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Udelsman BV, Canavan ME, Zhan PL, Ely S, Park HS, Boffa DJ, Mase VJ. Overall survival in low-comorbidity patients with stage I non-small cell lung cancer who chose stereotactic body radiotherapy compared to surgery. J Thorac Cardiovasc Surg 2024; 167:822-833.e7. [PMID: 37500052 DOI: 10.1016/j.jtcvs.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/10/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To evaluate trends in the utilization of stereotactic body radiotherapy (SBRT) and to compare overall survival (OS) of patients with early-stage non-small cell lung cancer (NSCLC) undergoing SBRT versus those undergoing surgery. METHODS The National Cancer Database was queried for patients without documented comorbidities who underwent surgical resection (lobectomy, segmentectomy, or wedge resection) or SBRT for clinical stage I NSCLC between 2012 and 2018. Peritreatment mortality and 5-year OS were compared among propensity score-matched cohorts. RESULTS A total of 30,658 patients were identified, including 24,729 (80.7%) who underwent surgery and 5929 (19.3%) treated with SBRT. Between 2012 and 2018, the proportion of patients receiving SBRT increased from 15.9% to 26.0% (P < .001). The 30-day mortality and 90-day mortality were higher among patients undergoing surgical resection versus those receiving SBRT (1.7% vs 0.3%, P < .001; 2.8% vs 1.7%, P < .001). In propensity score-matched patients, OS favored SBRT for the first several months, but this was reversed before 1 year and significantly favored surgical management in the long term (5-year OS, 71.0% vs 41.8%; P < .001). The propensity score-matched analysis was repeated to include only SBRT patients who had documented refusal of a recommended surgery, which again demonstrated superior 5-year OS with surgical management (71.4% vs 55.9%; P < .001). CONCLUSIONS SBRT is being increasingly used to treat early-stage lung cancer in low-comorbidity patients. However, for patients who may be candidates for either treatment, the long-term OS favors surgical management.
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Affiliation(s)
- Brooks V Udelsman
- Division of Thoracic Surgery, Department of Surgery, University of Southern California, Los Angeles, Calif.
| | - Maureen E Canavan
- Department of Internal Medicine, Cancer Outcomes Public Policy and Effectiveness Research Center, Yale University School of Medicine, New Haven, Conn
| | - Peter L Zhan
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Sora Ely
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Henry S Park
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Conn
| | - Daniel J Boffa
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Vincent J Mase
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
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Sakane T, Nakajima K, Iwata H, Nakano T, Hagui E, Oguri M, Nomura K, Hattori Y, Ogino H, Haneda H. Lobectomy versus proton therapy for stage I non-small cell lung cancer. J Thorac Cardiovasc Surg 2023; 166:1490-1501.e2. [PMID: 37625619 DOI: 10.1016/j.jtcvs.2023.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/02/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVE Lobectomy is the standard treatment for patients with early-stage non-small cell lung cancer (NSCLC). In recent years, an increasing number of patients with lung cancer have been treated using proton therapy (PT). We conducted a propensity score-matched analysis to compare the treatment outcomes of these 2 modalities. METHODS We retrospectively reviewed data from 275 patients with histologically confirmed clinical stage I NSCLC who underwent lobectomy (n = 206) or PT (n = 69) at our institution from July 2013 to December 2020. The end points were overall survival (OS), cause-specific survival, recurrence-free survival (RFS), local control, regional lymph node control, and distant control. Propensity score matching was performed to reduce selection bias in the 2 groups. RESULTS The matched cohort consisted of 59 patients who underwent lobectomy and 59 patients who underwent PT with a median follow-up period of 50 months. There were no significant differences in OS (P = .26), cause-specific survival (P = .33), RFS (P = .53), local control (P = .41), regional lymph node control (P = .98), and distant control (P = .31). In the lobectomy and PT groups, the 5-year OS rate was 85.8% and 79.1%, respectively, the RFS rate was 82.3% and 77.8%, and the local control rate was 92.1% and 96.6%. CONCLUSIONS We found no difference in survival or disease control between lobectomy and PT in patients with histologically confirmed clinical stage I NSCLC. Despite these findings, the potential for unmeasured confounding factors remains, and randomized control trials are needed to better compare these treatment modalities.
