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Campisi A, Catelli C, Gabryel P, Giovannetti R, Dell'Amore A, Kasprzyk M, Piwkowski C, Infante M. Upfront surgery for N2 NSCLC: a large retrospective multicenter cohort study. Gen Thorac Cardiovasc Surg 2023; 71:715-722. [PMID: 37179506 DOI: 10.1007/s11748-023-01942-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND The optimal sequence and combination of surgery, chemotherapy and radiotherapy in patients with N2 non-small cell lung cancer (NSCLC) remain undefined. The aim of our study was to compare two treatment options for N2 NSCLC-induction therapy with subsequent surgery versus upfront surgery with adjuvant treatment. METHODS We retrospectively reviewed 405 patients with N2 disease in two centers, between January 2010 and December 2016. They were divided into two groups: the Induction Group, composed of patients who received neoadjuvant chemotherapy, and the Upfront surgery Group, composed of patients who underwent surgery as first-line therapy. Propensity score-matched (PSM) analysis was performed, and 52 patients were included in each group. Primary endpoints were: recurrence, overall survival (OS) and disease-free survival (DFS). RESULTS After the PSM, no differences were observed in general characteristics, perioperative results, rates and severity of complications, and histopathology results. Seventeen patients (32.7%) of the induction group and 21 (40.4%) of the upfront surgery group had mediastinal lymph nodal involvement with skipping (p = 0.415). Recurrence rate was not different between the two groups (57.7% vs 50.0%, p = 0.478). No differences were observed in terms of OS (40.98 ± 35.78 vs 37.0 ± 40.69 months, p = 0.246) and DFS (29.67 ± 36.01 vs 27.96 ± 40.08 months, p = 0.697). The multivariable analysis identified the pT stage and skipping lymph node metastasis as independent predictive factors for OS. CONCLUSIONS Upfront surgery followed by adjuvant therapy does not appear inferior in terms of recurrence, OS and DFS, compared to induction chemotherapy with subsequent surgery.
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Affiliation(s)
- Alessio Campisi
- Thoracic Surgery Department, University and Hospital Trust-Borgo Trento, P.Le A. Stefani, 1-37126, Verona, Italy.
| | - Chiara Catelli
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery and Vascular Sciences, Padua University Hospital, University of Padua, Via Giustiniani 1, Padua, PD, Italy
| | - Piotr Gabryel
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Riccardo Giovannetti
- Thoracic Surgery Department, University and Hospital Trust-Borgo Trento, P.Le A. Stefani, 1-37126, Verona, Italy
| | - Andrea Dell'Amore
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery and Vascular Sciences, Padua University Hospital, University of Padua, Via Giustiniani 1, Padua, PD, Italy
| | - Mariusz Kasprzyk
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Cezary Piwkowski
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Maurizio Infante
- Thoracic Surgery Department, University and Hospital Trust-Borgo Trento, P.Le A. Stefani, 1-37126, Verona, Italy
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Süer H, Erus S, Cesur EE, Yavuz Ö, Ağcaoğlu O, Bulutay P, Önder TT, Tanju S, Dilege Ş. Combination of CEACAM5, EpCAM and CK19 gene expressions in mediastinal lymph node micrometastasis is a prognostic factor for non-small cell lung cancer. J Cardiothorac Surg 2023; 18:189. [PMID: 37312199 DOI: 10.1186/s13019-023-02297-z] [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: 03/07/2022] [Accepted: 05/27/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Lung cancer is known as the most common and highly metastatic form of cancer worldwide. Tumour node metastasis (TNM) staging is the gold standard classification system for the decision-making process for appropriate treatment. Particularly N status has the most important prognostic value in the absence of distant metastasis. Traditional diagnostic methods are capable of detecting metastasis; however, they may fail to detect micrometastasis, which plays a role in disease recurrence and patients' long-term survival. Occult micrometastasis can change the tumour's TNM staging and, consequently, the patient's treatment regimen. METHODS The median number of three lymph node tissues were collected from 30 patients who underwent surgery for non-small cell lung cancer. Lymph node tissues were collected from different lymph node stations according to the location of the patient's tumour. CK19, EpCAM and CEACAM5 gene expressions were analysed in tissues using quantitative real-time polymerase chain reaction to detect micrometastasis in distant lymph nodes. RESULTS Triple positivity was seen in 26 out of 30 patients which 19 patients were upstaged from N0 to N2. While survival was not significantly affected between upstaged and non-upstaged patients, patients upstaged with multiple-station N2 had a significantly higher recurrence and lower survival compared to single-station N2. CONCLUSION A combination of CK19, EpCAM and CEACAM5 gene expressions in lymph nodes can be used to identify micrometastasis which postoperatively may be used as a tool to predict patients' recurrence and survival.
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Affiliation(s)
- Hande Süer
- Graduate School of Health Sciences, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey.
| | - Suat Erus
- Thoracic Surgery Department, Koç University School of Medicine, Istanbul, Turkey
| | - Ekin E Cesur
- Thoracic Surgery Department, Vehbi Koç Foundation American Hospital, Istanbul, Turkey
| | - Ömer Yavuz
- Thoracic Surgery Department, Koç University School of Medicine, Istanbul, Turkey
| | - Orhan Ağcaoğlu
- General Surgery Department, Koç University School of Medicine, Istanbul, Turkey
| | - Pınar Bulutay
- Pathology Department, Koç University School of Medicine, Istanbul, Turkey
| | | | - Serhan Tanju
- Thoracic Surgery Department, Koç University School of Medicine, Istanbul, Turkey
| | - Şükrü Dilege
- Thoracic Surgery Department, Koç University School of Medicine, Istanbul, Turkey
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Thoracoscopic Surgery Shows Non-Inferiority to Open Surgery for Clinical N0-N2 and Pathologic N2 Non-Small Cell Lung Cancer. Int Surg 2021. [DOI: 10.9738/intsurg-d-16-00164.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives
Controversy has remained over the primary surgical management for stage IIIA-N2 non–small cell lung cancer. Minimal or non-bulky N2 disease defined as single-station nodal involvement may still be a candidate of radical surgery. The aim of this study was thus to assess the outcome of thoracoscopic surgery in clinical N0-N2 and pathologic N2 disease.
Methods
Seventy-nine cases of pathologic N2 diseases without induction therapy (clinical N0, 27; N1, 13; N2, 39) were operated on between September 2003 and December 2010 in our institute. Forty-seven patients underwent thoracoscopic surgery (group T) and 32 patients underwent standard thoracotomy (group S). Perioperative and oncologic outcomes were compared between the 2 groups.
Results
There were no significant differences between the 2 groups regarding dissected number of lymph nodes, operative time, morbidity, and mortality. However, blood loss in group T was less than in group S (Mean: T, 229 versus S, 534 mL, respectively; P = 0.0004). Although disease-free survival in group T did not differ from that in group S, overall survival in group T was better than in group S after propensity score matching to adjust confounding factors including tumor size and T factor (P = 0.03). Multivariate analysis showed that multinodal stations was significantly worse prognostic factor [hazard ratio (HR) = 4.79; 95% confidence interval (CI) = (1.6–14.3); P = 0.005) in disease-free and overall survivals [HR = 8.21; 95% CI = (1.9–35.4); P = 0.005]. Thoracoscopic surgery was favorable prognostic factor in overall survivals [HR = 0.13; 95% CI = (0.03–0.6); P = 0.009].
Conclusions
Our study demonstrated that thoracoscopic surgery for non-bulky N2 disease was feasible and not inferior to standard thoracotomy in terms of oncologic outcome.
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Seyrek Y, Cansever L, Akın H, Metin M, Bolat E, Bedirhan MA. The Significance of Skip Mediastinal Lymph Node Metastasis in the Prognosis of Patients with Resected Non-Small-Cell Lung Carcinoma: Is It Really a Better N2 Disease Subtype? Ann Thorac Cardiovasc Surg 2021; 27:304-310. [PMID: 33790147 PMCID: PMC8560541 DOI: 10.5761/atcs.oa.20-00289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: In this study, we aimed to reveal the prognostic differences between skip and non-skip metastasis mediastinal lymph node (MLN) metastasis. Methods: A total of 202 patients (179 males and 23 females; mean age, 59.66 ± 9.89 years; range: 29–84 years) who had ipsilateral single-station MLN metastasis were analyzed in two groups retrospectively between January 2009 and December 2017: “skip ipsilateral MLN metastasis” group (sN2) (n = 55,27.3%) [N1(–), N2(+)], “non-skip ipsilateral MLN metastasis” group (nsN2) (n = 147,72.7%) [N1(+), N2(+)]. Results: The mean follow-up was 42.63 ± 34.91 months (range: 2–117 months). Among all patients, and in the sN2 and nsN2 groups, the median overall survival times were 63.5 ± 4.56, 68.8 ± 7, and 59.3 ± 5.35 months, respectively, and the 5-year overall survival rates were 38.2%, 46.3%, and 36.4%. Conclusion: Skip metastasis did not take its rightful place in TNM classification; thus, further studies will be performed. To detect micrometastasis, future studies on skip metastasis should examine non-metastatic hilar lymph nodes (LNs) through staining methods so that heterogeneity in patient groups can be avoided, that is, to ensure that only true skip metastasis cases are included. Afterwards, more accurate and elucidative studies on skip metastasis can be achieved to propound its prognostic importance in the group of N2 disease.
