1
|
Ko RB, Abelson JA, Fleischmann D, Louie JD, Hwang GL, Sze DY, Schüler E, Kielar KN, Maxim PG, Le QT, Hara WH, Diehn M, Kothary N, Loo BW. Pulmonary interstitial lymphography: A prospective trial with potential impact on stereotactic ablative radiotherapy planning for early-stage lung cancer. Radiother Oncol 2024; 191:110079. [PMID: 38163486 DOI: 10.1016/j.radonc.2023.110079] [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: 11/27/2023] [Accepted: 12/29/2023] [Indexed: 01/03/2024]
Abstract
This prospective feasibility trial investigated pulmonary interstitial lymphography to identify thoracic primary nodal drainage (PND). A post-hoc analysis of nodal recurrences was compared with PND for patients with early-stage lung cancer; larger studies are needed to establish correlation. Exploratory PND-inclusive stereotactic ablative radiotherapy plans were assessed for dosimetric feasibility.
Collapse
Affiliation(s)
- Ryan B Ko
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA; Oakland University William Beaumont School of Medicine, Auburn Hills, MI, USA.
| | - Jonathan A Abelson
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA; Coastal Radiation Oncology, San Luis Obispo, CA, USA.
| | - Dominik Fleischmann
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - John D Louie
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Gloria L Hwang
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Daniel Y Sze
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Emil Schüler
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA; Department of Radiation Physics, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Kayla N Kielar
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA; Varian Medical Systems, Stanford, CA, USA
| | - Peter G Maxim
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA; Department of Radiation Oncology, University of California, Irvine, CA, USA
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Wendy H Hara
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Nishita Kothary
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA.
| |
Collapse
|
2
|
Xiong L, Wei Y, Zhou X, Dai P, Zhou X, Xu M, Zhao J, Tang H. Development and validation of nomograms based on clinical characteristics and CT reports for the preoperative prediction of precise lymph node dissection in lung cancer. Lung Cancer 2022; 172:35-42. [PMID: 35988508 DOI: 10.1016/j.lungcan.2022.08.009] [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: 01/22/2022] [Revised: 06/05/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To develop and validate nomograms for preoperative prediction of precision lymph node (LN) dissection in lung cancer. PATIENTS AND METHODS The prediction models of each group LNs (LNx) were developed in a primary cohort that consisted of 1380 patients with clinicopathologically confirmed lung cancer. Clinical characteristics and CT reports were extracted. Patients with LNx dissection were divided into training cohort and testing cohort. Nomograms were built through univariate and multivariate regression analysis in the training cohort and internally verified in the testing cohort. The accuracy of the models was verified by constructing survival analysis in patients without LNx dissection. RESULTS Due to the lack of sufficient patients for LN1, 8, 13, a total of 10 nomograms were constructed in this study, including LN-2 ∼ 7, 9 ∼ 12. According to the nomogram of each group LN, the most common independent risk factors predicting LN status were CT-reported lymphadenectasis, tumor diameter and location, and the others include age, gender, and whether there were multiple nodules, etc. All models showed good discrimination, with the average C-index of 0.738 in the training cohort and 0.707 in the testing cohort. Survival analysis in patients without LNx dissection all showed the high accuracy of each nomogram to predict LN metastasis status and TNM staging. CONCLUSION We constructed nomograms to predict the metastasis status of each group of lymph nodes based on clinical characteristics and CT reports. Surgeons can accurately determine the extent of lymph node dissection in patients with lung cancer based on our nomogram models before surgery.
Collapse
Affiliation(s)
- Lecai Xiong
- Department of Thoracic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Yanhong Wei
- Department of Rheumatology and Immunology, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Xiao Zhou
- Department of Thoracic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Peng Dai
- Department of Thoracic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Xuefeng Zhou
- Department of Thoracic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Ming Xu
- Department of Thoracic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Jinping Zhao
- Department of Thoracic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Hexiao Tang
- Department of Thoracic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.
| |
Collapse
|
3
|
Yang MZ, Tan ZH, Li JB, Long H, Fu JH, Zhang LJ, Lin P, Hou X, Yang HX. Station 3A lymph node dissection does not improve long-term survival in right-side operable non-small-cell lung cancer patients: A propensity score matching study. Thorac Cancer 2022; 13:2106-2116. [PMID: 35702992 PMCID: PMC9346165 DOI: 10.1111/1759-7714.14456] [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] [Received: 03/28/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background To investigate the impact of station 3A lymph node dissection (LND) on overall survival (OS) and disease‐free survival (DFS) in completely resected right‐side non‐small‐cell lung cancer (NSCLC) patients. Methods A total of 1661 cases with completely resected right‐side NSCLC were included. Propensity score matching (PSM) was performed to minimize selection bias, and a logistic regression model was conducted to investigate the risk factors associated with station 3A lymph node metastasis (LNM). The Kaplan–Meier method and Cox proportional hazards model were used to evaluate the impact of station 3A LND on survival. Results For the entire cohort, 503 patients (30.3%) underwent station 3A LND. Of those, 11.3% (57/503) presented station 3A LNM. Univariate and multivariate logistic analyses showed that station 10 LNM, tumor location, and the number of resected lymph nodes were independent risk factors associated with station 3A LNM. Before PSM, patients with station 3A LND had worse 5‐year OS (p = 0.002) and DFS (p = 0.011), and more drainage on postoperative day 1 (p = 0.041) than those without. After PSM, however, station 3A LND was not associated with the 5‐year OS (65.7% vs. 63.6%, p = 0.432) or DFS (57.4% vs. 56.0%, p = 0.437). The multivariate analysis further confirmed that station 3A LND was not a prognostic factor (OS, p = 0.361; DFS, p = 0.447). Conclusions Station 3A LND could not improve long‐term outcomes and it was unnecessary to dissect station 3A lymph nodes during surgery of right‐side NSCLC.
Collapse
Affiliation(s)
- Mu-Zi Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, China
| | - Zi-Hui Tan
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, China
| | - Ji-Bin Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, China.,Department of Clinical Research, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, China
| | - Hao Long
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, China
| | - Jian-Hua Fu
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, China
| | - Lan-Jun Zhang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, China
| | - Peng Lin
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, China
| | - Xue Hou
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, China
| | - Hao-Xian Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, China
| |
Collapse
|
4
|
Xie X, Li X, Tang W, Xie P, Tan X. Primary tumor location in lung cancer: the evaluation and administration. Chin Med J (Engl) 2021; 135:127-136. [PMID: 34784305 PMCID: PMC8769119 DOI: 10.1097/cm9.0000000000001802] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Lung cancer continues to be the leading cause of cancer-related death in the world, which is classically subgrouped into two major histological types: Non-small cell lung cancer (NSCLC) (85% of patients) and small-cell lung cancer (SCLC) (15%). Tumor location has been reported to be associated with the prognosis of various solid tumors. Several types of cancer often occur in a specific region and are more prone to spread to predilection locations, including colorectal cancer, prostate cancer, gastric cancer, ovarian cancer, cervical cancer, bladder cancer, lung tumor, and so on. Besides, tumor location is also considered as a risk factor for lung neoplasm with chronic obstructive pulmonary disease/emphysema. Additionally, the primary lung cancer location is associated with specific lymph node metastasis. And the recent analysis has shown that the primary location may affect metastasis pattern in metastatic NSCLC based on a large population. Numerous studies have enrolled the "location" factor in the risk model. Anatomy location and lobe-specific location are both important in prognosis. Therefore, it is important for us to clarify the characteristics about tumor location according to various definitions. However, the inconsistent definitions about tumor location among different articles are controversial. It is also a significant guidance in multimode therapy in the present time. In this review, we mainly aim to provide a new insight about tumor location, including anatomy, clinicopathology, and prognosis in patients with lung neoplasm.
Collapse
Affiliation(s)
- Xueqi Xie
- School of Medicine and Life Sciences, Shandong First Medical University, Jinan, Shandong 250117, China Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, China
| | | | | | | | | |
Collapse
|
5
|
Guberina M, Darwiche K, Hautzel H, Pöttgen C, Guberina N, Gauler T, Ploenes T, Umutlu L, Theegarten D, Aigner C, Eberhardt WEE, Metzenmacher M, Wiesweg M, Karpf-Wissel R, Schuler M, Herrmann K, Stuschke M. Patterns of nodal spread in stage III NSCLC: importance of EBUS-TBNA and 18F-FDG PET/CT for radiotherapy target volume definition. Radiat Oncol 2021; 16:176. [PMID: 34526050 PMCID: PMC8442338 DOI: 10.1186/s13014-021-01904-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/30/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose The aim of this study was to compare the pattern of intra-patient spread of lymph-node (LN)-metastases within the mediastinum as assessed by 18F-FDG PET/CT and systematic endobronchial ultrasound-guided transbronchial-needle aspiration (EBUS-TBNA) for precise target volume definition in stage III NSCLC. Methods This is a single-center study based on our preceding investigation, including all consecutive patients with initial diagnosis of stage IIIA-C NSCLC, receiving concurrent radiochemotherapy (12/2011–06/2018). Inclusion criteria were curative treatment intent, 18F-FDG PET/CT and EBUS-TBNA prior to start of treatment. The lymphatic drainage was classified into echelon-1 (ipsilateral hilum), echelon-2 (ipsilateral LN-stations 4 and 7) and echelon-3 (rest of the mediastinum, contralateral hilum). The pattern of spread was classified according to all permutations of echelon-1, echelon-2, and echelon-3 EBUS-TBNA findings. Results In total, 180 patients were enrolled. Various patterns of LN-spread could be identified. Skip lesions with an involved echelon distal from an uninvolved one were detected in less than 10% of patients by both EBUS-TBNA and PET. The pattern with largest asymmetry was detected in cases with EBUS-TBNA- or PET-positivity at all three echelons (p < 0.0001, exact symmetry test). In a multivariable logistic model for EBUS-positivity at echelon-3, prognostic factors were PET-positivity at echelon-3 (Hazard ratio (HR) = 12.1; 95%-CI: 3.2–46.5), EBUS-TBNA positivity at echelon-2 (HR = 6.7; 95%-CI: 1.31–31.2) and left-sided tumor location (HR = 4.0; 95%-CI: 1.24–13.2). There were significantly less combined ipsilateral upper (LN-stations 2 and 4) and lower (LN-station 7) mediastinal involvements (16.8% of patients) with EBUS-TBNA than with PET (38.9%, p < 0.0001, exact symmetry test). EBUS-TBNA detected a lobe specific heterogeneity between the odds ratios of LN-positivity in the upper versus lower mediastinum (p = 0.0021, Breslow-Day test), while PET did not (p = 0.19). Conclusion Frequent patterns of LN-metastatic spread could be defined by EBUS-TBNA and PET and discrepancies in the pattern were seen between both methods. EBUS-TBNA showed more lobe and tumor laterality specific patterns of LN-metastases than PET and skipped lymph node stations were rare. These systematic relations offer the opportunity to further refine multi-parameter risk of LN-involvement models for target volume delineation based on pattern of spread by EBUS-TBNA and PET. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-021-01904-4.
