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1.
Artigo em Inglês | MEDLINE | ID: mdl-35266536

RESUMO

OBJECTIVES: This study aimed to evaluate the prognostic impact of the combination of epidermal growth factor receptor (EGFR) mutation and the presence of high-grade patterns (solid or micropapillary component) in resected stage I lung adenocarcinoma. METHODS: Patients who underwent curative resection for pathological stage I lung adenocarcinoma and EGFR mutation analysis were included in this study. The impact of the combination of EGFR mutation and the presence of >5% high-grade patterns on recurrence-free survival (RFS) was retrospectively analysed using Cox proportional hazards model and propensity score-matched analysis. RESULTS: Among the included 721 patients, EGFR mutations were positive in 380 (52.7%). In the EGFR-mutated group, cases with high-grade patterns showed poorer RFS than those without (5-year RFS, 77.7% vs 92.5%, P < 0.001), whereas there were no significant prognostic differences in the EGFR wild-type group (5-year RFS, 89.8% vs 88.2%, P = 0.807). Multivariable analyses revealed that the combination of EGFR mutations and the presence of high-grade patterns was associated with poor RFS (hazard ratio = 1.655, P = 0.035). Furthermore, EGFR mutation was associated with poor RFS in the group with high-grade patterns (hazard ratio = 2.108, P = 0.008). After propensity score matching, EGFR-mutated cases with high-grade patterns showed poorer RFS (P = 0.028). CONCLUSIONS: The combination of EGFR mutation and the presence of high-grade patterns was associated with recurrence in resected stage I lung adenocarcinoma. Histological subtypes, including minor components, should be considered when evaluating the risk of recurrence in patients with EGFR-mutated lung adenocarcinoma.

2.
JTO Clin Res Rep ; 3(2): 100279, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35199054

RESUMO

INTRODUCTION: Although several studies have investigated the prognostic significance of the radiographic appearance of stage IA lung adenocarcinoma, the prognostic impact of solid component size or consolidation-to-tumor ratio (CTR) of part-solid nodules (PSNs) still remains controversial. This study aimed to clarify the combined prognostic impact of the mentioned radiographic features of PSNs and compare it with that of pure solid nodules in the current TNM classification. METHODS: We retrospectively investigated 1014 patients with clinical stage IA (TNM eighth edition) adenocarcinoma who underwent curative resection. Overall survival (OS) and pathologic characteristics of pure solid nodules, solid-dominant PSNs (CTR > 0.5), and ground-glass opacity (GGO)-dominant PSNs (CTR ≤ 0.5) were compared according to T category. RESULTS: Patients with pure solid nodules (297 cases) had significantly shorter OS compared with those with PSNs (717 cases) (p < 0.001) but a marginal difference compared with those with solid-dominant PSNs (286 cases) (p = 0.051). No significant difference in OS was found according to T category in those with GGO-dominant PSNs (431 cases). Patients with cT1b and T1c solid-dominant PSNs had significantly worse prognosis compared with those with other PSNs and had comparable prognosis with those with cT1b pure solid nodules (p = 0.892). Higher frequency of nodal and lymphovascular involvement and pathologic upstaging was observed with T category progression in solid-dominant PSNs. CONCLUSIONS: An hierarchy of prognosis and pathologic malignant characteristics was observed according to T category in patients with solid-dominant PSNs but not in those with GGO-dominant PSNs, suggesting the importance of classifying PSNs on the basis of solid component size and CTR for accurate prognostic comparison with pure solid nodules.

