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Uchida S, Hattori A, Fukui M, Matsunaga T, Takamochi K, Suzuki K. Long-term outcomes and risk factors for recurrence after lung segmentectomy. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 39:ivae125. [PMID: 38950179 PMCID: PMC11245319 DOI: 10.1093/icvts/ivae125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/24/2023] [Accepted: 06/29/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES The long-term oncological outcomes and risk factors for recurrence after lung segmentectomy are unclear. The aims of this study were to investigate the long-term prognosis and to evaluate risk factors for recurrence after segmentectomy. METHODS Between January 2008 and December 2012, a total of 177 patients underwent segmentectomy for clinical stage I non-small cell lung cancer. The median follow-up period was 120.1 months. The overall survival (OS) and recurrence-free survival curves were analysed using the Kaplan-Meier method with a log-rank test. Univariable and multivariable analyses were used to identify significant factors that predicted recurrence. RESULTS The study included 177 patients with a median age of 67 years. The median operative time was 155 min. No 30-day deaths were observed. Nine patients (5.1%) had recurrences: loco-regional in 3, distant in 3 and both in 3. The 5-year and 10-year recurrence-free survival rates were 89.7% and 79.8%, and the OS rates were 90.9% and 80.4%, respectively. On multivariable analysis, the risk factor associated with recurrence was a pure solid tumour [hazard ratio, 23.151; 95% confidence interval 2.575-208.178; P = 0.005]. The non-pure solid tumour group had a significantly better probability of survival (5-year OS: 95.4% vs 77.2%; 10-year OS: 86.5% vs 61.8%; P < 0.0001). A total of 113 patients received preoperative positron emission tomography/computed tomography. Patients with a higher maximum standardized uptake value had a significantly higher recurrence rate. CONCLUSIONS Segmentectomy for clinical stage I non-small cell lung cancer produced acceptable long-term outcomes. Pure solid radiographic appearance was associated with recurrence and decreased survival.
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Affiliation(s)
- Shinsuke Uchida
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Mariko Fukui
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takeshi Matsunaga
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Yuan L, An L, Zhu Y, Duan C, Kong W, Jiang P, Yu QQ. Machine Learning in Diagnosis and Prognosis of Lung Cancer by PET-CT. Cancer Manag Res 2024; 16:361-375. [PMID: 38699652 PMCID: PMC11063459 DOI: 10.2147/cmar.s451871] [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: 11/29/2023] [Accepted: 04/16/2024] [Indexed: 05/05/2024] Open
Abstract
As a disease with high morbidity and high mortality, lung cancer has seriously harmed people's health. Therefore, early diagnosis and treatment are more important. PET/CT is usually used to obtain the early diagnosis, staging, and curative effect evaluation of tumors, especially lung cancer, due to the heterogeneity of tumors and the differences in artificial image interpretation and other reasons, it also fails to entirely reflect the real situation of tumors. Artificial intelligence (AI) has been applied to all aspects of life. Machine learning (ML) is one of the important ways to realize AI. With the help of the ML method used by PET/CT imaging technology, there are many studies in the diagnosis and treatment of lung cancer. This article summarizes the application progress of ML based on PET/CT in lung cancer, in order to better serve the clinical. In this study, we searched PubMed using machine learning, lung cancer, and PET/CT as keywords to find relevant articles in the past 5 years or more. We found that PET/CT-based ML approaches have achieved significant results in the detection, delineation, classification of pathology, molecular subtyping, staging, and response assessment with survival and prognosis of lung cancer, which can provide clinicians a powerful tool to support and assist in critical daily clinical decisions. However, ML has some shortcomings such as slightly poor repeatability and reliability.
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Affiliation(s)
- Lili Yuan
- Jining NO.1 People’s Hospital, Shandong First Medical University, Jining, People’s Republic of China
| | - Lin An
- Jining NO.1 People’s Hospital, Shandong First Medical University, Jining, People’s Republic of China
| | - Yandong Zhu
- Jining NO.1 People’s Hospital, Shandong First Medical University, Jining, People’s Republic of China
| | - Chongling Duan
- Jining NO.1 People’s Hospital, Shandong First Medical University, Jining, People’s Republic of China
| | - Weixiang Kong
- Jining NO.1 People’s Hospital, Shandong First Medical University, Jining, People’s Republic of China
| | - Pei Jiang
- Translational Pharmaceutical Laboratory, Jining NO.1 People’s Hospital, Shandong First Medical University, Jining, People’s Republic of China
| | - Qing-Qing Yu
- Jining NO.1 People’s Hospital, Shandong First Medical University, Jining, People’s Republic of China
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Deng Y, Xia L, Zhang J, Deng S, Wang M, Wei S, Li K, Lai H, Yang Y, Bai Y, Liu Y, Luo L, Yang Z, Chen Y, Kang R, Gan F, Pu Q, Mei J, Ma L, Lin F, Guo C, Liao H, Zhu Y, Liu Z, Liu C, Hu Y, Yuan Y, Zha Z, Yuan G, Zhang G, Chen L, Cheng Q, Shen S, Liu L. Multicellular ecotypes shape progression of lung adenocarcinoma from ground-glass opacity toward advanced stages. Cell Rep Med 2024; 5:101489. [PMID: 38554705 PMCID: PMC11031428 DOI: 10.1016/j.xcrm.2024.101489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/26/2024] [Accepted: 03/06/2024] [Indexed: 04/02/2024]
Abstract
Lung adenocarcinoma is a type of cancer that exhibits a wide range of clinical radiological manifestations, from ground-glass opacity (GGO) to pure solid nodules, which vary greatly in terms of their biological characteristics. Our current understanding of this heterogeneity is limited. To address this gap, we analyze 58 lung adenocarcinoma patients via machine learning, single-cell RNA sequencing (scRNA-seq), and whole-exome sequencing, and we identify six lung multicellular ecotypes (LMEs) correlating with distinct radiological patterns and cancer cell states. Notably, GGO-associated neoantigens in early-stage cancers are recognized by CD8+ T cells, indicating an immune-active environment, while solid nodules feature an immune-suppressive LME with exhausted CD8+ T cells, driven by specific stromal cells such as CTHCR1+ fibroblasts. This study also highlights EGFR(L858R) neoantigens in GGO samples, suggesting potential CD8+ T cell activation. Our findings offer valuable insights into lung adenocarcinoma heterogeneity, suggesting avenues for targeted therapies in early-stage disease.
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Affiliation(s)
- Yulan Deng
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Liang Xia
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Jian Zhang
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Senyi Deng
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Mengyao Wang
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China; Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong, China
| | - Shiyou Wei
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Kaixiu Li
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China; Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong, China
| | - Hongjin Lai
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Yunhao Yang
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Yuquan Bai
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Yongcheng Liu
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Lanzhi Luo
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Zhenyu Yang
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Yaohui Chen
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Ran Kang
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Fanyi Gan
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Qiang Pu
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Jiandong Mei
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Lin Ma
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Feng Lin
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Chenglin Guo
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Hu Liao
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Yunke Zhu
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Zheng Liu
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Chengwu Liu
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Yang Hu
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Yong Yuan
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Zhengyu Zha
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Gang Yuan
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Gao Zhang
- Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong, China
| | - Luonan Chen
- State Key Laboratory of Cell Biology, Shanghai Key Laboratory of Molecular Andrology, Shanghai Institute of Biochemistry and Cell Biology, CAS Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, Shanghai, China; Center for Excellence in Animal Evolution and Genetics, Chinese Academy of Sciences, Kunming, China; Key Laboratory of Systems Biology, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Hangzhou, China
| | - Qing Cheng
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Shensi Shen
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China.
| | - Lunxu Liu
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China.
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Xu J, Jian J, Zhang Y, Wu J, Qiu Y. The efficacy of nasal administration of esketamine in patients having moderate-to-severe pain after preoperative CT-guided needle localization: a randomized, double-blind, placebo-controlled trial. Front Med (Lausanne) 2024; 11:1344160. [PMID: 38654836 PMCID: PMC11035877 DOI: 10.3389/fmed.2024.1344160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Background Whether nasal administration of esketamine can provide effective analgesia is unclear in patients with acute pain after preoperative CT-guided needle localization. Methods In this double-blind, randomized, placebo-controlled trial, patients were assigned to receive either nasal administration of esketamine (0.3 mg/kg or 0.5 mg/kg) or saline (identical in appearance to esketamine) when they had visual analog scale (VAS) pain scores >3/10 during deep breathing after preoperative CT-guided needle localization. The primary outcome was the percentage of patients with satisfactory pain relief, which was defined as VAS pain scores ≤3/10 measured 15 min after intranasal of esketamine or saline. Secondary outcomes included VAS measured following esketamine or saline, the incidence and cumulative dose of rescue hydromorphone use, and related adverse events. Results A total of 90 patients were included in the final analysis. Following intranasal treatment, the percentage of patients with satisfactory pain relief was 16.7% (5/30) in the saline group, 56.7% (17/30) in the 0.3 mg/kg esketamine group, and 53.3% (16/30) in the 0.5 mg/kg esketamine group (p = 0.002). The median VAS during deep breathing was less after the intranasal administration of esketamine {median (IQR), 3 (3, 5) in 0.3 mg/kg or 0.5 mg/kg esketamine compared to the saline group [5 (4, 6)], p = 0.009}. The incidence of rescue hydromorphone use was detected less in the esketamine group compared to the saline group (43.3% in the 0.3 mg/kg esketamine group, 36.7% in the 0.5 mg/kg esketamine group, and 73.3% in the saline group, p = 0.010). The adverse events were similar among the three groups (p > 0.05). Conclusion Intranasal administration of esketamine is easier and more effective in alleviating acute pain in patients after preoperative CT-guided needle localization without significant adverse effects.
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Affiliation(s)
- Jiangning Xu
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jin Jian
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
- Department of Anesthesiology, The People’s Hospital of YuBei District, Chongqing, China
| | - Yunyun Zhang
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jingxiang Wu
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
- Outcomes Research Consortium, Cleveland, OH, United States
| | - Yuwei Qiu
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
- Outcomes Research Consortium, Cleveland, OH, United States
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Streit A, Lampridis S, Seitlinger J, Renaud S, Routledge T, Bille A. Resectability versus Operability in Early-Stage Non-Small Cell Lung Cancer. Curr Oncol Rep 2024; 26:55-64. [PMID: 38133722 DOI: 10.1007/s11912-023-01477-3] [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] [Accepted: 11/13/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE OF REVIEW With increased detection of early-stage non-small cell lung cancer (NSCLC) owing to screening, determining optimal management increasingly hinges on assessing resectability and operability. Resectability refers to the feasibility of achieving microscopically negative margins based on tumour size, location and degree of local invasion and achieving an anatomical lobar resection. Operability reflects the patient's tolerance for resection based on comorbidities, cardiopulmonary reserve and frailty. Standardized criteria help guide these assessments, but application variability contributes to practice inconsistencies. This review synthesizes a strategic approach to evaluating resectability and operability in contemporary practice. Standardization promises reduced care variability and optimized patient selection to maximize curative outcomes in this new era of early detection. RECENT FINDINGS Recent pivotal trials demonstrate equivalency of sublobar resection to lobectomy for small, peripheral, node-negative NSCLC, expanding options for parenchymal preservation in borderline surgical candidates. Furthermore, recent phase 3 trials have highlighted the benefit of chemoimmunotherapy as a neoadjuvant treatment with an excellent pathological response and a down staging of the tumour, improving the resectability of the early-stage NSCLC. A good assessment of the operability and resectability is paramount in order to offer the best course of treatment for our patients. European and American societies have issued recommendations to help clinicians assess the cardiopulmonary function and predict the extension of pulmonary resection that could afford the patient. This operability assessment is closely linked with the evaluated tumour resectability which will determine the extension of pulmonary resection that is needed for the patient in order to achieve a good oncological outcome. Some major progresses have been done recently to improve the operability and resectability of patients. For instance, prehabilitation program allows better postoperative morbidity. Some studies have shown a potential good oncological outcome with sublobar resection expending access to surgery for patient with reduced lung function. Some others have identified the neoadjuvant immunochemotherapy as a potential solution for downstaging tumours. Work-up of early-stage NSCLC is a key moment and has to be done thoroughly and in full knowledge of the recent findings in order to propose the most appropriate treatment for the patient.
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Affiliation(s)
- Arthur Streit
- Department of Thoracic Surgery, Great Maze Pond, Guy's and St Thomas' NHS Trust Foundation, London, SE19RT, UK.
- Department of Thoracic Surgery, University Hospital of Nancy, Nancy, France.
| | - Savvas Lampridis
- Department of Thoracic Surgery, Great Maze Pond, Guy's and St Thomas' NHS Trust Foundation, London, SE19RT, UK
| | - Joseph Seitlinger
- Department of Thoracic Surgery, University Hospital of Nancy, Nancy, France
| | - Stéphane Renaud
- Department of Thoracic Surgery, University Hospital of Nancy, Nancy, France
| | - Tom Routledge
- Department of Thoracic Surgery, Great Maze Pond, Guy's and St Thomas' NHS Trust Foundation, London, SE19RT, UK
| | - Andrea Bille
- Department of Thoracic Surgery, Great Maze Pond, Guy's and St Thomas' NHS Trust Foundation, London, SE19RT, UK
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Zhao J, Cleland P, D'Souza DM, Kneuertz PJ. Single Anesthesia Strategy for Definitive Management of Bilateral Ground Glass Opacities Using Robotic Bronchoscopic Localization and Resection. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:531-534. [PMID: 37997914 DOI: 10.1177/15569845231211903] [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] [Indexed: 11/25/2023]
Abstract
This case series describes 2 patients who underwent a single anesthesia strategy for definitive management of bilateral ground-glass opacities harboring adenocarcinoma-spectrum lesions using robotic navigational localization paired with robotic thoracoscopic resection.
