Correlation Analysis between Thyroid Function Abnormality and Efficacy in Patients with Advanced Non-small Cell Lung Cancer after Immunotherapy / 中国肺癌杂志

BACKGROUND@#Thyroid function abnormality (TFA) is one of the common adverse reactions in patients with advanced non-small cell lung cancer (NSCLC) treated with immunotherapy, but the risk factors of TFA and its relationship with efficacy are not completely clear. The purpose of this study was to explore the risk factors of TFA and its relationship with efficacy in patients with advanced NSCLC after immunotherapy.@*METHODS@#The general clinical data of 200 patients with advanced NSCLC in The First Affiliated Hospital of Zhengzhou University from July 1, 2019 to June 31, 2021 were collected and analyzed retrospectively. χ² test and multivariate Logistic regression were used to explore the risk factors of TFA. Kaplan-Meier curve was drawn and Log-rank test was used for comparison between groups. Univariate and multivariate Cox analysis was used to explore the efficacy factors.@*RESULTS@#A total of 86 (43.0%) patients developed TFA. Logistic regression analysis showed that Eastern Cooperative Oncology Group Performance Status (ECOG PS), pleural effusion and lactic dehydrogenase (LDH) were factors influencing TFA (P<0.05). Compared with normal thyroid function group, the median progression-free survival (PFS) of patients in the TFA group was significantly longer (19.0 months vs 6.3 months, P<0.001), and the objective response rate (ORR) (65.1% vs 28.9%, P=0.020) and disease control rate (DCR) (100.0% vs 92.1%, P=0.020) of the TFA group were better than those of the normal thyroid function group. Cox regression analysis showed that ECOG PS, LDH, cytokeratin 19 fragment (CYFRA21-1) and TFA were factors influencing prognosis (P<0.05).@*CONCLUSIONS@#ECOG PS, pleural effusion and LDH may be risk factors affecting the occurrence of TFA and TFA may be a predictor of the efficacy of immunotherapy. Patients with advanced NSCLC who have TFA after immunotherapy may obtain better efficacy.

Chinese Expert Consensus on Non-small Cell Lung Cancer with EGFR Exon 20 Insertion Mutations (2023 Edition) / 中国肺癌杂志

With the development of precision diagnosis and treatment for non-small cell lung cancer (NSCLC), the epidermal growth factor receptor (EGFR) exon 20 insertion (ex20ins) mutations, as a rare subset of EGFR mutaions, have gradually attracted attention recently. The heterogeneity of EGFR ex20ins mutations is very high, different variants have different clinical benefits, and the prognosis is extremely poor. The available traditional treatment outcomes are poor in patients with EGFR ex20ins positive NSCLC and polymerase chain reaction (PCR) tests would miss aprocimately 50% of the variants. Therefore, high attention should be paid to EGFR ex20ins positive NSCLC during the clinical practice. The expert panel has formed a consensus on the standardized clinical diagnosis and treatment of EGFR ex20ins mutation NSCLC through reference to literature and clinical data, and combined with the experts' own clinical experience, the consensus recommendations including clinicopathologic characteristics, therapies, testing methods and recent relevant clinical trials for NSCLC patients with EGFR ex20ins mutation, in order to provide medication reference for clinical physicians at all levels.

Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2023 edition) / 中华肿瘤杂志

To standardize the prevention and clinical management of lung cancer, improve patients' survival outcomes, and offer professional insight for clinicians, the Oncology Society of Chinese Medical Association has summoned experts from departments of pulmonary medicine, oncology, thoracic surgery, radiotherapy, imaging, and pathology to formulate the Oncology Society of Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer in China (2023 edition) through consensus meetings. Updates in this edition include 1) cancer screening: deletion of high-risk traits of lung cancer based on epidemiological investigations in the Caucasian population, while preserving features confirmed by research on the Chinese population. Advice on screening institutions is also added to raise awareness of the merits and demerits of lung cancer screening through detailed illustrations. 2) Principles of histopathologic evaluation: characteristics of four types of neuroendocrine tumors (typical carcinoid, atypical carcinoid, large cell carcinoma, and small cell carcinoma) are reviewed. 3) Surgical intervention: more options of resection are available for certain peripheral lesions based on several clinical studies (CALGB140503, JCOG0802, JCOG1211). 4) neoadjuvant/adjuvant therapy: marked improvement in the prognosis of non-small cell lung cancer (NSCLC) patients receiving neoadjuvant immunotherapy are reviewed; more options for consolidation immunotherapy after radiochemotherapy have also emerged. 5) Targeted and immune therapy: tyrosine kinase inhibitors of sensitive driver mutations such as EGFR and ALK as well as rare targets such as MET exon 14 skipping, RET fusion, ROS1 fusion, and NTRK fusion have been approved, offering more treatment options for clinicians and patients. Furthermore, multiple immune checkpoint inhibitors have been granted for the treatment of NSCLC and SCLC, resulting in prolonged survival of late-stage lung cancer patients. This guideline is established based on the current availability of domestically approved medications, recommendations of international guidelines, and present clinical practice in China as well as integration of the latest medical evidence of pathology, genetic testing, immune molecular biomarker detection, and treatment methods of lung cancer in recent years, to provide recommendations for professionals in clinical oncology, radiology, laboratory, and rehabilitation.

