Comparative Analysis of Robotic Segmentectomy For Non-Small Cell Lung Cancer: A National Cancer Database Study

2021 ◽  
pp. 155698452199780
Author(s):  
Karishma Kodia ◽  
Syed S. Razi ◽  
Ahmed Alnajar ◽  
Dao M. Nguyen ◽  
Nestor Villamizar
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Small Cell Lung Cancer ◽  
Clinical Outcomes ◽  
Small Cell ◽  
National Cancer Database ◽  
Small Cell Lung ◽  
Lymph Node Yield ◽  
Node Yield

Objective The use of segmentectomy for peripheral T ≤2 cm, N0 non-small cell lung cancer (NSCLC) has increased in the last decade. We sought to compare clinical outcomes and overall survival between robotic, video-assisted thoracoscopic surgery (VATS), and open segmentectomy. Methods The National Cancer Database was queried for patients with clinical T ≤2 cm, N0 NSCLC who underwent segmentectomy via robotic, thoracoscopic (VATS), and open approaches (2010 to 2015). Univariate and Cox regression analyses were used to compare surgical approaches and to evaluate predictors of overall survival. Statistical analyses were done using SPSS Version 21.0. Results Segmentectomy was performed in 3,888 patients during the study period with 406 robotic, 1,837 VATS, and 1,645 open patients. VATS and robotic segmentectomy were performed more often at academic or comprehensive community cancer programs as compared to community programs ( P < 0.05). Conversion to open thoracotomy was similar between robotic and VATS groups when stratified by hospital volume. Lymph node yield was significantly higher for robotic (median = 6), compared to VATS (median = 5) or open (median = 4; P < 0.001). Length of stay was decreased for robotic versus open ( P < 0.01). No differences in 30-day readmissions ( P = 0.12) were observed among the 3 modalities. Overall survival was similar among groups ( P = 0.18). Conclusions Robotic segmentectomy provides similar clinical outcomes compared to other standardized approaches for clinical T ≤2 cm, N0 NSCLC. A higher lymph node yield in robotic segmentectomy was not associated with improved survival in this study population.

Role of radiation in extensive stage small cell lung cancer: a National Cancer Database registry analysis

2021 ◽  
Author(s):  
Saad Sheikh ◽  
Asoke Dey ◽  
Sujay Datta ◽  
Tarun K Podder ◽  
Charulata Jindal ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Propensity Score ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
National Cancer Database ◽  
Small Cell Lung ◽  
Extensive Stage

The role of prophylactic cranial irradiation (PCI) and thoracic radiation therapy (TRT) in extensive-stage small cell lung cancer remains controversial. The authors examined the National Cancer Database and identified patients with extensive-stage small cell lung cancer with no brain metastasis. Patients were excluded if they died 30 days from diagnosis, did not receive polychemotherapy, had other palliative radiation or had missing information. A propensity score-matched analysis was also performed. A total of 21,019 patients were identified. The majority of patients did not receive radiation (69%), whereas 10% received PCI and 21% received TRT. The addition of PCI and TRT improved median survival and survival at 1 and 2 years (p ≤ 0.05). The propensity score-matched analysis confirmed the same overall survival benefit with both PCI and TRT. This registry-based analysis of >1500 accredited cancer programs shows that PCI and TRT are not commonly utilized for extensive-stage small cell lung cancer patients who are treated with multiagent chemotherapy. The addition of PCI and TRT significantly improves overall survival in this otherwise poor prognostic group. Further research is needed to confirm the role of PCI and TRT, especially in the era of improved systemic therapy.

scholarly journals Clinical Relevance of an Amplicon-Based Liquid Biopsy for Detecting ALK and ROS1 Fusion and Resistance Mutations in Patients With Non–Small-Cell Lung Cancer

2020 ◽  
pp. 272-282 ◽  
Author(s):  
Laura Mezquita ◽  
Aurélie Swalduz ◽  
Cécile Jovelet ◽  
Sandra Ortiz-Cuaran ◽  
Karen Howarth ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Small Cell Lung Cancer ◽  
Clinical Outcomes ◽  
Liquid Biopsy ◽  
Clinical Relevance ◽  
Biopsy Specimen ◽  
Small Cell ◽  
Resistance Mutations ◽  
Small Cell Lung