Collapse
Affiliation(s)
- Maja Guberina
- Department of Radiation Therapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany.
| | - Kaid Darwiche
- Department of Pulmonary Medicine, Section of Interventional Pneumology, University Medicine Essen - Ruhrlandklinik, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Hubertus Hautzel
- Department of Nuclear Medicine, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Christoph Pöttgen
- Department of Radiation Therapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Nika Guberina
- Department of Radiation Therapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Thomas Gauler
- Department of Radiation Therapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Till Ploenes
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen - Ruhrlandklinik, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Lale Umutlu
- Institute of Diagnostic, Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen - Ruhrlandklinik, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Wilfried E E Eberhardt
- Department of Medical Oncology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany.,Division of Thoracic Oncology, University Medicine Essen - Ruhrlandklinik, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Martin Metzenmacher
- Department of Medical Oncology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany.,Division of Thoracic Oncology, University Medicine Essen - Ruhrlandklinik, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Marcel Wiesweg
- Department of Medical Oncology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany.,Division of Thoracic Oncology, University Medicine Essen - Ruhrlandklinik, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Rüdiger Karpf-Wissel
- Department of Pulmonary Medicine, Section of Interventional Pneumology, University Medicine Essen - Ruhrlandklinik, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Martin Schuler
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.,Department of Medical Oncology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany.,Division of Thoracic Oncology, University Medicine Essen - Ruhrlandklinik, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Martin Stuschke
- Department of Radiation Therapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| |
Collapse
|
6
|
Abughararah TZ, Jeong YH, Alabbood F, Chong Y, Yun JK, Lee GD, Choi S, Kim HR, Kim YH, Kim DK, Park SI. Lobe-specific lymph node dissection in stage IA non-small-cell lung cancer: a retrospective cohort study. Eur J Cardiothorac Surg 2021; 59:783-790. [PMID: 33150427 DOI: 10.1093/ejcts/ezaa369] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/29/2020] [Accepted: 09/06/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To investigate lymph node (LN) metastasis according to tumour location and assess the impact of lobe-specific LN dissection on survival in stage IA non-small-cell lung cancer (NSCLC). METHODS We retrospectively analysed the data of patients with clinical stage IA NSCLC treated with lobectomy and systematic LN dissection at Asan Medical Center (Seoul, Korea) between June 2005 and April 2017. Patients who received neoadjuvant therapy had multiple primary tumours or missed the follow-up during the first postoperative year were excluded. The patients were divided into five groups according to involved lung lobes: right upper lobe (RUL), right middle lobe (RML), right lower lobe (RLL), left upper lobe (LUL) and left lower lobe (LLL), which were further divided into subgroups according to LN station metastasis. Overall survival (OS) and the incidence of metastasis were calculated for each subgroup. Efficacy indices (EIs) were calculated to determine the correlation between each lung lobe and LN station, and the impact of the dissection of these stations on survival. RESULTS A total of 1202 patients were analysed. The 5-year OS in the RUL, RML, RLL, LUL and LLL groups was 74%, 88%, 78%, 80% and 75%, respectively. The incidence of single LN station metastasis was 11%, 10%, 10%, 16% and 14%, respectively. The lobe-specific LNs for RUL, RML, RLL, LUL and LLL were stations 2/3/4, 4/7, 2/4/7, 4/5/6 and 6/7/9, respectively. Moreover, the LN stations with high EIs for RUL, RML, RLL, LUL and LLL were 4, 7, 7, 5 and 7, respectively. In the RUL group, the incidence of metastasis to stations 2, 3 and 4 was 2.3%, 0.5% and 7.6%, and the EI was 0.8, 0.3 and 4.3, respectively. In RML, the incidence of metastasis to stations 4 and 7 was 4% and 6%, and the EI was 1.3 and 2.4, respectively. In RLL, the incidence of metastasis to stations 2, 4 and 7 was 4.4%, 5.6% and 8.3%, and the EI was 1.3, 1.4 and 3.3, respectively. In LUL, the incidence of metastasis to stations 4, 5 and 6 was 1.4%, 11.8% and 2.5%, and the EI was 0.4, 7.1 and 0.5, respectively. In LLL, the incidence of metastasis to stations 6, 7 and 9 was 1.1%, 5.7% and 1.7%, and the EI was 0.6, 2.3 and 0.5, respectively. Furthermore, the OS of patients with lobe-specific LN metastasis was statistically significantly different from that of the non-lobe-specific LN metastasis group with P-values of <0.001 for RUL, 0.002 for RML, 0.002 for RLL, 0.001 for LUL and 0.003 for LLL. CONCLUSIONS Our findings support the use of lobe-specific LN dissection in stage IA NSCLC. When LN stations with high EI were negative, LN metastasis in other stations was unlikely. The incidence of LN metastasis beyond lobe-specific LN stations was ∼1% in all subgroups. Dissection of non-lobe-specific LNs may not improve the OS; however, prospective randomized controlled trials are needed to modify the standard approach.
Collapse
Affiliation(s)
- Tariq Ziad Abughararah
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea.,Department of Thoracic Surgery, Prince Mohammed Bin Abdulaziz Hospital, MNGHA, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Yong Ho Jeong
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Fahd Alabbood
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Yooyoung Chong
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Jae Kwang Yun
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Sehoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| |
Collapse
|
7
|
Hu J, Qi M, Zhu X, Chen Y, Dai J, Zhang J, Jiang G, Zhang Z, Zhang P. Correlation between tumor location and survival in stage I lung adenocarcinoma and squamous cell carcinoma: a SEER-based study. J Cancer 2021; 12:5076-5085. [PMID: 34335924 PMCID: PMC8317522 DOI: 10.7150/jca.52572] [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] [Received: 08/29/2020] [Accepted: 06/13/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Whether location mattered remained controversial in early-stage non-small cell lung cancer. Methods: We conducted a retrospective study with the Surveillance, Epidemiology, and End Results (SEER) database. Overall survival (OS) and lung cancer-specific survival (LCSS) with landmark analysis and restricted mean survival time (RMST) were compared between patients with a tumor in upper lobe and non-upper lobe. The multivariable Cox analysis was applied to evaluate multiple prognostic factors. Results: Tumor in non-upper lobe had worse OS (hazard ratio [HR]: 1.354, p < 0.001) and LCSS (HR: 1.476, p = 0.005) than the upper lobe in stage IB adenocarcinoma in 32-month landmark and IA3 (OS, HR: 1.300, p < 0.001; LCSS, HR: 1.413, p = 0.004) adenocarcinoma in 48-month landmark, but not in stage IA1 and IA2 adenocarcinoma. The results remained positive in subgroups of < 4, ≥ 4 and ≥ 11 LN examined in stage IB tumor and ≥ 4 LN examined in stage IA3 tumor. For SCC, non-upper lobar tumor had similar OS and LCSS with upper lobar tumor in all stages. The multivariate Cox analysis confirmed that the non-upper lobe was an independent risk factor in stage IA3-IB adenocarcinoma, but not in SCC. Adjuvant chemotherapy (ACT) could improve OS in stage IB adenocarcinoma (HR: 0.586, p < 0.001) and SCC (HR: 0.708, p = 0.030) located in non-upper lobe. Conclusions: Non-upper lobar adenocarcinoma in stage IA3-IB was associated with worse prognosis. ACT may improve prognosis in stage IB tumor located in non-upper lobe.
Collapse
Affiliation(s)
- Junjie Hu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Mengfan Qi
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Xinsheng Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Yan Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Jie Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Jing Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Zhonghong Zhang
- Respiration Department II, The First Affiliated Hospital of Shihezi University Medical College, Shihezi, Xinjiang 832000, China
| | - Peng Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| |
Collapse
|
8
|
Tsitsias T, Okiror L, Veres L, King J, Harrison-Phipps K, Routledge T, Pilling J, Bille A. New N1/N2 classification and lobe specific lymphatic drainage: Impact on survival in patients with non-small cell lung cancer treated with surgery. Lung Cancer 2020; 151:84-90. [PMID: 33250210 DOI: 10.1016/j.lungcan.2020.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE to validate the proposed N descriptor revision on a large cohort of patients and assess the impact of tumour location on the distribution pattern of lymph node metastases for patients with NSCLC. METHODS This is a retrospective review of a consecutive series of patients who had anatomical lung resections. Systematic lymph node dissection was done for all patients. RESULTS Between January 2009 and December 2019 2566 patients had surgical resection for NSCLC. 448 patients (17.5%) had histologically confirmed lymph node metastases: 257 (57.4 %) had pN1 and 191 pN2. Median age of the study population was 69.1 years. Overall survival (OS) for study population was 37.3 months with 5-year survival rate of 35.7 %. The survival analysis of the N subgroups showed the pN2 patients had a median OS of 27.9 months vs. 41.7 months for pN1 patients (p = 0.013). Analysis as per the new proposal of the N subgroups N1a vs N1b vs N2a1 vs N2a2 vs N2b showed that median survival OS was 41.7 vs. 39.2 mo vs. 33.3 mo vs. 28.9 mo vs. 24.6 mo (p = 0.099). There was statistically significant difference in survival between N2 patients with skip metastasis and N2 patients without skip metastases: OS 32.2 (95 % CI: 16.8-47.6) months vs. 24.2 months (p = 0.024). On multivariate analysis only pathological N (p = 0.011) and the new proposed N classification (p = 0.006) were independent prognostic factors for survival. CONCLUSIONS N1 and N2 disease are heterogeneous groups and require further stratification. The number of N2 lymph node stations involved and the presence or not of N1 disease translated to significant differences in survival and therefore have to be included in N staging.
Collapse
Affiliation(s)
- Thomas Tsitsias
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - Lawrence Okiror
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - Lukacs Veres
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - Juliet King
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | | | - Tom Routledge
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - John Pilling
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - Andrea Bille
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom; Division of Cancer Studies, King's College London, Guy's Hospital, London, United Kingdom.
| |
Collapse
|
9
|
Endobronchial Ultrasound for Staging of the Radiologically Normal Mediastinum: Should We Individualize Our Approach? Ann Am Thorac Soc 2020; 17:1493-1496. [DOI: 10.1513/annalsats.202004-294rl] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
|
10
|
Meng S, Liu G, Wang S, Yang F, Wang J. Nodal Involvement Pattern in Clinical Stage IA Non-Small Cell Lung Cancer According to Tumor Location. Cancer Manag Res 2020; 12:7875-7880. [PMID: 32904622 PMCID: PMC7457550 DOI: 10.2147/cmar.s262623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/30/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate lymph node involvement pattern in clinical stage IA non-small cell lung cancer (NSCLC). PATIENTS AND METHODS Clinical stage ⅠA NSCLC patients who underwent lobectomy and lymph node resection were included in this retrospective study. Mediastinal lymph node involvement was distinguished by different lobes and tumor size. RESULTS From 2000 to 2015, a total of 759 patients were identified: 282 (37.2%) with tumors in the right upper lobe (RUL), 183 (24.1%) in the left upper lobe (LUL), 124 (16.3%) in the right lower lobe (RLL), 103 (13.6%) in the left lower lobe (LLL), and 67 (8.8%) in the right middle lobe (RML). Patients with tumor size ≤1 cm accounted for 19.6%, >1 and ≤2 cm for 47.8%, >2 and ≤3 cm for 32.5%. Patients with pN1 accounted for 8.2%, and pN2 for 12.5%. Among patients with pN2, the inferior mediastinum was involved in 9.7% of RULs and 17.4% of LULs; the superior mediastinum was involved in 52.2% of RLLs and 36.4% of LLLs. Mediastinal lymph node metastasis was found in 13.2% of patients with size >1 and ≤2 cm, and 19.0% of >2 and ≤3 cm. Patients with tumors ≤1 cm had no N2 lymph node involved. CONCLUSION Selective lymph node dissection based on tumor location is not recommended in clinical stage ⅠA NSCLC, and systemic lymph node dissection should be performed for NSCLC with size >1 cm.
Collapse
Affiliation(s)
- Shushi Meng
- Department of Thoracic Surgery, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Ganwei Liu
- Department of Thoracic Surgery, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Shaodong Wang
- Department of Thoracic Surgery, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Fan Yang
- Department of Thoracic Surgery, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Jun Wang
- Department of Thoracic Surgery, Peking University People’s Hospital, Beijing, People’s Republic of China
| |
Collapse
|
11
|
Virarkar M, Saleh M, Ramani NS, Morani AC, Bhosale P. Imaging spectrum of NUT carcinomas. Clin Imaging 2020; 67:198-206. [PMID: 32866821 DOI: 10.1016/j.clinimag.2020.07.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/03/2020] [Accepted: 07/23/2020] [Indexed: 12/22/2022]
Abstract
Nuclear protein of the testis (NUT) carcinoma (NC) (formerly known as NUT midline carcinoma) is an aggressive pleomorphic squamous cell carcinoma with a dismal prognosis. Primary NC tumors are commonly located in the chest or head and neck regions. Imaging plays an indispensable role in the staging, management, treatment response assessment, and surveillance of NC. Primary pulmonary NC usually presents as a large mass with lymphadenopathy and pleural involvement. Primary head and neck NC presents as a large expansile necrotic mass in the sinonasal region with locoregional destruction and occasional cervical lymph node involvement. These imaging features are relatively non-specific but are consistent among patients. Currently, there are no standardized guidelines for the treatment of NC. Because of its rarity, paucity of reports in the medical literature, and the lack of awareness among radiologists, NUT carcinoma (NC) has been largely underdiagnosed and misdiagnosed. Clinical aggressive features and pleomorphic/undifferentiated squamous cell carcinoma should prompt genetic evaluation for NUT translocation to diagnose NC. In this article, we discuss NC's clinicopathologic and imaging features and treatment options, including emerging new treatments.
