Hilar Node Involvement Research Articles

DARIER-ROUSSY SUBCUTANEOUS SARCOIDOSIS: A CASE-BASED REVIEW

Sarcoidosis is a systemic granulomatous inflammatory condition characterized by varied clinical manifestations, with a higher prevalence observed in individuals aged 25 to 40 and women over 50. Typical presentations involve symmetric involvement of hilar and mediastinal lymph nodes, followed by lung involvement. While initial stages are often asymptomatic, the disease can impact various organs. Cutaneous involvement, observed in up to a quarter of patients, includes lupus pernio, papules, plaques, erythema nodosum, and occasionally subcutaneous nodules. Subcutaneous sarcoidosis, once considered rare, is now increasingly recognized. We present a case of Darier-Roussy sarcoidosis in a middle-aged man, demonstrating multiple painless subcutaneous nodules confirmed through biopsy. Our findings suggest that Darier-Roussy sarcoidosis typically manifests early in the disease course, indicating non-severe systemic involvement. Additionally, our patient responded well to hydroxychloroquine treatment, suggesting a positive outcome.

Omitting Lymph Node Dissection for Small Ground-Glass Opacity–Dominant Tumors

BackgroundThe purpose of this study was to determine the optimal extent of lymph node dissection required in patients with small (≤3 cm) radiologically ground-glass opacity–dominant, peripheral, non-small cell lung cancer tumors. MethodsThe study analyzed the clinicopathologic findings and surgical outcomes of 988 patients with radiologic, ground-glass opacity–dominant non-small cell lung cancer without lymph node involvement who underwent complete resection of the primary tumor between 2010 and 2020. Patients were followed up for 54.5 months (median). Kaplan-Meier curves and the log-rank test were used in statistical analyses of the prognosis. ResultsMedian age, whole tumor size, solid tumor size, and maximum standardized uptake values were 68 years, 1.7 cm, 0.4 cm, and 0.9, respectively. Sixty percent of the cohort was female (n = 590). Wedge resection, segmentectomy, and lobectomy were performed in 206, 372, and 410 patients, respectively. A total of 982 of 988 (99%) tumors were adenocarcinomas. One patient had hilar lymph node involvement; however, no mediastinal lymph node metastasis or hilar or mediastinal lymph node recurrence was detected. The 5-year overall survival rate was 96.5% (95% CI, 94.8%-97.7%). Excellent survival outcomes were achieved regardless of procedure (wedge resection, 94.7% [95% CI, 89.1%-97.5%]; segmentectomy, 96.9% [95% CI, 93.7%-98.5%]; and lobectomy, 97.1% [95% CI, 94.4%-98.5%]). ConclusionsOmitting lymph node dissection may be acceptable with curative intent for small tumors with radiologic ground-glass opacity dominance. Appropriate surgical procedures such as wedge resection, segmentectomy, or lobectomy can provide satisfactory outcomes in patients with indolent tumors if surgical margins are secured.

Mediastinal lymphadenopathy in sarcoidosis: Can diffusion MRI play a role in its evaluation?

BackgroundSarcoidosis is a multisystem disease defined by non-caseous epithelioid cell granulomas that can affect virtually all organs. Lung, mediastinal and hilar lymph node involvement is prevalent, occurring in around 90% of the patients, and is responsible for the majority of the morbidity and mortality related to the disorder. Sarcoidosis is one of the differential diagnoses of the benign mediastinal lymphadenopathy. This research aimed to detect the diagnostic value of magnetic resonance imaging (MRI) diffusion in evaluation of mediastinal lymphadenopathy in sarcoid patients.ResultsThis cross study involved a total of 30 patients known to have sarcoidosis: 6 males and 24 females aged between 18 and 50 years (with a mean age 38.97 ± 8.67); all of them presented with mediastinal lymphadenopathy. For all patients, each lymph node group was evaluated for the average size and average ADC value. The mean ADC measured was (1.76 ± 0.28) × 10−3 mm2/s. Eight patients showed concurrent activity with poor response to the treatment, and they showed different ADC values with one of them showing low ADC with pattern of diffusion restriction displaying mean ADC value of 1.28 × 10−3 mm2/s.ConclusionsDiffusion-weighted MRI is an established imaging technique that could be utilized to evaluate mediastinal lymphadenopathy in sarcoidosis as the benign counterpart of mediastinal lymphadenopathy.

