A műtétileg kezelt tüdőrák klinikopatológiai jellemzőinek változása az ezredfordulónkon = Changes in the clinicopathological features of surgically treated lung cancer around the millennium

Absztrakt: Bevezetés: A tüdőrák Európában és hazánkban is a leggyakoribb rosszindulatú daganat, 2010-ben hazánkban 10 557 új megbetegedést regisztráltak. Ezen betegek 80–85%-a dohányos. Célkitűzés: Munkánk során az elmúlt 15 év adatait retrospektíven elemezve vizsgáltuk a műtéten átesett tüdőrákos betegek adatait. Módszer: Retrospektíven vizsgáltuk a demográfiai jellemzők mellett a tüdőrák szövettani típusát, stádiumát, az alkalmazott műtéti típust, az egyéb kiegészítő kezelést és a túlélést. Eredmények: Jelentős változásokat észleltünk a tüdőrák klinikopatológiai jellemzőiben: a megbetegedés a nőknél 50%-kal gyakoribbá vált, ami elsősorban az adenocarcinomák előretörésének tudható be. Az egyre javuló diagnosztikai módszereknek köszönhetően az utóbbi időben a korai (I/A stádiumú) tüdőrákos esetek száma megduplázódott, valamint pontosabbá vált a preoperatív stádiumbeosztás és állapotfelmérés. Bevezetésre került a neoadjuváns kezelés, növekedett a sublobaris reszekciók aránya, a pulmonectomiák és a sleeve reszekciók aránya azonossá vált, így a korábban funkcionális okokból műtétre nem kerülő betegek is operálhatóvá váltak, valamint az adjuváns kezelés tolerálhatósága is javult. A videotorakoszkópos lobectomia mindennapi rutinná vált, csökkentve a betegek műtéti megterhelését. Következtetés: Mindezen, a diagnosztikában és a terápiában elért fejlődés ellenére az emelkedő esetszám mellett az ötéves túlélés nem javult számottevően, továbbra is 50% körül van. Orv Hetil. 2018; 159(10): 391–396. | Abstract: Introduction: Lung cancer is the most common malignant tumor in Europe and Hungary. In 2010, 10 557 new cases were registered in Hungary; 80–85% of these cases were associated with smoking. Aim: In our work we analyzed the data of lung cancer patients of the last 15 years retrospectively. Method: We examined the demographic characteristics, the histological type, the stage of the lung cancer, the type of the surgical procedure used, other supplemental treatment and survival retrospectively. Results: Lung cancer has occurred 50 per cent more often among females in the last decade. This growth is due to the increase of adenocarcinoma cases. Thanks to the improving diagnostic modalities and the routine follow-up of oncological patients, the number of I/A cases has been doubled recently and the preoperative staging and physical condition check-up have become more accurate. Neoadjuvant treatment has been introduced, the proportion of sublobar resections has risen, the ratio of pneumonectomy and sleeve lobectomy has become equal, so many previously unresectable cases turned to be resectable and the tolerance of adjuvant therapy has also improved. Videothoracoscopic lobectomy has become an everyday practice, leading to a decrease in the operative stress on patients. Conclusion: In spite of this development, the five-year survival has not changed significantly, staying around 50%. Orv Hetil. 2018; 159(10): 391–396

The more the micropapillary pattern in stage I lung adenocarcinoma, the worse the prognosis: a retrospective study on digitalized slides

Although the majority of lung adenocarcinomas show mixed pattern, only the predominant component is taken into account according to the novel classification. We evaluated the proportion of different patterns and their impact on overall survival (OS) and disease-free survival (DFS). Patterns were recorded according to predominance and their proportions were rated and calculated by objective area measuring on digitalized, annotated slides of resected stage I lung adenocarcinomas. Spearman’s rank correlation, Kaplan-Meier models and the log rank test were used for statistical evaluation. Two hundred forty-three stage I adenocarcinoma were included. Lepidic pattern is more frequent in tumours without recurrence (20 vs. 8%), and lepidic predominant tumours have favourable prognosis (OS 90.5%, DFS 89.4%), but proportions above 25% are not associated with improving outcome. Solid and micropapillary patterns are more frequent in patients with recurrence (48 vs. 5% and 13 vs. 4%) and predominance of each one is associated with unfavourable prognosis (OS 64.1%, DFS 56.3% and OS 28.1%, DFS 28.1%, respectively). Above 25%, a growing proportion of solid or micropapillary pattern is not associated with worsening prognosis. In contrast, tumours having micropapillary pattern as secondly predominant form a different intermediate group (OS 51.1%, DFS 57.8%). Our study was based on measured area of each growth pattern on all available slides digitalized. This is the most precise way of determining the size of each component from the material available. We propose using predominant and secondly predominant patterns for prognostic purposes, particularly in tumours having solid or micropapillary patterns. © 2018 Springer-Verlag GmbH Germany, part of Springer Natur

