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Deng EZ, Wang X, Zhang J, Stinchcombe TE, Yang CF(J, Altorki N. Temporal Trends in the Utilization and Survival Outcomes of Lobar, Segmental, and Wedge Resection for Early-Stage NSCLC, 2004 to 2020. JTO Clin Res Rep 2025; 6:100794. [PMID: 39996091 PMCID: PMC11849078 DOI: 10.1016/j.jtocrr.2025.100794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 12/06/2024] [Accepted: 01/03/2025] [Indexed: 02/26/2025] Open
Abstract
Introduction Although lobectomy has long been the standard of surgical treatment for early-stage NSCLC, segmental and wedge resections have become another option often used over the past two decades. Methods To examine the trends over time in the utilization, quality, and overall survival (OS) differences of lobectomy, segmentectomy, and wedge resection, we performed an observational, population-level study of 76,466 patients with T1 or T2 N0M0 NSCLC tumors 2 cm or less in size in the National Cancer Database, from 2004 to 2020. To compare the OS of the three treatments, we used inverse probability of treatment weighting to analyze a subgroup of cases with nodal examination and minimal comorbidity burden. Results From 2004 to 2020, the use of lobectomy decreased from 75.2% to 67.6% of resections, wedge remained relatively stable (20.5%-22.8%), and segmentectomy increased from 4.3% to 9.7%. The likelihood of nodal assessments and negative margins has increased for all treatments. Younger patients, patients with low comorbidity burden, and patients with smaller tumors have become increasingly likely to receive segmental and wedge resections. Five-year OS of segmentectomy (80.6%, 95% confidence interval [CI]: 78.1%-83.2%) remained noninferior to lobectomy (83.6%, 95% CI: 83.1%-84.1%]), whereas wedge resection was inferior until 2016 to 2019 (five-y OS = 79.9%, 95% CI: 75.9%-83.8%). Conclusions Sublobar resections, particularly segmentectomies, have increased in frequency and quality. The growing use of sublobar resections for younger and healthier patients highlights the need for additional clinical evidence demonstrating whether these trends do indeed lead to better outcomes.
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Affiliation(s)
- Eden Z. Deng
- Department of Statistical Science, Duke University, Durham, North Carolina
| | - Xiaofei Wang
- Department of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Jianrong Zhang
- Centre for Cancer Research & Department of General Practice and Primary Care, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | | | - Chi-Fu (Jeffrey) Yang
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Nasser Altorki
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York–Presbyterian Hospital, New York, New York
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Bian R, Zhao F, Peng B, Zhang J, Mao Q, Wang L, Chen Q. A Nomogram for Predicting Recurrence in Stage I Non-Small Cell Lung Cancer. THE CLINICAL RESPIRATORY JOURNAL 2024; 18:e70022. [PMID: 39582149 PMCID: PMC11586294 DOI: 10.1111/crj.70022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 05/04/2024] [Accepted: 09/18/2024] [Indexed: 11/26/2024]
Abstract
BACKGROUND Early-stage non-small cell lung cancer (NSCLC) is being diagnosed increasingly, and in 30% of diagnosed patients, recurrence will develop within 5 years. Thus, it is urgent to identify recurrence-related markers to optimize the management of patient-tailored therapeutics. METHODS The eligible datasets were downloaded from TCGA and GEO. In the discovery phase, two algorithms, least absolute shrinkage and selector operation and support vector machine-recursive feature elimination, were used to identify candidate genes. The recurrence-associated signature was developed by penalized Cox regression. The nomogram was constructed and further tested via other independent cohorts. RESULTS In this retrospective study, 14 eligible datasets and 7 published signatures were included. A 13-gene based signature was generated by penalized Cox regression categorized training cohort into high-risk and low-risk subgroups (HR = 8.873, 95% CI: 4.228-18.480 p < 0.001). Furthermore, a nomogram integrating the recurrence-related signature, age, and histology was developed to predict the recurrence-free survival in the training cohort, which performed well in the two external validation cohorts (concordance index: 0.737, 95% CI: 0.732-0.742, p < 0.001; 0.666, 95% CI: 0.650-0.682, p < 0.001; 0.651, 95% CI: 0.637-0.665, p < 0.001, respectively). The nomogram was further performed well in the Jiangsu cohort enrolled 163 patients (HR = 2.723, 95% CI: 1.526-4.859, p = 0.001). Post-operative adjuvant therapy achieved evaluated disease-free survival in high and intermediate risk groups (HR = 4.791, 95% CI: 1.081-21.231, p = 0.039). CONCLUSIONS The proposed nomogram is a promising tool for estimating recurrence-free survival in stage I NSCLC, which might have tremendous value in management of early stage NSCLC and guiding adjuvant therapy strategies.
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Affiliation(s)
- Rongrong Bian
- Department of OncologyNanjing Liuhe District People's HospitalNanjingChina
| | - Feng Zhao
- Department of Thoracic SurgeryTaixing People's HospitalTaixingChina
| | - Bo Peng
- Department of Thoracic Surgery, Xuzhou Central HospitalXuZhou Clinical School of Xuzhou Medical UniversityXuzhouJiangsuChina
| | - Jin Zhang
- Department of Oncology, Department of Geriatric Lung Cancer LaboratoryThe Affiliated Geriatric Hospital of Nanjing Medical University, Jiangsu Province Geriatric HospitalNanjingChina
| | - Qixing Mao
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer ResearchNanjing Medical University Affiliated Cancer HospitalNanjingChina
| | - Lin Wang
- Department of Oncology, Department of Geriatric Lung Cancer LaboratoryThe Affiliated Geriatric Hospital of Nanjing Medical University, Jiangsu Province Geriatric HospitalNanjingChina
| | - Qiang Chen
- Department of Thoracic Surgery, Xuzhou Central HospitalXuZhou Clinical School of Xuzhou Medical UniversityXuzhouJiangsuChina
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Bertolaccini L, Tralongo AC, Del Re M, Facchinetti F, Ferrara R, Franchina T, Graziano P, Malapelle U, Menis J, Passaro A, Pilotto S, Ramella S, Rossi G, Trisolini R, Cinquini M, Passiglia F, Novello S. Segmentectomy vs. Lobectomy in stage IA non-small cell lung cancer: A systematic review and meta-analysis of perioperative and survival outcomes. Lung Cancer 2024; 197:107990. [PMID: 39461280 DOI: 10.1016/j.lungcan.2024.107990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 10/04/2024] [Accepted: 10/10/2024] [Indexed: 10/29/2024]
Abstract
While recent randomized controlled trials (RCT) have suggested superior overall survival (OS) outcomes with segmentectomy over lobectomy, questions remain regarding the comparability of these surgical procedures for treating early-stage non-small cell lung cancer (NSCLC). This systematic review and meta-analysis aimed to synthetize existing evidence and to compare the survival outcomes observed for stage IA NSCLC following segmentectomy or lobectomy. 40 studies (38 observational, 2 RCTs) encompassing 103,926 patients were analyzed. Primary outcomes included overall survival (OS), disease-free survival (DFS), local recurrences, harvested lymph nodes, postoperative morbidity, and length of hospital stay. Risk of bias was assessed using established tools, and evidence certainty was evaluated using GRADE. Non-RCTs showed an OS HR of 1.10 (95 % CI: 0.94-1.30, p = 0.24) with low certainty, contrasting with RCTs' HR of 0.82 (95 % CI: 0.66-1.02, p = 0.7) with moderate certainty. Local recurrences exhibited OR 1.40 (95 % CI: 0.94-2.08, p = 0.09) in non-RCTs with low certainty, and RR 1.61 (95 % CI: 1.12-2.31, p = 0.01) in RCTs with low certainty. Non-RCTs showed DFS HR 1.13 (95 % CI: 0.95-1.34, p = 0.18) with low certainty, while RCTs yielded HR 1.00 (95 % CI: 0.85-1.18, p = 0.97) with moderate certainty. Lobectomy resulted in more harvested lymph nodes. Postoperative morbidity and length of hospital stay did not differ significantly. While definitive evidence for OS, DFS, and postoperative outcomes differences was inconclusive, a potential increase in local recurrences following lobectomy was noted. Further well-designed studies are warranted to enhance evidence and inform clinical practice in stage I lung cancer surgery.
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Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Antonino Carmelo Tralongo
- Clinical Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy; Medical Oncology Unit, Umberto I Hospital, Azienda Sanitaria Provinciale Siracusa, Siracusa, Italy
| | - Marzia Del Re
- Saint Camillus International University of Health and Medical Sciences, Rome, Italy; Scientific Direction, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Francesco Facchinetti
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Roberto Ferrara
- Medical Oncology, Università Vita-Salute San Raffaele, Milan, Italy
| | - Tindara Franchina
- Department of Human Pathology "G. Barresi", University of Messina, Italy
| | - Paolo Graziano
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, AOU Policlinico Umberto I, Rome, Italy
| | - Umberto Malapelle
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Jessica Menis
- Department of Medical Oncology, University Hospital of Verona, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Sara Pilotto
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Italy
| | - Sara Ramella
- Research Unit of Radiation Oncology Unit, Department of Medicine and Surgery, Università Campus Bio-Medico, Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Giulio Rossi
- Services Department, Pathology Unit, Fondazione Poliambulanza Hospital Institute, Brescia, Italy
| | - Rocco Trisolini
- Interventional Pulmonology Division, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Hearth, Rome, Italy
| | - Michela Cinquini
- Clinical Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Francesco Passiglia
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, TO, Italy
| | - Silvia Novello
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, TO, Italy
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Snider M, Salama JK, Boyer M. Survival and recurrence rates following SBRT or surgery in medically operable Stage I NSCLC. Lung Cancer 2024; 197:107962. [PMID: 39366309 DOI: 10.1016/j.lungcan.2024.107962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 09/17/2024] [Accepted: 09/21/2024] [Indexed: 10/06/2024]
Abstract
OBJECTIVES Surgery is the standard of care for early-stage non-small cell lung cancer (NSCLC), with SBRT reserved for patients who are not surgical candidates. We hypothesized overall survival (OS), lung cancer-specific survival (LCSS), progression free survival (PFS), and recurrence rates following SBRT or surgery in medically operable patients with Stage I NSCLC from the Veterans' Health Care System (VAHS) would be equivalent. MATERIALS AND METHODS Medically operable patients diagnosed with Stage I NSCLC between 2000-2020 from the VAHS, determined by an FEV1 or DLCO > 60 % of predicted and Charlson comorbidity index (CCI) of 0 or 1, treated with SBRT or surgery were identified. SBRT patients were propensity score matched in a 1:1:1 ratio to those undergoing resection (SBRT:lobectomy:sub-lobar resection). OS, LCSS, and PFS and site of recurrence were determined. RESULTS 103 patients were included in each cohort. With a median follow-up of 7.9 years 5-year OS for all patients was 51 % (95 % CI 46-57 %). After propensity score matching, OS (HR 2.08, 1.59), LCSS (HR 2.28, 1.97), and PFS (1.97, 1.45) were significantly worse with SBRT compared to either lobectomy or sub-lobar resection, respectively, (p < 0.05 for each comparison). Regional recurrence was significantly higher following SBRT (15.5 % vs 6.8 % or 4.9 %; p < 0.05), but there was no significant difference in local (28.2 % vs 21.4 % or 21.4 %; p > 0.05) or distant recurrence (10.7 % vs 9.7 % or 13.6 %; p > 0.05) when compared to lobectomy or sub-lobar resection, respectively. CONCLUSION In medically operable patients, OS, LCSS, and PFS following either lobectomy or sub-lobar resection were superior to that for SBRT for Stage I NSCLC, likely due in part to higher regional recurrence following SBRT. This suggests that pulmonary function test results and CCI alone are insufficient to define a cohort of medically operable patients suited for SBRT. These data support strategies to overcome regional recurrences seen with SBRT.
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Affiliation(s)
- Michael Snider
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC, United States
| | - Joseph K Salama
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC, United States; Radiation Oncology Clinical Service, Durham VA Health Care System, Durham, NC, United States
| | - Matthew Boyer
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC, United States; Radiation Oncology Clinical Service, Durham VA Health Care System, Durham, NC, United States.
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Johnson SF, Tabatabaei SMH, Kim GHJ, Villegas BE, Brown M, Genshaft S, Suh RD, Barjaktarevic I, Wallace WD, Abtin F. Predicting Invasiveness in Lepidic Pattern Adenocarcinoma of Lung: Analysis of Visual Semantic and Radiomic Features. Med Sci (Basel) 2024; 12:57. [PMID: 39449413 PMCID: PMC11503399 DOI: 10.3390/medsci12040057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Revised: 10/14/2024] [Accepted: 10/14/2024] [Indexed: 10/26/2024] Open
Abstract
OBJECTIVES To differentiate invasive lepidic predominant adenocarcinoma (iLPA) from adenocarcinoma in situ (AIS)/minimally invasive adenocarcinoma (MIA) of lung utilizing visual semantic and computer-aided detection (CAD)-based texture features on subjects initially diagnosed as AIS or MIA with CT-guided biopsy. MATERIALS AND METHODS From 2011 to 2017, all patients with CT-guided biopsy results of AIS or MIA who subsequently underwent resection were identified. CT scan before the biopsy was used to assess visual semantic and CAD texture features, totaling 23 semantic and 95 CAD-based quantitative texture variables. The least absolute shrinkage and selection operator (LASSO) method or forward selection was used to select the most predictive feature and combination of semantic and texture features for detection of invasive lung adenocarcinoma. RESULTS Among the 33 core needle-biopsied patients with AIS/MIA pathology, 24 (72.7%) had invasive LPA and 9 (27.3%) had AIS/MIA on resection. On CT, visual semantic features included 21 (63.6%) part-solid, 5 (15.2%) pure ground glass, and 7 (21.2%) solid nodules. LASSO selected seven variables for the model, but all were not statistically significant. "Volume" was found to be statistically significant when assessing the correlation between independent variables using the backward selection technique. The LASSO selected "tumor_Perc95", "nodule surround", "small cyst-like spaces", and "volume" when assessing the correlation between independent variables. CONCLUSIONS Lung biopsy results showing noninvasive LPA underestimate invasiveness. Although statistically non-significant, some semantic features showed potential for predicting invasiveness, with septal stretching absent in all noninvasive cases, and solid consistency present in a significant portion of invasive cases.
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Affiliation(s)
- Sean F. Johnson
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA (B.E.V.)
| | - Seyed Mohammad Hossein Tabatabaei
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA (B.E.V.)
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Grace Hyun J. Kim
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA (B.E.V.)
| | - Bianca E. Villegas
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA (B.E.V.)
| | - Matthew Brown
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA (B.E.V.)
| | - Scott Genshaft
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA (B.E.V.)
| | - Robert D. Suh
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA (B.E.V.)
| | - Igor Barjaktarevic
- Department of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA
| | - William Dean Wallace
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Fereidoun Abtin
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA (B.E.V.)
