1
|
Akram F, Wolf JL, Trandafir TE, Dingemans AMC, Stubbs AP, von der Thüsen JH. Artificial intelligence-based recurrence prediction outperforms classical histopathological methods in pulmonary adenocarcinoma biopsies. Lung Cancer 2023; 186:107413. [PMID: 37939498 DOI: 10.1016/j.lungcan.2023.107413] [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: 07/23/2023] [Revised: 10/22/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Between 10 and 50% of early-stage lung adenocarcinoma patients experience local or distant recurrence. Histological parameters such as a solid or micropapillary growth pattern are well-described risk factors for recurrence. However, not every patient presenting with such a pattern will develop recurrence. Designing a model which can more accurately predict recurrence on small biopsy samples can aid the stratification of patients for surgery, (neo-)adjuvant therapy, and follow-up. MATERIAL AND METHODS In this study, a statistical model on biopsies fed with histological data from early and advanced-stage lung adenocarcinomas was developed to predict recurrence after surgical resection. Additionally, a convolutional neural network (CNN)-based artificial intelligence (AI) classification model, named AI-based Lung Adenocarcinoma Recurrence Predictor (AILARP), was trained to predict recurrence, with an ImageNet pre-trained EfficientNet that was fine-tuned on lung adenocarcinoma biopsies using transfer learning. Both models were validated using the same biopsy dataset to ensure that an accurate comparison was demonstrated. RESULTS The statistical model had an accuracy of 0.49 for all patients when using histology data only. The AI classification model yielded a test accuracy of 0.70 and 0.82 and an area under the curve (AUC) of 0.74 and 0.87 on patch-wise and patient-wise hematoxylin and eosin (H&E) stained whole slide images (WSIs), respectively. CONCLUSION AI classification outperformed the traditional clinical approach for recurrence prediction on biopsies by a fair margin. The AI classifier may stratify patients according to their recurrence risk, based only on small biopsies. This model warrants validation in a larger lung biopsy cohort.
Collapse
Affiliation(s)
- F Akram
- Department of Pathology and Clinical Bioinformatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J L Wolf
- Department of Pathology and Clinical Bioinformatics, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
| | - T E Trandafir
- Department of Pathology and Clinical Bioinformatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Anne-Marie C Dingemans
- Department of Pulmonary Diseases, Erasmus MC Cancer Center, University Medical Center, Rotterdam, The Netherlands
| | - A P Stubbs
- Department of Pathology and Clinical Bioinformatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J H von der Thüsen
- Department of Pathology and Clinical Bioinformatics, Erasmus Medical Center, Rotterdam, The Netherlands.
| |
Collapse
|
2
|
Plodkowski AJ, Araujo-Filho JAB, Simmers CDA, Girshman J, Raj M, Zheng J, Rimner A, Ginsberg MS. Pre-treatment CT imaging in stage IIIA lung cancer: Can we predict local recurrence after definitive chemoradiotherapy? Clin Imaging 2020; 69:133-138. [PMID: 32721848 DOI: 10.1016/j.clinimag.2020.07.005] [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: 05/09/2020] [Revised: 06/19/2020] [Accepted: 07/13/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to delineate computed tomography (CT) features of stage IIIA non-small cell lung cancers on pre-treatment staging studies and identify features that could predict local recurrence after definitive concurrent chemoradiotherapy. MATERIALS AND METHODS We retrospectively reviewed pre- and post-treatment CT scans for 91 patients with Stage IIIA non-small cell lung cancer undergoing definitive concurrent chemoradiotherapy. Pre-treatment CT qualitative features were evaluated by consensus. The primary endpoint was local recurrence as determined on post-treatment CT scans along with the radiotherapy fields. Local recurrence was defined as intrathoracic in-field and marginal as opposed to out-of-field failures. Competing risk regressions were used to examine associations between CT features and recurrence. RESULTS The median follow-up was 51.5 months (range 2.4-111.2). Median overall survival was 25.6 months (95% CI: 20.4-30). At last follow-up, 72 (79.1%) patients had died, 48 (52.7%) had in-field recurrence, and 30 (32.9%) presented with out-of-field recurrence. On pre-treatment CT scans, tumors presenting as pulmonary consolidations (hazard ratio = 2.34, 95% CI: 1.05-5.22; p 0.038) were more likely to have in-field failure. Tumors with 50-100% necrosis (hazard ratio = 0.15, 95% CI: 0.02-1.06) were associated with decreased out-of-field failure (overall p = 0.038). However, these were rare features in our sample which limit the ability of these features to be associated with such outcomes. CONCLUSIONS Pre-treatment CT features alone are limited in predicting locoregional recurrence. Larger studies using quantitative tools are needed to predict such outcomes.
Collapse
Affiliation(s)
- Andrew J Plodkowski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | | | - Cameron D A Simmers
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Jeffrey Girshman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Micheal Raj
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Junting Zheng
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Michelle S Ginsberg
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| |
Collapse
|
3
|
Integrated evaluation of clinical, pathological and radiological prognostic factors in squamous cell carcinoma of the lung. PLoS One 2019; 14:e0223298. [PMID: 31584965 PMCID: PMC6777828 DOI: 10.1371/journal.pone.0223298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 09/19/2019] [Indexed: 01/08/2023] Open
Abstract
Objective Little is known about prognostic factors for lung squamous cell carcinoma (SCC). We aimed to explore radiologic and clinical factors affecting prognosis and to compare the prognosis of both central and peripheral lung SCCs. Materials and methods Radiologic, clinical, and pathologic profiles of surgically confirmed SCCs from 382 patients were retrospectively reviewed. Tumor location, enhancement, necrosis, the presence of obstructive pneumonitis/atelectasis and underlying lung disease were evaluated on chest CT examination. Age, pulmonary function, tumor marker, and cancer stage were also assessed. Univariate and multivariate Cox regression analyses were performed to identify any correlation to overall survival (OS) and disease-free survival (DFS). Hazard rate estimation and competing risk analysis were done to evaluate recurrence pattern. Results The median follow-up period was 56.2 months. Tumors were located centrally in 230 patients (60.2%) and peripherally in 152 patients (39.8%). Age (p = 0.002, hazard ratio [HR] 1.03, 95% confidence interval [CI] = [1.01, 1.06]) and interstitial lung abnormalities (ILAs) (p<0.001, HR 5.41, 95% CI = [3.08, 9.52]) were associated with poor OS on multivariate analysis. ILAs also had a strong association to DFS (p<0.001, HR 4.25, 95% CI = [3.08, 9.52]). Central cancers had two peaks of local recurrence development at 15 and 60 months after surgery, and peripheral tumors showed rising curves for metastasis development at 60 months. Conclusions CT-determined ILAs are a strong biomarker predicting poor outcome. Prognosis may not vary according to tumor location, but the two groups exhibited different recurrence patterns.
