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Mi J, Li C, Yang F, Shi X, Zhang Z, Guo L, Jiang G, Li Y, Wang J, Yang F, Hu Z, Zhou J. Comparative Study of Indocyanine Green Fluorescence Imaging in Lung Cancer with Near-Infrared-I/II Windows. Ann Surg Oncol 2024; 31:2451-2460. [PMID: 38063990 DOI: 10.1245/s10434-023-14677-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/12/2023] [Indexed: 03/06/2024]
Abstract
BACKGROUND We compare the application of intravenous indocyanine green (ICG) fluorescence imaging in lung cancer with near-infrared-I (NIR-I) and near-infrared-II (NIR-II) windows. METHODS From March to December 2022, we enrolled patients who received an intravenous injection of ICG (5 mg/kg) 1 day before the planned lung cancer surgery. The lung cancer nodules were imaged by NIR-I/II fluorescence imaging systems, and the tumor-to-normal-tissue ratio (TNR) was calculated. In addition, the fluorescence intensity and signal-to-background ratio (SBR) of capillary glass tubes containing ICG covered with different thicknesses of lung tissue were measured by NIR-I/II fluorescence imaging systems. RESULTS In this study, 102 patients were enrolled, and the mean age was 59.9 ± 9.2 years. A total of 96 (94.1%) and 98 (96.1%) lung nodules were successfully imaged with NIR-I and NIR-II fluorescence, and the TNR of NIR-II was significantly higher than that of NIR-I (3.9 ± 1.3 versus 2.4 ± 0.6, P < 0.001). In multiple linear regression, solid nodules (P < 0.001) and squamous cell carcinoma (P < 0.001) were independent predictors of a higher TNR of NIR-I/II. When capillary glass tubes were covered with lung tissue whose thickness was more than 2 mm, the fluorescence intensity and the SBR of NIR-II were significantly higher than those of NIR-I. CONCLUSIONS We verified the feasibility of NIR-II fluorescence imaging in intravenous ICG lung cancer imaging for the first time. NIR-II fluorescence can improve the TNR and penetration depth of lung cancer with promising clinical prospects.
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Affiliation(s)
- Jiahui Mi
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Changjian Li
- School of Engineering Medicine, Beihang University, Beijing, China
- Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology, Beijing, China
| | - Feng Yang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Xiaojing Shi
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Zeyu Zhang
- School of Engineering Medicine, Beihang University, Beijing, China
- Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology, Beijing, China
| | - Lishuang Guo
- School of Engineering Medicine, Beihang University, Beijing, China
- Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology, Beijing, China
| | - Guanchao Jiang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Yun Li
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Jun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Fan Yang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.
| | - Zhenhua Hu
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China.
| | - Jian Zhou
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.
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Moon RJ, Taylor R, Miklavc P, Mehdi SB, Grant SW, Bittar MN. Wedge resection versus lobectomy in T1 lung cancer patients: a propensity matched analysis. J Cardiothorac Surg 2023; 18:252. [PMID: 37620956 PMCID: PMC10464042 DOI: 10.1186/s13019-023-02303-4] [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: 04/19/2022] [Accepted: 06/10/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVES Performing wedge resection rather than lobectomy for primary lung cancer remains controversial. Recent studies demonstrate no survival advantage for non-anatomical resection compared to lobectomy in patients with early-stage lung cancer. The objective of this study was to investigate whether in patients with T1 tumours, non-anatomical wedge resection is associated with equivalent survival to lobectomy. METHODS This was a retrospective cohort study of patients who underwent lung resection at the Lancashire Cardiac Centre between April 2005 and April 2018. Patients were subjected to multidisciplinary team discussion. The extent of resection was decided by the team based on British Thoracic Society guidelines. The primary outcome was overall survival. Propensity matching of patients with T1 tumours was also performed to determine whether differences in survival rates exist in a subset of these patients with balanced pre-operative characteristics. RESULTS There were 187 patients who underwent non-anatomical wedge resection and 431 patients who underwent lobectomy. Cox modelling demonstrated no survival difference between groups for the first 1.6 years then a risk of death 3-fold higher for wedge resection group after 1.6 years (HR 3.14, CI 1.98-4.79). Propensity matching yielded 152 pairs for which 5-year survival was 66.2% for the lobectomy group and 38.5% for the non-anatomical wedge group (SMD = 0.58, p = 0.003). CONCLUSIONS Non-anatomical wedge resection was associated with significantly reduced 5-year survival compared to lobectomy in matched patients. Lobectomy should remain the standard of care for patients with early-stage lung cancer who are fit enough to undergo surgical resection.
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Affiliation(s)
- Robert J Moon
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK.
| | - Rebecca Taylor
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
| | - Pika Miklavc
- School of Science, Engineering and Environment, University of Salford, Manchester, UK
| | - Syed B Mehdi
- Department of Respiratory Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Stuart W Grant
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
| | - Mohamad Nidal Bittar
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
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Wolf A, Laskey D, Yip R, Beasley MB, Yankelevitz DF, Henschke CI. Measuring the margin distance in pulmonary wedge resection. J Surg Oncol 2022; 126:1350-1358. [PMID: 35975701 DOI: 10.1002/jso.27053] [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: 05/22/2022] [Revised: 07/25/2022] [Accepted: 07/30/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Margin distance contributes to survival and recurrence during wedge resections for early-stage non-small cell lung cancer. The Initiative for Early Lung Cancer Research on Treatment sought to standardize a surgeon-measured margin intraoperatively. METHODS Lung cancer patients who underwent wedge resection were reviewed. Margins were measured by the surgeon twice as per a standardized protocol. Intraobserver variability as well as surgeon-pathologist variability were compared. RESULTS Forty-five patients underwent wedge resection. Same-surgeon measurement analysis indicated good reliability with a small mean difference and narrow limit of agreement for the two measures. The median surgeon-measured margin was 18.0 mm, median pathologist-measured margin was 16.0 mm and the median difference between the surgeon-pathologist margin was -1.0 mm, ranging from -18.0 to 12.0 mm. Bland-Altman analysis for margin measurements demonstrated a mean difference of 0.65 mm. The limit of agreement for the two approaches were wide, with the difference lying between -16.25 and 14.96 mm. CONCLUSIONS A novel protocol of surgeon-measured margin was evaluated and compared with pathologist-measured margin. High intraobserver agreement for repeat surgeon measurements yet low-to-moderate correlation or directionality between surgeon and pathologic measurements were found. DISCUSSION A standardized protocol may reduce variability in pathologic assessment. These findings have critical implications considering the impact of margin distance on outcomes.
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Affiliation(s)
- Andrea Wolf
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel Laskey
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mary B Beasley
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Tisch Center Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Center for Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Tisch Center Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Center for Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Yamanashi K, Hamaji M, Murakami K, Shimada Y, Kayawake H, Yutaka Y, Kawaguchi Y, Kudo Y, Ikeda N, Date H. Prognostic role of preoperative carcinoembryonic antigen level in part-solid lung adenocarcinoma. Asian Cardiovasc Thorac Ann 2022; 30:457-467. [PMID: 35040362 DOI: 10.1177/02184923211072486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Part-solid lung adenocarcinoma appears as a heterogeneous subgroup, and its surgical management is controversial. This study aimed to elucidate whether preoperative carcinoembryonic antigen, a time-honored tumor marker, can be used as a prognostic factor that contributes to its management. METHODS We retrospectively reviewed consecutive patients with clinical-T1a-cN0M0 part-solid adenocarcinoma who underwent surgical resection between January 2011 and December 2015 at two institutions. RESULTS Overall, 288 patients were identified. The median age was 69 years with 176 patients (61%) being female. The median follow-up time was 5.6 years. Lymph node metastases were found in 6 (15%) of 41 patients with elevated carcinoembryonic antigen levels, while 10 (4.0%) of 247 patients had normal carcinoembryonic antigen levels (P = 0.016). The 5-year overall survival rates in patients with normal and elevated carcinoembryonic antigen levels were 96.9% and 87.2%, respectively (P = 0.006), and the 5-year relapse-free survival rates were 91.8% and 62.8%, respectively (P < 0.001). The multivariable analysis revealed that preoperative carcinoembryonic antigen level was a significant prognostic factor for relapse-free survival (hazard ratio [HR] = 2.92, 95% confidence interval [CI] = 1.63-5.25, P < 0.001). Among the patients with elevated carcinoembryonic antigen levels, the 5-year overall survival rates in those undergoing lobar resection and segmentectomy were 87.0% and 88.9%, respectively (P = 0.59), and the 5-year relapse-free survival rates were 61.7% and 66.7%, respectively (P = 0.84). CONCLUSIONS Our data suggest that preoperative carcinoembryonic antigen level appears to be an important predictor of postoperative survival outcomes in early-stage part-solid adenocarcinoma. Further studies are required to optimize management of patients with elevated preoperative carcinoembryonic antigen levels, although segmentectomy appeared acceptable in those patients.
