the results of the PACIFIC trial and implications for the treatment of stage III lung cancer. In the PACIFIC trial, adding durvalumab as a maintenance therapy following the completion of chemoradiotherapy improved progression-free survival in patients with locally advanced unresectable stage III lung cancer. On the strength of these results, durvalumab has been approved by the US Food and Drug Administration for use in this setting, representing the first advance in the treatment of stage III lung cancer in nearly a decade.
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Affiliation(s)
- Michael R Shafique
- Department of Thoracic Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Lary A Robinson
- Department of Thoracic Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Scott Antonia
- Department of Thoracic Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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75
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Yılmaz U, Özdemir Ö, Yılmaz Ü. Comparison of seventh TNM and eighth TNM staging system in stage III non-small cell lung cancer patients treated with concurrent chemoradiotherapy. Curr Probl Cancer 2018; 43:33-42. [PMID: 29804944 DOI: 10.1016/j.currproblcancer.2018.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 04/20/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Ufuk Yılmaz
- Department of Pulmonology, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turkey
| | - Özer Özdemir
- Department of Pulmonology, Kemalpaşa State Hospital, İzmir, Turkey.
| | - Ülkü Yılmaz
- Department of Pulmonology, Atatürk Chest Disease and Surgery Training and Research Hospital, Ankara, Turkey
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76
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Liu Y, Kim J, Balagurunathan Y, Hawkins S, Stringfield O, Schabath MB, Li Q, Qu F, Liu S, Garcia AL, Ye Z, Gillies RJ. Prediction of pathological nodal involvement by CT-based Radiomic features of the primary tumor in patients with clinically node-negative peripheral lung adenocarcinomas. Med Phys 2018; 45:2518-2526. [PMID: 29624702 DOI: 10.1002/mp.12901] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/07/2018] [Accepted: 03/23/2018] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the potential of computed tomography (CT) based radiomic features of primary tumors to predict pathological nodal involvement in clinically node-negative (N0) peripheral lung adenocarcinomas. METHODS A total of 187 patients with clinical N0 peripheral lung adenocarcinomas who underwent preoperative CT scan and subsequently received systematic lymph node dissection were retrospectively reviewed. 219 quantitative 3D radiomic features of primary lung tumor were extracted; meanwhile, nine radiological semantic features were evaluated. Univariate and multivariate logistic regression analysis were used to explore the role of these features in predicting pathological nodal involvement. The areas under the ROC curves (AUCs) were compared between multivariate logistic regression models. RESULTS A total of 153 patients had pathological N0 status and 34 had pathological lymph node metastasis. On univariate analysis, fissure attachment and 17 radiomic features were significantly associated with pathological nodal involvement. Multivariate analysis revealed that semantic features of pleural retraction (P = 0.048) and fissure attachment (P = 0.023) were significant predictors of pathological nodal involvement (AUC = 0.659); and the radiomic feature F185 (Histogram SD Layer 1) (P = 0.0001) was an independent prognostic factor of pathological nodal involvement (AUC = 0.73). A logistic regression model produced from combining radiomic feature and semantic feature showed the highest AUC of 0.758 (95% CI: 0.685-0.831), and the AUC value computed by fivefold cross-validation method was 0.737 (95% CI: 0.73-0.744). CONCLUSIONS Features derived on primary lung tumor described by semantic and radiomic could provide information of pathological nodal involvement in clinical N0 peripheral lung adenocarcinomas.
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Affiliation(s)
- Ying Liu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin.,Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Jongphil Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Yoganand Balagurunathan
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Samuel Hawkins
- Department of Computer Sciences and Engineering, University of South Florida, Tampa, FL, USA
| | - Olya Stringfield
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Matthew B Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Qian Li
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin.,Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Fangyuan Qu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin
| | - Shichang Liu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin
| | - Alberto L Garcia
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Zhaoxiang Ye
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin
| | - Robert J Gillies
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, USA.,Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
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77
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Kruser TJ, Mohindra N, DeCamp MM. One size does not fit all: Nuances in postoperative N2 non-small cell lung cancer management. J Thorac Cardiovasc Surg 2018; 156:370-373. [PMID: 29681397 DOI: 10.1016/j.jtcvs.2018.02.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 02/03/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Tim J Kruser
- Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Ill; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Ill
| | - Nisha Mohindra
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Ill; Division of Hematology and Oncology, Department of Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Malcolm M DeCamp
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Ill; Division of Thoracic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.
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78
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Mueller MR. Tailored management of stage IIIa non-small-cell lung cancer in the era of the 8th edition of the TNM classification for lung cancer. Future Oncol 2018; 14:5-11. [PMID: 29664358 DOI: 10.2217/fon-2017-0382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Stage IIIA is a very heterogeneous group encompassing locally advanced disease with T3 and T4 tumors without any nodal involvement and very small T1a primary tumors with unilateral mediastinal lymphatic disease. Tailored management defines interdisciplinary management requiring board decisions, which can sometimes be difficult particularly in stage IIIa non-small-cell lung cancer (NSCLC). Lobectomy still is standard of care even for stage I NSCLC, which increasingly is implemented using minimally invasive surgical technique. On the other hand even locally extended tumors are today safely resected with low morbidity and mortality. According to the 2015 guidelines of the European Society of Thoracic Surgeons any kind of anatomical lung resection for lung cancer with curative intent has to be accompanied by formal mediastinal lymph node dissection. The transcervical route for complete bilateral mediastinal lymphadenectomy offers improved completeness of resection without the need for single lung ventilation and ideally supports the concept of minimally invasive surgery.
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Affiliation(s)
- Michael R Mueller
- Department of Thoracic Surgery, Sigmund Freud University Vienna, Otto Wagner Hospital, A1140 Vienna, Austria
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79
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El-Sherief AH, Lau CT, Carter BW, Wu CC. Staging Lung Cancer: Regional Lymph Node Classification. Radiol Clin North Am 2018; 56:399-409. [PMID: 29622075 DOI: 10.1016/j.rcl.2018.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This article reviews regional lymph node assessment in lung cancer. In the absence of a distant metastasis, the absence or location of lung cancer spread to a regional mediastinal lymph node affects treatment options and prognosis. Regional lymph node maps have been created to standardize assessment of the N descriptor. The International Association for the Study of Lung Cancer lymph node map is used for the standardization of N descriptor assessment. CT, PET/CT with fluorodeoxyglucose, endobronchial ultrasound-guided and/or esophageal ultrasound-guided biopsy, and mediastinoscopy are common modalities used to determine the N descriptor.
