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Marc Malovrh M, Adamic K. Unravelling the lung cancer diagnostic pathway: identifying gaps and opportunities for improvement. Radiol Oncol 2024; 58:268-278. [PMID: 38613841 PMCID: PMC11165972 DOI: 10.2478/raon-2024-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/20/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND A fast and well-organized complex diagnostic process is important for better success in the treatment of lung cancer patients. The aim of our study was to reveal the gaps and inefficiencies in the diagnostic process and to suggest improvement strategies in a single tertiary centre in Slovenia. PATIENTS AND METHODS We employed a comprehensive approach to carefully dissect all the steps in the diagnostic journey for individuals suspected of having lung cancer. We gathered and analysed information from employees and patients involved in the process by dedicated questionnaires. Further, we analysed the patients' data and calculated the diagnostic intervals for patients in two different periods. RESULTS The major concerns among employees were stress and excessive administrative work. The important result of the visual journey and staff reports was the design of electronic diagnostic clinical pathway (eDCP), which could substantially increase safety and efficacy by diminishing the administrative burden of the employees. The patients were generally highly satisfied with diagnostic journey, but reported too long waiting times. By analysing two time periods, we revealed that diagnostic intervals exceeded the recommended timelines and got importantly shorter after two interventions - strengthening the diagnostic team and specially by purchase of additional PET-CT machine (the average time from general practitioner (GP) referral to the multidisciplinary treatment board (MDTB) decision was 50.8 [± 3.0] prior and 37.1 [± 2.3] days after the interventions). CONCLUSIONS The study illuminated opportunities for refining the diagnostic journey for lung cancer patients, underscoring the importance of both administrative and capacity-related enhancements.
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Affiliation(s)
- Mateja Marc Malovrh
- University Clinic for Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Katja Adamic
- University Clinic for Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
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2
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Velayudham GK, Saqlain MS, Phillips I, Saloway J, Katti K. A Cadaveric Case of Bilateral Adrenal Hyperplasia With Lung Cancer: A Paraneoplastic Syndrome? Cureus 2024; 16:e59443. [PMID: 38826887 PMCID: PMC11140825 DOI: 10.7759/cureus.59443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
Bilateral adrenal hyperplasia associated with primary lung cancer may arise from either an adrenocorticotropic hormone (ACTH)-dependent paraneoplastic syndrome or metastatic hyperplasia. Ectopic Cushing's syndrome manifests as a paraneoplastic syndrome characterized by the secretion of ACTH from malignant cells. This secretion can in turn overstimulate the adrenal cortex, resulting in adrenal cortical hyperplasia followed by hypercortisolism. Though rare, lung cancer can metastasize to the adrenal glands bilaterally, occasionally resulting in hemorrhage causing a rapid increase in size. This cadaveric report aims to delineate an unusual case of metastatic lung cancer, presenting with bilateral adrenal hyperplasia and two abdominal aortic aneurysms (AAA). An 84-year-old white male cadaver was dissected during routine coursework. Dissection of the right lung revealed a pale-yellow mass measuring 10.0 x 7.4 x 7.0cm. An irregularly defined, necrotic, ulcerated lesion measuring 5.5 x 4.5 x 3.3cm was evident on the lateral surface of the left shoulder, consistent with a history of metastatic lung carcinoma. Upon abdominal dissection, bilaterally enlarged adrenal glands and two AAAs were observed. These AAAs measured 6.0cm and 11.0cm at their respective widest transverse diameters. The right and left adrenal glands measured 10.0 x 6.5 x 4.5cm and 7.3 x 4.7 x 3.5cm, respectively. We aim to discuss the possible pathophysiological correlation of these unusual findings in this cadaver.
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Affiliation(s)
- Ganesh K Velayudham
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, GBR
| | - Mohammed S Saqlain
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, GBR
| | - Isabel Phillips
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, GBR
| | - Juliette Saloway
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, GBR
| | - Karuna Katti
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, GBR
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3
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Yu KR, Julliard WA. Sublobar Resection of Non-Small-Cell Lung Cancer: Wedge Resection vs. Segmentectomy. Curr Oncol 2024; 31:2497-2507. [PMID: 38785468 PMCID: PMC11120128 DOI: 10.3390/curroncol31050187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Lung cancer is the most common cause of cancer death. The mainstay treatment for non-small-cell lung cancer (NSCLC), particularly in the early stages, is surgical resection. Traditionally, lobectomy has been considered the gold-standard technique. Sublobar resection includes segmentectomy and wedge resection. Compared to lobectomy, these procedures have been viewed as a compromise procedure, reserved for those with poor cardiopulmonary function or who are poor surgical candidates for other reasons. However, with the advances in imaging and surgical techniques, the subject of sublobar resection as a curative treatment is being revisited. Many studies have now shown segmentectomy to be equivalent to lobectomy in patients with small (<2.0 cm), peripheral NSCLC. However, there is a mix of evidence when it comes to wedge resection and its suitability as a curative procedure. At this time, until more data can be found, segmentectomy should be considered before wedge resection for patients with early-stage NSCLC.
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Affiliation(s)
| | - Walker A. Julliard
- Section of Thoracic & Foregut Surgery, Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA 23298, USA
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4
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El Alam R, Hammer MM, Byrne SC. Factors Associated With Delay in Lung Cancer Diagnosis and Surgery in a Lung Cancer Screening Program. J Thorac Imaging 2024:00005382-990000000-00125. [PMID: 38454761 DOI: 10.1097/rti.0000000000000778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
PURPOSE Delays to biopsy and surgery after lung nodule detection can impact survival from lung cancer. The aim of this study was to identify factors associated with delay in a lung cancer screening (LCS) program. MATERIALS AND METHODS We evaluated patients in an LCS program from May 2015 through October 2021 with a malignant lung nodule classified as lung CT screening reporting and data system (Lung-RADS) 4B/4X. A cutoff of more than 30 days between screening computed tomography (CT) and first tissue sampling and a cutoff of more than 60 days between screening CT and surgery were considered delayed. We evaluated the relationship between delays to first tissue sampling and surgery and patient sex, age, race, smoking status, median income by zip code, language, Lung-RADS category, and site of surgery (academic vs community hospital). RESULTS A total of 185 lung cancers met the inclusion criteria, of which 150 underwent surgical resection. The median time from LCS CT to first tissue sampling was 42 days, and the median time from CT to surgery was 52 days. 127 (69%) patients experienced a first tissue sampling delay and 60 (40%) had a surgical delay. In multivariable analysis, active smoking status was associated with delay to first tissue sampling (odds ratio: 3.0, CI: 1.4-6.6, P = 0.005). Only performing enhanced diagnostic CT of the chest before surgery was associated with delayed lung cancer surgery (odds ratio: 30, CI: 3.6-252, P = 0.02). There was no statistically significant difference in delays with patients' sex, age, race, language, or Lung-RADS category. CONCLUSION Delays to first tissue sampling and surgery in a LCS program were associated with current smoking and performing diagnostic CT before surgery.
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Affiliation(s)
- Raquelle El Alam
- Department of Radiology, Brigham and Women's Hospital
- Harvard Medical School, Boston, MA
| | - Mark M Hammer
- Department of Radiology, Brigham and Women's Hospital
- Harvard Medical School, Boston, MA
| | - Suzanne C Byrne
- Department of Radiology, Brigham and Women's Hospital
- Harvard Medical School, Boston, MA
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5
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Guan C, Chen H, Chen H, Li S, Chen Y, Chen J, Dong Y, Zheng Z, Wang K, Pan C. Treatment of lung cancer by acupuncture combined with medicine based on pathophysiological mechanism: A review. Medicine (Baltimore) 2024; 103:e37229. [PMID: 38335396 PMCID: PMC10860975 DOI: 10.1097/md.0000000000037229] [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: 12/15/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
Lung cancer is one of the most frequently diagnosed cancers in the world. There are an estimated 2.2 million new cases and 1.79 million deaths each year. Over the past 2 decades, our understanding of disease biology, the use of predictive biomarkers, and improvements in therapeutic approaches have made significant progress and transformed the outcomes of many patients. Treatment is determined by the subtype and stage of the cancer; however, the effect of personalized treatment remains unsatisfactory. The use of Chinese medicines has attracted increasing attention worldwide. Chinese medicine treatment of lung cancer has few side effects, which can effectively prolong the survival expectation of patients and improve their quality of life, and has attracted increasing attention. Based on the pathophysiological mechanism of lung cancer reported in modern medical research, this article explores the efficacy and safety of acupuncture combined with medicine in the treatment of lung cancer.
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Affiliation(s)
- Chenguang Guan
- Heilongjiang Academy of Chinese Medicine, Harbin, Heilongjiang Province, China
| | - Hong Chen
- Heilongjiang Academy of Chinese Medicine, Harbin, Heilongjiang Province, China
| | - Haipeng Chen
- Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Shuhua Li
- North Hospital of Qiqihar First Hospital, Qiqihar, Heilongjiang Province, China
| | - Yuhan Chen
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jingyu Chen
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yushan Dong
- Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province, China
| | - Zhitao Zheng
- Qiqihar First Hospital South Hospital, Qiqihar, Heilongjiang Province, China
| | - Kaiwen Wang
- Qiqihar First Hospital South Hospital, Qiqihar, Heilongjiang Province, China
| | - Chuqiao Pan
- Qiqihar First Hospital South Hospital, Qiqihar, Heilongjiang Province, China
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6
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Tajarernmuang P, Aliaga F, Alwakeel AJ, Tavaziva G, Turner K, Menzies D, Wang H, Ofiara L, Benedetti A, Gonzalez AV. Accuracy of Cytologic vs Histologic Specimens for Assessment of Programmed Cell Death Ligand-1 Expression in Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis. Chest 2024; 165:461-474. [PMID: 37739030 DOI: 10.1016/j.chest.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/28/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Programmed cell death ligand-1 (PD-L1) expression on tumor cells, evaluated by immunohistochemistry, guides the use of immunotherapy in advanced non-small cell lung cancer (NSCLC). RESEARCH QUESTION What is the sensitivity and specificity of PD-L1 testing performed in cytologic vs paired histologic specimens in patients with NSCLC? STUDY DESIGN AND METHODS The MEDLINE, Embase, Web of Science, and Cochrane Library databases were searched through June 1, 2021. The primary outcome was pooled sensitivity and specificity of PD-L1 testing performed on cytologic specimens compared with the reference standard of histologic specimens, analyzed at the PD-L1 expression cutoffs (tumor proportion score) ≥ 1% and ≥ 50%. Pooled sensitivity and specificity, and associated 95% CIs, were estimated using bivariate generalized linear mixed models. RESULTS Twenty-six articles were included, encompassing a total of 1,064 pairs of histology specimens and cytology cell blocks, and 267 pairs of histology specimens and direct smears. Among these, 946 paired specimens were acquired without interval treatment between the collection of histology and cytology samples. The pooled sensitivity and specificity of cytology specimens compared with paired histology specimens at the PD-L1 expression cutoff ≥ 1% were 0.84 (95% CI, 0.77-0.89) and 0.88 (95% CI, 0.82-0.93), respectively, whereas the pooled sensitivity and specificity at cutoff ≥ 50% were 0.78 (95% CI, 0.69-0.86) and 0.94 (95% CI, 0.91-0.96), respectively. When only paired specimens acquired without interval treatment were considered, the pooled sensitivity and specificity of cytology specimens at PD-L1 expression cutoff ≥ 1% were 0.84 (95% CI, 0.76-0.90) and 0.89 (95% CI, 0.82-0.94), respectively, whereas the pooled sensitivity and specificity at cutoff ≥ 50% were 0.80 (95% CI, 0.71-0.89) and 0.94 (95% CI, 0.91-0.96), respectively. INTERPRETATION Cytologic specimens provide an accurate assessment of PD-L1 expression in most patients with NSCLC, at both ≥ 1% and ≥ 50% cutoffs, when compared with histologic specimens. TRIAL REGISTRATION PROSPERO; No.: CRD42020153279; URL: https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
- Pattraporn Tajarernmuang
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada; Respiratory, Critical Care and Allergy Division, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Felipe Aliaga
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada; Facultad de Medicina Clínica Alemana, Universidad del Desarrollo (CAS-UDD), Santiago, Chile
| | - Amr J Alwakeel
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada; Pulmonary Medicine Division, Department of Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Gamuchirai Tavaziva
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Kimberly Turner
- Department of Psychiatry, McGill University Health Centre, Montreal, QC, Canada
| | - Dick Menzies
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada; Respiratory Division, McGill University Health Centre, Montreal, QC, Canada
| | - Hangjun Wang
- Department of Pathology, McGill University, Montreal, QC, Canada
| | - Linda Ofiara
- Department of Psychiatry, McGill University Health Centre, Montreal, QC, Canada
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada; Departments of Epidemiology, Biostatistics & Occupational Health, Medicine, McGill University, Montreal, QC, Canada
| | - Anne V Gonzalez
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada; Respiratory Division, McGill University Health Centre, Montreal, QC, Canada.
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7
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Godfrey CM, Shipe ME, Welty VF, Maiga AW, Aldrich MC, Montgomery C, Crockett J, Vaszar LT, Regis S, Isbell JM, Rickman OB, Pinkerman R, Lambright ES, Nesbitt JC, Maldonado F, Blume JD, Deppen SA, Grogan EL. The Thoracic Research Evaluation and Treatment 2.0 Model: A Lung Cancer Prediction Model for Indeterminate Nodules Referred for Specialist Evaluation. Chest 2023; 164:1305-1314. [PMID: 37421973 PMCID: PMC10635839 DOI: 10.1016/j.chest.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/03/2023] [Accepted: 06/01/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND Appropriate risk stratification of indeterminate pulmonary nodules (IPNs) is necessary to direct diagnostic evaluation. Currently available models were developed in populations with lower cancer prevalence than that seen in thoracic surgery and pulmonology clinics and usually do not allow for missing data. We updated and expanded the Thoracic Research Evaluation and Treatment (TREAT) model into a more generalized, robust approach for lung cancer prediction in patients referred for specialty evaluation. RESEARCH QUESTION Can clinic-level differences in nodule evaluation be incorporated to improve lung cancer prediction accuracy in patients seeking immediate specialty evaluation compared with currently available models? STUDY DESIGN AND METHODS Clinical and radiographic data on patients with IPNs from six sites (N = 1,401) were collected retrospectively and divided into groups by clinical setting: pulmonary nodule clinic (n = 374; cancer prevalence, 42%), outpatient thoracic surgery clinic (n = 553; cancer prevalence, 73%), or inpatient surgical resection (n = 474; cancer prevalence, 90%). A new prediction model was developed using a missing data-driven pattern submodel approach. Discrimination and calibration were estimated with cross-validation and were compared with the original TREAT, Mayo Clinic, Herder, and Brock models. Reclassification was assessed with bias-corrected clinical net reclassification index and reclassification plots. RESULTS Two-thirds of patients had missing data; nodule growth and fluorodeoxyglucose-PET scan avidity were missing most frequently. The TREAT version 2.0 mean area under the receiver operating characteristic curve across missingness patterns was 0.85 compared with that of the original TREAT (0.80), Herder (0.73), Mayo Clinic (0.72), and Brock (0.68) models with improved calibration. The bias-corrected clinical net reclassification index was 0.23. INTERPRETATION The TREAT 2.0 model is more accurate and better calibrated for predicting lung cancer in high-risk IPNs than the Mayo, Herder, or Brock models. Nodule calculators such as TREAT 2.0 that account for varied lung cancer prevalence and that consider missing data may provide more accurate risk stratification for patients seeking evaluation at specialty nodule evaluation clinics.