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Affiliation(s)
- Keiji Yamanashi
- Department of Thoracic Surgery, Graduate School of Medicine, 12918Kyoto University, Japan
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Graduate School of Medicine, 12918Kyoto University, Japan
| | - Kotaro Murakami
- 34797Department of Surgery, 13112Tokyo Medical University, Japan
| | | | - Hidenao Kayawake
- Department of Thoracic Surgery, Graduate School of Medicine, 12918Kyoto University, Japan
| | - Yojiro Yutaka
- Department of Thoracic Surgery, Graduate School of Medicine, 12918Kyoto University, Japan
| | - Yohei Kawaguchi
- 34797Department of Surgery, 13112Tokyo Medical University, Japan
| | - Yujin Kudo
- 34797Department of Surgery, 13112Tokyo Medical University, Japan
| | - Norihiko Ikeda
- 34797Department of Surgery, 13112Tokyo Medical University, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, 12918Kyoto University, Japan
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Peng WD, Xie J, Zhang X, Li C. The Change Trend of Cause of Death in Patients With Stage I Non-Small Cell Lung Cancer After Surgery in US: A Long-Term Follow-Up Study Based on SEER Database. Cancer Control 2021; 27:1073274820954461. [PMID: 33070629 PMCID: PMC7791446 DOI: 10.1177/1073274820954461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
There are few studies on the cause of death in patients with stage I non-small
cell lung cancer after surgery. Our aim is to study the trend of cause of death
and risk factors affecting prognosis in the patients. We retrospectively
reviewed patients in Surveillance, Epidemiology and End results database from
2004 to 2015. The change trend between cause of death and follow-up time was
studied by calculating the proportion of cause of death at different periods and
analyzing the cumulative risk. COX risk regression model was performed by
univariate and multivariate analyses for survival analysis. Finally, 23,652
patients were enrolled. In the whole cohort, lung cancer accounted for 18.68% of
deaths, followed by other causes (9.57%), heart disease (5.12%) and COPD
(3.89%). With the increasing of follow-up time, the cumulative incidence of lung
cancer was always the highest, but the growth rate in the late follow-up period
was slower than that caused by heart disease and COPD. The proportion of death
due to lung cancer decreased from 53.1%-73.1% in 0-30 months after follow-up to
7.8%-41.4% in 90 months after follow-up, while the proportion of deaths due to
heart disease and COPD increased. Age was an independent risk factor for lung
cancer-, heart disease- and COPD-specific survival, while lobectomy resection
was a protective factor, even in patients older than 70 years old. In
conclusion, during the follow-up period, lung cancer was still the main cause of
death, but the proportion of patients died of heart disease and COPD increased
gradually, especially in elderly. Furthermore, age was an important independent
factor affecting prognosis, particularly for heart disease- and COPD-related
mortality. The application of wedge resection in elderly patients needs further
exploration.
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Affiliation(s)
- Wan-da Peng
- Department of Respiration, First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jun Xie
- Department of Respiration, First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xian Zhang
- Department of Respiration, First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Chong Li
- Department of Respiration, First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, Changzhou, China
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Assessing Differences in Lymph Node Metastasis Based Upon Sex in Early Non-Small Cell Lung Cancer. World J Surg 2021; 45:2610-2618. [PMID: 33899137 DOI: 10.1007/s00268-021-06136-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUNDS Whether sex has any impact on the risk of lymph node (LN) metastasis (LNM) in patients with early-stage non-small cell lung cancer (NSCLC) remains controversial. Therefore, we aimed to objectively compared the risk of LNM between female and male patients with early-stage NSCLC so as to figure out whether sex-different extent of surgery may be justified for treating these patients. METHODS We retrospectively collected clinical data of patients undergoing lobectomy or segmentectomy with systematic hilar and mediastinal LN dissection for clinical stage IA peripheral NSCLC from June 2014 to April 2019. Both multivariate logistic regression analysis and propensity score-matched(PSM) analysis were applied to compare the risk of LNM between female and male patients. RESULTS We finally included a total of 660 patients for analysis. In the analysis of unmatched cohorts, there was no significant different rate of LNM (12.4% Vs 13.9%, P=0.556), hilar/intrapulmonary LNM (8.4% Vs 10.7%, P=0.318) and mediastinal LNM(7.9% Vs 7.5%, P=0.851) between female and male patients. In the multivariate analysis, sex was not found to be an independent predictor of LN in these patients. Moreover, in the analysis of well-matched cohorts generated by PSM analysis, there was still no significant different rate of LNM (13.8% Vs 13.4%, P=0.892), hilar/intrapulmonary LNM (9.1% Vs 11.2%, P=0.442) and mediastinal LNM (9.1% Vs 6.5%, P=0.289) between female and male patients. CONCLUSIONS Sex was not an independent predictor of LNM in early-stage NSCLC and there is no sufficient evidence justifying for sex-different extent of surgical resection for these patients.
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Moon Y. Is the size of the lepidic component negligible when measuring the size of the tumor to determine the stage of lung adenocarcinoma? J Thorac Dis 2021; 13:1434-1444. [PMID: 33841936 PMCID: PMC8024845 DOI: 10.21037/jtd-20-2963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background After applying the 8th edition of the TNM staging system, the invasive component size, not total tumor size, began to be used as a T descriptor for the stage. The aim of this study was to evaluate whether the size of the lepidic component can be negligible when using only the invasive component size as the T descriptor. Methods From 2010 to 2018, 613 consecutive patients were diagnosed as having stage IA lung adenocarcinoma and underwent anatomical lobectomy at a tertiary hospital. Pathologic specimens and medical records were reviewed retrospectively. Statistical analyses were conducted to find out whether the recurrence of stage IA lung adenocarcinoma was more affected by total tumor size (including lepidic component size) or invasive component size. Results The 5-year recurrence-free survival (RFS) rates of stage 0, stage IA1, stage IA2, and stage IA3 were 100%, 98.4%, 89.1%, and 81.7%, respectively. In multivariate analysis, total tumor size was not a risk factor for recurrence, whereas invasive component size was a significant risk factor for recurrence (Hazard ratio =1.658, P=0.043). In subgroup analysis, 5-year RFS rates of large lung adenocarcinoma (total tumor size >3 cm) and others (total tumor size ≤3 cm) in the same invasive component size group (stage IA2 and stage IA3) were not statistically different. Conclusions Invasive component size was a risk factor for recurrence of stage IA lung adenocarcinoma, while total tumor size was not a risk factor. Therefore, it seems to be appropriate to ignore the size of the lepidic component.
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Affiliation(s)
- Youngkyu Moon
- Department of Thoracic & Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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8
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Moon Y, Choi SY, Moon MH. Prognosis of wide wedge resection in patients with stage IA1 and IA2 lung adenocarcinoma with total tumor size including the lepidic component greater than 2 cm: a single center retrospective study. J Thorac Dis 2020; 12:4731-4741. [PMID: 33145046 PMCID: PMC7578457 DOI: 10.21037/jtd-20-1507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Stage I lung adenocarcinoma with a lepidic component has a good prognosis after sublobar resection. The purpose of this study is to evaluate the prognosis of wide wedge resection in patients diagnosed with stage IA1 and IA2 lung adenocarcinoma (based on the eighth edition of the TNM staging system) in which the total tumor size, including the lepidic component, is more than 2 cm. Methods From 2010 to 2018, 180 consecutive patients were diagnosed with stage IA1 and IA2 lung adenocarcinoma with a total tumor size (including the lepidic component) of more than 2 cm, and they underwent wide wedge resection or lobectomy at a hospital in Korea. The patients were determined as stage IA1 or stage IA2, and their clinicopathological characteristics and prognosis were compared between the wedge resection group and the lobectomy group. Results The clinicopathological characteristics were not statistically different between the wedge resection group and the lobectomy group. There were no recurrences and cancer-related deaths during the follow-up period for patients with stage IA1 lung adenocarcinoma in the wedge resection group and the lobectomy group. However, the 5-year recurrence-free survival rates of the wedge resection group and the lobectomy group were statistically different (73.9% and 90.8%, respectively; P=0.031) in stage IA2 lung adenocarcinoma. In a multivariate analysis of risk factors for recurrence, wedge resection [hazard ratio (HR) =15.883; P=0.026] and lymphovascular invasion (HR =13.854; P=0.023) were significant risk factors for recurrence in patients with stage IA2 lung adenocarcinoma. Conclusions In the cases of lung adenocarcinoma with a total tumor size (including the lepidic component) of more than 2 cm, a good prognosis can be expected with wide wedge resection in stage IA1, but not an appropriate surgical choice for the cases in stage IA2.
