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Martínez-Palau M, Sanz-Santos J, Barreiro B, Rami-Porta R. Inner margin ratio for the prediction of occult nodal metastases. J Thorac Cardiovasc Surg 2024; 167:e101-e102. [PMID: 37855787 DOI: 10.1016/j.jtcvs.2023.09.037] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Mireia Martínez-Palau
- Department of Pulmonology, Hospital Universitari Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - José Sanz-Santos
- Department of Pulmonology, Hospital Universitari Mútua Terrassa, University of Barcelona, Barcelona, Spain; Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Bienvenido Barreiro
- Department of Pulmonology, Hospital Universitari Mútua Terrassa, University of Barcelona, Barcelona, Spain; Departament de Medicina, Facultat de Medicina, Universitat de Vic-Central de Catalunya Vic, Barcelona, Spain
| | - Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Barcelona, Spain; Network of Centres for Biomedical Research on Respiratory Diseases, Lung Cancer Group, Barcelona, Spain
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Detterbeck FC, Ostrowski M, Hoffmann H, Rami-Porta R, Osarogiagbon RU, Donnington J, Infante M, Marino M, Marom EM, Nakajima J, Nicholson AG, van Schil P, Travis WD, Tsao MS, Edwards JG, Asamura H. The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for Revision of the Classification of Residual Tumor After Resection for the Forthcoming (Ninth) Edition of the TNM Classification of Lung Cancer. J Thorac Oncol 2024:S1556-0864(24)00129-1. [PMID: 38569931 DOI: 10.1016/j.jtho.2024.03.021] [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: 02/10/2024] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION The goal of surgical resection is to completely remove a cancer; it is useful to have a system to describe how well this was accomplished. This is captured by the residual tumor (R) classification, which is separate from the TNM classification that describes the anatomic extent of a cancer independent of treatment. The traditional R-classification designates as R0 a complete resection, as R1 a macroscopically complete resection but with microscopic tumor at the surgical margin, and as R2 a resection that leaves gross tumor behind. For lung cancer, an additional category encompasses situations in which the presence of residual tumor is uncertain. METHODS This paper represents a comprehensive review of evidence regarding these R categories and the descriptors thereof, focusing on studies published after the year 2000 and with adjustment for potential confounders. RESULTS Consistent discrimination between complete, uncertain, and incomplete resection is revealed with respect to overall survival. Evidence regarding specific descriptors is generally somewhat limited and only partially consistent; nevertheless, the data suggest retaining all descriptors but with clarifications to address ambiguities. CONCLUSION On the basis of this review, the R-classification for the ninth edition of stage classification of lung cancer is proposed to retain the same overall framework and descriptors, with more precise definitions of descriptors. These refinements should facilitate application and further research.
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Affiliation(s)
- Frank C Detterbeck
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
| | - Marcin Ostrowski
- Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Hans Hoffmann
- Division of Thoracic Surgery, Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain
| | - Ray U Osarogiagbon
- Oncology Research Group, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
| | | | - Maurizio Infante
- Department of Thoracic Surgery, Ospedale Borgo Trento, Verona, Italy
| | - Mirella Marino
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Edith M Marom
- Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Jun Nakajima
- Department of Thoracic Surgery, The University of Tokyo, Tokyo, Japan
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield NHS Hospitals, Guy's and St. Thomas' NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Paul van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem (Antwerp), Belgium
| | - William D Travis
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ming S Tsao
- Department of Pathology, The Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - John G Edwards
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals National Health Service Foundation Trust, Northern General Hospital, Sheffield, United Kingdom
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio School of Medicine, Tokyo, Japan
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Rami-Porta R, Nishimura KK, Giroux DJ, Detterbeck F, Cardillo G, Edwards JG, Fong KM, Giuliani M, Huang J, Kernstine KH, Marom EM, Nicholson AG, Van Schil PE, Travis WD, Tsao MS, Watanabe SI, Rusch VW, Asamura H. The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groups in the Forthcoming (Ninth) Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2024:S1556-0864(24)00079-0. [PMID: 38447919 DOI: 10.1016/j.jtho.2024.02.011] [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: 01/04/2024] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION The TNM classification of lung cancer is periodically revised. The International Association for the Study of Lung Cancer collected and analyzed a new database to inform the forthcoming ninth edition of the TNM classification. The results are herewith presented. METHODS After exclusions, 76,518 patients from a total of 124,581 registered patients were available for analyses: 58,193 with clinical stage, 39,192 with pathologic stage, and 62,611 with best stage NSCLC. The proposed new N2 subcategories (N2a, involvement of single ipsilateral mediastinal or subcarinal nodal station, and N2b, involvement of multiple ipsilateral mediastinal nodal stations with or without involvement of the subcarinal nodal station) and the new M1c subcategories (M1c1, multiple extrathoracic metastases in one organ system, and M1c2, multiple extrathoracic metastases in multiple organ systems) were considered in the survival analyses. Several potential stage groupings were evaluated, using multiple analyses, including recursive partitioning, assessment of homogeneity within and discrimination between potential groups, clinical and statistical significance of survival differences, multivariable regression, and broad assessment of generalizability. RESULTS T1N1, T1N2a, and T3N2a subgroups are assigned to IIA, IIB, and IIIA stage groups, respectively. T2aN2b and T2bN2b subgroups are assigned to IIIB. M1c1 and M1c2 remain in stage group IVB. Analyses reveal consistent ordering, discrimination of prognosis, and broad generalizability of the proposed ninth edition stage classification of lung cancer. CONCLUSIONS The proposed stages for the ninth edition TNM improve the granularity of nomenclature about anatomic extent that has benefits as treatment approaches become increasingly differentiated and complex.
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Affiliation(s)
- Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain; Network of Centers for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain.
| | | | | | | | - Giuseppe Cardillo
- Department of Thoracic Surgery, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy; UniCamillus-Saint Camillus International University of Health Science, Rome, Italy
| | - John G Edwards
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, United Kingdom
| | - Kwun M Fong
- Department of Thoracic Medicine, University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Chermside, Brisbane, Queensland, Australia
| | - Meredith Giuliani
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kemp H Kernstine
- Cardiovascular and Thoracic Surgery, University of Texas Southwestern, Dallas, Texas
| | - Edith M Marom
- The Chaim Sheba Medical Center, University of Tel Aviv, Tel Aviv, Israel
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield NHS Hospitals, Guy's and St. Thomas' NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Paul E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Edegem (Antwerp), Belgium
| | - William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ming S Tsao
- Department of Pathology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Shun-Ichi Watanabe
- Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Valerie W Rusch
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
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Call S, Reig-Oussedik N, Obiols C, Sanz-Santos J, Ochoa-Alba JM, Cabanillas LR, Serra-Mitjans M, Rami-Porta R. Video-assisted mediastinoscopic lymphadenectomy (VAMLA): Mature results for staging non-small cell lung cancer with normal mediastinum. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00098-9. [PMID: 38311066 DOI: 10.1016/j.jtcvs.2024.01.040] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/20/2024] [Accepted: 01/28/2024] [Indexed: 02/06/2024]
Abstract
OBJECTIVES The aim of this study is to analyze the accuracy of video-assisted mediastinoscopic lymphadenectomy (VAMLA) and the unsuspected (u) N2/3 rates in patients with non-small cell lung cancer (NSCLC) and normal mediastinum by integrated positron emission tomography-computed tomography. METHODS Prospective observational single-center study of 603 consecutive VAMLAs from 2010 to 2022. EXCLUSION CRITERIA other indications (n = 32), tumors different from NSCLC (n = 91), and clinical (c) N2/3 tumors by positron emission tomography-computed tomography (n = 46). Systematic nodal dissection was the gold standard to validate negative VAMLAs. Those patients with negative VAMLA and missing reference standard test were excluded. uN2/3 rates were analyzed in the global series and in the subgroups of tumors according to their clinical nodal and tumor categories. Pathologic findings were reviewed, and staging values were calculated. RESULTS Three hundred eighty-three patients with cN0/1 NSCLC underwent VAMLA. Staging values of VAMLA were: sensitivity, 0.98 (95% CI, 0.92-0.99); negative predictive value, 0.99 (95% CI, 0.98-1); and diagnostic accuracy, 0.99 (95% CI, 0.98-1). The uN2/3 rate for the whole series (N = 383) was 18.8%. The uN2/3 rates according to presurgical nodal and tumor categories determined by positron emission tomography computed tomography were: 3.6% (4 out of 111) in cT1N0; 16.3% (18 out of 110) in cT2N0; 10.25% (4 out of 39) in cT3N0; and 32% (7 out of 22) in cT4N0. Forty-two percent (39 out of 93) in cN1; complication rate was 7%. CONCLUSIONS This series of NSCLC with normal mediastinum staged by VAMLA demonstrates a high accuracy of this technique and a high rate of uN2/3 disease (specially in cN1 and cT4N0). VAMLA could be considered the reference staging procedure for staging cN0/1 NSCLC.
