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Singareddy A, Flanagan ME, Samson PP, Waqar SN, Devarakonda S, Ward JP, Herzog BH, Rohatgi A, Robinson CG, Gao F, Govindan R, Puri V, Morgensztern D. Trends in Stage I Lung Cancer. Clin Lung Cancer 2023; 24:114-119. [PMID: 36504141 DOI: 10.1016/j.cllc.2022.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/02/2022] [Accepted: 11/10/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The American Cancer Society has recently reported an increase in the percentage of patients with localized lung cancer from 2004 to 2018, coinciding with the initial lung cancer screening guidelines issued in 2013. We conducted a National Cancer Database (NCDB) study to further evaluate the trends in stage I according to patient and tumor characteristics. METHODS We selected patients with lung cancer from the NCDB Public Benchmark Report diagnosed between 2010 and 2017. Patients with stages I to IV according to the AJCC seventh edition were evaluated according to the year of diagnosis, histology, age, sex, race, and insurance. RESULTS Among the 1,447,470 patients identified in the database, 56,382 (3.9%) were excluded due to stage 0 or unknown, or incorrect histology, leaving 1,391,088 patients eligible. The percentage of patients with stage I increased from 23.5% in 2010 to 29.1% in 2017 for all lung cancers, from 25.9% to 31.8% in non-small-cell lung cancer (NSCLC), and from 5.0% to 5.4% in small-cell lung cancer (SCLC). Patients younger than 70 years, males and blacks had lower percentages of stage I compared to older patients, females, and nonblacks respectively. Patients with no insurance had the lowest percentage of stage I. CONCLUSIONS There has been a significant increase in the percentage of stage I lung cancer at diagnosis from 2010 to 2017, which occurred mostly in NSCLC. Although the staging shift was observed in all subsets of patients, there were noticeable imbalances according to demographic factors.
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Affiliation(s)
- Aashray Singareddy
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Mary Ellen Flanagan
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO
| | - Pamela P Samson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Saiama N Waqar
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO
| | - Siddhartha Devarakonda
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO
| | - Jeffrey P Ward
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO
| | - Brett H Herzog
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO
| | - Anjali Rohatgi
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO
| | - Clifford G Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Feng Gao
- Siteman Cancer Center Biostatistics Core, Division of Public Health Sciences, Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Comprehensive Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Ramaswamy Govindan
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO
| | - Varun Puri
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Daniel Morgensztern
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO.
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Shah RP, Selby HM, Mukherjee P, Verma S, Xie P, Xu Q, Das M, Malik S, Gevaert O, Napel S. Machine Learning Radiomics Model for Early Identification of Small-Cell Lung Cancer on Computed Tomography Scans. JCO Clin Cancer Inform 2021; 5:746-757. [PMID: 34264747 PMCID: PMC8812622 DOI: 10.1200/cci.21.00021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/26/2021] [Accepted: 06/08/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Small-cell lung cancer (SCLC) is the deadliest form of lung cancer, partly because of its short doubling time. Delays in imaging identification and diagnosis of nodules create a risk for stage migration. The purpose of our study was to determine if a machine learning radiomics model can detect SCLC on computed tomography (CT) among all nodules at least 1 cm in size. MATERIALS AND METHODS Computed tomography scans from a single institution were selected and resampled to 1 × 1 × 1 mm. Studies were divided into SCLC and other scans comprising benign, adenocarcinoma, and squamous cell carcinoma that were segregated into group A (noncontrast scans) and group B (contrast-enhanced scans). Four machine learning classification models, support vector classifier, random forest (RF), XGBoost, and logistic regression, were used to generate radiomic models using 59 quantitative first-order and texture Imaging Biomarker Standardization Initiative compliant PyRadiomics features, which were found to be robust between two segmenters with minimum Redundancy Maximum Relevance feature selection within each leave-one-out-cross-validation to avoid overfitting. The performance was evaluated using a receiver operating characteristic curve. A final model was created using the RF classifier and aggregate minimum Redundancy Maximum Relevance to determine feature importance. RESULTS A total of 103 studies were included in the analysis. The area under the receiver operating characteristic curve for RF, support vector classifier, XGBoost, and logistic regression was 0.81, 0.77, 0.84, and 0.84 in group A, and 0.88, 0.87, 0.85, and 0.81 in group B, respectively. Nine radiomic features in group A and 14 radiomic features in group B were predictive of SCLC. Six radiomic features overlapped between groups A and B. CONCLUSION A machine learning radiomics model may help differentiate SCLC from other lung lesions.
