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2.
Ann Thorac Surg ; 2020 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-31981498

RESUMO

BACKGROUND: While lung cancer screening improves cancer-specific mortality and is recommended for high-risk patients, barriers to screening still exist. We sought to determine our institution's screening rate, an urban safety net hospital, and to identify socioeconomic barriers to lung cancer screening. METHODS: We identified 8,935 smokers aged 55-80 evaluated by a primary care physician between March 2015 and March 2017 at our institution. We randomly selected one-third of these (n=2,978) to review for eligibility using the United States Preventive Services Task Force (USPSTF) criteria for lung cancer screening. Using our institution's Lung Cancer Screening Program clinical tracking database, we identified patients who were screened from March 2015 to March 2017. We collected demographic information (race, primary language, education status, and median income) and evaluated possible associations with screening. RESULTS: Among our institution population, 99 patients meeting USPSTF screening criteria underwent a screening CT, whereas 516 eligible patients were not screened, making our institution's estimated screening rate 16.1%. Comparing the unscreened population to those who received screening at our institution, the unscreened population was significantly older (screened median age: 63, unscreened: 66; p<0.001). African-Americans had a lower screening rate (37.6% of the screened population and 47.5% of the unscreened population; p<0.001). Unscreened patients had a lower annual household income. CONCLUSIONS: The lung cancer screening rate at our hospital is 16.1%. Unscreened patients were older, African-American, and had a lower median income. These findings highlight possible screening barriers and potential areas for targeted strategies to decrease disparities in lung cancer screening.

3.
Ann Thorac Surg ; 109(2): 337-342, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31593659

RESUMO

BACKGROUND: There is a paucity of prognostic factors for patients with stage I non-small cell lung cancer (NSCLC) undergoing operations. We investigated the prognostic role of preoperative complete blood count values in patients with stage I NSCLC patients undergoing operations. METHODS: A retrospective medical record review was performed of patients who underwent operations for stage I NSCLC between 2000 and 2015. Patients who died within 30 days of the operations were excluded. The primary end point was recurrence. Preoperative complete blood count values were analyzed, and a median value was used as the cutoff. Statistical analysis used χ2 and t tests along with univariate and multivariate analyses by Cox regression modeling. RESULTS: The study included 103 patients. A high lymphocyte count was significantly associated with recurrence (5-year recurrence-free survival [RFS] of 69.8% for high vs 95.7% for low, P = .003), as well as high platelet (5-year RFS of 72.0% for high vs 91.8% for low, P = .02). Independent prognostic factors on multivariate analysis were high lymphocyte (hazard ratio [HR], 7.27; P = .005) and platelet counts (HR, 7.49; P = .003) as well as tumor (HR, 5.40; P = .008) and treatment characteristics (HR, 4.59; P = .01). Among patients with pT1 lesions, high lymphocyte (HR, 8.41; P = .03) and high platelet counts (HR, 19.78; P = .004) remained independent prognostic factors. Neither NLR nor PLR were significantly associated with recurrence. CONCLUSIONS: In patients with pathologic stage I NSCLC undergoing surgical resection, the preoperative blood count from peripheral blood may provide prognostic value. Of significance, in patients with pT1 N0 NSCLC, high lymphocyte count and high platelet count were associated with higher recurrence.

