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George B, Baydoun A, Bhat S, Bailey L, Arsenault T, Sun Y, Zhang Y, Zheng Y, Vempati P, Podder T, Biswas T. Invasive Nodal Staging via Endobronchial Ultrasound and Outcome in Patients Treated with Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer - Results from a Single Institution Study. Clin Lung Cancer 2024; 25:e181-e188. [PMID: 38553326 DOI: 10.1016/j.cllc.2024.02.007] [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: 10/24/2023] [Revised: 02/11/2024] [Accepted: 02/19/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Stereotactic body radiation therapy (SBRT) is an effective treatment for medically inoperable early-stage non-small cell lung cancer (NSCLC). The prognostic value of invasive nodal staging (INS) for patients undergoing SRBT has not been studied extensively. Herein, we report the impact of INS in addition to 18F-FDG-PET on treatment outcome for patients with NSCLC undergoing SBRT. MATERIALS AND METHODS Patients with stage I/ II NSCLC who underwent SBRT were included with IRB approval. Clinical, dosimetric, and radiological data were obtained. Overall survival (OS), regional recurrence free survival (RRFS), local recurrence free survival (LRFS), and distant recurrence free survival (DRFS) were analyzed using Kaplan Meyer method. Univariable analysis (UVA) and multivariable analysis (MVA) were performed to assess the relationship between the variables and the outcomes. RESULTS A total of 376 patients were included in the analysis. Median follow up was 43 months (IQ 32.6-45.8). Median OS, LRFS, RRFS, DRFS were 40, 32, 32, 33 months, respectively. The 5-year local, regional, and distant failure rates were 13.4%, 23.5% and 25.3%, respectively. The 1-year, 3-year and 5-year OS were 83.8%, 55.6%, and 36.3%, respectively. On MVA, INS was not a predictor of either improved overall or any recurrence free survival endpoints while larger tumor size, age, and adjusted Charleston co-morbidity index (aCCI) were significant for inferior LRFS, RRFS, and DRFS. CONCLUSION Invasive nodal staging did not improve overall or recurrence free survival among patients with early-stage NSCLC treated with SBRT whereas older age, aCCI, and larger tumor size were significant predictors of LRFS, RRFS, and DRFS.
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Affiliation(s)
- Benjamin George
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | | | - Samar Bhat
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Lauryn Bailey
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Theodore Arsenault
- University Hospitals, Seidman Cancer Center, Cleveland, OH; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
| | - Yilun Sun
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Yuxia Zhang
- University Hospitals, Seidman Cancer Center, Cleveland, OH
| | - Yiran Zheng
- School of Medicine, Case Western Reserve University, Cleveland, OH; University Hospitals, Seidman Cancer Center, Cleveland, OH
| | - Prashant Vempati
- School of Medicine, Case Western Reserve University, Cleveland, OH; University Hospitals, Seidman Cancer Center, Cleveland, OH
| | - Tarun Podder
- School of Medicine, Case Western Reserve University, Cleveland, OH; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
| | - Tithi Biswas
- School of Medicine, Case Western Reserve University, Cleveland, OH; University Hospitals, Seidman Cancer Center, Cleveland, OH; MetroHealth, Cleveland, OH.
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Lin JT, Li XM, Zhong WZ, Hou QY, Liu CL, Yu XY, Ye KY, Cheng YL, Du JY, Sun YQ, Zhang FG, Yan HH, Liao RQ, Dong S, Jiang BY, Liu SY, Wu YL, Yang XN. Impact of preoperative [ 18F]FDG PET/CT vs. contrast-enhanced CT in the staging and survival of patients with clinical stage I and II non-small cell lung cancer: a 10-year follow-up study. Ann Nucl Med 2024; 38:188-198. [PMID: 38145431 DOI: 10.1007/s12149-023-01888-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 11/21/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVES To elucidate the impact of [18F]FDG positron emission tomography/computed tomography (PET/CT) vs. CT workup on staging and prognostic evaluation of clinical stage (c) I-II NSCLC. METHODS We retrospectively identified 659 cI-II NSCLC who underwent CT (267 patients) or preoperative CT followed by PET/CT (392 patients), followed by curative-intended complete resection in our hospital from January 2008 to December 2013. Differences were assessed between preoperative and postoperative stage. Five-year disease-free survival (DFS) and overall survival (OS) rates were calculated using the Kaplan-Meier approach and compared with log-rank test. Impact of preoperative PET/CT on survival was assessed by Cox regression analysis. RESULTS The study included 659 patients [mean age, 59.5 years ± 10.8 (standard deviation); 379 men]. The PET/CT group was superior over CT group in DFS [12.6 vs. 6.9 years, HR 0.67 (95% CI 0.53-0.84), p < 0.001] and OS [13.9 vs. 10.5 years, HR 0.64 (95% CI 0.50-0.81), p < 0.001]. In CT group, more patients thought to have cN0 migrated to pN1/2 disease as compared with PET/CT group [26.4% (66/250) vs. 19.2% (67/349), p < 0.001], resulting in more stage cI cases being upstaged to pII-IV [24.7% (49/198) vs. 16.1% (47/292), p = 0.02], yet this was not found in cII NSCLC [27.5% (19/69) vs. 27.0% (27/100), p = 0.94]. Cox regression analysis identified preoperative PET/CT as an independent prognostic factor of OS and DFS (p = 0.002, HR = 0.69, 95% CI 0.54-0.88; p = 0.004, HR = 0.72, 95% CI 0.58-0.90). CONCLUSION Addition of preoperative [18F]FDG PET/CT was associated with superior DFS and OS in resectable cI-II NSCLC, which may result from accurate staging and stage-appropriate therapy.
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Affiliation(s)
- Jun-Tao Lin
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan 2nd Road, Guangzhou, 510080, People's Republic of China
| | - Xiang-Meng Li
- Cancer Institute, Southern Medical University, Guangzhou, China
| | - Wen-Zhao Zhong
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan 2nd Road, Guangzhou, 510080, People's Republic of China
| | - Qing-Yi Hou
- Department of PET Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Chun-Ling Liu
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Xin-Yue Yu
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan 2nd Road, Guangzhou, 510080, People's Republic of China
| | - Kai-Yan Ye
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan 2nd Road, Guangzhou, 510080, People's Republic of China
| | - Yi-Lu Cheng
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan 2nd Road, Guangzhou, 510080, People's Republic of China
| | - Jia-Yu Du
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan 2nd Road, Guangzhou, 510080, People's Republic of China
| | - Yun-Qing Sun
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan 2nd Road, Guangzhou, 510080, People's Republic of China
| | - Fu-Gui Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan 2nd Road, Guangzhou, 510080, People's Republic of China
| | - Hong-Hong Yan
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan 2nd Road, Guangzhou, 510080, People's Republic of China
| | - Ri-Qiang Liao
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan 2nd Road, Guangzhou, 510080, People's Republic of China
| | - Song Dong
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan 2nd Road, Guangzhou, 510080, People's Republic of China
| | - Ben-Yuan Jiang
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan 2nd Road, Guangzhou, 510080, People's Republic of China
| | - Si-Yang Liu
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan 2nd Road, Guangzhou, 510080, People's Republic of China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan 2nd Road, Guangzhou, 510080, People's Republic of China.
| | - Xue-Ning Yang
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan 2nd Road, Guangzhou, 510080, People's Republic of China.
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Steinfort DP. Systematic mediastinal staging in non-small cell lung cancer: Filling in the guideline evidence gap. Respirology 2024; 29:89-91. [PMID: 38143423 DOI: 10.1111/resp.14647] [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: 11/29/2023] [Indexed: 12/26/2023]
Abstract
See related article
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Affiliation(s)
- Daniel P Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
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Song X, Duan X, He X, Wang Y, Li K, Deng B, Chen X, Wang Y, Li M, Shan H. Computer-aided diagnosis of distal metastasis in non-small cell lung cancer by low-dose CT based radiomics and deep learning signatures. LA RADIOLOGIA MEDICA 2024; 129:239-251. [PMID: 38214839 DOI: 10.1007/s11547-024-01770-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND This study aimed to develop and validate radiomics and deep learning (DL) signatures for predicting distal metastasis (DM) of non-small cell lung cancer (NSCLC) in low-dose computed tomography (LDCT). METHODS Images and clinical data were retrospectively collected for 381 NSCLC patients and prospectively collected for 114 patients at the Fifth Affiliated Hospital of Sun Yat-Sen University. Additionally, we enrolled 179 patients from the Jiangmen Central Hospital to externally validate the signatures. Machine-learning algorithms were employed to develop radiomics signature while the DL signature was developed using neural architecture search. The diagnostic efficiency was primarily quantified with the area under receiver operating characteristic curve (AUC). We interpreted the reasoning process of the radiomics signature and DL signature by radiomics voxel mapping and attention weight tracking. RESULTS A total of 674 patients with pathologically-confirmed NSCLC were included from two institutions, with 143 of them having DM. The radiomics signature achieved AUCs of 0.885, 0.854, and 0.733 in the internal validation, prospective validation, and external validation while those for DL signature were 0.893, 0.786, and 0.780. The proposed signatures achieved a promising performance in predicting the DM of NSCLC and outperformed the approaches proposed in previous studies. Interpretability analysis revealed that both radiomics and DL signatures could detect the variations among voxels inside tumors, which helped in identifying the DM of NSCLC. CONCLUSIONS Our study demonstrates the potential of LDCT-based radiomics and DL signatures for predicting DM in NSCLC. These signatures could help improve lung cancer screening regarding further diagnostic tests and treatment strategies.
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Affiliation(s)
- Xiaoyi Song
- Guangdong Provincial Engineering Research Center of Molecular Imaging, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, Guangdong Province, China
- Guangdong-Hong Kong-Macao University Joint Laboratory of Interventional Medicine, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, China
| | - Xiaobei Duan
- Department of Nuclear Medicine, Jiangmen Central Hospital, Jiangmen, 529030, China
| | - Xinghua He
- Department of Nuclear Medicine, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, Guangdong Province, China
| | - Yubo Wang
- Department of Nuclear Medicine, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, Guangdong Province, China
| | - Kunwei Li
- Department of Radiology, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, China
| | - Bangxuan Deng
- Department of Nuclear Medicine, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, Guangdong Province, China
| | - Xiangmeng Chen
- Department of Radiology, Jiangmen Central Hospital, Jiangmen, 529030, China
| | - Ying Wang
- Department of Nuclear Medicine, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, Guangdong Province, China.
| | - Man Li
- Guangdong Provincial Engineering Research Center of Molecular Imaging, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, Guangdong Province, China.
- Guangdong-Hong Kong-Macao University Joint Laboratory of Interventional Medicine, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, China.
- Department of Information Technology and Data Center, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, China.
- Biobank of the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, China.
| | - Hong Shan
- Guangdong Provincial Engineering Research Center of Molecular Imaging, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, Guangdong Province, China.
- Guangdong-Hong Kong-Macao University Joint Laboratory of Interventional Medicine, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, China.
- Department of Interventional Medicine, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, China.
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Huang CC, Tang EK, Shu CW, Chou YP, Goan YG, Tseng YC. Comparison of the Outcomes between Systematic Lymph Node Dissection and Lobe-Specific Lymph Node Dissection for Stage I Non-small Cell Lung Cancer. Diagnostics (Basel) 2023; 13:diagnostics13081399. [PMID: 37189500 DOI: 10.3390/diagnostics13081399] [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: 03/05/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND This study compares the surgical and long-term outcomes, including disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS), between lobe-specific lymph node dissection (L-SND) and systematic lymph node dissection (SND) among patients with stage I non-small cell lung cancer (NSCLC). METHODS In this retrospective study, 107 patients diagnosed with clinical stage I NSCLC undergoing video-assisted thoracic surgery lobectomy (exclusion of the right middle lobe) from January 2011 to December 2018 were enrolled. The patients were assigned to the L-SND (n = 28) and SND (n = 79) groups according to the procedure performed on them. Demographics, perioperative data, and surgical and long-term oncological outcomes were collected and compared between the L-SND and SND groups. RESULTS The mean follow-duration was 60.6 months. The demographic data and surgical outcomes and long-term oncological outcomes were not significantly different between the two groups. The 5-year OS of the L-SND and SND groups was 82% and 84%, respectively. The 5-year DFS of the L-SND and SND groups was 70% and 65%, respectively. The 5-year CSS of the L-SND and SND groups was 80% and 86%, respectively. All the surgical and long-term outcomes were not statistically different between the two groups. CONCLUSION L-SND showed comparable surgical and oncologic outcomes with SND for clinical stage I NSCLC. L-SND could be a treatment choice for stage I NSCLC.
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Affiliation(s)
- Ching-Chun Huang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - En-Kuei Tang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Chih-Wen Shu
- Institute of BioPharmaceutical Sciences, National Sun Yat-Sen University, Kaohsiung 804, Taiwan
- Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yi-Ping Chou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Division of Trauma, Department of Emergency, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
| | - Yih-Gang Goan
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Surgery, Kaohsiung Veterans General Hospital Pingtung Branch, Pingtung 900, Taiwan
| | - Yen-Chiang Tseng
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
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Aoun-Bacha Z, Bitar N, Saleh WA, Assi H, Bahous J, Boukhalil P, Chami H, Dabar G, El Karak F, Farhat F, Ghanem H, Ghosn M, Juvelikian G, Nasr F, Nehme R, Riachy M, Tabet G, Tfayli A, Waked M, Youssef P. Diagnosis and management of patients with stage III non‑small cell lung cancer: A joint statement by the Lebanese Society of Medical Oncology and the Lebanese Pulmonary Society (Review). Oncol Lett 2023; 25:113. [PMID: 36844621 PMCID: PMC9950344 DOI: 10.3892/ol.2023.13699] [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: 08/02/2022] [Accepted: 09/30/2022] [Indexed: 02/08/2023] Open
Abstract
Proper management of stage III non-small cell lung cancer (NSCLC) might result in a cure or patient long-term survival. Management should therefore be preceded by adequate and accurate diagnosis and staging, which will inform therapeutic decisions. A panel of oncologists, surgeons and pulmonologists in Lebanon convened to establish a set of recommendations to guide and unify clinical practice, in alignment with international standards of care. Whilst chest computerized tomography (CT) scanning remains a cornerstone in the discovery of a lung lesion, a positron-emission tomography (PET)/CT scan and a tumor biopsy allows for staging of the cancer and defining the resectability of the tumor(s). A multidisciplinary discussion meeting is currently widely advised for evaluating patients on a case-by-case basis, and should include at least the treating oncologist, a thoracic surgeon, a radiation oncologist and a pulmonologist, in addition to physicians from other specialties as needed. The standard of care for unresectable stage III NSCLC is concurrent chemotherapy and radiation therapy, followed by consolidation therapy with durvalumab, which should be initiated within 42 days of the last radiation dose; for resectable tumors, neoadjuvant therapy followed by surgical resection is recommended. This joint statement is based on the expertise of the physician panel, available literature and evidence governing the treatment, management and follow-up of patients with stage III NSCLC.
