Pier Filosso - Academia.edu (original) (raw)

Papers by Pier Filosso

Research paper thumbnail of The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: proposals for the N and M components for the forthcoming (8th) edition of the TNM classification of malignant tumors

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2014

Stage classification is an important underpinning of management of patients with cancer, and rest... more Stage classification is an important underpinning of management of patients with cancer, and rests on a combination of three components: T for tumor extent, N for nodal involvement, and M for more distant metastases. This article details an initiative to develop proposals for the first official stage classification system for thymic malignancies for the 8th edition of the stage classification manuals. Specifically, the results of analysis of a large database and the considerations leading to the proposed N and M components are described. Nodal involvement is divided into an anterior (N1) and a deep (N2) category. Metastases can involve pleural or pericardial nodules (M1a) or intraparenchymal pulmonary nodules or metastases to distant sites (M1b).

Research paper thumbnail of Pulmonary adenocarcinomas: a single-centre validation study of the clinical and prognostic utility of the WHO/IASLC subtype classification

Research paper thumbnail of PREVALENCE, CORRELATIONS, AND PROGNOSTIC SIGNIFICANCE OF THE PRESENCE OF MICROSCOPIC VASCULAR INVASION FOLLOWING COMPLETE RESECTION OF STAGE I NON-SMALL CELL LUNG CARCINOMA. AN UNDERESTIMATED FACTOR?

Research paper thumbnail of Significance of the Presence of Microscopic Vascular Invasion After Complete Resection of Stage I–II pT1-T2N0 Non-small Cell Lung Cancer and Its Relation with T-Size Categories

Journal of Thoracic Oncology, 2011

The aim of this study was to assess the significance of microscopic vascular invasion (MVI) in a ... more The aim of this study was to assess the significance of microscopic vascular invasion (MVI) in a population of resected patients with early-stage non-small cell lung cancer (NSCLC), along with an analysis of the effect of the combination of MVI and tumor size for the T-size categories T1a-T2b according to the 2009 7th edition of the tumor, node, metastasis (TNM) classification. Methods: From January 1993 to August 2008, 746 patients with pT1-T2N0 NSCLC received resection at our institution. MVI was ascertained using histopathological and immunohistochemical techniques. Results: MVI was observed in 257 patients (34%). Prevalence was higher in adenocarcinoma (ADK) than in squamous cell carcinoma (p ϭ 0.002). A significant correlation was found between MVI and ADK (p ϭ 0.03), increased tumor dimension (p ϭ 0.05), and the presence of tumor-infiltrating lymphocytes (p ϭ 0.02). The presence of MVI was associated with a reduced 5-year survival overall (p ϭ 0.003) and in ADK (p ϭ 0.0002). In a multivariate survival analysis, MVI was an indicator of poor survival overall (p ϭ 0.003) and in ADK (p ϭ 0.0005). In each T category (T1a-T2b) of the 2009 TNM staging system, survival of MVIϩ patients was significantly lower than the corresponding MVIϪ patients; T1a and T1b MVIϩ patients had a survival similar to MVIϪ T2 patients.

Research paper thumbnail of Large-cell neuroendocrine carcinoma (LCNC) of the lung: a dilemma

European Journal of Cardio-Thoracic Surgery, 2003

Research paper thumbnail of 338 Efficacy of lanreotide in the control of carcinoid syndrome. Preliminary results in patients operated for neuroendocrine carcinomas of the lung

Research paper thumbnail of Long-term survival of atypical bronchial carcinoids with liver metastases, treated with octreotideq

Objective: To demonstrate that liver metastases by radically resected atypical carcinoids of the ... more Objective: To demonstrate that liver metastases by radically resected atypical carcinoids of the lung can be effectively treated by new somatostatin analogs. Methods: Between January 1977 and December 1999, 126 patients affected by bronchial carcinoids were submitted to a radical resection of the lung. Seven of them (5.5%) presented liver metastases 27, 22, 14, 18, 16, 12 and 9 months

Research paper thumbnail of Pulmonary resection for metastases from colorectal cancer: factors influencing prognosis. Twenty-year experience

Objective: We reviewed our experience in the surgical management of 80 patients with colorectal p... more Objective: We reviewed our experience in the surgical management of 80 patients with colorectal pulmonary metastases and investigated factors affecting survival. Material and methods: From January 1980 to December 2000, 80 patients, 43 women and 37 men with median age 63 years (range 38-79 years) underwent 98 open surgical procedure (96 muscle-sparing thoracotomy, one clamshell and one median sternotomy) for

Research paper thumbnail of Bronchial carcinoid tumors: Surgical management and long-term outcome

We sought to determine the variables influencing long-term survival of patients treated for bronc... more We sought to determine the variables influencing long-term survival of patients treated for bronchial carcinoid tumors.