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Affiliation(s)
- Sergi Call
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain; Department of Morphological Sciences, Medical School, Autonomous University of Barcelona, Bellaterra, Spain.
| | - Nina Reig-Oussedik
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - Carme Obiols
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - José Sanz-Santos
- Department Pulmonology, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - Juan Manuel Ochoa-Alba
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - Lucía Reyes Cabanillas
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - Mireia Serra-Mitjans
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain; Network of Centers of Biomedical Research in Respiratory Diseases, Lung Cancer Group, Terrassa, Spain
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Serra Mitjà P, García-Cabo B, Garcia-Olivé I, Radua J, Rami-Porta R, Esteban L, Barreiro B, Call S, Centeno C, Andreo F, Obiols C, Ochoa JM, Martínez-Palau M, Reig N, Serra M, Sanz-Santos J. EBUS-TBNA for mediastinal staging of centrally located T1N0M0 non-small cell lung cancer clinically staged with PET/CT. Respirology 2024; 29:158-165. [PMID: 37885329 DOI: 10.1111/resp.14613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/09/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the diagnostic accuracy and clinical usefulness of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal staging of centrally located T1N0M0 non-small cell lung cancer (NSCLC) clinically staged with positron emission tomography/computed tomography (PET/CT). METHODS We conducted a study that included patients with centrally located T1N0M0 NSCLC, clinically staged with PET/CT who underwent EBUS-TBNA for mediastinal staging. Patients with negative EBUS-TBNA underwent mediastinoscopy, video-assisted mediastinoscopic lymphadenectomy (VAMLA) and/or lung resection with systematic nodal dissection, that were considered the gold standard. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), overall accuracy of EBUS-TBNA for diagnosing mediastinal metastases (N2 disease) and the number needed to treat (NNT: number of patients needed to undergo EBUS-TBNA to avoid a case of pathologic N2 disease after resection) were calculated. RESULTS One-hundred eighteen patients were included. EBUS-TBNA proved N2 disease in four patients. In the remaining 114 patients who underwent mediastinoscopy, VAMLA and/or resection there were two cases of N2 (N2 prevalence 5.1%). The sensitivity, specificity, NPV, PPV and overall accuracy for diagnosing mediastinal metastases (N2 disease) were of 66%, 100%, 98%, 100% and 98%, respectively. The NNT was 31 (95% CI: 15-119). CONCLUSION EBUS-TBNA in patients with central clinically staged T1N0M0 NSCLC presents a good diagnostic accuracy for mediastinal staging, even in a population with low prevalence of N2 disease. Therefore, its indication should be considered in the management of even these early lung cancers.
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Affiliation(s)
- Pere Serra Mitjà
- Pulmonology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Bruno García-Cabo
- Pulmonology Department, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Catalonia, Barcelona, Spain
| | - Ignasi Garcia-Olivé
- Pulmonology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Joaquim Radua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, University of Barcelona, Barcelona, Spain
| | - Ramón Rami-Porta
- Thoracic Surgery Department, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain
- Network of Centres for Biomedical Research on Respiratory Diseases (CIBERES), Lung Cancer Group, Terrassa, Barcelona, Spain
| | - Lluís Esteban
- Pulmonology Department, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain
| | - Bienvenido Barreiro
- Pulmonology Department, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain
| | - Sergi Call
- Thoracic Surgery Department, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain
- Department of Morphological Sciences, Medical School, Autonomous University of Barcelona, Bellaterra, Barcelona, Spain
| | - Carmen Centeno
- Pulmonology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Felipe Andreo
- Pulmonology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Carme Obiols
- Thoracic Surgery Department, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain
| | - Juan Manuel Ochoa
- Thoracic Surgery Department, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain
| | - Mireia Martínez-Palau
- Pulmonology Department, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain
| | - Nina Reig
- Thoracic Surgery Department, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain
| | - Mireia Serra
- Thoracic Surgery Department, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain
| | - José Sanz-Santos
- Pulmonology Department, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Catalonia, Barcelona, Spain
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Detterbeck FC, Asamura H, Rami-Porta R, Rusch VW. The Only Constant Is Change: Introducing the International Association for the Study of Lung Cancer Proposals for the Ninth Edition of TNM Stage Classification of Thoracic Tumors. J Thorac Oncol 2023; 18:1258-1260. [PMID: 37758342 DOI: 10.1016/j.jtho.2023.08.012] [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: 08/07/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Frank C Detterbeck
- Division of Thoracic Surgery, Department of Surgery, Yale University, New Haven, Connecticut.
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Valerie W Rusch
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Sanz-Santos J, Martínez-Palau M, Jaen À, Rami-Porta R. Quantitative geometrical measurement of tumour location. Eur J Cardiothorac Surg 2023; 63:ezad082. [PMID: 36883682 DOI: 10.1093/ejcts/ezad082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/07/2023] [Indexed: 03/09/2023] Open
Affiliation(s)
- José Sanz-Santos
- Pulmonology Department, Hospital Universitari Mútua Terrassa, University of Barcelona, Barcelona, Spain
- Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Mireia Martínez-Palau
- Pulmonology Department, Hospital Universitari Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | | | - Ramón Rami-Porta
- Thoracic Surgery Department, Hospital Universitari Mútua Terrassa, University of Barcelona, Barcelona, Spain
- Network of Centres for Biomedical Research on Respiratory Diseases (CIBERES), Lung Cancer Group, Barcelona, Spain
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Asamura H, Nishimura KK, Giroux DJ, Chansky K, Hoering A, Rusch V, Rami-Porta R. IASLC Lung Cancer Staging Project: The New Database to Inform Revisions in the Ninth Edition of the TNM Classification of Lung Cancer. J Thorac Oncol 2023; 18:564-575. [PMID: 36773775 DOI: 10.1016/j.jtho.2023.01.088] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 12/27/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/11/2023]
Abstract
In the past 20 years, the International Association for the Study of Lung Cancer (IASLC) has been working on a global project to revise the TNM classification of lung cancer. The first and second phases of the staging projects proposed recommendations for revision of the TNM classification, which were adopted by the Union for International Cancer Control and the American Joint Committee on Cancer as their seventh and eighth editions of the TNM classifications of lung cancer. For the third phase of the IASLC Staging Project, a new database of lung cancer cases diagnosed between January 2011 and December 2019 has been established. The Staging and Prognostic Factors Committee of the IASLC is in charge of the process of proposing new recommendations. The newly established database consisted of 124,581 cases. The data were obtained from Asia and Australia (56.0%), Europe (24.7%), North America (15.7%), South/Central America (3.4%), and Africa and the Middle East (0.1%). After cases with incomplete data are excluded, 87,043 cases were enrolled in the analysis, of which 52,069 (59.8%) were invasive adenocarcinoma and 15,872 (18.2%) were squamous cell carcinoma. Both clinical and pathologic stages were available in 44,831 (51.5%) cases. Analyses of this database are expected to provide proposals for changing the TNM classification toward the ninth edition, which is scheduled to be in use in January 2024. This newly established global database on lung cancer is described to provide fundamental elements for revisions of the TNM rules for staging lung cancer.
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Affiliation(s)
- Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | | | | | - Kari Chansky
- Cancer Research And Biostatistics (CRAB), Seattle, Washington
| | - Antje Hoering
- Cancer Research And Biostatistics (CRAB), Seattle, Washington
| | - Valerie Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Barcelona, Spain; Network of Centres for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain
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Rami-Porta R, Fong KM. Stage IV lung cancer: the relevance of tumour profile for the construction of prognostic groups. Eur Respir J 2023; 61:61/2/2202094. [PMID: 36731903 DOI: 10.1183/13993003.02094-2022] [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: 10/31/2022] [Accepted: 11/04/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain
- Network of Centres for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Spain
| | - Kwun M Fong
- The Prince Charles Hospital, University of Queensland Thoracic Research Centre, Department of Thoracic Medicine, Chermside, Australia
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Rami-Porta R, Edwards JG, Osarogiagbon RU. Is it time to revise the International Association for the Study of Lung Cancer definitions of completeness of lung cancer resection? Transl Cancer Res 2022; 11:4474-4478. [PMID: 36644172 PMCID: PMC9834576 DOI: 10.21037/tcr-22-2426] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain;,Network of Centres for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain
| | - John G. Edwards
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
| | - Raymond U. Osarogiagbon
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee, USA;,Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee, USA
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Zhong C, Zhou H, Rami-Porta R, Zhao Y. Case report: Primary pleural squamous cell carcinoma in a 68-year-old male. Front Surg 2022; 9:953989. [PMID: 36117809 PMCID: PMC9478332 DOI: 10.3389/fsurg.2022.953989] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionPrimary pleural squamous cell carcinoma (PPSCC) is a sporadic disease that is rarely reported in the literature. Due to its low incidence, the pathogenesis of PPSCC is unknown.Case summaryWe report a case of a 68-year-old male with PPSCC and sizable pulmonary bullae. Two months after complete resection of both lesions, a total dose of 50 Gy radiotherapy was administered over the operative field. After more than a year of follow-up, the patient is in steady condition without any sign of recurrence.ConclusionSince PPSCC is rarely reported, our case proposed that complete surgical resection combined with radiotherapy may be a promising therapeutic approach.