Collapse
|
4
|
Mao R, She Y, Zhu E, Chen D, Dai C, Wu C, Xie H, Zhu H, Fei K, Chen C. A Proposal for Restaging of Invasive Lung Adenocarcinoma Manifesting as Pure Ground Glass Opacity. Ann Thorac Surg 2018; 107:1523-1531. [PMID: 30576635 DOI: 10.1016/j.athoracsur.2018.11.039] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/05/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Invasive lung adenocarcinoma (IAC) occurs in 22.8% to 40.4% of pure ground-glass opacity (GGO) cases. This study assessed the malignancy and survival outcomes of IAC manifesting as pure GGO with the aim of providing suggestions on T staging of these tumors. METHODS From January 2010 to December 2012, the study focused on 109 cases of IAC that radiologically manifested as pure GGO. For comparison, 305 clinical stage IA part-solid IACs were also included. Clinicopathological characteristics, managements, and prognoses were evaluated. RESULTS As compared with part-solid nodules, pure GGOs showed lower T stage, lower N stage, smaller invasive size, less invasive predominant components, and better survival. Long-term outcomes were independently influenced by whether the tumors presented as pure GGO. For the pure GGO group, the 5-year overall and disease-free survival rates were 100% and 99.1%, respectively. The pT stage, invasive size, and predominant component type did not influence survival. CONCLUSIONS IAC radiologically manifesting as pure GGO is a group of tumors with low-grade malignancies and excellent prognosis. External validation is needed to assess whether it should be restaged in the TNM classification of non-small lung cancers.
Collapse
Affiliation(s)
- Rui Mao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai
| | - Erjia Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai
| | - Donglai Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai
| | - Chenyang Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai
| | - Chunyan Wu
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai
| | - Huikang Xie
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai
| | - Huiyuan Zhu
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai
| | - Ke Fei
- Department of Thoracic Surgery, East China Sanatorium, Wuxi, P.R. China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai.
| |
Collapse
|
5
|
Wei DM, Chen WJ, Meng RM, Zhao N, Zhang XY, Liao DY, Chen G. Augmented expression of Ki-67 is correlated with clinicopathological characteristics and prognosis for lung cancer patients: an up-dated systematic review and meta-analysis with 108 studies and 14,732 patients. Respir Res 2018; 19:150. [PMID: 30103737 PMCID: PMC6088431 DOI: 10.1186/s12931-018-0843-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/13/2018] [Indexed: 02/08/2023] Open
Abstract
Background Lung cancer ranks as the leading cause of cancer-related deaths worldwide and we performed this meta-analysis to investigate eligible studies and determine the prognostic effect of Ki-67. Methods In total, 108 studies in 95 articles with 14,732 patients were found to be eligible, of which 96 studies reported on overall survival (OS) and 19 studies reported on disease-free survival (DFS) with relation to Ki-67 expression in lung cancer patients. Results The pooled hazard ratio (HR) indicated that a high Ki-67 level could be a valuable prognostic factor for lung cancer (HR = 1.122 for OS, P < 0.001 and HR = 1.894 for DFS, P < 0.001). Subsequently, the results revealed that a high Ki-67 level was significantly associated with clinical parameters of lung cancer including age (odd ratio, OR = 1.246 for older patients, P = 0.018), gender (OR = 1.874 for males, P < 0.001) and smoking status (OR = 3.087 for smokers, P < 0.001). Additionally, significant positive correlations were found between Ki-67 overexpression and poorer differentiation (OR = 1.993, P = 0.003), larger tumor size (OR = 1.436, P = 0.003), and higher pathologic stages (OR = 1.867 for III-IV, P < 0.001). Furthermore, high expression of Ki-67 was found to be a valuable predictive factor for lymph node metastasis positive (OR = 1.653, P < 0.001) and advanced TNM stages (OR = 1.497 for stage III-IV, P = 0.024). Finally, no publication bias was detected in any of the analyses. Conclusions This study highlights that the high expression of Ki-67 is clinically relevant in terms of the prognostic and clinicopathological characteristics for lung cancer. Nevertheless, more prospective well-designed studies are warranted to validate these findings. Electronic supplementary material The online version of this article (10.1186/s12931-018-0843-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Dan-Ming Wei
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Wen-Jie Chen
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Rong-Mei Meng
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Na Zhao
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Xiang-Yu Zhang
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Dan-Yu Liao
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Gang Chen
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China.