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Affiliation(s)
- Rajesh P. Shah
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
- Department of Radiology, Stanford University, Stanford, CA
| | - Heather M. Selby
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
- Department of Medicine, Center for Biomedical Informatics Research (BMIR), Stanford University, Stanford, CA
| | - Pritam Mukherjee
- Department of Medicine, Center for Biomedical Informatics Research (BMIR), Stanford University, Stanford, CA
| | - Shefali Verma
- Palo Alto Veterans Institute for Research, Palo Alto, CA
| | - Peiyi Xie
- Department of Medicine, Center for Biomedical Informatics Research (BMIR), Stanford University, Stanford, CA
- Present address: Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qinmei Xu
- Department of Medicine, Center for Biomedical Informatics Research (BMIR), Stanford University, Stanford, CA
- Present address: Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China
| | - Millie Das
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
- Department of Medicine—Oncology, Stanford University, Stanford, CA
| | - Sachin Malik
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
- Department of Radiology, Stanford University, Stanford, CA
| | - Olivier Gevaert
- Department of Medicine, Center for Biomedical Informatics Research (BMIR), Stanford University, Stanford, CA
| | - Sandy Napel
- Department of Radiology, Stanford University, Stanford, CA
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Dziadziuszko K, Szurowska E. Pulmonary nodule radiological diagnostic algorithm in lung cancer screening. Transl Lung Cancer Res 2021; 10:1124-1135. [PMID: 33718050 PMCID: PMC7947388 DOI: 10.21037/tlcr-20-755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Publications of the final results of the two largest randomized lung cancer screening (LCS) trials in the United States and Europe confirmed the reduction in the mortality rate associated with the use of screening with low-dose computed tomography (LDCT). Results of these trials led to widespread acceptance of LCS in properly defined high-risk populations, and its implementation in the clinical practice. Many countries started preparation for national LCS and refreshed still open debate about lung nodule management. Detection of lung cancer in the early stage with a reduction of lung cancer mortality requires dedicated programs with optimized protocols, including a specified pulmonary nodule diagnostic algorithm. The screening protocol should be clear with a precise nodule diameter or volume threshold, based on which a positive screen result is defined. The application of risk-prediction models and the introduction of the semiautomated assessment of detected nodules improves screening accuracy and should be applied in LCS protocols as verified tools to aid radiological diagnosis. In this review, we have summarized recent data about the radiological protocols from the most important LCS programs and pulmonary diagnostic algorithms. These protocols should be taken into consideration in the ongoing and planned LCS programs.
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Affiliation(s)
| | - Edyta Szurowska
- II Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
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4
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Abstract
Small-cell lung cancer (SCLC) represents about 15% of all lung cancers and is marked by an exceptionally high proliferative rate, strong predilection for early metastasis and poor prognosis. SCLC is strongly associated with exposure to tobacco carcinogens. Most patients have metastatic disease at diagnosis, with only one-third having earlier-stage disease that is amenable to potentially curative multimodality therapy. Genomic profiling of SCLC reveals extensive chromosomal rearrangements and a high mutation burden, almost always including functional inactivation of the tumour suppressor genes TP53 and RB1. Analyses of both human SCLC and murine models have defined subtypes of disease based on the relative expression of dominant transcriptional regulators and have also revealed substantial intratumoural heterogeneity. Aspects of this heterogeneity have been implicated in tumour evolution, metastasis and acquired therapeutic resistance. Although clinical progress in SCLC treatment has been notoriously slow, a better understanding of the biology of disease has uncovered novel vulnerabilities that might be amenable to targeted therapeutic approaches. The recent introduction of immune checkpoint blockade into the treatment of patients with SCLC is offering new hope, with a small subset of patients deriving prolonged benefit. Strategies to direct targeted therapies to those patients who are most likely to respond and to extend the durable benefit of effective antitumour immunity to a greater fraction of patients are urgently needed and are now being actively explored.
