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Bongiolatti S, Gonfiotti A, Salvicchi A, Voltolini L. The role of minimally invasive surgery on cT4 tumours: still many unanswered question. Eur J Cardiothorac Surg 2024; 65:ezae049. [PMID: 38341663 DOI: 10.1093/ejcts/ezae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 02/12/2024] Open
Affiliation(s)
| | - Alessandro Gonfiotti
- Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Luca Voltolini
- Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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2
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Aigner C, Batirel H, Huber RM, Jones DR, Sihoe ADL, Štupnik T, Brunelli A. Resectable non-stage IV nonsmall cell lung cancer: the surgical perspective. Eur Respir Rev 2024; 33:230195. [PMID: 38508666 PMCID: PMC10951859 DOI: 10.1183/16000617.0195-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/11/2024] [Indexed: 03/22/2024] Open
Abstract
Surgery remains an essential element of the multimodality radical treatment of patients with early-stage nonsmall cell lung cancer. In addition, thoracic surgery is one of the key specialties involved in the lung cancer tumour board. The importance of the surgeon in the setting of a multidisciplinary panel is ever-increasing in light of the crucial concept of resectability, which is at the base of patient selection for neoadjuvant/adjuvant treatments within trials and in real-world practice. This review covers some of the topics which are relevant in the daily practice of a thoracic oncological surgeon and should also be known by the nonsurgical members of the tumour board. It covers the following topics: the pre-operative selection of the surgical candidate in terms of fitness in light of the ever-improving nonsurgical treatment alternatives unfit patients may benefit from; the definition of resectability, which is so important to include patients into trials and to select the most appropriate radical treatment; the impact of surgical access and surgical extension with the evolving role of minimally invasive surgery, sublobar resections and parenchymal-sparing sleeve resections to avoid pneumonectomy.
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Affiliation(s)
- Clemens Aigner
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Hasan Batirel
- Department of Thoracic Surgery, Marmara University, Istanbul, Turkey
| | - Rudolf M Huber
- Division of Respiratory Medicine and Thoracic Oncology, and Thoracic Oncology Centre Munich, Ludwig-Maximilians-Universität in Munich, Munich, Germany
| | - David R Jones
- Department of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Alan D L Sihoe
- Department of Cardio-Thoracic Surgery, CUHK Medical Centre, Hong Kong, China
| | - Tomaž Štupnik
- Department of Thoracic Surgery, Ljubljana University Medical Centre, Ljubljana, Slovenia
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3
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Mei W, Yao W, Song Z, Jiao W, Zhu L, Huang Q, An C, Shi J, Yu G, Sun P, Zhang Y, Shen J, Xu C, Yang H, Wang Q, Zhu Z. Development and validation of prognostic nomogram for T 1-3N 0M 0 non-small cell lung cancer after curative resection. BMC Cancer 2023; 23:715. [PMID: 37525124 PMCID: PMC10391852 DOI: 10.1186/s12885-023-11158-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 07/06/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Radical resection plus lymph node dissection is a common treatment for patients with T1-3N0M0 non-small cell lung cancer (NSCLC). Few models predicted the survival outcomes of these patients. This study aimed to developed a nomogram for predicting their overall survival (OS). MATERIALS AND METHODS This study involved 3002 patients with T1-3N0M0 NSCLC after curative resection between January 1999 and October 2013. 1525 Patients from Sun Yat-sen University Cancer Center were randomly allocated to training cohort and internal validation cohort in a ratio of 7:3. 1477 patients from ten institutions were recruited as external validation cohort. A nomogram was constructed based on the training cohort and validated by internal and external validation cohort to predict the OS of these patients. The accuracy and practicability were tested by Harrell's C-indexes, calibration plots and decision curve analyses (DCA). RESULTS Age, sex, histological classification, pathological T stage, and HI standard were independent factors for OS and were included in our nomogram. The C-index of the nomogram for OS estimates were 0.671 (95% CI, 0.637-0.705),0.632 (95% CI, 0.581-0.683), and 0.645 (95% CI, 0.617-0.673) in the training cohorts, internal validation cohorts, and external validation cohort, respectively. The calibration plots and DCA for predictions of OS were in excellent agreement. An online version of the nomogram was built for convenient clinical practice. CONCLUSIONS Our nomogram can predict the OS of patients with T1-3N0M0 NSCLC after curative resection. The online version of our nomogram offer opportunities for fast personalized risk stratification and prognosis prediction in clinical practice.
