1
|
Aigner C, Batirel H, Huber RM, Jones DR, Sihoe ADL, Štupnik T, Brunelli A. Resectable non-stage IV nonsmall cell lung cancer: the surgical perspective. Eur Respir Rev 2024; 33:230195. [PMID: 38508666 PMCID: PMC10951859 DOI: 10.1183/16000617.0195-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/11/2024] [Indexed: 03/22/2024] Open
Abstract
Surgery remains an essential element of the multimodality radical treatment of patients with early-stage nonsmall cell lung cancer. In addition, thoracic surgery is one of the key specialties involved in the lung cancer tumour board. The importance of the surgeon in the setting of a multidisciplinary panel is ever-increasing in light of the crucial concept of resectability, which is at the base of patient selection for neoadjuvant/adjuvant treatments within trials and in real-world practice. This review covers some of the topics which are relevant in the daily practice of a thoracic oncological surgeon and should also be known by the nonsurgical members of the tumour board. It covers the following topics: the pre-operative selection of the surgical candidate in terms of fitness in light of the ever-improving nonsurgical treatment alternatives unfit patients may benefit from; the definition of resectability, which is so important to include patients into trials and to select the most appropriate radical treatment; the impact of surgical access and surgical extension with the evolving role of minimally invasive surgery, sublobar resections and parenchymal-sparing sleeve resections to avoid pneumonectomy.
Collapse
Affiliation(s)
- Clemens Aigner
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Hasan Batirel
- Department of Thoracic Surgery, Marmara University, Istanbul, Turkey
| | - Rudolf M Huber
- Division of Respiratory Medicine and Thoracic Oncology, and Thoracic Oncology Centre Munich, Ludwig-Maximilians-Universität in Munich, Munich, Germany
| | - David R Jones
- Department of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Alan D L Sihoe
- Department of Cardio-Thoracic Surgery, CUHK Medical Centre, Hong Kong, China
| | - Tomaž Štupnik
- Department of Thoracic Surgery, Ljubljana University Medical Centre, Ljubljana, Slovenia
| | | |
Collapse
|
2
|
Gioutsos K, Hayoz YJ, Dorn P. Clinical and Oncological Outcomes after Uniportal Anatomical Segmentectomy for Stage IA Non-Small Cell Lung Cancer. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1064. [PMID: 37374269 DOI: 10.3390/medicina59061064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/24/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: The existing literature comparing sublobar and lobar resection in the treatment of stage IA lung cancer highlights the trend and overall need for further evaluation of minimally invasive, parenchymal-sparing techniques. The role of uniportal minimally invasive segmentectomy in the oncological therapy of early-stage non-small cell lung cancer (NSCLC) remains controversial. The aim of this study was to evaluate the clinical and midterm oncological outcomes of patients who underwent uniportal video-assisted anatomical segmentectomy for pathological stage IA lung cancer. Materials and Methods: We retrospectively analyzed all patients with pathological stage IA lung cancer (8th edition UICC) who underwent uniportal minimally invasive anatomical segmentectomy at our institution from January 2015 to December 2018. Results: 85 patients, 54 of whom were men, were included. The median length of hospital stay was 3 days (1.-3. IQR 3-5), whereas 30-day morbidity was 15.3% (13 patients), and the in-hospital mortality rate was 1.2% (1 patient). The 3-year overall survival rate was 87.9% for the total population. It was 90.5% in the IA1 group, 93.3% in the IA2 group, and 70.1% in the IA3 group, respectively. Conclusions: There were satisfactory short-term clinical outcomes with low 30-day morbidity and mortality and promising midterm oncological survival results following uniportal minimally invasive anatomical segmentectomy for pathological stage IA non-small cell lung cancer.
