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Berntheizel EK, Tollefson LJ, Fischer CP, Stefanowicz ET. A Patient With Pancoast Tumor Presenting With Cervical Radiculopathy: A Case Report. J Chiropr Med 2023; 22:328-333. [PMID: 38205223 PMCID: PMC10774608 DOI: 10.1016/j.jcm.2023.07.003] [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: 12/31/2021] [Revised: 05/07/2023] [Accepted: 07/21/2023] [Indexed: 01/12/2024] Open
Abstract
Objective The purpose of this report was to describe a patient with a Pancoast tumor who presented for chiropractic care with neck and arm pain. Clinical Features A 52-year-old male patient with right-sided cervicothoracic pain and numbness in the right upper extremity presented to a chiropractic office for care. The patient reported an occupational history of repetitive lifting motions and overuse injuries. The patient denied history of smoking at the time of presentation. Intervention and Outcome Radiographic imaging revealed tracheal deviation. A chest computed tomography image demonstrated a large lesion in the apex of the right lung, suggestive of bronchogenic carcinoma. The patient was referred to an oncology clinic, where he admitted to having a 20-year history of smoking. The diagnosis of adenocarcinoma was made via biopsy, and the oncologist's evaluation confirmed the cancer to be stage IIIC. The patient received palliative care treatments, as the advanced state of his condition determined that he was not a candidate for surgical intervention. Conclusion Chiropractors and other first-contact health care providers must keep in mind unusual presentations masquerading as common conditions. This case demonstrates the importance of including apical lung tumors in the differential diagnosis of unilateral arm and neck pain and neurologic deficits of the upper extremity. This case demonstrates the importance of thorough follow-up on images ordered, including the ordering clinicians viewing the images themselves.
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Bertolaccini L, Casiraghi M, Galetta D, Petrella F, Mazzella A, Lo Iacono G, Girelli L, Bardoni C, Mohamed S, Musso V, Sedda G, Spaggiari L. Surgical management of superior sulcus tumors: A twenty-year experience of an oncological high volume referral centre. Front Oncol 2023; 12:1080765. [PMID: 36713583 PMCID: PMC9878845 DOI: 10.3389/fonc.2022.1080765] [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: 10/26/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
Objectives Superior sulcus tumour, which affects the lung's apex, is an uncommon subtype of non-small cell lung cancer (NSCLC). The current study examined the clinical characteristics and management of superior sulcus NSCLC patients in a high-volume referral oncological centre over 22 years. Methods Retrospective review of 100 surgeries with curative intent for superior sulcus NSCLC over 22 years (July 1998 - December 2020). The surgical approach was defined according to the lesion site and the anatomy of the thoracic inlet. Survival curves, including non-cancer-related deaths, were drawn using the Kaplan-Meier methods, and the log-rank test was used to evaluate differences in survival across groups of patients. Cox proportional hazards regression was used to assess the association between selected clinical and pathologic characteristics on OS. Results 54 patients received induction treatments. The surgical approach was anterior thoracotomy in 53 patients, Paulson incision in 30, and a combined in 8. The median postoperative length of stay was 11 days (range: 5 - 27 days). Overall 90-day mortality was 6.93%. The median OS was 24.3 months. After a median follow-up of 3 years, 5-year and 10-year OS rates were 33.9% and 26.4%, respectively. A significantly lower 5-year OS was observed in patients with the nodal disease (46.6% in pN0 vs 13.2% in pN+; p = 0.024), without preoperative treatments (41.0% in patients without preoperative treatments versus 17.4%; p = 0.09) and anteriorly located tumour (anterior vs posterior: 17.4% vs 49.1%; p = 0.032). Cox proportional hazards regression showed better survival in the pT1 stage (HR = 4.6; 95% CI: 1.9 - 11.2; p = 0.00076) and in R0 (HR = 4.2; 95% CI: 1.4 - 12.5; p = 0.010). Conclusions Superior sulcus tumours still represent a life-threatening condition that, while curable in a significant proportion of cases, requires complex procedures with high surgical risks and a multimodality treatment setting. An optimal surgical approach should be planned to maximise resection completeness and survival. Other factors affecting survival are related to tumour staging, emphasising the importance of a meticulous preoperative workup and candidate selection to identify those expected to benefit from a survival benefit.