Research paper thumbnail of Solitary fibrous tumour of the pleura: surgical treatment

Objective: Solitary fibrous tumours (SFT) of the pleura are rare tumours originated from the mese... more Objective: Solitary fibrous tumours (SFT) of the pleura are rare tumours originated from the mesenchimal tissue underlying the mesothelial layer of the pleura. This tumours present unpredictable clinical course probably related to their histological and morphological characteristics. Methods: Twenty-one patients affected by SFT of the pleura were referred to us for surgical resection from September 1984 to April 2000. They

Research paper thumbnail of Multidisciplinary management of advanced lung neuroendocrine tumors

Journal of thoracic disease, 2015

The optimal clinical management of aggressive/advanced lung neuroendocrine tumors (NETs) is still... more The optimal clinical management of aggressive/advanced lung neuroendocrine tumors (NETs) is still debated, due to their rarity and the lack of prospective randomized studies. Results derive from retrospective mono-Institutional series, and few dedicated prospective trials, recently designed, are still ongoing. In low-grade tumors [bronchial carcinoids (BCs)] surgery, whenever feasible, remains the mainstay of treatment, and chemo/radiotherapy (RT) should be reserved to progressive diseases (PD). In case of resected N1-N2 BCs, a "watch and see" policy associated with a close clinical/radiological follow-up is recommended. Somatostatin analogs (SSA) seem to be effective in controlling BCs associated endocrine syndromes, while SSA antiproliferative effect has also been reported in the past. Targeted therapy with new drugs (Everolimus) seems to be very promising, but further trials are needed. Surgery alone is not sufficient to treat high-grade NETs: adjuvant CT is required al...

Research paper thumbnail of Addressing a missing point: The short- and long-term effects of a lung sealant patch

The Journal of thoracic and cardiovascular surgery, Jan 13, 2015

Research paper thumbnail of 9114 Malignant pleural mesothelioma: the prognostic significance of different surgical treatments. A retrospective study from a single-institution experience

Research paper thumbnail of Exploring Stage I non-small-cell lung cancer: development of a prognostic model predicting 5-year survival after surgical resection

European Journal of Cardio-Thoracic Surgery, 2014

OBJECTIVES: Despite impressive results in diagnosis and treatment of non-small-cell lung cancer (... more OBJECTIVES: Despite impressive results in diagnosis and treatment of non-small-cell lung cancer (NSCLC), more than 30% of patients with Stage I NSCLC die within 5 years after surgical treatment. Identification of prognostic factors to select patients with a poor prognosis and development of tailored treatment strategies are then advisable. The aim of our study was to design a model able to define prognosis in patients with Stage I NSCLC, submitted to surgery with curative intent.

Research paper thumbnail of Thymic neuroendocrine tumors

Thymic neuroendocrine tumors (NETs) are rare and account for approximately 2% to 5% of all thymic... more Thymic neuroendocrine tumors (NETs) are rare and account for approximately 2% to 5% of all thymic tumors. 1,2 In the last SEER database, the reported incidence of thymic NETs was 0.02/ 100,000 population per year. The median age at diagnosis is about 54 years with a male prevalence (male-to-female ratio of 3:1). Up to 25% of thymic NETs arise in patients with multiple endocrine neoplasia type 1 (MEN-1), 4,5 and among them, 3% to 8% develop thymic NETs. 5,6 Nearly all cases associated with MEN-1 are men and smokers. 7

Research paper thumbnail of Extended transcervical thymectomy with partial upper sternotomy: results in non-thymomatous patients with myasthenia gravis

European Journal of Cardio-Thoracic Surgery, 2014

OBJECTIVES: Thymectomy is a recognized treatment for myasthenia gravis (MG), but the optimal surg... more OBJECTIVES: Thymectomy is a recognized treatment for myasthenia gravis (MG), but the optimal surgical approach is yet to be determined. This study analysed the results in non-thymomatous MG patients treated at our institution using an extended transcervical access with partial upper sternotomy (TC-US), in order to describe cumulative incidence of remission and its predictors.