Selective Mediastinal Lymph Node Dissection Strategy for Clinical T1N0 Invasive Lung Cancer: A Prospective, Multicenter, Clinical Trial

IntroductionWe aimed to prospectively evaluate our previously proposed selective mediastinal lymph node (LN) dissection strategy for peripheral clinical T1N0 invasive NSCLC. MethodsThis is a multicenter, prospective clinical trial in China. We set six criteria for predicting negative LN stations and finally guiding selective LN dissection. Consolidation tumor ratio less than or equal to 0.5, segment location, lepidic-predominant adenocarcinoma (LPA), negative hilar nodes (stations 10–12), and negative visceral pleural invasion (VPI) were used separately or in combination as predictors of negative LN status in the whole, superior, or inferior mediastinal zone. LPA, hilar node involvement, and VPI were diagnosed intraoperatively. All patients actually underwent systematic mediastinal LN dissection. The primary end point was the accuracy of the strategy in predicting LN involvement. If LN metastasis occurred in certain mediastinal zone that was predicted to be negative, it was considered as an “inaccurate” case. ResultsA total of 720 patients were enrolled. The median number of LN dissected was 15 (interquartile range: 11–20). All negative node status in certain mediastinal zone was correctly predicted by the strategy. Compared with final pathologic findings, the accuracy of frozen section to diagnose LPA, VPI, and hilar node metastasis was 94.0%, 98.9%, and 99.6%, respectively. Inaccurate intraoperative diagnosis of LPA, VPI, or hilar node metastasis did not lead to inaccurate prediction of node-negative status. ConclusionsThis is the first prospective trial validating the specific mediastinal LN metastasis pattern in cT1N0 invasive NSCLC, which provides important evidence for clinical applications of selective LN dissection strategy.

Low-Grade Primary Splenic CD10-Positive Small B-Cell Lymphoma/Follicular Lymphoma.

Primary splenic lymphoma (PSL) is a rare malignancy representing about 1% of all lymphoproliferative disorders, when using a strict definition that allows only involvement of spleen and hilar lymph nodes. In contrast, secondary low-grade B-cell lymphomas in the spleen, such as follicular lymphomas (FL), lymphoplasmacytic lymphoma and chronic lymphocytic leukemia/ small lymphocytic lymphoma, particularly as part of advanced stage disease, are more common. Indolent B cell lymphomas expressing CD10 almost always represent FL, which in its primary splenic form is the focus of this review. Primary splenic follicular lymphoma (PSFL) is exceedingly infrequent. This type of lymphoproliferative disorder is understudied and, in most cases, clinically characterized by splenomegaly or cytopenias related to hypersplenism. The diagnosis requires correlation of histopathology of spleen, blood and/or bone marrow with the correct immunophenotype (determined by flow cytometry and/or immunohistochemistry) and if necessary, additional molecular profiling. Management of this incurable disease is evolving, and splenectomy remains the mainstream treatment for stage I PSFL.

Prognostic nomogram incorporating radiological features for predicting overall survival in patients with AIDS-related non-Hodgkin lymphoma.