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Affiliation(s)
- Ahmed H El-Sherief
- Section of Thoracic Imaging, Department of Diagnostic Radiology, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Building 500, Los Angeles, CA 90073, USA; David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA.
| | - Charles T Lau
- Section of Cardiothoracic Imaging, Radiology Service, Veterans Affairs Palo Alto Healthcare System, 3801 Miranda Avenue, Palo Alto, CA 94304, USA
| | - Brett W Carter
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA
| | - Carol C Wu
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA
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80
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Rami-Porta R. A Spanish thoracic surgeon visits China-reflections on the surgical treatment of lung cancer. J Thorac Dis 2018; 10:718-722. [PMID: 29607141 DOI: 10.21037/jtd.2018.01.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ramón Rami-Porta
- Thoracic Surgery Service, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain.,Network of Centres for Biomedical Research on Respiratory Diseases (CIBERES), Lung Cancer Group, Terrassa, Barcelona, Spain
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81
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Li N, Tan F, Li J, Shao K, Zhao J, Mu J, Gao S, He J. Blind spot in lung cancer lymph node metastasis: Cross-lobe peripheral lymph node metastasis in early stage patients. Thorac Cancer 2018. [PMID: 29517861 PMCID: PMC5879049 DOI: 10.1111/1759-7714.12620] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND At present, it has not yet been determined whether metastasis can be transferred cross-lobe to peripheral lymph nodes (LNs) from other lobes in early stages of lung cancer, especially without any direct involvement to the pleura and parenchyma of the lobe. This study was conducted to investigate this issue. METHODS A retrospective analysis was conducted at the Chinese Academy of Medical Sciences. Patients undergoing right middle and lower lobectomy with lymphadenectomy for preoperative clinical stage Ia-IIIa from 2014 to 2015 were identified. To avoid interference, cases were limited to tumors within the primary lobe. When a tumor is completely located in the lower lobe, no direct invasion occurs into the visceral pleura/bronchus/parenchyma of the middle lobe and tumor cell metastasis into the peripheral LNs (stations 12-14) in the middle lobe is defined as cross-lobe lymph node metastasis (CLM). RESULTS A total of 68 patients were identified, of which nine (13.2%) had CLM. Seven had squamous cell carcinoma, one adenocarcinoma, and one small cell carcinoma. Seven cases (77.8%) had intermediate bronchus invasion, and seven cases (77.8%) intermediate bronchus adjacent lymph node involvement (station 11). Compared to non-CLM patients, tumor diameter (5.2 vs. 3.2; P = 0.28), N2 lymph node metastasis rate (66.7% vs. 28.8%; P = 0.03), late stage (IIIa 77.8% vs. 35.6%; P = 0.04), and invasion of intermediate bronchus (77.8% vs. 45.8%; P = 0.07) relatively increased. CONCLUSION Non-primary lobe peripheral LN metastasis exists in lung cancer and requires greater attention and further study.
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Affiliation(s)
- Ning Li
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengwei Tan
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiagen Li
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kang Shao
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Zhao
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Juwei Mu
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, China
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82
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Jin BF, Yang F, Ying XM, Gong L, Hu SF, Zhao Q, Liao YD, Chen KZ, Li T, Tai YH, Cao Y, Li X, Huang Y, Zhan XY, Qin XH, Wu J, Chen S, Guo SS, Zhang YC, Chen J, Shen DH, Sun KK, Chen L, Li WH, Li AL, Wang N, Xia Q, Wang J, Zhou T. Signaling protein signature predicts clinical outcome of non-small-cell lung cancer. BMC Cancer 2018; 18:259. [PMID: 29510676 PMCID: PMC5840771 DOI: 10.1186/s12885-018-4104-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 02/06/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Non-small-cell lung cancer (NSCLC) is characterized by abnormalities of numerous signaling proteins that play pivotal roles in cancer development and progression. Many of these proteins have been reported to be correlated with clinical outcomes of NSCLC. However, none of them could provide adequate accuracy of prognosis prediction in clinical application. METHODS A total of 384 resected NSCLC specimens from two hospitals in Beijing (BJ) and Chongqing (CQ) were collected. Using immunohistochemistry (IHC) staining on stored formalin-fixed paraffin-embedded (FFPE) surgical samples, we examined the expression levels of 75 critical proteins on BJ samples. Random forest algorithm (RFA) and support vector machines (SVM) computation were applied to identify protein signatures on 2/3 randomly assigned BJ samples. The identified signatures were tested on the remaining BJ samples, and were further validated with CQ independent cohort. RESULTS A 6-protein signature for adenocarcinoma (ADC) and a 5-protein signature for squamous cell carcinoma (SCC) were identified from training sets and tested in testing sets. In independent validation with CQ cohort, patients can also be divided into high- and low-risk groups with significantly different median overall survivals by Kaplan-Meier analysis, both in ADC (31 months vs. 87 months, HR 2.81; P < 0.001) and SCC patients (27 months vs. not reached, HR 9.97; P < 0.001). Cox regression analysis showed that both signatures are independent prognostic indicators and outperformed TNM staging (ADC: adjusted HR 3.07 vs. 2.43, SCC: adjusted HR 7.84 vs. 2.24). Particularly, we found that only the ADC patients in high-risk group significantly benefited from adjuvant chemotherapy (P = 0.018). CONCLUSIONS Both ADC and SCC protein signatures could effectively stratify the prognosis of NSCLC patients, and may support patient selection for adjuvant chemotherapy.
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Affiliation(s)
- Bao-Feng Jin
- State Key Laboratory of Proteomics, Institute of Basic Medical Sciences, China National Center of Biomedical Analysis, Beijing, 100850 China
| | - Fan Yang
- Department of Thoracic Surgery, People’s Hospital, Peking University, Beijing, 100044 China
| | - Xiao-Min Ying
- Computational Medicine Laboratory, Beijing Institute of Basic Medical Sciences, Beijing, 100850 China
| | - Lin Gong
- State Key Laboratory of Proteomics, Institute of Basic Medical Sciences, China National Center of Biomedical Analysis, Beijing, 100850 China
| | - Shuo-Feng Hu
- Computational Medicine Laboratory, Beijing Institute of Basic Medical Sciences, Beijing, 100850 China
| | - Qing Zhao
- State Key Laboratory of Proteomics, Institute of Basic Medical Sciences, China National Center of Biomedical Analysis, Beijing, 100850 China
| | - Yi-Da Liao
- Department of Thoracic Surgery, People’s Hospital, Peking University, Beijing, 100044 China
| | - Ke-Zhong Chen
- Department of Thoracic Surgery, People’s Hospital, Peking University, Beijing, 100044 China
