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Wang L, Ge L, Zhang G, Wang Z, Liu Y, Ren Y. Clinical characteristics and survival outcomes of patients with pneumonectomies: A population-based study. Front Surg 2022; 9:948026. [PMID: 36017516 PMCID: PMC9395916 DOI: 10.3389/fsurg.2022.948026] [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: 05/19/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPrognostic factors in a pneumonectomy (PN) are not yet fully defined. This study sought to analyze and evaluate long-term survival after pneumonectomies (PNs) for patients with non-small cell lung cancer (NSCLC).MethodsWe obtained data from the Surveillance, Epidemiology, and End Results (SEER) database for patients who underwent PNs between 2004 and 2015. Propensity score matching (PSM) analysis and Kaplan–Meier curves were used to estimate overall survival (OS), while univariate and multivariable Cox proportional hazards regression analyses were applied to create a forest plot.ResultsIn total, 1,376 patients were grouped according to right/left PNs. Before matching, OS was worse after a right PN [hazard ratio (HR): 1.459; 95% CI 1.254–1.697; P < 0.001] and after matching, survival differences between groups were not significant (HR: 1.060; 95% CI 0.906–1.240; P = 0.465). Regression analysis revealed that age, gender, grade, lymph node dissection, N-stage, and chemotherapy were independent predictors of OS (P < 0.05). Chemotherapy was associated with improved OS (P < 0.001).ConclusionsLaterality was not a significant prognostic factor for long-term survival after a PN for NSCLC. Chemotherapy was a significant independent predictor of improved OS. Long-term survival and outcomes analyses should be conducted on larger numbers of patients.
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Affiliation(s)
- Linlin Wang
- Department of Thoracic Surgery, Shenyang Chest Hospital & Tenth People's Hospital, Shenyang, China
| | - Lihui Ge
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Guofeng Zhang
- Department of Thoracic Surgery, Shenyang Chest Hospital & Tenth People's Hospital, Shenyang, China
| | - Ziyi Wang
- Department of Thoracic Surgery, Shenyang Chest Hospital & Tenth People's Hospital, Shenyang, China
| | - Yongyu Liu
- Department of Thoracic Surgery, Shenyang Chest Hospital & Tenth People's Hospital, Shenyang, China
| | - Yi Ren
- Department of Thoracic Surgery, Shenyang Chest Hospital & Tenth People's Hospital, Shenyang, China
- Correspondence: Yi Ren
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Minervini F, Kocher GJ, Bertoglio P, Kestenholz PB, Gálvez Muñoz C, Patrini D, Ceulemans LJ, Begum H, Lutz J, Shojai M, Shargall Y, Scarci M. Pneumonectomy for lung cancer in the elderly: lessons learned from a multicenter study. J Thorac Dis 2021; 13:5835-5842. [PMID: 34795932 PMCID: PMC8575851 DOI: 10.21037/jtd-21-869] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/08/2021] [Indexed: 12/25/2022]
Abstract
Background 60% of patients diagnosed with lung cancer are older than 65 years and are at risk for substandard treatment due to a reluctance to recommend surgery. Pneumonectomy remains a high risk procedure especially in elderly patients. Nevertheless, the impact of age and neoadjuvant treatment on outcomes after pneumonectomy is still not well described. Methods We performed a multicentric retrospective study, analyzing outcomes of patients older than 70 years who underwent pneumonectomy for central primary lung malignancy between January 2009 and June 2019 in 7 thoracic surgery departments: Lucerne and Bern (Switzerland), Hamilton (Canada), Alicante (Spain), Monza (Italy), London (UK), Leuven (Belgium). Survival was estimated with Kaplan-Meier, and differences in survival were determined by log-rank analysis. We investigated pre- and post-operative prognostic factors using Cox proportional hazards regression model; multivariable analysis was performed only with variables, which were statistically significant at the invariable analysis. Results A total of 136 patients were included in the study. Mean age was 73.8 years (SD 3.6). 24 patients (17.6%) had an induction treatment (chemotherapy alone in 15 patients and chemo-radiation in 9). Mean length of stay (LOS) was 12.6 days (SD 10.39) and 74 patients (54.4%) had experienced a post-operative complication: 29 (21.3%) had a pulmonary complication, 33 (24.3%) had a cardiac complication and in 12 cases (8.8%) patients experienced both cardiac and pulmonary complications. 16 patients were readmitted [median LOS 13.7 days (range, 2–39 days)] and of those 14 (10.3%) required redo surgery. Median overall survival (OS) of the entire cohort was 38 months (95% CI: 29.9–46.1 months); in-hospital mortality was 1.5%, 30-day mortality rate was 3.7%, while 90-day mortality was 8.8% accounting for 5 and 12 patients respectively. Patients receiving neo-adjuvant therapy did not experience a higher incidence of postoperative complications (P=0.633), did not have a longer postoperative course (P=0.588), nor did they have an increased mortality rate (P=0.863). Conclusions Age should not be considered an absolute contraindication for pneumonectomy in elderly patients even after neoadjuvant treatment. It has become apparent that especially in these patients, a patient-tailored approach with a careful selection should be used to define the risk-benefit balance.
