Thomas D'Amico

Overview:

Lung Cancer

1.Role of molecular markers in the prognosis and therapy of lung cancer
2.Genomic analysis lung cancer mutations


Esophageal Cancer

1.Role of molecular markers in the prognosis and therapy of esophageal cancer
2.Genomic analysis esophageal cancer mutations

Positions:

Gary Hock Distinguished Professor of Surgery

Surgery, Cardiovascular and Thoracic Surgery
School of Medicine

Professor of Surgery

Surgery, Cardiovascular and Thoracic Surgery
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1987

Columbia University

Grants:

Genetics, Inflammation & Post-op Cognitive Dysfunction

Administered By
Anesthesiology, Cardiothoracic
Awarded By
National Institutes of Health
Role
Co Investigator
Start Date
End Date

Publications:

The Impact of Adjuvant Therapy on Survival After Esophagectomy for Node-negative Esophageal Adenocarcinoma.

OBJECTIVE: Determine whether adjuvant chemotherapy is associated with a survival benefit in high risk T2-4a, pathologically node-negative distal esophageal adenocarcinoma. SUMMARY OF BACKGROUND DATA: There is minimal literature to substantiate the NCCN guidelines recommending adjuvant therapy for patients with distal esophageal adenocarcinoma and no pathologic evidence of nodal disease. METHODS: The National Cancer Database was used to identify adult patients with pT2-4aN0M0 esophageal adenocarcinoma who underwent definitive surgery (2004-2015) and had characteristics considered high risk by the NCCN. Patients were stratified by receipt of adjuvant chemotherapy with or without radiation. The primary outcome was overall survival, which was evaluated using Kaplan-Meier and multivariable Cox Proportional Hazards models. A 1:1 propensity score-matched analysis was also performed to compare survival between the groups. RESULTS: Four hundred three patients met study criteria: 313 (78%) without adjuvant therapy and 90 who received adjuvant chemotherapy with or without radiation (22%). In both unadjusted and multivariable analysis, adjuvant chemotherapy with or without radiation was not associated with a significant survival benefit compared to no adjuvant therapy. In a subgroup analysis of 335 patients without high risk features by NCCN criteria, adjuvant chemotherapy was not independently associated with a survival benefit. CONCLUSION: In this analysis, adjuvant chemotherapy with or without radiation was not associated with a significant survival benefit in completely resected, pathologically node-negative distal esophageal adenocarcinoma, independent of presence of high risk characteristics. The risks and benefits of adjuvant therapy should be weighed before offering it to patients with completely resected pT2-4aN0M0 esophageal adenocarcinoma.
Authors
Rucker, AJ; Raman, V; Jawitz, OK; Voigt, SL; Harpole, DH; D'Amico, TA; Tong, BC
MLA Citation
Rucker, A. Justin, et al. “The Impact of Adjuvant Therapy on Survival After Esophagectomy for Node-negative Esophageal Adenocarcinoma.Ann Surg, Mar. 2020. Pubmed, doi:10.1097/SLA.0000000000003886.
URI
https://scholars.duke.edu/individual/pub1435752
PMID
32209899
Source
pubmed
Published In
Ann Surg
Published Date
DOI
10.1097/SLA.0000000000003886

Effect of Lymph Node Assessment on Outcomes in Surgery for Limited Stage Small Cell Lung Cancer.

