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Kanzaki R, Fukuda H, Kobayashi M, Horiguchi J, Kawagishi S, Maniwa T, Fujii M, Okami J. Pathological Pleural Invasion is a Risk Factor for Late Recurrence in Long-Term Survivors of Non-small Cell Lung Cancer after Complete Resection. Ann Surg Oncol 2024; 31:5038-5046. [PMID: 38647914 DOI: 10.1245/s10434-024-15279-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/25/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Information regarding late recurrence after pulmonary resection for non-small cell lung cancer (NSCLC) is limited. This study aimed to analyze the risk factors for late recurrence after surgery for NSCLC in the current era. PATIENTS AND METHODS We conducted a retrospective study of patients who underwent complete resection for pathological I-III NSCLC between 2006 and 2015. Late recurrence was defined as a recurrence that met the following conditions: (1) the patient underwent chest computed tomography (CT) at or after 54 months after surgery and recurrence was not detected at that time, and (2) recurrence that occurred more than 5 years after surgery. The factors influencing late recurrence, relapse-free survival (RFS), and overall survival (OS) after surgery were analyzed. RESULTS A total of 1275 with 5-year relapse-free survival after surgery were enrolled in this study. The mean age of the patients was 66.4 years and 54% of the patients were men. The median interval between surgery and the latest follow-up examination was 98 months. In total, 35 patients (2.7%) experienced late recurrence and 138 patients have died thus far. The cumulative recurrence, RFS, and OS rates at 10 years were 3.9%, 84.9%, and 86.3%, respectively. A multivariate analysis revealed that pleural invasion was an independent risk factor for late recurrence. Pleural invasion was a poor prognostic factor for both RFS and OS. CONCLUSIONS Pleural invasion was a predictor of late recurrence. Age > 67 years, preoperative serum carcinoembryonic antigen (CEA) > 5 ng/ml, non-adenocarcinoma, and pleural invasion were poor prognostic factors for RFS.
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Affiliation(s)
- Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan.
| | - Hiroyuki Fukuda
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Masao Kobayashi
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Julian Horiguchi
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Sachi Kawagishi
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Tomohiro Maniwa
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Makoto Fujii
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Jiro Okami
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
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2
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Fick CN, Dunne EG, Toumbacaris N, Tan KS, Mastrogiacomo B, Park BJ, Adusumilli PS, Molena D, Gray KD, Sihag S, Huang J, Bott MJ, Rocco G, Isbell JM, Jones DR. Late recurrence of completely resected stage I to IIIA lung adenocarcinoma. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00548-8. [PMID: 38950771 DOI: 10.1016/j.jtcvs.2024.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/10/2024] [Accepted: 06/24/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVE Research into the risk factors associated with late recurrence (>2 years after surgery) of lung adenocarcinoma is limited. We investigated the incidence of and clinicopathologic and genomic features associated with late recurrence of resected stage I-IIIA lung adenocarcinoma. METHODS We performed a retrospective analysis of patients with completely resected pathologic stage I-IIIA lung adenocarcinoma (2010-2019). Patients with a history of lung cancer, neoadjuvant therapy, or mucinous or noninvasive lung adenocarcinoma, or with follow-up of less than 2 years were excluded. Cox and logistic regression modeling were used to compare clinicopathologic variables among patients with no, early (≤2 years), and late recurrence. Comparisons of genomic mutations were corrected for multiple testing. RESULTS Of the 2349 patients included, 537 developed a recurrence during follow-up. Most recurrences (55% [297/537]) occurred early; 45% (240/537) occurred late. A larger proportion of late recurrences than early recurrences were locoregional (37% vs 29%; P = .047). Patients with late recurrence had more aggressive pathologic features (International Association for the Study of Lung Cancer grade 2 and 3, lymphovascular invasion, visceral pleural invasion) and higher stage than patients without recurrence. Pathologic features were similar between patients with early and late recurrence, except stage IIIA disease was more common in the early cohort. No genomic mutations were associated with late recurrence. CONCLUSIONS Late recurrence of lung adenocarcinoma after resection is more common than previously reported. Patients without disease more than 2 years after surgery who had aggressive pathologic features at the time of resection have an elevated risk of recurrence and may benefit from more aggressive follow-up.
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Affiliation(s)
- Cameron N Fick
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elizabeth G Dunne
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Kay See Tan
- Department of Epidemiology and Biostatistics, MSK, New York, NY
| | | | - Bernard J Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Druckenmiller Center for Lung Cancer Research, MSK, New York, NY
| | - Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Druckenmiller Center for Lung Cancer Research, MSK, New York, NY
| | - Daniela Molena
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Druckenmiller Center for Lung Cancer Research, MSK, New York, NY
| | - Katherine D Gray
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Druckenmiller Center for Lung Cancer Research, MSK, New York, NY
| | - Smita Sihag
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Druckenmiller Center for Lung Cancer Research, MSK, New York, NY
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Druckenmiller Center for Lung Cancer Research, MSK, New York, NY
| | - Matthew J Bott
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Druckenmiller Center for Lung Cancer Research, MSK, New York, NY
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Druckenmiller Center for Lung Cancer Research, MSK, New York, NY
| | - James M Isbell
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Druckenmiller Center for Lung Cancer Research, MSK, New York, NY
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Druckenmiller Center for Lung Cancer Research, MSK, New York, NY.
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3
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Mizuno T, Katsumata S, Konno H, Nagata T, Isaka M, Ohde Y. Long term outcomes beyond 5 years after pulmonary resection for non-small-cell lung cancer. Gen Thorac Cardiovasc Surg 2024; 72:401-407. [PMID: 38066298 DOI: 10.1007/s11748-023-01993-w] [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: 06/28/2023] [Accepted: 11/09/2023] [Indexed: 05/26/2024]
Abstract
OBJECTIVES We investigated the incidence of late recurrence beyond 5 years after pulmonary resection and aimed to identify candidates for long-term surveillance. METHODS We retrospectively reviewed the medical records of 978 non-small-cell lung cancer patients who underwent pulmonary resection between 2002 and 2015 and survived without recurrence for 5 years. Clinicopathological factors associated with recurrence-free survival beyond 5 years after surgery were investigated using univariate and multivariate analyses. The development of late metachronous malignancies was also investigated. RESULTS The median follow-up period from 5 years post-surgery was 27 months in the whole cohort. Late recurrence occurred in 37 (3.8%) patients. Late metachronous malignancies were diagnosed in 116 patients (11.9%), including 57 (5.8%) with lung cancer. One-, three-, and five-year recurrence-free survival rates beyond 5 years after surgery were 97.6%, 94.7%, and 94.7%, respectively. The recurrence-free survival of patients with pN1-2 was significantly poorer than that of patients with pN0 disease. Multivariate analysis revealed that adenocarcinoma and pN1-2 status were significantly associated with poor recurrence-free survival beyond 5 years post-surgery (P = 0.009 and 0.007, respectively). CONCLUSIONS Non-adenocarcinoma histology and pN0 status were significant favorable factors for recurrence-free survival beyond 5 years post-surgery. The efficacies of long-term surveillance for the detection of late recurrence were considered limited for these populations. Twelve percent of the patients experienced late metachronous malignancies after pulmonary resection.
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Affiliation(s)
- Tetsuya Mizuno
- Division of Thoracic Surgery, Shizuoka Cancer Center, Shimonagakubo 1007, Nagaizumi-cho, Shunto-gun, Shizuoka, 411-8777, Japan.
| | - Shinya Katsumata
- Division of Thoracic Surgery, Shizuoka Cancer Center, Shimonagakubo 1007, Nagaizumi-cho, Shunto-gun, Shizuoka, 411-8777, Japan
| | - Hayato Konno
- Division of Thoracic Surgery, Shizuoka Cancer Center, Shimonagakubo 1007, Nagaizumi-cho, Shunto-gun, Shizuoka, 411-8777, Japan
| | - Toshiyuki Nagata
- Division of Thoracic Surgery, Shizuoka Cancer Center, Shimonagakubo 1007, Nagaizumi-cho, Shunto-gun, Shizuoka, 411-8777, Japan
| | - Mitsuhiro Isaka
- Division of Thoracic Surgery, Shizuoka Cancer Center, Shimonagakubo 1007, Nagaizumi-cho, Shunto-gun, Shizuoka, 411-8777, Japan
| | - Yasuhisa Ohde
- Division of Thoracic Surgery, Shizuoka Cancer Center, Shimonagakubo 1007, Nagaizumi-cho, Shunto-gun, Shizuoka, 411-8777, Japan
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Suzuki T, Deguchi S, Matsushima K, Katsumata S, Kojima H, Koki M, Konno H, Isaka M, Oishi T, Ohde Y, Sugino T, Mitsuya K, Hayashi N. Brain Metastasis of Non-small Cell Lung Cancer After Disease-Free Survival of 5 years: Case Series and Comprehensive Literature Review. World Neurosurg 2024; 186:e353-e359. [PMID: 38570091 DOI: 10.1016/j.wneu.2024.03.139] [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: 02/22/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND In the treatment of nonsmall cell lung cancer (NSCLC), a disease-free survival of 5 years is a criterion for cure. This study aimed to evaluate the characteristics and outcomes of patients with brain metastases of NSCLC after a disease-free survival of 5 years (late recurrent brain metastasis [LRBM]). METHODS We reviewed 1281 consecutive patients with brain metastasis of lung cancer at a single institute between November 2014 and December 2022. Relevant articles were retrieved from PubMed. Only peer-reviewed journals published in English were included. RESULTS Six patients (0.47%) showed LRBM. Three were male. The median age at lung cancer diagnosis was 45 years. The histological diagnosis of all patients was adenocarcinoma. Driver gene mutations were observed in five patients. The median latency period from lung cancer treatment to the development of brain metastasis was 13 years. All patients had no metastasis to any other organs and underwent craniotomies. The median follow-up duration after craniotomy was 3.5 years. No local intracranial recurrences were observed. Three patients had distant intracranial recurrences at 7, 2, and 0.6 years after craniotomy. Five patients survived for 8, 4, 3, 2, and 0.3 years after craniotomy. One patient experienced re-recurrence in the lung 4 years after craniotomy and died 3.7 years later. In our systematic review, only six studies described LRBM of NSCLC. CONCLUSIONS LRBM is rare in patients with NSCLC. In our institution, many of these patients harbored driver gene mutations, and achieved long-term survival with aggressive local therapy. Multicenter analysis is mandatory.
