201
|
Sebastião MM, Ho RS, de Carvalho JPV, Nussbaum M. Diagnostic Accuracy of Next Generation Sequencing Panel using Circulating Tumor DNA in Patients with Advanced Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2020; 7:158-163. [PMID: 33043062 PMCID: PMC7539761 DOI: 10.36469/jheor.2020.17088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND/OBJECTIVES Until now, no meta-analysis has been published to evaluate the diagnostic performance of next-generation sequencing (NGS) panel using circulating tumor (ctDNA) in patients with advanced non-small cell lung cancer (aNSCLC). The aim of the study was to carry out a systematic review and a meta-analysis in order to determine the accuracy of NGS of ctDNA to detect six oncogenic driver alterations: epidermal growth factor receptor (EGFR); anaplastic lymphoma kinase (ALK); ROS proto-oncogene 1, receptor tyrosine kinase (ROS-1); serine/threonine-protein kinase B-RAF (BRAF); RET proto-oncogene (RET); and MET proto-oncogene, receptor tyrosine kinase (MET) exon 14 in patients with aNSCLC. METHODS MEDLINE/PubMed, Cochrane Library, Latin American and Caribbean Health Sciences Literature (LILACS), and Centre for Reviews and Dissemination databases and articles obtained from other sources were searched for relevant studies that evaluate the accuracy (sensitivity and specificity) of NGS using ctDNA in patients with aNSCLC. The studies were eligible when NGS of ctDNA was compared with tissue tests to detect at least one of the six oncogenic driver alterations. Diagnostic measures (sensitivity and specificity) were pooled with a bivariate diagnostic random effect. All statistical analyses were performed with software R, v.4.0.0. RESULTS Ten studies were eligible for data extraction. The overall pooled estimates of sensitivity and specificity were 0.766 (95% CI: 0.678-0.835); 0.999 (95% CI: 0.990-1.000), respectively. CONCLUSIONS The analysis has demonstrated that the NGS panel using ctDNA has a high accuracy to identify the six actionable oncogenic driver alterations in patients with aNSCLC. Therefore, it can be considered a reliable alternative to guide the patients with aNSCLC to the right treatment who cannot undergo an invasive procedure or have insufficient tissue material for molecular tests.
Collapse
|
202
|
de Groot PM, Chung JH, Ackman JB, Berry MF, Carter BW, Colletti PM, Hobbs SB, McComb BL, Movsas B, Tong BC, Walker CM, Yom SS, Kanne JP. ACR Appropriateness Criteria ® Noninvasive Clinical Staging of Primary Lung Cancer. J Am Coll Radiol 2020; 16:S184-S195. [PMID: 31054745 DOI: 10.1016/j.jacr.2019.02.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 12/19/2022]
Abstract
Lung cancer is the leading cause of cancer-related deaths in both men and women. The major risk factor for lung cancer is personal tobacco smoking, particularly for small-cell lung cancer (SCLC) and squamous cell lung cancers, but other significant risk factors include exposure to secondhand smoke, environmental radon, occupational exposures, and air pollution. Education and socioeconomic status affect both incidence and outcomes. Non-small-cell lung cancer (NSCLC), including adenocarcinoma, squamous cell carcinoma, and large cell carcinoma, comprises about 85% of lung cancers. SCLC accounts for approximately 13% to 15% of cases. Prognosis is directly related to stage at presentation. NSCLC is staged using the eighth edition of the tumor-node-metastasis (TNM) criteria of the American Joint Committee on Cancer. For SCLC the eighth edition of TNM staging is recommended to be used in conjunction with the modified Veterans Administration Lung Study Group classification system distinguishing limited stage from extensive stage SCLC. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
| | | | - Jeanne B Ackman
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark F Berry
- Stanford University Medical Center, Stanford, California; The Society of Thoracic Surgeons
| | - Brett W Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | | | - Betty C Tong
- Duke University School of Medicine, Durham, North Carolina; The Society of Thoracic Surgeons
| | | | - Sue S Yom
- University of California San Francisco, San Francisco, California
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| |
Collapse
|
203
|
Xie S, Deng H, Liu G, Liu Q. A case of different gene mutations in primary and metastatic lesions after EGFR-TKI treatment of lung cancer. TUMORI JOURNAL 2020; 106:NP52-NP56. [PMID: 32867626 DOI: 10.1177/0300891620949920] [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]
Abstract
BACKGROUND It remains controversial whether patients with EGFR-mutant lung adenocarcinoma should stop using epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) after progression during treatment. CASE REPORT We report a 35-year-old man with poorly differentiated adenocarcinoma of the left upper lobe and an exon 19 deletion (Ex19Del) mutation found by large-panel next-generation sequencing. The patient underwent video-assisted thoracoscopic surgery 12 months after oral administration of icotinib 125 mg tid, and the left upper lobe and surrounding lymph nodes were removed. Postoperative pathology supported a diagnosis of left upper lobe adenocarcinoma and subcarinal (1/2), main pulmonary artery window (1/2), and left hilar (1/2) lymph node metastases. The EGFR mutations in the residual lesions had disappeared, and Ex19Del mutations were still visible in the mediastinal lymph node metastasis. CONCLUSION Spatial heterogeneity of the resistance mechanism may explain why patients who continue to receive EGFR-TKIs in combination with local therapies (e.g., radiotherapy) for progressing lesions may benefit even after progression during EGFR-TKI therapy. The loss of the EGFR mutation allele as a putative resistance mechanism requires additional preclinical and clinical confirmation.
