1
|
Gabryel P, Skrzypczak P, Roszak M, Campisi A, Zielińska D, Bryl M, Stencel K, Piwkowski C. Influencing Factors on the Quality of Lymph Node Dissection for Stage IA Non-Small Cell Lung Cancer: A Retrospective Nationwide Cohort Study. Cancers (Basel) 2024; 16:346. [PMID: 38254835 PMCID: PMC10814584 DOI: 10.3390/cancers16020346] [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: 12/15/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Lymphadenectomy is an essential part of complete surgical operation for non-small cell lung cancer (NSCLC). This retrospective, multicenter cohort study aimed to identify factors that influence the lymphadenectomy quality. Data were obtained from the Polish Lung Cancer Study Group Database. The primary endpoint was lobe-specific mediastinal lymph node dissection (L-SMLND). The study included 4271 patients who underwent VATS lobectomy for stage IA NSCLC, operated between 2007 and 2022. L-SMLND was performed in 1190 patients (27.9%). The remaining 3081 patients (72.1%) did not meet the L-SMLND criteria. Multivariate logistic regression analysis showed that patients with PET-CT (OR 3.238, 95% CI: 2.315 to 4.529; p < 0.001), with larger tumors (pT1a vs. pT1b vs. pT1c) (OR 1.292; 95% CI: 1.009 to 1.653; p = 0.042), and those operated on by experienced surgeons (OR 1.959, 95% CI: 1.432 to 2.679; p < 0.001) had a higher probability of undergoing L-SMLND. The quality of lymphadenectomy decreased over time (OR 0.647, 95% CI: 0.474 to 0.884; p = 0.006). An analysis of propensity-matched groups showed that more extensive lymph node dissection was not related to in-hospital mortality, complication rates, and hospitalization duration. Actions are needed to improve the quality of lymphadenectomy for NSCLC.
Collapse
Affiliation(s)
- Piotr Gabryel
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland
| | - Piotr Skrzypczak
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland
| | - Magdalena Roszak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Rokietnicka 7 Street, 60-806 Poznan, Poland
| | - Alessio Campisi
- Department of Thoracic Surgery, University and Hospital Trust–Ospedale Borgo Trento, Piazzale Aristide Stefani 1, 37126 Verona, Italy
| | - Dominika Zielińska
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland
| | - Maciej Bryl
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland
| | - Katarzyna Stencel
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland
| | - Cezary Piwkowski
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland
| |
Collapse
|
2
|
Permissible Outcomes of Lobe-Specific Lymph Node Dissection for Elevated Carcinoembryonic Antigen in Non-Small Cell Lung Cancer. Medicina (B Aires) 2021; 57:medicina57121365. [PMID: 34946309 PMCID: PMC8709178 DOI: 10.3390/medicina57121365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: Lobe-specific nodal dissection (L-SND) is currently acceptable for the dissection of early-stage non-small cell lung cancer (NSCLC) but not for cancers of more advanced clinical stages. We aimed to assess the efficacy of L-SND, compared to systemic nodal dissection (SND). Materials and Methods: We retrospectively collected the clinical data of patients with carcinoembryonic antigen (CEA) abnormality who underwent complete resection of NSCLC via lobectomy or more in addition to either SND or L-SND at two cancer-specific institutions from January 2006 to December 2017. Results: A total of 799 patients, including 265 patients who underwent SND and 534 patients who underwent L-SND, were included. On multivariate analysis, thoracotomy, more than lobectomy, cN1-2, advanced pathological stage, adjuvant treatment, and EGFR or ALK were strongly associated with SND. No significant differences were found in overall survival, disease-free survival, and overtime survival after propensity adjustment (p = 0.09, p = 0.11, and p = 0.50, respectively). There were no significant differences in local (p = 0.16), regional (p = 0.72), or distant (p = 0.39) tumor recurrence between the two groups. Conclusions: SND did not improve the prognosis of NSCLC patients with CEA abnormality. Complete pulmonary resection via L-SND seems useful for NSCLC patients with CEA abnormality.
Collapse
|
3
|
Nakao M, Saji H, Mun M, Nakamura H, Okumura N, Tsuchida M, Sonobe M, Miyazaki T, Aokage K, Haruki T, Okada M, Suzuki K, Chida M. Prognostic Impact of Mediastinal Lymph Node Dissection in Octogenarians With Lung Cancer: JACS1303. Clin Lung Cancer 2021; 23:e176-e184. [PMID: 34690079 DOI: 10.1016/j.cllc.2021.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/31/2021] [Accepted: 09/15/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The prognostic significance of mediastinal lymph node dissection (MLND) in elderly patients with non-small cell lung cancer (NSCLC) remains unclear. This post hoc analysis of a nationwide multicenter cohort study (JACS1303) evaluated the prognostic significance of MLND in octogenarians with NSCLC. MATERIALS AND METHODS We included 622 octogenarians with NSCLC who underwent lobectomy. The median follow-up duration was 41.1 months. We compared survival and perioperative outcomes between patients who did and did not undergo MLND. RESULTS In total, 414 (67%) patients underwent MLND (ND2 group), whereas 208 (33%) did not undergo MLND (ND0-1 group). The disease stage was more advanced in the ND2 group than in the ND0-1 group. Disease-free survival was slightly greater in the ND0-1 group with marginal significance (P= .079). In the matched cohort (N = 228), which mainly consisted of patients with clinical stage I disease (96%), there was no significant difference between the 2 groups regarding overall and disease-free survival (P= .908 and P = .916, respectively). Operative time and blood loss were significantly lower in the ND0-1 group than in the ND2 group in the entire cohort (P< .001 and P = .050, respectively) and in the matched cohort (P = .003 and P= .046, respectively). CONCLUSION Based on a nationwide prospective database, we found limited prognostic impact of MLND, suggesting that MLND can be omitted for octogenarians with early-stage NSCLC.