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Affiliation(s)
- Yunus Seyrek
- Department of Thoracic Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Center, Istanbul, Turkey
| | - Levent Cansever
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Health Application and Research Center, Health Sciences University, Istanbul, Turkey
| | - Hasan Akın
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Health Application and Research Center, Health Sciences University, Istanbul, Turkey
| | - Muzaffer Metin
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Health Application and Research Center, Health Sciences University, Istanbul, Turkey
| | - Erkut Bolat
- Department of Biostatistics and Medical Informatics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Ali Bedirhan
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Health Application and Research Center, Health Sciences University, Istanbul, Turkey
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Brascia D, De Iaco G, Schiavone M, Panza T, Signore F, Geronimo A, Sampietro D, Montrone M, Galetta D, Marulli G. Resectable IIIA-N2 Non-Small-Cell Lung Cancer (NSCLC): In Search for the Proper Treatment. Cancers (Basel) 2020; 12:cancers12082050. [PMID: 32722386 PMCID: PMC7465235 DOI: 10.3390/cancers12082050] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/18/2020] [Accepted: 07/21/2020] [Indexed: 12/25/2022] Open
Abstract
Locally advanced non-small cell lung cancer accounts for one third of non-small cell lung cancer (NSCLC) at the time of initial diagnosis and presents with a wide range of clinical and pathological heterogeneity. To date, the combined multimodality approach involving both local and systemic control is the gold standard for these patients, since occult distant micrometastatic disease should always be suspected. With the rapid increase in treatment options, the need for an interdisciplinary discussion involving oncologists, surgeons, radiation oncologists and radiologists has become essential. Surgery should be recommended to patients with non-bulky, discrete, or single-level N2 involvement and be included in the multimodality treatment. Resectable stage IIIA patients have been the subject of a number of clinical trials and retrospective analysis, discussing the efficiency and survival benefits on patients treated with the available therapeutic approaches. However, most of them have some limitations due to their retrospective nature, lack of exact pretreatment staging, and the involvement of heterogeneous populations leading to the awareness that each patient should undergo a tailored therapy in light of the nature of his tumor, its extension and his performance status.
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Affiliation(s)
- Debora Brascia
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Giulia De Iaco
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Marcella Schiavone
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Teodora Panza
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Francesca Signore
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Alessandro Geronimo
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Doroty Sampietro
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Michele Montrone
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70121 Bari, Italy; (M.M.); (D.G.)
| | - Domenico Galetta
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70121 Bari, Italy; (M.M.); (D.G.)
| | - Giuseppe Marulli
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
- Correspondence: or
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Bryan DS, Donington JS. The Role of Surgery in Management of Locally Advanced Non-Small Cell Lung Cancer. Curr Treat Options Oncol 2019; 20:27. [DOI: 10.1007/s11864-019-0624-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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7
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Minkov P, Gulubova M, Chilingirov P, Ananiev J. The Position of Neutrophils-To-Lymphocytes and Lymphocytes-To-Platelets Ratio as Predictive Markers of Progression and Prognosis in Patients with Non-Small Cell Lung Cancer. Open Access Maced J Med Sci 2018; 6:1382-1386. [PMID: 30159061 PMCID: PMC6108783 DOI: 10.3889/oamjms.2018.210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 06/15/2018] [Accepted: 06/18/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) is an insidious metastasis condition of the lungs often presenting no symptoms at the onset. Defining markers for quick determination of prognosis is essential for building up a treatment strategy. AIM The aim of this study is to define the role of the Neutrophils-to-Lymphocytes ratio (NLR) and Platelets-to- Lymphocytes ratio (PLR) as biomarkers in patients with NSCLC, according to the stage and prognosis of the disease. METHODS We investigated 20 patients with NSCLC. NLR and PLR are calculated and are evaluated according to the presence or absence of metastasis, stage of the disease, histological type and survival rate. RESULTS We found that thirteen of the patients had low NLR, while the rest 7 had high NLR (mean 3.15). By analysing PLR we found that 11 patients have low and 9 have high level of PLR (mean 1.42). After the correlations have been made we discovered that in 90.1% of the patients with low PLR no lymph metastasises were detected, while in 50% of the patients with high PLR lymph metastasises were observed (χ2 = 3.99; P = 0.046). We also discovered that in 84.6% of the patients with low NLR lymph metastases were absent, while in 42.9% with high NLR lymph metastasises were present (χ 2 = 1.83; P = 0.176). CONCLUSION In conclusion, NLR and PLR were discovered as prominent biomarkers which provide relatively fast determination for prognosis in patients with NSCLC.
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Affiliation(s)
| | - Maya Gulubova
- Department of General and Clinical Pathology, Forensic Medicine and Deontology, Trakia University, Stara Zagora, Bulgaria
| | | | - Julian Ananiev
- Department of General and Clinical Pathology, Forensic Medicine and Deontology, Trakia University, Stara Zagora, Bulgaria
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8
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Affiliation(s)
- Gaetano Rocco
- Division of Thoracic Surgery, Thoracic Department, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy.
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9
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Mutational Diversity of Lung Cancer and Associated Lymph Nodes. An Exploratory Prospective Study of 4 Resected cIIIA-N2. Pathol Oncol Res 2017; 25:319-325. [PMID: 29110262 DOI: 10.1007/s12253-017-0352-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/25/2017] [Indexed: 01/08/2023]
Abstract
Mutational heterogeneity could explain different metastatic patterns among IIIA-N2 lung cancer and influence prognosis. The identification of subclonal mutations using deep sequencing to evaluate the degree of molecular heterogeneity may improve IIIA-N2 classification. The aim of this prospective study was to assess mutational and immunohistochemical characteristics in primary tumours and involved lymph nodes (LN) in operated patients. Four patients operated for primary lung carcinoma and unisite N2 mediastinal involvement were consecutively selected. Samples (tumour and paired LN) were analysed for PD1, PD-L1 and CD8 immunostaining. Somatic mutation testing was performed by deep targeted next generation sequencing (NGS), with the AmpliSeq™ Colon and Lung Cancer Panel (LifeTechnology). A total of 9 primary lung cancer samples and 10 LN stations were analysed. For each cancer, we found 2 mutations, with allelic ratios from 3% to 72%. Mutational patterns were heterogeneous for 2 primary tumours. In 3 cases, mutations observed in the primary tumour were not found in LN metastases (ALK, FGFR3, MET). Inversely, in 1 case, a KRAS mutation was found in LN but not in the primary tumour. All primary tumours were found PD-L1 positive while CD8+ T cells infiltrate varied. In the different examined LN samples, PD-L1 expression, CD8+ and PD1+ T cells infiltrate were not similar to the primary tumour. This preliminary prospective study shows the diversity of intra-tumour and LN mutations using routinely-used targeted NGS, concerning both mutated gene and allelic ratio. Further studies are needed to evaluate its prognostic impact.
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10
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Yamauchi Y, Safi S, Muley T, Warth A, Herth FJF, Dienemann H, Hoffmann H, Eichhorn ME. C-reactive protein-albumin ratio is an independent prognostic predictor of tumor recurrence in stage IIIA-N2 lung adenocarcinoma patients. Lung Cancer 2017; 114:62-67. [PMID: 29173768 DOI: 10.1016/j.lungcan.2017.11.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/29/2017] [Accepted: 11/02/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To systematically evaluate the prognostic value of nutrition/inflammation-based markers for recurrence-free survival (RFS) in pN2-stage IIIA lung adenocarcinoma patients. MATERIALS AND METHODS Data from 156 patients who had pathologically confirmed pN2-stage IIIA primary lung adenocarcinoma and received complete surgical resection from 2010 to 2014 were retrospectively analyzed. The data for Glasgow prognostic score (GPS), modified GPS (mGPS), high-sensitivity mGPS, C-reactive protein/albumin ratio (CAR), neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and prognostic nutritional index were analyzed. Univariate and multivariate Cox proportional-hazards regression analyses were used to identify the prognostic factors associated with RFS. RESULTS The optimal cutoff value for the CAR was set at 0.6. A significant correlation was found between the CAR and RFS (P=0.001) by univariate analysis. Multivariate analysis between RFS and the factors selected from univariate analysis showed that ECOG performance status, pneumonectomy, multi-level N2, and high CAR were independent predictors of RFS. CONCLUSION The CAR was the best prognostic marker to predict tumor recurrence in pN2-stage IIIA lung adenocarcinoma patients among the 7 nutrition/inflammation-based markers. The preoperative CAR may identify patients with a high risk of postoperative tumor recurrence.
