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Huang Z, Chen D, Hong Z, Kang M. Estimating the cure proportion of stage IA lung adenocarcinoma: a population-based study. BMC Pulm Med 2023; 23:417. [PMID: 37907906 PMCID: PMC10619226 DOI: 10.1186/s12890-023-02725-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/20/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND We aimed to investigate the factors influencing the cure, recurrence, and metastasis rates of stage IA lung adenocarcinoma, using a mixed cure model. METHODS A total of 1,064 patients who underwent video-assisted thoracoscopic pulmonectomy were included. Variable screening was performed using the random forest algorithm and least absolute shrinkage and selection operator approaches. The mixed cure model was used to identify factors affecting patient cure and survival, and a sequential analysis was performed on 5%, 10%, and 20% of the presentational subtype concurrently. A receiver operating characteristics curve was used to determine the best model and construct a nomogram to predict the cure rate. RESULTS The median follow-up time was 58 (range: 3-115) months. Results from the cure part of the mixed model indicated that the predominant subtype, presentational subtype, and tumor diameter were the main prognostic factors affecting cure rate. Therefore, the nomogram to predict the cure rate was constructed based on these factors. The survival part indicated that the predominant subtype was the only factor that influenced recurrence and metastasis. A sequential analysis of the presentational subtype showed it had no significant effect on survival (P > 0.05). Regardless of the recording mode, no significant improvement was observed in the model's discriminative ability. Only a few postoperative pathological specimens showed lymphovascular invasion (LVI); however, the survival curve suggested a significant effect on patient survival. CONCLUSIONS After excluding the existence of long-term survivors, the predominant tumor subtype was determined to be the only factor influencing recurrence and metastasis. Although LVI is rare in stage IA lung adenocarcinoma, its significance cannot be discounted in terms of determining patient prognosis.
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Affiliation(s)
- Zhixin Huang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou, Fuzhou, Fujian, 350001, People's Republic of China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Dinghang Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou, Fuzhou, Fujian, 350001, People's Republic of China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Zhinuan Hong
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou, Fuzhou, Fujian, 350001, People's Republic of China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Mingqiang Kang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou, Fuzhou, Fujian, 350001, People's Republic of China.
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, China.
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
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Vascular Invasion Predicts Recurrence in Stage IA2-IB Lung Adenocarcinoma but not Squamous Cell Carcinoma. Clin Lung Cancer 2022; 24:e126-e133. [PMID: 36631388 DOI: 10.1016/j.cllc.2022.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/02/2022] [Accepted: 12/20/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Lymphovascular invasion (LVI) is an adverse prognostic feature in resected stage I non-small cell lung cancer (NSCLC); however, it is unclear if the prognostic significance applies to both lung adenocarcinoma (LUAD) and squamous cell carcinoma (LUSC). MATERIALS AND METHODS A retrospective review of H&E-stained slides from surgically resected AJCC 8th ed. stage IA2-IB LUAD (n = 344) and LUSC (n = 102) from two institutions was performed. LVI was defined as either lymphatic (LI) or vascular (VI) invasion. Outcomes were assessed by 5-year recurrence-free survival (RFS) estimates using the Kaplan-Meier method. RESULTS The cohorts of LUAD and LUSC showed no significant differences in 5-year RFS (81% each), stage, age, race, or surgical procedure. The presence of LVI, VI, and LI was predictive of 5-year RFS for LUAD (LVI + 71% vs. LVI - 92%, P < 0.001; VI + 64% vs. VI - 90%, P < 0.001; LI + 75% vs. LI - 84%, P = 0.030) but not LUSC (LVI + 84% vs. LVI - 79%, P = 0.740; VI + 83% vs. VI- 80%, P = 0.852; LI + 84% vs. LI - 81%, P = 0.757). Among LUAD with LVI, VI was a stronger predictor of 5-year RFS than the remaining subset of VI-LI + tumors (64% vs. 87%, P = 004). Subset analysis of LI among LUAD stratified by VI showed no significant prognostic advantage to adding LI for risk stratification (VI-LI + 87% vs. VI-LI - 92%, P = 0.347 & VI+LI + 62% vs. VI + LI- 66%, P = 0.422). VI was present in 36% of LUAD. CONCLUSION Vascular invasion is a strong predictor of recurrence in stage IA2-IB LUAD but not in LUSC. Adjuvant therapy trials should be directed at this subgroup.
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Wang YF, Deng HY, Huang W, Zhou Q. Segmentectomy for early-stage non-small-cell lung cancer with invasive characteristics: the definitions of invasiveness and feasibility of segmentectomy. Eur J Cardiothorac Surg 2022; 62:6565839. [PMID: 35396844 DOI: 10.1093/ejcts/ezac236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 03/28/2022] [Indexed: 02/05/2023] Open
Affiliation(s)
- Yi-Feng Wang
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Han-Yu Deng
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Weijia Huang
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Qinghua Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, China
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Yambayev I, Sullivan TB, Rieger-Christ KM, Servais EL, Stock CT, Quadri SM, Sands JM, Suzuki K, Burks EJ. Vascular invasion identifies the most aggressive histologic subset of stage I lung adenocarcinoma: Implications for adjuvant therapy. Lung Cancer 2022; 171:82-89. [DOI: 10.1016/j.lungcan.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/08/2022] [Accepted: 07/21/2022] [Indexed: 11/15/2022]
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Construction and Validation of a Recurrent Risk Nomogram Model for Non-Small Cell Lung Cancer within 1 Year after Radical Resection. JOURNAL OF ONCOLOGY 2022; 2022:8967162. [PMID: 35909898 PMCID: PMC9325597 DOI: 10.1155/2022/8967162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/24/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022]
Abstract
Objective To explore the risk factors of recurrence within 1 year after radical resection of non-small cell lung cancer (NSCLC) and construct the nomogram model. Methods The clinical data of 186 patients with NSCLC treated with radical surgery in Affiliated Hospital of Youjiang Medical University for Nationalities of Baise were retrospectively analyzed. Multivariate logistic regression was applied to analyze the risk factors of recurrence within 1 year after radical resection of NSCLC. The R language (R 4.0.3 software package) was used in constructing the nomogram model, and the predictive value of the model was evaluated. Results The recurrence rate of 186 patients within 1 year after radical surgery was 29.57%. After multivariate logistic regression analysis, pathological stage, number of lymph node metastasis, chronic obstructive pulmonary disease (COPD), postoperative plasma D-dimer, and carcinoembryonic antigen were independent factors for recurrence within 1 year after radical resection of NSCLC (P < 0.05). Based on the above independent risk factors, a nomogram model was established, with the distinction of AUC = 0.891 (95% CI: 0.819–0.964) and sensitivity and specificity of 70.3% and 97.8%, respectively. The calibration curve was close to the ideal curve. External validation of the model showed AUC = 0.801 (95% CI: 0.674–0.928), and sensitivity and specificity were 66.7% and 84.2%, respectively. Conclusion The recurrence of NSCLC within 1 year after radical surgery was related to a variety of factors, and the nomogram model constructed based on risk factors had good goodness of fit, calibration, consistency of prediction, and prediction efficiency.
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Lymph but Not Blood Vessel Invasion Is Independent Prognostic in Lung Cancer Patients Treated by VATS-Lobectomy and Might Represent a Future Upstaging Factor for Early Stages. Cancers (Basel) 2022; 14:cancers14081893. [PMID: 35454799 PMCID: PMC9031652 DOI: 10.3390/cancers14081893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/02/2022] [Accepted: 04/06/2022] [Indexed: 12/04/2022] Open
Abstract
Lung cancer is the most frequent cause of cancer-related death worldwide. The patient’s outcome depends on tumor size, lymph node involvement and metastatic spread at the time of diagnosis. The prognostic value of lymph and blood vessel invasion, however, is still insufficiently investigated. We retrospectively examined the invasion of lymph vessels and blood vessels separately as two possible prognostic factors in 160 patients who underwent a video-assisted thoracoscopic lobectomy for non-small-cell lung cancer at our institution between 2014 and 2019. Lymph vessel invasion was significantly associated with the UICC stage, lymph node involvement, tumor dedifferentiation, blood vessel invasion and recurrence. Blood vessel invasion tended to be negative prognostic, but missed the level of significance (p = 0.108). Lymph vessel invasion, on the other hand, proved to be a prognostic factor for both histological subtypes, adenocarcinoma (p < 0.001) as well as squamous cell carcinoma (p = 0.018). After multivariate analysis apart from the UICC stage, only lymph vessel invasion remained independently prognostic (p = 0.018). Remarkably, we found analogue survival curve progressions of patients with stage I, with lymph vessel invasion, compared to stage II non-small-cell lung cancer. After further validation in prospective studies, lymph vessel invasion might be considered as an upstaging factor in resectable lung cancer. Especially in the early-stage of the disease, it might represent an additional risk factor to consider adjuvant therapy after surgical resection.
