No abstract

Background: Lung cancer death rates and incidence in both men and women have decreased over the past two decades. However, certain subsets of non-small cell lung cancer (NSCLC) have arisen with poor outcomes. Identifying factors which contribute to poorer outcomes as well as those that inform early detection strategies remain unmet needs. We present data from a contemporaneous group of NSCLC patients that received care at a single University teaching hospital to understand clinical and pathological factors influencing outcomes in the past decade. Methods: A cohort of 2,289 patients with NSCLC who established care at the Rogel Cancer Center, University of Michigan between January 2011 and April 2019 were identified. Patient characteristics and clinical outcomes were recorded using electronic health records. The Kaplan-Meier method and the Cox proportional model were used to assess relationship between clinic-pathological factors and survival.Results: Of the 2,289 patients, 92% were >50 years of age while 8% were <50 years of age. The majority (70%) of older patients were former smokers. The majority (61%) of younger patients were diagnosed as having Stage IV NSCLC. Among younger patients, 87% had histologically confirmed non-squamous histology. Univariate analysis revealed that overall survival was significantly lower in patients diagnosed with pneumonia prior to the diagnosis of NSCLC than in those who were not diagnosed with pneumonia (1.9 vs. 21.8 months; P<0.001).Multivariate analysis revealed that older patients had poorer survival than younger patients (HR 1.57, 95% CI: 1.10-2.06, P=0.01) and that patients diagnosed with pneumonia prior to their lung cancer diagnosis had poorer survival across all age groups, particularly in those with advanced-stage disease. Conclusions: Findings from this study merit prospective studies to understand cost-benefit ratio of followup cross sectional imaging of all patients diagnosed with unprovoked pneumonia, including in younger non/ current smokers.

We performed a systematic review to determine whether the physical examination can reliably assist in the diagnostic approach for patients suspected of having pulmonary hypertension (PH). Using dual extraction, two investigators independently searched PubMed, Ovid MEDLINE, Cochrane Library, and Embase for studies that compared physical examination findings with a right heart catheterization, from inception until July 10, 2021. We obtained data from four studies that evaluated physical examination findings in patients receiving a right heart catheterization to diagnose PH. Pooled diagnostic odds ratios (DOR) were calculated for right ventricular heave, a loud pulmonic component of the second heart sound (P2), jugular venous pressure (JVP) 3 cm above sternal angle, and a palpable P2.Three physical examination findings had DOR that supports the diagnosis of PH: the JVP > 3 cm above the sternal angle (5.90, 95% CI 2.57, 13.57), a loud P2 (2.91, 95% CI 1.38, 6.10), and a right ventricular heave (2.78, 95% CI 1.12, 6.89). The palpable P2 had a DOR less than one and was not able to be conclusive in diagnosing PH.Our systematic review found a small body of evidence supporting the use of physical examination tests in the diagnostic evaluation of pulmonary hypertension. The JVP > 3 cm above the sternal angle was the most accurate physical examination sign for the diagnosis of PH. Larger cohort studies using a combination of tests may shed more light on the role of the physical examination in the diagnosis and early detection of pulmonary hypertension.