| |
Collapse
|
6
|
Tsukioka T, Izumi N, Mizuguchi S, Kyukwang C, Komatsu H, Toda M, Hara K, Miyamoto H, Nishiyama N. Positive correlation between sarcopenia and elevation of neutrophil/lymphocyte ration in pathological stage IIIA (N2-positive) non-small cell lung cancer patients. Gen Thorac Cardiovasc Surg 2018; 66:716-722. [DOI: 10.1007/s11748-018-0985-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 08/03/2018] [Indexed: 12/22/2022]
|
7
|
Hwang KE, Oh SJ, Park C, Jeon SJ, Lee JM, Cha BK, Yoon KH, Jeong ET, Kim HR. Computed tomography morphologic features of pulmonary adenocarcinoma with brain/bone metastasis. Korean J Intern Med 2018; 33:340-346. [PMID: 28192888 PMCID: PMC5840592 DOI: 10.3904/kjim.2016.134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 09/30/2016] [Accepted: 11/07/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND/AIMS Brain and bone metastases are common in patients with lung cancer. The development of metastasis is associated with poor survival in lung cancer patients. Although tumor morphologic features on radiographs are routinely assessed for differentiation between benign and malignant lung nodules, they are not used to predict metastasis. We assessed morphologic features of pulmonary adenocarcinomas with brain/bone metastasis on computed tomography (CT) to identify related factors for metastasis. METHODS We performed a retrospective analysis of initial chest CT findings (size, type of contour, percentage of necrosis, enhancement, presence or absence of calcification, and air cavity) from 2009 to 2010 of patients with brain or bone metastasis and compared the findings with those of patients without metastases. RESULTS In total, 128 patients were included (78 men, 52 women; mean age 69 years; range, 36 to 87). Nineteen patients had brain metastases and 32 had bone metastases. Morphologic features associated with brain metastasis included size ≥ 50 mm (odds ratio [OR], 3.37; 95% confidence interval [CI], 1.24 to 9.17; p = 0.013), necrosis ≥ 30% (OR, 4.51; 95% CI, 1.62 to 12.55; p =0.002), and presence of calcification (OR, 3.97; 95% CI, 1.16 to 13.55; p = 0.035). Morphologic features associated with bone metastasis included necrosis ≥ 30% (OR, 4.639; 95% CI, 1.98 to 10.82; p < 0.001) and T 3 to 4 stage (OR, 2.53; 95% CI, 1.07 to 6.00; p = 0.031). CONCLUSIONS We found that necrosis ≥ 30% was associated with pulmonary adenocarcinoma with brain and bone metastasis at initial chest CT morphologic feature. To validate these results, further research should be conducted.
Collapse
Affiliation(s)
- Ki-Eun Hwang
- Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Su-Jin Oh
- Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Chul Park
- Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Se-Jeong Jeon
- Department of Radiology, Wonkwang University School of Medicine, Iksan, Korea
| | - Jeong-Mi Lee
- Department of Public Health, Wonkwang University School of Medicine, Iksan, Korea
| | - Byong-Ki Cha
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, Jeonju, Korea
| | - Kwon-Ha Yoon
- Department of Radiology, Wonkwang University School of Medicine, Iksan, Korea
| | - Eun-Taik Jeong
- Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Hak-Ryul Kim
- Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
- Correspondence to Hak-Ryul Kim, M.D. Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, 895 Muwang-ro, Iksan 54538, Korea Tel: +82-63-859-2583 Fax: +82-63-855-2025 E-mail:
| |
Collapse
|
8
|
Tsukioka T, Izumi N, Kyukwang C, Komatsu H, Toda M, Hara K, Nishiyama N. Loss of Muscle Mass is a Novel Predictor of Postoperative Early Recurrence in N2-Positive Non-Small-Cell Lung Cancer. Ann Thorac Cardiovasc Surg 2018; 24:121-126. [PMID: 29459570 PMCID: PMC6033530 DOI: 10.5761/atcs.oa.17-00215] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: We often experienced early recurrence in patients with completely resected N2-positive non-small-cell lung cancer (NSCLC). Loss of muscle mass is a poor prognostic factor in patients with several stages of NSCLC. This study aimed to investigate the relationship between preoperative loss of muscle mass and postoperative early recurrence in patients with N2-positive NSCLC. Methods: We retrospectively analyzed 47 male patients with completely resected pathological N2-positive NSCLC. Early recurrence was defined as that diagnosed within 1 year after the operation. We used the L3 muscle index (cross-sectional area of muscle at the L3 level, normalized for height) as a clinical measurement of loss of muscle mass (cutoff value, 52.4 cm2/m2). Results: In all, 18 patients with early recurrence had significantly poorer outcomes compared with those without (P <0.01). In univariate analysis, loss of muscle mass (P = 0.023), carcinoembryonic antigen (CEA) level >5.0 ng/mL (P = 0.002), and absence of postoperative chemotherapy (P = 0.042) were predictors of postoperative early recurrence. In multivariate analysis, loss of muscle mass (P = 0.004) and CEA level >5.0 ng/mL (P = 0.001) were independent predictors. Conclusions: Loss of muscle mass is an independent predictor of postoperative early recurrence in pathological N2-positive NSCLC patients.
Collapse
Affiliation(s)
- Takuma Tsukioka
- Department of Thoracic Surgery, Osaka City University Hospital, Osaka, Osaka, Japan
| | - Nobuhiro Izumi
- Department of Thoracic Surgery, Osaka City University Hospital, Osaka, Osaka, Japan
| | - Chung Kyukwang
- Department of Thoracic Surgery, Osaka City University Hospital, Osaka, Osaka, Japan
| | - Hiroaki Komatsu
- Department of Thoracic Surgery, Osaka City University Hospital, Osaka, Osaka, Japan
| | - Michihito Toda
- Department of Thoracic Surgery, Osaka City University Hospital, Osaka, Osaka, Japan
| | - Kantaro Hara
- Department of Thoracic Surgery, Osaka City University Hospital, Osaka, Osaka, Japan
| | - Noritoshi Nishiyama
- Department of Thoracic Surgery, Osaka City University Hospital, Osaka, Osaka, Japan
| |
Collapse
|
9
|
Tsukioka T, Nishiyama N, Izumi N, Mizuguchi S, Komatsu H, Okada S, Toda M, Hara K, Ito R, Shibata T. Sarcopenia is a novel poor prognostic factor in male patients with pathological Stage I non-small cell lung cancer. Jpn J Clin Oncol 2017; 47:363-368. [PMID: 28158497 DOI: 10.1093/jjco/hyx009] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/17/2017] [Indexed: 12/26/2022] Open
Abstract
Objectives Sarcopenia is the progressive loss of muscle mass and strength, and has a risk of adverse outcomes such as disability, poor quality of life and death. As prognosis depends not only on disease aggressiveness, but also on a patient's physical condition, sarcopenia can predict survival in patients with various cancer types. However, its effects on postoperative prognosis in patients with localized non-small cell lung cancers (NSCLC) have never been reported. Methods We retrospectively investigated 215 male patients with pathological Stage I NSCLC. L3 muscle index is defined as the cross-section area of muscle at the third lumbar vertebra level, normalized for height, and is a clinical measurement of sarcopenia. We then investigated the effect of preoperative sarcopenia on their postoperative prognosis. Results Our 215 subjects included 30 patients with sarcopenia. Sarcopenia was significantly associated with body mass index, nutritional condition, serum CYFRA 21-1 level and pathological stage, but not with preoperative respiratory function or performance status. Frequency of postoperative complications, length of postoperative hospital stay, thoracic drainage period or causes of death were not correlated with the presence of sarcopenia. The sarcopenia group had a significantly shorter median overall survival (32 months) than the no-sarcopenia group. Conclusion Sarcopenia might not affect short-term outcomes in patients with early-stage lung cancer. Sarcopenia was a predictor of poor prognosis in male patients with Stage I NSCLC. As sarcopenic patients with NSCLC patients are at risk for significantly worse outcomes, their treatments require careful planning, even for those with Stage I disease.