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Affiliation(s)
- Weijian Mei
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Wang Yao
- Department of Interventional Oncology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhengbo Song
- Department of Medical Oncology, Cancer Hospital of University of Chinese Academy of Sciences; Zhejiang Cancer Hospital, Hangzhou, China
| | - Wenjie Jiao
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lianxin Zhu
- Medical College of Nanchang University, Nanchang, China
- Queen Mary University of London, London, UK
| | - Qinghua Huang
- Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Chaolun An
- Department of Thoracic Surgery, Nantong Third People's Hospital Nantong University, Nantong, China
| | - Jianguang Shi
- Department of Thoracic Surgery, Ningbo First Hospital of Zhejiang University, Ningbo, China
| | - Guiping Yu
- Department of Thoracic Surgery, Affiliated Jiangyin Hospital of Southeast University, Jiangyin, China
| | - Pingli Sun
- Department of Pathology Department, The Second Hospital of Jilin University, Changchun, China
| | - Yinbin Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, China
| | - Jianfei Shen
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou, China
| | - Chunwei Xu
- Department of Respiratory Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Suqian Hospital of Chinese Medicine, 9 Hongzehu Dong Road, Suqian, 223800, Jiangsu, China.
| | - Han Yang
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China.
| | - Qian Wang
- Department of Respiratory Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Suqian Hospital of Chinese Medicine, 9 Hongzehu Dong Road, Suqian, 223800, Jiangsu, China.
| | - Zhihua Zhu
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China.
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4
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Inci I. Extended Pulmonary Resection for T4 Non-Small Cell Lung Cancer. PRAXIS 2023; 112:103-110. [PMID: 36722106 DOI: 10.1024/1661-8157/a003991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
T4 non-small cell lung cancer is a locally advanced disease with poor prognosis. The operation can be challenging even for an experienced surgeon. N2 disease has been shown repeatedly as a risk factor for poor outcome, and these patients should not be candidates for surgical treatment. Surgery for locally advanced T4 tumors without mediastinal lymph node involvement (T4N0 and T4N1) has been demonstrated to result in good outcomes in carefully selected patients. Patients with T4N0-1M0 should be rejected for surgery only after consulting an expert surgical center. As with other stages, the decision for resectability and surgery should be made by a multidisciplinary team.
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Affiliation(s)
- Ilhan Inci
- Klinik Hirslanden, Chirurgisches Zentrum Zürich, Thoracic Surgery, Zurich, Switzerland
- School of Medicine, University of Zurich, Zurich, Switzerland
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5
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Kaba E, Cosgun T, Yardimci H, Toker A. Prognostic Factors in Patients with Clinic Locally Advanced T4 Lung Cancer: Surgical Considerations. Thorac Cardiovasc Surg 2022; 71:231-236. [PMID: 36535651 DOI: 10.1055/s-0042-1759722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
Background Inclusion of surgery in the treatment of T4 lung cancer has been a debate for the last two decades. The aim of this study is to investigate the potential prognostic factors which could affect the outcome.
Methods Fifty-seven clinical T4 non-small cell lung carcinoma (NSCLC) patients out of 716 lung resections, who were operated at a single institution in 7 years period, were included in this study. Patients are grouped into three groups as patients with neoadjuvant treatment group (group 1 n: 16), salvage surgery group (surgery after 3 months of definitive chemotherapy and radiotherapy) (group 2 n: 14), and straightforward surgery group (group 3 n: 27) with adjuvant treatment. Groups were analyzed and compared in terms of postoperative complications, 30 days of mortality, disease free survival, and overall survival.
