Surgery, Oncology, Pulmonary and Respiratory Medicine, Medicine
6
Scopus Publications
Scopus Publications
Segmentectomy Versus Lobectomy in Early Non-Small Cell Lung Cancer: A Population-Based Analysis in Northern Italy Lucia Mangone, Francesco Marinelli, Isabella Bisceglia, Daniel Bianchi, Cristian Rapicetta, et al. Thoracic Cancer, 2025 BackgroundAlthough smoking cessation remains the most effective preventive measure against lung cancer, the implementation of low‐dose computed tomography screening has facilitated early tumor detection, increasing the need for less invasive surgical approaches. This study evaluated the efficacy of segmentectomy vs. lobectomy for early‐stage non‐small cell lung cancer (NSCLC) in northern Italy.Material and MethodsThe analysis included 200 patients with stage I NSCLC, selected from a cancer registry. Of these, 100 underwent lobectomy and 100 underwent segmentectomy. We calculated loco‐regional and distant recurrences, overall survival, and disease‐free survival (DFS).ResultsOver a median follow‐up of 6.3 years, segmentectomy was associated with a lower recurrence rate (28%) compared to lobectomy (35%) and a lower incidence of distant metastases (39.6% vs. 60.4%). Multivariable analysis showed a greater risk of recurrence in patients undergoing lobectomy [OR 1.32; 95% CI: 0.71–2.45] and in females [OR 1.69; 95% CI: 0.89–3.18], while a decreased risk was observed among elderly patients over 70 years [OR 0.72; 95% CI: 0.39–1.32] and those with adenocarcinoma histology [OR 0.82; 95% CI: 0.41–1.64].Five‐year survival was higher in the segmentectomy group (67%; 95% CI: 57–76) compared to the lobectomy group (55%; 95% CI: 45–65); a similar result was observed for DFS: 59% (95% CI: 48–68) versus 47% (95% CI 37–57). The risk of death appeared lower in the segmentectomy group [HR 0.85; 95% CI: 0.59–1.22].DiscussionThe outcomes appear to favor segmentectomy, as previously demonstrated in clinical trials. The observed effects are less pronounced, due to the absence of patient selection in this real‐world setting.
Prognostic Thresholds of Mitotic Count and Ki-67 Labeling Index for Recurrence and Survival in Lung Atypical Carcinoids Patrick Soldath, Daniel Bianchi, Beatrice Manfredini, Andreas Kjaer, Seppo W. Langer, et al. Cancers, 2024 Atypical carcinoid (AC) is a rare neuroendocrine neoplasm of the lung, which exhibits a varying malignant potential. In this study, we aimed to identify the prognostic thresholds of the mitotic count and Ki-67 labeling index for recurrence and survival in AC. We retrospectively reviewed 78 patients who had been radically resected for AC and calculated said thresholds using time-dependent receiver operating characteristic curves and the Youden index. We then dichotomized the patients into groups of above or below these thresholds and estimated the cumulative incidences of the groups using the Aalen–Johansen estimator. We compared the groups using univariable and multivariable Fine–Gray subdistribution hazard models. Our findings show that more patients recurred and died from this disease if their mitotic count exceeded three and four mitoses per 2 mm2, respectively, or if their Ki-67 labeling index exceeded 14% and 11%, respectively. Both thresholds independently predicted survival (p < 0.001 and p = 0.015, respectively). These thresholds may serve as a valuable tool for clinicians and researchers in making treatment plans and predicting outcomes for patients with AC.
ALDH Expression in Angiosarcoma of the Lung: A Potential Marker of Aggressiveness? Beatrice Aramini, Valentina Masciale, Daniel Bianchi, Beatrice Manfredini, Federico Banchelli, et al. Frontiers in Medicine, 2020 Background: Primary angiosarcoma of the lung is a very aggressive rare malignant disease resulting in a severe prognosis (1). This type of cancer represents about 2% of all soft tissue sarcomas and has a high rate of metastasis through the hematogenous route. For the rarity of this malignant vascular tumor it is still challenging to set a diagnosis (1). The diagnostic features that have thus far been considered include primarily clinical and radiological findings. In some cases, immunohistochemical characteristics based on the most common markers used in pathology have been described. The aim of this report is to present two cases of angiosarcoma of the lung in which the aldehyde dehydrogenase (ALDH) marker was analyzed by immunohistochemistry. Methods: We report two cases of angiosarcoma of the lung in patients underwent lung surgery at our Unit. In addition to the standard histopathological analysis for this disease, immunohistochemistry using an ALDH1A1 antibody was performed in both of the cases. For ALDH quantification, a semi-quantitative method based on the positivity of the tumor cells was used: 0 (<5%), 1 (5–25%), 2 (>25–50%), 3 (>50–75%), 4 (>75%). Results: One patient with recurrent lung disease survived, achieving complete remission after chemo- and radiotherapy. The second patient died of recurrent disease within 5 years of diagnosis. ALDH1A1 was evaluated in both of these cases using an immunohistochemistry scoring system based on the positivity for this marker. The scores were consistent with the patients' clinical outcomes, as the lower (score 1) was observed in the patient with the better clinical outcome, while the higher (score 3) was seen in the patient with the worse outcome. Conclusion: Our data suggest that ALDH may be an important clinical marker in angiosarcoma of the lung. Although further studies need to be performed in a larger cohort of patients, we believe that, if the results will be confirmed, ALDH1A1 may be used to stratify patients in terms of prognosis and for targeted therapy.
Expression of ALDH and SOX-2 in Pulmonary Sclerosing Pnemocytoma (PSP) of the Lung: Is There a Meaning Behind? Beatrice Aramini, Valentina Masciale, Beatrice Manfredini, Daniel Bianchi, Federico Banchelli, et al. Frontiers in Medicine, 2020 Background: Pulmonary sclerosing pneumocytoma (PSP) is a rare benign pulmonary tumor that derives from primitive respiratory epithelium of the pulmonary alveolus. The etiology and pathogenesis are still unclear. Histopathological diagnosis focuses on cells that are positive for TTF1, EMA, cytokeratin-7, and CAM 5.2. The aim of our study is to highlight the elevated expression of ALDH and the presence of SOX-2 in pulmonary sclerosing pneumocytoma. Methods: We report five cases of pulmonary sclerosing pneumocytoma undergone surgery at our Division of Thoracic Surgery, during a period between 1994 and 2011. ALDH and SOX-2 markers were also tested for positivity in all the patients. Results: Patients showed elevated expression of ALDH during immunohistochemistry and mild expression of SOX-2, although in two cases in which SOX-2 was highly expressed. Among these two patients, one presented with lymph node recurrence while the other had no recurrence with a PET-positive nodule. In particular, the patient who had developed recurrence had an ALDH score of 4 and a SOX-2 score of 3, whereas the patient with the PET-positive nodule showed an ALDH score of 4 with a mild SOX-2 expression of score 1. Conclusions: This is the first attempt demonstrating the elevated expression of ALDH in this disease. SOX-2 expression was noted in both the patient who developed recurrence and the patient with a PET-positive nodule. We believe that further investigation may be highly useful to better characterize these two markers as well as understand their function.
