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Vucicevic RS, Zavras AG, Fice MP, Khan ZA, Gusho C, Gasparro M, Gitelis S, Blank A, Colman MW. Internal hemipelvectomy: A single institution's learning curve and longitudinal experience. J Surg Oncol 2024; 129:981-994. [PMID: 38287517 DOI: 10.1002/jso.27585] [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: 08/14/2023] [Revised: 12/18/2023] [Accepted: 12/26/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND AND OBJECTIVES Wide margin resection for pelvic tumors via internal hemipelvectomy is among the most technically challenging procedures in orthopedic oncology. As such, surgeon experience and technique invariably affect patient outcomes. The aim of this clinical study was to assess how an individual surgeon's experiences and advancements in technology and techniques in the treatment of internal hemipelvectomy have impacted patient outcomes at our institution. METHODS This study retrospectively examined a single tertiary academic institution's consecutive longitudinal experience with internal hemipelvectomy for primary sarcoma or pelvic metastases over a 26-year period between the years 1994 and 2020. Outcomes were assessed using two separate techniques. The first stratified patients into cohorts based on the date of surgery with three distinct "eras" ("early," "middle," and "modern"), which reflect the implementation of new techniques, including three-dimensional (3D) computer navigation and cutting guide technology into our clinical practice. The second method of cohort selection grouped patients based on each surgeon's case experience with internal hemipelvectomy ("inexperienced," "developing," and "experienced"). Primary endpoints included margin status, complication profiles, and long-term oncologic outcomes. Whole group multivariate analysis was used to evaluate variables predicting blood loss, operative time, tumor-free survival, and mortality. RESULTS A total of 72 patients who underwent internal hemipelvectomy were identified. Of these patients, 24 had surgery between 1994 and 2007 (early), 28 between 2007 and 2015 (middle), and 20 between 2016 and 2020 (modern). Twenty-eight patients had surgery while the surgeon was still inexperienced, 24 while developing, and 20 when experienced. Evaluation by era demonstrated that a greater proportion of patients were indicated for surgery for oligometastatic disease in the modern era (0% vs. 14.3% vs. 35%, p = 0.022). Fewer modern cases utilized freehand resection (100% vs. 75% vs. 55%, p = 0.012), while instead opting for more frequent utilization of computer navigation (0% vs. 25% vs. 20%, p = 0.012), and customized 3D-printed cutting guides (0% vs. 0% vs. 25%, p = 0.002). Similarly, there was a decline in the rate of massive blood loss observed (72.2% vs. 30.8% vs. 35%, p = 0.016), and interdisciplinary collaboration with a general surgeon for pelvic dissection became more common (4.2% vs. 32.1% vs. 85%, p < 0.001). Local recurrence was less prevalent in patients treated in middle and modern eras (50% vs. 15.4% vs. 25%, p = 0.045). When stratifying by case experience, surgeries performed by experienced surgeons were less frequently complicated by massive blood loss (66.7% vs. 40% vs. 20%, p = 0.007) and more often involved a general surgeon for pelvic dissection (17.9% vs. 37.5% vs. 65%, p = 0.004). Whole group multivariate analysis demonstrated that the use of patient-specific instrumentation (PSI) predicted lower intraoperative blood loss (p = 0.040). However, surgeon experience had no significant effect on operative time (p = 0.125), tumor-free survival (p = 0.501), or overall patient survival (p = 0.735). CONCLUSION While our institution continues to utilize neoadjuvant and adjuvant therapies following current guideline-based care, we have noticed changing trends from early to modern periods. With the advent of new technologies, we have seen a decline in freehand resections for hemipelvectomy procedures, and a transition to utilizing more 3D navigation and customized 3D cutting guides. Furthermore, we have employed the use of an interdisciplinary team approach more regularly for these complicated cases. Although our results do not demonstrate a significant change in perioperative outcomes over the years, our institution's willingness to treat more complex cases likely obscures the benefits of surgeon experience and recent technological advances for patient outcomes.