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Affiliation(s)
- Caroline M Godfrey
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Maren E Shipe
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Valerie F Welty
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Amelia W Maiga
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN; Division of Thoracic Surgery, Veterans Hospital, Tennessee Valley Healthcare System, Nashville, TN
| | - Melinda C Aldrich
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | | | - Jerod Crockett
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Shawn Regis
- Department of Radiation Oncology, Lahey Hospital and Medical Center, Burlington, MA
| | - James M Isbell
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Otis B Rickman
- Division of Pulmonary Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Rhonda Pinkerman
- Division of Thoracic Surgery, Veterans Hospital, Tennessee Valley Healthcare System, Nashville, TN
| | - Eric S Lambright
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Jonathan C Nesbitt
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN; Division of Thoracic Surgery, Veterans Hospital, Tennessee Valley Healthcare System, Nashville, TN
| | - Fabien Maldonado
- Division of Pulmonary Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Jeffrey D Blume
- School of Data Science, University of Virginia, Charlottesville, VA
| | - Stephen A Deppen
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Eric L Grogan
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN; Division of Thoracic Surgery, Veterans Hospital, Tennessee Valley Healthcare System, Nashville, TN.
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8
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Leal AIC, Mathios D, Jakubowski D, Johansen JS, Lau A, Wu T, Cristiano S, Medina JE, Phallen J, Bruhm DC, Carey J, Dracopoli NC, Bojesen SE, Scharpf RB, Velculescu VE, Vachani A, Bach PB. Cell-Free DNA Fragmentomes in the Diagnostic Evaluation of Patients With Symptoms Suggestive of Lung Cancer. Chest 2023; 164:1019-1027. [PMID: 37116747 DOI: 10.1016/j.chest.2023.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/13/2023] [Accepted: 04/16/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND The diagnostic workup of individuals suspected of having lung cancer can be complex and protracted because conventional symptoms of lung cancer have low specificity and sensitivity. RESEARCH QUESTION Among individuals with symptoms of lung cancer, can a blood-based approach to analyze cell-free DNA (cfDNA) fragmentation (the DNA evaluation of fragments for early interception [DELFI] score) enhance evaluation for the possible presence of lung cancer? STUDY DESIGN AND METHODS Adults were referred to Bispebjerg Hospital (Copenhagen, Denmark) for diagnostic evaluation of initial imaging anomalies and symptoms consistent with lung cancer. Numbers and types of symptoms were extracted from medical records. cfDNA from plasma samples obtained at the prediagnostic visit was isolated, sequenced, and analyzed for genome-wide cfDNA fragmentation patterns. The relationships among clinical presentation, cancer status, and DELFI score were examined. RESULTS A total of 296 individuals were analyzed. Median DELFI scores were higher for those with lung cancer (n = 98) than those without cancer (n = 198; 0.94 vs 0.19; P < .001). In a multivariate model adjusted for age, smoking history, and presenting symptoms, the addition of the DELFI score improved the prediction of lung cancer for those who demonstrated symptoms (area under the receiver operating characteristic curve, 0.74-0.94). INTERPRETATION The DELFI score distinguishes individuals with lung cancer from those without cancer better than suspicious symptoms do. These results represent proof-of-concept support that fragmentation-based biomarker approaches may facilitate diagnostic resolution for patients with concerning symptoms of lung cancer.
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Affiliation(s)
| | - Dimitrios Mathios
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Jakob S Johansen
- Department of Oncology, Copenhagen University Hospital-Herlev and Gentofte Hospital, Herlev, Denmark
| | - Anna Lau
- Delfi Diagnostics, Inc., Baltimore, MD
| | - Tony Wu
- Delfi Diagnostics, Inc., Baltimore, MD
| | - Stephen Cristiano
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jamie E Medina
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jillian Phallen
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel C Bruhm
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Stig E Bojesen
- Department of Clinical Biochemistry, Copenhagen University Hospital-Herlev and Gentofte Hospital, Herlev, Denmark
| | - Robert B Scharpf
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Victor E Velculescu
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anil Vachani
- University of Pennsylvania School of Medicine, Philadelphia, PA
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Husnain SMN, Sarkar A, Huseini T. Utility and Safety of Bronchoscopic Cryotechniques-A Comprehensive Review. Diagnostics (Basel) 2023; 13:2886. [PMID: 37761254 PMCID: PMC10530195 DOI: 10.3390/diagnostics13182886] [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: 05/31/2023] [Revised: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Cryosurgical techniques are employed for diagnostic and therapeutic bronchoscopy and serve as important tools for the management of pulmonary diseases. The diagnosis of interstitial lung disease requires multidisciplinary team discussions after a thorough assessment of history, physical exam, computed tomography, and lung-function testing. However, histological diagnosis is required in selected patients. Surgical lung biopsy has been the gold standard but this can be associated with increased morbidity and mortality. Transbronchial lung cryobiopsy is an emerging technique and multiple studies have shown that it has a high diagnostic yield with a good safety profile. There is wide procedural variability and the optimal technique for cryobiopsy is still under investigation. There is emerging data that demonstrate that cryobiopsy is safe and highly accurate in the diagnosis of thoracic malignancies. Furthermore, cryorecanalization procedures are a useful adjunct for the palliation of tumors in patients with central airway obstruction. One should keep in mind that these procedures are not free from complications and should be carried out in a specialized center by a trained and experienced bronchoscopy team. We present a review of the literature on the diagnostic and therapeutic utility of bronchoscopy-guided cryosurgical procedures and their safety profile.
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Affiliation(s)
- Shaikh M. Noor Husnain
- Department of Internal Medicine, Division of Interventional Pulmonary Medicine, Westchester Medical Center, New York, NY 10595, USA
| | - Abhishek Sarkar
- Department of Internal Medicine, Division of Interventional Pulmonary Medicine, Westchester Medical Center, New York, NY 10595, USA
| | - Taha Huseini
- Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, WA 6150, Australia
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10
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Teng J, Liu Y, Xia J, Luo Y, Zou H, Wang H. Impact of time-to-treatment initiation on survival in single primary non-small cell lung Cancer: A population-based study. Heliyon 2023; 9:e19750. [PMID: 37810045 PMCID: PMC10559072 DOI: 10.1016/j.heliyon.2023.e19750] [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: 05/15/2023] [Revised: 08/17/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023] Open
Abstract
Background Understanding the effects of a delayed time-to-treatment initiation(TTI) for non-small cell lung cancer (NSCLC) is vital. Methods We analyzed NSCLC data from the Surveillance, Epidemiology, and End Results database, focusing on lung adenocarcinoma (LUAD) and lung squamous carcinoma (LUSC). TTI was studied as both continuous and dichotomous variables. Restricted cubic splines were employed to identify potential nonlinear dependency between the hazard ratio (HR) and TTI. Propensity score matching was used to ensure a balanced patient allocation, and then survival differences between groups were assessed using Kaplan-Meier analysis and competing risk models. We used overall survival (OS) as the primary outcome and cancer-specific cumulative mortality (CSCM) as a complementary indicator. Finally, sensitivity analyses were performed on censored data. Results A total of 80,020 with NSCLC were analyzed. TTI was assessed as a continuous variable, showing a noticeable increase in the HR for stage I to II NSCLC with TTI >1 month. Conversely, the trend for stage III to IV NSCLC was the opposite. In stage I LUAD, the 'early' group demonstrated a higher OS compared to the 'delayed' group (Log-rank P = 0.002), while there was no significant difference in CSCM (Fine-gray P = 0.321). In stage I LUSC, there was no significant difference in OS(Log-rank P = 0.260), but the 'early' group had a lower CSCM (Fine-gray P = 0.018). For stage II-IV NSCLC, the 'delayed' group did not exhibit a negative impact on OS or CSCM. The sensitivity analysis further supported the results of the main analysis. Conclusion Prolongation of TTI ≥31 days has a negative impact on OS or CSCM in stage I NSCLC only. Further exploration and validation are needed to determine whether these results can be used as evidence for a 'safe' TTI threshold setting for future NSCLC.
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Affiliation(s)
- Jun Teng
- Respiratory Disease Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, Beijing, China
| | - Yan Liu
- Respiratory Disease Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, Beijing, China
| | - Junyan Xia
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, Beijing, China
| | - Yi Luo
- Respiratory Disease Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, Beijing, China
| | - Heng Zou
- Respiratory Disease Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, Beijing, China
| | - Hongwu Wang
- Respiratory Disease Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, Beijing, China
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Zhang L, Wang L, Wang J, Chen J, Meng Z, Liu Z, Jiang X, Wang X, Huang C, Chen P, Liang Y, Jiang R, Wang J, Zhong D, Shang Y, Zhang Y, Zhang C, Huang D. Anlotinib plus icotinib as a potential treatment option for EGFR-mutated advanced non-squamous non-small cell lung cancer with concurrent mutations: final analysis of the prospective phase 2, multicenter ALTER-L004 study. Mol Cancer 2023; 22:124. [PMID: 37543587 PMCID: PMC10403846 DOI: 10.1186/s12943-023-01823-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/13/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutation and concurrent mutations have a poor prognosis. This study aimed to examine anlotinib plus icotinib as a first-line treatment option for advanced NSCLC carrying EGFR mutation with or without concurrent mutations. METHODS This phase 2, single-arm, multicenter trial (ClinicalTrials.gov NCT03736837) was performed at five hospitals in China from December 2018 to November 2020. Non-squamous NSCLC cases with EGFR-sensitizing mutations were treated with anlotinib and icotinib. The primary endpoint was progression-free survival (PFS). Secondary endpoints included the objective response rate (ORR), disease control rate (DCR), overall survival (OS), and toxicity. RESULTS Sixty participants were enrolled, including 31 (52%) and 29 (48%) with concurrent mutations and pathogenic concurrent mutations, respectively. The median follow-up was 26.9 (range, 15.0-38.9) months. ORR and DCR were 68.5% and 98.2%, respectively. Median PFS was 15.1 (95%CI: 12.6-17.6) months which met the primary endpoint, median DoR was 13.5 (95%CI: 10.0-17.1) months, and median OS was 30.0 (95%CI: 25.5-34.5) months. Median PFS and OS in patients with pathogenic concurrent mutations were 15.6 (95%CI: 12.5-18.7) months and not reached (95%CI: 17.46 months to not reached), respectively. All patients experienced TRAEs, including 26 (43%) and 1 (1.7%) who had grade ≥ 3 and serious treatment-related adverse events (TRAEs). CONCLUSIONS Anlotinib combined with icotinib was effective and well-tolerated as a first-line treatment option for EGFR mutation-positive advanced NSCLC with or without concurrent mutations. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03736837.
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Affiliation(s)
- Linlin Zhang
- Department of Medical Oncology, Tianjin Medical University General Hospital, No.154, Anshandao, Heping District, Tianjin, 300052, China
| | - Liuchun Wang
- Department of Thoracic Oncology, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, 300060, P. R. China
| | - Jingya Wang
- Department of Thoracic Oncology, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, 300060, P. R. China
| | - Jinliang Chen
- Department of Thoracic Oncology, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, 300060, P. R. China
| | - Zhaoting Meng
- Department of Thoracic Oncology, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, 300060, P. R. China
| | - Zhujun Liu
- Department of Thoracic Oncology, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, 300060, P. R. China
| | - Xiangli Jiang
- Department of Thoracic Oncology, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, 300060, P. R. China
| | - Xinyue Wang
- Department of Thoracic Oncology, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, 300060, P. R. China
| | - Chun Huang
- Department of Thoracic Oncology, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, 300060, P. R. China
| | - Peng Chen
- Department of Thoracic Oncology, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, 300060, P. R. China
| | - Yan Liang
- Department of Thoracic Oncology, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, 300060, P. R. China
| | - Richeng Jiang
- Department of Thoracic Oncology, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, 300060, P. R. China
| | - Jing Wang
- Department of Thoracic Oncology, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, 300060, P. R. China
| | - Diansheng Zhong
- Department of Medical Oncology, Tianjin Medical University General Hospital, No.154, Anshandao, Heping District, Tianjin, 300052, China
| | - Yanhong Shang
- Hebei Key Laboratory of Cancer Radiotherapy and Chemotherapy, Department of Medical Oncology, Affiliated Hospital of Hebei University, Baoding, China.
| | - Yan Zhang
- Department of Oncology IV, First Hospital of Shijiazhuang, Shijiazhuang, China.
| | - Cuiying Zhang
- Cancer center, Inner Mongolia Autonomous Region People's Hospital, Huhhot, People's Republic of China.
| | - Dingzhi Huang
- Department of Thoracic Oncology, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, 300060, P. R. China.
