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Wu B, Zhang X, Feng N, Hu Z, Wu J, Zhou W, Wei Y, Zhang W, Wang K. Treatment strategies for stage IA non-small cell lung cancer: A SEER-based population study. PLoS One 2024; 19:e0298470. [PMID: 38683794 PMCID: PMC11057715 DOI: 10.1371/journal.pone.0298470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/24/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND There are various therapeutic methods for treating stage IA (T1N0M0) non-small cell lung cancer (NSCLC), but no studies have systematically assessed multiple treatments to determine the most effective therapy. METHODS Stage IA NSCLC patient data collected between 2004 and 2018 were gathered from the Surveillance, Epidemiology, and End Results (SEER) database. Treatment modalities included observation, chemotherapy alone (CA), radiation alone (RA), radiation+chemotherapy (RC), surgery alone (SA), surgery+chemotherapy (SC), surgery+radiation (SR) and surgery+radiation+chemotherapy (SRC). Comparisons were made of overall survival (OS) and lung cancer-specific survival (LCSS) among patients based on different therapeutic methods by survival analysis. RESULTS Ultimately, 89147 patients with stage IA NSCLC between 2004 and 2018 were enrolled in this study. The order of multiple treatment modalities based on the hazard ratio (HR) for OS for the entire cohort revealed the following results: SA (HR: 0.20), SC (HR: 0.25), SR (HR: 0.42), SRC (HR: 0.46), RA (HR: 0.56), RC (HR: 0.72), CA (HR: 0.91) (P<0.001), and observation (HR: Ref). The SA group had the best OS and LCSS, and similar results were found in most subgroup analyses (all P<0.001). The order of surgical modalities based on the HR for OS for the entire cohort revealed the following results: lobectomy (HR: 0.32), segmentectomy (HR: 0.41), wedge resection (HR: 0.52) and local tumor destruction (HR: Ref). Lobectomy had the best effects on OS and LCSS, and similar results were found in all subgroup analyses (all P<0.001). CONCLUSION SA appeared to be the optimal treatment modality for patients with stage IA NSCLC, and lobectomy was associated with the best prognosis. There may be some indication and selection bias in our study, and the results of this study should be confirmed in a prospective study.
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Affiliation(s)
- Bo Wu
- Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Xiang Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Nan Feng
- Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Zhuozheng Hu
- Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Jiajun Wu
- Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Weijun Zhou
- Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Yiping Wei
- Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Wenxiong Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Kang Wang
- Department of Traditional Chinese Medicine, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
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Pan XL, Liao ZL, Yao H, Yan WJ, Wen DY, Wang Y, Li ZL. Prognostic value of ground glass opacity on computed tomography in pathological stage I pulmonary adenocarcinoma: A meta-analysis. World J Clin Cases 2021; 9:10222-10232. [PMID: 34904092 PMCID: PMC8638064 DOI: 10.12998/wjcc.v9.i33.10222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/18/2021] [Accepted: 09/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The clinical role of ground glass opacity (GGO) on computed tomography (CT) in stage I pulmonary adenocarcinoma patients currently remains unclear.
AIM To explore the prognostic value of GGO on CT in lung adenocarcinoma patients who were pathologically diagnosed with tumor-node-metastasis stage I.
METHODS A comprehensive and systematic search was conducted through the PubMed, EMBASE and Web of Science databases up to April 3, 2021. The hazard ratio (HR) and corresponding 95% confidence interval (CI) were combined to assess the association between the presence of GGO and prognosis, representing overall survival and disease-free survival. Subgroup analysis based on the ratio of GGO was also conducted. STATA 12.0 software was used for statistical analysis.
RESULTS A total of 12 studies involving 4467 patients were included. The pooled results indicated that the GGO predicted favorable overall survival (HR = 0.44, 95%CI: 0.34-0.59, P < 0.001) and disease-free survival (HR = 0.35, 95%CI: 0.18-0.70, P = 0.003). Subgroup analysis based on the ratio of GGO further demonstrated that the proportion of GGO was a good prognostic indicator in pathological stage I pulmonary adenocarcinoma patients, and patients with a higher ratio of GGO showed better prognosis than patients with a lower GGO ratio did.
