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Łochowski MP, Chałubińska-Fendler J, Szlachcińska A, Łochowska B, Brzeziński D, Kaczmarski J, Kozak J. Prognostic Value of Lymph Node Ratio (LNR) in Patients with Postoperative N2 Feature in Non-Small Cell Lung Cancer (NSCLC). J Clin Med 2024; 13:4570. [PMID: 39124836 PMCID: PMC11313622 DOI: 10.3390/jcm13154570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/19/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
Introduction: One of the most important prognostic factors in non-small cell lung cancer (NSCLC), a condition with a high mortality rate, is the presence of mediastinal lymph node metastases alongside distant metastases. The aim of this study was to evaluate the prognostic value of selected parameters of N2 stage NSCLC with a special focus on lymph node ratio (LNR). Material: The study included 163 patients (61 women and 102 men) operated on due to NSCLC, postoperatively diagnosed as stage N2. The age of the patients ranged from 38 to 82 years (mean age: 62.4 years). The effects of the following factors on clinical data and survival rate were assessed: N1 stage, total number of all metastatic nodes, LNR and LNR N2 ratios, and the presence of skip, single- or multistation metastases. Results: Univariate analysis showed patient survival to be correlated with LNR and LNR N2 ratios, single/multistation metastases, and the number of nodes involved in metastasis. A multivariate model based on patient clinical data found nicotine dependence (p = 0.013), LNR > 0.26 (p = 0.004), and Charlson Comorbidity Index (CCI) value > 3 (p = 0.014) to be independent adverse prognostic factors in this group. Conclusions: LNR ratio is a significant cancer disease-derived independent prognostic factor for patients with postoperative N2 stage NSCLC. In addition, smoking and comorbidities also appear to have prognostic value.
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Affiliation(s)
- Mariusz Piotr Łochowski
- Department of Thoracic Surgery and Respiratory Rehabilitation, Medical University of Lodz, Regional Multi-Specialist Center for Oncology and Traumatology, Nicolaus Copernicus Memorial Hospital, 93-513 Lodz, Poland; (A.S.); (D.B.); (J.K.); (J.K.)
| | - Justyna Chałubińska-Fendler
- Department of Radiotherapy, Military Institute of Medicine—National Research Inisitute, 04-141 Warsaw, Poland;
| | - Aleksandra Szlachcińska
- Department of Thoracic Surgery and Respiratory Rehabilitation, Medical University of Lodz, Regional Multi-Specialist Center for Oncology and Traumatology, Nicolaus Copernicus Memorial Hospital, 93-513 Lodz, Poland; (A.S.); (D.B.); (J.K.); (J.K.)
| | - Barbara Łochowska
- Department of Radiotherapy and General Oncology, Regional Multi-Specialist Center for Oncology and Traumatology, Nicolaus Copernicus Memorial Hospital, 93-513 Lodz, Poland;
| | - Daniel Brzeziński
- Department of Thoracic Surgery and Respiratory Rehabilitation, Medical University of Lodz, Regional Multi-Specialist Center for Oncology and Traumatology, Nicolaus Copernicus Memorial Hospital, 93-513 Lodz, Poland; (A.S.); (D.B.); (J.K.); (J.K.)
| | - Jacek Kaczmarski
- Department of Thoracic Surgery and Respiratory Rehabilitation, Medical University of Lodz, Regional Multi-Specialist Center for Oncology and Traumatology, Nicolaus Copernicus Memorial Hospital, 93-513 Lodz, Poland; (A.S.); (D.B.); (J.K.); (J.K.)
| | - Józef Kozak
- Department of Thoracic Surgery and Respiratory Rehabilitation, Medical University of Lodz, Regional Multi-Specialist Center for Oncology and Traumatology, Nicolaus Copernicus Memorial Hospital, 93-513 Lodz, Poland; (A.S.); (D.B.); (J.K.); (J.K.)