Collapse
Affiliation(s)
- Konstantinos Gioutsos
- Department of Thoracic Surgery, Inselspital, University Hospital of Bern, 3010 Bern, Switzerland
| | - Yves J Hayoz
- Department of Thoracic Surgery, Inselspital, University Hospital of Bern, 3010 Bern, Switzerland
| | - Patrick Dorn
- Department of Thoracic Surgery, Inselspital, University Hospital of Bern, 3010 Bern, Switzerland
| |
Collapse
|
3
|
Prognostic impact of artificial intelligence-based volumetric quantification of the solid part of the tumor in clinical stage 0-I adenocarcinoma. Lung Cancer 2022; 170:85-90. [PMID: 35728481 DOI: 10.1016/j.lungcan.2022.06.007] [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: 04/13/2022] [Revised: 05/30/2022] [Accepted: 06/09/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The size of the solid part of a tumor, as measured using thin-section computed tomography, can help predict disease prognosis in patients with early-stage lung cancer. Although three-dimensional volumetric analysis may be more useful than two-dimensional evaluation, measuring the solid part of some lesions is difficult using this methods. We developed an artificial intelligence-based analysis software that can distinguish the solid and non-solid parts (ground-grass opacity). This software calculates the solid part volume in a totally automated and reproducible manner. The predictive performance of the artificial intelligence software was evaluated in terms of survival or recurrence-free survival. METHODS We analyzed the high-resolution computed tomography images of the primary lesion in 772 consecutive patients with clinical stage 0-I adenocarcinoma. We performed automated measurement of the solid part volume using an artificial intelligence-based algorithm in collaboration with FUJIFILM Corporation. The solid part size, the solid part volume based on traditional three-dimensional volumetric analysis, and the solid part volume based on artificial intelligence were compared. RESULTS Higher areas under the curve related to the solid part volume were provided by the artificial intelligence-based method (0.752) than by the solid part size (0.722) and traditional three-dimensional volumetric analysis-based method (0.723). Multivariate analysis demonstrated that the solid part volume based on artificial intelligence was independently correlated with overall survival (P = 0.019) and recurrence-free survival (P < 0.001). CONCLUSION The solid part volume measured by artificial intelligence was superior to conventional methods in predicting the prognosis of clinical stage 0-I adenocarcinoma.
Collapse
|
4
|
Bade BC, Blasberg JD, Mase VJ, Kumbasar U, Li AX, Park HS, Decker RH, Madoff DC, Brandt WS, Woodard GA, Detterbeck FC. A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation-part 3: systematic review of evidence regarding surgery in compromised patients or specific tumors. J Thorac Dis 2022; 14:2387-2411. [PMID: 35813753 PMCID: PMC9264070 DOI: 10.21037/jtd-21-1825] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/09/2022] [Indexed: 11/06/2022]
Abstract
Background Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options [lobectomy, segmentectomy, wedge, stereotactic body radiotherapy (SBRT), thermal ablation], weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making. Methods A PubMed systematic review from 2000-2021 of outcomes after lobectomy, segmentectomy and wedge resection in older patients, patients with limited pulmonary reserve and favorable tumors is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons (NRCs) with adjustment for confounders. The analysis involved careful assessment, including characteristics of patients, settings, residual confounding etc. to expose degrees of uncertainty and applicability to individual patients. Evidence is summarized that provides an at-a-glance overall impression as well as the ability to delve into layers of details of the patients, settings and treatments involved. Results In older patients, perioperative mortality is minimally altered by resection extent and only slightly affected by increasing age; sublobar resection may slightly decrease morbidity. Long-term outcomes are worse after lesser resection; the difference is slightly attenuated with increasing age. Reported short-term outcomes are quite acceptable in (selected) patients with severely limited pulmonary reserve, not clearly altered by resection extent but substantially improved by a minimally invasive approach. Quality-of-life (QOL) and impact on pulmonary function hasn't been well studied, but there appears to be little difference by resection extent in older or compromised patients. Patient selection is paramount but not well defined. Ground-glass and screen-detected tumors exhibit favorable long-term outcomes regardless of resection extent; however solid tumors <1 cm are not a reliably favorable group. Conclusions A systematic, comprehensive summary of evidence regarding resection extent in compromised patients and favorable tumors with attention to aspects of applicability, uncertainty and effect modifiers provides a foundation for a framework for individualized decision-making.
