Patterns of Surgical Care of Lung Cancer Patients

Little, Alex G.; Rusch, Valerie W.; Bonner, James A.; Gaspar, Laurie E.; Green, Mark R.; Webb, W. Richard; Stewart, Andrew K.

doi:10.1016/j.athoracsur.2005.06.071

Cited by 393 publications

(267 citation statements)

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“…In these patients, limited resections are usually indicated owing to the lower risk of postoperative respiratory failure, perioperative mortality, and long-term disability (24)(25)(26). Given the higher risk of recurrence associated with limited resection, we investigated whether PORT or adjuvant chemotherapy, individually or in combination, are associated with improved patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Adjuvant Treatment for Elderly Patients with Early-Stage Lung Cancer Treated with Limited Resection

Mhango

Bonomi²,

Neugut

et al. 2013

Annals ATS

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Objectives: Limited resection is commonly used for treating older patients with early-stage non-small cell lung cancer (NSCLC) who cannot tolerate lobectomy. However, parenchymal-sparing procedures leave patients at increased risk of recurrence. The role of postoperative radiotherapy (PORT) and chemotherapy after limited resection is not established. Methods:We identified 1,929 patients with stage I-II (<5 cm in size) NSCLC who underwent limited resection (wedge or segmentectomy) from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Using propensity score methods, we compared toxicity and survival of patients treated with limited resection alone, PORT, adjuvant chemotherapy, or PORT and chemotherapy. We conducted secondary analysis stratifying the sample by size (.2-5 cm), stage (IA vs. IB/IIA), and type of limited resection (wedge resection vs. segmentectomy).Measurements and Main Results: Overall, 1,656 (85.8%), 159 (8.3%), 74 (3.8%), and 40 (2.1%) patients were treated with limited resection alone, PORT, adjuvant chemotherapy, or PORT and chemotherapy, respectively. Adjusted analysis using inverse probability weighting showed that PORT (hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.45-1.69), adjuvant chemotherapy (HR, 1.48; 95% CI, 1.36-1.61), and PORT and chemotherapy (HR, 1.73; 95% CI, 1.61-1.86) were associated with worse survival compared with limited resection alone. Similar results were obtained in secondary analyses. Compared with limited resection alone, the adjusted odds ratios for toxicity were 1.97 (95% CI, 1.6-2.4), 3.15 (95% CI, 2.58-3.85), 2.59 (95% CI, 2.0-3.4) for PORT, chemotherapy, and PORT and chemotherapy, respectively.Conclusions: PORT and adjuvant chemotherapy are not beneficial and appear to be associated with increased toxicity and worse survival after limited resection in elderly patients with early-stage NSCLC. Alternative strategies should be explored to improve local control.

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Section: Discussionmentioning

confidence: 99%

Adjuvant Treatment for Elderly Patients with Early-Stage Lung Cancer Treated with Limited Resection

Mhango

Bonomi²,

Neugut

et al. 2013

Annals ATS

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“…(8) This objective has been given considerable weight, as have and the refinement of CS and PS. However, one group of authors, (9) in a series of 11,668 patients submitted to surgical treatment for NSCLC, found that only 27% had been submitted to cervical mediastinoscopy and that, of this group, only 46% had undergone lymph node biopsy. In addition, only 60% of the patients had been submitted IA, 51.6% for IB, 48.2% for IIB, and 33.3% for IIIA.…”

Section: Discussionmentioning

confidence: 99%

Concordância entre os estadiamentos clínico e patológico em pacientes com câncer de pulmão não-pequenas células, estádios I e II, submetidos a tratamento cirúrgico

et al. 2007

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Objective: To compare clinical and pathological staging in patients with non-small cell lung cancer submitted to surgical treatment, as well as to identify the causes of discordance. Methods: Data related to patients treated at the Department of Thoracic Surgery of the Pontifical Catholic University of Rio Grande do Sul São Lucas Hospital were analyzed retrospectively. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for clinical stages IA, IB, and IIB. The kappa index was used to determine the concordance between clinical and pathological staging. Results: Of the 92 patients studied, 33.7% were classified as clinical stage IA, 50% as IB, and 16.3% as IIB. The concordance between clinical and pathological staging was 67.5% for stage IA, 54.3% for IB, and 66.6% for IIB. The accuracy of the clinical staging was greater for stage IA, and a kappa of 0.74, in this case, confirmed a substantial association with pathological staging. The difficulty in evaluating nodal metastatic disease is responsible for the low concordance in patients with clinical stage IB. Conclusions: The concordance between clinical and pathological staging is low, and patients are frequently understaged (in the present study, only one case was overstaged). Strategies are necessary to improve clinical staging and, consequently, the treatment and prognosis of patients with non-small cell lung cancer.

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“…Current evidence suggests that the utilization and sampling of mediastinoscopy is suboptimal. A survey of 729 hospitals (11,668 patients of NSCLC) conducted by the American College of Surgeons in 2001 showed that only 27.1% of patients had preoperative mediastinoscopy and that tissue biopsy material was obtained from <50% of these procedures [27]. A Dutch study from one nonteaching university and three community hospitals reported mediastinoscopy sampling per expected standard in only 40% of cases [28].…”

Section: Cervical Mediastinoscopymentioning

confidence: 99%