Women With Pathologic Stage I, II, and III Non-small Cell Lung Cancer Have Better Survival Than Men*

Size: px
Start display at page:

Download "Women With Pathologic Stage I, II, and III Non-small Cell Lung Cancer Have Better Survival Than Men*"

Transcription

1 Original Research LUNG CANCER Women With Pathologic Stage I, II, and III Non-small Cell Lung Cancer Have Better Survival Than Men* Robert James Cerfolio, MD, FCCP; Ayesha S. Bryant, MSPH, MD; Ethan Scott, MD; Manisha Sharma, MD; Francisco Robert, MD; Sharon A. Spencer, MD; and Robert I. Garver, MD Objective: Bronchogenic malignancy is the number one cause of cancer deaths in both men and women worldwide. National registry-based studies have shown gender disparity in clinicopathologic characteristics and in survival. This study evaluates the risk factors and trends of lung cancer between genders. Methods: A prospective cohort of consecutive patients with non-small cell lung cancer (NSCLC) who were carefully clinically (all underwent dedicated positron emission tomography scans) and pathologically staged with stage I, II, or III disease underwent homogenous treatment algorithms and were followed up over a period of 7 years. Primary outcomes were 5-year survival and response to neoadjuvant therapy. Results: There were 1,085 patients (671 men and 414 women). Groups were similar for race, pulmonary function, smoking history, comorbidities, neoadjuvant therapy, histology, and resection rates. Women were younger (p 0.014), had a higher incidence of adenocarcinoma (p 0.01), and presented at an earlier pathologic stage (p 0.01) than men. The overall age-adjusted and stage-adjusted 5-year survival rate favored women (60% vs 50%, respectively; p < 0.001). Women had better stage-specific 5-year survival rates (stage I disease, 69% vs 64%, respectively [p 0.034]; stage II disease, 60% vs 50%, respectively [p 0.042]; and stage III disease, 46% vs 37%, respectively [p 0.024]). Women who received neoadjuvant chemotherapy alone (n 76) were more likely to be a complete or partial responder than men (n 142; p 0.025). Conclusions: Despite uniform staging and treatment, the 5-year survival rate of women with stage I to III NSCLC was better than men overall and at each stage. Women are more likely to have adenocarcinoma, to present with earlier stage disease, and to be younger. Interestingly, women respond better to neoadjuvant chemotherapy. (CHEST 2006; 130: ) Key words: lung cancer; staging; surgery Abbreviations: FDG 2-deoxy-2 18F-fluoro-D-glucose F-18; NSCLC non-small cell lung cancer; PET positron emission tomography *From the Divisions of Cardiothoracic Surgery (Drs. Cerfolio and Bryant), Hematology and Oncology (Dr. Robert), and Pulmonary/Allergy/Critical Care (Dr. Garver), the Department of Radiation Oncology (Dr. Spencer), and the School of Medicine (Drs. Scott and Sharma), University of Alabama at Birmingham, Birmingham, AL. The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article. Although smoking rates have declined in the United States, lung cancer continues to be a pandemic. 1 It is the number one cause of cancerrelated deaths worldwide. In 2003, there were 171,900 patients in whom lung cancer was diagnosed, and 157,200 deaths due to lung cancer in the Manuscript received April 9, 2006; revision accepted June 16, Reproduction of this article is prohibited without written permission from the American College of Chest Physicians ( org/misc/reprints.shtml). Correspondence to: Robert J. Cerfolio, MD, FCCP, Professor of Surgery, Chief of Thoracic Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, 1900 University Blvd, THT 712, Birmingham, AL 35294; Robert.cerfolio@ccc.uab.edu DOI: /chest Original Research

2 United States alone. 1 Lung cancer takes the lives of more female Americans than the next three most common female cancers (ie, breast, colorectal, and ovarian cancer) combined. In addition, it kills more American men than the next three most common male cancers (ie, prostate, colorectal, and pancreatic cancer) combined. Lung cancer alone is responsible for an estimated 27% of all cancer deaths. 2 It has claimed the lives of American icons such as Walt Disney, John Wayne, Yul Brunner, Nat King Cole, Ed Sullivan, Lucille Ball, Roger Maris, and most recently Peter Jennings. Eighty percent of patients afflicted with lung cancer have non-small cell lung cancer (NSCLC), which is potentially curable if diagnosed early. Although the incidence of lung cancer in men has declined, it had sharply risen in women until If these current trends continue, the incidence of lung cancer is projected to be identical for women and men over the next decade. 3 Furthermore, lung cancer may be avoidable since 9 in 10 patients are smokers. Given these statistics, aggressive approaches to identify epidemiologic and biological trends of lung cancer as well as to better target prevention, screening, and treatment efforts are needed at both the national and individual institution level. Genderassociated differences in the clinicopathologic characteristics and survival of patients with lung cancer appear to exist, but the findings are conflicting. Previous studies 4 7 have reported that women receive a diagnosis at a younger age ( 50 years of age) have an increased susceptibility to the development of lung cancer and better survival. Gender-related differences in the incidence of histologic subtypes, stage at presentation, and survival rates have also been reported. 4,6 However, these reports are plagued by the inherent limitations of studies that use large registry-based databases, feature inconsistent staging, use clinical instead of pathologic staging, 8 are retrospective, have many patients with advanced disease, apply different treatment algorithms for different stages of disease, and use a multitude of physicians. Additionally, survival analysis from data obtained over long time periods may be subject to lead-time bias, is confounded by multiple treatment strategies, has exposure to evolving chemotherapeutic agents, and uses surrogate end points for the assessment of treatment success. Thus, we decided in January of 1998 to prospectively study gender-associated clinicopathologic and survival differences for patients with NSCLC who presented to our surgical clinic. This study eliminates many of these aforementioned confounders because a large number of patients presented to one institution from several geographic regions, all underwent careful pathologic staging as opposed to clinical staging, and patients were treated with homogenous protocols. In addition, we focused on those with early-stage disease (ie, not stage IV disease) in an attempt to examine survival differences between men and women. Study Design and Patients Materials and Methods This is a consecutive cohort of patients with biopsy-proven NSCLC who were pathologically staged by one surgeon at University Hospital at the University of Alabama at Birmingham. All data were prospectively entered in an electronic database by the attending surgeon. Patients were seen and followed up between January 1998 and March Patients were excluded if they were 19 years of age, had histology that was not NSCLC, or had biopsy-proven stage IV cancer. Figure 1 outlines the algorithm used. In general, patients with stage I disease underwent resection, those with stage II disease received neoadjuvant platinum-based chemotherapy, and those with biopsyproven stage IIIa disease received neoadjuvant chemoradiotherapy. Patients with Pancoast tumors were excluded from this study (because they had stage II disease but received radiation and chemotherapy). Selected patients with stage IV disease who underwent complete resection (some with a single brain metastasis and others with unsuspected M1 nodules in the same lung) were also excluded from this study. All patients were clinically staged using 5-mm collimated CT scans of the chest and upper abdomen, and in addition all patients underwent dedicated positron emission tomography (PET) using 2-deoxy-2 18Ffluoro-D-glucose F-18 (FDG). Pathologic staging was required for inclusion in this study. The institutional review board at the University of Alabama at Birmingham approved this study as well as the prospective database used to collect the data. Staging Patients were carefully staged. All suspicious N2 and/or N3 lymph nodes (maximum standardized uptake value 2.5 on FDG-PET scan or 1 cm on the greatest axis on CT scan) were biopsied prior to pulmonary resection. Mediastinoscopy and/or endoscopic ultrasound fine-needle aspiration were used to biopsy different nodal stations as previously described. 9 All suspicious metastatic (M1) sites determined by FDG-PET scan or CT scan were also investigated and/or biopsied. Patients with suspected M1 disease in the liver, adrenal gland, or contralateral lung underwent definitive biopsy to prove or disprove the presence of M1 cancer. If the bone or brain was suspected to harbor metastases, MRI was considered to be the standard reference. The TNM pathologic stage was assessed using the international staging system. 10 Treatment Strategy If a patient had biopsy-proven N2 disease, they underwent platinum-based chemoradiotherapy (using 4,500 to 6,600 cgy) and were restaged with dedicated PET and CT scans. If patients were negative for N2 disease after the completion of their neoadjuvant therapy, they underwent resection. If a patient had biopsy-proven or suspected N1 disease, they underwent neoadjuvant platinum-based chemotherapy and then resection. If CHEST / 130 / 6/ DECEMBER,