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Zhou S, Zhai Y, Zhao K, Men Y, Meng X, Hui Z. Real world practice of postoperative radiotherapy for patients with completely resected pIIIA-N2 non-small cell lung cancer: a national survey of radiation oncologists in China. Radiat Oncol 2023; 18:17. [PMID: 36698150 PMCID: PMC9875489 DOI: 10.1186/s13014-023-02208-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Results from Lung ART and PORT-C trials suggest that postoperative radiotherapy (PORT) cannot routinely be recommended as standard treatment in completely resected pIIIA-N2 NSCLC patients, but their effects on the real-world practice of PORT in China remain unclear. METHODS A national cross-section survey was conducted by using an online survey service. Participants were voluntarily recruited using a river sampling strategy. A link to the survey was posted on websites of radiation oncologist associations and tweets from public WeChat accounts. The survey collected the real names of participants to ensure that they were board-certified radiation oncologists. RESULTS A total of 484 radiation oncologists were included with a median age of 40 years (IQR, 35-47). A total of 377 (77.9%) participants were male, and 282 (58.1%) had more than 10 years of clinical experience practicing thoracic radiotherapy. Before Lung ART and PORT-C trials were published, 313 (64.7%) respondents recommended PORT, 11 (2.3%) did not recommend it, and 160 (33.1%) reported that they made decisions based on risk factors. After the presentation of two trials, only 42 (8.7%) did not recommend PORT, while 108 (22.3%) recommended it, and 334 (69.0%) made decisions based on risk factors. The five most commonly considered risk factors among these 334 respondents were as follows: nodal extracapsular extension, the highest lymph node (LN) station involved, the number of dissected mediastinal LN stations, the number of positive mediastinal LN stations, and surgical approaches. In addition, the majority of all 484 respondents recommended a total dose of 50 Gy, lung stump + ipsilateral hilus + regions containing positive LNs as the targeted region, lung V20 < 25%, and heart V30 < 40% as dose constraints for PORT. CONCLUSION Most Chinese radiation oncologists recommended PORT for completely resected IIIA-N2 NSCLC patients based on risk factors, especially status of LN station.
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Affiliation(s)
- Shujie Zhou
- grid.440144.10000 0004 1803 8437Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, 250117 Shandong China
| | - Yirui Zhai
- grid.506261.60000 0001 0706 7839Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Kaikai Zhao
- grid.440144.10000 0004 1803 8437Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yu Men
- grid.506261.60000 0001 0706 7839Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China ,grid.506261.60000 0001 0706 7839Department of VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Xiangjiao Meng
- grid.440144.10000 0004 1803 8437Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Zhouguang Hui
- grid.506261.60000 0001 0706 7839Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China ,grid.506261.60000 0001 0706 7839Department of VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
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Liu B, Wang Z, Zhao H, Gao S, Wang H, Zhang Y, Fan K, Tao R, Li Y, Feng J, Sun Y, Zhang J, Zhang G. The Value of Radiotherapy in Patients With Resectable Stage IIIA Non-Small-Cell Lung Cancer in the Era of Individualized Treatment: A Population-Based Analysis. Clin Lung Cancer 2023; 24:18-28. [PMID: 36446703 DOI: 10.1016/j.cllc.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION No consensus has been achieved on the benefit of radiotherapy for resected stage IIIA NSCLC patients. The division of stage IIIA has changed significantly in 2017. This study aims to explore the effects of radiotherapy on the survival of patients with resectable stage IIIA NSCLC in the new era. PATIENTS AND METHODS Patients diagnosed with NSCLC between 2010 and 2018 were identified in the 8th edition TNM classification from the Surveillance, Epidemiology, and End Results database. A nomogram was developed by integrating all independent predictors for lung cancer-specific survival (LCSS). The Propensity Score Matching (PSM) and subgroup analysis were applied to mitigate potential bias. Survival analyses were conducted using the Kaplan Meier curves and Cox proportional hazards regression. RESULTS A total of 2632 stage IIIA NSCLC patients were enrolled. The C-index of the nomogram for the prediction of LCSS was 0.636 (95% CI, 0.616-0.656). In the group of patients with N2 stage who featured more than 5 positive regional lymph nodes, compared with non-PORT, PORT did prolong postoperative survival time (50 vs. 31 months; P= .005). N2 patients with visceral pleural invasion (VPI), older (age >65), or had a larger tumor (size >3 cm) could also benefit from adjuvant radiotherapy. CONCLUSION Treatment protocol for stage IIIA NSCLC patients should be individualized. Based on our findings, N2 patients with more than 5 positive regional lymph nodes, VPI, larger tumor size (greater than 3 cm), and older (age above 65) could benefit from adjuvant radiotherapy. Further well-designed randomized trials are warranted.