Collapse
Affiliation(s)
- Masayuki Nakao
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Hisashi Saji
- Department of Chest Surgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Mingoyn Mun
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiroshige Nakamura
- Division of General Thoracic Surgery, Tottori University Hospital, Tottori, Japan
| | - Norihito Okumura
- Department of Thoracic Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Masanori Tsuchida
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Makoto Sonobe
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takuro Miyazaki
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Keiju Aokage
- Division of Thoracic Surgery, Department of Thoracic Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Tomohiro Haruki
- Division of General Thoracic Surgery, Tottori University Hospital, Tottori, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan; Committee for Scientific Affairs, The Japanese Association for Chest Surgery, Kyoto, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan; Committee for Scientific Affairs, The Japanese Association for Chest Surgery, Kyoto, Japan
| | - Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University, Shimotsuga, Japan; The Japanese Association for Chest Surgery, Kyoto, Japan
| |
Collapse
|
4
|
Montagne F, Guisier F, Venissac N, Baste JM. The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives-State of the Art. Cancers (Basel) 2021; 13:3711. [PMID: 34359612 PMCID: PMC8345199 DOI: 10.3390/cancers13153711] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 12/25/2022] Open
Abstract
Non-small cell lung cancers (NSCLC) are different today, due to the increased use of screening programs and of innovative systemic therapies, leading to the diagnosis of earlier and pre-invasive tumors, and of more advanced and controlled metastatic tumors. Surgery for NSCLC remains the cornerstone treatment when it can be performed. The role of surgery and surgeons has also evolved because surgeons not only perform the initial curative lung cancer resection but they also accompany and follow-up patients from pre-operative rehabilitation, to treatment for recurrences. Surgery is personalized, according to cancer characteristics, including cancer extensions, from pre-invasive and local tumors to locally advanced, metastatic disease, or residual disease after medical treatment, anticipating recurrences, and patients' characteristics. Surgical management is constantly evolving to offer the best oncologic resection adapted to each NSCLC stage. Today, NSCLC can be considered as a chronic disease and surgery is a valuable tool for the diagnosis and treatment of recurrences, and in palliative conditions to relieve dyspnea and improve patients' comfort.
Collapse
Affiliation(s)
- François Montagne
- Department of Thoracic Surgery, Calmette Hospital, University Hospital of Lille, Boulevard du Pr. J Leclercq, F-59000 Lille, France; (F.M.); (N.V.)
| | - Florian Guisier
- Department of Pneumology, Rouen University Hospital, 1 rue de Germont, F-76000 Rouen, France;
- Clinical Investigation Center, Rouen University Hospital, CIC INSERM 1404, 1 rue de Germont, F-76000 Rouen, France
- Faculty of Medicine and Pharmacy of Rouen, Normandie University, LITIS QuantIF EA4108, 22 Boulevard Gambetta, F-76183 Rouen, France
| | - Nicolas Venissac
- Department of Thoracic Surgery, Calmette Hospital, University Hospital of Lille, Boulevard du Pr. J Leclercq, F-59000 Lille, France; (F.M.); (N.V.)
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Rouen University Hospital, 1 rue de Germont, F-76000 Rouen, France
- Faculty of Medicine and Pharmacy of Rouen (UNIROUEN), Normandie University, INSERM U1096, 22 Boulevard Gambetta, F-76000 Rouen, France
| |
Collapse
|
5
|
Mediastinal lymph node dissection for the elderly with clinical stage I non-small cell lung cancer. Gen Thorac Cardiovasc Surg 2021; 69:1560-1566. [PMID: 34050889 DOI: 10.1007/s11748-021-01656-8] [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: 02/24/2021] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES We aimed to compare the differences in prognosis and perioperative complications between patients with and without mediastinal lymph node dissection (MLND) among elderly patients with clinical stage I non-small cell lung cancer (NSCLC). METHODS We analysed 439 patients ≥ 75 years of age with NSCLC classified as clinical stage I who underwent complete resection with lobectomy. We divided the patients into two groups. Those with MLND were included in the MLND group (n = 365), and those without MLND or adequate systematic mediastinal lymph node sampling were included in the non-MLND group (n = 74). To reduce selection bias, a propensity score matching method (3:1) was implemented. We compared survival and the incidence of perioperative complications. RESULTS After matching, we compared 171 patients in the MLND group to 57 patients in the non-MLND group. There were no significant differences in clinicopathological characteristics between the groups. The non-MLND group did not show a significantly better prognosis than the MLND group in overall survival and cancer-specific survival (p = 0.246 and 0.150, respectively). The cumulative incidence of recurrence was similar in the two groups. MLND did not affect chest drain duration or hospitalization. The numbers of patients with perioperative complications ≥ grade 2 or ≥ grade 3 did not differ between the groups (p = 0.312 and > 0.999, respectively). CONCLUSIONS Anatomical pulmonary resection without MLND might be a treatment option for elderly patients with clinical stage I NSCLC. Further investigation is needed to clarify the value of MLND, especially for vulnerable elderly individuals.