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Affiliation(s)
- Rajko S Vucicevic
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Athan G Zavras
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Michael P Fice
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Zeeshan A Khan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Charles Gusho
- Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Matthew Gasparro
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Steven Gitelis
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Alan Blank
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Matthew W Colman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Heidinger M, Simonnet E, Koh LM, Frey Tirri B, Vetter M. Therapeutic approaches in patients with bone metastasis due to endometrial carcinoma - A systematic review. J Bone Oncol 2023; 41:100485. [PMID: 37250286 PMCID: PMC10213377 DOI: 10.1016/j.jbo.2023.100485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/07/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023] Open
Abstract
Background Bone metastases (BM) are uncommon in endometrial carcinoma (EC), without information on the optimal oncologic management of patients with BM in EC. Here, we systematically review clinical characteristics, treatment approaches and prognosis in patients with BM in EC. Methods We conducted a systematic literature search until 27th March 2022 on PubMed, MEDLINE, Embase and clinicaltrials.gov. Outcomes included treatment frequency and survival after BM with comparators being treatment approaches (local cytoreductive bone surgery, systemic therapy, and local radiotherapy). Risk of bias was assessed using the NIH Quality Assessment Tool and Navigation Guide methodology. Results We retrieved 1096 records of which 112 retrospective studies (12 cohort studies, 12/12 fair quality; 100 case studies, 100/100 low quality) with a total of 1566 patients were included. The majority had a primary diagnosis of FIGO stage IV, grade 3 endometrioid EC. Singular BM were present in a median of 39.2%, multiple BM in 60.8% and synchronous additional distant metastases in 48.1% of patients respectively. In patients with secondary BM median time to bone recurrence was 14 months. Median survival after BM was 12 months. Local cytoreductive bone surgery was assessed in 7/13 cohorts and performed in a median of 15.8% (interquartile range [IQR] 10.3-43.0) of patients. Chemotherapy was assessed in 11/13 cohorts and administered in a median of 55.5% (IQR 41.0-63.9), hormonal therapy (7/13 cohorts) in 24.7% (IQR 16.3-36.0), and osteooncologic therapy (4/13 cohorts) in 2.7% (IQR 0.0-7.5) of patients respectively. Local radiotherapy was assessed in 9/13 cohorts and performed in a median of 66.7% (IQR 55.6-70.0) of patients. Survival benefits were seen in 2/3 cohorts after local cytoreductive bone surgery, and in 2/7 cohorts after chemotherapy without survival benefits in the remaining cohorts and investigated therapies. Limitations include the lack of controlled intervention studies, the heterogeneity and retrospective nature of the investigated populations. Conclusions This systematic review shows heterogenous therapeutic approaches in clinical practice without clear evidence for optimal oncologic management for patients with BM in EC.
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Affiliation(s)
- Martin Heidinger
- Women’s Clinic, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
- University of Basel, Petersplatz 1, 4001 Basel, Switzerland
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Elisa Simonnet
- Women’s Clinic, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Li Mei Koh
- Women’s Clinic, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Brigitte Frey Tirri
- Women’s Clinic, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Marcus Vetter
- University of Basel, Petersplatz 1, 4001 Basel, Switzerland
- Medical Oncology, Cantonal Hospital Baselland, Medical University Clinic, Muehlemattstrasse 13, 4410 Liestal, Switzerland
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Nistor CE, Ciuche A, Cucu AP, Nitipir C, Slavu C, Serban B, Cursaru A, Cretu B, Cirstoiu C. Management of Lung Cancer Presenting with Solitary Bone Metastasis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101463. [PMID: 36295624 PMCID: PMC9612355 DOI: 10.3390/medicina58101463] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/09/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022]
Abstract
Lung neoplasm is the main cause of cancer-related mortality, and bone metastasis is among the most common secondary tumors. The vast majority of patients also present with multiple bone metastases, which makes systemic and adjuvant pain therapy preferable to surgery. The optimal approach for a resectable non-small-cell lung tumor that also presents a unique, resectable bone metastasis is not fully established. The number of papers addressing this subject is small, and most are case reports; nevertheless, survival rates seem to increase with radical surgery. The sequencing of local versus systemic treatment should always be discussed within the multidisciplinary team that will choose the best approach for each patient. As targeted systemic therapies become more accessible, radical surgery, together with existing reconstructive methods, will lead to an increase in life expectancy and a better quality of life.