Collapse
Affiliation(s)
- Mayur Virarkar
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
| | - Mohammed Saleh
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Nisha Subhashchandra Ramani
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Ajaykumar C Morani
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Priya Bhosale
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| |
Collapse
|
12
|
Tumor Primary Location May Affect Metastasis Pattern for Patients with Stage IV NSCLC: A Population-Based Study. JOURNAL OF ONCOLOGY 2020; 2020:4784701. [PMID: 32695165 PMCID: PMC7368215 DOI: 10.1155/2020/4784701] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/30/2020] [Indexed: 12/26/2022]
Abstract
Background Most patients with nonsmall cell lung cancer (NSCLC) were initially diagnosed with distant metastasis. At present, there is no study to clarify the correlation between the primary location of the tumor and the metastasis pattern in advanced NSCLC. So we conducted this study to explored the relationship between the tumor primary location and metastasis pattern in stage IV NSCLC. Methods A total of 19,295 eligible patients were identified from 2010 to 2012 in the SEER database. The main endpoint of our study was overall survival (OS). The survival curves were created by using the Kaplan-Meier method and compared by the usage of the Log Rank test. The clinical variable characteristics were compared by the chi-square test, and multivariate logistic regression analyses were used to evaluate the risk factors on metastasis patterns. All statistical P values were two-sided, and it was considered statistically significant when P ≤ 0.05. Results We found that different proportions of metastatic sites could be found in different tumor primary locations. In addition, the prognosis of lung metastasis was relatively good in patients with tumor location in main bronchus (P < 0.001), upper lobe (P < 0.001), lower lobe (P < 0.001) , and middle lobe (P = 0.005). Besides, there was no significant OS difference for patients whose primary location was overlapping lesion (P = 0.226). The results also demonstrated that compared with patients with primary tumor located in the main bronchus, those in the upper lobe were more likely to have brain metastasis (P = 0.01) and lung metastasis (P = 0.024), those in the middle lobe were more prone to develop lung metastasis (P = 0.035) and those in the lower lobe were more apt to cause bone metastasis (P = 0.005) and lung metastasis (P = 0.001). In addition, there was no statistical difference in metastasis patterns among patients with overlapping lesions (P > 0.05). Conclusions Different primary tumor locations might affect the metastasis pattern in patients with stage IV NSCLC.
Collapse
|
13
|
Bingula R, Filaire E, Molnar I, Delmas E, Berthon JY, Vasson MP, Bernalier-Donadille A, Filaire M. Characterisation of microbiota in saliva, bronchoalveolar lavage fluid, non-malignant, peritumoural and tumour tissue in non-small cell lung cancer patients: a cross-sectional clinical trial. Respir Res 2020; 21:129. [PMID: 32450847 PMCID: PMC7249392 DOI: 10.1186/s12931-020-01392-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 05/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND While well-characterised on its molecular base, non-small cell lung cancer (NSCLC) and its interaction with local microbiota remains scarcely explored. Moreover, current studies vary in source of lung microbiota, from bronchoalveolar lavage fluid (BAL) to tissue, introducing potentially differing results. Therefore, the objective of this study was to provide detailed characterisation of the oral and multi-source lung microbiota of direct interest in lung cancer research. Since lung tumours in lower lobes (LL) have been associated with decreased survival, characteristics of the microbiota in upper (UL) and lower tumour lobes have also been examined. METHODS Using 16S rRNA gene sequencing technology, we analysed microbiota in saliva, BAL (obtained directly on excised lobe), non-malignant, peritumoural and tumour tissue from 18 NSCLC patients eligible for surgical treatment. Detailed taxonomy, diversity and core members were provided for each microbiota, with analysis of differential abundance on all taxonomical levels (zero-inflated binomial general linear model with Benjamini-Hochberg correction), between samples and lobe locations. RESULTS Diversity and differential abundance analysis showed clear separation of oral and lung microbiota, but more importantly, of BAL and lung tissue microbiota. Phylum Proteobacteria dominated tissue samples, while Firmicutes was more abundant in BAL and saliva (with class Clostridia and Bacilli, respectively). However, all samples showed increased abundance of phylum Firmicutes in LL, with decrease in Proteobacteria. Also, clades Actinobacteria and Flavobacteriia showed inverse abundance between BAL and extratumoural tissues depending on the lobe location. While tumour microbiota seemed the least affected by location, peritumoural tissue showed the highest susceptibility with markedly increased similarity to BAL microbiota in UL. Differences between the three lung tissues were however very limited. CONCLUSIONS Our results confirm that BAL harbours unique lung microbiota and emphasise the importance of the sample choice for lung microbiota analysis. Further, limited differences between the tissues indicate that different local tumour-related factors, such as tumour type, stage or associated immunity, might be the ones responsible for microbiota-shaping effect. Finally, the "shift" towards Firmicutes in LL might be a sign of increased pathogenicity, as suggested in similar malignancies, and connected to worse prognosis of the LL tumours. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT03068663. Registered February 27, 2017.
Collapse
Affiliation(s)
- Rea Bingula
- Université Clermont Auvergne, INRAE, UNH, F-63000 Clermont–Ferrand, France
| | - Edith Filaire
- Université Clermont Auvergne, INRAE, UNH, F-63000 Clermont–Ferrand, France
- Greentech SA, Biopole Clermont-Limagne, 63360 Saint-Beauzire, France
| | - Ioana Molnar
- Centre Jean Perrin, INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, F-63011 Clermont-Ferrand, France
- Délégation Recherche Clinique & Innovation, Centre Jean Perrin, Centre de Lutte contre le Cancer, F-63011 Clermont-Ferrand, France
- Centre d’Investigation Clinique, UMR501, F-63001 Clermont-Ferrand, France
| | - Eve Delmas
- Université Clermont Auvergne, INRAE, MEDIS, 63122 Saint-Genes-Champanelle, France
| | - Jean-Yves Berthon
- Greentech SA, Biopole Clermont-Limagne, 63360 Saint-Beauzire, France
| | - Marie-Paule Vasson
- Université Clermont Auvergne, INRAE, UNH, F-63000 Clermont–Ferrand, France
- Centre Jean Perrin, CHU Gabriel-Montpied, Clinical Nutrition Unit, F-63000 Clermont-Ferrand, France
| | | | - Marc Filaire
- Université Clermont Auvergne, INRAE, UNH, F-63000 Clermont–Ferrand, France
- Thoracic Surgery Department, Centre Jean Perrin, 63011 Clermont-Ferrand, France
| |
Collapse
|
14
|
[Lung cancer and elective nodal irradiation: A solved issue?]. Cancer Radiother 2019; 23:701-707. [PMID: 31501024 DOI: 10.1016/j.canrad.2019.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/27/2019] [Indexed: 12/25/2022]
Abstract
Lung cancer treatment is a heavy workload for radiation oncologist and that field showed many evolutions over the last two decades. The issue about target volume was raised when treatment delivery became more precise with the development of three-dimensional conformal radiotherapy. Initially based upon surgical series, numerous retrospective and prospective studies aimed to evaluate the risk of elective nodal failure of involved-field radiotherapy compared to standard large field elective nodal irradiation. In every setting, locally advanced non-small cell lung cancer, localized non-small cell lung cancer, localized small cell lung cancer, exclusive chemoradiation or postoperative radiotherapy, most of the studies showed no significant difference between involved-field radiotherapy or elective nodal irradiation with elective nodal failure rate under 5% at 2 years, provided staging had been done with modern imaging and diagnostic techniques (positron emission tomography scan, endoscopy, etc.). Moreover, if reducing irradiated volumes are safe regarding recurrences, involved-field radiotherapy allowed dose escalation while reducing acute and late oesophageal, cardiac and pulmonary toxicities. Consequently, major clinical trials involving radiotherapy initiated in the last two decades and international clinical guidelines recommended omission of elective nodal irradiation in favour of in-field radiotherapy.
Collapse
|
15
|
Yang MZ, Hou X, Liang RB, Lai RC, Yang J, Li S, Long H, Fu JH, Lin P, Wang X, Rong TH, Yang HX. The incidence and distribution of mediastinal lymph node metastasis and its impact on survival in patients with non-small-cell lung cancers 3 cm or less: data from 2292 cases. Eur J Cardiothorac Surg 2019; 56:159-166. [DOI: 10.1093/ejcts/ezy479] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Abstract
OBJECTIVES
Our goal was to investigate the incidence and distribution of mediastinal lymph node metastases (MLNM) in non-small-cell lung cancers (NSCLC) 3 cm or less, with the purpose of guiding mediastinal lymph node dissection.
METHODS
A total of 2292 cases seen between January 2001 and December 2014 were included. These patients were grouped according to the lobes with the primary tumours. The incidence and distribution of pathological MLNM were compared among the groups. The impact of MLNM on overall survival was also compared.
RESULTS
The most common mediastinal metastatic sites for different primary tumour lobes were as follows: right upper lobe, 17.7% (87/492) for level 4R; right middle lobe, 14.9% (28/188) for level 7; right lower lobe, 19.8% (82/414) for level 7; left upper lobe, 18.2% (96/528) for level 5; and left lower lobe, 16.6% (42/253) for level 7. For patients with tumours in the upper lobe, the median survival time was 32 months for those with MLNM in the subcarinal zone or lower zone compared with 83 months for those with MLNM only in the upper zone (P < 0.01). When the tumours were 1 cm or less, the incidence of MLNM to the lower zone for upper lobe tumours and of MLNM to the upper zone for lower lobe tumours was zero.
CONCLUSIONS
Different primary NSCLC lobe locations have a different propensity to be sites of MLNM for those tumours that are 3 cm or less. For tumours no larger than 1 cm, a lower zone mediastinal lymph node dissection might be unnecessary for upper lobe tumours and an upper zone mediastinal lymph node dissection might be unnecessary for lower lobe tumours.
