scholarly journals Elevated preoperative CEA is associated with subclinical nodal involvement and worse survival in stage I non-small cell lung cancer: a systematic review and meta-analysis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Awrad Nasralla ◽  
Jeremy Lee ◽  
Jerry Dang ◽  
Simon Turner
Keyword(s):  
Lung Cancer ◽  
Lymph Node ◽  
Tumor Markers ◽  
Advanced Disease ◽  
Meta Analysis ◽  
Clinical Stage ◽  
Stage I ◽  
Clinical Staging ◽  
Lymph Node Staging ◽  
Nodal Involvement

Abstract Background The standard for clinical staging of lung cancer is the use of CT and PET scans, however, these may underestimate the burden of the disease. The use of serum tumor markers might aid in the detection of subclinical advanced disease. The aim of this study is to review the predictive value of tumor markers in patients with clinical stage I NSCLC. Methods A comprehensive search was performed using the Medline, EMBASE, Scopus data bases. Abstracts included based on the following inclusion criteria: 1) adult ≥18 years old, 2) clinical stage I NSCLC, 3) Tumor markers (CEA, SCC, CYFRA 21-1), 4) further imaging or procedure, 5) > 5 patients, 6) articles in English language. The primary outcome of interest was utility of tumour markers for predicting nodal involvement and oncologic outcomes in patients with clinical stage I NSCLC. Secondary outcomes included sub-type of lung cancer, procedure performed, and follow-up duration. Results Two hundred seventy articles were screened, 86 studies received full-text assessment for eligibility. Of those, 12 studies were included. Total of 4666 patients were involved. All studies had used CEA, while less than 50% used CYFRA 21-1 or SCC. The most common tumor sub-type was adenocarcinoma, and the most frequently performed procedure was lobectomy. Meta-analysis revealed that higher CEA level is associated with higher rates of lymph node involvement and higher mortality. Conclusion There is significant correlation between the CEA level and both nodal involvement and survival. Higher serum CEA is associated with advanced stage, and poor prognosis. Measuring preoperative CEA in patient with early stage NSCLC might help to identify patients with more advanced disease which is not detected by CT scans, and potentially identify candidates for invasive mediastinal lymph node staging, helping to select the most effective therapy for patients with potentially subclinical nodal disease. Further prospective studies are needed to standardize the use of CEA as an adjunct for NSCLC staging.

Standardizing Robotic Lobectomy

2017 ◽  
Vol 12 (2) ◽  
pp. 77-81 ◽  
Author(s):  
John F. Lazar ◽  
Laurence N. Spier ◽  
Alan R. Hartman ◽  
Richard S. Lazzaro
Keyword(s):  
Lung Cancer ◽  
Length Of Stay ◽  
Minimally Invasive ◽  
Meta Analysis ◽  
Stage I ◽  
Clinical Staging ◽  
Perioperative Outcomes ◽  
Vats Lobectomy ◽  
End Points ◽  
Nodal Upstaging

Objective Single-surgeon cohorts assessing robotically assisted video-assisted thoracic (RA-VATS) lobectomy have reported good outcomes, but there are little data regarding multiple surgeons applying a standard technique in separate hospitals. The purpose of this study was to show how a standardized robotic technique is both safe and reproducible between surgeons and institutions. Methods From July 1, 2012, to October 1, 2013, patients undergoing RA-VATS lobectomy for both benign and malignant disease were identified from a prospectively collected database of two thoracic surgeons from different hospitals within the same healthcare system and retrospectively analyzed. Each surgeon employed an identical “rule of 10” completely port-based approach through all 128 cases. The primary end points of the study were in-hospital and 30-day mortality. Secondary end points were differences in morbidity and perioperative outcomes between the two surgeons based on their “rule of 10” technique. Results A total of 128 cases were performed with 121 lobectomies, 3 bilobectomies, and 4 pneumonectomies for both malignant and benign disease. Each surgeon had 64 cases without a single in-hospital or 30-day mortality. Overall morbidity was 16.4%. Each surgeon had one readmission and take back to operating room (a washout and a mechanical pleurodesis). The most common complication was prolonged air leak (38.1%, 8/21 patients). There was no statistical difference in length of stay, complications, severity of illness, and clinical staging between the two surgeons. There was a significant difference in resected lymph nodes (11.79 vs 14.45, P = 0.0086). Compared with published national meta-analysis on RA-VAT lobectomies, there was a significantly reduced length of stay (4.2 vs 6 days, P = 0.0436) and bleeding (0.8 vs 1.8%, P = 0.0003). Nodal upstaging from cN0 to pN1 was 8% and cN0 to pN2 was 2% for an overall nodal upstaging of 10% for stage I nonsmall cell lung cancer. Conclusions By standardizing how a robotic lobectomy is performed, we were able to show that RA-VATS lobectomy is safe and may allow for the expansion of minimally invasive lobectomy to surgeons who otherwise have failed to adopt traditional VATS. When compared with the most recent national meta-analysis, we had reduced morbidity, mortality, bleeding, and length of stay. Robotic nodal upstaging for stage I nonsmall lung cancer was consistent with larger multicenter study. We hope that these results will help lead to the standardization robotic lobectomy and a larger multisurgeon/institutional study that could pave the way for greater adoption of minimally invasive lobectomy.