BACKGROUND: The National Comprehensive Cancer Network guidelines recommend surgery for limited stage small cell lung cancer (SCLC). However, there is no literature on minimum acceptable lymph node retrieval in surgery for SCLC. METHODS: The National Cancer Database was queried for adult patients undergoing lobectomy for limited stage (cT1-2N0M0) SCLC from 2004-2015. Patients with unknown survival, staging, or nodal assessment and those who received neoadjuvant therapy were excluded. The number of lymph nodes assessed was studied both as a continuous variable and as a categorical variable stratified into distribution quartiles. The primary outcome was overall survival and the secondary outcome was pathologic nodal upstaging. RESULTS: A total of 1051 patients met study criteria. In multivariable analysis, only a retrieval of 8-12 nodes was associated with a significant survival benefit (hazard ratio [HR] 0.73; 95%CI 0.56-0.98). However, when modeled as a continuous variable, there was no association between number of nodes assessed and survival (HR 1.00; 95%CI 0.98-1.02). The overall rate of pathologic nodal upstaging was 19%. Modeled as a continuous variable, greater than 7 lymph nodes assessed at time of resection was significantly associated with nodal upstaging in multivariable regression (odds ratio [OR] 1.03; 95%CI 1.01-1.06). CONCLUSION: In this study, there was no clear difference in survival based on increasing the number of lymph nodes assessed during lobectomy for limited stage SCLC. However, the number of retrieved lymph nodes was associated with pathologic nodal upstaging. Therefore, patients may benefit from retrieval of greater than 7 lymph nodes during lobectomy for SCLC.
Authors
Rucker, AJ; Raman, V; Jawitz, OK; Voigt, SL; Tong, BC; D'Amico, TA; Harpole, DH
MLA Citation
Rucker, A. Justin, et al. “Effect of Lymph Node Assessment on Outcomes in Surgery for Limited Stage Small Cell Lung Cancer.Ann Thorac Surg, June 2020. Pubmed, doi:10.1016/j.athoracsur.2020.04.117.
URI
https://scholars.duke.edu/individual/pub1448243
PMID
32544452
Source
pubmed
Published In
The Annals of Thoracic Surgery
Published Date
DOI
10.1016/j.athoracsur.2020.04.117

The Effect of Timing of Adjuvant Therapy on Survival After Esophagectomy.

BACKGROUND: Adjuvant chemotherapy (AC) after esophagectomy improves survival in esophageal cancer when induction therapy is not given; however, the optimal timing for initiation of AC is poorly characterized. We aimed to determine the impact of timing of AC on survival after esophagectomy. METHODS: The National Cancer Database was queried for patients with pT1-4aNxM0 esophageal cancer receiving AC with or without radiation from 2004 to 2015. The median and interquartile range of time to AC were determined. Patients were stratified by initiation of AC into 4 cohorts based on quartiles. Kaplan-Meier curves were generated and factors associated with survival were identified by Cox proportional hazards modeling. A separate analysis was performed with time to AC as a continuous variable. RESULTS: A total of 1634 patients received AC after esophagectomy. Median time to receipt of AC was 59 (interquartile range, 45-78) days. There was no significant difference in overall survival at 5 years (P = .86) between groups. Median survival was 29 months in those receiving AC within 45 days and was 28 months in those receiving AC at other time points. On multivariable analysis, delay in receipt of AC beyond 45 days was not associated with inferior survival. This was preserved when time to AC was analyzed as a continuous variable (hazard ratio, 1.0; 95% confidence interval, 1.0-1.0). CONCLUSIONS: Timing of initiation of AC after esophagectomy does not appear to impact survival. Given the highly variable postoperative course after esophagectomy, the decision to start AC should involve multidisciplinary discussion and be made on a patient-by-patient basis.
Authors
Rhodin, KE; Raman, V; Jawitz, OK; Tong, BC; Harpole, DH; D'Amico, TA
MLA Citation
Rhodin, Kristen E., et al. “The Effect of Timing of Adjuvant Therapy on Survival After Esophagectomy.Ann Thorac Surg, Apr. 2020. Pubmed, doi:10.1016/j.athoracsur.2020.03.040.
URI
https://scholars.duke.edu/individual/pub1438062
PMID
32330471
Source
pubmed
Published In
The Annals of Thoracic Surgery
Published Date
DOI
10.1016/j.athoracsur.2020.03.040

Impact of Positive Margins and Radiation After Tracheal Adenoid Cystic Carcinoma Resection on Survival.