Collapse
Affiliation(s)
- Shaonan Xie
- Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Huiyan Deng
- Department of Pathology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Guangjie Liu
- Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qingyi Liu
- Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| |
Collapse
|
204
|
Giraud P, Lerouge D, Latorzeff I, Mirabel X, Dohan A, Mordant P, Barry de Longchamps N. [Stereotaxic radiotherapy of primary extracranial tumors]. Cancer Radiother 2020; 24:513-522. [PMID: 32830055 DOI: 10.1016/j.canrad.2020.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/10/2020] [Accepted: 06/16/2020] [Indexed: 12/25/2022]
Abstract
Stereotactic radiotherapy is a fundamental change from the conventional fractionated radiotherapy and represents a new therapeutic indication. Stereotactic radiotherapy is now a standard of care for inoperable patients or patients who refuse surgery. The results are encouraging with local control and survival rates very high in selected populations. The rate of late toxicity remains acceptable. Good tolerability makes it appropriate even for elderly and frail patients. In these fragile patients or in certain specific clinical situations, different surgical, radiotherapy or interventional radiology attitudes can be discussed on a case-by-case basis. These situations are considered in this article for the pulmonary, hepatic and prostatic localizations.
Collapse
Affiliation(s)
- P Giraud
- Service d'oncologie radiothérapie, université de Paris, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France.
| | - D Lerouge
- Département de radiothérapie, centre François-Baclesse, avenue du Général-Harris, 14076 Caen, France
| | - I Latorzeff
- Département de radiothérapie-oncologie, bâtiment Atrium, clinique Pasteur, 1, rue de la Petite-Vitesse, 31300 Toulouse, France
| | - X Mirabel
- Département de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - A Dohan
- Service de radiologie A, université de Paris, unité de radiologie abdominopelvienne et interventionnelle, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - P Mordant
- Service de chirurgie vasculaire, thoracique, et de transplantation pulmonaire, hôpital Bichat, Assistance publique-Hôpitaux de Paris, unité Inserm U1152, université de Paris, 46, rue Henri-Huchard, 75018 Paris, France
| | - N Barry de Longchamps
- Service d'urologie, Inserm U1151 - équipe 4/Institut Necker Enfants Malades, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| |
Collapse
|
205
|
Gentzler RD, Riley DO, Martin LW. Striving toward Improved Outcomes for Surgically Resectable Non-Small Cell Lung Cancer: the Promise and Challenges of Neoadjuvant Immunotherapy. Curr Oncol Rep 2020; 22:109. [PMID: 32803520 DOI: 10.1007/s11912-020-00969-w] [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] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Immunotherapy has revolutionized the treatment of non-surgical stage III and stage IV non-small cell lung cancer (NSCLC). Here, we review emerging data on the safety, feasibility, and efficacy of neoadjuvant immunotherapy in the setting of earlier stage surgically resectable lung cancer. RECENT FINDINGS Several small studies support the safety and feasibility of neoadjuvant immunotherapy, noting similar perioperative rates of morbidity and mortality compared with historical controls. Data from several phase II trials have shown high rates of major pathologic response (MPR), though it is unclear if this will correlate with a survival benefit. Phase III trials of neoadjuvant immunotherapy alone or in combination with chemotherapy are ongoing. Neoadjuvant immunotherapy offers a promising treatment modality in earlier stage NSCLC patients. Results of ongoing phase II and phase III trials will be essential in determining how to best integrate this treatment modality in the future.
