Primary Lung Cancer Group Research Articles

A Retrospective Analysis Comparing VATS Cost Discrepancies and Outcomes in Primary Lung Cancer vs. Second Primary Lung Cancer Patients.

This study aimed to compare the outcomes and cost differences between primary lung cancer (PLC) and second primary lung cancer (SPLC) patients who underwent video-assisted thoracoscopic surgery (VATS). This was a retrospective analysis of 124 patients with lung cancer stages I, II, and III who underwent VATS between January 2018 and January 2023. The patients were divided into two groups based on their cancer status that was matched by age and gender: the PLC group (n = 62) and the SPLC group (n = 62). The results showed that there was no significant difference in the clinical characteristics between the 2 groups, except for the Charlson Comorbidity Index (CCI), with a score above 3 in 62.9% of PLC patients and 80.6% among SPLC patients (p = 0.028). Regarding the surgical outcomes, the operative time for the VATS intervention was significantly higher in the SPLC group, with a median of 300 min, compared with 260 min in the PLC group (p = 0.001), varying by the cancer staging as well. The average duration of hospitalization was significantly longer before and after surgery among patients with SPLC (6.1 days after surgery), compared with 4.2 days after surgery in the PLC group (0.006). Regarding the cost analysis, the total hospitalization cost was significantly higher in the SPLC group (15,400 RON vs. 12,800 RON; p = 0.007). Lastly, there was a significant difference in the survival probability between the two patient groups (log-rank p-value = 0.038). The 2-year survival was 41.9% among PLC patients and only 24.2% among those with SPLC. At the 5-year follow-up, there were only 1.6% survivors in the SPLC group, compared with 11.3% in the PLC group (p-value = 0.028). In conclusion, this study found that VATS is a safe and effective surgical approach for both PLC and SPLC patients. However, SPLC patients have a higher VATS operating time and require more healthcare resources than PLC patients, resulting in higher hospitalization costs. These findings suggest that careful pre-operative evaluation and individualized surgical planning are necessary to optimize the outcomes and cost-effectiveness of VATS for lung cancer patients. Nevertheless, the 5-year survival remains very low and concerning.

Early surgical and oncological outcomes during adoption of a single port VATS lung resection in a tertiary cancer center: a retrospective analysis

BackgroundVideo-assisted thoracoscopic surgery (VATS) is a safe and effective surgical approach for pulmonary resection. VATS can be accomplished with only a single incision, resulting in less postoperative pain and paresthesia, better cosmetic results, and greater patient satisfaction. Single-port VATS (spVATS) has become increasingly common for lung resection. We assess the early surgical and oncological outcomes after adopting this new technique at our tertiary cancer center as the first institution to do so in the country.MethodMedical records for 257 patients in a tertiary cancer center, with a diagnosis of non-small cell lung cancer, pulmonary metastasis, or other chest-confined pathology, were accessed to obtain perioperative outcomes, pathologic results, post-operative follow-up data, and early surgical and oncological outcomes. All patients underwent spVATS for limited or major lung resection. Simple descriptive analysis was utilized.ResultsspVATS was either performed with curative intent (79.8%, N = 205), or as a diagnostic procedure (20.2%, N = 52). Resection types were subcategorized for curative intent group as limited (73.6%, N = 151), lobectomy (16.6%, N = 34), and complex (9.7%, N = 20). Resection with a negative margin (R0) rate was 100% for the primary lung cancer (PLC) patients and 97% for the pulmonary metastasectomy (PM) group. The complication rate was 5%. Three-year disease-free survival was 87% and 68.5% for PLC and PM group, respectively. The 3-year overall-survival was 91.3% for the PLC and 82.8% for PM. Operation duration showed a downtrend over the study period in each curative subcategory with a borderline difference in the limited resection (P value = 0.05).ConclusionAll the spVATS procedures were successfully performed without perioperative severe complications or mortality, regardless of complexity. R0 resection was excellent. Middle- and long-term efficacies of spVATS for lung cancer require further follow-up. With proper training, appropriate indication and meticulous application, adopting spVATS is safe and feasible technique that does not compromise surgical and oncological outcomes.