3 Figure 1. Study algorithm. EUS-FNA endoscopic ultrasound fine-needle aspiration. patients had biopsy-proven N3 or M1 disease, they were treated with chemoradiotherapy and did not undergo resection. Patients who were negative for N1 and N2 disease underwent thoracotomy with pulmonary resection. At thoracotomy, complete thoracic lymphadenectomy (not nodal sampling) was used exclusively. Pathologic review was performed via standard techniques, and immunohistochemical staining was employed when appropriate. Definitions Downstaging was defined as pathologic proof of reduction in the nodal status and/or decrease in the T status of the tumor. A pathologic complete responder or a complete pathologic response was defined as having no residual viable tumor in the resected pathologic specimen in a patient with biopsy-proven NSCLC who had undergone neoadjuvant therapy. Partial response was defined as pathologic confirmation of some but not complete cellular death of viable cancer cells. Statistical Analysis Continuous data are presented as medians, and categoric data are presented as percentages. Characteristics of the patients and treatments were compared by Fisher exact test or Pearson 2 test for categoric data, and by the Wilcoxon test for continuous data. Survival estimates were derived by Kaplan-Meier analysis, and log-rank tests were used to assess differences in survival among the groups. Stratified log rank analyses and Cox proportionalhazards modeling were used to investigate and adjust for major prognostic and stratification factors. A two-sided p value of 0.05 was considered to be statistically significant. Patients who were alive at the end of the study period were censored for purposes of data analysis. Analysis was performed using a statistical software package (SAS, version 9.0; SAS Institute; Cary, NC). Data Collection and Follow-up Patients were actively followed up after pathologic staging and treatment until the end of this study. For patients who underwent complete resection, follow-up consisted of chest and abdominal CT scan every 6 months for the first 2 years and yearly afterward. Patients who did not undergo complete resection underwent more frequent follow-ups. Data were obtained from multiple sources, such as clinic letters, follow-up scans, hospital computer information systems, tumor registry, social security death index, and telephone calls and letters from oncologists and other physicians. The time to disease recurrence (defined as biopsyproven recurrent NSCLC), disease progression, or death due to lung cancer was recorded. All information was entered into our prospective database. Data acquisition for new patients was stopped on March 1, 2005, for this study, but the collection of follow-up data continued. Results Patient Characteristics Between January 1998 and March 2005, 1,085 patients (671 men and 414 women) were entered 1798 Original Research

4 into this study. Patient characteristics are shown in Table 1. Race, comorbidities, smoking rates, pulmonary function test results, neoadjuvant therapy rates, and resection rates were similar between men and women. However, women were younger than men (p 0.014), presented with an earlier disease stage (p 0.01), and had a higher incidence of adenocarcinoma (p 0.01). Survival analysis was performed on the 93.4% of patients who were followed up (6.6% were lost to follow-up). Table 1 Patient Characteristics and Tumor Pathology* Variables Men (n 671) Women (n 414) p Value Race White 561 (84%) 356 (86%) Black 110 (16%) 58 (14%) Age, yr 68 (26 84) 62 (23 78) Pulmonary function, % predicted FEV 1 78% 83% Dlco 69% 71% MVV 79% 78% History of smoking 614 (92%) 364 (88%) Cardiovascular disease 145 (22%) 82 (20%) Treatment Not resected 126 (19%) 74 (18%) Resected 545 (81%) 340 (82%) Neoadjuvant therapy 142 (21%) 76 (19%) Tumor characteristics Histology Adenocarcinoma 261 (39%) 190 (46%) 0.01 Squamous cell carcinoma 290 (43%) 135 (33%) Other# 116 (17%) 89 (21%) Differentiation** Well 279 (45%) 191 (48%) Moderate 100 (16%) 60 (15%) Poor 241 (39%) 148 (37%) Pathologic stage of NSCLC I 288 (43%) 212 (51%) II 171 (25%) 67 (16%) III 212 (32%) 135 (33%) *Values given as median No. (%), unless otherwise indicated. Dlco diffusing capacity of the lung for carbon monoxide; MVV maximum voluntary ventilation. Values are given as the median (range). Values are given as the median. Defined as a history of coronary artery bypass grafting, left ventricular function 35%, hypertension, myocardial infarction, angina, or coronary artery stenting. Mediastinoscopy, endoscopic ultrasound fine-needle aspiration, and/or wedge. Segmentectomy, lobectomy, or pneumonectomy. #Includes cases of unspecified NSCLC, as well as some cases of adenosquamous carcinoma, large cell carcinoma, carcinoid tumor, and bronchoalveolar carcinoma. **Not reported for all tumor samples. After, for example, mediastinoscopy or endoscopic ultrasound fine-needle aspiration, and prior to any neoadjuvant therapy. Survival Gender (p 0.001), pathologic stage prior to receiving any neoadjuvant therapy (p 0.001), and age (p 0.02) impacted 5-year survival rate by Kaplan-Meier analysis. Borderline effects were shown with histology (p 0.07) favoring adenocarcinoma. Figure 2 shows the overall 5-year survival rate controlled for age, histology, and disease stage. Survival was significantly higher in women (60%) than in men (50%; p 0.001). Survival analysis stratified by stage of NSCLC is shown in Figures 3, 4, and 5. These curves show that women enjoyed improved survival at all three pathologic stages, and that this achieved statistical significance at disease stages I (p 0.034), II (p 0.042), and stage III (p 0.024). Even when the use of adjuvant chemotherapy (which was offered after resection for patients stage Ib, IIa, and IIb after January 2004) was eliminated, the survival advantage for women was still apparent. Response to Neoadjuvant Treatment Patients with stage II disease received platinumbased chemotherapy alone, and those with stage IIIa disease received neoadjuvant platinum-based chemoradiotherapy. A separate analysis was performed for patient with both stages of disease and found that women who received neoadjuvant chemotherapy alone responded better than men (Table 2). There was no difference between men and women with stage IIIa disease, however. These patients were treated with concurrent radiotherapy, which was added to the platinum-based chemotherapy. Finally, when the patients who received neoadjuvant and Figure 2. Overall 5-year survival times for all patients (n 1,085) stratified by gender and controlling for variables that were found to be significant on Kaplan-Meier analysis (ie, age and stage; histology, which was of borderline significance, was controlled for as well). The overall 5-year survival rate was significantly higher in female patients (60%) than in male patients (50%; p 0.001). The y-axis starts at a nonzero value. CHEST / 130 / 6/ DECEMBER,

5 Figure 3. Stage I disease (T1-T2N0M0). The 5-year survival rate for women was 69%; that for men was 64.0%. Men and women had similar proportions of T1 and T2 lesions. The survival difference was statistically significant (p 0.034). Actual 5-year survival curves for men and women based on the pathologic stage of NSCLC are shown. adjuvant therapy were completely eliminated from the survival analysis, women still had improved survival over men. Discussion Previous reports have suggested that women with NSCLC fare better men. However, many of these studies have been registry-based or metaanalyses 5,7,11 13 and thus may have been flawed by their retrospective nature and inaccurate data. In contrast, this study was prospective. It included 1,000 consecutive patients and features the best clinical staging available followed by careful pathologic staging. In addition, if patients underwent resection, complete thoracic lymphadenectomy was performed as opposed to nodal sampling. Furthermore, after Figure 5. Stage III disease (T1-T3N2-N3M0). The 5-year survival rate for women was 46%; that for men was 37%. This difference was statistically significant (p 0.024). The y coordinate-axis starts at a nonzero value. Actual 5-year survival curves for men and women based on the pathologic stage of NSCLC are shown. pathologic staging all patients had treatment strategies determined by one physician at one university that serves a large geographic are in the southeastern region of the United States. Limitations of this study include the loss to follow-up of 6.6% of patients, the fact that the patient population studied was composed of those who presented to a surgical clinic, the minor variations in the doses and types of chemotherapy, and variations in the amount of radiotherapy used. The fact that this is a surgical series obviously biases the data toward earlier stage disease. This may further accentuate the role that gender plays, which may not be clinically significant in patients with stage IV disease. Certain clinicopathologic differences among men and women were found in this study. Visbal et al 3 in 2004, Alexiou et al 14 in 2001, and Minami et al 15 in 2000 found that women are more likely than men to have adenocarcinoma. We report a similar finding. This may be attributed to the effects of estrogen, which is a known risk factor for the development of Table 2 Pathologic Response to Chemotherapy Alone and Chemoradiotherapy for Men and Women* Variables Men (n 142) Women (n 76) Figure 4. Stage II disease (T1-T3N0-N1M0). The 5-year survival rate for women was 60%; that for men was 50%. This difference was statistically significant (p 0.042). Actual 5-year survival curves for men and women based on the pathologic stage of NSCLC are shown. Chemotherapy only Complete responders 7 (10%) 8 (20%) Partial responders 29 (41%) 24 (59%) Nonresponders 34 (49%) 9 (22%) Chemoradiotherapy Complete responders 14 (19%) 11 (31%) Partial responders 40 (56%) 13 (37%) Nonresponders 18 (25%) 11 (31%) *A total of 218 of 1,085 patients (20%) received neoadjuvant treatment. Response to chemotherapy only was significantly different between men and women, favoring women (p 0.03) Original Research

