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Hui WK, Charaf Z, Hendriks JMH, Van Schil PE. True Prevalence of Unforeseen N2 Disease in NSCLC: A Systematic Review + Meta-Analysis. Cancers (Basel) 2023; 15:3475. [PMID: 37444585 DOI: 10.3390/cancers15133475] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Patients with unforeseen N2 (uN2) disease are traditionally considered to have an unfavorable prognosis. As preoperative and intraoperative mediastinal staging improved over time, the prevalence of uN2 changed. In this review, the current evidence on uN2 disease and its prevalence will be evaluated. A systematic literature search was performed to identify all studies or completed, published trials that included uN2 disease until 6 April 2023, without language restrictions. The Newcastle-Ottawa Scale (NOS) was used to score the included papers. A total of 512 articles were initially identified, of which a total of 22 studies met the predefined inclusion criteria. Despite adequate mediastinal staging, the pooled prevalence of true unforeseen pN2 (9387 patients) was 7.97% (95% CI 6.67-9.27%), with a pooled OS after five years (892 patients) of 44% (95% CI 31-58%). Substantial heterogeneity regarding the characteristics of uN2 disease limited our meta-analysis considerably. However, it seems patients with uN2 disease represent a subcategory with a similar prognosis to stage IIb if complete surgical resection can be achieved, and the contribution of adjuvant therapy is to be further explored.
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Affiliation(s)
- Wing Kea Hui
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Zohra Charaf
- Department of Cardiothoracic Surgery, University Hospital Brussels, Laarbeeklaan 101, 1090 Jette, Belgium
| | - Jeroen M H Hendriks
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- ASTARC (Antwerp Surgical Training, Anatomy and Research Centre), University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Paul E Van Schil
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- ASTARC (Antwerp Surgical Training, Anatomy and Research Centre), University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
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2
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Aljanabi R, Alsous L, Sabbah DA, Gul HI, Gul M, Bardaweel SK. Monoamine Oxidase (MAO) as a Potential Target for Anticancer Drug Design and Development. Molecules 2021; 26:molecules26196019. [PMID: 34641563 PMCID: PMC8513016 DOI: 10.3390/molecules26196019] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/12/2021] [Accepted: 09/28/2021] [Indexed: 12/12/2022] Open
Abstract
Monoamine oxidases (MAOs) are oxidative enzymes that catalyze the conversion of biogenic amines into their corresponding aldehydes and ketones through oxidative deamination. Owing to the crucial role of MAOs in maintaining functional levels of neurotransmitters, the implications of its distorted activity have been associated with numerous neurological diseases. Recently, an unanticipated role of MAOs in tumor progression and metastasis has been reported. The chemical inhibition of MAOs might be a valuable therapeutic approach for cancer treatment. In this review, we reported computational approaches exploited in the design and development of selective MAO inhibitors accompanied by their biological activities. Additionally, we generated a pharmacophore model for MAO-A active inhibitors to identify the structural motifs to invoke an activity.
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Affiliation(s)
- Reem Aljanabi
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Jordan, Amman 11942, Jordan; (R.A.); (L.A.)
| | - Lina Alsous
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Jordan, Amman 11942, Jordan; (R.A.); (L.A.)
| | - Dima A. Sabbah
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, P.O. Box 130, Amman 11733, Jordan;
| | - Halise Inci Gul
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Ataturk University, Yakutiye 25030, Turkey;
| | - Mustafa Gul
- Department of Physiology, School of Medicine, Ataturk University, Yakutiye 25030, Turkey;
| | - Sanaa K. Bardaweel
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Jordan, Amman 11942, Jordan; (R.A.); (L.A.)
- Correspondence: ; Tel.: +962-6535-5000 (ext. 23318)
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3
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Yang H, Mei T. The prognostic value of lymph node ratio in patients with surgically resected stage I-III small-cell lung cancer: a propensity score matching analysis of the SEER database. Eur J Cardiothorac Surg 2021; 60:1212-1220. [PMID: 34195790 DOI: 10.1093/ejcts/ezab287] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/12/2021] [Accepted: 05/13/2021] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Due to the lack of prospective studies, the role of the lymph node ratio (LNR) in small-cell lung cancer (SCLC) remains unknown. This study aimed to assess the prognostic effect of LNR in surgically resected stage I-III SCLC patients. METHODS Clinical data of stage I-III (excluding N3 and NX) SCLC patients diagnosed between 1998 and 2016 were extracted from the Surveillance, Epidemiology and End Results database. Patients were divided into low-risk and high-risk subsets based on the LNR cut-off value of 0.15 using X-tile software. Propensity score matching analysis was employed to reduce bias in baseline characteristics. Kaplan-Meier analysis was performed to determine the overall survival (OS) and lung cancer-specific survival (LCSS). Cox regression analysis was performed to evaluate the effects of multiple variables. RESULTS A total of 978 patients were identified, of whom 669 (68.40%) had LNR ≤0.15. Patients with LNR ≤0.15 showed better OS (P < 0.001) and LCSS (P < 0.001) both before and after propensity score matching. Multivariable analyses of the matched population confirmed LNR as an independent prognostic factor. Patients with LNR >0.15 showed poorer OS [hazard ratio (HR) 1.55, 95% confidence interval (CI) 1.09-2.19; P = 0.015] and LCSS (HR 1.65, 95% CI 1.13-2.43; P = 0.010). Subgroup analyses revealed that LNR ≤0.15 was associated with favourable OS (P = 0.009 and 0.197, respectively) and LCSS (P = 0.010 and 0.169, respectively) in N1 and N2 patients. CONCLUSIONS LNR was determined as an independent predictor for surgically resected stage I-III SCLC, indicating that higher LNR is associated with reduced survival. The predictive value of LNR should to be further validated in prospective studies.