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Affiliation(s)
- Youngkyu Moon
- Department of Thoracic & Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Si Young Choi
- Department of Thoracic & Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mi Hyoung Moon
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Zhang H, Li Y, Yimin N, He Z, Chen X. CT-guided hook-wire localization of malignant pulmonary nodules for video assisted thoracoscopic surgery. J Cardiothorac Surg 2020; 15:307. [PMID: 33036640 PMCID: PMC7545541 DOI: 10.1186/s13019-020-01279-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/01/2020] [Indexed: 12/26/2022] Open
Abstract
Objectives Video assisted thoracoscopic surgery (VATS) can currently be used to diagnose and treat pulmonary nodules. However, intraoperative location of pulmonary nodules in VATS is challenging due to their small diameter and deep location in the pulmonary parenchyma. The purpose of this study was to report the clinical safety and effectiveness of CT-guided hook-wire for preoperative localization of malignant pulmonary nodules smaller than 1 cm in diameter. Methods From February 2017 to January 2018, we collected the data of 80 patients with malignant pulmonary nodules less than 1 cm in diameter who underwent CT-guided hook-wire preoperative localization and VATS surgery. The effectiveness of preoperative localization was evaluated based on surgical duration, success rate of VATS surgery, and localization-related complications. Results The diameter of pulmonary nodules were 0.85 ± 0.17 mm with a distance to the pleural surface of 19.66 ± 14.10 mm. The length of the hook-wire in the lung parenchyma was 29.17 ± 13.14 mm and hook-wire dislodgement occurred in 2 patients. Complications included 27 cases of minor pneumothorax and 18 cases of mild parenchymal hemorrhage. A significant correlation was observed between the length of the hook-wire in the lung parenchyma and mild parenchymal hemorrhage (P = 0.044). The average time of hook-wire localization was 9.0 ± 2.6 min and the average operation time for VATS was 89.02 ± 23.35 min without conversion thoracotomy. Conclusions CT-guided hook-wire localization of the lesion during VATS resection is safe for malignant pulmonary nodules with diameter less than 1 cm.
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Affiliation(s)
- Huijun Zhang
- Department of Cardiothoracic Surgery, Huashan Hospital of Fudan University, Shanghai, 200040, China.
| | - Ying Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Nadier Yimin
- Department of Cardiothoracic Surgery, Huashan Hospital of Fudan University, Shanghai, 200040, China
| | - Zelai He
- Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China.
| | - Xiaofeng Chen
- Department of Cardiothoracic Surgery, Huashan Hospital of Fudan University, Shanghai, 200040, China.
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Choi SY, Moon MH, Moon Y. The prognosis of small-sized non-small cell lung cancer with visceral pleural invasion after sublobar resection. Transl Cancer Res 2020; 9:6431-6443. [PMID: 35117251 PMCID: PMC8797775 DOI: 10.21037/tcr-20-1995] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/03/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Sublobar resection is sometimes performed as a surgical treatment for small peripheral tumors. However, there is a question about whether sublobar resection is adequate treatment when visceral pleural invasion is diagnosed postoperatively. The purpose of this study was to evaluate the prognosis of patients with small-sized stage IB non-small cell lung cancer (NSCLC) after sublobar resection. METHODS From January 2010 to December 2018, 227 consecutive patients with eighth edition TNM stage IB NSCLC (per the joint staging system of the International Association for the Study of Lung Cancer and the American Joint Committee on Cancer) underwent curative surgery at a single center. Those patients were reviewed retrospectively. The clinicopathological characteristics and prognosis were compared between the sublobar resection group and the lobectomy group. The sublobar resection group included only small-sized (invasive component size ≤2 cm) NSCLC. RESULTS In all study patients, clinicopathological characteristics between the sublobar resection and lobectomy groups were not different except in maximum standardized uptake value (SUVmax) and invasive component size. The 5-year recurrence-free survival (RFS) rate was 80.7% after sublobar resection and 73.4% after lobectomy (P=0.349). The 5-year overall survival (OS) rate was 87.3% after sublobar resection and 84.8% after lobectomy (P=0.503). In patients with small-sized NSCLC, the clinicopathological characteristics were not different between the sublobar resection group and the lobectomy group. The 5-year RFS rate was 80.7% after sublobar resection and 72.3% after lobectomy (P=0.417). The 5-year OS rate was 87.3% after sublobar resection and 91.2% after lobectomy (P=0.956). Sublobar resection was not a risk factor for recurrence in the multivariate analysis. CONCLUSIONS The prognosis of sublobar resection in patients with small-sized stage IB NSCLC was comparable with lobectomy. Thus, additional completion lobectomy may not be essential in this setting, despite postoperative upstaging from T1 to T2a.
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Affiliation(s)
- Si Young Choi
- Department of Thoracic & Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mi Hyoung Moon
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Youngkyu Moon
- Department of Thoracic & Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Yamanashi K, Hamaji M, Tsunoda S, Nakanishi T, Omasa M, Nakajima N, Ohsumi A, Menju T, Chen-Yoshikawa TF, Date H. Survival outcomes of resection for pulmonary malignancies including non-small cell lung cancer and pulmonary metastasis after esophagectomy for esophageal carcinoma. Gen Thorac Cardiovasc Surg 2020; 68:1179-1186. [PMID: 32361810 DOI: 10.1007/s11748-020-01373-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 04/15/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This study investigated survival outcomes of resection for pulmonary malignancies after esophagectomy for esophageal carcinoma, comparing non-small cell lung cancer and pulmonary metastases. METHODS We retrospectively reviewed consecutive patients who underwent resection for pulmonary malignancies after esophagectomy for esophageal carcinoma between 2009 and 2018. The overall survival and relapse-free survival rate were assessed using Kaplan-Meier analysis. RESULTS Eleven patients had non-small cell lung cancer and eight patients had pulmonary metastases from esophageal carcinoma. The 5-year overall survival rate was 92.9% in all patients with a median follow-up period of 50.4 (range: 9.1-130.2) months. While the 5-year overall survival rate was 100.0% in patients with non-small cell lung cancer, it was 85.7% in patients with pulmonary metastases from esophageal carcinoma. The 5-year relapse-free survival rate was 85.7% in patients with non-small cell lung cancer. CONCLUSIONS Our data suggest that resection for pulmonary malignancies after esophagectomy for esophageal carcinoma is associated with favorable survival outcomes and should be considered in selected patients.
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Affiliation(s)
- Keiji Yamanashi
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Shigeru Tsunoda
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takao Nakanishi
- Department of Thoracic Surgery, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Mitsugu Omasa
- Department of Thoracic Surgery, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Naoki Nakajima
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Akihiro Ohsumi
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Toshi Menju
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | | | - Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Zheng E, Yang M, Li R, Ni J, Xu X, Zhao G. Prognostic impact of lymphadenectomy on outcomes of sublobar resection for non-small cell lung cancer ≤1 or >1 to 2 cm. J Thorac Dis 2020; 12:2049-2060. [PMID: 32642107 PMCID: PMC7330392 DOI: 10.21037/jtd-19-3773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Lymphadenectomy is an important part of surgical treatment for non-small cell lung cancer (NSCLC). However, the prognostic impact of lymph node (LN) dissection for patients with NSCLC ≤1 and >1 to 2 cm who underwent sublobar resection is still unclear. Methods A group of patients numbering 7,627 with NSCLC 2 cm or less who underwent sublobar resection were identified from the Surveillance, Epidemiology, and End Results (SEER) database between January 2010 and November 2015. The overall survival (OS) and lung cancer-specific survival (LCSS) were evaluated among patients who had undergone dissection of ≥4 LNs, 1 to 3 LNs or who had no-LN dissection; log-rank and Cox proportional-hazards regression analyses were used for the evaluation. Results Patients with NSCLC ≤2 cm who underwent ≥4 LNs dissection had better OS and LCSS compared with those who underwent dissection of 1 to 3 LNs or who had no-LN dissection after sublobar resection. Subgroup analysis showed that dissection of ≥4 LNs had better OS and LCSS than those of 1 to 3 LNs dissection in NSCLC >1 to 2 cm, whereas had similar OS and LCSS in NSCLC ≤1 cm. Multivariate Cox analysis showed that dissection of 1 to 3 LNs was not an independent risk factor of OS and LCSS than dissection of ≥4 LNs in NSCLC ≤1 cm after sublobar resection. Conclusions The extent of LN dissection is associated with the survival outcomes in patients with NSCLC ≤2 cm after sublobar resection. Dissection of ≥4 LNs should be recommended for NSCLC >1 to 2 cm, whereas surgeons can rely on surgical skills and patient profiles to decide ≥4 LNs or 1 to 3 LNs dissection for NSCLC ≤1 cm during sublobar resection.