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Affiliation(s)
- Fabrizio Minervini
- Department of Thoracic Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Gregor J Kocher
- Division of Thoracic Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pietro Bertoglio
- Division of Thoracic Surgery, IRCSS Azienda Ospedaliero-Universitaria, Bologna, Italy
| | - Peter B Kestenholz
- Department of Thoracic Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Carlos Gálvez Muñoz
- Department of Thoracic Surgery, University Hospital Alicante, Alicante, Spain
| | - Davide Patrini
- Department of Thoracic Surgery, University College London Hospitals, London, UK
| | - Laurens J Ceulemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism, Laboratory BREATHE, KULeuven, Leuven, Belgium
| | - Housne Begum
- Department of Thoracic Surgery, McMaster University, Hamilton, Canada
| | - Jon Lutz
- Division of Thoracic Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Max Shojai
- Division of Thoracic Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yaron Shargall
- Department of Thoracic Surgery, McMaster University, Hamilton, Canada
| | - Marco Scarci
- Department of Thoracic surgery, San Gerardo Hospital, Monza, Italy
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Guo X, Wang H, Wei Y. [Pneumonectomy for Non-small Cell Lung Cancer: Predictors of Operative Mortality and Survival]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:573-581. [PMID: 32702791 PMCID: PMC7406439 DOI: 10.3779/j.issn.1009-3419.2020.101.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
外科手术是目前根治非小细胞肺癌(non-small cell lung cancer, NSCLC)的最有效方式。全肺切除作为一种术式被应用于临床中。对于中央型肺癌,袖式肺叶切除术因其术后肺功能丧失少、术后并发症及死亡率低逐渐取代全肺切除术成为主流。然而为保证肿瘤学效果,当其他术式无法完全切除时,全肺切除术式仍是必要的。全肺切除术后主要发生心肺并发症,充分了解全肺切除术后相关并发症能帮助临床医师及时做出诊断,并进一步采取相关措施降低术后并发症对患者的不良影响。充分了解预后相关危险因素可帮助临床医师提前采取措施尽可能规避风险,从而改善患者预后。
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Affiliation(s)
- Xiaokang Guo
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Huafeng Wang
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Yucheng Wei
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
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Abstract
Lung cancer is the leading cause of cancer-associated mortality in the USA. The median age at diagnosis of lung cancer is 70 years, and thus, about one-half of patients with lung cancer fall into the elderly subgroup. There is dearth of high level of evidence regarding the management of lung cancer in the elderly in the three broad stages of the disease including early-stage, locally advanced, and metastatic disease. A major reason for the lack of evidence is the underrepresentation of elderly in prospective randomized clinical trials. Due to the typical decline in physical and physiologic function associated with aging, most elderly do not meet the stringent eligibility criteria set forth in age-unselected clinical trials. In addition to performance status, ideally, comorbidity, cognitive, and psychological function, polypharmacy, social support, and patient preferences should be taken into account before applying prevailing treatment paradigms often derived in younger, healthier patients to the care of the elderly patient with lung cancer. The purpose of this chapter was to review the existing evidence of management of early-stage, locally advanced disease, and metastatic lung cancer in the elderly.
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Affiliation(s)
- Archana Rao
- Department of Medicine, Upstate Medical University, 750 E Adams Street, Syracuse, NY, 13210, USA
| | - Namita Sharma
- Department of Medicine, Upstate Medical University, 750 E Adams Street, Syracuse, NY, 13210, USA
| | - Ajeet Gajra
- Department of Medicine, Upstate Medical University, 750 E Adams Street, Syracuse, NY, 13210, USA.
