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dc.contributor.advisorJohn Varlotto
dc.contributor.authorVarlotto, John M.
dc.contributor.authorMartins Emmerick, Isabel Cristina
dc.contributor.authorMaddox, Debra
dc.contributor.authorHerbert, Christine
dc.contributor.authorGriffin, Molly
dc.contributor.authorRava, Paul
dc.contributor.authorFitzgerald, Thomas J.
dc.contributor.authorOliveira, Paulo
dc.contributor.authorBaima, Jennifer
dc.contributor.authorSood, Rahul N
dc.contributor.authorWalsh, William
dc.contributor.authorMcIntosh, Lacey J.
dc.contributor.authorLou, Feiran
dc.contributor.authorMaxfield, Mark W.
dc.date2022-08-11T08:08:24.000
dc.date.accessioned2022-08-23T15:54:08Z
dc.date.available2022-08-23T15:54:08Z
dc.date.issued2020-05-26
dc.date.submitted2020-07-16
dc.identifier.citation<p>Varlotto JM, Emmerick I, Voland R, DeCamp MM, Flickinger JC, Maddox DJ, Herbert C, Griffin M, Rava P, Fitzgerald TJ, Oliveira P, Baima J, Sood R, Walsh W, McIntosh LJ, Lou F, Maxfield M, Rassaei N, Uy K. The Incidence of Node-Positive Non-small-Cell Lung Cancer Undergoing Sublobar Resection and the Role of Radiation in Its Management. Front Oncol. 2020 May 26;10:417. doi: 10.3389/fonc.2020.00417. PMID: 32528866; PMCID: PMC7264374. <a href="https://doi.org/10.3389/fonc.2020.00417">Link to article on publisher's site</a></p>
dc.identifier.issn2234-943X (Linking)
dc.identifier.doi10.3389/fonc.2020.00417
dc.identifier.pmid32528866
dc.identifier.urihttp://hdl.handle.net/20.500.14038/29491
dc.description<p>Molly Griffin participated in this study as a medical student in the Senior Scholars research program at the University of Massachusetts Medical School.</p><p>Full author list omitted for brevity. For the full list of authors, see article.</p>
dc.description.abstractPurpose: To identify the incidence, preoperative risk factors, and prognosis associated with pathologically positive lymph node (pN+) in patients undergoing a sub-lobar resection (SLR). Methods: This is a retrospective study using the National Cancer Database (NCDB) from 2004 to 2014 analyzing SLR excluding those with any preoperative chemotherapy and/or radiation, follow-up < 3 months, stage IV disease, or > 1 tumor nodule. Multivariable modeling (MVA) was used to determine factors associated with overall survival (OS). Propensity score matching (PSM) was used to determine preoperative risk factors for pN+ in patients having at least one node examined to assess radiation's effect on OS in those patients with pN+ and to determine whether SLR was associated with inferior OS as compared to lobectomy for each nodal stage. Results: A total of 40,202 patients underwent SLR, but only 58.3% had one lymph node examined. Then, 2,615 individuals had pN+ which decreased progressively from 15.1% in 2004 to 8.9% in 2014 (N1, from 6.3 to 3.0%, and N2, from 8.4 to 5.9%). A lower risk of pN+ was noted for squamous cell carcinomas, bronchioloalveolar adenocarcinoma (BAC), adenocarcinomas, and right upper lobe locations. In the pN+ group, OS was worse without chemotherapy or radiation. Radiation was associated with a strong trend for OS in the entire pN+ group (p = 0.0647) which was largely due to the effects on those having N2 disease (p = 0.009) or R1 resections (p = 0.03), but not N1 involvement (p = 0.87). PSM noted that SLR was associated with an inferior OS as compared to lobectomy by nodal stage in the overall patient population and even for those with tumors < 2 cm. Conclusion: pN+ incidence in SLRs has decreased over time. SLR was associated with inferior OS as compared to lobectomy by nodal stage. Radiation appears to improve the OS in patients undergoing SLR with pN+, especially in those with N2 nodal involvement and/or positive margins.