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Affiliation(s)
- Hao Yang
- Department of Respiratory and Critical Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Tonghua Mei
- Department of Respiratory and Critical Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
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Adachi K, Kuroda H, Tanahashi M, Takao M, Ohde Y, Yokoi K, Tarukawa T. Survival benefits of salvage surgery for primary lung cancer based on routine clinical practice. Thorac Cancer 2021; 12:1716-1720. [PMID: 33942531 PMCID: PMC8169288 DOI: 10.1111/1759-7714.13961] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Premeditated induction chemotherapy followed by surgical resection is accepted as safe and effective. Studies on salvage surgery in patients with incompletely cured lung cancer are lacking. This study aimed to demonstrate the safety and efficacy of salvage surgery. METHODS We conducted a retrospective multi-institutional cohort study on patients who underwent salvage surgery for advanced (stage III and IV) non-small cell lung cancer (NSCLC) between January 2005 and December 2016 at the 14 hospitals of the Chubu Lung Cancer Surgery Study Group. A total of 37 patients were assigned to the salvage surgery group; a lobectomy with mediastinal lymph node dissection was performed. The survival benefit was assessed using the Kaplan-Meier method and the Cox proportional hazard model. RESULTS Although postoperative complications were observed in 11 patients (29.7%), surgery-related death occurred in only one patient (mortality rate: 2.7%) resulting from respiratory failure caused by interstitial pneumonia exacerbation. Postoperative recurrence was observed in 22 patients (61.1%), the incidence of brain metastasis being high (nine patients: 40.9%). The five-year survival rate from the first day of treatment was 60%. The survival of the postoperative pathological stage (s'-stage) I group was significantly better (five-year survival rate: 80.9%) than that of the other groups (p < 0.05). S'-stage was the most significant factor (p < 0.01) associated with long-term survival. CONCLUSIONS Salvage surgery is a feasible therapeutic modality for advanced lung cancer. Downstaging to s'-stage I with previous treatment was most important for survival. Complete resection (R0) should be the goal because surgical procedures were tolerated despite intense treatment.
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Affiliation(s)
- Katsutoshi Adachi
- Department of Thoracic Surgery, Mie Chuo Medical Center, Tsu, Japan.,The Chubu Lung Cancer Surgery Study Group, Chubu, Japan
| | - Hiroaki Kuroda
- The Chubu Lung Cancer Surgery Study Group, Chubu, Japan.,Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Masayuki Tanahashi
- The Chubu Lung Cancer Surgery Study Group, Chubu, Japan.,Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Motoshi Takao
- The Chubu Lung Cancer Surgery Study Group, Chubu, Japan.,Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan
| | - Yasuhisa Ohde
- The Chubu Lung Cancer Surgery Study Group, Chubu, Japan.,Department of Thoracic Surgery, Shizuoka Cancer Center, Sunto-gun, Japan
| | - Kohei Yokoi
- The Chubu Lung Cancer Surgery Study Group, Chubu, Japan.,Department of Thoracic Surgery, Nagoya University School of Medicine, Nagoya, Japan
| | - Tomohito Tarukawa
- Department of Thoracic Surgery, Mie Chuo Medical Center, Tsu, Japan.,The Chubu Lung Cancer Surgery Study Group, Chubu, Japan
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Cai JS, Li S, Yan SM, Yang J, Yang MZ, Xie CL, Li JB, Feng YF, Yang HX, Hou X. Is major pathologic response sufficient to predict survival in resectable nonsmall-cell lung cancer patients receiving neoadjuvant chemotherapy? Thorac Cancer 2021; 12:1336-1346. [PMID: 33751832 PMCID: PMC8088941 DOI: 10.1111/1759-7714.13903] [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: 12/20/2020] [Revised: 02/06/2021] [Accepted: 02/06/2021] [Indexed: 12/20/2022] Open
Abstract
Background Major pathologic response (MPR) is mainly focused on residual viable tumor in the tumor bed regardless of lymph node. Herein, we investigated the predictive value of MPR and node status on survival in nonsmall‐cell lung cancer (NSCLC) patients receiving neoadjuvant chemotherapy (NAC) and surgery. Methods A total of 194 eligible cases were included. Tumor pathologic response and node status were assessed. Based on these evaluations, patients were divided into the MPR group and the non‐MPR group, the nodal downstaging (ND) group and non‐ND group. Furthermore, patients were assigned into four subgroups (MPR + ND, MPR + non‐ND, non‐MPR + ND, and non‐MPR + non‐ND). Overall survival (OS) and disease‐free survival (DFS) were compared between groups. Multivariate analyses were performed to identify prognostic factors. Results MPR was identified in 32 patients and ND was present in 108 patients. OS and DFS were better in the MPR group than in the non‐MPR group, but with no statistical significance (OS, p = 0.158; DFS, p = 0.126). The ND group had better OS than the non‐ND group (p = 0.031). However, the DFS between these two groups was comparable (p = 0.103). Further analyses suggested that both OS and DFS were better in the MPR + ND group than in the non‐MPR + non‐ND group (OS, p = 0.017; DFS, p = 0.029). Multivariate analyses confirmed that MPR + ND was an independent favorable predictor. Conclusions MPR combined with ND could improve the predictive value on survival in NSCLC patients receiving NAC.