Surgical outcomes of second primary lung cancer after the extrapulmonary malignancy.

To study the surgical outcomes of patients with a second primary lung cancer after the extrapulmonary malignancy. Patients who underwent surgical resection for lung cancers between January 2005 and December 2014 were reviewed. Clinical data, imaging characteristics of tumors, surgical approaches, and outcomes were analyzed with a mean follow-up of 97months. Of 1075 patients, 166 (15.4%) had a second primary lung cancer after extrapulmonary malignancy. There were no differences in overall 5-year survival rates (81.8% for the group of lung cancer vs. 72.9% for the second primary lung cancer group, p = 0.069) and 5-year disease-free survival (70.1% for the lung cancer group vs. 70.3% for the second primary lung cancer group, p = 0.863) between the two groups. Gender, performance status, tumor size, and maximum standard uptake value (SUVmax) were significantly different between the two groups. After propensity-score matching analysis, patients in the group with lung cancers had better 5-year overall survival (88.1% vs. 72.1% for the group with second primary lung cancers, p = 0.016) and 5-year disease-free survival (80.6% vs. 70.3% for the group with second primary lung cancers; p = 0.054). In the second primary lung cancer group, the patients with preceding breast or thyroid cancers had better prognoses than did those with other extrapulmonary malignancy. Second primary lung cancers following extrapulmonary malignancies were not uncommon. Surgical resection is considered for early stage secondary primary lung cancer after meticulous work up and result in fair outcome.

Characteristics of metachronous second primary lung cancers

AIM: In this study, we aimed to investigate the characteristics of metachronous second primary lung cancer (MSPLC) and the differences between primary lung cancer (PLC) and metachronous lung cancer. MATERIALS AND METHODS: Patients diagnosed with lung cancer between January 2014 and December 2016 were retrospectively studied. MSPLC tumor cases and a new diagnosis of PLC were evaluated. Clinical, radiological, and demographic findings of the two groups, previous histopathologic diagnosis of MSPLC, histopathologic diagnosis of lung cancer in both groups, stages of treatment, and treatment history were recorded. All data were analyzed using the Chi-square, t-test, Kaplan–Meier, and Log-rank method. In all tests, P RESULTS: There were 53 (16.1%) cases in MSPLC group and 277 (83.9%) cases in the PLC group. There were no statistically significant differences between clinical, radiological, and demographic findings, cancer histopathologies, tumor stages, oncological, and surgical treatment characteristics of the cases (P > 0.05). The most frequent primary cancers were laryngeal carcinoma (11 cases) in the MSPLC group, with higher age (64 and 61, P = 0.01, respectively). Tumor size was smaller (44 mm and 52 mm, respectively) than the PLC group (P = 0.03). All other characteristics of both groups (P > 0.05) and survival were similar (15 months and 17 months, P = 0.87, respectively). CONCLUSION: Among the lung cancers diagnosed in our clinic, 16% were detected as MSPLC. MSPLC group were older than the PLC group and tumor size is lower than the PLC group. There was no significant difference in treatment options and survival between the two groups.

Single-port video-assisted thoracic surgery in 1063 cases: a single-institution experience

Single-port video-assisted thoracic surgery (VATS) technique has been used for thoracic diseases. There was no report about single-port VATS in large series. Outcomes following single-port VATS were analysed to determine its efficacy and safety. From June 2012 to June 2014, 1063 single-port VATSs were performed by four surgeons. Patient demographics, perioperative parameters, histopathology and outcomes were analysed. There were 1063 patients (524 men and 539 women). The median age was 56.1 ± 8.7 years (range, 15-86 years). Lobectomy was performed in 569 patients, segmentectomy in 162, wedge resection in 264, pleural biopsy in 7, drainage of effusion in 20, pleural tumour resection in 5, mediastinal tumour resection in 54, mediastinal tumour biopsy in 2, bilobectomy in 7, sleeve lobectomy in 3 and pneumonectomy in 2. Synchronous bilateral single-port VATS was performed in 27 cases, whereas metachronous bilateral single-port VATS was performed in 5 cases. Pathological diagnoses included primary lung cancer in 635 cases, metastatic lung cancer in 19, mediastinal tumour in 56, pleural disease in 32 and benign pulmonary conditions in 353. Fifteen intraoperative vascular injuries were identified in 15 patients. The total conversion rate was 4.6%. The average operation time was 135 ± 31 min (range, 30-230 min), and the average blood loss was 117 ± 47 ml (range, 50-2000 ml). The median intensive care unit stay was 1 day (0-4 days). The postoperative hospital stay was 6.2 ± 2.6 days on average. There was no operative death, and operative complications occurred in 59 patients (5.6%). The 1-year overall survival and 1-year disease-free survival for the primary lung cancer group were 98 and 96%, respectively. Our findings indicate that single-port VATS for thoracic diseases is safe and feasible.