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Xu Z, Ma Z, Zhao F, Li J, Kong R, Li S, Jiang J, Kang H, Liu D. Choice of wedge resection for selected T1a/bN0M0 non-small cell lung cancer. Sci Rep 2024; 14:24206. [PMID: 39406938 PMCID: PMC11480474 DOI: 10.1038/s41598-024-76413-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 10/14/2024] [Indexed: 10/19/2024] Open
Abstract
Recently, several studies have reported that the survival benefit of wedge resection might not be inferior to that of lobectomy in early-stage NSCLC patients, but there is no unified definition of the details or cutoff value. Patients with early-stage NSCLC with a tumour size ≤ 2.0 cm were chosen from the SEER database. The influence of confounding factors was minimized by 1:1 propensity score matching (PSM). Kaplan‒Meier curves and Cox proportional hazards models were used to evaluate the overall survival (OS) and lung cancer-specific survival (LCSS) of patients undergoing lobectomy and wedge resection. A total of 3891 patients with early-stage NSCLC with tumour size ≤ 2.0 cm were enrolled, of whom 2839 underwent lobectomy and 1052 underwent wedge resection. Both before and after PSM, lobectomy significantly improved OS and LCSS compared with wedge resection in the unstratified study population. In the tumour size ≤ 1 cm group, lobectomy had better OS and LCSS than wedge resection (P < 0.05) before PSM; after PSM, there was no significant difference in OS (P = 0.16) and LCSS (P = 0.17). In Grade I patients, before PSM, lobectomy was superior to wedge resection in LCSS (P = 0.038), while there was no significant difference in OS (P = 0.16); after PSM, there were no significant differences in either OS (P = 0.78) or LCSS (P = 0.11). For early-stage NSCLC patients with a tumour size ≤ 1 cm or with a tumour size ≤ 2 cm and with Grade I, there was no significant difference in survival between wedge resection and lobectomy.
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Affiliation(s)
- Zhengshui Xu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, P. R. China
| | - Zhenchuan Ma
- Department of Thoracic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, P. R. China
| | - Feng Zhao
- Department of Thoracic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, P. R. China
| | - Jianzhong Li
- Department of Thoracic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, P. R. China
| | - Ranran Kong
- Department of Thoracic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, P. R. China
| | - Shaomin Li
- Department of Thoracic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, P. R. China
| | - Jiantao Jiang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, P. R. China
| | - Huafeng Kang
- The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, P. R. China.
| | - Dandan Liu
- The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, P. R. China.
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Song W, Shi J, Zhou B, Meng X, Liang M, Gao Y. Nomogram predicting overall and cancer specific prognosis for poorly differentiated lung adenocarcinoma after resection based on SEER cohort analysis. Sci Rep 2024; 14:22045. [PMID: 39333682 PMCID: PMC11436654 DOI: 10.1038/s41598-024-73486-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 09/18/2024] [Indexed: 09/29/2024] Open
Abstract
The prognosis of poorly differentiated lung adenocarcinoma (PDLA) is determined by many clinicopathological factors. The aim of this study is identifying prognostic factors and developing reliable nomogram to predict the overall survival (OS) and cancer-specific survival (CSS) in patients with PDLA. Patient data from the Surveillance, Epidemiology and End Results (SEER) database was collected and analyzed. The SEER database was used to screen 1059 eligible patients as the study cohort. The whole cohort was randomly divided into a training cohort (n = 530) and a test cohort (n = 529). Cox proportional hazards analysis was used to identify variables and construct a nomogram based on the training cohort. C-index and calibration curves were performed to evaluate the performance of the model in the training cohort and test cohorts. For patients with PDLA, age at diagnosis, gender, tumor size were independent prognostic factors both for overall survival (OS) and cancer-specific survival (CSS), while race and number of nodes were specifically related to OS. The calibration curves presented excellent consistency between the actual and nomogram-predict survival probabilities in the training and test cohorts. The C-index values of the nomogram were 0.700 and 0.730 for OS and CSS, respectively. The novel nomogram provides new insights of the risk of each prognostic factor and can assist doctors in predicting the 1-year, 3-year and 5-year OS and CSS in patients with PDLA.
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Affiliation(s)
- Weijian Song
- Department of Thoracic Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Nanli 17, Panjiayuan, Beijing, 100021, People's Republic of China
| | - Jianwei Shi
- Department of Thoracic Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Nanli 17, Panjiayuan, Beijing, 100021, People's Republic of China
| | - Boxuan Zhou
- Department of Thoracic Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Nanli 17, Panjiayuan, Beijing, 100021, People's Republic of China
| | - Xiangzhi Meng
- Department of Thoracic Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Nanli 17, Panjiayuan, Beijing, 100021, People's Republic of China
| | - Mei Liang
- Department of Thoracic Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Nanli 17, Panjiayuan, Beijing, 100021, People's Republic of China
| | - Yushun Gao
- Department of Thoracic Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Nanli 17, Panjiayuan, Beijing, 100021, People's Republic of China.
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Ventura L, Fiorelli A, Rossi M, Gnetti L, Natale G, Wang Y, Carbognani P, Fang W, Waller D. Is Lobectomy Actually Worse Than Segmentectomy for All Stage I Non-Small Cell Lung Cancer? J Surg Res 2024; 300:298-308. [PMID: 38838427 DOI: 10.1016/j.jss.2024.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 03/24/2024] [Accepted: 04/20/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION The recent results of the JCOG 0802 and CALGB 140503 studies suggest that segmentectomy should be considered instead of lobectomy for patients with peripheral <2 cm node-negative non-small cell lung cancer (NSCLC). This study aimed to test this hypothesis in a retrospective analysis of a larger dataset of patients with stage I NSCLC recorded in the Surveillance, Epidemiology, and End Results database. METHODS Patients with all stage I NSCLC (≤4 cm in size) who underwent either segmentectomy or lobectomy from 2000 to 2017 were analyzed. The primary endpoints were overall survival and lung cancer-specific survival, while the secondary endpoints were the 30-day and 90-day mortality. RESULTS Overall, 32,673 patients treated by lobectomy and 2166 patients treated by segmentectomy were included in the initial data collection. After 1:1 propensity score matching (PSM), 2016 patients in each group were enrolled in the final analysis with well-balanced baseline characteristics. After PSM, there was no difference between segmentectomy and lobectomy for all stage IA NSCLC (≤3 cm in size) in both overall survival and lung cancer-specific survival (hazard ratio: 0.87 [0.74-1.02], P value: 0.09 and hazard ratio: 0.81 [0.4-1.03], P value: 0.09, respectively). Furthermore, lobectomy had higher 30-day mortality than segmentectomy: 1.1% versus 2.1%, P value: 0.01. However, this difference was not significant for 90-day mortality, even after PSM (3.9% versus 3.0%, P value: 0.17). CONCLUSIONS We found no evidence to support the use of lobectomy rather than segmentectomy in stage IA NSCLC in terms of either overall or lung cancer-specific long-term survival. The choice of lobectomy may also be detrimental to early postoperative recovery.
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Affiliation(s)
- Luigi Ventura
- Cardiothoracic Surgery Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; School of Medicine and Population Health, The University of Sheffield, Sheffield, UK.
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Maurizio Rossi
- Department of Clinical and Experimental Medicine, University Hospital of Parma, Parma, Italy
| | - Letizia Gnetti
- Pathology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Giovanni Natale
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Yiyang Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiaotong University Medical School, Shanghai, China
| | - Paolo Carbognani
- Thoracic Surgery Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiaotong University Medical School, Shanghai, China
| | - David Waller
- Barts Thorax Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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Xiu J, Wang S, Wang X, Xu W, Hu Y, Hua Y, Xu S. Effectiveness and safety of segmentectomy vs. wedge resection for the treatment of patients with operable non‑small cell lung cancer: A meta‑analysis and systematic review. Oncol Lett 2024; 28:336. [PMID: 38846430 PMCID: PMC11153982 DOI: 10.3892/ol.2024.14469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/13/2024] [Indexed: 06/09/2024] Open
Abstract
The present study compared the differences in effectiveness and safety between segmentectomy (ST) and wedge resection (WR) in patients with operable non-small cell lung cancer (NSCLC). The PubMed, EMBASE, Cochrane Library and Web of Science databases were searched for papers published from inception until July 2023. The inclusion criteria were based on the population, intervention, comparator, outcomes and study designs. ROBINS-I was selected to assess the risk of bias and quality of evidence in the included non-randomised studies. Appropriate effect sizes were selected, and subgroup analyses, heterogeneity tests, sensitivity analyses and publication bias were applied. A total of 18 retrospective studies were included, involving 19,381 patients with operable NSCLC. The 5-year overall survival rate [hazard ratio (HR), 0.19; 95% confidence interval (CI), 0.04, 0.34; P=0.014; I2=76.3%], lung cancer-specific survival rate (HR, 0.3; 95% CI, 0.21, 0.38; P<0.01; I2=13.8%) and metastasis rate [odds ratio (OR), 1.56; 95% CI, 1.03, 2.38; P=0.037] in patients with operable NSCLC treated with WR were worse than those in patients treated with ST. The incidence of postoperative complications (OR, 0.44; 95% CI, 0.23, 0.82) in the WR group was lower than in the ST treatment group. There was no difference in postoperative recurrence (OR, 2.15; 95% CI, 0.97, 4.74; P=0.058) and mortality (risk difference, 0.04; 95% CI, -0.03, 0.11; P=0.287) between groups. Based on current evidence, patients with NSCLC treated with ST surgery have better postoperative survival but more complications than those patients treated with WT, while the effect of WR and ST on the recurrence rate and distant metastasis rate remains controversial.
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Affiliation(s)
- Jiawei Xiu
- Department of Thoracic Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, P.R. China
- Graduate School, China Medical University, Shenyang, Liaoning 110122, P.R. China
| | - Shiqi Wang
- Department of Thoracic Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, P.R. China
| | - Xilong Wang
- Department of Thoracic Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, P.R. China
| | - Wei Xu
- Department of Thoracic Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, P.R. China
| | - Yuhang Hu
- Department of Thoracic Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, P.R. China
| | - Yujuan Hua
- Department of Anaesthesiology, General Hospital of Northern Theater, Shenyang, Liaoning 110016, P.R. China
| | - Shiguang Xu
- Department of Thoracic Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, P.R. China
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Zhang Z, Li F, Chen S, Hu B. Is wedge resection equivalent to segmentectomy in pathological stage IA (≤2 cm) non-small cell lung cancers? Thorac Cancer 2024; 15:1553-1562. [PMID: 38812274 PMCID: PMC11246781 DOI: 10.1111/1759-7714.15377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/29/2024] [Accepted: 05/13/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Sublobar resection (wedge resection and segmentectomy) has been established as an oncologically equivalent option to lobectomy for early-stage patients with non-small cell lung cancer (NSCLC) ≤ 2 cm. However, the optimal approach of sublobar resection remains subject to debate. In the present study we aimed to compare the oncological outcomes of wedge resection and segmentectomy in these patients. METHODS We identified patients with pT1a-bN0M0 NSCLC who underwent wedge resection and segmentectomy from the Surveillance, Epidemiology, and End Results database between 2010 and 2020. A Cox regression model and propensity-score matching (PSM) analysis were used. Overall survival (OS) and lung cancer-specific survival (LCSS) were compared using the Kaplan-Meier method. RESULTS A total of 4190 patients met our selection criteria, including wedge resection in 3137 and segmentectomy in 1053. Patients undergoing wedge resection were less likely to have total lymph nodes resected (4 vs. 7, p < 0.001). Before PSM, patients undergoing segmentectomy had a higher 5-year OS rate (87.75% vs. 82.72%; p = 0.0023), while exhibiting a similar LCSS rate (93.45% vs. 92.73%; p = 0.32). After PSM, segmentectomy consistently demonstrated significantly better OS and there was no statistically significant difference in LCSS. Analysis of causes of death revealed that a higher incidence of deaths related to other causes among patients undergoing wedge resection compared to those undergoing segmentectomy. CONCLUSIONS Both wedge resection and segmentectomy yield comparable oncological outcomes for patients with NSCLC ≤ 2 cm, although segmentectomy exhibits superior OS due to less death related to other causes.
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Affiliation(s)
- Zhirong Zhang
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao‐Yang HospitalCapital Medical UniversityBeijingChina
| | - Feng Li
- Department of Pulmonary Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital)Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of SciencesHangzhouChina
| | - Shuo Chen
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao‐Yang HospitalCapital Medical UniversityBeijingChina
| | - Bin Hu
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao‐Yang HospitalCapital Medical UniversityBeijingChina
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Guo C, Liu L, Zhang J, Zhao K, Chen Y, Huang C, Li S. Bibliometric analysis of the top 100 highly cited articles on sublobectomy for non-small cell lung cancer. J Cardiothorac Surg 2024; 19:378. [PMID: 38926754 PMCID: PMC11201329 DOI: 10.1186/s13019-024-02854-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVES The goal of this research is to pinpoint the top 100 most frequently referenced studies on sublobectomy for non-small cell lung cancer. METHODS We identified the top 100 most frequently referenced studies on sublobectomy for non-small cell lung cancer by searching the Web of Science database. We extracted key information from the selected studies, including the author, journal, impact factor, type of article, year of publication, country, organization, and keyword. RESULTS To the best of our understanding, this is the inaugural bibliometric study on sublobectomy for non-small cell lung cancer. The publication years of the top 100 most frequently referenced studies span from 1994 to 2022, with citation counts ranging from 51 to 795. The majority of the included studies are original (93/100) and primarily retrospective studies (82/93). The United States leads in terms of published articles and citations, with the Annals of Thoracic Surgery being the most frequently sourced journal (n = 27). High-density keywords primarily originate from limited resection, lobectomy, survival, carcinoma, recurrence, randomized trial, radiotherapy, lung cancer, outcome, 2 cm, as revealed by CiteSpace analysis. CONCLUSIONS Our research compiles and analyzes the top 100 most frequently referenced studies in the field of sublobectomy for non-small cell lung cancer. The United States has the most published and cited works on this topic. Currently, the hot keywords for sublobectomy research are gradually shifting towards prognosis and obtaining better evidence-based medical evidence to demonstrate its value in the treatment of non-small cell lung cancer.
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Affiliation(s)
- Chao Guo
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Shuaifuyuan 1, Wangfujing Street, Dongcheng District, Beijing, P. R. China
| | - Lei Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Shuaifuyuan 1, Wangfujing Street, Dongcheng District, Beijing, P. R. China
| | - Jiaqi Zhang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Shuaifuyuan 1, Wangfujing Street, Dongcheng District, Beijing, P. R. China
| | - Ke Zhao
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Shuaifuyuan 1, Wangfujing Street, Dongcheng District, Beijing, P. R. China
| | - Yeye Chen
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Shuaifuyuan 1, Wangfujing Street, Dongcheng District, Beijing, P. R. China
| | - Cheng Huang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Shuaifuyuan 1, Wangfujing Street, Dongcheng District, Beijing, P. R. China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Shuaifuyuan 1, Wangfujing Street, Dongcheng District, Beijing, P. R. China.
