Erratum to nodal management and upstaging of disease. Initial results from the Italian VATS Lobectomy Registry

[This corrects the article DOI: 10.21037/jtd.2017.06.12.]

Pleural lavage cytology predicts recurrence and survival, even in early non-small cell lung cancer

PURPOSE: The TNM staging remains the best prognostic descriptor of lung cancer; however, new independent prognostic factors are needed, particularly for early stage disease. METHODS: An evaluation of the pleural lavage cytology (PLC) was performed in 436 consecutive NSCLC patients who underwent surgical resection; clinical, pathological and follow-up data were available for 414 patients. RESULTS: The PLC was positive in 15 patients (3.6 %). The overall five-year survival was 35.9 % in PLC-positive and 57.8 % in PLC-negative patients (p = 0.004). To compare groups with the same prognostic characteristics, the analysis was restricted to p-stage I patients, but the survival remained worse in the PLC-positive patients (42.9 vs 69.4 %; p = 0.001). Recurrence was also observed more frequently in PLC-positive cases: 69.2 vs 34.5 %, OR 4.28 (95 % CI 1.29-14.18; p = 0.01). Among the PLC-positive patients, no difference between the local (44.4 %) and distant (55.6 %) relapse patterns was found (p = 0.82). The multivariate analysis identified four independent prognostic factors: age (p < 0.001), disease stage (p < 0.001), gender (p = 0.025) and PLC status (p = 0.012). CONCLUSIONS: PLC is an independent prognostic factor for NSCLC. PLC-positive NSCLC patients have a worse overall survival and a higher recurrence rate, even in stage I disease. PLC-positive patients should be considered a high risk category, who should potentially be eligible for adjuvant therapy regardless of their p-stage

La citologia su lavaggio pleurico come fattore prognostico nel carcinoma polmonare non a piccole cellule

Objective: The aim of our study was to assess the prognostic value of Pleural Lavage Cytology in patients undergoing pulmonary resections for NSCLC. Methods: From January 2003 to July 2006 we performed PLC on 191 consecutive operable NSCLC without macroscopic pleural effusion. PLC was carried out soon after thoracotomy and before any lung manipulation, through the instillation of saline solution in the pleural cavity. PLC outcomes and patients clinicopathologic data were collected to evaluate their impact on prognosis. Results: In our series PLC was positive in 8 patients (4,2%): positive finding were related to histological diagnosis of adenocarcinoma (p = 0,01), grading G3-4 (p = 0,036), local infiltration as pT3-4 (p< 0,001), nodal dissemination as pN2-3 (p = 0,016) and number of involved lymphatic stations (p = 0,001). The 5-years survival rates were 37% in the positive group and 29% in the negative (p = 0,629), furthermore we observed a cancer recurrence rate of 37,5% in patients with positive PLC versus 6,3% in negative (p = 0,001). In the positive group cancer progressions were commonly local recurrences (25% vs 4% of negative) and cerebral metastasis (12,5% vs 0,5% of negative, p <0,000). Conclusions:We found that PLC has a small impact on survival, it is however a good prognostic factor in predict cancer recurrence

Nodal management and upstaging of disease: Initial results from the Italian VATS Lobectomy Registry

Background: VATS lobectomy is an established option for the treatment of early-stage NSCLC. Complete lymph node dissection (CD), systematic sampling (SS) or resecting a specific number of lymph nodes (LNs) and stations are possible intra-operative LN management strategies. Methods: All VATS lobectomies from the "Italian VATS Group" prospective database were retrospectively reviewed. The type of surgical approach (CD or SS), number of LN resected (RN), the positive/resected LN ratio (LNR) and the number and types of positive LN stations were recorded. The rates of nodal upstaging were assessed based on different LN management strategies. Results: CD was the most frequent approach (72.3%). Nodal upstaging rates were 6.03% (N0-to-N1), 5.45% (N0-to-N2), and 0.58% (N1-to-N2). There was no difference in N1 or N2 upstaging rates between CD and SS. The number of resected nodes was correlated with both N1 (OR =1.02; CI, 1.01-1.04; P=0.03) and N2 (OR =1.02; CI, 1.01-1.05; P=0.001) upstaging. Resecting 12 nodes had the best ability to predict upstaging (6 N1 LN or 7 N2 LN). The finding of two positive LN stations best predicted N2 upstaging [area under the curve (AUC) of receiver operating characteristic (ROC) =0.98]. Conclusions: Nodal upstaging (and, indirectly, the effectiveness of intra-operative nodal management) cannot be predicted based on the surgical technique (CD or SS). A quantitative assessment of intra-operative LN management may be a more appropriate and measurable approach to justify the extension of LN resection during VATS lobectomy

Erratum: Nodal management and upstaging of disease: Initial results from the Italian VATS Lobectomy Registry [J Thorac Dis, 9, (2017), (2061-2070)] DOI: 10.21037/jtd.2017.06.12