Background:Acquired immune deficiency syndrome (AIDS)-related non-Hodgkin lymphoma (AR-NHL) is a high-risk factor for morbidity and mortality in patients with AIDS. This study aimed to determine the prognostic factors associated with overall survival (OS) and to develop a prognostic nomogram incorporating computed tomography imaging features in patients with acquired immune deficiency syndrome-related non-Hodgkin lymphoma (AR-NHL).Methods:A total of 121 AR-NHL patients between July 2012 and November 2019 were retrospectively reviewed. Clinical and radiological independent predictors of OS were confirmed using multivariable Cox analysis. A prognostic nomogram was constructed based on the above clinical and radiological factors and then provided optimum accuracy in predicting OS. The predictive accuracy of the nomogram was determined by Harrell C-statistic. Kaplan–Meier survival analysis was used to determine median OS. The prognostic value of adjuvant therapy was evaluated in different subgroups.Results:In the multivariate Cox regression analysis, involvement of mediastinal or hilar lymph nodes, liver, necrosis in the lesions, the treatment with chemotherapy, and the CD4 ≤100 cells/μL were independent risk factors for poor OS (all P < 0.050). The predictive nomogram based on Cox regression has good discrimination (Harrell C-index = 0.716) and good calibration (Hosmer–Lemeshow test, P = 0.620) in high- and low-risk groups. Only patients in the high-risk group who received adjuvant chemotherapy had a significantly better survival outcome.Conclusion:A survival-predicting nomogram was developed in this study, which was effective in assessing the survival outcomes of patients with AR-NHL. Notably, decision-making of chemotherapy regimens and more frequent follow-up should be considered in the high-risk group determined by this model.

A modified pathological N1 classification strategy based on the systematic dissection of N1 nodes for non-small cell lung cancer

The Tumor, Node, Metastasis (TNM) staging system has been adopted by the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC) for approximately 50 years. The N1 descriptor has rarely been modified since it was first proposed. Nevertheless, heterogeneity of the N1 disease should be prioritized because the survival outcomes vary greatly in N1 cohort. It has been discovered that prognostic differences exist between various patterns of N1 lymph node metastasis in previous studies. However, the absence of stations 13/14 lymph nodes data has always been an urgent problem to be solved. On the premise of complete intrapulmonary lymph node retrieval, based on the clinical experience our team had accumulated, we used subcategories within the N1 descriptor based on the location of involved N1 lymph nodes. We defined new N1a as involvement of peripheral zone lymph nodes (stations 12-14), and new N1b as involvement of hilar zone lymph nodes (stations 10-11). This new system could improve the ability to identify the heterogeneity of N1 disease. We propose that this modified classification strategy can be used as a more effective N1 descriptor.

Spanish Lung Cancer Group SCAT trial: surgical audit to lymph node assessment based on IASLC recommendations

BackgroundThe Spanish Customized Adjuvant Therapy (SCAT) trial assessed the role of individualized adjuvant therapy in clinical N0 incidental pN1 and/or N2 non-small cell lung cancer (NSCLC) completely resected. We assessed surgical topics with an in-depth analysis of quality of lymphadenectomy based on International Association for the Study of Lung Cancer (IASLC) recommendations.MethodsPatients with information about lymphadenectomy available were included (N=451). Prospectively collected data about tumor, type of resection, and postoperative morbidity and quality of lymph node dissection (LND) were retrospectively evaluated. Role of lymph node assessment on survival was analyzed using Kaplan-Meier curves, using regression models to identify prognostic factors.ResultsIn 33.7%, 17.7% and 49.9% of cases, regions 7, 10 and 11 respectively were not assessed. In 21.1% of patients, less than three lymph node regions were biopsied, while in 19.6% of patients less than six lymph nodes were assessed. In 53,4% of patients only one N1 region was evaluated. From patients with positive N2, 8.9% had no N1 regions biopsied. Twenty-nine percent of patients with at least one N2 lymph node resected shown the highest region involved. Thirty-day postoperative mortality was unknown. Five-year overall survival (OS) was 61.7% (95% CI: 55.4–67.4%), 51.5% (95% CI: 39.2–62.4%) and 42.3% (95% CI: 32.1–52.2%) for patients with N1, N2 and N1+N2 disease, respectively (P<0.01). Both number of lymph nodes resected and number of lymph nodes involved by tumor were significantly related to prognosis.ConclusionsIASLC recommendations for surgical resections were not followed in a high proportion of surgical procedures. Hilar and mediastinal lymph node assessment and involvement showed to impact prognosis. Surgical issues such as postoperative mortality could not be evaluated owing to trial design.

