Detection of human telomerase reverse transcriptase mRNA in cells obtained by lavage of the pleura is not associated with worse outcome in patients with stage I/II non–small cell lung cancer: Results from Cancer and Leukemia Group B 159902

ObjectivePrevious studies suggest that cytologic analysis of cells obtained by lavage of the pleural surfaces at the time of resection of non–small cell lung cancer can identify patients at risk for recurrence. Because telomerase gene expression has been associated with worse outcome in non–small cell lung cancer, we hypothesized that identification of cells obtained from pleural lavage that express telomerase would identify patients at risk for recurrent disease.MethodsPatients with presumed non–small cell lung cancer underwent thoracotomy with curative intent. Cells obtained by lavage of the pleural surfaces were analyzed for telomerase catalytic subunit human telomerase reverse transcriptase mRNA expression using reverse transcriptase polymerase chain reaction.ResultsA total of 194 patients with stage I/II non–small cell lung cancer had adequate samples, and median follow-up was 60 months (17-91 months). By using Cox models, no statistical differences were found between human telomerase reverse transcriptase–negative and positive patients in disease-free survival (hazard ratio, 1.28; 95% confidence interval, 0.85-1.94; log-rank test, P = .2349) or overall survival (hazard ratio, 1.13; 95% confidence interval, 0.72-1.79; log-rank test, P = .5912)ConclusionsDetection of human telomerase reverse transcriptase in cells obtained from pleural lavage of patients with stage I/II non–small cell lung cancer does not identify patients at risk for recurrent disease

Peak oxygen consumption and long-term all-cause mortality in nonsmall cell lung cancer

Identifying strong markers of prognosis is critical to optimize treatment and survival outcomes in patients with non-small cell lung cancer (NSCLC). We investigated the prognostic significance of preoperative cardiorespiratory fitness (VO2peak) among operable candidates with NSCLC

Sublobar resection is equivalent to lobectomy for clinical stage 1A lung cancer in solid nodules

ObjectivesA single randomized trial established lobectomy as the standard of care for the surgical treatment of early-stage non–small cell lung cancer. Recent advances in imaging/staging modalities and detection of smaller tumors have once again rekindled interest in sublobar resection for early-stage disease. The objective of this study was to compare lung cancer survival in patients with non–small cell lung cancer with a diameter of 30 mm or less with clinical stage 1 disease who underwent lobectomy or sublobar resection.MethodsWe identified 347 patients diagnosed with lung cancer who underwent lobectomy (n = 294) or sublobar resection (n = 53) for non–small cell lung cancer manifesting as a solid nodule in the International Early Lung Cancer Action Program from 1993 to 2011. Differences in the distribution of the presurgical covariates between sublobar resection and lobectomy were assessed using unadjusted P values determined by logistic regression analysis. Propensity scoring was performed using the same covariates. Differences in the distribution of the same covariates between sublobar resection and lobectomy were assessed using adjusted P values determined by logistic regression analysis with adjustment for the propensity scores. Lung cancer–specific survival was determined by the Kaplan–Meier method. Cox survival regression analysis was used to compare sublobar resection with lobectomy, adjusted for the propensity scores, surgical, and pathology findings, when adjusted and stratified by propensity quintiles.ResultsAmong 347 patients, 10-year Kaplan–Meier for 53 patients treated by sublobar resection compared with 294 patients treated by lobectomy was 85% (95% confidence interval, 80-91) versus 86% (confidence interval, 75-96) (P = .86). Cox survival analysis showed no significant difference between sublobar resection and lobectomy when adjusted for propensity scores or when using propensity quintiles (P = .62 and P = .79, respectively). For those with cancers 20 mm or less in diameter, the 10-year rates were 88% (95% confidence interval, 82-93) versus 84% (95% confidence interval, 73-96) (P = .45), and Cox survival analysis showed no significant difference between sublobar resection and lobectomy using either approach (P = .42 and P = .52, respectively).ConclusionsSublobar resection and lobectomy have equivalent survival for patients with clinical stage IA non–small cell lung cancer in the context of computed tomography screening for lung cancer

Age Related Differences in Oxygen Free Radical Injury during Myocardial Ischemia

(J. Extra-Corpor. Technol. 19[3] p. 245-257 Fall 1987, 42 ref.) Myocardial protection with an oxygenated cardioplegic solution was studied in mature and immature animals. Isolated adult and neonatal rabbit hearts were exposed to 90 minutes of hypothermic 30°C ischemia, and one of the following treatments: multidose oxygenated (pO2<650 torr) cardioplegia, multidose nonoxygenated (pO2<200 torr) cardioplegia, and a noncardioplegic Krebs-Henseleit solution. Upon reperfusion, adult hearts that had not received either cardioplegia treatment failed to recover postischemic hemodynamic function. However, neonates given the same treatment were able to recover 74.0 ± 2.4% (Mean ± SEM) of preischemic cardiac output and 69.2 ± 5.7% recovery of stroke work. Oxygenated cardioplegia administered to adult and neonatal hearts resulted in postischemic cardiac output recovery of 90.8 ± 2.4% and 86.5 ± 8.6%, respectively. Cardiac output recovery in nonoxygenated cardioplegia groups was 105.3 ± 3.9% in the adults, and 95.2 ± 6.6% in the neonates. Coronary sinus creatine kinase was substantially elevated in all adult groups, but not in the cardioplegia treated neonates. Membrane lipid peroxidation was assessed by measuring malondialdehyde in myocardial tissue homogenates. Malondialdehyde remained at control levels across all neonatal groups, but in the mature hearts the nonoxygenated cardioplegia group had significantly lower peroxidative products than the oxygenated hearts. The results of this study indicate an increased susceptibility of the mature myocardium to both the damaging effects of ischemia and free oxygen radicals. Administration of an oxygenated cardioplegic solution failed to provide adequate protection during moderate hypothermic arrest, and resulted in increased membrane peroxidative activity

Impact of ASA score misclassification on NSQIP predicted mortality: a retrospective analysis

Abstract Background The ASA physical classification score has a major impact on the observed/expected (O/E) mortality ratio in the NSQIP General Vascular Mortality Model. The difference in predicted mortality is greatest between ASAs 3 and 4. We hypothesized under-classified ASA scores significantly affect the O/E mortality. Methods We conducted a retrospective review of NSQIP essential surgery cases from January 2014 to December 2014 (n = 1264) with mortality sub-analysis (n = 33) at our institution. We recorded transfer and emergency status and independently calculated the ASA score for mortalities using published definitions. A random sample of 50 survivors and 10 emergency survivors were reviewed and ASA recalculated. We performed statistical modeling to simulate the effects of ASA misclassifications. Statistical analysis was performed using JMP 10 and SAS 9.4. Results ASA was under-classified in 18.2% of mortalities, most commonly ASAs 3 and 4. Sixteen percent of ASA 3 survivors were misclassified, including 60% in the emergency subgroup (p < 0.05 vs. elective cases). Patients transferred from other institutions were more likely to be emergency cases than non-transferred patients (43.5 vs. 7.84%, p < 0.05). Transferred patients had a higher proportion of ASAs 3–5 vs. ASAs 1–2 compared with non-transfers (84.38 vs. 49.76%, p < 0.05) Simulation data showed ASA misclassification underestimated predicted mortality by 2.5 deaths on average. Conclusion ASA misclassification significantly impacts O/E mortality. With accurate ASA classification, observed mortality would not have exceeded expected mortality in our institution. Education regarding the impact of ASA scoring is critical to ensure accurate O/E mortality data at hospitals using NSQIP to assess surgical quality