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Affiliation(s)
- Jane Zhao
- Division of Thoracic Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Paul Cleland
- Division of Thoracic Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
- Ohio State University Comprehensive Cancer Center- James and Solove Research Institute, Columbus, USA
| | - Desmond M D'Souza
- Division of Thoracic Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
- Ohio State University Comprehensive Cancer Center- James and Solove Research Institute, Columbus, USA
| | - Peter J Kneuertz
- Division of Thoracic Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
- Ohio State University Comprehensive Cancer Center- James and Solove Research Institute, Columbus, USA
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Xue M, Li R, Wang K, Liu W, Liu J, Li Z, Ma Z, Zhang H, Tian H, Tian Y. Nomogram combining clinical and radiological characteristics for predicting the malignant probability of solitary pulmonary nodules measuring ≤ 2 cm. Front Oncol 2023; 13:1196778. [PMID: 37795448 PMCID: PMC10545867 DOI: 10.3389/fonc.2023.1196778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023] Open
Abstract
Background At present, how to identify the benign or malignant nature of small (≤ 2 cm) solitary pulmonary nodules (SPN) are an urgent clinical challenge. This retrospective study aimed to develop a clinical prediction model combining clinical and radiological characteristics for assessing the probability of malignancy in SPNs measuring ≤ 2 cm. Method In this study, we included patients with SPNs measuring ≤ 2 cm who underwent pulmonary resection with definite pathology at Qilu Hospital of Shandong University from January 2020 to December 2021. Clinical features, preoperative biomarker results, and computed tomography characteristics were collected. The enrolled patients were randomized at a ratio of 7:3 into a training cohort of 775 and a validation cohort of 331. The training cohort was used to construct the predictive model, while the validation cohort was used to test the model independently. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors. The prediction model and nomogram were established based on the independent risk factors. The receiver operating characteristic (ROC) curve was used to evaluate the identification ability of the model. The calibration power was evaluated using the Hosmer-Lemeshow test and calibration curve. The clinical utility of the nomogram was also assessed by decision curve analysis (DCA). Result A total of 1,106 patients were included in this study. Among them, the malignancy rate of SPNs was 85.08% (941/1,106). We finally identified the following six independent risk factors by logistic regression: age, carcinoembryonic antigen, nodule shape, calcification, maximum diameter, and consolidation-to-tumor ratio. The area under the ROC curve (AUC) for the training cohort was 0.764 (95% confidence interval [CI]: 0.714-0.814), and the AUC for the validation cohort was 0.729 (95% CI: 0.647-0.811), indicating that the prediction accuracy of nomogram was relatively good. The calibration curve of the predictive model also demonstrated a good calibration in both cohorts. DCA proved that the clinical prediction model was useful in clinical practice. Conclusion We developed and validated a predictive model and nomogram for estimating the probability of malignancy in SPNs measuring ≤ 2 cm. With the application of predictive models, thoracic surgeons can make more rational clinical decisions while avoiding overtreatment and wasting medical resources.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Hui Tian
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Yu Tian
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
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Koike H, Ashizawa K, Tsutsui S, Kurohama H, Okano S, Nagayasu T, Kido S, Uetani M, Toya R. Differentiation Between Heterogeneous GGN and Part-Solid Nodule Using 2 D Grayscale Histogram Analysis of Thin-Section CT Image. Clin Lung Cancer 2023; 24:541-550. [PMID: 37407293 DOI: 10.1016/j.cllc.2023.06.001] [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: 04/27/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION/BACKGROUND To evaluate cases of surgically resected pulmonary adenocarcinoma (Ad) with heterogenous ground-glass nodules (HGGNs) or part-solid nodules (PSNs) and to clarify the differences between them, and between invasive adenocarcinoma (IVA) and minimally invasive adenocarcinoma (MIA) + adenocarcinoma in situ (AIS) using grayscale histogram analysis of thin-section computed tomography (TSCT). MATERIALS AND METHODS 241 patients with pulmonary Ad were retrospectively classified into HGGNs and PSNs on TSCT by three thoracic radiologists. Sixty HGGNs were classified into 17 IVAs, 26 MIAs, and 17 AISs. 181 PSNs were classified into 114 IVAs, 55 MIAs, and 12 AISs. RESULTS We found significant differences in area (P = 0.0024), relative size of solid component (P <0.0001), circumference (P <0.0001), mean CT value (P <0.0001), standard deviation of the CT value (P <0.0001), maximum CT value (P <0.0001), skewness (P <0.0001), kurtosis (P <0.0001), and entropy (P <0.0001) between HGGNs and PSNs. In HGGNs, we found significant differences in relative size of solid component (P <0.0001), mean CT value (P = 0.0005), standard deviation of CT value (P = 0.0071), maximum CT value (P = 0.0237), and skewness (P = 0.0027) between IVAs and MIA+AIS lesions. In PSNs, we found significant differences in area (P = 0.0029), relative size of solid component (P = 0.0003), circumference (P = 0.0004), mean CT value (P = 0.0011), skewness (P = 0.0009), and entropy (P = 0.0002) between IVAs and the MIA+AIS lesions. CONCLUSION Quantitative evaluations using grayscale histogram analysis can clearly distinguish between HGGNs and PSNs, and may be useful for estimating the pathology of such lesions.
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Affiliation(s)
- Hirofumi Koike
- Departments of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazuto Ashizawa
- Departments of Clinical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Shin Tsutsui
- Departments of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hirokazu Kurohama
- Department of Pathology, Nagasaki University Hospital, Nagasaki, Japan
| | - Shinji Okano
- Department of Pathology, Nagasaki University Hospital, Nagasaki, Japan
| | - Takeshi Nagayasu
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shoji Kido
- Department of Artificial Intelligence Diagnostic Radiology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masataka Uetani
- Departments of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryo Toya
- Departments of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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9
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Hamada A, Kitajima K, Suda K, Koga T, Soh J, Kaida H, Ito K, Sekine T, Takegahara K, Daisaki H, Hashimoto M, Yoshida Y, Kabasawa T, Yamasaki T, Hirota S, Usuda J, Ishii K, Mitsudomi T. Prognostic role of preoperative fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography with an image-based harmonization technique: A multicenter retrospective study. JTCVS OPEN 2023; 14:502-522. [PMID: 37425462 PMCID: PMC10328817 DOI: 10.1016/j.xjon.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 07/11/2023]
Abstract
Objectives Despite the prognostic impacts of preoperative fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography examination, fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography-based prognosis prediction has not been used clinically because of the disparity in data between institutions. By applying an image-based harmonized approach, we evaluated the prognostic roles of fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography parameters in clinical stage I non-small cell lung cancer. Methods We retrospectively examined 495 patients with clinical stage I non-small cell lung cancer who underwent fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography examinations before pulmonary resection between 2013 and 2014 at 4 institutions. Three different harmonization techniques were applied, and an image-based harmonization, which showed the best-fit results, was used in the further analyses to evaluate the prognostic roles of fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography parameters. Results Cutoff values of image-based harmonized fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography parameters, maximum standardized uptake, metabolic tumor volume, and total lesion glycolysis were determined using receiver operating characteristic curves that distinguish pathologic high invasiveness of tumors. Among these parameters, only the maximum standardized uptake was an independent prognostic factor in recurrence-free and overall survivals in univariate and multivariate analyses. High image-based maximum standardized uptake value was associated with squamous histology or lung adenocarcinomas with higher pathologic grades. In subgroup analyses defined by ground-glass opacity status and histology or by clinical stages, the prognostic impact of image-based maximum standardized uptake value was always the highest compared with other fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography parameters. Conclusions The image-based fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography harmonization was the best fit, and the image-based maximum standardized uptake was the most important prognostic marker in all patients and in subgroups defined by ground-glass opacity status and histology in surgically resected clinical stage I non-small cell lung cancers.
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Affiliation(s)
- Akira Hamada
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Kazuhiro Kitajima
- Department of Radiology, Hyogo Medical University School of Medicine, Hyogo, Japan
| | - Kenichi Suda
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Takamasa Koga
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Junichi Soh
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Hayato Kaida
- Department of Radiology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Kimiteru Ito
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Tetsuro Sekine
- Department of Radiology, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Japan
| | - Kyoshiro Takegahara
- Department of Thoracic Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Hiromitsu Daisaki
- Department of Radiological Technology, School of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Japan
| | - Masaki Hashimoto
- Departments of Thoracic Surgery and Orthopedic Surgery, Hyogo Medical University School of Medicine, Hyogo, Japan
| | - Yukihiro Yoshida
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Takanobu Kabasawa
- Department of Pathological Diagnostics, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Takashi Yamasaki
- Department of Surgical Pathology, Hyogo Medical University School of Medicine, Hyogo, Japan
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo Medical University School of Medicine, Hyogo, Japan
| | - Jitsuo Usuda
- Department of Thoracic Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Kazunari Ishii
- Department of Radiology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Tetsuya Mitsudomi
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
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10
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Ji XY, Li H, Chen HH, Lin J. Diagnostic performance of RASSF1A and SHOX2 methylation combined with EGFR mutations for differentiation between small pulmonary nodules. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04745-8. [PMID: 37097393 DOI: 10.1007/s00432-023-04745-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 04/03/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND AND AIM Aberrant methylation of Ras association domain family 1, isoform A (RASSF1A), and short-stature homeobox gene 2 (SHOX2) promoters has been validated as a pair of valuable biomarkers for diagnosing early lung adenocarcinomas (LUADs). Epidermal growth factor receptor (EGFR) is the key driver mutation in lung carcinogenesis. This study aimed to investigate the aberrant promoter methylation of RASSF1A and SHOX2, and the genetic mutation of EGFR in 258 specimens of early LUADs. METHODS We retrospectively selected 258 paraffin-embedded samples of pulmonary nodules measuring 2 cm or less in diameter and evaluated the diagnostic performance of individual biomarker assays and multiple panels between noninvasive (group 1) and invasive lesions (groups 2A and 2B). Then, we investigated the interaction between genetic and epigenetic alterations. RESULTS The degree of RASSF1A and SHOX2 promoter methylation and EGFR mutation was significantly higher in invasive lesions than in noninvasive lesions. The three biomarkers distinguished between noninvasive and invasive lesions with reliable sensitivity and specificity: 60.9% sensitivity [95% confidence interval (CI) 52.41-68.78] and 80.0% specificity (95% CI 72.14-86.07). The novel panel biomarkers could further discriminate among three invasive pathological subtypes (area under the curve value > 0.6). The distribution of RASSF1A methylation and EGFR mutation was considerably exclusive in early LUAD (P = 0.002). CONCLUSION DNA methylation of RASSF1A and SHOX2 is a pair of promising biomarkers, which may be used in combination with other driver alterations, such as EGFR mutation, to support the differential diagnosis of LUADs, especially for stage I.
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Affiliation(s)
- Xiang-Yu Ji
- Department of Pathology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
- Department of Pathology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, People's Republic of China
| | - Hong Li
- Department of Pathology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Hui-Hui Chen
- Department of Pathology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Jie Lin
- Department of Pathology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China.
- Department of Pathology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, People's Republic of China.
- National Virtual and Reality Experimental Education Center for Medical Morphology, Southern Medical University, Guangzhou, People's Republic of China.
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11
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Udelsman BV, Blasberg JD. Using the robotic platform in the therapy of multifocal ground glass opacities. J Surg Oncol 2023; 127:262-268. [PMID: 36465021 DOI: 10.1002/jso.27154] [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: 10/15/2022] [Revised: 11/05/2022] [Accepted: 11/11/2022] [Indexed: 12/07/2022]
Abstract
Due to their association with invasive adenocarcinoma, ground glass opacities that reach 3 cm in size, develop a solid component ≥2 mm on mediastinal windows, or exhibit ≥25% annual growth warrant operative resection. Minimally invasive techniques are preferred given that approximately one third of patients will present with multifocal focal disease and may require additional operations. A robotic-assisted thoracoscopic surgical approach can be used with percutaneous or bronchoscopic localization techniques and are compatible with developing intraoperative molecular targeting techniques.
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Affiliation(s)
- Brooks V Udelsman
- Division of Thoracic Surgery, Yale-New Haven Hospital, New Haven, Connecticut, USA.,Yale University School of Medicine, New Haven, Connecticut, USA
| | - Justin D Blasberg
- Division of Thoracic Surgery, Yale-New Haven Hospital, New Haven, Connecticut, USA.,Yale University School of Medicine, New Haven, Connecticut, USA
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12
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Onozato Y, Iwata T, Uematsu Y, Shimizu D, Yamamoto T, Matsui Y, Ogawa K, Kuyama J, Sakairi Y, Kawakami E, Iizasa T, Yoshino I. Predicting pathological highly invasive lung cancer from preoperative [ 18F]FDG PET/CT with multiple machine learning models. Eur J Nucl Med Mol Imaging 2023; 50:715-726. [PMID: 36385219 PMCID: PMC9852187 DOI: 10.1007/s00259-022-06038-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/08/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE The efficacy of sublobar resection of primary lung cancer have been proven in recent years. However, sublobar resection for highly invasive lung cancer increases local recurrence. We developed and validated multiple machine learning models predicting pathological invasiveness of lung cancer based on preoperative [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) and computed tomography (CT) radiomic features. METHODS Overall, 873 patients who underwent lobectomy or segmentectomy for primary lung cancer were enrolled. Radiomics features were extracted from preoperative PET/CT images with the PyRadiomics package. Seven machine learning models and an ensemble of all models (ENS) were evaluated after 100 iterations. In addition, the probability of highly invasive lung cancer was calculated in a nested cross-validation to assess the calibration plot and clinical usefulness and to compare to consolidation tumour ratio (CTR) on CT images, one of the generally used diagnostic criteria. RESULTS In the training set, when PET and CT features were combined, all models achieved an area under the curve (AUC) of ≥ 0.880. In the test set, ENS showed the highest mean AUC of 0.880 and smallest standard deviation of 0.0165, and when the cutoff was 0.5, accuracy of 0.804, F1 of 0.851, precision of 0.821, and recall of 0.885. In the nested cross-validation, the AUC of 0.882 (95% CI: 0.860-0.905) showed a high discriminative ability, and the calibration plot indicated consistency with a Brier score of 0.131. A decision curve analysis showed that the ENS was valid with a threshold probability ranging from 3 to 98%. Accuracy showed an improvement of more than 8% over the CTR. CONCLUSION The machine learning model based on preoperative [18F]FDG PET/CT images was able to predict pathological highly invasive lung cancer with high discriminative ability and stability. The calibration plot showed good consistency, suggesting its usefulness in quantitative risk assessment.