Tüdőlebeny-eltávolítást követő kemoterápia tolerabilitását befolyásoló perioperatív tényezők = Perioperative factors influencing the tolerability of chemotherapy after lung lobe resection

Absztrakt: Bevezetés: Hazánkban a tüdőrák a vezető daganatos halálok. Gyógyítása összetett, sebészi és onkológiai kezelést igényel. Célkitűzés: Munkánkban a tüdőrák miatt operált betegek posztoperatív kemoterápiájának tolerabilitását befolyásoló tényezőket vizsgáltuk, a teljes/tervezett és nem teljes kemoterápiáknál. Módszer: 6 év alatt (2011. január 1.–2016. december 31.) 72, tüdőrákkal (adenocarcinoma és laphámrák) operált beteg adatait elemeztük, teljes (4 ciklus), illetve nem teljes (<4 ciklus) posztoperatív kemoterápia kapcsán. A csoportokban [teljes: n = 53; nem teljes: n = 19] a következő tényezőket vizsgáltuk: nemek megoszlása, átlagéletkor, testtömegindex, Malnutrition Universal Screening Tool, Charlson-féle komorbiditási index, második malignus tumor, pitvarfibrilláció, terhelés után 1 másodperc alatt kilégzett levegő, teljesítménystátusz, nyitott/videoasszisztált torakoszkópos sebészet (VATS) lobectomia, műtéti idő, posztoperatív láz, transzfúzióigény, tartós levegőkilépés, reoperáció, szövettan, tumorstádium. Eredmények: Az összes beteget tekintve, az egyváltozós logisztikus regressziós értékek közül jelentősen magasabb volt a tervezett/teljes kemoterápia aránya VATS-lobectomiák után [n = 26 (83,87%)], mint nyitott eseteket követően [n = 27 (65,85%)]; (p = 0,092; OR = 0,356), azonban szignifikáns különbség nem igazolódott. Multivariáns analízisnél (nyitott/VATS lobectomia, felső-, középső-, alsólebeny-eltávolítás, diabetes, tartós levegőkilépés, posztoperatív láz) a teljes kemoterápia felvételét a VATS-lobectomiák szignifikánsan pozitívan befolyásolták (p = 0,0495), míg a felső-, középsőlebeny-lobectomiák (p = 0,0678), valamint a diabetes hiánya (p = 0,0971) esetén jelentős, bár nem szignifikánsan pozitív hatást találtunk. Következtetés: A teljes tervezett, műtét utáni kemoterápiás kezelést a betegek 26%-a nem tudta felvenni. A VATS-lobectomián átesett betegek szignifikánsan több teljes posztoperatív kemoterápiás ciklust voltak képesek felvenni. A cukorbetegség és az alsó lebeny eltávolítása hátrányosan befolyásolta a posztoperatív kemoterápia tolerálhatóságát. Orv Hetil. 2018; 159(19): 748–755. | Abstract: Introduction: Lung cancer is the leading cause of malignancy-related deaths in Hungary, involving complex surgical and oncological treatment. Aim: Factors influencing the tolerability of complete/planned and incomplete postoperative chemotherapy after surgery were analyzed. Method: During a 6-year period (January 1, 2011–December 31, 2016), data of 72 patients operated with lung cancer (adenocarcinoma and squamous cell carcinoma), receiving complete (4 cycles) and incomplete (<4 cycles) postoperative chemotherapy were analyzed. The following factors among the two groups [complete: n = 53; incomplete: n = 19] were analyzed: gender, mean age, body mass index, Malnutrition Universal Screening Tool, Charlson Comorbidity Index, second malignant tumor, atrial fibrillation, Forced Expiratory Volume 1 sec, Performance Status, open/Video-Assisted Thoracic Surgery (VATS) lobectomy, duration of surgery, postoperative fever, need for transfusion, prolonged air leak, redo surgery, histology, tumor stage. Results: The rate of complete postoperative cycles obtained from logistic regression analysis, were substantially higher after VATS lobectomies [n = 26 (83.87%)] compared to open procedures [n = 27 (65.85%)]; (p = 0.092; OR = 0.356), without significance. Multivariate analysis (open/VATS lobectomy, upper/middle-lower lobe resection, diabetes, prolonged air leak, postoperative fever) showed significantly increased successful uptake of complete cycles after VATS (p = 0.0495), while upper/middle lobe resections (p = 0.0678) and the lack of diabetes (p = 0.0971) notably increased the number of complete cycles, without significance. Conclusion: Twenty-six percent of patients were unable to receive complete planned postoperative chemotherapy. VATS lobectomy patients received significantly higher number of complete cycles of postoperative chemotherapy. Diabetes and lower lobe lobectomies had a negative effect on the tolerability of postoperative chemotherapy. Orv Hetil. 2018; 159(19): 748–755

