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Udelsman BV, Canavan ME, Zhan PL, Ely S, Park HS, Boffa DJ, Mase VJ. Overall survival in low-comorbidity patients with stage I non-small cell lung cancer who chose stereotactic body radiotherapy compared to surgery. J Thorac Cardiovasc Surg 2024; 167:822-833.e7. [PMID: 37500052 DOI: 10.1016/j.jtcvs.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/10/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To evaluate trends in the utilization of stereotactic body radiotherapy (SBRT) and to compare overall survival (OS) of patients with early-stage non-small cell lung cancer (NSCLC) undergoing SBRT versus those undergoing surgery. METHODS The National Cancer Database was queried for patients without documented comorbidities who underwent surgical resection (lobectomy, segmentectomy, or wedge resection) or SBRT for clinical stage I NSCLC between 2012 and 2018. Peritreatment mortality and 5-year OS were compared among propensity score-matched cohorts. RESULTS A total of 30,658 patients were identified, including 24,729 (80.7%) who underwent surgery and 5929 (19.3%) treated with SBRT. Between 2012 and 2018, the proportion of patients receiving SBRT increased from 15.9% to 26.0% (P < .001). The 30-day mortality and 90-day mortality were higher among patients undergoing surgical resection versus those receiving SBRT (1.7% vs 0.3%, P < .001; 2.8% vs 1.7%, P < .001). In propensity score-matched patients, OS favored SBRT for the first several months, but this was reversed before 1 year and significantly favored surgical management in the long term (5-year OS, 71.0% vs 41.8%; P < .001). The propensity score-matched analysis was repeated to include only SBRT patients who had documented refusal of a recommended surgery, which again demonstrated superior 5-year OS with surgical management (71.4% vs 55.9%; P < .001). CONCLUSIONS SBRT is being increasingly used to treat early-stage lung cancer in low-comorbidity patients. However, for patients who may be candidates for either treatment, the long-term OS favors surgical management.
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Affiliation(s)
- Brooks V Udelsman
- Division of Thoracic Surgery, Department of Surgery, University of Southern California, Los Angeles, Calif.
| | - Maureen E Canavan
- Department of Internal Medicine, Cancer Outcomes Public Policy and Effectiveness Research Center, Yale University School of Medicine, New Haven, Conn
| | - Peter L Zhan
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Sora Ely
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Henry S Park
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Conn
| | - Daniel J Boffa
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Vincent J Mase
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
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Le VH, Kha QH, Minh TNT, Nguyen VH, Le VL, Le NQK. Development and Validation of CT-Based Radiomics Signature for Overall Survival Prediction in Multi-organ Cancer. J Digit Imaging 2023; 36:911-922. [PMID: 36717518 PMCID: PMC10287593 DOI: 10.1007/s10278-023-00778-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 02/01/2023] Open
Abstract
The malignant tumors in nature share some common morphological characteristics. Radiomics is not only images but also data; we think that a probability exists in a set of radiomics signatures extracted from CT scan images of one cancer tumor in one specific organ also be utilized for overall survival prediction in different types of cancers in different organs. The retrospective study enrolled four data sets of cancer patients in three different organs (420, 157, 137, and 191 patients for lung 1 training, lung 2 testing, and two external validation set: kidney and head and neck, respectively). In the training set, radiomics features were obtained from CT scan images, and essential features were chosen by LASSO algorithm. Univariable and multivariable analyses were then conducted to find a radiomics signature via Cox proportional hazard regression. The Kaplan-Meier curve was performed based on the risk score. The integrated time-dependent area under the ROC curve (iAUC) was calculated for each predictive model. In the training set, Kaplan-Meier curve classified patients as high or low-risk groups (p-value < 0.001; log-rank test). The risk score of radiomics signature was locked and independently evaluated in the testing set, and two external validation sets showed significant differences (p-value < 0.05; log-rank test). A combined model (radiomics + clinical) showed improved iAUC in lung 1, lung 2, head and neck, and kidney data set are 0.621 (95% CI 0.588, 0.654), 0.736 (95% CI 0.654, 0.819), 0.732 (95% CI 0.655, 0.809), and 0.834 (95% CI 0.722, 0.946), respectively. We believe that CT-based radiomics signatures for predicting overall survival in various cancer sites may exist.
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Affiliation(s)
- Viet Huan Le
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan
- Department of Thoracic Surgery, Khanh Hoa General Hospital, Nha Trang, 65000, Vietnam
| | - Quang Hien Kha
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan
| | - Tran Nguyen Tuan Minh
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan
| | - Van Hiep Nguyen
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan
- Oncology Center, Bai Chay Hospital, Quang Ninh, 20000, Vietnam
| | - Van Long Le
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan
- Department of Anesthesiology and Critical Care, Hue University of Medicine and Pharmacy, Hue University, Hue City, 52000, Vietnam
| | - Nguyen Quoc Khanh Le
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, 106, Taiwan.
- Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, 106, Taiwan.
- Translational Imaging Research Center, Taipei Medical University Hospital, Taipei, 110, Taiwan.
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Motono N, Iwai S, Yamagata A, Iijima Y, Usuda K, Yamada S, Uramoto H. Risk factors of chest wall invasion in non-small cell lung cancer. J Thorac Dis 2021; 13:824-830. [PMID: 33717555 PMCID: PMC7947525 DOI: 10.21037/jtd-20-1722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background The risk factors for the development of chest wall invasion (CWI) in non-small cell lung cancer (NSCLC) patients are unclear. If the risk factors for the development of CWI can be clarified, surgical treatment might be able to be performed before CWI development, thus improving the prognosis. Methods In the present study, we enrolled patients who received surgery for NSCLC between January 2008 and December 2019 with available data on the maximum standardized uptake value (SUVmax) on positron emission tomography (PET) with lesions adjacent to the visceral pleura. Furthermore, the preoperative white blood cell (WBC) count, the preoperative neutrophil-to-lymphocyte ratio (NLR), platelet (Plt) count, levels of lactate dehydrogenase (LDH) and C-reactive protein (CRP) were analyzed as predictive factors of CWI. Results The relationships between CWI and clinicopathological variables were analyzed, and there were significant differences between patients with and without CWI in the age (P=0.02), maximum tumor diameter on computed tomography (CT) (P<0.01), diameter of tumors adjacent to the visceral pleura (Pmax) (P<0.01), SUVmax (P<0.01), maximum tumor diameter on a pathological examination (P<0.01), WBC count (P=0.03), Plt count (P=0.04), and levels of LDH (P<0.01) and CRP (P=0.01). Logistic regression analyses of the risk factors related to CWI showed that the age (P=0.02), Pmax (P=0.02), SUVmax (P=0.01), and LDH (P<0.01) were significant risk factors. Conclusions The age, Pmax, SUVmax, and LDH levels might be associated with CWI.
