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Osarogiagbon RU, Van Schil P, Giroux DJ, Lim E, Putora PM, Lievens Y, Cardillo G, Kim HK, Rocco G, Bille A, Prosch H, Vásquez FS, Nishimura KK, Detterbeck F, Rami-Porta R, Rusch VW, Asamura H, Huang J. The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Overview of Challenges and Opportunities in Revising the Nodal Classification of Lung Cancer. J Thorac Oncol 2023; 18:410-418. [PMID: 36572339 PMCID: PMC10065917 DOI: 10.1016/j.jtho.2022.12.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 12/25/2022]
Abstract
The status of lymph node involvement is a major component of the TNM staging system. The N categories for lung cancer have remained unchanged since the fourth edition of the TNM staging system, partly because of differences in nodal mapping nomenclature, partly because of insufficient details to verify possible alternative approaches for staging. In preparation for the rigorous analysis of the International Association for the Study of Lung Cancer database necessary for the ninth edition TNM staging system, members of the N-Descriptors Subcommittee of the International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee reviewed the evidence for alternative approaches to categorizing the extent of lymph node involvement with lung cancer, which is currently based solely on the anatomical location of lymph node metastasis. We reviewed the literature focusing on NSCLC to stimulate dialogue and mutual understanding among subcommittee members engaged in developing the ninth edition TNM staging system for lung cancer, which has been proposed for adoption by the American Joint Committee on Cancer and Union for International Cancer Control in 2024. The discussion of the range of possible revision options for the N categories, including the pros and cons of counting lymph nodes, lymph node stations, or lymph node zones, also provides transparency to the process, explaining why certain options may be discarded, others deferred for future consideration. Finally, we provide a preliminary discussion of the future directions that the N-Descriptors Subcommittee might consider for the 10th edition and beyond.
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Affiliation(s)
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp University, Antwerp, Belgium
| | | | - Eric Lim
- Imperial College London, London, United Kingdom; The Academic Division of Thoracic Surgery, Royal Brompton Hospital, London, United Kingdom
| | - Paul Martin Putora
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Department of Radiation Oncology, University of Bern, Bern, Switzerland
| | - Yolande Lievens
- Radiation Oncology Department, Ghent University Hospital, Ghent, Belgium
| | - Giuseppe Cardillo
- Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy; UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gaetano Rocco
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrea Bille
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom; King's College University, London, United Kingdom
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Francisco Suárez Vásquez
- Thoracic Surgeon, Surgery Department, Clínica Santa María, Santiago, Chile; Universidad de Los Andes, Santiago, Chile
| | | | | | - Ramon Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain; Network of Centres for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain
| | - Valerie W Rusch
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - James Huang
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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2
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Minervini F, Kestenholz P, Bertoglio P, Li A, Nilius H. Role of intrapulmonary lymph nodes in patients with NSCLC and visceral pleural invasion. The VPI 1314 multicenter registry study protocol. PLoS One 2023; 18:e0285184. [PMID: 37141291 PMCID: PMC10159114 DOI: 10.1371/journal.pone.0285184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/10/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND In the lung cancer classification (TNM), the involvement of thoracic lymph nodes is relevant from a diagnostic and prognostic point of view. Even if imaging modality could help in selecting patients who should undergo surgery, a systematic lymph node dissection during lung surgery is mandatory to identify the subgroup of patients who can benefit from an adjuvant treatment. METHODS Patients undergoing elective lobectomy/bilobectomy/segmentectomy) for non-small cell lung cancer and lymphadenectomy with lymph nodes station 10-11-12-13-14 sampling that meet the inclusion and exclusion criteria will be recorded in a multicenter prospective database. The overall incidence of N1 patients (subclassified in: Hilar Lymph nodes, Lobar Lymph nodes and Sublobar Lymph nodes) will be examined as well as the incidence of visceral pleural invasion. DISCUSSION The aim of this multicenter prospective study is to evaluate the incidence of intrapulmonary lymph nodes metastases and the possible relation with visceral pleural invasion. Identifying patients with lymph node station 13 and 14 metastases and/or a link between visceral pleural invasion and presence of micro/macro metastases in intrapulmonary lymph nodes may have an impact on decision-making process. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05596578.