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Affiliation(s)
- Tadashi Sakane
- Department of Thoracic Surgery, Nagoya City University West Medical Center, Nagoya, Japan.
| | - Koichiro Nakajima
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, Japan
| | - Hiromitsu Iwata
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, Japan
| | - Tomoharu Nakano
- Department of Thoracic Surgery, Nagoya City University West Medical Center, Nagoya, Japan
| | - Emi Hagui
- Department of Thoracic Surgery, Nagoya City University West Medical Center, Nagoya, Japan
| | - Masanosuke Oguri
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, Japan
| | - Kento Nomura
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, Japan
| | - Yukiko Hattori
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, Japan
| | - Hiroyuki Ogino
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, Japan
| | - Hiroshi Haneda
- Department of Thoracic Surgery, Nagoya City University West Medical Center, Nagoya, Japan
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Kirk F, Crathern K, Chang S, Yong MS, He C, Hughes I, Yadav S, Lo W, Cole C, Windsor M, Naidoo R, Stroebel A. The influence of the COVID-19 pandemic on lung cancer surgery in Queensland. ANZ J Surg 2023. [PMID: 37079774 DOI: 10.1111/ans.18465] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 04/06/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND The coronavirus disease-19 (COVID-19) pandemic poses unprecedented challenges to global healthcare. The contemporary influence of COVID-19 on the delivery of lung cancer surgery has not been examined in Queensland. METHODS We performed a retrospective registry analysis of the Queensland Cardiac Outcomes Registry (QCOR), thoracic database examining all adult lung cancer resections across Queensland from 1/1/2016 to 30/4/2022. We compared the data prior to, and after, the introduction of COVID-restrictions. RESULTS There were 1207 patients. Mean age at surgery was 66 years and 1115 (92%) lobectomies were performed. We demonstrated a significant delay from time of diagnosis to surgery from 80 to 96 days (P < 0.0005), after introducing COVID-restrictions. The number of surgeries performed per month decreased after the pandemic and has not recovered (P = 0.012). 2022 saw a sharp reduction in cases with 49 surgeries, compared to 71 in 2019 for the same period. CONCLUSION Restrictions were associated with a significant increase in pathological upstaging, greatest immediately after the introduction of COVID-restrictions (IRR 1.71, CI 0.93-2.94, P = 0.05). COVID-19 delayed the access to surgery, reduced surgical capacity and consequently resulted in pathological upstaging throughout Queensland.
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Affiliation(s)
- Frazer Kirk
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Department Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, James Cook University Hospital, Townsville, Queensland, Australia
| | - Kelsie Crathern
- Department Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Shantel Chang
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Matthew S Yong
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Department Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Cheng He
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Department Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Ian Hughes
- Office for Research Governance and Development, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Sumit Yadav
- Department of Cardiothoracic Surgery, The Townsville University Hospital, Townsville, Queensland, Australia
| | - Wing Lo
- Department of Cardiothoracic Surgery, Princess Alexandria Hospital, Brisbane, Queensland, Australia
| | - Christopher Cole
- Department of Cardiothoracic Surgery, Princess Alexandria Hospital, Brisbane, Queensland, Australia
| | - Morgan Windsor
- The Department of Thoracic Surgery, Royal Brisbane Women's Hospital, Brisbane, Queensland, Australia
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Rishendran Naidoo
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Andrie Stroebel
- Department Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
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Kirk F, Chang S, Yong MS, He C, Hughes I, Yadav S, Lo W, Cole C, Windsor M, Naidoo R, Stroebel A. Thoracic Surgery and the Elderly; Is Lobectomy Safe in Octogenarians? Heart Lung Circ 2023:S1443-9506(23)00140-3. [PMID: 37003939 DOI: 10.1016/j.hlc.2023.03.005] [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: 09/21/2022] [Revised: 01/05/2023] [Accepted: 03/08/2023] [Indexed: 04/03/2023]