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Hu A, Chen Z, Liu C, Gao Y, Deng C, Liu X. Incidence and Prognosis Nomogram of Small Solitary Lung Cancer (≤2 cm) With Extra-Thoracic Metastasis at Initial Diagnosis:A Population-Based Study. Cancer Control 2022; 29:10732748221141560. [PMID: 36428219 PMCID: PMC9703543 DOI: 10.1177/10732748221141560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/22/2022] [Accepted: 11/07/2022] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Small solitary lung cancer (≤2 cm) with extra-thoracic metastasis and no nodal metastasis or intra-thoracic metastasis is a rare situation in clinic. METHODS Lung cancer patients with stage T1aN0M0 and T1aN0M1b from 2010 to 2015 were identified from the Surveillance, Epidemiology, and End Results database. The identified significant parameters were utilized to develop 2 nomogram to predict the extra-thoracic metastasis rates and the overall survival for the group of patients with stage T1aN0M1b. RESULTS Small solitary lung cancers which occur in the males, younger patients, or locate in the main bronchus or left lung, or with histologic type as small cell lung cancer, or with undifferentiated type, tend to have extra-thoracic metastasis. Application of the nomogram in the intra-group still gave good discrimination and good calibration. Univariable and multivariable analysis identified several clinical data as the prognostic factors for lung cancer patients with stage T1aN0M1b, all the factors above were incorporated into the nomogram. ROC curve analysis showed that the nomogram had good discrimination, with AUC of .779, .786 and .77 for 1-, 3- and 5-year survival in the development group and validation group, respectively. Moreover, decision curve analysis has been implemented to evaluate and compare prediction and prognostic nomogram. CONCLUSIONS Younger male patients whose lung cancer locates in main bronchus or left lung, or with undifferentiated type, or with histologic type as small cell lung cancer are more likely to have extra-thoracic metastasis. The proposed nomogram reliably predicted OS for lung cancer patients with stage T1aN0M1b, though further validation is needed, it may be a useful tool in clinical practice. These models can be wildly used for easy facilitate the lung cancer individualized prediction of extra-thoracic metastasis and OS.
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Affiliation(s)
- Ao’ran Hu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Zui Chen
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Chaoyuan Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Yuan Gao
- Logan University, 1851 Schoettler Road, Chesterfield, MO 63017
| | - Chao Deng
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Xianling Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, P.R. China
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Liu K, Li K, Wu T, Liang M, Zhong Y, Yu X, Li X, Xie C, Zhang L, Liu X. Improving the accuracy of prognosis for clinical stage I solid lung adenocarcinoma by radiomics models covering tumor per se and peritumoral changes on CT. Eur Radiol 2021; 32:1065-1077. [PMID: 34453574 DOI: 10.1007/s00330-021-08194-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 06/22/2021] [Accepted: 07/02/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To assess methods to improve the accuracy of prognosis for clinical stage I solid lung adenocarcinoma using radiomics based on different volumes of interests (VOIs). METHODS This retrospective study included patients with postoperative clinical stage I solid lung adenocarcinoma from two hospitals, center 1 and center 2. Three databases were generated: dataset A (training set from center 1), dataset B (internal test set from center 1), and dataset C (external validation test from center 2). Disease-free survival (DFS) data were collected. CT radiomics models were constructed based on four VOIs: gross tumor volume (GTV), 3 mm external to the tumor border (peritumoral volume [PTV]0~+3), 6 mm crossing tumor border (PTV-3~+3), and 6 mm external to the tumor border (PTV0~+6). The area under the receiver operating characteristic curve (AUC) was used to compare the model accuracies. RESULTS A total of 334 patients were included (204 and 130 from centers 1 and 2). The model using PTV-3~+3 (AUC 0.81 [95% confidence interval {CI}: 0.75, 0.94], 0.81 [0.63, 0.90] for datasets B and C) outperformed the other three models, GTV (0.73 [0.58, 0.81], 0.73 [0.58, 0.83]), PTV0~+3 (0.76 [0.52, 0.87], 0.75 [0.60, 0.83]), and PTV0~+6 (0.72 [0.60, 0.81], 0.69 [0.59, 0.81]), in datasets B and C, all p < 0.05. CONCLUSIONS A radiomics model based on a VOI of 6 mm crossing tumor border more accurately predicts prognosis of clinical stage I solid lung adenocarcinoma than that based on VOIs including overall tumor or external rims of 3 mm and 6 mm. KEY POINTS • Radiomics is a useful approach to improve the accuracy of prognosis for stage I solid adenocarcinoma. • The radiomics model based on VOIs that includes 3 mm within and external to the tumor border (peritumoral volume [PTV]-3~+3) outperformed models that included either only the tumor itself or those that only included the peritumoral volume.
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Affiliation(s)
- Kunfeng Liu
- Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Kunwei Li
- Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Tingfan Wu
- Translational Medicine Team, GE Healthcare, Shanghai, China
| | - Mingzhu Liang
- Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Yinghua Zhong
- Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xiangyang Yu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xin Li
- Translational Medicine Team, GE Healthcare, Shanghai, China
| | - Chuanmiao Xie
- Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lanjun Zhang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xueguo Liu
- Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China. .,Department of Radiology, Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.
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Yun JK, Lee GD, Choi S, Kim HR, Kim YH, Kim DK, Park SI. Comparison of prognostic impact of lymphovascular invasion in stage IA non-small cell lung cancer after lobectomy versus sublobar resection: A propensity score-matched analysis. Lung Cancer 2020; 146:105-111. [PMID: 32526600 DOI: 10.1016/j.lungcan.2020.04.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Lymphovascular invasion (LVI) is a well-known poor prognostic factor after lobectomy for non-small cell lung cancer. However, the prognostic effect of LVI in patients who undergo sublobar resection has not been fully evaluated. Thus, we compared the prognostic impact of LVI in stage IA patients who underwent lobectomy or sublobar resection. MATERIALS AND METHODS We retrospectively reviewed the data from patients with stage IA NSCLC who underwent surgical resection between 2007 and 2016. The prognostic impact of LVI was calculated by the Cox proportional hazard regression model. To adjust for the differences in confounding variables between LVI-positive and LVI-negative patients, propensity score matching (PSM) was carried out in patients who underwent lobectomy or sublobar resection. RESULTS Among the stage IA NSCLC patients (n = 2134), 184 (8.6%) had been diagnosed with LVI, of whom 144 (8.9%) were in the lobectomy group (n = 1614) and 40 (7.7%) were in the sublobar resection group (n = 520). In multivariable analysis, LVI was a significant risk factor for both overall survival (OS) (hazard ratio [HR], 2.03; 95% confidence interval [CI], 1.39-2.96; p < 0.001) and recurrence-free survival (RFS) (HR, 2.31; 95% CI, 1.68-3.17; p < 0.001). After PSM, the prognostic impact of LVI was greater in the sublobar resection group (HR = 4.93 and 4.25 for OS and RFS, respectively) than in the lobectomy group (HR = 1.77 and 2.51 for OS and RFS, respectively). CONCLUSIONS The presence of LVI was significantly associated with worse OS and RFS in stage IA NSCLC patients. The prognostic impact of LVI was more pronounced in the sublobar resection group than in the lobectomy group.
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Affiliation(s)
- Jae Kwang Yun
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Sehoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
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Samejima J, Yokose T, Ito H, Nakayama H, Nagashima T, Suzuki M, Hamanaka R, Yamada K, Masuda M. Prognostic significance of blood and lymphatic vessel invasion in pathological stage IA lung adenocarcinoma in the 8th edition of the TNM classification. Lung Cancer 2019; 137:144-148. [PMID: 31593845 DOI: 10.1016/j.lungcan.2019.09.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The prognostic significance of blood and lymphatic vessel invasion in the 8th edition of the Tumor, Node, Metastasis (TNM) classification remains unclear. Therefore, this study aimed to evaluate the prognostic significance of blood and lymphatic vessel invasion in p-stage IA lung adenocarcinoma in the 8th edition of the TNM classification. MATERIALS ANDMETHODS We retrospectively examined patients with p-Stage 0-IA lung adenocarcinoma, reclassified according to the 8th edition of the TNM classification. Blood and lymphatic vessel invasion were evaluated using hematoxylin-eosin and Elastica van Gieson and hematoxylin-eosin and anti-podoplanin antibody staining, respectively. Combined blood and lymphatic vessel invasion constituted tumor vessel invasion (TVI). RESULTS Overall, 306 patients were evaluated. The median follow-up period was 98.0 (range: 10-216) months. The 5-year recurrence-free survival differed significantly among patients with and without TVI in p-stage IA1 (TVI-: 100%, TVI+: 88.9%, P = 0.007) and IA2 (TVI-: 94.6%, TVI+: 80.8%, P = 0.012) but not in p-stage IA3 (TVI-: 66.7%, TVI+: 75.0%, P = 0.598). The 5-year lung cancer-specific survival also differed significantly among those with and without TVI in p-stage IA1 (TVI-: 100%, TVI+: 88.9%, P < 0.001) and IA2 (TVI-: 98.2%, TVI+: 88.7%, P = 0.043) but not in p-Stage IA3 (TVI-: 66.7%, TVI+: 75.0%, P = 0.858). No recurrence and lung cancer-specific deaths occurred in p-stage IA1 patients without TVI. On multivariate analysis, the presence of TVI was independently associated with recurrence and lung cancer-specific death in patients with p-stage IA1-2 lung adenocarcinoma. TVI did not affect the prognosis of those with p-stage IA3 adenocarcinoma. CONCLUSION TVI is a prognostic factor in patients with p-stage IA1-2 lung adenocarcinoma. P-stage IA1 lung adenocarcinoma without TVI may therefore be classified as minimally invasive.