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Affiliation(s)
- Chuan Zhong
- Department of Thoracic Surgery, Suining Central Hospital, Suining, China
- Correspondence: Chuan Zhong
| | - Haining Zhou
- Department of Thoracic Surgery, Suining Central Hospital, Suining, China
| | - Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - Yunfei Zhao
- Department of Pathology, Suining Central Hospital, Suining, China
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Thomas PA, Edwards JG, Rami-Porta R, Van Schil P, Mercier O, Le Rochais JP, Falcoz PE, Meunier JP, Gkika E, Kheira H, Riesterer O, Ghigna MR, Bardet A, Le Pechoux C. The Lung ART adjuvant radiotherapy phase 3 randomized trial: Impact of quality of resection in stage IIIAN2 patients. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.8522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8522 Background: Lung ART is an international phase 3 trial whose main objective was to evaluate the impact of post-operative conformal radiotherapy (PORT) on disease-free survival (DFS) in patients with completely resected pathologically proven N2 non-small cell lung cancer (NSCLC), with or without neo- or adjuvant chemotherapy. Previously communicated results showed no impact of PORT on DFS. However, as quality of surgical resection and extent of lymph node dissection were expected to be critically important in the interpretation of results, surgical and pathological reports were centrally reviewed by a surgical committee. Methods: A surgical advisory committee composed of 4 expert thoracic surgeons reviewed anonymized surgical and pathological reports of all included patients. Pre-defined classification rules were defined using published guidelines from the International Association for the Study of Lung Cancer and the European Society of Thoracic Surgeons. Tumor resection was defined as complete (no residual tumor and adequate lymph node assessment), uncertain (highest mediastinal nodal station involved, incomplete nodal exploration, involved N2 removed in fragments) or incomplete (presence of residual tumor). Nodal exploration was classified as sampling, selective dissection or extensive dissection. Results: 501 patients were included in the Lung ART trial. Before surgical committee review intervention, all patients except 2 had complete resection. 496 patients’ reports were analyzed by the surgical advisory committee. The basic characteristics are specified in the following table: Conclusions: Monitoring of the quality of nodal exploration and of resection should be implemented in randomized studies evaluating peri-operative strategies in NSCLC in order to provide reliable and generalizable results. Clinical trial information: NCT00410683. [Table: see text]
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Affiliation(s)
| | | | - Ramón Rami-Porta
- Hospital Mutua de Terrassa, Thoracic Surgery Service, Terrassa, Spain
| | | | - Olaf Mercier
- Department of Thoracic Surgery, Institut d'Oncologie Thoracique, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | | | | | | | - Eleni Gkika
- Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany
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Sanz-Santos J, Martínez-Palau M, Rami-Porta R, Barreiro B. Quantitative Tumor Location Methods. Chest 2022; 161:e328-e329. [PMID: 35526910 DOI: 10.1016/j.chest.2021.12.666] [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: 12/13/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- José Sanz-Santos
- Department of Pulmonology, Hospital Universitari Mútua Terrassa, Terrassa, Spain; School of Medicine, University of Barcelona, Terrassa, Spain.
| | | | - Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, Terrassa, Spain; Lung Cancer Group, Network of Centers for Biomedical Research (CIBERES), Terrassa, Spain
| | - Bienvenido Barreiro
- Department of Pulmonology, Hospital Universitari Mútua Terrassa, Terrassa, Spain
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Obiols C, Call S, Rami-Porta R, Jaén Á, Gómez de Antonio D, Crowley Carrasco S, Royo-Crespo Í, Embún R. Radicality of lymphadenectomy in lung cancer resections by thoracotomy and video-assisted thoracoscopic approach: A prospective, multicentre and propensity-score adjusted study. Lung Cancer 2022; 165:63-70. [PMID: 35091211 DOI: 10.1016/j.lungcan.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/16/2021] [Revised: 12/20/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To analyse differences in intraoperative nodal assessment in patients undergoing lung cancer resection by thoracotomy and video-assisted thoracoscopy (VATS) in the Spanish Video-Assisted Thoracic Surgery Group (GEVATS). METHODS Prospective multicentre cohort study of anatomic pulmonary resections (n = 3533) performed from December 2016 to March 2018. Main surgical, clinical and oncological variables related with lymphadenectomy were compared according to surgical approach. Corresponding tests for homogeneity were performed. Multiple logistic regression analyses were used to determine the odds ratio (OR) and 95% confidence interval (95%CI). Covariate adjustment using the propensity score (PS) was performed to reduce confounding effects. RESULTS After exclusions, 2532 patients were analysed. Systematic nodal dissection (SND) was performed in 65%, with a median of resected/sampled lymph nodes (LN) of 7 (IQR 4-12) and pathologic (p) N2 and uncertain (u) pNu rates of 9.4% and 28.9%, respectively. At multivariate analysis, the following were associated with thoracotomy (OR; 95%CI): SND (1.4; 1.08-1.96; p = 0.014), staging mediastinoscopy (2.6; 1.59-4.25; p < 0.001), tumor > 3 cm (2.1; 1.66-2.78; p < 0.001), central tumor (2.5; 1.90-3.24; p < 0.001); pN1 (1.8; 1.25-2.67; p < 0.002), pN2 (1.8; 1.18-2.76; p = 0.006), lower FEV1 (0.9; 0.98-0.99; p < 0.001), squamous cell carcinoma (1.5; 1.16-1.98; p = 0.002) and inexperienced surgeons in VATS (compared with > 100 VATS experience) (37.6; 13.55-104.6; p < 0.001). After PS adjustment, SND maintained the OR, but in the limit of signification (1.4; 1-1.98; p = 0.05). Nodal upstaging was significantly higher in the thoracotomy group. Complication rates of SND and no SND were similar. CONCLUSIONS Thoracotomy was associated with a more thorough lymphadenectomy in GEVATS. Therefore, intraoperative lymph node evaluation performed at VATS should be improved to have better prognostic information and more solid grounds to indicate adjuvant therapy.
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Affiliation(s)
- Carme Obiols
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain.
| | - Sergi Call
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain; Department of Morphological Sciences, Medical School, Autonomous University of Barcelona, Bellaterra, Spain
| | - Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain; Network of Centres of Biomedical Research in Respiratory Diseases (CIBERES), Lung Cancer Group, Terrassa, Spain
| | - Ángeles Jaén
- Unit of Research. Fundació Docència i Recerca Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - David Gómez de Antonio
- Department of Thoracic Surgery, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Silvana Crowley Carrasco
- Department of Thoracic Surgery, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Íñigo Royo-Crespo
- Department of Thoracic Surgery, IIS Aragón, Hospital Universitario Miguel Servet and Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Raúl Embún
- Department of Thoracic Surgery, IIS Aragón, Hospital Universitario Miguel Servet and Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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15
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Rami-Porta R, Call S, Obiols C. Resection of Persistent N2 Lung Cancer After Induction Therapy. Ann Thorac Surg 2022; 114:2392. [PMID: 35149048 DOI: 10.1016/j.athoracsur.2022.01.024] [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: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Ramón Rami-Porta
- Thoracic Surgery Service, Hospital Universitari Mútua Terrassa, Plaza Dr. Robert 5, 08221 Terrassa (Barcelona), Spain..