Collapse
Affiliation(s)
- Brett C. Bade
- Department of Pulmonary Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Justin D. Blasberg
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Vincent J. Mase
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Ulas Kumbasar
- Department of Thoracic Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Andrew X. Li
- Department of General Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Henry S. Park
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Roy H. Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - David C. Madoff
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Whitney S. Brandt
- Department of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Gavitt A. Woodard
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Frank C. Detterbeck
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
5
|
Abstract
The increasing use of low-dose CT for screening for lung cancer will inevitably identify many small, asymptomatic lung nodules and ground-glass opacities (GGOs). Current guidelines for the management of screening-detected lesions tend to advise a conservative approach based on serial imaging and intervention only if ‘suspicious’ features emerge. However, more recent developments in thoracic surgery and in the understanding of the screening-detected lesions themselves prompt some pertinent questions over this conservatism. Is CT surveillance sufficiently reliable to exclude malignancy? Is it really necessary to hold back on operative biopsy and resection given modern surgical safety and efficacy? Is the option for early surgical therapy a viable one—especially with the availability of sublobar resection today? Modern data suggests that the risk of inaction for some screening-detected lesions may be higher than expected, whereas the potential harm of surgical intervention may be substantially reduced by sublobar resection and the latest minimally invasive surgical techniques. A more pro-active approach towards offering surgery for screening-detected lesions should now be considered.
Collapse
Affiliation(s)
- Alan D L Sihoe
- Gleneagles Hong Kong Hospital, Hong Kong, China.,International Medical Centre, Hong Kong, China
| |
Collapse
|
6
|
Kawaguchi Y, Nakao M, Omura K, Iwamoto N, Ozawa H, Kondo Y, Ichinose J, Matsuura Y, Okumura S, Mun M. The utility of three-dimensional computed tomography for prediction of tumor invasiveness in clinical stage IA lung adenocarcinoma. J Thorac Dis 2021; 12:7218-7226. [PMID: 33447410 PMCID: PMC7797862 DOI: 10.21037/jtd-20-2131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background It is critical to have an accurate measurement of solid tumor size in order to predict the invasiveness of small lung adenocarcinomas. Some lesions cannot be measured accurately via High-resolution computed tomography (HRCT) due to their irregular shape and unclear borders. For this reason, we evaluated the relative efficacy of three-dimensional (3D) CT for predicting invasive adenocarcinoma. Methods We evaluated 195 patients with clinical stage IA adenocarcinomas, including 109 with lesions documented as invasive that were surgically resected at our institute during 2017. All lesions were categorized as either (I) lesions that were difficult to evaluate (i.e., hazy lesions; HL) or (II) more typical lesions (TL). The relationships between solid tumor size as determined by HRCT, solid tumor volume as determined by 3D CT and pathologic diagnosis were evaluated. Results Fifty-seven patients (29%) were diagnosed with HL. We set the cut-off value for the solid volume at 225 mm3 as predictive for invasive adenocarcinoma. When evaluating all 195 patients as a group, the accuracy, sensitivity, and specificity based on the solid tumor volume were similar to those based on the solid tumor size. When we limit our analysis to the HL group, the specificity based on solid tumor volume (65.5%) was higher than that based on solid tumor size (44.8%) with a difference that approached statistical significance (P=0.070). Conclusions 3D CT was equivalent to HRCT for predicting invasive adenocarcinoma and may be particularly useful for diagnosing lesions that are difficult to evaluate on HRCT.
Collapse
Affiliation(s)
- Yohei Kawaguchi
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masayuki Nakao
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kenshiro Omura
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Naoya Iwamoto
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiroki Ozawa
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yasuto Kondo
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junji Ichinose
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yosuke Matsuura
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Sakae Okumura
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Mingyon Mun
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| |
Collapse
|
7
|
Sihoe ADL. Video-assisted thoracoscopic surgery as the gold standard for lung cancer surgery. Respirology 2020; 25 Suppl 2:49-60. [PMID: 32734596 DOI: 10.1111/resp.13920] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/20/2020] [Accepted: 07/07/2020] [Indexed: 12/25/2022]
Abstract
Surgical resection remains the only effective means of cure in the vast majority of patients with early-stage lung cancer. It can be performed via a traditional open approach (particularly thoracotomy) or a minimally invasive approach. VATS is 'keyhole' surgery in the chest, and was first used for lung cancer resection in the early 1990s. Since then, a large volume of evolving clinical evidence has confirmed that VATS lung cancer resection offered proven safety and feasibility, better patient-reported post-operative outcomes, less surgical trauma as quantified by objective outcome measures and equivalent or better survival than open surgery. This has firmly established VATS as the surgical approach of choice for early-stage lung cancer today. Although impressive new non-surgical lung cancer therapies have emerged in recent years, VATS is also being constantly rejuvenated by the development of 'next generation' VATS techniques, the refinement of VATS sublobar resection for selected patients, the utilization of bespoke post-operative recovery programmes for VATS and the synthesis of VATS into multi-modality lung cancer therapy. There is little doubt that VATS will remain as the gold standard for lung cancer surgery for the foreseeable future.
