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Aprile V, Ambrogi MC, Lucchi M. Surgery in Stage IV Non-small Cell Lung Cancer: Good Time for a Chance. Ann Surg Oncol 2024; 31:4847-4848. [PMID: 38710909 DOI: 10.1245/s10434-024-15308-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/02/2024] [Indexed: 05/08/2024]
Affiliation(s)
- Vittorio Aprile
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.
| | - Marcello Carlo Ambrogi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Marco Lucchi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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2
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Werner RS, Rechsteiner M, Moch H, Curioni-Fontecedro A, Weller M, Weiss T, Regli L, Le Rhun E, Mairinger F, Opitz I, Soltermann A. Genetic profiles of oligometastatic non-small-cell lung cancer and corresponding brain metastases. Eur J Cardiothorac Surg 2024; 65:ezae217. [PMID: 38796684 PMCID: PMC11162753 DOI: 10.1093/ejcts/ezae217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/12/2024] [Accepted: 05/24/2024] [Indexed: 05/28/2024] Open
Abstract
OBJECTIVES In patients with oligometastatic non-small-cell lung cancer (NSCLC), systemic therapy in combination with local ablative treatment of the primary tumour and all metastatic sites is associated with improved prognosis. For patient selection and treatment allocation, further knowledge about the molecular characteristics of the oligometastatic state is necessary. Here, we performed a genetic characterization of primary NSCLC and corresponding brain metastases (BM). METHODS We retrospectively identified patients with oligometastatic NSCLC and synchronous (<3 months) or metachronous (>3 months) BM who underwent surgical resection of both primary tumour and BM. Mutation profiling of formalin-fixed paraffin-embedded tumour cell blocks was performed by targeted next-generation sequencing using the Oncomine Focus Assay panel. RESULTS Sequencing was successful in 46 paired samples. An oncogenic alteration was present in 31 primary tumours (67.4%) and 40 BM (86.9%). The alteration of the primary tumours was preserved in the corresponding BM in 29 out of 31 cases (93.5%). The most prevalent oncogenic driver in both primary tumours and BM was a KRAS (Kirsten rat sarcoma viral oncogene) mutation (s = 21). In 16 patients (34.8%), the BM harboured additional oncogenic alterations. The presence of a private genetic alteration in the BM was an independent predictor of shorter overall survival. CONCLUSIONS In oligometastatic NSCLC, BM retain the main genetic alterations of the primary tumours. Patients may profit from targeted inhibition of mutated KRAS. Additional private genetic alterations in the BM are dismal.
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Affiliation(s)
- Raphael S Werner
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Markus Rechsteiner
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | | | - Michael Weller
- Department of Neurology and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Tobias Weiss
- Department of Neurology and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Emilie Le Rhun
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Fabian Mairinger
- Department of Pathology, University Hospital Essen, Essen, Germany
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
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3
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Vettori E, Borella A, Costantinides F, Rizzo R, Maglione M. Mandibular metastasis of pulmonary adenocarcinoma: How unexpected could it be? Gerodontology 2024; 41:283-288. [PMID: 37496280 DOI: 10.1111/ger.12707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE Metastatic tumours of bone must be considered in all patients with unexplained bone pain and particularly in patients who present with a known cancer, localised pain at multiple sites, and radiographic findings suggestive of metastasis. The purpose of this report was to present a case of a pathological fracture of the mandible as a consequence of metastatic pulmonary adenocarcinoma. MATERIALS AND METHODS In July 2018 a 68-year-old male patient was hospitalised because of pulmonary adenocarcinoma and attended our department for an oral maxillo-facial evaluation. He complained of pain and swelling in the right temporomandibular region resulting in a reported functional limitation. An Orthopantomogram (OPG) demonstrated a right intracapsular condylar compound fracture associated with an osteolytic lesion at the condyle base with jagged margins. Subsequently, a CT scan with contrast of the maxillo-facial complex and a fine-needle aspiration of the lesion was performed. RESULTS CT images showed the presence of a right mandibular condyle fracture associated with a large osteolytic lesion which confirmed the pathological nature of the fracture. Fine-needle aspiration of the lesion confirmed its metastatic nature. It was not possible to proceed with a mandibular resection due to the critical clinical condition of the patient who died in September 2018. CONCLUSION Lung cancer frequently produces lytic-type metastasis, sometimes even in the jaw. In patients with an established diagnosis of lung cancer, any radiolucent lesion of the jaw or an unexplained painful symptomatology to the oro-maxillo facial complex should be placed in differential diagnosis with metastasis of the primary tumour.
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Affiliation(s)
- Erica Vettori
- Unit of Maxillofacial Surgery and Stomatology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Alberto Borella
- Unit of Maxillofacial Surgery and Stomatology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Fulvia Costantinides
- Unit of Maxillofacial Surgery and Stomatology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Roberto Rizzo
- Unit of Maxillofacial Surgery and Stomatology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Michele Maglione
- Unit of Maxillofacial Surgery and Stomatology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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4
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Park S, Choe J, Lee SM, Choi S, Kim MJ, Chae EJ, Seo JB. Surgical Outcomes in Non-Small Cell Lung Cancer with Distant Metastasis: The Prognostic Significance of Delayed Metastasis Diagnosis. Ann Surg Oncol 2024; 31:3448-3458. [PMID: 38386197 DOI: 10.1245/s10434-024-14984-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/16/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND The diagnosis of distant metastasis on preoperative examinations for non-small cell lung cancer (NSCLC) can be challenging, leading to surgery for some patients with uncertain metastasis. This study evaluated the prognostic impact of delayed diagnosis of metastasis on patients who underwent upfront surgery. METHODS The study enrolled patients who underwent lobectomy or pneumonectomy for NSCLC between June 2010 and December 2017 and evaluated the presence of distant metastasis before surgery. Overall survival (OS) for patients with stage IV cancer was compared with that for patients without metastasis, and the prognostic factors were analyzed. RESULTS Of 3046 patients (mean age, 63 years; 1770 men), 100 (3.3 %) had distant metastasis, diagnosed preoperatively in 1.4 % (42/3046) and postoperatively in 1.9 % (58/3046) of the patients. The two most common metastasis sites diagnosed after surgery were contralateral lung (22/58, 37.9 %) and ipsilateral pleura (16/58, 27.6 %). The OS (median, 42.7 months) for the patients with stage IV cancer diagnosed postoperatively was comparable with that for the patients with stage IIIB cancer (P = 0.865), whereas the OS (median OS, 91.7 months) for the patients with stage IV cancer diagnosed preoperatively was better than for the patients with stage IIIB cancer (P = 0.001). Among the patients with distant metastasis, squamous cell type (hazard ratio [HR], 3.15; P = 0.002) and systemic treatment for metastasis (HR, 2.42; P = 0.002) were independent predictors of worse OS. CONCLUSIONS Among NSCLC patients undergoing upfront surgery, the OS for the patients with stage IV cancer diagnosed postoperatively was comparable with that for the patients with stage IIIB cancer. For patients with stage IV disease, squamous cell type and systemic treatment for metastasis were prognostic factors for poorer OS.