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Affiliation(s)
- Nozomu Motono
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Shun Iwai
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Aika Yamagata
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Yoshihito Iijima
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Katsuo Usuda
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Sohsuke Yamada
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Hidetaka Uramoto
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
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Neves M, Fumagalli A, van den Bor J, Marin P, Smit MJ, Mayor F. The Role of ACKR3 in Breast, Lung, and Brain Cancer. Mol Pharmacol 2019; 96:819-825. [PMID: 30745320 DOI: 10.1124/mol.118.115279] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 01/30/2019] [Indexed: 12/24/2022] Open
Abstract
Recent reports regarding the significance of chemokine receptors in disease have put a spotlight on atypical chemokine receptor 3 (ACKR3). This atypical chemokine receptor is overexpressed in numerous cancer types and has been involved in the modulation of tumor cell proliferation and migration, tumor angiogenesis, or resistance to drugs, thus contributing to cancer progression and metastasis occurrence. Here, we focus on the clinical significance and potential mechanisms underlying the pathologic role of ACKR3 in breast, lung, and brain cancer and discuss its possible relevance as a prognostic factor and potential therapeutic target in these contexts.
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Affiliation(s)
- Maria Neves
- Departamento de Biología Molecular and Centro de Biología Molecular "Severo Ochoa" (UAM-CSIC), Universidad Autónoma Madrid, Madrid, Spain (M.N., F.M.); Institut de Génomique Fonctionnelle (IGF), Université de Montpellier, CNRS, INSERM, Montpellier, France (A.F., P.M.); Amsterdam Institute for Molecules, Medicines and Systems (AIMMS), Division of Medicinal Chemistry, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands (J.B., M.J.S.); and CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain (F.M.)
| | - Amos Fumagalli
- Departamento de Biología Molecular and Centro de Biología Molecular "Severo Ochoa" (UAM-CSIC), Universidad Autónoma Madrid, Madrid, Spain (M.N., F.M.); Institut de Génomique Fonctionnelle (IGF), Université de Montpellier, CNRS, INSERM, Montpellier, France (A.F., P.M.); Amsterdam Institute for Molecules, Medicines and Systems (AIMMS), Division of Medicinal Chemistry, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands (J.B., M.J.S.); and CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain (F.M.)
| | - Jelle van den Bor
- Departamento de Biología Molecular and Centro de Biología Molecular "Severo Ochoa" (UAM-CSIC), Universidad Autónoma Madrid, Madrid, Spain (M.N., F.M.); Institut de Génomique Fonctionnelle (IGF), Université de Montpellier, CNRS, INSERM, Montpellier, France (A.F., P.M.); Amsterdam Institute for Molecules, Medicines and Systems (AIMMS), Division of Medicinal Chemistry, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands (J.B., M.J.S.); and CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain (F.M.)
| | - Philippe Marin
- Departamento de Biología Molecular and Centro de Biología Molecular "Severo Ochoa" (UAM-CSIC), Universidad Autónoma Madrid, Madrid, Spain (M.N., F.M.); Institut de Génomique Fonctionnelle (IGF), Université de Montpellier, CNRS, INSERM, Montpellier, France (A.F., P.M.); Amsterdam Institute for Molecules, Medicines and Systems (AIMMS), Division of Medicinal Chemistry, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands (J.B., M.J.S.); and CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain (F.M.)
| | - Martine J Smit
- Departamento de Biología Molecular and Centro de Biología Molecular "Severo Ochoa" (UAM-CSIC), Universidad Autónoma Madrid, Madrid, Spain (M.N., F.M.); Institut de Génomique Fonctionnelle (IGF), Université de Montpellier, CNRS, INSERM, Montpellier, France (A.F., P.M.); Amsterdam Institute for Molecules, Medicines and Systems (AIMMS), Division of Medicinal Chemistry, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands (J.B., M.J.S.); and CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain (F.M.)
| | - Federico Mayor
- Departamento de Biología Molecular and Centro de Biología Molecular "Severo Ochoa" (UAM-CSIC), Universidad Autónoma Madrid, Madrid, Spain (M.N., F.M.); Institut de Génomique Fonctionnelle (IGF), Université de Montpellier, CNRS, INSERM, Montpellier, France (A.F., P.M.); Amsterdam Institute for Molecules, Medicines and Systems (AIMMS), Division of Medicinal Chemistry, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands (J.B., M.J.S.); and CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain (F.M.)
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Oh TK, Kim K, Jheon S, Lee J, Do SH, Hwang JW, Song IA. Long-Term Oncologic Outcomes for Patients Undergoing Volatile Versus Intravenous Anesthesia for Non-Small Cell Lung Cancer Surgery: A Retrospective Propensity Matching Analysis. Cancer Control 2018; 25:1073274818775360. [PMID: 29739245 PMCID: PMC6028176 DOI: 10.1177/1073274818775360] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Propofol-based total intravenous anesthesia (TIVA) has been reported to improve long-term outcome following cancer surgery, when compared with inhalation agents. However, such investigational reports are still controversial, and no studies have been conducted in relation to non-small cell lung cancer (NSCLC) surgery. The present study aimed to compare the favorable effects of TIVA versus inhalation agents on recurrence-free survival and overall survival after curative resection of NSCLC. This retrospective cohort study examined medical records of the patients who were diagnosed with NSCLC and underwent curative resection at Seoul National University Bundang Hospital from August 2003 to July 2012. The primary outcome included the comparison of postoperative overall survival and recurrence-free survival in both groups. To balance the 2 groups for analysis, a propensity matching method was used, and stratified Cox proportional hazard models were used for statistical analysis. This study included 943 cases of NSCLC for final analysis, and the cases were divided into the TIVA group (n = 749) and inhalation group (n = 194). Propensity matching produced 196 patients in each group. The final analysis revealed no significant difference in the hazard ratio (HR) for recurrence between the TIVA and inhalation groups ( P = .233). The HR for death between the 2 groups was not significantly different either ( P = .551). In this study, we found no benefit of propofol-based TIVA for long-term oncologic outcome after NSCLC surgery, relative to inhalation agents.
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Affiliation(s)
- Tak Kyu Oh
- 1 Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, Korea
| | - Kwhanmien Kim
- 2 Department of Thoracic Surgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, Korea
| | - Sanghoon Jheon
- 2 Department of Thoracic Surgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, Korea
| | - Jaebong Lee
- 3 Medical Research Collaborating Center, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - Sang-Hwan Do
- 1 Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, Korea
| | - Jung-Won Hwang
- 1 Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, Korea
| | - In-Ae Song
- 1 Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, Korea
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Oh TK, Kim K, Jheon S, Lee J, Do SH, Hwang JW, Kim HJ, Song IA. Impact of Statin Use on Recurrence or Survival After Surgical Curative Resection of Non-Small Cell Lung Cancer. Cancer Control 2018; 25:1073274818778000. [PMID: 29781295 PMCID: PMC6028179 DOI: 10.1177/1073274818778000] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Statins are known for their anticancer effects, and many studies have shown the effectiveness of statins for cancer prevention and improvement of cancer-related long-term oncologic outcome. However, their effectiveness on recurrence or survival of non-small cell lung cancer (NSCLC) after curative resection remains unknown. This was a retrospective cohort study that assessed the medical records of patients who were diagnosed with NSCLC and treated with curative resection at a tertiary care hospital between August 2003 and July 2012. The primary outcome was the comparison of postoperative overall survival (OS) and recurrence-free survival (RFS) between the statin group of patients, who were administered statins at least 1 month before the surgery and continued it after the surgery, and the nonstatin group of patients, who were not administered statins. Propensity score (PS) matching was used to balance the 2 groups, and the analysis was performed using a Cox proportional hazards model. In total, 994 patients with NSCLC were included in the final analysis: 135 patients in the statin group and 859 patients in the nonstatin group. After PS matching, there was no significant difference in postoperative recurrence (P = .862) or death (P = .074) between the statin group and the nonstatin group. Similarly, there was no significant difference in postoperative RFS (P = .862) and OS (P = .072) between the 2 groups after PS matching. This study demonstrated that statin administration had no significant association with recurrence or survival after NSCLC treatment.