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Affiliation(s)
- Claudiu-Eduard Nistor
- Department Thoracic Surgery, Dr. Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Adrian Ciuche
- Department Thoracic Surgery, Dr. Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Anca Pati Cucu
- Department Thoracic Surgery, Dr. Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Cornelia Nitipir
- Department of Medical Oncology, Carol Davila University Medicine & Pharmacy, Elias University Emergency Hospital, 011468 Bucharest, Romania
| | - Cristina Slavu
- Department of Medical Oncology, Carol Davila University Medicine & Pharmacy, Elias University Emergency Hospital, 011468 Bucharest, Romania
| | - Bogdan Serban
- Department Orthopedic & Traumatology, Carol Davila University Medicine & Pharmacy, University Emergency Hospital, 050098 Bucharest, Romania
| | - Adrian Cursaru
- Department Orthopedic & Traumatology, Carol Davila University Medicine & Pharmacy, University Emergency Hospital, 050098 Bucharest, Romania
| | - Bogdan Cretu
- Department Orthopedic & Traumatology, Carol Davila University Medicine & Pharmacy, University Emergency Hospital, 050098 Bucharest, Romania
- Correspondence:
| | - Catalin Cirstoiu
- Department Orthopedic & Traumatology, Carol Davila University Medicine & Pharmacy, University Emergency Hospital, 050098 Bucharest, Romania
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Wang F, Gao J, Ren Y, Su H, She Y, Xie D, Chen C. Predicted outcomes of subdividing M1-stage metastatic lung cancer based on the prognosis and the response to local consolidative therapy. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1293. [PMID: 34532430 PMCID: PMC8422121 DOI: 10.21037/atm-21-1383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/01/2021] [Indexed: 11/06/2022]
Abstract
Background For stage IV non-small cell lung cancer (NSCLC) patients, systemic therapy is the main strategy, and local consolidative therapy tends to be performed for patients with oligometastases. The porpose of this article is to evaluate the prognostic effects of local consolidative therapy for patients with stage IV NSCLC and divide these patients into different subcategories to stratify the prognoses. Methods A total of 30,583 patients with stage IV NSCLC were identified in the Surveillance, Epidemiology, and End Results (SEER) database. To identify factors related to high cancer-specific mortality (CSM) rates and compare the prognostic effects of different treatment strategies, a competing risk model was developed. Furthermore, independent prognostic factors identified through multivariable analysis were employed to supplement the current M1 subcategory. Cumulative incidence curves were estimated using the Kaplan-Meier method, and the log-rank test was used to compare prognostic differences. Results The CSM rates of M1a, M1b, and M1c patients were significantly different [M1b versus M1a: subdistribution hazard ratio (SHR), 1.38; 95% confidence interval (CI), 1.31-1.45; P<0.001; M1c vs. M1a: SHR, 1.76; 95% CI, 1.67-1.85; P<0.001]. Patients were divided into five groups depending on the M1 subcategory and liver involvement (Group A, M1c NSCLC with liver involvement; Group B, M1c NSCLC without liver involvement; Group C, M1b NSCLC with liver involvement; Group D, M1b NSCLC without liver involvement; and Group E, M1a NSCLC). Univariable analysis showed that liver involvement was associated with increased cancer-specific mortality (CSM) rates in both M1b and M1c patients (A vs. B: SHR, 1.36; 95% CI, 1.30-1.43; P<0.001; C vs. D: SHR, 1.27; 95% CI, 1.20-1.35; P<0.001). Primary tumor surgery plus chemotherapy may substantially benefit patients, especially M1b patients (surgery alone: SHR, 0.425; 95% CI, 0.361-0.500; P<0.001 vs. chemotherapy alone: SHR, 0.366; 95% CI, 0.352-0.382; P<0.001 vs. chemotherapy plus surgery: SHR, 0.194; 95% CI, 0.165-0.228; P<0.001; no treatment used as reference). Conclusions Subdivision of M1 disease and awareness of liver involvement may help to inform the prognosis of stage IV NSCLC patients and facilitate treatment planning.
