Highlights • Interstitial lung abnormalities were present in 14% of stage IV NSCLC patients. • ILA was more common in older patients with heavier smoking history. • ILA was associated with shorter ...survival after adjusting for smoking and therapy. • ILA could be an additional independent marker for survival in advanced NSCLC.
The prevalence of incidental nonneoplastic lung disease in patients undergoing resection for mass lesions is unknown. We determined the prevalence and characteristics of parenchymal findings in ...patients with lung nodules, aiming to increase awareness of findings that could potentially impact patient management. A total of 397 patients with benign or malignant mass lesions with available presurgical chest computed tomography scans resected between January 2001 and July 2015 were included. Retrospective histologic assessment of parenchymal abnormalities in at least 1 section of grossly normal lung was performed for each case by 2 pulmonary pathologists and correlated with original pathology reports, clinical history, and radiologic findings. A total of 233 women and 164 men underwent resections for carcinomas (78%) or benign nodules (22%). One hundred one (25%) patients showed parenchymal abnormalities, including 14 patients with multiple findings. The most common abnormal findings were fibrotic interstitial changes (10%), including usual interstitial pneumonia (1%), followed by granulomatous processes (8%). Other findings included aspiration (4%), intravascular thrombi (2%), Langerhans cell histiocytosis (1.5%), constrictive bronchiolitis (1%), atypical lymphoid infiltrates (1%), and amyloidosis (0.5%). Abnormalities were more likely to have been documented in the original pathology report by pulmonary pathologists (68%) than by general pathologists (15%) (P < .0001). Cases with histologic parenchymal abnormalities were more likely to show radiologic interstitial lung abnormalities than those without (16% versus 5%; P = .001). Evaluation of background lung parenchyma may yield valuable and unanticipated information in patients undergoing surgical resections for lung masses that may correlate with radiographic interstitial lung abnormalities and influence clinical management.
•Incidental parenchymal abnormalities are frequent in lung resections for mass lesions.•Most incidental lung parenchymal findings are underrecognized and underreported.•The presence of incidental lung abnormalities is unrelated to nature of nodule and smoking status.•Pulmonary thrombotic angiopathy and aspiration may be associated with adverse clinical events.
Correspondence to Dr Tetsuro Araki, Department of Radiology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston 02215, Massachusetts, USA; taraki@partners.org ...We appreciate the comments by Franzblau et al 1 on our recent article ‘Pleural abnormalities in the Framingham Heart Study: prevalence and CT image features’.2 Our study described CT image findings of pleural abnormalities including pleural plaques and pleural thickening in the Framingham Heart Study. ...they also suggested the importance of dedicated training and standardised method of reading.7 Again, we are grateful for the comments on our study and sincerely hope our study may contribute to the improvement of radiological diagnosis of asbestos-related pleural disease and patient management. Inter-reader agreement in HRCT detection of pleural plaques and asbestosis in participants with previous occupational exposure to asbestos.
Interstitial lung abnormalities (ILA) share many features with idiopathic pulmonary fibrosis; however, it is not known if ILA are associated with decreased mean telomere length (MTL).
Telomere length ...was measured with quantitative PCR in the Genetic Epidemiology of Chronic Obstructive Pulmonary Disease (COPDGene) and Age Gene/Environment Susceptibility Reykjavik (AGES-Reykjavik) cohorts and Southern blot analysis was used in the Framingham Heart Study (FHS). Logistic and linear regression were used to assess the association between ILA and MTL; Cox proportional hazards models were used to assess the association between MTL and mortality.
In all three cohorts, ILA were associated with decreased MTL. In the COPDGene and AGES-Reykjavik cohorts, after adjustment there was greater than twofold increase in the odds of ILA when comparing the shortest quartile of telomere length to the longest quartile (OR 2.2, 95% CI 1.5-3.4, p=0.0001, and OR 2.6, 95% CI 1.4-4.9, p=0.003, respectively). In the FHS, those with ILA had shorter telomeres than those without ILA (-767 bp, 95% CI 76-1584 bp, p=0.03). Although decreased MTL was associated with chronic obstructive pulmonary disease (OR 1.3, 95% CI 1.1-1.6, p=0.01) in COPDGene, the effect estimate was less than that noted with ILA. There was no consistent association between MTL and risk of death when comparing the shortest quartile of telomere length in COPDGene and AGES-Reykjavik (HR 0.82, 95% CI 0.4-1.7, p=0.6, and HR 1.2, 95% CI 0.6-2.2, p=0.5, respectively).
ILA are associated with decreased MTL.
Background
The 8th edition of TNM staging of non‐small cell lung cancer (NSCLC) has revised M classification and defined M1b disease with single extrathoracic metastasis, which is distinguished from ...M1c with multiple extrathoracic metastases. We investigated the prevalence, characteristics, and overall survival (OS) of M1b disease in patients with stage IV NSCLC.
Methods
The study reviewed the medical records and imaging studies of 567 patients with stage IV NSCLC to determine M stage using the 8th edition of TNM staging. Clinical characteristics and OS were compared according to M stages.