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Affiliation(s)
- Jing-Sheng Cai
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shuo Li
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shu-Mei Yan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jie Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Mu-Zi Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chu-Long Xie
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ji-Bin Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Epidemiology and Biostatistic, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yan-Fen Feng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hao-Xian Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xue Hou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
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Cackowski MM, Gryszko GM, Zbytniewski M, Dziedzic DA, Orłowski TM. Alternative methods of lymph node staging in lung cancer: a narrative review. J Thorac Dis 2020; 12:6042-6053. [PMID: 33209438 PMCID: PMC7656442 DOI: 10.21037/jtd-20-1997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The nodal status indicator in non-small cell lung cancer is one of the most crucial prognostic factors available. However, there are still many arguments among scientists regarding whether the currently used nodal status descriptor should be changed in the forthcoming editions of the Tumor Node Metastasis classification or whether it is precise enough and should be maintained as is. We reviewed studies concerning nodal factor classifications to evaluate their accuracy in non-small cell lung cancer patients and to address the previously mentioned challenge. We reviewed the PubMed database regarding the following classifications: ongoing 8th edition of the Tumor Node Metastasis classification, number of positive lymph nodes, number of negative lymph nodes, number of dissected lymph nodes, lymph node ratio, nodal chains, log odds of positive lymph nodes, zone-based classification and one that is based on the number of lymph node stations involved. Moreover, we analysed data regarding various combinations of these classifications. Our analysis showed that the present nodal staging may not accurately categorize every lung cancer patient. The number of positive lymph nodes and lymph node ratio or the log odds of positive lymph nodes (as the mathematical modification of lymph node ratio) are more legitimate, as they possess very robust data and should be considered initially as additional factors that can be incorporated in ongoing nodal staging systems. Forthcoming non-small cell lung cancer staging systems could benefit from the addition of quantitative-based parameters. Additionally, the minimal extent of lymphadenectomy should be established as staging benefits from it. International, prospective validation studies need to be performed to optimize the cut-off values and prognostic groups and to confirm the superiority of the newly suggested descriptors in non-small cell lung cancer nodal staging.
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Affiliation(s)
- Marcin M Cackowski
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Grzegorz M Gryszko
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Marcin Zbytniewski
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Dariusz A Dziedzic
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Tadeusz M Orłowski
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
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Zhou J, Lin Z, Lyu M, Chen N, Liao H, Wang Z, Hao J, Yan C, Liu L. Prognostic value of lymph node ratio in non-small-cell lung cancer: a meta-analysis. Jpn J Clin Oncol 2020; 50:44-57. [PMID: 31735973 DOI: 10.1093/jjco/hyz120] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/07/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This meta-analysis aimed to investigate the prognostic value of lymph node ratio in non-small-cell lung cancer. METHODS We searched systematically for eligible studies in PubMed, Web of Science, Medline (via Ovid) and Cochrane library through 6 November 2018. The primary outcome was overall survival. Disease-free survival and cancer-specific survival were considered as secondary outcomes. Hazard ratio with corresponding 95% confidence interval were pooled. Quality assessment of included studies was conducted. Subgroup analyses were performed based on N descriptors, types of tumor resection, types of lymphadenectomy and study areas. Sensitivity analysis and evaluation of publication bias were also performed. RESULTS Altogether, 20 cohorts enrolling 76 929 patients were included. Mean Newcastle-Ottawa Scale was 7.65 ± 0.59, indicating the studies' quality was high. The overall result showed non-small-cell lung cancer patients with lower lymph node ratio was associated with better overall survival (HR: 1.946; 95% CI: 1.746-2.169; P < 0.001), disease-free survival (HR: 2.058; 95% CI: 1.717-2.467; P < 0.001) and cancer-specific survival (HR: 2.149; 95% CI: 1.864-2.477; P < 0.001). Subgroup analysis prompted types of lymphadenectomy and the station of positive lymph node have an important effect on the prognosis. No significant discovery was found in sensitivity analysis. CONCLUSION Patients with lower lymph node ratio was associated with better survival, indicating that lymph node ratio may be a promising prognostic predictor in non-small-cell lung cancer. The type of lymphadenectomy, an adequate examined number and the removed stations should be considered for more accurate prognosis assessment.
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Affiliation(s)
- Jian Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Zhangyu Lin
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Mengyuan Lyu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Nan Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Hu Liao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Zihuai Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Jianqi Hao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Chunyi Yan
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
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Romero-Vielva L, Viteri S, Moya-Horno I, Toscas JI, Maestre-Alcácer JA, Ramón Y Cajal S, Rosell R. Salvage surgery after definitive chemo-radiotherapy for patients with Non-Small Cell Lung Cancer. Lung Cancer 2019; 133:117-122. [PMID: 31200817 DOI: 10.1016/j.lungcan.2019.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/26/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Despite all treatment advances, lung cancer is still the main cause of death worldwide. Treatment for resectable stage IIIA remains controversial including definitive chemoradiotherapy and induction treatment followed by surgery. After definitive chemoradiation up to 35% of patients will relapse locally. Experience with salvage resection after definitive chemoradiotherapy in lung cancer is limited. We present our experience in 27 patients who underwent surgical resection after definitive treatment. PATIENTS AND METHODS Between January 2007 and December 2016, 27 patients were evaluated in our department for surgical resection after receiving definitive chemoradiation treatment in different institutions. We conducted a retrospective study gathering the following data: age, gender, clinical and pathologic stage, histology, chemotherapy treatment regimen, radiotherapy dosage, surgical procedure and complications. Time between surgical resection and last follow-up was used to calculate Overall Survival (OS). Disease-Free Survival (DFS) was calculated from surgical resection to diagnosis of relapse. RESULTS Most of the patients were men with a median age of 56.09 years. Median follow-up time was 46.94 months. All patients received platinum-based chemotherapy regimen and high-dose radiotherapy, except for one patient who received 45 Gy. Lobectomy and bilobectomy was performed in 7 patients each, and pneumonectomy in 13. Complications appeared in 5 patients. Bronchopleural fistula appeared in two patients, and only one death in the early postoperative period. The analysis showed an OS of 75.56 months, with 1-year, 3-year and 5-year survival of 74.1%, 57.8% and 53.3% respectively. CONCLUSION Salvage surgery in selected patients is technically feasible, with low morbidity and mortality rates and good long-term outcomes.