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12
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Pini C, Bottoni E, Fiz F, Giudici VM, Alloisio M, Testori A, Rodari M, Sollini M, Chiti A, Cariboni U, Antunovic L. Radioisotope-Guided Excision of Mediastinal Lymph Nodes in Patients with Non-Small Cell Lung Carcinoma: Feasibility and Clinical Impact. Cancers (Basel) 2023; 15:3320. [PMID: 37444438 DOI: 10.3390/cancers15133320] [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: 05/21/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Intraoperative localisation of nodal disease in non-small cell lung cancer (NSCLC) can be challenging. Lymph node localisation via radiopharmaceuticals is used in many conditions; we tested the feasibility of this approach in NSCLC. METHODS NSCLC patients were prospectively recruited. Intraoperative peri-tumoral injections of [99mTc]Tc-albumin nanocolloids were performed, followed by removing the tumour and locoregional lymph nodes. These were examined ex vivo with a gamma probe and labelled sentinel lymph nodes (SLNs) if they showed any activity or non-sentinel lymph nodes (nSLNs) if they did not. Thereafter, the surgical field was scanned with the probe; any further radioactive lymph node was removed and labelled as "extra" SLNs (eSLNs). All specimens were sent to histology, and metastatic status was recorded. RESULTS 48 patients were enrolled, and 290 nodal stations were identified: 179 SLNs, 87 nSLNs, and 24 eSLNs. A total of 44 nodal metastases were identified in 22 patients, with 36 of them (82%) located within SLNs. Patients with nSLNs metastases had at least a co-existing positive SLN. No metastases were found in eSLNs. CONCLUSIONS The technique shows high sensitivity for intraoperative nodal metastases identification. This information could allow selective lymphadenectomies in low-risk patients or more aggressive approaches in high-risk patients.
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Affiliation(s)
- Cristiano Pini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Diagnostic Imaging Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Edoardo Bottoni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Francesco Fiz
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Ente Ospedaliero "Ospedali Galliera", 16128 Genoa, Italy
- Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Veronica Maria Giudici
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Marco Alloisio
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Alberto Testori
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Marcello Rodari
- Diagnostic Imaging Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Martina Sollini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Diagnostic Imaging Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Arturo Chiti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
| | - Umberto Cariboni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Lidija Antunovic
- Diagnostic Imaging Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
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13
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Siddiqi N, Pan G, Liu A, Lin Y, Jenkins K, Zhao J, Mak K, Tapan U, Suzuki K. Timeliness of Lung Cancer Care From the Point of Suspicious Image at an Urban Safety Net Hospital. Clin Lung Cancer 2023; 24:e87-e93. [PMID: 36642641 DOI: 10.1016/j.cllc.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/03/2022] [Accepted: 12/08/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Timeliness of care is an important metric for lung cancer patients, and care delays in the safety-net setting have been described. Timeliness from the point of the suspicious image is not well-studied. Herein, we evaluate time intervals in the workup of lung cancer at an urban, safety net hospital and assess for disparities by demographic and clinical factors. PATIENTS AND METHODS We performed a retrospective analysis of lung cancer patients receiving some portion of their care at Boston Medical Center between 2015 and 2020. A total of 687 patients were included in the final analysis. Median times from suspicious image to first treatment (SIT), suspicious image to diagnosis (SID), and diagnosis to treatment (DT) were calculated. Nonparametric tests were applied to assess for intergroup differences in time intervals. RESULTS SIT, SID, and DT for the entire cohort was 78, 34, and 32 days, respectively. SIT intervals were 87 days for females and 72 days for males (p < .01). SIT intervals were 106, 110, 81, and 41 days for stages I, II, III, and IV, respectively (p < .01). SID intervals differed between black (40.5) and Hispanic (45) patients compared to white (28) and Asian (23) patients (p < .05). CONCLUSION Advanced stage at presentation and male gender were associated with more timely treatment from the point of suspicious imaging while white and Asian were associated with more timely lung cancer diagnosis. Future analyses should seek to elucidate drivers of timeliness differences and assess for the impact of timeliness disparities on patient outcomes in the safety net setting.
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Affiliation(s)
- Noreen Siddiqi
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Gilbert Pan
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Anqi Liu
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Yue Lin
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Kendall Jenkins
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Jenny Zhao
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Kimberley Mak
- Department of Radiation Oncology, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Umit Tapan
- Department of Hematology/Oncology, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Kei Suzuki
- Department of Surgery, Inova Fairfax Hospital, Fairfax, VA
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14
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Muslim Z, Stroever S, Razi SS, Poulikidis K, Baig MZ, Connery CP, Bhora FY. Increasing Time-to-Treatment for Lung Cancer: Are We Going Backward? Ann Thorac Surg 2023; 115:192-199. [PMID: 35780818 DOI: 10.1016/j.athoracsur.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/26/2022] [Accepted: 06/06/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Treatment delays in lung cancer care in the United States may be attributable to a diverse range of patient, provider, and institutional factors, the precise contributions of which remain unclear. The objective of our study was to use the National Cancer Database to investigate specific predictors of increased time-to-treatment initiation. METHODS We identified 567 783 patients undergoing treatment for stage I to stage IV non-small cell lung cancer during 2010 to 2018. Time-to-treatment initiation was defined as the number of days from radiologic diagnosis to initiation of first treatment. We used mixed effect negative binomial regression to determine predictors of time-to-treatment initiation. RESULTS We noted a steady rise in the overall mean time-to-treatment initiation interval from 33 days (2010) to 39 days (2018; P < .01). Black race, a later year at diagnosis, nonprivate insurance, and diagnosis and treatment at different facilities were independent predictors of increased time-to-treatment initiation, irrespective of disease stage. Compared with White race, Black race corresponded to a 15% to 20% increase in time-to-treatment initiation, depending on disease stage (P < .01). For stages I and II, radiation as first course of therapy corresponded with a 69% and 33% increase in time-to-treatment initiation, respectively, compared with surgery (P < .01). CONCLUSIONS Lung cancer treatment initiation times have seen an upward trajectory in recent years. Black patients encountered significantly longer treatment initiation times, regardless of treatment modality or disease stage. Prolonged initiation times appear to contribute to existing health care disparities by disproportionately affecting medically underserved communities.
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Affiliation(s)
- Zaid Muslim
- Division of Thoracic Surgery, Rudy L. Ruggles Biomedical Research Institute, Danbury, Connecticut.
| | - Stephanie Stroever
- Department of Research and Innovation, Nuvance Health, Danbury, Connecticut
| | - Syed S Razi
- Division of Thoracic Surgery, Department of Surgery, Memorial Healthcare System, Hollywood, Florida
| | | | - Mirza Zain Baig
- Division of Thoracic Surgery, Nuvance Health, Danbury, Connecticut
| | - Cliff P Connery
- Division of Thoracic Surgery, Nuvance Health, Poughkeepsie, New York
| | - Faiz Y Bhora
- Division of Thoracic Surgery, Rudy L. Ruggles Biomedical Research Institute, Danbury, Connecticut; Division of Thoracic Surgery, Nuvance Health, Danbury, Connecticut; Division of Thoracic Surgery, Nuvance Health, Poughkeepsie, New York
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15
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Evaluation of Novel Technology Targeting the Lung Periphery "Just Because We Can…". J Bronchology Interv Pulmonol 2023; 30:5-6. [PMID: 36597198 DOI: 10.1097/lbr.0000000000000864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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16
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Parente P, Carbonelli C, Biancofiore G, Sukthi A, Di Micco CM, Vairo M, Fuso P, Taurchini M, Graziano P. Handling and standardization of EBUS needle aspiration in NSCLC patients: The value of the cell block, a monoinstitutional experience. Thorac Cancer 2022; 13:2480-2488. [PMID: 35868633 PMCID: PMC9436690 DOI: 10.1111/1759-7714.14581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lung cancer is the main cause of cancer-related death worldwide, and 85% of all lung tumors are non-small cell lung cancers (NSCLC). More than 60% of all lung tumors are diagnosed at an advanced stage, leading to poor prognosis. Given the growing demand for NSCLC profiling for selection of the most appropriate therapy, the acquisition of adequate tumor samples has become increasingly crucial, mostly in advanced NSCLC patients due to old age and/or comorbidities. Being a mini-invasive sampling technique, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) represents a valuable alternative to traditional transthoracic or surgical sampling in these patients, and perfoming cell block (CB) could be crucial to maximize the potential biological information. The aim of this study is to describe a monoinstitutional interprofessional experience in handling EBUS-TBNA and CB in 464 patients. METHODS We retrospectively collected all the consecutive CBs obtained from EBUS TBNA performed between 2014 and 2021 on the lung lesions or mediastinal lymph nodes. All the CBs were handled in a standardized method. RESULTS A total of 95.5% (448/464 samples) of adequacy for site and 92.6% (430/464) of adequacy for diagnosis were observed. Moreover, in the adenocarcinoma histotype, ALK, ROS1 and tumor proportion score (TPS) PD-L1 assessment by IHC was possible in 96% (140/146) of cases, and molecular profile was obtained in 93.8% (137/146) of cases. In the squamous cell carcinoma histotype, TPS PD-L1 assessment was possible in 81% (13/16) of cases. All four CB results obtained from carcinoma NOS were adequate for ALK, ROS1 and PD-L1 assessment and molecular profiling. All 39 metastatic samples from extra-pulmonary primary were adequate for immunohistochemical characterization and molecular profiling. Finally, reporting of the tumor sample adequacy to the clinicians took a median time of about 30 h (range: 24-80 h). CONCLUSION Careful cytological smear management together with the handling and standardization of CB obtained from EBUS-TBNA could represent an effective method to increase the adequacy of the tumor specimen for both diagnosis and molecular profile.
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Affiliation(s)
- Paola Parente
- Pathology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Cristiano Carbonelli
- Pneumology Unit, Department of Medical Sciences, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giovanni Biancofiore
- Pathology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Andi Sukthi
- Pneumology Unit, Department of Medical Sciences, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Concetta Martina Di Micco
- Oncology Unit, Department of Medical Sciences, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Matteo Vairo
- Pathology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Paolo Fuso
- Department of Medical and Surgical Sciences, Institute of Respiratory Disease, Policlinico Universitario 'Riuniti' di Foggia, University of Foggia, Foggia, Italy
| | - Marco Taurchini
- Thoracic Surgery Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Paolo Graziano
- Pathology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
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Erefai O, Soulaymani A, Mokhtari A, Obtel M, Hami H. Diagnostic delay in lung cancer in Morocco: A 4-year retrospective study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Chen WM, Chen M, Hsu JG, Lee TS, Shia BC, Wu SY. Use of Preoperative FDG PET/CT and Survival of Patients with Resectable Non-Small Cell Lung Cancer. Radiology 2022; 305:219-227. [PMID: 35727156 DOI: 10.1148/radiol.212798] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background The added value of preoperative PET/CT for the overall survival of patients with resectable non-small cell lung cancer (NSCLC) is unknown. Purpose To investigate the association of the use of preoperative PET/CT on survival of patients with resectable stage I-IIIB NSCLC. Materials and Methods In this retrospective study, patients with resectable stage I-IIIB NSCLC who underwent thoracic surgery from January 1, 2009, to December 31, 2018, from the Taiwan Cancer Registry were included. The last follow-up date was December 31, 2019. Patients were categorized into two groups according to whether they underwent preoperative metabolic imaging with fluorine 18 fluorodeoxyglucose PET/CT. Patients who did not undergo preoperative imaging were used as the control group. The primary outcome of interest was all-cause mortality. Patients in both groups were propensity score matched at a ratio of 1:1. Matching variables used were sex, age, histologic findings, American Joint Committee on Cancer clinical stage, cT stage, cN stage, current and past smoker history, adjuvant chemotherapy, adjuvant chemoradiation, Charlson comorbidity index, and hospital type. Survival curves were generated using the Kaplan-Meier method and compared using the log-rank test. Results In the matched cohort, 6754 patients (3349 men, mean age ± SD: 64 years ± 11) underwent PET/CT and 6754 did not (3362 men, mean age: 64 years ± 11). In adjusted analysis, patients with stage IIIA or IIIB NSCLC and preoperative PET/CT had a lower risk of death versus those without PET/CT (for stage IIIA: hazard ratio [HR] = 0.90 [95% CI: 0.79, 0.94], P = .02; for stage IIIB: HR = 0.80 [95% CI: 0.71, 0.90], P < .01). There was no improvement in a lower risk of death for patients with stage I-II NSCLC (after multivariable adjustment, the HR was 1.19 [95% CI: 0.89, 1.30], P = .65). Conclusion Use of preoperative PET/CT was associated with lower risk of death in patients with stage IIIA-IIIB non-small cell lung cancer compared with those without preoperative PET/CT. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Wan-Ming Chen
- From the Graduate Institute of Business Administration, College of Management (W.M.C., M.C., J.G.H., T.S.L., B.C.S., S.Y.W.), and Artificial Intelligence Development Center (B.C.S., S.Y.W.), Fu Jen Catholic University, Taipei, Taiwan; Big Data Center (W.M.C., S.Y.W.), Division of Radiation Oncology (S.Y.W.), and Cancer Center (S.Y.W.), Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, No. 111, Section 3, Hsing-Long Rd, Taipei 116, Taiwan; Department of Food Nutrition and Health Biotechnology (S.Y.W.) and Department of Healthcare Administration (S.Y.W.), College of Medical and Health Science, Asia University, Taichung, Taiwan; Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (S.Y.W.); and Department of Management, College of Management, Fo Guang University, Yilan, Taiwan (S.Y.W.)
| | - Mingchih Chen
- From the Graduate Institute of Business Administration, College of Management (W.M.C., M.C., J.G.H., T.S.L., B.C.S., S.Y.W.), and Artificial Intelligence Development Center (B.C.S., S.Y.W.), Fu Jen Catholic University, Taipei, Taiwan; Big Data Center (W.M.C., S.Y.W.), Division of Radiation Oncology (S.Y.W.), and Cancer Center (S.Y.W.), Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, No. 111, Section 3, Hsing-Long Rd, Taipei 116, Taiwan; Department of Food Nutrition and Health Biotechnology (S.Y.W.) and Department of Healthcare Administration (S.Y.W.), College of Medical and Health Science, Asia University, Taichung, Taiwan; Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (S.Y.W.); and Department of Management, College of Management, Fo Guang University, Yilan, Taiwan (S.Y.W.)
| | - Jeng-Guan Hsu
- From the Graduate Institute of Business Administration, College of Management (W.M.C., M.C., J.G.H., T.S.L., B.C.S., S.Y.W.), and Artificial Intelligence Development Center (B.C.S., S.Y.W.), Fu Jen Catholic University, Taipei, Taiwan; Big Data Center (W.M.C., S.Y.W.), Division of Radiation Oncology (S.Y.W.), and Cancer Center (S.Y.W.), Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, No. 111, Section 3, Hsing-Long Rd, Taipei 116, Taiwan; Department of Food Nutrition and Health Biotechnology (S.Y.W.) and Department of Healthcare Administration (S.Y.W.), College of Medical and Health Science, Asia University, Taichung, Taiwan; Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (S.Y.W.); and Department of Management, College of Management, Fo Guang University, Yilan, Taiwan (S.Y.W.)