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Affiliation(s)
- Zeina Aoun-Bacha
- Division of Pulmonary Medicine, Hôtel-Dieu de France Medical Center, Saint-Joseph University, Beirut 1104 2020, Lebanon,Correspondence to: Dr Zeina Aoun-Bacha, Department of Pulmonology and Critical Care, Hôtel Dieu de France Medical Center, Saint-Joseph University, Alfred Naccache Boulevard, Ashrafieh, P.O. Box 2064-6613, Beirut 1104 2020, Lebanon, E-mail:
| | - Nizar Bitar
- Division of Hematology-Oncology, Sahel General Hospital, Beirut 1514, Lebanon
| | - Wajdi Abi Saleh
- Division of Pulmonary Medicine and Critical Care, Clémenceau Medical Center, Beirut 1103, Lebanon
| | - Hazem Assi
- Division of Hematology/Oncology, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Joudy Bahous
- Division of Pulmonary Medicine, Saint Georges Hospital University Medical Center, Beirut 1481, Lebanon
| | - Pierre Boukhalil
- Division of Pulmonary Medicine and Critical Care, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Hasan Chami
- Division of Pulmonary Medicine and Critical Care, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Georges Dabar
- Division of Pulmonary Medicine, Hôtel-Dieu de France Medical Center, Saint-Joseph University, Beirut 1104 2020, Lebanon
| | - Fadi El Karak
- Division of Hematology-Oncology, Hôtel-Dieu de France Medical Center, Saint-Joseph University, Beirut 1104 2020, Lebanon
| | - Fadi Farhat
- Division of Hematology Oncology, Hammoud Hospital University Medical Center, Sidon 1551, Lebanon
| | - Hadi Ghanem
- Division of Hematology-Oncology, Lebanese American University Medical Center-Rizk Hospital, Beirut 1481, Lebanon
| | - Marwan Ghosn
- Division of Hematology-Oncology, Hôtel-Dieu de France Medical Center, Saint-Joseph University, Beirut 1104 2020, Lebanon
| | - George Juvelikian
- Division of Pulmonary Medicine, Saint Georges Hospital University Medical Center, Beirut 1481, Lebanon
| | - Fadi Nasr
- Division of Hematology-Oncology, Hôtel-Dieu de France Medical Center, Saint-Joseph University, Beirut 1104 2020, Lebanon
| | - Ralph Nehme
- Division of Pulmonary Medicine and Critical Care, Lebanese American University Medical Center-Rizk Hospital, Beirut 1481, Lebanon
| | - Moussa Riachy
- Division of Pulmonary Medicine, Hôtel-Dieu de France Medical Center, Saint-Joseph University, Beirut 1104 2020, Lebanon
| | - Georges Tabet
- Department of Thoracic Surgery, Hôtel-Dieu de France Medical Center, Saint-Joseph University, Beirut 1004 2020, Lebanon
| | - Arafat Tfayli
- Division of Hematology/Oncology, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Mirna Waked
- Division of Pulmonary Medicine, Saint Georges Hospital University Medical Center, Beirut 1481, Lebanon
| | - Pierre Youssef
- Department of Surgery, Saint Georges Hospital University Medical Center, Beirut 1481, Lebanon
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Ni L, Lin G, Zhang Z, Sun D, Liu Z, Liu X. Surgery versus radiotherapy in octogenarians with stage Ia non‑small cell lung cancer: propensity score matching analysis of the SEER database. BMC Pulm Med 2022; 22:411. [DOI: 10.1186/s12890-022-02177-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/27/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
To compare overall survival (OS) and cancer-specific survival (CSS) outcomes of surgery with radiotherapy in octogenarians with stage Ia non-small cell lung cancer (NSCLC).
Materials and methods
Patients aged ≥ 80 years with clinical stage Ia (T1N0M0) NSCLC between 2012 and 2017 were identified from the population-based Surveillance, Epidemiology, and End Results (SEER) database. Patients were assigned into surgery and radiotherapy groups. Multivariate Cox regression analysis was used to identify survival-associated factors. Treatment groups were adjusted by propensity score matching (PSM) analysis while OS and CSS outcomes were compared among groups by Kaplan–Meier analysis.
Results
A total of 1641 patients were identified, with 46.0% in the surgical group and 54.0% in the radiotherapy group. Compared to surgery, radiotherapy-treated patients were older, later diagnosed, had more often unmarried, more squamous cell carcinoma, more unknown grade and increased tumor sizes. Radiotherapy was associated with a significantly worse OS, compared to surgery (hazard ratio 2.426; 95% CI 2.003–2.939; P < .001). After PSM, OS (P < 0.001) and CSS (P < 0.001) were higher in the surgery group. The 1-, 3-, and 5-year OS rates of surgical and radiotherapy group were 90.0%, 76.9%, 59.9%, and 86.0%, 54.3%, 28.0%, respectively. The 1-, 3-, and 5-year CSS rates of surgical and radiotherapy group were 94.5%, 86.1%, 78.0% and 90.7%, 74.5%, 61.0%, respectively. There were no survival differences between the matched surgery without lymph node examination (LNE) and radiotherapy group, as well as between the matched surgery and radiotherapy who were recommended but refused surgery group.
Conclusions
In octogenarians with stage Ia NSCLC, surgery with lymph node dissection offers better OS and CSS outcomes than radiotherapy.
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Yuan H, Zou Y, Gao Y, Zhang S, Zheng X, You X. Correlation analysis between unenhanced and enhanced CT radiomic features of lung cancers presenting as solid nodules and their efficacy for predicting hilar and mediastinal lymph node metastases. FRONTIERS IN RADIOLOGY 2022; 2:911179. [PMID: 37492652 PMCID: PMC10365119 DOI: 10.3389/fradi.2022.911179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/21/2022] [Indexed: 07/27/2023]
Abstract
Objectives If hilar and mediastinal lymph node metastases occur in solid nodule lung cancer is critical for tumor staging, which determines the treatment strategy and prognosis of patients. We aimed to develop an effective model to predict hilar and mediastinal lymph node metastases by using texture features of solid nodule lung cancer. Methods Two hundred eighteen patients with solid nodules on CT images were analyzed retrospectively. The 3D tumors were delineated using ITK-SNAP software. Radiomics features were extracted from unenhanced and enhanced CT images based on AK software. Correlations between radiomics features of unenhanced and enhanced CT images were analyzed with Spearman rank correlation analysis. According to pathological findings, the patients were divided into no lymph node metastasis group and lymph node metastasis group. All patients were randomly divided into training group and test group at a ratio of 7:3. Valuable features were selected. Multivariate logistic regression was used to build predictive models. Two predictive models were established with unenhanced and enhanced CT images. ROC analysis was used to estimate the predictive efficiency of the models. Results A total of 7 categories of features, including 107 features, were extracted. There was a high correlation between the 7 categories of features from unenhanced CT images and enhanced CT images (all r > 0.7, p < 0.05). Among them, the shape features had the strongest correlation (mean r = 0.98). There were 5 features in the enhanced model and the unenhanced model, which had important predicting significance. The AUCs were 0.811 and 0.803, respectively. There was no significant difference in the predictive performance of the two models (DeLong's test, p = 0.05). Conclusion Our study models achieved higher accuracy for predicting hilar and mediastinal lymph node metastasis of solid nodule lung cancer and have some value in promoting the staging accuracy of lung cancer. Our results show that CT radiomics features have potential to predict hilar and mediastinal lymph node metastases in solid nodular lung cancer. In addition, enhanced and unenhanced CT radiomics models had comparable predictive power in predicting hilar and mediastinal lymph node metastases.
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Affiliation(s)
- Huanchu Yuan
- Department of Radiology, Dongguan People’s Hospital, Dongguan, China
| | - Yujian Zou
- Department of Radiology, Dongguan People’s Hospital, Dongguan, China
| | - Yun Gao
- Department of Radiology, Dongguan People’s Hospital, Dongguan, China
| | - Shihao Zhang
- Department of Pathology, Dongguan People’s Hospital, Dongguan, China
| | - Xiaolin Zheng
- Department of Radiology, Dongguan People’s Hospital, Dongguan, China
| | - Xiaoting You
- Department of Radiology, Dongguan People’s Hospital, Dongguan, China
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9
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Assisi D, Gallina FT, Forcella D, Tajè R, Melis E, Visca P, Pierconti F, Venti E, Facciolo F. Transesophageal Endoscopic Ultrasound Fine Needle Biopsy for the Diagnosis of Mediastinal Masses: A Retrospective Real-World Analysis. J Clin Med 2022; 11:jcm11185469. [PMID: 36143116 PMCID: PMC9506435 DOI: 10.3390/jcm11185469] [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: 08/06/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Endoscopic ultrasound (EUS) plays an important role in the diagnosis and staging of thoracic disease. Our report studies the diagnostic performance and clinical impact of EUS fine needle aspiration (FNA) in a homogenous cohort of patients according to the distribution of the enlarged MLNs or pulmonary masses. Methods: We retrospectively reviewed the diagnostic performance of 211 EUS-FNA in 200 consecutive patients with enlarged or PET-positive MLNs and para-mediastinal masses who were referred to our oncological center between January 2019 and May 2020. Results: The overall sensitivity of EUS-FNA was 85% with a corresponding negative predictive value (NPV) of 56% and an accuracy of 87.5%. The sensitivity and accuracy in patients with abnormal MLNs were 81.1% and 84.4%, respectively. In those with para-mediastinal masses, sensitivity and accuracy were 96.4% and 96.8%. The accuracy for both masses and lymph nodes was 100%, and in the LAG (left adrenal gland), it was 66.6%. Conclusions: Our results show that, in patients with suspected mediastinal masses, EUS-FNA is an accurate technique to evaluate all reachable mediastinal nodal stations, including station 5.
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Affiliation(s)
- Daniela Assisi
- Digestive Endoscopy Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Filippo Tommaso Gallina
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
- Correspondence: ; Tel.: +39-0652665218
| | - Daniele Forcella
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Riccardo Tajè
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Enrico Melis
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Paolo Visca
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Federico Pierconti
- Anesthesiology and Intensive Care Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Emanuela Venti
- Anesthesiology and Intensive Care Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Francesco Facciolo
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
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Zhi X, Sun X, Chen J, Wang L, Ye L, Li Y, Xie W, Sun J. Combination of 18F-FDG PET/CT and convex probe endobronchial ultrasound elastography for intrathoracic malignant and benign lymph nodes prediction. Front Oncol 2022; 12:908265. [PMID: 35992813 PMCID: PMC9389119 DOI: 10.3389/fonc.2022.908265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPositron emission tomography–computed tomography (PET/CT) and convex probe endobronchial ultrasound (CP-EBUS) elastography are important diagnostic methods in predicting intrathoracic lymph nodes (LNs) metastasis, but a joint analysis of the two examinations is still lacking. This study aimed to compare the diagnostic efficiency of the two methods and explore whether the combination can improve the diagnostic efficiency in differentiating intrathoracic benign LNs from malignant LNs.Materials and MethodsLNs examined by EBUS-guided transbronchial needle aspiration (EBUS-TBNA) and PET/CT from March 2018 to June 2019 in Shanghai Chest Hospital were retrospectively analyzed as the model group. Four PET/CT parameters, namely, maximal standardized uptake value mean standardized uptake value (SUVmean), SUVmean, metabolic tumor volume (MTV), and tumor lesion glycolysis (TLG); four quantitative elastography indicators (stiff area ratio, mean hue value, RGB, and mean gray value); and the elastography grading score of targeted LNs were analyzed. A prediction model was constructed subsequently and the dataset from July to November 2019 was used to validate the diagnostic capability of the model.ResultsA total of 154 LNs from 135 patients and 53 LNs from 47 patients were enrolled in the model and validation groups, respectively. Mean hue value and grading score were independent malignancy predictors of elastography, as well as SUVmax and TLG of PET/CT. In model and validation groups, the combination of PET/CT and elastography demonstrated sensitivity, specificity, positive and negative predictive values, and accuracy for malignant LNs diagnosis of 85.87%, 88.71%, 91.86%, 80.88%, and 87.01%, and 94.44%, 76.47%, 89.47%, 86.67%, and 88.68%, respectively. Moreover, elastography had better diagnostic accuracies than PET/CT in both model and validation groups (85.71% vs. 79.22%, 86.79% vs. 75.47%).ConclusionEBUS elastography demonstrated better efficiency than PET/CT and the combination of the two methods had the best diagnostic efficacy in differentiating intrathoracic benign from malignant LNs, which may be helpful for clinical application.
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Affiliation(s)
- Xinxin Zhi
- Department of Respiratory Endoscopy, Shanghai Jiao Tong University, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Xiaoyan Sun
- Department of Nuclear Medicine, The Fifth People’s Hospital of Shanghai Fu Dan University, Shanghai, China
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Junxiang Chen
- Department of Respiratory Endoscopy, Shanghai Jiao Tong University, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Lei Wang
- Department of Ultrasound, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Lin Ye
- Department of Respiratory Endoscopy, Shanghai Jiao Tong University, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Ying Li
- Department of Respiratory Endoscopy, Shanghai Jiao Tong University, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Wenhui Xie
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Jiayuan Sun, ; Wenhui Xie,
| | - Jiayuan Sun
- Department of Respiratory Endoscopy, Shanghai Jiao Tong University, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
- *Correspondence: Jiayuan Sun, ; Wenhui Xie,
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11
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Husta BC, Kalchiem-Dekel O, Beattie JA, Yasufuku K. Mediastinal Staging with Endobronchial Ultrasound in Early-Stage Non-Small Cell Lung Cancer: Is It Necessary? Semin Respir Crit Care Med 2022; 43:503-511. [PMID: 36104026 DOI: 10.1055/s-0042-1748189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Herein we examine the need for minimally invasive mediastinal staging for patients with early-stage non-small cell lung cancer (NSCLC) using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Early NSCLC, stages 1 and 2, has a 5-year survival rate between 53 and 92%, whereas stages 3 and 4 have a 5-year survival of 36% and below. With more favorable outcomes in earlier stages, greater emphasis has been placed on identifying lung cancer earlier in its disease process. Accurate staging is crucial as it dictates both prognosis and therapy. Inaccurate staging can adversely impact surgical candidacy (if falsely "over-staged") or lead to inadequate treatment (if "under-staged"). Clinical staging utilizes noninvasive methods to evaluate the anatomic extent of disease; however, it remains controversial whether mediastinal staging of early NSCLC with radiological exams alone is sufficient. EBUS-TBNA has altered the landscape of invasive mediastinal staging and is a crucial component to improving confidence in lung cancer staging, specifically in early NSCLC. Radiographic occult lymph node metastasis identified upon review of surgical resection specimens of early NSCLC may support the argument to perform EBUS-TBNA in all cases of early-stage disease. Other data suggest that EBUS-TBNA could be spared in cases of peripheral cT1aN0 and cT1bN0 for which surgical resection with lymph node dissection is planned. By reviewing reported EBUS-TBNA outcomes in patients with early NSCLC, we aim to emphasize the necessity of staging with EBUS in this population.