| | - Teng Li
- State Key Laboratory of Proteomics, Institute of Basic Medical Sciences, China National Center of Biomedical Analysis, Beijing, 100850 China
| | - Yan-Hong Tai
- The 90th Hospital of Jinan, Jinan, 250031 China
- Department of Pathology, The 307th Hospital of Chinese PLA, Beijing, 100071 China
| | - Yuan Cao
- The 90th Hospital of Jinan, Jinan, 250031 China
| | - Xiao Li
- Department of Thoracic Surgery, People’s Hospital, Peking University, Beijing, 100044 China
| | - Yan Huang
- State Key Laboratory of Proteomics, Institute of Basic Medical Sciences, China National Center of Biomedical Analysis, Beijing, 100850 China
| | - Xiao-Yan Zhan
- State Key Laboratory of Proteomics, Institute of Basic Medical Sciences, China National Center of Biomedical Analysis, Beijing, 100850 China
| | - Xuan-He Qin
- State Key Laboratory of Proteomics, Institute of Basic Medical Sciences, China National Center of Biomedical Analysis, Beijing, 100850 China
| | - Jin Wu
- State Key Laboratory of Proteomics, Institute of Basic Medical Sciences, China National Center of Biomedical Analysis, Beijing, 100850 China
| | - Shuai Chen
- State Key Laboratory of Proteomics, Institute of Basic Medical Sciences, China National Center of Biomedical Analysis, Beijing, 100850 China
| | - Sai-Sai Guo
- State Key Laboratory of Proteomics, Institute of Basic Medical Sciences, China National Center of Biomedical Analysis, Beijing, 100850 China
| | - Yu-Cheng Zhang
- State Key Laboratory of Proteomics, Institute of Basic Medical Sciences, China National Center of Biomedical Analysis, Beijing, 100850 China
| | - Jing Chen
- State Key Laboratory of Proteomics, Institute of Basic Medical Sciences, China National Center of Biomedical Analysis, Beijing, 100850 China
| | - Dan-Hua Shen
- Department of Pathology, People’s Hospital, Peking University, Beijing, 100044 China
| | - Kun-Kun Sun
- Department of Pathology, People’s Hospital, Peking University, Beijing, 100044 China
| | - Lu Chen
- Institute of Pathology, Southwest Cancer Center, Southwest Hospital, Chongqing, 400038 China
| | - Wei-Hua Li
- State Key Laboratory of Proteomics, Institute of Basic Medical Sciences, China National Center of Biomedical Analysis, Beijing, 100850 China
| | - Ai-Ling Li
- State Key Laboratory of Proteomics, Institute of Basic Medical Sciences, China National Center of Biomedical Analysis, Beijing, 100850 China
| | - Na Wang
- State Key Laboratory of Proteomics, Institute of Basic Medical Sciences, China National Center of Biomedical Analysis, Beijing, 100850 China
| | - Qing Xia
- State Key Laboratory of Proteomics, Institute of Basic Medical Sciences, China National Center of Biomedical Analysis, Beijing, 100850 China
| | - Jun Wang
- Department of Thoracic Surgery, People’s Hospital, Peking University, Beijing, 100044 China
| | - Tao Zhou
- State Key Laboratory of Proteomics, Institute of Basic Medical Sciences, China National Center of Biomedical Analysis, Beijing, 100850 China
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Zhang R, Ma Y, Xu G, Gao X, Luo G, Lin Q, Yang Y, Wang X, Zhang L. Endobronchial ultrasound-guided transbronchial needle aspiration and cervical mediastinoscopy for mediastinal staging of non-small cell lung cancer: a retrospective comparison study. J Thorac Dis 2018; 10:1951-1959. [PMID: 29707351 DOI: 10.21037/jtd.2018.01.51] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Invasive mediastinal lymph node staging is essential to resectable non-small cell lung cancer (NSCLC) patients. This retrospective study aimed to compare the diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) against cervical mediastinoscopy (CMS) in radiologically enlarged mediastinal lymph nodes. Methods Retrospective data were collected from January 2009 to March 2016. Suspected lung cancer patients with enlarged mediastinal lymph nodes (short axis ≥10 mm), underwent EBUS-TBNA or CMS for invasive mediastinal staging were enrolled. Substantial radical resection with systematic mediastinal lymphadenectomy (SML) was used as the gold standard. Mediastinal lymph nodes diagnostic comparison and N staging analysis were conducted in this study. Results Fifty-five patients received EBUS-TBNA and one hundred and ninety patients received CMS were included into the analysis set. In per case analysis, no significant differences were seen between EBUS-TBNA and CMS in N staging accuracy (83.6% vs. 78.9%, P=0.444). EBUS-TBNA had significantly higher sensitivity than CMS (82.4% vs. 47.6%, P=0.039) in malignant lymph nodes diagnosis. In lymph nodes diagnosis comparison (station #2, #4 and #7), both EBUS-TBNA and CMS showed high diagnostic sensitivity, specificity and accuracy (82.4% vs. 94.7%, P=0.130; 97.4% vs. 100%, P=0.173; 98.8% vs. 92.9%, P=0.025; respectively), CMS had slightly better diagnostic accuracy rate than EBUS-TBNA. Malignant lymph nodes had longer short axis than benign nodes (mean 14.2 vs. 6.5 mm, P<0.001). In lymph nodes with a short axis ≥15 mm, the malignant rate was 48.8%. More complications and injuries were found in patients receiving CMS. Conclusions For clinically suspected lung cancers with enlarged mediastinal lymph nodes, both EBUS-TBNA and CMS are favorable invasive mediastinal staging options. EBUS-TBNA may be preferred for its higher malignant diagnostic sensitivity and fewer complications.
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Affiliation(s)
- Rong Zhang
- Department of Endoscopy, Medical Oncology, Ultrasound and Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yuxiang Ma
- Department of Endoscopy, Medical Oncology, Ultrasound and Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Guoliang Xu
- Department of Endoscopy, Medical Oncology, Ultrasound and Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Xiaoyan Gao
- Department of Endoscopy, Medical Oncology, Ultrasound and Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Guangyu Luo
- Department of Endoscopy, Medical Oncology, Ultrasound and Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Qingguang Lin
- Department of Endoscopy, Medical Oncology, Ultrasound and Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yunpeng Yang
- Department of Endoscopy, Medical Oncology, Ultrasound and Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Xin Wang
- Department of Endoscopy, Medical Oncology, Ultrasound and Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Li Zhang
- Department of Endoscopy, Medical Oncology, Ultrasound and Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
