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Chen L. Assessing the diagnostic utility of serum tumor markers for lung cancer detection in patients with interstitial pneumonia. Clin Transl Oncol 2024:10.1007/s12094-024-03638-7. [PMID: 39095684 DOI: 10.1007/s12094-024-03638-7] [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: 06/04/2024] [Accepted: 07/22/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND The prevalence of lung cancer among individuals afflicted with interstitial pneumonia (IP) stands at approximately 20%. The early detection of lung cancer via chest computed tomography (CT) surveillance proves challenging in IP patients. Our investigation sought to identify a potential biomarker capable of providing early indications of the presence of lung tumors in such patients. MATERIALS AND METHODS We examined the attributes of serum tumor markers, imaging characteristics, and histological findings in individuals diagnosed with IP, both with and without concurrent lung cancer. RESULTS 106 patients diagnosed with IP were included in the study, comprising 36 individuals with concurrent lung cancer and 70 patients solely diagnosed with IP. Serum concentrations of CEA and CA12-5 were notably elevated in IP patients with lung cancer, compared to those with IP alone. Logistic regression analyses revealed that, in comparison to IP patients within the first quartile of CEA levels, the relative risk of developing lung cancer associated with IP escalated by 4.0-fold, 3.1-fold, 11.0-fold, and 13.3-fold in the second, third, fourth, and fifth quartiles, respectively. Upon controlling for gender and age, statistical significance in risk was observed solely for the fourth and fifth quartiles. Receiver operating characteristic (ROC) curve analysis conducted in patients diagnosed with ILD-CA identified a CEA cutoff point of 6.9 ng/mL, demonstrating sensitivities of 61.1% and specificities of 78.5%. The area under the curve was calculated as 0.7(95% CI: 0.63-0.81). CONCLUSION The serum levels of CEA were notably elevated in IP patients with concurrent lung cancer in contrast to those who were just suffering from IP. The heightened serum CEA levels correlate with an escalated risk of cancer occurrence among IP patients, suggesting that serum CEA levels could potentially serve as an indicative marker for the presence of cancer in IP patients.
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Affiliation(s)
- Lulu Chen
- People' Hospital Affiliated to Fujian University of Traditional Chinese Medicine, 817 Middle Road 602, Taijiang District, Fuzhou, Fujian Province, China.
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Karapinar K, Yurt S, Toptaş M, Bahadir A, Erdoğu V, Akçil AM, Onur ST. Selection of the appropriate treatment for the combination of interstitial lung disease and lung cancer: A retrospective observational study. Medicine (Baltimore) 2024; 103:e37186. [PMID: 38335429 PMCID: PMC10860948 DOI: 10.1097/md.0000000000037186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024] Open
Abstract
Interstitial lung disease (ILD) independently heightens the risk of lung cancer (LC), often necessitating chemoradiotherapy (CRT) due to advanced disease stages. However, CRT may compromise survival through complications such as ILD exacerbation or radiation pneumonitis. The aim of this study was to determine the optimal surgical or nonsurgical treatment approaches for patients with concurrent ILD and LC. Over a 10-year period, a retrospective evaluation was conducted on 647 patients with confirmed diagnoses of LC and ILD from a total of 4541 patients examined in the polyclinic. This assessment included a comprehensive review of demographic, treatment, and survival records. Study groups included those treated for both ILD and LC with surgical treatment (ST), chemotherapy (CT), radiotherapy (RT), or CRT. A control group comprised ILD-only cases. In the whole sample of 647 patients with complete data, the length of stay in hospital and respiratory intensive care unit was significantly shorter in the ST group and longer in the CT group. Significant differences in discharge status (P < .001) were observed, with higher recovery rates in the ST and RT groups. The CT group showed an increased rate of transfer to other centers, in-hospital mortality was determined to be higher in the CRT group, and the control group exhibited no change in discharge. No statistically significant difference was determined between the groups with respect to the 24- and 48-month survival rates (P = .100). Although no disparity was found in 2- and 4-year survival rates, there were seen to be advantages in survival and quality of life with the addition of radiotherapy to regions aligning with surgical margins for LC patients with ILD, evaluated as radiological N0, undergoing wedge resection. This underscores the need for personalized treatment strategies to balance effective cancer control and to minimize ILD-related complications.
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Affiliation(s)
- Kemal Karapinar
- Department of Thoracic Surgery, University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sibel Yurt
- Department of Pulmonology, University of Health Sciences Turkey, Başakşehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Mehmet Toptaş
- Department of Anesthesiology, University of Health Sciences Turkey, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ayşe Bahadir
- Department of Pulmonology, University of Health Sciences Turkey, Başakşehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Volkan Erdoğu
- Department of Thoracic Surgery, University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali Murat Akçil
- Department of Thoracic Surgery, University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Seda Tural Onur
- Department of Pulmonology, University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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Huang C, Sun YG, Ma C, Jiao P, Wu QJ, Tian WX, Yu HB, Tong HF. Surgical outcomes and perioperative risk factors of patients with interstitial lung disease after pulmonary resection. J Cardiothorac Surg 2024; 19:72. [PMID: 38331909 PMCID: PMC10851510 DOI: 10.1186/s13019-024-02508-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Patients of interstitial lung disease (ILD) combined with pulmonary lesions are increasingly common in clinical practice. Patients with ILD are at significantly higher risk for complications after pulmonary resection (including lobectomy and sublobar resection), especially acute exacerbations of ILD (AE-ILD). The purpose of this study is to summarize the short-term and long-term outcomes after pulmonary resection in ILD patients and to analyze the clinical factors affecting surgical safety. METHODS From January 2004 to January 2022, a total of 78 patients who were diagnosed with ILD and underwent pulmonary resection at our center were enrolled in this study. Clinical data, pathological findings, surgical procedures, and intraoperative safety of these patients were collected retrospectively. Postoperative 90-day complications and mortality, long-term surgical outcomes from postoperative 90 days to 24 months, and changes in ILD condition were investigated. Logistic regression analysis was used to identify the risk factors associated with postoperative complications. RESULTS The median age of patients was 66.5 (range 33-86) years, 82.1% (64/78) of patients were male, and 78.2% (61/78) of patients had comorbidities. Idiopathic ILD and secondary ILD accounted for 86% and 14%, thoracotomy and video-assisted thoracoscopic surgery accounted for 12.8% and 87.2%, and lobectomy and sublobar resection accounted for 37.2% and 62.8%, respectively. Postoperative 90-day complications occurred in 25.6% (20/78) of patients, with pulmonary complications and AE-ILD occurring in 15.4% and 9.0% of patients, respectively. The postoperative 90-day mortality rate was 5.1% (4/78), and the cause of death was AE-ILD. Exacerbation of ILD or other complications occurred in 12.8% (10/78) of patients from postoperative 90 days to 24 months. Univariate logistic regression analysis showed that comorbidity, extent of resection, systemic lymph node dissection, operation time, intraoperative blood loss, and pathology of pulmonary lesion were associated with postoperative 90-day complications. In multivariate logistic regression analysis, age-adjusted Charlson Comorbidity Index and intraoperative blood loss were identified as independent risk factors of postoperative 90-day complications. CONCLUSIONS Patients with ILD have a significantly higher risk of postoperative 90-day complications and mortality after pulmonary resection, especially pulmonary complications and AE-ILD. After postoperative 90 days, the risk of deterioration of pulmonary status remains high, including exacerbation of ILD and complications associated with long-term use of glucocorticoids and immunosuppressant. Age, comorbidity and intraoperative blood loss are high risk factors for postoperative 90-day complications.
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Affiliation(s)
- Chuan Huang
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, NO.1 Da Hua Road, Dongdan, Beijing, 100730, P.R. China
| | - Yao-Guang Sun
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, NO.1 Da Hua Road, Dongdan, Beijing, 100730, P.R. China
| | - Chao Ma
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, NO.1 Da Hua Road, Dongdan, Beijing, 100730, P.R. China
| | - Peng Jiao
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, NO.1 Da Hua Road, Dongdan, Beijing, 100730, P.R. China
| | - Qing-Jun Wu
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, NO.1 Da Hua Road, Dongdan, Beijing, 100730, P.R. China
| | - Wen-Xin Tian
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, NO.1 Da Hua Road, Dongdan, Beijing, 100730, P.R. China
| | - Han-Bo Yu
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, NO.1 Da Hua Road, Dongdan, Beijing, 100730, P.R. China
| | - Hong-Feng Tong
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, NO.1 Da Hua Road, Dongdan, Beijing, 100730, P.R. China.
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Klipsch E, Engelhardt KE. Objective Guidelines Needed for the Uniform Collection of Data in National Registries. Ann Thorac Surg 2023; 116:541-542. [PMID: 37285948 DOI: 10.1016/j.athoracsur.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/13/2023] [Indexed: 06/09/2023]
Affiliation(s)
- Eric Klipsch
- Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC 29401
| | - Kathryn E Engelhardt
- Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC 29401.
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Axtell AL, David EA, Block MI, Parsons N, Habib R, Muniappan A. Association Between Interstitial Lung Disease and Outcomes After Lung Cancer Resection. Ann Thorac Surg 2023; 116:533-541. [PMID: 37271447 DOI: 10.1016/j.athoracsur.2023.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/08/2023] [Accepted: 04/04/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Prior studies have noted that patients with interstitial lung disease (ILD) possess an increased incidence of lung cancer and risk of postoperative respiratory failure and death. We sought to understand the impact of ILD on national-scale outcomes of lung resection. METHODS A retrospective cohort analysis using The Society of Thoracic Surgeons General Thoracic Surgery Database was conducted of patients who underwent a pulmonary resection for non-small cell lung cancer between 2009 and 2019. Baseline characteristics and postoperative outcomes were compared between patients with and without ILD (defined as interstitial fibrosis based on clinical, radiographic, or pathologic evidence). Multivariable logistic regression models identified risk factors associated with postoperative mortality, acute respiratory distress syndrome, and composite morbidity and mortality. RESULTS ILD was documented in 1.5% (1873 of 128,723) of patients who underwent a pulmonary resection for non-small cell lung cancer. Patients with ILD were more likely to smoke (90% vs 85%, P < .001), have pulmonary hypertension (6% vs 1.7%, P < .001), impaired diffusing capacity of lung for carbon monoxide (diffusing capacity of lung for carbon monoxide 40%-75%: 64% vs 51%; diffusing capacity of lung for carbon monoxide <40%: 11% vs 4%, P < .001), and undergo more sublobar resections (34% vs 23%, P < .001) compared with patients without ILD. Patients with ILD had increased postoperative mortality (5.1% vs 1.2%, P < .001), acute respiratory distress syndrome (1.9% vs 0.5%, P < .001), and composite morbidity and mortality (13.2% vs 7.4%, P < .001). ILD remained a strong predictor of mortality (odds ratio, 3.94; 95% CI, 3.09-5.01; P < .001), even when adjusted for patient comorbidities, pulmonary function, extent of resection, and center volume effects. CONCLUSIONS ILD is a risk factor for operative mortality and morbidity after lung cancer resection, even in patients with normal pulmonary function.
