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Fukui M, Matsunaga T, Hattori A, Takamochi K, Nojiri S, Suzuki K. Sublobar resection is not always superior for early-stage lung cancer in high-risk patients. Eur J Cardiothorac Surg 2024; 65:ezad325. [PMID: 37756703 DOI: 10.1093/ejcts/ezad325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/06/2023] [Accepted: 09/23/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVES The phase III trial, Japan Clinical Oncology Group 0802, illustrated the superiority of sublobar resection for early-stage lung cancer in terms of overall survival, with more non-lung cancer-related deaths after a lobectomy. The advantages of sublobar resection may be more pronounced in high-risk patients. The goal of this study was to elucidate the prognoses of high-risk patients. METHODS Patients with a risk of being ineligible for Japan Clinical Oncology Group 0802 for general conditions were classified as the high-risk group, and those who were not at risk of being ineligible were classified as the normal-risk group. Overall survival and prognostic factors were analysed in the high-risk group. RESULTS There were 254 (19.4%) and 1054 patients in the high- and normal-risk groups, respectively. Five-year survival rates were 94.5% and 79.1% in the normal-risk and high-risk groups, respectively (P < 0.001). More patients in the high-risk group died of lung cancer (P < 0.001) and non-lung cancer deaths (P < 0.001) than patients in the normal-risk group.In the high-risk group, 151 lobectomies and 103 sublobar resections were performed. There was no significant difference in the numbers of lung cancer deaths and of non-lung cancer deaths between the procedures. Stratified survival analyses showed that the diffusing capacity of the lungs for carbon monoxide < 40% tended to favour sublobar resection; being female and having a high carcinoembryonic antigen level tended to favour a lobectomy. CONCLUSIONS Sublobar resection is not always superior for early-stage lung cancer. Even in such cases, the surgical method should be determined by taking into consideration the patient's background and lung cancer surveillance.
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Affiliation(s)
- Mariko Fukui
- Department of General Thoracic Surgery and Juntendo University School of Medicine, Tokyo, Japan
| | - Takeshi Matsunaga
- Department of General Thoracic Surgery and Juntendo University School of Medicine, Tokyo, Japan
| | - Aritoshi Hattori
- Department of General Thoracic Surgery and Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery and Juntendo University School of Medicine, Tokyo, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery and Juntendo University School of Medicine, Tokyo, Japan
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2
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Behinaein P, Treffalls J, Hutchings H, Okereke IC. The Role of Sublobar Resection for the Surgical Treatment of Non-Small Cell Lung Cancer. Curr Oncol 2023; 30:7019-7030. [PMID: 37504369 PMCID: PMC10378348 DOI: 10.3390/curroncol30070509] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023] Open
Abstract
Lung cancer is the most common cancer killer in the world. The standard of care for surgical treatment of non-small cell lung cancer has been lobectomy. Recent studies have identified that sublobar resection has non-inferior survival rates compared to lobectomy, however. Sublobar resection may increase the number of patients who can tolerate surgery and reduce postoperative pulmonary decline. Sublobar resection appears to have equivalent results to surgery in patients with small, peripheral tumors and no lymph node disease. As the utilization of segmentectomy increases, there may be some centers that perform this operation more than other centers. Care must be taken to ensure that all patients have access to this modality. Future investigations should focus on examining the outcomes from segmentectomy as it is applied more widely. When employed on a broad scale, morbidity and survival rates should be monitored. As segmentectomy is performed more frequently, patients may experience improved postoperative quality of life while maintaining the same oncologic benefit.
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Affiliation(s)
- Parnia Behinaein
- School of Medicine, Wayne State University, Detroit, MI 48202, USA
| | - John Treffalls
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Hollis Hutchings
- Department of Surgery, Henry Ford Health, Detroit, MI 48202, USA
| | - Ikenna C Okereke
- Department of Surgery, Henry Ford Health, Detroit, MI 48202, USA
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3
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Pyroptosis-Related Gene Model Predicts Prognosis and Immune Microenvironment for Non-Small-Cell Lung Cancer. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:1749111. [PMID: 36092153 PMCID: PMC9453043 DOI: 10.1155/2022/1749111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/12/2022] [Accepted: 08/09/2022] [Indexed: 12/13/2022]
Abstract
Non-small-cell lung cancer (NSCLC) has a high incidence and mortality worldwide. Moreover, it needs more accurate means for predicting prognosis and treatments. Pyroptosis is a novel form of cell death about inflammation which was highly related to the occurrence and development of tumors. Despite having some studies about pyroptosis-related genes (PRGs) and cancer, the correlation has not been explored enough between PRGs and immune in NSCLC. In this study, we constructed a PRG model by WGCNA to access the prognosis value PRGs have. The testing cohort (n = 464) with four datasets from the GEO database conducted a survival analysis to confirm the stability of the prognostic model. The risk score and age are examined as independent prognostic factors. Based on the PRGs, we found multiple pathways enriched in immune in NSCLC. Separating samples into three subtypes by consensus cluster analysis, Cluster 3 was identified as immune-inflamed phenotype with an optimistic prognostic outcome. A three-gene PRG signature (BNIP3, CASP9, and CAPN1) was identified, and BNIP3 was identified as the core gene. Knockdown of BNIP3 significantly inhibited the growth of H358 cells and induced pyroptosis. In conclusion, the model construction based on PRGs provides novel insights into the prediction of NSCLC prognosis, and BNIP3 can serve as a diagnostic biomarker for NSCLC.
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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.
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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
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5
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Huang W, Deng HY, Xu K, Lin MY, Li P, Yuan C, Zhou Q. Initial treatment of early-stage small-sized non-small cell lung cancer for octogenarians: a population-based study. Updates Surg 2022; 74:1461-1470. [PMID: 35386041 DOI: 10.1007/s13304-022-01281-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/17/2022] [Indexed: 02/05/2023]
Abstract
The objectives of this study is to figure out the appropriate initial treatment and criteria for clinical decision for early-stage small-sized non-small cell lung cancer (NSCLC) among octogenarians. Elderly patients (≥80 years) with stage I NSCLC (<3 cm) were identified between 2004 and 2015 in the Surveillance, Epidemiology, and End Results database. Patients were divided into four cohorts regarding treatment modalities, and overall survival and cancer-specific survival were evaluated via Kaplan-Meier analysis and Cox proportional hazard model. The propensity score matching method was introduced in the subgroup analysis stratified by four clinical characteristics to identify the preferable treatment. A total of 7861 patients were included with a median overall survival of 43 months (range 1-155 months). In younger patients (80-85 years), lobectomy was superior in improving the survival (versus segmentectomy, HR = 0.68, 95%CI 0.55-0.84; versus wedge resection, HR = 0.77; 95%CI 0.67-0.88). While in those over 85 years, lobectomy was superior to wedge resection (HR = 0.72; 95%CI 0.53-0.98), and all other treatments were comparable. As stratified by T stage in those over 85 years, lobectomy was superior to wedge resection (P = 0.023) for T1 disease, and the four treatments were all comparable in overall survival for T2 disease. In conclusions, the favored treatment of early stage NSCLC for octogenarians may be evaluated by age and T stage. Lobectomy might be preferred in patients between 80 and 85 years whenever possible. Among those over 85 years, radiotherapy might lead to a comparable prognosis and could be recommended as the prior treatment, while should surgery be recommended, lobectomy might be preferred for T1 disease and wedge resection for T2 disease.
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Affiliation(s)
- Weijia Huang
- Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, People's Republic of China
| | - Han-Yu Deng
- Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, People's Republic of China
| | - Kai Xu
- Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, People's Republic of China.,West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Ming-Ying Lin
- West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Peiwei Li
- West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Chi Yuan
- West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Qinghua Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, People's Republic of China.
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6
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Tekneci AK, Ozgur GK, Akcam TI, Cagirici U. Bibliometric Analysis of 50 Most Cited Articles Comparing Lobectomy with Sublobar Resection. Thorac Cardiovasc Surg 2022; 71:307-316. [PMID: 35135027 DOI: 10.1055/s-0041-1740557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Recent years have seen an increase in the number of studies of the sublobar resection approach in non-small cell lung cancer (NSCLC) surgery. The purpose of this bibliometric analysis is to assess the significance and impact of articles comparing sublobar resection and lobectomy in NSCLC surgery. MATERIAL AND METHODS The Web of Science database was searched to identify studies comparing sublobar resection and lobectomy in NSCLC surgery published between 2005 and 2020 (accessed: September 11, 2020). The 50 most cited articles were analyzed by years, countries, authors, authors' affiliations, journals, journals' addresses, and impact factors. RESULTS The bibliometric analysis revealed that the most cited article had 443 citations, while the total number of citations of all articles was 2,820. The mean number of citations, in turn, was 56.4 ± 75.62 (1-443) times. The highest number of publications over the past 15 years was in 2016, with eight articles. The Annals of Thoracic Surgery (n = 10; 20%) had the highest number of publications on the list. The articles included in the present study were mostly (n = 35, 70%) published in U.S. journals. While multiple subject matters and analyses were presented by many studies, survival was the topic of greatest interest, with 37 (74%) studies. CONCLUSION This study revealed that interest in studies comparing sublobar resection with lobectomy has increased in recent years. It also presents both quantitative and qualitative analyses of the most cited articles in the literature on this topic. Therefore, it can serve as a guide for researchers.
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Affiliation(s)
| | - Gizem Kececi Ozgur
- Department of Thoracic Surgery, Ege University School of Medicine, İzmir, Turkey
| | - Tevfik Ilker Akcam
- Department of Thoracic Surgery, Ege University School of Medicine, İzmir, Turkey
| | - Ufuk Cagirici
- Department of Thoracic Surgery, Ege University School of Medicine, İzmir, Turkey
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7
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Wang P, Wang S, Liu Z, Sui X, Wang X, Li X, Qiu M, Yang F. Segmentectomy and Wedge Resection for Elderly Patients with Stage I Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11020294. [PMID: 35053989 PMCID: PMC8782039 DOI: 10.3390/jcm11020294] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/27/2021] [Accepted: 01/05/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Considerable controversies exist regarding the efficacies of segmentectomy and wedge resection for elderly patients with early-stage non-small cell lung cancer (NSCLC). This systematic review and meta-analysis aimed to solve these issues. Methods: We searched the online databases PubMed, Web of Science, EMBASE, and Cochrane Library to identify eligible studies. Elderly patients were defined as ≥65 years. Early-stage NSCLC was defined as stage I based on TNM systems. The primary endpoints were survival outcomes (overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS)) and recurrence patterns. The second endpoints were perioperative morbidities. The hazard rate (HR) and odds ratio (OR) were effect sizes. Results: Sixteen cohort studies (3140 participants) and four database studies were finally included. Segmentectomy and lobectomy showed no significant difference in OS (cohort studies HR 1.00, p = 0.98; database studies HR 1.07, p = 0.14), CSS (HR 0.91, p = 0.85), or DFS (HR 1.04, p = 0.78) in elderly patients with stage I NSCLC. In contrast, wedge resection showed inferior OS (HR 1.28, p < 0.001), CSS (HR 1.17, p = 0.001) and DFS (HR 1.44, p = 0.042) compared to lobectomy. Segmentectomy also showed comparable local recurrence risk with lobectomy (OR 0.98, p = 0.98), while wedge resection showed increased risk (OR 5.46, p < 0.001). Furthermore, sublobar resections showed a decreased risk of 30/90-day mortality, pneumonia, and leak complications compared to lobectomy. Conclusion: Segmentectomy is promising when applied to elderly patients with stage I NSCLC, while wedge resection should be limited. Randomized controlled trials are warranted to validate these findings.