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Affiliation(s)
- Enkuo Zheng
- Department of Thoracic Surgery, Hua Mei Hospital, University of Chinese Academy of Science, Ningbo 315012, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Science, Ningbo 315012, China
| | - Minglei Yang
- Department of Thoracic Surgery, Hua Mei Hospital, University of Chinese Academy of Science, Ningbo 315012, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Science, Ningbo 315012, China
| | - Rui Li
- Department of Thoracic Surgery, Hua Mei Hospital, University of Chinese Academy of Science, Ningbo 315012, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Science, Ningbo 315012, China
| | - Junjun Ni
- Department of Thoracic Surgery, Hua Mei Hospital, University of Chinese Academy of Science, Ningbo 315012, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Science, Ningbo 315012, China
| | - Xiang Xu
- Department of Thoracic Surgery, Hua Mei Hospital, University of Chinese Academy of Science, Ningbo 315012, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Science, Ningbo 315012, China
| | - Guofang Zhao
- Department of Thoracic Surgery, Hua Mei Hospital, University of Chinese Academy of Science, Ningbo 315012, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Science, Ningbo 315012, China
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13
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Deng HY, Zhou J, Wang RL, Jiang R, Qiu XM, Zhu DX, Tang XJ, Zhou Q. Surgical Choice for Clinical Stage IA Non-Small Cell Lung Cancer: View From Regional Lymph Node Metastasis. Ann Thorac Surg 2019; 109:1079-1085. [PMID: 31846634 DOI: 10.1016/j.athoracsur.2019.10.056] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/08/2019] [Accepted: 10/18/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND We aimed to investigate the pattern of regional lymph node (LN) metastasis of early-stage non-small cell lung cancer (NSCLC) to provide novel rationale for surgical choice (lobectomy, segmentectomy, or wedge resection) for these patients. METHODS We retrospectively collected clinical data of patients undergoing lobectomy with systematic mediastinal LN dissection or sampling for cT1N0M0 peripheral NSCLC from January 2015 to December 2018. The regional LN metastasis pattern was analyzed based on tumor size. RESULTS We included a total of 354 patients for analysis. The rate of hilar or intrapulmonary LN metastasis was 13.6%. When stratified by tumor size, NSCLC less than or equal to 1 cm had no hilar or intrapulmonary LN metastasis (0%) while NSCLC greater than 2 cm but less than or equal to 3 cm had a significantly high rate of hilar or intrapulmonary LN metastasis (18.4%) and the rates of hilar, interlobar, and peripheral LN metastasis were also relatively high (5.4%, 5.4%, and 12.2%, respectively). NSCLC greater than 1.5 cm but less than or equal to 2 cm also had relatively high rates of hilar (6.5%) and peripheral (18.3%) LN metastasis, while NSCLC greater than 1 cm but less than or equal to 1.5 cm had significantly low rates of hilar or intrapulmonary (2.5%) and peripheral (2.5%) LN metastasis. Radiographic feature and histology were found to be independent predictors of regional LN metastasis. CONCLUSIONS The pattern of regional LN metastasis in clinical stage IA peripheral NSCLC was significantly influenced by tumor size, which may provide evidence on surgical choice (lobectomy, segmentectomy, or wedge resection) for these early-stage NSCLC patients based on tumor size.
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Affiliation(s)
- Han-Yu Deng
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ru-Lan Wang
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Jiang
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao-Ming Qiu
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Da-Xing Zhu
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao-Jun Tang
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qinghua Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
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Second Primary Lung Cancers Demonstrate Similar Survival With Wedge Resection and Lobectomy. Ann Thorac Surg 2019; 108:1724-1728. [DOI: 10.1016/j.athoracsur.2019.06.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 04/29/2019] [Accepted: 06/03/2019] [Indexed: 12/20/2022]
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15
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Mi J, Wang S, Li X, Jiang G. [Clinical Characteristics and Prognosis of Sub-centimeter Lung Adenocarcinoma]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:500-506. [PMID: 31451140 PMCID: PMC6717866 DOI: 10.3779/j.issn.1009-3419.2019.08.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
背景与目的 随着肺癌筛查的逐渐推广,越来越多的患者被确诊为亚厘米(直径≤1 cm)肺腺癌。亚厘米肺腺癌多为早期肺癌,但目前关于亚厘米肺腺癌的研究仍不充分。本研究针对亚厘米肺腺癌患者临床特征及预后进行分析,为该类患者的诊疗提供依据。 方法 回顾性分析2012年1月-2016年12月北京大学人民医院经胸腔镜手术病理确诊为亚厘米肺腺癌患者的临床及预后资料。根据结节影像学特征将患者分为纯磨玻璃结节(pure ground-glass nodules, pGGN)、混杂性磨玻璃结节(mixed ground-glass nodules, mGGN)和实性结节(solid nodules, SN)组,对比三组患者临床特征并对不同直径结节行亚组分析。此外,通过多因素分析筛选亚厘米肺浸润性腺癌的独立危险因素。 结果 本组共182例患者,中位年龄54(27-75)岁。男性57例,女性125例。女性亚厘米肺腺癌患者无吸烟史比例显著高于男性(P < 0.001)。所有1 mm-10 mm pGGN、1 mm-5 mm mGGN及1 mm-5 mm SN患者术后病理除原发灶外无其他阳性发现。46例6 mm-10 mm mGGN患者中有3例侵犯胸膜,1例发现脉管癌栓。39例6 mm-10 mm SN患者中有5例侵犯胸膜,2例发现脉管癌栓,2例出现淋巴结转移。侵犯胸膜、发现脉管癌栓或淋巴结转移的患者其病理类型均为浸润性腺癌。多因素Logistic回归分析发现吸烟史、既往肿瘤病史、mGGN、SN和肿瘤直径 > 5 mm是病理为肺浸润性腺癌的独立危险因素。中位随访时间44(22-82)个月,全组患者5年无复发生存率100.0%,总生存率98.9%。 结论 亚厘米肺腺癌患者发病年龄相对较小。影像学表现为6 mm-10 mm mGGN和6 mm-10 mm SN的亚厘米肺浸润性腺癌患者存在侵犯胸膜或淋巴结转移可能。吸烟史、既往肿瘤病史、mGGN、SN和肿瘤直径 > 5 mm为亚厘米肺浸润性腺癌的独立危险因素。对于亚厘米肺腺癌患者,早期发现并采取合适且有效的外科干预可获得良好的预后。
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Affiliation(s)
- Jiahui Mi
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Shaodong Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Xiao Li
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Guanchao Jiang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
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Moon Y, Park JK, Lee KY, Kim ES. Prognosis after wedge resection in patients with 8 th edition TNM stage IA1 and IA2 non-small cell lung cancer. J Thorac Dis 2019; 11:2361-2372. [PMID: 31372273 DOI: 10.21037/jtd.2019.05.79] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background According to the 8th edition TNM classification for non-small cell lung cancer (NSCLC), tumor stage (T) is determined by the maximum size of the invasive component, without the lepidic component, and the T category has been further subdivided. We investigated the indications for wedge resection using the 8th edition TNM staging system, which measures only the size of the invasive component in tumor size. Methods We compared 5-year disease-free survival (DFS) rates in 429 consecutive patients with 8th edition stage IA1 and IA2 NSCLC who underwent lobectomy or wedge resection from 2007 to 2017. We also analyzed the risk factors for recurrence after surgical resection. Results There were no significant differences in clinicopathological factors or 5-year DFS in patients with stage IA1 disease (5-year DFS 95.0%, lobectomy, vs. 91.6%, wedge resection; P=0.435). For patients with stage IA2 tumors, the 5-year DFS was 88.3% after lobectomy and 74.0% after wedge resection (P=0.118). There were significant differences in clinicopathological characteristics between lobectomy and wedge resection groups in stage IA2 NSCLC. On multivariate analysis, serum CEA level [hazard ratio (HR) =1.040, P=0.046] and lymphovascular invasion (HR =2.664, P=0.027), but not wedge resection, were significant risk factors for recurrence in stage IA2 NSCLC. On multivariate analysis for recurrence risk after wedge resection in stage IA1 and stage IA2 NSCLC, only the width of the resection margin was associated with recurrence. Conclusions Wedge resection may be an acceptable procedure in stage IA1 NSCLC. When performing wedge resection, it is necessary to ensure a sufficient resection margin distance.