Collapse
Affiliation(s)
- Takuma Tsukioka
- Department of General Thoracic Surgery, Osaka City University Hospital,Osaka, Japan
| | - Noritoshi Nishiyama
- Department of General Thoracic Surgery, Osaka City University Hospital,Osaka, Japan
| | - Nobuhiro Izumi
- Department of General Thoracic Surgery, Osaka City University Hospital,Osaka, Japan
| | - Shinjiro Mizuguchi
- Department of General Thoracic Surgery, Osaka City University Hospital,Osaka, Japan
| | - Hiroaki Komatsu
- Department of General Thoracic Surgery, Osaka City University Hospital,Osaka, Japan
| | - Satoshi Okada
- Department of General Thoracic Surgery, Osaka City University Hospital,Osaka, Japan
| | - Michihito Toda
- Department of General Thoracic Surgery, Osaka City University Hospital,Osaka, Japan
| | - Kantaro Hara
- Department of General Thoracic Surgery, Osaka City University Hospital,Osaka, Japan
| | - Ryuichi Ito
- Department of General Thoracic Surgery, Osaka City University Hospital,Osaka, Japan
| | - Toshihiko Shibata
- Department of General Thoracic Surgery, Osaka City University Hospital,Osaka, Japan
| |
Collapse
|
10
|
Sun W, Yang X, Liu Y, Yuan Y, Lin D. Primary Tumor Location Is a Useful Predictor for Lymph Node Metastasis and Prognosis in Lung Adenocarcinoma. Clin Lung Cancer 2017; 18:e49-e55. [DOI: 10.1016/j.cllc.2016.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 05/31/2016] [Accepted: 06/13/2016] [Indexed: 01/14/2023]
|
11
|
Lee JY, Choi JY, Heo JH, Han J, Jang SJ, Kim K, Kim J, Shim YM, Kim BT. Prognostic significance of volume-based 18F-FDG PET/CT parameter in patients with surgically resected non-small cell lung cancer. Comparison with immunohistochemical biomarkers. Nuklearmedizin 2015; 55:7-14. [PMID: 26875430 DOI: 10.3413/nukmed-0754-15-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/30/2015] [Indexed: 12/22/2022]
Abstract
AIM We investigated the prognostic value of volume-based 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) parameters compared with other factors including several immunohistochemical biomarkers in patients with surgically resected non-small cell lung cancer (NSCLC). PATIENTS, METHODS STUDY PARTICIPANTS 290 patients with surgically resected and histopathologically confirmed NSCLC. The maxmum standardized uptake value (SUVmax) and metabolic tumour volume (MTV) of the primary tumour were obtained on 18F-FDG PET/ computed tomography (CT) for initial staging and Ki-67 labeling index (LI), p16, CD31 and cyclin E were evaluated in the primary tumours by immunohistochemical staining. Survival analyses for variables including PET parameters, immunohistochemical biomarker and other clinical factors were performed using the Kaplan-Meier method and Cox proportional hazards regression analysis. RESULTS In univariate analyses, tumour stage, tumour size, and MTV were significant prognostic factors for decreased overall survival (OS) and disease-free survival (DFS). Multivariate analyses showed MTV and tumour stage were significant predictors of poor OS (MTV, hazard ratio (HR) = 1.135, p = 0.015; stage, HR = 0.644, p = 0.025) and DFS (MTV, HR = 1.128, p = 0.043; stage, HR = 0.541, p = 0.009). CONCLUSION The MTV of primary tumours is a significant prognostic factor for survival along with tumour stage in patients with surgically resected NSCLC. The MTV can predict OS and DFS better than immunohistochemical biomarkers.
Collapse
Affiliation(s)
| | - J Y Choi
- Joon Young Choi, MD, PhD, Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 lrwon-dong, Gangnam-gu, 135-710 Seoul, Republic of Korea, Tel. +82/2/34 10 26 48; Fax +82/2/34 10 26 39,
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Gürel D, Ulukuş Ç, Karaçam V, Ellidokuz H, Umay C, Öztop İ, Sarıoğlu S. The prognostic value of morphologic findings for lung squamous cell carcinoma patients. Pathol Res Pract 2015; 212:1-9. [PMID: 26608418 DOI: 10.1016/j.prp.2015.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 07/14/2015] [Accepted: 10/20/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Novel histopathological prognostic features for squamous cell carcinoma (SCC) of lung, such as tumor budding, mitotic rate, tumor stroma ratio, stroma type, stromal inflammation and necrosis, have been evaluated in the literature. In this study, the prognostic value of multiple morphological features is assessed in lung SCC. MATERIALS AND METHODS This study reports on seventy-six patients with lung SCC treated with complete surgical excision. Tumor size, tumor stage, lymph node status, lymphovascular invasion, histopathologic grade, mitotic count, necrosis, tumor budding, tumor stroma ratio, stroma type, stromal lymphoplasmacytic reaction and ratios of stromal plasma cells and their relationship with the prognosis were evaluated. Univariate and multivariate analyses were performed for histopathological markers for local disease free survival (LDFS), distant disease free survival (DDFS), overall disease free survival (ODFS) and overall survival (OS). RESULTS The univariate prognostic analysis of the pathological factors revealed that the pathological stage (OS: p=0.001, DDFS: p=0.040), lymph node metastases (OS: p=0.013), mitotic index (OS: p=0.026), tumor necrosis (DDFS: p=0.013, ODFS: p=0.021) and tumor size (OS: p=0.002) had a prognostic significance. The multivariate analysis demonstrated that the pathological stage (OS: p=0.021), tumor size (OS: p=0.044), lymph node status (DDFS: p=0.019, ODFS; p=0.041) and necrosis (ODFS: p=0.048) were independent prognostic factors. CONCLUSIONS Although many histopathological factors have recently been proposed as important prognostic markers, we only found significant results for mitotic index and tumor necrosis, as well as the well known parameters such as tumor stage and lymph node status. To the best of our knowledge, this is the first study evaluating such a wide range of morphological prognostic factors in lung SCC.