Abstract No. 291: Radiofrequency ablation of the lung tumors can be safely performed in patients previously treated with radiation therapy

Abstract No. 291: Radiofrequency ablation of the lung tumors can be safely performed in patients previously treated with radiation therapy

Abstract P6-03-05: An Approach for the Differential Diagnosis of Primary Lung Cancer and Breast Cancer Relapse Presenting as a Solitary Pulmonary Nodule in Patients after Breast Surgery

Abstract Background: The distinction of primary lung cancer from metastatic breast cancer is crucial in patients presenting with a solitary pulmonary nodule after breast surgery. However definitive diagnosis of these nodules is often difficult due to similar radiological and pathological features in primary lung and metastatic breast cancer nodules. We assessed the feasibility of our diagnostic approach for these nodules by morphopathological and immunohistochemical examination, and estimated the frequency of primary lung cancer occurrence in breast cancer patients. Material and Methods: We evaluated solitary pulmonary nodules appearing in 24 patients (0.62% : 24/3851) after breast surgery between 1994 and 2006. Patients with metastases to organs other than lungs were not included. For histological examination, CT-guided core needle biopsy (CT-CNB), trans-bronchial lung biopsy (TBLB), or surgical resection was performed. Besides conventional morphopathological examination using HE staining, differential diagnosis was performed by immunohistochemical examination (thyroid transcription factor-1: TTF-1, surfactant pro-protein B: SPPB, estrogen receptor: ER, mammaglobin1: MGB1). The immunopositive results for TTF-1 and SPPB support the specimen diagnosis of primary lung cancer. The immunopositive and immunonegative results for ER and both TTF-1 and SPPB, respectively, suggest that the specimen has a high probability of being metastatic breast cancer. And for cases in which differential diagnosis failed in the morpopathological and TTF-1, SPPB, and ER examination, MGB1 examination was conducted. Several patient and tumor characteristics were evaluated according to the definitive diagnosis of pulmonary nodules in both metastatic breast and primary lung cancer groups, which were then compared using Student's t-test. Results: Biopsy specimens were obtained using minimally invasive methods (CT-CNB and TBLB) in 21 patients (87.5%). Surgical resection was performed for diagnosis and treatment in three patients. Differential diagnosis was obtained by morphopathological methods alone in 18 patients (75.0%, primary lung cancer: 6 cases, metastaic breast cancer: 12 cases) and by immunohistochemical examination in the remaining 6 (25.0%, primary lung cancer: 1 case, metastaic breast cancer: 5 cases). Final diagnosis was metastatic breast and primary lung cancer in 17 (70. 8%) and 7 patients (29.2%), respectively. The mean age was significantly higher in the primary lung than metastatic breast cancer patients group (67 years vs. 57 years: p=0.036). No significant difference in the average diameter of pulmonary nodules was observed between metastatic breast and primary lung cancer patients (2.32cm vs. 2.29 cm). Furthermore, there were no clinical findings between metastatic breast cancer patients group and primary lung cancer group. Conclusions: Our results show the clinical feasibility of our approach to the differential diagnosis of breast cancer relapse and primary lung cancer presenting as a solitary nodule in patients after breast surgery. Further, replication of our findings under independent setting is recommended. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-03-05.