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Affiliation(s)
- Joji Samejima
- Kanagawa Cancer Center, Department of Thoracic Surgery, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa, 241-8515, Japan.
| | - Tomoyuki Yokose
- Kanagawa Cancer Center, Department of Pathology, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa, 241-8515, Japan
| | - Hiroyuki Ito
- Kanagawa Cancer Center, Department of Thoracic Surgery, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa, 241-8515, Japan
| | - Haruhiko Nakayama
- Kanagawa Cancer Center, Department of Thoracic Surgery, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa, 241-8515, Japan
| | - Takuya Nagashima
- Kanagawa Cancer Center, Department of Thoracic Surgery, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa, 241-8515, Japan
| | - Masaki Suzuki
- Kanagawa Cancer Center, Department of Pathology, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa, 241-8515, Japan
| | - Rurika Hamanaka
- Kanagawa Cancer Center, Division of General Thoracic Surgery, Department of Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Kouzo Yamada
- Kanagawa Cancer Center, Department of Thoracic Oncology, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa, 241-8515, Japan
| | - Munetaka Masuda
- Kanagawa Cancer Center, Department of Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa, 236-0004, Japan
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Lymphatic invasion is a cause of local recurrence after wedge resection of primary lung cancer. Gen Thorac Cardiovasc Surg 2019; 67:861-866. [PMID: 30820912 DOI: 10.1007/s11748-019-01095-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/24/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE After securing a sufficient surgical margin at wedge resection and finding no pathologic evidence of residual tumor at the surgical margin, a considerable number of patients develop local recurrence. We investigated the correlation between sub-pleural lymphatic flow and local recurrence. METHODS We retrospectively reviewed the medical records of 144 non-small cell lung cancer patients who underwent wedge resection between January 2006 and December 2014 at our institution. RESULTS Postoperative recurrence was observed in 36 patients (25%). Of these, local recurrence was observed in 29 patients (80.5%). The proportion of all recurrence and local recurrence were significantly higher among patients with lymphatic vessel invasion (LVI) (p < 0.0001). Recurrence-free survival rate was significantly lower in patients with LVI (24.8%) than in patients without LVI (80.2%, p < 0.0001). Multivariate logistic regression analysis demonstrated LVI (odds ratio = 6.420, p = 0.0009) as a significant predictor of local recurrence. CONCLUSIONS Intratumoral lymphatic invasion represents a major cause of local recurrence. Although we should aim for radical surgery whenever possible, when limited surgery is the only option, postoperative adjuvant treatment may need to be considered for patients showing lymphatic invasion even at an early stage.
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Prognostic impact of microscopic vessel invasion and visceral pleural invasion and their correlations with epithelial-mesenchymal transition, cancer stemness, and treatment failure in lung adenocarcinoma. Lung Cancer 2018; 128:13-19. [PMID: 30642445 DOI: 10.1016/j.lungcan.2018.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/29/2018] [Accepted: 12/03/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Microscopic vessel invasion (MVI) and visceral pleural invasion (VPI) have been recently reported as poor prognostic factors of non-small cell lung cancer. Epithelial-mesenchymal transition (EMT) and cancer stemness (CS) are known malignant phenotypes that induce resistance to cancer therapy. We aimed to assess the prognostic significance of MVI and the correlations among VPI/MVI, EMT, CS, and treatment failure for recurrent tumor. MATERIALS AND METHODS From 2002 to 2013, 1034 consecutive patients with pathological T1-4N0-2M0 lung adenocarcinoma underwent complete resection. Moreover, we established 206 tissue microarray (TMA) samples from 2002 to 2007. We then evaluated the prognostic impact of MVI, including conventional clinicopathological factors, and analyzed the VPI/MVI, EMT, CS, and treatment failure by TMA immunohistochemical staining. RESULTS Among the 1034 cases, the proportion of patients with a 5-year overall survival (OS) period was 63.9% and 88.2% (MVI: +/-; p < .001). Multivariate analysis revealed that both MVI and VPI were independent predictors of OS (HR 1.57 and 1.47, respectively). Significant separation of the OS rate curves was observed among the 3 groups [VPI/MVI: both positive (2), either positive (1), and both negative (0)]. Among the 206 TMA cases, these 3 groups of VPI/MVI were significantly correlated with EMT and CS. The median time to progression after recurrence were 3.8, 8.9, and 15.9 months, respectively (VPI/MVI: 2/1/0; p = 0.016). CONCLUSION MVI and VPI are significant prognostic factors of lung cancer, and they are correlated with EMT, CS, and treatment failure for recurrent tumor.
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Adjuvant chemotherapy may improve prognosis after resection of stage I lung cancer with lymphovascular invasion. J Thorac Cardiovasc Surg 2018; 156:2006-2015.e2. [DOI: 10.1016/j.jtcvs.2018.06.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 05/26/2018] [Accepted: 06/09/2018] [Indexed: 12/25/2022]
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Wang S, Zhang B, Qian J, Qiao R, Xu J, Zhang L, Zhao Y, Zhang Y, Wang R, Zhao R, Han B. Proposal on incorporating lymphovascular invasion as a T-descriptor for stage I lung cancer. Lung Cancer 2018; 125:245-252. [PMID: 30429028 DOI: 10.1016/j.lungcan.2018.09.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/12/2018] [Accepted: 09/29/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Lymphovascular invasion (LVI) and Visceral Pleural Invasion (VPI) have been reported to be risk factors for stage I Non-Small Cell Lung Cancer (NSCLC). However, only VPI was incorporated into the current 8th Tumor-Node-Metastasis (TNM) classification. This study aimed to explore the prognostic effect of LVI and VPI on TNM staging in pathological stage I NSCLC. METHOD We retrospectively reviewed 2633 consecutive p-stage I NSCLC patients in the Shanghai Chest Hospital (2008-2012). By using the Kaplan-Meier method and Cox proportional hazard regression model, we identified the correlations between LVI, VPI, and clinical outcomes in p-stage 1 NSCLC. RESULTS Of all 2633 p-stage I NSCLC patients, 222 were pathologically diagnosed with LVI and 836 pathologically with VPI. The 5-year recurrence free survival (RFS) and overall survival (OS) rates of patients with LVI was significantly worse compared to those without LVI (61.2% vs 82.0%, p < 0.001; 73.3% vs 88.1%, p < 0.001). The same results emerged for patients with VPI (70.1% vs 85.9%, p < 0.001; 82.3% vs 90.0%, p < 0.001). Using the univariable and multivariable analysis, we found that when tumor diameter was 3 cm or smaller, LVI (RFS: hazard ratio [HR], 2.54; 95% confidence interval [CI], 1.86-3.50; p < .001; OS: HR, 2.53; 95% CI, 1.72-3.71; p < .001) and VPI (RFS: HR, 2.14; 95% CI, 1.71-2.67; p < .001; OS: HR, 1.56; 95% CI, 1.12-2.04; p = 0.01) were significant prognostic factors for RFS and OS. When tumor size was between 3-4 cm, LVI (HR, 1.84; 95% CI, 1.03-3.29; p = 0.039) and VPI (HR, 2.56; 95% CI, 1.61-4.07; p < .001) were associated with inferior OS. CONCLUSIONS The presence of LVI significantly affected OS and RFS in stage I NSCLC patients. Our results suggested that it might be better to incorporate LVI as a T descriptor as VPI in the further TNM classification.
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Affiliation(s)
- Shuyuan Wang
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 230032, China
| | - Bo Zhang
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 230032, China
| | - Jie Qian
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 230032, China
| | - Rong Qiao
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 230032, China
| | - Jianlin Xu
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 230032, China
| | - Lele Zhang
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 230032, China
| | - Yiming Zhao
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 230032, China
| | - Yanwei Zhang
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 230032, China
| | - Rui Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, 230032, China
| | - Ruiying Zhao
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 230032, China
| | - Baohui Han
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 230032, China.
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Paracha N, Abdulla A, MacGilchrist KS. Systematic review of health state utility values in metastatic non-small cell lung cancer with a focus on previously treated patients. Health Qual Life Outcomes 2018; 16:179. [PMID: 30208899 PMCID: PMC6134713 DOI: 10.1186/s12955-018-0994-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 08/08/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Health state utility values (HSUVs) are an important input to economic evaluations and the choice of HSUV can affect the estimate of relative cost-effectiveness between interventions. This systematic review identified utility scores for patients with metastatic non-small cell lung cancer (mNSCLC), as well as disutilities or utility decrements relevant to the experience of patients with mNSCLC, by treatment line and health state. METHODS The MEDLINE®, Embase and Cochrane Library databases were systematically searched (September 2016) for publications describing HSUVs in mNSCLC in any treatment line. The EQ-5D website, the School of Health and Related Research Health Utilities Database (ScHARRHUD) and major pharmacoeconomic and clinical conferences in 2015-2016 were also queried. Studies in adults with previously treated mNSCLC were selected for further analysis. The information extracted included study design, description of treatment and health state, respondent details, instrument and tariff, HSUV or (dis) utility decrement estimates, quality of study, and appropriateness for use in economic evaluations. RESULTS Of 1883 references identified, 36 publications of 34 studies were included: 19 reported EQ-5D scores; eight reported HSUVs from valuations of vignettes made by members of the public using standard gamble (SG) or time trade-off (TTO); two reported SG or TTO directly elicited from patients; two reported EQ-5D visual analogue scale scores only; one reported Assessment of Quality of Life instrument scores; one reported HSUVs for caregivers to patients with mNSCLC using the 12-item Short-Form Health Survey; and one estimated HSUVs based on expert opinion. The range of HSUVs identified for comparable health states showed how differences in study type, tariff, health state and the measures used can drive variation in HSUV estimates. CONCLUSIONS This systematic review provides a set of published HSUVs that are relevant to the experience of adult patients previously treated for mNSCLC. Our review begins to address the challenge of identifying reliable estimates of utility values in mNSCLC that are suitable for use in economic evaluations, and also highlights how varying estimates result from differences in methodology.