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Affiliation(s)
| | | | | | | | | | | | | | - Fan Yang
- Correspondence: ; Tel.: +86-(10)-88326657
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8
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Zhang W, Liu Y, Wu J, Wang W, Zhou J, Guo J, Wang Q, Zhang X, Xie J, Xing Y, Hu D. Surgical Treatment is Still Recommended for Patients Over 75 Years with IA NSCLC: A Predictive Model Based on Surveillance, Epidemiology and End Results Database. Cancer Control 2022; 29:10732748221142750. [DOI: 10.1177/10732748221142750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background To determine the populations who suitable for surgical treatment in elderly patients (age ≥ 75 y) with IA stage. Methods The clinical data of NSCLC patients diagnosed from 2010 to 2015 were collected from the SEER database and divided into surgery group (SG) and no-surgery groups (NSG). The confounders were balanced and differences in survival were compared between groups using PSM (Propensity score matching, PSM). Cox regression analysis was used to screen the independent factors that affect the Cancer-specific survival (CSS). The surgery group was defined as the patients who surgery-benefit and surgery-no benefit according to the median CSS of the no-surgery group, and then randomly divided into training and validation groups. A surgical benefit prediction model was constructed in the training and validation group. Finally, the model is evaluated using a variety of methods. Results A total of 7297 patients were included. Before PSM (SG: n = 3630; NSG: n = 3665) and after PSM (SG: n = 1725, NSG: n = 1725) confirmed that the CSS of the surgery group was longer than the no-surgery group (before PSM: 82 vs. 31 months, P < .0001; after PSM: 55 vs. 39 months, P < .0001). Independent prognostic factors included age, gender, race, marrital, tumor grade, histology, and surgery. In the surgery cohort after PSM, 1005 patients (58.27%) who survived for more than 39 months were defined as surgery beneficiaries, and the 720 patients (41.73%) were defined surgery-no beneficiaries. The surgery group was divided into training group 1207 (70%) and validation group 518 (30%). Independent prognostic factors were used to construct a prediction model. In training group (AUC = .678) and validation group (AUC = .622). Calibration curve and decision curve prove that the model has better performance. Conclusions This predictive model can well identify elderly patients with stage IA NSCLC who would benefit from surgery, thus providing a basis for clinical treatment decisions.
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Affiliation(s)
- Wenting Zhang
- School of Medicine, Anhui University of Science and Technology, Huainan, P.R. China
| | - Yafeng Liu
- School of Medicine, Anhui University of Science and Technology, Huainan, P.R. China
| | - Jing Wu
- School of Medicine, Anhui University of Science and Technology, Huainan, P.R. China
- Anhui Province Engineering Laboratory of Occupational Health and Safety, Anhui University of Science and Technology, Huainan, P.R. China
| | - Wenyang Wang
- School of Medicine, Anhui University of Science and Technology, Huainan, P.R. China
| | - Jiawei Zhou
- School of Medicine, Anhui University of Science and Technology, Huainan, P.R. China
| | - Jianqiang Guo
- School of Medicine, Anhui University of Science and Technology, Huainan, P.R. China
| | - Qingsen Wang
- School of Medicine, Anhui University of Science and Technology, Huainan, P.R. China
| | - Xin Zhang
- School of Medicine, Anhui University of Science and Technology, Huainan, P.R. China
| | - Jun Xie
- Cancer Hospital of Anhui University of Science and Technology, Huainan, P.R. China
| | - Yingru Xing
- School of Medicine, Anhui University of Science and Technology, Huainan, P.R. China
- Cancer Hospital of Anhui University of Science and Technology, Huainan, P.R. China
- Department of Clinical Laboratory, Anhui Zhongke Gengjiu Hospital, Hefei, P.R. China
| | - Dong Hu
- School of Medicine, Anhui University of Science and Technology, Huainan, P.R. China
- Anhui Province Engineering Laboratory of Occupational Health and Safety, Anhui University of Science and Technology, Huainan, P.R. China
- Department of Clinical Laboratory, Anhui Zhongke Gengjiu Hospital, Hefei, P.R. China
- Key Laboratory of Industrial Dust Prevention and Control & Occupational Safety and Health of the Ministry of Education, Anhui University of Science and Technology, Huainan, P.R. China
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9
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Seo YS, Park WY, Kim SW, Kim D, Min BJ, Kim WD. Virtual randomized study comparing lobectomy and particle beam therapy for clinical stage IA non-small cell lung cancer in operable patients. JOURNAL OF RADIATION RESEARCH 2021; 62:884-893. [PMID: 34218277 PMCID: PMC8438263 DOI: 10.1093/jrr/rrab060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/30/2021] [Indexed: 06/13/2023]
Abstract
To the best of our knowledge there have been no randomized controlled trials comparing lobectomy-a standard treatment for patients with early-stage non-small cell lung cancer (NSCLC)-and particle beam therapy (PBT), the best performing existing radiotherapy. We conducted a virtual randomized trial in medically operable patients with stage IA NSCLC to compare lobectomy and PBT effectiveness. A Markov model was developed to predict life expectancy after lobectomy and PBT in a cohort of patients with stage IA NSCLC. Ten thousand virtual patients were randomly assigned to each group. Sensitivity analyses were performed as model variables and scenarios changed to determine which treatment strategy was best for improving life expectancy. All estimated model parameters were determined using variables extracted from a systematic literature review of previously published articles. The preferred strategy differed depending on patient age. In young patients, lobectomy showed better life expectancy than that of PBT. The difference in life expectancy between lobectomy and PBT was statistically insignificant in older patients. Our model predicted lobectomy as the preferred strategy when operative mortality was under 5%. However, the preferred strategy changed to PBT if operative mortality post lobectomy was over 5%. For medically operable patients with stage IA NSCLC, our Markov model revealed the preferred strategy of lobectomy or PBT regarding operative mortality changed with varying age and comorbidity. Until randomized controlled trial results become available, we hope the current results will provide a rationale background for clinicians to decide treatment modalities for patients with stage IA NSCLC.
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Affiliation(s)
- Young-Seok Seo
- Department of Radiation Oncology, Chungbuk National University Hospital, Cheongju 28644, Korea
| | - Woo-Yoon Park
- Department of Radiation Oncology, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju 28644, Korea
| | - Si-Wook Kim
- Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju 28644, Korea
| | - Dohun Kim
- Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju 28644, Korea
| | - Byung Jun Min
- Corresponding authors: Byung Jun Min, PhD, Department of Radiation Oncology, Chungbuk National University Hospital, Cheongju 28644, Korea. Phone: +82-43-269-6213, Fax: +82-43-269-6208, E-mail: ; Won-Dong Kim, MD, PhD, Department of Radiation Oncology, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju 28644, Korea. Phone: +82-43-269-6212, Fax: +82-43-269-6208, E-mail:
| | - Won-Dong Kim
- Corresponding authors: Byung Jun Min, PhD, Department of Radiation Oncology, Chungbuk National University Hospital, Cheongju 28644, Korea. Phone: +82-43-269-6213, Fax: +82-43-269-6208, E-mail: ; Won-Dong Kim, MD, PhD, Department of Radiation Oncology, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju 28644, Korea. Phone: +82-43-269-6212, Fax: +82-43-269-6208, E-mail:
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10
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Zhang B, Liu R, Ren D, Li X, Wang Y, Huo H, Zhu S, Chen J, Song Z, Xu S. Comparison of Lobectomy and Sublobar Resection for Stage IA Elderly NSCLC Patients (≥70 Years): A Population-Based Propensity Score Matching's Study. Front Oncol 2021; 11:610638. [PMID: 34026604 PMCID: PMC8139614 DOI: 10.3389/fonc.2021.610638] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 04/14/2021] [Indexed: 01/22/2023] Open
Abstract
Background To investigate the differences in survival between lobectomy and sub-lobar resection for elderly stage I non-small-cell lung cancer (NSCLC) patients using the Surveillance, Epidemiology, and End Results (SEER) registry. Method The data of stage IA elderly NSCLC patients (≥ 70 years) with tumors less than or equal to 3 cm in diameter were extracted. Propensity-matched analysis was used. Lung cancer-specific survival (LCSS) was compared among the patients after lobectomy and sub-lobar resection. The proportional hazards model was applied to identify multiple prognostic factors. Results A total of 3,504 patients met criteria after propensity score matching (PSM). Although the LCSS was better for lobectomy than for sub-lobar resection in patients with tumors ≤ 3 cm before PSM (p < 0.001), no significant difference in the LCSS was identified between the two treatment groups after PSM (p = 0.191). Multivariate Cox regression showed the elder age, male gender, squamous cell carcinoma (SQC) histology type, poor/undifferentiated grade and a large tumor size were associated with poor LCSS. The subgroup analysis of tumor sizes, histologic types and lymph nodes (LNs) dissection, there were also no significant difference for LCSS between lobectomy and sub-lobar resection. The sub-lobar resection was further divided into segmentectomy or wedge resection, and it demonstrated that no significant differences in LCSS were identified among the treatment subgroups either. Multivariate Cox regression analysis showed that the elder age, poor/undifferentiated grade and a large tumor size were a statistically significant independent factor associated with survival. Conclusion In terms of LCSS, lobectomy has no significant advantage over sub-lobar resection in elderly patients with stage IA NSCLC if lymph node assessment is performed adequately. The present data may contribute to develop a more suitable surgical treatment strategy for the stage IA elderly NSCLC patients.
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Affiliation(s)
- Bo Zhang
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Renwang Liu
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Dian Ren
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiongfei Li
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Yanye Wang
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Huandong Huo
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Shuai Zhu
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Chen
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumour Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Zuoqing Song
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumour Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Song Xu
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumour Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
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11
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Zhang X, Lin G, Li J. Comparative Effectiveness of Lobectomy, Segmentectomy, and Wedge Resection for Pathological Stage I Non-small Cell Lung Cancer in Elderly Patients: A Population-Based Study. Front Surg 2021; 8:652770. [PMID: 33937317 PMCID: PMC8082105 DOI: 10.3389/fsurg.2021.652770] [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] [Received: 01/13/2021] [Accepted: 03/05/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: This study was designed to assess the long-term survival of lobectomy, segmentectomy, and wedge resection for pathological stage I non-small cell lung cancer (NSCLC) in patients over 75 years of age. Patients and methods: Pathological stage I NSCLC patients aged ≥75 years who underwent lobectomy, segmentectomy, or wedge resection were identified from the Surveillance, Epidemiology, and End Results database. Propensity score–matched and competing risks analyses were conducted. The overall survival (OS) rate and lung cancer–specific survival (LCSS) rate were compared among the three groups based on the pathological stage. Results: A total of 3,345 patients were included. In the full cohort, the OS rate and LCSS rate of lobectomy were superior to wedge resection, but not to segmentectomy, the OS advantage diminished when patients were over 85 years old or when at least one lymph node was examined during the procedure. Stratified analyses showed that there was no significant difference in OS and LCSS rates among the three surgical procedures for patients with tumors smaller than 1.0 cm. The OS and LCSS of wedge resection, not segmentectomy, were inferior to lobectomy in stage IA2–IB tumors. Conclusion: Lobectomy should be recognized as the “gold standard” procedure for pathological stage I NSCLC in patients over 75 years of age, and segmentectomy could be considered as an effective alternative. Wedge resection could be considered for patients with compromised cardiopulmonary function or tumors smaller than 1.0 cm, and intraoperative lymph node examination should be conducted.
