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Christensen J, Prosper AE, Wu CC, Chung J, Lee E, Elicker B, Hunsaker AR, Petranovic M, Sandler KL, Stiles B, Mazzone P, Yankelevitz D, Aberle D, Chiles C, Kazerooni E. ACR Lung-RADS v2022: Assessment Categories and Management Recommendations. J Am Coll Radiol 2024; 21:473-488. [PMID: 37820837 DOI: 10.1016/j.jacr.2023.09.009] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/08/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023]
Abstract
The ACR created the Lung CT Screening Reporting and Data System (Lung-RADS) in 2014 to standardize the reporting and management of screen-detected pulmonary nodules. Lung-RADS was updated to version 1.1 in 2019 and revised size thresholds for nonsolid nodules, added classification criteria for perifissural nodules, and allowed for short-interval follow-up of rapidly enlarging nodules that may be infectious in etiology. Lung-RADS v2022, released in November 2022, provides several updates including guidance on the classification and management of atypical pulmonary cysts, juxtapleural nodules, airway-centered nodules, and potentially infectious findings. This new release also provides clarification for determining nodule growth and introduces stepped management for nodules that are stable or decreasing in size. This article summarizes the current evidence and expert consensus supporting Lung-RADS v2022.
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Affiliation(s)
- Jared Christensen
- Vice Chair and Professor of Radiology, Department of Radiology, Duke University, Durham, North Carolina; Chair, ACR Lung-RADS Committee.
| | - Ashley Elizabeth Prosper
- Assistant Professor and Section Chief of Cardiothoracic Imaging, Department of Radiological Sciences, University of California, Los Angeles, California
| | - Carol C Wu
- Professor of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jonathan Chung
- Professor of Radiology Vice Chair of Quality Section Chief of Cardiopulmonary Imaging, University of Chicago, Chicago, Illinois
| | - Elizabeth Lee
- Clinical Associate Professor, Radiology, Michigan Medicine, Ann Arbor, Michigan
| | - Brett Elicker
- Chief of the Cardiac & Pulmonary Imaging Section, University of California, San Francisco, California
| | - Andetta R Hunsaker
- Brigham and Women's Hospital, Boston, Massachusetts; Associate Professor Harvard Medical School Chief Division of Thoracic Imaging
| | - Milena Petranovic
- Instructor, Radiology, Harvard Medical School Divisional Quality Director, Thoracic Imaging and Intervention, Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kim L Sandler
- Associate Professor, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brendon Stiles
- Professor and Chair, Thoracic Surgery and Surgical Oncology, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York
| | | | | | - Denise Aberle
- Professor of Radiology, Department of Radiological Sciences; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Caroline Chiles
- Professor of Radiology Director, Lung Screening Program, Atrium Health Wake Forest, Winston-Salem, North Carolina
| | - Ella Kazerooni
- Professor of Radiology & Internal Medicine and Associate Chief Clinical Officer for Diagnostics, Michigan Medicine/University of Michigan Medical School, Ann Arbor, Michigan; Clinical Information Management, University of Michigan Medical Group
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Christensen J, Prosper AE, Wu CC, Chung J, Lee E, Elicker B, Hunsaker AR, Petranovic M, Sandler KL, Stiles B, Mazzone P, Yankelevitz D, Aberle D, Chiles C, Kazerooni E. ACR Lung-RADS v2022: Assessment Categories and Management Recommendations. Chest 2024; 165:738-753. [PMID: 38300206 DOI: 10.1016/j.chest.2023.10.028] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
The American College of Radiology created the Lung CT Screening Reporting and Data System (Lung-RADS) in 2014 to standardize the reporting and management of screen-detected pulmonary nodules. Lung-RADS was updated to version 1.1 in 2019 and revised size thresholds for nonsolid nodules, added classification criteria for perifissural nodules, and allowed for short-interval follow-up of rapidly enlarging nodules that may be infectious in etiology. Lung-RADS v2022, released in November 2022, provides several updates including guidance on the classification and management of atypical pulmonary cysts, juxtapleural nodules, airway-centered nodules, and potentially infectious findings. This new release also provides clarification for determining nodule growth and introduces stepped management for nodules that are stable or decreasing in size. This article summarizes the current evidence and expert consensus supporting Lung-RADS v2022.
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Affiliation(s)
- Jared Christensen
- Vice Chair and Professor of Radiology, Department of Radiology, Duke University, Durham, North Carolina; Chair, ACR Lung-RADS Committee.
| | - Ashley Elizabeth Prosper
- Assistant Professor and Section Chief of Cardiothoracic Imaging, Department of Radiological Sciences, University of California, Los Angeles, California
| | - Carol C Wu
- Professor of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jonathan Chung
- Professor of Radiology Vice Chair of Quality Section Chief of Cardiopulmonary Imaging, University of Chicago, Chicago, Illinois
| | - Elizabeth Lee
- Clinical Associate Professor, Radiology, Michigan Medicine, Ann Arbor, Michigan
| | - Brett Elicker
- Chief of the Cardiac & Pulmonary Imaging Section, University of California, San Francisco, California
| | - Andetta R Hunsaker
- Brigham and Women's Hospital, Boston, Massachusetts; Associate Professor Harvard Medical School Chief Division of Thoracic Imaging
| | - Milena Petranovic
- Instructor, Radiology, Harvard Medical School Divisional Quality Director, Thoracic Imaging and Intervention, Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kim L Sandler
- Associate Professor, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brendon Stiles
- Professor and Chair, Thoracic Surgery and Surgical Oncology, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York
| | | | | | - Denise Aberle
- Professor of Radiology, Department of Radiological Sciences; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Caroline Chiles
- Professor of Radiology Director, Lung Screening Program, Atrium Health Wake Forest, Winston-Salem, North Carolina
| | - Ella Kazerooni
- Professor of Radiology & Internal Medicine and Associate Chief Clinical Officer for Diagnostics, Michigan Medicine/University of Michigan Medical School, Ann Arbor, Michigan; Clinical Information Management, University of Michigan Medical Group
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3
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Rodriguez-Quintero JH, Kamel MK, Jindani R, Elbahrawy M, Vimolratana M, Chudgar N, Stiles B. ASO Visual Abstract: The Effect of Neoadjuvant Therapy on Esophagectomy for cT2N0M0 Esophageal Adenocarcinoma. Ann Surg Oncol 2024; 31:1595-1596. [PMID: 38105376 DOI: 10.1245/s10434-023-14675-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Affiliation(s)
| | - Mohamed K Kamel
- Department of Cardiothoracic Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Rajika Jindani
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mostafa Elbahrawy
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marc Vimolratana
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY, USA
| | - Neel Chudgar
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY, USA
| | - Brendon Stiles
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY, USA
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Ohri N, Chudgar NP, Vimolratana M, Cheng H, Stiles B. Comments on "Effect of Surgical Treatment for N2-Positive c-Stage III Non-Small Cell Lung Carcinoma in the "PACIFIC" Era". Clin Lung Cancer 2024; 25:e75-e76. [PMID: 38057187 DOI: 10.1016/j.cllc.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/01/2023] [Indexed: 12/08/2023]
Affiliation(s)
- Nitin Ohri
- Montefiore Einstein Comprehensive Cancer Center, Bronx, NY.