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Nicholson AG, Tsao MS, Travis WD, Patil DT, Galateau-Salle F, Marino M, Dacic S, Beasley MB, Butnor KJ, Yatabe Y, Pass HI, Rusch VW, Detterbeck FC, Asamura H, Rice TW, Rami-Porta R. Eighth Edition Staging of Thoracic Malignancies: Implications for the Reporting Pathologist. Arch Pathol Lab Med 2018; 142:645-661. [PMID: 29480761 DOI: 10.5858/arpa.2017-0245-ra] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context The Staging and Prognostic Factors Committee of the International Association for the Study of Lung Cancer, in conjunction with the International Mesothelioma Interest Group, the International Thymic Malignancy Interest Group, and the Worldwide Esophageal Cancer Collaboration, developed proposals for the 8th edition of their respective tumor, node, metastasis (TNM) staging classification systems. Objective To review these changes and discuss issues for the reporting pathologist. Data Sources Proposals were based on international databases of lung (N = 94 708), with an external validation using the US National Cancer Database; mesothelioma (N = 3519); thymic epithelial tumors (10 808); and epithelial cancers of the esophagus and esophagogastric junction (N = 22 654). Conclusions These proposals have been mostly accepted by the Union for International Cancer Control and the American Joint Committee on Cancer and incorporated into their respective staging manuals (2017). The Union for International Cancer Control recommended implementation beginning in January 2017; however, the American Joint Committee on Cancer has deferred deployment of the eighth TNM until January 1, 2018, to ensure appropriate infrastructure for data collection. This manuscript summarizes the updated staging of thoracic malignancies, specifically highlighting changes from the 7th edition that are relevant to pathologic staging. Histopathologists should become familiar with, and start to incorporate, the 8th edition staging in their daily reporting of thoracic cancers henceforth.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ramon Rami-Porta
- From the Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (Dr Nicholson); the Department of Pathology, The Princess Margaret Cancer Centre, Toronto, Ontario, Canada (Dr Tsao); the Department of Pathology (Dr Travis) and the Thoracic Service, Department of Surgery (Dr Rusch), Memorial Sloan-Kettering Cancer Center, New York, New York; the Departments of Pathology (Dr Patil) and Thoracic and Cardiovascular Surgery (Dr Rice), Cleveland Clinic, Cleveland, Ohio; the Departement de Biopathologie, Cancer Center Leon Bernard, Lyon, France (Dr Galateau-Salle); the Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy (Dr Marino); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington (Dr Butnor); the Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan (Dr Yatabe); the Department of Thoracic Surgery, New York University, New York, New York (Dr Pass); the Department of Thoracic Surgery, Yale University, New Haven, Connecticut (Dr Detterbeck); the Department of Thoracic Surgery, Keio University, Tokyo, Japan (Dr Asamura); and the Thoracic Surgery Service, Hospital Universitari Mutua Terrassa, University of Barcelona, and CIBERES Lung Cancer Group, Terrassa, Barcelona, Spain (Dr Rami-Porta)
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85
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Giroux DJ, Van Schil P, Asamura H, Rami-Porta R, Chansky K, Crowley JJ, Rusch VW, Kernstine K. The IASLC Lung Cancer Staging Project: A Renewed Call to Participation. J Thorac Oncol 2018; 13:801-809. [PMID: 29476906 DOI: 10.1016/j.jtho.2018.02.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/14/2018] [Accepted: 02/14/2018] [Indexed: 12/22/2022]
Abstract
Over the past two decades, the International Association for the Study of Lung Cancer (IASLC) Staging Project has been a steady source of evidence-based recommendations for the TNM classification for lung cancer published by the Union for International Cancer Control and the American Joint Committee on Cancer. The Staging and Prognostic Factors Committee of the IASLC is now issuing a call for participation in the next phase of the project, which is designed to inform the ninth edition of the TNM classification for lung cancer. Following the case recruitment model for the eighth edition database, volunteer site participants are asked to submit data on patients whose lung cancer was diagnosed between January 1, 2011, and December 31, 2019, to the project by means of a secure, electronic data capture system provided by Cancer Research And Biostatistics in Seattle, Washington. Alternatively, participants may transfer existing data sets. The continued success of the IASLC Staging Project in achieving its objectives will depend on the extent of international participation, the degree to which cases are entered directly into the electronic data capture system, and how closely externally submitted cases conform to the data elements for the project.
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Affiliation(s)
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Ramón Rami-Porta
- Thoracic Surgery Service, Hospital Universitari Mútua Terrassa, Terrassa, Spain; Network of Centers of Biomedical Research in Respiratory Diseases (CIBERES), Lung Cancer Group, Terrassa, Spain
| | - Kari Chansky
- Cancer Research And Biostatistics, Seattle, Washington
| | | | - Valerie W Rusch
- Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Kemp Kernstine
- Cardiovascular and Thoracic Surgery, University of Texas Southwestern, Dallas, Texas
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Underperformance of Mediastinal Lymph Node Evaluation in Resectable Non-Small Cell Lung Cancer. Ann Thorac Surg 2018; 105:943-949. [PMID: 29397099 DOI: 10.1016/j.athoracsur.2017.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 08/22/2017] [Accepted: 10/05/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Mediastinal lymph node evaluation (MLNE) is considered to be the standard of care in curative lung cancer surgery although it is not always performed. This study identifies factors associated with patients not being evaluated (non-MLNE) in cases of resectable non-small cell lung cancer. METHODS A retrospective observational study using the Surveillance, Epidemiology, and End Results Program database was conducted. Adult patients diagnosed with non-small cell lung cancer stage I to IIIA (2004 to 2013) were included. Multilevel logistic regression analysis was performed to identify factors that were associated with non-MLNE. RESULTS There were 86,721 patients included in this study: 73,034 (84.2%) with MLNE and 13,687 (15.8%) without. The use of MLNE gradually increased from 82.7% in 2004 to 85.8% in 2013. In multivariable analysis, factors associated with non-MLNE included the following: age more than 75 years (adjusted odds ratio [ORadj] 1.20, 95% confidence interval [CI]: 1.13 to 1.27); black (ORadj 1.11, 95% CI: 1.32 to 1.20); Native American/Alaskan (ORadj 1.63, 95% CI: 1.15 to 2.31); uninsured (ORadj 1.28, 95% CI: 1.05 to 1.56); residing in a low-income county (ORadj 1.12, 95% CI: 1.04 to 1.21); lesion at the middle lobe (ORadj 1.42, 95% CI: 1.29 to 1.56); lower lobe (ORadj 1.06, 95% CI: 1.01 to 1.11) or main bronchus (ORadj 2.38, 95% CI: 1.93 to 2.94); stage IA (ORadj 1.24, 95% CI: 1.17 to 1.32); sublobar resection (ORadj 11.08, 95% CI: 11.30 to 12.33); and preoperative treatment (ORadj 1.21, 95% CI: 1.08 to 1.36). Non-MLNE was less likely to occur in patients with adenocarcinoma (ORadj 0.88, 95% CI: 0.83 to 0.92) and more likely in other cell types (ORadj 1.23, 95% CI: 1.15 to 1.32), compared with squamous cell carcinoma. CONCLUSIONS Patient demographics and socioeconomic status are associated with the decision to perform MLNE. Thoracic surgeons should access these factors and perform MLNE to accurately determine tumor stage and improve survival.
