• elderly
• meta‐analysis
• non‐small‐cell lung cancer
• stereotactic body radiotherapy
• surgery

• Humans
• Carcinoma, Non-Small-Cell Lung/mortality
• Carcinoma, Non-Small-Cell Lung/surgery
• Carcinoma, Non-Small-Cell Lung/radiotherapy
• Carcinoma, Non-Small-Cell Lung/pathology
• Radiosurgery/mortality
• Lung Neoplasms/mortality
• Lung Neoplasms/surgery
• Lung Neoplasms/radiotherapy
• Lung Neoplasms/pathology
• Aged
• Neoplasm Staging
• Pneumonectomy/mortality
• Treatment Outcome
• Survival Rate
• Aged, 80 and over
• Male

• A2302048 Shenzhen Medical Research Special Funds
• 82102171 The National Natural Science Foundation of China Young Scientist Grant
• 19SXHZ0351 Nanchong Science and Technology Bureau Municipal School Cooperation Program

• comparative studies
• high-risk
• image-guided ablation
• stage I non-small cell lung cancer
• stereotactic body radiation treatment
• sublobar resection
• systematic review

• Humans
• Carcinoma, Non-Small-Cell Lung/pathology
• Carcinoma, Non-Small-Cell Lung/mortality
• Carcinoma, Non-Small-Cell Lung/surgery
• Carcinoma, Non-Small-Cell Lung/diagnostic imaging
• Lung Neoplasms/pathology
• Lung Neoplasms/mortality
• Lung Neoplasms/surgery
• Lung Neoplasms/diagnostic imaging
• Radiosurgery/adverse effects
• Radiosurgery/mortality
• Pneumonectomy/adverse effects
• Pneumonectomy/mortality
• Pneumonectomy/methods
• Neoplasm Staging
• Risk Factors
• Treatment Outcome
• Ablation Techniques/adverse effects
• Ablation Techniques/mortality
• Risk Assessment
• Surgery, Computer-Assisted/adverse effects
• Surgery, Computer-Assisted/mortality

• air leak
• thoracoscopy
• wound infection

• Humans
• Lung Neoplasms/surgery
• Lung Neoplasms/complications
• Thoracotomy/adverse effects
• Thoracotomy/methods
• Surgical Wound Infection/etiology
• Surgical Wound Infection/surgery
• Postoperative Complications/etiology
• Postoperative Complications/surgery

• meta-analysis
• single-port video-assisted thoracoscopy
• surgical site infection
• wound healing

• Humans
• Bandages
• Lung Neoplasms/surgery
• Surgical Wound Infection
• Wound Healing
• Thoracic Surgery, Video-Assisted

• 20200708109YY Jilin Provincial Science and Technology Development Project and Special Fund for Medicine and Health (Research and development of lung cancer gene detection kit based on circulating tumor DNA (ctDNA) and NGS technology) by Jilin Provincial Department of Science and Technology

• Humans
• Carcinoma, Non-Small-Cell Lung/therapy
• Carcinoma, Non-Small-Cell Lung/drug therapy
• Lung Neoplasms/therapy
• Lung Neoplasms/drug therapy
• B7-H1 Antigen
• Prognosis
• Retrospective Studies

• External validation
• Lobectomy
• Lymph node dissection
• Non-small cell lung cancer (NSCLC)
• Sublobectomy

• Lung cancer
• ablation
• quality-of-life (QOL)
• radiotherapy
• surgery

• UL1 TR001863 NCATS NIH HHS

Higher capital costs and operating room costs associated with Lobectomy via Robot Assisted Thoracic Surgery (RATS) have previously been suggested as the principal contributors to the elevated overall cost. This study uses a micro-costing approach to a previous analysis of clinical outcomes of RATS, Video-Assisted Thoracic Surgery (VATS) and Open Lobectomy to evaluate the most significant cost drivers for the higher cost of robot-assisted lobectomy. A micro-costing model was developed to reflect the pathway of patients from day of surgery through the first 30 days following lobectomy. Costs were provided for RATS, VATS and Open approaches. Sensitivity analysis was performed specifically in the area of staff costs. A threshold sensitivity analysis of the overall cost components was also performed. Total cost per case for the RATS approach was €13,321 for the VATS approach €11,567, and for the Open approach €12,582. The overall cost differences were driven primarily by the elevated consumable costs associated with RATS Lobectomy. Capital costs account for a relatively small proportion of the per-case cost difference. This study presents a detailed analysis of the cost drivers for lobectomy, modelled for the three primary surgical approaches. We believe this is a useful tool for surgeons, hospital management, and service commissioning agencies to accurately and comprehensively determine where cost savings can be applied in their programme to improve the cost-effectiveness of RATS lobectomy.

