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Kagimoto A, Ishida M, Mimura T. Significance of the Goddard Score in Predicting Complications Related to Air Leak After Lobectomy. Ann Thorac Surg 2024; 118:233-239. [PMID: 37858880 DOI: 10.1016/j.athoracsur.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 08/30/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Postoperative air leakage is a frequent complication after lung resection, and emphysema is a risk factor. However, no study has investigated the relationship between emphysema severity and postoperative complications related to air leak by the Goddard score (GS), a visual evaluation method of radiologic emphysema using computed tomography. METHODS This study included patients who underwent lobectomy for non-small cell lung cancer between April 2009 and March 2022. The utility of GS in predicting complications related to air leak (air leak prolonged for ≥5 days, pleurodesis, and reoperation for air leak) was investigated by receiver operating characteristic curve analysis and multivariable analysis with a logistic regression model. RESULTS This study included 477 patients. The GS was a significant predictor of complications related to air leak (area under the curve, 0.696; P < .001). Based on the receiver operating characteristic curve analysis, GS of 6 points was used as the cutoff point for multivariable analysis. In the multivariable analysis, GS of ≥6 points was a significant predictor of complications related to air leak (odds ratio, 2.719; P = .007). In the subgroup analysis of patients with emphysema, GS of ≥6 points was a significant predictor of complications related to air leak (P = .014). CONCLUSIONS The GS was useful in predicting complications related to air leak. Patients with radiologic findings of emphysema with GS of ≥6 points should be recognized as a high-risk group for complications related to air leak.
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Affiliation(s)
- Atsushi Kagimoto
- Department of General Thoracic Surgery, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | - Masayuki Ishida
- Department of General Thoracic Surgery, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | - Takeshi Mimura
- Department of General Thoracic Surgery, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan.
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Miura K, Ide S, Minamisawa M, Mishima S, Matsuoka S, Eguchi T, Hamanaka K, Shimizu K. Sublobar resection or lobectomy and postoperative respiratory complications in emphysematous lungs. Eur J Cardiothorac Surg 2024; 65:ezae061. [PMID: 38447190 DOI: 10.1093/ejcts/ezae061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/27/2024] [Accepted: 03/04/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVES Pulmonary resection in patients with severe emphysema may impact postoperative respiratory complications. Low-attenuation areas evaluated using three-dimensional computed tomography to assess emphysematous changes are strongly associated with postoperative respiratory complications. Herein, we investigated the relationship between low-attenuation area, the surgical procedure and resected lung volume, which has not been explored in previous studies. METHODS We retrospectively evaluated patients with primary or metastatic lung cancer who underwent surgical resection. The low-attenuation area percentage (low-attenuation area/total lung area × 100) and resected lung volume were calculated using three-dimensional computed tomography software, and the relationship with postoperative respiratory complications was analysed. RESULTS Postoperative respiratory complications occurred in 66 patients (17%) in the total cohort (n = 383). We set the median value of 1.1% as the cut-off value for low-attenuation area percentage to predict postoperative respiratory complications, which occurred in 24% and 10% of patients with low-attenuation area >1.1% and <1.1%, respectively (P < 0.001). Postoperative respiratory complications occurred in approximately one-third of the patients with low-attenuation area >1.1%, whose resected lung volume was ≥15.8% or ≥5 resected subsegments. Multivariable analysis revealed that sublobar resection was associated with a significantly lower risk of postoperative respiratory complications in patients with low-attenuation area >1.1% (odds ratio 0.4, 95% confidence interval 0.183-0.875). CONCLUSIONS Emphysema is a risk factor for postoperative respiratory complications, and lobectomy is an independent predictive risk factor. Preserving more lung parenchyma may yield better short-term prognoses in patients with emphysematous lungs.
