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Ujiie H, Kato T, Lee D, Hu HP, Fujino K, Kaji M, Kaga K, Matsui Y, Yasufuku K. Overexpression of MAGEA2 has a prognostic significance and is a potential therapeutic target for patients with lung cancer. Int J Oncol 2017; 50:2154-2170. [PMID: 28498455 DOI: 10.3892/ijo.2017.3984] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/16/2017] [Indexed: 11/06/2022] Open
Abstract
Melanoma-associated antigens (MAGE) are expressed in different type of cancers including lung cancer and have been shown to be functionally related to p53 tumor suppressor gene. Little is known about the relationship between MAGE genes and p53 aberrant expression in lung cancer. The aims of this study were to observe the expression of MAGEA2, examine the role of MAGEA2 in lung cancer survival, investigate its correlation between MAGEA2 and p53, and explore its clinicopathologic significance as a prognostic marker. Quantitative reverse transcription-polymerase chain reaction was performed to detect the expression of MAGEA2 using 36 primary tumors and 31 metastatic lymph nodes from patients with lung cancer. The role of MAGEA2 in cancer cell growth and in the regulation of p53 downstream genes were examined using small interfering RNA. The expression of MAGEA2 and p53 were analyzed immunohistochemically using tissue microarray from 353 resected lung specimens. High-level expression of MAGEA2 (High-MAGEA2) was confirmed in lung tumors with high frequency. Inhibiting MAGEA2 expression effectively suppressed cancer cell growth and decreased the expression of p53 downstream target genes in vitro. In adenocarcinoma, High-MAGEA2 was strongly associated with aberrant p53 expression (P<0.001) and was associated with worse clinical outcomes (5-year OS, 87.1% in low vs. 74.1% in high, P=0.014). Aberrant p53 expression was also significant worse prognostic factor (P=0.029). Among the adenocarcinoma patients with wild-type p53, High-MAGEA2 had poorer prognosis than low-level MAGEA2 groups (5-year OS, 90.1% vs. 72.1%, P=0.037), whereas had no difference in p53 aberrant tumors. On multivariate analysis, MAGEA2 was independently associated with survival (hazard ratio; 2.12, P=0.030). In conclusion, suppression of MAGEA2 in lung cancer cells significantly reduced the growth/survival of cancer cells. High-MAGEA2 was identified as an independent prognostic factor in lung adenocarcinoma. Specific inhibition of MAGEA2 may be a promising therapeutic strategy for patients with lung cancer.
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Affiliation(s)
- Hideki Ujiie
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, University of Toronto, Ontario, Canada
| | - Tatsuya Kato
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, University of Toronto, Ontario, Canada
| | - Daiyoon Lee
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, University of Toronto, Ontario, Canada
| | - Hsin-Pei Hu
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, University of Toronto, Ontario, Canada
| | - Kosuke Fujino
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, University of Toronto, Ontario, Canada
| | - Mitsuhito Kaji
- Department of Thoracic Surgery, Sapporo Minami-sanjo Hospital, Sapporo, Hokkaido, Japan
| | - Kichizo Kaga
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Yoshiro Matsui
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, University of Toronto, Ontario, Canada
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Kris MG, Gaspar LE, Chaft JE, Kennedy EB, Azzoli CG, Ellis PM, Lin SH, Pass HI, Seth R, Shepherd FA, Spigel DR, Strawn JR, Ung YC, Weyant M. Adjuvant Systemic Therapy and Adjuvant Radiation Therapy for Stage I to IIIA Completely Resected Non-Small-Cell Lung Cancers: American Society of Clinical Oncology/Cancer Care Ontario Clinical Practice Guideline Update. J Clin Oncol 2017; 35:2960-2974. [PMID: 28437162 DOI: 10.1200/jco.2017.72.4401] [Citation(s) in RCA: 243] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose The panel updated the American Society of Clinical Oncology (ASCO) adjuvant therapy guideline for resected non-small-cell lung cancers. Methods ASCO convened an update panel and conducted a systematic review of the literature, investigating adjuvant therapy in resected non-small-cell lung cancers. Results The updated evidence base covered questions related to adjuvant systemic therapy and included a systematic review conducted by Cancer Care Ontario current to January 2016. A recent American Society for Radiation Oncology guideline and systematic review, previously endorsed by ASCO, was used as the basis for recommendations for adjuvant radiation therapy. An update of these systematic reviews and a search for studies related to radiation therapy found no additional randomized controlled trials. Recommendations Adjuvant cisplatin-based chemotherapy is recommended for routine use in patients with stage IIA, IIB, or IIIA disease who have undergone complete surgical resections. For individuals with stage IB, adjuvant cisplatin-based chemotherapy is not recommended for routine use. However, a postoperative multimodality evaluation, including a consultation with a medical oncologist, is recommended to assess benefits and risks of adjuvant chemotherapy for each patient. The guideline provides information on factors other than stage to consider when making a recommendation for adjuvant chemotherapy, including tumor size, histopathologic features, and genetic alterations. Adjuvant chemotherapy is not recommended for patients with stage IA disease. Adjuvant radiation therapy is not recommended for patients with resected stage I or II disease. In patients with stage IIIA N2 disease, adjuvant radiation therapy is not recommended for routine use. However, a postoperative multimodality evaluation, including a consultation with a radiation oncologist, is recommended to assess benefits and risks of adjuvant radiation therapy for each patient with N2 disease. Additional information is available at www.asco.org/lung-cancer-guidelines and www.asco.org/guidelineswiki .