Renal neoplasia with papillary architecture involving the pelvicalyceal system

Pelvicalyceal system (PS) involvement by renal cell carcinoma (RCC) is staged as pT3a disease (American Joint Committee on Cancer [AJCC], 8th edition). As papillary RCC (PRCC) has been infrequently represented in studies looking at the prognostic impact of PS involvement, we reviewed our institutional cohort of 8225 cases for PS involvement by PRCC. Nine such cases were subjected to histopathologic review and immunohistochemistry. Fluorescence in situ hybridization for TFE3/TFEB alterations was performed if indicated. One case each (1 of 9, 11%) was classified as TFE3-rearranged and FH-deficient RCC. The majority were high grade (World Health Organization/International Society of Urologic Pathology grade 3: 8 of 9, 89%) or had features of aggressive disease, including hilar fat (6 of 9, 67%) and regional lymph node involvement (5 of 7, 71%). One low-grade 3.3-cm tumor with isolated PS involvement with a germline heterozygous FH p.Lys477dup alteration with retained FH, lack of increased S-(2-succino)-cysteine expression, BRAF V600E immunohistochemistry positivity, and lack of trisomy 7/17 on chromosomal microarray was identified, arguing against an FH-deficient and conventional PRCC. Our study shows that PS involvement by renal neoplasia with papillary architecture is a rare event. Aside from PRCC, it is important to note that these may include other aggressive and nonaggressive subtypes of renal neoplasia with papillary architecture. One case of isolated PS involvement by a low-grade, noninvasive tumor that we refer to as nephrogenic papillary neoplasmwas identified. At present, there are insufficient data to stage such tumors as pT3a (AJCC, 8th edition), and additional studies are needed to address this question.

Robotic surgery for thoracic surgery

SummaryIndications for the use of RATS vary between the facilities but correspond as far as possible to other minimally invasive surgical findings. In general, RATS is currently a therapeutic option for the management of early-stage NSCLC without mediastinal lymph node involvement in oncological surgery, although depending on the planned intervention and the surgical facility, hilar lymph node involvement may be accepted

Surgical treatment of pulmonary metastases in metastatic renal cell carcinoma

Between 20 and 30 % of patients diagnosed with renal cell carcinoma suffer from metastatic disease by the time of diagnosis and a further 20 - 30 % develop metachronous metastases after initial treatment with curative intent. The therapeutic landscape of metastatic renal cell carcinoma seems be changing rapidly, with new systemic therapies or combination therapies available and established concepts being questioned because of long-awaited data. Apart from systemic therapy, metastases can be treated by surgical resection. As the most common site of metastases in renal cell carcinoma, the lung plays an important role in local treatment. Pulmonal metastasectomy is a safe procedure with low morbidity and mortality in the "right" patients. Nevertheless, there are only data from retrospective non-randomised comparative studies, which seem to show that complete metastasectomy is associated with a better prognosis and overall survival of patients. Patients with a solitary pulmonal metastasis, without involvement of hilar or mediastinal lymph nodes and a long disease-free interval after primary therapy, might benefit the most from surgery. Repeated metastasectomy can also be performed, although the data are sparse - which emphasises the need for interdisciplinary case discussions and individual therapy, as recommended in primary metastasectomy.