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Affiliation(s)
- Kentaro Miura
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shogo Ide
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masatoshi Minamisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shuji Mishima
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shunichiro Matsuoka
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takashi Eguchi
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazutoshi Hamanaka
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kimihiro Shimizu
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Zou Y, Mao Q, Zhao Z, Zhou X, Pan Y, Zuo Z, Zhang W. Intratumoural and peritumoural CT-based radiomics for diagnosing lepidic-predominant adenocarcinoma in patients with pure ground-glass nodules: a machine learning approach. Clin Radiol 2024; 79:e211-e218. [PMID: 38044199 DOI: 10.1016/j.crad.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/10/2023] [Accepted: 11/06/2023] [Indexed: 12/05/2023]
Abstract
AIM To develop and validate a diagnostic model utilising machine-learning algorithms that differentiates lepidic predominant adenocarcinoma (LPA) from other pathological subtypes in patients with pure ground-glass nodules (pGGNs). MATERIALS AND METHODS This bicentric study was conducted across two medical centres and included 151 patients diagnosed with lung adenocarcinoma based on histopathological confirmation of pGGNs. The training cohort consisted of 99 patients from Institution 1, while the test cohort included 52 patients from Institution 2. Radiomics features were extracted from both tumours and the 2 mm peritumoural parenchyma. The tumoural and peritumoural radiomics were designated as Modeltumoural and Modelperitumoural, respectively. The diagnostic efficacy of various models was evaluated through the receiver operating characteristic (ROC) curve analysis. Subsequently, a machine-learning-based prediction model that combined Modeltumoural, Modelperitumoural, and Modelclinical-radiological was developed to differentiate LPA from other pathological subtypes in patients with pGGNs. RESULTS Modeltumoural achieved area under the curve (AUC) values of 0.762 and 0.783 in the training and validation sets, respectively. Modelperitumoural attained AUCs of 0.742 and 0.667, and Modelclinical-radiological generated an AUC of 0.727 and 0.739 in the training and validation sets, respectively. Among the machine-learning models evaluated, gradient boosting machines demonstrated the best diagnostic efficacy, with accuracy, AUC, F1 score, and log loss values of 0.885, 0.956, 0.943, and 0.260, respectively. CONCLUSION The combined model based on machine learning that incorporated tumour and peritumoural parenchyma, as well as clinical and imaging characteristics, may offer benefits in assessing the pathological subtype of pGGNs.
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Affiliation(s)
- Y Zou
- Department of Radiology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, 545006, China; Guangxi Key Clinical Specialties of Medical Imaging, Liuzhou, 545006, China; Liuzhou Key Laboratory of Molecular Imaging, Liuzhou, 545006, China
| | - Q Mao
- Department of Radiology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, 545006, China; Guangxi Key Clinical Specialties of Medical Imaging, Liuzhou, 545006, China; Liuzhou Key Laboratory of Molecular Imaging, Liuzhou, 545006, China
| | - Z Zhao
- Department of Radiology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, 545006, China; Guangxi Key Clinical Specialties of Medical Imaging, Liuzhou, 545006, China; Liuzhou Key Laboratory of Molecular Imaging, Liuzhou, 545006, China
| | - X Zhou
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, 411000, China
| | - Y Pan
- Department of Radiology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, 545006, China; Guangxi Key Clinical Specialties of Medical Imaging, Liuzhou, 545006, China; Liuzhou Key Laboratory of Molecular Imaging, Liuzhou, 545006, China
| | - Z Zuo
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, 411000, China
| | - W Zhang
- Department of Radiology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, 545006, China; Guangxi Key Clinical Specialties of Medical Imaging, Liuzhou, 545006, China; Liuzhou Key Laboratory of Molecular Imaging, Liuzhou, 545006, China.