6 adenocarcinoma It has also been shown that patients with adenocarcinoma may have improved survival. 19,20 We have shown that squamous cell carcinoma has a higher maximum standard uptake value on FDG-PET scans than adenocarcinoma, and a higher maximum standardized uptake value has been correlated with more virulent and biologically aggressive tumors and worse patient survival rates. 21 In addition, we have shown that patients with squamous cell cancer may respond better to cisplatinbased neoadjuvant chemotherapy than those with adenocarcinoma. 22 However, even though we did not find a statistically significant impact on survival based on tumor histology, we performed a separate analysis that controlled for tumor type, and even then women had superior survival rate than men. The median age of patients in our series (67 years of age) was higher than that reported by Radzikowska et al 6 in 2002, which was a study of 20,561 patients with NSCLC from Poland. Our report, which has a wider age range (23 to 84 years of age) and a higher median age is more representative of patients with NSCLC in the United States. This may be due to the fact that our series used a consecutive group of patients. Our study, like most other reports, 4 7 found that women presented at a younger age than men. This age difference may be linked to genetic abnormalities between the sexes such as oncogenes, tumor suppressor genes, viral infections specific to women such as human papilloma virus, growth factors, or a reflection of the changing gender-based trends in smoking over the past few decades. Further studies are needed. Like previous studies, we found that women have a better age-adjusted 5-year survival rate than men overall 23 as well as within each stage. 24 These findings held true even on multivariate analysis, which controlled for the several univariate factors that affected survival (ie, age, histology, and stage). Possible causes include biological, hormonal, and molecular factors that differ between genders. For example, women are known to have a different nicotine metabolism than men, 25 have a higher incidence of p53 and K-ras mutations, 26,27 and have a greater susceptibility to tobacco. Additionally, human papilloma virus infection has been shown to be associated with NSCLC. 28,29 Yet, despite these risk factors for women, women have a better 5-year survival rate even when adjusted for age. Obviously, there is a complex array of other unknown factors at work, and further research is needed to better understand the pathophysiologic mechanisms. A careful inspection of Figure 3 suggests that the survival advantage for women occurs predominantly within the first few months after diagnosis. However, we could not demonstrated any treatment-related mortality to explain this finding, and a further separation of the curves is also noted between 20 and 24 months as well. One of the most provocative findings in this study is that women in whom stage II NSCLC was diagnosed had a statistically higher response rate to neoadjuvant chemotherapy than men. This is a unique finding and is made possible only because of the strict treatment algorithm we employed for these patients, since many studies do not offer neoadjuvant therapy for patients with clinical N1 disease. Interestingly, when neoadjuvant radiotherapy was added to the chemotherapy employed for those patients with stage IIIa-from-N2 disease, the survival advantage was lost. A trial by the Southwest Oncology Group showed that female gender was a positive independent prognostic factor for survival in patients who received neoadjuvant radiochemotherapy for stage III NSCLC. 30 The mechanism for this remains unclear. In conclusion, we found in this large prospective study, which features strict entry criteria, staging, and similar treatment algorithms, that women with pathologic stage I, II, and III NSCLC have a better overall survival rate, as well as a better stage-forstage 5-year survival rate than men. Women are more likely to be younger and to have adenocarcinoma. Interestingly, women are more likely to respond to neoadjuvant chemotherapy. Further studies are needed to prove or disprove these findings as well as to elucidate the pathophysiology. These data may help us to improve the dismal 13% overall 5-year survival rate for patients with NSCLC by helping to target new therapeutic options. References 1 Jemal A, Murray T, Samuels A, et al. Cancer statistics, CA Cancer J Clin 2003; 53: Thun MJ. Cancer facts & figures Atlanta, GA: American Cancer Society, Visbal AL, Williams BA, Nichols FC, et al. Gender differences in non-small cell lung cancer survival: an analysis of 4,618 patients diagnosed between 1997 and Ann Thorac Surg 2004; 78: Ferguson MF, Skosey C, Hoffman PC, et al. Sex-associated differences in presentation and survival in patients with lung cancer. J Clin Oncol 1990; 8: Agudo A, Ahrens W, Benhamou E, et al. Lung cancer and cigarette smoking in women: a multi-center case control study in Europe. Int J Cancer 2000; 88: Radzikowska E, Glaz P, Roszkowski K. Lung cancer in women: age, smoking, histology, performance status, stage, initial treatment and survival: population-based study of 20,561 cases. Ann Oncol 2002; 13: McDuffie H, Klaassen D, Dosman J, et al. Female-male differences in patients with primary lung cancer. Cancer 1987; 59: Cerfolio RJ, Bryant AS, Buddhiwardan O, et al. Improving CHEST / 130 / 6/ DECEMBER,

7 the inaccuracies of clinical staging of patients with NSCLC: a prospective trial. Ann Thorac Surg 2005; 80: Eloubedi MA, Cerfolio RJ, Chen VK, et al. Endoscopic ultrasound guided fine needle aspiration of mediastinal lymph node in patients with suspected lung cancer after positron emission tomography and computed tomography scans. Ann Thorac Surg 2005; 79: Mountain CF. Revisions in the International Systems for Staging Lung Cancer. Chest 1997; 111: Devesa SS, Bray F, Vizacaino AP, et al. International lung cancer trends by histologic type: male:female differences diminishing and adenocarcinoma rates rising. Int J Cancer 2005; 117: Fu JB, Kau TY, Severson RK, et al. Lung cancer in women: analysis of the national Surveillance, Epidemiology, and End Results database. Chest 2005; 127: International Adjuvant Lung Cancer Trial Collaborative Group. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med 2004; 350: Alexiou C, Onyeaka CV, Beggs D, et al. Do women live longer following lung resection for carcinoma? Eur J Cardiothorac Surg 2002; 21: Minami H, Yoshida T, Okutsu K, et al. Lung cancer treated surgically in patients 50 years of age. Chest 2001; 120: Stabile LP, Davis AL, Gubish CT, et al. Human non-small cell lung tumors and cell derived from normal lung express both estrogen receptor and and show biological responses to estrogen. Cancer Res 2002; 62: Canver CC, Memoli VA, Vanderveer PL, et al. Sex hormone receptors in non-small cell lung cancer in human beings. J Thorac Cardiovasc Surg 1994; 108: Olak J, Colson Y. Gender differences in lung cancer: have we really come a long way, baby? J Thorac Cardiovasc Surg 2004; 128: Janne PA, Gurubhagabatula S, Yeap BY, et al. Outcomes of patients with advanced non-small cell lung cancer treated with gefitinib (Iressa) on an expanded access study. Lung Cancer 2004; 44: Keller SM, Vangel MG, Adak S, et al. The influence of gender on survival and tumor recurrence following adjuvant therapy for completely resected stages II and IIIa non-small cell lung cancer. Lung Cancer 2002; 37: Cerfolio RJ, Bryant AS, Ohja B. The maximum standardized uptake values on positron emission tomography of a nonsmall cell lung cancer predict stage, recurrence and survival. J Thorac Cardiovasc Surg 2005; 130: Cerfolio RJ, Bryant AS, Winokur TS, et al. Repeat FDG-PET after neoadjuvant therapy is a predictor of pathologic response in patients with non-small cell lung cancer. Ann Thorac Surg 2004; 78: Chatkin JM, Abreu CM, Fritscher CC, et al. Is there a gender difference in non-small cell lung cancer survival? Gend Med 2004; 1: Ferguson MK, Wang J, Hoffman PC. Sex-associated differences in survival of patients undergoing resection for lung cancer. Ann Thorac Surg 69: Ryberg D, Hewe A, Phillips DH, et al. Different susceptibility to smoking-induced DNA damage among male and female lung cancer patients. Cancer Res 1994; 54: Kure EH, Ryberg D, Hewer A, et al. p53 mutations in lung tumours: relationship to gender and lung DNA adduct levels. Carcinogenesis 1996; 17: Ahrendt SA, Decker PA, Alawi EA, et al. Cigarette smoking is strongly associated with mutation of the K-ras gene in patients with primary adenocarcinoma of the lung. Cancer 2001; 92: Hirayasu T, Iwamasa T, Kamada Y, et al. Human papilloma virus DNA in squamous cell carcinoma of the lung. J Clin Pathol 1996; 49: Yousem SA, Ohori, Sonmez-Alpan E. Occurrence of human papillomavirus DNA in primary lung neoplasms. Cancer 1992; 69: Albain KS, Rusch VW, Crowley JJ. Concurrent cisplatin/ etoposide plus chest radiotherapy followed by surgery for stages IIIA (N2) and IIIB non-small cell lung cancer: mature results of the Southwest Oncology Group phase II study J Clin Oncol 1995; 13: Original Research