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Affiliation(s)
- Laura Romero-Vielva
- Thoracic Surgery Department, University Hospital General de Catalunya, C/ Pedro i Pons, 1., 08195, Sant Cugat del Vallès, Spain.
| | - Santiago Viteri
- Medical Oncology Department, Rosell Oncology Institute (IOR), Dexeus University Hospital, Quironsalud Group, C/ Sabino Arana 5-19, 08028, Barcelona, Spain
| | - Irene Moya-Horno
- Medical Oncology Department Instituto Oncológico Dr Rosell (IOR), University Hospital General de Catalunya, C/ Pedro i Pons, 1., 08195, Sant Cugat del Vallès, Spain
| | - José Ignacio Toscas
- Radio-oncology Department, Institut Oncològic Teknon (IOT), Carrer de Vilana, 12, 08022, Barcelona, Spain
| | - José Antonio Maestre-Alcácer
- Thoracic Surgery Department, University Hospital General de Catalunya, C/ Pedro i Pons, 1., 08195, Sant Cugat del Vallès, Spain
| | - Santiago Ramón Y Cajal
- Pathology Department, Vall d'Hebron Institute of Research, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Rafael Rosell
- Medical Oncology Department, Rosell Oncology Institute (IOR), Dexeus University Hospital, Quironsalud Group, C/ Sabino Arana 5-19, 08028, Barcelona, Spain
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Shang X, Li Z, Lin J, Wang H, Wang Z. PLNR≤20% may be a benefit from PORT for patients with IIIA-N2 NSCLC: a large population-based study. Cancer Manag Res 2018; 10:3561-3567. [PMID: 30271204 PMCID: PMC6152602 DOI: 10.2147/cmar.s173856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purpose Our study was to evaluate the influence of positive lymph nodes ratio (PLNR) on survival for patients with pathological stage IIIA-N2 non-small cell lung cancer (NSCLC) after receiving postoperative radiotherapy (PORT). Patients and methods The chi-squared test was used to compare the patient baseline characteristics. Cox proportional hazard model was used to analyze the influence of different variables on overall survival (OS). X-tile model was applied to determine the cutoff values of PLNR. Kaplan–Meier method and log-rank test were used to compare survival differences. Based on different cutoff values of PLNR, Cox proportional hazard model was also used to analyze the influence factors on OS. Results Multivariate Cox regression analysis showed that PLNR (P=0.001) and PORT (HR=1.283; 95% CI 1.154–1.426; P<0.001) were significant independent prognostic factors for OS in patients with resected IIIA-N2 NSCLC. The X-tile model was used to screen three different cutoff values including PLNR≤20%, 20%<PLNR≤40%, PLNR>40%. Based on these different cutoff values, we found that patients with PLNR≤20% receiving PORT have a better OS (P=0.007). Further multivariable analysis showed that PORT is an independent prognostic factor of OS only for patients with PLNR≤20% (HR=1.328; 95% CI 1.139–1.549; P<0.001). Conclusion: PLNR≤20% may be a prognostic factor for patients with IIIA-N2 NSCLC receiving PORT.
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Affiliation(s)
- Xiaoling Shang
- Department of Internal Medicine- Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, People's Republic of China, ;
| | - Zhenxiang Li
- Department of Internal Medicine- Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, People's Republic of China, ;
| | - Jiamao Lin
- Department of Internal Medicine- Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, People's Republic of China, ;
| | - Haiyong Wang
- Department of Internal Medicine- Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, People's Republic of China, ;
| | - Zhehai Wang
- Department of Internal Medicine- Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, People's Republic of China, ;
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10
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Haager B, Wiesemann S, Passlick B, Schmid S. Prognostic value of lymph node ratio after induction therapy in stage IIIA/N2 non-small cell lung cancer: a monocentric clinical study. J Thorac Dis 2018; 10:3225-3231. [PMID: 30069318 DOI: 10.21037/jtd.2018.05.138] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background The optimal treatment modalities for patients with stage IIIA N2 non-small cell lung cancer (NSCLC) are still a matter of debate. To provide best outcome and to avoid unnecessary treatment patient selection for surgical therapy is crucial. In addition to mediastinal downstaging the lymph node ratio (LNR) has been suggested as a prognosticator in this patient group. Methods We retrospectively reviewed clinical and histopathologic data of 78 patients with stage IIIA N2 NSCLC, who underwent induction therapy with two cycles of platinum-based chemotherapy for intended surgery at our clinic between 2009 and 2016. To evaluate the prognostic value of the LNR the cut off was set at 0.33 as reported in prior literature. Results The median follow-up time was 30.1 months. In multivariate analysis mediastinal down staging was associated with a longer overall survival (OS): 52.2 (range, 5.9-89.7) months for ypN0 versus 24.6 (4.4-84.2) months for ypN1/2 (HR, 2.76; 95% CI, 1.07-7.1, P=0.0348). LNR ≤0.33 was linked to a better OS of 39.3 (range, 5.9-89.7) months compared to 14.7 (range, 4.4-66.2) months for a LNR >0.33 in univariate analysis (P=0.037). In multivariate analysis a statistical trend could be observed (HR, 2.82; 95% CI, 0.98-8.14, P=0.1). In patients with persistent lymph node involvement the LNR could also identify a subgroup of patients with a favorable prognosis (30.1 vs. 14.7 months, P=0.145). Conclusions Mediastinal downstaging remains the best prognosticator in stage IIIA N2 NSCLC after induction therapy. However, using the LNR in patients with persistent mediastinal lymph node metastasis a subgroup with a favorable prognosis could be identified. The LNR could aid in finding the best treatment modalities for these patients.
