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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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Prognostic Impact of the Number of Metastatic Lymph Nodes on the Eighth Edition of the TNM Classification of NSCLC. J Thorac Oncol 2019; 14:1408-1418. [PMID: 31055075 DOI: 10.1016/j.jtho.2019.04.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 04/07/2019] [Accepted: 04/19/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Current nodal staging of NSCLC is defined only by anatomical location of lymph nodes (LNs). The aim of this study is to investigate prognostic impacts of the number of metastatic LNs by stratifying the present N classification. METHODS We analyzed 1989 patients with NSCLC who underwent complete resection by lobectomy or pneumonectomy involving dissection of the hilar and mediastinal LNs from 2003 to 2012. We classified patients according to the number of metastatic nodes and stations and their current category of metastatic LNs. We analyzed the overall survival in each group and assessed the survival impact of the combination of them. RESULTS In the multivariate analyses of all patients, pathological N1 (pN1) (reference [ref.] pN2) and single-node metastasis (ref. multiple-node) were independent prognostic factors whereas single-station metastasis (ref. multiple-station) was not. In the respective multivariate analyses of pN1 and pN2 disease, multiple-node metastasis (ref. single-node) was an independent prognostic factor in pN1 disease (hazard ratio: 1.41, p = 0.04), but not in pN2 disease. Investigation for other boundaries of a number of metastatic LNs of three or more (ref. one to two), four or more (ref. one to three), and five or more (ref. one to four) found that all of them were independent prognostic factors in both pN1 and pN2 diseases. CONCLUSIONS The number of metastatic LNs had a strong impact on survival in addition to the current pN classification. To clarify its prognostic impact, further study is needed in other datasets including patients treated by nonsurgical modalities.
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Liu H, Yan T, Zhang T, Chen X, Wang Y, Du J. Proposal of a new nodal classification for operable non-small cell lung cancer based on the number of negative lymph nodes and the anatomical location of metastatic lymph nodes. Medicine (Baltimore) 2019; 98:e15645. [PMID: 31096486 PMCID: PMC6531103 DOI: 10.1097/md.0000000000015645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Lymph node metastasis is one of the most important prognostic indicators in patients with radically resected non-small cell lung cancer (NSCLC). This retrospective study aimed to compare the predictive value of metastatic lymph nodes (MNs), lymph node ratio (LNR), resected lymph nodes (RNs), and negative lymph nodes (NNs) with the currently used pathologic nodal (pN) staging category.We conducted a retrospective analysis of 1019 consecutive NSCLC patients treated with complete resection in a single institution. Prognostic values of various lymph node factors were evaluated by analysis of univariate and multivariate Cox proportional hazards model, and the results were compared with those using the location-based pN stage classification.The median follow-up duration was 47 months. During this period, 353 cases of cancer recurrence and 337 deaths were reported. Multivariate cox analysis indicated that both pN and NN categories were independent predictors of patient survival. The patients were divided into six groups on the basis of pN and NN categories. The survival rates of the groups were as follows: pN0, NN≥8, 81.4%; pN0, NN<8, 73.8%; pN1, NN≥8, 61.4%; pN1, NN<8, 54.2%; pN2, NN≥8, 48.4%; and pN2>1, NN<8, 35.0%. Comparison of the predictive values of the lymph node factors showed that the new N category was a more valuable prognostic factor in operable NSCLC.The combination of anatomically based pN stage classification and the number of MNs is an accurate prognostic determinant in patients with operable NSCLC which can be equal to 8th N category.
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Affiliation(s)
- Hongfeng Liu
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University
- Department of Thoracic Surgery. Jining No. 1 People's Hospital, Jining, PR China
| | - Tao Yan
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University
| | - Tiehong Zhang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan
| | - Xiaowei Chen
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University
| | - Yadong Wang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University
| | - Jiajun Du
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University
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54
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Hattori A, Takamochi K, Oh S, Suzuki K. New revisions and current issues in the eighth edition of the TNM classification for non-small cell lung cancer. Jpn J Clin Oncol 2019; 49:3-11. [PMID: 30277521 DOI: 10.1093/jjco/hyy142] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 09/24/2018] [Indexed: 12/25/2022] Open
Abstract
In the eighth edition of the TNM classification of lung cancer, the prognostic impact of tumor size is emphasized as a descriptor of all T categories. Especially in lung cancer where tumor size is 5 cm or less, the 1-cm cutoff point significantly differentiated the survival outcome. In addition, the new staging categories were assigned, namely, Tis (adenocarcinoma in situ) and T1mi (minimally invasive adenocarcinoma). Furthermore, the measurement of a radiological solid component size excluding the ground glass opacity component or pathological invasive size without a lepidic component was proposed for deciding the cT/pT categories for lung adenocarcinoma. The N descriptors were kept the same as in the eventh edition on the whole, however, quantification of nodal disease had a prognostic impact based on the number of nodal stations involved in the eighth edition, i.e. N1a as a single N1 station, N1b as a multiple N1 station, N2a1 as a single N2 station without N1 (skip metastasis), N2a2 as a single N2 station with N1 disease, and N2b as a multiple N2 station. In the M descriptors, subclassification was performed based on the location or numbers of distantly metastatic lesions, i.e. M1a as any intrathoracic metastases, M1b as a single distant metastatic lesion in one organ, and M1c as multiple distant metastases in either a single organ or multiple organs. Survival analysis of the eighth edition of the TNM classification clearly separated the distinct groups, however, unsolved issues still remain that should be discussed and further revised for the forthcoming TNM staging system.
