Surgery for non-small cell lung cancer--new trends

Exploratory Study of a CT Radiomics Model for the Classification of Small Cell Lung Cancer and Non-small-Cell Lung Cancer

Background: Radiomics can quantify tumor phenotypic characteristics non-invasively by applying feature algorithms to medical imaging data. In this study, we investigated the association between radiomics features and the tumor histological subtypes, and we aimed to establish a nomogram for the classification of small cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC). Methods: This was a retrospective single center study. In total, 468 cases including 202 patients with SCLC and 266 patients with NSCLC were enrolled in our study, and were randomly divided into a training set (n = 327) and a validation set (n = 141) in a 7:3 ratio. The clinical data of the patients, including age, sex, smoking history, tumor maximum diameter, clinical stage, and serum tumor markers, were collected. All patients underwent enhanced computed tomography (CT) scans, and all lesions were pathologically confirmed. A radiomics signature was generated from the training set using the least absolute shrinkage and selection operator algorithm. Independent risk factors were identified by multivariate logistic regression analysis, and a radiomics nomogram based on the radiomics signature and clinical features was constructed. The capability of the nomogram was evaluated in the training set and validated in the validation set. Results: Fourteen of 396 radiomics parameters were screened as important factors for establishing the radiomics model. The radiomics signature performed well in differentiating SCLC and NSCLC, with an area under the curve (AUC) of 0.86 (95% CI: 0.82-0.90) in the training set and 0.82 (95% CI: 0.75-0.89) in the validation set. The radiomics nomogram had better predictive performance [AUC = 0.94 (95% CI: 0.90-0.98) in the validation set] than the clinical model [AUC = 0.86 (95% CI: 0.80-0.93)] and the radiomics signature [AUC = 0.82 (95% CI: 0.75-0.89)], and the accuracy was 86.2% (95% CI: 0.79-0.92) in the validation set. Conclusion: The enhanced CT radiomics signature performed well in the classification of SCLC and NSCLC. The nomogram based on the radiomics signature and clinical factors has better diagnostic performance for the classification of SCLC and NSCLC than the simple application of the radiomics signature.

Clinical stage of lung cancer revised by accidental pneumothorax and positron emission tomography

Clinical lung cancer staging is an important basis for choosing treatment modalities and prognosing outcomes. However, it is not always accurate. We reported an interesting process of clinically staging in a case with lung cancer. According to admission computer tomography findings, he was preliminarily diagnosed as stage IV with nonprimary-tumor lobe metastasis and chest wall invasion. Computer tomography findings after accidental pneumothorax resulting from percutaneous puncture biopsy and positron emission tomography findings denied the chest wall invasion and nonprimary-tumor lobe metastasis. His diagnosis was revised as stage IIa that was confirmed subsequently by histological staging after surgery and follow-up. Our experiences indicate computer tomography scanning after artificial pneumothorax is a useful tool for identifying whether or not chest wall is invaded directly by an adjacent tumor, and positron emission tomography scanning needs to be considered for accurately evaluating the nature of concurrent pulmonary nodules in patients with lung cancer.

Trends in in-patient Hospital Utilization and Surgical Procedures for Breast, Prostate, Lung and Colorectal Cancers in Canada

OBJECTIVE

To analyse population-based trends of in-patient surgical procedures for breast (female), prostate, lung and colorectal cancers.

METHODS

The Hospital Morbidity Files supplied hospital data and the Canadian Cancer Registry, incidence data. Age-adjusted rates were standardized to the 1991 Canadian population.

RESULTS

All four cancers showed major changes in trends of surgical procedures. For breast cancer, the rate of in-patient breast conservation surgery (BCS) increased from 1981 to the early 1990s while the rate of mastectomy decreased. Because day surgery was not included, the subsequent in-patient BCS rate stayed level. For prostate cancer, the rate of transurethral prostatectomy was initially high but decreased after 1990, while the rate of radical prostatectomy increased rapidly, only minimally affected by the PSA-related peak in incidence. The lung cancer lobectomy rate in men remained at 10/100,000 after 1986, but in women rose from 3/100,000 to 7/100,000, reflecting increasing lung cancer incidence. For colorectal cancer, right hemicolectomies and anterior resections increased, especially in men.

CONCLUSIONS

Surgery trends reflected changes in incidence and treatment preferences. Canadian trends were generally similar to US trends, although the timing of some of the changes differed. Canadians tended to use less invasive procedures such as BCS and anterior resection.

The beneficial effects of specialist thoracic surgery on the resection rate for non-small-cell lung cancer

We aimed to evaluate the effect of the appointment of a dedicated specialist thoracic surgeon on surgical practice for lung cancer previously served by cardio-thoracic surgeons. Outcomes were compared for the 240 patients undergoing surgical resection for lung cancer in two distinct 3-year periods: Group A: 65 patients, 1994-1996 (pre-specialist); Group B: 175 patients, 1997-1999 (post-specialist). The changes implemented resulted in a significant increase in resection rate (from 12.2 to 23.4%, P < 0.001), operations in the elderly (over 75 years) and extended resections. There were no significant differences in stage distribution, in-hospital mortality or stage-specific survival after surgery. Lung cancer surgery provided by specialists within a multidisciplinary team resulted in increased surgical resection rates without compromising outcome. Our results strengthen the case for disease-specific specialists in the treatment of lung cancer.

Evaluation of operability before lung resection

Lung resection remains the treatment of choice in the curative approach to nonsmall cell lung cancer. Because most lung cancer patients are current or former smokers, they are at increased risk of chronic obstructive pulmonary disease and coronary artery disease, conditions associated with increased surgical morbidity and mortality. Careful preoperative assessment of the cardiopulmonary reserves is therefore of great importance. Various single and combined parameters for the functional assessment before surgery have been proposed. Currently the emphasis is on the determination of forced expiratory volume in the first second, the diffusing capacity for carbon monoxide, and exercise testing with the measurement of maximal oxygen uptake. Adherence to established algorithms for this preoperative evaluation, advances in operative technique (video-assisted thoracoscopic surgery and combined operations of lung cancer surgery with lung volume reduction surgery), and perioperative care permit resections in patients who until recently would have been considered functionally inoperable.