| | - Sergi Call
- Thoracic Surgery Service, Hospital Universitari Mútua Terrassa, Plaza Dr. Robert 5, 08221 Terrassa (Barcelona), Spain
| | - Carme Obiols
- Thoracic Surgery Service, Hospital Universitari Mútua Terrassa, Plaza Dr. Robert 5, 08221 Terrassa (Barcelona), Spain
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16
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Rami-Porta R, Goldstraw P, Asamura H. Commemorating the Silver Anniversary of the International Association for the Study of Lung Cancer International Workshop on Intrathoracic Staging. J Thorac Oncol 2021; 16:902-905. [PMID: 34034886 DOI: 10.1016/j.jtho.2021.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain; Lung Cancer Group, Network of Centers for Biomedical Research in Respiratory Diseases (CIBERES), Terrassa, Spain.
| | - Peter Goldstraw
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Department of Thoracic Surgery, Royal Brompton Hospital, London, United Kingdom
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
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Martínez-Palau M, Trujillo-Reyes JC, Jaen À, Call S, Martínez-Hernández NJ, Provencio M, Vollmer I, Rami-Porta R, Sanz-Santos J. How do we Classify a Central Tumor? Results of a Multidisciplinary Survey from the SEPAR Thoracic Oncology Area. Arch Bronconeumol 2021; 57:359-365. [PMID: 32828588 DOI: 10.1016/j.arbres.2020.06.009] [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: 04/08/2020] [Revised: 05/27/2020] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION In patients with non-small cell lung cancer (NSCLC) and normal mediastinal imaging tests, centrally located tumors have greater occult mediastinal involvement. Clinical guidelines, therefore, recommend invasive mediastinal staging in this situation. However, definitions of centrality in the different guidelines are inconsistent. The SEPAR Thoracic Oncology area aimed to evaluate the degree of familiarity with various concepts related to tumor site among professionals who see patients with NSCLC in Spain. METHODS A questionnaire was distributed to members of Spanish medical societies involved in the management of NSCLC, structured according to the 3 aspects to be evaluated: 1) uniformity in the definition of central tumor location; 2) uniformity in the classification of lesions that extend beyond dividing lines; and 3) ability to delineate lesions in the absence of dividing lines. RESULTS A total of 430 participants responded. The most voted definition of centrality was «lesions in contact with hilar structures» (49.7%). The lines most often chosen to delimit the hemitorax were concentric hilar lines (89%). Most participants (92.8%) classified tumors according to the side of the dividing line that contained most of their volume. Overall, 78.6% were able to correctly classify a central lesion in the absence of dividing lines. CONCLUSIONS In our survey, the most widely accepted definition of centrality is not one of the proposals specified in the clinical guidelines. The results reflect wide variability in the classification of tumor lesions.
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Affiliation(s)
- Mireia Martínez-Palau
- Servicio de Neumología, Hospital Universitari Mútua Terrassa, Barcelona, España; Departament de Medicina, Facultat de Medicina, Universitat de Barcelona, Barcelona, España
| | - Juan Carlos Trujillo-Reyes
- Servicio de Cirugía Torácica, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Departament de Cirurgia, Universitat Autonoma de Barcelona, Barcelona, España; Sociedad Española de Neumología y Cirugía Torácica, Área de Oncología Torácica, Barcelona, España
| | - Àngels Jaen
- Fundació Mútua Terrassa per a la Recerca Biomèdica i Social, Barcelona, España
| | - Sergi Call
- Servicio de Cirugía Torácica. Hospital Universitari Mútua Terrassa, Barcelona, España; Departament de Ciències Morfològiques, Àrea d'anatomia i embriologia humana, Universitat Autònoma de Barcelona, Barcelona, España
| | - Néstor J Martínez-Hernández
- Servicio de Cirugía Torácica. Hospital Universitari de la Ribera, Valencia, España; Sociedad Española de Cirugía Torácica, Comité Científico, Madrid, España
| | - Mariano Provencio
- Servicio de Oncología Médica, Hospital Universitario Puerta de Hierro, Madrid, España; Facultad de Medicina, Universidad Autónoma de Madrid, España; Grupo Español de Cáncer de Pulmón, Barcelona, España
| | - Iván Vollmer
- Servicio de Radiologia, Centre Diagnòstic per la Imatge (CDI), Hospital Clínic, Barcelona, España; Sociedad Española de Imagen Cardiotorácica, Valencia, España
| | - Ramón Rami-Porta
- Servicio de Cirugía Torácica. Hospital Universitari Mútua Terrassa, Barcelona, España
| | - José Sanz-Santos
- Servicio de Neumología, Hospital Universitari Mútua Terrassa, Barcelona, España; Departament de Medicina, Facultat de Medicina, Universitat de Barcelona, Barcelona, España.
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18
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Rami-Porta R. Review of Thymus Surgery, edited by Jiang Fan and Yuming Zhu— AME Publishing Company, Hong Kong, 2020. J Thorac Dis 2021. [PMCID: PMC8024821 DOI: 10.21037/jtd-2021-05] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain
- Network of Centers for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain
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19
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Moukasse Y, Pourel N, Lerouge D, Faivre-Finn C, Ramella S, Edwards J, Van Schil P, Rami-Porta R, Thomas P, Bardet A, Le Pechoux C. PH-0280: Quality of surgery and RT in stage IIIN2 NSCLC: Insights from the Lung Adjuvant Radiotherapy trial. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00304-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Remon J, Reguart N, García-Campelo R, Conde E, Lucena CM, Persiva O, Navarro-Martin A, Rami-Porta R. Lung Cancer in Spain. J Thorac Oncol 2020; 16:197-204. [PMID: 33109473 DOI: 10.1016/j.jtho.2020.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Jordi Remon
- Department of Medical Oncology, Centro Integral Oncológico Clara Campal, Hospital HM Delfos, HM Hospitales, Barcelona, Spain.
| | - Noemí Reguart
- Thoracic Oncology Unit, Department of Medical Oncology, Hospital Clínic Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumours, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Rosario García-Campelo
- Department of Medical Oncology, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Esther Conde
- Pathology and Laboratory of Therapeutic Targets, Hospital Universitario HM Sanchinarro-Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
| | - Carmen-María Lucena
- Thoracic Oncology Unit, Department of Pulmonology, Respiratory Institute, Hospital Clínic Barcelona, Barcelona, Spain
| | - Oscar Persiva
- Department of Radiology, Hospital Vall d'Hebron de Barcelona, Barcelona, Spain
| | - Arturo Navarro-Martin
- Department of Radiation Oncology Department, Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain
| | - Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain; Lung Cancer Group, Network of Centers for Biomedical Research in Respiratory Diseases/Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Terrassa, Barcelona, Spain
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21
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Rami-Porta R, Wittekind C, Goldstraw P. Complete Resection in Lung Cancer Surgery: From Definition to Validation and Beyond. J Thorac Oncol 2020; 15:1815-1818. [PMID: 33067147 DOI: 10.1016/j.jtho.2020.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/06/2020] [Accepted: 09/11/2020] [Indexed: 01/23/2023]
Affiliation(s)
- Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain; Network of Centers for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain.
| | | | - Peter Goldstraw
- National Heart and Lung Institute, Imperial College, London, United Kingdom; Thoracic Surgery, Royal Brompton Hospital, London, United Kingdom
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22
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Affiliation(s)
- Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain.,Network of Centres for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain
| | - Sergi Call
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain.,Department of Morphological Sciences, Unit of Human Anatomy and Embryology, Medical School, Autonomous University of Barcelona, Bellaterra, Barcelona, Spain
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23
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Rosell R, Ito M, Codony-Servat J, Giménez-Capitán A, Serra-Mitjans M, Pérez-Ochoa F, Llige D, Chaib I, Rami-Porta R, Obiols C, Call S, Belda-Sanchis J, Tarroch-Sarasa X, Karachaliou N, Molina Vila MA, Okada M. SRC-homology 2 domain-containing phosphatase 2 (SHP2) in epidermal growth factor receptor (EGFR)-mutant lung adenocarcinoma (LUAD). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.9540] [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: 11/20/2022] Open
Abstract
9540 Background: Epidermal growth factor (EGFR)-mutant lung adenocarcinomas (LUADs) display impaired phosphorylation of extracellular signal-regulated kinase (ERK) and SRC-homology 2 domain-containing phosphatase 2 (SHP2) in comparison with EGFR wild-type LUADs. However, the function of SHP2 in early EGFR-mutant LUADs and EGFR wild-type LUADs has not been reported. We posit that SHP2 mRNA expression could be a predictive marker in resected EGFR-mutant LUADs versus EGFR wild-type patients (pts). Methods: We examined 267 resected LUADs from Japan and Spain. mRNA expression levels of AXL, MET, CDCP1, STAT3, YAP1 and SHP2 were analyzed by quantitative reverse transcriptase polymerase chain reaction (PCR). EGFR mutant cell lines were investigated for their activity of SHP2. Results: Among the 267 enrolled pts, 100 (37.3%) were EGFR-mutant LUADs. Five-year recurrence-free survival (RFS) and overall survival (OS) were lower for EGFR-mutant LUADs with high SHP2 mRNA levels (hazard ratio = 1.83 and 2.28, respectively. p = 0.03 and p = 0.04). However, SHP2 was not associated with RFS nor OS in the 167 wild-type EGFR LUADs. In EGFR-mutant cells, RMC-4550 (SHP2 inhibitor) plus erlotinib showed synergism via inhibition of AKT (S473) and ERK1/2 (T202/Y204). While erlotinib translocates SHP2 (Y542) into the nucleus, either RMC-4550 alone, or in combination with erlotinib, relocalizes SHP2 into the cytoplasm membrane, limiting AKT and ERK activation. Conclusions: High SHP2 mRNA is related to shorter RFS and OS in EGFR-mutant LUADs, but not in EGFR wild-type LUADs. The findings indicate that the addition of SHP2 inhibitors could improve adjuvant therapy in EGFR-mutant LUADs.