| | - Tian-Shyug Lee
- From the Graduate Institute of Business Administration, College of Management (W.M.C., M.C., J.G.H., T.S.L., B.C.S., S.Y.W.), and Artificial Intelligence Development Center (B.C.S., S.Y.W.), Fu Jen Catholic University, Taipei, Taiwan; Big Data Center (W.M.C., S.Y.W.), Division of Radiation Oncology (S.Y.W.), and Cancer Center (S.Y.W.), Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, No. 111, Section 3, Hsing-Long Rd, Taipei 116, Taiwan; Department of Food Nutrition and Health Biotechnology (S.Y.W.) and Department of Healthcare Administration (S.Y.W.), College of Medical and Health Science, Asia University, Taichung, Taiwan; Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (S.Y.W.); and Department of Management, College of Management, Fo Guang University, Yilan, Taiwan (S.Y.W.)
| | - Ben-Chang Shia
- From the Graduate Institute of Business Administration, College of Management (W.M.C., M.C., J.G.H., T.S.L., B.C.S., S.Y.W.), and Artificial Intelligence Development Center (B.C.S., S.Y.W.), Fu Jen Catholic University, Taipei, Taiwan; Big Data Center (W.M.C., S.Y.W.), Division of Radiation Oncology (S.Y.W.), and Cancer Center (S.Y.W.), Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, No. 111, Section 3, Hsing-Long Rd, Taipei 116, Taiwan; Department of Food Nutrition and Health Biotechnology (S.Y.W.) and Department of Healthcare Administration (S.Y.W.), College of Medical and Health Science, Asia University, Taichung, Taiwan; Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (S.Y.W.); and Department of Management, College of Management, Fo Guang University, Yilan, Taiwan (S.Y.W.)
| | - Szu-Yuan Wu
- From the Graduate Institute of Business Administration, College of Management (W.M.C., M.C., J.G.H., T.S.L., B.C.S., S.Y.W.), and Artificial Intelligence Development Center (B.C.S., S.Y.W.), Fu Jen Catholic University, Taipei, Taiwan; Big Data Center (W.M.C., S.Y.W.), Division of Radiation Oncology (S.Y.W.), and Cancer Center (S.Y.W.), Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, No. 111, Section 3, Hsing-Long Rd, Taipei 116, Taiwan; Department of Food Nutrition and Health Biotechnology (S.Y.W.) and Department of Healthcare Administration (S.Y.W.), College of Medical and Health Science, Asia University, Taichung, Taiwan; Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (S.Y.W.); and Department of Management, College of Management, Fo Guang University, Yilan, Taiwan (S.Y.W.)
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Access to Care Metrics in Stage I Lung Cancer: Improved Access Is Associated with Improved Survival. Ann Thorac Surg 2022; 114:1810-1815. [PMID: 35724700 DOI: 10.1016/j.athoracsur.2022.05.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/20/2022] [Accepted: 05/08/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Equitable access to care is a critical component of comprehensive surgical lung cancer management. Despite this, quality measures (QMs) assessing pre-operative access to care are lacking. We determined several pre-operative QMs based on contemporary treatment guidelines and hypothesized that poor access to care was associated with worse outcomes. METHODS We performed a retrospective cohort study using a uniquely compiled Veterans Health Administration (VHA) dataset of patients with clinical stage I non-small cell lung cancer (NSCLC) receiving surgical treatment (2006-2016). We defined four QMs that patients with clinical stage I NSCLC should routinely meet in the pre-operative period: timely surgery, positron emission tomography imaging, appropriate smoking management, and pulmonary function testing. We assessed the relationship between meeting these QMs and various short- and long-term outcomes. RESULTS Among 9,749 Veterans undergoing surgery for clinical stage I NSCLC, 3,371 (34.6%) met all QMs. Factors associated with lower likelihood of meeting all QMs included black race (adjusted odds ratio [aOR] 0.744, 95% CI 0.652-0.848), higher area deprivation index score (e.g., quartile 5 vs. 1, aOR 0.747, 0.647-0.863), and increased distance to hospital (e.g., quartile 5 vs. 1, aOR 0.700, 0.605-0.811). Adherence to all QMs was associated with significantly lower likelihood of post-operative mortality (aOR 0.623, 0.433-0.896) and improved overall survival (adjusted hazard ratio [aHR] 0.897, 0.844-0.954). CONCLUSIONS Inadequate access to pre-operative care is associated with worse short- and long-term outcomes in clinical stage I NSCLC. Future VHA policy measures should focus on providing more equitable guideline-concordant care to Veterans.
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Rodríguez De Dios N, Navarro-Martin A, Cigarral C, Chicas-Sett R, García R, Garcia V, Gonzalez JA, Gonzalo S, Murcia-Mejía M, Robaina R, Sotoca A, Vallejo C, Valtueña G, Couñago F. GOECP/SEOR radiotheraphy guidelines for non-small-cell lung cancer. World J Clin Oncol 2022; 13:237-266. [PMID: 35582651 PMCID: PMC9052073 DOI: 10.5306/wjco.v13.i4.237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 08/27/2021] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
Non-small cell lung cancer (NSCLC) is a heterogeneous disease accounting for approximately 85% of all lung cancers. Only 17% of patients are diagnosed at an early stage. Treatment is multidisciplinary and radiotherapy plays a key role in all stages of the disease. More than 50% of patients with NSCLC are treated with radiotherapy (curative-intent or palliative). Technological advances-including highly conformal radiotherapy techniques, new immobilization and respiratory control systems, and precision image verification systems-allow clinicians to individualize treatment to maximize tumor control while minimizing treatment-related toxicity. Novel therapeutic regimens such as moderate hypofractionation and advanced techniques such as stereotactic body radiotherapy (SBRT) have reduced the number of radiotherapy sessions. The integration of SBRT into routine clinical practice has radically altered treatment of early-stage disease. SBRT also plays an increasingly important role in oligometastatic disease. The aim of the present guidelines is to review the role of radiotherapy in the treatment of localized, locally-advanced, and metastatic NSCLC. We review the main radiotherapy techniques and clarify the role of radiotherapy in routine clinical practice. These guidelines are based on the best available evidence. The level and grade of evidence supporting each recommendation is provided.
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Affiliation(s)
- Núria Rodríguez De Dios
- Department of Radiation Oncology, Hospital del Mar, Barcelona 08003, Spain
- Radiation Oncology Research Group, Hospital Del Mar Medical Research Institution, Barcelona 08003, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona 08003, Spain
| | - Arturo Navarro-Martin
- Department of Radiation Oncology, Thoracic Malignancies Unit, Hospital Duran i Reynals. ICO, L´Hospitalet de L, Lobregat 08908, Spain
| | - Cristina Cigarral
- Department of Radiation Oncology, Hospital Clínico de Salamanca, Salamanca 37007, Spain
| | - Rodolfo Chicas-Sett
- Department of Radiation Oncology, ASCIRES Grupo Biomédico, Valencia 46004, Spain
| | - Rafael García
- Department of Radiation Oncology, Hospital Ruber Internacional, Madrid 28034, Spain
| | - Virginia Garcia
- Department of Radiation Oncology, Hospital Universitario Arnau de Vilanova, Lleida 25198, Spain
| | | | - Susana Gonzalo
- Department of Radiation Oncology, Hospital Universitario La Princesa, Madrid 28006, Spain
| | - Mauricio Murcia-Mejía
- Department of Radiation Oncology, Hospital Universitario Sant Joan de Reus, Reus 43204, Tarragona, Spain
| | - Rogelio Robaina
- Department of Radiation Oncology, Hospital Universitario Arnau de Vilanova, Lleida 25198, Spain
| | - Amalia Sotoca
- Department of Radiation Oncology, Hospital Ruber Internacional, Madrid 28034, Spain
| | - Carmen Vallejo
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - German Valtueña
- Department of Radiation Oncology, Hospital Clínico Universitario Lozano Blesa, Zaragoza 50009, Spain
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud, Madrid 28223, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
- Department of Clinical, Universidad Europea, Madrid 28670, Spain
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Ansar A, Lewis V, McDonald CF, Liu C, Rahman MA. Defining timeliness in care for patients with lung cancer: a scoping review. BMJ Open 2022; 12:e056895. [PMID: 35393318 PMCID: PMC8990712 DOI: 10.1136/bmjopen-2021-056895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Early diagnosis and reducing the time taken to achieve each step of lung cancer care is essential. This scoping review aimed to examine time points and intervals used to measure timeliness and to critically assess how they are defined by existing studies of the care seeking pathway for lung cancer. METHODS This scoping review was guided by the methodological framework for scoping reviews by Arksey and O'Malley. MEDLINE, EMBASE, CINAHL and PsycINFO electronic databases were searched for articles published between 1999 and 2019. After duplicate removal, all publications went through title and abstract screening followed by full text review and inclusion of articles in the review against the selection criteria. A narrative synthesis describes the time points, intervals and measurement guidelines used by the included articles. RESULTS A total of 2113 articles were identified from the initial search. Finally, 68 articles were included for data charting process. Eight time points and 14 intervals were identified as the most common events researched by the articles. Eighteen different lung cancer care guidelines were used to benchmark intervals in the included articles; all were developed in Western countries. The British Thoracic Society guideline was the most frequently used guideline (20%). Western guidelines were used by the studies in Asian countries despite differences in the health system structure. CONCLUSION This review identified substantial variations in definitions of some of the intervals used to describe timeliness of care for lung cancer. The differences in healthcare delivery systems of Asian and Western countries, and between high-income countries and low-income-middle-income countries may suggest different sets of time points and intervals need to be developed.
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Affiliation(s)
- Adnan Ansar
- School of Nursing and Midwifery, College of Science Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep (IBAS), Melbourne, Victoria, Australia
| | - Virginia Lewis
- School of Nursing and Midwifery, College of Science Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
- Australian Institute for Primary Care and Aging, La Trobe University, Bundoora, Victoria, Australia
| | - Christine Faye McDonald
- Institute for Breathing and Sleep (IBAS), Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Muhammad Aziz Rahman
- Institute for Breathing and Sleep (IBAS), Melbourne, Victoria, Australia
- Australian Institute for Primary Care and Aging, La Trobe University, Bundoora, Victoria, Australia
- School of Health, Federation University Australia, Berwick, Victoria, Australia
- Department of Noncommunicable Diseases, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
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Green J, Nath S, Semaan R. Recent Advances in Transbronchial Lung Cryobiopsy. CURRENT PULMONOLOGY REPORTS 2022. [DOI: 10.1007/s13665-022-00288-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Silva F, Pereira T, Neves I, Morgado J, Freitas C, Malafaia M, Sousa J, Fonseca J, Negrão E, Flor de Lima B, Correia da Silva M, Madureira AJ, Ramos I, Costa JL, Hespanhol V, Cunha A, Oliveira HP. Towards Machine Learning-Aided Lung Cancer Clinical Routines: Approaches and Open Challenges. J Pers Med 2022; 12:jpm12030480. [PMID: 35330479 PMCID: PMC8950137 DOI: 10.3390/jpm12030480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/28/2022] [Accepted: 03/10/2022] [Indexed: 12/15/2022] Open
Abstract
Advancements in the development of computer-aided decision (CAD) systems for clinical routines provide unquestionable benefits in connecting human medical expertise with machine intelligence, to achieve better quality healthcare. Considering the large number of incidences and mortality numbers associated with lung cancer, there is a need for the most accurate clinical procedures; thus, the possibility of using artificial intelligence (AI) tools for decision support is becoming a closer reality. At any stage of the lung cancer clinical pathway, specific obstacles are identified and “motivate” the application of innovative AI solutions. This work provides a comprehensive review of the most recent research dedicated toward the development of CAD tools using computed tomography images for lung cancer-related tasks. We discuss the major challenges and provide critical perspectives on future directions. Although we focus on lung cancer in this review, we also provide a more clear definition of the path used to integrate AI in healthcare, emphasizing fundamental research points that are crucial for overcoming current barriers.
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Affiliation(s)
- Francisco Silva
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
- FCUP—Faculty of Science, University of Porto, 4169-007 Porto, Portugal
- Correspondence: (F.S.); (T.P.)
| | - Tania Pereira
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
- Correspondence: (F.S.); (T.P.)
| | - Inês Neves
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
- ICBAS—Abel Salazar Biomedical Sciences Institute, University of Porto, 4050-313 Porto, Portugal
| | - Joana Morgado
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
| | - Cláudia Freitas
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
- FMUP—Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - Mafalda Malafaia
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
- FEUP—Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
| | - Joana Sousa
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
| | - João Fonseca
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
- FEUP—Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
| | - Eduardo Negrão
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
| | - Beatriz Flor de Lima
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
| | - Miguel Correia da Silva
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
| | - António J. Madureira
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
- FMUP—Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - Isabel Ramos
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
- FMUP—Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - José Luis Costa
- FMUP—Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- IPATIMUP—Institute of Molecular Pathology and Immunology of the University of Porto, 4200-135 Porto, Portugal
| | - Venceslau Hespanhol
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
- FMUP—Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - António Cunha
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
- UTAD—University of Trás-os-Montes and Alto Douro, 5001-801 Vila Real, Portugal
| | - Hélder P. Oliveira
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
- FCUP—Faculty of Science, University of Porto, 4169-007 Porto, Portugal
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Capaccione KM, Huang S, D'souza B, Leb J, Luk L, Goldstein J, May B, Deng A, Salvatore MM. Radiographic features of pneumonitis in patients treated with immunotherapy compared to traditional chemotherapy for non-small cell lung cancer. Clin Imaging 2022; 93:106-112. [DOI: 10.1016/j.clinimag.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 03/04/2022] [Accepted: 03/06/2022] [Indexed: 11/25/2022]
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Sesma J, Bolufer S, García-Valentín A, Embún R, López ÍJ, Moreno-Mata N, Jiménez U, Trancho FH, Martín-Ucar AE, Gallar J. Thoracoscopic segmentectomy versus lobectomy: A propensity score–matched analysis. JTCVS OPEN 2022; 9:268-278. [PMID: 36003470 PMCID: PMC9390783 DOI: 10.1016/j.xjon.2022.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 01/12/2022] [Indexed: 11/30/2022]
Abstract
Objectives The aim of this study is to compare the postoperative complications, perioperative course, and survival among patients from the multicentric Spanish Video-assisted Thoracic Surgery Group database who received video-assisted thoracic surgery lobectomy or video-assisted thoracic surgery anatomic segmentectomy. Methods From December 2016 to March 2018, a total of 2250 patients were collected from 33 centers. Overall analysis (video-assisted thoracic surgery lobectomy = 2070; video-assisted thoracic surgery anatomic segmentectomy = 180) and propensity score–matched adjusted analysis (video-assisted thoracic surgery lobectomy = 97; video-assisted thoracic surgery anatomic segmentectomy = 97) were performed to compare postoperative results. Kaplan–Meier and competing risks method were used to compare survival. Results In the overall analysis, video-assisted thoracic surgery anatomic segmentectomy showed a lower incidence of respiratory complications (relative risk, 0.56; confidence interval, 0.37-0.83; P = .002), lower postoperative prolonged air leak (relative risk, 0.42; 95% confidence interval, 0.23-0.78; P = .003), and shorter median postoperative stay (4.8 vs 6.2 days; P = .004) than video-assisted thoracic surgery lobectomy. After propensity score–matched analysis, prolonged air leak remained significantly lower in video-assisted thoracic surgery anatomic segmentectomy (relative risk, 0.33; 95% confidence interval, 0.12-0.89; P = .02). Kaplan–Meier and competing risk curves showed no differences during the 3-year follow-up (median follow-up in months: 24.4; interquartile range, 20.8-28.3) in terms of overall survival (hazard ratio, 0.73; 95% confidence interval, 0.45-1.7; P = .2), tumor progression–related mortality (subdistribution hazard ratio, 0.41; 95% confidence interval, 0.11-1.57; P = .2), and disease-free survival (subdistribution hazard ratio, 0.73; 95% confidence interval, 0.35-1.51; P = .4) between groups. Conclusions Video-assisted thoracic surgery segmentectomy showed results similar to lobectomy in terms of postoperative outcomes and midterm survival. In addition, a lower incidence of prolonged air leak was found in patients who underwent video-assisted thoracic surgery anatomic segmentectomy.
