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Campisi A, Dell'Amore A, Chen C, Gabryel P, Bertolaccini L, Ciarrocchi AP, Ji C, Piwkowski C, Spaggiari L, Fang W, Rea F. Long term results of surgery for NSCLC and aortic invasion. A multicenter retrospective cohort study. Aorta involvement in NSCLC. Eur J Surg Oncol 2021; 48:761-767. [PMID: 34895971 DOI: 10.1016/j.ejso.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/20/2021] [Accepted: 12/04/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Aortic invasion from non-small cell lung cancers (NSCLC) is a relative contraindication to surgery for oncological and technical reasons. Only a few studies have been published showing good results. Our aim was to evaluate short and long-term results of surgery for T4 NSCLC with aortic resection. METHODS This is a multicenter retrospective study including 47 patients (33 males and 14 females) who received a major lung resection with aortic surgery in our centers between January 2000 and December 2016. RESULTS Adenocarcinoma was diagnosed in 31 patients (66.0%). Induction therapy was used in 14 patients. Pneumonectomy was performed in 34 patients (72.3%). A subadventitial dissection with or without endovascular stent graft was carried out in 40 patients (85.1%), a cardiopulmonary bypass was used in 3 patients and left heart bypass in 4. Intraoperatively, two patients had bleeding (4.3%) and one ventricular fibrillation (2.1%). Twenty-three patients (48.9%) experienced at least one postoperative complication. A radical resection was achieved in 39 patients (83.0%). Thirty-day and 90-day mortality were 2.1% and 4.3%. One-, 3- and 5-year overall survival were 85.1%, 57.4% and 53.2%. Overall and disease-free survivals were significantly influenced by pathological lymph node status and R status that were independent predictive factors for poorer survival at the multivariate analyses. CONCLUSIONS Aortic resection during surgery for NSCLC is a challenging situation. Nevertheless, oncologic outcomes may be favorable in selected cases justifying a risky procedure that should be performed in experienced hands.
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Affiliation(s)
- Alessio Campisi
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
| | - Andrea Dell'Amore
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery and Vascular Sciences, Padua University Hospital, University of Padua, Padua, Italy
| | - Chunji Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Piotr Gabryel
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Angelo Paolo Ciarrocchi
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, Forlì, Italy
| | - Chunyu Ji
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Cezary Piwkowski
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - 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
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Federico Rea
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery and Vascular Sciences, Padua University Hospital, University of Padua, Padua, Italy
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Abstract
Background Aortic regurgitation is the most common cardiovascular damage in Chinese patients with Behçet’s disease (BD) and is usually associated with aortic disease. These patients are easily misdiagnosed, and their prognosis is poor, even after surgical treatment. This study aimed to analyse potential factors that can improve the prognosis of BD patients with aortic regurgitation and/or aortic involvement. Methods Twenty-two patients with diagnosed or suspected BD as well as aortic regurgitation and/or aortic involvement in our hospital from 2012 through 2017 were collected in this study. Their clinical characteristics were listed, and the diagnosis of BD was evaluated by two different criteria sets. The influences of surgical treatment and immunosuppressive therapy (IST) on their prognosis were also explored. Results The diagnostic positive rate of the International Criteria for Behçet’s Disease was higher than that of the International Study Group criteria (kappa value 0.31, p < 0.05), indicating that the diagnostic consistency between the criteria sets was poor. There was no significant difference in survival between patients who had undergone ≤ 1 operation and those with ≥ 2 operations. Aortic valve replacement alone or in combination with aortic root replacement had no significant effect on the incidence of reoperation or death, but IST did significantly reduce this incidence (p < 0.05). However, there was no significant difference in the occurrence of reoperation or death between preoperative and postoperative IST versus postoperative IST only. Conclusion IST significantly improved the prognosis of BD patients with aortic regurgitation and/or aortic involvement. Supplementary Information The online version of this article (10.1007/s12471-021-01567-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- X Li
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, Hunan, China.,Modern Cardiovascular Disease Clinical Technology Research Centre of Hunan Province, Changsha, Hunan, China.,Cardiovascular Disease Research Centre of Hunan Province, Changsha, Hunan, China
| | - X Wen
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - J Xu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, Hunan, China.,Modern Cardiovascular Disease Clinical Technology Research Centre of Hunan Province, Changsha, Hunan, China.,Cardiovascular Disease Research Centre of Hunan Province, Changsha, Hunan, China
| | - Q Lin
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, Hunan, China.,Modern Cardiovascular Disease Clinical Technology Research Centre of Hunan Province, Changsha, Hunan, China.,Cardiovascular Disease Research Centre of Hunan Province, Changsha, Hunan, China
| | - L Liu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China. .,Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, Hunan, China. .,Modern Cardiovascular Disease Clinical Technology Research Centre of Hunan Province, Changsha, Hunan, China. .,Cardiovascular Disease Research Centre of Hunan Province, Changsha, Hunan, China.