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Affiliation(s)
| | | | - Jordi Codony-Servat
- Pangaea Oncology, Laboratory of Molecular Biology, Quirón-Dexeus University Institute, Barcelona, Spain
| | - Ana Giménez-Capitán
- Pangaea Oncology, Laboratory of Oncology, Quirón-Dexeus University Hospital, Barcelona, Spain
| | | | | | - David Llige
- Health Sciences Research Institute of the Germans Trias i Pujol Foundation (IGTP), Badalona, Barcelona, Spain
| | - Imane Chaib
- Institute for Health Science Research Germans Trias i Pujol (IGTP), Laboratory of Molecular Biology, Badalona, Barcelona, Spain
| | - Ramón Rami-Porta
- Hospital Mutua de Terrassa, Thoracic Surgery Service, Terrassa, Spain
| | - Carme Obiols
- Hospital Mutua de Terrassa, Thoracic Surgery Service, Terrassa, Spain
| | - Sergi Call
- Hospital Mutua de Terrassa, Thoracic Surgery Service, Terrassa, Spain
| | | | | | - Niki Karachaliou
- Pangaea Oncology, Laboratory of Oncology, Quirón-Dexeus University Hospital, Barcelona, Spain
| | | | - Morihito Okada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University Hospital, Hiroshima, Japan
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Sanz-Santos J, Rami-Porta R, Call S. Lessons Already Learnt From the Coronavirus Disease 2019 Pandemic. J Thorac Oncol 2020; 15:e107-e108. [PMID: 32333979 PMCID: PMC7175906 DOI: 10.1016/j.jtho.2020.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 11/26/2022]
Affiliation(s)
- José Sanz-Santos
- Department of Pulmonology, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain; Department of Medicine, Medical School, University of Barcelona, Terrassa, Barcelona, Spain; Network of Centers for Biomedical Research in Respiratory Diseases (CIBERES), Lung Cancer Group, Terrassa, Barcelona, Spain.
| | - Ramón Rami-Porta
- Network of Centers for Biomedical Research in Respiratory Diseases (CIBERES), Lung Cancer Group, Terrassa, Barcelona, Spain; Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain
| | - Sergi Call
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain; Department of Morphological Sciences, Unit of Human Anatomy and Embryology, Medical School, Autonomous University of Barcelona, Bellaterra, Barcelona, Spain
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Rami-Porta R. Review of A Marvelous Experience, edited by Lili Liao—AME Publishing Company, Hong Kong, 2018. J Thorac Dis 2020. [PMCID: PMC7139008 DOI: 10.21037/jtd.2020.03.09] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain
- Network of Centers for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain
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26
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Caupena C, Costa R, Pérez-Ochoa F, Call S, Jaen À, Rami-Porta R, Obiols C, Esteban L, Albero-González R, Luizaga LA, Serra M, Belda J, Tarroch X, Sanz-Santos J. Nodal size ranking as a predictor of mediastinal involvement in clinical early-stage non-small cell lung cancer. Medicine (Baltimore) 2019; 98:e18208. [PMID: 31852077 PMCID: PMC6922489 DOI: 10.1097/md.0000000000018208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In non-small cell lung cancer (NSCLC) patients, the recommended minimum requirement for an endoscopy-based mediastinal staging procedure is sampling the largest lymph node (LN) in right and left inferior paratracheal, and subcarinal stations. We aimed to analyze the percentage of cases where the largest LN in each mediastinal station was malignant in a cohort of NSCLC patients with mediastinal metastases diagnosed in the lymphadenectomy specimen. Furthermore, we investigated the sensitivity of a preoperative staging procedure in a hypothetical scenario where only the largest LN of each station would have been sampled.Prospective data of patients with mediastinal nodal metastases diagnosed in the lymphadenectomy specimens were retrospectively analyzed. The long-axis diameter of the maximal cut surface of all LNs was measured on hematoxylin and eosin-stained sections.Seven hundred seventy five patients underwent operation and 49 (6%) with mediastinal nodal disease were included. A total of 713 LNs were resected and 119 were involved. Sixty seven nodal stations revealed malignant LNs: in these, the largest LN was malignant in 39 (58%). In a "per patient" analysis, a preoperative staging procedure that sampled only the largest LN would have attained a sensitivity of 0.67; and if the largest and the second largest were sampled, sensitivity would be 0.87.In patients with NSCLC, nodal size ranking is not reliable enough to predict malignancy. In clinical practice, regardless of the preoperative staging method, systematic thorough sampling of all visible LNs is to be recommended over selective random samplings.
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Affiliation(s)
- Cristina Caupena
- Department of Pulmonology, Hospital Universitari Mútua Terrassa, Terrassa
| | - Roser Costa
- Department of Pulmonology, Hospital Universitari Mútua Terrassa, Terrassa
- Universitat de Barcelona, Facultad de Medicina, Departament de Medicina, Barcelona
| | | | - Sergi Call
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa
| | | | - Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa
- Network of Centers for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Spain
| | - Carme Obiols
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa
| | - Lluis Esteban
- Department of Pulmonology, Hospital Universitari Mútua Terrassa, Terrassa
| | | | | | - Mireia Serra
- Universitat de Barcelona, Facultad de Medicina, Departament de Medicina, Barcelona
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa
| | - Josep Belda
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa
| | | | - José Sanz-Santos
- Department of Pulmonology, Hospital Universitari Mútua Terrassa, Terrassa
- Universitat de Barcelona, Facultad de Medicina, Departament de Medicina, Barcelona
- Network of Centers for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Spain
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González-Rivas D, Rami-Porta R. Reply from the authors: The quantification of nodal disease has prognostic relevance. J Thorac Cardiovasc Surg 2019; 159:e146-e147. [PMID: 31610966 DOI: 10.1016/j.jtcvs.2019.09.007] [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: 09/11/2019] [Revised: 09/11/2019] [Accepted: 09/11/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Diego González-Rivas
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China; Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit, Coruña Hospital, Coruña, Spain
| | - Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain; Network of Centers for Biomedical Research in Respiratory Diseases Lung Cancer Group, Terrassa, Spain
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Obiols C, Call S, Rami-Porta R, Jaen A, De Antonio DG, Crowley S, Royo I, Embún R. OA12.07 Radicality of Lymphadenectomy in Lung Cancer According to Surgical Approach. Results from the Spanish Group of Video-Assisted Thoracic Surgery. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.476] [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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Ito M, Serra M, Rami-Porta R, Belda-Sanchis J, Chaib I, Okada M, Karachaliou N, Rosell R. P1.17-08 mRNA Expression Level of Receptor Tyrosine Kinases and Non-Receptor Tyrosine Kinases as a Recurrence Risk in Resected Adenocarcinoma of the Lung. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1282] [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: 11/17/2022]
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Alcaraz J, Carrasco J, Laura M, Martínez-Romero A, De Cos JS, Rami-Porta R, Seijo L, Ramirez J, Reguart N, Barreiro E, Monsó E. MA15.10 Stromal Markers of Activated Tumor Associated Fibroblasts Predict Poor Survival and Are Associated with Necrosis in Non-Small Cell Lung Cancer. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.626] [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: 11/25/2022]
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31
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González-Rivas D, Rami-Porta R. Commentary: Intraoperative lymph node assessment by robotic, video-assisted thoracoscopic surgery, and thoracotomy: None meet the international recommendations. J Thorac Cardiovasc Surg 2019; 158:1469-1470. [PMID: 31444064 DOI: 10.1016/j.jtcvs.2019.06.088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 06/23/2019] [Accepted: 06/25/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Diego González-Rivas
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China; Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit, Coruña Hospital, Coruña, Spain.
| | - Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Terrassa, Spain; Network of Centers for Biomedical Research in Respiratory Diseases Lung Cancer Group, Terrassa, Spain
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Molins L, Rami-Porta R, Belda Sanchis J. Fourth International Joint Meeting on Thoracic Surgery, Barcelona 2018. J Thorac Dis 2018; 10:S2574-S2575. [PMID: 30345091 DOI: 10.21037/jtd.2018.08.37] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Laureano Molins
- Department of Thoracic Surgery, Hospital Clínic & Sagrat Cor, Barcelona, Spain
| | - Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - José Belda Sanchis
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, Barcelona, Spain.,Department of Thoracic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Thoracic Surgery, Hospital del Mar, Barcelona, Spain
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Belda-Sanchis J, Trujillo-Reyes JC, Obiols C, Martínez-Téllez E, Call S, Serra-Mitjans M, Guarino M, Rami-Porta R. Transcervical videomediastino-thoracoscopy. J Thorac Dis 2018; 10:S2649-S2655. [PMID: 30345101 DOI: 10.21037/jtd.2018.03.132] [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
Although technical advances in non-invasive and minimally invasive approaches to lung and pleural cancer diagnosis and staging have become more widely available and accurate, surgical techniques remain the gold standard in assessing the extent of loco-regional involvement. Precise surgical staging of lung or pleural tumours is pivotal in the selection of surgical candidates and for predicting survival. In some patients, both mediastinal and pleural exploration may be needed for many different reasons. Transcervical videomediastino-thoracoscopy (VMT) combines simultaneously the exploration of both the mediastinum and the pleural cavities through a single cervical incision, allowing for biopsies or sampling of the mediastinal lymph nodes, lymphadenectomy and pleuropulmonary assessment (mainly pleural effusions, tumour involvement of the visceral and parietal pleura and pulmonary nodules). Thoracic surgeons should be aware of this combined surgical approach and completely familiar with classical indications and technical details of the transcervical approach to the mediastinum and thoracoscopic exploration of the pleural cavities.
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Affiliation(s)
- Josep Belda-Sanchis
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Joan Carles Trujillo-Reyes
- Department of Thoracic Surgery, Hospital Universitari de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Carme Obiols
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Elisabeth Martínez-Téllez
- Department of Thoracic Surgery, Hospital Universitari de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Sergi Call
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Mireia Serra-Mitjans
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Mauro Guarino
- Department of Thoracic Surgery, Hospital Universitari de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Barcelona, Spain.,Network of Centres for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Barcelona, Spain
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Affiliation(s)
- Ivan Vollmer
- Centre of Imaging Diagnosis, Radiology Dept, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Marcelo Sánchez
- Centre of Imaging Diagnosis, Radiology Dept, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ramón Rami-Porta
- Dept of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Barcelona, Spain.,Network of Centres for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Barcelona, Spain
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35
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Millares L, Barreiro E, Cortes R, Martinez-Romero A, Balcells C, Cascante M, Enguita AB, Alvarez C, Rami-Porta R, Sánchez de Cos J, Seijo L, Monsó E. Tumor-associated metabolic and inflammatory responses in early stage non-small cell lung cancer: Local patterns and prognostic significance. Lung Cancer 2018; 122:124-130. [DOI: 10.1016/j.lungcan.2018.06.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/27/2018] [Accepted: 06/09/2018] [Indexed: 12/25/2022]
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Martínez-Téllez E, Trujillo-Reyes JC, Guarino M, Rami-Porta R, Belda-Sanchis J. Subxiphoid video-thoracoscopy. J Thorac Dis 2018; 10:S2643-S2648. [PMID: 30345100 PMCID: PMC6178299 DOI: 10.21037/jtd.2018.03.99] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 02/20/2018] [Accepted: 03/01/2018] [Indexed: 12/31/2022]
Abstract
Surgical procedures of pleural cavity are crucial to complete the diagnoses or planning treatment of pleural effusions with an unknown aetiology. Traditionally, the transthoracic approach has been the most used procedure to study the pleural cavity. The subxiphoid video-thoracoscopy is becoming an alternative to the transthoracic approach. Subxiphoid video-thoracoscopy is a minimally invasive technique that allows us to study both pleural cavities with a single subxiphoid incision. In the supine decubitus, through a small subxiphoid incision, a rigid video-mediastinoscope is introduced. Once all the tissues are dissected, mediastinal pleura can be identified and incised. A 30° thoracoscopy is then inserted into the pleural cavity through the video-mediastinoscope to obtain samples of pleural fluid and biopsies of the parietal pleura and lung nodules if present. Subxiphoid approach has some advantages compared with the traditional transthoracic approach. On the one hand, contrary to traditional thoracoscopy, in subxiphoid video-thoracoscopy it is not necessary to do a transthoracic approach even for the insertion of a chest tube. Avoidance of intercostal ports probably decreases the risk of post-operative pain and the patients can be discharged 24 hours after surgery with no increase in surgical risk. On the other hand, we can explore both pleural cavities at the same time through a single incision, in case of bilateral pleural effusion. If malignancy is confirmed by frozen-section or by macroscopic evidence of intrapleural tumour infiltration or implants, a pleurodesis to avoid recurrence can be performed prior to tube insertion and closure.
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Affiliation(s)
- Elisabeth Martínez-Téllez
- Department of Thoracic Surgery, Hospital Universitari de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Carlos Trujillo-Reyes
- Department of Thoracic Surgery, Hospital Universitari de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mauro Guarino
- Department of Thoracic Surgery, Hospital Universitari de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ramón Rami-Porta
- Network of Centres for Biomedical Research on Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Terrassa, Barcelona, Spain
| | - Josep Belda-Sanchis
- Department of Thoracic Surgery, Hospital Universitari de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Terrassa, Barcelona, Spain
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37
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Rami-Porta R, Eberhardt WEE. Clinical implications of the innovations in the primary tumour and metastasis of the 8 th edition of the TNM classification for lung cancer. J Thorac Dis 2018; 10:S2682-S2685. [PMID: 30345105 DOI: 10.21037/jtd.2018.03.100] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 12/17/2022]
Abstract
The 8th edition of the tumour, node and metastasis (TNM) classification for lung cancer introduced two new categories to accommodate adenocarcinoma in situ (AIS)-Tis(AIS)-and minimally invasive adenocarcinoma-T1mi; subdivided T1 into T1a (≤1 cm), T1b (>1-2 cm) and T1c (>2-3 cm); and T2 into T2a (>3-4 cm) and T2b (>4-5 cm); reclassified tumours >5-7 cm as T3, and those >7 cm as T4; reclassified endobronchial location <2 cm from the carina and total atelectasis/pneumonitis as T2a; and reclassified invasion of the diaphragm as T4. Regarding metastasis, the 7th edition M1a category remained the same, but M1b is now redefined to include single extrathoracic metastasis; and a new category, M1c, has been created for multiple extrathoracic metastases in one or in several organs. Tumours with worse prognosis than that assigned in previous editions, such as T3-4N2M0 and T3-4N3M0, were grouped in stages IIIB and IIIC, respectively. Stage IV was subdivided into IVA, for intrathoracic and single extrathoracic metastasis (M1a and M1b, respectively) and IVB, for multiple extrathoracic metastases (M1c). From the clinical point of view, these innovations will demand a more precise registration of tumour size, a thoughtful assessment of locally advanced tumours at multidisciplinary discussions, and a thorough search of extrathoracic metastases because the number of the metastatic sites has prognostic relevance and may influence therapy.
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Affiliation(s)
- Ramón Rami-Porta
- Thoracic Surgery Service, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain.,Network of Centres for Biomedical Research on Respiratory Diseases (CIBERES), Lung Cancer Group, Terrassa, Spain
| | - Wilfried E E Eberhardt
- Department of Medical Oncology, West German Cancer Centre, Ruhrlandklinik, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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Rami-Porta R, Call S, Dooms C, Obiols C, Sánchez M, Travis WD, Vollmer I. Lung cancer staging: a concise update. Eur Respir J 2018; 51:13993003.00190-2018. [PMID: 29700105 DOI: 10.1183/13993003.00190-2018] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/04/2018] [Indexed: 12/13/2022]
Abstract
Diagnosis and clinical staging of lung cancer are fundamental to planning therapy. The techniques for clinical staging, i.e anatomic and metabolic imaging, endoscopies and minimally invasive surgical procedures, should be performed sequentially and with an increasing degree of invasiveness. Intraoperative staging, assessing the magnitude of the primary tumour, the involved structures, and the loco-regional lymphatic spread by means of systematic nodal dissection, is essential in order to achieve a complete resection. In resected tumours, pathological staging, with the systematic study of the resected specimens, is the strongest prognostic indicator and is essential to make further decisions on therapy. In the present decade, the guidelines on lung cancer staging of the American College of Chest Physicians and the European Society of Thoracic Surgeons are based on the best available evidence and are widely followed. Recent advances in the classification of the adenocarcinoma of the lung, with the definition of adenocarcinoma in situ, minimally invasive adenocarcinoma and lepidic predominant adenocarcinoma, and the publication of the eighth edition of the tumour, node and metastasis classification of lung cancer, have to be integrated into the staging process. The present review complements the latest guidelines on lung cancer staging by providing an update of all these issues.