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Affiliation(s)
- Bohao Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xie F, China
| | - Zhiyu Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xie F, China
| | - Heng Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xie F, China
| | - Shan Gao
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xie F, China
| | - Hongyi Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xie F, China
| | - Yanpeng Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xie F, China
| | - Kun Fan
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xie F, China
| | - Runyi Tao
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xie F, China
| | - Yixing Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xie F, China
| | - Jinteng Feng
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xie F, China
| | - Yuchen Sun
- Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xie F, China
| | - Jia Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xie F, China
| | - Guangjian Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xie F, China.
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Wu LL, Chen WT, Liu X, Jiang WM, Huang YY, Lin P, Long H, Zhang LJ, Ma GW. A Nomogram to Predict Long-Term Survival Outcomes of Patients Who Undergo Pneumonectomy for Non-small Cell Lung Cancer With Stage I-IIIB. Front Surg 2021; 8:604880. [PMID: 33996882 PMCID: PMC8118124 DOI: 10.3389/fsurg.2021.604880] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 04/09/2021] [Indexed: 12/23/2022] Open
Abstract
Background: In this study, we aim to establish a nomogram to predict the prognosis of non-small cell lung cancer (NSCLC) patients with stage I-IIIB disease after pneumonectomy. Methods: Patients selected from the Surveillance, Epidemiology, and End Results (SEER, N = 2,373) database were divided into two cohorts, namely a training cohort (SEER-T, N = 1,196) and an internal validation cohort (SEER-V, N = 1,177). Two cohorts were dichotomized into low- and high-risk subgroups by the optimal risk prognostic score (PS). The model was validated by indices of concordance (C-index) and calibration plots. Kaplan-Meier analysis and the log-rank tests were used to compare survival curves between the groups. The primary observational endpoint was cancer-specific survival (CSS). Results: The nomogram comprised six factors as independent prognostic indictors; it significantly distinguished between low- and high-risk groups (all P < 0.05). The unadjusted 5-year CSS rates of high-risk and low-risk groups were 33 and 60% (SEER-T), 34 and 55% (SEER-V), respectively; the C-index of this nomogram in predicting CSS was higher than that in the 8th TNM staging system (SEER-T, 0.629 vs. 0.584, P < 0.001; SEER-V, 0.609 vs. 0.576, P < 0.001). In addition, the PS might be a significant negative indictor on CSS of patients with white patients [unadjusted hazard ration (HR) 1.008, P < 0.001], black patients (unadjusted HR 1.007, P < 0.001), and Asian or Pacific Islander (unadjusted HR 1.008, P = 0.008). In cases with squamous cell carcinoma (unadjusted HR 1.008, P < 0.001) or adenocarcinoma (unadjusted HR 1.008, P < 0.001), PS also might be a significant risk factor. Conclusions: For post-pneumonectomy NSCLC patients, the nomogram may predict their survival with acceptable accuracy and further distinguish high-risk patients from low-risk patients.