Treatment Sequencing Strategies in Lung Cancer / 中国肺癌杂志

BACKGROUND@#The advances in the lung cancer screening methods and therapeutics, together with awareness towards deleterious habits, such as smoking, is increasing the overall survival with better quality of life for the patients. However, lung cancer is still one of the most common and fatal neoplasm with a high incidence and consequently burden to public health worldwide. Thus, based on guidelines and recent phases II and III clinical trials studies, this manuscript summarizes the current treatment sequencing strategies in lung cancer.@*METHODS@#A comprehensive search of related articles was performed focused on phases II and III clinical trials studies.@*RESULTS@#The lung cancer management should take into consideration the tumor characteristics, histology, molecular pathology and be discussed in a multidisciplinary team. Lung cancer treatment options comprises surgery whenever possible, radiotherapy associate with/or chemotherapy and immunotherapy as monotherapy, or combined with chemotherapy and best palliative care.@*CONCLUSIONS@#The screening predictability in more patients, smoking reduction, early diagnosis, better disease understanding and individualized, more effective and tolerable therapeutics are related to an increasing in overall survival and quality of life. In the near future improvement of personalized therapy in precision medicine is expected, enhancing new predictive biomarkers, optimal doses and optimal treatment sequencing as well as anti-cancer vaccines development.

Research Progress of Immunotherapy for Non-small Cell Lung Cancer with Drive Gene Mutation / 中国肺癌杂志

Lung cancer is the most lethal malignancy around the world and non-small cell lung cancer (NSCLC) accounts for 80% of all cases. Most of the NSCLC patients has "driver gene mutations" and targeted therapy achieved a relatively good efficacy, but some patients progressed or relapsed after treatment. Previous studies demonstrated that immune checkpoint inhibitor could improve the prognosis of advanced-stage NSCLC and prolong the survival time. However, the efficacy of immune therapy varies in NSCLC patients with different immune and molecular features. The efficacy of immune therapy was controversial in NSCLC patients with driver gene mutation. The present review will summarize the immune characteristics of NSCLC patients with driver mutation and the directions of immunotherapy for patients with driver mutation.
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Research Progress of Immunotherapy Biomarkers for Non-small Cell Lung Cancer / 中国肺癌杂志

Lung cancer is one of the most prevalent malignancies with the highest morbidity and mortality rates worldwide. In recent years, with the development of immune-oncology research and several therapeutic antibodies have reach the clinic, many breakthroughs have been made in immunotherapy. The advent of immunotherapy has revolutionized the treatment of NSCLC, but the response and durable clinical benefit are only observed in a small subset of patients. Therefore, strategies to screen the potential beneficial population and improve the efficacy of immunotherapy remain an essential topic. In the current article, the author review the biomarkers that have potential to better predict responders to immunotherapy and to provide ideas for the clinical application of immunotherapy.
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Advances in Biomarkers for Immunotherapy of Non-small Cell Lung Cancer / 中国肺癌杂志

Lung cancer is a malignant tumor with the highest mortality in the world. The most common pathological type of lung cancer is non-small cell lung cancer (NSCLC). In recent years, immunotherapy has brought about epoch-making changes in the treatment of NSCLC. In particular, immune checkpoint inhibitors (ICIs) targeting programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) have been approved for first-line and second-line treatment in patients with metastatic NSCLC. However, only 15% to 30% of patients with advanced NSCLC can achieve sustained remission and long-term survival from immunotherapy. Therefore, biomarker for predicting the efficacy of immunotherapy is particularly important. This article reviews the relevant literatures on predictive biomarkers for immunotherapy of NSCLC and provides direction for future research.
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Expert Consensus on Tumor Mutational Burden for Immunotherapy in Lung Cancer / 中国肺癌杂志

Lung cancer is one of the malignant tumors with the highest morbidity and mortality in the world. Immune checkpoint inhibitors (ICIs), including programmed cell death 1 (PD-1) antibody, programmed cell death ligand 1 (PD-L1) antibody, and cytotoxic T lymphocyte associated protein 4 (CTLA-4) antibody. It has brought significant survival benefits to some patients with advanced lung cancer and changed the treatment pattern of advanced lung cancer. Previous studies have shown that the objective response rate of PD-1/PD-L1 antibody in advanced non-small cell lung cancer (NSCLC) is only about 20%. So reliable biomarkers are urgently needed to screen out the potential benefit population of ICIs and improve the clinical response rate. Tumor mutational burden (TMB) is an emerging biomarker of immunotherapy in addition to PD-L1 expression. There is little correlation between PD-L1 expression and TMB in lung cancer. It is estimated that TMB can expand the benefit population of immunotherapy. However, in clinical practice, the detection of TMB, the determination of cut-off value and the clinical guidance strategy are still not standardized. This consensus will give guiding suggestions on the detection and application scenarios of TMB, so as to promote the standardization of TMB application for immunotherapy in lung cancer.
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Vacuna terapéutica racotumomab en un anciano con cáncer avanzado de pulmón / Racotumomab therapeutic vaccine in an elderly with advanced lung cancer

Se presenta el caso clínico de un anciano de 84 años de edad, fumador, con diagnóstico de cáncer de pulmón en etapa IV, quien fue incluido en el ensayo clínico de fase III para ser tratado con racotumumab. Se observó mejoría clínica y del estado general del paciente, pues según la escala funcional concluyó el estudio con ECOG 0. Por tanto, es oportuno destacar que esta vacuna incrementa la supervivencia de los afectados por cáncer de pulmón de células no pequeñas recurrentes o en estadios avanzados.