Collapse
Affiliation(s)
- Ryan D Gentzler
- Division of Hematology/Oncology, University of Virginia, PO Box 800716, Charlottesville, VA, 22908, USA.
| | - David O Riley
- Division of Hematology/Oncology, University of Virginia, PO Box 800716, Charlottesville, VA, 22908, USA
| | - Linda W Martin
- Division of Thoracic Cardiovascular Surgery, University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
206
|
Qu J, Wang L, Jiang M, Zhao D, Wang Y, Zhang F, Li J, Zhang X. A Review About Pembrolizumab in First-Line Treatment of Advanced NSCLC: Focus on KEYNOTE Studies. Cancer Manag Res 2020; 12:6493-6509. [PMID: 32801888 PMCID: PMC7395702 DOI: 10.2147/cmar.s257188] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/24/2020] [Indexed: 12/14/2022] Open
Abstract
Lung cancer is currently the malignant tumor with the highest incidence and mortality in the world, while non-small cell lung cancer (NSCLC) is the most common pathological type of lung caner. In the past few decades, the only treatment options available for advanced NSCLC patients have been targeted therapy or chemotherapy, but these therapies are inevitably tolerated by tumors. The discovery of immune checkpints that mediate the immune escape of tumor cells have been promoting a series of immune checkpoint inhibitors to be used in cancer treatment and achieved great results. Among them, pembrolizumab is currently the only PD-1 inhibitor approved for first-line treatment of NSCLC, whether it is monotherapy or combination therapy, for creditable performance in KEYNOTE studies. In this review, we systematically integrate the latest series of clinical trial results, pharmacological mechanisms, adverse events (AEs) and predictive biomarkers in the first-line treatment of NSCLC. We hope pembrolizumab could become a better choice for more clinicians and benefit more patients with advanced NSCLC.
Collapse
Affiliation(s)
- Jialin Qu
- Department of Medical Oncology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, People's Republic of China
| | - Li Wang
- Department of Medical Oncology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, People's Republic of China
| | - Man Jiang
- Department of Medical Oncology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, People's Republic of China
| | - Deze Zhao
- Department of Medical Oncology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, People's Republic of China
| | - Yuyang Wang
- Department of Medical Oncology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, People's Republic of China
| | - Feng Zhang
- Department of Medical Oncology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, People's Republic of China
| | - Jing Li
- Department of Medical Oncology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, People's Republic of China
| | - Xiaochun Zhang
- Department of Medical Oncology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, People's Republic of China
| |
Collapse
|
207
|
Primary Driver Mutations in GTF2I Specific to the Development of Thymomas. Cancers (Basel) 2020; 12:cancers12082032. [PMID: 32722121 PMCID: PMC7466068 DOI: 10.3390/cancers12082032] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/16/2020] [Accepted: 07/22/2020] [Indexed: 12/17/2022] Open
Abstract
Thymomas are rare mediastinal tumors that are difficult to treat and pose a major public health concern. Identifying mutations in target genes is vital for the development of novel therapeutic strategies. Type A thymomas possess a missense mutation in GTF2I (chromosome 7 c.74146970T>A) with high frequency. However, the molecular pathways underlying the tumorigenesis of other thymomas remain to be elucidated. We aimed to detect this missense mutation in GTF2I in other thymoma subtypes (types B). This study involved 22 patients who underwent surgery for thymomas between January 2014 and August 2019. We isolated tumor cells from formalin-fixed paraffin-embedded tissues from the primary lesions using laser-capture microdissection. Subsequently, we performed targeted sequencing to detect mutant GTF2I coupled with molecular barcoding. We used PyClone analysis to determine the fraction of tumor cells harboring mutant GTF2I. We detected the missense mutation (chromosome 7 c.74146970T>A) in GTF2I in 14 thymomas among the 22 samples (64%). This mutation was harbored in many type B thymomas as well as type A and AB thymomas. The allele fraction for the tumors containing the mutations was variable, primarily owing to the coexistence of normal lymphocytes in the tumors, especially in type B thymomas. PyClone analysis revealed a high cellular prevalence of mutant GTF2I in tumor cells. Mutant GTF2I was not detected in other carcinomas (lung, gastric, colorectal, or hepatocellular carcinoma) or lymphomas. In conclusion, the majority of thymomas harbor mutations in GTF2I that can be potentially used as a novel therapeutic target in patients with thymomas.
Collapse
|
208
|
Xu C, Yuan Q, Hu H, Wang W, Zhang Q, Li L, Wang J, Yang R. Expression of Cripto-1 predicts poor prognosis in stage I non-small cell lung cancer. J Cell Mol Med 2020; 24:9705-9711. [PMID: 32697011 PMCID: PMC7520286 DOI: 10.1111/jcmm.15518] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/14/2020] [Accepted: 05/24/2020] [Indexed: 02/06/2023] Open
Abstract
Cripto-1 (CR-1) is related to the biological behaviour and prognosis of carcinomas. The purpose of this study was to investigate the significance of CR-1 expression in surgically resected stage I non-small cell lung cancer (NSCLC). One hundred and forty-eight patients with completely resected stage I NSCLC and available clinical follow-up data were assessed. The protein expression of CR-1 in the tumours was detected by immunohistochemistry. CR-1 was highly expressed in 64 of 148 tumours. Among patients with high CR-1 expression, progression-free survival and overall survival rate were significantly lower than those of patients with low CR-1 levels (P = .013 and P = .019, respectively). The incidence of distant metastasis in patients with high CR-1 expression was significantly higher than that of in patients with low CR-1 expression (57.13% vs 21.43%, P = .001). The results of the multivariate analysis confirmed that a high CR-1 was a significant factor for poor prognosis. In conclusion, CR-1 could be a useful prognostic factor in patients with stage I NSCLC, likely as an indicator of the metastatic propensity of the tumour.
