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Laforge L, Eberst G, Calais F, Malouf RS, Marchal C, Westeel V, Roqué-Figuls M. Overall prognosis of index lung cancer recurrence or of second primary lung cancer in people with non-small cell lung cancer operated with complete resection. Cochrane Database Syst Rev 2024; 8:CD015319. [PMID: 39087518 PMCID: PMC11292786 DOI: 10.1002/14651858.cd015319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
OBJECTIVES This is a protocol for a Cochrane Review (prognosis). The objectives are as follows: We aim to compare overall survival in people with recurrence and second primary lung cancer (SPLC) after lung cancer surgery. If survival differs between those people categorised as having index lung cancer recurrence and those categorised as having SPLC, it might be possible to identify the definition that has the best discriminatory capacity from the various published definitions of these conditions, so that it can be used in future.
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Affiliation(s)
- Louis Laforge
- Department of Chest Diseases and Thoracic Oncology, University Hospital of Besançon, Besançon, France
| | - Guillaume Eberst
- Department of Chest Diseases and Thoracic Oncology, University Hospital of Besançon, Besançon, France
- EFS, INSERM, UMR RIGHT, Université de Franche-Comté, CHU Besançon, Besancon, France
| | - François Calais
- Bibliothèque Universitaire de Santé, Université de Franche-Comté, Besançon, France
| | - Reem S Malouf
- Big data Institute (BDI), University of Oxford, Oxford, UK
| | | | - Virginie Westeel
- Department of Chest Diseases and Thoracic Oncology, University Hospital of Besançon, Besançon, France
- EFS, INSERM, UMR RIGHT, Université de Franche-Comté, CHU Besançon, Besançon, France
| | - Marta Roqué-Figuls
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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LI B, YANG Z, ZHAO Y, CHEN Y, HUANG Y. [Recent Advances in Diagnosis and Treatment Strategies for Multiple Primary Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2023; 26:863-873. [PMID: 38061888 PMCID: PMC10714049 DOI: 10.3779/j.issn.1009-3419.2023.102.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Indexed: 12/18/2023]
Abstract
As the utilization of computed tomography in lung cancer screening becomes more prevalent in the post-pandemic era, the incidence of multiple primary lung cancer (MPLC) has surged in various countries and regions. Despite the continued application of advanced histologic and sequencing technologies in this research field, the differentiation between MPLC and intrapulmonary metastasis (IM) remains challenging. In recent years, the specific mechanisms of genetic and environmental factors in MPLC have gradually come to light. Lobectomy still predominates in the treatment of MPLC, but the observation that tumor-specific sublobar resection has not detrimentally impacted survival appears to be a viable option. With the evolution of paradigms, the amalgamated treatment, primarily surgical, is an emerging trend. Among these, stereotactic ablative radiotherapy (SABR) and lung ablation techniques have emerged as efficacious treatments for early unresectable tumors and control of residual lesions. Furthermore, targeted therapies for driver-positive mutations and immunotherapy have demonstrated promising outcomes in the postoperative adjuvant phase. In this manuscript, we intend to provide an overview of the management of MPLC based on the latest discoveries.
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Soro-García J, Cilleruelo Ramos Á, Fuentes-Martín Á, Loucel Bellino MA, Mora Puentes DA, Victoriano Soriano GI, Matilla González JM. Outcomes of Surgery for Metachronous Second Primary Non-small Cell Lung Cancer. Arch Bronconeumol 2023; 59:743-749. [PMID: 37612175 DOI: 10.1016/j.arbres.2023.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE The optimal surgical approach for second primary metachronous lung cancer (MPLC) remains unclear. Our aim is to evaluate the morbidity and prognostic value based on the extent of surgical resection in MPLC. METHODS Retrospective study of 84 patients with a history of anatomical resection for lung cancer and MPLC surgically treated between January 2010 and December 2020. RESULTS The interval between the initial primary tumor and the second was 50.38±32.89 months. The second resection was contralateral in 43 patients (51.2%) and ipsilateral in 41 (48.8%). Thirty-six patients (42.9%) underwent a second anatomical resection, and in 48 patients (57.1%), it was non-anatomical. Postoperative complications were observed in 29 patients (34.5%) after the second lung resection. According to the Clavien-Dindo classification, 95.2% were mild (Clavien-Dindo I-II), and a single patient died (1.2%) in the postoperative period (Grade V). Prolonged air leak (p=0.037), postoperative arrhythmias (p=0.019) and hospital stay showed significant differences depending on the extent of surgery in ipsilateral resections. The main histological type was adenocarcinoma (47.6%) and the median tumor size was 17.74±11.74mm. The overall survival was 58.07 months (95% CI 49.29-66.85) for patients undergoing anatomical resection and 50.97 months (95% CI 43.31-58.63) for non-anatomical without significant differences (p=0.144). The disease-free survival after the second surgery was 53.75 months (95% CI 45.28-62.23) for anatomical resection and 41.34 months (95% CI 33.04-49.65) for non-anatomical group. CONCLUSION Second anatomical resections provide good long-term outcomes and have been shown to provide better disease-free survival compared to non-anatomical resections in properly selected patients.
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Affiliation(s)
- José Soro-García
- Thoracic Surgery Department, Hospital Clínico Universitario de Valladolid, Spain.
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Choi E, Su CC, Wu JT, Aredo JV, Neal JW, Leung AN, Backhus LM, Lui NS, Le Marchand L, Stram DO, Liang SY, Cheng I, Wakelee HA, Han SS. Second Primary Lung Cancer Among Lung Cancer Survivors Who Never Smoked. JAMA Netw Open 2023; 6:e2343278. [PMID: 37966839 PMCID: PMC10652150 DOI: 10.1001/jamanetworkopen.2023.43278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/05/2023] [Indexed: 11/16/2023] Open
Abstract
Importance Lung cancer among never-smokers accounts for 25% of all lung cancers in the US; recent therapeutic advances have improved survival among patients with initial primary lung cancer (IPLC), who are now at high risk of developing second primary lung cancer (SPLC). As smoking rates continue to decline in the US, it is critical to examine more closely the epidemiology of lung cancer among patients who never smoked, including their risk for SPLC. Objective To estimate and compare the cumulative SPLC incidence among lung cancer survivors who have never smoked vs those who have ever smoked. Design, Setting, and Participants This population-based prospective cohort study used data from the Multiethnic Cohort Study (MEC), which enrolled participants between April 18, 1993, and December 31, 1996, with follow-up through July 1, 2017. Eligible individuals for this study were aged 45 to 75 years and had complete smoking data at baseline. These participants were followed up for IPLC and further SPLC development through the Surveillance, Epidemiology, and End Results registry. The data were analyzed from July 1, 2022, to January 31, 2023. Exposures Never-smoking vs ever-smoking exposure at MEC enrollment. Main Outcomes and Measures The study had 2 primary outcomes: (1) 10-year cumulative incidence of IPLC in the entire study cohort and 10-year cumulative incidence of SPLC among patients with IPLC and (2) standardized incidence ratio (SIR) (calculated as the SPLC incidence divided by the IPLC incidence) by smoking history. Results Among 211 414 MEC participants, 7161 (3.96%) developed IPLC over 4 038 007 person-years, and 163 (2.28%) developed SPLC over 16 470 person-years. Of the participants with IPLC, the mean (SD) age at cohort enrollment was 63.6 (7.7) years, 4031 (56.3%) were male, and 3131 (43.7%) were female. The 10-year cumulative IPLC incidence was 2.40% (95% CI, 2.31%-2.49%) among ever-smokers, which was 7 times higher than never-smokers (0.34%; 95% CI, 0.30%-0.37%). However, the 10-year cumulative SPLC incidence following IPLC was as high among never-smokers (2.84%; 95% CI, 1.50%-4.18%) as ever-smokers (2.72%; 95% CI, 2.24%-3.20%), which led to a substantially higher SIR for never-smokers (14.50; 95% CI, 8.73-22.65) vs ever-smokers (3.50; 95% CI, 2.95-4.12). Conclusions and Relevance The findings indicate that SPLC risk among lung cancer survivors who never smoked is as high as among those with IPLC who ever-smoked, highlighting the need to identify risk factors for SPLC among patients who never smoked and to develop a targeted surveillance strategy.
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Affiliation(s)
- Eunji Choi
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
| | - Chloe C. Su
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
| | - Julie T. Wu
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | | | - Joel W. Neal
- Department of Medicine, Stanford University School of Medicine, Stanford, California
- Stanford Cancer Institute, Stanford, California
| | - Ann N. Leung
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Leah M. Backhus
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Natalie S. Lui
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Loïc Le Marchand
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu
| | - Daniel O. Stram
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Su-Ying Liang
- Sutter Health, Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Heather A. Wakelee
- Department of Medicine, Stanford University School of Medicine, Stanford, California
- Stanford Cancer Institute, Stanford, California
| | - Summer S. Han
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
- Stanford Cancer Institute, Stanford, California
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
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Wang T, Zhou J, Zheng Q, Wu D, Lu T, Lin M, Pu Q, Mei J, Liu L. Risk-based screening for second primary extrapulmonary malignancies in stage I lung cancer patients: A study based on SEER database. Lung Cancer 2023; 180:107218. [PMID: 37146472 DOI: 10.1016/j.lungcan.2023.107218] [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: 02/18/2023] [Revised: 04/16/2023] [Accepted: 04/24/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVES We conducted this study to identify the risk for second primary malignancy (SPM), especially for second primary extrapulmonary malignancy (SPEM), in resected stage I lung cancer patients. MATERIALS AND METHODS Resected stage I lung cancer patients were retrospectively enrolled from the SEER database (2008-2017). Standardized incidence ratio (SIR) was used to evaluate the relative risk of SPM of patients as compared to general population. Competing risk model was utilized to identify the risk factors for SPEM of increased risk (rSPEM). A simplified nomogram based on the factors was developed to stratify patients at different risks of rSPEM. RESULTS A total of 14,495 patients were enrolled, and 1779 (12.27%) patients developed SPM during follow-up, of which 896 (50.37%) were SPEM. Enrolled patients had higher risk of SPM than general population (SIR: 1.92, 95% CI: 1.83 - 2.01). The yearly morbidity of SPM was about 3% - 4% over time. The three most frequent SPEM were prostate cancer, breast cancer, and urinary bladder cancer. The competing-risk multivariable analysis showed that increasing age, male, and white race were independent risk factors for rSPEM. The simplified nomogram showed favorable performance in stratifying patients at different risks of rSPEM (P < 0.001). CONCLUSION The risk of SPM in stage I lung cancer patients was high. Risk factors for rSPEM were identified and the corresponding simplified nomogram based on the risk factors could discriminate patients at different risks well. The nomogram might help physicians to make more appropriate screening strategy for the SPEM.