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Affiliation(s)
- Fang Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jiani Gao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yijiu Ren
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hang Su
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
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Lim CH, Ahn TR, Moon SH, Cho YS, Choi JY, Kim BT, Lee KH. PET/CT features discriminate risk of metastasis among single-bone FDG lesions detected in newly diagnosed non-small-cell lung cancer patients. Eur Radiol 2018; 29:1903-1911. [PMID: 30315418 DOI: 10.1007/s00330-018-5764-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/09/2018] [Accepted: 09/14/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVES We investigated the capacity of fluorodeoxyglucose (FDG) PET/CT features for stratifying probability of metastasis for single-bone FDG lesions in non-small-cell lung cancer (NSCLC). METHODS Subjects were 118 newly diagnosed NSCLC patients with a solitary bone FDG lesion and no evidence of other distant metastasis based on PET/CT, brain MRI, and contrast-enhanced chest CT. Bone lesion SUVmax and CT findings, primary tumor SUVmax, clinical T stage, and N stage were analyzed. RESULTS The bone lesions were determined by biopsy, characteristic MRI findings and clinical follow-up to be metastatic in 33 (28.0%) and benign in 85 cases (72.0%). A cutoff bone SUVmax of 4.3 showed good diagnostic performance (81.8% sensitivity, 84.7% specificity, and 83.9% accuracy), but there was considerable overlap. Bone lesion PET/CT features of SUVmax ≤ 2, osteosclerotic rim or fracture correctly diagnosed 20/20 benign, while SUVmax > 10, soft-tissue mass or bone destruction correctly diagnosed 18/18 metastatic cases. In the remaining 80 cases, bone features of SUVmax > 4.3 and osteolytic change, and lung tumor features of SUVmax > 6.4, ≥ T2 stage (n = 70), and ≥ N1 stage (n = 43) favored metastasis. The presence of one or less of these features correctly diagnosed 38/38 benign, while the presence of four or more features correctly diagnosed 5/5 metastatic cases. The 37 cases with two or three features had either benign (n = 27) or metastatic bone disease (n = 10). CONCLUSION Combining bone lesion and lung tumor PET/CT features can help stratify risk of bone metastasis in these patients. KEY POINTS • In NSCLC with a single-bone FDG lesion, lesion SUVmaxis useful for differential diagnosis. • CT features of the single-bone FDG lesions provide additional diagnostic value. • High NSCLC SUVmax, greater T stage, and FDG positive nodes also favor metastasis.
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Affiliation(s)
- Chae Hong Lim
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Tae Ran Ahn
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea
| | - Seung Hwan Moon
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Young Seok Cho
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Byung-Tae Kim
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Kyung-Han Lee
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
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Lin X, Liu X, Gong C. Expression of engrailed homeobox 2 regulates the proliferation, migration and invasion of non-small cell lung cancer cells. Oncol Lett 2018; 16:536-542. [PMID: 29963129 DOI: 10.3892/ol.2018.8693] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 11/29/2017] [Indexed: 12/14/2022] Open
Abstract
The present study aimed to investigate the expression, biological function and mechanism of action of engrailed homeobox 2 (EN2) in non-small cell lung cancer (NSCLC) at the tissue and cellular level. A total of 42 patients who underwent surgical resection of NSCLC tissues between January 2014 and January 2015 were included in the present study. EN2 mRNA expression levels in explanted NSCLC tissues were determined using reverse-transcription quantitative polymerase chain reaction analysis. Adenocarcinoma human alveolar basal epithelial A549 cells were transfected with negative control plasmids or those containing EN2, enabling its overexpression. To assess the effect of EN2 overexpression in A549 cells, a Cell Counting kit-8 assay was used to analyze cellular proliferation, a Transwell assay was used to evaluate cellular migration and invasion and flow cytometry was used to detect the cell cycle distribution. To measure protein expression of EN2 and β-catenin in A549 cells, western blotting was also conducted. EN2 mRNA expression levels in NSCLC tissues were lower than those in normal tissues, and were associated with metastasis, clinical staging and differentiation degrees of NSCLC. Increased expression of EN2 inhibited the proliferation of A549 cells in vitro, and suppressed their migration and invasion. Elevated EN2 expression inhibited the proliferation of A549 cells by regulating the G1/S phase transition. β-catenin protein expression levels and nuclear translocation in A549 cells were inhibited by EN2 overexpression. The present study demonstrated that expression of EN2 in NSCLC tissues was downregulated and negatively associated with the degree of disease differentiation, lymphatic metastasis and clinical staging. Overexpression of EN2 inhibits the proliferation, migration and invasion of A549 cells, as well as the expression of β-Catenin and nuclear translocation.