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Affiliation(s)
- Mark G Kris
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - Laurie E Gaspar
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - Jamie E Chaft
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - Erin B Kennedy
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - Christopher G Azzoli
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - Peter M Ellis
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - Steven H Lin
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - Harvey I Pass
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - Rahul Seth
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - Frances A Shepherd
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - David R Spigel
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - John R Strawn
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - Yee C Ung
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - Michael Weyant
- Mark G. Kris and Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Harvey I. Pass, New York University Langone Medical Center, New York; Rahul Seth, Upstate Medical Center, Syracuse University, Syracuse, NY; Laurie E. Gaspar and Michael Weyant, University of Colorado School of Medicine, Aurora, CO; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Christopher G. Azzoli, Massachusetts General Hospital, Boston, MA; Steven H. Lin, MD Anderson Cancer Center; John R. Strawn, Patient Representative, Houston, TX; David R. Spigel, Sarah Cannon Cancer Center, Nashville, TN; Peter M. Ellis, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton; Frances A. Shepherd, Princess Margaret Cancer Centre, University Health Network; and Yee C. Ung, Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
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Taunk NK, Rimner A, Culligan M, Friedberg JS, Brahmer J, Chaft J. Immunotherapy and radiation therapy for operable early stage and locally advanced non-small cell lung cancer. Transl Lung Cancer Res 2017; 6:178-185. [PMID: 28529900 PMCID: PMC5420541 DOI: 10.21037/tlcr.2017.03.05] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 03/15/2017] [Indexed: 12/26/2022]
Abstract
Non-small cell lung cancer (NSCLC) is the most common cause of cancer mortality. Although a significant proportion of patients can be cured with surgery, with or without adjuvant or neoadjuvant chemotherapy and radiation, a significant proportion of patients will fail, particularly distantly. Over fifty percent of patients present with stage IV disease. There are multiple forms of immunotherapy available including T-cell transfer, cytokine therapy, and oncolytic viruses. Checkpoint inhibitors have shown tremendous activity in NSCLC and are currently under intense study given promising data on response. Immunotherapy and radiation therapy (RT) both show significant immune editing activity in NSCLC that may allow the innate and adaptive immune system to help control systemic disease by both radiosensitization and a sustained systemic immune response. Multiple clinical trials are underway exploring the role of adjuvant or neoadjuvant immunotherapy in operable NSCLC. A substantial amount of progress is to be made in terms of optimizing radiation dose and fractionation, immunotherapy type and dose, and integrating both to best realize the benefits of immunotherapy and radiation in operable lung cancer.
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Affiliation(s)
- Neil K. Taunk
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Melissa Culligan
- Department of Surgery, Division of Thoracic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joseph S. Friedberg
- Department of Surgery, Division of Thoracic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Julie Brahmer
- Thoracic Oncology Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Jamie Chaft
- Thoracic Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, USA
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154
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Huang KY, Ko PZ, Yao CW, Hsu CN, Fang HY, Tu CY, Chen HJ. Inaccuracy of lung adenocarcinoma subtyping using preoperative biopsy specimens. J Thorac Cardiovasc Surg 2017; 154:332-339.e1. [PMID: 28366548 DOI: 10.1016/j.jtcvs.2017.02.059] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 01/19/2017] [Accepted: 02/19/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND The prognostic significance of the new classification of lung adenocarcinoma proposed in the 2015 World Health Organization guideline has been validated. This study aimed to compare the preoperative classification of the adenocarcinoma subtype based on computed tomography-guided 18-gauge core needle biopsy (CTNB) or radial probe endobronchial ultrasound (R-EBUS) specimens, with the postoperative classification based on the resected specimens. METHODS We retrospectively analyzed a consecutive series of 128 patients (60 CTNB and 68 R-EBUS) who underwent surgery for preoperatively confirmed lung adenocarcinoma between 2010 and 2014. Comprehensive histological subtyping was performed according to the 2015 World Health Organization classification system. Diagnostic concordance of subtypes between small biopsy and resection specimens was assessed. RESULTS Concordant subtyping of adenocarcinomas between the predominant pattern on resections and biopsy sections was observed in 58.6% of cases (75 of 128; 95% confidence interval [CI], 49.9%-66.8%). Preoperative subtyping was accurate in only 30% of samples (3 of 10) with a predominance of solid patterns. None of the 5 micropapillary predominant cases was detected by CTNB or R-EBUS. For the concordance of the presence or absence of micropapillary/solid component, the sensitivity was as low as 16.5% (95% CI, 9.1%-26.5%). The detection rate by CTNB/R-EBUS increased with the increase in the percentage of micropapillary/solid component; however, even in the ≥40% micropapillary/solid group, only 24% of cases were detected by CTNB/R-EBUS. CONCLUSIONS The accuracy of the estimation of adenocarcinoma histological subtype based on preoperative biopsy sections was unsatisfactory.
