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Choi W, Liu CJ, Alam SR, Oh JH, Vaghjiani R, Humm J, Weber W, Adusumilli PS, Deasy JO, Lu W. Preoperative 18F-FDG PET/CT and CT radiomics for identifying aggressive histopathological subtypes in early stage lung adenocarcinoma. Comput Struct Biotechnol J 2023; 21:5601-5608. [PMID: 38034400 PMCID: PMC10681940 DOI: 10.1016/j.csbj.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023] Open
Abstract
Lung adenocarcinoma (ADC) is the most common non-small cell lung cancer. Surgical resection is the primary treatment for early-stage lung ADC while lung-sparing surgery is an alternative for non-aggressive cases. Identifying histopathologic subtypes before surgery helps determine the optimal surgical approach. Predominantly solid or micropapillary (MIP) subtypes are aggressive and associated with a higher likelihood of recurrence and metastasis and lower survival rates. This study aims to non-invasively identify these aggressive subtypes using preoperative 18F-FDG PET/CT and diagnostic CT radiomics analysis. We retrospectively studied 119 patients with stage I lung ADC and tumors ≤ 2 cm, where 23 had aggressive subtypes (18 solid and 5 MIPs). Out of 214 radiomic features from the PET/CT and CT scans and 14 clinical parameters, 78 significant features (3 CT and 75 PET features) were identified through univariate analysis and hierarchical clustering with minimized feature collinearity. A combination of Support Vector Machine classifier and Least Absolute Shrinkage and Selection Operator built predictive models. Ten iterations of 10-fold cross-validation (10 ×10-fold CV) evaluated the model. A pair of texture feature (PET GLCM Correlation) and shape feature (CT Sphericity) emerged as the best predictor. The radiomics model significantly outperformed the conventional predictor SUVmax (accuracy: 83.5% vs. 74.7%, p = 9e-9) and identified aggressive subtypes by evaluating FDG uptake in the tumor and tumor shape. It also demonstrated a high negative predictive value of 95.6% compared to SUVmax (88.2%, p = 2e-10). The proposed radiomics approach could reduce unnecessary extensive surgeries for non-aggressive subtype patients, improving surgical decision-making for early-stage lung ADC patients.
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Affiliation(s)
- Wookjin Choi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Chia-Ju Liu
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Sadegh Riyahi Alam
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jung Hun Oh
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Raj Vaghjiani
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - John Humm
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Wolfgang Weber
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Prasad S. Adusumilli
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Joseph O. Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Wei Lu
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Chan JWY, Siu ICH, Chang ATC, Li MSC, Lau RWH, Mok TSK, Ng CSH. Transbronchial Techniques for Lung Cancer Treatment: Where Are We Now? Cancers (Basel) 2023; 15:cancers15041068. [PMID: 36831411 PMCID: PMC9954491 DOI: 10.3390/cancers15041068] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/29/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023] Open
Abstract
The demand for parenchyma-sparing local therapies for lung cancer is rising owing to an increasing incidence of multifocal lung cancers and patients who are unfit for surgery. With the latest evidence of the efficacy of lung cancer screening, more premalignant or early-stage lung cancers are being discovered and the paradigm has shifted from treatment to prevention. Transbronchial therapy is an important armamentarium in the local treatment of lung cancers, with microwave ablation being the most promising based on early to midterm results. Adjuncts to improve transbronchial ablation efficiency and accuracy include mobile C-arm platforms, software to correct for the CT-to-body divergence, metal-containing nanoparticles, and robotic bronchoscopy. Other forms of energy including steam vapor therapy and pulse electric field are under intensive investigation.
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Affiliation(s)
- Joyce W. Y. Chan
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ivan C. H. Siu
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Aliss T. C. Chang
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Molly S. C. Li
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Rainbow W. H. Lau
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tony S. K. Mok
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Calvin S. H. Ng
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
- Correspondence:
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Abstract
Sublobar resections are commonly performed operations that have seen an increase in applicability. The sublobar approach, comprising segmentectomy and wedge resections, can provide lung preservation and thus is better tolerated in select patients in comparison to lobectomy. These operations are offered for a variety of benign and malignant lesions. Understanding the indications and technical aspects of these approaches is paramount as improvements in lung cancer screening protocols and the imaging modalities has led to an increase in the detection of early-stage cancer. In this article, we discuss the anatomy, indications, technical approaches, and outcomes for sublobar resection.