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Affiliation(s)
- Tak Kyu Oh
- 1 Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kwhanmien Kim
- 2 Department of Thoracic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sanghoon Jheon
- 2 Department of Thoracic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jaebong Lee
- 3 Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sang-Hwan Do
- 1 Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jung-Won Hwang
- 1 Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyo Jin Kim
- 4 Department of Anesthesiology and Pain Medicine, Inje University Seoul Paik Hospital, Seoul, Republic of Korea
| | - In-Ae Song
- 1 Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Oh TK, Kim K, Jheon S, Lee HJ, Do SH. Association between perioperative cholesterol level and analgesia after video-assisted thoracoscopic surgery. Korean J Anesthesiol 2018; 72:135-142. [PMID: 29969888 PMCID: PMC6458511 DOI: 10.4097/kja.d.18.00122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cholesterol plays an important role in the action of opioid analgesics, but its association with postoperative pain has not been clarified. Our study examined the association of pre- and postoperative total serum cholesterol (TSC), and change between the pre- and postoperative TSC levels with postoperative pain outcomes in patients with non-small cell lung cancer (NSCLC) who underwent video-assisted thoracoscopic surgery (VATS) lobectomy. METHODS We retrospectively reviewed medical records of patients with NSCLC who underwent VATS lobectomy at the Seoul National University Bundang Hospital in South Korea. We sought to determine the association between preoperative TSC, TSC on postoperative day (POD) 0-1, and pre- and postoperative changes in TSC by comparing numeric rating scale (NRS) scores on POD 0, 1, and 2 and total morphine equivalent consumption on POD 0-2. Multivariate linear regression analyses were used, and P < 0.05 was considered statistically significant. RESULTS A total of 1,720 patients with NSCLC who underwent VATS lobectomy were included in the analysis. The change in TSC, preoperative TSC, and postoperative TSC showed no associations with morphine equivalent consumption on POD 0-2 (P > 0.05). In addition, the changes in TSC, preoperative TSC, and postoperative TSC were not associated with postoperative NRS pain score on POD 0, 1, and 2 (P > 0.05). CONCLUSIONS Our results indicated that no significant association was observed between pre- and postoperative TSC level and postoperative pain outcome after VATS lobectomy of the lung.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kwanmien Kim
- Department of Thoracic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sanghoon Jheon
- Department of Thoracic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hei-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Hwan Do
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Lv Y, Pan Y, Dong C, Liu P, Zhang C, Xing D. Modified Glasgow Prognostic Score at Recurrence Predicts Poor Survival in Resected Non-Small Cell Lung Cancer (NSCLC) Patients. Med Sci Monit 2017; 23:3780-3788. [PMID: 28775246 PMCID: PMC5553437 DOI: 10.12659/msm.903710] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background The purpose of this study was to investigate the impact of the modified Glasgow Prognostic Score (GPS) at the time of recurrence on post-recurrence survival (PRS) in non-small cell lung cancer (NSCLC) patients after surgical resection. Material/Methods The clinicopathologic characteristics and outcome data of 266 patients with recurrent NSCLC were collected and reviewed retrospectively. The prognostic impact of mGPS at recurrence in patients with recurrent NSCLC was investigated in univariate and multivariate analyses. Results A total of 266 patients were analyzed. The mGPS at the time of recurrence of 0, 1, and 2 was assigned to 60.9%, 33.1%, and 6.0% of total patients, respectively. In univariate analyses, the median post-recurrence survival times for those with mGPS 0, 1, and 2 were 19, 14, and 4 months, respectively (log-rank test; P=0.005). No statistically significant difference in post-recurrence survival was observed among the patients with different mGPS before surgery (log-rank test; P=0.064). Age at surgery, histological type, C-reactive protein (CRP), albumin, and mGPS at recurrence significantly predicted PRS. After adjusting for confounding variables in the model, age (hazard ratio 1.59, P=0.003) as well as disease-free interval (DFI) (hazard ratio 1.40, P=0.023), and mGPS at recurrence (hazard ratio 1.47, P=0.002) remained independent predictors of PRS. Conclusions mGPS at the time of recurrence might be an independent adverse prognostic factor in recurrent NSCLC.
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Affiliation(s)
- Yongbin Lv
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, Shandong, China (mainland)
| | - Yinghua Pan
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, Shandong, China (mainland)
| | - Changxia Dong
- Department of Ophthalmology, Yantai Yuhuangding Hospital, Yantai, Shandong, China (mainland)
| | - Peiji Liu
- Department of Radiotherapy, Yantai Yuhuangding Hospital, Yantai, Shandong, China (mainland)
| | - Chunping Zhang
- Department of Stomatology, Yantai Yuhuangding Hospital, Yantai, Shandong, China (mainland)
| | - Dong Xing
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, Shandong, China (mainland)
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Muñoz-Largacha JA, Gower AC, Sridhar P, Deshpande A, O'Hara CJ, Yamada E, Godfrey TE, Fernando HC, Litle VR. miRNA profiling of primary lung and head and neck squamous cell carcinomas: Addressing a diagnostic dilemma. J Thorac Cardiovasc Surg 2017; 154:714-727. [DOI: 10.1016/j.jtcvs.2017.02.071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 01/31/2017] [Accepted: 02/25/2017] [Indexed: 12/12/2022]
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Investigation of opioid use and long-term oncologic outcomes for non-small cell lung cancer patients treated with surgery. PLoS One 2017; 12:e0181672. [PMID: 28732026 PMCID: PMC5521798 DOI: 10.1371/journal.pone.0181672] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 07/05/2017] [Indexed: 11/19/2022] Open
Abstract
Opioids are commonly used for postoperative pain control in cancer patients. In addition to pain control, an association between opioid use and long-term oncologic outcomes, such as recurrence or overall survival, has been postulated. The aim of this study was to determine whether postoperative opioid use in patients with non-small cell lung cancer is associated with long-term oncologic outcomes, including recurrence and death. Data obtained from 1009 medical records of patients who underwent curative resection at the National Cancer Center, Korea between January 2006 and December 2010 were retrospectively analyzed. Seven-day opioid use was divided into four quartiles to analyze probability of recurrence and death. Multivariate regression analyses of recurrence and death was conducted, including the calculation of odds ratios. A total of 871 patients were analyzed. When opioid dosage was examined by quartiles, the probability of death and recurrence increased gradually with increasing opioid use. However, in the multivariate regression analysis, the amount of opioid usage did not affect the risk of recurrence or death of lung cancer (P = 0.520 for recurrence; P = 0.659 for death). Opioid use was correlated with outcome when stratified by lung cancer stage (P = 0.004 for recurrence; P = 0.049 for death); however, the odds ratios only slightly increased (1.001 for stage IA–IIIA) for both outcomes. In non-small cell lung cancer patients, the amount of opioid usage does not affect the risk of recurrence and death of lung cancer. There was an association with stage (IA–IIIA), but the effect was negligible. A well-designed prospective study is needed.