The case report of a 84 years elderly smoker, is presented with diagnosis of lung cancer in stage IV who was included in the phase III clinical trial to be treated with racotumomab. Clinical improvement and recovery of the patient's general state was observed, because according to the functional scale the study concluded with ECOG 0. Therefore, it is opportune to highlight that this vaccine increases the survival of those affected by recurrent non-small cells lung cancer or in advanced stages.

HIF-1α Levels in patients receiving chemoradiotherapy for locally advanced non-small cell lung carcinoma

SUMMARY AIM To examine the relationship between treatment response and hypoxia-inducible factor-1 alpha (HIF-1α) levels in patients with locally advanced non-small cell lung cancer (NSCLC) who received chemoradiotherapy (CRT). METHODS Eighty patients with NSCLC were included in the study and treated at Acibadem Mehmet Ali Aydınlar University Medical Faculty. HIF-1 α levels were measured before and after CRT by the enzyme-linked immunosorbent assay (ELISA) method. RESULTS Patients' stages were as follows; stage IIIA (65%) and stage IIIB (35%). Squamous histology was 45%, adenocarcinoma was 44%, and others were 11%. Chemotherapy and radiotherapy were given concurrently to 80 patients. Forty-five (56%) patients received cisplatin-based chemotherapy, and 35 (44%) received carboplatin-based chemotherapy. Serum HIF-1α levels (42.90 ± 10.55 pg/mL) after CRT were significantly lower than the pretreatment levels (63.10 ± 10.22 pg/mL, p<0.001) in patients with locally advanced NSCLC. CONCLUSION The results of this study revealed that serum HIF-1α levels decreased after CRT. Decrease of HIF-1α levels after the initiation of CRT may be useful for predicting the efficacy of CRT.

RESUMO OBJETIVO Examinar a relação entre a resposta ao tratamento e os níveis de fator 1 induzida por hipóxia (HIF-1α) em pacientes com câncer de pulmão de células não pequenas localmente avançado (NSCLC) que receberam quimiorradioterapia (CRT). MÉTODO Oitenta pacientes com NSCLC foram incluídos no estudo e foram tratados na Faculdade de Medicina da Acibadem Mehmet Ali Aydınlar University. O nível de HIF-1α foi medido antes e depois da TRC pelo método de ensaio imunoenzimático (ELISA). RESULTADOS Os estágios dos pacientes foram os seguintes; estágio IIIA (65%) e estágio IIIB (35%). A histologia escamosa foi de 45%, o adenocarcinoma de 44% e o outro de 11%. Quimioterapia e radioterapia foram dadas simultaneamente a 80 pacientes. Quarenta e cinco (56%) pacientes receberam quimioterapia à base de cisplatina e 35 (44%) receberam quimioterapia à base de carboplatina. Os níveis séricos de HIF-1α (42,90 ± 10,55 pg / mL) após a TRC foram significativamente menores do que os níveis pré-tratamento (63,10 ± 10,22 pg / mL, p <0,001) em pacientes com NSCLC localmente avançado. CONCLUSÃO Os resultados deste estudo revelaram que os níveis séricos de HIF-1α diminuíram após a TRC. A diminuição dos níveis de HIF-1α após o início da TRC pode ser útil para prever a eficácia da TRC.

La inmunoterapia una alternativa terapéutica en ancianos con cáncer de pulmón de células no pequeñas / Immunotherapy, a therapeutic option in elder people with non small cells lung cancer

RESUMEN El cáncer es un problema prioritario de salud pública en el mundo. En Cuba constituye la segunda causa de muerte en la mayoría de grupos de edades y fundamentalmente en la población mayor de 60 años. El objetivo fue evaluar el impacto de la inmunoterapia como una alternativa terapéutica que mejora las funciones de supervivencia en pacientes ancianos con cáncer de pulmón de células no pequeñas. Se realizó un estudio analítico experimental donde el universo estuvo integrado por 123 ancianos con diagnóstico de cáncer de pulmón los cuales fueron tratados con inmunoterapia en Matanzas. Fueron utilizadas variables de control a las cuales se les aplicaron las medidas de resumen correspondientes utilizando las pruebas de hipótesis de chi cuadrado y las razones de verosimilitud para su análisis y estadístico y fueron evaluadas las funciones de supervivencia usando las curvas de Kaplan Meier. Se demostró la eficacia y seguridad de la inmunoterapia en el tratamiento de los pacientes estudiados. Por ello consideramos que el impacto secuencial de la combinación de la cirugía, la quimioterapia, la radioterapia y las terapias biológicas, tiende a prolongar la supervivencia de los pacientes que sufren cáncer de pulmón de células no pequeñas con una calidad de vida éticamente aceptable. Las nuevas terapias inmunológicas que consisten en devolver al sistema inmunológico de los pacientes, la capacidad de reconocer al tumor como extraño, y por tanto luchar contra él; han producido respuestas y beneficios muy importantes (AU).

