51
|
Wang L, Zhao Q, Wang J, Wang T, Sun L, Chen Q, Li J, Zeng F. A novel model for extrapleural cavity metastasis assessment in patients with lung cancer. Biomark Med 2021; 15:389-399. [PMID: 33709781 DOI: 10.2217/bmm-2020-0413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To investigate the clinical value of tumor markers in extrapleural tumor metastasis assessment of newly diagnosed lung cancer patients. Materials & methods: This study retrospectively analyzed 306 patients diagnosed with lung cancer accompanied by tumor metastasis. Patients were grouped into extrapleural tumor metastasis and intrapleural tumor metastasis. Seven serum tumor markers were included for analysis. Results: The area under curves of receiver operating characteristic curve based on binning decision tree algorithm were above 0.8 in both training and validation sets. A scorecard with a score below 3 suggested extrapleural tumor metastasis in newly diagnosed lung cancer patients. Conclusion: The serum tumor marker-derived model is a convenient and fast approach for extrapleural cavity metastasis assessment, which may provide positive implications in newly diagnosed lung cancer patients.
Collapse
Affiliation(s)
- Luqing Wang
- Faculty of Information Technology, Macau University of Science & Technology, Macao, China
| | - Qinglin Zhao
- Faculty of Information Technology, Macau University of Science & Technology, Macao, China
| | - Jiasi Wang
- Department of Clinical laboratory, Dazhou Central Hospital, Dazhou, Sichuan, China.,Department of Clinical Research Center, Dazhou Central Hospital, Dazhou, Sichuan, China
| | - Tingjie Wang
- Department of Respiratory Medicine, Dazhou Central Hospital, Dazhou, Sichuan, China
| | - Liangli Sun
- Department of Respiratory Medicine, Dazhou Central Hospital, Dazhou, Sichuan, China
| | - Qianlai Chen
- Department of Clinical laboratory, Dazhou Central Hospital, Dazhou, Sichuan, China
| | - Jie Li
- Department of Clinical Research Center, Dazhou Central Hospital, Dazhou, Sichuan, China
| | - Fanxin Zeng
- Department of Clinical Research Center, Dazhou Central Hospital, Dazhou, Sichuan, China
| |
Collapse
|
52
|
Han J, Fu C, Li B. Clinical outcomes of extensive-stage small cell lung cancer patients treated with thoracic radiotherapy at different times and fractionations. Radiat Oncol 2021; 16:47. [PMID: 33663551 PMCID: PMC7934361 DOI: 10.1186/s13014-021-01773-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/18/2021] [Indexed: 02/06/2023] Open
Abstract
Objective The purpose of this study was to assess whether thoracic radiotherapy (TRT) combined with chemotherapy (CHT) showed promising anti-tumour activity in extensive-stage small cell lung cancer (ES-SCLC), to explore practice patterns for the radiation time and dose/fractionation and to identify prognostic factors for patients who would benefit from CHT/TRT. Methods A total of 492 ES-SCLC patients were included from January 2010 to March 2019, 244 of whom received CHT/TRT. Propensity score matching was performed to minimize bias between the CHT/TRT and CHT-alone groups. Patients in the CHT/TRT group were categorized into four subgroups based on the number of induction CHT cycles. For effective dose fractionation calculations, we introduced the time-adjusted biological effective dose (tBED). Categorical variables were analysed with chi-square tests and Fisher’s exact tests. Kaplan–Meier curves were generated to estimate survival rates using the R-project. Multivariate prognostic analysis was performed with Cox proportional hazards models. Results Patients who received CHT/TRT experienced improved overall survival (OS) (18.1 vs 10.8 months), progression-free survival (PFS) (9.3 vs 6.0 months) and local recurrence-free survival (LRFS) (12.0 vs 6.6 months) before matching, with similar results after matching. In the CHT/TRT group, the median LRFS times for the groups based on the radiation time were 12.7, 12.0, 12.0, and 9.0 months, respectively. Early TRT had a tendency to prolong PFS (median 10.6 vs 9.8 vs 9.0 vs 7.7 months, respectively, p = 0.091) but not OS (median 17.6 vs 19.5 vs 17.2 vs 19.0 months, respectively, p = 0.622). Notably, patients who received TRT within 6 cycles of CHT experienced prolonged LRFS (p = 0.001). Regarding the radiation dose, patients in the high-dose group (tBED > 50 Gy) who achieved complete response and partial response (CR and PR) to systemic therapy had relatively short OS (median 27.1 vs 22.7, p = 0.026) and PFS (median 11.4 vs 11.2, p = 0.032), but the abovementioned results were not obtained after the exclusion of patients who received hyperfractionated radiotherapy (all p > 0.05). Conclusion CHT/TRT could improve survival for ES-SCLC patients. TRT performed within 6 cycles of CHT and hyperfractionated radiotherapy (45 Gy in 30 fractions) may be a feasible treatment scheme for ES-SCLC patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-021-01773-x.
Collapse
Affiliation(s)
- Jinmin Han
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China
| | - Chengrui Fu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China.,Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Baosheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China.
| |
Collapse
|
53
|
Spigel DR, Vicente D, Ciuleanu TE, Gettinger S, Peters S, Horn L, Audigier-Valette C, Pardo Aranda N, Juan-Vidal O, Cheng Y, Zhang H, Shi M, Luft A, Wolf J, Antonia S, Nakagawa K, Fairchild J, Baudelet C, Pandya D, Doshi P, Chang H, Reck M. Second-line nivolumab in relapsed small-cell lung cancer: CheckMate 331 ☆. Ann Oncol 2021; 32:631-641. [PMID: 33539946 DOI: 10.1016/j.annonc.2021.01.071] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patients with relapsed small-cell lung cancer (SCLC) have few treatment options and dismal survival. Phase I/II data show activity of nivolumab in previously treated SCLC. PATIENTS AND METHODS CheckMate 331 is a randomized, open-label, phase III trial of nivolumab versus standard chemotherapy in relapsed SCLC. Patients with relapse after first-line, platinum-based chemotherapy were randomized 1 : 1 to nivolumab 240 mg every 2 weeks or chemotherapy (topotecan or amrubicin) until progression or unacceptable toxicity. Primary endpoint was overall survival (OS). RESULTS Overall, 284 patients were randomized to nivolumab and 285 to chemotherapy. Minimum follow-up was 15.8 months. No significant improvement in OS was seen with nivolumab versus chemotherapy [median OS, 7.5 versus 8.4 months; hazard ratio (HR), 0.86; 95% confidence interval (CI), 0.72-1.04; P = 0.11]. A survival benefit with nivolumab was suggested in patients with baseline lactate dehydrogenase ≤ upper limit of normal and in those without baseline liver metastases. OS (nivolumab versus chemotherapy) was similar in patients with programmed death-ligand 1 combined positive score ≥1% versus <1%. Median progression-free survival was 1.4 versus 3.8 months (HR, 1.41; 95% CI, 1.18-1.69). Objective response rate was 13.7% versus 16.5% (odds ratio, 0.80; 95% CI, 0.50-1.27); median duration of response was 8.3 versus 4.5 months. Rates of grade 3 or 4 treatment-related adverse events were 13.8% versus 73.2%. CONCLUSION Nivolumab did not improve survival versus chemotherapy in relapsed SCLC. No new safety signals were seen. In exploratory analyses, select baseline characteristics were associated with improved OS for nivolumab.
Collapse
Affiliation(s)
- D R Spigel
- Oncology Department, Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, USA.
| | - D Vicente
- Department of Medical Oncology, Hosp Univ Virgen Macarena, Seville, Spain
| | - T E Ciuleanu
- Medical Oncology, Prof. Dr. Ion Chiricuta Institute of Oncology and UMF Iuliu Hatieganu, Cluj-Napoca, Romania
| | - S Gettinger
- Medical Oncology, Yale Cancer Center, New Haven, USA
| | - S Peters
- Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - L Horn
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Nashville, USA
| | | | - N Pardo Aranda
- Thoracic Unit, Medical Oncology Department, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - O Juan-Vidal
- Department of Medical Oncology, Hospital Universitario La Fe, Valencia, Spain
| | - Y Cheng
- Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun, Jilin, China
| | - H Zhang
- Department of Oncology, Tangdu Hospital, Xi'an, Shaanxi, China
| | - M Shi
- Department of Medical Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - A Luft
- Department of Thoracic Surgery, Leningrad Regional Clinical Hospital, St. Petersburg, Russian Federation
| | - J Wolf
- Clinic I for Internal Medicine, Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
| | - S Antonia
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | - K Nakagawa
- Department of Medical Oncology, Kindai University Hospital, Osaka, Japan
| | - J Fairchild
- Clinical Development, Bristol Myers Squibb, Princeton, USA
| | - C Baudelet
- Global Drug Development, Biometrics & Data Sciences, Bristol Myers Squibb, Princeton, USA
| | - D Pandya
- Translational Pathology, Bristol Myers Squibb, Princeton, USA
| | - P Doshi
- Translational Medicine, Bristol Myers Squibb, Princeton, USA
| | - H Chang
- Translational Bioinformatics, Bristol Myers Squibb, Princeton, USA
| | - M Reck
- Thoracic Oncology, LungenClinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany
| |
Collapse
|
54
|
da Silva LM, da Silva GT, Bergmann A, Costa GJ, Zamboni MM, Santos Thuler LC. Impact of different patterns of metastasis in non-small-cell lung cancer patients. Future Oncol 2021; 17:775-782. [PMID: 33508966 DOI: 10.2217/fon-2020-0587] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aim: The aim of this study was to evaluate the frequency and median time for the development of metastases and prognosis by metastatic site after the diagnosis of non-small-cell lung cancer (NSCLC). Patients & methods: This cohort study was conducted with 1096 patients diagnosed with NSCLC between 2006 and 2014. Results: The most prevalent site of NSCLC metastases was the respiratory system. The nervous and adrenal systems presented the longest median time for the development of metastases. The 6-month survival varied from 68.2% for liver to 79.9% for the nervous system. Bone metastases were associated with a higher risk of death. Conclusion: The respiratory system was the most prevalent site of metastases. OS and risk of death varied according to the metastatic site.
Collapse
Affiliation(s)
- Larissy Machado da Silva
- Brazilian National Cancer Institute & Federal University of The State of Rio de Janeiro, Rio de Janeiro, 22290-240, Brazil
| | | | - Anke Bergmann
- Brazilian National Cancer Institute, Rio de Janeiro, 20231-092, Brazil
| | - Guilherme Jorge Costa
- Instituto de Medicina Integral Prof. Fernando Figueira & Hospital de Câncer de Pernambuco, Recife, Pernambuco, 41825-906, Brazil
| | | | - Luiz Claudio Santos Thuler
- Brazilian National Cancer Institute & Federal University of The State of Rio de Janeiro, Rio de Janeiro, 22290-240, Brazil
| |
Collapse
|
55
|
Wang Y, Zeng Z, Tang M, Zhang M, Bai Y, Cui H, Xu Y, Guo X, Ma W, Xu G, Qi L, Wang J, Chen S, Gu D, Mao M, Wang X, Zhang C. Sex Disparities in the Clinical Characteristics, Synchronous Distant Metastasis Occurrence and Prognosis: A Pan-cancer Analysis. J Cancer 2021; 12:498-507. [PMID: 33391446 PMCID: PMC7739003 DOI: 10.7150/jca.50536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/25/2020] [Indexed: 12/24/2022] Open
Abstract
Background: This study aims to assess the sex disparities in clinical characteristics and synchronous distant metastasis occurrence at diagnosis, as well as the subsequent prognosis in non-sex-specific cancers. Methods: The study included details from patients diagnosed with non-sex-specific cancers, during the period from 2010 to 2016, in the Surveillance, Epidemiology, and End Results (SEER) program. The distant metastasis prevalence and subsequent survival time were summarized in the total population and the population with specific cancers of different systems. The multivariable logistic and the Cox proportional hazards regressions were applied to evaluate the sex effect on distant metastasis occurrence and prognosis. The results were combined using meta-analysis. Results: Across all non-sex-specific cancers, the pooled prevalence of distant metastasis was 15.2% (95% CI: 14.7-15.7%) and 7.1% (95% CI: 6.8-7.3%) for males and females, respectively. The pooled median survival time was 8.40 months (95% CI: 7.99-8.81) for male patients and 9.40 months (95% CI: 8.84-10.02) for female patients. After combining all non-sex-specific cancers, male patients displayed a higher distant metastasis occurrence than females (pooled OR=1.06, 95% CI: 1.04-1.08; P<0.01), as well as worse overall survival after distant metastasis (pooled HR=1.08, 95% CI: 1.05-1.10; P<0.01). The sex differences were more significant in patients younger than 65 years (P<0.01). Additionally, the sex influence on prognosis was most predominant amongst patients from Asian or Pacific Islander ethnic groups. Conclusion: Male gender appears to be an independent risk factor associated with the occurrence and prognosis of synchronous distant metastasis. Therefore, sex-specific preventions and treatments should become the focus of future research.
Collapse
Affiliation(s)
- Yutong Wang
- Department of Health Management Center (Epidemiology and Biostatistics), First Affiliated Hospital, Army Medical University, Chongqing 400038, China
| | - Ziqian Zeng
- Department of Health Management Center (Epidemiology and Biostatistics), First Affiliated Hospital, Army Medical University, Chongqing 400038, China.,Department of Epidemiology, Chengdu Medical College, Chengdu, 610599, Sichuan province, China
| | - Mingshuang Tang
- Department of Health Management Center (Epidemiology and Biostatistics), First Affiliated Hospital, Army Medical University, Chongqing 400038, China
| | - Min Zhang
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing 400038, China
| | - Ye Bai
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing 400038, China
| | - Huijie Cui
- Department of Health Management Center (Epidemiology and Biostatistics), First Affiliated Hospital, Army Medical University, Chongqing 400038, China
| | - Yao Xu
- Department of Bone and Soft Tissue Tumours, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Xu Guo
- Department of Bone and Soft Tissue Tumours, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China.,Department of Orthopedics, Cangzhou Central Hospital, Cangzhou, Hebei, 061000, China
| | - Wenjuan Ma
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Guijun Xu
- Department of Bone and Soft Tissue Tumours, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China.,Department of Orthopedics, Tianjin Hospital, Tianjin 300060, China
| | - Lisha Qi
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Jingyi Wang
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Siyu Chen
- Department of Health Management Center (Epidemiology and Biostatistics), First Affiliated Hospital, Army Medical University, Chongqing 400038, China
| | - Dongqing Gu
- Department of Health Management Center (Epidemiology and Biostatistics), First Affiliated Hospital, Army Medical University, Chongqing 400038, China
| | - Min Mao
- Department of Pathology and Southwest Cancer Center, First Affiliated Hospital, Army Medical University, Chongqing 400038, China
| | - Xin Wang
- Department of Health Management Center (Epidemiology and Biostatistics), First Affiliated Hospital, Army Medical University, Chongqing 400038, China
| | - Chao Zhang
- Department of Bone and Soft Tissue Tumours, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| |
Collapse
|
56
|
Abstract
Cancer mortality predominantly results from distant metastases that are undetectable at diagnosis and escape initial therapies to lie as dormant micrometastases for years. To study the behavior of micrometastases-how they resist initial treatments and then awaken from a dormant state-we utilize the Legacy LiverChip®, an all-human ex vivo hepatic microphysiological system. The functional liver bioreactor, comprising hepatocytes and non-parenchymal cells in a 3D microperfused culture format, mimics the dormant-emergent metastatic progression observed in human patients: (a) a subpopulation of cancer cells spontaneously enter dormancy, (b) cycling cells are eliminated by standard chemotherapies, while quiescent dormant cells remain, and (c) chemoresistant dormant cells can be stimulated to emerge. The system effluent and tissue can be queried for proteomic and genomic data, immunofluorescent imaging as well as drug efficacy and metabolism. This microphysiological system continues to provide critical insights into the biology of dormant and re-emergent micrometastases and serves as an accessible tool to identify new therapeutic strategies targeting the various stages of metastasis, while concurrently evaluating antineoplastic agent efficacy for metastasis, metabolism, and dose-limiting toxicity.