| | - Neel P Chudgar
- Montefiore Einstein Comprehensive Cancer Center, Bronx, NY
| | | | - Haiying Cheng
- Montefiore Einstein Comprehensive Cancer Center, Bronx, NY
| | - Brendon Stiles
- Montefiore Einstein Comprehensive Cancer Center, Bronx, NY
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D'Aiello A, Stiles B, Ohri N, Levy B, Cohen P, Halmos B. Perioperative Immunotherapy for Non-Small Cell Lung Cancer: Practical Application of Emerging Data and New Challenges. Clin Lung Cancer 2024:S1525-7304(24)00015-9. [PMID: 38462413 DOI: 10.1016/j.cllc.2024.02.004] [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: 10/02/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 03/12/2024]
Abstract
Immune checkpoint inhibition, with or without chemotherapy, is an established standard of care for metastatic non-small cell lung cancer (NSCLC). For locally advanced NSCLC treated with chemoradiotherapy, consolidation immunotherapy has dramatically improved outcomes. Recently, immunotherapy has also been established as a valuable component of treatment for resectable NSCLC with pembrolizumab, atezolizumab, and nivolumab all approved for use in this setting. As more results read out from ongoing perioperative clinical trials, navigating treatment options will likely become increasingly complex for the practicing oncologist. In this paper, we distill key outcomes from major perioperative trials and highlight current knowledge gaps. In addition, we provide practical considerations for incorporating perioperative immunotherapy into the clinical management of operable NSCLC.
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Affiliation(s)
- Angelica D'Aiello
- Department of Oncology, Montefiore Einstein Comprehensive Cancer Center, Albert Einstein College of Medicine, Bronx, NY.
| | - Brendon Stiles
- Division of Thoracic Surgery and Surgical Oncology, Montefiore Einstein Comprehensive Cancer Center, Albert Einstein College of Medicine, Bronx, NY
| | - Nitin Ohri
- Department of Radiation Oncology, Montefiore Einstein Comprehensive Cancer Center, Albert Einstein College of Medicine, Bronx, NY
| | - Benjamin Levy
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Perry Cohen
- Division of Anatomic and Clinical Pathology, Department of Pathology, Montefiore Einstein Comprehensive Cancer Center, Albert Einstein College of Medicine, Bronx, NY
| | - Balazs Halmos
- Department of Oncology, Montefiore Einstein Comprehensive Cancer Center, Albert Einstein College of Medicine, Bronx, NY.
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Mirza M, Shrivastava A, Matthews C, Leighl N, Ng CSH, Planchard D, Popat S, Rotow J, Smit EF, Soo R, Tsuboi M, Yang F, Stiles B, Grohe C, Wu YL. Treatment decision for recurrences in non-small cell lung cancer during or after adjuvant osimertinib: an international Delphi consensus report. Front Oncol 2024; 13:1330468. [PMID: 38322280 PMCID: PMC10845045 DOI: 10.3389/fonc.2023.1330468] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/31/2023] [Indexed: 02/08/2024] Open
Abstract
Introduction Osimertinib is recommended by major guidelines for use in the adjuvant setting in patients with EGFR mutation-positive NSCLC following the significant improvement in disease-free survival observed in the Phase III ADAURA trials. Due to limited real-world data in the adjuvant setting, little guidance exists on how to approach potential recurrences either during or after the completion of the treatment. This study aimed to reach a broad consensus on key treatment decision criteria in the events of recurrence. Methods To reach a broad consensus, a modified Delphi panel study was conducted consisting of two rounds of surveys, followed by two consensus meetings and a final offline review of key statements. An international panel of experts in the field of NSCLC (n=12) was used to provide clinical insights regarding patient management at various stages of NSCLC disease including patient monitoring, diagnostics, and treatment approach for specific recurrence scenarios. This study tested recurrences occurring 1) within or outside the central nervous system (CNS), 2) during or after the adjuvant-osimertinib regimen in NSCLC disease which is 3) amenable or not amenable to local consolidative therapy. Results Panellists agreed on various aspects of patient monitoring and diagnostics including the use of standard techniques (e.g., CT, MRI) and tumour biomarker assessment using tissue and liquid biopsies. Consensus was reached on 6 statements describing treatment considerations for the specific NSCLC recurrence scenarios. Panellists agreed on the value of osimertinib as a monotherapy or as part of the overall treatment strategy within the probed recurrence scenarios and acknowledged that more clinical evidence is required before precise recommendations for specific patient populations can be made. Discussion This study provides a qualitative expert opinion framework for clinicians to consider within their treatment decision-making when faced with recurrence during or after adjuvant-osimertinib treatment.
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Affiliation(s)
| | | | | | - Natasha Leighl
- Department of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Calvin S. H. Ng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - David Planchard
- Department of Medical Oncology, Thoracic Group and International Center for Thoracic Cancers (CICT), Gustave Roussy, Villejuif, France
- Faculty of Medicine, Paris-Saclay University, Paris, France
| | - Sanjay Popat
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- Lung Unit, The Royal Marsden, London, United Kingdom
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Julia Rotow
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Egbert F. Smit
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Ross Soo
- Department of Haematology-Oncology, National University Hospital, Singapore, Singapore
| | - Masahiro Tsuboi
- Department of Thoracic Surgery and Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Fan Yang
- Thoracic Surgery Department, Peking University People’s Hospital, Beijing, China
| | - Brendon Stiles
- Thoracic Surgery and Surgical Oncology, Albert Einstein College of Medicine and Montefiore Medical Centre, New York, NY, United States
| | - Christian Grohe
- Department of Pneumology, Evangelische Lungenklinik (ELK) Berlin, Berlin, Germany
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People’s Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
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Rodriguez-Quintero JH, Kamel MK, Jindani R, Zhu R, Friedmann P, Vimolratana M, Chudgar NP, Stiles B. Is underutilization of adjuvant therapy in resected non-small-cell lung cancer associated with socioeconomic disparities? Eur J Cardiothorac Surg 2023; 64:ezad383. [PMID: 37952179 PMCID: PMC11007729 DOI: 10.1093/ejcts/ezad383] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/17/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023] Open
Abstract
OBJECTIVES Although adjuvant systemic therapy (AT) has demonstrated improved survival in patients with resected non-small-cell lung cancer (NSCLC), it remains underutilized. Recent trials demonstrating improved outcomes with adjuvant immunotherapy and targeted treatment imply that low uptake of systemic therapy in at-risk populations may widen existing outcome gaps. We, therefore, sought to determine factors associated with the underutilization of AT. METHODS The National Cancer Database (2010-2018) was queried for patients with completely resected stage II-IIIA NSCLC and stratified based on the receipt of AT. Logistic regression was used to identify factors associated with AT delivery. The Kaplan-Meier method was applied to estimate survival after propensity-matching to adjust for confounders. RESULTS Of 37 571 eligible patients, only 20 616 (54.9%) received AT. While AT rates increased over time, multivariable analysis showed that older age [adjusted odds ratio (aOR) 0.45, 95% confidence interval (CI) 0.43-0.47], male sex (aOR 0.88, 95% CI 0.85-0.93) and multiple comorbidities (aOR 0.86, 95% CI: 0.81-0.91) were associated with decreased AT. Socioeconomic factors were additionally associated with underutilization, including public insurance (aOR 0.70, 95% CI: 0.66-0.74), lower education indicators (aOR 0.93, 95% CI: 0.88-0.97) and living more than 10 miles from a treatment facility (aOR 0.89, 95% CI: 0.85-0.93). After propensity matching, receipt of adjuvant therapy was associated with improved overall survival (median 76.35 vs 47.57 months, P ≤ 0.001). CONCLUSIONS AT underutilization in patients with resected stage II-III NSCLC is associated with patient, institutional and socioeconomic factors. It is critical to implement measures to address these inequities, especially in light of newer adjuvant immunotherapy and targeted therapy treatment options which are expected to improve survival.