Significant changes in advanced lung cancer survival during the past decade in Hungary: impact of modern immunotherapy and the COVID-19 pandemic

ObjectiveThe approval of immunotherapy (I-O) for the treatment of late-stage non-small cell lung cancer (NSCLC) opened new perspectives in improving survival outcomes. However, survival data have not yet been provided from the period of the Covid-19 pandemic. The aims of our study were to assess and compare survival outcomes of patients with advanced LC receiving systemic anticancer treatment (SACT) before and after the approval of immunotherapy in Hungary, and to examine the impact of pandemic on survival outcomes using data from the Hungarian National Health Insurance Fund (NHIF) database.MethodsThis retrospective, longitudinal study included patients aged ≥20 years who were diagnosed with advanced stage lung cancer (LC) (ICD-10 C34) between 1 January 2011 and 31 December 2021 and received SACT treatment without LC-related surgery. Survival rates were evaluated by year of diagnosis, sex, age, and LC histology.ResultsIn total, 35,416 patients were newly diagnosed with advanced LC and received SACT during the study period (mean age at diagnosis: 62.1–66.3 years). In patients with non-squamous cell carcinoma, 3-year survival was significantly higher among those diagnosed in 2019 vs. 2011–2012 (28.7% [95% CI: 26.4%–30.9%] vs. 14.45% [95% CI: 13.21%–15.69%], respectively). In patients with squamous cell carcinoma, 3-year survival rates were 22.3% (95% CI: 19.4%–25.2%) and 13.37% (95% CI: 11.8%–15.0%) in 2019 and 2011–2012, respectively, the change was statistically significant. Compared to 2011–2012, the hazard ratio of survival change for non-squamous cell carcinoma patients was 0.91, 0.82, and 0.62 in 2015–2016, 2017–2018, and 2019, respectively (p&lt;0.001 for all cases). In the squamous cell carcinoma group, corresponding hazard ratios were 0.93, 0.87, and 0.78, respectively (p&lt;0.001 for all cases). Survival improvements remained significant in both patient populations during the Covid-19 pandemic (2020–2021). No significant improvements were found in the survival of patients with small cell carcinoma. Platinum-based chemotherapy was the most common first-line treatment in all diagnostic periods, however, the proportion of patients receiving first- or second-line immunotherapy significantly increased during the study period.Conclusion3-year survival rates of NSCLC almost doubled among patients with non-squamous cell carcinoma and significantly improved at squamous cell carcinoma over the past decade in Hungary. Improvements could potentially be attributable by the introduction of immunotherapy and were not offset by the Covid-19 pandemic

The efficacy and safety of bevacizumab in addition to platinum-based chemotherapy for the first-line treatment of patients with advanced nonsquamous non-small-cell lung cancer : Final results of AVALANCHE, an observational cohort study

