Lung cancer : journal of the International Association for the Study of Lung Cancer
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The World Health Organization Classification of Lung Tumors considers "Spread Through Air Spaces (STAS)" as a form of invasion in lung adenocarcinoma. However, its existence as an independent pathologic entity rather than an artifact caused by spreading through a knife surface is still controversial. Therefore, we performed comprehensive analyses on the genetic and clinicopathologic characteristics of lung adenocarcinoma with STAS. ⋯ STAS is associated with certain pathological and molecular subtypes. STAS might be a parameter for tumor aggressiveness in that it is strongly associated with poor prognostic factors and recurrence, including to extrathoracic sites.
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We compared the performance of 7th and 8th edition of the Union for International Cancer Control (UICC) / American Joint Committee on Cancer (AJCC) TNM staging for non-small cell lung cancer (NSCLC) in non-metastatic (stage I-III) North American cohort undergoing primary radiation treatment. ⋯ In an independent cohort of non-metastatic NSCLC undergoing primary radiation treatment, improved performance of 8th edition UICC/AJCC staging system over 7th edition was observed.
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Acute kidney injury (AKI) frequently occurs in several medical and surgical settings, and it is associated with increased morbidity and mortality. In patients undergoing lung cancer surgery, AKI has not been fully investigated. We prospectively evaluated the incidence, clinical relevance, and risk factors of AKI in patients undergoing lung cancer surgery. Moreover, we estimated the accuracy of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the prediction of AKI. ⋯ Acute kidney injury occurs in 10% of patients undergoing lung cancer surgery, and it is associated with a high incidence of postoperative complications. The risk of AKI can be accurately predicted by the combined evaluation of preoperative serum creatinine and NT-proBNP.
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Case Reports
Synchronous primary lung adenocarcinomas harboring distinct MET Exon 14 splice site mutations.
When a patient is found to have multiple lung tumors, distinguishing whether they represent metastatic nodules or separate primary cancers is crucial for staging and therapy. We report the case of a 79-year-old patient with two surgically resected synchronous left upper lobe adenocarcinomas initially pathologically staged as T3 (IIB), indicating adjuvant chemotherapy should be recommended. However, the tumors appeared radiographically distinct, so next-generation sequencing was performed on each nodule. ⋯ Thus, the patient was down-staged to having two separate IA tumors, spared of adjuvant chemotherapy, and routine surveillance was recommended. This case highlights the utility of using molecular analysis in diagnosing and treating multifocal lung tumors, and the process of convergent molecular evolution toward a common oncogenic driver mutation. This is the first case of multiple synchronous lung tumors each harboring a distinct MET exon 14 splice site mutation.
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A role for erlotinib and bevacizumab as single agents has been established in the treatment of non-small cell lung cancer (NSCLC). However, the efficacy and safety of erlotinib in combination with bevacizumab compared with single agents remain unclear. This meta-analysis aimed to investigate the status of this combined strategy in NSCLC. ⋯ Erlotinib plus bevacizumab enhances OS for EGFR-mutant patients, with rash and diarrhea common but acceptable adverse effects. Combination treatment can be recommended as the preferable option for EGFR-mutant patients. Further large-scale, well-designed RCTs are required to confirm our validation.