Thomas D'Amico

Overview:

Lung Cancer

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


Esophageal Cancer

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

Positions:

Gary Hock Distinguished Professor of Surgery

Surgery, Cardiovascular and Thoracic Surgery
School of Medicine

Professor of Surgery

Surgery, Cardiovascular and Thoracic Surgery
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1987

Columbia University

Grants:

Genetics, Inflammation & Post-op Cognitive Dysfunction

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

Publications:

Impact of Age on Surgical Outcomes for Locally Advanced Esophageal Cancer.

BACKGROUND: Older patients are often considered high-risk surgical candidates for locally advanced esophageal cancer, and the benefit of surgery in this population is unclear. This national analysis examines the effect of age on esophagectomy outcomes and compares surgery versus chemoradiation in older patients. METHODS: The National Cancer Database was used to identify patients with clinical stage II to III esophageal adenocarcinoma undergoing surgery or definitive chemoradiation between 2004 and 2015. Restricted cubic splines were used to examine the relationship between age and survival after esophagectomy, and maximally selected rank statistics were used to identify an age at which survival worsened. We used Cox proportional hazard models including an interaction term between age and treatment to compare overall survival, as well as survival of patients receiving esophagectomy versus definitive chemoradiation. RESULTS: Of 17,495 patients, 11,680 underwent esophagectomy and 5815 received chemoradiation. Survival after esophagectomy worsened with increasing age and decreased considerably after age 73 (hazard ratio = 1.05, 95% confidence interval, 1.04-1.06, per increasing year after 73 versus hazard ratio = 1.01, 95% confidence interval, 1.00-1.01, per increasing year to 73; both P < .001). Chemoradiation was increasingly used over surgery as age increased. The interaction between age and treatment was significant, and a graph of this interaction demonstrated a survival benefit for surgery over chemoradiation at most ages, including octogenarians. CONCLUSIONS: Survival worsens with age after esophagectomy for locally advanced esophageal cancer. However, esophagectomy is associated with improved survival compared with definitive chemoradiation at most ages, including octogenarians. Esophagectomy may be considered over chemoradiation for patients who can tolerate surgery regardless of age.
Authors
Farrow, NE; Raman, V; Jawitz, OK; Voigt, SL; Tong, BC; Harpole, DH; D'Amico, TA
MLA Citation
Farrow, Norma E., et al. “Impact of Age on Surgical Outcomes for Locally Advanced Esophageal Cancer.Ann Thorac Surg, vol. 111, no. 3, Mar. 2021, pp. 996–1003. Pubmed, doi:10.1016/j.athoracsur.2020.06.055.
URI
https://scholars.duke.edu/individual/pub1457111
PMID
32853569
Source
pubmed
Published In
The Annals of Thoracic Surgery
Volume
111
Published Date
Start Page
996
End Page
1003
DOI
10.1016/j.athoracsur.2020.06.055

Commentary: Surgery for small cell lung cancer: This is the way.

Authors
MLA Citation
D’Amico, Thomas A. “Commentary: Surgery for small cell lung cancer: This is the way.J Thorac Cardiovasc Surg, vol. 161, no. 3, Mar. 2021, pp. 772–73. Pubmed, doi:10.1016/j.jtcvs.2020.11.090.
URI
https://scholars.duke.edu/individual/pub1469160
PMID
33341267
Source
pubmed
Published In
The Journal of Thoracic and Cardiovascular Surgery
Volume
161
Published Date
Start Page
772
End Page
773
DOI
10.1016/j.jtcvs.2020.11.090

Patterns of Use of Induction Therapy for T2N0 Esophageal Cancer.

BACKGROUND: Induction therapy for patients with cT2N0M0 esophageal cancer is controversial. We performed a retrospective cohort analysis of the National Cancer Database to examine the patterns of use of induction therapy for this population. METHODS: The National Cancer Database was queried for patients with cT2N0M0 esophageal cancer who underwent esophagectomy (2004-2015). Patients were stratified by upfront surgery or induction therapy. Overall survival was analyzed and a multivariable logistic regression performed to identify factors associated with receipt of induction therapy. RESULTS: Overall 2540 patients met study criteria: 1177 (46%) received upfront esophagectomy and 1363 (53%) received induction therapy. Patients receiving induction therapy were more likely to be younger, male, without comorbidities, privately insured, and treated at a nonacademic center. These patients were also less likely to be treated in highest volume surgery centers. In multivariable regression, factors independently associated with receipt of induction therapy included later year of diagnosis, increasing tumor size, and increasing tumor grade. Factors associated with upfront esophagectomy included advancing age, comorbidities, lack of insurance, geographic location, and highest volume centers. The receipt of induction chemotherapy was not associated with a survival benefit compared with no induction therapy. CONCLUSIONS: Several patient-, treatment center-, and tumor-related factors are associated with receipt of induction therapy for cT2N0M0 esophageal cancer, although induction therapy is not associated with a survival benefit. Further inquiry into these differences and the potential benefit or lack thereof of induction therapy should be conducted to provide more equitable and appropriate care for patients with esophageal cancer.
Authors
Rhodin, KE; Raman, V; Jawitz, OK; Voigt, SL; Farrow, NE; Harpole, DH; Tong, BC; D'Amico, TA
MLA Citation
Rhodin, Kristen E., et al. “Patterns of Use of Induction Therapy for T2N0 Esophageal Cancer.Ann Thorac Surg, vol. 111, no. 2, Feb. 2021, pp. 440–47. Pubmed, doi:10.1016/j.athoracsur.2020.05.089.
URI
https://scholars.duke.edu/individual/pub1452370
PMID
32681837
Source
pubmed
Published In
The Annals of Thoracic Surgery
Volume
111
Published Date
Start Page
440
End Page
447
DOI
10.1016/j.athoracsur.2020.05.089

The Effect of Tumor Size and Histologic Findings on Outcomes After Segmentectomy vs Lobectomy for Clinically Node-Negative Non-Small Cell Lung Cancer.