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Affiliation(s)
- Xiangxiao Lin
- Respiratory Department, Affiliated Hospital of Jining Medical University, Jining, Shandong 272000, P.R. China
| | - Xincun Liu
- Respiratory Department, Affiliated Hospital of Jining Medical University, Jining, Shandong 272000, P.R. China
| | - Cunqi Gong
- Department of Clinical Laboratory, Jining No. 1 People's Hospital, Jining, Shandong 272000, P.R. China
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Bates JE, Milano MT. Prognostic significance of sites of extrathoracic metastasis in patients with non-small cell lung cancer. J Thorac Dis 2017; 9:1903-1910. [PMID: 28839988 DOI: 10.21037/jtd.2017.06.117] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Metastatic non-small cell lung cancer (NSCLC) continues to have a poor prognosis despite recent advances in both targeted radiotherapy methodologies such as stereotactic body radiotherapy (SBRT) and immunotherapies. The impact of location of metastatic disease in patients with NSCLC has not been investigated; we aimed to investigate this using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS We included 39,910 patients from the SEER database treated for M1b NSCLC from 2010-2013. We identified patients with metastatic disease in the brain, lung, liver, and bone. We used Kaplan-Meier analyses and Cox proportional hazards models to assess the impact of varying sites of metastatic disease on overall survival (OS). RESULTS Patients with disease coded as in the brain without other disease in the lung, liver, or bone had improved OS relative to all other comers with M1b disease (HR =0.84, 95% CI, 0.84-0.90, P<0.001). Likewise, patients with disease coded as in the bone without other disease in the lung, liver, or brain had improved OS relative to all other comers with M1b disease (HR =0.89, 95% CI, 0.86-0.92, P<0.001). CONCLUSIONS This hypothesis-generating analysis suggests that patients with limited metastatic NSCLC to the bone or brain may particularly benefit from aggressive upfront therapies.
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Affiliation(s)
- James E Bates
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Michael T Milano
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
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Püsküllüoğlu M, Zygulska AL, Tomaszewska IM, Ochenduszko S, Konopka K, Tomaszewski KA. Evaluation of health-related quality of life and its main influencing factors in a Polish population of patients with bone metastases. Curr Probl Cancer 2016; 40:183-197. [PMID: 27855962 DOI: 10.1016/j.currproblcancer.2016.09.008] [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: 05/09/2016] [Revised: 08/23/2016] [Accepted: 09/21/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Regardless of cancer type, the skeleton is one of the most common sites for cancer spread. Health-related Quality of Life (HRQoL) can be considered a primary endpoint in clinical trials concerning cancer patients with palliative disease. The proper measurement of this endpoint requires valid and reliable instruments. The aim of this study was to evaluate HRQoL and its main influencing factors using validated EORTC tools - the QLQ-C30 and the QLQ-BM22 in Polish population of patients with skeletal metastases. METHODS Patients with bone metastases and histologically confirmed malignancy were qualified for the study. They filled out a personal questionnaire, the Polish version of the EORTC QLQ-C30 and its supplementary module QLQ-BM22. The influence of numerous socio-clinical factors such as age, gender, working status, level of education, performance status, primary location, and previous treatment received was assessed. RESULTS One hundred and ten patients (65 women) were enrolled into this study (mean age ±SD; 57.8±13.8). The most significant HRQoL issues were fatigue (59.29/100); pain (56.97/100) and insomnia (56.36/100). Men coped worse with pain (p=0.013), fatigue (p=0.050), nausea and vomiting (p=0.024) and financial difficulties (p=0.016) than women. CONCLUSIONS The main factors influencing HRQoL in Polish patients with bone metastases are fatigue, pain and insomnia, and as such should be a primary focus of patient-centered care in this group.