Collapse
Affiliation(s)
- Chunhua Xu
- Department of Respiratory Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, China
| | - Qi Yuan
- Department of Respiratory Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, China
| | - Huidi Hu
- Department of Pathology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Wang
- Department of Respiratory Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, China
| | - Qian Zhang
- Department of Respiratory Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, China
| | - Li Li
- Department of Respiratory Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, China
| | - Jiwang Wang
- Department of Respiratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Rusong Yang
- Department of Thoracic Surgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
209
|
Lang D, Huemer F, Rinnerthaler G, Horner A, Wass R, Brehm E, Akbari K, Granitz M, Hutarew G, Kaiser B, Greil R, Lamprecht B. Therapy Line and Associated Predictors of Response to PD-1/PD-L1-Inhibitor Monotherapy in Advanced Non-small-Cell Lung Cancer: A Retrospective Bi-centric Cohort Study. Target Oncol 2020; 14:707-717. [PMID: 31654203 PMCID: PMC6875512 DOI: 10.1007/s11523-019-00679-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Evidence on PD-1/PD-L1-directed immune checkpoint inhibitor (ICI) therapy for advanced non-small-cell lung cancer (NSCLC) is mainly based on clinical trials in first- or second-line settings. OBJECTIVE We aimed to investigate response and prognostic factors with special regard to third- or later-line therapy. PATIENTS AND METHODS We retrospectively analyzed all patients who had received ICI monotherapy with nivolumab, pembrolizumab, or atezolizumab for advanced NSCLC. Computed tomography evaluations were analyzed using response evaluation criteria in solid tumors (RECIST, version 1.1). Kaplan-Meier analyses were conducted to calculate progression-free (PFS) and overall (OS) survival; the impact of influencing variables was evaluated using uni- and multivariate Cox-regression analyses. RESULTS Among 153 patients (59% men, mean age 66 years), median PFS was 4 months [mo; 95% confidence interval (95% CI) 3-5], OS was 13 mo (10-17), and objective response rate (ORR) was 22%. Therapy line ≥ 3 was associated with significantly inferior PFS (p = 0.003) and OS (p = 0.001). In first-line therapy PFS, OS, and ORR were 7 mo (3-11), 17 mo [9-not evaluable (n.e.)], and 36%; in second-line 4 mo (3-7), 18 mo (13-n.e.) and 19%, and in ≥ third-line 2 mo (1-3), 9 mo (4-12), and 13%. PFS was significantly influenced by PD-L1 expression in first-line therapy (p = 0.006). In ≥ third-line patients, Eastern Cooperative Oncology Group (ECOG) performance status significantly affected PFS and OS (both p < 0.001). CONCLUSIONS Third- or later-line single-agent anti-PD-1/PD-L1 therapy is less efficacious as compared to first- and second-line treatment. In that setting, ECOG performance status predominates known predictors like PD-L1 expression or presence of an alteration in EGFR or ALK.
Collapse
Affiliation(s)
- David Lang
- Department of Pulmonology, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria.
