1
|
López I, Aguinagalde B, Urreta I, Royo I, Bolufer S, Sánchez L, Zabaleta J, Fernández-Monge A, Embún R. Presurgical invasive mediastinal staging in lung cancer, unexpected N2 and long-term survival: a registry-based study with data from the Spanish group for video-assisted thoracic surgery. J Thorac Dis 2024; 16:2856-2865. [PMID: 38883688 PMCID: PMC11170386 DOI: 10.21037/jtd-23-1900] [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: 12/14/2023] [Accepted: 03/22/2024] [Indexed: 06/18/2024]
Abstract
Background Mediastinal lymph node staging is a key element in the diagnosis of lung cancer. The combination of computed tomography (CT) and positron emission tomography (PET) has improved staging but some circumstances are known to influence their negative predictive value. The objective of this study was to assess the impact on survival of avoiding invasive mediastinal staging in surgical lung cancer patients with negative mediastinum in CT and PET and intermediate risk of unexpected pN2. Methods Data were collected from the prospective cohort of the Spanish Group for Video-Assisted Thoracic Surgery (GEVATS), from December 2016 to March 2018. For this study, patients were selected if they had negative mediastinum in CT and PET findings but tumours >3 cm or located centrally, or with cN1 disease. Patients who did and did not undergo invasive staging [invasive group (IG) and non-invasive group (NIG)] were compared, analysing unexpected pN2 and survival with Kaplan-Meier curves and Cox regression. Results A total of 2,826 patients underwent surgery for primary lung cancer. We selected 1,247 patients who had tumours >3 cm, central tumours or cN1. Invasive staging was performed in 275 (22.1%) cases. The unexpected pN2 rate was 9.6% in the NIG and 13.8% in the IG, but half of them were discovered prior to surgery in the IG. Five-year overall survival (OS) was poorer in the IG (52.4% vs. 64%; P<0.001). In the Cox regression model, male sex, older age, diabetes, synchronous tumour, lower diffusing capacity for carbon monoxide, larger tumour size, higher pathological N-stage, and IG status were significant independent risk factors. Conclusions Invasive staging recommended by guidelines could be reduced with an appropriate selection in mediastinal CT- and PET-negative patients with risk factors for unexpected pN2, because rates of pN2 and survival did not worsen without invasive staging.
Collapse
Affiliation(s)
- Iker López
- Thoracic Surgery Department, University Hospital Donostia, San Sebastián-Donostia, Spain
- Biogipuzkoa Health Research Institute, San Sebastián-Donostia, Spain
| | - Borja Aguinagalde
- Thoracic Surgery Department, University Hospital Donostia, San Sebastián-Donostia, Spain
- Biogipuzkoa Health Research Institute, San Sebastián-Donostia, Spain
| | - Iratxe Urreta
- Biogipuzkoa Health Research Institute, San Sebastián-Donostia, Spain
- Osakidetza-Basque Health Service, Donostia University Hospital, Clinical Epidemiology Unit, San Sebastián-Donostia, Spain
- CIBER on Epidemiology and Public Health (CIBERESP), Spain
| | - Iñigo Royo
- Thoracic Surgery Department, University Hospital Miguel Servet and Lozano Blesa, Zaragoza, Spain
- Aragón Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | - Sergio Bolufer
- Thoracic Surgery Department, University General Hospital of Alicante, Alicante, Spain
| | - Laura Sánchez
- Thoracic Surgery Department, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Jon Zabaleta
- Thoracic Surgery Department, University Hospital Donostia, San Sebastián-Donostia, Spain