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Affiliation(s)
- Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shiaki Oh
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Crombag LMM, Dooms C, Stigt JA, Tournoy KG, Schuurbiers OCJ, Ninaber MK, Buikhuisen WA, Hashemi SMS, Bonta PI, Korevaar DA, Annema JT. Systematic and combined endosonographic staging of lung cancer (SCORE study). Eur Respir J 2019; 53:13993003.00800-2018. [PMID: 30578389 DOI: 10.1183/13993003.00800-2018] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 11/07/2018] [Indexed: 12/25/2022]
Abstract
Guidelines recommend endosonography for mediastinal nodal staging in patients with resectable nonsmall cell lung cancer (NSCLC). We hypothesise that a systematic endobronchial ultrasound (EBUS) evaluation combined with an oesophageal investigation using the same EBUS bronchoscope (EUS-B) improves mediastinal nodal staging versus the current practice of targeted positron emission tomography (PET)-computed tomography (CT)-guided EBUS staging alone.A prospective, multicentre, international study (NCT02014324) was conducted in consecutive patients with (suspected) resectable NSCLC. After PET-CT, patients underwent systematic EBUS and EUS-B. Node(s) suspicious on CT, PET, EBUS and/or EUS-B imaging and station 4R, 4L and 7 (short axis ≥8 mm) were sampled. For patients without N2/N3 disease determined on endosonography, surgical-pathological staging was the reference standard.229 patients were included in this study. The prevalence of N2/N3 disease was 103 out of 229 patients (45%). A PET-CT-guided targeted approach by EBUS identified 75 patients with N2/N3 disease (sensitivity 73%, 95% CI 63-81%; negative predictive value (NPV) 81%, 95% CI 74-87%). Four additional patients with N2/N3 disease were found by systematic EBUS (sensitivity 77%, 95% CI 67-84%; NPV 84%, 95% CI 76-89%) and five more by EUS-B (84 patients total; sensitivity 82%, 95% CI 72-88%; NPV 87%, 95% CI 80-91%). Additional clinical relevant staging information was obtained in 23 out of 229 patients (10%).Systematic EBUS followed by EUS-B increased sensitivity for the detection of N2/N3 disease by 9% compared to PET-CT-targeted EBUS alone.
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Affiliation(s)
- Laurence M M Crombag
- Dept of Respiratory Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Christophe Dooms
- Dept of Respiratory Disease, University Hospitals KU Leuven, Leuven, Belgium
| | - Jos A Stigt
- Dept of Respiratory Medicine, Isala Hospital, Zwolle, The Netherlands
| | - Kurt G Tournoy
- Dept of Respiratory Medicine, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Olga C J Schuurbiers
- Dept of Respiratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maarten K Ninaber
- Dept of Respiratory Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Wieneke A Buikhuisen
- Dept of Thoracic Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sayed M S Hashemi
- Dept of Respiratory Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Peter I Bonta
- Dept of Respiratory Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniël A Korevaar
- Dept of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jouke T Annema
- Dept of Respiratory Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Zheng D, Wang Y, Li Y, Sun Y, Chen H. Predicting prognosis of post-chemotherapy patients with resected IIIA non-small cell lung cancer. J Thorac Dis 2018; 10:4186-4194. [PMID: 30174863 DOI: 10.21037/jtd.2018.06.160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Recently, nomogram has been widely used in cancer prognoses. However, the predicting model for post-chemotherapy patients with resected IIIA non-small cell lung cancer (NSCLC) still remains scarce. Here, we tried to develop nomograms for predicting the recurrence and survival of these patients. Methods We retrospectively analyzed our database from October 2007 to May 2013 at Fudan University Shanghai Cancer Center. 437 qualified patients were included. Univariable and multivariable analyses of cox regression were performed successively to select prognostic factors and nomograms for recurrence-free survival (RFS) and overall survival (OS) were developed. Concordance indexes (C-index) and calibration curves were created to measure the consistency between predicted and actual survivals. Finally, risk group stratifications according to risk scores calculated from nomograms were delineated. Results With a total of 437 patients, five independent prognostic factors related to RFS and two to OS were selected to develop nomograms, respectively. Both 3- and 5-year RFS and OS calibration curves indicated a moderate concordance between the predicted and actual outcomes, consisted with the C-index 0.656 (95% CI: 0.626-0.687) for RFS and 0.651 (95% CI: 0.611-0.691) for OS. Different risk groups showed significant differences in RFS and OS. Conclusions We developed nomograms of RFS and OS for predicting recurrence and survival of post-chemotherapy patients with resected IIIA NSCLC. These nomograms could help doctors more easily estimate the prognosis and choose optimal decisions for individual during clinical practices.
