Andrew Kaufman

Baseline and annual repeat rounds of screening: implications for optimal regimens of screening

AbstractObjectivesDifferences in results of baseline and subsequent annual repeat rounds provide important information for optimising the regimen of screening.MethodsA prospective cohort study of 65,374 was reviewed to examine the frequency/percentages of the largest noncalcified nodule (NCN), lung cancer cell types and Kaplan–Meier (K-M) survival rates, separately for baseline and annual rounds.ResultsOf 65,374 baseline screenings, NCNs were identified in 28,279 (43.3%); lung cancer in 737 (1.1%). Of 74,482 annual repeat screenings, new NCNs were identified in 4959 (7%); lung cancer in 179 (0.24%). Only adenocarcinoma was diagnosed in subsolid NCNs. Percentages of lung cancers by cell type were significantly different (p < 0.0001) in the baseline round compared with annual rounds, reflecting length bias, as were the ratios, reflecting lead times. Long-term K-M survival rate was 100% for typical carcinoids and for adenocarcinomas manifesting as subsolid NCNs; 85% (95% CI 81–89%) for adenocarcinoma, 74% (95% CI 63–85%) for squamous cell, 48% (95% CI 34–62%) for small cell. The rank ordering by lead time was the same as the rank ordering by survival rates.ConclusionsThe significant differences in the frequency of NCNs and frequency and aggressiveness of diagnosed cancers in baseline and annual repeat need to be recognised for an optimal regimen of screening.Key Points• Lung cancer aggressiveness varies considerably by cell type and nodule consistency. • Kaplan–Meier survival rates varied by cell type between 100% and 48%. • The percentages of lung cancers by cell type in screening rounds reflect screening biases. • Rank ordering by cell type survival is consistent with that by lead times. • Empirical evidence provides critical information for the regimen of screening.

Second Primary Lung Cancers Demonstrate Better Survival with Surgery than Radiation

Patients who have had curative surgery for lung cancer are at the highest risk of developing a new lung cancer. Individual studies are usually underpowered to describe the clinical characteristics and outcomes in second primary lung cancer (SPLC). The goal of this study is to determine which treatment is best associated with survival in patients who develop a new primary lung cancer. All pathologically proven stage I lung cancer cases that received cancer-directed surgery included in the Surveillance Epidemiology and End Results database between 2004 and 2010 were selected. Cases that received radiation therapy were excluded. Cases that developed a SPLC 6 or more months after the diagnosis of the first cancer were analyzed. The original data set consisted of 9564 stage I lung cancer cases treated with surgery; 520 of them developed a second primary, and completed data were available for 494 of them. Stage I disease was diagnosed in 272 patients with SPLCs (58.5%); 45.8% of these underwent cancer surgery alone, and 31.6% received radiation alone. Surgery was performed more frequently in early stages and younger patients. Surgical patients had statistically significant longer survival than patients treated with radiation (log-rank P < 0.0001) or not treated with surgery or radiation (log-rank P < 0.0001). The incidence of SPLCs was 5.4%. Stage I second primaries had improved survival when compared with later stage disease, and surgery conferred an increased survival benefit as compared with radiation.

Minimally invasive thymectomy for thymoma: does surgical approach matter or is it a question of stage?

Complete (R0) surgical resection remains the primary treatment modality for thymoma in both early and advanced stage disease. Following trends seen in surgery for other malignancies, minimally invasive thymectomy (MIT) utilizing VATS or robotic approaches have increased in popularity due to the short term and cosmetic benefits associated with minimally invasive surgery.

Correction to: Baseline and annual repeat rounds of screening: implications for optimal regimens of screening

The original version of this article unfortunately contained a mistake. The conflict of interest was incorrect.

The influence of insurance type on stage at presentation, treatment, and survival between Asian American and non-Hispanic White lung cancer patients

The effect of insurance type on lung cancer diagnosis, treatment, and survival in Asian patients living in the United States is still under debate. We have analyzed this issue using the Surveillance, Epidemiology, and End Results database. There were 102,733 lung cancer patients age 18–64 years diagnosed between 2007 and 2013. Multilevel regression analysis was performed to identify the association between insurance types, stage at diagnosis, treatment modalities, and overall mortality in Asian and non‐Hispanic White (NHW) patients. Clinical characteristics were significantly different between Asian and NHW patients, except for gender. Asian patients were more likely to present with advanced disease than NHW patients (ORadj = 1.12, 95% CI = 1.06–1.19). Asian patients with non‐Medicaid insurance underwent lobectomy more than NHW patients with Medicaid or uninsured; were more likely to undergo mediastinal lymph node evaluation (MLNE) (ORadj = 1.98, 95% CI = 1.72–2.28) and cancer‐directed surgery and/or radiation therapy (ORadj = 1.41, 95% CI = 1.20–1.65). Asian patients with non‐Medicaid insurance had the best overall survival. Uninsured or Medicaid‐covered Asian patients were more likely to be diagnosed with advanced disease, less likely to undergo MLNE and cancer‐directed treatments, and had shorter overall survival than their NHW counterpart.

Laparoscopic Repair of an Intrapericardial Diaphragmatic Hernia After Convergent Maze Procedure

The convergent maze procedure (CMP) is a new minimally invasive technique for the surgical treatment of atrial fibrillation (AF). Recently, multiple groups have published excellent results and few adverse events with CMP. However, we now report the second case of an intrapericardial diaphragmatic hernia with small bowel obstruction that resulted from CMP. This adverse event was managed successfully by laparoscopic repair of the hernia and the use of a polytetrafluoroethylene mesh closure with hepatic buttress, achieving an excellent result. With the expanding use of CMP for the treatment of AF, awareness of this adverse event and its appropriate management are increasingly important.