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Affiliation(s)
- Kuo-Yang Huang
- Division of Chest Medicine, Department of Internal Medicine, Yuanlin Christian Hospital, Changhua, Taiwan
| | - Pin-Zuo Ko
- Department of Pathology, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Wei Yao
- Division of Chest Medicine, Department of Internal Medicine, Everan Hospital, Taichung, Taiwan
| | - Cheng-Nan Hsu
- Department of Radiology, China Medical University Hospital, Taichung, Taiwan
| | - Hsin-Yuan Fang
- Division of Thoracic Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Yeh Tu
- School of Medicine, College of Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hung-Jen Chen
- Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Respiratory Therapy, China Medical University, Taichung, Taiwan.
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155
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Evaluation of a New Ultrasound Thoracoscope for Localization of Lung Nodules in Ex Vivo Human Lungs. Ann Thorac Surg 2017; 103:926-934. [DOI: 10.1016/j.athoracsur.2016.08.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/24/2016] [Accepted: 08/08/2016] [Indexed: 11/18/2022]
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156
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MacMahon H, Naidich DP, Goo JM, Lee KS, Leung ANC, Mayo JR, Mehta AC, Ohno Y, Powell CA, Prokop M, Rubin GD, Schaefer-Prokop CM, Travis WD, Van Schil PE, Bankier AA. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017. Radiology 2017; 284:228-243. [PMID: 28240562 DOI: 10.1148/radiol.2017161659] [Citation(s) in RCA: 1352] [Impact Index Per Article: 193.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Fleischner Society Guidelines for management of solid nodules were published in 2005, and separate guidelines for subsolid nodules were issued in 2013. Since then, new information has become available; therefore, the guidelines have been revised to reflect current thinking on nodule management. The revised guidelines incorporate several substantive changes that reflect current thinking on the management of small nodules. The minimum threshold size for routine follow-up has been increased, and recommended follow-up intervals are now given as a range rather than as a precise time period to give radiologists, clinicians, and patients greater discretion to accommodate individual risk factors and preferences. The guidelines for solid and subsolid nodules have been combined in one simplified table, and specific recommendations have been included for multiple nodules. These guidelines represent the consensus of the Fleischner Society, and as such, they incorporate the opinions of a multidisciplinary international group of thoracic radiologists, pulmonologists, surgeons, pathologists, and other specialists. Changes from the previous guidelines issued by the Fleischner Society are based on new data and accumulated experience. © RSNA, 2017 Online supplemental material is available for this article. An earlier incorrect version of this article appeared online. This article was corrected on March 13, 2017.
