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Kondo Y, Ichinose J, Ninomiya H, Hashimoto K, Matsuura Y, Nakao M, Ishikawa Y, Okumura S, Satoh Y, Mun M. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6546235. [PMID: 35266536 PMCID: PMC9297517 DOI: 10.1093/icvts/ivac062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/19/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Yasuto Kondo
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Thoracic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Junji Ichinose
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
- Corresponding author. Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo 135-8550, Japan. Tel: +81-3-3520-0111; e-mail: (J. Ichinose)
| | - Hironori Ninomiya
- Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kohei Hashimoto
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yosuke Matsuura
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masayuki Nakao
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yuichi Ishikawa
- Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Pathology, Mita Hospital, International University of Health and Welfare, Tokyo, Japan
| | - Sakae Okumura
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yukitoshi Satoh
- Department of Thoracic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Mingyon Mun
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Iijima Y, Ishikawa M, Iwai S, Motono N, Yamagishi S, Koizumi K, Uramoto H. Is extrathoracic metastasis screening necessary for clinical stage IA non-small cell lung cancer? Sci Prog 2022; 105:368504221085152. [PMID: 35275504 PMCID: PMC10358501 DOI: 10.1177/00368504221085152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Detecting distant metastases when staging lung cancer is critical to avoid unnecessary surgery and provide appropriate multidisciplinary treatment. However, it is controversial as to whether staging studies should be performed routinely for patients with early-stage lung cancer who have no evidence of distant metastasis. Thus, this study aimed to examine the need for extrathoracic metastasis screening in patients with clinical stage IA non-small cell lung cancer, understand the association between extrathoracic metastasis and other clinical features, and evaluate the diagnostic efficiency of imaging screening for preoperative extrathoracic metastasis in patients with early-stage lung cancer. METHODS From 2010 to 2019, 510 patients diagnosed with clinical T1N0 lung cancer, excluding contralateral lung metastases, pleural dissemination, malignant pleural effusion, and malignant pericardial effusion, were treated for primary lung cancer. Patients were divided into two groups, and their clinicopathological characteristics were investigated. RESULTS Five patients (1.0%) had extrathoracic metastases. The histological types were adenocarcinoma in three of the cases, and squamous cell carcinoma and large cell neuroendocrine carcinoma in the other two cases. The T factor was T1b in one case and T1c in four cases. Four patients had solid tumors and one had a solid predominant tumor with an average tumor diameter of 23.0 ± 2.9 mm. The size of solid tumors with extrathoracic metastases was larger than their counterparts. CONCLUSION When evaluating stage IA non-small cell lung cancer with a solid component diameter < 22 mm, or clinical T1mi-1bN0 in computed tomography evaluation, screening for preoperative extrathoracic metastasis may be omitted.
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Affiliation(s)
- Yoshihito Iijima
- Department of Thoracic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Masahito Ishikawa
- Department of Thoracic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Shun Iwai
- Department of Thoracic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Nozomu Motono
- Department of Thoracic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Shigeki Yamagishi
- Department of Thoracic Surgery, Aidu Chuo Hospital, Aizuwakamatsu, Fukushima, Japan
| | - Kiyoshi Koizumi
- Department of Thoracic Surgery, Aidu Chuo Hospital, Aizuwakamatsu, Fukushima, Japan
| | - Hidetaka Uramoto
- Department of Thoracic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
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Gross DJ, Chintala NK, Vaghjiani RG, Grosser R, Tan KS, Li X, Choe J, Li Y, Aly RG, Emoto K, Zheng H, Dux J, Cheema W, Bott MJ, Travis WD, Isbell JM, Li BT, Jones DR, Adusumilli PS. Tumor and Tumor-Associated Macrophage Programmed Death-Ligand 1 Expression Is Associated With Adjuvant Chemotherapy Benefit in Lung Adenocarcinoma. J Thorac Oncol 2022; 17:89-102. [PMID: 34634452 PMCID: PMC8692446 DOI: 10.1016/j.jtho.2021.09.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/03/2021] [Accepted: 09/20/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Patients with stage II to III lung adenocarcinomas are treated with adjuvant chemotherapy (ACT) to target the premetastatic niche that persists after curative-intent resection. We hypothesized that the premetastatic niche is a scion of resected lung tumor microenvironment and that analysis of tumor microenvironment can stratify survival benefit from ACT. METHODS Using tumor and tumoral stroma from 475 treatment-naive patients with stage II to III lung adenocarcinomas, we constructed a tissue microarray and performed multiplex immunofluorescent staining for immune markers (programmed death-ligand 1 [PD-L1], tumor-associated macrophages [TAMs], and myeloid-derived suppressor cells) and derived myeloid-lymphoid ratio. The association between immune markers and survival was evaluated using Cox models adjusted for pathologic stage. RESULTS Patients with high PD-L1 expression on TAMs or tumor cells in resected tumors had improved survival with ACT (TAMs: hazard ratio [HR] = 1.79, 95% confidence interval [CI]: 1.12-2.85; tumor cells: HR = 3.02, 95% CI: 1.69-5.40). Among patients with high PD-L1 expression on TAMs alone or TAMs and tumor cells, ACT survival benefit is pronounced with high myeloid-lymphoid ratio (TAMs: HR = 3.87, 95% CI: 1.79-8.37; TAMs and tumor cells: HR = 2.19, 95% CI: 1.02-4.71) or with high stromal myeloid-derived suppressor cell ratio (TAMs: HR = 2.53, 95% CI: 1.29-4.96; TAMs and tumor cells: HR = 3.21, 95% CI: 1.23-8.35). Patients with low or no PD-L1 expression on TAMs or tumor cells had no survival benefit from ACT. CONCLUSIONS Our observation that PD-L1 expression on TAMs or tumor cells is associated with improved survival with ACT provides rationale for prospective investigation and developing chemoimmunotherapy strategies for patients with lung adenocarcinoma.
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Affiliation(s)
- Daniel J Gross
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Navin K Chintala
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Raj G Vaghjiani
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rachel Grosser
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kay See Tan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Xiaoyu Li
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jennie Choe
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yan Li
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Pathology, Union Hospital, Tongi Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Rania G Aly
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Pathology, Alexandria University, Alexandria, Egypt
| | - Katsura Emoto
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Hua Zheng
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medical Oncology, Beijing Chest Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Joseph Dux
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Waseem Cheema
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew J Bott
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James M Isbell
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bob T Li
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, New York.
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Zhai W, Liang D, Duan F, Wong W, Yan Q, Gong L, Lai R, Dai S, Long H, Wang J. Prognostic Nomograms Based on Ground Glass Opacity and Subtype of Lung Adenocarcinoma for Patients with Pathological Stage IA Lung Adenocarcinoma. Front Cell Dev Biol 2021; 9:769881. [PMID: 34957101 PMCID: PMC8692790 DOI: 10.3389/fcell.2021.769881] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/04/2021] [Indexed: 12/03/2022] Open
Abstract
The value of lung adenocarcinoma (LUAD) subtypes and ground glass opacity (GGO) in pathological stage IA invasive adenocarcinoma (IAC) has been poorly understood, and reports of their association with each other have been limited. In the current study, we retrospectively reviewed 484 patients with pathological stage IA invasive adenocarcinoma (IAC) at Sun Yat-sen University Cancer Center from March 2011 to August 2018. Patients with at least 5% solid or micropapillary presence were categorized as high-risk subtypes. Independent indicators for disease-free survival (DFS) and overall survival (OS) were identified by multivariate Cox regression analysis. Based on these indicators, we developed prognostic nomograms of OS and DFS. The predictive performance of the two nomograms were assessed by calibration plots. A total of 412 patients were recognized as having the low-risk subtype, and 359 patients had a GGO. Patients with the low-risk subtype had a high rate of GGO nodules (p < 0.001). Multivariate Cox regression analysis showed that the high-risk subtype and GGO components were independent prognostic factors for OS (LUAD subtype: p = 0.002; HR 3.624; 95% CI 1.263–10.397; GGO component: p = 0.001; HR 3.186; 95% CI 1.155–8.792) and DFS (LUAD subtype: p = 0.001; HR 2.284; 95% CI 1.448–5.509; GGO component: p = 0.003; HR 1.877; 95% CI 1.013–3.476). The C-indices of the nomogram based on the LUAD subtype and GGO components to predict OS and DFS were 0.866 (95% CI 0.841–0.891) and 0.667 (95% CI 0.586–0.748), respectively. Therefore, the high-risk subtype and GGO components were potential prognostic biomarkers for patients with stage IA IAC, and prognostic models based on these indicators showed good predictive performance and satisfactory agreement between observational and predicted survival.
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Affiliation(s)
- Wenyu Zhai
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Dachuan Liang
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Fangfang Duan
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wingshing Wong
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Qihang Yan
- Department of Thoracic Surgery, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Li Gong
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Renchun Lai
- Department of Anaesthesiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shuqin Dai
- Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hao Long
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Junye Wang
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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Zhang S, Lin D, Yu Y, Cao Q, Liu G, Jiang D, Wang H, Fang Y, Shen Y, Yin J, Hou Y, Shi H, Ge D, Wang Q, Tan L. Which will carry more weight when CTR > 0.5, solid component size, CTR, tumor size or SUVmax? Lung Cancer 2021; 164:14-22. [PMID: 34974221 DOI: 10.1016/j.lungcan.2021.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 12/01/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study was conducted to explore the clinical significance of the maximum standard uptake value (SUVmax) in the clinical stage IA lung adenocarcinoma with tumor size ≤ 2 cm and consolidation to tumor ratio (CTR) > 0.5. METHODS We retrospectively reviewed non-small cell lung cancer patients who underwent surgeries between January 2014 and March 2017. Clinical stage IA lung adenocarcinoma patients with tumor of size ≤ 2 cm and CTR > 0.5 were enrolled. The patients were divided into two groups: part-solid and pure-solid based on whether CTR = 1.0 or not. Nodules with any amount of solid or micropapillary components were regarded as the high-risk subtype. Time-dependent ROC curve was used to determine the best cut-off value. Finally, we analyzed the relationship between SUVmax, high-risk subtypes, node metastasis and 5-year relapse-free survival and overall survival. RESULTS Totally, 270 patients were included. The distribution of pathological subtypes (p < 0.001), SUVmax (p < 0.001), and pathological N stage (p < 0.001) were different between the two groups. Multivariable analysis indicated that SUVmax could predict high-risk subtypes in cases of part-solid nodules (p < 0.001) and both high-risk subtypes (p = 0.022) and node metastasis (p < 0.001) in cases of pure-solid ones. SUVmax ≥ 2.6 and SUVmax ≥ 5.1 were strongly associated with 5-year relapse-free survival (p < 0.001) and 5-year overall survival (p < 0.001) among all the patients, respectively. CONCLUSION Part-solid nodules with 0.5 < CTR < 1 and pure-solid nodules in lung adenocarcinoma show different clinicopathological characteristics, especially in SUVmax. SUVmax is significantly associated with high-risk subtypes, node metastasis, 5-year relapse-free survival and overall survival.
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Affiliation(s)
- Shaoyuan Zhang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Dong Lin
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200080, China
| | - Yangli Yu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Qiqi Cao
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Guobing Liu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Dongxian Jiang
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hao Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yong Fang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yaxing Shen
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jun Yin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yingyong Hou
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Di Ge
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
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Lamort AS, Kaiser JC, Pepe MAA, Lilis I, Ntaliarda G, Somogyi K, Spella M, Behrend SJ, Giotopoulou GA, Kujawa W, Lindner M, Koch I, Hatz RA, Behr J, Sotillo R, Schamberger AC, Stathopoulos GT. Prognostic phenotypes of early-stage lung adenocarcinoma. Eur Respir J 2021; 60:13993003.01674-2021. [PMID: 34887322 DOI: 10.1183/13993003.01674-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/11/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Survival after curative resection of early-stage lung adenocarcinoma (LUAD) varies and prognostic biomarkers are urgently needed. METHODS Large-format tissue samples from a prospective cohort of 200 patients with resected LUAD were immunophenotyped for cancer hallmarks TP53, NF1, CD45, PD-1, PCNA, TUNEL, and FVIII, and were followed for median (95%CI)=2.34 (1.71-3.49) years. RESULTS Unsupervised hierarchical clustering revealed two patient subgroups with similar clinicopathologic features and genotype, but with markedly different survival: "proliferative" patients (60%) with elevated TP53, NF1, CD45, and PCNA expression had 50% 5-year overall survival while "apoptotic" patients (40%) with high TUNEL had 70% 5-year survival [HR95%CI=2.23 (1.33-3.80); p=0.0069]. Cox regression and machine learning algorithms including random forests built clinically useful models: a score to predict overall survival and a formula and nomogram to predict tumour phenotype. The distinct LUAD phenotypes were validated in TCGA and KMplotter data and showed prognostic power supplementary to IASLC TNM stage and WHO histologic classification. CONCLUSIONS Two molecular subtypes of LUAD exist and their identification provides important prognostic information.
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Affiliation(s)
- Anne-Sophie Lamort
- Comprehensive Pneumology Center (CPC) and Institute for Lung Biology and Disease (iLBD), Helmholtz Center Munich-German Research Center for Environmental Health (HMGU), Munich, Bavaria, Germany.,German Center for Lung Research, Gießen, Hesse, Germany.,Equally contributing authors
| | - Jan Christian Kaiser
- Institute of Radiation Medicine (IRM), Helmholtz Center Munich-German Research Center for Environmental Health (HMGU), Neuherberg, Bavaria, Germany.,Equally contributing authors
| | - Mario A A Pepe
- Comprehensive Pneumology Center (CPC) and Institute for Lung Biology and Disease (iLBD), Helmholtz Center Munich-German Research Center for Environmental Health (HMGU), Munich, Bavaria, Germany.,German Center for Lung Research, Gießen, Hesse, Germany
| | - Ioannis Lilis
- Department of Physiology, Faculty of Medicine, University of Patras, Rio, Achaia, Greece
| | - Giannoula Ntaliarda
- Department of Physiology, Faculty of Medicine, University of Patras, Rio, Achaia, Greece
| | - Kalman Somogyi
- German Center for Lung Research, Gießen, Hesse, Germany.,Division of Molecular Thoracic Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Magda Spella
- Department of Physiology, Faculty of Medicine, University of Patras, Rio, Achaia, Greece
| | - Sabine J Behrend
- Comprehensive Pneumology Center (CPC) and Institute for Lung Biology and Disease (iLBD), Helmholtz Center Munich-German Research Center for Environmental Health (HMGU), Munich, Bavaria, Germany.,German Center for Lung Research, Gießen, Hesse, Germany
| | - Georgia A Giotopoulou
- Comprehensive Pneumology Center (CPC) and Institute for Lung Biology and Disease (iLBD), Helmholtz Center Munich-German Research Center for Environmental Health (HMGU), Munich, Bavaria, Germany.,German Center for Lung Research, Gießen, Hesse, Germany
| | - Willem Kujawa
- Comprehensive Pneumology Center (CPC) and Institute for Lung Biology and Disease (iLBD), Helmholtz Center Munich-German Research Center for Environmental Health (HMGU), Munich, Bavaria, Germany.,German Center for Lung Research, Gießen, Hesse, Germany
| | - Michael Lindner
- German Center for Lung Research, Gießen, Hesse, Germany.,Center for Thoracic Surgery Munich, Ludwig-Maximilian-University of Munich and Asklepios Medical Center, Gauting, Bavaria, Germany
| | - Ina Koch
- German Center for Lung Research, Gießen, Hesse, Germany.,Center for Thoracic Surgery Munich, Ludwig-Maximilian-University of Munich and Asklepios Medical Center, Gauting, Bavaria, Germany
| | - Rudolf A Hatz
- German Center for Lung Research, Gießen, Hesse, Germany.,Center for Thoracic Surgery Munich, Ludwig-Maximilian-University of Munich and Asklepios Medical Center, Gauting, Bavaria, Germany
| | - Juergen Behr
- German Center for Lung Research, Gießen, Hesse, Germany.,Department of Medicine V, University Hospital, Ludwig-Maximilians-University of Munich, Munich, Bavaria, Germany
| | - Rocio Sotillo
- German Center for Lung Research, Gießen, Hesse, Germany.,Division of Molecular Thoracic Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TRLC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Andrea C Schamberger
- Comprehensive Pneumology Center (CPC) and Institute for Lung Biology and Disease (iLBD), Helmholtz Center Munich-German Research Center for Environmental Health (HMGU), Munich, Bavaria, Germany.,German Center for Lung Research, Gießen, Hesse, Germany
| | - Georgios T Stathopoulos
- Comprehensive Pneumology Center (CPC) and Institute for Lung Biology and Disease (iLBD), Helmholtz Center Munich-German Research Center for Environmental Health (HMGU), Munich, Bavaria, Germany .,German Center for Lung Research, Gießen, Hesse, Germany.,Equally contributing authors
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Huang W, Zhang H, Zhang Z, Zhang B, Sun X, Huo Y, Feng Y, Tian P, Mo H, Wang C. A prognostic nomogram based on a new classification of combined micropapillary and solid components for stage IA invasive lung adenocarcinoma. J Surg Oncol 2021; 125:796-808. [PMID: 34862621 DOI: 10.1002/jso.26760] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/06/2021] [Accepted: 11/21/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND We aimed to develop a prognostic nomogram based on a new classification of combined micropapillary and solid components in pathological stage IA invasive lung adenocarcinoma (LUAD). METHODS According to the total proportion of solid and micropapillary components (TPSM), the X-tile software was applied to classify patients into the following three groups: TPSM-low (TPSM-L), TPSM-middle (TPSM-M), and TPSM-high (TPSM-H). The postoperative survival was compared among the three groups. The multivariate Cox regression analysis was performed to identify independent prognostic factors for survival. According to these factors, a nomogram model was developed to provide a personalized prognostic evaluation. RESULTS A total of 595 patients with pathological stage IA invasive LUAD were included in our study. The 5-year disease-free survival and overall survival rates in patients with TPSM-H and TPSM-M were significantly lower than those with TPSM-L. The multivariate Cox regression analysis revealed that the TPSM classification was an independent prognostic factor for survival. According to TPSM classification, we developed a nomogram model which had good calibration and reliable discrimination ability to evaluate survival. CONCLUSIONS The nomogram based on the combination of micropapillary and solid components has good prognostic value in predicting postoperative recurrence and survival of patients with pathological stage IA invasive LUAD.