4.
Artigo em Inglês | MEDLINE | ID: mdl-31866573

RESUMO

Social determinants of health have been associated with poor outcomes in esophageal cancer. Primary language and immigration status have not been examined in relation to esophageal cancer outcomes. This study aims to investigate the impact of these variables on stage of presentation, treatment, and outcomes of esophageal cancer patients at an urban safety-net hospital. Clinical data of patients with esophageal cancer at our institution between 2003 and 2018 were reviewed. Demographic, tumor, and treatment characteristics were obtained. Outcomes included median overall survival, stage-specific survival, and utilization of surgical and perioperative therapy. Statistical analysis was conducted using Chi-square test, Fisher's exact tests, Kaplan-Meier method, and logistic regression. There were 266 patients; 77% were male. Mean age was 63.9 years, 23.7% were immigrants, 33.5% were uninsured/Medicaid, and 16.2% were non-English speaking. Adenocarcinoma was diagnosed in 55.3% and squamous cell in 41.0%. More patients of non-Hispanic received esophagectomies when compared to those of Hispanic origin (64% vs 25%, P = 0.012). Immigrants were less likely to undergo esophagectomy compared to US-born patients (42% vs 76%, P = 0.001). Patients with adenocarcinoma were more likely than squamous cell carcinoma patients to undergo esophagectomy (odds ratio = 4.40, 95% confidence interval 1.61-12.01, P = 0.004). More commercially/privately insured patients (75%) received perioperative therapy compared to Medicaid/uninsured (54%) and Medicare (49%) patients (P = 0.030). There was no association between demographic factors and the utilization of perioperative chemoradiation for patients with operable disease. Approximately 23% of patients with operable disease were too frail or declined to undergo surgical intervention. In this small single-center study, race and primary language were not associated with median survival for patients treated for esophageal cancer. US-born patients experienced higher surgical utilization and privately insured patients were more likely to receive perioperative therapy. Many patients with operable cancer were too frail to undergo a curative surgery. Studies should expand on the relationships between social determinants of health and nonclinical services on delivery of care and survival of vulnerable populations with esophageal cancer.

5.
Artigo em Inglês | MEDLINE | ID: mdl-31691801

RESUMO

Herein, we report the case of a 35-year-old female with a trapped right lung secondary to catamenial haemothorax. Following surgical decortication, re-expansion of the lung was not observed until postoperative day 81. This delay represents a heretofore unencountered complication that should be considered in the surgical management of catamenial haemothorax due to thoracic endometriosis syndrome.

7.
Clin Exp Gastroenterol ; 12: 219-229, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31190949

RESUMO

Purpose: The incidence of esophageal adenocarcinoma (EAC) has increased by 700% in Western countries over the last 30 years. Although clinical guidelines call for endoscopic surveillance for EAC among high-risk populations, fewer than 5% of new EAC patients are under surveillance at the time of diagnosis. We studied the accuracy of combined cytopathology and MUC2 immunohistochemistry (IHC) for screening of Intestinal Metaplasia (IM), dysplasia and EAC, using specimens collected from the EsophaCap swallowable encapsulated cytology sponge from Canada and United States. Patients and methods: By comparing the EsophaCap cytological diagnosis with concurrent endoscopic biopsies performed on the same patients in 28 cases, we first built up the cytology diagnostic categories and criteria. Based on these criteria, 136 cases were evaluated by both cytology and MUC2 IHC with blinded to patient biopsy diagnosis. Results: We first set up categories and criteria for cytological diagnosis of EscophaCap samples. Based on these, we divided our evaluated cytological samples into two groups: non-IM group and IM or dysplasia or adenocarcinoma group. Using the biopsy as our gold standard to screen IM, dysplasia and EAC by combined cytology and MUC2 IHC, the sensitivity and specificity were 68% and 91%, respectively, which is in the range of clinically useful cytological screening tests such as the cervical Pap smear. Conclusions: Combined EsophaCap cytology and MUC2 IHC could be a good screening test for IM and Beyond.

8.
Ann Thorac Surg ; 108(3): 828-836, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31229485

RESUMO

BACKGROUND: The benefit of adjuvant treatment for esophageal cancer patients with positive lymph nodes after induction therapy and esophagectomy is uncertain. This in-depth multicenter study assessed the benefit of adjuvant therapy in this population. METHODS: A retrospective cohort study from 9 institutions included patients who received neoadjuvant treatment, underwent esophagectomy from 2000 to 2014, and had positive lymph nodes on pathology. Factors associated with administration of adjuvant therapy were assessed using multilevel random-intercept modeling to account for institutional variation in practice. Kaplan-Meier analyses were performed based on adjuvant treatment status. Variables associated with survival were identified using Cox proportional hazards modeling. RESULTS: The study analyzed 1082 patients with node-positive cancer after induction therapy and esophagectomy: 209 (19.3%) received adjuvant therapy and 873 (80.7%) did not. Administration of adjuvant treatment varied significantly from 3.2% to 50.0% between sites (P < .001). Accounting for institution effect, factors associated with administration of adjuvant therapy included clinically positive and negative prognostic characteristics: younger age, higher pathologic stage, pathologic grade, no neoadjuvant radiotherapy nonsmoking status, and absence of postoperative infection. Kaplan-Meier analysis showed patients receiving adjuvant therapy had a longer median survival of 2.6 years vs 2.3 years (P = .02). Cox modeling identified adjuvant treatment as independently associated with improved survival, with a 24% reduction in mortality (hazard ratio, 0.76; P = .005). CONCLUSIONS: Adjuvant therapy was associated with improved overall survival. Therefore, consideration should be given to administration of adjuvant therapy to esophageal cancer patients who have persistent node-positive disease after induction therapy and esophagectomy and are able to tolerate additional treatment.


