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Rodriguez-Quintero JH, Ghanie A, Jindani R, Kamel MK, Zhu R, Vimolratana M, Chudgar NP, Stiles BM. Pneumonectomy for non-small cell lung cancer. A National Cancer Database analysis of geographic and temporal trends, outcomes, and associated factors. Surgery 2024; 176:918-926. [PMID: 38965005 DOI: 10.1016/j.surg.2024.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/02/2024] [Accepted: 05/20/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND The circumstances under which pneumonectomy should be performed are controversial. This study aims to investigate national trends in pneumonectomy use to determine which patients, in what geographic areas, and under what clinical circumstances pneumonectomy is performed in the United States. METHODS We queried the National Cancer Database and included all patients undergoing anatomic surgical resection for non-small cell lung cancer (2015-2020). The association between demographic and clinical factors and the use of pneumonectomy were investigated. RESULTS Who: A total of 128,421 patients were identified, of whom 738 (0.6%) underwent pneumonectomy. Those patients were younger (median 65 vs 68 years, P < .001), more often male (59.9% vs 44.9%, P < .001), more likely to be below median income level (44.2% vs 38.6%, P = .002), and more likely to have lower education indicators (53% vs 48.6%, P = .02) than those who underwent other anatomic resections. Notably, there was a decreasing trend in pneumonectomy use during the study period (0.9% down to 0.4%, P < .001). Where: Patients undergoing pneumonectomy were less likely to live in metropolitan areas (77.9% vs 81.7%, P = .008) and to live closer (<12 miles) to their treating facility (45% vs 49%, P = .02). Regional geographic differences also were identified (P < .001). Why: Patients who underwent pneumonectomy were more likely to have received neoadjuvant therapy (20.6% vs 5.3%, P < .001), to be clinically N (+) (39.3% vs 12.3%, P < .001), and to have more advanced tumors (cT3-4: 46.3% vs 11.3%, P < .001). CONCLUSION Although primarily driven by advanced oncologic features, socioeconomic and geographic factors also were associated independently with the use of pneumonectomy. Standardizing pneumonectomy indications nationwide is crucial to prevent widening outcome gaps for patients with lung cancer.
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Affiliation(s)
- Jorge Humberto Rodriguez-Quintero
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. https://www.twitter.com/huroqu90
| | - Amanda Ghanie
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Rajika Jindani
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Mohamed K Kamel
- Department of Cardiothoracic Surgery, University of Rochester Medical Center, NY
| | - Roger Zhu
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Marc Vimolratana
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Neel P Chudgar
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Brendon M Stiles
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
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Edwards DM, Pirzadeh M, Van T, Jiang R, Tate A, Schaefer G, James J, Bishop C, Wilson C, Nedzesky N, Alseri A, Leveque A, Malus A, Waljee A, Elliott DA, Deng J, Schwartz A, Schipper M, Bryant AK, Ramnath N, Green MD. Impact of lung cancer screening on stage migration and mortality among the national Veterans Health Administration population with lung cancer. Cancer 2024; 130:2910-2917. [PMID: 38853532 DOI: 10.1002/cncr.35340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/22/2024] [Accepted: 03/27/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Despite randomized trials demonstrating a mortality benefit to low-dose computed tomography screening to detect lung cancer, uptake of lung cancer screening (LCS) has been slow, and the benefits of screening remain unclear in clinical practice. METHODS This study aimed to assess the impact of screening among patients in the Veterans Health Administration (VA) health care system diagnosed with lung cancer between 2011 and 2018. Lung cancer stage at diagnosis, lung cancer-specific survival, and overall survival between patients with cancer who did and did not receive screening before diagnosis were evaluated. We used Cox regression modeling and inverse propensity weighting analyses with lead time bias adjustment to correlate LCS exposure with patient outcomes. RESULTS Of 57,919 individuals diagnosed with lung cancer in the VA system between 2011 and 2018, 2167 (3.9%) underwent screening before diagnosis. Patients with screening had higher rates of stage I diagnoses (52% vs. 27%; p ≤ .0001) compared to those who had no screening. Screened patients had improved 5-year overall survival rates (50.2% vs. 27.9%) and 5-year lung cancer-specific survival (59.0% vs. 29.7%) compared to unscreened patients. Among screening-eligible patients who underwent National Comprehensive Cancer Network guideline-concordant treatment, screening resulted in substantial reductions in all-cause mortality (adjusted hazard ratio [aHR], 0.79; 95% confidence interval [CI], 0.67-0.92; p = .003) and lung-specific mortality (aHR, 0.61; 95% CI, 0.50-0.74; p < .001). CONCLUSIONS While LCS uptake remains limited, screening was associated with earlier stage diagnoses and improved survival. This large national study corroborates the value of LCS in clinical practice; efforts to widely adopt this vital intervention are needed.