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Affiliation(s)
- Takahiro Suzuki
- Division of Neurosurgery, Shizuoka Cancer Center, Shizuoka, Japan; Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shoichi Deguchi
- Division of Neurosurgery, Shizuoka Cancer Center, Shizuoka, Japan.
| | - Keigo Matsushima
- Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Shinya Katsumata
- Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hideaki Kojima
- Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Maeda Koki
- Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hayato Konno
- Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Mitsuhiro Isaka
- Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takuma Oishi
- Division of Diagnostic Pathology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yasuhisa Ohde
- Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takashi Sugino
- Division of Diagnostic Pathology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Koichi Mitsuya
- Division of Neurosurgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Nakamasa Hayashi
- Division of Neurosurgery, Shizuoka Cancer Center, Shizuoka, Japan
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Niimi T, Samejima J, Wakabayashi M, Miyoshi T, Tane K, Aokage K, Taki T, Nakai T, Ishii G, Kikuchi A, Yoshioka E, Yokose T, Ito H, Tsuboi M. Ten-year follow-up outcomes of limited resection trial for radiologically less-invasive lung cancer. Jpn J Clin Oncol 2024; 54:479-488. [PMID: 38183216 DOI: 10.1093/jjco/hyad187] [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: 08/04/2023] [Accepted: 12/13/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND The JCOG0804/WJOG4507L single-arm confirmatory trial indicated a satisfactory 10-year prognosis for patients who underwent limited resection for radiologically less-invasive lung cancer. However, only one prospective trial has reported a 10-year prognosis. METHODS We conducted a multicenter prospective study coordinated by the National Cancer Center Hospital East and Kanagawa Cancer Center. We analyzed the long-term prognosis of 100 patients who underwent limited resection of a radiologically less-invasive lung cancer in the peripheral lung field. We defined radiologically less-invasive lung cancer as lung adenocarcinoma with a maximum tumor diameter of ≤2 cm, tumor disappearance ratio of ≥0.5 and cN0. The primary endpoint was the 10-year local recurrence-free survival. RESULTS Our patients, with a median age of 62 years, included 39 males. A total of 58 patients were non-smokers; 87 had undergone wide wedge resection and 9 underwent segmentectomy. A total of four cases were converted to lobectomy because of the presence of poorly differentiated components in the frozen specimen or insufficient margin with segmentectomy. The median follow-up duration was 120.9 months. The 10-year recurrence-free survival and overall survival rates of patients with lung cancer were both 96.0%. Following the 10-year long-term follow-up, two patients experienced recurrences at resection ends after wedge resection. CONCLUSIONS Limited resection imparted a satisfactory prognosis for patients with radiologically less-invasive lung cancer, except two cases of local recurrence >5 years after surgery. These findings suggest that patients with this condition who underwent limited resection may require continued follow-up >5 years after surgery.
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Affiliation(s)
- Takahiro Niimi
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba
| | - Joji Samejima
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba
| | - Masashi Wakabayashi
- Biostatistics Division, Center for Research Administration and Support, National Cancer Center Hospital East, Kashiwa
| | - Tomohiro Miyoshi
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba
| | - Kenta Tane
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba
| | - Keiju Aokage
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba
| | - Tetsuro Taki
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba
| | - Tokiko Nakai
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba
| | - Genichiro Ishii
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba
- Division of Innovative Pathology and Laboratory Medicine, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiba, Chiba
| | - Akitomo Kikuchi
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Kanagawa
| | - Emi Yoshioka
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Kanagawa
| | - Tomoyuki Yokose
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Kanagawa
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Masahiro Tsuboi
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba
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Mammadova J, Tanvetyanon T. Association Between ALK Rearrangement and Ultra-Late Recurrence in Lung Cancer: Case Report and Pooled Analysis. Cureus 2023; 15:e51354. [PMID: 38292996 PMCID: PMC10824627 DOI: 10.7759/cureus.51354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 02/01/2024] Open
Abstract
Ultra-late recurrence, defined as recurrence occurring 10 years or longer after curative treatment, is uncommon for non-small cell lung cancer (NSCLC). To date, factors associated with ultra-late recurrence remain unknown. We report a case with ultra-late recurrence and reviewed the literature published during 2010-2023. This is a case of a 66-year-old woman, with a significant smoking history and a previous history of lung adenocarcinoma, who underwent surgery for a brain metastasis detected on imaging. The pathology confirmed lung adenocarcinoma with an epidermal growth factor receptor (EGFR) exon 20 insertion, a finding consistent with the initial lung surgery a decade ago. With receiving intrathecal topotecan, the patient has maintained stable disease 10 months post-surgery. Given the rarity of ultra-late recurrence of NSCLC, we also conducted a pooled analysis with the outcome of interest being a time to recurrence. Data from this case report was analyzed along with previously published 26 cases of ultra-late recurrence. Multivariable analysis indicated that the only factor significantly predicting time to recurrence was anaplastic lymphoma kinase (ALK) rearrangement.
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Affiliation(s)
- Jamila Mammadova
- Department of Hematology and Oncology, University of South Florida, Tampa, USA
| | - Tawee Tanvetyanon
- Department of Thoracic Oncology, Moffitt Cancer Center and Research Institute, Tampa, USA
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7
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Jia Y, Ji Q, Zhang L, She Y, Su M, Shi Z. Prognosis of early-stage lung adenocarcinoma in young patients. Clin Exp Pharmacol Physiol 2023; 50:826-832. [PMID: 37414099 DOI: 10.1111/1440-1681.13806] [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: 03/20/2023] [Revised: 06/08/2023] [Accepted: 06/11/2023] [Indexed: 07/08/2023]
Abstract
Lung adenocarcinoma (LUAD) is a familiar lung cancer with a poor prognosis. This study was meant to determine whether there are differences in survival between younger and older patients with early-stage LUAD because of the rise in the incidence of LUAD in young individuals over the previous few decades. We analysed the clinical, therapeutic and prognostic features of a cohort (2012-2013) of 831 consecutive patients with stage I/II LUAD who underwent curative surgical resection at Shanghai Pulmonary Hospital. Propensity score matching (PSM) was performed for age, sex, tumour size, tumour stage and therapy in a 2:1 ratio between the two groups without taking gender, illness stage at operation or decisive treatment into account. Following PSM analysis to create a 2:1 match for comparison, the final survival study included 163 patients with early-stage LUAD <50 years and 326 patients ≥50 years. Surprisingly, younger patients were overwhelmingly female (65.6%) and never smokers (85.9%). There were no statistical differences between the two groups in terms of the overall survival rate (P = 0.067) or time to advancement (P = 0.76). In conclusion, no significant differences stood out between older and younger patients with stage I/II LUAD regarding overall and disease-free survival rates. Younger patients with early-stage LUAD were more likely to be female and never smokers, which suggests that risk factors other than active smoking may be responsible for lung carcinogenesis in these patients.
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Affiliation(s)
- Yaping Jia
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qiuliang Ji
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lei Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Minghang Su
- Department of Thoracic Surgery, People's Hospital of Zunyi City Bozhou District, Zunyi, China
| | - Zhe Shi
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
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Jovanoski N, Bowes K, Brown A, Belleli R, Di Maio D, Chadda S, Abogunrin S. Survival and quality-of-life outcomes in early-stage NSCLC patients: a literature review of real-world evidence. Lung Cancer Manag 2023; 12:LMT60. [PMID: 37693293 PMCID: PMC10485735 DOI: 10.2217/lmt-2023-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/22/2023] [Indexed: 09/12/2023] Open
Abstract
Aim Assess the long-term survival and quality-of-life outcomes in early-stage NSCLC (eNSCLC) patients. Methods Review of long-term survival and quality-of-life after curative treatment in eNSCLC patients in observational studies. Results Disease-free proportion decreased in stage III vs stage I patients. Recurrence-free proportion decreased with age and disease stage. Advanced stage and vascular invasion increased risk of late recurrence. Conditional 5-year relative survival rates did not exceed 87%, indicating higher mortality in eNSCLC survivors. Lower conditional survival rates and relative survival rates were associated with older age and advanced disease. Survivors of eNSCLC had poorer physical quality-of-life. Conclusion Despite curative-intent therapy, survivors of eNSCLC still face significant risks of recurrence, excess mortality, and diminished quality-of-life.
