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Long-term outcome and cost-effectiveness of complete versus assisted video-assisted thoracic surgery for non-small cell lung cancer.

To compare the outcomes and costs of two methods of video-assisted thoracoscopic surgery (VATS) major pulmonary resection in patients with clinically resectable non-small cell lung cancer (NSCLC).

METHODS: Between January 2000 and December 2007, 1,058 patients with proven stages I-IIIA NSCLC underwent complete VATS (c-VATS) or assisted VATS (a-VATS) major pulmonary resection together with a systematic nodal dissection.

RESULTS: The study cohort consisted of 736 men and 322 women. Mean operative time was shorter for the a-VATS cohort compared with the c-VATS group (P = 0.038). Overall survival (OS) at 5 years based on Kaplan-Meier analysis was 55.3% (95%CI, 50.6-60.0%) for those who underwent c-VATS and 47.7% (95%CI, 41.2-54.2%) for those who underwent a-VATS (P = 0.404). Gender, final pathology, TNM stage, and pT status were significant predictive factors for OS according to multivariate analysis. The total cost of a-VATS lobectomy was lower than that of c-VATS lobectomy.

CONCLUSIONS: c-VATS and a-VATS yield similar results in patients with clinically resectable NSCLC. a-VATS, however, may be less expensive and easier to adopt, making it a particularly attractive option for thoracic surgeons in developing countries. J. Surg. Oncol. © 2011 Wiley-Liss, Inc.

Prediction of survival and cancer recurrence using F-18 FDG PET/CT in patients with surgically resected early stage (Stage I and II) non-small cell lung cancer.

The aim of the current study was to investigate the prognostic value of SUVmax in patients with completely resected early stage (stage I and II) NSCLC.

A retrospective review identified 76 patients with surgically resected early (stage I and II) NSCLC who received F-18 FDG PET/CT at diagnosis of cancer. Survival analysis was conducted using Kaplan-Meier analysis, and survival curves stratified by age, sex, mediastinal lymph node involvement, SUVmax, and TNM staging were generated for estimation of overall survival and disease free survival (DFS). Independent predictive factors for survival were determined using Cox proportional hazard model.

For overall survival, the median survival of the patients with tumor SUVmax≤6.7 was 48.9 months and was significantly longer than the patients with tumor SUVmax>6.7 (Log rank test, Χ2=18.01, p5.9. The median survival of the patients with tumor SUVmax≤5.9 was 31.7 months (Log rank test, Χ2=16, p=0.0001).

In conclusion, high FDG uptake measured by F-18 FDG PET/CT might have a prognostic value for overall survival and DFS in surgically resected early stage (stage I and II) NSCLC even after stratified by pathologic stages.  Keywords: F-18 FDG, Early stage, non-small cell lung cancer, overall survival, disease free survival.

Clinical impact of the use of the revised International Association for the Study of Lung Cancer staging system to operable non-small-cell lung cancers.

The purpose of this study, therefore, was to evaluate the impact of the use of the present classification IASLC staging system (TNM7) on the categorization of patients and survival after resection.

METHODS: Between August 1985 and January 2007, 414 consecutive patients underwent pulmonary resection with a curative intention for NSCLC at the British Hospital in Buenos Aires were included in this study only if they were pathologically staged as N0-M0. Preoperative staging was performed according to the TNM classification system of the International Union Against Cancer (173 men, 58 women).

RESULTS: 231 tumours were identified as pathological N0. Mean age was 61.4 years. 173 patients (74.9%) were men. When the TNM7 was applied, 28 patients (12.1%) changed their T factor staging (14 were moved towards a higher T and 14 were moved to a lower T) and 41 patients (17.7%) changed their pathological staging by applying the TNM7: 14 patients were downstaged (6.1%) and 27 (11.7%) were upstaged. With the present T definition among 103 patients in stage IB 27 were upstaged (18 to IIA and 9 to IIB) and in the group of stage IIIB (n=14) all of them were downstaged (5 to IIB and 9 to IIA). The current T definition showed a statistically significant difference between the two T1 subgroups (93% versus 70% 5 year survival between T1a and T1b, p=0.027).

CONCLUSION: This study shows that the clinical impact of the using the IASLC proposed staging system would be modest but relevant, identifying a subgroup with a better prognosis (T1a).

Prognostic stratification of patients with T3N1M0 non-small cell lung cancer: which phase should it be?

In the 1997 revision of the TNM staging system for lung cancer, patients with T3N0M0 disease were moved from stage IIIA to stage IIB since these patients have a better prognosis. Despite this modification, the local lymph node metastasis remained the most important prognostic factor in patients with lung cancer.

The present study aimed to evaluate the prognosis of patients with T3N1 disease as compared with that of patients with stages IIIA and IIB disease. During 7-year period, 313 patients with non-small cell lung cancer (297 men, 16 women) who had resection were enrolled. The patients were staged according the 2007 revision of Lung Cancer Staging by American Joint Committee on Cancer. The Kaplan-Meier statistics was used for survival analysis, and comparisons were made using Cox proportional hazard method. The 5-year survival of patients with stage IIIA disease excluding T3N1 patients was 40%, whereas the survival of the patients with stage IIB disease was 66% at 5 years. The 5-year survival rates of stage III T3N1 patients (single-station N1) was found to be higher than those of patients with stage IIIA disease (excluding pT3N1 patients, P = 0.04), while those were found to be similar with those of patients with stage IIB disease (P = 0.4). Survival of the present cohort of patients with T3N1M0 disease represented the survival of IIB disease rather than IIIA non-small cell lung cancer.

Further studies are needed to suggest further revisions in the recent staging system regarding T3N1MO disease.

Link Between Asthma, Smoking And Nicotine Dependence

New research out of the University of Cincinnati suggests that being diagnosed with asthma is significantly associated with a greater risk for a lifetime history of daily smoking and nicotine dependence. The findings are reported in the online preview issue of the Journal of Health Psychology.

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