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Affiliation(s)
- Donna M Edwards
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Radiation Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Mina Pirzadeh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Division of Pulmonary and Critical Care, Department of Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Tony Van
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Ralph Jiang
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Akshay Tate
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Grace Schaefer
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jadyn James
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Caroline Bishop
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Cydnee Wilson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas Nedzesky
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Aaren Alseri
- Department of Radiology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Anthony Leveque
- Section of Hematology Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Amanda Malus
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Akbar Waljee
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - David A Elliott
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Radiation Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Jane Deng
- Division of Pulmonary and Critical Care, Department of Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Program in Immunology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ann Schwartz
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Matthew Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Alex K Bryant
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Radiation Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Nithya Ramnath
- Section of Hematology Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
- Division of Hematology Oncology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael D Green
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Radiation Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
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Hsin-Hung C, En-Kuei T, Yun-Ju W, Fu-Zong W. Impact of annual trend volume of low-dose computed tomography for lung cancer screening on overdiagnosis, overmanagement, and gender disparities. Cancer Imaging 2024; 24:73. [PMID: 38867342 PMCID: PMC11170916 DOI: 10.1186/s40644-024-00716-5] [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: 03/21/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND With the increasing prevalence of nonsmoking-related lung cancer in Asia, Asian countries have increasingly adopted low-dose computed tomography (LDCT) for lung cancer screening, particularly in private screening programs. This study examined how annual LDCT volume affects lung cancer stage distribution, overdiagnosis, and gender disparities using a hospital-based lung cancer database. METHODS This study analyzed the annual utilized LDCT volume, clinical characteristics of lung cancer, stage shift distribution, and potential overdiagnosis. At the individual level, this study also investigated the relationship between stage 0 lung cancer (potential strict definition regarding overdiagnosis) and the clinical characteristics of lung cancer. RESULTS This study reviewed the annual trend of 4971 confirmed lung cancer cases from 2008 to 2021 and conducted a link analysis with an LDCT imaging examination database over these years. As the volume of lung cancer screenings has increased over the years, the number and proportion of stage 0 lung cancers have increased proportionally. Our study revealed that the incidence of stage 0 lung cancer increased with increasing LDCT scan volume, particularly during the peak growth period from 2017 to 2020. Conversely, stage 4 lung cancer cases remained consistent across different time intervals. Furthermore, the increase in the lung cancer screening volume had a more pronounced effect on the increase in stage 0 lung cancer cases among females than it had among males. The estimated potential for overdiagnosis brought about by the screening process, compared to non-participating individuals, ranged from an odds ratio of 7.617 to one of 17.114. Both strict and lenient definitions of overdiagnosis (evaluating cases of stage 0 lung cancer and stages 0 to 1 lung cancer) were employed. CONCLUSIONS These results provide population-level evidence of potential lung cancer overdiagnosis in the Taiwanese population due to the growing use of LDCT screening, particularly concerning the strict definition of stage 0 lung cancer. The impact was greater in the female population than in the male population, especially among females younger than 40 years. To improve lung cancer screening in Asian populations, creating risk-based prediction models for smokers and nonsmokers, along with gender-specific strategies, is vital for ensuring survival benefits and minimizing overdiagnosis.
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Affiliation(s)
- Chen Hsin-Hung
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, 813414, Taiwan
| | - Tang En-Kuei
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, 813414, Taiwan
| | - Wu Yun-Ju
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wu Fu-Zong
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Faculty of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Xu X, Du L, Yin D. Dual-branch feature fusion S3D V-Net network for lung nodules segmentation. J Appl Clin Med Phys 2024; 25:e14331. [PMID: 38478388 PMCID: PMC11163502 DOI: 10.1002/acm2.14331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/01/2024] [Accepted: 03/04/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Accurate segmentation of lung nodules can help doctors get more accurate results and protocols in early lung cancer diagnosis and treatment planning, so that patients can be better detected and treated at an early stage, and the mortality rate of lung cancer can be reduced. PURPOSE Currently, the improvement of lung nodule segmentation accuracy has been limited by his heterogeneous performance in the lungs, the imbalance between segmentation targets and background pixels, and other factors. We propose a new 2.5D lung nodule segmentation network model for lung nodule segmentation. This network model can well improve the extraction of edge information of lung nodules, and fuses intra-slice and inter-slice features, which makes good use of the three-dimensional structural information of lung nodules and can more effectively improve the accuracy of lung nodule segmentation. METHODS Our approach is based on a typical encoding-decoding network structure for improvement. The improved model captures the features of multiple nodules in both 3-D and 2-D CT images, complements the information of the segmentation target's features and enhances the texture features at the edges of the pulmonary nodules through the dual-branch feature fusion module (DFFM) and the reverse attention context module (RACM), and employs central pooling instead of the maximal pooling operation, which is used to preserve the features around the target and to eliminate the edge-irrelevant features, to further improve the performance of the segmentation of the pulmonary nodules. RESULTS We evaluated this method on a wide range of 1186 nodules from the LUNA16 dataset, and averaging the results of ten cross-validated, the proposed method achieved the mean dice similarity coefficient (mDSC) of 84.57%, the mean overlapping error (mOE) of 18.73% and average processing of a case is about 2.07 s. Moreover, our results were compared with inter-radiologist agreement on the LUNA16 dataset, and the average difference was 0.74%. CONCLUSION The experimental results show that our method improves the accuracy of pulmonary nodules segmentation and also takes less time than more 3-D segmentation methods in terms of time.