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Affiliation(s)
- Tengyong Wang
- Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jian Zhou
- Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Quan Zheng
- Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Dongsheng Wu
- Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Tianyi Lu
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Mingying Lin
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Qiang Pu
- Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jiandong Mei
- Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lunxu Liu
- Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu 610041, China.
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Ripley RT, Antonoff M, Huang J, Suzuki K, Gibney BC. Management of Multiple Ground Glass Opacities before or after Lobectomy. Semin Thorac Cardiovasc Surg 2023; 35:574-582. [PMID: 37087345 DOI: 10.1053/j.semtcvs.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Indexed: 04/24/2023]
Affiliation(s)
- R Taylor Ripley
- Micheal E. DeBakey Department of Surgery, Division of General Thoracic Surgery, Baylor College of Medicine, Houston, Texas.
| | - Mara Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Barry C Gibney
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
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He D, Zhang J, Xiang Y, Wu P, Li G, Chang H, Wang Q, Shao Q, Zhu S. Association between radiotherapy for surgically treated oral cavity cancer and secondary lung cancer. Front Public Health 2023; 11:1120671. [PMID: 37033050 PMCID: PMC10073750 DOI: 10.3389/fpubh.2023.1120671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/03/2023] [Indexed: 04/11/2023] Open
Abstract
Background There is limited research on the incidence of secondary lung cancer (SLC) after radiotherapy (RT) for oral cavity cancer (OCC). Therefore, we investigated the association between RT for OCC and the risk of SLC and the overall survival of these patients. Methods Patients diagnosed with OCC between 1975 and 2015 were selected from the Surveillance, Epidemiology, and End Results database. The cumulative incidence of SLC, relative risk (RR) of RT vs. no RT (NRT), standardized incidence ratios (SIR), and survival outcomes were assessed. Results A total of 10,936 patients with OCC were included. Of these, 429 (3.92%) patients developed SLC, where 136 (5.02%) received RT and 293 (3.56%) did not. The cumulative incidence of SLC during follow-up was 6.89% and 4.84% in the RT and NRT patients, respectively. RT was associated with a higher risk of SLC. In the subset analysis, the results showed that a higher risk of developing SLC among patients with index OCC in most subgroups. Dynamic RR and SIR revealed a decreased risk of SLC with increasing latency time. No difference was observed in the 10-year survival rates for patients with SLC who received RT or not or compared with primary lung cancer. Conclusion RT was associated with a higher risk of SLC, and patients diagnosed with OCC could be followed for 5-10 years after diagnosis.
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Affiliation(s)
- Dongjie He
- Department of Radiation Oncology, Tangdu Hospital, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Jun Zhang
- Department of Otolaryngology, Tangdu Hospital, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Ying Xiang
- Department of Traditional Chinese Medicine, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Peiwen Wu
- Department of Radiation Oncology, Tangdu Hospital, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Gaiyan Li
- Department of Radiation Oncology, Tangdu Hospital, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Hao Chang
- Department of Radiation Oncology, Tangdu Hospital, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Qiming Wang
- Department of Radiation Oncology, Tangdu Hospital, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Qiuju Shao
- Department of Radiation Oncology, Tangdu Hospital, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Siying Zhu
- Department of Radiation Oncology, Tangdu Hospital, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
- *Correspondence: Siying Zhu
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Westeel V, Foucher P, Scherpereel A, Domas J, Girard P, Trédaniel J, Wislez M, Dumont P, Quoix E, Raffy O, Braun D, Derollez M, Goupil F, Hermann J, Devin E, Barbieux H, Pichon E, Debieuvre D, Ozenne G, Muir JF, Dehette S, Virally J, Grivaux M, Lebargy F, Souquet PJ, Freijat FA, Girard N, Courau E, Azarian R, Farny M, Duhamel JP, Langlais A, Morin F, Milleron B, Zalcman G, Barlesi F. Chest CT scan plus x-ray versus chest x-ray for the follow-up of completely resected non-small-cell lung cancer (IFCT-0302): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol 2022; 23:1180-1188. [DOI: 10.1016/s1470-2045(22)00451-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 01/09/2023]
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Song C, Lu Z, Li D, Pan S, Li N, Geng Q. Survival after wedge resection versus lobectomy for stage IA second primary NSCLC with previous lung cancer-directed surgery. Front Oncol 2022; 12:890033. [PMID: 36033457 PMCID: PMC9399676 DOI: 10.3389/fonc.2022.890033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/14/2022] [Indexed: 12/02/2022] Open
Abstract
Background The surgical procedure for early-stage second primary non-small cell lung cancer (SP-NSCLC) remains controversial, especially for patients with previous lung cancer-directed surgery. This study aims to compare the survival after wedge resection and lobectomy for these patients. Methods Stage IA SP-NSCLC patients with clear clinical information were searched from the Surveillance, Epidemiology, and End Results (SEER) database. The Cox proportional hazard model, the competing risk model, and the Kaplan–Meier survival curve were used to describe the survival difference between wedge resection and lobectomy. A 1:1 propensity score matching (PSM) method was also performed to reduce the potential impact of confounding factors between the two groups. Results Of the 320 eligible stage IA SP-NSCLC patients included in this study, 238 (74.4%) patients underwent wedge resection and 82 (25.6%) patients received lobectomy. The 5-year overall survival (OS) was 61.3% with wedge resection and was 66.1% with lobectomy. Both before and after PSM, wedge resection showed similar OS and lung cancer-specific mortality as lobectomy in the entire cohort. Additionally, in all subgroup analyses, wedge resection demonstrated equivalent survival to lobectomy. However, in the female, sublobectomy for the first primary lung cancer, and interval ≤ 24 months subgroups, wedge resection displayed a higher lung cancer-specific mortality than lobectomy (fine-gray test, all p < 0.05). Conclusion Overall, wedge resection is comparable to lobectomy in OS for stage IA SP-NSCLC patients with previous lung cancer-directed surgery. Therefore, we believe that wedge resection may be sufficient for these patients, although, in some cases, wedge resection has a higher lung cancer-specific mortality rate than lobectomy.
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Cilleruelo Ramos Á, Figueroa Almánzar S, López Castro R, Martínez Hernández NJ, Mezquita Pérez L, Moreno Casado P, Zabaleta Jiménez J. Spanish Society of Thoracic Surgery (SECT) consensus document. Long-term follow-up for operated patients with lung cancer. Cir Esp 2022; 100:320-328. [PMID: 35643357 DOI: 10.1016/j.cireng.2022.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/02/2021] [Indexed: 06/15/2023]
Abstract
The most effective treatment for lung cancer is complete lung resection, although recurrences reach up to 10% and the appearance of second neoplasms, up to 6%. Therefore, the follow-up of these patients will be essential for the early detection and treatment of these events; however there is no definition of the form, time and cadence of these follow-ups. In this consensus document, we try to define them based on the available scientific evidence. A critical review of the literature is carried out (meta-analysis, systematic reviews, reviews, consensus recommendations of scientific societies, randomized controlled studies, non-randomized controlled studies, observational studies and case series studies) and communications to the main congresses on oncology and thoracic surgery in Spanish, English and French. The evidences found are classified following the GRADE system. It is defined according to the existing evidence that the patient resected for lung cancer should be followed up, as well as that this follow-up should be close during the first years and with CT (not being necessary to follow up with PET-CT, biomarkers or bronchoscopy). Cessation of smoking is also recommended in this follow-up.
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Affiliation(s)
- Ángel Cilleruelo Ramos
- Servicio de Cirugía Torácica, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
| | | | - Rafael López Castro
- Servicio de Oncología Médica, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Paula Moreno Casado
- Servicio de Cirugía Torácica, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | - Jon Zabaleta Jiménez
- Servicio de Cirugía Torácica, Hospital Universitario de Donostia, San Sebastián, San Sebastián, Spain
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Recent Advances in the Diagnosis and Management of Multiple Primary Lung Cancer. Cancers (Basel) 2022; 14:cancers14010242. [PMID: 35008406 PMCID: PMC8750235 DOI: 10.3390/cancers14010242] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/31/2021] [Accepted: 01/01/2022] [Indexed: 12/25/2022] Open
Abstract
With the wide application of computed tomography in lung cancer screening, the incidence of multiple primary lung cancer (MPLC) has been increasingly reported. Despite the established criteria, the differentiation between MPLC and intrapulmonary metastasis remains challenging. Although histologic features are helpful in some circumstances, a molecular analysis is often needed. The application of next-generation sequencing could aid in distinguishing MPLCs from intrapulmonary metastasis, decreasing ambiguity. For MPLC management, surgery with lobectomy is the main operation method. Limited resection does not appear to negatively affect survival, and it is a reasonable alternative. Stereotactic ablative radiotherapy (SABR) has become a standard of care for patients refusing surgery or for those with medically inoperable early-stage lung cancer. However, the efficacy of SABR in MPLC management could only be found in retrospective series. Other local ablation techniques are an emerging alternative for the control of residual lesions. Furthermore, systemic therapies, such as targeted therapy for oncogene-addicted patients, and immunotherapy have shown promising results in MPLC management after resection. In this paper, the recent advances in the diagnosis and management of MPLC are reviewed.
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Keshava HB, Tan KS, Dycoco J, Huang J, Berkowitz A, Sumner D, Devigne A, Adusumilli P, Bains M, Bott M, Isbell J, Downey R, Molena D, Park B, Rocco G, Sihag S, Jones DR, Rusch VW. Long-term assessment of efficacy with a novel thoracic survivorship program for patients with lung cancer. J Thorac Cardiovasc Surg 2021; 163:1645-1653.e4. [PMID: 34922758 PMCID: PMC9018489 DOI: 10.1016/j.jtcvs.2021.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE We developed a novel, nurse practitioner-run Thoracic Survivorship Program to aid in long-term follow-up. Patients with non-small cell lung cancer who were disease-free at least 1 year after resection could be referred to the Thoracic Survivorship Program by their surgeon. Our objectives were to summarize follow-up compliance and assess long-term outcomes between Thoracic Survivorship Program enrollment and non-Thoracic Survivorship Program. METHODS Patients who underwent R0 resection for stages I to IIIA between 2006 and 2016 were stratified by enrollment in Thoracic Survivorship Program versus surgeon only follow-up (non-Thoracic Survivorship Program). Follow-up included 6-month chest computed tomography scans for 2 years and then annually. Lack of follow-up compliance was defined by 2 or more consecutive delayed annual computed tomography scans/visits ± 90 days. Relationships between Thoracic Survivorship Program and second primary non--small cell lung cancers, extrathoracic cancers, and survival were quantified using multivariable Cox proportional hazards regression with time-varying covariate reflecting timing of enrollment. RESULTS A total of 1162 of 3940 patients (29.5%) were enrolled in the Thoracic Survivorship Program. The median time to enrollment was 2.3 years; 3279 of 3940 (83%) had complete computed tomography scan data, and 60 of 3279 (1.8%) had 2 or more delayed scans; 323 of 9082 (3.6%) non-Thoracic Survivorship Program visits were noncompliant versus 132 of 4823 (2.7%) of Thoracic Survivorship Program visits (P = .009); 136 of 1146 Thoracic Survivorship Program patients developed second primary non-small cell lung cancer, and 69 of 1123 developed extrathoracic cancer, whereas 322 of 2794 of non-Thoracic Survivorship Program patients developed second primary non-small cell lung cancer and 225 of 2817 patients developed extrathoracic cancer. In multivariable analyses, Thoracic Survivorship Program enrollment was associated with improved disease-free survival (hazard ratio, 0.57; 95% confidence interval, 0.48-0.67; P < .001). CONCLUSIONS Our novel nurse practitioner-run Thoracic Survivorship Program is associated with high patient compliance and outcomes not different from those seen with physician-based follow-up. These results have important implications for health care resource allocation and costs.