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Kubo Y, Sugimoto S, Shiotani T, Matsubara K, Hashimoto K, Tanaka S, Shien K, Suzawa K, Miyoshi K, Yamamoto H, Okazaki M, Toyooka S. Percentage of low attenuation area on computed tomography detects chronic lung allograft dysfunction, especially bronchiolitis obliterans syndrome, after bilateral lung transplantation. Clin Transplant 2023; 37:e15077. [PMID: 37461238 DOI: 10.1111/ctr.15077] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 09/18/2023]
Abstract
INTRODUCTION The percentage of low attenuation area (%LAA) on computed tomography (CT) is useful for evaluating lung emphysema, and higher %LAA was observed in patients with chronic lung allograft dysfunction (CLAD). This study investigated the relationship between the %LAA and the development of CLAD after bilateral lung transplantation (LT). METHODS We conducted a single-center retrospective study of 75 recipients who underwent bilateral LT; the recipients were divided into a CLAD group (n = 30) and a non-CLAD group (n = 45). The %LAA was calculated using CT and compared between the two groups from 4 years before to 4 years after the diagnosis of CLAD. The relationships between the %LAA and the percent baseline values of the pulmonary function test parameters were also calculated. RESULTS The %LAA was significantly higher in the CLAD group than in the non-CLAD group from 2 years before to 2 years after the diagnosis of CLAD (P < .05). In particular, patients with bronchiolitis obliterans syndrome (BOS) exhibited significant differences even from 4 years before to 4 years after diagnosis (P < .05). Significant negative correlations between the %LAA and the percent baseline values of the forced expiratory volume in 1 s (r = -.36, P = .0031), the forced vital capacity (r = -.27, P = .027), and the total lung capacity (r = -.40, P < .001) were seen at the time of CLAD diagnosis. CONCLUSION The %LAA on CT was associated with the development of CLAD and appears to have the potential to predict CLAD, especially BOS, after bilateral LT.
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Affiliation(s)
- Yujiro Kubo
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Seiichiro Sugimoto
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toshio Shiotani
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kei Matsubara
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kohei Hashimoto
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shin Tanaka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazuhiko Shien
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ken Suzawa
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kentaroh Miyoshi
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiromasa Yamamoto
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Mikio Okazaki
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Mizusawa H, Shiraishi O, Shiraishi M, Sugiya R, Kimura T, Ishikawa A, Yasuda T, Higashimoto Y. Quantitative emphysema on computed tomography imaging of chest is a risk factor for prognosis of esophagectomy: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e35547. [PMID: 37832075 PMCID: PMC10578713 DOI: 10.1097/md.0000000000035547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/15/2023] [Indexed: 10/15/2023] Open
Abstract
The low attenuation area percentage (LAA%) is gaining popularity. LAA% is an index of quantitative emphysema on computed tomography (CT) imaging of the chest. This study aims to retrospectively investigate whether preoperative LAA% is associated with postoperative prognosis in patients with esophageal cancer who were scheduled for esophagectomy. From January 2016 to March 2020, 105 patients with esophageal cancer underwent esophagectomy via right thoracotomy and neoadjuvant chemotherapy. A Synapse Vincent volume analyzer (Fujifilm Medical, Tokyo, Japan) was used for measurement. The software automatically quantified LAA% using a threshold of less than - 950 Hounsfield units on CT images of lung regions. Cox proportional hazard analyses were performed in univariable and multivariable forms. Estimates of the receiver operating curve are used to determine the cutoff value for death of LAA%, and the binary value is then inserted into Cox proportional hazard analyses. The preoperative LAA% cutoff value was ≥ 6.3%. Patients with a preoperative LAA% ≥6.3% had a significantly worse prognosis than those with a preoperative LAA% of < 6.3%. LAA% ≥6.3% (hazard ratio: 6.76; 95% confidence interval: 2.56-17.90, P < .001) was the most influential preoperative factor for overall survival after esophagectomy in multivariate Cox proportional hazard analyses. LAA% is one of the preoperative risk factors for survival after esophagectomy and an indicator of lung condition using routinely performed preoperative CT images. We quantified the extent of preoperative emphysema in patients with esophageal cancer, who were scheduled for surgery, and for the first time, reported LAA% as one of the preoperative risk factors for survival after esophagectomy.