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Affiliation(s)
- Bryan C Husta
- Section of Interventional Pulmonology, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Or Kalchiem-Dekel
- Section of Interventional Pulmonology, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Jason A Beattie
- Section of Interventional Pulmonology, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto
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12
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Wang K, Xue M, Qiu J, Liu L, Wang Y, Li R, Qu C, Yue W, Tian H. Genomics Analysis and Nomogram Risk Prediction of Occult Lymph Node Metastasis in Non-Predominant Micropapillary Component of Lung Adenocarcinoma Measuring ≤ 3 cm. Front Oncol 2022; 12:945997. [PMID: 35912197 PMCID: PMC9326108 DOI: 10.3389/fonc.2022.945997] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/21/2022] [Indexed: 11/22/2022] Open
Abstract
Background The efficacy of sublobar resection and selective lymph node dissection is gradually being accepted by thoracic surgeons for patients within early-stage non-small cell lung cancer (NSCLC). Nevertheless, there are still some NSCLC patients develop lymphatic metastasis at clinical T1 stage. Lung adenocarcinoma with a micropapillary (MP) component poses a higher risk of lymph node metastasis and recurrence even when the MP component is not predominant. Our study aimed to explore the genetic features and occult lymph node metastasis (OLNM) risk factors in patients with a non-predominant micropapillary component (NP-MPC) in a large of patient’s cohort with surgically resected lung adenocarcinoma. Methods Between January 2019 and December 2021, 6418 patients who underwent complete resection for primary lung adenocarcinoma at the Qilu Hospital of Shandong University. In our study, 442 patients diagnosed with lung adenocarcinoma with NP-MPC with a tumor size ≤3 cm were included. Genetic alterations were analyzed using amplification refractory mutation system-polymerase chain reaction (ARMS-PCR). Abnormal protein expression of gene mutations was validated using immunohistochemistry. A nomogram risk model based on clinicopathological parameters was developed to predict OLNM. This model was invalidated using the calibration plot and concordance index. Results In our retrospective cohort, the incidence rate of the micropapillary component was 11.17%, and OLNM was observed in 20.13% of the patients in our study. ARMS-PCR suggested that EGFR exon 19 del was the most frequent alteration in NP-MCP patients compared with other gene mutations (frequency: 21.2%, P<0.001). Patients harboring exon 19 del showed significantly higher risk of OLNM (P< 0.001). A nomogram was developed based on five risk parameters, which showed good calibration and reliable discrimination ability (C-index = 0.84) for evaluating OLNM risk. Conclusions. Intense expression of EGFR exon 19 del characterizes lung adenocarcinoma in patients with NP-MCP and it’s a potential risk factor for OLNM. We firstly established a nomogram based on age, CYFRA21-1 level, tumor size, micropapillary and solid composition, that was effective in predicting OLNM among NP-MCP of lung adenocarcinoma measuring ≤ 3 cm.
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Affiliation(s)
- Kun Wang
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Mengchao Xue
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Jianhao Qiu
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Ling Liu
- Department of Pathology, Qilu Hospital of Shandong University, Jinan, China
| | - Yueyao Wang
- Department of Pathology, Qilu Hospital of Shandong University, Jinan, China
| | - Rongyang Li
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Chenghao Qu
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Weiming Yue
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Hui Tian
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
- *Correspondence: Hui Tian,
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Rationale for Combing Stereotactic Body Radiation Therapy with Immune Checkpoint Inhibitors in Medically Inoperable Early-Stage Non-Small Cell Lung Cancer. Cancers (Basel) 2022; 14:cancers14133144. [PMID: 35804917 PMCID: PMC9264861 DOI: 10.3390/cancers14133144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 02/07/2023] Open
Abstract
Simple Summary The rate of recurrence remains high for lymph node negative early-stage non-small cell lung cancer that are over 2–3 cm in size following stereotactic body radiation therapy (SBRT). This is due to the increased incidence of out-of-field failures, which warrants the addition of systemic therapy. Immune checkpoint inhibitors (ICIs), a class of immunotherapy, may induce a strong distant therapeutic effect known as the “abscopal” effect. This makes them a very suitable class of drugs to be combined with SBRT when treating early lung cancer with high-risk features, such as larger tumor size. In this review, we discuss the rationale and evidence for doing so. Abstract Stereotactic body radiation therapy (SBRT) has been widely adopted as an alternative to lobar resection in medically inoperable patients with lymph-node negative (N0) early-stage (ES) non-small cell lung cancer (NSCLC). Excellent in-field local control has been consistently achieved with SBRT in ES NSCLC ≤ 3 cm in size. However, the out-of-field control following SBRT remains suboptimal. The rate of recurrence, especially distant recurrence remains high for larger tumors. Additional systemic therapy is warranted in N0 ES NSCLC that is larger in size. Radiation has been shown to have immunomodulatory effects on cancer, which is most prominent with higher fractional doses. Strong synergistic effects are observed when immune checkpoint inhibitors (ICIs) are combined with radiation doses in SBRT’s dose range. Unlike chemotherapy, ICIs can potentiate a strong systemic response outside of the irradiated field when combined with SBRT. Together with their less toxic nature, ICIs represent a very suitable class of systemic agents to be combined with SBRT when treating ES NSCLC with high-risk features, such as larger tumor size. In this review, we describe the rationale and emerging evidence, as well as ongoing investigations in this area.
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Kim H, Choi H, Lee KH, Cho S, Park CM, Kim YT, Goo JM. Definitions of Central Tumors in Radiologically Node-Negative, Early-Stage Lung Cancer for Preoperative Mediastinal Lymph Node Staging: A Dual-Institution, Multireader Study. Chest 2022; 161:1393-1406. [PMID: 34785237 DOI: 10.1016/j.chest.2021.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/25/2021] [Accepted: 11/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Definitions for central lung cancer (CLC) have been ambiguous in guidelines, causing difficulty in selecting candidates for invasive mediastinal staging among patients with radiologically node-negative, early-stage lung cancer. RESEARCH QUESTION What is the optimal definition for CLC that is robust to interreader and institutional variation to select candidates for invasive mediastinal staging among those with clinical T1N0M0 lung cancer? STUDY DESIGN AND METHODS Two retrospective cohorts were evaluated for the associations of central lung cancer according to 13 definitions based on chest CT scan with occult nodal metastasis. Univariate and multivariate ordinal logistic regression analyses were performed with the pathologic N category as an ordinal outcome. Robust definitions, which retained statistical significance across multireader, dual-institutional datasets, were identified. For these definitions, binary diagnostic performance and interreader agreement were investigated. RESULTS In the two cohorts, 807 patients (median age, 63 years; interquartile range [IQR], 56-71 years; 410 women; 33 pN1, 48 pN2, and 1 pN3) and 510 patients (median age, 65 years; IQR, 58-71 years; 267 women; 33 pN1, 20 pN2, and no pN3) were included, respectively. Three definitions robust to interreader variation and dataset heterogeneity were identified: definition 7 (concentric lines arising from the midline, inner one-third, medial margin; adjusted OR, 2.01; 95% CI, 1.13-3.51; P = .02), definition 10 (location index-based inner one-third, center; adjusted OR, 3.60; 95% CI, 1.49-8.25; P = .003), and definition 12 (location index-based inner one-third, medial margin; adjusted OR, 3.57; 95% CI, 1.91-6.52; P < .001). Definition 12 showed higher interreader agreement than definition 7 (Cohen κ, 0.80 vs 0.66; P = .005). Nevertheless, the sensitivity and positive predictive value of the three definitions were < 50%. INTERPRETATION Three definitions exhibited robust associations with occult nodal metastasis. However, selecting candidates for invasive mediastinal staging solely based on a central tumor location would be suboptimal.
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Affiliation(s)
- Hyungjin Kim
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyewon Choi
- Department of Radiology, Chung-Ang University Hospital, Seoul, South Korea
| | - Kyung Hee Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea; Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea.
| | - Sukki Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, South Korea; Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea; Cancer Research Institute, Seoul National University, Seoul, South Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea; Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea; Cancer Research Institute, Seoul National University, Seoul, South Korea
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15
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Wang Y, Zhou P, Cui C, He X, Bian Y, Wang X. The expression of Nanog protein and fibroblast growth factor-inducible molecule 14 in patients with non-small cell lung cancer and their relationship with pathological characteristics and prognosis. Transl Cancer Res 2022; 10:2470-2477. [PMID: 35116561 PMCID: PMC8797829 DOI: 10.21037/tcr-21-724] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/19/2021] [Indexed: 12/25/2022]
Abstract
Background This study aimed to explore the expression of Nanog and fibroblast growth factor-inducible molecule 14 (Fn14) in patients with non-small cell lung cancer (NSCLC), and to explore their relationship with pathological characteristics and prognosis. Methods The clinical data of 89 patients with NSCLC admitted to this hospital from March 2015 to January 2019 were analyzed. The expression of Nanog and Fn14 in NSCLC tissues and normal tissues (5 cm around the tumor tissue) were analyzed by immunohistochemical staining. The relationship between Nanog and Fn14 expression and the patients’ pathological parameters was analyzed. Receiver operating characteristic curve (ROC) and Kaplan-Meier survival curves were drawn to analyze the influence of Nanog and Fn14 expression on prognosis, and logistic regression analysis was used to examine the related factors affecting the 2-year prognostic mortality of patients. Results The positive rates of Nanog and Fn14 in the observation group were significantly higher than those in the control group (P<0.05). The positive expression rates of Nanog and Fn14 were higher in patients with moderate/high differentiation, TNM stage III-IV, and lymph node metastasis (P<0.05). Among 89 patients with NSCLC, 25 patients died within 2 years of follow-up, with a survival rate of 71.91%. The mortality of patients with positive expression of Nanog and Fn14 was significantly higher than that of patients with negative expression (P<0.05). The median survival times of patients with negative and positive Nanog expression were (20.60±2.71) months and (18.03±2.11) months, respectively. The median survival times of patients with negative and positive Fn14 expression were (19.55±2.60) months and (15.65±2.14) months, respectively. The Kaplan-Meier survival curve showed that patients with both negative expression of Nanog and Fn14 had a longer survival time (P<0.05). Poor differentiation, TNM stage III-IV, lymph node metastasis, positive expression of Nanog, and positive expression of Fn14 were identified as risk factors affecting the prognostic mortality of patients with NSCLC (P<0.05). Conclusions Nanog and Fnl4 are closely related to the occurrence, development, and prognosis of NSCLC. Detection of their expression levels can provide reliable information for the early diagnosis of patients with NSCLC.
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Affiliation(s)
- Yaqian Wang
- General Medicine Department, Hengshui People's Hospital, Hengshui, China
| | - Ping Zhou
- Department of Thoracic Surgery, Hengshui People's Hospital, Hengshui, China
| | - Cunxiao Cui
- General Medicine Department, Hengshui People's Hospital, Hengshui, China
| | - Xinxia He
- General Medicine Department, Hengshui People's Hospital, Hengshui, China
| | - Yali Bian
- General Medicine Department, Hengshui People's Hospital, Hengshui, China
| | - Xiuzheng Wang
- Tuberculosis Department, The Affiliated Hospital of Hebei University, Baoding, China
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16
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Clinicopathological and computed tomographic features associated with occult lymph node metastasis in patients with peripheral solid non-small cell lung cancer. Eur J Radiol 2021; 144:109981. [PMID: 34624648 DOI: 10.1016/j.ejrad.2021.109981] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/31/2021] [Accepted: 09/24/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To investigate the value of combining clinicopathological characteristics with computed tomographic (CT) features of tumours for predicting occult lymph node metastasis (OLNM) in peripheral solid non-small cell lung cancer (PS-NSCLC). METHODS The study included 478 NSCLC clinically N0 (cN0) patients who underwent lobectomy and systemic lymph node dissection from January 2014 to August 2019. Patients were classified into OLNM and negative lymph node metastasis (NLNM) groups. The CT features of non-metastatic and metastatic lymph nodes with a largest short-diameter > 5 mm were compared in the OLNM group. Thereafter, the clinicopathological characteristics and CT morphological features of tumours were compared between both groups. Multivariable logistic regression analysis and receiver-operating characteristic curve were developed. RESULTS CT images detected 103 metastatic and 705 non-metastatic lymph nodes, and no significant differences in CT features of lymph nodes were found in all 161 OLNM patients (P > 0.05). For both groups, sex, carcinoembryonic antigen and pathological type differed significantly (all P < 0.05), while tumour size, necrosis, calcification, vascular convergence, pleural involvement, and the shortest interval of tumour-pleura differed significantly on CT images (all P < 0.05). Multivariable logistic regression analysis showed that carcinoembryonic antigen > 5.00 ng/ml, adenocarcinoma, absence of vascular convergence, and pleural involvement of Type II (one linear or cord-like pleural tag or tumour abut to the pleura with a broad base observed on both lung and mediastinal window images) were independent predicting factors of OLNM. CONCLUSIONS CT findings of lymph nodes can provide limited value and integrating clinicopathological characteristics with the CT morphological features of tumours is helpful in predicting OLNM in patients with PS-NSCLC.