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Affiliation(s)
| | - Ahmed Abdulla
- F. Hoffmann-La Roche AG, Basel, Switzerland
- Present address: Digipharm, Zug, Switzerland
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Abstract
The advent of the 8th edition of the lung cancer staging system reflects a further meticulous evidence-based advance in the stratification of the survival of patients with lung cancer. Although addressing many limitations of earlier staging systems, several limitations in staging remain. This article reviews from a radiological perspective the limitations of the current staging system, highlighting the process of TNM restructuring, the residual issues with regards to the assignment of T, N, M descriptors, and their associated stage groupings and how these dilemmas impact guidance of multidisciplinary teams taking care of patients with lung cancer.
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Affiliation(s)
- Ioannis Vlahos
- Department of Radiology, St. George's NHS Foundation Trust Hospitals and School of Medicine, St James' Wing, Blackshaw Road, London SW17 0QT, UK.
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Prognostic Effect of Lymphovascular Invasion on TNM Staging in Stage I Non–Small-cell Lung Cancer. Clin Lung Cancer 2018; 19:e109-e122. [DOI: 10.1016/j.cllc.2017.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 06/08/2017] [Accepted: 06/13/2017] [Indexed: 12/25/2022]
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Li Q, Balagurunathan Y, Liu Y, Qi J, Schabath MB, Ye Z, Gillies RJ. Comparison Between Radiological Semantic Features and Lung-RADS in Predicting Malignancy of Screen-Detected Lung Nodules in the National Lung Screening Trial. Clin Lung Cancer 2017; 19:148-156.e3. [PMID: 29137847 DOI: 10.1016/j.cllc.2017.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 08/16/2017] [Accepted: 10/04/2017] [Indexed: 01/10/2023]
Abstract
RATIONALE Lung computed tomography (CT) Screening Reporting and Data System (lung-RADS) has standardized follow-up and management decisions in lung cancer screening. To date, little is known how lung-RADS classification compares with radiological semantic features in risk prediction and diagnostic discrimination. OBJECTIVES To compare the performance of radiological semantic features and lung-RADS in predicting nodule malignancy in lung cancer screening. METHODS We used data and low-dose CT (LDCT) images from the National Lung Screening Trial (NLST). The training cohort contained 60 patients with screen-detected incident lung cancers who had a positive baseline screen (T0) that was not diagnosed and then was diagnosed at second follow-up (T2), and 139 nodule-positive controls who had 3 consecutive positive screens (T0 to T2) that were not diagnosed as lung cancer. The testing cohort included 40 patients with incident lung cancers that were diagnosed at first follow-up (T1) and 40 nodule-positive controls. Twenty-four semantic features were scored on a point scale from the LDCT images. Multivariable linear predictor model was built on the semantic features and the performances were compared with lung-RADS in 3 screening rounds. We also combined non-size-based semantic features with lung-RADS to improve malignancy detection. RESULTS At T0, the average area under the receiver operating characteristic curve (AUROC) for border definition in risk prediction was 0.72. The average AUROC for contour at T1 in risk prediction and T2 in diagnostic discrimination was 0.82 and 0.88, respectively. By comparison, the average AUROC of lung-RADS at T0, T1 and T2 were 0.60, 0.76 and 0.87, respectively. The combined model of the semantic features and lung-RADS shows improvement with AUROCs of 0.74, 0.88 and 0.96 at T0, T1, and T2, respectively, achieved by adding border definition (at T0) or contour (at T1 and T2). CONCLUSION We find semantic features defined by border definition and contour performed similar to lung-RADS at follow-up time point and outperformed lung-RADS at baseline. These semantics alongside of lung-RADS shows improved performance to detect malignancy.
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Affiliation(s)
- Qian Li
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China; Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center, Tampa, FL
| | | | - Ying Liu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Jin Qi
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China; Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Matthew B Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Zhaoxiang Ye
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
| | - Robert J Gillies
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center, Tampa, FL.
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Li Q, Kim J, Balagurunathan Y, Qi J, Liu Y, Latifi K, Moros EG, Schabath MB, Ye Z, Gillies RJ, Dilling TJ. CT imaging features associated with recurrence in non-small cell lung cancer patients after stereotactic body radiotherapy. Radiat Oncol 2017; 12:158. [PMID: 28946909 PMCID: PMC5613447 DOI: 10.1186/s13014-017-0892-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 09/14/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Predicting recurrence after stereotactic body radiotherapy (SBRT) in non-small cell lung cancer (NSCLC) patients is problematic, but critical for the decision of following treatment. This study aims to investigate the association of imaging features derived from the first follow-up computed tomography (CT) on lung cancer patient outcomes following SBRT, and identify patients at high risk of recurrence. METHODS Fifty nine biopsy-proven non-small cell lung cancer patients were qualified for this study. The first follow-up CTs were performed about 3 months after SBRT (median time: 91 days). Imaging features included 34 manually scored radiological features (semantics) describing the lesion, lung and thorax and 219 quantitative imaging features (radiomics) extracted automatically after delineation of the lesion. Cox proportional hazard models and Harrel's C-index were used to explore predictors of overall survival (OS), recurrence-free survival (RFS), and loco-regional recurrence-free survival (LR-RFS). Five-fold cross validation was performed on the final prognostic model. RESULTS The median follow-up time was 42 months. The model for OS contained Eastern Cooperative Oncology Group (ECOG) performance status (HR = 3.13, 95% CI: 1.17-8.41), vascular involvement (HR = 3.21, 95% CI: 1.29-8.03), lymphadenopathy (HR = 3.59, 95% CI: 1.58-8.16) and the 1st principle component of radiomic features (HR = 1.24, 95% CI: 1.02-1.51). The model for RFS contained vascular involvement (HR = 3.06, 95% CI: 1.40-6.70), vessel attachment (HR = 3.46, 95% CI: 1.65-7.25), pleural retraction (HR = 3.24, 95% CI: 1.41-7.42), lymphadenopathy (HR = 6.41, 95% CI: 2.58-15.90) and relative enhancement (HR = 1.40, 95% CI: 1.00-1.96). The model for LR-RFS contained vascular involvement (HR = 4.96, 95% CI: 2.23-11.03), lymphadenopathy (HR = 2.64, 95% CI: 1.19-5.82), circularity (F13, HR = 1.60, 95% CI: 1.10-2.32) and 3D Laws feature (F92, HR = 1.96, 95% CI: 1.35-2.83). Five-fold cross-validated the areas under the receiver operating characteristic curves (AUC) of these three models were all above 0.8. CONCLUSIONS Our analysis reveals disease progression could be prognosticated as early as 3 months after SBRT using CT imaging features, and these features would be helpful in clinical decision-making.
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Affiliation(s)
- Qian Li
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Huan-Hu-Xi Road, Ti-Yuan-Bei, He Xi District, Tianjin, 300060, China
| | - Jongphil Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Yoganand Balagurunathan
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jin Qi
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Huan-Hu-Xi Road, Ti-Yuan-Bei, He Xi District, Tianjin, 300060, China.,Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Ying Liu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Huan-Hu-Xi Road, Ti-Yuan-Bei, He Xi District, Tianjin, 300060, China
| | - Kujtim Latifi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Eduardo G Moros
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Matthew B Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Zhaoxiang Ye
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Huan-Hu-Xi Road, Ti-Yuan-Bei, He Xi District, Tianjin, 300060, China.
| | - Robert J Gillies
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Thomas J Dilling
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
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Li Q, Kim J, Balagurunathan Y, Liu Y, Latifi K, Stringfield O, Garcia A, Moros EG, Dilling TJ, Schabath MB, Ye Z, Gillies RJ. Imaging features from pretreatment CT scans are associated with clinical outcomes in nonsmall-cell lung cancer patients treated with stereotactic body radiotherapy. Med Phys 2017; 44:4341-4349. [PMID: 28464316 DOI: 10.1002/mp.12309] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 03/29/2017] [Accepted: 04/12/2017] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To investigate whether imaging features from pretreatment planning CT scans are associated with overall survival (OS), recurrence-free survival (RFS), and loco-regional recurrence-free survival (LR-RFS) after stereotactic body radiotherapy (SBRT) among nonsmall-cell lung cancer (NSCLC) patients. PATIENTS AND METHODS A total of 92 patients (median age: 73 yr) with stage I or IIA NSCLC were qualified for this study. A total dose of 50 Gy in five fractions was the standard treatment. Besides clinical characteristics, 24 "semantic" image features were manually scored based on a point scale (up to 5) and 219 computer-derived "radiomic" features were extracted based on whole tumor segmentation. Statistical analysis was performed using Cox proportional hazards model and Harrell's C-index, and the robustness of final prognostic model was assessed using tenfold cross validation by dichotomizing patients according to the survival or recurrence status at 24 months. RESULTS Two-year OS, RFS and LR-RFS were 69.95%, 41.3%, and 51.85%, respectively. There was an improvement of Harrell's C-index when adding imaging features to a clinical model. The model for OS contained the Eastern Cooperative Oncology Group (ECOG) performance status [Hazard Ratio (HR) = 2.78, 95% Confidence Interval (CI): 1.37-5.65], pleural retraction (HR = 0.27, 95% CI: 0.08-0.92), F2 (short axis × longest diameter, HR = 1.72, 95% CI: 1.21-2.44) and F186 (Hist-Energy-L1, HR = 1.27, 95% CI: 1.00-1.61); The prognostic model for RFS contained vessel attachment (HR = 2.13, 95% CI: 1.24-3.64) and F2 (HR = 1.69, 95% CI: 1.33-2.15); and the model for LR-RFS contained the ECOG performance status (HR = 2.01, 95% CI: 1.12-3.60) and F2 (HR = 1.67, 95% CI: 1.29-2.18). CONCLUSIONS Imaging features derived from planning CT demonstrate prognostic value for recurrence following SBRT treatment, and might be helpful in patient stratification.
