Minimally Invasive! Minimally Invasive! Minimally Invasive! Battling T4 Stage Non-Small-Cell Lung Cancer
Surgical Options for Treating Clinical T4 Stage Non-Small-Cell Lung Cancer in the U.S. – An Analysis by Montefiore Medical Center
Hello everyone! Today, I’m going to discuss a very serious yet incredibly hopeful topic—the new treatment trends for non-small-cell lung cancer (NSCLC). For clinical T4 patients, traditional treatment options often meant undergoing open surgery, but a 2024 study published by Dr. Jorge Humberto and the cardiothoracic surgery team at Montefiore Medical Center highlights that patients may have more options now! (Minimally invasive surgery for clinical T4 non-small-cell lung cancer: national trends and outcomes—European Journal of Cardio-Thoracic Surgery 2024, 65(3), ezae009)
Here are the key takeaways:Among 3,715 patients with T4 stage non-small-cell lung cancer:
64.1% underwent open surgery, while 35.9% underwent minimally invasive surgery (31.5% of those were robot-assisted, and 68.5% were video-assisted thoracoscopic surgeries).
Trends Over Time and Influencing Factors:
From 2010 to 2019, the percentage of T4 NSCLC patients undergoing minimally invasive surgery (MIS) increased from 17.2% to 47.9%, showing the growing use of MIS in clinical practice.
The proportion of robot-assisted surgeries among MIS also increased, reaching about half by 2019.
Older patients, women, higher-income patients, those treated at teaching hospitals, clinically node-negative patients, and those receiving lung resections rather than pneumonectomy were more likely to choose MIS.
Patients with positive nodal metastasis or those receiving neoadjuvant therapy were less likely to undergo MIS.
Surgical Outcomes Comparison:
There was no significant difference between the MIS and open surgery groups in terms of R0 resection rate, readmission rate, or 30/90-day mortality.
Patients in the MIS group had shorter hospital stays.
Overall survival time and 5-year survival rates were also statistically similar between the two groups.
Differences Between Clinical and Pathological Staging:
67.5% of patients clinically diagnosed with T4 stage were confirmed to be pathologically T4 post-surgery.
Limitations:
The lack of specific information on T4 subtypes meant that the study could not differentiate the various reasons behind T4 staging.
Conclusion and Recommendations:
In summary, the study supports the use of minimally invasive surgery for select T4 NSCLC patients. However, it also highlights the need for further exploration of T4 subtypes and the refinement of evaluation systems. Physicians should carefully weigh the pros and cons of MIS based on the individual case to achieve the best treatment outcomes.
Q&A Session
What is T4 Stage Non-Small-Cell Lung Cancer?
According to the 8th edition of the American Joint Committee on Cancer (AJCC) staging system, T4 lung cancer is defined as a tumor greater than 7 cm in size, multiple tumor nodules in the same lung lobe, or invasion into surrounding critical structures such as the mediastinum, major blood vessels, trachea, spine, or esophagus. Treatment at this stage is highly complex, and the choice of treatment method is particularly crucial.
Advantages and Applications of Minimally Invasive Surgery
Minimally invasive surgery (MIS), including robotic-assisted surgery and video-assisted thoracoscopic surgery (VATS), is favored for its small incisions, reduced postoperative complications, and quicker recovery. It is widely used in the treatment of early-stage lung cancer. Over time, MIS is increasingly being applied in T4 stage NSCLC.
How to Choose T4 Patients Suitable for Minimally Invasive Surgery?
Tumor Characteristics: Tumor size and the structures it invades are the main factors. The study noted that the median tumor size for the MIS group was 58 mm, while for the open surgery group, it was 55 mm, suggesting that even larger tumors can be addressed with MIS if their nature and location permit.
Patient Health: Most patients in the study (about 84%) had a Charlson-Deyo comorbidity index of 0-1, indicating good overall health. Older patients were more likely to undergo MIS, reflecting that doctors often make decisions based on the patient’s overall condition. Patients who received neoadjuvant therapy were more likely to undergo open surgery, possibly due to poorer health post-treatment, making them less able to tolerate MIS.
Dear readers, I hope today’s discussion has given you a deeper understanding of the trends in minimally invasive treatment for non-small-cell lung cancer. Thank you for taking the time to read, and stay tuned for our next update!