CONCLUSION This meta-analysis manifested that the presence of GGO on CT predicted favorable prognosis in tumor-node-metastasis stage I lung adenocarcinoma. Patients with a higher GGO ratio were more likely to have a better prognosis than patients with a lower GGO ratio.
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Affiliation(s)
- Xue-Lin Pan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Zi-Ling Liao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hui Yao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Wei-Jie Yan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - De-Ying Wen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yan Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Zhen-Lin Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Chiang XH, Lu TP, Hsieh MS, Tsai TM, Liao HC, Kao TN, Chang CH, Lin MW, Hsu HH, Chen JS. Thoracoscopic Wedge Resection Versus Segmentectomy for cT1N0 Lung Adenocarcinoma. Ann Surg Oncol 2021; 28:8398-8411. [PMID: 34145505 DOI: 10.1245/s10434-021-10213-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/05/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND The choice between wedge resection and segmentectomy as a sublobar resection method for patients with cT1N0 lung cancer remains debatable. This study aimed to evaluate the clinical outcomes after wedge resection and segmentectomy for patients with cT1N0 lung adenocarcinoma. METHODS The study enrolled 1002 consecutive patients with cT1N0 lung adenocarcinoma who underwent sublobar resection at the authors' institution between 2011 and 2017. A propensity score-matching analysis was used to compared the clinical outcomes between the wedge resection and segmentectomy groups. RESULTS Wedge resection was performed for 810 patients (80.8%), and segmentectomy was performed for 192 patients (19.2%). Wedge resection resulted in better perioperative outcomes than segmentectomy. The multivariate analysis showed that the significant risk factors for poor disease-free survival (DFS) were elevated preoperative serum carcinoembryonic antigen levels, total tumor diameter greater than 2 cm, and a consolidation-to-tumor (C/T) ratio higher than 50%. After propensity-matching, no differences in overall survival or DFS were noted between the two matched groups. However, subgroup analysis showed that segmentectomy was associated with better DFS than wedge resection (p = 0.039) for the patients with a tumor diameter greater than 2 cm and a C/T ratio higher than 50%. CONCLUSION Segmentectomy is the appropriate surgical method for sublobar resection in cT1N0 lung adenocarcinoma patients with a tumor diameter greater than 2 cm and a C/T ratio higher than 50%. Wedge resection may be a safe and feasible sublobar resection method for patients with a tumor diameter of 2 cm or smaller or a C/T ratio of 50% or lower.
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Affiliation(s)
- Xu-Heng Chiang
- Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan
| | - Tzu-Pin Lu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Min-Shu Hsieh
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tung-Ming Tsai
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan.,Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsien-Chi Liao
- Department of Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tzu-Ning Kao
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-Hong Chang
- Statistics Education Center, National Taiwan University, Taipei, Taiwan
| | - Mong-Wei Lin
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Hsao-Hsun Hsu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jin-Shing Chen
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan.,Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Feasibility of limited resection for peripheral small-sized non-small cell lung cancer: a retrospective single-center-based study. J Cancer Res Clin Oncol 2020; 147:1519-1527. [PMID: 33151370 DOI: 10.1007/s00432-020-03441-1] [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: 09/14/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study aimed to establish new criteria for limited resection of non-small cell lung cancer (NSCLC) based on computed tomography findings and maximum standardized uptake value (SUVmax). METHODS Between December 2007 and December 2015, 611 patients underwent lung cancer surgery; of these, 70 with cT1aN0M0 who underwent limited resection were enrolled. Criteria for undergoing intentional limited resection (ILR) were (1) tumor ground-glass opacity (GGO) ratio of ≥ 0.75 and (2) tumor SUVmax ≤ 1.5. Patients who met criteria (1) and (2) underwent partial resection, and those who only met criteria (2) underwent segmentectomy as ILR. The control group was subjected to limited surgery without meeting the criteria. RESULTS Overall, 45 and 25 patients who met the criteria were included in the ILR and control groups, respectively. In the ILR group, 13 patients underwent partial resection, and 32 underwent segmentectomy; in the control group, 18 patients underwent partial resection and 7 underwent segmentectomy. According to our criteria, no relapsed cases occurred in the ILR group, although six patients showed recurrence of lung cancer in the control group. The 5-year overall survival (OS) rates in the ILR and control groups were 100% and 67.7%, respectively, and the relapse-free survival (RFS) rates were 100% and 61.6%, respectively. The log-rank test showed that this difference was statistically significant (OS: P < 0.0001, RFS: P < 0.0001). CONCLUSIONS SUVmax may serve as a predictive marker of recurrence to determine the treatment strategy for patients with NSCLC. Patients with low GGO ratio and low SUVmax may be cured by limited resection.