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Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy,*Correspondence: Luca Bertolaccini,
| | - Monica Casiraghi
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Domenico Galetta
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Francesco Petrella
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Antonio Mazzella
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giorgio Lo Iacono
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Lara Girelli
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Claudia Bardoni
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Shehab Mohamed
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Valeria Musso
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giulia Sedda
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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3
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Wu CW, Chen JS, How CH. Resection of the mediastinal dedifferentiated liposarcoma with trachea compression via the Masaoka approach. Asian J Surg 2022; 45:2856-2857. [PMID: 35739027 DOI: 10.1016/j.asjsur.2022.06.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/10/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Cheng-Wei Wu
- Division of Thoracic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jer-Shen Chen
- Division of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Cheng-Hung How
- Division of Thoracic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
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Buja A, Pasello G, Schiavon M, De Luca G, Rivera M, Cozzolino C, De Polo A, Scioni M, Bortolami A, Baldo V, Conte P. Cost-effectiveness analysis of the new oncological drug durvalumab in Italian patients with stage III non-small cell lung cancer. Thorac Cancer 2022; 13:2692-2698. [PMID: 35971638 PMCID: PMC9527163 DOI: 10.1111/1759-7714.14531] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 12/03/2022] Open
Abstract
Background The monoclonal antibody durvalumab, an immune‐checkpoint inhibitor (ICI) antiprogrammed death ligand 1 (PD‐L1), is available for unresectable stage III NSCLC patients as consolidation therapy following induction chemoradiotherapy, with very promising overall survival (OS) and progression‐free survial (PFS) results in registration trials. The purpose of this study was to provide policymakers with an estimate of the cost‐effectiveness of durvalumab in the treatment of non‐small cell lung cancer (NSCLC). Methods The study developed a Markov model covering a 5‐year period to compare costs and outcomes of treating PD‐L1 positive patients with or without durvalumab. We conducted a series of sensitivity analyses (Tornado analysis and Monte Carlo simulation) by varying some parameters to assess the robustness of our model and identify the parameters with the greatest impact on cost‐effectiveness. Results Prior to the release of durvalumab, the management of NSCLC over a 5‐year period cost €33 317 per patient, with an average life expectancy of 2.01 years. After the introduction of the drug, this increased to €37 317 per patient, with an average life expectancy of 2.13 years. Treatment with durvalumab led to an incremental cost‐effectiveness ratio (ICER) of €35 526 per year. OS is the variable that contributes the most to the variability of the ICER. Conclusions The study observed that durvalumab is a cost‐effective treatment option for patients with unresectable stage III NSCLC.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giulia Pasello
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.,Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Marco Schiavon
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giuseppe De Luca
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Michele Rivera
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Claudia Cozzolino
- Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Anna De Polo
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Manuela Scioni
- Statistics Department, University of Padua, Padua, Italy
| | - Alberto Bortolami
- Rete Oncologica Veneta (ROV), Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Vincenzo Baldo
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - PierFranco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.,Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
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Wang S, Chen Z, Zhang K, Tan L, Ge D, Qi F, Zhang Y, Zhu T, Chen Z, Wang Q, Jiang W. Individualized surgical treatment for patients with tumours of the cervicothoracic junction. Interact Cardiovasc Thorac Surg 2021; 34:1024-1030. [PMID: 34849938 PMCID: PMC9159439 DOI: 10.1093/icvts/ivab297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/24/2021] [Accepted: 09/26/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The cervicothoracic junction is a special section that connects the neck, thoracic cavity, mediastinum and axilla. Tumours in the region often invade or compress surrounding tissues and organs, which makes the surgical treatment difficult. METHODS A retrospective analysis involving 69 patients with tumours at the cervicothoracic junction. Clinical data with regard to manifestation, surgical approach, resection degree, outcome and pathological types were collected. RESULTS A total of 48 cases of asymptomatic patients and 21 cases of patients with ≥1 clinical manifestation were enrolled in the study. Twenty-seven patients received radical resection with video-assisted thoracoscopic surgery. Anterior approach was the predominant treatment method in open surgery (25 cases, 36.2%), while the anterolateral approach was used in 8 cases (6 cases of hemiclamshell incisions and 2 cases of trap-door incisions). In addition, we observed 1 case of posterior approach, 2 cases of posterolateral approach and 1 case of supraclavicular approach combined with posterolateral approach. Pathological examination results revealed 67 cases of radical resection and 2 cases of microscopic residual. Neurilemmoma was the most widespread pathological type (30 cases, 43.5%), followed by tumour originating from fibrous tissues (5 cases, 7.2%). A 3-year overall survival rate of the 69 patients was 89.9%, while a 5-year overall survival rate was 85.5%. CONCLUSIONS Tumours associated with the cervicothoracic junction are characterized by their unique location, complex anatomy and various histopathological subtypes. An individualized approach during surgery enhances safety and standardized of treatments for patients with tumours located at the cervicothoracic junction.
