1
|
Imai K, Kurihara N, Konno M, Mori N, Takashima S, Kuriyama S, Demura R, Suzuki H, Harata Y, Fujibayashi T, Shibano S, Wakita A, Nagaki Y, Sato Y, Nomura K, Minamiya Y. Does clinical T1N0 GGN really require checking for distant metastasis during initial staging for lung cancer? Cancer Imaging 2024; 24:69. [PMID: 38831467 PMCID: PMC11149246 DOI: 10.1186/s40644-024-00714-7] [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: 09/29/2023] [Accepted: 05/28/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Accurate clinical staging is crucial for selection of optimal oncological treatment strategies in non-small cell lung cancer (NSCLC). Although brain MRI, bone scintigraphy and whole-body PET/CT play important roles in detecting distant metastases, there is a lack of evidence regarding the indication for metastatic staging in early NSCLCs, especially ground-grass nodules (GGNs). Our aim was to determine whether checking for distant metastasis is required in cases of clinical T1N0 GGN. METHODS This was a retrospective study of initial staging using imaging tests in patients who had undergone complete surgical R0 resection for clinical T1N0 Stage IA NSCLC. RESULTS A total of 273 patients with cT1N0 GGNs (n = 183) or cT1N0 solid tumors (STs, n = 90) were deemed eligible. No cases of distant metastasis were detected on initial routine imaging evaluations. Among all cT1N0M0 cases, there were 191 incidental findings on various modalities (128 in the GGN). Most frequently detected on brain MRI was cerebral leukoaraiosis, which was found in 98/273 (35.9%) patients, while cerebral infarction was detected in 12/273 (4.4%) patients. Treatable neoplasms, including brain meningioma and thyroid, gastric, renal and colon cancers were also detected on PET/CT (and/or MRI). Among those, 19 patients were diagnosed with a treatable disease, including other-site cancers curable with surgery. CONCLUSIONS Extensive staging (MRI, scintigraphy, PET/CT etc.) for distant metastasis is not required for patients diagnosed with clinical T1N0 GGNs, though various imaging modalities revealed the presence of adventitious diseases with the potential to increase surgical risks, lead to separate management, and worsen patient outcomes, especially in elderly patients. If clinically feasible, it could be considered to complement staging with whole-body procedures including PET/CT.
Collapse
Affiliation(s)
- Kazuhiro Imai
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
| | - Nobuyasu Kurihara
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Motoko Konno
- Department of Radiology, Akita University Graduate School of Medicine, Akita, Japan
| | - Naoko Mori
- Department of Radiology, Akita University Graduate School of Medicine, Akita, Japan
| | - Shinogu Takashima
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Shoji Kuriyama
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Ryo Demura
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Haruka Suzuki
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Yuzu Harata
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Tatsuki Fujibayashi
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Sumire Shibano
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Akiyuki Wakita
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Yushi Nagaki
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Yusuke Sato
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Kyoko Nomura
- Department of Health Environmental Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshihiro Minamiya
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| |
Collapse
|
2
|
Stefanidis K, Bellos I, Konstantelou E, Yusuf G, Hardavella G, Jacob T, Goldman A, Senbanjo T, Vlahos I. 18F-FDG PET/CT anatomic and metabolic guidance in CT-guided lung biopsies. Eur J Radiol 2024; 171:111315. [PMID: 38237515 DOI: 10.1016/j.ejrad.2024.111315] [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: 04/20/2023] [Revised: 08/21/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To evaluate the role of Fluorine-18 fluorodeoxyglucose (18F-FDG) PET/CT as a metabolic guide in increasing the accuracy, diagnostic yield and safety of CT-guided percutaneous needle lung biopsy (PNB). METHODS AND MATERIALS Retrospective analysis of 340 consecutive patients with suspicious lung nodules, masses or extensive disease that underwent lung biopsy over a 3-year period. Patients were divided into three groups; those that had PET/CT prior to the biopsy, those that had PET-CT following the biopsy and those who did not undergo PET-CT. Correlation was made with the histopathological result. RESULTS 353 PNBs were performed (median lesion size 30 mm, 7-120 mm) with overall diagnostic rate of 83.9 % (95.8 % malignant). Biopsy success rate was 88.8 % with PET-CT pre-PNB, versus 78.9 % of 175 PNB without PET-CT upfront (p < 0.01 Fisher exact test). Correct targeting to PET-CT-maximum activity area (MAA) was present in 87.1 %. Biopsy success rate was 88.8 % for PNBs targeting the PET-CT-MAA region and only 52.8 % for PNBs not targeting the PET-CT-MAA (p < 0.0001). PET-CT pre-PNB had higher rates of PET-CT-MAA targeting compared to PET-CT post PNB (91.0 % v 80.0 %, p = 0.01). The availability of PET-CT before the PNB lead to significantly increased biopsy success rates in patients with a mass (OR:7.01p = 0.004), compared to a nodule (p = 0.498) or multiple nodules (p = 0.163). Patients with a PET-CT pre-PNB underwent fewer PNB passes (mean 2.6 v 3.1, p < 0.0001 Mann Whitney U). Serious complications were less common in PET-CT pre-PNB group (4.5 % v 10.9 %, p < 0.05). Pre-PNB PET-CT performance improvement applied to all 3 radiologists and was greatest for masses and infiltrative abnormalities. CONCLUSION Metabolic information provided by 18F-FDG PET/CT and PNB localisation to the PET-CT maximum activity region is associated with higher diagnostic biopsy rates especially in masses and appears to account for improved performance, less needle passes and complications when available pre-biopsy.
Collapse
Affiliation(s)
| | - Ioannis Bellos
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece
| | | | - Gibran Yusuf
- Radiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Georgia Hardavella
- 9(th) Department of Respiratory Medicine, "Sotiria" Athens Chest Diseases Hospital, Athens, Greece
| | - Teresa Jacob
- Radiology Department, St George's Hospital, NHS Foundation Trust, London, UK
| | - Anouscka Goldman
- Radiology Department, St George's Hospital, NHS Foundation Trust, London, UK
| | - Taiwo Senbanjo
- Radiology Department, Epsom and St Helier, NHS Foundation Trust, London, UK
| | - Ioannis Vlahos
- Department of Thoracic Radiology, Division of Diagnostic Imaging. University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
3
|
Sætre LMS, Rasmussen S, Balasubramaniam K, Søndergaard J, Jarbøl DE. A population-based study on social inequality and barriers to healthcare-seeking with lung cancer symptoms. NPJ Prim Care Respir Med 2022; 32:48. [PMID: 36335123 PMCID: PMC9637082 DOI: 10.1038/s41533-022-00314-7] [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: 04/25/2022] [Accepted: 10/17/2022] [Indexed: 11/08/2022] Open
Abstract
Healthcare-seeking with lung cancer symptoms is a prerequisite for improving timely diagnosis of lung cancer. In this study we aimed to explore barriers towards contacting the general practitioner (GP) with lung cancer symptoms, and to analyse the impact of social inequality. The study is based on a nationwide survey with 69,060 individuals aged ≥40 years, randomly selected from the Danish population. The survey included information on lung cancer symptoms, GP contacts, barriers to healthcare-seeking and smoking status. Information about socioeconomics was obtained by linkage to Danish Registers. Descriptive statistics and multivariate logistic regression model were used to analyse the data. “Being too busy” and “Being worried about wasting the doctor’s time” were the most frequent barriers to healthcare-seeking with lung cancer symptoms. Individuals out of workforce and individuals who smoked more often reported “Being worried about what the doctor might find” and “Being too embarrassed” about the symptoms. The social inequality in barriers to healthcare-seeking with lung cancer symptoms is noticeable, which emphasises the necessity of focus on vulnerable groups at risk of postponing relevant healthcare-seeking.
Collapse
Affiliation(s)
- Lisa Maria Sele Sætre
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sanne Rasmussen
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kirubakaran Balasubramaniam
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Dorte Ejg Jarbøl
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
4
|
Zhang B, Yang Y. Epidemiological Study of Lung Cancer and Clinical Medication in England from 2001 to 2019. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:3577312. [PMID: 35368924 PMCID: PMC8967509 DOI: 10.1155/2022/3577312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/21/2022] [Indexed: 11/18/2022]
Abstract
We aimed to explore the epidemiological characteristics and changes of lung cancer and the clinical medication in England from 2001 to 2019. We searched related research using search engine systems such as MEDLINE, PubMed, and PsychINFO. Lung cancer is a serious disease and the prognosis is usually very poor. The overall mortality rate of lung cancer decreased year by year in England from 2001 to 2019, but men, the elderly, and people exposed to polluted air are still more likely to be infected with lung cancer or die as a result, the prevalence and mortality rate of lung cancer in the north of England is significantly higher than that in the south, and the gap is increasing year by year. Lung cancer has changeable risk factors such as quitting smoking and improving air quality, which can effectively reduce the related risk. Paclitaxel, docetaxel, gemcitabine, and vinorelbine are the main drugs for the treatment of lung cancer in England and the treatment of these drugs is beneficial to the survival and quality of life of patients. Men and the elderly are at high risk of lung cancer, which means that lung cancer has obvious gender inequality and age inequality. At the same time, based on the statistical data of lung cancer risk in different regions, it can be concluded that lung cancer also has strong geographical and economic inequality. Changing risk factors and using drugs can effectively reduce the risk of lung cancer and provide effective treatment.
Collapse
Affiliation(s)
- Baokun Zhang
- The University of Sheffield, Western Bank, Sheffield S10 2TN, UK
| | - Ying Yang
- The University of Sheffield, Western Bank, Sheffield S10 2TN, UK
| |
Collapse
|
5
|
Significance of Brain Imaging for Staging in Patients With Clinical Stage T1-2 N0 Non-Small-Cell Lung Cancer on Positron Emission Tomography/Computed Tomography. Clin Lung Cancer 2021; 22:562-569. [PMID: 34253472 DOI: 10.1016/j.cllc.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Routine positron emission tomography/computed tomography (PET/CT) has been recommended even for clinical stage I non-small-cell lung cancer (NSCLC). In spite of the progress in the screening procedure, and revisions to TNM classification, there is no evidence to support brain imaging screening of patients assessed with the current staging protocol including PET/CT. MATERIALS AND METHODS We retrospectively investigated the frequency of extrathoracic metastasis in 466 consecutive patients with clinical stage T1-2 N0 NSCLC with the complete staging assessment comprised of thin-section CT, PET/CT, and brain contrast-enhanced magnetic resonance imaging between 2008 and 2016. All patients were reclassified according to the eighth edition of the tumor, node, and metastasis (TNM) classification. RESULTS Among all patients, 70% of the tumors were pure solid and 30% had part-solid ground-glass opacity on thin-section CT, and 388 (83%) and 78 (17%) were classified into clinical stages T1 and T2, respectively. Eight patients (1.7%) had extrathoracic metastasis, including 3 (0.6%) with brain metastasis, and all showed pure-solid tumors. The frequency of extrathoracic and brain metastasis was 1.0% and 0.5% in 388 T1 patients, and 5.0% and 3.0% in 78 T2 patients. Although brain metastases were detected in 2 of 7 patients (29%) with PET/CT detectable extrathoracic metastases and 1 of 459 patients (0.2%) without PET/CT detectable extrathoracic metastasis, there were no neurologically asymptomatic brain metastases in patients with early-stage NSCLC confirmed by PET/CT. CONCLUSION Routine screening of brain imaging is unnecessary in patients with early-stage NSCLC, assessed with the current staging protocol including PET/CT.
Collapse
|
6
|
Zhu D, Ding R, Ma Y, Chen Z, Shi X, He P. Comorbidity in lung cancer patients and its association with hospital readmission and fatality in China. BMC Cancer 2021; 21:557. [PMID: 34001011 PMCID: PMC8130249 DOI: 10.1186/s12885-021-08272-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 04/29/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Comorbidity has been established as one of the important predictors of poor prognosis in lung cancer. In this study, we analyzed the prevalence of main comorbidities and its association with hospital readmission and fatality for lung cancer patients in China. METHODS The analyses are based on China Urban Employees' Basic Medical insurance (UEBMI) and Urban Residents' Basic Medical Insurance (URBMI) claims database and Hospital Information System (HIS) Database in the Beijing University Cancer Hospital in 2013-2016. We use Elixhauser Comorbidity Index to identify main types of comorbidities. RESULTS Among 10,175 lung cancer patients, 32.2% had at least one comorbid condition, and the proportion of patients with one, two, and three or more comorbidities was 21.7, 8.3 and 2.2%, respectively. The most prevalent comorbidities identified were other malignancy (7.5%), hypertension (5.4%), pulmonary disease (3.7%), diabetes mellitus (2.5%), cardiovascular disease (2.4%) and liver disease (2.3%). The predicted probability of having comorbidity and the predicted number of comorbidities was higher for middle elderly age groups, and then decreased among patients older than 85 years. Comorbidity was positively associated with increased risk of 31-days readmission and in-hospital death. CONCLUSION Our study is the first to provide an overview of comorbidity among lung cancer patients in China, underlines the necessity of incorporating comorbidity in the design of screening, treatment and management of lung cancer patients in China.