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Affiliation(s)
- Heber MacMahon
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - David P Naidich
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Jin Mo Goo
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Kyung Soo Lee
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Ann N C Leung
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - John R Mayo
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Atul C Mehta
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Yoshiharu Ohno
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Charles A Powell
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Mathias Prokop
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Geoffrey D Rubin
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Cornelia M Schaefer-Prokop
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - William D Travis
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Paul E Van Schil
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Alexander A Bankier
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
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Mao R, Chen C, Fei K. The Clinical Implications and Thoughts on Different Patterns in Resected Lung Adenocarcinoma. J Thorac Oncol 2017; 12:e24-e25. [PMID: 28215725 DOI: 10.1016/j.jtho.2016.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 12/04/2016] [Indexed: 01/15/2023]
Affiliation(s)
- Rui Mao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
| | - Ke Fei
- Department of Thoracic Surgery, East China Sanatorium, Wuxi, People's Republic of China
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158
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Kubouchi Y, Kidokoro Y, Ohno T, Yurugi Y, Wakahara M, Haruki T, Nakamura H. Prognostic Factors for Post Recurrence Survival in Resected Pathological Stage I Non-small Cell Lung Cancer. Yonago Acta Med 2017. [DOI: 10.33160/yam.2017.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Yasuaki Kubouchi
- Division of General Thoracic Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683- 8504, Japan
| | - Yoshiteru Kidokoro
- Division of General Thoracic Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683- 8504, Japan
| | - Takashi Ohno
- Division of General Thoracic Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683- 8504, Japan
| | - Yohei Yurugi
- Division of General Thoracic Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683- 8504, Japan
| | - Makoto Wakahara
- Division of General Thoracic Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683- 8504, Japan
| | - Tomohiro Haruki
- Division of General Thoracic Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683- 8504, Japan
| | - Hiroshige Nakamura
- Division of General Thoracic Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683- 8504, Japan
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159
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Hu H, Sun Z, Li Y, Zhang Y, Li H, Zhang Y, Pan Y, Shen L, Wang R, Sun Y, Chen H. The Histologic Classifications of Lung Adenocarcinomas Are Discriminable by Unique Lineage Backgrounds. J Thorac Oncol 2016; 11:2161-2172. [DOI: 10.1016/j.jtho.2016.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/09/2016] [Accepted: 07/12/2016] [Indexed: 02/07/2023]
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160
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Impact of age and comorbidity on treatment of non-small cell lung cancer recurrence following complete resection: A nationally representative cohort study. Lung Cancer 2016; 102:108-117. [PMID: 27987578 DOI: 10.1016/j.lungcan.2016.11.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/21/2016] [Accepted: 11/04/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Older patients with non-small cell lung cancer (NSCLC) are less likely to receive guideline-recommended treatment at diagnosis, independent of comorbidity. However, national data on treatment of postoperative recurrence are limited. We evaluated the associations between age, comorbidity, and other patient factors and treatment of postoperative NSCLC recurrence in a national cohort. MATERIALS AND METHODS We randomly selected 9001 patients with surgically resected stage I-III NSCLC in 2006-2007 from the National Cancer Data Base. Patients were followed for 5 years or until first NSCLC recurrence, new primary cancer, or death, whichever came first. Perioperative comorbidities, first recurrence, treatment of recurrence, and survival were abstracted from medical records and merged with existing registry data. Factors associated with active treatment (chemotherapy, radiation, and/or surgery) versus supportive care only were analyzed using multivariable logistic regression. RESULTS Median age at initial diagnosis was 67; 69.7% had >1 comorbidity. At 5-year follow-up, 12.3% developed locoregional and 21.5% developed distant recurrence. Among patients with locoregional recurrence, 79.5% received active treatment. Older patients (OR 0.49 for age >75 compared with <55; 95% CI 0.27-0.88) and those with substance abuse (OR 0.43; 95% CI 0.23-0.81) were less likely to receive active treatment. Women (OR 0.62; 95% CI 0.43-0.89) and patients with symptomatic recurrence (OR 0.69; 95% CI 0.47-0.99) were also less likely to receive active treatment. Among those with distant recurrence, 77.3% received active treatment. Older patients (OR 0.42 for age >75 compared with <55; 95% CI 0.26-0.68) and those with any documented comorbidities (OR 0.59; 95% CI 0.38-0.89) were less likely to receive active treatment. CONCLUSION Older patients independent of comorbidity, patients with substance abuse, and women were less likely to receive active treatment for postoperative NSCLC recurrence. Studies to further characterize these disparities in treatment of NSCLC recurrence are needed to identify barriers to treatment.
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161
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Leeman JE, Rimner A, Montecalvo J, Hsu M, Zhang Z, von Reibnitz D, Panchoo K, Yorke E, Adusumilli PS, Travis W, Wu AJ. Histologic Subtype in Core Lung Biopsies of Early-Stage Lung Adenocarcinoma is a Prognostic Factor for Treatment Response and Failure Patterns After Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2016; 97:138-145. [PMID: 27839909 DOI: 10.1016/j.ijrobp.2016.09.037] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/12/2016] [Accepted: 09/22/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE Stereotactic body radiation therapy (SBRT) has emerged as an effective treatment for early-stage lung cancer. The histologic subtype of surgically resected lung adenocarcinoma is recognized as a prognostic factor, with the presence of solid or micropapillary patterns predicting poor outcomes. We describe the outcomes after SBRT for early-stage lung adenocarcinoma stratified by histologic subtype. METHODS AND MATERIALS We identified 119 consecutive patients (124 lesions) with stage I to IIA lung adenocarcinoma who had undergone definitive SBRT at our institution from August 2008 to August 2015 and had undergone core biopsy. Histologic subtyping was performed according to the 2015 World Health Organization classification. Of the 124 tumors, 37 (30%) were a high-risk subtype, defined as containing a component of solid and/or micropapillary pattern. The cumulative incidences of local, nodal, regional, and distant failure were compared between the high-risk and non-high-risk adenocarcinoma subtypes using Gray's test, and multivariable-adjusted hazard ratios (HRs) were estimated from propensity score-weighted Cox regression models. RESULTS The median follow-up for the entire cohort was 17 months and for surviving patients was 21 months. The 1-year cumulative incidence of and adjusted HR for local, nodal, regional, and distant failure in high-risk versus non-high-risk lesions was 7.3% versus 2.7% (HR 16.8; 95% confidence interval [CI] 3.5-81.4), 14.8% versus 2.6% (HR 3.8; 95% CI 0.95-15.0), 4.0% versus 1.2% (HR 20.9; 95% CI 2.3-192.3), and 22.7% versus 3.6% (HR 6.9; 95% CI 2.2-21.1), respectively. No significant difference was seen with regard to overall survival. CONCLUSIONS The outcomes after SBRT for early-stage adenocarcinoma of the lung correlate highly with histologic subtype, with micropapillary and solid tumors portending significantly higher rates of locoregional and metastatic progression. In this context, the histologic subtype determined from core biopsies is a prognostic factor and could have important implications for patient selection, adjuvant treatment, biopsy methods, and clinical trial design.