Collapse
|
6
|
Cackowski MM, Gryszko GM, Zbytniewski M, Dziedzic DA, Orłowski TM. Alternative methods of lymph node staging in lung cancer: a narrative review. J Thorac Dis 2020; 12:6042-6053. [PMID: 33209438 PMCID: PMC7656442 DOI: 10.21037/jtd-20-1997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The nodal status indicator in non-small cell lung cancer is one of the most crucial prognostic factors available. However, there are still many arguments among scientists regarding whether the currently used nodal status descriptor should be changed in the forthcoming editions of the Tumor Node Metastasis classification or whether it is precise enough and should be maintained as is. We reviewed studies concerning nodal factor classifications to evaluate their accuracy in non-small cell lung cancer patients and to address the previously mentioned challenge. We reviewed the PubMed database regarding the following classifications: ongoing 8th edition of the Tumor Node Metastasis classification, number of positive lymph nodes, number of negative lymph nodes, number of dissected lymph nodes, lymph node ratio, nodal chains, log odds of positive lymph nodes, zone-based classification and one that is based on the number of lymph node stations involved. Moreover, we analysed data regarding various combinations of these classifications. Our analysis showed that the present nodal staging may not accurately categorize every lung cancer patient. The number of positive lymph nodes and lymph node ratio or the log odds of positive lymph nodes (as the mathematical modification of lymph node ratio) are more legitimate, as they possess very robust data and should be considered initially as additional factors that can be incorporated in ongoing nodal staging systems. Forthcoming non-small cell lung cancer staging systems could benefit from the addition of quantitative-based parameters. Additionally, the minimal extent of lymphadenectomy should be established as staging benefits from it. International, prospective validation studies need to be performed to optimize the cut-off values and prognostic groups and to confirm the superiority of the newly suggested descriptors in non-small cell lung cancer nodal staging.
Collapse
Affiliation(s)
- Marcin M Cackowski
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Grzegorz M Gryszko
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Marcin Zbytniewski
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Dariusz A Dziedzic
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Tadeusz M Orłowski
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| |
Collapse
|
7
|
Nakao M, Ichinose J, Matsuura Y, Okumura S, Mun M. Outcomes after thoracoscopic surgery in octogenarian patients with clinical N0 non-small-cell lung cancer. Jpn J Clin Oncol 2020; 50:926-932. [PMID: 32415303 DOI: 10.1093/jjco/hyaa061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/16/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The number of surgeries for elderly patients with lung cancer is increasing. In our institute, thoracoscopic lobectomy and hilar lymph node dissection are the standard procedure for octogenarian patients with clinical N0 non-small-cell lung cancer. The aim of this study was to determine the outcome of our strategy for octogenarian patients. METHODS Seventy octogenarian patients with clinical N0 non-small-cell lung cancer who underwent surgery were enrolled (O group). As a control group, 205 septuagenarian patients were also enrolled (S group). We compared several clinicopathological factors and outcomes. RESULTS The median age of the O group was 82. There was no significant difference in the comorbidity ratio between the two groups. The 5-year overall survival ratio for the O group (72.8%) was significantly worse than that for the S group (88.3%). However, multivariate analysis proved age was not an independent predictor of outcome. The rates of recurrences involving ipsilateral mediastinal lymph nodes were equal in the two groups. After propensity score matching, clinical T1 patients were dominant (85%) in two matched group and no statistically significant differences were observed in the 5-year overall survival between the two groups. CONCLUSIONS Our strategy for octogenarian patients with non-small-cell lung cancer, including omission of mediastinal lymph node dissection, was determined to be feasible, in particularly with cT1N0 disease.
Collapse
Affiliation(s)
- Masayuki Nakao
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junji Ichinose
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yosuke Matsuura
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Sakae Okumura
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Mingyon Mun
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| |
Collapse
|
8
|
Chen Y, Zhang J, Chen L, Dai J, Hu J, Zhu X, Zhang K, Yu H, Zhang H, Fei K, Zhang P. Lymph Node Examination for Stage I Second Primary Lung Cancer Patients Who Received Second Surgical Treatment. Ann Surg Oncol 2020; 28:1810-1818. [PMID: 32892269 DOI: 10.1245/s10434-020-08975-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/04/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE This study aims to investigate the effect of lymph node examination on overall survival (OS) and lung cancer-specific survival (LCSS) in stage I second primary lung cancer (SPLC) patients who underwent second pulmonary resection. PATIENTS AND METHODS We conducted a retrospective study with the Surveillance, Epidemiology, and End Results (SEER) database to identify stage I SPLC patients who received surgery from 1998 to 2015. The Kaplan-Meier method with landmark analysis and multivariable Cox regression analysis were performed to evaluate the prognostic value of lymph node examination. RESULTS A total of 842 patients from the SEER database with stage I SPLC who underwent a second surgical treatment were included. The 5-year survival rate was 54.8% for the whole cohort. Multivariable analysis revealed that the number of lymph nodes examined (LNE) was associated with better OS and LCSS in SPLC patients after 12 months postoperatively. Patients with contralateral SPLC had significantly more nodes removed than those with ipsilateral SPLC. For contralateral SPLC, more than 10 LNE was correlated with improved long-term survival outcomes. Ipsilateral SPLC patients benefited from 4 or more LNE. However, the current analysis did not show a significant survival benefit from lymph node examination within 12 months after surgery. CONCLUSIONS For stage I SPLC patients who received surgical treatment after initial resection, an adequate number of LNE would improve both OS and LCSS. We recommend more than 10 LNE for contralateral SPLC and at least 4 LNE for ipsilateral SPLC.