Collapse
Affiliation(s)
- Mu-Zi Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, PR China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Xue Hou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Run-Bin Liang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, PR China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Ren-Chun Lai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
- Department of Anesthesiology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Jie Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, PR China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Shuo Li
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, PR China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Hao Long
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, PR China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Jian-Hua Fu
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, PR China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Peng Lin
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, PR China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Xin Wang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, PR China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Tie-Hua Rong
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, PR China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Hao-Xian Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, PR China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| |
Collapse
|
16
|
Zhao F, Zhen FX, Zhou Y, Huang CJ, Yu Y, Li J, Li QF, Zhu CX, Yang XY, You SH, Wu QG, Qin XY, Liu Y, Chen L, Wang W. Clinicopathologic predictors of metastasis of different regional lymph nodes in patients intraoperatively diagnosed with stage-I non-small cell lung cancer. BMC Cancer 2019; 19:444. [PMID: 31088404 PMCID: PMC6518627 DOI: 10.1186/s12885-019-5632-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 04/23/2019] [Indexed: 12/22/2022] Open
Abstract
Background Selection of the best lymph node for dissection is a controversial topic in clinical stage-I non-small cell lung cancer (NSCLC). Here, we sought to identify the clinicopathologic predictors of regional lymph node metastasis in patients intraoperatively diagnosed with stage-I NSCLC. Methods A retrospective review of 595 patients intraoperatively diagnosed as stage I non-small-cell lung cancer who underwent lobectomy with complete lymph node dissection was performed. Univariate and multivariable logistic regression analysis was performed to determine the independent predictors of regional lymph node metastasis. Results Univariate logistic regression and multivariable analysis revealed three independent predictors of the presence of metastatic hilar lymph nodes, five independent predictors for lobe specific mediastinal lymph nodes, two independent predictors for lobe nonspecific mediastinal lymph nodes and two independent predictors for skipping mediastinal lymph nodes. Conclusions A complete mediastinal lymph node dissection may be considered for patients suspected of nerve invasion and albumin (> 43.1 g/L) or nerve and vascular invasions. Lobe-specific lymph node dissection should probably be performed for patients suspected of pulmonary membrane invasion, vascular invasion, CEA (> 2.21 ng/mL), and tumor (> 1.6 cm) in the right lower lobe or mixed lobes. Hilar lymph node dissection should probably be performed for patients suspected of having bronchial mucosa and cartilage invasion, vascular invasion, and CEA (> 2.21 ng/mL). Electronic supplementary material The online version of this article (10.1186/s12885-019-5632-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Fei Zhao
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Fu-Xi Zhen
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Yue Zhou
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Chen-Jun Huang
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Yue Yu
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Jun Li
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Qi-Fan Li
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Cheng-Xiang Zhu
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Xiao-Yu Yang
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Shu-Hui You
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Qian-Ge Wu
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Xue-Yun Qin
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Yi Liu
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Liang Chen
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
| | - Wei Wang
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
| |
Collapse
|
17
|
Liang RB, Yang J, Zeng TS, Long H, Fu JH, Zhang LJ, Lin P, Wang X, Rong TH, Hou X, Yang HX. Incidence and Distribution of Lobe-Specific Mediastinal Lymph Node Metastasis in Non-small Cell Lung Cancer: Data from 4511 Resected Cases. Ann Surg Oncol 2018; 25:3300-3307. [DOI: 10.1245/s10434-018-6394-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Indexed: 08/30/2023]
|
18
|
Kenamond MC, Siochi RA, Mattes MD. The dosimetric effects of limited elective nodal irradiation in volumetric modulated arc therapy treatment planning for locally advanced non-small cell lung cancer. ACTA ACUST UNITED AC 2018; 7:45-51. [PMID: 30220961 DOI: 10.1007/s13566-017-0327-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective Contemporary radiotherapy guidelines for locally advanced non-small cell lung carcinoma (LA-NSCLC) recommend omitting elective nodal irradiation, despite the fact that evidence supporting this came primarily from older reports assessing comprehensive nodal coverage using 3D conformal techniques. Herein, we evaluated the dosimetric implications of the addition of limited elective nodal irradiation (LENI) to standard involved field irradiation (IFI) using volumetric modulated arc therapy (VMAT) planning. Method Target volumes and organs-at-risk (OARs) were delineated on CT simulation images of 20 patients with LA-NSCLC. Two VMAT plans (IFI and LENI) were generated for each patient. Involved sites were treated to 60 Gy in 30 fractions for both IFI and LENI plans. Adjacent uninvolved nodal regions, considered high risk based on the primary tumor site and extent of nodal involvement, were treated to 51 Gy in 30 fractions in LENI plans using a simultaneous integrated boost approach. Results All planning objectives for PTVs and OARs were achieved for both IFI and LENI plans. LENI resulted in significantly higher esophagus Dmean (15.3 vs. 22.5 Gy, p < 0.01), spinal cord Dmax (34.9 vs. 42.4 Gy, p = 0.02) and lung Dmean (13.5 vs. 15.9 Gy, p = 0.02), V20 (23.0 vs. 27.9%, p = 0.03), and V5 (52.6 vs. 59.4%, p = 0.02). No differences were observed in heart parameters. On average, only 32.2% of the high-risk nodal volume received an incidental dose of 51 Gy when untargeted in IFI plans. Conclusion The addition of LENI to VMAT plans for LA-NSCLC is feasible, with only modestly increased doses to OARs and marginal expected increase in associated toxicity.
Collapse
Affiliation(s)
- Mark C Kenamond
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - R Alfredo Siochi
- Department of Radiation Oncology, West Virginia University, One Medical Center Drive, PO Box 9234, Morgantown, WV, USA
| | - Malcolm D Mattes
- Department of Radiation Oncology, West Virginia University, One Medical Center Drive, PO Box 9234, Morgantown, WV, USA
| |
Collapse
|
19
|
Shaverdian N, Veruttipong D, Wang J, Kupelian P, Steinberg M, Lee P. Location Matters: Stage I Non-Small-cell Carcinomas of the Lower Lobes Treated With Stereotactic Body Radiation Therapy Are Associated With Poor Outcomes. Clin Lung Cancer 2016; 18:e137-e142. [PMID: 27908620 DOI: 10.1016/j.cllc.2016.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/01/2016] [Accepted: 09/06/2016] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The lung is a heterogeneous organ with relative overperfusion of the lung bases. We determined whether a lower lobe primary tumor location was associated with poor outcomes in the setting of stage I non-small-cell lung cancer (NSCLC) treated with stereotactic body radiation therapy (SBRT). PATIENTS AND METHODS The data from consecutive patients with stage I NSCLC treated from 2009 to 2014 with curative intent SBRT were analyzed. Primary tumors in the right and left lower lobes were compared against the tumors in all other locations to determine whether a lower lobe location was associated with worse local, regional, and distant control and worse relapse-free and overall survival. The survival rates were estimated using Kaplan-Meier analysis, and multivariate analysis was completed using the Cox proportional hazards model, adjusting for age, stage, performance status, and radiation dose. RESULTS A total of 122 patients with early-stage NSCLC who underwent SBRT were evaluated at a median follow-up period of 28.6 months. On multivariate analysis, lower lobe tumors were associated with poor relapse-free survival (hazard ratio [HR], 2.78; 95% confidence interval [CI], 1.21-7.76; P = .04) and poor overall survival (HR, 2.33; 95% CI, 1.09-5.64; P = .04). The 3-year relapse-free survival for patients with a lower lobe primary was 75% compared with 89% for patients with a non-lower lobe primary (P = .04). Additionally, the 3-year overall survival rate for patients with a lower lobe primary was 63% versus 82% in patients with a non-lower lobe primary (P = .01). CONCLUSION Lower lobe stage I NSCLC tumors treated with SBRT are associated with poor relapse-free and overall survival.
Collapse
Affiliation(s)
- Narek Shaverdian
- Department of Radiation Oncology, University of California, Los Angeles, School of Medicine, Los Angeles, CA
| | - Darlene Veruttipong
- Department of Radiation Oncology, University of California, Los Angeles, School of Medicine, Los Angeles, CA
| | - Jason Wang
- Department of Radiation Oncology, University of California, Los Angeles, School of Medicine, Los Angeles, CA
| | - Patrick Kupelian
- Department of Radiation Oncology, University of California, Los Angeles, School of Medicine, Los Angeles, CA
| | - Michael Steinberg
- Department of Radiation Oncology, University of California, Los Angeles, School of Medicine, Los Angeles, CA
| | - Percy Lee
- Department of Radiation Oncology, University of California, Los Angeles, School of Medicine, Los Angeles, CA.
| |
Collapse
|
20
|
Riquet M, Pricopi C, Arame A, Le Pimpec Barthes F. From anatomy to lung cancer: questioning lobe-specific mediastinal lymphadenectomy reliability. J Thorac Dis 2016; 8:2387-2390. [PMID: 27746983 DOI: 10.21037/jtd.2016.08.90] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Marc Riquet
- General Thoracic Surgery Department, Georges Pompidou European Hospital, Paris, France
| | - Ciprian Pricopi
- General Thoracic Surgery Department, Georges Pompidou European Hospital, Paris, France
| | - Alex Arame
- General Thoracic Surgery Department, Georges Pompidou European Hospital, Paris, France
| | | |
Collapse
|
21
|
Ding N, Mao Y. [Advances in Lymph Node Metastasis and the Modes of Lymph Node
Dissection in Early Stage Non-small Cell Lung Caner]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:359-63. [PMID: 27335297 PMCID: PMC6015195 DOI: 10.3779/j.issn.1009-3419.2016.06.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
目前,肺癌已是全球范围内发病率及死亡率最高的恶性肿瘤,非小细胞肺癌(non-small cell lung cancer, NSCLC)约占肺癌80%。手术治疗在早期NSCLC治疗中占主导地位,而淋巴结分期及手术中清扫程度直接影响着患者术后生活质量及患者的预后。解剖性肺叶切除加系统性淋巴结清扫一直以来被认为是NSCLC的标准手术方式,但对早期NSCLC患者纵隔淋巴结清扫程度问题上一直存在较大争议,精确评估区域淋巴结的转移及淋巴结清扫的程度是影响患者围手术期并发症和预后的重要因素。对于早期肺癌行肺叶特异性或选择性淋巴结清扫已逐渐为国内外学者接受,并可能成为临床Ⅰ期NSCLC患者标准淋巴结清扫方式。
Collapse
Affiliation(s)
- Ningning Ding
- Department of Thoracic Surgery, Chinese Academy of Medical Sciences Cancer Hospital, Peking Union Medical College,
National Cancer Institute, Beijing 100021, China
| | - Yousheng Mao
- Department of Thoracic Surgery, Chinese Academy of Medical Sciences Cancer Hospital, Peking Union Medical College,
National Cancer Institute, Beijing 100021, China
| |
Collapse
|
22
|
Kuroda H, Sakao Y, Mun M, Motoi N, Ishikawa Y, Nakagawa K, Yatabe Y, Okumura S. Therapeutic value of lymph node dissection for right middle lobe non-small-cell lung cancer. J Thorac Dis 2016; 8:795-802. [PMID: 27162652 DOI: 10.21037/jtd.2016.03.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Superior mediastinal and #11i lymph node (LN) metastases are adverse prognostic factors in patients with middle lobe lung cancer. We aimed to clarify the benefit of thorough lymphadenectomy by LN station or zone in middle lobe non-small-cell lung cancer (NSCLC). METHODS Among 295 patients who underwent pulmonary resection and thorough lymphadenectomy for primary right middle lobe (RML) NSCLC at two institutions, we enrolled 68 patients (33 men, 35 women) and retrospectively studied their data. We divided each N1 location (i.e., #10, #11s and #11i) into N1(-)N2(+) and N1(+)N2(+) and divided the #12m location into N1(+)N2(-), N1(-)N2(+) and N1(+)N2(+). RESULTS Interlobar node involvement was rare in pN1 NSCLC when compared with that in other N1 nodes. Lymph node dissection (LND) was beneficial when the hilar zone (HZ)/interlobar zone (IZ) LNs were located at the intermediate point of the upper zones (UZs) and subcarinal zones (SCZs), with the therapeutic benefit at the SCZ being 2.8-fold higher than that at the UZ and 9.7-fold higher than that at the lower zone (LZ). Furthermore, LND evidently had greater therapeutic value for the SCZ than the UZ, which was compatible with skip N2 metastases. CONCLUSIONS For middle lobe NSCLC, mediastinal LND should be considered a priority in the SCZ than in the UZ. Moreover, the HZ/IZ is central to unfavourable prognoses in patients with pN2 middle lobe NSCLC.
