Background: A solitary pulmonary nodule (SPN) is a common and increasing clinical problem, mainly due to the lung cancer (LC) screening programs and easier access to complementary diagnostic tests. Differential diagnosis is broad and often challenging for decision making, particularly in small and not accessible lesions. The process of selecting the right strategy must address the probability of malignancy, nodule characteristics observed on CT/PET-CT, patient preferences and institutional-related expertise. The aim of this study was to evaluate the accuracy of the multidisciplinary lung cancer tumor (MLCT) board team in the management of SPN. Method: We retrospectively reviewed all SPN patients who underwent surgical resections between January 2015 and March 2017. All patients were evaluated at a MLCT meeting. We characterized demographic, clinical and radiological features, surgical procedure, histology and outcomes. Result: We included 73 patients, 37 male (50.7%), with a mean age of 63.3±10.2, 64.4% smokers (current or former) and none with asbestos/radon exposure. Twentyfive patients (34.2%) had previous history of cancer and 5 (6.8%) of tuberculosis. Emphysema was present in 21 patients (28.8%). Fifty-six were solid SPN (6e20 mm) and 17 sub solid SPN (9-18 mm): 15 with solid component (2-13.5 mm) and 2 pure ground glass nodules (10 and 12.3 mm). Of the 73 patients, 11 (15.1%) had a definitive histological result before the surgical intervention: 10 LC and 1 metastasis. Among patients without diagnosis (n¼62), frozen section was performed in 45 patients (61.6%): 31 of these (70%) were malignant disease (25 LC and 6 metastases) and 14 were benign lesions. In this group, we performed 17 lobectomies, 15 anatomic segmentectomies and 13 wedge resections. All patients with LC underwent mediastinal lymph node dissection (MLND). Among the 25 patients with LC, 7 were adenocarcinoma in situ and 18 invasive lesions (17 in stage I). In the other 17 cases without previous diagnosis, a direct surgery was performed, based either on the location of the lesion, size or clinical suspicion. Twelve of these patients (70.6%) were confirmed to have LC in the final pathology evaluation (all invasive LC in stage I). They underwent an upper bilobectomy, 10 lobectomies, 3 anatomic segmentectomies, all with MLND, and 3 wedge resections. No major complications were reported. Conclusion: This study suggests that surgery is a safe strategy in the diagnosis and treatment of SPN without previous diagnosis.
fractions (range 50-75Gy, 3-35 fractions). 106 were stage I, 56 were stage II and 232 were stage III. Average age was 68 years. 26 patients received stereotactic body radiotherapy. ECOG, stage and weight loss were all associated with survival (p¼0.007, p¼0.022, p¼0.032 respectively). Modified comorbidity score and interval between diagnosis and start of radiotherapy were not (p¼0.101 and p¼0.353 respectively). A retrospectively assigned Charlston comorbidity score was available for 271 of the 394 patients who were analyzed using the same variables as above but substituting the Charlston score for the modified comorbidity score. ECOG PS and Charlston score were significantly associated with survival (p¼0.012 and p¼0.046 respectively, but stage, weight loss and interval to radiotherapy were not (p¼0.129, p¼0.150 and p¼0.09 respectively). When Colinet score was introduced to the analysis it did not reach statistical significance (p¼0.729) but Charlston score retained it (p¼0.042). Conclusion:Delay from date of diagnosis to initiation of radiotherapy could not be demonstrated to correlate negatively with survival, at least in the time range encountered in our patients. Although counterintuitive, this is in agreement with the limited published data which are retrospective to our knowledge. The modified comorbidity score was not specifically developed by Colinet et al to prognosticate for lung cancer and indeed appears inadequate for this purpose. The Charlston score however, is confirmed as prognostic in our study and although more complex and time consuming to determine, should be the preferred comorbidity index for prognostication of radically treated non-small cell lung cancer patients.
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