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Affiliation(s)
- Fabrizio Minervini
- Division of Thoracic Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Peter Kestenholz
- Division of Thoracic Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Pietro Bertoglio
- Division of Thoracic Surgery, IRCSS Azienda Ospedaliero-Universitaria, Bologna, Italy
| | - Allen Li
- The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Henning Nilius
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, Bern, Switzerland
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3
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Liao Y, Yin G, Fan X. The Positive Lymph Node Ratio Predicts Survival in T 1-4N 1-3M 0 Non-Small Cell Lung Cancer: A Nomogram Using the SEER Database. Front Oncol 2020; 10:1356. [PMID: 32903785 PMCID: PMC7438846 DOI: 10.3389/fonc.2020.01356] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/29/2020] [Indexed: 12/14/2022] Open
Abstract
Background: An increasing number of studies have shown that the positive lymph node ratio (pLNR) can be used to evaluate the prognosis of non-small cell lung cancer (NSCLC) patients. To determine the predictive value of the pLNR, we collected data from the Surveillance, Epidemiology, and End Results (SEER) database and performed a retrospective analysis. Methods: We collected survival and clinical information on patients with T1-4N1-3M0 NSCLC diagnosed between 2010 and 2016 from the SEER database and screened them according to inclusion and exclusion criteria. X-tile software was used to obtain the best cut-off value for the pLNR. Then, we randomly divided patients into a training set and a validation set at a ratio of 7:3. Pearson's correlation coefficient, tolerance and the variance inflation factor (VIF) were used to detect collinearity between variables. Univariate and multivariate Cox regression analyses were used to identify significant prognostic factors, and nomograms was constructed to visualize the results. The concordance index (C-index), calibration curves, and decision curve analysis (DCA) were used to assess the predictive ability of the nomogram. We divided the patient scores into four groups according to the interquartile interval and constructed a survival curve using Kaplan-Meier analysis. Results: A total of 6,245 patients were initially enrolled. The best cut-off value for the pLNR was determined to be 0.55. The nomogram contained 13 prognostic factors, including the pLNR. The pLNR was identified as an independent prognostic factor for both overall survival (OS) and cancer-specific survival (CSS). The C-index was 0.703 (95% CI, 0.695-0.711) in the training set and 0.711 (95% CI, 0.699-0.723) in the validation set. The calibration curves and DCA also indicated the good predictability of the nomogram. Risk stratification revealed a statistically significant difference among the four groups of patients divided according to quartiles of risk score. Conclusion: The nomogram containing the pLNR can accurately predict survival in patients with T1-4N1-3M0 NSCLC.
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Affiliation(s)
- Yi Liao
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Inflammation & Allergic Diseases Research Unit, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Guofang Yin
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Inflammation & Allergic Diseases Research Unit, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xianming Fan
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Inflammation & Allergic Diseases Research Unit, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Zhou J, Lin Z, Lyu M, Chen N, Liao H, Wang Z, Hao J, Yan C, Liu L. Prognostic value of lymph node ratio in non-small-cell lung cancer: a meta-analysis. Jpn J Clin Oncol 2020; 50:44-57. [PMID: 31735973 DOI: 10.1093/jjco/hyz120] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/07/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This meta-analysis aimed to investigate the prognostic value of lymph node ratio in non-small-cell lung cancer. METHODS We searched systematically for eligible studies in PubMed, Web of Science, Medline (via Ovid) and Cochrane library through 6 November 2018. The primary outcome was overall survival. Disease-free survival and cancer-specific survival were considered as secondary outcomes. Hazard ratio with corresponding 95% confidence interval were pooled. Quality assessment of included studies was conducted. Subgroup analyses were performed based on N descriptors, types of tumor resection, types of lymphadenectomy and study areas. Sensitivity analysis and evaluation of publication bias were also performed. RESULTS Altogether, 20 cohorts enrolling 76 929 patients were included. Mean Newcastle-Ottawa Scale was 7.65 ± 0.59, indicating the studies' quality was high. The overall result showed non-small-cell lung cancer patients with lower lymph node ratio was associated with better overall survival (HR: 1.946; 95% CI: 1.746-2.169; P < 0.001), disease-free survival (HR: 2.058; 95% CI: 1.717-2.467; P < 0.001) and cancer-specific survival (HR: 2.149; 95% CI: 1.864-2.477; P < 0.001). Subgroup analysis prompted types of lymphadenectomy and the station of positive lymph node have an important effect on the prognosis. No significant discovery was found in sensitivity analysis. CONCLUSION Patients with lower lymph node ratio was associated with better survival, indicating that lymph node ratio may be a promising prognostic predictor in non-small-cell lung cancer. The type of lymphadenectomy, an adequate examined number and the removed stations should be considered for more accurate prognosis assessment.