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Affiliation(s)
- Hiroki Mizusawa
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University, Osaka, Japan
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Osamu Shiraishi
- Faculty of Medicine, Department of Surgery, Kindai University, Osaka, Japan
| | - Masashi Shiraishi
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University, Osaka, Japan
| | - Ryuji Sugiya
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University, Osaka, Japan
| | - Tamotsu Kimura
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University, Osaka, Japan
| | - Akira Ishikawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Takushi Yasuda
- Faculty of Medicine, Department of Surgery, Kindai University, Osaka, Japan
| | - Yuji Higashimoto
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University, Osaka, Japan
- Department of Respiratory Medicine and Allergology, School of Medicine, Kindai University, Osaka, Japan
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Yun T, Choi H, Kim H, Na KJ, Park S, Park IK, Kang CH, Goo JM, Kim YT. CT-defined visual emphysema in smokers with normal spirometry: association with prolonged air leak and other respiratory complications after lobectomy for lung cancer. Eur Radiol 2022; 32:4395-4404. [DOI: 10.1007/s00330-022-08540-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/01/2021] [Accepted: 12/28/2021] [Indexed: 11/24/2022]
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Shiotani T, Sugimoto S, Yamamoto H, Miyoshi K, Otani S, Suzawa K, Yamamoto H, Okazaki M, Yamane M, Toyooka S. Emphysematous changes and lower levels of plasma irisin are associated with bronchiolitis obliterans syndrome after bilateral living-donor lobar lung transplantation. Surg Today 2021; 52:294-305. [PMID: 34251508 DOI: 10.1007/s00595-021-02339-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/19/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Decreased irisin levels may be associated with the development of emphysema. Similarly, emphysematous changes may develop in patients with chronic lung allograft dysfunction (CLAD) after living-donor lobar lung transplantation (LDLLT). We investigated the severity of emphysematous changes and the relationship between irisin levels and CLAD after bilateral LDLLT and cadaveric lung transplantation (CLT). METHODS The subjects of this retrospective study were 59 recipients of bilateral LDLLT (n = 31) or CLT (n = 28), divided into a non-CLAD group (n = 41), a LDLLT-CLAD group (n = 11), and a CLT-CLAD group (n = 7). We compared the severity of emphysematous changes, the skeletal muscle mass, and the plasma irisin levels among the groups. RESULTS The emphysematous changes were significantly more severe in the LDLLT-CLAD and CLT-CLAD groups (p = 0.046 and 0.036), especially in patients with bronchiolitis obliterans syndrome (BOS), than in the non-CLAD group. Although the skeletal muscle mass was similar in all the groups, the plasma irisin levels were significantly lower in the LDLLT-CLAD group (p = 0.022), especially in the patients with BOS after LDLLT, than in the non-CLAD group. CONCLUSION Emphysematous changes and lower levels of plasma irisin were associated with CLAD, especially in patients with BOS, after bilateral LDLLT.
