Computed tomography angiography for the diagnosis of coronary artery disease among patients undergoing transcatheter aortic valve implantation

Background Coronary artery disease (CAD) is frequently seen in patients suffering from severe aortic valve stenosis (AS), as both pathologies share the same pathophysiology. In a transcatheter aortic valve implantation (TAVI) work-up, patients beneficiate from both computed tomography angiography (CTA) and invasive coronary angiography (ICA). Some studies evaluated the performance of CTA to diagnose CAD among patients undergoing TAVI and showed interesting results1-4. Nevertheless, data remain scarce and this diagnostic method is not validated in this population. In this context, we thought to evaluate the diagnostic performance of CTA to diagnose CAD among patients selected for TAVI. Methods A total of 199 patients that had a TAVI in the Lausanne University Hospital between the 1st of June 2013 and the 31st of December 2017 were retrospectively included. Exclusion criteria were coronary artery bypass graft (CABG) prior to CTA and unavailable CTA images. Finally, 127 patients were included. Two independent radiologists – blinded for ICA report – were asked to read the CTA of these patients and to indicate the presence of ≥50% and ≥70% stenosis in the 4 main coronary vessels. Their evaluation was then compared with ICA reports and analyses were performed at vessel and patient levels. Results A total of 342 vessels were analyzable. Based on ICA, significant CAD (at least 1 ≥50% stenosis) was present in 49 (38.6%) patients. Severe CAD (≥70% stenosis) was found in 29 (22.8%) patients. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CTA to diagnose significant CAD were 81.1%, 87.9%, 44.8%, 97.5% and 87.1% at vessel level using the cut-off of 50% and 42.8%, 97.8%, 56.3%, 96.3% and 94.4% for severe CAD, using the cut-off of 70%. At patient level, sensitivity, specificity, positive and negative predictive values were respectively 84.6%, 64.6%, 56.4% and 88.6% for significant CAD. Conclusion Pre-TAVI CTA shows good performance to rule out significant and severe CAD and could be used as a gatekeeper for ICA. Positive findings on CTA should be confirmed with ICA given the low positive predictive value

Summary report of the Standards, Options and Recommendations for the management of patients with non-small-cell lung carcinoma (2000)

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Brain metastases at the time of presentation of non-small cell lung cancer: a multi-centric AERIO analysis of prognostic factors

A multi-centre retrospective study involving 4 French university institutions has been conducted in order to identify routine pre-therapeutic prognostic factors of survival in patients with previously untreated non-small cell lung cancer and brain metastases at the time of presentation. A total of 231 patients were recorded regarding their clinical, radiological and biological characteristics at presentation. The accrual period was January 1991 to December 1998. Prognosis was analysed using both univariate and multivariate (Cox model) statistics. The median survival of the whole population was 28 weeks. Univariate analysis (log-rank), showed that patients affected by one of the following characteristics proved to have a shorter survival in comparison with the opposite status of each variable: male gender, age over 63 years, poor performance status, neurological symptoms, serum neuron-specific enolase (NSE) level higher than 12.5 ng ml−1, high serum alkaline phosphatase level, high serum LDH level and serum sodium level below 132 mmol l−1. In the Cox's model, the following variables were independent determinants of a poor outcome: male gender: hazard ratio (95% confidence interval): 2.29 (1.26–4.16), poor performance status: 1.73 (1.15–2.62), age: 1.02 (1.003–1.043), a high serum NSE level: 1.72 (1.11–2.68), neurological symptoms: 1.63 (1.05–2.54), and a low serum sodium level: 2.99 (1.17–7.62). Apart from 4 prognostic factors shared in common with other stage IV NSCLC patients, whatever the metastatic site (namely sex, age, gender, performance status and serum sodium level) this study discloses 2 determinants specifically resulting from brain metastasis: i.e. the presence of neurological symptoms and a high serum NSE level. The latter factor could be in relationship with the extent of normal brain tissue damage caused by the tumour as has been demonstrated after strokes. Additionally, the observation of a high NSE level as a prognostic determinant in NSCLC might reflect tumour heterogeneity and understimated neuroendocrine differentiation. © 2001 Cancer Research Campaignhttp://www.bjcancer.co

Positive thyroid transcription factor 1 staining strongly correlates with survival of patients with adenocarcinoma of the lung

This study investigated the relation between positive thyroid transcription factor 1 (TTF1) staining and survival of patients affected by primary adenocarcinoma (ADC) of the lung. Pathological tissue from consecutive ADC patients was collected from 2002 to 2004. The anti-TTF1 antibody (8G7G3/1, dilution of 1/200) was used. Thyroid transcription factor 1 staining was assessed for each tumour as positive or negative. Probability of survival was estimated by Kaplan–Meier and difference tested by log-rank test. A Cox's regression multivariate analysis was carried out. In all, 106 patients were studied (66% male, 69% PS0–1, 83% with stage III or IV). Tumours expressed positive TTF1 staining in 66% of cases. Multivariate analysis demonstrated an independent lower risk of death for patients whose tumour expresses positive TTF1 staining (HR=0.51, 95% CI 0.30–0.85; P=0.01) and higher grade of differentiation (HR=0.40, 95% CI 0.24–0.68; P=0.001). In conclusion, positive TTF1 staining strongly and independently correlates with survival of patients with primary ADC of the lung

Pathological complete response induced by first-line chemotherapy with single agent docetaxel in a patient with advanced non small cell lung cancer

<p>Abstract</p> <p>Background</p> <p>Defining the optimal treatment for patients with inoperable non small cell lung cancer (NSCLC), presenting with metastatic mediastinal lymph nodes, is challenging. Nevertheless, preoperative chemotherapy or radiotherapy might offer a chance for these patients for radical surgical resection and, possibly, complete recovery.</p> <p>Case Presentation</p> <p>A 62-year old man with IIIA-N2 inoperable NSCLC was treated with first-line single agent docetaxel. A platinum-based treatment, though considered more active, was ruled out because of renal impairment. The patient tolerated the treatment very well and, although his initial response was not impressive, after 14 cycles he obtained a complete clinical response, which was confirmed pathologically after he underwent surgical lobectomy.</p> <p>Conclusion</p> <p>In non-operable NSCLC patients not eligible for a platinum-based treatment, single-agent docetaxel can provide complete pathologic responses. Failure to obtain a response after the first few cycles should not automatically discourage to continue treatment.</p