Abstract
PURPOSE Non-small cell lung cancer is the most common malignancy of the elderly, with 5-year survival estimates of 16.8%. The prognostic benefit of surgical resection for early lung cancer is irrefutable and maintained irrespective of age, even in patients over 75 years. Concerningly, despite the prognostic benefit of surgery there are deviations from standard treatment protocols with increasing age due to concerns of increased morbidity and mortality with surgery, without evidence to support this. METHOD A state-wide retrospective registry study of Queensland's Cardiac Outcomes Registry's (QCOR) Thoracic Database examining the influence of age on the safety of Lung Resection (1 January 2016-20 April 2022). RESULTS This included 1,232 patients, mean age at surgery was 66 years (range 14-91 years), with 918 thoracotomies performed. Three deaths occurred within 30-days (0.24%). Octogenarians (n=60) had lower rates of smoking (26% vs 6%), respiratory, cardiovascular, and cerebrovascular disease suggesting this subset of patients is carefully selected. Octogenarian status was not associated with an increased all-cause morbidity (p=0.09) or 30-day mortality (p=0.06). Further to this it was not associated with re-operation (4.4% vs 8.3%, p=0.1), increased postoperative stay (6.66 vs 6.65 days, p=0.99) or myocardial infarction. An independent predictor of morbidity was male sex (OR 1.58, CI 1.2-2.1 p=0.001). CONCLUSION Age ≥80 years did not increase surgical morbidity or mortality in the appropriately selected patient and should not be a barrier to referral for consideration of surgical resection.
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Affiliation(s)
- Frazer Kirk
- Department Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Qld, Australia; School of Medicine and Dentistry, James Cook University, Townsville, Qld, Australia; School of Medicine and Dentistry, Griffith University, Gold Coast, Qld, Australia.
| | - Shantel Chang
- School of Medicine and Dentistry, Griffith University, Gold Coast, Qld, Australia
| | - Matthew S Yong
- Department Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Qld, Australia; School of Medicine and Dentistry, Griffith University, Gold Coast, Qld, Australia
| | - Cheng He
- Department Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Qld, Australia; School of Medicine and Dentistry, Griffith University, Gold Coast, Qld, Australia
| | - Ian Hughes
- Office for Research Governance and Development, Gold Coast University Hospital, Gold Coast, Qld, Australia
| | - Sumit Yadav
- Department of Cardiothoracic Surgery, The Townsville University Hospital, Townsville, Qld, Australia
| | - Wing Lo
- Department of Cardiothoracic Surgery, Princess Alexandria Hospital, Brisbane, Qld, Australia
| | - Christopher Cole
- Department of Cardiothoracic Surgery, Princess Alexandria Hospital, Brisbane, Qld, Australia
| | - Morgan Windsor
- The Department of Thoracic Surgery, Royal Brisbane Women's Hospital, Brisbane, Qld, Australia; Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia
| | - Rishendran Naidoo
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia
| | - Andrie Stroebel
- Department Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Qld, Australia
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Huang W, Deng HY, Wu XN, Xu K, Li P, Lin MY, Yuan C, Zhou Q. Surgical resection versus radiotherapy for clinical stage IA lung cancer ≤1 cm in size: A population-based study. Asian J Surg 2023; 46:385-393. [PMID: 35525696 DOI: 10.1016/j.asjsur.2022.04.078] [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: 02/10/2022] [Revised: 04/11/2022] [Accepted: 04/21/2022] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE With the increasing incidence of stage IA lung cancer ≤1 cm in size, the optimal primary treatment remains to be controversial, and thus, we compared the survival of these patients treated with radiotherapy, wedge resection, segmentectomy, or lobectomy in a large population. METHODS We identified patients with stage IA lung cancer ≤1 cm in size between 2004 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database. We compared the overall survival (OS) via Kaplan-Meier analysis and conducted Cox regression