| | - Florian Huemer
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute, Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Cancer Cluster Salzburg, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Gabriel Rinnerthaler
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute, Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Cancer Cluster Salzburg, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Andreas Horner
- Department of Pulmonology, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Romana Wass
- Department of Pulmonology, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Elmar Brehm
- Department of Pulmonology, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Kaveh Akbari
- Central Radiology Institute, Kepler University Hospital, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Marcel Granitz
- Institute of Diagnostic Radiology, Paracelsus Medical University Salzburg, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Georg Hutarew
- Institute of Pathology, Paracelsus Medical University Salzburg, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Bernhard Kaiser
- Department of Pulmonology, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute, Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Cancer Cluster Salzburg, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Bernd Lamprecht
- Department of Pulmonology, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria
| |
Collapse
|
210
|
Sakakura N, Mizuno T, Kuroda H, Sakao Y. Primary pneumonectomy, pneumonectomy after induction therapy, and salvage pneumonectomy: a comparison of surgical and prognostic outcomes. J Thorac Dis 2020; 12:2672-2682. [PMID: 32642175 PMCID: PMC7330390 DOI: 10.21037/jtd.2020.03.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Surgical outcomes of pneumonectomy for lung cancer differ based on various therapeutic strategies. Methods One hundred and fifty-one patients who underwent pneumonectomy were divided into three groups based on patients' therapeutic conditions: a primary pneumonectomy group (no preoperative treatment, n=137), an induction group (planned surgery after induction chemotherapy or chemoradiotherapy, n=10), and a salvage group (surgery for residual or enlarged lesions after radical non-operative therapies, n=4). Results Multivariate analysis showed that completeness of resection (P=0.003), subcategorization of whether there was no invasion, infiltration only to the main bronchus or pleura, or invasion of other deeper structures (P=0.008), and the presence or absence of mediastinal lymph node metastasis (P=0.033) were significant prognostic factors. Severe postoperative complications occurred in 5.1% (7/137), 20% (2/10), and 0% (0/4) in the primary pneumonectomy, induction, and salvage groups, respectively. Among patients with pN0-1 disease, the 3-year overall survival rate was 58.7% in the primary pneumonectomy group, 100% and 40% in cases with high and low pathological effects in the induction group, respectively, and 50% in the salvage group. Among patients with pN2 disease, this rate was 41.4% in the primary pneumonectomy group, and no patients survived for postoperative 2 years in the other groups. Conclusions For patients undergoing pneumonectomy, subcategorization based on the invasion status (none/bronchus/pleura or other deeper structures) is a crucial prognostic factor. To consider pneumonectomy in the induction or salvage setting, selecting patients with pN0-1 disease may be mandatory.
Collapse
Affiliation(s)
- Noriaki Sakakura
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Tetsuya Mizuno
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yukinori Sakao
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| |
Collapse
|
211
|
Nicosia L, Di Muzio J, Agolli L, Alongi F, Mazzola R, Valeriani M, Badellino S, Osti MF, Ricardi U. What is the role of reirradiation in the management of locoregionally relapsed non small-cell lung cancer? Lung Cancer 2020; 146:263-275. [PMID: 32593916 DOI: 10.1016/j.lungcan.2020.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/06/2020] [Accepted: 06/13/2020] [Indexed: 12/25/2022]
Abstract
The prognosis of lung cancer patients has improved in the last few years. Despite definitive therapy, local recurrence or a second primary tumour can occur in many patients within previously irradiated areas. Recent developement of more accurate techniques in radiation oncology allows delivery of high radiation dose to the tumor with the aim of improving local control, delaying disease progression and in some cases even curing. Nevertheless, the use of high dose in the reirradiation setting is not without risks, especially when treatment volumes overlap with previously irradiated tissues. The risk of adverse effects must be balanced with the choice of an effective treatment by selecting suitable candidates and the best radiation technique. In this systemic review efficacy and toxicity of reirradiation in locoregionally recurrent non-small-cell lung cancer is extensively discussed. Results indicate that reirradiation might be beneficial in well-selected patients. Prospective and high quality studies are necessary in this field.
Collapse
Affiliation(s)
- Luca Nicosia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Italy.
| | - Jacopo Di Muzio
- Radiation Oncology Department AO Città della Salute e della Scienza - Molinette, University of Turin, Turin, Italy
| | - Linda Agolli
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Italy; University of Brescia, Italy
| | - Rosario Mazzola
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Italy
| | - Maurizio Valeriani
- Department of Radiation Oncology, Sant'Andrea Hospital, "Sapienza" University of Rome, Italy
| | - Serena Badellino
- Radiation Oncology Department AO Città della Salute e della Scienza - Molinette, University of Turin, Turin, Italy
| | - Mattia F Osti
- Department of Radiation Oncology, Sant'Andrea Hospital, "Sapienza" University of Rome, Italy
| | - Umberto Ricardi
