Sentinel node sampling limits lymphadenectomy in stage I non-small cell lung cancer

Development and validation of 18F-FDG PET/CT radiomics-based nomogram to predict visceral pleural invasion in solid lung adenocarcinoma

OBJECTIVES

This study aimed to establish a radiomics model based on 18F-FDG PET/CT images to predict visceral pleural invasion (VPI) of solid lung adenocarcinoma preoperatively.

METHODS

We retrospectively enrolled 165 solid lung adenocarcinoma patients confirmed by histopathology with 18F-FDG PET/CT images. Patients were divided into training and validation at a ratio of 0.7. To find significant VPI predictors, we collected clinicopathological information and metabolic parameters measured from PET/CT images. Three-dimensional (3D) radiomics features were extracted from each PET and CT volume of interest (VOI). Receiver operating characteristic (ROC) curve was performed to determine the performance of the model. Accuracy, sensitivity, specificity and area under curve (AUC) were calculated. Finally, their performance was evaluated by concordance index (C-index) and decision curve analysis (DCA) in training and validation cohorts.

RESULTS

165 patients were divided into training cohort (n = 116) and validation cohort (n = 49). Multivariate analysis showed that histology grade, maximum standardized uptake value (SUVmax), distance from the lesion to the pleura (DLP) and the radiomics features had statistically significant differences between patients with and without VPI (P < 0.05). A nomogram was developed based on the logistic regression method. The accuracy of ROC curve analysis of this model was 75.86% in the training cohort (AUC: 0.867; C-index: 0.867; sensitivity: 0.694; specificity: 0.889) and the accuracy rate in validation cohort was 71.55% (AUC: 0.889; C-index: 0.819; sensitivity: 0.654; specificity: 0.739).

CONCLUSIONS

A PET/CT-based radiomics model was developed with SUVmax, histology grade, DLP, and radiomics features. It can be easily used for individualized VPI prediction.

The comparison of Lobe-Specific or Systematic Mediastinal Lymph Node Dissection for Early-Stage Lung Adenocarcinoma With Consolidation Tumor Ratio Over 0.5

INTRODUCTION

Surgery is the most effective treatment for early-stage lung cancer. This study will propose a personalized plan for mediastinal lymph node dissection in early-stage lung adenocarcinoma to reduce the risk of surgery and improve the quality of life.

METHODS

This study retrospectively analyzed the patients underwent lobectomy and lymph node dissection in the Department of Thoracic Surgery, Zhongshan Hospital, Fudan University. Clinical stage I lung adenocarcinoma patients with solid component ratio (CTR) between 0.5 and 1 were included. Patients were divided into systematic (S-MLND) and lobe-specific (L-MLND) mediastinal lymph node dissection groups. The days of hospitalization, the presence or absence of complications, the recurrence-free survival rate, and the overall survival rate were calculated to evaluate the postoperative quality and operation risk of the patients.

RESULTS

210 patients (138 L-MLND and 72 S-MLND) were included. 2 lymph node metastases appeared in the S-MLND group while none in the L-MLND group (P = .049). No differences were shown in age, tumor site, size, solid component, degree of tumor invasion, and stage. The proportion of patients with severe postoperative cough and the length of hospital stay in the L-MLND group decreased. The 5-year OS of the entire cohort was 98.1%, 98.6% in L-MLND, compared with 97.2% in S-MLND; RFS was 94.8%, 95.7% in L-MLND, compared with 93.0% in S-MLND.

CONCLUSION

For cIA lung adenocarcinoma, according to the Thin-slice CT within 1 month before the operation, if the main lesion was less than 3 cm and CTR over 0.5, L-MLND is as effective as S-MLND.

Oncologic Outcomes of Surgery Versus SBRT for Non-Small-Cell Lung Carcinoma: A Systematic Review and Meta-analysis

BACKGROUND

The optimal treatment of stage I non-small-cell lung carcinoma is subject to debate. The aim of this study was to compare overall survival and oncologic outcomes of lobar resection (LR), sublobar resection (SR), and stereotactic body radiotherapy (SBRT).

METHODS

A systematic review and meta-analysis of oncologic outcomes of propensity matched comparative and noncomparative cohort studies was performed. Outcomes of interest were overall survival and disease-free survival. The inverse variance method and the random-effects method for meta-analysis were utilized to assess the pooled estimates.

RESULTS

A total of 100 studies with patients treated for clinical stage I non-small-cell lung carcinoma were included. Long-term overall and disease-free survival after LR was superior over SBRT in all comparisons, and for most comparisons, SR was superior to SBRT. Noncomparative studies showed superior long-term overall and disease-free survival for both LR and SR over SBRT. Although the papers were heterogeneous and of low quality, results remained essentially the same throughout a large number of stratifications and sensitivity analyses.

CONCLUSION

Results of this systematic review and meta-analysis showed that LR has superior outcomes compared to SBRT for cI non-small-cell lung carcinoma. New trials are underway evaluating long-term results of SBRT in potentially operable patients.

Analysis of lymph node metastasis in 200 patients with non-small cell lung cancer

Background

Lymph node metastasis occurs although clinical stage IA is a relatively early stage for patients with non-small cell lung cancer (NSCLC). This study aimed to explore the influencing factors of lymph node metastasis.

Methods

A total of 200 patients diagnosed with clinical stage IA NSCLC preoperatively from July 2014 to July 2016 were examined. Every patient underwent lobectomy and systematic lymph node dissection. Their clinicopathological characteristics and status of lymph node metastasis are analyzed.

