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Nakahashi K, Nakatsuka M, Endo M, Shiono S. Tumor volume doubling time as a potential predictor of prognosis in clinical stage I lung squamous cell carcinoma. J Thorac Dis 2023; 15:3849-3859. [PMID: 37559608 PMCID: PMC10407515 DOI: 10.21037/jtd-23-292] [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: 02/25/2023] [Accepted: 06/12/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Tumor volume doubling time (VDT) has been shown to predict prognosis in various non-small cell lung carcinoma with scant evidence for lung squamous cell carcinoma (SCC). The purpose of this study was to investigate the prognostic value of tumor VDT in resected lung SCCs. METHODS In this study, subjects were 51 patients who underwent lobectomy for clinical stage I SCC of the peripheral lung at our institution between January 2006 and April 2020. Univariable and multivariable analyses of overall survival (OS) and recurrence-free survival (RFS) were performed using the Cox proportional hazards model. The Kaplan-Meier method was used to create OS and RFS curves and to determine statistical significance. The cut-off value of VDT was defined by receiver operating characteristic (ROC) curve analysis on survival. RESULTS Multivariable analysis found only VDT (HR, 0.990; 95% CI: 0.979-0.997) to be an independent predictor of OS. Also, only VDT (HR, 0.989; 95% CI: 0.978-0.995) was an independent predictor of RFS. The 5-year OS rates were 88.4% and 30.4% in the long (≥150 days) and short (<150 days) VDT groups, respectively (P=0.002). The 5-year RFS rates were 88.8% and 26.5% in the long (≥150 days) and short (<150 days) VDT groups, respectively (P<0.001). CONCLUSIONS Tumor VDT was found to be a useful prognostic predictor in clinical stage I lung SCC in this study.
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Affiliation(s)
- Kenta Nakahashi
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Marina Nakatsuka
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Makoto Endo
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Satoshi Shiono
- Faculty of Medicine, Second Department of Surgery, Yamagata University, Yamagata, Japan
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Gkikas A, Kakos C, Lampridis S, Godolphin PJ, Patrini D. Preoperative prognostic factors for 5-year survival following pulmonary metastasectomy from colorectal cancer: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2023; 63:ezad059. [PMID: 36806915 DOI: 10.1093/ejcts/ezad059] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/05/2023] [Accepted: 02/19/2023] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVES We seek to identify preoperative prognostic factors and measure their effect on 5-year survival following pulmonary metastasectomy (PM) for Colorectal Cancer (CRC). METHODS We systematically reviewed the databases of Cochrane Library, MEDLINE, Embase and Google Scholar from January 2000 to April 2021 to identify preoperative factors that have been investigated for their prognostic effect on survival following PM. Quality assessment was performed using the QUIPS tool. The prognostic effect of each identified factor on 5-year survival post-PM was estimated using random-effects meta-analyses. RESULTS We identified 115 eligible articles which included 13 294 patients who underwent PM from CRC. The overall 5-year survival after resection of the lung metastasis was 54.1%. The risk of bias of the included studies was at least moderate in 93% (107/115). Seventy-seven preoperative factors had been investigated for their prognostic effect. Our analysis showed that 11 factors had favourable and statistically significant prognostic effect on 5-year survival post-PM. These included solitary metastasis, size <2 cm, unilateral location, N0 thoracic disease, no history of extra-thoracic or liver metastasis, normal carcinoembryonic antigen levels both before PM and CRC excision, no neo-adjuvant chemotherapy before PM, CRC T-stage < T4 and no p53 mutations on CRC. Disease-free interval at 24 months did not appear to affect 5-year survival. CONCLUSIONS Despite the considerable risk of bias in the literature, our study consolidates the available evidence on preoperative prognostic factors for PM from CRC. These findings can complement both clinical practice and the design of future research on the field of PM.