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Wang G, Ma W, Li Y, Jiang Y, Ma G, Zhang X, Meng L, Du J. Prognostic value of Twist, Snail and E-cadherin expression in pathological N0 non-small-cell lung cancer: a retrospective cohort study. Eur J Cardiothorac Surg 2018; 54:237-245. [PMID: 29415155 DOI: 10.1093/ejcts/ezy022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 01/07/2018] [Indexed: 01/29/2023] Open
Affiliation(s)
- Guanghui Wang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Wei Ma
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yun Li
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yuanzhu Jiang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Guoyuan Ma
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xiangwei Zhang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Long Meng
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Jiajun Du
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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88
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Erkisi Z, Yaylim-Eraltan I, Turna A, Görmüs U, Camlica H, Isbir T. Polymorphisms in the Microsomal Epoxide Hydrolase Gene: Role in Lung Cancer Susceptibility and Prognosis. TUMORI JOURNAL 2018; 96:756-63. [DOI: 10.1177/030089161009600519] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background The aim of this study was to investigate the relationship between EPHXI exon 3 Tyr113His and exon 4 His139Arg polymorphisms, predicted microsomal epoxide hydrolase (mEH) activity, and lung cancer development. mEH is a protective enzyme involved in oxidative defences against a number of environmental chemicals and pollutants, but it is also responsible for the xenobiotic activation of carcinogens. Methods We investigated the two polymorphisms of the mEH gene (EPHX1) in 58 lung cancer patients and 41 controls using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results The exon 3 Tyr113His polymorphism was associated with lung cancer (P <0.001). The frequency of the His113His homozygote genotype in exon 3 was significantly increased in patients compared with controls (P <0.001). In contrast, there was no significant difference in exon 4 polymorphisms between patients and controls. When the exon 3 and 4 polymorphisms were considered together, the combined EPHX1 His113His113/His139His139 genotype (very low predicted enzyme activity) was found to be associated with an increased risk of lung cancer (P = 0.044, OR = 3.063, CI = 0.932–10.069). We observed that patients with T3 + T4 tumors had an approximately 3-fold higher risk of the Tyr113/His113 genotype than patients with T1 + T2 tumors. Lung cancer patients carrying aheterozygote Tyr113/His113 genotype had a 2-fold increased risk of lymph node metastases (P = 0.051). Conclusion These findings suggest that the exon 3 Tyr113His and exon 4 His139Arg polymorphisms of EPHXI may be associated with a increased risk of lung cancer and a worse prognosis. Free full text available at www.tumorionline.it
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Affiliation(s)
- Zelal Erkisi
- Department of Medicine, Institute of Experimental Medical Research, University of Istanbul, Istanbul
| | - Ilhan Yaylim-Eraltan
- Department of Medicine, Institute of Experimental Medical Research, University of Istanbul, Istanbul
| | - Akif Turna
- Department of Thoracic Surgery, Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, Istanbul
| | - Uzay Görmüs
- Department of Medicine, Institute of Experimental Medical Research, University of Istanbul, Istanbul
| | - Hakan Camlica
- Division of Cancer Epidemiology and Biostatistics, Institute of Oncology, University of Istanbul, Istanbul
| | - Turgay Isbir
- Department of Medical Biology, Medical Faculty, Yeditepe University, Istanbul, Turkey
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89
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Marulli G, Verderi E, Comacchio GM, Monaci N, Natale G, Nicotra S, Rea F. Predictors of unexpected nodal upstaging in patients with cT1-3N0 non-small cell lung cancer (NSCLC) submitted to thoracoscopic lobectomy. J Vis Surg 2018; 4:15. [PMID: 29445601 DOI: 10.21037/jovs.2017.12.23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/21/2017] [Indexed: 12/26/2022]
Abstract
Background In the last decades, the use of video-assisted thoracoscopic surgery (VATS) lobectomy for the treatment of early stage non-small cell lung cancer is continuously growing. This is mainly due to the development of more advanced surgical devices, to the rising incidence of peripheral lung tumors and is also favored by the increased reliability of preoperative staging techniques. Despite this progress, postoperative unexpected nodal upstaging is still a relevant issue. Aim of this study is to identify possible predictors of unexpected nodal upstaging in patients affected by cT1-3N0 NSCLC submitted to VATS lobectomy. Methods A total of 231 cases of cT1-3N0 patients submitted to thoracoscopic lobectomy at our centre between June 2012 and October 2016 were retrospectively reviewed. All data regarding clinical staging by means of computed tomography (CT) and positron-emission tomography (PET)/CT were collected and reviewed. The subsequent pathological staging has been analyzed, with special regards to the possible type of nodal involvement, and the number of pathological nodal stations. Results Most of the patients included in this study were in a clinical stage cT1aN0, cT1bN0 (stage IA) and cT2aN0 (stage IB), 86 (37.2%) patients, 73 (31.6%) patients and 62 (26.8%) patients, respectively. Postoperative histopathological analysis showed that the most frequent tumor histotype was adenocarcinoma (192 patients, 83.1%). Thirty-eight (16.5%) patients had a nodal upstaging; among these, 17 (7.4%) patients had N2 disease (8 patients with isolated mediastinal nodal involvement, 9 patients with N1 + N2 disease) and 21 (9.1%) patients had an isolated hilar nodal involvement (N1). At bivariate analysis, the clinical T (cT)-parameter (P=0.023), the histotype (P=0.029) and the pathological T (pT)-parameter (P=0.003) were identified as statistically significant predictors of nodal upstaging. Concerning the type of nodal upstaging, the pT was found to be statistically significant (P=0.042). At bivariate analysis for the number of involved nodal stations, a statistical significance was highlighted for the parameters cT (P=0.030) and pT (P=0.027). With linear logistic regression, histology as well as pT reached statistical significance (P=0.0275 and P=0.0382, respectively). No correlation was found between nodal upstaging and the intensity of FDG uptake in the primary lung tumor or with the timing between PET and surgery. Conclusions There is a strong correlation between the clinical staging of the parameter T evaluated with CT and the possible unexpected nodal upstaging. The same correlation with nodal upstaging is found for pT. At equal clinical stage, in patients affected by adenocarcinoma of the lung the relative risk of having a postoperative unexpected nodal upstaging is almost 7 times higher than in patients with squamous cell carcinoma.
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Affiliation(s)
- Giuseppe Marulli
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, University of Padova, Padova, Italy
| | - Enrico Verderi
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, University of Padova, Padova, Italy
| | - Giovanni M Comacchio
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, University of Padova, Padova, Italy
| | - Nicola Monaci
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, University of Padova, Padova, Italy
| | - Giuseppe Natale
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, University of Padova, Padova, Italy
| | - Samuele Nicotra
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, University of Padova, Padova, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, University of Padova, Padova, Italy
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90
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Prevalence of nodal metastases in lymph node stations 8 & 9 in a large UK lung cancer surgical centre without routine pre-operative EUS nodal staging. Lung Cancer 2018; 115:127-130. [PMID: 29290254 DOI: 10.1016/j.lungcan.2017.11.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 11/06/2017] [Accepted: 11/22/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Endoscopic ultrasound (EUS) allows access to the inferior mediastinal lymph node stations (8 and 9) which are beyond the reach of endobronchial ultrasound (EBUS). The addition of EUS to EBUS procedures requires cost and resource investment. This study sought to describe the prevalence of station 8/9 nodal metastases from intra-operative lymph node sampling in a UK region where routine pre-operative EUS is not available. METHODS A retrospective review of all lung cancer resections at the University Hospital South Manchester from 2011 to 2014. Surgical variables, pre-operative PET variables and survival outcomes were collected and analysed. RESULTS 1421 surgical resections were performed in the study period. Lymph node stations 8 and/or 9 were sampled in 52% (736/1421) of patients. Overall, there were 34 patients with lymph node metastases at station 8/9. This represents 2.4% of the study populations and 4.6% of patients in whom stations 8/9 were sampled intra-operatively. Of those patients with station 8/9 metastases, 65% (22/34) had multi-station N2 disease and the majority of the additional N2 disease was present in EBUS-accessible areas (lymph node stations 2, 4 and 7). Two percent (16/736) of patients in whom station 8/9 lymph nodes were sampled intra-operatively had N2 disease that was only accessible endoscopically with EUS. There was no significant difference in overall survival in patients with pathological N2 disease stratified according to whether stations 8/9 were involved or not. CONCLUSIONS The prevalence of lymph node metastases in stations 8/9 in this UK surgical centre where routine pre-operative EUS is not performed is low at approximately 5%. Given the identification of N2 disease in two-thirds of these patients can potentially be achieved through EBUS alone, this questions whether the resource implications of EUS are justified by the impact on patient management.