3.
Surg Today ; 2022 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-35211804

RESUMO

PURPOSE: To establish the prognostic significance of C-reactive protein (CRP) and albumin in octogenarians with non-small cell lung cancer (NSCLC) based on the study of the Japanese Association for Chest Surgery (JACS 1303). METHODS: A total of 618 octogenarians with pathological stage I NSCLC, who underwent pulmonary resection, were included in the analysis. We conducted multivariable Cox regression analysis to evaluate the CRP to albumin ratio (CAR) as a potential prognostic factor. Other clinicopathological factors were also evaluated. RESULTS: The median age was 82 years. Operations included lobectomy (n = 388; 62.8%) segmentectomy (n = 95; 15%), and wedge resection (n = 135; 22%). Pathological stage IA was diagnosed in 380 (61.5%) patients. The 3-year (OS) and cancer-specific survival (CS) rates were 86.7% and 94.6%, respectively. OS was significantly higher for patients with low CAR (< 0.106) than for those with high CAR (≥ 0.106) (hazard ratio = 3.13, 95% confidence interval: 1.99-4.93, p < 0.0001). Univariate analysis identified sex, poor performance status, smoking status, comorbidity, solid tumor, histology, high Glasgow prognostic scale, and high CAR as significant prognostic factors. Multivariate analysis identified only the CAR as a significant prognostic factor for both OS and CS. CONCLUSIONS: Our analysis of the nationwide data demonstrated that the CAR is a useful prognostic factor for elderly patients with stage I NSCLC.

4.
Surg Today ; 2022 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-35041090

RESUMO

PURPOSE: Postoperative complications have a significant impact on perioperative outcomes; however, their association with the long-term prognosis remains unclear. We evaluated the impact of postoperative complications on the long-term outcomes after curative surgery in lung cancer patients. METHODS: This study included 1129 patients with primary lung cancer who underwent lobectomy between April 2011 and March 2017. Univariate and multivariate analyses were performed to assess the association of postoperative complications with the overall and recurrence-free survival. RESULTS: Postoperative complications were observed in 147 (13.0%) patients over a median follow-up period of 5-years. Compared to patients without complications, those with complications showed had worse long-term outcomes, including the 5-year overall survival (75.3% vs. 86.1%, p < 0.001) and 5-year recurrence-free survival (64.2% vs. 74.4%, p = 0.004). A multivariate analysis revealed that the incidence of postoperative complications was significantly associated with the overall survival (hazard ratio = 1.665, p = 0.006) and recurrence-free survival (hazard ratio = 1.416, p = 0.025) in all patients. The prognostic influence was greater in patients with pathological stages II and III cancer (overall survival: hazard ratio = 2.019, p = 0.005; recurrence-free survival: hazard ratio = 1.90, p = 0.001) than in those with pathological stage I cancer. CONCLUSION: Postoperative complications are independent predictors of the overall and recurrence-free survival in lung cancer patients, especially advanced-stage cancer patients.

5.
J Thorac Cardiovasc Surg ; 163(2): 441-451.e1, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-33131892

RESUMO

OBJECTIVE: Anaplastic lymphoma kinase (ALK) rearrangement is a representative lung cancer with driver mutation because of the efficacy of ALK-tyrosine kinase inhibitors. ALK-tyrosine kinase inhibitors are extensively used for ALK-rearranged lung cancer, whereas the therapeutic benefit of surgery remains unclear. Thus, we aimed to assess the clinical benefit of surgery in ALK-rearranged lung cancer and to elucidate the oncologic characteristics of ALK-rearranged lung cancer through surgically resected cases. METHODS: We retrospectively evaluated 1925 lung adenocarcinoma cases surgically resected between 1996 and 2017 at our institute. Moreover, 75 ALK-rearranged and 75 non-ALK-rearranged cases were extracted using propensity score matching. The survival rates, prognostic factors, and post-recurrence state were assessed. RESULTS: Multivariable analysis revealed that ALK rearrangement was an independent prognostic factor for improved cancer-specific survival (hazard ratio, 0.2; 95% confidence interval, 0.05-0.88; P = .033). In the matched cohort, the 5-year cancer-specific survival rates after surgery in the ALK-rearranged and non-ALK-rearranged groups were 97% and 77%, respectively. The ALK-rearranged group had a significantly better cancer-specific survival than did the non-ALK-rearranged group (log-rank test; P = .003). With respect to post-recurrence state, oligo-recurrence was highly frequent in the ALK-rearranged group, and post-recurrence survival was significantly improved by administration of either ALK-tyrosine kinase inhibitors (log-rank test; P = .011) or local ablative therapies (log-rank test; P = .035). CONCLUSIONS: Surgically resected ALK-rearranged lung adenocarcinoma has excellent long-term outcome. Not only ALK-tyrosine kinase inhibitors but also a combination of local and systemic therapies may be important treatment strategies for ALK-rearranged lung adenocarcinoma even in the post-recurrence state.


