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Takatsu F, Suzawa K, Okazaki M, Shien K, Yamamoto H, Watanabe M, Hayama M, Ueno T, Sugimoto R, Maki Y, Fujiwara T, Okita R, Inokawa H, Tao H, Hirami Y, Matsuda E, Kataoka K, Yamashita M, Sano Y, Matsuura M, Mizutani H, Toyooka S. Clinical Features of Patients With Second Primary Lung Cancer After Head and Neck Cancer. Ann Thorac Surg 2024; 117:181-188. [PMID: 35595090 DOI: 10.1016/j.athoracsur.2022.04.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/17/2022] [Accepted: 04/13/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND In survivors of head and neck cancer (HNC), second primary lung cancer (SPLC) often develop as a result of a common risk factor, that is, smoking. A multicenter experience was reviewed to evaluate how the history of a diagnosis of HNC affects the outcomes of patients undergoing pulmonary resection for SPLC. METHODS A multicenter retrospective analysis of patients hospitalized between January 2012 and December 2018 was performed. From a cohort of 4521 patients undergoing therapeutic pulmonary resection for primary non-small cell lung cancer, 100 patients with a previous history of HNC (HNC group) were identified. These patients were compared with a control group consisting of 200 patients without an HNC history from the same cohort pair-matched with operating facility, age, sex, and pathologic stage of lung cancer. RESULTS At the time of surgery for SPLC, the HNC group showed malnutrition with a lower prognostic nutritional index compared with the control group (P < .001). The HNC group was determined to have postoperative complications more frequently (P = .02). The 5-year overall survival rates in the HNC and control groups were 59.0% and 83.2%, respectively (P < .001). Statistically, HNC history, lower prognostic nutritional index, squamous cell lung cancer, and TNM stage were identified to be independently associated with poor survival. CONCLUSIONS Patients with SPLC after primary HNC often present with malnutrition and are predisposed to postoperative complications and poor survival after pulmonary resection.
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Affiliation(s)
- Fumiaki Takatsu
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan; Okayama University Thoracic Surgery Study Group, Okayama, Japan
| | - Ken Suzawa
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan; Okayama University Thoracic Surgery Study Group, Okayama, Japan.
| | - Mikio Okazaki
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan; Okayama University Thoracic Surgery Study Group, Okayama, Japan
| | - Kazuhiko Shien
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan; Okayama University Thoracic Surgery Study Group, Okayama, Japan
| | - Hiromasa Yamamoto
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan; Okayama University Thoracic Surgery Study Group, Okayama, Japan
| | - Mototsugu Watanabe
- Okayama University Thoracic Surgery Study Group, Okayama, Japan; Department of Thoracic Surgery, National Hospital Organization Iwakuni Clinical Center, Yamaguchi, Japan
| | - Makio Hayama
- Okayama University Thoracic Surgery Study Group, Okayama, Japan; Department of Thoracic Surgery, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Tsuyoshi Ueno
- Okayama University Thoracic Surgery Study Group, Okayama, Japan; Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | - Ryujiro Sugimoto
- Okayama University Thoracic Surgery Study Group, Okayama, Japan; Department of Thoracic Surgery, Ehime University Hospital, Ehime, Japan
| | - Yuho Maki
- Okayama University Thoracic Surgery Study Group, Okayama, Japan; Department of Thoracic Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Toshiya Fujiwara
- Okayama University Thoracic Surgery Study Group, Okayama, Japan; Department of Thoracic Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Riki Okita
- Okayama University Thoracic Surgery Study Group, Okayama, Japan; Department of Thoracic Surgery, National Hospital Organization Yamaguchi-Ube Medical Center, Yamaguchi, Japan
| | - Hidetoshi Inokawa
- Okayama University Thoracic Surgery Study Group, Okayama, Japan; Department of Thoracic Surgery, National Hospital Organization Yamaguchi-Ube Medical Center, Yamaguchi, Japan
| | - Hiroyuki Tao
- Okayama University Thoracic Surgery Study Group, Okayama, Japan; Department of Thoracic Surgery, Japanese Red Cross Society Himeji Hospital, Hyogo, Japan
| | - Yuji Hirami
- Okayama University Thoracic Surgery Study Group, Okayama, Japan; Department of Thoracic Surgery, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Eisuke Matsuda
- Okayama University Thoracic Surgery Study Group, Okayama, Japan; Department of Thoracic Surgery, Saiseikai Imabari Hospital, Ehime, Japan
| | - Kazuhiko Kataoka
- Okayama University Thoracic Surgery Study Group, Okayama, Japan; Department of Thoracic Surgery, National Hospital Organization Iwakuni Clinical Center, Yamaguchi, Japan
| | - Motohiro Yamashita
- Okayama University Thoracic Surgery Study Group, Okayama, Japan; Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | - Yoshifumi Sano
- Okayama University Thoracic Surgery Study Group, Okayama, Japan; Department of Thoracic Surgery, Ehime University Hospital, Ehime, Japan
| | - Motoki Matsuura
- Okayama University Thoracic Surgery Study Group, Okayama, Japan; Department of Thoracic Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Hisao Mizutani
- Okayama University Thoracic Surgery Study Group, Okayama, Japan; Department of Thoracic Surgery, Japanese Red Cross Society Himeji Hospital, Hyogo, Japan
| | - Shinichi Toyooka
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan; Okayama University Thoracic Surgery Study Group, Okayama, Japan
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Wu Q, Zou S, Liu W, Liang M, Chen Y, Chang J, Liu Y, Yu X. A novel onco-cardiological mouse model of lung cancer-induced cardiac dysfunction and its application in identifying potential roles of tRNA-derived small RNAs. Biomed Pharmacother 2023; 165:115117. [PMID: 37406509 DOI: 10.1016/j.biopha.2023.115117] [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: 05/20/2023] [Revised: 06/28/2023] [Accepted: 07/01/2023] [Indexed: 07/07/2023] Open
Abstract