Collapse
|
57
|
Definitions, outcomes, and management of hyperprogression in patients with non-small-cell lung cancer treated with immune checkpoint inhibitors. Lung Cancer 2020; 152:109-118. [PMID: 33385736 DOI: 10.1016/j.lungcan.2020.12.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/29/2020] [Accepted: 12/21/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The advent of immune checkpoint inhibitors (ICI) has been a breakthrough in the care of patients with non-small-cell lung cancers (NSCLC). However, physicians are now facing a previously unidentified clinical situation called hyperprogression (HP), which presents as a fast and unexpected increase in tumor burden. HP's existence and specificity to ICIs remains controversial because a widely acknowledged definition is currently lacking. Meanwhile, management remains elusive. METHODS Medical records from all consecutive NSCLC patients who were treated with ICI from 2015 to 2018 were retrospectively analyzed. The HP incidence rate was calculated according to five definitions (tumor growth rate [TGR]ratio, ΔTGR, tumor growth kinetic [TGK], RECIST, and time to treatment failure [TTF]), and the agreement between such definitions was determined. The HP impact on overall survival (OS) was then assessed. The association between HP (defined using the TGRratio definition) and clinical and biological variables was also assessed. Clinical HP management and its impact on outcomes were described. RESULTS We identified 169 consecutive ICI-treated patients, with potential HP accounting for 11.3 %, 5.7 %, 17.0 %, 9.6 %, and 31.7 % patients, according to TGRratio, ΔTGR, TGK, RECIST, and TTF definitions. Agreement between the different HP definitions was highly heterogeneous (range 29 %-77 %) and globally poor. HP was associated with shorter OS, compared to standard RECIST progressive disease, but this difference only reached statistical significance when using the TTF definition. TGRratio-based HP was significantly associated with hepatic metastases. In TGRratio-based HP patients, neither resuming chemotherapy nor corticosteroids use was associated with statistically significant impact on overall survival. CONCLUSION We found fairly heterogeneous HP rates using different definitions. TTF was the only definition leading to significantly worsened OS. Further studies are needed to provide consensus recommendations for the assessment, definition, and management of HP, whose existence is likely real.
Collapse
|
58
|
Raviadaran R, Ng MH, Chandran D, Ooi KK, Manickam S. Stable W/O/W multiple nanoemulsion encapsulating natural tocotrienols and caffeic acid with cisplatin synergistically treated cancer cell lines (A549 and HEP G2) and reduced toxicity on normal cell line (HEK 293). MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 121:111808. [PMID: 33579452 DOI: 10.1016/j.msec.2020.111808] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 01/20/2023]
Abstract
This work aimed to evaluate the effects of encapsulated tocotrienols (TRF) and caffeic acid (CA) in water-in-oil-in-water (W/O/W) multiple nanoemulsion with cisplatin towards cancer cells. This work is important considering the limited efficacy of cisplatin due to tumour resistance, as well as its severe side effects. A549 and HEP G2 cancer cell lines were utilised for evaluating the efficacy of the encapsulated W/O/W while HEK 293 normal cell line was used for evaluating the toxicity. TRF, CA and CIS synergistically improved apoptosis in the late apoptotic phase in A549 and HEP G2 by 23.1% and 24.9%, respectively. The generation of ROS was enhanced using TRF:CA:CIS by 16.9% and 30.2% for A549 and HEP G2, respectively. Cell cycle analysis showed an enhanced cell arrest in the G0/G1 phase for both A549 and HEP G2. TRF, CA and CIS led to cell death in A549 and HEP G2. For HEK 293, ~33% cell viability was found when only CIS was used while >95% cell viability was observed when TRF, CA and CIS were used. This study demonstrates that the encapsulated TRF and CA in W/O/W with CIS synergistically improved therapeutic efficacy towards cancer cells, as well as lowered the toxicity effects towards normal cells.
Collapse
Affiliation(s)
- Revathi Raviadaran
- Department of Chemical and Environmental Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, Jalan Broga, 43500 Semenyih, Selangor Darul Ehsan, Malaysia; Malaysian Palm Oil Board (MPOB), 6 Persiaran Institusi, Bandar Baru Bangi, 43000 Kajang, Selangor, Malaysia
| | - Mei Han Ng
- Malaysian Palm Oil Board (MPOB), 6 Persiaran Institusi, Bandar Baru Bangi, 43000 Kajang, Selangor, Malaysia
| | - Davannendran Chandran
- Graphene & Advanced 2D Materials Research Group (GAMRG), School of Science and Technology, Sunway University, No. 5, Jalan Universiti, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia
| | - Kah Kooi Ooi
- Research Centre for Crystalline Materials (RCCM), School of Science and Technology, Sunway University, No. 5, Jalan Universiti, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia
| | - Sivakumar Manickam
- Department of Chemical and Environmental Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, Jalan Broga, 43500 Semenyih, Selangor Darul Ehsan, Malaysia; Petroleum and Chemical Engineering, Faculty of Engineering, Universiti Teknologi Brunei, Bandar Seri Begawan BE1410, Brunei Darussalam.
| |
Collapse
|
59
|
The Combination of CA125 and NSE Is Useful for Predicting Liver Metastasis of Lung Cancer. DISEASE MARKERS 2020; 2020:8850873. [PMID: 33376560 PMCID: PMC7746448 DOI: 10.1155/2020/8850873] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/10/2020] [Accepted: 11/02/2020] [Indexed: 02/07/2023]
Abstract
Purpose Liver metastasis is the final stage of cancer progression and is associated with poor prognosis. Although numerous indicators have been identified as having prognostic value for lung cancer and liver metastasis, liver metastases are still not diagnosed by imaging in many patients. To provide a more accurate method for clinical prediction of liver metastasis, we analyzed multiple factors to identify potential predictive factors for liver metastasis of lung cancer. Methods Patients first diagnosed with lung cancer between 2002 and 2016 (n = 1746) were divided into two groups, with and without liver metastasis. Serum concentrations of calcium, carcinoembryonic antigen (CEA), cancer antigen-125 (CA125), cancer antigen-153 (CA153), carbohydrate antigen-199 (CA199), cytokeratin fraction 21-1 (CYFRA21-1), total prostate-specific antigen (TPSA), and neuron-specific enolase (NSE) were analyzed in both patient groups. Results There was no significant difference in age or sex between the two groups. CA125 and NSE were significantly associated with liver metastasis. Compared with CA125, NSE was more specific, while it was less sensitive (P < 0.001). Further analysis of NSE concentrations was conducted in patients with non-small-cell lung cancer and indicated that NSE concentration differed significantly between those with and without liver metastasis (P = 0.023). We conducted analysis with NSE and CA125 combined, resulting in acceptable sensitivity (51.2%), specificity (72.6%), and area under the curve (0.64) values; sensitivity and area under the curve values were higher than those for individual factors, while specificity was higher than that for CA125. Conclusions The combination of CA125 and NSE can assist prediction of liver metastasis of lung cancer, providing improved diagnostic accuracy.
Collapse
|
60
|
Campos‐Balea B, de Castro Carpeño J, Massutí B, Vicente‐Baz D, Pérez Parente D, Ruiz‐Gracia P, Crama L, Cobo Dols M. Prognostic factors for survival in patients with metastatic lung adenocarcinoma: An analysis of the SEER database. Thorac Cancer 2020; 11:3357-3364. [PMID: 32986309 PMCID: PMC7606019 DOI: 10.1111/1759-7714.13681] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/11/2020] [Accepted: 09/11/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Lung adenocarcinoma (ADC) is the main cause of death related to lung cancer. The aim of this study was to identify poor prognostic factors for overall survival (OS) in patients with stage IV lung ADC in real-world clinical practice. METHODS Patients were selected from the Surveillance Epidemiology and End Results (SEER) database. Chi-square bivariate analysis was used for the association of binary qualitative variables. A multivariate Cox regression analysis was performed to determine the impact of these prognostic factors on OS. RESULTS A total of 46 030 patients were included (51.3% men, mean age 67.03 ± 11.6), of whom 41.3% presented with metastases in bone, 28.9% in brain, 17.1% in liver and 31.8% in lung. Patients with liver metastases presented with two or more metastatic sites more frequently than patients without liver metastases (P < 0.001). Male sex (HR 0.78, 95% CI: 0.76-0.80), age ≥ 65 years (HR 1.37, 95% CI: 1.33-1.40), lack of family support (HR 0.80, 95% CI: 0.78-0.81) and presence of liver (HR 1.45, 95% CI: 1.40-1.50), bone (HR 1.21, 95% CI: 1.18-1.24) or brain metastases (HR 1.18, 95% CI: 1.15-1.21) were identified as poor prognostic factors for OS. Patients with liver metastasis showed the highest hazard ratio value (P < 0.001). CONCLUSIONS The presence of liver metastases was the worst prognostic factor for patients with metastatic lung ADC. This factor should be considered as a stratification factor for future studies evaluating new cancer treatments including immunotherapy. KEY POINTS SIGNIFICANT FINDINGS OF THE STUDY: Regression analysis identified poor prognostic factors for overall survival. Factors were male sex, age ≥ 65 years, lack of family support and presence of liver, bone and brain metastases. Patients with liver metastasis showed the highest HR (HR = 1.45 95% CI: 1.40-1.50). This study included the highest number of adenocarcinoma patients analyzed so far (N = 46 030). What this study adds The presence of liver metastases should be considered as a stratification factor for future studies evaluating new cancer treatments including immunotherapy.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Leonardo Crama
- Lung Cancer. Medical Affairs Department, Roche Farma S.AMadridSpain
| | - Manuel Cobo Dols
- Medical Oncology, Unidad de Gestión Clínica Intercentros de Oncología Médica. Hospitales Universitarios Regional y Virgen de la Victoria. IBIMAMálagaSpain
| |
Collapse
|
61
|
Arterial Embolization Using Microspheres for Hypervascular Liver Metastases Refractory to Standard Treatments: A Multicenter Prospective Clinical Trial. Cardiovasc Intervent Radiol 2020; 44:392-400. [PMID: 33098022 DOI: 10.1007/s00270-020-02673-5] [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: 06/17/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the clinical utility of bland arterial embolization using microspheres in patients with hypervascular liver metastases refractory to standard treatments. MATERIALS AND METHODS Primary endpoints of this prospective single-arm non-comparative study were objective response and disease control rates (ORR and DCR), based on the modified Response Evaluation Criteria in Solid Tumors at 4 weeks after embolization. Secondary endpoints were ORR according to primary tumor, overall survival, progression-free survival (PFS), and safety. RESULTS Twenty-five patients with a median age of 66 years (range, 40-95 years) were enrolled in this study. The median maximum diameter of liver metastasis was 3.7 cm (range, 2.0-15.2 cm). Primary lesions were colorectal cancer in 12 patients (48%, 12/25), other cancer in 7 (28%, 7/25), neuroendocrine tumor in 4 (16%, 4/25), and sarcoma in 2 (8%, 2/25). ORR and DCR were 52% (13/25) and 72% (18/25) in all patients, 42% (5/12) and 75% (9/12) in colorectal cancer patients, and 62% (8/13) and 69% (9/13) in other malignant tumor patients (p = 0.43, p > 0.99). Median survival time was 19 months in all patients, 19 months in colorectal cancer patients, and 8 months (p = 0.16) in other malignant tumor patients. Median PFS time was 4 months in all patients, 4 months in colorectal cancer patients, and 6 months (p = 0.0085) in other malignant tumor patients. There were no grade-3 or -4 adverse events. CONCLUSION Microsphere embolization appears to be an effective and safe treatment for hypervascular liver metastases refractory to standard treatments.
Collapse
|
62
|
Differential Efficacy of Pembrolizumab According to Metastatic Sites in Patients With PD-L1 Strongly Positive (TPS ≥ 50%) NSCLC. Clin Lung Cancer 2020; 22:127-133.e3. [PMID: 33183972 DOI: 10.1016/j.cllc.2020.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/23/2020] [Accepted: 10/01/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Pembrolizumab has shown significantly better efficacy than platinum doublet chemotherapy in patients with programmed cell death ligand 1 (PD-L1) strongly positive (tumor proportion score ≥ 50%) non-small-cell lung cancer (NSCLC). However, the predictors of response to pembrolizumab have not yet been fully elucidated for patients with PD-L1 strongly positive NSCLC. PATIENTS AND METHODS We retrospectively analyzed 145 patients who had been treated with pembrolizumab for PD-L1 strongly positive (TPS ≥ 50%) NSCLC without an EGFR (epidermal growth factor receptor) mutation or ALK rearrangement from February 2017 to March 2020. Various clinical characteristics, including Eastern Cooperative Oncology Group performance status, treatment line, PD-L1 expression, C-reactive protein level, neutrophil/lymphocyte ratio, and metastatic sites, and the clinical outcome of pembrolizumab treatment were examined. RESULTS Patients with higher PD-L1 expression (≥ 75%; n = 90) had a higher objective response rate (ORR) and longer progression-free survival (PFS) compared with those with lower expression (50%-74%; n = 55; ORR, 51% vs. 33%; P = .0305; median PFS, 13.9 months vs. 5.2 months; P = .0111). In addition, 15 patients with liver metastasis (LM) had a significantly lower ORR and shorter PFS than the 130 patients without LM (ORR, 20% vs. 47%; P = .0468; median PFS, 3.4 months vs. 9.4 months; P = .0018). A multivariate analysis indicated that PD-L1 expression and LM were significant predictors of PFS after pembrolizumab treatment (higher PD-L1 expression: hazard ratio, 0.58; 95% confidence interval, 0.38-0.91; P = .0183; presence of LM: hazard ratio, 2.05; 95% confidence interval, 1.03-3.82; P = .0420). CONCLUSION PD-L1 expression and LM status were predictors of the efficacy of pembrolizumab in patients with PD-L1 strongly positive NSCLC.