Collapse
Affiliation(s)
- Yan Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jing Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Linsong Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jie Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Junjie Hu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xinsheng Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kaixuan Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huansha Yu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haiping Zhang
- Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Ke Fei
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Peng Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
| |
Collapse
|
9
|
Veluswamy RR, Whittaker Brown SA, Mhango G, Sigel K, Nicastri DG, Smith CB, Bonomi M, Galsky MD, Taioli E, Neugut AI, Wisnivesky JP. Comparative Effectiveness of Robotic-Assisted Surgery for Resectable Lung Cancer in Older Patients. Chest 2019; 157:1313-1321. [PMID: 31589843 DOI: 10.1016/j.chest.2019.09.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 08/29/2019] [Accepted: 09/14/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Robotic-assisted surgery (RAS) is a novel surgical approach increasingly used for patients with non-small cell lung cancer (NSCLC). However, data comparing the effectiveness and costs of RAS vs open thoracotomy and video-assisted thoracoscopic surgery (VATS) for NSCLC are limited. METHODS Patients > 65 years old with stage I to IIIA NSCLC treated with RAS, VATS, or open thoracotomy were identified from the Surveillance, Epidemiology, and End Results-Medicare database and matched according to age, sex, stage, and extent of resection. Propensity score methods were used to compare adjusted rates of postoperative complications, adequate lymph node staging, survival, and treatment-related costs. RESULTS In this matched study cohort of 2,766 patients with resected NSCLC, RAS was associated with lower complication rates (OR, 0.57; 95% CI, 0.42-0.79) compared with open thoracotomy, and similar complication rates (OR, 1.02; 95% CI, 0.76-1.37) compared with VATS. Patients undergoing RAS were as likely to have adequate lymph node sampling as those undergoing open thoracotomy (OR, 1.28; 95% CI, 0.94-1.74) or VATS (OR, 0.88; 95% CI, 0.66-1.18). There was no significant difference in overall survival after RAS vs open thoracotomy (hazard ratio, 0.81; 95% CI, 0.63-1.04) or VATS (hazard ratio, 0.91; 95% CI, 0.70-1.18). Costs were similar for RAS ($54,702) vs open thoracotomy ($57,104; P = .08), and higher compared with VATS ($48,729; P = .02). CONCLUSIONS RAS led to improved operative outcomes compared with open thoracotomy but may not offer an advantage over VATS. The comparative effectiveness of RAS should be further evaluated prior to widespread adoption.
Collapse
Affiliation(s)
- Rajwanth R Veluswamy
- Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY; Institute of Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Stacey-Ann Whittaker Brown
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Grace Mhango
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Keith Sigel
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Daniel G Nicastri
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Cardinale B Smith
- Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY; Hertzberg Palliative Care Institute of the Brookdale Department of Geriatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Marcelo Bonomi
- Department of Medical Oncology, The Ohio State University, Columbus, OH
| | - Matthew D Galsky
- Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Emanuela Taioli
- Institute of Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alfred I Neugut
- Division of Hematology/Oncology, Department of Medicine, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Juan P Wisnivesky
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
10
|
Dai J, Liu M, Yang Y, Li Q, Song N, Rocco G, Sihoe ADL, Gonzalez-Rivas D, Suen HC, He W, Duan L, Fan J, Zhao D, Wang H, Zhu Y, Chen C, Diasio RB, Jiang G, Yang P, Zhang P. Optimal Lymph Node Examination and Adjuvant Chemotherapy for Stage I Lung Cancer. J Thorac Oncol 2019; 14:1277-1285. [PMID: 31009811 DOI: 10.1016/j.jtho.2019.03.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 03/17/2019] [Accepted: 03/28/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine the optimal number of lymph nodes (LNs) examined and the role of adjuvant chemotherapy in stage I lung cancer. METHODS The National Cancer Database was queried for surgically treated patients with pathologic stage I lung cancer between 2006 and 2014 (N = 65,438). The optimal LN numbers were determined in the multivariate Cox model and were further validated in the cohort with clinical stage I disease (N = 117,112) in terms of nodal upstaging and prognostic stratification. The role of adjuvant chemotherapy in patients with suboptimal staging (number of LNs examined was less than than the optimum) was evaluated in each T stage. RESULTS The number of LNs examined correlated with tumor size (p < 0.001). There were increasing survival benefits with each additional LN examined-up to eight, nine, 10, and 11 nodes for patients with T1a, T1b, T1c, and T2a, respectively. Validation from the cohort with clinically staged disease showed that the threshold of eight to 11 LNs was an independent predictor of nodal upstaging (OR = 1.706, 95% confidence interval [CI] 1.608-1.779) and survival outcome (hazard ratio = 0.890, 95% CI: 0.865-0.916). After propensity matching, adjuvant chemotherapy was associated with improved survival in patients with stage T2a disease having suboptimal staging (hazard ratio = 0.841, 95% CI: 0.714-0.990), but not in patients with stage T1a to T1c disease. CONCLUSION LN evaluation was important for accurate staging and adequate treatment, and examinations of an increasing number of nodes for progressively higher T components (i.e., eight, nine, 10, and 11 nodes for T1a, T1b, T1c, and T2a tumors, respectively) seemed crucial to predict upstaging and survival outcomes. Adjuvant chemotherapy might be beneficial to patients with stage T2a disease who have suboptimal nodal staging.