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Holgersson G, Hoye E, Bergqvist M, Ekman S, Nyman J, Helsing M, Friesland S, Holgersson M, Ekberg L, Blystad T, Ewers SB, Mörth C, Löden B, Henriksson R, Bergström S. Swedish Lung Cancer Radiation Study Group: predictive value of age at diagnosis for radiotherapy response in patients with non-small cell lung cancer. Acta Oncol 2012; 51:759-67. [PMID: 22793039 DOI: 10.3109/0284186x.2012.681064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The aim of the present study was to investigate the impact of age at diagnosis on prognosis in patients treated with curatively intended radiotherapy for NSCLC. MATERIAL AND METHODS This is a joint effort among all the Swedish Oncology Departments that includes all identified patients with a diagnosed non-small cell lung cancer that have been subjected to curatively intended irradiation (≥50 Gy) treated during 1990 to 2000. Included patients had a histopathological/cytological diagnosis date as well as a death date or a last follow-up date. The following variables were studied in relation to overall and disease-specific survival: age, gender, histopathology, time period, smoking status, stage and treatment. RESULTS The median overall survival of all 1146 included patients was 14.7 months, while the five-year overall survival rate was 9.5%. Younger patients (<55 years), presented with a more advanced clinical stage but had yet a significantly better overall survival compared with patients in the age groups 55-64 years (p = 0.035) and 65-74 years (p = 0.0097) in a multivariate Cox regression analysis. The overall survival of patients aged ≥75 years was comparable to those aged <55 years. CONCLUSION In this large retrospective study we describe that patients younger than 55 years treated with curatively intended radiotherapy for NSCLC have a better overall survival than patients aged 55-64 and 65-74 years and that younger patients seem to benefit more from the addition of surgery and/or chemotherapy to radiotherapy. Due to the exploratory nature of the study, these results should be confirmed in future prospective trials.
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Suksompong S, Thamtanavit S, von Bormann B, Thongcharoen P. Thoracic surgery mortality and morbidity in a university hospital. Asian Cardiovasc Thorac Ann 2012; 20:182-7. [DOI: 10.1177/0218492311436017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study was undertaken to determine the mortality and morbidity of lung resection surgery in the 2,415-bed Siriraj University Hospital, Thailand, and compare them to rates in similar facilities (benchmarking). Demographic and clinical data as well as perioperative outcome variables of patients who underwent elective thoracic surgery from January 2006 to May 2010 were reviewed retrospectively. There were 558 cases of lung resection. Mortality was 0.9% and perioperative morbidity was 8.2%. Univariate analysis identified age >75 years, history of pulmonary disease, preoperative rehabilitation consultation, and operative time >2 h as predictors of mortality and morbidity. With less statistical power, hypertension, cancer, peripheral vascular disease, and thoracotomy also contributed to perioperative outcome. Comparisons with data from the current literature place our results in the range of good quality. Following benchmarking criteria, perioperative outcomes after lung resection surgery in our hospital are good. To further improve quality, we will pay special attention to patients with advanced age and history of pulmonary disease.
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Affiliation(s)
- Sirilak Suksompong
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sarawut Thamtanavit
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Benno von Bormann
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Punnaruk Thongcharoen
- Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Vinod SK, Sidhom MA, Delaney GP. Do multidisciplinary meetings follow guideline-based care? J Oncol Pract 2011; 6:276-81. [PMID: 21358954 DOI: 10.1200/jop.2010.000019] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2010] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Multidisciplinary meetings (MDMs) are increasingly being mandated as essential to oncology practice. However, there is a paucity of data on their effectiveness. The aim of this study was to assess whether MDM recommendations were concordant with guidelines in the treatment of lung cancer. PATIENTS AND METHODS The Lung Cancer Multidisciplinary Meeting in South West Sydney, Australia, prospectively collects data on all patients whose cases have been presented. New patients with lung cancer who presented between December 1, 2005, and December 31, 2007, were reviewed. Patients were assigned to treatment on the basis of evidence-based guidelines according to pathology, stage, and Eastern Cooperative Oncology Group (ECOG) performance status. MDM recommendations were compared with guideline treatment, and reasons for discrepancy were noted. RESULTS There were 335 patients with a median age of 69 years. Of these, 82% had non-small-cell lung cancer (NSCLC), 14% had small-cell lung cancer, and 4% had no pathologic diagnosis. Eighty-four percent had locally advanced or metastatic disease. Concordance of MDM recommendations with guideline treatment existed in 29 (58%) of 50 cases for surgery, 201 (88%) of 228 cases for radiotherapy, and 200 (77%) of 260 cases for chemotherapy. Overall concordance with guideline treatment was 71% (239 of 335 cases). On multivariate analysis, age greater than 70 years, ECOG performance status of 2 or higher, and stage III NSCLC were associated with the MDM not recommending guideline treatment. The primary reasons for this were physician decision (39%), comorbidity (25%), and technical factors (22%). CONCLUSION MDM recommendations were largely concordant with guidelines. Physician discretion in not recommending guideline treatment was most often exercised in older patients and those with borderline performance status. Individual factors that may preclude guideline treatment cannot be accounted for by guidelines.