Results
Among 567 patients, 57 patients (10%) had M1b disease, whereas 119 patients (21%) had M1a disease and 391 patients (69%) had M1c disease. Squamous histology was more common in M1b (16%) than in M1a (6%) and M1c (6%; p = .03). The median OS of patients with M1b disease was 14.8 months, compared with 22.6 months for patients with M1a and 13.4 months for those with M1c disease (p < .0001). Significant OS differences of M1b compared with single‐organ M1c and multiorgan M1c groups were noted (single‐organ M1c vs. M1b: hazard ratio HR, 1.49; p = .02; multiorgan M1c vs. M1b: HR, 1.57; p = .01) in multivariable analyses adjusting for smoking and systemic therapy types. Among patients with M1b disease, the brain was the most common site of single metastasis (28/57; 49%), followed by bone (16/57; 28%). Single brain metastasis was more frequently treated with local treatment (p < .0001).
Conclusion
M1b disease was noted in 10% of patients with stage IV NSCLC. Squamous histology was more common in M1b group than others. The brain was the most common site of single metastasis and was often treated locally.
Implications for Practice
The newly defined group of M stage consists of a unique subset among patients with stage IV non‐small cell lung cancer that can be studied further to optimize treatment approaches.
摘要
背景。第 8 版非小细胞肺癌 (NSCLC) TNM 分期修订了 M 分类并定义了伴随单发胸外远处转移的 M1b 疾病，这与多发性胸外远处转移的 M1c 不同。我们调查了 IV 期 NSCLC 患者 M1b 疾病的患病率、特征和总生存期 (OS)。
方法。本研究回顾了 567 例 IV 期 NSCLC 患者的病历和影像学研究，使用第 8 版 TNM 分期以确定 M 分期。根据 M 分期比较了临床特征和 OS。
结果。在 567 名患者中，57 名患者 (10%) 患有 M1b 疾病，而 119 名患者 (21%) 患有 M1a 疾病，391 名患者 (69%) 患有 M1c 疾病。鳞状组织在 M1b (16%) 中比在 M1a (6%) 和 M1c(6%； p = 0.03)中更常见。M1b 疾病患者的中位 OS 为 14.8 个月，而 M1a 患者为 22.6 个月，M1c 患者为 13.4 个月(p < 0.000 1)。在多变量分析中，校正了吸烟和全身治疗类型后，注意到与单器官 M1c 和多器官 M1c 两组相比，M1b 有显著的 OS 差异单器官 M1c 对比 M1b:风险比(HR)，1.49； p = 0.02；多器官 M1c 对比 M1b:HR，1.57；p = 0.01。在患有 M1b 疾病的患者中，脑部是最常见的单发转移部位(28/57；49%)，其次是骨骼(16/57；28%)。单发脑转移更常用局部治疗(p < 0.000 1)。
结论。10% 的 IV 期 NSCLC 患者为 M1b 疾病。鳞状组织在 M1b 组中比在其他组中更常见。脑部是单发转移最常见的部位，通常予以局部治疗。
实践意义:新定义的 M 分期组由 IV 分期非小细胞肺癌患者中的一个独特子集组成，可以进一步研究以优化治疗方法。
The 8th edition of TNM staging of lung cancer revised M staging and defined M1b disease with single extrathoracic metastasis, to be distinguished from M1c with multiple extrathoracic metastases in one or more organs. This new distinct category of M1b disease consists of patients with a single extrathoracic metastasis, thus consisting of a strictly defined oligometastatic disease. This article reports the prevalence of M1b disease among patients with stage IV non‐small cell lung cancer, focusing on the clinical characteristics and patterns of single extrathoracic metastasis and relationships with overall survival.
The prevalence of incidental non-neoplastic lung disease in patients undergoing resection for mass lesions is unknown. We determined the prevalence and characteristics of parenchymal findings in ...patients with lung nodules, aiming to increase awareness of findings that could potentially impact patient management. 397 patients with benign or malignant mass lesions with available pre-surgical chest computed tomography scans resected between January 2001 and July 2015 were included. Retrospective histologic assessment of parenchymal abnormalities in at least one section of grossly normal lung was performed for each case by two pulmonary pathologists and correlated with original pathology reports, clinical history, and radiologic findings. 233 women and 164 men underwent resections for carcinomas (78%) or benign nodules (22%). 101 (25%) patients showed parenchymal abnormalities, including 14 patients with multiple findings. The most common abnormal findings were fibrotic interstitial changes (10%), including usual interstitial pneumonia (1%), followed by granulomatous processes (8%). Other findings included aspiration (4%), intravascular thrombi (2%), Langerhans cell histiocytosis (1.5%), small airway obliteration (1%), atypical lymphoid infiltrates (1%), and amyloidosis (0.5%). Abnormalities were more likely to have been documented in the original pathology report by pulmonary pathologists (68%) than by general pathologists (15%) (P < 0.0001). Cases with histologic parenchymal abnormalities were more likely to show radiologic interstitial lung abnormalities than those without (16% vs. 5%;
P
= 0.001). Evaluation of background lung parenchyma may yield valuable and unanticipated information in patients undergoing surgical resections for lung masses that may correlate with radiographic interstitial lung abnormalities and influence clinical management.
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