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Affiliation(s)
- Youngkyu Moon
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Kil Park
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
| | - Kyo Young Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Sung Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
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Zhang WH, Bai YY, Guo W, Li M, Chang GX, Liu W, Mao Y. Application of intrapulmonary wire combined with intrapleural fibrin glue in preoperative localization of small pulmonary nodules. Medicine (Baltimore) 2019; 98:e14029. [PMID: 30681559 PMCID: PMC6358377 DOI: 10.1097/md.0000000000014029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 11/30/2018] [Accepted: 12/13/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study aims to investigate the accuracy of the preoperative localization of small nodules by computerized tomography (CT)-guided placing wire and intrapleural fibrin glue near the nodules at 3 days before the operation. METHODS From October 2015 to December 2017, a total of 79 patients, who received preoperative localization of small pulmonary nodules and surgical treatment in the Department of Thoracic Surgery of Hohhot First Hospital, were enrolled into this study. These patients were randomly divided into 2 groups: methylene blue localization group (n = 47), and modified localization group (n = 32), where the patients received preoperative localization of the small nodules by CT-guided placing wire and intrapleural fibrin glue near the nodule at 3 days before the operation. Localization accuracy, operation time and difficulty in postoperative seeking for pathological specimens were compared between these 2 groups. RESULTS In the methylene blue localization group, 3 patients had localization failure due to the intrathoracic diffusion of methylene blue, and the success rate was 93.61%. In the modified localization group, all 32 patients succeeded in the localization, and the success rate was 100%. Operation time and difficulty of finding the specimen was significantly lower in the modified localization group than in the methylene blue localization group (P < .05). CONCLUSION The application of preoperative localization of small nodules by placing wire and intrapleural fibrin glue improves the success rate of resection, reduces operation time and the risk of the operation, and lowers the difficulty of finding pathological specimens after the operation. Hence this operative procedure is worthy of popularization.
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Affiliation(s)
- Wen-Hua Zhang
- Department of Thoracic Surgery, The First Hospital of Hohhot
| | - Yan-Yan Bai
- Department of Anesthesiology, The First Hospital of Hohhot, Inner Mongolia, China
| | - Wei Guo
- Department of Thoracic Surgery, The First Hospital of Hohhot
| | - Ming Li
- Department of Thoracic Surgery, The First Hospital of Hohhot
| | - Gui-Xia Chang
- Department of Thoracic Surgery, The First Hospital of Hohhot
| | - Wei Liu
- Department of Thoracic Surgery, The First Hospital of Hohhot
| | - Yu Mao
- Department of Thoracic Surgery, The First Hospital of Hohhot
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Mizutani K, Guo X, Shioya A, Zhang J, Zheng J, Kurose N, Ishibashi H, Motono N, Uramoto H, Yamada S. The impact of PRDX4 and the EGFR mutation status on cellular proliferation in lung adenocarcinoma. Int J Med Sci 2019; 16:1199-1206. [PMID: 31588184 PMCID: PMC6775271 DOI: 10.7150/ijms.36071] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/10/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Oxidative stress plays key roles in the progression of lung adenocarcinoma. Recently, we reported that peroxiredoxin 4 (PRDX4), an antioxidant enzyme, can be a prognostic marker of lung adenocarcinoma (LUAD). In the present study, we aimed to further investigate the relationship among the PRDX4 expression, epidermal growth factor receptor (EGFR) mutations and cell proliferation in LUAD. Methods: The expression of PRDX4 was immunohistochemically analyzed and the EGFR mutation status was examined in 127 paraffin-embedded human surgical specimens from patients with stage I LUAD. The PRDX4 expression was considered to be high when >40% of the adenocarcinoma cells were positively stained. In vitro, using plasmid transfection methods, PRDX4 plasmid DNAs were transfected into human lung adenocarcinoma cell lines, A549 (EGFR-wild) or PC-9 (EGFR mutant). The viability of these cells was analyzed using a Cell Counting Kit-8 kit. Results: The number of cases with high PRDX4 expression levels among patients with LUAD with EGFR mutations was significantly larger than that in patients with EGFR wild-type. The combination of the PRDX4 expression level with the EGFR mutation status was closely associated with the prognosis of patients with stage I LUAD. Viability assays showed that the proliferation of A549 cells was significantly suppressed after PRDX4 plasmid transfection, while the overexpression of PRDX4 had no effect on the proliferation of EGFR-mutant PC-9 cells. Conclusions: The PRDX4 expression and EGFR mutation status were significantly associated with the prognosis of patients with stage I LUAD, and EGFR mutations affected the role of PRDX4 in the proliferation of LUAD cells.
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Affiliation(s)
- Kenichi Mizutani
- Departments of Pathology and Laboratory Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Xin Guo
- Departments of Pathology and Laboratory Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Akihiro Shioya
- Departments of Pathology and Laboratory Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Jing Zhang
- Departments of Pathology and Laboratory Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Jianbo Zheng
- Departments of Pathology and Laboratory Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Nozomu Kurose
- Departments of Pathology and Laboratory Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Hiroaki Ishibashi
- Departments of Oral and Maxillofacial Surgery, Kanazawa Medical University, Ishikawa, Japan
| | - Nozomu Motono
- Departments of Thoracic Surgery, Kanazawa Medical University, Ishikawa, Japan
| | - Hidetaka Uramoto
- Departments of Thoracic Surgery, Kanazawa Medical University, Ishikawa, Japan
| | - Sohsuke Yamada
- Departments of Pathology and Laboratory Medicine, Kanazawa Medical University, Ishikawa, Japan
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Wolf A, Alpert N, Tran BV, Liu B, Flores R, Taioli E. Persistence of racial disparities in early-stage lung cancer treatment. J Thorac Cardiovasc Surg 2018; 157:1670-1679.e4. [PMID: 30685165 DOI: 10.1016/j.jtcvs.2018.11.108] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/02/2018] [Accepted: 11/28/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Although the incidence of lung cancer has decreased over the past decades, disparities in survival and treatment modalities have been observed for black and white patients with early-stage non-small cell lung cancer, despite the fact that surgical resection has been established as the standard of care. Possible contributors to these disparities are stage at diagnosis, comorbidities, socioeconomic factors, and patient preference. This study examines racial disparities in treatment, adjusting for clinicodemographic factors. METHODS The Surveillance, Epidemiology, and End Results-Medicare dataset was queried to identify patients diagnosed with primary stage I non-small cell lung cancer between 1992 and 2009. Multivariable logistic regressions were performed to assess the association between race and treatment modalities within 1 year of diagnosis, adjusted for clinical and demographic factors. Adjusted Cox proportional hazards models were performed to evaluate disparities in survival, accounting for mode of treatment. RESULTS We identified 22,724 patients; 21,230 (93.4%) white and 1494 (6.6%) black. Black patients were less likely to receive treatment (odds ratio [OR]adj, 0.62; 95% confidence interval [CI], 0.53-0.73) and less likely to receive surgery only when treated (ORadj, 0.70, 95% CI, 0.61-0.79). Although univariate survival for black patients was worse, when accounting for treatment mode, there was no difference in survival (hazard ratioadj, 0.97; 95% CI, 0.90-1.04 for all patients, hazard ratioadj, 0.98; 95% CI: 0.90-1.06 for treated patients). CONCLUSIONS Treatment disparities persist, even when adjusting for clinical and demographic factors. However, when black patients receive similar treatment, survival is comparable with white patients.
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Affiliation(s)
- Andrea Wolf
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Naomi Alpert
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Benjamin V Tran
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Bian Liu
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Raja Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Emanuela Taioli
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY.