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Affiliation(s)
- Charles M Rudin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Elisabeth Brambilla
- Institute for Advanced Biosciences, Université Grenoble Alpes, Grenoble, France
| | - Corinne Faivre-Finn
- Department of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Julien Sage
- Department of Pediatrics, Stanford University, Stanford, CA, USA
- Department of Genetics, Stanford University, Stanford, CA, USA
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Sung P, Yoon SH, Kim J, Hong JH, Park S, Goo JM. Bronchovascular bundle thickening on CT as a predictor of survival and brain metastasis in patients with stage IA peripheral small cell lung cancer. Clin Radiol 2020; 76:76.e37-76.e46. [PMID: 32948314 DOI: 10.1016/j.crad.2020.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/19/2020] [Indexed: 01/03/2023]
Abstract
AIM To determine if bronchovascular bundle (BVB) thickening on pretreatment computed tomography (CT) images helps predict survival in patients with peripheral small cell lung cancer (pSCLC) ≤3 cm. MATERIALS AND METHODS The pretreatment CT examinations of 79 histopathologically proven pSCLC ≤3 cm (TNM stage I, 21; II, 13; III, 22; IV, 23) were reviewed retrospectively. The CT characteristics of the nodule and associated findings, including BVB thickening, were evaluated. Progression-free survival (PFS), overall survival (OS), and brain metastasis-free survival were compared with the presence of BVB thickening using Kaplan-Meier and Cox regression analysis. RESULTS Among the 79 patients, 34 (43%) had BVB thickening. BVB thickening was prevalent in patients with mediastinal lymph node metastasis (50.9% versus 22.7%; p=0.024) and distant metastasis (60.9% versus 35.7%; p=0.049). Out of the 21 patients with TNM stage IA disease, the 16 patients (76.2%) without BVB thickening showed better PFS, OS, and brain metastasis-free survival (mean, 1,762 versus 483 days; p=0.019: 2,243 versus 1,328 days; p=0.038: 2,274 versus 1,287 days; p=0.038, respectively). Multivariate Cox regression analysis showed that the absence of BVB thickening (hazard ratio [HR], 7.806; 95% CI, 1.241-49.091; p=0.029) and surgery (HR, 0.075; 95% CI, 0.008-0.746; p=0.027) were independent and useful prognostic factors for PFS. CONCLUSIONS BVB thickening was found more frequently in patients with advanced-stage pSCLC ≤3 cm, and the PFS was more favourable in patients without BVB thickening, with a similar tendency to that of OS and brain metastasis-free survival, in stage IA pSCLC.
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Affiliation(s)
- P Sung
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - S H Yoon
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 030804, South Korea.
| | - J Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea
| | - J H Hong
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - S Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - J M Goo
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 030804, South Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
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Mazzone PJ, Jett J. Principled Lung Cancer Screening Follows Screening Principles. Chest 2019; 154:1265-1266. [PMID: 30526961 DOI: 10.1016/j.chest.2018.08.1056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 01/22/2023] Open
Affiliation(s)
- Peter J Mazzone
- Department of Pulmonary, Allergy, and Critical Care Medicine, Cleveland Clinic Foundation, Cleveland, OH.