Collapse
Affiliation(s)
- Alan D L Sihoe
- Gleneagles Hong Kong Hospital, Hong Kong SAR, China.,International Medical Centre, Hong Kong SAR, China
| |
Collapse
|
8
|
Divisi D, De Vico A, Zaccagna G, Crisci R. Lobectomy versus sublobar resection in patients with non-small cell lung cancer: a systematic review. J Thorac Dis 2020; 12:3357-3362. [PMID: 32642260 PMCID: PMC7330740 DOI: 10.21037/jtd.2020.02.54] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Surgery is the gold standard treatment of lung cancer. The minimally invasive technique does not only concern access to the chest but also the limits of parenchymal resection. The study debates on the safety and oncological adequacy of sublobar resections in bronchogenic carcinoma patients. A systematic analysis of the data in the literature was carried out, comparing the outcomes of patients with resectable non-small lung cancer (NSCLC) who underwent lobectomy or sublobar resection. These last interventions include both segmentectomies and wedge resections taking into consideration the following parameters: complications, relapse rate and overall survival. The complication rate is higher in patients underwent lobectomy compared to sublobar resection, especially in presence of high comorbidity index or octogenarian patients (overall values respectively between 0 and 48% and 0 and 46.6%). Contrarily, the relapse rate (6.2% to 32% vs. 3.6% to 53.4%) and overall survival (50.2% to 93.8% vs. 38.6% to 100%) are more favorable in patients undergoing lobectomy. Sublobar resections are particularly indicated in elderly patients and in patients with high comorbidity index or reduced respiratory functional reserve. However, pulmonary lobectomy still remains the safest and oncologically correct method in patients with good performance status or higher risk of recurrence.
Collapse
Affiliation(s)
- Duilio Divisi
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital of Teramo, Teramo, Italy
| | - Andrea De Vico
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital of Teramo, Teramo, Italy
| | - Gino Zaccagna
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital of Teramo, Teramo, Italy
| | - Roberto Crisci
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital of Teramo, Teramo, Italy
| |
Collapse
|
9
|
Ijsseldijk MA, Shoni M, Siegert C, Wiering B, van Engelenburg AKC, Tsai TC, Ten Broek RPG, Lebenthal A. Oncologic Outcomes of Surgery Versus SBRT for Non-Small-Cell Lung Carcinoma: A Systematic Review and Meta-analysis. Clin Lung Cancer 2020; 22:e235-e292. [PMID: 32912754 DOI: 10.1016/j.cllc.2020.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/21/2020] [Accepted: 04/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The optimal treatment of stage I non-small-cell lung carcinoma is subject to debate. The aim of this study was to compare overall survival and oncologic outcomes of lobar resection (LR), sublobar resection (SR), and stereotactic body radiotherapy (SBRT). METHODS A systematic review and meta-analysis of oncologic outcomes of propensity matched comparative and noncomparative cohort studies was performed. Outcomes of interest were overall survival and disease-free survival. The inverse variance method and the random-effects method for meta-analysis were utilized to assess the pooled estimates. RESULTS A total of 100 studies with patients treated for clinical stage I non-small-cell lung carcinoma were included. Long-term overall and disease-free survival after LR was superior over SBRT in all comparisons, and for most comparisons, SR was superior to SBRT. Noncomparative studies showed superior long-term overall and disease-free survival for both LR and SR over SBRT. Although the papers were heterogeneous and of low quality, results remained essentially the same throughout a large number of stratifications and sensitivity analyses. CONCLUSION Results of this systematic review and meta-analysis showed that LR has superior outcomes compared to SBRT for cI non-small-cell lung carcinoma. New trials are underway evaluating long-term results of SBRT in potentially operable patients.
