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Mansur A, Saleem Z, Beqari J, Mathey-Andrews C, Potter AL, Cranor J, Nees AT, Srinivasan D, Yang ME, Yang CFJ, Auchincloss HG. Wedge Resection versus Stereotactic Body Radiation Therapy for Non-Small Cell Lung Cancer Tumors ≤8 mm. Curr Oncol 2024; 31:1529-1542. [PMID: 38534949 PMCID: PMC10969215 DOI: 10.3390/curroncol31030116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/12/2024] [Accepted: 03/01/2024] [Indexed: 05/26/2024] Open
Abstract
The objective of this study was to evaluate the overall survival of patients with ≤8 mm non-small cell lung cancer (NSCLC) who undergo wedge resection versus stereotactic body radiation therapy (SBRT). Kaplan-Meier analysis, multivariable Cox proportional hazards modeling, and propensity score-matched analysis were performed to evaluate the overall survival of patients with ≤8 mm NSCLC in the National Cancer Database (NCDB) from 2004 to 2017 who underwent wedge resection versus patients who underwent SBRT. The above-mentioned matched analyses were repeated for patients with no comorbidities. Patients who were coded in the NCDB as having undergone radiation because surgery was contraindicated due to patient risk factors (e.g., comorbid conditions, advance age, etc.) and those with a history of prior malignancy were excluded from analysis. Of the 1505 patients who had NSCLC ≤8 mm during the study period, 1339 (89%) patients underwent wedge resection, and 166 (11%) patients underwent SBRT. In the unadjusted analysis, multivariable Cox modeling and propensity score-matched analysis, wedge resection was associated with improved survival when compared to SBRT. These results were consistent in a sensitivity analysis limited to patients with no comorbidities.
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Affiliation(s)
- Arian Mansur
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA 02114, USA; (Z.S.); (J.B.); (C.M.-A.); (A.L.P.); (J.C.); (A.T.N.); (D.S.); (M.E.Y.); (C.-F.J.Y.); (H.G.A.)
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Kirk F, Crathern K, Chang S, Yong MS, He C, Hughes I, Yadav S, Lo W, Cole C, Windsor M, Naidoo R, Stroebel A. The influence of the COVID-19 pandemic on lung cancer surgery in Queensland. ANZ J Surg 2023. [PMID: 37079774 DOI: 10.1111/ans.18465] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 04/06/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND The coronavirus disease-19 (COVID-19) pandemic poses unprecedented challenges to global healthcare. The contemporary influence of COVID-19 on the delivery of lung cancer surgery has not been examined in Queensland. METHODS We performed a retrospective registry analysis of the Queensland Cardiac Outcomes Registry (QCOR), thoracic database examining all adult lung cancer resections across Queensland from 1/1/2016 to 30/4/2022. We compared the data prior to, and after, the introduction of COVID-restrictions. RESULTS There were 1207 patients. Mean age at surgery was 66 years and 1115 (92%) lobectomies were performed. We demonstrated a significant delay from time of diagnosis to surgery from 80 to 96 days (P < 0.0005), after introducing COVID-restrictions. The number of surgeries performed per month decreased after the pandemic and has not recovered (P = 0.012). 2022 saw a sharp reduction in cases with 49 surgeries, compared to 71 in 2019 for the same period. CONCLUSION Restrictions were associated with a significant increase in pathological upstaging, greatest immediately after the introduction of COVID-restrictions (IRR 1.71, CI 0.93-2.94, P = 0.05). COVID-19 delayed the access to surgery, reduced surgical capacity and consequently resulted in pathological upstaging throughout Queensland.