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Affiliation(s)
- Wuhao Huang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Hua Zhang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Zhiwei Zhang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thoracic Surgery, The Fifth Central Hospital of Tianjin, Tianjin, China
| | - Bin Zhang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Xiaoyan Sun
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yansong Huo
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yingnan Feng
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Pengfei Tian
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Huilan Mo
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Changli Wang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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Wang T, She Y, Yang Y, Liu X, Chen S, Zhong Y, Deng J, Zhao M, Sun X, Xie D, Chen C. Radiomics for Survival Risk Stratification of Clinical and Pathologic Stage IA Pure-Solid Non-Small Cell Lung Cancer. Radiology 2021; 302:425-434. [PMID: 34726531 DOI: 10.1148/radiol.2021210109] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Radiomics-based biomarkers enable the prognostication of resected non-small cell lung cancer (NSCLC), but their effectiveness in clinical stage and pathologic stage IA pure-solid tumors requires further determination. Purpose To construct an efficient radiomics signature for survival risk stratification personalized for patients with clinical stage and pathologic stage IA pure-solid NSCLC. Materials and Methods In this retrospective study, six radiomics signatures were constructed for patients with stage IA pure-solid NSCLC who underwent resection between January 2011 and December 2013 at authors' institution and were tested in the radiogenomics data set. The radiomics features were extracted from the intratumoral two-dimensional region, three-dimensional volume, and peritumoral area using PyRadiomics. The discriminative abilities of the signatures were quantified using the area under the time-dependent receiver operating characteristic curve (AUC), and the optimal signature was selected for patient stratification. Results The study included 592 patients with stage IA pure-solid NSCLC (median age, 61 years; interquartile range, 55-66 years; 269 women) for radiomics analysis: 381 patients for training, 163 for internal validation, and 48 for external validation. The radiomics signature combining three-region features yielded the highest 3- and 5-year AUCs of 0.77 and 0.78, respectively, in the internal validation set and 0.76 and 0.75, respectively, in the external validation set. Multivariable analysis suggested that the radiomics signature remained an independent prognostic factor (hazard ratio, 6.2; 95% CI: 3.5, 11.0; P < .001) and improved the discriminative ability and clinical usefulness of conventional clinical predictors. Conclusion The radiomics signature with multiregional features helped stratify the survival risk of patients with clinical stage and pathologic stage IA pure-solid non-small cell lung cancer. Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Hsu and Sohn in this issue.
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Affiliation(s)
- Tingting Wang
- From the Departments of Radiology (T.W., Y.Y., X.S.) and Thoracic Surgery (Y.S., X.L., Y.Z., J.D., M.Z., D.X., C.C.), Shanghai Pulmonary Hospital, Tongji University School of Medicine, Zhengmin Rd 507, Shanghai 200443, China; and Department of Computer Science and Technology, College of Electronics and Information Engineering, Tongji University, Shanghai, China (S.C.)
| | - Yunlang She
- From the Departments of Radiology (T.W., Y.Y., X.S.) and Thoracic Surgery (Y.S., X.L., Y.Z., J.D., M.Z., D.X., C.C.), Shanghai Pulmonary Hospital, Tongji University School of Medicine, Zhengmin Rd 507, Shanghai 200443, China; and Department of Computer Science and Technology, College of Electronics and Information Engineering, Tongji University, Shanghai, China (S.C.)
| | - Yang Yang
- From the Departments of Radiology (T.W., Y.Y., X.S.) and Thoracic Surgery (Y.S., X.L., Y.Z., J.D., M.Z., D.X., C.C.), Shanghai Pulmonary Hospital, Tongji University School of Medicine, Zhengmin Rd 507, Shanghai 200443, China; and Department of Computer Science and Technology, College of Electronics and Information Engineering, Tongji University, Shanghai, China (S.C.)
| | - Xinyue Liu
- From the Departments of Radiology (T.W., Y.Y., X.S.) and Thoracic Surgery (Y.S., X.L., Y.Z., J.D., M.Z., D.X., C.C.), Shanghai Pulmonary Hospital, Tongji University School of Medicine, Zhengmin Rd 507, Shanghai 200443, China; and Department of Computer Science and Technology, College of Electronics and Information Engineering, Tongji University, Shanghai, China (S.C.)
| | - Shouyu Chen
- From the Departments of Radiology (T.W., Y.Y., X.S.) and Thoracic Surgery (Y.S., X.L., Y.Z., J.D., M.Z., D.X., C.C.), Shanghai Pulmonary Hospital, Tongji University School of Medicine, Zhengmin Rd 507, Shanghai 200443, China; and Department of Computer Science and Technology, College of Electronics and Information Engineering, Tongji University, Shanghai, China (S.C.)
| | - Yifan Zhong
- From the Departments of Radiology (T.W., Y.Y., X.S.) and Thoracic Surgery (Y.S., X.L., Y.Z., J.D., M.Z., D.X., C.C.), Shanghai Pulmonary Hospital, Tongji University School of Medicine, Zhengmin Rd 507, Shanghai 200443, China; and Department of Computer Science and Technology, College of Electronics and Information Engineering, Tongji University, Shanghai, China (S.C.)
| | - Jiajun Deng
- From the Departments of Radiology (T.W., Y.Y., X.S.) and Thoracic Surgery (Y.S., X.L., Y.Z., J.D., M.Z., D.X., C.C.), Shanghai Pulmonary Hospital, Tongji University School of Medicine, Zhengmin Rd 507, Shanghai 200443, China; and Department of Computer Science and Technology, College of Electronics and Information Engineering, Tongji University, Shanghai, China (S.C.)
| | - Mengmeng Zhao
- From the Departments of Radiology (T.W., Y.Y., X.S.) and Thoracic Surgery (Y.S., X.L., Y.Z., J.D., M.Z., D.X., C.C.), Shanghai Pulmonary Hospital, Tongji University School of Medicine, Zhengmin Rd 507, Shanghai 200443, China; and Department of Computer Science and Technology, College of Electronics and Information Engineering, Tongji University, Shanghai, China (S.C.)
| | - Xiwen Sun
- From the Departments of Radiology (T.W., Y.Y., X.S.) and Thoracic Surgery (Y.S., X.L., Y.Z., J.D., M.Z., D.X., C.C.), Shanghai Pulmonary Hospital, Tongji University School of Medicine, Zhengmin Rd 507, Shanghai 200443, China; and Department of Computer Science and Technology, College of Electronics and Information Engineering, Tongji University, Shanghai, China (S.C.)
| | - Dong Xie
- From the Departments of Radiology (T.W., Y.Y., X.S.) and Thoracic Surgery (Y.S., X.L., Y.Z., J.D., M.Z., D.X., C.C.), Shanghai Pulmonary Hospital, Tongji University School of Medicine, Zhengmin Rd 507, Shanghai 200443, China; and Department of Computer Science and Technology, College of Electronics and Information Engineering, Tongji University, Shanghai, China (S.C.)
| | - Chang Chen
- From the Departments of Radiology (T.W., Y.Y., X.S.) and Thoracic Surgery (Y.S., X.L., Y.Z., J.D., M.Z., D.X., C.C.), Shanghai Pulmonary Hospital, Tongji University School of Medicine, Zhengmin Rd 507, Shanghai 200443, China; and Department of Computer Science and Technology, College of Electronics and Information Engineering, Tongji University, Shanghai, China (S.C.)
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Gross DJ, Hsieh MS, Li Y, Dux J, Rekhtman N, Jones DR, Travis WD, Adusumilli PS. Spread Through Air Spaces (STAS) in Non-Small Cell Lung Carcinoma: Evidence Supportive of an In Vivo Phenomenon. Am J Surg Pathol 2021; 45:1509-1515. [PMID: 34366424 PMCID: PMC8516688 DOI: 10.1097/pas.0000000000001788] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tumor spread through air spaces (STAS) is associated with locoregional recurrence in patients undergoing limited resection (LR) for non-small cell lung carcinoma (NSCLC). We hypothesized that the observation of STAS in both the initial LR specimen and the additional resection specimen from the same patient, processed using different knives, would provide evidence that STAS is an in vivo phenomenon contributing to locoregional recurrence. We retrospectively identified patients with NSCLC (9 adenocarcinoma, 1 squamous cell carcinoma) who underwent LR, had STAS in the LR specimen, and underwent additional resection (lobectomy or LR). The LR and additional resection specimens from each patient were processed at different times using different tissue-processing knives. All specimens were analyzed for STAS. All 10 patients underwent LR with negative margins (R0). All additional resection specimens had STAS: 8 patients had STAS clusters in their completion lobectomy specimens, and 2 had STAS in their additional LR specimens. In 2 patients, STAS was found in the completion lobectomy specimen only after extensive sampling (>10 sections) from the staple line adjacent to the initial LR. The presence of STAS in both the LR and the additional resection specimen processed using different knives supports the concept that STAS is an in vivo phenomenon, rather than an artifact from tissue processing. This observation indicates that occult STAS tumor cells can be present in the lung tissue of the remaining unresected lobe after LR and supports the concept that STAS is a contributing factor for locoregional recurrence following LR.
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Affiliation(s)
- Daniel J. Gross
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Min-Shu Hsieh
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yan Li
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Pathology, Union Hospital, Tongi Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Joseph Dux
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Natasha Rekhtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David R. Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William D. Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Prasad S. Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Isaka T, Ito H, Nakayama H, Yokose T, Saito H, Masuda M. Impact of the initial site of recurrence on prognosis after curative surgery for primary lung cancer. Eur J Cardiothorac Surg 2021; 61:778-786. [PMID: 34686875 DOI: 10.1093/ejcts/ezab442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 08/28/2021] [Accepted: 09/10/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES This retrospective study aimed to elucidate the impact of the initial site of recurrence on relapse-free survival and post-recurrence survival (PRS) after the curative resection of primary lung cancer. METHODS We enrolled 325 patients who developed recurrence after curative resection of pathological stage I-IIIA primary lung cancer between January 2006 and December 2018 at the Kanagawa Cancer Center. Cases were classified as follows based on the initial site of recurrence: cervicothoracic lymph node (n = 144), lung (n = 121), pleural dissemination (n = 52), bone (n = 59), brain and meningeal dissemination (n = 50) and abdominal organ (n = 34) cases. The relapse-free survival and PRS of patients with and without recurrence at each site were compared using the log-rank test. The impact of the initial site of recurrence on PRS was analysed using the Cox proportional hazards model. RESULTS Relapse-free survival was significantly poorer in patients with abdominal organ recurrence than in patients without abdominal organ recurrence (11.5 vs 17.6 months, P = 0.024). The PRS of patients with bone and abdominal organ recurrences was worse than that of patients without bone (18.4 vs 31.1 months, P < 0.001) or abdominal organ (13.8 vs 30.6 months, P < 0.001) recurrence. Multiple recurrence sites were observed more frequently in patients with bone and abdominal organ recurrences. Bone [hazard ratio (HR) 2.13; P < 0.001] and abdominal organ metastasis (HR 1.71; P = 0.026) were independent poor prognostic factors for PRS. CONCLUSIONS This study suggests surveillance for abdominal organ recurrence in the early postoperative period. Patients with bone and abdominal organ recurrence should receive multimodality treatment to improve their prognosis.
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Affiliation(s)
- Tetsuya Isaka
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan.,Department of Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Haruhiko Nakayama
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Tomoyuki Yokose
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Haruhiro Saito
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
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Wang C, Shao J, Lv J, Cao Y, Zhu C, Li J, Shen W, Shi L, Liu D, Li W. Deep learning for predicting subtype classification and survival of lung adenocarcinoma on computed tomography. Transl Oncol 2021; 14:101141. [PMID: 34087705 PMCID: PMC8184655 DOI: 10.1016/j.tranon.2021.101141] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES The subtype classification of lung adenocarcinoma is important for treatment decision. This study aimed to investigate the deep learning and radiomics networks for predicting histologic subtype classification and survival of lung adenocarcinoma diagnosed through computed tomography (CT) images. METHODS A dataset of 1222 patients with lung adenocarcinoma were retrospectively enrolled from three medical institutions. The anonymised preoperative CT images and pathological labels of atypical adenomatous hyperplasia, adenocarcinoma in situ, minimally invasive adenocarcinoma, invasive adenocarcinoma (IAC) with five predominant components were obtained. These pathological labels were divided into 2-category classification (IAC; non-IAC), 3-category and 8-category. We modeled the classification task of histological subtypes based on modified ResNet-34 deep learning network, radiomics strategies and deep radiomics combined algorithm. Then we established the prognostic models in lung adenocarcinoma patients with survival outcomes. The accuracy (ACC), area under ROC curves (AUCs) and C-index were primarily performed to evaluate the algorithms. RESULTS This study included a training set (n = 802) and two validation cohorts (internal, n = 196; external, n = 224). The ACC of deep radiomics algorithm in internal validation achieved 0.8776, 0.8061 in the 2-category, 3-category classification, respectively. Even in 8 classifications, the AUC ranged from 0.739 to 0.940 in internal set. Further, we constructed a prognosis model that C-index was 0.892(95% CI: 0.846-0.937) in internal validation set. CONCLUSIONS The automated deep radiomics based triage system has achieved the great performance in the subtype classification and survival predictability in patients with CT-detected lung adenocarcinoma nodules, providing the clinical guide for treatment strategies.