Collapse
Affiliation(s)
- Dawei Zhu
- China Center for Health Development Studies, Peking University, Beijing, 100191, China
| | - Ruoxi Ding
- China Center for Health Development Studies, Peking University, Beijing, 100191, China
| | - Yong Ma
- China Health Insurance Research Association, Beijing, 100013, China
| | - Zhishui Chen
- Department of Medical Insurance, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, 100142, China
| | - Xuefeng Shi
- School of Management, Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, 100191, China.
| |
Collapse
|
7
|
Conibear J. Rationale for concurrent chemoradiotherapy for patients with stage III non-small-cell lung cancer. Br J Cancer 2020; 123:10-17. [PMID: 33293671 PMCID: PMC7735212 DOI: 10.1038/s41416-020-01070-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
When treating patients with unresectable stage III non-small-cell lung cancer (NSCLC), those with a good performance status and disease measured within a radical treatment volume should be considered for definitive concurrent chemoradiotherapy (cCRT). This guidance is based on key scientific rationale from two large Phase 3 randomised studies and meta-analyses demonstrating the superiority of cCRT over sequential (sCRT). However, the efficacy of cCRT comes at the cost of increased acute toxicity versus sequential treatment. Currently, there are several documented approaches that are addressing this drawback, which this paper outlines. At the point of diagnosis, a multidisciplinary team (MDT) approach can enable accurate assessment of patients, to determine the optimal treatment strategy to minimise risks. In addition, reviewing the Advisory Committee on Radiation Oncology Practice (ACROP) guidelines can provide clinical oncologists with additional recommendations for outlining target volume and organ-at-risk delineation for standard clinical scenarios in definitive cCRT (and adjuvant radiotherapy). Furthermore, modern advances in radiotherapy treatment planning software and treatment delivery mean that radiation oncologists can safely treat substantially larger lung tumours with higher radiotherapy doses, with greater accuracy, whilst minimising the radiotherapy dose to the surrounding healthy tissues. The combination of these advances in cCRT may assist in creating comprehensive strategies to allow patients to receive potentially curative benefits from treatments such as immunotherapy, as well as minimising treatment-related risks.
Collapse
Affiliation(s)
- John Conibear
- Department of Clinical Oncology, St. Bartholomew's Hospital, London, UK.
| |
Collapse
|
8
|
Ruparel M, Quaife SL, Dickson JL, Horst C, Tisi S, Hall H, Taylor M, Ahmed A, Shaw P, Burke S, Soo MJ, Nair A, Devaraj A, Sennett K, Duffy SW, Navani N, Bhowmik A, Baldwin DR, Janes SM. Lung Screen Uptake Trial: results from a single lung cancer screening round. Thorax 2020; 75:908-912. [PMID: 32759387 PMCID: PMC7509385 DOI: 10.1136/thoraxjnl-2020-214703] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/22/2020] [Accepted: 06/03/2020] [Indexed: 12/26/2022]
Abstract
The Lung Screen Uptake Trial tested a novel invitation strategy to improve uptake and reduce socioeconomic and smoking-related inequalities in lung cancer screening (LCS) participation. It provides one of the first UK-based 'real-world' LCS cohorts. Of 2012 invited, 1058 (52.6%) attended a 'lung health check'. 768/996 (77.1%) in the present analysis underwent a low-dose CT scan. 92 (11.9%) and 33 (4.3%) participants had indeterminate pulmonary nodules requiring 3-month and 12-month surveillance, respectively; 36 lung cancers (4.7%) were diagnosed (median follow-up: 1044 days). 72.2% of lung cancers were stage I/II and 79.4% of non-small cell lung cancer had curative-intent treatment.
Collapse
Affiliation(s)
- Mamta Ruparel
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, England, UK
| | - Samantha L Quaife
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Jennifer L Dickson
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, England, UK
| | - Carolyn Horst
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, England, UK
| | - Sophie Tisi
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, England, UK
| | - Helen Hall
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, England, UK
| | - Magali Taylor
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, London, UK
| | - Asia Ahmed
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, London, UK
| | - Penny Shaw
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, London, UK
| | - Stephen Burke
- Department of Radiology, Homerton University Hospital NHS Foundation Trust, London, London, UK
| | - May-Jan Soo
- Department of Radiology, Homerton University Hospital NHS Foundation Trust, London, London, UK
| | - Arjun Nair
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, London, UK
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, London, UK
| | | | - Stephen W Duffy
- Wolfson Institute of Preventive Medicine, Barts and London, London, UK
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, England, UK
- Thoracic Medicine Department, University College London Hospitals NHS Foundation Trust, London, London, UK
| | - Angshu Bhowmik
- Respiratory Medicine, Homerton University Hospital NHS Foundation Trust, London, London, UK
| | - David R Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, Nottinghamshire, UK
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, England, UK
| |
Collapse
|
9
|
Patterns of percutaneous transthoracic needle biopsy (PTNB) of the lung and risk of PTNB-related severe pneumothorax: A nationwide population-based study. PLoS One 2020; 15:e0235599. [PMID: 32649662 PMCID: PMC7351186 DOI: 10.1371/journal.pone.0235599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 06/19/2020] [Indexed: 12/12/2022] Open
Abstract
Background As percutaneous transthoracic needle biopsy (PTNB) of the lung is a well-established diagnostic method for the evaluating pulmonary lesions, evidence of safety based on representative data is limited. This study investigated the practice patterns of PTNB of the lung and assessed the incidence and risk factors of PTNB-related severe pneumothorax in Korea. Methods We used a national-level health insurance database between January 1, 2007 and December 31, 2015. Patients who underwent PTNB of the lung were identified using procedure codes for organ biopsy, fluoroscopy, computed tomography, chest radiography, and lung-related diagnosis codes. The annual age-/sex-standardized rate of PTNB and the incidence of PTNB-related severe pneumothorax were calculated. We defined severe pneumothorax as the pneumothorax requiring intervention. The odds ratios of risk factors were assessed by a generalized estimating equation model with exchangeable working correlation matrix to address clustering effect within institution. Results A total of 66,754 patients were identified between 2007 and 2015. The annual age-/sex-standardized rate of PTNB per 100,000 population was 19.6 in 2007 and 22.4 in 2015, and it showed an increasing trend. The incidence of severe pneumothorax was 2.4% overall: 2.5% in men and 1.2% in women, and 2.6%, 2.7%, 2.1%, 2.1%, 1.9%, 2.4%, and 2.4% from 2009 to 2015. Older age (≥60), male sex, presence of chronic obstructive pulmonary disease, receiving treatment in an urban or rural area versus a metropolitan area, and receiving treatment at a general hospital were significantly associated with the risk of severe pneumothorax. Conclusions Considering the increasing trend of PTNB, more attention needs to be paid to patients with risk factors for severe pneumothorax.
Collapse
|
10
|
Lee HW, Cho J, Kwak N, Hwang I, Park YS, Lee CH, Lee SM, Yoo CG, Kim YW, Choi SM. Clinical course of asymptomatic small enhancing brain nodules in patients with nonsmall cell lung cancer: do we have to follow them up? ERJ Open Res 2020; 6:00109-2020. [PMID: 32964000 PMCID: PMC7487354 DOI: 10.1183/23120541.00109-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 06/04/2020] [Indexed: 11/06/2022] Open
Abstract
AIMS Brain magnetic resonance imaging (MRI) is recommended during the initial work-up for nonsmall cell lung cancer (NSCLC). Although small enhancing brain nodules not radiologically confirmed as metastatic lesions have often been detected, their clinical course has not been well studied. METHODS This nested case-control study included NSCLC patients who had small enhancing brain nodules detected by serial brain MRIs from January 2014 through December 2018 at a tertiary university hospital. Small enhancing brain nodules were defined as round enhancing nodules of ≤10 mm diameter without oedema in thin-section (1 mm) contrast MRIs. The incidence, natural course and risk factors of growing nodules were evaluated. RESULTS A total of 171 small enhancing brain nodules in 123 patients were observed over an average of 22.1 months. The incidence of nodule growth was 49.1% with mean growth rate of 11 mm·year-1. We found that 25.0% of the growing nodules contributed to clinical upstaging compared to the initial stage. Cerebral events were more common in growing nodules; therefore, local therapy was performed more often. However, there was no difference in the cerebral event-related mortality. Nodule growth was more frequent in younger individuals, multiple nodules, advanced disease, poorly differentiated carcinoma, rim enhancement and larger initial size. In multivariable analysis, predictors of growth were N stage ≥1, existence of epidermal growth factor receptor mutation and larger initial size. CONCLUSION Considering the clinical course of small enhancing brain nodules, more intensive evaluation is required for early detection and pre-emptive intervention when accompanied by risk factors.
Collapse
Affiliation(s)
- Hyun Woo Lee
- Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Jaeyoung Cho
- Division of Pulmonary and Critical Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Nakwon Kwak
- Division of Pulmonary and Critical Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Inpyeong Hwang
- Dept of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Young Sik Park
- Division of Pulmonary and Critical Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Chang-Hoon Lee
- Division of Pulmonary and Critical Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Chul-Gyu Yoo
- Division of Pulmonary and Critical Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Young Whan Kim
- Division of Pulmonary and Critical Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sun Mi Choi
- Division of Pulmonary and Critical Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| |
Collapse
|
11
|
Steinhauser Motta JP, Steffen RE, Samary Lobato C, Souza Mendonça V, Lapa e Silva JR. Endobronchial ultrasound-guided transbronchial needle aspiration versus mediastinoscopy for mediastinal staging of lung cancer: A systematic review of economic evaluation studies. PLoS One 2020; 15:e0235479. [PMID: 32603376 PMCID: PMC7326228 DOI: 10.1371/journal.pone.0235479] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/16/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction The emergence of endobronchial ultrasound (EBUS) changed the approach to staging lung cancer. As a new method being incorporated, the use of EBUS may lead to a shift in clinical and costs outcomes. Objective The aim of this systematic review is to gather information to better understand the economic impact of implementing EBUS. Methods This review is reported according to the PRISMA statement and registered on PROSPERO (CRD42019107901). Search keywords were elaborated considering descriptors of terms related to the disease (lung cancer / mediastinal staging of lung cancer) and the technologies of interest (EBUS and mediastinoscopy) combined with a specific economic filter. The literature search was performed in MEDLINE, EMBASE, LILACS, Cochrane Library of Trials, Web of Science, Scopus and National Health System Economic Evaluation Database (NHS EED) of the Center for Reviews and Dissemination (CRD). Screening, selection of articles, data extraction and quality assessment were carried out by two reviewers. Results Seven hundred and seventy publications were identified through the database searches. Eight articles were included in this review. All publications are full economic evaluation studies, one cost-effectiveness, three cost-utility, and four cost-minimization analyses. The costs of strategies using EBUS-TBNA were lower than the ones using mediastinoscopy in all studies analyzed. Two of the best quality scored studies demonstrate that the mediastinoscopy strategy is dominated by the EBUS-TBNA strategy. Conclusion Information gathered in the eight studies of this systematic review suggest that EBUS is cost-effective compared to mediastinoscopy for mediastinal staging of lung cancer.
Collapse
Affiliation(s)
| | - Ricardo E. Steffen
- Instituto de Medicina Social, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Caroliny Samary Lobato
- Programa de Pós-Graduação em Clínica Médica da Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Vanessa Souza Mendonça
- Biblioteca do Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | |
Collapse
|
12
|
Predictive values of lung cancer alarm symptoms in the general population: a nationwide cohort study. NPJ Prim Care Respir Med 2020; 30:15. [PMID: 32265450 PMCID: PMC7138801 DOI: 10.1038/s41533-020-0173-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 03/12/2020] [Indexed: 11/30/2022] Open
Abstract
We aimed to firstly determine the 1-year predictive values of lung cancer alarm symptoms in the general population and to analyse the proportion of alarm symptoms reported prior to diagnosis, and secondly analyse how smoking status and reported contact with general practitioners (GPs) regarding lung cancer alarm symptoms influence the predictive values. The study was a nationwide prospective cohort study of 69,060 individuals aged ≥40 years, randomly selected from the Danish population. Using information gathered in a survey regarding symptoms, lifestyle and healthcare-seeking together with registry information on lung cancer diagnoses in the subsequent year, we calculated the predictive values and likelihood ratios of symptoms that might be indicative of lung cancer. Furthermore, we analysed how smoking status and reported contact with GPs regarding the alarm symptoms affected the predictive values. We found that less than half of the patients had reported an alarm symptom six months prior to lung cancer diagnosis. The positive predictive values of the symptoms were generally very low, even for patients reporting GP contact regarding an alarm symptom. The highest predictive values were found for dyspnoea, hoarseness, loss of appetite and for current heavy smokers. The negative predictive values were high, all close to 100%. Given the low positive predictive values, our findings emphasise that diagnostic strategies should not focus on single, specific alarm symptoms, but should perhaps focus on different clusters of symptoms. For patients not experiencing alarm symptoms, the risk of overlooking lung cancer is very low.