PURPOSE Liquid biopsy specimen genomic profiling is integrated in non–small-cell lung cancer (NSCLC) guidelines; however, data on the clinical relevance for ALK /ROS1 alterations are scarce. We evaluated the clinical utility of a targeted amplicon-based assay in a large prospective cohort of patients with ALK/ROS1-positive NSCLC and its impact on outcomes. PATIENTS AND METHODS Patients with advanced ALK/ROS1-positive NSCLC were prospectively enrolled in the study by researchers at eight French institutions. Plasma samples were analyzed using InVisionFirst-Lung and correlated with clinical outcomes. RESULTS Of the 128 patients included in the study, 101 were positive for ALK and 27 for ROS1 alterations. Blood samples (N = 405) were collected from 29 patients naïve for treatment with tyrosine kinase inhibitors (TKI) or from 375 patients under treatment, including 105 samples collected at disease progression (PD). Sensitivity was 67% (n = 18 of 27) for ALK/ROS1 fusion detection. Higher detection was observed for ALK fusions at TKI failure (n = 33 of 74; 46%) versus in patients with therapeutic response (n = 12 of 109; 11%). ALK-resistance mutations were detected in 22% patients (n = 16 of 74) overall; 43% of the total ALK-resistance mutations identified occurred after next-generation TKI therapy. ALK G1202R was the most common mutation detected (n = 7 of 16). Heterogeneity of resistance was observed. ROS1 G2032R resistance was detected in 30% (n = 3 of 10). The absence of circulating tumor DNA mutations at TKI failure was associated with prolonged median overall survival (105.7 months). Complex ALK-resistance mutations correlated with poor overall survival (median, 26.9 months v NR for single mutation; P = .003) and progression-free survival to subsequent therapy (median 1.7 v 6.3 months; P = .003). CONCLUSION Next-generation, targeted, amplicon-based sequencing for liquid biopsy specimen profiling provides clinically relevant detection of ALK/ROS1 fusions in TKI-naïve patients and allows for the identification of resistance mutations in patients treated with TKIs. Liquid biopsy specimens from patients treated with TKIs may affect clinical outcomes and capture heterogeneity of TKI resistance, supporting their role in selecting sequential therapy.

scholarly journals Effect of immunotherapy on overall survival in limited-stage small cell lung carcinoma: a national cancer database analysis

2021 ◽  
Vol 13 ◽  
pp. 175883592098280
Author(s):  
Nadeem Bilani ◽  
Evan Alley ◽  
Leah Elson ◽  
Zeina Nahleh ◽  
Rafael Arteta-Bulos
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
National Database ◽  
National Cancer Database ◽  
Small Cell Lung ◽  
Limited Stage ◽  
The Impact

Background: While immune-based therapies have been approved for extensive-stage small cell lung cancer, there is limited data on the efficacy of immunotherapy in patients with limited-stage disease. Methods: We used the National Cancer Database to first evaluate factors associated with the inclusion of immunotherapy as part of the initial therapeutic course in patients diagnosed with limited-stage small cell lung cancer (LS-SCLC). Consequently, we evaluated the impact of this immunotherapy on 2-year and 5-year overall survival (OS). We did this by performing 1:1 matching for controls that did not receive immunotherapy, and comparing survival between cohorts using the Kaplan–Meier method. Results: A total of 98 patients with LS-SCLC received immunotherapy as part of their initial therapeutic regimen. Age and facility type were the only significant predictors of the use of immunotherapy. There was no statistically significant difference between matched case-control cohorts in median OS ( p = 0.985), 2-year OS ( p = 0.747), and 5-year OS ( p = 0.934). Conclusion: In this study using a large national database, we found that the inclusion of immunotherapy as part of the initial systemic therapy regimen was not significantly associated with improved OS in a cohort of LS-SCLC patients.

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