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Affiliation(s)
- Shalini K Vinod
- Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), Liverpool Hospital, Liverpool BC; University of New South Wales, Sydney, Australia
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Abstract
INTRODUCTION A significant proportion of lung cancer patients receive no anticancer treatment. This varies from 19% in USA, 33% in Australia, 37% in Scotland, and 50% in Ireland. The aim of this study was to identify the reasons behind this. METHODS The Lung Cancer Multidisciplinary Meeting (MDM) in South-West Sydney prospectively collects data on all patients presented. All new lung cancer patients presented between December 1, 2005, and December 31, 2007, were reviewed. Patients were assigned optimal treatment based on evidence-based guidelines. Those patients in whom guidelines recommended no treatment (GNT) were compared with those whom the MDM recommended no treatment (MNT) and with those who actually received no treatment (ANT). RESULTS There were 335 patients with a median age of 69 years. A total of 82% had non-small cell lung cancer, 14% had small cell lung cancer, and 4% had no pathologic diagnosis. Eighty-five percent had locally advanced or metastatic disease. GNT was recommended in 4% (n = 13), MNT in 10% (n = 32) but ANT comprised 20% (n = 66). The differences between GNT and MNT were mainly due to patient comorbidities and clinician decision, but the differences between MNT and ANT were due to patient preference and declining performance status. In multivariate analysis, older age, poorer Eastern Cooperative Oncology Group status, non-small cell lung cancer, and non-English language predicted for ANT. CONCLUSIONS The proportion of patients with lung cancer receiving no treatment is greater than that predicted by guidelines or recommended by the MDM but lower than that described in population-based studies suggesting that MDMs can improve treatment utilization in lung cancer.
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Meniga IN, Tiljak MK, Ivankovic D, Aleric I, Zekan M, Hrabac P, Mazuranic I, Puljic I. Prognostic Value of Computed Tomography Morphologic Characteristics in Stage I Non–Small-Cell Lung Cancer. Clin Lung Cancer 2010; 11:98-104. [DOI: 10.3816/clc.2010.n.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
PURPOSE Lung cancer is the leading cause of cancer death in Australia, but little is known about how Australian patients with this disease are managed. METHODS Lung cancer patients diagnosed from November 1, 2001 to December 31, 2002 were identified through the population-based New South Wales Central Cancer Registry. Information was collected on diagnosis, staging, referrals, and treatment. Cross-tabulations and logistic regression examined factors related to not receiving cancer-specific therapy. RESULTS There were 2931 potentially eligible patients registered by the Central Cancer Registry and completed questionnaires were obtained for 1812 patients (62%); median age 71 years and 66% men. The pathology was non-small cell in 71%, small cell in 15% and not confirmed in 13% of patients. Eleven percent of patients did not see a lung cancer specialist and 33% received no cancer-specific therapy after initial diagnosis. Treatment utilization rates were 17% for surgery, 39% for radiotherapy, and 30% for chemotherapy. Factors significantly associated with having no cancer-specific therapy included female gender, older age, weight loss, poorer performance status, advanced or unknown disease stage, and consultation with a low patient volume lung cancer specialist or a non-lung cancer specialist. The median survival was 172 days and 2-year crude survival was 17%. CONCLUSIONS Treatment patterns were in broad concordance with present national guidelines. Nevertheless, a significant proportion of lung cancer patients did not receive cancer-specific therapy. Treatment decisions should be multidisciplinary and decision-makers should include experienced lung cancer specialists.
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Bryant AS, Cerfolio RJ. Differences in Outcomes Between Younger and Older Patients With Non–Small Cell Lung Cancer. Ann Thorac Surg 2008; 85:1735-9; discussion 1739. [DOI: 10.1016/j.athoracsur.2008.01.031] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2007] [Revised: 01/07/2008] [Accepted: 01/07/2008] [Indexed: 12/18/2022]
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Beshay M, Dorn P, Ris HB, Schmid RA. Influence of comorbidity on outcome after pulmonary resection in the elderly. Asian Cardiovasc Thorac Ann 2008; 15:297-302. [PMID: 17664201 DOI: 10.1177/021849230701500406] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to determine the influence of comorbidity on outcome after pulmonary resection in patients over 75 years old. Three hundred and thirty-three patients with non-small-cell lung cancer operated on between 1998 and 2002 were divided into 3 age groups: < 60 years (group 1), 60-75 years (group 2), > 75 years (group 3). Overall operative mortality was 0.3%; 30-day mortality was 1%. There were more major complications with re-operation in groups 1 and 2, but minor complications occurred significantly more frequently in group 3 (36% vs 16%). Overall mean hospital stay was 12 days, with no significant difference among groups. Three-year survival rates were: 80%, 70%, and 65% in groups 1, 2, and 3, respectively, with no significant difference among groups. Age or the presence of comorbidity should not be considered contraindications for lung resection. With proper patient selection and careful preoperative evaluation, many major complications after pneumonectomy are avoidable.