Local Control for Primary versus Metastatic Lung Cancer using Stereotactic Body Radiotherapy at 48 Gy in Four Fractions

Local Control for Primary versus Metastatic Lung Cancer using Stereotactic Body Radiotherapy at 48 Gy in Four Fractions

Surgical Resection of Recurrent Lung Cancer in Patients Following Curative Resection

We reviewed our experience with resection of recurrent lung cancer to evaluate the benefit and risk of the procedure. From December 1994 to December 2003, 29 consecutive patients underwent pulmonary resections for recurrent lung cancer. The mean duration from the first resection to second surgery was 25.4±15.1 months for the definite 2nd primary lung cancer (n=20) and 8.9±5.7 months for metastatic lung cancer (n=9). The procedures at the second operations were completion-pneumonectomy in 11 patients, lobectomy in 5 patients, wedge resection in 12 patients and resection and anastomosis of trachea in 1 patient. Morbidity was observed in 6 (21%) of the patients and the in-hospital mortality was two patients (7%) after the repeated lung resection. Tumor recurrence after reoperation was observed in 14 patients (48%). The actuarial 5-yr survival rate was 69% and the 5-yr disease free rate following reoperation was 44%. No significant difference was found in overall survival and disease free survival between the 2nd primary lung cancer group and the metastatic lung cancer group. The recurrence rate following reoperation was significantly different between the wedge resection group and lobectomy/completion pneumonectomy group (p=0.008), but the survival rate was not significantly different (p=0.41). Surgical intervention for recurrent lung cancers can be performed with acceptable mortality and morbidity. If tolerable, completion pneumonectomy or lobectomy is recommended for resection of recurrent lung cancer.

Differential diagnoses of solitary pulmonary nodules in patients with an extrathoracic malignant tumor: CT and pathologic correlations

To determine the possibility of definitive diagnosis for solitary pulmonary nodules in patients with a primary extrathoracic malignant neoplasm (ETM-SPN), and to further evaluate the value of CT for differential diagnosis in ETM-SPN by a multivariate retrospective study. Eighty-three patients with pathologically and clinically proven ETM-SPN with a diameter smaller than 3 cm were included in this study. The pathological characteristics of the SPN were correlated with those of the extrathoracic neoplasm, with the patient’s age, gender, smoking history, disease -free time interval between the diagnosis of the extrathoracic malignancy and that of the lung lesion. In all 83 cases, CT scans were reviewed to confirm the solitary nature, size, and nodular morphology of the lung lesion. Of all 83 cases, the mean age was (57.43±15.34) years. There were 51 males and 32 females, with the ratio of 1.59:1. The lesions included solitary metastasis in 43 cases, pulmonary malignant lesions in 33, and benign lesions in seven. Between the primary lung cancers and solitary metastasis groups, there was no significant difference in the gender ratio (1.20:1 vs 2.31:1, x2=0.0209,P>0.05), but there was a significant difference between the mean age (62.48 ±11.96 years vs 54.10±16.49 years,t =3.34,P 0.05). Of 81 cases who were followed-up, the mean time of the disease-free interval between extrapulmonary malignancy diagnosis and pulmonary lesion differentiation was 39.73 ±6.29 months (range 0∼300 months, median 20.00 months), whereas those in the primary lung cancer group and metastatic group were 65.62 ±13.45 months and 22.83 ±4.19 months respectively. This difference was significant between the two groups (Wilcoxon rank sum test,U=2.796,P 0.05), without showing a statistically significant relevance between the pathologic patterns of extrapulmonary malignancy and characteristics of the lung nodules. Of all the 83 cases, the mean diameters were (2.77 ±.25) cm, whereas the diameters of 33 cases of primary lung cancer and 43 cases of a solitary metastatic lesion were (2.86±1.18) cm and (2.62±1.31) cm, respectively. There was no association between the two groups (t=1.29,P>0.05). There was a statistically significant association between primary lung cancer and the metastatic group with spiculate and smooth edges of the lung lesion (Ξ2=8.562,P 0.05). The likelihood of a primary lung cancer versus a metastasis of ETM-SPN smaller than 3 cm mainly depends on the patient’s age, free interval between the two tumors and CT morphological characteristics of the lung lesion. This study showed there was no significant relevancy to factors such as gender, smoking history, pathological patterns of the extrapulmonary neoplasm or whether there has hilar or mediastinal adenopathy.

