ABSTRACT
The objective of the present study was to elaborate a survival model that integrates anatomic factors, according to the 2010 seventh edition of the tumour, node and metastasis (TNM) staging system, with clinical and molecular factors. Pathologic TNM descriptors (group A), clinical variables (group B), laboratory parameters (group C) and molecular markers (tissue microarrays; group D) were collected from 512 early-stage nonsmall cell lung cancer (NSCLC) patients with complete resection. A multivariate analysis stepped supervised learning classification algorithm was used. The prognostic performance by groups was: areas under the receiver operating characteristic curve (C-index): 0.67 (group A), 0.65 (Group B), 0.57 (group C) and 0.65 (group D). Considering all variables together selected for each of the four groups (integrated group) the C-index was 0.74 (95% CI 0.70-0.79), with statistically significant differences compared with each isolated group (from p = 0.006 to p < 0.001). Variables with the greatest prognostic discrimination were the presence of another ipsilobar nodule and tumour size > 3 cm, followed by other anatomical and clinical factors, and molecular expressions of phosphorylated mammalian target of rapamycin (phospho-mTOR), Ki67cell proliferation index and phosphorylated acetyl-coenzyme A carboxylase. This study on early-stage NSCLC shows the benefit from integrating pathological TNM, clinical and molecular factors into a composite prognostic model. The model of the integrated group classified patients with significantly higher accuracy compared to the TNM 2010 staging.
Subject(s)
Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Non-Small-Cell Lung/genetics , Lung Neoplasms/diagnosis , Lung Neoplasms/genetics , Neoplasm Staging/methods , Aged , Algorithms , Area Under Curve , Carcinoma, Non-Small-Cell Lung/therapy , Cohort Studies , Humans , Ki-67 Antigen/biosynthesis , Lung Neoplasms/therapy , Medical Oncology/methods , Middle Aged , Neoplasm Metastasis , Probability , Prognosis , Time FactorsABSTRACT
No disponible
Subject(s)
Humans , Carcinoma, Bronchogenic/surgery , Lung Neoplasms/surgery , Algorithms , Postoperative Care , Preoperative Care , Risk Assessment , Risk Factors , Respiratory Function TestsABSTRACT
No disponible
Subject(s)
Humans , Thoracic Surgical Procedures/adverse effects , Postoperative Complications/epidemiology , Risk AssessmentABSTRACT
UNLABELLED: Transesophageal sonography was originally used to assess esophageal-gastric neoplasm. The technique may also be useful in the evaluation of pulmonary neoplasms for possible mediastinal involvement, with regard to both T and N factors. OBJECTIVE: To consider the validity of this minimally-invasive technique for assessing possible mediastinal involvement by direct tumoral invasion (T4) and to help obtain the most accurate staging of lung cancer. PATIENTS AND METHODS: Sixteen patients with confirmed histopathological diagnoses of pulmonary neoplasm were examined by transesophageal sonography in order to evaluate possible mediastinal involvement. They had previously been classified by computed tomography as T4 (12 patients) or possible T4 (4 patients). Mediastinal involvement was also assessed by mediastinotomy or thoracotomy in 15 of the 16 patients. RESULTS: Transesophageal sonography revealed mediastinal involvement in eight of the 16 patients; the rest had no such involvement. Surgical exploration of the mediastinum confirmed involvement in seven of those who had been so classified by sonography (with the remaining patient not having been assessed surgically). Among the eight patients who were considered free of mediastinal involvement, there was in fact none, although we found previously undetected infiltration of the posterior surface of the right pulmonary artery in one patient. Sensitivity was 87.5%, specificity 100% and accuracy 93.3%. CONCLUSION: Transesophageal ultrasound is a diagnostic tool that can provide additional information to complement other diagnostic strategies.
Subject(s)
Echocardiography, Transesophageal , Lung Neoplasms/pathology , Mediastinal Neoplasms/diagnostic imaging , Mediastinal Neoplasms/secondary , HumansABSTRACT
La ecografía transesofágica es una técnica inicialmente empleada en la valoración de las neoplasias esofagogástricas. Su utilización en la evaluación de las neoplasias pulmonares puede ser una ayuda valiosa a la hora de considerar la posible afectación mediastínica tanto en el factor T como en el N. Objetivo: Considerar la validez de esta exploración incruenta para determinar la posible afectación mediastínica por invasión directa del tumor (T4) como medio para conseguir una más correcta estadificación del cáncer de pulmón. Pacientes y métodos: Dieciséis pacientes con neoplasia de pulmón confirmada histopatológicamente han sido explorados mediante ecografía transesofágica para evaluar una posible afectación mediastínica. Previamente habían sido etiquetados por tomografía computarizada como T4 (12) o dudosos T4 (4). En 15 de los 16 pacientes se evaluó la afectación del mediastino con mediastinotomía o toractomía. Resultados: De los 16 pacientes, ocho presentaban afectación mediastínica mediante ecografía transesofágica y en el resto no. La evaluación quirúrgica del mediastino confirmó la afectación de éste en siete de los detectados por la ecografía (uno no se evaluó quirúrgicamente). De los 8 pacientes considerados como sin afectación mediastínica en siete no existía y en uno no se detectó una infiltración de la cara posterior de la arteria pulmonar derecha. La sensibilidad fue del 87,5 por ciento, la especificidad, del 100 por ciento y la exactitud del 93,3 por ciento. Conclusión: La ecografía transesofágica es un método diagnóstico que puede aportar información adicional y complementaria a otros métodos diagnósticos. (AU)