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Affiliation(s)
| | - Mohamed K Kamel
- Department of Cardiothoracic Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Rajika Jindani
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Roger Zhu
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Patricia Friedmann
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marc Vimolratana
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Neel P Chudgar
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Brendon Stiles
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
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Pompili C, Opitz I, Elswick E, Novoa N, Cabalo M, Beck Shimmer B, Sardari Nia P, Stiles B. Importance of personal development for a diverse workforce in thoracic surgery: the art of Curriculum Vitae building and interviewing. Interdiscip Cardiovasc Thorac Surg 2023; 37:ivad144. [PMID: 37659769 PMCID: PMC10474968 DOI: 10.1093/icvts/ivad144] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/29/2023] [Indexed: 09/04/2023]
Affiliation(s)
| | | | | | - Nuria Novoa
- University Hospital Puerta de Hierro—Majadahonda, Madrid, Spain
| | | | | | | | - Brendon Stiles
- Albert Einstein College of Medicine and Montefiore Medical Center, New York, NY, USA
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Kidane B, Bott M, Spicer J, Backhus L, Chaft J, Chudgar N, Colson Y, D'Amico TA, David E, Lee J, Najmeh S, Sepesi B, Shu C, Yang J, Swanson S, Stiles B. The American Association for Thoracic Surgery (AATS) 2023 Expert Consensus Document: Staging and multidisciplinary management of patients with early-stage non-small cell lung cancer. J Thorac Cardiovasc Surg 2023; 166:637-654. [PMID: 37306641 DOI: 10.1016/j.jtcvs.2023.04.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/27/2023] [Indexed: 06/13/2023]
Abstract
Novel targeted therapy and immunotherapy drugs have recently been approved for use in patients with surgically resectable lung cancer. Accurate staging, early molecular testing, and knowledge of recent trials are critical to optimize oncologic outcomes in these patients.
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Affiliation(s)
| | - Matthew Bott
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | - Jamie Chaft
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | | | | | - Jay Lee
- University of California, Los Angeles, Los Angeles, Calif
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Phan D, Riccardi R, Dawodu G, Rodriguez Quintero J, Ferrell B, Sarosh Sohail S, Friedmann P, Chudgar N, Stiles B. PP01.04 Hispanic Patients are at Higher Risk for Delayed Time to Surgery Following Identification of a Solid Lung Nodule. J Thorac Oncol 2023. [DOI: 10.1016/j.jtho.2022.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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11
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Kamel MK, Kariyawasam S, Stiles B. Overestimation of screening related complications in the National Lung Screening Trial. J Thorac Cardiovasc Surg 2022:S0022-5223(22)01239-9. [DOI: 10.1016/j.jtcvs.2022.10.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/09/2022] [Accepted: 10/28/2022] [Indexed: 11/16/2022]
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12
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Haramati L, Ortiz D, Serrano M, Cruz C, Torres J, Seu R, Chudgar N, Kalnicki S, Stiles B. EP01.04-001 A Programmatic Approach to Improve Efficiency in Lung Cancer Screening. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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13
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Studts J, Carter L, Feldman J, Donaldson D, Pantelas J, Ostroff J, Stiles B, Scharnetzki E, Smith R, Kazernooni E, Rosenthal L, Durden K, Burn K, A. Campaign to End Lung Cancer Stigma. P2.08-07 The Campaign to End Lung Cancer Stigma: The ACS National Lung Cancer Roundtable Efforts to Confront and Extinguish Lung Cancer Stigma. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Local ablative therapies, including surgery or stereotactic radiotherapy (SABR), are becoming an integral component in the treatment of oligometastatic disease in non-small-cell lung cancer. In this review, we summarize recent randomized evidence supporting progression-free survival and overall survival benefits of local ablation in these patients, as well as upcoming phase III data which should help us better understand the ideal treatment conditions and provide more insight into the oligometastatic state. Since practical management of oligometastatic disease in non-small-cell lung cancer can be challenging, we discuss a modern framework to identify patient, tumor, and treatment characteristics that can best guide management.
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Affiliation(s)
- Katie Jasper
- Division of Radiation Oncology, Western University, London Health Sciences Centre, London, Canada.,Division of Radiation Oncology, University of British Columbia, BC Cancer, Vancouver, Canada
| | - Brendon Stiles
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Fiona McDonald
- Department of Cardiothoracic and Vascular Surgery, Montefiore-Einstein Cancer Center, New York, NY
| | - David A Palma
- Division of Radiation Oncology, Western University, London Health Sciences Centre, London, Canada
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15
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Long SM, Feit NZ, Chern A, Cooley V, Hill SS, Rajwani K, Schenck EJ, Stiles B, Tassler AB. Percutaneous and Open Tracheostomy in Patients With COVID-19: The Weill Cornell Experience in New York City. Laryngoscope 2021; 131:E2849-E2856. [PMID: 34037983 PMCID: PMC8242792 DOI: 10.1002/lary.29669] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/09/2021] [Accepted: 05/20/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Report long-term tracheostomy outcomes in patients with COVID-19. STUDY DESIGN Review of prospectively collected data. METHODS Prospectively collected data were extracted for adults with COVID-19 undergoing percutaneous or open tracheostomy between April 4, 2020 and June 2, 2020 at a major medical center in New York City. The primary endpoint was weaning from mechanical ventilation. Secondary outcomes included sedation weaning, decannulation, and discharge. RESULTS One hundred one patients underwent tracheostomy, including 48 percutaneous (48%) and 53 open (52%), after a median intubation time of 24 days (IQR 20, 31). The most common complication was minor bleeding (n = 18, 18%). The all-cause mortality rate was 15% and no deaths were attributable to the tracheostomy. Eighty-three patients (82%) were weaned off mechanical ventilation, 88 patients (87%) were weaned off sedation, and 72 patients (71%) were decannulated. Censored median times from tracheostomy to sedation and ventilator weaning were 8 (95% CI 6-11) and 18 (95% CI 14-22) days, respectively (uncensored: 7 and 15 days). Median time from tracheostomy to decannulation was 36 (95% CI 32-47) days (uncensored: 32 days). Of those decannulated, 82% were decannulated during their index admission. There were no differences in outcomes or complication rates between percutaneous and open tracheostomy. Likelihood of discharge from the ICU was inversely related to intubation time, though the clinical relevance of this was small (HR 0.97, 95% CI 0.943-0.998; P = .037). CONCLUSION Tracheostomy by either percutaneous or open technique facilitated sedation and ventilator weaning in patients with COVID-19 after prolonged intubation. Additional study on the optimal timing of tracheostomy in patients with COVID-19 is warranted. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E2849-E2856, 2021.