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20
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Wang C, Li Y, Li Y, Gong H, Zhang H, Yuan Y, Li W, Liu H, Chen J. [Expression and Clinical Significance of LC-3 and P62
in Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:445-450. [PMID: 29945702 PMCID: PMC6022032 DOI: 10.3779/j.issn.1009-3419.2018.06.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND LC-3 and P62, two of important autophagy-related proteins, were reported highly expressed in many kinds of human malignancies and associated with outcomes of the patients. The purpose of this study was to investigate the expression status of LC-3 and P62 in non-small cell lung cancer patients and define the clinical-pathologic features. METHODS 66 cases of non-small cell lung cancer patients were employed. The expression of LC-3 and P62 were detected by immunohistochemistry. RESULTS LC-3 was positive stained in 27 out of 66 cases (40.9%) and P62 was positive stained in 43 out of 66 cases (65.2%). LC-3 positive staining was more frequently in squamous cell carcinoma patients (P<0.05); while P62 positive staining was more frequently in late-stage adenocarcinoma patients with metastasis (P<0.05). There was a significant negative correlation between LC-3 and P62 expressions in non-small cell lung cancer tissues (rs=-0.065, P<0.001). Kaplan-Meier analysis showed that patients with positive LC-3 expression had favorable clinical outcomes compared with the patients with negative LC-3 expression (P<0.05). CONCLUSIONS LC-3 and P62 showed abnormal expression in non-small cell lung cancer tissues, suggesting that autophagy is involved in the occurrence and development of NSCLC.
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Affiliation(s)
- Cong Wang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yongwen Li
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Ying Li
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Hao Gong
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Hongbing Zhang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yin Yuan
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Weiting Li
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Hongyu Liu
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Jun Chen
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
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Taioli E, Lieberman-Cribbin W, Rosenzweig S, van Gerwen MAG, Liu B, Flores RM. Early stage lung cancer survival after wedge resection and stereotactic body radiation. J Thorac Dis 2018; 10:5702-5713. [PMID: 30505478 PMCID: PMC6236177 DOI: 10.21037/jtd.2018.09.140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/21/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND The comparative effectiveness of stereotactic body radiation therapy (SBRT) and wedge resection in the treatment of early stage lung cancer is still under debate. This meta-analysis compares the 5-year overall survival (OS) of wedge resection and SBRT in patients with stage I non-small cell lung cancer (NSCLC). METHODS Original research articles published between 1995 and 2017 were identified through the National Library of Medicine and National Institutes of Health PubMed database and through the reference lists of reviewed articles. Data were processed and analyzed in R (version 3.4.2) and a summary estimate that accounted for the sample size of each study was calculated. The combined percent survival was calculated using random effect models. Funnel plots were used to assess publication bias. Heterogeneity was tested using the Q statistic and the I2 statistic. RESULTS There were 16 studies totaling 1,984 patients with stage I NSCLC treated with wedge resection. The meta-estimate was 74% (95% CI, 66-81%), with significant heterogeneity across studies (Q =172.46, P<0.0001; I2=91.30%). Thirty-six studies including 3,309 patients with stage I NSCLC treated with SBRT/SABR produced a meta-estimate of 44% (95% CI, 38-50%), with significant heterogeneity (Q =423.55, P<0.0001; I2=91.74%). Two articles directly comparing stage I NSCLC patients treated with wedge resection to patients treated with SBRT both reported higher 5-year OS after wedge resection. CONCLUSIONS SBRT is a treatment option reserved to medically inoperable patients, but could be an alternative to surgery in medically operable patients who prefer a less invasive treatment. More standardized methods for data collection and reporting are necessary to allow better comparisons across published studies.
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Affiliation(s)
- Emanuela Taioli
- Department of Population Health Science and Policy and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Wil Lieberman-Cribbin
- Department of Population Health Science and Policy and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shoshana Rosenzweig
- Department of Population Health Science and Policy and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maaike A. G. van Gerwen
- Department of Population Health Science and Policy and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bian Liu
- Department of Population Health Science and Policy and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raja M. Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Flores R, Taioli E, Yankelevitz DF, Becker BJ, Jirapatnakul A, Reeves A, Schwartz R, Yip R, Fevrier E, Tam K, Steiger B, Henschke CI, Flores R, Kaufman A, Lee DS, Nicastri D, Wolf A, Rosenzweig K, Gomez J, Beasley MB, Zakowski M, Chung M, Yankelevitz D, Henschke C, Futamura R, Kantor S, Wallace C, Bhora F, Raad W, Evans A, Choi W, Buyuk Z, Friedman A, Dreifuss R, Verzosa S, Yakubox M, Aloferdova K, Stacey P, De Nobrega S, Futamura R, Kantor S, Wallace C, Hakami A, Tam K, Wallace C, Pass H, Crawford B, Donnington J, Cooper B, Moreirea A, Sorensen A, Kohman L, Dunton R, Wallen J, Curtiss C, Scalzetti E, Ellinwood L, Aye R, Vallieres E, Louie B, Frivar A, Mehta V, Manning K, Chona M, Smith A, Connery CP, Torres E, Cruzer D, Gendron B, Alyea S, Lackaye D, Studer L, Flores R, Henschke C, Taioli E, Yankelevitz D, Becker B, Jirapatnakul A, Reeves A, Schwartz R, Yip R, Fevrier E, Tam K, Steiger B. Initiative for Early Lung Cancer Research on Treatment: Development of Study Design and Pilot Implementation. J Thorac Oncol 2018; 13:946-957. [DOI: 10.1016/j.jtho.2018.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 01/31/2018] [Accepted: 03/04/2018] [Indexed: 01/15/2023]
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Moon Y, Lee KY, Park JK. Prognosis After Sublobar Resection of Small-sized Non-small Cell Lung Cancer with Visceral Pleural or Lymphovascular Invasion. World J Surg 2018; 41:2769-2777. [PMID: 28597091 DOI: 10.1007/s00268-017-4075-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although standard surgical treatment of stage I non-small cell lung cancer (NSCLC) is lobectomy, sublobar resection may be elected for small-sized (≤2 cm) peripheral tumors. Our aim was examine the need for completion lobectomy in the event of confirmed pleural or lymphovascular invasion after sublobar resection of NSCLC. METHODS A total of 271 consecutive patients undergoing curative resection of stage I NSCLC ≤2 cm were reviewed retrospectively, analyzing clinicopathologic findings and survival times of those with invasion-positive (visceral pleural or lymphovascular invasion) or invasion-negative (neither visceral pleural nor lymphovascular invasion) tumors by surgical approach (sublobar resection vs lobectomy). RESULTS Aside from age and pulmonary function, clinicopathologic characteristics of the patient subsets did not differ significantly, nor did 5-year recurrence-free survival rates of surgical subsets (sublobar resection vs lobectomy) in respective tumor groups (invasion-positive 78.9 vs 79.8%, p = 0.928; invasion-negative 80.2 vs 85.4%, p = 0.505). In multivariate analysis, dissected lymph node count was the sole parameter significantly impacting recurrence of stage I invasion-positive NSCLC (hazard ratio = 0.914, 95% confidence interval 0.845-0.988; p = 0.023). Sublobar resection was not a risk factor for recurrence. CONCLUSIONS Survival rates for patients with small-sized (≤2 cm) NSCLC and visceral pleural or lymphovascular invasion did not differ significantly, whether sublobar resection or lobectomy was done. Hence, completion lobectomy is unnecessary in this setting.
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Affiliation(s)
- Youngkyu Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
| | - Kyo Young Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Kil Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
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Harrison S, Stiles B, Altorki N. What is the role of wedge resection for T1a lung cancer? J Thorac Dis 2018; 10:S1157-S1162. [PMID: 29785289 DOI: 10.21037/jtd.2018.03.188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Since 1995, lobar resection became the standard of care for medically fit patients with early stage lung cancer. This was based on the results of a single randomized trial comparing lobectomy and sublobar resection (SLR) in stage I lung cancer conducted by the lung cancer study group between 1982 and 1988. The conclusions of the study included a statistically significant tripling in loco-regional recurrence (LR) after limited resection but no difference between the two arms of the trial in systemic recurrence. Although both overall survival and cancer specific survival favored lobectomy, neither achieved statistical significance. Regardless, this landmark trial established lobectomy as the preferred oncological resection for early stage lung cancer. The practice of thoracic surgery has evolved significantly since the study period of the Lung Cancer Study Group, and this has led some surgeons to question its relevance to contemporary practice. The increased detection of smaller more precisely staged tumors combined with the rising segment of the population that is elderly with limited cardiopulmonary reserve has renewed interest in sub-lobar resection including wedge resection as either a definitive therapeutic strategy or as a compromise approach in patients with poor performance status. The interest in wedge resections is also to some extent further fueled by the emergence and increased utilization of competing technologies of local control such as stereotactic radiation or percutaneous and trans-bronchial ablative techniques. Although the results of the LCSG still cast a long shadow over the soundness of wedge resection as a cancer operation, much literature has been published in the subsequent years on this topic. We present in this review an overview of the conflicting data and offer our perspective on the role of wedge resection in early stage lung cancer.