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Affiliation(s)
- Andrea L Axtell
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Elizabeth A David
- Section of Thoracic Surgery, University of Colorado Hospital, Aurora, Colorado
| | - Mark I Block
- Division of Thoracic Surgery, Memorial Healthcare System, Hollywood, Florida
| | - Niharika Parsons
- The Society of Thoracic Surgeons Research Center, Chicago, Illinois
| | - Robert Habib
- The Society of Thoracic Surgeons Research Center, Chicago, Illinois
| | - Ashok Muniappan
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
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Patel AJ, Walters GI, Watkins S, Rogers V, Fallouh H, Kalkat M, Naidu B, Bishay ES. Lung cancer resection in patients with underlying usual interstitial pneumonia: a meta-analysis. BMJ Open Respir Res 2023; 10:10/1/e001529. [PMID: 36944451 PMCID: PMC10032402 DOI: 10.1136/bmjresp-2022-001529] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/10/2023] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVE Patients with lung cancer with underlying idiopathic pulmonary fibrosis and usual interstitial pneumonia (UIP) pattern on CT represent a very high-risk group in terms of postoperative UIP acute exacerbations (AEs) and in-hospital mortality. We sought to investigate the outcomes in these patients. METHODS We carried out a meta-analysis, searching four international databases from 1 January 1947 to 27 April 2022, for studies in any language reporting on the acute postoperative outcomes of patients with lung cancer undergoing surgical resection with underlying UIP (the primary outcome). Random effects meta-analyses (DerSimonian and Laird) were conducted. We analysed the difference in incidence of postoperative AE as well as the difference in long-term overall survival among subpopulations. These were stratified by the extent of surgical resection, with meta-regression testing (uniivariate and multivariate) according to the stage of disease, operative decision making and country of origin. This study was registered with PROSPERO (CRD42022319245). RESULTS The overall incidence of AE of UIP postoperatively from 10 studies (2202 patients) was 14.6% (random effects model, 95% CI 9.8 to 20.1, I2=74%). Sublobar resection was significantly associated with a reduced odds of postoperative AE (OR 0.521 (fixed effects model), 95% CI 0.339 to 0.803, p=0.0031, I2=0%). The extent of resection was not significantly associated with overall survival following lung cancer resection in UIP patients (HR for sublobar resection 0.978 (random effects model), 95% CI 0.521 to 1.833, p=0.9351, I2=71%). CONCLUSIONS With appropriate implementation of perioperative measures such as screening for high-risk cases, appropriate use of steroids, antifibrotics and employing sublobar resection in select cases, the risk of local recurrence versus in-hospital mortality from AEUIP can be balanced and long-term survival can be achieved in a super-selected group of patients. Further investigation in the form of a randomised study is warranted.
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Affiliation(s)
- Akshay Jatin Patel
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Gareth I Walters
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Department of Respiratory Medicine, University Hospitals Birmingham, Birmingham, UK
| | - Steven Watkins
- Department of Radiation Oncology, University Hospitals Birmingham, Birmingham, UK
| | - Vanessa Rogers
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Hazem Fallouh
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Maninder Kalkat
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Babu Naidu
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Ehab S Bishay
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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Ki MS, Kim SY, Kim EY, Jung JY, Kang YA, Park MS, Kim YS, Park SY, Lee SH. Clinical Outcomes and Prognosis of Patients With Interstitial Lung Disease Undergoing Lung Cancer Surgery: A Propensity Score Matching Study. Clin Lung Cancer 2023; 24:e27-e38. [PMID: 36376171 DOI: 10.1016/j.cllc.2022.10.003] [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: 05/12/2022] [Revised: 08/22/2022] [Accepted: 10/09/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients with interstitial lung disease (ILD) may have a poor prognosis after lung cancer surgery because of respiratory complications and increased recurrence rates due to limited resection. Few studies have investigated prognosis after surgery by matching clinical variables between patients with and without ILD. PATIENTS AND METHODS Medical records of patients who underwent lung cancer surgery between January 2010 and August 2020 at a referral hospital in South Korea were reviewed. Patients with ILD were identified based on preoperative computed tomography findings. Through propensity score matching, the clinical outcomes and prognoses of patients with (ILD group) and without ILD (control group) were compared. RESULTS Of 1629 patients, 113 (6.9%) patients with ILD were identified, of whom 104 patients were matched. Before matching, patients with ILD had higher mean age, proportion of men, and rates of sublobar resection and squamous cell carcinoma than those without ILD. After matching, there was no significant difference in postoperative mortality rates between the control and ILD groups. The 5-year survival rate was significantly lower in the ILD group (66%) than in the control group (78.8%; P= .007). The 5-year survival rate of the ILD-GAP (Gender, Age, Physiology) stage III group (12.6%) was significantly lower than that of the ILD-GAP stage I (73.5%) and II groups (72.6%; P< .0001). Multivariable Cox analysis demonstrated that idiopathic pulmonary fibrosis, higher clinical stage, and recurrence were independent prognostic factors for mortality. CONCLUSION Concomitant ILD negatively affects long-term prognosis after lung cancer surgery, and ILD subtype and physiological severity assessment help predict prognosis after surgery.
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Affiliation(s)
- Min Seo Ki
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Song Yee Kim
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Young Kim
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Ye Jung
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Ae Kang
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moo Suk Park
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Sam Kim
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Hoon Lee
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Tseng SC, Hino T, Hatabu H, Park H, Sanford NN, Lin G, Nishino M, Mamon H. Interstitial Lung Abnormalities in Patients With Locally Advanced Esophageal Cancer: Prevalence, Risk Factors, and Clinical Implications. J Comput Assist Tomogr 2022; 46:871-877. [PMID: 35995596 PMCID: PMC9675694 DOI: 10.1097/rct.0000000000001366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Interstitial lung abnormalities (ILAs) represent nondependent abnormalities on chest computed tomography (CT) indicating lung parenchymal damages due to inflammation and fibrosis. Interstitial lung abnormalities have been studied as a predictor of clinical outcome in lung cancer, but not in other thoracic malignancies. The present study investigated the prevalence of ILA in patients with esophageal cancer and identified risk factors and clinical implications of ILA in these patients. METHODS The study included 208 patients with locally advanced esophageal cancer (median age, 65.6 years; 166 males, 42 females). Interstitial lung abnormality was scored on baseline CT scans before treatment using a 3-point scale (0 = no evidence of ILA, 1 = equivocal for ILA, 2 = ILA). Clinical characteristics and overall survival were compared in patients with ILA (score 2) and others. RESULTS An ILA was present in 14 of 208 patients (7%) with esophageal cancer on pretreatment chest CT. Patients with ILA were significantly older (median age, 69 vs 65, respectively; P = 0.011), had a higher number of pack-years of smoking ( P = 0.02), and more commonly had T4 stage disease ( P = 0.026) than patients with ILA score of 1 or 0. Interstitial lung abnormality on baseline scan was associated with a lack of surgical resection after chemoradiotherapy (7/14, 50% vs 39/194, 20% respectively; P = 0.016). Interstitial lung abnormality was not associated with overall survival (log-rank P = 0.75, Cox P = 0.613). CONCLUSIONS An ILA was present in 7% of esophageal cancer patients, which is similar to the prevalence in general population and in smokers. Interstitial lung abnormality was strongly associated with a lack of surgical resection after chemoradiotherapy, indicating an implication of ILA in treatment selection in these patients, which can be further studied in larger cohorts.
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Affiliation(s)
- Shu-Chi Tseng
- Department of Radiology, Brigham and Women’s Hospital and Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave. Boston MA, 02215, USA
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Takuya Hino
- Department of Radiology, Brigham and Women’s Hospital and Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave. Boston MA, 02215, USA
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women’s Hospital and Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave. Boston MA, 02215, USA
| | - Hyesun Park
- Department of Radiology, Brigham and Women’s Hospital and Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave. Boston MA, 02215, USA
| | - Nina N. Sanford
- Department of Radiation Oncology, University of Texas Southwestern
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Mizuki Nishino
- Department of Radiology, Brigham and Women’s Hospital and Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave. Boston MA, 02215, USA
| | - Harvey Mamon
- Department of Radiation Oncology, Brigham and Women’s Hospital and Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave. Boston MA, 02215, USA
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Tandon S, Biraris P, Bhaskar M. Pulmonary Oncology—Scope of the Pulmonologist. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1742653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractThe International Agency for Research on Cancer GLOBOCAN project has predicted that India's cancer burden will nearly double in the next 20 years, from slightly more than a million new cases in 2012 to more than 1·7 million by 2035. In India, chronic respiratory diseases have emerged as a leading health care burden with chronic obstructive pulmonary disease (COPD) being the second leading cause of deaths and disability-adjusted life years. Patients with COPD are 6.35 times more likely to develop lung cancer. The deadly dual epidemic of “chronic respiratory diseases and cancer” warrants not only prevention but also creating an increased awareness among oncologists as well as pulmonologists to enable early diagnosis and treatment. It would be incorrect to assume that the scope of a pulmonologist in oncology is just diagnosing and treating lung cancer or prescribing chemotherapy for lung cancer. There is a larger world full of opportunities beyond that, and we look at the pulmonologist as a member of a multidisciplinary oncology team working together with the surgical, radiation, and medical oncologist and ancillary specialties to address all the issues highlighted earlier that are faced in oncology practice. The current exposure to pulmonary oncology and related complications during postgraduate training for respiratory medicine in India is limited. It is necessary not only to educate the pulmonologist on their role in an oncology setup but also to increase the awareness across all oncology specialties regarding the pulmonologist's contribution in management of the cancer patient. In this review, written based on our experience gained in our pulmonology service in our tertiary oncology center, we have tried to portray the wide role of the pulmonologist in oncology. We have realized that what is lacking is the basic awareness regarding the above potential, both among pulmonologists and oncologists. Our mission is to take this message across specialists in India, highlighting how we can work synergistically in the fight against cancer.
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Affiliation(s)
- Sandeep Tandon
- Department of Pulmonary Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Pavankumar Biraris
- Department of Pulmonary Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Maheema Bhaskar
- Department of Pulmonary Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Wang H, Yang R, Jin J, Wang Z, Li W. Impact of concomitant idiopathic pulmonary fibrosis on prognosis in lung cancer patients: A meta-analysis. PLoS One 2021; 16:e0259784. [PMID: 34767608 PMCID: PMC8589161 DOI: 10.1371/journal.pone.0259784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 10/26/2021] [Indexed: 02/05/2023] Open
Abstract
Background Current studies showed that idiopathic pulmonary fibrosis (IPF) may lead to a poor prognosis of lung cancer. We conducted a meta-analysis to explore the impact of concomitant IPF in lung cancer and its prognostic value. Methods We searched the databases of PubMed, Web of Science, Embase up to Feb 10th, 2021 for relevant researches and merged the hazard ratios (HRs) and 95% confidence intervals (CIs) to evaluate the association between concomitant IPF and overall survival (OS) in patients with lung cancer. Results Twelve studies involving 58424 patients were included in our meta-analysis. The results indicated that concomitant IPF was correlated with poor prognosis of lung cancer patients (HR = 1.99, 95%CI, 1.59–2.51). The association remained consistent after subgroup analysis and meta-regression stratified by study region, sample size, tumor histology, and therapy. In addition, our results were robust even after sensitivity analysis. Conclusions Concomitant IPF may be a prognostic factor of lung cancer, which can lead to poor survival. However, further studies were necessary for evidence in clinical application.
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Affiliation(s)
- Haoyu Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Ruiyuan Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Jing Jin
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Zhoufeng Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
- * E-mail:
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Can acute exacerbations occurring late after surgery with interstitial lung diseases be predicted? Gen Thorac Cardiovasc Surg 2021; 70:160-169. [PMID: 34533756 DOI: 10.1007/s11748-021-01707-0] [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: 05/17/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The incidence of acute exacerbation (AE) 31 days after surgery in lung cancer (LC) patients with interstitial lung disease (ILD) has not yet been elucidated. This study aimed to identify the AE incidence rate, mortality rate, and risk factors in patients with late-stage LC with ILD. METHODS We conducted a retrospective study on 410 patients with ILD on preoperative computed tomography among 3939 patients with LC who underwent their first surgery between August 2008 and July 2019. We divided the patients into Group A (early AE; 18cases), Group B (late AE; 40 cases), and Group C (no AE; 352 cases). RESULTS There were no significant differences in the clinical background between Groups A and B. The AE incidence rates were 0.56 case per person-years at ≤ 30 days, 0.24 at 90 days, 0.14 at 180 days, 0.10 at 1 year, 0.078 at 2 years, 0.086 at 3 years, 0.064 at 4 years, and 0.059 at 5 years after surgery. The mortality rates of the first AE were 10/18 (56%), 3/5 (60%), 7/13 (54%), and 7/22 (32%) at onset ≤ 30 days, 31-90 days, 91-365 days, and 366-1825 days after surgery, respectively. Multivariate Cox proportional analysis showed that adjuvant chemotherapy and a usual IP (UIP) pattern on CT + KL-6 ≥ 1000 (hazard ratio 3.647, 2.631) were predictors of late AEs. CONCLUSIONS Patients with adjuvant chemotherapy and a usual IP (UIP) pattern on CT + KL-6 ≥ 1000 are likely to develop later AEs. Therefore, early intervention with antifibrotic therapy is recommended.