Research paper thumbnail of Thymic carcinoma outcomes and prognosis: Results of an international analysis

The Journal of thoracic and cardiovascular surgery, 2015

The objectives of this collaborative study were to characterize patients with thymic carcinoma, t... more The objectives of this collaborative study were to characterize patients with thymic carcinoma, their treatment patterns, and association with overall survival (OS) and recurrence-free survival (RFS). Clinical, pathologic, treatment, and follow-up information were analyzed. OS and RFS were the primary outcome measures. In 1042 cases of thymic carcinoma, 42 (5%) patients had pathologic Masaoka stage I, 138 (17%) had stage II, 370 (45%) had stage III, and 274 (33%) had stage IV disease. Overall, 166 patients (22%) underwent induction chemotherapy and 48 (6%) had preoperative radiation therapy. An R0 resection was performed in 447 cases (61%), R1 in 102 cases (14%), and R2 in 184 cases (25%). Squamous cell carcinoma was the predominant histologic subtype (n = 560; 79%). Adjuvant chemotherapy was administered to 237 (31%) patients, and 449 (60%) received adjuvant radiation therapy. The median OS was 6.6 years (95% confidence interval [CI], 5.8-8.3) and the cumulative incidence of recurr...

Research paper thumbnail of 904 Quantitative perfusion lung scanning in the surgery of the lung cancer in the elderly

Research paper thumbnail of Adenosquamous lung carcinomas: A histologic subtype with poor prognosis

Lung Cancer, 2011

Introduction: The aim of this study is to evaluate the prognostic factors and outcome of patients... more Introduction: The aim of this study is to evaluate the prognostic factors and outcome of patients operated for adenosquamous (ADS) carcinoma of the lung, in comparison with adenocarcinoma (AD) and squamous cell carcinoma (SCC). Methods: a retrospective review of our thoracic cancer surgical database for patients operated for ADS, SCC and AD between January, 1995 and December, 2009 was done. Results: Forty-eight patients (39 males, 81.3%) had ADS; complete tumor resection and lymphadenectomy was accomplished in all patients. A higher stage at presentation was observed in ADS, as compared to AD or SCC (p = 0.0001). Three and 5-year survival rates were 25% and 15%. ADS overall survival was worse than AD or SCC (p = 0.0005). Three and 5-year survival rates of ADS Stage I were similar to those of Stage IIIA AD or SCC. More than half ADS patients developed distant metastases (MTS) or local recurrences. Brain MTS were the most frequent. Median survival for those patients was 8 ± 2.3 months. Postoperative platinumbased chemotherapy statistically improved patients survival (p = 0.02). In the multivariate analysis, the presence of MTS (p = 0.001), the tumor perineural invasion (p = 0.01) and the tumor stage (p = 0.0005) were factors associated with poor prognosis. Adjuvant chemotherapy was a significant positive prognostic factor (p = 0.00001). Conclusions: ADS are uncommon and extremely aggressive lung tumors. Adjuvant chemotherapy should be administered even in Stage I radically resected tumors. A whole brain postoperative prophylactic radiotherapy could be proposed to reduce risk of developing brain MTS.

Research paper thumbnail of Radical resection of a giant, invasive and symptomatic malignant Solitary Fibrous Tumour (SFT) of the pleura

Lung Cancer, 2009

Solitary Fibrous Tumours (SFTs) of the pleura are rare neoplasms, with unpredictable biological b... more Solitary Fibrous Tumours (SFTs) of the pleura are rare neoplasms, with unpredictable biological behaviour. Although usually benign, malignant SFTs are described, and they are often associated with large, necrotic and locally invasive tumours. Radical resection represents the treatment of choice in all cases; recurrences are uncommon, and redo-surgery should be considered.