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Affiliation(s)
- Qian Li
- Department of Radiology, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Jongphil Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Yoganand Balagurunathan
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Ying Liu
- Department of Radiology, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Kujtim Latifi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Olya Stringfield
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Alberto Garcia
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Eduardo G Moros
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.,Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Thomas J Dilling
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Matthew B Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Zhaoxiang Ye
- Department of Radiology, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Robert J Gillies
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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Shimada Y, Saji H, Kato Y, Kudo Y, Maeda J, Yoshida K, Hagiwara M, Matsubayashi J, Kakihana M, Kajiwara N, Ohira T, Ikeda N. The Frequency and Prognostic Impact of Pathological Microscopic Vascular Invasion According to Tumor Size in Non-Small Cell Lung Cancer. Chest 2016; 149:775-85. [DOI: 10.1378/chest.15-0559] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/17/2015] [Accepted: 08/10/2015] [Indexed: 11/01/2022] Open
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Moon Y, Sung SW, Lee KY, Kim YK, Park JK. The importance of the lepidic component as a prognostic factor in stage I pulmonary adenocarcinoma. World J Surg Oncol 2016; 14:37. [PMID: 26879575 PMCID: PMC4754885 DOI: 10.1186/s12957-016-0791-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 02/11/2016] [Indexed: 12/25/2023] Open
Abstract
Background Stage I pulmonary adenocarcinoma (PA) can offer an unfavorable prognosis. The aim of this study was to classify the prognosis of stage I PA on the basis of the lepidic component and to confirm whether the lepidic component can be used as a criterion for predicting the prognosis of stage I PA. Methods We conducted a retrospective study of patients who underwent curative surgery for stage I and IIA PA. Stage I disease was divided into three groups on the basis of the lepidic component: group 1, ≤10 %; group 2, >10 to 50 %; and group 3, >50 %. We compared recurrence-free survival (RFS) rates among groups 1, 2, and 3, and stage IIA disease. We also evaluated risk factors for disease recurrence with multivariate analysis. Results A total of 224 patients were included in our study; most patients (n = 201) had stage I disease. Three-year RFS rates in group 1 (n = 73), group 2 (n = 75), and group 3 (n = 53) were 74.1, 90.4, and 90.0 %, respectively. There was a significant difference in RFS between group 1 and group 2 (p = 0.009). The 3-year RFS rate in stage IIA disease was 61.4 %. There were no significant differences in RFS between group 1 and stage IIA disease (p = 0.163). In multivariate analysis, group 1 had the highest risk of recurrence (HR 5.806, p = 0.006) in stage I PA. Conclusions Stage I PA with a lepidic component ≤10 % was associated with an unfavorable prognosis that was similar to the prognosis of stage IIA disease. The prognosis for stage I PA should not be based on general criteria, but instead, the lepidic component should be evaluated and considered when determining disease prognosis.
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Affiliation(s)
- Youngkyu Moon
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sook Whan Sung
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Kyo Young Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Kyoon Kim
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Kil Park
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Patel AJ, Daniel G, Naidu B, Bishay E. The significance of microvascular invasion after complete resection of early-stage non-small-cell lung cancer: Table 1:. Interact Cardiovasc Thorac Surg 2015; 22:101-5. [DOI: 10.1093/icvts/ivv287] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 09/10/2015] [Indexed: 11/14/2022] Open
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Gulack BC, Yang CFJ, Speicher PJ, Meza JM, Gu L, Wang X, D'Amico TA, Hartwig MG, Berry MF. The impact of tumor size on the association of the extent of lymph node resection and survival in clinical stage I non-small cell lung cancer. Lung Cancer 2015; 90:554-60. [PMID: 26519122 DOI: 10.1016/j.lungcan.2015.10.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 10/04/2015] [Accepted: 10/05/2015] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Lymph node evaluation for node-negative non-small cell lung cancer (NSCLC) is associated with long-term survival but it is not clear if smaller tumors require as extensive a pathologic nodal assessment as larger tumors. This study evaluated the relationship of tumor size and optimal extent of lymph node resection using the National Cancer Data Base (NCDB). MATERIALS AND METHODS The incremental survival benefit of each additional lymph node that was evaluated for patients in the NCDB who underwent lobectomy for clinical Stage I NSCLC from 2003 to 2006 was evaluated using Cox multivariable proportional hazards regression modeling. The impact of tumor size was assessed by repeating the Cox analysis with patients stratified by tumor size ≥2 cm vs <2 cm. RESULTS A median of 7 [interquartile range: 4,11] lymph nodes were examined in 13,827 patients who met study criteria. Following adjustment, the evaluation of each additional lymph node demonstrated a significant survival benefit through 11 lymph nodes. After grouping patients by tumor size, patients with tumors <2 cm demonstrated a significant survival benefit for the incremental resection of each additional lymph node through 4 lymph nodes while patients with tumors ≥2 cm had a significant survival benefit through 14 lymph nodes. CONCLUSION Pathologic lymph node evaluation is associated with improved survival for clinically node-negative NSCLC, but the extent of the necessary evaluation varies by tumor size. These results have implications for guidelines for lymph node assessment as well as the choice of surgery vs other ablative techniques for clinical stage I NSCLC.
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Affiliation(s)
- Brian C Gulack
- Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Chi-Fu Jeffrey Yang
- Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Paul J Speicher
- Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | - James M Meza
- Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Lin Gu
- Department of Biostatistics, Duke University Medical Center, Durham, NC, United States
| | - Xiaofei Wang
- Department of Biostatistics, Duke University Medical Center, Durham, NC, United States
| | - Thomas A D'Amico
- Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Matthew G Hartwig
- Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Mark F Berry
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, United States.
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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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26
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Marquez-Medina D, Martin-Marco A, Caldero SG, Montero-Fernandez A. Little things make big things happen: angiolymphatic invasion and tumor necrosis prognosticate the outcome of locally advanced non-small cell lung cancer treated with a prior induction therapy. Am J Clin Pathol 2015; 143:889-94. [PMID: 25972332 DOI: 10.1309/ajcpyq8v3bxswrwg] [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] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Size, invasion of thoracic structures, and ipsilateral mediastinal lymph node involvement (pN2) are well-known prognostic factors that configure the staging of resectable, locally advanced non-small cell lung cancer (LA-NSCLC). The prognostic impact of angiolymphatic invasion (ALI) and tumor necrosis (TN) has been barely explored in LA-NSCLC treated with prior induction therapies. METHODS We retrospectively reviewed 47 resected LA-NSCLCs treated with a prior platin-based chemotherapy or chemoradiation. The impact of ALI, TN, and other pathologic features on survival was analyzed. RESULTS ALI was presented in 23.4% of cases and TN in 29.8%. Disease-free and overall survival decreased when ALI, TN, or pN2 was present. The incidence of ALI was lower in LA-NSCLC with a good response to induction. CONCLUSION Our series is the first to report the prognostic impact of ALI and TN in induction-treated LA-NSCLC. The presence of ALI and TN should be included in the pathologic reports.
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Affiliation(s)
- Diego Marquez-Medina
- Medical Oncology Department, Arnau de Vilanova University Hospital of Lleida, Lleida, Spain
| | - Antonio Martin-Marco
- Medical Oncology Department, Arnau de Vilanova University Hospital of Lleida, Lleida, Spain
| | - Sonia Gatius Caldero
- Pathology Department, Arnau de Vilanova University Hospital of Lleida, Lleida, Spain
| | - Angeles Montero-Fernandez
- Histopathology Department, Royal Brompton and Harefield NHS Trust Foundation and Imperial College of London, London, UK
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Li P, He HQ, Zhu CM, Ling YH, Hu WM, Zhang XK, Luo RZ, Yun JP, Xie D, Li YF, Cai MY. The prognostic significance of lymphovascular invasion in patients with resectable gastric cancer: a large retrospective study from Southern China. BMC Cancer 2015; 15:370. [PMID: 25947284 PMCID: PMC4435771 DOI: 10.1186/s12885-015-1370-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 04/25/2015] [Indexed: 12/26/2022] Open
Abstract
Background The focus of this study was to assess the impact of lymphovascular invasion (LVI) on both the recurrence of cancer and the long-term survival of Chinese patients with resectable gastric cancer (GC). Methods A retrospective analysis of the clinicopathological data for 1148 GC patients who had undergone gastrectomy with regional lymphadenectomy was performed. The primary objective was to assess the correlation between LVI and post-surgery outcomes for each patient. This was done by routine H & E staining for LVI on patients’ disease-free survival (DFS) and disease-specific survival (DSS). Results LVI was detected in 404 (35.2%) of the 1148 GC patients. The presence of LVI was significantly correlated with the level of CA19-9, the tumor size, the Lauren classification, tumor differentiation, gastric wall invasive depth, lymph node involvement, distant metastasis and an advanced TNM stage. There was a lower DFS and DSS in the patients with LVI as compared to the patients without LVI. A multivariate analysis also identified LVI as an independent prognostic factor of both DSS and DFS. Conclusions The presence of LVI is a risk factor for the recurrence of cancer and an independent indicator of a poor outcome in GC patients following surgery. The LVI status should be taken into consideration when determining the best approach for the treatment of the individual.