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Affiliation(s)
- Sohee Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jooae Choe
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sehoon Choi
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Min-Ju Kim
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Eun Jin Chae
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joon Beom Seo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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5
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Antonoff MB, Deboever N, Werner R, Altan M, Gomez D, Opitz I. Surgery for oligometastatic non-small cell lung cancer. J Thorac Cardiovasc Surg 2024; 167:508-516.e1. [PMID: 37778504 DOI: 10.1016/j.jtcvs.2023.09.048] [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: 06/23/2023] [Revised: 08/21/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex.
| | - Nathaniel Deboever
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Raphael Werner
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Mehmet Altan
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Daniel Gomez
- Department of Thoracic Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
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6
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Sponholz S, Koch A, Mese M, Becker S, Sebastian M, Fischer S, Trainer S, Schreiner W. Lung Cancer Resection after Immunochemotherapy Versus Chemotherapy in Oligometastatic Nonsmall Cell Lung Cancer. Thorac Cardiovasc Surg 2023; 71:656-663. [PMID: 36746400 DOI: 10.1055/a-2028-7955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Neoadjuvant immunochemotherapy is currently being tested in pivotal trials for stage I to III nonsmall cell lung cancer (NSCLC). The impact of immunochemotherapy in patients with oligometastatic disease (OMD) remains undefined. This study aimed to compare the outcomes of radical treatment after the neoadjuvant course of immunochemotherapy versus chemotherapy. METHODS We retrospectively analyzed patients with OMD who were treated with immunochemotherapy or chemotherapy combined with local ablation of metastases and radical primary tumor resection between 2017 and 2021. Group A included eight patients with immunochemotherapy; Group B included seven patients with chemotherapy. Descriptive statistical analysis included the characteristics of the patients, tumors, and outcomes. RESULTS There was no difference in postoperative morbidity rates between the groups (p = 0.626). The 30-day mortality in both groups was 0%. The median overall survival for Group A was not reached, with a median follow-up time of 25 (range: 13-35) months; the median overall survival for Group B was 26 (range: 5-53) months. In Group A, all patients remained alive; in contrast, in Group B, four patients died (p = 0.026). There was no local thoracic recurrence in either group. In Group B, the recurrent disease was identified significantly more often (12.5 vs. 85.75%; p = 0.009). The rates of complete and major pathologic response were 37.5 and 0% in Group A and 42.85 and 14.25% in Group B, respectively. CONCLUSION Despite the small patient number and short-term results, the progression-free and overall survival in patients with OMD after local therapy for metastases and primary tumor resection following a neoadjuvant course of immunochemotherapy might be promising compared with chemotherapy.
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Affiliation(s)
- Stefan Sponholz
- Department of Thoracic Surgery, Agaplesion Markus Krankenhaus Frankfurt, Frankfurt, Germany
| | - Agnes Koch
- Department of Thoracic Surgery, Agaplesion Markus Krankenhaus Frankfurt, Frankfurt, Germany
| | - Mesut Mese
- Department of Thoracic Surgery, Agaplesion Markus Krankenhaus Frankfurt, Frankfurt, Germany
| | - Silvan Becker
- Department of Oncology, Agaplesion Markus Krankenhaus Frankfurt, Frankfurt, Germany
| | - Martin Sebastian
- Department of Medicine II, Hematology/Oncology, University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Frankfurt Cancer Institute, Goethe University Frankfurt, Frankfurt, Germany
| | | | - Stephan Trainer
- Department of Thoracic Surgery, Agaplesion Markus Krankenhaus Frankfurt, Frankfurt, Germany
| | - Waldemar Schreiner
- Department of Thoracic Surgery, University Hospital Frankfurt, Frankfurt, Germany
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7
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Etienne H, Kalt F, Park S, Opitz I. The oncologic efficacy of extended resections for lung cancer. J Surg Oncol 2023; 127:296-307. [PMID: 36630100 DOI: 10.1002/jso.27183] [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: 11/14/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 01/12/2023]
Abstract
Extended lung resections for T3-T4 non-small-cell lung cancer remain challenging. Multimodal management is mandatory in multidisciplinary tumor boards, and here the determination of resectability is key. Long-term oncologic efficacy depends mostly on complete resection (R0) and the extent of N2 disease. The development of novel innovative treatments (targeted therapy and immune checkpoint inhibitors) sets interesting perspectives to reinforce current therapeutic options in the induction and adjuvant setting.
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Affiliation(s)
- Harry Etienne
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Fabian Kalt
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Samina Park
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
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8
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Na KJ, Kim YT. The "new" oligometastatic disease state and associated therapies in non-small cell lung cancer: A narrative review. J Surg Oncol 2023; 127:282-287. [PMID: 36464990 DOI: 10.1002/jso.27165] [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: 11/09/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 12/11/2022]
Abstract
Patients with non-small cell lung cancer (NSCLC) at stage IV have typically been considered incurable. Nonetheless, there is growing evidence that certain patient groups with fewer metastases, or so-called oligometastatic disease, which may have a more indolent biological nature than widespread metastatic diseases, may survive longer if definitive local treatment is administered to all metastatic sites. According to several retrospective investigations, this subgroup had a better prognosis than other stage IV patients, and the eighth edition of TNM staging was revised to reflect these findings. As a result of rapidly emerging systemic therapies, such as immune checkpoint inhibitors and a growing number of targeted therapies, more patients with this uncommon clinical opportunity have been identified and have received greater clinical attention. Currently, there is no established protocol for the management of oligometastatic disease, and the majority of therapeutic decisions are made through multidisciplinary discussion. In addition to systemic treatment, the two primary local therapeutic options for oligometastatic diseases are surgery and radiotherapy. A few phase 2 trials suggest that aggressive local ablative therapy may significantly improve the prognosis of patients with oligometastatic NSCLC. This review summarizes the most recent data on the management of oligometastatic NSCLC, with a focus on the prognostic significance of local ablative therapy in these patients.
