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Senchukova MA, Kalinin EA, Volchenko NN. Predictors of disease recurrence after radical resection and adjuvant chemotherapy in patients with stage IIb-IIIa squamous cell lung cancer: A retrospective analysis. World J Exp Med 2024; 14:89319. [PMID: 38590307 PMCID: PMC10999066 DOI: 10.5493/wjem.v14.i1.89319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/20/2023] [Accepted: 01/10/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Lung cancer (LC) is a global medical, social and economic problem and is one of the most common cancers and the leading cause of mortality from malignant neoplasms. LC is characterized by an aggressive course, and in the presence of disease recurrence risk factors, patients, even at an early stage, may be indicated for adjuvant therapy to improve survival. However, combined treatment does not always guarantee a favorable prognosis. In this regard, establishing predictors of LC recurrence is highly important both for determining the optimal treatment plan for the patients and for evaluating its effectiveness. AIM To establish predictors of disease recurrence after radical resection and adjuvant chemotherapy in patients with stage IIb-IIIa lung squamous cell carcinoma (LSCC). METHODS A retrospective case-control cohort study included 69 patients with LSCC who underwent radical surgery at the Orenburg Regional Clinical Oncology Center from 2009 to 2018. Postoperatively, all patients received adjuvant chemotherapy. Histological samples of the resected lung were stained with Mayer's hematoxylin and eosin and examined under a light microscope. Univariate and multivariate analyses were used to identify predictors associated with the risk of disease recurrence. Receiver operating characteristic curves were constructed to discriminate between patients with a high risk of disease recurrence and those with a low risk of disease recurrence. Survival was analyzed using the Kaplan-Meier method. The log-rank test was used to compare survival curves between patient subgroups. Differences were considered to be significant at P < 0.05. RESULTS The following predictors of a high risk of disease recurrence in patients with stage IIb-IIa LSCC were established: a low degree of tumor differentiation [odds ratio (OR) = 7.94, 95%CI = 1.08-135.81, P = 0.049]; metastases in regional lymph nodes (OR = 5.67, 95%CI = 1.09-36.54, P = 0.048); the presence of loose, fine-fiber connective tissue in the tumor stroma (OR = 21.70, 95%CI = 4.27-110.38, P = 0.0002); and fragmentation of the tumor solid component (OR = 2.53, 95%CI = 1.01-12.23, P = 0.049). The area under the curve of the predictive model was 0.846 (95%CI = 0.73-0.96, P < 0.0001). The sensitivity, accuracy and specificity of the method were 91.8%, 86.9% and 75.0%, respectively. In the group of patients with a low risk of LSCC recurrence, the 1-, 2- and 5-year disease-free survival (DFS) rates were 84.2%, 84.2% and 75.8%, respectively, while in the group with a high risk of LSCC recurrence the DFS rates were 71.7%, 40.1% and 8.2%, respectively (P < 0.00001). Accordingly, in the first group of patients, the 1-, 2- and 5-year overall survival (OS) rates were 94.7%, 82.5% and 82.5%, respectively, while in the second group of patients, the OS rates were 89.8%, 80.1% and 10.3%, respectively (P < 0.00001). CONCLUSION The developed method allows us to identify a group of patients at high risk of disease recurrence and to adjust to ongoing treatment.