• Cost analysis
• Healthcare economics
• Lobectomy
• Robotic surgery
• Thoracic surgery

The effect of marginal lung function on outcomes after lung resection has traditionally been studied in the context of open thoracic surgery. Its impact on postoperative outcomes in the era of minimally invasive lung resection is unclear.

In this retrospective cohort study, we included adult patients who underwent minimally invasive lung resection at our institution between January 2017 and May 2020 for known malignancy or lung nodule. Marginal lung function was defined as pre-operative forced expiratory volume in 1 second (FEV1) and/or diffusion lung capacity of carbon monoxide <60% of predicted. Our outcomes included a composite outcome of pulmonary morbidity and/or 30- and 90-day mortality, and hospital length of stay. We used multivariable logistic and Poisson regression models to identify associations with outcomes, and Kaplan-Meier and Cox models to estimate survival.

Of 300 patients, 88 (29%) had marginal lung function. Patients in the marginal group were more likely to be female (69% vs. 56%; P=0.028), and more likely to have: hypertension (HTN) (83% vs. 71%; P=0.028), chronic obstructive pulmonary disease (COPD) (38% vs. 12%; P<0.001), interstitial lung disease (ILD) (9% vs. 3%; P<0.019), and ischemic heart disease (28% vs. 18%; P=0.033). Patients were similar in terms of age (68±8 vs. 68±10 years; P=0.932), and other comorbidities. Anatomic lung resection comprised 56.8% of the marginal group vs. 74% in the non-marginal group (P=0.003). The most common complication was prolonged air leak (18.2% vs. 11.8%; P=0.479). Marginal lung function had a trend toward increased composite respiratory complications (22.7% vs. 15.1%; P=0.112) and 90-day mortality (5.7% vs. 4.2%; P=0.591), although they did not reach statistical significance. There was a statistically significant 1-day average increase in length of stay in the marginal lung function cohort (4.6 vs. 3.4 days; P<0.015) with a stronger association with diffusion lung capacity of carbon monoxide than FEV1. Survival was similar (marginal function HR =1.0; P=0.994).

In the era of minimally invasive thoracic surgery, lung resection in patients with marginal lung function may be considered in select patients. These findings aid in the selection consideration and counseling of this patient population.

• Minimally invasive thoracic surgery
• marginal lung function
• robotic-assisted thoracic surgery (RATS)

• CT scan
• computed tomography
• cost–effectiveness analysis
• health economics
• imaging
• lobectomy
• lung cancer surgery
• segmentectomy
• wedge resection

• Early stage
• Lung cancer
• Radiofrequency ablation
• Stereotactic radiosurgery
• Sublobar resection
• Video-assisted thoracoscopic surgery

• Lobectomy
• Mortality
• Non–small cell lung cancer
• Stage I
• Wedge

• Homogeneous dose distribution
• SABR
• late toxicity

• Medically operable
• NSCLC
• SABR
• SBRT
• Stereotactic ablative radiotherapy

• Octogenarians
• non-small-cell lung cancer
• stereotactic body radiation therapyr

• Adenocarcinoma/radiotherapy
• Aged, 80 and over
• Carcinoma, Non-Small-Cell Lung/radiotherapy
• Carcinoma, Squamous Cell/radiotherapy
• Comorbidity
• Disease-Free Survival
• Dose Fractionation, Radiation
• Female
• Four-Dimensional Computed Tomography
• Humans
• Lung Neoplasms/radiotherapy
• Male
• Neoplasm Recurrence, Local
• Neoplasm Staging
• Radiation Injuries/etiology
• Radiation Pneumonitis/etiology
• Radiosurgery/methods
• Retrospective Studies
• Treatment Outcome