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17
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Rogasch JMM, Frost N, Bluemel S, Michaels L, Penzkofer T, von Laffert M, Temmesfeld-Wollbrück B, Neudecker J, Rückert JC, Ochsenreither S, Böhmer D, Amthauer H, Furth C. FDG-PET/CT for pretherapeutic lymph node staging in non-small cell lung cancer: A tailored approach to the ESTS/ESMO guideline workflow. Lung Cancer 2021; 157:66-74. [PMID: 33994197 DOI: 10.1016/j.lungcan.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/23/2021] [Accepted: 05/01/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES In patients with NSCLC, current ESTS and ESMO guidelines recommend invasive lymph node (LN) staging with EBUS-TBNA even if FDG-PET/CT is negative for mediastinal LNs if at least one of three risk factors is present (cN1, non-peripheral primary or primary >3 cm). Modified workflows to avoid unnecessary invasive procedures were evaluated. MATERIALS AND METHODS Monocentric retrospective analysis of pretherapeutic FDG-PET/CT in 247 patients with NSCLC (62 % male; age, 68 [43-88] years) using an analog or digital PET/CT scanner. PET windowing was standardized. LNs were positive if 'LN uptake > mediastinal blood pool' or short axis >10 mm. Surgery or EBUS-TBNA served as reference for diagnostic accuracy per LN station. In all patients with negative mediastinal LNs by PET/CT, LN histology from surgery was available. RESULTS Among 700 L N stations analyzed, 180 were malignant. Sensitivity and specificity of PET/CT per LN station were 93 % and 71 %. Following current guidelines, 76 patients with mediastinal negative PET/CT required confirmatory invasive staging. Only 5/76 patients had unexpected pN2 (all had adenocarcinoma). In a modified approach, confirmatory invasive staging was confined to patients with mediastinal negative PET/CT who showed all three risk factors. Using this modification, EBUS-TBNA could have been omitted in 62 (82 %) of the 76 patients who required EBUS-TBNA based on current recommendation. Among these 62 patients, only one patient had unsuspected pN2 (single-level) while the remaining 61 of 62 omitted EBUS-TBNA were deemed unnecessary because mediastinal LNs were confirmed to be negative. No multi-level pN2 would have been missed. CONCLUSION In the current analysis, 82 % of EBUS-TBNA procedures in patients with mediastinal negative PET/CT could have been omitted by modifying the current guideline workflow as proposed (i.e., restricting EBUS-TBNA in patients with cN0/1 to those with all three risk factors). This was consistent with different PET/CT scanners. Prospective confirmation is required.
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Affiliation(s)
- Julian M M Rogasch
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Nuclear Medicine, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178 Berlin, Germany.
| | - Nikolaj Frost
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Infectious Diseases and Pulmonary Medicine, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Stephanie Bluemel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Nuclear Medicine, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Liza Michaels
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Nuclear Medicine, Augustenburger Platz 1, 13353 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Tobias Penzkofer
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Maximilian von Laffert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pathology, Charitéplatz 1, 10117 Berlin, Germany.
| | - Bettina Temmesfeld-Wollbrück
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Infectious Diseases and Pulmonary Medicine, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Jens Neudecker
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of General, Visceral, Vascular and Thoracic Surgery, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Jens-Carsten Rückert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of General, Visceral, Vascular and Thoracic Surgery, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Sebastian Ochsenreither
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Hematology and Medical Oncology, Hindenburgdamm 30, 12203 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Comprehensive Cancer Center, Charitéplatz 1, 10115 Berlin, Germany.
| | - Dirk Böhmer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Holger Amthauer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Nuclear Medicine, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Christian Furth
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Nuclear Medicine, Augustenburger Platz 1, 13353 Berlin, Germany.
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18
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Buero A, Chimondeguy DJ, Auvieux R, Lyons GA, Pankl LG, Puchulo G, Quadrelli S. Utility of PET-CT in non-small cell lung cancer clinical stage IB-IIA according to AJCC 8th edition staging system: an alternative to invasive mediastinal staging? Ecancermedicalscience 2021; 15:1250. [PMID: 34267806 PMCID: PMC8241449 DOI: 10.3332/ecancer.2021.1250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Indexed: 12/25/2022] Open
Abstract
Objective Mediastinal nodal staging in lung cancer is essential to determine treatment strategy and prognosis. There are controversies as to whether a mediastinal negative result in PET-CT may spare the invasive staging of the mediastinum. The main endpoint is to evaluate the negative predictive value (NPV) of PET-CT in non-small cell lung cancer (NSCLC) clinical stage IB-IIA without clinical nodal involvement. The secondary endpoint is to evaluate the prevalence of mediastinal and hilar nodal affection in this population. Methods We performed an observational descriptive study from January 2010 to January 2020, including 76 patients with clinical stage IB-IIA, who underwent pulmonary resection with systematic nodal sampling (pre-determined lymph node stations based on tumour location) for primary NSCLC. Clinically, nodal involvement was defined as any lymph node greater than 1 cm in the short axis on a CT or with metabolic uptake greater than 2.5 SUV on PET-CT. The prevalence of nodal metastases was recorded. Results Fifty six patients had clinical stage IB and 20 had clinical stage IIA. Mean tumour size was 3.74 ± 0.5 cm. Lobectomy was the resection procedure most frequently performed. Of the 76 patients with clinical N0 by PET-CT who underwent surgical resection, 10 (13.1%) were upstaged to pN1 and none were upstaged to pN2. NPV of PET-CT for overall nodal metastasis was 87% (95% CI: 0.79-0.94). NPV of PET-CT for N2 metastasis was 100%. Conclusion PET-CT might be an alternative to invasive mediastinal staging in patients with NSCLC clinical stage IB-IIA who are surgical candidates. Further prospective multi-institutional studies are necessary to verify the external validity of our study.
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Affiliation(s)
- Agustin Buero
- Department of Thoracic Surgery, Buenos Aires British Hospital, Perdriel 74, C1280AEB, Buenos Aires, Argentina.,https://orcid.org/0000-0001-5984-3270
| | - Domingo J Chimondeguy
- Department of Thoracic Surgery, Buenos Aires British Hospital, Perdriel 74, C1280AEB, Buenos Aires, Argentina.,Department of Thoracic Surgery, Austral University Hospital, Av Juan Domingo Perón 1500, B1629AHJ, Buenos Aires, Argentina
| | - Rodolfo Auvieux
- Department of Thoracic Surgery, Buenos Aires British Hospital, Perdriel 74, C1280AEB, Buenos Aires, Argentina
| | - Gustavo A Lyons
- Department of Thoracic Surgery, Buenos Aires British Hospital, Perdriel 74, C1280AEB, Buenos Aires, Argentina
| | - Leonardo G Pankl
- Department of Thoracic Surgery, Buenos Aires British Hospital, Perdriel 74, C1280AEB, Buenos Aires, Argentina
| | - Guillermo Puchulo
- Department of Thoracic Surgery, Austral University Hospital, Av Juan Domingo Perón 1500, B1629AHJ, Buenos Aires, Argentina
| | - Silvia Quadrelli
- Department of Pneumonology, Buenos Aires British Hospital, Perdriel 74, C1280AEB, Buenos Aires, Argentina
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19
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Martínez-Palau M, Trujillo-Reyes JC, Jaen À, Call S, Martínez-Hernández NJ, Provencio M, Vollmer I, Rami-Porta R, Sanz-Santos J. How do we Classify a Central Tumor? Results of a Multidisciplinary Survey from the SEPAR Thoracic Oncology Area. Arch Bronconeumol 2021; 57:359-365. [PMID: 32828588 DOI: 10.1016/j.arbres.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/27/2020] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION In patients with non-small cell lung cancer (NSCLC) and normal mediastinal imaging tests, centrally located tumors have greater occult mediastinal involvement. Clinical guidelines, therefore, recommend invasive mediastinal staging in this situation. However, definitions of centrality in the different guidelines are inconsistent. The SEPAR Thoracic Oncology area aimed to evaluate the degree of familiarity with various concepts related to tumor site among professionals who see patients with NSCLC in Spain. METHODS A questionnaire was distributed to members of Spanish medical societies involved in the management of NSCLC, structured according to the 3 aspects to be evaluated: 1) uniformity in the definition of central tumor location; 2) uniformity in the classification of lesions that extend beyond dividing lines; and 3) ability to delineate lesions in the absence of dividing lines. RESULTS A total of 430 participants responded. The most voted definition of centrality was «lesions in contact with hilar structures» (49.7%). The lines most often chosen to delimit the hemitorax were concentric hilar lines (89%). Most participants (92.8%) classified tumors according to the side of the dividing line that contained most of their volume. Overall, 78.6% were able to correctly classify a central lesion in the absence of dividing lines. CONCLUSIONS In our survey, the most widely accepted definition of centrality is not one of the proposals specified in the clinical guidelines. The results reflect wide variability in the classification of tumor lesions.
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Affiliation(s)
- Mireia Martínez-Palau
- Servicio de Neumología, Hospital Universitari Mútua Terrassa, Barcelona, España; Departament de Medicina, Facultat de Medicina, Universitat de Barcelona, Barcelona, España
| | - Juan Carlos Trujillo-Reyes
- Servicio de Cirugía Torácica, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Departament de Cirurgia, Universitat Autonoma de Barcelona, Barcelona, España; Sociedad Española de Neumología y Cirugía Torácica, Área de Oncología Torácica, Barcelona, España
| | - Àngels Jaen
- Fundació Mútua Terrassa per a la Recerca Biomèdica i Social, Barcelona, España
| | - Sergi Call
- Servicio de Cirugía Torácica. Hospital Universitari Mútua Terrassa, Barcelona, España; Departament de Ciències Morfològiques, Àrea d'anatomia i embriologia humana, Universitat Autònoma de Barcelona, Barcelona, España
| | - Néstor J Martínez-Hernández
- Servicio de Cirugía Torácica. Hospital Universitari de la Ribera, Valencia, España; Sociedad Española de Cirugía Torácica, Comité Científico, Madrid, España
| | - Mariano Provencio
- Servicio de Oncología Médica, Hospital Universitario Puerta de Hierro, Madrid, España; Facultad de Medicina, Universidad Autónoma de Madrid, España; Grupo Español de Cáncer de Pulmón, Barcelona, España
| | - Iván Vollmer
- Servicio de Radiologia, Centre Diagnòstic per la Imatge (CDI), Hospital Clínic, Barcelona, España; Sociedad Española de Imagen Cardiotorácica, Valencia, España
| | - Ramón Rami-Porta
- Servicio de Cirugía Torácica. Hospital Universitari Mútua Terrassa, Barcelona, España
| | - José Sanz-Santos
- Servicio de Neumología, Hospital Universitari Mútua Terrassa, Barcelona, España; Departament de Medicina, Facultat de Medicina, Universitat de Barcelona, Barcelona, España.
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20
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Yuan XS, Chen WC, Lin QR, Liu YJ, Zhu YY, Sun XJ, Wu QY, Liu JS, Xu YP. A propensity-matched analysis of stereotactic body radiotherapy and sublobar resection for stage I non-small cell lung cancer in patients at high risk for lobectomy: the results in a Chinese population. J Thorac Dis 2021; 13:1822-1832. [PMID: 33841971 PMCID: PMC8024811 DOI: 10.21037/jtd-21-339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background To investigate the comparative effectiveness of stereotactic body radiotherapy (SBRT) and sublobar resection (SLR) in patients with stage I non-small cell lung cancer (NSCLC) considered to be high-risk lobectomy patients. Methods From January 2012 to December 2015, patients who underwent SBRT or SLR for clinical stage I NSCLC were examined retrospectively. Propensity score matching (PSM) was performed to reduce selection bias in SBRT and SLR patients. Results Data from 86 SBRT and 79 SLR patients was collected. Median follow-up periods of the SBRT and SLR groups were 32 and 37 months, respectively. Patients treated with SBRT exhibited significantly higher age, higher likelihood of being male, larger tumor diameter, lower forced expiratory volume in 1 second (FEV1), and poorer performance status compared with SLR patients. There were no significant differences between SBRT and SLR patients for 3-year overall survival (OS) (80.3% and 82.3%, P=0.405), cause-specific survival (CSS) (81.3% and 83.4%, P=0.383), and local control (LC) (89.7% and 86.0%, P=0.501). Forty-nine patients were identified from each group after performing PSM. After patients were matched for age, gender, performance status, tumor characteristics and pulmonary function, no significant differences were observed in 3-year OS (85.4% and 73.3%, P=0.649), CSS (87.2% and 74.9%, P=0.637) and LC (95.6% and 82.1%, P=0.055). Prevalence of significant adverse events (grade 3 or worse) was 0% and 10.2% in the matched SBRT and SLR groups (P=0.056), respectively. Conclusions Disease control and survival in the SBRT patients was equivalent to that seen in SLR patients with stage I NSCLC considered high-risk lobectomy candidates. SBRT could therefore be an alternative option to SLR in treating patients with a high operative risk.