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Affiliation(s)
- Marina A Senchukova
- Department of Oncology, Orenburg State Medical University, Orenburg 460000, Russia
| | - Evgeniy A Kalinin
- Department of Thoracic Surgery, Orenburg Regional Cancer Clinic, Orenburg 460021, Russia
| | - Nadezhda N Volchenko
- Department of Pathology, P. A. Hertzen Moscow Oncology Research Centre, National Medical Research Centre of Radiology, Moscow 125284, Russia
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Liu S, Wan S, Feng J, Pang Y, Wang H, Zeng H, Xu X. Meta-analysis of the efficacy of postoperative adjuvant chemotherapy for stage IB non-small cell lung cancer. Medicine (Baltimore) 2024; 103:e36839. [PMID: 38181235 PMCID: PMC10766225 DOI: 10.1097/md.0000000000036839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/12/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Many clinical trials have shown that postoperative adjuvant chemotherapy can provide a survival benefit for patients with stage IB non-small cell lung cancer. However, whether adjuvant chemotherapy should be routinely given after surgery remains controversial. Therefore, we performed a meta-analysis to investigate the efficacy of adjuvant chemotherapy versus surgery alone for stage IB non-small cell lung cancer (NSCLC). METHODS Relevant retrospective studies or randomized controlled trial comparing the efficacy of postoperative adjuvant chemotherapy versus observation on the survival outcomes of NSCLC patients up to October 30, 2023 were searched in PubMed, Web of Science, EMBASE, Cochrane Library, VIP database, Wanfang database, and China National Knowledge Internet database. Patient survival data, population characteristics, and other relevant information were extracted, and data were analyzed using Review Manager 5.4. The primary endpoints included overall survival, disease-free survival, and recurrence-free survival. RESULTS A total of 13 randomized controlled trials or cohort studies including 19,442 patients were included. The results of the meta-analysis showed that postoperative adjuvant chemotherapy in patients with stage IB NSCLC had better overall survival (odds ratio [OR] = 1.25, 95% confidence interval [CI] 1.19-1.31, P < .00001) and disease-free survival or recurrence-free survival (OR = 1.57, 95% CI 1.3-1.9, P < .00001) compared with observation; and the 4-year survival rate of patients who received postoperative adjuvant chemotherapy was better than the observation group (OR = 1.52, 95% CI 1.05-2.18, P = .03); and the 8-year survival rate of patients receiving postoperative adjuvant chemotherapy (OR = 1.5, 95% CI 0.94-2.4, P = .09) was comparable to the observation group. CONCLUSION Receiving postoperative adjuvant chemotherapy improved people's survival and prolonged disease-free survival and recurrence-free survival in patients with stage IB non-small cell lung cancer compared with surgery alone.
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Affiliation(s)
- Siqi Liu
- Department of Oncology, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People’s Hospital, Yichang, China
| | - Sha Wan
- Department of Anatomy, College of Basic Medicine, Guilin Medical University, Guilin, China
| | - Jinghui Feng
- Department of Oncology, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People’s Hospital, Yichang, China
| | - Yaqi Pang
- Department of Oncology, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People’s Hospital, Yichang, China
| | - Haiqing Wang
- Department of Oncology, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People’s Hospital, Yichang, China
| | - Hui Zeng
- Department of Oncology, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People’s Hospital, Yichang, China
| | - Xinhua Xu
- Department of Oncology, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People’s Hospital, Yichang, China
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Xu R, Chen J, Chen D, Zhang X, Cui W, Deng Y, Sun D, Yuan B, Li J. CT-guided Percutaneous Microwave Ablation Combined with Local Radiotherapy or Chemotherapy of Malignant Pulmonary Tumors. Curr Radiopharm 2024; 17:184-199. [PMID: 38204263 PMCID: PMC11327768 DOI: 10.2174/0118744710261655231214105406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/18/2023] [Accepted: 10/30/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND AND OBJECTIVE The study aimed to investigate the clinical efficacy of CT-guided microwave ablation (MWA) combined with 125I seed implantation or bronchial arterial infusion (BAI) chemotherapy in the treatment of malignant pulmonary tumors. METHODS A total of 56 patients who underwent MWA, MWA combined with 125I particle implantation, or MWA combined with BAI chemotherapy for advanced lung cancer or metastatic lung cancer from January 2015 to June 2021 in Guangdong Provincial People's Hospital were enrolled. Among them, 21 patients were treated with MWA (MWA), 18 with MWA combined with 