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Affiliation(s)
- Nick Jovanoski
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Building 002/OG18, CH-4070, Basel, Switzerland
| | - Kathleen Bowes
- Genesis Research, West One, Forth Banks, Newcastle, NE1 3PA, UK
| | - Audrey Brown
- Genesis Research, West One, Forth Banks, Newcastle, NE1 3PA, UK
| | - Rossella Belleli
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Building 002/OG18, CH-4070, Basel, Switzerland
| | - Danilo Di Maio
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Building 002/OG18, CH-4070, Basel, Switzerland
| | - Shkun Chadda
- Genesis Research, West One, Forth Banks, Newcastle, NE1 3PA, UK
| | - Seye Abogunrin
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Building 002/OG18, CH-4070, Basel, Switzerland
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9
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Zhang L, Liu J, Yang D, Ni Z, Lu X, Liu Y, Liu Z, Wang H, Feng M, Zhang Y. A Nomogram Based on Consolidation Tumor Ratio Combined with Solid or Micropapillary Patterns for Postoperative Recurrence in Pathological Stage IA Lung Adenocarcinoma. Diagnostics (Basel) 2023; 13:2376. [PMID: 37510119 PMCID: PMC10378621 DOI: 10.3390/diagnostics13142376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Patients with pathological stage IA lung adenocarcinoma (LUAD) are at risk of relapse. The value of the TNM staging system is limited in predicting recurrence. Our study aimed to develop a precise recurrence prediction model for stage IA LUAD. MATERIALS AND METHODS Patients with pathological stage IA LUAD who received surgical treatment at Zhongshan Hospital Fudan University were retrospectively analyzed. Multivariate Cox proportional hazards regression models were used to create nomograms for recurrence-free survival (RFS). The predictive performance of the model was assessed using calibration plots and the concordance index (C-index). RESULTS The multivariate Cox regression analysis revealed that CTR (0.75 < CTR ≤ 1; HR = 9.882, 95% CI: 2.036-47.959, p = 0.004) and solid/micropapillary-predominance (SMPP; >5% and the most dominant) (HR = 4.743, 95% CI: 1.506-14.933, p = 0.008) were independent prognostic factors of RFS. These risk factors were used to construct a nomogram to predict postoperative recurrence in these patients. The C-index of the nomogram for predicting RFS was higher than that of the eighth T-stage system (0.873 for the nomogram and 0.643 for the eighth T stage). The nomogram also achieved good predictive performance for RFS with a well-fitted calibration curve. CONCLUSIONS We developed and validated a nomogram based on CTR and SMP patterns for predicting postoperative recurrence in pathological stage IA LUAD. This model is simple to operate and has better predictive performance than the eighth T stage system, making it suitable for selecting further adjuvant treatment and follow-up.
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Affiliation(s)
- Longfu Zhang
- Department of Pulmonary and Critical Care Medicine, Shanghai Xuhui Central Hospital, Shanghai 200031, China
| | - Jie Liu
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Dawei Yang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital (Xiamen), Fudan University, Xiamen 361015, China
| | - Zheng Ni
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xinyuan Lu
- Key Laboratory of Public Health Safety, School of Public Health, Ministry of Education, Fudan University, Shanghai 200032, China
| | - Yalan Liu
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zilong Liu
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hao Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Mingxiang Feng
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yong Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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10
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Kawaguchi T, Yoshikawa D, Nakai T, Ohbayashi C, Sawabata N. Outcome of Resected Lung Cancers with Subcentimeter Solid Component on Computed Tomography. Thorac Cardiovasc Surg 2022; 71:214-221. [PMID: 36323327 DOI: 10.1055/s-0042-1758072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background Although the opportunity to treat subcentimeter lung cancers has increased, the optimal surgical methods remain unclear. We performed a retrospective study to examine the clinical outcome of subcentimeter lung cancers.
Patients and Methods In total, 118 patients who underwent curative resection for subcentimeter lung cancer from January 2005 to December 2013 were analyzed. Multivariate Cox proportional hazards models were used to calculate the hazard ratio to identify independent predictors of recurrence-free survival (RFS) and overall survival (OS).
Results Anatomical resections were performed for 64 patients (59 lobectomies and 5 segmentectomies) and wedge resections for 54 patients. Recurrence developed in six patients who had consolidation-predominant tumors (consolidation/tumor [C/T] ratio of >0.5) and underwent wedge resections. The first recurrence patterns were regional recurrences in three patients, both regional and distant in one, and distant in two. Seventeen patients died of other causes. The multivariate analysis revealed that the C/T ratio was the independent predictor of RFS (p = 0.008) and OS (p = 0.011).
Conclusion Patients with subcentimeter lung cancer rarely developed recurrence. The C/T ratio was the independent prognostic factor, and all relapsed patients received wedge resections. Even for subcentimeter lung cancers, we should select the extent of pulmonary resection after thoroughly considering whether wedge resection (less invasiveness) is a reasonable alternative to anatomical resection (superior oncologic efficacy) considering the C/T ratio of the lesion.
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Affiliation(s)
- Takeshi Kawaguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Nara, Japan
| | - Daiki Yoshikawa
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Nara, Japan
| | - Tokiko Nakai
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Chiho Ohbayashi
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Noriyoshi Sawabata
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Nara, Japan
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11
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Kuligina ES, Iyevleva AG, Imyanitov EN. Integration of the blood test into the low-dose computed tomography lung cancer screening: reliable discrimination between malignant and non-malignant radiographic findings. Transl Lung Cancer Res 2021; 10:4035-4038. [PMID: 34858791 PMCID: PMC8577980 DOI: 10.21037/tlcr-21-680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/24/2021] [Indexed: 12/09/2022]
Affiliation(s)
- Ekaterina S Kuligina
- N.N. Petrov Institute of Oncology, St.-Petersburg, Russia.,St.-Petersburg Pediatric Medical University, St.-Petersburg, Russia
| | - Aglaya G Iyevleva
- N.N. Petrov Institute of Oncology, St.-Petersburg, Russia.,St.-Petersburg Pediatric Medical University, St.-Petersburg, Russia
| | - Evgeny N Imyanitov
- N.N. Petrov Institute of Oncology, St.-Petersburg, Russia.,St.-Petersburg Pediatric Medical University, St.-Petersburg, Russia.,I.I. Mechnikov North-Western Medical University, St.-Petersburg, Russia
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12
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Seo YS, Park WY, Kim SW, Kim D, Min BJ, Kim WD. Virtual randomized study comparing lobectomy and particle beam therapy for clinical stage IA non-small cell lung cancer in operable patients. JOURNAL OF RADIATION RESEARCH 2021; 62:884-893. [PMID: 34218277 PMCID: PMC8438263 DOI: 10.1093/jrr/rrab060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/30/2021] [Indexed: 06/13/2023]
Abstract
To the best of our knowledge there have been no randomized controlled trials comparing lobectomy-a standard treatment for patients with early-stage non-small cell lung cancer (NSCLC)-and particle beam therapy (PBT), the best performing existing radiotherapy. We conducted a virtual randomized trial in medically operable patients with stage IA NSCLC to compare lobectomy and PBT effectiveness. A Markov model was developed to predict life expectancy after lobectomy and PBT in a cohort of patients with stage IA NSCLC. Ten thousand virtual patients were randomly assigned to each group. Sensitivity analyses were performed as model variables and scenarios changed to determine which treatment strategy was best for improving life expectancy. All estimated model parameters were determined using variables extracted from a systematic literature review of previously published articles. The preferred strategy differed depending on patient age. In young patients, lobectomy showed better life expectancy than that of PBT. The difference in life expectancy between lobectomy and PBT was statistically insignificant in older patients. Our model predicted lobectomy as the preferred strategy when operative mortality was under 5%. However, the preferred strategy changed to PBT if operative mortality post lobectomy was over 5%. For medically operable patients with stage IA NSCLC, our Markov model revealed the preferred strategy of lobectomy or PBT regarding operative mortality changed with varying age and comorbidity. Until randomized controlled trial results become available, we hope the current results will provide a rationale background for clinicians to decide treatment modalities for patients with stage IA NSCLC.
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Affiliation(s)
- Young-Seok Seo
- Department of Radiation Oncology, Chungbuk National University Hospital, Cheongju 28644, Korea
| | - Woo-Yoon Park
- Department of Radiation Oncology, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju 28644, Korea
| | - Si-Wook Kim
- Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju 28644, Korea
| | - Dohun Kim
- Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju 28644, Korea
| | - Byung Jun Min
- Corresponding authors: Byung Jun Min, PhD, Department of Radiation Oncology, Chungbuk National University Hospital, Cheongju 28644, Korea. Phone: +82-43-269-6213, Fax: +82-43-269-6208, E-mail: ; Won-Dong Kim, MD, PhD, Department of Radiation Oncology, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju 28644, Korea. Phone: +82-43-269-6212, Fax: +82-43-269-6208, E-mail:
| | - Won-Dong Kim
- Corresponding authors: Byung Jun Min, PhD, Department of Radiation Oncology, Chungbuk National University Hospital, Cheongju 28644, Korea. Phone: +82-43-269-6213, Fax: +82-43-269-6208, E-mail: ; Won-Dong Kim, MD, PhD, Department of Radiation Oncology, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju 28644, Korea. Phone: +82-43-269-6212, Fax: +82-43-269-6208, E-mail:
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13
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Aokage K, Miyoshi T, Wakabayashi M, Ikeno T, Suzuki J, Tane K, Samejima J, Tsuboi M. Prognostic influence of epidermal growth factor receptor mutation and radiological ground glass appearance in patients with early-stage lung adenocarcinoma. Lung Cancer 2021; 160:8-16. [PMID: 34365179 DOI: 10.1016/j.lungcan.2021.07.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/30/2021] [Accepted: 07/29/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The ADAURA demonstrated the efficacy of osimertinib as adjuvant therapy in patients with resected stage IB-IIIA adenocarcinoma harboring epidermal growth factor receptor (EGFR) mutations. However, it is controversial whether adjuvant therapy should be applied to all these patients because of their heterogeneities. This study aimed to examine the influence of GGO and EGFR mutations on the prognosis and to identify optimal targets for the development of perioperative therapy. MATERIAL AND METHODS Among the patients who underwent complete resection between 2003 and 2014 and had pathological stage IA3-IIA adenocarcinoma, 505 consecutive patients were examined for EGFR mutation status. The prognosis was analyzed among the clinicopathological factors including EGFR status and presence or absence of GGO. RESULTS Of the 489 patients, 193 (39.5%) showed EGFR mutations. The recurrence-free survival (RFS) and overall survival (OS) of the EGFR mutant were slightly better than those of the EGFR wild type. There was no difference in RFS and OS between EGFR mutant and wild type in patients with GGO; however, EGFR mutant showed better OS than EGFR wild type in patients without GGO. The presence of GGO was a strong independent prognostic predictor in OS and RFS, but EGFR mutations was not predictors. In patients without GGO, EGFR mutants showed slightly higher recurrence, especially with a hazard ratio of 1.427 in stage IB. CONCLUSIONS Adenocarcinoma with GGO show a very good prognosis, so may not require adjuvant therapy. It will be necessary to further develop perioperative therapy in patients with poor prognosis.