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Affiliation(s)
- Xining Zhang
- Department of Thoracic Surgery, Peking University First Hospital, Beijing, China
| | - Gang Lin
- Department of Thoracic Surgery, Peking University First Hospital, Beijing, China
| | - Jian Li
- Department of Thoracic Surgery, Peking University First Hospital, Beijing, China
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12
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Wang S, Liu G, Fu Z, Jiang Z, Qiu J. Predicting Pathological Invasiveness of Lung Adenocarcinoma Manifesting as GGO-Predominant Nodules: A Combined Prediction Model Generated From DECT. Acad Radiol 2021; 28:509-516. [PMID: 32303445 DOI: 10.1016/j.acra.2020.03.007] [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: 02/08/2020] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate qualitative and quantitative indicators generated from Dual-energy computed tomography (DECT) for preoperatively differentiating between invasive adenocarcinoma (IAC) and preinvasive or minimally invasive adenocarcinoma (MIA) lesions manifesting as ground-glass opacity-predominant (GGO-predominant) nodules. MATERIALS AND METHODS We retrospectively enrolled 143 cases of completely resected GGO-predominant lung adenocarcinoma with DECT examinations between December 2017 and July 2019. Qualitative and quantitative parameters of GGO-predominant nodules were compared after grouping nodules into IAC and preinvasive-MIA groups. A multivariate logistic regression models were used for analyzing these parameters. The diagnostic performance of different parameters was compared by receiver operating characteristic (ROC) curves and Z tests. RESULTS This study included 137 patients (58 years ± 11; male: female = 52:91) with 143 GGO-predominant nodules. The proportion of margins, internal dilated/distorted/cut-off bronchi, internal thickened/stiff/distorted vasculature, pleural indentation, and vascular convergence were higher in the IAC group than in the preinvasive-MIA group, as were the maximum diameter (Dmax), the diameter of the solid component (Dsolid) and the enhanced monochromatic CT value at 40 keV-190 keV (CT40 keV-190 keV) (p range: 0.001-0.019). Logistic regression analyses revealed that margin, Dmax, and CT60 keV values were independent predictors of the IAC group. The area under the curve (AUC) for the combination of margin, Dmax, and CT60 keV was 0.896 (90.2% sensitivity, 70.7% specificity, 84.6% accuracy), which was significantly higher than that for each two of them (all p < 0.05). CONCLUSION The combined prediction model generated from DECT allows for effective preoperative differentiation between IAC and preinvasive-MIA in GGO-predominant lung adenocarcinomas.
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13
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Dauriat G, LePavec J, Pradere P, Savale L, Fabre D, Fadel E. Our current understanding of and approach to the management of lung cancer with pulmonary hypertension. Expert Rev Respir Med 2021; 15:373-384. [PMID: 33107356 DOI: 10.1080/17476348.2021.1842202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Lung cancer is a frequent pathology for which the best curative treatment is pulmonary resection. Pulmonary arterial hypertension is a rare disease but pulmonary hypertension associated with parenchymal disease or left heart disease is frequently observed in these patients. The diagnosis of pulmonary hypertension before lung resection makes the perioperative management of these patients more difficult and sometimes leads to rejecting patients for surgery. AREAS COVERED We performed a review of literature on PubMed on Pulmonary hypertension associated lung resection, preoperative assessment of lung resection and perioperative management of PH patients, including guidelines and clinical trials.In this review, we summarize the current state of knowledge regarding the pre and perioperative management of patients with suspected or confirmed PH who can benefit from surgical treatment of lung cancer. EXPERT OPINION Management of PH patients before lung resection should include a very careful workup including at least right heart catheterization with evaluation of the targeted PH treatment in an expert center and evaluation of other comorbidities. Perioperative management must be carried out in a specialized center.
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Affiliation(s)
- Gaelle Dauriat
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital GHPSJ, Institut d'Oncologie Thoracique and Paris Saclay University, France
| | - Jerome LePavec
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital GHPSJ, Institut d'Oncologie Thoracique and Paris Saclay University, France
| | - Pauline Pradere
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital GHPSJ, Institut d'Oncologie Thoracique and Paris Saclay University, France
| | - Laurent Savale
- AP-HP, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Séveère, Hôpital Bicêtre, France
| | - Dominique Fabre
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital GHPSJ, Institut d'Oncologie Thoracique and Paris Saclay University, France
| | - Elie Fadel
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital GHPSJ, Institut d'Oncologie Thoracique and Paris Saclay University, France
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14
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Wu CF, Fu JY, Li YS, Wen CT, Wan YL, Liu YH, Hsieh MJ, Wu CY. Surgical result in non small cell lung cancer patients presenting with ground glass opacity predominant lesion less than 2 cm: Anatomic versus wedge resection. Biomed J 2020; 44:S235-S241. [PMID: 35300942 PMCID: PMC9068530 DOI: 10.1016/j.bj.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 09/02/2020] [Accepted: 11/02/2020] [Indexed: 12/20/2022] Open
Abstract
Background Image characteristics of tumor, including tumor size and component are crucial for patients’ survival. Patients who presented with ground glass opacity (GGO) was found less risk of intrapulmonary lymph node metastases and good survival. However, it is difficult to get tissue prove for small GGO lesion preoperatively because of its tiny size and the accuracy of intraoperation frozen section. Some patients received another operation for anatomic resection after malignancy has been confirmed and others refused reoperation and only received wedge resection. The aim of this study was tried to compare the treatment result between anatomic and wedge resection for non small cell lung cancer patients who present as small ground glass opacity (GGO) predominant lesion in pre-operation CT. Methods From January 2010 to May 2014, 500 non small cell lung cancer patients who underwent tumor resection were included. Patients who presented with small GGO predominant lesion in pre-operation CT were included and medical records were reviewed retrospectively. The survival status between anatomic and wedge resection was analyzed. Results 37 patients received anatomic resection (Group A) and 9 patients received wedge resection (Group B). Group B showed less staple usage (p = 0.01) and blood loss (p = 0.02). From view of pathology result, only less intrapulmonary lymph nodes was dissected was identified in group B. From view of survival, similar disease free and overall survival without statistical differences in both groups. Conclusion Wedge resection may provide equivalent treatment result for patients who presented as peripheral GGO or GGO predominant lesions that less than 2 cm in size.
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Yi E, Cho S, Kim K, Jheon S. Comparison of survival outcomes between sublobar resection and lobectomies in early-stage lung adenocarcinoma by propensity score matching analysis. Indian J Thorac Cardiovasc Surg 2020; 36:382-387. [PMID: 33061146 DOI: 10.1007/s12055-019-00897-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/10/2019] [Accepted: 10/23/2019] [Indexed: 10/24/2022] Open
Abstract
Background The aim of this study was to investigate the clinical outcomes of sublobar resections and compare these with those of lobectomies in early-stage lung adenocarcinoma patients. Methods We retrospectively reviewed medical records of 871 patients who underwent lobectomies or sublobar resections for early-stage lung adenocarcinomas. Two hundred thirty-five (27.0%) patients underwent sublobar resections (wedge and segmentectomies), and 636 (73.0%) underwent lobectomies. Propensity score matching resulted in 2 groups each with 219 patients. Survival analysis was performed. Results Mean age of matched patients was 61.9 (± 10.38, range of 21 to 91) years, mean follow-up period was 50.8 (± 27.57, range of 6.1 to 128.9) months, and mean tumor size was 15.2 (± 6.49, range of 3.0 to 45.0) mm. Overall recurrence rate was 9.4% (41 patients), and it was 8.7% (19 patients) in sublobar resection patients and 9.6% (21 patients) in lobectomy patients. Rates and sites of recurrence were not significantly different between the two surgical groups (p = 0.500 and 0.401, respectively). Overall 5-year survival and recurrence-free survival of sublobar resection patients were 90.6 and 89.5%, respectively, whereas those of lobectomy patients were 91.9 and 88.3%, respectively. No significant differences in overall 5-year survival rate or recurrence-free survival rate were found between the two groups (p = 0.636 and p = 0.975, respectively). Conclusions Prognosis of early-stage lung adenocarcinoma treated with sublobar resection was not inferior to that treated with lobectomy in carefully selected cases. Further investigations, including randomized controlled trials, are needed to identify the equivalent oncologic efficacy of sublobar resections.
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Affiliation(s)
- Eunjue Yi
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Sukki Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi South Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kwhanmien Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi South Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Sanghoon Jheon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi South Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, South Korea
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16
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Nguyen D, Gharagozloo F, Tempesta B, Meyer M, Gruessner A. Long-term results of robotic anatomical segmentectomy for early-stage non-small-cell lung cancer. Eur J Cardiothorac Surg 2020; 55:427-433. [PMID: 30325403 DOI: 10.1093/ejcts/ezy332] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/27/2018] [Accepted: 08/30/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Anatomical segmentectomy is advocated for curative resection in select patients. We investigated the long-term results of robotic anatomical segmentectomy with mediastinal nodal dissection in patients with early-stage lung cancer. METHODS We retrospectively reviewed patients who underwent robotic anatomical segmentectomy for early-stage non-small-cell lung cancer (NSCLC). The follow-up data were obtained to determine survival and statistically significant risk factors in both univariable and multivariable models. RESULTS Seventy-one patients had clinical stage I NSCLC (36 men, 35 women, mean age 70 ± 12 years). All patients underwent R0 resection. The mean operating time was 134 min. Ten of 71 (14%) patients were upstaged. Eight of 71 (11%) patients were upstaged due to the size of tumour in the pathological specimen, and 2 of 71 (3%) patients were upstaged due to microscopic N2 nodal metastasis. Median hospitalization was 4 days (2-31 days). Complication rate was 29%. There were no complications attributable to the surgical robot. No patient died within 90 days. Mean follow-up was 54 months (range 2 months to 9 years). The overall 5-year survival was 43%, whereas lung cancer-specific 5-year survival was 55%. The 5-year lung cancer-specific survival for pathological stage I disease was 73%. Local or mediastinal recurrence occurred in 4 of 71(5%) patients. Pathological upstaging or recurrence resulted in 0% 5-year survival. The univariable and multivariable analyses showed that advanced age and pathological upstaging were statistically significant risk factors for lung cancer-specific death. CONCLUSIONS Robotic anatomical segmentectomy with mediastinal nodal dissection is a safe and feasible procedure. Accurate preoperative clinical staging is of critical importance for long-term survival.
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Affiliation(s)
- Duy Nguyen
- Division of Cardiothoracic Surgery, The University of Arizona Medical Center, Tucson, AZ, USA
| | - Farid Gharagozloo
- Global Robotics Institute, Florida Hospital Celebration Health and University of Central Florida, Orlando, FL, USA
| | - Barbara Tempesta
- Global Robotics Institute, Florida Hospital Celebration Health and University of Central Florida, Orlando, FL, USA
| | - Mark Meyer
- Division of Cardiothoracic Surgery, The University of Arizona Medical Center, Tucson, AZ, USA
| | - Angelika Gruessner
- Department of Biostatistics, The University of Arizona Medical Center, Tucson, AZ, USA
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17
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Hao B, Zhang L, Fan T, Liu B, Jiang W, Hu H, Geng Q. Survival Following Segmentectomy or Lobectomy in Patients With Stage IB Non-small-cell Lung Cancer. Front Oncol 2020; 10:661. [PMID: 32500023 PMCID: PMC7243118 DOI: 10.3389/fonc.2020.00661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/08/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Lobectomy with mediastinal lymph node dissection has always been recognized as the standardized treatment for early-stage non-small-cell lung cancer. However, the feasibility of segmentectomy performed in stage IB non-small-cell lung cancer (NSCLC) patients remains controversial. The present study aims to investigate whether the outcome of stage IB NSCLC patients undergoing segmentectomy was comparable to those who underwent lobectomy. Method: We retrospectively collected data of 11,010 patients with primary stage IB non-small-cell lung cancer from the Surveillance, Epidemiology, and End Results database. Overall survival (OS) and lung cancer-specific survival (LCSS) were assessed among patients who were performed lobectomy or segmentectomy. To further assess the impact of the surgical procedures on patients with different tumor sizes, subgroups stratified by tumor size were analyzed. Results: A total of 11,010 patients who were pathologically confirmed to be stage IB were included, of whom 10,453 received lobectomy and 557 received segmentectomy. Both univariate and multivariate Cox regression analyses showed that the patients receiving lobectomy had better OS [hazards ratio (HR) = 1.197, 95% confidence interval (CI) (1.066, 1.343), P < 0.001] than those receiving segmentectomy. However, multivariate analysis showed that there was no significant difference in LCSS between lobectomy and segmentectomy [HR = 1.172, 95% CI (0.963, 1.427), P = 0.114]. Meanwhile, subgroup analyses showed that lobectomy rather than segmentectomy was associated with better OS [HR = 1.278, 95% CI (1.075, 1.520) P = 0.006] and LCSS [HR = 1.118, 95% CI (1.005, 1.280), P = 0.047] for patients with a tumor size (TS) of ≤ 40 and >30 mm, while for patients with a TS of ≤ 30 mm, lobectomy yielded similar OS [TS ≤ 20 mm: HR = 1.068, 95% CI (0.853, 1.336), P = 0.566; TS > 20 mm and ≤ 30 mm: HR = 1.195, 95% CI (0.961, 1.487), P = 0.109] and LCSS [TS ≤ 20 mm: HR = 1.029, 95% CI: (0.682, 1.552), P = 0.893; TS > 20 and ≤ 30 mm: HR = 1.144, 95% CI (0.795, 1.645), P = 0.469] to that of segmentectomy. Conclusion: Segmentectomy achieved equivalent OS and LCSS in stage IB NSCLC patients with TS ≤ 30 mm compared with lobectomy. Lobectomy showed better OS and LCSS than segmentectomy for patients with a TS of >30 and ≤ 40 mm. Segmentectomy may be acceptable in patients with an older age and a smaller TS.