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Affiliation(s)
- Difan Zheng
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200433, China
| | - Yiyang Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200433, China
| | - Yuan Li
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200433, China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Yihua Sun
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200433, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200433, China
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57
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Deng W, Xu T, Wang Y, Xu Y, Yang P, Gomez D, Liao Z. Log odds of positive lymph nodes may predict survival benefit in patients with node-positive non-small cell lung cancer. Lung Cancer 2018; 122:60-66. [DOI: 10.1016/j.lungcan.2018.05.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/02/2018] [Accepted: 05/19/2018] [Indexed: 01/10/2023]
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58
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Łochowski M, Łochowska B, Rębowski M, Brzeziński D, Cieślik-Wolski B, Kozak J. Five-year survival analysis and prognostic factors in patients operated on for non-small cell lung cancer with N2 disease. J Thorac Dis 2018; 10:3180-3186. [PMID: 30069313 DOI: 10.21037/jtd.2018.05.173] [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] [Indexed: 12/22/2022]
Abstract
Background The aim of the study is to analyse 5-year survival and prognostic factors in patients operated due to lung cancer with postoperatively confirmed metastases to N2 group nodes. Methods In the years 2007-2015, 1,148 patients with lung cancer were treated surgically. A postoperative histopathological study confirmed N2 feature in 150 patients. One hundred and ten patients, in whom a 5-year survival analysis was possible to perform, were included in such analysis. The patients underwent the following procedures: pneumonectomy, 31 patients; lobectomy, 61; bilobectomy, 10; and wedge resection, 8. All patients were subjected to supplementary treatment after the surgery. Results Five-year survival was achieved in 23 patients (21%). The patients' survival did not depend on the type of surgery, type of tumour, its location or presence of metastases in N1 nodes (P=0.82, P=0.51, P=0.36 and P=0.23, respectively). A statistically significant correlation was observed (P=0.01) between the 5-year survival of a patient and the occurrence of metastases only in one group of lymph nodes of the N2 feature (22 patients, 20%). Involvement of three or more mediastinal nodal groups resulted in survival shorter than 5-year. Conclusions (I) In patients with the N2 feature, the type of performed surgery, type of tumour and the occurrence of metastases in the lymph nodes of the lung hilum do not affect 5-year survival; (II) involvement of only one nodal group allows to achieve 5-year survival in 20% of patients; (III) involvement of three and more nodal groups with the N2 feature results in decreased 5-year survival.