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Affiliation(s)
- Kwon J Na
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young T Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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9
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Yoo S, Cho WC, Lee GD, Choi S, Kim HR, Kim YH, Kim DK, Park SI, Yun JK. Long-term Surgical Outcomes in Oligometastatic Non-small Cell Lung Cancer: A Single-Center Study. J Chest Surg 2023; 56:25-32. [PMID: 36517949 PMCID: PMC9845856 DOI: 10.5090/jcs.22.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/26/2022] [Accepted: 11/06/2022] [Indexed: 12/16/2022] Open
Abstract
Background We reviewed the clinical outcomes of patients with oligometastatic (OM) non-small cell lung cancer (NSCLC) who received multimodal therapy including lung surgery. Methods We retrospectively analyzed 117 patients with OM NSCLC who underwent complete resection of the primary tumor from 2014 to 2017. Results The median follow-up duration was 2.91 years (95% confidence interval, 1.48-5.84 years). The patients included 73 men (62.4%), and 76 patients (64.9%) were under the age of 65 years. Based on histology, 97 adenocarcinomas and 14 squamous cell carcinomas were included. Biomarker analysis revealed that 53 patients tested positive for epidermal growth factor receptor, anaplastic lymphoma kinase, or ROS1 mutations, while 36 patients tested negative. Metastases were detected in the brain in 74 patients, the adrenal glands in 12 patients, bone in 5 patients, vertebrae in 4 patients, and other locations in 12 patients. Radiation therapy for organ metastasis was performed in 81 patients and surgical resection in 27 patients. The 1-year overall survival (OS) rate in these patients was 82.8%, and the 3- and 5-year OS rates were 52.6% and 37.2%, respectively. Patients with positive biomarker test results had 1-, 3-, and 5-year OS rates of 98%, 64%, and 42.7%, respectively. These patients had better OS than those with negative biomarker test results (p=0.031). Patients aged ≤65 years and those with pT1-2 cancers also showed better survival (both p=0.008). Conclusion Surgical resection of primary lung cancer is a viable treatment option for selected patients with OM NSCLC in the context of multimodal therapy.
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Affiliation(s)
- Seungmo Yoo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Chul Cho
- Department of Thoracic and Cardiovascular Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sehoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Kwang Yun
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea,Corresponding author Jae Kwang Yun Tel 82-2-3010-1685 Fax 82-2-3010-3580 E-mailORCIDhttps://orcid.org/0000-0001-5364-5548 See Commentary page 33
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10
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Zhang S, Sun Q, Cai F, Li H, Zhou Y. Local therapy treatment conditions for oligometastatic non-small cell lung cancer. Front Oncol 2022; 12:1028132. [PMID: 36568167 PMCID: PMC9773544 DOI: 10.3389/fonc.2022.1028132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
Standard treatments for patients with metastatic non-small cell lung cancer (NSCLC) include palliative chemotherapy and radiotherapy, but with limited survival rates. With the development of improved immunotherapy and targeted therapy, NSCLC prognoses have significantly improved. In recent years, the concept of oligometastatic disease has been developed, with randomized trial data showing survival benefits from local ablation therapy (LAT) in patients with oligometastatic NSCLC (OM-NSCLC). LAT includes surgery, stereotactic ablation body radiation therapy, or thermal ablation, and is becoming an important treatment component for OM-NSCLC. However, controversy remains on specific management strategies for the condition. In this review, we gathered current randomized trial data to analyze prognostic factors affecting patient survival, and explored ideal treatment conditions for patients with OM-NSCLC with respect to long-term survival.
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Affiliation(s)
- Suli Zhang
- Department of Radiation Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, Anhui, China
| | - Qian Sun
- Department of Radiation Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, Anhui, China,*Correspondence: Yufu Zhou, ; Qian Sun,
| | - Feng Cai
- Department of Radiation Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, Anhui, China
| | - Hui Li
- Department of Nuclear Medicine, First Affiliated Hospital, Bengbu Medical College, Bengbu, Anhui, China
| | - Yufu Zhou
- Department of Radiation Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, Anhui, China,*Correspondence: Yufu Zhou, ; Qian Sun,
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11
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Recurrence patterns and impact of brain metastases in synchronous single organ oligometastatic lung cancer following local ablative treatment – A multicenter analysis. Lung Cancer 2022; 170:165-175. [DOI: 10.1016/j.lungcan.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/20/2022] [Accepted: 06/26/2022] [Indexed: 11/21/2022]
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12
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The Role of Surgery for Oligometastatic Non-Small Cell Lung Cancer. Cancers (Basel) 2022; 14:cancers14102524. [PMID: 35626125 PMCID: PMC9139825 DOI: 10.3390/cancers14102524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022] Open
Abstract
Oligometastatic non-small cell lung cancer (NSCLC) is metastatic disease that refers to a limited number of metastatic sites. It is analogous to an intermediate stage of NSCLC, between localized and widely metastatic disease, even though no staging criteria establishes this distinction. Oligometastatic NSCLC describes a patient subgroup with limited metastasis to one or a few organs. These patients seem to have a more indolent cancer than those with diffuse metastasis. For these select patients with oligometastatic disease, the use of palliative systemic therapy over local aggressive treatment may be a missed opportunity to improve survival. The clear definition of this subgroup and identification of the best treatment remains the current challenge in the management of the disease. Surgery was the early cornerstone in the treatment of limited disease; however, as modalities such as chemotherapy, stereotactic radiosurgery, and immunotherapy have matured, the role of excision is less clearly defined. There are sparse randomized controlled trials comparing the efficacy of different treatment modalities in patients with oligometastatic NSCLC. However, there is a growing body of retrospective research detailing the prognostic factors that characterize the role of surgery in the management of these patients. This article clarifies the context and definition of the term oligometastatic, as it applies to NSCLC, and reviews the current results in the use of surgery for its management.