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Affiliation(s)
- Chengdi Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China Medical School, Sichuan University, No. 37 Guo Xue Alley, Chengdu 610041, China
| | - Jun Shao
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China Medical School, Sichuan University, No. 37 Guo Xue Alley, Chengdu 610041, China
| | - Junwei Lv
- Hangzhou YITU Healthcare Technology Co., Ltd. Hangzhou, China; Shanghai Key Laboratory of Artificial Intelligence for Medical Image and Knowledge Graph, Shanghai, China
| | - Yidi Cao
- Hangzhou YITU Healthcare Technology Co., Ltd. Hangzhou, China; Shanghai Key Laboratory of Artificial Intelligence for Medical Image and Knowledge Graph, Shanghai, China
| | - Chaonan Zhu
- Hangzhou YITU Healthcare Technology Co., Ltd. Hangzhou, China; Shanghai Key Laboratory of Artificial Intelligence for Medical Image and Knowledge Graph, Shanghai, China
| | - Jingwei Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China Medical School, Sichuan University, No. 37 Guo Xue Alley, Chengdu 610041, China
| | - Wei Shen
- Hangzhou YITU Healthcare Technology Co., Ltd. Hangzhou, China; Shanghai Key Laboratory of Artificial Intelligence for Medical Image and Knowledge Graph, Shanghai, China
| | - Lei Shi
- Hangzhou YITU Healthcare Technology Co., Ltd. Hangzhou, China; Shanghai Key Laboratory of Artificial Intelligence for Medical Image and Knowledge Graph, Shanghai, China
| | - Dan Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China Medical School, Sichuan University, No. 37 Guo Xue Alley, Chengdu 610041, China.
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China Medical School, Sichuan University, No. 37 Guo Xue Alley, Chengdu 610041, China.
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The Emerging Importance of Tumor Genomics in Operable Non-Small Cell Lung Cancer. Cancers (Basel) 2021; 13:cancers13153656. [PMID: 34359558 PMCID: PMC8345160 DOI: 10.3390/cancers13153656] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/14/2021] [Accepted: 07/19/2021] [Indexed: 12/25/2022] Open
Abstract
During the last two decades, next-generation sequencing (NGS) has played a key role in enhancing non-small cell lung cancer treatment paradigms through the application of "targeted therapy" in advanced and metastatic disease. The use of specific tyrosine kinase inhibitors in patients with oncogenic driver alterations, such as EGFR, ALK, ROS1, BRAF V600E, MET, and NTRK mutations, among others, has changed treatment approaches and improved outcomes in patients with late-stage disease. Although NGS technology has mostly been used in the setting of systemic therapy to identify targets, response to therapy, and mechanisms of resistance, it has multiple potential applications for patients with earlier-stage disease, as well. In this review, we discuss the emerging role of NGS technologies to better understand tumor biology in patients with non-small cell lung cancer who are undergoing surgery with curative intent. In this patient cohort, we examine tumor heterogeneity, the underlying tumor genomics associated with lung adenocarcinoma subtypes, the prediction of recurrence after complete surgical resection, the use of plasma circulating tumor DNA for detection of early cancers and monitoring for minimal residual disease, the differentiation of separate primaries from intrapulmonary metastases, and the use of NGS to guide induction and adjuvant therapies.
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63
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Lai J, Li Q, Fu F, Zhang Y, Li Y, Liu Q, Chen H. Subsolid Lung Adenocarcinomas: Radiological, Clinical and Pathological Features and Outcomes. Semin Thorac Cardiovasc Surg 2021; 34:702-710. [PMID: 34087379 DOI: 10.1053/j.semtcvs.2021.04.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 04/12/2021] [Indexed: 02/02/2023]
Abstract
Lung adenocarcinomas manifesting as subsolid nodules usually have a favorable prognosis. This study aimed to have a comprehensive investigation of the radiological and clinicopathologic features and oncological outcomes of subsolid nodules. Between March 2010 and December 2015, 865 patients with surgically resected clinical IA subsolid lung adenocarcinoma were retrospectively reviewed. Patients were classified into the pure ground-glass nodules (GGN) (pGGN [n = 358], without solid component on lung and mediastinal windows), heterogeneous GGN (hGGN [n = 65], only with solid components on lung window), and real part-solid nodule (rPSN [n = 442], with solid component on both lung and mediastinal windows) groups. The clinicopathological features and survival time of the three groups were compared between groups. There was a significant increase in median tumor size (P < 0.001), solid component size measured at lung window (LW-SCS) (P < 0.001), and the proportion of invasive adenocarcinoma subtypes (P < 0.001) from pGGNs to hGGNs to rPSNs. After adjustment for LW-SCS, adenocarcinomas with predominant lepidic patterns were still more common in hGGNs than in rPSNs (P = 0.009). Patients with rPSNs had a significantly worse recurrence-free survival (RFS) than those with pGGNs and hGGNs (5-year: 91.9% versus 100% versus 100%, P < 0.001). Multivariate Cox analyses revealed that gender (both P < 0.05) and clinical T category (based on lung window [LW-cT] [P = 0.002] or mediastinal window [MW-cT] [P < 0.001]) were independent prognostic factors of RFS in the rPSN group. HGGNs represented as an intermediate subtype between pGGNs and rPSNs. Both pGGNs and hGGNs had excellent outcomes, while rPSNs exhibited a worse prognosis than them. Clinical T category and gender had prognostic implications for rPSNs.
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Affiliation(s)
- Jinglei Lai
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qiao Li
- Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Fangqiu Fu
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yang Zhang
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuan Li
- Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Quan Liu
- Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.
| | - Haiquan Chen
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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Ng J, Masuda Y, Ng JJ, Leow L, Choong AMTL, Mithiran H. Lobar versus Sublobar Resection in the Elderly for Early Lung Cancer: A Meta-Analysis. Thorac Cardiovasc Surg 2021; 70:217-232. [PMID: 34062599 DOI: 10.1055/s-0041-1726100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES We performed a systematic review and meta-analysis of outcomes of lobectomy versus sublobar resection in elderly patients (≥65) with stage 1 nonsmall cell lung carcinoma (NSCLC). METHODS We searched for relevant articles using a set of inclusion and exclusion criteria. Meta-analytic techniques were applied. RESULTS Twelve studies (n = 5834) were chosen. Our results indicate that in the elderly, lobectomy for stage 1 NSCLC confers a survival advantage over sublobar resection. Lobectomy patients had a lower risk of death within 5 years and lower odds of local cancer recurrence. Our results show that lobectomy had a better 5-year cancer-specific survival and 5-year disease-free survival that trended toward significance. The sublobar resection group showed better 30-day operative mortality that trended toward significance. Subgroup analysis of stage 1A cancer demonstrated no difference in 5-year overall survival rates. However, for stage 1B tumors 5-year overall survival favored lobectomy. CONCLUSION Lobectomy for stage 1 NSCLC in elderly patients is superior to sublobar resection in terms of survival and cancer recurrence and should be afforded where possible. For stage 1A tumors, sublobar resection is noninferior and may be considered. Further randomized controlled trials in this topic is required.
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Affiliation(s)
- Josiah Ng
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Yoshio Masuda
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Jun Jie Ng
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lowell Leow
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, Singapore, Singapore
| | - Andrew M T L Choong
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Harish Mithiran
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, Singapore, Singapore
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Jeon HW, Kim YD, Sim SB, Moon MH. Significant difference in recurrence according to the proportion of high grade patterns in stage IA lung adenocarcinoma. Thorac Cancer 2021; 12:1952-1958. [PMID: 34037324 PMCID: PMC8258359 DOI: 10.1111/1759-7714.13984] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Patients with early lung cancer are the best candidates for surgical resection. However, those patients with high grade patterns (micropapillary or solid) do not have a good prognosis, even if they have been diagnosed with stage I lung adenocarcinoma. A new modified grading system has been introduced and this study aimed to identify the prognostic role of the new grading system in patients with stage IA lung adenocarcinoma. METHODS Patients with pathological stage IA lung adenocarcinoma, according to the eighth TNM classification who underwent curative resection, were reviewed. The pathological data of stage IA adenocarcinoma was reviewed 1 (grade 1: lepidic predominant with no or less than 20% of high grade patterns, grade 2: acinar or papillary predominant with no or less than 20% of high grade patterns, grade 3: any tumor with 20% or more of high grade patterns). Prognostic factors were analyzed for disease-free interval (DFI) and overall survival (OS) using Cox proportional models. RESULTS The medical records of 429 patients with stage IA lung adenocarcinoma were reviewed. DFI (p < 0.001) and OS (p < 0.001) were significantly lower in patients diagnosed with grade 3 compared with grade 1 and grade 2. Multivariate analysis showed that smoking (p = 0.013), value of SUVmax (p = 0.005), lymphovascular invasion (p = 0.004) and grade 3 (p = 0.008) were significant prognostic factors for DFI. CONCLUSIONS The proportion of high grade patterns showed a different prognosis, even if curative resection had been performed for stage IA adenocarcinoma. This new grading system is more simple and useful in the prediction of a prognosis in patients with stage IA lung adenocarcinoma.
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Affiliation(s)
- Hyun Woo Jeon
- Department of Thoracic and Cardiovascular Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Du Kim
- Department of Thoracic and Cardiovascular Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Bo Sim
- Department of Thoracic and Cardiovascular Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mi Hyoung Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Jeon HW, Kim YD, Sim SB, Moon MH. Prognostic impact according to the proportion of the lepidic subtype in stage IA acinar-predominant lung adenocarcinoma. Thorac Cancer 2021; 12:2072-2077. [PMID: 34033216 PMCID: PMC8287017 DOI: 10.1111/1759-7714.14013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 01/15/2023] Open
Abstract
Background Adenocarcinoma is the most common type of lung cancer and most adenocarcinomas have heterogeneous subtypes. Acinar‐predominant adenocarcinoma is the most common. This study aimed to identify the prognostic impact of other mixed histological subtypes in acinar‐predominant lung adenocarcinoma. Methods The medical records of patients with pathological stage IA acinar‐predominant lung adenocarcinoma between January 2010 and April 2016 were reviewed. The patients were divided into two groups according to the proportion of the lepidic subtype, with a cutoff value of 20%, and prognostic factors were analyzed. Results A total of 215 patients with stage IA acinar‐predominant adenocarcinoma were reviewed. The 20% or more lepidic subtype group had a low value of SUVmax (p = 0.001), good differentiation (p < 0.001) and a low incidence of the solid histological subtype (p = 0.016). Recurrence was significantly lower in the 20% or more lepidic subtype group (p = 0.008). The disease‐free survival (p = 0.007) and overall survival (p = 0.046) were significantly different between the two groups. Multivariate analysis showed that lymphovascular invasion (p = 0.006) and no or less than 20% lepidic subtype (p = 0.036) were significant prognostic factors for disease‐free survival. Conclusions The lepidic proportion may be useful to predict recurrence in acinar‐predominant stage IA lung adenocarcinoma.
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Affiliation(s)
- Hyun Woo Jeon
- Department of Thoracic and Cardiovascular Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Du Kim
- Department of Thoracic and Cardiovascular Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Bo Sim
- Department of Thoracic and Cardiovascular Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mi Hyoung Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Zhang S, Chen W, Wang Y, Wu J, Xu L, Yu Y, Tian J, Xu R, Fang Z, Jiang L, Luo Y, Li Y. Chinese Herbal Prescription Fu-Zheng-Qu-Xie Prevents Recurrence and Metastasis of Postoperative Early-Stage Lung Adenocarcinoma: A Prospective Cohort Study Followed with Potential Mechanism Exploration. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:6673828. [PMID: 34055197 PMCID: PMC8133853 DOI: 10.1155/2021/6673828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/16/2021] [Accepted: 04/01/2021] [Indexed: 12/24/2022]
Abstract
Chinese herbal Fu-Zheng-Qu-Xie (FZQX) prescription has been found to improve the immune function and survival of patients with early-stage lung cancer. However, the therapeutic efficacy needs to be evaluated objectively, and the precise mechanism remains unclear. In the present study, a double-center, prospective cohort study was carried out to assess the clinical efficacy of the FZQX prescription in preventing the recurrence and metastasis of postoperative early-stage lung adenocarcinoma. Our results indicated that the FZQX prescription could significantly reduce the 3-year postoperative recurrence rate and improve the life quality. Moreover, the peripheral blood indices showed that the positive immune index (CD4 +T/CD8 +T) increased and the negative immune indices (CD8 +T, Myeloid-derived suppressor cells (MDSCs), Treg) decreased after treatment with the FZQX prescription. Since the positive regulatory effect of the FZQX prescription on immune function, a series of experiments were conducted to verify the tumor-suppressive effect and elucidate the underlying mechanisms. Through the MDSC clearance xenograft model, we confirmed that the FZQX prescription could effectively suppress tumor growth with lesser side effects in vivo, and MDSCs may be involved in the biological process of the FZQX prescription's intervention in lung cancer progression. By establishing the coculture system of MDSCs/LLC to simulate the immune microenvironment of lung cancer, the tumor suppression effect of the FZQX prescription was further validated by in vitro experiments. Besides, it was confirmed that the FZQX prescription could regulate MDSCs to remodel the immunosuppressive tumor microenvironment, thus exerting its preventive effect on relapse of lung cancer. Finally, the pathway activator and inhibitor were further used to explore the potential molecular mechanism. Results demonstrated that the IL-1β/NF-κB signaling pathway was one of the critical signaling pathways of FZQX prescription regulating MDSCs to prevent the recurrence and metastasis of lung adenocarcinoma.
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Affiliation(s)
- Sufang Zhang
- Department of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of Traditional Chinese and Western Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wanqing Chen
- Department of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuli Wang
- Department of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jianchun Wu
- Department of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lili Xu
- Department of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yongchun Yu
- Dean's Office, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Jianhui Tian
- Department of Oncology, Shanghai Longhua Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Rongzhong Xu
- Department of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhihong Fang
- Department of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lei Jiang
- Department of Thoracic surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yingbin Luo
- Department of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Li
- Department of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Lopci E, Kobe C, Gnanasegaran G, Adam JA, de Geus-Oei LF. "PET/CT Variants and Pitfalls in Lung Cancer and Mesothelioma". Semin Nucl Med 2021; 51:458-473. [PMID: 33993985 DOI: 10.1053/j.semnuclmed.2021.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
2-deoxy-2-[18F]fluoro-D-glucose [18F]FDG-PET/CT represents the metabolic imaging of choice in various cancer types. Used either at diagnosis or during treatment response assessment, the modality allows for a more accurate definition of tumor extent compared to morphological imaging and is able to predict the therapeutic benefit earlier in time. Due to the aspecific uptake property of [18F]FDG there is an overlap of its distribution in normal and pathological conditions, which can make the interpretation of the imaging challenging. Lung and pleural neoplasia are no exception to this, thus acknowledging of possible pitfalls and artifacts are mandatory for image interpretation. While most pitfalls and artifacts are common for all indications with metabolic imaging with [18F]FDG-PET/CT, there are specific variants and pitfalls in lung cancer and malignant pleural mesothelioma. The aim of the present article is to shed light on the most frequent and relevant variants and pitfalls in [18F]FDG-PET/CT imaging in lung cancer and malignant pleural mesothelioma.