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Thomas A, Pattanayak P, Szabo E, Pinsky P. Characteristics and Outcomes of Small Cell Lung Cancer Detected by CT Screening. Chest 2018; 154:1284-1290. [PMID: 30080997 DOI: 10.1016/j.chest.2018.07.029] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/17/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Previous studies with a limited number of patients have reported divergent findings on whether screening can detect small cell lung cancer (SCLC) at an earlier stage and whether there might be a survival benefit. METHODS This study examined the characteristics of SCLC detected by using low-dose CT (LDCT) screening in the National Lung Screening Trial, a randomized study of individuals at high risk for developing lung cancer comparing LDCT imaging vs chest radiography. SCLC was denoted as screen detected if diagnosed ≤ 1 year of a positive screen or after a longer period but with no time gap between diagnostic procedures of > 1 year; interval detected if diagnosed ≤ 1 year of a negative screen; and nonscreen detected if the subject did not receive any screens or otherwise as postscreening. RESULTS A total of 143 cases of SCLC were diagnosed, including 49 (34.2%) screen detected, 15 (10.5%) interval detected, and 79 (55.2%) nonscreened/postscreening. Of the screening phase-diagnosed cases (ie, screen or interval detected), a higher proportion of SCLC cases compared with NSCLC cases were interval detected (23% vs 5%; P < .0001). A higher proportion of all SCLC cases compared with NSCLC cases were advanced stage (III/IV: 86% vs 36%; P < .0001). The unfavorable SCLC stage distribution extended across screen-detected (80% stage III/IV), interval-detected (86%), and nonscreened/postscreening (90%) cancers. Among screen-detected SCLC, only 63.3% had ≥ 1 noncalcified nodule in the cancer lobe compared with 85.4% of NSCLC cases (P < .0001). Even with very small LDCT screen-detected nodules, a high proportion of SCLC cases were late stage. There was no significant difference in survival between screen- and interval-detected or postscreening SCLC. CONCLUSIONS "Early detection" with the use of LDCT imaging had no impact on SCLC outcomes. A successful screening modality should ideally detect SCLC earlier than when it can be detected on LDCT scans.
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Affiliation(s)
- Anish Thomas
- Developmental Therapeutics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
| | - Puskar Pattanayak
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD
| | - Eva Szabo
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Paul Pinsky
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Hofer F, Kauczor HU, Stargardt T. Cost-utility analysis of a potential lung cancer screening program for a high-risk population in Germany: A modelling approach. Lung Cancer 2018; 124:189-198. [PMID: 30268459 DOI: 10.1016/j.lungcan.2018.07.036] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer death in Germany. Although several randomized trials in Europe have evaluated the effectiveness of lung cancer screening programs, evidence on the cost-effectiveness of lung cancer screening is scarce. OBJECTIVE To evaluate the cost-effectiveness of a population-based lung cancer screening program from the perspective of a German payer. METHODS We conducted a cost-effectiveness analysis from the public payer perspective for a high-risk population defined as heavy former and current smokers (≥20 cigarettes per day) between 55 and 75 years of age. The underlying model consisted of two Markov models. We differentiated between a population-based annual screening program and standard clinical care. Depending on stage at diagnosis, simulated patients were assigned to one of five treatment paths according to the German clinical guideline for the diagnosis and treatment of lung cancer. Costs, life years saved, and quality adjusted life years (QALYs) were used as outcomes. Values for input parameters were taken from the literature. The model was run for 60 cycles with a cycle length of three months. Deterministic and probabilistic sensitivity analyses were conducted. RESULTS In the base case, annual lung cancer screening led to an increase in incremental costs (€ 1,153 per person) compared to standard clinical care. However, the screening approach was associated with an incremental gain in life years (0.06 per person) and QALYs (0.04 per person). Thus, the incremental cost-effectiveness ratio (ICER) was € 19,302 per life year saved and € 30,291 per QALY. A probabilistic sensitivity analysis with 10,000 draws resulted in average ICERs of € 22,118 per life year and € 34,841 per QALY. CONCLUSION We provide evidence that lung cancer screening for a high-risk population may be more effective, but also more costly, than standard clinical care from the perspective of a German payer.