Assuntos
Adenocarcinoma de Pulmão/cirurgia , Quinase do Linfoma Anaplásico/genética , Biomarcadores Tumorais/genética , Rearranjo Gênico , Neoplasias Pulmonares/cirurgia , Pneumonectomia , Adenocarcinoma de Pulmão/genética , Adenocarcinoma de Pulmão/mortalidade , Adenocarcinoma de Pulmão/patologia , Adulto , Idoso , Feminino , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Pneumonectomia/efeitos adversos , Pneumonectomia/mortalidade , Retratamento , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
6.
Clin Lung Cancer ; 23(1): 82-90, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34836824

RESUMO

BACKGROUND: The concept of oligo-recurrence in non-small-cell lung cancer (NSCLC) has been suggested to describe the possibility of achieving long-term survival or even cure with local therapy for recurrence despite having recurrent disease. Oligo-recurrence involves a limited number of metachronous recurrences that can be treated with local therapy. However, the number of recurrences that constitutes an oligo-recurrence has varied among studies and remains to be defined. The aim of this study was to elucidate the number of recurrences that constitutes an oligo-recurrence in NSCLC. PATIENTS AND METHODS: We retrospectively reviewed 577 patients with NSCLC who had underwent complete resection and developed recurrence between 1990 and 2009, and these patients were evaluated. Patients were categorized according to the number of recurrences, and postrecurrence survival (PRS) was compared between groups. RESULTS: Altogether, 270 patients underwent local therapy for all recurrent lesions. In these patients, sex (female), histological type (adenocarcinoma), gene mutation status, recurrence-free interval <1 year, and presence of 1 or 2 recurrences were factors associated with prolonged PRS. Additionally, all patients who maintained a cancer-free status for at least 5 years after treatment for recurrence and were considered possibly cured, had 1 or 2 recurrences. CONCLUSION: Among patients receiving radical local therapy, the PRS was particularly longer among those with 1 or 2 recurrences, and these patients were able to aim for postrecurrence cure. Thus, a reasonable threshold to define oligo-recurrence in NSCLC is 1 or 2 recurrences that can be treated with local therapy.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/patologia , Neoplasias Pulmonares/patologia , Recidiva Local de Neoplasia , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
JCI Insight ; 7(1)2022 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-34874919

RESUMO

Immune checkpoint therapy targeting the PD-1/PD-L1 axis is a potentially novel development in anticancer therapy and has been applied to clinical medicine. However, there are still some problems, including a relatively low response rate, innate mechanisms of resistance against immune checkpoint blockades, and the absence of reliable biomarkers to predict responsiveness. In this study of in vitro and in vivo models, we demonstrate that PD-L1-vInt4, a splicing variant of PD-L1, plays a role as a decoy in anti-PD-L1 antibody treatment. First, we showed that PD-L1-vInt4 was detectable in clinical samples and that it was possible to visualize the secreting variants with IHC. By overexpressing the PD-L1-secreted splicing variant on MC38 cells, we observed that an immune-suppressing effect was not induced by their secretion alone. We then demonstrated that PD-L1-vInt4 secretion resisted anti-PD-L1 antibody treatment, compared with WT PD-L1, which was explicable by the PD-L1-vInt4's decoying of the anti-PD-L1 antibody. The decoying function of PD-L1 splicing variants may be one of the reasons for cancers being resistant to anti-PD-L1 therapy. Measuring serum PD-L1 levels might be helpful in deciding the therapeutic strategy.


