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Tong, Betty Caroline

Positions:

Associate 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.S. 1995

M.S. — Georgia Institute of Technology

M.D. 1999

M.D. — Duke University

M.H.S. 2009

M.H.S. — Johns Hopkins University

Grants:

Access to screening facilities for U.S. populations at risk for lung cancer: A geospatial analysis of access to CT facilities for individuals eligible for lung cancer screening

Administered By
Radiology, Cardiothoracic Imaging
AwardedBy
Ge-Aur Radiology Research
Role
Mentor
Start Date
July 01, 2017
End Date
June 30, 2018

Publications:

Rationale and Design of the Lung Cancer Screening Implementation. Evaluation of Patient-Centered Care Study.

Screening for lung cancer using low-dose computed tomography has been demonstrated to reduce lung cancer-related mortality and is being widely implemented. Further research in this area is needed to assess the impact of screening on patient-centered outcomes. Here, we describe the design and rationale for a new study entitled Lung Cancer Screening Implementation: Evaluation of Patient-Centered Care. The protocol is composed of an interconnected series of studies evaluating patients and clinicians who are engaged in lung cancer screening in real-world settings. The primary goal of this study is to evaluate communication processes that are being used in routine care and to identify best practices that can be readily scaled up for implementation in multiple settings. We hypothesize that higher overall quality of patient-clinician communication processes will be associated with lower levels of distress and decisional conflict as patients decide whether or not to participate in lung cancer screening. This work is a critical step toward identifying modifiable mechanisms that are associated with high quality of care for the millions of patients who will consider lung cancer screening. Given the enormous potential benefits and burdens of lung cancer screening on patients, clinicians, and the healthcare system, it is important to identify and then scale up quality communication practices that positively influence patient-centered care.

Authors
Miranda, LS; Datta, S; Melzer, AC; Wiener, RS; Davis, JM; Tong, BC; Golden, SE; Slatore, CG
MLA Citation
Miranda, LS, Datta, S, Melzer, AC, Wiener, RS, Davis, JM, Tong, BC, Golden, SE, and Slatore, CG. "Rationale and Design of the Lung Cancer Screening Implementation. Evaluation of Patient-Centered Care Study." Annals of the American Thoracic Society 14.10 (October 2017): 1581-1590.
PMID
28640670
Source
epmc
Published In
Annals of the American Thoracic Society
Volume
14
Issue
10
Publish Date
2017
Start Page
1581
End Page
1590
DOI
10.1513/annalsats.201705-378sd

Platelet Counts and Postoperative Stroke After Coronary Artery Bypass Grafting Surgery.

Declining platelet counts may reveal platelet activation and aggregation in a postoperative prothrombotic state. Therefore, we hypothesized that nadir platelet counts after on-pump coronary artery bypass grafting (CABG) surgery are associated with stroke.We evaluated 6130 adult CABG surgery patients. Postoperative platelet counts were evaluated as continuous and categorical (mild versus moderate to severe) predictors of stroke. Extended Cox proportional hazard regression analysis with a time-varying covariate for daily minimum postoperative platelet count assessed the association of day-to-day variations in postoperative platelet count with time to stroke. Competing risks proportional hazard regression models examined associations between day-to-day variations in postoperative platelet counts with timing of stroke (early: 0-1 days; delayed: ≥2 days).Median (interquartile range) postoperative nadir platelet counts were 123.0 (98.0-155.0) × 10/L. The incidences of postoperative stroke were 1.09%, 1.50%, and 3.02% for platelet counts >150 × 10/L, 100 to 150 × 10/L, and <100 × 10/L, respectively. The risk for stroke increased by 12% on a given postoperative day for every 30 × 10/L decrease in platelet counts (adjusted hazard ratio [HR], 1.12; 95% confidence interval [CI], 1.01-1.24; P= .0255). On a given day, patients with moderate to severe thrombocytopenia were almost twice as likely to develop stroke (adjusted HR, 1.89; 95% CI, 1.13-3.16; P= .0155) as patients with nadir platelet counts >150 × 10/L. Importantly, such thrombocytopenia, defined as a time-varying covariate, was significantly associated with delayed (≥2 days after surgery; adjusted HR, 2.83; 95% CI, 1.48-5.41; P= .0017) but not early postoperative stroke.Our findings suggest an independent association between moderate to severe postoperative thrombocytopenia and postoperative stroke, and timing of stroke after CABG surgery.

Authors
Karhausen, JA; Smeltz, AM; Akushevich, I; Cooter, M; Podgoreanu, MV; Stafford-Smith, M; Martinelli, SM; Fontes, ML; Kertai, MD
MLA Citation
Karhausen, JA, Smeltz, AM, Akushevich, I, Cooter, M, Podgoreanu, MV, Stafford-Smith, M, Martinelli, SM, Fontes, ML, and Kertai, MD. "Platelet Counts and Postoperative Stroke After Coronary Artery Bypass Grafting Surgery." Anesthesia and analgesia 125.4 (October 2017): 1129-1139.
Website
http://hdl.handle.net/10161/14968
PMID
28632537
Source
epmc
Published In
Anesthesia and Analgesia
Volume
125
Issue
4
Publish Date
2017
Start Page
1129
End Page
1139
DOI
10.1213/ane.0000000000002187

Immune Activation in Early-Stage Non-Small Cell Lung Cancer Patients Receiving Neoadjuvant Chemotherapy Plus Ipilimumab.

Purpose: To determine the immunologic effects of neoadjuvant chemotherapy plus ipilimumab in early-stage non-small cell lung cancer (NSCLC) patients.Experimental Design: This is a single-arm chemotherapy plus phased ipilimumab phase II study of 24 treatment-naïve patients with stage IB-IIIA NSCLC. Patients received neoadjuvant therapy consisting of 3 cycles of paclitaxel with either cisplatin or carboplatin and ipilimumab included in the last 2 cycles.Results: Chemotherapy alone had little effect on immune parameters in PBMCs. Profound CD28-dependent activation of both CD4 and CD8 cells was observed following ipilimumab. Significant increases in the frequencies of CD4+ cells expressing activation markers ICOS, HLA-DR, CTLA-4, and PD-1 were apparent. Likewise, increased frequencies of CD8+ cells expressing the same activation markers, with the exception of PD-1, were observed. We also examined 7 resected tumors and found higher frequencies of activated tumor-infiltrating lymphocytes than those observed in PBMCs. Surprisingly, we found 4 cases of preexisting tumor-associated antigens (TAA) responses against survivin, PRAME, or MAGE-A3 present in PBMC at baseline, but neither increased frequencies nor the appearance of newly detectable responses following ipilimumab therapy. Ipilimumab had little effect on the frequencies of circulating regulatory T cells and MDSCs.Conclusions: This study did not meet the primary endpoint of detecting an increase in blood-based TAA T-cell responses after ipilimumab. Collectively, these results highlight the immune activating properties of ipilimumab in early-stage NSCLC. The immune profiling data for ipilimumab alone can contribute to the interpretation of immunologic data from combined immune checkpoint blockade immunotherapies. Clin Cancer Res; 1-9. ©2017 AACR.

Authors
Yi, JS; Ready, N; Healy, P; Dumbauld, C; Osborne, R; Berry, M; Shoemaker, D; Clarke, J; Crawford, J; Tong, B; Harpole, D; D'Amico, TA; McSherry, F; Dunphy, F; McCall, SJ; Christensen, JD; Wang, X; Weinhold, KJ
MLA Citation
Yi, JS, Ready, N, Healy, P, Dumbauld, C, Osborne, R, Berry, M, Shoemaker, D, Clarke, J, Crawford, J, Tong, B, Harpole, D, D'Amico, TA, McSherry, F, Dunphy, F, McCall, SJ, Christensen, JD, Wang, X, and Weinhold, KJ. "Immune Activation in Early-Stage Non-Small Cell Lung Cancer Patients Receiving Neoadjuvant Chemotherapy Plus Ipilimumab." Clinical cancer research : an official journal of the American Association for Cancer Research (September 26, 2017).
PMID
28951518
Source
epmc
Published In
Clinical cancer research : an official journal of the American Association for Cancer Research
Publish Date
2017
DOI
10.1158/1078-0432.ccr-17-2005

Lung cancer screening: No more excuses.

Authors
Tong, BC
MLA Citation
Tong, BC. "Lung cancer screening: No more excuses." The Journal of thoracic and cardiovascular surgery (September 5, 2017).
PMID
28942978
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Publish Date
2017
DOI
10.1016/j.jtcvs.2017.08.090

A National Analysis of Long-term Survival Following Thoracoscopic Versus Open Lobectomy for Stage I Non-small-cell Lung Cancer.

The objective of this study was to compare the long-term survival of open versus thoracoscopic (VATS) lobectomy for early stage non-small-cell lung cancer (NSCLC).Data from national studies on long-term survival for VATS versus open lobectomy are limited.Outcomes of patients who underwent open versus VATS lobectomy for clinical T1-2, N0, M0 NSCLC in the National Cancer Data Base were evaluated using propensity score matching.The median follow-up of 7114 lobectomies (5566 open and 1548 VATS) was 52.0 months. Propensity score matching resulted in 1464 open and 1464 VATS patients who were well-matched by 14 common prognostic covariates including tumor size and comorbidities. The VATS approach was associated with a shorter median length of stay (5 vs. 6 days, P < 0.001) and better 5-year survival (66.0% vs. 62.5%, P = 0.026), and was not significantly different compared with the open approach with regard to nodal upstaging (11.2% vs. 12.5%, P = 0.46), and 30-day mortality (1.7% vs. 2.5%, P = 0.14). In the propensity-matched analysis of 2928 patients, there were no significant differences in 5-year survival between the VATS and open groups (66.3% vs. 65.8%, P = 0.92).In this national analysis, VATS lobectomy was used in the minority of patients with stage I NSCLC. VATS lobectomy was associated with shorter length of stay and noninferior long-term survival when compared with open lobectomy. These results support previous findings from smaller single- and multi-institutional studies that suggest that VATS does not compromise oncologic outcomes when used for early-stage lung cancer and suggest the need for broader implementation of VATS techniques.

Authors
Yang, C-FJ; Kumar, A; Klapper, JA; Hartwig, MG; Tong, BC; Harpole, DH; Berry, MF; D'Amico, TA
MLA Citation
Yang, C-FJ, Kumar, A, Klapper, JA, Hartwig, MG, Tong, BC, Harpole, DH, Berry, MF, and D'Amico, TA. "A National Analysis of Long-term Survival Following Thoracoscopic Versus Open Lobectomy for Stage I Non-small-cell Lung Cancer." Annals of surgery (August 9, 2017).
PMID
28799982
Source
epmc
Published In
Annals of Surgery
Publish Date
2017
DOI
10.1097/sla.0000000000002342

Induction chemotherapy for T3N0M0 non-small-cell lung cancer increases the rate of complete resection but does not confer improved survival.

The objective of this study was to evaluate outcomes of induction therapy prior to an operation in patients with cT3 non-small-cell lung cancer (NSCLC).Patients diagnosed with cT3N0M0 NSCLC from 2006 to 2011 in the National Cancer Database who were treated with lobectomy or pneumonectomy were stratified by treatment strategy: an operation first versus induction chemotherapy. Propensity scores were developed and matched cohorts were generated. Short-term outcomes included margin status, 30- and 90-day mortality rates, readmission and length of stay. Survival analyses using Kaplan-Meier methods were performed on both the unadjusted and propensity matched cohorts.A total of 3791 cT3N0M0 patients were identified for inclusion, of which 580 (15%) were treated with induction chemotherapy. Prior to adjustment, patients treated with induction chemotherapy were younger, had a higher comorbidity burden and were more likely to have private insurance (all P  < 0.001). Following matching, patients receiving induction chemotherapy were more likely to subsequently undergo an open procedure (87.3 vs 77.8%, P  = 0.005). These patients were more likely to obtain R0 resection (93.1% vs 90.0%, P  = 0.04) and were thereby less likely to have positive margins at the time of resection (6.9% vs 10.0%, P  = 0.03). Patients who received induction therapy had higher rates of 90-day mortality (6.6% vs 3.4%) but there was no difference in long-term survival between the groups.Despite yielding increased rates of R0 resection, induction chemotherapy for cT3N0M0 NSCLC is not associated with improved survival and should not be considered routinely. Further studies are warranted to elucidate cohorts that may benefit from induction therapy.

Authors
Anderson, KL; Mulvihill, MS; Yerokun, BA; Speicher, PJ; D'Amico, TA; Tong, BC; Berry, MF; Hartwig, MG
MLA Citation
Anderson, KL, Mulvihill, MS, Yerokun, BA, Speicher, PJ, D'Amico, TA, Tong, BC, Berry, MF, and Hartwig, MG. "Induction chemotherapy for T3N0M0 non-small-cell lung cancer increases the rate of complete resection but does not confer improved survival." European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 52.2 (August 2017): 370-377.
PMID
28402406
Source
epmc
Published In
European Journal of Cardio-Thoracic Surgery
Volume
52
Issue
2
Publish Date
2017
Start Page
370
End Page
377
DOI
10.1093/ejcts/ezx091

In the eye of the beholder.

Authors
Tong, BC
MLA Citation
Tong, BC. "In the eye of the beholder." The Journal of thoracic and cardiovascular surgery 154.2 (August 2017): 649-.
PMID
28456361
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
154
Issue
2
Publish Date
2017
Start Page
649
DOI
10.1016/j.jtcvs.2017.03.135

Patterns of Failure After Surgery for Non-Small-cell Lung Cancer Invading the Chest Wall.

The patterns of failure after resection of non-small-cell lung cancer (NSCLC) invading the chest wall are not well documented, and the role of adjuvant radiation therapy (RT) is unclear, prompting the present analysis.The present institutional review board-approved study evaluated patients who had undergone surgery from 1995 to 2014 for localized NSCLC invading the chest wall. Patients with superior sulcus tumors were excluded. The clinical outcomes were estimated using the Kaplan-Meier method and compared using a log-rank test. The prognostic factors were assessed using a multivariate analysis, and the patterns of failure were scored.Seventy-four patients were evaluated. Most patients had undergone lobectomy or pneumonectomy (85%) with en bloc chest wall resection (80%) and had pathologically node negative findings (81%). The surgical margins were positive in 10 patients (14%) and most commonly involved the chest wall (7 of 10). Adjuvant treatment included RT in 21 (28%) and chemotherapy in 28 (38%). A total of 24 local recurrences developed. The chest wall was a component of local disease recurrence in 19 of 24 cases (79%). The local control rate at 5 years for the entire population was 60% (95% confidence interval, 46%-74%). The local control rate was 74% with adjuvant RT versus 55% without RT (P = .43). On multivariate analysis, only resection less than lobectomy or pneumonectomy was associated with worse local control. The overall survival rate was 38% with RT versus 34% without RT (P = .59).Positive surgical margins and local disease recurrence were common after resection of NSCLC invading the chest wall. The primary pattern of failure was local recurrence in the chest wall. Adjuvant RT was not associated with improved local control or survival.

Authors
Tandberg, DJ; Kelsey, CR; D'Amico, TA; Crawford, J; Chino, JP; Tong, BC; Ready, NE; Wright, A
MLA Citation
Tandberg, DJ, Kelsey, CR, D'Amico, TA, Crawford, J, Chino, JP, Tong, BC, Ready, NE, and Wright, A. "Patterns of Failure After Surgery for Non-Small-cell Lung Cancer Invading the Chest Wall." Clinical lung cancer 18.4 (July 2017): e259-e265.
PMID
27965012
Source
epmc
Published In
Clinical lung cancer
Volume
18
Issue
4
Publish Date
2017
Start Page
e259
End Page
e265
DOI
10.1016/j.cllc.2016.11.008

Surgery Versus Optimal Medical Management for N1 Small Cell Lung Cancer.