Results

The rates of both N1 and N2 lymph node metastasis increase with the increase in the tumor diameter. The N1 lymph node metastasis rate is 0%, 2.82%, and 9.52%, while the N2 lymph node metastasis rate is 0%, 4.23%, and 25.40% for pure ground-glass nodules, mixed ground-glass nodules (solid component <50%), and mixed ground-glass nodules (solid component >50%), respectively. The difference is statistically significant (P=0.000). Patients with squamous cell carcinoma have a relatively higher N1 lymph node metastasis rate comparing with patients with adenocarcinoma (P<0.05). Tumors locate in the inner half lobe (close to hilus) are prone to metastasize to lymph nodes (P=0.018). Multiple regression analysis shows that tumor diameter, solid component rate, and tumor location are relevant factors for lymph node metastasis.

Conclusions

In patients with NSCLC, who have tumors smaller than 1 cm, pure ground-glass nodules, or tumors locate in the lateral half lobe, lymph node metastasis is rare and selective lymphadenectomy is considerable.

Use of Autofluorescence to Intraoperatively Diagnose Visceral Pleural Invasion From Frozen Sections in Patients With Lung Adenocarcinoma 2 cm or Less

OBJECTIVES

We prospectively investigate the accuracy of frozen sections for diagnosing visceral pleural invasion (VPI) by autofluorescence and evaluated its usefulness in sublobar resection.

METHODS

We included patients with lung adenocarcinoma 2 cm or less to evaluate the diagnostic performance of autofluorescence for VPI in frozen sections via a fluorescence microscope. Furthermore, the impact of VPI on patients treated with sublobar resection was assessed in another cohort.

RESULTS

A total of 112 patients were enrolled. The accuracy, sensitivity, and specificity of autofluorescence for VPI diagnosis was 95.5%, 86.8%, and 100%, respectively. Sublobar resection was an independent risk factor for recurrence in patients with lung adenocarcinomas 2 cm or less with VPI positivity (hazard ratio, 3.30; P = .023), whereas it was not in those with VPI negativity.

CONCLUSIONS

Using autofluorescence in frozen sections appears to be an accurate method for diagnosing VPI, which is helpful for surgical decision making.

[Research for mediastinal lymph node desection style of stage Ib upper lobe non-small cell lung cancer]

背景与目的

淋巴转移是肺癌最主要的转移途径，也是影响肺癌患者预后的主要因素之一。现有的研究显示上叶肺癌较之中、下叶肺癌更易发生区域性纵隔淋巴结转移。本研究回顾分析Ib期上叶非小细胞肺癌（non-small cell lung cancer, NSCLC）纵隔淋巴结清扫方式的选择及影响预后的相关因素。

方法

147例行肺上叶完全性切除术的NSCLC患者，其中左肺上叶71例，右肺上叶76例。术后病理均为Ib期（T2aN0M0）。术中共清扫淋巴结925枚，其中纵隔淋巴结491枚（上纵隔组266枚，下纵隔组225枚）。采用Kaplan-Meier乘积法和Log-rank检验对患者进行单因素生存分析，采用Cox回归模型进行多因素生存分析。

结果

① 单因素及多因素分析均显示：年龄、肿瘤直径及上纵隔淋巴结清扫站数是影响患者预后的重要因素；②对于Ib期右肺上叶NSCLC，#4组淋巴结与预后存在统计学意义（P=0.021），而对于Ib期左肺上叶NSCLC，#5组淋巴结与预后存在统计学意义（P=0.024）。

结论

对于Ib期上叶NSCLC而言，年龄、肿瘤直径及上纵隔淋巴结清扫站数是影响患者预后的重要因素；对于此类患者，采用肺叶特异性系统性淋巴结清扫或许是更为高效的手术方式。

Clinical outcome of resected solid-type small-sized c-stage IA non-small cell lung cancer

BACKGROUND

The chances of pulmonary resection for small-sized lung cancer have increased because of the development of thin-slice computed tomography (CT). Though sublobar resection could be indicated for ground glass opacity (GGO)-dominant adenocarcinoma with low-grade behaviour, the malignant potential of solid-type, small-sized lung cancer has not been sufficiently assessed. We aimed to address the clinical outcomes of resected solid-type c-stage IA non-small cell lung cancer (NSCLC) smaller than 2 cm.

METHODS

A retrospective observational study involving 118 patients who had undergone a complete resection for lung cancer smaller than 2 cm with solid component more than 50% on CT was conducted, and their postoperative survival and recurrence pattern were analysed.

RESULTS

Thirty-five patients with solid component-dominant lesion (SCDL) and 83 patients with pure solid lesion (PSL) without GGO were enrolled. Lymph node involvement was found in 15 patients with PSL (18%). The 5-year disease-free survival (DFS) was 100% in SDCL patients and 83% in PSL patients. Multivariate analysis of PSL patients showed that lymph node metastasis and pleural invasion were independent negative prognostic predictors. The 5-year DFS was 88%, 80% and 46% in p-N0, p-N1 and p-N2 patients, respectively. The 5-year DFS was 33% for patients with pleural invasion, which was significantly worse than that for patients without pleural involvement. Postoperative recurrence was mainly observed as intrathoracic lesions within 3 years.

CONCLUSIONS

A proportion of solid-type NSCLC has malignant potential, even for tumours smaller than 2 cm. Periodic intrathoracic evaluation is required following complete resection.

[Progress of lymphadenectomy on lung cancer surgery]

淋巴道转移是肺癌最主要的转移途径，也是影响肺癌患者预后的主要因素之一。目前，淋巴结清扫已成为标准肺癌手术的重要组成部分。但是到目前为止，对于不同病理类型、不同病理分期、不同肺叶的肺癌而言，术中淋巴结的清扫方式及范围仍存在一定的争议。本文拟就目前肺癌手术中淋巴结清扫的临床意义、清扫方式、清扫范围的研究新进展进行综述。