Collapse
|
13
|
Putora PM, Leskow P, McDonald F, Batchelor T, Evison M. International guidelines on stage III N2 nonsmall cell lung cancer: surgery or radiotherapy? ERJ Open Res 2020; 6:00159-2019. [PMID: 32083114 PMCID: PMC7024765 DOI: 10.1183/23120541.00159-2019] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 12/12/2019] [Indexed: 12/12/2022] Open
Abstract
Stage III N2 nonsmall cell lung cancer (NSCLC) is a complex disease with poor treatment outcomes. For patients in whom the disease is considered technically resectable, the main treatment options include surgery (with neoadjuvant or adjuvant chemotherapy/neoadjuvant chemoradiotherapy (CRT)) or CRT followed by adjuvant immunotherapy (dependent on programmed death ligand 1 status). As there is no clear evidence demonstrating a survival benefit between these options, patient preference plays an important role. A lack of a consensus definition of resectability of N2 disease adds to the complexity of the decision-making process. We compared 10 international guidelines on the treatment of NSCLC to investigate the recommendations on preoperatively diagnosed stage III N2 NSCLC. This comparison simplified the treatment paths to multimodal therapy based on surgery or radiotherapy (RT). We analysed factors relevant to decision-making within these guidelines. Overall, for nonbulky mediastinal lymph node involvement there was no clear preference between surgery and CRT. With increasing extent of mediastinal nodal disease, a tendency towards multimodal treatment based on RT was identified. In multiple scenarios, surgery or RT-based treatments are feasible and patient involvement in decision-making is critical. For many patients with stage III N2 NSCLC, radiotherapy or surgery are options and should be discussed with the patienthttp://bit.ly/2Z39MW5
Collapse
Affiliation(s)
- Paul Martin Putora
- Dept of Radiation Oncology, Kantonsspital St Gallen, St Gallen, Switzerland.,Dept of Radiation Oncology, University of Bern, Bern, Switzerland
| | - Pawel Leskow
- Dept of Thoracic Surgery, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Fiona McDonald
- Dept of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
| | - Tim Batchelor
- Dept of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Matthiew Evison
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|
14
|
Management of patients with early stage lung cancer - why do some patients not receive treatment with curative intent? BMC Cancer 2020; 20:109. [PMID: 32041572 PMCID: PMC7011272 DOI: 10.1186/s12885-020-6580-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/27/2020] [Indexed: 12/25/2022] Open
Abstract
Backgrounds This study aims to understand the factors that influence whether patients receive potentially curative treatment for early stage lung cancer. A key question was whether indigenous Māori patients were less likely to receive treatment. Methods Patients included those diagnosed with early stage lung cancer in 2011–2018 and resident in the New Zealand Midland Cancer Network region. Logistic regression model was used to estimate the odds ratios of having curative surgery/ treatment. The Kaplan Meier method was used to examine the all-cause survival and Cox proportional hazard model was used to estimate the hazard ratio of death. Results In total 419/583 (71.9%) of patients with Stage I and II disease were treated with curative intent - 272 (46.7%) patients had curative surgery. Patients not receiving potentially curative treatment were older, were less likely to have non-small cell lung cancer (NSCLC), had poorer lung function and were more likely to have an ECOG performance status of 2+. Current smokers were less likely to be treated with surgery and more likely to receive treatment with radiotherapy and chemotherapy. Those who were treated with surgery had a 2-year survival of 87.8% (95% CI: 83.8–91.8%) and 5-year survival of 69.6% (95% CI: 63.2–76.0%). Stereotactic ablative body radiotherapy (SABR) has equivalent effect on survival compared to curative surgery (hazard ratio: 0.77, 95% CI: 0.37–1.61). After adjustment we could find no difference in treatment and survival between Māori and non-Māori. Conclusions The majority of patients with stage I and II lung cancer are managed with potentially curative treatment – mainly surgery and increasingly with SABR. The outcomes of those being diagnosed with stage I and II disease and receiving treatment is positive with 70% surviving 5 years.
Collapse
|
15
|
Ost DE, Niu J, Zhao H, Grosu HB, Giordano SH. Quality Gaps and Comparative Effectiveness in Lung Cancer Staging and Diagnosis. Chest 2019; 157:1322-1345. [PMID: 31610159 DOI: 10.1016/j.chest.2019.09.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/28/2019] [Accepted: 09/21/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Guidelines recommend mediastinal sampling first for patients with mediastinal lymphadenopathy with suspected lung cancer. The objective of this study was to describe practice patterns and outcomes of diagnostic strategies in patients with lung cancer. METHODS This study included a retrospective cohort of 15,914 patients with lung cancer with T1-3N1-3M0 disease diagnosed from 2004 to 2013 in the National Cancer Institute's Surveillance, Epidemiology, and End Results or Texas Cancer Registry Medicare-linked databases. Patients who had mediastinal sampling as their first invasive test were classified as guideline consistent; all others were guideline inconsistent. Propensity matching was used to compare the number of tests performed, and multivariable logistic regression was used to compare the incidence of complications. RESULTS Guideline-consistent care increased from 23% to 34% of patients from 2004 to 2013 (P < .001). Use of endobronchial ultrasound-guided transbronchial needle aspiration increased from 0.1% to 25% of all patients (P < .001), and mediastinal sampling increased from 54% to 64% (P < .0001). Guideline-consistent care was associated with fewer thoracotomies (38% vs 71%; P < .001) and CT scan-guided biopsies (10% vs 75%; P < .001) than guideline-inconsistent care but more transbronchial needle aspirations (59% vs 12%; P < .001). Guideline-consistent care was associated with fewer pneumothoraxes (5.1% vs 22%; P < .001), chest tubes (0.9% vs 4.4%; P < .001), hemorrhages (3.5% vs 5.8%; P < .001), and respiratory failure events (2.7% vs 3.7%; P = .047) than guideline-inconsistent care. Bronchoscopic mediastinal sampling was associated with fewer complications than surgical mediastinal sampling. CONCLUSIONS Guideline-consistent care with mediastinal sampling first was associated with fewer tests and complications. Quality gaps decreased with the introduction of endobronchial ultrasound-guided transbronchial needle aspiration but persist. Gaps include failure to sample the mediastinum first, failure to sample the mediastinum at all, and overuse of thoracotomy.
Collapse
Affiliation(s)
- David E Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Jiangong Niu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hui Zhao
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Horiana B Grosu
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
16
|
Crosbie PA, Balata H, Evison M, Atack M, Bayliss-Brideaux V, Colligan D, Duerden R, Eaglesfield J, Edwards T, Elton P, Foster J, Greaves M, Hayler G, Higgins C, Howells J, Irion K, Karunaratne D, Kelly J, King Z, Lyons J, Manson S, Mellor S, Miller D, Myerscough A, Newton T, O'Leary M, Pearson R, Pickford J, Sawyer R, Screaton NJ, Sharman A, Simmons M, Smith E, Taylor B, Taylor S, Walsham A, Watts A, Whittaker J, Yarnell L, Threlfall A, Barber PV, Tonge J, Booton R. Second round results from the Manchester 'Lung Health Check' community-based targeted lung cancer screening pilot. Thorax 2019; 74:700-704. [PMID: 30420406 PMCID: PMC6585285 DOI: 10.1136/thoraxjnl-2018-212547] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/12/2018] [Accepted: 10/22/2018] [Indexed: 12/02/2022]
Abstract
We report results from the second annual screening round (T1) of Manchester's 'Lung Health Check' pilot of community-based lung cancer screening in deprived areas (undertaken June to August 2017). Screening adherence was 90% (n=1194/1323): 92% of CT scans were classified negative, 6% indeterminate and 2.5% positive; there were no interval cancers. Lung cancer incidence was 1.6% (n=19), 79% stage I, treatments included surgery (42%, n=9), stereotactic ablative radiotherapy (26%, n=5) and radical radiotherapy (5%, n=1). False-positive rate was 34.5% (n=10/29), representing 0.8% of T1 participants (n=10/1194). Targeted community-based lung cancer screening promotes high screening adherence and detects high rates of early stage lung cancer.
Collapse
Affiliation(s)
- Phil A Crosbie
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Molecular and Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Haval Balata
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Matthew Evison
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Melanie Atack
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Val Bayliss-Brideaux
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Denis Colligan
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Rebecca Duerden
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Josephine Eaglesfield
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Timothy Edwards
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Peter Elton
- Greater Manchester, Lancashire, South Cumbria Strategic Clinical Network, Manchester, UK
| | | | - Melanie Greaves
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Graham Hayler
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Coral Higgins
- Manchester Health and Care Commissioning, Manchester, UK
| | - John Howells
- Department of Radiology, Royal Preston Hospital, Preston, UK
| | - Klaus Irion
- Department of Radiology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Devinda Karunaratne
- Department of Radiology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jodie Kelly
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Zoe King
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Judith Lyons
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sarah Manson
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Stuart Mellor
- Department of Radiology, Royal Blackburn Hospital, Blackburn, UK
| | | | - Amanda Myerscough
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Tom Newton
- Department of Radiology, Royal Blackburn Hospital, Blackburn, UK
| | | | - Rachel Pearson
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | | | - Richard Sawyer
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Anna Sharman
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Maggi Simmons
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Elaine Smith
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ben Taylor
- Department of Radiology, Christie NHS Foundation Trust, Manchester, UK
| | - Sarah Taylor
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Anna Walsham
- Department of Radiology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Angela Watts
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - James Whittaker
- Department of Radiology, Stockport NHS Foundation Trust, Stockport, UK
| | - Laura Yarnell
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Anthony Threlfall
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Phil V Barber
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Janet Tonge
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Richard Booton
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|
17
|
Benn BS, Parikh M, Tsau PH, Seeley E, Krishna G. Using a Dedicated Interventional Pulmonology Practice Decreases Wait Time Before Treatment Initiation for New Lung Cancer Diagnoses. Lung 2019; 197:249-255. [PMID: 30783733 DOI: 10.1007/s00408-019-00207-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/07/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE While there is significant mortality and morbidity with lung cancer, early stage diagnoses carry a better prognosis. As lung cancer screening programs increase with more pulmonary nodules detected, expediting definitive treatment initiation for newly diagnosed patients is imperative. The objective of our analysis was to determine if the use of a dedicated interventional pulmonology practice decreases time delay from new diagnosis of lung cancer or metastatic disease to the chest to treatment initiation. METHODS Retrospective chart analysis was done of 87 consecutive patients with a new diagnosis of primary lung cancer or metastatic cancer to the chest from our interventional pulmonology procedures. Demographic information and time intervals from abnormal imaging to procedure and to treatment initiation were recorded. RESULTS Patients were older (mean age 69) and former or current smokers (72%). A median of 27 days (1-127 days) passed from our diagnostic biopsy to treatment initiation. A median of 53 total days (2-449 days) passed from abnormal imaging to definitive treatment. Endobronchial ultrasound-guided transbronchial needle aspiration was the most commonly used diagnostic procedure (59%), with non-small cell lung cancer the majority diagnosis (64%). For surgical patients, all biopsy-negative lymph nodes from our procedures were cancer-free at surgical excision. CONCLUSIONS Compared to prior reports from international and United States cohorts, obtaining a tissue biopsy diagnosis through a gatekeeper interventional pulmonology practice decreases median delay from abnormal imaging to treatment initiation. This finding has the potential to positively impact patient outcomes and requires further evaluation.
Collapse
Affiliation(s)
- Bryan S Benn
- Division of Pulmonary and Critical Care Medicine, University of California, Los Angeles, 10833 LeConte Avenue, Los Angeles, CA, 90095, USA.
| | - Mihir Parikh
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Pei H Tsau
- Division of Thoracic Surgery, Palo Alto Medical Foundation, Palo Alto, CA, USA
| | - Eric Seeley
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Ganesh Krishna
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA
- Division of Pulmonary and Critical Care Medicine, Palo Alto Medical Foundation, Palo Alto, CA, USA
| |
Collapse
|
18
|
Zhuge L, Huang Y, Wang S, Xie J, Huang B, Zheng D, Zheng S, Zhao Y, Mao H, Wilson DO, Luketich JD, Xiang J, Chen H, Zhang J. Preoperative brain MRI for clinical stage IA lung cancer: is routine scanning rational? J Cancer Res Clin Oncol 2018; 145:503-509. [PMID: 30536037 PMCID: PMC6373267 DOI: 10.1007/s00432-018-2814-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 12/04/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Early detection and control of lung cancer brain metastases (BMs) are important. However, several guideline recommendations are inconsistent with regard to routine preoperative brain MRI, especially in patients with clinical stage IA lung cancer. Our study evaluated the value of preoperative brain MRI in patients with clinical stage IA lung cancer. METHODS A retrospective analysis of patients with lung cancer was performed using a prospectively collected database. Clinical data and the results of brain MRI were collected and analyzed. RESULTS Patients with pathologically proved primary lung cancer who underwent an MRI at initial diagnosis were identified (3392 patients). In total, 170 patients (5.0%) were diagnosed with BMs. The increased frequency of BMs was significantly associated with advanced clinical stage (P = 0.000) and pathological type (P = 0.011). BMs were detected in 11 out of 1595 patients with clinical stage IA lung cancer (0.7%). BMs were more common in patients with clinical stage cT1c lung cancer (1.9%) than those with clinical stage cT1a or cT1b (0.1%, odds ratio = 21.30, 95% confidence interval: 2.7-166.9, P = 0.000). All patients with stage IA lung cancer and BMs had solid lung lesions (P = 0.002). CONCLUSIONS Preoperative brain MRI might help identify BMs in patients with lung cancer that has progressed beyond stage IA. In patients with clinical stage IA lung cancer, we do not recommend preoperative brain MRI, but it may potentially be beneficial in those with solid T1c cancers.