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Affiliation(s)
- Bo Hao
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lin Zhang
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Tao Fan
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bohao Liu
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wenyang Jiang
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hao Hu
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qing Geng
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
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18
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Liao M, He Z, Xu E, Wu D. [Value of preoperative localization techniques for solitary pulmonary nodules in singleport thoracoscopic surgery]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:718-722. [PMID: 32897207 DOI: 10.12122/j.issn.1673-4254.2020.05.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
ObjectiveTo evaluate the value and clinical effect of different preoperative localization techniques for solitary pulmonary nodules (SPN) before single-port thoracoscopic surgery.MethodFrom January 2018 to June 2019, 54 patients diagnosed with solitary pulmonary nodules received single-port thoracoscopic surgery in Thoracic Department of General Hospital of Southern Theater Command of PLA. Based on the location methods of the nodules, the patients were divided into group A (34 cases) with preoperative CT-guided Hook-wire (a common positioning needle usually using in mammary gland) positioning and group B (20 cases) with preoperative CT-guided methylene blue location.ResultsThe success rate of localization in group A was 94.18% (32/34), significantly higher than that in group B [85% (17/20), P < 0.05). No intraoperative conversion to thoracotomy occurred in group A, while the conversion rate was 10% (2/20) in group B (P < 0.05). The average positioning cost was significantly higher in group A than in group B (1715±109 vs 1021±86 RMB yuan, P < 0.05), but the total hospitalization cost was similar between the two groups (50 114±3788 vs 47871±5902 RMB yuan, P>0.05). The length of hospital stay was significantly shorter in group A than in group B (6.71±1.23 vs 8.19±2.61 days, P < 0.05).ConclusionCompared with the traditional methylene blue localization method, Hook-wire localization positioning can significantly increase the success rate of localization, and can be used as the standard preoperative localization method in patients undergoing single-port thoracoscopic pulmonary nodule resection, especially in those with deep nodule location from the visceral pleura.
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Affiliation(s)
- Ming Liao
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Zhe He
- Department of Thoracic Surgery, General Hospital of Southern Theater Command, PLA, Guangzhou 510010, China
| | - Enwu Xu
- Department of Thoracic Surgery, General Hospital of Southern Theater Command, PLA, Guangzhou 510010, China
| | - Dehua Wu
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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19
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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.
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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
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20
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Zheng E, Yang M, Li R, Ni J, Xu X, Zhao G. Prognostic impact of lymphadenectomy on outcomes of sublobar resection for non-small cell lung cancer ≤1 or >1 to 2 cm. J Thorac Dis 2020; 12:2049-2060. [PMID: 32642107 PMCID: PMC7330392 DOI: 10.21037/jtd-19-3773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Lymphadenectomy is an important part of surgical treatment for non-small cell lung cancer (NSCLC). However, the prognostic impact of lymph node (LN) dissection for patients with NSCLC ≤1 and >1 to 2 cm who underwent sublobar resection is still unclear. Methods A group of patients numbering 7,627 with NSCLC 2 cm or less who underwent sublobar resection were identified from the Surveillance, Epidemiology, and End Results (SEER) database between January 2010 and November 2015. The overall survival (OS) and lung cancer-specific survival (LCSS) were evaluated among patients who had undergone dissection of ≥4 LNs, 1 to 3 LNs or who had no-LN dissection; log-rank and Cox proportional-hazards regression analyses were used for the evaluation. Results Patients with NSCLC ≤2 cm who underwent ≥4 LNs dissection had better OS and LCSS compared with those who underwent dissection of 1 to 3 LNs or who had no-LN dissection after sublobar resection. Subgroup analysis showed that dissection of ≥4 LNs had better OS and LCSS than those of 1 to 3 LNs dissection in NSCLC >1 to 2 cm, whereas had similar OS and LCSS in NSCLC ≤1 cm. Multivariate Cox analysis showed that dissection of 1 to 3 LNs was not an independent risk factor of OS and LCSS than dissection of ≥4 LNs in NSCLC ≤1 cm after sublobar resection. Conclusions The extent of LN dissection is associated with the survival outcomes in patients with NSCLC ≤2 cm after sublobar resection. Dissection of ≥4 LNs should be recommended for NSCLC >1 to 2 cm, whereas surgeons can rely on surgical skills and patient profiles to decide ≥4 LNs or 1 to 3 LNs dissection for NSCLC ≤1 cm during sublobar resection.
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Affiliation(s)
- Enkuo Zheng
- Department of Thoracic Surgery, Hua Mei Hospital, University of Chinese Academy of Science, Ningbo 315012, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Science, Ningbo 315012, China
| | - Minglei Yang
- Department of Thoracic Surgery, Hua Mei Hospital, University of Chinese Academy of Science, Ningbo 315012, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Science, Ningbo 315012, China
| | - Rui Li
- Department of Thoracic Surgery, Hua Mei Hospital, University of Chinese Academy of Science, Ningbo 315012, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Science, Ningbo 315012, China
| | - Junjun Ni
- Department of Thoracic Surgery, Hua Mei Hospital, University of Chinese Academy of Science, Ningbo 315012, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Science, Ningbo 315012, China
| | - Xiang Xu
- Department of Thoracic Surgery, Hua Mei Hospital, University of Chinese Academy of Science, Ningbo 315012, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Science, Ningbo 315012, China
| | - Guofang Zhao
- Department of Thoracic Surgery, Hua Mei Hospital, University of Chinese Academy of Science, Ningbo 315012, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Science, Ningbo 315012, China
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21
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Drevet G, Maury JM, Ginoux M, Tronc F. [Short-term results of video-assisted lung cancer surgery in octogenarians]. Rev Mal Respir 2020; 37:293-298. [PMID: 32273117 DOI: 10.1016/j.rmr.2020.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 01/31/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Due to an increase in life expectancy, onco-pulmonologists and thoracic surgeons are more frequently faced with octogenarian patients with lung cancer. In this age group, treatment modalities may need to be revised because of the increasing presence of comorbidities. Surgery remains the reference treatment for early stage disease, but mortality rates and postoperative complications are higher in this group of patients. One of the solutions to reduce the operative risk would be to develop videoassisted thoracoscopic pulmonary resection surgery. The aim of this study was to evaluate the results of this form of lung cancer surgery in octogenarians. METHODS All patients 80 years old or more who underwent videoassisted lung cancer surgery from 2014 to 2018 at Lyon University Hospital were included. Wedge resections and diagnostic procedures were excluded. RESULTS Nineteen patients (13 men, 6 women) were included. The median age was 82 years old. All patients had undergone videoassisted lobectomy. Three patients required conversion to thoracotomy (15.8%). All patients underwent complete resection (R0). One patient had N1 lymph node involvement, all others were N0. The postoperative complication rate was 68.4%, the majority of which were grade II of the Clavien classification. Perioperative mortality was 5.3%. CONCLUSIONS Videoassisted lung cancer resection in a selected population of octogenarians is associated with satisfactory short-term results. It is reasonable to favour minimally invasive techniques in this population, even if the proof of their superiority has not yet been firmly established.
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Affiliation(s)
- G Drevet
- Service de chirurgie thoracique, de transplantation pulmonaire et cardiopulmonaire, hôpital Louis-Pradel, Lyon, France.
| | - J-M Maury
- Service de chirurgie thoracique, de transplantation pulmonaire et cardiopulmonaire, hôpital Louis-Pradel, Lyon, France
| | - M Ginoux
- Service de pneumologie, hôpital Louis-Pradel, Lyon, France
| | - F Tronc
- Service de chirurgie thoracique, de transplantation pulmonaire et cardiopulmonaire, hôpital Louis-Pradel, Lyon, France
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22
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Liu B. [Diagnosis and Treatment of Pulmonary Ground-glass Nodules]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:449-456. [PMID: 31315784 PMCID: PMC6712268 DOI: 10.3779/j.issn.1009-3419.2019.07.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Recent widespread use of high resolution computed tomography (HRCT) for the screening of lung cancer have led to an increase in the detection rate of very faint and smaller lesions known as ground-glass nodule (GGN). However, it had been proved that GGN was well associated with lung cancer in previous studies. Therefore, the classification, imaging characteristics, pathological type, follow-up, suggested managements and other clinical concerns of GGN were reviewed in this paper.
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Affiliation(s)
- Baodong Liu
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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23
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Tsutani Y, Tsubokawa N, Ito M, Misumi K, Hanaki H, Miyata Y, Okada M. Postoperative complications and prognosis after lobar resection versus sublobar resection in elderly patients with clinical Stage I non-small-cell lung cancer. Eur J Cardiothorac Surg 2019; 53:366-371. [PMID: 28958068 DOI: 10.1093/ejcts/ezx296] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 07/09/2017] [Accepted: 07/24/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The study aimed to investigate the outcomes of sublobar resection in elderly patients with non-small-cell lung cancer. METHODS A total of 205 patients aged ≥75 years were identified from 794 consecutive patients who underwent complete surgical resection for clinical Stage I non-small-cell lung cancer. The outcomes of lobectomy and sublobar resection were compared. Propensity scores were estimated for multivariable analyses and matching. RESULTS Sublobar resection (n = 99) was more frequently performed than lobectomy (n = 106) in older patients (P = 0.027) and those with lower maximum standardized uptake on positron emission tomography (P < 0.001), lower T stage (P < 0.001), lower %vital capacity (P = 0.007) and lower %diffusing capacity of the lungs for carbon monoxide (P = 0.025). Severe (≥Grade IIIa) postoperative complications occurred more frequently with lobectomy (11 of 106 procedures, 10.4%) than with sublobar resection (5 of 99, 5.1%; P = 0.16). In propensity score-adjusted multivariable analysis, lobectomy was an independent predictive factor for severe postoperative complications (odds ratio 3.49, 95% confidence interval 1.01-12.05; P = 0.048). Overall survival (OS) was not significantly different following lobectomy (5-year OS 67.2%) or sublobar resection (5-year OS 73.9%; P = 0.93). In multivariable analysis, the surgical procedure was not an independent predictive factor for OS (lobectomy: hazard ratio 1.03, 95% confidence interval 0.49-2.16; P = 0.94). CONCLUSIONS Sublobar resection may be the optimal procedure in elderly patients with clinical Stage I non-small-cell lung cancer and is associated with less severe postoperative complications than lobectomy and similar OS.