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Affiliation(s)
- Toshio Shiotani
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.,Organ Transplant Center, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Seiichiro Sugimoto
- Organ Transplant Center, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Haruchika Yamamoto
- Department of General Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Kentaroh Miyoshi
- Department of General Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Shinji Otani
- Department of General Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Ken Suzawa
- Department of General Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Hiromasa Yamamoto
- Department of General Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Mikio Okazaki
- Department of General Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Masaomi Yamane
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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Tane S, Nishikubo M, Kitazume M, Fujibayashi Y, Kimura K, Kitamura Y, Takenaka D, Nishio W. Cluster analysis of emphysema for predicting pulmonary complications after thoracoscopic lobectomy. Eur J Cardiothorac Surg 2021; 60:607-613. [PMID: 34008011 DOI: 10.1093/ejcts/ezab237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 03/22/2021] [Accepted: 04/07/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Despite significant advances in surgical techniques, including thoracoscopic approaches and perioperative care, the morbidity rate remains high after lung resection. This study focused on a low attenuation cluster analysis, which represented the size distribution of pulmonary emphysema and assessed its utility for predicting postoperative pulmonary complications after thoracoscopic lobectomy. METHODS From April 2013 to September 2018, lung cancer patients who received spirometry and computed tomography (CT) before surgery and underwent thoracoscopic lobectomy were included. The cumulative size distribution of the low attenuation area (LAA, defined as ≤-950 Hounsfield unit on CT) clusters followed a power-law characterized by an exponent D-value, a measure of the complexity of the alveolar structure. D-value and LAA% (LAA/total lung volume) were calculated using preoperative 3-dimensional CT software. The relationship between pulmonary complications and patient characteristics, including D-value and LAA%, was investigated. RESULTS Among 471 patients, there were 61 respiratory complication cases (12.9%). Receiver operation characteristic curve analysis revealed that the best predictive cut-off value of D-value and LAA% for pulmonary complications was 2.27 and 16.5, respectively, with an area under the curve of 0.72 and 0.58, respectively. D-value was significantly correlated with % forced expiratory volume in 1 s. Per univariate analysis, gender, smoking history, forced expiratory volume in 1 s/forced vital capacity, LAA% and D-value were risk factors for predicting postoperative pulmonary complications. In the multivariate analysis, D-value remained a significant predictive factor. CONCLUSION Preoperative assessment of emphysema cluster analysis may represent the vulnerability of the operated lung and could be the novel predictor for pulmonary complications after thoracoscopic lobectomy.
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Affiliation(s)
- Shinya Tane
- Division of Chest Surgery, Hyogo Cancer Center, Akashi, Japan
| | | | - Mai Kitazume
- Division of Chest Surgery, Hyogo Cancer Center, Akashi, Japan
| | | | - Kenji Kimura
- Division of Chest Surgery, Hyogo Cancer Center, Akashi, Japan
| | | | - Daisuke Takenaka
- Division of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Japan
| | - Wataru Nishio
- Division of Chest Surgery, Hyogo Cancer Center, Akashi, Japan
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Isoyama S, Ishikawa N, Hamai K, Matsumura M, Kobayashi H, Nomura A, Ueno S, Tanimoto T, Maeda H, Iwamoto H, Hattori N. Efficacy of mepolizumab in elderly patients with severe asthma and overlapping COPD in real-world settings: A retrospective observational study. Respir Investig 2021; 59:478-486. [PMID: 33849780 DOI: 10.1016/j.resinv.2021.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/14/2021] [Accepted: 02/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) are the most common respiratory diseases, presenting overlapping prevalence with age. Mepolizumab is a humanized monoclonal antibody targeting interleukin-5. In major randomized clinical trials, this antibody reportedly reduced the circulating eosinophil count, exacerbation rate, and oral corticosteroid (OCS) dosage in patients with severe eosinophilic asthma. However, data regarding the efficacy of mepolizumab in elderly patients with asthma and overlapping COPD are limited. METHODS This was a single-center, retrospective, observational study. Elderly patients (age ≥65 years) administered mepolizumab between August 2016 and March 2019 were enrolled and the effects of mepolizumab on the eosinophil level, exacerbation numbers, OCS dosage, and lung functions were assessed. We compared treatment responses in patients with asthma and COPD overlap (ACO) with responses observed in patients with severe asthma alone. Adverse events were also evaluated. RESULTS Twenty patients (10 men and 10 women), with a mean age of 77.5 ± 1.3 years, were included. Mepolizumab significantly reduced the blood eosinophil count, as well as significantly decreased clinically significant exacerbation, in both populations. The OCS dosage was significantly reduced in patients treated receiving maintenance OCS therapy. However, mepolizumab did not improve lung function in either population, and no significant difference was observed in treatment responses between patients with asthma alone and ACO. CONCLUSIONS Mepolizumab may be effective in elderly patients with eosinophilic asthma and ACO.