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Affiliation(s)
- Ramón Rami-Porta
- Dept of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Barcelona, Spain.,Network of Centres for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Barcelona, Spain
| | - Sergi Call
- Dept of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Barcelona, Spain.,Dept of Morphological Sciences, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Christophe Dooms
- Dept of Respiratory Diseases, University Hospitals, KU Leuven, Leuven, Belgium
| | - Carme Obiols
- Dept of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Barcelona, Spain
| | - Marcelo Sánchez
- Centre of Imaging Diagnosis, Radiology Dept, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - William D Travis
- Dept of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ivan Vollmer
- Centre of Imaging Diagnosis, Radiology Dept, Hospital Clínic, University of Barcelona, Barcelona, Spain
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Rami-Porta R. A Spanish thoracic surgeon visits China-reflections on the surgical treatment of lung cancer. J Thorac Dis 2018; 10:718-722. [PMID: 29607141 DOI: 10.21037/jtd.2018.01.175] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ramón Rami-Porta
- Thoracic Surgery Service, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain.,Network of Centres for Biomedical Research on Respiratory Diseases (CIBERES), Lung Cancer Group, Terrassa, Barcelona, Spain
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Giroux DJ, Van Schil P, Asamura H, Rami-Porta R, Chansky K, Crowley JJ, Rusch VW, Kernstine K. The IASLC Lung Cancer Staging Project: A Renewed Call to Participation. J Thorac Oncol 2018; 13:801-809. [PMID: 29476906 DOI: 10.1016/j.jtho.2018.02.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 12/19/2017] [Revised: 01/14/2018] [Accepted: 02/14/2018] [Indexed: 12/22/2022]
Abstract
Over the past two decades, the International Association for the Study of Lung Cancer (IASLC) Staging Project has been a steady source of evidence-based recommendations for the TNM classification for lung cancer published by the Union for International Cancer Control and the American Joint Committee on Cancer. The Staging and Prognostic Factors Committee of the IASLC is now issuing a call for participation in the next phase of the project, which is designed to inform the ninth edition of the TNM classification for lung cancer. Following the case recruitment model for the eighth edition database, volunteer site participants are asked to submit data on patients whose lung cancer was diagnosed between January 1, 2011, and December 31, 2019, to the project by means of a secure, electronic data capture system provided by Cancer Research And Biostatistics in Seattle, Washington. Alternatively, participants may transfer existing data sets. The continued success of the IASLC Staging Project in achieving its objectives will depend on the extent of international participation, the degree to which cases are entered directly into the electronic data capture system, and how closely externally submitted cases conform to the data elements for the project.
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Affiliation(s)
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Ramón Rami-Porta
- Thoracic Surgery Service, Hospital Universitari Mútua Terrassa, Terrassa, Spain; Network of Centers of Biomedical Research in Respiratory Diseases (CIBERES), Lung Cancer Group, Terrassa, Spain
| | - Kari Chansky
- Cancer Research And Biostatistics, Seattle, Washington
| | | | - Valerie W Rusch
- Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Kemp Kernstine
- Cardiovascular and Thoracic Surgery, University of Texas Southwestern, Dallas, Texas
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Trujillo-Reyes JC, Martínez-Téllez E, Rami-Porta R, Obiols C, Call S, Belda-Sanchis J. Combination video-assisted mediastinoscopic lymphadenectomy and transcervical thoracoscopy. Multimed Man Cardiothorac Surg 2018; 2018. [PMID: 29384599 DOI: 10.1510/mmcts.2018.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Surgical staging of lung and pleural cancers is crucial for planning treatment and assessing prognosis. In some cases, we need to explore both the mediastinum and the pleural cavity to confirm or rule out tumor dissemination. The combination of video-assisted mediastinoscopic lymphadenectomy (VAMLA) and thoracoscopy through a single transcervical incision allows the surgeon to widen the range of the exploration and improve the staging for lung and pleural cancers. VAMLA consists of complete removal of the mediastinal fat and lymph nodes of the subcarinal space, the right paratracheal and pretracheal areas, and the left paratracheal space. Once this mediastinal tissue is removed, the right mediastinal pleura can be identified and incised. A 30o thoracoscope is then inserted through the video-mediastinoscope into the pleural cavity to obtain samples of pleural fluid and biopsies of the parietal pleura and lung nodules, if present. In the case of left-sided thoracoscopy the access route to the left pleural cavity is anterior to the aortic arch, as for extended cervical mediastinoscopy. The combination of VAMLA and thoracoscopy is useful for exploring the mediastinum and the pleural space from a single incision and in the same surgical setting as the transcervical approach.
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Affiliation(s)
| | - Elisabeth Martínez-Téllez
- Department of Thoracic Surgery, Hospital Universitari de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Decaluwe H, Dooms C, D'Journo X, Call S, Sanchez-Lorente D, Haager B, Beelen R, Kara V, Klikovits T, Aigner C, Tournoy K, Moons J, Brioude G, Trujillo J, Bethe B, Klepetko W, Turna A, Passlick B, Molins L, Rami-Porta R, Thomas P, De Leyn P. OA 16.06 Mediastinal Staging by Videomediastinoscopy in Clinical N1 Non-Small Cell Lung Cancer: a Prospective Multicenter Study. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.424] [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: 11/17/2022]
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Edwards J, Chansky K, Shemanski L, Van Schil P, Asamura H, Rami-Porta R. PL 02.06 The IASLC Lung Cancer Staging Project: Analysis of Resection Margin Status and Proposals for R Status Descriptors for Non-Small Cell Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Millares L, Alcaraz J, Martinez A, Benchea I, Carrasco J, De Cos JS, Gonzalez-Castro M, Blanco A, Sanchez-Gil R, Serra M, Rami-Porta R, Sauleda J, Fernandez E, Melchor R, Seijo L, De Esteban Julvez L, Barreiro E, Monsó E. P1.05-019 Effects of Tumor Stroma and Inflammation on Survival of Stage I-IIp Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.891] [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: 11/28/2022]
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Rami-Porta R. ES 01.01 New TNM Classification. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.105] [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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Chansky K, Detterbeck FC, Nicholson AG, Rusch VW, Vallières E, Groome P, Kennedy C, Krasnik M, Peake M, Shemanski L, Bolejack V, Crowley JJ, Asamura H, Rami-Porta R. The IASLC Lung Cancer Staging Project: External Validation of the Revision of the TNM Stage Groupings in the Eighth Edition of the TNM Classification of Lung Cancer. J Thorac Oncol 2017; 12:1109-1121. [PMID: 28461257 DOI: 10.1016/j.jtho.2017.04.011] [Citation(s) in RCA: 287] [Impact Index Per Article: 41.0] [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: 02/03/2017] [Revised: 03/27/2017] [Accepted: 04/03/2017] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Revisions to the TNM stage classifications for lung cancer, informed by the international database (N = 94,708) of the International Association for the Study of Lung Cancer (IASLC) Staging and Prognostic Factors Committee, need external validation. The objective was to externally validate the revisions by using the National Cancer Data Base (NCDB) of the American College of Surgeons. METHODS Cases presenting from 2000 through 2012 were drawn from the NCDB and reclassified according to the eighth edition stage classification. Clinically and pathologically staged subsets of NSCLC were analyzed separately. The T, N, and overall TNM classifications were evaluated according to clinical, pathologic, and "best" stage (N = 780,294). Multivariate analyses were carried out to adjust for various confounding factors. A combined analysis of the NSCLC cases from both databases was performed to explore differences in overall survival prognosis between the two databases. RESULTS The databases differed in terms of key factors related to data source. Survival was greater in the IASLC database for all stage categories. However, the eighth edition TNM stage classification system demonstrated consistent ability to discriminate TNM categories and stage groups for clinical and pathologic stage. CONCLUSIONS The IASLC revisions made for the eighth edition of lung cancer staging are validated by this analysis of the NCDB database by the ordering, statistical differences, and homogeneity within stage groups and by the consistency within analyses of specific cohorts.
