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Journal and News Scan

Source: Journal of Thoracic Oncology
Author(s): Cressman, Sonya and others

Costs of lung cancer screening were determined for individuals with a 2% or greater risk of lung cancer over 3 years for 2059 subjects participating in the Pan-Canadian Early Detection of Lung Cancer Study.  During the first 18 mos of screening the per-person cost was $453.  Surgical therapy cost $33,344 over 2 years compared to costs of treating advanced stage cancers of $47,792. 

Source: Journal of Thoracic Oncology
Author(s): den Hengst, Willem A.; Hendriks, Jeroen M.H.; Balduyck, Bram; Rodrigus, Inez; Vermorken, Jan B.; Lardon, Filip; Versteegh, Michel I.M.; Braun, Jerry; Gelderblom, Hans; Schramel, Franz M.N.H.; Van Boven, Wim-Jan; Van Putte, Bart P.; Birim, Özcan; Maat, Alexander P.W.M.; Van Schil, Paul E.Y.

This phase II trial evaluated outcomes of isolated lung perfusion with Melphalan and complete surgical resection for pulmonary metastases from colorectal cancer or sarcoma in 50 pts.  Surgical mortality was 0%, but morbidity (primarily grade 3 or 4 pulmonary morbidity) was 44%.  30 patients suffered local recurrence.  3-year survival was 57% and recurrence-free survival was 36%. 

Source: Journal of Thoracic Oncology
Author(s): Deppen, Stephen A.; Blume, Jeffrey D.; Aldrich, Melinda C.; Fletcher, Sarah A.; Massion, Pierre P.; Walker, Ronald C.; Chen, Heidi C.; Speroff, Theodore; Degesys, Catherine A.; Pinkerman, Rhonda; Lambright, Eric S.; Nesbitt, Jonathan C.; Putnam, Joe B.; Grogan, Eric L.

A model for predicting lung cancer in patients with suspicious lung nodules (TREAT) was developed using single institutional data (Vanderbilt), validated using data from another institution, and compared to the Mayo Clinic predictive model.  The model accuracy was 87% in the development cohort and 89% in the validation cohort, compared to 80% in the Mayo Clinic model. 

Source: The Lancet
Author(s): Robert C Rintoul, Andrew J Ritchie, John G Edwards, David A Waller, Aman S Coonar, Maxine Bennett, Eleonora Lovato, Victoria Hughes, Julia A Fox-Rushby, Linda D Sharples, on behalf of the MesoVATS Collaborators

This randomized controlled trial compared VATS partial pleurectomy (VAT-PP) to talc pleurodesis in patients with malignant mesothelioma and a pleural effusion, evaluating overall survival.  VAT-PP was associated with significantly greater surgical complications, a higher rate of respiratory complications and prolonged air leak, and a significantly longer median hospital length of stay.  Survival at 1 year was similar to the talc pleurodesis group (52% vs 57%).  VAT-PP is not recommended for improving survival in patients with malignant mesothelioma and a pleural effusion.

Source: Journal of Clinical Oncology
Author(s): Andrew R. Davies, James A. Gossage, Janine Zylstra, Fredrik Mattsson, Jesper Lagergren, Nick Maisey, Elizabeth C. Smyth, David Cunningham, William H. Allum and Robert C. Mason

This retrospective review evaluated the relationship of pretreatment vs post-induction therapy stage to survival in patients undergoing surgery for esophageal adenocarcinoma in 2 centers in London.  Among 584 pts, 400 underwent induction therapy.  Downstaging predicted improved survival (HR 0.43).  Downstaging was associated with decreased rates of local and distant recurrence.  Survival was more closely associated with stage after induction therapy than initial stage.

Source: JAMA
Author(s): Stephen A. Deppen; Jeffrey D. Blume; Clark D. Kensinger; Ashley M. Morgan; Melinda C. Aldrich; Pierre P. Massion; Ronald C. Walker; Melissa L. McPheeters; Joe B. Putnam Jr; Eric L. Grogan

This meta-analysis of 70 studies evaluated the utility of PET in assessing over 8,511 lung nodules, comparing regions in which infectious lung disease is endemic to other regions.  Specificity was lower in regions with endemic infectious diseases, 61% vs 77%.  Overall, the accuracy of PET was extremely heterogeneous.

Source: JAMA Intern Med.
Author(s): Du DT, McKean S, Kelman JA, Laschinger J, Johnson C, Warnock R, Worrall CM, Sedrakyan A, Encinosa W, MaCurdy TE, Izurieta HS.

In this manuscript, the authors describe their findings of a cohort analysis of 66 453 Medicare beneficiaries over the age of 65, who underwent aortic valve replacement (AVR) ± CABG and compare date of surgery, 30-day and one-year mortality between those receiving biological and mechanical prosthesis.

The mortality rate for the date of surgery and the first 30 days after the date of surgery was statistically higher among mechanical valve recipients than biological valve recipients. The unadjusted OR for death between recipients of mechanical and biological prosthesis was highest on the date of surgery. The difference in mortality rate between both groups was not statistically significant for the first 30 days after the date of hospital discharge and within 31 to 365 days after the date of surgery. Subgroup analyses suggest that the mortality difference between recipients of biological and mechanical valves in the overall population is primarily driven by high-risk patients who underwent concurrent CABG. Patients undergoing isolated AVR may have little or no increased risk for early death after mechanical AVR when

compared with bioprosthetic AVR.

Source: Circulation
Author(s): De Bonis M, Lapenna E, Maisano F, Barili F, La Canna G, Buzzatti N, Pappalardo F, Calabrese M, Nisi T, Alfieri O.

In this retrospective review, the authors evaluate the long-term outcome of 61 patients undergoing edge-to-edge mitral valve repair without annuloplasty ring for degenerative mitral regurgitation (MR). The reasons for not performing annuloplasty were either severe annular calcification or absence of significant annular dilatation. Follow up was 100%. Overall survival at 12 years was 51±7%, and freedom from MR ≥3+ was 43±7.6%. Twenty-one patients required reoperation during the follow up period. These findings lead the authors to conclude that in degenerative MR, the overall long-term results of the surgical edge-to edge technique without annuloplasty are not satisfactory. The authors underscore the relevance this may have in transcatheter mitral valve repair procedures.

Source: Annals of Surgery
Author(s): Patel, Himanshu J; Williams, David M; Drews, Joseph D; Dasika, Narasimham L; Eliason, Jonathan L; Passow, Mary C; Deeb, G Michael

This retrospective review summarizes a single institution experience with thoracic aortic endovascular stenting in 420 pts over 20 years.  Indications were aneurysm (238), dissection (100) and trauma (39).  78% of pts were deemed to be at high risk for open repair.  Mortality was 4.8%, stroke incidence was 5%, and cord ischemia was temporary in 7.9% and permanent in 1.7%.  10 year freedom from failure was 63%; failure was predicted by pre-existing renal failure, presentation with rupture, or need for arch intervention. 15 year survival was 32%. 

Source: Annals of Surgery
Author(s): Sugarbaker, David J; Richards, William G; Bueno, Raphael

This retrospective review of pts undergoing complete resection by extrapleural pneumonectomy 1998-2011 for malignant mesothelioma focused on stage predictors of survival.  Surgical mortality was 5%.  Overall survival at 5 years was 14%, and median survival was 18 mos.   Median survival for N1 or N2 disease was 17 and 13 mos, respectively.  Nodal staging is important for estimating prognosis and for patient selection.