125I seed implantation (MWA+125I), and 17 with MWA combined with BAI chemotherapy (MWA+BAI). The short-term outcomes, complications, Eastern Cooperative Oncology Group (ECOG) performance score (Zubrod-ECOG-WHO, ZPS), survival, and factors related to survival were compared between the three groups. RESULTS The response rate of the MWA group (9.52%) was significantly lower than that of the MWA+125I group (50.00%) and MWA+BAI chemotherapy group (47.06%), and the differences were statistically significant (p < 0.05). The incidence of complications in the MWA, MWA+125I, and MWA+BAI chemotherapy groups was 47.62%, 55.56%, and 52.94%, respectively, with no significant difference (p > 0.05). Three months after the treatment, the ZPS of the MWA+125I and MWA+BAI chemotherapy groups was significantly lower than before treatment and significantly lower than that of the MWA group in the same period; the differences were statistically significant (p < 0.05). The median survival time of the MWA+125I group was 18 (9.983, 26.017) months and that of the MWA+BAI chemotherapy group was 21 (0.465, 41.535) months, both of which were higher than that of the MWA group [11 (6.686, 15.314) months]; the differences were statistically significant (p < 0.05). Cox regression analysis was performed on the factors related to survival and revealed treatment mode as a protective factor [HR = 0.433, 95% CI = (0.191, 0.984), p = 0.046]. Other factors, such as gender, age, and tumor size, did not independently affect survival. CONCLUSION CT-guided MWA combined with 125I seed implantation and MWA combined with BAI chemotherapy are safe and effective for the treatment of advanced lung cancer and metastatic lung cancer, and can control tumor progression and prolong survival time.
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Affiliation(s)
- Rongde Xu
- Department of Interventional Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510080, China
| | - Jingjing Chen
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510080, China
| | - Daohua Chen
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, 510080, China
| | - Xiaobo Zhang
- School of Automation, Guangdong University of Technology, Guangzhou, Guangdong, 510006, China
| | - Wei Cui
- Department of Interventional Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510080, China
| | - Yi Deng
- Department of Pulmonary and Critical Care Medicine, The First People's Hospital of Yunnan Province. The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, 650000, China
- Medical School, Kunming University of Science and Technology, Kunming, Yunnan, 650000, China
| | - Danxiong Sun
- Department of Pulmonary and Critical Care Medicine, The First People's Hospital of Yunnan Province. The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, 650000, China
| | - Bing Yuan
- Department of Pulmonary and Critical Care Medicine, The First People's Hospital of Yunnan Province. The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, 650000, China
| | - Jing Li
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510080, China
- Department of Pulmonary and Critical Care Medicine, The First People's Hospital of Yunnan Province. The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, 650000, China
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Cheng YF, Chen YL, Liu CC, Lin CM, Tong SS, Wang BY. Adjuvant chemotherapy in pathological node-negative non-small cell lung cancer. Sci Rep 2023; 13:19137. [PMID: 37932436 PMCID: PMC10628181 DOI: 10.1038/s41598-023-46679-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/03/2023] [Indexed: 11/08/2023] Open
Abstract
Non-small cell lung cancer (NSCLC) is associated with a poor survival rate, even for patients with early-stage cancer. Identifying patients with pathological N0 NSCLC who may benefit from adjuvant chemotherapy treatment after surgery is essential. We conducted a retrospective cohort study used data from the Surveillance, Epidemiology, and End Results database and included 26,380 patients with pathological N0 NSCLC after surgery between January 2018, and December 2019. Among 26,380 patients, 24,273 patients received surgery alone and the other 2107 patients received surgery plus adjuvant chemotherapy. After 1:1 propensity score matching, both groups contained 2107 patients. Adjuvant chemotherapy did not show significantly better 24-month survival in T2aN0 NSCLC patients (83.41% vs. 82.91%, p = 0.067), although it did for T2bN0 patients (86.36% vs. 81.70%, p = 0.028). Poorly-differentiated NSCLC remained a high-risk factor for pT2N0, and adjuvant chemotherapy provided better 24-month survival after matching (86.36% vs. 81.70%, p = 0.029). In conclusion, when treating pN0 NSCLC, adjuvant chemotherapy had a beneficial effect when the tumor size was larger than 4 cm. The effect when the tumor size was between 3 and 4 cm was not remarkable. Poorly-differentiated NSCLC was a high-risk factor in the pT2N0 stage.