Satellite Pulmonary Nodule in the Same Lobe (T4N0) Should Not Be Staged as IIIB Non Small Cell Lung Cancer

Satellite Pulmonary Nodule in the Same Lobe (T4N0) Should Not Be Staged as IIIB Non Small Cell Lung Cancer Satellite Pulmonary Nodule in the Same Lobe (T4N0) Should Not Be Staged as IIIB Non Small Cell Lung Cancer Ayesha S. Bryant, MSPH, MD, Sara J. Pereira, MD, Daniel L. Miller, MD, and Robert James Cerfolio,

More information

Charles Mulligan, MD, FACS, FCCP 26 March 2015

Charles Mulligan, MD, FACS, FCCP 26 March 2015 Charles Mulligan, MD, FACS, FCCP 26 March 2015 Review lung cancer statistics Review the risk factors Discuss presentation and staging Discuss treatment options and outcomes Discuss the status of screening

More information

Slide 1. Slide 2. Slide 3. Investigation and management of lung cancer Robert Rintoul. Epidemiology. Risk factors/aetiology

Slide 1. Slide 2. Slide 3. Investigation and management of lung cancer Robert Rintoul. Epidemiology. Risk factors/aetiology Slide 1 Investigation and management of lung cancer Robert Rintoul Department of Thoracic Oncology Papworth Hospital Slide 2 Epidemiology Second most common cancer in the UK (after breast). 38 000 new

More information

GTS. The Journal of Thoracic and Cardiovascular Surgery c Volume 137, Number 3 605

GTS. The Journal of Thoracic and Cardiovascular Surgery c Volume 137, Number 3 605 Change in maximum standardized uptake value on repeat positron emission tomography after chemoradiotherapy in patients with esophageal cancer identifies complete responders Robert J. Cerfolio, MD, FACS,

More information

Tristate Lung Meeting 2014 Pro-Con Debate: Surgery has no role in the management of certain subsets of N2 disease

Tristate Lung Meeting 2014 Pro-Con Debate: Surgery has no role in the management of certain subsets of N2 disease Tristate Lung Meeting 2014 Pro-Con Debate: Surgery has no role in the management of certain subsets of N2 disease Jennifer E. Tseng, MD UFHealth Cancer Center-Orlando Health Sep 12, 2014 Background Approximately

More information

Lung cancer is the second most common type of. Lung Cancer in Women* Analysis of the National Surveillance, Epidemiology, and End Results Database

Lung cancer is the second most common type of. Lung Cancer in Women* Analysis of the National Surveillance, Epidemiology, and End Results Database Lung Cancer in Women* Analysis of the National Surveillance, Epidemiology, and End Results Database Jennifer B. Fu, MD; T. Ying Kau, PhD; Richard K. Severson, PhD; and Gregory P. Kalemkerian, MD Objectives:

More information

Superior and Basal Segment Lung Cancers in the Lower Lobe Have Different Lymph Node Metastatic Pathways and Prognosis

Superior and Basal Segment Lung Cancers in the Lower Lobe Have Different Lymph Node Metastatic Pathways and Prognosis ORIGINAL ARTICLES: Superior and Basal Segment Lung Cancers in the Lower Lobe Have Different Lymph Node Metastatic Pathways and Prognosis Shun-ichi Watanabe, MD, Kenji Suzuki, MD, and Hisao Asamura, MD

More information

Marcel Th. M. van Rens, MD; Aart Brutel de la Rivière, MD, PhD, FCCP; Hans R. J. Elbers, MD, PhD; and Jules M. M. van den Bosch, MD, PhD, FCCP

Marcel Th. M. van Rens, MD; Aart Brutel de la Rivière, MD, PhD, FCCP; Hans R. J. Elbers, MD, PhD; and Jules M. M. van den Bosch, MD, PhD, FCCP Prognostic Assessment of 2,361 Patients Who Underwent Pulmonary Resection for Non-small Cell Lung Cancer, Stage I, II, and IIIA* Marcel Th. M. van Rens, MD; Aart Brutel de la Rivière, MD, PhD, FCCP; Hans

More information

The right middle lobe is the smallest lobe in the lung, and

The right middle lobe is the smallest lobe in the lung, and ORIGINAL ARTICLE The Impact of Superior Mediastinal Lymph Node Metastases on Prognosis in Non-small Cell Lung Cancer Located in the Right Middle Lobe Yukinori Sakao, MD, PhD,* Sakae Okumura, MD,* Mun Mingyon,

More information

In 1989, Deslauriers et al. 1 described intrapulmonary metastasis

In 1989, Deslauriers et al. 1 described intrapulmonary metastasis ORIGINAL ARTICLE Prognosis of Resected Non-Small Cell Lung Cancer Patients with Intrapulmonary Metastases Kanji Nagai, MD,* Yasunori Sohara, MD, Ryosuke Tsuchiya, MD, Tomoyuki Goya, MD, and Etsuo Miyaoka,

More information

ORIGINAL PAPER. Marginal pulmonary function is associated with poor short- and long-term outcomes in lung cancer surgery

ORIGINAL PAPER. Marginal pulmonary function is associated with poor short- and long-term outcomes in lung cancer surgery Nagoya J. Med. Sci. 79. 37 ~ 42, 2017 doi:10.18999/nagjms.79.1.37 ORIGINAL PAPER Marginal pulmonary function is associated with poor short- and long-term outcomes in lung cancer surgery Naoki Ozeki, Koji

More information

Repeat FDG-PET After Neoadjuvant Therapy is a Predictor of Pathologic Response in Patients With Non-Small Cell Lung Cancer

Repeat FDG-PET After Neoadjuvant Therapy is a Predictor of Pathologic Response in Patients With Non-Small Cell Lung Cancer Repeat FDG-PET After Neoadjuvant Therapy is a Predictor of Pathologic Response in Patients With Non-Small Cell Lung Cancer Robert J. Cerfolio, MD, Ayesha S. Bryant, MSPH, Thomas S. Winokur, MD, Buddhiwardhan

More information

The tumor, node, metastasis (TNM) staging system of lung

The tumor, node, metastasis (TNM) staging system of lung ORIGINAL ARTICLE Peripheral Direct Adjacent Lobe Invasion Non-small Cell Lung Cancer Has a Similar Survival to That of Parietal Pleural Invasion T3 Disease Hao-Xian Yang, MD, PhD,* Xue Hou, MD, Peng Lin,

More information

THORACIC MALIGNANCIES

THORACIC MALIGNANCIES THORACIC MALIGNANCIES Summary for Malignant Malignancies. Lung Ca 1 Lung Cancer Non-Small Cell Lung Cancer Diagnostic Evaluation for Non-Small Lung Cancer 1. History and Physical examination. 2. CBCDE,

More information

Utility of PET-CT for detection of N2 or N3 nodal mestastases in the mediastinum in patients with non-small cell lung cancer (NSCLC)

Utility of PET-CT for detection of N2 or N3 nodal mestastases in the mediastinum in patients with non-small cell lung cancer (NSCLC) Utility of PET-CT for detection of N2 or N3 nodal mestastases in the mediastinum in patients with non-small cell lung cancer (NSCLC) Poster No.: C-1360 Congress: ECR 2015 Type: Scientific Exhibit Authors:

More information

Patients with stage IIIa non-small cell lung cancer

Patients with stage IIIa non-small cell lung cancer GENERAL THORACIC When is it Best to Repeat a 2-Fluoro-2-Deoxy-D- Glucose Positron Emission Tomography/Computed Tomography Scan on Patients with Non-Small Cell Lung Cancer Who Have Received Neoadjuvant

More information

Mediastinal Staging. Samer Kanaan, M.D.

Mediastinal Staging. Samer Kanaan, M.D. Mediastinal Staging Samer Kanaan, M.D. Overview Importance of accurate nodal staging Accuracy of radiographic staging Mediastinoscopy EUS EBUS Staging TNM Definitions T Stage Size of the Primary Tumor

More information

Lung cancer is a major cause of cancer deaths worldwide.