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Affiliation(s)
- Jian Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Zhangyu Lin
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Mengyuan Lyu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Nan Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Hu Liao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Zihuai Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Jianqi Hao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Chunyi Yan
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
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5
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Griff S, Taber S, Bauer TT, Pfannschmidt J. Prognostic significance of the pattern of pathological N1 lymph node metastases for non-small cell lung cancer. J Thorac Dis 2019; 11:3449-3458. [PMID: 31559050 DOI: 10.21037/jtd.2019.07.73] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background In patients with non-small cell lung cancer (NSCLC) the pathologic lymph node status N1 is a heterogeneous entity, and different forms of lymph node involvement may represent different prognoses. For methodological reasons, the 8th edition of the TNM staging system for NSCLC makes no official changes to the N descriptor. However, there is evidence that different subforms of N1 disease are associated with different prognoses, and it is now recommended that clinicians record the number of affected lymph nodes and nodal stations for further analyses. In this investigation we sought to determine whether patients with different levels and types of N1 lymph node involvement had significantly different 5-year survival rates. Methods We retrospectively identified 90 patients with NSCLC (61 men, 29 women), who were treated between 2008 and 2012 and found to have pathologic N1 lymph node involvement and tumor sizes corresponding to T1 or T2. All patients were treated in curative intent with surgical lung resection and systematic mediastinal and hilar lymph node dissection. Results The overall 5-year survival rate was 56.3%. In the univariate analysis, lower tumor stage and tumor histology other than large-cell carcinoma were significantly associated with better long-term survival. Patients with solitary lymph node metastases also had longer disease-free survival than those with multiple nodal metastases. In the multivariate analysis, large-cell carcinoma and Union for International Cancer Control (UICC) stage IIB were independently associated with worse survival, while pneumonectomy, compared to lobar or sublobar resection, was independently associated with better survival. Conclusions Although we did not observe significant prognostic differences between N1 subcategories within our patient population, other analyses may yield different results. Therefore, these data highlight the need for large, well-designed multicenter studies to confirm the clinical significance of N1 subcategories.
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Affiliation(s)
- Sergej Griff
- Institute of Pathology, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Samantha Taber
- Department of Thoracic Surgery, Heckeshorn Lung Clinic, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Torsten T Bauer
- Department of Pneumology, Heckeshorn Lung Clinic, 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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6
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Bertolaccini L, Pardolesi A, Brandolini J, Solli P. The surgeon thunderbolts in 2016 lung cancer literature. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:96. [PMID: 29666819 DOI: 10.21037/atm.2017.06.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, AUSL Romagna Teaching Hospital, Ravenna, Italy
| | | | - Jury Brandolini
- Department of Thoracic Surgery, AUSL Romagna Teaching Hospital, Forlì, Italy
| | - Piergiorgio Solli
- Department of Thoracic Surgery, AUSL Romagna Teaching Hospital, Ravenna, Italy.,Department of Thoracic Surgery, AUSL Romagna Teaching Hospital, Forlì, Italy
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7
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Nicholson AG, Tsao MS, Travis WD, Patil DT, Galateau-Salle F, Marino M, Dacic S, Beasley MB, Butnor KJ, Yatabe Y, Pass HI, Rusch VW, Detterbeck FC, Asamura H, Rice TW, Rami-Porta R. Eighth Edition Staging of Thoracic Malignancies: Implications for the Reporting Pathologist. Arch Pathol Lab Med 2018; 142:645-661. [PMID: 29480761 DOI: 10.5858/arpa.2017-0245-ra] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context The Staging and Prognostic Factors Committee of the International Association for the Study of Lung Cancer, in conjunction with the International Mesothelioma Interest Group, the International Thymic Malignancy Interest Group, and the Worldwide Esophageal Cancer Collaboration, developed proposals for the 8th edition of their respective tumor, node, metastasis (TNM) staging classification systems. Objective To review these changes and discuss issues for the reporting pathologist. Data Sources Proposals were based on international databases of lung (N = 94 708), with an external validation using the US National Cancer Database; mesothelioma (N = 3519); thymic epithelial tumors (10 808); and epithelial cancers of the esophagus and esophagogastric junction (N = 22 654). Conclusions These proposals have been mostly accepted by the Union for International Cancer Control and the American Joint Committee on Cancer and incorporated into their respective staging manuals (2017). The Union for International Cancer Control recommended implementation beginning in January 2017; however, the American Joint Committee on Cancer has deferred deployment of the eighth TNM until January 1, 2018, to ensure appropriate infrastructure for data collection. This manuscript summarizes the updated staging of thoracic malignancies, specifically highlighting changes from the 7th edition that are relevant to pathologic staging. Histopathologists should become familiar with, and start to incorporate, the 8th edition staging in their daily reporting of thoracic cancers henceforth.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ramon Rami-Porta