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Affiliation(s)
- Egesta Lopci
- Nuclear Medicine, IRCCS - Humanitas Research Hospital, Rozzano MI, Italy.
| | - Carsten Kobe
- Department of Nuclear Medicine, University Hospital and Medical Faculty, University of Cologne, Cologne, University of Cologne, Cologne, Germany
| | | | - Judit A Adam
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, AMS, the Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands
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Wang Y, Zheng D, Luo J, Zhang J, Pompili C, Ujiie H, Matsuura N, Chen H, Yao F. Risk stratification model for patients with stage I invasive lung adenocarcinoma based on clinical and pathological predictors. Transl Lung Cancer Res 2021; 10:2205-2217. [PMID: 34164270 PMCID: PMC8182714 DOI: 10.21037/tlcr-21-393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background The aim of this study was to propose a new kind of pathological classification and further establish a prognostic model for resected stage I invasive adenocarcinoma (IADC). Methods Clinicopathological data were collected from 2 hospitals. The new proposed pathological reclassification was defined according to certain subtype instead of a predominant one. Survival curves were plotted by Kaplan-Meier analysis. Cox regressions were analyzed for recurrence-free survival (RFS) and overall survival (OS), through which prognostic scores and stratification models were established. The comparison between risk models and the eighth edition of tumor, node, metastasis (TNM) classification was conducted through receiver operating characteristic curves (ROC), as identified by the area under the curve (AUC) and z test. Results In all, 1,196 patients were enrolled. At multivariable analysis, solid and micropapillary of the new pathological reclassification, along with stage IA3 and IB were independent predictors for poorer RFS. Stage IB and smoking status significantly indicated worse OS. After normalization and standardization of log-hazard ratio (HR), personalized scores were calculated and the risk stratifications with 3 risk groups were generated. Compared with TNM classification, the risk model of RFS showed advantage over early-recurrence prediction (1-year: 0.653 vs. 0.556, P=0.033; 3-year: 0.663 vs. 0.076, P=0.008). No marked difference was observed in long-term RFS or OS. Conclusions Considering the harboring of certain patterns may be a new concept in adenocarcinoma classification. The risk stratification model based on this pathological classification and the eighth TNM classification showed remarkable superiority over TNM alone in predicting early recurrence of stage I adenocarcinoma. However, TNM classification remained valuable for long-term recurrence and survival prediction.
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Affiliation(s)
- Yiyang Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Difan Zheng
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jizhuang Luo
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Zhang
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Cecilia Pompili
- Department of Thoracic Surgery, University of Leeds, Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research at St. James's, St. James' Institute of Oncology, Leeds, UK
| | - Hideki Ujiie
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University, Hokkaido, Japan
| | - Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Asakura, Maebashi City, Gunma, Japan
| | - Haiquan Chen
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institutes of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Feng Yao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Saito R, Ninomiya H, Okumura S, Mun M, Sasano H, Ishikawa Y. Novel Histologic Classification of Small Tumor Cell Nests for Lung Adenocarcinoma With Prognostic and Etiological Significance: Small Solid Nests and Pure Micropapillary Nests. Am J Surg Pathol 2021; 45:604-615. [PMID: 33835080 DOI: 10.1097/pas.0000000000001696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Small tumor cell nests such as micropapillary nests are histologic poor prognostic markers for adenocarcinomas of various organs, including the lung. However, for the lung, the association of micropapillary patterns with smoking is controversial, which may be because of a vague definition of micropapillary patterns. This study clarifies the implications of small tumor cell nests by introducing a new dichotomic classification based on the glandular polarity of tumor cells: pure micropapillary nests (pMPs), preserving glandular polarity, and small solid nests (SSNs), lacking polarity. We examined the clinicopathologic factors in 436 resected adenocarcinomas, and analyzed the overall survival between groups classified by either the presence or absence of pMPs and SSNs. pMP was positively associated with nonsmoking-related features such as epidermal growth factor receptor mutations and thyroid transcription factor 1 expression. By contrast, SSN was positively associated with smoking-related features such as KRAS mutations and hepatocyte nuclear factor-4a expressions. Besides, pMP and SSN were significant and independent indicators of poor prognosis in all stages. SSN was an indicator in stage I too, whereas pMP was not. Furthermore, prognoses of the group with SSN were significantly worse than those of pMP-only group. In conclusion, the present study has revealed 2 completely different patterns of small tumor cell nests in lung adenocarcinoma, the nonsmoking-related pMPs, and the smoking-related SSNs, by considering glandular polarity. MPP should include only pMPs, and SSNs should be in a solid pattern. This novel classification might boast clinical significance as a potent poor prognostic marker as well as a factor reflecting etiological and genetic characters.
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Affiliation(s)
- Ryoko Saito
- Division of Pathology, The Cancer Institute, The Cancer Institute Hospital, Japanese Foundation for Cancer Research
- Department of Pathology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Hironori Ninomiya
- Division of Pathology, The Cancer Institute, The Cancer Institute Hospital, Japanese Foundation for Cancer Research
| | - Sakae Okumura
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research
| | - Mingyon Mun
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research
| | - Hironobu Sasano
- Department of Pathology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yuichi Ishikawa
- Division of Pathology, The Cancer Institute, The Cancer Institute Hospital, Japanese Foundation for Cancer Research
- Department of Pathology, Mita Hospital, International University of Health and Welfare, Tokyo
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71
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Zhang Y, Fan Q, Guo Y, Zhu K. Eight-gene signature predicts recurrence in lung adenocarcinoma. Cancer Biomark 2021; 28:447-457. [PMID: 32508318 DOI: 10.3233/cbm-190329] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recurrence significantly influences the survival in patients with lung adenocarcinoma (LUAD). However, there are less gene signatures that predict recurrence risk of LUAD. OBJECTIVE We performed this study to construct a model to predict risk of recurrence in LUAD. METHODS RNA-seq data from 426 patients with LUAD were downloaded from The Cancer Genome Atlas (TCGA) and were randomly assigned into the training (n= 213) and validation set (n= 213). Differentially expressed genes (DEGs) between recurrent and non-recurrent tumors in the training set were identified. Recurrence-associated DEGs were selected using multivariate Cox regression analysis. The recurrence risk model that identifies patients at low and high risk for recurrence was constructed, followed by the validation of its performance in the validation set and a microarray dataset. RESULTS In total, 378 DEGs, including 20 recurrence-associated DEGs, were identified between the recurrent and non-recurrent tumors in the training set. The signatures of 8 genes (including AZGP1, INPP5J, MYBPH, SPIB, GUCA2A, HTR1B, SLC15A1 and TNFSF11) were used to construct the prognostic model to assess the risk of recurrence. This model indicated that patients with high risk scores had shorter recurrence-free survival time compared with patients with low risk scores. ROC curve analysis of this model showed it had high predictive accuracy (AUC > 0.8) to predict LUAD recurrence in the TCGA cohort (the training and validation sets) and GSE50081 dataset. This prognostic model showed high predictive power and performance in predicting recurrence in LUAD. CONCLUSION We concluded that this model might be of great value for evaluating the risk of recurrence of LUAD in clinics.
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Affiliation(s)
- Yongjian Zhang
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China.,Department of Cardiothoracic Surgery, The Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Qiang Fan
- Department of Oncology Radiology, The Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China.,Department of Cardiothoracic Surgery, The Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Yingying Guo
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Koujun Zhu
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
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Li Y, Tan Y, Hu S, Xie J, Yan Z, Zhang X, Zong Y, Han-Zhang H, Li Q, Li C. Targeted Sequencing Analysis of Predominant Histological Subtypes in Resected Stage I Invasive Lung Adenocarcinoma. J Cancer 2021; 12:3222-3229. [PMID: 33976731 PMCID: PMC8100815 DOI: 10.7150/jca.51405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 03/15/2021] [Indexed: 01/11/2023] Open
Abstract
Objective: Lung adenocarcinoma (LADC) is classified into five main histological subtypes with distinct clinicopathologic characteristics: lepidic-predominant adenocarcinoma (LPA), acinar-predominant adenocarcinoma (APA), papillary-predominant adenocarcinoma (PPA), micropapillary-predominant adenocarcinoma (MPA) and solid-predominant adenocarcinoma (SPA). However, the mutational profiles of predominant histological subtypes have not been well defined. In this study, we aimed to reveal the genomic landscape of 5 main histological subtypes. Patients and Methods: We performed next-generation sequencing (NGS) in a cohort of 86 stage I invasive adenocarcinoma (IAC) patients, using a customized panel including 168 cancer-associated genes. Results: Our analysis identified a total of 302 genomic alterations. Five subtypes showed different mutation profiles with LPA, APA, PPA, MPA and SPA had an average mutation rate of 1.95 (range: 0-5), 2.56 (range: 1-6), 3.5 (range: 1-7), 3.75 (range: 1-8) and 6.05 (range: 2-12), respectively (p=4.17e-06). Driver mutations occurred in 96.55% (83/86) of all patients. EGFR (73.3%), KRAS (9.3%), ALK (4.7%) and MET (4.7%) are the most commonly mutated lung cancer driver genes, TP53 is the top mutated tumor suppressor gene. SPA patients harbored more driver mutations and higher frequency of TP53 than LPA patients. Interestingly, LRP1B mutations, which has been reported to be associated with high tumor mutation burden and better response to immunotherapy, were only detected from 5 SPA patients (p=0.001). No patients from other four cohorts harbored LRP1B mutations. Conclusions: We revealed distinctive mutation landscape of the 5 major histological subtypes of LADC, evident by distinctive average mutation rate with SPA and LPA having the highest and lowest average mutation rate, respectively. SPA patients showed higher mutation rate of LRP1B and higher rates for PD-L1 positivity, indicating that SPA patients may have better response to immunotherapy.
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Affiliation(s)
- Yan Li
- Department of Respiratory Medicine, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, China
- Department of Respiratory Medicine, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, China
| | - Yan Tan
- Department of Pathology, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, China
| | - Song Hu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, China
| | - Jun Xie
- Department of Respiratory Medicine, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, China
| | - Zhantao Yan
- Department of Pathology, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, China
| | - Xian Zhang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, China
| | - Yun Zong
- Department of Respiratory Medicine, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, China
| | - Han Han-Zhang
- Burning Rock Biotech, Guangzhou, Guangdong, 510300, China
| | - Qing Li
- Department of Pathology, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, China
| | - Chong Li
- Department of Respiratory Medicine, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, China
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Tumor cell proliferation (Ki-67) expression and its prognostic significance in histological subtypes of lung adenocarcinoma. Lung Cancer 2021; 154:69-75. [PMID: 33626488 DOI: 10.1016/j.lungcan.2021.02.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/22/2021] [Accepted: 02/10/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Ki-67 is a key molecular marker to indicate the proliferative activity of tumor cells in lung cancer. However, Ki-67 expression and its prognostic significance in histological subtypes of lung adenocarcinoma (LUAD) remain unclear. MATERIALS AND METHODS We retrospectively analyzed 1028 invasive LUAD patients who underwent surgery treatment between January 2012 and April 2020 in our department. Associations between Ki-67 expression and histological subtypes of LUAD, as well as other clinicopathological characteristics, were evaluated. The prognostic role of Ki-67 in LUAD subtypes was further assessed using log-rank test and univariate/multivariate Cox proportional hazards regression analyses. RESULTS Ki-67 expression differed across LUAD histological subtypes. The solid-predominant adenocarcinoma (SPA, 46.31 ± 24.72) had the highest expression level of Ki-67, followed by micropapillary (MPA, 31.71 ± 18.14), papillary (PPA, 22.09 ± 19.61), acinar (APA, 19.73 ± 18.71) and lepidic-predominant adenocarcinoma (LPA, 9.86 ± 8.10, P < 0.001). Tumors with solid or micropapillary components also had a higher Ki-67 expression than those without solid or micropapillary components. Besides, males, smokers, larger tumor size, lymph node metastasis and EGFR wild type were correlated with elevated Ki-67 expression. Univariate analysis indicated that increased Ki-67 expression and MPA/SPA subtypes were significantly associated with a poorer prognosis. Notably, the survival differences between LUAD subtypes vanished after adjusting for tumor size and Ki-67 expression in multivariate analysis, while Ki-67 was an independent prognostic factor of LUAD. Patients with MPA/SPA had non-inferior overall and disease-free survival than LPA/APA/PPA patients with a Ki-67 expression comparable to MPA/SPA subjects. CONCLUSION Ki-67 expression varied considerably according to the predominant histological subtypes of LUAD. Ki-67 expression level and tumor size contributed to the survival differences between LUAD histological subtypes.
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Arrieta O, Salas AA, Cardona AF, Díaz-García D, Lara-Mejía L, Escamilla I, García AP, Pérez EC, Raez LE, Rolfo C, Rosell R. Risk of development of brain metastases according to the IASLC/ATS/ERS lung adenocarcinoma classification in locally advanced and metastatic disease. Lung Cancer 2021; 155:183-190. [PMID: 33558063 DOI: 10.1016/j.lungcan.2021.01.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/23/2020] [Accepted: 01/23/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Brain metastases (BM) are frequent among lung cancer patients, affecting prognosis and quality of life. The International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS) and European Respiratory Society (ERS) lung adenocarcinoma (LADC) classification (IASLC/ATS/ERS) has prognostic impact in early-stage disease; however, its role in the advanced setting is not precise. This study aims to determine the correlation between the predominant histological subtype and the risk of developing brain metastases (BM) in locally advanced and metastatic (stages IIIB-IV) LADC. METHODS A total of 710 patients with LADC were treated at our institution from January 2010 to December 2017. After excluding patients with brain metastases at diagnoses (n = 151), they were categorized according to the IASLC/ATS/ERS LADC classification to estimate the risk of developing brain metastases. A competing risk analysis was employed, considering death a competing risk event. RESULTS From 559 patients, the mean age was 59 ± 13.2 years, women (52.4 %), and clinical-stage IV (79.2 %). LADC subtypes distribution was lepidic (11.6 %), acinar (37.9 %), papillary (10.2 %), micropapillary (6.8 %), and solid (33.5 %). A total of 27.0 % of patients developed BM, 32.9 % died without brain affection, and 40.0 % did not progress. The predominantly solid subtype showed the greatest probability of all subtypes for developing BM [HR 4.0; 95 % CI (1.80-8.91), p = 0.0006], followed by micropapillary [HR1.11; 95 % CI (0.36-3.39), p = 0.85). The solid subtype, moderately differentiated tumors, age, and ECOG PS (>2) were associated with increased hazards in the multivariate analysis. CONCLUSION According to the IASLC/ATS/ERS classification, the predominantly solid pattern was significantly associated with an increased risk of developing BM in patients with locally advanced and metastatic LADC. Its prognostic value might help explore novel clinical approaches, modify monitoring for earlier detection, prevent complications, and reduce morbidity.