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Affiliation(s)
- Shoko Isoyama
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Hiroshima, Japan; Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuhisa Ishikawa
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Hiroshima, Japan.
| | - Kosuke Hamai
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Mirai Matsumura
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Hiroki Kobayashi
- Department of Rheumatology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Akio Nomura
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Hiroshima, Japan; Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Sayaka Ueno
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Takuya Tanimoto
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Hiroyuki Maeda
- Department of Rheumatology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Hiroshi Iwamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Noboru Hattori
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Takasaka N, Seki Y, Fujisaki I, Uchiyama S, Matsubayashi S, Sato A, Yamanaka Y, Odashima K, Kazuyori T, Seki A, Takeda H, Ishikawa T, Kuwano K. Impact of emphysema on sputum culture conversion in male patients with pulmonary tuberculosis: a retrospective analysis. BMC Pulm Med 2020; 20:287. [PMID: 33160360 PMCID: PMC7648401 DOI: 10.1186/s12890-020-01325-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/27/2020] [Indexed: 11/24/2022] Open
Abstract
Background Although cigarette smoking may have a negative impact on the clinical outcome of pulmonary tuberculosis (PTB), few studies have investigated the impact of smoking-associated lung diseases. Emphysema is a major pathological finding of smoking-related lung damage. We aimed to clarify the effect of emphysema on sputum culture conversion rate for Mycobacterium tuberculosis (MTB). Methods We retrospectively studied 79 male patients with PTB confirmed by acid-fast bacillus smear and culture at Jikei University Daisan Hospital between January 2015 and December 2018. We investigated the sputum culture conversion rates for MTB after starting standard anti-TB treatment in patients with or without emphysema. Emphysema was defined as Goddard score ≥ 1 based on low attenuation area < − 950 Hounsfield Unit (HU) using computed tomography (CT). We also evaluated the effect on PTB-related CT findings prior to anti-TB treatment. Results Mycobacterial median time to culture conversion (TCC) in 38 PTB patients with emphysema was 52.0 days [interquartile range (IQR) 29.0–66.0 days], which was significantly delayed compared with that in 41 patients without emphysema (28.0 days, IQR 14.0–42.0 days) (p < 0.001, log-rank test). Multivariate Cox proportional hazards analysis showed that the following were associated with delayed TCC: emphysema [hazard ratio (HR): 2.43; 95% confidence interval (CI): 1.18–4.97; p = 0.015), cavities (HR: 2.15; 95% CI: 1.83–3.89; p = 0.012) and baseline time to TB detection within 2 weeks (HR: 2.95; 95% CI: 1.64–5.31; p < 0.0001). Cavities and consolidation were more often identified by CT in PTB patients with than without emphysema (71.05% vs 43.90%; p = 0.015, and 84.21% vs 60.98%; p = 0.021, respectively). Conclusions This study suggests that emphysema poses an increased risk of delayed TCC in PTB. Emphysema detection by CT might be a useful method for prediction of the duration of PTB treatment required for sputum negative conversion.
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Affiliation(s)
- Naoki Takasaka
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan.