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Affiliation(s)
- Morris Beshay
- Division of General Thoracic Surgery, University Hospital of Berne, Berne, Switzerland.
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Abstract
Lung cancer is a disease of older persons. It is the most common cause of cancer death in men and women in the United States. A comprehensive evaluation of medical comorbidities and functional status is important in all patients but perhaps more so in older adults, and it should be included in the assessment of older patients who have lung cancer. Age, per se, should not be a limiting factor to treatment, because a large body of evidence demonstrates that fit older patients who have lung cancer can safely undergo the same treatments as their younger counterparts with equally good results.
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Abstract
Until additional multi-institutional, randomized, controlled trials provide evidence to the contrary, open lobectomy with mediastinal lymphadenectomy should be considered the gold standard for treating patients with stage I NSCLC with sufficient cardiopulmonary reserve, including older patients. It is the operation with which alternative pulmonary resections, including video-assisted thoracoscopic lobectomy and sublobar resection, should be compared. In treating stage I NSCLC patients, sublobar resection should be reserved for patients with inadequate physiologic reserve to tolerate lobectomy and for those enrolled in clinical trials.
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Affiliation(s)
- Shawn S Groth
- Department of Surgery, University of Minnesota Medical School, MMC 207, 420 Delaware Street SE, Minneapolis, MN 55455, USA.
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VINOD SK, BARTON MB. Actual versus optimal utilization of radiotherapy in lung cancer: Where is the shortfall? Asia Pac J Clin Oncol 2007. [DOI: 10.1111/j.1743-7563.2006.00080.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Birim O, Kappetein AP, van Klaveren RJ, Bogers AJJC. Prognostic factors in non-small cell lung cancer surgery. Eur J Surg Oncol 2005; 32:12-23. [PMID: 16297591 DOI: 10.1016/j.ejso.2005.10.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Accepted: 10/04/2005] [Indexed: 11/17/2022] Open
Abstract
AIMS Complete surgical resection of primary tumours remains the treatment with the greatest likelihood for survival in early-stage non-small cell lung cancer (NSCLC). Although TNM stage is the most important prognostic parameter in NSCLC, additional parameters are required to explain the large variability in postoperative outcome. The present review aims at providing an overview of the currently known prognostic markers for postoperative outcome. METHODS We performed an electronic literature search on the MEDLINE database to identify relevant studies describing the risk factors in NSCLC surgery. The references reported in all the identified studies were used for completion of the literature search. RESULTS Poor pulmonary function, cardiovascular disease, male gender, advanced age, TNM stage, non-squamous cell histology, pneumonectomy, low hospital volume and little experience of the surgeon were identified as risk factors for postoperative outcome. However, with the exception of TNM stage and extent of resection, the literature demonstrates conflicting results on the prognostic power of most factors. The role of molecular biological factors, neoadjuvant treatment and adjuvant treatment is not well investigated yet. CONCLUSIONS The advantage of knowing about the existence of comorbidity and prognostic risk factors may provide the clinician with the ability to identify poor prognostic patients and establish the most appropriate treatment strategy. The assessment of prognostic factors remains an area of active investigation and a promising field of research in optimising therapy of NSCLC patients.