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Affiliation(s)
- Hari B Keshava
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kay See Tan
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joe Dycoco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alison Berkowitz
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dyana Sumner
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Amy Devigne
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Prasad Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Manjit Bains
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Matthew Bott
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James Isbell
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert Downey
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniela Molena
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bernard Park
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Smita Sihag
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
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13
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Luo SJ, Choi E, Aredo JV, Wilkens LR, Tammemägi MC, Le Marchand L, Cheng I, Wakelee HA, Han SS. Smoking Cessation After Lung Cancer Diagnosis and the Risk of Second Primary Lung Cancer: The Multiethnic Cohort Study. JNCI Cancer Spectr 2021; 5:pkab076. [PMID: 34611582 PMCID: PMC8487318 DOI: 10.1093/jncics/pkab076] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/28/2021] [Accepted: 08/18/2021] [Indexed: 12/23/2022] Open
Abstract
Background Smoking cessation reduces lung cancer mortality. However, little is known about whether diagnosis of lung cancer impacts changes in smoking behaviors. Furthermore, the effects of smoking cessation on the risk of second primary lung cancer (SPLC) have not been established yet. This study aims to examine smoking behavior changes after initial primary lung cancer (IPLC) diagnosis and estimate the effect of smoking cessation on SPLC risk following IPLC diagnosis. Methods The study cohort consisted of 986 participants in the Multiethnic Cohort Study who were free of lung cancer and active smokers at baseline (1993-1996), provided 10-year follow-up smoking data (2003-2008), and were diagnosed with IPLC in 1993-2017. The primary outcome was a change in smoking status from “current” at baseline to “former” at 10-year follow-up (ie, smoking cessation), analyzed using logistic regression. The second outcome was SPLC incidence after smoking cessation, estimated using cause-specific Cox regression. All statistical tests were 2-sided. Results Among 986 current smokers at baseline, 51.1% reported smoking cessation at 10-year follow-up. The smoking cessation rate was statistically significantly higher (80.6%) for those diagnosed with IPLC between baseline and 10-year follow-up vs those without IPLC diagnosis (45.4%) during the 10-year period (adjusted odds ratio = 5.12, 95% confidence interval [CI] = 3.38 to 7.98; P < .001). Incidence of SPLC was statistically significantly lower among the 504 participants who reported smoking cessation at follow-up compared with those without smoking cessation (adjusted hazard ratio = 0.31, 95% CI = 0.14 to 0.67; P = .003). Conclusion Lung cancer diagnosis has a statistically significant impact on smoking cessation. Quitting smoking after IPLC diagnosis may reduce the risk of developing a subsequent malignancy in the lungs.
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Affiliation(s)
- Sophia J Luo
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Eunji Choi
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Lynne R Wilkens
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Martin C Tammemägi
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Loïc Le Marchand
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Heather A Wakelee
- Stanford University School of Medicine, Stanford, CA, USA.,Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Summer S Han
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA.,Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
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14
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Sesti J, Decker J, Bell J, Nguyen A, Lackey A, Turner AL, Hilden P, Paul S. Long-term Outcomes After Lung Cancer Resection in Smokers: Analysis of the National Lung Screening Trial. World J Surg 2021; 46:265-271. [PMID: 34591149 DOI: 10.1007/s00268-021-06311-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Smoking is a known risk factor for perioperative complications after lung resection; however, little data exists looking at the impact of smoking status (current versus former) on long-term oncologic outcomes after lung cancer surgery. We sought to compare overall survival (OS), progression-free survival (PFS), and cancer-specific mortality (CSM) in current and former smokers using data from the National Lung Screening Trial (NLST). Additionally, we performed subset analysis in current smokers in order to evaluate the effect of modern surgical techniques on long-term outcomes. METHODS Patients with clinical stage IA or IB NSCLC who underwent upfront resection within 180 days of diagnosis were identified in the NLST database. Cox proportional hazard regression models were used to assess differences in patient and treatment characteristics with respect to OS and PFS, with a cause-specific hazard model used for CSM. RESULTS A total of 593 patients were included in the study (269 former smokers, 324 current smokers). Lobar resection (LR) was performed more often than sublobar resection (SLR) (481 vs. 112), and thoracotomy was performed more often than thoracoscopy (482 vs. 86). Comparison of current versus former smokers showed no difference in OS or PFS after resection. Higher CSM was seen in current smokers (p = 0.049). Subset analysis of current smokers revealed no difference in OS or PFS between sub-lobar and lobar resection or thoracotomy and thoracoscopy. Although higher CSM was associated with thoracoscopy versus thoracotomy in this group, this finding was limited by a relatively small thoracoscopy sample size of 44 patients (p = 0.026). CONCLUSION Our analysis of the NLST database shows no significant difference in OS and PFS when comparing current and former smokers undergoing resection for stage I NSCLC. Active smoking status was associated with higher CSM. Subset analysis of current smokers showed no difference in OS or PFS between sub-lobar and lobar resection or thoracotomy and thoracoscopy. Higher CSM was seen in current smokers who underwent thoracoscopy compared to thoracotomy; however, this finding was limited by a small sample size.
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Affiliation(s)
- Joanna Sesti
- Thoracic Surgical Services, RWJBarnabas Health, 101 Old Short Hills Road, West Orange, NJ, 07052, USA.
| | - Jonathan Decker
- Department of Surgery, Newark Beth Israel Medical Center, 201 Lyons Avenue, Newark, NJ, 07112, USA
| | - Jaimie Bell
- Thoracic Surgical Services, RWJBarnabas Health, 101 Old Short Hills Road, West Orange, NJ, 07052, USA
| | - Andrew Nguyen
- Thoracic Surgical Services, RWJBarnabas Health, 101 Old Short Hills Road, West Orange, NJ, 07052, USA
| | - Adam Lackey
- Thoracic Surgical Services, RWJBarnabas Health, 101 Old Short Hills Road, West Orange, NJ, 07052, USA
| | - Amber L Turner
- Department of Surgery, RWJBarnabas Health, 94 Old Short Hills Road, Livingston, NJ, 07039, USA
| | - Patrick Hilden
- Department of Biostatistics, Saint Barnabas Medical Center, 94 Old Short Hills Road, Livingston, NJ, 07039, USA
| | - Subroto Paul
- Thoracic Surgical Services, RWJBarnabas Health, 101 Old Short Hills Road, West Orange, NJ, 07052, USA
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Cilleruelo Ramos Á, Figueroa Almánzar S, López Castro R, Martínez Hernández NJ, Mezquita Pérez L, Moreno Casado P, Zabaleta Jiménez J. Spanish Society of Thoracic Surgery (SECT) consensus document. Long-term follow-up for operated patients with lung cancer. Cir Esp 2021; 100:S0009-739X(21)00250-5. [PMID: 34521509 DOI: 10.1016/j.ciresp.2021.08.003] [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: 05/15/2021] [Revised: 06/27/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
The most effective treatment for lung cancer is complete lung resection, although recurrences reach up to 10% and the appearance of second neoplasms, up to 6%. Therefore, the follow-up of these patients will be essential for the early detection and treatment of these events; however, there is no definition of the form, time and cadence of these follow-ups. In this consensus document, we try to define them based on the available scientific evidence. A critical review of the literature is carried out (meta-analysis, systematic reviews, reviews, consensus recommendations of scientific societies, randomized controlled studies, non-randomized controlled studies, observational studies and case series studies) and communications to the main congresses on oncology and thoracic surgery in Spanish, English and French. The evidences found are classified following the GRADE system. It is defined according to the existing evidence that the patient resected for lung cancer should be followed up, as well as that this follow-up should be close during the first years and with CT (not being necessary to follow up with PET-CT, biomarkers or bronchoscopy). Cessation of smoking is also recommended in this follow-up.
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Affiliation(s)
- Ángel Cilleruelo Ramos
- Servicio de Cirugía Torácica, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | | | - Rafael López Castro
- Servicio de Oncología Médica. Hospital Clínico Universitario de Valladolid, Valladolid, España
| | | | | | - Paula Moreno Casado
- Servicio de Cirugía Torácica. Hospital Universitario Reina Sofía de Córdoba, Córdoba, España
| | - Jon Zabaleta Jiménez
- Servicio de Cirugía Torácica. Hospital Universitario de Donostia, San Sebastián, San Sebastián, España
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16
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Gregoire J. Guiding Principles in the Management of Synchronous and Metachronous Primary Non-Small Cell Lung Cancer. Thorac Surg Clin 2021; 31:237-254. [PMID: 34304832 DOI: 10.1016/j.thorsurg.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Multiple lung cancers can be found simultaneously, with incidence ranging from 1% to 8%. Documentation of more than 1 pulmonary lesion can be challenging, because these solid, ground-glass, or mixed-density tumors may represent multicentric malignant disease or intrapulmonary metastases. If mediastinal nodal and distant deposits are excluded, surgery should be contemplated. After surgical treatment of lung cancer, patients should be followed closely for an undetermined period of time. Good clinical judgment is of outmost importance in deciding which individuals will benefit from those surgical interventions and which are candidates for alternate therapies. Every case should be discussed in a multidisciplinary meeting.
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Affiliation(s)
- Jocelyn Gregoire
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Quebec, Quebec G1V 4G5, Canada.