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Baig MZ, Razi SS, Weber JF, Connery CP, Bhora FY. Lobectomy is superior to segmentectomy for peripheral high grade non-small cell lung cancer ≤2 cm. J Thorac Dis 2020; 12:5925-5933. [PMID: 33209425 PMCID: PMC7656350 DOI: 10.21037/jtd-20-1530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Current practice guidelines recommend the following criteria for segmentectomy for non-small cell lung cancer (NSCLC): size ≤2 cm, margins ≥2 cm and no lymph node involvement. We sought to further stratify the selection criteria for segmentectomy for small peripheral high-grade tumors. Methods This retrospective database study was conducted using the Surveillance, Epidemiology and End Results (SEER) database. We queried for patients with high-grade (poorly differentiated/undifferentiated) pathological (p)T1a/b peripheral NSCLC (tumor size ≤2 cm), who underwent either lobectomy or segmentectomy between 2004 and 2015. Patients with node-positive disease or those who received any form of induction or adjuvant treatments were excluded. Results A total of 4,332 patients met the inclusion criteria, with 3,977 patients (91.8%) treated with lobectomy and 355 patients (8.2%) who underwent segmentectomy. In a propensity matched pair analysis of 640 patients, lobectomy (n=320) showed significantly improved 5-year survival of 45.9% vs. 33.8% for segmentectomy (n=320), P<0.01. In a multivariate Cox regression analysis, lobectomy was associated with significantly improved survival (HR: 0.84, 95% CI: 0.714–0.989, P=0.036). Interestingly, married status, adenocarcinoma histology, number of lymph nodes sampled were associated with better survival (P<0.05), while advanced age and male gender had worse survival outcomes (P<0.05). Conclusions For small peripheral NSCLC ≤2 cm and high grades of tumor differentiation, lobectomy is associated with better long-term survival outcomes as compared to segmentectomy. Additional data is needed to further stratify various NSCLC histologies with their respective grades to allow for better selection for segmentectomy.