Collapse
Affiliation(s)
- Hiroaki Kuroda
- 1 Department of Thoracic Surgery, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya 464-8681, Japan ; 2 Department of Thoracic Surgical Oncology, 3 Department of Pathology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Kotouku, Tokyo 135-8550, Japan ; 4 Department of Pathology and Molecular Diagnosis, Aichi Cancer Hospital, Chikusa-ku, Nagoya 464-8681, Japan
| | - Yukinori Sakao
- 1 Department of Thoracic Surgery, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya 464-8681, Japan ; 2 Department of Thoracic Surgical Oncology, 3 Department of Pathology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Kotouku, Tokyo 135-8550, Japan ; 4 Department of Pathology and Molecular Diagnosis, Aichi Cancer Hospital, Chikusa-ku, Nagoya 464-8681, Japan
| | - Mingyon Mun
- 1 Department of Thoracic Surgery, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya 464-8681, Japan ; 2 Department of Thoracic Surgical Oncology, 3 Department of Pathology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Kotouku, Tokyo 135-8550, Japan ; 4 Department of Pathology and Molecular Diagnosis, Aichi Cancer Hospital, Chikusa-ku, Nagoya 464-8681, Japan
| | - Noriko Motoi
- 1 Department of Thoracic Surgery, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya 464-8681, Japan ; 2 Department of Thoracic Surgical Oncology, 3 Department of Pathology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Kotouku, Tokyo 135-8550, Japan ; 4 Department of Pathology and Molecular Diagnosis, Aichi Cancer Hospital, Chikusa-ku, Nagoya 464-8681, Japan
| | - Yuichi Ishikawa
- 1 Department of Thoracic Surgery, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya 464-8681, Japan ; 2 Department of Thoracic Surgical Oncology, 3 Department of Pathology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Kotouku, Tokyo 135-8550, Japan ; 4 Department of Pathology and Molecular Diagnosis, Aichi Cancer Hospital, Chikusa-ku, Nagoya 464-8681, Japan
| | - Ken Nakagawa
- 1 Department of Thoracic Surgery, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya 464-8681, Japan ; 2 Department of Thoracic Surgical Oncology, 3 Department of Pathology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Kotouku, Tokyo 135-8550, Japan ; 4 Department of Pathology and Molecular Diagnosis, Aichi Cancer Hospital, Chikusa-ku, Nagoya 464-8681, Japan
| | - Yasushi Yatabe
- 1 Department of Thoracic Surgery, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya 464-8681, Japan ; 2 Department of Thoracic Surgical Oncology, 3 Department of Pathology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Kotouku, Tokyo 135-8550, Japan ; 4 Department of Pathology and Molecular Diagnosis, Aichi Cancer Hospital, Chikusa-ku, Nagoya 464-8681, Japan
| | - Sakae Okumura
- 1 Department of Thoracic Surgery, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya 464-8681, Japan ; 2 Department of Thoracic Surgical Oncology, 3 Department of Pathology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Kotouku, Tokyo 135-8550, Japan ; 4 Department of Pathology and Molecular Diagnosis, Aichi Cancer Hospital, Chikusa-ku, Nagoya 464-8681, Japan
| |
Collapse
|
23
|
Xiong J, Wang R, Sun Y, Chen H. Lymph node metastasis according to primary tumor location in T1 and T2 stage non-small cell lung cancer patients. Thorac Cancer 2016; 7:304-9. [PMID: 27148415 PMCID: PMC4846618 DOI: 10.1111/1759-7714.12328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/23/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To evaluate the pattern of lymph node metastasis (LNM) according to primary tumor location in T1 and T2 stage non-small cell lung cancer (NSCLC) patients. METHODS The data of 1916 NSCLC patients with LNM who underwent surgery with systematic nodal resection between November 2008 to December 2014 were included in the study. Analyses of tumor location, pathological T stage, and nodal metastasis were performed. RESULTS In T1a stage patients, superior mediastinum, aortopulmonary, and inferior mediastinum lymph node metastases were observed in primary tumors present in the right upper lobe (RUL), left upper lobe (LUL) and right middle lobe (RML), respectively. In T1b-stage patients, superior mediastinum, aortopulmonary, and inferior mediastinum lymph node metastases were observed in the RML, LUL, and right lower lobe (RLL), respectively. In patients with T2a-stage, superior mediastinum, aortopulmonary and inferior mediastinum lymph node metastases were observed in the RUL, LUL, and RLL, respectively. However, in T2b-stage patients, RUL, LUL and RML locations were associated with superior mediastinum, aortopulmonary, and inferior mediastinum lymph node metastases, respectively. Multivariable logistic regression showed that T stage was significantly associated with mediastinal and intrapulmonary lymph node metastases. In addition, tumor location was significantly associated with N2 station LNM. CONCLUSION LNM varied according to tumor location and T-stage, which are independent factors influencing N2 station LNM.
Collapse
Affiliation(s)
- Jian Xiong
- Department of Thoracic Surgery Fudan University Shanghai Cancer Center Shanghai China; Department of Oncology Shanghai Medical College Fudan University Shanghai China
| | - Rui Wang
- Department of Thoracic Surgery Fudan University Shanghai Cancer Center Shanghai China; Department of Oncology Shanghai Medical College Fudan University Shanghai China
| | - Yihua Sun
- Department of Thoracic Surgery Fudan University Shanghai Cancer Center Shanghai China; Department of Oncology Shanghai Medical College Fudan University Shanghai China
| | - Haiquan Chen
- Department of Thoracic Surgery Fudan University Shanghai Cancer Center Shanghai China; Department of Oncology Shanghai Medical College Fudan University Shanghai China
| |
Collapse
|
24
|
F-18-FDG-avid lymph node metastasis along preferential lymphatic drainage pathways from the tumor-bearing lung lobe on F-18-FDG PET/CT in patients with non-small-cell lung cancer. Ann Nucl Med 2016; 30:287-97. [PMID: 27007128 DOI: 10.1007/s12149-016-1063-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 01/17/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE F-18-FDG-avid lymph node (LN) metastasis may preferentially occur along the lymphatic drainage pathway (LDP) from the tumor-bearing lobe in patients with non-small cell lung cancer (NSCLC) on FDG PET/CT. This study evaluated whether the identification of metastatic LNs according to LDP-based visual image interpretation can improve LN staging on FDG PET/CT in these patients. METHODS FDG PET/CT study was performed in 265 patients with NSCLC. The presence and LN station of metastatic LNs were determined by surgery or the clinical course. In the LDP-based interpretation, FDG-avid LNs, which were located along the preferential LDP from each tumor-bearing lobe and visually more intense in FDG uptake compared with the remaining LNs straying away from the preferential LDP, were diagnosed as metastatic. The result was compared with the quantitative method using a cutoff value of 2.5 for the maximum standardized uptake value. RESULTS Of the total 1031 mediastinal and hilar LN stations with FDG-avid LNs in 265 patients, 179 stations in 66 patients were metastatic and the remaining 852 were benign. All the metastatic LN stations except for 2 stations showing skip metastasis were located along the main preferential LDP or another preferential LDP via a direct anatomic pathway from each tumor-bearing lung lobe. The specificity, accuracy, and PPV for identifying metastatic LN stations by LDP-based interpretation were 97.9, 95.7 and 89.5 %, respectively, which were significantly greater compared with those of 92.7, 90.8 and 70.3 % by the SUV-based method (P < 0.001). CONCLUSIONS The present study shows that FDG-avid LN metastasis preferentially occurs along the LDP from the tumor-bearing lobe in NSCLC patients. LDP-based visual image interpretation on FDG PET/CT can improve LN staging in these patients.
Collapse
|
25
|
Komatsu T, Kunieda E, Kitahara T, Akiba T, Nagao R, Fukuzawa T. Dosimetric evaluation of the feasibility of stereotactic body radiotherapy for primary lung cancer with lobe-specific selective elective nodal irradiation. JOURNAL OF RADIATION RESEARCH 2016; 57:75-83. [PMID: 26566656 PMCID: PMC4708921 DOI: 10.1093/jrr/rrv067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/19/2015] [Accepted: 09/29/2015] [Indexed: 06/05/2023]
Abstract
More than 10% of all patients treated with stereotactic body radiotherapy (SBRT) for primary lung cancer develop regional lymph node recurrence. We evaluated the dosimetric feasibility of SBRT with lobe-specific selective elective nodal irradiation (ENI) on dose-volume histograms. A total of 21 patients were treated with SBRT for Stage I primary lung cancer between January 2010 and June 2012 at our institution. The extents of lobe-specific selective ENI fields were determined with reference to prior surgical reports. The ENI fields included lymph node stations (LNS) 3 + 4 + 11 for the right upper lobe tumors, LNS 7 + 11 for the right middle or lower lobe tumors, LNS 5 + 11 for the left upper lobe tumors, and LNS 7 + 11 for the left lower lobe tumors. A composite plan was generated by combining the ENI plan and the SBRT plan and recalculating for biologically equivalent doses of 2 Gy per fraction, using a linear quadratic model. The V20 of the lung, D(1cm3) of the spinal cord, D(1cm3) and D(10cm3) of the esophagus and D(10cm3) of the tracheobronchial wall were evaluated. Of the 21 patients, nine patients (43%) could not fulfill the dose constraints. In all these patients, the distance between the planning target volume (PTV) of ENI (PTVeni) and the PTV of SBRT (PTVsrt) was ≤2.0 cm. Of the three patients who developed regional metastasis, two patients had isolated lymph node failure, and the lymph node metastasis was included within the ENI field. When the distance between the PTVeni and PTVsrt is >2.0 cm, SBRT with selective ENI may therefore dosimetrically feasible.
Collapse
Affiliation(s)
- Tetsuya Komatsu
- Department of Radiation Oncology, Tokai University School of Medicine
| | - Etsuo Kunieda
- Department of Radiation Oncology, Tokai University School of Medicine
| | - Tadashi Kitahara
- Department of Radiation Oncology, Tokai University School of Medicine
| | - Takeshi Akiba
- Department of Radiation Oncology, Tokai University School of Medicine
| | - Ryuta Nagao
- Department of Radiation Oncology, Tokai University School of Medicine
| | - Tsuyoshi Fukuzawa
- Department of Radiation Oncology, Tokai University School of Medicine
| |
Collapse
|
26
|
Lung adenocarcinoma: Are skip N2 metastases different from non-skip? J Thorac Cardiovasc Surg 2015; 150:790-5. [DOI: 10.1016/j.jtcvs.2015.03.067] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 03/24/2015] [Accepted: 03/30/2015] [Indexed: 12/30/2022]
|
27
|
Ding N, Mao Y. [Advances of mediastinal lymph node metastasis and the extent of lymph node
dissection in patients with stage T1 non-small cell lung cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2015; 18:34-41. [PMID: 25603871 PMCID: PMC5999745 DOI: 10.3779/j.issn.1009-3419.2015.01.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
肺癌是我国发病率和死亡率最高的恶性肿瘤。非小细胞肺癌(non-small cell lung cancer, NSCLC)约占肺癌80%。临床上,早期NSCLC以手术治疗为主要治疗方式,淋巴结分期及手术中清扫程度直接影响着患者的预后。不同肺叶原发NSCLC的淋巴结转移区域存在一定规律。解剖性肺叶切除加系统性淋巴结清扫一直以来被认为是NSCLC的标准手术方式,但近年来T1期NSCLC手术中纵隔淋巴结清扫的程度存在较大争议,选择性淋巴结清扫已逐渐被大多数学者所重视。
Collapse
Affiliation(s)
- Ningning Ding
- Department of Thoracic Surgery, Cancer Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences,
Beijing 100021, China
| | - Yousheng Mao
- Department of Thoracic Surgery, Cancer Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences,
Beijing 100021, China
| |
Collapse
|
28
|
A Predictive Model for Lymph Node Involvement with Malignancy on PET/CT in Non–Small-Cell Lung Cancer. J Thorac Oncol 2015. [DOI: 10.1097/jto.0000000000000601] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
29
|
ZHANG NAN, XIE FUBO, GAO WEI, YU SHUWEN, QIU LIYUN, LIN WENLI, SUN YUPING, JIA TANGHONG. Expression of hepatocyte growth factor and c-Met in non-small-cell lung cancer and association with lymphangiogenesis. Mol Med Rep 2014; 11:2797-804. [DOI: 10.3892/mmr.2014.3071] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 11/07/2014] [Indexed: 11/06/2022] Open
|
30
|
Gorai A, Sakao Y, Kuroda H, Uehara H, Mun M, Ishikawa Y, Nakagawa K, Masuda M, Okumura S. The clinicopathological features associated with skip N2 metastases in patients with clinical stage IA non-small-cell lung cancer. Eur J Cardiothorac Surg 2014; 47:653-8. [PMID: 24957260 DOI: 10.1093/ejcts/ezu244] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Understanding the clinicopathological features of patients with skip N2 metastases (SN2) in clinical early stage lung cancer is important for surgical planning and other treatment considerations; however, the factors associated with SN2 are unclear. This study aimed to investigate the clinicopathological features associated with SN2 in patients with clinical stage IA (cIA) non-small-cell lung cancer (NSCLC). METHODS We retrospectively studied patients with cIA NSCLC who underwent pulmonary resection (at least lobectomy) and extensive lymphadenectomy (more than ND2a-1) at our institution between January 2004 and December 2010. We investigated the following factors for their association with SN2: age; sex; tumour marker (carcinoembryonic antigen); tumour size on computed tomography (CT), evaluated with a lung-window (LW) and a mediastinal-window (MW) setting; pathology, with or without adenocarcinoma; differentiation; visceral pleural invasion (VPI) and vascular/lymphatic invasion. RESULTS In total, 422 patients were enrolled, with the following pathological node (pN) statuses: 331 pN0 (78.4%), 39 pN1 (9.3%) and 52 pN2 (12.3%). There were 21 (23.1%) SN2 cases among the patients with nodal metastases. When the cut-off level was defined as a receiver operating characteristic curve with MW (11.5 mm), the sensitivity and specificity of SN2 was 95.2% and 42.9%, respectively. VPI was a statistically independent relevant factor for SN2 in both the patients with cIA and in those with nodal involvement. The VPI classification comprised 59 PL-0 (64.8%), 12 PL-1 (13.2%) and 20 PL-2 (22.0%) with nodal metastases, and there was a significant difference between the three groups (P = 0.03) according to SN2 frequency. There was no difference between VPI 1 and 2 (P = 0.27). CONCLUSIONS In conclusion, our study suggests that the incidence of SN2 is significantly associated with VPI in patients with cIA NSCLC. Although MW (>11.5 mm) had a low specificity in the assessment of SN2, it had a high sensitivity, suggesting the possibility of a superior benefit compared with LW. Standard hilar and mediastinal lymph node dissection should be required in patients with suspicious VPI and MW (>11.5 mm) on preoperative CT.