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Affiliation(s)
- Yasuhiro Tsutani
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Norifumi Tsubokawa
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Masaoki Ito
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Keizo Misumi
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Hideaki Hanaki
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yoshihiro Miyata
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
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24
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New T1 classification. Gen Thorac Cardiovasc Surg 2019; 68:665-671. [PMID: 31679135 DOI: 10.1007/s11748-019-01233-0] [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: 10/05/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
Abstract
The IASLC staging and Prognostic Factor Committee proposed new changes to the descriptors for the 8th edition of the Tumour Node Metastasis Staging for Lung Cancer. The T1 descriptor changes include (1) T1 tumours are subclassified into T1a (< 1 cm), T1b (> 1 to < 2 cm), T1c (> 2 to < 3 cm). The corresponding changes are introduced to the overall staging: T1aN0M0 = Stage IA1; T1bN0M0 = Stage IA2; T1cN0M0 = Stage IA3. (2) The introduction of the pathological entities Adenocarcinoma-In-Situ (AIS), Minimally Invasive Adenocarcinoma, and Lepidic Predominant Adenocarcinoma. The corresponding changes on the T descriptor are as follows: Adenocarcinoma-in situ is coded as Tis (AIS); Minimally Invasive Adenocarcinoma is coded as T1a(mi). In this review, the basis for these changes will be described, and the implications on clinical practice will be discussed.
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25
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Chang CC, Yen YT, Lin CY, Chen YY, Huang WL, Tseng YL. Single-port video-assisted thoracoscopic surgery subsegmentectomy: The learning curve and initial outcome. Asian J Surg 2019; 43:625-632. [PMID: 31672480 DOI: 10.1016/j.asjsur.2019.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/07/2019] [Accepted: 09/19/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND We report initial surgical results and learning process of single-port video-assisted thoracoscopic surgery (VATS) subsegmentectomy in comparison with segmentectomy in our institution as the presentative of minimal invasiveness and precise resection for early stage lung cancer. METHODS All patients undergoing single-port VATS sublobar anatomic resection between January 2014 and December 2018 for clinical diagnosis of lung cancer were included. The learning curve was analyzed using the cumulative summation (CUSUM) method. Comparisons were done between those who underwent single-port VATS subsegmentectomy and segmentectomy. RESULTS A total of 364 patients underwent single-port VATS segmentectomy and 91 patients underwent single-port VATS subsegmentectomy were included. Lung adenocarcinoma was the most common (61.1%) diagnosis. The operative time and blood loss in the subsegmentectomy group were less than the segmentectomy group. The incidence of intraoperative complication was also lower in the subsegmentectomy group. The surgical proficiency was reached at 28 cases in single-port VATS subsegmentectomy. For primary lung cancer, the tumor size in subsegmentectomy group was smaller than segmentectomy group (1.1 cm versus 1.4 cm, p = 0.026). The resection margin was smaller in subsegmentectomy group, and both groups reached adequate margin without significant difference (94.7% versus 95.5%, p = 0.737). During the follow-up period, 2 (3.5%) patients in subsegmentectomy group and 9 (4.1%) patients in segmentectomy group developed distant metastasis. CONCLUSION Single-port VATS subsegmentectomy is safe and feasible for small-sized lung lesion, providing the benefit of minimal invasiveness, preservation of pulmonary function, and clearance of lymphatic drainage at the intersegmental plane. The surgical proficiency could be achieved based on the experiences in single-port VATS segmentectomy.
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Affiliation(s)
- Chao-Chun Chang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of Trauma and Acute Care Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Ying Lin
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ying-Yuan Chen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Li Huang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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26
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Guo J, Liu Y, Tian X, Ren Z, Lin J, Wang B, Liang C. Less is more in solid-dominant lung cancer? Sublobar resection versus lobectomy for solid-dominant stage IA non-small-cell lung cancer: A meta-analysis study. Mol Clin Oncol 2019; 11:465-473. [PMID: 31620277 PMCID: PMC6788015 DOI: 10.3892/mco.2019.1914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 06/27/2019] [Indexed: 12/19/2022] Open
Abstract
Although lobectomy is well established as the standard surgical procedure for stage IA non-small-cell lung cancer (NSCLC), sublobar resection is increasingly preferred, particularly in intentional segmentectomy for radiologically less-invasive small NSCLC. However, the indication for sublobar resection of radiologically pure solid or solid-dominant NSCLC remains controversial, owing to its invasive pathological characteristics. Therefore, the present meta-analysis was conducted to compare the efficacy of sublobar resection with lobectomy for treating solid-dominant stage IA NSCLC. An electronic search was conducted using four online databases from their dates of inception to April 2017. The hazard ratio (HR) was used as a summary statistic for censored outcomes and the odds ratio (OR) was used as the summary statistic for dichotomous variables. A total of nine studies met the selection criteria, including a total of 2,265 patients (1,728 patients underwent lobectomy, 425 segmentectomy and 112 wedge resection). From the available data, patients treated with a sublobar resection had a higher risk of local recurrence compared with patients treated with lobectomy [OR=1.89; 95% confidence interval (CI), 1.02–3.50; P=0.04]. However, no obvious difference in local recurrence was found in a subgroup analysis of segmentectomy compared with lobectomy (OR=1.19; 95% CI, 0.68–2.10; P=0.61). Sublobar resection was not associated with a significantly negative impact on distant recurrence (OR=1.09; 95% CI, 0.55–2.16; P=0.796). Patients in the sublobar resection group had no significant differences in recurrence-free survival (RFS; HR=1.43; 95% CI, 0.76–2.69; P=0.27) and overall survival (OS; HR=0.96; 95% CI, 0.75–1.23; P=0.77) compared with those in the lobectomy group. In the subgroup analysis of anatomic segmentectomy compared with lobectomy, there was no significant difference in RFS, with mild inter-study heterogeneity. The current meta-analysis suggested that segmentectomy had a comparable oncologic efficacy to lobectomy for solid-dominant stage IA NSCLC. Therefore, segmentectomy may be a feasible alternative in selected cases of solid-dominant stage IA NSCLC. However, these findings should be confirmed by prospective randomized controlled trials in the future.
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Affiliation(s)
- Juntang Guo
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Yang Liu
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Xiaodong Tian
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Zhipeng Ren
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Jixing Lin
- Department of Thoracic Surgery, Hainan Branch, Chinese PLA General Hospital, Sanya, Hainan 572014, P.R. China
| | - Bailin Wang
- Department of Thoracic Surgery, Hainan Branch, Chinese PLA General Hospital, Sanya, Hainan 572014, P.R. China
| | - Chaoyang Liang
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China
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27
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Fiorelli A, Mauro I, Cicchitto G, Prencipe A, Polverino M, Di Crescenzo VG, Santini M. Lobar or sublobar resections are safe procedures for management of early lung cancer. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S107. [PMID: 31576314 DOI: 10.21037/atm.2019.05.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | | | | | - Aldo Prencipe
- Cardio-Thoracic Surgery, Spedali Civili di Brescia, Brescia, Italy
| | | | | | - Mario Santini
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
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Seo YS, Kim HJ, Wu HG, Choi SM, Park S. Lobectomy versus stereotactic ablative radiotherapy for medically operable patients with stage IA non-small cell lung cancer: A virtual randomized phase III trial stratified by age. Thorac Cancer 2019; 10:1489-1499. [PMID: 31124275 PMCID: PMC6558457 DOI: 10.1111/1759-7714.13103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Although the choice between stereotactic ablative radiotherapy (SABR) and lobectomy for early-stage non-small cell lung cancer (NSCLC) has been debated for years, the two procedures have not yet been directly compared in a randomized trial. We conducted a virtual randomized phase III trial stratified by age to compare the effectiveness of lobectomy and SABR for medically operable patients with stage IA (AJCC eighth) NSCLC using the Markov model analysis. METHODS A Markov model was developed to simulate a cohort of patients aged 45-85 years with stage IA NSCLC who had undergone either lobectomy or SABR and were followed up for their remaining lifetime. Each virtual patient was randomly assigned to undergo lobectomy or SABR, and 10 000 patients were allocated to each group. All estimates of the variables were obtained by a systematic review of published articles. RESULTS The lobectomy group showed a better life expectancy than the SABR group, in patients under 75 years of age. However, no statistically significant difference was seen in patients 75 years or older. The predicted life expectancy was 9.43 and 8.70 years in 75-year-old patients in the lobectomy and SABR groups, respectively. However, the 95%CI for the difference in life expectancy between the two groups was - 0.06-1.50 years (P = 0.0689). CONCLUSIONS The Markov model showed no statistically significant difference in the expected overall survival in stage IA NSCLC patients who were older than 75 years and had undergone SABR or lobectomy.
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Affiliation(s)
- Young-Seok Seo
- Department of Radiation Oncology, ChungBuk National University Hospital, Chungcheongbuk-do, Republic of Korea.,Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiation Oncology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hong Gyun Wu
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiation Oncology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun Mi Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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29
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Zhang Z, Feng H, Zhao H, Hu J, Liu L, Liu Y, Li X, Xu L, Li Y, Lu X, Fu X, Yang H, Liu D. Sublobar resection is associated with better perioperative outcomes in elderly patients with clinical stage I non-small cell lung cancer: a multicenter retrospective cohort study. J Thorac Dis 2019; 11:1838-1848. [PMID: 31285876 DOI: 10.21037/jtd.2019.05.20] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Sublobar resection has emerged as an alternative to lobectomy for management of early-stage non-small cell lung cancer (NSCLC). However, controversy remains as to whether it is adequate for elderly patients. The present study aimed to comparatively study the perioperative outcomes and overall survival of sublobar resection vs. lobectomy for management of elderly patients (≥65 years) with clinical stage I NSCLC. Methods This is a multicenter retrospective cohort study. Clinical stage I NSCLC patients who underwent lobar or sublobar resection (segmentectomy and wedge resection) at the Department of Thoracic Surgery of 10 tertiary hospitals between January 2014 and September 2017 were retrospectively reviewed from the national collaborative prospective lung cancer database (LinkDoc Technology Co, Ltd., Beijing, China). Clinical data on demographic and tumor characteristics, surgical details were collected. Perioperative outcomes and overall survival were analyzed by using propensity score matching to adjust for selection bias. Subgroup analysis was further carried out to explore the potential sources of heterogeneity. Results Among the 1,579 eligible patients, 1,164 (73.7%) underwent lobectomy and 415 (26.3%) underwent sublobar resection (106 segmentectomy and 309 wedge resection). Sublobar resection was more frequently performed in patients who were elder, had more comorbidities and smaller, left-sided adenocarcinoma (P<0.001). Propensity-matched analysis showed significant association of sublobar resection with less blood loss, shorter operation time, chest drainage and hospital stay, while with less lymph node removal when compared with lobectomy (P<0.001). Short term survival analysis showed comparable results even after adjusted in the matched analysis. Similar results were obtained when limiting patients to those aged >75 years, at pathologic stage I, and those who smoking or undergoing video-assisted thoracoscopic surgery (VATS) or segmentectomy and lobectomy. Conclusions Sublobar resection was associated with significantly better perioperative outcomes without compromising short term survival in elderly patients with clinical stage I NSCLC. However, the importance of patient selection and management process, as well as accurate lymph node staging must be acknowledged when making the surgical decision (clinical registration number: NCT03429673).