Collapse
|
63
|
Zhang S, Li S, Cheng Y. Efficacy and safety of PD-1/PD-L1 inhibitor plus chemotherapy versus chemotherapy alone as first-line treatment for extensive-stage small cell lung cancer: A systematic review and meta-analysis. Thorac Cancer 2020; 11:3536-3546. [PMID: 33058504 PMCID: PMC7705912 DOI: 10.1111/1759-7714.13698] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Immunotherapy has afforded new treatment options for extensive small cell lung cancer (ES-SCLC). However, reports on the effectiveness of immune checkpoint inhibitors (ICIs) combined with chemotherapy on survival in ES-SCLC patients are inconsistent. Therefore, we conducted a meta-analysis on the efficacy and safety of ICI combined with chemotherapy for ES-SCLC. METHODS We searched for randomized controlled clinical trials related to first-line treatment of ES-SCLC with ICI combined with chemotherapy in PUBMED, ESMO, ASCO, and WCLC since 2018. The primary outcome was overall survival (OS). RESULTS Four studies were included. Compared to chemotherapy alone, ICI in combination with chemotherapy as first-line treatment reduced the risk of death (hazard ratio [HR]: 0.76; 95% CI: 0.68-0.86; P < 0.00001) and disease progression (HR: 0.76; 95% CI: 0.68-0.84; P < 0.00001). The objective response rate (ORR) with ICI plus chemotherapy was significantly higher than that with chemotherapy alone (HR: 1.10; 95% CI: 1.02-1.19, P = 0.01). The duration of response (DoR) rate at one year was also better with ICI plus chemotherapy (HR: 3.46; 95% CI: 2.24-5.33; P < 0.00001). Security analysis revealed that the incidence of immune-mediated adverse events (imAEs) (HR: 3.77; 95% CI: 1.99-7.15, P < 0.0001) and grade 3/4 imAEs (HR: 7.01; 95% CI: 2.48-19.81; P = 0.0002) increased significantly with ICI plus chemotherapy. CONCLUSIONS ICI combined with chemotherapy as first-line treatment can significantly improve the OS and progression-free survival (PFS) of ES-SCLC patients, but the toxicity caused by immunotherapy should be carefully considered. KEY POINTS Significant findings of the studyOur meta-analysis shows that PD-L1/PD-1 plus chemotherapy can significantly improve the OS and PFS of ES-SCLC patients when used as first-line therapy. WHAT THIS STUDY ADDS This study fills gaps regarding the efficacy of immunotherapy combined with chemotherapy as first-line treatment for ES-SCLC, and provides better evidence for the use of PD-L1/PD-1 immunotherapy plus chemotherapy for patients with ES-SCLC.
Collapse
Affiliation(s)
- Shuang Zhang
- Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun, China
| | - Shuang Li
- Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun, China
| | - Ying Cheng
- Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun, China
| |
Collapse
|
64
|
Britschgi C, Addeo A, Rechsteiner M, Delaloye R, Früh M, Metro G, Banini M, Gautschi O, Rothschild SI, Wild PJ, Banna GL, Curioni-Fontecedro A. Real-World Treatment Patterns and Survival Outcome in Advanced Anaplastic Lymphoma Kinase (ALK) Rearranged Non-Small-Cell Lung Cancer Patients. Front Oncol 2020; 10:1299. [PMID: 32974130 PMCID: PMC7472246 DOI: 10.3389/fonc.2020.01299] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/22/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Survival of ALK-rearranged NSCLC patients has dramatically improved by the use of multiple ALK-tyrosine kinase inhibitors (ALK-TKI). However, still little is known about the impact of drug sequencing and clinical features on survival in a real-world setting. Methods: Patients with stage IV ALK-rearranged NSCLC treated at six centers in Switzerland and Italy were identified and standard clinical variables collected. OS curves were constructed using the Kaplan–Meier method and compared with the log-rank test. Multivariate Cox proportional hazard analysis was applied to determine the correlations between clinical features and OS. In four patients, biopsies were subjected to NGS. Results: One-hundred and twenty-one patients with stage IV ALK-rearranged NSCLC diagnosed between 2011 and 2016 were included. With a median follow-up time of 39.5 months, the median OS from diagnosis of stage IV disease was 48.0 months. First-line treatment consisted of an ALK-TKI in 24% of patients, with crizotinib in 83% of them. Chemotherapy as first-line treatment did not influence OS (p = 0.955). The use of more than one ALK-TKI line positively correlated with OS (p = 0.016), as well as the use of alectinib or lorlatinib in any treatment line, as compared to the use of crizotinib ± ceritinib (p = 0.022). A never smoking history was an independent prognostic factor for OS (p = 0.032). Moreover, treatment with alectinib significantly improved OS. Conclusions: Targeted treatment for ALK-positive NSCLC patients lead to prolonged OS. Smoking status was a negative independent prognostic factor in a multi-variate analysis. The use of alectinib or lorlatinib in any treatment line improved overall outcome.
Collapse
Affiliation(s)
- Christian Britschgi
- Department of Medical Oncology and Hematology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alfredo Addeo
- Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Markus Rechsteiner
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Raphaël Delaloye
- Department of Medical Oncology and Hematology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Früh
- Department of Oncology and Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.,Department of Oncology, University Hospital of Bern, Bern, Switzerland
| | - Giulio Metro
- Medical Oncology, Azienda Ospedaliera Di Perugia, Perugia, Italy
| | - Marco Banini
- Medical Oncology, Azienda Ospedaliera Di Perugia, Perugia, Italy
| | - Oliver Gautschi
- University of Bern and Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Sacha I Rothschild
- Department of Internal Medicine, Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Peter J Wild
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | | | - Alessandra Curioni-Fontecedro
- Department of Medical Oncology and Hematology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
65
|
Passaro A, Attili I, Morganti S, Del Signore E, Gianoncelli L, Spitaleri G, Stati V, Catania C, Curigliano G, de Marinis F. Clinical features affecting survival in metastatic NSCLC treated with immunotherapy: A critical review of published data. Cancer Treat Rev 2020; 89:102085. [PMID: 32771858 DOI: 10.1016/j.ctrv.2020.102085] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/26/2020] [Accepted: 07/16/2020] [Indexed: 12/18/2022]
Abstract
Immune checkpoint inhibitors (ICIs) represent one of the main steps forward for the treatment of advanced or metastatic non-small-cell lung cancer (NSCLC), without oncogenic driver alterations. Despite this recent progress, only a minority of patients achieve a broad and durable benefit and another proportion report poor survival and sometimes fast disease progression, confirming the need to optimise the patient's selection. To date, several issues are unsolved about how to personalise the immunotherapy treatment for individual patients. In this review, analysing data from pivotal randomised clinical trials (RCTs), we discuss patient baseline clinical and demographic features, including sex, age, ECOG performance status, smoking habit and specific site of metastases (liver, bone and brain) that may influence the efficacy outcomes in patients treated with ICIs. The high performance of the ICIs blurred the vision on different efficacy-limiting factors, which require extensive evaluation to improve the understanding ofthe tumour-specificimmune response, in which clinical drivers could be useful for better patient stratification.
Collapse
Affiliation(s)
- Antonio Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Ilaria Attili
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Stefania Morganti
- Division of Early Drug Development for Innovative Therapies, IEO European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Ester Del Signore
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Letizia Gianoncelli
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gianluca Spitaleri
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Valeria Stati
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Chiara Catania
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giuseppe Curigliano
- Division of Early Drug Development for Innovative Therapies, IEO European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Filippo de Marinis
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| |
Collapse
|
66
|
Tumor Primary Location May Affect Metastasis Pattern for Patients with Stage IV NSCLC: A Population-Based Study. JOURNAL OF ONCOLOGY 2020; 2020:4784701. [PMID: 32695165 PMCID: PMC7368215 DOI: 10.1155/2020/4784701] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/30/2020] [Indexed: 12/26/2022]
Abstract
Background Most patients with nonsmall cell lung cancer (NSCLC) were initially diagnosed with distant metastasis. At present, there is no study to clarify the correlation between the primary location of the tumor and the metastasis pattern in advanced NSCLC. So we conducted this study to explored the relationship between the tumor primary location and metastasis pattern in stage IV NSCLC. Methods A total of 19,295 eligible patients were identified from 2010 to 2012 in the SEER database. The main endpoint of our study was overall survival (OS). The survival curves were created by using the Kaplan-Meier method and compared by the usage of the Log Rank test. The clinical variable characteristics were compared by the chi-square test, and multivariate logistic regression analyses were used to evaluate the risk factors on metastasis patterns. All statistical P values were two-sided, and it was considered statistically significant when P ≤ 0.05. Results We found that different proportions of metastatic sites could be found in different tumor primary locations. In addition, the prognosis of lung metastasis was relatively good in patients with tumor location in main bronchus (P < 0.001), upper lobe (P < 0.001), lower lobe (P < 0.001) , and middle lobe (P = 0.005). Besides, there was no significant OS difference for patients whose primary location was overlapping lesion (P = 0.226). The results also demonstrated that compared with patients with primary tumor located in the main bronchus, those in the upper lobe were more likely to have brain metastasis (P = 0.01) and lung metastasis (P = 0.024), those in the middle lobe were more prone to develop lung metastasis (P = 0.035) and those in the lower lobe were more apt to cause bone metastasis (P = 0.005) and lung metastasis (P = 0.001). In addition, there was no statistical difference in metastasis patterns among patients with overlapping lesions (P > 0.05). Conclusions Different primary tumor locations might affect the metastasis pattern in patients with stage IV NSCLC.
Collapse
|
67
|
Kobayashi K, Soejima K, Fukunaga K, Shintani Y, Sekine I, Shukuya T, Takayama K, Inoue A, Okamoto I, Kiura K, Takahashi K, Yamamoto N, Takiguchi Y, Miyaoka E, Okumura M, Yoshino I. Key prognostic factors for EGFR-mutated non-adenocarcinoma lung cancer patients in the Japanese Joint Committee of Lung Cancer Registry Database. Lung Cancer 2020; 146:236-243. [PMID: 32590236 DOI: 10.1016/j.lungcan.2020.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The efficacy of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) for EGFR-mutated non-adenocarcinoma (ADC) non-small cell lung cancer patients is not well established. Herein, we investigated key prognostic factors influencing the efficacy of EGFR-TKIs in these patients. METHODS A total of 12,320 lung cancer patients pathologically diagnosed in 2012 at teaching hospitals in Japan were retrospectively selected. The follow-up survey was closed in 2016. RESULTS EGFR-mutated non-ADC patients were more prone to malignant pleural effusion (MPE) and distant metastasis than ADC patients (P = 0.071 and 0.022, respectively). EGFR-mutated ADC patients were likely to have a longer median overall survival (OS) than non-ADC patients [hazard ratio (HR) 1.3 (95 % CI, 0.97-1.8, P = 0.072)-29.5 months (95 % CI, 27.9-31.1 months) versus 19.5 months (95 % CI, 10.8-28.2 months) (P = 0.068)]. There was no significant difference in median OS between EGFR-positive ADC and non-ADC patients receiving treatment with first-generation EGFR-TKI. Among EGFR-positive non-ADC patients, the median OS was significantly longer for patients receiving EGFR-TKI treatment than for those who did not [HR 4.5 (95 % CI, 2.1-9.8, P < 0.001)-25.5 months (95 % CI, 8.1-42.9 months) versus 7.5 months (95 % CI, 3.4-11.6 months) (P < 0.001)]. While there was no significant difference in the median OS for ADC patients with either 19 del or L858R mutations, the median OS was significantly longer for EGFR-mutated non-ADC patients with 19 del than for those with L858R mutation (HR 3.2 [95 % CI, 1.5-6.9, P = 0.004]; it was not reached for 19 del and was 15.5 months for L858R [95 % CI, 6.6-24.4 months], P = 0.002). DISCUSSION EGFR-mutated non-ADC patients were more prone to MPE and distant metastasis. Both ADC and EGFR del19-positive non-ADC patients can benefit from EGFR-TKI treatment, whereas EGFR L858R-positive non-ADC patients might require different therapeutic options.
Collapse
Affiliation(s)
- Keigo Kobayashi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Kenzo Soejima
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ikuo Sekine
- Department of Medical Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takehito Shukuya
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Koichi Takayama
- Department of Respirology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Miyagi, Japan
| | - Isamu Okamoto
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu, Japan
| | - Katsuyuki Kiura
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobuyuki Yamamoto
- Third Department of Internal Medicine, Wakayama Medical University Hospital, Wakayama, Japan
| | - Yuichi Takiguchi
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Etsuo Miyaoka
- Department of Mathematics, Science University of Tokyo, Tokyo, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, National Hospital Organization Toneyama Hospital, Osaka, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | |
Collapse
|
68
|
Horn SR, Stoltzfus KC, Lehrer EJ, Dawson LA, Tchelebi L, Gusani NJ, Sharma NK, Chen H, Trifiletti DM, Zaorsky NG. Epidemiology of liver metastases. Cancer Epidemiol 2020; 67:101760. [PMID: 32562887 DOI: 10.1016/j.canep.2020.101760] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/22/2020] [Accepted: 05/30/2020] [Indexed: 02/09/2023]
Abstract
AIMS The objectives of this study were to (1) characterize the epidemiology of liver metastases at the time of primary cancer diagnosis (synchronous liver metastases), (2) characterize the incidence trends of synchronous liver metastases from 2010-2015 and (3) assess survival of patients with synchronous liver metastases. METHODS The Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015 was queried to obtain cases of patients with liver metastases at the time of primary cancer diagnosis. The primary cancers with an incidence rate of liver metastasis >0.1 are presented in this analysis. RESULTS Among 2.4 million cancer patients, 5.14 % of cancer patients presented with synchronous liver metastases. The most common primary site was breast cancers for younger women (ages 20-50), and colorectal cancers for younger men. As patients get older, a more heterogenous population of the top cancers with liver metastases emerges including esophageal, stomach, small intestine, melanoma, and bladder cancer in addition to the large proportion of lung, pancreatic, and colorectal cancers. The 1-year survival of all patients with liver metastases was 15.1 %, compared to 24.0 % in those with non-hepatic metastases. Regression analysis showed that the presence of liver metastasis was associated with reduced survival, particularly in patients with cancers of the testis, prostate, breast, and anus, and in those with melanoma. CONCLUSIONS The most common primary sites for patients with liver metastases varied based on age at diagnosis. Survival for patients with liver metastasis was significantly decreased as compared to patients without liver metastasis.