Lung cancer is a major cause of cancer deaths worldwide. ORIGINAL ARTICLE Prognostic Factors in 3315 Completely Resected Cases of Clinical Stage I Non-small Cell Lung Cancer in Japan Teruaki Koike, MD,* Ryosuke Tsuchiya, MD, Tomoyuki Goya, MD, Yasunori Sohara,

More information

Post-Induction PET Does Not Correlate with Persistent Nodal Disease or Overall Survival in Surgically Treated Stage IIIA Non-Small Cell Lung Cancer

Post-Induction PET Does Not Correlate with Persistent Nodal Disease or Overall Survival in Surgically Treated Stage IIIA Non-Small Cell Lung Cancer Post-Induction PET Does Not Correlate with Persistent Nodal Disease or Overall Survival in Surgically Treated Stage IIIA Non-Small Cell Lung Cancer R. Taylor Ripley, Kei Suzuki, Kay See Tan, Manjit Bains,

More information

Although the international TNM classification system

Although the international TNM classification system Prognostic Significance of Perioperative Serum Carcinoembryonic Antigen in Non-Small Cell Lung Cancer: Analysis of 1,000 Consecutive Resections for Clinical Stage I Disease Morihito Okada, MD, PhD, Wataru

More information

Research Article Prognostic Factors in Advanced Non-Small-Cell Lung Cancer Patients: Patient Characteristics and Type of Chemotherapy

Research Article Prognostic Factors in Advanced Non-Small-Cell Lung Cancer Patients: Patient Characteristics and Type of Chemotherapy SAGE-Hindawi Access to Research Lung Cancer International Volume 2011, Article ID 152125, 4 pages doi:10.4061/2011/152125 Research Article Prognostic Factors in Advanced Non-Small-Cell Lung Cancer Patients:

More information

Temporal Trends in Demographics and Overall Survival of Non Small-Cell Lung Cancer Patients at Moffitt Cancer Center From 1986 to 2008

Temporal Trends in Demographics and Overall Survival of Non Small-Cell Lung Cancer Patients at Moffitt Cancer Center From 1986 to 2008 Special Report Temporal Trends in Demographics and Overall Survival of Non Small-Cell Lung Cancer Patients at Moffitt Cancer Center From 1986 to 2008 Matthew B. Schabath, PhD, Zachary J. Thompson, PhD,

More information

Pneumonectomy After Induction Rx: Is it Safe?

Pneumonectomy After Induction Rx: Is it Safe? Pneumonectomy After Induction Rx: Is it Safe? David J. Sugarbaker, M.D. Director, Chief, Division of Thoracic Surgery The Olga Keith Weiss Chair of Surgery of Medicine at, Pneumonectomy after induction

More information

Complete surgical excision remains the greatest potential

Complete surgical excision remains the greatest potential ORIGINAL ARTICLE Wedge Resection for Non-small Cell Lung Cancer in Patients with Pulmonary Insufficiency: Prospective Ten-Year Survival John P. Griffin, MD,* Charles E. Eastridge, MD, Elizabeth A. Tolley,

More information

Small cell lung cancer (SCLC), which represents 20%

Small cell lung cancer (SCLC), which represents 20% ORIGINAL ARTICLES: GENERAL THORACIC Surgical Results for Small Cell Lung Cancer Based on the New TNM Staging System Masayoshi Inoue, MD, Shinichiro Miyoshi, MD, Tsutomu Yasumitsu, MD, Takashi Mori, MD,

More information

Prognostic value of visceral pleura invasion in non-small cell lung cancer q

Prognostic value of visceral pleura invasion in non-small cell lung cancer q European Journal of Cardio-thoracic Surgery 23 (2003) 865 869 www.elsevier.com/locate/ejcts Prognostic value of visceral pleura invasion in non-small cell lung cancer q Jeong-Han Kang, Kil Dong Kim, Kyung

More information

LYMPH NODE METASTASIS IN SMALL PERIPHERAL ADENOCARCINOMA OF THE LUNG

LYMPH NODE METASTASIS IN SMALL PERIPHERAL ADENOCARCINOMA OF THE LUNG LYMPH NODE METASTASIS IN SMALL PERIPHERAL ADENOCARCINOMA OF THE LUNG Tsuneyo Takizawa, MD a Masanori Terashima, MD a Teruaki Koike, MD a Takehiro Watanabe, MD a Yuzo Kurita, MD b Akira Yokoyama, MD b Keiichi

More information

Ratio of maximum standardized uptake value to primary tumor size is a prognostic factor in patients with advanced non-small cell lung cancer

Ratio of maximum standardized uptake value to primary tumor size is a prognostic factor in patients with advanced non-small cell lung cancer Original Article Ratio of maximum standardized uptake value to primary tumor size is a prognostic factor in patients with advanced non-small cell lung cancer Fangfang Chen 1 *, Yanwen Yao 2 *, Chunyan

More information

Risk Factors for Occult Mediastinal Metastases in Clinical Stage I Non-Small Cell Lung Cancer

Risk Factors for Occult Mediastinal Metastases in Clinical Stage I Non-Small Cell Lung Cancer ORIGINAL ARTICLES: SURGERY: The Annals of Thoracic Surgery CME Program is located online at http://cme.ctsnetjournals.org. To take the CME activity related to this article, you must have either an STS

More information

MEDIASTINAL STAGING surgical pro

MEDIASTINAL STAGING surgical pro MEDIASTINAL STAGING surgical pro Paul E. Van Schil, MD, PhD Department of Thoracic and Vascular Surgery University of Antwerp, Belgium Mediastinal staging Invasive techniques lymph node mapping cervical

More information

Molly Boyd, MD Glenn Mills, MD Syed Jafri, MD 1/1/2010

Molly Boyd, MD Glenn Mills, MD Syed Jafri, MD 1/1/2010 LSU HEALTH SCIENCES CENTER NSCLC Guidelines Feist-Weiller Cancer Center Molly Boyd, MD Glenn Mills, MD Syed Jafri, MD 1/1/2010 Initial Evaluation/Intervention: 1. Pathology Review 2. History and Physical

More information

Lung Cancer in Women: A Different Disease? James J. Stark, MD, FACP

Lung Cancer in Women: A Different Disease? James J. Stark, MD, FACP Lung Cancer in Women: A Different Disease? James J. Stark, MD, FACP Medical Director, Cancer Program and Director of Palliative Care Maryview Medical Center Professor of Medicine Eastern Virginia Medical

More information

Early-stage locally advanced non-small cell lung cancer (NSCLC) Clinical Case Discussion

Early-stage locally advanced non-small cell lung cancer (NSCLC) Clinical Case Discussion Early-stage locally advanced non-small cell lung cancer (NSCLC) Clinical Case Discussion Pieter Postmus The Clatterbridge Cancer Centre Liverpool Heart and Chest Hospital Liverpool, United Kingdom 1 2

More information

Adam J. Hansen, MD UHC Thoracic Surgery

Adam J. Hansen, MD UHC Thoracic Surgery Adam J. Hansen, MD UHC Thoracic Surgery Sometimes seen on Chest X-ray (CXR) Common incidental findings on computed tomography (CT) chest and abdomen done for other reasons Most lung cancers discovered

More information

Pulmonary resection remains the most effective. Survival in Synchronous vs Single Lung Cancer. Upstaging Better Reflects Prognosis

Pulmonary resection remains the most effective. Survival in Synchronous vs Single Lung Cancer. Upstaging Better Reflects Prognosis Survival in Synchronous vs Single Lung Cancer Upstaging Better Reflects Prognosis Marcel Th. M. van Rens, MD; Pieter Zanen, MD, PhD; Aart Brutel de la Rivière, MD, PhD, FCCP; Hans R. J. Elbers, MD, PhD;

More information

After primary tumor treatment, 30% of patients with malignant

After primary tumor treatment, 30% of patients with malignant ESTS METASTASECTOMY SUPPLEMENT Alberto Oliaro, MD, Pier L. Filosso, MD, Maria C. Bruna, MD, Claudio Mossetti, MD, and Enrico Ruffini, MD Abstract: After primary tumor treatment, 30% of patients with malignant

More information

Improving the Inaccuracies of Clinical Staging of Patients with NSCLC: A Prospective Trial

Improving the Inaccuracies of Clinical Staging of Patients with NSCLC: A Prospective Trial Improving the Inaccuracies of Clinical Staging of Patients with NSCLC: A Prospective Trial Robert James Cerfolio, MD, FACS, Ayesha S. Bryant, MD, MSPH, Buddhiwardhan Ojha, MD, MPH, and Mohammad Eloubeidi,

More information

Lung Cancer Update. HARMESH R NAIK, MD. February 28, 2001

Lung Cancer Update. HARMESH R NAIK, MD. February 28, 2001 Lung Cancer Update HARMESH R NAIK, MD. February 28, 2001 Progress update Prevention Screening Staging Treatment Epidemiology Estimated 169,500 new cases Estimated 157,400 deaths Second commonest cancer

More information

Early and locally advanced non-small-cell lung cancer (NSCLC)

Early and locally advanced non-small-cell lung cancer (NSCLC) Early and locally advanced non-small-cell lung cancer (NSCLC) ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up P. E. Postmus, K. M. Kerr, M. Oudkerk, S. Senan, D. A. Waller, J.