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Affiliation(s)
- Yoshikane Yamauchi
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, Heidelberg, Germany; Translational Lung Research Center (TLRC), Heidelberg, Member of German Center for Lung Research (DZL), Germany
| | - Seyer Safi
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, Heidelberg, Germany; Translational Lung Research Center (TLRC), Heidelberg, Member of German Center for Lung Research (DZL), Germany
| | - Thomas Muley
- Section translational research (STF), Thoraxklinik, Heidelberg University, Germany; Translational Lung Research Center (TLRC), Heidelberg, Member of German Center for Lung Research (DZL), Germany
| | - Arne Warth
- Institute of Pathology, Heidelberg University, Heidelberg, Germany; Translational Lung Research Center (TLRC), Heidelberg, Member of German Center for Lung Research (DZL), Germany
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, Heidelberg University, Heidelberg, Germany; Translational Lung Research Center (TLRC), Heidelberg, Member of German Center for Lung Research (DZL), Germany
| | - Hendrik Dienemann
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, Heidelberg, Germany; Translational Lung Research Center (TLRC), Heidelberg, Member of German Center for Lung Research (DZL), Germany
| | - Hans Hoffmann
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, Heidelberg, Germany; Translational Lung Research Center (TLRC), Heidelberg, Member of German Center for Lung Research (DZL), Germany
| | - Martin E Eichhorn
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, Heidelberg, Germany; Translational Lung Research Center (TLRC), Heidelberg, Member of German Center for Lung Research (DZL), Germany.
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Riquet M, Pricopi C, Mangiameli G, Arame A, Badia A, Le Pimpec Barthes F. Occult pN2 disease in lung cancer patients: a wide range of diseases endangering the long term prognosis. J Thorac Dis 2017; 9:2271-2275. [PMID: 28932522 DOI: 10.21037/jtd.2017.07.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Marc Riquet
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris, France
| | - Ciprian Pricopi
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris, France
| | - Giuseppe Mangiameli
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris, France
| | - Alex Arame
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris, France
| | - Alain Badia
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris, France
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Akinci Ozyurek B, Sahin Ozdemirel T, Buyukyaylaci Ozden S, Erdogan Y, Kaplan B, Kaplan T. Prognostic Value of the Neutrophil to Lymphocyte Ratio (NLR)
in Lung Cancer Cases. Asian Pac J Cancer Prev 2017; 18:1417-1421. [PMID: 28612596 PMCID: PMC5555556 DOI: 10.22034/apjcp.2017.18.5.1417] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Haemogram assessment is a cheap and easy method which can be readily performed for almost all patients. Leucocyte, neutrophil and lymphocyte counts and the neutrophil to lymphocyte ratio (NLR) are markers of systemic inflammation. We here aimed to evaluate haemogram parameters of our patients with lung cancer according to the pathologic diagnosis of small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Materials and Methods: The study included 386 patients diagnosed with lung cancer in our hospital between January 2006 and January 2014. A retrospective examination was made of the data from the patient records and the hospital information. NLR values were categorised into two groups: <3 and ≥3. Results: Median survival time in patients aged <65 years was 28.7 months and in those aged ≥65 years, it was 18.4 months (p<0.001). The median survival time was 20.2 months in NSCLC and 13.0 months in SCLC patients (p<0.001). In NSCLC cases with NLR<3 the median survival time (31.1 months) was longer than that of patients with NLR≥3 (18 months) (p=0.003). In SCLC patients, no relationship could be found between NLR and median survival time (p=0.408). With every 1 unit increase in lymphocyte count a 5.5% decrease in risk of periodic death ((1/0.947)x100=5.5%) was noted. Conclusion: The results of this study demonstrated that lymphocyte count, neutrophil count, Hb, Htc, and NLR are useful in determining prognosis in lung cancer (LC) patients and NLR could be more significant in determining the prognosis in NSCLC than in SCLC cases.
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Affiliation(s)
- Berna Akinci Ozyurek
- Ataturk Chest Diseases And Chest Surgery Education And Research Hospital, Chest Diseases Clinic, Ankara, Turkey.
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13
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Topography of the sentinel node according to the affected lobe in lung cancer. Clin Transl Oncol 2017; 19:858-864. [DOI: 10.1007/s12094-017-1615-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/13/2017] [Indexed: 10/20/2022]
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14
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Shien K, Toyooka S. Role of surgery in N2 NSCLC: pros. Jpn J Clin Oncol 2016; 46:1168-1173. [PMID: 27655902 DOI: 10.1093/jjco/hyw125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/09/2016] [Accepted: 08/10/2016] [Indexed: 12/25/2022] Open
Abstract
The optimal management of clinical N2 Stage IIIA non-small cell lung cancer is still controversial. For a cure of locally advanced IIIA/N2 non-small cell lung cancer, the control of both local regions and possible distant micrometastases is crucial. Chemotherapy is generally expected to prevent distant recurrence. For local tumor control, radiotherapy or surgery has been adopted singly or in combination. If a complete resection can be safely performed, surgery remains the strongest modality for 'eradicating' local disease. Many retrospective studies have reported a possible survival benefit of induction treatment followed by surgery in selected patients with IIIA/N2 non-small cell lung cancer; however, randomized Phase III trials have failed to demonstrate the superiority of induction treatment followed by surgery over chemoradiotherapy, mainly because of the heterogeneity of the N2 status. IIIA/N2 non-small cell lung cancer consists of a heterogeneous group of disease ranging from microscopically single station to radiologically bulky ipsilateral multi-station mediastinal lymph node involvement. A recent definition proposed by the American College of Chest Physicians classified non-small cell lung cancer based on the N2 status, such as discrete or infiltrative type, and recommendations were made according to this N2 status, with definitive chemoradiotherapy recommended for infiltrative clinical N2 and definitive chemoradiotherapy or induction treatment followed by surgery recommended for other cases. Thus, the introduction of a multimodality treatment strategy seems to be necessary for the improved prognosis of non-small cell lung cancer patients with IIIA/N2 disease. In this review, we discuss the role of surgery and the optimal surgical management for patients with IIIA/N2 non-small cell lung cancer.
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Affiliation(s)
- Kazuhiko Shien
- Department of Thoracic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | - Shinichi Toyooka
- Department of Thoracic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama .,Department of Clinical Genomic Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Renaud S, Garelli E, Falcoz PE, Massard G. Reply to Riquet et al. Eur J Cardiothorac Surg 2016; 51:196. [PMID: 27229667 DOI: 10.1093/ejcts/ezw174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stéphane Renaud
- Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Elena Garelli
- Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France
| | | | - Gilbert Massard
- Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France
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16
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Riquet M, Legras A, Pricopi C, Le-Pimpec-Barthes F. Microscopic pN2 in lung cancer: a better prognosis? Eur J Cardiothorac Surg 2016; 51:195-196. [PMID: 27229668 DOI: 10.1093/ejcts/ezw173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/20/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Marc Riquet
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris, France
| | - Antoine Legras
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris, France
| | - Ciprian Pricopi
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris, France
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Antonângelo L, Tuma T, Fabro A, Acencio M, Terra R, Parra E, Vargas F, Takagaki T, Capelozzi V. Id-1, Id-2, and Id-3 co-expression correlates with prognosis in stage I and II lung adenocarcinoma patients treated with surgery and adjuvant chemotherapy. Exp Biol Med (Maywood) 2016; 241:1159-68. [PMID: 26869608 DOI: 10.1177/1535370216632623] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 01/22/2016] [Indexed: 12/25/2022] Open
Abstract
Inhibitors of DNA binding/inhibitors of differentiation (Id) protein family have been shown to be involved in carcinogenesis. However, the roles of Id during lung adenocarcinoma (ADC) progression remain unclear. Eighty-eight ADC samples were evaluated for Id-1,2,3 level and angiogenesis (CD 34 and VEGF microvessel density) by immunohistochemistry and morphometry. The impact of these markers was tested on follow-up until death or recurrence. A significant difference between tumor and normal tissue was found for Id-1,2,3 expression (P < 0.01). In addition, high levels of nuclear Id-1 were associated with higher angiogenesis in the tumor stroma (P < 0.01). Equally significant was the association between patients in T1-stage and low cytoplasmic Id-2, as well as patients in stage-IIb and low Id-3. High cytoplasm Id-3 expression was also directly associated to lymph nodes metastasis (P = 0.05). Patients at stages I to III, with low Id-1 and Id-3 cytoplasm histoscores showed significant long metastasis-free survival time than those with high Id-1 or Id-3 expression (P = 0.04). Furthermore, high MVD-CD34 and MVD-VEGF expression were associated with short recurrence-free survival compared to low MVD-CD34 and MVD-VEGF expressions (P = 0.04). Cox model analyses controlled for age, lymph node metastasis, and adjuvant treatments showed that nuclear Id-1, cytoplasmic Id-3, and MVD-CD34 were significantly associated with survival time. Median score for nuclear Id-1 and cytoplasmic Id-3 divided patients in two groups, being that those with increased Id-1 and Id-3 presented higher risk of death. Ids showed an independent prognostic value in patients with lung ADC, regardless of disease stage. Id-1 and Id-3 should be considered new target candidates in the development of personalized therapy in lung ADC.