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Affiliation(s)
- Sallie M. Long
- Department of Otolaryngology—Head and Neck SurgeryNewYork‐Presbyterian Hospital/Weill Cornell MedicineNew YorkNew YorkU.S.A.
| | - Noah Z. Feit
- Weill Cornell Medical CollegeNew YorkNew YorkU.S.A.
| | - Alexander Chern
- Department of Otolaryngology—Head and Neck SurgeryNewYork‐Presbyterian Hospital/Weill Cornell MedicineNew YorkNew YorkU.S.A.
| | - Victoria Cooley
- Division of Biostatistics and EpidemiologyWeill Cornell MedicineNew YorkNew YorkU.S.A.
| | - Shanna S. Hill
- Department of AnesthesiologyNewYork‐Presbyterian Hospital/Weill Cornell MedicineNew YorkNew YorkU.S.A.
| | - Kapil Rajwani
- Division of Pulmonary and Critical Care MedicineNewYork‐Presbyterian Hospital/Weill Cornell MedicineNew YorkNew YorkU.S.A.
| | - Edward J. Schenck
- Division of Pulmonary and Critical Care MedicineNewYork‐Presbyterian Hospital/Weill Cornell MedicineNew YorkNew YorkU.S.A.
| | - Brendon Stiles
- Department of Cardiothoracic SurgeryNewYork‐Presbyterian Hospital/Weill Cornell MedicineNew YorkNew YorkU.S.A.
| | - Andrew B. Tassler
- Department of Otolaryngology—Head and Neck SurgeryNewYork‐Presbyterian Hospital/Weill Cornell MedicineNew YorkNew YorkU.S.A.
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Smeltzer M, Bunn B, Choi Y, Coate L, Corona-Cruz J, Drilon A, Duma N, Edelman M, Fidler M, Gadgeel S, Goto Y, Herbst R, Hesdorffer M, Higgins K, Labdi B, Leal T, Liu S, Mazotti J, Novello S, Patel S, Popat S, Ramirez R, Reckamp K, Reguart N, Soo R, Tan A, Wolf J, Yano S, Stiles B, Baird A. OA17.04 The Global Impact of COVID-19 on Telehealth and Care for Persons With Thoracic Cancers. J Thorac Oncol 2021. [PMCID: PMC8523155 DOI: 10.1016/j.jtho.2021.08.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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17
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Smeltzer M, Spigel D, Shiller M, Lee P, Feller-Kopman D, Spira A, West H, Martin N, Stiles B, Plotkin E, Kim J, Lucas L, Boehmer L. P53.06 A Multi-Phase Quality Initiative to Improve Processes of Care for Non-small Cell Lung Cancer (NSCLC) in US Community Cancer Centers. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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18
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Wang Y, Yan F, Nasar A, Chen ZS, Altorki NK, Stiles B, Narula N, Zhou P. CUL4 high Lung Adenocarcinomas Are Dependent on the CUL4-p21 Ubiquitin Signaling for Proliferation and Survival. Am J Pathol 2021; 191:1638-1650. [PMID: 34119472 PMCID: PMC8420861 DOI: 10.1016/j.ajpath.2021.05.018] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/16/2021] [Accepted: 05/21/2021] [Indexed: 11/20/2022]
Abstract
Cullin (CUL) 4A and 4B ubiquitin ligases are often highly accumulated in human malignant neoplasms and are believed to possess oncogenic properties. However, the underlying mechanisms by which CUL4A and CUL4B promote pulmonary tumorigenesis remain largely elusive. This study reports that CUL4A and CUL4B are highly expressed in patients with non-small cell lung cancer (NSCLC), and their high expression is associated with disease progression, chemotherapy resistance, and poor survival in adenocarcinomas. Depletion of CUL4A (CUL4Ak/d) or CUL4B (CUL4Bk/d) leads to cell cycle arrest at G1 and loss of proliferation and viability of NSCLC cells in culture and in a lung cancer xenograft model, suggesting that CUL4A and 4B are oncoproteins required for tumor maintenance of certain NSCLCs. Mechanistically, increased accumulation of the cell cycle-dependent kinase inhibitor p21/Cip1/WAF1 was observed in lung cancer cells on CUL4 silencing. Knockdown of p21 rescued the G1 arrest of CUL4Ak/d or CUL4Bk/d NSCLC cells, and allowed proliferation to resume. These findings reveal that p21 is the primary downstream effector of lung adenocarcinoma dependence on CUL4, highlight the notion that not all substrates respond equally to abrogation of the CUL4 ubiquitin ligase in NSCLCs, and imply that CUL4Ahigh/CUL4Bhigh may serve as a prognostic marker and therapeutic target for patients with NSCLC.
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Affiliation(s)
- Yannan Wang
- Department of Pathology and Laboratory Medicine, The Joan and Stanford I. Weill Medical College of Cornell University, New York, New York
| | - Fan Yan
- Department of Pathology and Laboratory Medicine, The Joan and Stanford I. Weill Medical College of Cornell University, New York, New York
| | - Abu Nasar
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York
| | - Zhe-Sheng Chen
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St John's University, Queens, New York
| | - Nasser Khaled Altorki
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York
| | - Brendon Stiles
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York
| | - Navneet Narula
- Department of Pathology and Laboratory Medicine, The Joan and Stanford I. Weill Medical College of Cornell University, New York, New York
| | - Pengbo Zhou
- Department of Pathology and Laboratory Medicine, The Joan and Stanford I. Weill Medical College of Cornell University, New York, New York.
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Rahouma M, Harrison S, Wish J, Kamel M, Lee B, Chow O, Morsi M, Port J, Altorki N, Stiles B. P08.04 Progress in Early Stage Lung Cancer Among Economically Disadvantaged Patients. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Long SM, Chern A, Feit NZ, Chung S, Ramaswamy AT, Li C, Cooley V, Hill S, Rajwani K, Villena-Vargas J, Schenck E, Stiles B, Tassler AB. Percutaneous and Open Tracheostomy in Patients with COVID-19: Comparison and Outcomes of an Institutional Series in New York City. Ann Surg 2021; 273:403-409. [PMID: 32889885 DOI: 10.1097/sla.0000000000004428] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this study was to report the safety, efficacy, and early results of tracheostomy in patients with COVID-19 and determine whether differences exist between percutaneous and open methods. SUMMARY BACKGROUND DATA Prolonged respiratory failure is common in symptomatic patients with COVID-19, the disease process caused by infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Tracheostomy, although posing potential risk to the operative team and other healthcare workers, may be beneficial for safe weaning of sedation and ventilator support. However, short- and long-term outcomes remain largely unknown. METHODS A prospectively collected database of patients with COVID-19 undergoing tracheostomy at a major medical center in New York City between April 4 and April 30, 2020 was reviewed. The primary endpoint was need for continued mechanical ventilation. Secondary outcomes included complication rates, sedation weaning, and need for intensive care unit (ICU) level of care. Patient characteristics, perioperative conditions, and outcomes between percutaneous and open groups were analyzed. RESULTS During the study period, 67 consecutive patients underwent tracheostomy, including 48 males and 19 females with a median age of 66 years [interquartile range (IQR) 52-72]. Two surgeons alternated techniques, with 35 tracheostomies performed percutaneously and 32 via an open approach. The median time from intubation to tracheostomy was 23 days (IQR 20-26). At a median follow-up of 26 days, 52 patients (78%) no longer required mechanical ventilation and 58 patients (87%) were off continuous sedation. Five patients (7.5%) died of systemic causes. There were 11 total complications (16%) in 10 patients, most of which involved minor bleeding. There were no significant differences in outcomes between percutaneous and open methods. CONCLUSIONS Tracheostomy under apneic conditions by either percutaneous or open technique can be safely performed in patients with respiratory failure due to COVID-19. Tracheostomy facilitated weaning from continuous intravenous sedation and mechanical ventilation. Continued follow-up of these patients to ascertain long-term outcome data is ongoing.