Assuntos
Antígeno B7-H1 , Resistencia a Medicamentos Antineoplásicos/genética , Inibidores de Checkpoint Imunológico , Imunoterapia , Neoplasias Pulmonares , Animais , Antígeno B7-H1/sangue , Antígeno B7-H1/genética , Antígeno B7-H1/metabolismo , Linhagem Celular Tumoral , Feminino , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Poliadenilação/genética , Isoformas de Proteínas/sangue , Isoformas de Proteínas/genética , Isoformas de Proteínas/metabolismo , RNA Mensageiro/genética , RNA Mensageiro/metabolismo
8.
Gen Thorac Cardiovasc Surg ; 70(3): 312-314, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34813002

RESUMO

We developed a novel three-dimensional (3D) image simulation system, focused on pulmonary segmentectomy. The novel algorithms run by the software, which are independent of the differences in computed tomography (CT) values of vascular structures, enabled the creation of 3D images from unenhanced CT data with accuracy comparable to that from contrast-enhanced CT data. To evaluate the anatomical accuracy, we compared it between images created from unenhanced and contrast-enhanced CT in seven patients who underwent thoracoscopic segmentectomy. With regard to the automatic recognition of pulmonary vessels, the 3D image from unenhanced CT falsely recognized one or two points in two cases, whereas that from contrast-enhanced CT false recognitions in one case. Both 3D images had similar creation time and capability for identifying the intersegmental plain. The novel 3D image simulation for segmentectomy from unenhanced CT had sufficient anatomical accuracy for practical use but required attention due to inevitable minor false recognition.


Assuntos
Imageamento Tridimensional , Neoplasias Pulmonares , Humanos , Imageamento Tridimensional/métodos , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Tomografia Computadorizada por Raios X/métodos
9.
Gen Thorac Cardiovasc Surg ; 70(4): 366-371, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34800224

RESUMO

OBJECTIVES: Advances in thoracoscopic surgery have made skin incisions smaller, but there are concerns about cancer cell contamination during sample extraction. We performed retrieval bag lavage cytology (BLC) during thoracoscopic surgery to evaluate the risk of cancer dissemination and the prognostic influence of BLC status. METHODS: BLC was investigated in 893 patients who underwent thoracoscopic lobectomy or segmentectomy for lung cancer between 2013 and 2018. The clinicopathological features and prognosis were compared between the BLC-positive and BLC-negative groups. RESULTS: Forty-nine patients (5.5%) were positive for BLC. BLC correlated with pleural invasion (49.0% vs. 12.9%, P < 0.001); however, BLC was positive in 3.3% of cases without pleural invasion. Multivariate analysis revealed that tumor size, lymph node metastasis, lymphatic and pleural invasion were predictive factors for positive BLC. Prognosis was poorer in the BLC-positive group than in the BLC-negative group (5-year overall survival, 73.6% vs. 90.2%, P < 0.001); nevertheless, positive BLC was not an independent prognostic factor. The locoregional recurrence rate was higher among BLC-positive patients than among BLC-negative patients, whereas there was no significant difference in the distant recurrence rate. Positive BLC was associated with locoregional recurrence (hazard ratio 1.87, P = 0.044) and the correlation was stronger in stage I lung cancer. There were no cases of extraction bag breakage or port-site recurrence. CONCLUSIONS: BLC positivity was correlated with the risk of locoregional recurrence in patients with surgically resected lung cancer, although it was not an independent prognostic factor. Careful manipulation is essential for extracting specimens from the thoracic cavity.


Assuntos
Neoplasias Pulmonares , Irrigação Terapêutica , Humanos , Neoplasias Pulmonares/patologia , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida
10.
Ann Thorac Surg ; 113(2): 459-465, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33667462

RESUMO

BACKGROUND: Smoking has a major role in the risk of postoperative pulmonary complications. This study aimed to elucidate the correlation between smoking status and pulmonary complications after thoracoscopic surgery for lung cancer. METHODS: A total of 1751 patients who underwent thoracoscopic lobectomy or segmentectomy for lung cancer between April 2011 and March 2020 were assessed. The rate of pulmonary complications was evaluated according to smoking status and preoperative duration of smoking cessation. Univariate and multivariate logistic regression analyses were performed. RESULTS: Pulmonary complications were observed in 50 patients (2.9%), whereas 3 (0.2%) died within 90 days of surgery. The rate of pulmonary complications was higher in smokers than in nonsmokers (4.6% vs 0.9%; P < .001), and smoking history was an independent risk factor for pulmonary complications (odds ratio, 3.31; P = .007). The complication rate in patients with a cessation period of more than 2 months was significantly lower than that in patients who ceased smoking within 2 months (4.0% vs 8.5%; P = .043), but it was still higher than that in nonsmokers (4.0% vs 0.9%; P < .001). In the multivariable analysis for smokers, preoperative short-term smoking cessation within 2 months, male sex, histologic type, tumor size, and cardiopulmonary comorbidities were associated with pulmonary complications instead of pack-year smoking history. CONCLUSIONS: Smoking habits and preoperative smoking cessation were independently associated with pulmonary complications after thoracoscopic surgery for lung cancer. A preoperative smoking cessation period of 2 months or more is preferable for reducing the risk of such complications.


