F-036EPIDERMAL GROWTH FACTOR RECEPTOR MUTATIONS ARE LINKED TO SKIP N2 LYMPH NODE METASTASIS IN RESECTED NON-SMALL CELL LUNG CANCER ADENOCARCINOMAS

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The IASLC/ITMIG thymic epithelial tumors staging project: Proposals for the T component for the forthcoming (8th) edition of the TNM classification of malignant tumors

Despite longstanding recognition of thymic epithelial neoplasms, there is no official American Joint Committee on Cancer/ Union for International Cancer Control stage classification. This article summarizes proposals for classification of the T component of stage classification for use in the 8th edition of the tumor, node, metastasis classification for malignant tumors. This represents the output of the International Association for the Study of Lung Cancer and the International Thymic Malignancies Interest Group Staging and Prognostics Factor Committee, which assembled and analyzed a worldwide database of 10,808 patients with thymic malignancies from 105 sites. The committee proposes division of the T component into four categories, representing levels of invasion. T1 includes tumors localized to the thymus and anterior mediastinal fat, regardless of capsular invasion, up to and including infiltration through the mediastinal pleura. Invasion of the pericardium is designated as T2. T3 includes tumors with direct involvement of a group of mediastinal structures either singly or in combination: lung, brachiocephalic vein, superior vena cava, chest wall, and phrenic nerve. Invasion of more central structures constitutes T4: aorta and arch vessels, intrapericardial pulmonary artery, myocardium, trachea, and esophagus. Size did not emerge as a useful descriptor for stage classification. This classification of T categories, combined with a classification of N and M categories, provides a basis for a robust tumor, node, metastasis classification system for the 8th edition of American Joint Committee on Cancer/Union for International Cancer Control stage classification

PREVALENCE, CORRELATIONS, AND PROGNOSTIC SIGNIFICANCE OF THE PRESENCE OF MICROSCOPIC VASCULAR INVASION FOLLOWING COMPLETE RESECTION OF STAGE I NON-SMALL CELL LUNG CARCINOMA. AN UNDERESTIMATED FACTOR?

Objective: The significance of microscopic invasion of blood vessels (Microscopic Vascular Invasion, MVI) in patients with non-small cell lung carcinoma (NSCLC) remains controversial. The aim of this study was to evaluate prevalence, correlations and the prognostic significance of MVI in patients following complete resection of Stage I NSCLC. Methods: From 1/1998 to 10/2008 1521 patients received resection for NSCLC at our Institution, of whom 737 were at pathological Stage I after surgery. There were 323 adenocarcinomas (ADK) (44%), 322 squamous cell carcinomas (SCC) (44%), 53 bronchioloalveolar carcinomas (BAC) (7%), 29 large cell anaplastic carcinomas (LCC) (4%). Histologic grading was: 114 G1 (15%), 279 G2 (38%) and 344 G3 (47%). Mean tumour dimension was 36 mm. MVI was ascertained using routine histopathological workup. Immunohistochemical staining with antibody anti-CD34 was done to evaluate blood vessels on a selective basis. Prevalence differences, logistic regression and survival analysis were used for analysis. Results: MVI was observed in 228 patients (31%). Prevalence was significantly higher in ADK (131/323, 41%) than in SCC (80/322, 25%, p0.002). A significant correlation was found between the presence of MVI and ADK (OR 0.8, 95% CI 0.7-0.9) and increased tumour dimension (OR 1.1, 95% CI 1.01-1.24). Univariate survival analysis indicates that the presence of MVI was associated with a significantly reduced 5-year survival overall (65% vs. 52%, p0.0003) and in ADK (68% vs. 54%, p0.0002) but not in SCC (58% vs. 49%, p0.25). In a multivariate survival analysis, the presence of MVI was a significant indicator of poor survival overall (HR 1.61, 95% CI 1.30 \u20132.15) and in ADK (HR 2.02, 95% CI 1.36 \u20133-02). Conclusions: The finding of MVI in completely resected Stage I NSCLC is not infrequent. MVI is strongly correlated with adenocarcinoma histotype and increased tumour dimensions. The presence of MVI is an independent negative prognostic factor, which is particularly significant in adenocarcinomas. The use of adjuvant chemotherapy might be taken into consideration in these patients

Malignant pleural mesothelioma: the prognostic significance of different surgical treatments. A retrospective study from a single-institution experience