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Efficacy and Safety of Carbon-Ion Radiotherapy for Stage I Non-Small Cell Lung Cancer with Coexisting Interstitial Lung Disease. Cancers (Basel) 2021; 13:cancers13164204. [PMID: 34439358 PMCID: PMC8391416 DOI: 10.3390/cancers13164204] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/13/2021] [Accepted: 08/18/2021] [Indexed: 12/25/2022] Open
Abstract
Simple Summary Interstitial lung disease (ILD) is a risk factor for lung cancer, but the treatment options are often limited because of concerns that ILD may worsen with treatment. In this study, we analyzed whether the presence or absence of ILD affects the outcome of carbon-ion radiotherapy (CIRT) for clinical stage I non-small cell lung cancer (NSCLC). For all cases, CT and clinical data were reviewed by a respiratory physician to determine the presence of ILD. Overall survival and disease-specific survival were lower in patients with ILD than in patients without ILD. There was no significant difference between the ILD group and the non-ILD group with respect to safety. CIRT was not associated with significantly more side-effects in patients with ILD than in patients without ILD. Coexisting ILD was a poor prognostic factor with respect to CIRT for clinical stage I lung cancer, as reported for other treatment methods. Abstract Interstitial lung disease (ILD) is a risk factor both for the development and treatment failure of lung cancer. In this retrospective study, we analyzed the outcome of carbon-ion radiotherapy (CIRT) in 124 patients with clinical stage I non-small cell lung cancer (NSCLC), of whom 26 (21%) had radiological signs of pre-existing ILD. ILD was diagnosed retrospectively by a pulmonologist based on critical review of CT-scans. Ninety-eight patients were assigned to the non-ILD group and 26 patients (21.0%) to the ILD group. There were significant differences in pre-treatment KL-6 values between the two groups. The three year overall survival and cause-specific survival rates were 83.2% and 90.7%, respectively, in the non-ILD group, and 59.7% and 59.7%, respectively, in the ILD group (between-group differences, p = 0.002 and p < 0.001). Radiation pneumonitis worse than Grade 2 was observed in three patients (3.0%) in the non-ILD group and two patients (7.6%) in the ILD group (p = 0.29). There were no cases of acute exacerbation in the ILD group. CIRT for stage I NSCLC was as safe in the ILD group as in the non-ILD group. Coexisting ILD was a poor prognostic factor in CIRT for clinical stage I lung cancer.
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Abstract
Rationale: Characteristics and outcomes of lung cancer in patients with idiopathic pulmonary fibrosis (IPF) in the United States remain understudied.Objectives: To determine the tumor characteristics and survival of patients with IPF with non-small cell lung cancer (NSCLC) using U.S. population-based data.Methods: We selected Medicare beneficiaries from the Surveillance, Epidemiology, and End Results registry with histologically confirmed NSCLC diagnosed between 2007 and 2011. IPF was identified using two validated claims-based algorithms. We compared tumor characteristics and used logistic and Cox regression to compare rates of stage-appropriate therapy and of overall and lung cancer-specific survival in those with IPF and without IPF.Results: A total of 54,453 patients with NSCLC were included. Those with IPF were more likely to be diagnosed at an earlier stage (P < 0.01) and to have squamous histology (46% vs. 35%; P < 0.01) and lower-lobe tumors (38% vs. 28%; P < 0.01) than those without IPF. Patients with IPF and stages I-II disease had odds of receiving stage-appropriate therapy similar to patients without IPF who had stages I-II disease (odds ratio [OR], 1.13; 95% confidence interval [CI], 0.89-1.43); however, those with advanced disease were less likely to be treated (OR, 0.82; 95% CI, 0.68-0.99). Overall and lung cancer-specific survival were worse in patients with IPF (respectively, hazard ratio [HR], 1.35; 95% CI, 1.26-1.45; and HR, 1.21; 95% CI, 1.10-1.32).Conclusions: NSCLC has a unique presentation in patients with IPF and is associated with poorer prognosis. Further research is needed to identify optimal treatment strategies in this population.
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Shao W, Zhou Q, Tang X. Current and emerging treatment options for lung cancer in patients with pre-existing connective tissue disease. Pulm Pharmacol Ther 2020; 63:101937. [PMID: 32810582 DOI: 10.1016/j.pupt.2020.101937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/14/2020] [Accepted: 08/11/2020] [Indexed: 11/29/2022]
Abstract
An association between connective tissue disease (CTD) and lung cancer has been claimed in accumulating studies. However, the management of lung cancer with CTD is challenging because the pre-existing CTDs have proved to be significant risk factors for treatment-related toxicity, resulting in poor survival. In this review, we summarize the available information related to the treatment for lung cancer with CTD, discuss risk factors for treatment-related toxicities and management recommendations, which attempts to approach lung cancer with comorbid CTD systematically. Preliminary data show that: i) limited studies have focused on the effect of traditional therapeutic modalities, such as surgical treatment and chemotherapy; ii) with the development of the modern radiation techniques, radiotherapy would be well tolerated in this challenging clinical situation, but a cautious decision should be made for patients with CTD associated interstitial lung disease (ILD); iii) for patients with inactive CTD, immunotherapy was shown to have excellent local control with acceptable toxicity; iv) little information is available on the effects of tyrosine kinase inhibitors because of acute exacerbation (AE) of ILD risks; v) antiangiogenic therapy might be useful in preventing the progression in both lung cancer and CTD without increasing the AE-ILD risk; vi) Nintedanib would be a potentially promising novel therapy since it has recently been developed with promising results for both lung cancer and CTD-ILD. Further large-scale, randomized, controlled studies are still required to develop better therapeutic management for patients with lung cancer and pre-existing CTD.
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Affiliation(s)
- Weihua Shao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaokui Tang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Hayashi K, Nakashima K, Noma S, Aoshima M, Kusanagi H. Laparoscopic surgery in patients with interstitial lung disease: A single-center retrospective observational cohort study. Asian J Endosc Surg 2020; 13:279-286. [PMID: 31691544 DOI: 10.1111/ases.12762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 08/11/2019] [Accepted: 10/06/2019] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Laparoscopic surgery requiring longer operative times and artificial pneumoperitoneum may affect pulmonary function; its feasibility in patients with interstitial lung disease remains unknown. Therefore, we examined the feasibility of laparoscopic surgery in patients with interstitial lung disease. METHODS We conducted a retrospective observational cohort study and examined the clinical data of patients with interstitial lung disease who had undergone abdominal surgery under general anesthesia. The primary end-point was the incidence of pulmonary complications. The secondary end-points were non-pulmonary complications and in-hospital mortality. RESULTS Twenty-nine patients who had undergone abdominal surgery were diagnosed with interstitial lung disease after a review of their clinical and imaging records. Laparoscopic surgery and open surgery were performed in 11 and 18 patients, respectively. Acute exacerbation occurred in one (9%) patient in the laparoscopic group and three patients (17%) in the open group; all had undergone emergency surgery. Postoperative pneumonia did not occur in any patients. Non-pulmonary complications occurred in one patient (9%) in the laparoscopic group and two patients (11%) in the open group. One patient in each group died of acute exacerbation during hospitalization. CONCLUSION Neither acute exacerbation nor pulmonary complications occurred after elective laparoscopic or open surgery in patients with interstitial lung disease. The risk of acute exacerbation after elective laparoscopic surgery may not be as high as that after elective thoracic surgery.
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Affiliation(s)
- Kentaro Hayashi
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Japan
| | - Kei Nakashima
- Department of Pulmonology, Kameda Medical Center, Kamogawa, Japan
| | - Satoshi Noma
- Department of Pulmonology, Kameda Medical Center, Kamogawa, Japan
| | - Masahiro Aoshima
- Department of Pulmonology, Kameda Medical Center, Kamogawa, Japan
| | - Hiroshi Kusanagi
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Japan
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Song MJ, Kim DJ, Paik HC, Cho S, Kim K, Jheon S, Lee SH, Park JS. Impact of idiopathic pulmonary fibrosis on recurrence after surgical treatment for stage I-III non-small cell lung cancer. PLoS One 2020; 15:e0235126. [PMID: 32598373 PMCID: PMC7323957 DOI: 10.1371/journal.pone.0235126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/09/2020] [Indexed: 11/19/2022] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) is an independent risk factor for lung cancer (LC) development; however, its effect on recurrence after curative surgery remains unclear. Objectives This study aimed to determine the impact of IPF on recurrence-free survival following curative surgical resection of stage I–III non-small cell lung cancer (NSCLC) and investigate the effects of patient and surgical factors on the risk of recurrence. Methods We reviewed retrospectively collected data of patients with surgically resected stage I–III NSCLC from two tertiary care hospitals in South Korea. By propensity score matching, patients with IPF (LC with IPF) were matched to those without IPF (LC without IPF). Results In total, 3416 patients underwent surgical resection, and 96 were diagnosed with underlying IPF. In the LC with IPF group, 89.6% patients were men, and the average age was 69.7 years. Sublobar resection was performed more frequently in the LC with IPF group than in the LC without IPF group, while the rate of mediastinal lymph node dissection and dissected node number were lower in the former group. The 5-year recurrence-free survival rate was significantly lower in the LC with IPF group (49.2%) than in the LC without IPF group (69.1%; P<0.001). Multivariable Cox regression analysis revealed that IPF and postoperative stage III were independent risk factors for recurrence. Conclusions IPF may increase the risk of recurrence after curative surgical treatment for NSCLC. Close surveillance for recurrence is mandatory for patients with underlying IPF.
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Affiliation(s)
- Myung Jin Song
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Dae Jun Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo Chae Paik
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sukki Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kwhanmien Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sanghoon Jheon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sang Hoon Lee
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Diseases, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail: (JSP); (SHL)
| | - Jong Sun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- * E-mail: (JSP); (SHL)
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Ma W, Li H, Tian Z, Wang S, Zheng X, Hou J. Complete regression of pulmonary squamous carcinoma in IPF following gemcitabine plus cisplatin: a case report and literature review. BMC Pulm Med 2020; 20:69. [PMID: 32197657 PMCID: PMC7082954 DOI: 10.1186/s12890-020-1094-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 02/19/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Lung cancer is one of the most common co-morbid conditions in patients with idiopathic pulmonary fibrosis (IPF) and negatively affects the prognosis of IPF; Current guidelines for the management of IPF do not give a clear statement on how to manage these patients, and traditional chemotherapy for lung cancer had a limited efficiency rate. Here, we present a rare case of primary lung squamous carcinoma in a patient with IPF whose tumor completely regressed following gemcitabine plus cisplatin therapy; the cancer was no longer detectable after 2 years upon follow-up. CASE PRESENTATION Sixty-seven year-old male patient with IPF was admitted to hospital due to acute onset hemoptysis. In addition to a definite usual interstitial pneumonia (UIP) pattern, a chest CT scan showed a non-enhancing nodular opacity in the right upper lobe and an enhancing nodule in the right lower lobe. Bronchoscopic biopsy of the nodule in the right lower lobe revealed squamous lung cancer. After 2 cycles of chemotherapy with gemcitabine and cisplatin, the tumor in the right lower lobe was no longer detectable after 2 years of follow-up; however, the nodule in the right upper lobe had increased significantly. Finally, Mycobacterium tuberculosis (MTB) was cultured from the bronchoalveolar (BAL) sample submitted at the last evaluation, and the patient was confirmed to have active pulmonary TB. CONCLUSION We report the first documented case of complete pulmonary squamous carcinoma regression in IPF following gemcitabine plus cisplatin. Traditional chemotherapy is considered inadequate to cause the resulting regression of the tumor. The concomitant active pulmonary tuberculosis possibly underlies the mechanism.