Collapse
Affiliation(s)
- Samantha R Horn
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA
| | - Kelsey C Stoltzfus
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA
| | - Eric J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laura A Dawson
- Department of Radiation Oncology, University of Toronto, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario Canada
| | - Leila Tchelebi
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA
| | - Niraj J Gusani
- Department of Surgery, Penn State College of Medicine, Hershey, PA, USA; Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Navesh K Sharma
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA
| | - Hanbo Chen
- Department of Radiation Oncology, Amsterdam University Medical Centers - Location VUmc, Amsterdam, Netherlands
| | | | - Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA; Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
| |
Collapse
|
69
|
Predictors of prognosis of synchronous brain metastases in small-cell lung cancer patients. Clin Exp Metastasis 2020; 37:531-539. [PMID: 32500410 DOI: 10.1007/s10585-020-10040-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/29/2020] [Indexed: 10/24/2022]
Abstract
Patients with small cell lung cancer (SCLC) are more likely to have synchronous brain metastasis (SBM) at the time of diagnosis than patients with any other extracranial primary malignancy. We sought to identify which factors predicted an increased risk of SBM in SCLC as well as which factors affected the prognosis of these patients. 38,956 Patients in the Surveillance, Epidemiology, and End Results (SEER) database with microscopically confirmed SCLC from 2010 to 2016 were identified. 6264 (16.1%) Patients with SCLC had SBM at the time of diagnosis. In the multivariable logistic regression, disease specific factors that were predictive of SBM were primary tumor size > 7 cm (adjusted OR = 1.14, 95% CI [1.02, 1.28], p = 0.02), synchronous lung metastases, and synchronous bone metastases. Demographic specific factors predictive of increased SBM risk in this model were younger age, male sex, and race (American Indian/Alaska Native and black patients). Patients insured through Medicaid were less likely to present with SBM. In the multivariate Cox proportional hazards model, lack of insurance was the strongest predictor of mortality (adjusted HR = 1.47, 95% CI [1.26, 1.73], p < 0.001). Other factors associated with an increased risk of mortality include male sex, older age, health insurance coverage through Medicaid, synchronous liver metastasis, synchronous lung metastasis, and primary tumor size > 7 cm. In contrast, Asian patients had a lower risk of mortality. This study identifies risk factors for SBM among patients with SCLC, as well as indicators of prognosis among this patient population.
Collapse
|
70
|
Oligoprogressive Non-Small-Cell Lung Cancer under Treatment with PD-(L)1 Inhibitors. Cancers (Basel) 2020; 12:cancers12041046. [PMID: 32340408 PMCID: PMC7226015 DOI: 10.3390/cancers12041046] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 11/23/2022] Open
Abstract
Oligoprogression (OPD) of non-small-cell lung cancer (NSCLC) occurs in approximately half of patients under targeted compounds (TKI) and facilitates use of regional therapies that can prolong survival. In order to characterize OPD in immunotherapy (IO)-treated NSCLC, we analyzed the failure pattern under PD-1/PD-L1 inhibitors (n = 297) or chemoimmunotherapy (n = 75). Under IO monotherapy, OPD was more frequent (20% vs. 10%, p < 0.05), occurred later (median 11 vs. 5 months, p < 0.01), affected fewer sites (mean 1.1 vs. 1.5, p < 0.05), and involved fewer lesions (1.4 vs. 2.3, p < 0.05) in the first compared to later lines. Lymph nodes (42%, mainly mediastinal) and the brain (39%) were mostly affected, followed by the lung (24%) and other organs. Compared to multifocal progression, OPD occurred later (11 vs. 4 months, p < 0.001) and was associated with longer survival (26 vs. 13 months, p < 0.001) and higher tumor PD-L1 expression (p < 0.001). Chemoimmunotherapy showed a similar incidence of OPD as IO monotherapy (13% vs. 11% at 2 years). Local treatments were applied regularly for brain but only in 50% for extracranial lesions. Thus, NSCLC oligoprogression is less common under IO than under TKI, but also favorable. Since its frequency drops later in the disease, regular restaging and multidisciplinary evaluation are essential in order to exploit the full therapeutic potential.
Collapse
|
71
|
Zhang HY, Shan Li S, Guo X, Zhao N. Hyoid Bone Metastasis in Patients With Lung Adenocarcinoma: A Case Report. EAR, NOSE & THROAT JOURNAL 2020; 100:NP373-NP376. [PMID: 32283978 DOI: 10.1177/0145561320916985] [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] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Hyoid bone metastasis from lung adenocarcinoma is exceedingly rare. This study aims to provide an experience to clinicians in the differential diagnosis of hyoid tumors and discusses its possible source. METHODS AND RESULTS We report a 68-year-old male patient having hyoid bone metastasis from lung adenocarcinoma. The initial symptom of the hyoid bone metastasis was neck pain exacerbated by swallowing. The hyoid bone mass was resected based on comprehensive analysis including whole-body bone imaging and pathologic analysis of the hyoid bone mass. The adenocarcinoma of hyoid was identified as a metastatic lesion of lung adenocarcinoma. The patient recovered well and the anterior cervical pain was significantly alleviated after surgery and the patient underwent corresponding chemotherapy. CONCLUSION In patients with hyoid metastasis of lung adenocarcinoma, surgical resection may reduce the pain in anterior cervical after full consideration of physical condition.
Collapse
Affiliation(s)
- Hong-Yang Zhang
- Department of Otolaryngological Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Shan Shan Li
- Department of Otolaryngological Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xing Guo
- Department of Otolaryngological Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ning Zhao
- Department of Otolaryngological Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| |
Collapse
|
72
|
Systemic Therapy Plus Thermal Ablation Versus Systemic Therapy Alone for Oligometastatic Liver Metastases from Non-small Cell Lung Cancer. Cardiovasc Intervent Radiol 2020; 43:1285-1293. [PMID: 32236671 DOI: 10.1007/s00270-020-02456-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/12/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE This study assessed and compared the efficacy and long-term outcomes of systemic therapy plus image-guided thermal ablation versus systemic therapy alone for oligometastatic liver metastases (LMs) from non-small cell lung cancer (NSCLC). MATERIALS AND METHODS This retrospective study was approved by the institutional review board. Written informed consent was waived due to the retrospective design. From November 2012 to December 2017, 61 patients (mean age 59.0 years; 35 males) with oligometastatic LMs from NSCLC (≤ 5 metastatic lesions) who received systemic therapy with (n = 21, group A) or without (n = 40, group B) thermal ablation were analyzed. Progression-free survival (PFS) and overall survival (OS) were estimated by Kaplan-Meier curves. RESULTS The demographic and clinical characteristics were not significantly different between the groups (all P ≥ .05). In total, 28 LMs were entirely ablated, rendering a technical success rate of 100%, without major complications. The overall 6-month response rate was significantly higher in group A than in group B [57.1% (12/21) vs. 26.3% (10/38); P = .026]. The median PFS in group A was significantly longer than in group B [11.0 (95% CI 7.9-16.2) months vs. 5.2 (95% CI 3.7-7.9) months; P = .001]. However, the median OS was not significantly different [27.7 (95% CI 20.6-44.4) months vs. 17.7 (95% CI 14.5-27.5) months; P = .152]. CONCLUSION Systemic therapy plus thermal ablation may prolong PFS but not OS in oligometastatic LMs from NSCLC.
Collapse
|
73
|
von Eiff D, Bozorgmehr F, Chung I, Bernhardt D, Rieken S, Liersch S, Muley T, Kobinger S, Thomas M, Christopoulos P, Steins M. Paclitaxel for treatment of advanced small cell lung cancer (SCLC): a retrospective study of 185 patients. J Thorac Dis 2020; 12:782-793. [PMID: 32274145 PMCID: PMC7139030 DOI: 10.21037/jtd.2019.12.74] [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] [Indexed: 12/18/2022]
Abstract
Background Etoposide-/platinum-based chemotherapy is the standard first-line treatment for extensive-disease small cell lung cancer (SCLC), but responses are short-lived and subsequent options limited. Here, we present our experience with paclitaxel in advanced treatment lines. Methods We retrospectively studied the clinical course of all paclitaxel-treated SCLC patients between 2005 and 2015 in our institution. Prognostic and predictive factors were analyzed by Kaplan-Meier and Cox regression analyses. Results A total of 185 patients [119 men, median age 65 years, median ECOG performance status (PS) 1] were identified. One hundred and sixty-eight patients had extensive disease (ED) at the time of paclitaxel therapy. Paclitaxel was mainly given as third- or fourth-line therapy (93%). The response rate (RR) was 17% and disease control rate (DCR) 28%. Patients reached a median progression-free survival (PFS) of 1.6 (95% CI: 1.4-1.8) months and median overall survival (OS) of 3.3 (95% CI: 2.8-3.9) months. Main toxicities were fatigue (25%) and polyneuropathy (17%). Dose reduction of ≥25% was associated with shorter PFS [1.9 (95% CI: 1.5-2.3) vs. 1.4 (95% CI: 1.3-1.5) months; P=0.004]. Further independent predictive factors for PFS were gender, age, and hepatic/brain metastases (P<0.05). Tumor response to paclitaxel, PS, number and location of metastases, dose reduction, and smoking history were significant factors for OS in univariable analyses (P<0.05), while PS, dose reduction, status of cerebral/hepatic metastases, tumor response, and smoking history were retained as independent prognostic factors in multivariable testing. Notably, ECOG PS 2 patients had toxicity rates similar to ECOG PS 0-1 patients (63% vs. 62%), as well as a comparable DCR (29% vs. 28%), which was associated with prolonged survival (4.5 vs. 3.2 months for refractory cases, P=0.034). Conclusions Paclitaxel has clinically relevant activity in heavily pretreated SCLC. While patients with good PS and no cerebral/hepatic metastases derive the greatest benefit, ECOG PS 2 per se should not be used as a criterion to exclude patients.
Collapse
Affiliation(s)
- Damian von Eiff
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Germany
| | - Farastuk Bozorgmehr
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Germany
| | - Inn Chung
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Germany
| | - Denise Bernhardt
- Heidelberg University Hospital, Department of Radiation Oncology, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - Stefan Rieken
- Heidelberg University Hospital, Department of Radiation Oncology, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - Stephan Liersch
- Pharmacy Department, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Muley
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Germany.,Translational Research Unit, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Sonja Kobinger
- Translational Research Unit, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Germany
| | - Petros Christopoulos
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Germany
| | - Martin Steins
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Germany
| |
Collapse
|
74
|
Negre E, Coffy A, Langlais A, Daures JP, Lavole A, Quoix E, Molinier O, Greillier L, Audigier-Valette C, Moro-Sibilot D, Westeel V, Morin F, Roch B, Pujol JL. Development and Validation of a Simplified Prognostic Score in SCLC. JTO Clin Res Rep 2020; 1:100016. [PMID: 34589918 PMCID: PMC8474253 DOI: 10.1016/j.jtocrr.2020.100016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 01/16/2023] Open
Abstract
Introduction This study aimed at generating a new simplified prognostic score (SPS) using common clinical and biological variables to discriminate a limited number of subgroups of patients with SCLC differing by their overall survival (OS). Methods The SPS was developed exploring the Montpellier University Hospital retrospective database of 401 patients over a 16-year period. All patients had received etoposide - platinum-based chemotherapy as first-line treatment. The SPS development took into account significant determinants of OS in the Cox model, weighted by their regression β coefficients. Validation of the consequent SPS has been done separately in a combined population of 213 patients accrued from two different published trials (NCT03059667 and NCT00930891). Results The significant independent determinants of OS included the following: (1) American Joint Committee on Cancer TNM stage IV (hazard ratio [HR]: 2.52; 95% confidence interval [CI]: 1.91–3.33); (2) Eastern Cooperative Oncology Group performance status greater than 1 (HR: 2.27; 95% CI: 1.79–2.87); (3) the presence of liver metastases (HR: 1.66; 95% CI: 1.29–2.15); and (4) neutrophil-to-lymphocyte ratio greater than 4 (HR: 1.39; 95% CI: 1.11–1.92). The SPS generated with these four variables, segregated three groups (good, intermediate, and poor prognosis) with respective median OS of 26.9 months (95% CI: 20.1–38.9), 11.5 months (95% CI: 9.8–13.0), and 6.8 months (95% CI: 5.8–8.3; log-rank p < 10–4). Harrell's C statistic estimate was 0.68 ± 0.012, suggesting goodness of calibration. In the validation cohort, the SPS segregated the aforementioned three subgroups in a nearly similar manner, with respective median OS: 27.2, 12.3, and 8.6 months (log-rank p < 10–3; Harrell’s C statistic: 0.58 ± 0.02). Conclusions The SPS is easy to calculate in real-life practice and efficiently discriminates three populations with different prognoses. This study deserves further validation of this score in patients with SCLC receiving immunochemotherapy.
Collapse
Affiliation(s)
- Elodie Negre
- Department of Thoracic Oncology, Montpellier Regional University Hospital, Montpellier, France
| | - Amandine Coffy
- Laboratory of Biostatistics and Epidemiology, University Institute for Clinical Research, Montpellier University, Montpellier, France
| | | | - Jean-Pierre Daures
- Laboratory of Biostatistics and Epidemiology, University Institute for Clinical Research, Montpellier University, Montpellier, France
| | | | - Elisabeth Quoix
- Department of Pneumology, University Hospital, Strasbourg, France
| | - Olivier Molinier
- Department of Pneumology, Centre Hospitalier Le Mans, Le Mans, France
| | - Laurent Greillier
- Department of Multidisciplinary Oncology and Therapeutic Innovations, Assistance Publique-Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | | | | | - Virginie Westeel
- Department of pneumology, Hopital Universitaire, Besançon, France
| | - Franck Morin
- French Cooperative Thoracic Intergroup (IFCT), Paris, France
| | - Benoît Roch
- Department of Thoracic Oncology, Montpellier Regional University Hospital, Montpellier, France.,Montpellier Cancer Research Institute, INSERM U1194, Montpellier, France
| | - Jean-Louis Pujol
- Department of Thoracic Oncology, Montpellier Regional University Hospital, Montpellier, France.,Montpellier Cancer Research Institute, INSERM U1194, Montpellier, France
| |
Collapse
|
75
|
Qin BD, Jiao XD, Liu J, Liu K, He X, Wu Y, Ling Y, Duan XP, Qin WX, Wang Z, Zang YS. The effect of liver metastasis on efficacy of immunotherapy plus chemotherapy in advanced lung cancer. Crit Rev Oncol Hematol 2020; 147:102893. [PMID: 32065969 DOI: 10.1016/j.critrevonc.2020.102893] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/08/2020] [Accepted: 01/29/2020] [Indexed: 12/12/2022] Open
Abstract
The present study aimed to evaluate the effect of liver metastases on the efficacy from the combination of PD-1/PD-L1 inhibitor with chemotherapy as first-line treatment in lung cancer using the meta-analysis. A total of 8 randomized controlled trials (RCTs) were included. In patients without liver metastases, PD-1/PD-L1 inhibitor plus chemotherapy could decrease the risk of progression by 40% and risk of death by 29% (HR = 0.60; 95%CI,0.55- 0.65 and HR = 0.71;95%CI,0.58-0.90 respectively). In patients with liver metastases, PD-1/PD-L1 inhibitor plus chemotherapy could decrease the risk of progression by 31% and risk of death by 21% (HR = 0.69;95%CI,0.58-0.81; and HR = 0.79; 95%CI,0.62-0.80, respectively). The pooled ratios of PFS-HRs and OS- HRs reported in lung cancer patients with liver metastases versus those without liver metastases were 1.11 (95%CI, 0.92-1.34) and 1.03 (95%CI, 0.80-1.35), respectively, suggesting that lung cancer patients with and without liver metastases could obtain comparable efficacy.