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Affiliation(s)
- Xiaoru Xu
- School of Automation and Information EngineeringSichuan University of Science and EngineeringZigongPeople's Republic of China
- Artificial Intelligence Key Laboratory of Sichuan Province, Sichuan University of Science & EngineeringZigongPeople's Republic of China
| | - Lingyan Du
- School of Automation and Information EngineeringSichuan University of Science and EngineeringZigongPeople's Republic of China
- Artificial Intelligence Key Laboratory of Sichuan Province, Sichuan University of Science & EngineeringZigongPeople's Republic of China
| | - Dongsheng Yin
- School of Automation and Information EngineeringSichuan University of Science and EngineeringZigongPeople's Republic of China
- Artificial Intelligence Key Laboratory of Sichuan Province, Sichuan University of Science & EngineeringZigongPeople's Republic of China
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Udelsman BV, Detterbeck F, Tanoue L, Mase V, Boffa D, Blasberg J, Dhanasopon A, Ely S, Mazzarelli LJ, Bader A, Woodard G. Impact of the COVID-19 Pandemic on Lung Cancer Screening Processes in a Northeast Tertiary Health Care Network. J Comput Assist Tomogr 2024; 48:222-225. [PMID: 37832536 DOI: 10.1097/rct.0000000000001549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
ABSTRACT The coronavirus disease 2019 (COVID-19) pandemic disrupted health care systems, including implementation of lung cancer screening programs. The impact and recovery from this disruption on screening processes is not well appreciated. Herein, the radiology database of a Northeast tertiary health care network was reviewed before and during the pandemic (2013-2022). In the 3 months before the pandemic, an average of 77.3 lung cancer screening with computed tomography scans (LCS-CT) were performed per month. The average dropped to 23.3 between April and June of 2020, whereas COVID-19 hospitalizations peaked at 1604. By July, average hospitalizations dropped to 50, and LCS-CTs rose to >110 per month for the remaining year. LCS-CTs did not decline during COVID-19 surges in December of 2021 and 2022. The LCS-CT performance grew by 4.5% in 2020, 69.6% in 2021, and 27.0% in 2022, exceeding projected growth by 722 examinations. This resiliency indicates a potentially smaller impact of COVID-19 on lung cancer diagnoses than initially feared.
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Affiliation(s)
- Brooks V Udelsman
- From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Frank Detterbeck
- From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Lynn Tanoue
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Vincent Mase
- From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Daniel Boffa
- From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Justin Blasberg
- From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Andrew Dhanasopon
- From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Sora Ely
- From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | | | - Anna Bader
- Department of Radiology, Yale University School of Medicine, New Haven, CT
| | - Gavitt Woodard
- From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
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6
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Lim WH, Lee KH, Lee JH, Park H, Nam JG, Hwang EJ, Chung JH, Goo JM, Park S, Kim YT, Kim H. Diagnostic performance and prognostic value of CT-defined visceral pleural invasion in early-stage lung adenocarcinomas. Eur Radiol 2024; 34:1934-1945. [PMID: 37658899 DOI: 10.1007/s00330-023-10204-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/07/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVES To analyze the diagnostic performance and prognostic value of CT-defined visceral pleural invasion (CT-VPI) in early-stage lung adenocarcinomas. METHODS Among patients with clinical stage I lung adenocarcinomas, half of patients were randomly selected for a diagnostic study, in which five thoracic radiologists determined the presence of CT-VPI. Probabilities for CT-VPI were obtained using deep learning (DL). Areas under the receiver operating characteristic curve (AUCs) and binary diagnostic measures were calculated and compared. Inter-rater agreement was assessed. For all patients, the prognostic value of CT-VPI by two radiologists and DL (using high-sensitivity and high-specificity cutoffs) was investigated using Cox regression. RESULTS In 681 patients (median age, 65 years [interquartile range, 58-71]; 382 women), pathologic VPI was positive in 130 patients. For the diagnostic study (n = 339), the pooled AUC of five radiologists was similar to that of DL (0.78 vs. 0.79; p = 0.76). The binary diagnostic performance of radiologists was variable (sensitivity, 45.3-71.9%; specificity, 71.6-88.7%). Inter-rater agreement was moderate (weighted Fleiss κ, 0.51; 95%CI: 0.43-0.55). For overall survival (n = 680), CT-VPI by radiologists (adjusted hazard ratio [HR], 1.27 and 0.99; 95%CI: 0.84-1.92 and 0.63-1.56; p = 0.26 and 0.97) or DL (HR, 1.44 and 1.06; 95%CI: 0.86-2.42 and 0.67-1.68; p = 0.17 and 0.80) was not prognostic. CT-VPI by an attending radiologist was prognostic only in radiologically solid tumors (HR, 1.82; 95%CI: 1.07-3.07; p = 0.03). CONCLUSION The diagnostic performance and prognostic value of CT-VPI are limited in clinical stage I lung adenocarcinomas. This feature may be applied for radiologically solid tumors, but substantial reader variability should be overcome. CLINICAL RELEVANCE STATEMENT Although the diagnostic performance and prognostic value of CT-VPI are limited in clinical stage I lung adenocarcinomas, this parameter may be applied for radiologically solid tumors with appropriate caution regarding inter-reader variability. KEY POINTS • Use of CT-defined visceral pleural invasion in clinical staging should be cautious, because prognostic value of CT-defined visceral pleural invasion remains unexplored. • Diagnostic performance and prognostic value of CT-defined visceral pleural invasion varied among radiologists and deep learning. • Role of CT-defined visceral pleural invasion in clinical staging may be limited to radiologically solid tumors.
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Affiliation(s)
- Woo Hyeon Lim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Kyung Hee Lee
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-Do, Korea
| | - Jong Hyuk Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Hyungin Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Ju Gang Nam
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Eui Jin Hwang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - Jin-Haeng Chung
- Department of Pathology and Translational Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-Do, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
- Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Young Tae Kim
- Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hyungjin Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea.