Assuntos
Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Medição de Risco/métodos , Fumar/efeitos adversos , Toracoscopia/métodos , Idoso , Broncoscopia/métodos , Endossonografia/métodos , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de Tempo , Tomografia Computadorizada por Raios X
11.
Medicina (Kaunas) ; 57(12)2021 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-34946309

RESUMO

Background and Objectives: Lobe-specific nodal dissection (L-SND) is currently acceptable for the dissection of early-stage non-small cell lung cancer (NSCLC) but not for cancers of more advanced clinical stages. We aimed to assess the efficacy of L-SND, compared to systemic nodal dissection (SND). Materials and Methods: We retrospectively collected the clinical data of patients with carcinoembryonic antigen (CEA) abnormality who underwent complete resection of NSCLC via lobectomy or more in addition to either SND or L-SND at two cancer-specific institutions from January 2006 to December 2017. Results: A total of 799 patients, including 265 patients who underwent SND and 534 patients who underwent L-SND, were included. On multivariate analysis, thoracotomy, more than lobectomy, cN1-2, advanced pathological stage, adjuvant treatment, and EGFR or ALK were strongly associated with SND. No significant differences were found in overall survival, disease-free survival, and overtime survival after propensity adjustment (p = 0.09, p = 0.11, and p = 0.50, respectively). There were no significant differences in local (p = 0.16), regional (p = 0.72), or distant (p = 0.39) tumor recurrence between the two groups. Conclusions: SND did not improve the prognosis of NSCLC patients with CEA abnormality. Complete pulmonary resection via L-SND seems useful for NSCLC patients with CEA abnormality.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Antígeno Carcinoembrionário , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Excisão de Linfonodo , Linfonodos/patologia , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Pneumonectomia , Estudos Retrospectivos
12.
Clin Lung Cancer ; 2021 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-34690079

RESUMO

INTRODUCTION: The prognostic significance of mediastinal lymph node dissection (MLND) in elderly patients with non-small cell lung cancer (NSCLC) remains unclear. This post hoc analysis of a nationwide multicenter cohort study (JACS1303) evaluated the prognostic significance of MLND in octogenarians with NSCLC. MATERIALS AND METHODS: We included 622 octogenarians with NSCLC who underwent lobectomy. The median follow-up duration was 41.1 months. We compared survival and perioperative outcomes between patients who did and did not undergo MLND. RESULTS: In total, 414 (67%) patients underwent MLND (ND2 group), whereas 208 (33%) did not undergo MLND (ND0-1 group). The disease stage was more advanced in the ND2 group than in the ND0-1 group. Disease-free survival was slightly greater in the ND0-1 group with marginal significance (P= .079). In the matched cohort (N = 228), which mainly consisted of patients with clinical stage I disease (96%), there was no significant difference between the 2 groups regarding overall and disease-free survival (P= .908 and P = .916, respectively). Operative time and blood loss were significantly lower in the ND0-1 group than in the ND2 group in the entire cohort (P< .001 and P = .050, respectively) and in the matched cohort (P = .003 and P= .046, respectively). CONCLUSION: Based on a nationwide prospective database, we found limited prognostic impact of MLND, suggesting that MLND can be omitted for octogenarians with early-stage NSCLC.