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Wu B, Zhang X, Feng N, Hu Z, Wu J, Zhou W, Wei Y, Zhang W, Wang K. Treatment strategies for stage IA non-small cell lung cancer: A SEER-based population study. PLoS One 2024; 19:e0298470. [PMID: 38683794 PMCID: PMC11057715 DOI: 10.1371/journal.pone.0298470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/24/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND There are various therapeutic methods for treating stage IA (T1N0M0) non-small cell lung cancer (NSCLC), but no studies have systematically assessed multiple treatments to determine the most effective therapy. METHODS Stage IA NSCLC patient data collected between 2004 and 2018 were gathered from the Surveillance, Epidemiology, and End Results (SEER) database. Treatment modalities included observation, chemotherapy alone (CA), radiation alone (RA), radiation+chemotherapy (RC), surgery alone (SA), surgery+chemotherapy (SC), surgery+radiation (SR) and surgery+radiation+chemotherapy (SRC). Comparisons were made of overall survival (OS) and lung cancer-specific survival (LCSS) among patients based on different therapeutic methods by survival analysis. RESULTS Ultimately, 89147 patients with stage IA NSCLC between 2004 and 2018 were enrolled in this study. The order of multiple treatment modalities based on the hazard ratio (HR) for OS for the entire cohort revealed the following results: SA (HR: 0.20), SC (HR: 0.25), SR (HR: 0.42), SRC (HR: 0.46), RA (HR: 0.56), RC (HR: 0.72), CA (HR: 0.91) (P<0.001), and observation (HR: Ref). The SA group had the best OS and LCSS, and similar results were found in most subgroup analyses (all P<0.001). The order of surgical modalities based on the HR for OS for the entire cohort revealed the following results: lobectomy (HR: 0.32), segmentectomy (HR: 0.41), wedge resection (HR: 0.52) and local tumor destruction (HR: Ref). Lobectomy had the best effects on OS and LCSS, and similar results were found in all subgroup analyses (all P<0.001). CONCLUSION SA appeared to be the optimal treatment modality for patients with stage IA NSCLC, and lobectomy was associated with the best prognosis. There may be some indication and selection bias in our study, and the results of this study should be confirmed in a prospective study.
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Affiliation(s)
- Bo Wu
- Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Xiang Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Nan Feng
- Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Zhuozheng Hu
- Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Jiajun Wu
- Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Weijun Zhou
- Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Yiping Wei
- Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Wenxiong Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Kang Wang
- Department of Traditional Chinese Medicine, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
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Pan Z, Hu G, Zhu Z, Tan W, Han W, Zhou Z, Song W, Yu Y, Song L, Jin Z. Predicting Invasiveness of Lung Adenocarcinoma at Chest CT with Deep Learning Ternary Classification Models. Radiology 2024; 311:e232057. [PMID: 38591974 DOI: 10.1148/radiol.232057] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Background Preoperative discrimination of preinvasive, minimally invasive, and invasive adenocarcinoma at CT informs clinical management decisions but may be challenging for classifying pure ground-glass nodules (pGGNs). Deep learning (DL) may improve ternary classification. Purpose To determine whether a strategy that includes an adjudication approach can enhance the performance of DL ternary classification models in predicting the invasiveness of adenocarcinoma at chest CT and maintain performance in classifying pGGNs. Materials and Methods In this retrospective study, six ternary models for classifying preinvasive, minimally invasive, and invasive adenocarcinoma were developed using a multicenter data set of lung nodules. The DL-based models were progressively modified through framework optimization, joint learning, and an adjudication strategy (simulating a multireader approach to resolving discordant nodule classifications), integrating two binary classification models with a ternary classification model to resolve discordant classifications sequentially. The six ternary models were then tested on an external data set of pGGNs imaged between December 2019 and January 2021. Diagnostic performance including accuracy, specificity, and sensitivity was assessed. The χ2 test was used to compare model performance in different subgroups stratified by clinical confounders. Results A total of 4929 nodules from 4483 patients (mean age, 50.1 years ± 9.5 [SD]; 2806 female) were divided into training (n = 3384), validation (n = 579), and internal (n = 966) test sets. A total of 361 pGGNs from 281 patients (mean age, 55.2 years ± 11.1 [SD]; 186 female) formed the external test set. The proposed strategy improved DL model performance in external testing (P < .001). For classifying minimally invasive adenocarcinoma, the accuracy was 85% and 79%, sensitivity was 75% and 63%, and specificity was 89% and 85% for the model with adjudication (model 6) and the model without (model 3), respectively. Model 6 showed a relatively narrow range (maximum minus minimum) across diagnostic indexes (accuracy, 1.7%; sensitivity, 7.3%; specificity, 0.9%) compared with the other models (accuracy, 0.6%-10.8%; sensitivity, 14%-39.1%; specificity, 5.5%-17.9%). Conclusion Combining framework optimization, joint learning, and an adjudication approach improved DL classification of adenocarcinoma invasiveness at chest CT. Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Sohn and Fields in this issue.
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Affiliation(s)
- Zhengsong Pan
- From the Department of Radiology (Z.P., Z. Zhu, W.S., L.S., Z.J.), Medical Research Center (G.H.), State Key Laboratory of Complex Severe and Rare Disease (G.H.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China; 4 + 4 Medical Doctor Program (Z.P., Z. Zhu), Department of Epidemiology and Health Statistics (W.H.), Institute of Basic Medicine Sciences (W.H.), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Deepwise AI Laboratory, Beijing Deepwise & League of PhD Technology, Beijing, China (W.T., Z. Zhou, Y.Y.); and Department of Computer Science, The University of Hong Kong, Hong Kong, China (Y.Y.)
| | - Ge Hu
- From the Department of Radiology (Z.P., Z. Zhu, W.S., L.S., Z.J.), Medical Research Center (G.H.), State Key Laboratory of Complex Severe and Rare Disease (G.H.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China; 4 + 4 Medical Doctor Program (Z.P., Z. Zhu), Department of Epidemiology and Health Statistics (W.H.), Institute of Basic Medicine Sciences (W.H.), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Deepwise AI Laboratory, Beijing Deepwise & League of PhD Technology, Beijing, China (W.T., Z. Zhou, Y.Y.); and Department of Computer Science, The University of Hong Kong, Hong Kong, China (Y.Y.)
| | - Zhenchen Zhu
- From the Department of Radiology (Z.P., Z. Zhu, W.S., L.S., Z.J.), Medical Research Center (G.H.), State Key Laboratory of Complex Severe and Rare Disease (G.H.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China; 4 + 4 Medical Doctor Program (Z.P., Z. Zhu), Department of Epidemiology and Health Statistics (W.H.), Institute of Basic Medicine Sciences (W.H.), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Deepwise AI Laboratory, Beijing Deepwise & League of PhD Technology, Beijing, China (W.T., Z. Zhou, Y.Y.); and Department of Computer Science, The University of Hong Kong, Hong Kong, China (Y.Y.)
| | - Weixiong Tan
- From the Department of Radiology (Z.P., Z. Zhu, W.S., L.S., Z.J.), Medical Research Center (G.H.), State Key Laboratory of Complex Severe and Rare Disease (G.H.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China; 4 + 4 Medical Doctor Program (Z.P., Z. Zhu), Department of Epidemiology and Health Statistics (W.H.), Institute of Basic Medicine Sciences (W.H.), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Deepwise AI Laboratory, Beijing Deepwise & League of PhD Technology, Beijing, China (W.T., Z. Zhou, Y.Y.); and Department of Computer Science, The University of Hong Kong, Hong Kong, China (Y.Y.)
| | - Wei Han
- From the Department of Radiology (Z.P., Z. Zhu, W.S., L.S., Z.J.), Medical Research Center (G.H.), State Key Laboratory of Complex Severe and Rare Disease (G.H.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China; 4 + 4 Medical Doctor Program (Z.P., Z. Zhu), Department of Epidemiology and Health Statistics (W.H.), Institute of Basic Medicine Sciences (W.H.), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Deepwise AI Laboratory, Beijing Deepwise & League of PhD Technology, Beijing, China (W.T., Z. Zhou, Y.Y.); and Department of Computer Science, The University of Hong Kong, Hong Kong, China (Y.Y.)
| | - Zhen Zhou
- From the Department of Radiology (Z.P., Z. Zhu, W.S., L.S., Z.J.), Medical Research Center (G.H.), State Key Laboratory of Complex Severe and Rare Disease (G.H.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China; 4 + 4 Medical Doctor Program (Z.P., Z. Zhu), Department of Epidemiology and Health Statistics (W.H.), Institute of Basic Medicine Sciences (W.H.), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Deepwise AI Laboratory, Beijing Deepwise & League of PhD Technology, Beijing, China (W.T., Z. Zhou, Y.Y.); and Department of Computer Science, The University of Hong Kong, Hong Kong, China (Y.Y.)
| | - Wei Song
- From the Department of Radiology (Z.P., Z. Zhu, W.S., L.S., Z.J.), Medical Research Center (G.H.), State Key Laboratory of Complex Severe and Rare Disease (G.H.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China; 4 + 4 Medical Doctor Program (Z.P., Z. Zhu), Department of Epidemiology and Health Statistics (W.H.), Institute of Basic Medicine Sciences (W.H.), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Deepwise AI Laboratory, Beijing Deepwise & League of PhD Technology, Beijing, China (W.T., Z. Zhou, Y.Y.); and Department of Computer Science, The University of Hong Kong, Hong Kong, China (Y.Y.)
| | - Yizhou Yu
- From the Department of Radiology (Z.P., Z. Zhu, W.S., L.S., Z.J.), Medical Research Center (G.H.), State Key Laboratory of Complex Severe and Rare Disease (G.H.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China; 4 + 4 Medical Doctor Program (Z.P., Z. Zhu), Department of Epidemiology and Health Statistics (W.H.), Institute of Basic Medicine Sciences (W.H.), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Deepwise AI Laboratory, Beijing Deepwise & League of PhD Technology, Beijing, China (W.T., Z. Zhou, Y.Y.); and Department of Computer Science, The University of Hong Kong, Hong Kong, China (Y.Y.)
| | - Lan Song
- From the Department of Radiology (Z.P., Z. Zhu, W.S., L.S., Z.J.), Medical Research Center (G.H.), State Key Laboratory of Complex Severe and Rare Disease (G.H.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China; 4 + 4 Medical Doctor Program (Z.P., Z. Zhu), Department of Epidemiology and Health Statistics (W.H.), Institute of Basic Medicine Sciences (W.H.), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Deepwise AI Laboratory, Beijing Deepwise & League of PhD Technology, Beijing, China (W.T., Z. Zhou, Y.Y.); and Department of Computer Science, The University of Hong Kong, Hong Kong, China (Y.Y.)
| | - Zhengyu Jin
- From the Department of Radiology (Z.P., Z. Zhu, W.S., L.S., Z.J.), Medical Research Center (G.H.), State Key Laboratory of Complex Severe and Rare Disease (G.H.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China; 4 + 4 Medical Doctor Program (Z.P., Z. Zhu), Department of Epidemiology and Health Statistics (W.H.), Institute of Basic Medicine Sciences (W.H.), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Deepwise AI Laboratory, Beijing Deepwise & League of PhD Technology, Beijing, China (W.T., Z. Zhou, Y.Y.); and Department of Computer Science, The University of Hong Kong, Hong Kong, China (Y.Y.)
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Li J, Wang Y, Liu Y, Liu Q, Shen H, Ren X, Du J. Survival analysis and clinicopathological features of patients with stage IA lung adenocarcinoma. Heliyon 2024; 10:e23205. [PMID: 38169765 PMCID: PMC10758825 DOI: 10.1016/j.heliyon.2023.e23205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/23/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024] Open
Abstract
Background With the development of medical technology and change of life habits, early-stage lung adenocarcinoma (LUAD) has become more common. This study aimed to systematically analyzed clinicopathological factors associated to the overall survival (OS) of patients with Stage IA LUAD. Methods A total of 5942 Stage IA LUAD patients were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier methods and log-rank tests were used to compare the differences in OS. A nomogram constructed based on the Cox regression was evaluated by Concordance index (C index), calibration curve, decision curve analysis (DCA) and area under curve (AUC). And 136 patients were recruited from Shandong Province Hospital for external validation. Results Cox analysis regression indicated that 12 factors, such as Diagnosis to Treatment Interval (DTI) and Income Level, were independent prognostic factors and were included to establish the nomogram. The C-index of our novel model was 0.702, 0.724 and 0.872 in the training, internal and external validation cohorts, respectively. The 3-year and 5-year survival AUCs and calibration curves showed excellent agreement in each cohort. Some new factors in the SEER database, including DTI and Income Level, were firstly confirmed as independent prognostic factors of Stage IA LUAD patients. The distribution of these factors in the T1a, T1b, and T1c subgroups differed and had different effects on survival. Conclusion We summarized 12 factors that affect prognosis and constructed a nomogram to predict OS of Stage IA LUAD patients who underwent operation. For the first time, new SEER database parameters, including DTI and Income Level, were proved to be survival-related.
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Affiliation(s)
- Jiahao Li
- Institute of Oncology, Shandong Provincial Hospital, Shandong University, Jinan, PR China
| | - Yadong Wang
- Institute of Oncology, Shandong Provincial Hospital, Shandong University, Jinan, PR China
| | - Yong Liu
- Institute of Oncology, Shandong Provincial Hospital, Shandong University, Jinan, PR China
| | - Qiang Liu
- Institute of Oncology, Shandong Provincial Hospital, Shandong University, Jinan, PR China
| | - Hongchang Shen
- Institute of Oncology, Shandong Provincial Hospital, Shandong University, Jinan, PR China
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, PR China
| | - Xiaoyang Ren
- Department of Thoracic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, PR China
| | - Jiajun Du
- Institute of Oncology, Shandong Provincial Hospital, Shandong University, Jinan, PR China
- Department of Thoracic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, PR China
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Bertolaccini L, Mohamed S, Diotti C, Uslenghi C, Cara A, Chiari M, Casiraghi M, Spaggiari L. Differences in selected postoperative outcomes between simple and complex segmentectomies for lung cancer: A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107101. [PMID: 37778194 DOI: 10.1016/j.ejso.2023.107101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/14/2023] [Accepted: 09/26/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND This systematic review and meta-analysis aimed to synthesize the evidence on the preoperative characteristics, operative outcomes, and postoperative complications of simple and complex segmentectomy for lung cancer. METHODS A systematic review of EMBASE (through Ovid), MEDLINE (via PubMed), and Cochrane CENTRAL (January 1990 - January 2023) was done. We included studies to compare simple versus complex segmentectomies for lung cancer in terms of characteristics and operative and postoperative outcomes. RESULTS There was a statistically significant difference regarding higher operative time in favor of simple segmentectomies (Mean Difference, MD = 15.76, 95% Confidence Interval, CI: 2.46 - 29.07, p = 0.02). The incidence of postoperative complications did not change between the two groups (Risk Ratio, RR = 0.86, 95% CI: 0.66 - 1.13, p = 0.27). There were no significant differences regarding postoperative length of hospital stay between simple or complex segmentectomies (MD = -0.02, 95% CI: 0.56 - 0.51, p = 0.93). CONCLUSIONS Simple and complex segmentectomies have comparable postoperative outcomes; in particular, postoperative complication rates and length of hospital stay were similar. Complex segmentectomies were associated with a longer operative time.