Collapse
Affiliation(s)
- Lingdun Zhuge
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yangle Huang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Shengfei Wang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Juntao Xie
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Binhao Huang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Difan Zheng
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Shanbo Zheng
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yue Zhao
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Hengyu Mao
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - David O Wilson
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - James D Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - Jiaqing Xiang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Jie Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China. .,Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA.
| |
Collapse
|
19
|
Rice SR, Molitoris JK, Vyfhuis MAL, Edelman MJ, Burrows WM, Feliciano J, Nichols EM, Suntharalingam M, Donahue J, Carr SR, Friedberg J, Badiyan S, Simone CB, Feigenberg SJ, Mohindra P. Lymph Node Size Predicts for Asymptomatic Brain Metastases in Patients With Non-small-cell Lung Cancer at Diagnosis. Clin Lung Cancer 2018; 20:e107-e114. [PMID: 30337268 DOI: 10.1016/j.cllc.2018.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 09/13/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND We questioned whether the National Comprehensive Cancer Network recommendations for brain magnetic resonance imaging (MRI) for patients with stage ≥ IB non-small-cell lung cancer (NSCLC) was high-yield compared with American College of Clinical Pharmacy and National Institute for Health and Care Excellence guidelines recommending stage III and above NSCLC. We present the prevalence and factors predictive of asymptomatic brain metastases at diagnosis in patients with NSCLC without extracranial metastases. MATERIALS AND METHODS A retrospective analysis of 193 consecutive, treatment-naïve patients with NSCLC diagnosed between January 2010 and August 2015 was performed. Exclusion criteria included no brain MRI staging, symptomatic brain metastases, or stage IV based on extracranial disease. Univariate and multivariate logistic regression was performed. RESULTS The patient characteristics include median age of 65 years (range, 36-90 years), 51% adenocarcinoma/36% squamous carcinoma, and pre-MRI stage grouping of 31% I, 22% II, 34% IIIA, and 13% IIIB. The overall prevalence of brain metastases was 5.7% (n = 11). One (2.4%) stage IA and 1 (5.6%) stage IB patient had asymptomatic brain metastases at diagnosis, both were adenocarcinomas. On univariate analysis, increasing lymph nodal stage (P = .02), lymph nodal size > 2 cm (P = .009), multi-lymph nodal N1/N2 station involvement (P = .027), and overall stage (P = .005) were associated with asymptomatic brain metastases. On multivariate analysis, increasing lymph nodal size remained significant (odds ratio, 1.545; P = .009). CONCLUSION Our series shows a 5.7% rate of asymptomatic brain metastasis for patients with stage I to III NSCLC. Increasing lymph nodal size was the only predictor of asymptomatic brain metastases, suggesting over-utilization of MRI in early-stage disease, especially in lymph node-negative patients with NSCLC. Future efforts will explore the utility of baseline MRI in lymph node-positive stage II and all stage IIIA patients.
Collapse
Affiliation(s)
- Stephanie R Rice
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Jason K Molitoris
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Melissa A L Vyfhuis
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Martin J Edelman
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Whitney M Burrows
- Division of Thoracic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Josephine Feliciano
- Division of Hematology/Oncology, Department of Medicine, Johns Hopkins Bayview Hospital, Baltimore, MD
| | - Elizabeth M Nichols
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Mohan Suntharalingam
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - James Donahue
- Division of Thoracic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Shamus R Carr
- Division of Thoracic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Joseph Friedberg
- Division of Thoracic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Shahed Badiyan
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Steven J Feigenberg
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD.
| |
Collapse
|
20
|
Doubeni CA, Gabler NB, Wheeler CM, McCarthy AM, Castle PE, Halm EA, Schnall MD, Skinner CS, Tosteson ANA, Weaver DL, Vachani A, Mehta SJ, Rendle KA, Fedewa SA, Corley DA, Armstrong K. Timely follow-up of positive cancer screening results: A systematic review and recommendations from the PROSPR Consortium. CA Cancer J Clin 2018; 68:199-216. [PMID: 29603147 PMCID: PMC5980732 DOI: 10.3322/caac.21452] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/09/2018] [Accepted: 02/21/2018] [Indexed: 12/19/2022] Open
Abstract
Timely follow-up for positive cancer screening results remains suboptimal, and the evidence base to inform decisions on optimizing the timeliness of diagnostic testing is unclear. This systematic review evaluated published studies regarding time to follow-up after a positive screening for breast, cervical, colorectal, and lung cancers. The quality of available evidence was very low or low across cancers, with potential attenuated or reversed associations from confounding by indication in most studies. Overall, evidence suggested that the risk for poorer cancer outcomes rises with longer wait times that vary within and across cancer types, which supports performing diagnostic testing as soon as feasible after the positive result, but evidence for specific time targets is limited. Within these limitations, we provide our opinion on cancer-specific recommendations for times to follow-up and how existing guidelines relate to the current evidence. Thresholds set should consider patient worry, potential for loss to follow-up with prolonged wait times, and available resources. Research is needed to better guide the timeliness of diagnostic follow-up, including considerations for patient preferences and existing barriers, while addressing methodological weaknesses. Research is also needed to identify effective interventions for reducing wait times for diagnostic testing, particularly in underserved or low-resource settings. CA Cancer J Clin 2018;68:199-216. © 2018 American Cancer Society.
Collapse
Affiliation(s)
- Chyke A. Doubeni
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Nicole B. Gabler
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Cosette M. Wheeler
- Departments of Pathology, and Obstetrics and Gynecology, University of New Mexico Health Science Center, Albuquerque, NM
| | - Anne Marie McCarthy
- General Medicine Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Philip E. Castle
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Ethan A. Halm
- Departments of Internal Medicine and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mitchell D. Schnall
- Department of Radiology, Breast Imaging Section, University of Pennsylvania, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Celette S. Skinner
- Department of Clinical Sciences and Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | - Anna N. A. Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Donald L. Weaver
- Department of Pathology, UVM Cancer Center, University of Vermont, Burlington, VT
| | - Anil Vachani
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Shivan J. Mehta
- Department of Medicine, Perelman School of Medicine and Penn Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA
| | - Katharine A. Rendle
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Stacey A Fedewa
- Surveillance and Health Services Research, American Cancer Society. Atlanta, GA
| | - Douglas A. Corley
- Kaiser Permanente Division of Research, Oakland, CA, and San Francisco Medical, Kaiser Permanente Northern California, San Francisco, CA
| | - Katrina Armstrong
- General Medicine Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
21
|
Hashimoto N, Ando A, Iwano S, Sakamoto K, Okachi S, Matsuzaki A, Okada Y, Wakai K, Yokoi K, Hasegawa Y. Thin-section computed tomography-determined usual interstitial pneumonia pattern affects the decision-making process for resection in newly diagnosed lung cancer patients: a retrospective study. BMC Pulm Med 2018; 18:2. [PMID: 29304775 PMCID: PMC5756392 DOI: 10.1186/s12890-017-0565-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 12/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is only limited information on the impact of thin-section computed tomography (TSCT)-determined usual interstitial pneumonia (UIP) pattern in the decision-making for resection in newly diagnosed lung cancer patients. METHODS In this retrospective analysis, data were reviewed from 499 newly diagnosed lung cancer patients who received bronchoscopy between 2010 and 2014. The clinical impact of TSCT-determined UIP pattern on the decision-making process for resection in this cohort was evaluated. RESULTS The prevalence rate of TSCT-determined fibrosis was 14.8% (74/499 cases), 86.5% (64/74 cases) of which also had TSCT-determined emphysema. The fibrosis group comprised 40 patients with possible UIP and 34 patients with the UIP pattern. Among surgical candidates, the number of surgeries performed was lower in the fibrosis group (60.8%) than in the normal and emphysema groups (84.7 and 77.3%, respectively). Although the proportion of possible UIP did not differ between surgical candidates and patients with resected lung cancer, the proportion of UIP pattern in patients with resected lung cancer was decreased by 8.5%, compared to the surgical candidates. Although measurement of diffusing capacity of the lung for carbon monoxide (DLCO) was performed in more than 97% of patients with thoracic surgery, only 58% of patients without thoracic surgery had DLCO measurement. Multivariate analysis showed that the finding of UIP pattern independently affects the decision-making process for thoracic surgery. The adjusted odds ratios for the comparison between the patients without fibrosis and the patients with UIP pattern was 0.266 (95% confidence intervals: 0.087-0.812). CONCLUSIONS The presence of TSCT-determined UIP pattern might independently affect the decision-making process for proposing thoracic surgery with curative intent.
Collapse
Affiliation(s)
- Naozumi Hashimoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Akira Ando
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shingo Iwano
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koji Sakamoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shotaro Okachi
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Asuka Matsuzaki
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yu Okada
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kohei Yokoi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| |
Collapse
|
22
|
Munoz ML, Lechtzin N, Li QK, Wang K, Yarmus LB, Lee HJ, Feller-Kopman DJ. Bronchoscopy with endobronchial ultrasound guided transbronchial needle aspiration vs. transthoracic needle aspiration in lung cancer diagnosis and staging. J Thorac Dis 2017; 9:2178-2185. [PMID: 28840019 DOI: 10.21037/jtd.2017.07.26] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND In evaluating patients with suspected lung cancer, it is important to not only obtain a tissue diagnosis, but also to obtain enough tissue for both histologic and molecular analysis in order to appropriately stage the patient with a safe and efficient strategy. The diagnostic approach may often be dependent on local resources and practice patterns rather than current guidelines. We Describe lung cancer staging at two large academic medical centers to identify the impact different procedural approaches have on patient outcomes. METHODS We conducted a retrospective cohort study of all patients undergoing a lung cancer diagnostic evaluation at two multidisciplinary centers during a 1-year period. Identifying complication rates and the need for multiple biopsies as our primary outcomes, we developed a multivariate regression model to determine features associated with complications and need for multiple biopsies. RESULTS Of 830 patients, 285 patients were diagnosed with lung cancers during the study period. Those staged at the institution without an endobronchial ultrasound (EBUS) program were more likely to require multiple biopsies (OR 3.62, 95% CI: 1.71-7.67, P=0.001) and suffer complications associated with the diagnostic procedure (OR 10.2, 95% CI: 3.08-33.58, P<0.001). Initial staging with transthoracic needle aspiration (TTNA) and conventional bronchoscopy were associated with greater need for subsequent biopsies (OR 8.05 and 14.00, 95% CI: 3.43-18.87 and 5.17-37.86, respectively) and higher complication rates (OR 37.75 and 7.20, 95% CI: 10.33-137.96 and 1.36-37.98, respectively). CONCLUSIONS Lung cancer evaluation at centers with a dedicated EBUS program results in fewer biopsies and complications than at multidisciplinary counterparts without an EBUS program.
