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Cabañero A, Cavestany C, Fra S, Muñoz G. Mediastinal lymph node dissection: punishment or discipline? Eur J Cardiothorac Surg 2021; 60:1242-1243. [PMID: 34113978 DOI: 10.1093/ejcts/ezab233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alberto Cabañero
- Department of Thoracic Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - Cristina Cavestany
- Department of Thoracic Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - Sara Fra
- Department of Thoracic Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - Gemma Muñoz
- Department of Thoracic Surgery, Ramón y Cajal University Hospital, Madrid, Spain
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Dai J, Liu M, Yang Y, Li Q, Song N, Rocco G, Sihoe ADL, Gonzalez-Rivas D, Suen HC, He W, Duan L, Fan J, Zhao D, Wang H, Zhu Y, Chen C, Diasio RB, Jiang G, Yang P, Zhang P. Optimal Lymph Node Examination and Adjuvant Chemotherapy for Stage I Lung Cancer. J Thorac Oncol 2019; 14:1277-1285. [PMID: 31009811 DOI: 10.1016/j.jtho.2019.03.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 03/17/2019] [Accepted: 03/28/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine the optimal number of lymph nodes (LNs) examined and the role of adjuvant chemotherapy in stage I lung cancer. METHODS The National Cancer Database was queried for surgically treated patients with pathologic stage I lung cancer between 2006 and 2014 (N = 65,438). The optimal LN numbers were determined in the multivariate Cox model and were further validated in the cohort with clinical stage I disease (N = 117,112) in terms of nodal upstaging and prognostic stratification. The role of adjuvant chemotherapy in patients with suboptimal staging (number of LNs examined was less than than the optimum) was evaluated in each T stage. RESULTS The number of LNs examined correlated with tumor size (p < 0.001). There were increasing survival benefits with each additional LN examined-up to eight, nine, 10, and 11 nodes for patients with T1a, T1b, T1c, and T2a, respectively. Validation from the cohort with clinically staged disease showed that the threshold of eight to 11 LNs was an independent predictor of nodal upstaging (OR = 1.706, 95% confidence interval [CI] 1.608-1.779) and survival outcome (hazard ratio = 0.890, 95% CI: 0.865-0.916). After propensity matching, adjuvant chemotherapy was associated with improved survival in patients with stage T2a disease having suboptimal staging (hazard ratio = 0.841, 95% CI: 0.714-0.990), but not in patients with stage T1a to T1c disease. CONCLUSION LN evaluation was important for accurate staging and adequate treatment, and examinations of an increasing number of nodes for progressively higher T components (i.e., eight, nine, 10, and 11 nodes for T1a, T1b, T1c, and T2a tumors, respectively) seemed crucial to predict upstaging and survival outcomes. Adjuvant chemotherapy might be beneficial to patients with stage T2a disease who have suboptimal nodal staging.
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Affiliation(s)
- Jie Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Ming Liu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Yang Yang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Qiuyuan Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Nan Song
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York
| | - Alan D L Sihoe
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China; Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China; Division of Thoracic Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen, People's Republic of China
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China; Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain
| | - Hon Chi Suen
- Center for Cardiothoracic Surgery, Inc., St. Louis, Missouri
| | - Wenxin He
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Liang Duan
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Jiang Fan
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Deping Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Haifeng Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | | | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Ping Yang
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Peng Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China.
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Rami-Porta R, Call S, Dooms C, Obiols C, Sánchez M, Travis WD, Vollmer I. Lung cancer staging: a concise update. Eur Respir J 2018; 51:13993003.00190-2018. [PMID: 29700105 DOI: 10.1183/13993003.00190-2018] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/04/2018] [Indexed: 12/13/2022]
Abstract
Diagnosis and clinical staging of lung cancer are fundamental to planning therapy. The techniques for clinical staging, i.e anatomic and metabolic imaging, endoscopies and minimally invasive surgical procedures, should be performed sequentially and with an increasing degree of invasiveness. Intraoperative staging, assessing the magnitude of the primary tumour, the involved structures, and the loco-regional lymphatic spread by means of systematic nodal dissection, is essential in order to achieve a complete resection. In resected tumours, pathological staging, with the systematic study of the resected specimens, is the strongest prognostic indicator and is essential to make further decisions on therapy. In the present decade, the guidelines on lung cancer staging of the American College of Chest Physicians and the European Society of Thoracic Surgeons are based on the best available evidence and are widely followed. Recent advances in the classification of the adenocarcinoma of the lung, with the definition of adenocarcinoma in situ, minimally invasive adenocarcinoma and lepidic predominant adenocarcinoma, and the publication of the eighth edition of the tumour, node and metastasis classification of lung cancer, have to be integrated into the staging process. The present review complements the latest guidelines on lung cancer staging by providing an update of all these issues.
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Affiliation(s)
- Ramón Rami-Porta
- Dept of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Barcelona, Spain.,Network of Centres for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Barcelona, Spain
| | - Sergi Call
- Dept of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Barcelona, Spain.,Dept of Morphological Sciences, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Christophe Dooms
- Dept of Respiratory Diseases, University Hospitals, KU Leuven, Leuven, Belgium
| | - Carme Obiols
- Dept of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Barcelona, Spain
| | - Marcelo Sánchez
- Centre of Imaging Diagnosis, Radiology Dept, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - William D Travis
- Dept of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ivan Vollmer
- Centre of Imaging Diagnosis, Radiology Dept, Hospital Clínic, University of Barcelona, Barcelona, Spain
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Riquet M, Arame A, Pricopi C. Systematic lymphadenectomy: 'meta-lysis' does not need meta-analysis. Eur J Cardiothorac Surg 2017; 52:1011-1012. [PMID: 28950369 DOI: 10.1093/ejcts/ezx299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 07/25/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marc Riquet
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris, France
| | - Alex Arame
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris, France
| | - Ciprian Pricopi
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris, France
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Riquet M, Pricopi C, Mangiameli G, Arame A, Badia A, Le Pimpec Barthes F. Occult pN2 disease in lung cancer patients: a wide range of diseases endangering the long term prognosis. J Thorac Dis 2017; 9:2271-2275. [PMID: 28932522 DOI: 10.21037/jtd.2017.07.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Marc Riquet
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris, France
| | - Ciprian Pricopi
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris, France
| | - Giuseppe Mangiameli
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris, France
| | - Alex Arame
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris, France
| | - Alain Badia
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris, France
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