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Affiliation(s)
- Mariusz Łochowski
- Department of Thoracic Surgery, Memorial Copernicus Hospital, Medical University of Lodz, Lodz, Poland
| | - Barbara Łochowska
- Department of Chemotherapy, Memorial Copernicus Hospital, Medical University of Lodz, Lodz, Poland
| | - Marek Rębowski
- Department of Thoracic Surgery, Memorial Copernicus Hospital, Medical University of Lodz, Lodz, Poland
| | - Daniel Brzeziński
- Department of Thoracic Surgery, Memorial Copernicus Hospital, Medical University of Lodz, Lodz, Poland
| | - Bartosz Cieślik-Wolski
- Department of Thoracic Surgery, Memorial Copernicus Hospital, Medical University of Lodz, Lodz, Poland
| | - Józef Kozak
- Department of Thoracic Surgery, Memorial Copernicus Hospital, Medical University of Lodz, Lodz, Poland
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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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Zhou X, Cai L, Liu J, Hua X, Zhang Y, Zhao H, Wang B, Li B, Gai P. Analyzing EGFR mutations and their association with clinicopathological characteristics and prognosis of patients with lung adenocarcinoma. Oncol Lett 2018; 16:362-370. [PMID: 29928422 PMCID: PMC6006462 DOI: 10.3892/ol.2018.8681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/29/2018] [Indexed: 12/13/2022] Open
Abstract
Epidermal growth factor receptor (EGFR) is an important gene in the development of lung adenocarcinoma. However, there is controversy regarding the association between EGFR mutations and survival time of patients with lung adenocarcinoma. In the present study, tissue specimens and clinical data were collected from 219 patients with lung adenocarcinoma who had not undergone prior radiotherapy or chemotherapy. EGFR mutations were detected using a fluorescence polymerase chain reaction method, and the association between EGFR mutations and clinicopathological characteristics was analyzed. Overall survival (OS) curves were constructed using the Kaplan-Meier method and the influence of clinicopathological characteristics on OS was analyzed using the Cox regression model. The EGFR mutation rate was 50.7%, and the most common mutations were the L858R substitution mutation in exon 21 (L858R; 54.9%) and the deletion mutation in exon 19 (19-Del; 36%). The presence of EGFR mutations varied significantly with sex, smoking history, T stage, vascular invasion and adenocarcinoma subtypes (P<0.05). The survival time was significantly longer for female, young (<60 years-old), non-smokers or patients exhibiting EGFR mutations (G719X, 19-Del, L858R and L861Q). The survival time was also significantly longer for patients with a 19-Del mutation, early stage tumors, tyrosine kinase inhibitors targeted therapy-treated patients, for those not exhibiting nerve or vascular invasion, and for those without disease recurrence (P<0.05). Multivariate analysis revealed that tumor pathological Tumor-Node-Metastasis (pTNM) stage, nerve invasion, vascular invasion, EGFR mutation and the 19-Del mutation were independent predictors (P<0.05). Therefore, tumor pTNM stage, nerve invasion, vascular invasion and EGFR mutation status, particularly that of 19-Del, were independent prognostic factors for patients with lung adenocarcinoma.
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Affiliation(s)
- Xiuzhi Zhou
- Department of Microbiology, Qingdao University, Qingdao, Shandong 266071, P.R. China.,School of Basic Medical Sciences, Binzhou Medical University, Yantai, Shandong 264003, P.R. China
| | - Li Cai
- Department of Pathology and Medicine, Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China
| | - Junjie Liu
- School of Basic Medical Sciences, Binzhou Medical University, Yantai, Shandong 264003, P.R. China
| | - Xiaomin Hua
- Department of Microbiology, Qingdao University, Qingdao, Shandong 266071, P.R. China
| | - Ying Zhang
- School of Basic Medical Sciences, Binzhou Medical University, Yantai, Shandong 264003, P.R. China
| | - Huilin Zhao
- School of Basic Medical Sciences, Binzhou Medical University, Yantai, Shandong 264003, P.R. China
| | - Bin Wang
- Department of Microbiology, Qingdao University, Qingdao, Shandong 266071, P.R. China
| | - Boqing Li
- School of Basic Medical Sciences, Binzhou Medical University, Yantai, Shandong 264003, P.R. China
| | - Pengzhou Gai
- Department of Pathology and Medicine, Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China
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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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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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63
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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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Abstract
Lung cancer remains the leading cause of cancer-related mortality in the United States, and accurate staging of disease plays an important role in the formulation of treatment strategies and optimization of patient outcomes. The International Association for the Study of Lung Cancer has recently proposed changes to the upcoming eighth edition of the tumor, node, and metastasis (TNM-8) staging system used for lung cancer. This revised classification is based on significant differences in patient survival identified on analysis of a new large international database of lung cancer cases. Key changes include: further modifications to the T descriptors based on 1 cm increments in tumor size; grouping of tumors resulting in partial or complete lung atelectasis/pneumonitis; grouping of tumors involving a main bronchus with respect to distance from the carina; reassignment of diaphragmatic invasion; elimination of mediastinal pleural invasion as a descriptor; and further subdivision of metastatic disease into distinct descriptors based on the number of extrathoracic metastases and involved organs. Because of these changes, several new stage groups have been developed, and others have shifted. Although TNM-8 represents continued improvement upon modifications previously made to the staging system, reflecting an evolving understanding of tumor behavior and patient management, several limitations and unaddressed issues persist. Understanding the proposed revisions to TNM-8 and awareness of key limitations and potential controversial issues still unaddressed will allow radiologists to accurately stage patients with lung cancer and optimize treatment decisions.