Adjuvant chemotherapy has been demonstrated to improve the outcomes of patients with N1 non-small cell lung cancer. It is unknown whether patients previously thought to have unresectable small cell lung cancer (SCLC) may have tumors amenable to surgery if adjuvant therapies can be given. This study was undertaken to evaluate whether surgery, in the setting of modern adjuvant therapies, can be beneficial for patients with N1-positive SCLC.Patients with clinical T1-3 N1 M0 SCLC who underwent concurrent chemoradiation versus surgery and adjuvant therapy in the National Cancer Data Base from 2003 to 2011 were examined. Overall survival was assessed using Kaplan-Meier and Cox proportional hazards analysis and propensity score-matched analysis.Of 1,041 patients with cT1-3 N1 M0 SCLC who met inclusion criteria, 96 patients (9%) underwent surgery and adjuvant chemotherapy with or without radiation and 945 (91%) underwent concurrent chemoradiation alone. Multivariable Cox modeling demonstrated that surgery with adjuvant chemotherapy with or without radiation (hazard ratio 0.74, 95% confidence interval: 0.56 to 0.97) was associated with improved survival compared with concurrent chemoradiation. After propensity matching, surgery with adjuvant chemotherapy with or without radiation was associated with improved 5-year survival compared with concurrent chemoradiation (31.4% versus 26.3%).In an analysis of a national population-based cancer database, surgery followed by adjuvant chemotherapy with or without radiation for cT1-3 N1 SCLC had improved outcomes compared with concurrent chemoradiation. These results support the re-evaluation of the role of surgery in multimodality therapy for N1 SCLC in a clinical trial setting.

Authors
Yang, C-FJ; Chan, DY; Speicher, PJ; Gulack, BC; Tong, BC; Hartwig, MG; Kelsey, CR; D'Amico, TA; Berry, MF; Harpole, DH
MLA Citation
Yang, C-FJ, Chan, DY, Speicher, PJ, Gulack, BC, Tong, BC, Hartwig, MG, Kelsey, CR, D'Amico, TA, Berry, MF, and Harpole, DH. "Surgery Versus Optimal Medical Management for N1 Small Cell Lung Cancer." The Annals of thoracic surgery 103.6 (June 2017): 1767-1772.
PMID
28385378
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
103
Issue
6
Publish Date
2017
Start Page
1767
End Page
1772
DOI
10.1016/j.athoracsur.2017.01.043

Less is more.

Authors
Tong, BC
MLA Citation
Tong, BC. "Less is more." The Journal of thoracic and cardiovascular surgery 153.1 (January 2017): 196-.
PMID
27986253
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
153
Issue
1
Publish Date
2017
Start Page
196
DOI
10.1016/j.jtcvs.2016.10.020

Intraoperative Frontal Alpha-Band Power Correlates with Preoperative Neurocognitive Function in Older Adults.

Each year over 16 million older Americans undergo general anesthesia for surgery, and up to 40% develop postoperative delirium and/or cognitive dysfunction (POCD). Delirium and POCD are each associated with decreased quality of life, early retirement, increased 1-year mortality, and long-term cognitive decline. Multiple investigators have thus suggested that anesthesia and surgery place severe stress on the aging brain, and that patients with less ability to withstand this stress will be at increased risk for developing postoperative delirium and POCD. Delirium and POCD risk are increased in patients with lower preoperative cognitive function, yet preoperative cognitive function is not routinely assessed, and no intraoperative physiological predictors have been found that correlate with lower preoperative cognitive function. Since general anesthesia causes alpha-band (8-12 Hz) electroencephalogram (EEG) power to decrease occipitally and increase frontally (known as "anteriorization"), and anesthetic-induced frontal alpha power is reduced in older adults, we hypothesized that lower intraoperative frontal alpha power might correlate with lower preoperative cognitive function. Here, we provide evidence that such a correlation exists, suggesting that lower intraoperative frontal alpha power could be used as a physiological marker to identify older adults with lower preoperative cognitive function. Lower intraoperative frontal alpha power could thus be used to target these at-risk patients for possible therapeutic interventions to help prevent postoperative delirium and POCD, or for increased postoperative monitoring and follow-up. More generally, these results suggest that understanding interindividual differences in how the brain responds to anesthetic drugs can be used as a probe of neurocognitive function (and dysfunction), and might be a useful measure of neurocognitive function in older adults.

Authors
Giattino, CM; Gardner, JE; Sbahi, FM; Roberts, KC; Cooter, M; Moretti, E; Browndyke, JN; Mathew, JP; Woldorff, MG; Berger, M; MADCO-PC Investigators,
MLA Citation
Giattino, CM, Gardner, JE, Sbahi, FM, Roberts, KC, Cooter, M, Moretti, E, Browndyke, JN, Mathew, JP, Woldorff, MG, Berger, M, and MADCO-PC Investigators, . "Intraoperative Frontal Alpha-Band Power Correlates with Preoperative Neurocognitive Function in Older Adults." Frontiers in systems neuroscience 11 (January 2017): 24-.
Website
http://hdl.handle.net/10161/14971
PMID
28533746
Source
epmc
Published In
Frontiers in Systems Neuroscience
Volume
11
Publish Date
2017
Start Page
24
DOI
10.3389/fnsys.2017.00024

A Risk Score to Assist Selecting Lobectomy Versus Sublobar Resection for Early Stage Non-Small Cell Lung Cancer.

The long-term survival benefit of lobectomy over sublobar resection for early-stage non-small cell lung cancer must be weighed against a potentially increased risk of perioperative mortality. The objective of the current study was to create a risk score to identify patients with favorable short-term outcomes following lobectomy.The 2005-2012 American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing a lobectomy or sublobar resection (either segmentectomy or wedge resection) for lung cancer. A multivariable logistic regression model was utilized to determine factors associated with 30-day mortality among the lobectomy group and to develop an associated risk score to predict perioperative mortality.Of the 5,749 patients who met study criteria, 4,424 (77%) underwent lobectomy, 1,098 (19%) underwent wedge resection, and 227 (4%) underwent segmentectomy. Age, chronic obstructive pulmonary disease, previous cerebrovascular event, functional status, recent smoking status, and surgical approach (minimally invasive versus open) were utilized to develop the risk score. Patients with a risk score of 5 or lower had no significant difference in perioperative mortality by surgical procedure. Patients with a risk score greater than 5 had significantly higher perioperative mortality after lobectomy (4.9%) as compared to segmentectomy (3.6%) or wedge resection (0.8%, p < 0.01).In this study, we have developed a risk model that predicts relative operative mortality from a sublobar resection as compared to a lobectomy. Among patients with a risk score of 5 or less, lobectomy confers no additional perioperative risk over sublobar resection.

Authors
Gulack, BC; Yang, C-FJ; Speicher, PJ; Yerokun, BA; Tong, BC; Onaitis, MW; D'Amico, TA; Harpole, DH; Hartwig, MG; Berry, MF
MLA Citation
Gulack, BC, Yang, C-FJ, Speicher, PJ, Yerokun, BA, Tong, BC, Onaitis, MW, D'Amico, TA, Harpole, DH, Hartwig, MG, and Berry, MF. "A Risk Score to Assist Selecting Lobectomy Versus Sublobar Resection for Early Stage Non-Small Cell Lung Cancer." The Annals of thoracic surgery 102.6 (December 2016): 1814-1820.
PMID
27592602
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
102
Issue
6
Publish Date
2016
Start Page
1814
End Page
1820
DOI
10.1016/j.athoracsur.2016.06.032

Patient Preferences in Treatment Choices for Early-Stage Lung Cancer.

Decision-making for lung cancer treatment can be complex because it involves both provider recommendations based on the patient's clinical condition and patient preferences. This study describes the relative importance of several considerations in lung cancer treatment from the patient's perspective.A conjoint preference experiment began by asking respondents to imagine that they had just been diagnosed with lung cancer. Respondents then chose among procedures that differed regarding treatment modalities, the potential for treatment-related complications, the likelihood of recurrence, provider case volume, and distance needed to travel for treatment. Conjoint analysis derived relative weights for these attributes.A total of 225 responses were analyzed. Respondents were most willing to accept minimally invasive operations for treatment of their hypothetical lung cancer, followed by stereotactic body radiation therapy (SBRT); they were least willing to accept thoracotomy. Treatment type and risk of recurrence were the most important attributes from the conjoint experiment (each with a relative weight of 0.23), followed by provider volume (relative weight of 0.21), risk of major complications (relative weight of 0.18), and distance needed to travel for treatment (relative weight of 0.15). Procedural and treatment preferences did not vary with demographics, self-reported health status, or familiarity with the procedures.Survey respondents preferred minimally invasive operations over SBRT or thoracotomy for treatment of early-stage non-small cell lung cancer. Treatment modality and risk of cancer recurrence were the most important factors associated with treatment preferences. Provider experience outweighed the potential need to travel for lung cancer treatment.

Authors
Tong, BC; Wallace, S; Hartwig, MG; D'Amico, TA; Huber, JC
MLA Citation
Tong, BC, Wallace, S, Hartwig, MG, D'Amico, TA, and Huber, JC. "Patient Preferences in Treatment Choices for Early-Stage Lung Cancer." The Annals of thoracic surgery 102.6 (December 2016): 1837-1844.
PMID
27623277
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
102
Issue
6
Publish Date
2016
Start Page
1837
End Page
1844
DOI
10.1016/j.athoracsur.2016.06.031

Outcomes of Major Lung Resection After Induction Therapy for Non-Small Cell Lung Cancer in Elderly Patients.

This study analyzes the impact of age on perioperative outcomes and long-term survival of patients undergoing surgery after induction chemotherapy for non-small cell lung cancer.Short- and long-term outcomes of patients with non-small cell lung cancer who were at least 70 years and received induction chemotherapy followed by major lung resection (lobectomy or pneumonectomy) from 1996 to 2012 were assessed using multivariable logistic regression, Kaplan-Meier, and Cox proportional hazard analysis. The outcomes of these elderly patients were compared with those of patients younger than 70 years who underwent the same treatment from 1996 to 2012.Of the 317 patients who met the study criteria, 53 patients were at least 70 years. The median age was 74 years (range, 70 to 82 years) in the elderly group, and induction chemoradiation was used in 24 (45%) patients. Thirty-day mortality was similar between the younger (n = 12) and elderly (n = 3) patients (5% versus 6%; p = 0.52). There were no significant differences in the incidence of postoperative complications between younger and elderly patients (49% versus 57%; p = 0.30). Patients younger than 70 years had a median overall survival (30 months; 95% confidence interval [CI], 24 to 43) and a 5-year survival (39%; 95% CI, 33 to 45) that was not significantly different from patients at least 70 years (median overall survival, 30 months; 95% CI, 18 to 68; and 5-year overall survival, 36%; 95% CI, 21 to 51). However, there was a trend toward worse survival in the elderly group after multivariable adjustment (hazard ratio, 1.43; 95% CI, 0.97 to 2.12; p = 0.071).Major lung resection after induction chemotherapy can be performed with acceptable short- and long-term results in appropriately selected patients at least 70 years, with outcomes that are comparable to those of younger patients.

Authors
Yang, C-FJ; Mayne, NR; Wang, H; Meyerhoff, RR; Hirji, S; Tong, BC; Hartwig, M; Harpole, D; D'Amico, TA; Berry, M
MLA Citation
Yang, C-FJ, Mayne, NR, Wang, H, Meyerhoff, RR, Hirji, S, Tong, BC, Hartwig, M, Harpole, D, D'Amico, TA, and Berry, M. "Outcomes of Major Lung Resection After Induction Therapy for Non-Small Cell Lung Cancer in Elderly Patients." The Annals of thoracic surgery 102.3 (September 2016): 962-970.
PMID
27234579
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
102
Issue
3
Publish Date
2016
Start Page
962
End Page
970
DOI
10.1016/j.athoracsur.2016.03.088

Induction Chemotherapy is Not Superior to a Surgery-First Strategy for Clinical N1 Non-Small Cell Lung Cancer.

Guidelines recommend primary surgical resection for non-small cell lung cancer (NSCLC) patients with clinical N1 disease and adjuvant chemotherapy if nodal disease is confirmed after resection. We tested the hypothesis that induction chemotherapy for clinical N1 (cN1) disease improves survival.Patients treated with lobectomy or pneumonectomy for cT1-3 N1 M0 NSCLC from 2006 to 2011 in the National Cancer Data Base were stratified by treatment strategy: surgery first vs induction chemotherapy. Propensity scores were developed and matched with a 2:1 nearest neighbor algorithm. Survival analyses using Kaplan-Meier methods were performed on the unadjusted and propensity-matched cohorts.A total of 5,364 cN1 patients were identified for inclusion, of which 565 (10.5%) were treated with induction chemotherapy. Clinical nodal staging was accurate in 68.6% (n = 3,292) of patients treated with surgical resection first, whereas 16.3% (n = 780) were pN0 and 10.7% (n = 514) were pN2-3. Adjuvant chemotherapy was given to 60.9% of the surgery-first patients who were pN1-3 after resection. Before adjustment, patients treated with induction chemotherapy were younger, with lower comorbidity burden, were more likely to be treated at an academic center and to have private insurance (all p < 0.001), but were significantly more likely to have T3 tumors (28.7% vs 9.9%, p < 0.001) and to require pneumonectomy (23.5% vs 18.5%, p = 0.005). The unadjusted and propensity-matched analyses found no differences in short-term outcomes or survival between groups.Induction chemotherapy for cN1 NSCLC is not associated with improved survival. This finding supports the currently recommended treatment paradigm of surgery first for cN1 NSCLC.

Authors
Speicher, PJ; Fitch, ZW; Gulack, BC; Yang, C-FJ; Tong, BC; Harpole, DH; D'Amico, TA; Berry, MF; Hartwig, MG
MLA Citation
Speicher, PJ, Fitch, ZW, Gulack, BC, Yang, C-FJ, Tong, BC, Harpole, DH, D'Amico, TA, Berry, MF, and Hartwig, MG. "Induction Chemotherapy is Not Superior to a Surgery-First Strategy for Clinical N1 Non-Small Cell Lung Cancer." The Annals of thoracic surgery 102.3 (September 2016): 884-894.
PMID
27476819
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
102
Issue
3
Publish Date
2016
Start Page
884
End Page
894
DOI
10.1016/j.athoracsur.2016.05.065

TEAM: Together Everyone Achieves More.

Authors
Tong, BC
MLA Citation
Tong, BC. "TEAM: Together Everyone Achieves More." The Journal of thoracic and cardiovascular surgery 152.2 (August 2016): 317-318.
PMID
27423831
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
152
Issue
2
Publish Date
2016
Start Page
317
End Page
318
DOI
10.1016/j.jtcvs.2016.04.080

Long-term survival following open versus thoracoscopic lobectomy after preoperative chemotherapy for non-small cell lung cancer.

Video-assisted thoracoscopic (VATS) lobectomy is increasingly accepted for the management of early-stage non-small cell lung cancer (NSCLC), but its role for locally advanced cancers has not been as well characterized. We compared outcomes of patients who received induction therapy followed by lobectomy, via VATS or thoracotomy.Perioperative complications and long-term survival of all patients with NSCLC who received induction chemotherapy (ICT) (with or without induction radiation therapy) followed by lobectomy from 1996-2012 were assessed using Kaplan-Meier and Cox proportional hazard analysis. Propensity score-matched comparisons were used to assess the potential impact of selection bias.From 1996 to 2012, 272 patients met inclusion criteria and underwent lobectomy after ICT: 69 (25%) by VATS and 203 (75%) by thoracotomy. An 'intent-to-treat' analysis was performed. Compared with thoracotomy patients, VATS patients had a higher clinical stage, were older, had greater body mass index, and were more likely to have coronary disease and chronic obstructive pulmonary disease. Induction radiation was used more commonly in thoracotomy patients [VATS 28% (n = 19) vs open 72% (n = 146), P < 0.001]. Thirty-day mortality was similar between the VATS [3% (n = 2)] and open [4% (n = 8)] groups (P = 0.69). Seven (10%) of the VATS cases were converted to thoracotomy due to difficulty in dissection from fibrotic tissue and adhesions (n = 5) or bleeding (n = 2); none of these conversions led to perioperative deaths. In univariate analysis, VATS patients had improved 3-year survival compared with thoracotomy (61% vs 43%, P = 0.010). In multivariable analysis, the VATS approach showed a trend towards improved survival, but this did not reach statistical significance (hazard ratio, 0.56; 95% confidence interval, 0.32-1.01; P = 0.053). Moreover, a propensity score-matched analysis balancing patient characteristics demonstrated that the VATS approach had similar survival to an open approach (P = 0.56).VATS lobectomy in patients treated with induction therapy for locally advanced NSCLC is feasible and effective and does not appear to compromise oncologic outcomes.