Robotic Approach Offers Similar Nodal Upstaging to Open Lobectomy for Clinical Stage I Non-small Cell Lung Cancer

Appropriate nodal dissection during pulmonary resection improves pathologic staging accuracy. Detection of unexpected nodal metastases can be a surrogate for nodal dissection adequacy and reflect oncologic resection quality. The goal of this study was to determine whether robotic lobectomy carries worse, same, or better incidence of nodal upstaging as open lobectomy for clinical stage I non-small cell lung cancer (NSCLC). Data for patients with clinical stage I NSCLC (≤cT2a N0 M0, American Joint Committee on Cancer, 7th Edition) who underwent lobectomy from 2010 through 2015 were abstracted from the National Cancer Database (NCDB). Propensity score matching was performed for robotic (n= 7452) and open (n= 50,186) approaches. Primary outcomes were the number of lymph nodes examined and incidence of nodal upstaging, defined as unexpected hilar or mediastinal lymph node involvement. Secondary outcomes included resection margins and overall survival. Matching generated 7452 well-matched pairs. There were no differences in nodal upstaging between robotic and open procedures (820 [11.0%] vs 863 [11.6%], P= .28), despite more examined lymph nodes in the robotic group (10 vs 8, P < .001). Incidence of positive margins (145 [2.0%] vs 178 [2.4%], P= .071) was similar. The robotic group had lower 30-day (73 [1.3%] vs 105 [1.9%], P= .02) and 90-day mortality (125 [2.3%] vs 188 [3.5%], P < .001). The 5-year overall survival was similar between both groups (65.6% vs 66.7%, log-rank P= .25). Robotic lobectomy for clinical stage I NSCLC is an equivalent to open lobectomy as assessed by similar nodal upstaging rates, completeness of resection, and overall survival. This suggests that the robotic technology has been adopted appropriately in early-stage NSCLC.

Segment Location and Ground Glass Opacity Ratio Reliably Predict Node-Negative Status in Lung Cancer

Although selective mediastinal lymph node dissection based on lobe-specific nodal metastasis has been proposed for non-small cell lung cancer, controversy remains over its validity. We hypothesized that different segments within the same lobe might have different patterns of lymph node metastasis. Data on 2749 invasive non-small cell lung cancer patients who underwent pulmonary resection with systematic lymph node dissection from April 2008 to December 2015 were retrospectively analyzed. The segment location and consolidation tumor ratio were identified using preoperative computed tomography scans. None of the 151 tumors with consolidation tumor ratio ≤ 0.5 had lymph node involvement. None of the 333 tumors located in apical segments had inferior mediastinal lymph node metastasis. When the analysis was limited to patients without hilar nodes involvement, only 7 out of 740 (0.9%) peripheral upper lobe tumors had inferior mediastinal lymph node metastasis. Interestingly, all these 7 tumors showed visceral pleural invasion. If hilar nodes were negative, superior mediastinal lymph node metastasis was not present for lower lobe ground glass opacity lesions. Among patients with left lower lobe tumors, if hilar nodes were negative, station 4L lymph node metastasis was not found in superior-segment or basal-segment tumors, and station 5/6 lymph node involvement was always absent in basal-segment tumors. Segment location, ground glass opacity proportion, and absence of hilar lymph nodes involvement are reliable predictors of node-negative status in specific mediastinal regions. Based on these findings, we propose a new selective mediastinal lymph node dissection strategy for non-small cell lung cancer.