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Affiliation(s)
- Mirza Zain Baig
- Division of Thoracic Surgery, Rudy L. Ruggles Biomedical Research Institute, Nuvance Health Systems, Danbury, CT, USA
| | - Syed S Razi
- Division of Thoracic Surgery, Memorial Healthcare System, South Broward, FL, USA
| | - Joanna F Weber
- Division of Thoracic Surgery, Rudy L. Ruggles Biomedical Research Institute, Nuvance Health Systems, Danbury, CT, USA
| | - Cliff P Connery
- Division of Thoracic Surgery, Nuvance Health Systems, Poughkeepsie, NY, USA
| | - Faiz Y Bhora
- Division of Thoracic Surgery, Rudy L. Ruggles Biomedical Research Institute, Nuvance Health Systems, Danbury, CT, USA
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Impact of tumor disappearance ratio on the prognosis of lung adenocarcinoma ≤2 cm in size: A retrospective cohort study. J Formos Med Assoc 2020; 120:874-882. [PMID: 32891489 DOI: 10.1016/j.jfma.2020.08.024] [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: 03/10/2020] [Revised: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND/PURPOSE Lung cancer patients can have advanced-stages at diagnosis, even the tumor size is ≤2 cm. We aimed to study the relationship between image characteristics, clinical, and patholoigcal results. METHODS We retrospectively enrolled patients with lung adenocarcinoma at Taichung Veterans General Hospital and Chang Gung Memorial Hospital from 2007 to 2015, who were diagnosed with treatment naïve primary tumor lesions at sizes less than 2 cm, as measured by computed tomography (CT) scans. The patient was analyzed for lymph node (LN) and distant metastasis evaluation, with clinicopathological characteristics, including tumor-disappearance ratio (TDR) (tumor diameter at the mediastinal/lung window) over chest CT scans, pathological diagnosis, disease-free survival (DFS), and overall survival (OS). RESULTS Totally 280 patients were surveyed initially and showed significantly increase of clinical LN involvement and distant metastasis when TDR ≤75% compared with >75% (21.6% vs 0% for LN involvement; 27.1% vs 0% for distant metastasis; both p < 0.001). We included 199 patients having surgical treatment and follow-up for the survival analysis. With a TDR ≤75%, significantly worse DFS (HR, 19.23; 95% CI, 2.60-142.01; p = 0.004) and a trend of worse OS (HR, 4.97; 95% CI, 0.61-40.61; p = 0.134) were noted by Kaplan-Meier method. TDR ≤75% revealed more advanced pathological stage, and more tumors containing micropapillary or solid subtypes when diagnosed adenocarcinoma. CONCLUSION For lung cancer patients with primary tumor ≤2 cm, TDR ≤75% was related to more advanced stages, the presence of micropapillary or solid components of adenocarcinoma subtypes, worse DFS, and a trend of worse OS.
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Raman V, Jawitz OK, Voigt SL, Rhodin KE, D'Amico TA, Harpole DH, Jeffrey Yang CF, Tong BC. The Effect of Tumor Size and Histologic Findings on Outcomes After Segmentectomy vs Lobectomy for Clinically Node-Negative Non-Small Cell Lung Cancer. Chest 2020; 159:390-400. [PMID: 32652096 DOI: 10.1016/j.chest.2020.06.066] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The interaction between tumor size and the comparative prognosis of lobar and sublobar resection has been defined poorly. RESEARCH QUESTION The purpose of this study was to characterize the relationship between tumor size and the receipt of segmentectomy or lobectomy in association with overall survival in patients with clinically node-negative non-small cell lung cancer (NSCLC). STUDY DESIGN AND METHODS The 2004-2015 National Cancer Database (NCDB) was queried for patients with cT1-3N0M0 NSCLC who underwent segmentectomy or lobectomy without neoadjuvant therapy or missing survival data. The primary outcome was overall survival, which was evaluated using multivariate Cox proportional hazards including an interaction term between tumor size and type of surgery. RESULTS A total of 143,040 patients were included: 135,446 (95%) underwent lobectomy and 7594 (5%) underwent segmentectomy. In multivariate Cox regression, a significant three-way interaction was found among tumor size, histologic results, and type of surgery (P < .001). When patients were stratified by histologic results, lobectomy was associated with significantly improved survival compared with segmentectomy beyond a tumor size of approximately 10 mm for adenocarcinoma and 15 mm for squamous cell carcinoma that was recapitulated in subgroup analyses. No interaction between tumor size and type of surgery was found for patients with neuroendocrine tumors. INTERPRETATION In this NCDB study of patients with node-negative NSCLC, we found different tumor size thresholds, based on histologic results, that identified populations of patients who least and most benefitted from lobectomy compared with segmentectomy.