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Affiliation(s)
- Xiao-Shuai Yuan
- Department of Radiation Oncology, Shanghai Pulmonary Hospital Tongji University, Shanghai, China
| | - Wu-Cheng Chen
- First Clinical Medical School, Wenzhou Medical University, Wenzhou, China
| | - Qing-Ren Lin
- Department of Radiation Oncology, Cancer Hospital, University of Chinese Academy of Sciences, Hangzhou, China
| | - Yuan-Jun Liu
- Department of Radiation Oncology, Cancer Hospital, University of Chinese Academy of Sciences, Hangzhou, China
| | - Yao-Yao Zhu
- Department of Radiation Oncology, Shanghai Pulmonary Hospital Tongji University, Shanghai, China
| | - Xiao-Jiang Sun
- First Clinical Medical School, Wenzhou Medical University, Wenzhou, China
| | - Qiong-Ya Wu
- Department of Radiation Oncology, Shanghai Pulmonary Hospital Tongji University, Shanghai, China
| | - Jin-Shi Liu
- Department of Thoracic Oncology, Cancer Hospital, University of Chinese Academy of Sciences, Hangzhou, China
| | - Ya-Ping Xu
- Department of Radiation Oncology, Shanghai Pulmonary Hospital Tongji University, Shanghai, China.,First Clinical Medical School, Wenzhou Medical University, Wenzhou, China.,Department of Radiation Oncology, Cancer Hospital, University of Chinese Academy of Sciences, Hangzhou, China
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21
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Mullins BT, Moore DT, Rivera MP, Marks LB, Akulian J, Pearlstein KA, Wang K, Burks AC, Weiner AA. The impact of pathologic staging of the hilar/mediastinal nodes on outcomes in patients with early-stage NSCLC receiving stereotactic body radiotherapy. J Thorac Dis 2021; 13:1045-1054. [PMID: 33717577 PMCID: PMC7947488 DOI: 10.21037/jtd-20-2808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The importance of invasive mediastinal nodal staging in early-stage non-small cell lung cancer (NSCLC) in the PET/CT era is dependent on tumor factors that increase risk of nodal metastasis. At our institution, patients undergo biopsy via either CT-guidance (without nodal staging) or navigational bronchoscopy with endobronchial ultrasound transbronchial needle aspiration for nodal staging. This study aims to compare outcomes after stereotactic body radiotherapy (SBRT) stratified by receipt of invasive mediastinal nodal staging. Methods In this retrospective study, records of all consecutive patients undergoing SBRT for early-stage NSCLC between 2010 and 2017 were analyzed. The association between time-to event outcomes (recurrence and survival) were evaluated with covariates of interest including tumor size, location, histology, smoking history, prior lung cancer history, radiation dose and receipt of nodal staging. Both univariable and multivariable analyses were used to examine these comparisons. Results Overall, 158 patients were treated with SBRT. One hundred forty-nine out of one hundred fifty-eight patients (94%) underwent PET/CT staging, and all patients underwent tumor-directed biopsy. Seventy-nine patients underwent navigational bronchoscopy with nodal staging and 79 patients underwent CT-guided biopsy without nodal staging. Receipt of nodal staging was not associated with tumor size (P=0.35), yet was associated with central tumor location (P<0.001). There was no statistically significant association between receipt of nodal staging and time-to-event recurrence or survival outcomes; for example 3-year overall survival (OS) was 65% vs. 67% (P=0.65) and 3-year freedom from nodal failure was 84% vs. 69% (P=0.1) for those with and without nodal staging, respectively. Conclusions Similar recurrence and survival outcomes were observed after SBRT regardless of receipt of invasive mediastinal nodal staging. Further prospective evaluation can help identify which patients might derive greatest benefit from invasive staging of the mediastinum in the PET/CT era.
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Affiliation(s)
- Brandon T Mullins
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Dominic T Moore
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Patricia Rivera
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lawrence B Marks
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jason Akulian
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kevin A Pearlstein
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kyle Wang
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Allen C Burks
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ashley A Weiner
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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22
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Guinde J, Bourdages-Pageau E, Ugalde PA, Fortin M. Central location and risk of imaging occult mediastinal lymph node involvement in cN0T2-4 non-small cell lung cancer. J Thorac Dis 2020; 12:7156-7163. [PMID: 33447404 PMCID: PMC7797819 DOI: 10.21037/jtd-20-1565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Appropriate pre-operative staging is a cornerstone in the treatment of non-small cell lung cancer (NSCLC). Central location and size greater than 3 cm are amongst indications for pre-operative invasive mediastinal staging but the quality of the evidence behind this recommendation is low. Methods We retrospectively reviewed all cases of cT2-4N0M0 NSCLCL after CT and TEP-CT which underwent surgical resection with lymph node dissection or had a positive invasive pre-operative mediastinal staging in our institution from 2014 to 2018. Results Three hundred and ten patients met inclusion criteria, 79 (25.5%) central and 231 (74.5%) peripheral tumors. Central tumor location was associated with a higher prevalence of pN2-3 disease (17.7% vs. 6.1%, P<0.001). In a multivariate analysis, central tumor location remained the only factor statistically associated with imaging occult mediastinal disease (OR 3.23, 95% CI: 1.45–7.18). NPV of PET-CT for occult mediastinal disease was 0.83 (95% CI: 0.72–0.90) in central and 0.94 (95% CI: 0.90–0.97) in peripheral tumor. Central location was also associated with a higher prevalence of occult N1 to N3 disease (43.0% vs. 15.2%, P<0.001). Conclusions This study suggests that invasive mediastinal staging is required in central cT2-4N0 NSCLC but can be questioned in peripheral one, especially in cT2N2 subgroup if the patient is a candidate for lobar resection.
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Affiliation(s)
- Julien Guinde
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada.,Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France
| | - Etienne Bourdages-Pageau
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
| | - Paula Antonia Ugalde
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
| | - Marc Fortin
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
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23
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Okoye CC, Cho CJ, Liu M, Louie AV, Obayomi-Davies O, Siva S, Lo SS. Dose matters for stereotactic body radiotherapy for early stage non-small cell lung cancer. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1197. [PMID: 33241046 PMCID: PMC7576082 DOI: 10.21037/atm-20-3149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Christian C Okoye
- Department of Radiation Oncology, St. Bernards Medical Center, Jonesboro, AR, USA
| | - C Jane Cho
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Alexander V Louie
- Department of Radiation Oncology, Sunnybrook Health Science Centre, Toronto, ON, Canada
| | | | - Shankar Siva
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
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24
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Bai W, Li S. Prognosis of segmentectomy in the treatment of stage IA non-small cell lung cancer. Oncol Lett 2020; 21:74. [PMID: 33365085 PMCID: PMC7716705 DOI: 10.3892/ol.2020.12335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/26/2020] [Indexed: 12/24/2022] Open
Abstract
With improvements in detection technology, increasing numbers of patients with non-small cell lung cancer (NSCLC) are being diagnosed at an early stage. In order to treat the illness with minimal invasion and preserve lung function to the greatest possible extent, there has been an increasing tendency towards treating early-stage NSCLC by segmentectomy. However, questions remain regarding whether patients may benefit from this procedure considering the surgical and oncological outcomes. Whether adequate margin distance and lymph node dissection may be achieved is one of the most important issues associated with this procedure. The present study reviews the prognosis of segmentectomy in the treatment of stage IA NSCLC.
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Affiliation(s)
- Wenliang Bai
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P.R. China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P.R. China
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25
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Kennedy WR, Samson PP, Gabani P, Nikitas J, Bradley JD, Roach MC, Robinson CG. Impact of invasive nodal staging on regional and distant recurrence rates after SBRT for inoperable stage I NSCLC. Radiother Oncol 2020; 150:206-210. [PMID: 32622780 PMCID: PMC7556754 DOI: 10.1016/j.radonc.2020.06.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/31/2020] [Accepted: 06/26/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE/OBJECTIVES Before definitive stereotactic body radiation therapy (SBRT) for presumably node-negative, early-stage NSCLC, many patients are staged with PET/CT alone. In patients undergoing PET/CT prior to SBRT, the role of invasive nodal staging (INS) with endobronchial ultrasound (EBUS) or mediastinoscopy is uncertain. We sought to characterize the impact of nodal staging modality on outcomes. MATERIALS/METHODS Patients receiving definitive SBRT for T1-2N0 NSCLC deemed node-negative by either PET/CT plus INS (EBUS or mediastinoscopy) or PET/CT alone were identified. Patients with initially equivocal or positive nodes on PET/CT were excluded from this analysis. All patients received 3-5 fraction SBRT according to institutional guidelines. Control was assessed by at least one follow-up CT in all patients. Multivariable logistic regression (MVA) was performed to identify variables independently associated with use of INS. RESULTS We identified 651 eligible patients at our institution from 2005-2016. INS was performed in 15.2% of patients (n = 99) with EBUS (n = 78) or mediastinoscopy (n = 21). Median follow-up was 19.4 months (0.2-135.1). Median survival was 28.5 months (0.6-140). Factors predictive of increased likelihood of INS after negative PET/CT on MVA were age (OR for decreasing age 1.033; 95% CI 1.058-1.010), Caucasian race (OR vs. non-white 1.852; 1.044-3.289), male sex (1.629; 1.031-2.575), central location (1.978; 1.218-3.211) and squamous histology (2.564; 1.243-5.287). Nodal and/or distant control at 2 years was similar between PET/CT alone (78%, 95% CI 74-82%) and INS + PET/CT (75%, 95% CI 65-85%) (p = 0.877) as well as on MVA. Overall survival did not differ based on staging modality. CONCLUSIONS In patients with early-stage NSCLC deemed node-negative by PET/CT, addition of INS did not appreciably alter patterns of failure or survival after definitive SBRT. This study does not question the established value of INS for equivocal or suspicious nodes.
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Affiliation(s)
- William R Kennedy
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, United States
| | - Pamela P Samson
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, United States
| | - Prashant Gabani
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, United States
| | - John Nikitas
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, United States
| | - Jeffrey D Bradley
- Department Radiation Oncology, Emory School of Medicine, Atlanta, United States
| | - Michael C Roach
- Department of Radiation Oncology, Cancer Center of Hawaii, Honolulu, United States
| | - Clifford G Robinson
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, United States.
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26
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Recent and Current Advances in FDG-PET Imaging within the Field of Clinical Oncology in NSCLC: A Review of the Literature. Diagnostics (Basel) 2020; 10:diagnostics10080561. [PMID: 32764429 PMCID: PMC7459495 DOI: 10.3390/diagnostics10080561] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 02/07/2023] Open
Abstract
Lung cancer is the leading cause of cancer-related deaths around the world, the most common type of which is non-small-cell lung cancer (NSCLC). Computed tomography (CT) is required for patients with NSCLC, but often involves diagnostic issues and large intra- and interobserver variability. The anatomic data obtained using CT can be supplemented by the metabolic data obtained using fluorodeoxyglucose F 18 (FDG) positron emission tomography (PET); therefore, the use of FDG-PET/CT for staging NSCLC is recommended, as it provides more accuracy than either modality alone. Furthermore, FDG-PET/magnetic resonance imaging (MRI) provides useful information on metabolic activity and tumor cellularity, and has become increasingly popular. A number of studies have described FDG-PET/MRI as having a high diagnostic performance in NSCLC staging. Therefore, multidimensional functional imaging using FDG-PET/MRI is promising for evaluating the activity of the intratumoral environment. Radiomics is the quantitative extraction of imaging features from medical scans. The chief advantages of FDG-PET/CT radiomics are the ability to capture information beyond the capabilities of the human eye, non-invasiveness, the (virtually) real-time response, and full-field analysis of the lesion. This review summarizes the recent advances in FDG-PET imaging within the field of clinical oncology in NSCLC, with a focus on surgery and prognostication, and investigates the site-specific strengths and limitations of FDG-PET/CT. Overall, the goal of treatment for NSCLC is to provide the best opportunity for long-term survival; therefore, FDG-PET/CT is expected to play an increasingly important role in deciding the appropriate treatment for such patients.
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Brascia D, De Iaco G, Schiavone M, Panza T, Signore F, Geronimo A, Sampietro D, Montrone M, Galetta D, Marulli G. Resectable IIIA-N2 Non-Small-Cell Lung Cancer (NSCLC): In Search for the Proper Treatment. Cancers (Basel) 2020; 12:cancers12082050. [PMID: 32722386 PMCID: PMC7465235 DOI: 10.3390/cancers12082050] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/18/2020] [Accepted: 07/21/2020] [Indexed: 12/25/2022] Open
Abstract
Locally advanced non-small cell lung cancer accounts for one third of non-small cell lung cancer (NSCLC) at the time of initial diagnosis and presents with a wide range of clinical and pathological heterogeneity. To date, the combined multimodality approach involving both local and systemic control is the gold standard for these patients, since occult distant micrometastatic disease should always be suspected. With the rapid increase in treatment options, the need for an interdisciplinary discussion involving oncologists, surgeons, radiation oncologists and radiologists has become essential. Surgery should be recommended to patients with non-bulky, discrete, or single-level N2 involvement and be included in the multimodality treatment. Resectable stage IIIA patients have been the subject of a number of clinical trials and retrospective analysis, discussing the efficiency and survival benefits on patients treated with the available therapeutic approaches. However, most of them have some limitations due to their retrospective nature, lack of exact pretreatment staging, and the involvement of heterogeneous populations leading to the awareness that each patient should undergo a tailored therapy in light of the nature of his tumor, its extension and his performance status.
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Affiliation(s)
- Debora Brascia
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Giulia De Iaco
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Marcella Schiavone
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Teodora Panza
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Francesca Signore
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Alessandro Geronimo
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Doroty Sampietro
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Michele Montrone
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70121 Bari, Italy; (M.M.); (D.G.)
| | - Domenico Galetta
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70121 Bari, Italy; (M.M.); (D.G.)
| | - Giuseppe Marulli
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
- Correspondence: or
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Ernani V, Appiah AK, Baine MJ, Smith LM, Ganti AK. The impact of histology in the outcomes of patients with early-stage non-small cell lung cancer (NSCLC) treated with stereotactic body radiation therapy (SBRT) and adjuvant chemotherapy. Cancer Treat Res Commun 2020; 24:100197. [PMID: 32777751 DOI: 10.1016/j.ctarc.2020.100197] [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: 02/12/2020] [Revised: 04/10/2020] [Accepted: 07/16/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Stereotactic body radiation therapy (SBRT) is the standard of care treatment for nonsurgical patients with early-stage non-small cell lung cancer (NSCLC). A recent report has indicated an improvement in overall survival (OS) with adjuvant chemotherapy in patients with tumors ≥ 4 cm treated with SBRT. We present a retrospective study evaluating the impact of histology in patients treated with SBRT and adjuvant chemotherapy. MATERIALS AND METHODS Patients (≥18 years) diagnosed with clinical stages I-II NSCLC from 2004 to 2013 were identified using the National Cancer Database (n = 12,055). The Kaplan-Meier method was used to estimate overall survival (OS) distributions and the log-rank test was used to compare distributions by treatment strategy. Clinical stages I and II were subdivided according to the TNM staging and log-rank tests was used to compare survival distributions by treatment strategy within each subgroup. We performed subgroup analysis for the three main NSCLC histologies (i.e., adenocarcinoma, squamous cell carcinoma (SCC), and large cell). RESULTS In patients with adenocarcinoma, SCC and, large cell carcinoma; adjuvant chemotherapy was associated with worse OS in tumors < 4 cm (P<.0001, P<.0099, and P=.0082, respectively). In patients with adenocarcinoma and tumor ≥ 4 cm, adjuvant chemotherapy was not associated with improved OS (P=.262); however, in patients with SCC and large cell, adjuvant chemotherapy improved OS (P<.0001, and P=.0129, respectively). CONCLUSION In patients with NSCLC ≥ 4 cm treated with SBRT, adjuvant chemotherapy was associated with improved OS in patients with SCC and large cell histologies.