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Affiliation(s)
- Oscar Arrieta
- Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología, Mexico City, 14080, Mexico.
| | - Alejandro Avilés Salas
- Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología, Mexico City, 14080, Mexico
| | - Andrés F Cardona
- Clinical and Translational Oncology Group, Clinica del Country, Bogotá, Colombia; Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia; Molecular Oncology and Biology Systems Group (G-FOX), Universidad El Bosque, Bogotá, Colombia
| | - Diego Díaz-García
- Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología, Mexico City, 14080, Mexico
| | - Luis Lara-Mejía
- Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología, Mexico City, 14080, Mexico
| | - Ixel Escamilla
- Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología, Mexico City, 14080, Mexico
| | - Ariana Pereira García
- Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología, Mexico City, 14080, Mexico
| | - Enrique Caballé Pérez
- Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología, Mexico City, 14080, Mexico
| | - Luis E Raez
- Thoracic Oncology Program Memorial Cancer Institute, Memorial Healthcare System/Florida International University, Miami, FL, United States
| | - Christian Rolfo
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Rafael Rosell
- Catalan Institute of Oncology, Germans Trials i Pujol Research Institute and Hospital Campus Can Ruti, Barcelona, Spain
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Kamer I, Bab-Dinitz E, Zadok O, Ofek E, Gottfried T, Daniel-Meshulam I, Hout-Siloni G, Ben Nun A, Barshack I, Onn A, Bar J. Immunotherapy response modeling by ex-vivo organ culture for lung cancer. Cancer Immunol Immunother 2021; 70:2223-2234. [PMID: 33484295 DOI: 10.1007/s00262-020-02828-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/09/2020] [Indexed: 12/19/2022]
Abstract
One of the major hurdles for the advancement of cancer immunotherapy is lack of robust, accessible experimental models. We aimed to produce an ex-vivo organ culture (EVOC) model of immunotherapy for non-small cell lung cancer (NSCLC). Freshly resected early stage tumors were collected from the operating room, fragmented to clusters < 450 µm and cultured with fetal calf serum and human autologous serum. The resulting EVOC includes cancer epithelial cells within tumor tissue clusters and immune cells. Original tissue features are reflected in the EVOCs. The response to immune checkpoint inhibitors (ICI) was assessed by IFNγ gene induction. Interestingly, IFNγ EVOC induction was numerically higher when anti-CTLA4 was added to anti-PD-L1 treatment, supporting the notion that anti-CTLA4 impacts cancer partly through tumor-resident immune cells. In parallel, immunohistochemistry (IHC) for key immune-related proteins was performed on the formalin-fixed paraffin embedded (FFPE) corresponding tumors. EVOC IFNγ induction by ICI correlated with basal non-induced IFNγ, CD8, CD4 and FOXP3 mRNA levels within EVOCs and with tumor-FFPE-IHC for CD8 and granzyme B. A weaker correlation was seen with tumor-FFPE-IHC for CD3, CD4, CD68, FOXP3 and tumor-PD-L1. Tertiary lymphoid structure density was also correlated with the ICI response. Our study provides novel data about biomarkers that correlate with ICI-induced response of early stage NSCLC. Retention of the microenvironment and minimal addition of exogenous factors suggest this model to reliably represent the original tumor. The cluster-based EVOC model we describe can provide a valuable, yet simple and widely applicable tool for the study of immunotherapy in NSCLC.
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Affiliation(s)
- Iris Kamer
- Institute of Oncology, Sheba Medical Center, Tel Hashomer, 52620000, Ramat Gan, Israel
| | - Elizabeta Bab-Dinitz
- Institute of Oncology, Sheba Medical Center, Tel Hashomer, 52620000, Ramat Gan, Israel
| | - Oranit Zadok
- Institute of Oncology, Sheba Medical Center, Tel Hashomer, 52620000, Ramat Gan, Israel
| | - Efrat Ofek
- Pathology Department, Sheba Medical Center, Ramat Gan, Israel
| | - Teodor Gottfried
- Institute of Oncology, Sheba Medical Center, Tel Hashomer, 52620000, Ramat Gan, Israel
| | - Inbal Daniel-Meshulam
- Institute of Oncology, Sheba Medical Center, Tel Hashomer, 52620000, Ramat Gan, Israel
| | | | - Alon Ben Nun
- Thoracic Surgery Department, Sheba Medical Center, Ramat Gan, Israel
- Affiliated with Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Thoracic Surgery Department, Assuta Medical Center, Tel Aviv, Israel
| | - Iris Barshack
- Pathology Department, Sheba Medical Center, Ramat Gan, Israel
- Affiliated with Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amir Onn
- Pulmonology Institute, Sheba Medical Center, Ramat Gan, Israel
- Affiliated with Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jair Bar
- Institute of Oncology, Sheba Medical Center, Tel Hashomer, 52620000, Ramat Gan, Israel.
- Affiliated with Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Increased VEGF-A in solid type of lung adenocarcinoma reduces the patients' survival. Sci Rep 2021; 11:1321. [PMID: 33446784 PMCID: PMC7809025 DOI: 10.1038/s41598-020-79907-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/24/2020] [Indexed: 12/25/2022] Open
Abstract
The histological classification of lung adenocarcinoma includes 5 types: lepidic, acinar, papillary, micropapillary and solid. The complex gene interactions and anticancer immune response of these types are not well known. The aim of this study was to reveal the survival rates, genetic alterations and immune activities of the five histological types and provide treatment strategies. This study reviewed the histological findings of 517 patients with lung adenocarcinoma from The Cancer Genome Atlas (TCGA) database and classified them into five types. We performed gene set enrichment analysis (GSEA) and survival analysis according to the different types. We found six oncogenic gene sets that were higher in lung adenocarcinoma than in normal tissues. In the survival analysis of each type, the acinar type had a favorable prognosis, and the solid subtype had an unfavorable prognosis; however, the survival differences between the other types were not significant. Our study focused on the solid type, which had the poorest prognosis. The solid type was related to adaptive immune resistance associated with elevated CD8 T cells and high CD274 (encoding PD-L1) expression. In the pathway analyses, the solid type was significantly related to high vascular endothelial growth factor (VEGF)-A expression, reflecting tumor angiogenesis. Non-necrosis/low immune response affected by high VEGF-A was associated with worse prognosis. The solid type associated with high VEGF-A expression may contribute to the development of therapeutic strategies for lung adenocarcinoma.
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77
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Hong JH, Park S, Kim H, Goo JM, Park IK, Kang CH, Kim YT, Yoon SH. Volume and Mass Doubling Time of Lung Adenocarcinoma according to WHO Histologic Classification. Korean J Radiol 2020; 22:464-475. [PMID: 33169551 PMCID: PMC7909861 DOI: 10.3348/kjr.2020.0592] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 12/26/2022] Open
Abstract
Objective This study aimed to evaluate the tumor doubling time of invasive lung adenocarcinoma according to the International Association of the Study for Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) histologic classification. Materials and Methods Among the 2905 patients with surgically resected lung adenocarcinoma, we retrospectively included 172 patients (mean age, 65.6 ± 9.0 years) who had paired thin-section non-contrast chest computed tomography (CT) scans at least 84 days apart with the same CT parameters, along with 10 patients with squamous cell carcinoma (mean age, 70.9 ± 7.4 years) for comparison. Three-dimensional semiautomatic segmentation of nodules was performed to calculate the volume doubling time (VDT), mass doubling time (MDT), and specific growth rate (SGR) of volume and mass. Multivariate linear regression, one-way analysis of variance, and receiver operating characteristic curve analyses were performed. Results The median VDT and MDT of lung cancers were as follows: acinar, 603.2 and 639.5 days; lepidic, 1140.6 and 970.1 days; solid/micropapillary, 232.7 and 221.8 days; papillary, 599.0 and 624.3 days; invasive mucinous, 440.7 and 438.2 days; and squamous cell carcinoma, 149.1 and 146.1 days, respectively. The adjusted SGR of volume and mass of the solid-/micropapillary-predominant subtypes were significantly shorter than those of the acinar-, lepidic-, and papillary-predominant subtypes. The histologic subtype was independently associated with tumor doubling time. A VDT of 465.2 days and an MDT of 437.5 days yielded areas under the curve of 0.791 and 0.795, respectively, for distinguishing solid-/micropapillary-predominant subtypes from other subtypes of lung adenocarcinoma. Conclusion The tumor doubling time of invasive lung adenocarcinoma differed according to the IASCL/ATS/ERS histologic classification.
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Affiliation(s)
- Jung Hee Hong
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyungjin Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
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78
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Yao J, Zhu E, Li M, Liu J, Zhang L, Ke H, Su H, Xie H, Xu G, Zhu L, Fan J, Chen C. Prognostic impact of micropapillary component in patients with node-negative subcentimeter lung adenocarcinoma: A Chinese cohort study. Thorac Cancer 2020; 11:3566-3575. [PMID: 33058505 PMCID: PMC7705621 DOI: 10.1111/1759-7714.13702] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 12/25/2022] Open
Abstract
Background In this study, we investigated the prognostic significance of a micropapillary (MP) component in patients with subcentimeter lung adenocarcinoma. Methods A total of 311 patients with subcentimeter lung adenocarcinoma who underwent surgical resection between January 2009 to December 2012 from seven medical centers were included. Recurrence‐free survival (RFS) and overall survival (OS) were analyzed. Results The five‐year RFS was 79.8% in 97 (97/311, 31%) cases of adenocarcinoma with a MP component and 93.5% in the 214 (214/311, 69%) cases without. In multivariate analysis, MP was an independent risk factor for worse RFS (hazard ratio [HR], 3.73; 95% confidence interval [CI]: 1.87–7.42; P < 0.001) and OS (HR, 5.84; 95% CI: 2.20–15.49; P < 0.001). There was no significant difference among wedge resection, segmentectomy and lobectomy on RFS (P = 0.256) and OS (P = 0.103) in patients without MP. Regarding patients with a MP component, lobectomy achieved equivalent prognosis than segmentectomy, and both were better than wedge resection (P = 0.001). Conclusions A MP component still suggest a poor prognosis in subcentimeter lung adenocarcinoma. Patients with subcentimeter lung adenocarcinoma with a MP component of 5% or greater treated with wedge resection were at higher risk of recurrence than patients treated with anatomical resection.
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Affiliation(s)
- Jie Yao
- Department of Thoracic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Erjia Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ming Li
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Nanjing Medical University, Nanjing, China
| | - Jinshi Liu
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou, China
| | - Lei Zhang
- Department of Thoracic Surgery, The First People's Hospital of Changzhou, Changzhou, China
| | - Honggang Ke
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Hang Su
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huikang Xie
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guanxin Xu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Ling Zhu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Junqiang Fan
- Department of Thoracic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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Lam S, Bryant H, Donahoe L, Domingo A, Earle C, Finley C, Gonzalez AV, Hergott C, Hung RJ, Ireland AM, Lovas M, Manos D, Mayo J, Maziak DE, McInnis M, Myers R, Nicholson E, Politis C, Schmidt H, Sekhon HS, Soprovich M, Stewart A, Tammemagi M, Taylor JL, Tsao MS, Warkentin MT, Yasufuku K. Management of screen-detected lung nodules: A Canadian partnership against cancer guidance document. CANADIAN JOURNAL OF RESPIRATORY CRITICAL CARE AND SLEEP MEDICINE 2020. [DOI: 10.1080/24745332.2020.1819175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Stephen Lam
- British Columbia Cancer Agency & the University of British Columbia, Vancouver, British Columbia, Canada
| | - Heather Bryant
- Screening and Early Detection, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Laura Donahoe
- Division of Thoracic Surgery, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Ashleigh Domingo
- Screening and Early Detection, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Craig Earle
- Screening and Early Detection, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Christian Finley
- Department of Thoracic Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada
| | - Anne V. Gonzalez
- Division of Respiratory Medicine, McGill University, Montreal, Quebec, Canada
| | - Christopher Hergott
- Division of Respiratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rayjean J. Hung
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Anne Marie Ireland
- Patient and Family Advocate, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Michael Lovas
- Patient and Family Advocate, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Daria Manos
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John Mayo
- Department of Radiology, Vancouver Coastal Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna E. Maziak
- Surgical Oncology Division of Thoracic Surgery, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Micheal McInnis
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Renelle Myers
- British Columbia Cancer Agency & the University of British Columbia, Vancouver, British Columbia, Canada
| | - Erika Nicholson
- Screening and Early Detection, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Christopher Politis
- Screening and Early Detection, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Heidi Schmidt
- University Health Network and Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Harman S. Sekhon
- Department of Pathology and Laboratory Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Marie Soprovich
- Patient and Family Advocate, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Archie Stewart
- Patient and Family Advocate, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Martin Tammemagi
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Jana L. Taylor
- Department of Radiology, McGill University, Montreal, Quebec, Canada
| | - Ming-Sound Tsao
- Department of Laboratory Medicine and Pathobiology, University Health Network and Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Matthew T. Warkentin
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Department of Surgery and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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80
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Qu CH, Li T, Tang ZP, Zhu XR, Han JY, Tian H. Platelet Count is Associated with the Rate of Lymph Node Metastasis in Lung Adenocarcinoma. Cancer Manag Res 2020; 12:9765-9774. [PMID: 33116836 PMCID: PMC7548228 DOI: 10.2147/cmar.s273328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/08/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose Emerging studies have revealed that platelets are involved in tumor metastasis in lung adenocarcinoma (ADC). The solid pathological subtype of lung ADC is associated with metastasis, recurrence, and poor prognosis. However, there is no study exploring the relationship between platelets and different lung pathological subtypes. Patients and Methods The association between platelet counts and lymph node metastasis was analyzed in 852 patients with lung ADC who underwent surgery and lymph node dissection. Multivariate logistic analysis was conducted to identify the risk factors of lymph node metastasis. Then, lymph node metastasis and other factors were analyzed to determine their correlation with platelet count and histological subtype. Results We found that the platelet count was associated with lymph node metastasis (P = 0.01) in multivariable analysis, independent of tumor size, predominant subtype, visceral pleural invasion, and microvessel invasion. In patients with a platelet count ≥300 × 109/L, the rate of lymph node metastasis was 38.5%, almost twice as high as that in patients with a platelet count <300 × 109/L (23.2%). Additionally, elevated platelet counts, even those within the normal range, were significantly associated with a higher rate of lymph node metastasis. The mean platelet count in patients with solid-predominant histology (269.70 ± 69.38 × 109/L) was significantly higher than that in patients with other histologies (P < 0.001). Conclusion Elevated platelet counts are significantly associated with a higher rate of lymph node metastasis, even if the platelet counts are within the reference range. Platelet counts were significantly higher in patients with solid-predominant histology than in patients with other histologies. In addition, VEGF-C may play an important role in lymphatic metastasis in patients with lung ADC. We hypothesize that antiplatelet therapy may reduce lymph node metastasis in lung ADC patients.
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Affiliation(s)
- Cheng-Hao Qu
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, People's Republic of China.,Department of Thoracic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, People's Republic of China
| | - Tong Li
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, People's Republic of China.,Department of Thoracic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, People's Republic of China
| | - Zhan-Peng Tang
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, People's Republic of China.,Department of Thoracic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, People's Republic of China
| | - Xi-Rui Zhu
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, People's Republic of China.,Department of Thoracic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, People's Republic of China
| | - Jing-Yi Han
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, People's Republic of China.,Department of Thoracic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, People's Republic of China
| | - Hui Tian
- Department of Thoracic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, People's Republic of China
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81
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Morphological, immune and genetic features in biopsy sample associated with the efficacy of pembrolizumab in patients with non-squamous non-small cell lung cancer. J Cancer Res Clin Oncol 2020; 147:1227-1237. [PMID: 32997195 DOI: 10.1007/s00432-020-03413-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The usefulness of the histopathology of biopsy samples for predicting the efficacy of immunotherapy in non-squamous, non-small cell lung cancer (NSq NSCLC) patients remains unclear. METHODS We retrospectively investigated the associations between the histopathological features in biopsy samples and survival outcomes in advanced NSq NSCLC patients receiving pembrolizumab. NSq NSCLC was classified histopathologically as morphological adenocarcinoma or non-small cell carcinoma (NSCC: absence of definitive features of either adenocarcinoma or a squamous morphology). We investigated the association between the tumor morphological features and immune/genetic features by examining the tumor PD-L1 expression and tumor mutation burden (TMB). RESULTS Among 33 advanced NSq NSCLC patients with tumor PD-L1 scores ≥ 50% receiving pembrolizumab as first-line therapy, a biopsy diagnosis of NSCC was associated with a significantly longer progression-free survival [median 16.8 vs. 2.3 months; hazard ratio (HR) 0.26; 95% CI 0.10-0.62, P = 0.01] and overall survival (median NR vs. 10.1 months; HR 0.35; 0.12-0.97, P = 0.04) as compared to that of morphological adenocarcinoma. In an analysis of 367 biopsy samples, the NSCC group showed a higher percentage of samples with PD-L1 scores ≥ 50% than the morphological adenocarcinoma group (35% vs. 10%). The NSCC group (n = 8) also showed a significantly higher TMB than the morphological adenocarcinoma group (n = 7) (median 236 vs. 25 mutations/whole exome, P = 0.01). CONCLUSION Absence of definitive morphological features in a biopsy sample could be a useful predictor of the efficacy of pembrolizumab in NSq NSCLC patients with tumor PD-L1 scores ≥ 50%, as these tumors are likely to show high tumor PD-L1 expression and high TMB.