In the article that appeared on page 2061-2070, Vol 9, No 7 (July 2017) Issue of the Journal of Thoracic Disease (1), there are some mistakes in the presented authors information. In the list of collaborators of the Italian VATS Group are not included the following author names: Alessandro Bertani, Alessandro Gonfiotti, Mario Nosotti, Paolo Albino Ferrari, Lavinia De Monte, Emanuele Russo, Gioacchino Di Paola, Piergiorgio Solli, Andrea Droghetti, Luca Bertolaccini, Roberto Crisci. The correct list of collaborators of the Italian VATS Group should have been shown as below. Alessandro Bertani, MD (IRCCS ISMETT, Palermo); Alessandro Gonfiotti, MD (Careggi Hospital, Firenze); Mario Nosotti, MD (Policlinico Ca'Granda, Milano); Paolo Albino Ferrari, MD (IRCCS ISMETT, Palermo); Lavinia De Monte, MD (IRCCS ISMETT, Palermo); Emanuele Russo, MD (IRCCS ISMETT, Palermo); Gioacchino Di Paola, MD (IRCCS ISMETT, Palermo); Piergiorgio Solli, MD PhD (AUSL Romagna Teaching Hospital, Forlì); Andrea Droghetti, MD (ASST Mantova-Cremona, Mantova); Luca Bertolaccini, MD PhD (AUSL Romagna Teaching Hospital, Forlì); Roberto Crisci, MD PhD (Università dell'Aquila, L'Aquila); Carlo Curcio, MD (Monaldi Hospital, Napoli); Dario Amore, MD (Monaldi Hospital, Napoli); Giuseppe Marulli, MD (University of Padova); Samuele Nicotra, MD (University of Padova); Andrea De Negri, MD (San Martino Hospital, Genova); Paola Maineri, MD (San Martino Hospital, Genova); Gaetano di Rienzo (Vito Fazzi Hospital, Lecce); Camillo Lopez, MD (Vito Fazzi Hospital, Lecce); Angelo Morelli, MD (S. Maria delle Misericordia Hospital, Udine); Francesco Londero, MD (S. Maria delle Misericordia Hospital, Udine); Lorenzo Spaggiari, MD (IEO Hospital, Milano); Roberto Gasparri, MD (IEO Hospital, Milano); Guido Baietto, MD (Maggiore della Carità Hospital, Novara); Caterina Casadio, MD (Maggiore della Carità Hospital, Novara); Maurizio Infante, MD (Borgo Trento Hospital, Verona); Cristiano Benato, MD (Borgo Trento Hospital, Verona); Marco Alloisio, MD (IRCCS Humanitas, Milano); Edoardo Bottoni, MD (IRCCS Humanitas, Milano); Giuseppe Cardillo, MD (Forlanini Hospital, Roma); Francesco Carleo, MD (Forlanini Hospital, Roma); Franco Stella, MD (S. Orsola Hospital, Bologna); Giampiero Dolci, MD (S. Orsola Hospital, Bologna); Francesco Puma, MD (University of Perugia); Damiano Vinci, MD (University of Perugia); Giorgio Cavallesco, MD (University of Ferrara); Pio Maniscalco, MD (University of Ferrara); Luca Ampollini, MD (University of Parma); Paolo Carbognani, MD (University of Parma); Alberto Terzi, MD (Negrar Hospital, Verona); Andrea Viti, MD (Negrar Hospital, Verona); Giampiero Negri, MD (S. Raffaele Hospital, Milano); Alessandro Bandiera, MD (S. Raffaele Hospital, Milano); Reinhold Perkmann, MD (Bolzano Hospital, Bolzano); Francesco Zaraca, MD (Bolzano Hospital, Bolzano); Claudio Andretti, MD (S. Andrea Hospital, Roma); Camilla Poggi, MD (S. Andrea Hospital, Roma); Felice Mucilli, MD (S. Maria Annunziata Hospital, Chieti); Pierpaolo Camplese, MD (S. Maria Annunziata Hospital, Chieti); Luca Luzzi, MD (University of Siena); Marco Ghisalberti, MD (University of Siena); Andrea Imperatori, MD (University of Varese); Nicola Rotolo, MD (University of Varese); Luigi Bortolotti, MD (Humanitas Gavazzeni Hospital, Bergamo); Giovanna Rizzardi, MD (Humanitas Gavazzeni Hospital, Bergamo); Massimo Torre, MD (Niguarda Hospital, Milano); Alessandro Rinaldo, MD (Niguarda Hospital, Milano); Armando Sabbatini, MD (Ospedali Riuniti, Ancona); Majed Refai, MD (Ospedali Riuniti, Ancona); Mauro Roberto Benvenuti, MD (Spedali Civili, Brescia); Diego Benetti, MD (Spedali Civili, Brescia); Alessandro Stefani, MD (Ospedale Policlinico, Modena); Pamela Natali, MD (Ospedale Policlinico, Modena); Paolo Lausi, MD (Ospedale Molinette, Torino); Francesco Guerrera, MD (Ospedale Molinette, Torino)