- Radiation Oncology Department AO Città della Salute e della Scienza - Molinette, University of Turin, Turin, Italy
| |
Collapse
|
212
|
Li Y, Zhang Z, Hu Y, Yan X, Song Q, Wang G, Chen R, Jiao S, Wang J. Pretreatment Neutrophil-to-Lymphocyte Ratio (NLR) May Predict the Outcomes of Advanced Non-small-cell Lung Cancer (NSCLC) Patients Treated With Immune Checkpoint Inhibitors (ICIs). Front Oncol 2020; 10:654. [PMID: 32656072 PMCID: PMC7324627 DOI: 10.3389/fonc.2020.00654] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/08/2020] [Indexed: 12/26/2022] Open
Abstract
Background: Recent studies have demonstrated the predictive value of pretreatment neutrophil-to-lymphocyte ratio (NLR) in advanced cancers; however, the role of NLR in patients with advanced non-small-cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs) remained to be explored. Thus, we aimed to investigate whether pretreatment NLR was associated with the outcomes of advanced NSCLC patients treated with ICIs. Methods: A comprehensive literature research was first conducted in PubMed, the Cochrane Central Library, and Embase for studies that evaluated the association between pretreatment NLR and survival of advanced NSCLC patients with ICIs treatment. We then conducted a retrospective study in Chinese People's Liberation Army (PLA) General Hospital (Beijing, China) to validate these findings. Results: A total of 17 eligible studies with 2,106 patients were included in our meta-analysis, of which, 12 studies reported progression-free survival (PFS), and 13 studies reported overall survival (OS). The pooled results showed that high pretreatment NLR was significantly associated with poorer PFS (HR = 1.44, 95% CI 1.26–1.65; P < 0.001) and OS (HR = 2.86, 95% CI 2.11–3.87; P < 0.001) compared with those with low pretreatment NLR. Subgroup analysis demonstrated that the association between baseline NLR and PFS remained significant except that the cut-off value of NLR was 3 (HR = 1.48, 95% CI 0.93–2.37; P = 0.098) and region of Asia (HR = 1.55, 95% CI 1.00–2.39; P = 0.051). These results were further validated in our retrospective study that patients with pretreatment NLR ≥ 6.0 had shorter PFS (median: 5.0 vs. 9.1 months, HR = 1.39; 95% CI 1.01–1.91; P = 0.02) and OS (median: 10.0 vs. 17.3 months, HR = 1.71; 95% CI 1.18–2.46; P < 0.001) compared with those with NLR < 6.0. The associations between NLR and survival were consistent in subgroup analysis stratified by age, gender, ECOG PS, histology, stage, smoking history, treatment, and prior lines of therapy. Dynamics of NLR (dNLR) that increased ≥3.0 from baseline was also significantly associated with worse PFS (median: 3.1 vs. 9.1 months; P = 0.01) and OS (median: 6.8 vs. 17.0 months; P < 0.0001). Conclusions: Our study demonstrates that pretreatment NLR and dNLR from baseline are associated with the outcomes of advanced NSCLC patients treated with ICIs; however, it warrants further prospective studies.
Collapse
Affiliation(s)
- Ye Li
- Department of Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing, China.,Oncology Laboratory, The First Medical Center of Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Zhibo Zhang
- Department of Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China.,The 78th Group Army Hospital of Chinese PLA, Mudanjiang, China
| | - Yi Hu
- Department of Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiang Yan
- Department of Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qi Song
- Department of Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Guoqiang Wang
- The Medical Department, 3D Medicines Inc, Shanghai, China
| | - Runzhe Chen
- Departments of Thoracic/Head and Neck Medical Oncology and Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Shunchang Jiao
- Department of Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jinliang Wang
- Department of Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
213
|
Uprety D, Borgert AJ, Fitzsimmons AJ, Parsons BM. External Validation of AJCC Eighth Edition of Non-small-cell Lung Cancer Staging Among African Americans. Clin Lung Cancer 2020; 22:e371-e378. [PMID: 32713769 DOI: 10.1016/j.cllc.2020.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 05/09/2020] [Accepted: 05/26/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The American Joint Committee on Cancer (AJCC) eighth staging classification system for non-small-cell lung cancer was based on data from a multinational study consisting of 94,708 patients. African Americans were not included in this large database. MATERIALS AND METHODS The authors aimed to compare the performance of the AJCC eighth staging system with that of the seventh in predicting overall survival among African Americans utilizing the National Cancer Database. Cases with T- and M- categories were classified into 2 groups based on the AJCC seventh and eighth edition staging systems. Kaplan-Meier curves for overall survival were then constructed for each subgroup. Concordance index was computed using Uno's methodology to assess the overall performance between the 2 staging systems in predicting the mortality. Time-dependent area under the curve was calculated at each follow-up event for the seventh and eighth edition clinical and pathologic staging using an inverse probability of censoring weighted methodology. A 2-sided P-value < .05 was considered to show statistical significance. RESULTS The database identified a total of 70,606 African American patients in the study period of 2004 through 2014. Area under the curve values were consistently higher for the eighth edition scheme compared with the seventh edition (concordance 0.630 vs. 0.624, respectively; P < .0001 for clinical staging scheme and 0.596 vs. 0.591, respectively; P = .01 for pathologic staging scheme). CONCLUSION The AJCC eighth edition staging system showed better prognostic value in predicting overall survival when compared with the AJCC seventh edition staging scheme among African American patients with non-small-cell lung cancer.