SUMMARY Cancer is a priority public health problem in the world. In Cuba, it is the second cause of death in most age groups and mainly in the population aged over 60 years. To evaluate the impact of immunotherapy as a therapeutic alternative that improves survival functions in elder patients with non-small cell lung cancer. An experimental analytical study was carried out; the universe was composed by 123 elder people diagnosed with lung cancer who were treated with immunotherapy in Matanzas. Control variables were used to which the corresponding summary measures were applied using chi-square hypothesis tests and likelihood ratios for their analysis and statistics; survival functions were evaluated using Kaplan Meier curves. The efficacy and safety of immunotherapy in the treatment of the studied patients was demonstrated. Therefore, the authors believe that the sequential impact of the combination of surgery, chemotherapy, radiotherapy and biological therapies tends to extend the survival of patients suffering from non-small cell lung cancer with an ethically acceptable life quality. The new immunological therapy, consisting in returning to the patients´ immunologic system the capacity of recognizing a tumor as foreign, and therefore, fighting against it, have yielded very important answers and benefits (AU).

Epigenetics in non-small cell lung carcinomas / Epigenetica en carcinomas pulmonares de células no pequeñas

Abstract: Objective: To perform a systematic review of the main epigenetic aberrations involved in non-small cell lung carcinomas' (NSCLC) diagnosis, progression, and therapeutics. Materials and methods: We performed a systematic review of the scientific literature on lung cancer epigenetics, focusing on NSCLC. Results: Several advances in the molecular study of classical epigenetic mechanisms and massive studies of lung cancer epigenome have contributed relevant new evidence revealing that various molecular complexes are functionally influencing genetic-epigenetic and transcriptional mechanisms that promote lung tumorigenesis (initiation, promotion, and progression), and are also involved in NSCLC therapy-resistance mechanisms. Conclusion: Several epigenetic complexes and mechanisms must be analyzed and considered for the design of new and efficient therapies, which could be fundamental to develop an integrated knowledge to achieve a comprehensive lung cancer personalized medicine.

Resumen: Objetivo: Realizar una revisión sistemática y estructurada de las principales aberraciones epigenéticas involucradas en el diagnóstico, progresión y terapia del cáncer pulmonar de células no pequeñas (CPCNP). Material y métodos: Revisión sistemática de literatura científica sobre epigenética del cáncer pulmonar del grupo CPCNP. Resultados: El estudio de los diversos mecanismos epigenéticos y su impronta epigenética en el epigenoma del cáncer pulmonar han arrojado nuevas evidencias a nivel biológico, biomédico y médico-clínico del impacto que los mecanismos epigenético-transcripcionales promueven de manera activa y reversible sobre los procesos de tumorigénesis, progresión histopatológica y mecanismos de resistencia a la terapia oncológica pulmonar. Conclusión: Deben analizarse diferentes complejos y mecanismos epigenéticos para el estudio y diseño de esquemas nuevos y eficaces de terapia epigenética, los cuales podrían ser fundamentales para desarrollar un conocimiento integral en el desarrollo de la medicina personalizada en el cáncer pulmonar del grupo CPCNP.

Estimated costs of advanced lung cancer care in a public reference hospital / Estimativa dos custos da assistência do câncer de pulmão avançado em hospital público de referência

ABSTRACT OBJECTIVE To estimate the direct medical costs of advanced non-small cell lung cancer care. METHODS We assessed a cohort of 277 patients treated in the Brazilian National Cancer Institute in 2011. The costs were estimated from the perspective of the hospital as a service provider of reference for the Brazilian Unified Health System. The materials and procedures used were identified and quantified, per patient, and we assigned to them monetary values, consolidated in phases of the assistance defined. The analyses had a descriptive character with costs in Real (R$). RESULTS Overall, the cohort represented a cost of R$2,473,559.91, being 71.5% related to outpatient care and 28.5% to hospitalizations. In the outpatient care, costs with radiotherapy (34%) and chemotherapy (22%) predominated. The results pointed to lower costs in the initial phase of treatment (7.2%) and very high costs in the maintenance phase (61.6%). Finally, we identified statistically significant differences of average cost by age groups, education levels, physical performance, and histological type. CONCLUSIONS This study provides a current, useful, and relevant picture of the costs of patients with non-small cell lung cancer treated in a public hospital of reference and it provides information on the magnitude of the problem of cancer in the context of public health. The results confirm the importance of radiation treatment and hospitalizations as the main components of the cost of treatment. Despite some losses of follow-up, we assess that, for approximately 80% of the patients included in the study, the estimates presented herein are satisfactory for the care of the disease, from the perspective of a service provider of reference of the Brazilian Unified Health System, as it provides elements for the management of the service, as well as for studies that result in more rational forms of resource allocation.