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91
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Divisi D, Barone M, Crisci R. Current role of standardized uptake value max-derived ratios in N2 fluorine-18 fluorodeoxyglucose positron-emission tomography non-small cell lung cancer. J Thorac Dis 2018; 10:503-507. [PMID: 29600085 DOI: 10.21037/jtd.2017.11.137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Mediastinal staging is a crucial moment in management of non-small cell lung cancer (NSCLC) patients. In integrated pathways, 18-fluorine fluorodeoxyglucose positron-emission tomography (18F-FDG-PET/CT) is an indispensable imaging resource with its peculiarities and its limitations. A critical review of work up protocols would certainly help to standardize procedures with important reflections also on the diagnostic value of this examination. In this regard, new semi-quantitative and semi-qualitative indexes have been proposed with the aim of increasing the accuracy of 18F-FDG-PET/CT in mediastinal lymph node staging. These latter, such as SUVn/t and SUV indexes, seem to overcome the problem of spatial resolution and discrimination of malignancy by endorsing a new predictive and prognostic role.
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Affiliation(s)
- Duilio Divisi
- Department of Thoracic Surgery, University of L'Aquila, "G. Mazzini" Hospital, Teramo, Italy
| | - Mirko Barone
- Department of Thoracic Surgery, University of L'Aquila, "G. Mazzini" Hospital, Teramo, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, University of L'Aquila, "G. Mazzini" Hospital, Teramo, Italy
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92
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Zhong WZ, Wang Q, Mao WM, Xu ST, Wu L, Shen Y, Liu YY, Chen C, Cheng Y, Xu L, Wang J, Fei K, Li XF, Li J, Huang C, Liu ZD, Xu S, Chen KN, Xu SD, Liu LX, Yu P, Wang BH, Ma HT, Yan HH, Yang XN, Zhou Q, Wu YL. Gefitinib versus vinorelbine plus cisplatin as adjuvant treatment for stage II-IIIA (N1-N2) EGFR-mutant NSCLC (ADJUVANT/CTONG1104): a randomised, open-label, phase 3 study. Lancet Oncol 2017; 19:139-148. [PMID: 29174310 DOI: 10.1016/s1470-2045(17)30729-5] [Citation(s) in RCA: 373] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/03/2017] [Accepted: 09/12/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cisplatin-based adjuvant chemotherapy is the standard of care for patients with resected stage II-IIIA non-small-cell lung cancer (NSCLC). RADIANT and SELECT trial data suggest patients with EGFR-mutant stage IB-IIIA resected NSCLC could benefit from adjuvant EGFR tyrosine kinase inhibitor treatment. We aimed to compare the efficacy of adjuvant gefitinib versus vinorelbine plus cisplatin in patients with completely resected EGFR-mutant stage II-IIIA (N1-N2) NSCLC. METHODS We did a randomised, open-label, phase 3 trial at 27 centres in China. We enrolled patients aged 18-75 years with completely resected (R0), stage II-IIIA (N1-N2), EGFR-mutant (exon 19 deletion or exon 21 Leu858Arg) NSCLC. Patients were stratified by N stage and EGFR mutation status and randomised (1:1) by Pocock and Simon minimisation with a random element to either gefitinib (250 mg once daily) for 24 months or intravenous vinorelbine (25 mg/m2 on days 1 and 8) plus intravenous cisplatin (75 mg/m2 on day 1) every 3 weeks for four cycles. The primary endpoint was disease-free survival in the intention-to-treat population, which comprised all randomised patients; the safety population included all randomised patients who received at least one dose of study medication. Enrolment to the study is closed but survival follow-up is ongoing. The study is registered with ClinicalTrials.gov, number NCT01405079. FINDINGS Between Sept 19, 2011, and April 24, 2014, 483 patients were screened and 222 patients were randomised, 111 to gefitinib and 111 to vinorelbine plus cisplatin. Median follow-up was 36·5 months (IQR 23·8-44·8). Median disease-free survival was significantly longer with gefitinib (28·7 months [95% CI 24·9-32·5]) than with vinorelbine plus cisplatin (18·0 months [13·6-22·3]; hazard ratio [HR] 0·60, 95% CI 0·42-0·87; p=0·0054). In the safety population, the most commonly reported grade 3 or worse adverse events in the gefitinib group (n=106) were raised alanine aminotransferase and asparate aminotransferase (two [2%] patients with each event vs none with vinorelbine plus cisplatin). In the vinorelbine plus cisplatin group (n=87), the most frequently reported grade 3 or worse adverse events were neutropenia (30 [34%] patients vs none with gefitinib), leucopenia (14 [16%] vs none), and vomiting (eight [9%] vs none). Serious adverse events were reported for seven (7%) patients who received gefitinib and 20 (23%) patients who received vinorelbine plus cisplatin. No interstitial lung disease was noted with gefitinib. No deaths were treatment related. INTERPRETATION Adjuvant gefitinib led to significantly longer disease-free survival compared with that for vinorelbine plus cisplatin in patients with completely resected stage II-IIIA (N1-N2) EGFR-mutant NSCLC. Based on the superior disease-free survival, reduced toxicity, and improved quality of life, adjuvant gefitinib could be a potential treatment option compared with adjuvant chemotherapy in these patients. However, the duration of benefit with gefitinib after 24 months might be limited and overall survival data are not yet mature. FUNDING Guangdong Provincial Key Laboratory of Lung Cancer Translational Medicine; National Health and Family Planning Commission of People's Republic of China; Guangzhou Science and Technology Bureau; AstraZeneca China.
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Affiliation(s)
- Wen-Zhao Zhong
- Guangdong Lung Cancer Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qun Wang
- Fudan University Affiliated Zhongshan Hospital, Shanghai, China
| | | | - Song-Tao Xu
- Fudan University Affiliated Zhongshan Hospital, Shanghai, China
| | - Lin Wu
- Hunan Cancer Hospital, Changsha, China
| | - Yi Shen
- The Affiliated Hospital of Medical College Qingdao University, Qingdao, China
| | | | - Chun Chen
- Fujian Medical University Union Hospital, Fuzhou, China
| | - Ying Cheng
- Jilin Provincial Tumor Hospital, Changchun, China
| | - Lin Xu
- Jiangsu Cancer Hospital, Nanjing, China
| | - Jun Wang
- The People's Hospital of Peking University, Beijing, China
| | - Ke Fei
- Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
| | | | - Jian Li
- Peking University First Hospital, Beijing, China
| | | | | | - Shun Xu
- The First Hospital of China Medical University, Shenyang, China
| | | | - Shi-Dong Xu
- Harbin Medical University Cancer Hospital, Harbin, China
| | - Lun-Xu Liu
- West China Hospital of Sichuan University, Chengdu, China
| | - Ping Yu
- Sichuan Cancer Hospital, Chengdu, China
| | - Bu-Hai Wang
- The Northern Jiangsu People's Hospital, Yangzhou, China
| | - Hai-Tao Ma
- The First Affiliated Hospital of Suzhou University, Suzhou, China
| | - Hong-Hong Yan
- Guangdong Lung Cancer Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xue-Ning Yang
- Guangdong Lung Cancer Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qing Zhou
- Guangdong Lung Cancer Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China.