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Affiliation(s)
- Vignesh Raman
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
| | - Oliver K Jawitz
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Soraya L Voigt
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Kristen E Rhodin
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Thomas A D'Amico
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - David H Harpole
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Chi-Fu Jeffrey Yang
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Palo Alto, CA
| | - Betty C Tong
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
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Xie B, Sui T, Qin Y, Miao S, Jiao W. [Comparison of Short-term Outcomes of Lung Segmentectomy by Robotic-assisted and Video-assisted Thoracoscopic Surgery]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 22:767-771. [PMID: 31874672 PMCID: PMC6935034 DOI: 10.3779/j.issn.1009-3419.2019.12.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
背景与目的 肺段切除术的开展越来越广泛,在现在的外科技术下,电视辅助胸腔镜手术(video-assisted thoracic surgery, VATS)是广泛采用的手术方式,同时机器人辅助胸腔镜手术(robot-assisted thoracic surgery, RATS)也提供了一种精准高效的手术方式,本研究旨在对比两种手术方式在肺段切除术中的短期效果。 方法 回顾性分析2016年1月-2017年4月在青岛大学附属医院胸外科行VATS及RATS肺段切除术的患者临床资料,比较两组患者基线数据及手术时间、术中失血量、淋巴结切除数、术后胸腔引流管带管天数、术后住院天数、术后房颤及肺部感染发生率等。 结果 共166例患者接受肺段切除术,两组均无中转开胸及围手术期死亡病例。其中VATS 85例,RATS 81例,术中淋巴结切除数在RATS组多于VATS组,差异具有统计学意义[(13.07±5.08)个vs(10.81±5.74)个,P=0.010)],两组在手术时间、术中失血量、术后带管时间及住院时间无统计学差异(P > 0.05),术后的房颤、肺漏气(≥6 d)及术后肺炎发生率方面二组差异无统计学意义(P > 0.05)。 结论 相比于VATS,RATS具有相似的安全性及可操作性,淋巴结切除数目较VATS明显为多。
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Affiliation(s)
- Boheng Xie
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266071, China
| | - Tianyi Sui
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266071, China
| | - Yi Qin
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266071, China
| | - Shuncheng Miao
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266071, China
| | - Wenjie Jiao
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266071, China
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Ijsseldijk MA, Shoni M, Siegert C, Wiering B, van Engelenburg AKC, Tsai TC, Ten Broek RPG, Lebenthal A. Oncologic Outcomes of Surgery Versus SBRT for Non-Small-Cell Lung Carcinoma: A Systematic Review and Meta-analysis. Clin Lung Cancer 2020; 22:e235-e292. [PMID: 32912754 DOI: 10.1016/j.cllc.2020.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/21/2020] [Accepted: 04/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The optimal treatment of stage I non-small-cell lung carcinoma is subject to debate. The aim of this study was to compare overall survival and oncologic outcomes of lobar resection (LR), sublobar resection (SR), and stereotactic body radiotherapy (SBRT). METHODS A systematic review and meta-analysis of oncologic outcomes of propensity matched comparative and noncomparative cohort studies was performed. Outcomes of interest were overall survival and disease-free survival. The inverse variance method and the random-effects method for meta-analysis were utilized to assess the pooled estimates. RESULTS A total of 100 studies with patients treated for clinical stage I non-small-cell lung carcinoma were included. Long-term overall and disease-free survival after LR was superior over SBRT in all comparisons, and for most comparisons, SR was superior to SBRT. Noncomparative studies showed superior long-term overall and disease-free survival for both LR and SR over SBRT. Although the papers were heterogeneous and of low quality, results remained essentially the same throughout a large number of stratifications and sensitivity analyses. CONCLUSION Results of this systematic review and meta-analysis showed that LR has superior outcomes compared to SBRT for cI non-small-cell lung carcinoma. New trials are underway evaluating long-term results of SBRT in potentially operable patients.