Collapse
Affiliation(s)
- Duygu Gürel
- Department of Pathology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey.
| | - Çağnur Ulukuş
- Department of Pathology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey.
| | - Volkan Karaçam
- Department of Thoracic Surgery, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey.
| | - Hülya Ellidokuz
- Institute of Oncology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey.
| | - Cenk Umay
- Department of Radiation Oncology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey.
| | - İlhan Öztop
- Institute of Oncology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey.
| | - Sülen Sarıoğlu
- Department of Pathology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey.
| |
Collapse
|
13
|
Yeo CD, Park GS, Kang N, Choi SY, Kim HY, Lee DS, Kim YS, Kim YK, Park JG, Sung SW, Lee KY, Park MS, Yim HW, Kim SJ, Lee JH. Bis Expression in Patients with Surgically Resected Lung Cancer and its Clinical Significance. Ann Surg Oncol 2015; 22 Suppl 3:S1365-70. [DOI: 10.1245/s10434-015-4576-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Indexed: 11/18/2022]
|
14
|
Ki-67 is a strong prognostic marker of non-small cell lung cancer when tissue heterogeneity is considered. BMC Clin Pathol 2014; 14:23. [PMID: 24860257 PMCID: PMC4032346 DOI: 10.1186/1472-6890-14-23] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 05/02/2014] [Indexed: 01/08/2023] Open
Abstract
Background Ki-67 expression is a well-established prognostic marker in various cancers. However, Ki-67 expression is also known as being heterogeneous. We investigated the prognostic significance of Ki-67 from the view of staining heterogeneity by the technique of Spiral Array. Methods 100 cases of resected lung cancer from Toyama university hospital archive were collected. Spiral Array blocks were generated out of 100 cases using 100 μm thick paraffin sections. Four μm thick sections of the Array block were stained for Ki-67. Staining results in each reel were scored for areas with lowest (LS), highest (HS), and average (AS) expression, exclusively in the cancer cells. Heterogeneity score (HeS) was designed as the difference between HS and LS. The scores were divided into four grades (0–3). Clinical information was collected, and the prognostic significance of Ki-67 was analyzed. Results Pathological stage was available for 91 patients (43 stage IA, 22 stage IB, 2 stage IIA, 9 stage IIB, 13 stage IIIA, 1 stage IIIB, and 1 stage IV). The HS of Ki-67 score in non-small cell lung cancer was 3 in 17 cases, 2 in 27 cases, 1 in 28 cases, 0 in 21 cases, and 4 reels were lost. 78 cases had clinical follow up. 74 cases had all the information available and were analyzed for correlation between Ki-67 expression and survival. Cases with score 2 and 3 of HS and HeS showed significant poorer prognosis (both P < 0.001), whereas LS or AS did not show significance. The results were identical when analyzing adenocarcinoma and squamous cell carcinoma, separately. Cox multivariate analysis of Ki-67 showed that HS was an independent risk factor affecting overall survival. Conclusions Ki-67 is a strong prognostic marker for non-small cell lung cancer when the degree of highest staining frequency or heterogeneity is considered.
Collapse
|
15
|
Gkogkou C, Frangia K, Saif MW, Trigidou R, Syrigos K. Necrosis and apoptotic index as prognostic factors in non-small cell lung carcinoma: a review. SPRINGERPLUS 2014; 3:120. [PMID: 24634811 PMCID: PMC3951652 DOI: 10.1186/2193-1801-3-120] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 02/25/2014] [Indexed: 12/21/2022]
Abstract
Necrosis and apoptosis represent two pathogenetically distinct types of cell death. Necrosis is associated with pathologic conditions while apoptosis is a physiological process of programmed cell death, which is associated with normal tissue growth and is frequently impaired in various forms of cancer. Tumor necrosis and apoptotic index (AI) have been previously evaluated as prognostic biomarkers in lung cancer, but their exact clinical value remains unclear. The aim of this study was to perform a systematic review of the MEDLINE literature on the prognostic significance of these histopathological markers in patients with non-small cell lung carcinoma (NSCLC). Although a substantial body of evidence suggests that tumor necrosis may be a strong predictor of aggressive tumor behavior and reduced survival in patients with NSCLC, the independent prognostic value of this biomarker remains to be firmly established. Furthermore, previous data on the prognostic significance of apoptotic index in NSCLC are relatively limited and largely controversial. More prospective studies are necessary in order to further validate tumor necrosis and AI as prognostic markers in NSCLC.
Collapse
Affiliation(s)
| | | | - Muhammad W Saif
- Division of Hematology/Oncology, Tufts Medical Center, Boston, USA
| | - Rodoula Trigidou
- Pathology Department, "SOTIRIA" General Hospital, Athens, Greece
| | - Konstantinos Syrigos
- Oncology Unit GPP, "SOTIRIA" General Hospital, Athens School of Medicine, Athens, Greece ; Yale School of Medicine, New Haven, USA
| |
Collapse
|
16
|
Chung HJ, Mahalingam M. Angiogenesis, vasculogenic mimicry and vascular invasion in cutaneous malignant melanoma – implications for therapeutic strategies and targeted therapies. Expert Rev Anticancer Ther 2014; 14:621-39. [DOI: 10.1586/14737140.2014.883281] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
17
|
Shimizu K, Funai K, Sugimura H, Sekihara K, Kawase A, Shiiya N. D2-40-positive lymphatic vessel invasion is not a poor prognostic factor in stage I lung adenocarcinoma. Pathol Int 2013; 63:201-5. [PMID: 23692420 DOI: 10.1111/pin.12048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 03/21/2013] [Indexed: 11/29/2022]
Abstract
The present study investigates whether lymphatic vessel invasion (LVI) detected by D2-40 staining is a prognostic factor for stage I adenocarcinoma of the lung. We retrospectively reviewed 124 patients who underwent complete resection for stage I adenocarcinoma of the lung from January 1983 to June 2003. LVI was microscopically evaluated using D2-40 immunostaining. The median follow-up was 71 months. The LVI positive rate was 37%. The 5-year cancer-specific survival rates of the D2-40 positive LVI and negative groups were 88.8% and 84.3%, respectively (P = 0.630). The stage I lung adenocarcinoma patients who were determined to be LVI positive based on D2-40 immunostaining did not have a significantly poorer prognosis than the LVI negative cases. Thus, lymphatic microinvasion may not be a prognostic indicator in early lung cancer, although advanced LVI does appear to correlate with survival. It is therefore unnecessary to use D2-40 immunostaining to diagnose LVI in practical settings, and Hematoxylin-Eosin and Elastica van Gieson staining should continue to be used to predict the prognosis of patients with stage I lung adenocarcinoma.