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Choi E, Sanyal N, Ding VY, Gardner RM, Aredo JV, Lee J, Wu JT, Hickey TP, Barrett B, Riley TL, Wilkens LR, Leung AN, Le Marchand L, Tammemägi MC, Hung RJ, Amos CI, Freedman ND, Cheng I, Wakelee HA, Han SS. Development and Validation of a Risk Prediction Tool for Second Primary Lung Cancer. J Natl Cancer Inst 2021; 114:87-96. [PMID: 34255071 PMCID: PMC8755509 DOI: 10.1093/jnci/djab138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/04/2021] [Accepted: 07/12/2021] [Indexed: 12/25/2022] Open
Abstract
Background With advancing therapeutics, lung cancer (LC) survivors are rapidly increasing in
number. Although mounting evidence suggests LC survivors have high risk of second
primary lung cancer (SPLC), there is no validated prediction model available for
clinical use to identify high-risk LC survivors for SPLC. Methods Using data from 6325 ever-smokers in the Multiethnic Cohort (MEC) study diagnosed with
initial primary lung cancer (IPLC) in 1993-2017, we developed a prediction model for
10-year SPLC risk after IPLC diagnosis using cause-specific Cox regression. We evaluated
the model’s clinical utility using decision curve analysis and externally validated it
using 2 population-based data—Prostate, Lung, Colorectal, and Ovarian Cancer Screening
Trial (PLCO) and National Lung Screening Trial (NLST)—that included 2963 and 2844 IPLC
(101 and 93 SPLC cases), respectively. Results Over 14 063 person-years, 145 (2.3%) ever-smoking IPLC patients developed SPLC in MEC.
Our prediction model demonstrated a high predictive accuracy (Brier score = 2.9, 95%
confidence interval [CI] = 2.4 to 3.3) and discrimination (area under the receiver
operating characteristics [AUC] = 81.9%, 95% CI = 78.2% to 85.5%) based on bootstrap
validation in MEC. Stratification by the estimated risk quartiles showed that the
observed SPLC incidence was statistically significantly higher in the 4th vs 1st
quartile (9.5% vs 0.2%; P < .001). Decision curve
analysis indicated that in a wide range of 10-year risk thresholds from 1% to 20%, the
model yielded a larger net-benefit vs hypothetical all-screening or no-screening
scenarios. External validation using PLCO and NLST showed an AUC of 78.8% (95% CI =
74.6% to 82.9%) and 72.7% (95% CI = 67.7% to 77.7%), respectively. Conclusions We developed and validated a SPLC prediction model based on large population-based
cohorts. The proposed prediction model can help identify high-risk LC patients for SPLC
and can be incorporated into clinical decision making for SPLC surveillance and
screening.
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Affiliation(s)
- Eunji Choi
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA, USA
| | - Nilotpal Sanyal
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA, USA
| | - Victoria Y Ding
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA, USA
| | - Rebecca M Gardner
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Justin Lee
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA, USA
| | - Julie T Wu
- Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | - Lynne R Wilkens
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Ann N Leung
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Loïc Le Marchand
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Martin C Tammemägi
- Department of Health Sciences, Brock University, St Catharines, Ontario, Canada
| | - Rayjean J Hung
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | | | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Heather A Wakelee
- Stanford University School of Medicine, Stanford, CA, USA.,Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Summer S Han
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA, USA.,Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA.,Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
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18
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Aredo JV, Luo SJ, Gardner RM, Sanyal N, Choi E, Hickey TP, Riley TL, Huang WY, Kurian AW, Leung AN, Wilkens LR, Robbins HA, Riboli E, Kaaks R, Tjønneland A, Vermeulen RCH, Panico S, Le Marchand L, Amos CI, Hung RJ, Freedman ND, Johansson M, Cheng I, Wakelee HA, Han SS. Tobacco Smoking and Risk of Second Primary Lung Cancer. J Thorac Oncol 2021; 16:968-979. [PMID: 33722709 PMCID: PMC8159872 DOI: 10.1016/j.jtho.2021.02.024] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Lung cancer survivors are at high risk of developing a second primary lung cancer (SPLC). However, SPLC risk factors have not been established and the impact of tobacco smoking remains controversial. We examined the risk factors for SPLC across multiple epidemiologic cohorts and evaluated the impact of smoking cessation on reducing SPLC risk. METHODS We analyzed data from 7059 participants in the Multiethnic Cohort (MEC) diagnosed with an initial primary lung cancer (IPLC) between 1993 and 2017. Cause-specific proportional hazards models estimated SPLC risk. We conducted validation studies using the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (N = 3423 IPLC cases) and European Prospective Investigation into Cancer and Nutrition (N = 4731 IPLC cases) cohorts and pooled the SPLC risk estimates using random effects meta-analysis. RESULTS Overall, 163 MEC cases (2.3%) developed SPLC. Smoking pack-years (hazard ratio [HR] = 1.18 per 10 pack-years, p < 0.001) and smoking intensity (HR = 1.30 per 10 cigarettes per day, p < 0.001) were significantly associated with increased SPLC risk. Individuals who met the 2013 U.S. Preventive Services Task Force's screening criteria at IPLC diagnosis also had an increased SPLC risk (HR = 1.92; p < 0.001). Validation studies with the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial and European Prospective Investigation into Cancer and Nutrition revealed consistent results. Meta-analysis yielded pooled HRs of 1.16 per 10 pack-years (pmeta < 0.001), 1.25 per 10 cigarettes per day (pmeta < 0.001), and 1.99 (pmeta < 0.001) for meeting the U.S. Preventive Services Task Force's criteria. In MEC, smoking cessation after IPLC diagnosis was associated with an 83% reduction in SPLC risk (HR = 0.17; p < 0.001). CONCLUSIONS Tobacco smoking is a risk factor for SPLC. Smoking cessation may reduce the risk of SPLC. Additional strategies for SPLC surveillance and screening are warranted.
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Affiliation(s)
| | - Sophia J Luo
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Rebecca M Gardner
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Nilotpal Sanyal
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Eunji Choi
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | | | | | - Wen-Yi Huang
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland
| | - Allison W Kurian
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California; Department of Medicine, Stanford University School of Medicine, Stanford, California; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
| | - Ann N Leung
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Lynne R Wilkens
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | | | - Elio Riboli
- Epidemiology and Prevention, School of Public Health, Imperial College London, London, United Kingdom
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Center for Lung Research, Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
| | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Roel C H Vermeulen
- Division Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Salvatore Panico
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Loïc Le Marchand
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | | | - Rayjean J Hung
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Neal D Freedman
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland
| | | | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Heather A Wakelee
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Summer S Han
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California; Department of Neurosurgery, Stanford University School of Medicine, Stanford, California.
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Westeel V. Surveillance After Curative-Intent Treatment for NSCLC: More to It Than Meets the Eye. J Thorac Oncol 2021; 16:719-721. [PMID: 33896570 DOI: 10.1016/j.jtho.2021.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Virginie Westeel
- Service de Pneumologie, Oncologie Thoracique et Allergologie Respiratoire, CHU Hôpital Jean Minjoz, Besançon, France; INSERM UMR1098, Université de Bourgogne-Franche-Comté, Besançon, France; Intergroupe Francophone de Cancérologie Thoracique (IFCT), Paris, France.
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20
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Miyahara N, Nii K, Benazzo A, Iwasaki A, Klepetko W, Hoetzenecker K. Completion Pneumonectomy for Second Primary/Primary Lung Cancer and Local Recurrence Lung Cancer. Ann Thorac Surg 2021; 114:1073-1083. [PMID: 33964258 DOI: 10.1016/j.athoracsur.2021.04.063] [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: 11/26/2020] [Revised: 04/04/2021] [Accepted: 04/27/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Completion pneumonectomy (CP) for second primary/primary lung cancer (SPLC) and local recurrence lung cancer (LRLC) is still controversial. Although several case series on such a practice exist, the oncological benefit is under debate. The purpose of this study was to review available literatures on CP for SPLC and LRLC and evaluate postoperative and long-term outcomes. METHODS MEDLINE, SCOPUS and Web of Science were reviewed for eligible studies in January 2021. Studies were included if they indicated outcomes of patients with lung cancer undergoing CP. Overall survival (OS) was defined as the primary end point; secondary end points included operative morbidity and 30-day mortality. Random-effects meta-analysis based on a binomial distribution was used to create pooled estimates. RESULTS Thirty-two eligible studies including 1,157 patients were identified. These studies were uniformly retrospective reports. Pooled estimates for 3- and 5-year OS were 50.6% [95% confidence interval (CI) 34.7-66.5] and 38.9% [95% CI 32.2-46.1] in SPLC patients. When the SPLC was a stage I tumor, pooled 5-year OS was favorable with 60.7% [95% CI 43.2-75.9]. In LRLC, pooled 3- and 5-year OS were 47.6% [95% CI 36.1-59.4] and 33.8% (95% CI 26.8-41.5). Pooled morbidity and 30-day mortality was reported in 38.2% (95% CI 32.0-44.9), and 10.0% (95% CI 8.1-12.3). CONCLUSIONS CP for SPLC and LRLC is a challenging procedure with significant perioperative morbimortality. However, published evidence indicates good long-term survival for selected patients. Further studies are needed to identify patient subgroups which benefit most from CP.
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Affiliation(s)
- Naofumi Miyahara
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria; Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University Hospital, Fukuoka, Japan
| | - Kazuhito Nii
- Department of General Thoracic Surgery, Breast and Endocrinological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Alberto Benazzo
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Akinori Iwasaki
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University Hospital, Fukuoka, Japan
| | - Walter Klepetko
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
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21
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Fisher A, Kim S, Farhat D, Belzer K, Milczuk M, French C, Mamdani H, Sukari A, Baciewicz F, Schwartz AG, Wozniak A, Nagasaka M. Risk Factors Associated with a Second Primary Lung Cancer in Patients with an Initial Primary Lung Cancer. Clin Lung Cancer 2021; 22:e842-e850. [PMID: 34053862 PMCID: PMC8536802 DOI: 10.1016/j.cllc.2021.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 12/25/2022]
Abstract
Targeted surveillance strategies following initial primary lung cancer (IPLC) treatment are currently limited. One hundred twenty patients diagnosed with IPLC who did not develop second primary lung cancer (SPLC) were matched to 121 patients who developed SPLC. Our analysis found IPLC surgical resection increases SPLC emergence risk regardless of procedure type. Increased survival after IPLC resection warrants close SPLC monitoring.
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Affiliation(s)
- Amanda Fisher
- Wayne State University, School of Medicine, Detroit MI, USA
| | - Seongho Kim
- Wayne State University, School of Medicine, Detroit MI, USA; Karmanos Cancer Institute, Department of Oncology, Detroit, MI USA
| | - Dina Farhat
- Karmanos Cancer Institute, Department of Oncology, Detroit, MI USA
| | - Kimberly Belzer
- Karmanos Cancer Institute, Department of Oncology, Detroit, MI USA
| | - MaryAnn Milczuk
- Karmanos Cancer Institute, Department of Oncology, Detroit, MI USA
| | - Courtney French
- Karmanos Cancer Institute, Department of Oncology, Detroit, MI USA
| | - Hirva Mamdani
- Karmanos Cancer Institute, Department of Oncology, Detroit, MI USA
| | - Ammar Sukari
- Karmanos Cancer Institute, Department of Oncology, Detroit, MI USA
| | | | - Ann G Schwartz
- Wayne State University, School of Medicine, Detroit MI, USA; Karmanos Cancer Institute, Department of Oncology, Detroit, MI USA
| | | | - Misako Nagasaka
- Karmanos Cancer Institute, Department of Oncology, Detroit, MI USA; St. Marianna University School of Medicine, Department of Internal Medicine, Kawasaki, Japan.