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Affiliation(s)
- Weirong Ma
- Department of Respiratory and Critical Care Medicine, General Hospital of Ningxia Medical University, No.804 Shenglijie, Xingqing District, Yinchuan, 750004, China
| | - Hui Li
- Ningxia Medical University, Yinchuan, Ningxia, China
| | - Zhigang Tian
- Department of Respiratory and Critical Care Medicine, General Hospital of Ningxia Medical University, No.804 Shenglijie, Xingqing District, Yinchuan, 750004, China
| | - Shaojin Wang
- Department of Respiratory and Critical Care Medicine, General Hospital of Ningxia Medical University, No.804 Shenglijie, Xingqing District, Yinchuan, 750004, China
| | - Xiwei Zheng
- Department of Respiratory and Critical Care Medicine, General Hospital of Ningxia Medical University, No.804 Shenglijie, Xingqing District, Yinchuan, 750004, China
| | - Jia Hou
- Department of Respiratory and Critical Care Medicine, General Hospital of Ningxia Medical University, No.804 Shenglijie, Xingqing District, Yinchuan, 750004, China.
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Gibiot Q, Monnet I, Levy P, Brun AL, Antoine M, Chouaïd C, Cadranel J, Naccache JM. Interstitial Lung Disease Associated with Lung Cancer: A Case-Control Study. J Clin Med 2020; 9:jcm9030700. [PMID: 32150840 PMCID: PMC7141363 DOI: 10.3390/jcm9030700] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/24/2020] [Accepted: 03/02/2020] [Indexed: 01/13/2023] Open
Abstract
Interstitial lung disease (ILD) seems to be associated with an increased risk of lung cancer (LC) and to have a poorer prognosis than LC without ILD. The frequency of ILD in an LC cohort and its prognosis implication need to be better elucidated. This retrospective, observational, cohort study evaluated the frequency of ILD among LC patients (LC–ILD) diagnosed over a 2-year period. LC–ILD patients’ characteristics were compared to those with LC without ILD (LC–noILD). Lastly, we conducted a case–control study within this cohort, matching three LC–noILDs to each LC–ILD patient, to evaluate the ILD impact on LC patients’ prognoses. Among 906 LC patients, 49 (5.4%) also had ILD. Comparing LC–ILD to LC–noILD patients, respectively, more were men (85.7% vs. 66.2%; p = 0.02); adenocarcinomas were less frequent (47.1% vs. 58.7%, p = 0.08); median [range] and overall survival was shorter: (9 [range: 0.1–39.4] vs. 17.5 [range: 0.8–50.4] months; p = 0.01). Multivariate analysis (hazard ratio [95% confidence interval]) retained two factors independently associated with LC risk of death: ILD (1.79 [1.22–2.62]; p = 0.003) and standard-of-care management (0.49 [0.33–0.72]; p < 0.001). Approximately 5% of patients with a new LC diagnosis had associated ILD. ILD was a major prognosis factor for LC and should be taken into consideration for LC management. Further studies are needed to determine the best therapeutic strategy for the LC–ILD population.
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Affiliation(s)
- Quentin Gibiot
- Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France; (Q.G.); (C.C.)
- Faculté de Médecine, Université Paris-Est Créteil, 94000 Créteil, France
| | - Isabelle Monnet
- Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France; (Q.G.); (C.C.)
| | - Pierre Levy
- Institut Pierre-Louis de Santé Publique (EPAR Team) et Sorbonne Université, Department de Santé Publique, APHP, Hôpital Tenon, 75020 Paris, France;
| | - Anne-Laure Brun
- Service de Radiologie, APHP, Hôpital Cochin, Paris 75014, France, Faculté de Médecine, Université Paris Descartes, 75020 Paris, France
| | - Martine Antoine
- Service d’Anatomie et Cytologie Pathologique, APHP, Hôpital Tenon, 75020 Paris, France;
| | - Christos Chouaïd
- Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France; (Q.G.); (C.C.)
- Faculté de Médecine, Université Paris-Est Créteil, 94000 Créteil, France
| | - Jacques Cadranel
- Service de Pneumologie, Site constitutif du centre de référence des maladies pulmonaires rares OrphaLung, APHP, Hôpital Tenon, 75020 Paris, France;
- Faculté de Médecine, Université Paris Descartes, 75020 Paris, France
| | - Jean-Marc Naccache
- Service de Pneumologie, Site constitutif du centre de référence des maladies pulmonaires rares OrphaLung, APHP, Hôpital Tenon, 75020 Paris, France;
- Correspondence: ; Tel.: +33-(0)1-56-01-70-48; Fax: +33(0)1-56-01-62-29
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Hirji SA, Cote C, Lee J, Kiehm S, McGurk S, Pelletier MP, Aranki S, Shekar P, Shah P, Kaneko T. Transcatheter vs surgical aortic valve replacement in patients with interstitial lung disease. J Card Surg 2020; 35:571-579. [PMID: 31981435 DOI: 10.1111/jocs.14421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with underlying interstitial lung disease (ILD) who undergo cardiac surgery are at high risk of postoperative pulmonary complications. It remains unclear if transcatheter aortic valve replacement (TAVR) offers any benefit over surgical aortic valve replacement (SAVR) in ILD patients with severe aortic stenosis. METHODS All adult patients with a diagnosis of ILD who underwent either a TAVR or isolated SAVR between January 2002 and December 2017 were retrospectively reviewed. Operative mortality, 30-day readmissions, and adjusted 1-year survival were compared between the two cohorts. RESULTS The overall cohort included 52 TAVR and 74 SAVR patients. While TAVR patients were significantly older (77.2 vs 72.9 years) with higher Society of Thoracic Surgeons predicted risk of mortality (STS-PROM) scores compared with SAVR patients (6.29 vs 4.49; all P < .02), operative mortality was similar (5.8% vs 4.1%; P = .45). Rates of postoperative stroke, permanent pacemaker implantation, reintubation, and 30-day readmissions did not differ between the two groups (all P > .46). However, TAVR was associated with significantly shorter hospital and intensive care unit (ICU) length of stay, shorter ventilation times, and less requirement for ICU admission (all P < .05). Thirty-day readmissions and adjusted 1-year survival were also similar between the two groups (hazard ratio for TAVR vs SAVR = 1.34; 95% CI: 0.7-2.6). CONCLUSIONS Among ILD patients with symptomatic aortic stenosis, TAVR was associated with comparable operative and risk-adjusted 1-year survival to SAVR. TAVR patients also had shorter ventilator times, ICU and hospital stay despite being at higher risk. Together, our findings suggest that TAVR may be a better option in this unique cohort.
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Affiliation(s)
- Sameer A Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Claudia Cote
- Division of Cardiac Surgery, Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jiyae Lee
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Spencer Kiehm
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Siobhan McGurk
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marc P Pelletier
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sary Aranki
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Prem Shekar
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pinak Shah
- Division of Cardiac Surgery, Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Prognosis of non-small-cell lung cancer in patients with idiopathic pulmonary fibrosis. Sci Rep 2019; 9:12561. [PMID: 31467375 PMCID: PMC6715712 DOI: 10.1038/s41598-019-49026-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/19/2019] [Indexed: 11/25/2022] Open
Abstract
The risk of lung cancer is higher in idiopathic pulmonary fibrosis (IPF) because both conditions share common risk factors. However, no standard treatment modality for LC in IPF exists due to rare incidence, poor prognosis, and acute exacerbation (AE) of IPF during treatment. We aimed to determine the efficacy of LC treatments and the prognosis in LC patients with IPF according to the LC stage and GAP (gender [G], age [A], and two physiology variables [P]) stage. From 2003 to 2016, 160 retrospectively enrolled patients were classified according to the LC clinical stage and GAP stage. The average (±standard deviation) patient age was 70.1 ± 8.2 years; the cohort predominantly comprised men (94.4%). In GAP stage I, surgery was significantly associated with better survival outcomes in LC. In contrast, no treatment modality yielded significant clinical improvement in GAP stage II/III. The incidences of AE in IPF and its mortality during treatment were 13.8% and 6.3%, respectively. AE occurred commonly in advanced GAP stage. Active treatment should be considered in GAP stage I. The performance status and LC stage should be considered when deciding about the necessity of surgery for patients in advanced GAP stage.
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21
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Halldorsson H, Orrason AW, Oskarsdottir GN, Petursdottir A, Fridriksson BM, Magnusson MK, Jonsson S, Gudbjartsson T. Improved long-term survival following pulmonary resections for non-small cell lung cancer: results of a nationwide study from Iceland. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:88. [PMID: 31019938 DOI: 10.21037/atm.2019.01.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background We studied the outcome of pulmonary resection with curative intent for non-small cell lung cancer (NSCLC) in a nationwide study covering a 24-year period, focusing on survival. Methods All patients who underwent pulmonary resection for NSCLC in Iceland in the period 1991-2014 were reviewed for demographics, TNM stage and survival. Median length of follow-up was 45 months. Three 8-year periods were compared, overall survival was estimated, and prognostic factors for survival were identified. Results Altogether, 652 surgical resections were performed on 644 individuals (52% females): 492 lobectomies (75%), 77 pneumonectomies (12%), and 83 sublobar resections (13%). Mean age increased from 65 to 68 yrs during the study period (P=0.002). The number of cases operated at stage IA increased substantially between the first and last periods (29% vs. 37%; P<0.001). Survival improved from 75% to 88% at 1 year and from 38% to 53% at 5 years (P<0.001). Independent prognostic factors for mortality were advanced TNM stage (HR =2.68 for stage IIIA vs. I), age (HR =1.04), ischaemic heart disease (HR =1.26), any minor complication (HR =1.26), and sublobar resection (HR =1.33), but surgical margins free from tumour growth (HR =0.59) and treatment during the latter two eight-year periods were predictors of lower mortality. The best survival was seen between 2007 and 2014 (HR =0.61, 95% CI: 0.48-0.78; P<0.001). Conclusions Survival of patients who have undergone pulmonary resection for NSCLC has improved significantly in Iceland. This may be explained by the increased number of patients diagnosed at lower stages and improved preoperative staging, with fewer understaged patients.
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Affiliation(s)
- Hannes Halldorsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
| | - Andri Wilberg Orrason
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
| | | | - Astridur Petursdottir
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
| | - Bjorn Mar Fridriksson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
| | | | - Steinn Jonsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Pulmonology, Landspitali University Hospital, Reykjavik, Iceland
| | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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Hung YP, Hunninghake GM, Miller ER, Putman R, Nishino M, Araki T, Hatabu H, Sholl LM, Vivero M. Incidental nonneoplastic parenchymal findings in patients undergoing lung resection for mass lesions. Hum Pathol 2019; 86:93-101. [PMID: 30658062 DOI: 10.1016/j.humpath.2019.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 11/17/2022]
Abstract
The prevalence of incidental nonneoplastic lung disease in patients undergoing resection for mass lesions is unknown. We determined the prevalence and characteristics of parenchymal findings in patients with lung nodules, aiming to increase awareness of findings that could potentially impact patient management. A total of 397 patients with benign or malignant mass lesions with available presurgical chest computed tomography scans resected between January 2001 and July 2015 were included. Retrospective histologic assessment of parenchymal abnormalities in at least 1 section of grossly normal lung was performed for each case by 2 pulmonary pathologists and correlated with original pathology reports, clinical history, and radiologic findings. A total of 233 women and 164 men underwent resections for carcinomas (78%) or benign nodules (22%). One hundred one (25%) patients showed parenchymal abnormalities, including 14 patients with multiple findings. The most common abnormal findings were fibrotic interstitial changes (10%), including usual interstitial pneumonia (1%), followed by granulomatous processes (8%). Other findings included aspiration (4%), intravascular thrombi (2%), Langerhans cell histiocytosis (1.5%), constrictive bronchiolitis (1%), atypical lymphoid infiltrates (1%), and amyloidosis (0.5%). Abnormalities were more likely to have been documented in the original pathology report by pulmonary pathologists (68%) than by general pathologists (15%) (P < .0001). Cases with histologic parenchymal abnormalities were more likely to show radiologic interstitial lung abnormalities than those without (16% versus 5%; P = .001). Evaluation of background lung parenchyma may yield valuable and unanticipated information in patients undergoing surgical resections for lung masses that may correlate with radiographic interstitial lung abnormalities and influence clinical management.