Results Mean overall survival (OS) was 48.43 ± 4.4 months and mean disease-free survival (DFS) 40.55 ± 4.46 months for all patients. Thirty days mortality was 5.2% and complication rates were 63.1%. Two years OS was 61.4 ± 6.4%, DFS was 58.1 ± 7.8%. Group 1, Group 2, and Group 3 patients had mean 39.14 ± 5.6, 44.7 ± 7.1, and 62.9 ± 4.8 months for OS (p: 0.09), and 29.6 ± 7.2, 38.4 ± 9.1, and 46.9 ± 6 months for DFS (p: 0.27). Patients who received blood transfusion showed significantly worse outcomes (p: 0.001 for DFS and p: 0.004 for OS).
Conclusion According to our outcomes, surgery should be included in the treatment of clinical T4 lung cancer when physiologically and oncologically possible with careful patient selection. This study demonstrates that patients receiving straightforward surgery have longer survival, in spite of higher perioperative mortality rate. Risks and benefits should be considered carefully.
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Affiliation(s)
- Erkan Kaba
- Department of Thoracic Surgery, TC Demiroğlu Bilim Üniversitesi Ringgold Standard Institution, Istanbul, İstanbul, Turkey
| | - Tugba Cosgun
- Department of Thoracic Surgery, Istinye University Ringgold Standard Institution, Istanbul, Turkey
| | - Halit Yardimci
- Department of Thoracic Surgery, İstanbul Dr Siyami Ersek Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi Ringgold Standard Institution, Istanbul, Turkey
| | - Alper Toker
- Department of Thoracic Surgery, West Virginia University Ringgold Standard Institution, Morgantown, West Virginia, United States
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6
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Guberina N, Pöttgen C, Schuler M, Guberina M, Stamatis G, Plönes T, Metzenmacher M, Theegarten D, Gauler T, Darwiche K, Aigner C, Eberhardt WEE, Stuschke M. Long-term survival of patients with central or > 7 cm T4 N0/1 M0 non-small-cell lung cancer treated with definitive concurrent radiochemotherapy in comparison to trimodality treatment. Radiat Oncol 2022; 17:126. [PMID: 35842712 PMCID: PMC9288731 DOI: 10.1186/s13014-022-02080-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background To examine long-term-survival of cT4 cN0/1 cM0 non-small-cell lung carcinoma (NSCLC) patients undergoing definitive radiochemotherapy (ccRTx/CTx) in comparison to the trimodality treatment, neoadjuvant radiochemotherapy followed by surgery, at a high volume lung cancer center. Methods All consecutive patients with histopathologically confirmed NSCLC (cT4 cN0/1 cM0) with a curative-intent-to-treat ccRTx/CTx were included between 01.01.2001 and 01.07.2019. Mediastinal involvement was excluded by systematic EBUS-TBNA or mediastinoscopy. Following updated T4-stage-defining-criteria initial staging was reassessed by an expert-radiologist according to UICC-guidelines [8th edition]. Outcomes were compared with previously reported results from patients of the same institution with identical inclusion criteria, who had been treated with neoadjuvant radiochemotherapy and resection. Factors for treatment selection were documented. Endpoints were overall-survival (OS), progression-free-survival (PFS), and cumulative incidences of isolated loco-regional failures, distant metastases, secondary tumors as well as non-cancer deaths within the first year. Results Altogether 46 consecutive patients with histopathologically confirmed NSCLC cT4 cN0/1 cM0 [cN0 in 34 and cN1 in 12 cases] underwent ccRTx/CTx after induction chemotherapy (iCTx). Median follow-up was 133 months. OS-rates at 3-, 5-, and 7-years were 74.9%, 57.4%, and 57.4%, respectively. Absolute OS-rate of ccRTx/CTx at 5 years were within 10% of the trimodality treatment reference group (Log-Rank p = 0.184). The cumulative incidence of loco-regional relapse was higher after iCTx + ccRT/CTx (15.2% vs. 0% at 3 years, p = 0.0012, Gray’s test) while non-cancer deaths in the first year were lower than in the trimodality reference group (0% vs 9.1%, p = 0.0360, Gray’s test). None of the multiple recorded prognostic parameters were significantly associated with survival after iCTx + ccRT/CTx: Propensity score weighting for adjustment of prognostic factors between iCTx + ccRT/CTx and trimodality treatment did not change the results of the comparisons. Conclusions Patients with cT4 N0/1 M0 NSCLC have comparable OS with ccRTx/CTx and trimodality treatment. Loco-regional relapses were higher and non-cancer related deaths lower with ccRTx/CTx. Definitive radiochemotherapy is an adequate alternative for patients with an increased risk of surgery-related morbidity. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-022-02080-9.
