Daniel Boffa1, Felix G Fernandez2, Sunghee Kim3, Andrzej Kosinski3, Mark W Onaitis4, Patricia Cowper3, Jeffrey P Jacobs5, Cameron D Wright6, Joe B Putnam7, Anthony P Furnary8. 1. Department of Thoracic Surgery, Yale New Haven Hospital, New Haven, Connecticut. Electronic address: daniel.boffa@yale.edu. 2. Department of Thoracic Surgery, Emory University, Atlanta, Georgia. 3. Duke Clinical Research Institute, Durham, North Carolina. 4. Department of Thoracic Surgery, University of California-San Diego, San Diego, California. 5. Department of Cardiothoracic Surgery, Johns Hopkins All Children's Heart Institute, Saint Petersburg, Florida. 6. Department of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts. 7. Department of Thoracic Surgery, Baptist MD Anderson Cancer Center, Jacksonville, Florida. 8. Starr-Wood Cardiac Group, Portland, Oregon.
Abstract
BACKGROUND: The role of surgical resection in patients with clinical stage IIIA-N2 positive (cIIIA-N2) lung cancer is controversial, partly because of the variability in short- and long-term outcomes. The objective of this study was to characterize the management of cIIIA-N2 lung cancer in The Society of Thoracic Surgeons General Thoracic Surgery Database (STS-GTSD). METHODS: The STS-GTSD was queried for patients who underwent operations for cIIIA-N2 lung cancer between 2002 and 2012. A subset of patients aged older than 65 years was linked to Medicare data. RESULTS: Identified were 3,319 surgically managed, cIIIA-N2 patients, including 1,784 (54%) treated with upfront resection (treatment naïve upfront surgery group, and 1,535 (46%) with induction therapy. A positron emission tomography scan was documented in 93% of patients, and 51% of patients were coded in STS-GTSD as having undergone invasive mediastinal staging. Nodal overstaging (cN2→pN0/N1) was observed in 43% of upfront surgery patients. Lobectomy was performed in 69% of patients and pneumonectomy in 11%. Operative mortality was similar between patients treated with upfront surgery (1.9%) and induction therapy (2.5%, p = .2583). The unadjusted Kaplan-Meier estimate of 5-year survival of cIII-N2 patients treated with induction therapy then resection was 35%. CONCLUSIONS: STS surgeons achieve excellent short- and long-term results treating predominantly lobectomy-amenable cIIIA-N2 lung cancer. However, prevalent overstaging and abstention from induction therapy suggest "overcoding" of false positives on imaging or variable compliance with current guidelines for cIIIA-N2 lung cancer. Efforts are needed to improve clinical stage determination and guideline compliance in the GTSD for this cohort.
BACKGROUND: The role of surgical resection in patients with clinical stage IIIA-N2 positive (cIIIA-N2) lung cancer is controversial, partly because of the variability in short- and long-term outcomes. The objective of this study was to characterize the management of cIIIA-N2 lung cancer in The Society of Thoracic Surgeons General Thoracic Surgery Database (STS-GTSD). METHODS: The STS-GTSD was queried for patients who underwent operations for cIIIA-N2 lung cancer between 2002 and 2012. A subset of patients aged older than 65 years was linked to Medicare data. RESULTS: Identified were 3,319 surgically managed, cIIIA-N2 patients, including 1,784 (54%) treated with upfront resection (treatment naïve upfront surgery group, and 1,535 (46%) with induction therapy. A positron emission tomography scan was documented in 93% of patients, and 51% of patients were coded in STS-GTSD as having undergone invasive mediastinal staging. Nodal overstaging (cN2→pN0/N1) was observed in 43% of upfront surgery patients. Lobectomy was performed in 69% of patients and pneumonectomy in 11%. Operative mortality was similar between patients treated with upfront surgery (1.9%) and induction therapy (2.5%, p = .2583). The unadjusted Kaplan-Meier estimate of 5-year survival of cIII-N2patients treated with induction therapy then resection was 35%. CONCLUSIONS: STS surgeons achieve excellent short- and long-term results treating predominantly lobectomy-amenable cIIIA-N2 lung cancer. However, prevalent overstaging and abstention from induction therapy suggest "overcoding" of false positives on imaging or variable compliance with current guidelines for cIIIA-N2 lung cancer. Efforts are needed to improve clinical stage determination and guideline compliance in the GTSD for this cohort.
Authors: Felix G Fernandez; Anthony P Furnary; Andrzej S Kosinski; Mark W Onaitis; Sunghee Kim; Daniel Boffa; Patricia Cowper; Jeffrey P Jacobs; Cameron D Wright; Joe B Putnam Journal: Ann Thorac Surg Date: 2016-05-05 Impact factor: 4.330
Authors: Daniel J Boffa; Jacquelyn G Hancock; Xiaopan Yao; Sarah Goldberg; Joshua E Rosen; Anthony W Kim; Amy Moreno; Frank C Detterbeck Journal: Ann Thorac Surg Date: 2014-11-20 Impact factor: 4.330
Authors: Joshua E Rosen; Jacquelyn G Hancock; Anthony W Kim; Frank C Detterbeck; Daniel J Boffa Journal: Ann Thorac Surg Date: 2014-10-18 Impact factor: 4.330
Authors: Haejin In; Bryan E Palis; Ryan P Merkow; Mitchell C Posner; Mark K Ferguson; David P Winchester; Christopher M Pezzi Journal: Ann Surg Date: 2016-02 Impact factor: 12.969
Authors: David W Johnstone; Roger W Byhardt; David Ettinger; Charles B Scott Journal: Int J Radiat Oncol Biol Phys Date: 2002-10-01 Impact factor: 7.038
Authors: Daniel J Boffa; Andrzej S Kosinski; Subroto Paul; John D Mitchell; Mark Onaitis Journal: Ann Thorac Surg Date: 2012-06-27 Impact factor: 4.330
Authors: Nithya Ramnath; Thomas J Dilling; Loren J Harris; Anthony W Kim; Gaetane C Michaud; Alex A Balekian; Rebecca Diekemper; Frank C Detterbeck; Douglas A Arenberg Journal: Chest Date: 2013-05 Impact factor: 9.410
Authors: Gerard A Silvestri; Anne V Gonzalez; Michael A Jantz; Mitchell L Margolis; Michael K Gould; Lynn T Tanoue; Loren J Harris; Frank C Detterbeck Journal: Chest Date: 2013-05 Impact factor: 9.410
Authors: Daniel J Boffa; Mark S Allen; Joshua D Grab; Henning A Gaissert; David H Harpole; Cameron D Wright Journal: J Thorac Cardiovasc Surg Date: 2007-12-21 Impact factor: 5.209
Authors: Andrew Tang; Andrew Feczko; Sudish C Murthy; Siva Raja; Alejandro Bribriesco; Dean Schraufnagel; Usman Ahmad; Daniel P Raymond; Monisha Sudarshan Journal: JTCVS Open Date: 2022-02-23
Authors: Hari B Keshava; Kay See Tan; Joseph Dycoco; Jennifer Livschitz; Matthew J Bott; James Huang; Valerie W Rusch; James M Isbell; Daniela Molena; Manjit S Bains; David R Jones; Gaetano Rocco Journal: Semin Thorac Cardiovasc Surg Date: 2020-08-25