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Affiliation(s)
- Benedikt Haager
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Sebastian Wiesemann
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Bernward Passlick
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Severin Schmid
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
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11
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Jeremić B, Casas F, Dubinsky P, Gomez-Caamano A, Čihorić N, Videtic G, Igrutinovic I. Treatment-Related Predictive and Prognostic Factors in Trimodality Approach in Stage IIIA/N2 Non-Small Cell Lung Cancer. Front Oncol 2018. [PMID: 29527511 PMCID: PMC5829546 DOI: 10.3389/fonc.2018.00030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
While there are no established pretreatment predictive and prognostic factors in patients with stage IIIA/pN2 non-small cell lung cancer (NSCLC) indicating a benefit to surgery as a part of trimodality approach, little is known about treatment-related predictive and prognostic factors in this setting. A literature search was conducted to identify possible treatment-related predictive and prognostic factors for patients for whom trimodality approach was reported on. Overall survival was the primary endpoint of this study. Of 30 identified studies, there were two phase II studies, 5 “prospective” studies, and 23 retrospective studies. No study was found which specifically looked at treatment-related predictive factors of improved outcomes in trimodality treatment. Of potential treatment-related prognostic factors, the least frequently analyzed factors among 30 available studies were overall pathologic stage after preoperative treatment and UICC downstaging. Evaluation of treatment response before surgery and by pathologic tumor stage after induction therapy were analyzed in slightly more than 40% of studies and found not to influence survival. More frequently studied factors—resection status, degree of tumor regression, and pathologic nodal stage after induction therapy as well as the most frequently studied factor, the treatment (in almost 75% studies)—showed no discernible impact on survival, due to conflicting results. Currently, it is impossible to identify any treatment-related predictive or prognostic factors for selecting surgery in the treatment of patients with stage IIIA/pN2 NSCLC.
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Affiliation(s)
| | | | - Pavol Dubinsky
- University Hospital to East Slovakia Institute of Oncology, Kosice, Slovakia
| | | | - Nikola Čihorić
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Ivan Igrutinovic
- Faculty of Science, University of Kragujevac, Kragujevac, Serbia
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12
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Liu F, Hu L, Ma Y, Huang B, Xiu Z, Zhang P, Zhou K, Tang X. Increased expression of monoamine oxidase A is associated with epithelial to mesenchymal transition and clinicopathological features in non-small cell lung cancer. Oncol Lett 2018; 15:3245-3251. [PMID: 29435065 PMCID: PMC5778774 DOI: 10.3892/ol.2017.7683] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 12/14/2017] [Indexed: 12/30/2022] Open
Abstract
Monoamine oxidase A (MAOA), a mitochondrial enzyme, is closely associated with neurological disorders. Recently, MAOA has been linked to the progression of prostate cancer, hepatocellular carcinoma, and cholangiocarcinoma. However, MAOA was reported to have different effects on the progression of these types of cancer, and the role of MAOA in non-small cell lung cancer (NSCLC) progression remains unclear. The present study determined the expression of MAOA and epithelial to mesenchymal transition (EMT) markers in 45 pairs of NSCLC and matched non-tumor adjacent lung tissues, and further analyzed the correlation between MAOA expression and the EMT or the development of clinicopathological features. The results demonstrated that protein and mRNA expression levels of MAOA in NSCLC tissues were higher than those observed in the matched non-tumor adjacent lung tissues. Furthermore, the increased MAOA expression in NSCLC tissues was positively correlated with N-cadherin (r=0.525, P=0.002), Slug (r=0.515, P=0.001), and Twist (r=0.448, P=0.008) expressions, but negatively correlated with E-cadherin expression (r=-0.387, P=0.01). Additionally, the elevated MAOA expression in NSCLC tissues was associated with late stage NSCLC (Z=-2.596, P=0.029) and lymph node metastases (Z=-2.378, P=0.020). These findings suggest that MAOA may have a role in promoting NSCLC progression by mediating EMT.