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Affiliation(s)
- Sallie M Long
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY
| | - Alexander Chern
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY
| | | | - Sei Chung
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY
| | - Apoorva T Ramaswamy
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY
| | - Carol Li
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY
| | - Victoria Cooley
- Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY
| | - Shanna Hill
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY
| | - Kapil Rajwani
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY
| | | | - Edward Schenck
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY
| | - Brendon Stiles
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Andrew B Tassler
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY
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Wennerberg E, Hung C, Valeta A, McGraw T, Demaria S, Stiles B. Abstract 2158: ART1 tumor expression mediates immune resistance in non-small cell lung cancer by elimination of P2 × 7R+ CD8 tissue resident memory T cells and conventional type I dendritic cells. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-2158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Extracellular NAD+ (eNAD) is released from stressed and dying cells where it acts as a proinflammatory mediator. However, in the presence of mono-ADP-ribosyltransferases (ARTs) eNAD serves as a substrate for ADP-ribosylation of the P2 × 7 receptor (P2RX7), resulting in NAD-induced cell death (NICD). P2RX7 is expressed on several immune cells including CD103+ conventional type I dendritic cells (cDC1s) which are essential for initiation of tumor-specific immune responses as well as on tissue resident memory T cells (TRMs), of which high tumor infiltration has been associated with improved survival in non-small cell lung cancer (NSCLC) [1]. NICD of P2 × 7R+ TRMs was recently identified as a regulator of TRM tissue homeostasis [2]. CD38 is expressed on activated immune cells and can reduce eNAD levels by converting eNAD into ADPR. We tested the hypothesis that ART1 expression in NSCLC constitutes a mechanism of immune resistance by mediating NICD of P2 × 7R+ TRMs and P2 × 7R+ cDC1s.
ART1 expression in human NSCLC samples was determined by immunohistochemistry scoring of NSCLC tumors using a tissue microarray (TMA) (n=493). In addition, matched tumor and adjacent normal lung tissue samples were analyzed for ART1 expression by qPCR (n=40) and for infiltration of TRM and cDC1s by flow cytometry. A mouse KP1 lung tumor cell line with high ART1 expression was established from KRASG12D/P53−/− mice and transduced with a doxycycline-inducible shRNA targeting ART1 (ART1KD). KP1 cells and their derivatives were intravenously injected into syngeneic C57BL/6 mice to generate orthotopic lung tumors. Lung tumor nodules were enumerated two weeks after tumor inoculation using H&E-stained FFPE lung sections and lung-derived cell suspensions were analyzed by flow cytometry for infiltration of T cell and DC subsets.
Increased expression of ART1 in tumor compared to normal lung was observed in 55% of NSCLC samples by TMA analysis, and confirmed by qPCR. The frequency of P2RX7+ CD8 TRMs (p<0.05) and P2 × 7R+ cDC1s (p<0.01) were reduced in ART1+ tumors compared to matched normal lung tissue. In line with the hypothesis that CD38 protects P2 × 7R+ cells from ART1-mediated NICD, P2 × 7R+ CD8 TRMs and P2 × 7R+ cDC1s present within ART1+ tumors had elevated expression of CD38. In mice, knockdown of ART1 in KP1 tumors resulted in significantly delayed growth in immunocompetent mice (p<0.001) but not in nude or CD8-depeleted mice. In an orthotopic lung model, ART1KD resulted in a 75% decrease in lung metastatic nodules (p<0.01) and was associated with increased infiltration of CD8 T cells (P<0.0001) and cDC1s (p<0.01). In vitro experiments confirmed that CD38- P2RX7+ CD8 T cells were susceptible to ADP-ribosylation and NICD when co-cultured with ART1high lung tumor cells, while P2 × 7R+ CD8 T cells that co-expressed CD38 were resistant to NICD.
In conclusion, we show that ART1 is overexpressed in NSCLC and identify ART1-mediated NICD of P2 × 7R+ TRMs and cDC1s as a possible novel immune escape mechanism in NSCLC.
Furthermore, we describe a novel role of CD38 expression on immune cells in its protection against NICD.
1. Nizard, M., et al., Induction of resident memory T cells enhances the efficacy of cancer vaccine. Nat Commun, 2017. 8: p. 15221.
2. Stark, R., et al., T RM maintenance is regulated by tissue damage via P2RX7. Sci Immunol, 2018. 3(30).
Citation Format: Erik Wennerberg, Clarey Hung, Amanda Valeta, Timothy McGraw, Sandra Demaria, Brendon Stiles. ART1 tumor expression mediates immune resistance in non-small cell lung cancer by elimination of P2 × 7R+ CD8 tissue resident memory T cells and conventional type I dendritic cells [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2158.
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Shah MA, Kennedy EB, Catenacci DV, Deighton DC, Goodman KA, Malhotra NK, Willett C, Stiles B, Sharma P, Tang L, Wijnhoven BPL, Hofstetter WL. Treatment of Locally Advanced Esophageal Carcinoma: ASCO Guideline. J Clin Oncol 2020; 38:2677-2694. [PMID: 32568633 DOI: 10.1200/jco.20.00866] [Citation(s) in RCA: 145] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To develop an evidence-based clinical practice guideline to assist in clinical decision making for patients with locally advanced esophageal cancer. METHODS ASCO convened an Expert Panel to conduct a systematic review of the more recently published literature (1999-2019) on therapy options for patients with locally advanced esophageal cancer and provide recommended care options for this patient population. RESULTS Seventeen randomized controlled trials met the inclusion criteria. Where possible, data were extracted separately for squamous cell carcinoma and adenocarcinoma. RECOMMENDATIONS Multimodality therapy for patients with locally advanced esophageal carcinoma is recommended. For the subgroup of patients with adenocarcinoma, preoperative chemoradiotherapy or perioperative chemotherapy should be offered. For the subgroup of patients with squamous cell carcinoma, preoperative chemoradiotherapy or chemoradiotherapy without surgery should be offered. Additional subgroup considerations are provided to assist with implementation of these recommendations. Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.