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Affiliation(s)
- Florian Hofer
- Hamburg Center for Health Economics (HCHE), University of Hamburg, Esplanade 36, 20354 Hamburg, Germany.
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Tom Stargardt
- Hamburg Center for Health Economics (HCHE), University of Hamburg, Esplanade 36, 20354 Hamburg, Germany
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Sheard S, Moser J, Sayer C, Stefanidis K, Devaraj A, Vlahos I. Lung Cancers Associated with Cystic Airspaces: Underrecognized Features of Early Disease. Radiographics 2018; 38:704-717. [DOI: 10.1148/rg.2018170099] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Sarah Sheard
- From the Department of Radiology, St George’s Hospitals NHS Trust, Blackshaw Rd, London SW17 0QT, England (S.S., J.M., K.S., I.V.); Department of Radiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, England (C.S.); and Department of Radiology, Royal Brompton and Harefield NHS Trust, London, England (A.D.)
| | - Joanna Moser
- From the Department of Radiology, St George’s Hospitals NHS Trust, Blackshaw Rd, London SW17 0QT, England (S.S., J.M., K.S., I.V.); Department of Radiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, England (C.S.); and Department of Radiology, Royal Brompton and Harefield NHS Trust, London, England (A.D.)
| | - Charlie Sayer
- From the Department of Radiology, St George’s Hospitals NHS Trust, Blackshaw Rd, London SW17 0QT, England (S.S., J.M., K.S., I.V.); Department of Radiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, England (C.S.); and Department of Radiology, Royal Brompton and Harefield NHS Trust, London, England (A.D.)
| | - Konstantinos Stefanidis
- From the Department of Radiology, St George’s Hospitals NHS Trust, Blackshaw Rd, London SW17 0QT, England (S.S., J.M., K.S., I.V.); Department of Radiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, England (C.S.); and Department of Radiology, Royal Brompton and Harefield NHS Trust, London, England (A.D.)
| | - Anand Devaraj
- From the Department of Radiology, St George’s Hospitals NHS Trust, Blackshaw Rd, London SW17 0QT, England (S.S., J.M., K.S., I.V.); Department of Radiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, England (C.S.); and Department of Radiology, Royal Brompton and Harefield NHS Trust, London, England (A.D.)
| | - Ioannis Vlahos
- From the Department of Radiology, St George’s Hospitals NHS Trust, Blackshaw Rd, London SW17 0QT, England (S.S., J.M., K.S., I.V.); Department of Radiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, England (C.S.); and Department of Radiology, Royal Brompton and Harefield NHS Trust, London, England (A.D.)
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Yao Y, Zhou Y, Yang Z, Huang H, Shen H. Adjuvant Chemotherapy Following Surgical Resection Improves Survival in Patients With Early Stage Small Cell Lung Cancer. Oncol Res 2018. [PMID: 29523217 PMCID: PMC7848360 DOI: 10.3727/096504018x15202953107093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The purpose of this study was to determine the effects of resection coupled with standard chemotherapy on the survival prognosis of patients with early stage small cell lung carcinoma (SCLC). Patients (n = 110) with mediastinal lymph node-negative SCLC were enrolled in this study. The baseline clinical data of patients with surgery were retrospectively reviewed. Overall survival (OS) and progression-free survival (PFS) were measured by Kaplan-Meier and log-rank test analyses. Ninety-eight patients received mediastinoscopy biopsy, and pulmonary lobectomy or sublobar resection, and 67 patients underwent adjuvant chemotherapy after pulmonary lobectomy. Adjuvant chemotherapy after surgical intervention was associated with longer OS (median OS: 42.14 vs. 33.53 months, p = 0.01) and PFS (median PFS: 25.20 vs. 13.48 months, p = 0.000) compared to resection alone for all patients. Adjuvant chemotherapy was associated with improvement of survival for N1 patients with stage II (median OS: 36.42 vs. 26.68 months, p = 0.021). The median PFS was 19.02 m (16.08, 21.96) and 13.25 m (10.19, 16.30) (p = 0.031), respectively, for patients of N1 stage who received chemotherapy and those who did not. Cox regression analysis demonstrated that age, TNM stage (N stage, not T stage), and chemotherapy were independent risk factors that might affect overall survival in patients with mediastinal lymph node-negative SCLC. These findings suggest that the application of adjuvant chemotherapy following pulmonary lobectomy is associated with improvements of survival prognoses for patients with SCLC. The combination of surgical intervention with conventional therapy should be taken into consideration as a prospective multidisciplinary regimen for early stage SCLC.