Collapse
Affiliation(s)
- Dipesh Uprety
- Department of Medical Oncology, Mayo Clinic, Rochester, MN.
| | - Andrew J Borgert
- Department of Medical Research, Gundersen Health System, La Crosse, WI
| | | | - Benjamin M Parsons
- Department of Hematology and Medical Oncology, Gundersen Health System, La Crosse, WI
| |
Collapse
|
214
|
Indini A, Rijavec E, Bareggi C, Grossi F. Novel treatment strategies for early-stage lung cancer: the oncologist's perspective. J Thorac Dis 2020; 12:3390-3398. [PMID: 32642264 PMCID: PMC7330760 DOI: 10.21037/jtd.2020.02.46] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Management of early-stage non-small cell lung cancer (NSCLC) consists in multimodal treatment, including surgery, radiotherapy and chemotherapy. The mainstay of treatment is radical surgery. Definitive radiotherapy using stereotactic techniques can provide adequate local disease control, and is the treatment of choice in medically inoperable patients. Most early-stage patients are at significant risk of disease relapse after local treatment. Adjuvant platinum-based chemotherapy has demonstrated to provide an absolute survival benefit of 5% compared to observation. However, unlike advanced/metastatic disease, little progress has been made in the treatment of early-stage NSCLC over the past decade. In recent years, plenty of research has focused on the optimization of adjuvant and neoadjuvant treatment. Several trials with novel drugs, such as targeted agents and immune-checkpoint inhibitors are currently underway, with preliminary positive results. Customization of treatment on patients’ characteristics before, and major pathological response after therapy, will further improve survival outcomes in this subset of patients.
Collapse
Affiliation(s)
- Alice Indini
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Erika Rijavec
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Claudia Bareggi
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Francesco Grossi
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| |
Collapse
|
215
|
Hakozaki T, Hosomi Y, Kitadai R, Kitagawa S, Okuma Y. Efficacy of immune checkpoint inhibitor monotherapy for patients with massive non-small-cell lung cancer. J Cancer Res Clin Oncol 2020; 146:2957-2966. [PMID: 32462297 DOI: 10.1007/s00432-020-03271-1] [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: 03/13/2020] [Accepted: 05/20/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Baseline tumor size (BTS) and the presence of massive lesions are important for predicting the clinical course of cancer. However, their impact on survival and clinical response in patients with advanced NSCLC undergoing immune checkpoint inhibitor (ICI) treatment has been scarcely investigated. METHODS We retrospectively reviewed 294 patients who underwent ICI therapy for advanced or recurrent non-small-cell lung cancer (NSCLC) between January 2016 and July 2019. RESULTS Of these 294 patients, 284 (96.6%) had at least one measurable lesion. Of these, 263 patients treated with ICI monotherapy were included in the analysis. The median total and maximum target lesion diameters were 96.5 mm and 49.1 mm, respectively. Median progression-free survival (PFS) with massive lesions (max BTS > 50 mm, group A) and without massive lesions (max BTS ≤ 50 mm, group B) was 2.5 months (95% CI 1.8-3.7) and 6.7 months (95% CI 5.1-9.7), respectively. Median overall survival (OS) for groups A and B was 9.5 months (95% CI 5.5-12.3) and 20.0 months (95% CI 13.3-32.0), respectively. The multivariate analysis revealed marked associations between the presence of massive lesions and both PFS and OS. CONCLUSION The presence of massive lesions (max diameters > 50 mm) is an independent prognostic factor in advanced NSCLC treated with ICI monotherapy. Although overall response rates were similar between groups A and B, the disease control rate was significantly poorer for group A. Max BTS might be useful for predicting clinical outcomes for patients undergoing immunotherapy as a parameter reflecting their tumor burden.
Collapse
Affiliation(s)
- Taiki Hakozaki
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo, 113-8677, 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, 113-8677, Japan.
| | - Rui Kitadai
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo, 113-8677, Japan
| | - Shingo Kitagawa
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo, 113-8677, 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, 113-8677, Japan.,Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1Tsukiji, Chuo, Tokyo, 105-0045, Japan
| |
Collapse
|
216
|
Zhao Y, Han H, Gao Z, Hu H, Xiang J, Sun Y, Chen H. Evolutionary Action Score of TP53 Enhances the Prognostic Prediction for Stage I Lung Adenocarcinoma. Semin Thorac Cardiovasc Surg 2020; 33:221-229. [PMID: 32450216 DOI: 10.1053/j.semtcvs.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/20/2020] [Indexed: 11/11/2022]
Abstract
Stage I lung adenocarcinoma usually has a good prognosis after surgery. However, some patients do suffer disease recurrence during follow-up. Here, we report the prognostic value of evolutionary action score of TP53, which calculates the functional prediction of TP53, in patients with stage I lung adenocarcinoma. From January 2011 to August 2013, 83 patients with a complete follow-up history (36 with a disease recurrence and 47 without recurrence during follow-up) who were pathologically confirmed stage I lung adenocarcinoma were included. Whole-exome sequencing were performed on those paired tumor-normal specimens. Evolutionary action score of TP53 (EAp53) was calculated and patients were divided into groups according to their TP53 mutational status. Tumor mutational burden and survival analyses were performed to assess the prognostic value of EAp53. TP53 mutation was identified in 31 patients (37.3%). Of them, 11 were high-risk point mutations, 9 were low-risk point mutations, and 11 were truncating mutations. The high-risk group showed a poorer recurrence-free survival compared with the low-risk group (P = 0.046) and the wild-type group (P = 0.007). In multivariable analysis, the high-risk/truncating group showed a poorer recurrence-free survival (P = 0.007) and overall survival (P = 0.009) compared with the low-risk/wild-type group. Moreover, tumor mutational burden was higher in the high-risk/truncating group (P < 0.001). EAp53 is of prognostic value in patients with stage I lung adenocarcinoma. The mutational type of TP53 should be paid attention to when predicting the prognosis of patients with stage I lung adenocarcinoma.