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Neslund-Dudas C, Tang A, Alleman E, Zarins KR, Li P, Simoff MJ, Lafata JE, Rendle KA, Hartman ANB, Honda SA, Oshiro C, Olaiya O, Greenlee RT, Vachani A, Ritzwoller DP. Uptake of Lung Cancer Screening CT After a Provider Order for Screening in the PROSPR-Lung Consortium. J Gen Intern Med 2024; 39:186-194. [PMID: 37783984 PMCID: PMC10853157 DOI: 10.1007/s11606-023-08408-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/31/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Uptake of lung cancer screening (LCS) has been slow with less than 20% of eligible people who currently or formerly smoked reported to have undergone a screening CT. OBJECTIVE To determine individual-, health system-, and neighborhood-level factors associated with LCS uptake after a provider order for screening. DESIGN AND SUBJECTS We conducted an observational cohort study of screening-eligible patients within the Population-based Research to Optimize the Screening Process (PROSPR)-Lung Consortium who received a radiology referral/order for a baseline low-dose screening CT (LDCT) from a healthcare provider between January 1, 2015, and June 30, 2019. MAIN MEASURES The primary outcome is screening uptake, defined as LCS-LDCT completion within 90 days of the screening order date. KEY RESULTS During the study period, 18,294 patients received their first order for LCS-LDCT. Orders more than doubled from the beginning to the end of the study period. Overall, 60% of patients completed screening after receiving their first LCS-LDCT order. Across health systems, uptake varied from 41 to 87%. In both univariate and multivariable analyses, older age, male sex, former smoking status, COPD, and receiving care in a centralized LCS program were positively associated with completing LCS-LDCT. Unknown insurance status, other or unknown race, and lower neighborhood socioeconomic status, as measured by the Yost Index, were negatively associated with screening uptake. CONCLUSIONS Overall, 40% of patients referred for LCS did not complete a LDCT within 90 days, highlighting a substantial gap in the lung screening care pathway, particularly in decentralized screening programs.
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Affiliation(s)
- Christine Neslund-Dudas
- Henry Ford Health System and Henry Ford Cancer Institute, Detroit, MI, USA.
- Department of Public Health Sciences, Henry Ford Health System, One Ford Place, Suite 3E, Detroit, MI, 48202, USA.
| | - Amy Tang
- Henry Ford Health System and Henry Ford Cancer Institute, Detroit, MI, USA
| | - Elizabeth Alleman
- Henry Ford Health System and Henry Ford Cancer Institute, Detroit, MI, USA
| | - Katie R Zarins
- Henry Ford Health System and Henry Ford Cancer Institute, Detroit, MI, USA
| | - Pin Li
- Henry Ford Health System and Henry Ford Cancer Institute, Detroit, MI, USA
| | - Michael J Simoff
- Henry Ford Health System and Henry Ford Cancer Institute, Detroit, MI, USA
| | - Jennifer Elston Lafata
- Henry Ford Health System and Henry Ford Cancer Institute, Detroit, MI, USA
- UNC Eshelman School of Pharmacy and Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Katharine A Rendle
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Stacey A Honda
- Center for Integrated Healthcare Research, Kaiser Permanente Hawaii, Honolulu, HI, USA
- Hawaii Permanente Medical Group, Honolulu, HI, USA
| | - Caryn Oshiro
- Center for Integrated Healthcare Research, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | | | | | - Anil Vachani
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
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8
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Zhou Y, Xiang Z, Lin W, Lin J, Wen Y, Wu L, Ma J, Chen C. Long-term trends of lung cancer incidence and survival in southeastern China, 2011-2020: a population-based study. BMC Pulm Med 2024; 24:25. [PMID: 38200537 PMCID: PMC10782768 DOI: 10.1186/s12890-024-02841-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Lung cancer is the primary cause of cancer-related deaths in China. This study analysed the incidence and survival trends of lung cancer from 2011 to 2020 in Fujian Province, southeast of China, and provided basis for formulating prevention and treatment strategies. METHODS The population-based cancer data was used to analyse the incidence of lung cancer between 2011 and 2020, which were stratified by sex, age and histology. The change of incidence trend was analysed using Joinpoint regression. The relative survival of lung cancer with onset in 2011-2014, 2015-2017 and 2018-2020 were calculated using the cohort, complete and period methods, respectively. RESULTS There were 23,043 patients diagnosed with lung cancer in seven registries between 2011 and 2020, with an age-standardized incidence rate (ASIR) of 37.7/100,000. The males ASIR increased from 51.1/100,000 to 60.5/100,000 with an annual percentage change (APC) of 1.5%. However, females ASIR increased faster than males, with an APC of 5.7% in 2011-2017 and 21.0% in 2017-2020. Compared with 2011, the average onset age of males and females in 2020 was 1.5 years and 5.9 years earlier, respectively. Moreover, the proportion of adenocarcinoma has increased, while squamous cell carcinoma and small cell carcinoma have decreased over the past decade. The 5-year relative survival of lung cancer increased from 13.8 to 23.7%, with a greater average increase in females than males (8.7% and 2.6%). The 5-year relative survival of adenocarcinoma, squamous cell carcinoma and small cell carcinoma reached 47.1%, 18.3% and 6.9% in 2018-2020, respectively. CONCLUSIONS The incidence of lung cancer in Fujian Province is on the rise, with a significant rise in adenocarcinoma, a younger age of onset and the possibility of overdiagnosis. Thus, Fujian Province should strengthen the prevention and control of lung cancer, giving more attention to the prevention and treatment of lung cancer in females and young populations.
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Affiliation(s)
- Yan Zhou
- Department of Epidemiology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, 350014, Fuzhou, China
- Fujian Key Laboratory of Advanced Technology for Cancer Screening and Early Diagnosis, 350014, Fuzhou, China
| | - Zhisheng Xiang
- Department of Epidemiology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, 350014, Fuzhou, China
| | - Weikai Lin
- Department of Thoracic Surgery, The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, 350003, Fuzhou, China
| | - Jinghui Lin
- Department of Thoracic oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, 350014, Fuzhou, China
| | - Yeying Wen
- Department of Epidemiology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, 350014, Fuzhou, China
| | - Linrong Wu
- Fujian Provincial Office for Cancer Prevention and Control, 350014, Fuzhou, China
| | - Jingyu Ma
- Department of Epidemiology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, 350014, Fuzhou, China.
| | - Chuanben Chen
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No.420 Fuma Road, 350014, Fuzhou, China.