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Affiliation(s)
- Yuki Onozato
- Division of Thoracic Surgery, Chiba Cancer Centre, 666-2, Nitona-Cho, Chuo-Ku, Chiba, 260-8717 Japan
| | - Takekazu Iwata
- Division of Thoracic Surgery, Chiba Cancer Centre, 666-2, Nitona-Cho, Chuo-Ku, Chiba, 260-8717 Japan
| | - Yasufumi Uematsu
- Division of Thoracic Surgery, Chiba Cancer Centre, 666-2, Nitona-Cho, Chuo-Ku, Chiba, 260-8717 Japan
| | - Daiki Shimizu
- Division of Thoracic Surgery, Chiba Cancer Centre, 666-2, Nitona-Cho, Chuo-Ku, Chiba, 260-8717 Japan
| | - Takayoshi Yamamoto
- Division of Thoracic Surgery, Chiba Cancer Centre, 666-2, Nitona-Cho, Chuo-Ku, Chiba, 260-8717 Japan
| | - Yukiko Matsui
- Division of Thoracic Surgery, Chiba Cancer Centre, 666-2, Nitona-Cho, Chuo-Ku, Chiba, 260-8717 Japan
| | - Kazuyuki Ogawa
- Division of Nuclear Medicine, Chiba Cancer Centre, 666-2, Nitona-Cho, Chuo-Ku, Chiba, 260-8717 Japan
| | - Junpei Kuyama
- Division of Nuclear Medicine, Chiba Cancer Centre, 666-2, Nitona-Cho, Chuo-Ku, Chiba, 260-8717 Japan
| | - Yuichi Sakairi
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Eiryo Kawakami
- Department of Artificial Intelligence Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Toshihiko Iizasa
- Division of Thoracic Surgery, Chiba Cancer Centre, 666-2, Nitona-Cho, Chuo-Ku, Chiba, 260-8717 Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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13
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Koike H, Ashizawa K, Tsutsui S, Fukuda M, Okano S, Matsumoto K, Nagayasu T, Honda S, Uetani M. Surgically resected lung adenocarcinoma: do heterogeneous GGNs and part-solid nodules on thin-section CT show different prognosis? Jpn J Radiol 2023; 41:164-171. [PMID: 36219310 PMCID: PMC9889431 DOI: 10.1007/s11604-022-01345-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/27/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aimed to evaluate the clinical courses of patients with surgically resected stage IA pulmonary adenocarcinoma (Ad) who exhibited heterogeneous ground-glass nodules (GGNs) or part-solid nodules on thin-section computed tomography (TSCT) and to clarify the prognostic differences between them. MATERIALS AND METHODS The cases of 242 patients with proven pulmonary Ad with heterogeneous GGN or part-solid nodule who underwent surgical resection were retrospectively reviewed. After surgery, they were examined pathologically. Disease-free survival (DFS) and overall survival (OS) were also investigated. RESULTS There were no cases of recurrent pulmonary Ad or death from the primary disease in the heterogeneous GGN group. In the part-solid nodule group, recurrent pulmonary Ad and death from the primary disease were observed in 12 and 6 of 181 patients, respectively. Heterogeneous GGNs were associated with significantly longer DFS than part-solid nodules (p = 0.042). While, there was no significant difference in OS between the two groups (p = 0.134). Pathological diagnoses were available for all 242 patients. 181 part-solid nodules were classified into 116 invasive Ads, 54 minimally invasive Ads (MIAs), and 11 Ad in situ (AIS) lesions, and 61 heterogeneous GGNs were classified into 18 invasive Ads, 25 MIAs, and 18 AIS lesions. CONCLUSION Heterogeneous GGNs were significantly associated with longer DFS than part-solid nodules. Pathologically, there were significant differences between the heterogeneous GGNs and part-solid nodules.
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Affiliation(s)
- Hirofumi Koike
- Departments of Radiology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
| | - Kazuto Ashizawa
- Clinical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
| | - Shin Tsutsui
- Departments of Radiology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
| | - Minoru Fukuda
- Clinical Oncology Center, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
| | - Shinji Okano
- Depatment of Pathology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
| | - Keitaro Matsumoto
- Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
| | - Takeshi Nagayasu
- Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
| | - Sumihisa Honda
- Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nursing, Nagasaki, 852-8501 Japan
| | - Masataka Uetani
- Departments of Radiology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
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14
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Sato D, Matsubara H, Matsuoka H, Kondo T, Sasanuma H, Sugimura A, Onuki Y, Uchida T, Nakajima H. Lepidic growth component as a favorable prognostic factor in non-small cell lung cancer of ≤3 cm. Thorac Cancer 2022; 13:3274-3283. [PMID: 36218004 PMCID: PMC9715824 DOI: 10.1111/1759-7714.14680] [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: 08/03/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Many non-small cell lung cancer (NSCLC) tumors present complex histology with various components. The effects of the lepidic growth component (LGC) on the prognosis of NSCLC have not been investigated. Here, we investigated whether an LGC is a relevant prognostic factor for NSCLC. METHODS This study retrospectively investigated the clinicopathologic characteristics of 379 patients with NSCLC ≤3 cm who underwent complete surgical resection between 2004 and 2016 at the University of Yamanashi Hospital. The histologic subtypes were classified into NSCLC with or without an LGC. We evaluated the effect of an LGC on the clinicopathologic features and 5-year overall survival of patients with NSCLC. RESULTS On final pathology, 214 (56%) of 379 patients had an LGC, and 165 (44%) did not. Sex, smoking history, ground-glass opacity component, pathologic invasive size, lymph node metastasis, pleural invasion, vessel invasion, pathologic stage, and histologic type were significantly different between the groups. Multivariate analysis of 5-year overall survival, identified age (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.035-1.105; p < 0.001), pathologic invasive size (HR, 1.548; 95% CI, 1.088-2.202; p = 0.015) and LGC (HR, 2.11; 95% CI, 1.099-4.051; p = 0.025) as independent prognostic factors. When the pathologic invasive size was matched, the 5-year overall survival of the LGC and non-LGC groups was 93% and 77%, respectively (p = 0.006). CONCLUSIONS LGC is a significantly favorable prognostic factor for NSCLC with a pathologic invasive size of ≤3 cm.
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Affiliation(s)
- Daisuke Sato
- Department of Thoracic SurgeryUniversity of YamanashiYamanashiJapan,Department of Thoracic SurgeryNihon University School of MedicineTokyoJapan
| | | | | | - Tetsuo Kondo
- Department of PathologyUniversity of YamanashiYamanashiJapan
| | | | - Aya Sugimura
- Department of Thoracic SurgeryUniversity of YamanashiYamanashiJapan
| | - Yuichiro Onuki
- Department of Thoracic SurgeryUniversity of YamanashiYamanashiJapan
| | - Tsuyoshi Uchida
- Department of Thoracic SurgeryUniversity of YamanashiYamanashiJapan
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15
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Kishi N, Matsuo Y, Menju T, Hamaji M, Nakakura A, Hanazawa H, Takehana K, Date H, Mizowaki T. Propensity score-based analysis of stereotactic body radiotherapy, lobectomy and sublobar resection for stage I non-small cell lung cancer. JOURNAL OF RADIATION RESEARCH 2022; 63:758-771. [PMID: 35818291 PMCID: PMC9494527 DOI: 10.1093/jrr/rrac041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/16/2022] [Indexed: 06/15/2023]
Abstract
We applied two propensity score-based analyses to simultaneously compare three treatment modalities-stereotactic body radiotherapy (SBRT), lobectomy, or sublobar resection (SLR)-for stage I non-small cell lung cancer (NSCLC), with the aim of clarifying the average treatment effect (ATE) and formulating a risk-adapted approach to treatment selection. A retrospective review of 823 patients aged ≥65 years who underwent SBRT, lobectomy, or SLR for stage I NSCLC was conducted. The following two analyses using machine learning-based propensity scores were performed: (i) propensity score weighting (PSW) to assess the ATE in the entire cohort, and (ii) propensity score subclassification (PSS) to evaluate treatment effects of subgroups. PSW showed no significant difference in the 5-year overall survival (OS) between SBRT and SLR (60.0% vs 61.2%; P = 0.70) and significant difference between SBRT and lobectomy (60.0% vs 77.6%; P = 0.026). Local (LR) and distant recurrence (DR) rates were significantly lower in lobectomy than in SBRT, whereas there was no significant difference between SBRT and SLR. PSS identified four subgroups with different patient characteristics: lobectomy-oriented (5-year cumulative incidences of non-lung cancer death, 7.5%), SLR-oriented (14.2%), SBRT-oriented (23.8%) and treatment-neutral subgroups (16.1%). Each subgroup showed different survival trends regarding the three treatments. The ATE of SBRT was not significantly different from that of SLR, but it was inferior to lobectomy. Four subgroups with different risks of non-lung cancer death and different survival trends for each treatment were identified. These would help decision-making for patients with stage I NSCLC.
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Affiliation(s)
- Noriko Kishi
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yukinori Matsuo
- Corresponding author. Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan. Phone: +81-75-751-3762; Fax: +81-75-771-9749, E-mail:
| | - Toshi Menju
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Akiyoshi Nakakura
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Hideki Hanazawa
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Keiichi Takehana
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
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16
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Mimae T, Miyata Y, Tsutani Y, Shimada Y, Ito H, Nakayama H, Ikeda N, Okada M. Role of ground-glass opacity in pure invasive and lepidic component in pure solid lung adenocarcinoma for predicting aggressiveness. JTCVS OPEN 2022; 11:300-316. [PMID: 36172403 PMCID: PMC9510793 DOI: 10.1016/j.xjon.2022.04.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/16/2022] [Accepted: 04/27/2022] [Indexed: 10/27/2022]
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17
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Sun X, Chen T, Xie C, Liu L, Lei B, Wang L, Ruan M, Yan H, Zhang Q, Chang C, Xie W. Relationships between SUVmax of lung adenocarcinoma and different T stages, histological grades and pathological subtypes: a retrospective cohort study in China. BMJ Open 2022; 12:e056804. [PMID: 35580966 PMCID: PMC9114855 DOI: 10.1136/bmjopen-2021-056804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Cancer cell has aberrant metabolism. The purpose of this study aimed to investigate relationships between maximum standard uptake value (SUVmax)of 18fluoro-2-deoxy-d-glucose and T stages, histological grades and pathological subtypes of lung adenocarcinoma. DESIGN Retrospective cohort study, employing the Kruskal-Wallis, Bonferroni-Dunn and Mann-Whitney tests to compare SUVmax of different T stages, histological grades and pathological subtypes of lung adenocarcinoma. SETTING The outpatients who had aberrant positron emission tomography/CT (PET/CT) images in chest were enrolled this study from August 2016 to November 2018 in Shanghai, China. PARTICIPANT Initial 11 270 patients with suspected lung cancer who underwent PET/CT examinations were surveyed. A total of 1454 patients who were diagnosed as lung adenocarcinoma by pathologist were included in this project. PRIMARY OUTCOME MEASURES SUVmax value at different tumour-node-metastasis stages of lung adenocarcinoma before surgery. RESULTS The mean SUVmax of patients with lung adenocarcinoma was significantly elevated with the increase in T stages. There were significant evident differences in SUVmax among T1a-T1c (p<0.05). However, after the staging of patients was more than T1 stage, SUVmax of T2a, T2b, T2 visceral pleural invasion, T3 and T4 had not dramatic changes. SUVmax value of lung adenocarcinoma in the same T stage group was the highest in patients with the high grade of malignancy and solid-predominant invasive adenocarcinoma. CONCLUSIONS SUVmax value was significantly associated with T stages, grades of malignancy and pathological subtypes of lung adenocarcinoma.
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Affiliation(s)
- Xiaoyan Sun
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Tianxiang Chen
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China, Shanghai, China
| | - Chun Xie
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Liu Liu
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Bei Lei
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Lihua Wang
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Maomei Ruan
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Yan
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qi Zhang
- Department of Nuclear Medicine, Anhui Chest Hospital, Anhui, China
| | - Cheng Chang
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wenhui Xie
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Saji H, Okada M, Tsuboi M, Nakajima R, Suzuki K, Aokage K, Aoki T, Okami J, Yoshino I, Ito H, Okumura N, Yamaguchi M, Ikeda N, Wakabayashi M, Nakamura K, Fukuda H, Nakamura S, Mitsudomi T, Watanabe SI, Asamura H. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet 2022; 399:1607-1617. [PMID: 35461558 DOI: 10.1016/s0140-6736(21)02333-3] [Citation(s) in RCA: 522] [Impact Index Per Article: 261.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Lobectomy is the standard of care for early-stage non-small-cell lung cancer (NSCLC). The survival and clinical benefits of segmentectomy have not been investigated in a randomised trial setting. We aimed to investigate if segmentectomy was non-inferior to lobectomy in patients with small-sized peripheral NSCLC. METHODS We conducted this randomised, controlled, non-inferiority trial at 70 institutions in Japan. Patients with clinical stage IA NSCLC (tumour diameter ≤2 cm; consolidation-to-tumour ratio >0·5) were randomly assigned 1:1 to receive either lobectomy or segmentectomy. Randomisation was done via the minimisation method, with balancing for the institution, histological type, sex, age, and thin-section CT findings. Treatment allocation was not concealed from investigators and patients. The primary endpoint was overall survival for all randomly assigned patients. The secondary endpoints were postoperative respiratory function (6 months and 12 months), relapse-free survival, proportion of local relapse, adverse events, proportion of segmentectomy completion, duration of hospital stay, duration of chest tube placement, duration of surgery, amount of blood loss, and the number of automatic surgical staples used. Overall survival was analysed on an intention-to-treat basis with a non-inferiority margin of 1·54 for the upper limit of the 95% CI of the hazard ratio (HR) and estimated using a stratified Cox regression model. This study is registered with UMIN Clinical Trials Registry, UMIN000002317. FINDINGS Between Aug, 10, 2009, and Oct 21, 2014, 1106 patients (intention-to-treat population) were enrolled to receive lobectomy (n=554) or segmentectomy (n=552). Patient baseline clinicopathological factors were well balanced between the groups. In the segmentectomy group, 22 patients were switched to lobectomies and one patient received wide wedge resection. At a median follow-up of 7·3 years (range 0·0-10·9), the 5-year overall survival was 94·3% (92·1-96·0) for segmentectomy and 91·1% for lobectomy (95% CI 88·4-93·2); superiority and non-inferiority in overall survival were confirmed using a stratified Cox regression model (HR 0·663; 95% CI 0·474-0·927; one-sided p<0·0001 for non-inferiority; p=0·0082 for superiority). Improved overall survival was observed consistently across all predefined subgroups in the segmentectomy group. At 1 year follow-up, the significant difference in the reduction of median forced expiratory volume in 1 sec between the two groups was 3·5% (p<0·0001), which did not reach the predefined threshold for clinical significance of 10%. The 5-year relapse-free survival was 88·0% (95% CI 85·0-90·4) for segmentectomy and 87·9% (84·8-90·3) for lobectomy (HR 0·998; 95% CI 0·753-1·323; p=0·9889). The proportions of patients with local relapse were 10·5% for segmentectomy and 5·4% for lobectomy (p=0·0018). 52 (63%) of 83 patients and 27 (47%) of 58 patients died of other diseases after lobectomy and segmentectomy, respectively. No 30-day or 90-day mortality was observed. One or more postoperative complications of grade 2 or worse occurred at similar frequencies in both groups (142 [26%] patients who received lobectomy, 148 [27%] who received segmentectomy). INTERPRETATION To our knowledge, this study was the first phase 3 trial to show the benefits of segmentectomy versus lobectomy in overall survival of patients with small-peripheral NSCLC. The findings suggest that segmentectomy should be the standard surgical procedure for this population of patients. FUNDING National Cancer Center Research and the Ministry of Health, Labour, and Welfare of Japan.