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Affiliation(s)
- Keiju Aokage
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
| | - Tomohiro Miyoshi
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Masashi Wakabayashi
- Biostatistics Division, Center for Research Administration and Support, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takashi Ikeno
- Clinical Research Support Office, National Cancer Center Hospital East, Kashiwa, Japan
| | - Jun Suzuki
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kenta Tane
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Joji Samejima
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Masahiro Tsuboi
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
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14
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Pathological features and prognostic implications of ground-glass opacity components on computed tomography for clinical stage I lung adenocarcinoma. Surg Today 2021; 51:1188-1202. [PMID: 33745094 DOI: 10.1007/s00595-021-02235-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/22/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE To investigate the prognostic implications and pathological features of clinical stage I lung adenocarcinoma with ground-glass opacity (GGO) on computed tomography (CT). METHODS The subjects of this retrospective study were 1228 patients with lung adenocarcinoma classified as clinical stage I, who underwent complete resection by lobectomy. The patients were divided into four groups based on the presence and proportion of GGO according to the consolidation-to-tumor ratio (CTR); A, CTR ≤ 0.5; B, 0.5 < CTR ≤ 0.75; C, 0.75 < CTR ≤ 1.0 with GGO; D, without GGO (pure-solid). We compared overall survival, pathological findings (N/ly/v/STAS), and histological subtypes within each clinical stage among the four groups. RESULTS We found no significant differences among tumors with GGO (groups A, B and C) for prognosis or pathological findings in all the clinical stages. The prognoses of groups A, B and C were significantly better than that of group D for patients with clinical stages IA2-IB disease. Tumors without GGO on CT had a significantly larger number of positive N, ly, v and STAS in almost all stages than tumors with GGO on CT. Tumors without GGO on CT had significantly more solid predominant and less lepidic predominant adenocarcinoma. CONCLUSION Not the proportion of GGO, but its presence on CT, as well as the size of the solid component, were correlated significantly with pathological characteristics and survival.
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15
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Abstract
Metastatic dissemination occurs very early in the malignant progression of a cancer but the clinical manifestation of metastases often takes years. In recent decades, 5-year survival of patients with many solid cancers has increased due to earlier detection, local disease control and adjuvant therapies. As a consequence, we are confronted with an increase in late relapses as more antiproliferative cancer therapies prolong disease courses, raising questions about how cancer cells survive, evolve or stop growing and finally expand during periods of clinical latency. I argue here that the understanding of early metastasis formation, particularly of the currently invisible phase of metastatic colonization, will be essential for the next stage in adjuvant therapy development that reliably prevents metachronous metastasis.
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Affiliation(s)
- Christoph A Klein
- Experimental Medicine and Therapy Research, University of Regensburg, Regensburg, Germany.
- Division of Personalized Tumor Therapy, Fraunhofer Institute for Toxicology and Experimental Medicine, Regensburg, Germany.
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16
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Merritt RE, Abdel-Rasoul M, Fitzgerald M, D'Souza DM, Kneuertz PJ. Nomograms for Predicting Overall and Recurrence-free Survival From Pathologic Stage IA and IB Lung Cancer After Lobectomy. Clin Lung Cancer 2020; 22:e574-e583. [PMID: 33234491 DOI: 10.1016/j.cllc.2020.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/21/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Stage I non-small-cell lung cancer (NSCLC) is potentially curable with surgical resection. Significant proportions of patients may still experience recurrence and death despite undergoing curative surgery. This study describes predictive nomograms for recurrence-free (RFS) and overall survival (OS) after lobectomy. PATIENTS AND METHODS A total of 301 patients with the American Joint Committee on Cancer pathologic stage IA and IB NSCLC who underwent open, thoracoscopic, or robotic lobectomy from January 2011 to April 2017 were analyzed. Multivariate Cox proportional hazards regression models were used to create nomograms for OS and RFS. Kaplan-Meier survival curves were calculated for OS and RFS comparing high-risk and low-risk cohorts based on nomogram scores. RESULTS Histology (hazard ratio [HR], 0.24; 95% confidence interval [CI], 0.10-0.56; P = .002), lymphovascular invasion (HR, 0.46; 95% CI, 0.29-0.74; P = .001), smoking status (HR, 3.46; 95% CI, 1.25-9.55: P = .02), and total lymph nodes removed (HR, 1.05; 95% CI, 1.01-1.10; P = .021) were significant predictors for OS in a multivariate model. Lymphovascular invasion (HR, 0.55; 95% CI, 0.36-0.83; P = .0040), smoking status (HR, 2.56; 95% CI, 1.16-5.62; P = .02), total lymph nodes removed (HR, 1.04; 95% CI, 1.00-1.08; P = .029), and tumor size (HR, 1.30; 95% CI, 1.30-1.68; P = .047) were significant predictors of RFS in a multivariate model. CONCLUSION Nomograms can predict OS and RFS for pathologic stage IA and IB NSCLC after lobectomy regardless of operative approach. The risk for death and recurrence after stratification by the nomogram scores may provide guidance regarding adjuvant therapy and surveillance.
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Affiliation(s)
- Robert E Merritt
- Thoracic Surgery Division, The Ohio State University Wexner Medical Center, Columbus, OH.
| | - Mahmoud Abdel-Rasoul
- Center for Biostatistics, Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH
| | - Morgan Fitzgerald
- Thoracic Surgery Division, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Desmond M D'Souza
- Thoracic Surgery Division, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Peter J Kneuertz
- Thoracic Surgery Division, The Ohio State University Wexner Medical Center, Columbus, OH
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17
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Ijsseldijk MA, Shoni M, Siegert C, Wiering B, van Engelenburg AKC, Tsai TC, Ten Broek RPG, Lebenthal A. Oncologic Outcomes of Surgery Versus SBRT for Non-Small-Cell Lung Carcinoma: A Systematic Review and Meta-analysis. Clin Lung Cancer 2020; 22:e235-e292. [PMID: 32912754 DOI: 10.1016/j.cllc.2020.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/21/2020] [Accepted: 04/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The optimal treatment of stage I non-small-cell lung carcinoma is subject to debate. The aim of this study was to compare overall survival and oncologic outcomes of lobar resection (LR), sublobar resection (SR), and stereotactic body radiotherapy (SBRT). METHODS A systematic review and meta-analysis of oncologic outcomes of propensity matched comparative and noncomparative cohort studies was performed. Outcomes of interest were overall survival and disease-free survival. The inverse variance method and the random-effects method for meta-analysis were utilized to assess the pooled estimates. RESULTS A total of 100 studies with patients treated for clinical stage I non-small-cell lung carcinoma were included. Long-term overall and disease-free survival after LR was superior over SBRT in all comparisons, and for most comparisons, SR was superior to SBRT. Noncomparative studies showed superior long-term overall and disease-free survival for both LR and SR over SBRT. Although the papers were heterogeneous and of low quality, results remained essentially the same throughout a large number of stratifications and sensitivity analyses. CONCLUSION Results of this systematic review and meta-analysis showed that LR has superior outcomes compared to SBRT for cI non-small-cell lung carcinoma. New trials are underway evaluating long-term results of SBRT in potentially operable patients.
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Affiliation(s)
- Michiel A Ijsseldijk
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Melina Shoni
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Charles Siegert
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA
| | - Bastiaan Wiering
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands
| | | | - Thomas C Tsai
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Richard P G Ten Broek
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Abraham Lebenthal
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA; Harvard Medical School, Boston, MA
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18
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Grinnell M, Appiah AK, Baine M, Ernani V, Marr A, Zhang C, Zhen W, Buddharaju LNR, Smith LM, Ganti AK. Adjuvant chemotherapy following SBRT for early stage non-small cell lung cancer (NSCLC) in older patients. J Geriatr Oncol 2020; 11:1145-1153. [PMID: 32389520 DOI: 10.1016/j.jgo.2020.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/12/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022]
Abstract
Adjuvant chemotherapy improves overall survival (OS) following stereotactic body radiotherapy (SBRT) in patients with early stage non-small cell lung cancer and tumors ≥four cm. Here, we aim to evaluate its role following SBRT in older patients. Patients >70 years diagnosed with clinical stages I-II NSCLC, (N0 disease), who received SBRT, were identified using the National Cancer Database (n = 7042). The Kaplan-Meier method was used to estimate OS, and the log-rank test was used to compare distributions by treatment strategy overall and within clinical stages I and II. There were 3533 female patients (50.2%), and 6074 (86.3%) had stage I disease. Among stage I patients, 643 (10.6%) received adjuvant chemotherapy, compared to 372 stage II patients (38.4%). Median OS was better with SBRT in patients with stage I disease (25.4 vs. 20.3 months; p < .001); while patients with stage II NSCLC had better OS with SBRT + chemotherapy (20.2 vs. 14.2 months; p < .001). On multivariate analysis, patients with stage I NSCLC who received SBRT alone had better overall survival (HR: 0.79; 95% CI, 0.73, 0.87). SBRT alone was associated with an increased risk of death in patients with stage II disease (HR: 1.34; 95% CI, 1.15, 1.55). Patients with tumors ≥4 cm had better OS with SBRT + chemotherapy (18.5 vs. 15.5 months; p = .003), while patients with tumors <4 cm did better with SBRT (median OS of 24.1 vs. 20.3 months; p < .001). In >70 years old patients with tumors ≥4 cm, adjuvant chemotherapy following SBRT was associated with improved OS.