13.
Cancer Treat Res Commun ; 29: 100446, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34450406

RESUMO

OBJECTIVE: The coexistence of interstitial lung disease (ILD) is associated with poor prognosis in patients with lung cancer. The tumor doubling time (TDT) of lung cancer reflects cancer aggressiveness and is related to its prognosis. However, the relationship between the TDT of lung cancer and underlying ILD has not been fully evaluated. This study aimed to identify this crucial relationship. MATERIALS AND METHODS: Patients with lung cancer who underwent surgery between 2007 and 2020 were reviewed retrospectively. The propensity score matching method was used to balance the characteristics of patients with ILD (n = 100) and those without ILD (n = 100). TDT was calculated based on the difference of three-dimensional volumes defined from the two-time CT scans before surgery. We compared the TDT of lung cancer and other characteristics between the two groups. RESULTS: The median TDT of all patients was 149 days. The TDT was significantly shorter in patients with ILD (134 days) than in those without (204 days). The rate of short-term tumor enlargement (TDT < 90 days) was significantly higher in patients with ILD than in those without ILD, and ILD was an independent factor related to short-term tumor enlargement (odds ratio, 2.30; p = 0.015). We focused on 25 patients with usual interstitial pneumonitis (UIP) findings of patients with ILD. However, the presence of the UIP pattern was not related to the TDT among patients with ILD. CONCLUSION: ILD was an independent predictor of short-term tumor enlargement in lung cancer patients, regardless of the presence of the UIP pattern.


Assuntos
Imageamento Tridimensional/métodos , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Idoso , Estudos de Casos e Controles , Humanos , Estudos Retrospectivos
14.
Gen Thorac Cardiovasc Surg ; 69(12): 1545-1552, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34181182

RESUMO

OBJECTIVE: The aim of this study was to create the preoperative predictive model on mediastinal lymph-node metastasis based on artificial intelligence in surgically resected lung adenocarcinoma. METHODS: We enrolled 301 surgical resections of patients with clinical stage N0-1 lung adenocarcinoma, who received positron emission tomography preoperatively between 2015 and 2019. We randomly assigned the patients into two groups: the training (n = 201) and validation groups (n = 100). The training group was used to obtain basic data for learning by artificial intelligence, whereas the validation group was used to verify the constructed algorithm. We used an automatic machine learning platform, to create artificial intelligence model. For comparison, multivariate analysis was performed in the training group, whereas for calculating and verifying the prediction accuracy rate, significant predicting factors were applied to the validation group. RESULTS: Of the 301 patients, 41 patients were diagnosed as mediastinal lymph node metastasis. In multivariate analysis, the maximum standardized uptake value was an individual predictive factor. The accuracy rate of artificial intelligence model was 84%, and the specificity was 98% which were higher than those of the maximum standardized uptake value (61% and 57%). However, in terms of sensitivity, artificial intelligence model remarked low at 12%. CONCLUSIONS: An artificial intelligence-based diagnostic algorithm showed remarkable specificity compared with the maximum standardized uptake value. Although this model is not ready to practical use and the result was preliminary because of poor sensitivity, artificial intelligence could be able to complement the shortcomings of existing diagnostic modalities.


Assuntos
Inteligência Artificial , Neoplasias Pulmonares , Fluordesoxiglucose F18 , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Linfonodos/patologia , Metástase Linfática , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons , Estudos Retrospectivos
15.
Gen Thorac Cardiovasc Surg ; 69(9): 1360-1365, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34128191

RESUMO

We developed a novel three-dimensional (3D) image simulation system that is especially focused on pulmonary segmentectomy using new 3D computed tomography (CT) software. Based on contrast-enhanced high-resolution computed tomography (HRCT) images, the new software can quickly construct 3D pulmonary and bronchovascular images and generate a proposal for the appropriate segments to be resected. We performed the 3D image simulation and evaluated its accuracy in 20 patients for whom thoracoscopic segmentectomy was planned. We evaluated the anatomical validity comparing with HRCT findings and anatomical consistency with the operative findings on a three-point scale, respectively. The 3D image was evaluated as "good" for anatomical validity in 19 cases (95%) and for anatomical consistency with operative findings in 18 cases (90%). The novel 3D image simulation appeared to be easy to prepare, was anatomically reliable, and, therefore, was determined to be potentially useful.