analysis via propensity score matching (PSM) method to identify the relative hazard ratio (HR) and difference of OS among these treatments in the subgroup stratified by four variables (age, total number of tumors, pathological grade, and histology). RESULTS A total of 5435 patients were included with a median age of 68 years (range, 6-94 years), of which 2131 (39.2%) were male, and 3510 (64.6%) were adenocarcinoma. The 5-year OS rate was 67.1%, 34.5%, 61.6%, 72.1%, and 75.0% for the entire study population, radiotherapy, wedge resection, segmentectomy, and lobectomy, respectively. In PSM analysis, wedge resection and segmentectomy were all superior to radiotherapy (P < 0.001), and segmentectomy was superior to wedge resection (P = 0.043), while segmentectomy was comparable with lobectomy (P = 0.058). In patients with multiple tumors, radiotherapy brought similar survival to surgery (wedge resection versus radiotherapy, P = 0.323; segmentectomy versus radiotherapy, P = 0.170; lobectomy versus radiotherapy, P = 0.796). CONCLUSIONS Among stage IA lung cancer with ≤1 cm, segmentectomy and lobectomy were identified as the potential effective treatments, with segmentectomy more preferred, while radiotherapy would be recommended in those with multiple tumors, which requires further verification.
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Affiliation(s)
- Weijia Huang
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, PR China
| | - Han-Yu Deng
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, PR China.
| | - Xiao-Na Wu
- West China Hospital, Sichuan University, Chengdu, PR China
| | - Kai Xu
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, PR China; West China School of Medicine, Sichuan University, Chengdu, PR China
| | - Peiwei Li
- West China School of Medicine, Sichuan University, Chengdu, PR China
| | - Ming-Ying Lin
- West China School of Medicine, Sichuan University, Chengdu, PR China
| | - Chi Yuan
- West China School of Medicine, Sichuan University, Chengdu, PR China
| | - Qinghua Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, PR China.
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6
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Udelsman BV, Chang DC, Boffa DJ, Gaissert HA. Association of Lymph Node Sampling and Clinical Volume in Lobectomy for Non-Small Cell Lung Cancer. Ann Thorac Surg 2023; 115:166-173. [PMID: 35752354 DOI: 10.1016/j.athoracsur.2022.05.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/16/2022] [Accepted: 05/09/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Sampling of ≥10 lymph nodes during lobectomy for non-small cell lung cancer (NSCLC) was a previous surveillance metric and potential quality metric of the American College of Surgeons Commission on Cancer. We sought to determine guideline adherence and its relationship to hospital lobectomy volume within The Society of Thoracic Surgeons General Thoracic Surgery Database. METHODS Participant centers providing elective lobectomy for NSCLC within The Society of Thoracic Surgeons General Thoracic Surgery Database (2012-2019) were divided into tertiles according to annual volume. Average hospital nodal harvest of ≥10 nodes per lobectomy defined the primary outcome. Univariable analysis compared average patient and operative characteristics between the participant centers. Multivariable logistic regression was used to determine independent factors associated with average clinical center nodal harvest of ≥10 nodes. RESULTS Median annual lobectomy volume was 6.2, 19.9, and 42.7 for low-, medium-, and high-volume participant centers. Among 305 centers and 43 597 patients, 5.6% of lobectomies occurred in low-volume centers, 24.0% in medium-volume centers, and 70.4% in high-volume centers. Average rates of ≥10 nodes per lobectomy were excised in 44.0% of low-volume centers, 70.6% of medium-volume centers, and 75.2% of high-volume centers (P < .001). On multivariable analysis, average nodal excision of ≥10 nodes was strongly associated with medium-volume (odds ratio, 2.94; CI, 1.57-5.50, P < .01) and high-volume (odds ratio, 3.82; CI, 1.95-7.46; P < .001) participant centers. CONCLUSIONS Although higher center volume and increased nodal harvest are associated, 25% of high-volume centers average a rate of <10 lymph nodes per lobectomy for NSCLC. Low nodal yield may underestimate stage, with implications for adjuvant therapy and long-term survival.
