Explaining differential effects of tiotropium on mortality in COPD
The editorial by Jenkins and Beasley
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Inclusion of latent tuberculosis infection as a separate entity into the international classification of diseases
The 11th revision of the International Classification of Diseases (ICD-11) proposed by the WHO is currently in the consultation phase. In common with previous versions of the ICD this revised version does not contain a code for latent tuberculosis infection (LTBI), contrasting with the inclusion of a large number of codes for various manifestations of active tuberculosis (TB). Inclusion of a separate code for LTBI into ICD-11 is critically important for epidemiological, clinical and research purposes. On behalf of the Paediatric Tuberculosis Network European Trialsgroup, we encourage colleagues worldwide who are caring for TB patients or are involved in TB research to join us in supporting the case for a long overdue ICD code for LTBI.
Inhaled corticosteroids in COPD: quantifying risks and benefits
It is by no means straightforward to analyse the change in the rate of chronic obstructive pulmonary disease (COPD) exacerbations in clinical trials. Exacerbation rates do not follow a normal distribution, nor do they occur at random. High exacerbation rates in a few patients can make average rates difficult to calculate and interpret. So, surely, transforming exacerbation rates into numbers needed to treat (NNT) should help. Not necessarily so—this is the message from Professor Suissa's paper.
I have used the exponential model suggested by Suissa, with the data from two of the arms of...
Effect of insurance status on the surgical treatment of early-stage non-small cell lung cancer.
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Effect of insurance status on the surgical treatment of early-stage non-small cell lung cancer.
Ann Thorac Surg. 2013 Apr;95(4):1221-6
Authors: Groth SS, Al-Refaie WB, Zhong W, Vickers SM, Maddaus MA, D'Cunha J, Habermann EB
Abstract
BACKGROUND: Social disparities permeate non-small cell lung cancer (NSCLC) treatment, yet little is known about the effect of insurance status on the delivery of guideline surgical treatment for early-stage (I or II) NSCLC.
METHODS: We used the California Cancer Registry (1996 through 2008) to identify patients 50 to 94 years old with early-stage NSCLC. We used logistic regression models to assess whether or not insurance status (private insurance, Medicare, Medicaid, no insurance, and unknown) had an effect on whether or not a lobectomy (or bilobectomy) is performed.
RESULTS: A total of 10,854 patients met our inclusion criteria. Compared with patients with private insurance, we found that patients with Medicare (adjusted odds ratio [aOR] 0.87; 95% confidence interval [CI]: 0.79 to 0.95), Medicaid (aOR 0.45; 95% CI: 0.36 to 0.57), or no insurance (aOR 0.45; 95% CI: 0.29 to 0.70) were significantly less likely to undergo lobectomy, even after adjusting for patient factors (age, race, and gender) and tumor characteristics (histology and tumor size). Increasing age, African American race, squamous cell carcinoma, and increasing tumor size were significant independent negative predictors of whether or not a lobectomy was performed.
CONCLUSIONS: Patients without private insurance were significantly less likely than patients with private insurance to undergo a lobectomy for early-stage NSCLC. The variables(s) contributing to this disparity have yet to be elucidated.
PMID: 23415239 [PubMed - indexed for MEDLINE]
Adenosquamous carcinoma of the lung: surgical management, pathologic characteristics, and prognostic implications.
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Adenosquamous carcinoma of the lung: surgical management, pathologic characteristics, and prognostic implications.
Ann Thorac Surg. 2013 Apr;95(4):1189-95
Authors: Mordant P, Grand B, Cazes A, Foucault C, Dujon A, Le Pimpec Barthes F, Riquet M
Abstract
BACKGROUND: Adenosquamous carcinoma (ASC) is a mixed glandular and squamous cell carcinoma with a more aggressive behavior than the other histologic subtypes of lung cancer. We revisited the pathologic characteristics and surgical results associated with ASC.
METHODS: Patients who underwent surgical resection of non-small cell lung cancer in two French centers were retrospectively reviewed. Patients presenting with ASC (n=141) were compared to those with adenocarcinomas (AC, n=2415) and squamous cell carcinomas (SCC, n=2662) regarding preoperative data, histologic characteristics, and outcome.
RESULTS: The frequency of ASC and SCC decreased over time. ASC patients were similar to AC patients regarding age, sex, and smoking habits. The type of resections performed in ASC patients was intermediary between SCC (more pneumonectomy) and AC (more lobectomy) patients. ASC was associated with larger size, more frequent visceral pleura invasion, microinvasion of the lymphatic vessels, and ipsilateral second nodules, compared with SCC and AC. Among the 135 patients with documented ASC, 48% presented with a combination of AC and SCC tumor cells ranging between 40% and 60% of each component, and 55% of cases were associated with undifferentiated large cells. ASC was associated with a lower 5-year survival rate (37%) than SCC and AC (43.4% and 42.8%, respectively, p=0.017). For ASC patients, survival was better during the last decade or in cases of balanced AC/SCC components.
CONCLUSIONS: ASC is characterized by both histologic aggressiveness and adverse prognosis. In this setting, the impact of adjuvant therapies needs to be reevaluated.
PMID: 23473060 [PubMed - indexed for MEDLINE]