Assuntos
Neoplasias Esofágicas/terapia , Esofagectomia/métodos , Linfonodos/patologia , Terapia Neoadjuvante , Centros Médicos Acadêmicos , Idoso , Quimiorradioterapia Adjuvante , Estudos de Coortes , Intervalo Livre de Doença , Educação Médica Continuada , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Linfonodos/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Resultado do Tratamento , Estados Unidos
9.
J Thorac Cardiovasc Surg ; 158(2): 632-641.e3, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30857819

RESUMO

OBJECTIVE: Recent industry studies have projected a deficit in cardiothoracic surgeons by 2030. Little is known about the difficulties of the job search process after cardiothoracic training. The purpose of this study is to explore the current practices of the first job hunt and contract negotiation for young cardiothoracic surgeons, and to identify the gaps in resources available to applicants. METHODS: In October 2017, a 56-question survey was e-mailed to recent (2013-2017) board-certified cardiothoracic surgeons in the United States inquiring about their experience securing their first cardiothoracic job. The survey was administered via REDCap, and responses were accepted over 3 months. RESULTS: The response rate was 12.8% (61/475). The majority of cardiothoracic program graduates (86.9%) interviewed for jobs between October and March of their final cardiothoracic training year, and 79.7% of contracts were signed before completing training. Sixty-four percent of respondents negotiated their first contract. The most influential factor in job selection was partner mentorship. Average starting pretax salary for respondents was $375,588 (±$107,265). More than half of respondents reported needing more resources and support for the identification (59%) and comparison (54.1%) of job opportunities, contract negotiation (70.5%), and salary guidelines navigation (77%). CONCLUSIONS: Little guidance exists to support the search and securing of young cardiothoracic surgeons' first employment. Resources, whether institutional or organizational, are sparse and difficult to tailor to individual needs. Given the potential ramification of early career decisions, focused support is needed to remediate the lack of preparation available to the newest generations of cardiothoracic surgeons.

10.
Tumori ; 105(4): 331-337, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30905273

RESUMO

OBJECTIVE: To determine if induction chemotherapy with concurrent high-dose radiation followed by resection is associated with improved survival in patients with nonsuperior sulcus lung cancer with chest wall invasion. METHODS: We performed a retrospective review of clinical T3 (chest wall invasion) N0/N1 patients with non-small cell lung cancer who underwent surgical resection between January 1, 1992, and January 31, 2017. Exclusion criteria included superior sulcus tumors and resection performed for palliation/recurrence. Patients undergoing induction chemoradiation followed by surgical resection were compared to those undergoing resection first or those receiving induction radiation followed by resection. Overall survival was calculated using the Kaplan-Meier method. RESULTS: Thirty-four patients were included in the analysis, with 5-year overall survival (OS) of 30%. By clinical stage, 31 (91%) were IIB (T3N0) and 3 (9%) were IIIA (T3N1). Sixteen patients (47%) received induction chemoradiation before surgery. Of the remaining 18 patients, 5 (15%) received induction radiation followed by surgery, and 13 (38%) underwent surgery as the first treatment. Three patients belonging to the group not receiving induction chemoradiation died within 30 days after surgery and were excluded from survival analysis. In the remaining 31 patients, induction chemoradiation was associated with improved 5-year OS (53% for induction chemoradiation vs 7% for others; P<0.01). Disease recurrence was evident in 9 cases, 2 (12.5%) in the induction chemoradiation group and 7 (46.6%) in the others (median disease-free time 103.0 months for induction chemoradiation group vs 8.0 months for others; P<0.01). CONCLUSION: In patients with nonsuperior sulcus lung cancer with chest wall invasion, induction chemoradiation therapy followed by resection is associated with improved OS.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/radioterapia , Parede Torácica/efeitos dos fármacos , Parede Torácica/efeitos da radiação , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/patologia , Quimiorradioterapia/métodos , Terapia Combinada/métodos , Feminino , Humanos , Quimioterapia de Indução/métodos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/radioterapia , Estadiamento de Neoplasias/métodos , Estudos Retrospectivos , Análise de Sobrevida , Parede Torácica/patologia
11.
Ann Thorac Surg ; 107(5): 1472-1479, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30605641