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Affiliation(s)
- Ya-Fu Cheng
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua City, Changhua County, 500, Taiwan
| | - Yi-Ling Chen
- Surgery Clinical Research Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Chia-Chi Liu
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua City, Changhua County, 500, Taiwan
| | - Ching-Min Lin
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua City, Changhua County, 500, Taiwan
| | - Shao-Syuan Tong
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua City, Changhua County, 500, Taiwan
| | - Bing-Yen Wang
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua City, Changhua County, 500, Taiwan.
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
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Monteiro AS, Araújo SRDC, Araujo LH, Souza MCD. Impact of microvascular invasion on 5-year overall survival of resected non-small cell lung cancer. JORNAL BRASILEIRO DE PNEUMOLOGIA : PUBLICACAO OFICIAL DA SOCIEDADE BRASILEIRA DE PNEUMOLOGIA E TISILOGIA 2022; 48:e20210283. [PMID: 35830051 PMCID: PMC9262425 DOI: 10.36416/1806-3756/e20210283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/07/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Non-small cell lung cancer (NSCLC) is an incidental and aggressive type of cancer. Although curative treatment can be offered, the recurrence rate is relatively high. Identifying factors that have a prognostic impact may guide changes in the staging system and recommendations for adjuvant therapy. The aim of this study was to evaluate the impact of microvascular invasion on the 5-year overall survival (OS) of patients with resected NSCLC treated at a reference cancer center. METHODS This retrospective, observational cohort study included patients diagnosed with early-stage NSCLC (clinical stages I-IIIA), treated with curative-intent surgery at the Brazilian National Cancer Institute between 2010 and 2016. RESULTS The dataset comprised 91 surgical patients, mostly females and white, with a mean age of 62 years (range between 29-83). Cases were distributed as stages I, II, and III in 55%, 29%, and 16%. Adenocarcinoma was the predominant histological subtype (67%), and microvascular invasion was present in 25% of the patients. The 5-year OS probability was 60% (95% CI, 48.3-68.9). Among all characteristics, advanced stages (p = 0.001) and the presence of microvascular invasion (p< 0.001) were related to a worse 5-year OS. After adjusting for age group and pathological stage, the presence of microvascular invasion was associated with a 4-fold increased risk of death (HR 3.9, 95% CI, 1.9-8.2). CONCLUSION The presence of microvascular invasion was an independent factor related to worse survival and, therefore, should be routinely assessed in resected specimens.
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Affiliation(s)
| | | | - Luiz Henrique Araujo
- . Divisão de Pesquisa Clínica, Instituto Nacional de Câncer, Rio de Janeiro (RJ), Brasil
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Hou X, Yang MZ, Li JB, Tan ZH, Long H, Fu JH, Zhang LJ, Lin P, Yang HX. Who are the real high-risk patients with pathological T2N0M0 non-small-cell lung cancer that can benefit from adjuvant chemotherapy? ESMO Open 2022; 7:100508. [PMID: 35688064 PMCID: PMC9184557 DOI: 10.1016/j.esmoop.2022.100508] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 04/19/2022] [Accepted: 05/05/2022] [Indexed: 11/18/2022] Open
Abstract
Background Methods Results Conclusions ACT could not improve long-term survival in pT2N0M0 NSCLC in general. ACT could only improve OS and DFS in pT2N0M0 NSCLC >4 cm. ACT could not improve CSS in any subgroup of pT2N0M0 NSCLC. For patients with other high-risk factors, ACT failed to improve long-term survival.
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Affiliation(s)
- X Hou
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, P. R. China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, P. R. China
| | - M-Z Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, P. R. China; Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, P. R. China
| | - J-B Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, P. R. China; Department of Clinical Research, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, P. R. China
| | - Z-H Tan
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, P. R. China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, P. R. China
| | - H Long
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, P. R. China; Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, P. R. China
| | - J-H Fu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, P. R. China; Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, P. R. China
| | - L-J Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, P. R. China; Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, P. R. China
| | - P Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, P. R. China; Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, P. R. China
| | - H-X Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, P. R. China; Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, P. R. China.