RESUMO OBJETIVO Estimar os custos médicos diretos da assistência ao câncer de pulmão não pequenas células avançado. MÉTODOS Foi avaliada uma coorte de 277 pacientes matriculados no Instituto Nacional do Câncer em 2011. Os custos foram estimados sob a perspectiva do hospital como prestador de serviços de referência para o SUS. Insumos e procedimentos utilizados foram identificados e quantificados, por paciente, sendo a eles atribuídos valores monetários, consolidados por fases da assistência definidas. As análises tiveram caráter descritivo com custos em reais (R$). RESULTADOS Em termos globais, a coorte representou um custo de R$2.473.559,91, sendo 71,5% relacionados à atenção ambulatorial e 28,5% as internações. Na atenção ambulatorial, predominaram os custos com radioterapia (34%) e quimioterapia (22%). Os resultados apontaram para custos menores na fase inicial de tratamento (7,2%) e custos muito elevados na fase de manutenção (61,6%). Por fim, identificaram-se diferenças estatisticamente significativas das médias dos custos por faixas etárias, níveis de escolaridade, desempenho físico e tipo histológico. CONCLUSÕES Este estudo fornece um retrato atual, útil e relevante sobre os custos de pacientes com câncer de pulmão não pequenas células assistidos em um hospital público de referência e provê elementos sobre a magnitude do problema do câncer no âmbito da saúde pública. Os resultados ratificam a importância do tratamento radioterápico e das internações como principais componentes de custo do tratamento. Apesar de algumas perdas de seguimento avalia-se que, para cerca de 80% dos pacientes incluídos no estudo, as estimativas aqui apresentadas sejam satisfatoriamente fidedignas ao cuidado da doença, sob a perspectiva de um prestador de referência do SUS, fornecendo elementos para a gestão do serviço, bem como para estudos que redundem em formas mais racionais de alocação de recursos.

Factors associated with disease-specific survival of patients with non-small cell lung cancer / Fatores associados à sobrevida doença-específica em pacientes com câncer de pulmão de células não pequenas

ABSTRACT Objective: Lung cancer is a global public health problem and is associated with high mortality. Lung cancer could be largely avoided by reducing the prevalence of smoking. The objective of this study was to analyze the effects of social, behavioral, and clinical factors on the survival time of patients with non-small cell lung cancer treated at Cancer Hospital I of the José Alencar Gomes da Silva National Cancer Institute, located in the city of Rio de Janeiro, Brazil, between 2000 and 2003. Methods: This was a retrospective hospital cohort study involving 1,194 patients. The 60-month disease-specific survival probabilities were calculated with the Kaplan-Meier method for three stage groups. The importance of the studied factors was assessed with a hierarchical theoretical model after adjustment by Cox multiple regression. Results: The estimated 60-month specific-disease lethality rate was 86.0%. The 60-month disease-specific survival probability ranged from 25.0% (stages I/II) to 2.5% (stage IV). The performance status, the intention to treat, and the initial treatment modality were the major prognostic factors identified in the study population. Conclusions: In this cohort of patients, the disease-specific survival probabilities were extremely low. We identified no factors that could be modified after the diagnosis in order to improve survival. Primary prevention, such as reducing the prevalence of smoking, is still the best method to reduce the number of people who will suffer the consequences of lung cancer.

RESUMO Objetivo: O câncer de pulmão é um problema de saúde pública global e é associado a elevada mortalidade. Ele poderia ser evitado em grande parte com a redução da prevalência do tabagismo. O objetivo deste estudo foi analisar os efeitos de fatores sociais, comportamentais e clínicos sobre o tempo de sobrevida de pacientes com câncer de pulmão de células não pequenas atendidos, entre 2000 e 2003, no Hospital do Câncer I do Instituto Nacional de Câncer José Alencar Gomes da Silva, localizado na cidade do Rio de Janeiro. Métodos: Estudo retrospectivo de coorte hospitalar com 1.194 pacientes. As probabilidades de sobrevida doença-específica em 60 meses foram calculadas com o método de Kaplan-Meier para três grupos de estadiamento. A importância dos fatores estudados foi avaliada por um modelo teórico hierarquizado após o ajuste de modelos de regressão múltipla de Cox. Resultados: Foi estimada uma taxa de letalidade doença-específica em 60 meses de 86,0%. A probabilidade de sobrevida doença-específica em 60 meses variou de 25,0%, nos estádios iniciais, a 2,5%, no estádio IV. A situação funcional, a intenção e a modalidade do tratamento inicial foram os principais fatores prognósticos identificados na população estudada. Conclusões: As probabilidades de sobrevida doença-específica estimadas na amostra estudada foram muito baixas, e não foram identificados fatores que pudessem ser modificados após o diagnóstico visando uma melhora da sobrevida. A prevenção primária, como a redução da prevalência do tabagismo, ainda é a melhor forma de evitar que mais pessoas sofram as consequências do câncer de pulmão.