Research paper thumbnail of The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: proposals for the N and M components for the forthcoming (8th) edition of the TNM classification of malignant tumors

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2014

Stage classification is an important underpinning of management of patients with cancer, and rest... more Stage classification is an important underpinning of management of patients with cancer, and rests on a combination of three components: T for tumor extent, N for nodal involvement, and M for more distant metastases. This article details an initiative to develop proposals for the first official stage classification system for thymic malignancies for the 8th edition of the stage classification manuals. Specifically, the results of analysis of a large database and the considerations leading to the proposed N and M components are described. Nodal involvement is divided into an anterior (N1) and a deep (N2) category. Metastases can involve pleural or pericardial nodules (M1a) or intraparenchymal pulmonary nodules or metastases to distant sites (M1b).

Research paper thumbnail of Pulmonary adenocarcinomas: a single-centre validation study of the clinical and prognostic utility of the WHO/IASLC subtype classification

Research paper thumbnail of PREVALENCE, CORRELATIONS, AND PROGNOSTIC SIGNIFICANCE OF THE PRESENCE OF MICROSCOPIC VASCULAR INVASION FOLLOWING COMPLETE RESECTION OF STAGE I NON-SMALL CELL LUNG CARCINOMA. AN UNDERESTIMATED FACTOR?

Research paper thumbnail of Significance of the Presence of Microscopic Vascular Invasion After Complete Resection of Stage I–II pT1-T2N0 Non-small Cell Lung Cancer and Its Relation with T-Size Categories

Journal of Thoracic Oncology, 2011

The aim of this study was to assess the significance of microscopic vascular invasion (MVI) in a ... more The aim of this study was to assess the significance of microscopic vascular invasion (MVI) in a population of resected patients with early-stage non-small cell lung cancer (NSCLC), along with an analysis of the effect of the combination of MVI and tumor size for the T-size categories T1a-T2b according to the 2009 7th edition of the tumor, node, metastasis (TNM) classification. Methods: From January 1993 to August 2008, 746 patients with pT1-T2N0 NSCLC received resection at our institution. MVI was ascertained using histopathological and immunohistochemical techniques. Results: MVI was observed in 257 patients (34%). Prevalence was higher in adenocarcinoma (ADK) than in squamous cell carcinoma (p ϭ 0.002). A significant correlation was found between MVI and ADK (p ϭ 0.03), increased tumor dimension (p ϭ 0.05), and the presence of tumor-infiltrating lymphocytes (p ϭ 0.02). The presence of MVI was associated with a reduced 5-year survival overall (p ϭ 0.003) and in ADK (p ϭ 0.0002). In a multivariate survival analysis, MVI was an indicator of poor survival overall (p ϭ 0.003) and in ADK (p ϭ 0.0005). In each T category (T1a-T2b) of the 2009 TNM staging system, survival of MVIϩ patients was significantly lower than the corresponding MVIϪ patients; T1a and T1b MVIϩ patients had a survival similar to MVIϪ T2 patients.

Research paper thumbnail of Large-cell neuroendocrine carcinoma (LCNC) of the lung: a dilemma

European Journal of Cardio-Thoracic Surgery, 2003

Research paper thumbnail of 338 Efficacy of lanreotide in the control of carcinoid syndrome. Preliminary results in patients operated for neuroendocrine carcinomas of the lung

Research paper thumbnail of Long-term survival of atypical bronchial carcinoids with liver metastases, treated with octreotideq

Objective: To demonstrate that liver metastases by radically resected atypical carcinoids of the ... more Objective: To demonstrate that liver metastases by radically resected atypical carcinoids of the lung can be effectively treated by new somatostatin analogs. Methods: Between January 1977 and December 1999, 126 patients affected by bronchial carcinoids were submitted to a radical resection of the lung. Seven of them (5.5%) presented liver metastases 27, 22, 14, 18, 16, 12 and 9 months

Research paper thumbnail of Pulmonary resection for metastases from colorectal cancer: factors influencing prognosis. Twenty-year experience

Objective: We reviewed our experience in the surgical management of 80 patients with colorectal p... more Objective: We reviewed our experience in the surgical management of 80 patients with colorectal pulmonary metastases and investigated factors affecting survival. Material and methods: From January 1980 to December 2000, 80 patients, 43 women and 37 men with median age 63 years (range 38-79 years) underwent 98 open surgical procedure (96 muscle-sparing thoracotomy, one clamshell and one median sternotomy) for

Research paper thumbnail of Bronchial carcinoid tumors: Surgical management and long-term outcome

We sought to determine the variables influencing long-term survival of patients treated for bronc... more We sought to determine the variables influencing long-term survival of patients treated for bronchial carcinoid tumors.