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Affiliation(s)
- Benjamin Wei
- Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA; Birmingham Veterans Administration Medical Center, Birmingham, AL 35233, USA.
| | - Frank Gleason
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA
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Motono N, Mizoguchi T, Ishikawa M, Iwai S, Iijima Y, Uramoto H. Adaptation criterion for segmentectomy in small-sized early stage non-small cell lung cancer. Thorac Cancer 2022; 13:2985-2991. [PMID: 36165084 PMCID: PMC9626306 DOI: 10.1111/1759-7714.14647] [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: 08/12/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Although the utility of segmentectomy for early-stage non-small cell lung cancer (NSCLC) has been reported, the adaptation criterion for segmentectomy is unclear. METHODS In total, 171 NSCLC patients who underwent segmentectomy or lobectomy with a consolidation tumor diameter on computed tomography of ≤20 mm were analyzed. RESULTS Consolidation diameter (p = 0.01), consolidation to tumor ratio (CTR) (p < 0.01), maximum standardized uptake value (SUVmax ) (p < 0.01), and segmentectomy (p = 0.01) were significantly different upon univariate analysis among patients stratified by recurrence. Positive correlations were observed between the consolidation diameter on CT and CEA (correlation coefficient; r = 0.19, p = 0.01), SUVmax (r = 0.48, p < 0.01), and CTR (r = 0.83, p < 0.01). Because there was a significant correlation among the consolidation diameter of tumors on CT, CTR, and SUVmax in this study, we integrated these factors into one. Consolidation, CTR, and SUVmax (hazard ratio [HR]: 3.77, 95% confidence interval [CI]: 1.35-11.29, p = 0.01) and segmentectomy (HR: 0.24, 95% CI: 0.03-0.90, p = 0.03) were risk factors for recurrence in a multivariate analysis. There was a significant difference between the segmentectomy and lobectomy groups (5-year relapse-free survival [RFS] 96.5% vs. 80.7%, p = 0.02). CONCLUSIONS Consolidation tumor diameter on CT, CTR, and SUVmax is a risk factor for recurrence. These results suggest that for patients with small-sized early stage NSCLC, this combined factor is important for determining the indication for segmentectomy.
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Affiliation(s)
- Nozomu Motono
- Department of Thoracic SurgeryKanazawa Medical UniversityUchinadaJapan
| | - Takaki Mizoguchi
- Department of Thoracic SurgeryKanazawa Medical UniversityUchinadaJapan
| | - Masahito Ishikawa
- Department of Thoracic SurgeryKanazawa Medical UniversityUchinadaJapan
| | - Shun Iwai
- Department of Thoracic SurgeryKanazawa Medical UniversityUchinadaJapan
| | - Yoshihito Iijima
- Department of Thoracic SurgeryKanazawa Medical UniversityUchinadaJapan
| | - Hidetaka Uramoto
- Department of Thoracic SurgeryKanazawa Medical UniversityUchinadaJapan
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Daniel Humberto Pozza, Ramon Bezerra Andrade de Mello. Treatment Sequencing Strategies in Lung Cancer. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2022; 25:323-336. [PMID: 35599008 PMCID: PMC9127753 DOI: 10.3779/j.issn.1009-3419.2022.104.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND The advances in the lung cancer screening methods and therapeutics, together with awareness towards deleterious habits, such as smoking, is increasing the overall survival with better quality of life for the patients. However, lung cancer is still one of the most common and fatal neoplasm with a high incidence and consequently burden to public health worldwide. Thus, based on guidelines and recent phases II and III clinical trials studies, this manuscript summarizes the current treatment sequencing strategies in lung cancer. METHODS A comprehensive search of related articles was performed focused on phases II and III clinical trials studies. RESULTS The lung cancer management should take into consideration the tumor characteristics, histology, molecular pathology and be discussed in a multidisciplinary team. Lung cancer treatment options comprises surgery whenever possible, radiotherapy associate with/or chemotherapy and immunotherapy as monotherapy, or combined with chemotherapy and best palliative care. CONCLUSIONS The screening predictability in more patients, smoking reduction, early diagnosis, better disease understanding and individualized, more effective and tolerable therapeutics are related to an increasing in overall survival and quality of life. In the near future improvement of personalized therapy in precision medicine is expected, enhancing new predictive biomarkers, optimal doses and optimal treatment sequencing as well as anti-cancer vaccines development.