Value of wide-margin wedge resection for solitary pulmonary nodule: a single center experience.

Despite refinements of the diagnostic procedures, often surgery remains the only option to ascertain the histopathological nature of solitary pulmonary nodules (SPN). Aim of the present study was to ascertain the value of wide-margin wedge resection (WMWR) with curative intent in a consecutive cohort of patients afflicted by SPN. From January 1995 to January 2002, 129 patients (74 male, mean age 60.5+/-14.4 years) underwent WMWR of a SPN. In-hospital outcome was prospectively collected and retrospectively analyzed. Incidence of malignancy was obtained by histology. Patients found to be afflicted by primary lung cancer (PLC) were sub-grouped according to their preoperative cardiopulmonary status (CPS). In-hospital and mid-term clinical outcome of all the patients is presented. There were 3 (2.3%) in-hospital deaths. Distribution of histology included 61 (47.3%) PLC (41 poor CPS), 20 (15.5%) secondary lung cancer (SLC), and 48 (37.2%) miscellaneous benign lesions. Twenty patients with PLC were fit and underwent completion lobectomy within 2 weeks following WMWR. Hospital length of stay was longer in patients with PLC as compared to patients with SLC (P=0.04). There were 17/61 (27%) recurrences in the PLC group. Of these, 2 occurred in fit patients undergone previous WMWR-lobectomy, and 15 in patients with poor baseline CPS. All these patients were referred for adjuvant therapy. Overall 5-year survival of the PLC group was 66% (61.1% for those with poor CPS and 82.5% for those with good CPR (P=NS). Seven out of 20 (35%) patients with SLC had late recurrent disease, leading to 1 re-operation. The overall 5-year survival in this group was 58.8%. There was only 1 non-related late death in the benign group. The WMWR resection of a primarily malignant SPN determines a valuable 5-year survival but a relatively high incidence of late recurrence. WMWR is a safe and effective surgical option for patients presenting with poor cardiopulmonary reserve.

Differential diagnoses of solitary pulmonary nodule in patients with extrapulmonary malignant tumor:CT and pathologic correlation

目的 用多因素回顾性研究的方法,探讨肺外恶性肿瘤患者肺内直径＜3 cm的孤立性结节(ETM-SPN)定性诊断的可能性,并评价CT的鉴别诊断价值.方法搜集经证实的直径＜3 cm的ETM-SPN病例83例,通过对性别、年龄、吸烟史、肺内外病灶的平均时间间隔、肺内结节的CT形态学特征,以及肺外肿瘤病理类型与肺结节性质的关系等行多因素分析,探讨ETM-SPN定性诊断的相关因素.结果83例肺部结节中孤立性转移瘤、原发性支气管肺癌、良性病灶分别为43、33和7例.平均年龄为(57.43±15.33)岁,男女之比为1.59:1.原发性支气管肺癌和孤立性转移瘤组的平均年龄和男女之比分别为(62.48±11.96)岁、1.20:1和(54.10±16.49)岁(t=3.34,P＜0.05)、2.31:1(x2=0.0209,P＞0.05).各组吸烟率间,原发性支气管肺癌组(39.3%,11/17)与孤立性转移瘤组(35.9%,14/39)和非原发性肺癌组(33.3%,15/45)间差异均无显著意义(χ2=0.640,P＞0.05;χ2=0.931,P＞0.05).原发性肺癌组和孤立性转移瘤组的肺内外肿瘤确诊的平均时间间隔分别为(65.62±13.45)个月和(22.83±4.19)个月,两组间差异有显著性意义(Wilcoxon秩和检验,U=2.796,P＜0.01).肺外肿瘤为鳞癌(10例)和腺癌(58例)者,其肺内病灶原发性肺癌、孤立性转移瘤比例分别为7:3和24:34,差异无显著性意义(χ2=1.781,P＞0.05).CT形态学特征分析结果,原发性肺癌和孤立性转移瘤两组间毛刺和光整的显示率差异有显著性意义(χ2=8.562,P＜0.01;χ2=15.220,P＜0.001);而分叶显示率差异无显著性意义(χ2=2.054,P＞0.05).原发性肺癌组和孤立性转移瘤组肺结节平均最大径分别为(2.86±1.18)cm和(2.62±1.31)cm,两组间差异无显著性意义(t=1.29,P＞0.05).CT和手术病理对照分析37例经肺门和纵隔淋巴结清扫术的病例,结果原发性肺癌和孤立性转移瘤组淋巴结癌细胞浸润率间差异无显著性意义(χ2=2.801,P＞0.05).结论直径＜3 cm的ETM-SPN的定性诊断,主要应结合患者的年龄、两瘤时间间隔和肺内病灶的CT形态学特征,而与性别、吸烟史、是否有肺门纵隔淋巴结转移,以及肺外肿瘤的病理类型无显著相关性。