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Affiliation(s)
- Julio Sesma
- Thoracic Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
- Miguel Hernandez de Elche University, Alicante, Spain
- Address for reprints: Julio Sesma, MD, Pintor Baeza 12. 03013, Alicante, Spain.
| | - Sergio Bolufer
- Thoracic Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
- Miguel Hernandez de Elche University, Alicante, Spain
| | - Antonio García-Valentín
- Thoracic Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
- Miguel Hernandez de Elche University, Alicante, Spain
| | - Raúl Embún
- Cardiac Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Íker Javier López
- Thoracic Surgery Department, Hospital Universitario Miguel Servet and Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, Spain
| | - Nicolás Moreno-Mata
- Thoracic Surgery Department, Hospital Universitario de Donostia, San Sebastián-Donostia, Spain
| | - Unai Jiménez
- Thoracic Surgery Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Antonio Eduardo Martín-Ucar
- Thoracic Surgery Department, Hospital Clínico San Carlos, Madrid, Spain
- Thoracic Surgery Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Juana Gallar
- Miguel Hernandez de Elche University, Alicante, Spain
- Thoracic Surgery Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
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Romine PE, Sun Q, Fedorenko C, Li L, Tang M, Eaton KD, Goulart BHL, Martins RG. Impact of Diagnostic Delays on Lung Cancer Survival Outcomes: A Population Study of the US SEER-Medicare Database. JCO Oncol Pract 2022; 18:e877-e885. [PMID: 35119911 DOI: 10.1200/op.21.00485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Time from diagnosis to treatment has been associated with worse survival outcomes in non-small-cell lung cancer (NSCLC). However, little is known about the impact of delay in time to diagnosis. We aimed to evaluate the impact of time from radiographic suspicion to histologic diagnosis on survival outcomes using the US SEER-Medicare population database. METHODS We identified patients from the SEER-Medicare data set diagnosed with any stage NSCLC between January 1, 2011, and December 31, 2015, who received stage-appropriate treatment and had a computed tomography scan within 1 year of diagnosis. Time to confirmation was determined as the interval between most recent computed tomography imaging and date of histologic diagnosis. Our primary outcome was overall survival (OS). RESULTS In total, 10,824 eligible patients were identified. The median time to confirmation was 20 (range 0-363) days. Using multivariate Cox regression models, longer time to confirmation was associated with improved OS in all comers driven by stage IV patients after adjustment for age, sex, diagnosis year, histology, and comorbidity index. In a separate landmark analysis excluding patients deceased within 6 months of diagnosis, the association between time to diagnosis and survival was no longer evident. CONCLUSION Time to confirmation of NSCLC was inversely associated with OS in this US SEER population study. This association was lost when patients deceased within 6 months of diagnosis were excluded, suggesting that retrospective registry-claims databases may not be the optimal data source to study time to diagnosis as a quality metric because of the unaccounted confounding effects of tumor behavior. Prospective evaluations of clinically enriched data sources may better serve this purpose.
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Affiliation(s)
- Perrin E Romine
- Division of Medical Oncology, University of Washington, Seattle, WA
| | - Qin Sun
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Catherine Fedorenko
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Li Li
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Mariel Tang
- Georgetown University Law Center/Johns Hopkins Bloomberg School of Public Health, Washington, DC
| | - Keith D Eaton
- Division of Medical Oncology, University of Washington, Seattle, WA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Renato G Martins
- Division of Medical Oncology, University of Washington, Seattle, WA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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Wang J, Gong M, Fan X, Huang D, Zhang J, Huang C. Autophagy-related signaling pathways in non-small cell lung cancer. Mol Cell Biochem 2022; 477:385-393. [PMID: 34757567 DOI: 10.1007/s11010-021-04280-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/15/2021] [Indexed: 12/25/2022]
Abstract
Lung cancer is one of the most prevalent causes of morbidity and mortality in both men and women across the globe. The disease has a quiet phenotype at first, which leads to chronic tumor development. Non-small cell lung cancer (NSCLC) is the most common kind of lung cancer, accounting for 85 percent of all lung malignancies. Autophagy has been described as an intracellular "recycle bin" where damaged proteins and molecules are degraded. Autophagy regulation is mainly dependent on signaling pathways such as phosphoinositide 3-kinases (PI3K), AKT, and the mammalian target of rapamycin (mTOR). In the context of NSCLC, studies on these signaling pathways are inconsistent, but our literature review suggests that the inhibition of mTOR, PI3K/AKT, and epidermal growth factor receptor signaling pathways by different medications can active autophagy and inhibit NSCLC progression. In conclusion, signaling pathways related to autophagy are effective therapeutic approaches for the treatment of NSCLC.
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Affiliation(s)
- Jing Wang
- Department of Cancer Center, Fujian Medical University Xiamen Humanity Hospital, Xiamen City, 361006, Fujian Province, China
| | - Mei Gong
- Department of Cancer Center, Fujian Medical University Xiamen Humanity Hospital, Xiamen City, 361006, Fujian Province, China
| | - Xirong Fan
- Department of Cancer Center, Fujian Medical University Xiamen Humanity Hospital, Xiamen City, 361006, Fujian Province, China
| | - Dalu Huang
- Department of Cancer Center, Fujian Medical University Xiamen Humanity Hospital, Xiamen City, 361006, Fujian Province, China
| | - Jinshu Zhang
- Department of Cancer Center, Fujian Medical University Xiamen Humanity Hospital, Xiamen City, 361006, Fujian Province, China
| | - Cheng Huang
- Department of Cancer Center, Fujian Medical University Xiamen Humanity Hospital, Xiamen City, 361006, Fujian Province, China.
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Biciuşcă V, Popescu IAS, Traşcă DM, Olteanu1 M, Stan IS, Durand P, Camen GC, Bălteanu MA, Cazacu IM, Demetrian AD, Streba CT, Călăraşu C, Cioboată R, Cioboată R. Diagnosis of lung cancer by flexible fiberoptic bronchoscopy: a descriptive study. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2022; 63:369-381. [PMID: 36374142 PMCID: PMC9804073 DOI: 10.47162/rjme.63.2.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Flexible fiberoptic bronchoscopy (FFB) remains the most important minimally invasive method for the diagnosis of lung cancer (LC). We performed a retrospective study to assess the main endoscopic findings of malignant lung tumors in the large airways in a cohort of Romanian patients. The group consisted of 32 (84.21%) men and six (15.78%) women, with an average age of 64.63±6.07 years. The bronchoscopic examination allowed the detection and biopsy of 36 malignant lung tumors, and in two other cases, due to malignant atelectasis, the patients were sent to a Department of Thoracic Surgery, to perform the biopsy following the surgery. Histopathological (HP) examination revealed the presence of squamous cell carcinoma (SCC) in 19 (50%) patients, adenocarcinoma (ADC) in 11 (28.94%) patients and small cell lung cancer (SCLC) in eight (21.05%) patients. The macroscopic and microscopic analysis of the lung tumors showed that infiltrative forms were found in most cases (58.33%), followed by exophytic (mass) endobronchial lesions (22.22%) and mixed forms (19.44%). If most infiltrative forms were SCC (66.66%), the exophytic and mixed lesions were most frequently ADC (50% and 57.14%). The tumor lesions caused both malignant bronchial stenosis (57.89%) and malignant atelectasis (42.1%). The main mechanisms involved in bronchial malignant obstruction were endoluminal (50%), mixed (31.57%) and extraluminal (18.42%) mechanisms. In conclusion, FFB remains the main method of diagnosing LC in the large airways. The most common macroscopic appearance of lung tumors revealed by bronchoscopy was the infiltrative appearance. In half of our patients, the malignant bronchial obstruction was achieved by endoluminal mechanism. The most common pathological form found in our patients was the SCC, as described in half of the investigated patients.
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Affiliation(s)
- Viorel Biciuşcă
- Department of Internal Medicine, Department of Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania; ;
| | - Iulian Alin Silviu Popescu
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Diana Maria Traşcă
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Mihai Olteanu1
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Ionelia Sorina Stan
- Resident Physician, Department of Internal Medicine, Emergency County Hospital, Craiova, Romania
| | - Patricia Durand
- Resident Physician, Department of Internal Medicine, Filantropia Municipal Hospital, Craiova, Romania
| | - Georgiana-Cristiana Camen
- Department of Radiology and Medical Imaging, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Mara Amalia Bălteanu
- Department of Pneumology, Faculty of Medicine, Titu Maiorescu University, Romania
| | - Irina Mihaela Cazacu
- Department of Oncology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alin Dragoş Demetrian
- Department of Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Costin Teodor Streba
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Cristina Călăraşu
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Ramona Cioboată
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
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Selected Disorders of the Respiratory System. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Marshall T, Kalanjeri S, Almeida FA. Lung cancer staging, the established role of bronchoscopy. Curr Opin Pulm Med 2022; 28:17-30. [PMID: 34720099 DOI: 10.1097/mcp.0000000000000843] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Lung cancer is the leading cause of cancer-related deaths worldwide. In the absence of distant metastases, accurate mediastinal nodal staging determines treatment approaches to achieve most favourable outcomes for patients. Mediastinal staging differentiates N0/N1 disease from N2/N3 in surgical candidates. Likewise, presence of nodal involvement in nonsurgical candidates who are being considered for stereotactic body radiation therapy is also critical. This review article seeks to discuss the current options available for mediastinal staging in nonsmall cell lung cancer (NSCLC), particularly the role of bronchoscopy. RECENT FINDINGS Although several techniques are available to stage the mediastinum, bronchoscopy with EBUS-TBNA with or without EUS-FNA appears to be superior in most clinical situations based on its ability to concomitantly diagnose and stage at once, safety, accessibility to the widest array of lymph node stations, cost and low risk of complications. However, training and experience are required to achieve consistent diagnostic accuracy with EBUS-TBNA. SUMMARY EBUS-TBNA with or without EUS-FNA is considered the modality of choice in the diagnosis and staging of NSCLC in both surgical and nonsurgical candidates.
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Affiliation(s)
- Tanya Marshall
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, Ohio
| | - Satish Kalanjeri
- Pulmonary and Critical Care Medicine, Harry S. Truman Memorial Veterans Hospital
- Pulmonary and Critical Care Medicine, University of Missouri School of Medicine, Columbia, Missouri
| | - Francisco Aecio Almeida
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Cheng Y, Wang Q, Li K, Shi J, Wu L, Han B, Chen G, He J, Wang J, Qin H, Li X. Anlotinib for patients with small cell lung cancer and baseline liver metastases: A post hoc analysis of the ALTER 1202 trial. Cancer Med 2021; 11:1081-1087. [PMID: 34939373 PMCID: PMC8855912 DOI: 10.1002/cam4.4507] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/02/2021] [Accepted: 12/10/2021] [Indexed: 12/25/2022] Open
Abstract
Liver metastasis is common in advanced small cell lung cancer (SCLC). There is no evidence-proven treatment beyond the second line in patients with SCLC and liver metastasis. This study aimed to investigate survival in patients with SCLC and liver metastasis treated with anlotinib compared with placebo. This study was a post hoc analysis of the phase II ALTER 1202 trial, including patients who had liver metastasis at baseline. The participants were randomized 2:1 to receive either 12 mg/day anlotinib (anlotinib group) or placebo (placebo group). Tumor response, progression-free survival (PFS), and overall survival (OS) were compared. In the original trial, there were 39 participants with liver metastasis at baseline, including 27 and 12 in the anlotinib and placebo groups, respectively. The objective response rate was 3.7% and 0% in the anlotinib and placebo groups, respectively (p = 0.9999). An elevated disease control rate was found in the anlotinib group (44.4%) compared with the placebo group (8.3%, p = 0.0173). The median PFS was 1.51 vs. 0.71 months in favor of anlotinib (hazard ratio [HR] = 0.365, 95% confidence interval [CI]: 0.17-0.78; p = 0.0064), with no marked difference in median OS (3.29 vs. 1.91 months; HR = 0.51, 95% CI: 0.22-1.16; p = 0.0996). The most common AEs in the anlotinib group were hypertension (40.7%), fatigue (29.6%), loss of appetite (22.2%), and weight loss (22.2%). There were no grade 5 AE. In conclusion, anlotinib increased PFS compared with placebo in patients with SCLC and liver metastasis.