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13
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Donaldson AE, Scarci M, Batirel H, Seder CW. Editorial: Assessing the Safety of Thoracic Surgery Techniques for Non-small Cell Lung Cancer. Front Surg 2022; 9:859648. [PMID: 35321077 PMCID: PMC8936082 DOI: 10.3389/fsurg.2022.859648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andrew E. Donaldson
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Marco Scarci
- Department of Thoracic Surgery, San Gerardo Hospital, Monza, Italy
| | - Hasan Batirel
- Department of Thoracic Surgery, Marmara University Hospital, Istanbul, Turkey
| | - Christopher W. Seder
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, United States
- *Correspondence: Christopher W. Seder
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14
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Jasper K, Stiles B, McDonald F, Palma DA. Practical Management of Oligometastatic Non-Small-Cell Lung Cancer. J Clin Oncol 2022; 40:635-641. [PMID: 34985915 DOI: 10.1200/jco.21.01719] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Local ablative therapies, including surgery or stereotactic radiotherapy (SABR), are becoming an integral component in the treatment of oligometastatic disease in non-small-cell lung cancer. In this review, we summarize recent randomized evidence supporting progression-free survival and overall survival benefits of local ablation in these patients, as well as upcoming phase III data which should help us better understand the ideal treatment conditions and provide more insight into the oligometastatic state. Since practical management of oligometastatic disease in non-small-cell lung cancer can be challenging, we discuss a modern framework to identify patient, tumor, and treatment characteristics that can best guide management.
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Affiliation(s)
- Katie Jasper
- Division of Radiation Oncology, Western University, London Health Sciences Centre, London, Canada.,Division of Radiation Oncology, University of British Columbia, BC Cancer, Vancouver, Canada
| | - Brendon Stiles
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Fiona McDonald
- Department of Cardiothoracic and Vascular Surgery, Montefiore-Einstein Cancer Center, New York, NY
| | - David A Palma
- Division of Radiation Oncology, Western University, London Health Sciences Centre, London, Canada
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15
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Patient Selection for Local Aggressive Treatment in Oligometastatic Non-Small Cell Lung Cancer. Cancers (Basel) 2021; 13:cancers13246374. [PMID: 34944994 PMCID: PMC8699700 DOI: 10.3390/cancers13246374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Since the first introduction of the oligometastatic state with a low burden of metastases in non-small cell lung cancer, accumulating evidence from retrospective and prospective studies has shown that a local aggressive, multimodality treatment may significantly improve the prognosis in these patients. Local aggressive treatment includes a systemic therapy of micrometastatic disease, as well as a radical resection of the primary tumor and surgical resection and/or radiation therapy of distant metastases. However, patient selection and treatment allocation remain a central challenge in oligometastatic disease. In this review, we aimed to address the current evidence on criteria for patient selection for local aggressive treatment in non-small cell lung cancer. Abstract One-fourth of all patients with metastatic non-small cell lung cancer presents with a limited number of metastases and relatively low systemic tumor burden. This oligometastatic state with limited systemic tumor burden may be associated with remarkably improved overall and progression-free survival if both primary tumor and metastases are treated radically combined with systemic therapy. This local aggressive therapy (LAT) requires a multidisciplinary approach including medical oncologists, radiation therapists, and thoracic surgeons. A surgical resection of the often advanced primary tumor should be part of the radical treatment whenever feasible. However, patient selection, timing, and a correct treatment allocation for LAT appear to be essential. In this review, we aimed to summarize and discuss the current evidence on patient selection criteria such as characteristics of the primary tumor and metastases, response to neoadjuvant or first-line treatment, molecular characteristics, mediastinal lymph node involvement, and other factors for LAT in oligometastatic NSCLC.
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16
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Hecker E, Gesierich W. [Mediastinal Staging]. Pneumologie 2021; 75:981-996. [PMID: 34875713 DOI: 10.1055/a-1582-6919] [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]
Abstract
Thorough mediastinal staging is pivotal for prognostic assessment and treatment planning in patients with non-small-cell lung cancer (NSCLC) without distant metastasis. It aims to answer the question of whether a technically and functionally feasible operation also makes sense from an oncological point of view. In case of a nodal-free mediastinum, primary surgical therapy can be considered. If the ipsilateral mediastinal lymph nodes are affected, multimodal therapy should be sought. Operating is usually no longer the first step, especially with extensive lymph node infestation. Surgery is recommended, if neoadjuvant (radio-)chemotherapy has achieved downstaging or major response. If the contralateral mediastinal lymph nodes are involved, curative surgery is no longer part of the therapeutic concept. The therapy of choice in this situation is definitive chemo-radiotherapy.Guidelines for mediastinal staging consistently require to combine radiological, nuclear medicine and minimally invasive methods. Imaging with CT and PET allows an initial assessment of the mediastinal status. In most cases it has to be complemented with tissue confirmation. Echoendoscopic assessment of the mediastinum with needle biopsy is the minimally invasive method of first choice ("needle first"). Surgical staging methods are reserved for situations, that cannot be satisfactorily clarified by echoendoscopy.Technique and outcome of the different methods are described and algorithms are presented for different oncological situations.