An increasing body of research suggests cancer-induced cardiovascular diseases, leading to the appearance of an interdisciplinary study known as onco-cardiology. Lung cancer has the highest incidence and mortality. Cardiac dysfunction constitutes a major cause of death in lung cancer patients. However, its mechanism has not been elucidated because suitable animal models that adequately mimic clinical features are lacking. Here, we established a novel chemically induced lung cancer mouse model using benzo[a]pyrene and urethane to recapitulate the general characteristics of cardiac dysfunction caused by lung cancer, the cardiac disorders in the context of the progression of lung cancer were evaluated using echocardiographic and histological approaches. The pathological changes included myocardial ischaemia, pericarditis, cardiac pre-cachexia, and pulmonary artery hypertension. We performed sequencing to detect the tRNA-derived fragments and tRNA-derived stress-induced RNAs (tRFs/tiRNAs) expressions in mouse heart tissue. 22 upregulated and 16 downregulated tRFs/tiRNAs were identified. Subsequently, the top 10 significant results of Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were presented. The in vitro model was established by exposing neonatal rat cardiomyocytes and myocardial fibroblasts to lung tumour cell-conditioned medium, respectively. Western blotting revealed significant changes in cardiac failure markers (atrial natriuretic peptide and α-myosin heavy chain) and cardiac fibrosis markers (Collagen-1 and Collagen-3). Our model adequately reflects the pathological features of lung cancer-induced cardiac dysfunction. Furthermore, the altered tRF/tiRNA profiles showed great promise as novel targets for therapies. These results might pave the way for research on therapeutic targets in onco-cardiology.
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Affiliation(s)
- Qian Wu
- Department of Pharmacology, the Municipal & Provincial Key Laboratory of Molecular Target & Clinical Pharmacology, National Medical Products Administration & State Key Laboratory of Respiratory Disease, School of Pharmaceutical Sciences & The Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou 511436, PR China
| | - Shiting Zou
- Department of Pharmacology, the Municipal & Provincial Key Laboratory of Molecular Target & Clinical Pharmacology, National Medical Products Administration & State Key Laboratory of Respiratory Disease, School of Pharmaceutical Sciences & The Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou 511436, PR China
| | - Wanjie Liu
- Department of Pharmacology, the Municipal & Provincial Key Laboratory of Molecular Target & Clinical Pharmacology, National Medical Products Administration & State Key Laboratory of Respiratory Disease, School of Pharmaceutical Sciences & The Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou 511436, PR China
| | - Miao Liang
- Department of Pharmacology, the Municipal & Provincial Key Laboratory of Molecular Target & Clinical Pharmacology, National Medical Products Administration & State Key Laboratory of Respiratory Disease, School of Pharmaceutical Sciences & The Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou 511436, PR China
| | - Yuling Chen
- Department of Pharmacology, the Municipal & Provincial Key Laboratory of Molecular Target & Clinical Pharmacology, National Medical Products Administration & State Key Laboratory of Respiratory Disease, School of Pharmaceutical Sciences & The Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou 511436, PR China
| | - Jishuo Chang
- Department of Pharmacology, the Municipal & Provincial Key Laboratory of Molecular Target & Clinical Pharmacology, National Medical Products Administration & State Key Laboratory of Respiratory Disease, School of Pharmaceutical Sciences & The Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou 511436, PR China
| | - Yinghua Liu
- Department of Pharmacology, the Municipal & Provincial Key Laboratory of Molecular Target & Clinical Pharmacology, National Medical Products Administration & State Key Laboratory of Respiratory Disease, School of Pharmaceutical Sciences & The Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou 511436, PR China.
| | - Xiyong Yu
- Department of Pharmacology, the Municipal & Provincial Key Laboratory of Molecular Target & Clinical Pharmacology, National Medical Products Administration & State Key Laboratory of Respiratory Disease, School of Pharmaceutical Sciences & The Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou 511436, PR China.
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Peng C, Yang F, Peng L, Zhang C, Lin Z, Chen C, Gao H, He J, Jin Z. Temporal trends and outcomes in acute ischaemic stroke patients with a current or historical diagnosis of cancer. Eur J Neurol 2023; 30:951-962. [PMID: 36704907 DOI: 10.1111/ene.15699] [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: 12/06/2022] [Revised: 12/24/2022] [Accepted: 01/12/2023] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE The aim was to evaluate the temporal trends, characteristics and in-hospital outcomes of patients hospitalized with acute ischaemic stroke (AIS) between those with and without current or historical malignancies. METHODS Adult hospitalizations with a primary diagnosis of AIS were identified from the National Inpatient Sample database 2007-2017. Logistic regression was used to compare the differences in the utilization of AIS interventions and in-hospital outcomes. For further analysis, subgroup analyses were performed stratified by cancer subtypes. RESULTS There were 892,862 hospitalizations due to AIS, of which 108,357 (12.14%) had a concurrent diagnosis of current cancer (3.41%) or historical cancer (8.72%). After adjustment for confounders, patients with current malignancy were more likely to have worse clinical outcomes. The presence of historical cancers was not associated with an increase in poor clinical outcomes. Additionally, AIS patients with current malignancy were less likely to receive intravenous thrombolysis (adjusted odds ratio 0.66, 95% confidence interval 0.63-0.71). Amongst the subgroups of AIS patients treated with intravenous thrombolysis or mechanical thrombectomy, outcomes varied by cancer types. Notably, despite these acute stroke interventions, outcome remains poor in AIS patients with lung cancer. CONCLUSIONS Although AIS patients with malignancy generally have worse in-hospital outcomes versus those without, there were considerable variations in these outcomes according to different cancer types and the use of AIS interventions. Finally, treatment of these AIS patients with a current or historical cancer diagnosis should be individualized.