BACKGROUND: The interaction between tumor size and the comparative prognosis of lobar and sublobar resection has been defined poorly. RESEARCH QUESTION: The purpose of this study was to characterize the relationship between tumor size and the receipt of segmentectomy or lobectomy in association with overall survival in patients with clinically node-negative non-small cell lung cancer (NSCLC). STUDY DESIGN AND METHODS: The 2004-2015 National Cancer Database (NCDB) was queried for patients with cT1-3N0M0 NSCLC who underwent segmentectomy or lobectomy without neoadjuvant therapy or missing survival data. The primary outcome was overall survival, which was evaluated using multivariate Cox proportional hazards including an interaction term between tumor size and type of surgery. RESULTS: A total of 143,040 patients were included: 135,446 (95%) underwent lobectomy and 7594 (5%) underwent segmentectomy. In multivariate Cox regression, a significant three-way interaction was found among tumor size, histologic results, and type of surgery (P < .001). When patients were stratified by histologic results, lobectomy was associated with significantly improved survival compared with segmentectomy beyond a tumor size of approximately 10 mm for adenocarcinoma and 15 mm for squamous cell carcinoma that was recapitulated in subgroup analyses. No interaction between tumor size and type of surgery was found for patients with neuroendocrine tumors. INTERPRETATION: In this NCDB study of patients with node-negative NSCLC, we found different tumor size thresholds, based on histologic results, that identified populations of patients who least and most benefitted from lobectomy compared with segmentectomy.
Authors
Raman, V; Jawitz, OK; Voigt, SL; Rhodin, KE; D'Amico, TA; Harpole, DH; Jeffrey Yang, C-F; Tong, BC
MLA Citation
Raman, Vignesh, et al. “The Effect of Tumor Size and Histologic Findings on Outcomes After Segmentectomy vs Lobectomy for Clinically Node-Negative Non-Small Cell Lung Cancer.Chest, vol. 159, no. 1, Jan. 2021, pp. 390–400. Pubmed, doi:10.1016/j.chest.2020.06.066.
URI
https://scholars.duke.edu/individual/pub1450944
PMID
32652096
Source
pubmed
Published In
Chest
Volume
159
Published Date
Start Page
390
End Page
400
DOI
10.1016/j.chest.2020.06.066

Patterns of Care in Neoadjuvant Chemoradiotherapy for Node-Positive Esophageal Adenocarcinoma.

BACKGROUND: The aims of this study were to examine the factors associated with use of neoadjuvant chemoradiotherapy (NCR) for patients with locally advanced esophageal cancer and to evaluate the effect of NCR on survival. METHODS: The 2004 to 2015 National Cancer Database was used to identify patients with cT1-4aN1-3M0 (stage II-IVA) esophageal adenocarcinoma who underwent esophagectomy. Patients were stratified by receipt of NCR. A multivariable logistic regression was performed to examine factors associated with NCR, and survival between the 2 groups was compared using a multivariable Cox model. RESULTS: Of 8076 patients meeting the study criteria, 1616 (20%) did not receive NCR and 6460 (80%) did. In a multivariable regression, factors associated with receipt of NCR were a later year of diagnosis, treatment in a high-volume center, and clinical stage III disease. Factors associated with nonreceipt of NCR were increasing age, comorbidities, and treatment in a Middle Atlantic, South Central, or Pacific state. Receipt of trimodality therapy was associated with improved survival compared with other or no perioperative therapies (adjusted hazard ratio, 0.80; 95% confidence interval, 0.74-0.87). CONCLUSIONS: Numerous personal-, demographic-, and treatment center-related factors account for variability in NCR for clinically node-positive esophageal adenocarcinoma, although neoadjuvant therapy was associated with a survival benefit. Further efforts are needed to identify reasons for these differences and design interventions to provide more equitable care for patients with esophageal cancer.
Authors
Raman, V; Jawitz, OK; Voigt, SL; Rhodin, KE; Kim, AW; Tong, BC; D'Amico, TA; Harpole, DH
MLA Citation
Raman, Vignesh, et al. “Patterns of Care in Neoadjuvant Chemoradiotherapy for Node-Positive Esophageal Adenocarcinoma.Ann Thorac Surg, vol. 110, no. 6, Dec. 2020, pp. 1832–39. Pubmed, doi:10.1016/j.athoracsur.2020.05.069.
URI
https://scholars.duke.edu/individual/pub1450452
PMID
32622794
Source
pubmed
Published In
The Annals of Thoracic Surgery
Volume
110
Published Date
Start Page
1832
End Page
1839
DOI
10.1016/j.athoracsur.2020.05.069