Collapse
Affiliation(s)
- Bao-Dong Qin
- Department of Medical Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, 200072 China
| | - Xiao-Dong Jiao
- Department of Medical Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, 200072 China
| | - Jun Liu
- Department of Medical Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, 200072 China
| | - Ke Liu
- Department of Medical Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, 200072 China
| | - Xi He
- Department of Medical Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, 200072 China
| | - Ying Wu
- Department of Medical Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, 200072 China
| | - Yan Ling
- Department of Medical Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, 200072 China
| | - Xiao-Peng Duan
- Department of Medical Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, 200072 China
| | - Wen-Xing Qin
- Department of Medical Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, 200072 China
| | - Zhan Wang
- Department of Medical Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, 200072 China
| | - Yuan-Sheng Zang
- Department of Medical Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, 200072 China.
| |
Collapse
|
76
|
Survival Implications of De Novo Versus Recurrent Metastatic Non-Small Cell Lung Cancer. Am J Clin Oncol 2019; 42:292-297. [PMID: 30608237 DOI: 10.1097/coc.0000000000000513] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Metastatic non-small cell lung cancer (NSCLC) has a poor prognosis. Most patients present with stage IV, and many patients treated curatively with stage I to III develop recurrent metastatic disease. It is unknown whether the natural history differs between patients with recurrent versus de novo metastatic NSCLC. We hypothesized that de novo metastatic status is associated with decreased overall survival compared with recurrent metastatic disease. MATERIALS AND METHODS A retrospective review was completed of all patients with NSCLC referred to BC Cancer from 2005 to 2012. Two cohorts were created; de novo metastatic disease and patients treated with curative intent (surgery or radiotherapy) that developed recurrent, metastatic disease. Information was collected on known prognostic and predictive factors. Overall survival was calculated from the date of diagnosis of metastatic disease. RESULTS A total of 9651 patients were evaluated, 5782 (60%) with de novo stage IV disease, and 3869 (40%) with stage I to III disease. Of the 1658 patients who received curative therapy for stage I to III disease, 757 (46%) developed metastases. Patients in the de novo cohort versus recurrent cohort were more likely male (52% vs. 48%), have poorer performance status (Eastern Cooperative Oncology Group≥2 50% vs. 44%), and receive no palliative systemic therapy (67% vs. 61%). The median overall survival in the de novo cohort was 4.7 versus 6.9 m in the recurrent cohort (P<0.001). De novo status was associated with shorter overall survival and this remained significant in a multivariate model that incorporated known prognostic factors. CONCLUSIONS In a large population-based study of NSCLC, de novo metastatic status was independently associated with decreased overall survival from the time of metastatic disease diagnosis.
Collapse
|
77
|
Kitadai R, Okuma Y, Hakozaki T, Hosomi Y. The efficacy of immune checkpoint inhibitors in advanced non-small-cell lung cancer with liver metastases. J Cancer Res Clin Oncol 2019; 146:777-785. [PMID: 31828427 DOI: 10.1007/s00432-019-03104-w] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/02/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Although liver metastasis has been known to be associated with poor prognosis, only a few studies have shown an association between liver metastasis and treatment outcomes with immune checkpoint inhibitors (ICI). Furthermore, factors associated with prognosis have remained unclear. The present study therefore evaluates the efficacy of nivolumab, pembrolizumab, and atezolizumab among patients with non-small cell lung cancer (NSCLC) who had liver metastasis and identifies factors correlated with prognosis. MATERIALS AND METHODS A total of 215 patients with advanced and recurrent NSCLC who received ICI therapy at a single center were retrospectively reviewed. A total of 41 patients (19.1%) had liver metastasis upon initiation of ICI therapy. Overall, 125, 64, and 26 patients were treated with nivolumab, pembrolizumab, and atezolizumab, respectively. RESULTS Among the included patients, those with liver metastasis had shorter overall survival (OS) [hazard ratio (HR), 2.04; 95% CI 1.33-3.13] and progression-free survival (PFS) (HR, 1.89; 95% CI 1.29-1.71) compared to those without the same. Patients with liver metastasis had a response rate (RR) of 22.5%. Among patients with liver metastasis, inferior OS was associated with low albumin, poor Eastern Cooperative Oncology Group performance status, driver mutation, and number of liver metastasis (≥ 5). Moreover, patients with liver metastasis who had good Royal Marsden Hospital (0-1) and Gustave Roussy Immune (0-1) scores showed significantly longer OS and PFS. CONCLUSION Despite the poor outcomes with ICI treatment in patients with advanced and recurrent NSCLC who had liver metastasis, some characteristics among patients with liver metastasis may be associated with prognosis.
Collapse
Affiliation(s)
- Rui Kitadai
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo, Tokyo, 113-0022, Japan
| | - Yusuke Okuma
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo, Tokyo, 113-0022, Japan. .,Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo, Tokyo, 104-0045, Japan.
| | - Taiki Hakozaki
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo, Tokyo, 113-0022, Japan
| | - Yukio Hosomi
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo, Tokyo, 113-0022, Japan
| |
Collapse
|
78
|
Li J, Liu F, Yu H, Zhao C, Li Z, Wang H. Different distant metastasis patterns based on tumor size could be found in extensive-stage small cell lung cancer patients: a large, population-based SEER study. PeerJ 2019; 7:e8163. [PMID: 31824772 PMCID: PMC6896937 DOI: 10.7717/peerj.8163] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 11/05/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Small-cell lung cancer (SCLC) is a malignant cancer with the ability to metastasize quickly. The relationship between tumor size and the distant metastasis patterns of Extensive-Stage Small Cell Lung Cancer (ES-SCLC) has not been reported. OBJECTIVES The aim of this study was to determine the different distant metastasis patterns as they related to tumor size in ES-SCLC. PATIENTS AND METHODS We used Surveillance, Epidemiology, and End Results (SEER) population-based data collected from 2010 through 2013 to identify 11058 ES-SCLC patients with definite evidence of distant metastases. Multivariate logistic regression analysis was used to demonstrate the association between tumor size and distant metastasis patterns including bone, liver, brain, and lung metastases. Age, race, sex, and N stage were also selected in the logistic regression model. RESULTS Subtle differences in metastasis patterns were found among patients based on different tumor sizes. Patients with tumors 3-7 cm have a higher risk of bone metastasis compared with those that have tumors ≤3 cm (OR 1.165, 95% CI [1.055-1.287], P = 0.003) and patients with tumors ≥7 cm have a higher risk of lung metastasis (OR 1.183, 95% CI [1.039-1.347], P = 0.011). In addition, patients with tumors ≥7 cm had a lower risk of brain metastasis and liver metastasis than patients with tumors ≤3 cm (OR 0.799, 95% CI [0.709-0.901], P < 0.001; OR 0.747, 95% CI [0.672-0.830], P < 0.001). Interestingly, there was no correlation between a larger tumor and a higher risk of metastasis. However, the tumor metastasis pattern did have some correlation with age, gender, race and N-status. CONCLUSION The pattern of distant metastasis of ES-SCLC is related to the tumor size and the tumor size is indicative of the metastatic site. Larger tumor sizes did not correlate with a higher risk of distant metastasis, but the size is related to the pattern of distant metastasis. The study of different distant metastasis patterns based on tumor size and other clinical features (e.g., age, race, sex, and N stage) in ES-SCLC is clinically valuable.
Collapse
Affiliation(s)
- Jia Li
- Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Feng Liu
- Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Haining Yu
- Human Resources Department, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Chenglong Zhao
- Department of Pathology Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Zhenxiang Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Haiyong Wang
- Department of Internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| |
Collapse
|
79
|
Vokes EE, Ready N, Felip E, Horn L, Burgio MA, Antonia SJ, Arén Frontera O, Gettinger S, Holgado E, Spigel D, Waterhouse D, Domine M, Garassino M, Chow LQM, Blumenschein G, Barlesi F, Coudert B, Gainor J, Arrieta O, Brahmer J, Butts C, Steins M, Geese WJ, Li A, Healey D, Crinò L. Nivolumab versus docetaxel in previously treated advanced non-small-cell lung cancer (CheckMate 017 and CheckMate 057): 3-year update and outcomes in patients with liver metastases. Ann Oncol 2019; 29:959-965. [PMID: 29408986 DOI: 10.1093/annonc/mdy041] [Citation(s) in RCA: 354] [Impact Index Per Article: 70.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Long-term data with immune checkpoint inhibitors in non-small-cell lung cancer (NSCLC) are limited. Two phase III trials demonstrated improved overall survival (OS) and a favorable safety profile with the anti-programmed death-1 antibody nivolumab versus docetaxel in patients with previously treated advanced squamous (CheckMate 017) and nonsquamous (CheckMate 057) NSCLC. We report results from ≥3 years' follow-up, including subgroup analyses of patients with liver metastases, who historically have poorer prognosis among patients with NSCLC. Patients and methods Patients were randomized 1 : 1 to nivolumab (3 mg/kg every 2 weeks) or docetaxel (75 mg/m2 every 3 weeks) until progression or discontinuation. The primary end point of each study was OS. Patients with baseline liver metastases were pooled across studies by treatment for subgroup analyses. Results After 40.3 months' minimum follow-up in CheckMate 017 and 057, nivolumab continued to show an OS benefit versus docetaxel: estimated 3-year OS rates were 17% [95% confidence interval (CI), 14% to 21%] versus 8% (95% CI, 6% to 11%) in the pooled population with squamous or nonsquamous NSCLC. Nivolumab was generally well tolerated, with no new safety concerns identified. Of 854 randomized patients across both studies, 193 had baseline liver metastases. Nivolumab resulted in improved OS compared with docetaxel in patients with liver metastases (hazard ratio, 0.68; 95% CI, 0.50-0.91), consistent with findings from the overall pooled study population (hazard ratio, 0.70; 95% CI, 0.61-0.81). Rates of treatment-related hepatic adverse events (primarily grade 1-2 liver enzyme elevations) were slightly higher in nivolumab-treated patients with liver metastases (10%) than in the overall pooled population (6%). Conclusions After 3 years' minimum follow-up, nivolumab continued to demonstrate an OS benefit versus docetaxel in patients with advanced NSCLC. Similarly, nivolumab demonstrated an OS benefit versus docetaxel in patients with liver metastases, and remained well tolerated. Clinical trial registration CheckMate 017: NCT01642004; CheckMate 057: NCT01673867.
Collapse
Affiliation(s)
- E E Vokes
- Department of Medicine, University of Chicago Medicine & Biological Sciences, Chicago, USA.
| | - N Ready
- Department of Medicine, Duke University Medical Center, Durham, USA
| | - E Felip
- Lung Cancer Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - L Horn
- Thoracic Oncology Program, Vanderbilt-Ingram Cancer Center, Nashville, USA
| | - M A Burgio
- Medical Oncology Unit, Istituto Scientifico Romagnolo Per lo Studio e la Cura dei Tumori (IRST) IRCSS, Meldola, Italy
| | - S J Antonia
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, USA
| | - O Arén Frontera
- Oncologia Medica, Centro Internacional de Estudios Clinicos, Santiago, Chile, USA
| | - S Gettinger
- Department of Internal Medicine, Yale Comprehensive Cancer Center, New Haven, USA
| | - E Holgado
- Department of Medicine, Hospital De Madrid, Madrid, Spain
| | - D Spigel
- Research Consortium, Sarah Cannon Research Institute, Nashville, USA; Tennessee Oncology, PLLC, Nashville, USA
| | - D Waterhouse
- Department of Medical Oncology, OHC (Oncology Hematology Care), Cincinnati, USA; US Oncology, Cincinnati, USA
| | - M Domine
- Department of Medical Oncology, Fundación Jiménez Díaz, Madrid, Spain
| | - M Garassino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - L Q M Chow
- Department of Medicine, University of Washington, Seattle, USA
| | - G Blumenschein
- Department of Thoracic/Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, USA
| | - F Barlesi
- Multidisciplinary Oncology & Therapeutic Innovations Departmen, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - B Coudert
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - J Gainor
- Cancer Center, Massachusetts General Hospital, Boston, USA
| | - O Arrieta
- Thoracic Oncology Unit and Laboratory, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - J Brahmer
- Thoracic Oncology Program, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, USA
| | - C Butts
- Department of Oncolog, Division of Medical Oncology, Cross Cancer Institute, Edmonton, Canada
| | - M Steins
- Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany
| | - W J Geese
- Immuno-Oncology, Bristol-Myers Squibb, Princeton, USA
| | - A Li
- Immuno-Oncology, Bristol-Myers Squibb, Princeton, USA
| | - D Healey
- Immuno-Oncology, Bristol-Myers Squibb, Princeton, USA
| | - L Crinò
- Medical Oncology Unit, Istituto Scientifico Romagnolo Per lo Studio e la Cura dei Tumori (IRST) IRCSS, Meldola, Italy
| |
Collapse
|
80
|
Oliver AJ, Davey AS, Keam SP, Mardiana S, Chan JD, von Scheidt B, Beavis PA, House IG, Van Audernaerde JR, Darcy PK, Kershaw MH, Slaney CY. Tissue-specific tumor microenvironments influence responses to immunotherapies. Clin Transl Immunology 2019; 8:e1094. [PMID: 31768254 PMCID: PMC6869967 DOI: 10.1002/cti2.1094] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/24/2019] [Accepted: 10/30/2019] [Indexed: 01/18/2023] Open
Abstract
Objectives Investigation of variable response rates to cancer immunotherapies has exposed the immunosuppressive tumor microenvironment (TME) as a limiting factor of therapeutic efficacy. A determinant of TME composition is the tumor location, and clinical data have revealed associations between certain metastatic sites and reduced responses. Preclinical models to study tissue‐specific TMEs have eliminated genetic heterogeneity, but have investigated models with limited clinical relevance. Methods We investigated the TMEs of tumors at clinically relevant sites of metastasis (liver and lungs) and their impact on αPD‐1/αCTLA4 and trimAb (αDR5, α4‐1BB, αCD40) therapy responses in the 67NR mouse breast cancer and Renca mouse kidney cancer models. Results Tumors grown in the lungs were resistant to both therapies whereas the same tumor lines growing in the mammary fat pad (MFP), liver or subcutaneously could be completely eradicated, despite greater tumor burden. Assessment of tumor cells and drug delivery in 67NR lung or MFP tumors revealed no differences and prompted investigation into the immune TME. Lung tumors had a more immunosuppressive TME with increased myeloid‐derived suppressor cell infiltration, decreased T cell infiltration and activation, and decreased NK cell activation. Depletion of various immune cell subsets indicated an equivalent role for NK cells and CD8+ T cells in lung tumour control. Thus, targeting T cells with αPD‐1/αCTLA4 or trimAb was not sufficient to elicit a robust antitumor response in lung tumors. Conclusion Taken together, these data demonstrate that tissue‐specific TMEs influence immunotherapy responses and highlight the importance in defining tissue‐specific response patterns in patients.
