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Rshaidat H, Whitehorn GL, Collins M, Mack SJ, Martin J, Grenda TR, Evans NR, Okusanya OT. Factors Associated With Margin Positivity After Lung Resection Surgery. Clin Lung Cancer 2024:S1525-7304(24)00043-3. [PMID: 38658271 DOI: 10.1016/j.cllc.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 03/01/2024] [Accepted: 03/31/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION The purpose of this study is to utilize a representative national sample to investigate the factors associated with margin positivity after attempted surgical resection. Given the changes in surgical approaches to lung cancer for the last 10 years, margin positivity and outcomes between robotic, video assisted thoracoscopic surgery (VATS) and open surgical resections may vary. METHODS This retrospective cohort study utilized the National Cancer Database. Patients with non-small-cell lung cancer, 18 or older and who had a surgical lung resection between 2010 and 2019 were included. Demographic data, along with patient-level clinical variables were extracted. Patient-level outcome variables including 30-day, 90-day mortality and readmission rates were analyzed. Univariable and multivariable logistic regression was utilized to assess factors associated with margin positivity. RESULTS A total of 226,884 patients were identified. Of the total cohort, 9229 had positive margins (4.2%). Patients with positive margins had statistically significant increased 30-day, 90-day mortality, as well as increased readmission rate. Older age, male sex, patients undergoing an open resection, patients who underwent a wedge resection, higher clinical stage, larger tumor size, squamous and adenosquamous histologies, and higher Charlson-Deyo Comorbidity Index were all associated with having a positive margin after resection. CONCLUSION In conclusion, there was no difference in margin positivity when comparing robotic and VATS resection, however, open resection had increased rates of margin positivity. Increasing tumor size, clinical stage, squamous and adenosquamous histologies, male sex, and patients undergoing a wedge resection were all associated with increased rates of margin positivity.
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Affiliation(s)
- Hamza Rshaidat
- Department of Surgery, Division of Esophageal and Thoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Gregory L Whitehorn
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Micaela Collins
- Department of Surgery, Division of Esophageal and Thoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Shale J Mack
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Jonathan Martin
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Tyler R Grenda
- Department of Surgery, Division of Esophageal and Thoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Nathaniel R Evans
- Department of Surgery, Division of Esophageal and Thoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Olugbenga T Okusanya
- Department of Surgery, Division of Esophageal and Thoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
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Gloriane C Luna H, Severino Imasa M, Juat N, Hernandez KV, May Sayo T, Cristal-Luna G, Marie Asur-Galang S, Bellengan M, John Duga K, Brian Buenaobra B, De Los Santos MI, Medina D, Samo J, Minerva Literal V, Andrew Bascos N, Sy-Naval S. Expression landscapes in non-small cell lung cancer shaped by the thyroid transcription factor 1. Lung Cancer 2023; 176:121-131. [PMID: 36634573 DOI: 10.1016/j.lungcan.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/20/2022] [Accepted: 12/24/2022] [Indexed: 12/28/2022]
Abstract
TTF-1-expressing non-small cell lung cancer (NSCLC) is one of the most prevalent lung cancer types worldwide. However, theparadoxical activity of TTF-1 in both lung carcinogenesis and tumor suppression is believed to be context-dependentwhich calls for a deeper understanding about the pathological expression of TTF-1. In addition, the expression circuitry of TTF-1-target genes in NSCLC has not been well examined which necessitates to revisit the involvement of TTF-1- in a multitude of oncologic pathways. We used RNA-seq and clinical data of patients from The Cancer Genome Atlas (TCGA) and Genotype-Tissue Expression (GTEx), including ChIP-seq data from different NSCLC cell lines, and mapped the proteome of NSCLC tumor. Our analysis showed significant variability in TTF-1 expression among NSCLC,and further clarified that this variability is orchestrated at the transcriptional level. We also found that high TTF-1 expression could negatively influence the survival outcomes of stage 1 LUAD which may be attributed to growth factor receptor-driven activation of mitogenic and angiogenic pathways. Mechanistically, TTF-1 may also control the genes associated with pathways involved in acquired TKI drug resistance or response to immune checkpoint inhibitors. Lastly, proteome-based biomarker discovery in stage 1 LUAD showed that TTF-1 positivity is potentially associated with the upregulation of several oncogenes which includes interferon proteins, MUC1, STAT3, and EIF2AK2. Collectively, this study highlights the potential involvement of TTF-1 in cell proliferation, immune evasion, and angiogenesis in early-stage NSCLC.
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Affiliation(s)
- Herdee Gloriane C Luna
- Department of Internal Medicine, Lung Center of the Philippines, Quezon Ave, Diliman, Quezon City, Metro Manila 1100, Philippines; Department of Internal Medicine, National Kidney and Transplant Institute, East Avenue, Diliman, Quezon City 1101, Philippines.