BACKGROUND: Achieving negative margins for adenoid cystic carcinoma (ACC) of the trachea can be technically difficult. This study evaluated the impact of positive margins on prognosis and tested the hypothesis that radiation improves survival in the setting of incomplete resection. METHODS: The impact of margin status and adjuvant therapy on overall survival of patients with tracheal ACC in the National Cancer Database (1998 to 2014) who underwent resection with known margin status and with no documented nodal or distant disease was evaluated using Kaplan-Meier and Cox proportional hazard analysis. RESULTS: Of 132 patients who met study criteria, 79 (59.8%) had positive margins after resection. Adjuvant radiation was given to 95 patients overall (72.0%) and to 62 of the 79 patients with positive margins (78.5%). The survival of patients with positive margins was not significantly different from that of patients with negative margins (5-year survival, 82.2% [95% confidence interval (CI), 71.3-89.3] compared with 82.0% [95% CI, 67.0-90.6], P = .97), even after multivariable adjustment (hazard ratio, 1.73; 95% CI, 0.62-4.84; P = .30). In the subset of patients with positive margins, there was no significant difference in survival between patients who did or did not receive postoperative radiation therapy (5-year survival, 82.0% [95% CI, 68.8-89.9] compared with 82.4% [95% CI, 54.7-93.9]; P = .80), even after multivariable adjustment (hazard ratio, 1.04; 95% CI, 0.21-5.25; P = .96). CONCLUSIONS: The majority of tracheal ACC resections performed in this national cohort had positive margins. Adjuvant radiation was commonly used for positive margins but was not associated with an overall survival benefit.
Authors
Yang, C-FJ; Shah, SA; Ramakrishnan, D; Raman, V; Diao, K; Wang, H; Commander, SJ; D'Amico, TA; Berry, MF
MLA Citation
Yang, Chi-Fu Jeffrey, et al. “Impact of Positive Margins and Radiation After Tracheal Adenoid Cystic Carcinoma Resection on Survival.Ann Thorac Surg, vol. 109, no. 4, Apr. 2020, pp. 1026–32. Pubmed, doi:10.1016/j.athoracsur.2019.08.094.
URI
https://scholars.duke.edu/individual/pub1415379
PMID
31589850
Source
pubmed
Published In
The Annals of Thoracic Surgery
Volume
109
Published Date
Start Page
1026
End Page
1032
DOI
10.1016/j.athoracsur.2019.08.094

A national analysis of open versus minimally invasive thymectomy for stage I to III thymoma.

OBJECTIVE: The oncologic efficacy of minimally invasive thymectomy for thymoma is not well characterized. We compared short-term outcomes and overall survival between open and minimally invasive (video-assisted thoracoscopic and robotic) approaches using the National Cancer Data Base. METHODS: Perioperative outcomes and survival of patients who underwent open versus minimally invasive thymectomy for clinical stage I to III thymoma from 2010 to 2014 in the National Cancer Data Base were evaluated using multivariable Cox proportional hazards modeling and propensity score-matched analysis. Predictors of minimally invasive use were evaluated using multivariable logistic regression. Outcomes of surgical approach were evaluated using an intent-to-treat analysis. RESULTS: Of the 1223 thymectomies that were evaluated, 317 (26%) were performed minimally invasively (141 video-assisted thoracoscopic and 176 robotic). The minimally invasive group had a shorter median length of stay when compared with the open group (3 [2-4] days vs 4 [3-6] days, P < .001). In a propensity score-matched analysis of 185 open and 185 minimally invasive (video-assisted thoracoscopic + robotic) thymectomy, the minimally invasive group continued to have a shorter median length of stay (3 vs 4 days, P < .01) but did not have significant differences in margin positivity (P = .84), 30-day readmission (P = .28), 30-day mortality (P = .60), and 5-year survival (89.4% vs 81.6%, P = .20) when compared with the open group. CONCLUSIONS: In this national analysis, minimally invasive thymectomy was associated with shorter length of stay and was not associated with increased margin positivity, perioperative mortality, 30-day readmission rate, or reduced overall survival when compared with open thymectomy.
Authors
Yang, C-FJ; Hurd, J; Shah, SA; Liou, D; Wang, H; Backhus, LM; Lui, NS; D'Amico, TA; Shrager, JB; Berry, MF
MLA Citation
Yang, Chi-Fu Jeffrey, et al. “A national analysis of open versus minimally invasive thymectomy for stage I to III thymoma.J Thorac Cardiovasc Surg, vol. 160, no. 2, Aug. 2020, pp. 555-567.e15. Pubmed, doi:10.1016/j.jtcvs.2019.11.114.
URI
https://scholars.duke.edu/individual/pub1436854
PMID
32245668
Source
pubmed
Published In
The Journal of Thoracic and Cardiovascular Surgery
Volume
160
Published Date
Start Page
555
End Page
567.e15
DOI
10.1016/j.jtcvs.2019.11.114