Authors
Yang, C-FJ; Meyerhoff, RR; Mayne, NR; Singhapricha, T; Toomey, CB; Speicher, PJ; Hartwig, MG; Tong, BC; Onaitis, MW; Harpole, DH; D'Amico, TA; Berry, MF
MLA Citation
Yang, C-FJ, Meyerhoff, RR, Mayne, NR, Singhapricha, T, Toomey, CB, Speicher, PJ, Hartwig, MG, Tong, BC, Onaitis, MW, Harpole, DH, D'Amico, TA, and Berry, MF. "Long-term survival following open versus thoracoscopic lobectomy after preoperative chemotherapy for non-small cell lung cancer." European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 49.6 (June 2016): 1615-1623.
PMID
26719408
Source
epmc
Published In
European Journal of Cardio-Thoracic Surgery
Volume
49
Issue
6
Publish Date
2016
Start Page
1615
End Page
1623
DOI
10.1093/ejcts/ezv428

Impact of patient selection and treatment strategies on outcomes after lobectomy for biopsy-proven stage IIIA pN2 non-small cell lung cancer.

We evaluated the impact of patient selection and treatment strategies on long-term outcomes of patients who had lobectomy after induction therapy for stage IIIA pN2 non-small cell lung cancer (NSCLC).The impact of various patient selection, induction therapy and operative strategies on survival of patients with biopsy-proven stage IIIA pN2 NSCLC who received induction chemotherapy ± radiation followed by lobectomy from 1995 to 2012 was assessed using Cox proportional hazards analysis.From 1995 to 2012, 111 patients had lobectomy for stage IIIA pN2 NSCLC after chemotherapy ± radiation with an overall 5-year survival of 39%. The use of induction chemoradiation decreased over time; from 1996 to 2007, 46/65 (71%) patients underwent induction chemoradiation, whereas from 2007 to 2012, 36/46 (78%) patients underwent induction chemotherapy. The use of video-assisted thoracoscopic surgery (VATS) increased over the time period of the study, from 0/26 (0%) in 1996-2001, to 4/39 (10%) in 2002-07 to 33/46 (72%) in 2008-12. Compared with patients given induction chemotherapy alone, patients given additional induction radiation were more likely to have complete pathologic response (30 vs 11%, P = 0.01) but had worse 5-year survival in univariable analysis (31 vs 48%, log-rank P = 0.021). Patients who underwent pathologic mediastinal restaging following induction therapy but prior to resection had an improved overall survival compared with patients who did not undergo pathologic mediastinal restaging {5-year survival: 45.2 [95% confidence interval (CI): 33.9-55.9] vs 13.9% (95% CI: 2.5-34.7); log-rank, P = 0.004}. In multivariable analysis, the particular induction therapy strategy and the surgical approach used, as well as the extent of mediastinal disease were not important predictors of survival. However, pathologic mediastinal restaging was associated with improved survival (HR 0.39; 95% CI: 0.21-0.72; P = 0.003).For patients with stage IIIA pN2 NSCLC, the VATS approach or the addition of radiation to induction therapy can be selectively employed without compromising survival. The strategy of assessing response to induction therapy with pathologic mediastinal restaging allows one to select appropriate patients for complete resection and is associated with a 5-year overall survival of 39% in this population.

Authors
Yang, C-FJ; Adil, SM; Anderson, KL; Meyerhoff, RR; Turley, RS; Hartwig, MG; Harpole, DH; Tong, BC; Onaitis, MW; D'Amico, TA; Berry, MF
MLA Citation
Yang, C-FJ, Adil, SM, Anderson, KL, Meyerhoff, RR, Turley, RS, Hartwig, MG, Harpole, DH, Tong, BC, Onaitis, MW, D'Amico, TA, and Berry, MF. "Impact of patient selection and treatment strategies on outcomes after lobectomy for biopsy-proven stage IIIA pN2 non-small cell lung cancer." European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 49.6 (June 2016): 1607-1613.
PMID
26719403
Source
epmc
Published In
European Journal of Cardio-Thoracic Surgery
Volume
49
Issue
6
Publish Date
2016
Start Page
1607
End Page
1613
DOI
10.1093/ejcts/ezv431

Surgery versus optimal medical management of early-stage small cell lung cancer.

Authors
Yang, C-FJ; Chan, DY; Yerokun, B; Wang, XF; Tong, BC; D'Amico, TA; Onaitis, MW; Hartwig, MG; Berry, MF; Harpole, D
MLA Citation
Yang, C-FJ, Chan, DY, Yerokun, B, Wang, XF, Tong, BC, D'Amico, TA, Onaitis, MW, Hartwig, MG, Berry, MF, and Harpole, D. "Surgery versus optimal medical management of early-stage small cell lung cancer." May 20, 2016.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
34
Issue
15
Publish Date
2016
DOI
10.1200/JCO.2016.34.15_suppl.8511

Role of Adjuvant Therapy in a Population-Based Cohort of Patients With Early-Stage Small-Cell Lung Cancer.

Data on optimal adjuvant therapy after complete resection of small-cell lung cancer (SCLC) are limited, and in particular, there have been no studies evaluating the role of adjuvant chemotherapy, with or without prophylactic cranial irradiation, relative to no adjuvant therapy for stage T1-2N0M0 SCLC. This National Cancer Data Base analysis was performed to determine the potential benefits of adjuvant chemotherapy with and without prophylactic cranial irradiation in patients who undergo complete resection for early-stage small-cell lung cancer.Overall survival of patients with pathologic T1-2N0M0 SCLC who underwent complete resection in the National Cancer Data Base from 2003 to 2011, stratified by adjuvant therapy regimen, was evaluated using Kaplan-Meier and Cox proportional hazards analysis. Patients treated with induction therapy and those who died within 30 days of surgery were excluded from analysis.Of 1,574 patients who had pT1-2N0M0 SCLC during the study period, 954 patients (61%) underwent complete R0 resection with a 5-year survival of 47%. Adjuvant therapy was administered to 59% of patients (n = 566), including chemotherapy alone (n = 354), chemoradiation (n = 190, including 99 patients who underwent cranial irradiation), and radiation alone (n = 22). Compared with surgery alone, adjuvant chemotherapy with or without radiation was associated with significantly improved survival. In addition, multivariable Cox modeling demonstrated that treatment with adjuvant chemotherapy (hazard ratio [HR], 0.78; 95% CI, 0.63 to 0.95) or chemotherapy with radiation directed at the brain (HR, 0.52; 95% CI, 0.36 to 0.75) was associated with improved survival when compared with no adjuvant therapy.Patients with pT1-2N0M0 SCLC treated with surgical resection alone have worse outcomes than those who undergo resection with adjuvant chemotherapy alone or chemotherapy with cranial irradiation.

Authors
Yang, C-FJ; Chan, DY; Speicher, PJ; Gulack, BC; Wang, X; Hartwig, MG; Onaitis, MW; Tong, BC; D'Amico, TA; Berry, MF; Harpole, DH
MLA Citation
Yang, C-FJ, Chan, DY, Speicher, PJ, Gulack, BC, Wang, X, Hartwig, MG, Onaitis, MW, Tong, BC, D'Amico, TA, Berry, MF, and Harpole, DH. "Role of Adjuvant Therapy in a Population-Based Cohort of Patients With Early-Stage Small-Cell Lung Cancer." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 34.10 (April 2016): 1057-1064.
PMID
26786925
Source
epmc
Published In
Journal of Clinical Oncology
Volume
34
Issue
10
Publish Date
2016
Start Page
1057
End Page
1064
DOI
10.1200/jco.2015.63.8171

Use and Outcomes of Minimally Invasive Lobectomy for Stage I Non-Small Cell Lung Cancer in the National Cancer Data Base.

Previous studies have raised concerns that video-assisted thoracoscopic (VATS) lobectomy may compromise nodal evaluation. The advantages or limitations of robotic lobectomy have not been thoroughly evaluated.Perioperative outcomes and survival of patients who underwent open versus minimally-invasive surgery (MIS [VATS and robotic]) lobectomy and VATS versus robotic lobectomy for clinical T1-2, N0 non-small cell lung cancer from 2010 to 2012 in the National Cancer Data Base were evaluated using propensity score matching.Of 30,040 lobectomies, 7,824 were VATS and 2,025 were robotic. After propensity score matching, when compared with the open approach (n = 9,390), MIS (n = 9,390) was found to have increased 30-day readmission rates (5% versus 4%, p < 0.01), shorter median hospital length of stay (5 versus 6 days, p < 0.01), and improved 2-year survival (87% versus 86%, p = 0.04). There were no significant differences in nodal upstaging and 30-day mortality between the two groups. After propensity score matching, when compared with the robotic group (n = 1,938), VATS (n = 1,938) was not significantly different from robotics with regard to nodal upstaging, 30-day mortality, and 2-year survival.In this population-based analysis, MIS (VATS and robotic) lobectomy was used in the minority of patients for stage I non-small cell lung cancer. MIS lobectomy was associated with shorter length of hospital stay and was not associated with increased perioperative mortality, compromised nodal evaluation, or reduced short-term survival when compared with the open approach. These results suggest the need for broader implementation of MIS techniques.

Authors
Yang, C-FJ; Sun, Z; Speicher, PJ; Saud, SM; Gulack, BC; Hartwig, MG; Harpole, DH; Onaitis, MW; Tong, BC; D'Amico, TA; Berry, MF
MLA Citation
Yang, C-FJ, Sun, Z, Speicher, PJ, Saud, SM, Gulack, BC, Hartwig, MG, Harpole, DH, Onaitis, MW, Tong, BC, D'Amico, TA, and Berry, MF. "Use and Outcomes of Minimally Invasive Lobectomy for Stage I Non-Small Cell Lung Cancer in the National Cancer Data Base." The Annals of thoracic surgery 101.3 (March 2016): 1037-1042.
PMID
26822346
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
101
Issue
3
Publish Date
2016
Start Page
1037
End Page
1042
DOI
10.1016/j.athoracsur.2015.11.018

How I Teach a Thoracoscopic Lobectomy.

Authors
Zwischenberger, BA; D'Amico, TA; Tong, BC
MLA Citation
Zwischenberger, BA, D'Amico, TA, and Tong, BC. "How I Teach a Thoracoscopic Lobectomy." The Annals of thoracic surgery 101.3 (March 2016): 846-849.
PMID
26897185
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
101
Issue
3
Publish Date
2016
Start Page
846
End Page
849
DOI
10.1016/j.athoracsur.2015.12.033

Preoperative Evaluation and Indications for Pulmonary Metastasectomy.

Most patients with pulmonary metastases will not be candidates for pulmonary metastasectomy. Preoperative evaluation determines whether a patient is both fit enough for surgery and has disease that is actually resectable. Both components are necessary for patients who undergo resection with curative intent. In general, to be considered for pulmonary metastasectomy, patients must fit the following criteria: the primary disease site and any extrathoracic disease are both controlled; complete resection of pulmonary involvement is achievable with adequate pulmonary reserve; and there are no effective medical therapies.

Authors
Erhunmwunsee, L; Tong, BC
MLA Citation
Erhunmwunsee, L, and Tong, BC. "Preoperative Evaluation and Indications for Pulmonary Metastasectomy." Thoracic surgery clinics 26.1 (February 2016): 7-12. (Review)
PMID
26611505
Source
epmc
Published In
Thoracic Surgery Clinics
Volume
26
Issue
1
Publish Date
2016
Start Page
7
End Page
12
DOI
10.1016/j.thorsurg.2015.09.002

Video assisted transaxillary first rib resection in treatment of thoracic outlet syndrome (TOS).

Authors
Kara, HV; Balderson, SS; Tong, BC; D'Amico, TA
MLA Citation
Kara, HV, Balderson, SS, Tong, BC, and D'Amico, TA. "Video assisted transaxillary first rib resection in treatment of thoracic outlet syndrome (TOS)." Annals of cardiothoracic surgery 5.1 (January 2016): 67-69. (Review)
PMID
26904437
Source
epmc
Published In
Annals of cardiothoracic surgery
Volume
5
Issue
1
Publish Date
2016
Start Page
67
End Page
69
DOI
10.3978/j.issn.2225-319x.2015.08.09

A stitch (or scan) in time saves nine.

Authors
Tong, BC
MLA Citation
Tong, BC. "A stitch (or scan) in time saves nine." The Journal of thoracic and cardiovascular surgery 150.3 (September 2015): 529-530.
PMID
26253872
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
150
Issue
3
Publish Date
2015
Start Page
529
End Page
530
DOI
10.1016/j.jtcvs.2015.07.029

Right-Sided vs. Left-Sided Pneumonectomy after Induction Therapy for Non-Small Cell Lung Cancer

Authors
Yang, C-FJ; Chan, DY; Gulack, BC; Ranney, DN; Tong, BC; Onaitis, MW; Harpole, D; D'Amico, TA; Hartwig, MG; Berry, MF
MLA Citation
Yang, C-FJ, Chan, DY, Gulack, BC, Ranney, DN, Tong, BC, Onaitis, MW, Harpole, D, D'Amico, TA, Hartwig, MG, and Berry, MF. "Right-Sided vs. Left-Sided Pneumonectomy after Induction Therapy for Non-Small Cell Lung Cancer." JOURNAL OF THORACIC ONCOLOGY 10.9 (September 2015): S335-S336.
Source
wos-lite
Published In
Journal of Thoracic Oncology
Volume
10
Issue
9
Publish Date
2015
Start Page
S335
End Page
S336

Survival after Surgery for pN1 and pN2 Small Cell Lung Cancer: A Comparison with Surgical Treatment of Non-Small Cell Lung Cancer

Authors
Yang, C-FJ; Chan, DY; Gulack, BC; Speicher, PJ; Hartwig, MG; Berry, MF; Tong, BC; Onaitis, MW; D'Amico, TA; Harpole, D
MLA Citation
Yang, C-FJ, Chan, DY, Gulack, BC, Speicher, PJ, Hartwig, MG, Berry, MF, Tong, BC, Onaitis, MW, D'Amico, TA, and Harpole, D. "Survival after Surgery for pN1 and pN2 Small Cell Lung Cancer: A Comparison with Surgical Treatment of Non-Small Cell Lung Cancer." JOURNAL OF THORACIC ONCOLOGY 10.9 (September 2015): S399-S400.
Source
wos-lite
Published In
Journal of Thoracic Oncology
Volume
10
Issue
9
Publish Date
2015
Start Page
S399
End Page
S400

Long-Term Survival after Surgery for Pathologic N1 and N2 Small Cell Lung Cancer: A Comparison with Nonoperative Management

Authors
Yang, C-FJ; Chan, DY; Speicher, PJ; Gulack, BC; Onaitis, MW; Hartwig, MG; Tong, BC; Berry, MF; D'Amico, TA; Harpole, D
MLA Citation
Yang, C-FJ, Chan, DY, Speicher, PJ, Gulack, BC, Onaitis, MW, Hartwig, MG, Tong, BC, Berry, MF, D'Amico, TA, and Harpole, D. "Long-Term Survival after Surgery for Pathologic N1 and N2 Small Cell Lung Cancer: A Comparison with Nonoperative Management." JOURNAL OF THORACIC ONCOLOGY 10.9 (September 2015): S193-S194.
Source
wos-lite
Published In
Journal of Thoracic Oncology
Volume
10
Issue
9
Publish Date
2015
Start Page
S193
End Page
S194

Wedge Resection vs Segmentectomy for Patients with T1A N0 Non-Small Cell Lung Cancer

Authors
Yang, C-FJ; Chan, DY; Gulack, BC; Speicher, PJ; Onaitis, MW; Tong, BC; D'Amico, TA; Harpole, D; Berry, MF; Hartwig, MG
MLA Citation
Yang, C-FJ, Chan, DY, Gulack, BC, Speicher, PJ, Onaitis, MW, Tong, BC, D'Amico, TA, Harpole, D, Berry, MF, and Hartwig, MG. "Wedge Resection vs Segmentectomy for Patients with T1A N0 Non-Small Cell Lung Cancer." JOURNAL OF THORACIC ONCOLOGY 10.9 (September 2015): S242-S242.
Source
wos-lite
Published In
Journal of Thoracic Oncology
Volume
10
Issue
9
Publish Date
2015
Start Page
S242
End Page
S242

Impact of Radiation on Recurrence Patterns and Survival for Patients Undergoing Lobectomy for Stage IIIA-pN2 Non-Small Cell Lung Cancer

Authors
Yang, C-FJ; Adil, SM; Meyerhoff, RR; Anderson, KL; Hirji, SA; Harpole, D; Tong, BC; Onaitis, MW; Hartwig, MG; D'Amico, TA; Berry, MF
MLA Citation
Yang, C-FJ, Adil, SM, Meyerhoff, RR, Anderson, KL, Hirji, SA, Harpole, D, Tong, BC, Onaitis, MW, Hartwig, MG, D'Amico, TA, and Berry, MF. "Impact of Radiation on Recurrence Patterns and Survival for Patients Undergoing Lobectomy for Stage IIIA-pN2 Non-Small Cell Lung Cancer." JOURNAL OF THORACIC ONCOLOGY 10.9 (September 2015): S573-S573.
Source
wos-lite
Published In
Journal of Thoracic Oncology
Volume
10
Issue
9
Publish Date
2015
Start Page
S573
End Page
S573

Impact of Pulmonary Function Measurements on Long-Term Survival After Lobectomy for Stage I Non-Small Cell Lung Cancer.