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Affiliation(s)
- Fei Liu
- Institute of Biochemistry and Molecular Biology, Guangdong Medical University, Zhanjiang, Guangdong 524023, P.R. China
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical University, Dongguan, Guangdong 523808, P.R. China
| | - Liang Hu
- Institute of Biochemistry and Molecular Biology, Guangdong Medical University, Zhanjiang, Guangdong 524023, P.R. China
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical University, Dongguan, Guangdong 523808, P.R. China
| | - Yuefan Ma
- Institute of Biochemistry and Molecular Biology, Guangdong Medical University, Zhanjiang, Guangdong 524023, P.R. China
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical University, Dongguan, Guangdong 523808, P.R. China
| | - Bingyu Huang
- Institute of Biochemistry and Molecular Biology, Guangdong Medical University, Zhanjiang, Guangdong 524023, P.R. China
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical University, Dongguan, Guangdong 523808, P.R. China
| | - Zihan Xiu
- Institute of Biochemistry and Molecular Biology, Guangdong Medical University, Zhanjiang, Guangdong 524023, P.R. China
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical University, Dongguan, Guangdong 523808, P.R. China
| | - Peihua Zhang
- Institute of Plastic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong 524001, P.R. China
| | - Keyuan Zhou
- Institute of Biochemistry and Molecular Biology, Guangdong Medical University, Zhanjiang, Guangdong 524023, P.R. China
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical University, Dongguan, Guangdong 523808, P.R. China
| | - Xudong Tang
- Institute of Biochemistry and Molecular Biology, Guangdong Medical University, Zhanjiang, Guangdong 524023, P.R. China
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical University, Dongguan, Guangdong 523808, P.R. China
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13
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Brosseau S, Naltet C, Nguenang M, Gounant V, Mordant P, Milleron B, Castier Y, Zalcman G. [Current knowledge on perioperative treatments of non-small cell lung carcinomas]. Rev Mal Respir 2017; 34:618-634. [PMID: 28709816 DOI: 10.1016/j.rmr.2016.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/16/2016] [Indexed: 12/25/2022]
Abstract
Surgery is still the main treatment in early-stage of non-small cell lung cancer with 5-year survival of stage IA patients exceeding 80%, but 5-year survival of stage II patients rapidly decreasing with tumor size, N status, and visceral pleura invasion. The major metastatic risk in such patients has supported clinical research assessing systemic or loco-regional perioperative treatments. Modern phase 3 trials clearly validated adjuvant or neo-adjuvant platinum-based chemotherapy in resected stage I-III patients as a standard treatment of which value has been reassessed several independent meta-analyses, showing a 5% benefit in 5y-survival, and a decrease of the relative risk for death around from 12 to 25%. Conversely perioperative treatments were not validated for stage IA and IB patients. In more advanced stage patients, neo-adjuvant radio-chemotherapy has not been validated either. Adjuvant radiotherapy for N2 patients is currently tested in the large international phase 3 trial Lung-ART/IFCT-0503. The development of video-assisted thoracic surgery (VATS) has helped adjuvant chemotherapies for elderly patients. Perioperative targeted treatments in NSCLC with EGFR or ALK molecular alterations is currently assessed in the U.S. ALCHEMIST prospective trial. Finally, the role of immune check-points inhibitors is currently evaluated in a large international phase 3 trial testing adjuvant anti-PD-L1 monoclonal antibody, the BR31/IFCT-1401 trial, while a proof-of principle neo-adjuvant trial IONESCO/IFCT-1601, has just begun by the end of the 2016 year, with survival results of both trials expected in 5 to 7 years.
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Affiliation(s)
- S Brosseau
- Service d'oncologie thoracique, CIC 1425/CLIP(2) Paris-Nord, hôpital Bichat-Claude-Bernard, Assistance publique-Hôpitaux de Paris, université Paris-Diderot, 46, rue Henri-Huchard, 75018 Paris, France
| | - C Naltet
- Service d'oncologie thoracique, CIC 1425/CLIP(2) Paris-Nord, hôpital Bichat-Claude-Bernard, Assistance publique-Hôpitaux de Paris, université Paris-Diderot, 46, rue Henri-Huchard, 75018 Paris, France
| | - M Nguenang
- Service d'oncologie thoracique, CIC 1425/CLIP(2) Paris-Nord, hôpital Bichat-Claude-Bernard, Assistance publique-Hôpitaux de Paris, université Paris-Diderot, 46, rue Henri-Huchard, 75018 Paris, France
| | - V Gounant
- Service d'oncologie thoracique, CIC 1425/CLIP(2) Paris-Nord, hôpital Bichat-Claude-Bernard, Assistance publique-Hôpitaux de Paris, université Paris-Diderot, 46, rue Henri-Huchard, 75018 Paris, France
| | - P Mordant
- Service de chirurgie vasculaire, thoracique et transplantation, hôpital Bichat-Claude-Bernard, Assistance publique-Hôpitaux de Paris, université Paris-Diderot, 46, rue Henri-Huchard, 75018 Paris, France
| | - B Milleron
- Service d'oncologie thoracique, CIC 1425/CLIP(2) Paris-Nord, hôpital Bichat-Claude-Bernard, Assistance publique-Hôpitaux de Paris, université Paris-Diderot, 46, rue Henri-Huchard, 75018 Paris, France
| | - Y Castier
- Service de chirurgie vasculaire, thoracique et transplantation, hôpital Bichat-Claude-Bernard, Assistance publique-Hôpitaux de Paris, université Paris-Diderot, 46, rue Henri-Huchard, 75018 Paris, France
| | - G Zalcman
- Service d'oncologie thoracique, CIC 1425/CLIP(2) Paris-Nord, hôpital Bichat-Claude-Bernard, Assistance publique-Hôpitaux de Paris, université Paris-Diderot, 46, rue Henri-Huchard, 75018 Paris, France; U830 Inserm « génétique et biologie des cancers », centre de recherche, institut Curie, 26, rue d'Ulm, 75248 Paris cedex 05, France.