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Xu Y, Wan B, Zhu S, Zhang T, Xie J, Liu H, Zhan P, Lv T, Song Y. Effect of Adjuvant Chemotherapy on Survival of Patients With 8th Edition Stage IB Non-Small Cell Lung Cancer. Front Oncol 2022; 11:784289. [PMID: 35155190 PMCID: PMC8828472 DOI: 10.3389/fonc.2021.784289] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/24/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The efficacy of adjuvant chemotherapy in patients with 8th edition stage IB (tumor size ≤4 cm) non-small cell lung cancer (NSCLC) remains unclear. METHODS We identified 9757 eligible patients (non-chemotherapy group: n=8303; chemotherapy group: n=1454) between 2004 and 2016 from the Surveillance, Epidemiology and End Results (SEER) database. Log-rank test was used to compare overall survival (OS) between the chemotherapy and non-chemotherapy groups. Cox regression model was applied to investigate the independent prognosis factors of all surgically treated stage IB patients, and then the nomogram was constructed. Propensity score matching (PSM) was performed to reduce the confounding bias, and subgroup analyses of the matched cohort were also performed. Finally, we reviewed 184 patients with stage IB NSCLC from July 2008 to December 2016 in Jinling Hospital as a validation cohort, and compared disease-free survival (DFS) and OS between the two groups. RESULTS In the SEER database cohort, adjuvant chemotherapy was associated with improved OS in both unmatched and matched (1417 pairs) cohorts (all P <0.05). The survival benefit (both OS and DFS) was confirmed in the validation cohort (P <0.05). Multivariate analysis showed age, race, sex, marital status, histology, tumor location, tumor size, differentiation, surgical method, lymph nodes (LNs) examined, radiotherapy and chemotherapy were prognostic factors for resected stage IB NSCLC (all P <0.05). The concordance index and calibration curves demonstrated good prediction effect. Subgroup analyses showed patients with the following characteristics benefited from chemotherapy: old age, poor differentiation to undifferentiation, 0-15 LNs examined, visceral pleural invasion (VPI), lobectomy and no radiotherapy (all P <0.05). CONCLUSIONS Adjuvant chemotherapy is associated with improved survival in 8th edition stage IB NSCLC patients, especially in those with old age, poorly differentiated to undifferentiated tumors, 0-15 LNs examined, VPI, lobotomy and no radiotherapy. Further prospective trials are needed to confirm these conclusions. Besides, the nomogram provides relatively accurate prediction for the prognosis of resected stage IB NSCLC patients.
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Affiliation(s)
- Yangyang Xu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Bing Wan
- Department of Respiratory and Critical Care Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Suhua Zhu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Tianli Zhang
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Jingyuan Xie
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Hongbing Liu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China.,Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.,Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Ping Zhan
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China.,Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.,Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Tangfeng Lv
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China.,Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.,Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Yong Song
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China.,Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.,Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Southeast University, Nanjing, China
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8
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Ninomiya H, Inamura K, Mun M, Nishio M, Ishikawa Y. Relationship between pT1 categories and pathological factors affecting prognosis in pulmonary adenocarcinoma. JTO Clin Res Rep 2022; 3:100293. [PMID: 35400083 PMCID: PMC8983344 DOI: 10.1016/j.jtocrr.2022.100293] [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: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction The eight TNM classification of lung tumors provides a more precise prediction of prognosis than previous classification systems, especially in T1 tumors, the invasion size of which are less than or equal to 3 cm. T1 is divided into T1a (6–10 mm), T1b (11–20 mm), and T1c (21–30 mm), but the relationship between pathologic T (pT)1 categories and other pathologic factors has not been thoroughly evaluated. Methods Surgically resected pulmonary adenocarcinomas (N = 551) were extracted on the basis of computed tomography-based tumor size measurements, including 302 pT1a to c cases (pT1a: n = 98, pT1b: n = 156, and pT1c: n = 48). Pathologic factors, including a minor component of micropapillary or solid subtype, were analyzed by new T categories. Recurrence-free and disease-specific survivals (DSSs) were evaluated using univariable and multivariable analyses and Cox proportional hazards models. Results Lymphatic invasion, vascular invasion, and nodal metastasis increased remarkably from pT1a to pT1c, step-wisely. Visceral pleural invasion was elevated from 7% (6–10 mm) to 33% (21–30 mm) along with an increase in invasion size. Recurrence-free survival (RFS) and DSS relevantly deteriorated from the group of pathologic stages 0, IA1, and IA2 to the group IA3 and IB. Multivariable analysis revealed that lymph node metastasis and solid components were independent prognostic factors for both RFS and DSS in pT1a to c cases. Conclusions The new TNM classification precisely predicts prognosis. Tumor invasion size is closely associated with lymphatic and vascular invasion, nodal metastasis, and visceral pleural invasion. As a minor component, solid subtype was a potent adverse prognostic factor affecting both RFS and DSS after surgery in T1 categories.