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Rotman JA, Plodkowski AJ, Hayes SA, de Groot PM, Shepard JAO, Munden RF, Ginsberg MS. Postoperative complications after thoracic surgery for lung cancer. Clin Imaging 2015; 39:735-49. [PMID: 26117564 DOI: 10.1016/j.clinimag.2015.05.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/18/2015] [Accepted: 05/21/2015] [Indexed: 11/17/2022]
Abstract
UNLABELLED Lung cancer is the leading cause of cancer-related deaths in the United States. Several surgical techniques are currently used as part of the standard of care for early-stage lung cancer. Differentiating normal postoperative changes from complications is essential in the management of these patients. This article will review the various surgical approaches used, ranging from wedge resection to pneumonectomy, and will outline their expected postsurgical changes. Early and late postsurgical complications will be described, some of which are unique to the type of surgery performed. In addition, local tumor recurrence is a form of postoperative complication and must be distinguished from typical postoperative or postradiation change. Knowledge of both common and uncommon postoperative complications is crucial in the follow-up of lung cancer patients. SUMMARY STATEMENT Familiarity with the appearance of postoperative complications in lung cancer patients is vital to distinguish it from the normal postoperative or postradiation appearance in follow-up imaging.
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Affiliation(s)
- Jessica A Rotman
- Department of Radiology, NY Presbyterian/Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065.
| | - Andrew J Plodkowski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065.
| | - Sara A Hayes
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065.
| | - Patricia M de Groot
- Department of Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030.
| | - Jo-Anne O Shepard
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114.
| | - Reginald F Munden
- Department of Radiology, Houston Methodist Hospital, 6550 Fannin Street, Houston, TX, 77030.
| | - Michelle S Ginsberg
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065.
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Stirling RG, Evans SM, McLaughlin P, Senthuren M, Millar J, Gooi J, Irving L, Mitchell P, Haydon A, Ruben J, Conron M, Leong T, Watkins N, McNeil JJ. The Victorian Lung Cancer Registry Pilot: Improving the Quality of Lung Cancer Care Through the Use of a Disease Quality Registry. Lung 2014; 192:749-58. [DOI: 10.1007/s00408-014-9603-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 05/21/2014] [Indexed: 12/25/2022]
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13
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Watanabe SI. Lymph node dissection for lung cancer: past, present, and future. Gen Thorac Cardiovasc Surg 2014; 62:407-14. [DOI: 10.1007/s11748-014-0412-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Indexed: 10/25/2022]
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Bae SH, Ahn YC, Nam H, Park HC, Pyo HR, Shim YM, Kim J, Kim K, Ahn JS, Ahn MJ, Park K. High dose involved field radiation therapy as salvage for loco-regional recurrence of non-small cell lung cancer. Yonsei Med J 2012; 53:1120-7. [PMID: 23074111 PMCID: PMC3481375 DOI: 10.3349/ymj.2012.53.6.1120] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To determine the effectiveness of salvage radiation therapy (RT) in patients with loco-regional recurrences (LRR) following initial complete resection of non-small cell lung cancer (NSCLC) and assess prognostic factors affecting survivals. MATERIALS AND METHODS Between 1994 and 2007, 64 patients with LRR after surgery of NSCLC were treated with high dose RT alone (78.1%) or concurrent chemo-radiation therapy (CCRT, 21.9%) at Samsung Medical Center. Twenty-nine patients (45.3%) had local recurrence, 26 patients (40.6%) had regional recurrence and 9 patients (14.1%) had recurrence of both components. The median RT dose was 54 Gy (range, 44-66 Gy). The radiation target volume included the recurrent lesions only. RESULTS The median follow-up time from the start of RT in survivors was 32.0 months. The rates of in-field failure free survival, intra-thoracic failure free survival and extra-thoracic failure free survival at 2 years were 52.3%, 33.9% and 59.4%, respectively. The median survival after RT was 18.5 months, and 2-year overall survival (OS) rate was 47.9%. On both univariate and multivariate analysis, the interval from surgery till recurrence and CCRT were significant prognostic factors for OS. CONCLUSION The current study demonstrates that involved field salvage RT is effective for LRR of NSCLC following surgery.
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Affiliation(s)
- Sun Hyun Bae
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heerim Nam
- Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Ryull Pyo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Mog Shim
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jhingook Kim
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwhanmien Kim
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Seok Ahn
- Department of Medicine (Division of Hematooncology), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung-Ju Ahn
- Department of Medicine (Division of Hematooncology), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keunchil Park
- Department of Medicine (Division of Hematooncology), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Xu Y, Shentu Y, Zheng M, Guo M. [The clinical value of routine preoperative surgical staging to mediastinal lymph nodes on lung cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2010; 13:624-7. [PMID: 20681451 PMCID: PMC6015148 DOI: 10.3779/j.issn.1009-3419.2010.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
背景与目的 探讨肺癌术前常规纵隔淋巴结外科分期的临床价值。 方法 76例肺癌患者开胸术前常规行纵隔淋巴结活检,以术后病理为金标准,比对术前胸部CT和纵隔镜对肺癌纵隔淋巴结转移的诊断效能。 结果 术前胸部CT对纵隔淋巴结转移的诊断敏感性、特异性、准确性、阳性预测值和阴性预测值分别为68.5%、66.7%、68.4%、84.6%和16.7%。纵隔镜检查术则分别为87.5%、100%、84.2%、100%和60%。 结论 肺癌术前常规纵隔镜检查术对纵隔淋巴结分期的优势明显,具有极高的临床实用价值。
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Affiliation(s)
- Ye Xu
- Department of Thoracic Surgery, Shanghai Changning District Central Hospital, Shanghai 200336, China
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Wang L, Wang LE, Mao L, Spitz MR, Wei Q. A functional variant of tandem repeats in human telomerase gene was associated with survival of patients with early stages of non-small cell lung cancer. Clin Cancer Res 2010; 16:3779-85. [PMID: 20466886 DOI: 10.1158/1078-0432.ccr-10-0269] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Elevated levels of human telomerase (hTERT) mRNA in tumors is a marker for poorer survival in patients with stage I non-small cell lung cancer (NSCLC). A functional variant of MNS16A-short tandem repeats in hTERT (S allele) is associated with higher expression levels of hTERT mRNA compared with the MNS16A-long (L) allele. It is unknown, however, whether or not the hTERT MNS16A variant genotype predicts survival of NSCLC patients. EXPERIMENTAL DESIGN The hTERT genotypes of 808 patients with NSCLC were determined by direct PCR with genomic DNA. Overall median survival times were estimated by the life-table method, and the log-rank test was used to test for homogeneity of the survival curves. Both univariate and multivariate Cox proportional hazards models were used to assess the associations between survival time and the hTERT genotype as well as other known risk factors. RESULTS The hTERT variant genotype was not associated with overall survival among the 808 patients. However, among 221 patients with stage I or II NSCLC, the S allele was associated with shorter survival time (P = 0.027, by log-rank test). The adjusted hazard ratios were 1.30 (95% confidence interval, 0.79-2.14; P = 0.310) for the SL-genotype and 2.34 (95% confidence interval, 1.20-4.56, P = 0.012) for the SS-genotype compared with the LL-genotype (P = 0.021 for trend test). These findings were not evident in 587 patients with stage III or IV NSCLC. CONCLUSION The functional MNS16A-SS genotype may be a marker for poorer survival in early-stage NSCLC.