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Affiliation(s)
- Andreas Gkikas
- Department of General Surgery, Hillingdon Hospital, The Hillingdon Hospitals NHS Foundation Trust, London, UK
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Christos Kakos
- Department of General Surgery, Royal Victoria Hospital, Belfast, UK
| | - Savvas Lampridis
- Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Peter J Godolphin
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Davide Patrini
- Department of Thoracic Surgery, University College London Hospitals, London, UK
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Nakahashi K, Shiono S, Nakatsuka M, Endo M. Prognostic impact of the tumor volume doubling time in clinical T1 non-small cell lung cancer with solid radiological findings. J Surg Oncol 2022; 126:1330-1340. [PMID: 35921201 DOI: 10.1002/jso.27043] [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: 04/19/2022] [Revised: 07/01/2022] [Accepted: 07/22/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The purpose of this study was to investigate better radiological prognostic factors in clinical T1 pure-solid non-small cell lung cancer (NSCLC). METHODS This study enrolled 284 patients with clinical T1 solid NSCLC who underwent anatomical lung resection. The Cox proportional hazard model was used to evaluate the prognostic impact of tumor volume doubling time (VDT) at disease-free survival (DFS) and cancer-specific survival (CSS). RESULTS The median VDT was 347 days. Age (hazard ratio (HR) = 1.04; 95% confidence interval (CI), 1.01-1.07) and standardized uptake value max (SUVmax) (>6.0) (HR = 2.61; 95% CI, 1.52-4.66) were identified as significantly independent worse prognostic factors for DFS in a multivariable analysis without VDT. Furthermore, a multivariable analysis without SUVmax identified age (HR = 1.06; 95% CI, 1.03-1.09), CEA (>5.0 ng/ml) (HR = 2.34; 95% CI, 1.30-4.02), tumor diameter on CT (>2.0 cm) (HR = 1.91; 95% CI, 1.18-3.13), and VDT (HR = 4.03; 95% CI, 2.41-6.93) as significantly independent worse prognostic factors for DFS. CONCLUSIONS The VDT value could be a useful prognostic factor in clinical T1 solid NSCLC.
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Affiliation(s)
- Kenta Nakahashi
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Yamagata, Japan
| | - Satoshi Shiono
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Yamagata, Japan
| | - Marina Nakatsuka
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Yamagata, Japan
| | - Makoto Endo
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Yamagata, Japan
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Uporov A, Taber S, Estèvez Schwarz L, Groene J, Pilz LR, Foerster G, Bittner R, Pfannschmidt J. Implication of FDG-PET/CT in patients with potentially operable colorectal lung metastases. Innov Surg Sci 2021; 6:89-95. [PMID: 35224176 PMCID: PMC8826161 DOI: 10.1515/iss-2021-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 10/07/2021] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
This prospective study assessed the role of F-18-FDG-PET/CT in clinical staging for patients with colorectal cancer planned for pulmonary metastasectomy by thoracotomy or video-assisted surgery.
Patients and methods
In addition to conventional imaging, we performed 86 F-18-FDG-PET/CT studies in 76 patients with potentially resectable metastatic colorectal lung metastases. We then investigated the effect that PET/CT had on further clinical management. Based on the results from the 47 thoracotomies performed, we compared the number of pulmonary metastases discovered after histologic examination with the number predicted by the conventional computed tomography (CT) as an independent part of the F-18-FDG-PET/CT examination and by the F-18-FDG-PET component.
Results
F-18-FDG-PET/CT led to changes in treatment regime and diagnostic planning in many patients. In five patients PET/CT revealed previously undetected local recurrence of the primary colorectal cancer, in four patients hepatic metastases, in three patients bone metastases, in two patients soft-tissue metastases, and in three patients histologically preoperatively proven N2 or N3 station lymph node involvement. These all constituted exclusion criteria, and consequently the previously planned pulmonary metastasectomy was not performed. The sensitivity and positive predictive value (PPV) for detection of pulmonary metastases were 84.2% and 36.4% for CT and 75.0% and 61.6% for F-18-FDG-PET study. The calculated sensitivity, specificity, PPV, and NPV of F-18-FDG-PET/CT for detecting thoracic lymph node involvement were 85.7%, 93.0%, 66.7%, and 97.5%, respectively. Furthermore, we found that F-18-FDG-PET/CT may predict thoracic lymph node involvement based on the SUV of pulmonary nodules.
Conclusions
F-18-FDG-PET/CT has a clear role in the diagnostic workup for pulmonary metastatic colorectal cancer and may save patients from futile surgery. It cannot, however, be relied on to detect all possible pulmonary and nodal metastases, which surgeons must always consider when making treatment decisions.