Collapse
Affiliation(s)
- Jie Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Ming Liu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Yang Yang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Qiuyuan Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Nan Song
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York
| | - Alan D L Sihoe
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China; Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China; Division of Thoracic Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen, People's Republic of China
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China; Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain
| | - Hon Chi Suen
- Center for Cardiothoracic Surgery, Inc., St. Louis, Missouri
| | - Wenxin He
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Liang Duan
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Jiang Fan
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Deping Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Haifeng Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | | | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Ping Yang
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Peng Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China.
| |
Collapse
|
11
|
Okami J. Treatment strategy and decision-making for elderly surgical candidates with early lung cancer. J Thorac Dis 2019; 11:S987-S997. [PMID: 31183181 DOI: 10.21037/jtd.2019.04.01] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Among elderly cancer patients of the same chronological age, there is a wide range of heterogeneity in their ability to tolerate surgery. When an elderly patient comes to a thoracic surgeon, the surgeon first considers how healthy the patient is. If the patient looks healthy or in fit condition, the surgeon offers lobectomy plus mediastinal lymph node dissection. On the other hand, if the patient looks frail, the surgeon may offer, instead of a standard treatment, lobectomy without lymph node dissection, sublobar resection, or radiotherapy or may not offer any kind of treatment. This review was conducted to obtain an overview of these options and compare the treatment outcomes reported in the literature for the purpose of making a good decision for elderly surgical candidates with early lung cancer.
Collapse
Affiliation(s)
- Jiro Okami
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| |
Collapse
|
12
|
Yang X, Pan X, Liu H, Gao D, He J, Liang W, Guan Y. A new approach to predict lymph node metastasis in solid lung adenocarcinoma: a radiomics nomogram. J Thorac Dis 2018; 10:S807-S819. [PMID: 29780627 DOI: 10.21037/jtd.2018.03.126] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Lymph node metastasis (LNM) of lung cancer is an important factor related to survival and recurrence. The association between radiomics features of lung cancer and LNM remains unclear. We developed and validated a radiomics nomogram to predict LNM in solid lung adenocarcinoma. Methods A total of 159 eligible patients with solid lung adenocarcinoma were divided into training (n=106) and validation cohorts (n=53). Radiomics features were extracted from venous-phase CT images. We built a radiomics nomogram using a multivariate logistic regression model combined with CT-reported lymph node (LN) status. The performance of the radiomics nomogram was evaluated using the area under curve (AUC) of receiver operating characteristic curve. We performed decision curve analysis (DCA) within training and validation cohorts to assess the clinical usefulness of the nomogram. Results Fourteen radiomics features were chosen from 94 candidate features to build a radiomics signature that significantly correlated with LNM. The model showed good calibration and discrimination in the training cohort, with an AUC of 0.871 (95% CI: 0.804-0.937), sensitivity of 85.71% and specificity of 77.19%. In the validation cohort, AUC was 0.856 (95% CI: 0.745-0.966), sensitivity was 91.66%, and specificity was 82.14%. DCA demonstrated that the nomogram was clinically useful. The nomogram also showed good predictive ability in patients at high risk for LNM in the CT-reported LN negative (cN0) subgroup. Conclusions The radiomics nomogram, based on preoperative CT images, can be used as a noninvasive method to predict LNM in patients with solid lung adenocarcinoma.
Collapse
Affiliation(s)
- Xinguan Yang
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases, Guangzhou 510000, China
| | - Xiaohuan Pan
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases, Guangzhou 510000, China
| | - Hui Liu
- 12 Sigma Technologies, Shanghai 200000, China
| | - Dashan Gao
- 8910 University Center Ln, #420, San Diego, CA, USA.,12 Sigma Technologies, San Diego, CA, USA
| | - Jianxing He
- National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases, Guangzhou 510000, China.,Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Wenhua Liang
- National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases, Guangzhou 510000, China.,Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Yubao Guan
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases, Guangzhou 510000, China
| |
Collapse
|
13
|
Yamanashi K, Okumura N, Yamamoto Y, Takahashi A, Nakashima T, Matsuoka T, Kameyama K. Adjuvant chemotherapy for elderly patients with non-small-cell lung cancer. Asian Cardiovasc Thorac Ann 2017; 25:371-377. [DOI: 10.1177/0218492317714669] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Adjuvant chemotherapy after complete surgical resection is currently the standard of care for patients with stage IB, II, or IIIA non-small-cell lung cancer. However, the generalizability of this treatment to elderly patients is controversial. We investigated the effects of adjuvant chemotherapy in patients aged over 75 years with stage IB-IIIA non-small-cell lung cancer. Methods We retrospectively analyzed 246 consecutive patients aged over 75 years with stage IB-IIIA non-small-cell lung cancer who underwent standard lung cancer surgery between January 2001 and December 2015. They were divided into 102 who had adjuvant chemotherapy and 144 who had none (control group). The outcomes were compared between the two groups, and prognostic factors were evaluated. Results Relapse-free survival and overall survival were significantly shorter in the control group than the chemotherapy group ( p = 0.006 and p = 0.008, respectively). In multivariable analyses, adjuvant chemotherapy was found to be an independent prognostic factor for relapse-free survival and overall survival (hazard ratio = 0.594, 95% confidence interval: 0.396–0.893, p = 0.012; and hazard ratio = 0.616, 95% confidence interval: 0.397–0.957, p = 0.031, respectively). After inverse-probability-of-treatment weighting adjustment using the propensity score for baseline characteristics, chemotherapy almost improved relapse-free survival and overall survival (hazard ratio = 0.652, 95% confidence interval: 0.433–0.981, p = 0.040; and hazard ratio = 0.657, 95% confidence interval: 0.429–1.004, p = 0.052, respectively). Conclusions Adjuvant chemotherapy improved the prognosis after standard lung cancer surgery in patients aged over 75 years with stage IB-IIIA non-small-cell lung cancer.