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Affiliation(s)
- Peng Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China. .,Department of Pathology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, 510060, Guangzhou, China.
| | - Hao-Qiang He
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China. .,Diagnostic Imaging and Intervening Center, Sun Yat-sen University Cancer Center, Guangzhou, China.
| | - Chong-Mei Zhu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China. .,Department of Pathology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, 510060, Guangzhou, China.
| | - Yi-Hong Ling
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China. .,Department of Pathology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, 510060, Guangzhou, China.
| | - Wan-Ming Hu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China. .,Department of Pathology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, 510060, Guangzhou, China.
| | - Xin-Ke Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China. .,Department of Pathology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, 510060, Guangzhou, China.
| | - Rong-Zhen Luo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China. .,Department of Pathology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, 510060, Guangzhou, China.
| | - Jing-Ping Yun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China. .,Department of Pathology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, 510060, Guangzhou, China.
| | - Dan Xie
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
| | - Yuan-Fang Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China. .,Department of Gastric & Pancreatic Surgery, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, 510060, Guangzhou, China.
| | - Mu-Yan Cai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China. .,Department of Pathology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, 510060, Guangzhou, China.
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Hamanaka R, Yokose T, Sakuma Y, Tsuboi M, Ito H, Nakayama H, Yamada K, Masuda R, Iwazaki M. Prognostic impact of vascular invasion and standardization of its evaluation in stage I non-small cell lung cancer. Diagn Pathol 2015; 10:17. [PMID: 25884820 PMCID: PMC4413537 DOI: 10.1186/s13000-015-0249-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 03/11/2015] [Indexed: 11/11/2022] Open
Abstract
Background Patients with pathologic stage (p-Stage) IA non-small cell lung cancer (NSCLC) have a good survival rate because of possible curative resection. However, up to 10% of these patients relapse postoperatively. To identify unfavorable prognostic factors, we retrospectively analyzed the clinicopathological features of p-Stage IA disease, focusing on vascular invasion. Methods Of 467 patients with p-Stage I NSCLC, 335 were diagnosed with p-Stage IA or IB disease based on a lesion size ≤3 cm and the presence of pleural invasion (PL). Univariate and multivariate analyses of recurrence-free survival (RFS) were performed with age, sex, PL, and vascular invasion (blood vessel invasion [v] and lymphatic vessel invasion [ly]) as variables. To examine vascular invasion, hematoxylin-eosin (HE), Elastica van Gieson staining, and immunostaining with anti-podoplanin antibody were performed. The presence or absence of v and ly was recorded; the number of involved vessels was counted. Survival rates were obtained using the Kaplan–Meier method and log-rank test. Multivariate analyses were performed using the Cox proportional hazards model. Results RFS differed significantly between patients with no or one involved blood vessel (0 v or 1 v) and those with ≥2 involved vessels (≥2 v). Similarly, RFS differed significantly between patients with no lymphatic vessel involvement (0 ly) and those with one involved lymphatic vessel (1 ly). Thus, BVI(+) and BVI(−) were defined as ≥2 v and 0 v + 1 v, and LVI(+) and LVI(−) as ≥1 ly and 0 ly, respectively. BVI and LVI together represented tumor vessel invasion (TVI). On multivariate analyses, PL and TVI were independently associated with recurrence. Additionally, patients with p-Stage IA TVI(+) disease had a comparable recurrence rate to those with p-Stage IB disease. Conclusions Similar to PL, TVI is an important factor increasing the likelihood of recurrence. As HE staining alone is insufficient for evaluating vascular invasion, specific staining is necessary. Moreover, patients with p-Stage IA TVI(+) disease had a recurrence rate comparable to those with p-Stage IB disease; therefore, further studies should aim to elucidate whether patients with p-Stage IA TVI(+) disease should be administered postoperative chemotherapy similar to that received by p-Stage IB patients. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/5213064891369688
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Affiliation(s)
- Rurika Hamanaka
- Department of Thoracic Oncology, Kanagawa Cancer Center Hospital, Yokohama, Japan. .,Division of General Thoracic Surgery, Department of Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
| | - Tomoyuki Yokose
- Department of Pathology, Kanagawa Cancer Center Hospital, 2-3-2 Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan.
| | - Yuji Sakuma
- Department of Pathology, Kanagawa Cancer Center Hospital, 2-3-2 Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan.
| | - Masahiro Tsuboi
- Division of Thoracic Surgery, Respiratory Disease Center Yokohama City University Medical Center, 4-57 Urafune, Minami-Ku, Yokohama, Kanagawa, 232-0024, Japan.
| | - Hiroyuki Ito
- Department of Thoracic Oncology, Kanagawa Cancer Center Hospital, Yokohama, Japan.
| | - Haruhiko Nakayama
- Department of Thoracic Oncology, Kanagawa Cancer Center Hospital, Yokohama, Japan.
| | - Kouzo Yamada
- Department of Thoracic Oncology, Kanagawa Cancer Center Hospital, Yokohama, Japan.
| | - Ryota Masuda
- Division of General Thoracic Surgery, Department of Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
| | - Masayuki Iwazaki
- Division of General Thoracic Surgery, Department of Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
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Massuti B, Sanchez JM, Hernando-Trancho F, Karachaliou N, Rosell R. Are we ready to use biomarkers for staging, prognosis and treatment selection in early-stage non-small-cell lung cancer? Transl Lung Cancer Res 2015; 2:208-21. [PMID: 25806234 DOI: 10.3978/j.issn.2218-6751.2013.03.06] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 03/11/2013] [Indexed: 01/16/2023]
Abstract
Lung cancer accounts for the majority of cancer-related deaths worldwide. At present, platinum-based therapy represents the standard of care in fit stage II and IIIA non-small cell lung cancer (NSCLC) patients following surgical resection. In advanced disease, personalized chemotherapy and targeted biologic therapy based on histological and molecular tumor profiling have already shown promise in terms of optimizing treatment efficacy. While disease stage is associated with outcome and is commonly used to determine adjuvant treatment eligibility, it is known that a subset of patients with early stage disease experience shorter survival than others with the same clinicopathological characteristics. Improved methods for identifying these individuals, at or near the time of initial diagnosis, may inform the decision to pursue adjuvant therapy options. Among the numerous candidate molecular biomarkers, only few gene-expression profiling signatures provide clinically relevant information, while real-time quantitative polymerase-chain reaction (RT-qPCR) strategy involving relatively small numbers of genes offers a practical alternative with high cross-platform performance. mRNA and/or protein expression levels of excision repair cross-complementation group 1 (ERCC1), ribonucleotide reductase M subunit 1 (RRM1) and breast cancer susceptibility gene 1 (BRCA1) are among the most promising potential biomarkers for early disease and their clinical utility is currently being evaluated in randomized phase II and III clinical trials. This review describes the most promising clinicopathological and molecular biomarkers with predictive and prognostic significance in lung cancer that have been identified through advanced research and which could influence adjuvant and neoadjuvant chemotherapy decisions for operable NSCLC in routine clinical practice.
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Affiliation(s)
| | | | | | - Niki Karachaliou
- Breakthrough Cancer Research Unit, Pangaea Biotech S.L, Barcelona, Spain
| | - Rafael Rosell
- Breakthrough Cancer Research Unit, Pangaea Biotech S.L, Barcelona, Spain ; ; Catalan Institute of Oncology, Badalona, Spain
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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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Moon Y, Kim KS, Sung SW, Lee KY, Kim YK, Kang JH, Kim YS, Park JK. Correlation of histological components with tumor invasion in pulmonary adenocarcinoma. World J Surg Oncol 2014; 12:388. [PMID: 25519483 PMCID: PMC4301793 DOI: 10.1186/1477-7819-12-388] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 12/13/2014] [Indexed: 01/15/2023] Open
Abstract
Background Pulmonary adenocarcinoma (PA) is the most common histologic type of primary lung cancer. Generally, adenocarcinoma was composed by five major components. The present study aimed to evaluate changes in the composition of adenocarcinoma components as the tumor grows; in addition, to analyze the correlation between the occupancy rates of histologic components of the tumor in regard to prognosis. Methods Pathologic data were retrospectively evaluated for 206 patients who underwent curative resection of PA. We investigated how histologic component occupancy rates changed as tumor size and N stage increased. To evaluate local invasiveness, the major components of the present group and absent group of pleural invasion, lymphatic invasion, and vascular invasion were compared. Results The mean percentages of acinar and solid components significantly increased with an increase in size (P = 0.006, P < 0.001) ; however, the percentage of lepidic components decreased (P < 0.001). In cases with a solid component and a micropapillary component, a gradual increase was found with an increase N stage (P = 0.001, P < 0.001); however the percentage of lepidic components decreased (P < 0.001). Average differences of histologic components dependent upon whether pleural, lympathic and vascular invasion were present, the difference of micropapillary and lepidic components were statistically significant. With logistic regression analysis, as the occupancy rate of the lepidic component increased, the probability of pleural invasion, lymphatic invasion, and vascular invasion decreased; in cases with a micropapillary component, as the occupancy rate of increased, the probability of lymphatic invasion and vascular invasion increased. In multivariate analysis using the Cox propotional hazards model, the occupancy rates of acinar(p = 0.043; odds ratio = 1.023), micropapillary(p = 0.002; odds ratio = 1.051) and lepidic (p = 0.005; odds ratio = 0.966) components were significantly associated with recurrence. Conclusions The lower the occupancy rate of a lepidic component and the higher the occupancy rates of acinar, solid, and micropapillary components, the likelihood of tumor progression increased. In addition, as the occupancy rate of a lepidic component decreased and a micropapillary component increased, local invasiveness and recurrence rate increased; thus, increasing the probability of a poor prognosis.
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Affiliation(s)
| | | | | | | | | | | | | | - Jae Kil Park
- Department of Thoracic & Cardiovascular Surgery, The Catholic University of Korea, Seoul St, Mary's Hospital, Seoul, Republic of Korea.