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9
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Liang X, Zhang C, Ye X. Overdiagnosis and overtreatment of ground-glass nodule-like lung cancer. Asia Pac J Clin Oncol 2024. [PMID: 38178320 DOI: 10.1111/ajco.14042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/03/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024]
Abstract
Lung cancer has had one of the highest incidences and mortality in the world over the last few decades, which has aided in the promotion and popularization of screening for lung ground-glass nodules (GGNs). People have great psychological anxiety about GGN because of the chance that it will develop into lung cancer, which makes clinical treatment of GGN a generally excessive phenomenon. Overdiagnosis in screening has recently been mentioned in the literature. An important research emphasis of screening is how to reduce the incidence of overdiagnosis and overtreatment. This paper discusses from different aspects how to characterize the occurrence of overdiagnosis and overtreatment, how to reduce overdiagnosis and overtreatment, and future screening, follow-up, and treatment approaches.
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Affiliation(s)
- Xinyu Liang
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
| | - Chao Zhang
- Department of Oncology, Qujing No. 1 Hospital and Affiliated Qujing Hospital of Kunming Medical University, Qujing, China
| | - Xin Ye
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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Wu TC, Smith LM, Woolf D, Faivre-Finn C, Lee P. Exploring the Advantages and Challenges of MR-Guided Radiotherapy in Non-Small-Cell Lung Cancer: Who are the Optimal Candidates? Semin Radiat Oncol 2024; 34:56-63. [PMID: 38105094 DOI: 10.1016/j.semradonc.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
The landscape of lung radiotherapy (RT) has rapidly evolved over the past decade with modern RT and surgical techniques, systemic therapies, and expanding indications for RT. To date, 2 MRI-guided RT (MRgRT) units, 1 using a 0.35T magnet and 1 using a 1.5T magnet, are available for commercial use with more systems in the pipeline. MRgRT offers distinct advantages such as real-time target tracking, margin reduction, and on-table treatment adaptation, which may help overcome many of the common challenges associated with thoracic RT. Nonetheless, the use of MRI for image guidance and the current MRgRT units also have intrinsic limitations. In this review article, we will discuss clinical experiences to date, advantages, challenges, and future directions of MRgRT to the lung.
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Affiliation(s)
- Trudy C Wu
- Department of Radiation Oncology, University of California, Los Angeles, CA
| | - Lauren M Smith
- Department of Radiation Oncology, University of California, Los Angeles, CA
| | - David Woolf
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom.; Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom.; Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - Percy Lee
- Department of Radiation Oncology, City of Hope National Medical Center, Los Angeles, CA..
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11
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Hahn EE, Ritzwoller DP, Munoz-Plaza CE, Gander J, Kushi LH, McMullen C, Oshiro C, Roblin DW, Wernli KJ, Staab J. Incidence and Survival for Patients Diagnosed With Breast, Colorectal, and Lung Cancer in an Integrated System. Perm J 2023; 27:129-135. [PMID: 37724894 PMCID: PMC10723094 DOI: 10.7812/tpp/23.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
INTRODUCTION Documenting trends in cancer incidence and survival is a national priority. This study estimated age- and sex-adjusted incidence and 5-year relative survival among patients with cancer diagnosed within Kaiser Permanente compared to Surveillance, Epidemiology, and End Results (SEER) estimates. METHODS The cohort included Kaiser Permanente health plan members diagnosed with breast (BC), colorectal (CRC), or lung cancer (LC) between January 1, 1999 and December 31, 2018. Incidence was computed as age-adjusted rates per 100,000 member-years. SEER*Stat was used to compute 5-year relative survival. RESULTS Kaiser Permanente BC incidence rates were persistently higher than SEER from 2004 (126.5 [95% confidence interval (CI) = 123.2-129.9] vs 122.6 [95% CI = 121.3-123.2]) through 2013 (132.06 [95% CI = 129.5-135.7] vs 126.7 [95% CI = 125.9-127.5]). Kaiser Permanente CRC and LC incidence rates were lower than SEER for all years except 2008, showing a spike in CRC incidence (51.5 [95% CI = 49.9-53.0] vs 46.1 [95% CI = 45.7-46.4]). Kaiser Permanente BC, CRC, and LC survival estimates for all stages were higher than SEER. CONCLUSIONS Incidence rates for all-stage and localized-stage BC were consistently higher for Kaiser Permanente than for SEER. CRC and LC rates were lower. Kaiser Permanente survival rates were consistently higher than for SEER. The strengths of these findings are associated with the ability to capture "gold-standard" cancer registry data on defined Kaiser Permanente populations. However, findings should be interpreted cautiously given differences in the underlying populations and secular and regional differences between Kaiser Permanente and SEER. The Kaiser Permanente population is younger and more racially diverse than SEER aggregate populations, and Kaiser Permanente members are insured with access to preventive care (eg, smoking cessation programs, cancer screening).
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Affiliation(s)
- Erin E Hahn
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Corrine E Munoz-Plaza
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Jennifer Gander
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Carmit McMullen
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Caryn Oshiro
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | - Douglas W Roblin
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Jenny Staab
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
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Na KJ, Kim YT. Optimal resection strategies for small-size lung cancer: Is a wedge enough? Is lobectomy too much? JTCVS OPEN 2023; 16:17-21. [PMID: 38204652 PMCID: PMC10775088 DOI: 10.1016/j.xjon.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/02/2023] [Accepted: 10/11/2023] [Indexed: 01/12/2024]
Abstract
Recently published large multicenter prospective clinical trials have demonstrated that sublobar resection is noninferior to lobectomy, the traditional treatment of choice, for peripherally located early-stage lung cancer. Most clinical trials and several retrospective studies published to date have used the consolidation-to-tumor ratio to define the indication for sublobar resection, as it is well known that the size of the solid portion seen on high-resolution computed tomography is highly correlated with pathologic invasiveness. However, it is difficult to accurately predict pathologic features that may increase the risk of locoregional recurrence, such as specific adenocarcinoma subtypes or spread through air spaces, based on imaging characteristics alone, and the location of the nodule also should be considered one of the important factors in obtaining an adequate parenchymal resection margin. In this article, we summarize the results of the most recently published clinical trials related to sublobar resection and discuss various factors that should be considered for optimal candidate selection for sublobar resection.