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Affiliation(s)
- Vinicius Ernani
- Division of Oncology-Hematology, University of Nebraska Medical Center, Fred and Pamela Buffett Cancer Center, 986840 Nebraska Medical Center, Omaha, NE 68198-6840, USA.
| | - Adams Kusi Appiah
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michael J Baine
- Division of Radiation Oncology, University of Nebraska Medical Center, Fred and Pamela Buffett Cancer Center, Omaha, NE, USA
| | - Lynette M Smith
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Apar Kishor Ganti
- Department of Internal Medicine, VA Nebraska Western Iowa Health Care System, Omaha, NE, USA
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DuComb EA, Tonelli BA, Tuo Y, Cole BF, Mori V, Bates JHT, Washko GR, San José Estépar R, Kinsey CM. Evidence for Expanding Invasive Mediastinal Staging for Peripheral T1 Lung Tumors. Chest 2020; 158:2192-2199. [PMID: 32599066 DOI: 10.1016/j.chest.2020.05.607] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/13/2020] [Accepted: 05/13/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Guidelines recommend invasive mediastinal staging for patients with non-small cell lung cancer and a "central" tumor. However, there is no consensus definition for central location. As such, the decision to perform invasive staging largely remains on an empirical foundation. RESEARCH QUESTION Should patients with peripheral T1 lung tumors undergo invasive mediastinal staging? STUDY DESIGN AND METHODS All participants with a screen-detected cancer with a solid component between 8 and 30 mm were identified from the National Lung Screening Trial. After translation of CT data, cancer location was identified and the X, Y, Z coordinates were determined as well as distance from the main carina. A multivariable logistic regression model was constructed to evaluate for predictors associated with lymph node metastasis. RESULTS Three hundred thirty-two participants were identified, of which 69 had lymph node involvement (20.8%). Of those with lymph node metastasis, 39.1% were N2. There was no difference in rate of lymph node metastasis based on tumor size (OR, 1.03; P = .248). There was also no statistical difference in rate of lymph node metastasis based on location, either by distance from the carina (OR, 0.99; P = .156) or tumor coordinates (X: P = .180; Y: P = .311; Z: P = .292). When adjusted for age, sex, histology, and smoking history, there was no change in the magnitude of the risk, and tests of significance were not altered. INTERPRETATION Our data indicate a high rate of N2 metastasis among T1 tumors and no significant relationship between tumor diameter or location. This suggests that patients with small, peripheral lung cancers may benefit from invasive mediastinal staging.
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Affiliation(s)
- Emily A DuComb
- Division of Pulmonary and Critical Care, University of Vermont Medical Center, Burlington VT
| | - Benjamin A Tonelli
- Division of Pulmonary and Critical Care, University of Vermont Medical Center, Burlington VT
| | - Ya Tuo
- Department of Mathematics and Statistics, University of Vermont, Burlington VT
| | - Bernard F Cole
- Department of Mathematics and Statistics, University of Vermont, Burlington VT
| | - Vitor Mori
- Department of Biomedical Engineering, University of Sao Paulo, Sao Paulo, Brazil
| | - Jason H T Bates
- Division of Pulmonary and Critical Care, University of Vermont Medical Center, Burlington VT
| | - George R Washko
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA
| | | | - C Matthew Kinsey
- Division of Pulmonary and Critical Care, University of Vermont Medical Center, Burlington, VT.
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Gregor A, Inage T, Hwangbo B, Yasufuku K. Lung cancer staging: State of the art in the era of ablative therapies and surgical segmentectomy. Respirology 2020; 25:924-932. [PMID: 32323421 DOI: 10.1111/resp.13827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/25/2020] [Accepted: 04/01/2020] [Indexed: 12/25/2022]
Abstract
Implementation of lung cancer screening and improvements in imaging are expected to increase the proportion of lung cancer diagnosed at an early stage. The standard of care has historically been anatomic lobectomy; however, there is now an array of surgical and non-surgical approaches for management of local disease either in active use or under investigation. By their nature, these new modalities offer a theoretical trade-off of reduced morbidity in exchange for reduced efficacy in the setting of advanced disease. It is therefore critical that patients being considered for these approaches (e.g. surgical segmentectomy and SABR) be accurately staged to maximize the potential for definitive treatment. In this article, we will review current approaches to the staging of patients being considered for segmentectomy or ablation. This will serve as a foundation to highlight important questions deserving further investigation.
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Affiliation(s)
- Alexander Gregor
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Terunaga Inage
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Bin Hwangbo
- Division of Pulmonology, Center for Lung Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
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Resio BJ, Canavan M, Mase V, Dhanasopon AP, Blasberg JD, Boffa DJ. Invasive Staging Procedures Do Not Prevent Nodal Metastases From Being Missed in Stage I Lung Cancer. Ann Thorac Surg 2020; 110:390-397. [PMID: 32283084 DOI: 10.1016/j.athoracsur.2020.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/21/2020] [Accepted: 03/16/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Up to 20% of clinical stage I lung cancer patients harbor lymph node metastases that go undetected (missed) during the clinical staging evaluation. We investigated to what degree the addition of invasive nodal staging procedures to imaging, as currently practiced, prevents radiographically occult nodal metastases from being missed during the clinical staging evaluation. METHODS Treatment-naive patients, imaged by positron emission tomography and computed tomography, who underwent lobectomy for clinical stage I lung cancer from 2012 to 2017 in The Society of Thoracic Surgeons General Thoracic Surgery Database were studied. Rates of missed nodal metastases (MNM) (ie, nodal metastases in lobectomy specimens undetected during clinical staging evaluation) were determined. Risk factors were assessed with multivariable modeling. RESULTS Of the 30,685 clinical stage I patients identified, 3895 (12.7%) underwent preoperative endobronchial ultrasound and 3341 (10.9%) underwent mediastinoscopy. Invasive staging was more common with tumors > 2 cm (66.4% vs 50.2%, P < .001) and squamous histology (26.9% vs 16.9%, P < .001). MNM were discovered in 14.7% of patients, including 20.1% of patients (95% confidence interval, 18.8%-21.5%) who had undergone endobronchial ultrasound and 18.2% (95% confidence interval, 16.7%-19.6%) who had undergone mediastinoscopy. Hilar nodes were most often "missed" (9.5%). Using cut-points in tumor size, histology, laterality, and age, patients could be stratified into particularly high-risk (25% MNM) and low-risk (6% MNM) cohorts. CONCLUSIONS Substantial risk of occult lymph node metastases persists in patients with clinical stage I lung cancer despite negative invasive nodal staging, positron emission tomography, and computed tomography. In the absence of a thorough surgical nodal evaluation, early-stage lung cancer patients are at risk of under-treatment.
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Affiliation(s)
- Benjamin J Resio
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Maureen Canavan
- Department of Internal Medicine, Cancer Outcomes and Public Policy and Effectiveness Research (COPPER), Yale School of Medicine, New Haven, Connecticut
| | - Vincent Mase
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Andrew P Dhanasopon
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Justin D Blasberg
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Daniel J Boffa
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
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Central Tumor Location and Occult Lymph Node Metastasis in cT1N0M0 Non–Small-Cell Lung Cancer. Ann Am Thorac Soc 2020; 17:522-525. [DOI: 10.1513/annalsats.201909-711rl] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Venturini M, Cariati M, Marra P, Masala S, Pereira PL, Carrafiello G. CIRSE Standards of Practice on Thermal Ablation of Primary and Secondary Lung Tumours. Cardiovasc Intervent Radiol 2020; 43:667-683. [PMID: 32095842 DOI: 10.1007/s00270-020-02432-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 02/10/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital, Insubria University, Varese, Italy.
| | - Maurizio Cariati
- Department of Diagnostic and Interventional Radiology, ASST Santi Carlo e Paolo Hospital, Milan, Italy
| | - Paolo Marra
- Department of Radiology, Papa Giovanni XXIII Hospital Bergamo, Milano-Bicocca University, Milan, Italy
| | - Salvatore Masala
- Department of Radiology, San Giovanni Battista Hospital, Tor Vergata University, Rome, Italy
| | - Philippe L Pereira
- Clinic for Radiology, Minimally-Invasive Therapies and Nuclear Medicine, SLK-Kliniken GmbH, Heilbronn, Germany
| | - Gianpaolo Carrafiello
- Department of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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Ayoub Z, Ning MS, Brooks ED, Kang J, Welsh JW, Chen A, Gandhi S, Heymach JV, Vaporciyan AA, Chang JY. Definitive Management of Presumed Synchronous Early Stage Non-Small Cell Lung Cancers: Outcomes and Utility of Stereotactic Ablative Radiation Therapy. Int J Radiat Oncol Biol Phys 2020; 107:261-269. [PMID: 32044413 DOI: 10.1016/j.ijrobp.2020.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/30/2020] [Accepted: 02/02/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Management of synchronous early-stage non-small cell lung cancer (NSCLC) remains controversial because resection is not always feasible. This study evaluates efficacy and patterns of failure after SABR for synchronous early-stage NSCLC. METHODS AND MATERIALS From 2005 to 2015, patients presenting with ≥2 synchronous NSCLC tumors (T1a-T2b) and receiving SABR to ≥1 lesion were reviewed. The most common prescriptions were 50 Gy in 4 or 70 Gy in 10 fractions. Patients underwent multidisciplinary management with workup including chest computed tomography and positron emission tomography/computed tomography, plus brain imaging and endoscopic bronchial ultrasound for most patients to rule out mediastinal and distant disease. Synchronous lesions were defined as multiple ipsilateral or contralateral intrapulmonary lesions diagnosed within 6 months. RESULTS Of 912 patients treated with SABR for early-stage NSCLC at our institution, 82 (9%) presented with synchronous disease, with a total of 169 lesions. SABR was delivered to 142 lesions (84%), with 57 patients (69.5%) receiving SABR for all sites. Median overall survival (OS) and progression-free survival (PFS) were 5.1 and 2.7 years, respectively. At a median follow-up of 58 months, OS was 67% and 52% at 3 and 5 years, and corresponding PFS was 47% and 29%. Thirty-nine patients (48%) had progression, with 21 (26%) experiencing distant failure, and intralobar recurrence was among the first failure for 15 patients (18%). Of the 142 SABR-treated sites, these included 6 in-field (4%) and 4 marginal (3%) recurrences. There were no grade ≥3 adverse events. Among patients receiving SABR for all sites, there were no differences in OS (P = .946), PFS (P = .980), local control (P = .683), regional and distant control (P = .656), or toxicity (P = .791). On multivariable analysis, ipsilateral synchronous disease was associated with greater regional and distant failure (hazard ratio, 2.691; P = .025). CONCLUSIONS Synchronous NSCLC can be managed with definitive local therapy. With high control rates and favorable outcomes, SABR is an effective and feasible treatment for synchronous early-stage NSCLC.
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Affiliation(s)
- Zeina Ayoub
- Department of Radiation Oncology, the Naef K. Basile Cancer Institute, the American University of Beirut Medical Center, Beirut, Lebanon
| | - Matthew S Ning
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eric D Brooks
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jingjing Kang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - James W Welsh
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Aileen Chen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Saumil Gandhi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John V Heymach
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ara A Vaporciyan
- Department of Thoracic Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joe Y Chang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Abstract
BACKGROUND Accurate staging is crucial for the proper management of patients with nonsmall cell lung cancer, especially for choosing the best treatment strategy. Different Imaging methods are used to stage patients with non-small cell lung cancer. In the last two decades, FDG PET/CT is carried out in almost all the main Hospitals around the world in this setting. OBJECTIVE The aim of this paper is to focus on the value of integrated FDG PET/CT in the TNM staging of the non-small cell lung cancer. METHODS A non-systematic revision of the literature was performed in order to identify all papers about the role of FDG PET/CT in the evaluation of non-small cell lung cancer and to highlight the value of FDG PET/CT in this setting. RESULTS Many data are now available about this topic, including also randomized controlled trials. FDG PET/CT is of limited added value in the characterization of T status but it increases the diagnostic accuracy for the assessment of the nodal status. The main advantage of FDG PET/CT over conventional imaging methods is its higher sensitivity in identifying extra-thoracic metastases, especially bone and adrenal lesions. CONCLUSION PET/CT with FDG should be included in the diagnostic work-up of patients with lung cancer, because it provides useful information for appropriate therapy.
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Affiliation(s)
- Mohsen Farsad
- Department of Nuclear Medicine, Central Hospital of Bolzano, Via Lorenz Böhler 5, 39100 Bolzano, Bozen, Italy
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Li F, Yang L, Zhao Y, Yuan L, Wang S, Mao Y. Intraoperative frozen section for identifying the invasion status of lung adenocarcinoma: A systematic review and meta-analysis. Int J Surg 2019; 72:175-184. [DOI: 10.1016/j.ijsu.2019.10.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/15/2019] [Accepted: 10/31/2019] [Indexed: 12/20/2022]
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Preoperative Risk Assessment of Lymph Node Metastasis in cT1 Lung Cancer: A Retrospective Study from Eastern China. J Immunol Res 2019; 2019:6263249. [PMID: 31886306 PMCID: PMC6914921 DOI: 10.1155/2019/6263249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/28/2019] [Indexed: 12/26/2022] Open
Abstract
Background Lymph node status of clinical T1 (diameter ≤ 3 cm) lung cancer largely affects the treatment strategies in the clinic. In order to assess lymph node status before operation, we aim to develop a noninvasive predictive model using preoperative clinical information. Methods We retrospectively reviewed 924 patients (development group) and 380 patients (validation group) of clinical T1 lung cancer. Univariate analysis followed by polytomous logistic regression was performed to estimate different risk factors of lymph node metastasis between N1 and N2 diseases. A predictive model of N2 metastasis was established with dichotomous logistic regression, externally validated and compared with previous models. Results Consolidation size and clinical N stage based on CT were two common independent risk factors for both N1 and N2 metastases, with different odds ratios. For N2 metastasis, we identified five independent predictors by dichotomous logistic regression: peripheral location, larger consolidation size, lymph node enlargement on CT, no smoking history, and higher levels of serum CEA. The model showed good calibration and discrimination ability in the development data, with the reasonable Hosmer-Lemeshow test (p = 0.839) and the area under the ROC being 0.931 (95% CI: 0.906-0.955). When externally validated, the model showed a great negative predictive value of 97.6% and the AUC of our model was better than other models. Conclusion In this study, we analyzed risk factors for both N1 and N2 metastases and built a predictive model to evaluate possibilities of N2 metastasis of clinical T1 lung cancers before the surgery. Our model will help to select patients with low probability of N2 metastasis and assist in clinical decision to further management.