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Affiliation(s)
- Nika Guberina
- Department of Radiation Therapy, West German Cancer Center (WTZ), University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.
| | - Christoph Pöttgen
- Department of Radiation Therapy, West German Cancer Center (WTZ), University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany.,Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen - Ruhrlandklinik, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Maja Guberina
- Department of Radiation Therapy, West German Cancer Center (WTZ), University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Georgios Stamatis
- Department of Thoracic Surgery, West German Cancer Center, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Till Plönes
- Department of Thoracic Surgery, West German Cancer Center, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Martin Metzenmacher
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany.,Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen, Essen, Germany
| | - Thomas Gauler
- Department of Radiation Therapy, West German Cancer Center (WTZ), University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Kaid Darwiche
- Department of Pulmonary Medicine, West German Cancer Center, Section of Interventional Pneumology, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Clemens Aigner
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.,Department of Thoracic Surgery, West German Cancer Center, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Wilfried E E Eberhardt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany.,Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Martin Stuschke
- Department of Radiation Therapy, West German Cancer Center (WTZ), University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
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7
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Erdoğu V, Çitak N, Sezen CB, Cansever L, Aker C, Onay S, Doğru MV, Saydam Ö, Bedirhan MA, Metin M. Correlation between outcomes and tumor size in >7 cm T4 non-small cell lung cancer patients: A tumor size-based comparison study. Asian Cardiovasc Thorac Ann 2021; 29:784-791. [PMID: 34424097 DOI: 10.1177/02184923211025429] [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: 11/15/2022]
Abstract
BACKGROUND We investigated whether all size-based pathological T4N0-N1 non-small cell lung cancer patients with tumors at any size >7 cm had the same outcomes. METHODS We reviewed non-small cell lung cancer patients with tumors >7 cm who underwent anatomical lung resection between 2010 and 2016. A total of 251 size-based T4N0-N1 patients were divided into two groups based on tumor size. Group S (n = 192) included patients with tumors of 7.1-9.9 cm and Group L (n = 59) as tumor size ≥10 cm. RESULTS The mean tumor size was 8.83 ± 1.7 cm (Group S: 8.06 ± 0.6 cm, Group L: 11.3 ± 1.6 cm). There were 146 patients with pathological N0 and 105 patients with pathological N1 disease. Mean overall survival and disease-free survival were 64.2 and 51.4 months, respectively. The five-year overall survival and disease-free survival rates were 51.2% and 43.5% (five-year OS; pT4N0:52.7%, pT4N1:47.9%, DFS; pT4N0:44.3%, pT4N1: 42.3%). No significant differences were observed between T4N0 and T4N1 patients in terms of five-year OS or DFS (p = 0.325, p = 0.505 respectively). The five-year overall survival and disease-free survival rates were 52% and 44.6% in Group S, and 48.5% and 38.9% in Group L. No significant difference was observed between the groups in terms of five-year overall survival or disease-free survival (p = 0.699, p = 0.608, respectively). CONCLUSIONS Above 7 cm, any further increase in tumor size in non-small cell lung cancer patients had no significant effect on survival, confirming it is not necessary to further discriminate among patients with tumors in that size class.