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Affiliation(s)
- Zhenrong Zhang
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Hongxiang Feng
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Heng Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai 200030, China
| | - Jian Hu
- Department of Thoracic Surgery, First Hospital Affiliated to Medical College of Zhejiang University, Hangzhou 310000, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yang Liu
- Department of Thoracic Surgery, Chinese People's Liberation Army General Hospital, Beijing 1000853, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Lin Xu
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, Cancer Institute of Jiangsu Province, Nanjing 210009, China.,Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing 210009, China
| | - Yin Li
- Department of Thoracic Surgery, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Xike Lu
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300051, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Haiying Yang
- Medical Affairs, LinkDoc Technology Co, Ltd., Beijing 100080, China
| | - Deruo Liu
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
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30
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Dong S, Roberts SA, Chen S, Zhong X, Yang S, Qu X, Xu S. Survival after lobectomy versus sub-lobar resection in elderly with stage I NSCLC: a meta-analysis. BMC Surg 2019; 19:38. [PMID: 30987622 PMCID: PMC6466711 DOI: 10.1186/s12893-019-0500-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 03/29/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND We present a critical comparison of lobectomy and sub-lobar resection in elderly patients with early stage non-small cell lung cancer using meta-analytical techniques. METHODS A literature search was conducted between the period of December 1997 to March 2019 to identify the comparative studies evaluating 1-, 3-, and 5-year survival rates. The pooled odds ratios (OR) and the 95% confidence intervals (95% CI) were calculated with either the fixed or random effect models, respectively. RESULTS Six retrospective studies are included in our meta-analysis for a total of 1205 patients. 843 of the individuals were treated with lobectomy, while 362 were treated with sub-lobar resection. We found no significant difference between the lobectomy and the sub-lobar resection in either of the 1-, 3-, or 5-year survival rates. CONCLUSIONS This study suggests that in elderly individuals with stage I NSCLC, a sub-lobar resection is statistically equivalent to the lobectomy in terms of 1-, 3-, and 5-year survival rates. Further large-scale randomized studies are needed to confirm our results.
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Affiliation(s)
- Siyuan Dong
- Department of Thoracic Surgery, First Hospital of China Medical University, 155 North Nanjing Street, Shenyang, Liaoning, China
| | - Steven A Roberts
- Ott lab, Massachusetts General Hospital, Harvard Medical School, 185 Cambridge Street, Boston, USA
| | - Shuang Chen
- Department of Cardiovascular, First Hospital of China Medical University, 155 North Nanjing Street, Shenyang, Liaoning, China
| | - Xinwen Zhong
- Department of Thoracic Surgery, First Hospital of China Medical University, 155 North Nanjing Street, Shenyang, Liaoning, China
| | - Shize Yang
- Department of Thoracic Surgery, First Hospital of China Medical University, 155 North Nanjing Street, Shenyang, Liaoning, China
| | - Xiaohan Qu
- Department of Thoracic Surgery, First Hospital of China Medical University, 155 North Nanjing Street, Shenyang, Liaoning, China
| | - Shun Xu
- Department of Thoracic Surgery, First Hospital of China Medical University, 155 North Nanjing Street, Shenyang, Liaoning, China.
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31
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Okami J. Treatment strategy and decision-making for elderly surgical candidates with early lung cancer. J Thorac Dis 2019; 11:S987-S997. [PMID: 31183181 DOI: 10.21037/jtd.2019.04.01] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Among elderly cancer patients of the same chronological age, there is a wide range of heterogeneity in their ability to tolerate surgery. When an elderly patient comes to a thoracic surgeon, the surgeon first considers how healthy the patient is. If the patient looks healthy or in fit condition, the surgeon offers lobectomy plus mediastinal lymph node dissection. On the other hand, if the patient looks frail, the surgeon may offer, instead of a standard treatment, lobectomy without lymph node dissection, sublobar resection, or radiotherapy or may not offer any kind of treatment. This review was conducted to obtain an overview of these options and compare the treatment outcomes reported in the literature for the purpose of making a good decision for elderly surgical candidates with early lung cancer.
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Affiliation(s)
- Jiro Okami
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
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32
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Hong S, Moon YK, Park JK. Comparison of Surgical Outcomes and Survival between Octogenarians and Younger Patients after Pulmonary Resection for Stage I Lung Cancer. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 51:312-321. [PMID: 30402390 PMCID: PMC6200170 DOI: 10.5090/kjtcs.2018.51.5.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 11/20/2022]
Abstract
Background Treatment strategies for octogenarians with lung cancer remain controversial. The purpose of this study was to compare surgical outcomes and survival between octogenarians and younger patients with stage IA and IB lung cancer. Methods We reviewed the medical records of 34 consecutive octogenarians and 457 younger patients (<70 years) with stage I lung cancer who underwent surgical resection from January 2007 to December 2015. We analyzed the survival and surgical outcomes of the 2 groups according to the lung cancer stage (IA and IB). Results The only significant differences in the clinicopathological features between the groups were the higher proportion of sublobar resection (56.3% vs. 18.9%) and the smaller number of dissected lymph nodes (LNs) in octogenarians. There was no significant difference in hospital stay (11 days vs. 9 days), pneumonia (5.8% vs 1.9%), or operative mortality (0% vs 0.6%) between the 2 groups. Among patients with stage IA lung cancer, 5-year recurrence-free survival was not significantly different between the octogenarians (n=16) and younger patients (n=318) (86.2% vs. 89.1%, p=0.548). However, 5-year overall survival was significantly lower in octogenarians than in younger patients (79.4% vs. 93.4%, p=0.009). Among patients with stage IB lung cancer, there was no significant difference in 5-year recurrence-free survival (62.1% vs. 73.5%, p=0.55) or overall survival (77.0% vs 85.0%, p=0.75) between octogenarians (n=18) and younger patients (n=139). In multivariable analysis, male sex, the number of dissected LNs, and tumor size were factors related to survival (hazard ratio [HR], 5.795; p=0.017; HR, 0.346, p=0.025; and HR, 1.699; p=0.035, respectively). Conclusion Surgical outcomes and survival after pulmonary resection for stage I lung cancer were comparable in octogenarians and younger patients. Continued careful selection of octogenarians for pulmonary resection is important to achieve good results.
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Affiliation(s)
- Seokbeom Hong
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Young Kyu Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Jae Kil Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
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33
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Zhang Z, Feng H, Xiao F, Liu D. Limited resection in clinical stage I non-small cell lung cancer patients aged 75 years old or more: a meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:359. [PMID: 30370286 DOI: 10.21037/atm.2018.08.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study aims to compare perioperative and oncologic efficacy of limited resection with lobectomy in clinical stage I non-small cell lung cancer (NSCLC) patients ≥75 years old. Methods A systemic search of database including PubMed, OVID and Cochrane was carried out to identify the potential relevant studies published. Data extracted were analyzed with Revman 5.1. Results 5,304 citations were identified by the electronically search. A total of 3,461 patients were included, of whom 1,323 received limited resection and 2,139 received lobectomy. There was higher postoperative complication ratio after lobectomy (32.93% vs. 23.87%, RR =0.71; 95% CI, 0.54-0.93; P=0.01). There were similar total recurrent (18.56%, RR =1.15; 95% CI, 0.82-1.61; P=0.43), and distant recurrent ratio (16.17%, RR =0.67; 95% CI, 0.43-1.05; P=0.08) between groups. Lower local-regional recurrent ratio (2.40%, RR =4.31; 95% CI, 1.98-9.39; P<0.001) was observed after lobectomy. Compared with lobectomy, patients received limited resection showed poorer overall survival (HR =1.24; 95% CI, 1.07-1.44; P=0.004) and lung cancer specific survival (HR =1.37; 95% CI, 1.14-1.64; P<0.001). Conclusions This analysis showed superior lung cancer specific survival, and overall survival after lobectomy over limited resection for clinical stage I NSCLC patients aged ≥75 years old. Our results confirmed that lobectomy should be considered in aged patients if tolerable.
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Affiliation(s)
- Zhenrong Zhang
- Department of Thoracic Surgery, Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China
| | - Hongxiang Feng
- Department of Thoracic Surgery, Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China
| | - Fei Xiao
- Department of Thoracic Surgery, Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China
| | - Deruo Liu
- Department of Thoracic Surgery, Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China
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Kamel MK, Rahouma M, Lee B, Harrison SW, Stiles BM, Altorki NK, Port JL. Segmentectomy Is Equivalent to Lobectomy in Hypermetabolic Clinical Stage IA Lung Adenocarcinomas. Ann Thorac Surg 2018; 107:217-223. [PMID: 30240764 DOI: 10.1016/j.athoracsur.2018.07.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/30/2018] [Accepted: 07/10/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Recent studies have suggested that lobectomy and segmentectomy hold equivalent oncologic outcomes, particularly for small, peripheral, subsolid nodules. However, for hypermetabolic nodules that are frequently associated with high rates of nodal disease, recurrence, or mortality, the optimum oncologic procedure was not assessed. We hypothesize that for hypermetabolic, cT1 N0 adenocarcinoma, lobectomy and segmentectomy are associated with comparable outcomes. METHODS A prospectively collected database was queried for patients with clinical stage IA lung adenocarcinoma who underwent lobectomy or segmentectomy (2000 to 2016) for hypermetabolic tumors (maximum standard uptake value [SUVmax] ≥ 3g/dL). To obtain balanced groups of patients, a propensity matching analysis was done. RESULTS A total of 414 patients had hypermetabolic tumors and underwent lobectomy or segmentectomy. Patients were propensity matched (4:1) (lobectomy: n = 156, segmentectomy: n = 46). Patients in the lobectomy group had a higher rate of pathologic nodal upstaging (17% versus 7%, p = 0.085) and a higher pathologic upstaging rate (38% versus 26%, p = 0.143) than the segmentectomy group. In addition, the lobectomy group had a higher number of resected lymph nodes than the segmentectomy group (median lymph nodes resected: 14 versus 7, p < 0.001). No differences were found in in 5-year recurrence-free survival (RFS; 72% versus 69%, p = 0.679) or in 5-year cancer-specific survival (CSS; 92% versus 83%, p = 0.557) between patients who underwent lobectomy or segmentectomy, respectively. CONCLUSIONS Our data show that lobectomy and segmentectomy are comparable oncologic procedures for patients with carefully staged cT1 N0 lung adenocarcinoma with hypermetabolic tumors (SUVmax ≥ 3g/dL). Although lobectomy was associated with a more thorough lymph node dissection, this did not translate into a higher rate of RFS or CSS compared with segmentectomy.
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Affiliation(s)
- Mohamed K Kamel
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
| | - Mohamed Rahouma
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
| | - Benjamin Lee
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
| | - Sebron W Harrison
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
| | - Brendon M Stiles
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
| | - Nasser K Altorki
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
| | - Jeffrey L Port
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York.
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Tada M, Miyajima M, Mishina T, Takahashi Y, Maki R, Watanabe A. Thoracoscopic Right Basilar Segmentectomy After Right Upper Lobectomy. Ann Thorac Surg 2018; 107:e123-e125. [PMID: 30077592 DOI: 10.1016/j.athoracsur.2018.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/31/2018] [Accepted: 06/08/2018] [Indexed: 11/30/2022]
Abstract
This report describes a case of thoracoscopic right basilar segmentectomy after upper lobectomy. A 76-year-old man who underwent right upper lobectomy for lung tuberculosis 50 years earlier had a diagnosis of squamous cell carcinoma, stage IB (T2a N0 M0), in the right lower lobe and underwent right basilar segmentectomy for limited resection. The postoperative course was uneventful. The patient showed no recurrence clinically, and the 1-year postoperative chest computed tomographic scan showed adequate volume of the middle and residual right lower lobe without emphysematous changes.
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Affiliation(s)
- Makoto Tada
- Department of Thoracic Surgery, Sapporo Medical University School of Medicine and Hospital, Sapporo, Japan
| | - Masahiro Miyajima
- Department of Thoracic Surgery, Sapporo Medical University School of Medicine and Hospital, Sapporo, Japan
| | - Taijiro Mishina
- Department of Thoracic Surgery, Sapporo Medical University School of Medicine and Hospital, Sapporo, Japan
| | - Yuki Takahashi
- Department of Thoracic Surgery, Sapporo Medical University School of Medicine and Hospital, Sapporo, Japan
| | - Ryunosuke Maki
- Department of Thoracic Surgery, Sapporo Medical University School of Medicine and Hospital, Sapporo, Japan
| | - Atsushi Watanabe
- Department of Thoracic Surgery, Sapporo Medical University School of Medicine and Hospital, Sapporo, Japan.