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Honguero Martínez A, García Jiménez M, García Vicente A, Genovés Crespo M, Rodríguez Ortega C, Lázaro Sahuquillo M, Soriano Castrejón Á, León Atance P. Is the prognosis of occult N2 disease similar to that of positive positron emission tomography-computed tomography (PET/CT) scan single-station N2 disease in patients with non-small cell lung cancer treated by surgical resection? Rev Esp Med Nucl Imagen Mol 2017. [DOI: 10.1016/j.remnie.2017.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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94
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Van Schil PE, Berzenji L, Yogeswaran SK, Hendriks JM, Lauwers P. Surgical Management of Stage IIIA Non-Small Cell Lung Cancer. Front Oncol 2017; 7:249. [PMID: 29124039 PMCID: PMC5662551 DOI: 10.3389/fonc.2017.00249] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/06/2017] [Indexed: 12/12/2022] Open
Abstract
According to the eighth edition of the tumor–node–metastasis classification, stage III non-small cell lung cancer is subdivided into stages IIIA, IIIB, and IIIC. They represent a heterogeneous group of bronchogenic carcinomas with locoregional involvement by extension of the primary tumor and/or ipsilateral or contralateral lymph node involvement. Surgical indications have not been definitely established but, in general, long-term survival is only obtained in those patients in whom a complete resection is obtained. This mini-review mainly focusses on stage IIIA disease comprising patients with locoregionally advanced lung cancers. Different subcategories of N2 involvement exist, which range from unexpected N2 disease after thorough preoperative staging or “surprise” N2, to bulky N2 involvement, mostly treated by chemoradiation, and finally, the intermediate category of potentially resectable N2 disease treated with a combined modality regimen. After induction therapy for preoperative N2 involvement, best surgical results are obtained with proven mediastinal downstaging when a lobectomy is feasible to obtain a microscopic complete resection. However, no definite, universally accepted guidelines exist. A relatively new entity is salvage surgery applied for recurrent disease after full-dose chemoradiation when no other therapeutic options exist. Equally, only a small subset of patients with T4N0-1 disease qualify for surgical resection after thorough discussion within a multidisciplinary tumor board on the condition that a complete resection is feasible. Targeted therapies and immunotherapy have recently become part of our therapeutic armamentarium, and it might be expected that they will be incorporated in current regimens after careful evaluation in randomized clinical trials.
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Affiliation(s)
- Paul E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Lawek Berzenji
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Suresh K Yogeswaran
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Jeroen M Hendriks
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Patrick Lauwers
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
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95
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Bille A, Woo KM, Ahmad U, Rizk NP, Jones DR. Incidence of occult pN2 disease following resection and mediastinal lymph node dissection in clinical stage I lung cancer patients. Eur J Cardiothorac Surg 2017; 51:674-679. [PMID: 28200091 DOI: 10.1093/ejcts/ezw400] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 10/10/2016] [Indexed: 12/22/2022] Open
Abstract
Objectives Early clinical stage (T1 and T2) non-small cell lung cancer (NSCLC) is commonly treated with anatomic lung resection and lymph node sampling or dissection. The aims of this study were to evaluate the incidence and the distribution of occult N2 disease according to tumour location and the short- and long-term outcomes. Methods We performed a retrospective review of patients with clinical stage I NSCLC who underwent anatomic lung resection and lymphadenectomy. Mediastinal lymphadenectomy (ML) was defined as resection of at least 2 mediastinal stations, always including station 7 lymph nodes. Patients who had a lobe-specific lymphadenectomy were excluded. Results One thousand six hundred and sixty-seven consecutive patients met inclusion criteria and were included. Overall, 9% (146/1667) of the patients had occult pN2 disease. At multivariable analysis, adenocarcinoma histology and vascular invasion were independently associated with greater risk of occult pN2 disease. In left and right upper lobe tumours, station 7 nodes were involved in 5 and 13% of pN2 positive cases, respectively. Station 5 and station 2/4 nodes were involved in 29 and 18% of left and right lower lobe pN2 tumours, respectively. There was no postoperative mortality, and postoperative morbidity was 28%. The median overall survival was 77.4 months. N0 patients had a median overall survival of 83.7 months vs 48.0 months and 37.9 months in N1 and N2 populations, respectively ( P < 0.001). Conclusions Sixteen percent of pN2 patients had mediastinal lymph node metastasis beyond the lobe-specific lymphatic drainage. We recommend a complete lymphadenectomy be performed, even in clinical stage I NSCLC.
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Affiliation(s)
- Andrea Bille
- Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kaitlin M Woo
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Usman Ahmad
- Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nabil P Rizk
- Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David R Jones
- Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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96
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Wu YC, Wei NC, Hung JJ, Yeh YC, Su LJ, Hsu WH, Chou TY. Generating a robust prediction model for stage I lung adenocarcinoma recurrence after surgical resection. Oncotarget 2017; 8:79712-79721. [PMID: 29108351 PMCID: PMC5668084 DOI: 10.18632/oncotarget.19161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 06/28/2017] [Indexed: 01/11/2023] Open
Abstract
Lung cancer mortality remains high even after successful resection. Adjuvant treatment benefits stage II and III patients, but not stage I patients, and most studies fail to predict recurrence in stage I patients. Our study included 211 lung adenocarcinoma patients (stages I-IIIA; 81% stage I) who received curative resections at Taipei Veterans General Hospital between January 2001 and December 2012. We generated a prediction model using 153 samples, with validation using an additional 58 clinical outcome-blinded samples. Gene expression profiles were generated using formalin-fixed, paraffin-embedded tissue samples and microarrays. Data analysis was performed using a supervised clustering method. The prediction model generated from mixed stage samples successfully separated patients at high vs. low risk for recurrence. The validation tests hazard ratio (HR = 4.38) was similar to that of the training tests (HR = 4.53), indicating a robust training process. Our prediction model successfully distinguished high- from low-risk stage IA and IB patients, with a difference in 5-year disease-free survival between high- and low-risk patients of 42% for stage IA and 45% for stage IB (p < 0.05). We present a novel and effective model for identifying lung adenocarcinoma patients at high risk for recurrence who may benefit from adjuvant therapy. Our prediction performance of the difference in disease free survival between high risk and low risk groups demonstrates more than two fold improvement over earlier published results.