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22
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Xia S, Zhu X, Xiong J. A meta-analysis of survival of patients with second primary non-small cell lung cancer after pulmonary lobectomy and partial pulmonary lobectomy. Am J Transl Res 2021; 13:2422-2431. [PMID: 34017400 PMCID: PMC8129240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE A meta-analysis of the screened data was performed to investigate the survival status of patients with second primary non-small cell lung cancer (SPNSCLC) after pulmonary lobectomy and partial pulmonary lobectomy, and assess the applicability of such option in the treatment of such disease. METHODS Based on the databases of PubMed, Ovid, and CNKI, relevant reports on postoperative survival of patients with SPNSCLC were obtained, and the information, including authors, publication year, research type, tumor staging, tumor diameter, surgical options, reasons for resection, and overall survival (OS), was extracted. The data were analyzed using Review Manager 5.3. RESULTS A total of 11 studies published from 2010 to 2017 were collected. Patients with SPNSCLC were mainly in stage Ia and Ib, 51.4% of whom underwent pulmonary lobectomy and 34.7% of whom underwent partial pulmonary lobectomy. The analysis results showed that after the second lobectomy, the mortality rate of the patients undergoing intensive surgery was 8%, the incidence of postoperative complications was 29%, and the 5-year OS rate was 53% after the second lobectomy for patients with SPNSCLC. CONCLUSION The survival rate of patients with SPNSCLC is lower than that of patients with early lung cancer. In view of this, surgical resection is feasible. There are remarkable differences between pulmonary lobectomy and partial pulmonary lobectomy.
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Affiliation(s)
- Shaofeng Xia
- Department of Cardiothoracic Surgery, Jiujiang No. 1 People's Hospital Jiujiang, Jiangxi, China
| | - Xueyu Zhu
- Department of Cardiothoracic Surgery, Jiujiang No. 1 People's Hospital Jiujiang, Jiangxi, China
| | - Jiajun Xiong
- Department of Cardiothoracic Surgery, Jiujiang No. 1 People's Hospital Jiujiang, Jiangxi, China
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Sato S, Shimizu Y, Goto T, Koike T, Koizumi T, Watanabe T, Shinohara H, Yamato Y, Tsuchida M. Surgical outcomes of ipsilateral metachronous second primary lung cancer. Interact Cardiovasc Thorac Surg 2021; 32:896-903. [PMID: 33611522 DOI: 10.1093/icvts/ivab025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/16/2020] [Accepted: 01/01/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The optimal surgical approach for metachronous second primary lung cancer (MSPLC), especially ipsilateral MSPLC, remains unclear. This study aimed to review postoperative complications and examine surgical outcomes based on the extent of resection after surgery for ipsilateral MSPLC. METHODS Clinical data from 61 consecutive patients who underwent pulmonary resection for ipsilateral MSPLC according to the Martini-Melamed criteria between January 2005 and December 2017 in 3 institutes were retrospectively reviewed. RESULTS Postoperative complications were identified in 12 patients (19.7%). Regarding the combination of initial and second surgery, intraoperative bleeding was significantly greater in patients with anatomic-anatomic resection than in others (P < 0.001). Operation time was significantly longer in patients with anatomic-anatomic resection than in others (P < 0.001). However, postoperative complications showed no significant differences based on the combination of surgeries. Five-year overall survival rates in patients with anatomic resection and wedge resection after second surgery were 75.8% and 75.8%, respectively (P = 0.738), and 5-year recurrence-free survival rates were 54.2% and 67.6%, respectively (P = 0.368). Cox multivariate analysis identified ever-smoker status (P = 0.029), poor performance status (P = 0.011) and tumour size >20 mm (P = 0.001) as independent predictors of poor overall survival, while ever-smoker status (P = 0.040) and tumour size >20 mm (P = 0.007) were considered independent predictors of poor recurrence-free survival. CONCLUSIONS Regarding postoperative and long-term outcomes for patients with ipsilateral MSPLC, surgical intervention is safe and offers good long-term survival. Wedge resection is an acceptable provided tumours ≤2 cm and ground-glass opacity-predominant as a second surgery for early-stage ipsilateral MSPLC.
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Affiliation(s)
- Seijiro Sato
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuki Shimizu
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tatsuya Goto
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Terumoto Koike
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takahisa Koizumi
- Department of Thoracic Surgery, National Hospital Organization Nishi-Niigata Chuo Hospital, Niigata, Japan
| | - Takehiro Watanabe
- Department of Thoracic Surgery, National Hospital Organization Nishi-Niigata Chuo Hospital, Niigata, Japan
| | - Hirohiko Shinohara
- Division of General Thoracic Surgery, Nagaoka Red Cross Hospital, Niigata, Japan
| | - Yasushi Yamato
- Division of General Thoracic Surgery, Nagaoka Red Cross Hospital, Niigata, Japan
| | - Masanori Tsuchida
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Management of Pulmonary Nodules in Oncologic Patients: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2020; 216:1423-1431. [PMID: 33355489 DOI: 10.2214/ajr.20.24907] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Cancer survivors are at higher risk than the general population for development of a new primary malignancy, most commonly lung cancer. Current lung cancer screening guidelines recommend low-dose chest CT for high-risk individuals, including patients with a history of cancer and a qualifying smoking history. However, major lung cancer screening trials have inconsistently included cancer survivors, and few studies have assessed management of lung nodules in this population. This narrative review highlights relevant literature and provides expert opinion for management of pulmonary nodules detected incidentally or by screening in oncologic patients. In patients with previously treated lung cancer, a new nodule most likely represents distant metastasis from the initial lung cancer or a second primary lung cancer; CT features such as nodule size and composition should guide decisions regarding biopsy, PET/CT, and CT surveillance. In patients with extrapulmonary cancers, nodule management requires individualized risk assessment; smoking is associated with increased odds of primary lung cancer, whereas specific primary cancer types are associated with increased odds of pulmonary metastasis. Nonneoplastic causes, such as infection, medication toxicity, and postradiation or postsurgical change, should also be considered. Future prospective studies are warranted to provide evidence-based data to assist clinical decision-making in this context.
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Ma B, Qin G, Zhang Y, Su C, Wu Z. Life-long follow-up of second primary lung and extra-pulmonary cancer in lung cancer patients is needed. J Cancer 2020; 11:4709-4715. [PMID: 32626517 PMCID: PMC7330703 DOI: 10.7150/jca.44581] [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: 02/05/2020] [Accepted: 05/08/2020] [Indexed: 11/05/2022] Open
Abstract
Background: Lung cancer (LC) patients are at high risk of developing second primary cancer (SPC). This study aimed to explore the risk factors associated with SPC and provide an individualized risk prediction model for LC patients. Methods: Initial primary lung cancer (IPLC) patients diagnosed between 1998 and 2011 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. A Fine-Gray multivariate competing-risk model was used to estimate the risk of SPC, and the model was assessed regarding discrimination and calibration. A nomogram was designed for clinical convenience to predict the 3-, 5-, and 10- year probabilities of developing SPCs. Results: A total of 142,491 IPLC patients were considered in this study and 14,374(10.01%) developed SPC within a maximum study period of approximately 19 years. Seven independent prognostic factors were identified according to the competing-risk model, and the SEER summary stage and surgery were the strongest predictors. The model was well calibrated and had good discrimination ability(C-index = 0.746). Conclusions: LC survivors had an increased risk of SPC and factors associated with good prognosis often predicted SPC. Consideration should be given to increasing the duration of routine follow-up even after 10 years of initial diagnosis for those at the highest risk and site-specific follow-up strategy is also required.
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Affiliation(s)
- Bingqing Ma
- Department of Biostatistics, School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
| | - Guoyou Qin
- Department of Biostatistics, School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
| | - Yue Zhang
- Department of Biostatistics, School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
| | - Chang Su
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, China
| | - Zhenyu Wu
- Department of Biostatistics, School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
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Sato S, Nakamura M, Shimizu Y, Goto T, Kitahara A, Koike T, Tsuchida M. Impact of postoperative complications on outcomes of second surgery for second primary lung cancer. Surg Today 2020; 50:1452-1460. [PMID: 32488477 DOI: 10.1007/s00595-020-02038-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/05/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The best surgical approach for second primary lung cancer remains a subject of debate. The purpose of this study was to review the postoperative complications after second surgery for second primary lung cancer and to investigate the outcomes based on these complications. METHODS The clinical data of 105 consecutive patients who underwent pulmonary resection for multiple primary lung cancers between January, 1996 and December, 2017, were reviewed according to the Martini-Melamed criteria. RESULTS After the second surgery, low body mass index (BMI) (< 18.5 kg/m2) (P = 0.004) and high Charlson comorbidity index (CCI) (P = 0.002) were independent predictors of postoperative complications. Survival analysis revealed the 5-year overall survival rates of 74.5% and 61.4% for patients without postoperative complications and those with postoperative complications (P = 0.044), respectively, but the 5-year cancer-specific survival rates of 82.5% and 80.0% (P = 0.926), respectively. During this period, there were significantly more respiratory-related deaths of patients with complications than of those without complications (P = 0.011). CONCLUSION Surgical intervention is feasible and potentially effective for second primary lung cancer but may not achieve positive perioperative and long-term outcomes for patients with a low BMI or a high CCI. Treatment options should be considered carefully for these patients.