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14
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Guerrera F, Renaud S, Tabbó F, Voegeli’ AC, Filosso PL, Legrain M, Boita M, Schaeffer M, Beau-Faller M, Ruffini E, Falcoz PE, Inghirami G, Oliaro A, Massard G. Epidermal growth factor receptor mutations are linked to skip N2 lymph node metastasis in resected non-small-cell lung cancer adenocarcinomas†. Eur J Cardiothorac Surg 2016; 51:680-688. [DOI: 10.1093/ejcts/ezw362] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/13/2016] [Indexed: 12/25/2022] Open
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15
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Kim H, Ahn YC, Pyo H, Oh D, Noh JM, Sun JM, Ahn JS, Ahn MJ, Park K, Choi YS, Kim J, Zo JI, Shim YM, Lee M, Han J. Do New pN Subclassifications Proposed by IASLC’s Lung Cancer Staging Project Agree with ypN Categories after Trimodality Therapy for Initial N2 Disease? J Thorac Oncol 2016; 11:2202-2207. [DOI: 10.1016/j.jtho.2016.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/11/2016] [Accepted: 07/05/2016] [Indexed: 11/30/2022]
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16
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Seitlinger J, Renaud S, Falcoz PE, Schaeffer M, Olland A, Reeb J, Santelmo N, Legrain M, Voegeli AC, Weingertner N, Chenard MP, Beau-Faller M, Massard G. Epidermal growth factor receptor and v-Ki-ras2 Kirsten rat sarcoma viral oncogen homologue-specific amino acid substitutions are associated with different histopathological prognostic factors in resected non-small-cell lung cancer. Interact Cardiovasc Thorac Surg 2016; 23:902-907. [DOI: 10.1093/icvts/ivw250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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17
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Massard G, Renaud S, Reeb J, Santelmo N, Olland A, Falcoz PE. N2-IIIA non-small cell lung cancer: a plea for surgery! J Thorac Dis 2016; 8:S849-S854. [PMID: 27942406 DOI: 10.21037/jtd.2016.09.34] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Management of stage IIIA-N2 non-small cell lung cancer is still matter of ongoing controversy. The debate is flawed by the heterogeneity of this group of patients, lack of strong evidence from controlled trials, diverging treatment strategies, and hesitating estimation of prognosis. Surgery is credited a survival advantage in a trimodality setting. For many teams, N2 is by principle managed with induction chemotherapy, followed by surgery if the patient is down-staged. However, surgery remains a suitable option even in case of persistent N2. On the other hand, outcomes are comparable, regardless whether chemotherapy has been given as induction or adjuvant treatment. Hence, upfront surgery without invasive staging, followed by adjuvant therapies, appears reasonable in resectable single station N2 disease, simplifying patient care and reducing cost. We expect that molecular biomarkers will improve estimation of prognosis and patient selection in the future.
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Affiliation(s)
- Gilbert Massard
- Service de chirurgie thoracique, University Hospital of Strasbourg, Strasbourg, France;; Research unit EA 7293 "Vascular and Tissular Stress in Transplantation", Translational Research Federation, Strasbourg University, Strasbourg, France
| | - Stéphane Renaud
- Service de chirurgie thoracique, University Hospital of Strasbourg, Strasbourg, France;; Research unit EA 3430 "Tumour progression and microenvironment", Translational Research Federation, Strasbourg University, Strasbourg, France
| | - Jérémie Reeb
- Service de chirurgie thoracique, University Hospital of Strasbourg, Strasbourg, France;; Research unit EA 7293 "Vascular and Tissular Stress in Transplantation", Translational Research Federation, Strasbourg University, Strasbourg, France
| | - Nicola Santelmo
- Service de chirurgie thoracique, University Hospital of Strasbourg, Strasbourg, France
| | - Anne Olland
- Service de chirurgie thoracique, University Hospital of Strasbourg, Strasbourg, France;; Research unit EA 7293 "Vascular and Tissular Stress in Transplantation", Translational Research Federation, Strasbourg University, Strasbourg, France
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18
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Sun G, Xue L, Wang M, Zhao X. Lymph node ratio is a prognostic factor for non-small cell lung cancer. Oncotarget 2016; 6:33912-8. [PMID: 26393881 PMCID: PMC4741811 DOI: 10.18632/oncotarget.5669] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 08/22/2015] [Indexed: 11/29/2022] Open
Abstract
The lymph node ratio (LNR) is defined as the number of pathologically positive LNs divided by the number of LNs examined. Some studies reported that high LNR was significantly associated with poor survival of non-small cell lung cancer (NSCLC). However, other studies could not confirm this result. PubMed, Embase, and the Cochrane Register of Controlled Trials were searched for relevant studies published up to July 2015. Primary outcome was the relationship between LNR and disease-specific survival (DSS) and overall survival (OS). Twelve studies with 25138 NSCLC patients were included in this meta-analysis. Higher LNR was significantly associated with decreased OS (HR = 1.93; 95% CI 1.64 – 2.28; P < 0.00001) and DSS (HR = 1.82; 95% CI 1.55 – 2.14; P < 0.00001). In the subgroup analysis, N1 stage NSCLC patients with higher LNR also showed decreased OS (HR = 1.60; 95% CI 1.25 – 2.28; P = 0.0002) and DSS (HR = 1.82; 95% CI 1.55 – 2.21; P < 0.0001). This meta-analysis indicated that LNR was an independent predictor of survival in patients with NSCLC.