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Affiliation(s)
- Jonathan E Leeman
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joseph Montecalvo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Meier Hsu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Zhigang Zhang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Donata von Reibnitz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kelly Panchoo
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Prasad S Adusumilli
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - William Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Abraham J Wu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
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162
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Yu Y, Ding Z, Jian H, Shen L, Zhu L, Lu S. Prognostic value of MMP9 activity level in resected stage I B lung adenocarcinoma. Cancer Med 2016; 5:2323-31. [PMID: 27456862 PMCID: PMC5055171 DOI: 10.1002/cam4.821] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/17/2016] [Accepted: 06/17/2016] [Indexed: 12/12/2022] Open
Abstract
The clinical outcomes of patients with early-stage non-small cell lung cancer (NSCLC) have remained unsatisfactory after complete surgical resection. The objective of this study was to explore the prognostic value of matrix metalloproteinase 9 (MMP9) activity level in Chinese patients with stage I B lung adenocarcinoma. A sensitive and validated method was employed for determining the activity of MMP9 in human lung adenocarcinoma cells in vitro. Then, the association was examined between the level of MMP9 enzymatic activity and clinical outcomes. A total of 104 cases were stratified according to the IASLC/ATS/ERS classification scheme and activity of MMP9 was analyzed by SensoLyte® assay kit. The results showed that the MMP9 activity was the highest in solid predominant and micropapillary predominant subtypes, intermediate in acinar predominant and papillary predominant subtypes, and the lowest in lepidic predominant subtype. Multivariate analysis revealed that pathological subtype and activity of MMP9 were independent prognostic factors for disease-free survival (DFS), respectively (P = 0.005 and 0.029). Significant relationship existed between enzyme activity of MMP9 and prognosis. And the 30 months DFS of high- and low-level MMP9 activity tumors was 44.2% and 84.1% (P < 0.0001), respectively. High-level MMP9 activity is correlated with aggressive tumor behaviors and poor clinical outcomes in early-stage lung adenocarcinoma after complete resection.
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Affiliation(s)
- Yongfeng Yu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 West Huaihai Road, Xuhui District, Shanghai, 200030, China
| | - Zhengping Ding
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 West Huaihai Road, Xuhui District, Shanghai, 200030, China
| | - Hong Jian
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 West Huaihai Road, Xuhui District, Shanghai, 200030, China
| | - Lan Shen
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 West Huaihai Road, Xuhui District, Shanghai, 200030, China
| | - Lei Zhu
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 West Huaihai Road, Xuhui District, Shanghai, 200030, China
| | - Shun Lu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 West Huaihai Road, Xuhui District, Shanghai, 200030, China.
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163
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Beasley MB, Dembitzer FR, Flores RM. Surgical pathology of early stage non-small cell lung carcinoma. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:238. [PMID: 27429964 DOI: 10.21037/atm.2016.06.13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The histologic classification of non-small cell lung carcinoma (NSCLC), particularly adenocarcinoma (ADC), has undergone extensive study in recent decades, ultimately resulting in an extensively updated classification system. The 2015 World Health Organization (WHO) classification of ADC provides greatly improved prognostic information in comparison to the 2004 WHO classification. Several issues still require further investigation: lepidic predominant ADC, prognostic significance of poor prognostic subtypes such as micropapillary carcinoma, the more recently described concept of spread of tumor through airspaces (STAS), and the utility of sublobar resections. While limited resection appears to be suitable for tumors with a ground glass radiographic appearance, which typically correspond to adenocarcinoma in situ (MIS) or minimally invasive adenocarcinoma (MIA) histologically, the role of sublobar resection in radiographic solid tumors is not as clear, and the impact of histologic subtypes with a poor prognosis needs further evaluation. Squamous cell carcinoma (SCC) has not been as extensively studied and the current classification lacks subclassification with significant prognostic information.