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Affiliation(s)
- Hisashi Saji
- Department of Chest Surgery, St Marianna University School of Medicine, Kawasaki, Japan.
| | - Morihito Okada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Masahiro Tsuboi
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Ryu Nakajima
- Department of Thoracic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Keiju Aokage
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tadashi Aoki
- Department of Thoracic Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Jiro Okami
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Norihito Okumura
- Department of Thoracic Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Masafumi Yamaguchi
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Masashi Wakabayashi
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Kenichi Nakamura
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | | | - Tetsuya Mitsudomi
- Department of Thoracic Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
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Preoperative Patient and Lesion Features Are Valuable for Predicting the Prognosis of Resectable Peripheral Non-Small Cell Lung Cancer. J Comput Assist Tomogr 2022; 46:584-592. [PMID: 35405686 DOI: 10.1097/rct.0000000000001317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the preoperative factors affecting the survival of patients with resectable peripheral non-small cell lung cancer (NSCLC) to improve the management of NSCLC. METHODS One hundred ninety-nine patients with peripheral NSCLC diagnosed clinically without lymph node metastasis were enrolled. The preoperative computed tomography characteristics of the tumors were retrospectively analyzed and the preoperative clinical data were collected. The size of the solid components for lung adenocarcinomas containing ground-glass opacity (GGO) component were measured. Kaplan-Meier method with log-rank test was used to compare overall survival (OS) between groups. Univariate and multivariate cox regression analyses were used to identify prognostic factors. RESULTS Survival analysis showed that the OS of the group with a tumor of 3 cm or less was longer than that of the group with a tumor greater than 3 cm, the OS of the group with GGO component was superior to that of the group without GGO component, and the OS of the group with elevated carcinoembryonic antigen (CEA) levels was inferior to that of the group with normal CEA levels. Multivariate Cox regression analysis showed that tumor size, density, and preoperative CEA level were independent factors affecting OS, with hazard ratios of 2.401, 0.457, and 1.948, respectively. The analysis of lung adenocarcinomas with GGO component demonstrated that the mean size of the solid component in the nonsurviving group was significantly larger than that in the surviving group (mean, 23 ± 6.4 vs 8.6 ± 7.0 mm). The area under the receiver operating characteristic curve of the solid component size of lung cancer containing GGO component to predict postoperative death was 0.932. CONCLUSIONS Tumor size, density, and preoperative CEA level were independent prognostic factors of patients with resectable peripheral NSCLCs. Preoperative computed tomography findings can be valuable for predicting the prognosis of patients with NSCLC after surgery.
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Hamada A, Suda K, Fujino T, Nishino M, Ohara S, Koga T, Kabasawa T, Chiba M, Shimoji M, Endoh M, Takemoto T, Soh J, Yanagawa N, Shiono S, Mitsudomi T. Presence of a Ground-glass Opacity Component is the True Prognostic Determinant in Clinical Stage I Non-Small Cell Lung Cancer. JTO Clin Res Rep 2022; 3:100321. [PMID: 35574192 PMCID: PMC9097453 DOI: 10.1016/j.jtocrr.2022.100321] [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: 01/27/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Recent studies have suggested that including presence or absence of ground-glass opacity (GGO) may improve the tumor descriptor (T descriptor) classification in clinical stage I NSCLC. In this study, we analyzed prognostic implications of presence or absence of GGO, size of the solid component, and predominant histology to identify the true prognostic determinant for early-stage NSCLC. Methods We retrospectively examined 384 patients with clinical stage I NSCLC (solid: 242, part solid: 142) who underwent complete resection between 2009 and 2013. Results Survival curves of the whole cohort revealed good separation using the current TNM classification. Nevertheless, the part-solid group had a favorable prognosis irrespective of solid component size. Conversely, patients in the solid tumor group with tumors between 3 and 4 cm had a worse prognosis than patients whose tumors were less than or equal to 3 cm. Thus, we propose the following novel T descriptor classification: IA, part-solid tumors; IB, solid tumors less than or equal to 3 cm; and IC, solid tumors between 3 and 4 cm. This novel classification system stratified patient prognosis better than the current classification. On pathologic evaluation, the part-solid group always had better prognoses than the solid group in each subgroup divided by pathologic grade. Conclusions These results suggest that presence of GGO is the true prognostic determinant of stage I NSCLC, irrespective of the size of the solid component. Our novel T descriptor classification system could more accurately predict prognoses of clinical stage I NSCLC cases.
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21
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Management of Ground-Glass Nodules: When and How to Operate? Cancers (Basel) 2022; 14:cancers14030715. [PMID: 35158981 PMCID: PMC8833330 DOI: 10.3390/cancers14030715] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 01/23/2022] [Accepted: 01/27/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary An increasing number of lung cancer screening programs have detected the frequent occurrence of small pulmonary ground-glass nodules (GGNs). If GGN is an incidental finding, it should be followed according to the guidelines. A multidisciplinary team discussion should be initiated if a new solid component develops or the solid portion grows on follow-up CT. Preoperative attempts to biopsy solid components in part-solid GGNs are often not feasible and not helpful. If malignancy is suspected, a surgical biopsy with the guidance of various localization methods is recommended. Once the GGN is confirmed to be malignant, sub-lobar resection may be reasonable in the majority of cases, and the extent of lung resection should be determined based on the CT finding or intraoperative frozen section examination using special inflation technique. Although rare, the recurrence in the remaining lobe can occur especially in patients with high risk histologic features, which currently cannot accurately diagnosed either pre- or intra-operatively. Abstract With the increased popularity of low-dose computed tomography (LDCT), many patients present with pulmonary ground-glass nodules (GGNs), and the appropriate diagnostic and management strategy of those lesions make physicians be on the horn of the clinical dilemma. As there is not enough data available to set universally acceptable guidelines, the management of GGNs may be different. If GGN is an incidental finding through LDCT, the lesion should be followed according to the current guidelines. We recommend a multidisciplinary team discussion to be initiated if a new solid component develops or the solid portion size grows on follow-up CT as the risk of malignancy is high. Attempts to preoperatively biopsy solid components in part-solid GGNs are often not feasible and not helpful in clinical settings. Currently, if malignancy is suspected, a surgical biopsy with the guidance of various localization methods is recommended. If malignancy is confirmed, sub-lobar resection may provide an excellent oncologic outcome.
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22
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HATTORI ARITOSHI, SUZUKI KENJI. Latest Clinical Evidence and Operative Strategy for Small-Sized Lung Cancers. JUNTENDO IJI ZASSHI = JUNTENDO MEDICAL JOURNAL 2022; 68:52-59. [PMID: 38911012 PMCID: PMC11189789 DOI: 10.14789/jmj.jmj21-0030-ot] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/01/2021] [Indexed: 06/25/2024]
Abstract
Many thoracic surgeons revealed that consolidation tumor ratio or solid component size on thin-section computed tomography has been considered more prognostic than maximum tumor size in non-small cell lung cancer (NCSLC). According to the results, the 8th TNM classification drastically changed the staging system, i.e., clinical T category was determined based on the invasive or solid component size excluding a ground-glass opacity (GGO). However, several debates are arising over the application of radiological solid size for the clinical T staging. Meanwhile, recent several institutional reports have noticed a significantly simple fact that the presence of a GGO denotes an influence on the favorable prognosis of NSCLC. More important, radiologic pure-solid lung cancers without a GGO exhibit more malignant behaviors with regard to both the clinical and pathological aspects, and show several histologic types that have a poorer prognosis than radiologic part-solid lung cancer. In contrast, favorable prognostic impact of the presence of a GGO component was demonstrated, which was irrespective of the solid component size in cases in which the tumor showed a GGO component. Recently, this concept has been gradually noticed on a nationwide level. Obvious distinctions regarding the several baseline characteristics between the tumor with/without GGO component is a fundamental biological feature of early-stage lung cancer, which would result in a big difference in prognosis, modes of recurrence, overall behavior, and appropriate operative strategies. As a future perspective, the presence or absence of a GGO should be considered as an important parameter in the next clinical T classification.
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Affiliation(s)
- ARITOSHI HATTORI
- Corresponding author: Aritoshi Hattori, Department of General Thoracic Surgery, Juntendo University School of Medicine 1-3, Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan, TEL: +81-3-3813-3111 FAX: +81-3-5800-0281 E-mail:
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23
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Updates in grading and invasion assessment in lung adenocarcinoma. Mod Pathol 2022; 35:28-35. [PMID: 34615984 DOI: 10.1038/s41379-021-00934-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 01/15/2023]
Abstract
The pathologic evaluation of lung adenocarcinoma, because of greater understanding of disease progression and prognosis, has become more complex. It is clear that histologic growth patterns reflect indolent and aggressive disease, resulting in clearer morphologic groups that can be the underpinning of a grading system. In addition, the progression of adenocarcinoma from a tumor that preserves alveolar architecture to one that remodels and effaces lung structure has led to criteria that reflect invasive rather than in-situ growth. While some of these are based on tumor cell growth pattern, aspects of this remodeling from desmoplasia to artifacts of lung collapse and sectioning, can lead to difficult to interpret patterns with lower reproducibility between observers. Such scenarios are examined to provide updates on new histologic concepts and to highlight ongoing problem areas.
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Jianlong B, Pinyi Z, Xiaohong W, Su Z, Sainan P, Jinfeng N, Shidong X. Risk factors for lymph node metastasis and surgical scope in patients with cN0 non-small cell lung cancer: a single-center study in China. J Cardiothorac Surg 2021; 16:304. [PMID: 34663403 PMCID: PMC8522086 DOI: 10.1186/s13019-021-01695-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/10/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND It is difficult to determine the lymph node metastasis of patients with clinically negative lymph nodes (cN0) non-small cell lung cancer (NSCLC) before surgery. The purpose of this study is to investigate risk factors of lymph node metastasis in cN0 NSCLC, thereby to identify the surgical indications for lymph node dissection in cN0 NSCLC. METHODS We conducted a retrospective study of patients with tumor size ≤ 30 mm who underwent radical resection of NSCLC. Binary logistic regression analysis was applied to predict risk factors for lymph node metastasis, and subject operating characteristics (ROC) curve was used to evaluate the independent risk factors. RESULTS Overall, 44 patients (6.8%) with cN0 NSCLC had lymph node metastasis. Factors of tumor consolidation diameter (p < 0.001) and preoperative serum carcinoembryonic antigen (CEA) level (p = 0.017) are independent risk factors lymph node metastasis in cN0 NSCLC. The ROC curve showed that the cut-off value of consolidation diameter was 16.5 mm, and the area under the curve (AUC) was 0.825 (p < 0.001, 95% CI 0.780-0.870); the cut-off value of serum CEA level was 1.765 μg/L, and the AUC was 0.661 (p < 0.001, 95% CI: 0.568-0.754). Moreover, 8 of 461 patients with tumor parenchyma ≤ 16.5 mm had lymph node metastasis, and 36 of 189 patients with tumor parenchyma > 16.5 mm had lymph node metastasis. CONCLUSION Tumor consolidation diameter and preoperative serum CEA are independent factors to predict cN0 NSCLC with tumor size ≤ 30 mm. For patients with tumor parenchyma > 16.5 mm, the probability of lymph node metastasis is higher and lymph node dissection is recommended. For patients with tumor parenchyma ≤ 16.5 mm, the probability of lymph node metastasis is lower and lymph node sampling is feasible.
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Affiliation(s)
- Bu Jianlong
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Nangang District, Harbin, 150081, China
| | - Zhang Pinyi
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Wu Xiaohong
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Zhao Su
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Nangang District, Harbin, 150081, China
| | - Pang Sainan
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Nangang District, Harbin, 150081, China
| | - Ning Jinfeng
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Nangang District, Harbin, 150081, China.
| | - Xu Shidong
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Nangang District, Harbin, 150081, China.