More information

Treatment of Clinical Stage I Lung Cancer: Thoracoscopic Lobectomy is the Standard

Treatment of Clinical Stage I Lung Cancer: Thoracoscopic Lobectomy is the Standard Treatment of Clinical Stage I Lung Cancer: Thoracoscopic Lobectomy is the Standard AATS General Thoracic Surgery Symposium May 5, 2010 Thomas A. D Amico MD Professor of Surgery, Duke University Medical

More information

Visceral pleural involvement (VPI) of lung cancer has

Visceral pleural involvement (VPI) of lung cancer has Visceral Pleural Involvement in Nonsmall Cell Lung Cancer: Prognostic Significance Toshihiro Osaki, MD, PhD, Akira Nagashima, MD, PhD, Takashi Yoshimatsu, MD, PhD, Sosuke Yamada, MD, and Kosei Yasumoto,

More information

The roles of adjuvant chemotherapy and thoracic irradiation

The roles of adjuvant chemotherapy and thoracic irradiation Factors Predicting Patterns of Recurrence After Resection of N1 Non-Small Cell Lung Carcinoma Timothy E. Sawyer, MD, James A. Bonner, MD, Perry M. Gould, MD, Robert L. Foote, MD, Claude Deschamps, MD,

More information

Thoracic Surgery; An Overview

Thoracic Surgery; An Overview Thoracic Surgery What we see Thoracic Surgery; An Overview James P. Locher, Jr, MD Methodist Cardiovascular and Thoracic Surgery Lung cancer Mets Fungus and TB Lung abcess and empyema Pleural based disease

More information

The Itracacies of Staging Patients with Suspected Lung Cancer

The Itracacies of Staging Patients with Suspected Lung Cancer The Itracacies of Staging Patients with Suspected Lung Cancer Gerard A. Silvestri, MD,MS, FCCP Professor of Medicine Medical University of South Carolina Charleston, SC silvestri@musc.edu Staging Lung

More information

Correlation of pretreatment surgical staging and PET SUV(max) with outcomes in NSCLC. Giancarlo Moscol, MD PGY-5 Hematology-Oncology UTSW

Correlation of pretreatment surgical staging and PET SUV(max) with outcomes in NSCLC. Giancarlo Moscol, MD PGY-5 Hematology-Oncology UTSW Correlation of pretreatment surgical staging and PET SUV(max) with outcomes in NSCLC Giancarlo Moscol, MD PGY-5 Hematology-Oncology UTSW BACKGROUND AJCC staging 1 gives valuable prognostic information,

More information

Proper Treatment Selection May Improve Survival in Patients With Clinical Early-Stage Nonsmall Cell Lung Cancer

Proper Treatment Selection May Improve Survival in Patients With Clinical Early-Stage Nonsmall Cell Lung Cancer Proper Treatment Selection May Improve Survival in Patients With Clinical Early-Stage Nonsmall Cell Lung Cancer Özcan Birim, MD, A. Pieter Kappetein, MD, PhD, Tom Goorden, MD, Rob J. van Klaveren, MD,

More information

Multifocal Lung Cancer

Multifocal Lung Cancer Multifocal Lung Cancer P. De Leyn, MD, PhD Department of Thoracic Surgery University Hospitals Leuven Belgium LEUVEN LUNG CANCER GROUP Department of Thoracic Surgery Department of Pneumology Department

More information

Diagnosis and Staging of Non-Small Cell Lung Cancer Carlos Eduardo Oliveira Baleeiro, MD. November 18, 2017

Diagnosis and Staging of Non-Small Cell Lung Cancer Carlos Eduardo Oliveira Baleeiro, MD. November 18, 2017 Diagnosis and Staging of Non-Small Cell Lung Cancer Carlos Eduardo Oliveira Baleeiro, MD November 18, 2017 Disclosures I do not have a financial interest/arrangement or affiliation with one or more organizations

More information

Prognostic Factors for Survival of Stage IB Upper Lobe Non-small Cell Lung Cancer Patients: A Retrospective Study in Shanghai, China

Prognostic Factors for Survival of Stage IB Upper Lobe Non-small Cell Lung Cancer Patients: A Retrospective Study in Shanghai, China www.springerlink.com Chin J Cancer Res 23(4):265 270, 2011 265 Original Article Prognostic Factors for Survival of Stage IB Upper Lobe Non-small Cell Lung Cancer Patients: A Retrospective Study in Shanghai,

More information

Predictive risk factors for lymph node metastasis in patients with small size non-small cell lung cancer

Predictive risk factors for lymph node metastasis in patients with small size non-small cell lung cancer Original Article Predictive risk factors for lymph node metastasis in patients with small size non-small cell lung cancer Feichao Bao, Ping Yuan, Xiaoshuai Yuan, Xiayi Lv, Zhitian Wang, Jian Hu Department

More information

Treatment of oligometastatic NSCLC

Treatment of oligometastatic NSCLC Treatment of oligometastatic NSCLC Jarosław Kużdżał Department of Thoracic Surgery Jagiellonian University Collegium Medicum, John Paul II Hospital, Cracow New idea? 14 NSCLC patients with solitary extrathoracic

More information

Lung cancer is one of the most common and most. Delays in the Diagnosis and Treatment of Lung Cancer*

Lung cancer is one of the most common and most. Delays in the Diagnosis and Treatment of Lung Cancer* Delays in the Diagnosis and Treatment of Lung Cancer* Eija-Riitta Salomaa, MD, PhD; Susanna Sällinen, BM; Heikki Hiekkanen, MSc; and Kari Liippo, MD, PhD Study objectives: This study was undertaken to

More information

The Prognostic Value of Ratio-Based Lymph Node Staging in Resected Non Small-Cell Lung Cancer

The Prognostic Value of Ratio-Based Lymph Node Staging in Resected Non Small-Cell Lung Cancer Original Article The Prognostic Value of Ratio-Based Lymph Node Staging in Resected Non Small-Cell Lung Cancer Chen Qiu, MD,* Wei Dong, MD,* Benhua Su, MBBS, Qi Liu, MD,* and Jiajun Du, PhD Introduction:

More information

PET/CT in lung cancer

PET/CT in lung cancer PET/CT in lung cancer Andrei Šamarin North Estonia Medical Centre 3 rd Baltic Congress of Radiology 08.10.2010 Imaging in lung cancer Why do we need PET/CT? CT is routine imaging modality for staging of

More information

Surgical treatment in non-small cell lung cancer with pulmonary oligometastasis

Surgical treatment in non-small cell lung cancer with pulmonary oligometastasis He et al. World Journal of Surgical Oncology (2017) 15:36 DOI 10.1186/s12957-017-1105-8 RESEARCH Open Access Surgical treatment in non-small cell lung cancer with pulmonary oligometastasis Jinyuan He,

More information

Revisit of Primary Malignant Neoplasms of the Trachea: Clinical Characteristics and Survival Analysis

Revisit of Primary Malignant Neoplasms of the Trachea: Clinical Characteristics and Survival Analysis Jpn J Clin Oncol 1997;27(5)305 309 Revisit of Primary Malignant Neoplasms of the Trachea: Clinical Characteristics and Survival Analysis -, -, - - 1 Chest Department and 2 Section of Thoracic Surgery,

More information

Non-Small Cell Lung Cancer: Disease Spectrum and Management in a Tertiary Care Hospital

Non-Small Cell Lung Cancer: Disease Spectrum and Management in a Tertiary Care Hospital Non-Small Cell Lung Cancer: Disease Spectrum and Management in a Tertiary Care Hospital Muhammad Rizwan Khan,Sulaiman B. Hasan,Shahid A. Sami ( Department of Surgery, The Aga Khan University Hospital,

More information

Advanced primary pulmonary lymphoepithelioma-like carcinoma: clinical manifestations, treatment, and outcome

Advanced primary pulmonary lymphoepithelioma-like carcinoma: clinical manifestations, treatment, and outcome Original Article Advanced primary pulmonary lymphoepithelioma-like carcinoma: clinical manifestations, treatment, and outcome Chun-Yu Lin 1,2, Ying-Jen Chen 1,2, Meng-Heng Hsieh 2,3, Chih-Wei Wang 2,4,

More information

and Strength of Recommendations

and Strength of Recommendations ASTRO with ASCO Qualifying Statements in Bold Italics s patients with T1-2, N0 non-small cell lung cancer who are medically operable? 1A: Patients with stage I NSCLC should be evaluated by a thoracic surgeon,

More information

Case presentation. Paul De Leyn, MD, PhD Thoracic Surgery University Hospitals Leuven Belgium

Case presentation. Paul De Leyn, MD, PhD Thoracic Surgery University Hospitals Leuven Belgium Case presentation Paul De Leyn, MD, PhD Thoracic Surgery University Hospitals Leuven Belgium Perspectives in Lung Cancer Brussels 6-7 march 2009 LEUVEN LUNG CANCER GROUP Department of Thoracic Surgery