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Affiliation(s)
- Chi Peng
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Fan Yang
- Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Third Military Medical University (Army Medical University) and Key Laboratory of Tumor Immunopathology, Ministry of Education of China, Chongqing, China
| | - Liwei Peng
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Chenxu Zhang
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Zhen Lin
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Chenxin Chen
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Huachen Gao
- Department of Plastic Surgery and Burns, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Jia He
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Zhichao Jin
- Department of Health Statistics, Naval Medical University, Shanghai, China
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Fujii M, Morishima T, Nagayasu M, Kudo H, Ohno Y, Sobue T, Miyashiro I. Cause of Death among Long-Term Cancer Survivors: The NANDE Study. Healthcare (Basel) 2023; 11:healthcare11060835. [PMID: 36981492 PMCID: PMC10048527 DOI: 10.3390/healthcare11060835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 03/18/2023] Open
Abstract
Survival information for Japanese patients with cancer is based only on survival status and the cause of death among these patients remains unclear. In this study, Osaka Cancer Registry data (1985–2014) and vital statistics data (1985–2016) were linked to create a database, permitting the extraction of data on the causes of death. In total, 522,566 subjects diagnosed with cancer between 1995 and 2011 were analyzed. Follow-up for vital status was conducted 5 and 10 years after cancer diagnosis. To evaluate the three causes of death (index cancer, non-index cancer, and non-cancer death), cause-specific hazard and cumulative incidence functions were estimated using a life table and Gray’s methods. The number of deaths owing to any of the causes in the observation period (median: 3.51 years, mean: 4.90 years) was 394,146. The 5- and 10-year cancer-specific survival rate was 48.56% and 39.92%, respectively. Immediately after cancer onset, the hazard of index cancer death was high. The proportion of non-index cancer deaths was high in patients with mouth and pharynx cancers. The hazard of index cancer death remained constant for breast and liver cancers. In prostate, breast, and laryngeal cancers with good prognosis, the hazard of non-index cancer and non-cancer death constantly increased.
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Affiliation(s)
- Makoto Fujii
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Suita 5650871, Osaka, Japan
- Correspondence: ; Tel.: +81-6-6879-2614
| | - Toshitaka Morishima
- Cancer Control Center, Osaka International Cancer Institute Otemae, 3-1-69, Osaka 5418567, Osaka, Japan
| | - Mayumi Nagayasu
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Suita 5650871, Osaka, Japan
| | - Haruka Kudo
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Suita 5650871, Osaka, Japan
- Cancer Control Center, Osaka International Cancer Institute Otemae, 3-1-69, Osaka 5418567, Osaka, Japan
| | - Yuko Ohno
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Suita 5650871, Osaka, Japan
| | - Tomotaka Sobue
- Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita 5650871, Osaka, Japan
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute Otemae, 3-1-69, Osaka 5418567, Osaka, Japan
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Herbach E, O'Rorke MA, Carnahan RM, McDowell BD, Allen B, Grumbach I, London B, Smith BJ, Spitz DR, Seaman A, Chrischilles EA. Cardiac Adverse Events Associated With Chemo-Radiation Versus Chemotherapy for Resectable Stage III Non-Small-Cell Lung Cancer: A Surveillance, Epidemiology and End Results-Medicare Study. J Am Heart Assoc 2022; 11:e027288. [PMID: 36453633 PMCID: PMC9851429 DOI: 10.1161/jaha.122.027288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background We compared cardiac outcomes for surgery-eligible patients with stage III non-small-cell lung cancer treated adjuvantly or neoadjuvantly with chemotherapy versus chemo-radiation therapy in the Surveillance, Epidemiology and End Results-Medicare database. Methods and Results Patients were age 66+, had stage IIIA/B resectable non-small-cell lung cancer diagnosed between 2007 and 2015, and received adjuvant or neoadjuvant chemotherapy or chemo-radiation within 121 days of diagnosis. Patients having chemo-radiation and chemotherapy only were propensity-score matched and followed from day 121 to first cardiac outcome, noncardiac death, radiation initiation by patients who received chemotherapy only, fee-for-service enrollment interruption, or December 31, 2016. Cause-specific hazard ratios (HRs) and competing risks subdistribution HRs were estimated. The primary outcome was the first of these severe cardiac events: acute myocardial infarction, other hospitalized ischemic heart disease, hospitalized heart failure, percutaneous coronary intervention/coronary artery bypass graft, cardiac death, or urgent/inpatient care for pericardial disease, conduction abnormality, valve disorder, or ischemic heart disease. With median follow-up of 13 months, 70 of 682 patients who received chemo-radiation (10.26%) and 43 of 682 matched patients who received chemotherapy only (6.30%) developed a severe cardiac event (P=0.008) with median time to first event 5.45 months. Chemo-radiation increased the rate of severe cardiac events (cause-specific HR: 1.62 [95% CI, 1.11-2.37] and subdistribution HR: 1.41 [95% CI, 0.97-2.04]). Cancer severity appeared greater among patients who received chemo-radiation (noncardiac death cause-specific HR, 2.53 [95% CI, 1.93-3.33] and subdistribution HR, 2.52 [95% CI, 1.90-3.33]). Conclusions Adding radiation therapy to chemotherapy is associated with an increased risk of severe cardiac events among patients with resectable stage III non-small-cell lung cancer for whom survival benefit of radiation therapy is unclear.