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Affiliation(s)
- Leila Antonângelo
- Department of Pathology, University of Sao Paulo, Sao Paulo 01246903,Brazil
| | - Taila Tuma
- Department of Pathology, University of Sao Paulo, Sao Paulo 01246903,Brazil
| | - Alexandre Fabro
- Department of Pathology, University of Sao Paulo, Sao Paulo 01246903,Brazil
| | - Milena Acencio
- Pulmonary Division, Heart Institute Clinics Hospital, University of Sao Paulo, Sao Paulo 01246903, Brazil
| | - Ricardo Terra
- Pulmonary Division, Heart Institute Clinics Hospital, University of Sao Paulo, Sao Paulo 01246903, Brazil
| | - Edwin Parra
- Department of Pathology, University of Sao Paulo, Sao Paulo 01246903,Brazil
| | - Francisco Vargas
- Pulmonary Division, Heart Institute Clinics Hospital, University of Sao Paulo, Sao Paulo 01246903, Brazil
| | - Teresa Takagaki
- Pulmonary Division, Heart Institute Clinics Hospital, University of Sao Paulo, Sao Paulo 01246903, Brazil
| | - Vera Capelozzi
- Department of Pathology, University of Sao Paulo, Sao Paulo 01246903,Brazil
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Ding N, Mao Y. [Advances of mediastinal lymph node metastasis and the extent of lymph node
dissection in patients with stage T1 non-small cell lung cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2015; 18:34-41. [PMID: 25603871 PMCID: PMC5999745 DOI: 10.3779/j.issn.1009-3419.2015.01.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
肺癌是我国发病率和死亡率最高的恶性肿瘤。非小细胞肺癌(non-small cell lung cancer, NSCLC)约占肺癌80%。临床上,早期NSCLC以手术治疗为主要治疗方式,淋巴结分期及手术中清扫程度直接影响着患者的预后。不同肺叶原发NSCLC的淋巴结转移区域存在一定规律。解剖性肺叶切除加系统性淋巴结清扫一直以来被认为是NSCLC的标准手术方式,但近年来T1期NSCLC手术中纵隔淋巴结清扫的程度存在较大争议,选择性淋巴结清扫已逐渐被大多数学者所重视。
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Affiliation(s)
- Ningning Ding
- Department of Thoracic Surgery, Cancer Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences,
Beijing 100021, China
| | - Yousheng Mao
- Department of Thoracic Surgery, Cancer Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences,
Beijing 100021, China
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Yang H, Dai L, Li P, Shen L, Yan W, Fan M, Chen K. [Survival Analysis of 121 Stage N2-IIIa Non-small Cell Lung Cancer Patients
Treated with Surgery]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2015; 18:505-11. [PMID: 26302348 PMCID: PMC6000234 DOI: 10.3779/j.issn.1009-3419.2015.08.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
背景与目的 N2-Ⅲa期非小细胞肺癌(non-small cell lung cancer, NSCLC)手术抑或非手术仍存颇多争议。我们通过回顾性分析121例手术的N2-Ⅲa期NSCLC患者的生存,探讨N2-Ⅲa期NSCLC患者术后远期生存的因素。 方法 选取北京大学肿瘤医院单医生组肺癌前瞻性数据库2000年1月-2013年6月共1, 290例NSCLC手术患者,其中N2-Ⅲa期NSCLC患者121例。分析性别、年龄、吸烟、围手术期化疗、切口、病理、脉管癌栓、pT分期、肿瘤大小对N2-Ⅲa期患者生存的影响;比较单站N2与多站N2的生存差异;比较术中或术后病理N2者(Ⅲa1/a2)与治疗前N2者(Ⅲa3/a4)的生存差异。单因素分析采用Kaplan-Meier法计算生存,Log-rank检验。多因素分析采用Cox回归分析。 结果 全组121例患者5年生存率为43.6%,中位生存时间50.3个月。单因素分析显示单站N2转移与多站N2转移的5年生存率分别为58.3%和25.5%(P=0.001);Ⅲa1/a2期者与Ⅲa3/a4期者5年生存率分别为52.7%和38.4%(P=0.020)。多因素分析显示仅单站N2转移(HR=0.326, 95%CI: 0.186-0.572, P < 0.001)与Ⅲa1/a2(HR=0.494, 95%CI: 0.259-0.941, P=0.032)是影响本组N2-Ⅲa期患者远期生存的独立因素。 结论 N2-Ⅲa期NSCLC中单站N2转移者预后好于多站N2转移者。Ⅲa1/a2期患者预后好于Ⅲa3/a4期患者。高选择性N2-Ⅲa期NSCLC患者采取以外科手术为主的多学科综合治疗可获得较满意的远期生存。
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Affiliation(s)
- Heli Yang
- Department of Thoracic Surgery I, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University School of Oncology, Beijing Cancer Hospital, Beijing 100142, China
| | - Liang Dai
- Department of Thoracic Surgery I, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University School of Oncology, Beijing Cancer Hospital, Beijing 100142, China
| | - Pei Li
- Department of Breast Surgery, Guizhou Province Cancer Hospital, Guiyang 010059, China
| | - Luyan Shen
- Department of Thoracic Surgery I, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University School of Oncology, Beijing Cancer Hospital, Beijing 100142, China
| | - Wanpu Yan
- Department of Thoracic Surgery I, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University School of Oncology, Beijing Cancer Hospital, Beijing 100142, China
| | - Mengying Fan
- Department of Thoracic Surgery I, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University School of Oncology, Beijing Cancer Hospital, Beijing 100142, China
| | - Keneng Chen
- Department of Thoracic Surgery I, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University School of Oncology, Beijing Cancer Hospital, Beijing 100142, China
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20
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Yin Y, Wang J, Wang X, Gu L, Pei H, Kuai S, Zhang Y, Shang Z. Prognostic value of the neutrophil to lymphocyte ratio in lung cancer: A meta-analysis. Clinics (Sao Paulo) 2015; 70. [PMID: 26222823 PMCID: PMC4498150 DOI: 10.6061/clinics/2015(07)10] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Recently, a series of studies explored the correlation between the neutrophil to lymphocyte ratio and the prognosis of lung cancer. However, the current opinion regarding the prognostic role of the neutrophil to lymphocyte ratio in lung cancer is inconsistent. We performed a meta-analysis of published articles to investigate the prognostic value of the neutrophil to lymphocyte ratio in lung cancer. The hazard ratio (HR) and its 95% confidence interval (CI) were calculated. An elevated neutrophil to lymphocyte ratio predicted worse overall survival, with a pooled HR of 1.243 (95%CI: 1.106-1.397; P(heterogeneity)=0.001) from multivariate studies and 1.867 (95%CI: 1.487-2.344; P(heterogeneity)=0.047) from univariate studies. Subgroup analysis showed that a high neutrophil to lymphocyte ratio yielded worse overall survival in non-small cell lung cancer (NSCLC) (HR=1.192, 95%CI: 1.061-1.399; P(heterogeneity)=0.003) as well as small cell lung cancer (SCLC) (HR=1.550, 95% CI: 1.156-2.077; P(heterogeneity)=0.625) in multivariate studies. The synthesized evidence from this meta-analysis of published articles demonstrated that an elevated neutrophil to lymphocyte ratio was a predictor of poor overall survival in patients with lung cancer.