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Affiliation(s)
- Mary Beth Beasley
- Department of Pathology, Mount Sinai Health System, Icahn School of Medicine, New York, NY, USA
| | - Francine R Dembitzer
- Department of Pathology, Mount Sinai Health System, Icahn School of Medicine, New York, NY, USA
| | - Raja M Flores
- Department of Thoracic Surgery, Mount Sinai Health System, Icahn School of Medicine, New York, NY, USA
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164
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Cha YJ, Kim HR, Lee CY, Cho BC, Shim HS. Clinicopathological and prognostic significance of programmed cell death ligand-1 expression in lung adenocarcinoma and its relationship with p53 status. Lung Cancer 2016; 97:73-80. [DOI: 10.1016/j.lungcan.2016.05.001] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/26/2016] [Accepted: 05/02/2016] [Indexed: 02/07/2023]
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165
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Naylor EC. Adjuvant Therapy for Stage I and II Non–Small Cell Lung Cancer. Surg Oncol Clin N Am 2016; 25:585-99. [DOI: 10.1016/j.soc.2016.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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166
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Yanagawa N, Shiono S, Abiko M, Katahira M, Osakabe M, Ogata SY. The Clinical Impact of Solid and Micropapillary Patterns in Resected Lung Adenocarcinoma. J Thorac Oncol 2016; 11:1976-1983. [PMID: 27374456 DOI: 10.1016/j.jtho.2016.06.014] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 06/08/2016] [Accepted: 06/20/2016] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Since the new adenocarcinoma (ADC) classification was presented in 2011, several authors have reported that patients with solid (S) and/or micropapillary (MP) predominant patterns showed a worse prognosis. On the other hand, there are several patients who have S and/or MP patterns even if their patterns are not predominant. However, the evaluation of these patients is uncertain. METHODS A total of 531 ADCs were examined. We classified the patients into five subgroups according to the proportion of S and/or MP patterns: (1) both patterns absent (S-/MP-), (2) S predominant (S pre), (3) MP predominant (MP pre), (4) S pattern present although not predominant and MP pattern absent (S+ not pre/MP-), and (5) MP pattern present although not predominant (MP+ not pre). RESULTS Of the 531 ADCs, 384 (72.3%) were classified as S-/MP-, 55 (10.4%) as S pre, 11 (2.1%) as MP pre, 42 (7.9%) as S+ not pre/MP-, and 39 (7.3%) as MP+ not pre. In a univariate analysis, the recurrence-free survival (RFS) and overall survival differed significantly among the five subgroups (p < 0.01 and p < 0.01, respectively). In a multivariate analysis, patients with S-/MP- had significantly higher RFS rates than did those with other subgroups. On the other hand, patients with MP pre had lower RFS rates than did those with other subgroups. CONCLUSION Patients with S and/or MP patterns have a poorer prognosis even if their patterns are not predominant. The S and/or MP patterns must be treated at the time of diagnosis.
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Affiliation(s)
- Naoki Yanagawa
- Department of Diagnostic Pathology, Yamagata Prefectural Central Hospital, Yamagata, Japan.
| | - Satoshi Shiono
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Masami Abiko
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Masato Katahira
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Mitsumasa Osakabe
- Department of Diagnostic Pathology, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Shin-Ya Ogata
- Department of Diagnostic Pathology, Yamagata Prefectural Central Hospital, Yamagata, Japan
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167
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Billè A, Ahmad U, Woo KM, Suzuki K, Adusumilli P, Huang J, Jones DR, Rizk NP. Detection of Recurrence Patterns After Wedge Resection for Early Stage Lung Cancer: Rationale for Radiologic Follow-Up. Ann Thorac Surg 2016; 102:1067-73. [PMID: 27345095 DOI: 10.1016/j.athoracsur.2016.04.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 02/01/2016] [Accepted: 04/20/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Wedge resection for selected patients with early stage non-small cell lung cancer is considered to be a valid treatment option. The aim of this study was to evaluate the recurrence patterns after wedge resection, to analyze the survival of patients under routine follow-up, and to recommend a follow-up regimen. METHODS A retrospective analysis was done of 446 consecutive patients between May 2000 and December 2012 who underwent a wedge resection for clinical stage I non-small cell lung cancer. All patients were followed up with a computed tomography scan with or without contrast. The recurrence was recorded as local (involving the same lobe of wedge resection), regional (involving mediastinal or hilar lymph nodes or a different lobe), or distant (including distant metastasis and pleural disease). RESULTS Median follow-up for survivors (n = 283) was 44.6 months. In all, 163 patients died; median overall survival was 82.6 months. Thirty-six patients were diagnosed with new primary non-small cell lung cancer, and 152 with recurrence (79 local, 45 regional, and 28 distant). There was no difference in the incidence of recurrence detection detected by computed tomography scans with versus without contrast (p = 0.18). The cumulative incidence of local recurrences at 1, 2, and 3 years was higher than the cumulative incidence for local, regional, and distant recurrences: 5.2%, 11.1%, and 14.9% versus 3.7%, 6.6%, and 9.5% versus 2.3%, 4.7%, and 6.4%, respectively. Primary tumor diameter was associated with local recurrence in univariate analysis. CONCLUSIONS Wedge resection for early stage non-small cell lung cancer is associated with a significant risk for local and regional recurrence. Long-term follow-up using noncontrast computed tomography scans at consistent intervals is appropriate to monitor for these recurrences.