Collapse
Affiliation(s)
- Amanda J Oliver
- Cancer Immunology Program Peter MacCallum Cancer Centre Melbourne VIC Australia.,Sir Peter MacCallum Department of Oncology The University of Melbourne Parkville VIC Australia
| | - Ashleigh S Davey
- Cancer Immunology Program Peter MacCallum Cancer Centre Melbourne VIC Australia.,Sir Peter MacCallum Department of Oncology The University of Melbourne Parkville VIC Australia
| | - Simon P Keam
- Cancer Immunology Program Peter MacCallum Cancer Centre Melbourne VIC Australia.,Tumour Suppression Laboratory Peter MacCallum Cancer Centre Melbourne VIC Australia
| | - Sherly Mardiana
- Cancer Immunology Program Peter MacCallum Cancer Centre Melbourne VIC Australia.,Sir Peter MacCallum Department of Oncology The University of Melbourne Parkville VIC Australia
| | - Jack D Chan
- Cancer Immunology Program Peter MacCallum Cancer Centre Melbourne VIC Australia.,Sir Peter MacCallum Department of Oncology The University of Melbourne Parkville VIC Australia
| | - Bianca von Scheidt
- Cancer Immunology Program Peter MacCallum Cancer Centre Melbourne VIC Australia
| | - Paul A Beavis
- Cancer Immunology Program Peter MacCallum Cancer Centre Melbourne VIC Australia.,Sir Peter MacCallum Department of Oncology The University of Melbourne Parkville VIC Australia
| | - Imran G House
- Cancer Immunology Program Peter MacCallum Cancer Centre Melbourne VIC Australia.,Sir Peter MacCallum Department of Oncology The University of Melbourne Parkville VIC Australia
| | - Jonas Rm Van Audernaerde
- Cancer Immunology Program Peter MacCallum Cancer Centre Melbourne VIC Australia.,Center for Oncological Research Faculty of Medicine and Health Sciences University of Antwerp Antwerp Belgium
| | - Phillip K Darcy
- Cancer Immunology Program Peter MacCallum Cancer Centre Melbourne VIC Australia.,Sir Peter MacCallum Department of Oncology The University of Melbourne Parkville VIC Australia
| | - Michael H Kershaw
- Cancer Immunology Program Peter MacCallum Cancer Centre Melbourne VIC Australia.,Sir Peter MacCallum Department of Oncology The University of Melbourne Parkville VIC Australia
| | - Clare Y Slaney
- Cancer Immunology Program Peter MacCallum Cancer Centre Melbourne VIC Australia.,Sir Peter MacCallum Department of Oncology The University of Melbourne Parkville VIC Australia
| |
Collapse
|
81
|
Landi L, D’Incà F, Gelibter A, Chiari R, Grossi F, Delmonte A, Passaro A, Signorelli D, Gelsomino F, Galetta D, Giannarelli D, Soto Parra H, Minuti G, Tiseo M, Migliorino MR, Cognetti F, Toschi L, Bidoli P, Piantedosi F, Calabro’ L, Cappuzzo F. Bone metastases and immunotherapy in patients with advanced non-small-cell lung cancer. J Immunother Cancer 2019; 7:316. [PMID: 31752994 PMCID: PMC6868703 DOI: 10.1186/s40425-019-0793-8] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/30/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Bone metastases (BoM) are a negative prognostic factor in non-small-cell lung cancer (NSCLC). Beyond its supportive role, bone is a hematopoietic organ actively regulating immune system. We hypothesized that BoM may influence sensitivity to immunotherapy. METHODS Pretreated non-squamous (cohort A) and squamous (cohort B) NSCLCs included in the Italian Expanded Access Program were evaluated for nivolumab efficacy according to BoM. RESULTS Cohort A accounted for 1588 patients with non-squamous NSCLC, including 626 (39%) with (BoM+) and 962 (61%) without BoM (BoM-). Cohort B accounted for 371 patients with squamous histology including 120 BoM+ (32%) and 251 (68%) BoM- cases. BoM+ had lower overall response rate (ORR; Cohort A: 12% versus 23%, p < 0.0001; Cohort B: 13% versus 22%, p = 0.04), shorter progression free survival (PFS; Cohort A: 3.0 versus 4.0 months, p < 0.0001; Cohort B: 2.7 versus 5.2 months, p < 0.0001) and overall survival (OS; Cohort A: 7.4 versus 15.3 months, p < 0.0001; Cohort B: 5.0 versus 10.9 months, p < 0.0001). Moreover, BoM negatively affected outcome irrespective of performance status (PS; OS in both cohorts: p < 0.0001) and liver metastases (OS cohort A: p < 0.0001; OS Cohort B: p = 0.48). At multivariate analysis, BoM independently associated with higher risk of death (cohort A: HR 1.50; cohort B: HR 1.78). CONCLUSIONS BoM impairs immunotherapy efficacy. Accurate bone staging should be included in clinical trials with immunotherapy.
Collapse
Affiliation(s)
- Lorenza Landi
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy
| | | | | | - Rita Chiari
- Medical Oncology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Francesco Grossi
- Division of Medical Oncology, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo Delmonte
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | | | - Domenico Galetta
- Oncologia Medica Toracica, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | | | | | - Gabriele Minuti
- UO Oncologia Medica, Azienda Usl Toscana Nord Ovest, Livorno, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital, Parma, Italy
| | | | | | - Luca Toschi
- Humanitas Cancer Center, Rozzano, Milan, Italy
| | - Paolo Bidoli
- Oncology Unit, ASST, Ospedale S. Gerardo, Monza, Italy
| | | | - Luana Calabro’
- Medical Oncology and Immunotherapy, Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | | |
Collapse
|
82
|
Bone-marrow-derived cell-released extracellular vesicle miR-92a regulates hepatic pre-metastatic niche in lung cancer. Oncogene 2019; 39:739-753. [PMID: 31558801 DOI: 10.1038/s41388-019-1024-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/29/2019] [Accepted: 05/11/2019] [Indexed: 11/08/2022]
Abstract
Metastatic tumors have been shown to establish a supportive pre-metastatic niche (PMN) in distant organs, which in turn determines disseminated tumor cells' targeting of such organs. PMN is formed through the recruitment of bone-marrow-derived cells (BMDCs); however, the role of BMDCs in PMN formation is not fully understood. On the basis of RNA-seq data and bioinformatic analysis, secretion of extracellular vesicle (EV) miR-92a by BMDCs of lung cancer-bearing mice contributes to the establishment of liver PMN. Both BMDC-derived EVs and miR-92a mimics potentiate the activation of hepatic stellate cells (HSCs), subsequently increasing extracellular matrix (ECM) deposition in mice. Consequently, remodeling of the liver microenvironment enhanced immunosuppressive cell accumulation and cancer cell attachment. EVs miR-92a directly suppressed its target SMAD7, leading to the enhancement of transforming growth factor-β signaling in HSC. Elevated levels of circulating miR-92a are found in the sera of lung cancer patients, and EVs isolated from these patients have a similar ability to increase HSCs activation and ECM protein expression. Our study reveals the sequential steps of liver PMN formation in lung cancer, providing critical mediators that prepare PMN in the liver, and identifies new targets that offer valuable options for diagnosis and therapeutic intervention.
Collapse
|
83
|
Wang Y, Pang Z, Chen X, Bie F, Wang Y, Wang G, Liu Q, Du J. Survival nomogram for patients with initially diagnosed metastatic non-small-cell lung cancer: a SEER-based study. Future Oncol 2019; 15:3395-3409. [PMID: 31512954 DOI: 10.2217/fon-2019-0007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aim: Prognosis of patients with metastatic non-small-cell lung cancer differ widely. Methods: All patients were randomly divided into training or validation cohort. Cox-regression analyses were conducted to select independent predictors. We built a nomogram by R code and evaluated the accuracy and the reliability of the model using C-index, calibration curves and decision curve analyses. We made a risk classification system based on the nomogram. Results: In the validation cohort, C-index was 0.729 and 0.738 for 1- and 2-year overall survival. Calibration plots and decision curve analyses presented great prognostic accuracy and clinical applicability. Its prognostic accuracy preceded the American Joint Committee on Cancer staging with evaluated integrated discrimination improvement. Conclusion: The model can be a practical tool in treatment decision and individual counseling.
Collapse
Affiliation(s)
- Yu Wang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, PR China
| | - Zhaofei Pang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, PR China
| | - Xiaowei Chen
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, PR China
| | - Fenglong Bie
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, PR China
| | - Yadong Wang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, PR China
| | - Guanghui Wang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, PR China
| | - Qi Liu
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, PR China
| | - Jiajun Du
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, PR China.,Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, PR China
| |
Collapse
|
84
|
Wong WB, Wu N, Yang E, Davies J, Chae YK. Real-World Clinical and Economic Outcomes and the Role of Bevacizumab in Patients With Non-Small-Cell Lung Cancer With Liver Metastases. J Oncol Pract 2019; 15:e878-e887. [PMID: 31509482 DOI: 10.1200/jop.19.00166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Liver metastases are associated with poor outcomes in patients with advanced non-small-cell lung cancer (aNSCLC). Nevertheless, the vasculature in the liver microenvironment may be conducive to the use of antiangiogenesis inhibitors to potentially improve outcomes. Limited real-world clinical and economic data are currently available for this patient subpopulation. METHODS Two retrospective cohort analyses were conducted using data from an electronic health record (n = 14,209) and a claims database (n = 9,017). Patients with aNSCLC with and without liver metastases were identified in each database. Patients with baseline liver metastases in the electronic health record database were further categorized into two subgroups-those who had or had not received bevacizumab-containing regimens. Multivariable Cox proportional hazards regression models were used to adjust for baseline characteristics to evaluate the effect of treatment of bevacizumab. RESULTS Liver metastases were associated with significantly poorer survival (median overall survival, 6.3 months v 10.1 months) and higher costs and health care resource utilization-total per-patient-per-month costs of $27,589 versus $19,607. Cost differences were primarily driven by inpatient costs, including a two-fold increase in hospitalizations and a 1.7-fold higher mean length of stay. Treatment with bevacizumab was associated with improved survival. Whereas overall survival improved in patients with and without baseline liver metastases who received bevacizumab, the relative survival benefit was greater in patients with liver metastases (hazard ratio, 0.63 [95% CI, 0.50 to 0.81] v hazard ratio, 0.80 [95% CI, 0.74 to 0.86]). CONCLUSION Patients with aNSCLC with liver metastases have poorer survival and a higher cost and health care resource utilization burden. Bevacizumab was associated with a survival benefit in patients with aNSCLC with liver metastases.
Collapse
Affiliation(s)
| | - Ning Wu
- Genentech, South San Francisco, CA
| | | | - Jessica Davies
- F. Hoffmann-La Roche, Welwyn Garden City, United Kingdom
| | | |
Collapse
|
85
|
The prognostic impact of lymph node metastasis in patients with non-small cell lung cancer and distant organ metastasis. Clin Exp Metastasis 2019; 36:457-466. [PMID: 31420766 DOI: 10.1007/s10585-019-09985-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/29/2019] [Indexed: 12/29/2022]
Abstract
This study aimed to identify the prognostic value of lymph node metastasis in patients with non-small cell lung cancer (NSCLC) and distant organ metastasis. A total of 42,613 NSCLC patients with distant metastasis from the surveillance, epidemiology, and end results database between 2010 and 2013 were included for analysis. The proportion of N0 stage in M1a patients was significantly higher than that in M1b patients, 34.0% and 22.7% respectively (P < 0.001). Compared with N0 patients, patients had higher odds of experiencing multiorgan metastases (MOM) if they had higher N stage at diagnoses (P < 0.001). The Kaplan-Meier curves suggested both M1a and M1b groups patients at stage N0 had better survival than those at higher N stage (P < 0.001). Further analysis indicated that better survival was observed in N0 stage compared with N2 or N3 stage if patients had bone metastasis, brain metastasis, or MOM (P < 0.001, P < 0.001, and P = 0.002, respectively), but there was no significant difference in survival among each N stage patients with liver metastasis only. Cox regression analysis showed that compared with N0 patients, higher hazard for disease-specific mortality was observed for patients with higher N stage. Among NSCLC patients with distant organ metastasis, lymph node metastasis was associated with higher odds of experiencing MOM and a worse prognosis in terms of longer survival except patients with liver metastasis. Better understandings of the role of lymphatic metastasis in M1 NSCLC could help clinicians with better management of the disease.
Collapse
|
86
|
Yang X, Meng G. Establishment of a non-small-cell lung cancer-liver metastasis patient-derived tumor xenograft model for the evaluation of patient-tailored chemotherapy. Biosci Rep 2019; 39:BSR20182082. [PMID: 31221816 PMCID: PMC6609754 DOI: 10.1042/bsr20182082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 11/17/2022] Open
Abstract
In order to optimize patient-tailored chemotherapy, a non-small-cell lung cancer (NSCLC)-liver metastasis patient-derived tumor xenograft (PDTX) model is developed. Computed tomography (CT)-guided NSCLC percutaneous biopsy was subcutaneously inoculated into the flank of non-obese diabetic/severe combined immunodeficiency (NOD/SCID) female mice (PDTX F1) and allowed to reach 500 mm3 volume. Then, the tumors were re-transplanted into Balb/c nude mice and liver metastasis was confirmed (PDTX F2), which were further assigned into doxorubicin (DOX), docetaxel (DTX), and non-treatment control group. H&E staining and Keratin 20 (CK20) staining were applied to determine the consistency of PDTX models and primary tumors. Tumor growth curve, body weight, and the expression of p65 nuclear factor (NF)-κB and the secretion of interferon (IFN)-γ were investigated. The successive transplant procedure can induce the NSCLC-liver metastasis PDTX model, and morphological and structural characteristics of PDTX models (F2) were in accordance with primary tumors. DOX and DTX could delay tumor growth, activate the NF-κB pathway, and promote IFN-γ secretion in the PDTX models. The NSCLC-liver metastasis PDTX model is established and provides a powerful mean to assess chemotherapeutic efficacy.
Collapse
Affiliation(s)
- Xue Yang
- Cangzhou Central Hospital, No. 16 Xinhua West Road, Cangzhou 061000, Hebei, China
| | - Gaopei Meng
- Cangzhou Central Hospital, No. 16 Xinhua West Road, Cangzhou 061000, Hebei, China
| |
Collapse
|
87
|
Wang B, Chen L, Huang C, Lin J, Pan X, Shao Z, Hu S, Zhang X, Wang X. The homogeneous and heterogeneous risk factors for occurrence and prognosis in lung cancer patients with bone metastasis. J Bone Oncol 2019; 17:100251. [PMID: 31372332 PMCID: PMC6661364 DOI: 10.1016/j.jbo.2019.100251] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/08/2019] [Accepted: 07/08/2019] [Indexed: 01/26/2023] Open
Abstract
Purpose To analyse the homogeneous and heterogeneous risk factors for occurrence and prognosis in lung cancer patients diagnosed with bone metastasis (BM) by using the Surveillance, Epidemiology, and End Results (SEER) database. Patients and methods The medical records of lung cancer patients with or without bone metastasis were identified in the SEER database between 2010 and 2015. A multivariate logistic regression analysis was performed to identify risk factors, and a multivariate Cox regression was used to determine the prognostic effects of every variable on survival. Results In total, 34,585 eligible patients from the SEER database were included in the analysis. Male gender and metastasis to the liver were factors that were both positively associated with a risk for the development and prognosis of bone metastasis in patients with lung cancer. Younger age, poor tumour differentiation grade, higher N stage (N3), adenocarcinoma and metastasis to the brain were all positively correlated with a risk of occurrence of BM, but these factors were not correlated with an unfavourable prognosis. Age, race, marital status, tumour size and pathologic type were independent risk factors for the prognosis of bone metastasis. Conclusion The morbidity of bone metastasis in lung cancer patients is dismal, with a rate of 25.9%. The findings of this study estimate the homogeneous and heterogeneous risk factors for the occurrence and prognosis of bone metastasis in lung cancer patients, which may provide clinical guidelines for physicians.