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Affiliation(s)
- Madison Grinnell
- University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Adams Kusi Appiah
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Michael Baine
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Vinicius Ernani
- Division of Oncology-Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Alissa Marr
- Division of Oncology-Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Chi Zhang
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Weining Zhen
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Laxmi Narayana R Buddharaju
- Division of Oncology-Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Lynette M Smith
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Apar Kishor Ganti
- Division of Oncology-Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America; Division of Oncology-Hematology, Department of Internal Medicine, VA-Nebraska Western Iowa Health Care System, Omaha, NE, United States of America.
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Karacz CM, Yan J, Zhu H, Gerber DE. Timing, Sites, and Correlates of Lung Cancer Recurrence. Clin Lung Cancer 2019; 21:127-135.e3. [PMID: 31932216 DOI: 10.1016/j.cllc.2019.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/22/2019] [Accepted: 12/13/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Understanding temporal and anatomic patterns of lung cancer recurrence could guide disease management and monitoring. However, these data are not available in population-based datasets and are not routinely recorded in clinical trials. MATERIALS AND METHODS We identified cases of stage 1 to 3 lung cancer diagnosed January 1, 2000, to December 31, 2017, in the tumor registry of a National Cancer Institute-designated comprehensive cancer center. For cases with documented disease recurrence, we recorded anatomic site(s) and timing. We estimated time to recurrence using Kaplan-Meier methods. Associations between case characteristics and recurrence features were assessed using univariable and multivariable logistic regression models and Cox regression models. RESULTS A total of 1619 cases of stage 1 to 3 lung cancer from 1549 patients were included in the analysis. Of these, 466 (30%) patients developed recurrent lung cancer. The most common type of first recurrence was distant disease, most commonly central nervous system (CNS) (37%). In multivariable analyses, race (P = .02) and primary treatment modality (P < .001) correlated with recurrent disease, whereas tumor histology (P = .004) and primary treatment modality (P < .001) were associated specifically with distant recurrence. Patient age (P = .05) and initial TNM stage (P = .001) correlated with timing of recurrence. CONCLUSION In this single-center series of stage 1 to 3 lung cancer, recurrent disease was associated with race, histology, and treatment modality, and most commonly occurred in the CNS. Modulation of clinical and radiographic disease monitoring according to recurrence risk, timing, and site may offer a means to identify future lung cancer when it remains asymptomatic and highly treatable.
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Affiliation(s)
- Chelsea M Karacz
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Orthopedics, Texas Scottish Rite Hospital for Children, Dallas, TX
| | - Jingsheng Yan
- Department of Population and Sciences, University of Texas Southwestern Medical Center, Dallas, TX; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Hong Zhu
- Department of Population and Sciences, University of Texas Southwestern Medical Center, Dallas, TX; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - David E Gerber
- Department of Population and Sciences, University of Texas Southwestern Medical Center, Dallas, TX; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX; Department of Internal Medicine (Hematology-Oncology), University of Texas Southwestern Medical Center, Dallas, TX.
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20
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Abstract
Lung cancer staging is a foundation of patient care, informing management decisions and prognosis. This comprehensive overview of the current 8th edition American Joint Committee on Cancer Cancer Staging Manual addresses common difficulties in staging, such as measuring the invasive component of adenocarcinomas and staging multiple lung nodules.
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Affiliation(s)
- Leila Kutob
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Emory University Hospital, 1364 Clifton Road Northeast, Atlanta, GA 30322, USA
| | - Frank Schneider
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Emory University Hospital, 1364 Clifton Road Northeast, Atlanta, GA 30322, USA.
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21
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Seo YS, Kim HJ, Wu HG, Choi SM, Park S. Lobectomy versus stereotactic ablative radiotherapy for medically operable patients with stage IA non-small cell lung cancer: A virtual randomized phase III trial stratified by age. Thorac Cancer 2019; 10:1489-1499. [PMID: 31124275 PMCID: PMC6558457 DOI: 10.1111/1759-7714.13103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Although the choice between stereotactic ablative radiotherapy (SABR) and lobectomy for early-stage non-small cell lung cancer (NSCLC) has been debated for years, the two procedures have not yet been directly compared in a randomized trial. We conducted a virtual randomized phase III trial stratified by age to compare the effectiveness of lobectomy and SABR for medically operable patients with stage IA (AJCC eighth) NSCLC using the Markov model analysis. METHODS A Markov model was developed to simulate a cohort of patients aged 45-85 years with stage IA NSCLC who had undergone either lobectomy or SABR and were followed up for their remaining lifetime. Each virtual patient was randomly assigned to undergo lobectomy or SABR, and 10 000 patients were allocated to each group. All estimates of the variables were obtained by a systematic review of published articles. RESULTS The lobectomy group showed a better life expectancy than the SABR group, in patients under 75 years of age. However, no statistically significant difference was seen in patients 75 years or older. The predicted life expectancy was 9.43 and 8.70 years in 75-year-old patients in the lobectomy and SABR groups, respectively. However, the 95%CI for the difference in life expectancy between the two groups was - 0.06-1.50 years (P = 0.0689). CONCLUSIONS The Markov model showed no statistically significant difference in the expected overall survival in stage IA NSCLC patients who were older than 75 years and had undergone SABR or lobectomy.
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Affiliation(s)
- Young-Seok Seo
- Department of Radiation Oncology, ChungBuk National University Hospital, Chungcheongbuk-do, Republic of Korea.,Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiation Oncology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hong Gyun Wu
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiation Oncology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun Mi Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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22
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Does FDG PET/CT have a role in determining adjuvant chemotherapy in surgical margin-negative stage IA non-small cell lung cancer patients? J Cancer Res Clin Oncol 2019; 145:1021-1026. [DOI: 10.1007/s00432-019-02858-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/06/2019] [Indexed: 02/03/2023]
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23
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Dai L, Yan W, Kang X, Fu H, Yang Y, Zhou H, Liang Z, Xiong H, Lin Y, Chen K. [Exploration of Postoperative Follow-up Strategies for Early Staged NSCLC Patients on the Basis of Follow-up Result of 416 Stage I NSCLC Patients after Lobectomy]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:199-203. [PMID: 29587940 PMCID: PMC5973021 DOI: 10.3779/j.issn.1009-3419.2018.03.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
背景与目的 目前国际上对于早期非小细胞肺癌(non-small cell lung cancer, NSCLC)的随访策略(随访间隔时间和随访内容)并未达成共识,相关的临床证据也十分有限。本研究通过Ⅰ期NSCLC的随访结果,总结其复发转移的部位及时间,为制定该类患者的随访间隔时间和内容提供参考。 方法 回顾性分析我科肺癌前瞻性数据库中2000年1月-2013年10月单一医生组连续行解剖性肺叶切除手术的416例Ⅰ期NSCLC患者,根据复发转移部位及时间,探讨该类患者的长期随访间隔时间和内容。 结果 全组患者5年无疾病生存率(disease free survival, DFS)与总生存率(overall survival, OS)分别为82.4%和85.4%;随访期间出现复发转移者共76例(18.3%),复发转移部位中常见者依次为肺转移21例(5.0%)、脑转移20例(4.8%)、骨转移12例(2.9%)和纵隔淋巴结转移12例(2.9%)。影响复发转移的因素中,pT2a者复发转移率高于pT1者(P=0.006),5年DFS分别为73.8%和87.6%(P=0.002),5年OS分别为77.7%和90.3%(P=0.011)。 结论 Ⅰ期NSCLC解剖性肺叶切除术后复发转移以肺、脑、骨及纵隔淋巴结最常见,2年内与3年-5年复发转移风险相当,可以根据T分期调整2年内随访次数及随访内容。
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Affiliation(s)
- Liang Dai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the First Department of Thoracic Surgery,
Peking University Cancer Hospital and Institute, Peking University School of Oncology, Beijing 100142, China
| | - Wanpu Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the First Department of Thoracic Surgery,
Peking University Cancer Hospital and Institute, Peking University School of Oncology, Beijing 100142, China
| | - Xiaozheng Kang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the First Department of Thoracic Surgery,
Peking University Cancer Hospital and Institute, Peking University School of Oncology, Beijing 100142, China
| | - Hao Fu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the First Department of Thoracic Surgery,
Peking University Cancer Hospital and Institute, Peking University School of Oncology, Beijing 100142, China
| | - Yongbo Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the First Department of Thoracic Surgery,
Peking University Cancer Hospital and Institute, Peking University School of Oncology, Beijing 100142, China
| | - Haitao Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the First Department of Thoracic Surgery,
Peking University Cancer Hospital and Institute, Peking University School of Oncology, Beijing 100142, China
| | - Zhen Liang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the First Department of Thoracic Surgery,
Peking University Cancer Hospital and Institute, Peking University School of Oncology, Beijing 100142, China
| | - Hongchao Xiong
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the First Department of Thoracic Surgery,
Peking University Cancer Hospital and Institute, Peking University School of Oncology, Beijing 100142, China
| | - Yao Lin
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the First Department of Thoracic Surgery,
Peking University Cancer Hospital and Institute, Peking University School of Oncology, Beijing 100142, China
| | - Keneng Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the First Department of Thoracic Surgery,
Peking University Cancer Hospital and Institute, Peking University School of Oncology, Beijing 100142, China
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Clinical and Pathological Staging Validation in the Eighth Edition of the TNM Classification for Lung Cancer: Correlation between Solid Size on Thin-Section Computed Tomography and Invasive Size in Pathological Findings in the New T Classification. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.06.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Chen H, Sui X, Yang F, Liu J, Wang J. Nomograms for predicting recurrence and survival of invasive pathological stage IA non-small cell lung cancer treated by video assisted thoracoscopic surgery lobectomy. J Thorac Dis 2017; 9:1046-1053. [PMID: 28523159 DOI: 10.21037/jtd.2017.03.130] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND A considerable portion of pathological stage (p-stage) IA non-small cell lung cancer (NSCLC) patients suffered from death and recurrence after video assisted thoracoscopic surgery (VATS) lobectomy. The purpose of our study was to develop nomograms to predict which subgroup patients were more likely to suffer from recurrence or death. METHODS Data of invasive p-stage IA NSCLC patients who underwent VATS lobectomy at Peking University People's Hospital from September 2006 to April 2014 were analyzed. Multivariate Cox proportional hazards regression was used to develop nomograms. The performance of the nomograms was evaluated by Harrell's concordance index (C-index), calibration plots and risk group stratification. RESULTS A total of 422 patients with NSCLC of invasive p-stage IA were included in the study. The median follow-up time was 40 months. Age [hazards ratio (HR) =1.067, 95% confidential interval (CI): 1.006-1.131], lymphovascular invasion (LVI) (HR=4.062, 95% CI: 1.278-12.912) and differentiation (HR =5.747, 95% CI: 2.151-15.353) were independent prognostic factors to predict overall survival (OS). Tumor diameter (HR =3.299, 95% CI: 1.814-6.001), LVI (HR =3.260, 95% CI: 1.221-8.708) and differentiation (HR =3.607, 95% CI: 1.776-7.327) were independent predictors of recurrence free survival (RFS). The nomogram for predicting OS demonstrated stronger discriminatory power than the 7th and 8th T stage systems (C-index: 0.894 for the nomogram, 0.700 for the 7th T stage and 0.742 for the 8th T stage). Likewise, the C-index of the nomogram for predicting RFS was higher than that of the 7th and 8th T stage systems (0.838 for the nomogram, 0.670 for the 7th T stage and 0.723 for the 8th T stage). CONCLUSIONS We developed nomograms that could predict individual accurate prognosis for invasive p-stage IA NSCLC patients after VATS lobectomy. Risk stratification by the nomograms might guide further adjuvant chemotherapy and follow-up.