| | - Yoshitaka Seki
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Ikumi Fujisaki
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Shota Uchiyama
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Sachi Matsubayashi
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Akihito Sato
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Yumie Yamanaka
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Kyuto Odashima
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Taisuke Kazuyori
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Aya Seki
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Hiroshi Takeda
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Takeo Ishikawa
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae-shi, Tokyo, 201-8601, Japan
| | - Kazuyoshi Kuwano
- Department of Internal Medicine, Division of Respiratory Diseases, The Jikei University School of Medicine, Tokyo, Japan
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Tane S, Nishio W, Fujibayashi Y, Nishikubo M, Nishioka Y, Ogawa H, Kitamura Y, Takenaka D, Yoshimura M. Thoracoscopic left S1 + 2 segmentectomy as a good resolution for preserving pulmonary function. Interact Cardiovasc Thorac Surg 2020; 31:331-338. [PMID: 32747959 DOI: 10.1093/icvts/ivaa105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/05/2020] [Accepted: 05/13/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Segmentectomies such as S1 + 2, S1 + 2+3 and S4 + 5 segmentectomy are used to treat patients with non-small-cell lung cancer (NSCLC) in the left upper lobe. However, the preservable lung volume and changes after such segmentectomies remain unknown. We compared the residual pulmonary function after thoracoscopic segmentectomy or lobectomy in the left upper lobe and examined the efficacy of S1 + 2 segmentectomy regarding postoperative pulmonary function. METHODS Patients with left upper lobe NSCLC who underwent thoracoscopic segmentectomy or lobectomy were included. Spirometry and computed tomography were performed before and 6 months after resection, and the ipsilateral preserved lobe volume was calculated using 3-dimensional computer tomography. The percentage of postoperative/preoperative forced expiratory volume in 1 s and actual/predicted regional forced expiratory volume in 1 s (preservation rate) in the residual lobe were compared. RESULTS Eighty-eight patients underwent lobectomy and 70 patients underwent segmentectomy (23 S1 + 2, 35 S1 + 2+3 and 12 S4 + 5 segmentectomies). The percentage of postoperative/preoperative forced expiratory volume in 1 s was 97 in S1 + 2, 82 in S1 + 2+3, 86 in S4 + 5 segmentectomy and 73 in left upper lobectomy, indicating that segmentectomy could be a meaningful approach to preserve pulmonary function. The preservation rate was 83% in S1 + 2 and 62% in S1 + 2+3 segmentectomy and was significantly higher in S1 + 2 than in S1 + 2+3 segmentectomy (P < 0.001). CONCLUSIONS Postoperative pulmonary function and the preservable lung volume of the residual lobe after thoracoscopic S1 + 2 segmentectomy were well-preserved among other segmentectomies and lobectomy. Thoracoscopic S1 + 2 segmentectomy is a good alternative for preserving postoperative function.
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Affiliation(s)
- Shinya Tane
- Division of Chest Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Wataru Nishio
- Division of Chest Surgery, Hyogo Cancer Center, Akashi, Japan
| | | | | | - Yuki Nishioka
- Division of Chest Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Hiroyuki Ogawa
- Division of Chest Surgery, Hyogo Cancer Center, Akashi, Japan
| | | | - Daisuke Takenaka
- Division of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Japan
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Shimada Y, Furumoto H, Imai K, Masuno R, Matsubayashi J, Kajiwara N, Ohira T, Ikeda N. Prognostic value of tumor solid-part size and solid-part volume in patients with clinical stage I non-small cell lung cancer. J Thorac Dis 2018; 10:6491-6500. [PMID: 30746193 DOI: 10.21037/jtd.2018.11.08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background This study aimed to predict the malignant potential of clinical stage I non-small cell lung cancer (c-I NSCLC) by semiautomatic three-dimensional (3D) volumetric measurement of a tumor (3D-data) and the axial computed tomography (CT) data derived from a 3D volumetric dataset (2D-data). The predictive performance was evaluated in terms of overall survival (OS), disease-free survival (DFS), and pathological invasive factors (positive lymphatic invasion, blood vessel invasion, pleural invasion, or lymph node metastasis). Methods We identified 252 patients (122 male; mean age, 68 years; range, 23-84 years) with c-I NSCLC who underwent high resolution CT and reconstruction of 3D imaging, followed by complete resection between January 2012 and December 2015. In this study, 2D-data including whole tumor size (WTS) and solid-part size (SPS) and 3D-data including whole tumor volume (WTV) and solid-part volume (SPV) acquired by a 3D volume rendering software were analyzed. Results The area under the receiver operating characteristic (ROC) curve for WTS, SPS, WTV, SPV relevant to recurrence was 0.667, 0.727, 0.654, and 0.751 while analyses of ROC curves revealed optimal WTS, SPS, WTV, and SPV cut-off values to predict recurrence of 2.48 cm, 2.03 cm, 3,258 mm3 and 1,889 mm3, respectively. The association between SPS and SPV was the coefficient of determination (R 2) =0.59. Multivariate analysis showed that SPV >1,889 mm3 (P=0.016) and male (P=0.041) were significant predictors of OS whereas SPV >1,889 mm3 (P=0.001), male (P=0.003), and the serum carcinoembryonic antigen value (P=0.041) were significantly correlated with DFS. SPS, SPV as well as the combination of SPS and SPV were all significantly correlated with the prediction of OS and DFS, and the incidence of pathological invasive factors. Conclusions SPV and the integrated use of SPS and SPV was highly beneficial for the prediction of postoperative prognosis in c-I NSCLC.