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Affiliation(s)
- Michiel A Ijsseldijk
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Melina Shoni
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Charles Siegert
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA
| | - Bastiaan Wiering
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands
| | | | - Thomas C Tsai
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Richard P G Ten Broek
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Abraham Lebenthal
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA; Harvard Medical School, Boston, MA
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Zheng E, Yang M, Li R, Ni J, Xu X, Zhao G. Prognostic impact of lymphadenectomy on outcomes of sublobar resection for non-small cell lung cancer ≤1 or >1 to 2 cm. J Thorac Dis 2020; 12:2049-2060. [PMID: 32642107 PMCID: PMC7330392 DOI: 10.21037/jtd-19-3773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Lymphadenectomy is an important part of surgical treatment for non-small cell lung cancer (NSCLC). However, the prognostic impact of lymph node (LN) dissection for patients with NSCLC ≤1 and >1 to 2 cm who underwent sublobar resection is still unclear. Methods A group of patients numbering 7,627 with NSCLC 2 cm or less who underwent sublobar resection were identified from the Surveillance, Epidemiology, and End Results (SEER) database between January 2010 and November 2015. The overall survival (OS) and lung cancer-specific survival (LCSS) were evaluated among patients who had undergone dissection of ≥4 LNs, 1 to 3 LNs or who had no-LN dissection; log-rank and Cox proportional-hazards regression analyses were used for the evaluation. Results Patients with NSCLC ≤2 cm who underwent ≥4 LNs dissection had better OS and LCSS compared with those who underwent dissection of 1 to 3 LNs or who had no-LN dissection after sublobar resection. Subgroup analysis showed that dissection of ≥4 LNs had better OS and LCSS than those of 1 to 3 LNs dissection in NSCLC >1 to 2 cm, whereas had similar OS and LCSS in NSCLC ≤1 cm. Multivariate Cox analysis showed that dissection of 1 to 3 LNs was not an independent risk factor of OS and LCSS than dissection of ≥4 LNs in NSCLC ≤1 cm after sublobar resection. Conclusions The extent of LN dissection is associated with the survival outcomes in patients with NSCLC ≤2 cm after sublobar resection. Dissection of ≥4 LNs should be recommended for NSCLC >1 to 2 cm, whereas surgeons can rely on surgical skills and patient profiles to decide ≥4 LNs or 1 to 3 LNs dissection for NSCLC ≤1 cm during sublobar resection.
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Affiliation(s)
- Enkuo Zheng
- Department of Thoracic Surgery, Hua Mei Hospital, University of Chinese Academy of Science, Ningbo 315012, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Science, Ningbo 315012, China
| | - Minglei Yang
- Department of Thoracic Surgery, Hua Mei Hospital, University of Chinese Academy of Science, Ningbo 315012, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Science, Ningbo 315012, China
| | - Rui Li
- Department of Thoracic Surgery, Hua Mei Hospital, University of Chinese Academy of Science, Ningbo 315012, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Science, Ningbo 315012, China
| | - Junjun Ni
- Department of Thoracic Surgery, Hua Mei Hospital, University of Chinese Academy of Science, Ningbo 315012, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Science, Ningbo 315012, China
| | - Xiang Xu
- Department of Thoracic Surgery, Hua Mei Hospital, University of Chinese Academy of Science, Ningbo 315012, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Science, Ningbo 315012, China
| | - Guofang Zhao
- Department of Thoracic Surgery, Hua Mei Hospital, University of Chinese Academy of Science, Ningbo 315012, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Science, Ningbo 315012, China
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11
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Lutfi W, Schuchert MJ, Dhupar R, Sarkaria I, Christie NA, Yang CFJ, Deng JZ, Luketich JD, Okusanya OT. Sublobar resection is associated with decreased survival for patients with early stage large-cell neuroendocrine carcinoma of the lung. Interact Cardiovasc Thorac Surg 2020; 29:517-524. [PMID: 31177277 DOI: 10.1093/icvts/ivz140] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/16/2019] [Accepted: 05/01/2019] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES Sublobar resection (SLR) for early non-small-cell lung carcinoma (NSCLC) has been shown to have a survival rate similar to that of lobectomy. Large-cell neuroendocrine carcinoma (LCNEC) of the lung, although treated like an NSCLC, has a poor prognosis compared to NSCLC. We sought to determine if outcomes are poor in patients with early stage LCNEC treated with SLR versus lobectomy. METHODS We searched for patients with pathological stage I LCNEC ≤3 cm within the National Cancer Database between 2004 and 2014. Propensity score matching was used to compare the 5-year overall survival rate of patients having SLR (wedge or segmentectomy) to that of patients having a lobectomy. Patients were matched for age, node sampling, comorbidity score, tumour size, insurance status and other factors. Patients who received neoadjuvant therapy were excluded. Kaplan-Meier methods were used for analysis. RESULTS A total of 1011 patients met the inclusion criteria: 263 were treated with SLR (223 wedges and 40 segmentectomies) and 748 patients, with lobectomy. Patients who received SLR were older, had more comorbidities and smaller tumours. On unadjusted Kaplan-Meier analysis, patients who had SLR had decreased 5-year overall survival compared to those who had a lobectomy (37.9% vs 56.6%, P < 0.001). Propensity score matching (1:1) across 12 demographic and tumour variables yielded 185 patients per group with 34 segmentectomies and 151 wedge resections in the SLR cohort. On Kaplan-Meier analysis of the matched cohort, patients who had SLR had a worse 5-year overall survival rate compared to those who had a lobectomy (41.5% vs 60.3%; P = 0.001). CONCLUSIONS SLR for early stage LCNEC is associated with a lower 5-year overall survival rate compared to lobectomy on unadjusted and propensity matched analyses.