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Affiliation(s)
- Anton Uporov
- Department of Thoracic Surgery , Heckeshorn Lung Clinic – HELIOS Klinikum Emil von Behring , Berlin , Germany
| | - Samantha Taber
- Department of Thoracic Surgery , Heckeshorn Lung Clinic – HELIOS Klinikum Emil von Behring , Berlin , Germany
| | | | - Joern Groene
- Department of Surgery , St. Joseph-Hospital , Berlin , Germany
| | - Lothar R. Pilz
- Medical Faculty Mannheim, Heidelberg University , Mannheim , Germany
| | - Gregor Foerster
- Department of Radiology and Nuclear Medicine , HELIOS Klinikum Emil von Behring , Berlin , Germany
| | - Roland Bittner
- Department of Radiology and Nuclear Medicine , HELIOS Klinikum Emil von Behring , Berlin , Germany
| | - Joachim Pfannschmidt
- Department of Thoracic Surgery , Heckeshorn Lung Clinic – HELIOS Klinikum Emil von Behring , Berlin , Germany
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Gutiérrez E, Sánchez I, Díaz O, Valles A, Balderrama R, Fuentes J, Lara B, Olimón C, Ruiz V, Rodríguez J, Bayardo LH, Chan M, Villafuerte CJ, Padayachee J, Sun A. Current Evidence for Stereotactic Body Radiotherapy in Lung Metastases. ACTA ACUST UNITED AC 2021; 28:2560-2578. [PMID: 34287274 PMCID: PMC8293144 DOI: 10.3390/curroncol28040233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 12/25/2022]
Abstract
Lung metastases are the second most common malignant neoplasms of the lung. It is estimated that 20–54% of cancer patients have lung metastases at some point during their disease course, and at least 50% of cancer-related deaths occur at this stage. Lung metastases are widely accepted to be oligometastatic when five lesions or less occur separately in up to three organs. Stereotactic body radiation therapy (SBRT) is a noninvasive, safe, and effective treatment for metastatic lung disease in carefully selected patients. There is no current consensus on the ideal dose and fractionation for SBRT in lung metastases, and it is the subject of study in ongoing clinical trials, which examines different locations in the lung (central and peripheral). This review discusses current indications, fractionations, challenges, and technical requirements for lung SBRT.
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Affiliation(s)
- Enrique Gutiérrez
- Princess Margaret Cancer Centre, Radiation Medicine Program, University Health Network, Toronto, ON M5G2M9, Canada; (E.G.); (M.C.); (C.J.V.); (J.P.)
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5G2M9, Canada
| | - Irving Sánchez
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Omar Díaz
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Adrián Valles
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Ricardo Balderrama
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Jesús Fuentes
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Brenda Lara
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Cipatli Olimón
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Víctor Ruiz
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - José Rodríguez
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Luis H. Bayardo
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Matthew Chan
- Princess Margaret Cancer Centre, Radiation Medicine Program, University Health Network, Toronto, ON M5G2M9, Canada; (E.G.); (M.C.); (C.J.V.); (J.P.)
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5G2M9, Canada
| | - Conrad J. Villafuerte
- Princess Margaret Cancer Centre, Radiation Medicine Program, University Health Network, Toronto, ON M5G2M9, Canada; (E.G.); (M.C.); (C.J.V.); (J.P.)
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5G2M9, Canada
| | - Jerusha Padayachee
- Princess Margaret Cancer Centre, Radiation Medicine Program, University Health Network, Toronto, ON M5G2M9, Canada; (E.G.); (M.C.); (C.J.V.); (J.P.)
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5G2M9, Canada
| | - Alexander Sun
- Princess Margaret Cancer Centre, Radiation Medicine Program, University Health Network, Toronto, ON M5G2M9, Canada; (E.G.); (M.C.); (C.J.V.); (J.P.)
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5G2M9, Canada
- Correspondence: ; Tel.: +1-41-6946-2853
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Huang J, Zang Q, Wen Y, Pan Z, Yao Z, Huang M, Huang J, Chen J, Wang R. Prognostic value of KRAS mutation in patients undergoing pulmonary metastasectomy for colorectal cancer: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2021; 160:103308. [PMID: 33753248 DOI: 10.1016/j.critrevonc.2021.103308] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/26/2021] [Accepted: 03/03/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The purpose of the study was to evaluate whether KRAS mutation could be an independent prognostic biomarker in patients undergoing pulmonary metastasectomy (PM) for colorectal cancer (CRC). METHODS A systemic review was performed by searching online databases to identify studies reporting overall survival (OS) and recurrence free survival (RFS) of CRC patients undergoing PM. Pooled HRs were calculated for OS and RFS. RESULTS A total of 15233 patients from 60 studies were included. Pooled analysis showed that KRAS mutation was associated with worse OS (HR: 1.86, 95 % Cl: 1.35-2.57) and RFS (HR: 1.68, 95 % Cl: 1.38-2.04). A significant effect on OS and/or RFS was also shown by other 18 factors. CONCLUSIONS This meta-analysis found that KRAS mutation is an important prognostic predictor for OS and RFS in CRC patients undergoing PM, supporting a comprehensive model including clinicopathological and biological factors for optimal patients selection and prognosis for surgical treatment.
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Affiliation(s)
- Junfeng Huang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China; Nanshan School of Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Qing Zang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China; Nanshan School of Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yaokai Wen
- Nanshan School of Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhe Pan
- Nanshan School of Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhiyuan Yao
- Nanshan School of Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Mingkai Huang
- Nanshan School of Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jiongqiang Huang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jingsong Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
| | - Rongchang Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
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