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Affiliation(s)
- Volkan Erdoğu
- Department of Thoracic Surgery, 147022Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Necati Çitak
- Department of Thoracic Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Celal B Sezen
- Department of Thoracic Surgery, 147022Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Levent Cansever
- Department of Thoracic Surgery, 147022Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Cemal Aker
- Department of Thoracic Surgery, 147022Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Selin Onay
- Department of Thoracic Surgery, 147022Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mustafa V Doğru
- Department of Thoracic Surgery, 147022Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Özkan Saydam
- Department of Thoracic Surgery, 147022Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet A Bedirhan
- Department of Thoracic Surgery, 147022Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Muzaffer Metin
- Department of Thoracic Surgery, 147022Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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8
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Yamanashi K, Menju T, Hamaji M, Tanaka S, Yutaka Y, Yamada Y, Nakajima D, Ohsumi A, Aoyama A, Sato T, Chen-Yoshikawa TF, Sonobe M, Date H. Prognostic factors related to postoperative survival in the newly classified clinical T4 lung cancer. Eur J Cardiothorac Surg 2021; 57:754-761. [PMID: 31633154 DOI: 10.1093/ejcts/ezz288] [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: 07/09/2019] [Revised: 09/09/2019] [Accepted: 09/20/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES T4 lung cancer has become a more heterogeneous group since the 8th edition of tumour, node, metastasis classification. The aim of this study was to identify predictive factors related to post-surgical survival in patients with clinical T4 non-small-cell lung cancer (NSCLC), based on the 8th edition of the classification. METHODS We retrospectively reviewed consecutive patients with clinical T4 NSCLC who underwent resection between January 2006 and December 2016, to identify factors associated with overall survival. RESULTS Ninety-three patients were identified. The criteria for clinical T4 disease included tumours larger than 7 cm (n = 54), great vessels or left atrial invasion (n = 22), mediastinal invasion (n = 11), vertebral invasion (n = 3), tracheal or carina invasion (n = 3), diaphragm invasion (n = 1) and ipsilateral different lobe pulmonary metastasis (n = 2). The postoperative nodal status was 0, 1, 2 and 3 in 59, 18, 15 and 1 patient, respectively. R0 resection was achieved in 80 patients, and the 30-day mortality was 0%. The median follow-up time was 37.6 months, and the 5-year overall survival rate was 56.3%. The multivariable analysis revealed that nodal status and R-status were significant prognostic factors for postoperative survival [hazard ratio (HR) 2.62, 95% confidence interval (CI) 1.20-5.72, P = 0.016 and HR 3.29, 95% CI 1.45-7.44, P = 0.004]. CONCLUSIONS Surgery provided encouraging survival outcomes for clinical T4 NSCLC based on the 8th edition of classification. The nodal status and R-status were significant prognostic factors for postoperative survival.