Collapse
Affiliation(s)
- Keiji Yamanashi
- Department of Thoracic Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Norihito Okumura
- Department of Thoracic Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Yoshiharu Yamamoto
- Department of Clinical Research, Kurashiki Central Hospital, Okayama, Japan
| | - Ayuko Takahashi
- Department of Thoracic Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Takashi Nakashima
- Department of Thoracic Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Tomoaki Matsuoka
- Department of Thoracic Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Kotaro Kameyama
- Department of Thoracic Surgery, Kurashiki Central Hospital, Okayama, Japan
| |
Collapse
|
14
|
Smith CB, Wolf A, Mhango G, Wisnivesky JP. Impact of Surgeon Volume on Outcomes of Older Stage I Lung Cancer Patients Treated via Video-assisted Thoracoscopic Surgery. Semin Thorac Cardiovasc Surg 2017; 29:223-230. [PMID: 28823334 DOI: 10.1053/j.semtcvs.2017.01.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 11/11/2022]
Abstract
Surgeon procedure volume influences outcomes of patients undergoing cancer operations. Limited data are available, however, on the volume-outcome relationship for video-assisted thoracoscopic surgery (VATS) in the treatment of non-small cell lung cancer (NSCLC). In this study, we used population-based data to evaluate the extent to which surgeon volume is associated with postoperative and long-term oncological outcomes following VATS resection for older patients with early-stage NSCLC. Stage I NSCLC patients >65 years treated with VATS wedge, segmentectomy, or lobectomy between 2000 and 2010 were identified from the Surveillance, Epidemiology, and End Results registry linked to Medicare. Surgeon volume was grouped into tertiles (low, intermediate, and high). Outcomes included perioperative complications, intensive care unit admission, extended length of stay, perioperative (30-day) mortality, and long-term overall and lung cancer-specific survival. We used propensity score methods to compare adjusted survival of patients by surgical volume group. A total of 2295 study patients were identified. Patients treated by high-volume surgeons had decreased intensive care unit admissions (hazard ratio [HR]: 0.46, 95% CI: 0.41-0.51) and postoperative length of stay (HR: 0.75, 95% CI: 0.61-0.92). Adjusted analyses showed that overall (HR: 0.73, 95% CI: 0.62-0.87) and lung cancer-specific (HR: 0.76, 95% CI: 0.58-0.99) survival was better for patients treated by high-volume surgeons. Elderly stage I NSCLC patients undergoing VATS by high-volume surgeons have reduced postoperative complications and improved survival. Organization of care favoring referrals of VATS candidates to high-volume providers may help improve the outcomes of patients with early-stage lung cancer.
Collapse
Affiliation(s)
- Cardinale B Smith
- Division of Hematology/Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Andrea Wolf
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Grace Mhango
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
15
|
Samayoa AX, Pezzi TA, Pezzi CM, Greer Gay E, Asai M, Kulkarni N, Carp N, Chun SG, Putnam JB. Rationale for a Minimum Number of Lymph Nodes Removed with Non-Small Cell Lung Cancer Resection: Correlating the Number of Nodes Removed with Survival in 98,970 Patients. Ann Surg Oncol 2016; 23:1005-1011. [DOI: 10.1245/s10434-016-5509-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Indexed: 01/28/2023]
|
16
|
|
17
|
Yu JB, Soulos PR, Cramer LD, Decker RH, Kim AW, Gross CP. Comparative effectiveness of surgery and radiosurgery for stage I non-small cell lung cancer. Cancer 2015; 121:2341-9. [PMID: 25847699 DOI: 10.1002/cncr.29359] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND Although surgery is the standard treatment for early-stage non-small cell lung cancer (NSCLC), stereotactic body radiotherapy (SBRT) has been disseminated as an alternative therapy. The comparative mortalities and toxicities of these treatments for patients of different life expectancies are unknown. METHODS The Surveillance, Epidemiology, and End Results-Medicare linked database was used to identify patients who were 67 years old or older and underwent SBRT or surgery for stage I NSCLC from 2007 to 2009. Matched patients were stratified into short life expectancies (<5 years) and long life expectancies (≥5 years). Mortality and complication rates were compared with Poisson regression. RESULTS Overall, 367 SBRT patients and 711 surgery patients were matched. Acute toxicity (0-1 month) was lower from SBRT versus surgery (7.9% vs 54.9%, P < .001). At 24 months after treatment, there was no difference (69.7% vs 73.9%, P = .31). The incidence rate ratio (IRR) for toxicity from SBRT versus surgery was 0.74 (95% confidence interval [CI], 0.64-0.87). Overall mortality was lower with SBRT versus surgery at 3 months (2.2% vs 6.1%, P = .005), but by 24 months, overall mortality was higher with SBRT (40.1% vs 22.3%, P < .001). For patients with short life expectancies, there was no difference in lung cancer mortality (IRR, 1.01; 95% CI, 0.40-2.56). However, for patients with long life expectancies, there was greater overall mortality (IRR, 1.49; 95% CI, 1.11-2.01) as well as a trend toward greater lung cancer mortality (IRR, 1.63; 95% CI, 0.95-2.79) with SBRT versus surgery. CONCLUSIONS SBRT was associated with lower immediate mortality and toxicity in comparison with surgery. However, for patients with long life expectancies, there appears to be a relative benefit from surgery versus SBRT.