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Affiliation(s)
- Daniel Humberto Pozza
- Department of Biomedicine, Faculty of Medicine and i3s, University of Porto, 4200-319 Porto, Portugal,Daniel Humberto Pozza, E-mail:
| | - Ramon Bezerra Andrade de Mello
- Discipline of Medical Oncology, Post-graduation Program in Medicine, Nine of July University (UNINOVE), São Paulo, Brazil./Nine of July Hospital, São Paulo, Brazil
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Zhou Y, Yu T, Zhang Y, Qian L, Xia Q. Comparison of surgical outcomes and prognosis between wedge resection and simple Segmentectomy for GGO diameter between 2 cm and 3 cm in non-small cell lung cancer: a multicenter and propensity score matching analysis. BMC Cancer 2022; 22:71. [PMID: 35034626 PMCID: PMC8761309 DOI: 10.1186/s12885-021-09129-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background As segmentectomy had become commonly used for Non-Small Cell Lung Cancer (NSCLC) treatment, which had the advantages of radical operation, however, it remains controversial owing to procedural complexity and risk of increased complications compared with wedge resection. We evaluated operative and postoperative outcomes of simple segmentectomy compared to wedge resection in ground-glass opacity (GGO) diameter between 2 cm and 3 cm NSCLC. Methods We retrospectively reviewed 1600 clinical GGO diameter between 2 cm and 3 cm NSCLC patients who received simple segmentectomy and wedge resection between Jan 2011 and Jan 2015. Participants were matched 1:1 on their propensity score for two groups. Clinic-pathologic, operative, and postoperative results of two groups were compared. Results After using propensity score methods to create a matched cohort of participants with simple segmentectomy group similar to that wedge resection, there were no significant differences detected in tumor size, margin distance, histology, age, sex, preoperative comorbidities and preoperative pulmonary function. Overall complications in simple segmentectomy group were more than wedge resection group (21% vs 3%, p = 0.03). Median operative time (110.6 vs. 71.2 min; p = 0.01) and prolonged air leakage (12% vs. 3%; p = 0.02) was significantly longer in the simple segmentectomy group. There was no difference in recurrence free survival (RFS) and overall survival (OS) of 5-years between simple segmentectomy group and wedge resection group. Postoperative pulmonary function in simple segmentectomy group recovered more slowly than wedge resection group. Conclusion Wedge resection may have comparable efficacy as simple segmentectomy for GGO diameter between 2 cm and 3 cm NSCLC, but lead to less complications, less surgical procedure and faster recovery of pulmonary function. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-09129-0.
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Affiliation(s)
- Yaodong Zhou
- Yaodong Zhou, Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, People's Republic of China.
| | - Tao Yu
- Yaodong Zhou, Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, People's Republic of China
| | - Yixin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital affiliated to Shanghai Jiaotong University, Shanghai, 200011, China
| | - Liqiang Qian
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, 200030, China
| | - Qing Xia
- Department of Neonate, Children's Hospital of Fudan University, Shanghai, 201102, China.
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Dauriat G, LePavec J, Pradere P, Savale L, Fabre D, Fadel E. Our current understanding of and approach to the management of lung cancer with pulmonary hypertension. Expert Rev Respir Med 2021; 15:373-384. [PMID: 33107356 DOI: 10.1080/17476348.2021.1842202] [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] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Lung cancer is a frequent pathology for which the best curative treatment is pulmonary resection. Pulmonary arterial hypertension is a rare disease but pulmonary hypertension associated with parenchymal disease or left heart disease is frequently observed in these patients. The diagnosis of pulmonary hypertension before lung resection makes the perioperative management of these patients more difficult and sometimes leads to rejecting patients for surgery. AREAS COVERED We performed a review of literature on PubMed on Pulmonary hypertension associated lung resection, preoperative assessment of lung resection and perioperative management of PH patients, including guidelines and clinical trials.In this review, we summarize the current state of knowledge regarding the pre and perioperative management of patients with suspected or confirmed PH who can benefit from surgical treatment of lung cancer. EXPERT OPINION Management of PH patients before lung resection should include a very careful workup including at least right heart catheterization with evaluation of the targeted PH treatment in an expert center and evaluation of other comorbidities. Perioperative management must be carried out in a specialized center.