RESUMO

BACKGROUND: Social determinants of health affect diagnosis and delivery of care to patients with esophageal cancer. This study hypothesized that hospital safety-net burden affects presentation, treatment, and outcomes in patients with esophageal cancer. METHODS: The National Cancer Database was queried for patients with esophageal cancer (2004 to 2013). Treating facilities were categorized according to their relative burden of uninsured or Medicaid-insured patients. Hospitals with low (LBH), medium (MBH), and high (HBH) safety-net burden were compared with respect to patient demographics, disease and treatment characteristics, and survival using χ2 analysis, Kaplan-Meier survival analysis, and multivariable modeling. RESULTS: There were 56,115 patients from 1,215 facilities. HBH treated a greater proportion of racial and ethnic minorities and patients with lower socioeconomic status. Patients at HBH presented at later stages and received primary surgical therapy less often than at MBH and LBH. Survival for patients with esophageal adenocarcinoma did not differ significantly between HBH and LBH after adjusting for age, sex, race, ethnicity, income, comorbidity, stage, histologic type, tumor location, facility type, insurance status, and treatment modality (hazard ratio, 1.06; 95% confidence interval, 0.99 to 1.14; p = 0.093). HBH were associated with a higher mortality risk than LBH for patients with squamous cell carcinoma (hazard ratio, 1.11; 95% confidence interval, 1.02 to 1.20; p = 0.014). CONCLUSIONS: There is a mortality risk for patients with squamous cell carcinoma, but not for adenocarcinoma at HBH compared with LBH. Further analysis of unadjusted variables such as performance status, completion of therapy, and continuity of care, and others should be undertaken among safety-net hospitals with the goal of creating appropriate clinical pathways for care of esophageal cancer in vulnerable populations.


Assuntos
Adenocarcinoma/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Neoplasias Esofágicas/epidemiologia , Provedores de Redes de Segurança , Adenocarcinoma/diagnóstico , Adenocarcinoma/terapia , Idoso , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Terapia Combinada , Bases de Dados Factuais , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/terapia , Esofagectomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Socioeconômicos , Taxa de Sobrevida , Resultado do Tratamento
13.
Ann Thorac Surg ; 107(3): e199-e201, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30218665

RESUMO

Tumor lysis syndrome is a life-threatening complication comprising hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia attributed to release of intracellular contents. Although traditionally associated with leukemia and lymphoma after chemotherapy, it is known to occur in solid malignancies. We herein report a rare case of this syndrome after resection of bulky carcinoid tumor of the lung.


Assuntos
Tumor Carcinoide/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias , Síndrome de Lise Tumoral/etiologia , Tumor Carcinoide/diagnóstico , Diagnóstico Diferencial , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Síndrome de Lise Tumoral/diagnóstico
14.
J Thorac Dis ; 10(Suppl 28): S3376-S3377, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30505524
15.
J Thorac Dis ; 10(Suppl 28): S3392-S3397, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30505526

RESUMO

The diagnosis of lung cancer can be delayed in patients with a history of infection with pulmonary tuberculosis that present with new lesions on chest imaging, due to a high initial index of suspicion for mycobacterium tuberculosis complex rather than malignancy. This may lead to diagnosis of malignancy at a more advanced stage of the disease with subsequent increased morbidity and mortality. We reviewed the current literature to evaluate various methods of differentiating between a diagnosis of lung cancer and tuberculosis including radiography, computerized tomography (CT), positron emission tomography (PET) and various biological markers. We included only papers published in English. Based on current data, we recommend that patients established as high risk, according to the American Association of Thoracic Surgery, patients with age greater than or equal to 55 years and a smoking history of greater than or equal to 30 pack years, should be assessed with CT for underlying malignancy prior to beginning tuberculosis treatment, even in the presence of a clinical or microbiologic diagnosis of tuberculosis. In patients with equivocal CT findings, we recommend examination of tumor markers miR128, miR210, miR126 along with CEA, if these tests are at the clinician's disposal.