- From the Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (Dr Nicholson); the Department of Pathology, The Princess Margaret Cancer Centre, Toronto, Ontario, Canada (Dr Tsao); the Department of Pathology (Dr Travis) and the Thoracic Service, Department of Surgery (Dr Rusch), Memorial Sloan-Kettering Cancer Center, New York, New York; the Departments of Pathology (Dr Patil) and Thoracic and Cardiovascular Surgery (Dr Rice), Cleveland Clinic, Cleveland, Ohio; the Departement de Biopathologie, Cancer Center Leon Bernard, Lyon, France (Dr Galateau-Salle); the Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy (Dr Marino); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington (Dr Butnor); the Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan (Dr Yatabe); the Department of Thoracic Surgery, New York University, New York, New York (Dr Pass); the Department of Thoracic Surgery, Yale University, New Haven, Connecticut (Dr Detterbeck); the Department of Thoracic Surgery, Keio University, Tokyo, Japan (Dr Asamura); and the Thoracic Surgery Service, Hospital Universitari Mutua Terrassa, University of Barcelona, and CIBERES Lung Cancer Group, Terrassa, Barcelona, Spain (Dr Rami-Porta)
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8
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Soo RA, Stone ECA, Cummings KM, Jett JR, Field JK, Groen HJM, Mulshine JL, Yatabe Y, Bubendorf L, Dacic S, Rami-Porta R, Detterbeck FC, Lim E, Asamura H, Donington J, Wakelee HA, Wu YL, Higgins K, Senan S, Solomon B, Kim DW, Johnson M, Yang JCH, Sequist LV, Shaw AT, Ahn MJ, Costa DB, Patel JD, Horn L, Gettinger S, Peters S, Wynes MW, Faivre-Finn C, Rudin CM, Tsao A, Baas P, Kelly RJ, Leighl NB, Scagliotti GV, Gandara DR, Hirsch FR, Spigel DR. Scientific Advances in Thoracic Oncology 2016. J Thorac Oncol 2017; 12:1183-1209. [PMID: 28579481 DOI: 10.1016/j.jtho.2017.05.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/15/2017] [Accepted: 05/23/2017] [Indexed: 12/21/2022]
Abstract
Lung cancer care is rapidly changing with advances in genomic testing, the development of next-generation targeted kinase inhibitors, and the continued broad study of immunotherapy in new settings and potential combinations. The International Association for the Study of Lung Cancer and the Journal of Thoracic Oncology publish this annual update to help readers keep pace with these important developments. Experts in thoracic cancer and care provide focused updates across multiple areas, including prevention and early detection, molecular diagnostics, pathology and staging, surgery, adjuvant therapy, radiotherapy, molecular targeted therapy, and immunotherapy for NSCLC, SCLC, and mesothelioma. Quality and value of care and perspectives on the future of lung cancer research and treatment have also been included in this concise review.
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Affiliation(s)
- Ross A Soo
- Cancer Science Institute of Singapore, National University of Singapore, Singapore; Department of Haematology-Oncology, National University Cancer Institute of Singapore, Singapore; School of Surgery, University of Western Australia, Perth, Australia
| | - Emily C A Stone
- Department of Thoracic Medicine, St. Vincent's Hospital, Kinghorn Cancer Centre, Sydney, Australia
| | - K Michael Cummings
- Hollings Cancer Center Medical University of South Carolina, Charleston, South Carolina
| | | | - John K Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, Liverpool, United Kingdom
| | - Harry J M Groen
- Department of Pulmonary Diseases, University Medical Center Groningen, Groningen, The Netherlands
| | - James L Mulshine
- Internal Medicine, Graduate College, Rush University Medical Center, Chicago, Illinois
| | - Yasushi Yatabe
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan
| | - Lukas Bubendorf
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Sanja Dacic
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ramon Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Network of Biomedical Research Centers in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain
| | | | - Eric Lim
- Academic Division of Thoracic Surgery, The Royal Brompton Hospital and Imperial College, London, United Kingdom
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Jessica Donington
- Cardiothoracic Surgery, New York University School of Medicine, New York, New York
| | - Heather A Wakelee
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, California
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Kristin Higgins
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Benjamin Solomon
- Department of Medical Oncology, Peter MacCallum Cancer Center, Melbourne, Australia
| | - Dong-Wan Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| | | | - James C H Yang
- Department of Oncology, National Taiwan University Hospital, Taipei, Republic of China
| | - Lecia V Sequist
- Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Alice T Shaw
- Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Myung-Ju Ahn
- Section of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Daniel B Costa
- Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jyoti D Patel
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Leora Horn
- Division of Hematology/Oncology, Vanderbilt Ingram Cancer Center, Nashville, Tennessee
| | - Scott Gettinger
- Medical Oncology, Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Solange Peters
- Medical Oncology and Thoracic Malignancies, Oncology Department, University Hospital Center Vaudois, Lausanne, Switzerland
| | - Murry W Wynes
- International Association for the Study of Lung Cancer, Aurora, Colorado
| | - Corinne Faivre-Finn
- Radiotherapy Related Research, Division of Cancer Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Christie Hospital NHS Trust, Manchester, United Kingdom
| | - Charles M Rudin
- Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anne Tsao
- Mesothelioma Program, Thoracic Chemo-Radiation Program, Department of Thoracic/Head and Neck Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Paul Baas
- Department of Chest Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ronan J Kelly
- Deptartment of Medical Oncology, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Natasha B Leighl
- Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | | | - David R Gandara
- Thoracic Oncology Program, University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Fred R Hirsch
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora.