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Affiliation(s)
- Luo Wang
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
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Iwakiri S, Mino N, Takahashi T, Sonobe M, Nagai S, Okubo K, Wada H, Date H, Miyahara R. Higher expression of chemokine receptor CXCR7 is linked to early and metastatic recurrence in pathological stage I nonsmall cell lung cancer. Cancer 2009; 115:2580-93. [PMID: 19309748 DOI: 10.1002/cncr.24281] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The authors elucidated particular chemokine receptors that are expressed on lung cancer cells, as well as the clinical significance of the expression of these chemokine receptors in completely resected nonsmall cell lung cancer (NSCLC). METHODS The authors examined gene expression of chemokine receptors (CCR1-11, CXCR1-7, XCR1, and CX3CR1) in 11 cell lines of lung cancer, and gene expression of CXCR3, CXCR4, and CXCR7 (CXCR3/4/7) in surgical specimens of 127 patients who underwent complete resection for their NSCLC between May 2001 and December 2002, using quantitative real-time reverse transcriptase-polymerase chain reaction (PCR). Mutation detection analysis of the EGFR genes using the PCR single-strand conformational polymorphism method was evaluated in patients with pathological (p-) stage I adenocarcinoma. RESULTS Substantial expression of CXCR3/4/7 mRNA was observed in all NSCLC cell lines examined. In p-stage I NSCLC, CXCR4 and CXCR7 expression values in patients with postoperative metastatic recurrence (Rec-Distant) were significantly higher than in those without recurrences (P = .003 and P = .007, respectively). In addition, the 5-year disease-free survival (DFS) rate of high CXCR7-expressing patients (63.2%) was significantly lower than that of low CXCR7-expressing patients (84.8%) (P = .033). The EGFR mutation was significantly more frequent in patients with higher CXCR7 expression (14 of 21 patients) than in those with lower CXCR7 expression (12 of 32 patients) (P = .038). A multivariate analysis confirmed that high CXCR7 expression was an independent and significant factor predicting a poor DFS in p-stage I NSCLC patients (P = .041). CONCLUSIONS Higher expression of CXCR7 is associated with Rec-Distant and poor DFS in patients with p-stage I NSCLC.
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Affiliation(s)
- Shotaro Iwakiri
- Department of Thoracic Surgery, Faculty of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
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Iwakiri S, Nagai S, Katakura H, Takenaka K, Date H, Wada H, Tanaka F. D2-40-Positive Lymphatic Vessel Density Is a Poor Prognostic Factor in Squamous Cell Carcinoma of the Lung. Ann Surg Oncol 2009; 16:1678-85. [DOI: 10.1245/s10434-009-0432-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2008] [Revised: 02/18/2009] [Accepted: 02/18/2009] [Indexed: 12/18/2022]
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Cantsilieris G, Jackson TJ, Street A. Patterns of first-coded complications in acute episodes of lung cancer care. Health Inf Manag 2008; 35:27-37. [PMID: 18216407 DOI: 10.1177/183335830603500105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this research was to document the most common first-recorded adverse events of inpatient care for lung cancer in Victoria, Australia. The sample comprised record abstracts for 3642 admissions (overnight or longer) of adult patients with lung cancer, extracted from the Victorian Admitted Episodes Database for 2000-2001. The method involved analysis of diagnoses prefixed with "C" (an indicator for diagnoses which arose only after hospitalisation), calculation of complication rates by intervention type, and analysis of complication type by intervention. Overall, 23% of episodes recorded at least one in-hospital complication, with highest rates for radiotherapy and surgical interventions. The highest surgical complication rates were for pneumonectomies, lobectomies, and lung resections. Nausea and vomiting were the most common first-recorded complications for both chemotherapy and radiotherapy. It was concluded that complications through the use of morbidity data may offer a timely and economical method for health care organisations to screen large numbers of patient episodes.
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21
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Iwakiri S, Sonobe M, Nagai S, Hirata T, Wada H, Miyahara R. Expression status of folate receptor alpha is significantly correlated with prognosis in non-small-cell lung cancers. Ann Surg Oncol 2008; 15:889-99. [PMID: 18181001 DOI: 10.1245/s10434-007-9755-3] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Revised: 11/12/2007] [Accepted: 11/14/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND To evaluate the prognostic value of folate receptor alpha (FOLR1) and/or reduced folate carrier (RFC1) expression, which are well-characterized folate transporters, in completely resected non-small-cell lung cancer (NSCLC). METHODS We quantitatively examined gene expression of FOLR1 and RFC1 in surgical specimens resected from NSCLC patients. A total of 119 consecutive patients from January 2003 to June 2004 were included. RESULTS In adenocarcinoma, the FOLR1 gene expression was downregulated in smokers and male patients (P = 0.006 and P < 0.001, respectively). In addition, FOLR1 expression values in patients with well-differentiated, early p-stage, pT1, pN0, EGFR mutant, and p53 wild-type cancers were significantly higher than those for poorly differentiated, advanced p-stage, pT2-4, pN1-3, EGFR wild-type, and p53 mutant (P < 0.001, P < 0.001, P < 0.001, P = 0.002, P < 0.001 and P = 0.023, respectively). In squamous cell carcinoma, FOLR1 expression values in patients with pN1-3 was significantly higher than those with pN0 (P = 0.037). Moreover, the 3-year survival rate and disease-free survival rate of high-FOLR1-expressing patients (94.7% and 75.4%) were significantly higher than those of low-FOLR1-expressing patients (80.9% and 60.8%) (P = 0.008 and P = 0.038). A multivariate analysis confirmed that high FOLR1 expression was an independent and significant factor predicting a favorable prognosis (P = 0.043). CONCLUSIONS Higher levels of FOLR1 appear to be associated with better prognoses for patients with lung adenocarcinomas.