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Xiao R, Huang Y, Meng S, Liu X, Zhao X, Wang J, Li X. A cross-sectional study of psychological burden in Chinese patients with pulmonary nodules: Prevalence and impact on the management of nodules. Thorac Cancer 2021; 12:3150-3156. [PMID: 34651451 PMCID: PMC8636209 DOI: 10.1111/1759-7714.14165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 12/26/2022] Open
Abstract
Background Uncertainty after the detection of pulmonary nodules (PNs) can cause psychological burden. We designed this study to quantitatively evaluate the prevalence, severity and possible impact of this burden on the preference of patients for management of nodules. Methods The Hospital Anxiety and Depression Scale (HADS) was used to evaluate psychological burden in patients. An independent t‐test and a Mann–Whitney U test were used to determine the significance of differences between groups in continuous variables. A chi‐square test was used to determine the significance of difference between groups in categorical variables. Results A total of 334 inpatients diagnosed with PNs were included in the study. A total of 17.96% of the participates screened positive for anxiety and 14.67% for depression. Female patients had significantly higher positive rates of both anxiety and depression screenings than male patients (21.57% vs. 12.31%, p = 0.032 and 18.05% vs. 9.30%, p = 0.028, respectively). Among patients screened positive for anxiety, the proportion of those who chose more aggressive management was significantly higher (34/60 vs. 113/274, p = 0.029). The rate of benign or precursor disease resected was significantly higher in patients with more aggressive management (46.94% vs. 9.63%, p < 0.01). Conclusions Anxiety and depression are common in Chinese patients with PNs. Patients with positive HADS anxiety screening results are more likely to adopt more aggressive management that leads to a higher rate of benign or precursor disease resected/biopsied. This study alerts clinicians to the need to assess and possibly treat emotional responses.
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Affiliation(s)
- Rongxin Xiao
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| | - Yuqing Huang
- Department of Thoracic Surgery, Beijing Haidian Hospital, Haidian Section of Peking University Third Hospital, Beijing, China
| | - Shushi Meng
- Department of Thoracic Surgery, Beijing Haidian Hospital, Haidian Section of Peking University Third Hospital, Beijing, China
| | - Xianping Liu
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| | - Xiaoyi Zhao
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| | - Jun Wang
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| | - Xiao Li
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
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Prognostic Impact of the Histologic Lepidic Component in Pathologic Stage IA Adenocarcinoma. J Thorac Oncol 2021; 17:67-75. [PMID: 34634451 DOI: 10.1016/j.jtho.2021.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/13/2021] [Accepted: 09/02/2021] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Because several articles have reported a prognostic association with the radiologic features of ground-glass opacity, we explored whether the histologic presence of a lepidic component had similar significance. METHODS We retrospectively evaluated 380 consecutive surgically resected lung adenocarcinomas (ADCs) of pathologic (p)stage IA. The tumors were classified into lepidic-positive and lepidic-negative ADCs. Clinicopathologic characteristics, radiographic ground-glass opacity status, and disease-free survival were compared between lepidic-positive and lepidic-negative ADCs and between part-solid and solid nodules on computed tomography images. RESULTS Of the 380 cases, 176 (46.3%) were lepidic-positive ADCs. Of the overall patients with pT1, lepidic-positive ADCs were found to have significantly better recurrence-free survival (5 y, 95.4% versus 87.0%, p = 0.005), but this significance was not reproduced in pT1 subcategories (pT1a, pT1b, and pT1c). Furthermore, the presence of the lepidic component was not an independent prognostic factor in the multivariate analysis (hazard ratio = 0.46 [95% confidence interval: 0.19-1.14], p = 0.09). We also analyzed the extent of the lepidic component with 10% incremental valuables. Although we found that a 10% or greater extent of lepidic component made the recurrence-free survival difference the largest, a clear prognostic impact was not obtained with this cutoff point. CONCLUSIONS Although lepidic-positive ADCs tended to have a favorable outcome, the lepidic component was not a clear independent prognostic factor in pstage I ADC.
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He J, Liang H, Wang W, Akopov A, Aiolfi A, Ang KL, Bertolaccini L, Cai K, Cao Q, Chen B, Chen C, Chen C, Chen D, Chen F, Chen J, Chen L, Chen M, Chen Y, Chen Z, Cheng C, Cui D, Cui F, Dai T, Dong Q, Ferrari PA, Flores RM, Fu J, Funaki S, Froudarakis ME, Gan X, Geng M, Guo J, Guo Q, Han Y, He J, He K, Hirai K, Hu J, Hu S, Huang J, Huang J, Jiang W, Kim KS, Kiss G, Kong F, Lan L, Leng X, Li B, Li G, Li H, Li H, Li H, Li J, Li X, Li S, Li Y, Li Z, Liang Y, Liang L, Liang W, Liao Y, Lin W, Lin X, Liu H, Liu H, Liu J, Liu J, Liu X, Liu Z, Lu X, Luo Q, Mao N, Pan Q, Pang D, Peng J, Peng J, Pompeo E, Qian R, Qiao K, Redwan B, Sang Z, Shao W, Shen J, Shen W, Sung SW, Tang W, Wang T, Wang G, Wang H, Wang H, Wang J, Wang W, Wang Y, Wang Z, Wei L, Wei W, Wu H, Wu J, Xia Z, Xu C, Xu E, Xu H, Xu N, Xu Q, Xu R, Xu S, Yang C, Yang H, Yang S, Yi J, Zhang G, Zhang H, Zhang J, Zhang M, Zhang X, Zhang Y, Zhang Z, Zhang Z, Zhao H, Zhao J, Zhao X, Zhou J, Zhou Y, Zhu C, Zhu S, Zhu X, Cui J, Yan Y, Chen KN. Tubeless video-assisted thoracic surgery for pulmonary ground-glass nodules: expert consensus and protocol (Guangzhou). Transl Lung Cancer Res 2021; 10:3503-3519. [PMID: 34584853 PMCID: PMC8435391 DOI: 10.21037/tlcr-21-663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/23/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Jianxing He
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Hengrui Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Wei Wang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Andrey Akopov
- Department of Thoracic Surgery, First Pavlov State Medical University, Saint-Petersburg, Russia
| | - Alberto Aiolfi
- Division of Minimally Invasive Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| | - Keng-Leong Ang
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Kaican Cai
- Department of Thoracic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, China
| | - Qingdong Cao
- Department of Thoracic Surgery, the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Baojun Chen
- Department of Thoracic Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Donglai Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fengxia Chen
- Department of Thoracic Surgery, Hainan General Hospital, Hainan, China
| | - Jun Chen
- Lung Cancer Department, Tianjin General Hospital, Tianjin Medical University, Tianjin, China
| | - Lei Chen
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Mingwu Chen
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yongbing Chen
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Soochow, China
| | - Zhuxing Chen
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Chao Cheng
- Department of Thoracic Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dong Cui
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Fei Cui
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Tianyang Dai
- Department of Thoracic Surgery, Southwest Medical University Affiliated Hospital, Luzhou, China
| | - Qinglong Dong
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Paolo A Ferrari
- Division of Thoracic Surgery, Oncology Hospital "A. Businco", A.R.N.A.S. "G. Brotzu", Cagliari, Italy
| | - Raja M Flores
- Department of Thoracic Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Junke Fu
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Marios E Froudarakis
- Department of Pneumonology and Thoracic Oncology, North Hospital, University Hospital of Saint-Etienne, St-Etienne, France
| | - Xiangfeng Gan
- Department of Thoracic Surgery, the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Mingfei Geng
- Department of Thoracic Surgery, Anyang Tumour Hospital, Anyang, China
| | - Jialong Guo
- Department of Cardiothoracic Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Qiang Guo
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Yongtao Han
- Division of Thoracic Surgery, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Jintao He
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Kaiming He
- Department of Thoracic Surgery, Southwest Medical University Affiliated Hospital, Luzhou, China
| | - Kyoji Hirai
- Division of Thoracic Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Jian Hu
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shuqiao Hu
- Department of Thoracic Surgery, Longyan City First Hospital, Longyan, China
| | - Jian Huang
- Department of Thoracic Surgery, Maoming People's Hospital, Maoming, China
| | - Jun Huang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Wenfa Jiang
- Department of Thoracic Surgery, Ganzhou People's Hospital, Ganzhou, China
| | - Kyung Soo Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gabor Kiss
- Department of Cardiovascular and Thoracic Surgery, Anaesthesia and Surgical Intensive Care, University Hospital Felix Guyon, Saint Denis, Reunion Island, France
| | - Fanyi Kong
- Department of Thoracic Surgery, Cangzhou Central Hospital, Cangzhou, China
| | - Lan Lan
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuefeng Leng
- Division of Thoracic Surgery, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Bin Li
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, China
| | - Gaofeng Li
- 2nd Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hefei Li
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Heng Li
- 2nd Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jiwei Li
- Department of Thoracic Surgery, Zhengzhou Key Laboratory for Surgical Treatment for End-stage Lung Disease, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, China
| | - Xiaoqiang Li
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Shuben Li
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Yinfen Li
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhuoyi Li
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Yi Liang
- Department of Cardiothoracic Surgery, Zhongshan City People's Hospital, Zhongshan, China
| | - Lixia Liang
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Yongde Liao
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wanli Lin
- Department of Thoracic Surgery, Gaozhou People's Hospital, Gaozhou, China
| | - Xu Lin
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hongxu Liu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Hui Liu
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jixian Liu
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jun Liu
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Xiang Liu
- Department of Thoracic Surgery, Second Affiliated Hospital of the University of South China, Hengyang, China
| | - Zihao Liu
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xingzhao Lu
- Department of Cardiothoracic Surgery, Dongguan People's Hospital, Dongguan, China
| | - Qingquan Luo
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Naiquan Mao
- Department of Thoracic Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Qi Pan
- Department of Thoracic Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Dazhi Pang
- Department of Thoracic Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Jun Peng
- Department of Thoracic Surgery, the First People's Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Jun Peng
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata University of Rome, Rome, Italy
| | - Rulin Qian
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Kun Qiao
- Department of Thoracic Surgery, Third People's Hospital of Shenzhen, Shenzhen, China
| | - Bassam Redwan
- Department of Thoracic Surgery, Klinik am Park, Klinikum Westfalen, Lünen, Germany
| | - Zi Sang
- Department of Thoracic Surgery, Anyang Tumour Hospital, Anyang, China
| | - Wenlong Shao
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jianfei Shen
- Department of Thoracic Surgery, Taizhou Hospital, Taizhou, China
| | - Weiyu Shen
- Department of Thoracic Surgery, Ningbo medical center LIHUILI Hospital, Ningbo, China
| | - Sook-Whan Sung
- Thoracic and Cardiovascular Surgery, Ewha Womens University Seoul Hospital, Seoul, Korea
| | - Wenfang Tang
- Department of Cardiothoracic Surgery, Zhongshan City People's Hospital, Zhongshan, China
| | - Tianhu Wang
- Department of Thoracic Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guangsuo Wang
- Department of Thoracic Surgery, People's Hospital of Shenzhen, Shenzhen, China
| | - Haitao Wang
- Department of Thoracic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Huien Wang
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, China
| | - Jiyong Wang
- Department of Cardiothoracic, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wen Wang
- Department of Cardio-Thoracic Surgery, Hunan Provincial People's Hospital and The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Yongyong Wang
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Soochow, China
| | - Zhenyuan Wang
- Department of Thoracic Surgery, The People's Hospital of Liaoning Province, Shenyang, China
| | - Li Wei
- Department of Thoracic Surgery, Zhengzhou Key Laboratory for Surgical Treatment for End-stage Lung Disease, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, China
| | - Wei Wei
- Department of Thoracic Surgery, Huizhou Municipal Central Hospital, Huizhou, China
| | - Hao Wu
- Department of Thoracic Surgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Jie Wu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Zhaohua Xia
- Department of Thoracic Surgery, Third People's Hospital of Shenzhen, Shenzhen, China
| | - Chenyang Xu
- Department of Thoracic Surgery, Ganzhou People's Hospital, Ganzhou, China
| | - Enwu Xu
- General Hospital of Southern Theater Command, PLA, Guangzhou, China
| | - Hai Xu
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Ning Xu
- Department of Thoracic Surgery, Anhui Chest Hospital, Hefei, China
| | - Quan Xu
- Department of Thoracic Surgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Rongyu Xu
- Department of Thoracic Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
| | - Shun Xu
- Department of Thoracic Surgery, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Chaokun Yang
- Department of Thoracic Surgery, The Second Peoples' Hospital of Yibin, Yibin, China
| | - Hanyu Yang
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shengli Yang
- Department of Thoracic Surgery, The First People's Hospital of Foshan, Foshan, China
| | - Jun Yi
- Department of Thoracic and Cardiovascular Surgery, The First People's Hospital of Jingmen, Jingmen, China
| | - Guangjian Zhang
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hao Zhang
- Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jia Zhang
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Man Zhang
- Department of Thoracic Surgery, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Xiao Zhang
- Department of Thoracic Surgery, The Affiliated Luoyang Central Hospital of Zhengzhou University, Luoyang, China
| | - Yajie Zhang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhe Zhang
- Department of Thoracic Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Zhifeng Zhang
- Department of Thoracic Surgery, Jieyang People's Hospital, Jieyang, China
| | - Honglin Zhao
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jian Zhao
- Department of Chest Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Xiaodong Zhao
- Department of Thoracic Surgery, the Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Jianping Zhou
- Department of Cardiothoracic Surgery, Dongguan People's Hospital, Dongguan, China
| | - Yanran Zhou
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chengchu Zhu
- Department of Thoracic Surgery, Taizhou Hospital, Taizhou, China
| | - Shaojin Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, China
| | - Xinhai Zhu
- Department of Thoracic Surgery, Zhejiang Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Jian Cui
- Department of Thoracic Surgery, The Fourth Affiliated Hospital of Harbin Medical University L, Harbin, China
| | - Yubo Yan
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Ke-Neng Chen
- Department of Thoracic Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
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Aokage K, Miyoshi T, Wakabayashi M, Ikeno T, Suzuki J, Tane K, Samejima J, Tsuboi M. Prognostic influence of epidermal growth factor receptor mutation and radiological ground glass appearance in patients with early-stage lung adenocarcinoma. Lung Cancer 2021; 160:8-16. [PMID: 34365179 DOI: 10.1016/j.lungcan.2021.07.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/30/2021] [Accepted: 07/29/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The ADAURA demonstrated the efficacy of osimertinib as adjuvant therapy in patients with resected stage IB-IIIA adenocarcinoma harboring epidermal growth factor receptor (EGFR) mutations. However, it is controversial whether adjuvant therapy should be applied to all these patients because of their heterogeneities. This study aimed to examine the influence of GGO and EGFR mutations on the prognosis and to identify optimal targets for the development of perioperative therapy. MATERIAL AND METHODS Among the patients who underwent complete resection between 2003 and 2014 and had pathological stage IA3-IIA adenocarcinoma, 505 consecutive patients were examined for EGFR mutation status. The prognosis was analyzed among the clinicopathological factors including EGFR status and presence or absence of GGO. RESULTS Of the 489 patients, 193 (39.5%) showed EGFR mutations. The recurrence-free survival (RFS) and overall survival (OS) of the EGFR mutant were slightly better than those of the EGFR wild type. There was no difference in RFS and OS between EGFR mutant and wild type in patients with GGO; however, EGFR mutant showed better OS than EGFR wild type in patients without GGO. The presence of GGO was a strong independent prognostic predictor in OS and RFS, but EGFR mutations was not predictors. In patients without GGO, EGFR mutants showed slightly higher recurrence, especially with a hazard ratio of 1.427 in stage IB. CONCLUSIONS Adenocarcinoma with GGO show a very good prognosis, so may not require adjuvant therapy. It will be necessary to further develop perioperative therapy in patients with poor prognosis.