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Affiliation(s)
- Andrea Billè
- Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Usman Ahmad
- Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kaitlin M Woo
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kei Suzuki
- Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Prasad Adusumilli
- Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James Huang
- Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David R Jones
- Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nabil Pierre Rizk
- Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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168
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The 2015 World Health Organization Classification of Lung Tumors: Impact of Genetic, Clinical and Radiologic Advances Since the 2004 Classification. J Thorac Oncol 2016; 10:1243-1260. [PMID: 26291008 DOI: 10.1097/jto.0000000000000630] [Citation(s) in RCA: 2865] [Impact Index Per Article: 358.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The 2015 World Health Organization (WHO) Classification of Tumors of the Lung, Pleura, Thymus and Heart has just been published with numerous important changes from the 2004 WHO classification. The most significant changes in this edition involve (1) use of immunohistochemistry throughout the classification, (2) a new emphasis on genetic studies, in particular, integration of molecular testing to help personalize treatment strategies for advanced lung cancer patients, (3) a new classification for small biopsies and cytology similar to that proposed in the 2011 Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification, (4) a completely different approach to lung adenocarcinoma as proposed by the 2011 Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification, (5) restricting the diagnosis of large cell carcinoma only to resected tumors that lack any clear morphologic or immunohistochemical differentiation with reclassification of the remaining former large cell carcinoma subtypes into different categories, (6) reclassifying squamous cell carcinomas into keratinizing, nonkeratinizing, and basaloid subtypes with the nonkeratinizing tumors requiring immunohistochemistry proof of squamous differentiation, (7) grouping of neuroendocrine tumors together in one category, (8) adding NUT carcinoma, (9) changing the term sclerosing hemangioma to sclerosing pneumocytoma, (10) changing the name hamartoma to "pulmonary hamartoma," (11) creating a group of PEComatous tumors that include (a) lymphangioleiomyomatosis, (b) PEComa, benign (with clear cell tumor as a variant) and
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169
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Scientific Advances in Lung Cancer 2015. J Thorac Oncol 2016; 11:613-638. [DOI: 10.1016/j.jtho.2016.03.012] [Citation(s) in RCA: 185] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/16/2016] [Accepted: 03/16/2016] [Indexed: 02/07/2023]
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170
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Deciphering intra-tumor heterogeneity of lung adenocarcinoma confirms that dominant, branching, and private gene mutations occur within individual tumor nodules. Virchows Arch 2016; 468:651-62. [DOI: 10.1007/s00428-016-1931-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 01/09/2016] [Accepted: 03/21/2016] [Indexed: 01/17/2023]
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171
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Takahashi Y, Eguchi T, Bains S, Adusumilli PS. Significance of IASLC/ATS/ERS classification for early-stage lung adenocarcinoma patients in predicting benefit from adjuvant chemotherapy. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:66. [PMID: 27004213 DOI: 10.3978/j.issn.2305-5839.2015.10.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Yusuke Takahashi
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan ; 3 Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Takashi Eguchi
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan ; 3 Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sarina Bains
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan ; 3 Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Prasad S Adusumilli
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan ; 3 Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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172
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Zhao Y, Wang R, Shen X, Pan Y, Cheng C, Li Y, Shen L, Zhang Y, Li H, Zheng D, Ye T, Zheng S, Sun Y, Chen H. Minor Components of Micropapillary and Solid Subtypes in Lung Adenocarcinoma are Predictors of Lymph Node Metastasis and Poor Prognosis. Ann Surg Oncol 2016; 23:2099-105. [PMID: 26842488 PMCID: PMC4858562 DOI: 10.1245/s10434-015-5043-9] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Indexed: 12/17/2022]
Abstract