• Japan Agency for Medical Research and Development
• National Cancer Center Research and Development Fund

• Lobar and sublobar resections
• NSCLC
• Stereotactic body radiation therapy
• Surgery
• Survival

• Aged
• Aged, 80 and over
• Fee-for-Service Plans
• Female
• Hospice Care
• Humans
• Male
• Medicare
• Neoplasms/diagnosis
• Neoplasms/epidemiology
• Neoplasms/therapy
• SEER Program
• United States/epidemiology

• P30 CA077598 NCI NIH HHS
• NIH

• Incidence
• Non-small cell lung cancer
• Octogenarian
• SEER database
• Survival
• Treatment

• Lung cancer
• Physician-hospital networks
• Prostate cancer
• SEER-Medicare
• Stereotactic body radiation therapy

• Humans
• Lung Neoplasms/secondary
• Lung Neoplasms/therapy
• Male
• Prostatic Neoplasms/complications
• Radiosurgery/methods

• P30 CA047904 NCI NIH HHS
• R03 AG048091 NIA NIH HHS
• P01 AG019783 NIA NIH HHS
• UL1 TR000005 NCATS NIH HHS
• K24 HL133444 NHLBI NIH HHS

The optimal treatment for elderly patients with early-stage non-small cell lung cancer (NSCLC) remains inconclusive. Previous studies have shown that stereotactic body radiotherapy (SBRT) provides encouraging local control though higher incidence of toxicity in elderly than younger populations. The objective of this study was to compare the outcomes of SBRT and surgical treatment in elderly patients with clinical stage I-II NSCLC.

This retrospective analysis included 205 patients aged ≥70 years with clinical stage I NSCLC who underwent SBRT or surgery at Zhejiang Cancer Hospital (Hangzhou, China) from January 2012 to December 2017. A propensity score matching analysis was performed between the two groups. In addition, we compared outcomes and related toxicity in both study arms.

Each group included 35 patients who met the inclusion criteria. Median follow-up was 50.1 (0.8–74.4) months for surgery and 35.5 (11.5–71.4) months for SBRT. The rate of cancer-specific survival was similar between the two treatment arms (p = 0.958). In patients who underwent surgery, the corresponding 3- and 5-year cancer-specific survival rates were 85.3 and 81.7%, respectively. In those who received radiotherapy, these rates were 91.3 and 74.9%, respectively. Moreover, the 3- and 5-year locoregional control in patients who underwent surgery were 90.0 and 80.0%, respectively. In those who received radiotherapy, these rates were 91.1 and 84.1%, respectively. Notably, the observed differences in progression-free survival were not statistically significant (p = 0.934). In the surgery group, grade 1–2 complications were observed in eleven patients (31%). One patient died due to perioperative infection within 30 days following surgery. There was no grade 3–5 toxicity observed in the SBRT group.

The outcomes of surgery and SBRT in elderly patients with early-stage NSCLC were similar.

• Advanced age
• Early-stage non-small cell lung cancer
• Radical resection of lung cancer
• Stereotactic body radiotherapy
• Toxicity
• Treatment outcome

• Aged
• Aged, 80 and over
• Carcinoma, Non-Small-Cell Lung/mortality
• Carcinoma, Non-Small-Cell Lung/pathology
• Carcinoma, Non-Small-Cell Lung/radiotherapy
• Carcinoma, Non-Small-Cell Lung/surgery
• Cohort Studies
• Female
• Humans
• Lung Neoplasms/mortality
• Lung Neoplasms/pathology
• Lung Neoplasms/radiotherapy
• Lung Neoplasms/surgery
• Male
• Neoplasm Staging
• Pneumonectomy
• Radiosurgery
• Survival Rate
• Time Factors

• U54 GM104942 NIGMS NIH HHS

• Cardiac substructure dosimetry
• Deep learning
• Early-stage lung cancer
• Stereotactic body radiotherapy
• Survivorship