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Affiliation(s)
- Brooks V Udelsman
- Division of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut.
| | - David C Chang
- Codman Center for Clinical Effectiveness, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniel J Boffa
- Division of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Henning A Gaissert
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Ni L, Lin G, Zhang Z, Sun D, Liu Z, Liu X. Surgery versus radiotherapy in octogenarians with stage Ia non‑small cell lung cancer: propensity score matching analysis of the SEER database. BMC Pulm Med 2022; 22:411. [DOI: 10.1186/s12890-022-02177-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/27/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
To compare overall survival (OS) and cancer-specific survival (CSS) outcomes of surgery with radiotherapy in octogenarians with stage Ia non-small cell lung cancer (NSCLC).
Materials and methods
Patients aged ≥ 80 years with clinical stage Ia (T1N0M0) NSCLC between 2012 and 2017 were identified from the population-based Surveillance, Epidemiology, and End Results (SEER) database. Patients were assigned into surgery and radiotherapy groups. Multivariate Cox regression analysis was used to identify survival-associated factors. Treatment groups were adjusted by propensity score matching (PSM) analysis while OS and CSS outcomes were compared among groups by Kaplan–Meier analysis.
Results
A total of 1641 patients were identified, with 46.0% in the surgical group and 54.0% in the radiotherapy group. Compared to surgery, radiotherapy-treated patients were older, later diagnosed, had more often unmarried, more squamous cell carcinoma, more unknown grade and increased tumor sizes. Radiotherapy was associated with a significantly worse OS, compared to surgery (hazard ratio 2.426; 95% CI 2.003–2.939; P < .001). After PSM, OS (P < 0.001) and CSS (P < 0.001) were higher in the surgery group. The 1-, 3-, and 5-year OS rates of surgical and radiotherapy group were 90.0%, 76.9%, 59.9%, and 86.0%, 54.3%, 28.0%, respectively. The 1-, 3-, and 5-year CSS rates of surgical and radiotherapy group were 94.5%, 86.1%, 78.0% and 90.7%, 74.5%, 61.0%, respectively. There were no survival differences between the matched surgery without lymph node examination (LNE) and radiotherapy group, as well as between the matched surgery and radiotherapy who were recommended but refused surgery group.
Conclusions
In octogenarians with stage Ia NSCLC, surgery with lymph node dissection offers better OS and CSS outcomes than radiotherapy.
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Establishment of a Prediction Model for Overall Survival after Stereotactic Body Radiation Therapy for Primary Non-Small Cell Lung Cancer Using Radiomics Analysis. Cancers (Basel) 2022; 14:cancers14163859. [PMID: 36010853 PMCID: PMC9405862 DOI: 10.3390/cancers14163859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Lung cancer remains the leading cause of cancer-related mortality worldwide. Although early-stage non-small cell lung cancer (NSCLC) is likely to be controlled with stereotactic body radiation therapy (SBRT), approximately 18% of patients lead to recurrence. The aim of this study was to identify prognostic factors and establish a predictive model for survival outcomes of patients with non-metastatic NSCLC treated with SBRT. Several radiomic features were selected as predictive factors and two prediction models were established from the pre-treatment computed tomography images of 250 patients in the training cohort. One radiomic factor remained a significant prognostic factor of overall survival (OS) (p = 0.044), and one predicting model could estimate OS time (mean: 37.8 months) similar to the real OS time (33.7 months). In this study, we identified one radiomic factor and one prediction model that can be widely used. Abstract Stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer (NSCLC) leads to recurrence in approximately 18% of patients. We aimed to extract the radiomic features, with which we predicted clinical outcomes and to establish predictive models. Patients with primary non-metastatic NSCLC who were treated with SBRT between 2002 and 2022 were retrospectively reviewed. The 358 primary tumors were randomly divided into a training cohort of 250 tumors and a validation cohort of 108 tumors. Clinical features and 744 radiomic features derived from primary tumor delineation on pre-treatment computed tomography were examined as prognostic factors of survival outcomes by univariate and multivariate analyses in the training cohort. Predictive models of survival outcomes were established from the results of the multivariate analysis in the training cohort. The selected radiomic features and prediction models were tested in a validation cohort. We found that one radiomic feature showed a significant difference in overall survival (OS) in the validation cohort (p = 0.044) and one predicting model could estimate OS time (mean: 37.8 months) similar to the real OS time (33.7 months). In this study, we identified one radiomic factor and one prediction model that can be widely used.