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Affiliation(s)
- Keiju Aokage
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
| | - Tomohiro Miyoshi
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Masashi Wakabayashi
- Biostatistics Division, Center for Research Administration and Support, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takashi Ikeno
- Clinical Research Support Office, National Cancer Center Hospital East, Kashiwa, Japan
| | - Jun Suzuki
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kenta Tane
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Joji Samejima
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Masahiro Tsuboi
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
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29
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Succony L, Rassl DM, Barker AP, McCaughan FM, Rintoul RC. Adenocarcinoma spectrum lesions of the lung: Detection, pathology and treatment strategies. Cancer Treat Rev 2021; 99:102237. [PMID: 34182217 DOI: 10.1016/j.ctrv.2021.102237] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 02/07/2023]
Abstract
Adenocarcinoma has become the most prevalent lung cancer sub-type and its frequency is increasing. The earliest stages in the development of lung adenocarcinomas are visible using modern computed tomography (CT) as ground glass nodules. These pre-invasive nodules can progress over time to become invasive lung adenocarcinomas. Lesions in this developmental pathway are termed 'adenocarcinoma spectrum' lesions. With the introduction of lung cancer screening programs there has been an increase in the detection of these lesions raising questions about natural history, surveillance and treatment. Here we review how the radiological appearance of an adenocarcinoma spectrum lesion relates to its underlying pathology and explore the natural history and factors driving lesion progression. We examine the molecular changes that occur at each stage of adenocarcinoma spectrum lesion development, including the effects of the driver mutations, EGFR and KRAS, that are key to invasive adenocarcinoma pathology. A better understanding of the development of pre-invasive disease will create treatment targets. Our understanding of how tumours interact with the immune system has led to the development of new therapeutic strategies. We review the role of the immune system in the development of adenocarcinoma spectrum lesions. With a clear preinvasive phase there is an opportunity to treat early adenocarcinoma spectrum lesions before an invasive lung cancer develops. We review current management including surveillance, surgical resection and oncological therapy as well as exploring potential future treatment avenues.
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Affiliation(s)
- L Succony
- Department of Thoracic Oncology, Royal Papworth Hospital, Cambridge CB2 0AY, United Kingdom
| | - D M Rassl
- Department of Pathology, Royal Papworth Hospital NHS Foundation Trust, Cambridge CB2 0AY, United Kingdom
| | - A P Barker
- Department of Radiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge CB2 0AY, United Kingdom
| | - F M McCaughan
- Department of Medicine, University of Cambridge, Addenbrookes Hospital, Cambridge CB2 0QQ, United Kingdom
| | - R C Rintoul
- Department of Thoracic Oncology, Royal Papworth Hospital, Cambridge CB2 0AY, United Kingdom; Department of Oncology, University of Cambridge, Cambridge CB2 0QQ United Kingdom.
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30
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Saeki Y, Kitazawa S, Yanagihara T, Kobayashi N, Kikuchi S, Goto Y, Ichimura H, Sato Y. Consolidation volume and integration of computed tomography values on three-dimensional computed tomography may predict pathological invasiveness in early lung adenocarcinoma. Surg Today 2021; 51:1320-1327. [PMID: 33547958 DOI: 10.1007/s00595-021-02231-7] [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: 08/24/2020] [Accepted: 12/10/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the relationship between three-dimensional computed tomography (3D-CT) findings and pathological invasiveness in lung adenocarcinoma. METHODS We retrospectively evaluated 95 patients who underwent surgical resection of lung adenocarcinoma of ≤ 20 mm. The diameters, volumes, and CT values of tumor consolidation were analyzed. We defined the modified CT value by setting air as 0 and water as 1000 and assumed a correlation with pathological invasiveness. Pre-invasive lesions and minimally invasive adenocarcinomas were classified as non-invasive adenocarcinoma. We compared the clinico-radiological features with pathological invasiveness. Receiver operator characteristic (ROC) curves and recurrence-free survival curves were constructed. RESULTS Twenty-six non-invasive adenocarcinomas and 69 invasive adenocarcinomas were evaluated. The multivariate analysis revealed that the consolidation volume and the integration of modified CT values were the most important predictors of pathological invasion. The area under the ROC curve and the cut-off values of the consolidation volume were 0.868 and 75 mm3, respectively. The area under the ROC curve and the cut-off values of the integration of modified CT values were 0.871 and 80,000, respectively. There was no recurrence in cases with values below the cut-off across all parameters. CONCLUSION The consolidation volume and integration of modified CT values were shown to be highly predictive of pathological invasiveness.
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Affiliation(s)
- Yusuke Saeki
- Department of General Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Shinsuke Kitazawa
- Department of General Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Takahiro Yanagihara
- Department of General Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Naohiro Kobayashi
- Department of General Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Shinji Kikuchi
- Department of General Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yukinobu Goto
- Department of General Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hideo Ichimura
- Department of General Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yukio Sato
- Department of General Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
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31
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Pêgo-Fernandes PM, Haddad FJ, Imaeda CJ, Sandrini M. The role of the surgeon in treating patients with lung cancer. An updating article. SAO PAULO MED J 2021; 139:293-300. [PMID: 34076231 PMCID: PMC9625005 DOI: 10.1590/1516-3180.2020.0763.16022021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/16/2021] [Indexed: 12/04/2022] Open
Abstract
Lung cancer is a type of neoplasia with one of the highest incidences worldwide and is the largest cause of mortality due to cancer in the world today. It is classified according to its histological and biological characteristics, which will determine its treatment and prognosis. Non-small cell lung cancer accounts for 85% of the cases, and these are the cases that surgeons mostly deal with. Small cell lung cancer accounts for the remaining 15%. Surgery is the main method for treating early stage lung cancer, and lobectomy is the preferred procedure for treating primary lung cancer, while sublobar resection is an alternative for patients with poor reserve or with very small tumors. Surgeons need to be trained to use the resources and techniques available for lung resection, including less invasive approaches such as video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS), and need to be familiar with new oncological approaches, including curative, adjuvant or palliative treatments for patients with lung cancer.
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Affiliation(s)
- Paulo Manuel Pêgo-Fernandes
- MD, PhD. Full Professor, Thoracic Surgery Program, Instituto do Coração (InCor), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo (SP), Brazil; Cardiothoracic Surgeon, Hospital Beneficência Portuguesa (BP), São Paulo (SP), Brazil.
| | - Fabio José Haddad
- MD, PhD. Thoracic Surgeon, Hospital Beneficência Portuguesa (BP) and Hospital Sírio-Libanês, São Paulo (SP), Brazil.
| | - Carlos Jogi Imaeda
- MD. Thoracic Surgeon, Hospital Beneficência Portuguesa (BP), São Paulo (SP), Brazil.
| | - Marcel Sandrini
- MD. Thoracic Surgeon, Hospital Beneficência Portuguesa (BP), São Paulo (SP), Brazil.
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32
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Watanabe Y, Hattori A, Nojiri S, Matsunaga T, Takamochi K, Oh S, Suzuki K. Clinical impact of a small component of ground-glass opacity in solid-dominant clinical stage IA non-small cell lung cancer. J Thorac Cardiovasc Surg 2020; 163:791-801.e4. [PMID: 33516459 DOI: 10.1016/j.jtcvs.2020.12.089] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Non-small cell lung cancers with a ground-glass opacity component have better prognosis than those with solid nodules of equivalent consolidation size. However, the impact of small ground-glass opacity components on prognosis is unknown. Therefore, we aimed to evaluate the significance of a small ground-glass opacity component in solid-dominant clinical stage IA non-small cell lung cancers. METHODS We reviewed the cases of 543 surgically resected solid-dominant c-stage IA non-small cell lung cancers, which was defined as a tumor with consolidation tumor ratio of 0.75 or more on computed tomography. The patients were classified into 2 groups: 0.75 or less consolidation tumor ratio less than 1 (n = 126) and consolidation tumor ratio of 1 (n = 417). The prognoses were compared between the 2 groups. RESULTS Among the 543 cases, multivariable analyses revealed that pure-solid appearance was a predictor of worse overall survival (hazard ratio, 2.051; 95% confidence interval, 1.044-4.028). Compared with the part-solid group, the pure-solid group was associated with poor survival in c-stages IA2 (5-year overall survival: 91.5% vs 76.8%, hazard ratio, 2.942; 95% confidence interval, 1.402-6.173; recurrence-free survival: 89.0% vs 68.8%, hazard ratio, 3.439; 95% confidence interval, 1.776-6.669) and IA3 (5-year overall survival: 93.5% vs 63.0%, hazard ratio, 5.110; 95% confidence interval, 1.607-16.241; recurrence-free survival: 80.5% vs 54.1%, hazard ratio, 2.789; 95% confidence interval, 1.290-6.027). The T categories significantly affected 5-year overall survival only in the pure-solid group (cT1a, 89.3%; cT1b, 76.8%; cT1c, 63.0%). CONCLUSIONS A small ground-glass opacity component has an impact on the prognosis of patients with solid-dominant c-stage IA non-small cell lung cancer. Therefore, c-stage IA non-small cell lung cancers should be evaluated separately for tumors with ground-glass opacity and pure-solid tumors.
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Affiliation(s)
- Yukio Watanabe
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Takeshi Matsunaga
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shiaki Oh
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
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Darras M, Ojanguren A, Forster C, Zellweger M, Perentes JY, Krueger T, Gonzalez M. Short-term local control after VATS segmentectomy and lobectomy for solid NSCLC of less than 2 cm. Thorac Cancer 2020; 12:453-461. [PMID: 33270380 PMCID: PMC7882390 DOI: 10.1111/1759-7714.13766] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction VATS pulmonary segmentectomy is increasingly proposed as a parenchyma‐sparing resection for tumors smaller than 2 cm in diameter. The aim of this study was to compare short‐term oncological results and local control in solid non‐small cell lung cancers (NSCLCs) <2 cm surgically treated by intentional VATS segmentectomy or lobectomy. Methods This study was a single center retrospective study of consecutive patients undergoing VATS lobectomy (VL) or segmentectomy (VS) for solid <2 cm NSCLC from January 2014 to October 2019. Results In total, 188 patients with a median age of 65 years (male/female: 99/89) underwent VS (n = 96) or VL (n = 92). Segmentectomies in the upper lobes were performed in 57% and as a single segment in 55% of cases. There was no statistically significant difference between VS and VL in terms of demographics, comorbidities, postoperative outcomes, dissected lymph node stations (2.89 ± 0.95 vs. 2.93 ± 1, P = 0.58), rate of pN1 (2.2% vs. 2.1%, P = 0.96) or pN2 upstaging (1.09% vs. 1.06%, P = 0.98). Adjuvant chemotherapy was given in 15% of patients in the VL and 11% in the VS group. During follow‐up (median: 23 months), no patients presented with local nodal recurrence or on the stapler line (VS group). Three patients on VL and two in VS groups presented with recurrence on the remnant operated lung. New primary pulmonary tumors were diagnosed in 3.3% and 6.3% of patients in the VL and VS groups, respectively. Conclusions Despite the short follow‐up, our preliminary data shows that local control is comparable for VATS lobectomy and VATS segmentectomy for patients with NSCLC <2 cm.
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Affiliation(s)
- Marc Darras
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Amaya Ojanguren
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Céline Forster
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Matthieu Zellweger
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Jean Yannis Perentes
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Thorsten Krueger
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
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Suzuki K, Watanabe SI, Wakabayashi M, Saji H, Aokage K, Moriya Y, Yoshino I, Tsuboi M, Nakamura S, Nakamura K, Mitsudomi T, Asamura H. A single-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer. J Thorac Cardiovasc Surg 2020; 163:289-301.e2. [PMID: 33487427 DOI: 10.1016/j.jtcvs.2020.09.146] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 09/15/2020] [Accepted: 09/19/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND The optimal mode of surgery for ground-glass opacity dominant peripheral lung cancer defined with thoracic thin-section computed tomography remains unknown. METHODS We conducted a single-arm confirmatory trial to evaluate the efficacy and safety of sublobar resection for ground-glass opacity dominant peripheral lung cancer. Lung cancer with maximum tumor diameter 2.0 cm or less and with consolidation tumor ratio 0.25 or less based on thin-section computed tomography were registered. The primary end point was 5-year relapse-free survival. The planned sample size was 330 with the expected 5-year relapse-free survival of 98%, threshold of 95%, 1-sided α of 5%, and power of 90%. The trial is registered with University Hospital Medical Information Network Clinical Trials Registry, number University Hospital Medical Information Network 000002008. RESULTS Between May 2009 and April 2011, 333 patients were enrolled from 51 institutions. Median age was 62 years (interquartile range, 56-68), and 109 were smokers. Median maximum tumor diameter was 1.20 cm (1.00-1.54). Median maximum tumor diameter of consolidation was 0 (0.00-0.20). The primary end point, 5-year relapse-free survival, was estimated on 314 patients who underwent sublobar resection. Operative modes were 258 wide wedge resections and 56 segmentectomies. Median pathological surgical margin was 15 mm (0-55). The 5-year relapse-free survival was 99.7% (90% confidence interval, 98.3-99.9), which met the primary end point. There was no local relapse. Grade 3 or higher postoperative complications based on Common Terminology Criteria for Adverse Effect v3.0 were observed in 17 patients (5.4%), without any grade 4 or 5. CONCLUSIONS Sublobar resection with enough surgical margin offered sufficient local control and relapse-free survival for lung cancer clinically resectable N0 staged by computed tomography with 3 or fewer peripheral lesions 2.0 cm or less amenable to sublobar resection and with a consolidation tumor ratio of 0.25 or less.
