Surgically Treated Unsuspected N2-Positive NSCLC : Role of Extent and Location of Lymph Node Metastasis

The role of positive lymph node location in non-small-cell lung cancer (NSCLC) patients and effects on survival was assessed. A total of 88 operated patients with unsuspected N2 disease or station 10 lymph nodes were included. No difference was found in survival between inferior positive mediastinal N2 node patients compared to multilevel N2 disease patients. The survival of patients with positive hilar disease was similar to the inferior mediastinal positive N2 group. Background: The role of surgery in the treatment of non-small-cell lung cancer that has spread to ipsilateral mediastinal or hilar lymph nodes (LNs) is controversial. We examined whether the location of LNs positive for non-small-cell lung cancer in mediastinum or hilum influences the survival of these patients. Patients and Methods: We reviewed data from 881 patients and analyzed those with unsuspected N2 disease or hilar (station 10) LNs. The patients were stratified into the following groups: group A, positive hilar Naruke 10; group B, superior mediastinal and aortic nodes (Naruke 1, 2, 3, 4, 5, and 6); group C, inferior mediastinal nodes (Naruke 7, 8, and 9), and multilevel group D (2 or more positive N2 levels). Results: A total of 69 pN2 and 19 pN1 patients were included. Progression-free survival (PFS) was statistically significant better in group B versus group C (P = .044) and group B versus group D (P = .0086). The overall survival (OS) of group A did not differ from that of group C. A statistically significant better OS was found between groups B and D (P= .051). Conclusion: Inferior positive mediastinal N2 node patients seem to have an OS and PFS as poor as multilevel N2 disease patients. The OS and PFS of patients with positive hilar disease are similar to those in the inferior mediastinal positive N2 group. Superior positive mediastinal N2 node patients have better OS and PFS than the inferior mediastinal positive N2 group. (C) 2018 Elsevier Inc. All rights reserved.Peer reviewe

Thoracotomy and VATS Surgery in Local Non-Small-Cell Lung Cancer : Differences in Long-Term Health-Related Quality Of Life

Very long-term health-related quality of life (HRQoL) is an important end point in operated early stage non-small-cell lung cancer with good prognosis. The results for very long-term HRQoL after minimally invasive video-assisted thoracoscopic surgery (VATS) has not been evaluated and compared to thoracotomy. Surprisingly, inferior overall HRQoL was evident for patients operated with VATS, independent of preoperative factors including age, comorbidities, and pulmonary function tests. Background: As a result of routine low-dose computed tomographic screening, lung cancer is more frequently diagnosed at earlier, operable stages of disease. In treating local non-small-cell lung cancer, video-assisted thoracoscopic surgery (VATS), a minimally invasive surgical approach, has replaced thoracotomy as the standard of care. While short-term quality-of-life outcomes favor the use of VATS, the impact of VATS on long-term health-related quality of life (HRQoL) is unknown. Patients and Methods: We studied patients who underwent lobectomy for the treatment of non-small-cell lung cancer from January 2006 to January 2013 at a single institution (n = 456). Patients who underwent segmentectomy (n = 27), who received neoadjuvant therapy (n = 13), or who were found to have clinical stage > T2 or > NO disease (n = 45) were excluded from analysis. At time of HRQoL assessment, 199 patients were eligible for study and were mailed the generic HRQoL instrument 15D. Results: A total of 180 patients (90.5%) replied; 92 respondents underwent VATS while 88 underwent open thoracotomy. The VATS group more often had adenocarcinoma (P = .006), and lymph node stations were sampled to a lesser extent (P = .004); additionally, hospital length of stay was shorter among patients undergoing VATS (P = .001). No other clinical or pathologic differences were observed between the 2 groups. Surprisingly, patients who underwent VATS scored significantly lower on HRQoL on the dimensions of breathing, speaking, usual activities, mental function, and vitality, and they reported a lower total 15D score, which reflects overall quality of life (P <.05). Conclusion: In contrast to earlier short-term reports, long-term quality-of-life measures are worse among patients who underwent VATS compared to thoracotomy. (C) 2019 Elsevier Inc. All rights reserved.Peer reviewe