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Affiliation(s)
- Yongmei Yin
- Jiangnan University, The Fifth People's Hospital of Wuxi, Radiology Department, Wuxi, Jiangsu, China
| | - Jun Wang
- Jiangnan University, The Fifth People's Hospital of Wuxi, Center of Clinical Laboratory, Wuxi, Jiangsu, China
- Corresponding author: E-mail:
| | - Xuedong Wang
- Jiangnan University, The Fifth People's Hospital of Wuxi, Radiology Department, Wuxi, Jiangsu, China
| | - Lan Gu
- Jiangnan University, The Fifth People's Hospital of Wuxi, Radiology Department, Wuxi, Jiangsu, China
| | - Hao Pei
- Jiangnan University, The Fifth People's Hospital of Wuxi, Center of Clinical Laboratory, Wuxi, Jiangsu, China
| | - Shougang Kuai
- Jiangnan University, The Fifth People's Hospital of Wuxi, Center of Clinical Laboratory, Wuxi, Jiangsu, China
| | - Yingying Zhang
- Jiangnan University, The Fifth People's Hospital of Wuxi, Center of Clinical Laboratory, Wuxi, Jiangsu, China
| | - Zhongbo Shang
- Jiangnan University, The Fifth People's Hospital of Wuxi, Center of Clinical Laboratory, Wuxi, Jiangsu, China
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A high lymph node ratio predicts loco-regional recurrence while microscopic N2 predicts survival after radiation therapy in pIIIA-N2 non-small cell lung cancer. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s13566-015-0196-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kawasaki K, Sato Y, Suzuki Y, Saito H, Nomura Y, Yoshida Y. Prognostic Factors for Surgically Resected N2 Non-small Cell Lung Cancer. Ann Thorac Cardiovasc Surg 2015; 21:217-22. [PMID: 25641029 DOI: 10.5761/atcs.oa.14-00218] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Non-small cell lung cancers (NSCLCs) with pathologically documented ipsilateral mediastinal lymph node (LN) metastases (pN2) are a broad spectrum of diseases. We retrospectively analyzed prognostic factors for cases of pN2 NSCLC treated by surgical resection. METHODS Clinicopathological data were reviewed for consecutive 121 patients who underwent anatomical pulmonary resection with mediastinal LN sampling or dissection for pN2 NSCLC over a 15-year period. RESULTS The 5-year survival rate for all patients was 29.9%. Clinical N status, curability, surgical procedure and adjuvant chemotherapy were favorable prognostic factors in univariate analysis, with 5-year survival rates of 35.0% for cN0/1 vs. 17.7% for cN2/3 cases; 33.1% for R0 vs. 14.7% for R1/2 resection; 31.5% for lobectomy vs. 25.0% for bilobectomy and 15.6% for pneumonectomy; and 72.7% with adjuvant chemotherapy vs. 23.8% without adjuvant chemotherapy. Survival did not differ significantly based on gender, age, smoking status, clinical T status, tumor location, histology, skip metastasis, subcarinal LN metastasis, or number of involved N2 levels. In multivariate analysis, adjuvant chemotherapy, R0 resection, and lobectomy emerged as independent favorable prognostic factors. CONCLUSION Complete resection using lobectomy and adjuvant chemotherapy are favorable prognostic factors in cases of pN2 NSCLC.
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Affiliation(s)
- Keishi Kawasaki
- Department of Surgery, Asahi General Hospital, Asahi, Chiba, Japan
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23
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Kacan T, Babacan NA, Seker M, Yucel B, Bahceci A, Eren AA, Eren MF, Kilickap S. Could the neutrophil to lymphocyte ratio be a poor prognostic factor for non small cell lung cancers? Asian Pac J Cancer Prev 2014; 15:2089-94. [PMID: 24716939 DOI: 10.7314/apjcp.2014.15.5.2089] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although many prognostic factors have been identified for lung cancers, new ones are needed to determine the course of the disease. Recently, a high neutrophil to lymphocyte ratio (NLR) prior to surgery or treatment has been shown to be an indicator of prognosis for cancer. The aim of this study was to investigate the value of NLR as a prognostic factor and the correlation between NLR and other probable clinical prognostic factors in non small cell lung cancer patients prior to treatment. MATERIALS AND METHODS Data of patients who were diagnosed with non-small cell lung cancer in our institution were retrospectively reviewed. Demographic and clinicopathologic characteristics were recorded. NLR was calculated before the application of any treatment. RESULTS A total of 299 patients, 270 (90%) males and 29 (10%) females, were included in the study. Age (p<0.001) stage (p<0.001), Eastern Cooperative Oncology Group performance status (p<0.001), weight loss (p<0.001), anemia (p<0.001), histopatology (p<0.001), NLR ≥ 3 (p=0.048), NLR ≥ 4 (p=0.025) and NLR ≥ 5 (p=0.018) were found to be the prognostic factors. Age, anemia, Eastern Cooperative Oncology Group performance status, the stage, NLR (≥ 5) were an independent prognostic factors. There was a positive correlation between NLR and the Eastern Cooperative Oncology Group performance status (0.23, p=0.001), the C reactive protein levels (r=0.36, p<0.001). CONCLUSIONS Prior to treatment high NLR was found as an independent poor prognosis factor. Besides, NLR correlated with Eastern Cooperative Oncology Group performance status and the C reactive protein levels.
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Affiliation(s)
- Turgut Kacan
- Department of Medical Oncology, Cumhuriyet University, Sivas, Turkey E-mail :
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Current status of induction treatment for N2-Stage III non-small cell lung cancer. Gen Thorac Cardiovasc Surg 2014; 62:651-9. [PMID: 25355643 DOI: 10.1007/s11748-014-0447-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Indexed: 12/25/2022]
Abstract
Locally advanced non-small cell lung cancer (NSCLC), particularly clinical Stage IIIA NSCLC with mediastinal lymph node metastasis, is known to be quite heterogeneous, comprising approximately one-fourth of cases of NSCLC. In this subset, patients with a minor tumor load in the mediastinal lymph nodes, such as microscopically or pathologically proven N2 in the resected specimens, are treated with surgery followed by adjuvant chemotherapy. Meanwhile, the current standard of care for patients with bulky or infiltrative N2 disease is concurrent chemoradiotherapy. The potential role of surgery in multi-modality treatment for clinical N2-Stage IIIA remains controversial. Several prospective clinical trials of this subset have been conducted; however, the heterogeneity of the N2 status and differences in chemotherapy regimens and/or radiation modalities between clinical trials make the results difficult to compare. No optimal chemotherapy regimen has been established to control possible micrometastasis, and radiotherapy is often used to achieve maximum local disease control and minimize post-surgical complications. This review summarizes the findings of prospective clinical trials that assessed the role of surgery in treating clinical N2-Stage IIIA patients within the last two decades and discusses the present status of induction treatment followed by surgery for clinical N2-Stage IIIA NSCLC.
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Role of lymphatic invasion in the prognosis of patients with clinical node-negative and pathologic node-positive lung adenocarcinoma. J Thorac Cardiovasc Surg 2014; 147:1820-6. [DOI: 10.1016/j.jtcvs.2013.11.050] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 10/22/2013] [Accepted: 11/22/2013] [Indexed: 11/21/2022]
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Riquet M, Rivera C, Pricopi C, Arame A, Mordant P, Foucault C, Dujon A, Le Pimpec-Barthes F. Is the lymphatic drainage of lung cancer lobe-specific? A surgical appraisal. Eur J Cardiothorac Surg 2014; 47:543-9. [PMID: 24875885 DOI: 10.1093/ejcts/ezu226] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Nowadays, early-stage lung cancers are more frequently encountered. Selective lymph node (LN) dissection based on lobe-specific lymphatic pathway has been proposed. Our aim was to study nodal involvement according to tumour location. METHODS We reviewed 1779 lobectomized patients and analysed their pathological characteristics according to tumour location: Group 1 (G1), right upper lobe; Group 2 (G2), right middle lobe; Group 3 (G3), right lower lobe; Group 4 (G4), left upper division; Group 5 (G5), lingula; Group 6 (G6), left lower lobe. The pN status was recorded for each group to analyse the lymphatic spread of non-small-cell lung cancer (NSCLC) according to tumour location. RESULTS The numbers and proportions of lobectomies in each group were 613 patients in G1 (59.2%), 64 in G2 (6.4%), 359 in G3 (34.6%), 404 in G4 (54.3%), 54 in G5 (7.3%) and 286 in G6 (38.4%). The rates of pN2 involvement were similar, whatever the group was, even when deciphering single- and multistation diseases. on the right side, single-station N2 disease was mainly found in the superior mediastinum (SM) for G1 (95%), and in the inferior for G3 (90%). On the left side, single-station N2 was mainly found in the SM in G4 (94%), and the inferior in G6 (48%). Whatever the side, in case of two-station involvement, both mediastina were concerned in 40% (in G4) to 81% of the case (in G3). Long-term survival rates were different in skip metastasis, single- and multistation involvement, but not between lobes. CONCLUSIONS Tumour location is not a predictor of nodal metastasis pattern. In surgical treatment of NSCLC, complete systematic mediastinal LN dissection remains the only acceptable procedure from an oncological point of view.