dc.language.isoen_US
dc.relation<p><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=32528866&dopt=Abstract">Link to Article in PubMed</a></p>
dc.rightsCopyright © 2020 Varlotto, Emmerick, Voland, DeCamp, Flickinger, Maddox, Herbert, Griffin, Rava, Fitzgerald, Oliveira, Baima, Sood, Walsh, McIntosh, Lou, Maxfield, Rassaei and Uy. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectincidence
dc.subjectlung cancer
dc.subjectnode positive
dc.subjectradiation
dc.subjectsub-lobar resection (SLR)
dc.subjectDiagnosis
dc.subjectDisease Modeling
dc.subjectNeoplasms
dc.subjectOncology
dc.subjectRadiology
dc.subjectRespiratory Tract Diseases
dc.subjectSurgery
dc.subjectSurgical Procedures, Operative
dc.subjectTherapeutics
dc.titleThe Incidence of Node-Positive Non-small-Cell Lung Cancer Undergoing Sublobar Resection and the Role of Radiation in Its Management
dc.typeJournal Article
dc.source.journaltitleFrontiers in oncology
dc.source.volume10
dc.identifier.legacyfulltexthttps://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=2726&amp;context=faculty_pubs&amp;unstamped=1
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/faculty_pubs/1714
dc.identifier.contextkey18546362
refterms.dateFOA2022-08-23T15:54:09Z
html.description.abstract<p>Purpose: To identify the incidence, preoperative risk factors, and prognosis associated with pathologically positive lymph node (pN+) in patients undergoing a sub-lobar resection (SLR).</p> <p>Methods: This is a retrospective study using the National Cancer Database (NCDB) from 2004 to 2014 analyzing SLR excluding those with any preoperative chemotherapy and/or radiation, follow-up < 3 months, stage IV disease, or > 1 tumor nodule. Multivariable modeling (MVA) was used to determine factors associated with overall survival (OS). Propensity score matching (PSM) was used to determine preoperative risk factors for pN+ in patients having at least one node examined to assess radiation's effect on OS in those patients with pN+ and to determine whether SLR was associated with inferior OS as compared to lobectomy for each nodal stage.</p> <p>Results: A total of 40,202 patients underwent SLR, but only 58.3% had one lymph node examined. Then, 2,615 individuals had pN+ which decreased progressively from 15.1% in 2004 to 8.9% in 2014 (N1, from 6.3 to 3.0%, and N2, from 8.4 to 5.9%). A lower risk of pN+ was noted for squamous cell carcinomas, bronchioloalveolar adenocarcinoma (BAC), adenocarcinomas, and right upper lobe locations. In the pN+ group, OS was worse without chemotherapy or radiation. Radiation was associated with a strong trend for OS in the entire pN+ group (p = 0.0647) which was largely due to the effects on those having N2 disease (p = 0.009) or R1 resections (p = 0.03), but not N1 involvement (p = 0.87). PSM noted that SLR was associated with an inferior OS as compared to lobectomy by nodal stage in the overall patient population and even for those with tumors < 2 cm.</p> <p>Conclusion: pN+ incidence in SLRs has decreased over time. SLR was associated with inferior OS as compared to lobectomy by nodal stage. Radiation appears to improve the OS in patients undergoing SLR with pN+, especially in those with N2 nodal involvement and/or positive margins.</p>
dc.identifier.submissionpathfaculty_pubs/1714
dc.contributor.departmentDepartment of Radiology
dc.contributor.departmentDepartment of Orthopedics and Rehabilitation
dc.contributor.departmentDepartment of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine
dc.contributor.departmentDepartment of Medical Oncology, University of Massachusetts Medical Center
dc.contributor.departmentDivision of Thoracic Surgery
dc.contributor.departmentDepartment of Radiation Oncology
dc.source.pages417


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Copyright © 2020 Varlotto, Emmerick, Voland, DeCamp, Flickinger, Maddox, Herbert, Griffin, Rava, Fitzgerald, Oliveira, Baima, Sood, Walsh, McIntosh, Lou, Maxfield, Rassaei and Uy. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Except where otherwise noted, this item's license is described as Copyright © 2020 Varlotto, Emmerick, Voland, DeCamp, Flickinger, Maddox, Herbert, Griffin, Rava, Fitzgerald, Oliveira, Baima, Sood, Walsh, McIntosh, Lou, Maxfield, Rassaei and Uy. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.