Collapse
Affiliation(s)
- Mark L Munoz
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Noah Lechtzin
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Qing Kay Li
- Department of Pathology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - KoPen Wang
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Lonny B Yarmus
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Hans J Lee
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - David J Feller-Kopman
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
23
|
Postmus PE, Kerr KM, Oudkerk M, Senan S, Waller DA, Vansteenkiste J, Escriu C, Peters S. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017; 28:iv1-iv21. [PMID: 28881918 DOI: 10.1093/annonc/mdx222] [Citation(s) in RCA: 1158] [Impact Index Per Article: 165.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- P E Postmus
- The Clatterbridge Cancer Centre and Liverpool Heart and Chest Hospital, Liverpool
| | - K M Kerr
- University of Aberdeen, Aberdeen, UK
| | - M Oudkerk
- Center for Medical Imaging, University of Groningen, Groningen
| | - S Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - D A Waller
- Department of Thoracic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - C Escriu
- The Clatterbridge Cancer Centre and Liverpool Heart and Chest Hospital, Liverpool
| | - S Peters
- Oncology Department, Service d'Oncologie Médicale, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| |
Collapse
|
24
|
Hudson Z, Internullo E, Edey A, Laurence I, Bianchi D, Addeo A. Brain imaging before primary lung cancer resection: a controversial topic. Ecancermedicalscience 2017; 11:749. [PMID: 28717395 PMCID: PMC5493439 DOI: 10.3332/ecancer.2017.749] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Indexed: 11/19/2022] Open
Abstract
Objective International and national recommendations for brain imaging in patients planned to undergo potentially curative resection of non-small-cell lung cancer (NSCLC) are variably implemented throughout the United Kingdom [Hudson BJ, Crawford MB, and Curtin J et al (2015) Brain imaging in lung cancer patients without symptoms of brain metastases: a national survey of current practice in EnglandClin Radiol https://doi.org/10.1016/j.crad.2015.02.007]. However, the recommendations are not based on high-quality evidence and do not take into account cost implications and local resources. Our aim was to determine local practice based on historic outcomes in this patient cohort. Methods This retrospective study took place in a regional thoracic surgical centre in the United Kingdom. Pathology records for all patients who had undergone lung resection with curative intent during the time period January 2012–December 2014 were analysed in October 2015. Electronic pathology and radiology reports were accessed for each patient and data collected about their histological findings, TNM stage, resection margins, and the presence of brain metastases on either pre-operative or post-operative imaging. From the dates given on imaging, we calculated the number of days post-resection that the brain metastases were detected. Results 585 patients were identified who had undergone resection of their lung cancer. Of these, 471 had accessible electronic radiology records to assess for the radiological evidence of brain metastases. When their electronic records were evaluated, 25/471 (5.3%) patients had radiological evidence of brain metastasis. Of these, five patients had been diagnosed with a brain metastasis at initial presentation and had undergone primary resection of the brain metastasis followed by resection of the lung primary. One patient had been diagnosed with both a primary lung and a primary bowel adenocarcinoma; on review of the case, it was felt that the brain metastasis was more likely to have originated from the bowel cancer. One had been clinically diagnosed with a cerebral abscess while the radiology had been reported as showing a metastatic deposit. Of the remaining 18/471 (3.8%) patients who presented with brain metastases after their surgical resection, 12 patients had adenocarcinoma, four patients had squamous cell carcinoma, one had basaloid, and one had large-cell neuroendocrine. The mean number of days post-resection that the brain metastases were identified was 371 days, range 14–1032 days, median 295 days (date of metastases not available for two patients). Conclusion The rate of brain metastases identified in this study was similar to previous studies. This would suggest that preoperative staging of the central nervous system may change the management pathway in a small group of patients. However, for this group of patients, the change would be significant either sparing them non-curative surgery or allowing aggressive management of oligometastatic disease. Therefore, we would recommend pre-operative brain imaging with MRI for all patients undergoing potentially curative lung resection.
Collapse
Affiliation(s)
- Zoe Hudson
- Bristol Cancer Institute, University Hospital Trust, Horfield Road, Bristol BS2 8ED, UK
| | - Eveline Internullo
- Cardio-thoracic Unit, University Hospital Trust, Horfield Road, Bristol BS2 8ED, UK
| | - Anthony Edey
- Radiology Department, Southmead Hospital, North Bristol Trust, Southmead Rd, Westbury-on-Trym, Bristol BS10 5NB, UK
| | - Isabel Laurence
- Radiology Department, Southmead Hospital, North Bristol Trust, Southmead Rd, Westbury-on-Trym, Bristol BS10 5NB, UK
| | - Davide Bianchi
- Reseau Santé Balcon du Jura, Rue des Rosiers Sainte-Croix, Vaud 1450, Switzerland
| | - Alfredo Addeo
- Bristol Cancer Institute, University Hospital Trust, Horfield Road, Bristol BS2 8ED, UK
| |
Collapse
|
25
|
Sullivan FM, Farmer E, Mair FS, Treweek S, Kendrick D, Jackson C, Robertson C, Briggs A, McCowan C, Bedford L, Young B, Vedhara K, Gallant S, Littleford R, Robertson J, Sewell H, Dorward A, Sarvesvaran J, Schembri S. Detection in blood of autoantibodies to tumour antigens as a case-finding method in lung cancer using the EarlyCDT®-Lung Test (ECLS): study protocol for a randomized controlled trial. BMC Cancer 2017; 17:187. [PMID: 28284200 PMCID: PMC5346215 DOI: 10.1186/s12885-017-3175-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/04/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Lung cancer is the most common cause of cancer related death worldwide. The majority of cases are detected at a late stage when prognosis is poor. The EarlyCDT®-Lung Test detects autoantibodies to abnormal cell surface proteins in the earliest stages of the disease which may allow tumour detection at an earlier stage thus altering prognosis. The primary research question is: Does using the EarlyCDT®-Lung Test to identify those at high risk of lung cancer, followed by X-ray and computed tomography (CT) scanning, reduce the incidence of patients with late-stage lung cancer (III & IV) or unclassified presentation (U) at diagnosis, compared to standard practice? METHODS A randomised controlled trial of 12 000 participants in areas of Scotland targeting general practices serving patients in the most deprived quintile of the Scottish Index of Multiple Deprivation. Adults aged 50-75 who are at high risk of lung cancer and healthy enough to undergo potentially curative therapy (Performance Status 0-2) are eligible to participate. The intervention is the EarlyCDT®-Lung Test, followed by X-ray and CT in those with a positive result. The comparator is standard clinical practice in the UK. The primary outcome is the difference, after 24 months, between the rates of patients with stage III, IV or unclassified lung cancer at diagnosis. The secondary outcomes include: all-cause mortality; disease specific mortality; a range of morbidity outcomes; cost-effectiveness and measures examining the psychological and behavioural consequences of screening. Participants with a positive test result but for whom the CT scan does not lead to a lung cancer diagnosis will be offered 6 monthly thoracic CTs for 24 months. An initial chest X-ray will be used to determine the speed and the need for contrast in the first screening CT. Participants who are found to have lung cancer will be followed-up to assess both time to diagnosis and stage of disease at diagnosis. DISCUSSION The study will determine the clinical and cost effectiveness of EarlyCDT®-Lung Test for early lung cancer detection and assess its suitability for a large-scale, accredited screening service. The study will also assess the potential psychological and behavioural harms arising from false positive or false negative results, as well as the potential benefits to patients of true negative EarlyCDT lung test results. A cost-effectiveness model of lung cancer screening based on the results of the EarlyCDT Lung Test study will be developed. TRIAL REGISTRATION NCT01925625 . August 19, 2013.
Collapse
Affiliation(s)
- F. M. Sullivan
- Gordon F. Cheesbrough Research Chair & Director of UTOPIAN, Department of Family and Community Medicine University of Toronto, North York General Hospital, 4001 Leslie St LE140, Toronto, ON M2K 1E1 Canada
| | - Eoghan Farmer
- School of Medicine,, St Andrews University, St Andrews, UK
| | - Frances S. Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Denise Kendrick
- School of Medicine, Division of Primary Care, Floor 13, Tower Building, University Park, Nottingham, UK
| | - Cathy Jackson
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, Livingstone Tower, 26 Richmond Street, Glasgow, G1 1XH UK
| | - Andrew Briggs
- Health Economics & Health Technology Assessment, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Colin McCowan
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Laura Bedford
- School of Medicine, Division of Primary Care, Medical School, Queen’s Medical Centre, Nottingham, UK
| | - Ben Young
- School of Medicine, Division of Primary Care, Medical School, Queen’s Medical Centre, Nottingham, UK
| | - Kavita Vedhara
- School of Medicine, Division of Primary Care, Floor 13, Tower Building, University Park, Nottingham, UK
| | - Stephanie Gallant
- Clinical Trial Manager, Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Roberta Littleford
- Senior Clinical Trial Manager, Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - John Robertson
- Graduate Entry Medicine & Health School (GEMS), University of Nottingham, Royal Derby Hospital, Nottingham, UK
| | - Herb Sewell
- Division of Immunology, School of Life Sciences, Queens Medical Centre, Nottingham, UK
| | | | - Joseph Sarvesvaran
- The Queen Elizabeth University Hospital Glasgow, 1345 Govan Road, Glasgow, G51 4TF UK
| | - Stuart Schembri
- Consultant Respiratory Physician, Ninewells Hospital, Dundee, UK
| |
Collapse
|
26
|
Karekla E, Liao WJ, Sharp B, Pugh J, Reid H, Quesne JL, Moore D, Pritchard C, MacFarlane M, Pringle JH. Ex Vivo Explant Cultures of Non-Small Cell Lung Carcinoma Enable Evaluation of Primary Tumor Responses to Anticancer Therapy. Cancer Res 2017; 77:2029-2039. [PMID: 28202521 DOI: 10.1158/0008-5472.can-16-1121] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 01/10/2017] [Accepted: 01/30/2017] [Indexed: 11/16/2022]
Abstract
To improve treatment outcomes in non-small cell lung cancer (NSCLC), preclinical models that can better predict individual patient response to novel therapies are urgently needed. Using freshly resected tumor tissue, we describe an optimized ex vivo explant culture model that enables concurrent evaluation of NSCLC response to therapy while maintaining the tumor microenvironment. We found that approximately 70% of primary NSCLC specimens were amenable to explant culture with tissue integrity intact for up to 72 hours. Variations in cisplatin sensitivity were noted with approximately 50% of cases responding ex vivo Notably, explant responses to cisplatin correlated significantly with patient survival (P = 0.006) irrespective of tumor stage. In explant tissue, cisplatin-resistant tumors excluded platinum ions from tumor areas in contrast to cisplatin-sensitive tumors. Intact TP53 did not predict cisplatin sensitivity, but a positive correlation was observed between cisplatin sensitivity and TP53 mutation status (P = 0.003). Treatment of NSCLC explants with the targeted agent TRAIL revealed differential sensitivity with the majority of tumors resistant to single-agent or cisplatin combination therapy. Overall, our results validated a rapid, reproducible, and low-cost platform for assessing drug responses in patient tumors ex vivo, thereby enabling preclinical testing of novel drugs and helping stratify patients using biomarker evaluation. Cancer Res; 77(8); 2029-39. ©2017 AACR.
Collapse
Affiliation(s)
- Ellie Karekla
- Department of Cancer Studies, University of Leicester, Leicester, United Kingdom
| | - Wen-Jing Liao
- Department of Cancer Studies, University of Leicester, Leicester, United Kingdom
| | - Barry Sharp
- Centre for Analytical Science, Department of Chemistry, Loughborough University, Loughborough, Leicestershire, United Kingdom
| | - John Pugh
- Centre for Analytical Science, Department of Chemistry, Loughborough University, Loughborough, Leicestershire, United Kingdom
| | - Helen Reid
- Centre for Analytical Science, Department of Chemistry, Loughborough University, Loughborough, Leicestershire, United Kingdom
| | - John Le Quesne
- Department of Cancer Studies, University of Leicester, Leicester, United Kingdom.,MRC Toxicology Unit, Leicester, United Kingdom
| | - David Moore
- Department of Cancer Studies, University of Leicester, Leicester, United Kingdom
| | - Catrin Pritchard
- Department of Cancer Studies, University of Leicester, Leicester, United Kingdom.
| | | | - James Howard Pringle
- Department of Cancer Studies, University of Leicester, Leicester, United Kingdom
| |
Collapse
|
27
|
Vernon J, Andruszkiewicz N, Schneider L, Schieman C, Finley CJ, Shargall Y, Fahim C, Farrokhyar F, Hanna WC. Comprehensive Clinical Staging for Resectable Lung Cancer: Clinicopathological Correlations and the Role of Brain MRI. J Thorac Oncol 2016; 11:1970-1975. [DOI: 10.1016/j.jtho.2016.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/10/2016] [Accepted: 06/12/2016] [Indexed: 12/25/2022]
|
28
|
Wang D, Koh ES, Descallar J, Pramana A, Vinod SK, Ho Shon I. Application of novel quantitative techniques for fluorodeoxyglucose positron emission tomography/computed tomography in patients with non-small-cell lung cancer. Asia Pac J Clin Oncol 2016; 12:349-358. [PMID: 27550522 DOI: 10.1111/ajco.12587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 11/09/2015] [Accepted: 01/16/2016] [Indexed: 11/28/2022]
Abstract
AIM Flurodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is routinely used in non-small-cell lung cancer. This study aims to assess the prognostic value of quantitative FDG-PET/CT parameters including standard uptake value (SUV), metabolic tumor volume (MTV) and total lesional glycolysis (TLG) in non-small-cell lung cancer. METHODS A retrospective review of 92 nonsurgical patients with pathologically confirmed stage I-III non-small-cell lung cancers treated with radical dose radiotherapy (≥50 Gy) was conducted. Metabolically active tumor regions on FDG-PET/CT scans were contoured manually. SUV, MTV and TLG were calculated for primary, nodal and whole-body disease. Univariate and multivariate (adjusting for age, sex, disease stage and primary tumor size in centimeters) Cox regression modeling were performed to assess the association between these parameters and both overall and progression-free survival (PFS). RESULTS On univariate analysis, overall survival (OS) was significantly associated with primary MTV (P = 0.03), whole-body MTV (P = 0.02), whole-body maximum SUV (P = 0.05) and whole-body TLG (P = 0.03). PFS was significantly associated with primary MTV (P = 0.01), primary TLG (P = 0.04), whole-body MTV (P < 0.01) and whole-body TLG (P = 0.01). On multivariate analysis, OS was significantly associated with whole-body MTV (P = 0.05). PFS was significantly associated with whole-body MTV (P = 0.02) and whole-body TLG (P = 0.05). CONCLUSIONS Whole-body MTV was significantly associated with overall and PFS, and whole-body TLG was significantly associated with PFS on multivariate analysis. These two parameters may be significant prognostic factors independent of other factors such as stage. SUV was not significantly associated with survival on multivariate analysis.