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Affiliation(s)
- Yuanshan Yao
- Department of Thoracic Surgery, Ningbo No. 2 Hospital, Zhejiang Province, P.R. China
| | - Yinjie Zhou
- Department of Thoracic Surgery, Ningbo No. 2 Hospital, Zhejiang Province, P.R. China
| | - Zhenhua Yang
- Department of Thoracic Surgery, Ningbo No. 2 Hospital, Zhejiang Province, P.R. China
| | - Hongbo Huang
- Department of Thoracic Surgery, Ningbo No. 2 Hospital, Zhejiang Province, P.R. China
| | - Haibo Shen
- Department of Thoracic Surgery, Ningbo No. 2 Hospital, Zhejiang Province, P.R. China
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Prophylactic Cranial Irradiation for Resectable Small-Cell Lung Cancer. Clin Lung Cancer 2018; 19:115-119. [DOI: 10.1016/j.cllc.2017.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/08/2017] [Accepted: 08/18/2017] [Indexed: 11/20/2022]
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Martin MD, Kanne JP, Broderick LS, Kazerooni EA, Meyer CA. Lung-RADS: Pushing the Limits. Radiographics 2017; 37:1975-1993. [DOI: 10.1148/rg.2017170051] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Maria D. Martin
- From the Department of Radiology, University of Wisconsin School of Medicine, 600 Highland Ave, Madison, WI 53792-3252 (M.D.M., J.P.K., L.S.B., C.A.M.); and Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.K.)
| | - Jeffrey P. Kanne
- From the Department of Radiology, University of Wisconsin School of Medicine, 600 Highland Ave, Madison, WI 53792-3252 (M.D.M., J.P.K., L.S.B., C.A.M.); and Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.K.)
| | - Lynn S. Broderick
- From the Department of Radiology, University of Wisconsin School of Medicine, 600 Highland Ave, Madison, WI 53792-3252 (M.D.M., J.P.K., L.S.B., C.A.M.); and Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.K.)
| | - Ella A. Kazerooni
- From the Department of Radiology, University of Wisconsin School of Medicine, 600 Highland Ave, Madison, WI 53792-3252 (M.D.M., J.P.K., L.S.B., C.A.M.); and Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.K.)
| | - Cristopher A. Meyer
- From the Department of Radiology, University of Wisconsin School of Medicine, 600 Highland Ave, Madison, WI 53792-3252 (M.D.M., J.P.K., L.S.B., C.A.M.); and Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.K.)