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Agrawal V, Coroller TP, Hou Y, Lee SW, Romano JL, Baldini EH, Chen AB, Kozono D, Swanson SJ, Wee JO, Aerts HJWL, Mak RH. Lymph node volume predicts survival but not nodal clearance in Stage IIIA-IIIB NSCLC. PLoS One 2017; 12:e0174268. [PMID: 28426673 PMCID: PMC5398511 DOI: 10.1371/journal.pone.0174268] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 03/06/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Locally advanced non-small cell lung cancer (LA-NSCLC) patients have poorer survival and local control with mediastinal node (N2) tumor involvement at resection. Earlier assessment of nodal burden could inform clinical decision-making prior to surgery. This study evaluated the association between clinical outcomes and lymph node volume before and after neoadjuvant therapy. MATERIALS AND METHODS CT imaging of patients with operable LA-NSCLC treated with chemoradiation and surgical resection was assessed. Clinically involved lymph node stations were identified by FDG-PET or mediastinoscopy. Locoregional recurrence (LRR), distant metastasis (DM), progression free survival (PFS) and overall survival (OS) were analyzed by the Kaplan Meier method, concordance index and Cox regression. RESULTS 73 patients with Stage IIIA-IIIB NSCLC treated with neoadjuvant chemoradiation and surgical resection were identified. The median RT dose was 54 Gy and all patients received concurrent chemotherapy. Involved lymph node volume was significantly associated with LRR and OS but not DM on univariate analysis. Additionally, lymph node volume greater than 10.6 cm3 after the completion of preoperative chemoradiation was associated with increased LRR (p<0.001) and decreased OS (p = 0.04). There was no association between nodal volumes and nodal clearance. CONCLUSION For patients with LA-NSCLC, large volume nodal disease post-chemoradiation is associated with increased risk of locoregional recurrence and decreased survival. Nodal volume can thus be used to further stratify patients within the heterogeneous Stage IIIA-IIIB population and potentially guide clinical decision-making.
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Affiliation(s)
- Vishesh Agrawal
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Thibaud P. Coroller
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Ying Hou
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Stephanie W. Lee
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA, United States of America
| | - John L. Romano
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Elizabeth H. Baldini
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Aileen B. Chen
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - David Kozono
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Scott J. Swanson
- Harvard Medical School, Boston, MA, United States of America
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Jon O. Wee
- Harvard Medical School, Boston, MA, United States of America
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Hugo J. W. L. Aerts
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Raymond H. Mak
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
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Butnor KJ, Asamura H, Travis WD. Node Doubt: Rigorous Surgical Nodal Procurement Combined With Thorough Pathologic Evaluation Improves Non-Small Cell Lung Carcinoma Staging Accuracy. Ann Thorac Surg 2017; 102:353-6. [PMID: 27449422 DOI: 10.1016/j.athoracsur.2016.05.075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 05/17/2016] [Accepted: 05/20/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Kelly J Butnor
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, Vermont
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
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Harms A, Kriegsmann M, Fink L, Länger F, Warth A. [The new TNM classification for lung tumors : Changes and the assessment of multiple tumor foci]. DER PATHOLOGE 2017; 38:11-20. [PMID: 28154917 DOI: 10.1007/s00292-017-0268-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Recently a new TNM classification for tumors of the lung was published, encompassing some relevant changes, for example how to deal with multiple lung tumors. This article comprehensively describes respective changes. Furthermore, background information on how the new TNM classification was built and what should be done in the future to further improve prognosis and outcome prediction is reviewed.
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Affiliation(s)
- A Harms
- Institut für Pathologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Deutschland.,Translational Lung Research Center, Deutsches Zentrum für Lungenforschung, Heidelberg, Deutschland
| | - M Kriegsmann
- Institut für Pathologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Deutschland
| | - L Fink
- Institut für Pathologie und Zytologie, Wetzlar, Deutschland.,Universities of Giessen and Marburg Lung Center, Deutsches Zentrum für Lungenforschung, Gießen, Deutschland
| | - F Länger
- Institut für Pathologie, Universitätsklinikum Hannover, Hannover, Deutschland.,Biomedical Research in Endstage and Obstructive Lung Disease, Deutsches Zentrum für Lungenforschung, Hannover, Deutschland
| | - A Warth
- Institut für Pathologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Deutschland. .,Translational Lung Research Center, Deutsches Zentrum für Lungenforschung, Heidelberg, Deutschland.