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Affiliation(s)
- Frazer Kirk
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Department Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, James Cook University Hospital, Townsville, Queensland, Australia
| | - Kelsie Crathern
- Department Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Shantel Chang
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Matthew S Yong
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Department Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Cheng He
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Department Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Ian Hughes
- Office for Research Governance and Development, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Sumit Yadav
- Department of Cardiothoracic Surgery, The Townsville University Hospital, Townsville, Queensland, Australia
| | - Wing Lo
- Department of Cardiothoracic Surgery, Princess Alexandria Hospital, Brisbane, Queensland, Australia
| | - Christopher Cole
- Department of Cardiothoracic Surgery, Princess Alexandria Hospital, Brisbane, Queensland, Australia
| | - Morgan Windsor
- The Department of Thoracic Surgery, Royal Brisbane Women's Hospital, Brisbane, Queensland, Australia
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Rishendran Naidoo
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Andrie Stroebel
- Department Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
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Kirk F, He C, Stroebel A. Lung cancer screening: The pulmonologist, the thoracic surgeon and working together in a team. Respirology 2023; 28:515-517. [PMID: 36972923 DOI: 10.1111/resp.14496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Frazer Kirk
- Department Cardiothoracic Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
- School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Cheng He
- Department Cardiothoracic Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Andrie Stroebel
- Department Cardiothoracic Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
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Zhou DH, Du QC, Fu Z, Wang XY, Zhou L, Wang J, Hu CK, Liu S, Li JM, Ma ML, Yu H. Development and validation of an epithelial–mesenchymal transition-related gene signature for predicting prognosis. World J Clin Cases 2022; 10:9285-9302. [PMID: 36159424 PMCID: PMC9477694 DOI: 10.12998/wjcc.v10.i26.9285] [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: 04/02/2022] [Revised: 06/30/2022] [Accepted: 07/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Currently, there are many therapeutic methods for lung adenocarcinoma (LUAD), but the 5-year survival rate is still only 15% at later stages. Epithelial– mesenchymal transition (EMT) has been shown to be closely associated with local dissemination and subsequent metastasis of solid tumors. However, the role of EMT in the occurrence and development of LUAD remains unclear.
AIM To further elucidate the value of EMT-related genes in LUAD prognosis.
METHODS Univariate, least absolute shrinkage and selection operator, and multivariate Cox regression analyses were applied to establish and validate a new EMT-related gene signature for predicting LUAD prognosis. The risk model was evaluated by Kaplan–Meier survival analysis, principal component analysis, and functional enrichment analysis and was used for nomogram construction. The potential structures of drugs to which LUAD is sensitive were discussed with respect to EMT-related genes in this model.
RESULTS Thirty-three differentially expressed genes related to EMT were found to be highly associated with overall survival (OS) by using univariate Cox regression analysis (log2FC ≥ 1, false discovery rate < 0.001). A prognostic signature of 7 EMT-associated genes was developed to divide patients into two risk groups by high or low risk scores. Kaplan–Meier survival analysis showed that the OS of patients in the high-risk group was significantly poorer than that of patients in the low-risk group (P < 0.05). Multivariate Cox regression analysis showed that the risk score was an independent risk factor for OS (HR > 1, P < 0.05). The results of receiver operator characteristic curve analysis suggested that the 7-gene signature had a perfect ability to predict prognosis (all area under the curves > 0.5).
CONCLUSION The EMT-associated gene signature classifier could be used as a feasible indicator for predicting OS.
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Affiliation(s)
- De-Hua Zhou
- Department of General Surgery, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai 200434, China
| | - Qian-Cheng Du
- Department of Thoracic surgery, Shanghai Xuhui Central Hospital, Shanghai 200031, China
| | - Zheng Fu
- Department of Thoracic surgery, Shanghai Xuhui Central Hospital, Shanghai 200031, China
| | - Xin-Yu Wang
- Department of General Surgery, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai 200434, China
| | - Ling Zhou
- Department of General Surgery, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai 200434, China
| | - Jian Wang
- Department of Thoracic surgery, Shanghai Xuhui Central Hospital, Shanghai 200031, China
| | - Cheng-Kai Hu
- Department of Thoracic surgery, Shanghai Xuhui Central Hospital, Shanghai 200031, China
| | - Shun Liu
- Department of Thoracic surgery, Shanghai Xuhui Central Hospital, Shanghai 200031, China
| | - Jun-Min Li
- Surgical Intensive Care Unit, Shanghai Xuhui Central Hospital, Shanghai 200031, China
| | - Meng-Li Ma
- Surgical Intensive Care Unit, Shanghai Xuhui Central Hospital, Shanghai 200031, China
| | - Hua Yu
- Department of General Surgery, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai 200434, China
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Bertolaccini L, Spaggiari L, Cusato J. Editorial: Bench Research Behind Lung Cancer Surgery. Front Surg 2022; 9:936922. [PMID: 35800115 PMCID: PMC9253461 DOI: 10.3389/fsurg.2022.936922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/03/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Correspondence: Luca Bertolaccini
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Jessica Cusato
- Department of Medical Sciences, University of Turin, Turin, Italy
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