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Affiliation(s)
- Guangyuan Sun
- Department of Thoracic and Cardiovascular Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Lei Xue
- Department of Thoracic and Cardiovascular Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Mingdong Wang
- Department of Thoracic and Cardiovascular Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Xuewei Zhao
- Department of Thoracic and Cardiovascular Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai, China
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19
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Specific KRAS amino acid substitutions and EGFR mutations predict site-specific recurrence and metastasis following non-small-cell lung cancer surgery. Br J Cancer 2016; 115:346-53. [PMID: 27336603 PMCID: PMC4973154 DOI: 10.1038/bjc.2016.182] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 04/27/2016] [Accepted: 05/17/2016] [Indexed: 12/30/2022] Open
Abstract
Background: We aimed to evaluate whether EGFR mutations (mEGFR) and KRAS amino acid substitutions can predict first site of recurrence or metastasis after non-small-cell lung cancer (NSCLC) surgery. Methods: Data were reviewed from 481 patients who underwent thoracic surgery for NSCLC between 2007 and 2012. Results: Patients with KRAS G12C developed significantly more bone metastases compared with the remainder of the cohort (59% vs 16%, P<0.0001). This was confirmed in multivariate analysis (MA) (odds ratio (OR): 0.113 (95% confidence interval (CI): 0.055–0.231), P<0.0001). Significantly, more patients with mEGFR developed liver and brain metastases compared with the remainder of the cohort (30% vs 10%, P=0.006; 59% vs 1%, P<0.0001, respectively). These were confirmed in MA (OR: 0.333 (95% CI: 0.095–0.998), P=0.05; OR: 0.032 (95% CI: 0.008–0.135), P<0.0001, respectively). Patients with KRAS G12V developed significantly more pleuro-pericardial metastases compared with the remainder of the cohort (94% vs 12%, P<0.0001). This was confirmed in MA (OR: 0.007 (95% CI: 0.001–0.031), P<0.0001). Wild-type patients developed significantly more lung metastases (35% vs 10%, P<0.0001). This was confirmed in MA (OR: 0.383 (95% CI: 0.193–0.762), P=0.006). Conclusion: Epidermal growth factor receptor mutation and KRAS amino acid substitutions seem to predict site-specific recurrence and metastasis after NSCLC surgery.
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Garelli E, Renaud S, Falcoz PE, Weingertner N, Olland A, Santelmo N, Massard G. Microscopic N2 disease exhibits a better prognosis in resected non-small-cell lung cancer. Eur J Cardiothorac Surg 2016; 50:322-8. [PMID: 26920941 DOI: 10.1093/ejcts/ezw036] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/18/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The management of pIIIA-N2 non-small-cell lung cancer (NSCLC) is still controversial. In particular, there are wide variations in overall survival (OS), suggesting the existence of subgroups among N2 patients. We aimed to evaluate the prognostic value of microscopic pN2 in NSCLC. METHODS Between 1996 and 2015, the data from all 982 pathologically stage IIIA-N2 patients who underwent surgery with curative intent for NSCLC were retrospectively reviewed. Microscopic pN2 disease was defined as a nodal metastasis ranging from 0.2 to 2 mm in size. RESULTS With a median follow-up of 17 months (2-101), the 5-year OS for the whole cohort was 31%. Microscopic N2 was observed in 309 (31.5%) patients. Microscopic N2 was associated with better median OS compared with macroscopic N2 [42 months (95% CI 36.85-47.15) vs 23 months (95% CI 19.7-26.29), P < 0.0001, with a corresponding 5-year OS rate of 39 and 21%, respectively]. In multivariate analysis, microscopic N2 remained a favourable independent prognostic factor [HR 0.681 (95% CI 0.481-0.967), P = 0.03]. The median OS of microscopic N2 patients who benefitted from simple follow-up was significantly better than those who underwent chemotherapy, radiation therapy or both [43 months (95% CI 24.22-61.78) vs 22 months (95% CI 17.43-26.47) vs 31 months (95% CI 27.66-34.34) vs 16 months (95% CI 14.6-17.4), P = 0.008]. CONCLUSION Microscopic N2 seems to be associated with better prognosis in patients with pIIIA-N2 NSCLC and these could benefit from a simple follow-up. Prospective cohort studies are necessary to confirm these preliminary results.
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Affiliation(s)
- Elena Garelli
- Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Stéphane Renaud
- Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France Research Unite EA3430: Tumoral Progression and Micro-environment, Translational and Epidemiological Approaches, Strasbourg University, Strasbourg, France
| | | | - Noëlle Weingertner
- Department of Pathology, Strasbourg University Hospital, Strasbourg, France
| | - Anne Olland
- Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Nicola Santelmo
- Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Gilbert Massard
- Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France
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Leuzzi G, Lococo F, Bria E, Facciolo F. eComment. Does resected lymph-node number influence survival in non-small cell lung cancer? Interact Cardiovasc Thorac Surg 2015; 20:227-8. [PMID: 25605823 DOI: 10.1093/icvts/ivu439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Giovanni Leuzzi
- Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute - IFO, Rome, Italy
| | - Filippo Lococo
- Unit of Thoracic Surgery, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Emilio Bria
- Division of Medical Oncology, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), University of Verona, Verona, Italy
| | - Francesco Facciolo
- Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute - IFO, Rome, Italy
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