Assuntos
Neoplasias Pulmonares , Cirurgiões , Humanos , Imageamento Tridimensional , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Pneumonectomia
16.
Ann Surg Oncol ; 28(12): 7219-7227, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33900499

RESUMO

BACKGROUND: Anatomic resection with lymph node dissection or sampling is the standard treatment for early non-small cell lung cancer (NSCLC), and wedge resection is an option for compromised patients. This study aimed to determine whether wedge resection can provide comparable prognoses for elderly patients with NSCLC. METHODS: The study analyzed the clinicopathologic findings and surgical outcomes during a median follow-up period of 39.6 months for 156 patients with solid dominant (consolidation-to-tumor ratio > 0.5) small (whole tumor size ≤ 2 cm) NSCLC among 892 patients 80 years of age or older with medically operable lung cancer between April 2015 and December 2016. RESULTS: The 3-year overall survival (OS) rates after wedge resection and after segmentectomy plus lobectomy did not differ significantly (86.5 %; 95 % confidence interval [CI], 74.6-93.0 % vs 83.7 % 95 % CI, 74.0-90.0 %; P = 0.92). Multivariable Cox regression analysis of OS with propensity scores showed that the surgical procedure was not an independent prognostic predictor (hazard ratio [HR], 0.84; 95 % CI, 0.39-1.8; P = 0.64). The 3-year OS rates were slightly better after wedge resection for 97 patients who could tolerate lobectomy than after segmentectomy plus lobectomy (89.4 %; 95 % CI, 73.8-95.9 % vs 75.8 %; 95 % CI, 62.0-85.2 %; P = 0.14). The cumulative incidence of other causes for death was marginally higher after segmentectomy plus lobectomy than after wedge resection (P = 0.079). CONCLUSIONS: Wedge resection might be equivalent to lobectomy or segmentectomy for selected patients 80 years of age or older with early-stage NSCLC who can tolerate lobectomy.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Carcinoma de Pequenas Células do Pulmão , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Estadiamento de Neoplasias , Pneumonectomia
17.
Gen Thorac Cardiovasc Surg ; 69(8): 1222-1229, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33683576

RESUMO

OBJECTIVES: To validate the efficacy of the Japanese National Clinical Database risk calculator, which predicts major morbidity in lung cancer surgery based on preoperative clinical characteristics. METHODS: In total, 660 patients who underwent complete surgical resection of primary lung cancer were enrolled. The predicted rate of major morbidity determined using the risk calculator was compared between the patients with and without major morbidity. We performed receiver operating characteristic curve analysis to determine their cut-off values to predict major morbidity and assessed the associated factors with major morbidity. Major morbidity was defined as the Clavien-Dindo classification grade IIIa or greater. RESULTS: The predicted rate of major morbidity was significantly higher in patients with major morbidity than in those without (P < 0.001). The cut-off value of the predicted rate of major morbidity to predict major morbidity was 3.0% (area under curve 0.741; sensitivity and specificity, 85.3% and 54.3%, respectively). The predicted rate of major morbidity ≥ 3.0% was significantly associated with occurrence of major morbidities (odds ratio 6.9; 95% confidence interval 2.63-18.04; P < 0.001) and the predicted rate of major morbidity had the highest odds ratio over other risk factors. This condition, namely the predicted rate of major morbidity ≥ 3.0%, was met in 315 (47%) of the total cases. However, only 29 (9%) of these cases had major morbidity in practice. CONCLUSIONS: The risk calculator was fairly useful for estimating high-risk patients; however, it was not possible to identify a specific cut-off value to predict major morbidity in this cohort.