Pulmonary function tests predict respiratory complications after lobectomy. We evaluated the impact of pulmonary function measurements on long-term survival after lobectomy for stage I non-small cell lung cancer.The relationship between percent predicted forced expiratory volume in 1 second (FEV1) and percent predicted diffusing capacity of the lung for carbon monoxide (Dlco) and overall survival for patients who underwent lobectomy without induction therapy for stage I (T1-2N0M0) non-small cell lung cancer from 1996 to 2012 was evaluated using the Kaplan-Meier approach and a multivariable Cox proportional hazard model.During the study period, 972 patients (mean Dlco 76 ± 21, mean FEV1 73 ± 21) met inclusion criteria. Perioperative mortality was 2.6% (n = 25). The 5-year survival of the entire cohort was 60.1%, with a median follow-up of 43 months. The 5-year survival for patients with percent predicted FEV1 stratified by more than 80%, 61% to 80%, 41% to 60%, and 40% or less was 70.1%, 59.3%, 52.5%, and 53.4%, respectively. The 5-year survival for patients with percent predicted Dlco stratified by more than 80%, 61% to 80%, 41% to 60%, and 40% or less was 70.2%, 63.4%, 44.2%, and 33.1%, respectively. In multivariable survival analysis, both larger tumor size (hazard ratio 1.15, p = 0.01) and lower Dlco (hazard ratio 0.986, p < 0.0001) were significant predictors of worse survival. The association of FEV1 and survival was not statistically significant (p = 0.18).Survival after lobectomy for patients with stage I non-small cell lung cancer is impacted by lower Dlco, which can be used in the risk and benefit assessment when choosing therapy.

Authors
Berry, MF; Yang, C-FJ; Hartwig, MG; Tong, BC; Harpole, DH; D'Amico, TA; Onaitis, MW
MLA Citation
Berry, MF, Yang, C-FJ, Hartwig, MG, Tong, BC, Harpole, DH, D'Amico, TA, and Onaitis, MW. "Impact of Pulmonary Function Measurements on Long-Term Survival After Lobectomy for Stage I Non-Small Cell Lung Cancer." The Annals of thoracic surgery 100.1 (July 2015): 271-276.
PMID
25986099
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
100
Issue
1
Publish Date
2015
Start Page
271
End Page
276
DOI
10.1016/j.athoracsur.2015.02.076

Imagine all the people....

Authors
Tong, BC
MLA Citation
Tong, BC. "Imagine all the people.." The Journal of thoracic and cardiovascular surgery 149.6 (June 2015): 1488-1489.
PMID
26060005
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
149
Issue
6
Publish Date
2015
Start Page
1488
End Page
1489
DOI
10.1016/j.jtcvs.2015.03.030

Lung cancer screening, version 1.2015: featured updates to the NCCN guidelines.

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Lung Cancer Screening provide recommendations for selecting individuals for lung cancer screening, and for evaluation and follow-up of nodules found during screening, and are intended to assist with clinical and shared decision-making. These NCCN Guidelines Insights focus on the major updates to the 2015 NCCN Guidelines for Lung Cancer Screening, which include a revision to the recommendation from category 2B to 2A for one of the high-risk groups eligible for lung cancer screening. For low-dose CT of the lung, the recommended slice width was revised in the table on "Low-Dose Computed Tomography Acquisition, Storage, Interpretation, and Nodule Reporting."

Authors
Wood, DE; Kazerooni, E; Baum, SL; Dransfield, MT; Eapen, GA; Ettinger, DS; Hou, L; Jackman, DM; Klippenstein, D; Kumar, R; Lackner, RP; Leard, LE; Leung, ANC; Makani, SS; Massion, PP; Meyers, BF; Otterson, GA; Peairs, K; Pipavath, S; Pratt-Pozo, C; Reddy, C; Reid, ME; Rotter, AJ; Sachs, PB; Schabath, MB; Sequist, LV; Tong, BC; Travis, WD; Yang, SC; Gregory, KM; Hughes, M; National comprehension cancer network,
MLA Citation
Wood, DE, Kazerooni, E, Baum, SL, Dransfield, MT, Eapen, GA, Ettinger, DS, Hou, L, Jackman, DM, Klippenstein, D, Kumar, R, Lackner, RP, Leard, LE, Leung, ANC, Makani, SS, Massion, PP, Meyers, BF, Otterson, GA, Peairs, K, Pipavath, S, Pratt-Pozo, C, Reddy, C, Reid, ME, Rotter, AJ, Sachs, PB, Schabath, MB, Sequist, LV, Tong, BC, Travis, WD, Yang, SC, Gregory, KM, Hughes, M, and National comprehension cancer network, . "Lung cancer screening, version 1.2015: featured updates to the NCCN guidelines." Journal of the National Comprehensive Cancer Network : JNCCN 13.1 (January 2015): 23-34.
PMID
25583767
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
13
Issue
1
Publish Date
2015
Start Page
23
End Page
34
DOI
10.6004/jnccn.2015.0006

Invited commentary.

Authors
Tong, BC
MLA Citation
Tong, BC. "Invited commentary." The Annals of thoracic surgery 98.5 (November 2014): 1754-.
PMID
25441785
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
98
Issue
5
Publish Date
2014
Start Page
1754
DOI
10.1016/j.athoracsur.2014.06.018

First nationwide survey of US integrated 6-year cardiothoracic surgical residency program directors.

The recently implemented integrated 6-year (I-6) format represents a significant change in cardiothoracic surgical residency training. We report the results of the first nationwide survey assessing I-6 program directors' impressions of this new format.A 28-question web-based survey was distributed to program directors of all 24 Accreditation Council for Graduate Medical Education-accredited I-6 training programs in November 2013. The response rate was a robust 67%.Compared with graduates of traditional residencies, most I-6 program directors with enrolled residents believed that their graduates will be better trained (67%), be better prepared for new technological advances (67%), and have superior comprehension of cardiothoracic disease processes (83%). Just as with traditional program graduates, most respondents believed their I-6 graduates would be able to independently perform routine adult cardiac and general thoracic operations (75%) and were equivocal on whether additional specialty training (eg, minimally invasive, heart failure, aortic) was necessary. Most respondents did not believe that less general surgical training disadvantaged I-6 residents in terms of their career (83%); 67% of respondents would have chosen the I-6 format for themselves if given the choice. The greater challenges in training less mature and experienced trainees and vulnerability to attrition were noted as disadvantages of the I-6 format. Most respondents believed that I-6 programs represent a natural evolution toward improved residency training rather than a response to declining interest among medical school graduates.High satisfaction rates with the I-6 format were prevalent among I-6 program directors. However, concerns with respect to training relatively less experienced, mature trainees were evident.

Authors
Lebastchi, AH; Tackett, JJ; Argenziano, M; Calhoon, JH; Gasparri, MG; Halkos, ME; Hicks, GL; Iannettoni, MD; Ikonomidis, JS; McCarthy, PM; Starnes, SL; Tong, BC; Yuh, DD
MLA Citation
Lebastchi, AH, Tackett, JJ, Argenziano, M, Calhoon, JH, Gasparri, MG, Halkos, ME, Hicks, GL, Iannettoni, MD, Ikonomidis, JS, McCarthy, PM, Starnes, SL, Tong, BC, and Yuh, DD. "First nationwide survey of US integrated 6-year cardiothoracic surgical residency program directors." The Journal of thoracic and cardiovascular surgery 148.2 (August 2014): 408-15.e1.
PMID
24820188
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
148
Issue
2
Publish Date
2014
Start Page
408
End Page
15.e1
DOI
10.1016/j.jtcvs.2014.04.004

Sex differences in early outcomes after lung cancer resection: analysis of the Society of Thoracic Surgeons General Thoracic Database.

Women with lung cancer have superior long-term survival outcomes compared with men, independent of stage. The cause of this disparity is unknown. For patients undergoing lung cancer resection, these survival differences could be due, in part, to relatively better perioperative outcomes for women. This study was undertaken to determine differences in perioperative outcomes after lung cancer surgery on the basis of sex.The Society of Thoracic Surgeons' General Thoracic Database was queried for all patients undergoing resection of lung cancer between 2002 and 2010. Postoperative complications were analyzed with respect to sex. Univariable analysis was performed, followed by multivariable modeling to determine significant risk factors for postoperative morbidity and mortality.A total of 34,188 patients (16,643 men and 17,545 women) were considered. Univariable analysis demonstrated statistically significant differences in postoperative complications favoring women in all categories of postoperative complications. Women also had lower in-hospital and 30-day mortality (odds ratio, 0.56; 95% confidence interval, 0.44-0.71; P < .001). Multivariable analysis demonstrated that several preoperative conditions independently predicted 30-day mortality: male sex, increasing age, lower diffusion capacity, renal insufficiency, preoperative radiation therapy, cancer stage, extent of resection, and thoracotomy as surgical approach. Coronary artery disease was an independent predictor of mortality in women but not in men. Thoracotomy as the surgical approach and preoperative radiation therapy were predictive of mortality for men but not for women. Postoperative prolonged air leak and empyema predicted mortality in men but not in women.Women have lower postoperative morbidity and mortality after lung cancer surgery. Some risk factors are sex-specific with regard to mortality. Further study is warranted to determine the cause of these differences and to determine their effect on survival.

Authors
Tong, BC; Kosinski, AS; Burfeind, WR; Onaitis, MW; Berry, MF; Harpole, DH; D'Amico, TA
MLA Citation
Tong, BC, Kosinski, AS, Burfeind, WR, Onaitis, MW, Berry, MF, Harpole, DH, and D'Amico, TA. "Sex differences in early outcomes after lung cancer resection: analysis of the Society of Thoracic Surgeons General Thoracic Database." The Journal of thoracic and cardiovascular surgery 148.1 (July 2014): 13-18.
PMID
24726742
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
148
Issue
1
Publish Date
2014
Start Page
13
End Page
18
DOI
10.1016/j.jtcvs.2014.03.012

Tumor acquisition for biomarker research in lung cancer.

The biopsy collection data from two lung cancer trials that required fresh tumor samples be obtained for microarray analysis were reviewed. In the trial for advanced disease, microarray data were obtained on 50 patient samples, giving an overall success rate of 60.2%. The majority of the specimens were obtained through CT-guided lung biopsies (N = 30). In the trial for early-stage patients, 28 tissue specimens were collected from excess tumor after surgical resection with a success rate of 85.7%. This tissue procurement program documents the feasibility in obtaining fresh tumor specimens prospectively that could be used for molecular testing.

Authors
Stevenson, M; Christensen, J; Shoemaker, D; Foster, T; Barry, WT; Tong, BC; Wahidi, M; Shofer, S; Datto, M; Ginsburg, G; Crawford, J; D'Amico, T; Ready, N
MLA Citation
Stevenson, M, Christensen, J, Shoemaker, D, Foster, T, Barry, WT, Tong, BC, Wahidi, M, Shofer, S, Datto, M, Ginsburg, G, Crawford, J, D'Amico, T, and Ready, N. "Tumor acquisition for biomarker research in lung cancer." Cancer investigation 32.6 (July 2014): 291-298.
PMID
24810245
Source
epmc
Published In
Cancer Investigation (Informa)
Volume
32
Issue
6
Publish Date
2014
Start Page
291
End Page
298
DOI
10.3109/07357907.2014.911880

Differential prognostic significance of extralobar and intralobar nodal metastases in patients with surgically resected stage II non-small cell lung cancer.

We sought to determine the prognostic significance of extralobar nodal metastases versus intralobar nodal metastases in patients with lung cancer and pathologic stage N1 disease.A retrospective review of a prospectively maintained lung resection database identified 230 patients with pathologic stage II, N1 non-small cell lung cancer from 1997 to 2011. The surgical pathology reports were reviewed to identify the involved N1 stations. The outcome variables included recurrence and death. Univariate and multivariate analyses were performed using the R statistical software package.A total of 122 patients had extralobar nodal metastases (level 10 or 11); 108 patients were identified with intralobar nodal disease (levels 12-14). The median follow-up was 111 months. The baseline characteristics were similar in both groups. No significant differences were noted in the surgical approach, anatomic resections performed, or adjuvant therapy rates between the 2 groups. Overall, 80 patients developed recurrence during follow-up: 33 (30%) of 108 in the intralobar and 47 (38%) of 122 in the extralobar cohort. The median overall survival was 46.9 months for the intralobar cohort and 24.4 months for the extralobar cohort (P < .001). In a multivariate Cox proportional hazard model that included the presence of extralobar nodal disease, age, tumor size, tumor histologic type, and number of positive lymph nodes, extralobar nodal disease independently predicted both recurrence-free and overall survival (hazard ratio, 1.96; 95% confidence interval, 1.36-2.81; P = .001).In patients who underwent surgical resection for stage II non-small cell lung cancer, the presence of extralobar nodal metastases at level 10 or 11 predicted significantly poorer outcomes than did nodal metastases at stations 12 to 14. This finding has prognostic importance and implications for adjuvant therapy and surveillance strategies for patients within the heterogeneous stage II (N1) category.

Authors
Haney, JC; Hanna, JM; Berry, MF; Harpole, DH; D'Amico, TA; Tong, BC; Onaitis, MW
MLA Citation
Haney, JC, Hanna, JM, Berry, MF, Harpole, DH, D'Amico, TA, Tong, BC, and Onaitis, MW. "Differential prognostic significance of extralobar and intralobar nodal metastases in patients with surgically resected stage II non-small cell lung cancer." The Journal of thoracic and cardiovascular surgery 147.4 (April 2014): 1164-1168.
PMID
24507984
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
147
Issue
4
Publish Date
2014
Start Page
1164
End Page
1168
DOI
10.1016/j.jtcvs.2013.12.015

Thoracoscopic superior segmentectomy.

Authors
Moremen, JR; Tong, BC; Ceppa, DP
MLA Citation
Moremen, JR, Tong, BC, and Ceppa, DP. "Thoracoscopic superior segmentectomy." Annals of cardiothoracic surgery 3.2 (March 2014): 202-203. (Review)
PMID
24790847
Source
epmc
Published In
Annals of cardiothoracic surgery
Volume
3
Issue
2
Publish Date
2014
Start Page
202
End Page
203
DOI
10.3978/j.issn.2225-319x.2014.02.02

Computed tomography screening for lung cancer: where are we now?