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Affiliation(s)
- Yoshihisa Shimada
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hideyuki Furumoto
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kentaro Imai
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Ryuhei Masuno
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Jun Matsubayashi
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Naohiro Kajiwara
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Tatsuo Ohira
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Norihiko Ikeda
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
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Eriguchi D, Shimada Y, Imai K, Furumoto H, Okano T, Masuno R, Matsubayashi J, Kajiwara N, Ohira T, Ikeda N. Predictive accuracy of lepidic growth subtypes in early-stage adenocarcinoma of the lung by quantitative CT histogram and FDG-PET. Lung Cancer 2018; 125:14-21. [PMID: 30429012 DOI: 10.1016/j.lungcan.2018.08.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/25/2018] [Accepted: 08/29/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this study was to analyze the accuracy of computed tomography (CT) and F-18 fluorodeoxyglucose-positron emission tomography/CT (FDG-PET/CT) to distinguish lepidic growth adenocarcinoma (LGA), including adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and lepidic-predominant adenocarcinoma, all of which have favorable survival outcomes, from the more aggressive and invasive non-LGA subtypes. MATERIALS AND METHODS We identified 225 patients with c-0/I adenocarcinoma of the lung who underwent PET/CT and 3DCT followed by complete resection. Maximum standardized uptake values (SUVmax) of FDG and several histogram parameters were analyzed. Histological grades were classified according to the predominant subtype (G1: lepidic; G3: micropapillary or solid; and G2: subtypes other than G1/G3). RESULTS The proportion of pathological invasive factors (lymphatic vessel involvement/blood vessel invasion/pleural invasion/lymph node metastasis) of patients with preinvasive adenocarcinoma, G1, G2, and G3 tumors were 0%, 3.6%, 48.0%, and 100%, respectively; p < 0.001). Multivariate analysis with CT-related parameters demonstrated that 75th percentile CT attenuation value (75th%, p < 0.001) and maximum CT attenuation value (maxCT, p = 0.009) were associated with incidence of non-LGA, whereas the value of SUVmax demonstrated a significant correlation (p < 0.001). When all patients were dichotomized according to ground-glass opacities (GGO)/solid-dominancy for CT maximum diameter, a significant correlation with non-LGA was shown in patients with solid-dominant tumor on SUVmax (p < 0.001) and with GGO-dominant tumor on 75th% (p = 0.006) and maxCT (p = 0.007). The combination of one of the two significant histogram parameters and SUVmax revealed higher predictive performance for pathological high malignant features (positive pathological invasive factors, non-LGA, and the highly malignant subtype covering G2 with moderately or poorly-differentiated carcinoma and G3) than the individual use of either factor. CONCLUSION The 75th%, maxCT, and SUVmax were highly useful in distinguishing LGA from non-LGA in c-0/I adenocarcinoma.
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Affiliation(s)
| | | | - Kentaro Imai
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | | | - Tetsuya Okano
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Ryuhei Masuno
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Jun Matsubayashi
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | | | - Tatsuo Ohira
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
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