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Affiliation(s)
- Emma Herbach
- Department of Epidemiology, College of Public HealthUniversity of IowaIowa CityIA
| | - Michael A. O'Rorke
- Department of Epidemiology, College of Public HealthUniversity of IowaIowa CityIA
- Holden Comprehensive Cancer CenterUniversity of IowaIowa CityIA
| | - Ryan M. Carnahan
- Department of Epidemiology, College of Public HealthUniversity of IowaIowa CityIA
| | | | - Bryan Allen
- Holden Comprehensive Cancer CenterUniversity of IowaIowa CityIA
- Department of Radiation Oncology, Carver College of MedicineUniversity of IowaIowa CityIA
| | - Isabella Grumbach
- Division of Cardiovascular Medicine, Department of Internal Medicine and Abboud Cardiovascular Research CenterUniversity of IowaIowa CityIA
- Department of Internal Medicine, Carver College of MedicineUniversity of IowaIowa CityIA
| | - Barry London
- Division of Cardiovascular Medicine, Department of Internal Medicine and Abboud Cardiovascular Research CenterUniversity of IowaIowa CityIA
- Department of Internal Medicine, Carver College of MedicineUniversity of IowaIowa CityIA
| | - Brian J. Smith
- Holden Comprehensive Cancer CenterUniversity of IowaIowa CityIA
- Department of Biostatistics, College of Public HealthUniversity of IowaIowa CityIA
| | - Douglas R. Spitz
- Holden Comprehensive Cancer CenterUniversity of IowaIowa CityIA
- Department of Radiation Oncology, Carver College of MedicineUniversity of IowaIowa CityIA
| | - Aaron Seaman
- Holden Comprehensive Cancer CenterUniversity of IowaIowa CityIA
- Department of Internal Medicine, Carver College of MedicineUniversity of IowaIowa CityIA
| | - Elizabeth A. Chrischilles
- Department of Epidemiology, College of Public HealthUniversity of IowaIowa CityIA
- Holden Comprehensive Cancer CenterUniversity of IowaIowa CityIA
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Yang SP, Rao MY, Chen QS, Zhou P, Lian CL, Wu SG. Causes of Death in Long-Term Nasopharyngeal Carcinoma Survivors. Front Public Health 2022; 10:912843. [PMID: 35875003 PMCID: PMC9301133 DOI: 10.3389/fpubh.2022.912843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/31/2022] [Indexed: 12/08/2022] Open
Abstract
Purpose To assess the causes of death (COD) and long-term survival after nasopharyngeal carcinoma (NPC) diagnosis. Methods Using linked data from the Surveillance, Epidemiology, and End Results program, patients with NPC diagnosed from 1990 to 2010 and followed up >5 years were identified. Chi-squared test, the Kaplan–Meier method, and the Cox proportional hazard model were used for analyses. Results Among the 3,036 long-term NPC survivors, 1,432 survived for >5–10 years and 1,604 survived for >10 years. The most common COD was primary NPC (36.9%), followed by other causes (28.7%), other cancers (15.3%), cardiac disease (12.9%), and non-malignant pulmonary disease (6.2%). With a median follow-up of 125 months, deaths from NPC decreased with increasing time from diagnosis, while death because of cardiac disease and other causes increased. In those aged <50 years, death due to NPC remained the main COD over time, while cardiopulmonary disease-related death was the leading COD in patients aged ≥50 years. In White patients, death due to NPC decreased, and death due to cardiac disease increased over time. Death from NPC remained significant in Black and Asian patients even 15 years after the diagnosis of NPC, while death due to cardiac disease significantly increased after 9 years of diagnosis in Black patients. Multivariate analyses showed that the independent factors associated with inferior NPC-specific survival were older age, Asians, American Indian/Alaska Native, regional stage, distant stage, and diagnosis in the early years. Conclusions The probability of death from primary NPC remains significant even 15 years after the NPC diagnosis. Our study advocates continued surveillance for NPC survivors beyond the traditional 5 years. Individualized follow-up strategies are required for patients with NPC of different ages and races.
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Affiliation(s)
- Shi-Ping Yang
- Department of Radiation Oncology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Ming-Yue Rao
- Department of Radiology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Qing-Shuang Chen
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Ping Zhou
- Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Chen-Lu Lian
- Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- *Correspondence: San-Gang Wu
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Wu XQ, Li JY, Du WJ. Causes of death following small cell lung cancer diagnosis: a population-based analysis. BMC Pulm Med 2022; 22:262. [PMID: 35787685 PMCID: PMC9254402 DOI: 10.1186/s12890-022-02053-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/21/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To examine the distribution of causes of death (CODs) in patients with small cell lung cancer (SCLC). METHODS Patients diagnosed with SCLC were identified from the Surveillance, Epidemiology, and End Results Program database during 2004-2015. Standardized mortality rates (SMRs) were performed for each COD to present changes in risk for a particular COD following SCLC diagnosis. RESULTS A total of 44,506 patients diagnosed with SCLC were identified in this study, and 42,476 patients died during the follow-up. Of total deaths, 69.5% occurred within the first years after diagnosis, 26% occurred from 1 to 3 years, and 4.5% individuals survived longer than 3 years. In addition, 88.7% of deaths were caused by SCLC, followed by non-cancer causes (7.1%) and other cancers (4.2%). Moreover, non-cancer CODs increased from 6.3 to 30% over time after 3 years of diagnosis. As for non-cancer CODs, cardiovascular diseases, COPD, and septicemia were the most common in SCLC. CONCLUSION Non-cancer CODs, such as cardiovascular events, COPD and septicemia, contribute to a considerable proportion of deaths among long-term SCLC survivors, supporting the involvement of multidisciplinary care for the follow-up strategy in SCLC.