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Affiliation(s)
- Yin P Hung
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115
| | - Gary M Hunninghake
- Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115
| | - Ezra R Miller
- Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115
| | - Rachel Putman
- Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115
| | - Mizuki Nishino
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, 02115
| | - Tetsuro Araki
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, 02115
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, 02115
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115
| | - Marina Vivero
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115.
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23
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Wang J, Wang X, Wang Y, Li S, Wang X. Krüppel like factor 6 splice variant 1 (KLF6-SV1) overexpression recruits macrophages to participate in lung cancer metastasis by up-regulating TWIST1. Cancer Biol Ther 2018; 20:680-691. [PMID: 30590988 PMCID: PMC6605981 DOI: 10.1080/15384047.2018.1550570] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/07/2018] [Accepted: 11/15/2018] [Indexed: 01/10/2023] Open
Abstract
The aim of this study was to investigate the mechanism by which KLF6-SV1 promoted lung cancer metastasis through tumor-associated macrophages (TAMs). Plasmid transfection was used to construct cells that upregulated or silenced gene. Tumor-bearing mouse model was established using A549 cells. SP staining was performed to detect the CD163 and CD68. Six-well plates and Transwell chamber were used for co-culture of lung cancer A549 cells and macrophages. CCK-8 and Transwell assay were applied to detected the cell viability and migration respectively. Protein and mRNA were tested by Western blot and quantitative real-time polymerase chain reaction (qRT-PCR).KLF6-SV1 overexpression promoted the expression levels of TWIST1 and CCL2, and also induce macrophage polarization to M2 and epithelial-mesenchymal transition (EMT). In vitro experiments showed that KLF6-SV1 might regulate the migration of lung cancer cells by regulating the expression of TWIST1 and CCL-2. M2 macrophages did not affect the expression of KLF6-SV1, TWIST1 and CCL-2. The co-culture system could up-regulate the EMT of A549 cells.Overexpression of KLF6-SV1 promoted the expression of TWIST1 and CCL2, and up-regulation of TWIST1 expression might promote the infiltration of M2 macrophages, which promoted the involvement of EMT in the metastasis of lung cancer cells.
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Affiliation(s)
- Jian Wang
- Department of Medical oncology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Xiao Wang
- Department of Rheumatology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Yawei Wang
- Department of Medical oncology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Shuguang Li
- Department of Medical oncology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Xiuwen Wang
- Department of Medical oncology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
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24
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Kawaguchi T, Sawabata N, Miura S, Kawai N, Yasukawa M, Tojo T, Taniguchi S. Prognostic impact of underlying lung disease in pulmonary wedge resection for lung cancer. Int J Clin Oncol 2018; 24:366-374. [PMID: 30443810 DOI: 10.1007/s10147-018-1367-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/01/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pulmonary wedge resection is an option for lung cancer patients with limited cardiopulmonary preservation. As the impact of underlying lung status on the prognosis of such patients remains unclear, we assessed this issue. METHODS A total of 149 borderline surgical candidates with localized lung cancer who had undergone wedge resection were retrospectively investigated. Clinical variables related to perioperative morbidity, local control rate, and oncological outcomes based on underlying lung disease were analyzed. RESULTS According to the risk analysis of postoperative complications, underlying lung disease did not influence the surgical morbidity. Postoperative recurrence occurred in 65 patients (locoregional recurrence in 36, distant metastasis in 12, and both simultaneously in 17). Multivariate analysis revealed that emphysema on computed tomography (CT) [hazard ratio (HR) 0.45; 95% confidence interval (CI) 0.21-0.99] was an independent indicator of locoregional recurrence. Forty-four patients died of lung cancer and 29 of other causes. Multivariate analysis demonstrated that interstitial lung disease on CT (HR 1.98; 95% CI 1.01-3.89) was a predictor of poor prognosis. CONCLUSION Pulmonary wedge resection can be safely undergone by lung cancer patients regardless of pulmonary comorbidity, although underlying lung disease may influence the prognosis after wedge resection.
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Affiliation(s)
- Takeshi Kawaguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Noriyoshi Sawabata
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Sachiko Miura
- Department of Radiation Oncology, Nara Medical University, Kashihara, Nara, Japan
| | - Norikazu Kawai
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Motoaki Yasukawa
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Takashi Tojo
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Shigeki Taniguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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25
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Pagès PB, Mariet AS, Pforr A, Cottenet J, Madelaine L, Abou-Hanna H, Bernard A, Quantin C. Does age over 80 years have to be a contraindication for lung cancer surgery-a nationwide database study. J Thorac Dis 2018; 10:4764-4773. [PMID: 30233848 PMCID: PMC6129874 DOI: 10.21037/jtd.2018.07.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 04/14/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Nowadays surgery remains the best treatment for localized lung cancer (LC). However, patients over 80 years old are often denied surgery because of the postoperative risk of death. This study aimed to estimate in-hospital mortality (IHM) and determine whether age over 80 is the most important predictor of IHM after LC surgery. METHODS From January 2005 to December 2015, 97,440 patients, including 4,438 patients over 80 years old, were operated on for LC and recorded in the French Administrative Database. Characteristics of patients, hospitals and surgery were analysed. RESULTS Crude IHM was 3.73% (n=3,639) and 7.77% (n=345) for the over 80s vs. 3.54% (n=3,294) for younger patients (P<0.0001). In multivariate analysis, predictive factors for IHM with the odds ratios (OR) were: 2.60 for age ≥80 (95% CI: 2.30-2.94; P=0.0001), 5.85 for a previous liver disease (95% CI: 4.79-7.16; P=0.0001) and 5 for previous lung disease (95% CI: 4.25-5.9; P=0.0001). IHM was also linked to hospital volume with an OR of 0.75 (95% CI: 0.69-0.81; P=0.0001) and a linear decrease for predicted IHM according to hospital volume for the over 80s. Adjusted ORs were 1.15 (95% CI: 0.96-1.4; P=0.0116) for lobectomy, 2.18 for bilobectomy (95% CI: 1.7-2.8; P=0.0001) and 3.83 (95% CI: 3.2-4.6; P=0.0001) for pneumonectomy. CONCLUSIONS Concerning IHM, age ≥80 had a lower weight than did a previous pulmonary or liver disease and the type of pulmonary resection. Patients over 80s with localized LC and no significant comorbidities should be referred for surgery if lobectomy or sublobar resection could be performed.
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Affiliation(s)
- Pierre-Benoit Pagès
- Department of Thoracic Surgery, CHU Dijon, Bocage Central, Dijon, France
- INSERM UMR 1231, CHU Bocage, University of Burgundy, Dijon, France
| | - Anne-Sophie Mariet
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France; Bourgogne Franche-Comté University, Dijon, France
| | - Arnaud Pforr
- Department of Thoracic Surgery, CHU Dijon, Bocage Central, Dijon, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France; Bourgogne Franche-Comté University, Dijon, France
| | - Leslie Madelaine
- Department of Thoracic Surgery, CHU Dijon, Bocage Central, Dijon, France
| | - Halim Abou-Hanna
- Department of Thoracic Surgery, CHU Dijon, Bocage Central, Dijon, France
| | - Alain Bernard
- Department of Thoracic Surgery, CHU Dijon, Bocage Central, Dijon, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France; Bourgogne Franche-Comté University, Dijon, France
- INSERM, CIC 1432, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, CHU Bocage, University of Burgundy, Dijon, France
- Department of Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
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26
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Saito S, Lasky JA, Hagiwara K, Kondoh Y. Ethnic differences in idiopathic pulmonary fibrosis: The Japanese perspective. Respir Investig 2018; 56:375-383. [PMID: 30061050 DOI: 10.1016/j.resinv.2018.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 05/03/2018] [Accepted: 06/12/2018] [Indexed: 01/20/2023]
Abstract
Epidemiologic data suggest that there are ethnic differences between Japanese and other populations with regard to the important clinical aspects of interstitial lung disease (ILD), such as the cause of death and prognostic factors in patients with idiopathic pulmonary fibrosis (IPF). Acute exacerbation (AE) of IPF may be more common in Japan than in the rest of the world, although this suggestion remains controversial. Moreover, AE of ILD induced by gefitinib may also be more common in Japan, indicating that Japanese patients have a genetic vulnerability or susceptibility to AE. Recent large-scale studies are starting to reveal ethnic differences in the genetics of ILD, including the prevalence of the genetic polymorphisms associated with the clinical course of ILD. We anticipate that ongoing and upcoming research regarding ethnic differences will continue to provide valuable insights into the pathogenesis and management of ILD.
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Affiliation(s)
- Shigeki Saito
- Department of Medicine, Section of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Science Center, New Orleans, LA, USA.
| | - Joseph A Lasky
- Department of Medicine, Section of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Science Center, New Orleans, LA, USA.
| | - Koichi Hagiwara
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan.
| | - Yasuhiro Kondoh
- Nagoya University School of Medicine, Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi 489-8642, Japan.
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27
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Goto T. Measuring Surgery Outcomes of Lung Cancer Patients with Concomitant Pulmonary Fibrosis: A Review of the Literature. Cancers (Basel) 2018; 10:cancers10070223. [PMID: 29973551 PMCID: PMC6070817 DOI: 10.3390/cancers10070223] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/24/2018] [Accepted: 06/30/2018] [Indexed: 12/25/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF), the most common form of idiopathic interstitial pneumonias, often progresses to restrictive respiratory disturbance and mortality, typically within 10 years. IPF frequently coexists with lung cancer, and the combination of these two disease entities is far more difficult to treat than either lung cancer or IPF alone. In particular, surgery for lung cancer with IPF in the background increases postoperative morbidity and mortality by exacerbating pre-existing IPF, i.e., acute exacerbation of IPF (AEIPF). Furthermore, the long-term outcome after lung cancer surgery is considerably worsened by the presence of IPF. We present here a comprehensive review of AEIPF and the long-term outcomes after surgery.
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Affiliation(s)
- Taichiro Goto
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Kofu 400-8506, Japan.
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28
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Naccache JM, Gibiot Q, Monnet I, Antoine M, Wislez M, Chouaid C, Cadranel J. Lung cancer and interstitial lung disease: a literature review. J Thorac Dis 2018; 10:3829-3844. [PMID: 30069384 DOI: 10.21037/jtd.2018.05.75] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The association between lung cancer (LC) and interstitial lung disease (ILD) can be explained by the shared risk factors like smoking and physiopathology of fibrogenesis and cancerogenesis. The relative LC risk is shown to be 3.5- to 7.3-times higher in ILD, with LC occurrence estimated at 10-20% in ILD, with >15% of ILD patients likely to die from LC. ILD incidence upon LC diagnosis varied from 2.4-10.9%. Primary radiological presentations consist of peripheral lesions, mostly in the inferior pulmonary lobes, either close to or within the ILD areas. There is a trend towards inverted proportion of adenocarcinomas and squamous-cell carcinomas, with EGFR mutations very rarely found. ILD negatively impacted LC prognosis, with surgery associated with increased morbidity-mortality, particularly due to acute exacerbation (AE) of ILD. Limited resection reduced this risk, whilst increasing that of cancer mortality. Studies on radiotherapy that can induce AE-ILD are scarce. Chemotherapy was associated with similar response rates to those in LC patients without ILD, yet worse survival. This difference may be accounted for by ILD patients' poorer health and higher risk of drug-induced pneumonitis. Further studies are warranted to better understand cancer physiopathology within the fibrotic areas, along with the therapeutic strategies required.