• Aged
• Aged, 80 and over
• Carcinoma, Non-Small-Cell Lung/mortality
• Carcinoma, Non-Small-Cell Lung/pathology
• Carcinoma, Non-Small-Cell Lung/surgery
• Carcinoma, Squamous Cell/mortality
• Carcinoma, Squamous Cell/pathology
• Carcinoma, Squamous Cell/surgery
• Cardiotoxicity/diagnosis
• Cardiotoxicity/etiology
• Cardiotoxicity/mortality
• Female
• Follow-Up Studies
• Humans
• Lung Neoplasms/mortality
• Lung Neoplasms/pathology
• Lung Neoplasms/surgery
• Male
• Middle Aged
• Neoplasm Staging
• Neural Networks, Computer
• Radiosurgery/adverse effects
• Radiosurgery/mortality
• Radiotherapy Dosage
• Retrospective Studies
• Survival Rate

• Lung cancer
• big data
• large databases
• limitations
• observational
• radiation oncology
• radiotherapy

• Humans
• Lung Neoplasms/diagnosis
• Lung Neoplasms/secondary
• Lung Neoplasms/therapy
• Neoplasm Metastasis
• Neoplasm Staging
• Radiosurgery/methods
• Thoracic Surgical Procedures/methods
• Tomography, X-Ray Computed

• Cancer care delivery
• Comparative effectiveness
• Health services research

• Thoracic surgery
• database
• outcomes research

• circulating tumor cells
• lung cancer
• meta-analysis

• Biomarkers, Tumor
• Humans
• Lung Neoplasms/diagnosis
• Lung Neoplasms/metabolism
• Neoplastic Cells, Circulating/metabolism
• Odds Ratio
• Sensitivity and Specificity

• Lung cancer
• Non-small cell lung carcinoma
• Operable
• Stereotactic ablative radiotherapy
• Stereotactic body radiation therapy

• meta-analysis
• non–small cell lung cancer
• stereotactic body radiation therapy
• surgery
• survival

• Carcinoma, Non-Small-Cell Lung/radiotherapy
• Carcinoma, Non-Small-Cell Lung/surgery
• Humans
• Lung Neoplasms/radiotherapy
• Lung Neoplasms/surgery
• Radiosurgery

• P30 CA008748 NCI NIH HHS

• Non-small cell lung cancer (NSCLC)
• early-stage lung cancer
• stereotactic ablative radiotherapy (SABR)

• Elderly
• Lung cancer
• Non-small cell lung cancer (NSCLC)
• Older adult
• Stereotactic ablative radiotherapy (SABR)
• Stereotactic body radiation therapy (SBRT)

The aim of the study was to investigate the efficacy and safety of minimally invasive segmentectomy in the treatment of lung cancer. A total of 86 lung cancer patients in early stage were selected for the treatment between May, 2010 and December, 2010. The patients were randomly divided into the control (n=43) and observation (n=43) groups. Patients in the control group received conventional thoracotomy as treatment, while thoracoscopic segmentectomy was performed for patients in the observation group. Factors including intraoperative bleeding amount, number of dissected lymph nodes, surgery duration, postoperative intubation time and length of stay (LOS) were compared between the two groups. A visual analogue scale was used for comparison of the postoperative incisional pain experienced by patients in the two groups. The incidence rate of postoperative complications of patients in the two groups was observed. We also assayed variations in the levels of serum inflammatory factors C-reaction protein (CRP), interleukin (IL) −6 and −10 of patients prior to operation and on the 3rd, 5th and 7th days and after operation via ELISA, and on the 7th day after operation, we determined the pulmonary function of patients. During the 5-year follow-up, the recurrence and survival rate of patients in the two groups were observed. In the observation group, the intraoperative bleeding amount of patients was significantly lower than that in the control group, and the surgery duration, postoperative intubation time and LOS were all shorter than those in the control group (P<0.05). By contrast, no significant difference was detected in a comparison of the number of dissected lymph nodes of patients between the two groups (P>0.05). Additionally, in the observation group, patients suffered less pain after operation than those in the control group (P<0.05), and on the 3rd, 5th and 7th days after operation, the levels of CRP, IL-6 and −10 in the observation group were significantly lower than those in the control group (P<0.05). After operation, the incidence rate of complications in the observation group was significantly lower than that in the control group (P<0.05), and the recovery in pulmonary function after operation was superior to that in the control group (P<0.05). In addition, the 5-year survival rate of patients in the observation group was significantly higher than that in the control group, and the recurrence rate was significantly lower than that in the control group (P<0.05). Minimally invasive segmentectomy shows better efficacy in the treatment of lung cancer at early stage than the conventional thoracotomy. In addition to the high safety during surgery, this technique can lower the incidence rate of postoperative complications, protect the pulmonary function, increase the survival rate and decrease the recurrence rate, which shows great value in clinical practice.