Collapse
Affiliation(s)
- Atsuo Gorai
- Department of Thoracic Surgical Oncology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Yukinori Sakao
- Department of Thoracic Surgical Oncology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan Department of Thoracic Surgery, Aichi Cancer Center Hospital, Aichi, Japan
| | - Hiroaki Kuroda
- Department of Thoracic Surgical Oncology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan Department of Thoracic Surgery, Aichi Cancer Center Hospital, Aichi, Japan
| | - Hirofumi Uehara
- Department of Thoracic Surgical Oncology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Mingyon Mun
- Department of Thoracic Surgical Oncology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Yuichi Ishikawa
- Department of Pathology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Ken Nakagawa
- Department of Thoracic Surgical Oncology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Sakae Okumura
- Department of Thoracic Surgical Oncology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| |
Collapse
|
31
|
Riquet M, Rivera C, Pricopi C, Arame A, Mordant P, Foucault C, Dujon A, Le Pimpec-Barthes F. Is the lymphatic drainage of lung cancer lobe-specific? A surgical appraisal. Eur J Cardiothorac Surg 2014; 47:543-9. [PMID: 24875885 DOI: 10.1093/ejcts/ezu226] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Nowadays, early-stage lung cancers are more frequently encountered. Selective lymph node (LN) dissection based on lobe-specific lymphatic pathway has been proposed. Our aim was to study nodal involvement according to tumour location. METHODS We reviewed 1779 lobectomized patients and analysed their pathological characteristics according to tumour location: Group 1 (G1), right upper lobe; Group 2 (G2), right middle lobe; Group 3 (G3), right lower lobe; Group 4 (G4), left upper division; Group 5 (G5), lingula; Group 6 (G6), left lower lobe. The pN status was recorded for each group to analyse the lymphatic spread of non-small-cell lung cancer (NSCLC) according to tumour location. RESULTS The numbers and proportions of lobectomies in each group were 613 patients in G1 (59.2%), 64 in G2 (6.4%), 359 in G3 (34.6%), 404 in G4 (54.3%), 54 in G5 (7.3%) and 286 in G6 (38.4%). The rates of pN2 involvement were similar, whatever the group was, even when deciphering single- and multistation diseases. on the right side, single-station N2 disease was mainly found in the superior mediastinum (SM) for G1 (95%), and in the inferior for G3 (90%). On the left side, single-station N2 was mainly found in the SM in G4 (94%), and the inferior in G6 (48%). Whatever the side, in case of two-station involvement, both mediastina were concerned in 40% (in G4) to 81% of the case (in G3). Long-term survival rates were different in skip metastasis, single- and multistation involvement, but not between lobes. CONCLUSIONS Tumour location is not a predictor of nodal metastasis pattern. In surgical treatment of NSCLC, complete systematic mediastinal LN dissection remains the only acceptable procedure from an oncological point of view.
Collapse
Affiliation(s)
- Marc Riquet
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Caroline Rivera
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Ciprian Pricopi
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Alex Arame
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Pierre Mordant
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Christophe Foucault
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Antoine Dujon
- Department of General Thoracic Surgery, Cedar Surgical Centre, Bois-Guillaume, France
| | - Françoise Le Pimpec-Barthes
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France
| |
Collapse
|
32
|
Wang W, Mao F, Shen-Tu Y, Mei Y. [Research for mediastinal lymph node desection style of stage Ib upper lobe non-small cell lung cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 16:584-90. [PMID: 24229624 PMCID: PMC6000618 DOI: 10.3779/j.issn.1009-3419.2013.11.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
背景与目的 淋巴转移是肺癌最主要的转移途径,也是影响肺癌患者预后的主要因素之一。现有的研究显示上叶肺癌较之中、下叶肺癌更易发生区域性纵隔淋巴结转移。本研究回顾分析Ib期上叶非小细胞肺癌(non-small cell lung cancer, NSCLC)纵隔淋巴结清扫方式的选择及影响预后的相关因素。 方法 147例行肺上叶完全性切除术的NSCLC患者,其中左肺上叶71例,右肺上叶76例。术后病理均为Ib期(T2aN0M0)。术中共清扫淋巴结925枚,其中纵隔淋巴结491枚(上纵隔组266枚,下纵隔组225枚)。采用Kaplan-Meier乘积法和Log-rank检验对患者进行单因素生存分析,采用Cox回归模型进行多因素生存分析。 结果 ① 单因素及多因素分析均显示:年龄、肿瘤直径及上纵隔淋巴结清扫站数是影响患者预后的重要因素;②对于Ib期右肺上叶NSCLC,#4组淋巴结与预后存在统计学意义(P=0.021),而对于Ib期左肺上叶NSCLC,#5组淋巴结与预后存在统计学意义(P=0.024)。 结论 对于Ib期上叶NSCLC而言,年龄、肿瘤直径及上纵隔淋巴结清扫站数是影响患者预后的重要因素;对于此类患者,采用肺叶特异性系统性淋巴结清扫或许是更为高效的手术方式。
Collapse
Affiliation(s)
- Wenli Wang
- Department of Thoracic and Cardiovascular Surgery, Tongji Hospital, Affliated to Tongji University, Shanghai 200065, China
| | | | | | | |
Collapse
|
33
|
Is the rate of pneumonectomy higher in right middle lobe lung cancer than in other right-sided locations? Ann Thorac Surg 2013; 97:402-7. [PMID: 24365214 DOI: 10.1016/j.athoracsur.2013.10.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 10/15/2013] [Accepted: 10/18/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Historically, right middle lobe (RML) non-small cell lung cancer (NSCLC) has been reported to be associated with a higher rate of pneumonectomy than other right-sided locations. Because this would discourage minimally invasive approaches in RML-NSCLC, we sought to update this assertion through the study of a large surgical series. METHODS Clinical records of patients who underwent operations for right-sided NSCLC in 2 French surgical centers were prospectively entered and retrospectively reviewed. Demographic and pathologic characteristics of RML NSCLC were compared with other right-sided NSCLC. RESULTS This study included 3,234 right-sided and 211 RML (6.5%) NSCLC patients. After exclusion of 14 patients who underwent exploratory thoracotomy, patients were a mean age of 61.5 years, most RML resections occurred in men (134 [72.8%]), and most were lobectomies (wedge, n=4; lobectomy, n=102; bilobectomy, n=22; pneumonectomy, n=56). Pathologic analysis revealed adenocarcinoma in 88 patients (47.8%) and squamous cell carcinoma in 80 (43.5%). pStaging was stage I in 86 patients (46.7%), II in 42 (22.8%), III in 47 (25.5%), and IV in 9 (4.9%). Superior and inferior mediastinal N2 were found in 45.4% and 54.6% of patients, respectively, when 1 station was involved. When compared with other right-sided NSCLC, RML was characterized by higher T status and higher rates of bilobectomy (10.9% vs 5.6%, p=0.0017) and pneumonectomy (30.3% vs 22.3%, p=0.0071) but similar 5-year survival (47.4%). CONCLUSIONS Compared with other right-sided NSCLC, RML location is associated with a higher albeit limited rate of pneumonectomy.
Collapse
|
34
|
Jouin A, Pourel N. Marges dans le cancer pulmonaire : volume cible interne/volume cible anatomoclinique. Cancer Radiother 2013; 17:428-33. [DOI: 10.1016/j.canrad.2013.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 05/25/2013] [Indexed: 10/26/2022]
|
35
|
Prognostic Factors for Survival of Stage IB Upper Lobe Non-small Cell Lung Cancer Patients: A Retrospective Study in Shanghai, China. Chin J Cancer Res 2013; 23:265-70. [PMID: 23359092 DOI: 10.1007/s11670-011-0265-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 05/27/2011] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVE To identify clinical and pathologic factors that were associated with the survival of stage IB upper lobe non-small cell lung cancer (NSCLC) patients. METHODS A retrospective study of 147 subjects who had undergone curative resection for stage IB upper lobe NSCLC was performed. Patients who had received any adjuvant or neo-adjuvant chemotherapy were excluded. Survival function curves were estimated using the Kaplan-Meier procedure. Crude and adjusted hazard ratios (HRs) of potential prognostic factors were estimated using Cox proportional hazards models. RESULTS Five factors, including age, tumor size, histologic grade of differentiation, number of removed superior mediastinal lymph node stations and presence of visceral pleura invasion, were significantly and independently associated with mortality risk. Adjusted HRs were 2.6 [95% confidence interval (95% CI): 1.1-6.5] and 4.6 (95% CI: 1.9-11) for those aged 58-68 years and those >68 years, respectively, relative to those aged <58 years. HRs for those with poorly and moderately differentiated tumors were 6.4 (95% CI: 2.3-18) and 1.4 (95% CI: 0.7-2.8), respectively. HRs for those with tumor size 3.1-5 cm and >5 cm (vs≤3.0 cm) were 2.3 (95% CI: 1.1-4.9) and 4.3 (95% CI: 1.9-10), respectively. The presence of visceral pleura invasion also increased the risk of mortality (HR=4.0, 95% CI: 1.3-12). CONCLUSION Advanced age, larger tumor size, poorly differentiated histology, smaller number of removed superior mediastinal lymph node stations, and presence of visceral pleura invasion were associated with poor survival of surgically treated stage IB upper lobe NSCLC patients.