Collapse
Affiliation(s)
- Ben Wang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, Zhejiang, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Lijie Chen
- Department of Surgical Oncology, Taizhou Hospital of Wenzhou Medical University, Taizhou 317000, Zhejiang, China
| | - Chongan Huang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, Zhejiang, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Jialiang Lin
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, Zhejiang, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Xiangxiang Pan
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, Zhejiang, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Zhenxuan Shao
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, Zhejiang, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Sunli Hu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, Zhejiang, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Xiaolei Zhang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, Zhejiang, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Chinese Orthopaedic Regenerative Medicine Society, Hangzhou, Zhejiang, China
| | - Xiangyang Wang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, Zhejiang, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| |
Collapse
|
88
|
Sridhar S, Paz-Ares L, Liu H, Shen K, Morehouse C, Rizvi N, Segal NH, Jin X, Zheng Y, Narwal R, Gupta A, Dennis PA, Ye J, Mukhopadhyay P, Higgs BW, Ranade K. Prognostic Significance of Liver Metastasis in Durvalumab-Treated Lung Cancer Patients. Clin Lung Cancer 2019; 20:e601-e608. [PMID: 31327642 DOI: 10.1016/j.cllc.2019.06.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/08/2019] [Accepted: 06/15/2019] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Two clinical studies (Study 1108 and ATLANTIC) were analyzed to evaluate the prognostic value of baseline liver metastases (LMs) in advanced/metastatic non-small-cell lung cancer patients treated with durvalumab 10 mg/kg every 2 weeks. PATIENTS AND METHODS A multivariate Cox proportional hazards analysis was conducted; covariates included performance status, tumor stage, histology, sex, age, smoking status, and programmed cell death ligand 1 (PD-L1) status. RESULTS In all, 569 patients were included. LMs were present in 31.6% (96/304) of Study 1108 patients and 17.9% (47/263) of ATLANTIC patients. Median overall survival (OS) was shorter in patients with LMs than in those without in both studies. In both studies, LMs were an independent negative prognostic factor for OS and progression-free survival. Objective response rates were also significantly lower. PD-L1 independently predicted benefit across all patients. CONCLUSION Liver metastases were associated with worse outcomes irrespective of PD-L1 status, but PD-L1 status predicted benefit from durvalumab irrespective of LMs.
Collapse
Affiliation(s)
| | - Luis Paz-Ares
- Hospital Universitario 12 de Octubre, CNIO, Universidad Complutense & Ciberonc, Madrid, Spain
| | - Hao Liu
- AstraZeneca, Gaithersburg, MD
| | | | | | - Naiyer Rizvi
- Columbia University Medical Center, New York, NY
| | - Neil H Segal
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | | | | | | |
Collapse
|
89
|
Xu Z, Yang Q, Chen X, Zheng L, Zhang L, Yu Y, Chen M, You Q, Sun J. Clinical associations and prognostic value of site-specific metastases in non-small cell lung cancer: A population-based study. Oncol Lett 2019; 17:5590-5600. [PMID: 31186781 PMCID: PMC6507334 DOI: 10.3892/ol.2019.10225] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/25/2019] [Indexed: 02/06/2023] Open
Abstract
The prognosis of non-small cell lung cancer (NSCLC) is poor, particularly for patients with metastatic disease. Numerous efforts have been made to improve the prognosis of these patients; however, only a small number of studies have explored the occurrence rate and prognostic value of different patterns of distant metastasis (DM) in NSCLC systematically. To investigate these, information from patients diagnosed with NSCLC between 2010 and 2014 was collected from the Surveillance, Epidemiology and End Results database. Survival rate comparisons were performed using Kaplan-Meier analysis and log-rank tests. A Cox proportional hazard model was established to determine factors associated with improved overall survival (OS) and cancer-specific survival (CSS). The present study revealed that the most common site of single metastasis occurrence was bone, and the least common was the liver for NSCLC. As for multi-site metastases, the most common two-site metastasis involved bone and lung, and the most common three-site metastasis involved bone, liver and lung. As for NSCLC subtypes, large cell carcinoma (LCC) exhibited more specific metastatic features. The most common single metastatic site was the brain for patients with LCC, and the most common two-site metastatic combination was bone and liver. Patients with isolated liver metastasis exhibited the worst OS and CSS among patients with single metastasis. Furthermore, for patients with multi-site metastases, metastases involving the liver were associated with the worst OS and CSS among various combinations. To the best of our knowledge, the present study is the first to investigate the occurrence rate and prognostic value of different metastatic patterns of site-specific DM for NSCLC using a large population-based dataset. The findings of the present study may have vital implications for classifying patients with advanced NSCLC, thus laying a foundation for individualized precise treatment.
Collapse
Affiliation(s)
- Zihan Xu
- Department of Oncology, Cancer Institute of The People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
| | - Qiao Yang
- Department of Oncology, Cancer Institute of The People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
| | - Xiewan Chen
- Department of Medical English, College of Basic Medicine, Army Medical University, Chongqing 400038, P.R. China
| | - Linpeng Zheng
- Department of Oncology, Cancer Institute of The People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
| | - Luping Zhang
- Department of Oncology, Cancer Institute of The People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
| | - Yongxin Yu
- Department of Oncology, Cancer Institute of The People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
| | - Mingjing Chen
- Department of Oncology, Cancer Institute of The People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
| | - Qiai You
- Department of Oncology, Cancer Institute of The People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
| | - Jianguo Sun
- Department of Oncology, Cancer Institute of The People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
| |
Collapse
|
90
|
Wu B, Wei S, Tian J, Song X, Hu P, Cui Y. [Comparison of the Survival Time in the Non-small Cell Lung Cancer Patients with Different Organ Metastasis]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:105-110. [PMID: 30827327 PMCID: PMC6397941 DOI: 10.3779/j.issn.1009-3419.2019.02.05] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The purpose of this study is to compare the survival time of non-small cell lung cancer (NSCLC) patients with different organ metastasis. Among all cancers, the morbidity and mortality of lung cancer is the highest worldwide, which may caused by local recurrence and distant metastasis, and the location of metastasis may predict the prognosis of patients. METHODS A total of 117,542 patients with NSCLC diagnosed between 2010 and 2014 were enrolled from Surveillance, Epidemiology, and End Result (SEER) databases, and the relationship between distant metastasis and survival time was retrospectively analyzed. RESULTS Of all the 117,542 patients diagnosed with non-small cell lung cancer, 42,071 (35.8%) patients had different degrees of distant metastasis during their medical history, including 26,932 single organ metastases and 15,139 multiple organ metastases, accounting for 64.0% and 36.0% of the metastatic patients respectively. Compared with patients with no metastasis, whose median survival time was 21 months, the median survival time of patients with metastases was 7 months (lung), 6 months (brain), 5 months (bone), 4 months (liver), and 3 months (multiple organ) respectively, and the difference was significant (P<0.001, except liver vs multiple organ P=0.650); Most patients with NSCLC (88.4%) eventually died of lung cancer. CONCLUSIONS Distant metastasis of NSCLC patients indicates poor prognosis. In NSCLC patients with single organ metastasis, the prognosis of lung metastasis is the best, and liver metastasis is the worst, and multiple organ metastasis is worse than single organ metastasis.
Collapse
Affiliation(s)
- Bingqun Wu
- Department of Thoracic Surgery, First Affiliated Hospital of Tsinghua University, Beijing 100016, China
| | - Shenhai Wei
- Department of Thoracic Surgery, First Affiliated Hospital of Tsinghua University, Beijing 100016, China
| | - Jintao Tian
- Department of Thoracic Surgery, First Affiliated Hospital of Tsinghua University, Beijing 100016, China
| | - Xiaoping Song
- Department of Thoracic Surgery, First Affiliated Hospital of Tsinghua University, Beijing 100016, China
| | - Pengcheng Hu
- Department of Thoracic Surgery, First Affiliated Hospital of Tsinghua University, Beijing 100016, China
| | - Yong Cui
- Department of Thoracic Surgery, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, China
| |
Collapse
|
91
|
Üstün F, Tokuc B, Tastekin E, Durmuş Altun G. Tumor characteristics of lung cancer in predicting axillary lymph node metastases. Rev Esp Med Nucl Imagen Mol 2019. [DOI: 10.1016/j.remnie.2018.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
92
|
Arrieta O, Barrón F, Maldonado F, Cabrera L, Corona-Cruz JF, Blake M, Ramírez-Tirado LA, Zatarain-Barrón ZL, Cardona AF, García O, Arén O, De la Garza J. Radical consolidative treatment provides a clinical benefit and long-term survival in patients with synchronous oligometastatic non-small cell lung cancer: A phase II study. Lung Cancer 2019; 130:67-75. [PMID: 30885354 DOI: 10.1016/j.lungcan.2019.02.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/30/2019] [Accepted: 02/06/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Evidence is rapidly accumulating for the use of radical consolidative treatment (RCT) for patients with oligometastatic non-small cell lung cancer (NSCLC). Nonetheless, published studies have several limitations, including a selection of patients whose favorable characteristics might dictate therapeutic success, as well as scarce prospective data regarding overall survival (OS). The objective of this study was to determine whether RCT increases OS in patients with oligometastatic NSCLC. MATERIALS AND METHODS In this prospective, single-arm phase II study, we sought to evaluate the efficacy of RCT in patients with oligometastatic NSCLC in terms of OS. Patients with pathologically confirmed stage IV NSCLC who presented ≤5 synchronous, any-site metastases (including central nervous system [CNS] metastases), as assessed by PET-CT, were included. All patients received four initial cycles of systemic treatment. Following, those with stable disease/partial response received RCT to the primary site and metastases. The response to RCT was evaluated with PET-CT. The primary end-point was OS. Secondary end-points included progression-free survival (PFS) and best response by PET-CT. The study is registered in clinicaltrials.gov (NCT02805530). RESULTS Thirty-seven patients were included in the analysis. The mean age was 55.8 years (range: 33-75 years). At diagnosis, 43.2% of patients presented with CNS metastases. Following RCT, 19 (51.4%) patients achieved a complete-response (CR) by PET-CT, while 18 (48.6%) had a non-complete response (NON-CR). The median OS was nonreached (NR) and was positively affected by CR on PET-CT (NR vs. 27.4 [95% CI: 16.4-38.3]; p = 0.011). The median PFS was 23.5 months (95% CI: 13.6-33.3) and was positively affected by CR on PET-CT (NR vs. 14.3 [95% CI: 11.7-16.9]; p < 0.001; HR: 0.19 [0.07-0.52]; p=0.001). CONCLUSION Patients with oligometastatic NSCLC who undergo RCT have a high response rate and favorable OS. Patients with a CR by PET-CT have significantly longer OS, rendering this an important potential prognostic marker.
Collapse
Affiliation(s)
- Oscar Arrieta
- Thoracic Oncology Unit, National Cancer Institute (INCan), San Fernando #22, Sección XVI, Tlalpan, CP 14080, Mexico City, Mexico.
| | - Feliciano Barrón
- Thoracic Oncology Unit, National Cancer Institute (INCan), San Fernando #22, Sección XVI, Tlalpan, CP 14080, Mexico City, Mexico
| | - Federico Maldonado
- Thoracic Oncology Unit, National Cancer Institute (INCan), San Fernando #22, Sección XVI, Tlalpan, CP 14080, Mexico City, Mexico
| | - Luis Cabrera
- Thoracic Oncology Unit, National Cancer Institute (INCan), San Fernando #22, Sección XVI, Tlalpan, CP 14080, Mexico City, Mexico; Médica Sur Oncology Center, Mexico
| | - José Francisco Corona-Cruz
- Thoracic Oncology Unit, National Cancer Institute (INCan), San Fernando #22, Sección XVI, Tlalpan, CP 14080, Mexico City, Mexico
| | - Monika Blake
- Thoracic Oncology Unit, National Cancer Institute (INCan), San Fernando #22, Sección XVI, Tlalpan, CP 14080, Mexico City, Mexico
| | - Laura Alejandra Ramírez-Tirado
- Thoracic Oncology Unit, National Cancer Institute (INCan), San Fernando #22, Sección XVI, Tlalpan, CP 14080, Mexico City, Mexico
| | - Zyanya Lucia Zatarain-Barrón
- Thoracic Oncology Unit, National Cancer Institute (INCan), San Fernando #22, Sección XVI, Tlalpan, CP 14080, Mexico City, Mexico
| | - Andrés F Cardona
- Clinical and Traslational Oncology Group, Clínica del Country, Bogotá, Colombia; Foundation for Clinical and Applied Cancer Research- FICMAC, Bogotá, Colombia; Clinical Research and Biology Systems Department, Universidad El Bosque, Bogotá, Colombia
| | - Osvaldo García
- Thoracic Oncology Unit, National Cancer Institute (INCan), San Fernando #22, Sección XVI, Tlalpan, CP 14080, Mexico City, Mexico
| | - Osvaldo Arén
- Centro de Investigación Clínica Bradford Hill, Santiago, Chile
| | - Jaime De la Garza
- Thoracic Oncology Unit, National Cancer Institute (INCan), San Fernando #22, Sección XVI, Tlalpan, CP 14080, Mexico City, Mexico
| |
Collapse
|
93
|
Üstün F, Tokuc B, Tastekin E, Durmuş Altun G. Tumor characteristics of lung cancer in predicting axillary lymph node metastases. Rev Esp Med Nucl Imagen Mol 2019; 38:80-86. [PMID: 30638878 DOI: 10.1016/j.remn.2018.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/29/2018] [Accepted: 09/08/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In lung cancer, axillary lymph node metastases (ALM) are rare, and according to the 8th grading system, it is classified as M1b disease. The aim of this study is to evaluate1) the presence of ALM and2) the effect of the primary tumors characteristics on the development of ALM. METHODS We performed a descriptive cross-sectional study, with retrospective revision, to identify ALM. RESULTS There were 157 patients included in this analysis: ALM (63 patients) and control group (94 patients). The presence of extrathoracic lymph node, contralateral pulmonary parenchymal and distant metastasis and all SUVmax values were significantly higher in the study group versus the control group (P<0.05). The SUVmax value of the primary tumor was not a predictor of ALM. According to the primary histopathologic diagnosis, small cell lung cancer was found to cause ALM development 3.4 times as much as squamous cancer (SQC) (OR: 3.40 [95% CI 1.3-10.20], P=0.029) and adenocarcinoma group was found to cause ALM development 4 times as much as SQC (OR: 4.02 [95% CI 1.73-9.34], P=0.001). The likelihood of developing ALM was significantly higher in tumors located in the central and upper lobe versus the lower lobe. CONCLUSION The finding of ALM on PET/CT images, the necessity of histopathologic confirmation is determined according to the results of primary tumor localization, primary tumor histopathology, M stage on PET/CT imaging, localization of ALM according to primary tumor, and N stage on PET/CT imaging.