Low-dose computed tomography (LDCT) screening has been shown to result in detection of earlier-stage lung cancers, with a 20% reduction in cancer-related deaths. LDCT screening offers significant potential benefits to selected patients; however, many questions remain, including questions about the applicability of lung cancer screening in clinical practice.

Authors
Christensen, JD; Tong, BC
MLA Citation
Christensen, JD, and Tong, BC. "Computed tomography screening for lung cancer: where are we now?." N C Med J 74.5 (September 2013): 406-410.
PMID
24165769
Source
pubmed
Published In
North Carolina Medical Journal
Volume
74
Issue
5
Publish Date
2013
Start Page
406
End Page
410

Impact of T status and N status on perioperative outcomes after thoracoscopic lobectomy for lung cancer.

OBJECTIVE: We sought to evaluate the effect of tumor size, location, and clinical nodal status on outcomes after thoracoscopic lobectomy for lung cancer. METHODS: All patients who underwent attempted thoracoscopic lobectomy for lung cancer between June 1999 and October 2010 at a single institution were reviewed. A model for morbidity including published risk factors as well as tumor size, location, and clinical N status was developed by multivariable logistic regression. RESULTS: During the study period, 916 thoracoscopic lobectomies met study criteria: 329 for peripheral, clinical N0 tumors ≤ 3 cm and 504 for tumors that were central, clinical node positive, or >3 cm. Tumor location could not be documented for 83 patients. Conversions to thoracotomy occurred in 36 patients (4%); patients with clinically node-positive disease had higher conversion rates (11 conversions in 153 clinical N1 to N3 patients [7.2%] vs 25 in 763 clinical N0 patients [3.3%, P = .03]. Overall operative mortality was 1.6% (14 patients) and morbidity was 32% (296 patients). Although patients with larger tumors (P = .006) and central tumors (P = .01) had increased complications by univariate analysis, tumor size >3 cm (P = .17) and central location (P = .5) did not predict significantly overall morbidity in multivariate analysis. Clinical node status did not predict increased complications by univariate or multivariate analysis. Significant predictors of morbidity in multivariable analysis were increasing age, decreasing forced expiratory volume in 1 second, prior chemotherapy, and congestive heart failure. CONCLUSIONS: Thoracoscopic lobectomy for lung cancers that are central, clinically node positive, or >3 cm does not confer increased morbidity compared with peripheral, clinical N0 cancers that are <3 cm.

Authors
Villamizar, NR; Darrabie, M; Hanna, J; Onaitis, MW; Tong, BC; D'Amico, TA; Berry, MF
MLA Citation
Villamizar, NR, Darrabie, M, Hanna, J, Onaitis, MW, Tong, BC, D'Amico, TA, and Berry, MF. "Impact of T status and N status on perioperative outcomes after thoracoscopic lobectomy for lung cancer." J Thorac Cardiovasc Surg 145.2 (February 2013): 514-520.
PMID
23177123
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
145
Issue
2
Publish Date
2013
Start Page
514
End Page
520
DOI
10.1016/j.jtcvs.2012.10.039

Weighting composite endpoints in clinical trials: essential evidence for the heart team.

BACKGROUND: Coronary revascularization trials often use a composite endpoint of major adverse cardiac and cerebrovascular events (MACCE). The usual practice in analyzing data with a composite endpoint is to assign equal weights to each of the individual MACCE elements. Noninferiority margins are used to offset effects of presumably less important components, but their magnitudes are subject to bias. This study describes the relative importance of MACCE elements from a patient perspective. METHODS: A discrete choice experiment was conducted. Survey respondents were presented with a scenario that would make them eligible for the Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) trial three-vessel disease cohort. Respondents chose among pairs of procedures that differed on the 3-year probability of MACCE, potential for increased longevity, and procedure/recovery time. Conjoint analysis derived relative weights for these attributes. RESULTS: In all, 224 respondents completed the survey. The attributes did not have equal weight. Risk of death was most important (relative weight 0.23), followed by stroke (0.18), potential increased longevity and recovery time (each 0.17), myocardial infarction (0.14), and risk of repeat revascularization (0.11). Applying these weights to the SYNTAX 3-year endpoints resulted in a persistent, but decreased margin of difference in MACCE favoring coronary artery bypass graft surgery compared to percutaneous coronary intervention. When labeled only as "procedure A" and "procedure B," 87% of respondents chose coronary artery bypass graft surgery over percutaneous coronary intervention. When procedures were labeled as "coronary stent" and "coronary bypass surgery," only 73% chose coronary artery bypass graft surgery. Procedural preference varied with demographics, sex, and familiarity with the procedures. CONCLUSIONS: The MACCE elements do not carry equal weight in a composite endpoint, from a patient perspective. Using a weighted composite endpoint increases the validity of statistical analyses and trial conclusions. Patients are subject to bias by labels when considering coronary revascularization.

Authors
Tong, BC; Huber, JC; Ascheim, DD; Puskas, JD; Ferguson, TB; Blackstone, EH; Smith, PK
MLA Citation
Tong, BC, Huber, JC, Ascheim, DD, Puskas, JD, Ferguson, TB, Blackstone, EH, and Smith, PK. "Weighting composite endpoints in clinical trials: essential evidence for the heart team." Ann Thorac Surg 94.6 (December 2012): 1908-1913.
PMID
22795064
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
94
Issue
6
Publish Date
2012
Start Page
1908
End Page
1913
DOI
10.1016/j.athoracsur.2012.05.027

Thoracoscopic lobectomy has increasing benefit in patients with poor pulmonary function: a Society of Thoracic Surgeons Database analysis.

OBJECTIVE: Using a national database, we asked whether video-assisted thoracoscopic surgery (VATS) lobectomy is beneficial in high-risk pulmonary patients. BACKGROUND: Single-institution series demonstrated benefit of VATS lobectomy over lobectomy via thoracotomy in poor pulmonary function patients [FEV1 (forced expiratory volume in 1 second) or DLCO (diffusion capacity of the lung to carbon monoxide) <60% predicted]. METHODS: The STS General Thoracic Database was queried for patients having undergone lobectomy by either thoracotomy or VATS between 2000 and 2010. Postoperative pulmonary complications included those defined by the STS database. RESULTS: In the STS database, 12,970 patients underwent lobectomy (thoracotomy, n = 8439; VATS, n = 4531) and met inclusion criteria. The overall rate of pulmonary complications was 21.7% (1832/8439) and 17.8% (806/4531) in patients undergoing lobectomy with thoracotomy and VATS, respectively (P < 0.0001). In a multivariable model of pulmonary complications, thoracotomy approach (OR = 1.25, P < 0.001), decreasing FEV1% predicted (OR = 1.01 per unit, P < 0.001) and DLCO% predicted (OR = 1.01 per unit, P < 0.001), and increasing age (1.02 per year, P < 0.001) independently predicted pulmonary complications. When examining pulmonary complications in patients with FEV1 less than 60% predicted, thoracotomy patients have markedly increased pulmonary complications when compared with VATS patients (P = 0.023). No significant difference is noted with FEV1 more than 60% predicted. CONCLUSIONS: Poor pulmonary function predicts respiratory complications regardless of approach. Respiratory complications increase at a significantly greater rate in lobectomy patients with poor pulmonary function after thoracotomy compared with VATS. Planned surgical approach should be considered while determining whether a high-risk patient is an appropriate resection candidate.

Authors
Ceppa, DP; Kosinski, AS; Berry, MF; Tong, BC; Harpole, DH; Mitchell, JD; D'Amico, TA; Onaitis, MW
MLA Citation
Ceppa, DP, Kosinski, AS, Berry, MF, Tong, BC, Harpole, DH, Mitchell, JD, D'Amico, TA, and Onaitis, MW. "Thoracoscopic lobectomy has increasing benefit in patients with poor pulmonary function: a Society of Thoracic Surgeons Database analysis." Ann Surg 256.3 (September 2012): 487-493.
PMID
22868367
Source
pubmed
Published In
Annals of Surgery
Volume
256
Issue
3
Publish Date
2012
Start Page
487
End Page
493
DOI
10.1097/SLA.0b013e318265819c

Needs assessment for an errors-based curriculum on thoracoscopic lobectomy.

BACKGROUND: Research suggests a benefit from a skills curriculum emphasizing error prevention, identification, and management. Our purpose was to identify common errors committed by trainees during simulated thoracoscopic lobectomy for use in developing an error-based curriculum. METHODS: Twenty-one residents (postgraduate years 1 to 8) performed a thoracoscopic left upper lobectomy on a previously validated simulator. Videos of the procedure were reviewed in a blinded fashion using a checklist listing 66 possible cognitive and technical errors. RESULTS: Of the 21 residents, 15 (71%) self-reported completing the anatomic lobectomy; however, only 7 (33%) had actually divided all of the necessary structures correctly. While dissecting the superior pulmonary vein, 16 residents (76%) made at least one error. The most common (n=13, 62%) was dissecting individual branches rather than the entire vein. On the bronchus, 14 (67%) made at least one error. Again, the most common (n=9, 43%) was dissecting branches. During these tasks, cognitive errors were more common than technical errors. While dissecting arterial branches, 18 residents (86%) made at least one error. Technical and cognitive errors occurred with equal frequency during arterial dissection. The most common arterial error was excess tension on the vessel (n=10, 48%). CONCLUSIONS: Curriculum developers should identify skill-specific technical and judgment errors to verify the scope of errors typically committed. For a thoracoscopic lobectomy curriculum, emphasis should be placed on correct identification of anatomic landmarks during dissection of the vein and airway and on proper tissue handling technique during arterial dissection.

Authors
Meyerson, SL; Tong, BC; Balderson, SS; D'Amico, TA; Phillips, JD; DeCamp, MM; DaRosa, DA
MLA Citation
Meyerson, SL, Tong, BC, Balderson, SS, D'Amico, TA, Phillips, JD, DeCamp, MM, and DaRosa, DA. "Needs assessment for an errors-based curriculum on thoracoscopic lobectomy." Ann Thorac Surg 94.2 (August 2012): 368-373.
PMID
22633499
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
94
Issue
2
Publish Date
2012
Start Page
368
End Page
373
DOI
10.1016/j.athoracsur.2012.04.023

Validation of a thoracoscopic lobectomy simulator.

OBJECTIVES: Although simulation is considered integral to general surgery training, its role has only recently been recognized in thoracic surgical education, perhaps due to a lack of widely available, validated simulators for advanced thoracic procedures. This study evaluates the construct, content and face validity of an inexpensive, easily reproducible simulator for teaching thoracoscopic lobectomy. METHODS: Construct validity (ability of the simulator to discriminate between users of different skill levels) was assessed by having surgical trainees perform a lobectomy on the simulator. Participants were divided into three groups (experienced, intermediate and novice) based on self-reported experience with minimally invasive surgery. After instruction and practice time to limit the effect of any simulator-specific learning curve, each performed a left upper lobectomy that was scored using a standardized assessment tool incorporating total time plus weighted penalty minutes assigned for errors. Content validity (simulator requires same steps and decision-making as a clinical lobectomy) was assessed using a Likert scale by those participants who had previously seen a thoracoscopic lobectomy in a patient. RESULTS: Thirty-one residents participated in the study (12 experienced, 6 intermediate and 13 novice). All 12 experienced participants completed the lobectomy. The other groups were less successful with 4 of 6 in the intermediate group and 5 of 13 in the novice group completing the lobectomy (P = 0.004). The mean times for lobectomy + penalty minutes were 35 + 6.8 (experienced), 50 + 13 (intermediate) and 54 + 20 (novice). Differences between groups were statistically significant for experienced vs. novice (P < 0.001) and experienced vs. intermediate (P < 0.04). Content validity was assessed by the 18 participants who had previously seen a thoracoscopic lobectomy with a mean of 9.2 of 10 possible points. CONCLUSIONS: The thoracoscopic lobectomy simulator used in this study demonstrates acceptable validity and can be a useful tool for teaching thoracoscopic lobectomy to trainees or experienced surgeons.

Authors
Tong, BC; Gustafson, MR; Balderson, SS; D'Amico, TA; Meyerson, SL
MLA Citation
Tong, BC, Gustafson, MR, Balderson, SS, D'Amico, TA, and Meyerson, SL. "Validation of a thoracoscopic lobectomy simulator." Eur J Cardiothorac Surg 42.2 (August 2012): 364-369.
PMID
22315356
Source
pubmed
Published In
European Journal of Cardio-Thoracic Surgery
Volume
42
Issue
2
Publish Date
2012
Start Page
364
End Page
369
DOI
10.1093/ejcts/ezs012

Outcomes after surgical management of synchronous bilateral primary lung cancers.

BACKGROUND: Distinguishing between synchronous primary lung cancers and metastatic disease in patients with bilateral lung masses is often difficult. The objective of this study is to examine outcomes associated with a strategy of performing staged bilateral resections in patients without N2 disease based on invasive mediastinal staging and without distant metastases. METHODS: Patients undergoing resections of bilateral synchronous primary lung cancer at our institution between 1997 and 2010 were reviewed. Perioperative complications were graded according to National Cancer Institute guidelines. Survival was estimated using the Kaplan-Meier method and compared using a log-rank test. End points included overall survival, disease-free survival, operative death, cancer recurrence, and postoperative complications. RESULTS: Resections of bilateral synchronous primary lung cancers were performed in 47 patients. Forty-five patients (96%) had at least a unilateral thoracoscopic approach; 28 (60%) had bilateral thoracoscopic approaches. The median postresection length of stay was 3 days. Thirteen patients (28%) had a postoperative complication; only 3 (6%) were grade 3 or higher. There was 1 perioperative death (2%). Eleven patients received adjuvant therapy; only 3 patients in whom adjuvant therapy was indicated did not receive the recommended treatment. The overall 3-year survival was 35%. Survival of patients whose bilateral tumors had identical histology did not differ from patients whose histology was different (p = 0.57). Three-year disease-free survival was 24%. CONCLUSIONS: Aggressive surgical treatment of apparent synchronous bilateral primary lung cancer can be performed with low morbidity. Most patients tolerate the bilateral surgeries and adjuvant therapy. Overall survival is sufficiently high to support this aggressive approach.

Authors
Shah, AA; Barfield, ME; Kelsey, CR; Onaitis, MW; Tong, B; Harpole, D; D'Amico, TA; Berry, MF
MLA Citation
Shah, AA, Barfield, ME, Kelsey, CR, Onaitis, MW, Tong, B, Harpole, D, D'Amico, TA, and Berry, MF. "Outcomes after surgical management of synchronous bilateral primary lung cancers." Ann Thorac Surg 93.4 (April 2012): 1055-1060.
PMID
22381451
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
93
Issue
4
Publish Date
2012
Start Page
1055
End Page
1060
DOI
10.1016/j.athoracsur.2011.12.070

Feasibility of hybrid thoracoscopic lobectomy and en-bloc chest wall resection.

OBJECTIVES: Lobectomy with an en-bloc chest wall resection is an effective but potentially morbid treatment of lung cancer invading the chest wall. Minimally invasive approaches to lobectomy have reduced morbidity compared with thoracotomy for early stage lung cancer, but there is insufficient evidence regarding the feasibility of hybrid thoracoscopic lobectomy chest wall resection. We reviewed our experience with an en-bloc chest wall resection and lobectomy to evaluate the outcomes of a hybrid approach using thoracoscopic lobectomy combined with the chest wall resection where rib spreading is avoided. METHODS: All patients who underwent lobectomy and en-bloc chest wall resection with ribs for primary non-small cell lung cancer from January 2000 to July 2010 were reviewed. Starting in April 2003, a hybrid approach was introduced where thoracoscopic techniques were utilized to accomplish the pulmonary resection and a limited counter incision was used to perform the en-bloc resection of the chest wall, avoiding scapular mobilization and rib spreading. Preoperative, perioperative and outcome variables were assessed using the standard descriptive statistics. RESULTS: During the study period, 105 patients underwent en-bloc lobectomy and chest wall resection, including 93 patients with resection via thoracotomy and 12 patients with resection via the hybrid thoracoscopic approach. Complete resection was achieved in all patients in both groups. Tumour size and the extent of resection were similar in the two groups. There were no conversions and no perioperative mortality in the hybrid group. Post-operative outcomes were similar, although patients who underwent the hybrid approach had a shorter length of stay (P = 0.03). CONCLUSIONS: A hybrid approach that combines thoracoscopic lobectomy and chest wall resection is feasible and effective in selected patients. The use of a limited counter incision without rib spreading does not compromise oncologic efficacy. Further experience is needed to determine if this approach provides any advantage in outcomes, including post-operative morbidity.