Surgical Resection of SCLC: Prognostic Factors and the Tumor Microenvironment

IntroductionSurgery in SCLC is limited to very early stages, but several reports suggest a potential broader role. Little is known of the influence of microenvironment on the biology of SCLC. MethodsWe assessed the clinical prognostic factors in a large series of resected SCLC patients. The prognostic value of programmed cell death ligand 1 (PD-L1) expression in tumor cells and tumor infiltrating lymphocytes (TILs) and the percentage of CD3-, CD20-, CD45- and CD68-positive cells, were also investigated. ResultsTwo hundred five SCLC cases were resected between 2005 and 2015 and the median follow-up was 29 months (range: 2 to 135 months). Median survival of all patients was 69 months, and 5-year survival rates were 63.8%, 65.5%, 34.9%, and 0% for pathologic stages I, II, III, and IV, respectively. By multivariate analysis complete resection, cigarette index, lymph node metastatic rate, percentage of CD3-positive cells, PD-L1 expression in tumor cells, and TILs were independent prognostic factors. High PD-L1 expression was present in 3.2% and 33.5% of all tumor samples in tumor cells and TILs, respectively. High PD-L1 expression in tumor cells or TILs correlated with shorter survival, whereas high expression of CD3, CD20, and CD45 correlated with better survival. ConclusionsResected stage II SCLC patients have similar survival as stage I, suggesting that surgery could be extended to patients with hilar lymph node involvement. Survival was better in tumors with a higher percentage of T cells and B cells, whereas PD-L1 expression in tumor cells and TILs correlated with worse survival, which suggests a potential role of immunotherapy in resected SCLC.

The imaging features and prognosis of primary central airway salivary gland-type tumor

Objective To analyze the image features and prognosis of primary central airway salivary gland-type tumor (SGT). Methods The clinical and imaging data of 25 cases with SGT confirmed by histopathology were retrospectively analyzed in our hospital from October 2009 to November 2017. Follow up of patients for survival was performed. Among 25 cases of SGT, there were 14 cases of adenoid cystic carcinoma (ACC), ten cases of mucoepidermoid carcinoma (MEC) and one case of mucoepidermoid carcinoma (EMC). All cases had non-enhanced CT scans (among which 20 cases underwent CT scan with contrast). Post-processing were performed to evaluate the location, range, density, degree of enhancement of the lesions and involvement of hilar or mediastinal lymph nodes. Eight cases underwent PET/CT imaging and one underwent MR imaging, respectively. Independent sample t test was used to compare difference in ages between ACC group and MEC group. Nonparametric test was performed to compare difference in tumor′s diameter between ACC group and MEC group. Comparison of genders, history of smoking, tumor-node-metastasis (TNM) stage and CT features between ACC group and MEC group were tested using Fisher′s exact tests. Survival was calculated using the Kaplan-Meier method, and the survival curves were compared by the log-rank test. Results Compared to MEC, patients with ACC were older. There were significant difference between the two groups (t=3.154, P<0.05). ACC tended to involved trachea or main bronchi (13/14) while MEC were mostly located at lobar or segment bronchi (6/10). The shape of ACC tumors were mainly lobulated or presented as circumferential wall thickening (13/14), while MECs were smoothly oval (7/10). On contrast-enhanced CT scans, ACC mainly showed mild or moderate enhancement (9/10), While most of MEC had shown avid enhancement (8/10). CT findings suggestive of airway obstructive disease were seen more with MEC (9/10) than ACC (4/14). There were significant differences of the above CT features between ACC and MEC group (P<0.05). A case of EMC in an 43 years old female presented rounded nodule in tracheal; The SUVmax in 6 of 8 cases of PET/CT exceeded 2.2; Overall survival (OS) was 87.5% in all cases. No significant difference was found between ACC and MEC groups regarding OS (χ2=0, P=1.000). Ages, surgical and nonsurgical patients and TNM stage were found to be related to OS (χ2=13.799, 13.799, 13.171, respectively, P<0.05). Conclusions Primary central airway salivary gland-type tumors are commonly occurred in patients at a low age, with weak invasive feature and good prognosis. The predominant site and CT characteristics between ACC and MEC were significantly different. Key words: Salivary gland neoplasms; Tomography, X-ray computed; Magnetic resonance imaging; Prognosis

Decadal Experience of Renal Cell Carcinoma from a Tertiary Care Teaching Institute in North India.