Is CT-based selective nodal irradiation safe for clinical stage N0-1 LD-SCLC patients?

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e18551-e18551
Author(s):  
Man Hu ◽  
Bingjie Fan ◽  
Li Kong ◽  
Jinming Yu
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastases ◽  
Mediastinal Lymph Node ◽  
Clinical Stage ◽  
Clinical Staging ◽  
Lymph Node Staging ◽  
Pathological Staging ◽  
Contrast Enhanced Ct ◽  
Node Metastases ◽  
Mediastinal Lymph Node Metastases

e18551 Background: Radiotherapy plays an important role in the management of limited-disease small-cell lung cancer (LD-SCLC). However, volume of irradiation remains unanswered as well as optimal total dose, timing and sequencing of radiation. In this study, we compared the clinical lymph node staging with pathological staging, with the aim of investigating the safety of CT-based selective nodal irradiation for clinical stage N0-1 LD-SCLC patients. Methods: From July 2004 to March 2012, 20 potentially operable patients with clinical stage N0-1 LD-SCLC underwent contrast-enhanced CT scans and other routine initial staging procedures followed by radical resection of primary tumor and systemic intra-thoracic lymph node dissection. The results of reviewing clinical staging for the mediastinal lymph node metastases were compared with pathologic findings. Results: Preoperative nodal staging was compared with postoperative pathological staging, 35% (7 of 20) of patients were under staged by clinical staging. Of all the 7 patients with mediastinal lymph node metastases, 4 patients (57.1%) had subcrinal nodes (station 7) metastases, 1 had right upper paratracheal nodes (station 2R) metastases, 1 had left lower paratracheal nodes (station 4L) metastases, 1 had aortopulmonary nodes (station 5) metastases. Conclusions: CT-based selective nodal irradiation for LD-SCLC may result in geographical miss in clinical stage N0-1 patients. Mediastinal lymph node regions especially the subcrinal nodes should be contained in the clinical target volume for radiotherapy.

scholarly journals Survival outcomes of lobectomy in comparison with segmentectomy in clinical stage I non-small-cell lung cancer: a meta-analysis

2019 ◽  
Author(s):  
Jian Feng ◽  
Yan-Yue Han ◽  
Yue Wang ◽  
Xiu-Yu Wu ◽  
Feng Lv ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Literature Search ◽  
Meta Analysis ◽  
Clinical Stage ◽  
Small Cell ◽  
Stage I ◽  
Survival Outcomes ◽  
Small Cell Lung

Abstract Background: The gold standard surgical therapy for patients with Clinical stage I non-small-cell lung cancer (NSCLC) is lobectomy with mediastinal lymph node dissection. While, segmentectomy has emerged as an alternative choice with the advantage of fewer postoperative complications. While the acceptance of this procedure still remains controversial, and conflicting results exist in the retrospective trials. Objectives: The aim of this meta-analysis was to analysis the survival outcomes of Lobectomy in comparison with segmentectomy in treatment of Clinical stage I non-small-cell lung cancer. Methods: Computerized literature search was done on the published trials in Pubmed, Embase, Cochrane library databases to June, 2019 to identify clinical trials. Lung cancer-specific survival (LCSS) and overall survival (OS) were measured as outcomes. Statistical analysis was performed in the Meta-analysis Revman 5.3 software. Results: A systematic literature search was conducted including 7 studies. In this meta-analysis, results indicate that lobectomy confers an equivalent survival outcome compared with segmentectomy. Conclusion: No significant differences were found in survival outcomes between lobectomy and segmentectomy. Further prospective large-scale, prospective, randomized trials are needed to explore the reasonable surgical treatment for early resectable lung cancer.

scholarly journals Survival Outcomes of Lobectomy in Comparison With Segmentectomy in Clinical Stage I Non-small-cell Lung Cancer: a Meta-analysis

2021 ◽  
Author(s):  
Jian Feng ◽  
Yan-Yue Han ◽  
Yue Wang ◽  
Xiu-Yu Wu ◽  
Feng Lv ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Literature Search ◽  
Meta Analysis ◽  
Clinical Stage ◽  
Small Cell ◽  
Stage I ◽  
Survival Outcomes ◽  
Small Cell Lung

Abstract Background: The gold standard surgical therapy for patients with clinical stage I non-small-cell lung cancer (NSCLC) is lobectomy with mediastinal lymph node dissection. While, segmentectomy has emerged as an alternative choice with the advantage of fewer postoperative complications. However, the acceptance of this procedure still remains controversial, and conflicting results exist in the retrospective trials.Objectives: The aim of this meta-analysis was to analysis the survival outcomes of lobectomy in comparison with segmentectomy in treatment of clinical stage I non-small-cell lung cancer. Methods: Computerized literature search was done on the published trials in Pubmed, Embase, Cochrane library databases to June, 2019 to identify clinical trials. Lung cancer-specific survival (LCSS) and overall survival (OS) were measured as outcomes. Statistical analysis was performed using the Meta-analysis Revman 5.3 software.Results: A systematic literature search was conducted including 7 studies. In this meta-analysis, results indicate that lobectomy confers an equivalent survival outcome compared with segmentectomy. Conclusion: No significant differences were found in survival outcomes between lobectomy and segmentectomy. Further prospective large-scale, prospective, randomized trials are needed to explore the reasonable surgical treatment for early resectable lung cancer.

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