Background Lung adenocarcinoma with micropapillary and solid predominant subtypes was reported to be associated with poor prognosis; however, whether minor components (non-predominant) of micropapillary and solid subtypes predict poor prognosis remains unknown. In this study, we investigated the predictive and prognostic value of lymph node metastasis of minor micropapillary and solid components. Methods Specimens of resected tumors of 1244 patients were reclassified to determine the predominant subtype and minor components (>5 %, but not predominant). Of these specimens, 105 contained a micropapillary component and 210 contained a solid component. The correlation between each subtype and lymph node metastasis was analyzed, and survival analyses were used to determine the association between each subtype and patient survival. Results Adenocarcinomas harboring micropapillary and/or solid components held higher rates of metastatic lymph node stations (25.2 % vs. 15.6 %, p = 0.002; and 24.0 % vs. 14.9 %, p < 0.001, respectively) and lymph nodes (17.3 % vs. 10.1 %, p = 0.004; and 15.5 % vs. 9.7 %, p = 0.001, respectively). Patients with micropapillary and solid components in their tumors showed a shorter median recurrence-free survival (15.8 vs. 62.8 months, p < 0.001; and 20.8 months vs. not reached, p < 0.001) and overall survival (47.0 months vs. not reached, p < 0.001; and 69.0 months vs. not reached, p < 0.001). Conclusions Minor components of micropapillary and/or solid subtypes of lung adenocarcinoma are correlated with lymph node metastasis and poor prognosis. Thus, it is beneficial to focus not only on predominant subtypes but also minor components to predict prognoses and make therapeutic strategies more comprehensively. Electronic supplementary material The online version of this article (doi:10.1245/s10434-015-5043-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yue Zhao
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Rui Wang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xuxia Shen
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yunjian Pan
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chao Cheng
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuan Li
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Lei Shen
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yang Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hang Li
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Difan Zheng
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ting Ye
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shanbo Zheng
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yihua Sun
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China. .,Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China. .,Institutes of Biomedical Sciences, Fudan University, Shanghai, China.
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173
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Hung JJ, Yeh YC, Jeng WJ, Wu YC, Chou TY, Hsu WH. Factors predicting occult lymph node metastasis in completely resected lung adenocarcinoma of 3 cm or smaller. Eur J Cardiothorac Surg 2016; 50:329-36. [PMID: 26819290 DOI: 10.1093/ejcts/ezv485] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 12/22/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of the study is to demonstrate the relationship between clinicopathological variables and occult lymph node metastasis in resected lung adenocarcinoma. METHODS The clinicopathological characteristics of 471 patients with clinical N2-negative status undergoing resection for lung adenocarcinoma of 3 cm or smaller at Taipei Veterans General Hospital between 2004 and 2012 were retrospectively reviewed. The association between clinicopathological variables and lymph node metastasis was analysed by univariate and multivariate logistic regression. RESULTS Among the 471 patients, there were 386 (82.0%) patients with pathological N0 status, 35 (7.4%) with pathological N1 status and 50 (10.6%) with pathological N2 status. Greater tumour size (P = 0.002), presence of a micropapillary pattern (P < 0.001), presence of a solid pattern (P < 0.001) and predominant pattern group (micropapillary/solid predominant) (P = 0.001) were significantly associated with higher percentage of occult N2 lymph node metastasis. In multivariate analysis, greater tumour size (P = 0.008), presence of micropapillary pattern (P < 0.001) and presence of solid pattern (P = 0.001) were significant predictors of occult N2 lymph node metastasis in tumours of 3 cm or smaller. When histological pattern was entered as the predominant pattern in multivariate analysis, micropapillary/solid predominant pattern (P = 0.005) was also a significant predictor of occult N2 lymph node metastasis. CONCLUSIONS The presence of micropapillary or solid pattern, as well as micropapillary/solid predominant pattern, is significantly associated with occult N2 lymph node metastasis in lung adenocarcinoma. Radical mediastinal lymph node dissection may help to identify occult lymph node metastasis in these patients.
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Affiliation(s)
- Jung-Jyh Hung
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Chen Yeh
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Juei Jeng
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan Department of Internal Medicine, Chang Gung Memorial Hospital and School of Medicine, Chang Gung University, Taipei, Taiwan
| | - Yu-Chung Wu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Teh-Ying Chou
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Hu Hsu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan
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174
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Bains S, Adusumilli PS. Is spread through alveolar spaces, the newly recognized pattern of invasion, a potential game changer in lung adenocarcinoma? ANNALS OF TRANSLATIONAL MEDICINE 2016; 3:350. [PMID: 26807405 DOI: 10.3978/j.issn.2305-5839.2015.09.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sarina Bains
- Thoracic Service, Department of Surgery, Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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175
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Nouvelle classification OMS 2015 des adénocarcinomes pulmonaires et prénéoplasies. Ann Pathol 2016; 36:5-14. [DOI: 10.1016/j.annpat.2015.11.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 11/08/2015] [Indexed: 11/17/2022]
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