Severity of emphysema predicts location of lung cancer and 5-y survival of patients with stage I non–small cell lung cancer

Background

Non–small cell lung cancer (NSCLC) has a predilection to occur in emphysematous lungs. The relation between the regional severity of emphysema and the location of NSCLC as well as long-term survival has been poorly studied.

Methods

Computed tomography (CT) scans of 153 patients with biopsy-proven stage I NSCLC diagnosed between 2001 and 2006 were assigned an emphysema severity score in four regions of the lung. The location of the cancer was compared with the severity of emphysema in that region. Survival was also analyzed.

Results

Thirty-nine patients had no emphysema documented on CT scan and 114 did. The most common location of cancer was the right upper quadrant with 37% of cancers, followed by the left upper quadrant with 23% of cancers. Twenty-two percent of the cancers occurred in the right lower quadrant, and only 12% were in the left lower quadrant. There is a strong association for cancer being located in the area with the highest degree of emphysema (P < 0.001). Emphysema severity score was also associated with long-term survival (log-rank P = 0.03).

Conclusions

The regional severity of emphysema assessed via a visual scale using CT appears to be associated with the location of lung cancer and is an independent predictor of long-term survival.     

Is it safe to wait? The effect of surgical wait time on survival in patients with non–small cell lung cancer

Background

The effect of surgical wait times on survival in patients with non–small cell lung cancer (NSCLC) remains largely unknown. Our objective was to determine the effect of surgical wait time on survival and incidence of upstaging in patients with stage I and II NSCLC.

Methods

All patients with clinical stage I and II NSCLC who underwent surgical resection in a single centre between January 2010 and December 2011 were reviewed. Analysis was stratified based on preoperative clinical stage. We assessed the effect of wait time on survival using a Cox proportional hazard model with wait time in months as a categorical variable. Incidence of upstaging at least 1 stage was assessed using logistic regression.

Results

We identified 222 patients: 180 were stage I and 42 were stage II. For stage I, wait times up to 4 months had no significant effect on survival or incidence of upstaging. For stage II, patients waiting between 2 and 3 months had significantly decreased survival (hazard ratio 3.6, p = 0.036) and increased incidence of upstaging (odds ratio 2.0, p = 0.020) than those waiting 0 to 1 month. For those waiting between 1 and 2 months, there was no significant difference in survival or upstaging.

Conclusion

We did not identify an effect of wait time up to 4 months on survival or upstaging for patients with stage I NSCLC. For patients with stage II disease, wait times greater than 2 months adversely affected survival and upstaging.     

Clinical impact of lung age on postoperative complications in non–small cell lung cancer patients aged >70 y

Background

Surgery for elderly patients with primary lung neoplasms has become relatively common as populations age; however, the high frequency of postoperative complications has prevented its broad application. Recently, the Japanese Respiratory Society proposed lung age (LA) as an index of lung function, but reports on the association between LA and the risk factors for postoperative complications with non–small cell lung cancer (NSCLC) surgery have been limited. In this study, we analyzed the clinical applicability of LA for elderly patients with NSCLC.

Materials and methods

We studied 320 patients aged >70 y underwent curative resections for NSCLC. LA was calculated based on the formula provided by the Japanese Respiratory Society, which depended on the patient's preoperative respiratory function and was divided into four age gap (AG) groups between the LA and the true age (TA). The categorical data were compared among the four groups.

Results

The numbers of patients in groups A, B, C, and D were 80, 77, 79, and 84, respectively. For the univariate analysis, the preoperative factors for postoperative complications were gender, AG, and smoking (P < 0.05). In a multivariate analysis, AG proved to be an independent factor. Although we found no significant differences, there was a tendency for the prognosis to worsen with an increase in the AG (P = 0.06).

Conclusions

The AG was significantly associated with and an independent predictive factor for postoperative complications. We conclude that LA and AG are useful factors for predicting the risk of postoperative complications.     

Compared with radical nephrectomy,nephron-sparing surgery offers a long-term survival advantage in patients between the ages of 20 and 44 years with renal cell carcinomas (≤4 cm): An analysis of the SEER database

PurposeCompared with radical nephrectomy (RN), partial nephrectomy (PN) decreases the risk of developing chronic kidney disease. Although numerous studies have demonstrated the survival advantage of PN in older patients, they have been criticized by selection bias toward the procedure owing to comorbidities. We hypothesized that long-standing effects of renal preservation would manifest in a survival advantage of a younger patient population, where selection bias owing to comorbidities is minimized.Materials and methodsThe Surveillance, Epidemiology, and End Results 18-registries database was queried for patients aged 20 to 44 years surgically treated between 1993 and 2003 for renal cell carcinoma (RCC)≤4 cm with known grade and histology. Patients with prior RCC, multiple tumors, and metastatic or locally advanced disease were excluded. The final cohorts consisted of 222 and 494 subjects treated with PN and RN, respectively. The chi-square and log-rank analyses compared patient and tumor characteristics and patient survival, respectively.ResultsThere were no differences between the groups in demographics or tumor characteristics. Additionally, there was no difference in cancer-specific survival at 5 or 10 years (P = 0.34 and P = 0.1, respectively). Although there was no difference in 5-year overall survival (P = 0.07), PN offered an advantage in 10-year overall survival (P = 0.025).ConclusionsPresent Surveillance, Epidemiology, and End Results analyses demonstrate that compared with RN, PN improved overall survival in patients with small, localized RCC. As expected, the survival advantage is observed late and supports the importance of long-term renal functional preservation. Although our study is limited by lack of comorbidities, the results suggest that detrimental effects of RN may have implications on overall survival in younger patients with RCC.