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Henschke CI, Li K, Yip R, Salvatore M, Yankelevitz DF. The importance of the regimen of screening in maximizing the benefit and minimizing the harms. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:153. [PMID: 27195271 PMCID: PMC4860488 DOI: 10.21037/atm.2016.04.06] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 04/14/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND In CT screening for lung cancer, the regimen of screening is critical in diagnosing lung cancer early while limiting unnecessary tests and invasive procedures. The International Early Lung Cancer Action Program (I-ELCAP) has developed a regimen based on evidence collected in the I-ELCAP cohort of more than 70,000 participants. METHODS Important in the development of the regimen is the recognition of the profound difference between the first, baseline round of screening and all subsequent rounds of repeat screening. For each person undergoing screening, the baseline round happens only once while repeat rounds will be performed annually for many years. This difference needs to be clearly recognized as it is these annual rounds which allow for identification of small, early, yet aggressive, lung cancers which have high cure rates despite their aggressiveness. The importance of nodule consistency and size are key factors in the regimen. The regimen needs to be continuously updated by incorporating advances in technology and knowledge. RESULTS The use of the I-ELCAP regimen reduces the workup of participants in the screening program to less than 10% in the baseline round and less than 6% in the annual repeat rounds. By use of this regimen, estimated cure rate of lung cancers diagnosed under screening is 80% or higher in both baseline and annual repeat rounds. CONCLUSIONS The I-ELCAP collaboration provides a new paradigm that answers the 2002 NCI call for multiple approaches to address relevant questions about screening and the Institute of Medicine (IOM) Roundtable on Evidence-based Medicine from the National Academy of Science's call for a "new clinical research paradigm that takes better advantage of data generated in the course of healthcare delivery would speed and improve the development of evidence for real-world decision making".
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When is surgery indicated for small-cell lung cancer? Lung Cancer 2015; 90:582-9. [DOI: 10.1016/j.lungcan.2015.10.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/08/2015] [Accepted: 10/12/2015] [Indexed: 01/29/2023]
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Henschke CI, Boffetta P, Yankelevitz DF, Altorki N. Computed Tomography Screening. Thorac Surg Clin 2015; 25:129-43. [DOI: 10.1016/j.thorsurg.2014.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fukushima T, Tateishi K, Hanaoka M, Koizumi T. Clinical outcomes in patients with small cell lung cancer in a single institute: Comparative analysis of radiographic screening with symptom-prompted patients. Lung Cancer 2015; 88:48-51. [PMID: 25703893 DOI: 10.1016/j.lungcan.2015.01.025] [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: 09/23/2014] [Revised: 01/20/2015] [Accepted: 01/31/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The present study was performed to evaluate the differences in clinical characteristics and survival outcomes of patients with small cell lung cancer (SCLC) according to methods used for detecting the disease: radiographic screening or symptomatically prompted. MATERIALS AND METHODS The clinical findings and actual treatment outcomes were estimated according to three means of detection of SCLC: computed tomography (CT), radiographic test, and symptom-prompted cases. RESULTS We identified 147 patients (male/female ratio: 127/20; mean age: 68.1 years old) between 2000 and 2011. The patients were divided into three categories according to method of detection: chest CT (CT; n=24), radiographic screening (CXR; n=37), and symptom-prompted cases (symptom; n=86). There was no significant shift to early TNM stage distribution in the CT or CXR group compared with the symptom group. However, the rates of limited disease (LD)-SCLC were significantly higher in the CT and CXR groups than the symptom group. Median survival times were 17.0 months (95% confidence interval (CI): 11.6-22.4) in the CT group, 19.0 months (95%CI: 11.7-126.3) in the CXR group, and 12.0 months (95%CI: 9.6-14.4) in the symptom group. There were statistically significant differences in overall survival between CT and symptom groups (P<0.05) and between CXR and symptom groups (P<0.001). However, there was no significant difference in survival between CT and CXR groups. CONCLUSIONS Radiographic (CT plus CXR) testing contributes to better clinical outcome in patients with SCLC.
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Affiliation(s)
- Toshirou Fukushima
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, 3-1-1 Asahi Matsumoto, Nagano 390-8621, Japan; First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi Matsumoto, Nagano 390-8621, Japan
| | - Kazunari Tateishi
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi Matsumoto, Nagano 390-8621, Japan
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi Matsumoto, Nagano 390-8621, Japan
| | - Tomonobu Koizumi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, 3-1-1 Asahi Matsumoto, Nagano 390-8621, Japan.
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Commentary on "Small cell lung cancer: time to diagnosis and treatment". South Med J 2012; 105:424-5. [PMID: 22864100 DOI: 10.1097/smj.0b013e3182600ee1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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