Collapse
|
36
|
Abelson JA, Murphy JD, Trakul N, Bazan JG, Maxim PG, Graves EE, Quon A, Le QT, Diehn M, Loo BW. Metabolic imaging metrics correlate with survival in early stage lung cancer treated with stereotactic ablative radiotherapy. Lung Cancer 2012; 78:219-24. [PMID: 23009727 DOI: 10.1016/j.lungcan.2012.08.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 08/14/2012] [Accepted: 08/27/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE To test whether (18)F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) imaging metrics correlate with outcomes in patients with stage I non-small cell lung cancer (NSCLC) treated with stereotactic ablative radiotherapy (SABR). MATERIAL AND METHODS Fifty-four patients with stage I NSCLC underwent pre-SABR PET at simulation and/or post-SABR PET within 6 months. We analyzed maximum standardized uptake value (SUV(max)) and metabolic tumor volume defined using several thresholds (MTV50%, or MTV2, 4, 7, and 10). Endpoints included primary tumor control (PTC), progression-free survival (PFS), overall survival (OS) and cancer-specific survival (CSS). We performed Kaplan-Meier, competing risk, and Cox proportional hazards survival analyses. RESULTS Patients received 25-60 Gy in 1 to 5 fractions. Median follow-up time was 13.2 months. The 1-year estimated PTC, PFS, OS and CSS were 100, 83, 87 and 94%, respectively. Pre-treatment SUV(max) (p=0.014), MTV(7) (p=0.0077), and MTV(10) (p=0.0039) correlated significantly with OS. In the low-MTV(7)vs. high-MTV(7) sub-groups, 1-year estimated OS was 100 vs. 78% (p=0.0077) and CSS was 100 vs. 88% (p=0.082). CONCLUSIONS In this hypothesis-generating study we identified multiple pre-treatment PET-CT metrics as potential predictors of OS and CSS in patients with NSCLC treated with SABR. These could aid risk-stratification and treatment individualization if validated prospectively.
Collapse
Affiliation(s)
- Jonathan A Abelson
- Department of Radiation Oncology, School of Medicine, Stanford University, Stanford, CA 94305, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Whitson BA, Groth SS, Andrade RS, Habermann EB, Maddaus MA, D'Cunha J. T1/T2 non-small-cell lung cancer treated by lobectomy: does tumor anatomic location matter? J Surg Res 2012; 177:185-90. [PMID: 22921916 DOI: 10.1016/j.jss.2012.05.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 04/11/2012] [Accepted: 05/04/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The effect of tumor location on long-term survival after lobectomy for stage I non-small-cell lung cancer is unclear. Current data are limited to a retrospective single-institution series. We sought to determine if tumor anatomic location (i.e., the particular lobe that was involved) confers a survival advantage based on population-based data. METHODS Using the Surveillance, Epidemiology and End Results database (1988-2007), we identified patients who underwent lobectomy for pathologic T1/T2 adenocarcinoma or squamous cell carcinomas. Wedge resections, segmentectomies, and pneumonectomies were excluded. We evaluated the association between the particular lobe that was involved, lymph node (LN) yield, and survival using the Kaplan-Meier method. To adjust for potential confounders, we used a Cox proportional hazards regression model. RESULTS We identified 13,650 patients who met our inclusion criteria. There were significant differences in unadjusted overall (P=0.03) and cancer-specific survivals (P=0.03) based on tumor location. However, after adjusting for patient factors, geographic location of treatment, and tumor characteristics, we found that tumor location was not associated with significant differences in survival. We found that male gender, black race, squamous cell histology, increasing grade, and age were independent negative predictors of survival. Higher LN yields were independently associated with improved survival. Although adjusted survival rates were not significantly different, there were significant differences (P<0.0001) in LN yield based on tumor location; right middle lobe had the lowest yield (5.1 nodes), and left upper lobe had the highest yield (eight nodes). CONCLUSIONS LN counts are independent predictors of survival. Although it is associated with significant difference in LN yield, tumor location is not an independent predictor of survival. Age, race, gender, tumor size, histology, and grade appear to be more important prognostic factors. These data suggest that treatment of T1/T2 non-small-cell lung cancer should be dictated by the same oncologic principles, regardless of tumor location.
Collapse
Affiliation(s)
- Bryan A Whitson
- Division of Thoracic and Foregut Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | | | | | | | | | | |
Collapse
|
38
|
Saeteng S, Tantraworasin A, Euathrongchit J, Lertprasertsuke N, Wannasopha Y. Nodal involvement pattern in resectable lung cancer according to tumor location. Cancer Manag Res 2012; 4:151-8. [PMID: 22740775 PMCID: PMC3379857 DOI: 10.2147/cmar.s30526] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The aim in this study was to define the pattern of lymph node metastasis according to the primary tumor location. In this retrospective cohort study, each of the operable patients diagnosed with lung cancer was grouped by tumor mass location. The International Association for the Study of Lung Cancer nodal chart with stations and zones, established in 2009, was used to define lymph node levels. From 2006 to 2010, 197 patients underwent a lobectomy with systematic nodal resection for primary lung cancer at Chiang Mai University Hospital. There were 123 male and 74 female patients, with ages ranging from 16– 85 years old and an average age of 61.31. Analyses of tumor location, histology type, and nodal metastasis were performed. The locations were the right upper lobe in 63 patients (31.98%), the right middle lobe in 18 patients (9.14%), the right lower lobe in 30 patients (15.23%), the left upper lobe in 55 patients (27.92%), the left lower lobe in 16 patients (8.12%), and mixed lobes (more than one lobe) in 15 patients (7.61%). The mean tumor size was 4.45 cm in diameter (range 1.2–16.5 cm). Adenocarcinoma was the most common histological type, which occurred in 132 cases (67.01%), followed by squamous cell carcinoma in 41 cases (20.81%), bronchiolo alveolar cell carcinoma in nine cases (4.57%), and large cell carcinoma in seven cases (3.55%). Eighteen cases (9.6%) had skip metastasis (mediastinal lymph node metastasis without hilar node metastasis). Adenocarcinoma and intratumoral lymphatic invasion were the predictors of mediastinal lymph node metastases. There were statistically significant differences between a tumor in the right upper lobe and the right lower lobe. However, there were no statistically significant differences between tumors in the other lobes. In conclusion, tumor location is not a precise predictor of the pattern of nodal metastasis. Systematic lymph node dissection is the only way to accurately determine lymph node status. Further studies are required for evaluation and conclusions.
Collapse
Affiliation(s)
- Somcharoen Saeteng
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Thailand
| | | | | | | | | |
Collapse
|
39
|
|
40
|
Lankarani A, Wallace MB. Endoscopic ultrasonography/fine-needle aspiration and endobronchial ultrasonography/fine-needle aspiration for lung cancer staging. Gastrointest Endosc Clin N Am 2012; 22:207-19, viii. [PMID: 22632944 DOI: 10.1016/j.giec.2012.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This article reviews different techniques available for diagnosis and staging of patients with non-small cell lung cancer (NSCLC). The advantages and disadvantages of each staging method are highlighted. The role of the gastroenterologist in NSCLC staging is explored. A new algorithm is proposed for the staging of NSCLC that incorporates endoscopic and endobronchial ultrasonography for mediastinal staging in patients with intrathoracic disease.
Collapse
Affiliation(s)
- Ali Lankarani
- Department of Gastroenterology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224, USA
| | | |
Collapse
|
41
|
Takahashi K, Sasaki T, Nabaa B, van Beek EJ, Stanford W, Aburano T. Pulmonary lymphatic drainage to the mediastinum based on computed tomographic observations of the primary complex of pulmonary histoplasmosis. Acta Radiol 2012; 53:161-7. [PMID: 22262867 DOI: 10.1258/ar.2011.110467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND In the primary infection of pulmonary histoplasmosis, pulmonary lesions are commonly solitary and associated with hilar and/or mediastinal nodal diseases, which spontaneously resolve, resulting in calcifications in individuals with normal cellular immunity. PURPOSE To assess the lymphatic drainage to the mediastinum from each pulmonary segment and lobe using computed tomographic (CT) observations of a calcified primary complex pulmonary histoplasmosis and predict which patients with N2 disease that would benefit from surgery. MATERIAL AND METHODS We collected 585 CT studies of patients with primary complex histoplasmosis consisting of solitary calcified pulmonary lesions and calcified hilar and/or mediastinal nodal disease. Using the N stage criteria of non-small cell lung cancer, we assessed the distribution of the involved hilar and mediastinal nodes depending on the pulmonary segment of the lesion, with a focus on skip involvement. We also assessed the correlation between the incidence of N1 and skip N2 involvement and the mean number of involved mediastinal nodal stations in the non-skip N2 and skip N2 groups. RESULTS Skip involvement was common in the apical segment (9/45, 20.0%), posterior segment (7/31, 22.6%), and mediolbasal segment (13/20, 65.0%) in the right lung, and in the apicoposterior segment (7/55, 12.7%), lateral basal segment (6/26, 23.1%), and posterobasal segment (16/47, 34.0%) in the left lung. The incidence of skip involvement in each segment showed a significant inverse correlation with that of N1 involvement (r = -0.51, P <0.05) in both lungs. The mean number of involved mediastinal nodal stations in the non-skip N2 and skip N2 groups in all segments of both lungs were 1.4 (434/301) and 1.2 (93/77), and the former was significantly greater than the latter (P <0.01). CONCLUSION Our data showed a predictable pattern of segmental and lobar lymphatic drainage to the mediastinum and suggested that skip involvement could represent the initial mediastinal node involvement via direct lymphatic drainage.
Collapse
Affiliation(s)
- Koji Takahashi
- Department of Radiology, Asahikawa Medical University and Hospital, Asahikawa, Japan
| | - Tomoaki Sasaki
- Department of Radiology, Asahikawa Medical University and Hospital, Asahikawa, Japan
| | - Basim Nabaa
- Department of Radiology, Asahikawa Medical University and Hospital, Asahikawa, Japan
| | - Edwin Junior van Beek
- Clinical Research Imaging Centre, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - William Stanford
- Department of Radiology, University of Iowa College of Medicine, Iowa City, Iowa, USA
| | - Tamio Aburano
- Department of Radiology, Asahikawa Medical University and Hospital, Asahikawa, Japan
| |
Collapse
|
42
|
Martin KL, Gomez J, Nazareth DP, Warren GW, Singh AK. Quantification of incidental mediastinal and hilar irradiation delivered during definitive stereotactic body radiation therapy for peripheral non-small cell lung cancer. Med Dosim 2011; 37:182-5. [PMID: 21978531 DOI: 10.1016/j.meddos.2011.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 06/24/2011] [Indexed: 12/12/2022]
Abstract
To determine the amount of incidental radiation dose received by the mediastinal and hilar nodes for patients with non-small cell lung cancer (NSCLC) treated with stereotactic body radiation therapy (SBRT). Fifty consecutive patients with NSCLC, treated using an SBRT technique, were identified. Of these patients, 38 had a prescription dose of 60 Gy in 20-Gy fractions and were eligible for analysis. For each patient, ipsilateral upper (level 2) and lower (level 4) paratracheal, and hilar (level 10) nodal regions were contoured on the planning computed tomography (CT) images. Using the clinical treatment plan, dose and volume calculations were performed retrospectively for each nodal region. SBRT to upper lobe tumors resulted in an average total ipsilateral mean dose of between 5.2 and 7.8 Gy for the most proximal paratracheal nodal stations (2R and 4R for right upper lobe lesions, 2L and 4L for left upper lobe lesions). SBRT to lower lobe tumors resulted in an average total ipsilateral mean dose of between 15.6 and 21.5 Gy for the most proximal hilar nodal stations (10R for right lower lobe lesions, 10 l for left lower lobe lesions). Doses to more distal nodes were substantially lower than 5 Gy. The often substantial incidental irradiation, delivered during SBRT for peripheral NSCLC of the lower lobes to the most proximal hilar lymph nodes may be therapeutic for low-volume, subclinical nodal disease. Treatment of peripheral upper lobe lung tumors delivers less incidental irradiation to the paratracheal lymph nodes with lower likelihood of therapeutic benefit.