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Affiliation(s)
- Manish A Shah
- New York Hospital/Weill Cornell Medical Center, New York, NY
| | | | | | | | | | | | | | - Brendon Stiles
- New York Hospital/Weill Cornell Medical Center, New York, NY
| | - Prateek Sharma
- University of Kansas School of Medicine and VAMC, Kansas City, KS
| | - Laura Tang
- Memorial Sloan Kettering Cancer Center, New York, NY
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Altorki N, Stiles B. Commentary: Where is the leak? From the anastomosis or the database? J Thorac Cardiovasc Surg 2020; 160:1096-1097. [PMID: 32127206 DOI: 10.1016/j.jtcvs.2020.01.068] [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: 01/23/2020] [Accepted: 01/26/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Nasser Altorki
- Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY.
| | - Brendon Stiles
- Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY
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Kamel MK, Cheng A, Vaughan B, Stiles B, Altorki N, Spector JA, Port JL. Sternal Reconstruction Using Customized 3D-Printed Titanium Implants. Ann Thorac Surg 2019; 109:e411-e414. [PMID: 31765620 DOI: 10.1016/j.athoracsur.2019.09.087] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 09/15/2019] [Accepted: 09/24/2019] [Indexed: 11/26/2022]
Abstract
In this report, we describe the use of custom-designed 3D-printed titanium implants to reconstruct the anterior chest wall, including the sternum and adjacent ribs, in two patients. These cases are the first to be reported in the United States, and they are among a handful performed around the world.
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Affiliation(s)
- Mohamed K Kamel
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York
| | - Ann Cheng
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York
| | - Bruna Vaughan
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York
| | - Brendon Stiles
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York
| | - Nasser Altorki
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York
| | - Jason A Spector
- Division of Plastic and Reconstructive Surgery, Department of General Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York
| | - Jeffrey L Port
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York.
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25
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Altorki N, Stiles B. Commentary: High-dose induction chemoradiation for lung cancer: The past is prologue. J Thorac Cardiovasc Surg 2019; 160:1346-1347. [PMID: 31668538 DOI: 10.1016/j.jtcvs.2019.09.010] [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: 09/06/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Nasser Altorki
- Division of Thoracic Surgery, Weill-Cornell Medicine, New York-Presbyterian Hospital, New York, NY.
| | - Brendon Stiles
- Division of Thoracic Surgery, Weill-Cornell Medicine, New York-Presbyterian Hospital, New York, NY
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26
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Sholi A, Kamel M, Nasar A, Naik A, Harrison S, Lee B, Port J, Altorki N, Stiles B. MA06.03 Poor Pulmonary Function Does Not Define “Medical Inoperability”: Short and Long Term Results of a Matched Lung Cancer Cohort. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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27
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Kamel M, Sholi A, Naik A, Harrison S, Lee B, Stiles B, Altorki N, Port J. P1.12-02 Nationwide Assessment of the Role of Adjuvant Systemic Therapy in High-Risk Lung Carcinoids. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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28
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Kamel M, Sholi A, Harrison S, Lee B, Port J, Altorki N, Stiles B. P2.18-06 Trends and Outcomes of Minimally Invasive Approaches for Lung Cancer Resection After Induction Therapy in the United States. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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29
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Altorki N, Borczuk A, Saxena A, Port J, Stiles B, Lee B, Sanfilippo N, Ko E, Scheff R, Pua B, Gruden J, Christos P, Spinelli C, Gakuria J, Mittal V, Mcgraw T, Formenti S. P2.04-92 Neoadjuvant Durvalumab With or Without Sub-Ablative Stereotactic Radiotherapy (SBRT) in Patients with Resectable NSCLC (NCT02904954). J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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30
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Marcus A, Narula N, Kamel MK, Koizumi J, Port JL, Stiles B, Moreira A, Altorki NK, Giorgadze T. Sensitivity and specificity of fine needle aspiration for the diagnosis of mediastinal lesions. Ann Diagn Pathol 2019; 39:69-73. [DOI: 10.1016/j.anndiagpath.2019.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
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31
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Rahouma M, Kamel M, Narula N, Nasar A, Harrison S, Lee B, Stiles B, Altorki NK, Port JL. Pulmonary sarcomatoid carcinoma: an analysis of a rare cancer from the Surveillance, Epidemiology, and End Results database. Eur J Cardiothorac Surg 2019; 53:828-834. [PMID: 29240878 DOI: 10.1093/ejcts/ezx417] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/31/2017] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Pulmonary sarcomatoid carcinoma (PSC) is a rare malignant neoplasm that accounts for a small percentage of non-small-cell lung carcinoma (NSCLC). At least 10% of PSCs has a spindle and/or giant cell component, which is often associated with a poor prognosis. We reviewed the Surveillance, Epidemiology, and End Results (SEER) database for the clinicopathological characteristics and surgical outcomes of PSCs. METHODS The SEER database (1973-2013) was queried for PSC. A comparison between PSC and other NSCLC patients was performed. Cox regression for overall survival (OS) and logistic regression for node-positive predictors were performed. A propensity-matched (1:2) analysis (including age, gender, grade and stage) among surgically treated cases was done to compare OS in PSC versus other NSCLCs. RESULTS A total of 955 899 NSCLC patients were identified; of these, 4987 patients had been diagnosed with PSC (0.52%). Men represented 60.9% of cases, with a median age of 68 years. The median size of the tumour was 5 cm and 3.5 cm in PSCs and NSCLCs, respectively (P < 0.001). PSC patients had significantly less Stage I, more high-grade tumours, advanced T stage, N+ disease and M1 disease (P < 0.001). In the PSC cohort, the most significant predictor of N+ disease on multivariate analysis was advanced T stage (P < 0.001). Predictors of OS in Stages I/II PSC on multivariate analysis were advanced age [P < 0.001, hazard ratio (HR) = 1.03], male gender (P = 0.024, HR = 1.25), carcinosarcoma (P = 0.002, HR = 1.76), grade (P = 0.033, HR = 1.81), T stage (P = 0.003, HR = 1.75), N status (P = 0.001, HR = 1.90) and surgical resection (P < 0.001, HR = 0.58). Among matched surgically resected cohorts, a poorer prognosis for OS was evident in PSCs in early stages (I/II) than in other NSCLCs (P = 0.009). CONCLUSIONS PSC patients present with more advanced stage and with worse survival outcomes than other NSCLC patients. While surgical resection conveys a survival advantage in PSC, this group represents a population at a high risk for relapse and should be evaluated for novel adjuvant therapies.
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Affiliation(s)
- Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Mohamed Kamel
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Navneet Narula
- Department of Pathology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Abu Nasar
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Sebron Harrison
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Benjamin Lee
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Brendon Stiles
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Nasser K Altorki
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Jeffrey L Port
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
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Abstract
Lung cancer is a major global health problem, as it is the leading cause of cancer-related deaths worldwide. Major advances in the identification of key mutational alterations have led to the development of molecularly targeted therapies, whose efficacy has been limited by emergence of resistance mechanisms. US Food and Drug Administration (FDA)-approved therapies targeting angiogenesis and more recently immune checkpoints have reinvigorated enthusiasm in elucidating the prognostic and pathophysiological roles of the tumour microenvironment in lung cancer. In this Review, we highlight recent advances and emerging concepts for how the tumour-reprogrammed lung microenvironment promotes both primary lung tumours and lung metastasis from extrapulmonary neoplasms by contributing to inflammation, angiogenesis, immune modulation and response to therapies. We also discuss the potential of understanding tumour microenvironmental processes to identify biomarkers of clinical utility and to develop novel targeted therapies against lung cancer.
