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Eisenberg M, Deboever N, Antonoff MB. Salvage surgery in lung cancer following definitive therapies. J Surg Oncol 2023; 127:319-328. [PMID: 36630094 DOI: 10.1002/jso.27155] [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: 10/29/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 01/12/2023]
Abstract
Salvage surgery refers to operative resection of persistent or recurrent disease in patients initially treated with intention-to-cure nonoperative management. In non-small-cell lung cancer, salvage surgery may be effective in treating selected patients with locally progressive tumors, recurrent local or locoregional disease, or local complications after nonoperative therapy. Importantly, those patients who may be candidates for salvage surgery are evolving, in terms of disease stage as well as the types of attempted definitive therapy received.
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Affiliation(s)
- Michael Eisenberg
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nathaniel Deboever
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Blumenthaler AN, Hofstetter WL, Mehran RJ, Rajaram R, Rice DC, Roth JA, Sepesi B, Swisher SG, Vaporciyan AA, Walsh GL, Strange CD, Antonoff MB. Preoperative Maximum Standardized Uptake Value Associated with Recurrence Risk In Early Lung Cancer. Ann Thorac Surg 2021; 113:1835-1844. [PMID: 34252403 DOI: 10.1016/j.athoracsur.2021.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/07/2021] [Accepted: 06/01/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND We aimed to investigate the maximum standardized uptake value (SUVmax) as a predictor of recurrence and timing of recurrence after resection of early-stage non-small cell lung cancer. METHODS We retrospectively reviewed patients from a single institution who underwent lobectomy for stage I-IIa non-small cell lung cancer from 2013-2018. Exclusion criteria included preoperative therapy and neuroendocrine histology. We collected recurrence and follow-up data, as well as preoperative SUVmax. A receiver operator characteristic curve was used to identify the optimal SUVmax for predicting recurrence. Kaplan-Meier curves and Cox Regression analyses were used to identify predictors of freedom from recurrence (FFR). RESULTS The study included 238 patients, 30(12.6%) of whom developed recurrence. The receiver operator characteristic curve had an area-under-the-curve of 0.671 and identified 4.93 as the optimal SUVmax cut-off. Patients were stratified into groups based on this value; each group included 119 patients. High SUVmax was associated with larger tumor size, poor differentiation, lymphovascular invasion, and shorter FFR. The proportion of patients without recurrence at 5 years in the low- and high-SUVmax groups were 92.4% and 73.4%, respectively (p<0.001). On univariate analysis, poor differentiation (HR:2.35, 95%CI:1.04-5.31; p=0.04), lymphovascular invasion (HR:3.19;95%CI:1.37-7.44;p=0.007), visceral pleural invasion (HR:2.33;95%CI:1.05-5.20;p=0.04), and SUVmax≥4.93 (HR:4.51;95%CI:1.84-11.03;p=0.001) predicted FFR. On multivariable analysis, only SUVmax≥4.93 remained significant (HR:5.36, 95%CI:1.50-19.17; p=0.01). CONCLUSIONS SUVmax is independently associated with risk of recurrence after resection of early-stage lung cancer. SUVmax may be a valuable tool in stratifying patients with early-stage lung cancer for adjuvant therapy and surveillance frequency.
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Affiliation(s)
- Alisa N Blumenthaler
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wayne L Hofstetter
- Departments of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Reza J Mehran
- Departments of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ravi Rajaram
- Departments of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David C Rice
- Departments of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jack A Roth
- Departments of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Boris Sepesi
- Departments of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen G Swisher
- Departments of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ara A Vaporciyan
- Departments of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Garrett L Walsh
- Departments of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chad D Strange
- Departments of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mara B Antonoff
- Departments of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Masago K, Seto K, Fujita S, Sasaki E, Hosoda W, Kuroda H. Long-Term Recurrence of Completely Resected NSCLC. JTO Clin Res Rep 2020; 1:100076. [PMID: 34589953 PMCID: PMC8474471 DOI: 10.1016/j.jtocrr.2020.100076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/25/2020] [Accepted: 07/07/2020] [Indexed: 11/10/2022] Open
Abstract
Introduction The aim of this study is to evaluate the clinical backgrounds, including driver mutations, of those patients with early stage NSCLC who experienced recurrence beyond 5 years after complete resection. Methods We used a cohort of 512 consecutive cases of surgically resected NSCLC without other malignances from 2006 to 2011 in Aichi Cancer Center Hospital. The inclusion criteria for this cohort were patients with primary NSCLC who underwent a surgically curable operation. Results A total of 172 patients (32.8%) had recurrence after the surgery. Among the recurrent cases, 17 patients (3.3%) had a relapse more than 5 years after the surgery, and all except one (16 of 17, 94.1%) had driver mutations, including gene rearrangements. Conclusions Even in early stage NSCLC after complete resection, it was found that some cases had a relapse more than 5 years after the surgery. Most of these cases had some kind of driver mutations; so more than 5 years of postoperative surveillance may be beneficial, especially in those with driver gene mutants.
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Affiliation(s)
- Katsuhiro Masago
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan
| | - Katsutoshi Seto
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan.,Department of Respiratory Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Shiro Fujita
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan
| | - Eiichi Sasaki
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan
| | - Waki Hosoda
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan
| | - Hiroaki Kuroda
- Department of Respiratory Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
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