Collapse
Affiliation(s)
- Kei Shimizu
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | | | | | | | | | | |
Collapse
|
18
|
Komatsu H, Mizuguchi S, Izumi N, Chung K, Hanada S, Inoue H, Suehiro S, Nishiyama N. Sialyl Lewis X as a predictor of skip N2 metastasis in clinical stage IA non-small cell lung cancer. World J Surg Oncol 2013; 11:309. [PMID: 24313932 PMCID: PMC4029375 DOI: 10.1186/1477-7819-11-309] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 11/22/2013] [Indexed: 12/25/2022] Open
Abstract
Background Radical segmentectomy has been performed for small-sized non-small cell lung cancer (NSCLC). However, underestimation of mediastinal lymph node metastasis in the absence of hilar or interlobar metastasis (skip N2) affects surgical strategy. Our aim was to investigate preoperative and intraoperative predictors of skip N2 in clinical stage (c-stage) IA NSCLC. Methods From 1998 to 2011, 279 patients (155 men and 124 women) with c-stage IA NSCLC (230 pN0, 17 pN1, 12 skip N2, 20 non-skip N2) underwent systematic lobectomy (R0 resection) at our institute. We compared preoperative serum concentrations of carcinoembryonic antigen, cytokeratin 19 fragment, sialyl Lewis X (SLX), and pre- and intraoperative clinicopathological features of pN0 and skip N2 patients. Receiver operator characteristic (ROC) curve analysis was performed to distinguish between the two patient groups. Results The 5-year survival rate of skip N2 patients was 78.6%, higher than that of non-skip N2 patients (44.9%), and not significantly different than that of pN0 (86.7%) or pN1 patients (82.4%). The mean serum SLX concentration in skip N2 patients (28.0 U/ml) was elevated compared to that in pN0 patients (22.9 U/ml). In ROC analysis of SLX, the area under the curve was 0.710, and the optimal cut-off value was 21.4 U/ml (sensitivity, 91.7%; specificity, 51.7%). In multivariate analysis, SLX was an independent predictor of skip N2 in patients with c-stage IA NSCLC (odds ratio, 9.43; p = 0.006). Conclusions Skip N2 metastasis is common in patients with c-stage IA NSCLC with high serum SLX, and lobectomy with complete dissection of hilar and mediastinal lymph nodes should remain the standard surgical procedure for these cases.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Noritoshi Nishiyama
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
| |
Collapse
|
19
|
Colt HG, Murgu SD, Korst RJ, Slatore CG, Unger M, Quadrelli S. Follow-up and Surveillance of the Patient With Lung Cancer After Curative-Intent Therapy. Chest 2013; 143:e437S-e454S. [DOI: 10.1378/chest.12-2365] [Citation(s) in RCA: 157] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
|
20
|
Jakobsen JN, Sørensen JB. Clinical impact of ki-67 labeling index in non-small cell lung cancer. Lung Cancer 2012; 79:1-7. [PMID: 23137549 DOI: 10.1016/j.lungcan.2012.10.008] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Revised: 09/27/2012] [Accepted: 10/15/2012] [Indexed: 02/06/2023]
Abstract
The ki-67 index is a marker of proliferation in malignant tumors. Studies from the period 2000 to 2012 on the prognostic and predictive value of ki-67 labeling index (LI) in non-small cell cancer (NSCLC) are reviewed. Twenty-eight studies reported on the prognostic value of ki-67 index with various endpoints. No consensus on the prognostic value of ki-67 LI was found among the published studies neither according to disease stage nor histological subtype. Comparison of studies is hampered by differences in patient populations, methodologies and cut-off values. Five studies explored the predictive value of ki-67 to chemotherapy and none revealed significant influence. Ki-67 index seems to be of prognostic influence in NSCLC although largely variable cut-off levels have been used in the various studies and standardization of methodology is required. The relative importance of ki-67 compared to newer biomarkers has not been explored. It is likely that a signature of several biomarkers in combination may be necessary to more sufficiently stratify patients to various treatment options than is currently possible, especially when it comes to the question of the optimal use of classical chemotherapy. A predictive impact of ki-67 to treatment in NSCLC remains unclear.
Collapse
Affiliation(s)
- Jan Nyrop Jakobsen
- Department of Oncology, Finsencentre, Rigshospitalet, 9 Blegdamsvej, 2100 Copenhagen, Denmark.