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Affiliation(s)
- Marc Riquet
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Caroline Rivera
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Ciprian Pricopi
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Alex Arame
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Pierre Mordant
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Christophe Foucault
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Antoine Dujon
- Department of General Thoracic Surgery, Cedar Surgical Centre, Bois-Guillaume, France
| | - Françoise Le Pimpec-Barthes
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France
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Legras A, Mordant P, Arame A, Foucault C, Dujon A, Le Pimpec Barthes F, Riquet M. Long-term survival of patients with pN2 lung cancer according to the pattern of lymphatic spread. Ann Thorac Surg 2014; 97:1156-62. [PMID: 24582052 DOI: 10.1016/j.athoracsur.2013.12.047] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 12/13/2013] [Accepted: 12/30/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND N2 involvement has dramatic consequences on the prognosis and management of patients with non-small cell lung cancer (NSCLC). N2-NSCLC may present with or without N1 involvement, constituting non-skip (pN1N2) and skip (pN0N2) diseases, respectively. As the prognostic impact of this subclassification is still a matter of debate, we analyzed the prognosis of pN2 patients according to the pN1-involvement and the number of N2-stations concerned. METHODS The medical records of consecutive patients who underwent surgery for pN2-NSCLC in 2 French centers between 1980 and 2009 were prospectively collected and retrospectively reviewed. Patients undergoing induction therapy, exploratory thoracotomy, incomplete mediastinal lymphadenectomy, or incomplete resections were excluded. The prognoses of pN1N2 and pN0N2 patients were first compared, and then deciphered according to the number of N2 stations involved (single-station: 1S, multi-station: 2S). RESULTS All together, 871 patients underwent first-line complete surgical resection for pN2-NSCLC during the study period, including 258 pN0N2 (29.6%) and 613 pN1N2 (70.4%) patients. Mean follow-up was 72.8±48 months. Median, 5- and 10-year survivals were, respectively, 30 months, 34%, and 24% for pN0N2 and 20 months, 21%, and 14% for pN1N2 patients (p<0.001). Multivariate analysis revealed 3 different prognostic groups; ie, favorable in pN0N2-1S disease, intermediate in pN0N2-2S and pN1N2-1S diseases, and poor in pN1N2-2S disease (p<0.001). CONCLUSIONS Among pN2 patients, the combination of N1 involvement (pN0N2 vs pN1N2) and number of involved N2 stations (1S vs 2S) are independent prognostic factors. These results might be taken into consideration to sub-classify the heterogeneous pN2-NSCLC group of patients.
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Affiliation(s)
- Antoine Legras
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Descartes University, Paris, France
| | - Pierre Mordant
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Descartes University, Paris, France
| | - Alex Arame
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Descartes University, Paris, France
| | - Christophe Foucault
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Descartes University, Paris, France
| | | | - Françoise Le Pimpec Barthes
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Descartes University, Paris, France
| | - Marc Riquet
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Descartes University, Paris, France.
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Mordant P, Fabre É, Gibault L, Arame A, Pricopi C, Dujon A, Le Pimpec-Barthes F, Riquet M. [Impact of induction therapies on pathology and outcome after surgical resection of non-small lung cancer: a 30-year experience of 859 patients]. REVUE DE PNEUMOLOGIE CLINIQUE 2014; 70:9-15. [PMID: 24566030 DOI: 10.1016/j.pneumo.2013.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 12/19/2013] [Accepted: 12/19/2013] [Indexed: 06/03/2023]
Abstract
UNLABELLED The management of localized non-small cell lung cancer (NSCLC) has been modified over the last decades, with induction therapies being increasingly recommended as a prerequisite to surgical resection. However, the relative impact of chemo- and chemoradiotherapy on tumours' pathology and patients' survival is still discussed. METHODS We set a retrospective study including every patient who underwent surgical resection for NSCLC in 2 French centres from 1980 to 2009. We then compared the tumours' pathology and patients' survival according to the use of induction chemotherapy (group 1) or induction chemoradiotherapy (group 2). RESULTS There were 733 patients in group 1 and 126 patients in group 2. In group 1, 669 patients (91%) had platinum-based chemotherapy, for 2 to 3 cycles in 564 cases (77%). In group 2, chemoradiotheray was concomitant in 68 patients (54%), and sequential in 58 patients (46%). As compared with group 1, group 2 was characterized by younger age (mean 59.8±9.5 vs 56.4±9.6, respectively, P<.001), a higher rate of tumours deemed unresectable before induction treatment (25% vs 44%, P<.001), and a higher proportion of T4 (25% vs 44%, P<.001) or N2 diseases (56% vs 69%, P=.005). The type of resection, postoperative complications, and postoperative mortality were not significantly different between groups. On final pathologic report, as compared with group 1, there were more N0 and N1 disease in group 2 (N0: 43% vs 58%, P=.002; N1: 22% vs 10%, P=.002) while the rate of N2 disease was comparable (34% vs 32%, P=ns). The median, 5-, and 10-year survivals were 28 months, 35%, and 21% for group 1, and 29 months, 36%, and 23% for group 2, respectively (P=ns). CONCLUSION As compared with induction chemotherapy, induction chemoradiotherapy was performed in more advanced NSCLC, and resulted in better downstaging, similar postoperative course, and comparable long-term outcome after surgical resection.
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Affiliation(s)
- P Mordant
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Descartes, 20, rue Leblanc, 75015 Paris, France
| | - É Fabre
- Service d'oncologie médicale, hôpital européen Georges-Pompidou, université Descartes, 20, rue Leblanc, 75015 Paris, France
| | - L Gibault
- Service d'anatomopathologie, hôpital européen Georges-Pompidou, université Descartes, 20, rue Leblanc, 75015 Paris, France
| | - A Arame
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Descartes, 20, rue Leblanc, 75015 Paris, France
| | - C Pricopi
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Descartes, 20, rue Leblanc, 75015 Paris, France
| | - A Dujon
- Service de chirurgie thoracique, centre médico-chirurgical du Cèdre, 76230 Bois-Guillaume, France
| | - F Le Pimpec-Barthes
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Descartes, 20, rue Leblanc, 75015 Paris, France
| | - M Riquet
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Descartes, 20, rue Leblanc, 75015 Paris, France.
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Mutlu H, Buyukcelik A, Aksahin A, Kibar M, Cihan YB, Kaya E, Seyrek E, Yavuz S, Erden A, Calikusu Z, Aslan T, Akca Z. Does sunlight exposure improve survival in patients with non-small cell lung cancer? Asian Pac J Cancer Prev 2014; 14:6301-4. [PMID: 24377521 DOI: 10.7314/apjcp.2013.14.11.6301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Some epidemiological studies reported that sunlight exposure and highvitamin D levels may decrease the morbidity and mortality related to cancer. We aimed to evaluate whether sunlight exposure has an impact on survival in patients with non small cell lung cancer. MATERIALS AND METHODS A total of 546 patients with NSCLC from two different regions (Kayseri and Adana) differing according to sunlight exposure were analysed retrospectively. RESULTS The median overall survival (OS) rates were 11. 6 (CI: 9.50-13.6) and 15.6 months (CI: 12.4-18.8) for Kayseri and Adana, respectively, in all patients (p=0.880). CONCLUSIONS There were no differences between groups in terms of OS. While there is strong evidence regarding inverse relationship between cancer incidence and sunlight exposure, it is still controversial whether sunlight exposure is a good prognostic factor for survival in patients with lung cancer.
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Affiliation(s)
- Hasan Mutlu
- Department of Medical Oncology, Acibadem Kayseri Hospital, Kayseri, Turkey E-mail :
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Galbis Caravajal JM, Cremades Mira A, Zuñiga Cabrera Á, Estors Guerrero M, Tembl Ferrairó A, Martinez Hernandez NJ, Gironés Sarrió R, Aparisi Aparisi F, Gaspar Martinez C. El ganglio centinela en el carcinoma pulmonar. Estudio molecular tras detección con radioisótopo. Cir Esp 2014. [DOI: 10.1016/j.ciresp.2013.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Boudaya MS, Smadhi H, Marghli A, Charmiti F, Ouerghi S, Mohamed J, Brahem E, Smati B, Mestiri T, Kilani T. What outcome after the prescription of neoadjuvant chemotherapy in lung cancer? Asian Cardiovasc Thorac Ann 2013; 21:432-6. [DOI: 10.1177/0218492312462576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The treatment of patients with locally advanced non-small-cell lung cancer is controversial. Surgery remains the gold standard, even in this group. Neoadjuvant chemotherapy could allow surgical resection in patients initially judged inoperable. Methods From January 2009 to May 2010, neoadjuvant chemotherapy was indicated in 27 patients with NSCLC (25 men, 2 women). Their mean age was 65 years. The stages were: IIB in 5, IIIA in 17 (6 in stage IIIAN2), IIIB in 2, and IV in 3. Results 23 patients received neoadjuvant chemotherapy, 2 refused induction treatment, and 2 had impaired status. The neoadjuvant chemotherapy regimen was gemcitabine-cisplatin in 17 patients and vinorelbine-cisplatin in 6. Only 5 patients underwent complete surgical treatment after induction: 1 in stage IIB, 1 in stage IIIAN0, 1 in IIIB, and 2 in stage IV (1 operated brain metastasis, and 1 operated adrenal metastasis). Surgical treatment was not achieved after neoadjuvant chemotherapy in 18 patients because of progressive disease. Conclusion Neoadjuvant chemotherapy offers several potential benefits, but it may delay surgery or eliminate eligibility as a surgical candidate. Rigorous patient selection for this type of multimodal treatment is essential.