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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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Impact of extratumoral lymphatic permeation on postoperative survival of non-small-cell lung cancer patients. J Thorac Oncol 2014; 9:337-44. [PMID: 24496002 PMCID: PMC4132028 DOI: 10.1097/jto.0000000000000073] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Lymphatic permeation has been reported as a prognostic factor for patients with resected non–small-cell lung cancer (NSCLC). Lymphatic canals are located in both intratumoral and extratumoral areas. Since 2001, we have prospectively evaluated lymphatic permeation based on its location. The purpose of this study was to determine the survival impact of extratumoral lymphatic permeation in patients with resected NSCLC by analyzing the long-term follow-up data. Methods: We reviewed 1069 consecutive patients with NSCLC who underwent complete resection between 2001 and 2006. Lymphatic permeation was classified as follows: ly0, absence of lymphatic permeation; ly1, intratumoral; and ly2, extratumoral. Results: There were 845 patients (79%) with ly0, 134 (12%) with ly1, and 90 (9%) with ly2. Ly2 was more frequently observed in patients with advanced disease and intrapulmonary metastases than ly0–1. The 5-year overall survival (OS) rates of the ly0, ly1, and ly2 groups were 75%, 63%, and 34%, respectively. The OS rate was significantly worse in the ly2 group compared with OS rate in the ly0 (p < 0.01) and ly1 groups (p < 0.01). In multivariate analyses, ly2 proved to be an independent poor prognostic factor (hazard ratio, 1.73; p < 0.01). OS and recurrence-free survival of patients with T1 and T2 tumors with ly2 were not statistically different from that of the patients with T3 tumor (OS, p = 0.43 and p = 0.77; recurrence-free survival, p = 0.94 and p = 0.94, respectively). Conclusions: The adverse prognostic impact of lymphatic permeation was remarkably different whether it is detected in intratumoral or extratumoral lymphatic canals. We recommend that lymphatic permeation in resected NSCLC should be evaluated by considering its location.
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Mollberg NM, Bennette C, Howell E, Backhus L, Devine B, Ferguson MK. Lymphovascular Invasion as a Prognostic Indicator in Stage I Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis. Ann Thorac Surg 2014; 97:965-71. [DOI: 10.1016/j.athoracsur.2013.11.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 10/28/2013] [Accepted: 11/01/2013] [Indexed: 11/26/2022]
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Differences in the prognostic implications of vascular invasion between lung adenocarcinoma and squamous cell carcinoma. Lung Cancer 2013; 82:407-12. [DOI: 10.1016/j.lungcan.2013.09.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 08/19/2013] [Accepted: 09/04/2013] [Indexed: 11/22/2022]
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Nentwich MF, Bohn BA, Uzunoglu FG, Reeh M, Quaas A, Grob TJ, Perez D, Kutup A, Bockhorn M, Izbicki JR, Vashist YK. Lymphatic invasion predicts survival in patients with early node-negative non–small cell lung cancer. J Thorac Cardiovasc Surg 2013; 146:781-7. [DOI: 10.1016/j.jtcvs.2013.04.037] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Revised: 04/14/2013] [Accepted: 04/24/2013] [Indexed: 11/30/2022]
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Shimada Y, Saji H, Yoshida K, Kakihana M, Honda H, Nomura M, Usuda J, Kajiwara N, Ohira T, Ikeda N. Prognostic factors and the significance of treatment after recurrence in completely resected stage I non-small cell lung cancer. Chest 2013; 143:1626-1634. [PMID: 23348916 DOI: 10.1378/chest.12-1717] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE The objective of this study was to identify the clinicopathologic factors influencing postrecurrence survival (PRS) in and the effect of postrecurrence therapy (PRT) on patients with completely resected stage I non-small cell lung cancer (NSCLC). METHODS We reviewed the data of 919 patients in whom complete resection of stage I NSCLC had been performed. RESULTS Of the 919 patients, 170 (18.5%) had recurrent disease. Initial PRT was performed in 118 patients (69.1%) (surgery in eight, chemotherapy in 79, radiotherapy in 10, and chemoradiotherapy in 21). On multivariate analyses, PRT (hazard ratio [HR], 0.542; 95% CI, 0.344-0.853; P = .008), female sex (HR, 0.487; 95% CI, 0.297-0.801; P = .005), and differentiation (HR, 1.810; 95% CI, 1.194-2.743; P = .005) demonstrated a statistically significant association with favorable PRS. Bone metastasis (HR, 3.288; 95% CI, 1.783-6.062; P < .001), liver metastasis (HR, 4.518; 95% CI, 1.793-11.379; P = .001), chemotherapy (HR, 0.478; 95% CI, 0.236-0.975; P = .040), epidermal growth factor receptor-tyrosine kinase inhibitors treatment (EGFR-TKIs) (HR, 0.460; 95% CI, 0.245-0.862; P = .015), and nonadenocarcinoma (HR, 2.136; 95% CI, 1.273-3.585; P = .004) were independently and significantly associated with PRS in the 118 patients who underwent any PRT. Subgroup analysis with a combination of these five PRS factors in the patients who underwent any PRT revealed median PRS times of 42.4 months for 20 patients lacking all five risk factors and 18.8 months for 98 patients with at least one of these risk factors (P = .001). CONCLUSIONS PRT, sex, and differentiation were independently associated with PRS. In the patients who underwent any PRT, PRS was related to EGFR-TKIs, chemotherapy, histology, and initial recurrence sites. One challenge for the future will be to create systematic treatment strategies for recurrent NSCLC according to the risk factor status of individual patients.
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Affiliation(s)
- Yoshihisa Shimada
- Department of Surgery I, Tokyo Medical University Hospital, Tokyo, Japan.
| | - Hisashi Saji
- Department of Surgery I, Tokyo Medical University Hospital, Tokyo, Japan
| | - Koichi Yoshida
- Department of Surgery I, Tokyo Medical University Hospital, Tokyo, Japan
| | - Masatoshi Kakihana
- Department of Surgery I, Tokyo Medical University Hospital, Tokyo, Japan
| | - Hidetoshi Honda
- Department of Surgery I, Tokyo Medical University Hospital, Tokyo, Japan
| | - Masaharu Nomura
- Department of Surgery I, Tokyo Medical University Hospital, Tokyo, Japan
| | - Jitsuo Usuda
- Department of Surgery I, Tokyo Medical University Hospital, Tokyo, Japan
| | - Naohiro Kajiwara
- Department of Surgery I, Tokyo Medical University Hospital, Tokyo, Japan
| | - Tatsuo Ohira
- Department of Surgery I, Tokyo Medical University Hospital, Tokyo, Japan
| | - Norihiko Ikeda
- Department of Surgery I, Tokyo Medical University Hospital, Tokyo, Japan
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Kudo Y, Saji H, Shimada Y, Matsubayashi J, Nagao T, Kakihana M, Usuda J, Kajiwara N, Ohira T, Ikeda N. Proposal on incorporating blood vessel invasion into the T classification parts as a practical staging system for stage I non-small cell lung cancer. Lung Cancer 2013; 81:187-93. [DOI: 10.1016/j.lungcan.2013.04.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 04/10/2013] [Accepted: 04/14/2013] [Indexed: 02/08/2023]
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Bergman P, Brodin D, Lewensohn R, de Petris L. Validation of the 7th TNM classification for non-small cell lung cancer: a retrospective analysis on prognostic implications for operated node-negative cases. Acta Oncol 2013; 52:1189-94. [PMID: 23215828 DOI: 10.3109/0284186x.2012.742960] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The 7th TNM staging system for non-small cell lung cancer (NSCLC) developed by the International Association for the study of Lung Cancer (IASLC) has been applied in Sweden since the beginning of the year 2010. The aim of this retrospective study was to evaluate the prognostic role of the 7th TNM staging system in a surgical Swedish patient cohort with node-negative NSCLC. MATERIAL AND METHODS We collected data from stage I patients (pT1-2 pN0, 6th TNM system) who underwent surgery for NSCLC at Karolinska University Hospital from 1987 to 2002. Tumors were restaged according to the 7th TNM version. Cox multivariate survival analysis was implemented in order to determine the prognostic impact of pathological stage when classified according to either the 6th or the 7th TNM systems. RESULTS The patient population consisted of 452 subjects. Tumor size was ≤ 3 cm in 51% of cases. The predominant histology was adenocarcinoma (53%) and lobectomy was the most common surgical procedure (82% of patients). The five-year survival rate in patients with stage IA vs. IB (6th TNM) was 62% vs. 51%, respectively (log-rank p = 0.036). Corresponding figures for the 7th TNM system were 70% in stage IA-T1a, 51% in stage IA-T1b, 54% in stage IB, 51% in stage IIA and 35% in stage IIB (log-rank p = 0.002). On multivariate analysis, adjusted by age, gender, histology, kind of surgery, grade of differentiation and smoking status, pathological stage was an independent prognostic factor if classified according to the 7th TNM version (p = 0.001), but not if scored according to the 6th TNM edition (p = 0.090). CONCLUSION The 7th TNM classification system is a more accurate predictor of prognosis in stage I operated patients than the old classification. The new system should be implemented even on retrospective cohorts especially when investigating the prognostic implication of the expression of molecular biomarkers.
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Affiliation(s)
- Per Bergman
- Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital Solna, Stockholm, Sweden.