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Affiliation(s)
- Seijiro Sato
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan.
| | - Masaya Nakamura
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
- Division of General Thoracic Surgery, Niigata Prefectural Central Hospital, Niigata, Japan
| | - Yuki Shimizu
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Tatsuya Goto
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Akihiko Kitahara
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
- Division of General Thoracic Surgery, Niigata Prefectural Shibata Hospital, Niigata, Japan
| | - Terumoto Koike
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Masanori Tsuchida
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
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Wu GX, Ituarte PH, Ferrell B, Sun V, Erhunmwunsee L, Raz DJ, Kim JY. Causes of Death and Hospitalization in Long-term Lung Cancer Survivors: A Population-based Appraisal. Clin Lung Cancer 2020; 21:204-213. [DOI: 10.1016/j.cllc.2019.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/20/2019] [Accepted: 08/24/2019] [Indexed: 12/17/2022]
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Gierada DS, Black WC, Chiles C, Pinsky PF, Yankelevitz DF. Low-Dose CT Screening for Lung Cancer: Evidence from 2 Decades of Study. Radiol Imaging Cancer 2020; 2:e190058. [PMID: 32300760 PMCID: PMC7135238 DOI: 10.1148/rycan.2020190058] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/15/2019] [Accepted: 11/20/2019] [Indexed: 12/17/2022]
Abstract
Lung cancer remains the overwhelmingly greatest cause of cancer death in the United States, accounting for more annual deaths than breast, prostate, and colon cancer combined. Accumulated evidence since the mid to late 1990s, however, indicates that low-dose CT screening of high-risk patients enables detection of lung cancer at an early stage and can reduce the risk of dying from lung cancer. CT screening is now a recommended clinical service in the United States, subject to guidelines and reimbursement requirements intended to standardize practice and optimize the balance of benefits and risks. In this review, the evidence on the effectiveness of CT screening will be summarized and the current guidelines and standards will be described in the context of knowledge gained from lung cancer screening studies. In addition, an overview of the potential advances that may improve CT screening will be presented, and the need to better understand the performance in clinical practice outside of the research trial setting will be discussed. © RSNA, 2020.
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Affiliation(s)
- David S. Gierada
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St Louis, MO 63110 (D.S.G.); Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (W.C.B.); Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC (C.C.); Division of Cancer Prevention, National Cancer Institute, Bethesda, Md (P.F.P.); and Department of Radiology, Mount Sinai School of Medicine, New York, NY (D.F.Y.)
| | - William C. Black
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St Louis, MO 63110 (D.S.G.); Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (W.C.B.); Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC (C.C.); Division of Cancer Prevention, National Cancer Institute, Bethesda, Md (P.F.P.); and Department of Radiology, Mount Sinai School of Medicine, New York, NY (D.F.Y.)
| | - Caroline Chiles
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St Louis, MO 63110 (D.S.G.); Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (W.C.B.); Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC (C.C.); Division of Cancer Prevention, National Cancer Institute, Bethesda, Md (P.F.P.); and Department of Radiology, Mount Sinai School of Medicine, New York, NY (D.F.Y.)
| | - Paul F. Pinsky
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St Louis, MO 63110 (D.S.G.); Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (W.C.B.); Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC (C.C.); Division of Cancer Prevention, National Cancer Institute, Bethesda, Md (P.F.P.); and Department of Radiology, Mount Sinai School of Medicine, New York, NY (D.F.Y.)
| | - David F. Yankelevitz
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St Louis, MO 63110 (D.S.G.); Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (W.C.B.); Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC (C.C.); Division of Cancer Prevention, National Cancer Institute, Bethesda, Md (P.F.P.); and Department of Radiology, Mount Sinai School of Medicine, New York, NY (D.F.Y.)
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Vincenten JPL, van Essen HF, Lissenberg-Witte BI, Bulkmans NWJ, Krijgsman O, Sie D, Eijk PP, Smit EF, Ylstra B, Thunnissen E. Clonality analysis of pulmonary tumors by genome-wide copy number profiling. PLoS One 2019; 14:e0223827. [PMID: 31618260 PMCID: PMC6795528 DOI: 10.1371/journal.pone.0223827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 09/30/2019] [Indexed: 01/15/2023] Open
Abstract
Multiple tumors in patients are frequently diagnosed, either synchronous or metachronous. The distinction between a second primary and a metastasis is important for treatment. Chromosomal DNA copy number aberrations (CNA) patterns are highly unique to specific tumors. The aim of this study was to assess genome-wide CNA-patterns as method to identify clonally related tumors in a prospective cohort of patients with synchronous or metachronous tumors, with at least one intrapulmonary tumor. In total, 139 tumor pairs from 90 patients were examined: 35 synchronous and 104 metachronous pairs. Results of CNA were compared to histological type, clinicopathological methods (Martini-Melamed-classification (MM) and ACCP-2013-criteria), and, if available, EGFR- and KRAS-mutation analysis. CNA-results were clonal in 74 pairs (53%), non-clonal in 33 pairs (24%), and inconclusive in 32 pairs (23%). Histological similarity was found in 130 pairs (94%). Concordance between histology and conclusive CNA-results was 69% (74 of 107 pairs: 72 clonal and two non-clonal). In 31 of 103 pairs with similar histology, genetics revealed non-clonality. In two out of four pairs with non-matching histology, genetics revealed clonality. The subgroups of synchronous and metachronous pairs showed similar outcome for the comparison of histological versus CNA-results. MM-classification and ACCP-2013-criteria, applicable on 34 pairs, and CNA-results were concordant in 50% and 62% respectively. Concordance between mutation matching and conclusive CNA-results was 89% (8 of 9 pairs: six clonal and two non-clonal). Interestingly, in one patient both tumors had the same KRAS mutation, but the CNA result was non-clonal. In conclusion, although some concordance between histological comparison and CNA profiling is present, arguments exist to prefer extensive molecular testing to determine whether a second tumor is a metastasis or a second primary.
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Affiliation(s)
- Julien P. L. Vincenten
- Amsterdam UMC, location VUmc, Department of Pulmonary Diseases, Amsterdam, The Netherlands
- Albert Schweitzer Hospital, Department of Pulmonary Diseases, Dordrecht, The Netherlands
| | - Hendrik F. van Essen
- Amsterdam UMC, location VUmc, Tumor Genome Analysis Core, Cancer Center Amsterdam, The Netherlands
| | | | | | - Oscar Krijgsman
- Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Molecular Oncology & Immunology, Amsterdam, The Netherlands
| | - Daoud Sie
- Amsterdam UMC, location VUmc, Tumor Genome Analysis Core, Cancer Center Amsterdam, The Netherlands
| | - Paul P. Eijk
- Amsterdam UMC, location VUmc, Tumor Genome Analysis Core, Cancer Center Amsterdam, The Netherlands
| | - Egbert F. Smit
- Amsterdam UMC, location VUmc, Department of Pulmonary Diseases, Amsterdam, The Netherlands
- Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Thoracic Oncology, Amsterdam, The Netherlands
| | - Bauke Ylstra
- Amsterdam UMC, location VUmc, Tumor Genome Analysis Core, Cancer Center Amsterdam, The Netherlands
| | - Erik Thunnissen
- Amsterdam UMC, location VUmc, Department of Pathology, Amsterdam, The Netherlands
- * E-mail:
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Leroy T, Monnet E, Guerzider S, Jacoulet P, De Bari B, Falcoz PE, Gainet-Brun M, Lahourcade J, Alfreijat F, Almotlak H, Adotevi O, Pernet D, Polio JC, Desmarets M, Woronoff AS, Westeel V. Let us not underestimate the long-term risk of SPLC after surgical resection of NSCLC. Lung Cancer 2019; 137:23-30. [PMID: 31521979 DOI: 10.1016/j.lungcan.2019.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/29/2019] [Accepted: 09/02/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Several studies have reported that patients operated on for non-small cell lung cancer (NSCLC) are at high risk of second primary lung cancer (SPLC). However, widely varying estimates of this risk have been reported, with very few studies taking into account that these patients are at particularly high competing risk of death, due to recurrence of the initial disease and to comorbidities. Risk factor evaluation over time has significant repercussions on the post-surgery surveillance strategy offered for NSCLC. This study primarily sought to measure the risk of SPLC in a long-term follow-up series, using statistical methods considering competing risks of death. MATERIALS AND METHODS The cumulative SPLC risk was estimated using the cumulative incidence of patients with completely resected Stage I-III NSCLC diagnosed between 2002 and 2015 based on the Doubs and Belfort cancer registry (France). A proportional sub-distribution hazard model (sdRH) was used to investigate factors associated with SPLC risk in the presence of competing risks. RESULTS Among the 522 patients, adenocarcinoma and Stage I or II disease accounted for 52.3% and 75.7% of patients, respectively. Overall, 84 patients developed SPLC (16.1%). The cumulative risk of SPLC was 20.2% at 10 years post-surgery (95% confidence interval [CI]: 15.3-23.2), and 25.2% (CI: 19.4-31.3) at 14 years post-surgery. On multivariate analysis, the SPLC risk was significantly higher in patients with postoperative thoracic radiotherapy (sdRH 2.79; 95% CI: 1.41-5.52; p = 0.003). CONCLUSION This study using appropriate statistical methods to consider competing risks showed that after complete NSCLC resection, the cumulative incidence function of SPLC was high, with patients receiving postoperative thoracic radiotherapy at higher risk. These data support the need for life-long follow-up of patients who undergo NSCLC surgery, with the objective of screening for SPLC.
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Affiliation(s)
- Taylor Leroy
- Doubs and Belfort Territory Cancer Registry, Besançon University Hospital, F-25000 Besançon, France; EA3181, University of Bourgogne-Franche-Comté, F-25000, Besançon, France.
| | - Elisabeth Monnet
- INSERM CIC 1431, Besançon University Hospital, F-25000 Besançon, France.
| | - Stéphane Guerzider
- Department of Respiratory Diseases, Besançon University Hospital, F-25000, Besançon, France.
| | - Pascale Jacoulet
- Department of Respiratory Diseases, Besançon University Hospital, F-25000, Besançon, France.
| | - Bernardino De Bari
- Department of Radiotherapy, Besançon University Hospital, F-25000, Besançon, France.
| | - Pierre-Emmanuel Falcoz
- University Hospital of Strasbourg, Nouvel Hôpital Civil, F-67000, Strasbourg, France; University of Strasbourg, F-67000, Strasbourg, France; INSERM UMR 1260, Regenerative Nanomedicine (RNM), FMTS, F-67000 Strasbourg, France.
| | - Marie Gainet-Brun
- Department of Respiratory Diseases, Besançon University Hospital, F-25000, Besançon, France.
| | - Jean Lahourcade
- Department of Respiratory Diseases, Besançon University Hospital, F-25000, Besançon, France.
| | - Faraj Alfreijat
- Department of Respiratory Diseases, Nord Franche-Comté Hospital, F-90400 Trévenans, France.
| | - Hamadi Almotlak
- Department of Respiratory Diseases, Nord Franche-Comté Hospital, F-90400 Trévenans, France.
| | - Olivier Adotevi
- Department of Oncology, Besançon University Hospital, F-25000 Besançon, France; INSERM UMR 1098, University of Bourgogne-Franche-Comté, F-25000 Besançon, France.
| | - Didier Pernet
- Department of Respiratory Diseases, Besançon University Hospital, F-25000, Besançon, France.
| | - Jean-Charles Polio
- Department of Respiratory Diseases, Besançon University Hospital, F-25000, Besançon, France.
| | - Maxime Desmarets
- INSERM CIC 1431, Besançon University Hospital, F-25000 Besançon, France; INSERM UMR 1098, University of Bourgogne-Franche-Comté, F-25000 Besançon, France.
| | - Anne-Sophie Woronoff
- Doubs and Belfort Territory Cancer Registry, Besançon University Hospital, F-25000 Besançon, France; EA3181, University of Bourgogne-Franche-Comté, F-25000, Besançon, France.
| | - Virginie Westeel
- Department of Respiratory Diseases, Besançon University Hospital, F-25000, Besançon, France; INSERM UMR 1098, University of Bourgogne-Franche-Comté, F-25000 Besançon, France.