Collapse
Affiliation(s)
- James B Yu
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.,Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | - Pamela R Soulos
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Laura D Cramer
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut
| | - Roy H Decker
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.,Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | - Anthony W Kim
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut.,Department of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Cary P Gross
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
18
|
Malhotra J, Mhango G, Gomez J, Smith C, Galsky M, Strauss G, Wisnivesky J. Adjuvant chemotherapy for elderly patients with stage I non-small-cell lung cancer ≥4 cm in size: an SEER–Medicare analysis. Ann Oncol 2015; 26:768-773. [DOI: 10.1093/annonc/mdv008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
19
|
Comparative outcomes of elderly stage I lung cancer patients treated with segmentectomy via video-assisted thoracoscopic surgery versus open resection. J Thorac Oncol 2014; 9:383-9. [PMID: 24495998 DOI: 10.1097/jto.0000000000000083] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Video-assisted thorcacic surgery (VATS) is considered an alternative to open lobectomy for the treatment of non-small-cell lung cancer (NSCLC). Limited data are available, however, regarding the equivalence of open versus VATS segmental resections, particularly among elderly patients. METHODS From the Surveillance, Epidemiology, and End Results-Medicare database we identified 577 stage I NSCLC patients aged more than 65 years treated with VATS or open segmentectomy. We used propensity score methods to control for differences in the baseline characteristics of patients treated with VATS versus open segmentectomy. Outcomes included perioperative complications, need for intensive care unit, extended hospital stay, perioperative mortality, and survival. RESULTS Overall, 27% of patients underwent VATS. VATS-treated patients had lower rates of postoperative complications (odds ratio [OR]: 0.55, 95% confidence interval [CI]: 0.37-0.83), intensive care unit admissions (OR: 0.18, 95% CI: 0.12-0.28), and decreased length of stay (OR: 0.41, 95% CI: 0.21-0.81) after adjusting for propensity scores. Postoperative outcomes were not significantly different across groups after adjusting for surgeon characteristics. Overall (hazard ratio: 0.80, 95% CI: 0.60-1.06) and lung cancer-specific (hazard ratio: 0.71, 95% CI: 0.45-1.12) survival was similar across groups. CONCLUSIONS VATS segmentectomy can be safely performed among elderly NSCLC patients and is associated with equivalent postoperative and oncologic outcomes.
Collapse
|
20
|
Paul S, Isaacs AJ, Treasure T, Altorki NK, Sedrakyan A. Long term survival with thoracoscopic versus open lobectomy: propensity matched comparative analysis using SEER-Medicare database. BMJ 2014; 349:g5575. [PMID: 25277994 PMCID: PMC4183188 DOI: 10.1136/bmj.g5575] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To compare long term survival after minimally invasive lobectomy and thoracotomy lobectomy. DESIGN Propensity matched analysis. SETTING Surveillance, Epidemiology and End Results (SEER)-Medicare database. PARTICIPANTS All patients with lung cancer from 2007 to 2009 undergoing lobectomy. MAIN OUTCOME MEASURE Influence of less invasive thoracoscopic surgery on overall survival, disease-free survival, and cancer specific survival. RESULTS From 2007 to 2009, 6008 patients undergoing lobectomy were identified (n=4715 (78%) thoracotomy). The median age of the entire cohort was 74 (interquartile range 70-78) years. The median length of follow-up for entire group was 40 months. In a matched analysis of 1195 patients in each treatment category, no statistical differences in three year overall survival, disease-free survival, or cancer specific survival were found between the groups (overall survival: 70.6% v 68.1%, P=0.55; disease-free survival: 86.2% v 85.4%, P=0.46; cancer specific survival: 92% v 89.5%, P=0.05). CONCLUSION This propensity matched analysis showed that patients undergoing thoracoscopic lobectomy had similar overall, cancer specific, and disease-free survival compared with patients undergoing thoracotomy lobectomy. Thoracoscopic techniques do not seem to compromise these measures of outcome after lobectomy.
Collapse
Affiliation(s)
- Subroto Paul
- Department of Health Policy and Research, Patient Centered Comparative Effectiveness Program, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY 10065, USA Department of Cardiothoracic Surgery, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY 10065, USA
| | - Abby J Isaacs
- Department of Health Policy and Research, Patient Centered Comparative Effectiveness Program, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY 10065, USA
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
| | - Nasser K Altorki
- Department of Cardiothoracic Surgery, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY 10065, USA
| | - Art Sedrakyan
- Department of Health Policy and Research, Patient Centered Comparative Effectiveness Program, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY 10065, USA Department of Cardiothoracic Surgery, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY 10065, USA
| |
Collapse
|
21
|
Pallis AG, Gridelli C, Wedding U, Faivre-Finn C, Veronesi G, Jaklitsch M, Luciani A, O'Brien M. Management of elderly patients with NSCLC; updated expert's opinion paper: EORTC Elderly Task Force, Lung Cancer Group and International Society for Geriatric Oncology. Ann Oncol 2014; 25:1270-1283. [PMID: 24638905 DOI: 10.1093/annonc/mdu022] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Non-small-cell lung cancer (NSCLC) is a very common disease in the elderly population and its incidence in this particular population is expected to increase further, because of the ageing of the Western population. Despite this, limited data are available for the treatment of these patients and, therefore, the development of evidence-based treatment recommendations is challenging. In 2010, European Organization for Research and Treatment of Cancer (EORTC) took an initiative in collaboration with International Society of Geriatric Oncology (SIOG) and created an experts panel that provided an experts' opinion consensus paper for the management of elderly NSCLC patients. Since this publication, important new data are available and EORTC and SIOG recommended to update the 2010 recommendations. Besides recommendations for surgery, adjuvant chemotherapy and radiotherapy, treatment of locally advanced and metastatic disease, recommendations were expanded, to include data on patient preferences and geriatric assessment.