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17
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Chao C, Qian Y, Li X, Sang C, Wang B, Zhang XY. Surgical Survival Benefits With Different Metastatic Patterns for Stage IV Extrathoracic Metastatic Non-Small Cell Lung Cancer: A SEER-Based Study. Technol Cancer Res Treat 2021; 20:15330338211033064. [PMID: 34496678 PMCID: PMC8442485 DOI: 10.1177/15330338211033064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: With the knowledge of oligometastases, primary surgery plays an increasingly
vital role in metastatic non-small cell lung cancer. We aimed to evaluate
the survival benefit of primary surgery based on metastatic patterns. Materials and Methods: The selected patients with stage IV extrathoracic metastatic (m1b) non-small
cell lung cancer between 2010 and 2015 were included in a retrospective
cohort study from the Surveillance, Epidemiology, and End Results (SEER)
database. Multiple imputation was used for the missing data. Patients were
divided into 2 groups depending on whether surgery was performed. After
covariate balancing propensity score (CBPS) weighting, multivariate Cox
regression models and Kaplan-Meier survival curve were built to identify the
survival benefit of different metastatic patterns. Results: Surgery can potentially increase the overall survival (OS) (adjusted HR:
0.68, P < 0.001) of non-small cell lung cancer. The
weighted 3-year OS in the surgical group was 16.9%, compared with 7.8% in
the nonsurgical group. For single organ metastasis, surgery could improve
the survival of metastatic non-small cell lung cancer. Meanwhile, no
significant survival improvements in surgical group were observed in
patients with multiple organ metastases. Conclusion: The surgical survival benefits for extrathoracic metastatic non-small cell
lung cancer could be divided by metastatic pattern.
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Affiliation(s)
- Ce Chao
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Yongxiang Qian
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xihao Li
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Chen Sang
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Bin Wang
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xiao-Ying Zhang
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
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18
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Chen YY, Yen YT, Lai WW, Huang WL, Chang CC, Tseng YL. Outcomes of salvage lung resections in advanced EGFR-mutant lung adenocarcinomas under EGFR TKIs. Thorac Cancer 2021; 12:2655-2665. [PMID: 34498378 PMCID: PMC8520796 DOI: 10.1111/1759-7714.13646] [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: 06/01/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 11/28/2022] Open
Abstract
Background Studies regarding the outcomes of salvage lung resections of epidermal growth factor receptor (EGFR)‐mutant advanced lung adenocarcinomas (ALAs) following treatment with EGFR tyrosine kinase inhibitors (TKIs) are limited, hence the objective of this study was to investigate such outcomes. Methods A total of 29 patients with EGFR‐mutant ALA who underwent salvage surgery after EGFR‐TKI treatment from October 2013 through January 2019 were enrolled. The patients were divided into two groups according to the surgical indications. Their perioperative parameters and surgical outcomes, including progression‐free survival (PFS) and overall survival (OS), were then analyzed. Results The initial stages of the patients were stage IIIB (seven patients), IVA (17 patients), and IVB (five patients). Their surgical indications included residual tumor (25 patients) and progressive disease (PD) (four patients). They all underwent surgery via minimally invasive approaches and the median follow‐up was 33.9 months. Within that follow‐up duration, the median PFS after surgery was 36.4 months, and the median OS was still not reached. There were no significant differences in PFS or OS according to the different EGFR‐TKIs used, the different durations of EGFR‐TKI treatment before surgery, or the different surgical indications. However, the patients presenting with pleural seeding before EGFR‐TKI treatment had significantly poorer PFS and OS than the other patients (P < 0.001). Conclusions Salvage surgery following EGFR‐TKI treatment of ALAs is a safe procedure with acceptable intra‐ and postoperative results. However, studies involving more cases and longer follow‐up periods are needed to clarify its benefits. Key points Salvage surgery following EGFR‐TKI treatment of ALAs is a safe procedure with acceptable intra‐ and postoperative results. Our results support the use of surgery following treatment with EGFR‐TKIs such as afatinib in advanced lung cancer.
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Affiliation(s)
- Ying-Yuan Chen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Wu-Wei Lai
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Wei-Li Huang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan
| | - Chao-Chun Chang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
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19
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Hecker E, Gesierich W. Mediastinales Staging. Zentralbl Chir 2021; 146:S33-S47. [PMID: 34488231 DOI: 10.1055/a-1478-0954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Thorough mediastinal staging is pivotal for prognostic assessment and treatment planning in patients with non-small-cell lung cancer (NSCLC) without distant metastasis. It aims to answer the question of whether a technically and functionally feasible operation also makes sense from an oncological point of view. In case of a nodal-free mediastinum, primary surgical therapy can be considered. If the ipsilateral mediastinal lymph nodes are affected, multimodal therapy should be sought. Operating is usually no longer the first step, especially with extensive lymph node infestation. Surgery is recommended, if neoadjuvant (radio-)chemotherapy has achieved downstaging or major response. If the contralateral mediastinal lymph nodes are involved, curative surgery is no longer part of the therapeutic concept. The therapy of choice in this situation is definitive chemo-radiotherapy.Guidelines for mediastinal staging consistently require to combine radiological, nuclear medicine and minimally invasive methods. Imaging with CT and PET allows an initial assessment of the mediastinal status. In most cases it has to be complemented with tissue confirmation. Echoendoscopic assessment of the mediastinum with needle biopsy is the minimally invasive method of first choice ("needle first"). Surgical staging methods are reserved for situations, that cannot be satisfactorily clarified by echoendoscopy.Technique and outcome of the different methods are described and algorithms are presented for different oncological situations.