Linfadenectomía transcervical diagnóstico-terapéutica en el carcinoma pulmonar de células no pequeñas / Diagnostic-therapeutic transcervical lymphadenectomy in non-small cell lung carcinoma

El cáncer de pulmón es el tumor más frecuente del árbol respiratorio y el que origina mayor número de muertes. Uno de los objetivos más importantes en su manejo es la estadificación, de la cual, el análisis de los ganglios linfáticos del mediastino es de suma importancia para definir los pacientes que pueden recibir cirugía. Para el estudio ganglionar invasivo, la linfadenectomía transcervical ocupa un lugar importante cuando existe evidencia de afectación ganglionar de la zona superior como método diagnóstico y terapéutico inicial en pacientes que después de quimioterapia de inducción y re-estadificación reúnen las condiciones para resección. Se presenta este trabajo con el objetivo de mostrar a la comunidad quirúrgica, la linfadenectomía transcervical utilizada para el diagnóstico y tratamiento del carcinoma pulmonar de células no pequeñas en el Hospital Provincial Universitario Manuel Ascunce Domenech de Camagüey por el grupo de cirugía torácica(AU)

Lung cancer is the most common tumor of the respiratory tract and the one casing more deaths. One of the most important objectives in its treatment is stage characterization, for which analyzing mediastinal lymph nodes is paramount to define patients who can receive surgery. For the nodal invasive study, transcervical lymphadenectomy occupies an important place, when there is evidence of lymph node involvement in the upper area as an initial diagnostic and therapeutic method in patients who, after inducted chemotherapy and stage characterization, are candidates for resection. This work is presented with the aim to present to the surgical community the transcervical lymphadenectomy used by the group of thoracic surgery for diagnosis and treatment of non-small cell lung carcinoma at the Manuel Ascunce Domenech University Provincial Hospital of Camagüey(AU)

Gefitinibe na Primeira Linha de Tratamento para o Câncer de Pulmão de não Pequenas Células / Gefitinib as Non-Small Cell Lung Cancer First Line Treatment

Introdução: os inibidores de tirosina quinase (TKIs - tyrosine kinase inhibitor) são o tratamento de primeira linha no câncer de pulmão de não pequenas células (CPNPC) localmente avançado ou metastático com mutação do EGFR (receptor do fator de crescimento epidérmico - epidermal growth factor receptor). Esta revisão compara o tratamento do CPNPC com o gefitinibe, um TKI de primeira geração, versus o tratamento quimioterápico. Método: foi realizada revisão de literatura com palavras-chave relevantes e análise descritiva dos resultados. Resultados: os pacientes com CPNPC e mutação do EGFR apresentaram melhora da sobrevida livre de progressão (SLP), taxa de resposta objetiva (TRO) e taxa de controle da doença (TCR) em relação à quimioterapia citotóxica. A taxa de eventos adversos graves, eventos adversos que levaram à descontinuação do tratamento e os que levaram à redução de dose foram menores com o gefitinibe. O gefitinibe também foi relacionado à melhora da qualidade devida. Conclusão: o uso do gefitinibe em primeira linha no tratamento do CPNPC com mutação EGFR demonstrou superioridade de eficácia, segurança e qualidade de vida, quando comparado ao tratamento quimioterápico.

Introduction: tyrosine kinase inhibitors (TKIs) are the first line treatment for EGFR (epidermal growth factor receptor) mutated non-small cells lung cancer (NSCLC) locally advanced or metastatic. The aim of this review is to compare the treatment of NSCLC with the first-generation EGFR-TKI gefitinib versus chemotherapy . Methods: a review of the literature was performed using relevant keywords and descriptive analysis of the results. Results: patients with NSCLC and EGFR mutation showed improved progression-free survival (PFS), objective response rate (ORR) and disease control rate (DCR) compared cytotoxic chemotherapy. The rate of serious adverse events, adverse events leading to discontinuation of treatment and that led to dose reduction were lower with gefitinib. Quality of life improvement was also related to the treatment with gefitinib. Conclusion: the use of gefitinib as first-line treatment of EGFR mutated NSCLC showed improved efficacy, safety and quality of life when compared to chemotherapy.

Frequent users of emergency services: associated factors and reasons for seeking care / Usuários frequentes de serviço de emergência: fatores associados e motivos de busca por atendimento / Usuarios frecuentes de servicios de emergencia: factores asociados y motivos de la búsqueda de atención

Aim: to identify the profile of frequent users of emergency services, to verify the associated factors and to analyze the reasons for the frequent use of the services. METHOD: An explanatory sequential type mixed method was adopted. Quantitative data were collected from the electronic medical records, with a sample of 385 users attended four or more times in an emergency service, during the year 2011. Qualitative data were collected through semi-structured interviews with 18 users, intentionally selected from the results of the quantitative stage. Quantitative data were analyzed using descriptive and inferential statistics and qualitative data using thematic analysis. RESULTS: It was found that 42.9% were elderly, 84.9% had chronic diseases, 63.5% were classified as urgent, 42.1% stayed for more than 24 hours in the service and 46.5% were discharged. Scheduled follow-up appointment, risk classification, length of stay and outcome were factors associated with frequent use. The reasons for seeking the services were mainly related to the exacerbation of chronic diseases, to easier access and concentration of technology, to the bond, and to the scheduled appointments. CONCLUSIONS: The results contribute to comprehending the repeated use of emergency services and provide additional data to plan alternatives to reduce frequent use. .

