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:

Estimating the Impact of Extended Delay to Surgery for Stage I Non-small-cell Lung Cancer on Survival.

OBJECTIVE: The purpose of this study is to evaluate the impact of extended delay to surgery for stage I NSCLC. SUMMARY OF BACKGROUND DATA: During the COVID-19 pandemic, patients with NSCLC may experience delays in care, and some national guidelines recommend delays in surgery by >3 months for early NSCLC. METHODS: Using data from the National Lung Screening Trial, a multi-center randomized trial, and the National Cancer Data Base, a multi-institutional oncology registry, the impact of "early" versus "delayed" surgery (surgery received 0-30 vs 90-120 days after diagnosis) for stage I lung adenocarcinoma and squamous cell carcinoma (SCC) was assessed using multivariable Cox regression analysis with penalized smoothing spline functions and propensity score-matched analyses. RESULTS: In Cox regression analysis of the National Lung Screening Trial (n = 452) and National Cancer Data Base (n = 80,086) cohorts, an increase in the hazard ratio was seen the longer surgery was delayed. In propensity score-matched analysis, no significant differences in survival were found between early and delayed surgery for stage IA1 adenocarcinoma and IA1-IA3 SCC (all P > 0.13). For stage IA2-IB adenocarcinoma and IB SCC, delayed surgery was associated with worse survival (all P < 0.004). CONCLUSIONS: The mortality risk associated with an extended delay to surgery differs across patient subgroups, and difficult decisions to delay care during the COVID-19 pandemic should take substage and histologic subtype into consideration.
Authors
Mayne, NR; Elser, HC; Darling, AJ; Raman, V; Liou, DZ; Colson, YL; D'Amico, TA; Yang, C-FJ
MLA Citation
Mayne, Nicholas R., et al. “Estimating the Impact of Extended Delay to Surgery for Stage I Non-small-cell Lung Cancer on Survival.Ann Surg, vol. 273, no. 5, May 2021, pp. 850–57. Pubmed, doi:10.1097/SLA.0000000000004811.
URI
https://scholars.duke.edu/individual/pub1475044
PMID
33630435
Source
pubmed
Published In
Ann Surg
Volume
273
Published Date
Start Page
850
End Page
857
DOI
10.1097/SLA.0000000000004811

Perioperative outcomes of pulmonary resection after neoadjuvant pembrolizumab in patients with non-small cell lung cancer.

OBJECTIVES: Pembrolizumab is a programmed death receptor-1 masking antibody approved for metastatic non-small cell lung cancer. This Phase 2 study (NCT02818920) of neoadjuvant pembrolizumab in non-small cell lung cancer had a primary end point of safety and secondary end points of efficacy and correlative science. METHODS: Patients with untreated clinical stage IB to IIIA non-small cell lung cancer were enrolled. Two cycles of pembrolizumab (200 mg) were administered before surgery. Standard adjuvant chemotherapy and radiation were encouraged but not required. Four cycles of adjuvant pembrolizumab were provided. RESULTS: Of 35 patients enrolled, 30 received neoadjuvant pembrolizumab and 25 underwent lung resection. Only 1 patient had a delay before surgery attributed to pembrolizumab; this was due to thyroiditis. All patients underwent anatomic resection and mediastinal lymph node dissection; the majority (18/25%, 72%) of patients underwent lobectomy. Of the 25 patients, 23 had an initial minimally invasive approach (92%); 5 of these were converted to thoracotomy (21.7%). R0 resection was achieved in 22 patients (88%), and major pathologic response was observed in 7 of 25 patients (28%). The most common postoperative adverse event was atrial fibrillation, affecting 6 of 25 patients (24%). Median chest tube duration and length of stay were 3 and 4 days, respectively. One patient required readmission to the hospital within 30 days. There was no mortality within 90 days of surgery. CONCLUSIONS: In this study, pembrolizumab was safe and well tolerated in the neoadjuvant setting, and its use was not associated with excess surgical morbidity or mortality. Minimally invasive approaches are feasible in this patient population, but may be more challenging than in cases without neoadjuvant immunotherapy. Pathologic response was higher than typically observed with standard neoadjuvant chemotherapy.
Authors
Tong, BC; Gu, L; Wang, X; Wigle, DA; Phillips, JD; Harpole, DH; Klapper, JA; Sporn, T; Ready, NE; D'Amico, TA
MLA Citation
Tong, Betty C., et al. “Perioperative outcomes of pulmonary resection after neoadjuvant pembrolizumab in patients with non-small cell lung cancer.J Thorac Cardiovasc Surg, Apr. 2021. Pubmed, doi:10.1016/j.jtcvs.2021.02.099.
URI
https://scholars.duke.edu/individual/pub1482178
PMID
33985811
Source
pubmed
Published In
The Journal of Thoracic and Cardiovascular Surgery
Published Date
DOI
10.1016/j.jtcvs.2021.02.099

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

A National Analysis of Minimally Invasive Vs Open Segmentectomy for Stage IA Non-Small-Cell Lung Cancer.

The objective of this study was to compare long-term outcomes of open vs minimally invasive (MIS) segmentectomy for early stage non-small-cell lung cancer (NSCLC), which has not been previouslyevaluated using national studies. Outcomes of open vs MIS segmentectomy for clinical T1, N0, M0 NSCLC in the National Cancer Data Base (2010-2015) were evaluated using propensity score matching. Of the 39,351 patients who underwent surgery for stage IA NSCLC from 2010 to 2015, 770 underwent segmentectomy by thoracotomy and 1056 by MIS approach (876 thoracoscopic [VATS], 180 robotic). The MIS to open conversion rate was 6.7% (n = 71). After propensity score matching, all baseline characteristics were well-balanced between the open (n = 683) and MIS (n = 683) groups. When compared to the open group, the MIS group had shorter median length of stay (4 vs 5 days, P< 0.001) and lower 30-day mortality (0.6% vs 1.9%, P = 0.037). There were no significant differences between MIS and open groups with regard to 30-day readmission (5.0% vs 3.7%, P = 0.43), or upstaging from cN0 to pN1/N2/N3 (3.1% vs 3.6%, P = 0.89). The MIS approach was associated with similar long-term overall survival as the open approach (5-year survival: 62.3% vs 63.5%, P = 0.89; multivariable-adjusted hazard ratio: 0.99, 95% Confidence Intervial (CI): 0.82-1.21, P = 0.96). In this national analysis of open vs MIS segmentectomy for clinical stage IA NSCLC, MIS was associated with shorter length of stay and lower perioperative mortality, and similar nodal upstaging and 5-year survival when compared to segmentectomy via thoracotomy. MIS segmentectomy does not appear to compromise oncologic outcomes for clinical stage IA NSCLC.
Authors
Kumar, A; Deng, JZ; Raman, V; Okusanya, OT; Baiu, I; Berry, MF; D'Amico, TA; Yang, C-FJ
MLA Citation
Kumar, Arvind, et al. “A National Analysis of Minimally Invasive Vs Open Segmentectomy for Stage IA Non-Small-Cell Lung Cancer.Semin Thorac Cardiovasc Surg, vol. 33, no. 2, pp. 535–44. Pubmed, doi:10.1053/j.semtcvs.2020.09.009.
URI
https://scholars.duke.edu/individual/pub1460797
PMID
32977013
Source
pubmed
Published In
Semin Thorac Cardiovasc Surg
Volume
33
Start Page
535
End Page
544
DOI
10.1053/j.semtcvs.2020.09.009

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