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Rena O. The "N"-factor in non-small cell lung cancer: staging system and institutional reports. J Thorac Dis 2017; 8:3049-3052. [PMID: 28066580 DOI: 10.21037/jtd.2016.11.37] [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)
- Ottavio Rena
- Thoracic Surgery Unit, University of Eastern Piedmont, AOU Maggiore della Carità, Novara, Italy
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The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for the Revision of the N Descriptors in the Forthcoming 8th Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2016; 10:1675-84. [PMID: 26709477 DOI: 10.1097/jto.0000000000000678] [Citation(s) in RCA: 451] [Impact Index Per Article: 56.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Nodal status is considered to be one of the most reliable indicators of the prognosis in patients with lung cancer and thus is indispensable in determining the optimal therapeutic options. We sought to determine whether the current nodal (N) descriptors should be maintained or revised for the next edition (8th) of the International Lung Cancer Staging System. METHODS The new International Association for the Study of Lung Cancer lung cancer database was created from 94,708 patients diagnosed as having lung cancer between 1999 and 2010. Among these, 38,910 and 31,426 patients with non-small-cell lung carcinoma were available for an analysis of the clinical (c)N and pathological (p)N status, respectively. The anatomical location of lymph node involvement was defined by either the Naruke (for Japanese data) or American Thoracic Society (for non-Japanese data) nodal charts. Survival was calculated by the Kaplan-Meier method, and prognostic groups were assessed by a Cox regression analysis. RESULTS The current N0 to N3 descriptors for both the cN and pN status consistently separated prognostically distinct groups. The 5-year survival rates according to the cN and pN status were 60% and 75% (N0), 37% and 49% (N1), 23% and 36% (N2), and 9% and 20% (N3), respectively. The differences in survival between all neighboring nodal categories were highly significant for both the cN and pN status. With regard to pathological staging, additional analyses regarding the prognosis were performed by further dividing N1 into N1 at a single station (N1a) and N1 at multiple stations (N1b); N2 into N2 at a single station without N1 involvement ("skip" metastasis, N2a1), N2 at a single station with N1 involvement (N2a2), and N2 at multiple stations (N2b). The survival curves for N1b and N2a2 overlapped each other, and N2a1 had numerically a better prognosis than N1b, although the difference was not significant. Geographic difference in N-specific prognosis was observed for both c-settings and p-settings. This might have been because of the difference in the used nodal map, surgical technique, and pathologist's handling of the resected specimen. CONCLUSIONS Current N descriptors adequately predict the prognosis and therefore should be maintained in the forthcoming staging system. Furthermore, we recommend that physicians record the number of metastatic lymph nodes (or stations) and to further classify the N category using new descriptors, such as N1a, N1b, N2a, N2b, and N3, for further testing.
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Ding X, Hui Z, Dai H, Fan C, Men Y, Ji W, Liang J, Lv J, Zhou Z, Feng Q, Xiao Z, Chen D, Zhang H, Yin W, Lu N, He J, Wang L. A Proposal for Combination of Lymph Node Ratio and Anatomic Location of Involved Lymph Nodes for Nodal Classification in Non–Small Cell Lung Cancer. J Thorac Oncol 2016; 11:1565-73. [DOI: 10.1016/j.jtho.2016.05.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 04/08/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
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Wu CY, Fu JY, Wu CF, Hsieh MJ, Liu YH, Wu YC, Yang CT, Tsai YH. Survival Prediction Model Using Clinico-Pathologic Characteristics for Nonsmall Cell Lung Cancer Patients After Curative Resection. Medicine (Baltimore) 2015; 94:e2013. [PMID: 26559298 PMCID: PMC4912292 DOI: 10.1097/md.0000000000002013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The current TNM staging system did not provide disease relapse information. The aim of study was try to establish a predictive survival model for disease and overall survival in nonsmall cell lung cancer patients who presented as resectable disease and to develop a reference for follow-up imaging tool selection.From January 2005 to December 2011, 442 patients who initially presented as resectable disease (stages I-IIIa) and received anatomic resection and mediastinal lymph node dissection were included in the study.Medical charts were thoroughly reviewed and clinico-pathologic factors were collected and analyzed.Visceral pleural invasion, tumor size >5 cm, and postoperative adjuvant therapy were identified as risk factors for poorer disease-free survival. The 5-year disease-free survival from score 0 to 3 was 68.7%, 46.6%, 31.9%, and 26.1%, respectively. The disease relapse percentage for scores 0 to 3 were 26.49%, 50.61%, 65.05%, and 73.81%, respectively. For analysis of overall survival, age >60 years, tumor size >3 cm, and total metastatic lymph node ratio >0.05 were correlated to worse overall survival. Because greater age may be correlated with poor general condition, we re-scored risk factors that correlated to disease severity that ranging from 0 to 2. The 5-year overall survival range from score 0 to 2 was 56.3%, 43.1%, and 13.1%, respectively.Poor prognostic factors correlated to disease-free survival were tumor size >5 cm, visceral pleural invasion, and patients needing to receive postoperative adjuvant therapy. Disease-free survival of resectable nonsmall cell lung cancer patients and disease relapse can be stratified by these 3 factors. Chest tomography may be recommended for patients with 1 or more poor disease-free survival risk factors.