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Guo F, Li X, Wang X, Zheng W, Wang Q, Song W, Yu T, Fan Y, Wang Y. [Value of CT Features on Differential Diagnosis of Pulmonary Subsolid Nodules and Degree of invasion Prediction in Pulmonary Adenocarcinoma]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:451-457. [PMID: 29945703 PMCID: PMC6022034 DOI: 10.3779/j.issn.1009-3419.2018.06.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
背景与目的 亚实性肺结节为肺原发腺癌的常见计算机体层成像(computed tomography, CT)表现,依据其CT影像特征预测病理分型对确定临床治疗策略具有临床价值。本研究根据病理分类,回顾性分析良性、不典型腺瘤样增生(atypical adenomatous hyperplasia, AAH)/原位腺癌(adenocarcinoma in situ, AIS)/微侵袭性腺癌(minimally invasive adenocarcinoma, MIA)、侵袭性腺癌三组亚实性肺结节的CT征象,评估其在良恶性鉴别及恶性侵袭程度判别中的价值。 方法 回顾性分析106例经手术切除亚实性结节的CT征象。依据手术病理分为良性和恶性组,恶性组根据侵袭程度分为无/微侵袭组(AAH/AIS/MIA)、侵袭性腺癌组,测量结节大小、实性成分比例、瘤肺界面、形状、边缘、胸膜牵拉征、空气支气管征、结节内血管异常等CT征象。根据单因素分析(χ2检验、非参数检验Mann-Whitney U检验)结果筛选有统计学差异的变量,纳入Logistic回归多因素分析。 结果 Logistic回归分析显示清晰的瘤肺界面、空气支气管征以及结节内血管异常是恶性结节的重要预测指标,风险比分别为38.1(95%CI: 5.0-287.7; P < 0.01)、7.9(95%CI: 1.3-49.3; P=0.03)、7.2(95%CI: 1.4-37.0; P=0.02)。更大的实性成分所占比例是侵袭性腺癌与AAH/AIS/MIA组鉴别的重要指标,其风险比分别为1.04(95%CI: 1.01-1.06, P=0.01)。 结论 亚实性结节中出现清晰的瘤肺界面、空气支气管征、结节内血管异常提示其恶性概率增加。恶性结节中实性成分所占比例越大预示着侵袭性更高。
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Affiliation(s)
- Fangfang Guo
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xinling Li
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xinyue Wang
- Department of Radiology, Shijiazhuang First Hospital, Shijiazhuang 050011, China
| | - Wensong Zheng
- Department of Radiology, The Third Hospital of Hebei Medical University, Shijiazhuang 050001, China
| | - Qing Wang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Wenjing Song
- Department of Pathology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Tielian Yu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yaguang Fan
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Ying Wang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
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Yen YT, Tseng YL. Surgery for mediastinal lymph node and early stage lung cancer: individualized practice based on clinical database. J Thorac Dis 2018; 10:1233-1235. [PMID: 29707273 DOI: 10.21037/jtd.2018.02.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan.,Division of Trauma and Acute Care Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan
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Dong S, Zhang L. [Progress of Sublobectomy for the Treatment of Stage I Non-small Cell Lung Cancer in the Elderly]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 20:710-714. [PMID: 29061219 PMCID: PMC5972990 DOI: 10.3779/j.issn.1009-3419.2017.10.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
肺癌是世界范围内发病率最高的恶性肿瘤,且有逐年增加的趋势,随着人口老龄化和薄层电子计算机断层扫描(computed tomography, CT)的应用,老年早期肺癌被越来越多的发现,手术仍然是这类人群的主要治疗方式,目前主要手术方式为肺叶切除和亚肺叶切除两种,由于老年群体的特殊性,对手术方式的选择也趋于“个性化”,本文对这两种手术方式的选择问题做一综述。
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Affiliation(s)
- Siyuan Dong
- Department of Thoracic Surgery, the First Hospital of China Medical University, Shenyang 110001, China
| | - Lin Zhang
- Department of Thoracic Surgery, the First Hospital of China Medical University, Shenyang 110001, China
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Clinical significance of the preoperative platelet count and platelet-to-lymphocyte ratio (PLT-PLR) in patients with surgically resected non-small cell lung cancer. Oncotarget 2017; 7:36198-36206. [PMID: 27105529 PMCID: PMC5094993 DOI: 10.18632/oncotarget.8809] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/31/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the prognostic significance of the preoperative platelet count (PLT) and platelet-to-lymphocyte ratio (PLR) in patients with surgically resected non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS We retrospectively reviewed 202 patients treated for NSCLC between January 2002 and December 2007. Preoperative PLT and PLR scores were calculated using data obtained at the time of admission. Patients were assigned a PLT-PLR score of 0, 1, or 2 based upon the presence of thrombocytosis, an elevated PLR, or both. RESULTS Patients with a PLT-PLR score of 2 had a significantly lower median overall survival (OS) [12.715 mo; 95% confidence interval (CI) 1.215-24.215] when compared with patients with PLT-PLR scores of 1 (52.238 mo; 95% CI 17.062-87.414, p = 0.002) or 0 (not reached, p < 0.001). Relapse-free survival (RFS) was also significantly decreased in patients with a PLT-PLR score of 2 (10.107 mo; 95% CI 3.388-16.826) relative to patients with a PLT-PLR score of 1 (27.214 mo; 95% CI 0-56.253, p = 0.002) or 0 (58.893 mo; 95% CI 32.938-84.848, p < 0.001). In multivariate analysis, a PLT-PLR score of 2 was an independent prognostic factor for poor OS (hazard ratio (HR) 3.473; 95% CI 1.765-6.835, p < 0.001) and RFS (HR 2.286; 95% CI 1.243-4.206, p = 0.008) compared with a PLT-PLR score of 0. CONCLUSIONS Preoperative PLT-PLR scores can be useful for predicting disease prognosis in patients with surgically resected NSCLC. Further large prospective studies will be necessary to validate our findings.
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Abstract
The present study investigated and analyzed the clinical impact of sublobectomy on pulmonary functions.Changes in pulmonary function before and after sublobectomy were compared to the changes after lobectomy.Changes in the pulmonary function before and after sublobectomy and lobectomy did not exhibit remarkable differences in long-term effects. Surgery-related indexes of the sublobectomy group were significantly lower than those of the lobectomy group (P < .05). The indexes of pulmonary function both before and after surgery in the sublobectomy group were not associated with a significant decrease in the quality of survival based on pulmonary function as the main index (P > .05).Compared with lobectomy, sublobectomy maximally retained the normal healthy pulmonary tissue, with similar local recurrence rate, 5-year recurrence-free survival rate, and 5-year survival rate. Sublobectomy decreased the impact on respiratory functions to the minimum. After the operation, the quality of survival with pulmonary functions as the main index did not decrease significantly. Therefore, sublobectomy could be an appropriate choice for elderly patients with poor cardiopulmonary function or with chronic diseases.
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41
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Qu X, Wang K, Zhang T, Shen H, Dong W, Liu Q, Du J. Long-term outcomes of stage I NSCLC (≤3 cm) patients following segmentectomy are equivalent to lobectomy under analogous extent of lymph node removal: a PSM based analysis. J Thorac Dis 2017; 9:4561-4573. [PMID: 29268526 DOI: 10.21037/jtd.2017.10.129] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Segmentectomy has the advantage of less complications, but might have less lymph node sampling and higher risk of recurrence. We aimed to compare treatment outcome between two surgical options, and explore the effect of regional lymph node removal on the prognostic difference. Methods We retrospectively analyzed data of stage I non-small cell lung cancer (NSCLC) (≤3 cm in size) patients who underwent either segmentectomy, or lobectomy, collected from the Surveillance, Epidemiology and End Results (SEER) database, from 2003 to 2013. The primary endpoints were overall survival (OS) and lung cancer-specific survival (LCSS). We also collected data from Shandong Provincial Hospital as validation. Results Ultimately 1,156 patients treated by segmentectomy and 17,748 patients treated by lobectomy from SEER database were included in the analysis. Overall, segmentectomy was inferior to lobectomy in terms of OS [hazard ratio (HR): 1.316 (1.186-1.461), P<0.001] and LCSS [HR: 1.310 (1.142-1.504), P<0.001]. When the removal of regional lymph nodes (LN) was taken into consideration, no significant difference was found in OS and LCSS, in any Scope of Regional Lymph Node Surgery layer (0, 1-3, more than 3, and biopsy/sentinel layer, all P>0.05). After propensity score matching (PSM), there was no difference between segmentectomy and lobectomy in OS [HR: 1.081 (0.937-1.248), P=0.286] and LCSS [HR: 1.039 (0.861-1.253), P=0.692]. Only sex, age, histology, summary stage, differentiation, tumor size, and radiation still remained as independent prognostic factors for both OS and LCSS. For validation part, there was no significantly prognostic difference between lobectomy and sublobectomy group in overall (P=0.132) and each regional LN removed layer (0, 1-3, more than 3 layers: all P>0.05). Conclusions Segmentectomy with proper lymph node resection or sampling could be a good alternative to lobectomy.
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Affiliation(s)
- Xiao Qu
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Kai Wang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China.,Department of Healthcare Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Tiehong Zhang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Hongchang Shen
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Wei Dong
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Qi Liu
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Jiajun Du
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China.,Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
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Baldvinsson K, Oskarsdottir GN, Orrason AW, Halldorsson H, Thorsteinsson H, Sigurdsson MI, Jonsson S, Gudbjartsson T. Resection rate and operability of elderly patients with non-small cell lung cancer: Nationwide study from 1991 to 2014. Interact Cardiovasc Thorac Surg 2017; 24:733-739. [PMID: 28329255 DOI: 10.1093/icvts/ivw415] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 11/17/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES An increasing number of elderly patients are diagnosed with non-small cell lung cancer (NSCLC). We compared the surgical resection rate, operability and survival in this age group (≥75 years) to younger patients using centralized databases in Iceland. METHODS The study population comprised all patients diagnosed with NSCLC in Iceland from 1991 to 2014. A total of 140 elderly patients (≥75 years) with NSCLC underwent pulmonary resection and were compared with 550 surgically resected patients less than 75 years, with respect to resection rate, short and long-term survival and complications of surgery. Reasons for exclusion from surgery were registered for elderly surgical candidates (stages IA-IIB). RESULTS Surgical resection rate in the elderly group was 18% compared to 32% in the younger age group ( P < 0.001). The most frequent reasons for not operating on elderly patients in stages IA-IIB were poor pulmonary function (58%), heart disease (17%) or multiple comorbidities (17%). The rate of major complications following surgery was comparable in the elderly versus the younger age group, 13 vs 11%, respectively ( P = 0.578). The same was true for 30 day mortality (2 vs 1%, P = 0.397). Five-year overall survival was 40% vs 44% ( P = 0.019) and cancer-specific survival 51% vs 50% ( P = 0.802). CONCLUSIONS Elderly patients with resectable NSCLC according to stage are frequently excluded from surgery due to comorbid conditions. Although the operated patients may represent a selected group, their favourable 30-day and long-term survival indicate that more elderly patients with NSCLC could be operated on.