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Takahashi Y, Eguchi T, Lu S, Downey RJ, Jones DR, Travis WD, Adusumilli PS. Preponderance of High-Grade Histologic Subtype in Autologous Metastases in Lung Adenocarcinoma. Am J Respir Crit Care Med 2019; 197:816-818. [PMID: 28862875 DOI: 10.1164/rccm.201705-0924le] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Yusuke Takahashi
- 1 Memorial Sloan Kettering Cancer Center New York, New York.,2 Keio University School of Medicine Tokyo, Japan
| | - Takashi Eguchi
- 1 Memorial Sloan Kettering Cancer Center New York, New York.,3 Shinshu University School of Medicine Matsumoto, Japan and
| | - Shaohua Lu
- 1 Memorial Sloan Kettering Cancer Center New York, New York.,4 Fudan University Shanghai, China
| | | | - David R Jones
- 1 Memorial Sloan Kettering Cancer Center New York, New York
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Hu ZG, Li WX, Ruan YS, Zeng FJ. Incidence trends and risk prediction nomogram of metachronous second primary lung cancer in lung cancer survivors. PLoS One 2018; 13:e0209002. [PMID: 30557376 PMCID: PMC6296553 DOI: 10.1371/journal.pone.0209002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 11/28/2018] [Indexed: 12/23/2022] Open
Abstract
Background This study was designed to estimate the trends in 5-year incidence of metachronous second primary lung cancer(SPLC) and to establish a risk prediction model to identify candidates who were at high risk of developing metachronous SPLC. Methods Incidence data between 2004 and 2007 were obtained from SEER database, including 42453 participants who survived ≥ 2 years after the initial diagnosis of lung cancer. Joinpoint regression analysis was used to calculate the 5-year incidence rates of metachronous SPLC per 100 000 population. Related risk factors of the survivors who developed MSPLC during five years were identified through logistic regression analysis, followed by establishment of risk prediction nomogram. Discrimination (C-index), calibration and decision analysis were further performed to assess the validation and clinical net benefit of risk prediction nomogram. Results A total of 1412 survivors with lung cancer developed MSPLC during five years, with 3546 per 100 000 population of age-adjusted 5-year incidence. Age, histology, tumor stage, and radiation were recognized as risk factors of metachronous SPLC, as indicated by logistic regression analysis. The risk prediction nomogram of metachronous SPLC harbored moderate discrimination(C-index = 0.67) and good calibration, with the risk of 0.01 to 0.11.The decision curve analysis showed that clinical net benefit of this risk prediction nomogram in a range of risk thresholds (0.01 to 0.06) was higher compared to all-screening or no-screening strategies. Conclusions Collectively, the cumulative risk of metachronous SPLC of the survivors increased over time. The risk prediction nomogram was available to select high-risk survivors who should regularly undergo computed tomography screening.
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Affiliation(s)
- Zhi Gang Hu
- Respiratory Disease Research Institute of China, The First College of Clinical Medical Science, Three Gorges University, Yichang, China
- Department of Respiratory Medicine, Yichang Central People's Hospital, Yichang, China
- * E-mail: (ZGH); (FJZ)
| | - Wen Xin Li
- Respiratory Disease Research Institute of China, The First College of Clinical Medical Science, Three Gorges University, Yichang, China
- Department of Respiratory Medicine, Yichang Central People's Hospital, Yichang, China
| | - Yu Shu Ruan
- Respiratory Disease Research Institute of China, The First College of Clinical Medical Science, Three Gorges University, Yichang, China
- Department of Respiratory Medicine, Yichang Central People's Hospital, Yichang, China
| | - Fan Jun Zeng
- Respiratory Disease Research Institute of China, The First College of Clinical Medical Science, Three Gorges University, Yichang, China
- Department of Respiratory Medicine, Yichang Central People's Hospital, Yichang, China
- * E-mail: (ZGH); (FJZ)
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Yang X, Zhan C, Li M, Huang Y, Zhao M, Yang X, Lin Z, Shi Y, Jiang W, Wang Q. Lobectomy Versus Sublobectomy in Metachronous Second Primary Lung Cancer: A Propensity Score Study. Ann Thorac Surg 2018; 106:880-887. [DOI: 10.1016/j.athoracsur.2018.04.071] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/26/2018] [Accepted: 04/23/2018] [Indexed: 12/20/2022]
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Abstract
PURPOSE OF REVIEW After 'curative' resection, many patients are still at risk for further lung cancer, either as a recurrence or a new metachronous primary. In theory, close follow-up should improve survival by catching relapse early - but in reality, many experts feel that surveillance for recurrence is of uncertain value. In this article, we explore the reasons behind the controversy, what the current guidelines recommend, and what future solutions are in development that may ultimately resolve this debate. RECENT FINDINGS Although postoperative surveillance for a new lung cancer may impart a survival advantage, this benefit does not appear to extend to the phenomenon of recurrence. Nevertheless, close radiographic follow-up after curative resection is still recommended by most professional societies, with more frequent scanning in the first 2 years, and then annual screening thereafter. Given the radiation risk, however, low-dose and minimal-dose computed tomography options are under investigation, as well as timing scans around expected peaks of recurrence rather than a set schedule. SUMMARY Applying the same surveillance algorithm to all lung cancer patients after curative resection may not be cost-effective or reasonable, especially if there is no demonstrable mortality benefit. Therefore, future research should focus on finding safer nonradiographic screening options, such as blood or breath biomarkers, or developing nomograms for predicting which patients will relapse and require closer follow-up. Ultimately, however, better tools for surveillance may be moot until we develop better treatment options for lung cancer recurrence.
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Postmus PE, Kerr KM, Oudkerk M, Senan S, Waller DA, Vansteenkiste J, Escriu C, Peters S. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017; 28:iv1-iv21. [PMID: 28881918 DOI: 10.1093/annonc/mdx222] [Citation(s) in RCA: 1181] [Impact Index Per Article: 168.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- P E Postmus
- The Clatterbridge Cancer Centre and Liverpool Heart and Chest Hospital, Liverpool
| | - K M Kerr
- University of Aberdeen, Aberdeen, UK
| | - M Oudkerk
- Center for Medical Imaging, University of Groningen, Groningen
| | - S Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - D A Waller
- Department of Thoracic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - C Escriu
- The Clatterbridge Cancer Centre and Liverpool Heart and Chest Hospital, Liverpool
| | - S Peters
- Oncology Department, Service d'Oncologie Médicale, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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Han SS, Rivera GA, Tammemägi MC, Plevritis SK, Gomez SL, Cheng I, Wakelee HA. Risk Stratification for Second Primary Lung Cancer. J Clin Oncol 2017. [PMID: 28644772 DOI: 10.1200/jco.2017.72.4203] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose This study estimated the 10-year risk of developing second primary lung cancer (SPLC) among survivors of initial primary lung cancer (IPLC) and evaluated the clinical utility of the risk prediction model for selecting eligibility criteria for screening. Methods SEER data were used to identify a population-based cohort of 20,032 participants diagnosed with IPLC between 1988 and 2003 and who survived ≥ 5 years after the initial diagnosis. We used a proportional subdistribution hazards model to estimate the 10-year risk of developing SPLC among survivors of lung cancer LC in the presence of competing risks. Considered predictors included age, sex, race, treatment, histology, stage, and extent of disease. We examined the risk-stratification ability of the prediction model and performed decision curve analysis to evaluate the clinical utility of the model by calculating its net benefit in varied risk thresholds for screening. Results Although the median 10-year risk of SPLC among survivors of LC was 8.36%, the estimated risk varied substantially (range, 0.56% to 14.3%) when stratified by age, histology, and extent of IPLC in the final prediction model. The stratification by deciles of estimated risk showed that the observed incidence of SPLC was significantly higher in the tenth-decile group (12.5%) versus the first-decile group (2.9%; P < 10-10). The decision curve analysis yielded a range of risk thresholds (1% to 11.5%) at which the clinical net benefit of the risk model was larger than those in hypothetical all-screening or no-screening scenarios. Conclusion The risk stratification approach in SPLC can be potentially useful for identifying survivors of LC to be screened by computed tomography. More comprehensive environmental and genetic data may help enhance the predictability and stratification ability of the risk model for SPLC.