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Affiliation(s)
- Ching-Yang Wu
- From the Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou; Chang Gung University (C-YW, C-FW, M-JH, Y-HL, Y-CW); Division of Chest and Critical Care, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou; Chang Gung University (J-YF); Division of Chest and Critical Care, Department of Internal Medicine, Change Gung Memorial Hospital, Taoyuan; Chang Gung University (C-TY); and Division of Chest and Critical Care, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi; Chang Gung University (Y-HT)
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Takanen S, Bangrazi C, Graziano V, Parisi A, Resuli B, Simione L, Caiazzo R, Raffetto N, Tombolini V. Number of mediastinal lymph nodes as a prognostic factor in PN2 non small cell lung cancer: a single centre experience and review of the literature. Asian Pac J Cancer Prev 2015; 15:7559-62. [PMID: 25292028 DOI: 10.7314/apjcp.2014.15.18.7559] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Currently the most important prognostic factor in lung cancer is the stage. In the current lung TNM classification system, N category is defined exclusively by anatomic nodal location though, in other type of tumours, number of lymph nodes is confirmed to be a fundamental prognostic factor. Therefore we evaluated the number of mediastinal lymph nodes as a prognostic factor in locally advanced NSCLC after multimodality treatment, observing a significant effect of the number of lymph nodes in terms of OS (p<0.01) and DFS (p<0.001): patients with a low number of positive mediastinal nodes have a better prognosis.
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Affiliation(s)
- Silvia Takanen
- Department of Radiation Oncology, Azienda Policlinico Umberto I, "Sapienza" University of Rome. Viale del Policlinico Italy E-mail :
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Kudo Y, Shimada Y, Saji H, Kato Y, Yoshida K, Matsubayashi J, Nagase S, Kakihana M, Kajiwara N, Ohira T, Nagao T, Ikeda N. Prognostic Factors for Survival After Recurrence in Patients With Completely Resected Lung Adenocarcinoma: Important Roles of Epidermal Growth Factor Receptor Mutation Status and the Current Staging System. Clin Lung Cancer 2015; 16:e213-21. [PMID: 25986624 DOI: 10.1016/j.cllc.2015.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/10/2015] [Accepted: 04/14/2015] [Indexed: 12/13/2022]
Abstract
UNLABELLED Epidermal growth factor receptor (EGFR) status and pathological stage (p-stage) were shown to be essential prognostic factors for estimating survival after recurrence of lung adenocarcinoma. In patients with EGFR mutations, those with early p-stage tumors showed better survival after disease recurrence than those with advanced p-stage tumors. The EGFR mutation status and p-stage could also prompt the design of clinical trials on adjuvant therapy for patients after complete surgical resection. BACKGROUND The current staging system and epidermal growth factor receptor (EGFR) mutation status are key factors for predicting survival. However, the significance of these factors as predictors of survival after disease recurrence (PRS) has not been sufficiently elucidated. The objective of this study was to investigate the clinicopathological factors, particularly the EGFR mutation status and pathological stage (p-stage), which affect PRS in patients with completely resected lung adenocarcinoma. PATIENTS AND METHODS We retrospectively reviewed the data of 198 consecutive lung adenocarcinoma patients with disease recurrence who previously underwent complete surgical resection in our hospital. RESULTS Of the 198 patients, 117 were examined for EGFR mutations (mutants). Mutants were detected in 57 patients (28.7%). The patients with mutants had a significantly better 3-year PRS (3y-PRS) rate (68.6%) than those with an EGFR wild type (WT) status (51.7%) or an unknown (UN) status (27.0%). The 3y-PRS rates for p-stage I to II (p-I-II) and p-stage III (p-III) were 52.5% and 29.3%, respectively. Multivariate survival analysis showed that the EGFR mutation status and p-stage had significant associations with favorable PRS. The 3y-PRS rate for mutants/p-I-II (81.4%) was significantly better than that for mutants/p-III (48.0%). Conversely, there was no significant difference between mutants/p-III and WT/UN/p-I-II (3y-PRS: 40.7%) or between mutants/p-III and WT/UN/p-III (3y-PRS: 24.4%). CONCLUSION EGFR status and p-stage were shown to be essential prognostic factors for estimating PRS. In patients with mutants, those with early p-stage tumors showed better PRS than those with advanced p-stage tumors.