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Affiliation(s)
- Erich Hecker
- Klinik für Thoraxchirurgie, Thoraxzentrum Ruhrgebiet, Herne-Eickel, Deutschland
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20
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Gobbini E, Bertolaccini L, Giaj-Levra N, Menis J, Giaj-Levra M. Epidemiology of oligometastatic non-small cell lung cancer: results from a systematic review and pooled analysis. Transl Lung Cancer Res 2021; 10:3339-3350. [PMID: 34430371 PMCID: PMC8350077 DOI: 10.21037/tlcr-20-982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 07/07/2021] [Indexed: 12/25/2022]
Abstract
Background To describe the incidence and the clinical characteristics of oligometastatic non-small cell lung cancer (NSCLC) patients. Oligometastatic NSCLC is gaining recognition as a clinical condition with a different prognosis compared to multi metastatic disease. Usually, four different scenarios of oligometastatic disease can be described but not epidemiological data are available. To date, it is difficult to delineate an exhaustive epidemiological scenario because no uniform or shared definition of oligometastatic status exists, even though a recent consensus defined synchronous oligometastatic disease as having a maximum of 5 metastases in 3 different organs. Methods A systematic review and a pooled analysis of literature were performed. Article selection was based on the following characteristics: focus on lung cancers; dealing with oligometastatic settings and providing a definition of oligometastatic disease; number of metastatic lesions with or without the number of organs involved; providing some incidence or clinical characteristics of oligometastatic NSCLC patients. Series focusing on a specific single metastatic organ were excluded. The research was launched in MEDLINE (OvidSP) in March 2020. Full articles were individually and collectively read by the authors according to the previous criteria. Each author inspected the reference list included in the eligible articles. If the selection criteria were recognized, the article was reviewed by all authors and then included. Data on patient clinical features were pooled together from 31 articles selected. Results A total number of 31 articles have been selected for the analysis. The following variables were extracted from the publications: (I) number of metastases, (II) number of organs involved, (III) number of patients, (IV) number and percentage of males and females, (V) number and percentage of squamous and non-squamous histology, (VI) T and N status and/or stage of primary disease for oligometastatic setting. The data collected have been analyzed according to the oligometastatic setting. Conclusions Oligometastatic status is globally identified as a different clinical condition from multi metastatic NSCLC, although the clinical characteristics were consistent in the general metastatic population, even with a lower-than-expected TN status. The brain and bones were the most frequent organs involved. Lacking consensus definition, these results must be interpreted cautiously and a prospective evaluation is urgently needed.
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Affiliation(s)
- Elisa Gobbini
- Cancer Research Center Lyon, Center Léon Bérard, Lyon, France.,Thoracic Oncology Unit, Grenoble University Hospital, Grenoble, France
| | - Luca Bertolaccini
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Niccolò Giaj-Levra
- Department of Advanced Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Jessica Menis
- Section of Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - Matteo Giaj-Levra
- Thoracic Oncology Unit, Grenoble University Hospital, Grenoble, France.,Institute for Advanced Biosciences INSERM U1209 CNRS UMR5309, Université Grenoble Alpes, France
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21
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Bertolaccini L, Casiraghi M, Sedda G, de Marinis F, Spaggiari L. Clinical prognostic factors in surgically treated oligometastatic non-small cell lung cancer: a systematic review. Transl Lung Cancer Res 2021; 10:3401-3408. [PMID: 34430375 PMCID: PMC8350109 DOI: 10.21037/tlcr-20-1123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/19/2021] [Indexed: 12/11/2022]
Abstract
Background Since the concept of oligometastatic (OM) disease was introduced in the oncological scenario of non-small cell lung cancer (NSCLC), these patients progressively became a new category of stage IV NSCLC in whom the multimodality approach, including surgery, may improve prognosis. This systematic review aimed to investigate the clinical prognostic factors in OM-NSCLC surgically treated with radical intent. Methods This systematic review is reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Cochrane’s Collaboration Tool was used to determine the risk of bias for the included studies’ primary outcome. A search strategy using a combination of free-text words, relevant MeSH headings and appropriate restrictions (time limit: from January 1997 to March 2020, language: English) was designed. Potentially qualified papers were subjected to an in-depth full-text examination after preliminary title/abstract screening to identify studies for inclusion in the systematic review. Data extracted included: study characteristics, baseline patient characteristics, primary and secondary outcomes. The Cochrane’s Collaboration Tool was used to determine the risk of bias for included studies’ primary outcome. The risk of bias due to incomplete outcome data was evaluated at an outcome level. However, at the study stage, the possibility of bias due to sequence generation, allocation concealment, blinding, selective reporting, or funding was assessed. Two independent observers calculated the probability of bias, and differences were resolved through dialogue and consensus. Results Nine studies were selected. Overall survival (OS) was 51.8 months and varied from 21.1 to 60 months, but results were not statistically significant. Positive prognostic factors for survival were cessation of smoking, age <60, a histologic grade of G1/G2, pN0. The presence of extra-brain OM and multiple metastases negatively affected survival. Discussion For otherwise stable patients with a single organ site with synchronous (or metachronous) extrathoracic M1 disease and no intrathoracic lymph node involvement, aggressive treatment should be used in the absence of randomized evidence to help determine the effective management of OM-NSCLC.
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Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Monica Casiraghi
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giulia Sedda
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Filippo de Marinis
- Department of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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22
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Rashdan S, Iyengar P, Minna JD, Gerber DE. Narrative review: molecular and genetic profiling of oligometastatic non-small cell lung cancer. Transl Lung Cancer Res 2021; 10:3351-3368. [PMID: 34430372 PMCID: PMC8350108 DOI: 10.21037/tlcr-21-448] [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: 05/28/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022]
Abstract
Objective The objectives of this review are to discuss: the definition, clinical and biologic features of oligometastatic non-small cell lung cancer (NSCLC), as well as the concept of treating oligoprogression in oligometastatic NSCLC. Background A substantial proportion of patients diagnosed with lung cancer present with metastatic disease, and a large portion of patients who present with localized disease later develop metastases. Oligometastatic NSCLC is defined as an intermediate state between localized and widespread metastatic disease, where there may be a role for curative localized therapy approach by treating the primary tumor and all metastases with radiotherapy or surgery. Despite the increasing application of this approach in patients with lung cancer, the identification of patients who might benefit from this approach is yet to be well characterized. Methods After a systematic review of the literature, a PubMed search was performed using the English language and the key terms: oligometastatic, non-small cell lung cancer (NSCLC), localized consolidative treatment (LCT), biomarkers, biologic features, clinical features. Over 500 articles were retrieved between 1889–2021. A total of 178 papers discussing the definition, clinical and biologic factors leading to oligometastatic NSCLC were reviewed and included in the discussion of this paper. Conclusions Oligometastatic NSCLC is a unique entity. Identifying patients who have oligometastatic NSCLC accurately using a combination of clinical and biologic features and treating them with localized consolidative approach appropriately results in improvement of outcome. Further understanding of the molecular mechanisms driving the formation of oligometastatic NSCLC is an important area of focus for future studies.