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Affiliation(s)
- Sebron Harrison
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA.,Department of Cardiothoracic Surgery, New York-Presbyterian Brooklyn Methodist Hospital, New York, NY, USA
| | - Brendon Stiles
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Nasser Altorki
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
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Namkoong M, Moon Y, Park JK. Lobectomy versus Sublobar Resection in Non-Lepidic Small-Sized Non-Small Cell Lung Cancer. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 50:415-423. [PMID: 29234607 PMCID: PMC5716643 DOI: 10.5090/kjtcs.2017.50.6.415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/13/2017] [Accepted: 05/09/2017] [Indexed: 12/31/2022]
Abstract
Background Recently, many surgeons have chosen sublobar resection for the curative treatment of lung tumors with ground-glass opacity, which is a hallmark of lepidic lung cancer. The purpose of this study was to evaluate the oncological results of sublobar resection for non-lepidic lung cancer in comparison with lobectomy. Methods We conducted a retrospective chart review of 328 patients with clinical N0 non-small cell lung cancer sized ≤2 cm who underwent curative surgical resection from January 2009 to December 2014. The patients were classified on the basis of their lesions into non-lepidic and lepidic groups. The survival rates following lobectomy and sublobar resection were compared within each of these 2 groups. Results The non-lepidic group contained a total of 191 patients. The 5-year recurrence-free survival rate was not significantly different between patients who received sublobar resection or lobectomy in the non-lepidic group (80.1% vs. 79.2%, p=0.822) or in the lepidic group (100% vs. 97.4%, p=0.283). Multivariate analysis indicated that only lymphatic invasion was a significant risk factor for recurrence in the non-lepidic group. Sublobar resection was not a risk factor for recurrence in the non-lepidic group. Conclusion The oncological outcomes of sublobar resection and lobectomy in small-sized non-small cell lung cancer did not significantly differ according to histological type.
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Affiliation(s)
- Min Namkoong
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Youngkyu Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Jae Kil Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
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Abstract
The present study investigated and analyzed the clinical impact of sublobectomy on pulmonary functions.Changes in pulmonary function before and after sublobectomy were compared to the changes after lobectomy.Changes in the pulmonary function before and after sublobectomy and lobectomy did not exhibit remarkable differences in long-term effects. Surgery-related indexes of the sublobectomy group were significantly lower than those of the lobectomy group (P < .05). The indexes of pulmonary function both before and after surgery in the sublobectomy group were not associated with a significant decrease in the quality of survival based on pulmonary function as the main index (P > .05).Compared with lobectomy, sublobectomy maximally retained the normal healthy pulmonary tissue, with similar local recurrence rate, 5-year recurrence-free survival rate, and 5-year survival rate. Sublobectomy decreased the impact on respiratory functions to the minimum. After the operation, the quality of survival with pulmonary functions as the main index did not decrease significantly. Therefore, sublobectomy could be an appropriate choice for elderly patients with poor cardiopulmonary function or with chronic diseases.
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Moon Y, Lee KY, Park JK. Margin Width of Resected Lepidic Lung Cancer Does Not Affect Recurrence After Sublobar Resection. World J Surg 2017; 42:1449-1457. [DOI: 10.1007/s00268-017-4291-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Wolf AS, Swanson SJ, Yip R, Liu B, Tarras ES, Yankelevitz DF, Henschke CI, Taioli E, Flores RM. The Impact of Margins on Outcomes After Wedge Resection for Stage I Non-Small Cell Lung Cancer. Ann Thorac Surg 2017; 104:1171-1178. [PMID: 28669499 DOI: 10.1016/j.athoracsur.2017.04.024] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 04/02/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The relationship between margin distance and recurrence and survival for stage I non-small cell lung carcinoma (NSCLC) less than or equal to 2 cm is not clear. METHODS Patient clinicopathologic data were reviewed from a pooled data set of stage I NSCLC lesions less than or equal to 2 cm resected by wedge resection at Brigham and Women's Hospital (BWH) between 2000 and 2005 and the International Early Lung and Cardiac Action Program (I-ELCAP) between 1999 and 2015. Multivariable models were constructed to evaluate the relationship between margin distance and recurrence and survival, adjusting for patient age, sex, tumor size, and histologic type. Optimal margin distance was determined for recurrence-free and overall survival using maximum χ2 values among survival distributions. RESULTS Of 182 cases, 138 tumors had margin distance reported (113 BWH and 25 I-ELCAP). The average tumor size was 13.3 mm, and margin distance was 8.3 mm. During a mean follow-up of 49.6 months, there were 33 recurrences and 59 deaths. Increased margin distance was independently associated with lower risk of recurrence (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.83-0.98). Margin distance was also independently associated with longer survival (hazard ratio [HR], 0.94; 95% CI, 0.90-0.98). A margin distance greater than 9 mm was associated with longest recurrence-free survival and a margin distance greater than 11 mm was associated with longest overall survival. CONCLUSIONS Increased margin distance was independently associated with lower risk of recurrence and longer overall survival in patients undergoing wedge resection for NSCLC tumors less than or equal to 2 cm. These findings suggest that with a minimum appropriate margin distance, wedge resection may yield outcomes comparable to those of lobectomy.
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Affiliation(s)
- Andrea S Wolf
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Scott J Swanson
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bian Liu
- Department of Population Health Science and Policy and Institute of Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Elizabeth S Tarras
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Emanuela Taioli
- Department of Population Health Science and Policy and Institute of Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Raja M Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Date H. Revisiting Ginsberg and Rubinstein's study. J Thorac Cardiovasc Surg 2017. [PMID: 28625774 DOI: 10.1016/j.jtcvs.2017.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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Computed Tomography Screening for Lung Cancer: Mediastinal Lymph Node Resection in Stage IA Nonsmall Cell Lung Cancer Manifesting as Subsolid and Solid Nodules. Ann Surg 2017; 265:1025-1033. [PMID: 27232256 DOI: 10.1097/sla.0000000000001802] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare long-term survival rates of patients with first, primary, clinical stage IA nonsmall cell lung cancer from a large cohort undergoing computed tomography screening with and without mediastinal lymph node resection (MLNR) under an Institutional Review Board-approved common protocol from 1992 to 2014. BACKGROUND Assessing survival differences of patients with and without MLNR manifesting as solid and subsolid nodules. METHODS Long-term Kaplan-Meier (K-M) survival rates for those with and without MLNR were compared and Cox regression analyses were used to adjust for demographic, computed tomography, and surgical covariates. RESULTS The long-term K-M rates for 462 with and 145 without MLNR was 92% versus 96% (P = 0.19), respectively. For 203 patients with a subsolid nodule, 151 with and 52 without MLNR, the rate was 100%. For the 404 patients with a solid nodule, 311 with and 93 without MLNR, the rate was 87% versus 94% (P = 0.24) and Cox regression showed no statistically significant difference (P = 0.28) when adjusted for all covariates. Risk of dying increased significantly with increasing decades of age (hazard ratio [HR] 2.3, 95% confidence interval [CI] 1.4-3.8), centrally located tumor (HR 2.5, 95% CI 1.2-5.2), tumor size 21 to 30 mm (HR 2.7, 95% CI 1.2-6.0), and invasion beyond the lung stroma (HR 3.0, 95% CI 1.4-6.1). For the 346 patients with MLNR, tumor size was 20 mm or less; K-M rates for the 269 patients with and 169 patients without MLNR were also not significantly different (HR 2.1, P = 0.24). CONCLUSIONS It is not mandatory to perform MLNR when screen-diagnosed nonsmall cell lung cancer manifests as a subsolid nodule.