To study the current trends of renal cell carcinoma (RCC) in terms of demographic characteristics, clinical presentation, staging, mode of management, histopathology, and survival characteristics from a high volume tertiary care teaching institute in North India. We retrospectively reviewed the records of all patients of RCC between January 2006 and December 2015 and variables like age, gender, symptoms, tumor size/location/number, stage, type of surgery, histopathology, and survival characteristics were studied. One hundred forty-four patients were included in the study. Most common age group of presentation was 50-59years (29.8%), male to female ratio was 2.5, and majority of cases were smokers. Flank pain was the most common presenting complaint (38.2%), classical triad (pain, fever, hematuria) was present in 25%, and incidental diagnosis was made in 11.1% cases. Stage T2a was most common presentation with majority of tumors present in upper pole (27.1%). Renal vein involvement (T3a) was present in 10.4%, hilar lymph node involvement in 25%, and distant metastasis was observed in 20.1% cases. Radical nephrectomy was most common surgery performed (75%) and clear cell carcinoma was the most common histopathology (75.7%) followed by papillary (11.1%). Women reported more chromophobe type and low-grade cancers, although rest of clinico-pathological features did not show any gender difference. Mean follow-up of the study was 6-122months with younger (< 29years) patients reporting lower 5-year survival and higher stage disease. Renal cell carcinoma shows a different trend in our study population, compared to western data, with large size tumors and advanced stage presentation being more common.

Pathological lymph node involvement is not a predictor of adverse outcomes in patients undergoing thoracoscopic lobectomy for lung cancer

OBJECTIVES As the practice of video-assisted thoracoscopic surgery (VATS) lobectomy gains widespread acceptance, the complexity of procedures attempted increases and the stage of tumour that may be safely approached remains controversial. We examined the impact of nodal involvement with respect to perioperative outcomes after VATS lobectomy. METHODS All patients listed for VATS lobectomy for non-small-cell lung cancer at our institution from 2012 to 2016 were analysed. Bronchoplastic or chest wall resections and tumours over 7 cm were considered a contraindication to a thoracoscopic approach. RESULTS Of the 489 patients identified, 97 (19.8%) patients had pathological nodal involvement. The overall conversion rate was 6.1%, reoperation rate was 5.3% and readmission rate was 5.9%. Median hospital stay was 5 days, 30-day mortality was 0.6% and 90-day mortality was 1.6%. No significant difference was identified between the nodal-negative or -positive groups in terms of preoperative demographics, hospital stay, postoperative complications, conversion rate, reoperation rate or readmission rate. Univariate logistic regression identified gender, Thoracoscore, dyspnoea score, performance status, chronic obstructive pulmonary disease, previous stroke, preoperative lung function and non-adenocarcinoma as predictors of postoperative complications. A multivariate model including nodal status identified Thoracoscore (odds ratio 1.57, 95% confidence interval 1.16-2.18; P < 0.001) and preoperative transfer factor (odds ratio 0.97, 95% confidence interval 0.96-0.98; P < 0.001) as the only predictors of complications. CONCLUSIONS In non-small-cell lung cancer patients with pathological hilar or mediastinal lymph node involvement, VATS lobectomy can be safely performed, as there does not appear to be an adverse effect on the incidence of perioperative complications, length of stay or readmissions.

Peritoneum as the sole distant metastatic site of lung adenosquamous cell carcinoma: a case report

BackgroundPeritoneum metastasis of lung cancer is a rare event which, in addition to the peritoneum, usually involves multiple metastatic tissues. Here we report a case of a patient with lung adenosquamous cell carcinoma with the peritoneum as the sole distant metastatic site.Case presentationAn 82-year-old Han Chinese man, in the teaching profession, was diagnosed with lung adenosquamous cell carcinoma in the upper lobe of his left lung with the involvement of ipsilateral hilar and mediastinal lymph nodes, and was initially staged as IIIa (cT2N2M0). Molecular testing identified a mutation at KRAS G12A. Due to his poor physical condition, our patient was given gamma knife radiotherapy with a total dose of 28.0 Gy. Two weeks later, our patient was diagnosed as peritoneal metastasis identified by using magnetic resonance imaging and confirmed with ascitic cytology and peritoneal histology. No other distant metastatic sites such as liver, brain, bone, paranephroi, and lungs were found. Subsequently, our patient received palliative intraperitoneal chemotherapy, and died within 2 months.ConclusionsOur patient represented a rare case of lung adenosquamous cell carcinoma harboring the KRAS G12A mutation, which metastasized distantly to the peritoneum only, and progressed rapidly.