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Affiliation(s)
- Keiji Yamanashi
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshi Menju
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satona Tanaka
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yojiro Yutaka
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshito Yamada
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Daisuke Nakajima
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akihiro Ohsumi
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akihiro Aoyama
- Department of Thoracic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Toshihiko Sato
- Department of General Thoracic, Breast, and Pediatric Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | | | - Makoto Sonobe
- Department of Thoracic Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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9
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Kuijvenhoven JC, Livi V, Szlubowski A, Ninaber M, Stöger JL, Widya RL, Bonta PI, Crombag LC, Braun J, van Boven WJ, Trisolini R, Korevaar DA, Annema JT. Endobronchial ultrasound for T4 staging in patients with resectable NSCLC. Lung Cancer 2021; 158:18-24. [PMID: 34098221 DOI: 10.1016/j.lungcan.2021.05.032] [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: 02/28/2021] [Revised: 05/11/2021] [Accepted: 05/26/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND In lung cancer patients, accurate assessment of mediastinal and vascular tumor invasion (stage T4) is crucial for optimal treatment allocation and to prevent unnecessary thoracotomies. We assessed the diagnostic accuracy of linear endobronchial ultrasound (EBUS) for T4-status in patients with centrally located lung cancer. METHODS This is a retrospective study among consecutive patients who underwent EBUS for diagnosis and staging of lung cancer in four hospitals in The Netherlands (Amsterdam, Leiden), Italy (Bologna) and Poland (Zakopane) between 04-2012 and 04-2019. Patients were included if the primary tumor was detected by EBUS and subsequent surgical-pathological staging was performed, which served as the reference standard. T4-status was extracted from EBUS and pathology reports. Chest CT's were re-reviewed for T4-status. RESULTS 104 patients with lung cancer in whom EBUS detected the primary tumour, and who underwent subsequent surgical-pathological staging were included. 36 patients (35 %) had T4-status, based on vascular (n = 17), mediastinal (n = 15), both vascular and mediastinal (n = 3), or oesophageal invasion (n = 1). For EBUS, sensitivity, specificity, PPV and NPV for T4-status were (n = 104): 63.9 % (95 %CI 46.2-79.2 %), 92.6 % (83.7-97.6 %), 82.1 % (65.6-91.7 %), and 82.9 % (75.7-88.2 %), respectively. For chest CT (n = 72): 61.5 % (95 %CI 40.6-79.8 %), 37.0 % (23.2-52.5 %), 35.6 % (27.5-44.6 %), and 63.0 % (47.9-75.9 %), respectively. When combining CT and EBUS with concordant T4 status (n = 33): 90.9 % (95 %CI 58.7-99.8 %), 77.3 % (54.6-92.20 %), 66.7 % (47.5-81.6 %), and 94.4 % (721-99.1%), respectively. CONCLUSION Both EBUS and CT alone are inaccurate for assessing T4-status as standalone test. However, combining a negative EBUS with a negative CT may rule out T4-status with high certainty.
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Affiliation(s)
- Jolanda C Kuijvenhoven
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Location Academic Medical Center (AMC), Amsterdam, the Netherlands
| | - Vanina Livi
- Interventional Pulmonology Unit, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Artur Szlubowski
- Bronchoscopy Unit, Pulmonary Hospital Zakopane, Zakopane, Poland
| | - Maarten Ninaber
- Department of Respiratory Medicine, Leiden University Medical Centre, Leiden, the Netherlands
| | - J Lauran Stöger
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Ralph L Widya
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Peter I Bonta
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Location Academic Medical Center (AMC), Amsterdam, the Netherlands
| | - Laurence C Crombag
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Location Academic Medical Center (AMC), Amsterdam, the Netherlands
| | - Jerry Braun
- Department of Cardio-thoracic Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Willem Jan van Boven
- Department of Cardio-thoracic Surgery, Amsterdam University Medical Centers, Location Academic Medical Center (AMC), Amsterdam, the Netherlands
| | - Rocco Trisolini
- Interventional Pulmonology Unit, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Daniël A Korevaar
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Location Academic Medical Center (AMC), Amsterdam, the Netherlands
| | - Jouke T Annema
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Location Academic Medical Center (AMC), Amsterdam, the Netherlands.