Collapse
Affiliation(s)
- Duo Wang
- The University of New South Wales, Sydney, Australia.,Concord Repatriation General Hospital, Sydney, Australia
| | - Eng-Siew Koh
- The University of New South Wales, Sydney, Australia.,Ingham Institute of Applied Medical Research, Sydney, Australia.,Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia
| | - Joseph Descallar
- The University of New South Wales, Sydney, Australia.,Ingham Institute of Applied Medical Research, Sydney, Australia
| | | | - Shalini K Vinod
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia.,University of Western Sydney, Sydney, Australia.,Southwestern Sydney Clinical School, UNSW, Sydney, Australia
| | - Ivan Ho Shon
- The University of New South Wales, Sydney, Australia.,Department of Nuclear Medicine and PET, Prince of Wales Hospital, Sydney, Australia
| |
Collapse
|
29
|
Fernández-Villar A, Mouronte-Roibás C, Botana-Rial M, Ruano-Raviña A. Ten Years of Linear Endobronchial Ultrasound: Evidence of Efficacy, Safety and Cost-effectiveness. Arch Bronconeumol 2015; 52:96-102. [PMID: 26565072 DOI: 10.1016/j.arbres.2015.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 08/21/2015] [Accepted: 08/26/2015] [Indexed: 12/25/2022]
Abstract
Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is one of the major landmarks in the history of bronchoscopy. In the 10 years since it was introduced, a vast body of literature on the procedure and its results support the use of this technique in the study of various mediastinal and pulmonary lesions. This article is a comprehensive, systematic review of all the available scientific evidence on the more general indications for this technique. Results of specific studies on efficacy, safety and cost-effectiveness available to date are examined. The analysis shows that EBUS-TBNA is a safe, cost-effective technique with a high grade of evidence that is a valuable tool in the diagnosis and mediastinal staging of patients with suspected or confirmed lung cancer. However, more studies are needed to guide decision-making in the case of a negative result. Evidence on the role of EBUS-TBNA in the diagnosis of sarcoidosis and extrathoracic malignancies is also high, but much lower when used in the study of tuberculosis, lymphoma and for the re-staging of lung cancer after neoadjuvant chemotherapy. Nevertheless, due to its good safety record and lack of invasiveness compared to surgical techniques, the grade of evidence for recommending EBUS-TBNA as the initial diagnostic test in patients with these diseases is very high in most cases.
Collapse
Affiliation(s)
- Alberto Fernández-Villar
- Servicio de Neumología de la EOXI Vigo, Instituto de Investigación Biomédica de Vigo, Vigo, Pontevedra, España.
| | - Cecilia Mouronte-Roibás
- Servicio de Neumología de la EOXI Vigo, Instituto de Investigación Biomédica de Vigo, Vigo, Pontevedra, España
| | - Maribel Botana-Rial
- Servicio de Neumología de la EOXI Vigo, Instituto de Investigación Biomédica de Vigo, Vigo, Pontevedra, España
| | - Alberto Ruano-Raviña
- Departamento de Medicina Preventiva, Facultad de Medicina, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, España; CIBER de Epidemiología y Salud Pública, CIBERESP, España
| |
Collapse
|
30
|
Pricopi C, Rivera C, Abdennadher M, Arame A, Foucault C, Dujon A, Le Pimpec Barthes F, Riquet M. [Place of limited resections and prognostic factors in non-small lung cancer]. REVUE DE PNEUMOLOGIE CLINIQUE 2015; 71:207-216. [PMID: 25794877 DOI: 10.1016/j.pneumo.2014.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 09/15/2014] [Accepted: 09/21/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Results of surgery for non-small-cell lung cancer (NSCLC) are poorer after limited resection, wedge and segmentectomy, than after lobectomy. Guidelines recommend avoiding wedge-resection, which new techniques (radiofrequency ablation and cyberknife) tend to replace. This work aimed to study the wedge-resection carcinological value. PATIENTS AND METHODS NSCLC without previous other cancer history and neoadjuvant therapy measuring less than 31 millimetres and operated from 1980 to 2009 were reviewed. Analyzed variables were: location, gender, age, FEVS, type of resection, histology, pT and pN. RESULTS There were 66 wedge-resections (10.9%), 32 segmentectomies (5.3%), 507 lobectomies (83.8%), nine postoperative deaths (1.5%), 136 complications (22.5%), 557 complete resections (R0=92%); 72.2% of NSCLC upper lobe location (437/605). Age was more advanced in wedge-resection and segmentectomy, FEVS lower and NSCLC most often a squamous cell pN0 and pStage I carcinoma than in lobectomy. Lymphadenectomy was not performed in half the wedge-resections. Five-year survival rates were poorer after wedge-resection: 50% versus segmentectomy 59.8% (P=0.09), and lobectomy 66% (P=0.0035), but the number of recurrences was similar. Multivariate analysis demonstrated that age, FEVS, type of surgery and lymphadenectomy, pN in pTNM were the only prognosis factors. CONCLUSION Wedge-resection is less carcinological than segmentectomy when the patient-status and NSCLC location allow performing the latter, but more than the new techniques, because of its pathological yield, when the patient-status and nodule peripheral location allow wedging.
Collapse
Affiliation(s)
- C Pricopi
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - C Rivera
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - M Abdennadher
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - A Arame
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - C Foucault
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - A Dujon
- Service de chirurgie thoracique, centre médico-chirurgical du Cèdre, Bois-Guillaume, France
| | - F Le Pimpec Barthes
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - M Riquet
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
| |
Collapse
|
31
|
Garutti Martínez I, González Aragoneses F, Ramírez JM. Multimodal rehabilitation program in thoracic surgery. Arch Bronconeumol 2015; 51:159-60. [PMID: 25641355 DOI: 10.1016/j.arbres.2014.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 11/28/2014] [Accepted: 11/28/2014] [Indexed: 12/20/2022]
Affiliation(s)
| | | | - José Manuel Ramírez
- Servicio de Cirugía General, Hospital Universitario de Zaragoza, Zaragoza, España
| |
Collapse
|
32
|
O'Dowd EL, McKeever TM, Baldwin DR, Anwar S, Powell HA, Gibson JE, Iyen-Omofoman B, Hubbard RB. What characteristics of primary care and patients are associated with early death in patients with lung cancer in the UK? Thorax 2015; 70:161-8. [PMID: 25311471 PMCID: PMC4316923 DOI: 10.1136/thoraxjnl-2014-205692] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/22/2014] [Accepted: 08/07/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND The UK has poor lung cancer survival rates and high early mortality, compared to other countries. We aimed to identify factors associated with early death, and features of primary care that might contribute to late diagnosis. METHODS All cases of lung cancer diagnosed between 2000 and 2013 were extracted from The Health Improvement Network database. Patients who died within 90 days of diagnosis were compared with those who survived longer. Standardised chest X-ray (CXR) and lung cancer rates were calculated for each practice. RESULTS Of 20,142 people with lung cancer, those who died early consulted with primary care more frequently prediagnosis. Individual factors associated with early death were male sex (OR 1.17; 95% CI 1.10 to 1.24), current smoking (OR 1.43; 95% CI 1.28 to 1.61), increasing age (OR 1.80; 95% CI 1.62 to 1.99 for age ≥80 years compared to 65-69 years), social deprivation (OR 1.16; 95% CI 1.04 to 1.30 for Townsend quintile 5 vs 1) and rural versus urban residence (OR 1.22; 95% CI 1.06 to 1.41). CXR rates varied widely, and the odds of early death were highest in the practices which requested more CXRs. Lung cancer incidence at practice level did not affect early deaths. CONCLUSIONS Patients who die early from lung cancer are interacting with primary care prediagnosis, suggesting potentially missed opportunities to identify them earlier. A general increase in CXR requests may not improve survival; rather, a more timely and appropriate targeting of this investigation using risk assessment tools needs further assessment.
Collapse
Affiliation(s)
- Emma L O'Dowd
- Division of Public Health and Epidemiology, University of Nottingham, Nottingham, UK
| | - Tricia M McKeever
- Division of Public Health and Epidemiology, University of Nottingham, Nottingham, UK
| | - David R Baldwin
- Department of Respiratory Medicine, Nottingham City Hospital, Nottingham, UK
| | - Sadia Anwar
- Department of Respiratory Medicine, Nottingham City Hospital, Nottingham, UK
| | - Helen A Powell
- Division of Public Health and Epidemiology, University of Nottingham, Nottingham, UK
| | - Jack E Gibson
- Division of Public Health and Epidemiology, University of Nottingham, Nottingham, UK
| | | | - Richard B Hubbard
- Division of Public Health and Epidemiology, University of Nottingham, Nottingham, UK
| |
Collapse
|
33
|
Chatwin J, Povey A, Kennedy A, Frank T, Firth A, Booton R, Barber P, Sanders C. The mediation of social influences on smoking cessation and awareness of the early signs of lung cancer. BMC Public Health 2014; 14:1043. [PMID: 25293382 PMCID: PMC4209024 DOI: 10.1186/1471-2458-14-1043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 09/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whilst there has been no clear consensus on the potential for earlier diagnosis of lung cancer, recent research has suggested that the time between symptom onset and consultation can be long enough to plausibly affect prognosis. In this article, we present findings from a qualitative study involving in-depth interviews with patients who had been diagnosed with lung cancer (n = 11), and people who were at heightened risk of developing the disease (n = 14). METHODS A grounded theory methodology was drawn upon to conduct thematic and narrative based approaches to analysis. RESULTS The paper focuses on three main themes which emerged from the study: i) fatalism and resignation in pathways to help-seeking and the process of diagnosis; ii) Awareness of smoking risk and response to cessation information and advice. iii) The role of social and other networks on help-seeking. Key findings included: poor awareness among participants of the symptoms of lung cancer; ambivalence about the dangers of smoking; the perception of lung cancer as part of a homogenisation of multiple illnesses; close social networks as a key trigger in help-seeking. CONCLUSIONS We suggest that future smoking cessation and lung cancer awareness campaigns could usefully capitalise on the influence of close social networks, and would benefit from taking a 'softer' approach.
Collapse
Affiliation(s)
- John Chatwin
- School of Nursing, Midwifery, Social Work & Social Sciences, University of Salford UK, Allerton Building, Salford M6 6PU, UK.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Ofiara LM, Navasakulpong A, Beaudoin S, Gonzalez AV. Optimizing tissue sampling for the diagnosis, subtyping, and molecular analysis of lung cancer. Front Oncol 2014; 4:253. [PMID: 25295226 PMCID: PMC4170137 DOI: 10.3389/fonc.2014.00253] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 09/03/2014] [Indexed: 01/15/2023] Open
Abstract
Lung cancer has entered the era of personalized therapy with histologic subclassification and the presence of molecular biomarkers becoming increasingly important in therapeutic algorithms. At the same time, biopsy specimens are becoming increasingly smaller as diagnostic algorithms seek to establish diagnosis and stage with the least invasive techniques. Here, we review techniques used in the diagnosis of lung cancer including bronchoscopy, ultrasound-guided bronchoscopy, transthoracic needle biopsy, and thoracoscopy. In addition to discussing indications and complications, we focus our discussion on diagnostic yields and the feasibility of testing for molecular biomarkers such as epidermal growth factor receptor and anaplastic lymphoma kinase, emphasizing the importance of a sufficient tumor biopsy.
Collapse
Affiliation(s)
- Linda Marie Ofiara
- Respiratory Medicine Division, Department of Medicine, McGill University Health Centre, Montreal Chest Institute , Montreal, QC , Canada
| | - Asma Navasakulpong
- Respiratory Medicine Division, Department of Medicine, McGill University Health Centre, Montreal Chest Institute , Montreal, QC , Canada ; Pulmonary and Respiratory Critical Care Division, Faculty of Medicine, Prince of Songkla University , Hatyai , Thailand
| | - Stephane Beaudoin
- Respiratory Medicine Division, Department of Medicine, McGill University Health Centre, Montreal Chest Institute , Montreal, QC , Canada
| | - Anne Valerie Gonzalez
- Respiratory Medicine Division, Department of Medicine, McGill University Health Centre, Montreal Chest Institute , Montreal, QC , Canada
| |
Collapse
|
35
|
Abstract
PURPOSE OF REVIEW This review focuses on neurocognitive outcome with respect to potential pathophysiological inflammatory mechanisms of thoracic surgery and one-lung ventilation, risk factors of postoperative delirium and postoperative cognitive dysfunction (POCD) as well as anti-inflammatory strategies. RECENT FINDINGS Neurocognitive dysfunction is associated with increased mortality and disability. The incidence of postoperative delirium and POCD is often underestimated in the perioperative care setting. Both are threatening complications after major surgery and independently associated with an increased morbidity and mortality. Nevertheless, in thoracic surgery, the clinical relevance of neurocognitive dysfunction is still underestimated. Currently, there has been a growing interest in inflammation as a cause of the pathogenesis of postoperative delirium and POCD. Furthermore, thoracic surgery often requires one-lung ventilation, which is accompanied with important physiological disturbances, and leads to a pulmonary arteriovenous shunt with the decrease of arterial oxygen content and an exaggerated activation of inflammatory processes. As inflammation is involved in brain dysfunction, anti-inflammatory strategies in the perioperative setting seem to be potential neuroprotective targets concerning specially high-risk patients undergoing thoracic surgery under one-lung ventilation. SUMMARY There is evidence that important key strategies improve neurocognitive outcome after thoracic surgery. This includes adequate risk stratification, the anesthetic management and postoperative critical care strategies.