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Washington I, Chino JP, Marks LB, D'Amico TA, Berry MF, Ready NE, Higgins KA, Yoo DS, Kelsey CR. Diabetes mellitus: A significant co-morbidity in the setting of lung cancer? Thorac Cancer 2013; 4:123-130. [DOI: 10.1111/j.1759-7714.2012.00162.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Strano S, Lupo A, Lococo F, Schussler O, Loi M, Younes M, Bobbio A, Damotte D, Regnard JF, Alifano M. Prognostic Significance of Vascular and Lymphatic Emboli in Resected Pulmonary Adenocarcinoma. Ann Thorac Surg 2013; 95:1204-10. [DOI: 10.1016/j.athoracsur.2012.12.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 12/03/2012] [Accepted: 12/07/2012] [Indexed: 11/16/2022]
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A pooled exploratory analysis of the effect of tumor size and KRAS mutations on survival benefit from adjuvant platinum-based chemotherapy in node-negative non-small cell lung cancer. J Thorac Oncol 2012; 7:963-72. [PMID: 22588152 DOI: 10.1097/jto.0b013e31824fe9e6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The staging of node-negative non-small-cell lung cancer is modified in the 7th edition TNM classification. Here, we pool data from the National Cancer Institute of Canada Clinical Trials Group JBR.10 trial and the Cancer and Leukemia Group B-9633 trial to explore the prognostic and predictive effects of the new T-size descriptors and KRAS mutation status. METHODS Node-negative patients were reclassified as T2a (>3-≤5 cm), T2b (>5-≤7 cm), T3 (>7 cm) or T ≤ 3 cm (≤3 cm, but other T2 characteristics). RESULTS Of 538 eligible patients, 288 (53.5%) were T2a, 111 (21%) T2b, 62 (11.5%) T3, whereas 77 (14%) T≤3 cm were excluded to avoid confounding. KRAS mutations were detected in 104 of 390 patients (27%). T-size was prognostic for disease-free survival (p = 0.03), but borderline for overall survival (OS; p = 0.10), on multivariable analysis. Significant interaction between the prognostic value of KRAS and tumor size was observed for OS (p = 0.01), but not disease-free survival (p = 0.10). There was a nonsignificant trend (p = 0.24) for increased chemotherapy effect on OS with advancing T-size (hazard ratio [HR] T2a 0.90, [0.63-1.30]; T2b 0.69, [0.38-1.24]; and T3 0.57, [0.28-1.17]). The HR for chemotherapy effect on OS in T2a patients with KRAS wild-type tumors was 0.81 (p = 0.36), whereas a trend for detrimental effect was observed in those with mutant tumors (HR 2.11; p = 0.09; interaction p = 0.05). Similar trends were observed in T2b to T3 patients with wild-type (HR 0.86; p = 0.62), and KRAS mutant tumors (HR 1.16; p = 0.74; interaction p = 0.58). CONCLUSION Chemotherapy effect seems to increase with tumor size. However, this small study could not identify subgroups of patients who did or did not derive significant benefit from adjuvant chemotherapy based on T-size or KRAS status.
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Hishida T, Yoshida J, Maeda R, Ishii G, Aokage K, Nishimura M, Nagai K. Prognostic impact of intratumoural microvascular invasion and microlymphatic permeation on node-negative non-small-cell lung cancer: which indicator is the stronger prognostic factor? Eur J Cardiothorac Surg 2012; 43:772-7. [PMID: 22864791 DOI: 10.1093/ejcts/ezs396] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Microvascular invasion and microlymphatic permeation are indicators of microscopic tumour invasion into small vessels and have been considered to be powerful prognostic indicators for non-small-cell lung cancer (NSCLC). Several studies have suggested that these should be included in the TNM classification, but, there have been conflicting results regarding the prognostic impact of microvascular invasion and microlymphatic permeation. The aim of the current study was to clarify the prognostic impact of microvascular invasion and microlymphatic permeation on resected node-negative NSCLC by comparative analyses. METHODS We reviewed the data of 1039 consecutive patients with pathological size-based stage T1a-3N0M0 NSCLC who underwent lobectomy or greater resection between 1993 and 2005. The median follow-up period was 108 months. Microvascular invasion and microlymphatic permeation were identified by the Victoria blue-van Gieson staining. The overall survival was then analysed. RESULTS Microvascular invasion and microlymphatic permeation were observed in 358 (34.5%) and 205 (19.7%) of patients, respectively. Both microvascular invasion and microlymphatic permeation were more prevalent in non-adenocarcinoma and larger-sized tumours. The 5-year overall survival rate of the microvascular invasion-positive group and microlymphatic permeation-positive group were 69.2 and 84.6%, respectively, and the difference was statistically significant (P = 0.002). On multivariate analyses, microvascular invasion, but not microlymphatic permeation, was an independent prognostic factor (microvascular invasion, hazard ratio [HR] 1.648, P = 0.001; microlymphatic permeation, HR 1.138, P = 0.588). The 5-year overall survival rate of either the microvascular invasion- or microlymphatic permeation-positive T1a-b group was significantly lower than that of the corresponding double-negative (dn) T1a-b group (dnT1a-b, 93.7%; microvascular invasion-positive T1a-b, 85.2%, P < 0.001; microlymphatic permeation-positive T1a-b, 85.4%, P = 0.014), and overlapped to that of the dnT2a group (84.8%). However, in the T2a-b group, only microvascular invasion-positive T2a-b patients showed significantly lower overall survival than dnT2a-b patients, and their overall survival overlapped that of dnT3 patients (dn T2a-b, 83.5%; microvascular invasion-positive T2a-b, 60.6%, P < 0.001; dnT3, 53.8%; P = 0.316). The 5-year overall survival of microlymphatic permeation-positive T2a-b patients (86.2%) did not statistically differ from that of dnT2a-b patients (P = 0.856). CONCLUSIONS Microvascular invasion and microlymphatic permeation have different impact on survival, and microvascular invasion rather than microlymphatic permeation is a strong prognostic factor in resected node-negative NSCLC. Microvascular invasion and microlymphatic permeation should be examined separately by elastic staining.
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Affiliation(s)
- Tomoyuki Hishida
- Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan.
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Pathological Vascular Invasion and Tumor Differentiation Predict Cancer Recurrence in Stage ia Non–Small-Cell Lung Cancer After Complete Surgical Resection. J Thorac Oncol 2012; 7:1263-70. [DOI: 10.1097/jto.0b013e31825cca6e] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bonomi M, Pilotto S, Milella M, Massari F, Cingarlini S, Brunelli M, Chilosi M, Tortora G, Bria E. Adjuvant chemotherapy for resected non-small-cell lung cancer: future perspectives for clinical research. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2011; 30:115. [PMID: 22206620 PMCID: PMC3284429 DOI: 10.1186/1756-9966-30-115] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 12/29/2011] [Indexed: 12/26/2022]
Abstract
Adjuvant chemotherapy for non-small-cell lung carcinoma (NSCLC) is a debated issue in clinical oncology. Although it is considered a standard for resected stage II-IIIA patients according to the available guidelines, many questions are still open. Among them, it should be acknowledged that the treatment for stage IB disease has shown so far a limited (if sizable) efficacy, the role of modern radiotherapies requires to be evaluated in large prospective randomized trials and the relative impact of age and comorbidities should be weighted to assess the reliability of the trials' evidences in the context of the everyday-practice. In addition, a conclusive evidence of the best partner for cisplatin is currently awaited as well as a deeper investigation of the fading effect of chemotherapy over time. The limited survival benefit since first studies were published and the lack of reliable prognostic and predictive factors beyond pathological stage, strongly call for the identification of bio-molecular markers and classifiers to identify which patients should be treated and which drugs should be used. Given the disappointing results of targeted therapy in this setting have obscured the initial promising perspectives, a biomarker-selection approach may represent the basis of future trials exploring adjuvant treatment for resected NSCLC.
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Affiliation(s)
- Maria Bonomi
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
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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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Overexpression of the mammalian target of rapamycin (mTOR) and angioinvasion are poor prognostic factors in early stage NSCLC: a verification study. Lung Cancer 2011; 75:217-22. [PMID: 21802763 DOI: 10.1016/j.lungcan.2011.06.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 06/04/2011] [Accepted: 06/27/2011] [Indexed: 01/04/2023]
Abstract
BACKGROUND A recent study by Dhillon et al. [12], identified both angioinvasion and mTOR as prognostic biomarkers for poor survival in early stage NSCLC. The aim of this study was to verify the above study by examining the angioinvasion and mTOR expression profile in a cohort of early stage NSCLC patients and correlate the results to patient clinico-pathological data and survival. METHODS Angioinvasion was routinely recorded by the pathologist at the initial assessment of the tumor following resection. mTOR was evaluated in 141 early stage (IA-IIB) NSCLC patients (67 - squamous; 60 - adenocarcinoma; 14 - others) using immunohistochemistry (IHC) analysis with an immunohistochemical score (IHS) calculated (% positive cells×staining intensity). Intensity was scored as follows: 0 (negative); 1+ (weak); 2+ (moderate); 3+ (strong). The range of scores was 0-300. Based on the previous study a cut-off score of 30 was used to define positive versus negative patients. The impact of angioinvasion and mTOR expression on prognosis was then evaluated. RESULTS 101 of the 141 tumors studied expressed mTOR. There was no difference in mTOR expression between squamous cell carcinoma and adenocarcinoma. Angioinvasion (p=0.024) and mTOR staining (p=0.048) were significant univariate predictors of poor survival. Both remained significant after multivariate analysis (p=0.037 and p=0.020, respectively). CONCLUSIONS Our findings verify angioinvasion and mTOR expression as new biomarkers for poor outcome in patients with early stage NSCLC. mTOR expressing patients may benefit from novel therapies targeting the mTOR survival pathway.
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Durand M. Lymph node involvement in T1 non-small-cell lung cancer: do not miss radical lymphadenectomy. Eur J Cardiothorac Surg 2011; 41:467-8; author reply 468-9. [PMID: 21664140 DOI: 10.1016/j.ejcts.2011.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 04/06/2011] [Accepted: 04/26/2011] [Indexed: 11/24/2022] Open
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