| | | |
Collapse
|
21
|
Toll A, Gimeno-Beltrán J, Ferrandiz-Pulido C, Masferrer E, Yébenes M, Jucglà A, Abal L, Martí RM, Sanmartín O, Baró T, Casado B, Gandarillas A, Barranco C, Costa I, Mojal S, García-Patos V, Pujol RM. D2-40 immunohistochemical overexpression in cutaneous squamous cell carcinomas: a marker of metastatic risk. J Am Acad Dermatol 2012; 67:1310-8. [PMID: 22521203 DOI: 10.1016/j.jaad.2012.03.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 03/06/2012] [Accepted: 03/08/2012] [Indexed: 01/05/2023]
Abstract
BACKGROUND Approximately 4% of cutaneous squamous cell carcinomas (cSCCs) develop lymphatic metastases. The value of lymphatic endothelial markers to enhance the detection of lymphatic tumor invasion in cSCC has not been assessed previously. OBJECTIVE We sought to evaluate the use of the antibody D2-40, a podoplanin immunohistochemical marker, to identify tumor lymph vessel invasion in cSCC and to assess its expression in tumor cells. METHODS This was a retrospective case-control study. A series of 101 cSCC, including 51 cases that developed lymphatic metastatic spread (metastasizing cSCC [MSCC]) and 50 cases that resolved definitely after surgical excision (non-MSCC) were included in the study. Lymph vessel invasion using D2-40 was evaluated on all primary biopsy specimens. The percentage of tumor cells showing D2-40 positivity and intensity scoring were recorded. All the immunohistochemical findings were correlated with the clinicopathological features. RESULTS Lymph vessel invasion was observed in 8% of non-MSCCs and in 25.5% of MSCCs (P = .031). D2-40 expression was significantly increased, both in intensity (odds ratio 4.42 for intensity ++/+++) and in area (odds ratio 2.29 for area >10%), in MSCC when compared with non-MSCC. Interestingly, almost half (49%) of the MSCC had moderate to intense D2-40 positivity compared with 16% of non-MSCC. D2-40 immunohistochemical expression was increased in tumors with an infiltrative pattern of extension. In the multivariate analysis, histologically poorly differentiated tumors, recurrent lesions, and cSCC showing D2-40 overexpression (in intensity) were significantly associated with lymphatic metastases development (odds ratios 15.67, 14.72, and 6.07, respectively). LIMITATIONS This was a retrospective study. CONCLUSION The expression of podoplanin associates with high metastatic risk in cSCC.
Collapse
Affiliation(s)
- Agustí Toll
- Department of Dermatology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Chu ZG, Yang ZG, Shao H, Zhu ZY, Deng W, Tang SS, Chen J, Li Y. Small peripheral lung adenocarcinoma: CT and histopathologic characteristics and prognostic implications. Cancer Imaging 2011; 11:237-46. [PMID: 22201671 PMCID: PMC3266590 DOI: 10.1102/1470-7330.2011.0033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Since the introduction of computed tomography (CT), detection of small lung cancer, especially small peripheral adenocarcinoma, is common. Recently, the morphological characteristics, including thin-section CT and pathologic findings, and prognosis of small peripheral lung adenocarcinomas have been studied extensively. The radiologic and microscopic findings correlate well with each other and are closely associated with tumour prognosis. Most importantly, some subtypes of small lung adenocarcinomas with specific CT or pathologic features are curable. Therefore, all defining characteristics (CT, pathologic and prognostic) of this kind of tumour should be integrated to improve our understanding, provide guidelines for management and accurately assess its prognosis.
Collapse
Affiliation(s)
- Zhi-gang Chu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Shimada Y, Yoshida J, Hishida T, Nishimura M, Ishii G, Nagai K. Predictive factors of pathologically proven noninvasive tumor characteristics in T1aN0M0 peripheral non-small cell lung cancer. Chest 2011; 141:1003-1009. [PMID: 21852293 DOI: 10.1378/chest.11-0017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND We retrospectively analyzed preoperative factors that may predict pathologically invasive tumor characteristics, including lymph node involvement, and pleural and vessel invasion in patients with cT1aN0M0 peripheral non-small cell lung cancer (NSCLC), in an attempt to identify candidates for pulmonary resection less than lobectomy. METHODS We reviewed the charts of 363 patients in whom cT1aN0M0 lung cancer in the lung periphery had been diagnosed or was suspected, based on high-resolution CT scan of 1- or 2-mm-slice intervals, within 1 month of surgical resection, and examined the relationships between preoperative clinical information and pathologic invasive tumor characteristics, corresponding to lymph node involvement and pleural and vessel invasion. RESULTS Multivariate analysis showed that a tumor disappearance ratio (TDR) < 0.5, the presence of spiculation, and an absence of air bronchograms were statistically significant independent predictors of pathologic invasiveness. Most TDR ≥ 0.5 tumors were noninvasive (98.7%), and only one patient had a recurrence within 5 years after surgical resection. Of the tumors with a TDR ≥ 0.5 without spiculation, 98.3% were noninvasive, and all those patients remained recurrence-free for 5 years after surgery. CONCLUSION The combination of a TDR ≥ 0.5 and the absence of spiculation was highly predictive of noninvasive or minimally invasive NSCLC. Future studies should evaluate whether limited resection of these tumors provides acceptable outcomes.
Collapse
Affiliation(s)
- Yoshihisa Shimada
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Junji Yoshida
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
| | - Tomoyuki Hishida
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Mitsuyo Nishimura
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Genichiro Ishii
- Pathology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Kanji Nagai
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| |
Collapse
|
24
|
Inoue M, Honda O, Tomiyama N, Minami M, Sawabata N, Kadota Y, Shintani Y, Ohno Y, Okumura M. Risk of pleural recurrence after computed tomographic-guided percutaneous needle biopsy in stage I lung cancer patients. Ann Thorac Surg 2011; 91:1066-71. [PMID: 21440124 DOI: 10.1016/j.athoracsur.2010.12.032] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 12/12/2010] [Accepted: 12/16/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND A computed tomographic-guided percutaneous needle biopsy (CTGNB) is useful as an option for pathologic diagnosis of lung cancer, especially in patients with peripheral small-sized nodules. We aimed to assess the risk of pleural seeding of cancer cells, leading to postoperative relapse with dissemination caused by the procedure. METHODS We investigated the clinical outcomes of 447 stage I lung cancer patients. Survival analysis was performed using the Kaplan-Meier method and a log-rank test. Pleural recurrence rates were also determined. Furthermore, propensity score matching analysis was used to reduce background bias from patient characteristics. RESULTS The 5-year, disease-free survival rate was 89.1% in patients diagnosed with CTGNB, and 85.5% in those diagnosed using a transbronchial biopsy or open lung biopsy procedure. Local recurrence with pleural dissemination was found in 8 of 13 recurrence cases (61.5%) in the CTGNB group, which was higher as compared with the transbronchial biopsy or open lung biopsy group (p < 0.01). Subset analyses of p stage IB cases and those with subpleural lesions showed that local recurrence with dissemination was significantly more frequent in the CTGNB group (p = 0.02 and p < 0.01, respectively). In patients with subpleural lesions diagnosed with CTGNB, the rate of local recurrence with dissemination was 15.4%. Propensity score matching analysis confirmed the significantly increased frequency of pleural dissemination after CTGNB. CONCLUSIONS The CTGNB procedure might increase the risk of pleural implantation in stage I lung cancer patients, especially p stage IB cases with subpleural lesions, whereas the overall disease-free survival rate was not affected by this small population of patients with recurrence.