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Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Shehab Mohamed
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Cristina Diotti
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Clarissa Uslenghi
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Andrea Cara
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Matteo Chiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Monica Casiraghi
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Li Z, He Z, Xu W, Wang J, Zhu Q, Chen L, Wu W. Segmentectomy versus lobectomy for deep clinical T1a-bN0M0 non-small cell lung cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106946. [PMID: 37286427 DOI: 10.1016/j.ejso.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/22/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Whether segmentectomy could yield similar oncological outcomes with lobectomy for cT1a-bN0M0 non-small cell lung cancer (NSCLC) in the deep lung parenchyma remained unclear. This study aimed to compare the long-term prognosis of segmentectomy and lobectomy for deep NSCLC. MATERIALS AND METHODS We retrospectively screened cT1a-bN0M0 NSCLC patients who underwent segmentectomy or lobectomy between 2012 and 2019. The 3D multiplanar reconstruction software was used to determine the tumor location. Log-rank test, Cox hazard proportional regression, and propensity score matching analyses were adopted for prognostic evaluation. RESULTS In total, 321 patients with segmentectomy and 239 subjects undergoing lobectomy with a median follow-up time of 48.2 months remained. All the patients had a R0 resection, and no 30-day or 90-day mortality was observed. The 5-year overall survival and disease-free survival were 99.0% and 96.6% for patients undergoing segmentectomy. No significant survival differences existed between segmentectomy and lobectomy after adjusting other factors (disease-free survival, DFS: HR = 1.20, 95%CI: 0.49-2.99, P = 0.688; overall survival, OS: HR = 1.09, 95%CI: 0.30-3.95, P = 0.892). After propensity score matching, patients with segmentectomy (n = 128) had a similar OS (P = 0.870) and DFS (P = 0.900) with those receiving lobectomy (n = 128). To further evaluate the outcomes of segmentectomy for deep lung cancer, 557 peripheral lung cancer patients who underwent segmentectomy at the same period were taken as the reference. As expected, segmentectomy for deep lesions achieved equivalent OS (P = 0.610) and DFS (P = 0.580) with the peripheral lesions. CONCLUSIONS Segmentectomy could achieve comparable long-term outcomes with lobectomy for deep cT1a-bN0M0 NSCLC with careful preoperative design and 3D navigation.
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Affiliation(s)
- Zhihua Li
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhicheng He
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wenzheng Xu
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Wang
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Quan Zhu
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Liang Chen
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Department of Thoracic Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, China.
| | - Weibing Wu
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Xiao Z, Zhang M, Liu Z, Wang X, Liu Z, Zhang Z. Distance between tumor and bronchial resection margin is an independent predictor of recurrence-free survival and overall survival in primary endobronchial neoplasm. J Cancer Res Clin Oncol 2023; 149:11171-11180. [PMID: 37351623 DOI: 10.1007/s00432-023-04917-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/23/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND The distance between tumor and bronchial resection margin (DBTM) had no clear standard in lung cancer surgery. We aimed to select the optimal cut-off value to provide a standard for surgery of the patients with primary endobronchial neoplasm. METHODS We retrospectively analyzed patients with primary endobronchial neoplasm who underwent surgical resection between 2005 and 2012. The receiver operating characteristic curves and the Youden index were used to calculate the optimal cut-off value of the DBTM. Propensity score matching was applied to reduce selection bias. Survival was assessed with Kaplan-Meier analysis, log-rank test and Cox proportional hazards model. RESULTS A total of 1048 patients comprised in the study cohort and 1.7 cm was determined the optimal cut-off value, including 531 grouped in DBTM ≤ 1.7 cm and 517 grouped in DBTM > 1.7 cm. Before propensity score matching, the 5-year recurrence-free survival was 38.7% in DBTM ≤ 1.7 cm group and 67.1% in DBTM > 1.7 cm (hazard ratio 0.48, P < 0.001), while the 5-year overall survival was 30.1% and 50.7%, respectively (hazard ratio 0.64, P < 0.001). After propensity score matching, the 5-year recurrence-free survival was 38.8% in DBTM ≤ 1.7 cm group and 66.1% in DBTM > 1.7 cm (hazard ratio 0.51, P < 0.001), while the 5-year overall survival was 34.7% and 50%, respectively (hazard ratio 0.81, P = 0.012). Multivariable cox model showed that the DBTM was an independent predictor for recurrence-free survival (hazard ratio 0.51, P = 0.001) and overall survival (hazard ratio 0.84, P = 0.026). CONCLUSIONS The DBTM was an independent predictor for outcomes in primary endobronchial neoplasm, and patients with the DBTM ≤ 1.7 cm should actively receive adjuvant therapy after surgery. The distance between tumor and bronchial resection margin (DBTM), the distance between the most proximal border of the macroscopic tumor and bronchial resection margin was measured by pathologist in the fresh specimens before formalin fixation. The DBTM less than 1.7cm had higher recurrence-free survival and overall survival and was an independent prognostic factor for patients with primary endobronchial neoplasm.
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Affiliation(s)
- Zengtuan Xiao
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Huanhu West Rd, Hexi District, Tianjin, China
- Department of Immunology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Mengzhe Zhang
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Huanhu West Rd, Hexi District, Tianjin, China
| | - Zuo Liu
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Huanhu West Rd, Hexi District, Tianjin, China
| | - Xiaofei Wang
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Huanhu West Rd, Hexi District, Tianjin, China
| | - Zhe Liu
- Department of Immunology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Zhenfa Zhang
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Huanhu West Rd, Hexi District, Tianjin, China.
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Li Z, Xu W, Wang J, Zhu Q, Wu W, Chen L. Three-Dimensional Guided Cone-Shaped Segmentectomy Versus Lobectomy for Small-sized Non-Small Cell Lung Cancer in the Middle Third of the Lung Field. Ann Surg Oncol 2023; 30:6684-6692. [PMID: 37378847 DOI: 10.1245/s10434-023-13772-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/02/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Segmentectomy has been recommended for peripheral small-sized non-small cell lung cancer (NSCLC). This study aimed to evaluate whether three dimensionally (3D) guided cone-shaped segmentectomy can achieve long-term outcomes comparable with lobectomy for small-sized NSCLC in the middle third of the lung parenchyma. METHODS This study retrospectively screened patients with small NSCLC (≤2 cm) who underwent segmentectomy or lobectomy between January 2012 and June 2019. Tumor location was determined by 3D multiplanar reconstruction. The cone-shaped segmentectomy was performed with the guidance of 3D computed tomographic bronchography and angiography. The log-rank test, Cox hazard proportional regression, and propensity score-matching analyses were adopted for prognostic evaluation. RESULTS After screening, 278 patients with segmentectomy and 174 subjects undergoing lobectomy were selected. All the patients had R0 resection, and no 30- or 90-day mortality was observed. The median follow-up time was 47.3 months. The 5-year overall survival (OS) was 99.6 %, and the disease-free survival (DFS) was 97.5 % for the patients undergoing segmentectomy. After propensity score-matching, the patients with segmentectomy (n = 112) had an OS (P = 0.530) and a DFS (P = 0.390) similar to those of the patients who underwent lobectomy (n = 112). The multivariable Cox regression analysis indicated no significant survival differences between segmentectomy and lobectomy [DFS: hazard ratio, 0.56 (95 % confidence interval (CI) 0.16-1.97, P = 0.369); OS: HR, 0.35 (95 % CI 0.06-2.06, P = 0.245)] after adjustment for other factors. Further analysis showed that segmentectomy achieved comparable OS (P = 0.540) and DFS (P = 0.930) for NSCLC in the middle-third and peripheral lung parenchyma (n = 454). CONCLUSIONS For selected NSCLCs size 2 cm or smaller in the middle third of the lung field, 3D-guided cone-shaped segmentectomy was able to achieve long-term outcomes comparable with lobectomy.
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Affiliation(s)
- Zhihua Li
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Wenzheng Xu
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Jun Wang
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Quan Zhu
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Weibing Wu
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
| | - Liang Chen
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
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Isaka T, Nagashima T, Adachi H, Narimatsu H, Murakami K, Shigefuku S, Kikunishi N, Shigeta N, Watabe K, Kudo Y, Miyata Y, Okada M, Ikeda N, Ito H. Wedge resection vs. segmentectomy for lung cancer measuring ≤ 2 cm with consolidation tumor ratio > 0.25. Front Oncol 2023; 13:1253414. [PMID: 37700837 PMCID: PMC10493869 DOI: 10.3389/fonc.2023.1253414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/15/2023] [Indexed: 09/14/2023] Open
Abstract
Objectives We aimed to clarify the differences in prognosis between wedge resection and segmentectomy performed for cN0 non-small cell lung cancer (NSCLC) measuring ≤ 2 cm, with consolidation tumor ratio (CTR) > 0.25. Methods This multicenter study included 570 patients with cN0 NSCLC (tumor size ≤ 2 cm, CTR > 0.25) who underwent wedge resection (n = 244) and segmentectomy (n = 326) between January 2010 and December 2018. After propensity score matching (PSM, 1:1 method), 182 patients were matched for clinical characteristics (age, sex, laterality, smoking index, tumor size, CTR, carcinoembryonic antigen value, positron-emission tomography-documented maximum standardized uptake value, clinical stage, and tumor disappearance rate) and intergroup comparison of disease-free survival (DFS) and overall survival (OS). Using Gray's test, an intergroup comparison of the cumulative incidence of lung cancer-specific mortality was performed. Results After PSM, similar DFS (5-year DFS, 79.9% vs. 87.1%, p = 0.103) and OS (5-year OS, 88.7% vs. 88.9%, p = 0.719) rates were observed in the wedge resection and segmentectomy groups. We observed no significant intergroup differences in lung cancer-specific mortality (5-year cumulative incidence: 4.6% vs. 3.5%; p = 0.235). Subgroup analysis revealed no specific subgroup demonstrating improved DFS or OS after undergoing wedge resection or segmentectomy. Conclusion DFS, OS, and lung cancer-specific mortality were comparable between wedge resection and segmentectomy of cN0 NSCLC-tumor size ≤ 2 cm and CTR > 0.25. Large-scale prospective clinical trials are warranted to compare the prognoses of wedge resection and segmentectomy for these tumors.
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Affiliation(s)
- Tetsuya Isaka
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Takuya Nagashima
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Hiroyuki Adachi
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Hiroto Narimatsu
- Department of Genetic Medicine, Kanagawa Cancer Center, Yokohama, Japan
- Cancer Prevention and Cancer Control Division, Kanagawa Cancer Center Research Institute, Yokohama, Japan
| | - Kotaro Murakami
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | | | | | - Naoko Shigeta
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Kozue Watabe
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Yujin Kudo
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yoshihiro Miyata
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
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Gioutsos K, Hayoz YJ, Dorn P. Clinical and Oncological Outcomes after Uniportal Anatomical Segmentectomy for Stage IA Non-Small Cell Lung Cancer. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1064. [PMID: 37374269 DOI: 10.3390/medicina59061064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/24/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: The existing literature comparing sublobar and lobar resection in the treatment of stage IA lung cancer highlights the trend and overall need for further evaluation of minimally invasive, parenchymal-sparing techniques. The role of uniportal minimally invasive segmentectomy in the oncological therapy of early-stage non-small cell lung cancer (NSCLC) remains controversial. The aim of this study was to evaluate the clinical and midterm oncological outcomes of patients who underwent uniportal video-assisted anatomical segmentectomy for pathological stage IA lung cancer. Materials and Methods: We retrospectively analyzed all patients with pathological stage IA lung cancer (8th edition UICC) who underwent uniportal minimally invasive anatomical segmentectomy at our institution from January 2015 to December 2018. Results: 85 patients, 54 of whom were men, were included. The median length of hospital stay was 3 days (1.-3. IQR 3-5), whereas 30-day morbidity was 15.3% (13 patients), and the in-hospital mortality rate was 1.2% (1 patient). The 3-year overall survival rate was 87.9% for the total population. It was 90.5% in the IA1 group, 93.3% in the IA2 group, and 70.1% in the IA3 group, respectively. Conclusions: There were satisfactory short-term clinical outcomes with low 30-day morbidity and mortality and promising midterm oncological survival results following uniportal minimally invasive anatomical segmentectomy for pathological stage IA non-small cell lung cancer.
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Affiliation(s)
- Konstantinos Gioutsos
- Department of Thoracic Surgery, Inselspital, University Hospital of Bern, 3010 Bern, Switzerland
| | - Yves J Hayoz
- Department of Thoracic Surgery, Inselspital, University Hospital of Bern, 3010 Bern, Switzerland
| | - Patrick Dorn
- Department of Thoracic Surgery, Inselspital, University Hospital of Bern, 3010 Bern, Switzerland
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Lee BE, Altorki N. Sub-Lobar Resection: The New Standard of Care for Early-Stage Lung Cancer. Cancers (Basel) 2023; 15:2914. [PMID: 37296877 PMCID: PMC10251869 DOI: 10.3390/cancers15112914] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
The Lung Cancer Study Group previously established lobectomy as the standard of care for treatment of clinical T1N0 NSCLC. Advances in imaging technology and refinements in staging have prompted a re-investigation to determine the non-inferiority of sub-lobar resections to lobectomies. Two recent randomized studies, JCOG 0802 and CALGB 140503, are reviewed here in the context of LCSG 0821. The studies confirm non-inferiority for sub-lobar resection (wedge or segmentectomy) compared to lobectomy for peripheral T1N0 NSCLC less than or equal to 2 cm. Sub-lobar resection should therefore be considered the new standard of care in this sub-set of patients with NSCLC.