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Affiliation(s)
- Kristjan Baldvinsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
| | | | - Andri Wilberg Orrason
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
| | | | - Hunbogi Thorsteinsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
| | | | - Steinn Jonsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Pulmonology, Landspitali University, Reykjavik, Iceland
| | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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Yano T, Kawashima O, Takeo S, Adachi H, Tagawa T, Fukuyama S, Shimokawa M. A Prospective Observational Study of Pulmonary Resection for Non-small Cell Lung Cancer in Patients Older Than 75 Years. Semin Thorac Cardiovasc Surg 2017; 29:540-547. [PMID: 29698655 DOI: 10.1053/j.semtcvs.2017.05.004] [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] [Accepted: 05/24/2017] [Indexed: 11/11/2022]
Abstract
The operative morbidity rate in elderly patients with lung cancer is high in comparison to nonelderly patients, probably because of the increase in comorbidities that occurs with aging. However, previous reports were retrospective and were performed at single institutions; thus, the preoperative comorbidities and operative morbidity could not be fully assessed. We conducted a multi-institutional prospective observational study of elderly patients (>75 years of age) with a completely resected non-small cell lung cancer. From March 2014 to April 2015, 264 patients from 22 hospitals affiliated with the National Hospital Organization in Japan were prospectively registered in the present study. The primary end point was operative morbidity (National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0). The secondary end points were operative mortality and the risk factors for operative morbidity. Preoperative comorbidities were assessed according to the Adult Comorbidity Evaluation-27 index. The mean age at the time of surgery was 79.3 years (range 75-90 years). Forty-one percent of the patients were >80 years of age. Twenty-six percent underwent sublobar resection. The incidence of morbidities of any grade was 43.2% (90% confidence interval: 38.2%-48.2%). Respiratory system-related morbidity (19.3%), followed by cardiovascular system-related morbidity (10.2%), was the most common morbidity. The in-hospital mortality rate was 1.1% (3 of 264 patients). A multivariate analysis of the risk factors for operative morbidity showed that both Adult Comorbidity Evaluation-27 grade and the blood loss volume were significant factors. The results of the present prospective multi-institutional study should be used as a reference in the surgical treatment of elderly patients with lung cancer.
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Affiliation(s)
- Tokujiro Yano
- Department of General Thoracic Surgery, National Hospital Organization Beppu Medical Center, Beppu, Japan.
| | - Osamu Kawashima
- Department of Chest Surgery, National Hospital Organization Shibukawa Medical Center, Shibukawa, Japan
| | - Sadanori Takeo
- Department of Thoracic Surgery, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Hirofumi Adachi
- Department of Thoracic Surgery, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Tsutomu Tagawa
- Department of Thoracic Surgery, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Seiichi Fukuyama
- Department of General Thoracic Surgery, National Hospital Organization Beppu Medical Center, Beppu, Japan
| | - Mototsugu Shimokawa
- Cancer Biostatistics Laboratory, Clinical Research Institute, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
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Wang J, Zhao H. [Issues Need to be Considered in Sublobectomy for Early Stage Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 19:351-4. [PMID: 27335295 PMCID: PMC6015199 DOI: 10.3779/j.issn.1009-3419.2016.06.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
随着医学技术的进步,早期肺癌患者数量逐年增加,亚肺叶切除治疗在早期肺癌个体化治疗的价值逐渐受到重视。目前,在早期肺癌的术式选择上,肺叶切除和亚肺叶切除孰优孰劣尚存在一些争议。本文就当前亚肺叶切除治疗早期肺癌的下述争议点进行了总结:①循证医学证据;②楔形和肺段的适应症选择;③肿瘤直径和切缘距离的权重比较;④老年人的术式选择。
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Affiliation(s)
- Jun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Hui Zhao
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
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Brooks ED, Sun B, Zhao L, Komaki R, Liao Z, Jeter M, Welsh JW, O'Reilly MS, Gomez DR, Hahn SM, Heymach JV, Rice DC, Chang JY. Stereotactic Ablative Radiation Therapy is Highly Safe and Effective for Elderly Patients With Early-stage Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2016; 98:900-907. [PMID: 28258887 DOI: 10.1016/j.ijrobp.2016.12.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 12/11/2016] [Accepted: 12/14/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE To discern the effectiveness and toxicity of stereotactic ablative radiation therapy (SABR) in the elderly population (aged ≥75 years) and to consider how SABR outcomes compare with surgical outcomes historically reported in the elderly. METHODS AND MATERIALS A total of 772 patients with clinical early-stage I-II non-small cell lung cancer (NSCLC; stage T1-T3N0M0) underwent SABR (50 Gy in 4 fractions or 70 Gy in 10 fractions) from 2004 to 2014 at our center (n=442, aged <75 years; n=330, aged ≥75 years). The primary endpoints included overall survival (OS), time-to-progression, and grade ≥3 toxicity. The median follow-up time was approximately 55 months. RESULTS Compared with patients aged <75 years, those aged ≥75 years had no difference in the time-to-progression (P=.419), lung cancer-specific survival (P=.275), or toxicity (P=.536). OS was the same between both age groups at 2 years of follow-up but diverged thereafter, with patients aged <75 years when treatment began having greater OS rates at 5 years. The median OS rates for patients aged ≥75 years were 86% at 1 year, 57.5% at 3 years, and 39.5% at 5 years. The median OS rates for patients aged <75 years were 87.3% at 1 year, 67.6% at 3 years, and 51.5% at 5 years. No patient aged ≥75 years experienced any grade 4 or 5 toxicity. CONCLUSIONS The effectiveness of SABR was the same for the elderly as for the average-age population according to lung cancer-specific survival and time-to-progression. It also poses no increased toxicity. Compared with the historical outcomes with surgery in the elderly, SABR outcomes can be considered comparable for stage I-II disease but with less morbidity.
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Affiliation(s)
- Eric D Brooks
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bing Sun
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lina Zhao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ritsuko Komaki
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zhonxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Melenda Jeter
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - James W Welsh
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael S O'Reilly
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Daniel R Gomez
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen M Hahn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John V Heymach
- Department of Thoracic and Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joe Y Chang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Qiu C, Wang G, Xu J, Cui L, Dong W, Ni Y, Qu X, Du J. Sublobectomy versus lobectomy for stage I non-small cell lung cancer in the elderly. Int J Surg 2016; 37:1-7. [PMID: 27890654 DOI: 10.1016/j.ijsu.2016.11.090] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/22/2016] [Accepted: 11/22/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of our study was to compare the operative characteristics and long term survival for elderly patients with stage I non-small cell lung cancer (NSCLC) who underwent sublobectomy versus lobectomy. METHODS We identified 245 consecutive elderly patients (≥65y) with pathologic stage I NSCLC who underwent lobectomy or sublobectomy at our institution between 2006 and 2012, and assessed the operative characteristics, recurrence, and survival differences between these approaches. RESULTS A total of 39 patients underwent sublobectomy and 206 patients had lobectomy. There were significantly more COPD (p = 0.046) and low percent of predicted FEV1 (p = 0.034) in sublobectomy patients compared to the lobectomy group. Sublobectomy patients had significantly shorter operating time (p = 0.001), less blood loss (p = 0.000), and trended toward fewer chest tube days (p = 0.001) and shorter hospital length of stay (p = 0.030). The 1-, 3-, and 5-year survival rates in patients with lobectomy were 91.3, 77.7, and 64.1%, respectively, and has no significantly difference with those underwent sublobectomy (87.2, 74.4, and 61.5%, respectively, p = 0.623). Subgroups survival analysis showed no significant difference in the OS and DFS for patients with T < 2 cm or %FEV1<80%, but survival after sublobectomy was worse if performed on patients with larger tumours (T ≥ 2 cm) or relatively strong lung function (%FEV1≥80%). CONCLUSION We concluded that sublobectomy might achieve similar survival rates when compared with lobectomy in elderly stage I NSCLC patients, especially for patients with low %FEV1 and stage IA tumours less than 2 cm in diameter.
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Affiliation(s)
- Chen Qiu
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, #324 Jingwu Road, Jinan 250021, PR China; Department of Oncology, Shandong University Qilu Hospital, Shandong University, #107 West Wenhua Road, Jinan 250010, PR China
| | - Guanghui Wang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, #324 Jingwu Road, Jinan 250021, PR China
| | - Jun Xu
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, #324 Jingwu Road, Jinan 250021, PR China; Department of Thoracic Surgery, Jining First People's Hospital of Shandong Province, #6 Health Road, Jining 272111, PR China
| | - Lixuan Cui
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, #324 Jingwu Road, Jinan 250021, PR China
| | - Wei Dong
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, #324 Jingwu Road, Jinan 250021, PR China
| | - Yang Ni
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, #324 Jingwu Road, Jinan 250021, PR China
| | - Xiao Qu
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, #324 Jingwu Road, Jinan 250021, PR China
| | - Jiajun Du
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, #324 Jingwu Road, Jinan 250021, PR China; Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, #324 Jingwu Road, Jinan 250021, PR China.
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Gulack BC, Yang CFJ, Speicher PJ, Yerokun BA, Tong BC, Onaitis MW, D'Amico TA, Harpole DH, Hartwig MG, Berry MF. A Risk Score to Assist Selecting Lobectomy Versus Sublobar Resection for Early Stage Non-Small Cell Lung Cancer. Ann Thorac Surg 2016; 102:1814-1820. [PMID: 27592602 DOI: 10.1016/j.athoracsur.2016.06.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/26/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The long-term survival benefit of lobectomy over sublobar resection for early-stage non-small cell lung cancer must be weighed against a potentially increased risk of perioperative mortality. The objective of the current study was to create a risk score to identify patients with favorable short-term outcomes following lobectomy. METHODS The 2005-2012 American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing a lobectomy or sublobar resection (either segmentectomy or wedge resection) for lung cancer. A multivariable logistic regression model was utilized to determine factors associated with 30-day mortality among the lobectomy group and to develop an associated risk score to predict perioperative mortality. RESULTS Of the 5,749 patients who met study criteria, 4,424 (77%) underwent lobectomy, 1,098 (19%) underwent wedge resection, and 227 (4%) underwent segmentectomy. Age, chronic obstructive pulmonary disease, previous cerebrovascular event, functional status, recent smoking status, and surgical approach (minimally invasive versus open) were utilized to develop the risk score. Patients with a risk score of 5 or lower had no significant difference in perioperative mortality by surgical procedure. Patients with a risk score greater than 5 had significantly higher perioperative mortality after lobectomy (4.9%) as compared to segmentectomy (3.6%) or wedge resection (0.8%, p < 0.01). CONCLUSIONS In this study, we have developed a risk model that predicts relative operative mortality from a sublobar resection as compared to a lobectomy. Among patients with a risk score of 5 or less, lobectomy confers no additional perioperative risk over sublobar resection.
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Affiliation(s)
- Brian C Gulack
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Chi-Fu Jeffrey Yang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Paul J Speicher
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Babatunde A Yerokun
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Betty C Tong
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Mark W Onaitis
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Thomas A D'Amico
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - David H Harpole
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Matthew G Hartwig
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Mark F Berry
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California.
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Dai J, Shi J, Soodeen-Lalloo AK, Zhang P, Yang Y, Wu C, Jiang S, Jia X, Fei K, Jiang G. Air bronchogram: A potential indicator of epidermal growth factor receptor mutation in pulmonary subsolid nodules. Lung Cancer 2016; 98:22-28. [DOI: 10.1016/j.lungcan.2016.05.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 04/16/2016] [Accepted: 05/12/2016] [Indexed: 02/07/2023]
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Hu B, Li Q. [Strategies of Individual Surgical Treatment for Early Stage Non-small Cell Lung Cancer and the Guidance of Intraoperative Frozen Pathology]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:364-7. [PMID: 27335298 PMCID: PMC6015198 DOI: 10.3779/j.issn.1009-3419.2016.06.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
早期非小细胞肺癌尤其是电子计算机断层扫描(computed tomography, CT)筛查出的微小的在影像学表现为磨玻璃密度样(ground-glass opacity, GGO)的肺癌在亚洲人群中逐渐增多。临床回顾性数据表明对此类患者施行亚肺叶切除术疗效可能并不次于肺叶切除,而且保留了更多的肺功能。研究证明除仔细地评估术前影像表现外,术中冰冻病理诊断为原位腺癌或微浸润肺腺癌可能更适合做亚肺叶切除。更精准的个体化手术策略应基于术中快速冰冻病理诊断。
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Affiliation(s)
- Bin Hu
- Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610000, China
| | - Qiang Li
- Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610000, China
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