Pathological lymph node involvement is not a predictor of adverse outcomes in patients undergoing thoracoscopic lobectomy for lung cancer†.

As the practice of video-assisted thoracoscopic surgery (VATS) lobectomy gains widespread acceptance, the complexity of procedures attempted increases and the stage of tumour that may be safely approached remains controversial. We examined the impact of nodal involvement with respect to perioperative outcomes after VATS lobectomy. All patients listed for VATS lobectomy for non-small-cell lung cancer at our institution from 2012 to 2016 were analysed. Bronchoplastic or chest wall resections and tumours over 7 cm were considered a contraindication to a thoracoscopic approach. Of the 489 patients identified, 97 (19.8%) patients had pathological nodal involvement. The overall conversion rate was 6.1%, reoperation rate was 5.3% and readmission rate was 5.9%. Median hospital stay was 5 days, 30-day mortality was 0.6% and 90-day mortality was 1.6%. No significant difference was identified between the nodal-negative or -positive groups in terms of preoperative demographics, hospital stay, postoperative complications, conversion rate, reoperation rate or readmission rate. Univariate logistic regression identified gender, Thoracoscore, dyspnoea score, performance status, chronic obstructive pulmonary disease, previous stroke, preoperative lung function and non-adenocarcinoma as predictors of postoperative complications. A multivariate model including nodal status identified Thoracoscore (odds ratio 1.57, 95% confidence interval 1.16-2.18; P < 0.001) and preoperative transfer factor (odds ratio 0.97, 95% confidence interval 0.96-0.98; P < 0.001) as the only predictors of complications. In non-small-cell lung cancer patients with pathological hilar or mediastinal lymph node involvement, VATS lobectomy can be safely performed, as there does not appear to be an adverse effect on the incidence of perioperative complications, length of stay or readmissions.

Low dose palliative radiotherapy for refractory aggressive lymphoma

AimTo determine the efficacy of low-dose palliative radiotherapy in patients with refractory aggressive lymphoma. BackgroundThere are few reports on the administration of palliative radiotherapy to patients with aggressive lymphoma. Materials and methodsThe present study included 11 patients with 30 sites of aggressive lymphoma (diffuse large cell lymphoma, n=7; mantle cell lymphoma, n=2; follicular large cell lymphoma, n=1; and peripheral T cell lymphoma, n=1). The patients received local palliative radiotherapy after receiving a median of 4 chemotherapy regimens. The radiotherapy doses administered to the 30 sites were as follows: 8Gy, single fraction (n=27); 6Gy, single fraction (n=1); 4Gy, single fraction (n=1); and 4Gy, 2 fractions (n=1). ResultsThe complete response rate was 45% (5/11); the partial response rate was 36% (4/11). Toxicity occurred at one irradiated site (the mandibular), which showed temporal acute gingivitis; however, medication was not required. Retreatment was required for 3 sites on the head (parotid, face and mandible) due to persistent discomfort. None of the other sites (27/30) required retreatment. A patient with refractory DLBCL underwent radiotherapy (4Gy, single fraction) for hepatic hilar lymph node involvement but did not recover from jaundice and died of DLBCL. ConclusionsEight Gray single fraction radiotherapy was one of meaningful options for the treatment of refractory aggressive lymphoma in terms of its efficacy and the incidence of adverse events. The use of 8Gy single fraction radiotherapy is therefore recommended for achieving local control in patients with refractory aggressive lymphoma.