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Chao C, Di D, Wang M, Liu Y, Wang B, Qian Y. Identifying octogenarians with non-small cell lung cancer who could benefit from surgery: A population-based predictive model. Front Surg 2022; 9:972014. [PMID: 35965875 PMCID: PMC9366359 DOI: 10.3389/fsurg.2022.972014] [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: 06/20/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background As the population ages, there will be an increasing number of octogenarian patients with non-small cell lung cancer (NSCLC). In carefully selected elderly patients, surgery can improve long-term survival. To identify candidates who would benefit from surgery, we performed this study and built a predictive model. Materials and methods Data from NSCLC patients over 80 years old were obtained from the Surveillance, Epidemiology and End Results database. A 1:1 propensity score matching was performed to balance the clinicopathological features between the surgery and non-surgery groups. Kaplan-Meier analyses and log-rank tests were used to assess the significance of surgery to outcome, and Cox proportional-hazards regression and competing risk model were conducted to determine the independent prognostic factors for these patients. A nomogram was built using multivariable logistic analyses to predict candidates for surgery based on preoperative factors. Results The final study population of 31,462 patients were divided into surgery and non-surgery groups. The median cancer-specific survival time respectively was 53 vs. 13 months. The patients’ age, sex, race, Tumor, Node, Metastasis score, stage, chemotherapy use, tumor histology and nuclear grade were independent prognostic factors. Apart from race and chemotherapy, other variates were included in the predictive model to distinguish the optimal surgical octogenarian candidates with NSCLC. Internal and external validation confirmed the efficacy of this model. Conclusion Surgery improved the survival time of octogenarian NSCLC patients. A novel nomogram was built to help clinicians make the decision to perform surgery on elderly patients with NSCLC.
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Affiliation(s)
| | | | | | | | - Bin Wang
- Correspondence: Bin Wang ; Yongxiang Qian
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Park HS, Detterbeck FC, Madoff DC, Bade BC, Kumbasar U, Mase VJ, Li AX, Blasberg JD, Woodard GA, Brandt WS, Decker RH. A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation-part 4: systematic review of evidence involving SBRT and ablation. J Thorac Dis 2022; 14:2412-2436. [PMID: 35813762 PMCID: PMC9264060 DOI: 10.21037/jtd-21-1826] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/09/2022] [Indexed: 11/06/2022]
Abstract
Background Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options [lobectomy, segmentectomy, wedge, stereotactic body radiotherapy (SBRT), thermal ablation], weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making. Methods A PubMed systematic review from 2000-2021 of outcomes after SBRT or thermal ablation vs. resection is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons with at least some adjustment for confounders. The analysis involved careful assessment, including characteristics of patients, settings, residual confounding etc. to expose degrees of uncertainty and applicability to individual patients. Evidence is summarized that provides an at-a-glance overall impression as well as the ability to delve into layers of details of the patients, settings and treatments involved. Results Short-term outcomes are meaningfully better after SBRT than resection. SBRT doesn't affect quality-of-life (QOL), on average pulmonary function is not altered, but a minority of patients may experience gradual late toxicity. Adjusted non-randomized comparisons demonstrate a clinically relevant detriment in long-term outcomes after SBRT vs. surgery. The short-term benefits of SBRT over surgery are accentuated with increasing age and compromised patients, but the long-term detriment remains. Ablation is associated with a higher rate of complications than SBRT, but there is little intermediate-term impact on quality-of-life or pulmonary function tests. Adjusted comparisons show a meaningful detriment in long-term outcomes after ablation vs. surgery; there is less difference between ablation and SBRT. Conclusions A systematic, comprehensive summary of evidence regarding Stereotactic Body Radiotherapy or thermal ablation vs. resection with attention to aspects of applicability, uncertainty and effect modifiers provides a foundation for a framework for individualized decision-making.