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Affiliation(s)
- Nasser K Altorki
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
- Neuberger Berman Foundation Lung Cancer Research Center, Weill Cornell Medicine, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Geoffrey J Markowitz
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
- Neuberger Berman Foundation Lung Cancer Research Center, Weill Cornell Medicine, New York, NY, USA
| | - Dingcheng Gao
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
- Neuberger Berman Foundation Lung Cancer Research Center, Weill Cornell Medicine, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
- Department of Cell and Developmental Biology, Weill Cornell Medicine, New York, NY, USA
| | - Jeffrey L Port
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
- Neuberger Berman Foundation Lung Cancer Research Center, Weill Cornell Medicine, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Ashish Saxena
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Brendon Stiles
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
- Neuberger Berman Foundation Lung Cancer Research Center, Weill Cornell Medicine, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Timothy McGraw
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
- Department of Biochemistry, Weill Cornell Medicine, New York, NY, USA
| | - Vivek Mittal
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
- Neuberger Berman Foundation Lung Cancer Research Center, Weill Cornell Medicine, New York, NY, USA.
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA.
- Department of Cell and Developmental Biology, Weill Cornell Medicine, New York, NY, USA.
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Rahouma M, Kamel M, Nasar A, Harrison S, Lee B, Port J, Altorki N, Stiles B. P1.16-49 Treatment of NSCLC Patients with Clinical N1 Disease: Is There an Advantage to Neoadjuvant Therapy? J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Stiles B, Hussein M, Rahouma M, Lee B, Harrison S, Port J, Altorki N. OA06.03 Sublobar Resection is Equivalent to Lobectomy for Screen Detected Lung Cancer. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rahouma M, Kamel M, Nasar A, Harrison S, Lee B, Port J, Altorki N, Stiles B. OA06.07 Predictors and Consequences of Refusing Surgery for Clinical Stage I NSCLC: A National Cancer Database Analysis. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Rahouma M, Kamel M, Abouarab A, Eldessouki I, Nasar A, Harrison S, Lee B, Shostak E, Morris J, Stiles B, Altorki NK, Port JL. Lung cancer patients have the highest malignancy-associated suicide rate in USA: a population-based analysis. Ecancermedicalscience 2018; 12:859. [PMID: 30174721 PMCID: PMC6113987 DOI: 10.3332/ecancer.2018.859] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Previous studies have reported that psychological and social distresses associated with a cancer diagnosis have led to an increase in suicides compared to the general population. We sought to explore lung cancer-associated suicide rates in a large national database compared to the general population, and to the three most prevalent non-skin cancers [breast, prostate and colorectal cancer (CRC)]. METHODS The Surveillance, Epidemiology and End Results (SEER) database (1973-2013) was retrospectively reviewed to identify cancer-associated suicide deaths in all cancers combined, as well as for each of lung, prostate, breast or CRCs. Suicide incidence and standardised mortality ratio (SMR) were estimated using SEER*Stat-8.3.2 program. Suicidal trends over time and timing from cancer diagnosis to suicide were estimated for each cancer type. RESULTS Among 3,640,229 cancer patients, 6,661 committed suicide. The cancer-associated suicide rate was 27.5/100,000 person years (SMR = 1.57). The highest suicide risk was observed in patients with lung cancer (SMR = 4.17) followed by CRC (SMR = 1.41), breast cancer (SMR = 1.40) and prostate cancer (SMR = 1.18).Median time to suicide was 7 months in lung cancer, 56 months in prostate cancer, 52 months in breast cancer and 37 months in CRC (p < 0.001).We noticed a decreasing trend in suicide SMR over time, which is most notable for lung cancer compared to the other three cancers. In lung cancer, suicide SMR was higher in elderly patients (70-75 years; SMR = 12), males (SMR = 8.8), Asians (SMR = 13.7), widowed patients (SMR = 11.6), undifferentiated tumours (SMR = 8.6), small-cell lung cancer (SMR = 11.2) or metastatic disease (SMR = 13.9) and in patients who refused surgery (SMR = 13). CONCLUSION The cancer-associated suicide rate is nearly twice that of the general population of the United States of America. The suicide risk is highest among the patients with lung cancer, particularly elderly, widowed, male patients and patients with unfavourable tumour characteristics. The identification of high-risk patients is of extreme importance to provide proper psychological assessment, support and counselling to reduce these rates.
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Affiliation(s)
- Mohamed Rahouma
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY 14853 USA
| | - Mohamed Kamel
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY 14853 USA
| | - Ahmed Abouarab
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY 14853 USA
| | - Ihab Eldessouki
- Vontz Molecular Center, Hemato-oncology Department, University of Cincinnati, Cincinnati, OH 45220, USA
| | - Abu Nasar
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY 14853 USA
| | - Sebron Harrison
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY 14853 USA
| | - Benjamin Lee
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY 14853 USA
| | - Eugene Shostak
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY 14853 USA
| | - John Morris
- Vontz Molecular Center, Hemato-oncology Department, University of Cincinnati, Cincinnati, OH 45220, USA
| | - Brendon Stiles
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY 14853 USA
| | - Nasser K Altorki
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY 14853 USA
| | - Jeffrey L Port
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY 14853 USA
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Rahouma M, Harrison S, Kamel M, Nasar A, Lee B, Port J, Altorki N, Stiles B. Consequences of Refusing Surgery for Esophageal Cancer: A National Cancer Database Analysis. Ann Thorac Surg 2018; 106:1476-1483. [PMID: 30055137 DOI: 10.1016/j.athoracsur.2018.06.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/11/2018] [Accepted: 06/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Given the potential morbidity of esophagectomy, patients may pursue other treatments. We sought to determine predictors and outcomes of esophageal cancer patients who refused esophagectomy. METHODS The National Cancer Database (2004 to 2014) was queried for locally advanced esophageal cancer patients. A unique field allows identification of patients recommended to have surgery but who refused. Comparisons between the entire cohort and between propensity matched groups were performed using analysis of variance and χ2 tests. Survival was compared using Kaplan-Meier curves. Logistic regression was performed to identify predictors of refusing surgery. RESULTS We identified 18,459 patients with esophageal cancer meeting criteria, including 708 (3.8) who were recommended but refused surgery. By multivariate analysis, elderly, female, nonwhite race, squamous histology, early year of diagnosis, absence of insurance, treatment at nonacademic centers, lower income, and clinical stage I/II predicted refusal of surgery. Median survival was worse for patients who refused surgery compared with patients undergoing surgery. Among propensity matched groups (n = 525 each), median survival was better for patients undergoing surgery versus patients who refused (32 versus 21 months, p < 0.001). CONCLUSIONS Although patients may be reluctant to undergo esophagectomy for esophageal cancer, refusal of surgery when offered comes at the expense of decreased survival. These data allow for a discussion of alternative outcomes with those patients in the context of shared decision making.
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Affiliation(s)
- Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Sebron Harrison
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Mohamed Kamel
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Abu Nasar
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Benjamin Lee
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Jeffrey Port
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Nasser Altorki
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Brendon Stiles
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York.