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Stengl R, Bors A, Ágg B, Pólos M, Matyas G, Molnár MJ, Fekete B, Csabán D, Andrikovics H, Merkely B, Radovits T, Szabolcs Z, Benke K. Optimising the mutation screening strategy in Marfan syndrome and identifying genotypes with more severe aortic involvement. Orphanet J Rare Dis 2020; 15:290. [PMID: 33059708 PMCID: PMC7558671 DOI: 10.1186/s13023-020-01569-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/05/2020] [Indexed: 11/16/2022] Open
Abstract
Background Marfan syndrome (MFS) is a systemic connective tissue disorder with life-threatening manifestations affecting the ascending aorta. MFS is caused by dominant negative (DN) and haploinsufficient (HI) mutations of the FBN1 gene. Our aim was to identify mutations of MFS patients with high detection rate and to investigate the use of a gene panel for patients with Marfanoid habitus. We also aimed to examine correlations between genotype and cardiovascular manifestations to predict “malignant” mutations.
Methods 136 individuals were enrolled. In the first phase, next-generation sequencing (NGS) and Sanger sequencing were performed for 57 patients to screen the FBN1 gene, followed by multiplex ligation-dependent probe amplification (MLPA) in negative cases. For repeated negative results, NGS gene panel involving 9 genes was used. In the second phase, 79 patients were tested primarily with the same gene panel, negative samples were tested by MLPA. Results 84 pathogenic mutations were detected, out of which 78 affected FBN1, 6 non-FBN1 mutations (2 TGFB2, 1 TGFBR2, 2 TGFBR1, 1 SMAD3) are associated with Loeys-Dietz syndrome (LDS). LDS patients had lower systemic score and they were younger, but their aortic involvement did not differ. MLPA detected 4 multi-exon deletions of FBN1 gene, which could not be identified by our first-step screening method. Aortic involvement (aortic dissection and/or dilation) did not differ significantly among HI and DN mutations (p = 0.061). Combined group of HI and DN mutations eliminating a disulphide-bonding cysteine (DN Cys) had significantly higher aortic involvement rate than DN mutations not eliminating a disulphide-bonding cysteine (DN non-Cys) (p < 0.001). Patients with DN Cys required significantly more aortic surgeries than HI and DN non-Cys mutations (p = 0.042 and p = 0.015, respectively). Conclusions Due to the relevant number of mutations affecting genes other than FBN1, preferred approach for testing individuals with Marfanoid habitus is using a gene panel rather than single-gene analysis, followed by MLPA for negative samples. DN Cys and HI mutations should be considered as risk factors for aortic involvement. Genetic testing for patients with Marfanoid features and a systemic score under 7 is recommended, as LDS patients may have lower scores, but they may have severe cardiovascular manifestations.
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Affiliation(s)
- Roland Stengl
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary. .,Hungarian Marfan Foundation, Városmajor u. 68, Budapest, 1122, Hungary. .,Laboratory of Molecular Genetics, Central Hospital of Southern Pest, National Institute of Hematology and Infectious Diseases, Albert Flórián út 5-7, Budapest, 1097, Hungary.
| | - András Bors
- Laboratory of Molecular Genetics, Central Hospital of Southern Pest, National Institute of Hematology and Infectious Diseases, Albert Flórián út 5-7, Budapest, 1097, Hungary
| | - Bence Ágg
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary.,Hungarian Marfan Foundation, Városmajor u. 68, Budapest, 1122, Hungary.,Department of Pharmacology and Pharmacotherapy, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
| | - Miklós Pólos
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary.,Hungarian Marfan Foundation, Városmajor u. 68, Budapest, 1122, Hungary
| | - Gabor Matyas
- Center for Cardiovascular Genetics and Gene Diagnostics, Foundation for People With Rare Diseases, Wagistrasse 25, 8952, Schlieren, Zurich, Switzerland
| | - Mária Judit Molnár
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Tömő u. 25-29, Budapest, 1083, Hungary
| | - Bálint Fekete
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Tömő u. 25-29, Budapest, 1083, Hungary
| | - Dóra Csabán
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Tömő u. 25-29, Budapest, 1083, Hungary
| | - Hajnalka Andrikovics
- Laboratory of Molecular Genetics, Central Hospital of Southern Pest, National Institute of Hematology and Infectious Diseases, Albert Flórián út 5-7, Budapest, 1097, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
| | - Tamás Radovits
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
| | - Zoltán Szabolcs
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary.,Hungarian Marfan Foundation, Városmajor u. 68, Budapest, 1122, Hungary
| | - Kálmán Benke
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary.,Hungarian Marfan Foundation, Városmajor u. 68, Budapest, 1122, Hungary
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