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82
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Lin W, Huang M, Zhang Z, Chai T, Chen S, Gao L, Lin J, Kang M. A retrospective study of the relationship between the pathologic subtype and lymph node metastasis of lung adenocarcinomas of ≤3 cm diameter. Medicine (Baltimore) 2020; 99:e21453. [PMID: 32898994 PMCID: PMC7478443 DOI: 10.1097/md.0000000000021453] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
To analyze the relationship between pathologic subtype and lymph node metastasis for lung adenocarcinomas of ≤3 cm diameter.We retrospectively studied 384 patients with operable lung adenocarcinomas of ≤3 cm diameter that had been radically resected by lobectomy or anatomic segmentectomy with systematic nodal dissection, at the Fujian Medical University Union Hospital between March 2014 and March 2016.Lymph node metastasis pN1 + pN2 (pN+) was found in 2 of 104 (1.9%) patients with tumor diameter ≤1.0 cm, 12 of 159 (7.5%) patients with tumor diameter >1.0 cm but ≤2.0 cm, and 35 of 121 (28.9%) patients with tumor size >2.0 cm but ≤3.0 cm (P < .01). Lymph node metastasis pN+ was found in 19 of 53 (35.8%) patients with visceral invasion pleural (VIP) and 30 of 331 (9.0%) patients without VIP (P < .05). It was also found in 16 of 51 (31.3%) patients with high serum CEA concentrations and 28 of 297 (9.4%) patients with normal concentrations (P < .05). In a multivariate analysis, tumor diameter, VIP, high serum CEA concentration, and pathologic subtype were significant risk factors. The prevalences of lymph node metastasis pN+ were: 0.0% (0/2), 0.0% (0/89), 3.2% (1/31), 16.2% (34/209), 7.7% (1/13), 46.7% (7/15), 100% (4/4), and 11.8% (2/17) for adenocarcinoma in situ (AIS); minimally invasive adenocarcinoma (MIA); predominantly lepidic (LEP), acinar (ACI), papillary, solid (SOL), and micropapillary (MIP) tumors; and variants of invasive adenocarcinoma, respectively (P < .05). For predominant SOL and MIP tumors, the prevalences of lymph node involvement were significantly higher than for the other subtypes.We have shown that lymph node metastasis in patients with tumor diameter ≤3 cm differs according to lung adenocarcinoma subtype. AIS and MIA were not associated with lymph node metastasis; therefore, systematic nodal dissection may be unnecessary. The prevalence of lymph node metastasis rate was low for LEP, suggesting that systemic lymph node sampling is sufficient. In contrast, for other pathologic subtypes, including SOL and MIP, systematic lymph node dissection should be performed.
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Affiliation(s)
- Wenwei Lin
- Department of Thoracic Surgery, The Union Clinical Medical College of Fujian Medical University, Fuzhou
| | - Mingcheng Huang
- Department of Thoracic Surgery, Fujian Medical Hospital Affiliated to Zhangzhou Hospital, Zhangzhou, Fujian Province, China
| | - Zhenyang Zhang
- Department of Thoracic Surgery, The Union Clinical Medical College of Fujian Medical University, Fuzhou
| | - Tianci Chai
- Department of Thoracic Surgery, The Union Clinical Medical College of Fujian Medical University, Fuzhou
| | - Sui Chen
- Department of Thoracic Surgery, The Union Clinical Medical College of Fujian Medical University, Fuzhou
| | - Lei Gao
- Department of Thoracic Surgery, The Union Clinical Medical College of Fujian Medical University, Fuzhou
| | - Jiangbo Lin
- Department of Thoracic Surgery, The Union Clinical Medical College of Fujian Medical University, Fuzhou
| | - Mingqiang Kang
- Department of Thoracic Surgery, The Union Clinical Medical College of Fujian Medical University, Fuzhou
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83
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Chen C, Li WJ, Weng JJ, Chen ZJ, Wen YY, Deng T, Le HB, Zhang YK, Zhang BJ. Cancer-associated fibroblasts, matrix metalloproteinase-9 and lymphatic vessel density are associated with progression from adenocarcinoma in situ to invasive adenocarcinoma of the lung. Oncol Lett 2020; 20:130. [PMID: 32934699 PMCID: PMC7471727 DOI: 10.3892/ol.2020.11991] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/16/2020] [Indexed: 12/24/2022] Open
Abstract
The present study aimed to investigate the roles of cancer-associated fibroblasts (CAFs), matrix metalloproteinase-9 (MMP-9) and lymphatic vessel density (LVD) during the progression from adenocarcinoma in situ (AIS) to invasive lung adenocarcinoma (IAC). A total of 77 patients with stage 0-IA lung adenocarcinoma were enrolled. The expression levels of α-smooth muscle actin, MMP-9 and D2-40 were immunohistochemically analyzed. Survival analysis was performed using the Kaplan-Meier method. In the non-invasive component, the proportion of CAFs and the expression levels of MMP-9 increased from AIS to IAC; however, the LVD was not significantly different. CAFs were positively correlated with levels of MMP-9. The LVD had no significant correlation with CAFs and MMP-9. In the invasive component, CAFs, MMP-9 and LVD were significantly higher in IAC compared with in minimally invasive adenocarcinoma. CAFs, MMP-9 and LVD were all positively correlated with each other. The micropapillary subtype in IAC was associated with overall survival (OS). The LVD in IAC, but not MMP-9 and CAFs, was associated with OS. CAFs, MMP-9 and LVD were involved in the progression from AIS to IAC. CAFs exhibited a strong association with MMP-9 levels in the non-invasive and invasive components. The increase in the proportion of CAFs and the expression levels of MMP-9 may have been an early event before the adenocarcinoma became invasive. Once the adenocarcinoma was invasive, the LVD served an important role in tumor invasion and metastasis, and hence may be used as a prognostic marker of poor OS in stage IA IAC.
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Affiliation(s)
- Cheng Chen
- Department of Cardio-Thoracic Surgery, Zhoushan Hospital, Zhoushan, Zhejiang 316000, P.R. China
| | - Wu-Jun Li
- Department of Cardio-Thoracic Surgery, Zhoushan Hospital, Zhoushan, Zhejiang 316000, P.R. China
| | - Jing-Jing Weng
- Department of Cardio-Thoracic Surgery, Zhoushan Hospital, Zhoushan, Zhejiang 316000, P.R. China
| | - Zhi-Jun Chen
- Department of Cardio-Thoracic Surgery, Zhoushan Hospital, Zhoushan, Zhejiang 316000, P.R. China
| | - Yuan-Yuan Wen
- Department of Pathology, Zhoushan Hospital, Zhoushan, Zhejiang 316000, P.R. China
| | - Tao Deng
- Department of Pathology, Zhoushan Hospital, Zhoushan, Zhejiang 316000, P.R. China
| | - Han-Bo Le
- Department of Cardio-Thoracic Surgery, Zhoushan Hospital, Zhoushan, Zhejiang 316000, P.R. China
| | - Yong-Kui Zhang
- Department of Cardio-Thoracic Surgery, Zhoushan Hospital, Zhoushan, Zhejiang 316000, P.R. China
| | - Bin-Jie Zhang
- Department of Cardio-Thoracic Surgery, Zhoushan Hospital, Zhoushan, Zhejiang 316000, P.R. China
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84
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Caso R, Sanchez-Vega F, Tan KS, Mastrogiacomo B, Zhou J, Jones GD, Nguyen B, Schultz N, Connolly JG, Brandt WS, Bott MJ, Rocco G, Molena D, Isbell JM, Liu Y, Mayo MW, Adusumilli PS, Travis WD, Jones DR. The Underlying Tumor Genomics of Predominant Histologic Subtypes in Lung Adenocarcinoma. J Thorac Oncol 2020; 15:1844-1856. [PMID: 32791233 DOI: 10.1016/j.jtho.2020.08.005] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/24/2020] [Accepted: 08/01/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The purpose of the study is to genomically characterize the biology and related therapeutic opportunities of prognostically important predominant histologic subtypes in lung adenocarcinoma (LUAD). METHODS We identified 604 patients with stage I to III LUAD who underwent complete resection and targeted next-generation sequencing using the Memorial Sloan Kettering-Integrated Mutation Profiling of Actionable Cancer Targets platform. Tumors were classified according to predominant histologic subtype and grouped by architectural grade (lepidic [LEP], acinar or papillary [ACI/PAP], and micropapillary or solid [MIP/SOL]). Associations among clinicopathologic factors, genomic features, mutational signatures, and recurrence were evaluated within subtypes and, when appropriate, quantified using competing-risks regression, with adjustment for pathologic stage and extent of resection. RESULTS MIP/SOL tumors had higher tumor mutational burden (p < 0.001), fraction of genome altered (p = 0.001), copy number amplifications (p = 0.021), rate of whole-genome doubling (p = 0.008), and number of oncogenic pathways altered ( p < 0.001) as compared with LEP and ACI/PAP tumors. Across all tumors, mutational signatures attributed to APOBEC activity were associated with the highest risk of postresection recurrence: SBS2 (p = 0.021) and SBS13 (p = 0.005). Three oncogenic pathways (p53, Wnt, Myc) were altered with statistical significance in MIP/SOL tumors. Compared with LEP and ACI/PAP tumors, MIP/SOL tumors had a higher frequency of targetable BRAF-V600E mutations (p = 0.046). Among ACI/PAP tumors, alterations in the cell cycle (p < 0.001) and PI3K (p = 0.002) pathways were associated with recurrence; among MIP/SOL tumors, only PI3K alterations were associated with recurrence (p = 0.049). CONCLUSIONS These results provide the first in-depth assessment of tumor genomic profiling of predominant LUAD histologic subtypes, their associations with recurrence, and their correlation with targetable driver alterations in patients with surgically resected LUAD.
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Affiliation(s)
- Raul Caso
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Francisco Sanchez-Vega
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Computational Oncology Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kay See Tan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Brooke Mastrogiacomo
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Computational Oncology Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jian Zhou
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gregory D Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bastien Nguyen
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nikolaus Schultz
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James G Connolly
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Whitney S Brandt
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew J Bott
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Fiona and Stanley Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Fiona and Stanley Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniela Molena
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Fiona and Stanley Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James M Isbell
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Fiona and Stanley Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yuan Liu
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Fiona and Stanley Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marty W Mayo
- Department of Biochemistry & Molecular Genetics, University of Virginia, Virginia
| | - Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Fiona and Stanley Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York
| | - William D Travis
- Fiona and Stanley Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Fiona and Stanley Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York.
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85
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Recent and Current Advances in FDG-PET Imaging within the Field of Clinical Oncology in NSCLC: A Review of the Literature. Diagnostics (Basel) 2020; 10:diagnostics10080561. [PMID: 32764429 PMCID: PMC7459495 DOI: 10.3390/diagnostics10080561] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 02/07/2023] Open
Abstract
Lung cancer is the leading cause of cancer-related deaths around the world, the most common type of which is non-small-cell lung cancer (NSCLC). Computed tomography (CT) is required for patients with NSCLC, but often involves diagnostic issues and large intra- and interobserver variability. The anatomic data obtained using CT can be supplemented by the metabolic data obtained using fluorodeoxyglucose F 18 (FDG) positron emission tomography (PET); therefore, the use of FDG-PET/CT for staging NSCLC is recommended, as it provides more accuracy than either modality alone. Furthermore, FDG-PET/magnetic resonance imaging (MRI) provides useful information on metabolic activity and tumor cellularity, and has become increasingly popular. A number of studies have described FDG-PET/MRI as having a high diagnostic performance in NSCLC staging. Therefore, multidimensional functional imaging using FDG-PET/MRI is promising for evaluating the activity of the intratumoral environment. Radiomics is the quantitative extraction of imaging features from medical scans. The chief advantages of FDG-PET/CT radiomics are the ability to capture information beyond the capabilities of the human eye, non-invasiveness, the (virtually) real-time response, and full-field analysis of the lesion. This review summarizes the recent advances in FDG-PET imaging within the field of clinical oncology in NSCLC, with a focus on surgery and prognostication, and investigates the site-specific strengths and limitations of FDG-PET/CT. Overall, the goal of treatment for NSCLC is to provide the best opportunity for long-term survival; therefore, FDG-PET/CT is expected to play an increasingly important role in deciding the appropriate treatment for such patients.
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86
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Kidokoro Y, Sakabe T, Haruki T, Kadonaga T, Nosaka K, Nakamura H, Umekita Y. Gene expression profiling by targeted RNA sequencing in pathological stage I lung adenocarcinoma with a solid component. Lung Cancer 2020; 147:56-63. [PMID: 32673827 DOI: 10.1016/j.lungcan.2020.06.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 05/15/2020] [Accepted: 06/29/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Solid predominant adenocarcinoma is considered an independent predictor of an unfavorable prognosis in patients with stage I lung adenocarcinoma (LUAD). Furthermore, solid minor components are related to poor prognosis in patients with stage I LUAD. Therefore, it is imperative to elucidate the molecular determinants of the malignant potential of solid components (SC). Several studies reported the gene expression profiling specific for lepidic predominant adenocarcinoma or solid predominant adenocarcinoma, however; there is no report identifying the differentially expressed genes (DEGs) between SC and acinar component (AC) within the same tumor tissue in pathological (p)-stage I LUAD patients. MATERIALS AND METHODS LUAD tissue samples containing both SC and AC were obtained from 8 patients with p-stage I LUAD and each component was microdissected. Targeted RNA sequencing was performed by a high-throughput chip-based approach. RESULTS In total, 1272 DEGs were identified, including 677 upregulated genes and 595 downregulated genes in SC compared with AC. The most highly upregulated gene was TATA binding protein associated factor 7 (TAF7) and the most highly downregulated gene was homeobox B3 (HOXB3), which acts as a metastasis suppressor. A protein-protein interaction (PPI) network analysis of upregulated genes in SC identified ribosomal protein S27a (RPS27a) as a hub gene with the highest degree. First neighbors of RPS27a included PSMA6, which is a highly promising target for lung cancer. The subnetwork of PD-L1 had 10 first neighbors, including CMTM6, which enhances the ability of PD-L1-expressing tumor cells to inhibit T cells. The staining score for PD-L1 in SC was significantly higher than that in AC by immunohistochemistry (p = 0.001). CONCLUSION Our results revealed several new DEGs and key PPI network in SC compared to AC, contributing to understanding the biological features of SC and providing therapeutic targets for early-stage LUAD with SC in the future.
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Affiliation(s)
- Yoshiteru Kidokoro
- Division of Pathology, Department of Pathology, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Japan; Division of General Thoracic Surgery, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Tomohiko Sakabe
- Division of Pathology, Department of Pathology, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Tomohiro Haruki
- Division of General Thoracic Surgery, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Taichi Kadonaga
- Division of Pathology, Department of Pathology, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Japan; Division of General Thoracic Surgery, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Kanae Nosaka
- Division of Pathology, Department of Pathology, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Hiroshige Nakamura
- Division of General Thoracic Surgery, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Yoshihisa Umekita
- Division of Pathology, Department of Pathology, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Japan.