Collapse
Affiliation(s)
- Masayoshi Inoue
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Fohn LE, Rodriguez A, Kelley MC, Ye F, Shyr Y, Stricklin G, Robbins JB. D2-40 lymphatic marker for detecting lymphatic invasion in thin to intermediate thickness melanomas: Association with sentinel lymph node status and prognostic value—A retrospective case study. J Am Acad Dermatol 2011; 64:336-45. [DOI: 10.1016/j.jaad.2010.03.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 02/26/2010] [Accepted: 03/03/2010] [Indexed: 11/26/2022]
|
26
|
Yamashita SI, Moroga T, Tokuishi K, Miyawaki M, Chujo M, Yamamoto S, Kawahara K. Ki-67 Labeling Index Is Associated with Recurrence after Segmentectomy under Video-assisted Thoracoscopic Surgery in Stage I Non-small Cell Lung Cancer. Ann Thorac Cardiovasc Surg 2011; 17:341-6. [DOI: 10.5761/atcs.oa.10.01573] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
27
|
Sieren JC, Weydert J, Bell A, De Young B, Smith AR, Thiesse J, Namati E, McLennan G. An automated segmentation approach for highlighting the histological complexity of human lung cancer. Ann Biomed Eng 2010; 38:3581-91. [PMID: 20571856 DOI: 10.1007/s10439-010-0103-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 06/11/2010] [Indexed: 11/25/2022]
Abstract
Lung cancer nodules, particularly adenocarcinoma, contain a complex intermixing of cellular tissue types: incorporating cancer cells, fibroblastic stromal tissue, and inactive fibrosis. Quantitative proportions and distributions of the various tissue types may be insightful for understanding lung cancer growth, classification, and prognostic factors. However, current methods of histological assessment are qualitative and provide limited opportunity to systematically evaluate the relevance of lung nodule cellular heterogeneity. In this study we present both a manual and an automatic method for segmentation of tissue types in histological sections of resected human lung cancer nodules. A specialized staining approach incorporating immunohistochemistry with a modified Masson's Trichrome counterstain was employed to maximize color contrast in the tissue samples for automated segmentation. The developed, clustering-based, fully automated segmentation approach segments complete lung nodule cross-sectional histology slides in less than 1 min, compared to manual segmentation which requires multiple hours to complete. We found the accuracy of the automated approach to be comparable to that of the manual segmentation with the added advantages of improved time efficiency, removal of susceptibility to human error, and 100% repeatability.
Collapse
Affiliation(s)
- J C Sieren
- Department of Internal Medicine, University of Iowa, Iowa City, USA.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Surgical treatment strategy for small-sized, non-small cell lung cancer: A proposed algorithm for limited resection. ACTA ACUST UNITED AC 2010. [DOI: 10.2995/jacsurg.24.1004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
29
|
Using optical spectroscopy to longitudinally monitor physiological changes within solid tumors. Neoplasia 2009; 11:889-900. [PMID: 19724683 DOI: 10.1593/neo.09580] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Revised: 06/11/2009] [Accepted: 06/12/2009] [Indexed: 12/31/2022] Open
Abstract
The feasibility of using quantitative diffuse reflectance spectroscopy to longitudinally monitor physiological response to cancer therapy was evaluated in a preclinical model. This study included two groups of nude mice bearing 4T1 flank tumors (N = 50), half of which were treated with a maximum tolerated dose of doxorubicin (DOX). Diffuse reflectance spectra were collected from tumors during a period of 2 weeks using a fiber-optic probe coupled to a spectrometer. These spectra were quantified using an inverse scalable Monte Carlo model of light transport in tissue to extract the concentrations of oxygenated, deoxygenated hemoglobin (dHb), and a wavelength mean reduced scattering coefficient (<micro(s)'>). The tumor growth rates of the treated and control groups were nearly identical, as were changes in the scattering parameter <micro(s)'> during this time frame. However, tumors treated with DOX showed a transient but significant increase in blood oxygen saturation. A comparison between the optically derived and immunohistochemical end points in a subset of the 50 animals showed that the temporal kinetics of dHb concentration and <micro(s)'> were highly concordant with those of hypoxic and necrotic fractions, respectively. In conclusion, optical methods could function as a "screening" technology in longitudinal studies of small animal tumor models to accelerate development and testing of new anticancer drugs. This technique could isolate specific landmark time points at which more expensive and sophisticated imaging methods or immunohistochemistry could be performed.
Collapse
|
30
|
Abstract
Current World Health Organization (WHO) classification of lung adenocarcinomas includes noninvasive bronchioloalveolar carcinoma (BAC) and several patterns of invasive adenocarcinoma. The most common is a mixed subtype of adenocarcinoma. This group is very heterogenous and includes a wide spectrum of tumors ranging from adenocarcinomas with a dominant BAC growth pattern (lepidic growth) to frankly invasive adenocarcinoma with no BAC component. There is a tendency among clinicians to regard tumor as BAC if any significant amount of lepidic growth pattern within the tumor is identified. The change in WHO definition of BAC and introduction of mixed subtype of adenocarcinoma resulted in disconnect between surgical pathologists and clinicians regarding the use of terminology and criteria for diagnosis of BAC and mixed subtype of adenocarcinoma. It is clear that pure BAC is an extremely rare tumor, whereas mixed subtypes of adenocarcinomas may have various clinical presentations and outcomes. The mounting evidence suggests that a subset of mixed subtype of adenocarcinomas with areas of BAC and focal invasion probably represent more indolent tumors. On the basis of the published data, there is a proposal to define a subcategory of "minimally invasive adenocarcinoma" of the lung. Many morphologic factors seem to play a role in predicting the behavior of these tumors. Depending on the results of ongoing clinical trials, surgical management of these tumors may change in a near future.
Collapse
|