Collapse
Affiliation(s)
- Kate L Martin
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
| | | | | | | | | |
Collapse
|
43
|
Volterrani L, Mazzei MA, Banchi B, Voltolini L, La Sala F, Carbone SF, Ricci V, Gotti G, Zompatori M. MSCT multi-criteria: A novel approach in assessment of mediastinal lymph node metastases in non-small cell lung cancer. Eur J Radiol 2011; 79:459-66. [DOI: 10.1016/j.ejrad.2010.03.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 03/13/2010] [Accepted: 03/16/2010] [Indexed: 10/19/2022]
|
44
|
Re-appraisal of N2 disease by lymphatic drainage pattern for non-small-cell lung cancers: by terms of nodal stations, zones, chains, and a composite. Lung Cancer 2011; 74:497-503. [PMID: 21529990 DOI: 10.1016/j.lungcan.2011.03.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 03/25/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE N2 non-small-cell lung cancer (NSCLC) is a heterogeneous disease with an extremely wide range of 5-year survival rates. A composite method of sub-classification for N2 is likely to provide a more accurate method to more finely differentiate prognosis of N2 disease. METHODS A total of 720 pN2 (T1-4N2M0) NSCLC cases were enrolled in our retrospective analysis of the proposed composite method. Survival rates were respectively calculated according to the N2 stratification methods: singly by "nodal stations", "nodal zones", or "nodal chains", or by combination of all three. Statistical analysis was carried out by Kaplan-Meier and Cox regression models. RESULTS A total of 10,199 lymph nodes (8059 mediastinal; 2140 hilar and intra-lobar) were removed. By nodal station, there were 173 cases of single-station involvement and 547 multi-stations. By nodal zone, there were 413 single-zone involvement and 307 with multiple zones. By nodal chain, there were 311 cases with single-chain and 409 multi-chain involvements. The overall 5-year survival was 20% and median survival time was 27.52 months. The 5-year survival was significantly better for cases of single-zone involvement, as compared to multi-zones (29% vs. 6%, p<0.0001). The 5-year survival rates of single- and multi-chains involvement were 36% and 8%, respectively (p<0.0001). When taking all of the above grouping methods into consideration, the N2 disease state could be further sub-classified into two subgroups with respective survival rates of 36% and 7% (p<0.0001). Subgroup I was composed of individuals with single-chain involvement and having either one or two station metastasis; individuals with any other metastasis combinations formed Subgroup II. Multivariate analysis revealed that the composite sub-classification method, number of positive lymph nodes, ratio of nodal metastasis, and pT information were the most important risk factors of 5-year survival. CONCLUSIONS By combining the three N2 stratification methods based on "stations", "zones", and "chains" into one composite method, prognosis prediction was more accurate for N2 NSCLC disease. Single nodal chain involvement, which may be either one or two nodal stations metastasis, is associated with best outcome for pN2 patients.
Collapse
|
45
|
Chen J, Shen-Tu Y. [Research progress of lobe-specific lymphadenectomy on early stage lung cancer operation]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2011; 14:63-8. [PMID: 21219835 PMCID: PMC5999698 DOI: 10.3779/j.issn.1009-3419.2011.01.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
肺癌手术中系统性淋巴结清扫已成为标准术式,但对于早期肺癌尚存在多种清扫方式,各种清扫方式的利弊仍然存在争议。鉴于临床早期肺癌病例日趋增加,特别是Ⅰ期肺癌肺叶特异性淋巴结清扫的研究逐渐深入,本文就目前的相关进展予以综述。
Collapse
Affiliation(s)
- Jian Chen
- Shanghai Chest Hospital/Shanghai Lung Tumor Clinical Medical Center, Shanghai, China
| | | |
Collapse
|
46
|
Wang W, Shentu Y. [Progress of lymphadenectomy on lung cancer surgery]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2010; 13:744-7. [PMID: 20673492 PMCID: PMC6000375 DOI: 10.3779/j.issn.1009-3419.2010.07.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 05/31/2010] [Indexed: 11/21/2022]
Abstract
淋巴道转移是肺癌最主要的转移途径,也是影响肺癌患者预后的主要因素之一。目前,淋巴结清扫已成为标准肺癌手术的重要组成部分。但是到目前为止,对于不同病理类型、不同病理分期、不同肺叶的肺癌而言,术中淋巴结的清扫方式及范围仍存在一定的争议。本文拟就目前肺癌手术中淋巴结清扫的临床意义、清扫方式、清扫范围的研究新进展进行综述。
Collapse
Affiliation(s)
- Wenli Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital/Shanghai Lung Tumor Clinical Medical Center, Shanghai 200030, China
| | | |
Collapse
|
47
|
Puri V, Garg N, Engelhardt EE, Kreisel D, Crabtree TD, Meyers BF, Patterson GA, Krupnick AS. Tumor location is not an independent prognostic factor in early stage non-small cell lung cancer. Ann Thorac Surg 2010; 89:1053-9. [PMID: 20338306 DOI: 10.1016/j.athoracsur.2010.01.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2009] [Revised: 01/02/2010] [Accepted: 01/04/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Conventional thoracic surgical teaching suggests a worse outcome for lower lobe lung cancers. It is unclear whether this is due to stage migration or whether lobar location is an independent negative prognostic factor. METHODS We performed a retrospective review of our institutional database of patients undergoing resection for pathologic stage I or stage II lung cancer between Jan 2000 and December 2006. Survival analysis was used to compare outcomes in various groups using the log-rank test. Logistic regression analysis was used to compare the primary dependent variables; age, size, and location of tumor (both laterality and lobe), histology (adenocarcinoma, squamous, large cell, or neuroendocrine and others) and type of resection (wedge, lobectomy or segmentectomy, and pneumonectomy). RESULTS A total of 841 patients met the inclusion criteria. The mean age of patients was 64.9 years, mean tumor size 3.3 cm, and, 144 patients had N1 disease. The three-year and five-year survivals for stage I tumors were 346 of 478 (72.4%) and 277 of 497 (55.7%), respectively. There was no difference in survival based upon lobar location. The three-year and five-year survivals for stage II tumors were 81 of 175 (46.3%) and 39 of 150 (26%), respectively, and lobar location did not influence survival. Logistic regression analysis showed that for stage I tumors increasing age and having undergone a pneumonectomy were associated with worse survival, and for stage II tumors increasing age and adenocarcinoma histology were associated with worse survival. CONCLUSIONS Tumor location within the lung does not predict survival in pathologic stage I/II non-small cell lung carcinoma. Increasing age, adenocarcinoma histology, and pneumonectomy as the resection may lead to worse long-term survival.
Collapse
Affiliation(s)
- Varun Puri
- Department of Surgery, Washington University in St. Louis, St. Louis, Missouri 63110, USA
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Pinto Filho DR, Avino AJG, Brandão SLB, Spiandorello WP. Joint use of cervical mediastinoscopy and video-assisted thoracoscopy for the evaluation of mediastinal lymph nodes in patients with non-small cell lung cancer. J Bras Pneumol 2009; 35:1068-74. [PMID: 20011841 DOI: 10.1590/s1806-37132009001100003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Accepted: 07/01/2009] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of the joint use of cervical mediastinoscopy and video-assisted thoracoscopy for the sampling of mediastinal lymph nodes in patients with non-small cell lung cancer (NSCLC) and candidates for pulmonary resection. METHODS Sixty-two patients diagnosed with NSCLC were submitted to cervical mediastinoscopy and video-assisted thoracoscopy. The samples obtained (from paratracheal chains, anterior and posterior subcarinal chains, paraesophageal chains and pulmonary ligament) were submitted to frozen section analysis. The following variables were also evaluated: age; gender; weight loss; diagnostic method; tomographic findings; histological type; staging; and location and size of the primary tumor. RESULTS In 11 patients, mediastinoscopy showed no involvement of the subcarinal chain, whereas such involvement was identified when video-assisted thoracoscopy was used: positive predictive value = 88.89% (95% CI: 51.75-99.72); negative predictive value = 94.34% (95% CI: 84.34-98.82); prevalence = 17.74% (95% CI: 9.2-29.53); sensitivity = 72.73% (95% CI: 39.03-93.98); and specificity = 98.77% (95% CI: 93.31-99.97). In 60% of the patients with involvement of the posterior subcarinal chain, the primary tumor was in the right inferior lobe. (p = 0.029) CONCLUSIONS The joint use of cervical mediastinoscopy and video-assisted thoracoscopy for the evaluation of posterior mediastinal lymph nodes proved to be an efficacious method. When there is no access to posterior chains by means of ultrasound with transbronchial or transesophageal biopsy, which dispenses with general anesthesia, this should be the method of choice for the correct evaluation of mediastinal lymph nodes in patients with NSCLC.
Collapse
Affiliation(s)
- Darcy Ribeiro Pinto Filho
- Department of Thoracic Surgery, University of Caxias do Sul Foundation General Hospital, Caxias do Sul, Brazil.
| | | | | | | |
Collapse
|
49
|
Bastide K, Ugolin N, Levalois C, Bernaudin JF, Chevillard S. Are adenosquamous lung carcinomas a simple mix of adenocarcinomas and squamous cell carcinomas, or more complex at the molecular level? Lung Cancer 2009; 68:1-9. [PMID: 20004040 DOI: 10.1016/j.lungcan.2009.11.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Revised: 09/17/2009] [Accepted: 11/02/2009] [Indexed: 12/23/2022]
Abstract
Adenocarcinomas (AC), squamous cell carcinomas (SCC) and adenosquamous carcinomas (ASC) are three histological subtypes of non-small-cell lung carcinomas (NSCLC). ASC are morphologically mixed tumours that contain the two cell components AC and SCC. To understand if they are a "simple" mix of AC and SCC or if they present molecular specificities, as compared with the molecular characterization of both components, we performed a comparative transcriptome analysis on a series of nine ASC, five AC and five SCC induced in rats by radon exposure. We found that 72, 40 and 39 genes were differentially expressed when comparing AC_SCC, ASC_SCC and AC_ASC, respectively. Moreover, when classifying the three histological subtypes, using genes that discriminated AC and SCC, we observed that all ASC were classified as intermediate between the AC and SCC, some being closer to AC, others to SCC. These results indicated that, regarding gene expression, ASC could be considered as a mix of AC and SCC, both in various proportions. However, they also exhibit molecular specificities since we found specific genes discriminating ASC_SCC and AC_ASC. In conclusion, the ASC mixed lung tumours are more complex than simple mixes of AC and SCC components. Neuroendocrine differentiation and ERK proliferation pathways seemed preferentially deregulated in ASC compared to AC and SCC respectively, pathways that are worthy of being explored because they could partially explain the high clinical aggressiveness of ASC.
Collapse
MESH Headings
- Adenocarcinoma/chemically induced
- Adenocarcinoma/genetics
- Adenocarcinoma/metabolism
- Adenocarcinoma/pathology
- Animals
- Carcinoma, Adenosquamous/chemically induced
- Carcinoma, Adenosquamous/genetics
- Carcinoma, Adenosquamous/metabolism
- Carcinoma, Adenosquamous/pathology
- Carcinoma, Squamous Cell/chemically induced
- Carcinoma, Squamous Cell/genetics
- Carcinoma, Squamous Cell/metabolism
- Carcinoma, Squamous Cell/pathology
- Cell Line, Tumor
- Cell Transformation, Neoplastic
- DNA Mutational Analysis
- GATA6 Transcription Factor/genetics
- GATA6 Transcription Factor/metabolism
- Gene Expression Profiling
- Gene Expression Regulation, Neoplastic
- Genes, ras/genetics
- Lung/metabolism
- Lung/pathology
- Lung Neoplasms/chemically induced
- Lung Neoplasms/genetics
- Lung Neoplasms/metabolism
- Lung Neoplasms/pathology
- MAP Kinase Signaling System/genetics
- Microarray Analysis
- Mucin-1/genetics
- Mucin-1/metabolism
- Radon/toxicity
- Rats
- Rats, Sprague-Dawley
- Receptor, Notch2/genetics
- Receptor, Notch2/metabolism
Collapse
Affiliation(s)
- Kristell Bastide
- CEA, DSV, IRCM, SREIT, Laboratoire de Cancérologie Expérimentale, BP6, Fontenay-aux-Roses Cedex F-92265, France.
| | | | | | | | | |
Collapse
|
50
|
Kim AW. Lymph Node Drainage Patterns and Micrometastasis in Lung Cancer. Semin Thorac Cardiovasc Surg 2009; 21:298-308. [PMID: 20226342 DOI: 10.1053/j.semtcvs.2009.11.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2009] [Indexed: 11/11/2022]
|