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Affiliation(s)
| | - Nasser Altorki
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Suite M404, Weill Cornell Medicine of Cornell University, 525 East 68th Street, New York, NY 10065, USA
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Smoking Habit and Respiratory Function Predict Patients' Outcome after Surgery for Lung Cancer, Irrespective of Histotype and Disease Stage. J Clin Med 2023; 12:jcm12041561. [PMID: 36836096 PMCID: PMC9967492 DOI: 10.3390/jcm12041561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/05/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Growing evidence suggests that sublobar resections offer more favorable outcomes than lobectomy in early-stage lung cancer surgery. However, a percentage of cases that cannot be ignored develops disease recurrence irrespective of the surgery performed with curative intent. The goal of this work is thus to compare different surgical approaches, namely, lobectomy and segmentectomy (typical and atypical) to derive prognostic and predictive markers. PATIENTS AND METHODS Here we analyzed a cohort of 153 NSCLC patients in clinical stage TNM I who underwent pulmonary resection surgery with a mediastinal hilar lymphadenectomy from January 2017 to December 2021, with an average follow-up of 25.5 months. Partition analysis was also applied to the dataset to detect outcome predictors. RESULTS The results of this work showed similar OS between lobectomy and typical and atypical segmentectomy for patients with stage I NSCLC. In contrast, lobectomy was associated with a significant improvement in DFS compared with typical segmentectomy in stage IA, while in stage IB and overall, the two treatments were similar. Atypical segmentectomy showed the worst performance, especially in 3-year DFS. Quite unexpectedly, outcome predictor ranking analysis suggests a prominent role of smoking habits and respiratory function, irrespective of the tumor histotype and the patient's gender. CONCLUSIONS Although the limited follow-up interval cannot allow conclusive remarks about prognosis, the results of this study suggest that both lung volumes and the degree of emphysema-related parenchymal damage are the strongest predictors of poor survival in lung cancer patients. Overall, these data point out that greater attention should be addressed to the therapeutic intervention for co-existing respiratory diseases to obtain optimal control of early lung cancer.
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Wang H, Yang D, Lv Y, Lin J, Wang H. Operative versus Nonoperative Treatment in Patients with Advanced Non-Small-Cell Lung Cancer: Recommended for Surgery. Can Respir J 2023; 2023:4119541. [PMID: 36687390 PMCID: PMC9851779 DOI: 10.1155/2023/4119541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/20/2022] [Accepted: 12/30/2022] [Indexed: 01/14/2023] Open
Abstract
Background There is currently limited evidence for a correlation between the recommended operation and overall survival (OS) in patients with advanced non-small-cell lung cancer (NSCLC). Methods NSCLC patients with stages III and IV, recommended for operation, were identified in the US National Cancer Institute Surveillance, Epidemiology, and End Results database (SEER).We used propensity score matching (PSM) and multivariable Cox proportional hazards regression to ensure the robustness of our findings. The cumulative rates of death were compared between patients with and without recommended operations using the Kaplan-Meier curves. Results Operation was recommended for 3331 patients but was not performed in 912 (27.4%) patients (then on-operative group). After PSM, 553 pairs matched. Compared to the nonoperative group, the hazard ratios (HRs) in the operative group were 0.46 (95% CI 0.23-0.95 and p=0.037) in stage IIIA and 0.54 (95% CI 0.42-0.68 and p < 0.001) in stage IVA. However, in stages IIIB, IIIC, and IVB, the recommended operative group was not associated with better OS. The OS was not different in stage IIIA-N2, stage IVA-N1, and stage IVA-N3 patients between groups (p=0.28, p=0.14, and p=0.79, respectively). Moreover, the recommended operative group had better OS than the nonoperative group in stage IIIA-N0 (p=0.00085), stage IIIA-N1 (p=0.009), stage IVA-N0 (p < 0.001), and stage IVA-N2 (p=0.034). Conclusion Compared to the nonoperative group, recommended operation improved survival in NSCLC patients with stage IIIA-N0, stage IIIA-N1, stage IVA-N0, and stage IVA-N2. However, in stages IIIA-N2, IIIB, IIIC, IVA-N1, IVA-N3, and IVB, recommended operation did not lead to significantly improved survival time.
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Affiliation(s)
- Hui Wang
- Department of Clinical Laboratory, The Fourth Medical Centre, Chinese PLA General Hospital, No. 51 Fucheng Road, Beijing 100037, China
| | - Di Yang
- Department of Orthopedics Surgery, Chinese PLA General Hospital, No. 51 Fucheng Road, Beijing 100037, China
- Army Medical University NCO School, 450 Zhongshan Xi Lu, Shijiazhuang 050083, Hebei, China
| | - Yan Lv
- Department of Respiratory and Critical Care Medicine, The Fourth Medical Centre, Chinese PLA General Hospital, No. 51 Fucheng Road, Beijing 100037, China
| | - Jing Lin
- Department of Clinical Laboratory, The Fourth Medical Centre, Chinese PLA General Hospital, No. 51 Fucheng Road, Beijing 100037, China
| | - Haibin Wang
- Department of Clinical Laboratory, The Fourth Medical Centre, Chinese PLA General Hospital, No. 51 Fucheng Road, Beijing 100037, China
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Kamigaichi A, Mimae T, Tsubokawa N, Miyata Y, Adachi H, Shimada Y, Ito H, Ikeda N, Okada M. Wedge resection is an acceptable treatment option for radiologically low-grade lung cancer with solid predominance. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 36:6978240. [PMID: 36802259 PMCID: PMC9931075 DOI: 10.1093/icvts/ivac285] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/23/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES This study aimed to determine the clinical characteristics for predicting low-grade cancer in radiologically solid predominant non-small-cell lung cancer (NSCLC) and compare the survival outcomes of wedge resection with those of anatomical resection for patients with and without these characteristics. METHODS Consecutive patients with clinical stages IA1-IA2 NSCLC showing radiologically solid predominance ≤2 cm at 3 institutions were retrospectively evaluated. Low-grade cancer was defined as the absence of nodal involvement and blood vessel, lymphatic and pleural invasion. The predictive criteria for low-grade cancer were established by multivariable analysis. The prognosis of wedge resection was compared with that of anatomical resection for patients who met the criteria, using the propensity score-matched analysis. RESULTS Among 669 patients, multivariable analysis showed that ground-glass opacity (GGO) (P < 0.001) on thin-section computed tomography and an increased maximum standardized uptake value on 18-fluoro-2-deoxyglucose positron emission tomography/computed tomography (P < 0.001) were independent predictors of low-grade cancer. The predictive criteria were defined as GGO presence and maximum standardized uptake value ≤1.1 (specificity: 97.8%, sensitivity: 21.4%). In the propensity score-matched pairs (n = 189), overall survival (P = 0.41) and relapse-free survival (P = 0.18) were not significantly different between patients who underwent wedge resection and anatomical resection among those who fulfilled the criteria. CONCLUSIONS The radiologic criteria for GGO and a low maximum standardized uptake value could predict low-grade cancer, even in solid-dominant NSCLC sized ≤2 cm. Wedge resection could be an acceptable surgical option for patients with radiologically predicted indolent NSCLC showing a solid-dominant appearance.
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Affiliation(s)
| | - Takahiro Mimae
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | | | - Yoshihiro Miyata
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Hiroyuki Adachi
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | | | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Morihito Okada
- Corresponding author. Department of Surgical Oncology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan. Tel: +81-82-257-5869; fax: +81-82-256-7109; e-mail: (M. Okada)
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Adequate Number of Lymph Nodes Sampled May Determine Appropriate Surgical Modality for Early-Stage NSCLC: A Population-Based Real-World Study. Clin Lung Cancer 2022; 24:e141-e151. [PMID: 36639280 DOI: 10.1016/j.cllc.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND The standard surgical procedure for ≤ 2 cm non-small cell lung cancer (NSCLC), including the number of lymph nodes sampled (nLN) and surgical modality, remains controversial. This study was designed to determine the optimal cohort in which sublobectomy could be an alternative to lobectomy. MATERIALS (OR PATIENTS) AND METHODS Patients from 1998 to 2017 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The optimal cutoff value of nLN was identified using a restrictive cubic spline graph (RCS). Kaplan-Meier analysis was used to determine cancer-specific survival (CSS). The COX proportional hazard regression model was used to identify the influence of clinical and demographic variables on survival, and propensity score matching (PSM) was used to balance differences in baseline characteristics. Finally, we used an external cohort from a single-center medical institution to verify the conclusions drawn from the SEER database. RESULTS A total of 6150 patients were included. The sublobectomy subgroup included segmentectomy (308, 5.0%) and wedge resection (1611, 26.2%). The cutoff value for nLN was 7. In the nLN ≥7 subgroup of the PSM cohort, the CSS of segmentectomy and wedge resection was close to that of the lobectomy subgroup (P = .12), whereas in the nLN <7 subgroup, the CSS of the lobectomy subgroup was significantly higher than that of the sublobectomy with P < .001). Surgical methods, nLN, age, sex, and differentiated grade were independent predictors of CSS. External cohort validation: A total of 1106 patients from the Affiliated Jinhua Hospital of Zhejiang University School of Medicine between 2013 and 2020 were included. The grouping criteria were consistent with the SEER database. In the nLN≥7 subgroup, sublobectomy had a survival outcome similar to that of lobectomy (P = .81). CONCLUSION Sublobectomy and nLN < 7 were strongly associated with poorer CSS for early-stage NSCLC. On the premise of nLN ≥ 7, sublobectomy could provide similar survival outcomes to lobectomy for these patients.
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Xu B, Ye Z, Zhu L, Xu C, Lu M, Wang Q, Yao W, Zhu Z. Development and validation of a nomogram for predicting survival time and making treatment decisions for clinical stage IA NSCLC based on the SEER database. Front Med (Lausanne) 2022; 9:972879. [PMID: 36619647 PMCID: PMC9811385 DOI: 10.3389/fmed.2022.972879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
Background The aim of this study was to establish and validate a nomogram model for accurate prediction of patients' survival with T1aN0M0 none small cell lung cancer (NSCLC). Methods The patients, diagnosed with the stage IA NSCLC from 2004-2015, were identified from the Surveillance, Epidemiology and End Results (SEER) database. The variables with a P-value < 0.05 in a multivariate Cox regression were selected to establish the nomogram. The discriminative ability of the model was evaluated by the concordance index (C-index). The proximity of the nomogram prediction to the actual risk was depicted by a calibration plot. The clinical usefulness was estimated by the decision curve analysis (DCA). Survival curves were made with Kaplan-Meier method and compared by Log-Rank test. Results Eight variables, including treatment, age, sex, race, marriage, tumor size, histology, and grade were selected to develop the nomogram model by univariate and multivariate cox regression. The C-index was 0.704 (95% CI, 0.694-0.714) in the training set and 0.713 (95% CI, 0.697-0.728) in the test set, which performed significantly better than 8th edition AJCC TNM stage system (0.550, 95% CI, 0.408-0.683, P < 0.001). The calibration curve showed that the prediction ability of 3-years and 5-years survival rate demonstrated a high degree of agreement between the nomogram model and the actual observation. The DCA curves also proved that the nomogram-assisted decisions could improve patient outcomes. Conclusion We established and validated a prognostic nomogram to predict 3-years and 5-years overall survival in stage IA NSCLC.
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Affiliation(s)
- Bingchen Xu
- State Key Laboratory of Oncology in South China, Department of Thoracic Surgery, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ziming Ye
- State Key Laboratory of Oncology in South China, Department of Thoracic Surgery, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lianxin Zhu
- Medical College of Nanchang University, Nanchang, China,Queen Mary University of London, London, United Kingdom
| | - Chunwei Xu
- Department of Medical Oncology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Mingjian Lu
- Department of Radiology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Qian Wang
- Department of Respiratory Medicine, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China,*Correspondence: Qian Wang,
| | - Wang Yao
- Department of Interventional Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China,Wang Yao,
| | - Zhihua Zhu
- State Key Laboratory of Oncology in South China, Department of Thoracic Surgery, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China,Zhihua Zhu,
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Ding H, Song N, Zhang P, Jiang G, Wang H. Wedge resection plus adequate lymph nodes resection is comparable to lobectomy for small-sized non-small cell lung cancer. Front Oncol 2022; 12:1022904. [PMID: 36439429 PMCID: PMC9691685 DOI: 10.3389/fonc.2022.1022904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/12/2022] [Indexed: 01/19/2025] Open
Abstract
OBJECTIVES The study investigated whether wedge resection plus adequate lymph nodes resection conferred comparable survival to lobectomy for node-negative non-small cell lung cancer (NSCLC) ≤2 cm. METHODS The Surveillance, Epidemiology, and End Results database was used to identify patients diagnosed with node-negative NSCLC ≤2 cm and underwent wedge resection or lobectomy (2004-2015). Patients were stratified by the procedure (wedge resection, lobectomy) and the size of NSCLC (≤1 cm, 1-2 cm). We assessed survival between patients undergoing wedge resection and lobectomy. The optimal number of lymph nodes resected which made those two procedures comparable was explored by using Kaplan-Meier analysis and Cox regression analysis. Propensity score matching was performed to minimize the effect of confounding factors. RESULTS 7893 patients with lobectomy and 2536 patients with wedge resection were identified. Wedge resection was associated with worse survival either in the ≤1 cm or 1-2 cm NSCLC before and after matching. For lesions 1-2 cm and receiving lobectomy, more lymph nodes resected conferred statistically significant increase on survival and six nodes were optimal. For lesions ≤1 cm and receiving lobectomy, lymph nodes resection had no impact on survival. Wedge resection and lobectomy were comparable when one or more nodes for lesions ≤1 cm and six or more nodes for lesions 1-2 cm were resected. CONCLUSIONS Wedge resection was inferior to lobectomy for NSCLC ≤1 cm and 1-2 cm. Wedge resection plus adequate lymph nodes resection was comparable to lobectomy.
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Affiliation(s)
| | | | | | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haifeng Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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Kawaguchi T, Yoshikawa D, Nakai T, Ohbayashi C, Sawabata N. Outcome of Resected Lung Cancers with Subcentimeter Solid Component on Computed Tomography. Thorac Cardiovasc Surg 2022; 71:214-221. [PMID: 36323327 DOI: 10.1055/s-0042-1758072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background Although the opportunity to treat subcentimeter lung cancers has increased, the optimal surgical methods remain unclear. We performed a retrospective study to examine the clinical outcome of subcentimeter lung cancers.
Patients and Methods In total, 118 patients who underwent curative resection for subcentimeter lung cancer from January 2005 to December 2013 were analyzed. Multivariate Cox proportional hazards models were used to calculate the hazard ratio to identify independent predictors of recurrence-free survival (RFS) and overall survival (OS).
Results Anatomical resections were performed for 64 patients (59 lobectomies and 5 segmentectomies) and wedge resections for 54 patients. Recurrence developed in six patients who had consolidation-predominant tumors (consolidation/tumor [C/T] ratio of >0.5) and underwent wedge resections. The first recurrence patterns were regional recurrences in three patients, both regional and distant in one, and distant in two. Seventeen patients died of other causes. The multivariate analysis revealed that the C/T ratio was the independent predictor of RFS (p = 0.008) and OS (p = 0.011).
Conclusion Patients with subcentimeter lung cancer rarely developed recurrence. The C/T ratio was the independent prognostic factor, and all relapsed patients received wedge resections. Even for subcentimeter lung cancers, we should select the extent of pulmonary resection after thoroughly considering whether wedge resection (less invasiveness) is a reasonable alternative to anatomical resection (superior oncologic efficacy) considering the C/T ratio of the lesion.