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Affiliation(s)
- Gaelle Dauriat
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital GHPSJ, Institut d'Oncologie Thoracique and Paris Saclay University, France
| | - Jerome LePavec
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital GHPSJ, Institut d'Oncologie Thoracique and Paris Saclay University, France
| | - Pauline Pradere
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital GHPSJ, Institut d'Oncologie Thoracique and Paris Saclay University, France
| | - Laurent Savale
- AP-HP, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Séveère, Hôpital Bicêtre, France
| | - Dominique Fabre
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital GHPSJ, Institut d'Oncologie Thoracique and Paris Saclay University, France
| | - Elie Fadel
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital GHPSJ, Institut d'Oncologie Thoracique and Paris Saclay University, France
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Yu X, Zhang R, Zhang M, Lin Y, Zhang X, Wen Y, Yang L, Huang Z, Wang G, Zhao D, Gonzalez M, Baste JM, Petersen RH, Ng CSH, Brunelli A, Zheng L, Zhang L. Segmental resection is associated with decreased survival in patients with stage IA non-small cell lung cancer with a tumor size of 21-30 mm. Transl Lung Cancer Res 2021; 10:900-913. [PMID: 33718031 PMCID: PMC7947415 DOI: 10.21037/tlcr-20-1217] [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] [Indexed: 11/06/2022]
Abstract
Background The feasibility of segmental resection for early-stage non-small cell lung cancer (NSCLC) is still controversial. This study aimed to compare survival outcomes following lobectomy and segmental resection in patients with pathological T1cN0M0 (tumor size 21-30 mm) NSCLC. Methods Patients diagnosed between 1998 and 2016 with pathological stage IA NSCLC and with tumors measuring 21-30 mm were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The observational outcomes were cancer-specific survival (CSS) and overall survival (OS) at 5 years. Univariate survival analysis was carried out to identify potential prognostic factors of prolonged survival. Cox proportional hazards model was used to adjust for confounding factors. Additionally, pairwise comparisons were conducted between lobectomy and segmental resection for CSS and OS, and forest plots were drawn. Results Of the 9,580 patients analyzed, 400 patients (4.2%) underwent segmental resections. Patients with older age (P<0.001), smaller tumors (P<0.001), and left-sided tumors (P=0.002) were more likely to receive segmental resection. No difference was found in the operative mortality rates between the segmental resection group and the lobectomy group (1.0% vs. 1.2%, P=0.707). The CSS (HR, 1.429; 95% CI, 1.166-1.752; P=0.001) and OS (HR, 1.348; 95% CI, 1.176-1.544; P<0.001) in the segmental resection group were significantly worse than those in the lobectomy group. Subgroup analyses by age, year of diagnosis, sex, tumor size, histology, grade, and the number of dissected lymph nodes also confirmed that lobectomy was associated with improved CSS and OS. Conclusions Lobectomy and thorough removal of lymph nodes should continue to be the recommended standard of care for patients with surgically resectable stage IA NSCLC with tumor size of 21-30 mm.
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Affiliation(s)
- Xiangyang Yu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Rusi Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Mengqi Zhang
- Department of Pathology, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Yongbin Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xuewen Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Anesthesiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yingsheng Wen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Longjun Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zirui Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Gongming Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Dechang Zhao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Michel Gonzalez
- Service of Thoracic Surgery, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France
| | - Rene Horsleben Petersen
- Department of Cardiothoracic Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Calvin S H Ng
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | | | - Lie Zheng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Imaging, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lanjun Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
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Chan JWY, Yu PSY, Lau RWH, Ng CSH. ARTIS Pheno ®-the future of thoracic hybrid theatre for lung nodule resection? J Thorac Dis 2020; 12:4602-4605. [PMID: 33145031 PMCID: PMC7578484 DOI: 10.21037/jtd-2020-50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Joyce W Y Chan
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Peter S Y Yu
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Rainbow W H Lau