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Affiliation(s)
- Ying Cheng
- Department of Thoracic Medical Oncology, Jilin Cancer Hospital, Changchun, China
| | - Qiming Wang
- Department of Internal Medicine, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Kai Li
- Department of Pulmonary Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Jianhua Shi
- Department of Medical Oncology, Shandong Linyi Tumor Hospital, Linyi, China
| | - Lin Wu
- Department of Thoracic Medical Oncology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University (Hunan Cancer Hospital), Changsha, China
| | - Baohui Han
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Gongyan Chen
- Department of Respiratory Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jie Wang
- Department of Thoracic Medical Oncology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Haifeng Qin
- Department of Pulmonary Oncology, The Fifth Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Xiaoling Li
- Department of Medical Oncology, Liaoning Cancer Hospital, Shenyang, China
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Zhang J, Wu D, Zhang Z, Long J, Tian G, Wang Y, Ma X, Chen X, Han J, Hu W, Dai L, Nie J, Fang J. Pembrolizumab or Bevacizumab Plus Chemotherapy as First-Line Treatment of Advanced Nonsquamous Nonsmall Cell Lung Cancer: A Retrospective Cohort Study. Technol Cancer Res Treat 2021; 20:15330338211039676. [PMID: 34821175 PMCID: PMC8649085 DOI: 10.1177/15330338211039676] [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] [Indexed: 12/25/2022] Open
Abstract
Objective: Pembrolizumab and bevacizumab both have antitumor activity. According to NCCN updated guideline the benefit of pembrolizumab or bevacizumab as a first line in management of advanced nonsmall cell lung cancer (NSCLC) is documented in randomized controlled studies. The study aimed to evaluate the response and complications of patients with advanced NSCLC treated with pembrolizumab or bevacizumab plus chemotherapy. Methods: This study was a retrospective cohort study of patients with advanced nonsquamous NSCLC who received cisplatin with pemetrexed combined with pembrolizumab (A group) or bevacizumab (B group) from 07/02/2018 to 07/03/2021 at Peking University Cancer Hospital. Progression-free survival (PFS) was the primary outcome. The secondary outcomes included overall survival (OS), objective response rate (ORR), disease control rate (DCR), duration of response (DoR), and adverse events (AEs). Results: This study included 66 patients, 34 in A group and 32 in B group. There were no differences in median PFS (7.6 vs 9.9 months, P = .601). There were no differences in median OS (23.1 vs 24.2 months, P = .782). There were no differences in ORR (57.6% vs 41.9%, P = .211) and DCR (93.9% vs 100.0%, P = .164) between 2 groups. The occurrence of AEs was similar. No new safety signals were observed. Grade 3 to 4 treatment-related AEs occurred in 17 (50.0%) patients of A group and in 12 (37.5%) of B group (P > .05). Conclusion: The addition of pembrolizumab or bevacizumab to pemetrexed plus cisplatin was well tolerated and resulted in a clinically meaningful treatment benefit in advanced nonsquamous NSCLC. When pembrolizumab is not suitable, bevacizumab plus chemotherapy may be an option.
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Affiliation(s)
- Jie Zhang
- 12519Peking University Cancer Hospital & Institute, Beijing, China
| | - Di Wu
- 12519Peking University Cancer Hospital & Institute, Beijing, China
| | - Ziran Zhang
- 12519Peking University Cancer Hospital & Institute, Beijing, China
| | - Jieran Long
- 12519Peking University Cancer Hospital & Institute, Beijing, China
| | - Guangming Tian
- 12519Peking University Cancer Hospital & Institute, Beijing, China
| | - Yang Wang
- 12519Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiangjuan Ma
- 12519Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiaoling Chen
- 12519Peking University Cancer Hospital & Institute, Beijing, China
| | - Jindi Han
- 12519Peking University Cancer Hospital & Institute, Beijing, China
| | - Weiheng Hu
- 12519Peking University Cancer Hospital & Institute, Beijing, China
| | - Ling Dai
- 12519Peking University Cancer Hospital & Institute, Beijing, China
| | - Jun Nie
- 12519Peking University Cancer Hospital & Institute, Beijing, China
| | - Jian Fang
- 12519Peking University Cancer Hospital & Institute, Beijing, China
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Das Majumdar SK, Mahapatra BR, Muraleedharan A, Parida DK, Adhya AK. Response to Immunotherapy in Adenocarcinoma Lung With Gastric Metastasis: A Rare Case Report and Review of Literature. Cureus 2021; 13:e19790. [PMID: 34956782 PMCID: PMC8693547 DOI: 10.7759/cureus.19790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 11/05/2022] Open
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[Rapid outpatient diagnostic pathways for lung cancer: Evaluation after one year]. Rev Mal Respir 2021; 38:904-913. [PMID: 34756758 DOI: 10.1016/j.rmr.2021.07.005] [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: 12/03/2020] [Accepted: 07/28/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The introduction of coordinated care pathways for lung cancer diagnosis and treatment is a complex process. The purpose of the French Cancer Plan 2014-2019 was to improve referral to treatment waiting times in people with suspected malignancy. The aim of this study was to assess a rapid outpatient diagnostic program for lung cancer established in 2016. METHOD This retrospective study was carried out in the Pulmonology Department at Tenon Hospital, Paris, France between May 2016 and May 2017. RESULTS During this period, 118 patients (60%) of patients in the pathway were diagnosed with lung cancer. The median waiting time to first consultation (D1) was 4 (2-7) days. The median waiting time between diagnosis and treatment decision (D4) was 4 (0-8) days. The median waiting time to the first treatment (D5) was 10 (4-15) days for chemotherapy and 27 (16-34) days for surgery. The median waiting time between the first abnormal chest X-ray and the first treatment (D6) was 49 days (34-70). CONCLUSION Referral to treatment waiting times was consistent with international recommendations. Coordinating nurses improved care pathways in lung cancer patients.
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Liu Y, Cheng Y, Li K, Shi J, Liu Y, Wu L, Han B, Chen G, He J, Wang J, Qin H, Li X, Hamaji M, Park HS. Effect of prior thoracic radiotherapy on prognosis in relapsed small cell lung cancer patients treated with anlotinib: a subgroup analysis of the ALTER 1202 trial. Transl Lung Cancer Res 2021; 10:3793-3806. [PMID: 34733629 PMCID: PMC8512470 DOI: 10.21037/tlcr-21-632] [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: 05/28/2021] [Accepted: 09/01/2021] [Indexed: 12/24/2022]
Abstract
Background In ALTER 1202, anlotinib prolonged the progression-free survival (PFS) and overall survival (OS) of patients with relapsed small cell lung cancer (SCLC). The aim of this study was to explore the effect of front-line thoracic radiotherapy (RT) on the benefits of anlotinib as a third-line-or-beyond treatment. Methods This was a subgroup analysis of a multicenter, randomized, double-blind, placebo-controlled phase 2 trial (ALTER 1202). The participants were divided into RT (previous thoracic RT) and non-RT subgroups. The outcomes included PFS, OS, objective response rate (ORR), disease control rate (DCR), and safety. Results In the ALTER 1202 trial, 68 participants (anlotinib, n=46; placebo, n=22) received RT and 51 participants (anlotinib, n=35; placebo, n=16) did not. PFS was longer for anlotinib versus placebo in both the RT (5.49 vs. 0.69 months; P<0.001) and non-RT (2.83 vs. 0.76 months; P<0.001) subgroups. In the RT subgroup, the OS was longer for anlotinib vs. placebo (9.49 vs. 4.90 months; P=0.039). No differences were found in the ORR, but the DCR was higher in the anlotinib arm of the RT subgroup compared with the placebo arm (73.9% vs. 9.1%, P<0.001) and the non-RT subgroup (68.6% vs. 18.8%; P=0.002). Conclusions In relapsed SCLC patients with previous thoracic RT, anlotinib might have DCR, PFS, and OS benefits compared with placebo. In those without previous thoracic RT patients, anlotinib might have DCR and PFS benefits compared with placebo. The safety was similar between anlotinib and placebo groups.
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Affiliation(s)
- Yang Liu
- Department of Radiotherapy, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | | | - Kai Li
- Tianjin Medical University Cancer Hospital, Tianjin, China
| | | | - Ying Liu
- Jilin Cancer Hospital, Changchun, China
| | - Lin Wu
- Hunan Cancer Hospital, Changsha, China
| | - Baohui Han
- Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Gongyan Chen
- Harbin Medical University Cancer Hospital, Harbin, China
| | - Jianxing He
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jie Wang
- Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Haifeng Qin
- The Fifth Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Xiaoling Li
- Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Masatsugu Hamaji
- Department of General Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Henry S Park
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA
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Wang Z, Zhou C, Yang S. The roles, controversies, and combination therapies of autophagy in lung cancer. Cell Biol Int 2021; 46:3-11. [PMID: 34546599 DOI: 10.1002/cbin.11704] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/29/2021] [Accepted: 09/18/2021] [Indexed: 12/13/2022]
Abstract
Lung cancer is one of the leading causes of death among men and women worldwide. The disease initially has a silent phenotype, which leads to the progression of the disease and ultimately the lack of proper response to routine treatments. Autophagy, known as an intracellular "recycle bin" for the degradation of defective proteins and molecules, is one of the mechanisms that has been considered in the context of cancer in recent years. This study aims to provide a comprehensive review of published articles on autophagy in the context of lung cancer to have a complete view of the role of autophagy in lung cancer and its possible treatments. PubMed, Scopus, and Google Scholar were searched until June 15 to find related articles. No specific search filters or restrictions were applied. The results were entered into reference management software for aggregation and management. The full text of all articles was screened and studied. In conclusion, studies on the exact function of autophagy in lung cancer are contradictory, but what can be concluded from a review of literature on lung cancer is that targeting autophagy combined with traditional routine therapies such as chemotherapy, especially in advanced stages of lung cancer, can be an effective anticancer approach.
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Affiliation(s)
- Zijian Wang
- Department of Oncology, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Chunyang Zhou
- Department of Oncology, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, Jinan, Shandong, China.,Department of Clinical Medicine, Shandong University, Cheeloo College of Medicine, Jinan, Shandong, China
| | - Shengjie Yang
- Department of Phase I Clinical Trial Center, Capital Medical University, Beijing Shijitan Hospital, Beijing, China
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Zhang L, Hsieh MC, Rennert L, Neroda P, Wu XC, Hicks C, Wu J, Gimbel R. Diagnosis-to-surgery interval and survival for different histologies of stage I-IIA lung cancer. Transl Lung Cancer Res 2021; 10:3043-3058. [PMID: 34430346 PMCID: PMC8350104 DOI: 10.21037/tlcr-21-168] [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: 03/02/2021] [Accepted: 05/20/2021] [Indexed: 12/25/2022]
Abstract
Background Guidelines on timeliness of lung cancer surgery are inconsistent. Lung cancer histologic subtypes have different prognosis and treatment. It is important to understand the consequences of delayed surgery for each lung cancer histologic subtype. This study aimed to examine the association between diagnosis-to-surgery time interval and survival for early stage lung cancer and selected histologic subtypes. Methods Patients diagnosed with stage I–IIA lung cancer between 2004 and 2015 receiving definitive surgery and being followed up until Dec. 31, 2018, were identified from Surveillance, Epidemiology, and End Results database. Histologic subtypes included adenocarcinoma, squamous or epidermoid carcinoma, bronchioloalveolar carcinoma, large cell carcinoma, adenosquamous carcinoma, carcinoid carcinoma, and small cell carcinoma. Diagnosis-to-surgery interval was treated as multi-categorical variables (<1, 1–2, 2–3, and ≥3 months) and binary variables (≥1 vs. <1 month, ≥2 vs. <2 months, and ≥3 vs. <3 months). Outcomes included cancer-specific and overall survival. Covariates included age at diagnosis, sex, race, marital status, tumor size, grade, surgery type, chemotherapy, radiotherapy, and study period. Kaplan-Meier survival curves and Cox proportional hazards regression models were applied to examine the survival differences. Results With a median follow-up time of 51 months, a total of 40,612 patients were analyzed, including 40.1% adenocarcinoma and 24.5% squamous or epidermoid carcinoma. The proportion of patients receiving surgery <1, 1–2, 2–3, and ≥3 months from diagnosis were 34.2%, 33.9%, 19.8%, and 12.1%, respectively. Delayed surgery was associated with worse cancer-specific and overall survival for all lung cancers, adenocarcinoma, squamous or epidermoid, bronchioloalveolar, and large cell carcinoma (20–40% increased risk). Dose-dependent effects (longer delay, worse survival) were observed in all lung cancers, adenocarcinoma, and squamous and epidermoid carcinoma. No significant association between surgery delay and survival was observed in adenosquamous, carcinoid, and small cell carcinoma. Conclusions Our findings support the guidelines of undertaking surgery within 1 month from diagnosis in patients with stage I–IIA lung cancer. The observed dose-dependent effects emphasize the clinical importance of early surgery. Future studies with larger sample size of less frequent histologic subtypes are warranted to provide more evidence for histology-specific lung cancer treatment guidelines.
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Affiliation(s)
- Lu Zhang
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Mei-Chin Hsieh
- Louisiana Tumor Registry, School of Public Health Sciences, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Lior Rennert
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Paige Neroda
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Xiao-Cheng Wu
- Louisiana Tumor Registry, School of Public Health Sciences, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Chindo Hicks
- Genetic Department, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Jiande Wu
- Genetic Department, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Ronald Gimbel
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
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Zuniga PVS, Ost DE. Impact of Delays in Lung Cancer Treatment on Survival. Chest 2021; 160:1934-1958. [PMID: 34425080 DOI: 10.1016/j.chest.2021.08.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/08/2021] [Accepted: 08/10/2021] [Indexed: 12/25/2022] Open
Abstract
Timely care is an important dimension of health care quality, but the impact of delays in care on lung cancer outcomes is unclear. Quantifying the impact of delays in cancer treatment on survival is necessary to inform resource allocation, quality improvement initiatives, and lung cancer guidelines. Review of the available literature demonstrated significant heterogeneity between studies in terms of the impact of delay. Frequently paradoxical results were reported, with delay being associated with improved survival in patients with advanced disease. However, significant methodologic flaws were identified in many studies, which probably is the reason for the paradoxical results. The most significant methodologic limitations identified were incorrectly controlling for final pathologic stage (a mediator in the causal chain from delay to survival), failure to control for confounding by acuity of cancer presentation, and failure to consider effect measure modification. The effect of delay on survival probably varies by stage. The impact of delays is lowest for subcentimeter nodules, probably highest in stage II disease, and low in patients who are only eligible for palliative care. Precise quantification of the impact of delay is not currently possible. Given the available evidence, quality metrics for the timeliness of lung cancer care should focus on local barriers to care. These metrics should be carefully designed to take into account clinical-radiographic stage at initial presentation.
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Affiliation(s)
- Paula Valeria Sainz Zuniga
- The University of Texas MD Anderson Cancer Center, Houston, TX; Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, Mexico
| | - David E Ost
- The University of Texas MD Anderson Cancer Center, Houston, TX.