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Affiliation(s)
- Xue-Qin Wu
- Department of Radiotherapy, Shanxi Province Cancer Hospital, Taiyuan, 030000, Shanxi, China.,Department of Radiotherapy, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Taiyuan, 030000, Shanxi, China.,Department of Radiotherapy, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030000, Shanxi, China
| | - Jing-Yi Li
- Department of Radiotherapy, Shanxi Province Cancer Hospital, Taiyuan, 030000, Shanxi, China.,Department of Radiotherapy, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Taiyuan, 030000, Shanxi, China.,Department of Radiotherapy, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030000, Shanxi, China
| | - Wen-Jing Du
- Department of Radiotherapy, Shanxi Province Cancer Hospital, Taiyuan, 030000, Shanxi, China. .,Department of Radiotherapy, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Taiyuan, 030000, Shanxi, China. .,Department of Radiotherapy, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030000, Shanxi, China.
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Coronary Artery Disease and Cancer: Treatment and Prognosis Regarding Gender Differences. Cancers (Basel) 2022; 14:cancers14020434. [PMID: 35053596 PMCID: PMC8774086 DOI: 10.3390/cancers14020434] [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: 11/11/2021] [Revised: 01/04/2022] [Accepted: 01/12/2022] [Indexed: 12/27/2022] Open
Abstract
Simple Summary Cardiovascular disease and cancer are the leading causes of hospitalization and mortality in high-income countries. Studies of myocardial infarction show a disadvantage for the female sex in terms of survival and development of heart failure after myocardial infarction. The extent to which this also applies to the co-occurrence of coronary heart disease and cancer was investigated and analyzed here in large registry studies. Particular attention has been paid to the four most common cancers and hematologic diseases associated with coronary artery disease requiring treatment. Abstract Cardiovascular disease and cancer remain the leading causes of hospitalization and mortality in high-income countries. Survival after myocardial infarction has improved but there is still a difference in clinical outcome, mortality, and developing heart failure to the disadvantage of women with myocardial infarction. Most major cardiology trials and registries have excluded patients with cancer. As a result, there is only very limited information on the effects of coronary artery disease in cancer patients. In particular, the outcomes in women with cancer and coronary artery disease and its management remain empiric. We reviewed studies of over 27 million patients with coronary artery disease and cancer. Our review focused on the most important types of cancer (breast, colon, lung, prostate) and hematological malignancies with particular attention to sex-specific differences in treatment and prognosis.
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Moreno-Rubio J, Ponce S, Álvarez R, Olmedo ME, Falagan S, Mielgo X, Navarro F, Cruz P, Cabezón-Gutiérrez L, Aguado C, Colmenarejo G, Muñoz-Fernández de Leglaria M, Enguita AB, Cebollero M, Benito A, Alemany I, Del Castillo C, Ramos R, Ramírez de Molina A, Casado E, Sereno M. Clinical-pathological and molecular characterization of long-term survivors with advanced non-small cell lung cancer. Cancer Biol Med 2021; 17:444-457. [PMID: 32587780 PMCID: PMC7309469 DOI: 10.20892/j.issn.2095-3941.2019.0363] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/17/2020] [Indexed: 01/07/2023] Open
Abstract
Objective: Long-term survivors (LS) of non-small cell lung cancer (NSCLC) without driver alterations, displaying an overall survival (OS) of more than 3 years, comprise around 10% of cases in several series treated with chemotherapy. There are classical prognosis factors for these cases [stage, Eastern Cooperative Oncology Group (ECOG), etc.], but more data are required in the literature. In this multi-center study, we focused on LS of advanced NSCLC with OS above 36 months to perform a clinical-pathological and molecular characterization. Methods: In the first step, we conducted a clinical-pathological characterization of the patients. Afterwards, we carried out a genetic analysis by comparing LS to a sample of short-term survivors (SS) (with an OS less than 9 months). We initially used whole-genome RNA-seq to identify differentiating profiles of LS and SS, and later confirmed these with reverse transcription-polymerase chain reaction (RT-PCR) for the rest of the samples. Results: A total of 94 patients were included, who were mainly men, former smokers, having adenocarcinoma (AC)-type NSCLC with an ECOG of 0–1. We obtained an initial differential transcriptome expression, displaying 5 over- and 33 under-expressed genes involved in different pathways: namely, the secretin receptor, surfactant protein, trefoil factor 1 (TFF1), serpin, Ca-channels, and Toll-like receptor (TLRs) families. Finally, RT-PCR analysis of 40 (20 LS/20 SS) samples confirmed that four genes (surfactant proteins and SFTP) were significantly down-regulated in SS compared to LS by using an analysis of covariance (ANCOVA) model: SFTPA1 (P = 0.023), SFTPA2 (P = 0.027), SFTPB (P = 0.02), and SFTPC (P = 0.047). Conclusions: We present a sequential genetic analysis of a sample of NSCLC LS with no driver alterations, obtaining a differential RNA-seq/RT-PCR profile showing an abnormal expression of SF genes.