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Harrison S, Tangel V, Wu X, Christos P, Gaber-Baylis L, Turnbull Z, Port J, Altorki N, Stiles B. Are minimum volume standards appropriate for lung and esophageal surgery? J Thorac Cardiovasc Surg 2018; 155:2683-2694.e1. [DOI: 10.1016/j.jtcvs.2017.11.073] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/10/2017] [Accepted: 11/16/2017] [Indexed: 12/22/2022]
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Abstract
Since 1995, lobar resection became the standard of care for medically fit patients with early stage lung cancer. This was based on the results of a single randomized trial comparing lobectomy and sublobar resection (SLR) in stage I lung cancer conducted by the lung cancer study group between 1982 and 1988. The conclusions of the study included a statistically significant tripling in loco-regional recurrence (LR) after limited resection but no difference between the two arms of the trial in systemic recurrence. Although both overall survival and cancer specific survival favored lobectomy, neither achieved statistical significance. Regardless, this landmark trial established lobectomy as the preferred oncological resection for early stage lung cancer. The practice of thoracic surgery has evolved significantly since the study period of the Lung Cancer Study Group, and this has led some surgeons to question its relevance to contemporary practice. The increased detection of smaller more precisely staged tumors combined with the rising segment of the population that is elderly with limited cardiopulmonary reserve has renewed interest in sub-lobar resection including wedge resection as either a definitive therapeutic strategy or as a compromise approach in patients with poor performance status. The interest in wedge resections is also to some extent further fueled by the emergence and increased utilization of competing technologies of local control such as stereotactic radiation or percutaneous and trans-bronchial ablative techniques. Although the results of the LCSG still cast a long shadow over the soundness of wedge resection as a cancer operation, much literature has been published in the subsequent years on this topic. We present in this review an overview of the conflicting data and offer our perspective on the role of wedge resection in early stage lung cancer.
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Affiliation(s)
- Sebron Harrison
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA.,Department of Cardiothoracic Surgery, New York-Presbyterian Brooklyn Methodist Hospital, New York, NY, USA
| | - Brendon Stiles
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Nasser Altorki
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
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Weder W, Moghanaki D, Stiles B, Siva S, Rocco G. The great debate flashes: surgery versus stereotactic body radiotherapy as the primary treatment of early-stage lung cancer. Eur J Cardiothorac Surg 2017; 53:295-305. [DOI: 10.1093/ejcts/ezx410] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/23/2017] [Accepted: 10/28/2017] [Indexed: 12/25/2022] Open
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Kamel M, Stiles B, Rahouma M, Nasar A, Nguyen A, Harrison S, Lee B, Port J, Altorki N. F-047CLINICAL T1N0 OESOPHAGEAL CANCER: PATTERNS OF CARE AND OUTCOMES OVER 25 YEARS. Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx280.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Rahouma M, Kamel M, Narula N, Nasar A, Harrison S, Lee B, Stiles B, Altorki N, Port J. O-060PULMONARY SARCOMATOID CARCINOMA: AN ANALYSIS OF A RARE CANCER FROM THE SURVEILLANCE, EPIDEMIOLOGY AND END RESULTS (SEER) DATABASE. Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx280.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Stiles B, Rahouma M, Kamel M, Nasar A, Nguyen A, Harrison S, Lee B, Port J, Altorki N. F-031NEVER-SMOKERS WITH RESECTED LUNG CANCER: DIFFERENT DEMOGRAPHICS BUT SIMILAR SURVIVAL. Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx280.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fiorelli A, Caronia F, Prencipe A, Santini M, Stiles B. The role of video-assisted thoracoscopic surgery for management of symptomatic pleural effusion after coronary artery bypass surgery: a best evidence topic report. J Thorac Dis 2017; 9:2339-2343. [PMID: 28932537 DOI: 10.21037/jtd.2017.06.119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A best evidence topic in thoracic surgery was written addressing whether video-assisted thoracoscopic surgery (VATS) talc pleurodesis could be justified in patients with pleural effusion (PE) after coronary artery bypass graft (CABG) surgery and no-responded to repeated thoracentesis. Ten papers were identified to answer the question. Of these, two were case-series study including ≥4 patients, 7 retrospective analytical studies, and one observational study but no randomized controlled trial (RCTs) was included in the analysis. The score of the level of evidence was low; only one study presented a level of evidence of 2, 7 studies a level of 3b; and two studies a level of evidence of 4. The incidence of symptomatic post-CABG PE ranged from 2% to 9.7%. Management strategies included medical management, thoracentesis, and/or surgical drainage. Most of the authors treated early and late PE with thoracentesis or chest drainage, while VATS with pleurodesis was reserved only for selected patients with persistent effusion after repeating thoracentesis and/or chest drainage. All studies but one do not include follow-up, thus rendering it difficult to define the real role of thoracentesis or chest drainage as definitive treatments for effusion, given the incomplete data regarding how many patients' effusions recur. Conversely, with follow up reported, no case of recurrence was found after VATS procedure. In patients who underwent delayed VATS, it was common to identify the formation of tenacious peel that trapped the lung. In three cases conversion to thoracotomy was required to decorticate the inflammatory peel that covered the pleura and did not allow the lung re-expansion. However, only five papers showed that VATS for management of post-CABG PEs is safe and efficacious and its use could help to prevent trapped lung through the resection of adhesions and loculations sometimes associated with multiple previous thoracentesis or chest drainage. As the low grade of evidence from the present analysis, future randomized controlled studies are wanted to define the real effectiveness of VATS in this field.
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Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit, Università della Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Caronia
- Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy
| | - Aldo Prencipe
- Cardio-thoracic Surgery Unit, Spedali Civili di Brescia, Brescia, Italy
| | - Mario Santini
- Thoracic Surgery Unit, Università della Campania Luigi Vanvitelli, Naples, Italy
| | - Brendon Stiles
- Department of Cardiothoracic Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
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Jurado JE, Stiles B. Noteworthy Literature Published in 2016 for Thoracic Surgery. Semin Cardiothorac Vasc Anesth 2017; 21:36-44. [PMID: 28134011 DOI: 10.1177/1089253216688689] [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] [Indexed: 11/16/2022]
Abstract
The past year has produced several important articles in the field of thoracic surgery, spanning many different diseases. Thoracic surgeons continue to investigate methods to perform complex operations and procedures less invasively, with the least possible morbidity to our patients. We also continue to critically evaluate new technology and procedures to ensure that they meet our rigorous standards for oncologic efficacy and for management of benign disease. Importantly, as we continue to evolve, thoracic surgeons have remained focused on optimizing processes of care, both inside and outside the operating room. The purpose of this review is to highlight the major advances in thoracic surgical disease in the year 2016.
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Rahouma M, Kamel M, Ghaly G, Harrison S, Stiles B, Altorki N, Port J. PUB008 1,000 Video-Assisted Thoracoscopic Lobectomies (VATS): A Single Institution's Experience. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kamel M, Ghaly G, Nasar A, Port J, Stiles B, Altorki N. PUB004 Preoperative Therapy is Not Required for Clinically Occult N2 Non-Small Cell Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kamel M, Nasar A, Port J, Stiles B, Nguyen A, Altorki N, Paul S, Lee P. PUB003 Predictors of Mortality, Morbidity and Prolonged Length of Stay after Lobectomy: A Population Based Analysis. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rahouma M, Kamel M, Ghaly G, Nasar A, Harrison S, Stiles B, Altorki N, Port J. PUB010 Intraoperative Blood Loss is an Independent Predictor of Poor Disease Free Survival for Patients Undergoing VATS Lobectomy for Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kamel M, Narula N, Port J, Stiles B, Altorki N. PUB006 Impact of the New WHO Classification of Thymic Tumors: Cross-Validation of the Prognostic Value in a Single Institution Cohort. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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