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Tancoš V, Grendár M, Farkašová A, Huťka Z, Mičák J, Kviatkovská Z, Hardman TC, Hardy GAD, Plank L. Programmed death ligand 1 protein expression, histological tumour differentiation and intratumoural heterogeneity in pulmonary adenocarcinoma. Pathology 2020; 52:538-545. [PMID: 32586689 DOI: 10.1016/j.pathol.2020.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/23/2020] [Accepted: 03/30/2020] [Indexed: 01/15/2023]
Abstract
Intratumoural heterogeneity of pulmonary adenocarcinoma challenges the accurate interpretation of programmed death ligand 1 (PD-L1) immunohistochemistry, which is the only validated predictive marker for successful anti-PD-1/PD-L1 immunotherapy. The aim of this study was to determine whether PD-L1 expression is related to adenocarcinoma histological differentiation in a retrospective analysis of tumour biopsies with intratumoural histological heterogeneity. Adenocarcinomas with high intratumoural heterogeneity were categorised as 'mixed adenocarcinomas'. PD-L1 expression was determined immunohistochemically using tumour proportion scores (TPS). In 'mixed adenocarcinomas' PD-L1 scores were assessed across tumour areas with specific histological patterns. Comparisons were performed between histologically distinct differentiated tumours and/or histological areas. Poorly differentiated adenocarcinomas, represented by predominantly solid or micropapillary histological patterns, showed significantly higher expression of PD-L1 than other subtypes (p<0.001). Differentiation of intra-adenocarcinoma components was inversely correlated with PD-L1 expression: there were more PD-L1 positive cells in poorly differentiated areas than less differentiated (p<0.001), or than well differentiated areas (p<0.001), and in less differentiated more than well differentiated areas (p=0.001). In conclusion, PD-L1 expression is associated with poorly differentiated morphology in adenocarcinomas with intratumoural histological heterogeneity. Consequently, a TPS approach may not account for the contribution of more aggressive tumour components with higher levels of PD-L1 expression in within the tumour. Performing spectral analyses of PD-L1 expression across tumours is likely to be more accurate.
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Affiliation(s)
- Vladimír Tancoš
- Department of Pathological Anatomy, Comenius University in Bratislava, Jessenius Faculty of Medicine and University Hospital in Martin, Slovakia.
| | - Marián Grendár
- Department of Bioinformatics, Biomedical Centre Martin, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Slovakia
| | | | - Zdenko Huťka
- Department of Pathological Anatomy, Comenius University in Bratislava, Jessenius Faculty of Medicine and University Hospital in Martin, Slovakia
| | - Jozef Mičák
- Department of Pathological Anatomy, Comenius University in Bratislava, Jessenius Faculty of Medicine and University Hospital in Martin, Slovakia
| | | | | | | | - Lukáš Plank
- Department of Pathological Anatomy, Comenius University in Bratislava, Jessenius Faculty of Medicine and University Hospital in Martin, Slovakia; Martin's Biopsy Centre Ltd, Martin, Slovakia
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Microarray analysis of the expression profile of immune-related gene in rapid recurrence early-stage lung adenocarcinoma. J Cancer Res Clin Oncol 2020; 146:2299-2310. [PMID: 32556504 PMCID: PMC7382661 DOI: 10.1007/s00432-020-03287-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 06/05/2020] [Indexed: 02/07/2023]
Abstract
Background Although much progress has been made in the diagnosis of early-stage lung adenocarcinoma (ES-LUAD), the prognosis for ES-LUAD patients with rapid recurrence is still poor. Importantly, there is currently no effective and precise method to screen patients who may develop rapid recurrence. Therefore, it is necessary to identify potential differentially expressed genes (DEGs) in ES-LUAD patients with rapid recurrence and non-rapid recurrence. Methods Affymetrix GeneChip Human Transcriptome Array was used to identify DEGs between ES-LUAD patients with rapid recurrence and non-rapid recurrence. Rapid recurrence was defined as recurrence-free survival (RFS) ≦ 1 year and non-rapid recurrence was defined as RFS ≧ 3 years. The biological functions of the DEGs were analyzed by GO and KEGG pathway enrichment analyses. The protein–protein interaction (PPI) network of identified DEGs was conducted by STRING and Cytoscape software. The expression level of crucial hub genes and tumor-infiltrating lymphocytes (TILs) was verified by immunohistochemistry (IHC). Results A total of 416 DEGs were identified between ES-LUAD patients with and without rapid recurrence. The results of GO analysis revealed that 2 of the top 10 categories in the domain of cellular component, 2 of the top 10 in the domain of molecular function, and 9 of the top 10 in the domain of biological process were functionally related to immunity. The results of KEGG analysis showed that 6 of the top 8 pathways were functionally involved in immune regulation and inflammatory response. The PPI network analysis identified ten crucial nodal protein, including EGFR, MMP9, IL-1β, PTGS2, MMP1, and 5 histone proteins, which constituted 25 key interactions. IL-1β and PTGS2 expression were closely related to immunity and IHC analysis further revealed that low expression of IL-1β and PTGS2 is associated with rapid recurrence. Kaplan–Meier analysis further revealed that LUAD patients with lower IL-1β or PTGS2 expression had a worse RFS. When the TIL density of CD3+, CD4+, CD8+ and CD20+ subsets was less than 20%, ES-LUAD patients have a higher probability of rapid recurrence. Conclusion There were significant differences in the expression of immune-related genes between patients with rapid recurrence and patient with non-rapid recurrence. Immune-related genes such as IL-1β and PTGS2 and TIL density (20%) play important roles in rapid recurrence of ES-LUAD. This study provided a theoretical basis for distinguishing the two types of patients from an immunological perspective. Electronic supplementary material The online version of this article (10.1007/s00432-020-03287-7) contains supplementary material, which is available to authorized users.
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89
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Zhao Y, Han H, Gao Z, Hu H, Xiang J, Sun Y, Chen H. Evolutionary Action Score of TP53 Enhances the Prognostic Prediction for Stage I Lung Adenocarcinoma. Semin Thorac Cardiovasc Surg 2020; 33:221-229. [PMID: 32450216 DOI: 10.1053/j.semtcvs.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/20/2020] [Indexed: 11/11/2022]
Abstract
Stage I lung adenocarcinoma usually has a good prognosis after surgery. However, some patients do suffer disease recurrence during follow-up. Here, we report the prognostic value of evolutionary action score of TP53, which calculates the functional prediction of TP53, in patients with stage I lung adenocarcinoma. From January 2011 to August 2013, 83 patients with a complete follow-up history (36 with a disease recurrence and 47 without recurrence during follow-up) who were pathologically confirmed stage I lung adenocarcinoma were included. Whole-exome sequencing were performed on those paired tumor-normal specimens. Evolutionary action score of TP53 (EAp53) was calculated and patients were divided into groups according to their TP53 mutational status. Tumor mutational burden and survival analyses were performed to assess the prognostic value of EAp53. TP53 mutation was identified in 31 patients (37.3%). Of them, 11 were high-risk point mutations, 9 were low-risk point mutations, and 11 were truncating mutations. The high-risk group showed a poorer recurrence-free survival compared with the low-risk group (P = 0.046) and the wild-type group (P = 0.007). In multivariable analysis, the high-risk/truncating group showed a poorer recurrence-free survival (P = 0.007) and overall survival (P = 0.009) compared with the low-risk/wild-type group. Moreover, tumor mutational burden was higher in the high-risk/truncating group (P < 0.001). EAp53 is of prognostic value in patients with stage I lung adenocarcinoma. The mutational type of TP53 should be paid attention to when predicting the prognosis of patients with stage I lung adenocarcinoma.
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Affiliation(s)
- Yue Zhao
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Han Han
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhendong Gao
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hong Hu
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiaqing Xiang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yihua Sun
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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90
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Jung W, Cho S, Yum S, Chung JH, Lee KW, Kim K, Lee CT, Jheon S. Stepwise Disease Progression Model of Subsolid Lung Adenocarcinoma with Cystic Airspaces. Ann Surg Oncol 2020; 27:4394-4403. [PMID: 32363512 DOI: 10.1245/s10434-020-08508-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Subsolid lung adenocarcinoma with cystic airspaces (LACA) is a unique manifestation of lung cancer. This study was conducted to establish a radiologic disease progression model of LACA and to explore its association with the clinical course and clinicopathologic features of LACA. MATERIALS AND METHODS Sixty patients with LACA who underwent surgery at our center between 2004 and 2017 were retrospectively reviewed. The morphological changes of LACA over time on 98 serial computed tomography scans from 27 of 60 patients were tracked to establish a radiologic disease progression model. Associations between this model and the clinicopathologic characteristics of LACA were investigated. RESULTS The following stepwise progression model of LACA was developed: in phase I, cystic airspaces (CAs) appear in the middle of non-solid nodules; in phase II, the CAs grow; in phase III, a solid component appears on the border of the CAs; and in phase IV, the solid component gradually surrounds the CAs and becomes thicker, and the CAs shrink. In total, 10 (17%), 33 (55%), and 17 (28%) LACA patients were classified as belonging to phases II, III, and IV at the time of surgery, respectively. More advanced phases were associated with higher pathologic T and N staging, lymphovascular invasion, visceral pleural invasion, spread through air spaces, and solid/micropapillary subtype. In the multivariate analysis, our model demonstrated a good discrimination capability for cancer recurrence risk. CONCLUSIONS The stepwise disease progression model of LACA based on radiologic findings developed in this study represented its natural clinical course and clinicopathologic features well.
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Affiliation(s)
- Woohyun Jung
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Sukki Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea. .,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Sungwon Yum
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jin-Haeng Chung
- Department of Pathology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea.,Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung Won Lee
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kwhanmien Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Choon Taek Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sanghoon Jheon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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Lu D, Yang J, Liu X, Feng S, Dong X, Shi X, Zhai J, Mai S, Jiang J, Wang Z, Wu H, Cai K. Clinicopathological features, survival outcomes, and appropriate surgical approaches for stage I acinar and papillary predominant lung adenocarcinoma. Cancer Med 2020; 9:3455-3462. [PMID: 32207885 PMCID: PMC7221422 DOI: 10.1002/cam4.3012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/09/2019] [Accepted: 03/07/2020] [Indexed: 01/08/2023] Open
Abstract
Background Whether prognosis differs between lung acinar predominant adenocarcinoma (ACN) and papillary predominant adenocarcinoma (PAP) patients remains controversial. Furthermore, the appropriate surgical plan for each subtype is undetermined. Methods Data of stage I ACN or PAP patients from 2004 to 2015 were retrospectively reviewed by SEER*Stat 8.3.5. The primary outcome was overall survival (OS) and lung cancer specific survival (LCSS). Results 1531 patients (PAP, 484; ACN, 1047) were included. ACN patients had better OS (P = .001) and LCSS (P = .003) than PAP patients. Among stage I ACN patients, lobectomy with mediastinal lymph node dissection (Lob) (P = .001) or segmentectomy (Seg) (P = .003) provided a better OS than wedge resection (Wed). And ACN patients who received Lob had a equivalent LCSS, compared to those who received Seg (P = .895). For patients with PAP in stage I, those who received Lob tended to have a better prognosis than that received Seg (HR of OS, 0.605, 95% CI: 0.263‐1.393; HR of LCSS, 0.541, 95% CI: 0.194‐1.504) or Wed (HR of OS, 0.735, 95% CI: 0.481‐1.123; HR of LCSS, 0.688, 95% CI: 0.402‐1.180). Conclusions Among patients with lung adenocarcinoma in stage I, those with ACN have a better OS and LCSS than that with PAP. For patients with stage I ACN, Seg and Lob, rather than Wed, seem to be an equivalent treatment choice; however, Seg is the prior option because it could preserve more lung function than Lob. For patients with PAP, Lob tends to be a better choice than Wed and Seg, although the prognostic difference between them is nonsignificant.
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Affiliation(s)
- Di Lu
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianjun Yang
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiguang Liu
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Siyang Feng
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoying Dong
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoshun Shi
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianxue Zhai
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shijie Mai
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianjun Jiang
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhizhi Wang
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hua Wu
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kaican Cai
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Wang C, Wu Y, Shao J, Liu D, Li W. Clinicopathological variables influencing overall survival, recurrence and post-recurrence survival in resected stage I non-small-cell lung cancer. BMC Cancer 2020; 20:150. [PMID: 32093621 PMCID: PMC7041249 DOI: 10.1186/s12885-020-6621-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/11/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To investigate clinicopathological variables influencing overall survival, overall recurrence, and post-recurrence survival (PRS) in patients who experienced curative-intent surgical resection of stage I non-small-cell lung cancer (NSCLC). METHODS We investigated a series of 1387 patients with stage I NSCLC who underwent surgical resection from 2008 to 2015. The effect clinicopathological factors on death, recurrence, and PRS were evaluated by Kaplan-Meier estimates and cox regression analysis. RESULTS Among the 1387 stage I patients, 301 (21.7%) experienced recurrence. The 5-year cumulative incidence of recurrence (CIR) for all patients was 20.2% and median PRS was 25.5 months. The older age (P = 0.036), p-stage IB (P = 0.001), sublobar resection(P<0.001), histology subtype (P<0.001), and lymphovascular invasion (LVI) (P = 0.042) were significantly associated with worse overall survival. Among 301 recurrent patients, univariable analysis indicated that p-stage IB (versus IA) (P<0.001), LVI (P<0.001) and visceral pleural invasion (VPI) (P<0.001) were remarkably correlated with the higher incidence of recurrence. Taking the effect of clinicopathological variables on PRS into consideration, smoking history (P = 0.043), non-adenocarcinoma (P = 0.013), high architectural grade of LUAD (P = 0.019), EGFR wild status (P = 0.002), bone metastasis (P =0.040) and brain metastasis (P = 0.042) were substantially related with poorer PRS. Multivariate analysis demonstrated that high architectural grade of LUAD (P = 0.008), brain metastasis (P = 0.010) and bone metastasis (P = 0.043) were independently associated with PRS. CONCLUSION In patients with resected stage I NSCLC, the older age, p-stage IB (versus IA), sublobar resection, histology subtype, and LVI were significantly associated with worse overall survival. P-stage IB (versus IA), LVI, and VPI were significantly correlated with the higher incidence of recurrence. High architectural grade of LUAD, brain metastasis and bone metastasis were independent risk factors with PRS.
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Affiliation(s)
- Chengdi Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China Medical School, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - Yuxuan Wu
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China Medical School, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - Jun Shao
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China Medical School, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - Dan Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China Medical School, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan, China.
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China Medical School, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan, China.
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Lu L, Wang D, Wang L, E L, Guo P, Li Z, Xiang J, Yang H, Li H, Yin S, Schwartz LH, Xie C, Zhao B. A quantitative imaging biomarker for predicting disease-free-survival-associated histologic subgroups in lung adenocarcinoma. Eur Radiol 2020; 30:3614-3623. [PMID: 32086583 DOI: 10.1007/s00330-020-06663-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/11/2019] [Accepted: 01/17/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Classification of histologic subgroups has significant prognostic value for lung adenocarcinoma patients who undergo surgical resection. However, clinical histopathology assessment is generally performed on only a small portion of the overall tumor from biopsy or surgery. Our objective is to identify a noninvasive quantitative imaging biomarker (QIB) for the classification of histologic subgroups in lung adenocarcinoma patients. METHODS We retrospectively collected and reviewed 1313 CT scans of patients with resected lung adenocarcinomas from two geographically distant institutions who were seen between January 2014 and October 2017. Three study cohorts, the training, internal validation, and external validation cohorts, were created, within which lung adenocarcinomas were divided into two disease-free-survival (DFS)-associated histologic subgroups, the mid/poor and good DFS groups. A comprehensive machine learning- and deep learning-based analytical system was adopted to identify reproducible QIBs and help to understand QIBs' significance. RESULTS Intensity-Skewness, a QIB quantifying tumor density distribution, was identified as the optimal biomarker for predicting histologic subgroups. Intensity-Skewness achieved high AUCs (95% CI) of 0.849(0.813,0.881), 0.820(0.781,0.856) and 0.863(0.827,0.895) on the training, internal validation, and external validation cohorts, respectively. A criterion of Intensity-Skewness ≤ 1.5, which indicated high tumor density, showed high specificity of 96% (sensitivity 46%) and 99% (sensitivity 53%) on predicting the mid/poor DFS group in the training and external validation cohorts, respectively. CONCLUSIONS A QIB derived from routinely acquired CT was able to predict lung adenocarcinoma histologic subgroups, providing a noninvasive method that could potentially benefit personalized treatment decision-making for lung cancer patients. KEY POINTS • A noninvasive imaging biomarker, Intensity-Skewness, which described the distortion of pixel-intensity distribution within lesions on CT images, was identified as a biomarker to predict disease-free-survival-associated histologic subgroups in lung adenocarcinoma. • An Intensity-Skewness of ≤ 1.5 has high specificity in predicting the mid/poor disease-free survival histologic patient group in both the training cohort and the external validation cohort. • The Intensity-Skewness is a feature that can be automatically computed with high reproducibility and robustness.