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Affiliation(s)
- Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
| | - Shun-Ichi Watanabe
- Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Masashi Wakabayashi
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Hisashi Saji
- Department of General Thoracic Surgery, St Marianna University School of Medicine, Kanagawa, Japan
| | - Keiju Aokage
- Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Yasumitsu Moriya
- Department of Thoracic Surgery, Chiba Rosai Hospital, Chiba, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masahiro Tsuboi
- Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | | | - Kenichi Nakamura
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Tetsuya Mitsudomi
- Faculty of Medicine, Department of Surgery, Kindai University, Osaka, Japan
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
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Tsai PC, Hsu PK, Yeh YC, Chen CK, Chang YY, Huang CS, Hsu HS. Active surveillance or early resection for ground-glass nodules that need preoperative localization. J Surg Oncol 2020; 123:322-331. [PMID: 32989763 DOI: 10.1002/jso.26241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/11/2020] [Accepted: 09/17/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Few studies have investigated the impact of active surveillance on pathological outcome ground-glass nodules (GGNs). We focused on GGNs that needed preoperative localization before resection and compared the pathological results between GGNs that underwent early resection or active surveillance. METHODS We retrospectively reviewed data of resected GGNs between January 2017 and December 2018. GGNs were classified by early resection (Group A) and active surveillance (Group B). Group B was subclassified as no (Group B1) and with (Group B2) growth, and intergroup comparison of pathological results was undertaken. RESULTS In total, 509 GGNs (124, 275, and 110 in Groups A, B1, and B2, respectively) were included. Malignancy (primary lung cancer) ratios were 68% and 72% in Groups A and B (p = .312) and 65% and 92% in Groups B1 and B2, respectively (p < .001). The ratios of invasive carcinoma were 21.4%, 9.6%, and 35.6% in Groups A, B1, and B2, respectively. Predictors for invasive carcinoma included history of lung cancer, GGN size ≥ 10 mm, solid size ≥ 6 mm, and GGN growth. CONCLUSIONS The pathological findings were similar for GGNs in the early resection and active surveillance groups. However, rates of malignancy and invasive carcinoma increased in the group that manifested growth during active surveillance.
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Affiliation(s)
- Ping-Chung Tsai
- Department of Surgery, Division of Thoracic Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Kuei Hsu
- Department of Surgery, Division of Thoracic Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Chen Yeh
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Ku Chen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying-Yueh Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chien-Sheng Huang
- Department of Surgery, Division of Thoracic Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Han-Shui Hsu
- Department of Surgery, Division of Thoracic Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Impact of tumor disappearance ratio on the prognosis of lung adenocarcinoma ≤2 cm in size: A retrospective cohort study. J Formos Med Assoc 2020; 120:874-882. [PMID: 32891489 DOI: 10.1016/j.jfma.2020.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND/PURPOSE Lung cancer patients can have advanced-stages at diagnosis, even the tumor size is ≤2 cm. We aimed to study the relationship between image characteristics, clinical, and patholoigcal results. METHODS We retrospectively enrolled patients with lung adenocarcinoma at Taichung Veterans General Hospital and Chang Gung Memorial Hospital from 2007 to 2015, who were diagnosed with treatment naïve primary tumor lesions at sizes less than 2 cm, as measured by computed tomography (CT) scans. The patient was analyzed for lymph node (LN) and distant metastasis evaluation, with clinicopathological characteristics, including tumor-disappearance ratio (TDR) (tumor diameter at the mediastinal/lung window) over chest CT scans, pathological diagnosis, disease-free survival (DFS), and overall survival (OS). RESULTS Totally 280 patients were surveyed initially and showed significantly increase of clinical LN involvement and distant metastasis when TDR ≤75% compared with >75% (21.6% vs 0% for LN involvement; 27.1% vs 0% for distant metastasis; both p < 0.001). We included 199 patients having surgical treatment and follow-up for the survival analysis. With a TDR ≤75%, significantly worse DFS (HR, 19.23; 95% CI, 2.60-142.01; p = 0.004) and a trend of worse OS (HR, 4.97; 95% CI, 0.61-40.61; p = 0.134) were noted by Kaplan-Meier method. TDR ≤75% revealed more advanced pathological stage, and more tumors containing micropapillary or solid subtypes when diagnosed adenocarcinoma. CONCLUSION For lung cancer patients with primary tumor ≤2 cm, TDR ≤75% was related to more advanced stages, the presence of micropapillary or solid components of adenocarcinoma subtypes, worse DFS, and a trend of worse OS.
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Li X, Ren F, Wang S, He Z, Song Z, Chen J, Xu S. The Epidemiology of Ground Glass Opacity Lung Adenocarcinoma: A Network-Based Cumulative Meta-Analysis. Front Oncol 2020; 10:1059. [PMID: 32793469 PMCID: PMC7386063 DOI: 10.3389/fonc.2020.01059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction: Due to the introduction of low-dose computed tomography (CT) and screening procedures, the proportion of early-stage lung cancer with ground glass opacity (GGO) manifestation is increasing in clinical practice. However, its epidemiological characteristics is still not fully investigated. Methods: We retrieved all solitary GGO adenocarcinoma lung cancer (ADLC) on the PubMed, Cochrane Library, and Embase databases until January 1, 2019 and extracted the general information to perform the meta-analysis, mainly focusing on age, gender, and smoking status. Results: A total of 8,793 solitary GGO ADLC patients from 53 studies were included in this analysis. The final pooled analysis showed that the female proportion, average diagnosis age, and non-smoking proportion of solitary GGO ADLC was 0.62 (95% CI, 0.60–0.64), 56.97 (95% CI, 54.56–59.37), and 0.72 (95% CI, 0.66–0.77), respectively. The cumulative meta-analysis and meta-trend analysis confirmed that the average age at diagnosis has been decreasing while the non-smoking proportion significantly increased in the past two decades. Conclusions: From our epidemiological analysis, it demonstrates that the clinical characteristics of GGO lung cancer patients may be out of the high-risk factors. Therefore, we propose to reconsider the risk assessment and current lung cancer screening criteria.
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Affiliation(s)
- Xiongfei Li
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Fan Ren
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Shuhang Wang
- Department of Clinical Trials Center, National Cancer Center, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Zhicheng He
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zuoqing Song
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Chen
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Song Xu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
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Uchida T, Matsubara H, Onuki Y, Matsuoka H, Ichihara T, Nakajima H. Efficacy of measuring the invasive diameter of lung adenocarcinoma using mediastinal window settings: A retrospective study. Medicine (Baltimore) 2020; 99:e20594. [PMID: 32590735 PMCID: PMC7328984 DOI: 10.1097/md.0000000000020594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The recently published 8th edition of the tumor node and metastasis Classification of Lung Cancer proposes using the maximum dimension of the solid component of a ground glass nodule (GGN) for the T categorization. However, few studies have investigated the collection of this information when using mediastinal window settings. In this study, we evaluated tumor measurement data obtained from computed tomography (CT) scans when using mediastinal window settings.This study included 202 selected patients with persistent, partly solid GGNs detected on thin-slice CT after surgical treatment between 2004 and 2013. We compared the differences in tumor diameters measured by 2 different radiologists using a repeated-measures analysis of variance. We divided the patients into 2 groups based on the clinical T stage (T1a+T1b vs T1c) and estimated the probability of overall survival (OS) and disease-free survival (DFS) using Kaplan-Meier curves.The study included 94 male and 108 female patients. The inter-reviewer differences between tumor diameters were significantly smaller when the consolidation to maximum tumor diameter ratio was ≤0.5. The 2 clinical groups classified by clinical T stage differed significantly with respect to DFS when using the mediastinal window settings. However, no significant differences in OS or DFS were observed when using the lung window setting.Our study yielded 2 major findings. First, the diameters of GGNs could be measured more accurately using the mediastinal window setting. Second, measurements obtained using the mediastinal window setting more clearly depicted the effect of clinical T stage on DFS.
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Guo X, Shao J, Zhai B, Zou Q, Yan J, Gu H, Wang G. Relationship and prognostic significance between preoperative serum albumin to globulin ratio and CT features of non-small cell lung cancer. Eur J Radiol 2020; 128:109039. [PMID: 32417713 DOI: 10.1016/j.ejrad.2020.109039] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 03/26/2020] [Accepted: 04/23/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE This study was conducted to assess the relationship and prognostic significance between preoperative serum albumin to globulin ratio (AGR) and high-resolution computed tomography (HRCT) features of non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Demographic parameters, laboratory values including AGR and other clinical variables were evaluated in 180 patients with NSCLC, and 72 of these patients had results of radiology parameters detected with HRCT [including emphysema, tumor disappearance rate (TDR), CT values and CT enhanced values of the tumor mass] were assessed for survival analyses. The 72 patients were divided into two groups: normal lung group and emphysema group. The discriminatory values for AGR between these two groups were assessed by Mann-Whitney U test The relationship between TDR and AGR in NSCLC patients was evaluated by Pearson correlation analysis. RESULTS In multivariate analysis, TDR (p = 0.033), AGR (p = 0.038), emphysema (p = 0.009), and N stage (P = 0.026) were independent predictors of overall survival (OS). AGR was higher in NSCLC patients without emphysema than NSCLC patients with emphysema (z = -2.979, P = 0.003). TDR demonstrated that there was a positive relationship with AGR (r = 0.307, p = 0.009). A nomogram with AGR, TDR, emphysema, and N stage was established to predict 5-year survival. CONCLUSIONS There is a relationship between CT features and AGR in NSCLC. The integrative nomogram combined with CT images, clinical and hematologic features improved survival prediction in NSCLC patients, which offers a non-invasive, comprehensive, and convenient evaluation for individualized management of NSCLC patients.
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Affiliation(s)
- Xiaoli Guo
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong University, Nantong, Jiangsu 226001, PR China.
| | - Jingjing Shao
- Key Laboratory of Cancer Research Center Nantong, Nantong Tumor Hospital, Nantong University, Nantong, Jiangsu 226001, PR China
| | - Baoqian Zhai
- Department of Oncology, Nantong Tumor Hospital, Nantong University, Nantong, Jiangsu 226001, PR China
| | - Qijiu Zou
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong University, Nantong, Jiangsu 226001, PR China
| | - Jiaxin Yan
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong University, Nantong, Jiangsu 226001, PR China
| | - Hongmei Gu
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong University, Nantong, Jiangsu 226001, PR China.
| | - Gaoren Wang
- Key Laboratory of Cancer Research Center Nantong, Nantong Tumor Hospital, Nantong University, Nantong, Jiangsu 226001, PR China.
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Ito H, Suzuki K, Mizutani T, Aokage K, Wakabayashi M, Fukuda H, Watanabe SI. Long-term survival outcome after lobectomy in patients with clinical T1 N0 lung cancer. J Thorac Cardiovasc Surg 2020; 161:S0022-5223(20)30054-4. [PMID: 32067786 DOI: 10.1016/j.jtcvs.2019.12.072] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/30/2019] [Accepted: 12/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to assess long-term outcomes after lobectomy in patients with clinical T1 N0 lung cancer based on thin-section computed tomography. METHODS We collected the data of patients with pathological adenocarcinoma who had undergone lobectomy. The patients were categorized into 4 groups according to a consolidation tumor ratio and tumor size. Groups A and B included tumors with consolidation tumor ratio ≤0.5 and size ≤3 cm. Group A consisted of tumors ≤2 cm. Group B consisted of the remaining tumors. Groups C and D consisted of tumors with consolidation tumor ratio >0.5. Group C consisted of those with tumors ≤2 cm and Group D consisted of tumors of size 2 to 3 cm. The 10-year overall survival and recurrence-free survival rates were examined. RESULTS Among the 543 patients, the 10-year overall survival was 80.4% and the 10-year recurrence-free survival rate was 77.1%. The 10-year overall survival for group A was 94.0%, 92.7% for group B, 84.1% for group C, and 68.8% for group D, and the 10-year recurrence-free survival rate for each group was 94.0%, 89.0%, 79.7%, and 66.1%, respectively. Group A + B showed better overall survival than group C + D (hazard ratio, 2.78; 95% confidence interval, 1.45-5.06) and better 10-year recurrence-free survival (hazard ratio, 2.74; 95% confidence interval, 1.55-4.88). No patient in group A had recurrence. CONCLUSIONS Those patients with total tumor size ≤3 cm and consolidation tumor ratio ≤0.5 showed excellent prognosis and might be suitable candidates for sublobar resection. If noninferior survival of segmentectomy compared with lobectomy is confirmed in an ongoing Japan Clinical Oncology Group trial, segmentectomy will be included in the standard of care.
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Affiliation(s)
- Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan.
| | - Kenji Suzuki
- Department of Thoracic Surgery, Juntendo University, Tokyo, Japan
| | - Tomonori Mizutani
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Keiju Aokage
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Masashi Wakabayashi
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
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Kim TJ, Kim CH, Lee HY, Chung MJ, Shin SH, Lee KJ, Lee KS. Management of incidental pulmonary nodules: current strategies and future perspectives. Expert Rev Respir Med 2019; 14:173-194. [PMID: 31762330 DOI: 10.1080/17476348.2020.1697853] [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] [Indexed: 02/06/2023]
Abstract
Introduction: Detection and characterization of pulmonary nodules is an important issue, because the process is the first step in the management of lung cancers.Areas covered: Literature review was performed on May 15 2019 by using the PubMed, US National Library of Medicine National Institutes of Health, and the National Center for Biotechnology information. CT features helping identify the druggable mutations and predict the prognosis of malignant nodules were presented. Technical advancements in MRI and PET/CT were introduced for providing functional information about malignant nodules. Advances in various tissue biopsy techniques enabling molecular analysis and histologic diagnosis of indeterminate nodules were also presented. New techniques such as radiomics, deep learning (DL) technology, and artificial intelligence showing promise in differentiating between malignant and benign nodules were summarized. Recently, updated management guidelines for solid and subsolid nodules incidentally detected on CT were described. Risk stratification and prediction models for indeterminate nodules under active investigation were briefly summarized.Expert opinion: Advancement in CT knowledge has led to a better correlation between CT features and genomic alterations or tumor histology. Recent advances like PET/CT, MRI, radiomics, and DL-based approach have shown promising results in the characterization and prognostication of pulmonary nodules.
