Stage classification provides a nomenclature about the anatomic extent of a cancer; a consistent language provides the ability to communicate about a specific patient and about cohorts of patients in ...clinical studies. This paper summarizes the eighth edition of lung cancer stage classification, which is the worldwide standard as of January 1, 2017. This revision is based on a large global database, a sophisticated analysis, extensive internal validation as well as multiple assessments confirming generalizability. Practicing clinicians must be familiar with the stage classification system when managing contemporary patients with lung cancer.
Decisions to continue or suspend therapy with immune checkpoint inhibitors are commonly guided by tumor dynamics seen on serial imaging. However, immunotherapy responses are uniquely challenging to ...interpret because tumors often shrink slowly or can appear transiently enlarged due to inflammation. We hypothesized that monitoring tumor cell death in real time by quantifying changes in circulating tumor DNA (ctDNA) levels could enable early assessment of immunotherapy efficacy.
We compared longitudinal changes in ctDNA levels with changes in radiographic tumor size and with survival outcomes in 28 patients with metastatic non-small cell lung cancer (NSCLC) receiving immune checkpoint inhibitor therapy. CtDNA was quantified by determining the allele fraction of cancer-associated somatic mutations in plasma using a multigene next-generation sequencing assay. We defined a ctDNA response as a >50% decrease in mutant allele fraction from baseline, with a second confirmatory measurement.
Strong agreement was observed between ctDNA response and radiographic response (Cohen's kappa, 0.753). Median time to initial response among patients who achieved responses in both categories was 24.5 days by ctDNA versus 72.5 days by imaging. Time on treatment was significantly longer for ctDNA responders versus nonresponders (median, 205.5 vs. 69 days;
< 0.001). A ctDNA response was associated with superior progression-free survival hazard ratio (HR), 0.29; 95% CI, 0.09-0.89;
= 0.03, and superior overall survival (HR, 0.17; 95% CI, 0.05-0.62;
= 0.007).
A drop in ctDNA level is an early marker of therapeutic efficacy and predicts prolonged survival in patients treated with immune checkpoint inhibitors for NSCLC.
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The New Lung Cancer Staging System DETTERBECK, Frank C; BOFFA, Daniel J; TANOUE, Lynn T
Chest,
07/2009, Volume:
136, Issue:
1
Journal Article
Peer reviewed
The International Association for the Study of Lung Cancer (IASLC) has conducted an extensive initiative to inform the revision
of the lung cancer staging system. This involved development of an ...international database along with extensive analysis of
a large population of patients and their prognoses. This article reviews the recommendations of the IASLC International Staging
Committee for the definitions for the TNM descriptors and the stage grouping in the new non-small cell lung cancer staging
system.
Background
Extracellular fluid volume (ECF) is independently associated with chronic kidney disease (CKD) progression and mortality in patients with CKD, but the prognostic value of the trajectory of ...ECF over time beyond that of baseline value is unknown.
Objectives
To characterize ECF trajectory and evaluate its association with the risks of end‐stage kidney disease (ESKD) and mortality.
Methods
From the prospective tricentric NephroTest cohort, we included 1588 patients with baseline measured glomerular filtration rate (mGFR) ≥15 mL min−1/1.73 m2 and ECF measurement. ECF and GFR were measured repeatedly using the distribution volume and clearance of 51Cr‐EDTA, respectively. ESKD and mortality were traced through record linkage with the national registries. Adjusted shared random‐effect joint models were used to analyse the association between the trajectory of ECF over time and the two competing outcomes.
Results
Patients were mean age 58.7 years, 66.7% men, mean mGFR of 43.6 ± 18.6 mL min−1/1.73 m2 and mean ECF of 16.1 ± 3.6 L. Over a median follow‐up of 5.3 IQR: 3.0;7.4 years, ECF increased by 136 95%CI 106;167 mL per year on average, whilst diuretic prescription and 24‐hour urinary sodium excretion remained stable. ESKD occurred in 324 (20.4%) patients, and 185 (11.6%) patients died before ESKD. A higher current value of ECF was associated with increased hazards of ESKD (adjusted hazard ratio aHR: 1.12 95%CI 1.06;1.18; P < 0.001 per 1 L increase in ECF), and death before ESKD (aHR: 1.10 95%CI 1.04;1.17; P = 0.002).
Conclusions
The current value of ECF was associated with the risks of ESKD and mortality, independent of multiple potential confounders, including kidney function decline. This highlights the need for a close monitoring and adjustment of treatment to avoid fluid overload in CKD patients.