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Affiliation(s)
- O Birim
- Department of Cardio-Thoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
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Sawada S, Komori E, Nogami N, Bessho A, Segawa Y, Shinkai T, Nakata M, Yamashita M. Advanced Age Is Not Correlated With Either Short-term or Long-term Postoperative Results in Lung Cancer Patients In Good Clinical Condition. Chest 2005; 128:1557-63. [PMID: 16162758 DOI: 10.1378/chest.128.3.1557] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES Several investigators have reported that operative mortality in the elderly is acceptable. However, their patients are potentially biased with regard to some factors such as performance status (PS) and comorbidity. In this study, we discuss surgical indications for the elderly and effects on perioperative mortality and prognosis. STUDY DESIGN A retrospective study was carried out by reviewing the records of 1,114 patients who were referred for treatment of non-small cell lung cancer between January 1993 and December 2002. The patients were classified into younger (< or = 75 years of age) and elderly (> or = 76 years of age) groups. The histologic subtype, TNM stage, Eastern Cooperative Oncology Group PS, and treatment were reviewed for members of each group, and the proportion of patients who underwent surgery was compared between the two groups. The surgical procedures, perioperative mortality, and prognosis of the two groups were also compared. RESULTS There was a significant difference in the histologic distribution with no difference in TNM staging between the two groups. Regarding treatment, 51.0% of those in the younger group and 36.1% of those in the elderly group underwent surgery. The proportion of elderly patients who underwent surgery was significantly lower than that of the younger patients, mainly due to worse PS and comorbidity in the elderly patients. The perioperative mortality rates for the younger and elderly groups were 0.9% and 4.1%, respectively, with no significant difference, and the overall survival was similar between the two groups. CONCLUSIONS When compared to younger patients, fewer elderly patients underwent surgery because of worse PS and comorbidity. However, in elderly patients with good PS and no comorbidity, the rate of perioperative mortality and the prognosis were similar to those in the younger patients. Therefore, advanced age only is not a negative factor for surgery in elderly patients.
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Affiliation(s)
- Shigeki Sawada
- Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Horinouchi 13, Matsuyama, Ehime, 790-0007, Japan
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Diab S, Geriniere L, Carrie C, Souquet P. Traitement du cancer bronchique du sujet âgé. Rev Mal Respir 2004. [DOI: 10.1016/s0761-8425(04)71563-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Age is sometimes used as an excuse not to resect lung cancer. Nugent et al [10] noted that, although only 6% of patients younger than 45 years had stage I or II disease, 33% underwent surgical resection. In contrast, of the 33% of elderly patients who had stage I or II disease, only 6% underwent surgical resection. The elderly patients who are carefully selected for lung resection are undoubtedly stronger physiologically than others their same age. Patients with adequate predicted postoperative lung function, no contraindications from other medical problems, good performance status, and social support should be offered standard resection for early-stage NSCLC. Lung cancer resection in elderly patients is justified and has decreasing morbidity and mortality rates. Careful patient selection and operative planning are necessary, however. It is wise to have a diagnosis and staging done before the patient arrives in the operating suite. The surgeon should avoid extended resections when possible. In addition, elderly patients should be ambulated as soon as possible and adequate pain control should be ensured. Finally, the stage of the cancer and occurrence of cardiopulmonary complications are the main determinants of outcome.
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Affiliation(s)
- Elisabeth U Dexter
- Department of Surgery, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA.
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Hanna N, Brooks JA, Fyffe J, Kesler K. A retrospective analysis comparing patients 70 years or older to patients younger than 70 years with non-small-cell lung cancer treated with surgery at Indiana university: 1989-1999. Clin Lung Cancer 2003; 3:200-4. [PMID: 14662043 DOI: 10.3816/clc.2002.n.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Surgery remains the cornerstone of therapy for medically operable patients with early-stage non-small-cell lung cancer (NSCLC). However, there are few reports on the short-term morbidity and long-term survival following surgery in elderly patients with NSCLC. The surgical experience in 280 patients with NSCLC at Indiana University from 1989-1999 are reported with a comparison of patients who are >or= 70 years versus < 70 years of age. Preoperative characteristics, operative procedures, postoperative courses, and survival were compared between the age groups. Fifty percent of elderly patients had squamous cell carcinoma and 36.2% had adenocarcinoma, versus 41.3% and 44.4% in younger patients, respectively. In both groups, most patients had T1 or T2 tumors and N0 disease. The majority of patients in both age groups had a lobectomy. However, more patients younger than 70 years had chest wall resections and were more likely to undergo a pneumonectomy (19.5% vs. 6.9%). The median number of postoperative hospital days was shorter for younger patients (9 days vs. 11 days). Overall, more complications occurred in older patients, but no significant difference in cardiac or pulmonary complications was observed between the groups. There was no significant difference in survival between the age groups. This single-institution series demonstrates that surgical intervention for appropriately selected elderly patients with NSCLC results in similar complication rates and long-term survival when compared to their younger counterparts.
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Affiliation(s)
- Nasser Hanna
- Department of Medicine, Division of Oncology, Indiana University School of Medicine, Indianapolis, USA.