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Affiliation(s)
- Waseem Lutfi
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Matthew J Schuchert
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Rajeev Dhupar
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Inderpal Sarkaria
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Neil A Christie
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Chi-Fu J Yang
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - John Z Deng
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - James D Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Olugbenga T Okusanya
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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12
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Zhang H, Liu C, Tan Z, Zhang T. Segmentectomy Versus Wedge Resection for Stage I Non–Small Cell Lung Cancer: A Meta-analysis. J Surg Res 2019; 243:371-379. [DOI: 10.1016/j.jss.2019.05.058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/11/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
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13
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Xie B, Sun X, Qin Y, Liu A, Miao S, Jiao W. Short-term outcomes of typical versus atypical lung segmentectomy by minimally invasive surgeries. Thorac Cancer 2019; 10:1812-1818. [PMID: 31373437 PMCID: PMC6718014 DOI: 10.1111/1759-7714.13152] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 06/30/2019] [Accepted: 07/02/2019] [Indexed: 11/27/2022] Open
Abstract
Background Segmentectomy is increasingly used to resect lung nodules. Robotic‐assisted thoracic surgery (RATS) is considered a safe and practical method for segmentectomy. Few studies have compared robotic surgery and video‐assisted thoracic surgery (VATS) for lung segmentectomy. Method We retrospectively examined 215 consecutive patients who underwent typical (88 patients) or atypical (128 patients) segmentectomy by either robotic surgery or VATS. The postoperative characteristics including operation time, blood loss, pneumonia, tumor size, lymph nodes harvested, chest tube duration, prolonged air leak, atrial fibrillation, and postoperative hospital stay were recorded. Results A total of 88 patients underwent typical segmentectomy, while 127 patients underwent atypical segmentectomy. A greater number of lymph nodes were resected via RATS than by VATS (13.24 ± 4.84 vs. 11.71 ± 3.89; P = 0.018). The operation time for typical segmentectomy was shorter than that for atypical segmentectomy (115.69 ± 22.32 vs. 131.68 ± 22.52; P = 0). No significant differences were found between RATS and VATS in terms of chest drainage duration and postoperative hospital stay. The incidence of postoperative complications including prolonged air leak and atrial fibrillation was not significantly different between typical segmentectomy and atypical segmentectomy. Conclusion Atypical segmentectomy is more complicated than typical segmentectomy, which may lead to increases in complications and operation time. Robotic surgery was safe and practical for segmentectomy compared to VATS and more lymph nodes could be dissected by RATS without increasing the risk of postoperative complications.
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Affiliation(s)
- Boheng Xie
- Division of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China.,No.1 People's Hospital, Ningyang county, China
| | - Xiao Sun
- Division of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yi Qin
- Division of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ao Liu
- Division of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shuncheng Miao
- Division of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenjie Jiao
- Division of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
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