Authors
Berry, MF; Onaitis, MW; Tong, BC; Balderson, SS; Harpole, DH; D'Amico, TA
MLA Citation
Berry, MF, Onaitis, MW, Tong, BC, Balderson, SS, Harpole, DH, and D'Amico, TA. "Feasibility of hybrid thoracoscopic lobectomy and en-bloc chest wall resection." Eur J Cardiothorac Surg 41.4 (April 2012): 888-892.
PMID
22219441
Source
pubmed
Published In
European Journal of Cardio-Thoracic Surgery
Volume
41
Issue
4
Publish Date
2012
Start Page
888
End Page
892
DOI
10.1093/ejcts/ezr150

Molecular prognostication of lung cancer

Authors
Tong, BC; Harpole, DH
MLA Citation
Tong, BC, and Harpole, DH. "Molecular prognostication of lung cancer." Principles and Practice of Lung Cancer: The Official Reference Text of the International Association for the Study of Lung Cancer (IASLC): Fourth Edition. February 13, 2012. 147-162.
Source
scopus
Publish Date
2012
Start Page
147
End Page
162

Lung Cancer Screening

Authors
Wood, DE; Eapen, GA; Ettinger, DS; Hou, L; Jackman, D; Kazerooni, E; Klippenstein, D; Lackner, RP; Leard, L; Leung, ANC; Massion, PP; Meyers, BF; Munden, RF; Otterson, GA; Peairs, K; Pipavath, S; Pratt-Pozo, C; Reddy, C; Reid, ME; Rotter, AJ; Schabath, MB; Sequist, LV; Tong, BC; Travis, WD; Unger, M; Yang, SC
MLA Citation
Wood, DE, Eapen, GA, Ettinger, DS, Hou, L, Jackman, D, Kazerooni, E, Klippenstein, D, Lackner, RP, Leard, L, Leung, ANC, Massion, PP, Meyers, BF, Munden, RF, Otterson, GA, Peairs, K, Pipavath, S, Pratt-Pozo, C, Reddy, C, Reid, ME, Rotter, AJ, Schabath, MB, Sequist, LV, Tong, BC, Travis, WD, Unger, M, and Yang, SC. "Lung Cancer Screening." JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK 10.2 (February 2012): 240-265.
PMID
22308518
Source
wos-lite
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
10
Issue
2
Publish Date
2012
Start Page
240
End Page
265

Molecular markers for incidence, prognosis, and response to therapy.

Lung cancer is the most common malignancy in the United States and worldwide. In 2011, it is estimated that more than 221,000 people in the United States will be diagnosed with cancer of the lung and bronchus. For patients with early-stage disease, 5-year survival approaches only 50%. Recent advances using molecular, genetic, and proteomic profiling of lung tumors have enabled refining the prognosis for patients with non-small cell lung cancer. With targeted therapies, there is an opportunity to enhance long-term survival. This article discusses several key molecular markers used in the prognostication and treatment of non-small cell lung cancer.

Authors
Tong, BC; Harpole, DH
MLA Citation
Tong, BC, and Harpole, DH. "Molecular markers for incidence, prognosis, and response to therapy." Surg Oncol Clin N Am 21.1 (January 2012): 161-175.
PMID
22098838
Source
pubmed
Published In
Surgical Oncology Clinics of North America
Volume
21
Issue
1
Publish Date
2012
Start Page
161
End Page
175
DOI
10.1016/j.soc.2011.09.007

The Role of Thoracic Surgery in Palliative Care: A Review

Authors
Klapper, JA; Tong, BC
MLA Citation
Klapper, JA, and Tong, BC. "The Role of Thoracic Surgery in Palliative Care: A Review." Journal of Palliative Care & Medicine 02.07 (2012): 133-133.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
Start Page
133
End Page
133
DOI
10.4172/2165-7386.1000133

Perioperative management of patients on clopidogrel (Plavix) undergoing major lung resection.

BACKGROUND: Management of patients requiring antiplatelet therapy with clopidogrel (Plavix) and major lung resection must balance the risks of bleeding and cardiovascular events. We reviewed our experience with patients treated with clopidogrel perioperatively to examine outcomes, including results of a new strategy for high-risk patients. METHODS: Patients who underwent major lung resection and received perioperative clopidogrel between January 2005 and September 2010 were reviewed. Initially, clopidogrel management consisted of discontinuation approximately 5 days before surgery and resumption immediately after surgery. After July 2010, high-risk patients (drug-eluting coronary stent placement within prior year or previous coronary event after clopidogrel discontinuation) were admitted 2 to 3 days preoperatively and bridged with the intravenous glycoprotein IIb/IIIa receptor inhibitor eptifibatide (Integrilin) according to a multidisciplinary cardiology/anesthesiology/thoracic surgery protocol. Outcomes were compared with control patients (matched for preoperative risk factors and extent of pulmonary resection) who did not receive perioperative clopidogrel. RESULTS: Fifty-four patients who had major lung resection between January 2005 and September 2010 and received clopidogrel perioperatively were matched with 108 control subjects. Both groups had similar mortality, postoperative length of stay, and no differences in the rates of perioperative transfusions, reoperations for bleeding, myocardial infarctions, and strokes. Seven of the 54 clopidogrel patients were admitted preoperatively for an eptifibatide bridge. Two of these patients received perioperative transfusions, but there were no deaths, reoperations, myocardial infarctions, or stroke. CONCLUSIONS: Patients taking clopidogrel can safely undergo major lung resection. Treatment with an eptifibatide bridge may minimize the risk of cardiovascular events in higher risk patients.

Authors
Ceppa, DP; Welsby, IJ; Wang, TY; Onaitis, MW; Tong, BC; Harpole, DH; D'Amico, TA; Berry, MF
MLA Citation
Ceppa, DP, Welsby, IJ, Wang, TY, Onaitis, MW, Tong, BC, Harpole, DH, D'Amico, TA, and Berry, MF. "Perioperative management of patients on clopidogrel (Plavix) undergoing major lung resection." Ann Thorac Surg 92.6 (December 2011): 1971-1976.
PMID
21978871
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
92
Issue
6
Publish Date
2011
Start Page
1971
End Page
1976
DOI
10.1016/j.athoracsur.2011.07.052

Incorporating research into thoracic surgery practice.

The incorporation of research into a career in thoracic surgery is a complex process. Ideally, the preparation for a career in academic thoracic surgery begins with a research fellowship during training. In the academic setting, a research portfolio might include clinical research, translational research, or basic research. Using strategies for developing collaboration, thoracic surgeons in community-based programs may also be successful clinical investigators. In addition to the rigors of conducting research, strategies for reserving protected time and obtaining grant support must be considered to be successful in academic surgery.

Authors
D'Amico, TA; Tong, BC; Berry, MF; Burfeind, WR; Onaitis, MW
MLA Citation
D'Amico, TA, Tong, BC, Berry, MF, Burfeind, WR, and Onaitis, MW. "Incorporating research into thoracic surgery practice." Thorac Surg Clin 21.3 (August 2011): 369-377.
PMID
21762860
Source
pubmed
Published In
Thoracic Surgery Clinics
Volume
21
Issue
3
Publish Date
2011
Start Page
369
End Page
377
DOI
10.1016/j.thorsurg.2011.04.004

Utility of a simple algorithm to grade diastolic dysfunction and predict outcome after coronary artery bypass graft surgery.

BACKGROUND: Inclusion of a measure of left ventricular diastolic dysfunction (LVDD) may improve risk prediction after cardiac surgery. Current LVDD grading guidelines rely on echocardiographic variables that are not always available or aligned to allow grading. We hypothesized that a simplified algorithm involving fewer variables would enable more patients to be assigned a LVDD grade compared with a comprehensive algorithm, and also be valid in identifying patients at risk of long-term major adverse cardiac events (MACE). METHODS: Intraoperative transesophageal echocardiography data were gathered on 905 patients undergoing coronary artery bypass graft surgery, including flow and tissue Doppler-based measurements. Two algorithms were constructed to categorize LVDD: a comprehensive four-variable algorithm, A, was compared with a simplified version, B, with only two variables-transmitral early flow velocity and early mitral annular tissue velocity-for ease of grading and association with MACE. RESULTS: Using algorithm A, only 563 patients (62%) could be graded, whereas 895 patients (99%) received a grade with algorithm B. Over the median follow-up period of 1,468 days, Cox modeling showed that LVDD was significantly associated with MACE when graded with algorithm B (p=0.013), but not algorithm A (p=0.79). Patients with the highest incidence of MACE could not be graded with algorithm A. CONCLUSIONS: We found that an LVDD algorithm with fewer variables enabled grading of a significantly greater number of coronary artery bypass graft patients, and was valid, as evidenced by worsening grades being associated with MACE. This simplified algorithm could be extended to similar populations as a valid method of characterizing LVDD.

Authors
Swaminathan, M; Nicoara, A; Phillips-Bute, BG; Aeschlimann, N; Milano, CA; Mackensen, GB; Podgoreanu, MV; Velazquez, EJ; Stafford-Smith, M; Mathew, JP; Cardiothoracic Anesthesia Research Endeavors (CARE) Group,
MLA Citation
Swaminathan, M, Nicoara, A, Phillips-Bute, BG, Aeschlimann, N, Milano, CA, Mackensen, GB, Podgoreanu, MV, Velazquez, EJ, Stafford-Smith, M, Mathew, JP, and Cardiothoracic Anesthesia Research Endeavors (CARE) Group, . "Utility of a simple algorithm to grade diastolic dysfunction and predict outcome after coronary artery bypass graft surgery." Ann Thorac Surg 91.6 (June 2011): 1844-1850.
PMID
21492828
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
91
Issue
6
Publish Date
2011
Start Page
1844
End Page
1850
DOI
10.1016/j.athoracsur.2011.02.008

A model for morbidity after lung resection in octogenarians.

OBJECTIVE: Age is an important risk factor for morbidity after lung resection. This study was performed to identify specific risk factors for complications after lung resection in octogenarians. METHODS: A prospective database containing patients aged 80 years or older, who underwent lung resection at a single institution between January 2000 and June 2009, was reviewed. Preoperative, histopathologic, perioperative, and outcome variables were assessed. Morbidity was measured as a patient having any perioperative event as defined by the Society of Thoracic Surgeons General Thoracic Surgery Database. A multivariable risk model for morbidity was developed using a panel of established preoperative and operative variables. Survival was calculated using the Kaplan-Meier method. RESULTS: During the study period, 193 patients aged 80 years or older (median age 82 years) underwent lung resection: wedge resection in 77, segmentectomy in 13, lobectomy in 96, bilobectomy in four, and pneumonectomy in three. Resection was accomplished via thoracoscopy in 149 patients (77%). Operative mortality was 3.6% (seven patients) and morbidity was 46% (89 patients). A total of 181 (94%) patients were discharged directly home. Postoperative events included atrial arrhythmia in 38 patients (20%), prolonged air leak in 24 patients (12%), postoperative transfusion in 22 patients (11%), delirium in 16 patients (8%), need for bronchoscopy in 14 patients (7%), and pneumonia in 10 patients (5%). Significant predictors of morbidity by multivariable analysis included resection greater than wedge (odds ratio 2.98, p=0.006), thoracotomy as operative approach (odds ratio 2.6, p=0.03), and % predicted forced expiratory volume in 1s (odds ratio 1.28 for each 10% decrement, p=0.01). CONCLUSIONS: Octogenarians can undergo lung resection with low mortality. Extent of resection, use of a thoracotomy, and impaired lung function increase the risk of complications. Careful evaluation is necessary to select the most appropriate approach in octogenarians being considered for lung resection.

Authors
Berry, MF; Onaitis, MW; Tong, BC; Harpole, DH; D'Amico, TA
MLA Citation
Berry, MF, Onaitis, MW, Tong, BC, Harpole, DH, and D'Amico, TA. "A model for morbidity after lung resection in octogenarians." Eur J Cardiothorac Surg 39.6 (June 2011): 989-994.
PMID
21276728
Source
pubmed
Published In
European Journal of Cardio-Thoracic Surgery
Volume
39
Issue
6
Publish Date
2011
Start Page
989
End Page
994
DOI
10.1016/j.ejcts.2010.09.038

A comprehensive evaluation for aspiration after esophagectomy reduces the incidence of postoperative pneumonia

Authors
Berry, MF; Atkins, Z; Tong, BC; Harpole, DH; D'Amico, TA; Onaitis, MW
MLA Citation
Berry, MF, Atkins, Z, Tong, BC, Harpole, DH, D'Amico, TA, and Onaitis, MW. "A comprehensive evaluation for aspiration after esophagectomy reduces the incidence of postoperative pneumonia." Dysphagia 26.3 (2011): 326--.
Source
scival
Published In
Dysphagia
Volume
26
Issue
3
Publish Date
2011
Start Page
326-
DOI
10.1007/s00455-011-9343-3

A comprehensive evaluation for aspiration after esophagectomy reduces the incidence of postoperative pneumonia.

OBJECTIVE: This study assesses the effect of using a comprehensive swallowing evaluation before starting oral feedings on aspiration detection and pneumonia occurrence after esophagectomy. METHODS: The records of all patients undergoing esophagectomy between January 1996 and June 2009 were reviewed. Multivariable logistic regression analysis assessed the effect of preoperative and operative variables on the incidence of aspiration and pneumonia. Separate analyses were performed on patients before (early era, 1996-2002) and after (later era, 2003-2009) a rigorous swallowing evaluation was used routinely before starting oral feedings. RESULTS: During the study period, 799 patients (379 from the early era and 420 from the later era) underwent esophagectomy; 30-day mortality was 3.5% (28 patients). Cervical anastomoses were performed in 76% of patients in the later era compared with 40% of patients in the early era. Overall, 96 (12%) patients had evidence of aspiration postoperatively, and the pneumonia incidence was 14% (113 patients). Age (odds ratio, 1.05 per year; P < .0001) and later era (odds ratio, 1.90; P = .0001) predicted aspiration in all patients in a multivariable model. In the early era, cervical anastomosis and aspiration independently predicted pneumonia. With a comprehensive swallowing evaluation in the later era, the detected incidence of aspiration increased (16% vs 7%, P < .0001), whereas the incidence of pneumonia decreased (11% vs 18%, P = .004) compared with the early era, such that neither anastomotic location nor aspiration predicted pneumonia in the later era. CONCLUSIONS: Esophagectomy is often associated with occult aspiration. A comprehensive swallowing evaluation for aspiration before initiating oral feedings significantly decreases the occurrence of pneumonia.

Authors
Berry, MF; Atkins, BZ; Tong, BC; Harpole, DH; D'Amico, TA; Onaitis, MW
MLA Citation
Berry, MF, Atkins, BZ, Tong, BC, Harpole, DH, D'Amico, TA, and Onaitis, MW. "A comprehensive evaluation for aspiration after esophagectomy reduces the incidence of postoperative pneumonia." J Thorac Cardiovasc Surg 140.6 (December 2010): 1266-1271.
PMID
20884018
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
140
Issue
6
Publish Date
2010
Start Page
1266
End Page
1271
DOI
10.1016/j.jtcvs.2010.08.038

Invited commentary.

Authors
Tong, BC
MLA Citation
Tong, BC. "Invited commentary." Ann Thorac Surg 90.5 (November 2010): 1661-.
PMID
20971284
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
90
Issue
5
Publish Date
2010
Start Page
1661
DOI
10.1016/j.athoracsur.2010.07.027

Aspergillus niger: an unusual cause of invasive pulmonary aspergillosis.