- Biogipuzkoa Health Research Institute, San Sebastián-Donostia, Spain
| | - Arantza Fernández-Monge
- Thoracic Surgery Department, University Hospital Donostia, San Sebastián-Donostia, Spain
- Biogipuzkoa Health Research Institute, San Sebastián-Donostia, Spain
| | - Raúl Embún
- Thoracic Surgery Department, University Hospital Miguel Servet and Lozano Blesa, Zaragoza, Spain
- Aragón Institute for Health Research (IIS Aragón), Zaragoza, Spain
| |
Collapse
|
2
|
Lopez I, Aguinagalde B, Urreta I, Royo I, Bolufer S, Sanchez L, Zabaleta J, Fernández-Monge A, Recuero JL, Sesma J, Amor S, Moradiellos FJ, Arrarás MJ, Blanco AI, Boada M, Sanchez D, Cabañero A, Moreno N, Cal I, Moreno R, Cilleruelo Á, Crowley S, Gómez D, Fernández E, Hernando F, García S, López C, García MD, García JM, Rivo JE, Garcia JA, Gelbenzu JJ, Ramírez ME, Giraldo CF, Mongil R, Gómez MT, Jiménez M, Henández J, Fibla JJ, Illana JD, Jauregui A, Jiménez U, Rojo R, Martínez NJ, Martínez E, Trujillo JC, Milla L, Moreno SB, Congregado M, Obiols C, Call S, Quero F, Ramos R, Rodríguez A, Simón CM, Embun R. Results in mediastinal lymph node staging of surgical lung cancer: Data from the prospective cohort of the Spanish Video-Assisted Thoracic Surgery Group. Cir Esp 2022:S2173-5077(22)00157-0. [PMID: 35671974 DOI: 10.1016/j.cireng.2022.06.006] [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: 03/02/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The objective of this study was to assess the diagnostic performance of combined computerised tomography (CT) and positron emission tomography (PET) in mediastinal staging of surgical lung cancer based on data obtained from the prospective cohort of the Spanish Group for Video-Assisted Thoracic Surgery (GEVATS). METHODS A total of 2782 patients underwent surgery for primary lung carcinoma. We analysed diagnostic success in mediastinal lymph node staging (cN2) using CT and PET. Bivariate and multivariate analyses were performed of the factors involved in this success. The risk of unexpected pN2 disease was analysed for cases in which an invasive testing is recommended: cN1, the tumour centrally located or the tumour diameter >3 cm. RESULTS The overall success of CT together with PET was 82.9% with a positive predictive value of 0.21 and negative predictive value of 0.93. If the tumour was larger than 3 cm and for each unit increase in mediastinal SUVmax, the probability of success was lower with OR 0.59 (0.44-0.79) and 0.71 (0.66-0.75), respectively. In the video-assisted thoracic surgery (VATS) approach, the probability of success was higher with OR 2.04 (1.52-2.73). The risk of unexpected pN2 increased with the risk factors cN1, the tumour centrally located or the tumour diameter >3 cm: from 4.5% (0 factors) to 18.8% (3 factors) but did not differ significantly as a function of whether invasive testing was performed. CONCLUSIONS CT and PET together have a high negative predictive value. The overall success of the staging is lower in the case of tumours >3 cm and high mediastinal SUVmax, and it is higher when VATS is performed. The risk of unexpected pN2 is higher if the disease is cN1, the tumour centrally located or the tumour diameter >3 cm but does not vary significantly as a function of whether patients have undergone invasive testing.
Collapse
Affiliation(s)
- Iker Lopez
- Servicio de Cirugía Torácica, Hospital Universitario Donostia, Instituto de Investigación Sanitaria Biodonostia, San Sebastián-Donostia, Spain.