Collapse
Affiliation(s)
- Michiel A Ijsseldijk
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Melina Shoni
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Charles Siegert
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA
| | - Bastiaan Wiering
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands
| | | | - Thomas C Tsai
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Richard P G Ten Broek
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Abraham Lebenthal
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA; Harvard Medical School, Boston, MA
| |
Collapse
|
10
|
Sihoe AD. Surgical management of ground glass opacities of the lung. SURGICAL PRACTICE 2020. [DOI: 10.1111/1744-1633.12408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Alan D.L. Sihoe
- School of Biomedical SciencesThe University of Hong Kong Hong Kong SAR China
- Gleneagles Hong Kong Hospital Hong Kong SAR China
| |
Collapse
|
11
|
Shimada Y, Furumoto H, Imai K, Masuno R, Matsubayashi J, Kajiwara N, Ohira T, Ikeda N. Prognostic value of tumor solid-part size and solid-part volume in patients with clinical stage I non-small cell lung cancer. J Thorac Dis 2018; 10:6491-6500. [PMID: 30746193 DOI: 10.21037/jtd.2018.11.08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background This study aimed to predict the malignant potential of clinical stage I non-small cell lung cancer (c-I NSCLC) by semiautomatic three-dimensional (3D) volumetric measurement of a tumor (3D-data) and the axial computed tomography (CT) data derived from a 3D volumetric dataset (2D-data). The predictive performance was evaluated in terms of overall survival (OS), disease-free survival (DFS), and pathological invasive factors (positive lymphatic invasion, blood vessel invasion, pleural invasion, or lymph node metastasis). Methods We identified 252 patients (122 male; mean age, 68 years; range, 23-84 years) with c-I NSCLC who underwent high resolution CT and reconstruction of 3D imaging, followed by complete resection between January 2012 and December 2015. In this study, 2D-data including whole tumor size (WTS) and solid-part size (SPS) and 3D-data including whole tumor volume (WTV) and solid-part volume (SPV) acquired by a 3D volume rendering software were analyzed. Results The area under the receiver operating characteristic (ROC) curve for WTS, SPS, WTV, SPV relevant to recurrence was 0.667, 0.727, 0.654, and 0.751 while analyses of ROC curves revealed optimal WTS, SPS, WTV, and SPV cut-off values to predict recurrence of 2.48 cm, 2.03 cm, 3,258 mm3 and 1,889 mm3, respectively. The association between SPS and SPV was the coefficient of determination (R 2) =0.59. Multivariate analysis showed that SPV >1,889 mm3 (P=0.016) and male (P=0.041) were significant predictors of OS whereas SPV >1,889 mm3 (P=0.001), male (P=0.003), and the serum carcinoembryonic antigen value (P=0.041) were significantly correlated with DFS. SPS, SPV as well as the combination of SPS and SPV were all significantly correlated with the prediction of OS and DFS, and the incidence of pathological invasive factors. Conclusions SPV and the integrated use of SPS and SPV was highly beneficial for the prediction of postoperative prognosis in c-I NSCLC.
Collapse
Affiliation(s)
- Yoshihisa Shimada
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hideyuki Furumoto
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kentaro Imai
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Ryuhei Masuno
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Jun Matsubayashi
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Naohiro Kajiwara
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Tatsuo Ohira
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Norihiko Ikeda
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| |
Collapse
|
12
|
Furumoto H, Shimada Y, Imai K, Maehara S, Maeda J, Hagiwara M, Okano T, Masuno R, Kakihana M, Kajiwara N, Ohira T, Ikeda N. Prognostic impact of the integration of volumetric quantification of the solid part of the tumor on 3DCT and FDG-PET imaging in clinical stage IA adenocarcinoma of the lung. Lung Cancer 2018; 121:91-96. [DOI: 10.1016/j.lungcan.2018.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 02/11/2018] [Accepted: 05/03/2018] [Indexed: 12/25/2022]
|
13
|
Hattori A, Matsunaga T, Takamochi K, Oh S, Suzuki K. Locoregional recurrence after segmentectomy for clinical-T1aN0M0 radiologically solid non-small-cell lung carcinoma. Eur J Cardiothorac Surg 2017; 51:518-525. [PMID: 28082475 DOI: 10.1093/ejcts/ezw336] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/12/2016] [Indexed: 01/28/2023] Open
Abstract