Infections due to Aspergillus species cause significant morbidity and mortality. Most are attributed to Aspergillus fumigatus, followed by Aspergillus flavus and Aspergillus terreus. Aspergillus niger is a mould that is rarely reported as a cause of pneumonia. A 72-year-old female with chronic obstructive pulmonary disease and temporal arteritis being treated with steroids long term presented with haemoptysis and pleuritic chest pain. Chest radiography revealed areas of heterogeneous consolidation with cavitation in the right upper lobe of the lung. Induced bacterial sputum cultures, and acid-fast smears and cultures were negative. Fungal sputum cultures grew A. niger. The patient clinically improved on a combination therapy of empiric antibacterials and voriconazole, followed by voriconazole monotherapy. After 4 weeks of voriconazole therapy, however, repeat chest computed tomography scanning showed a significant progression of the infection and near-complete necrosis of the right upper lobe of the lung. Serum voriconazole levels were low-normal (1.0 microg ml(-1), normal range for the assay 0.5-6.0 microg ml(-1)). A. niger was again recovered from bronchoalveolar lavage specimens. A right upper lobectomy was performed, and lung tissue cultures grew A. niger. Furthermore, the lung histopathology showed acute and organizing pneumonia, fungal hyphae and oxalate crystallosis, confirming the diagnosis of invasive A. niger infection. A. niger, unlike A. fumigatus and A. flavus, is less commonly considered a cause of invasive aspergillosis (IA). The finding of calcium oxalate crystals in histopathology specimens is classic for A. niger infection and can be helpful in making a diagnosis even in the absence of conidia. Therapeutic drug monitoring may be useful in optimizing the treatment of IA given the wide variations in the oral bioavailability of voriconazole.

Authors
Person, AK; Chudgar, SM; Norton, BL; Tong, BC; Stout, JE
MLA Citation
Person, AK, Chudgar, SM, Norton, BL, Tong, BC, and Stout, JE. "Aspergillus niger: an unusual cause of invasive pulmonary aspergillosis." J Med Microbiol 59.Pt 7 (July 2010): 834-838.
Website
http://hdl.handle.net/10161/13899
PMID
20299503
Source
pubmed
Published In
Journal of medical microbiology
Volume
59
Issue
Pt 7
Publish Date
2010
Start Page
834
End Page
838
DOI
10.1099/jmm.0.018309-0

Pulmonary function tests do not predict pulmonary complications after thoracoscopic lobectomy.

BACKGROUND: Pulmonary function tests predict respiratory complications and mortality after lung resection through thoracotomy. We sought to determine the impact of pulmonary function tests upon complications after thoracoscopic lobectomy. METHODS: A model for morbidity, including published preoperative risk factors and surgical approach, was developed by multivariable logistic regression. All patients who underwent lobectomy for primary lung cancer between December 1999 and October 2007 with preoperative forced expiratory volume in 1 second (FEV1) or diffusion capacity to carbon monoxide (Dlco) 60% or less predicted were reviewed. Preoperative, histopathologic, perioperative, and outcome variables were assessed using standard descriptive statistics. Pulmonary complications were defined as atelectasis requiring bronchoscopy, pneumonia, reintubation, and tracheostomy. RESULTS: During the study period, 340 patients (median age 67) with Dlco or FEV1 60% or less (mean % predicted FEV1, 55+/-1; mean % predicted Dlco, 61+/-1) underwent lobectomy (173 thoracoscopy, 167 thoracotomy). Operative mortality was 5% (17 patients) and overall morbidity was 48% (164 patients). At least one pulmonary complication occurred in 57 patients (17%). Significant predictors of pulmonary complications by multivariable analysis for all patients included Dlco (odds ratio 1.03, p=0.003), FEV1 (odds ratio 1.04, p=0.003), and thoracotomy as surgical approach (odds ratio 3.46, p=0.0007). When patients were analyzed according to operative approach, Dlco and FEV1 remained significant predictors of pulmonary morbidity for patients undergoing thoracotomy but not thoracoscopy. CONCLUSIONS: In patients with impaired pulmonary function, preoperative pulmonary function tests are predictors of pulmonary complications when lobectomy for lung cancer is performed through thoracotomy but not through thoracoscopy.

Authors
Berry, MF; Villamizar-Ortiz, NR; Tong, BC; Burfeind, WR; Harpole, DH; D'Amico, TA; Onaitis, MW
MLA Citation
Berry, MF, Villamizar-Ortiz, NR, Tong, BC, Burfeind, WR, Harpole, DH, D'Amico, TA, and Onaitis, MW. "Pulmonary function tests do not predict pulmonary complications after thoracoscopic lobectomy." Ann Thorac Surg 89.4 (April 2010): 1044-1051.
PMID
20338305
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
89
Issue
4
Publish Date
2010
Start Page
1044
End Page
1051
DOI
10.1016/j.athoracsur.2009.12.065

Outcomes of video-assisted thoracoscopic decortication.

BACKGROUND: Video-assisted thoracoscopic surgical decortication (VATSD) is widely used for treatment of early empyema and hemothorax, but conversion to open thoracotomy for decortication (OD) is more frequent in the setting of complex, chronic empyema. This study compared indications for and outcomes associated with VATSD and OD. METHODS: The outcomes of 420 consecutive patients undergoing VATSD or OD for benign conditions from 1996 to 2006 were reviewed and compared with respect to baseline characteristics, preoperative management, and operative and postoperative course. Patients were analyzed on an intention-to-treat basis. RESULTS: The cohort consisted of 326 VATSD and 94 OD patients. The conversion rate from VATSD to OD was 11.4%. The operative time and median in-hospital length of stay were shorter for the VATSD group: 97 vs 155 minutes (p < 0.001), and 15 vs 21 days (p = 0.03), respectively. The median postoperative length of stay was 7 days for the VATSD group vs 10 days for the OD group (p < 0.001). Significantly fewer postoperative complications occurred in the VATSD group in the following categories: atelectasis, prolonged air leak, reintubation, ventilator dependence, need for tracheostomy, blood transfusion, sepsis, and 30-day mortality. CONCLUSIONS: Thoracoscopic decortication for empyema, complex pleural effusion, and hemothorax yields results that are at least equivalent to open decortication. Patients undergoing VATSD have fewer postoperative complications. The conversion and reoperation rates are low, suggesting that a thoracoscopic approach is an effective and reasonable first option for most patients with complex pleural effusions and empyema.

Authors
Tong, BC; Hanna, J; Toloza, EM; Onaitis, MW; D'Amico, TA; Harpole, DH; Burfeind, WR
MLA Citation
Tong, BC, Hanna, J, Toloza, EM, Onaitis, MW, D'Amico, TA, Harpole, DH, and Burfeind, WR. "Outcomes of video-assisted thoracoscopic decortication." Ann Thorac Surg 89.1 (January 2010): 220-225.
PMID
20103240
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
89
Issue
1
Publish Date
2010
Start Page
220
End Page
225
DOI
10.1016/j.athoracsur.2009.09.021

Risk factors for morbidity after lobectomy for lung cancer in elderly patients.

BACKGROUND: Studies evaluating risk factors for complications after lobectomy in elderly patients have not adequately analyzed the effect of using minimally invasive approaches. METHODS: A model for morbidity including published preoperative risk factors and surgical approach was developed by multivariable logistic regression. All patients aged 70 years or older who underwent lobectomy for primary lung cancer without chest wall resection or airway procedure between December 1999 and October 2007 at a single institution were reviewed. Preoperative, histopathologic, perioperative, and outcome variables were assessed using standard descriptive statistics. Morbidity was measured as a patient having any perioperative complication. The impact of bias in the selection of surgical approach was assessed using propensity scoring. RESULTS: During the study period, 338 patients older than 70 years (mean age, 75.7 +/- 0.2) underwent lobectomy (219 thoracoscopy, 119 thoracotomy). Operative mortality was 3.8% (13 patients) and morbidity was 47% (159 patients). Patients with at least one complication had increased length of stay (8.3 +/- 0.6 versus 3.8 +/- 0.1 days; p < 0.0001) and mortality (6.9% [11 of 159] versus 1.1% [2 of 179]; p = 0.008). Significant predictors of morbidity by multivariable analysis included age (odds ratio, 1.09 per year; p = 0.01) and thoracotomy as surgical approach (odds ratio, 2.21; p = 0.004). Thoracotomy remained a significant predictor of morbidity when the propensity to undergo thoracoscopy was considered (odds ratio, 4.9; p= 0.002). CONCLUSIONS: Patients older than 70 years of age can undergo lobectomy for lung cancer with low morbidity and mortality. Advanced age and the use of a thoracotomy increased the risk of complications in this patient population.

Authors
Berry, MF; Hanna, J; Tong, BC; Burfeind, WR; Harpole, DH; D'Amico, TA; Onaitis, MW
MLA Citation
Berry, MF, Hanna, J, Tong, BC, Burfeind, WR, Harpole, DH, D'Amico, TA, and Onaitis, MW. "Risk factors for morbidity after lobectomy for lung cancer in elderly patients." Ann Thorac Surg 88.4 (October 2009): 1093-1099.
PMID
19766786
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
88
Issue
4
Publish Date
2009
Start Page
1093
End Page
1099
DOI
10.1016/j.athoracsur.2009.06.012

Quality of life outcomes are equivalent after lobectomy in the elderly.

OBJECTIVE: Prospective analyses of quality of life in elderly patients after lobectomy are limited, yet surgeons often recommend suboptimal therapy to these patients on the basis of the belief that lobectomy is poorly tolerated. Surgical decision making in elderly patients with lung cancer is better informed when the benefits to survival and quality of life after lobectomy are understood. METHODS: By using a validated quality of life instrument, 422 patients were prospectively assessed preoperatively and 3, 6, and 12 months after lobectomy. Outcomes were analyzed with respect to age (group 1: < 70 years and group 2: > or = 70 years). The outcome domains of physical functioning, role functioning, emotional functioning, cognitive functioning, social functioning, global health, and pain in the chest were analyzed using a mixed model. The trend in quality of life was determined according to age. The Kaplan-Meier method was used for analysis of overall survival. RESULTS: The mean age was 60.1 years in group 1 (N = 256) and 74.7 years in group 2 (N = 166). Baseline demographics and quality of life were similar except that group 2 had better emotional functioning scores and worse pain in the chest scores. Postoperatively, both groups demonstrated significant decreases in quality of life at 3 months. However, at 6 and 12 months, all domains had returned to baseline except physical functioning, which remained below baseline in group 2. Emotional functioning improved postoperatively for both groups. Overall survival at 5 years was not different between groups. CONCLUSION: By using a validated quality of life assessment tool with measurements at baseline and serially after resection in a large patient population, this analysis quantifies the degree of impairment of quality of life after lobectomy and documents time to full recovery for both age groups.

Authors
Burfeind, WR; Tong, BC; O'Branski, E; Herndon, JE; Toloza, EM; D'Amico, TA; Harpole, LH; Harpole, DH
MLA Citation
Burfeind, WR, Tong, BC, O'Branski, E, Herndon, JE, Toloza, EM, D'Amico, TA, Harpole, LH, and Harpole, DH. "Quality of life outcomes are equivalent after lobectomy in the elderly." J Thorac Cardiovasc Surg 136.3 (September 2008): 597-604.
PMID
18805257
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
136
Issue
3
Publish Date
2008
Start Page
597
End Page
604
DOI
10.1016/j.jtcvs.2008.02.093

Audit, quality control, and performance in thoracic surgery: a North American perspective.

Although difficult to precisely define, health care quality is often measured by components of structure, outcomes, and process. One way for thoracic surgeons to evaluate their practices is to compare themselves with evidence-based national guidelines. Outcomes data are often generated from entries into large patient databases. The largest examples of these databases include the STS National Databases and the VA/ACS NSQIP programs. Each of these has unique features, but there is the common goal of enabling participants to examine their surgical outcomes and results relative to others. The data integrity of these databases is high. The new STS composite quality score for CABG combines providers' outcome and practice data into a calculated index for comparison with national averages. In addition to providing meaningful information regarding surgical outcomes and quality, these databases are used as the basis for risk-adjusted models to accurately predict surgical morbidity and mortality. These models can be used as auditing tools against which surgeon- and site-specific morbidity and mortality can be compared with predicted values. As practices and methods continue to evolve, measures of quality--and therefore quality itself--will continue to improve, resulting in better patient care.

Authors
Tong, BC; Harpole, DH
MLA Citation
Tong, BC, and Harpole, DH. "Audit, quality control, and performance in thoracic surgery: a North American perspective." Thorac Surg Clin 17.3 (August 2007): 379-386. (Review)
PMID
18072358
Source
pubmed
Published In
Thoracic Surgery Clinics
Volume
17
Issue
3
Publish Date
2007
Start Page
379
End Page
386
DOI
10.1016/j.thorsurg.2007.08.003

Molecular margin analysis predicts local recurrence after sublobar resection of lung cancer

Sublobar resection for early-stage lung cancer has been used for patients who are not candidates for lobar resection. However, sublobar resection is associated with high local recurrence rates in the context of tumor-free parenchymal margins. The mechanism underlying this high recurrence rate is not well understood. We hypothesized that this elevated risk of local recurrence is due to undetected tumor cells present at parenchymal margins thought to be negative by conventional light microscopy. Thirteen of 44 patients who underwent sublobar resection for lung cancer were found to have a k-ras mutation at codon 12.1. A novel fluorescence-based assay for detection of rare copies of mutant DNA in a background of wild-type DNA, fluorescent gap ligase chain reaction, was used to quantitate the mutant/wild-type DNA in a range of 1 to 1/10,000 in histologically normal margins from these resections. Nine of 13 patients had at least one margin with the number of mutant cells over or equal to a threshold of 1/5,000, and of these, 6/9 (67%) recurred locally. None of the remaining 4 patients without mutant DNA in any surgical margin had evidence of recurrence. The higher rate of local recurrence associated with sublobar resection of lung cancer is likely due to the occult presence of tumor cells at resection margins. These occult tumor cells can be quantitated using a novel fluorescence-based assay and define a group of patients at high risk for local recurrence who are candidates for adjuvant therapy or more extensive resection. This methodology may be adaptable to a real-time format for intraoperative use. © 2004 Wiley-Liss, Inc.

Authors
Masasyesva, BG; Tong, BC; Brock, MV; Pilkington, T; Goldenberg, D; Sidransky, D; Harden, S; Westra, WH; Califano, J
MLA Citation
Masasyesva, BG, Tong, BC, Brock, MV, Pilkington, T, Goldenberg, D, Sidransky, D, Harden, S, Westra, WH, and Califano, J. "Molecular margin analysis predicts local recurrence after sublobar resection of lung cancer." International Journal of Cancer 113.6 (2005): 1022-1025.
PMID
15515012
Source
scival
Published In
International Journal of Cancer
Volume
113
Issue
6
Publish Date
2005
Start Page
1022
End Page
1025
DOI
10.1002/ijc.20683

Cellular and physiological effects of arginine

Arginine is a semi-essential amino acid that is required during periods of maximal growth, severe stress, and injury. Arginine is a substrate for protein synthesis but also modulates cellular biochemical functions via conversion to a number of biologically active compounds. Arginine is utilized by a vast variety of metabolic pathways that produce a variety of biologically active compounds such as nitric oxide, creatine phosphate, agmatine, polyamines, ornithine, and citrulline. Arginine supply is primarily regulated by two enzyme systems: arginase (part of the urea cycle) and nitric oxide synthase. Arginine has many effects in the body that include modulation of immune function, wound healing, hormone secretion, vascular tone, insulin sensitivity, and endothelial function. Arginine mediates its effects via nitric oxide independent and dependent pathways. Nitric oxide modulates many cellular functions that include vascular tone, expression of adhesion molecules, leukocyte adhesion, and platelet aggregation. Arginine modulates the development of atherosclerotic cardiovascular disease, improves immune function in healthy and ill patients, stimulates wound healing in healthy and ill patients, and modulates carcinogenesis and tumor growth. Thus, arginine is a biologically active dietary compound with numerous physiologic and pharmacological activities. © 2004 Bentham Science Publishers Ltd.