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Affiliation(s)
- Sawsan Rashdan
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Puneeth Iyengar
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John D Minna
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Pharmacology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David E Gerber
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
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23
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Jones GD, Lengel HB, Hsu M, Tan KS, Caso R, Ghanie A, Connolly JG, Bains MS, Rusch VW, Huang J, Park BJ, Gomez DR, Jones DR, Rocco G. Management of Synchronous Extrathoracic Oligometastatic Non-Small Cell Lung Cancer. Cancers (Basel) 2021; 13:cancers13081893. [PMID: 33920810 PMCID: PMC8071146 DOI: 10.3390/cancers13081893] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 12/25/2022] Open
Abstract
Stage IV non-small cell lung cancer (NSCLC) accounts for 35 to 40% of newly diagnosed cases of NSCLC. The oligometastatic state-≤5 extrathoracic metastatic lesions in ≤3 organs-is present in ~25% of patients with stage IV disease and is associated with markedly improved outcomes. We retrospectively identified patients with extrathoracic oligometastatic NSCLC who underwent primary tumor resection at our institution from 2000 to 2018. Event-free survival (EFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Factors associated with EFS and OS were determined using Cox regression. In total, 111 patients with oligometastatic NSCLC underwent primary tumor resection; 87 (78%) had a single metastatic lesion. Local consolidative therapy for metastases was performed in 93 patients (84%). Seventy-seven patients experienced recurrence or progression. The five-year EFS was 19% (95% confidence interval (CI), 12-29%), and the five-year OS was 36% (95% CI, 27-50%). Factors independently associated with EFS were primary tumor size (hazard ratio (HR), 1.15 (95% CI, 1.03-1.29); p = 0.014) and lymphovascular invasion (HR, 1.73 (95% CI, 1.06-2.84); p = 0.029). Factors independently associated with OS were neoadjuvant therapy (HR, 0.43 (95% CI, 0.24-0.77); p = 0.004), primary tumor size (HR, 1.18 (95% CI, 1.02-1.35); p = 0.023), pathologic nodal disease (HR, 1.83 (95% CI, 1.05-3.20); p = 0.033), and visceral-pleural invasion (HR, 1.93 (95% CI, 1.10-3.40); p = 0.022). Primary tumor resection represents an important treatment option in the multimodal management of extrathoracic oligometastatic NSCLC. Encouraging long-term survival can be achieved in carefully selected patients, including those who received neoadjuvant therapy and those with limited intrathoracic disease.
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Affiliation(s)
- Gregory D. Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (G.D.J.); (H.B.L.); (R.C.); (J.G.C.); (M.S.B.); (V.W.R.); (J.H.); (B.J.P.); (D.R.J.)
| | - Harry B. Lengel
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (G.D.J.); (H.B.L.); (R.C.); (J.G.C.); (M.S.B.); (V.W.R.); (J.H.); (B.J.P.); (D.R.J.)
| | - Meier Hsu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (M.H.); (K.S.T.)
| | - Kay See Tan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (M.H.); (K.S.T.)
| | - Raul Caso
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (G.D.J.); (H.B.L.); (R.C.); (J.G.C.); (M.S.B.); (V.W.R.); (J.H.); (B.J.P.); (D.R.J.)
| | - Amanda Ghanie
- College of Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA;
| | - James G. Connolly
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (G.D.J.); (H.B.L.); (R.C.); (J.G.C.); (M.S.B.); (V.W.R.); (J.H.); (B.J.P.); (D.R.J.)
| | - Manjit S. Bains
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (G.D.J.); (H.B.L.); (R.C.); (J.G.C.); (M.S.B.); (V.W.R.); (J.H.); (B.J.P.); (D.R.J.)
- Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Valerie W. Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (G.D.J.); (H.B.L.); (R.C.); (J.G.C.); (M.S.B.); (V.W.R.); (J.H.); (B.J.P.); (D.R.J.)
- Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (G.D.J.); (H.B.L.); (R.C.); (J.G.C.); (M.S.B.); (V.W.R.); (J.H.); (B.J.P.); (D.R.J.)
- Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Bernard J. Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (G.D.J.); (H.B.L.); (R.C.); (J.G.C.); (M.S.B.); (V.W.R.); (J.H.); (B.J.P.); (D.R.J.)
- Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Daniel R. Gomez
- Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - David R. Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (G.D.J.); (H.B.L.); (R.C.); (J.G.C.); (M.S.B.); (V.W.R.); (J.H.); (B.J.P.); (D.R.J.)
- Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (G.D.J.); (H.B.L.); (R.C.); (J.G.C.); (M.S.B.); (V.W.R.); (J.H.); (B.J.P.); (D.R.J.)
- Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
- Correspondence:
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24
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Kaba E, Yardımcı EH, Kakuturu J, Toker A. In Spite of Curative Radical Pulmonary Procedures, Lesser Pulmonary Resection Shows More Favorable Prognosis in Surgically Treated NSCLC With Synchronous Isolated Cranial Oligometastases. Front Surg 2021; 8:645870. [PMID: 33718430 PMCID: PMC7947805 DOI: 10.3389/fsurg.2021.645870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/03/2021] [Indexed: 12/25/2022] Open
Abstract
Oligometastatic disease in lung cancer is not a rare condition as previously thought. Among 812 non-small cell lung cancer patients treated surgically with lung resection between October 2011 and October 2018 at the Department of Thoracic Surgery, Florence Nightingale Hospitals, Turkey, 28 patients (3.4%) had synchronous cranial metastases. We analyzed synchronous isolated cranial metastases patients treated by locally ablative treatments (surgery, radiotherapy, or both). Metastases existing at the diagnosis of primary cancer were considered as synchronous, and their treatment was performed before (at least 1 month) or after (for maximum 1 month) surgery of the primary lung lesion. Prognostic factors affecting survival are evaluated retrospectively to identify clinical factors predicting survival in an effort to better select patients for surgery. Patients having T1-T2 primary lung tumors, no mediastinal lymph node metastasis, receiving minor anatomical lung resection, receiving neoadjuvant chemotherapy, having single cranial metastasis, and receiving surgical cranial metastasectomy were found to have better survival. According to tumor histology, having adenocarcinoma, and not having lymphovascular or visceral pleura invasion correlated with better survival. Average survival time was 52.1 months and median survival was 32 months. The last mortality during the follow-up was at 24 months; cumulative survival was 48.3% at that time. Our study was designed to define the criteria for patients with oligometastatic disease who may benefit from lung resection.