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Affiliation(s)
- Jean-Marc Naccache
- Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service de Pneumologie, Paris, France
| | - Quentin Gibiot
- Centre Hospitalier Intercommunal de Creteil, Service de Pneumologie, Creteil, France.,INSERM UMR U955, Faculté de Médecine, Université Paris Est (UPEC), Créteil, France
| | - Isabelle Monnet
- Centre Hospitalier Intercommunal de Creteil, Service de Pneumologie, Creteil, France
| | - Martine Antoine
- Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service d'Anatomie et Cytologie pathologique, Paris, France
| | - Marie Wislez
- Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service de Pneumologie, Paris, France.,Sorbonne Universités, UPMC University Paris VI, Theranoscan, Paris, France
| | - Christos Chouaid
- Centre Hospitalier Intercommunal de Creteil, Service de Pneumologie, Creteil, France.,INSERM UMR U955, Faculté de Médecine, Université Paris Est (UPEC), Créteil, France
| | - Jacques Cadranel
- Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service de Pneumologie, Paris, France.,Sorbonne Universités, UPMC University Paris VI, Theranoscan, Paris, France
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29
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Bargagli E, Bonti V, Ferrari K, Rosi E, Bindi A, Bartolucci M, Chiara M, Voltolini L. Lung Cancer in Patients with Severe Idiopathic Pulmonary Fibrosis: Critical Aspects. ACTA ACUST UNITED AC 2018; 31:773-777. [PMID: 28652456 DOI: 10.21873/invivo.11130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 05/05/2017] [Accepted: 05/08/2017] [Indexed: 12/29/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a rare interstitial lung disease limited to the lung with an undefined etiopathogenesis and a very short life expectancy (less than 5 years). IPF susceptibility has been associated with several genetic and environmental risk factors and the prognosis is conditioned by comorbidities such as gastro-esophageal reflux, depression, venous thromboembolism, pulmonary hypertension and lung cancer. At 5 years follow-up, 15% of IPF patients develop lung cancer, which can significantly reduce their survival. Because diagnostic or therapeutic procedures such as surgical, radiation or pharmacological treatments may induce acute exacerbations and increase mortality, the management of lung cancer in IPF patients is a very difficult task. This study discusses advantages and disadvantages of lung cancer treatments in patients with severe IPF, highlighting several controversial aspects on this topic, including potential nintedanib treatment.
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Affiliation(s)
- Elena Bargagli
- Section of Respiratory Medicine, Careggi University Hospital, Florence, Italy
| | - Viola Bonti
- Section of Respiratory Medicine, Careggi University Hospital, Florence, Italy
| | - Katia Ferrari
- Section of Respiratory Medicine, Careggi University Hospital, Florence, Italy
| | - Elisabetta Rosi
- Section of Respiratory Medicine, Careggi University Hospital, Florence, Italy
| | - Alessandra Bindi
- UOC Radiodiagnostic, Careggi University Hospital, Florence, Italy
| | | | - Moroni Chiara
- UOC Radiodiagnostic, Careggi University Hospital, Florence, Italy
| | - Luca Voltolini
- Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy
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30
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Jing T, Miao X, Jiang F, Guo M, Xing L, Zhang J, Zuo D, Lei H, Zhai X. Discovery and optimization of tetrahydropyrido[4,3-d]pyrimidine derivatives as novel ATX and EGFR dual inhibitors. Bioorg Med Chem 2018; 26:1784-1796. [PMID: 29496411 DOI: 10.1016/j.bmc.2018.02.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/08/2018] [Accepted: 02/15/2018] [Indexed: 10/18/2022]
Abstract
In order to discovery autotaxin (ATX) and EGFR dual inhibitors with potential therapeutic effect on IPF-LC, a series of novel tetrahydropyrido[4,3-d]pyrimidine derivatives possessing semicarbazones moiety were designed and synthesized. The preliminary investigation at the cellular level indicated six compounds (7h, 8a, 8c, 8d, 9a and 9d) displayed preferable anti-tumor activities against A549, H1975, MKN-45 and SGC cancer cells. Further enzymatic assay against EGFR kinase identified 8a and 9a as promising hits with IC50 values of 18.0 nM and 24.2 nM. Meanwhile, anti-inflammatory assessment against cardiac fibroblasts (CFs) cell and RAW264.7 macrophages led to the discovery of candidate 9a, which exhibited considerable potency both on inhibition rate of 77% towards CFs and on reducing NO production to 1.05 μM at 10 μg/mL. Simultaneously, 9a indicated preferable potency towards ATX with IC50 value of 29.1 nM. Significantly, a RT-PCR study revealed the function of 9a to down-regulate the mRNA expression of TGF-β and TNF-α in a dose-dependent manner. The molecular docking analysis together with the pharmacological studies validated 9a as a potential ATX and EGFR dual inhibitor for IPF-LC treatments.
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Affiliation(s)
- Tongfei Jing
- Key Laboratory of Structure-Based Drug Design and Discovery, Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, PR China
| | - Xiuqi Miao
- Key Laboratory of Structure-Based Drug Design and Discovery, Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, PR China
| | - Feng Jiang
- Key Laboratory of Structure-Based Drug Design and Discovery, Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, PR China
| | - Ming Guo
- Key Laboratory of Structure-Based Drug Design and Discovery, Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, PR China
| | - Lingyun Xing
- Key Laboratory of Structure-Based Drug Design and Discovery, Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, PR China
| | - Junlong Zhang
- Key Laboratory of Structure-Based Drug Design and Discovery, Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, PR China
| | - Daiying Zuo
- Key Laboratory of Structure-Based Drug Design and Discovery, Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, PR China
| | - Hongrui Lei
- Key Laboratory of Structure-Based Drug Design and Discovery, Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, PR China
| | - Xin Zhai
- Key Laboratory of Structure-Based Drug Design and Discovery, Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, PR China.
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31
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Hashimoto N, Ando A, Iwano S, Sakamoto K, Okachi S, Matsuzaki A, Okada Y, Wakai K, Yokoi K, Hasegawa Y. Thin-section computed tomography-determined usual interstitial pneumonia pattern affects the decision-making process for resection in newly diagnosed lung cancer patients: a retrospective study. BMC Pulm Med 2018; 18:2. [PMID: 29304775 PMCID: PMC5756392 DOI: 10.1186/s12890-017-0565-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 12/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is only limited information on the impact of thin-section computed tomography (TSCT)-determined usual interstitial pneumonia (UIP) pattern in the decision-making for resection in newly diagnosed lung cancer patients. METHODS In this retrospective analysis, data were reviewed from 499 newly diagnosed lung cancer patients who received bronchoscopy between 2010 and 2014. The clinical impact of TSCT-determined UIP pattern on the decision-making process for resection in this cohort was evaluated. RESULTS The prevalence rate of TSCT-determined fibrosis was 14.8% (74/499 cases), 86.5% (64/74 cases) of which also had TSCT-determined emphysema. The fibrosis group comprised 40 patients with possible UIP and 34 patients with the UIP pattern. Among surgical candidates, the number of surgeries performed was lower in the fibrosis group (60.8%) than in the normal and emphysema groups (84.7 and 77.3%, respectively). Although the proportion of possible UIP did not differ between surgical candidates and patients with resected lung cancer, the proportion of UIP pattern in patients with resected lung cancer was decreased by 8.5%, compared to the surgical candidates. Although measurement of diffusing capacity of the lung for carbon monoxide (DLCO) was performed in more than 97% of patients with thoracic surgery, only 58% of patients without thoracic surgery had DLCO measurement. Multivariate analysis showed that the finding of UIP pattern independently affects the decision-making process for thoracic surgery. The adjusted odds ratios for the comparison between the patients without fibrosis and the patients with UIP pattern was 0.266 (95% confidence intervals: 0.087-0.812). CONCLUSIONS The presence of TSCT-determined UIP pattern might independently affect the decision-making process for proposing thoracic surgery with curative intent.
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Affiliation(s)
- Naozumi Hashimoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Akira Ando
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shingo Iwano
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koji Sakamoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shotaro Okachi
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Asuka Matsuzaki
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yu Okada
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kohei Yokoi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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32
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Nakajima M, Yamamoto N, Hayashi K, Karube M, Ebner DK, Takahashi W, Anzai M, Tsushima K, Tada Y, Tatsumi K, Miyamoto T, Tsuji H, Fujisawa T, Kamada T. Carbon-ion radiotherapy for non-small cell lung cancer with interstitial lung disease: a retrospective analysis. Radiat Oncol 2017; 12:144. [PMID: 28865463 PMCID: PMC5581450 DOI: 10.1186/s13014-017-0881-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 08/25/2017] [Indexed: 12/25/2022] Open
Abstract
Background Lung cancer is frequently complicated by interstitial lung disease (ILD). Treatment protocols for lung cancer patients with ILD have not been established; surgery, chemotherapy, and radiotherapy can all cause acute exacerbation of ILD. This study evaluated the toxicity and efficacy of carbon ion radiotherapy (CIRT) in patients with non-small cell lung cancer (NSCLC) and ILD. Methods Between June 2004 and November 2014, 29 patients diagnosed with NSCLC and ILD were treated with CIRT. No patient was eligible for curative surgery or conventional radiotherapy secondary to ILD. Owing to prior symptomology, radiation pneumonitis (RP) and symptom progression pre- and post-treatment were evaluated. The relationships between RP and clinical factors were investigated. Results Twenty-eight men and one woman, aged 62 to 90 years old, were followed for 2.7–77.1 months (median: 22.8 months). Single-grade symptomatic progression (grade 2–3) was observed in 4 patients, while 1 patient experiencedtwo-grade progression. Two patients experienced radiation-induced acute exacerbation. Local control at 3 years was 63.3% (72.2% for stage I disease); survival at 3 years was 46.3% (57.2% for stage I disease). Eighteen patients had died by the time of this writing, 10 of lung cancer progression. Radiation pneumonitis post-treatment progression correlated with dosimetric factors of the lungs (V5, V10) and a low pre-treatment serum surfactant protein-D. Conclusions We found that CIRT may be useful as a low-risk, curative option for NSCLC patients with ILD, a population that is typically ineligible for conventional therapy. The DVH analysis showed that minimizing the low-dose region is important for reducing the risk of severe RP. Trial registration NIRS-9404. Registered 1 March 1994.
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Affiliation(s)
- Mio Nakajima
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1, Anagawa, Inage-ward, Chiba, 263-8555, Japan.