Collapse
Affiliation(s)
- F Üstün
- Trakya University, Faculty of Medicine, Department of Nuclear Medicine, Edirne, Turquía.
| | - B Tokuc
- Trakya University, Faculty of Medicine, Department of Public Health, Edirne, Turquía
| | - E Tastekin
- Trakya University, Faculty of Medicine, Department of Pathology, Edirne, Turquía
| | - G Durmuş Altun
- Trakya University, Faculty of Medicine, Department of Nuclear Medicine, Edirne, Turquía
| |
Collapse
|
94
|
Deng J, Ren Z, Wen J, Wang B, Hou X, Xue Z, Chu X. Construction of a nomogram predicting the overall survival of patients with distantly metastatic non-small-cell lung cancer. Cancer Manag Res 2018; 10:6143-6156. [PMID: 30538562 PMCID: PMC6257075 DOI: 10.2147/cmar.s183878] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose This study aimed to establish a nomogram to predict the overall survival (OS) of the general non-small-cell lung cancer (NSCLC) patients with distant metastasis. Patients and methods We investigated Surveillance, Epidemiology, and End Results database for NSCLC patients with distant metastasis diagnosed between 2010 and 2014. Statistically significant prognostic factors were identified using uni- and multivariable Cox regression analyses. A nomogram incorporating these prognostic factors was developed and evaluated by the Harrell's concordance index (C-index), calibration plots, and risk group stratifications. Results We finally included 18,209 patients for analysis. These patients were divided into two groups, 14,567 cases for the training cohort and 3,642 for the validation cohort. Marital status, sex, race, age, histology, T stage, N stage, histological differentiation, bone metastasis, brain metastasis, liver metastasis, with M1a disease, surgery of primary cancer, and chemotherapy were identified as the prognostic factors of the OS and integrated to construct the nomogram. The nomogram had a C-index of 0.704 (95% CI: 0.699-0.709) in the training set and 0.699 (95% CI: 0.689-0.709) in the validation set. The calibration curves for 1- and 2-year OS in the training and validation sets showed acceptable agreement between the predicted and observed survival. Also, the nomogram was capable of stratifying patients into different risk groups within the patients who presented with bone, liver, or brain metastasis, as well as in each T, N stage, respectively. Conclusion A nomogram was established and validated to predict individual prognosis for the general patients with distantly metastatic NSCLC. Global prospective data with the latest TNM classification and more comprehensive prognostic factors are needed to improve this model.
Collapse
Affiliation(s)
- Jianqing Deng
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China,
| | - Zhipeng Ren
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China,
| | - Jiaxin Wen
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China,
| | - Bo Wang
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China,
| | - Xiaobin Hou
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China,
| | - Zhiqiang Xue
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China,
| | - Xiangyang Chu
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China,
| |
Collapse
|
95
|
Effects of primary tumor resection on the survival of patients with stage IV extrathoracic metastatic non-small cell lung cancer: A population-based study. Lung Cancer 2018; 129:98-106. [PMID: 30545693 DOI: 10.1016/j.lungcan.2018.11.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/07/2018] [Accepted: 11/09/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Selected non-small cell lung cancer (NSCLC) patients with extrathoracic metastases might benefit from surgical intervention; however, the evidence is limited. We investigated the benefit of surgery in these patients regarding the extent of the metastatic disease. METHODS Patients with extrathoracic metastatic NSCLC were identified in the US National Cancer Institute Surveillance, Epidemiology, and End Results database (2010-2015). Survival was compared before and after matching. Multivariate Cox regression models were built to identify factors associated with survival and to adjust for covariates in subgroup analysis. RESULTS Of the 39,655 patients, 1206 underwent primary tumor resection, and 630 patients were identified 1:1 in surgical and nonsurgical groups after matching. In the entire cohort, patients who underwent surgery had significant prolonged overall survival (OS) in both unmatched (median survival time, [MST]: 14 vs. 6 months, p < 0.001) and matched (MST: 11 vs. 7 months, p < 0.001) cohorts. In the highly selected surgery-recommended cohort, surgical group still had a significantly longer OS (MST: 14 vs. 6 months, p < 0.001). Multivariate regression showed that surgery was independently associated with improved OS and lung cancer-specific mortality (LCSM) (OS: hazard ratio [HR]: 0.60, 95% confidence interval [CI]: 0.56-0.64, p < 0.001; LCSM: subhazard ratio [SHR]: 0.61, 95% CI: 0.57-0.66, p < 0.001). Subgroup analysis showed that surgery was an independent favorable predictor to survival in all cohorts except patients with N3 disease, and patients with single-organ metastasis were associated with the most prominent survival benefit from surgery. CONCLUSIONS Primary tumor resection was associated with improved survival in extrathoracic metastatic NSCLC patients, particularly for those with single-organ metastasis.
Collapse
|
96
|
Abdel-Rahman O. Impact of baseline characteristics on extensive-stage SCLC patients treated with etoposide/carboplatin: A secondary analysis of a phase III study. CLINICAL RESPIRATORY JOURNAL 2018; 12:2519-2524. [PMID: 30073795 DOI: 10.1111/crj.12950] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/02/2018] [Accepted: 07/31/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND The purpose of the current study is to investigate the impact of baseline characteristics on the outcomes of extensive-stage small cell lung cancer (SCLC) patients recruited into a clinical trial. METHODS This is a secondary analysis of the control arm (etoposide/carboplatin arm) of the 'NCT00363415' study which is a phase III study conducted between 2006 and 2007. Univariate analysis of factors affecting overall and progression-free survival (PFS) was conducted through Cox regression analysis [including age, race, gender, Eastern Cooperative Oncology Group performance score, body mass index, Lactate dehydrogenase, number of metastatic sites and brain metastases]. Factors with P < .05 in the univariate analysis were then included in the multivariate analysis. RESULTS All patients within the control arm (etoposide/carboplatin) were included in the analysis (N = 455 patients). The following factors were predictive of worse overall survival (OS) in univariate analysis (P < .05): performance score = 2, LDH > upper limit of normal and ≥3 metastatic sites. Multivariate Cox regression analysis incorporating these three factors showed that only number of metastatic sites predicts worse OS (P < .0001). Likewise, the following factors were associated with worse PFS in univariate analysis (P < .05): performance score = 2 and ≥ 3 metastatic sites predict worse PFS (P < .05). Multivariate analysis incorporating these two factors showed that only number of metastatic sites predicts worse PFS (P < .0001). CONCLUSION Number of metastatic sites is the most important predictive factor for overall and PFS among patients with extensive-stage SCLC treated with systemic chemotherapy within a clinical trial.
Collapse
Affiliation(s)
- Omar Abdel-Rahman
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Department of Oncology, University of Calgary and Tom Baker Cancer Center, Calgary, Alberta, Canada
| |
Collapse
|
97
|
Mitsuhashi A, Okuma Y, Zenke Y, Hosomi Y. Prognostic effects of osteoclast inhibitors in extensive stage small cell lung cancer patients with bone metastases. Mol Clin Oncol 2018; 9:561-565. [PMID: 30345052 DOI: 10.3892/mco.2018.1710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/31/2018] [Indexed: 11/06/2022] Open
Abstract
Bone metastases (BM) often induce skeletal-related events (SREs) and contribute to poor prognoses in patients with cancer. Osteoclast inhibitors (OIs), such as bisphosphonates (BPs) and denosumab, reportedly prevent SREs and improve quality of life in patients with non-small cell lung cancer and BM, but have not been tested in extensive stage small cell lung cancer (ES-SCLC) patients. From 238 SCLC patient records, the present study reviewed those of 58 BM patients, including 23 who were treated with OIs (OIs group) and 35 who were untreated (untreated group). Patient backgrounds were balanced between groups using propensity score matching, and survival curves were compared using the log-rank test. The median overall survival (OS) times were 8.41 and 12.52 months in untreated and OIs groups, respectively, but these did not differ significantly between groups (log-rank test, P=0.409). The 1-year OS rate was higher in the OIs group (56.1%) when compared with the control group (22.6%). The results indicated that OIs tend to prolong the short term survival of ES-SCLC patients with BM. To the best of our knowledge, this is the first study to examine the prognostic effects of OIs in SCLC patients. The results of the present study may highlight the possibility that OIs improve the prognosis of ES-SCLC patients with BM.
Collapse
Affiliation(s)
- Atsushi Mitsuhashi
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo, Tokyo 113-8677, Japan
| | - Yusuke Okuma
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo, Tokyo 113-8677, Japan.,Division of Oncology, Research Center for Medical Sciences, Jikei University School of Medicine, Minato-ku, Tokyo 105-8461, Japan
| | - Yoshitaka Zenke
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo, Tokyo 113-8677, Japan
| | - Yukio Hosomi
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo, Tokyo 113-8677, Japan
| |
Collapse
|
98
|
Yang J, Zhang Y, Sun X, Gusdon AM, Song N, Chen L, Jiang G, Huang Y. The prognostic value of multiorgan metastases in patients with non-small cell lung cancer and its variants: a SEER-based study. J Cancer Res Clin Oncol 2018; 144:1835-1842. [PMID: 30003315 DOI: 10.1007/s00432-018-2702-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 07/04/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE This study aimed to investigate the prognostic value of different organs metastases in patients with non-small cell lung cancer (NSCLC) and its most common subtypes. METHODS We identified 45,423 NSCLC cases (25,129 men and 20,294 women) between 2010 and 2013 with distant metastases, with complete clinical information obtained from the surveillance, epidemiology, and end results (SEER) database. RESULTS Bone and liver were the most and the least common metastatic sites with rates of 37.1 and 16.8%, respectively. The mortality rates associated with bone, brain, liver, lung metastases, and multiorgan metastases (MOM) were 73.2, 72.7, 78.3, 65.4, and 77.5%, respectively. Kaplan-Meier analyses demonstrated that patients with MOM and liver metastasis had the worst survival. Compared with NSCLC cases with other organ metastasis, but without the four organs metastasis, hazard ratios (HRs) for lung, bone, brain, and liver metastases, and MOM were 0.906 (95% CI 0.866-0.947), 1.276 (95% CI 1.225-1.330), 1.318 (95% CI 1.260-1.379), 1.481 (95% CI 1.388-1.580), and 1.647 (95% CI 1.587-1.709), respectively. Similar results were obtained for adenocarcinoma (AD) cases. CONCLUSIONS The mortality risk is highest with MOM and liver metastasis followed by bone, brain, other organ, and lung metastases in NSCLC and AD which is the most common variant for NSCLC. These results will be helpful for pre-treatment evaluation regarding the prognosis of NSCLC patients.
Collapse
Affiliation(s)
- Jie Yang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433, China
| | - Yuan Zhang
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoting Sun
- Department of Health Services Research & Administration, University of Nebraska Medical Center, Omaha, NE, USA
| | - Aaron M Gusdon
- Division of Neurocritical Care, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nan Song
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433, China
| | - Linsong Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433, China.
| | - Yueye Huang
- Department of Endocrinology and Metabolism, The Center of Thyroid Diseases, The Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai, 200072, China.
| |
Collapse
|
99
|
Abdel-Rahman O. Outcomes of Surgery as Part of the Management of Metastatic Non-Small-Cell Lung Cancer: A Surveillance, Epidemiology and End Results Database Analysis. Cancer Invest 2018; 36:238-245. [PMID: 29775109 DOI: 10.1080/07357907.2018.1466895] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The role of local treatment in patients with oligometastatic non-small-cell lung cancer (NSCLC) is a subject of ongoing debate. This study assessed the survival impact of combined surgery to the primary tumor and metastatic disease in the management of metastatic NSCLC. Stage IV NSCLC patients at presentation, diagnosed from 2004 to 2013 were identified from the SEER (Surveillance, Epidemiology, and End Results) database. Propensity-matched analysis was performed considering baseline characteristics (age, gender, race, histology, TN stage, and site of metastases). A total of 144,334 patients were identified. The median age group was 65-70 years, and 1139 patients (0.8% of the patients) have received surgical treatment to both the primary tumor and metastatic disease. Both before and after propensity score matching, cancer-specific and overall survival were better in the surgical therapy group (P < 0.0001 for all). When the analysis was restricted to the subsets of patients with brain only M1 disease or isolated contra lateral nodule, overall survival was improved by combined surgery. However, in multivariate analysis of the overall population (postmatching), combined surgery was not associated with a better overall survival (0.576). Despite the apparently beneficial role of surgery in this study for some patients with metastatic disease, the absence of adequate information about systemic therapy as well as associated comorbidity hinders the generation of definite conclusions. Prospective studies are needed to confirm the role of surgery in the setting of metastatic disease.
Collapse
Affiliation(s)
- Omar Abdel-Rahman
- a Clinical Oncology Department , Faculty of Medicine , Ain Shams University , Cairo , Egypt
| |
Collapse
|
100
|
Abdel-Rahman O. Evaluation of the 8th AJCC staging system for pathologically versus clinically staged pancreatic adenocarcinoma: A time to revisit a dogma? Hepatobiliary Pancreat Dis Int 2018; 17:64-69. [PMID: 29428107 DOI: 10.1016/j.hbpd.2018.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/02/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The 8th edition of the American Joint Committee on Cancer (AJCC) staging system for pancreatic exocrine adenocarcinoma has been released. The current study seeks to assess the 7th and 8th editions among patients registered within the surveillance, epidemiology and end results (SEER) database. METHODS SEER database (2010-2013) has been accessed through SEER*Stat program and AJCC 8th edition stages were reconstructed utilizing the collaborative stage descriptions. Kaplan-Meier analysis of overall survival and pancreatic cancer-specific survival analyses (according to both 7th and 8th editions and according to whether pathological or clinical staging were conducted) has been performed. Multivariate analysis of factors affecting pancreatic cancer-specific survival was also conducted through a Cox proportional hazard model. RESULTS A total of 18 948 patients with pancreatic adenocarcinoma were identified in the period from 2010-2013. Pancreatic cancer-specific survival among pathologically staged patients and according to the 8th edition showed significant differences for all pair wise comparisons among different stages (P < 0.0001) except for the comparison between stage IA and stage IB (P = 0.307) and the comparison between stage IB and stage IIA (P = 0.116). Moreover, P value for stage IA vs IIA was 0.014; while pancreatic cancer-specific survival according to the 7th edition among pathologically staged patients showed significant differences for all pair wise comparisons among different stages (P < 0.0001) except for the comparison between IA and IB (P = 0.072), the comparison between stage IIA and stage IIB (P = 0.065), the comparison between stage IIA and stage III (P = 0.059) and the comparison between IIB and III (P = 0.595). Among clinically staged patients (i.e. those who did not undergo initial radical surgery), the prognostic performance of both 7th and 8th stages for both overall survival and pancreatic cancer-specific survival was limited. CONCLUSION There is clearly a need to have two staging systems for pancreatic adenocarcinoma: pathological and clinical staging systems.
Collapse
Affiliation(s)
- Omar Abdel-Rahman
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| |
Collapse
|