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Affiliation(s)
| | | | - Rosa Álvarez
- Gregorio Marañón University Hospital, Madrid 28009, Spain
| | | | - Sandra Falagan
- Infanta Sofía University Hospital, San Sebastián De Los Reyes, Madrid 28702, Spain
| | - Xabier Mielgo
- Fundación Alcorcon University Hospital, Alcorcon, Madrid 28922, Spain
| | - Fátima Navarro
- Príncipe de Asturias University Hospital, Alcalá De Henares, Madrid 28805, Spain
| | | | | | - Carlos Aguado
- Clinico San Carlos University Hospital, Madrid 28040, Spain
| | | | | | | | | | - Amparo Benito
- Ramon y Cajal University Hospital, Madrid 28034, Spain
| | - Isabel Alemany
- Fundación Alcorcon University Hospital, Alcorcon, Madrid 28922, Spain
| | | | - Ricardo Ramos
- Parque Científico de Madrid Foundation, Madrid 28049, Spain
| | | | - Enrique Casado
- Infanta Sofía University Hospital, San Sebastián De Los Reyes, Madrid 28702, Spain
| | - Maria Sereno
- Infanta Sofía University Hospital, San Sebastián De Los Reyes, Madrid 28702, Spain
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10
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Peng WD, Xie J, Zhang X, Li C. The Change Trend of Cause of Death in Patients With Stage I Non-Small Cell Lung Cancer After Surgery in US: A Long-Term Follow-Up Study Based on SEER Database. Cancer Control 2021; 27:1073274820954461. [PMID: 33070629 PMCID: PMC7791446 DOI: 10.1177/1073274820954461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
There are few studies on the cause of death in patients with stage I non-small
cell lung cancer after surgery. Our aim is to study the trend of cause of death
and risk factors affecting prognosis in the patients. We retrospectively
reviewed patients in Surveillance, Epidemiology and End results database from
2004 to 2015. The change trend between cause of death and follow-up time was
studied by calculating the proportion of cause of death at different periods and
analyzing the cumulative risk. COX risk regression model was performed by
univariate and multivariate analyses for survival analysis. Finally, 23,652
patients were enrolled. In the whole cohort, lung cancer accounted for 18.68% of
deaths, followed by other causes (9.57%), heart disease (5.12%) and COPD
(3.89%). With the increasing of follow-up time, the cumulative incidence of lung
cancer was always the highest, but the growth rate in the late follow-up period
was slower than that caused by heart disease and COPD. The proportion of death
due to lung cancer decreased from 53.1%-73.1% in 0-30 months after follow-up to
7.8%-41.4% in 90 months after follow-up, while the proportion of deaths due to
heart disease and COPD increased. Age was an independent risk factor for lung
cancer-, heart disease- and COPD-specific survival, while lobectomy resection
was a protective factor, even in patients older than 70 years old. In
conclusion, during the follow-up period, lung cancer was still the main cause of
death, but the proportion of patients died of heart disease and COPD increased
gradually, especially in elderly. Furthermore, age was an important independent
factor affecting prognosis, particularly for heart disease- and COPD-related
mortality. The application of wedge resection in elderly patients needs further
exploration.
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Affiliation(s)
- Wan-da Peng
- Department of Respiration, First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jun Xie
- Department of Respiration, First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xian Zhang
- Department of Respiration, First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Chong Li
- Department of Respiration, First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, Changzhou, China
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11
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Resilience process and its protective factors in long-term survivors after lung cancer surgery: a qualitative study. Support Care Cancer 2020; 29:1455-1463. [PMID: 32683484 DOI: 10.1007/s00520-020-05633-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/13/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Resilience was correlated with psychological outcomes and quality of life in lung cancer patients. But the resilience process and its protective factors remained uncertain. PURPOSE To investigate and analyze resilience process and its protective factors in long-term survivors after lung cancer surgery. METHODS This qualitative study included 19 patients who had survived at least 5 years after lung cancer surgery. Colaizzi's method of phenomenology was used for data analysis. RESULTS Analysis of this study was divided into the resilience process and protective factors. The resilience process was summarized into three stages, including initial stress, adaptation to disease, and personal growth. Five themes were regarded contributing to their own resilience in this process, including excellent psychological qualities, good social support, regular lifestyle and exercise, participating in social activities, and Chinese medicine. CONCLUSION This study showed the dynamic process of resilience and its protective factors in long-term survivors after lung cancer surgery. Future studies could identify average length of time of each stage and how patients transfer between stages during resilience process. Besides, interventions could be carried out to educate patients diagnosed with cancer about normal stages of change in body and resilience through time and strategies on adaptation and adjustment of lung cancer.
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12
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Cho IY, Han K, Shin DW, Park SH, Yoon DW, Shin S, Jeong SM, Cho JH. Cardiovascular risk and undertreatment of dyslipidemia in lung cancer survivors: A nationwide population-based study. Curr Probl Cancer 2020; 45:100615. [PMID: 32636025 DOI: 10.1016/j.currproblcancer.2020.100615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/01/2020] [Accepted: 06/10/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND In lung cancer survivors, cardiovascular diseases (CVDs) are the leading cause of noncancer deaths. Nonetheless, there is lack of information on management of dyslipidemia, a major risk factor for future CVD events, in lung cancer survivors. This study aimed to assess dyslipidemia management and prevalence of statin eligibility in lung cancer survivors. METHODS From the Korean National Health Insurance Service database, we selected 7349 lung cancer survivors who received surgery for lung cancer from 2007 to 2014. We used descriptive statistics for analyses of dyslipidemia management status on the basis of the National Cholesterol Education Program Adult Treatment Panel III guidelines. We also identified those who met the criteria for treatment on the basis of CVD risk according to the 2018 American College of Cardiology and American Heart Association (ACC/AHA) guidelines. RESULTS The overall awareness and treatment rates for lung cancer survivors with dyslipidemia were 31.8% and 29.7%, respectively. The overall control rate for those receiving treatment was 88.7%, but was lowest in the highest risk group (78.1%). Furthermore, undertreatment of dyslipidemia was more prominent in young, male lung cancer survivors and those diagnosed with lung cancer within 3 years. Among those not receiving treatment for dyslipidemia, 61.7% were indicated for statin according to the ACC/AHA guidelines. CONCLUSION Over half of lung cancer survivors were not receiving treatment, although they were eligible for statin under current guidelines. To reduce noncancer mortality, statin use and adequate management of CVD risk factors should be encouraged in lung cancer survivors.
