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Detterbeck FC, Mase VJ, Li AX, Kumbasar U, Bade BC, Park HS, Decker RH, Madoff DC, Woodard GA, Brandt WS, Blasberg JD. A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation-part 2: systematic review of evidence regarding resection extent in generally healthy patients. J Thorac Dis 2022; 14:2357-2386. [PMID: 35813747 PMCID: PMC9264068 DOI: 10.21037/jtd-21-1824] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/05/2022] [Indexed: 11/06/2022]
Abstract
Background Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options (lobectomy, segmentectomy, wedge, stereotactic body radiotherapy, thermal ablation), weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making. Methods A PubMed systematic review from 2000-2021 of outcomes after lobectomy, segmentectomy and wedge resection in generally healthy patients is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons with at least some adjustment for confounders. The analysis involved careful assessment, including characteristics of patients, settings, residual confounding etc. to expose degrees of uncertainty and applicability to individual patients. Evidence is summarized that provides an at-a-glance overall impression as well as the ability to delve into layers of details of the patients, settings and treatments involved. Results In healthy patients there is no short-term benefit to sublobar resection vs. lobectomy in randomized and non-randomized comparisons. A detriment in long-term outcomes is demonstrated by adjusted non-randomized comparisons, more marked for wedge than segmentectomy. Quality-of-life data is confounded by the use of video-assisted approaches; evidence suggests the approach has more impact than the resection extent. Differences in pulmonary function tests by resection extent are not clinically meaningful in healthy patients, especially for multi-segmentectomy vs. lobectomy. The margin distance is associated with the risk of recurrence. Conclusions A systematic, comprehensive summary of evidence regarding resection extent in healthy patients with attention to aspects of applicability, uncertainty and effect modifiers provides a foundation on which to build a framework for individualized clinical decision-making.
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Affiliation(s)
- Frank C. Detterbeck
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Vincent J. Mase
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew X. Li
- Department of General Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Ulas Kumbasar
- Department of Thoracic Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Brett C. Bade
- Department of Pulmonary Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Henry S. Park
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Roy H. Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - David C. Madoff
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Gavitt A. Woodard
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Whitney S. Brandt
- Department of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Justin D. Blasberg
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
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Kondo S, Kagawa K, Saito T, Oura M, Sogabe K, Harada T, Fujii S, Nakamura S, Miki H, Sato N, Ono R, Abe M, Katoh S. Allogeneic haematopoietic stem cell transplantation-clinical outcomes: impact of leg muscle strength. BMJ Support Palliat Care 2021:bmjspcare-2021-003256. [PMID: 34949601 DOI: 10.1136/bmjspcare-2021-003256] [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: 06/24/2021] [Accepted: 12/10/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Muscle strength decline is reported to predict mortality in many cancers. However, there is little knowledge of the relation between muscle strength decline and clinical outcomes of allogeneic haematopoietic stem cell transplantation (allo-HSCT). This study aimed to determine the impact of pre-transplant lower extremity muscle strength (LEMS) on post-transplant overall survival (OS) and non-relapse mortality (NRM). METHODS In this retrospective cohort study, 97 adult patients underwent allo-HSCT during 2012-2020. LEMS was defined as knee extension force divided by patient's body weight. The patients were divided into low and high LEMS groups based on pre-transplant LEMS. OS was measured using the Kaplan-Meier method and the Cox proportional hazards model. The cumulative incidence of NRM was evaluated using the Fine and Gray method, with relapse considered as a competing risk event. RESULTS Probability of OS was significantly lower in the low LEMS groups (HR 2.48, 95% CI 1.20 to 5.12, p=0.014) than in the high LEMS group on multivariate analysis. Five-year OS was 25.8% and 66.4% in the low and high LEMS groups, respectively. Risk of NRM was significantly higher in the low LEMS group (HR 4.49, 95% CI 1.28 to 15.68, p=0.019) than in the high LEMS group. The cumulative incidence of NRM was 41.4% and 11.1% in the low and high LEMS groups, respectively. CONCLUSIONS Pre-transplant LEMS was a significant factor in predicting OS and NRM.