| | - Borja Aguinagalde
- Servicio de Cirugía Torácica, Hospital Universitario Donostia, Instituto de Investigación Sanitaria Biodonostia, San Sebastián-Donostia, Spain
| | - Iratxe Urreta
- Instituto de Investigación Sanitaria Biodonostia, Grupo de Epidemiología Clínica, Servicio Vasco de Salud Osakidetza, Hospital Universitario Donostia, Unidad de Epidemiología Clínica, San Sebastián-Donostia, Spain
| | - Iñigo Royo
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet y Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, Spain
| | - Sergio Bolufer
- Servicio de Cirugía Torácica, Hospital Universitario General de Alicante, Alicante, Spain
| | - Laura Sanchez
- Servicio de Cirugía Torácica, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Jon Zabaleta
- Servicio de Cirugía Torácica, Hospital Universitario Donostia, Instituto de Investigación Sanitaria Biodonostia, San Sebastián-Donostia, Spain
| | - Arantza Fernández-Monge
- Servicio de Cirugía Torácica, Hospital Universitario Donostia, Instituto de Investigación Sanitaria Biodonostia, San Sebastián-Donostia, Spain
| | - José Luis Recuero
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet y Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, Spain
| | - Julio Sesma
- Servicio de Cirugía Torácica, Hospital Universitario General de Alicante, Alicante, Spain
| | - Sergio Amor
- Servicio de Cirugía Torácica, Hospital Universitario Quironsalud Madrid, Madrid, Spain
| | | | - Miguel Jesús Arrarás
- Servicio de Cirugía Torácica, Instituto Valenciano de Oncología, Valencia, Spain
| | - Ana Isabel Blanco
- Servicio de Cirugía Torácica, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Marc Boada
- Servicio de Cirugía Torácica, Hospital Clinic de Barcelona, Barcelona, Spain
| | - David Sanchez
- Servicio de Cirugía Torácica, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Alberto Cabañero
- Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Nicolás Moreno
- Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Isabel Cal
- Servicio de Cirugía Torácica, Hospital Universitario de la Princesa, Madrid, Spain
| | - Ramón Moreno
- Servicio de Cirugía Torácica, Hospital Universitario de la Princesa, Madrid, Spain
| | - Ángel Cilleruelo
- Servicio de Cirugía Torácica, Hospital Universitario Clínico de Valladolid, Valladolid, Spain
| | - Silvana Crowley
- Servicio de Cirugía Torácica, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - David Gómez
- Servicio de Cirugía Torácica, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Elena Fernández
- Servicio de Cirugía Torácica, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Santiago García
- Servicio de Cirugía Torácica, Hospital Universitario de Badajoz, Badajoz, Spain
| | - Cipriano López
- Servicio de Cirugía Torácica, Hospital Universitario de Badajoz, Badajoz, Spain
| | - María Dolores García
- Servicio de Cirugía Torácica, Hospital Universitario de Albacete, Albacete, Spain
| | - Jose María García
- Servicio de Cirugía Torácica, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - José Eduardo Rivo
- Servicio de Cirugía Torácica, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Jose Alberto Garcia
- Servicio de Cirugía Torácica, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Juan José Gelbenzu
- Servicio de Cirugía Torácica, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - María Elena Ramírez
- Servicio de Cirugía Torácica, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - Roberto Mongil
- Servicio de Cirugía Torácica, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - María Teresa Gómez
- Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, IBSAL, Salamanca, Spain
| | - Marcelo Jiménez
- Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, IBSAL, Salamanca, Spain
| | - Jorge Henández
- Servicio de Cirugía Torácica, Hospital Universitario Sagrat Cor, Barcelona, Spain
| | - Juan José Fibla
- Servicio de Cirugía Torácica, Hospital Universitario Sagrat Cor, Barcelona, Spain
| | | | - Alberto Jauregui
- Servicio de Cirugía Torácica, Hospital Universitario Vall d́Hebron, Barcelona, Spain
| | - Unai Jiménez
- Servicio de Cirugía Torácica, Hospital Universitario de Cruces, Bilbao, Spain
| | - Rafael Rojo
- Servicio de Cirugía Torácica, Hospital Universitario de Cruces, Bilbao, Spain
| | - Néstor J Martínez
- Servicio de Cirugía Torácica, Hospital Universitario La Ribera, Alcira, Valencia, Spain
| | - Elisabeth Martínez
- Servicio de Cirugía Torácica, Hospital Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Juan Carlos Trujillo
- Servicio de Cirugía Torácica, Hospital Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Lucía Milla
- Servicio de Cirugía Torácica, Hospital Arnau de Vilanova, Lleida, Spain
| | - Sergio B Moreno
- Servicio de Cirugía Torácica, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Miguel Congregado
- Servicio de Cirugía Torácica, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Carme Obiols
- Servicio de Cirugía Torácica, Hospital Universitario MútuaTerrasa, Universidad de Barcelona, Terrasa, Barcelona, Spain