| | - Naoyoshi Yamamoto
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1, Anagawa, Inage-ward, Chiba, 263-8555, Japan
| | - Kazuhiko Hayashi
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1, Anagawa, Inage-ward, Chiba, 263-8555, Japan
| | - Masataka Karube
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1, Anagawa, Inage-ward, Chiba, 263-8555, Japan.,Department of Radiology, the University of Tokyo Hospital, Hongo, Bunkyo-ward, Tokyo, 113-8655, Japan
| | - Daniel K Ebner
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1, Anagawa, Inage-ward, Chiba, 263-8555, Japan.,Brown University Alpert Medical School, Providence, RI, 02903, USA
| | - Wataru Takahashi
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1, Anagawa, Inage-ward, Chiba, 263-8555, Japan.,Department of Radiology, the University of Tokyo Hospital, Hongo, Bunkyo-ward, Tokyo, 113-8655, Japan
| | - Makoto Anzai
- Kansai Rosai Hospital, Inabaso, Amagasaki, 660-8511, Japan
| | - Kenji Tsushima
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ward, Chiba, 260-8670, Japan
| | - Yuji Tada
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ward, Chiba, 260-8670, Japan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ward, Chiba, 260-8670, Japan
| | - Tadaaiki Miyamoto
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1, Anagawa, Inage-ward, Chiba, 263-8555, Japan
| | - Hiroshi Tsuji
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1, Anagawa, Inage-ward, Chiba, 263-8555, Japan
| | - Takehiko Fujisawa
- Chiba Foundation for Health Promotion and Disease Prevention, Shinminato, Mihama-ward, Chiba, 261-0002, Japan
| | - Tadashi Kamada
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1, Anagawa, Inage-ward, Chiba, 263-8555, Japan
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Lee G, Kim KU, Lee JW, Suh YJ, Jeong YJ. Serial changes and prognostic implications of CT findings in combined pulmonary fibrosis and emphysema: comparison with fibrotic idiopathic interstitial pneumonias alone. Acta Radiol 2017; 58:550-557. [PMID: 27565631 DOI: 10.1177/0284185116664227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Although fibrotic idiopathic interstitial pneumonias (IIPs) alone and those combined with pulmonary emphysema are naturally progressive diseases, the process of deterioration and outcomes are variable. Purpose To evaluate and compare serial changes of computed tomography (CT) abnormalities and prognostic predictive factors in fibrotic IIPs alone and those combined with pulmonary emphysema. Material and Methods A total of 148 patients with fibrotic IIPs alone (82 patients) and those combined with pulmonary emphysema (66 patients) were enrolled. Semi-quantitative CT analysis was used to assess the extents of CT characteristics which were evaluated on initial and follow-up CT images. Univariate and multivariate analyses were performed to assess the effects of clinical and CT variables on survival. Results Significant differences were noted between fibrotic scores, as determined using initial CT scans, in the fibrotic IIPs alone (21.22 ± 9.83) and those combined with pulmonary emphysema groups (14.70 ± 7.28) ( P < 0.001). At follow-up CT scans, changes in the extent of ground glass opacities (GGO) were greater ( P = 0.031) and lung cancer was more prevalent ( P = 0.001) in the fibrotic IIPs combined with pulmonary emphysema group. Multivariate Cox proportional hazards analysis showed changes in the extent of GGO (hazard ratio, 1.056) and the presence of lung cancer (hazard ratio, 4.631) were predictive factors of poor survivals. Conclusion Although patients with fibrotic IIPs alone and those combined with pulmonary emphysema have similar mortalities, lung cancer was more prevalent in patients with fibrotic IIPs combined with pulmonary emphysema. Furthermore, changes in the extent of GGO and the presence of lung cancer were independent prognostic factors of poor survivals.
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Affiliation(s)
- Geewon Lee
- Department of Radiology, Pusan National University Hospital, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Ki Uk Kim
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Ji Won Lee
- Department of Radiology, Pusan National University Hospital, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, School of Medicine, Inha University, Incheon, Republic of Korea
| | - Yeon Joo Jeong
- Department of Radiology, Pusan National University Hospital, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
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Effect of collagen vascular disease-associated interstitial lung disease on the outcomes of lung cancer surgery. Surg Today 2017; 47:1072-1079. [PMID: 28247107 PMCID: PMC5532416 DOI: 10.1007/s00595-017-1476-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/04/2017] [Indexed: 12/24/2022]
Abstract
Purpose This study compared the effect of collagen vascular disease-associated interstitial lung disease (CVD-ILD) with that of idiopathic interstitial pneumonias (IIPs) on the outcomes of lung cancer surgery. Methods This study retrospectively reviewed the medical records of patients who underwent surgery for non-small cell lung cancer (NSCLC) and compared the data of 16 patients with CVD-ILD with those of 70 patients with IIPs. The patterns of interstitial lung disease (ILD) on chest computed tomography were classified into usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP) patterns. Results The numbers of UIP and NSIP patterns were 10 (62.5%) and 6 (37.5%) patients in CVD-ILD group, and 62 (88.6%) and 8 (11.4%) patients in IIPs group, respectively. A postoperative acute exacerbation (AE) appeared in 1 patient (6.3%) in the CVD-ILD group and 6 patients (8.6%) in the IIPs group. No significant differences in the incidence of postoperative AE and mortalities were observed between the two groups. The five-year overall survival rates of the CVD-ILD and IIPs groups were 37.5 and 49.2%, respectively. Conclusions Surgery for NSCLC in CVD-ILD patients appear to cause no increase in postoperative AE and mortality in comparison to that seen in IIPs patients. Similar to IIPs, CVD-ILD might therefore affect the prognosis of resected NSCLC.
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Concomitant lung cancer and interstitial lung disease: A challenge in clinical practice. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017; 23:104-105. [PMID: 28063797 DOI: 10.1016/j.rppnen.2016.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/27/2016] [Indexed: 10/20/2022] Open
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Hong JM, Kim E, Kim HK, Lee DW, Baik JS, Lee JY. Combined spinal-epidural anesthesia for radical hysterectomy in a patient with Sjȍgren syndrome with progressive interstitial lung disease. SPRINGERPLUS 2016; 5:1737. [PMID: 27777871 PMCID: PMC5053952 DOI: 10.1186/s40064-016-3352-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 07/28/2016] [Indexed: 11/24/2022]
Abstract
Introduction Interstitial lung disease (ILD), which is the most common form of respiratory involvement of Sjȍgren syndrome (SS), is highly associated with postoperative pulmonary complications after surgery. We report the successful anesthetic management of a cervical cancer patient with SS and ILD under combined spinal-epidural anesthesia (CSE) to avoid postoperative pulmonary complications. Case description A 41-year-old woman with SS complicated by recently progressive ILD was scheduled for an elective radical hysterectomy under the diagnosis of cervical cancer. We performed CSE with separate needle technique (SNT) using two different interspaces. An epidural catheter was inserted at T11–T12 before administration of spinal medication at L3–L4. We could achieve successful anesthetic management for radical hysterectomy, maintaining stable hemodynamic variables. Postoperative analgesia, using epidural catheter, was effective and devoid of any postoperative pulmonary morbidity. Discussion and Evaluation CSE could offer a high level of sensory blockade, profound muscular blockade, longer duration of surgical anesthesia, excellent postoperative pain control, and reduction in the incidence of pulmonary morbidity. Therefore it would be excellent anesthetic option for the patients with pulmonary impairment. Conclusion CSE with SNT may be particularly advantageous in patients with pulmonary impairment such as progressive ILD when general anesthesia is associated with high risk of postoperative complications.
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Affiliation(s)
- Jeong-Min Hong
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea ; Biomed Research Institute, Pusan National University Hospital, Busan, Korea
| | - Eunsoo Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea ; Biomed Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hae-Kyu Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea ; Biomed Research Institute, Pusan National University Hospital, Busan, Korea
| | - Do-Won Lee
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea ; Biomed Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ji-Seok Baik
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea ; Biomed Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ji-Youn Lee
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea
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Impact of Thin-Section Computed Tomography-Determined Combined Pulmonary Fibrosis and Emphysema on Outcomes Among Patients With Resected Lung Cancer. Ann Thorac Surg 2016; 102:440-7. [PMID: 27157056 DOI: 10.1016/j.athoracsur.2016.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 02/25/2016] [Accepted: 03/07/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND There is only limited information on the clinical impact of combined pulmonary fibrosis and emphysema (CPFE) on postoperative and survival outcomes among patients with resected lung cancer. METHODS In a retrospective analysis, data were reviewed from 685 patients with resected lung cancer between 2006 and 2011. The clinical impact of thin-section computed tomography (TSCT)-determined emphysema, fibrosis, and CPFE on postoperative and survival outcomes was evaluated. RESULTS The emphysema group comprised 32.4% of the study population, the fibrosis group 2.8%, and the CPFE group 8.3%. The CPFE group had a more advanced pathologic stage and higher prevalence of squamous cell carcinoma as compared with the normal group without emphysema or fibrosis findings on TSCT. The incidence of postoperative complications was significantly higher in the CPFE group. Overall, the 30-day mortality in the CPFE group was 5.3%. Cancer recurrence at pathologic stage I and death due to either cancer or other causes were significantly higher in the CPFE group. Survival curves indicated that a finding of CPFE was associated with worse overall survival for patients with any stage disease. Multivariate analysis suggested that pathologic stage and CPFE were independent factors associated with worse overall survival. The adjusted hazard ratio of overall survival for the CPFE group versus the normal group was 2.990 (95% confidence interval: 1.801 to 4.962). CONCLUSIONS Among patients with resected lung cancer, the presence of TSCT-determined CPFE might predict worse postoperative and survival outcomes.
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SABR vs. Limited Resection for Non-small Cell Lung Cancer: Are We Closer to an Answer? Curr Treat Options Oncol 2016; 17:27. [DOI: 10.1007/s11864-016-0407-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Distribution of interstitial pneumonia: a new radiological predictor of 90-day mortality after resection of lung cancer. Surg Today 2016; 46:66-73. [PMID: 25735738 DOI: 10.1007/s00595-015-1143-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/17/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND Surgery for lung cancer complicated by idiopathic interstitial pneumonia (IIP) is associated with a high rate of postoperative mortality. Thus, preoperative predictors of surgical mortality are needed to aid in the selection of suitable surgical candidates. METHODS The subjects of this retrospective study were 1625 patients who underwent resection of primary lung cancer between 2000 and 2012, 203 (12.5 %) of whom were found to have IIPs. The following radiological findings were also evaluated: presence of honeycombing and the distribution (diffuse or localized) and extension (central extension or peripheral localized) of honeycombing or infiltration. We also investigated clinical factors and conducted multivariate analyses to identify the predictors of surgical mortality. RESULTS The 30- and 90-day mortality rates were 0.5 and 1.4 % overall and 1.6 and 6.4 % in the IIP patients, respectively. Multivariate analysis revealed that a preoperative pO2 < 70 mmHg (HR 15.3), diffuse distribution and central extension of interstitial pneumonia on computed tomography (HR 9.2), and operative blood loss (ml: HR 1.003) were significant predictors of 90-day mortality. CONCLUSIONS Diffuse distribution and central extension of IIPs, as well as preoperative hypoxia and operative blood loss, were significant predictors of 90-day mortality.
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Rapicetta C, Lococo F, Carbonelli C, Sverzellati N, Di Paolo ML, Cavazza A, Serra S, Ricchetti T, Gasparini E, Cesario A, Sgarbi G, Brandi L, Paci M. A 79-Year-Old Man With Interstitial Lung Disease and Cryptic Area of High 18 Fluorodeoxyglucose Uptake in Left Upper Lobe. Chest 2015; 148:e175-e180. [PMID: 26621296 DOI: 10.1378/chest.14-2680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Seven years after left hemicolectomy and radical lymph nodal dissection followed by adjuvant chemotherapy for colorectal cancer (histotype, adenocarcinoma; stage, pT3N2M0; grading, G2), a slight increase in carcinoembryonic antigen levels (6.2 ng/mL; range, 0-5 ng/mL) was detected in a 79-year-old man. He was a heavy smoker with history of an interstitial fibrotic lung disease with associated areas of emphysema.