Long-Term Quality of Life in Operated Non-Small Cell Lung Cancer Patients

Lung cancer is a nefarious disease causing more deaths than any other cancer worldwide. It is also among the most common cancers in Finland and the leading cause of cancer-related deaths, with 5-year survival rates of only 10-15%. However, more cases are being diagnosed at an earlier, possibly curable stage – radical surgery being the main curative treatment. As more patients survive the disease, long-term results, including quality of life, have attained more weight as treatment outcome measures. Thus, less invasive video-assisted thoracoscopic surgery (VATS) has largely replaced the more invasive thoracotomy as the standard treatment for operable local non-small cell lung cancer (NSCLC) patients. This study assessed the long-term health-related quality of life (HRQoL) among surgically treated NSCLC survivors, determining possible patient and treatment factors affecting the long-term HRQoL and survival among these patients, and comparing the effects of VATS and thoracotomy on the long-term HRQoL. For Studies I and II, we gathered patient and operational characteristics on 579 patients operated on for NSCLC in our clinic at Helsinki University Central Hospital between January 2000 and June 2009. The 276 survivors received two HRQoL questionnaires, the generic 15D and the cancer-specific EORTC QLQ-C30, in 2011. The HRQoL of our 230 respondents was compared with that of the age- and gender-standardized general population. Study II utilized the same data to determine factors predicting survival and long-term HRQoL among NSCLC survivors via regression analyses. Study III compared long-term HRQoL between 88 thoracotomy and 92 VATS patients undergoing lobectomy for local NSCLC in our clinic from January 2006 to January 2013. All of the studies were retrospective in nature. The NSCLC survivors reported significantly lower long-term HRQoL than the general population, with the most severe deterioration observed on the dimensions of mobility and breathing. Long-term survival proved to be moderately predictable by objective patient, disease, and treatment features, such as age, disease stage, and perioperative complications, but the regression models failed to notably predict long-term HRQoL. VATS patients reported significantly lower long-term HRQoL than thoracotomy patients, although the groups had comparable pre- and perioperative characteristics, and particularly no differences favouring the thoracotomy group were observed. The apparent long-term reduction in HRQoL should be considered in patient counselling, and more resources directed to the pre- and postoperative rehabilitation of the most severely affected functions. Long-term postoperative HRQoL seems poorly predictable, or at least the commonly measured clinical features fail to have a marked effect on HRQoL.Keuhkosyöpä on maailmanlaajuisesti merkittävimpiä syöpätauteja sekä kokonaismäärällä että kuolleisuudella mitattuna. Nykyään potentiaalisesti taudin parantava leikkaushoito on kuitenkin yhä useammin mahdollinen ja tällöin myös ensisijainen hoitomuoto. Yhä useampien potilaiden selviytyessä myös pitkäaikainen elämänlaatu on noussut suurempaan arvoon leikkaustuloksen mittarina. Niinpä pienemmän kudosvaurion aiheuttava videoavusteinen tähystyskirurgia onkin pitkälti korvannut aiemmat avoleikkaukset leikkauskelpoisen keuhkosyövän ensisijaisena hoitomuotona. Tässä väitöskirjassa selvitimme ei-pienisoluisen keuhkosyövän vuoksi leikattujen potilaiden pitkäaikaista elämänlaatua, elämänlaatua ja selviytymistä mahdollisesti ennustavia tekijöitä sekä leikkaustekniikoiden välistä eroa pitkäaikaisessa elämänlaadussa. Tutkimuksia varten keräsimme tiedot ei-pienisoluisen keuhkosyövän vuoksi Helsingin yliopistollisessa keskussairaalassa tammikuun 2000 ja tammikuun 2013 välillä leikatuista potilaista. Kahdessa ensimmäisessä tutkimuksessa vertasimme vuonna 2011 elämänlaatukyselyihin vastanneiden 230 potilaan elämänlaatua ikä- ja sukupuolivakioidun verrokkiväestön tuloksiin sekä pyrimme vastausten pohjalta selvittämään tilastoanalyysien avulla selviytymistä ja pitkäaikaista elämänlaatua määrittäviä tekijöitä. Kolmannessa tutkimuksessa vertasimme tammikuun 2006 ja tammikuun 2013 välillä lohkonpoistolla hoidettujen 180 potilaan joukossa avoleikkauksen ja tähystyskirurgian mahdollisia eroja pitkäaikaisessa elämänlaadussa. Pitkäaikaisselviytyjien elämänlaatu oli merkittävästi verrokkiväestöä heikompaa ja voimakkaimmin alentunutta liikuntakyvyn ja hengitystoiminnan osalta. Selviytyminen oli kohtalaisen hyvin ennustettavissa potilas-, tauti- ja hoitotietojen, kuten iän ja taudin levinneisyyden pohjalta, mutta elämänlaadun ennustettavuus jäi heikoksi. Tähystyskirurgialla hoidettujen potilaiden pitkäaikainen elämänlaatu jäi merkittävästi avoleikkauksella hoidettujen potilaiden elämänlaatua heikommaksi, vaikka ryhmät olivatkin ominaisuuksiltaan vastaavia. Pitkäaikainen leikkauksenjälkeinen elämänlaatu näyttäytyy heikosti ennustettavana. Havaittu leikkaushoidon jälkeinen pitkäaikainen elämänlaadun alenema tulisi huomioida potilasohjauksessa ja eniten kärsineiden osa-alueiden kuntoutukseen tulisi panostaa enemmän

Patient features predicting long-term survival and health-related quality of life after radical surgery for non-small cell lung cancer

Background: This study presents a retrospective evaluation of patient, disease, and treatment features predicting long-term survival and health-related quality of life (HRQoL) among patients who underwent surgery for non-small cell lung cancer (NSCLC). Methods: Between January 2000 and June 2009, 586 patients underwent surgery at the Helsinki University Hospital. The 276 patients still alive in June 2011 received two validated quality of life questionnaires (QLQ): the generic 15D and the cancer-specific EORTC QLQ-C30 + QLQ-LC13. We used binary and linear regression analysis modeling to identify patient, disease, and treatment characteristics that predicted survival and long-term HRQoL. Results: When taking into account patient, disease, and treatment characteristics, long-term survival was quite predictable (69.5% correct), but no long-term HRQoL (R-2 between 0.041 and 0.119). Advanced age at the time of surgery, male gender, comorbidity (measured with the Charlson comorbidity index), clinical and pathological stages II-IV, and postoperative infectious complications predicted a lower survival rate. Features associated with poorer long-term HRQoL (measured with the 15D) were comorbidity, postoperative complications, and the use of the video-assisted thoracoscopic surgery (VATS) technique. Conclusions: Long-term HRQoL is only moderately predictable, while prediction of long-term survival is more reliable. Lower HRQoL is associated with comorbidities, complications, use of the VATS technique, and reduced pulmonary function, while adjuvant therapy is associated with higher HRQoL.Peer reviewe