| | - Sergi Call
- Servicio de Cirugía Torácica, Hospital Universitario MútuaTerrasa, Universidad de Barcelona, Terrasa, Barcelona, Spain
| | - Florencio Quero
- Servicio de Cirugía Torácica, Hospital Virgen de las Nieves, Granada, Spain
| | - Ricard Ramos
- Servicio de Cirugía Torácica, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Alberto Rodríguez
- Servicio de Cirugía Torácica, Hospital del Mar, Instituto de Investigación Médica Hospital del Mar, Barcelona, Spain
| | - Carlos María Simón
- Servicio de Cirugía Torácica, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Raul Embun
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet y Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, Spain
| |
Collapse
|
4
|
Serrano J, Crespo PC, Taboada B, Gonzalez AA, García RG, Caamaño AG, Reyes JCT, Mielgo-Rubio X, Couñago F. Postoperative radiotherapy in resected non-small cell lung cancer: The never-ending story. World J Clin Oncol 2021; 12:833-844. [PMID: 34733608 PMCID: PMC8546654 DOI: 10.5306/wjco.v12.i10.833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/20/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
This manuscript collects in a joint and orderly manner the existing evidence at the present time about postoperative treatment with radiotherapy in non-small cell lung cancer. It also systematically reviews the current evidence, the international recommendations in the most relevant guidelines, the most controversial aspects in clinical and pathological staging, the specific technical aspects of radiotherapy treatment, and also collects all the potential risk factors that have been postulated as significant in the prognosis of these patients, evaluating the possibility of segmenting a particularly sensitive subpopulation with a high risk of relapse on which an adjuvant treatment with radiotherapy could have an impact on their clinical evolution. Finally, currently active trials that aspire to provide more evidence on this topic are reviewed.
Collapse
Affiliation(s)
- Javier Serrano
- Department of Radiation Therapy, Clinica Universidad de Navarra, Madrid 28027, Spain
| | - Patricia Calvo Crespo
- Department of Radiation Oncology, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela 15706, Spain
| | - Begoña Taboada
- Department of Radiation Oncology, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela 15706, Spain
| | | | - Rafael Garcia García
- Department of Radiation Oncology, Hospital Ruber Internacional, Madrid 28034, Spain
| | - Antonio Gomez Caamaño
- Department of Radiation Oncology, Hospital Clínico Universitario Santiago de Compostela, A Coruña 15706, Spain
| | | | - Xabier Mielgo-Rubio
- Department of Medical Oncology, Hospital Universitario Fundación Alcorcón, Madrid 28922, Spain
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Hospital La Luz, Universidad Europea de Madrid, Madrid 28223, Spain
| |
Collapse
|
7
|
Gan Q, Stewart JM, Valik E, Eapen G, Caraway NP. Cytologic Evaluation of Positron Emission Tomography-Computed Tomography-Positive Lymph Nodes Sampled by Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: Experience at a Large Cancer Center. Arch Pathol Lab Med 2019; 143:1265-1270. [PMID: 31063012 DOI: 10.5858/arpa.2018-0483-oa] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is routinely used to evaluate mediastinal lymph nodes (LNs), especially for cancer staging. There are limited large studies evaluating the cytologic, radiologic, and clinical features of 18F-fluorodeoxy glucose positron emission tomography-computed tomography-positive (PET-CT+) LNs. OBJECTIVE.— To compare cytologic, radiologic, and clinical features of PET-CT+, cytology-malignant (PET-CT+/Cyto+) and PET-CT+, cytology-benign (PET-CT+/Cyto-) LNs. DESIGN.— The pathology database was searched for cases of mediastinal LNs obtained by EBUS-TBNA from January 1, 2015 to December 31, 2015. The cytologic, radiologic, and clinical features were collected for all PET-CT+ LNs. RESULTS.— Of 2267 mediastinal LNs obtained by EBUS-TBNA during this period, 577 LNs met the criteria. Of the latter, 263 (46%) were PET-CT+/Cyto+ and 314 (54%) were PET-CT+/Cyto-. All of the patients with PET-CT+/Cyto+ results had a prior or concurrent diagnosis of malignancy as compared to 89% of patients with PET-CT+/Cyto- results. Of the 224 patients with PET-CT+/Cyto+ LNs, 177 (79%) had metastases from lung primary, 43 (19%) had metastases from nonlung primaries, and 7 (3%) had lymphoma. Average LN size was larger in the PET-CT+/Cyto+ group than in the PET-CT+/Cyto- group (14.6 mm versus 9.58 mm), and mean standardized uptake value in PET-CT+/Cyto+ LNs was higher than that of PET-CT+/Cyto- LNs (10.05 versus 5.99). Significant cytologic findings in PET-CT+/Cyto- cases were necrosis and granulomatous inflammation, including 3 cases with fungal organisms. CONCLUSIONS.— PET-CT positivity alone was nonspecific for malignancy and insufficient to guide management of patients with mediastinal adenopathy, but specificity could be improved when combined with LN size and standardized uptake value.