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Affiliation(s)
- Shuai Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhencong Chen
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ke Zhang
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China.,Basic Research Key Laboratory of General Surgery for Digital Medicine, Baoding, China.,Institute of Life Science and Green Development, Hebei University, Baoding, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Di Ge
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fazhi Qi
- Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yong Zhang
- Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ting Zhu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zenggan Chen
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Jiang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Buja A, Rivera M, De Polo A, Brino ED, Marchetti M, Scioni M, Pasello G, Bortolami A, Rebba V, Schiavon M, Calabrese F, Mandoliti G, Baldo V, Conte P. Estimated direct costs of non-small cell lung cancer by stage at diagnosis and disease management phase: A whole-disease model. Thorac Cancer 2020; 12:13-20. [PMID: 33219738 PMCID: PMC7779199 DOI: 10.1111/1759-7714.13616] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/24/2020] [Accepted: 07/25/2020] [Indexed: 01/10/2023] Open
Abstract
Background Non‐small cell lung cancer (NSCLC) is the first cause of cancer‐related death among men and the second among women worldwide. It also poses an economic threat to the sustainability of healthcare services. This study estimated the direct costs of care for patients with NSCLC by stage at diagnosis, and management phase of pathway recommended in local and international guidelines. Methods Based on the most up‐to‐date guidelines, we developed a very detailed “whole‐disease” model listing the probabilities of all potentially necessary diagnostic and therapeutic actions involved in the management of each stage of NSCLC. We assigned a cost to each procedure, and obtained an estimate of the total and average per‐patient costs of each stage of the disease and phase of its management. Results The mean expected cost of a patient with NSCLC is 21,328 € (95% C.I. −20 897−22 322). This cost is 16 291 € in stage I, 19530 € in stage II, 21938 € in stage III, 22175 € in stage IV, and 28 711 € for a Pancoast tumor. In the early stages of the disease, the main cost is incurred by surgery, whereas in the more advanced stages radiotherapy, medical therapy, treatment for progressions, and supportive care become variously more important. Conclusions An estimation of the direct costs of care for NSCLC is fundamental in order to predict the burden of new oncological therapies and treatments on healthcare services, and thus orient the decisions of policy‐makers regarding the allocation of resources. Key points Significant findings of the study The high costs of surgery make the early stages of the disease no less expensive than the advanced stages. What this study adds An estimation of the direct costs of care is fundamental in order to orient the decisions of policy‐makers regarding the allocation of resources.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padua, Padua, Italy
| | - Michele Rivera
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padua, Padua, Italy
| | - Anna De Polo
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padua, Padua, Italy
| | | | | | - Manuela Scioni
- Statistics Department, University of Padua, Padua, Italy
| | - Giulia Pasello
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | | | - Vincenzo Rebba
- "Marco Fanno" Department of Economics and Management, University of Padua, Padua, Italy
| | - Marco Schiavon
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padua, Padua, Italy
| | - Fiorella Calabrese
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padua, Padua, Italy
| | - Giovanni Mandoliti
- U.O.C. Radioterapia oncologica, Ospedale Santa Maria della Misericordia, AULSS 5 "Polesana", Rovigo, Italy
| | - Vincenzo Baldo
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padua, Padua, Italy
| | - PierFranco Conte
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy.,Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
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Hao X, Wang Z, Cheng D, Zhou J, Chen N, Pu Q, Liu L. The Favorable Prognostic Factors for Superior Sulcus Tumor: A Systematic Review and Meta-Analysis. Front Oncol 2020; 10:561935. [PMID: 33194629 PMCID: PMC7606951 DOI: 10.3389/fonc.2020.561935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/01/2020] [Indexed: 02/05/2023] Open
Abstract
Background: Superior sulcus tumor is a rare non-small cell lung cancer with poor prognosis. Exploring the potential prognostic factors of patients with superior sulcus tumor and adopting individualized treatment for patients with different prognostic factors are of great significance for the prolongation of patients' lives. To figure out the prognostic factors of upper sulcus tumors, a meta-analysis was conducted. Method: We searched all the articles published until January 2020 in PubMed, Embase, and Web of Science databases, and the search strategy included the following terms, combining superior sulcus tumor and prognosis. Hazard ratio (HR) with associated confidential interval (CI) was evaluated for the purpose of investigating prognostic factors for superior sulcus tumor. STATA 16.0 was used for analysis of extracted data and assessment of publication bias. Result: Fifteen eligible studies, which had 1,009 patients with superior sulcus tumor, were included in this meta-analysis. The studies were published between 1994 and 2018, and the patient recruitment periods ranged from 1974 to 2016. The median follow-up time ranged from 18 to 95 months. The meta-analysis indicated that lower T stage (HR, 1.63; 95% CI, 1.35–1.97), lower N stage (HR, 3.08; 95% CI: 2.37–3.99), negative surgical margin (HR, 0.25; 95% CI, 0.17–0.38), and pathologic complete response (HR, 0.55; 95% CI, 0.39–0.77) were favorable prognostic factors. Conclusion: We found that T stage, N stage, surgical margin, and pathologic complete response are prognostic factors for superior sulcus tumor. To reach a better long-term survival, patients with these negative prognostic factors may need a more aggressive treatment, while more studies should be conducted to further validate these results and explore a more effective treatment.