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Bi L, Zhang H, Ge M, Lv Z, Deng Y, Rong T, Liu C. Intrapulmonary lymph node (stations 13 and 14) metastasis in peripheral non-small cell lung cancer. Medicine (Baltimore) 2021; 100:e26528. [PMID: 34232188 PMCID: PMC8270592 DOI: 10.1097/md.0000000000026528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 06/14/2021] [Indexed: 01/04/2023] Open
Abstract
It remains unknown whether dissecting the intrapulmonary lymph nodes (stations 13 and 14) when resecting peripheral non-small cell lung cancer (NSCLC) is necessary for accurate tumor node metastasis (TNM) staging. This study investigated intrapulmonary lymph node dissection (stations 13 and 14) on the pathological staging of peripheral NSCLC and the metastatic pattern of the lymph nodes.This retrospective study included patients with primary peripheral NSCLC who underwent radical dissection between January 2013 and December 2015. The clinical data of patients and examination results of intrapulmonary stations 12, 13, and 14 lymph nodes were analyzed.Of 3019 resected lymph nodes in a total of 234 patients (12.9/patient), 263 (8.7%) had metastasis. Ninety-nine patients had lymph node metastasis (42.3%): 40 (17.1%) were N1, 11 (4.7%) were N2, 48 (20.5%) were both N1 and N2, and 135 (57.7%) had no N1 or N2 metastasis. Sixteen (6.8%) patients had metastasis of stations 13 and/or 14. Metastasis in N1 positive patients of stations 10, 11, 12, 13, and 14 were 2.7%, 10.5%, 9.8%, 10.4%, and 8.5%, respectively. Missed detection without station 13 and 14 dissection was up to 6.8% (16/234).Dissection of stations 13 and 14 could be helpful for the identification of lymph node metastasis and for the accurate TNM staging of primary NSCLC.
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Affiliation(s)
- Lei Bi
- Department of Thoracic Surgery
| | - Hong Zhang
- Department of Traditional Chinese Medicine, The Bishan Hospital of Chongqing
| | - Mingjian Ge
- Department of Thoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing City, China
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Núñez ER, Caverly TJ, Zhang S, Glickman ME, Qian SX, Boudreau JH, Slatore CG, Miller DR, Wiener RS. Adherence to Follow-up Testing Recommendations in US Veterans Screened for Lung Cancer, 2015-2019. JAMA Netw Open 2021; 4:e2116233. [PMID: 34236409 PMCID: PMC8267608 DOI: 10.1001/jamanetworkopen.2021.16233] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Lung cancer screening (LCS) can reduce lung cancer mortality with close follow-up and adherence to management recommendations. Little is known about factors associated with adherence to LCS in real-world practice, with data limited to case series from selected LCS programs. OBJECTIVE To analyze adherence to follow-up based on standardized follow-up recommendations in a national cohort and to identify factors associated with delayed or absent follow-up. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted in Veterans Health Administration (VHA) facilities across the US. Veterans were screened for lung cancer between 2015 to 2019 with sufficient follow-up time to receive recommended evaluation. Patient- and facility-level logistic regression analyses were performed. Data were analyzed from November 26, 2019, to December 16, 2020. MAIN OUTCOMES AND MEASURES Receipt of the recommended next step after initial LCS according to Lung CT Screening Reporting & Data System (Lung-RADS) category, as captured in VHA or Medicare claims. RESULTS Of 28 294 veterans (26 835 [94.8%] men; 21 969 individuals [77.6%] were White; mean [SD] age, 65.2 [5.5] years) who had an initial LCS examination, 17 863 veterans (63.1%) underwent recommended follow-up within the expected timeframe, whereas 3696 veterans (13.1%) underwent late evaluation, and 4439 veterans (15.7%) had no apparent evaluation. Facility-level differences were associated with 9.2% of the observed variation in rates of late or absent evaluation. In multivariable-adjusted models, Black veterans (odds ratio [OR], 1.19 [95% CI, 1.10-1.29]), veterans with posttraumatic stress disorder (OR, 1.13 [95% CI, 1.03-1.23]), veterans with substance use disorders (OR, 1.11 [95% CI, 1.01-1.22]), veterans with lower income (OR, 0.88 [95% CI, 0.79-0.98]), and those living at a greater distance from a VHA facility (OR, 1.06 [95% CI, 1.02-1.10]) were more likely to experience delayed or no follow-up; veterans with higher risk findings (Lung-RADS category 4 vs Lung-RADS category 1: OR, 0.35 [95% CI, 0.28-0.43]) and those screened in high LCS volume facilities (OR, 0.38 [95% CI, 0.21-0.67]) or academic facilities (OR, 0.86 [95% CI, 0.80-0.92]) were less likely to experience delayed or no follow-up. In sensitivity analyses, varying how stringently adherence was defined, expected evaluation ranged from 14 486 veterans (49.7%) under stringent definitions to 20 578 veterans (78.8%) under liberal definitions. CONCLUSIONS AND RELEVANCE In this cohort study that captured follow-up care from the integrated VHA health care system and Medicare, less than two-thirds of patients received timely recommended follow-up after initial LCS, with higher risk of delayed or absent follow-up among marginalized populations, such as Black individuals, individuals with mental health disorders, and individuals with low income, that have long experienced disparities in lung cancer outcomes. Future work should focus on identifying facilities that promote high adherence and disseminating successful strategies to promote equity in LCS among marginalized populations.
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Affiliation(s)
- Eduardo R. Núñez
- Center for Healthcare Organization & Implementation Research, Bedford VA Healthcare System, Bedford, Massachusetts
- The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
| | - Tanner J. Caverly
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- University of Michigan School of Medicine, Ann Arbor
| | - Sanqian Zhang
- Center for Healthcare Organization & Implementation Research, Bedford VA Healthcare System, Bedford, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
- Department of Statistics, Harvard University, Cambridge, Massachusetts
| | - Mark E. Glickman
- Center for Healthcare Organization & Implementation Research, Bedford VA Healthcare System, Bedford, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
- Department of Statistics, Harvard University, Cambridge, Massachusetts
| | - Shirley X. Qian
- Center for Healthcare Organization & Implementation Research, Bedford VA Healthcare System, Bedford, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
| | - Jacqueline H. Boudreau
- Center for Healthcare Organization & Implementation Research, Bedford VA Healthcare System, Bedford, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
| | - Christopher G. Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon
- Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland
| | - Donald R. Miller
- Center for Healthcare Organization & Implementation Research, Bedford VA Healthcare System, Bedford, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
| | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, Bedford VA Healthcare System, Bedford, Massachusetts
- The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
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Phillips WW, Copeland J, Hofferberth SC, Armitage JR, Fox S, Kruithoff M, de Forcrand C, Catalano PJ, Lathan CS, Weissman JS, Odell DD, Colson YL. Lung Cancer Strategist Program: A novel care delivery model to improve timeliness of diagnosis and treatment in high-risk patients. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2021; 9:100563. [PMID: 34186305 DOI: 10.1016/j.hjdsi.2021.100563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 03/30/2021] [Accepted: 06/08/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The diagnosis and treatment of lung cancer is challenged by complex diagnostic pathways and fragmented care that can lead to care disparities for vulnerable patients. METHODS A multi-institutional, multidisciplinary conference was convened to address the complexity of lung cancer care particularly in patients at high-risk for treatment delay. The resulting care delivery model, called the Lung Cancer Strategist Program (LCSP), was led by a thoracic-trained advanced practice provider (APP) with emphasis on expedited surgery and early oncologic consultation in the assessment of a newly diagnosed suspicious lung nodule. We performed a retrospective review to evaluate care efficiency and oncologic outcomes in the first 100 LCSP patients compared to 100 concurrent patients managed via routine surgical referral. RESULTS In the 78 LCSP and 41 routine referral patients managed via nodule surveillance, LCSP patients had a shorter time from suspicious finding to work-up (3 vs. 26 days, p < 0.001) and to surveillance decision (12.5 vs. 39 days, p < 0.001). In the 22 LCSP and 59 routine referral patients treated for intrathoracic malignancy, LCSP patients had fewer hospital visits (4 vs 6, p < 0.001), clinicians seen (1.5 vs. 2, p = 0.08), and diagnostic studies (4 vs 5, p = 0.01) with a shorter time to diagnosis (30.5 vs. 48 days, p = 0.02) and treatment (40.5 vs. 68.5 days, p = 0.02). CONCLUSIONS Patient triage through a thoracic-trained APP in consultation with surgical, medical, and radiation oncology facilitates rapid assessment of benign versus malignant lesions with reduced time to diagnosis and treatment, even among patients at high-risk for treatment delay.
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Affiliation(s)
- William W Phillips
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica Copeland
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sophie C Hofferberth
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Julee R Armitage
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sam Fox
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Margaret Kruithoff
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Claire de Forcrand
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul J Catalano
- Department of Biostatistics & Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - Joel S Weissman
- JSW - Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - David D Odell
- Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Yolonda L Colson
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Stokstad T, Sørhaug S, Amundsen T, Grønberg BH. Associations Between Time to Treatment Start and Survival in Patients With Lung Cancer. In Vivo 2021; 35:1595-1603. [PMID: 33910841 DOI: 10.21873/invivo.12416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/11/2021] [Accepted: 03/18/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Time-to-treatment is defined as a quality indicator for cancer care but is not well documented. We investigated whether meeting Norwegian timeframes of 35/42 days from referral until start of chemotherapy or surgery/radiotherapy for lung cancer was associated with survival. PATIENTS AND METHODS The medical records of 439 lung cancer patients at a regional cancer center were reviewed and categorized according to treatment: (i) surgery; ii) radical radiotherapy; iii) stereotactic radiotherapy; iv) palliative treatment, no cancer symptoms; v) palliative treatment with severe cancer symptoms). RESULTS Proportions receiving timely treatment varied significantly at 39%, 48%, 10%, 44% and 89%, respectively (p<0.001). Overall, those starting treatment on time had the shortest median overall survival (10.6 vs. 22.6 months; p<0.001). This was also the case for palliative (5.3 vs. 11.4 months) (p<0.001) but not for curative treatment (not reached vs. 38.3 months) (p=0.038). CONCLUSION Timely treatment is not necessarily associated with improved survival.
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Affiliation(s)
- Trine Stokstad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Gynecology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sveinung Sørhaug
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Thoracic Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tore Amundsen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Thoracic Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Bjørn H Grønberg
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; .,Department of Oncology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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An Audit of CT Chest Reports and Their Potential Impact on the Workup of Patients with Suspected Lung Cancer. Can Respir J 2021; 2021:6647087. [PMID: 34194587 PMCID: PMC8203401 DOI: 10.1155/2021/6647087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background Quality gaps exist in the diagnostic evaluation of lung cancer patients. The initial CT chest guides the workup of patients with suspected lung cancer. We sought to determine how frequently CT reports provided guideline-concordant recommendations with regard to additional imaging studies and/or invasive diagnostic procedures. Methods. This was a retrospective study. The records of patients referred for investigation of suspected lung cancer between January 1, 2015, and June 30, 2016, were reviewed. Patients with confirmed lung cancer, for whom CT scan images and reports were available, are included. CT reports were reviewed, with attention to additional imaging studies and/or invasive diagnostic procedures suggested. These recommendations were examined against current guidelines for lung cancer diagnosis and staging, based on suspected disease stage. Results One hundred forty-six patients are included in the analysis. Most patients were diagnosed with non-small-cell lung cancer (NSCLC), and 63% had advanced disease (stages III and IV). Only 12% of CT reports contained guideline-concordant recommendations for additional imaging studies, with PET scan suggested in only 6% of reports. Potential invasive diagnostic procedures were suggested in one fifth of CT reports, and only 58% of these recommendations were in keeping with current guidelines. In particular, transthoracic needle aspiration (TTNA) was suggested in 26% of patients despite advanced stage disease. Conclusion Guideline-concordant recommendations for investigation of suspected lung cancer are rarely available on CT reports. This is true with respect to both imaging studies and invasive diagnostic procedures. Incorporation of more evidence-based suggestions may reduce quality gaps in lung cancer diagnosis and staging.
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Shaller BD, Almeida FA. "I Now Walk Into the Wild": Atelectasis During Peripheral Bronchoscopy Under General Anesthesia. Chest 2021; 158:2268-2269. [PMID: 33280747 DOI: 10.1016/j.chest.2020.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/10/2020] [Indexed: 10/22/2022] Open
Affiliation(s)
- Brian D Shaller
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA
| | - Francisco A Almeida
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
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Lopci E, Kobe C, Gnanasegaran G, Adam JA, de Geus-Oei LF. "PET/CT Variants and Pitfalls in Lung Cancer and Mesothelioma". Semin Nucl Med 2021; 51:458-473. [PMID: 33993985 DOI: 10.1053/j.semnuclmed.2021.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
2-deoxy-2-[18F]fluoro-D-glucose [18F]FDG-PET/CT represents the metabolic imaging of choice in various cancer types. Used either at diagnosis or during treatment response assessment, the modality allows for a more accurate definition of tumor extent compared to morphological imaging and is able to predict the therapeutic benefit earlier in time. Due to the aspecific uptake property of [18F]FDG there is an overlap of its distribution in normal and pathological conditions, which can make the interpretation of the imaging challenging. Lung and pleural neoplasia are no exception to this, thus acknowledging of possible pitfalls and artifacts are mandatory for image interpretation. While most pitfalls and artifacts are common for all indications with metabolic imaging with [18F]FDG-PET/CT, there are specific variants and pitfalls in lung cancer and malignant pleural mesothelioma. The aim of the present article is to shed light on the most frequent and relevant variants and pitfalls in [18F]FDG-PET/CT imaging in lung cancer and malignant pleural mesothelioma.