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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Li C, Jiang C, Gong J, Wu X, Luo Y, Sun G. A CT-based logistic regression model to predict spread through air space in lung adenocarcinoma. Quant Imaging Med Surg 2020; 10:1984-1993. [PMID: 33014730 DOI: 10.21037/qims-20-724] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Spread through air space (STAS) is a novel invasive pattern of lung adenocarcinoma and is also a risk factor for recurrence and worse prognosis of lung adenocarcinoma. This study aimed to develop and validate a computed tomography (CT)-based logistic regression model to predict STAS in lung adenocarcinoma. Methods This retrospective study was approved by the institutional review board of two centers and included 578 patients (462 from center I and 116 from center II) with pathologically confirmed lung adenocarcinoma. STAS was identified from 90 center I patients (19.5%) and 28 center II patients (24.1%) from. The maximum diameter, nodule area, and area of solid components in part-solid nodules were measured. Twenty-one semantic characteristics were assessed. Univariate analysis was used to select CT characteristics, which were associated with STAS in the patient cohort of center I. Multivariable logistic regression was used to develop a CT characteristics-based model on those variables with statistical significance. The model was validated in the validation cohort and then tested in the external test cohort (patients from center II). The diagnostic performance of the model was measured by area under the curve (AUC) of receiver operating characteristic (ROC). Results At univariate analysis, age and 11 CT characteristics, including the maximum diameter of the tumor, the maximum area of the tumor, the area and ratio of the solid component, nodule type, pleural thickening, pleural retraction, mediastinal lymph node enlargement, vascular cluster sign, and lobulation, specula were found to be significantly associated with STAS. The optimal logistic regression model included age, maximum diameter and ratio of solid component with odds ratio (OR) value of 0.967 (95% CI: 0.944-0.988), 1.027 (95% CI: 1.008-1.046) and 5.14 (95% CI: 2.180-13.321), respectively. This model achieved an AUC of 0.801 (95% CI: 0.709-0.892) and 0.692 (95% CI: 0.518-0.866) in the validation cohort and the external test cohort, respectively. The difference was not statistically significant (P=0.280). Conclusions CT-based logistic regression machine learning model could preoperatively predict STAS in lung adenocarcinoma with excellent diagnosis performance, which could be supplementary to routine CT interpretation.
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Affiliation(s)
- Chuanjun Li
- Department of Radiology, Pingshan District People's Hospital of Shenzhen, Shenzhen, China
| | - Changsi Jiang
- Department of Radiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Jingshan Gong
- Department of Radiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Xiaotao Wu
- Department of Radiology, Pingshan District People's Hospital of Shenzhen, Shenzhen, China
| | - Yan Luo
- Department of Radiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Guopin Sun
- Department of Radiology, Pingshan District People's Hospital of Shenzhen, Shenzhen, China
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Yu Y, Huang R, Wang P, Wang S, Ling X, Zhang P, Yu J, Wang J, Xiao J, Wang Z. Sublobectomy versus lobectomy for long-term survival outcomes of early-stage non-small cell lung cancer with a tumor size ≤2 cm accompanied by visceral pleural invasion: a SEER population-based study. J Thorac Dis 2020; 12:592-604. [PMID: 32274125 PMCID: PMC7138986 DOI: 10.21037/jtd.2019.12.121] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background The optimal surgical strategy for early-stage non-small cell lung cancer (NSCLC) with visceral pleural invasion (VPI) remains unclear. Due to limited prospective comparative data for these surgical modalities, the objective of the current study was to compare the long-term survival outcomes of sublobectomy (Sub) versus lobectomy (Lob) for NSCLC with a tumor size ≤2 cm and VPI. Methods Patients with early-stage NSCLC characterized by VPI diagnosed between 2004 and 2013 were identified from the Surveillance, Epidemiology, and End Results (SEER) program. The baseline demographic and cancer characteristics, treatment information as well as survival outcome data were extracted from the SEER database, and confounders were balanced by propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) analyses. Lung disease-specific survival (DSS) and overall survival (OS) rates were compared with Cox proportional hazards (PH) regression models based on the unmatched cohort, the propensity-based matched cohort, and the IPTW cohort. Results Of the 1,386 patients enrolled, 1,000 (72.15%) and 386 (27.85%) underwent lobectomy and sublobectomy, respectively. The 5-year DSS rate was 78.64% for the lobectomy group and 59.47% for the sublobectomy group. Cox regression models demonstrated that the operation type (Sub vs. Lob) was an independent prognostic factor for early-stage NSCLC with VPI based on the three different cohorts. Patients who underwent lobectomy showed better long-term DSS and OS rates than those treated with sublobectomy after PSM [DSS: hazard ratio (HR) 0.689, 95% confidence interval (CI): 0.490–0.968, P=0.032; OS: HR 0.723, 95% CI: 0.549–0.953, P=0.021]. The IPTW analysis yielded similar results. Conclusions Lobectomy showed superior long-term survival compared with sublobectomy in patients with early-stage NSCLC with a tumor size ≤2 cm and VPI.