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Affiliation(s)
- In Young Cho
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Digital Health, Samsung Advanced Institute of Health Science and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea.
| | - Sang Hyun Park
- Department of Biostatistics, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Woog Yoon
- Department of Thoracic and Cardiovascular Surgery, Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - Sujeong Shin
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Su-Min Jeong
- Department of Family Medicine, Boramae Medical Center, Seoul, Republic of Korea
| | - Jong Ho Cho
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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13
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Finke I, Behrens G, Schwettmann L, Gerken M, Pritzkuleit R, Holleczek B, Brenner H, Jansen L. Socioeconomic differences and lung cancer survival in Germany: Investigation based on population-based clinical cancer registration. Lung Cancer 2020; 142:1-8. [PMID: 32044589 DOI: 10.1016/j.lungcan.2020.01.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Studies from several countries reported socioeconomic inequalities in lung cancer survival. Hypothesized reasons are differences in cancer care or tumor characteristics. We investigated associations of small-area deprivation and lung cancer survival in Germany and the possible impact of differences in patient, tumor or treatment factors. MATERIALS AND METHODS Patients registered with a primary tumor of the lung between 2000-2015 in three German population-based clinical cancer registries were included. Area-based socioeconomic deprivation on municipality level was measured with the categorized German Index of Multiple Deprivation. Association of deprivation with overall survival was investigated with Cox regression models. RESULTS Overall, 22,905 patients were included. Five-year overall survival from the least to the most deprived quintile were 17.2%, 15.9%, 16.7%, 15.7%, and 14.4%. After adjustment for patient and tumor factors, the most deprived group had a lower survival compared to the least deprived group (Hazard Ratio (HR) 1.06, 95% confidence interval (CI) 1.01-1.11). Subgroup analyses revealed lower survival in the most deprived compared to the least deprived quintile in patients with stage I-III [HR: 1.14, 95% CI: 1.06-1.22]. The association persisted when restricting to patients receiving surgery but was attenuated for subgroups receiving either chemotherapy or radiotherapy. CONCLUSION Our results indicate differences in lung cancer survival according to area deprivation in Germany, which were more pronounced in patients with I-III stage cancer. Future research should address in more detail the underlying reasons for the observed inequalities and possible approaches to overcome them.
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Affiliation(s)
- Isabelle Finke
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany; Medical Faculty Heidelberg, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Gundula Behrens
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
| | - Lars Schwettmann
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany; Department of Economics, Martin Luther University Halle-Wittenberg, 06099 Halle (Saale), Germany
| | - Michael Gerken
- Tumor Center ‑ Institute for Quality Management and Health Services Research, University of Regensburg, Am BioPark 9, 93053 Regensburg, Germany
| | - Ron Pritzkuleit
- Institute for Cancer Epidemiology at the University of Lübeck, Cancer Registry Schleswig-Holstein, Ratzeburger Allee 160, Haus 50, 23538 Lübeck, Germany
| | - Bernd Holleczek
- Saarland Cancer Registry, Präsident-Baltz-Straße 5, 66119 Saarbrücken, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120 Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany.
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14
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Potts JE, Iliescu CA, Lopez Mattei JC, Martinez SC, Holmvang L, Ludman P, De Belder MA, Kwok CS, Rashid M, Fischman DL, Mamas MA. Percutaneous coronary intervention in cancer patients: a report of the prevalence and outcomes in the United States. Eur Heart J 2018; 40:1790-1800. [DOI: 10.1093/eurheartj/ehy769] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/25/2018] [Accepted: 11/16/2018] [Indexed: 12/17/2022] Open
Affiliation(s)
- Jessica E Potts
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele Road, Stoke-on-Trent, UK
| | - Cezar A Iliescu
- Department of Cardiology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Juan C Lopez Mattei
- Department of Cardiology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Sara C Martinez
- Division of Cardiology, Providence St. Peter Hospital, Olympia, WA, USA
| | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Ludman
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Mark A De Belder
- Department of Cardiology, James Cook University Hospital, Middlesborough, UK
| | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele Road, Stoke-on-Trent, UK
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele Road, Stoke-on-Trent, UK
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - David L Fischman
- Department of Medicine (Cardiology), Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele Road, Stoke-on-Trent, UK
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
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15
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Yegya-Raman N, Wang K, Kim S, Reyhan M, Deek MP, Sayan M, Li D, Patel M, Malhotra J, Aisner J, Marks LB, Jabbour SK. Dosimetric Predictors of Symptomatic Cardiac Events After Conventional-Dose Chemoradiation Therapy for Inoperable NSCLC. J Thorac Oncol 2018; 13:1508-1518. [PMID: 29883836 PMCID: PMC10905612 DOI: 10.1016/j.jtho.2018.05.028] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/23/2018] [Accepted: 05/25/2018] [Indexed: 12/25/2022]
Abstract
INTRODUCTION We hypothesized that higher cardiac doses correlates with clinically significant cardiotoxicity after standard-dose chemoradiation therapy (CRT) (∼60 Gy) for inoperable NSCLC. METHODS We retrospectively reviewed the records of 140 patients with inoperable NSCLC treated with concurrent CRT from 2007 to 2015. Extracted data included baseline cardiac status, dosimetric parameters to the whole heart (WH) and cardiac substructures, and the development of post-CRT symptomatic cardiac events (acute coronary syndrome [ACS], arrhythmia, pericardial effusion, pericarditis, and congestive heart failure [CHF]). Competing risks analysis was used to estimate time to cardiac events. RESULTS Median follow-up was 47.4 months. Median radiation therapy dose was 61.2 Gy (interquartile range, 60 to 66 Gy). Forty patients (28.6%) developed 47 symptomatic cardiac events at a median of 15.3 months to first event. On multivariate analysis, higher WH doses and baseline cardiac status were associated with an increased risk of symptomatic cardiac events. The 4-year cumulative incidence of symptomatic cardiac events was 48.6% versus 18.5% for mean WH dose ≥ 20 Gy versus < 20 Gy, respectively (p = 0.0002). Doses to the WH, ventricles, and left anterior descending artery were associated with ACS/CHF, whereas doses to the WH and atria were not associated with supraventricular arrhythmias. Symptomatic cardiac events (p = 0.0001) were independently associated with death. CONCLUSIONS Incidental cardiac irradiation was associated with subsequent symptomatic cardiac events, particularly ACS/CHF, and symptomatic cardiac events were associated with inferior survival. These results support the minimization of cardiac doses among patients with inoperable NSCLC receiving standard-dose CRT.