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Affiliation(s)
- Lei-Lei Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wu-Tao Chen
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Xuan Liu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wen-Mei Jiang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yang-Yu Huang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Peng Lin
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Hao Long
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Lan-Jun Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Guo-Wei Ma
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Zhang CC, Hou RP, Xia WY, Zeng WQ, Liu J, Wang JM, Lv CX, Luo QQ, Zhao H, Yu W, Zhang Q, Zhu ZF, Cai XW, Feng W, Fu XL. Prognostic index for estimating the survival benefit of postoperative radiotherapy in pathologic N2 non-small cell lung cancer: A real-world validation study. Lung Cancer 2021; 156:100-108. [PMID: 33940542 DOI: 10.1016/j.lungcan.2021.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/03/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study aimed to evaluate the effect of postoperative radiotherapy (PORT) in patients with resected pathologic N2 (pN2) non-small cell lung cancer (NSCLC) with different locoregional recurrence (LRR) risks. MATERIALS AND METHODS The primary cohort and validation cohort were retrieved from two independent medical centres. Data for all consecutive patients with completely resected pathologic stage T1-3N2M0 NSCLC were analysed. Patients without PORT in the primary cohort were identified as a training set. Significant prognostic factors for LRR were identified by the Fine-Gray model to develop a prognostic index (PI) in the training set. RESULTS The primary cohort consisted of 357 patients who met the eligibility criteria (training set, 287 patients without PORT). The external validation cohort consisted of 1044 patients who met the eligibility criteria (validation set, 711 patients without PORT). Heavy cigarette smoking history, clinical N2 status (cN2), and the number of positive lymph nodes >4 were identified as independent risk factors. The PI was computed as follows: PI=0.8*smoking history+0.5*cN2+0.7*the number of involved lymph nodes (reference level was assigned the value 1 and risk level the value 2). In the low-risk group (PI score< = 3), PORT showed a trend towards decreased LRR rates but not significantly improved overall survival (OS). In the high-risk group (PI score>3), PORT significantly reduced the risk of LRR and improved OS. CONCLUSIONS We constructed and validated a PI to predict individually the effect of PORT in patients with completely resected pN2 NSCLC. Patients with a higher PI score can benefit from PORT in terms of OS.
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Affiliation(s)
- Chen-Chen Zhang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 Huai-Hai Road, Shanghai 200030, China.
| | - Run-Ping Hou
- School of Biomedical Engineering, Shanghai Jiao Tong University, No. 800, Dong-Chuan Road, Shanghai 200030, China
| | - Wu-Yan Xia
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 Huai-Hai Road, Shanghai 200030, China
| | - Wan-Qin Zeng
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 Huai-Hai Road, Shanghai 200030, China
| | - Jun Liu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 Huai-Hai Road, Shanghai 200030, China
| | - Jia-Ming Wang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 Huai-Hai Road, Shanghai 200030, China
| | - Chang-Xing Lv
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 Huai-Hai Road, Shanghai 200030, China
| | - Qing-Quan Luo
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Heng Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Wen Yu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 Huai-Hai Road, Shanghai 200030, China
| | - Qin Zhang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 Huai-Hai Road, Shanghai 200030, China
| | - Zheng-Fei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, No. 270 Dong-An Road, Shanghai 200032, China
| | - Xu-Wei Cai
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 Huai-Hai Road, Shanghai 200030, China
| | - Wen Feng
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 Huai-Hai Road, Shanghai 200030, China.
| | - Xiao-Long Fu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 Huai-Hai Road, Shanghai 200030, China; Department of Radiation Oncology, Fudan University Shanghai Cancer Center, No. 270 Dong-An Road, Shanghai 200032, China.
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Zeng J, Cui X, Cheng L, Chen Y, Du X, Sheng L. Micropapillary pattern of stage IIIA-N 2 lung adenocarcinoma is a prognostic factor after adjuvant chemoradiotherapy. Future Oncol 2020; 16:3075-3084. [PMID: 32869661 DOI: 10.2217/fon-2020-0597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aim: This study aims to investigate the significance of a micropapillary pattern in stage IIIA-N2 lung adenocarcinoma after adjuvant chemoradiotherapy. Patients & methods: A total of 257 patients with stage IIIA-N2 lung adenocarcinoma were enrolled in this study. Patients were classified into three groups based on the proportion of micropapillary components: micropapillary negative, micropapillary minor component and micropapillary predominant component. Results: The micropapillary predominant group had the shortest median disease-free survival and overall survival times compared with the micropapillary minor component and micropapillary negative groups (median overall survival time: 54 months vs 64 months vs not reached; p = 0.004). Furthermore, the micropapillary pattern was an independent prognostic factor for disease-free survival and overall survival (p < 0.05). Conclusion: The micropapillary pattern of IIIA-N2 lung adenocarcinoma is related to worse prognosis.