Research paper thumbnail of Solitary fibrous tumour of the pleura: surgical treatment

Objective: Solitary fibrous tumours (SFT) of the pleura are rare tumours originated from the mese... more Objective: Solitary fibrous tumours (SFT) of the pleura are rare tumours originated from the mesenchimal tissue underlying the mesothelial layer of the pleura. This tumours present unpredictable clinical course probably related to their histological and morphological characteristics. Methods: Twenty-one patients affected by SFT of the pleura were referred to us for surgical resection from September 1984 to April 2000. They

Research paper thumbnail of Multidisciplinary management of advanced lung neuroendocrine tumors

Journal of thoracic disease, 2015

The optimal clinical management of aggressive/advanced lung neuroendocrine tumors (NETs) is still... more The optimal clinical management of aggressive/advanced lung neuroendocrine tumors (NETs) is still debated, due to their rarity and the lack of prospective randomized studies. Results derive from retrospective mono-Institutional series, and few dedicated prospective trials, recently designed, are still ongoing. In low-grade tumors [bronchial carcinoids (BCs)] surgery, whenever feasible, remains the mainstay of treatment, and chemo/radiotherapy (RT) should be reserved to progressive diseases (PD). In case of resected N1-N2 BCs, a "watch and see" policy associated with a close clinical/radiological follow-up is recommended. Somatostatin analogs (SSA) seem to be effective in controlling BCs associated endocrine syndromes, while SSA antiproliferative effect has also been reported in the past. Targeted therapy with new drugs (Everolimus) seems to be very promising, but further trials are needed. Surgery alone is not sufficient to treat high-grade NETs: adjuvant CT is required al...

Research paper thumbnail of Addressing a missing point: The short- and long-term effects of a lung sealant patch

The Journal of thoracic and cardiovascular surgery, Jan 13, 2015

Research paper thumbnail of 9114 Malignant pleural mesothelioma: the prognostic significance of different surgical treatments. A retrospective study from a single-institution experience

Research paper thumbnail of Exploring Stage I non-small-cell lung cancer: development of a prognostic model predicting 5-year survival after surgical resection

European Journal of Cardio-Thoracic Surgery, 2014

OBJECTIVES: Despite impressive results in diagnosis and treatment of non-small-cell lung cancer (... more OBJECTIVES: Despite impressive results in diagnosis and treatment of non-small-cell lung cancer (NSCLC), more than 30% of patients with Stage I NSCLC die within 5 years after surgical treatment. Identification of prognostic factors to select patients with a poor prognosis and development of tailored treatment strategies are then advisable. The aim of our study was to design a model able to define prognosis in patients with Stage I NSCLC, submitted to surgery with curative intent.

Research paper thumbnail of Thymic neuroendocrine tumors

Thymic neuroendocrine tumors (NETs) are rare and account for approximately 2% to 5% of all thymic... more Thymic neuroendocrine tumors (NETs) are rare and account for approximately 2% to 5% of all thymic tumors. 1,2 In the last SEER database, the reported incidence of thymic NETs was 0.02/ 100,000 population per year. The median age at diagnosis is about 54 years with a male prevalence (male-to-female ratio of 3:1). Up to 25% of thymic NETs arise in patients with multiple endocrine neoplasia type 1 (MEN-1), 4,5 and among them, 3% to 8% develop thymic NETs. 5,6 Nearly all cases associated with MEN-1 are men and smokers. 7

Research paper thumbnail of Extended transcervical thymectomy with partial upper sternotomy: results in non-thymomatous patients with myasthenia gravis

European Journal of Cardio-Thoracic Surgery, 2014

OBJECTIVES: Thymectomy is a recognized treatment for myasthenia gravis (MG), but the optimal surg... more OBJECTIVES: Thymectomy is a recognized treatment for myasthenia gravis (MG), but the optimal surgical approach is yet to be determined. This study analysed the results in non-thymomatous MG patients treated at our institution using an extended transcervical access with partial upper sternotomy (TC-US), in order to describe cumulative incidence of remission and its predictors.