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Affiliation(s)
- Kwon Joong Na
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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13
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Woodard GA, Udelsman BV, Prince SR, Blasberg JD, Dhanasopon AP, Gange CP, Traube L, Mase VJ, Boffa DJ, Detterbeck FC, Bader AS. Brief Report: Increasing Prevalence of Ground-Glass Nodules and Semisolid Lung Lesions on Outpatient Chest Computed Tomography Scans. JTO Clin Res Rep 2023; 4:100583. [PMID: 38074773 PMCID: PMC10709040 DOI: 10.1016/j.jtocrr.2023.100583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 03/13/2024] Open
Abstract
Introduction The increased use of cross-sectional imaging frequently identifies a growing number of lung nodules that require follow-up imaging studies and physician consultations. We report here the frequency of finding a ground-glass nodule (GGN) or semisolid lung lesion (SSL) in the past decade within a large academic health system. Methods A radiology system database review was performed on all outpatient adult chest computed tomography (CT) scans between 2013 and 2022. Radiology reports were searched for the terms "ground-glass nodule," "subsolid," and "semisolid" to identify reports with findings potentially concerning for an adenocarcinoma spectrum lesion. Results A total of 175,715 chest CT scans were performed between 2013 and 2022, with a steadily increasing number every year from 10,817 in 2013 to 21,916 performed in the year 2022. Identification of GGN or SSL on any outpatient CT increased from 5.9% in 2013 to 9.2% in 2022, representing a total of 2019 GGN or SSL reported on CT scans in 2022. The percentage of CT scans with a GGN or SSL finding increased during the study period in men and women and across all age groups above 50 years old. Conclusions The total number of CT scans performed and the percentage of chest CT scans with GGN or SSL has more than doubled between 2013 and 2022; currently, 9% of all chest CT scans report a GGN or SSL. Although not all GGN or SSL radiographic findings represent true adenocarcinoma spectrum lesions, they are a growing burden to patients and health systems, and better methods to risk stratify radiographic lesions are needed.
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Affiliation(s)
- Gavitt A. Woodard
- Division of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Brooks V. Udelsman
- Division of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Samantha R. Prince
- Division of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Justin D. Blasberg
- Division of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut
| | | | | | - Leah Traube
- Department of Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Vincent J. Mase
- Division of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Daniel J. Boffa
- Division of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Frank C. Detterbeck
- Division of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Anna S. Bader
- Department of Radiology, Yale School of Medicine, New Haven, Connecticut
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14
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Skolnick S, Cao P, Jeon J, Meza R. Contribution of smoking, disease history, and survival to lung cancer disparities in Black individuals. J Natl Cancer Inst Monogr 2023; 2023:204-211. [PMID: 37947334 PMCID: PMC10637023 DOI: 10.1093/jncimonographs/lgad016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/01/2023] [Accepted: 06/11/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer deaths and disproportionately affects self-identified Black or African American ("Black") people, especially considering their relatively low self-reported smoking intensity rates. This study aimed to determine the relative impact of smoking history and lung cancer incidence risk, histology, stage, and survival on these disparities. METHODS We used 2 lung cancer models (MichiganLung-All Races and MichiganLung-Black) to understand why Black people have higher rates of lung cancer deaths. We studied how different factors, such as smoking behaviors, cancer development, histology, stage at diagnosis, and lung cancer survival, contribute to these differences. RESULTS Adjusted for smoking history, approximately 90% of the difference in lung cancer deaths between the overall and Black populations (born in 1960) was the result of differences in the risk of getting lung cancer. Differences in the histology and stage of lung cancer and survival had a small impact (4% to 6% for each). Similar results were observed for the 1950 and 1970 birth cohorts, regardless of their differences in smoking patterns from the 1960 cohort. CONCLUSIONS After taking smoking into account, the higher rate of lung cancer deaths in Black people can mostly be explained by differences in the risk of developing lung cancer. As lung cancer treatments and detection improve, however, other factors may become more important in determining differences in lung cancer mortality between the Black and overall populations. To prevent current disparities from becoming worse, it is important to make sure that these improvements are available to everyone in an equitable way.
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Affiliation(s)
- Sarah Skolnick
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Pianpian Cao
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Abstract
Current lung cancer screening protocols use low-dose computed tomography scans in selected high-risk individuals. Unfortunately, utilization is low, and the rate of false-positive screens is high. Peripheral biomarkers carry meaningful promise in diagnosing and monitoring cancer with added potential advantages reducing invasive procedures and improving turnaround time. Herein, the use of such blood-based assays is considered as an adjunct to further utilization and accuracy of lung cancer screening.