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Affiliation(s)
- Henry S. Park
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Frank C. Detterbeck
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - David C. Madoff
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Brett C. Bade
- Department of Pulmonary Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Ulas Kumbasar
- Department of Thoracic Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Vincent J. Mase
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew X. Li
- Department of General Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Justin D. Blasberg
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Gavitt A. Woodard
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Whitney S. Brandt
- Department of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Roy H. Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
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11
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Miyazaki T, Saji H, Nakamura H, Nagayasu T, Okumura N, Tsuchida M, Sonobe M, Aokage K, Nakao M, Haruki T, Okada M, Suzuki K, Chida M, Yoshino I. The C-reactive protein to albumin ratio is a prognostic factor for stage I non-small cell lung cancer in elderly patients: JACS1303. Surg Today 2022; 52:1463-1471. [PMID: 35211804 DOI: 10.1007/s00595-022-02485-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/16/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To establish the prognostic significance of C-reactive protein (CRP) and albumin in octogenarians with non-small cell lung cancer (NSCLC) based on the study of the Japanese Association for Chest Surgery (JACS 1303). METHODS A total of 618 octogenarians with pathological stage I NSCLC, who underwent pulmonary resection, were included in the analysis. We conducted multivariable Cox regression analysis to evaluate the CRP to albumin ratio (CAR) as a potential prognostic factor. Other clinicopathological factors were also evaluated. RESULTS The median age was 82 years. Operations included lobectomy (n = 388; 62.8%) segmentectomy (n = 95; 15%), and wedge resection (n = 135; 22%). Pathological stage IA was diagnosed in 380 (61.5%) patients. The 3-year (OS) and cancer-specific survival (CS) rates were 86.7% and 94.6%, respectively. OS was significantly higher for patients with low CAR (< 0.106) than for those with high CAR (≥ 0.106) (hazard ratio = 3.13, 95% confidence interval: 1.99-4.93, p < 0.0001). Univariate analysis identified sex, poor performance status, smoking status, comorbidity, solid tumor, histology, high Glasgow prognostic scale, and high CAR as significant prognostic factors. Multivariate analysis identified only the CAR as a significant prognostic factor for both OS and CS. CONCLUSIONS Our analysis of the nationwide data demonstrated that the CAR is a useful prognostic factor for elderly patients with stage I NSCLC.
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Affiliation(s)
- Takuro Miyazaki
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Hisashi Saji
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroshige Nakamura
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Norihito Okumura
- Department of Thoracic Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Masanori Tsuchida
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Makoto Sonobe
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Keiju Aokage
- Division of Thoracic Surgery, Department of Thoracic Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Masayuki Nakao
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomohiro Haruki
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.,Committee for Scientific Affairs, The Japanese Association for Chest Surgery, Kyoto, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.,Committee for Scientific Affairs, The Japanese Association for Chest Surgery, Kyoto, Japan
| | - Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University, Shimotsuga, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan and President, The Japanese Association for Chest Surgery, Kyoto, Japan
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12
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[Stereotactic body radiotherapy compared to modern surgery for treatment of early stage non-small-cell lung cancer]. Strahlenther Onkol 2022; 198:315-318. [PMID: 35022819 DOI: 10.1007/s00066-021-01897-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 10/19/2022]
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13
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Gossot D. Lobar or sublobar resection for early-stage lung cancer: at the crossroads. Eur J Cardiothorac Surg 2021; 60:1295-1296. [PMID: 34549303 DOI: 10.1093/ejcts/ezab363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/14/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dominique Gossot
- Thoracic Department, Curie-Montsouris Thoracic Institute-Institut Mutualiste Montsouris, Paris, France
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