16.
17.
Semin Thorac Cardiovasc Surg ; 30(4): 496-497, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30359732
18.
J Thorac Dis ; 10(Suppl 8): S963-S968, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29744223

RESUMO

Venous thromboembolism (VTE), composed of deep vein thrombosis (DVT) and PE is a well-recognized cause for significant perioperative morbidity and mortality. While in orthopedic surgery and general oncology surgery there are well established guidelines regarding VTE prophylaxis, based on carefully conducted high level studies, in thoracic surgery the level of evidence and overall knowledge in the field is still lacking, The European Society of Thoracic Surgeons have established an international working group in 2016, whose task was the define contemporary best practice, coordinate research efforts and eventually define best practice guidelines. This collaboration has matured into a multi-organizational effort, with participation of the American Association for Thoracic Surgery, the International Society on Thrombosis and Haemostasis and Chinese and Japanese thoracic societies. Two major projects (International practice survey and an expert group Delphi process re best practice and VTE risk factors) have been completed so far. For 2018, the working group goals will be to establish VTE prophylaxis guidance in Thoracic Surgery.

19.
J Thorac Cardiovasc Surg ; 155(6): 2674-2681, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29534906

RESUMO

BACKGROUND: Safety net hospitals provide care mostly to low-income, uninsured, and vulnerable populations, in whom delays in cancer screening are established barriers. Socioeconomic barriers might pose important challenges to the success of a lung cancer screening program at a safety net hospital. We aimed to determine screening follow-up compliance, rates of diagnostic and treatment procedures, and the rate of cancer diagnosis in patients classified as category 4 by the Lung CT Screening Reporting and Data System (Lung-RADS 4). METHODS: We conducted a retrospective review of all patients enrolled in our multidisciplinary lung cancer screening program between March 2015 and July 2016. Demographics, smoking status, Lung-RADS score, and number of diagnostic and therapeutic interventions and cancer diagnoses were captured. RESULTS: A total of 554 patients were screened over a 16-month period. The mean patient age was 63 years (range, 47-85 years), and 60% were male. The majority (92%; 512 of 554) were classified as Lung-RADS 1 to 3, and 8% (42 of 554) were classified as Lung-RADS 4. Among the Lung-RADS 4 patients, 98% (41 of 42) completed their recommended follow-up; 29% (12 of 42) underwent a diagnostic procedure, for an overall diagnostic intervention rate of 2% (12 of 554). Eleven of these 12 patients had cancer, and 1 patient had sarcoidosis. The overall rate of surgical resection was 0.9% (5 of 554), and the rate of diagnostic intervention for noncancer diagnosis was 0.1% (1 of 554). CONCLUSIONS: Implementation of a multidisciplinary lung cancer screening program at a safety net hospital is feasible. Compliance with follow-up and interventional recommendations in Lung-RADS 4 patients was high despite anticipated social challenges. Overall diagnostic and surgical resection rates and interventions for noncancer diagnosis were low in our initial experience.


Assuntos
Detecção Precoce de Câncer , Neoplasias Pulmonares , Provedores de Redes de Segurança , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Serviços Urbanos de Saúde
20.
J Thorac Dis ; 10(1): E38-E41, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29600101

RESUMO

Head and neck cancer recurrence at the sternoclavicular junction (SCJ) in irradiated field poses a special challenge in terms of surgical planning. We herein present a case of tonsillar squamous cell cancer recurrence at the SCJ in a patient with history of tracheostomy and head and neck radiation. We describe our preoperative planning for vascular control and possible reconstruction as well as our approach for safe resection.

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