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Affiliation(s)
- Yu-Chung Wu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | - Jung-Jyh Hung
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Chen Yeh
- Division of Molecular Pathology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Jen Su
- Core Facilities for High Throughput Experimental Analysis, Institute of Systems Biology and Bioinformatics, National Central University, Jhong-Li, Taiwan
| | - Wen-Hu Hsu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Teh-Ying Chou
- Division of Molecular Pathology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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97
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Teraoka S, Fujimoto D, Morimoto T, Kawachi H, Ito M, Sato Y, Nagata K, Nakagawa A, Otsuka K, Uehara K, Imai Y, Ishida K, Fukuoka J, Tomii K. Early Immune-Related Adverse Events and Association with Outcome in Advanced Non-Small Cell Lung Cancer Patients Treated with Nivolumab: A Prospective Cohort Study. J Thorac Oncol 2017; 12:1798-1805. [PMID: 28939128 DOI: 10.1016/j.jtho.2017.08.022] [Citation(s) in RCA: 282] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/25/2017] [Accepted: 08/29/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Retrospective studies have shown immune-related adverse events (irAEs) to be associated with better prognosis. However, no prospective clinical trials have been conducted, and little is known regarding the association between irAEs and the outcome of patients with NSCLC after treatment with immunotherapy. METHODS We conducted a prospective cohort study of patients with advanced NSCLC who were treated with nivolumab between January and December 2016. The association between clinical outcome and irAEs 2 to 6 weeks after commencement of nivolumab treatment was investigated. IrAEs were assessed by at least three independent medical professionals. RESULTS A total of 43 patients were enrolled, including 19 patients with irAEs 2 weeks after commencement of nivolumab treatment. Common irAEs included rash, pyrexia, and diarrhea. Programmed cell death ligand 1-positive tumor cell expression was not significantly different between patients with and without irAEs. The objective response and disease control rates were higher in patients with irAEs than in those without irAEs (37% versus 17% and 74% versus 29% [p = 0.17 and p < 0.01], respectively]). Patients with irAEs were associated with a significantly longer median progression-free survival than those without (6.4 months [95% confidence interval: 2.5-not reached] versus 1.5 months [95% confidence interval: 1.2-2.3] [p = 0.01]). These findings were comparable to those for patients with and without irAEs 6 weeks after commencement of nivolumab treatment. CONCLUSIONS Early irAEs are associated with a better outcome after treatment with immunotherapy. We predicted responses to nivolumab by using early irAEs. Further research is needed to elucidate the mechanisms of these associations.
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Affiliation(s)
- Shunsuke Teraoka
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Daichi Fujimoto
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan.
| | - Takeshi Morimoto
- Clinical Research Center, Kobe City Medical Center General Hospital, Hyogo, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan
| | - Hayato Kawachi
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Munehiro Ito
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Yuki Sato
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Kazuma Nagata
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Atsushi Nakagawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Kojiro Otsuka
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Keiichiro Uehara
- Department of Clinical Pathology, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Yukihiro Imai
- Department of Clinical Pathology, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Kaori Ishida
- Department of Pathology, Nagasaki University Hospital, Nagasaki, Japan
| | - Junya Fukuoka
- Department of Pathology, Nagasaki University Hospital, Nagasaki, Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
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98
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Predictors for hilar/intrapulmonary lymph node metastasis in discrete type of clinical N1 non-small cell lung cancer. Gen Thorac Cardiovasc Surg 2017; 65:640-645. [PMID: 28866794 DOI: 10.1007/s11748-017-0827-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/28/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Accurate preoperative evaluation of lymph nodes can provide optimal treatment for patients. However, in patients with clinical N1 disease (cN1) non-small cell lung cancer (NSCLC), no suitable predictor has been identified for hilar/intrapulmonary lymph node metastasis (pathological N1 disease; pN1). The purpose of this study was to identify pN1 in cN1 NSCLC patients. METHODS We retrospectively reviewed the clinicoradiological features of 109 patients with a discrete type of cN1 NSCLC who had undergone complete resection at our institution from 2004 to 2015. The association between clinicoradiological variables and nodal status was analyzed to identify predictors for pN1. RESULTS The cohort consisted of 77 males and 32 females, ranging in age from 39 to 84 years. The breakdown by pathological N category was 40 (37%) pN0, 41 (38%) pN1, and 28 (25%) pN2 patients. Maximum lymph node diameter was identified as a significant predictor for pN1, with an odds ratio of 1.25 (P = 0.010). When limited to 63 patients who underwent positron emission tomography (FDG-PET) at our institution, the maximum standardized uptake value (SUVmax) of the lymph node was an independent predictor, with an odds ratio of 1.91 with logistic regression analysis (P = 0.004). The size of lymph node and the SUVmax were significant factors for pN1, with optimal cut-off values of 13 mm and 4.28, respectively. CONCLUSIONS Among the patients with cN1, maximum lymph node size and SUVmax of the FDG-PET were significant predictors for pN1.
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99
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Vial MR, O'Connell OJ, Grosu HB, Hernandez M, Noor L, Casal RF, Stewart J, Sarkiss M, Jimenez CA, Rice D, Mehran R, Ost DE, Eapen GA. Diagnostic performance of endobronchial ultrasound-guided mediastinal lymph node sampling in early stage non-small cell lung cancer: A prospective study. Respirology 2017; 23:76-81. [PMID: 28857362 DOI: 10.1111/resp.13162] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 05/22/2017] [Accepted: 06/09/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Standard nodal staging of lung cancer consists of positron emission tomography/computed tomography (PET/CT), followed by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) if PET/CT shows mediastinal lymphadenopathy. Sensitivity of EBUS-TBNA in patients with N0/N1 disease by PET/CT is unclear and largely based on retrospective studies. We assessed the sensitivity of EBUS-TBNA in this setting. METHODS We enrolled patients with proven or suspected lung cancer staged as N0/N1 by PET/CT and without metastatic disease (M0), who underwent staging EBUS-TBNA. Primary outcome was sensitivity of EBUS-TBNA compared with a composite reference standard of surgical stage or EBUS-TBNA stage if EBUS demonstrated N2/N3 disease. RESULTS Seventy-five patients were included in the analysis. Mean tumour size was 3.52 cm (±1.63). Fifteen of 75 patients (20%) had N2 disease. EBUS-TBNA identified six while nine were only identified at surgery. Sensitivity of EBUS-TBNA for N2 disease was 40% (95% CI: 16.3-67.7%). CONCLUSION A significant proportion of patients with N0/N1 disease by PET/CT had N2 disease (20%) and EBUS-TBNA identified a substantial fraction of these patients, thus improving diagnostic accuracy compared with PET/CT alone. Sensitivity of EBUS-TBNA however appears lower compared with historical data from patients with larger volume mediastinal disease. Therefore, strategies to improve EBUS-TBNA accuracy in this population should be further explored.
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Affiliation(s)
- Macarena R Vial
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Pulmonary Medicine, Interventional Pulmonology Unit, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - Oisin J O'Connell
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Horiana B Grosu
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mike Hernandez
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Laila Noor
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roberto F Casal
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Pulmonary and Critical Care Medicine, Michael E. DeBakey Veterans Affairs, Baylor College of Medicine, Houston, TX, USA
| | - John Stewart
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mona Sarkiss
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos A Jimenez
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Rice
- Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Reza Mehran
- Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David E Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - George A Eapen
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Shayani J, Flores RM, Hakami A. Mediastinal lymph node dissection: the debate is not resolved. J Thorac Dis 2017; 9:1848-1850. [PMID: 28839981 DOI: 10.21037/jtd.2017.06.128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jeffrey Shayani
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Raja M Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Ardeshir Hakami
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
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