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Ahanger AG, Shabir S, Dar AM, Lone GN, Bhatt MA, Mir A, Wani RA. Early operative mortality after surgical treatment of bronchogenic carcinoma. Indian J Thorac Cardiovasc Surg 2003. [DOI: 10.1007/s12055-003-0013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Stoelben E, Sauerbrei W, Ludwig C, Hasse J. Tumor stage and early mortality for surgical resections in lung cancer. Langenbecks Arch Surg 2003; 388:116-21. [PMID: 12712342 DOI: 10.1007/s00423-003-0354-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2002] [Accepted: 12/24/2002] [Indexed: 10/25/2022]
Abstract
BACKGROUND Postoperative mortality rates have been published in relation to operative procedure or preexisting pulmonary and extrapulmonary diseases. We analyzed our patients for the effect of the postoperative tumor stage on perioperative mortality. PATIENTS AND METHODS Retrospective study of all thoracotomies for resections ( n=1281) in primary lung cancer from January 1987 to December 1997. Uni- and multivariate analysis was performed for operative procedure, mortality (30 and 90 days), tumor stage, sex, age, tumor localization, and completeness of resection. Radical resection was achieved in 91.9% of the patients. RESULTS Overall postoperative deaths occurred in 4% and 7.3% of patients after 30 and 90 days respectively. Depending on the operative procedure the mortality after segmental resection ( n=116) was 0.9% and 1.7%, lobectomy ( n=621) 3.0% and 5.7%, sleeve lobectomy ( n=152) 5.3% and 7.9%, and pneumonectomy ( n=314) 6.7% and 12.5%, respectively. Within 30 and 90 days postoperatively deaths occurred, respectively, in 0.8% and 1.0% of stage I patients ( n=493), 5.4% and 5.4% of stage II ( n=147), 4.9% and 8.8% of stage IIIa ( n=388), 7.2% and 16.6% of stage IIIb ( n=148), 8.9% and 20.5% and of stage IV ( n=114). Multivariate analysis showed postoperative tumor stage to be the factor most closely related to within the first 90 days. CONCLUSIONS Tumor stage but not type of resection is the strongest predictor of postoperative mortality in these subpopulations.
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Affiliation(s)
- Erich Stoelben
- Department of Thoracic Surgery, University Hospital, 79106, Freiburg, Germany.
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Sartori F, Zuin A, Grapeggia M, Rea F. Surgical Treatment of Bronchogenic Carcinoma in Elderly Patients. TUMORI JOURNAL 2002; 88:S141-2. [PMID: 11989909 DOI: 10.1177/030089160208800141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Alexiou C, Beggs D, Rogers ML, Beggs L, Asopa S, Salama FD. Pneumonectomy for non-small cell lung cancer: predictors of operative mortality and survival. Eur J Cardiothorac Surg 2001; 20:476-80. [PMID: 11509266 DOI: 10.1016/s1010-7940(01)00823-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The purpose of this study was to identify predictors of operative mortality and survival following pneumonectomy for non-small cell lung cancer (NSCLC). METHODS All 206 patients having a pneumonectomy for NSCLC between 1991 and 1997 in our unit were prospectively studied. There were 162 males (79%) and 44 females (21%) with a mean age (+/- standard deviation) of 61+/-7.7 years (range 34-81 years). Squamous cell (75%) and adenocarcinoma (17.0%) were the predominant histological types. The possible impact of 29 parameters on operative mortality and survival was tested with univariate and multivariate analysis. The mean follow-up was 2.3+/-1.2 years, ranging between 0 and 6.8 years, and it was complete. RESULTS Operative mortality was 6.8% (14 deaths). On multiple logistic regression older age (P=0.04) and the development post-operatively of bronchopleural fistula (BPF) (P=0.01) were independent predictors of operative mortality. The overall, Kaplan-Meier, 1-, 3- and 5-year survival (+/- standard error from the mean), inclusive of operative mortality, was 68+/-3.3, 42+/-4.1 and 35+/-4.5%. On Cox proportional hazards regression adenocarcinoma (P=0.006), the development of BPF (P=0.003), older age (P=0.03) and higher pathological stage (P=0.02) were independent adverse predictors of survival. CONCLUSION Pneumonectomy for NSCLC carries a considerable, but acceptable, operative mortality and provides an important survival benefit. This study suggests that older age and BPF are major determinants of an unfavourable in-hospital outcome; older age, BPF, adenocarcinoma cell type and higher pathological stage significantly reduce the probability of a long-term survival.