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Affiliation(s)
- Takeshi Kawaguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Nara, Japan
| | - Daiki Yoshikawa
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Nara, Japan
| | - Tokiko Nakai
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Chiho Ohbayashi
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Noriyoshi Sawabata
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Nara, Japan
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Chang CH, Chang YC. Comparing the Therapeutic Efficacies of Lung Cancer: Network Meta-Analysis Approaches. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14324. [PMID: 36361201 PMCID: PMC9657796 DOI: 10.3390/ijerph192114324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In recent years, reduction of nuclear power generation and the use of coal-fired power for filling the power supply gap might have increased the risk of lung cancer. This study aims to explore the most effective treatment for different stages of lung cancer patients. METHODS We searched databases to investigate the treatment efficacy of lung cancer. The network meta-analysis was used to explore the top three effective therapeutic strategies among all collected treatment methodologies. RESULTS A total of 124 studies were collected from 115 articles with 171,757 participants in total. The results of network meta-analyses showed that the best top three treatments: (1) in response rate, for advanced lung cancer were Targeted + Targeted, Chemo + Immuno, and Targeted + Other Therapy with cumulative probabilities 82.9, 80.8, and 69.3%, respectively; for non-advanced lung cancer were Chemoradio + Targeted, Chemoradi + Immuno, and Chemoradio + Other Therapy with cumulative probabilities 69.0, 67.8, and 60.7%, respectively; (2) in disease-free control rate, for advanced lung cancer were Targeted + Others, Chemo + Immuno, and Targeted + Targeted Therapy with cumulative probabilities 93.4, 91.5, and 59.4%, respectively; for non-advanced lung cancer were Chemo + Surgery, Chemoradio + Targeted, and Surgery Therapy with cumulative probabilities 80.1, 71.5, and 43.1%, respectively. CONCLUSION The therapeutic strategies with the best effectiveness will be different depending on the stage of lung cancer patients.
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Affiliation(s)
- Chuan-Hsin Chang
- Research Center for Chinese Herbal Medicine, Graduate Institute of Healthy Industry Technology, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 33303, Taiwan
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, New Taipei City 25137, Taiwan
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Chen Z, Chen W, Huang R, Chen D, Li Z, Qi X, Sun L, Lin L, Zhang Z. Comprehensive analysis of clinical prognosis and CLIC1 immune invasion in lung adenocarcinoma. Medicine (Baltimore) 2022; 101:e30760. [PMID: 36181109 PMCID: PMC9524863 DOI: 10.1097/md.0000000000030760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Chloride intracellular channel 1 (CLIC1) plays an important role in the process of cell epithelial transport, and is also involved in tumor invasion and metastasis. Due to its aberrant expression in cancer, the mechanism of action of CLIC1 in cancer has been carefully studied. In this study, we tried to investigate the relationship between CLIC1 and lung adenocarcinoma (LUAD). METHODS The RNA-sequencing data and clinical information of CLIC1 in lung adenocarcinoma were collected from the the cancer genome altas (TCGA) database and analyzed with R software. Paired t test and Mann-Whitney U test were used to detect differences between LUAD tissue and adjacent normal tissue, and the pROC software package performed reactive oxygen species (ROC) curves to detect cutoff values for CLIC1. The expression of CLIC1 in normal human tissues was extracted from the human protein altas (HPA) database, and analyzed clinical proteomic tumor analysis consortium by using UALCAN programme. The relationship between CLIC1 and LUAD was explored by enrichment analysis using gene oncology and Kyoto encyclopedia of genes and genomes. The tumor immunity estimation resource (TIMER) and integrated repository portal for tumor-immune system interactions (TISIDB) databases were used to analyze the correlation between CLIC1 and LUAD immune cell infiltration. Survival analysis of CLIC1 in LUAD was assessed by the PrognoScan database. RESULTS Compared with normal tissues, both mRNA (messenger Ribose Nucleic Acid) and protein of CLIC1 were overexpressed in LUAD, which was associated with shorter overall survial (OS). In addition, CLIC1 expression was in connection with some clinical-pathological characteristics like tumor node metatasis stages and lymph node metastases. What's more, CLIC1 may play a role in the immune infiltration of LUAD. CONCLUSION In summary, CLIC1 is up-regulated in LUAD and is associated with tumor metastasis, tumor staging, and OS. It may be regarded as a novel marker for prognostic judgement in LUAD.
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Affiliation(s)
- Zhiqiang Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wenmin Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ruilan Huang
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Daman Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhuoyao Li
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiangjun Qi
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lingling Sun
- The First Affiliated Hospital to Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lizhu Lin
- The First Affiliated Hospital to Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Zhiquan Zhang and Lizhu Lin, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Jichang Road, Guangzhou, Guangdong, 510405, China (e-mail: and )
| | - Zhiquan Zhang
- The First Affiliated Hospital to Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Zhiquan Zhang and Lizhu Lin, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Jichang Road, Guangzhou, Guangdong, 510405, China (e-mail: and )
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Yang WY, He Y, Hu Q, Peng M, Zhang Z, Xie S, Yu F. Survival benefit of thermal ablation therapy for patients with stage II-III non-small cell lung cancer: A propensity-matched analysis. Front Oncol 2022; 12:984932. [PMID: 36081544 PMCID: PMC9446892 DOI: 10.3389/fonc.2022.984932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/03/2022] [Indexed: 11/15/2022] Open
Abstract
Background Thermal ablation (TA) is considered a safe alternative to surgical resection for the treatment of non-small cell lung cancer (NSCLC). While previous studies have shown that TA is beneficial for stage I NSCLC patients, however, few have reported on TA efficacy in patients with stage II-III NSCLC. The current study investigated the impact of TA on the overall survival (OS) and cancer-specific survival (CSS) of patients with stage II-III NSCLC. Methods Data on patients with stage II-III NSCLC who did not undergo surgical resection between 2004 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM), Kaplan-Meier survival curves, and Cox regression were used for statistical analyses. Results A total of 57,959 stage II-III NSCLC patients who did not undergo surgical resection were included in this study, 261 of whom received TA. Overall, TA was associated with a longer OS (p = 0.035) and CSS (p = 0.005) than non-ablation. After 1:3 PSM, 252 patients receiving TA and 732 patients not receiving ablation were enrolled in the matched cohort. The OS (p = 0.047) and CSS (p = 0.029) remained higher in the TA group than in the non-ablation group after PSM. Cox regression analysis showed that age, sex, primary tumor site, pathological type, tumor size, radiotherapy, chemotherapy, and thermal ablation were independently associated with OS and CSS (p <0.05). Subgroup analysis found that the advantages of TA were more pronounced among individuals ≥70 years of age, with tumor size ≤3.0 cm, or who did not receive radiotherapy. Conclusion TA could be an effective alternative treatment for stage II-III NSCLC patients unsuitable for surgical resection, particularly those ≥70 years of age, with tumor size ≤3.0 cm, or who have not received radiotherapy.
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Affiliation(s)
- Wei-Yu Yang
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
- Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yu He
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
- Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Qikang Hu
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
- Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Muyun Peng
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
- Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhe Zhang
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
- Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shouzhi Xie
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
- Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Fenglei Yu
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
- Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China
- *Correspondence: Fenglei Yu,
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Shao S, Song G, Wang Y, Yi T, Li S, Chen F, Li Y, Liu X, Han B, Liu Y. Selection of the surgical approach for patients with cStage IA lung squamous cell carcinoma: A population-based propensity score matching analysis. Front Oncol 2022; 12:946800. [PMID: 36081555 PMCID: PMC9445983 DOI: 10.3389/fonc.2022.946800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThis study aimed to conduct a comparative analysis of the survival rates after segmentectomy, wedge resection, or lobectomy in patients with cStage IA lung squamous cell carcinoma (SCC).MethodsWe enrolled 4,316 patients who had cStage IA lung SCC from the Surveillance, Epidemiology, and End Results (SEER) database. The Cox proportional hazards model was conducted to recognize the potential risk factors for overall survival (OS) and lung cancer-specific survival (LCSS). To eliminate potential biases of included patients, the propensity score matching (PSM) method was used. OS and LCSS rates were compared among three groups stratified according to tumor size.ResultsKaplan–Meier analyses revealed no statistical differences in the rates of OS and LCSS between wedge resection (WR) and segmentectomy (SG) groups for patients who had cStage IA cancers. In patients with tumors ≤ 1 cm, LCSS favored lobectomy (Lob) compared to segmentectomy (SG), but a similar survival rate was obtained for wedge resection (WR) and lobectomy (Lob). For patients with tumors sized 1.1 to 2 cm, lobectomy had improved OS and LCSS rates compared to the segmentectomy or wedge resection groups, with the exception of a similar OS rate for lobectomy and segmentectomy. For tumors sized 2.1 to 3 cm, lobectomy had a higher rate of OS or LCSS than wedge resection or segmentectomy, except that lobectomy conferred a similar LCSS rate compared to segmentectomy. Multivariable analyses showed that patients aged ≥75 and tumor sizes of >2 to ≤3 cm were potential risk factors for OS and LCSS, while lobectomy and first malignant primary indicator were considered protective factors. The Cox proportional analysis also confirmed that male patients aged ≥65 to <75 were independent prognostic factors that are indicative of a worse OS rate.ConclusionsThe tumor size can influence the surgical procedure recommended for individuals with cStage IA lung SCC. For patients with tumors ≤1 cm, lobectomy is the recommended approach, and wedge resection or segmentectomy might be an alternative for those who cannot tolerate lobectomy if adequate surgical margin is achievable and enough nodes are sampled. For tumors >1 to ≤3 cm, lobectomy showed better survival outcomes than sublobar resection. Our findings require further validation by randomized controlled trial (RCT) or other evidence.
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Hao B, Li F, Wan X, Pan S, Li D, Song C, Li N, Geng Q. Squamous cell carcinoma predicts worse prognosis than adenocarcinoma in stage IA lung cancer patients: A population-based propensity score matching analysis. Front Surg 2022; 9:944032. [PMID: 36090323 PMCID: PMC9461700 DOI: 10.3389/fsurg.2022.944032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background Although numerous studies have reported the association between histological types and the prognosis of IA non-small-cell lung cancer (NSCLC) patients, few studies have deeply investigated the impact of pathology on the outcome of NSCLC patients. In this study, we comprehensively explored whether the type of histology influenced the outcome of IA-stage NSCLC patients. Methods The study population was obtained from the Surveillance, Epidemiology, and End Results (SEER) program, which is supported by the National Cancer Institute of the United States. To avoid potential bias, the method of propensity score matching (PSM) was used to obtain a balanced cohort for further analysis. Results The results from univariate and multivariate regression models showed that lung squamous cell carcinoma (LSQCC) patients were at a significantly greater risk of undergoing shorter overall survival (OS) and lung cancer–specific survival (LCSS). After PSM analysis, LSQCC was still closely associated with a reduction in OS and LCSS. All of these suggested that the histological type was an independent prognostic factor for OS and LCSS. Conclusion Our study demonstrated that squamous cell carcinoma predicted worse OS and LCSS in IA-stage NSCLC patients compared with lung adenocarcinoma (LUAD). We suggest that the outcomes of LSQCC and LUAD are very different and that the two histological types should be differently analyzed.
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Affiliation(s)
- Bo Hao
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Fang Li
- Department of Ophthalmology, The First Hospital of Wuhan, Wuhan, China
| | - Xiaoxia Wan
- Department of Cardiothoracic Surgery, Ezhou Central Hospital, Ezhou, China
| | - Shize Pan
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Donghang Li
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Congkuan Song
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ning Li
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qing Geng
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
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Lei X, Zhou N, Zhang H, Li T, Ren F, Zhang B, Li X, Zu L, Song Z, Xu S. Lobe-Specific Analysis of Sublobar Lung Resection for NSCLC Patients with Tumors ≤ 2 cm. Cancers (Basel) 2022; 14:cancers14133265. [PMID: 35805037 PMCID: PMC9265391 DOI: 10.3390/cancers14133265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/25/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022] Open
Abstract
Simple Summary With the increase of the use of sublobar resection, the optimal strategy for early-stage NSCLC patients is essential. Previous studies showed tumors in different lobes are associated with different prognoses after radiotherapy and immunotherapy, inspiring us that each lobes had a different prognosis. Thus, we investigated the best surgical procedure for sublobar resection in patients with NSCLC ≤ 2 cm based on a lobe-specific analysis using propensity score matching. The results of this study will make it easier for surgeons to screen out patients with NSCLC ≤ 2 cm for segmentectomy or wedge resection, although this must be validated in larger cohorts. Abstract (1) Background: Sublobar resection can be used as an alternative surgical strategy for early-stage non-small-cell lung cancer (NSCLC) patients. However, the choice between wedge resection and segmentectomy remains contentious. In this study, we investigated the optimal surgical procedure for sublobar resection in patients with NSCLC ≤ 2 cm with a lobe-specific analysis; (2) Methods: Data for patients with T1N0M0 with a diameter of ≤2 cm who had undergone sublobar resection were retrieved. Propensity score matching (PSM) was used to reduce the inherent bias, and the Kaplan–Meier method and log-rank tests were used to assess the differences in survival; (3) Results: A total of 1882 patients were identified after the PSM. Patients with NSCLC ≤ 2 cm who had undergone segmentectomy showed better survival than those who had undergone wedge resection. However, when NSCLC was ≤1 cm, there was no significant difference in OS between the two groups. This demonstrated an OS advantage of segmentectomy over wedge resection for patients with NSCLC tumors of 1–2 cm (p = 0.024). Further analysis indicated that this survival benefit was only observed in patients with right upper NSCLC of 1–2 cm, but not with NSCLC in the other four lobes; (4) Conclusions: Segmentectomy showed a greater survival benefit than wedge resection only in patients with NSCLC of 1–2 cm, particularly those with primary tumors in the right upper lobe. Therefore, we propose a lobe-specific sublobar resection strategy for early-stage NSCLC patients (tumors of 1–2 cm) who cannot tolerate lobectomy.
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Affiliation(s)
- Xi Lei
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Ning Zhou
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Hao Zhang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Tong Li
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Fan Ren
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Bo Zhang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xiongfei Li
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Lingling Zu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Zuoqing Song
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Song Xu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
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Pei Q, Luo Y, Chen Y, Li J, Xie D, Ye T. Artificial intelligence in clinical applications for lung cancer: diagnosis, treatment and prognosis. Clin Chem Lab Med 2022; 60:1974-1983. [PMID: 35771735 DOI: 10.1515/cclm-2022-0291] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/17/2022] [Indexed: 12/12/2022]
Abstract
Artificial Intelligence (AI) is a branch of computer science that includes research in robotics, language recognition, image recognition, natural language processing, and expert systems. AI is poised to change medical practice, and oncology is not an exception to this trend. As the matter of fact, lung cancer has the highest morbidity and mortality worldwide. The leading cause is the complexity of associating early pulmonary nodules with neoplastic changes and numerous factors leading to strenuous treatment choice and poor prognosis. AI can effectively enhance the diagnostic efficiency of lung cancer while providing optimal treatment and evaluating prognosis, thereby reducing mortality. This review seeks to provide an overview of AI relevant to all the fields of lung cancer. We define the core concepts of AI and cover the basics of the functioning of natural language processing, image recognition, human-computer interaction and machine learning. We also discuss the most recent breakthroughs in AI technologies and their clinical application regarding diagnosis, treatment, and prognosis in lung cancer. Finally, we highlight the future challenges of AI in lung cancer and its impact on medical practice.