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Affiliation(s)
- Tae Jung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
| | - Cho Hee Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
| | - Ho Yun Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
| | - Myung Jin Chung
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
| | - Sun Hye Shin
- Respiratory and Critical Care Division of Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
| | - Kyung Jong Lee
- Respiratory and Critical Care Division of Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
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Should Pathologically Noninvasive Lung Adenocarcinoma Larger Than 3 cm Be Classified as T1a? Ann Thorac Surg 2019; 108:1678-1684. [DOI: 10.1016/j.athoracsur.2019.06.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 06/08/2019] [Accepted: 06/12/2019] [Indexed: 01/15/2023]
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Huang C, Wang C, Wang Y, Liu J, Bie F, Wang Y, Du J. The Prognostic Significance of Pure Ground Glass Opacities in Lung Cancer Computed Tomographic Images. J Cancer 2019; 10:6888-6895. [PMID: 31839823 PMCID: PMC6909955 DOI: 10.7150/jca.33132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 09/02/2019] [Indexed: 11/14/2022] Open
Abstract
Objective: Pure ground-glass opacity (GGO) nodules have been detected with increasing frequency using computed tomography (CT). We performed a retrospective study to clarify whether lung cancer patient prognoses correlated with pure GGO nodules. We also analyzed the clinical characters of patients with pure GGO nodules to provide diagnostic guidance on lung cancer identification and treatment of patients in clinical practice. Methods: We enrolled 39 of 1422 patients with pure GGO nodules who accepted surgical treatment of the lung cancer nodules, and reviewed materials from 404 patients to verify our conclusions. To discover which factors were prognostically significant, we used the Kaplan-Meier method to estimate the overall survival (OS) and progression-free survival (PFS) curves. Age, gender, smoking history, histology, tumor size, and stage were the factors examined in our study. We also performed subgroup and matching group analyses to clarify the correlation between the presence of pure GGO nodules and prognoses. Results: Pure GGO nodules were associated with non-smoking females that had adenocarcinoma. The prognoses of patients in the pure GGO nodule group was better than those in the non-pure GGO nodule group (p = 0.046). Age, grade, and stage (including tumor size and lymph node metastases) were had prognostic significance. In the matching group stage assessments, although patient prognoses were not significantly different among patients of the GGO group compared with thoses of the other group in long-term, while in the short term, patients with pure GGO nodules had longer PFS. Non-smoking female patients with lung cancer were more likely to have adenocarcinoma. Conclusions: As a subgroup of GGO nodules, pure GGO nodules predict a better prognosis in all lung cancer patients. Wheras our study showed that lung patients with pure GGO nodules in similar stages were not significantly different in long-term prognoses, in the short term; patients with pure GGO nodules had longer PFS.
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Affiliation(s)
- Cuicui Huang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, 250021, China
| | - Chao Wang
- Department of Respiratory Medicine, Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China
| | - Yadong Wang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, 250021, China
| | - Jichang Liu
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, 250021, China
| | - Fenglong Bie
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, 250021, China
| | - Yu Wang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, 250021, China
| | - Jiajun Du
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, 250021, China.,Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, 250021, China
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Rao S, Ye L, Min L, Zhao G, Chen Y, Huang Y, Yang J, Xiao S, Cao R. Meta-analysis of segmentectomy versus lobectomy for radiologically pure solid or solid-dominant stage IA non-small cell lung cancer. J Cardiothorac Surg 2019; 14:197. [PMID: 31722726 PMCID: PMC6854787 DOI: 10.1186/s13019-019-0996-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/16/2019] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Whether segmentectomy can be used to treat radiologically determined pure solid or solid-dominant lung cancer remains controversial owing to the invasive pathologic characteristics of these tumors despite their small size. This meta-analysis compared the oncologic outcomes after lobectomy and segmentectomy regarding relapse-free survival (RFS) and overall survival (OS) in patients with radiologically determined pure solid or solid-dominant clinical stage IA non-small cell lung cancer (NSCLC). METHODS A literature search was performed in the MEDLINE, EMBASE, and Cochrane Central databases for information from the date of database inception to March 2019. Studies were selected according to predefined eligibility criteria. The hazard ratio (HR) and associated 95% confidence interval (CI) were extracted or calculated as the outcome measure for data combining. RESULTS Seven eligible studies published between 2014 and 2018 enrolling 1428 patients were included in the current meta-analysis. Compared with lobectomy, segmentectomy had a significant benefit on the RFS of radiologically determined pure solid or solid-dominant clinical stage IA NSCLC patients (combined HR: 1.46; 95% CI, 1.05-2.03; P = 0.024) and there were no significant differences on the OS of these patients (HR: 1.52; 95% CI, 0.95-2.43; P = 0.08). CONCLUSIONS Segmentectomy leads to lower survival than lobectomy for clinical stage IA NSCLC patients with radiologically determined pure solid or solid-dominant tumors. Moreover, applying lobectomy to clinical stage IA NSCLC patients with radiologically determined pure solid or solid-dominant tumors (≤2 cm) could lead to an even bigger survival advantage. However, there are some limitations in the present study, and more evidence is needed to support the conclusion.
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Affiliation(s)
- Sunyin Rao
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lianhua Ye
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China.
| | - Li Min
- Department of Respiratory Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Guangqiang Zhao
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ya Chen
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yunchao Huang
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jichen Yang
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shouyong Xiao
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Run Cao
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
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Li W, Zhou F, Wan Z, Li M, Zhang Y, Bao X, Zhang L, Shi J. Clinicopathologic features and lymph node metastatic characteristics in patients with adenocarcinoma manifesting as part-solid nodule exceeding 3 cm in diameter. Lung Cancer 2019; 136:37-44. [DOI: 10.1016/j.lungcan.2019.07.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/23/2019] [Accepted: 07/29/2019] [Indexed: 11/17/2022]
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Chen L, Fang W. [A Review on Comparison of Lobectomy and Segmentectomy in the Treatment of
Early Stage Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:526-531. [PMID: 31451144 PMCID: PMC6717873 DOI: 10.3779/j.issn.1009-3419.2019.08.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Lung cancer is a worldwide malignancy with high morbidity and mortality in the world. With the application of low-dose spiral computed tomography in the screening and diagnosis of lung cancer, more lung cancers are detected at an early stage and cured by surgical treatment. Anatomical lobectomy has long been the standard procedure for the treatment of early stage non-small cell lung cancer. However, whether intentional segmentectomy can be more used remains controversial. And this paper focuses on the question.
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Affiliation(s)
- Liang Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
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Miyoshi T, Aokage K, Katsumata S, Tane K, Ishii G, Tsuboi M. Ground-Glass Opacity Is a Strong Prognosticator for Pathologic Stage IA Lung Adenocarcinoma. Ann Thorac Surg 2019; 108:249-255. [DOI: 10.1016/j.athoracsur.2019.01.079] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/26/2018] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
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Matsubayashi J, Miyake S, Kudo Y, Shimada Y, Maeda J, Saji H, Kakihana M, Park J, Kajiwara N, Inoue S, Saito K, Ohira T, Ikeda N, Tokuuye K, Nagao T. Cytological differences between invasive and noninvasive or minimally invasive lung adenocarcinomas diagnosed in Japanese patients using needle biopsy specimens of pulmonary lesions ≤3 cm in diameter. Diagn Cytopathol 2019; 47:688-694. [PMID: 30968597 PMCID: PMC6618248 DOI: 10.1002/dc.24171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/07/2018] [Accepted: 02/26/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND According to the WHO classification for lung cancer, adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) have a better prognosis than invasive adenocarcinoma (IAD). However, detecting the foci of invasion in lung adenocarcinomas radiologically remains difficult. The present study examined whether or not differences in the cytological characteristics between IAD and AIS or MIA (noninvasive or minimally invasive adenocarcinomas [NMIAD]) plays a role in the differential diagnosis. METHODS Seventy surgical resection specimens of primary lung adenocarcinoma with preoperative cytology, in which several parameters were evaluated and assessed. RESULTS The histopathological diagnoses of surgical resection specimens were AIS in 8, MIA in 31, IAD in 31 including lepidic adenocarcinoma in 9, and papillary adenocarcinoma in 22. NMIAD had a 100% 5-year recurrence-free survival (RFS), while IAD had an 82.8% 5-year RFS. The numbers of tumor cells (at ×10 magnification in 10 fields) were 60.3 ± 40.5 in IAD and 39.8 ± 28.7 in NMIAD (P = 0.0017). A univariate analysis of cytological parameters revealed significant differences in large tumor cell clusters, three-dimensional (3D) tumor cell clusters, and irregular nuclear contours between the two groups. The frequency of irregular nuclear contours continued to be significantly different according to a multivariate analysis. CONCLUSION Large or 3D tumor cell clusters and irregular nuclear contours may be important cytological factors for distinguishing IAD from NMIAD, with the latter being potentially more important for distinguishing between the two groups.
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Affiliation(s)
- Jun Matsubayashi
- Department of Anatomic PathologyTokyo Medical UniversityTokyoJapan
- Diagnostic Pathology DivisionTokyo Medical University HospitalTokyoJapan
| | - Shinji Miyake
- Diagnostic Pathology DivisionTokyo Medical University HospitalTokyoJapan
| | - Yujin Kudo
- Department of Thoracic SurgeryTokyo Medical UniversityTokyoJapan
| | | | - Junichi Maeda
- Department of Thoracic SurgeryTokyo Medical UniversityTokyoJapan
| | - Hisashi Saji
- Department of Chest SurgerySt. Marianna University School of MedicineKawasakiJapan
| | | | - Jinho Park
- Department of RadiologyTokyo Medical University Hachioji Medical CenterTokyoJapan
| | - Naohiro Kajiwara
- Department of Thoracic SurgeryTokyo Medical UniversityTokyoJapan
| | - Shigeru Inoue
- Department of Preventive Medicine and Public HealthTokyo Medical UniversityTokyoJapan
| | - Kazuhiro Saito
- Department of RadiologyTokyo Medical UniversityTokyoJapan
| | - Tatsuo Ohira
- Department of Thoracic SurgeryTokyo Medical UniversityTokyoJapan
| | - Norihiko Ikeda
- Department of Thoracic SurgeryTokyo Medical UniversityTokyoJapan
| | - Koichi Tokuuye
- Department of RadiologyTokyo Medical UniversityTokyoJapan
| | - Toshitaka Nagao
- Department of Anatomic PathologyTokyo Medical UniversityTokyoJapan
- Diagnostic Pathology DivisionTokyo Medical University HospitalTokyoJapan
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Hutchinson BD, Shroff GS, Truong MT, Ko JP. Spectrum of Lung Adenocarcinoma. Semin Ultrasound CT MR 2019; 40:255-264. [DOI: 10.1053/j.sult.2018.11.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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50
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Suzuki K, Saji H, Aokage K, Watanabe SI, Okada M, Mizusawa J, Nakajima R, Tsuboi M, Nakamura S, Nakamura K, Mitsudomi T, Asamura H. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg 2019; 158:895-907. [PMID: 31078312 DOI: 10.1016/j.jtcvs.2019.03.090] [Citation(s) in RCA: 292] [Impact Index Per Article: 58.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 03/03/2019] [Accepted: 03/17/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND No definitive comparisons of surgical morbidity between segmentectomy and lobectomy for non-small cell lung cancer have been reported. METHODS We conducted a randomized controlled trial to confirm the noninferiority of segmentectomy to lobectomy in regard to prognosis (trial No. JCOG0802/WJOG4607L). Patients with invasive peripheral non-small cell lung cancer tumor of a diameter ≤2 cm were randomized to undergo either lobectomy or segmentectomy. The primary end point was overall survival. Here, we have focused on morbidity and mortality. Predictors of surgical morbidity were evaluated by the mode of surgery. Segmentectomy was categorized into simple and complex. Simple segmentectomy was defined as segmental resection of the right or left segment 6, left superior, or lingular segment. Complex segmentectomy was resection of the other segment. This trial is registered with the University Hospital Medical Information Network--Clinical Trial Registry (UMIN000002317). RESULTS Between August 10, 2009, and October 21, 2014, 1106 patients (lobectomy n = 554 and segmentectomy n = 552) were enrolled. No mortality was noted. Complications (grade ≥ 2) occurred in 26.2% and 27.4% in the lobectomy and segmentectomy arms (P = .68), respectively. Fistula/pulmonary-lung (air leak) was detected in 21 (3.8%) and 36 (6.5%) patients in the lobectomy and segmentectomy arms (P = .04), respectively. Multivariable analysis revealed that predictors of pulmonary complications, including air leak and empyema (grade ≥ 2) were complex segmentectomy (vs lobectomy) (odds ratio, 2.07; 95% confidence interval, 1.11-3.88; P = .023), and > 20 pack-years of smoking (odds ratio, 2.61; 95% confidence interval, 1.14-5.97; P = .023). CONCLUSIONS There was no difference in almost any postoperative measure of intraoperative and postoperative complication in segmentectomy and lobectomy patients, except more air leakage was observed in the segmentectomy arm. Segmentectomy will be a standard treatment if the superior pulmonary function and noninferiority in overall survival are confirmed.
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Affiliation(s)
- Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
| | - Hisashi Saji
- Department of General Thoracic Surgery, St Marianna University School of Medicine, Kanagawa, Japan
| | - Keiju Aokage
- Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Shun-Ichi Watanabe
- Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Morihito Okada
- Department of Thoracic Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Ryu Nakajima
- Department of Thoracic Surgery, Osaka City General Medical Center, Osaka, Japan
| | - Masahiro Tsuboi
- Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | | | - Kenichi Nakamura
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Tetsuya Mitsudomi
- Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
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