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Affiliation(s)
- Mirosława Püsküllüoğlu
- Department of Clinical Oncology, University Hospital in Krakow, Poland; Department of Oncology, Jagiellonian University Medical College, Krakow, Poland.
| | - Aneta L Zygulska
- Department of Clinical Oncology, University Hospital in Krakow, Poland
| | - Iwona M Tomaszewska
- Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland
| | - Sebastian Ochenduszko
- Department of Clinical Oncology, University Hospital in Krakow, Poland; Department of Oncology, Jagiellonian University Medical College, Krakow, Poland
| | - Kamil Konopka
- Department of Clinical Oncology, University Hospital in Krakow, Poland
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Shin J, Keam B, Kim M, Park YS, Kim TM, Kim DW, Kim YW, Heo DS. Prognostic Impact of Newly Proposed M Descriptors in TNM Classification of Non-Small Cell Lung Cancer. J Thorac Oncol 2016; 12:520-528. [PMID: 27867003 DOI: 10.1016/j.jtho.2016.11.2216] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/11/2016] [Accepted: 11/07/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The International Association for the Study of Lung Cancer recently proposed new M descriptors for the next edition of the TNM classification for NSCLC, subdividing the current M1b category into two subcategories: M1b, which indicates a solitary extrathoracic metastasis in a single organ, and M1c, which indicates multiple extrathoracic metastasis. The purpose of this study was to validate the prognostic value of the newly proposed M descriptors in an independent cohort with multivariate and subgroup analysis. METHODS A total of 1024 patients in a consecutive lung cancer database who had stage IV NSCLC treated between 2011 and 2014 were analyzed. Newly proposed M staging was used for classification and comparison of survival. Adjustment for other clinical covariates and subgroup analysis was conducted. RESULTS According to the newly proposed M descriptors, 262 patients (25.6%), 152 patients (14.8%), and 610 patients (59.6%) were classified into the subgroups M1a, M1b, and M1c, respectively. The median overall survival times were 22.5, 17.8, and 13.6 months for the M1a, M1b, and M1c groups, respectively (p < 0.001). After adjustment for other covariates, Cox proportional hazards regression revealed statistically significantly shorter overall survival for the M1b group than for the M1a group (hazard ratio = 1.30; 95% confidence interval: 1.03-1.65, p = 0.03) and for the M1c than the M1b group (hazard ratio = 1.57; 95% confidence interval: 1.28-1.93, p < 0.001). These differences showed a consistent tendency regardless of pathologic and molecular subtypes. CONCLUSIONS The newly proposed M descriptors have prognostic value in patients with stage IV NSCLC.
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Affiliation(s)
- Junghoon Shin
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Miso Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Sik Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Whan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Zhang Q, Wu YL. Surgery in oligometastatic NSCLC patients in the targeted therapy era. Lung Cancer Manag 2016; 5:141-153. [PMID: 30643558 DOI: 10.2217/lmt-2016-0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/16/2016] [Indexed: 12/25/2022] Open
Abstract
More than 50% of NSCLC patients present with metastatic disease at first diagnosis, with a median survival of 8-11 months. However, selected patients with oligometastatic disease who receive appropriate local therapy for both the primary lesion and metastases enjoy long-term survival or are even cured. The new (eighth) edition of the tumor, node and metastasis classification of lung cancer suggests that patients with a single metastatic lesion in one distant organ should be placed into a new category, M1b, which will certainly lead to more applications of local therapy in such subpopulations. Moreover, as the applications of targeted therapy increase, surgery will play an evermore critical role in eliminating drug-resistant cancer clones of patients who exhibit mixed responses to tyrosine kinase inhibitors. The lung, brain and adrenal gland are the most common oligometastatic organs, and are reviewed separately.
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Affiliation(s)
- Qi Zhang
- Southern Medical University, Guangzhou, Guangdong 510515, PR China.,Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510515, PR China.,Southern Medical University, Guangzhou, Guangdong 510515, PR China.,Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510515, PR China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510515, PR China.,Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510515, PR China
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