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Affiliation(s)
- Nikhil Yegya-Raman
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Kyle Wang
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Sinae Kim
- Department of Biostatistics, School of Public Health, Rutgers University, Piscataway, New Jersey; Biometrics Division, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Meral Reyhan
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Matthew P Deek
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey; Department of Radiation Oncology & Molecular Radiation Sciences, the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mutlay Sayan
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Diana Li
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Malini Patel
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Jyoti Malhotra
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Joseph Aisner
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Lawrence B Marks
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey.
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16
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Abdel-Rahman O. Dissecting the heterogeneity of stage III non-small-cell lung cancer through incorporation of grade and histology. Future Oncol 2017; 13:2811-2821. [PMID: 29188724 DOI: 10.2217/fon-2017-0304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
AIM This study evaluated a grade-integrated American Joint Committee on Cancer (AJCC) staging system for non-small-cell lung cancer. PATIENTS & METHODS Surveillance, Epidemiology and End Results database was queried through SEER*Stat program. Through recursive partitioning analysis and subsequent decision-tree formation, suggested grade-modified stages were formulated. RESULTS All pairwise hazard ratio comparisons among AJCC eighth stages were significant (p < 0.05) except stage IIIB versus stage IIIC; while all pairwise hazard ratio comparisons among modified AJCC stages were significant (p < 0.05). When stratified by histology, there was a benefit for the modified system among adenocarcinoma rather than squamous cell carcinoma patients. CONCLUSION Grade integration improved the prognostication of the AJCC staging system particularly for stage III adenocarcinoma. This should be considered in future revisions of the AJCC staging system.
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Affiliation(s)
- Omar Abdel-Rahman
- Department of Clinical Oncology, Faculty of Medicine, Ain Shams University, Lotfy Elsayed Street, Cairo 11566, Egypt
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17
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Abdel-Rahman O. Impact of the staging method on the prognostic utility of the 8th AJCC staging system for non-small-cell lung cancer. Future Oncol 2017; 13:2277-2284. [DOI: 10.2217/fon-2017-0248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aim: To assess the impact of the staging method on the utility of the American Joint Committee on Cancer (AJCC) system for non-small-cell lung cancer. Methods: Surveillance, Epidemiology and End Results database was accessed and cancer-specific survival analyses were conducted. Results: For cancer-specific survival among pathologically staged patients, p-values for all pair wise comparisons were significant, except for stage IIIB versus IIIC; while among clinically staged patients, p-values for all pair wise comparisons were significant, except for stage IIA versus IIB. Among pathologically staged patients, AJCC eighth c-statistic was 0.705; while among clinically staged patients, AJCC eighth c-statistic was 0.687. Conclusion: The discriminatory power of eighth AJCC for non-small-cell lung cancer is lower for clinically staged compared with pathologically staged patients.
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Affiliation(s)
- Omar Abdel-Rahman
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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18
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Validation of the AJCC 8th lung cancer staging system among patients with small cell lung cancer. Clin Transl Oncol 2017; 20:550-556. [PMID: 28808860 DOI: 10.1007/s12094-017-1739-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 08/08/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The current study tried to validate the prognostic significance of the 8th American Joint Committee on Cancer (AJCC) staging system among small cell lung cancer (SCLC) patients recorded within the surveillance, epidemiology, and end results (SEER) database. PATIENTS AND METHODS SEER database (2004-2014) has been queried through SEER*Stat program, and both AJCC 7th and 8th edition stages were constructed. Cancer-specific and overall survival analyses according to both editions were performed through Kaplan-Meier analysis. The cause-specific Cox regression hazard for both AJCC editions (adjusted for age, gender, race, and surgery) was calculated and pair-wise comparisons of hazard ratios were conducted. RESULTS A total of 39,286 patients with SCLC were recruited in the period from 2004 to 2014. For overall and cancer-specific survival assessment, according to the AJCC 7th edition, P values for all pair-wise comparisons among different stages were significant (<0.0001) except for the comparisons between stage IB vs. stage IIA, and stage IIB vs. stage IIIA. For overall survival assessment, according to AJCC 8th, P values for all pair-wise comparisons were significant (<0.05) except for IA2 vs. IA3, IA3 vs. IB, IB vs. IIA, IIA vs. IIB, and IIIB vs. IIIC. For cancer-specific survival, according to AJCC 8th, P values for all pair-wise comparisons among different stages were significant (<0.05) except IA1 vs. IA2, IA2 vs. IA3, and IIA vs. IIB. When conducting pair-wise hazard ratio comparisons among different AJCC stages (for both editions), similar findings to the Kaplan-Meier analyses were reported. CONCLUSION While there is a clear improvement for both the AJCC 7th and 8th systems compared to the old veterans' administration system, there is a modest improvement for the 8th compared to the 7th system among patients with SCLC.
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19
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Abdel-Rahman O. Validation of the prognostic value of new sub-stages within the AJCC 8th edition of non-small cell lung cancer. Clin Transl Oncol 2017; 19:1414-1420. [DOI: 10.1007/s12094-017-1673-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 05/05/2017] [Indexed: 12/25/2022]
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