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Affiliation(s)
- Shotaro Iwakiri
- Department of Thoracic Surgery, Faculty of Medicine, Kyoto University, Shogoin-Kawara-cho 54, Sakyo-ku, Kyoto, 606-8507, Japan
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Voltolini L, Rapicetta C, Luzzi L, Ghiribelli C, Ligabue T, Paladini P, Gotti G. Lung cancer with chest wall involvement: Predictive factors of long-term survival after surgical resection. Lung Cancer 2006; 52:359-64. [PMID: 16644062 DOI: 10.1016/j.lungcan.2006.01.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2005] [Revised: 01/16/2006] [Accepted: 01/23/2006] [Indexed: 11/16/2022]
Abstract
UNLABELLED Multimodal management of lung cancer extending to chest wall and type of surgical procedure to be performed are still debated. The aim of this retrospective analysis was to analyze the predictive factors of long-term survival after surgery, focusing on depth of infiltration, type of surgical intervention and possible role of preoperative therapies, comparing survival of these patients with that of a group of patients affected by a Pancoast tumour and surgical treated in the same period. MATERIALS AND METHODS We reviewed records of 83 consecutive patients with NSCLC in stage T3 (owing to direct extension to chest wall), who underwent surgical resection in our Thoracic Surgery Unit between January 1994 and December 2003. Patients were classified in two groups: pancoast tumours (PT) or chest wall extending tumours (CW): survival and prognostic factors of each category were analyzed. RESULTS In the CW group we had 68 patients: 45 were in stage IIB (pT3N0), 23 in stage IIIA (pT3-N1-2). Histology revealed adenocarcinoma in 23 cases, squamous cell carcinoma in 34, large cells anaplastic carcinoma in 8, adenosquamous carcinoma in 3. An involvement of chest wall tissues beyond the endothoracic fascia was found in 21 patients, while in the remaining 47 the invasion of chest wall tissues was confined to the parietal pleura. An extrapleural dissection was performed in 48 patients while combined pulmonary and chest wall en bloc resection was required in 20 patients. Resection was incomplete in three cases. In the PT group we had 15 patients: 11 were in stage IIB and 4 in stage IIIA. Histological type was adenocarcinoma in 10 cases, squamous cell carcinoma in 4 and adenosquamous carcinoma in 1. A univariate analysis performed in the CW group showed that survival was significantly affected by nodal status, stage, extension of chest wall invasion, type of lung resection and residual disease. In a multivariate analysis we found that nodal status, completeness of resection and extension of chest wall involvement maintained a significant prognostic value. There was no difference between the survival curve of CW and PT group: considering the two subset of CW patients, on the basis of depth of infiltration, survival of PT patients was significantly better than that of CW patients with involvement of muscular tissues and ribs (p=0.02). CONCLUSION Nodal status, radical resection and depth of chest wall infiltration are the main predictive factors affecting long-term survival, while surgical procedure does not impact on it if margins of resection are free from disease. The better survival observed in PT patients let us to hypothesize that an induction chemo-radiation therapy, as routinely administered to PT patients, could have a potential benefit in survival of patients with CW tumour extending beyond parietal pleura.
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Affiliation(s)
- Luca Voltolini
- Thoracic Surgery Unit, University Hospital of Siena, viale Bracci 1, 53100 Siena, Italy
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Almasi CE, Høyer-Hansen G, Christensen IJ, Danø K, Pappot H. Prognostic impact of liberated domain I of the urokinase plasminogen activator receptor in squamous cell lung cancer tissue. Lung Cancer 2005; 48:349-55. [DOI: 10.1016/j.lungcan.2004.11.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2004] [Revised: 11/18/2004] [Accepted: 11/23/2004] [Indexed: 11/26/2022]
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Smulders SA, Smeenk FWJM, Janssen-Heijnen MLG, Wielders PLML, de Munck DRAJ, Postmus PE. Surgical mediastinal staging in daily practice. Lung Cancer 2005; 47:243-51. [PMID: 15639723 DOI: 10.1016/j.lungcan.2004.06.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2004] [Revised: 06/17/2004] [Accepted: 06/21/2004] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES An adequately staged mediastinum remains obligatory in patients with NSCLC prior to surgery. In this study, we investigated the accuracy of preoperative surgical mediastinal staging procedures in four hospitals. SETTING Non-university teaching hospital and three surrounding community hospitals in Eindhoven, The Netherlands. PATIENTS, MEASUREMENTS AND RESULTS Patients with NSCLC who underwent mediastinoscopy and/or thoracotomy, between 1993 and 1999. Adherence to guidelines for indicating and performing mediastinoscopy were investigated and compared in four hospitals. Guidelines for indicating mediastinoscopy were adequately followed in two-thirds of cases. Mediastinoscopy was performed according to gold standards in 40% of cases. The hospital with the smallest number of evaluated patients scored the worst. Postoperatively, 17% of patients appeared to have "unforeseen N2-3 disease". In approximately 18% of these "upstaged" patients, thoracotomy could have been prevented, if guidelines had been followed adequately. CONCLUSIONS In clinical practice the adherence to staging guidelines with respect to mediastinoscopy is insufficient in one-third of patients. Furthermore, mediastinoscopy was performed according to gold standards in 40% of patients.
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Affiliation(s)
- Sietske A Smulders
- Department of Pulmonary Diseases, Catharina Hospital, Eindhoven, PO Box 1350, 5602 ZA Eindhoven, The Netherlands.
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Oyanagi H, Takenaka K, Ishikawa S, Kawano Y, Adachi Y, Ueda K, Wada H, Tanaka F. Expression of LUN gene that encodes a novel RING finger protein is correlated with development and progression of non-small cell lung cancer. Lung Cancer 2005; 46:21-8. [PMID: 15364129 DOI: 10.1016/j.lungcan.2004.03.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2003] [Revised: 03/01/2004] [Accepted: 03/11/2004] [Indexed: 12/13/2022]
Abstract
LUN is a novel RING finger protein that is highly expressed in the lung and might be a transcriptional regulator of E-cadherin [J. Biol. Chem. 276 (2001) 14004]. It might be possible that LUN plays important roles in the development and progression of lung cancer through regulating expression of E-cadherin, but no clinical study on LUN expression has been reported. In the present study, we quantitatively examined gene expression of the LUN in surgical specimens resected from non-small cell lung cancer (NSCLC) patients. In normal lung tissues, the LUN gene expression was down-regulated in smokers (the mean LUN/GAPDH ratios, 0.222 for non-smokers and 0.144 for smokers; P = 0.030). In addition, the mean LUN/GAPDH ratio in lung cancer tissues was significantly lower than that in normal lung tissues (0.072 versus 0.162; P < 0.001). In addition, the LUN gene expression was slightly down-regulated along with progression of primary tumors, and strongly down-regulated along with nodal metastases (the mean LUN/GAPDH ratios, 0.091 for pN0, 0.073 for pN1, and 0.034 for pN2 diseases; P = 0.001). These results suggested that LUN might play important roles in inhibition of nodal metastases as well as in suppression of smoking-related oncogenesis in NSCLC.
