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Fifteen Is Just a Number
No full textLymph node dissection remains an essential part of any oncologic surgery. At a minimum, sentinel node sampling is required for some cancers. For many solid malignancies, including lung and esophageal cancer, the number of lymph nodes resected correlates with long-term outcomes. The debate remains regarding the relative contributions of the oncologic impact of a thorough lymph node sampling vs stage migration leading to the improved outcomes. An alternative explanation, still, is that a thorough lymph node sampling may just be a surrogate marker of comprehensive quality care, without having any direct impact on cancer-related outcomes
One Size Does Not Fit All
No full textWith broad strokes, major contributing oncogenic factors include the patient’s genetic composition, environmental exposures, and the host microbiome. Within specific cancer types, such as lung cancer, regional differences of genetics, environmental exposure, and the biome result in tumors with differential behaviors. Therefore, optimal lung cancer treatments in one part of the world may not be applicable elsewhere. For more than a decade, the Japanese have led the world’s pursuit of sublobar resections for early-stage lung cancers. Okada and colleagues showed in 2006 that the 5-year overall survival for patients with peripheral lung cancers ≤2 cm was nearly identical between patients treated with sublobar resections compared to lobectomy. Importantly, the survival in both groups was 89%, while the most patients had tumors at the at upper end of the ≤2 cm spectrum. This survival was notably better than what has been observed for similarly staged lung cancers in other regions of the world. Consistently, Japanese series have demonstrated better long-term survival for lung cancer patients in general and superior outcomes after sublobar resections compared with outcomes elsewhere. At the same time, Japanese lung cancer series typically are composed of greater proportions of women and nonsmokers than series in other regions of the world. These differences in demographics and outcomes suggest fundamental biological differences. As a result, treatments appropriate in Japan may or may not be applicable elsewhere. Recent results of a prospective, randomized, multiinstitutional North American study did support sublobar resections of small peripheral lung cancers.4 That study randomized 697 patients with ≤2 cm tumors over a 10-year period to lobectomy vs sublobar resection, resulting in similar outcomes with 5-year overall survival rates of 78.9% vs 80.3%, respectively.
Most retrospective reviews and prospective clinical trials have used 2 cm as a cutoff for tumors acceptably treated with sublobar resection. In this issue of The Annals of Thoracic Surgery, Mimae and colleagues have pushed the envelope further by examining the outcomes of patients with tumors 2-4 cm among a patient cohort aged >70 years. They observed statistically similar outcomes in patients treated with sublobar resections compared to lobectomy and concluded that a sublobar resection should be considered the procedure of choice for octogenarians with tumors up to 4 cm. It may be important to consider that excellent outcomes can be achieved with sublobar resections among older patients if similar selection criteria are used. Its notable that in the entire cohort, a lobectomy was performed more than 3 times more frequently than sublobar resections, suggesting that a lobectomy was actually the preferred approach. Differences between the 2 surgical groups imply that surgeons may have selectively offered sublobar resections to patients with more indolent-appearing tumors. A greater proportion of patients in the sublobar group had tumors 2-3 cm rather than 3-4 cm. In addition, patients in the sublobar group had tumors with a greater ground glass component. The comparable long-term survival results support the authors’ intuition leading them to recommend sublobar resections for patients with more indolent features
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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