Backgrounds: Optimal therapy in patients with Malignant Pleural Mesothelioma (MPM) is a matter of debate. Many authors questioned the role of major surgery in the treatment of MPM. We reviewed our recent experience among different treatment options in patients with MPM to assess their prognostic impact. Materials and Methods: From 10/97 to 10/08 326 patients were admitted to our Hospital with a diagnosis of MPM (223 men, 103 women, mean age 64 years, range 32 1294). Management options included pleural drainage with/without pleurodesis (24 patients), Video-Assisted Thoracic Surgery (VATS) with/without pleurodesis (195), partial pleurectomy (PL) (27), total PL (8), Extrapleural Pneumonectomy (EPP, 72). The last two treatments were intended as maximal debulking procedures before chemotherapy. Chemotherapy and radiotherapy were used when indicated in exclusive or multimodality protocols. Patients receiving total PL and EPP were compared with those receiving palliative procedures (drainage, VATS or partial PL). Survival analysis was performed using univariate and multivariate (Cox regression) models. Results: Patients receiving PL (partial or total) and EPP were significantly younger than those receiving pleural drainage or VATS (56 vs. 68 years, p = 0.002). Median survival (years) in the different management groups were: pleural drainage (0.97), VATS (0.82), partial PL (1.35), total PL (2.01), EPP (1.73) (p = 0.00001). Two-year survival rates among the groups were: pleural drainage 22%, VATS 18%, partial PL 20%, total PL 50%, EPP 32% (p = 0.00001). A significant survival advantage was observed in patients receiving EPP or total PL vs. those receiving palliative procedures (32% vs.18%, p = 0.0002). In multivariate survival analysis, advanced age was a significant negative prognostic factor (HR 1.02, 95% CI 1.00 121.03, p = 0.007), while EPP or total PL were a significant positive prognostic factor (HR 0.59, 95% CI 0.35 120.99, p = 0.04). Conclusions: In patients with MPM, different treatment options may be offered with either palliative or maximal cytoreductive intent. Patients receiving major surgery are a selected subset of patients younger than those receiving pleural drainage or VATS. A significant survival advantage was observed in patients after total PL or EPP. Our results indicate that surgery with maximal debulking intent offers a significant survival advantage over palliative procedures and should therefore be considered a valuable option in selected patients with MPM

Does the World Health Organization histological classification predict outcomes after thymomectomy? Results of a multicentre study on 750 patients.

OBJECTIVES: The World Health Organization (WHO) thymoma histological classification clinical value remains a controversy. In this study, we evaluated its prognostic significance in patients with thymoma treated with radical intent. METHODS: Six high-volume Italian Thoracic Surgery Institutions collaborated with their own retrospective anonymized datasets. Demographic, clinical, pathological and treatment data were examined. A WHO histological classification (WHO-HC) collapsed scheme (A/AB and B1/B2 types merged) was proposed and compared with the traditional one. Predictors of survival were assessed using a Cox model with shared frailty. Competing-risk regression models were performed to identify the association between individual factors and freedom from recurrence. RESULTS: Between 1990 and 2011, 750 thymomas were operated on in participating centres. Myasthenia gravis was observed in 363 (48%) patients. A complete resection was achieved in 676 (91%) cases. One hundred and nine pati

Clinical management of atypical carcinoid and large-cell neuroendocrine carcinoma: a multicentre study on behalf of the European Society of Thoracic Surgeons (ESTS) Neuroendocrine Tumours of the Lung Working Group

In 2012, the European Society of Thoracic Surgeons (ESTS) created the Lung Neuroendocrine Tumors Working Group (NETs-WG) with the aim to develop scientific knowledge on clinical management of such rare neoplasms. This paper outlines the outcome and prognostic factors of two aggressive NETs: atypical carcinoids (ACs) and large-cell neuroendocrine carcinomas (LCNCs). Using the ESTS NETs-WG database, we retrospectively collected data on 261 patients in seven institutions in Europe, between 1994 and 2011. We used a Cox regression model to evaluate variables affecting patient survival and disease-free survival. Univariate and multivariate analysis were also carried out. Five-year overall survival rates for ACs and LCNCs were 77 vs 28% (P < 0.001), respectively. We found that for ACs, age (P < 0.001), tumour size (P = 0.015) and sub-lobar surgical resection (P = 0.005) were independent negative prognostic factors; for LCNCs, only pTNM stage III tumours (P = 0.016) negatively affected outcome in the multivariate analysis. Local recurrences and distant metastases developed in 93 patients and were statistically more frequent in LCNCs (P = 0.02). The biological aggressiveness of ACs and LCNCs has been demonstrated with this study. Our aim is to confirm these results with enhanced data collection through the ESTS NETs database

Unmet medical needs in pulmonary neuroendocrine (Carcinoid) neoplasms

Pulmonary carcinoids (PCs) display the common features of all well-differentiated neuroendocrine neoplasms (NEN) and are classified as low- A nd intermediate-grade malignant tumours (i.e., typical and atypical carcinoid, respectively). There is a paucity of randomised studies dedicated to advanced PCs and management principles are drawn from the larger gastroenteropancreatic NEN experience. There is growing evidence that NEN anatomic subgroups have different biology and different responses to treatment and, therefore, should be investigated as separate entities in clinical trials. In this review, we discuss the existing evidence and limitations of tumour classification, diagnostics and staging, prognostication, and treatment in the setting of PC, with focus on unmet medical needs and directions for the future. © 2018 S. Karger AG, Basel. All rights reserved

Il trattamento videotoracoscopico dello pneumotorace spontaneo primitive nelle donne: risultati a lungo termine di una serie multicentrica

SCOPO DEL LAVORO: Valutare le recidive dopo trattamento videotoracoscopico dello pneumotorace spontaneo primitivo (PSP) in un gruppo di donne &lt;40 anni, ed identificarne possibili fattori di rischio. MATERIALI E METODI: In 9 centri, nel periodo 2007-2017, 1178 pazienti consecutivi &lt;40 anni, sono stati sottoposti a trattamento videotoracoscopico per PSP. Esclusi 936 maschi e 34 pazienti con follow-up incompleto, abbiamo analizzato i dati di 208 donne [et\ue0 mediana: 24 (19-31) anni]. Il tasso di pazienti libere da malattia \ue8 stato calcolato con metodo Kaplan-Meier, l\u2019analisi dei fattori di rischio di recidiva con regressione lineare binaria