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Affiliation(s)
- Hironori Ninomiya
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Pathology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
- Corresponding author. Address for correspondence: Hironori Ninomiya, MD, PhD, Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan.
| | - Kentaro Inamura
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Pathology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Mingyon Mun
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Makoto Nishio
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yuichi Ishikawa
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Pathology, Mita Hospital, International University of Health and Welfare, Tokyo, Japan
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Overall Survival Analyses following Adjuvant Chemotherapy or Nonadjuvant Chemotherapy in Patients with Stage IB Non-Small-Cell Lung Cancer. JOURNAL OF ONCOLOGY 2021; 2021:8052752. [PMID: 34335761 PMCID: PMC8313364 DOI: 10.1155/2021/8052752] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/10/2021] [Indexed: 02/05/2023]
Abstract
Background Adjuvant chemotherapy (ACT) can improve prognosis for stages II-IIIA patients with non-small-cell lung cancer (NSCLC), but its implication in stage I patients is still an intractable puzzle. This study aims to seek ACT candidates for stage IB NSCLC and establish a nomogram to predict overall survival (OS) of specific patient for clinician's decision. Method We performed a retrospective study on 16,765 patients (ACT group: n = 2,187; non-ACT group: n = 14,578) from the Surveillance, Epidemiology, and End Results (SEER) database. Overall survival was assessed in two groups. We performed propensity-score matching for risk adjustment. The risk factors were identified and used to create nomogram. Concordance index (C-index), Hosmer–Lemeshow test, and calibration were applied to evaluate model performance. To further evaluate the influence of tumor size on the selection of potential ACT candidates for patients with stage IB NSCLC, subgroup analyses were executed. Result Survival analysis for the entire study cohort showed that ACT had better OS than non-ACT (HR = 0.800, CI: (0.751–0.851), P < 0.0001). In matched cohort, ACT also presented better OS than non-ACT (HR = 0.775, CI: (0.704–0.853), P < 0.0001). Univariate and multivariate Cox regression analysis revealed that eight prognostic factors, including gender, age, grade, pathological subtype, tumor size, visceral pleural invasion, surgical procedure, and the number of removed lymph nodes, were significantly correlated with OS. The nomogram was further constructed based on these prognostic factors. The C-index of nomogram was 0.639 (95%CI: 0.632–0.646). The Hosmer–Lemeshow test, and calibration presented good congruence between the predictions and actual observations. Subgroup analyses of tumor size group showed that ACT shared similar OS to non-ACT in NSCLC patients with tumor size ≤20 mm (P > 0.05). However, for NSCLC patients with 20 mm < size ≤30 mm (HR = 0.845, 95%CI (0.724–0.986), P=0.032) and 30 mm < size ≤40 mm (HR = 0.912, 95%CI (0.833–1.000), P=0.049), ACT associated with better OS. Conclusion In this study, we found that ACT had better OS than non-ACT in patients with stage IB NSCLC. The nomogram provided an individual prediction of OS for patients after surgical resection. Patients with tumor size >20 mm and ≤40 mm may be potential candidates for ACT.