Assuntos
Neoplasias Pulmonares , Complicações Pós-Operatórias , Humanos , Japão/epidemiologia , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/cirurgia , Morbidade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
18.
J Surg Oncol ; 123(8): 1828-1835, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33684232

RESUMO

BACKGROUND AND OBJECTIVES: The effectiveness of local therapy has been reported in non-small-cell lung cancer (NSCLC) patients with oligo-recurrence. However, there is still no clear consensus on the choice of local therapy. We aimed to examine the choice of local therapy in NSCLC patients with lung oligo-recurrence. METHODS: Among 1760 consecutive NSCLC patients who underwent complete resection between 1990 and 2008, 535 patients developed recurrence. Lung oligo-recurrence was defined as 1-5 metachronous recurrences limited to the lungs only; such recurrence was found in 97 patients. We examined the differences in the prognosis of each therapy for these patients. RESULTS: The 5-year postrecurrence survival (PRS) rates in patients who underwent local therapy (n = 54) and those who did not (n = 43) were 55.6% and 31.1%, respectively; it was significantly higher in patients who underwent local therapy (p = 0.004). Among 47 patients who underwent resection or radiation therapy, the 5-year PRS rates were 61.5% and 47.6% (p = 0.258), and the 5-year postrecurrence progression-free survival rates were 30.3% and 24.7% (p = 0.665), respectively, without any significant difference. CONCLUSIONS: Patients with lung oligo-recurrence should consider local therapy individually, depending on their general condition.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/terapia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Terapia Combinada , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Estudos Retrospectivos , Taxa de Sobrevida
19.
Ann Thorac Surg ; 112(6): e403-e406, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-33737042

RESUMO

Postoperative pneumatocele is a rare complication of lung surgery. Here we describe 2 cases of pneumatoceles arising from the unaltered bottom part of the lower lobe a month or more after upper lobectomy. Based on histopathologic findings, we speculated that (1) negative pressure created by the volumetric gap between the thoracic cavity and the remnant lung and (2) increased positive pressure by the check valve mechanism from kinking or flexion of the airway after an upward movement of the remnant lung play crucial roles in the pathogenesis of postoperative pneumatoceles.


Assuntos
Cistos/etiologia , Pneumopatias/etiologia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Cistos/patologia , Humanos , Pneumopatias/patologia , Masculino , Pessoa de Meia-Idade , Pneumonectomia/métodos , Complicações Pós-Operatórias/patologia
20.
Lung Cancer ; 152: 78-85, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33360439

RESUMO

OBJECTIVES: In early stage non-small cell lung cancer, the optimal surgical approach for lymph node dissection remains controversial. Without a uniform standard for the quality of lymph node dissection, outcomes of nodal upstaging comparing video-assisted thoracoscopic surgery (VATS) versus open thoracotomy (OPEN) also remain controversial. Thus, we compared the clinical outcomes of nodal upstaging between each approach. MATERIALS AND METHODS: We retrospectively evaluated 1319 surgically resected lung cancer cases between 2008 and 2017 at our institute. Moreover, 348 VATS and 348 OPEN cases were extracted using propensity score matching. We investigated the frequency, prognosis, and post-recurrence course of nodal upstaging between each approach. RESULTS: A total of 193 nodal upstaging cases were identified. Nodal upstaging was more frequent in the OPEN group (24 %) than the VATS group (9%) (p < 0.001). However, multivariable analysis revealed the surgical approach was not significantly associated with nodal upstaging (OPEN: odds ratio, 1.3; 95 % confidence interval, 0.93-2.02; p = 0.108) and, after matching, nodal upstaging with each approach were of equivalent frequency (p = 0.752). The median follow-up period was 5.0 years. Nodal upstaging was an independent prognostic factor for worse overall survival, cancer-specific survival, and recurrence-free survival in multivariable analyses (all p < 0.001). Of all cases, 222 recurred after surgery. There were no significant differences in recurrence patterns and initial recurrence sites depending on surgical approach. The 5-year post-recurrence survival rate was 52 % after VATS and 30 % after OPEN; however, this difference was not statistically significant (p = 0.052). Moreover, post-recurrence survival rate was not significantly different between the VATS and OPEN groups (pN0: p = 0.268, pN1: p = 0.437, and pN2: p = 0.144). CONCLUSION: Outcomes of nodal upstaging between VATS and OPEN were found to be equivalent. The difference in the frequency of nodal upstaging was not due to inferior quality of lymph node dissection with VATS; rather, that difference resulted from selection bias.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Pneumonectomia , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida , Toracotomia
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