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Affiliation(s)
- Hiroki Oyanagi
- Department of Thoracic Surgery, Faculty of Medicine, Kyoto University, Shogoin-kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan
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Khan OA, Fitzgerald JJ, Field ML, Soomro I, Beggs FD, Morgan WE, Duffy JP. Histological determinants of survival in completely resected T1-2N1M0 nonsmall cell cancer of the lung. Ann Thorac Surg 2004; 77:1173-8. [PMID: 15063229 DOI: 10.1016/j.athoracsur.2003.08.080] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND The histologic determinants of survival after surgical resection of stage II nonsmall cell lung cancer are poorly understood. We analyzed the prognostic significance of a number of histologic features after complete resection of T1-2N1M0 nonsmall cell cancer of the lung. METHODS The case notes and histology of all patients who underwent a potentially curative surgical resection for T1-2N1M0 nonsmall cell carcinoma of the lung between 1991 and 1997 were reviewed retrospectively. The following histologic factors were recorded: histologic type of tumor; number of nodes with metastatic deposits together with their nodal station; the presence of vascular invasion, visceral pleural involvement, and cellular necrosis; and grade of tumor. The results from 98 patients were analyzed. Univariate and multivariate analyses were performed to identify prognostic factors. RESULTS Univariate analysis showed that only three factors had a statistically significant correlation with a poor prognosis: vascular invasion (p = 0.002), nonsquamous histology (p = 0.005), and visceral pleural involvement (p = 0.002). Multivariate analysis revealed that all three factors were significant independent adverse prognostic indicators. CONCLUSIONS Visceral pleural involvement, nonsquamous histology, and vascular invasion are all significant adverse prognostic factors after surgical resection of T1-2N1M0 nonsmall cell cancer of the lung. These findings conflict with previously published reports, and we advocate a prospective, large-scale study in order to clarify the prognostic significance of histologic characteristics in stage II disease.
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Affiliation(s)
- Omar A Khan
- Thoracic Unit, Nottingham City Hospital, Nottingham, United Kingdom.
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Banks SB, Rose DM, Moore JM, Kline AL. The spectrum of treatment and future diagnosis of early non-small cell lung carcinoma. ACTA ACUST UNITED AC 2004; 60:199-203. [PMID: 14972296 DOI: 10.1016/s0149-7944(02)00688-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Review the surgical treatment of 56 patients at a single institution of early stage non-small cell lung carcinoma (NSCLC). Briefly review the literature to report the current indications for limited pulmonary resection. Discuss newer methods of assessing early stage NSCLC. METHODS We reviewed 56 lobectomies performed at the Biloxi Veterans Administration Medical Center from January 1992 to December 1997 for NSCLC to report the incidence of N1 positive lymph nodes and survival data. Additionally, a search of PubMed, Ovid, and MDConsult.com, using search parameters of non-small cell lung carcinoma, limited pulmonary resection, lobectomy, and comorbidity, were used to determine indications for treating non-small cell lung carcinoma. RESULTS N1 positive lymph nodes occurred in 11 out of 56 patients; 4 were identified preoperatively. In this sample, 21 patients were Stage IA, 21 Stage IB, 6 Stage IIA, and 8 Stage IIB, and their 4-year median survival was as follows: (IA) greater than 44.80 months, (IB) greater than 48.0 months, (IIA) greater than 25.28 months, and (IIB) = 11.18 months. Four-year survival rates by stage were IA= 10/21 (47.62%), IB= 14/21 (66.67%), IIA= 2/6 (33.33%), and IIB= 0/8 (0.0%). CONCLUSIONS The 4-year survival data we reviewed were less favorable than is reported by others. Patient medical comorbidity, patient age, and sample size are thought to account for this difference. According to our literature review, reasons for limited pulmonary resection include poor physical performance, marginal lung reserve, synchronous bilateral tumors, and superior sulcus tumors (T3) in which the tumor primarily invades the chest wall. Heavier consideration of these indications might have improved the outcomes seen in this population.
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Affiliation(s)
- Shane B Banks
- Keesler Medical Center, Keesler Air Force Base, Mississippi 39534, USA.
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Licker M, Spiliopoulos A, Frey JG, Robert J, Höhn L, de Perrot M, Tschopp JM. Risk factors for early mortality and major complications following pneumonectomy for non-small cell carcinoma of the lung. Chest 2002; 121:1890-7. [PMID: 12065354 DOI: 10.1378/chest.121.6.1890] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To assess the mortality rate and the incidence of cardiopulmonary complications after pneumonectomy for non-small cell lung carcinoma (NSCLC) and to identify possible associated risk factors. DESIGN Observational study of patients who underwent pneumonectomy. Potential risk factors were analyzed from a local database including all thoracic surgical cases. SETTING A university hospital and a chest medical center. PATIENTS AND METHODS From January 1, 1990, to April 30, 2000, 193 consecutive pneumonectomies were performed for NSCLC in two affiliated institutions. The following information was recorded: demographic, clinical, functional, and surgical variables; as well as intraoperative and postoperative events. The risk of mortality and cardiopulmonary complications was evaluated using multiple logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS After undergoing pneumonectomy, all patients were successfully extubated in the operating room and then transferred to a postanesthesia care unit (126 patients) or ICU (67 patients). The 30-day mortality rate was 9.3%, and cardiovascular and/or pulmonary complications occurred in 47% of cases. Coronary artery disease (CAD) was a predictor of 30-day mortality (OR, 2.9; 95% CI, 1.1 to 8.9). Cardiac morbidity (mainly arrhythmias) was significantly related to advanced age (OR, 3.7; 95% CI, 1.6 to 8.6) and pathologic stages III/IV (OR, 1.4; 95% CI, 1.1 to 4.7), whereas continuous epidural analgesia was associated with a reduced incidence of respiratory complications (OR, 0.2; 95% CI, 0.1 to 0.6). CONCLUSIONS Pneumonectomy for lung cancer is a high-risk procedure, the risk for which is significantly related to the presence of CAD and advanced pathologic stages. Importantly, the provision of epidural analgesia contributes to lower the risk of respiratory complications.
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Affiliation(s)
- Marc Licker
- Department of Anesthesiology, Pharmacology, and Surgical Intensive Care, the University Hospital of Geneva, Geneva, Switzerland.
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Watanabe SI, Ladas G, Goldstraw P. Inter-observer variability in systematic nodal dissection: comparison of European and Japanese nodal designation. Ann Thorac Surg 2002; 73:245-8; discussion 248-9. [PMID: 11834017 DOI: 10.1016/s0003-4975(01)03177-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Systematic nodal dissection is accepted as an important component of the intrathoracic staging of patients undergoing thoracotomy for lung cancer. Several lymph node maps have been proposed in an attempt to ensure uniformity in designating lymph node stations. The Japan Lung Cancer Society has published detailed definitions for each nodal station adopting the Naruke map. However, since these definitions had not been interpreted into other languages, they have not been universally accepted. The objective of this study was to assess the inter-observer variability in the interpretation of lymph node stations. METHODS A total of 424 lymph node stations were removed from 41 patients undergoing thoracotomy for non-small cell lung cancer. All nodal stations were labeled using the Naruke map. As each station was excised, it was designated in a blind fashion by one of two surgeons trained in the UK and one surgeon trained in Japan. The designation accorded to each nodal station was analyzed. RESULTS The total concordance was 68.5% (right side 67.0%, left side 69.9%). The concordance rate for individual nodal stations varied from 0% to 100%. Considerable discordance existed between the Japanese and European surgeons in the designation of nodal stations 2, 4, 8 and N1 station 12. In 14 (34.1%) patients, discordance in the labeling of lymph nodes led to disease being categorized as N1 by one observer, whereas the other considered the same nodes to be N2. CONCLUSIONS Considerable discordance in the designation of nodal station has been demonstrated. We would expect similar inter-observer variability elsewhere between surgeons, institutions, or countries. More detailed nodal charts and precise, easily understood definitions of nodal stations are needed for intrathoracic staging. The first English version of the Japan Lung Cancer Society staging manual goes some way to address this.