Research paper thumbnail of Thymic carcinoma outcomes and prognosis: Results of an international analysis

The Journal of thoracic and cardiovascular surgery, 2015

The objectives of this collaborative study were to characterize patients with thymic carcinoma, t... more The objectives of this collaborative study were to characterize patients with thymic carcinoma, their treatment patterns, and association with overall survival (OS) and recurrence-free survival (RFS). Clinical, pathologic, treatment, and follow-up information were analyzed. OS and RFS were the primary outcome measures. In 1042 cases of thymic carcinoma, 42 (5%) patients had pathologic Masaoka stage I, 138 (17%) had stage II, 370 (45%) had stage III, and 274 (33%) had stage IV disease. Overall, 166 patients (22%) underwent induction chemotherapy and 48 (6%) had preoperative radiation therapy. An R0 resection was performed in 447 cases (61%), R1 in 102 cases (14%), and R2 in 184 cases (25%). Squamous cell carcinoma was the predominant histologic subtype (n = 560; 79%). Adjuvant chemotherapy was administered to 237 (31%) patients, and 449 (60%) received adjuvant radiation therapy. The median OS was 6.6 years (95% confidence interval [CI], 5.8-8.3) and the cumulative incidence of recurr...

Research paper thumbnail of 904 Quantitative perfusion lung scanning in the surgery of the lung cancer in the elderly

Research paper thumbnail of Adenosquamous lung carcinomas: A histologic subtype with poor prognosis

Lung Cancer, 2011

Introduction: The aim of this study is to evaluate the prognostic factors and outcome of patients... more Introduction: The aim of this study is to evaluate the prognostic factors and outcome of patients operated for adenosquamous (ADS) carcinoma of the lung, in comparison with adenocarcinoma (AD) and squamous cell carcinoma (SCC). Methods: a retrospective review of our thoracic cancer surgical database for patients operated for ADS, SCC and AD between January, 1995 and December, 2009 was done. Results: Forty-eight patients (39 males, 81.3%) had ADS; complete tumor resection and lymphadenectomy was accomplished in all patients. A higher stage at presentation was observed in ADS, as compared to AD or SCC (p = 0.0001). Three and 5-year survival rates were 25% and 15%. ADS overall survival was worse than AD or SCC (p = 0.0005). Three and 5-year survival rates of ADS Stage I were similar to those of Stage IIIA AD or SCC. More than half ADS patients developed distant metastases (MTS) or local recurrences. Brain MTS were the most frequent. Median survival for those patients was 8 ± 2.3 months. Postoperative platinumbased chemotherapy statistically improved patients survival (p = 0.02). In the multivariate analysis, the presence of MTS (p = 0.001), the tumor perineural invasion (p = 0.01) and the tumor stage (p = 0.0005) were factors associated with poor prognosis. Adjuvant chemotherapy was a significant positive prognostic factor (p = 0.00001). Conclusions: ADS are uncommon and extremely aggressive lung tumors. Adjuvant chemotherapy should be administered even in Stage I radically resected tumors. A whole brain postoperative prophylactic radiotherapy could be proposed to reduce risk of developing brain MTS.

Research paper thumbnail of Radical resection of a giant, invasive and symptomatic malignant Solitary Fibrous Tumour (SFT) of the pleura

Lung Cancer, 2009

Solitary Fibrous Tumours (SFTs) of the pleura are rare neoplasms, with unpredictable biological b... more Solitary Fibrous Tumours (SFTs) of the pleura are rare neoplasms, with unpredictable biological behaviour. Although usually benign, malignant SFTs are described, and they are often associated with large, necrotic and locally invasive tumours. Radical resection represents the treatment of choice in all cases; recurrences are uncommon, and redo-surgery should be considered.