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Moon Y. Is the size of the lepidic component negligible when measuring the size of the tumor to determine the stage of lung adenocarcinoma? J Thorac Dis 2021; 13:1434-1444. [PMID: 33841936 PMCID: PMC8024845 DOI: 10.21037/jtd-20-2963] [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 After applying the 8th edition of the TNM staging system, the invasive component size, not total tumor size, began to be used as a T descriptor for the stage. The aim of this study was to evaluate whether the size of the lepidic component can be negligible when using only the invasive component size as the T descriptor. Methods From 2010 to 2018, 613 consecutive patients were diagnosed as having stage IA lung adenocarcinoma and underwent anatomical lobectomy at a tertiary hospital. Pathologic specimens and medical records were reviewed retrospectively. Statistical analyses were conducted to find out whether the recurrence of stage IA lung adenocarcinoma was more affected by total tumor size (including lepidic component size) or invasive component size. Results The 5-year recurrence-free survival (RFS) rates of stage 0, stage IA1, stage IA2, and stage IA3 were 100%, 98.4%, 89.1%, and 81.7%, respectively. In multivariate analysis, total tumor size was not a risk factor for recurrence, whereas invasive component size was a significant risk factor for recurrence (Hazard ratio =1.658, P=0.043). In subgroup analysis, 5-year RFS rates of large lung adenocarcinoma (total tumor size >3 cm) and others (total tumor size ≤3 cm) in the same invasive component size group (stage IA2 and stage IA3) were not statistically different. Conclusions Invasive component size was a risk factor for recurrence of stage IA lung adenocarcinoma, while total tumor size was not a risk factor. Therefore, it seems to be appropriate to ignore the size of the lepidic component.
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Affiliation(s)
- Youngkyu Moon
- Department of Thoracic & Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Long FJ, Chen H, Wang YF, He LM, Chen L, Liang ZB, Chen YN, Gong XH. Research on the effect of health care integration on patients’ negative emotions and satisfaction with lung cancer nursing activities. World J Clin Cases 2020; 8:4059-4066. [PMID: 33024763 PMCID: PMC7520783 DOI: 10.12998/wjcc.v8.i18.4059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/25/2020] [Accepted: 08/13/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lung cancer is a clinical disease with multiple malignant tumors. Currently, it is difficult for patients to benefit from routine clinical nursing due to the lack of a pertinent and systematic approach.
AIM To investigate the effect of integrated nursing care on the negative emotions and satisfaction of lung cancer patients.
METHODS From January 2018 to December 2019, 92 patients with lung cancer were selected and divided into the study group and the control group; there were 46 patients in each group. The control group received routine nursing, and the study group received integrated medical care in addition to the care received by the control group. Negative emotions before and after the intervention, the self-management ability score after the intervention, family care burden after the intervention and nursing satisfaction after the intervention were measured in the two groups.
RESULTS After the intervention, the self-rating anxiety scale and self-rating depression scale scores in the study group were lower than those in the control group (P < 0.05); the scores for health knowledge, self-concept, self-responsibility and self-care skills in the study group were higher than those in the control group (P < 0.05); the scores for individual burden and responsibility burden in the study group were lower than those before the intervention (P < 0.05); and the nursing satisfaction in the study group (93.48%) was higher than that in the control group (78.26%, P < 0.05).
CONCLUSION An integrated nursing care approach for lung cancer patients can effectively relieve the patient’s negative feelings, improve their self-management ability, help to reduce the burden of family care and improve patient satisfaction with nursing activities.
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Affiliation(s)
- Feng-Jiao Long
- Department of Thoracic Oncology, the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
| | - Hui Chen
- Department of Thoracic Oncology, the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
| | - Yue-Feng Wang
- Department of Otolaryngology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
| | - Lan-Man He
- Department of Thoracic Oncology, the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
| | - Lin Chen
- Department of Thoracic Oncology, the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
| | - Zi-Bin Liang
- Department of Thoracic Oncology, the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
| | - Yan-Ni Chen
- Department of Otolaryngology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
| | - Xiao-Hua Gong
- Department of Thoracic Oncology, the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
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