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Affiliation(s)
- Mohamed-Sadok Boudaya
- Department of Cardiothoracic Surgery, Abderrahmen Mami University Hospital, Ariana, Tunisia
| | - Hanène Smadhi
- Department of Cardiothoracic Surgery, Abderrahmen Mami University Hospital, Ariana, Tunisia
| | - Adel Marghli
- Department of Cardiothoracic Surgery, Abderrahmen Mami University Hospital, Ariana, Tunisia
| | - Fatma Charmiti
- Department of Pulmonary Disease “4”, Abderrahmen Mami University Hospital, Ariana, Tunisia
| | - Sonia Ouerghi
- Department of Cardiothoracic Surgery, Abderrahmen Mami University Hospital, Ariana, Tunisia
| | - Jalel Mohamed
- Department of Cardiothoracic Surgery, Abderrahmen Mami University Hospital, Ariana, Tunisia
| | - Emna Brahem
- Department of Pathology and Cytology, Abderrahmen Mami University Hospital, Ariana, Tunisia
| | - Belhassen Smati
- Department of Cardiothoracic Surgery, Abderrahmen Mami University Hospital, Ariana, Tunisia
| | - Taher Mestiri
- Department of Cardiothoracic Surgery, Abderrahmen Mami University Hospital, Ariana, Tunisia
| | - Tarek Kilani
- Department of Cardiothoracic Surgery, Abderrahmen Mami University Hospital, Ariana, Tunisia
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Macia I, Ramos R, Moya J, Rivas F, Ureña A, Banque M, Escobar I, Rosado G, Rodriguez-Taboada P. Survival of Patients with Non-Small Cell Lung Cancer According to Lymph Node Disease: Single pN1 vs Multiple pN1 vs Single Unsuspected pN2. Ann Surg Oncol 2013; 20:2413-8. [DOI: 10.1245/s10434-012-2865-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Indexed: 11/18/2022]
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Mutlu H, Büyükçelik A, Kaya E, Kibar M, Seyrek E, Yavuz S, Calikuşu Z. Sunlight may increase the FDG uptake value in primary tumors of patients with non-small cell lung cancer. Oncol Lett 2013; 5:773-776. [PMID: 23426076 PMCID: PMC3576219 DOI: 10.3892/ol.2013.1112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 11/29/2012] [Indexed: 12/25/2022] Open
Abstract
Currently, positron emission tomography with computerized tomography (PET-CT) is the most sensitive technique for detecting extracranial metastases in non-small cell lung cancer (NSCLC). It has been reported that there is a correlation between the maximal standardized uptake value (SUV(max)) of primary tumors and prognosis in patients with NSCLC. The effect of sunlight exposure on PET-CT SUV(max) value is not known. Therefore, we aimed to evaluate the effect of sunlight exposure on PET-CT SUV(max) value in patients with NSCLC. A total of 290 patients with NSCLC from two different regions of Turkey (Kayseri, n=168 and Adana, n=122) that have different climate and sunlight exposure intensity, were included in the study. Age, gender, histology of cancer, cancer stage, smoking status, comorbidity and SUV(max) of the primary tumor area at the time of staging were evaluated as prognostic factors. In the multivariate analysis, we detected that the region was the only independent factor affecting SUV(max) (P=0.019). We identified that warmer climate and more sunlight exposure significantly increases the SUV(max) value of the primary tumor area in patients with NSCLC. Further studies are warranted to clarify the issue.
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Affiliation(s)
- Hasan Mutlu
- Department of Medical Oncology, Acibadem Kayseri Hospital, Kayseri 38000
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Okada H, Anayama T, Kume M, Hirohashi K, Miyazaki R, Matsumoto M, Orihashi K. Comparison of epidermal growth factor receptor mutation analysis results between surgically resected primary lung cancer and metastatic lymph nodes obtained by endobronchial ultrasound-guided transbronchial needle aspiration. Thorac Cancer 2012; 3:262-268. [PMID: 28920306 DOI: 10.1111/j.1759-7714.2012.00122.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Lung cancers with mutations in the epidermal growth factor receptor (EGFR) gene respond well to treatment with EGFR inhibitors. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is considered a useful modality to obtain samples from the mediastinal and hilar lymph nodes. However, the EGFR gene status of EBUS-TBNA samples may not always match that of primary tumors. METHODS In 14 node-positive patients diagnosed by EBUS-TBNA, EGFR mutation analysis results were compared between EBUS-TBNA samples and surgically removed primary tumors. EGFR mutation was screened with peptide nucleic acid-locked nucleic acid polymerase chain reaction (PNA-LNA PCR) clamp followed by direct sequence analysis. For one controversial case, gene mutation analyses were performed for the multiple micro-fractions of a metastatic lymph node, which exhibited the heterogeneous immunohistochemical features. RESULTS EBUS-TBNA diagnosed one case of exon 21 point mutations, one case of exon 19 deletion, and 12 cases of wild-type EGFR. Results were consistent with those of surgically removed primary tumors in 13 of 14 cases. One case of wild-type EGFR diagnosed by EBUS-TBNA exhibited exon 21 point mutation in the surgically removed primary tumor. The metastatic lymph node targeted by EBUS-TBNA mostly consisted of cancer cells with wild-type EGFR; however, a minor component positive for thyroid transcription factor-1 (TTF-1) and surfactant-associated protein A (PE-10) exhibited EGFR mutation. CONCLUSION The combination of EBUS-TBNA and PNA-LNA clamp is useful for EGFR mutation analysis. However, EGFR mutation status in EBUS-TBNA samples may not be consistent with that of the primary tumor when the tumor contains few EGFR mutations.
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Affiliation(s)
- Hironobu Okada
- Department of Surgery II, Kochi Medical School, Kochi Universtiy, Nankoku, Kochi, JapanLaboratory of Diagnostic Pathology, Kochi Medical School Hospital, Nankoku, Kochi, Japan
| | - Takashi Anayama
- Department of Surgery II, Kochi Medical School, Kochi Universtiy, Nankoku, Kochi, JapanLaboratory of Diagnostic Pathology, Kochi Medical School Hospital, Nankoku, Kochi, Japan
| | - Motohiko Kume
- Department of Surgery II, Kochi Medical School, Kochi Universtiy, Nankoku, Kochi, JapanLaboratory of Diagnostic Pathology, Kochi Medical School Hospital, Nankoku, Kochi, Japan
| | - Kentaro Hirohashi
- Department of Surgery II, Kochi Medical School, Kochi Universtiy, Nankoku, Kochi, JapanLaboratory of Diagnostic Pathology, Kochi Medical School Hospital, Nankoku, Kochi, Japan
| | - Ryouhei Miyazaki
- Department of Surgery II, Kochi Medical School, Kochi Universtiy, Nankoku, Kochi, JapanLaboratory of Diagnostic Pathology, Kochi Medical School Hospital, Nankoku, Kochi, Japan
| | - Manabu Matsumoto
- Department of Surgery II, Kochi Medical School, Kochi Universtiy, Nankoku, Kochi, JapanLaboratory of Diagnostic Pathology, Kochi Medical School Hospital, Nankoku, Kochi, Japan
| | - Kazumasa Orihashi
- Department of Surgery II, Kochi Medical School, Kochi Universtiy, Nankoku, Kochi, JapanLaboratory of Diagnostic Pathology, Kochi Medical School Hospital, Nankoku, Kochi, Japan
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[Indications for surgery in non-small cell lung cancer with lymph node invasion]. Rev Mal Respir 2011; 28:960-6. [PMID: 22099401 DOI: 10.1016/j.rmr.2011.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Accepted: 01/26/2011] [Indexed: 12/25/2022]
Abstract
Surgery is indicated for N1 non-small cell lung cancer and performed, with good results in some patients, when N2 disease is not diagnosed preoperatively "minimal N2". Following the publication of the "EORTC 08941" and "Intergroup 0139" trials, it remains debatable for patients with proven N2 disease. Good prognostic factors before treatment or post-induction favour surgery, which seems superior to radiochemotherapy if the operative risk is low (lobectomies, and some pneumonectomies). N3 status is a contraindication to surgery, except in some rare cases with a strong response to induction treatment.
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Berghmans T, Paesmans M, Sculier JP. Prognostic factors in stage III non-small cell lung cancer: a review of conventional, metabolic and new biological variables. Ther Adv Med Oncol 2011; 3:127-38. [PMID: 21904576 DOI: 10.1177/1758834011401951] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Lung cancer is one of the most frequently occurring neoplasms and usually has a poor prognosis because most of the patients present with advanced or metastatic disease at the time of diagnosis. Numerous prognostic factors (PFs) have been studied, but the two most prominent, having both prognostic and operational values, are disease stage and performance status. Even if the literature on PFs in lung cancer is impressive, the number of publications specifically dealing with PFs in stage III non-small cell lung cancer (NSCLC) is limited. We reviewed the literature on this topic and separated the available information into three groups: conventional PFs, metabolic criteria (standardized uptake value [SUV] measured on(18)F-FDG-PET) and new biomarkers. Performance status and the distinction between stage IIIA and IIIB confirmed their prognostic value in stage III NSCLC. Other conventional PFs have been suggested such as age, weight loss, response to treatment and some characteristics describing the locoregional extension of the tumour. There is a place for the SUV as a PF for survival in early NSCLC, but its role in stage III NSCLC has to be further assessed. Some new biomarkers involved in cell cycle regulation or in apoptosis have been shown to have potential value. Their role needs to be confirmed in large prospective studies including conventional PFs to determine their independent value as a PF in stage III NSCLC. In conclusion, few PFs have been well evaluated in stage III NSCLC. New studies, taking into account the modifications derived from the 7th international staging system of the UICC, have to be performed.