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Affiliation(s)
- Erkan Kaba
- Department of Thoracic Surgery, Group Florence Nightingale Hospitals, Demiroglu Bilim University, Istanbul, Turkey
| | - Eyüp Halit Yardımcı
- Department of Thoracic Surgery, Group Florence Nightingale Hospitals, Demiroglu Bilim University, Istanbul, Turkey
| | - Jahnavi Kakuturu
- Department of Cardiovascular and Thoracic Surgery, West Virginia University Heart & Vascular Institute, Morgantown, WV, United States
| | - Alper Toker
- Department of Cardiovascular and Thoracic Surgery, West Virginia University Heart & Vascular Institute, Morgantown, WV, United States
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Spaggiari L, Bertolaccini L, Facciolo F, Gallina FT, Rea F, Schiavon M, Margaritora S, Congedo MT, Lucchi M, Ceccarelli I, Alloisio M, Bottoni E, Negri G, Carretta A, Cardillo G, Ricciardi S, Ruffini E, Costardi L, Muriana G, Viggiano D, Rusca M, Ventura L, Marulli G, De Palma A, Rosso L, Mendogni P, Crisci R, De Vico A, Maniscalco P, Tamburini N, Puma F, Ceccarelli S, Voltolini L, Bongiolatti S, Morelli A, Londero F. A risk stratification scheme for synchronous oligometastatic non-small cell lung cancer developed by a multicentre analysis. Lung Cancer 2021; 154:29-35. [PMID: 33610120 DOI: 10.1016/j.lungcan.2021.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/20/2021] [Accepted: 02/01/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUNDS Oligometastatic Non-Small Cell Lung Cancer (NSCLC) patients represent a category without a standard therapeutic approach. However, in selected oligometastatic NSCLC, radical surgery seems to offer a good prognosis. This retrospective study aimed to analyse the long-term outcomes of synchronous oligometastatic patients treated with curative intent and identify the factors associated with better results and the proposal of a risk stratification system for classifying the synchronous oligometastatic NSCLC. METHODS The medical records of patients from 18 centres with pathologically diagnosed synchronous oligometastatic NSCLC were retrospectively reviewed. The inclusion criteria were synchronous oligometastatic NSCLC, radical surgical treatment of the primary tumour with or without neoadjuvant/adjuvant therapy and radical treatment of all metastatic sites. The Kaplan - Meier method estimated survivals. A stratified backward stepwise Cox regression model was assessed for multivariable survival analyses. RESULTS 281 patients were included. The most common site of metastasis was the brain, in 50.89 % patients. Median overall survival was 40 months (95 % CI: 29-53). Age ≤65 years (HR = 1.02, 95 % CI: 1.00-1.05; p = 0.019), single metastasis (HR = 0.71, 95 % CI: 0.45-1.13; p = 0.15) and presence of contralateral lung metastases (HR = 0.30, 95 % CI: 0.15 - 0.62; p = 0.001) were associated with a good prognosis. The presence of pathological N2 metastases negatively affected survival (HR = 2.00, 95 % CI: 1.21-3.32; p = 0.0065). These prognostic factors were used to build a simple risk classification scheme. CONCLUSIONS Treatment of selected synchronous oligometastatic NSCLC with curative purpose could be conducted safely and at acceptable 5-year survival levels, especially in younger patients with pN0 disease.
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Affiliation(s)
- Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Francesco Facciolo
- Thoracic Surgery Department, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Federico Rea
- Thoracic Surgery and Lung Transplantation Unit, University-Hospital of Padova, Padova, Italy
| | - Marco Schiavon
- Thoracic Surgery and Lung Transplantation Unit, University-Hospital of Padova, Padova, Italy
| | - Stefano Margaritora
- Thoracic Surgery Deparment, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Maria Teresa Congedo
- Thoracic Surgery Deparment, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Marco Lucchi
- Division of Thoracic Surgery, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Ilaria Ceccarelli
- Division of Thoracic Surgery, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Marco Alloisio
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Edoardo Bottoni
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Giampiero Negri
- Department of Thoracic Surgery, San Raffaele Hospital, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Angelo Carretta
- Department of Thoracic Surgery, San Raffaele Hospital, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini Hospital, Rome, Italy
| | - Sara Ricciardi
- Department of CardioThoracic Surgery, S. Orsola - Malpighi University Hospital, Bologna, Italy
| | - Enrico Ruffini
- Department of Surgical Sciences, Unit of Thoracic Surgery, University of Torino Italy, Torino, Italy
| | - Lorena Costardi
- Department of Surgical Sciences, Unit of Thoracic Surgery, University of Torino Italy, Torino, Italy
| | | | | | - Michele Rusca
- Thoracic Surgery Division, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Luigi Ventura
- Thoracic Surgery Division, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Giuseppe Marulli
- Thoracic Surgery Unit, Department of Emergency and Organ Transplantation (DETO), University Hospital, Bari, Italy
| | - Angela De Palma
- Thoracic Surgery Unit, Department of Emergency and Organ Transplantation (DETO), University Hospital, Bari, Italy
| | - Lorenzo Rosso
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberto Crisci
- Thoracic Surgery Unit, University of L'Aquila, Giuseppe Mazzini Hospital, Teramo, Italy
| | - Andrea De Vico
- Thoracic Surgery Unit, University of L'Aquila, Giuseppe Mazzini Hospital, Teramo, Italy
| | - Pio Maniscalco
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Nicola Tamburini
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Francesco Puma
- Section of Thoracic Surgery, Università degli Studi di Perugia, Azienda Ospedaliera S. Maria della Misericordia, Perugia, Italy
| | - Silvia Ceccarelli
- Section of Thoracic Surgery, Università degli Studi di Perugia, Azienda Ospedaliera S. Maria della Misericordia, Perugia, Italy
| | - Luca Voltolini
- Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy
| | | | - Angelo Morelli
- Department of Cardiothoracic Surgery, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Francesco Londero
- Department of Cardiothoracic Surgery, S. Maria della Misericordia University Hospital, Udine, Italy
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