More information

Sleeve lobectomy for lung adenocarcinoma treated with neoadjuvant afatinib

Sleeve lobectomy for lung adenocarcinoma treated with neoadjuvant afatinib Case Report Sleeve lobectomy for lung adenocarcinoma treated with neoadjuvant afatinib Ichiro Sakanoue 1, Hiroshi Hamakawa 1, Reiko Kaji 2, Yukihiro Imai 3, Nobuyuki Katakami 2, Yutaka Takahashi 1 1 Department

More information

Ethnic Disparities in the Treatment of Stage I Non-small Cell Lung Cancer. Juan P. Wisnivesky, MD, MPH, Thomas McGinn, MD, MPH, Claudia Henschke, PhD,

Ethnic Disparities in the Treatment of Stage I Non-small Cell Lung Cancer. Juan P. Wisnivesky, MD, MPH, Thomas McGinn, MD, MPH, Claudia Henschke, PhD, Ethnic Disparities in the Treatment of Stage I Non-small Cell Lung Cancer Juan P. Wisnivesky, MD, MPH, Thomas McGinn, MD, MPH, Claudia Henschke, PhD, MD, Paul Hebert, PhD, Michael C. Iannuzzi, MD, and

More information

Noninvasive Differential Diagnosis of Pulmonary Nodules Using the Standardized Uptake Value Index

Noninvasive Differential Diagnosis of Pulmonary Nodules Using the Standardized Uptake Value Index doi: 10.5761/atcs.oa.14-00241 Original Article Noninvasive Differential Diagnosis of Pulmonary Nodules Using the Standardized Uptake Value Index Satoshi Shiono, MD, 1 Naoki Yanagawa, MD, 2 Masami Abiko,

More information

Lung cancer Surgery. 17 TH ESO-ESMO MASTERCLASS IN CLINICAL ONCOLOGY March, 2017 Berlin, Germany

Lung cancer Surgery. 17 TH ESO-ESMO MASTERCLASS IN CLINICAL ONCOLOGY March, 2017 Berlin, Germany 17 TH ESO-ESMO MASTERCLASS IN CLINICAL ONCOLOGY 24-29 March, 2017 Berlin, Germany Lung cancer Surgery Sven Hillinger MD, Thoracic Surgery, University Hospital Zurich Case 1 59 y, female, 40 py, incidental

More information

Pulmonary Metastasectomy for Pulmonary Metastases of Head and Neck Squamous Cell Carcinomas

Pulmonary Metastasectomy for Pulmonary Metastases of Head and Neck Squamous Cell Carcinomas ORIGINAL ARTICLES: SURGERY: The Annals of Thoracic Surgery CME Program is located online at http://cme.ctsnetjournals.org. To take the CME activity related to this article, you must have either an STS

More information

Variability in Defining T1N0 Non-Small Cell Lung Cancer Impacts Locoregional Failure and Survival

Variability in Defining T1N0 Non-Small Cell Lung Cancer Impacts Locoregional Failure and Survival Variability in Defining T1N0 Non-Small Cell Lung Cancer Impacts Locoregional Failure and Survival Mert Saynak, MD, Jessica Hubbs, MS, Jiho Nam, MD, Lawrence B. Marks, MD, Richard H. Feins, MD, Benjamin

More information

POSITRON EMISSION TOMOGRAPHY (PET)

POSITRON EMISSION TOMOGRAPHY (PET) Status Active Medical and Behavioral Health Policy Section: Radiology Policy Number: V-27 Effective Date: 08/27/2014 Blue Cross and Blue Shield of Minnesota medical policies do not imply that members should

More information

Accepted Manuscript. Risk stratification for distant recurrence of resected early stage NSCLC is under construction. Michael Lanuti, MD

Accepted Manuscript. Risk stratification for distant recurrence of resected early stage NSCLC is under construction. Michael Lanuti, MD Accepted Manuscript Risk stratification for distant recurrence of resected early stage NSCLC is under construction Michael Lanuti, MD PII: S0022-5223(17)32392-9 DOI: 10.1016/j.jtcvs.2017.10.063 Reference:

More information

Endobronchial Ultrasound in the Diagnosis & Staging of Lung Cancer

Endobronchial Ultrasound in the Diagnosis & Staging of Lung Cancer Endobronchial Ultrasound in the Diagnosis & Staging of Lung Cancer Dr Richard Booton PhD FRCP Lead Lung Cancer Clinician, Consultant Respiratory Physician & Speciality Director Manchester University NHS

More information

Clinical Management Guideline for Small Cell Lung Cancer

Clinical Management Guideline for Small Cell Lung Cancer Diagnosis and Staging: Key Points 1. Ensure a CT scan that is

More information

Small-cell lung cancer (SCLC) represents approximately

Small-cell lung cancer (SCLC) represents approximately Original Article Bolstering the Case for Lobectomy in Stages I, II, and IIIA Small-Cell Lung Cancer Using the National Cancer Data Base Susan E. Combs, MA, Jacquelyn G. Hancock, BS, Daniel J. Boffa, MD,

More information

Lung Cancer staging Role of ENDOBRONCHIAL ULTRASOUND(Ebus) EBUS

Lung Cancer staging Role of ENDOBRONCHIAL ULTRASOUND(Ebus) EBUS Lung Cancer staging Role of ENDOBRONCHIAL ULTRASOUND(Ebus) Arvind Perathur Winter Retreat Feb 13 th 2011 Mason City IA 50401 EBUS Tiger now offers a very economical and environmentally friendly all electric

More information

Relevance of an extensive follow-up after surgery for nonsmall cell lung cancer

Relevance of an extensive follow-up after surgery for nonsmall cell lung cancer ORIGINAL ARTICLE LUNG CANCER Relevance of an extensive follow-up after surgery for nonsmall cell lung cancer Delphine Gourcerol 1,2, Arnaud Scherpereel 1,2, Stephane Debeugny 3, Henri Porte 2,4, Alexis

More information

Surgical management of lung cancer

Surgical management of lung cancer Surgical management of lung cancer Nick Roubos FRACS Cardiothoracic Surgeon Box Hill Hospital, Epworth Eastern Thoracic Oncology Non Small Cell Lung Cancer (NSCLC) Small Cell Lung Cancer Mesothelioma Pulmonary

More information

Overall survival analysis of neoadjuvant chemoradiotherapy and esophagectomy for esophageal cancer

Overall survival analysis of neoadjuvant chemoradiotherapy and esophagectomy for esophageal cancer Original Article Overall survival analysis of neoadjuvant chemoradiotherapy and esophagectomy for esophageal cancer Faisal A. Siddiqui 1, Katelyn M. Atkins 2, Brian S. Diggs 3, Charles R. Thomas Jr 1,

More information

LUNG CANCER. Agnieszka Słowik, MD. Department of Oncology, University Hospital in Cracow Jagiellonian University

LUNG CANCER. Agnieszka Słowik, MD. Department of Oncology, University Hospital in Cracow Jagiellonian University LUNG CANCER Agnieszka Słowik, MD Department of Oncology, University Hospital in Cracow Jagiellonian University Epidemiology Most common malignancy worldwide Place of lung cancer among other malignancies

More information

Standard treatment for pulmonary metastasis of non-small

Standard treatment for pulmonary metastasis of non-small ORIGINAL ARTICLE Resection of Pulmonary Metastasis of Non-small Cell Lung Cancer Kenichi Okubo, MD,* Toru Bando, MD,* Ryo Miyahara, MD,* Hiroaki Sakai, MD,* Tsuyoshi Shoji, MD,* Makoto Sonobe, MD,* Takuji

More information

Characteristics and prognostic factors of synchronous multiple primary esophageal carcinoma: A report of 52 cases

Characteristics and prognostic factors of synchronous multiple primary esophageal carcinoma: A report of 52 cases Thoracic Cancer ISSN 1759-7706 ORIGINAL ARTICLE Characteristics and prognostic factors of synchronous multiple primary esophageal carcinoma: A report of 52 cases Mei Li & Zhi-xiong Lin Department of Radiation

More information

Chirurgie beim oligo-metastatischen NSCLC

Chirurgie beim oligo-metastatischen NSCLC 24. Ärzte-Fortbildungskurs in Klinischer Onkologie 20.-22. Februar 2014, Kantonsspital St. Gallen Chirurgie beim oligo-metastatischen NSCLC Prof. Dr. med. Walter Weder Klinikdirektor Thoraxchirurgie, UniversitätsSpital