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Affiliation(s)
- Lin Lu
- Department of Radiology, Columbia University Medical Center, 710 West 168th Street, B26, New York, NY, 10032, USA
| | - Deling Wang
- Department of Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Lili Wang
- Department of Molecular Pathology, the Affiliated Hospital of Qingdao University, Qingdao University, Wutaishan Road 1677, Qingdao, 266000, Shandong, People's Republic of China
| | - Linning E
- Department of Radiology, Shanxi BETHUNE Hospital, 99 Longcheng Street, Taiyuan, 030032, Shanxi, People's Republic of China
| | - Pingzhen Guo
- Department of Radiology, Columbia University Medical Center, 710 West 168th Street, B26, New York, NY, 10032, USA
| | - Zhiming Li
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao University, Wutaishan Road 1677, Qingdao, 266000, Shandong, People's Republic of China
| | - Jin Xiang
- Department of Pathology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Hao Yang
- Department of Radiology, Columbia University Medical Center, 710 West 168th Street, B26, New York, NY, 10032, USA
| | - Hui Li
- Department of Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Shaohan Yin
- Department of Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Lawrence H Schwartz
- Department of Radiology, Columbia University Medical Center, 710 West 168th Street, B26, New York, NY, 10032, USA
| | - Chuanmiao Xie
- Department of Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
| | - Binsheng Zhao
- Department of Radiology, Columbia University Medical Center, 710 West 168th Street, B26, New York, NY, 10032, USA.
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94
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Wang S, Lin D, Yang X, Zhan C, Zhao S, Luo R, Wang Q, Tan L. Clinical significance of PET/CT uptake for peripheral clinical N0 non-small cell lung cancer. Cancer Med 2020; 9:2445-2453. [PMID: 32056387 PMCID: PMC7131855 DOI: 10.1002/cam4.2900] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/09/2020] [Accepted: 01/21/2020] [Indexed: 12/14/2022] Open
Abstract
Objective In this cohort study, we determined the clinical value of the maximum standardized uptake value (SUVmax) of primary tumors in non‐small cell lung cancer (NSCLC). Study Design A retrospective review of NSCLC patients was performed from January 2011 to December 2017. Peripheral cN0 NSCLC patients with tumor size ≤2 cm were included. SUVmax was calculated as a continuous variable for semiquantitative analyses. A receiver operating characteristic curve was analyzed to assess the cutoff threshold of SUVmax on pathological (p) nodal metastasis. We further evaluated the clinical relevance of SUVmax in peripheral cN0 NSCLC patients. Results A total of 670 peripheral NSCLC patients with tumor size ≤2 cm were deemed cN0 by preoperative PET/CT scan. Statistical analyses suggested significant correlations of SUVmax with smoking status (P = .026), tumor volume (P = .001), pathology type (P = .008), tumor differentiation (P < .001), vessel invasion (P = .001), plural invasion (P < .001), pT stage (P < .001), nodal involvement (P < .001), and pathological tumor node metastasis stage (P < .001). A cutoff point of SUVmax of 3.8 (P < .001) could be used to predict pathological nodal metastasis. Multivariable analyses indicated that preoperative SUVmax >3.8 (odds ratio, 12.149; P < .001) was an independent predictor of nodal metastasis. Overall survival analyses further suggested that SUVmax was an independent prognostic indicator (hazard ratio, 2.050; P = .017). Conclusion Preoperative SUVmax is a predictor of pathological nodal metastasis and prognosis for peripheral cN0 NSCLC patients with tumor size ≤2 cm. Our results indicate that assessment of PET SUVmax could improve stratification of these patients.
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Affiliation(s)
- Shuai Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Dong Lin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaodong Yang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cheng Zhan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shihai Zhao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rongkui Luo
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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95
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Wang Z, Zhang L, He L, Cui D, Liu C, Yin L, Zhang M, Jiang L, Gong Y, Wu W, Liu B, Li X, Cram DS, Liu D. Low-depth whole genome sequencing reveals copy number variations associated with higher pathologic grading and more aggressive subtypes of lung non-mucinous adenocarcinoma. Chin J Cancer Res 2020; 32:334-346. [PMID: 32694898 PMCID: PMC7369181 DOI: 10.21147/j.issn.1000-9604.2020.03.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective Histology grade, subtypes and TNM stage of lung adenocarcinomas are useful predictors of prognosis and survival. The aim of the study was to investigate the relationship between chromosomal instability, morphological subtypes and the grading system used in lung non-mucinous adenocarcinoma (LNMA). Methods We developed a whole genome copy number variation (WGCNV) scoring system and applied next generation sequencing to evaluate CNVs present in 91 LNMA tumor samples. Results Higher histological grades, aggressive subtypes and more advanced TNM staging were associated with an increased WGCNV score, particularly in CNV regions enriched for tumor suppressor genes and oncogenes. In addition, we demonstrate that 24-chromosome CNV profiling can be performed reliably from specific cell types (<100 cells) isolated by sample laser capture microdissection. Conclusions Our findings suggest that the WGCNV scoring system we developed may have potential value as an adjunct test for predicting the prognosis of patients diagnosed with LNMA.
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Affiliation(s)
- Zheng Wang
- Department of Pathology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Lin Zhang
- Department of Pathology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Lei He
- Department of Pathology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Di Cui
- Department of Pathology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Chenglong Liu
- Department of Pathology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Liangyu Yin
- Department of Pathology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Min Zhang
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Lei Jiang
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Yuyan Gong
- Berry Genomics Corporation, Beijing 102206, China
| | - Wang Wu
- Berry Genomics Corporation, Beijing 102206, China
| | - Bi Liu
- Berry Genomics Corporation, Beijing 102206, China
| | - Xiaoyu Li
- Berry Genomics Corporation, Beijing 102206, China
| | - David S Cram
- Berry Genomics Corporation, Beijing 102206, China
| | - Dongge Liu
- Department of Pathology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
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96
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Shiina Y, Nakajima T, Yamamoto T, Tanaka K, Sakairi Y, Wada H, Suzuki H, Yoshino I. The D-dimer level predicts the postoperative prognosis in patients with non-small cell lung cancer. PLoS One 2019; 14:e0222050. [PMID: 31877562 PMCID: PMC6932866 DOI: 10.1371/journal.pone.0222050] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/19/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Carcinoma cells often modulate coagulation and fibrinolysis among cancer patients. Plasma dimerized plasmin fragment D (D-dimer) has been reported as a prognostic marker of various types of malignancies, including non-small cell lung cancer (NSCLC). However, the associations between the plasma D-dimer level and peripheral small NSCLC remain unclear. METHODS Three hundred and sixty-two patients with NSCLC who underwent radical surgery were retrospectively reviewed. Patients who received anticoagulation therapy before surgery or who lacked preoperative D-dimer data were excluded. The other 235 patients were divided into a high D-dimer (over 1.0 μg/mL) group (HDD group, n = 47) and a normal D-dimer group (NDD group, n = 188) and investigated for their clinical characteristics, computed tomography (CT) findings, pathological findings, and clinical outcomes. RESULTS The mean D-dimer levels was 2.49±2.58 μg/ml in the HDD group and 0.42±0.23 μg/ml in the NDD group. The HDD group was characterized by a predominance of male gender, older age, pure solid appearance on chest CT, vascular invasion in pathology, and a large solid part of the tumor. The HDD group showed a worse overall survival, disease-free survival, and disease-specific survival than the NDD group (p<0.001, <0.001, <0.001, respectively). These survival features were also observed in p-Stage IA disease. There was no marked survival difference when tumors showed ground-glass opacity on CT. CONCLUSION In NSCLC patients with a solid tumor appearance on CT, high D-dimer levels predict a poor survival and early recurrence.
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Affiliation(s)
- Yuki Shiina
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba Japan
| | - Takahiro Nakajima
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba Japan
- * E-mail:
| | - Takayoshi Yamamoto
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba Japan
| | - Kazuhisa Tanaka
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba Japan
| | - Yuichi Sakairi
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba Japan
| | - Hironobu Wada
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba Japan
| | - Hidemi Suzuki
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba Japan
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97
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Chang C, Sun X, Zhao W, Wang R, Qian X, Lei B, Wang L, Liu L, Ruan M, Xie W, Shen J. Minor components of micropapillary and solid subtypes in lung invasive adenocarcinoma (≤ 3 cm): PET/CT findings and correlations with lymph node metastasis. Radiol Med 2019; 125:257-264. [PMID: 31823295 DOI: 10.1007/s11547-019-01112-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 11/13/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the PET/CT findings in lung invasive adenocarcinoma with minor components of micropapillary or solid contents and its association with lymph node metastasis. MATERIALS AND METHODS A total of 506 lung invasive adenocarcinoma (≤ 3 cm) patients who underwent a PET/CT examination and resection surgery were included. According to the proportion of solid/micropapillary components, the patients were classified into three groups: solid/micropapillary-negative (SMPN) (n = 258), solid/micropapillary-minor (SMPM; > 5% not predominant) (n = 158) and solid/micropapillary-predominant (SMPP; > 5% most dominant) (n = 90). The patients' PET/CT findings, including SUVmax, MTV, TLG and CT characteristics, and other clinical factors were compared by one-way ANOVA test. Logistic regression analysis was done to identify the most predictive findings for lymph node metastasis. RESULTS The value of SUVmax, MTV, TLG and tumor size was highest in SMPP group, followed by SMPM and SMPN group (P < 0.001).The areas under the curve for SUVmax, MTV and TLG for node metastasis were 0.822, 0.843 and 0.835, respectively. Univariate analysis found that the SMPP and SMPM group had more lymph node metastasis than the SMPN group (P < 0.001). Furthermore, the lymph node metastasis group had higher CEA, SUVmax, MTV, TLG, tumor size and more pleural invasion (P < 0.001). Logistic regression analysis found that SMPP pathological type, SMPM pathological type, higher CEA and male patients were risk factors for lymph node metastasis (P < 0.01). CONCLUSIONS Lung invasive adenocarcinoma with micropapillary or solid contents had higher SUVmax, MTV, TLG and tumor size and was associated with lymph node metastasis, even if they were not predominant.
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Affiliation(s)
- Cheng Chang
- Department of Radiology, Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Gusu District, Suzhou, 215000, Jiangsu, China.,Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 200030, China
| | - Xiaoyan Sun
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 200030, China
| | - Wenlu Zhao
- Department of Radiology, Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Gusu District, Suzhou, 215000, Jiangsu, China
| | - Rui Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 200030, China
| | - Xiaohua Qian
- Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Bei Lei
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 200030, China
| | - Lihua Wang
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 200030, China
| | - Liu Liu
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 200030, China
| | - Maomei Ruan
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 200030, China
| | - Wenhui Xie
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 200030, China.
| | - Junkang Shen
- Department of Radiology, Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Gusu District, Suzhou, 215000, Jiangsu, China.
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98
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Takahashi Y, Eguchi T, Lu S, Downey RJ, Jones DR, Travis WD, Adusumilli PS. Preponderance of High-Grade Histologic Subtype in Autologous Metastases in Lung Adenocarcinoma. Am J Respir Crit Care Med 2019; 197:816-818. [PMID: 28862875 DOI: 10.1164/rccm.201705-0924le] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Yusuke Takahashi
- 1 Memorial Sloan Kettering Cancer Center New York, New York.,2 Keio University School of Medicine Tokyo, Japan
| | - Takashi Eguchi
- 1 Memorial Sloan Kettering Cancer Center New York, New York.,3 Shinshu University School of Medicine Matsumoto, Japan and
| | - Shaohua Lu
- 1 Memorial Sloan Kettering Cancer Center New York, New York.,4 Fudan University Shanghai, China
| | | | - David R Jones
- 1 Memorial Sloan Kettering Cancer Center New York, New York
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99
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Shih AR, Uruga H, Bozkurtlar E, Chung J, Hariri LP, Minami Y, Wang H, Yoshizawa A, Muzikansky A, Moreira AL, Mino‐Kenudson M. Problems in the reproducibility of classification of small lung adenocarcinoma: an international interobserver study. Histopathology 2019; 75:649-659. [DOI: 10.1111/his.13922] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 05/17/2019] [Indexed: 12/17/2022]
Affiliation(s)
| | - Hironori Uruga
- Massachusetts General Hospital Boston MA USA
- Toranomon Hospital Tokyo Japan
| | | | - Jin‐Haeng Chung
- Seoul National University, Bundang Hospital Seongnam Republic of Korea
| | | | - Yuko Minami
- National Hospital Organization, Ibarakihigashi National Hospital Ibaraki Japan
| | - He Wang
- Temple University School of Medicine Philadelphia PA USA
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100
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Zhang R, Hu G, Qiu J, Wu H, Fu W, Feng Y, Zhang M, Chen C, Sun J, Zhang Y, Ren J. Clinical significance of the cribriform pattern in invasive adenocarcinoma of the lung. J Clin Pathol 2019; 72:682-688. [PMID: 31253654 DOI: 10.1136/jclinpath-2019-205883] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/30/2019] [Accepted: 06/07/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE According to the WHO, the cribriform pattern is a subtype of acinar (Aci) predominance in invasive adenocarcinoma (ADC) of the lung. Recently, several studies have demonstrated poor prognosis in patients with cribriform predominance. This study was performed to examine the correlations of cribriform pattern with the clinicopathology, molecular features and prognosis in patients with invasive ADC. METHODS Histological subtypes were evaluated in 279 patients who underwent complete resection for invasive ADC. Patients of the Aci-predominant subtype were divided into two subgroups according to the percentage of cribriform cancer (≥5% vs <5%). Clinicopathological characteristics, overall survival (OS), disease-free survival (DFS) and molecular changes were compared. In addition, both OS and DFS were compared between patients with cribriform-predominant (n=33) and pure Aci-predominant (n=88) ADCs. RESULTS A cribriform pattern was found in 111 (39.8%) cases and ranged from 5 % to 100 % of the total tumour volume (mean±SEM, 30%±2%). Of 117 patients with Aci predominance, 79 showed the cribriform pattern, while the remaining 38 did not. The cribriform pattern was associated with aggressive pathological behaviour, including advanced stages of cancer, nuclear atypia, mitoses, lymph node invasion, metastasis and larger tumour size. The subgroup with cribriform cancer (≥5%) had significantly poorer OS and DFS compared with the cribriform-negative (<5%) group. In addition, Cox multivariate analyses revealed that the cribriform pattern was an independent predictor of OS but not DFS. Moreover, OS was significantly lower in the cribriform-predominant group than in the Aci-predominant group. CONCLUSION The cribriform pattern is associated with aggressive pathological behaviour and is an independent poor prognostic indicator in patients with Aci-predominant ADC of the lung.
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Affiliation(s)
- Ruizhen Zhang
- Department of Pathology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.,Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Guiming Hu
- Department of Pathology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.,Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Jinhuan Qiu
- Department of Pathology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.,Department of Thoracic Surgery, The SecondAffiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Huifang Wu
- Department of Pathology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Wenjing Fu
- Department of Pathology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yikun Feng
- Department of Pathology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Min Zhang
- Department of Pathology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Chen Chen
- Department of Pathology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Jianping Sun
- Department of Pathology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yan Zhang
- Department of Pathology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Jingli Ren
- Department of Pathology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
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