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Affiliation(s)
- Jian Zeng
- Department of Thoracic Surgery, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Institute of Cancer & Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China.,Department of Radiotherapy, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China
| | - Xiaoying Cui
- Institute of Cancer & Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China.,Department of Radiotherapy, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Key Laboratory Diagnosis & Treatment Technology on Thoracic Oncology, Zhejiang, China.,The Second Clinical Medical College, Zhejiang Chinese Medical University
| | - Lei Cheng
- Institute of Cancer & Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China.,Department of Radiotherapy, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Key Laboratory Diagnosis & Treatment Technology on Thoracic Oncology, Zhejiang, China
| | - Ying Chen
- Department of Thoracic Surgery, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Institute of Cancer & Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China.,Department of Radiotherapy, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Key Laboratory Diagnosis & Treatment Technology on Thoracic Oncology, Zhejiang, China
| | - Xianghui Du
- Institute of Cancer & Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China.,Department of Radiotherapy, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Key Laboratory Diagnosis & Treatment Technology on Thoracic Oncology, Zhejiang, China
| | - Liming Sheng
- Institute of Cancer & Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China.,Department of Radiotherapy, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Key Laboratory Diagnosis & Treatment Technology on Thoracic Oncology, Zhejiang, China
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Helminen O, Valo J, Andersen H, Söderström J, Sihvo E. Extended resections and other special cases in lung cancer surgery: Real-world population-based outcomes. Thorac Cancer 2020; 11:2932-2940. [PMID: 32871056 PMCID: PMC7529548 DOI: 10.1111/1759-7714.13638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/09/2020] [Accepted: 08/10/2020] [Indexed: 12/25/2022] Open
Abstract
Background Lung cancer invading outside a lobe centrally or peripherally, or presenting with synchronous or metachronous tumors, requires a special approach. Here, we aimed to evaluate the rate and outcomes of surgery of these patients in a medium‐volume practice using real‐world, population‐based data. Methods All patients (n = 269) on whom lung cancer surgery was performed in Central Finland and Ostrobothnia between January 2013 and December 2019 were included. A total of 40 patients with sleeve (n = 18) or other extended resections (n = 9), multifocal diseases (n = 14), and other operated synchronous cancers (n = 3) required an extended or otherwise special surgical approach (extended group). Short‐ and long‐term outcomes were compared to high‐risk (n = 72) and normal patient groups (n = 157). Results The rate of extended resection was 14.9%. The rates of PET‐CT (95%), invasive staging (35%), and brain imaging (42.5%) were highest in extended group compared to other groups. Extended group had larger and higher rate of stage III tumors than high‐risk and normal groups. All extended group patients underwent anatomic lung resection with better lymph node yield than the other two groups, with a neoadjuvant and/or adjuvant treatment rate of 70.0%. Major complications occurred in 7.5% in the extended group, 19.4% in the high‐risk group, and 6.4% in the normal group; at one year, alive and living at home rates were 88.2%, 83.3%, and 97.8%, and overall five‐year survival rates 75.6%, 62.4%, and 63.9% (P = 0.287), respectively. Conclusions After guideline‐based evaluation, a significant rate of these special cases can be resected with a low complication rate and good long‐term survival in real‐world practice. Key points Significant findings of the study Extended resections for lung cancer include tumors spreading outside the lung The rate of extended resection was 14.9% in a population‐based setting Major complications occurred in 7.5% and five‐year survival was 75.6%
What this study addsComplication rate and long‐term outcome were similar compared to normal patients Guideline‐based evaluation results with excellent outcome in real‐world practice
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Affiliation(s)
- Olli Helminen
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Johanna Valo
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Heidi Andersen
- Department of Pulmonology, Vaasa Central Hospital, Vaasa, Finland
| | - Johan Söderström
- Department of Pulmonology, Vaasa Central Hospital, Vaasa, Finland
| | - Eero Sihvo
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
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Liao Y, Yin G, Fan X. The Positive Lymph Node Ratio Predicts Survival in T 1-4N 1-3M 0 Non-Small Cell Lung Cancer: A Nomogram Using the SEER Database. Front Oncol 2020; 10:1356. [PMID: 32903785 PMCID: PMC7438846 DOI: 10.3389/fonc.2020.01356] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/29/2020] [Indexed: 12/14/2022] Open
Abstract