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Affiliation(s)
- Egesta Lopci
- Nuclear Medicine, IRCCS - Humanitas Research Hospital, Rozzano MI, Italy.
| | - Carsten Kobe
- Department of Nuclear Medicine, University Hospital and Medical Faculty, University of Cologne, Cologne, University of Cologne, Cologne, Germany
| | | | - Judit A Adam
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, AMS, the Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands
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Carbonelli C, Rossi A, Ciliberti G, Grimaldi MA, Notarangelo S, Parente P, Copetti M, Zanforlin A, Lococo F, Taurchini M, Maiello E, De Cosmo S, Graziano P. Which are the limiting factors in lung tissue sampling and diagnostic accuracy for a new Interventional Pulmonology Unit? From expert consensus-based evidence to results of a new-born Unit. J Thorac Dis 2021; 13:2942-2951. [PMID: 34164185 PMCID: PMC8182518 DOI: 10.21037/jtd-20-2990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background There is a gap of knowledge about the factors that may determine the quality and the accuracy of diagnostic bronchoscopic procedures when setting up a new Interventional Pulmonology Unit. As little evidence-based medicine is available on this matter, an online consensus opinion of experts was gathered and compared with real-life data coming from a new Interventional Pulmonology (IP) Unit. Methods A survey was emailed to the heads of all Italian IP Units to investigate the factors influencing the success of the diagnostic yield of a new IP Unit. The survey consisted of 24 items grouped by topic; the level of agreement ranged from 1 (no influence) to 7 (strong influence). After responses were collected, we submitted the data on the accuracy of the endoscopic procedures performed during the first two years of our new IP Unit to the attention of the participants for a second round of survey; the level of consistency between the first and second round of responses was assessed. Results After having been shown the results of the first two years of activity of our Unit, in the second round of the survey the responders indicated the personal skills of the Interventional Pulmonologist, the availability of echoendoscopic technology and the expertise in evaluating cytological samples as the factors able to positively influence the performance of a newly established IP Unit. Neither the role of dedicated nursing assistance, the availability of a rapid on-site evaluation, nor the presence of anesthesiology assistance were considered to be limiting factors for the final accuracy results. Conclusions A consensus of opinion of a group of expert interventional pulmonologists highlighted the factors that may be responsible for the diagnostic success of a newly established Italian IP Unit. These factors are mainly three: personal skills of the interventional pulmonologist, the availability of echoendoscopic technology, and the expertise in reading cytological samples.
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Affiliation(s)
- Cristiano Carbonelli
- Department of Medical Sciences, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, (FG), Italy
| | - Antonio Rossi
- Oncology Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, (FG), Italy
| | - Gianluca Ciliberti
- Department of Medical Sciences, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, (FG), Italy
| | - Maria Arcangela Grimaldi
- Department of Medical Sciences, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, (FG), Italy
| | - Stefano Notarangelo
- Department of Medical Sciences, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, (FG), Italy
| | - Paola Parente
- Pathology Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, (FG), Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, (FG), Italy
| | | | - Filippo Lococo
- Department of Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Taurchini
- Thoracic Surgery Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, (FG), Italy
| | - Evaristo Maiello
- Oncology Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, (FG), Italy
| | - Salvatore De Cosmo
- Department of Medical Sciences, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, (FG), Italy
| | - Paolo Graziano
- Pathology Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, (FG), Italy
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Martinez-Zayas G, Almeida FA, Yarmus L, Steinfort D, Lazarus DR, Simoff MJ, Saettele T, Murgu S, Dammad T, Duong DK, Mudambi L, Filner JJ, Molina S, Aravena C, Thiboutot J, Bonney A, Rueda AM, Debiane LG, Hogarth DK, Bedi H, Deffebach M, Sagar AES, Cicenia J, Yu DH, Cohen A, Frye L, Grosu HB, Gildea T, Feller-Kopman D, Casal RF, Machuzak M, Arain MH, Sethi S, Eapen GA, Lam L, Jimenez CA, Ribeiro M, Noor LZ, Mehta A, Song J, Choi H, Ma J, Li L, Ost DE. Predicting Lymph Node Metastasis in Non-small Cell Lung Cancer: Prospective External and Temporal Validation of the HAL and HOMER Models. Chest 2021; 160:1108-1120. [PMID: 33932466 DOI: 10.1016/j.chest.2021.04.048] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Two models, the Help with the Assessment of Adenopathy in Lung cancer (HAL) and Help with Oncologic Mediastinal Evaluation for Radiation (HOMER), were recently developed to estimate the probability of nodal disease in patients with non-small cell lung cancer (NSCLC) as determined by endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA). The objective of this study was to prospectively externally validate both models at multiple centers. RESEARCH QUESTION Are the HAL and HOMER models valid across multiple centers? STUDY DESIGN AND METHODS This multicenter prospective observational cohort study enrolled consecutive patients with PET-CT clinical-radiographic stages T1-3, N0-3, M0 NSCLC undergoing EBUS-TBNA staging. HOMER was used to predict the probability of N0 vs N1 vs N2 or N3 (N2|3) disease, and HAL was used to predict the probability of N2|3 (vs N0 or N1) disease. Model discrimination was assessed using the area under the receiver operating characteristics curve (ROC-AUC), and calibration was assessed using the Brier score, calibration plots, and the Hosmer-Lemeshow test. RESULTS Thirteen centers enrolled 1,799 patients. HAL and HOMER demonstrated good discrimination: HAL ROC-AUC = 0.873 (95%CI, 0.856-0.891) and HOMER ROC-AUC = 0.837 (95%CI, 0.814-0.859) for predicting N1 disease or higher (N1|2|3) and 0.876 (95%CI, 0.855-0.897) for predicting N2|3 disease. Brier scores were 0.117 and 0.349, respectively. Calibration plots demonstrated good calibration for both models. For HAL, the difference between forecast and observed probability of N2|3 disease was +0.012; for HOMER, the difference for N1|2|3 was -0.018 and for N2|3 was +0.002. The Hosmer-Lemeshow test was significant for both models (P = .034 and .002), indicating a small but statistically significant calibration error. INTERPRETATION HAL and HOMER demonstrated good discrimination and calibration in multiple centers. Although calibration error was present, the magnitude of the error is small, such that the models are informative.
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Affiliation(s)
- Gabriela Martinez-Zayas
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Lonny Yarmus
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD
| | - Daniel Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Donald R Lazarus
- Department of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX
| | - Michael J Simoff
- Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI
| | - Timothy Saettele
- Department of Pulmonary Disease and Critical Care Medicine, Saint Luke's Hospital of Kansas City, Kansas City, MO
| | - Septimiu Murgu
- Division of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL
| | - Tarek Dammad
- Department of Pulmonary Medicine, University of New Mexico, Albuquerque, NM; Department of Pulmonary and Critical Care Medicine, CHRISTUS St. Vincent Medical Center, Santa Fe, NM
| | - D Kevin Duong
- Department of Pulmonary, Allergy and Critical Care Medicine, Stanford University Medical Center and School of Medicine, Stanford, CA
| | - Lakshmi Mudambi
- Division of Pulmonary and Critical Care, VA Portland Health Care System, Oregon Health and Science University, Portland, OR
| | - Joshua J Filner
- Department of Pulmonary Medicine, Northwest Permanente and The Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Sofia Molina
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carlos Aravena
- Department of Respiratory Diseases, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Jeffrey Thiboutot
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD
| | - Asha Bonney
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - Adriana M Rueda
- Department of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX
| | - Labib G Debiane
- Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI
| | - D Kyle Hogarth
- Division of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL
| | - Harmeet Bedi
- Department of Pulmonary, Allergy and Critical Care Medicine, Stanford University Medical Center and School of Medicine, Stanford, CA
| | - Mark Deffebach
- Division of Pulmonary and Critical Care, VA Portland Health Care System, Oregon Health and Science University, Portland, OR
| | - Ala-Eddin S Sagar
- Department of Pulmonary Medicine, Banner MD Anderson Cancer Center, Gilbert, AZ
| | - Joseph Cicenia
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
| | - Diana H Yu
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Avi Cohen
- Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI
| | - Laura Frye
- Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin, Madison, WI
| | - Horiana B Grosu
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Thomas Gildea
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
| | - David Feller-Kopman
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD
| | - Roberto F Casal
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Machuzak
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
| | - Muhammad H Arain
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sonali Sethi
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
| | - George A Eapen
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Louis Lam
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
| | - Carlos A Jimenez
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Manuel Ribeiro
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
| | - Laila Z Noor
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Atul Mehta
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
| | - Juhee Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Humberto Choi
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
| | - Junsheng Ma
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David E Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Kukhon FR, Lan X, Helgeson SA, Arunthari V, Fernandez-Bussy S, Patel NM. Occult lymph node metastasis in radiologic stage I non-small cell lung cancer: The role of endobronchial ultrasound. CLINICAL RESPIRATORY JOURNAL 2021; 15:676-682. [PMID: 33630405 DOI: 10.1111/crj.13344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/19/2021] [Indexed: 12/25/2022]
Abstract
RATIONALE The use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is currently recommended for staging non-small cell lung cancer (NSCLC) in centrally located tumors, tumors >3 cm, or with radiologic evidence of lymph node (LN) metastasis. Current guidelines do not recommend staging EBUS-TBNA in patients with stage I NSCLC who do not have any of the aforementioned conditions. OBJECTIVE We hypothesize that using EBUS-TBNA is useful for detecting occult metastasis in radiologic stage I NSCLC. METHODS In this single-center, retrospective study, charts of patients ≥18 years old who underwent staging EBUS-TBNA from January 2005 to May 2019 were reviewed. Only patients with combined positron-emission tomography and computed tomography (PET/CT) scans consistent with radiologic stage I NSCLC were included. Identified variables included: age, gender, personal history of any cancer, smoking history, tumor location, tumor centrality, tumor size, tumor PET activity, histopathologic type of NSCLC, and LN biopsy results. Patients whose LN samples showed a diagnosis other than NSCLC were excluded. The association between LN positivity, and each of the variables was assessed using Pearson's correlation for categorical variables, and logistic regression analysis for continuous variables. RESULTS From the 2,892 initially screened patients, 188 were included. Of those, 13 (6.9%; 95% CI, 4%-11%) had a malignancy-positive LN biopsy. The number needed to test (NNT) in order to detect one case of any occult metastasis was 15. Among the included variables, a significant association was found between LN positivity and tumor centrality, with central tumors found in 61.5% of patients with positive LN (n = 8) (p < 0.01). This association stayed significant after adjusting for age, gender, smoking history, tumor size, tumor location, and PET activity (p = 0.015). Among patients with malignancy-positive LN biopsies, five (38.5%; 95% CI, 17.6%-64.6%) were upstaged to N1, and eight (61.5%; 95% CI, 35.4%-82.4%) were upstaged to N2, with NNT of 23 to detect one case of occult N2 metastasis. Subgroup analysis comparing LN-positive patients based on their N stage did not show statistically significant association with any of the variables. CONCLUSION Based on our results and along with the existing evidence, EBUS-TBNA should be recommended as part of the routine staging in all patients with radiologic stage I NSCLC.
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Affiliation(s)
- Faeq R Kukhon
- Department of Pulmonary Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Xinyue Lan
- Department of Biology, Zanvyl Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Scott A Helgeson
- Department of Pulmonary Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Vichaya Arunthari
- Department of Pulmonary Medicine, Mayo Clinic, Jacksonville, FL, USA
| | | | - Neal M Patel
- Department of Pulmonary Medicine, Mayo Clinic, Jacksonville, FL, USA
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Apthorp C, Kirisnathas S, Stavrakas N, Warakagoda I, Crooks S, Mukherjee J. Assessment of serum calcium in -patients referred for suspected lung cancer: A quality -improvement project to enhance patient safety in clinical practice. Future Healthc J 2021; 8:e109-e112. [PMID: 33791487 PMCID: PMC8004297 DOI: 10.7861/fhj.2020-0068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Hypercalcaemia is a serious complication of lung cancer. A quality improvement project (QIP) was designed based on guidance from the American College of Chest Physician and the European Respiratory Society who recommend measuring serum calcium for patients referred with suspected lung cancer. METHOD Seventy-two patients were included in the initial data to ascertain the delay between referral to the lung cancer pathway and obtaining serum calcium levels as part of the initial work-up. New data were then collected after each intervention (including presentations at weekly respiratory multidisciplinary team meetings, posters within clinical areas and a hospital trust screensaver) to evaluate the delay. RESULTS Initially, 11.1% (n=8) did not have serum calcium measured at any point; two of which had lung cancer (including one metastatic malignancy). Of those who had serum calcium measured, there was a median delay of 13 days between first suspicion and obtaining serum calcium. After all the interventions were put in place, patients had a median of 7 days' delay (p=0.001). CONCLUSION This QIP design was based on continued feedback to improve the care of patients suspected of lung cancer. Although there was a significant reduction in delays post-intervention, increasing awareness in the community is suggested to maintain these improvements.
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Dziedzic R, Marjański T, Rzyman W. A narrative review of invasive diagnostics and treatment of early lung cancer. Transl Lung Cancer Res 2021; 10:1110-1123. [PMID: 33718049 PMCID: PMC7947400 DOI: 10.21037/tlcr-20-728] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The diagnosis and treatment of early-stage lung cancer remains a clinical challenge. The broadening implementation of lung cancer screening has resulted in positive findings in numerous patients that are mostly non-malignant. Many other patients have indeterminate nodules that are difficult to assess through simple observation. The critical interpretation of such screening results remains a challenge for radiologists and multidisciplinary teams involved in screening for lung cancer. The evaluation and diagnosis of each participant suspected for malignancy should be based on the basic clinical principles such as a carefully collected medical history, physical examination, and detailed analysis of all imaging tests performed. Indeed, the decision to go ahead with more invasive diagnostics requires consideration of the both the risks and benefits, with reflection upon the complete clinical and radiological picture. Although transthoracic needle aspiration biopsy remains the first-choice method of diagnosis, several newer technologies have slowly begun to emerge as potential replacements. The guiding strategy for method selection is to choose the least harmful approach that offers the most relevant potential insights. Transthoracic biopsy is an effective method that allows the collection of cytological and tissue material from small, peripheral tumors, but it carries a moderate risk of complications. Bronchofiberoscopy, especially in combination with electromagnetic navigation, fluoroscopy or radial EBUS, also allows effective diagnosis of the peripheral pulmonary nodules. One of the most important diagnostic methods is the EBUS examination, which allows determining of staging in addition to diagnosis. Anatomical lung lobe resection and lymphadenectomy or sampling of the hilar and mediastinal lymph nodes is currently the treatment of choice for patients with stage I and II non-small cell lung cancer (NSCLC), but sublobar resections are recommended when a patient has limited pulmonary function or other significant comorbidities. Notably, several studies have highlighted the potential utility of more limited resections in small malignant lesions less than 2cm in diameter, with pure AIS histology, when more than 50% of the diameter of pulmonary nodule has ground-glass opacity (GGO) attenuation on CT, or long volume doubling time (VDT). Videothoracoscopy is the preferred surgical approach for resection of early-stage lung cancer. Patients who are not candidates for surgery or do not agree to surgery can be offered radical radiotherapy. Stereotactic body radiation therapy (SBRT) is a type of radical radiotherapy with proven effectiveness, a high rate of local control and an acceptable risk of the development of later complications. Future trials are expected to define the role of SBRT in the treatment of early lung cancer in healthy subjects.
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Affiliation(s)
- Robert Dziedzic
- Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Tomasz Marjański
- Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Witold Rzyman
- Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland
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