• lung cancer
• minimally invasive surgery
• thoracoscopic segmentectomy

• communication
• patient-centered outcomes
• thoracic diseases

• lobectomy
• lung cancer
• non-small cell lung cancer
• stereotactic body radiation therapy
• sublobar resection
• surgery

Patients with tumors of 3 to 5 cm were divided into stages T2a (3 to 4 cm) and T2b (4 to 5 cm) based on the 8^th tumor-node-metastasis staging system for lung cancer. The objective of our study was to explore appropriate surgical modalities for the new stages, T2a and T2b. We selected 6,996 node-negative non-small-cell lung cancer patients with tumor sizes of 3 to 5 cm, diagnosed between 2009 and 2013, from the Surveillance, Epidemiology, and End Results (SEER) program. The Pearson \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\chi }^{2}$$\end{document}χ2. statistic test and Kaplan–Meier curve were used to analyze patient data. The prognosis of patients with stage T2a was significantly better than that of patients with stage T2b, both in overall survival (p = 0.018) and lung cancer specific survival (p = 0.001). For patients with stage T2a, lobectomy had a significantly better outcome. For patients with stage T2b, surgical modalities including pneumonectomy, segmental resection and lobectomy, had similar outcomes in terms of survival. Consequently, lobectomy was the most appropriate surgical treatment modality for new stage T2a patients, whereas, for new T2b patients, treatment outcome did not vary significantly with the choice of surgical modality.

• comorbidities
• lung cancer screening
• stage 1 lung cancer outcomes

• Circulating cell-free DNA
• lung cancer
• relapse
• surgery

Chemotherapy toxicity is a serious problem from which non-small cell lung cancer (NSCLC) patients suffer. The mismatch repair (MMR) system is associated with platinum-based chemotherapy toxicity in NSCLC patients. In this study, we aimed to investigate the relationship between genetic polymorphisms in the MMR pathway and platinum-based chemotherapy toxicity in NSCLC patients.

A total of 220 Chinese lung cancer patients who received at least two cycles of platinum-based chemotherapy were recruited for this study. Toxicity was evaluated in each patient after two cycles of chemotherapy. A total of 44 single nucleotide polymorphisms were selected to investigate their associations with platinum-based chemotherapy toxicity.

MutS homolog 2 (MSH2) rs6544991 [odds ratio (OR) 2.98, 95% confidence interval (CI) 1.20–7.40, P = 0.019] was associated with gastrointestinal toxicity in the dominant model; MSH3 rs6151627 (OR 2.38, 95% CI 1.23–4.60, P = 0.010), rs6151670 (OR 2.05, 95% CI 1.07–3.93, P = 0.031), and rs7709909 (OR 2.38, 95% CI 1.23–4.64, P = 0.010) were associated with hematologic toxicity in the dominant model. Additionally, MSH5 rs805304 was significantly associated with overall toxicity (OR 2.21, 95% CI 1.19–4.09, P = 0.012), and MSH5 rs707939 was significantly associated with both overall toxicity (OR 0.42, 95% CI 0.23–0.76, P = 0.004) and gastrointestinal toxicity (OR 0.44, 95% CI 0.20–0.96, P = 0.038) in the dominant model.

Genetic polymorphisms in the MMR pathway are potential clinical markers for predicting chemotherapy toxicity in NSCLC patients.

The online version of this article (doi:10.1186/s40880-016-0175-2) contains supplementary material, which is available to authorized users.

• Chemotherapy toxicity
• DNA mismatch repair
• Lung cancer
• Platinum