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Affiliation(s)
- Yue Yu
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Renhong Huang
- Department of General Surgery, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Pei Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Suyu Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Xinyu Ling
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Peng Zhang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Jingwen Yu
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Jun Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Jian Xiao
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Zhinong Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
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Qu G, Shi Y. [Progress on the Study of Tumor Spread Through Air Spaces in the Clinicopathological Characteristics of Lung Adenocarcinoma and Its Influence on the Surgical Treatment and Prognosis of Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:363-368. [PMID: 31196370 PMCID: PMC6580081 DOI: 10.3779/j.issn.1009-3419.2019.06.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
肿瘤肺泡腔内播散(tumor spread through air spaces, STAS)作为一种新的病理侵袭方式,与诸多临床病理因素紧密相关。在肺腺癌中,微乳头和实体型病理亚型与之关系最为密切;针对早期肺腺癌存在STAS,手术类型的治疗上肺叶切除似乎优于亚肺叶切除而获益,可能上调早期肺癌的病理分期;同时,STAS与鳞癌等非小细胞肺癌(non-small cell lung cancer, NSCLC)关系密切。此外,STAS的术中冰冻切片病理检测困难,亦有争议存在。STAS作为肿瘤复发的独立危险因素,亦是提示预后不良的重要因素,本文将STAS的研究现状和进展作一综述。
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Affiliation(s)
- Guidong Qu
- Elderly Thoracic Surgery, the First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Yunfei Shi
- Elderly Thoracic Surgery, the First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
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Motono N, Iwai S, Funasaki A, Sekimura A, Usuda K, Uramoto H. Low-dose indocyanine green fluorescence-navigated segmentectomy: prospective analysis of 20 cases and review of previous reports. J Thorac Dis 2019; 11:702-707. [PMID: 31019757 DOI: 10.21037/jtd.2019.02.70] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background A technique of visualizing the demarcation line based with indocyanine green (ICG) was recently developed, and its utility was reported. We demonstrated the safety and utility of low-dose (5 mg/body) ICG fluorescence-navigated video-assisted thoracic surgery (VATS) segmentectomy. Methods Patients who had undergone lung segmentectomy for early-stage non-small cell lung cancer (NSCLC) or small pulmonary metastasis were included in this study. ICG at 5 mg/body was rapidly injected into the peripheral vein, and the lung was observed using near-infrared (NIR) fluorescence thoracoscopy. We evaluated the identification rate of the demarcation line based on NIR fluorescence imaging with ICG and the perioperative outcomes. Results Lung segmentectomy NIR fluorescence imaging with ICG was performed in 20 patients. The identification of the target segmental line was possible in 18 (90%) of the 20 patients. The median duration of chest tube placement was one day, and the median length of postoperative stay was 8 days. Complications occurred in 5 (25%) of the 20 patients. All cases were prolonged air leak that required pleurodesis. There were no complications resulting from NIR fluorescence imaging with ICG. Conclusions NIR fluorescence imaging with ICG is safe and useful for the identification of the demarcation line for lung segmentectomy. Low-dose ICG might achieve a sufficient rate of identification of the segmental line.
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Affiliation(s)
- Nozomu Motono
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Shun Iwai
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Aika Funasaki
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Atsushi Sekimura
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Katsuo Usuda
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Hidetaka Uramoto
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
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Howell EB, Berfield KS, Wood DE. Stereotactic body radiotherapy for operable, early stage non-small cell lung cancer-let's all take a deep breath. J Thorac Dis 2018; 10:S2000-S2003. [PMID: 30023103 DOI: 10.21037/jtd.2018.04.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Eric B Howell
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
| | - Kathleen S Berfield
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
| | - Douglas E Wood
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
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Morales-Oyarvide V, Mino-Kenudson M. Taking the measure of lung adenocarcinoma: towards a quantitative approach to tumor spread through air spaces (STAS). J Thorac Dis 2017; 9:2756-2761. [PMID: 29221233 PMCID: PMC5708386 DOI: 10.21037/jtd.2017.07.97] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 07/24/2017] [Indexed: 01/15/2023]
Affiliation(s)
- Vicente Morales-Oyarvide
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Mari Mino-Kenudson
- Department Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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