Collapse
|
36
|
Ost DE, Niu J, Elting LS, Buchholz TA, Giordano SH. Determinants of practice patterns and quality gaps in lung cancer staging and diagnosis. Chest 2014; 145:1097-1113. [PMID: 24202651 DOI: 10.1378/chest.13-1628] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Guidelines recommend mediastinal lymph node sampling as the fi rst invasive diagnostic procedure in patients with suspected lung cancer with mediastinal lymphadenopathy without distant metastases. METHODS Patients were a retrospective cohort of 15,316 patients with lung cancer with regional spread without metastatic disease in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) or Texas Cancer Registry Medicare-linked databases. Patients were categorized based on the sequencing of invasive diagnostic tests performed: (1) evaluation consistent with guidelines, mediastinal sampling done fi rst; (2) evaluation inconsistent with guidelines, non-small cell lung cancer (NSCLC) present, mediastinal sampling performed but not as part of the fi rst invasive test; (3) evaluation inconsistent with guidelines, NSCLC present, mediastinal sampling never done; and (4) evaluation inconsistent with guidelines, small cell lung cancer. The primary outcome was whether guideline-consistent care was delivered. Secondary outcomes included whether patients with NSCLC ever had mediastinal sampling and use of transbronchial needle aspiration (TBNA) among pulmonologists. RESULTS Only 21% of patients had a diagnostic evaluation consistent with guidelines. Only 56% of patients with NSCLC had mediastinal sampling prior to treatment. There was significant regional variability in guideline-consistent care (range, 12%-29%). Guideline-consistent care was associated with lower patient age, metropolitan areas, and if the physician ordering or performing the test was male, trained in the United States, had seen more patients with lung cancer, and was a pulmonologist or thoracic surgeon who had graduated more recently. More recent pulmonary graduates were also more likely to perform TBNA ( P < .001). CONCLUSIONS Guideline-consistent care varied regionally and was associated with physician-level factors, suggesting that a lack of effective physician training may be contributing to the quality gaps observed.
Collapse
Affiliation(s)
- David E Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Jiangong Niu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Linda S Elting
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Thomas A Buchholz
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
37
|
Medford AR. Endobronchial ultrasound-guided versus conventional transbronchial needle aspiration: time to re-evaluate the relationship? J Thorac Dis 2014; 6:411-5. [PMID: 24822096 PMCID: PMC4014991 DOI: 10.3978/j.issn.2072-1439.2014.04.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 04/03/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Andrew Rl Medford
- North Bristol Lung Centre & University of Bristol, Southmead Hospital, Bristol BS10 5NB, England, UK
| |
Collapse
|
38
|
Ost DE, Niu J, Elting LS, Buchholz TA, Giordano SH. Quality gaps and comparative effectiveness in lung cancer staging and diagnosis. Chest 2014; 145:331-345. [PMID: 24091637 DOI: 10.1378/chest.13-1599] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Guidelines recommend mediastinal lymph node sampling as the first invasive test in patients with suspected lung cancer with mediastinal lymphadenopathy without distant metastases, but there are no comparative effectiveness studies on how test sequencing affects outcomes. The objective was to compare practice patterns and outcomes of diagnostic strategies in patients with lung cancer. METHODS The study included a retrospective cohort of 15,316 patients with lung cancer with regional spread without distant metastases in the Surveillance, Epidemiology, and End Results or Texas Cancer Registry Medicare-linked databases. If the first invasive test involved mediastinal sampling, patients were classified as receiving guideline-consistent care; otherwise, they were classified as receiving guideline-inconsistent care. We used propensity matching to compare the number of tests performed and multivariate logistic regression to compare the frequency of complications. RESULTS Twenty-one percent of patients had guideline-consistent diagnostic evaluations. Among patients with non-small cell lung cancer, 44% never had mediastinal sampling. Patients who had guideline-consistent care required fewer tests than those with guideline-inconsistent care (P < .0001), including thoracotomies (49% vs 80%, P < .001) and CT image-guided biopsies (9% vs 63%, P < .001), although they had more transbronchial needle aspirations (37% vs 4%, P < .001). The consequence was that patients with guideline-consistent care had fewer pneumothoraxes (4.8% vs 25.6%, P < .0001), chest tubes (0.7% vs 4.9%, P < .001), hemorrhages (5.4% vs 10.6%, P < .001), and respiratory failure events (5.3% vs 10.5%, P < .001). CONCLUSIONS Guideline-consistent care with mediastinal sampling first resulted in fewer tests and complications. We found three quality gaps: failure to sample the mediastinum first, failure to sample the mediastinum at all in patients with non-small cell lung cancer, and overuse of thoracotomy.
Collapse
Affiliation(s)
- David E Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Jiangong Niu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Linda S Elting
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Thomas A Buchholz
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
39
|
Almeida FA, Casal RF, Jimenez CA, Eapen GA, Uzbeck M, Sarkiss M, Rice D, Morice RC, Ost DE. Quality gaps and comparative effectiveness in lung cancer staging: the impact of test sequencing on outcomes. Chest 2014; 144:1776-1782. [PMID: 23703671 DOI: 10.1378/chest.12-3046] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Evidence-based guidelines recommend mediastinal sampling as the first invasive test in patients with suspected lung cancer and mediastinal adenopathy. The goal of this study was to assess practice patterns and outcomes of diagnostic strategies in this patient population. METHODS We conducted a retrospective analysis of all patients in 2009 who had mediastinal adenopathy without distant metastatic disease to determine whether guideline-consistent care was delivered. Guideline-consistent care was defined as mediastinal lymph node sampling being performed as part of the first invasive procedure. RESULTS One hundred thirty-seven patients were included. Guideline-consistent care was provided in 30 cases (22%). Patients receiving guideline-consistent care had fewer invasive tests than patients with guideline-inconsistent care (1.3 ± 0.5 tests/patient vs 2.3 ± 0.5 tests/patient, respectively; P < .0001) and fewer complications (0 of 30, 0% vs 18 of 108, 17%; P = .01). Most of the complications (16 of 18) were related to CT image-guided needle biopsy. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was sufficient to guide treatment decisions without any other invasive tests in 88 patients (64%). Although not all the complications and costs due to CT image-guided biopsies could have been avoided, roughly two-thirds could have been eliminated by just changing the testing sequence. CONCLUSION Quality gaps in lung cancer staging in patients with mediastinal adenopathy are common and lead to unnecessary testing and increased complications. In patients with suspected lung cancer without distant metastatic disease with mediastinal adenopathy, EBUS-TBNA should be the first test.
Collapse
Affiliation(s)
- Francisco A Almeida
- Department of Pulmonary, Allergy, and Critical Care Medicine, Cleveland Clinic, Cleveland, OH
| | - Roberto F Casal
- Department of Pulmonary and Critical Care Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, TX
| | - Carlos A Jimenez
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - George A Eapen
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mateen Uzbeck
- The Department of Pulmonary Medicine, Our Lady of Lourdes and Beaumont Hospitals, Dublin, Ireland
| | - Mona Sarkiss
- Department of Anesthesia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David Rice
- Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Rodolfo C Morice
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David E Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
40
|
Hashimoto N, Matsuzaki A, Okada Y, Imai N, Iwano S, Wakai K, Imaizumi K, Yokoi K, Hasegawa Y. Clinical impact of prevalence and severity of COPD on the decision-making process for therapeutic management of lung cancer patients. BMC Pulm Med 2014; 14:14. [PMID: 24498965 PMCID: PMC3922111 DOI: 10.1186/1471-2466-14-14] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 02/03/2014] [Indexed: 11/10/2022] Open
Abstract
Background Recent studies suggest that coexistence of chronic obstructive pulmonary disease (COPD) might be independently related to a worse prognosis for lung cancer. However, because data on the substantial prevalence of COPD and its severity in Asian lung cancer patients remain limited, clinical impact of prevalence and severity of COPD among the population has not been fully evaluated. Furthermore, patients with COPD often have comorbidities. Thus, whether the decision-making process for therapeutic management of lung cancer patients might be independently affected by COPD remains elusive. Methods Clinical impact of prevalence and severity of COPD were evaluated in 270 Japanese patients with newly diagnosed lung cancer who were sequentially registered and underwent bronchoscopy from August 2010 to July 2012 at Nagoya University hospital. Furthermore, to explore whether or not the severity of airflow obstruction might affect the decision to propose thoracic surgery with curative intent, we evaluated data from patients with lung cancer at stage 1A to 3A who underwent spirometry and bronchoscopy. Results The prevalence rate of COPD was 54.4% among Japanese patients with lung cancer who underwent bronchoscopy. The incidence of Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 1 and 2 was significantly higher than that of GOLD grade 3. Although COPD-related comorbidities were not independent factors for proposing thoracic surgery, the number of thoracic surgeries performed was significantly less in the COPD group than the non-COPD group. Multivariate analysis showed that more severe airway obstruction, advanced clinical staging, and higher age, were independent factors associated with the decision on thoracic surgery. Conclusions We demonstrated a high prevalence of COPD among Japanese lung cancer patients. Based on the knowledge that severity of COPD is one of the most important factors in the therapeutic decision, comprehensive assessment of COPD at bronchoscopy might allow us to implement the optimum management for lung cancer patients.
Collapse
Affiliation(s)
- Naozumi Hashimoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Lüchtenborg M, Riaz SP, Lim E, Page R, Baldwin DR, Jakobsen E, Vedsted P, Lind M, Peake MD, Mellemgaard A, Spicer J, Lang-Lazdunski L, Møller H. Survival of patients with small cell lung cancer undergoing lung resection in England, 1998-2009. Thorax 2013; 69:269-73. [PMID: 24172710 PMCID: PMC3932952 DOI: 10.1136/thoraxjnl-2013-203884] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction Chemotherapy or chemoradiotherapy is the recommended treatment for small cell lung cancer (SCLC), except in stage I disease where clinical guidelines state there may be a role for surgery based on favourable outcomes in case series. Evidence supporting adjuvant chemotherapy in resected SCLC is limited but this is widely offered. Methods Data on 359 873 patients who were diagnosed with a first primary lung cancer in England between 1998 and 2009 were grouped according to histology (SCLC or non-SCLC (NSCLC)) and whether they underwent a surgical resection. We explored their survival using Kaplan–Meier analysis and Cox regression, adjusting for age, sex, comorbidity and socioeconomic status. Results The survival of 465 patients with resected SCLC was lower than patients with resected NSCLC (5-year survival 31% and 45%, respectively), but much higher than patients of either group who were not resected (3%). The difference between resected SCLC and NSCLC diminished with time after surgery. Survival was superior for the subgroup of 198 ‘elective’ SCLC cases where the diagnosis was most likely known before resection than for the subgroup of 267 ‘incidental’ cases where the SCLC diagnosis was likely to have been made after resection. Conclusions These data serve as a natural experiment testing the survival after surgical management of SCLC according to NSCLC principles. Patients with SCLC treated surgically for early stage disease may have survival outcomes that approach those of NSCLC, supporting the emerging clinical practice of offering surgical resection to selected patients with SCLC.
Collapse
Affiliation(s)
- Margreet Lüchtenborg
- Cancer Epidemiology and Population Health, King's Health Partners Cancer Centre, , London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Posch F, Setinek U, Flores RM, Bernhard D, Hannigan GE, Mueller MR, Watzka SB. Serum integrin-linked kinase (sILK) concentration and survival in non-small cell lung cancer: a pilot study. Clin Transl Oncol 2013; 16:455-62. [PMID: 23979911 DOI: 10.1007/s12094-013-1101-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 08/06/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Integrin-linked kinase (ILK) is an intracellular signaling protein critically involved in cellular growth and motility. In non-small cell lung cancer (NSCLC), increased ILK expression has been associated with decreased recurrence-free and overall survival. Recently, ILK has also been detected in the serum of NSCLC patients. OBJECTIVE To assess the prognostic impact of preoperative serum ILK (sILK) concentration on overall survival in surgically amenable NSCLC. PATIENTS AND METHODS Preoperative sILK was quantified by ELISA in 50 newly diagnosed NSCLC patients. After surgery, patients were followed-up for a median interval of 2.5 years. RESULTS Serum ILK concentrations ranged from 0 to 2.44 ng/ml. Mean sILK was around 2.3 times higher in the 16 patients who died as compared to the 34 patients who survived (1.04 vs. 0.45 ng/ml, p = 0.001). In univariate time-to-event analysis, increased sILK was associated with adverse survival [Hazard ratio (HR): 4.03, 95 % CI: 2.00-8.13, p < 0.001]. This association prevailed after multivariable adjustment for several clinical, demographic, and laboratory parameters (HR: 3.85, 95 % CI: 1.53-9.72, p = 0.004). CONCLUSIONS Serum ILK shows potential as a novel strong and independent prognostic marker for postoperative survival in surgically amenable NSCLC.