More information

T3 NSCLC: Chest Wall, Diaphragm, Mediastinum

T3 NSCLC: Chest Wall, Diaphragm, Mediastinum for T3 NSCLC: Chest Wall, Diaphragm, Mediastinum AATS Postgraduate Course April 29, 2012 Thomas A. D Amico MD Professor of Surgery, Chief of Thoracic Surgery Duke University Health System Disclosure No

More information

The accurate assessment of lymph node involvement is

The accurate assessment of lymph node involvement is ORIGINAL ARTICLE Which is the Better Prognostic Factor for Resected Non-small Cell Lung Cancer The Number of Metastatic Lymph Nodes or the Currently Used Nodal Stage Classification? Shenhai Wei, MD, PhD,*

More information

Visceral pleura invasion (VPI) was adopted as a specific

Visceral pleura invasion (VPI) was adopted as a specific ORIGINAL ARTICLE Visceral Pleura Invasion Impact on Non-small Cell Lung Cancer Patient Survival Its Implications for the Forthcoming TNM Staging Based on a Large-Scale Nation-Wide Database Junji Yoshida,

More information

Lung Cancer in Octogenarians: Factors Affecting Morbidity and Mortality After Pulmonary Resection

Lung Cancer in Octogenarians: Factors Affecting Morbidity and Mortality After Pulmonary Resection ORIGINAL ARTICLES: SURGERY: The Annals of Thoracic Surgery CME Program is located online at http://cme.ctsnetjournals.org. To take the CME activity related to this article, you must have either an STS

More information

A Proposed Strategy for Treatment of Superficial Carcinoma. in the Thoracic Esophagus Based on an Analysis. of Lymph Node Metastasis

A Proposed Strategy for Treatment of Superficial Carcinoma. in the Thoracic Esophagus Based on an Analysis. of Lymph Node Metastasis Kitakanto Med J 2002 ; 52 : 189-193 189 A Proposed Strategy for Treatment of Superficial Carcinoma in the Thoracic Esophagus Based on an Analysis of Lymph Node Metastasis Susumu Kawate,' Susumu Ohwada,'

More information

North of Scotland Cancer Network Clinical Management Guideline for Non Small Cell Lung Cancer

North of Scotland Cancer Network Clinical Management Guideline for Non Small Cell Lung Cancer THIS DOCUMENT IS North of Scotland Cancer Network Clinical Management Guideline for Non Small Cell Lung Cancer [Based on WOSCAN NSCLC CMG with further extensive consultation within NOSCAN] UNCONTROLLED

More information

Cheng-Yang Song, Takehiro Sakai, Daisuke Kimura, Takao Tsushima, Ikuo Fukuda

Cheng-Yang Song, Takehiro Sakai, Daisuke Kimura, Takao Tsushima, Ikuo Fukuda Original Article Comparison of perioperative and oncological outcomes between video-assisted segmentectomy and lobectomy for patients with clinical stage IA non-small cell lung cancer: a propensity score

More information

Lung Cancer Epidemiology. AJCC Staging 6 th edition

Lung Cancer Epidemiology. AJCC Staging 6 th edition Surgery for stage IIIA NSCLC? Sometimes! Anne S. Tsao, M.D. Associate Professor Director, Mesothelioma Program Director, Thoracic Chemo-Radiation Program May 7, 2011 The University of Texas MD ANDERSON

More information

Best Papers. F. Fusco

Best Papers. F. Fusco Best Papers UROLOGY F. Fusco Best papers - 2015 RP/RT Oncological outcomes RP/RT IN ct3 Utilization trends RP/RT Complications Evolving role of elnd /Salvage LND This cohort reflects the current clinical

More information

Title: What has changed in the surgical treatment strategies of non-small cell lung cancer in

Title: What has changed in the surgical treatment strategies of non-small cell lung cancer in 1 Manuscript type: Original Article DOI: Title: What has changed in the surgical treatment strategies of non-small cell lung cancer in twenty years? A single centre experience Short title: Changes in the

More information

Physician Follow-Up and Guideline Adherence in Post- Treatment Surveillance of Colorectal Cancer

Physician Follow-Up and Guideline Adherence in Post- Treatment Surveillance of Colorectal Cancer Physician Follow-Up and Guideline Adherence in Post- Treatment Surveillance of Colorectal Cancer Gabriela M. Vargas, MD Kristin M. Sheffield, PhD, Abhishek Parmar, MD, Yimei Han, MS, Kimberly M. Brown,

More information

CT PET SCANNING for GIT Malignancies A clinician s perspective

CT PET SCANNING for GIT Malignancies A clinician s perspective CT PET SCANNING for GIT Malignancies A clinician s perspective Damon Bizos Head, Surgical Gastroenterology Charlotte Maxeke Johannesburg Academic Hospital Case presentation 54 year old with recent onset

More information

Maximum Standard Uptake Value of Mediastinal Lymph Nodes on Integrated FDG-PET-CT Predicts Pathology in Patients with Non-Small Cell Lung Cancer

Maximum Standard Uptake Value of Mediastinal Lymph Nodes on Integrated FDG-PET-CT Predicts Pathology in Patients with Non-Small Cell Lung Cancer Maximum Standard Uptake Value of Mediastinal Lymph odes on Integrated FDG-PET-CT Predicts Pathology in Patients with on-small Cell Lung Cancer Ayesha S. Bryant, MSPH, MD, Robert J. Cerfolio, MD, FACS,

More information

The 7th Edition of TNM in Lung Cancer.

The 7th Edition of TNM in Lung Cancer. 10th European Conference Perspectives in Lung Cancer. Brussels, March 2009. The 7th Edition of TNM in Lung Cancer. Peter Goldstraw, Consultant Thoracic Surgeon, Royal Brompton Hospital, Professor of Thoracic

More information

Validation of the T descriptor in the new 8th TNM classification for non-small cell lung cancer

Validation of the T descriptor in the new 8th TNM classification for non-small cell lung cancer Original Article Validation of the T descriptor in the new 8th TNM classification for non-small cell lung cancer Hee Suk Jung 1, Jin Gu Lee 2, Chang Young Lee 2, Dae Joon Kim 2, Kyung Young Chung 2 1 Department

More information

Dr Sneha Shah Tata Memorial Hospital, Mumbai.

Dr Sneha Shah Tata Memorial Hospital, Mumbai. Dr Sneha Shah Tata Memorial Hospital, Mumbai. Topics covered Lymphomas including Burkitts Pediatric solid tumors (non CNS) Musculoskeletal Ewings & osteosarcoma. Neuroblastomas Nasopharyngeal carcinomas

More information

PET/CT in breast cancer staging

PET/CT in breast cancer staging PET/CT in breast cancer staging Anni Morsing Consultant, PhD, DMSc Rigshospitalet 1 18F- FDG PET/CT for breastcancer staging Where is the clinical impact? To which women should 18F- FDG PET/CT be offered?

More information

Visceral Pleural Invasion Is Not Predictive of Survival in Patients With Lung Cancer and Smaller Tumor Size

Visceral Pleural Invasion Is Not Predictive of Survival in Patients With Lung Cancer and Smaller Tumor Size GENERAL THORACIC Visceral Pleural Invasion Is Not Predictive of Survival in Patients With Lung Cancer and Smaller Tumor Size Elizabeth David, MD, Peter F. Thall, PhD, Neda Kalhor, MD, Wayne L. Hofstetter,

More information

Lung cancer pleural invasion was recognized as a poor prognostic

Lung cancer pleural invasion was recognized as a poor prognostic Visceral pleural invasion classification in non small cell lung cancer: A proposal on the basis of outcome assessment Kimihiro Shimizu, MD a Junji Yoshida, MD a Kanji Nagai, MD a Mitsuyo Nishimura, MD

More information

EVIDENCE BASED MANAGEMENT OF STAGE III NSCLC MILIND BALDI

EVIDENCE BASED MANAGEMENT OF STAGE III NSCLC MILIND BALDI EVIDENCE BASED MANAGEMENT OF STAGE III NSCLC MILIND BALDI Overview Introduction Diagnostic work up Treatment Group 1 Group 2 Group 3 Stage III lung cancer Historically was defined as locoregionally advanced

More information

MEDIASTINAL LYMPH NODE METASTASIS IN PATIENTS WITH CLINICAL STAGE I PERIPHERAL NON-SMALL-CELL LUNG CANCER

MEDIASTINAL LYMPH NODE METASTASIS IN PATIENTS WITH CLINICAL STAGE I PERIPHERAL NON-SMALL-CELL LUNG CANCER MEDIASTINAL LYMPH NODE METASTASIS IN PATIENTS WITH CLINICAL STAGE I PERIPHERAL NON-SMALL-CELL LUNG CANCER Tsuneyo Takizawa, MD a Masanori Terashima, MD a Teruaki Koike, MD a Hideki Akamatsu, MD a Yuzo

More information