Authors
Tong, BC; Barbul, A
MLA Citation
Tong, BC, and Barbul, A. "Cellular and physiological effects of arginine." Mini-Reviews in Medicinal Chemistry 4.8 (2004): 823-832.
PMID
15544543
Source
scival
Published In
Mini-Reviews in Medicinal Chemistry
Volume
4
Issue
8
Publish Date
2004
Start Page
823
End Page
832

Use of single nucleotide polykorphism arrays to identify a novel region of loss on chromosome 6q in squamous cell carcinomas of the oral cavity

Background. A subset of patients with oral cavity squamous cell carcinoma (SCC), often of young age yet lacking a history of carcinogen exposure, has been identified, with no clear etiology for tumor development. Methods. To identify somatic genetic alterations unique to this patient population, we performed a high throughput single nucleotide polymorphism (SNP) analysis, quantitative PCR of the E6 and E7 regions of human papillomavirus (HPV) 16, sequencing of the IVSF-4+ locus of the FANC-C gene, and microsatellite analysis for 18 nonsmoking patients, age 23 to 57 years (median age, 39 years). We compared these results with oral SCC from 17 patients 47 to 81 (median, 64) years of age with significant tobacco exposure (>40 pack-years) to identify unique genetic alterations for each group. Results. SNP analysis demonstrated variable rates of allelic imbalance (Al) and no significant difference in terms of Al patterns between the two groups. However, we found an elevated rate of Al in chromosomal arms 6q (47% [17 of 36]) by performing microsatellite analysis of both groups. Only one tumor demonstrated the presence of HPV 16, and none of the tumors demonstrated mutations in the IVSF-4+ region of FANC-C. Conclusions. Despite variable marker density, SNP array analysis is an emerging technique for genome-wide assessment and is a useful tool for discovery of novel sites of allelic loss in oral SCC, including a novel region of allelic loss on chromosome 6q. © 2004 Wiley Periodicals, Inc.

Authors
Tong, BC; Dhir, K; Ha, PK; Westra, WH; Alter, BP; Sidransky, D; Koch, WM; Califano, JA
MLA Citation
Tong, BC, Dhir, K, Ha, PK, Westra, WH, Alter, BP, Sidransky, D, Koch, WM, and Califano, JA. "Use of single nucleotide polykorphism arrays to identify a novel region of loss on chromosome 6q in squamous cell carcinomas of the oral cavity." Head and Neck 26.4 (2004): 345-352.
PMID
15054738
Source
scival
Published In
Head and Neck
Volume
26
Issue
4
Publish Date
2004
Start Page
345
End Page
352
DOI
10.1002/hed.10391

Mitochondrial DNA alterations in thyroid cancer

Background: Alterations in mitochondrial DNA have been identified in a number of solid tumor types, including gastric, head and neck, breast, colorectal, lung, and bladder carcinomas. Recently, a homopolymeric C stretch (D310) located within the noncoding D-loop of the mitochondrial genome was identified and described as a mutational hotspot. The objective of the present study was to examine a series of thyroid cancers for genetic alterations in this region. Methods: Seventy-two (72) thyroid cancers were examined for alterations in D310 using PCR-based methods. The primary tumors tested included 35 papillary carcinomas, 18 medullary carcinomas, 9 anaplastic carcinomas, 9 follicular carcinomas, and 1 insular carcinoma. Results: Alterations in D310 were observed in 2/35 papillary carcinomas (5.7%), 1/18 medullary carcinomas (5.6%), 1/9 anaplastic carcinomas (11.1%), and 1/9 follicular carcinomas (11.1%). Overall, the rate of alterations was 5/72 (6.9%). Conclusions: Mutations in the D310 region of the D-loop of mitochondrial DNA are found in thyroid tumors of varying histologic types and grades. This mutation rate is lower than the reported rate of alteration in tumors of epithelial origin, and shows no relationship to histologic grade. © 2003 Wiley-Liss, Inc.

Authors
Tong, BC; Ha, PK; Dhir, K; Xing, M; Westra, WH; Sidransky, D; Califano, JA
MLA Citation
Tong, BC, Ha, PK, Dhir, K, Xing, M, Westra, WH, Sidransky, D, and Califano, JA. "Mitochondrial DNA alterations in thyroid cancer." Journal of Surgical Oncology 82.3 (2003): 170-173.
PMID
12619060
Source
scival
Published In
Journal of Surgical Oncology
Volume
82
Issue
3
Publish Date
2003
Start Page
170
End Page
173
DOI
10.1002/jso.10202

Methylation of the Thyroid-stimulating Hormone Receptor gene in epithelial thyroid tumors: A marker of malignancy and a cause of gene silencing

Thyroid-stimulating hormone receptor (TSHR) expression is frequently silenced in epithelial thyroid cancers associated with decreased or absent TSH-promoted iodine uptake. To study the underlying molecular mechanism of decreased TSHR expression, we examined the methylation status of the TSHR gene promoter by sequencing bisulfite-treated DNA from thyroid tumors. After identification of methylated sites by sequencing bisulfite-treated DNA, we used methylation-specific polymerase chain reaction and found frequent CpG methylation in papillary thyroid cancer (23 of 39 patients; 59%) and follicular thyroid cancers (7 of 15 patients; 47%). In contrast, we saw no methylation in normal thyroid tissues and benign adenomas (0 of 8 patients; 0%). In human thyroid tumor cell lines, we observed that TSHR was normally expressed at the protein and mRNA level in cells where the TSHR gene was unmethylated, whereas it was silenced in cell lines where the TSHR promoter was hypermethylated. Treatment of the latter cells with a demethylating agent partially restored TSHR expression. We thus demonstrate aberrant methylation of human TSHR as a likely molecular pathway responsible for the silencing of this gene in thyroid cancers. We propose that methylation of TSHR may provide a novel diagnostic marker of malignancy and a basis for potential use of demethylating agents in conjunction with TSH-promoted radioiodine therapy for epithelial thyroid cancers.

Authors
Xing, M; Usadel, H; Cohen, Y; Tokumaru, Y; Guo, Z; Westra, WB; Tong, BC; Tallini, G; Udelsman, R; Califano, JA; al, E
MLA Citation
Xing, M, Usadel, H, Cohen, Y, Tokumaru, Y, Guo, Z, Westra, WB, Tong, BC, Tallini, G, Udelsman, R, Califano, JA, and al, E. "Methylation of the Thyroid-stimulating Hormone Receptor gene in epithelial thyroid tumors: A marker of malignancy and a cause of gene silencing." Cancer Research 63.9 (2003): 2316-2321.
PMID
12727856
Source
scival
Published In
Cancer Research
Volume
63
Issue
9
Publish Date
2003
Start Page
2316
End Page
2321

Real-time quantitative PCR demonstrates low prevalence of human papillomavirus type 16 in premalignant and malignant lesions of the oral cavity

Purpose: Human papillomavirus (HPV) type-16 has been associated with invasive squamous cell carcinoma of the head and neck. This study examines the role of HPV-16 in the progression of oral head and neck cancer by determining the quantity of HPV-16 DNA in premalignant and malignant lesions, using real-time quantitative PCR, to more accurately determine the role of HPV-16 in oral head and neck squamous cell carcinogenesis. Experimental Design: We examined 102 microdissected premalignant head and neck lesions (85 from the oral cavity), 34 invasive oral cavity squamous cell carcinomas, as well as 18 invasive tumors known to be HPV positive by traditional molecular technology for the presence of HPV-16 DNA using real-time quantitative PCR. Results: HPV DNA was detected in 1 of 102 premalignant lesions (0.98%), 1 of 34 (2.9%) invasive oral cavity carcinomas, and 14 of 18 (78%) known HPV-positive tumors. Conclusions: HPV-16 infection and integration is seldom found in oral premalignant lesions and invasive carcinoma, and therefore rarely contributes to malignant progression in the oral cavity. Furthermore, quantitative PCR is a useful technique that reliably excludes contaminated samples and those with minimal HPV DNA content that is unlikely to be significant in carcinogenesis.

Authors
Ha, PK; Pai, SI; Westra, WH; Gillison, ML; Tong, BC; Sidransky, D; Califano, JA
MLA Citation
Ha, PK, Pai, SI, Westra, WH, Gillison, ML, Tong, BC, Sidransky, D, and Califano, JA. "Real-time quantitative PCR demonstrates low prevalence of human papillomavirus type 16 in premalignant and malignant lesions of the oral cavity." Clinical Cancer Research 8.5 (2002): 1203-1209.
PMID
12006539
Source
scival
Published In
Clinical Cancer Research
Volume
8
Issue
5
Publish Date
2002
Start Page
1203
End Page
1209

Bladder carcinoma in a transplant recipient: Evidence to implicate the BK human polyomavirus as a causal transforming agent

The BK polyomavirus (BKV) infects most of the human population, but clinically relevant infections are mostly limited to individuals who are immunosuppressed. In transplant recipients, BKV has been associated with ureteral stenosis, interstitial nephritis, and hemorrhagic cystitis. The role of BKV in the development of human tumors is intriguing but uncertain. BKV has been identified in various tumor types including urothelial carcinoma, but the ubiquitous presence of BKV as a latent infection has confounded efforts to validate any causal role in cancer development. We report the case of a simultaneous pancreas and kidney transplant recipient who developed BKV interstitial nephritis and carcinoma of the bladder with widespread metastases. High level expression of BKV large T antigen in the primary and metastatic carcinoma, but not in the nonneoplastic urothelium, implicates BKV as an etiologic agent in the development of this tumor.

Authors
Geetha, D; Tong, BC; Racusen, L; Markowitz, JS; Westra, WH
MLA Citation
Geetha, D, Tong, BC, Racusen, L, Markowitz, JS, and Westra, WH. "Bladder carcinoma in a transplant recipient: Evidence to implicate the BK human polyomavirus as a causal transforming agent." Transplantation 73.12 (2002): 1933-1936.
PMID
12131691
Source
scival
Published In
Transplantation
Volume
73
Issue
12
Publish Date
2002
Start Page
1933
End Page
1936

Mitochondrial C-tract alteration in premalignant lesions of the head and neck: A marker for progression and clonal proliferation

Purpose: Although mitochondrial DNA mutations have been described recently in many different tumor types, the nature and timing of such alterations remain unclear. In an effort to further examine the role of mitochondrial DNA mutations in carcinogenesis, we examined 137 premalignant lesions of the head and neck from 93 patients for DNA alterations in the poly-cytosine tract (C-tract) of the displacement loop, discovered recently to be a hot spot of mitochondrial DNA alteration. Experimental Design: All premalignant lesions were tested using a length-based PCR assay, which amplified the C-tract region of mitochondrial DNA. Somatic microsatellites at six loci were also tested on a subset of patients with metachronous or synchronous lesions found to possess a mitochondrial C-tract alteration. Results: Thirty-four of 93 (37%) patients harbored lesions that displayed a C-tract alteration. There was a clear increase in incidence from histologically benign hyperplasia (22%) to squamous carcinoma in situ (62%: P < 0.01). We also tested synchronous dysplastic lesions, metachronous dysplastic lesions, and normal epithelium adjacent to dysplastic epithelium with this assay. In most cases, the mitochondrial C-tract status identified a clonal relationship between these lesions. Genomic microsatellites also confirmed that a clonal relationship was present in many of these cases. Conclusions: Mitochondrial DNA alterations in the head and neck occur in the earliest premalignant lesions and demonstrate a rising incidence that parallels histological severity. These alterations are valuable as additional markers of histopathological progression.

Authors
Ha, PK; Tong, BC; Westra, WH; Sanchez-Cespedes, M; Parrella, P; Zahurak, M; Sidransky, D; Califano, JA
MLA Citation
Ha, PK, Tong, BC, Westra, WH, Sanchez-Cespedes, M, Parrella, P, Zahurak, M, Sidransky, D, and Califano, JA. "Mitochondrial C-tract alteration in premalignant lesions of the head and neck: A marker for progression and clonal proliferation." Clinical Cancer Research 8.7 (2002): 2260-2265.
PMID
12114429
Source
scival
Published In
Clinical Cancer Research
Volume
8
Issue
7
Publish Date
2002
Start Page
2260
End Page
2265

Mutation of the PTEN tumor suppressor gene is not a feature of ovarian cancers.

OBJECTIVE: The PTEN tumor suppressor gene on chromosome 10q23 undergoes inactivating mutations in several types of malignancies including glioblastomas and prostate and endometrial carcinomas. The aim of this study was to determine if mutation of the PTEN tumor suppressor gene is a feature of sporadic or BRCA1-associated ovarian carcinomas. METHODS: Genomic deoxyribonucleic acid was extracted from 11 ovarian cancer cell lines and 50 frozen ovarian cancers, including 4 cases that developed in women with germline mutations in the BRCA1 breast/ovarian cancer susceptibility gene. The polymerase chain reaction was used to amplify each of the nine exons and intronic splice sites of the PTEN gene. These products were then screened for mutations using single strand conformation polymorphism analysis. Variant bands were further evaluated using automated DNA sequencing. RESULTS: A previously unreported silent polymorphism at codon 240 (TAT to TAC) in exon 7 was noted in one of the primary ovarian carcinomas. Mutations in the PTEN gene were not found in any of the 50 primary ovarian cancers or 11 immortalized ovarian cancer cell lines. CONCLUSION: Alteration of the PTEN tumor suppressor gene does not appear to be a feature of sporadic or BRCA1-associated ovarian cancers.

Authors
Maxwell, GL; Risinger, JI; Tong, B; Shaw, H; Barrett, JC; Berchuck, A; Futreal, PA
MLA Citation
Maxwell, GL, Risinger, JI, Tong, B, Shaw, H, Barrett, JC, Berchuck, A, and Futreal, PA. "Mutation of the PTEN tumor suppressor gene is not a feature of ovarian cancers." Gynecologic oncology 70.1 (July 1998): 13-16. (Academic Article)
PMID
9698466
Source
manual
Published In
Gynecologic Oncology
Volume
70
Issue
1
Publish Date
1998
Start Page
13
End Page
16

Effect of uniaxial, cyclic stretch on the morphology of monocytes/macrophages in culture

Biological cells change their morphology and function in response to their mechanical environment. Cyclic stretch in particular has been found recently to have diverse effects on endothelial cells. In this study, cyclic stretch was applied to cultured monocyte/macrophage to determine whether the differentiation mode and orientation of these cells were affected by the mechanical stimulation.

Authors
Matsumoto, T; Delafontaine, P; Schnetzer, KJ; Tong, BC; Nerem, RM
MLA Citation
Matsumoto, T, Delafontaine, P, Schnetzer, KJ, Tong, BC, and Nerem, RM. "Effect of uniaxial, cyclic stretch on the morphology of monocytes/macrophages in culture." Journal of Biomechanical Engineering 118.3 (1996): 420-422.
PMID
8872266
Source
scival
Published In
Journal of Biomechanical Engineering
Volume
118
Issue
3
Publish Date
1996
Start Page
420
End Page
422

TGF- β Promotes the Growth of Bovine Chondrocytes in Monolayer Culture and the Formation of Cartilage Tissue on Three-Dimensional Scaffolds

Authors
Zimber, MP; Tong, B; Dunkelman, N; Pavelec, R; Grande, D; New, L; Purchio, AF
MLA Citation
Zimber, MP, Tong, B, Dunkelman, N, Pavelec, R, Grande, D, New, L, and Purchio, AF. "TGF- β Promotes the Growth of Bovine Chondrocytes in Monolayer Culture and the Formation of Cartilage Tissue on Three-Dimensional Scaffolds." Tissue Engineering 1.3 (September 1995): 289-300.
Source
crossref
Published In
Tissue Engineering
Volume
1
Issue
3
Publish Date
1995
Start Page
289
End Page
300
DOI
10.1089/ten.1995.1.289
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Research Areas:

  • Esophagus--Cancer--Surgery
  • Lungs--Cancer--Patients
  • Lungs--Cancer--Surgery
  • Mesothelioma
  • Small cell lung cancer