Background: An increasing number of studies have shown that the positive lymph node ratio (pLNR) can be used to evaluate the prognosis of non-small cell lung cancer (NSCLC) patients. To determine the predictive value of the pLNR, we collected data from the Surveillance, Epidemiology, and End Results (SEER) database and performed a retrospective analysis. Methods: We collected survival and clinical information on patients with T1-4N1-3M0 NSCLC diagnosed between 2010 and 2016 from the SEER database and screened them according to inclusion and exclusion criteria. X-tile software was used to obtain the best cut-off value for the pLNR. Then, we randomly divided patients into a training set and a validation set at a ratio of 7:3. Pearson's correlation coefficient, tolerance and the variance inflation factor (VIF) were used to detect collinearity between variables. Univariate and multivariate Cox regression analyses were used to identify significant prognostic factors, and nomograms was constructed to visualize the results. The concordance index (C-index), calibration curves, and decision curve analysis (DCA) were used to assess the predictive ability of the nomogram. We divided the patient scores into four groups according to the interquartile interval and constructed a survival curve using Kaplan-Meier analysis. Results: A total of 6,245 patients were initially enrolled. The best cut-off value for the pLNR was determined to be 0.55. The nomogram contained 13 prognostic factors, including the pLNR. The pLNR was identified as an independent prognostic factor for both overall survival (OS) and cancer-specific survival (CSS). The C-index was 0.703 (95% CI, 0.695-0.711) in the training set and 0.711 (95% CI, 0.699-0.723) in the validation set. The calibration curves and DCA also indicated the good predictability of the nomogram. Risk stratification revealed a statistically significant difference among the four groups of patients divided according to quartiles of risk score. Conclusion: The nomogram containing the pLNR can accurately predict survival in patients with T1-4N1-3M0 NSCLC.
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Affiliation(s)
- Yi Liao
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Inflammation & Allergic Diseases Research Unit, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Guofang Yin
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Inflammation & Allergic Diseases Research Unit, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xianming Fan
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Inflammation & Allergic Diseases Research Unit, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Yu Y, Zhang P, Yao R, Wang J, Wang P, Xue X, Xiao J, Wang Z. Prognostic value of log odds of positive lymph nodes in node-positive lung squamous cell carcinoma patients after surgery: a SEER population-based study. Transl Lung Cancer Res 2020; 9:1285-1301. [PMID: 32953505 PMCID: PMC7481584 DOI: 10.21037/tlcr-20-193] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Log odds of positive lymph nodes (LODDS) is a novel and promising ratio-based lymph node (LN) staging system in many malignancies. This study aimed to evaluate the prognostic value of LODDS, and comprehensively compare the prognostic predictive performance of LODDS with the American Joint Committee on Cancer (AJCC) N classification, number of positive lymph node (NPLN), and lymph node ratio (LNR) among node-positive lung squamous cell carcinoma (SCC) patients after surgery. Methods We identified 2,561 patients with N1/N2 stage SCC diagnosed between 2004 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) database. X-tile analysis was used to calculate the optimal cut-off value for each staging system. Univariable and Multivariable Cox regression analyses were used to assess the association of cancer-specific survival (CSS), and overall survival (OS) with N, NPLN, LNR, and LODDS, separately, and integrally. Moreover, linear trend χ2 score, likelihood ratio (LR) test, Akaike information criterion (AIC), and Harrell concordance index (C-index) were adopted as criteria for assessing the predictive ability of each model. Results The optimal cut-off values for NPLN, LNR, and LODDS were 3, 0.28, and −0.37, respectively. N, NPLN, LNR, and LODDS were identified as independent prognostic predictors for CSS and OS in patients with SCC when each of them was incorporated into multivariable Cox model separately. Additionally, LODDS had the higher linear trend χ2 score, higher LR χ2 test score, lower AIC, and higher C-index compared to the other three systems. Moreover, a combination of N, NPLN, and LODDS was superior to any staging system alone for predicting prognosis. Conclusions LODDS showed better predictive performance than N, NPLN, and LNR among patients with node-positive SCC after surgery. A combination of LODDS and the current AJCC TNM classification has the potential for becoming a better staging method to more precisely predicting prognosis.
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Affiliation(s)
- Yue Yu
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Peng Zhang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Renqi Yao
- Trauma Research Center, Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China.,Department of Burn Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Junnan Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China.,Medical Research Center of War Injuries and Trauma, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Pei Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Xiaofei Xue
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jian Xiao
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zhinong Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
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