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Affiliation(s)
- Qin Pei
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P.R. China
| | - Yanan Luo
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P.R. China
| | - Yiyu Chen
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P.R. China
| | - Jingyuan Li
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P.R. China
| | - Dan Xie
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P.R. China
| | - Ting Ye
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P.R. China
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Wei G, Chen Y. Editorial: Real-world surgical treatment of thoracic cancer in the era of precision medicine. Front Surg 2022; 9:928131. [PMID: 35846964 PMCID: PMC9278016 DOI: 10.3389/fsurg.2022.928131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/14/2022] [Indexed: 11/24/2022] Open
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Soh J, Toyooka S, Shintani Y, Okami J, Ito H, Ohtsuka T, Mori T, Watanabe SI, Asamura H, Chida M, Endo S, Nakanishi R, Kadokura M, Suzuki H, Miyaoka E, Yoshino I, Date H. Limited resection for stage IA radiologically invasive lung cancer: a real-world nationwide database study. Eur J Cardiothorac Surg 2022; 62:6604739. [PMID: 35678584 DOI: 10.1093/ejcts/ezac342] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/12/2022] [Accepted: 06/03/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Radiologically invasive non-small cell lung cancer, defined as consolidation size to maximum tumour diameter ratio of over 0.5, is associated with pathological invasiveness and worse prognosis. However, there are no real-world, nationwide database studies on limited resections that consider radiological invasiveness. This study aimed to investigate the prognostic validity of limited resection, such as segmentectomy and wedge resection, in cStage IA (TNM 8th edition) radiologically invasive lung cancer. METHODS We conducted a retrospective analysis of patients who underwent complete resection according to the Japanese Joint Committee of Lung Cancer Registry Database. The relationship between surgical procedures and prognosis was examined using stratification by cT factor and radiological invasiveness. RESULTS Among the 5,692 patients enrolled, lobectomy, segmentectomy, and wedge resection were performed in 4,323 (80.0%), 657 (11.5%), and 712 (12.5%) patients, respectively. Multivariable analysis with or without propensity score matching indicated that older age, poor performance status, and wedge resection were significantly associated with worse prognosis and that patients who underwent segmentectomy showed an equivalent prognosis to those who underwent lobectomy. Subset analyses revealed that segmentectomy showed an equivalent prognosis to lobectomy in patients with cT1b or less, but not in those with cT1c, especially for non-pure radiological invasive cT1c; 5-year overall survival rates were 91.4% vs 90.4% in cT1b with non-pure radiological invasiveness, and 80.0% vs 83.8% in cT1b with pure radiological invasiveness, respectively. CONCLUSIONS Segmentectomy can be an alternative to lobectomy in patients with radiologically invasive lung cancer with cT1b or less, but not in those with cT1c.
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Affiliation(s)
- Junichi Soh
- Department of Thoracic, Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.,Division of Thoracic Surgery, Department of Surgery, Kindai University, Faculty of Medicine, Osaka-Sayama, Japan
| | - Shinichi Toyooka
- Department of Thoracic, Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Jiro Okami
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Osaka, Japan
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Takashi Ohtsuka
- Division of Thoracic Surgery, Department of Surgery, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Takeshi Mori
- Department of Thoracic Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Kumamoto, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Hisao Asamura
- Division of General Thoracic Surgery, Department of Surgery, School of Medicine, Keio University, Minato-ku, Tokyo, Japan
| | - Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University, Shimotsuga-gun, Tochigi, Japan
| | - Shunsuke Endo
- Department of Thoracic Surgery, Jichi Medical School, Shimotsuke, Tochigi, Japan
| | - Ryoichi Nakanishi
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Mitsutaka Kadokura
- Respiratory Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Hidemi Suzuki
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Etsuo Miyaoka
- Department of Mathematics, Tokyo University of Science, Shinjuku-ku, Tokyo, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University, Kyoto, Kyoto, Japan
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Godfrey CM, Marmor HN, Lambright ES, Grogan EL. Minimally Invasive and Sublobar Resections for Lung Cancer. Surg Clin North Am 2022; 102:483-492. [PMID: 35671768 PMCID: PMC10089622 DOI: 10.1016/j.suc.2022.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Current guidelines for non-small cell lung cancer (NSCLC) recommend segmentectomy over lobectomy for patients with poor pulmonary reserve or for peripheral nodules less than or equal to 2 cm with adenocarcinoma in situ histology, greater than 50% ground-glass opacity on computed tomography, or radiologic doubling time greater than or equal to 400 days. However, emerging data suggest oncologic equivalence of segmentectomy to lobectomy for less than or equal to 2 cm, peripheral stage IA NSCLC regardless of histologic type or radiographic findings.
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Affiliation(s)
- Caroline M Godfrey
- Department of Thoracic Surgery, Vanderbilt University Medical Center, 1161 21st Avenue South, D-4311 MCN, Nashville, TN 37232, USA
| | - Hannah N Marmor
- Department of Thoracic Surgery, Vanderbilt University Medical Center, 609 Oxford House, 1313 21st Avenue South, Nashville, TN 37232, USA
| | - Eric S Lambright
- Department of Thoracic Surgery, Vanderbilt University Medical Center, 609 Oxford House, 1313 21st Avenue South, Nashville, TN 37232, USA
| | - Eric L Grogan
- Section of Thoracic Surgery, Tennessee Valley VA Healthcare System, 1310 24th Ave S. Nashville, TN, 37212, USA; Department of Thoracic Surgery, Vanderbilt University Medical Center, 609 Oxford House, 1313 21st Avenue South, Nashville, TN 37232, USA.
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Detterbeck FC, Mase VJ, Li AX, Kumbasar U, Bade BC, Park HS, Decker RH, Madoff DC, Woodard GA, Brandt WS, Blasberg JD. A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation-part 2: systematic review of evidence regarding resection extent in generally healthy patients. J Thorac Dis 2022; 14:2357-2386. [PMID: 35813747 PMCID: PMC9264068 DOI: 10.21037/jtd-21-1824] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/05/2022] [Indexed: 11/06/2022]
Abstract
Background Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options (lobectomy, segmentectomy, wedge, stereotactic body radiotherapy, thermal ablation), weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making. Methods A PubMed systematic review from 2000-2021 of outcomes after lobectomy, segmentectomy and wedge resection in generally healthy patients is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons with at least some adjustment for confounders. The analysis involved careful assessment, including characteristics of patients, settings, residual confounding etc. to expose degrees of uncertainty and applicability to individual patients. Evidence is summarized that provides an at-a-glance overall impression as well as the ability to delve into layers of details of the patients, settings and treatments involved. Results In healthy patients there is no short-term benefit to sublobar resection vs. lobectomy in randomized and non-randomized comparisons. A detriment in long-term outcomes is demonstrated by adjusted non-randomized comparisons, more marked for wedge than segmentectomy. Quality-of-life data is confounded by the use of video-assisted approaches; evidence suggests the approach has more impact than the resection extent. Differences in pulmonary function tests by resection extent are not clinically meaningful in healthy patients, especially for multi-segmentectomy vs. lobectomy. The margin distance is associated with the risk of recurrence. Conclusions A systematic, comprehensive summary of evidence regarding resection extent in healthy patients with attention to aspects of applicability, uncertainty and effect modifiers provides a foundation on which to build a framework for individualized clinical decision-making.
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Affiliation(s)
- Frank C. Detterbeck
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Vincent J. Mase
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew X. Li
- Department of General Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Ulas Kumbasar
- Department of Thoracic Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Brett C. Bade
- Department of Pulmonary Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Henry S. Park
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Roy H. Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - David C. Madoff
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Gavitt A. Woodard
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Whitney S. Brandt
- Department of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Justin D. Blasberg
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
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Bade BC, Blasberg JD, Mase VJ, Kumbasar U, Li AX, Park HS, Decker RH, Madoff DC, Brandt WS, Woodard GA, Detterbeck FC. A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation-part 3: systematic review of evidence regarding surgery in compromised patients or specific tumors. J Thorac Dis 2022; 14:2387-2411. [PMID: 35813753 PMCID: PMC9264070 DOI: 10.21037/jtd-21-1825] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/09/2022] [Indexed: 11/06/2022]
Abstract
Background Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options [lobectomy, segmentectomy, wedge, stereotactic body radiotherapy (SBRT), thermal ablation], weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making. Methods A PubMed systematic review from 2000-2021 of outcomes after lobectomy, segmentectomy and wedge resection in older patients, patients with limited pulmonary reserve and favorable tumors is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons (NRCs) with adjustment for confounders. The analysis involved careful assessment, including characteristics of patients, settings, residual confounding etc. to expose degrees of uncertainty and applicability to individual patients. Evidence is summarized that provides an at-a-glance overall impression as well as the ability to delve into layers of details of the patients, settings and treatments involved. Results In older patients, perioperative mortality is minimally altered by resection extent and only slightly affected by increasing age; sublobar resection may slightly decrease morbidity. Long-term outcomes are worse after lesser resection; the difference is slightly attenuated with increasing age. Reported short-term outcomes are quite acceptable in (selected) patients with severely limited pulmonary reserve, not clearly altered by resection extent but substantially improved by a minimally invasive approach. Quality-of-life (QOL) and impact on pulmonary function hasn't been well studied, but there appears to be little difference by resection extent in older or compromised patients. Patient selection is paramount but not well defined. Ground-glass and screen-detected tumors exhibit favorable long-term outcomes regardless of resection extent; however solid tumors <1 cm are not a reliably favorable group. Conclusions A systematic, comprehensive summary of evidence regarding resection extent in compromised patients and favorable tumors with attention to aspects of applicability, uncertainty and effect modifiers provides a foundation for a framework for individualized decision-making.
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Affiliation(s)
- Brett C. Bade
- Department of Pulmonary Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Justin D. Blasberg
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Vincent J. Mase
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Ulas Kumbasar
- Department of Thoracic Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Andrew X. Li
- Department of General Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Henry S. Park
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Roy H. Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - David C. Madoff
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Whitney S. Brandt
- Department of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Gavitt A. Woodard
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Frank C. Detterbeck
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
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Song W, Hou Y, Zhang J, Zhou Q. Comparison of outcomes following lobectomy, segmentectomy, and wedge resection based on pathological subtyping in patients with pN0 invasive lung adenocarcinoma ≤1 cm. Cancer Med 2022; 11:4784-4795. [PMID: 35570370 PMCID: PMC9761055 DOI: 10.1002/cam4.4807] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/11/2022] [Accepted: 04/26/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE We sought to analyze the prognostic significance of lung adenocarcinoma classification for patients with pathological N0 (pN0) lung invasive adenocarcinomas ≤1 cm who underwent surgical resection and investigate the optimal surgical procedure according to lung adenocarcinoma classification. METHODS A total of 1409 consecutive patients with resected pN0 invasive lung adenocarcinoma ≤1 cm were retrospectively reviewed. Comprehensive histologic subtyping was determined according to IASLC/ATS/ERS lung adenocarcinoma classification. Recurrence-free survival (RFS) and overall survival (OS) were compared between patients receiving lobectomy, segmentectomy, and wedge resection. RESULTS RFS and OS favored lobectomy and segmentectomy compared with wedge resection in the entire cohort. Five-year RFS rates were 100%, 98.2%, 97.3%, 77.8%, and 82.8% (p < 0.001) for lepidic, acinar, papillary, micropapillary, and solid predominant subtypes, while 5-year OS rates were 100%, 98.4%, 98.1%, 88.9%, and 96.5% (p < 0.001), respectively. Multivariate analysis showed that adenocarcinoma predominant pathological subtype and CT appearance were independent prognostic factors for RFS, and surgical procedure was independent factor for both RFS and OS. Specifically, wedge resection showed worse survival compared with anatomical resection in patients with papillary, micropapillary, or solid predominant subtypes, whereas in patients with lepidic predominant and acinar predominant subtypes, wedge resection showed comparable RFS with anatomical resection. CONCLUSIONS Anatomical resection showed better survival for patients with pN0 invasive lung adenocarcinoma ≤1 cm. For patients with invasive adenocarcinoma ≤1 cm in whom anatomical resection is not feasible, wedge resection could provide similar oncological effect when tumor is lepidic predominant or acinar predominant.
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Affiliation(s)
- Weijian Song
- Department of Thoracic Surgery, Shanghai Lung Cancer Center, Shanghai Chest HospitalShanghai Jiaotong University, School of MedicineShanghaiChina
| | - Yucheng Hou
- Department of Thoracic Surgery, Shanghai Lung Cancer Center, Shanghai Chest HospitalShanghai Jiaotong University, School of MedicineShanghaiChina
| | - Jianfeng Zhang
- Department of Thoracic Surgery, Shanghai Lung Cancer Center, Shanghai Chest HospitalShanghai Jiaotong University, School of MedicineShanghaiChina
| | - Qianjun Zhou
- Department of Thoracic Surgery, Shanghai Lung Cancer Center, Shanghai Chest HospitalShanghai Jiaotong University, School of MedicineShanghaiChina
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Wang L, Ge L, You S, Liu Y, Ren Y. Lobectomy versus segmentectomy in patients with stage T (> 2 cm and ≤ 3 cm) N0M0 non-small cell lung cancer: a propensity score matching study. J Cardiothorac Surg 2022; 17:110. [PMID: 35545793 PMCID: PMC9092858 DOI: 10.1186/s13019-022-01867-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/29/2022] [Indexed: 11/24/2022] Open
Abstract
Background The safety and effectiveness of lung segmentectomy in patients with early non-small cell lung cancer (NSCLC) remains controversial. We have therefore reviewed the clinicopathologic characteristics and survival outcomes of patients treated with lobectomy or segmentectomy for early T (> 2 and ≤ 3 cm) N0M0 NSCLC. Methods We obtained data from the Surveillance, Epidemiology, and End Results database for patients who underwent lobectomy or segmentectomy between 2004 and 2015. To reduce bias and imbalances between the treatment groups, propensity score matching analysis was performed. We used Kaplan–Meier curves to estimate overall survival (OS) and lung cancer-specific survival (LCSS). We conducted univariate and multivariate Cox proportional hazards regression analyses to identify independent prognostic factors for OS and cancer-specific survival, and applied the Cox proportional hazards model to create forest plots. Results Before matching, both univariate and multivariate Cox regression analyses revealed that patients who underwent lobectomy exhibited better OS (P < 0.001) and LCSS (P = 0.001) than patients who underwent segmentectomy. However, after matching, survival differences between the groups were not significant; OS (P = 0.434) and LCSS (P = 0.593). Regression analyses revealed that age and tumor grade were independent predictors of OS and LCSS (P < 0.05). Conclusions Patients with stage T (> 2 and ≤ 3 cm) N0M0 NSCLC undergoing segmentectomy can obtain OS and LCSS similar to those obtained with lobectomy. Further studies are required considering the solid component effects and pathologic tumor types regarding segmentectomies. Additional long-term survival and outcome analyses should be conducted with larger cohorts.