Objectives We aimed to identify the clinicopathological features of loco-regional recurrence after segmentectomy for clinical-T1aN0M0 radiologically invasive non-small-cell lung carcinoma (NSCLC). Methods Between 2008 and 2014, 353 patients underwent pulmonary lobectomy or segmentectomy with nodal dissection for clinical-T1aN0M0 radiologically invasive NSCLC showing 0.5 ≤ consolidation tumour ratio (CTR)≤1.0 on thin-section computed tomography (CT). Radiological invasive NSCLC was divided into two groups, i.e. part-solid (0.5 ≤ CTR < 1.0) and pure-solid (CTR = 1.0). Significant prognostic factors for oncological outcomes were evaluated by multivariate analysis. Results Lobectomy was performed in 270 (76.5%) patients and segmentectomy in 83 (23.5%). Locoregional recurrence-free survival (LRFS) of clinical-T1a radiologically invasive NSCLC on the whole showed no significant differences between the lobectomy and segmentectomy arms (3-year LRFS, 93.0 vs 90.1%, P = 0.2725). In contrast, the multivariate analysis revealed that radiologically pure-solid appearance and tumour size were significant predictors of loco-regional recurrence ( P = 0.0106, 0.0408). Among 212 clinical-T1a radiologically pure-solid NSCLCs, frequency of loco-regional recurrence was high in the segmentectomy arm (20.7%) compared with that of lobectomy arm (8.2%). Furthermore, segmentectomy and larger tumour size were independent significant clinical factors of loco-regional recurrence based on the multivariate analysis ( P = 0.0292, 0.0402). The 3-year LRFS of the segmentectomy arm was significantly worse than that of the lobectomy arm in the c-T1a disease (82.2 vs 90.6%, P = 0.0488) provided the tumour showed a pure-solid appearance. Conclusions Even in cases of small-sized lung carcinoma, segmentectomy should be applied with great caution especially for a radiological pure-solid NSCLC on thin-section CT due to their high incidence of loco-regional recurrence.
Collapse
Affiliation(s)
- Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takeshi Matsunaga
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shiaki Oh
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| |
Collapse
|
14
|
Tsunezuka H, Kato D, Okada S, Furuya T, Shimada J, Inoue M. Surgical outcome of wide wedge resection in poor-risk patients with clinical-N0 non-small cell lung cancer. Gen Thorac Cardiovasc Surg 2017; 65:581-586. [PMID: 28748318 DOI: 10.1007/s11748-017-0803-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/18/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Sublobar resection is practically indicated in poor-risk patients compromised cardiopulmonary reserve or for small ground-glass opacity-dominant adenocarcinomas. The aim of this study was to clarify the surgical outcomes of wide wedge resection in poor-risk patients with clinical-N0 non-small cell lung cancers. METHODS Sixty-two poor-risk patients, who underwent wedge resection for clinical-N0 lung cancer, were retrospectively reviewed. We defined the ratio of the maximum diameter of the consolidation to the maximum tumour diameter as the consolidation-to-tumour ratio using high-resolution computed tomography. RESULTS The 5-year overall, recurrence-free, and lung cancer specific survivals of all patients were 56.4, 46.6, and 81.1%, respectively, while other malignancies were frequently found as causes of death. Overall and recurrence-free survivals were favourable in patients with tumour size ≤3 cm, consolidation-to-tumour ratio ≤0.50, solid tumour size ≤1.2 cm, carcinoembryonic antigen level <5.0 ng/mL and adenocarcinoma. Multivariate Cox proportional hazard model revealed that solid tumour size ≤1.2 cm and consolidation-to-tumour ratio ≤0.50 were independent prognostic factors. CT-guided lipiodol marking was applied in 20 patients to identify the tumour location had no recurrence. CONCLUSIONS Wide wedge resection could be radical treatment option in poor-risk patients with clinical-N0 non-small cell lung cancer, though careful follow-up might be necessary for other malignancies. Patients with solid tumour ≤1.2 cm or ground-glass-dominant lesion are good candidates for wedge resection. CT-guided lipiodol marking is a useful option to identify the location and safe surgical tumour margin in wedge resection.
Collapse
Affiliation(s)
- Hiroaki Tsunezuka
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Daishiro Kato
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Satoru Okada
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tatsuo Furuya
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Junichi Shimada
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Masayoshi Inoue
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| |
Collapse
|
15
|
Hattori A, Matsunaga T, Takamochi K, Oh S, Suzuki K. Surgical resection for clinical-Stage I radiological pure-solid lung cancer that met the current high risk criteria. Jpn J Clin Oncol 2017; 47:630-638. [PMID: 28419333 DOI: 10.1093/jjco/hyx054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 04/03/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takeshi Matsunaga
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shiaki Oh
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| |
Collapse
|