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Affiliation(s)
- Xiaohu Hao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Zihuai Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Diou Cheng
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jian Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Nan Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
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Treatment of clinical T4 stage superior sulcus non-small cell lung cancer: a propensity-matched analysis of the surveillance, epidemiology, and end results database. Biosci Rep 2019; 39:BSR20181545. [PMID: 30647107 PMCID: PMC6356038 DOI: 10.1042/bsr20181545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/06/2018] [Accepted: 01/13/2019] [Indexed: 02/02/2023] Open
Abstract
Purpose/Objective(s): Treatments for superior sulcus non-small cell lung cancer (SS-NSCLC) have evolved, but adequate treatments of T4 disease have not been found. The aim of our study was to evaluate the prognostic factors and optimal treatment strategy for patients with T4 SS-NSCLC. Materials/Methods: We utilized the Surveillance, Epidemiology, and End Results (SEER) database (1973–2015) to identify patients diagnosed with T4 stage SS-NSCLC (according to the 7th edition American Joint Committee on Cancer (AJCC) staging system) from 2004 to 2015; those with M1 disease were excluded. Propensity score matching (PSM) with Kaplan–Meier and Cox proportional hazards’ models was performed to estimate prognosis. Results: A total of 384 patients were included. The majority was male (59.4%) at stage IIIB (56.6%), with N2 accounting for 45.3%. A total of 47 patients underwent cancer-directed surgery, while radiotherapy alone was received by 60.2% of patients. Median overall survival (OS) and lung cancer-specific survival (LCSS) were 12 and 17 months, respectively, and the 5-year OS and LCSS rates were 15.8 and 25.4%, respectively. In the matched population, the median survival outcomes were better following surgery (OS: 25 compared with 9.0 months, P<0.001; LCSS: not available (NA) compared with 11.0 months, P<0.001). Multivariate Cox analysis showed that ages ≥ 66 years (hazard ratio (HR) = 1.639, P=0.001), unmarried status (HR = 1.356, P=0.034), and tumor size ≥ 6.0 cm (HR = 1.694, P<0.001) were associated with inferior OS. Cancer-directed surgery (HR = 0.537, P=0.009) and radiotherapy (HR = 0.644, P=0.006) were independent prognostic factors for patients with T4 SS-NSCLC. Conversely, in the subgroup analysis, favorable impacts of radiotherapy were observed for nonsurgical patients (OS: HR = 0.58, P<0.001; LCSS: HR = 0.55, P<0.001). Conclusion: Our study showed that T4 stage SS-NSCLC patients had a poor prognosis. Surgical resection remains the best option for those with resectable disease. For nonsurgical T4 SS-NSCLC patients, radiotherapy should be actively considered.
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9
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Mariolo AV, Casiraghi M, Galetta D, Spaggiari L. Robotic Hybrid Approach for an Anterior Pancoast Tumor in a Severely Obese Patient. Ann Thorac Surg 2018; 106:e115-e116. [PMID: 29654726 DOI: 10.1016/j.athoracsur.2018.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 02/28/2018] [Accepted: 03/04/2018] [Indexed: 11/30/2022]
Abstract
Several different surgical approaches to anterior Pancoast tumors have been proposed. The osteomuscular-sparing transmanubrial approach allows optimal exposure and control of apical chest wall structures, but it requires an additional thoracotomy to perform the lobectomy with radical lymph node resection. The presented technique combines the osteomuscular-sparing transmanubrial approach with robotic-assisted upper lobectomy in a severely obese patient, thereby reducing the invasiveness of the surgical approach and the postoperative complications.
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Affiliation(s)
- Alessio Vincenzo Mariolo
- Division of Thoracic Surgery, European Institute of Oncology, University of Milan, Milan, Italy.
| | - Monica Casiraghi
- Division of Thoracic Surgery, European Institute of Oncology, University of Milan, Milan, Italy
| | - Domenico Galetta
- Division of Thoracic Surgery, European Institute of Oncology, University of Milan, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, University of Milan, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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10
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McFadden PM, Wiggins LM. Assessment of Contemporary Aggressive Surgical Resection for Superior Sulcus and Pancoast Lung Tumors. Semin Thorac Cardiovasc Surg 2017; 29:89-90. [PMID: 28684005 DOI: 10.1053/j.semtcvs.2017.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2017] [Indexed: 11/11/2022]
Affiliation(s)
- P Michael McFadden
- Division of Cardiothoracic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
| | - Luke M Wiggins
- Division of Cardiothoracic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
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