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Affiliation(s)
- Haiqing Chen
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing 100044, China
| | - Xizhao Sui
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing 100044, China
| | - Fan Yang
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing 100044, China
| | - Jun Liu
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing 100044, China
| | - Jun Wang
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing 100044, China
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Nakayama T, Takahashi Y, Uehara H, Matsutani N, Kawamura M. Outcome and risk factors of recurrence after thoracoscopic bullectomy in young adults with primary spontaneous pneumothorax. Surg Today 2016; 47:859-864. [PMID: 27909813 DOI: 10.1007/s00595-016-1452-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the risk factors of recurrence of pneumothorax following thoracoscopic bullectomy in young adults. METHODS Between January, 2005 and September, 2015, 167 patients aged ≤40 years underwent initial thoracoscopic bullectomy for primary spontaneous pneumothorax (PSP) at our hospital. Recurrence-free probability was calculated from the date of surgery to recurrence or last follow-up, using the Kaplan-Meier method. RESULTS Sixteen (9.6%) of the 167 patients suffered a recurrence (collective total, 16 recurrences). The recurrence-free intervals were 3-107 months (median 25.8 months), and the 5-year recurrence-free probability was 85.9%. Multivariate Cox analysis demonstrated that age ≤23 years (p = 0.029) and a history of ipsilateral pneumothorax before surgery (p = 0.029) were significantly associated with higher risk of recurrence. The 5-year recurrence-free probability was 72.3% for patients aged ≤23 years and a history of ipsilateral pneumothorax before surgery and 94.1% for those with neither of these factors (p = 0.001). Recurrence developed within 3 years after surgery in 14 of the 16 patients. CONCLUSIONS Patients ≤23 years of age with a history of ipsilateral pneumothorax before surgery are at significantly high risk of its recurrence, frequently within 3 years; thus, the risk of postoperative recurrence of a pneumothorax must be kept in mind.
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Affiliation(s)
- Takashi Nakayama
- Department of General Thoracic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan.
| | - Yusuke Takahashi
- Department of General Thoracic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan
| | - Hirofumi Uehara
- Department of General Thoracic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan
| | - Noriyuki Matsutani
- Department of General Thoracic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan
| | - Masafumi Kawamura
- Department of General Thoracic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan
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Prognostic value of the frequency of vascular invasion in stage I non-small cell lung cancer. Gen Thorac Cardiovasc Surg 2016; 65:32-39. [DOI: 10.1007/s11748-016-0720-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/05/2016] [Indexed: 12/31/2022]
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Shimizu K, Ohtaki Y, Nakazawa S, Mogi A, Kuwano H. Neither the maximum tumor size nor solid component size is prognostic in part-solid lung cancer: to be ground-glass opacity or not to be, is that really the question? J Thorac Dis 2016; 8:2334-2336. [PMID: 27746969 DOI: 10.21037/jtd.2016.08.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Kimihiro Shimizu
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Japan
| | - Yoichi Ohtaki
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Japan
| | - Seshiru Nakazawa
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Japan
| | - Akira Mogi
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Japan
| | - Hiroyuki Kuwano
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Japan
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JU LIXIA, HAN MINGQUAN. Isolated brain metastasis as a late recurrence of completely resected non-small cell lung cancer. Oncol Lett 2016; 12:731-733. [PMID: 27347208 PMCID: PMC4907295 DOI: 10.3892/ol.2016.4674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 02/19/2016] [Indexed: 11/06/2022] Open
Abstract
The brain is one of the most common sites for non-small cell lung cancer (NSCLC) metastasis; however, late isolated brain metastasis as a recurrence of NSCLC is rare. The present study describes a case of isolated solitary brain metastasis as a late recurrence of NSCLC, which occurred >2 years following the successful resection of the primary tumor, and was identified by magnetic resonance imaging. To the best of our knowledge, this is the first report of isolated brain metastasis as a postoperative recurrence of NSCLC. The aim of the present study was to highlight that, despite its rarity, such recurrence should be considered possible, and particular attention to the treatment of such patients should be paid.
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Affiliation(s)
- LIXIA JU
- Department of Integrative Medicine, Tongji University School of Medicine, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai 200092, P.R. China
| | - MINGQUAN HAN
- Department of Integrative Medicine, Tongji University School of Medicine, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai 200092, P.R. China
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30
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Matsumura Y, Yano M, Yoshida J, Koike T, Kameyama K, Shimamoto A, Nishio W, Yoshimoto K, Utsumi T, Shiina T, Watanabe A, Yamato Y, Watanabe T, Takahashi Y, Sonobe M, Kuroda H, Oda M, Inoue M, Tanahashi M, Adachi H, Saito M, Hayashi M, Otsuka H, Mizobuchi T, Moriya Y, Takahashi M, Nishikawa S, Suzuki H. Early and late recurrence after intentional limited resection for cT1aN0M0, non-small cell lung cancer: from a multi-institutional, retrospective analysis in Japan. Interact Cardiovasc Thorac Surg 2016; 23:444-9. [PMID: 27226401 DOI: 10.1093/icvts/ivw125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 03/08/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES In 2015, we reported the outcomes of patients undergoing intentional limited resection (ILR) for non-small-cell lung cancer (NSCLC) from a retrospective, multi-institutional large database in Japan. Here, we analyse the clinicopathological characteristics of the patients extracted from this database with late recurrence and compare them with those with early recurrence. METHODS Of 1538 patients in the database with cT1aN0M0 NSCLC, 92 (6%) had recurrence. In this study, early recurrence was defined as recurrence within 5 years and late recurrence as recurrence beyond 5 years after surgery. We compared the clinicopathological characteristics and post-recurrence survival (PRS) between patients with early and late recurrence. RESULTS Of the 92 patients with recurrence, 21 (23%) had late recurrence. Compared with the early recurrence group, there were significantly more adenocarcinomas and local recurrences in the late recurrence group (P = 0.04 for both). The 3- and 5-year PRS rates were 53 and 24%, respectively, and the median PRS period was 38 months. There were no significant differences in the PRS curves between patients with early and late recurrence (P = 0.12). Only 3 patients (0.2%) had recurrence more than 10 years after ILR. Of the 21 late-recurrence patients, 17 (81%) had tumours with a consolidation/tumour ratio (CTR) >0.25. CONCLUSIONS Late recurrence occurred in 21 (23%) of 92 patients with recurrence after ILR for cT1aN0M0 NSCLC. Late recurrence was more likely to involve adenocarcinoma and local recurrence. It is thus considered reasonable to follow patients with a CTR >0.25 for 10 years after ILR.