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Shin SH, Jeong BH, Jhun BW, Yoo H, Lee K, Kim H, Kwon OJ, Han J, Kim J, Lee KS, Um SW. The utility of endosonography for mediastinal staging of non-small cell lung cancer in patients with radiological N0 disease. Lung Cancer 2019; 139:151-156. [PMID: 31805443 DOI: 10.1016/j.lungcan.2019.11.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/24/2019] [Accepted: 11/25/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Recent practice guidelines recommend endosonography for patients with radiological N0 non-small cell lung cancer (NSCLC) when the primary tumors are >3 cm in diameter or centrally located. However, any role for endosonography remains debatable. We evaluated the utility of endosonography in patients with radiological N0 NSCLC based on tumor centrality, diameter and histology. MATERIALS AND METHODS Patients who underwent staging endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) with or without transesophageal bronchoscopic ultrasound-guided fine needle aspiration (EUS-B-FNA) for radiological N0 NSCLC were retrospectively investigated using prospectively collected endosonography data. The radiological N0 stage was defined by node diameter as evident on computed tomography images and 18F-FDG uptake using integrated positron emission tomography-computed tomography. RESULTS In total of 168 patients, the median size of the primary tumor was 39 mm, and 41 % of tumors were centrally located. The prevalence of occult mediastinal metastases was 11.3 % (19/168). The sensitivity of endosonography in terms of diagnosing occult mediastinal metastases was only 47 % (9/19); 6 of 10 patients with false-negative endosonography data exhibited metastases in accessible nodes. The diagnostic performance of endosonography did not differ by tumor centrality or diameter. Patients with adenocarcinoma histology showed higher prevalence of occult mediastinal metastases and higher false-negative results in endosonography compared with those with non-adenocarcinoma histology. CONCLUSION Not all patients with radiological N0 NSCLC benefit from endosonography, given the low prevalence of occult mediastinal metastases and the poor sensitivity of endosonography in this population. The strategy of invasive mediastinal staging needs to be tailored considering the histology of the tumor in this population.
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Affiliation(s)
- Sun Hye Shin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byung Woo Jhun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hongseok Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyungjong Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - O Jung Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jungho Han
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jhingook Kim
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Won Um
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Kandathil A, Kay FU, Butt YM, Wachsmann JW, Subramaniam RM. Role of FDG PET/CT in the Eighth Edition of TNM Staging of Non-Small Cell Lung Cancer. Radiographics 2019; 38:2134-2149. [PMID: 30422775 DOI: 10.1148/rg.2018180060] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Lung cancer is the leading cause of cancer-related mortality in the United States, and accurate staging plays a vital role in determining prognosis and treatment. The recently revised eighth edition of the TNM staging system for lung cancer defines new T and M descriptors and updates stage groupings on the basis of substantial differences in survival. There are new T descriptors that are based on the findings at histopathologic examination, and T descriptors are reassigned on the basis of tumor size and extent. No changes were made to the N descriptors in the eighth edition of the TNM staging of lung cancer, because the four N categories that are based on the location of the diseased nodes can be used to consistently predict prognosis. The eighth edition includes a new M1b descriptor for patients with a single extrathoracic metastatic lesion in a single organ (M1b), because they have better survival and different treatment options, compared with those with multiple extrathoracic lesions (M1c). Examination with fluorine 18 fluorodeoxyglucose (FDG) PET/CT is the standard of care and is an integral part of the clinical staging of patients with lung cancer. To provide the treating physicians with accurate staging information, radiologists and nuclear medicine physicians should be aware of the updated classification system and should be cognizant of the site-specific strengths and limitations of FDG PET/CT. In this article, the eighth edition of the TNM staging system is reviewed, as well as the role of FDG PET/CT in the staging of non-small cell lung carcinoma. ©RSNA, 2018.
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Affiliation(s)
- Asha Kandathil
- From the Departments of Radiology (A.K., F.U.K., J.W.W., R.M.S.) and Pathology (Y.M.B.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9316
| | - Fernando U Kay
- From the Departments of Radiology (A.K., F.U.K., J.W.W., R.M.S.) and Pathology (Y.M.B.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9316
| | - Yasmeen M Butt
- From the Departments of Radiology (A.K., F.U.K., J.W.W., R.M.S.) and Pathology (Y.M.B.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9316
| | - Jason W Wachsmann
- From the Departments of Radiology (A.K., F.U.K., J.W.W., R.M.S.) and Pathology (Y.M.B.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9316
| | - Rathan M Subramaniam
- From the Departments of Radiology (A.K., F.U.K., J.W.W., R.M.S.) and Pathology (Y.M.B.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9316
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Smith DE, Fernandez Aramburu J, Da Lozzo A, Montagne JA, Beveraggi E, Dietrich A. Accuracy of positron emission tomography and computed tomography (PET/CT) in detecting nodal metastasis according to histology of non-small cell lung cancer. Updates Surg 2019; 71:741-746. [PMID: 31552569 DOI: 10.1007/s13304-019-00680-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 09/16/2019] [Indexed: 11/25/2022]
Abstract
Positron emission tomography and computed tomography (PET-CT) is the non-invasive gold standard method for determining the oncological stage of patient with diagnosis of lung cancer. A correct preoperative staging is significant because only patients who do not have a history of regional or distant disease are those who will benefit from a surgical treatment. However, due to the different values of the PET-CT in terms of sensitivity and specificity to evaluate the mediastinal lymph node involvement, it is often necessary to perform a surgical mediastinal sampling through a cervical video mediastinoscopy (VM). Patient's risk factors which could modify the results of the PET scan, performing differences between non-invasive staging and the lymph node sampling due to VM are not yet clearly established in the literature. This knowledge will allow to identify in whom a surgical staging by sampling the mediastinal lymph nodes is needed. We included 234 patients with diagnosis of lung cancer who underwent a mediastinal lymph node staging by PET-CT images and histopathological results of mediastinal sampling by VM, analyzing the sensitivity and specificity of this non-invasive imaging study. We also analyzed variables that could modify the results of PET-CT, such as tumor type, location of the tumor and patient's history. We showed that those PET-CT presented an overall sensitivity and specificity of 93.8 and 62.7%, respectively, with negative and positive predictive values of 95.05 and 57.1%, respectively. The false-positive rate was 25% (57 of 234 patients). Analyzing risk factors involved in this false-positive rate (n = 57), we found that the only statistically significant factor that could explain these results was the histology of squamous carcinoma (p < 0.03). In this group of patients, it is essential to perform a mediastinal lymph node biopsy to know the real state of lymph node involvement.
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Affiliation(s)
- David E Smith
- Thoracic Surgery and Lung Transplant Section, Hospital Italiano de Buenos Aires, Perón 4190, 1181, Buenos Aires, Argentina
| | - Julian Fernandez Aramburu
- Thoracic Surgery and Lung Transplant Section, Hospital Italiano de Buenos Aires, Perón 4190, 1181, Buenos Aires, Argentina
| | - Alejandro Da Lozzo
- Thoracic Surgery and Lung Transplant Section, Hospital Italiano de Buenos Aires, Perón 4190, 1181, Buenos Aires, Argentina
| | - Juan A Montagne
- Thoracic Surgery and Lung Transplant Section, Hospital Italiano de Buenos Aires, Perón 4190, 1181, Buenos Aires, Argentina
| | - Enrique Beveraggi
- Thoracic Surgery and Lung Transplant Section, Hospital Italiano de Buenos Aires, Perón 4190, 1181, Buenos Aires, Argentina
| | - Agustin Dietrich
- Thoracic Surgery and Lung Transplant Section, Hospital Italiano de Buenos Aires, Perón 4190, 1181, Buenos Aires, Argentina.
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Multidisciplinary consensus statement on the clinical management of patients with stage III non-small cell lung cancer. Clin Transl Oncol 2019; 22:21-36. [PMID: 31172444 DOI: 10.1007/s12094-019-02134-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/11/2019] [Indexed: 12/17/2022]
Abstract
Stage III non-small cell lung cancer (NSCLC) is a very heterogeneous disease that encompasses patients with resected, potentially resectable and unresectable tumours. To improve the prognostic capacity of the TNM classification, it has been agreed to divide stage III into sub-stages IIIA, IIIB and IIIC that have very different 5-year survival rates (36, 26 and 13%, respectively). Currently, it is considered that both staging and optimal treatment of stage III NSCLC requires the joint work of a multidisciplinary team of expert physicians within the tumour committee. To improve the care of patients with stage III NSCLC, different scientific societies involved in the diagnosis and treatment of this disease have agreed to issue a series of recommendations that can contribute to homogenise the management of this disease, and ultimately to improve patient care.
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Osarogiagbon RU, Lee YS, Faris NR, Ray MA, Ojeabulu PO, Smeltzer MP. Invasive mediastinal staging for resected non-small cell lung cancer in a population-based cohort. J Thorac Cardiovasc Surg 2019; 158:1220-1229.e2. [PMID: 31147169 DOI: 10.1016/j.jtcvs.2019.04.068] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 04/18/2019] [Accepted: 04/20/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Invasive mediastinal nodal staging is recommended before curative-intent resection in patients with non-small cell lung cancer deemed at risk for mediastinal lymph node involvement. We evaluated the use and survival effect of preoperative invasive mediastinal nodal staging in a population-based non-small cell lung cancer cohort. METHODS We analyzed all curative-intent resections for non-small cell lung cancer from 2009 to 2018 in 11 hospitals in 4 contiguous Dartmouth Hospital Referral Regions, comparing patients who did not have invasive mediastinal nodal staging with those who did. RESULTS Preoperative invasive nodal staging was used in 22% of 2916 patients, including mediastinoscopy only in 13%, minimally invasive procedures only in 6%, and both approaches in 3%. Sixty-three percent of patients at risk for nodal disease (tumor size ≥3.0 cm/T2-T4; N1-N3 by computed tomography or positron-emission tomography-computerized tomography criterion) did not undergo invasive staging; among those who did not have invasive testing, 47% had at least 1 of the 3 clinical indications. Mediastinoscopy yielded a median of 3 lymph nodes and 2 nodal stations; 17% of mediastinoscopies and 31% of endobronchial ultrasound procedures yielded no lymph node material. Patients not invasively staged were more likely to have no nodes (6% vs 2%; P < .0001) and no mediastinal nodes (20% vs 11%; P < .0001) examined at surgery. Invasive staging was associated with significantly better survival (P = .0157). CONCLUSIONS More than a decade after the 2001 American College of Surgeons Patient Care Evaluation report, preoperative invasive nodal staging remains underused and of variable quality, but was associated with survival benefit in high-risk patients.
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Affiliation(s)
| | - Yu-Sheng Lee
- Division of Epidemiology, Biostatistics, and Environmental Health, University of Memphis School of Public Health, Memphis, Tenn
| | - Nicholas R Faris
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tenn
| | - Meredith A Ray
- Division of Epidemiology, Biostatistics, and Environmental Health, University of Memphis School of Public Health, Memphis, Tenn
| | - Philip O Ojeabulu
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tenn
| | - Matthew P Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, University of Memphis School of Public Health, Memphis, Tenn
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Shin SH, Jeong DY, Lee KS, Cho JH, Choi YS, Lee K, Um SW, Kim H, Jeong BH. Which definition of a central tumour is more predictive of occult mediastinal metastasis in nonsmall cell lung cancer patients with radiological N0 disease? Eur Respir J 2019; 53:13993003.01508-2018. [PMID: 30635291 PMCID: PMC6422838 DOI: 10.1183/13993003.01508-2018] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 12/18/2018] [Indexed: 12/25/2022]
Abstract
Background Guidelines recommend invasive mediastinal staging for centrally located tumours, even in radiological N0 nonsmall cell lung cancer (NSCLC). However, there is no uniform definition of a central tumour that is more predictive of occult mediastinal metastasis. Methods A total of 1337 consecutive patients with radiological N0 disease underwent invasive mediastinal staging. Tumours were categorised into central and peripheral by seven different definitions. Results About 7% (93 out of 1337) of patients had occult N2 disease, and they had significantly larger tumour size and more solid tumours on computed tomography. After adjustment for patient- and tumour-related characteristics, only the central tumour definition of the inner one-third of the hemithorax adopted by drawing concentric lines arising from the midline significantly predicted occult N2 disease (adjusted OR 2.13, 95% CI 1.17–3.87; p=0.013). This association was maintained after excluding patients with pure ground-glass nodules (adjusted OR 2.54, 95% CI 1.37–4.71; p=0.003) or only including those with solid tumours (adjusted OR 2.30, 95% CI 1.08–4.88; p=0.030). Conclusions We suggest that a central tumour should be defined using the inner one-third of the hemithorax adopted by drawing concentric lines from the midline. This is particularly useful for predicting occult N2 disease in patients with NSCLC. Central tumours defined as located in the inner one-third of the hemithorax adopted by drawing concentric lines from the midline are associated with occult mediastinal metastasis in patients with NSCLC and radiological N0 diseasehttp://ow.ly/scg630nbRmY
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Affiliation(s)
- Sun Hye Shin
- Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,These two authors contributed equally to this work
| | - Dong Young Jeong
- Dept of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,These two authors contributed equally to this work
| | - Kyung Soo Lee
- Dept of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Ho Cho
- Dept of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Soo Choi
- Dept of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyungjong Lee
- Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Won Um
- Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Toubat O, Farias AJ, Atay SM, McFadden PM, Kim AW, David EA. Disparities in the surgical management of early stage non-small cell lung cancer: how far have we come? J Thorac Dis 2019; 11:S596-S611. [PMID: 31032078 DOI: 10.21037/jtd.2019.01.63] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
It is currently estimated that nearly one-third of patients with newly diagnosed non-small cell lung cancer (NSCLC) have stage I-II disease on clinical evaluation. Curative-intent surgical resection has been a cornerstone of the therapeutic management of such patients, offering the best clinical and oncologic outcomes in the long-term. In 1999, Peter Bach and colleagues brought attention to racial disparities in the receipt of curative-intent surgery in the NSCLC population. In the time since this seminal study, there is accumulating evidence to suggest that disparities in the receipt of definitive surgery continue to persist for patients with early stage NSCLC. In this review, we sought to provide an up-to-date assessment of 20 years of surgical disparities literature in the NSCLC population. We summarized common and unrecognized disparities in the receipt of surgical resection for early stage NSCLC and demonstrated that demographic and socioeconomic factors such as race/ethnicity, special patient groups, income and insurance continue to impact the receipt of definitive resection. Additionally, we found that discrepancies in patient and provider perceptions of and attitudes toward surgery, access to invasive staging, distance to treatment centers and negative stigmas about lung cancer that patients experience may act to perpetuate disparities in surgical treatment of early stage lung cancer.