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Affiliation(s)
- Kari Chansky
- Cancer Research And Biostatistics, Seattle, Washington.
| | | | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College, London, United Kingdom
| | - Valerie W Rusch
- Thoracic Surgery Service, Sloan-Kettering Cancer Center, New York, New York
| | - Eric Vallières
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington
| | - Patti Groome
- Queen's Cancer Research Institute, Kingston, Ontario, Canada
| | | | - Mark Krasnik
- Gentofte University Hospital, Copenhagen, Denmark
| | - Michael Peake
- University of Leicester, Glenfield Hospital, Leicester, United Kingdom
| | | | | | | | - Hisao Asamura
- Division of Thoracic Surgery, Keio School of Medicine, Tokyo, Japan
| | - Ramón Rami-Porta
- Thoracic Surgery Service, Hospital Universitari Mutua Terrassa, University of Barcelona; Centros de Investigación Biomédica en Red de Enfermedades Respiratorias CIBERES Lung Cancer Group, Terrassa, Barcelona, Spain
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Abstract
Answer questions and earn CME/CNE The revision for the eighth edition of the tumor, node, and metastasis (TNM) classification of lung cancer was based on analyses of the International Association for the Study of Lung Cancer database, which included 77,156 evaluable patients diagnosed with lung cancer from 1999 to 2010. Among tumor (T) descriptors, the following new tumor-size groups were created: T1a, ≤1 cm; T1b, >1 to 2 cm; T1c, >2 to 3 cm; T2a, >3 to 4 cm; T2b, >4 to 5 cm; T3, >5 to 7 cm; and T4, >7 cm. Tis and T1mi were introduced for adenocarcinoma in situ and minimally invasive adenocarcinoma, respectively. Endobronchial tumors located <2 cm from the carina have better prognosis than those with any other T3 descriptor and were classified as T2. Total atelectasis/pneumonitis was classified as a T2 descriptor, because it has a T2 prognosis. Diaphragmatic invasion is now T4. Visceral pleural invasion remains unchanged, and mediastinal pleura invasion, which is seldom used, disappears as a T descriptor. The lymph node (N) component descriptors are unchanged, but the number of involved nodal stations has prognostic impact. For the metastasis (M) component, M1a (intrathoracic metastases) remains unchanged, but extrathoracic metastases are divided into a single extrathoracic metastasis (new M1b) and multiple extrathoracic metastases in a single organ or multiple organs (M1c). Stage IA is now divided into IA1, IA2, and IA3 to accommodate T1a, T1b, and T1cN0M0 tumors, respectively; all N1 disease is stage IIB except for T3-T4N1M0 tumors, which are stage IIIA; a new stage IIIC is created for T3-T4N3M0 tumors; and stage IV is divided into IVA (M1a and M1b) and IVB (M1c). This revision enhances our capacity for prognostication and will have an important impact in the management of patients with lung cancer and in future research. CA Cancer J Clin 2017;67:138-155. © 2017 American Cancer Society.
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Affiliation(s)
- Ramón Rami-Porta
- Attending Thoracic Surgeon, Department of Thoracic Surgery, University Hospital Mutua Terrassa, University of Barcelona, and Network of Biomedical Research Centers in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain
| | - Hisao Asamura
- Chief of Thoracic Surgery, Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - William D Travis
- Director, Thoracic Pathology, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Valerie W Rusch
- Vice Chair for Clinical Research and Miner Family Chair in Intrathoracic Cancers, Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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Affiliation(s)
- Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain; ; CIBERES Lung Cancer Group, Terrassa, Barcelona, Spain
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Osarogiagbon RU, Smeltzer MP, Faris N, Rami-Porta R, Goldstraw P, Asamura H. Comment on the Proposals for the Revision of the N Descriptors in the Forthcoming Eighth Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2016; 11:1612-4. [DOI: 10.1016/j.jtho.2016.06.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 06/16/2016] [Indexed: 12/25/2022]
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Rusch VW, Chansky K, Kindler HL, Nowak AK, Pass HI, Rice DC, Shemanski L, Galateau-Sallé F, McCaughan BC, Nakano T, Ruffini E, van Meerbeeck JP, Yoshimura M, Rami-Porta R, Asamura H, Ball D, Beer D, Beyruti R, Bolejack V, Chansky K, Crowley J, Detterbeck FC, Eberhardt WEE, Edwards J, Galateau-Sallé F, Giroux D, Gleeson F, Groome P, Huang J, Kennedy C, Kim J, Kim YT, Kingsbury L, Kondo H, Krasnik M, Kubota K, Lerut T, Lyons G, Marino M, Marom EM, van Meerbeeck JP, Mitchell A, Nakano T, Nicholson AG, Nowak A, Peake M, Rice TW, Rosenzweig K, Ruffini E, Rusch VW, Saijo N, Van Schil P, Sculier JP, Shemanski L, Stratton K, Suzuki K, Tachimori Y, Thomas CF, Travis WD, Tsao MS, Turrisi A, Vansteenkiste J, Watanabe H, Wu YL, Baas P, Erasmus J, Hasegawa S, Inai K, Kernstine K, Kindler H, Krug L, Nackaerts K, Pass H, Rice D, Falkson C, Filosso PL, Giaccone G, Kondo K, Lucchi M, Okumura M, Blackstone E, Asamura H, Batirel H, Bille A, Pastorino U, Call S, Cangir A, Cedres S, Friedberg J, Galateau-Sallé F, Hasagawa S, Kernstine K, Kindler H, McCaughan B, Nakano T, Nowak A, Ozturk CA, Pass H, de Perrot M, Rea F, Rice D, Rintoul R, Ruffini E, Rusch V, Spaggiari L, Galetta D, Syrigos K, Thomas C, van Meerbeeck J, Nafteux P, Vansteenkiste J, Weder W, Optiz I, Yoshimura M. The IASLC Mesothelioma Staging Project: Proposals for the M Descriptors and for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Mesothelioma. J Thorac Oncol 2016; 11:2112-2119. [PMID: 27687962 DOI: 10.1016/j.jtho.2016.09.124] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [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: 08/19/2016] [Revised: 09/11/2016] [Accepted: 09/11/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The M component and TNM stage groupings for malignant pleural mesothelioma (MPM) have been empirical. The International Association for the Study of Lung Cancer developed a multinational database to propose evidence-based revisions for the eighth edition of the TNM classification of MPM. METHODS Data from 29 centers were submitted either electronically or by transfer of existing institutional databases. The M component as it currently stands was validated by confirming sufficient discrimination (by Kaplan-Meier analysis) with respect to overall survival (OS) between the clinical M0 (cM0) and cM1 categories. Candidate stage groups were developed by using a recursive partitioning and amalgamation algorithm applied to all cM0 cases. RESULTS Of 3519 submitted cases, 2414 were analyzable and 84 were cM1 cases. Median OS for cM1 cases was 9.7 months versus 13.4 months (p = 0.0013) for the locally advanced (T4 or N3) cM0 cases, supporting inclusion of only cM1 in the stage IV group. Exploratory analyses suggest a possible difference in OS for single- versus multiple-site cM1 cases. A recursive partitioning and amalgamation-generated survival tree on the OS outcomes restricted to cM0 cases with the newly proposed (eighth edition) T and N components indicates that optimal stage groupings for the eighth edition will be as follows: stage IA (T1N0), stage IB (T2-3N0), stage II (T1-2N1), stage IIIA (T3N1), stage IIIB (T1-3N2 or any T4), and stage IV (any M1). CONCLUSIONS This first evidence-based revision of the TNM classification for MPM leads to substantial changes in the T and N components and the stage groupings.
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Affiliation(s)
- Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Kari Chansky
- Cancer Research And Biostatistics, Seattle, Washington
| | - Hedy L Kindler
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Anna K Nowak
- National Centre for Asbestos Related Diseases, School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia; Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Harvey I Pass
- Department of Cardiothoracic Surgery, New York University Medical Center, New York, New York
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, M.D. Anderson Cancer Center, Houston, Texas
| | | | | | - Brian C McCaughan
- Sydney Cardiothoracic Surgeons, Royal Prince Alfred Medical Centre, Sydney, New South Wales, Australia
| | - Takashi Nakano
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Enrico Ruffini
- Department of Surgical Sciences, City of Health and Science Hospital, University of Turin, Turin, Italy
| | - Jan P van Meerbeeck
- Department of Thoracic Oncology, Antwerp University Hospital, Edegem, Belgium
| | - Masahiro Yoshimura
- Department of Thoracic Surgery, Hyogo Cancer Center, Akashi City, Hyogo, Japan
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