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Affiliation(s)
- Nathaniel Deboever
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Edwin J Ostrin
- Department of General Internal Medicine, Pulmonary Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Sequist LV, Olazagasti C. Twenty-year Progress in Lung Cancer Screening: A Marathon, Not a Sprint. Radiology 2023; 309:e232850. [PMID: 37934096 DOI: 10.1148/radiol.232850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Affiliation(s)
- Lecia V Sequist
- From the Department of Radiology, Mass General Brigham and Harvard Medical School, 55 Fruit St, Boston, MA 02214 (L.V.S.); and Sylvester Comprehensive Cancer Center at the University of Miami, Miami, Fla (C.O.)
| | - Coral Olazagasti
- From the Department of Radiology, Mass General Brigham and Harvard Medical School, 55 Fruit St, Boston, MA 02214 (L.V.S.); and Sylvester Comprehensive Cancer Center at the University of Miami, Miami, Fla (C.O.)
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Wain K, Carroll NM, Honda S, Oshiro C, Ritzwoller DP. Individuals Eligible for Lung Cancer Screening Less Likely to Receive Screening When Enrolled in Health Plans With Deductibles. Med Care 2023; 61:665-673. [PMID: 37582296 PMCID: PMC10840830 DOI: 10.1097/mlr.0000000000001903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
BACKGROUND In 2015, the Centers for Medicare & Medicaid Services and commercial insurance plans began covering lung cancer screening (LCS) without patient cost-sharing for all plans. We explore the impact of enrolling into a deductible plan on the utilization of LCS services despite having no out-of-pocket cost requirement. METHODS This retrospective study analyzed data from the Population-based Research to Optimize the Screening Process Lung Consortium. Our cohort included non-Medicare LCS-eligible individuals enrolled in managed care organizations between February 5, 2015, and February 28, 2019. We estimate a series of sequential logistic regression models examining utilization across the sequence of events required for baseline LCS. We report the marginal effects of enrollment into deductible plans compared with enrollment in no-deductible plans. RESULTS The total effect of deductible plan enrollment was a 1.8 percentage-point (PP) decrease in baseline LCS. Sequential logistic regression results that explore each transition separately indicate deductible plan enrollment was associated with a 4.3 PP decrease in receipt of clinician visit, a 1.7 PP decrease in receipt of LCS order, and a 7.0 PP decrease in receipt of baseline LCS. Reductions persisted across all observable races and ethnicities. CONCLUSIONS These findings suggest individuals enrolled in deductible plans are more likely to forgo preventive LCS services despite requiring no out-of-pocket costs. This result may indicate that increased cost-sharing is associated with suboptimal choices to forgo recommended LCS. Alternatively, this effect may indicate individuals enrolling into deductible plans prefer less health care utilization. Patient outreach interventions at the health plan level may improve LCS.
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Affiliation(s)
- Kris Wain
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO
| | - Nikki M. Carroll
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO
| | - Stacey Honda
- Center for Integrated Healthcare Research, Kaiser Permanente Hawaii, Honolulu, HI
- Hawaii Permanente Medical Group, Honolulu, HI
| | - Caryn Oshiro
- Center for Integrated Healthcare Research, Kaiser Permanente Hawaii, Honolulu, HI
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Vachani A, Caruso C. Impact of low-dose computed tomography screening on lung cancer incidence and outcomes. Curr Opin Pulm Med 2023; 29:232-238. [PMID: 37191171 PMCID: PMC10247528 DOI: 10.1097/mcp.0000000000000974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE OF REVIEW To review findings from clinical trials of lung cancer screening (LCS), assess contemporary issues with implementation in clinical practice, and review emerging strategies to increase the uptake and efficiency of LCS. RECENT FINDINGS In 2013, the USPSTF recommended annual screening for individuals aged 55-80 years and currently smoke or quit within the past 15 years based on reduced mortality from lung cancer with annual low-dose computed tomography (LDCT) screening in the National Lung Screening Trial. Subsequent trials have demonstrated similar mortality outcomes in individuals with lower pack-year smoking histories. These findings, coupled with evidence for disparities in screening eligibility by race, resulted in updated guidelines by USPSTF to broaden eligibility criteria for screening. Despite this body of evidence, implementation in the United States has been suboptimal with fewer than 20% of eligible individuals receiving a screen. Barriers to efficient implementation are multifactorial and include patient, clinician, and system-level factors. SUMMARY Multiple randomized trials have established that annual LCS reduces mortality from lung cancer; however, several areas of uncertainty exist on the effectiveness of annual LDCT. Ongoing research is examining approaches to improve the uptake and efficiency of LCS, such as the use of risk-prediction models and biomarkers for identification of high-risk individuals.
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Affiliation(s)
- Anil Vachani
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Perelman School of Medicine
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Christopher Caruso
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Perelman School of Medicine
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Grant MJ, Woodard GA, Goldberg SB. The Evolving Role for Systemic Therapy in Resectable Non-small Cell Lung Cancer. Hematol Oncol Clin North Am 2023; 37:513-531. [PMID: 37024389 DOI: 10.1016/j.hoc.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
During the last 2 decades, the understanding of non-small cell lung cancer (NSCLC) has evolved from a purely histologic classification system to a more complex model synthesizing clinical, histologic, and molecular data. Biomarker-driven targeted therapies have been approved by the United States Food and Drug Administration for patients with metastatic NSCLC harboring specific driver alterations in EGFR, HER2, KRAS, BRAF, MET, ALK, ROS1, RET, and NTRK. Novel immuno-oncology agents have contributed to improvements in NSCLC-related survival at the population-level. However, only in recent years has this nuanced understanding of NSCLC permeated into the systemic management of patients with resectable tumors.