Collapse
Affiliation(s)
- Qiong Gan
- From the Section of Cytopathology, Department of Pathology (Drs Gan, Stewart, and Caraway) and Department of Pulmonology (Drs Valik and Eapen), The University of Texas MD Anderson Cancer Center, Houston
| | - John M Stewart
- From the Section of Cytopathology, Department of Pathology (Drs Gan, Stewart, and Caraway) and Department of Pulmonology (Drs Valik and Eapen), The University of Texas MD Anderson Cancer Center, Houston
| | - Erik Valik
- From the Section of Cytopathology, Department of Pathology (Drs Gan, Stewart, and Caraway) and Department of Pulmonology (Drs Valik and Eapen), The University of Texas MD Anderson Cancer Center, Houston
| | - George Eapen
- From the Section of Cytopathology, Department of Pathology (Drs Gan, Stewart, and Caraway) and Department of Pulmonology (Drs Valik and Eapen), The University of Texas MD Anderson Cancer Center, Houston
| | - Nancy P Caraway
- From the Section of Cytopathology, Department of Pathology (Drs Gan, Stewart, and Caraway) and Department of Pulmonology (Drs Valik and Eapen), The University of Texas MD Anderson Cancer Center, Houston
| |
Collapse
|
9
|
Rami-Porta R, Call S, Dooms C, Obiols C, Sánchez M, Travis WD, Vollmer I. Lung cancer staging: a concise update. Eur Respir J 2018; 51:13993003.00190-2018. [PMID: 29700105 DOI: 10.1183/13993003.00190-2018] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/04/2018] [Indexed: 12/13/2022]
Abstract
Diagnosis and clinical staging of lung cancer are fundamental to planning therapy. The techniques for clinical staging, i.e anatomic and metabolic imaging, endoscopies and minimally invasive surgical procedures, should be performed sequentially and with an increasing degree of invasiveness. Intraoperative staging, assessing the magnitude of the primary tumour, the involved structures, and the loco-regional lymphatic spread by means of systematic nodal dissection, is essential in order to achieve a complete resection. In resected tumours, pathological staging, with the systematic study of the resected specimens, is the strongest prognostic indicator and is essential to make further decisions on therapy. In the present decade, the guidelines on lung cancer staging of the American College of Chest Physicians and the European Society of Thoracic Surgeons are based on the best available evidence and are widely followed. Recent advances in the classification of the adenocarcinoma of the lung, with the definition of adenocarcinoma in situ, minimally invasive adenocarcinoma and lepidic predominant adenocarcinoma, and the publication of the eighth edition of the tumour, node and metastasis classification of lung cancer, have to be integrated into the staging process. The present review complements the latest guidelines on lung cancer staging by providing an update of all these issues.
Collapse
Affiliation(s)
- Ramón Rami-Porta
- Dept of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Barcelona, Spain.,Network of Centres for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Barcelona, Spain
| | - Sergi Call
- Dept of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Barcelona, Spain.,Dept of Morphological Sciences, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Christophe Dooms
- Dept of Respiratory Diseases, University Hospitals, KU Leuven, Leuven, Belgium
| | - Carme Obiols
- Dept of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Barcelona, Spain
| | - Marcelo Sánchez
- Centre of Imaging Diagnosis, Radiology Dept, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - William D Travis
- Dept of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ivan Vollmer
- Centre of Imaging Diagnosis, Radiology Dept, Hospital Clínic, University of Barcelona, Barcelona, Spain
| |
Collapse
|