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Affiliation(s)
- Shin Kondo
- Division of Rehabilitation, Tokushima University Hospital, Tokushima, Tokushima, Japan
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Hyogo, Japan
| | - Kumiko Kagawa
- Department of Hematology, Tokushima University Hospital, Tokushima, Japan
| | - Takashi Saito
- Division of Rehabilitation, Tokushima University Hospital, Tokushima, Tokushima, Japan
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Hyogo, Japan
| | - Masahiro Oura
- Department of Hematology, Tokushima University Hospital, Tokushima, Japan
| | - Kimiko Sogabe
- Department of Hematology, Tokushima University Hospital, Tokushima, Japan
| | - Takeshi Harada
- Department of Hematology, Tokushima University Hospital, Tokushima, Japan
| | - Shiro Fujii
- Department of Hematology, Tokushima University Hospital, Tokushima, Japan
| | - Shingen Nakamura
- Department of Hematology, Tokushima University Hospital, Tokushima, Japan
| | - Hirokazu Miki
- Division of Transfusion Medicine and Cell Therapy, Tokushima University Hospital, Tokushima, Japan
| | - Nori Sato
- Department of Rehabilitation Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Rei Ono
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Hyogo, Japan
| | - Masahiro Abe
- Department of Hematology, Tokushima University Hospital, Tokushima, Japan
| | - Shinsuke Katoh
- Department of Rehabilitation Medicine, Tokushima University Hospital, Tokushima, Japan
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Nakamichi T, Hashimoto M, Nakamura A, Kuroda A, Tanaka T, Takeuchi J, Matsumoto S, Morimoto T, Kondo N, Domen K, Hasegawa S. Quality of life and lung function after pleurectomy/decortication for malignant pleural mesothelioma. Interact Cardiovasc Thorac Surg 2021; 33:572-579. [PMID: 33963844 DOI: 10.1093/icvts/ivab139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/27/2021] [Accepted: 03/31/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Impact of pleurectomy/decortication (P/D) on quality of life (QOL) is not widely reported. We investigated QOL and lung function after P/D. METHODS A single-centre, retrospective cohort study was performed among patients who underwent P/D for malignant mesothelioma between June 2014 and June 2018 at Hyogo College of Medicine. Data at 4 points before and 3, 6 and 12 months on QOL and lung function were evaluated with the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and pulmonary function tests. RESULTS Forty-five out of 65 patients completed SF-36. Physical function and role physical decreased from 78 to 65 and 69 to 41 and did not recover. Body pain decreased from 74 to 52. It increased to 62 at 12 months but was lower than before. General health perceptions, vitality and social function decreased from 56 to 49, 50 to 47 and 63 to 50, respectively, but returned to baseline. Role emotional decreased from 75 to 54, then once increased to 63, but decreased again to 58. Mental health tended to improve from 58 to 70. Thirty-eight patients out of 45 completed pulmonary function tests. Forced vital capacity and forced expiratory volume in 1 s decreased from 98% to 61% and 93% to 67% and did not increase. Right-sided surgery or complications was the risk factors of poor lung function but no significant risk factors in QOL. CONCLUSIONS This study suggests that P/D had an impact on QOL. Despite the lack of recovery in lung function QOL in mental aspects tended to improve, suggesting that pulmonary function tests alone are limited in assessing QOL.
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Affiliation(s)
- Toru Nakamichi
- Department of Thoracic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Masaki Hashimoto
- Department of Thoracic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Akifumi Nakamura
- Department of Thoracic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Ayumi Kuroda
- Department of Thoracic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Takashi Tanaka
- Department of Rehabilitation Medicine, Hyogo College of Medicine Hospital, Hyogo, Japan
| | - Jiro Takeuchi
- Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan
| | - Seiji Matsumoto
- Department of Thoracic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan
| | - Nobuyuki Kondo
- Department of Thoracic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Seiki Hasegawa
- Department of Thoracic Surgery, Hyogo College of Medicine, Hyogo, Japan
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Leaman-Alcibar O, Cigarral C, Déniz C, Romero-Palomar I, Navarro-Martin A. Quality of Life After Stereotactic Body Radiation therapy Versus Video-Assisted Thoracic Surgery in Early stage Non-small Cell Lung Cancer. Is there Enough Data to Make a Recommendation? J Clin Transl Res 2021; 7:209-220. [PMID: 34104823 PMCID: PMC8177842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 01/22/2021] [Accepted: 02/28/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND AIM Health reported quality of life test (HRQOLT) in oncologic patients has become a major concern. Early stage in non-small cell lung cancer has two options for treatment in fragile population: Stereotactic body radiation therapy (SBRT) and video-assisted thoracic surgery (VATS). Which option should be recommended in daily clinical practice remains a challenging question. The current review is addressing this concern. Among 1256 articles, 19 met the inclusion criteria and 2034 patients were analyzed treated either with VATS or SBRT. Eleven manuscripts in SBRT, five VATS studies, and three reviews were summarized in the present review. In fragile population, SBRT seems to be a valuable option of treatment with minor or no changes in HRQOLT. However, baseline quality of life status or geriatric assessment tools before treatment could be a good strategy to select appropriate population for undergoing SBRT or surgery. RELEVANCE FOR PATIENTS In this paper, we present a systematic review where we compare the current evidence of two options for treatment in fragile population: SBRT and VATS.
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Affiliation(s)
- O. Leaman-Alcibar
- 1Department of Radiation Oncology, Gregorio Marañón General University Hospital, Madrid, Spain
| | - C. Cigarral
- 2Department of Radiation Oncology, Salamanca University Hospital, Spain
| | - C. Déniz
- 3Department of Thoracic Surgery. Bellvitge University Hospital. L’Hospitalet (Barcelona), Spain
| | - I. Romero-Palomar
- 4Gregorio Marañón General University Hospital Library. Madrid, Spain
| | - A. Navarro-Martin
- 5Department of Radiation Oncology, Catalan Institute of Oncology, L’Hospitalet (Barcelona), Spain,
Corresponding author: Arturo Navarro-Martin Department of Radiation Oncology. Catalan Institute of Oncology. Avda Gran Via 199-203. L’Hospitalet (Barcelona), Spain. E-mail:
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