| | - Marcelo Severino Imasa
- Department of Internal Medicine, Lung Center of the Philippines, Quezon Ave, Diliman, Quezon City, Metro Manila 1100, Philippines
| | - Necy Juat
- Department of Internal Medicine, National Kidney and Transplant Institute, East Avenue, Diliman, Quezon City 1101, Philippines
| | - Katherine V Hernandez
- Department of Internal Medicine, East Avenue Medical Center, East Ave, Diliman, Quezon City, Metro Manila 1100, Philippines
| | - Treah May Sayo
- Department of Internal Pathology, Lung Center of the Philippines, Quezon Ave, Diliman, Quezon City, Metro Manila 1100, Philippines
| | - Gloria Cristal-Luna
- Department of Internal Medicine, National Kidney and Transplant Institute, East Avenue, Diliman, Quezon City 1101, Philippines
| | - Sheena Marie Asur-Galang
- Clinical Proteomics for Cancer Initiative, Department of Science and Technology, Philippine Council for Health Research and Development, Philippines
| | - Mirasol Bellengan
- Clinical Proteomics for Cancer Initiative, Department of Science and Technology, Philippine Council for Health Research and Development, Philippines
| | - Kent John Duga
- Clinical Proteomics for Cancer Initiative, Department of Science and Technology, Philippine Council for Health Research and Development, Philippines
| | - Bien Brian Buenaobra
- Clinical Proteomics for Cancer Initiative, Department of Science and Technology, Philippine Council for Health Research and Development, Philippines
| | - Marvin I De Los Santos
- Clinical Proteomics for Cancer Initiative, Department of Science and Technology, Philippine Council for Health Research and Development, Philippines
| | - Daniel Medina
- Clinical Proteomics for Cancer Initiative, Department of Science and Technology, Philippine Council for Health Research and Development, Philippines
| | - Jamirah Samo
- Clinical Proteomics for Cancer Initiative, Department of Science and Technology, Philippine Council for Health Research and Development, Philippines
| | - Venus Minerva Literal
- Clinical Proteomics for Cancer Initiative, Department of Science and Technology, Philippine Council for Health Research and Development, Philippines
| | - Neil Andrew Bascos
- National Institute of Molecular Biology and Biotechnology, University of the Philippines - Diliman, Diliman, Quezon City, Metro Manila, Philippines; Protein, Proteomics and Metabolomics Facility, Philippine Genome Center, University of the Philippines System, Philippines
| | - Sullian Sy-Naval
- Department of Internal Medicine, Lung Center of the Philippines, Quezon Ave, Diliman, Quezon City, Metro Manila 1100, Philippines
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Toubat O, Ding L, Ding K, Wightman SC, Atay SM, Harano T, Kim AW, David EA. Benefit of adjuvant chemotherapy for resected pathologic N1 non-small cell lung cancer is unrecognized: A subgroup analysis of the JBR10 trial. Semin Thorac Cardiovasc Surg 2022:S1043-0679(22)00257-X. [PMID: 36272526 DOI: 10.1053/j.semtcvs.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 11/09/2022]
Abstract
Adjuvant chemotherapy is underutilized in clinical practice, in part, because its anticipated survival benefit is limited. We evaluated the impact of AC on overall and recurrence-free survival among completely resected pN1 NSCLC patients enrolled in the North American Intergroup phase III (JBR10) trial. A post-hoc subgroup analysis of pN1 NSCLC patients was performed. Participants were randomized to cisplatin+vinorelbine (AC) (n = 118) or observation (n = 116) following complete resection. The primary endpoint was overall survival (OS). The secondary endpoint was recurrence free survival (RFS). Kaplan-Meier methods were used to compare OS and RFS between the two treatment groups. Cox regression was used to identify factors associated with OS and RFS endpoints. Both groups had similar baseline characteristics. AC patients had improved 5-year OS (AC 61.4% vs observation 41.0%, log-rank p = .008) and 5-year RFS (AC 56.2% vs observation 39.9%, log-rank p = .011) rates compared to observation. Cox regression analyses confirmed the OS (HR 0.583, 95% CI 0.402-0.846, p = .005) and RFS (HR 0.573, 95% CI 0.395-0.830, p = .003) benefit associated with AC. AC was associated with a lower risk (HR 0.648, 95% CI 0.435-0.965, p = .0326) and a lower cumulative incidence (Subdistribution Hazard Ratio [SHR], 0.67, 95% CI 0.449-0.999, p = .0498) of lung cancer deaths. In the JBR10 trial, treatment with AC conferred a significant OS and RFS advantage over observation for pN1 NSCLC patients. These data suggest that pN1 NSCLC patients may experience a disproportionately greater clinical benefit from AC than the 6% survival advantage estimated by the LACE meta-analysis.
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Affiliation(s)
- Omar Toubat
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Li Ding
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, California
| | - Keyue Ding
- Department of Public Health Sciences, Canadian Cancer Trials Group, Queen's University, Kingston, Ontario, Canada
| | - Sean C Wightman
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Scott M Atay
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Takashi Harano
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Anthony W Kim
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Elizabeth A David
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.
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Lanuti M, Lin J, Ng T, Burt BM. A year in general thoracic surgery published in the Journal of Thoracic and Cardiovascular Surgery: 2020. J Thorac Cardiovasc Surg 2021; 162:253-258. [PMID: 34024614 PMCID: PMC8139187 DOI: 10.1016/j.jtcvs.2021.03.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Michael Lanuti
- Division of Thoracic, Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Jules Lin
- Section of Thoracic Surgery, University of Michigan, Ann Arbor, Mich
| | - Thomas Ng
- Division of Thoracic Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, Tenn
| | - Bryan M Burt
- Division of General Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
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Sesti J, Paul S. Commentary: Known unknowns and unknown unknowns: The case of the indeterminate margin. J Thorac Cardiovasc Surg 2019; 159:2042. [PMID: 31629497 DOI: 10.1016/j.jtcvs.2019.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 09/14/2019] [Accepted: 09/16/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Joanna Sesti
- Thoracic Surgical Services, RWJBarnabas Health, West Orange, NJ
| | - Subroto Paul
- Thoracic Surgical Services, RWJBarnabas Health, West Orange, NJ.
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