OBJETIVO: identificar o perfil de usuários frequentes de serviço de emergência, verificar fatores associados e analisar os motivos para utilização frequente do serviço. MÉTODO: adotou-se método misto, do tipo sequencial explanatório. Os dados quantitativos foram coletados em registros de prontuários eletrônicos, com amostra de 385 usuários, atendidos quatro vezes ou mais em um serviço de emergência, durante o ano de 2011. Os dados qualitativos foram obtidos por meio de entrevistas semiestruturadas, com 18 usuários, selecionados intencionalmente a partir dos resultados da etapa quantitativa. Os dados quantitativos foram analisados com estatística descritiva e inferencial e os qualitativos com análise temática. RESULTADOS: identificou-se que 42,9% eram idosos, 84,9% tinham doenças crônicas, 63,5% foram classificados como urgentes, 42,1% permaneceram mais de 24 horas no serviço e 46,5% tiveram alta. Os fatores associados à utilização frequente são retorno agendado, classificação de risco, tempo de permanência e desfecho. Os motivos da busca pelo serviço são relacionados, principalmente, à agudização de doenças crônicas, maior facilidade de acesso, concentração de tecnologia, vínculo e retornos agendados. CONCLUSÕES: os resultados contribuem para compreensão do uso repetido de serviços de emergência e oferecem subsídios para planejamento de alternativas para redução da utilização frequente. .

OBJETIVO: identificar el perfil de usuarios frecuentes de servicios de emergencia, verificar los factores asociados y analizar los motivos para utilización frecuente de ese servicio. MÉTODO: se adoptó un método mixto del tipo secuencial explicativo. Los datos cuantitativos fueron recolectados en registros de fichas electrónicas, con muestra de 385 usuarios atendidos cuatro veces o más, en un servicio de emergencia, durante el año de 2011. Los datos cualitativos fueron obtenidos por medio de entrevistas semiestructuradas con 18 usuarios, seleccionados intencionalmente a partir de los resultados de la etapa cuantitativa. Los datos cuantitativos fueron analizados con estadística descriptiva e inferencial y los cualitativos con análisis temático. RESULTADOS: se identificó que 42,9% eran ancianos, 84,9% tenían enfermedades crónicas, 63,5% fueron clasificados como urgentes, 42,1% permanecieron más de 24 horas en el servicio y 46,5% tuvieron alta para el domicilio. El retorno programado, la clasificación de riesgo, el tiempo de permanencia y el resultado, son factores asociados a la utilización frecuente. Los motivos de la búsqueda por el servicio son relacionados, principalmente a: la agudización de enfermedades crónicas, la mayor facilidad de acceso y concentración de tecnología, los vínculos, y a los retornos programados. CONCLUSIONES: los resultados contribuyen para la comprensión del uso repetido de servicios de emergencia y ofrecen informaciones para planificar alternativas para reducción de la utilización frecuente. .

Survival and prognostic factors in patients with Non-Small Cell Lung Cancer treated in private health care / Sobrevida e fatores prognósticos em pacientes com câncer de pulmão de células não pequenas assistidos na saúde suplementar

INTRODUCTION: Outcomes data on Non-Small Cell Lung Cancer (NSCLC) are scarce with regard to the private health care in Brazil. The aim of this study was to describe the characteristics, treatments performed, and the survival of patients with NSCLC in a Brazilian private oncologic institution. METHODS: Medical charts from patients treated between 1998 and 2010 were reviewed, and data were transferred to a clinical research form. Long-term follow-up and survival estimates were enabled through active surveillance. RESULTS: Five hundred sixty-six patients were included, and median age was 65 years. Most patients were diagnosed in advanced stages (79.6% III/IV). The overall survival was 19.0 months (95%CI 16.2 - 21.8). The median survival was 99.7, 32.5, 20.2, and 13.3 months for stages I, II, III, and IV, respectively (p < 0.0001). Among patients receiving palliative chemotherapy, the median survival was 12.2 months (95%CI 10.0 - 14.4). CONCLUSIONS: The outcomes described are favorably similar to the current literature from developed countries. Besides the better access to health care in the private insurance scenario, most patients are still diagnosed in late stages. .

INTRODUÇÃO: Dados de desfechos em câncer de pulmão de células não pequenas (CPCNP) são escassos no contexto da saúde suplementar no Brasil. O objetivo deste estudo foi descrever as características, tratamentos realizados e a sobrevida desses pacientes em uma instituição oncológica privada brasileira. MÉTODOS: Foram revisados os prontuários de pacientes atendidos entre 1998 e 2010 com diagnóstico de CPCNP. Os dados foram transferidos para uma ficha clínica individual e posteriormente analisados. Pacientes ou familiares foram contatados a fim de otimizar o seguimento e a estimativa da sobrevida. RESULTADOS: Foram incluídos 566 pacientes, com idade mediana de 65 anos. Predominaram os diagnósticos em estádios avançados (79,6% III/IV). A sobrevida mediana foi de 19,0 meses (IC95% 16,2 - 21,8), sendo de 99,7, 32,5, 20,2 e de 13,3 meses nos estádios I, II, III e IV, respectivamente (p < 0,0001). Entre os pacientes que receberam quimioterapia paliativa, a sobrevida mediana foi de 12,2 meses (IC95% 10,0 - 14.4). CONCLUSÕES: Os desfechos encontrados se assemelham aos de países desenvolvidos. Apesar do maior acesso médico em pacientes com cobertura de planos de saúde, a maioria dos diagnósticos ocorre tardiamente. .