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Affiliation(s)
- Shun-ichi Watanabe
- Department of Thoracic Surgery, Royal Brompton Hospital, London, England.
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Affiliation(s)
- D A Waller
- Glenfield Hospital, Leicester LE3 9QP, UK.
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31
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Knippel SL. SURGICAL THERAPIES FOR LUNG CARCINOMAS. Nurs Clin North Am 2001. [DOI: 10.1016/s0029-6465(22)02575-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Elia S, Griffo S, Gentile M, Costabile R, Ferrante G. Surgical treatment of lung cancer invading chest wall: a retrospective analysis of 110 patients. Eur J Cardiothorac Surg 2001; 20:356-60. [PMID: 11463557 DOI: 10.1016/s1010-7940(01)00735-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To retrospectively assess the results of surgical treatment in a consecutive series of 110 patients with Stage IIb and IIIa non small cell lung cancer (NSCLC) invading chest wall. METHODS A series of 110 patients underwent surgery for Stage IIb and IIIa NSCLC with involvement of chest wall. There were 101 male and 9 female patients, mean age was 61.4 (range 32--74), 52 (47.3%) of them complaining for chest pain. Surgical procedures were pneumonectomy in seven patients (6.4%), lobectomy in 73 (66.4%), bi-lobectomy in six (5.4%) and wedge resection in 24 (21.8%). In 63 patients (57.3%) an extrapleural resection was performed while in the other 47 (42.7%) an 'en bloc' resection of tumor with chest wall was required. In 22 patients (76.3%) repair was achieved by muscle flap while in 8 (26.7%) a prosthesis was required. Five-year survival was computed using the Kaplan--Meier method; P values correspond to the log-rank test. RESULTS There were neither intraoperative nor postoperative deaths. Postoperative staging revealed 83 T3N0M0, 17 T3N1M0 and 10 T3N2M0. Mean postoperative hospital stay was 17.7 days (range 5--40). For N0 patients 5 year survival was 47% (39/83) and no significant difference was noted when extrapleural and 'en bloc' resection groups were compared (P = 0.08). In N1/N2 patients no survival was observed (0/27) and comparison between surgical procedures was not statistically significant (P = 0.41). Moreover when N0 patients were compared with N1 patients the difference in survival was significant for both extrapleural (P = 0.02) and 'en bloc' (P = 0.04) groups. No difference was noted when the two surgical procedures were compared independently form N status (P = 0.94). Within the group of patients undergone 'en bloc' resection survival was significantly better for N0 patients as in the group of extrapleural resection. CONCLUSION Surgical treatment of Stage IIb and IIIa NSCLC invading chest wall by extrapleural or 'en bloc' resection is widely adopted and justified by the good results in terms of morbidity and relief of pain. Survival is always depending on the N status.
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Affiliation(s)
- S Elia
- Department of Thoracic Surgery, Medical Faculty, University Federico II, Naples, Italy.
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Tanaka F, Yanagihara K, Otake Y, Yamada T, Shoji T, Miyahara R, Inui K, Wada H. Prognostic factors in patients with resected pathologic (p-) T1-2N1M0 non-small cell lung cancer (NSCLC). Eur J Cardiothorac Surg 2001; 19:555-61. [PMID: 11343930 DOI: 10.1016/s1010-7940(01)00670-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES To clarify prognostic factors in resected pathologic (p-) T1-2N1M0 non-small cell lung cancer (NSCLC). METHODS A total of 95 consecutive patients who underwent complete tumor resection and mediastinal dissection for pT1-2N1M0 NSCLC between 1976 and 1997 were retrospectively reviewed. p53 status and proliferative activity were evaluated immunohistochemically. RESULTS The extent of N1 stations and p53 status proved to be significant prognostic factors. The 5-year survival rate for tumor without hilar node (#10) involvement was 66%, significantly higher than that for tumor with #10 involvement (39%, P<0.01). The 5-year survival rate for tumor with aberrant p53 expression was 37%, significantly lower than that for tumor without aberrant p53 expression (74%, P<0.01). There proved to be no significant difference in the prognosis between pT1 disease and pT2 disease; the 5-year survival rates for pT1 and pT2 diseases were 62 and 56%, respectively. Age, gender, performance status, grade of tumor differentiation, histological type, or proliferative activity were not significant factors. Multivariate analysis of prognostic factors using Cox's proportional hazard model confirmed these results. CONCLUSIONS Involvement of the hilar node and aberrant p53 expression were significant factors to predict a worse prognosis in resected T1-2N1M0 NSCLC.
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Affiliation(s)
- F Tanaka
- Department of Thoracic Surgery, Faculty of Medicine, Kyoto University, Shogoin-kawahara-cho 54, Sakyo-ku, 606-8507, Kyoto, Japan
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Tanaka F, Yanagihara K, Otake Y, Li M, Miyahara R, Wada H, Ito H. Biological features and preoperative evaluation of mediastinal nodal status in non-small cell lung cancer. Ann Thorac Surg 2000; 70:1832-8. [PMID: 11156080 DOI: 10.1016/s0003-4975(00)01987-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND To examine whether biological features of primary tumor can help preoperative evaluation of mediastinal nodal status in non-small cell lung cancer. METHODS A total of 450 patients who underwent tumor resection and mediastinal dissection were reviewed. p53 status and proliferative fraction (PI) were evaluated immunohistochemically. RESULTS The accuracy of preoperative evaluation of mediastinal nodal status with computed tomography (CT) was 72.2%; mediastinal nodal metastases had not been revealed until operation in 59 patients (13.1%) (false-negative), and no metastasis was revealed in 66 patients (14.7%) although mediastinal nodal enlargement had been demonstrated by CT (false-positive). The number of false-negative patients was significantly larger when p53 aberrant expression was positive or when PI was higher. Combined with p53 status and PI, there were 27 false-negatives (24.1%) among patients with aberrant p53 expression and higher PI, whereas only two false-negatives (1.5%) among those with negative p53 expression and lower PI. CONCLUSIONS Mediastinoscopy may be recommended for tumor showing aberrant p53 expression and higher PI, even when CT demonstrates no mediastinal nodal enlargement.
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Affiliation(s)
- F Tanaka
- Department of Thoracic Surgery, Kyoto University, Japan
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Lillington GA. Neoplasms of the lung. Curr Opin Pulm Med 2000; 6:353-5. [PMID: 10912645 DOI: 10.1097/00063198-200007000-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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