Collapse
Affiliation(s)
- F Posch
- Division of Thoracic Surgery, Karl Landsteiner Institute for Thoracic Oncology, Otto Wagner Hospital, Sanatoriumstrasse 2, 1140, Vienna, Austria
| | | | | | | | | | | | | |
Collapse
|
43
|
Brunelli A, Kim AW, Berger KI, Addrizzo-Harris DJ. Physiologic Evaluation of the Patient With Lung Cancer Being Considered for Resectional Surgery. Chest 2013; 143:e166S-e190S. [DOI: 10.1378/chest.12-2395] [Citation(s) in RCA: 542] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
|
44
|
Verstegen NE, Lagerwaard FJ, Senan S. Developments in early-stage NSCLC: advances in radiotherapy. Ann Oncol 2013; 23 Suppl 10:x46-51. [PMID: 22987992 DOI: 10.1093/annonc/mds301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
An increase in the number of predominantly elderly patients with early-stage non-small-cell lung cancer is anticipated in many Western populations. Patients often have major co-morbidities and are at increased risk for surgical morbidity and mortality. In the past decade, the use of stereotactic ablative radiotherapy (SABR) has achieved excellent results, with only mild toxicity in such vulnerable patient groups, leading to SABR becoming accepted as a standard of care for unfit patients in several countries. The planning and delivery of SABR has rapidly improved in recent years, particularly with the use of 'on-board' imaging at treatment units, and shortened treatment delivery times. Increasingly, more central tumors are being treated using lower doses per fraction (so-called risk-adapted schemes). It is also becoming clear that long-term follow-up should take place at specialist centers in order to distinguish the evolving fibrosis that is frequently observed from the relatively infrequent local recurrences. Given the high local control rates and limited toxicity, increasing attention is being paid to the use of SABR in the subgroup of so-called borderline operable patients, and clinical trials comparing surgery and SABR in these patients are ongoing.
Collapse
Affiliation(s)
- N E Verstegen
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | | | | |
Collapse
|
45
|
Jones NL, Edmonds L, Ghosh S, Klein AA. A review of enhanced recovery for thoracic anaesthesia and surgery. Anaesthesia 2012; 68:179-89. [PMID: 23121400 DOI: 10.1111/anae.12067] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2012] [Indexed: 12/12/2022]
Abstract
During the past decade, there has been a dramatic increase in the number of thoracic surgical procedures carried out in the UK. The current financial climate dictates that more efficient use of resources is necessary to meet escalating demands on healthcare. One potential means to achieve this is through the introduction of enhanced recovery protocols, designed to produce productivity savings by driving reduction in length of stay. These have been promoted by government bodies in a number of surgical specialties, including colorectal, gynaecological and orthopaedic surgery. This review focuses on aspects of peri-operative care that might be incorporated into such a programme for thoracic anaesthesia, for which an enhanced recovery programme has not yet been introduced in the UK, and a review of the literature specific to this area of practice has not been published before. We performed a comprehensive search for published work relating to the peri-operative management and optimisation of patients undergoing thoracic surgery, and divided these into appropriate areas of practice. We have reviewed the specific interventions that may be included in an enhanced recovery programme, including: pre-optimisation; minimising fasting time; thrombo-embolic prophylaxis; choice of anaesthetic and analgesic technique and surgical approach; postoperative rehabilitation; and chest drain management. Using the currently available evidence, the design and implementation of an enhanced recovery programme based on this review in selected patients as a package of care may reduce morbidity and length of hospital stay, thus maximising utilisation of available resources.
Collapse
Affiliation(s)
- N L Jones
- Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, UK
| | | | | | | |
Collapse
|
46
|
Dale CR, Madtes DK, Fan VS, Gorden JA, Veenstra DL. Navigational bronchoscopy with biopsy versus computed tomography-guided biopsy for the diagnosis of a solitary pulmonary nodule: a cost-consequences analysis. J Bronchology Interv Pulmonol 2012; 19:294-303. [PMID: 23207529 PMCID: PMC3611239 DOI: 10.1097/lbr.0b013e318272157d] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Solitary pulmonary nodules (SPNs) are frequent and can be malignant. Both computed tomography-guided biopsy and electromagnetic navigational bronchoscopy (ENB) with biopsy can be used to diagnose a SPN. A nondiagnostic computed tomography (CT)-guided or ENB biopsy is often followed by video-assisted thoracoscopic surgery (VATS) biopsy. The relative costs and consequences of these strategies are not known. METHODS A decision tree was created with values from the literature to evaluate the clinical consequences and societal costs of a CT-guided biopsy strategy versus an ENB biopsy strategy for the diagnosis of a SPN. The serial use of ENB after nondiagnostic CT-guided biopsy and CT-guided biopsy after nondiagnostic ENB biopsy were tested as alternate strategies. RESULTS In a hypothetical cohort of 100 patients, use of the ENB biopsy strategy on average results in 13.4 fewer pneumothoraces, 5.9 fewer chest tubes, 0.9 fewer significant hemorrhage episodes, and 0.6 fewer respiratory failure episodes compared with a CT-guided biopsy strategy. ENB biopsy increases average costs by $3719 per case and increases VATS rates by an absolute 20%. The sequential diagnostic strategy that combines CT-guided biopsy after nondiagnostic ENB biopsy and vice versa decreases the rate of VATS procedures to 3%. A sequential approach starting with ENB decreases average per case cost relative to CT-guided biopsy followed by VATS, if needed, by $507; and a sequential approach starting with CT-guided biopsy decreases the cost relative to CT-guided biopsy followed by VATS, if needed, by $979. CONCLUSIONS An ENB with biopsy strategy is associated with decreased pneumothorax rate but increased costs and increased use of VATS. Combining CT-guided biopsy and ENB with biopsy serially can decrease costs and complications.
Collapse
Affiliation(s)
| | - David K. Madtes
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA,
| | | | | | | |
Collapse
|
47
|
De Zoysa MK, Hamed D, Routledge T, Scarci M. Is limited pulmonary resection equivalent to lobectomy for surgical management of stage I non-small-cell lung cancer? Interact Cardiovasc Thorac Surg 2012; 14:816-20. [PMID: 22374287 DOI: 10.1093/icvts/ivs031] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: is limited pulmonary resection equivalent to lobectomy in terms of morbidity, long-term survival and locoregional recurrence in patients with stage I non-small-cell lung cancer (NSCLC)? A total of 166 papers were found using the reported search; of which, 16 papers, including one meta-analysis and one randomized control trial (RCT), represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. With regards to 5-year survival rates, the evidence is conflicting: a 2005 meta-analysis and six other retrospective or prospective nonrandomized analyses did not find any statistically significant difference when comparing lobectomy with limited resection. However, three studies found evidence of a decreased overall survival with limited resection, including the only randomized control trial, which showed a 50% increase in the cancer-related death rate (P = 0.09), and a 30% increase in the overall death rate in patients undergoing limited resection (P = 0.08). Age, tumour size and specific type of limited resection were also factors influencing the survival rates. Four studies, including the RCT, found increased locoregional recurrence rates with limited resection. There is also evidence that wedge resections, compared with segmentectomies, lead to lower survival and higher recurrence rates. In conclusion, lobectomy is still recommended for younger patients with adequate cardiopulmonary function. Although limited resection carries a decreased rate of complications and shorter hospital stays, it may also carry a higher rate of loco-regional recurrences. However, limited resection may be comparable for patients >71 years of age, and those with small peripheral tumours.
Collapse
Affiliation(s)
- Maya K De Zoysa
- Department of Thoracic Surgery, St Joseph's Healthcare, McMaster University, Hamilton, Canada.
| | | | | | | |
Collapse
|
48
|
Berglund A, Lambe M, Lüchtenborg M, Linklater K, Peake MD, Holmberg L, Møller H. Social differences in lung cancer management and survival in South East England: a cohort study. BMJ Open 2012; 2:bmjopen-2012-001048. [PMID: 22637374 PMCID: PMC3367157 DOI: 10.1136/bmjopen-2012-001048] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine possible social variations in lung cancer survival and assess if any such gradients can be attributed to social differences in comorbidity, stage at diagnosis or treatment. DESIGN Population-based cohort identified in the Thames Cancer Registry. SETTING South East England. PARTICIPANTS 15 582 lung cancer patients diagnosed between 2006 and 2008. MAIN OUTCOME MEASURES Stage at diagnosis, surgery, radiotherapy, chemotherapy and survival. RESULTS The likelihood of being diagnosed as having early-stage disease did not vary by socioeconomic quintiles (p=0.58). In early-stage non-small-cell lung cancer, the likelihood of undergoing surgery was lowest in the most deprived group. There were no socioeconomic differences in the likelihood of receiving radiotherapy in stage III disease, while in advanced disease and in small-cell lung cancer, receipt of chemotherapy differed over socioeconomic quintiles (p<0.01). In early-stage disease and following adjustment for confounders, the HR between the most deprived and the most affluent group was 1.24 (95% CI 0.98 to 1.56). Corresponding estimates in stage III and advanced disease or small-cell lung cancer were 1.16 (95% CI 1.01 to 1.34) and 1.12 (95% CI 1.05 to 1.20), respectively. In early-stage disease, the crude HR between the most deprived and the most affluent group was approximately 1.4 and constant through follow-up, while in patients with advanced disease or small-cell lung cancer, no difference was detectable after 3 months. CONCLUSION We observed socioeconomic variations in management and survival in patients diagnosed as having lung cancer in South East England between 2006 and 2008, differences which could not fully be explained by social differences in stage at diagnosis, co-morbidity and treatment. The survival observed in the most affluent group should set the target for what is achievable for all lung cancer patients, managed in the same healthcare system.
Collapse
Affiliation(s)
- Anders Berglund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Regional Cancer Centre of Central Sweden, University Hospital, Uppsala, Sweden
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Regional Cancer Centre of Central Sweden, University Hospital, Uppsala, Sweden
| | - Margreet Lüchtenborg
- King's College London, School of Medicine, Division of Cancer Studies, Thames Cancer Registry, London, UK
| | - Karen Linklater
- King's College London, School of Medicine, Division of Cancer Studies, Thames Cancer Registry, London, UK
| | - Michael D Peake
- Department of Respiratory Medicine, Glenfield Hospital, Leicester, UK
- National Cancer Intelligence Network, London, UK
| | - Lars Holmberg
- Regional Cancer Centre of Central Sweden, University Hospital, Uppsala, Sweden
- King's College London, School of Medicine, Division of Cancer Studies, Thames Cancer Registry, London, UK
| | - Henrik Møller
- King's College London, School of Medicine, Division of Cancer Studies, Thames Cancer Registry, London, UK
| |
Collapse
|
49
|
Medford ARL. Endobronchial ultrasound-guided transbronchial needle aspiration: Onwards and upwards. Thorac Cancer 2011; 2:131-133. [PMID: 27755848 DOI: 10.1111/j.1759-7714.2011.00065.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
|
50
|
Kaynar H, Meral M, Ucar EY, Saglam L, Yildirim U, Gorguner M, Akgun M. Clinical value of detection of metastasis of carina in patients with non-small cell lung cancer. Respir Med 2011; 105:1537-42. [PMID: 21684730 DOI: 10.1016/j.rmed.2011.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 05/16/2011] [Accepted: 05/24/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although the utility of blind biopsy in the detection of metastasis in the carina has been reported, submucosal fine needle aspiration (SMFNA) has not been evaluated. We investigated how SMFNA of the main carina and upper-lobe carina in addition to blind biopsy affect management of patients with NSCLC. METHODS Thirty-five patients were evaluated. During fiberoptic bronchoscopy (FOB), five blind biopsy and three SMFNA specimens were collected from normal-appearing main carina (n = 35) and/or upper-lobe carina (n = 18). Subjects were staged for operability using traditional staging system, without knowing the blind biopsy or SMFNA results. Then, patients were staged again after results were made known. RESULTS Thirty-five NSCLC patients were analyzed. The management of 12 patients (34%) was changed according to our results. Out of the patients, 8, 5 and one had microscopic metastasis in the main carina, ipsilateral upper-lobe carina and both, respectively. Although SMFNA were more diagnostic compared to blind forceps biopsy, there was no statistically difference between them. These procedures increased the success of detection of microscopic metastasis and the results changed management of those cases. CONCLUSION SMFNA adds valuable information to blind biopsy, and their combination changed the management in one quarter of our NSCLC patients.
Collapse
Affiliation(s)
- Hasan Kaynar
- Department of Pulmonary Medicine, Ataturk University, Erzurum, Turkey
| | | | | | | | | | | | | |
Collapse
|