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Affiliation(s)
- Linlin Wang
- Department of Thoracic Surgery, Shenyang Chest Hospital and Tenth People's Hospital, No. 11, Beihai Street, Dadong District, Shenyang, 110044, Liaoning, People's Republic of China
| | - Lihui Ge
- Department of Health Management, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, HePing District, Shenyang, 110004, Liaoning, People's Republic of China
| | - Sibo You
- Department of Thoracic Surgery, Shenyang Chest Hospital and Tenth People's Hospital, No. 11, Beihai Street, Dadong District, Shenyang, 110044, Liaoning, People's Republic of China
| | - Yongyu Liu
- Department of Thoracic Surgery, Shenyang Chest Hospital and Tenth People's Hospital, No. 11, Beihai Street, Dadong District, Shenyang, 110044, Liaoning, People's Republic of China
| | - Yi Ren
- Department of Thoracic Surgery, Shenyang Chest Hospital and Tenth People's Hospital, No. 11, Beihai Street, Dadong District, Shenyang, 110044, Liaoning, People's Republic of China.
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Wang Z, Wu Y, Huang J, Xie F, Gong L, Li S. Surgical strategies for patients with second primary non-small cell lung cancer lesions 2 cm or less in diameter. Surg Today 2022; 52:1358-1372. [PMID: 35522343 DOI: 10.1007/s00595-022-02464-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The wide application of low-dose computed tomography (CT) has led to an increase in the detection of small lung cancer lesions. Moreover, surgical recommendations for second primary non-small cell lung cancer (NSCLC) lesions ≤ 2 cm are obscure. This study compares the efficacy of wedge resection, lobectomy, and segmentectomy for small second primary NSCLC lesions. METHODS The cohort was established based on the SEER database. Univariate and multivariate cox regression analysis, least absolute shrinkage and selection operator (LASSO) regression, and restricted mean survival time (RMST) values were applied to identify prognostic factors. We used the Kaplan-Meier method to plot the survival curves of the different subgroups according to propensity score matching (PSM) analysis to then compare the therapeutic efficacy of the surgical procedures. RESULTS A total of 568 patients were enrolled in this study. Age, sex, grade, and lymph node ratio were selected as independent prognostic factors (p < 0.05). No significant differences were observed in survival probabilities among the groups of patients who underwent segmentectomy, wedge resection, or lobectomy (p > 0.05). We also established a nomogram model based on the four prognostic factors to guide clinical treatment. CONCLUSIONS Based on the findings of our study, segmentectomy was more appropriate than lobectomy for patients with a second primary NSCLC lesion ≤ 2 cm in diameter. The evidence to support other recommendations is insufficient.
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Affiliation(s)
- Zhile Wang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.,Peking Union Medical College, Eight-Year MD Program, Chinese Academy of Medical Sciences, Beijing, China
| | - Yijun Wu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.,Peking Union Medical College, Eight-Year MD Program, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Huang
- Peking Union Medical College, Eight-Year MD Program, Chinese Academy of Medical Sciences, Beijing, China
| | - Fucun Xie
- Peking Union Medical College, Eight-Year MD Program, Chinese Academy of Medical Sciences, Beijing, China
| | - Liang Gong
- Peking Union Medical College, Eight-Year MD Program, Chinese Academy of Medical Sciences, Beijing, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
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Ohtaki Y, Yajima T, Nagashima T, Nakazawa S, Kawatani N, Obayashi K, Yazawa T, Shimizu K, Shirabe K. Complex vs. simple segmentectomy: comparing surgical outcomes in the left upper division. Gan To Kagaku Ryoho 2022; 70:962-970. [DOI: 10.1007/s11748-022-01816-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/30/2022] [Indexed: 11/28/2022]
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Long-term survival analysis of sublobar resection versus lobectomy for older patients with early-stage pulmonary carcinoid tumour: a database-based propensity score-matched study. Aging Clin Exp Res 2022; 34:1925-1934. [PMID: 35347580 DOI: 10.1007/s40520-022-02112-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/09/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND The optimal extent of surgery for older patients with early-stage pulmonary carcinoid tumour (PC) remains controversial. AIMS To compare prognostic differences between sublobar resection versus lobectomy in older patients with early-stage PC. METHODS The SEER database was searched for stage T1N0M0 PC patients aged ≥ 65 years who underwent lobectomy or sublobar resection from 2000 to 2017. Propensity score matching (PSM) was used to determine intergroup covariate differences. Kaplan-Meier curves and the log-rank test were used for intergroup comparison of overall survival (OS). A Cox proportional hazard model was used to evaluate independent risk factors. RESULTS Among 1023 participants, 650 and 373 underwent lobectomy and sublobar resection, respectively. Before PSM, the 5- and 10-year OS in the sublobar resection group were lower than that of the lobectomy group (5-year OS 84.12% vs. 91.16%; 10-year OS 57.43% vs. 64.77%; p = 0.014); after PSM, no significant prognostic difference existed between lobectomy and sublobar resection (5-year OS 88.17% vs. 89.23%; 10-year OS 58.32% vs. 62.75%; p = 0.811). Subgroup analysis included tumour size, age, number of lymph nodes examined and histological type, and showed no statistically significant survival differences between the lobectomy and sublobar resection groups. Multivariable Cox analysis indicated that age ≥ 77 years, male sex, inadequate lymph node assessment (< 7), and atypical carcinoid were associated with reduced OS. CONCLUSION Sublobar resection showed a similar long-term survival rate for early-stage PC patients aged ≥ 65 years as with lobectomy, thereby providing a basis for the selection of surgical methods for PC.
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Peng L, Deng HY, Liu ZK, Shang QW, Huang KL, Zheng QQ, Li W, Wang Y. Wedge Resection vs. Stereotactic Body Radiation Therapy for Clinical Stage I Non-small Cell Lung Cancer: A Systematic Review and Meta-Analysis. Front Surg 2022; 9:850276. [PMID: 35372460 PMCID: PMC8967956 DOI: 10.3389/fsurg.2022.850276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/21/2022] [Indexed: 12/25/2022] Open
Abstract
BackgroundWhether wedge resection or stereotactic body radiation therapy (SBRT) has better effectiveness in treatment of clinical stage I non-small cell lung cancer (NSCLC) patients remains unclear. Here we conducted the first meta-analysis to directly compare the survival outcomes of clinical stage I NSCLCs treated with wedge resection and SBRT.MethodsWe systematically searched studies from PubMed, Embase, and Corchrane Library up to October 1, 2021. Data for analysis mainly included overall survival (OS) and disease-free survival (DFS), which were obtained directly from the text results or calculated from the Kaplan–Meier survival curve. We used the standard random-effect model test (DerSimonian and Laird method) to analyze the pooled hazard ratios (HRs) and 95% confidence intervals (CIs). The Q-test and I2-test were used to assess heterogeneity. The stability of pooled HRs was examined by sensitivity analysis.ResultsSix retrospective studies with a total of 11,813 clinical stage I NSCLCs who received wedge resection or SBRT were included. The results showed that patients receiving wedge resection had a significantly better OS (HR = 1.20, 95% CI = [1.07, 1.34], P = 0.002) than those with SBRT, but no significant difference of DFS (HR 1.53, 95% CI = [0.83–2.83], P = 0.17) was observed. There was no significant heterogeneity during our analysis, but there may be potential publication bias among these studies.ConclusionsOur meta-analysis showed that clinical stage I NSCLCs treated with wedge resection had superior OS than those treated with SBRT. However, more prospective clinical trials should be well-designed to evaluate the optimal treatment modality of early-stage NSCLCs.
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Affiliation(s)
- Lei Peng
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, China
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Han-Yu Deng
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, China
- *Correspondence: Han-Yu Deng
| | - Zhen-Kun Liu
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Qian-Wen Shang
- Department of Clinical Lab, Chongqing University Cancer Hospital and Chongqing Cancer Hospital, Chongqing, China
| | - Kai-Li Huang
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Qiang-Qiang Zheng
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Wen Li
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Yun Wang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
- Yun Wang
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Tekneci AK, Ozgur GK, Akcam TI, Cagirici U. Bibliometric Analysis of 50 Most Cited Articles Comparing Lobectomy with Sublobar Resection. Thorac Cardiovasc Surg 2022; 71:307-316. [PMID: 35135027 DOI: 10.1055/s-0041-1740557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Recent years have seen an increase in the number of studies of the sublobar resection approach in non-small cell lung cancer (NSCLC) surgery. The purpose of this bibliometric analysis is to assess the significance and impact of articles comparing sublobar resection and lobectomy in NSCLC surgery. MATERIAL AND METHODS The Web of Science database was searched to identify studies comparing sublobar resection and lobectomy in NSCLC surgery published between 2005 and 2020 (accessed: September 11, 2020). The 50 most cited articles were analyzed by years, countries, authors, authors' affiliations, journals, journals' addresses, and impact factors. RESULTS The bibliometric analysis revealed that the most cited article had 443 citations, while the total number of citations of all articles was 2,820. The mean number of citations, in turn, was 56.4 ± 75.62 (1-443) times. The highest number of publications over the past 15 years was in 2016, with eight articles. The Annals of Thoracic Surgery (n = 10; 20%) had the highest number of publications on the list. The articles included in the present study were mostly (n = 35, 70%) published in U.S. journals. While multiple subject matters and analyses were presented by many studies, survival was the topic of greatest interest, with 37 (74%) studies. CONCLUSION This study revealed that interest in studies comparing sublobar resection with lobectomy has increased in recent years. It also presents both quantitative and qualitative analyses of the most cited articles in the literature on this topic. Therefore, it can serve as a guide for researchers.
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Affiliation(s)
| | - Gizem Kececi Ozgur
- Department of Thoracic Surgery, Ege University School of Medicine, İzmir, Turkey
| | - Tevfik Ilker Akcam
- Department of Thoracic Surgery, Ege University School of Medicine, İzmir, Turkey
| | - Ufuk Cagirici
- Department of Thoracic Surgery, Ege University School of Medicine, İzmir, Turkey
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Huang Z, Peng K, Hong Z, Zhang P, Kang M. Nomogram for predicting recurrence and metastasis of stage IA lung adenocarcinoma treated by video-assisted thoracoscopic surgery lobectomy. Asian J Surg 2022; 45:2691-2699. [DOI: 10.1016/j.asjsur.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/17/2021] [Accepted: 01/15/2022] [Indexed: 12/24/2022] Open
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Chen Z, Zhang Y, Yan Z, Dong J, Cai W, Ma Y, Jiang J, Dai K, Liang H, He J. Artificial intelligence assisted display in thoracic surgery: development and possibilities. J Thorac Dis 2022; 13:6994-7005. [PMID: 35070382 PMCID: PMC8743398 DOI: 10.21037/jtd-21-1240] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/02/2021] [Indexed: 12/24/2022]
Abstract
In this golden age of rapid development of artificial intelligence (AI), researchers and surgeons realized that AI could contribute to healthcare in all aspects, especially in surgery. The popularity of low-dose computed tomography (LDCT) and the improvement of the video-assisted thoracoscopic surgery (VATS) not only bring opportunities for thoracic surgery but also bring challenges on the way forward. Preoperatively localizing lung nodules precisely, intraoperatively identifying anatomical structures accurately, and avoiding complications requires a visual display of individuals’ specific anatomy for surgical simulation and assistance. With the advance of AI-assisted display technologies, including 3D reconstruction/3D printing, virtual reality (VR), augmented reality (AR), and mixed reality (MR), computer tomography (CT) imaging in thoracic surgery has been fully utilized for transforming 2D images to 3D model, which facilitates surgical teaching, planning, and simulation. AI-assisted display based on surgical videos is a new surgical application, which is still in its infancy. Notably, it has potential applications in thoracic surgery education, surgical quality evaluation, intraoperative assistance, and postoperative analysis. In this review, we illustrated the current AI-assisted display applications based on CT in thoracic surgery; focused on the emerging AI applications in thoracic surgery based on surgical videos by reviewing its relevant researches in other surgical fields and anticipate its potential development in thoracic surgery.
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Affiliation(s)
- Zhuxing Chen
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Yudong Zhang
- Department of Thoracic Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zeping Yan
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.,Guangdong Association of Thoracic Diseases, Guangzhou, China
| | - Junguo Dong
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Weipeng Cai
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Yongfu Ma
- Department of Thoracic Surgery, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jipeng Jiang
- Department of Thoracic Surgery, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Keyao Dai
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Hengrui Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
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50
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Zhang S, Lin D, Yu Y, Cao Q, Liu G, Jiang D, Wang H, Fang Y, Shen Y, Yin J, Hou Y, Shi H, Ge D, Wang Q, Tan L. Which will carry more weight when CTR > 0.5, solid component size, CTR, tumor size or SUVmax? Lung Cancer 2021; 164:14-22. [PMID: 34974221 DOI: 10.1016/j.lungcan.2021.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 12/01/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study was conducted to explore the clinical significance of the maximum standard uptake value (SUVmax) in the clinical stage IA lung adenocarcinoma with tumor size ≤ 2 cm and consolidation to tumor ratio (CTR) > 0.5. METHODS We retrospectively reviewed non-small cell lung cancer patients who underwent surgeries between January 2014 and March 2017. Clinical stage IA lung adenocarcinoma patients with tumor of size ≤ 2 cm and CTR > 0.5 were enrolled. The patients were divided into two groups: part-solid and pure-solid based on whether CTR = 1.0 or not. Nodules with any amount of solid or micropapillary components were regarded as the high-risk subtype. Time-dependent ROC curve was used to determine the best cut-off value. Finally, we analyzed the relationship between SUVmax, high-risk subtypes, node metastasis and 5-year relapse-free survival and overall survival. RESULTS Totally, 270 patients were included. The distribution of pathological subtypes (p < 0.001), SUVmax (p < 0.001), and pathological N stage (p < 0.001) were different between the two groups. Multivariable analysis indicated that SUVmax could predict high-risk subtypes in cases of part-solid nodules (p < 0.001) and both high-risk subtypes (p = 0.022) and node metastasis (p < 0.001) in cases of pure-solid ones. SUVmax ≥ 2.6 and SUVmax ≥ 5.1 were strongly associated with 5-year relapse-free survival (p < 0.001) and 5-year overall survival (p < 0.001) among all the patients, respectively. CONCLUSION Part-solid nodules with 0.5 < CTR < 1 and pure-solid nodules in lung adenocarcinoma show different clinicopathological characteristics, especially in SUVmax. SUVmax is significantly associated with high-risk subtypes, node metastasis, 5-year relapse-free survival and overall survival.
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Affiliation(s)
- Shaoyuan Zhang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Dong Lin
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200080, China
| | - Yangli Yu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Qiqi Cao
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Guobing Liu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Dongxian Jiang
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hao Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yong Fang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yaxing Shen
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jun Yin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yingyong Hou
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Di Ge
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
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