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Affiliation(s)
- Yuki Matsumura
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan Division of Chest Surgery, Fukushima Medical University, Fukushima, Japan
| | - Motoki Yano
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Junji Yoshida
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Terumoto Koike
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Kotaro Kameyama
- Department of Thoracic Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Akira Shimamoto
- Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Wataru Nishio
- Department of General Thoracic Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan
| | - Kentaro Yoshimoto
- Department of Thoracic Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Tomoki Utsumi
- Department of Surgery, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Takayuki Shiina
- Department of Thoracic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Atsushi Watanabe
- Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yasushi Yamato
- Department of Thoracic Surgery, Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - Takehiro Watanabe
- Department of Thoracic Surgery, National Hospital Organization Nishi-Niigata Chuo National Hospital, Niigata, Japan
| | - Yusuke Takahashi
- Department of General Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Tokyo, Japan
| | - Makoto Sonobe
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Makoto Oda
- Department of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan
| | - Masayoshi Inoue
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masayuki Tanahashi
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Hirofumi Adachi
- Department of Thoracic Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Masao Saito
- Department of Thoracic Surgery, Tenri Hospital, Nara, Japan
| | - Masataro Hayashi
- Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Hajime Otsuka
- Department of Chest Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Teruaki Mizobuchi
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | | | - Mamoru Takahashi
- Department of Chest Surgery, Fukui Red Cross Hospital, Fukui, Japan
| | - Shigeto Nishikawa
- Division of Thoracic Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Hiroyuki Suzuki
- Division of Chest Surgery, Fukushima Medical University, Fukushima, Japan
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Prognostic Factors in Non-Small Cell Lung Cancer Less Than 3 Centimeters: Actuarial Analysis, Accumulative Incidence and Risk Groups. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.arbr.2015.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Kondo N, Takuwa T, Hashimoto M, Yoneda K, Matsumoto S, Shiraishi T, Hasegawa S. Gene Mutation Analysis in Determining Late Recurrence of Adenocarcinoma of the Lung. Ann Thorac Surg 2015; 100:711-3. [PMID: 26234846 DOI: 10.1016/j.athoracsur.2014.09.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 09/02/2014] [Accepted: 09/17/2014] [Indexed: 11/17/2022]
Abstract
A patient was found to have a new pleural lesion 14 years after undergoing complete resection of primary lung cancer. Histologic and genetic analysis of the previously resected specimen and the samples obtained of a newly performed biopsy confirmed that the tumors were identical, and the recurrence of lung cancer was determined. This case is instructive because of the rather long interval between the resection of the initial tumor and the recurrence and because of the presence of validated proof of recurrence by both clinical features and genetic analysis.
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Affiliation(s)
- Nobuyuki Kondo
- Department of Thoracic Surgery, Hyogo College of Medicine, Hyogo, Japan.
| | - Teruhisa Takuwa
- Department of Thoracic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Masaki Hashimoto
- Department of Thoracic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Kazue Yoneda
- Department of Thoracic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Seiji Matsumoto
- Department of Thoracic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Takeshi Shiraishi
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Seiki Hasegawa
- Department of Thoracic Surgery, Hyogo College of Medicine, Hyogo, Japan
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Peñalver Cuesta JC, Jordá Aragón C, Mancheño Franch N, Cerón Navarro JA, de Aguiar Quevedo K, Arrarás Martínez M, Vera Sempere FJ, Padilla Alarcón JD. Prognostic Factors in Non-Small Cell Lung Cancer Less Than 3 Centimeters: Actuarial Analysis, Accumulative Incidence and Risk Groups. Arch Bronconeumol 2015; 51:431-9. [PMID: 25596989 DOI: 10.1016/j.arbres.2014.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 11/19/2014] [Accepted: 11/20/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In TNM classification, factors determining the tumor (T) component in non-small cell lung cancer have scarcely changed over time and are still based solely on anatomical features. Our objective was to study the influence of these and other morphopathological factors on survival. METHODS A total of 263 patients undergoing lung resection due to stage I non-small cell lung cancer ≤3cm in diameter were studied. A survival analysis and competing-risk estimate study was made on the basis of clinical, surgical and pathological variables using actuarial analysis and accumulative incidence methods, respectively. A risk model was then generated from the results. RESULTS Survival at 5 and 10 years was 79.8 and 74.3%, respectively. The best prognostic factors were presence of symptoms, smoking habit and FEV1>60%, number of resected nodes>7, squamous histology, absence of vascular invasion, absence of visceral pleural invasion and presence of invasion more proximal than the lobar bronchus. All these were statistically significant according to the actuarial method. The factor "age<50 years" was close to the margin of statistical significance. Pleural invasion and vascular invasion were entered in the multivariate analysis. The competing-risk analysis showed a probability of death due to cancer of 14.3 and 35.1% at 5 and 10 years, respectively. Significant variables in the univariate and multivariate analyses were similar, with the exception of FEV1>60%. CONCLUSIONS Pleural invasion and vascular invasion determine survival or risk of death due to non-small cell lung cancer ≤3cm and can be used for generating a predictive risk model.
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Affiliation(s)
- Juan C Peñalver Cuesta
- Servicio de Cirugía Torácica, Fundación Instituto Valenciano de Oncología (FIVO), Valencia, España.
| | - Carlos Jordá Aragón
- Servicio de Cirugía Torácica, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Nuria Mancheño Franch
- Servicio de Anatomía Patológica, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - José A Cerón Navarro
- Servicio de Cirugía Torácica, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Karol de Aguiar Quevedo
- Servicio de Cirugía Torácica, Fundación Instituto Valenciano de Oncología (FIVO), Valencia, España
| | - Miguel Arrarás Martínez
- Servicio de Cirugía Torácica, Fundación Instituto Valenciano de Oncología (FIVO), Valencia, España
| | | | - Jose D Padilla Alarcón
- Servicio de Cirugía Torácica, Fundación Instituto Valenciano de Oncología (FIVO), Valencia, España
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Jordá Aragón C, Peñalver Cuesta JC, Mancheño Franch N, de Aguiar Quevedo K, Vera Sempere F, Padilla Alarcón J. [Mortality in early-stage, surgically resected non-small cell lung cancer less than 3 cm of size: Competing risk analysis]. Med Clin (Barc) 2014; 145:185-91. [PMID: 25433784 DOI: 10.1016/j.medcli.2014.07.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/09/2014] [Accepted: 07/21/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Survival studies of non-small cell lung cancer (NSCLC) are usually based on the Kaplan-Meier method. However, other factors not covered by this method may modify the observation of the event of interest. There are models of cumulative incidence (CI), that take into account these competing risks, enabling more accurate survival estimates and evaluation of the risk of death from other causes. We aimed to evaluate these models in resected early-stage NSCLC patients. PATIENTS AND METHOD This study included 263 patients with resected NSCLC whose diameter was ≤ 3 cm without node involvement (N0). Demographic, clinical, morphopathological and surgical variables, TNM classification and long-term evolution were analysed. To analyse CI, death by another cause was considered to be competitive event. For the univariate analysis, Gray's method was used, while Fine and Gray's method was employed for the multivariate analysis. RESULTS Mortality by NSCLC was 19.4% at 5 years and 14.3% by another cause. Both curves crossed at 6.3 years, and probability of death by another cause became greater from this point. In multivariate analysis, cancer mortality was conditioned by visceral pleural invasion (VPI) (P=.001) and vascular invasion (P=.020), with age>50 years (P=.034), smoking (P=.009) and the Charlson index ≥ 2 (P=.000) being by no cancer. CONCLUSIONS By the method of CI, VPI and vascular invasion conditioned cancer death in NSCLC >3 cm, while non-tumor causes of long-term death were determined.
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Affiliation(s)
- Carlos Jordá Aragón
- Servicio de Cirugía Torácica, Hospital Universitario y Politécnico La Fe, Valencia, España
| | | | - Nuria Mancheño Franch
- Servicio de Anatomía Patológica, Hospital Universitario y Politécnico La Fe, Departamento de Patología, Universidad de Valencia, Valencia, España
| | | | - Francisco Vera Sempere
- Servicio de Anatomía Patológica, Hospital Universitario y Politécnico La Fe, Departamento de Patología, Universidad de Valencia, Valencia, España
| | - José Padilla Alarcón
- Servicio de Cirugía Torácica, Instituto Valenciano de Oncología, Valencia, España.
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Ohtaka K, Hida Y, Kaga K, Kato T, Muto J, Nakada-Kubota R, Hirano S, Matsui Y. Limited resection and two-staged lobectomy for non-small cell lung cancer with ground-glass opacity. J Cardiothorac Surg 2013; 8:111. [PMID: 23618098 PMCID: PMC3646697 DOI: 10.1186/1749-8090-8-111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 04/12/2013] [Indexed: 11/24/2022] Open
Abstract
Background Lung tumors showing ground-glass opacities on high-resolution computed tomography indicate the presence of inflammation, atypical adenomatous hyperplasia, or localized bronchioloalveolar carcinoma. We adopted a two-staged video-assisted thoracoscopic lobectomy strategy involving completion lobectomy for localized bronchioloalveolar carcinoma with an invasive component according to postoperative pathological examination by permanent section after partial resection. Methods Forty-one patients with undiagnosed small peripheral ground-glass opacity lesions underwent partial resection from 2001 to 2007 in Hokkaido University Hospital. Localized bronchioloalveolar carcinoma was classified according to the Noguchi classification for adenocarcinoma. Malignant lesions other than Noguchi types A and B were considered for completion lobectomy and systemic mediastinal lymphadenectomy. Perioperative data of completion video-assisted thoracoscopic lobectomies were compared with data of 67 upfront video-assisted thoracoscopic lobectomies for clinical stage IA adenocarcinoma performed during the same period. Results Postoperative pathological examination revealed 35 malignant and 6 non-malignant diseases. Histologically, all of the malignant diseases were adenocarcinomas of Noguchi type A (n = 7), B (n = 9), C (n = 18), and F (n = 1). Eleven of 19 patients (58%) with Noguchi type C or F underwent two-staged video-assisted thoracoscopic lobectomy. Three patients refused a second surgery. There was no cancer recurrence. The two-staged lobectomy group had a significantly longer operative time and more blood loss than the upfront lobectomy group. There was no surgical mortality or cancer recurrence. Conclusions Two-staged lobectomy for undiagnosed small peripheral ground-glass opacity lesions showed satisfactory oncological results. However, low compliance for and invasiveness of the second surgery are concerns associated with this strategy.