The previous results of former clinical studies confirmed that first-line bevacizumab (BEV) in combination with chemotherapy improves clinical outcomes in patients with advanced non-squamous non-small cell lung cancer. The AVALANCHE study (ClinicalTrials.gov Identifier NCT03170284) was undertaken to assess the clinical outcomes of first-line BEV combined with standard platinum-based regimens in the Hungarian clinical practice. This observational study was conducted in 28 Hungarian sites, with patients enrolled between July 2008 and April 2011. Patients with untreated locally advanced, metastatic or recurrent lung adenocarcinoma received BEV (7.5 mg/kg, q3w) with any platinum-doublet for up to 6 cycles, and then non-progressors proceeded to receive BEV until disease progression or unacceptable toxicity. The primary endpoint was time-to-progression, and secondary endpoints included overall survival (OS), tumour control rate and safety. Patients were also analysed as two cohorts (non-progressors vs. progressors) based on whether or not they received BEV maintenance therapy following completion of first-line chemotherapy plus BEV. The study enrolled 283 patients (median age: 58.2 (18-78) years; males: 50.5%; stage: III/B: 18.4%, IV: 79.9%; adenocarcinoma/other: 95.8/4.2%; ECOG PS 0/1/2/≥3: 30.8/59.7/2.6/1.4%). Centrally located tumours were reported in 21.6%. Cisplatin/carboplatin-based regimens: 53.8/46.2%. A total of 43% of patients received BEV maintenance therapy. The median number of BEV cycles was 6. Median progression-free survival (PFS) was 7.2 months and OS was 15.2 months for the entire cohort. Longer PFS and OS were observed in patients who received BEV maintenance therapy [median OS, 26.2 vs. 10.2 months (P<0.001); median PFS, 9.2 vs. 5.8 months (P<0.001)]. Contrary to the results of previous OCS no significant difference was recorded in the different age groups or gender. Best tumour response: Complete remission/partial remission/stable disease/progressive disease/not reported were: 1.5/29.9/26.9/9.1/32.6% of all patients. In conclusion, clinical outcomes obtained in this real-life population were consistent with pivotal studies. BEV maintenance treatment was associated with a significantly longer PFS and OS

Primer pulmonalis epitheloid haemangioendothelioma = Primary pulmonary epitheloid haemangioendothelioma

Köhögés, fogyás, effort dyspnoe miatt került felvételre 2009 júliusában a 49 éves nőbeteg. A radiológiai vizsgálatok a már korábban is észlelt, változatlan megjelenésű pulmonalis kerekárnyékok mellett a jobb felső lebenyben lágyrész-árnyékot ábrázoltak, jobb hilusi és mediastinalis lymphadenomegaliával. A bronchoszkópia során nyert minta patológiai feldolgozása pulmonalis epitheloid haemangioendotheliomát igazolt, amely egy nagyon ritka endothelialis tumor, főként középkorú betegeket érint, női predominanciával. A betegség az esetek közel felében panaszt nem okoz, véletlenül kerül felismerésre, máskor mellkasi fájdalom, effort dyspnoe, köhögés, köpetürítés jelentkezik. Leggyakrabban multiplex, bilaterális nodulusok láthatók radiológiai vizsgálatokkal. Gyakran okoz komoly differenciáldiagnosztikai problémát. Jelenleg ritkasága miatt nincs elfogadott terápiás protokollja: sebészi kezelés, kemoterápia mellett palliatív irradiáció, immun- és hormonterápia jöhet szóba. A szerzők in vitro vizsgálatokkal keresték a leghatékonyabb kezelési lehetőséget, és az eredményeket felhasználva kezdtek kemoterápiás beavatkozást betegüknél, amely részleges regressziót eredményezett. Orv. Hetil., 2011, 152, 834–839. | A 49-year-old female patient was admitted in July 2009 because of cough, weight loss and effort dyspnoe. Chest X-ray and CT showed multiple bilateral nodules which have been identified earlier and these nodules were unchanged. However, there was a new parenchymal lesion in the right upper lobe, and new right hilar and mediastinal lymphadenomegaly was also found. Sample was taken by bronchoscope and the pathological diagnosis was pulmonary epitheloid haemangioendothelioma. This rare endothelial tumor usually affects middle-aged patients with a female predominance and it presents with chest pain, effort dyspnoe, cough, sputum, or it may remain asymptomatic. Multiple bilateral nodules are usually detected by radiologic examination. The diagnosis of this tumor is often challenging and, because of its rarity, it does not have any standard therapeutic regimen. Treatment can be surgery, chemo-, radio-, hormone- or immunotherapy. In order to find the most effective anticancer treatment, authors performed in vitro studies. On the basis of the results, chemotherapy was initiated which resulted in a partial regression. Orv. Hetil., 2011, 152, 834–839