Collapse
Affiliation(s)
- A G Pallis
- Medical Department, European Organization for Research and Treatment of Cancer, Brussels, Belgium.
| | - C Gridelli
- Division of Medical Oncology, 'S.G. Moscati' Hospital-Avellino, Avellino, Italy
| | - U Wedding
- Department of Internal Medicine II, Jena University Hospital, Jena, Germany
| | | | - G Veronesi
- Lung Cancer Early Detection Unit, Division of Thoracic Surgery, European Institute of Oncology, Milano, Italy
| | - M Jaklitsch
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - A Luciani
- Department of Medical Oncology, S. Paolo Hospital, Milan, Italy
| | - M O'Brien
- The Royal Marsden NHS Foundation, Surrey, UK
| |
Collapse
|
22
|
Identification of the methylation of p14ARF promoter as a novel non-invasive biomarker for early detection of lung cancer. Clin Transl Oncol 2013; 16:581-9. [PMID: 24154929 DOI: 10.1007/s12094-013-1122-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 10/09/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Recent diagnostic procedure advances have greatly improved early lung cancer detection. However, the invasive, unpleasant and inconvenient nature of current diagnostic procedures limits their application. There is a great need of novel non-invasive biomarkers for early lung cancer diagnosis. In the present study, we intend to determine whether the blood signatures of p14ARF promoter methylation are suitable for early detection of lung cancer. METHODS The study aimed to assess the probability of p14ARF promoter methylation in plasma samples to detect early lung cancer using nested methylation-specific PCR in the training set consisted of tumor tissues and paired blood. Besides, we were further to discuss the difference in time to progression between methylation and unmethylation of p14ARF promoter using univariate and multivariate analysis. RESULTS The methylation of p14ARF promoter was detected in 33.6 % of tumor tissues, and 12.1 and 25.2 % in distant-cancer mucosa and matched plasma, respectively, and our study has also demonstrated the positive correlation between them by Pearson's test (r = 0.300). The tumor-free survival time of the unmethylation of p14ARF promoter is significantly longer than that of the methylation of p14ARF promoter in tumor tissues (χ (2) = 7.149, P = 0.008). CONCLUSION The methylation of p14ARF promoter in plasma samples has strong potential as a novel non-invasive biomarker for early detection of lung cancer, and the methylation of p14ARF promoter was considered as prognostic factor in our study.
Collapse
|
23
|
Adjuvant treatment for elderly patients with early-stage lung cancer treated with limited resection. Ann Am Thorac Soc 2013; 10:622-8. [PMID: 24024700 DOI: 10.1513/annalsats.201305-127oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES Limited resection is commonly used for treating older patients with early-stage non-small cell lung cancer (NSCLC) who cannot tolerate lobectomy. However, parenchymal-sparing procedures leave patients at increased risk of recurrence. The role of postoperative radiotherapy (PORT) and chemotherapy after limited resection is not established. METHODS We identified 1,929 patients with stage I-II (≤ 5 cm in size) NSCLC who underwent limited resection (wedge or segmentectomy) from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Using propensity score methods, we compared toxicity and survival of patients treated with limited resection alone, PORT, adjuvant chemotherapy, or PORT and chemotherapy. We conducted secondary analysis stratifying the sample by size (>2-5 cm), stage (IA vs. IB/IIA), and type of limited resection (wedge resection vs. segmentectomy). MEASUREMENTS AND MAIN RESULTS Overall, 1,656 (85.8%), 159 (8.3%), 74 (3.8%), and 40 (2.1%) patients were treated with limited resection alone, PORT, adjuvant chemotherapy, or PORT and chemotherapy, respectively. Adjusted analysis using inverse probability weighting showed that PORT (hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.45-1.69), adjuvant chemotherapy (HR, 1.48; 95% CI, 1.36-1.61), and PORT and chemotherapy (HR, 1.73; 95% CI, 1.61-1.86) were associated with worse survival compared with limited resection alone. Similar results were obtained in secondary analyses. Compared with limited resection alone, the adjusted odds ratios for toxicity were 1.97 (95% CI, 1.6-2.4), 3.15 (95% CI, 2.58-3.85), 2.59 (95% CI, 2.0-3.4) for PORT, chemotherapy, and PORT and chemotherapy, respectively. CONCLUSIONS PORT and adjuvant chemotherapy are not beneficial and appear to be associated with increased toxicity and worse survival after limited resection in elderly patients with early-stage NSCLC. Alternative strategies should be explored to improve local control.
Collapse
|