European guideline for the management of scabies Salavastru, C.M.; Chosidow, O.; Boffa, M.J. ...
JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology,
August 2017, 2017-Aug, 2017-08-00, 20170801, Volume:
31, Issue:
8
Journal Article
Peer reviewed
Open access
Scabies is caused by Sarcoptes scabiei var. hominis. The disease can be sexually transmitted. Patients’ main complaint is nocturnal itch. Disseminated, excoriated, erythematous papules are usually ...seen on the anterior trunk and limbs. Crusted scabies occurs in immunocompromised hosts and may be associated with reduced or absent pruritus. Recommended treatments are permethrin 5% cream, oral ivermectin and benzyl benzoate 25% lotion. Alternative treatments are malathion 0.5% aqueous lotion, ivermectin 1% lotion and sulphur 6–33% cream, ointment or lotion. Crusted scabies therapy requires a topical scabicide and oral ivermectin. Mass treatment of large populations with endemic disease can be performed with a single dose of ivermectin (200 micrograms/kg of bodyweight). Partner management needs a look‐back period of 2 months. Screening for other STI is recommended. Patients and close contacts should avoid sexual contact until completion of treatment and should strictly observe personal hygiene rules when living in crowded spaces. Written information should be provided to suspected cases.
A case of bullous pemphigoid after the SARS‐CoV‐2 mRNA vaccine Young, J.; Mercieca, L.; Ceci, M. ...
JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology,
January 2022, Volume:
36, Issue:
1
Journal Article
2016 European guideline for the management of vulval conditions Meijden, W.I.; Boffa, M.J.; Harmsel, W.A. ...
JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology,
June 2017, Volume:
31, Issue:
6
Journal Article
Peer reviewed
Open access
Vulval conditions may present to a variety of clinicians, such as dermatologists, gynaecologists and general practitioners. Women with these conditions are best managed by a multidisciplinary ...approach, which includes clear referral pathways between disciplines or access to a specialist multidisciplinary vulval service. Informed consent is a prerequisite for all examinations, investigations and treatments. Consent is particularly important for intimate examinations of the anogenital area, and a chaperone should be offered in all cases. All efforts should be made to maintain a patient's dignity. Depending on symptoms and risk factors, screening for sexually transmitted infections (STI) should be considered. If the patient presents with vulval itch, particularly if also complaining of increased vaginal discharge, vulvaginal candidiasis should be excluded. Sexual dysfunction should be considered in all patients with vulval complaints, either as the cause of the symptoms or secondary to symptoms, and assessed if appropriate. This guideline covers several aspects, such as diagnosis and treatment, of the more common vulval conditions (relatively) often encountered at vulval clinics, i.e. vulval dermatitis (eczema), psoriasis, lichen simplex chronicus, lichen sclerosus, lichen planus, vulvodynia and vulval intraepithelial neoplasia (VIN).
Objectives Anatomic resection is currently the standard of care for clinical stage I lung cancer, yet clinicians increasingly pursue nonsurgical, ablative therapies to avoid the morbidity of ...thoracotomy. The video-assisted thoracic surgery (VATS) approach is a minimally invasive alternative to thoracotomy yet the effect of VATS on the morbidity of patients undergoing lung cancer resection is not fully characterized. We evaluated complications following anatomic resection of clinical stage I lung cancer by VATS and thoracotomy to clarify the effect of the minimally invasive approach. Methods The Society of Thoracic Surgeons database was queried for lobectomies and segmentectomies performed between 2001 and 2010 for clinical stage I primary cancer. Results A total of 11,531 (7137 open and 4394 VATS) patients with clinical stage I primary lung cancers underwent resection. Propensity scoring was used to match cases into 2745 well-balanced pairs. Overall complications were significantly more likely in the thoracotomy group (36%) than in the VATS cohort (30%; P < .001). Patients undergoing thoracotomy experienced significantly more pulmonary complications (21% vs 18%), atrial arrhythmias (13% vs 10%), and were more likely to undergo transfusion (6% vs 4%). Operative mortality was similar (thoracotomy 1.8%, VATS 1.3%; P = .13). Conclusions Anatomic resection of early stage lung cancer is performed with a low mortality rate, according to data from the Society of Thoracic Surgeons database. Perioperative complications are significantly less likely to occur when patients with stage I lung cancers undergo resection using the VATS approach. Further study is warranted to determine long-term effects of these differences in perioperative outcomes.
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