Eficácia da sublobectomia comparada à lobectomia no tratamento do câncer de pulmão de não pequenas células em estádios iniciais. Metanálise proporcional de série de casos / Effectiveness of sublobectomy compared to lobectomy for the treatment of lung cancer of non small cell in the early stages. Proportional meta-analysis of case series

A ressecção pulmonar é o tratamento de escolha no carcinoma brônquico, sendo a lobectomia o tipo de cirurgia de eleição nesta situação. A sublobectomia é um tipo de ressecção menos invasiva com maior preservação de parênquima pulmonar e pode ser uma alternativa à lobectomia em estágios iniciais da doença. Na literatura existe apenas um estudo clínico randomizado comparando as duas intervenções, e vários estudos de série de casos. Avaliar a eficácia da sublobectomia como tratamento cirúrgico no câncer de pulmão tipo carcinoma de não-pequenas células em estádios iniciais quando comparada com a lobectomia. Revisão e metanálise proporcional de série de casos em artigos que comparam os resultados da sublobectomia com os da lobectomia no tratamento do carcinoma de pulmão de não-pequenas células. Os estudos foram identificados na base de dados MEDLINE via PubMed, Embase e Lilacs. Referências bibliográficas também foram pesquisadas para encontrar estudos não indexados. A análise estatística foi realizada através do programa StatsDirect 2.7.9. Foram selecionados 21 artigos para essa metanálise, incluindo 19678 pacientes, sendo 17397 submetidos à lobectomia e 2281, à sublobectomia. Não houve diferença estatística na sobrevida em cinco anos entre os dois tipos de ressecção. A mortalidade pós-operatória analisada em 15 estudos também não apresentou diferença significante entre os dois tipos de ressecção. A recorrência local e a distância possíveis de serem avaliadas em nove artigos também não mostraram diferença estatisticamente significante, mas uma tendência da recorrência local ser maior na sublobectomia...

Pulmonary resection is the treatment of choice in bronchogenic carcinoma, lobectomy being the type of surgery of choice in this situation, the sublobectomy is a type of resection less invasive with greater preservation of lung parenchyma and can be an alternative to lobectomy for stage initial disease. In the literature there is only one randomized clinical trial comparing the two interventions, and several case series studies. To evaluate the effectiveness of sublobectomy as surgical treatment in non-small cell lung carcinoma in the early stages when compared with lobectomy. A review and meta-analysis proportional of cases series studies comparing the results with those of sublobectomy and lobectomy in the treatment of non-small cell lung carcinoma. Studies were identified in MEDLINE, Embase and Lilacs. References were also searched to find studies not indexed. Statistical analysis was performed using the program StatsDirect 2.7.9. 21 articles were selected for this meta-analysis, including 19678 patients, 17397 in lobectomy and 2281 in sublobectomy. There was no statistical difference in five-year survival between the two types of resection. The postoperative mortality analyzed in 15 studies also showed no significant difference between the two types of resection. The local and distant recurrence were able to be evaluated in nine studies showed no statistically significant difference, but a tendency of local recurrence was higher in sublobectomy...

Recomiendan personalizar la quimioterapia del cáncer de pulmón en ancianos / Chemotherapy of advanced non-small cell lung cancer in elderly patients

El cáncer de pulmón de células no pequeñas (CPCNP) es la principal causa de muerte asociada con el cáncer en el mundo y puede considerarse como característico de la ancianidad. La quimioterapia es el pilar principal del tratamiento, debido a que muchos pacientes se encuentran en un estadio avanzado de la enfermedad al momento del diagnóstico. En comparación con los más jóvenes, los pacientes ancianos toleran mal la quimioterapia a causa de la progresiva reducción de las funciones orgánicas y las enfermedades asociadas con la edad. Esto hace que los pacientes añosos frecuentemente no sean considerados elegibles para una quimioterapia agresiva basada en platino, el cual es el tratamiento estándar del CPCNP avanzado. A la fecha, en la práctica clínica, la quimioterapia con un solo agente, una droga de tercera generación, debe ser la opción recomendada para pacientes mayores no seleccionados con CPCNP avanzado. Sin embargo, la viabilidad de la quimioterapia basada en platino sigue siendo una cuestión no resuelta que debe probarse en estudios aleatorizados. Se debería dar una alta prioridad a la evaluación del papel que ocupan las llamadas terapias dirigidas mediante nuevas moléculas. Varios nuevos agentes biológicos se encuentran en diferentes etapas de investigación clínica en CPCNP avanzado y algunos de ellos han mostrado mejorías en varios parámetros. Su mejor tolerabilidad potencial los convierte en una alternativa atractiva para este subgrupo de pacientes. Incluso resulta obligatoria una evaluación geriátrica completa para la elección de un tratamiento individualizado del CPCNP en ancianos.