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Affiliation(s)
- Cristian Rapicetta
- Units of Thoracic Surgery, Hospital E. Franchini, Montecchio Emilia, Italy.
| | - Filippo Lococo
- Units of Thoracic Surgery, Hospital E. Franchini, Montecchio Emilia, Italy
| | | | - Nicola Sverzellati
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Arcispedale Santa Maria Nuova, Reggio Emilia; Section of Diagnostic Imaging, Hospital E. Franchini, Montecchio Emilia, Italy
| | | | - Alberto Cavazza
- Units of Anatomic Pathology, Hospital E. Franchini, Montecchio Emilia, Italy
| | - Silvia Serra
- Units of Anatomic Pathology, Hospital E. Franchini, Montecchio Emilia, Italy
| | - Tommaso Ricchetti
- Units of Thoracic Surgery, Hospital E. Franchini, Montecchio Emilia, Italy
| | - Elisa Gasparini
- Department of Surgery, University of Parma, Parma; and Unit of Oncology and General Medicine, Hospital E. Franchini, Montecchio Emilia, Italy
| | - Alfredo Cesario
- Research Activities and Systems Medicine, Hospital E. Franchini, Montecchio Emilia, Italy
| | - Giorgio Sgarbi
- Units of Thoracic Surgery, Hospital E. Franchini, Montecchio Emilia, Italy
| | - Loris Brandi
- Units of Thoracic Surgery, Hospital E. Franchini, Montecchio Emilia, Italy
| | - Massimiliano Paci
- Units of Thoracic Surgery, Hospital E. Franchini, Montecchio Emilia, Italy
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Leuzzi G, Facciolo F, Pastorino U, Rocco G. Methods for the postoperative management of the thoracic oncology patients: lessons from the clinic. Expert Rev Respir Med 2015; 9:751-67. [DOI: 10.1586/17476348.2015.1109453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Nishino M, Cardarella S, Dahlberg SE, Araki T, Lydon C, Jackman DM, Rabin MS, Hatabu H, Johnson BE. Interstitial lung abnormalities in treatment-naïve advanced non-small-cell lung cancer patients are associated with shorter survival. Eur J Radiol 2015; 84:998-1004. [PMID: 25726730 DOI: 10.1016/j.ejrad.2015.01.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 01/27/2015] [Accepted: 01/30/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Interstitial lung diseases are associated with increased risk of lung cancer. The prevalence of ILA at diagnosis of advanced non-small-cell lung cancer (NSCLC) and its impact on overall survival (OS) remain to be investigated. MATERIALS AND METHOD The study included 120 treatment-naïve stage IV NSCLC patients (53 males, 67 females). ILA was scored on CT prior to any systemic therapy using a 4-point scale [0=no evidence of ILA, 1=equivocal for ILA, 2=suspicious for ILA, 3=ILA] by a sequential reading method previously reported. ILA scores of 2 or 3 indicated the presence of ILA. RESULTS ILA was present in 17 patients (14%) with advanced NSCLC prior to any treatment (score3: n=2, score2: n=15). These 17 patients were significantly older (median age: 69 vs. 63, p=0.04) and had a heavier smoking history (median: 40 vs. 15.5 pack-year, p=0.003) than those with ILA score 0 or 1. Higher ILA scores were associated with shorter OS (p=0.001). Median OS of the 17 patients with ILA was 7.2 months [95%CI: 2.9-9.4] compared to 14.8 months [95%CI: 11.1-18.4] in patients with ILA score 0 or 1 (p=0.002). In a multivariate model, the presence of ILA remained significant for increased risk for death (HR=2.09, p=0.028) after adjusting for first-line systemic therapy (chemotherapy, p<0.001; TKI, p<0.001; each compared to no therapy) and pack years of smoking (p=0.40). CONCLUSION Radiographic ILA was present in 14% of treatment-naïve advanced NSCLC patients. Higher ILA scores were associated with shorter OS, indicating that ILA could be a marker of shorter survival in advanced NSCLC.
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Affiliation(s)
- Mizuki Nishino
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA; Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA.
| | - Stephanie Cardarella
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215
| | - Suzanne E Dahlberg
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA
| | - Tetsuro Araki
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA
| | - Christine Lydon
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215
| | - David M Jackman
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215
| | - Michael S Rabin
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA
| | - Bruce E Johnson
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215
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Impact of Pretreatment Interstitial Lung Disease on Radiation Pneumonitis and Survival after Stereotactic Body Radiation Therapy for Lung Cancer. J Thorac Oncol 2015; 10:116-25. [DOI: 10.1097/jto.0000000000000359] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Can patients with interstitial lung disease safely undergo pulmonary resection? J Thorac Cardiovasc Surg 2014; 149:71-2. [PMID: 25451491 DOI: 10.1016/j.jtcvs.2014.09.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 09/29/2014] [Indexed: 11/21/2022]
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Lei YM, Zu YF, Wang J, Bai S, Shi YF, Shi R, Duan J, Cui D, Chen J, Xiang Y, Dong J. Interleukin-1β-mediated suppression of microRNA-101 and upregulation of enhancer of zeste homolog 2 is involved in particle-induced lung cancer. Med Oncol 2014; 32:387. [PMID: 25428391 DOI: 10.1007/s12032-014-0387-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 11/18/2014] [Indexed: 12/21/2022]
Abstract
Lung cancer may be a result of complex factors. Small mineral particle is the well-known inducer of lung cancer. Previous study revealed the high morbidity of lung cancer in Xuan Wei in China, and the main cause of lung cancer is the use of smoky coal there. And it is generally accepted that chronic inflammation induced by small mineral particle may be a cause of lung cancer. But the relationship between chronic lung inflammation and lung cancer is largely unknown. In the present study, we found that silica particle was able to induce the secretion of interleukin-1β from a Xuan Wei lung cancer cell line, XWLC-05. At the same time, microRNA-101 (mir-101) was found to be downregulated by the treatment of silica particle. Interestingly, the interleukin 1 receptor antagonist and interleukin-1β antibody can reduce silica particle-induced downregulation of mir-101. Twenty-four Xuan Wei lung tumor tissues were collected to detect the expression level of mir-101 and enhancer of zeste homolog 2 (EZH2), which is the potential target of mir-101. The results showed that mir-101 was down-regulated and EZH2 were upregulated. Subsequently, the roles of mir-101 and EZH2 in tumor growth and progression in vitro were tested. Overexpression of mir-101 mimics was able to suppress the expression of EZH2 in XWLC-05 cells. And this resulted in the inhibited tumor cell growth and attenuated cell migration. The results in the present study showed that particle can induce the secretion of interleukin-1β. Interleukin-1β subsequently induces the downregulation of mir-101, which may result in the upregulated level of EZH2, and occurrence of lung cancer. We for the first time proposed the role interleukin-1β-mir-101-EZH2 axes in the particle-induced lung cancer. Further study may be needed to decipher the detailed mechanism involved.
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Affiliation(s)
- You-Ming Lei
- Department of Vip Surgery Ward and Department of Biotherapy, The First Affiliated Hospital of Kunming Medical University of Medical Science, Kunming, 650032, Yunnan, China
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To SABR or not to SABR? Indications and contraindications for stereotactic ablative radiotherapy in the treatment of early-stage, oligometastatic, or oligoprogressive non-small cell lung cancer. Semin Radiat Oncol 2014; 25:78-86. [PMID: 25771411 DOI: 10.1016/j.semradonc.2014.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Stereotactic ablative radiotherapy (SABR) is a highly effective treatment for early-stage non-small cell lung cancer. Although direct comparisons from randomized trials are not available, rates of both primary tumor control and distant metastasis are similar between SABR and surgery. Overall survival is lower after SABR compared with surgery, largely reflecting that a primary selection criterion for SABR has been medical inoperability because of decreased cardiopulmonary function and other comorbidities that lead to decreased survival independent of non-small cell lung cancer. Survival outcomes between SABR and surgery are much more similar in propensity-matched cohorts. Newer potential indications for SABR include treatment of operable patients; of oligometastatic lung cancer, in which SABR has emerged as an alternative to metastasectomy; and of oligoprogressive lung cancer, an attractive concept especially as improved personalized systemic therapies emerge, and prospective trials are currently being conducted in these settings. Although toxicity in modern series is low, SABR is clearly capable of producing fatal complications, and understanding the risk factors and approaches for mitigating them has been emerging in recent years. Thus, appropriate patient selection is a vital, evolving, and controversial topic.
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Kumagai S, Marumo S, Yamanashi K, Tokuno J, Ueda Y, Shoji T, Nishimura T, Huang CL, Fukui M. Prognostic significance of combined pulmonary fibrosis and emphysema in patients with resected non-small-cell lung cancer: a retrospective cohort study. Eur J Cardiothorac Surg 2014; 46:e113-9. [DOI: 10.1093/ejcts/ezu384] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Kumagai S, Marumo S, Shoji T, Sakuramoto M, Hirai T, Nishimura T, Arima N, Fukui M, Huang CL. Prognostic impact of preoperative monocyte counts in patients with resected lung adenocarcinoma. Lung Cancer 2014; 85:457-64. [PMID: 25043641 DOI: 10.1016/j.lungcan.2014.06.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 06/19/2014] [Accepted: 06/21/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Increasing evidence suggests that an elevated peripheral monocyte count at presentation predicts a poor prognosis in various types of malignancy, including malignant lymphoma. In lung adenocarcinoma, tumor-associated macrophages (TAMs) were reported to be associated with a poor prognosis. However, it is unknown if an elevated peripheral monocyte count is associated with a poor prognosis in lung adenocarcinoma. This study assessed the prognostic impact of the preoperative peripheral monocyte count in lung adenocarcinoma. MATERIALS AND METHODS We retrospectively analyzed 302 consecutive patients with lung adenocarcinoma who received curative resection at Kitano Hospital. The receiver operating characteristic (ROC) curve for the peripheral monocyte count was used to determine the cut-off value. The relations between peripheral monocyte counts and clinicopathological factors were assessed. We also evaluated the impacts of possible prognostic factors including the preoperative peripheral monocyte count on survival, using the two-tailed log-rank test and Cox proportional hazards model. In addition, immunohistochemical staining for CD68 was performed to evaluate the monocytes in primary tumors. RESULTS A peripheral monocyte count of 430mm(-3) was the optimal cut-off value for prognosis. An elevated peripheral monocyte count was significantly associated with sex, performance status, smoking history, chronic obstructive pulmonary disease and interstitial lung disease. The two-tailed log-rank test demonstrated that patients with an elevated peripheral monocyte count experienced a poorer recurrence-free survival (RFS) and overall survival (OS) (P=0.0063, P<0.0001, respectively). In the multivariate analysis an elevated peripheral monocyte count was shown to be an independent prognostic factor for the RFS and OS (HR: 1.765; 95% CI: 1.071-2.910; P=0.0258, HR: 4.339; 95% CI: 2.032-9.263; P=0.0001, respectively). Furthermore, numbers of the monocytes in primary tumors significantly correlated with peripheral monocyte counts (r=0.627, P<0.0001). CONCLUSION The preoperative peripheral monocyte count is an important prognostic factor for patients with lung adenocarcinoma after curative resection.
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Affiliation(s)
- Shogo Kumagai
- Respiratory Disease Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Satoshi Marumo
- Respiratory Disease Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Tsuyoshi Shoji
- Respiratory Disease Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Minoru Sakuramoto
- Respiratory Disease Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Tatsuya Hirai
- Respiratory Disease Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Takafumi Nishimura
- Department of Clinical Oncology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Nobuyoshi Arima
- Department of Hematology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Motonari Fukui
- Respiratory Disease Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Cheng-Long Huang
- Respiratory Disease Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan.
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Choi SM, Lee J, Park YS, Cho YJ, Lee CH, Lee SM, Yoon HI, Yim JJ, Lee JH, Yoo CG, Lee CT, Kim YW, Park JS. Postoperative pulmonary complications after surgery in patients with interstitial lung disease. Respiration 2014; 87:287-93. [PMID: 24577160 DOI: 10.1159/000357046] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 10/19/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with interstitial lung disease (ILD) have a high incidence of postoperative pulmonary complications (PPCs) after lung resection, but there is little data about these complications in ILD after other types of surgery. OBJECTIVES The aim of this study was to examine the characteristics and predictors of PPCs after major surgery in patients with ILD. METHODS We included 336 patients with ILD who underwent major surgery between January 2005 and December 2010 at two tertiary hospitals in Korea. All types of surgery that had been performed under general anesthesia were included. Demographic characteristics, preoperative lung function, and operative conditions including anesthesia time and estimated blood loss were compared between patients with and without PPCs. RESULTS PPCs occurred in 37 patients (11%). Thirteen patients developed pneumonia, the most common PPC, and 11 had acute exacerbation of ILD. In multivariable analysis, BMI <23 (OR = 2.488, 95% CI: 1.084-5.710, p = 0.031), emergency surgery (OR = 23.992, 95% CI: 2.629-218.949, p = 0.005), lung surgery (OR = 5.090, 95% CI: 1.391-18.628, p = 0.014), and longer anesthesia time (OR = 1.595, 95% CI: 1.143-2.227, p = 0.006) were statistically significant risk factors. CONCLUSIONS The incidence of PPCs detected over all surgeries was not as high as that reported for lung surgery alone in ILD patients. Lower BMI, emergency surgery, lung surgery, and longer anesthesia time were risk factors. Operative conditions as well as lung function should be considered in preoperative planning and management for ILD patients undergoing major surgery.
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Affiliation(s)
- Sun Mi Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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