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Affiliation(s)
- C Alexiou
- Department of Cardiothoracic Surgery, City Hospital, NG5 1PB, Nottingham, UK
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Padilla J, Peñalver J, Calvo V, García Zarza A, Pastor J, Blasco E, París F. [Model of mortality risk in stage I non-small cell bronchogenic carcinoma]. Arch Bronconeumol 2001; 37:287-91. [PMID: 11412527 DOI: 10.1016/s0300-2896(01)75072-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To develop and validate a mortality risk model for patients with resected stage I non-small cell bronchogenic carcinoma (NSCBC). PATIENTS AND METHOD Tumors from 798 patients with diagnoses of NSCBC were resected and classified in stage I. The Kaplan-Meier method and Cox's proportional hazard model were used to analyze the influence of clinical and pathologic variables on survival. RESULTS Univariate analysis revealed that age (p = 0.0461), symptoms (p = 0.0383), histology (p = 0.0489) and tumor size (p = 0.0002) and invasion (p = 0.0010) affected survival. Size (p = 0.0000) and age (p = 0.0269) were entered into multivariate analysis. Each patient's risk was estimated by applying the regression equation derived from multivariate analysis; the mean was 1.47 +/- 0.31 (range 0.68 to 2.92). The series was divided into three groups by degree of risk (low, intermediate and high), establishing the cutoff points at 1.16 and 1.78 (standard deviation of the mean). Five-year survival rates were 85%, 62% and 46%, respectively (p = 0.0000). To validate the model's predictive capacity, the series was divided randomly into two groups: the study group with 403 patients and the validation group with 395. Age (p = 0.0295), symptoms (p = 0.0396), tumor size (p = 0.0010) and invasion (p = 0.0010) affected survival in the univariate analysis. Size (p = 0.0000) and age (p = 0.0358) were entered into Cox's model. Mean risk was 1.94 +/- 0.36 (range 0.98 to 3.32). The series was divided into three risk groups, with cut-off points established at 1.58 and 2.30. Five year survival rates were 90%, 62% and 46% for the low, intermediate and high risk groups, respectively (p = 0.0000). The same model proved able to identify risk when applied to the validation group, in which five-year survival rates were 78%, 61% and 48%, respectively (p = 0.0000). CONCLUSIONS Risk models can identify patient subgroups, potentially influenced by co-adjuvant treatment, as well as facilitate comparison of patient series.
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Affiliation(s)
- J Padilla
- Servicio de Cirugía Torácica, Hospital Universitario La Fe, Valencia, Spain.
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Varela G, Cordovilla R, Jiménez MF, Novoa N. Utility of standardized exercise oximetry to predict cardiopulmonary morbidity after lung resection. Eur J Cardiothorac Surg 2001; 19:351-4. [PMID: 11251278 DOI: 10.1016/s1010-7940(01)00570-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES To evaluate if desaturation, measured by finger oximetry on standardized exercise, accurately predicts cardiopulmonary morbidity after pulmonary resection. METHODS A prospective observational clinical study was carried out on 81 consecutive lung carcinoma patients scheduled for pulmonary resection from February 1998 to March 1999. Finger oximetry was monitored during an incremental to exhaustion cycle exercise test. The presence or absence of desaturation (cut-off value 90%) during exercise was recorded. Other independent analyzed variables were: age of the patient (over 75th percentile), body-mass index (BMI) (over 75th percentile), presence of major cardiovascular co-morbidity, and calculated postoperative FEV1% (under 25th percentile) according to the number of resected segments (ppoFEV1%). Postoperative cardiopulmonary morbidity was the evaluated dependent outcome. Fisher's exact test and risk calculation on contingency tables were used for statistical analysis. RESULTS A lobectomy was performed in 62 cases, a pneumonectomy was performed in 16 cases, and a segmentectomy was performed in three cases. The mean age of the patients was 63.6 years (SD 10.3, range 34-79 years, 75th percentile 72 years), the mean BMI was 25.9 (SD 4.9, range 16.9-38.1, 75th percentile 29.3), and the mean ppoFEV1% was 64.1 (SD 2016.1, range 29.5-98.6, 25th percentile 50.5). In 14 patients exercise desaturation was registered. Postoperative cardiopulmonary morbidity was presented in 32 cases (five deaths). No correlation was found between postoperative morbidity and any of the following variables: age of the patient, BMI, and co-morbidity. On univariate analysis only low ppoFEV1% (P<0.001) was associated with the outcome, so no multivariate analysis has been carried out. CONCLUSIONS We have shown that desaturation during standardized exercise in this series adds no relevant information to predict postoperative cardiorespiratory morbidity after lung resection.
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Affiliation(s)
- G Varela
- Section of Thoracic Surgery, Salamanca University Hospital, 37007, Salamanca, Spain.
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Goldstraw P. Age does not influence early and late tumor-related outcome after surgery for bronchogenic carcinoma. Ann Thorac Surg 2000; 69:678-9. [PMID: 10750743 DOI: 10.1016/s0003-4975(99)01513-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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