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Is There a Prognostic Difference Between Stage IIIA Subgroups in Lung Cancer? Ann Thorac Surg 2020; 112:1656-1663. [DOI: 10.1016/j.athoracsur.2020.10.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 08/27/2020] [Accepted: 10/07/2020] [Indexed: 12/25/2022]
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Comparison of early tumour-associated versus late deaths in patients with central or >7 cm T4 N0/1 M0 non-small-cell lung-cancer undergoing trimodal treatment: Only few risks left to improve. Eur J Cancer 2020; 138:156-168. [PMID: 32889370 DOI: 10.1016/j.ejca.2020.07.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/06/2020] [Accepted: 07/19/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND The optimal treatment for patients with locally advanced non-small-cell lung-cancer (NSCLC) cT4 cN0/1 cM0 is still under debate. The purpose of this study was to examine the long-term survival of cT4 cN0/1 cM0 NSCLC patients undergoing induction chemotherapy and concurrent radiochemotherapy before surgery. METHODS All consecutive patients with confirmed NSCLC (cT4 cN0/1 cM0) treated with neoadjuvant chemotherapy, concurrent radiochemotherapy (RT/CTx) (45-46 Gy) and surgical resection between 2000 and 2015 were included. According to the UICC guidelines (8th edition), T4 stage was reanalysed by an expert radiologist. The mediastinal staging was performed by systematic EBUS-TBNA or mediastinoscopy. The primary end-point was overall-survival (OS). The power to detect an increase of early tumour-associated mortality (hazard ratio > 3.5) within the first 5 years after treatment in comparison to late deaths beyond 96 months was >80%. RESULTS Overall, 67 patients were treated with concurrent RT/CTx. T4 criteria were fulfilled by all patients, and multiple T4 criteria by 53 patients. Seventy percent of patients had an initial PET/CT staging. The median follow-up period was 134 months. OS rates at 2, 5, 10 and 15 years were 83.6 ± 4.5%, 65.4 ± 5.9%, 53.3 ± 6.3% and 36.6 ± 6.8%, respectively. A total of 44.8% of patients achieved a pathologic complete response. In multivariable analysis, ypT category was the most predictive factor. OS at 5 years for ypT0 (n = 31) was 80.5%, and ypT1 (n = 11) was 62.5%. Main sites of failure were brain and pulmonary metastases in seven and three patients, respectively. The intercurrent annual death rate was estimated from the survival curve beyond 96 months and was found to be 4.75% (95% CI 2.40-9.27%). No significant increased mortality was observed during the first 5 years (annual death rate: 8.31% [95% CI 5.60-12.24%], hazard-ratio = 1.72 [95% CI 0.81-3.65]). CONCLUSIONS The effectiveness of this trimodality schedule is high in patients with cT4 cN0/1 cM0 NSCLC with excellent local control rates. Considering the annual death rate beyond 8 years of survival as an intercurrent death rate due to comorbidity, this treatment schedule reduces annual mortality to background even in the first 5 years after therapy.
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Prognostic Factors and Survival in Resected T4 Non-small Cell Lung Cancer: Is There Any Difference in the T4 Subgroups? Zentralbl Chir 2020; 146:335-343. [PMID: 32746474 DOI: 10.1055/a-1209-3668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The eighth edition of the TNM classification revised the subgroups of T4 non-small cell lung cancer (NSCLC). This study aimed to compare the T4-NSCLC subgroups that underwent surgical treatment in terms of mortality, morbidity, survival, and prognostic factors based on the new classification. MATERIALS AND METHODS Between 2000 and 2014, a total of 284 T4-NSCLC patients who underwent lung resection (mediastinal organ invasion, n = 114; ipsilateral different lobe tumors, n = 32; and tumors larger than 7 cm, n = 138) were included in the present study. RESULTS Surgical mortality and morbidity were 5.6% (n = 16) and 23.9% (n = 68), respectively. The 5-year survival rates were 46% for ipsilateral different lobe tumors, 45.4% for tumours larger than 7 cm, and 36.6% for mediastinal organ invasion (28% for patients with heart/atrium invasion, 43.3% for carina invasion, 37.5% for large vessel invasion) (p = 0.223). Age above 65 (p = 0.002, HR = 1.781), pN2 versus pN0/1 (p < 0.0001, HR = 2.564), incomplete resection (p = 0.003, HR = 2.297), and pneumonectomy (p = 0.02, HR = 1.524) were identified as poor prognostic survival factors. According to multivariate analysis, mediastinal lymph node metastasis (p = 0.001) and incomplete resection (p = 0.0026) were the independent negative risk factors for survival. CONCLUSION According to the results of our study, surgical treatment is a good option in T4-NSCLC patients who have no mediastinal lymph node metastasis and are completely resectable. There is no difference in terms of survival among the T4 subgroups. The eighth edition of the TNM classification has a better prognostic definition than the previous version.