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Affiliation(s)
- Omar Toubat
- Keck School of Medicine of USC, Los Angeles, CA, USA.,Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Albert J Farias
- Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Scott M Atay
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - P Michael McFadden
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Anthony W Kim
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Elizabeth A David
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
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Casal RF, Sepesi B, Sagar AES, Tschirren J, Chen M, Li L, Sunny J, Williams J, Grosu HB, Eapen GA, Jimenez CA, Ost DE. Centrally located lung cancer and risk of occult nodal disease: an objective evaluation of multiple definitions of tumour centrality with dedicated imaging software. Eur Respir J 2019; 53:13993003.02220-2018. [DOI: 10.1183/13993003.02220-2018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 02/08/2019] [Indexed: 12/25/2022]
Abstract
IntroductionCurrent guidelines recommend invasive mediastinal staging in patients with centrally located radiographic stage T1N0M0 nonsmall cell lung cancer (NSCLC). The lack of a specific definition of a central tumour has resulted in discrepancies among guidelines and heterogeneity in practice patterns.MethodsOur objective was to study specific definitions of tumour centrality and their association with occult nodal disease. Pre-operative chest computed tomography scans from patients with clinical (c) T1N0M0 NSCLC were processed with a dedicated software system that divides the lungs in thirds following vertical and concentric lines. This software accurately assigns tumours to a specific third based both on the location of the centre of the tumour and its most medial aspect, creating eight possible definitions of central tumours.Results607 patients were included in our study. Surgery was performed for 596 tumours (98%). The overall pathological (p) N disease was: 504 (83%) N0, 56 (9%) N1, 47 (8%) N2 and no N3. The prevalence of N2 disease remained relatively low regardless of tumour location. Central tumours were associated with upstaging from cN0 to any N (pN1/pN2). Two definitions were associated with upstaging to any N: concentric lines, inner one-third, centre of the tumour (OR 3.91, 95% CI 1.85–8.26; p<0.001) and concentric lines, inner two-thirds, most medial aspect of the tumour (OR 1.91, 95% CI 1.23–2.97; p=0.004).ConclusionsWe objectively identified two specific definitions of central tumours. While the rate of occult mediastinal disease was relatively low regardless of tumour location, central tumours were associated with upstaging from cN0 to any N.
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Wink KCJ, Löck S, Rossi M, van Baardwijk A, Belderbos J, de Ruysscher D, Troost EGC. Contact of a tumour with the pleura is not associated with regional recurrence following stereotactic ablative radiotherapy for early stage non-small cell lung cancer. Radiother Oncol 2019; 131:120-126. [PMID: 30773178 DOI: 10.1016/j.radonc.2018.11.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/27/2018] [Accepted: 11/30/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE The aim was to investigate the incidence of isolated regional failure following stereotactic ablative radiotherapy (SABR) and risk factors for recurrence. MATERIALS AND METHODS Early stage non-small cell lung cancer (NSCLC) patients treated with SABR were included in this retrospective cohort study, with isolated regional recurrence (IRR) as primary endpoint, distant recurrence (DR) and overall survival (OS) as secondary endpoints. Survival analyses were performed using the cumulative incidence function (IRR and DR) or the Kaplan-Meier method (OS) and Cox proportional hazards modelling for univariate and multivariate analyses. The prognostic effect of contact between the tumour and the pleura was investigated using the CT scans used for SABR planning. RESULTS A total of 554 patients were included, of whom 494 could be analysed for IRR. The median follow-up for surviving patients was 48.1 months. Twenty-one patients developed an IRR (4%). The cumulative incidence of IRR and DR after 1-, 2-, and 5 years was 2%, 3%, 7% and 8%, 15% and 21%, respectively. Two year OS was 71%. The presence and type of pleural contact was not associated with any of the studied outcomes. CONCLUSION The presence, type and length of pleural contact as surrogate for visceral pleural invasion were not predictive for outcome. Further studies focussing on risk factors for occult nodal involvement, (I)RR, distant metastases and mortality in early stage NSCLC are warranted for the development of risk adapted diagnostic, treatment and follow-up strategies as more younger, operable and fitter patients receive SABR.
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Affiliation(s)
- Krista C J Wink
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre, the Netherlands.
| | - Steffen Löck
- Institute of Radiooncology - OncoRay, Helmholtz Zentrum Dresden - Rossendorf, Dresden, Germany; OncoRay, National Center for Radiation Research in Oncology, Dresden, Germany; Department of Radiation Oncology, University Hospital Carl Gustav Carus of Technische Universität Dresden, Germany; German Cancer Consortium (DKTK), Partnersite Dresden, Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Maddalena Rossi
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Angela van Baardwijk
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre, the Netherlands
| | - José Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Dirk de Ruysscher
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre, the Netherlands
| | - Esther G C Troost
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre, the Netherlands; Institute of Radiooncology - OncoRay, Helmholtz Zentrum Dresden - Rossendorf, Dresden, Germany; OncoRay, National Center for Radiation Research in Oncology, Dresden, Germany; Department of Radiation Oncology, University Hospital Carl Gustav Carus of Technische Universität Dresden, Germany; German Cancer Consortium (DKTK), Partnersite Dresden, Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
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Piloni D, Stella GM. Lymph-node mapping in lung cancer staging: accuracy and limits of the current approaches. Minerva Med 2019; 109:6-10. [PMID: 30642144 DOI: 10.23736/s0026-4806.18.05919-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lung cancer is among the most important causes of death worldwide. The presence of tumor metastasis in the mediastinum is one of the most relevant elements in determining the optimal treatment strategy in lung cancer. Lymph node "maps" are used to describe the location of nodal metastases, the latest was proposed by the International Association for the Study of Lung Cancer (IASLC) in 2009. Here we present and analyze a recent paper by El-Sherief and collaborators aimed to verify if and how lung cancer specialists really apply the IALSC lymph node map when classifying thoracic lymph nodes documented on CT scans during lung cancer staging. In addition, we discuss the critical issues related to a correct N staging of lung cancer, mainly focusing on the limits of the present approaches and on how the increasing knowledge on the molecular basis on lung carcinogenesis can be exploited to properly dissect ambiguous and doubtful cases.
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Affiliation(s)
- Davide Piloni
- Department of Internal Medicine, University of Pavia, Pavia, Italy -
| | - Giulia M Stella
- Unit of Pulmonology, IRCCS Foundation, Policlinico San Matteo di Pavia, Pavia, Italy
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Cerra-Franco A, Liu S, Azar M, Shiue K, Freije S, Hinton J, Deig CR, Edwards D, Estabrook NC, Ellsworth SG, Huang K, Diab K, Langer MP, Zellars R, Kong FM, Wan J, Lautenschlaeger T. Predictors of Nodal and Metastatic Failure in Early Stage Non-small-cell Lung Cancer After Stereotactic Body Radiation Therapy. Clin Lung Cancer 2018; 20:186-193.e3. [PMID: 30711394 DOI: 10.1016/j.cllc.2018.12.016] [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] [Received: 08/22/2018] [Revised: 12/21/2018] [Accepted: 12/23/2018] [Indexed: 12/25/2022]
Abstract
INTRODUCTION/BACKGROUND Many patients with early stage non-small-cell lung cancer (ES-NSCLC) undergoing stereotactic body radiation therapy (SBRT) develop metastases, which is associated with poor outcomes. We sought to identify factors predictive of metastases after lung SBRT and created a risk stratification tool. MATERIALS AND METHODS We included 363 patients with ES-NSCLC who received SBRT; the median follow-up was 5.8 years. The following patient and tumor factors were retrospectively analyzed for their association with metastases (defined as nodal and/or distant failure): gender; age; lobe involved; centrality; previous NSCLC; smoking status; gross tumor volume (GTV); T-stage; histology; dose; minimum, maximum, and mean GTV dose; and parenchymal lung failure. A metastasis risk-score linear-model using beta coefficients from a multivariate Cox model was built. RESULTS A total of 111 (27.3%) of 406 lesions metastasized. GTV and dose were significantly associated with metastases on univariate and multivariate Cox proportional hazards modeling (P < .001 and hazard ratio [HR], 1.02 per mL; P < .05 and HR, 0.99 per Gy, respectively). Histology, T-stage, centrality, lung parenchymal failures, and previous NSCLC were not associated with development of metastasis. A metastasis risk-score model using GTV and prescription dose was built: risk score = (0.01611 × GTV) - (0.00525 × dose [BED10]). Two risk-score cutoffs separating the cohort into low-, medium-, and high-risk subgroups were examined. The risk score identified significant differences in time to metastases between low-, medium-, and high-risk patients (P < .001), with 3-year estimates of 81.1%, 63.8%, and 38%, respectively. CONCLUSION GTV and radiation dose are associated with time to metastasis and may be used to identify patients at higher risk of metastasis after lung SBRT.
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Affiliation(s)
- Alberto Cerra-Franco
- Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Sheng Liu
- Department of Medical and Molecular Genetics, Collaborative Core for Cancer Bioinformatics, Indianapolis, IN
| | - Michella Azar
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Kevin Shiue
- Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Samantha Freije
- Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Jason Hinton
- Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Christopher R Deig
- Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Donna Edwards
- Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Neil C Estabrook
- Department of Radiation Oncology, Indiana University Health Arnett Hospital, Lafayette, IN
| | - Susannah G Ellsworth
- Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Ke Huang
- Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Khalil Diab
- Pulmonary, Critical Care, Sleep, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Mark P Langer
- Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Richard Zellars
- Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Feng-Ming Kong
- Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Jun Wan
- Department of Medical and Molecular Genetics, Collaborative Core for Cancer Bioinformatics, Indianapolis, IN
| | - Tim Lautenschlaeger
- Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
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Solid part size is an important predictor of nodal metastasis in lung cancer with a subsolid tumor. BMC Pulm Med 2018; 18:151. [PMID: 30200917 PMCID: PMC6131822 DOI: 10.1186/s12890-018-0709-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/14/2018] [Indexed: 12/18/2022] Open
Abstract
Background Candidates for preoperative or intraoperative nodal assessment among patients with non-small cell lung cancer (NSCLC) manifesting as a subsolid tumor are not established. The present study was conducted to demonstrate the distribution of nodal metastasis rate according to newly proposed T categories for subsolid tumors, and we further aimed to identify radiologic parameters that can be predictive of nodal metastasis. Methods We retrospectively reviewed cases of NSCLC manifesting as a subsolid tumor in computed tomography scans in a university-affiliated tertiary hospital between April 2013 and August 2016. All patients underwent mediastinal lymph node dissection during resection surgery. Multivariate analysis was performed among clinical and radiologic parameters. Results Of the 269 eligible patients, T-categories were classified as cTis (n = 23, 8.6%), cT1 (n = 203, 75.5%), and cT2 (n = 43, 16.0%). Ten patients (3.7%) had nodal metastasis: pN1 (n = 5, 1.9%), pN2 (n = 5, 1.9%). Nodal metastasis was not observed in tumors with a solid part ≤1.0 cm (cT1mi and cT1a) or in nonsolid tumors ≤3.0 cm (cTis). The nodal metastasis rate in cT1b, cT1c, and cT2 tumors was 6.1% (4/65), 8.3% (1/12), and 11.7% (5/43), respectively. Multivariate analysis showed that a solid part size > 1.5 cm [odds ratio, 5.89; 95% confidence interval, 1.25–27.68, p = 0.025] was significantly associated with nodal metastasis. Conclusions We observed nodal metastasis from cT1b tumors (solid part size > 1 cm) among proposed T categories for subsolid tumors and a solid part size is an important radiologic parameter predictive of nodal metastasis in NSCLC manifesting as a subsolid tumor. Considering the low rate of nodal metastasis, pathologic nodal assessment may be unnecessary in early T category tumors with a small solid part size.
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Hofmann HS, Braess J, Leipelt S, Allgäuer M, Klinkhammer-Schalke M, Szoeke T, Grosser C, Pfeifer M, Ried M. Multimodality therapy in subclassified stage IIIA-N2 non-small cell lung cancer patients according to the Robinson classification: heterogeneity and management. J Thorac Dis 2018; 10:3585-3594. [PMID: 30069356 DOI: 10.21037/jtd.2018.05.203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Non-small cell lung cancer (NSCLC) with mediastinal lymph node involvement (N2) is a heterogeneous entity. The objective of this analysis is to investigate the results of treatment strategies for N2-positive patients. Methods Retrospective study (2009-2014) of 104 consecutive patients with stage IIIA-N2 NSCLC classified according to the Robinson classification (IIIA1-IIIA4) and treated within a multimodality treatment regime. Results The Robinson subgroups were: IIIA1 (n=27), IIIA3 (n=60) and IIIA4 (n=17). We had no stage IIIA2 samples because we did not perform an intraoperative frozen section of lymph nodes. Surgical resection with systematic lymph node dissection was performed in all patients with stage IIIA1 (n=27). After chemotherapy or chemo-/radiotherapy, 53.3% of patients in stage IIIA3 (n=32) and 11.7% of patients in stage IIIA4 (n=2) underwent surgery with curative intention. R0 was achieved in 92.6% in stage IIIA1, 93.8% in stage IIIA3 and 100% in stage IIIA4. The 30-day mortality was 3.2%. The overall median survival was 31.7 months (5-year survival was 30.5%). There were no significant differences (P=0.583) in survival regarding the Robinson subgroups. Patients who underwent tumour resection had significantly better median survival (39.8 vs. 19.6 months; P=0.014) compared to patients treated conservatively. Deviation from the interdisciplinary recommended therapy (12%) led to a reduced median survival (11.4 vs. 31.8 months; P=0.137). Conclusions N2-patients should be subclassified according to the Robinson classification and discussed in the tumour board. Surgical resection should be recommended in specific cases of N2-disease (non-bulky, sensitivity to systemic treatment).
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Affiliation(s)
- Hans-Stefan Hofmann
- Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049 Regensburg, Germany.,Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Jan Braess
- Department of Oncology and Hematology, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049 Regensburg, Germany
| | - Susanne Leipelt
- Department of Oncology and Hematology, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049 Regensburg, Germany
| | - Michael Allgäuer
- Department of Radiotherapy, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049 Regensburg, Germany
| | | | - Tamas Szoeke
- Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049 Regensburg, Germany
| | - Christian Grosser
- Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049 Regensburg, Germany
| | - Michael Pfeifer
- Department of Pneumology, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049 Regensburg, Germany
| | - Michael Ried
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
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