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Affiliation(s)
- Michael J Grant
- Yale Cancer Center, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA; Department of Medicine (Medical Oncology), Yale School of Medicine, 330 Cedar Street, Rm BB 205, New Haven, CT 06520, USA.
| | - Gavitt A Woodard
- Yale Cancer Center, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA; Department of Surgery, Yale School of Medicine, PO Box 208028, New Haven, CT 06520, USA
| | - Sarah B Goldberg
- Yale Cancer Center, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA; Department of Medicine (Medical Oncology), Yale School of Medicine, 330 Cedar Street, Rm BB 205, New Haven, CT 06520, USA
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Rustagi AS, Slatore CG, Keyhani S. Self-Rated Health and Ability to Climb Stairs: A Pragmatic Health Assessment Before Lung Cancer Screening. Ann Intern Med 2023; 176:568-571. [PMID: 36877963 DOI: 10.7326/m22-3598] [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: 03/08/2023] Open
Affiliation(s)
- Alison S Rustagi
- Division of General Internal Medicine, Medical Service, San Francisco Veterans Affairs Health Care System, and Department of Medicine, University of California-San Francisco, San Francisco, California (A.S.R., S.K.)
| | - Christopher G Slatore
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC, and Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon (C.G.S.)
| | - Salomeh Keyhani
- Division of General Internal Medicine, Medical Service, San Francisco Veterans Affairs Health Care System, and Department of Medicine, University of California-San Francisco, San Francisco, California (A.S.R., S.K.)
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Kim YW, Kim HJ, Yoon SH, Song MJ, Kwon BS, Lim SY, Lee YJ, Park JS, Cho YJ, Lee JH, Lee CT. Electromagnetic Navigation Bronchoscopy Versus Radial Endobronchial Ultrasound for Diagnosing Lung Cancer: A Propensity Score-Matched Analysis. Arch Bronconeumol 2023:S0300-2896(23)00098-4. [PMID: 37005148 DOI: 10.1016/j.arbres.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/04/2023] [Accepted: 03/06/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Electromagnetic navigation bronchoscopy (ENB) and radial endobronchial ultrasound (R-EBUS) are advanced imaging-guided bronchoscopy techniques for diagnosing pulmonary lesions. This study aimed to determine the comparative diagnostic yield of sole ENB and R-EBUS under moderate sedation. METHODS We investigated 288 patients who underwent sole ENB (n=157) or sole R-EBUS (n=131) under moderate sedation for pulmonary lesion biopsy between January 2017 and April 2022. After a 1:1 propensity score-matching to control for pre-procedural factors, the diagnostic yield, sensitivity for malignancy, and procedure-related complications between both techniques were compared. RESULTS The matching resulted in 105 pairs/procedure for analyses with balanced clinical and radiological characteristics. The overall diagnostic yield was significantly higher for ENB than for R-EBUS (83.8% vs. 70.5%, p=0.021). ENB demonstrated a significantly higher diagnostic yield than R-EBUS among those with lesions>20mm in size (85.2% vs. 72.3%, p=0.034), radiologically solid lesions (86.7% vs. 72.7%, p=0.015), and lesions with a class 2 bronchus sign (91.2% vs. 72.3%, p=0.002), respectively. The sensitivity for malignancy was also higher for ENB than for R-EBUS (81.3% vs. 55.1%, p<0.001). After adjusting for clinical/radiological factors in the unmatched cohort, using ENB over R-EBUS was significantly associated with a higher diagnostic yield (odd ratio=3.45, 95% confidence interval=1.75-6.82). Complication rates for pneumothorax did not significantly differ between ENB and R-EBUS. CONCLUSION ENB demonstrated a higher diagnostic yield than R-EBUS under moderate sedation for diagnosing pulmonary lesions, with similar and generally low complication rates. Our data indicate the superiority of ENB over R-EBUS in a least-invasive setting.
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Liquid Biopsy for Lung Cancer: Up-to-Date and Perspectives for Screening Programs. Int J Mol Sci 2023; 24:ijms24032505. [PMID: 36768828 PMCID: PMC9917347 DOI: 10.3390/ijms24032505] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/09/2022] [Accepted: 12/19/2022] [Indexed: 01/31/2023] Open
Abstract
Lung cancer is the deadliest cancer worldwide. Tissue biopsy is currently employed for the diagnosis and molecular stratification of lung cancer. Liquid biopsy is a minimally invasive approach to determine biomarkers from body fluids, such as blood, urine, sputum, and saliva. Tumor cells release cfDNA, ctDNA, exosomes, miRNAs, circRNAs, CTCs, and DNA methylated fragments, among others, which can be successfully used as biomarkers for diagnosis, prognosis, and prediction of treatment response. Predictive biomarkers are well-established for managing lung cancer, and liquid biopsy options have emerged in the last few years. Currently, detecting EGFR p.(Tyr790Met) mutation in plasma samples from lung cancer patients has been used for predicting response and monitoring tyrosine kinase inhibitors (TKi)-treated patients with lung cancer. In addition, many efforts continue to bring more sensitive technologies to improve the detection of clinically relevant biomarkers for lung cancer. Moreover, liquid biopsy can dramatically decrease the turnaround time for laboratory reports, accelerating the beginning of treatment and improving the overall survival of lung cancer patients. Herein, we summarized all available and emerging approaches of liquid biopsy-techniques, molecules, and sample type-for lung cancer.
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Abstract
Lung cancer is a leading cause of cancer death in the United States and globally with the majority of lung cancer cases attributable to cigarette smoking. Given the high societal and personal cost of a diagnosis of lung cancer including that most cases of lung cancer when diagnosed are found at a late stage, work over the past 40 years has aimed to detect lung cancer earlier when curative treatment is possible. Screening trials using chest radiography and sputum failed to show a reduction in lung cancer mortality however multiple studies using low dose CT have shown the ability to detect lung cancer early and a survival benefit to those screened. This review will discuss the history of lung cancer screening, current recommendations and screening guidelines, and implementation and components of a lung cancer screening program.
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