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Çitak N, Aksoy Y, İşgörücü Ö, Obuz C, Açıkmeşe B, Büyükkale S, Fener NA, Metin M, Sayar A. The prognostic impact of the mediastinal fat tissue invasion in patients with non-small cell lung cancer. Gen Thorac Cardiovasc Surg 2020; 69:76-83. [PMID: 32676942 DOI: 10.1007/s11748-020-01440-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/07/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The prognosis of the mediastinal fat tissue invasion in non-small cell lung cancer (NSCLC) patients has not yet been clearly defined. The present study aimed to investigate the prognostic impact of the mediastinal fat tissue invasion in NSCLC patients. METHOD We analyzed 36 patients who were found mediastinal fat tissue invasion by pathological evaluation (mediastinal fat group) and 248 patients who were classified as T4-NSCLC according to the 8th TNM classification (T4 group; invasion of other mediastinal structures in 78 patients, ipsilateral different lobe satellite pulmonary nodule in 32 patients, and tumor diameter > 7 cm in 138 patients). RESULT Resection was regarded as complete (R0) in 255 patients (89.7%). Mediastinal fat group showed significantly higher incidence of incomplete resection (R1) and more left-sided tumors than the T4 group (p = 0.01, and p = 0.002, respectively). The survival was better in T4 group than mediastinal fat group (median 57 months versus 31 months), although it was not significant (p = 0.205). Even when only N0/1 or R0 patients were analyzed, the survival was not different between two groups (p = 0.420, and p = 0.418, respectively). 5-year survival rates for T4 subcategories (invasion of other structures, ipsilateral different lobe pulmonary nodule, and tumor diameter > 7 cm) were 39.4%, 41.9%, and 50.3%, respectively (p = 0.109). Multivariate analysis showed that age (p < 0.0001), nodal status (p = 0.0003), and complete resection (p < 0.0001) were independently influenced survival. CONCLUSION There is no significant difference in the prognosis between mediastinal fat tissue invasion and T4 disease in NSCLC patients.
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Affiliation(s)
- Necati Çitak
- Bakirkoy Dr. Sadi Konuk Research and Education Hospital, Tevfik Saglam Cd No 1 Dr. Sadi Konuk Hastanesi, Bakirköy, 34010, Istanbul, Turkey.
| | - Yunus Aksoy
- Yedikule Thoracic Surgery and Chest Disease Hospital, Istanbul, Turkey
| | - Özgür İşgörücü
- Bakirkoy Dr. Sadi Konuk Research and Education Hospital, Tevfik Saglam Cd No 1 Dr. Sadi Konuk Hastanesi, Bakirköy, 34010, Istanbul, Turkey
| | - Ciğdem Obuz
- Yedikule Thoracic Surgery and Chest Disease Hospital, Istanbul, Turkey
| | - Barış Açıkmeşe
- Bakirkoy Dr. Sadi Konuk Research and Education Hospital, Tevfik Saglam Cd No 1 Dr. Sadi Konuk Hastanesi, Bakirköy, 34010, Istanbul, Turkey
| | | | | | - Muzaffer Metin
- Yedikule Thoracic Surgery and Chest Disease Hospital, Istanbul, Turkey
| | - Adnan Sayar
- Private Memorial Hospital Istanbul, Istanbul, Turkey
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