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Affiliation(s)
- Summer S Han
- Summer S. Han, Sylvia K. Plevritis, and Heather A. Wakelee, Stanford University School of Medicine; Summer S. Han, Sylvia K. Plevritis, Scarlett L. Gomez, Iona Cheng, and Heather A. Wakelee, Stanford Cancer Institute; Heather A. Wakelee and Gabriel A. Rivera, Stanford University Department of Medicine, Division of Oncology, Stanford; Gabriel A. Rivera, Kaiser Permanente Fresno Medical Center, Fresno; Scarlett L. Gomez and Iona Cheng, Cancer Prevention Institute of California, Fremont, CA; and Martin C. Tammemägi, Brock University, St Catharines, Ontario, Canada
| | - Gabriel A Rivera
- Summer S. Han, Sylvia K. Plevritis, and Heather A. Wakelee, Stanford University School of Medicine; Summer S. Han, Sylvia K. Plevritis, Scarlett L. Gomez, Iona Cheng, and Heather A. Wakelee, Stanford Cancer Institute; Heather A. Wakelee and Gabriel A. Rivera, Stanford University Department of Medicine, Division of Oncology, Stanford; Gabriel A. Rivera, Kaiser Permanente Fresno Medical Center, Fresno; Scarlett L. Gomez and Iona Cheng, Cancer Prevention Institute of California, Fremont, CA; and Martin C. Tammemägi, Brock University, St Catharines, Ontario, Canada
| | - Martin C Tammemägi
- Summer S. Han, Sylvia K. Plevritis, and Heather A. Wakelee, Stanford University School of Medicine; Summer S. Han, Sylvia K. Plevritis, Scarlett L. Gomez, Iona Cheng, and Heather A. Wakelee, Stanford Cancer Institute; Heather A. Wakelee and Gabriel A. Rivera, Stanford University Department of Medicine, Division of Oncology, Stanford; Gabriel A. Rivera, Kaiser Permanente Fresno Medical Center, Fresno; Scarlett L. Gomez and Iona Cheng, Cancer Prevention Institute of California, Fremont, CA; and Martin C. Tammemägi, Brock University, St Catharines, Ontario, Canada
| | - Sylvia K Plevritis
- Summer S. Han, Sylvia K. Plevritis, and Heather A. Wakelee, Stanford University School of Medicine; Summer S. Han, Sylvia K. Plevritis, Scarlett L. Gomez, Iona Cheng, and Heather A. Wakelee, Stanford Cancer Institute; Heather A. Wakelee and Gabriel A. Rivera, Stanford University Department of Medicine, Division of Oncology, Stanford; Gabriel A. Rivera, Kaiser Permanente Fresno Medical Center, Fresno; Scarlett L. Gomez and Iona Cheng, Cancer Prevention Institute of California, Fremont, CA; and Martin C. Tammemägi, Brock University, St Catharines, Ontario, Canada
| | - Scarlett L Gomez
- Summer S. Han, Sylvia K. Plevritis, and Heather A. Wakelee, Stanford University School of Medicine; Summer S. Han, Sylvia K. Plevritis, Scarlett L. Gomez, Iona Cheng, and Heather A. Wakelee, Stanford Cancer Institute; Heather A. Wakelee and Gabriel A. Rivera, Stanford University Department of Medicine, Division of Oncology, Stanford; Gabriel A. Rivera, Kaiser Permanente Fresno Medical Center, Fresno; Scarlett L. Gomez and Iona Cheng, Cancer Prevention Institute of California, Fremont, CA; and Martin C. Tammemägi, Brock University, St Catharines, Ontario, Canada
| | - Iona Cheng
- Summer S. Han, Sylvia K. Plevritis, and Heather A. Wakelee, Stanford University School of Medicine; Summer S. Han, Sylvia K. Plevritis, Scarlett L. Gomez, Iona Cheng, and Heather A. Wakelee, Stanford Cancer Institute; Heather A. Wakelee and Gabriel A. Rivera, Stanford University Department of Medicine, Division of Oncology, Stanford; Gabriel A. Rivera, Kaiser Permanente Fresno Medical Center, Fresno; Scarlett L. Gomez and Iona Cheng, Cancer Prevention Institute of California, Fremont, CA; and Martin C. Tammemägi, Brock University, St Catharines, Ontario, Canada
| | - Heather A Wakelee
- Summer S. Han, Sylvia K. Plevritis, and Heather A. Wakelee, Stanford University School of Medicine; Summer S. Han, Sylvia K. Plevritis, Scarlett L. Gomez, Iona Cheng, and Heather A. Wakelee, Stanford Cancer Institute; Heather A. Wakelee and Gabriel A. Rivera, Stanford University Department of Medicine, Division of Oncology, Stanford; Gabriel A. Rivera, Kaiser Permanente Fresno Medical Center, Fresno; Scarlett L. Gomez and Iona Cheng, Cancer Prevention Institute of California, Fremont, CA; and Martin C. Tammemägi, Brock University, St Catharines, Ontario, Canada
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Kinsey CM, Hamlington KL, O’Toole J, Stapleton R, Bates JHT. Predicting the Mortality Benefit of CT Screening for Second Lung Cancer in a High-Risk Population. PLoS One 2016; 11:e0165471. [PMID: 27806080 PMCID: PMC5091818 DOI: 10.1371/journal.pone.0165471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 10/12/2016] [Indexed: 01/09/2023] Open
Abstract
Patients who survive an index lung cancer (ILC) after surgical resection continue to be at significant risk for a metachronous lung cancer (MLC). Indeed, this risk is much higher than the risk of developing an ILC in heavy smokers. There is currently little evidence upon which to base guidelines for screening at-risk patients for MLC, and the risk-reward tradeoffs for screening this patient population are unknown. The goal of this investigation was to estimate the maximum mortality benefit of CT screening for MLC. We developed a computational model to estimate the maximum rates of CT detection of MLC and surgical resection to be expected in a given population as a function of time after resection of an ILC. Applying the model to a hypothetical high-risk population suggests that screening for MLC within 5 years after resection of an ILC may identify only a very small number of treatable cancers. The risk of death from a potentially resectable MLC increases dramatically past this point, however, suggesting that screening after 5 years is imperative. The model also predicts a substantial detection gap for MLC that demonstrates the benefit to be gained as more sensitive screening methods are developed.
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Affiliation(s)
- C. Matthew Kinsey
- Pulmonary and Critical Care Division, University of Vermont College of Medicine, Burlington, Vermont, United States of America
- * E-mail:
| | - Katharine L. Hamlington
- Pulmonary and Critical Care Division, University of Vermont College of Medicine, Burlington, Vermont, United States of America
| | - Jacqueline O’Toole
- Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont, United States of America
| | - Renee Stapleton
- Pulmonary and Critical Care Division, University of Vermont College of Medicine, Burlington, Vermont, United States of America
| | - Jason H. T. Bates
- Pulmonary and Critical Care Division, University of Vermont College of Medicine, Burlington, Vermont, United States of America
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Hanna WC. Pros: long-term CT scan follow-up should be the standard of care in patients who are curatively treated for an early-stage non-small cell lung cancer. Transl Lung Cancer Res 2015; 4:476-8. [PMID: 26380190 DOI: 10.3978/j.issn.2218-6751.2015.07.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 06/30/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Waël C Hanna
- Division of Thoracic Surgery McMaster University, St Joseph's Healthcare, Hamilton, ON, Canada
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Yamauchi Y, Muley T, Safi S, Rieken S, Bischoff H, Kappes J, Warth A, Herth FJF, Dienemann H, Hoffmann H. The dynamic pattern of recurrence in curatively resected non-small cell lung cancer patients: Experiences at a single institution. Lung Cancer 2015; 90:224-9. [PMID: 26415991 DOI: 10.1016/j.lungcan.2015.09.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/08/2015] [Accepted: 09/12/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate the hazard function of tumor recurrence in patients with completely (R0) resected non-small cell lung cancer. METHODS A total of 1374 patients treated between 2003 and 2009 with complete resection and systematic lymph node dissection were studied. The risk of recurrence at a given time after operation was studied utilizing the cause-specific hazard function. Recurrence was categorized as local recurrence or distant recurrence. The risk distribution was assessed using clinical and pathological factors. RESULTS The hazard function for recurrence presented an early peak at approximately 10 months after surgery and maintained a tapered plateau-like tail extending up to 8 years. A similar risk pattern was detected for both local recurrence and distant recurrence, while the risk of distant recurrence was higher than that of local recurrence. The double-peaked pattern of hazard rate was present in several subgroups, such as p-stage IA patients. A comparison of histology and status of nodal involvement showed that pN1-2 adenocarcinoma patients demonstrated a high hazard rate of distant recurrence and that pN0 adenocarcinoma patients exhibited a small recurrent risk for a longer time. Squamous cell carcinoma patients showed only little difference in risk. CONCLUSIONS The data may be useful to select patients at high risk of recurrence and may provide information for each patient to decide how to manage the postoperative follow-up individually.
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Affiliation(s)
- Yoshikane Yamauchi
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, Heidelberg, Germany
| | - Thomas Muley
- Translational Research Unit, Thoraxklinik, Heidelberg University, Heidelberg, Germany; Translational Lung Research Center Heidelberg, Heidelberg, Germany
| | - Seyer Safi
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, Heidelberg, Germany
| | - Stefan Rieken
- Department of Radiation Oncology, Heidelberg University, Heidelberg, Germany
| | - Helge Bischoff
- Department of Thoracic Oncology/Internal Medicine, Thoraxklinik, Heidelberg University, Heidelberg, Germany
| | - Jutta Kappes
- Pneumology and Critical Care Medicine, Thoraxklinik, Heidelberg University, Heidelberg, Germany
| | - Arne Warth
- Institute of Pathology, Heidelberg University, Heidelberg, Germany; Translational Lung Research Center Heidelberg, Heidelberg, Germany
| | - Felix J F Herth
- Pneumology and Critical Care Medicine, Thoraxklinik, Heidelberg University, Heidelberg, Germany; Translational Lung Research Center Heidelberg, Heidelberg, Germany
| | - Hendrik Dienemann
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, Heidelberg, Germany
| | - Hans Hoffmann
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, Heidelberg, Germany.
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Hamaji M, Ali SO, Burt BM. A meta-analysis of resected metachronous second non-small cell lung cancer. Ann Thorac Surg 2015; 99:1470-8. [PMID: 25725930 DOI: 10.1016/j.athoracsur.2014.11.033] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 11/07/2014] [Accepted: 11/17/2014] [Indexed: 12/17/2022]
Abstract
This meta-analysis was designed to determine the effect of surgical treatment on overall survival of patients treated surgically for a second non-small cell lung cancer (NSCLC) that occurred after resection of an initial NSCLC. PubMed and Scopus databases were queried. Nine studies were identified. Meta-analyses revealed pooled operative mortality of 7% for the second resection, pooled 5-year overall survival of 46% after resection of the second NSCLC, and 79% after resection of the first NSCLC. These results suggest that surgical resection can be considered for patients who have a second primary NSCLC after resection of an initial lung cancer.
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Affiliation(s)
- Masatsugu Hamaji
- Department of Thoracic Surgery, Kyoto University Hospital, Shogoin, Sakyo-ku, Kyoto, Japan.
| | - Syed Osman Ali
- Division of Cardiothoracic Surgery, Altru Hospital, Grand Forks, North Dakota
| | - Bryan M Burt
- Division of Thoracic Surgery, Department of Surgery, Baylor College of Medicine, Houston, Texas
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Boyle JM, Tandberg DJ, Chino JP, D'Amico TA, Ready NE, Kelsey CR. Smoking history predicts for increased risk of second primary lung cancer: A comprehensive analysis. Cancer 2014; 121:598-604. [DOI: 10.1002/cncr.29095] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 09/10/2014] [Accepted: 09/12/2014] [Indexed: 01/22/2023]
Affiliation(s)
- John M. Boyle
- Department of Radiation Oncology; Duke University Medical Center; Durham North Carolina
| | - Daniel J. Tandberg
- Department of Radiation Oncology; Duke University Medical Center; Durham North Carolina
| | - Junzo P. Chino
- Department of Radiation Oncology; Duke University Medical Center; Durham North Carolina
| | - Thomas A. D'Amico
- Division of Cardiothoracic Surgery, Department of Surgery; Duke University Medical Center; Durham North Carolina
| | - Neal E. Ready
- Division of Medical Oncology, Department of Medicine; Duke University Medical Center; Durham North Carolina
| | - Chris R. Kelsey
- Department of Radiation Oncology; Duke University Medical Center; Durham North Carolina
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