Diagnostic Value of Cyfra 21-1 in Differential Diagnosis of Pleural Effusion

Background : Pleural effusion is a common clinical problem and many clinical and laboratory evaluations, such as tumor marks, have been studied to discriminate malignant pleural fluid from benign pleural fluid. However their usefulness in the diagnosis of pleural effusion is still not established fully. We studied the diagnostic value of cyfra 21-1 in diagnosis of malignant pleural effusion. Methods: Pleural fluid was obtained from 45 patients with malignant diseases(32 lung cancer patients, 13 metastatic malignant diseases) and 47 patients with benign diseases. The level of cyfra 21-1 in the pleural fluid and serum were determined using a CYFRA 21-1 enzyme immunoassay kit(Cis-Bio International Co.). The t-test was used for comparison between two diseases groups and receiver operating characteristic(ROC) curves were constructed by calculating the sensitivities and specificities of the cyfra 21-1 at several points to determine the diagnostic accuracy of the cyfra 21-1. Results: In patients with primary lung cancer, the level of cyfra 21-1 in the pleural fluid was significantly higher than those of patients with benign diseases and had positive correlations between the level of cyfra 21-1 in the pleural fluid and serum levels. In the ROC curve analysis of the pleural fluid, the curve for primary lung cancer group was located closer to the left upper comer and the cut off value, sensitivity and specificity of the cyfra 21-1 of the primary lung cancer group was determined as 22.25ng/ml, 81.8% and 78.7% respectively. Conclusions: Our data indicates that the measurement of cyfra 21-1 level in pleural effusion has useful diagnostic value to discriminate malignant pleural effusion in primary lung cancer from benign pleural effusion.

Diagnostic value of bronchoalveolar lavage and postbronchoscopic sputum cytology in peripheral lung cancer.

The objective of this study was to evaluate the value of bronchoalveolar lavage (BAL) and postbronchoscopic sputum cytology in diagnosing peripheral lung cancer. We performed a prospective study in 55 patients with lesions on chest radiographs who were suspected of having lung cancer and had non-endoscopically visible lesions on fiberoptic bronchoscopy. The sequence of procedures in all cases was BAL and transbronchial forceps biopsy. The final diagnosis of these patients were primary lung cancer in 30 patients, metatastic lung cancer in five and benign diseases in 20. In the primary lung cancer group, BAL was positive for malignant cells in 14 of the 30 patients (46.7%). In seven (50%) of these patients, the cell type diagnosed by BAL agreed with the final diagnosis. The diagnostic yield of BAL was influenced by the size and segmental location of the lesion. Bronchoalveolar lavage provided a higher diagnostic yield (46.7%) than transbronchial biopsy (16.7%). In five patients with metastatic lung cancer and 20 patients with benign disease, BAL gave negative results in all. Postbronchoscopic sputum cytology was positive in only two of the 26 patients (7.7%) from whom samples could be obtained. Bronchoalveolar lavage cytology proved to be a valuable diagnostic tool in detecting peripheral, primary lung cancer. Postbronchoscopic sputum cytology provided no significant additional information.