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Affiliation(s)
- Kazuto Ohtaka
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
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Schmidt-Hansen M, Page R, Hasler E. The Effect of Preoperative Smoking Cessation or Preoperative Pulmonary Rehabilitation on Outcomes After Lung Cancer Surgery: A Systematic Review. Clin Lung Cancer 2013; 14:96-102. [DOI: 10.1016/j.cllc.2012.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 07/09/2012] [Accepted: 07/30/2012] [Indexed: 12/26/2022]
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Wang J, Wang B, Zhao W, Guo Y, Chen H, Chu H, Liang X, Bi J. Clinical significance and role of lymphatic vessel invasion as a major prognostic implication in non-small cell lung cancer: a meta-analysis. PLoS One 2012; 7:e52704. [PMID: 23285161 PMCID: PMC3527568 DOI: 10.1371/journal.pone.0052704] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 11/19/2012] [Indexed: 11/30/2022] Open
Abstract
Background Lymphatic vessel invasion (LVI) exerts an important process in the progression and local spread of cancer cells. However, LVI as a prognostic factor for survival in non-small cell lung cancer (NSCLC) remains controversial. Methodology/Principal Findings A meta-analysis of published studies from PubMed and EMBASE electronic databases was performed to quantity the effects of LVI on both relapse-free survival and overall survival for patients with NSCLC. Hazard ratios (HRs) with 95% confidence intervals (95% CIs) were used to assess the strength of these effects. This meta-analysis included 18,442 NSCLC patients from 53 eligible studies. LVI appeared in 32.1% (median; range, 2.8% to 70.9%) of tumor samples. In all, patients with LVI were 2.48 times more likely to relapse by univariate analysis (95% CI: 1.92–3.22) and 1.73 times by multivariate analysis (95% CI: 1.24–2.41) compared with those without LVI. For the analyses of LVI and overall survival, the pooled HR estimate was 1.97 (95% CI: 1.75–2.21) by univariate analysis and 1.59 (95% CI: 1.41–1.79) by multivariate analysis. Multivariate analysis showed a risk was 91% higher for recurrence (HR = 1.91, 95% CI: 1.14–2.91) and 70% higher for mortality (HR = 1.70, 95% CI: 1.38–2.10) in LVI-positive I stage patients compared with LVI-negative I stage patients. Subgroup analyses showed similar significant adjusted risks for recurrence and death in adenocarcinomas, and a significant adjusted risk for death in studies that utilized elastic staining with or without immunohistochemistry in defining LVI. Conclusions/Significance The present study indicates that LVI appears to be an independent poor prognosticator in surgically managed NSCLC. NSCLC patients with LVI would require a more aggressive treatment strategy after surgery. However, large, well-designed prospective studies with clinically relevant modeling and standard methodology to assess LVI are required to address some of these important issues.
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Affiliation(s)
- Jun Wang
- Department of Oncology, General Hospital, Jinan Command of the People's Liberation Army, Jinan, China.
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Long-Term Outcomes of 50 Cases of Limited-Resection Trial for Pulmonary Ground-Glass Opacity Nodules. J Thorac Oncol 2012; 7:1563-6. [DOI: 10.1097/jto.0b013e3182641b5c] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Senan S, Palma DA, Lagerwaard FJ. Stereotactic ablative radiotherapy for stage I NSCLC: Recent advances and controversies. J Thorac Dis 2012; 3:189-96. [PMID: 22263087 DOI: 10.3978/j.issn.2072-1439.2011.05.03] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 05/17/2011] [Indexed: 12/25/2022]
Abstract
Stereotactic ablative radiotherapy (SABR) is a technique that has rapidly entered routine care for early-stage peripheral non-small cell lung cancer in many countries in the last decade. The adoption of SABR was partly stimulated by advances in the so-called 'image guided' radiotherapy delivery. In the last 2 years, a growing body of publications has reported on clinical outcomes, acute and late radiological changes after SABR, and sub-acute and late toxicity. The local control rates in many publications have exceeded 90% when tumors of up to 5 cm have been treated, with corresponding regional nodal failure rates of approximately 10%. However, these results are not universal: lower control rates reported by some authors serve to emphasize the importance of quality assurance in all steps of SABR treatment planning and delivery. High-grade toxicity is uncommon when so-called 'risk-adapted' fractionation schemes are applied; an approach which involves the use of lower daily doses and more fractions when critical normal organs are in the proximity of the tumor volume. This review will address the new data available on a number of controversial topics such as the treatment of patients without a tissue diagnosis of malignancy, data on SABR outcomes in patients with severe chronic obstructive airways disease, use of a classification system for late radiological changes post-SABR, late treatment-related toxicity, and the evidence to support a need for expert multi-disciplinary teams in the follow-up of such patients.
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Affiliation(s)
- Suresh Senan
- Department of Radiation Oncology, VU University medical center, Amsterdam, the Netherlands
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Predictors of Death, Local Recurrence, and Distant Metastasis in Completely Resected Pathological Stage-I Non–Small-Cell Lung Cancer. J Thorac Oncol 2012; 7:1115-23. [DOI: 10.1097/jto.0b013e31824cbad8] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Prognostic Predictors in Non-Small Cell Lung Cancer Patients Undergoing Intentional Segmentectomy. Ann Thorac Surg 2012; 93:1788-94. [DOI: 10.1016/j.athoracsur.2012.02.093] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 02/23/2012] [Accepted: 02/27/2012] [Indexed: 11/18/2022]
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Preliminary report of late recurrences, at 5 years or more, after stereotactic body radiation therapy for non-small cell lung cancer. J Thorac Oncol 2012; 7:453-6. [PMID: 22252562 DOI: 10.1097/jto.0b013e31823c5b29] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Long-term outcomes remain unknown after stereotactic body radiation therapy (SBRT). We observed a few patients who developed disease progression late, at 5 years or more, after SBRT. In this report, we describe the characteristics of those patients with late recurrence after SBRT. METHODS We retrospectively reviewed patients who underwent SBRT for non-small cell lung cancer with histological confirmation between January 1999 and December 2005 at our institution. During this period, 48 Gy of SBRT in four fractions at the isocenter was prescribed for all patients. RESULTS In total, 66 patients were eligible. With a median follow-up period of 35.9 months, the 5-year overall survival and disease-free survival rates were 44.6% (95% confidence interval, 33.5-59.5%) and 33.8% (95% confidence interval, 23.6-48.4%), respectively. Of the patients, 16 survived without disease progression for 5 years or more after SBRT. Of these, four patients developed late recurrence at 76, 101, 108, and 109 months after SBRT. Three of the patients were females with adenocarcinomas; the other was a male with squamous cell carcinoma. The initial sites of recurrence were local in two patients, distant in one, and simultaneously local and distant in one. A total of two patients with local recurrence alone were still alive at 138 months after SBRT. CONCLUSIONS The rate of late recurrence was not negligible in long-term survivors after SBRT. Our experiences indicate that long-term follow-up is needed after SBRT for non-small cell lung cancer.
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Wang J, Chen J, Chen X, Wang B, Li K, Bi J. Blood vessel invasion as a strong independent prognostic indicator in non-small cell lung cancer: a systematic review and meta-analysis. PLoS One 2011; 6:e28844. [PMID: 22194927 PMCID: PMC3237541 DOI: 10.1371/journal.pone.0028844] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 11/16/2011] [Indexed: 12/26/2022] Open
Abstract
Background and Objective Blood vessel invasion plays a very important role in the progression and metastasis of cancer. However, blood vessel invasion as a prognostic factor for survival in non-small cell lung cancer (NSCLC) remains controversial. The aim of this study is to explore the relationship between blood vessel invasion and outcome in patients with NSCLC using meta-analysis. Methods A meta-analysis of published studies was conducted to investigate the effects of blood vessel invasion on both relapse-free survival (RFS) and overall survival (OS) for patients with NSCLC. Hazard ratios (HRs) with 95% confidence intervals (95% CIs) were used to assess the strength of this association. Results A total of 16,535 patients from 52 eligible studies were included in the systematic review and meta-analysis. In total, blood vessel invasion was detected in 29.8% (median; range from 6.2% to 77.0%) of patients with NSCLC. The univariate and multivariate estimates for RFS were 3.28 (95% CI: 2.14–5.05; P<0.0001) and 3.98 (95% CI: 2.24–7.06; P<0.0001), respectively. For the analyses of blood vessel invasion and OS, the pooled HR estimate was 2.22 (95% CI: 1.93–2.56; P<0.0001) by univariate analysis and 1.90 (95% CI: 1.65–2.19; P<0.0001) by multivariate analysis. Furthermore, in stage I NSCLC patients, the meta-risk for recurrence (HR = 6.93, 95% CI: 4.23–11.37, P<0.0001) and death (HR = 2.15, 95% CI: 1.68–2.75; P<0.0001) remained highly significant by multivariate analysis. Conclusions This study shows that blood vessel invasion appears to be an independent negative prognosticator in surgically managed NSCLC. However, adequately designed large prospective studies and investigations are warranted to confirm the present findings.
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Affiliation(s)
- Jun Wang
- Department of Oncology, General Hospital, Jinan Command of the People's Liberation Army, Jinan, China.
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