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Affiliation(s)
- Thierry Berghmans
- Institut Jules Bordet, Rue Héger-Bordet, 1, B-1000 Brussels, Belgium
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Sakuraba M, Takahashi N, Oh S, Miyasaka Y, Inagaki T, Suzuki K. Long-term survival after complete mediastinal lymph node resection and lobectomy in patients with bulky N2 non-small cell lung cancer. Ann Thorac Cardiovasc Surg 2011; 17:124-9. [PMID: 21597408 DOI: 10.5761/atcs.oa.09.01475] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Accepted: 03/10/2010] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND At Juntendo University Hospital, Japan, two patients with complete resection of bulky N2 non-small cell lung cancer (NSCLC) has survived over the long term. Therefore, we decided to retrospectively study patients who also had a complete resection of the tumor including the "bulky" superior mediastinal node for the purpose of reviewing covariates that might be related to the favorable outcome. METHODS We retrospectively analyzed the relation between covariates and survival after complete lobectomy and mediastinal lymph node resection (from April 1997 to August 2007) in 15 patients with bulky N2 NSCLC, lymph nodes greater than 2 cm in short-axis diameter (bulky nodal disease) measured on preoperative chest computer tomography. RESULTS Of 15 patients, 5 with bulky N2 single station had survival after the resection. Univariate analysis revealed that the postoperative stage significantly affected overall survival (p = 0.0101). Single-station node involvement in bulky N2 disease was the covariate associated with overall survival (p = 0.0150) and disease free survival (p = 0.0052). CONCLUSIONS In the complete resection of bulky N2 NSCLC in patients with lymph nodes measuring more than 2 cm in short-axis diameter, single-station node involvement suggests a favorable outcome and long-term survival, compared to patients with multi-station involvement.
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Affiliation(s)
- Motoki Sakuraba
- Juntendo University School of Medicine, Department of General Thoracic Surgery, Tokyo, Japan.
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Zhang Z, Liu D, Guo Y, Shi B, Song Z, Tian Y. [Effects of multiple factors on the prognosis of pIIIa/N2 patients with non-small cell lung cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2010; 13:781-5. [PMID: 20704818 PMCID: PMC6000559 DOI: 10.3779/j.issn.1009-3419.2010.08.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
背景与目的 目前对pⅢa/N2期非小细胞肺癌患者所采取的治疗方法尚不一致。本研究旨在评价不同影响因素与pⅢa/N2非小细胞肺癌患者预后的相关性。 方法 回顾性分析1998年1月-2004年5月133例非小细胞肺癌患者经以外科干预为主的综合治疗后的无瘤生存期和5年生存率。研究因素包括年龄、性别、跳跃转移、淋巴结转移站数、手术类型、病理分型、辅助治疗等。应用SPSS 16.0软件统计生存率。 结果 133例pⅢa/N2期入组患者总的5年生存率为32.33%,单站淋巴结转移亚组与多站淋巴结转移亚组的5年生存率分别为39.62%和27.50%;临床N0-1分期(cN0-1)亚组与临床N2分期(cN2)亚组的5年生存率分别为37.78%和20.93%。Cox回归分析显示:淋巴结转移站数(P=0.013, OR=0.490, 95%CI: 0.427-0.781)及cN0-1(P=0.009, OR=0.607, 95%CI: 0.372-0.992)与N2患者预后呈正相关。 结论 非小细胞肺癌的cN分期、淋巴结转移站数目与pⅢa/N2期患者的预后呈正相关;在严格入组条件下,可以对选择性pⅢa/N2患者进行以外科治疗为主、联合辅助治疗的综合治疗,并可获得较满意的长期生存率。
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Affiliation(s)
- Zhenrong Zhang
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Peking University, Beijing 100029, China
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The Clinical Value of Lymphatic Micrometastases in Patients with Non-small Cell Lung Cancer. J Thorac Oncol 2010; 5:1201-5. [DOI: 10.1097/jto.0b013e3181e29ace] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Surgical management of non-small cell lung cancer with mediastinal lymphadenopathy. Clin Oncol (R Coll Radiol) 2010; 22:325-33. [PMID: 20156672 DOI: 10.1016/j.clon.2010.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 01/22/2010] [Indexed: 11/21/2022]
Abstract
Several issues regarding the surgical management of N2 disease remain unresolved. First, the anatomical attribution of a mediastinal nodal station, especially in certain areas (i.e., azygos recess), is a source of continuous debate. Second, the presence of occult N2, single or multilevel N2, bulky N2, the skip phenomenon and the observation of a different prognostic outlook for specific mediastinal nodal stations are all elements of discussion that cannot clarify whether stage IIIA-N2 non-small cell lung cancer is indeed a locally, albeit advanced, manifestation of the disease or the prodrome of an actual systemic dissemination. In this subset of patients lies the challenge for multidisciplinary treatment modalities, where the surgical role needs to be further defined in the context of an integrated collaborative effort with the medical oncologist and the radiotherapist.
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Shim MS, Kim JG, M.D. YSY, Chang SW, Kim HK, Choi YS, Kim KM, Shim YM. Outcomes of the Initial Surgical Treatment without Neoadjuvant Therapy in Patients with Unexpected N2 Non-small Cell Lung Cancer. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.1.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Man-shik Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jhin-Gook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Yoo-Sang Yoon M.D.
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Sung-Wook Chang
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hong-Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Yong-Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Kwhan-Mien Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Young-Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
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Abstract
PURPOSE OF REVIEW To describe the state-of-the-art of the surgical management of stage IIIA-N2 nonsmall cell lung cancer. RECENT FINDINGS When completely resected, occult N2 found at thoracotomy, skip metastases, and single-level N2 in selected locations are reported to portend acceptable survival rates. Conversely, preoperatively proven ipsilateral mediastinal nodal involvement requires a multidisciplinary approach on the basis of neoadjuvant chemotherapy or chemoradiation. In these patients, complete resection of the primary tumor remains among the strongest prognosticators of survival. When technically feasible, radical mediastinal lymphadenectomy could be of added value. Given the demonstrated increase in postoperative morbidity and mortality, pneumonectomy should be avoided when possible, whereas lobectomy and parenchymal sparing resections should be favored if compatible with the resection of the original extent of the primary on tumor-free margins. SUMMARY Only selected patients with N2 disease may benefit from primary surgery. The impact of postoperative morbidity after induction treatment is still being evaluated. In this setting, differences in treatment sequence and combination (chemotherapy alone or chemoradiation) may influence postsurgical outcome. Patients' selection revolves around the modern concepts of oncologic operability and surgical resectability intended as assessment of survival benefit and ability to completely resect all residual tumor after neoadjuvant therapy.
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Grannis FW. Minimal survival after chemoradiation therapy for "non-bulky" stage IIIA NSCLC: what are the implications? Ann Thorac Surg 2009; 87:1320; author reply 1320-1. [PMID: 19324191 DOI: 10.1016/j.athoracsur.2008.09.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Revised: 08/27/2008] [Accepted: 09/23/2008] [Indexed: 11/19/2022]
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Zhou X, Wang J, Wang J, Pan Y, Li J, Wang W, Zhao F. Analysis of prognostic factors for surgery after neo-adjuvant therapy for stage III non-small cell lung cancer. ACTA ACUST UNITED AC 2008; 28:677-80. [DOI: 10.1007/s11596-008-0614-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Indexed: 11/27/2022]
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Cerfolio RJ, Maniscalco L, Bryant AS. The Treatment of Patients with Stage IIIA Non-Small Cell Lung Cancer From N2 Disease: Who Returns to the Surgical Arena and Who Survives. Ann Thorac Surg 2008; 86:912-20; discussion 912-20. [DOI: 10.1016/j.athoracsur.2008.04.073] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 04/22/2008] [Accepted: 04/23/2008] [Indexed: 12/01/2022]
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Grannis FW. Is primary resection of stage IIIA lung cancer futile? Ann Thorac Surg 2008; 86:353-4; author reply 354. [PMID: 18573468 DOI: 10.1016/j.athoracsur.2008.01.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Revised: 12/28/2007] [Accepted: 01/08/2008] [Indexed: 10/21/2022]
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