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Lieberman-Cribbin W, Liu B, Leoncini E, Flores R, Taioli E. Temporal trends in centralization and racial disparities in utilization of high-volume hospitals for lung cancer surgery. Medicine (Baltimore) 2017; 96:e6573. [PMID: 28422849 PMCID: PMC5406065 DOI: 10.1097/md.0000000000006573] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Racial disparities have been suggested in hospital utilization and outcome for lung cancer surgery, but the effect of hospital centralization on closing this gap is unknown. We hypothesized that centralization has increased the utilization of high- or very-high-volume (HV/VHV) hospitals, a proxy for access to high-quality care, over the study period independently from race.Inpatient records were extracted from the New York Statewide Planning and Research Cooperative System database (1995-2012) according to Clinical Modification of the International Classification of Diseases, 9th Revision diagnosis codes 162.* and 165.* and surgical procedure codes 32.2-32.6 (n = 31,931). Patients treated exclusively with surgery of black or white race with a valid zip code were included. Logistic models were performed to determine factors associated with utilization of HV/VHV or low- or very-low-volume (LV/VLV) hospitals; these models were subsequently stratified by race.The percentage of both black and white patients utilizing HV/VHV hospitals increased over the study period (+22.7% and 13.9%, respectively). The distance to the nearest HV/VHV hospital and patient-hospital distance were significantly lower in black compared to white patients, however, blacks were consistently less likely to use HV/VHV than whites (odds ratioadj: 0.26; 95% confidence interval: 0.23-0.29), and were significantly more likely to utilize urban, teaching, and lower volume hospitals than whites. Likelihood of HV/VHV utilization decreased with an increasing distance from a HV/VHV hospital, overall and separately for black and white patients.Although centralization has increased the utilization of HV/VHV for both black and white patients, racial differences in access and utilization of HV hospitals persisted.
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Affiliation(s)
- Wil Lieberman-Cribbin
- Department of Population Health Science and Policy and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Bian Liu
- Department of Population Health Science and Policy and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Emanuele Leoncini
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Raja Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Emanuela Taioli
- Department of Population Health Science and Policy and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY
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Wang J, Zhao H. [Issues Need to be Considered in Sublobectomy for Early Stage Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 19:351-4. [PMID: 27335295 PMCID: PMC6015199 DOI: 10.3779/j.issn.1009-3419.2016.06.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
随着医学技术的进步,早期肺癌患者数量逐年增加,亚肺叶切除治疗在早期肺癌个体化治疗的价值逐渐受到重视。目前,在早期肺癌的术式选择上,肺叶切除和亚肺叶切除孰优孰劣尚存在一些争议。本文就当前亚肺叶切除治疗早期肺癌的下述争议点进行了总结:①循证医学证据;②楔形和肺段的适应症选择;③肿瘤直径和切缘距离的权重比较;④老年人的术式选择。
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Affiliation(s)
- Jun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Hui Zhao
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
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Moon Y, Sung SW, Moon SW, Park JK. Risk factors for recurrence after sublobar resection in patients with small (2 cm or less) non-small cell lung cancer presenting as a solid-predominant tumor on chest computed tomography. J Thorac Dis 2016; 8:2018-26. [PMID: 27621855 DOI: 10.21037/jtd.2016.07.90] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Sublobar resection is considered controversial for non-small cell lung cancer (NSCLC) presenting as a solid-predominant nodule. The aim of this study was to identify risk factors related to recurrence in small-sized NSCLC presenting as a solid-predominant nodule. METHODS We conducted a retrospective chart review of 118 patients who were treated for clinical N0 NSCLC sized ≤2 cm and who underwent sublobar resection with clear resection margins. We assigned them to two groups according to radiologic features: ground glass opacity (GGO)-predominant tumor and solid-predominant tumor. Clinicopathological characteristics and survival were analyzed in both groups. Risk factors for recurrence were analyzed in the solid-predominant tumor group. RESULTS Seventy-three patients had a GGO-predominant tumor, and 45 patients had a solid-predominant tumor. Five-year recurrence-free survival (RFS) in the solid-predominant tumor and GGO-predominant tumor groups was 64.9% and 95.5%, respectively. A multivariate analysis was performed to determine factors associated with recurrence after sublobar resection in the solid-predominant tumor group; it indicated that SUVmax [hazard ratio (HR) =1.482, 95% confidence interval (CI): 1.123-1.956, P=0.005] and histologic types other than adenocarcinoma (squamous cell carcinoma, HR =8.789, 95% CI: 1.572-49.134, P=0.013; other types, HR =53.569, 95% CI: 2.616-1096.849, P=0.010) were significant risk factors for recurrence. CONCLUSIONS Risk factors in solid-predominant tumors sized ≤2 cm after sublobar resection are a high SUVmax and histologic types other than adenocarcinoma. Thus, lobectomy should be considered for solid-predominant NSCLC sized ≤2 cm with a high SUVmax or non-adenocarcinoma types.
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Affiliation(s)
- Youngkyu Moon
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sook Whan Sung
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok Whan Moon
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Kil Park
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Taioli E, Flores R. Appropriateness of Surgical Approach in Black Patients with Lung Cancer-15 Years Later, Little Has Changed. J Thorac Oncol 2016; 12:573-577. [PMID: 27544057 DOI: 10.1016/j.jtho.2016.08.119] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/05/2016] [Accepted: 08/06/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Black patients with lung cancer receive an operation less often and have worse survival than white patients. Over the past several decades limited resection has become an acceptable alternative to lobectomy in selected cases, and mediastinal lymph node staging is recommended. The Surveillance, Epidemiology, and End Results database was explored to assess whether the type of surgical approach is similar in black and white patients with lung cancer. METHODS All cases of pathologically proven lung cancers within the site code International Classification of Diseases for Oncology, Third Edition, C340 to C349 (67,191 whites and 13,387 blacks), age 64 years or younger, diagnosed between 2007 and 2012 were identified. The odds of treatment (operation or radiation) in blacks versus whites were calculated using multivariable logistic regression, with race as the dependent variable, overall and by disease stage. RESULTS Surgical treatment was significantly less likely to be administered to black patients than to white patients overall (ORadjusted [ORadj] = 0.69, 95% confidence interval [CI]: 0.65-0.74) and according to stage. Opposite results were observed when radiation was analyzed (ORadj = 1.1, 95% CI: 1.04-1.12). Stratification by age groups (≤50 years versus >50 years) or insurance status did not influence the results. Among those who underwent a surgical procedure, black patients were less likely to have their lymph nodes resected overall (ORadj = 0.79, 95% CI: 0.7-0.89) and according to stage. CONCLUSIONS Racial disparities in appropriate lung cancer treatment are still observed independently from insurance status.
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Affiliation(s)
- Emanuela Taioli
- Department of Population Health Science and Policy and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Raja Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Therapeutic strategy for small-sized lung cancer. Gen Thorac Cardiovasc Surg 2016; 64:450-6. [PMID: 27300350 DOI: 10.1007/s11748-016-0676-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 06/03/2016] [Indexed: 12/19/2022]
Abstract
Minimizing the volume of lung resection without diminishing curability has recently become an important issue in primary lung cancer. In this review, we will discuss the current state of the feasibility of sublobar resection and specific issues for a segmentectomy procedure. A previous randomized controlled trial showed that lobectomy must still be considered the standard surgical procedure compared with sublobar resection for T1N0 non-small cell lung cancer with a tumor less than 3 cm in size. Since then, supporting studies for segmentectomy of lung cancer with a tumor less than 2 cm in size were reported. In addition, segmentectomy seems to be feasible for clinical stage I adenocarcinoma less than 2 cm in size, in women younger than 70 years old, with a low tumor 18F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) standardized uptake value (SUV) from propensity-matching studies. In a meta-analysis of sublobar resection vs. lobectomy, intentionally performed sublobar resection showed equivalent outcomes to lobectomy. In the near future, two ongoing prospective, randomized trials will report results. As specific issues for the surgical procedure of segmentectomy, achieving a sufficient surgical margin is an important issue for preventing loco-regional recurrence. More studies regarding the regional lymph node dissection area for segmentectomy are needed. Sublobar resection has the potential to become the standard procedure for peripheral small-sized lung cancer less than 2 cm. However, more information is needed about the characteristics of this cancer and the surgical procedure, including nodal dissection.
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Al-Ayoubi AM, Flores RM. Management of CT screen-detected lung nodule: the thoracic surgeon perspective. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:156. [PMID: 27195274 DOI: 10.21037/atm.2016.03.49] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Implementation of lung cancer CT screening programs will increase the incidence of pulmonary nodules and require multidisciplinary efforts for devising appropriate treatment plans. The role of the thoracic surgeon is paramount in leading the discussion and shaping the treatment strategies. Management of CT screen-detected lung nodules differ from conventional lung cancer nodules given their smaller size, varied histologies and potentially indolent growth. Here we present a brief overview of the thoracic surgeon's perspective on the clinical evaluation, diagnostic tests and surgical approach to these nodules in the setting of a comprehensive lung cancer screening program.
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Affiliation(s)
- Adnan M Al-Ayoubi
- Department of Thoracic Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raja M Flores
- Department of Thoracic Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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