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9
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Wang S, Zhang B, Li C, Cui C, Yue D, Shi B, Zhang Q, Zhang Z, Zhang X, Wang C. Prognostic value of number of negative lymph node in patients with stage II and IIIa non-small cell lung cancer. Oncotarget 2017; 8:79387-79396. [PMID: 29108317 PMCID: PMC5668050 DOI: 10.18632/oncotarget.18154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 05/06/2017] [Indexed: 12/14/2022] Open
Abstract
Background The definitive validation evidence of the implications of lymph node metastases regarding the survival of Non-Small Cell Lung Cancer (NSCLC) patients is lacking. We aimed to evaluate the prognostic impact of several lymph node metastases-associated risk factors including Number of Negative Lymph Node (NLN) and risk-stratify NSCLC patients into subsets with different prognosis. Method A total of 482 patients with N1 and N2 NSCLC were included in this study. The prognostic importance of a set of risk factors was examined by univariate and multivariate analysis. The cut-off points and 5 years survival rates were calculated to test the best grouping system to stratify the patients with difference outcome. Results Our analysis indicated that both Ratio of the Metastatic Lymph nodes (RML) and Number of Negative Lymph Node (NLN) were associated with overall survival (OS) and disease free survival (DFS). RML percentage 20% and 55%, and NLN counts 10 and 30 were proved as the optimal cut-off points to predict OS by classifying patients into 3 groups, respectively. RML and NLN actually are more powerful in predicting survival outcome for male patients compared to female patients. Stratified survival analyses using combined factors indicated that the 5-year survival rate (5-YSR) is high in RML I + NLN I/III subgroup (5-YSR = 57.1% and 43.3%) and low in RML III + NLN II/III subgroup (5-YSR = 0.0 % each). Conclusions NLN is a strong prognostic factor for OS and DFS of stage II/IIIa NSCLC patients, and provides a useful classification scheme for NSCLC patients when combined with RML.
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Affiliation(s)
- Shengguang Wang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.,Tianjin Lung Cancer Center, Tianjin, 300060, China.,Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.,National Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Bin Zhang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.,Tianjin Lung Cancer Center, Tianjin, 300060, China.,Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.,National Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Chenguang Li
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.,Tianjin Lung Cancer Center, Tianjin, 300060, China.,Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.,National Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Chao Cui
- Graduate School, Tianjin Medical University, Tianjin, 300070, China.,Department of Thoracic Surgery, Tianjin Haihe Hospital, Tianjin, 300350, China
| | - Dongsheng Yue
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.,Tianjin Lung Cancer Center, Tianjin, 300060, China.,Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.,National Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Bowen Shi
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.,Tianjin Lung Cancer Center, Tianjin, 300060, China.,Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.,National Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Qiang Zhang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.,Tianjin Lung Cancer Center, Tianjin, 300060, China.,Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.,National Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Zhenfa Zhang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.,Tianjin Lung Cancer Center, Tianjin, 300060, China.,Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.,National Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Xi Zhang
- Affiliated Yueqing Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China.,School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Changli Wang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.,Tianjin Lung Cancer Center, Tianjin, 300060, China.,Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.,National Clinical Research Center for Cancer, Tianjin, 300060, China
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