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Affiliation(s)
- Yujin Kudo
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan.
| | - Yoshihisa Shimada
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hisashi Saji
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan; Department of Chest Surgery, St Marianna University School of Medicine, Kanagawa, Japan
| | - Yasufumi Kato
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Koichi Yoshida
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Jun Matsubayashi
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Seisuke Nagase
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | | | - Naohiro Kajiwara
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Tatsuo Ohira
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Norihiko Ikeda
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
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Lee GD, Kim DK, Moon DH, Joo S, Hwang SK, Choi SH, Kim HR, Kim YH, Park SI. A comparison of the proposed classifications for the revision of N descriptors for non-small-cell lung cancer. Eur J Cardiothorac Surg 2015; 49:580-8. [PMID: 25890940 DOI: 10.1093/ejcts/ezv134] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 02/17/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Several new classifications have been proposed for revision of the N descriptors for non-small-cell lung cancer (NSCLC), but external validation is required. The aim of this study was to validate various newly proposed nodal classifications and to compare the discrimination abilities of these classifications. METHODS A retrospective analysis was conducted of 1487 patients who underwent complete resection with systematic lymph node dissection for NSCLC between 2000 and 2008. Four nodal classifications based on the following categories were analysed: zone-based classification (single-zone N1, multiple-zone N1, single-zone N2 and multiple-zone N2), number-based classification (the number of metastatic lymph nodes; 1-2, 3-6 and ≥7), rate-based classification (ratio of the number of metastatic lymph nodes to the total number of resected lymph nodes; ≤15, 15-40 and >40%) and the combination of location- and number-based classification (N1: 1-3, N1: ≥4, N2: 1-3 and N2: ≥4). Concordance (C)-index and net reclassification improvement (NRI) index were used to assess the discrimination abilities of the models. RESULTS In multivariate analysis, all of the newly proposed classifications were independent predictors (P < 0.001) of overall survival (OS) after adjustment for significant variables (age, tumour histology and pathological T status). The C-indices of the classifications based on the nodal zone, nodal number, rate and location alongside the number of metastatic lymph nodes were 0.6179, 0.6280, 0.6203 and 0.6221, respectively; however, the differences in the C-indices were statistically insignificant. Compared with the zone-based classification, the NRI for OS of classifications based on the nodal number, rate and location with number were 0.1101, 0.0972 and 0.0416, respectively. CONCLUSIONS All four proposed classifications based on the nodal zone, nodal number, rate and the combination of location and number are prognostically valid and could serve as future N descriptors after complete resection of NSCLC. The discrimination ability was not significantly different among the four proposed classifications, although the number-based classification tended to have a higher predictive ability compared with the zone-based classification. Future studies with an in-depth discussion are needed to clarify optimal future N descriptors for NSCLC.
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Affiliation(s)
- Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Duk Hwan Moon
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seok Joo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Su Kyung Hwang
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Se Hoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Ichinose J, Murakawa T, Hino H, Konoeda C, Inoue Y, Kitano K, Nagayama K, Nitadori JI, Anraku M, Nakajima J. Prognostic Impact of the Current Japanese Nodal Classification on Outcomes in Resected Non-small Cell Lung Cancer. Chest 2014; 146:644-649. [DOI: 10.1378/chest.14-0159] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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VanderLaan PA, Wang HH, Majid A, Folch E. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA): An overview and update for the cytopathologist. Cancer Cytopathol 2014; 122:561-76. [DOI: 10.1002/cncy.21431] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 03/27/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Paul A. VanderLaan
- Department of Pathology, Division of Cytopathology, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Helen H. Wang
- Department of Pathology, Division of Cytopathology, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Adnan Majid
- Department of Surgery, Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Erik Folch
- Department of Surgery, Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
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Mao W, Xia W, Chen J. Interobserver variability in grading acute rejection after lung transplantation. Chest 2014; 145:416-7. [PMID: 24493524 DOI: 10.1378/chest.13-1788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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