Collapse
Affiliation(s)
- Yue Zhao
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Han Han
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhendong Gao
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hong Hu
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiaqing Xiang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yihua Sun
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| |
Collapse
|
217
|
de Mol M, Visser S, Aerts J, Lodder P, van Walree N, Belderbos H, den Oudsten B. The association of depressive symptoms, personality traits, and sociodemographic factors with health-related quality of life and quality of life in patients with advanced-stage lung cancer: an observational multi-center cohort study. BMC Cancer 2020; 20:431. [PMID: 32423432 PMCID: PMC7236491 DOI: 10.1186/s12885-020-06823-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 04/02/2020] [Indexed: 01/11/2023] Open
Abstract
Background Identification of patient-related factors associated with Health-Related Quality of Life (HRQoL) and Quality of Life (QoL) at the start of treatment may identify patients who are prone to a decrease in HRQoL and/or QoL resulting from chemotherapy. Identification of these factors may offer opportunities to enhance patient care during treatment by adapting communication strategies and directing medical and psychological interventions. The aim was to examine the association of sociodemographic factors, personality traits, and depressive symptoms with HRQoL and QoL in patients with advanced-stage lung cancer at the start of chemotherapy. Methods Patients (n = 151) completed the State-Trait Anxiety Inventory (trait anxiety subscale), the Neuroticism-Extraversion-Openness-Five Factor Inventory (NEO-FFI), the Center for Epidemiologic Studies Depression (CES-D), the World Health Organization Quality of Life-BREF (WHOQOL-BREF), and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Simple linear regression analyses were performed to select HRQoL and QoL associated factors (a P ≤ 0.10 was used to prevent non-identification of important factors) followed by multiple linear regression analyses (P ≤ 0.05). Results In the multiple regression analyses, CES-D score (β = − 0.63 to − 0.53; P-values < 0.001) was most often associated with the WHOQOL-BREF domains and general facet, whereas CES-D score (β = − 0.67 to − 0.40; P-values < 0.001) and Eastern Cooperative Oncology Group (ECOG) performance status (β = − 0.30 to − 0.30; P-values < 0.001) were most often associated with the scales of the EORTC QLQ-C30. Personality traits were not related with HRQoL or QoL except for trait anxiety (Role functioning: β = 0.30; P = 0.02, Environment: β = − 0.39; P = 0.007) and conscientiousness (Physical health: β = 0.20; P-value < 0.04). Conclusions Higher scores on depressive symptoms and ECOG performance status were related to lower HRQoL and QoL in patients with advanced-stage non-small cell lung cancer. Supportive care interventions aimed at improvement of depressive symptoms and performance score may facilitate an increase of HRQoL and/or QoL during treatment.
Collapse
Affiliation(s)
- Mark de Mol
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800, RK, Breda, The Netherlands.,Department of Pulmonary Diseases, Erasmus MC Cancer Institute, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Sabine Visser
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800, RK, Breda, The Netherlands.,Department of Pulmonary Diseases, Erasmus MC Cancer Institute, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Joachim Aerts
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800, RK, Breda, The Netherlands.,Department of Pulmonary Diseases, Erasmus MC Cancer Institute, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Paul Lodder
- Department of Methodology and Statistics, Tilburg University, P.O. Box 90151, 5000, LE, Tilburg, The Netherlands.,Department of Medical and Clinical Psychology, Centre of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, P.O. Box 90151, 5000, LE, Tilburg, The Netherlands
| | - Nico van Walree
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800, RK, Breda, The Netherlands
| | - Huub Belderbos
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800, RK, Breda, The Netherlands
| | - Brenda den Oudsten
- Department of Medical and Clinical Psychology, Centre of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, P.O. Box 90151, 5000, LE, Tilburg, The Netherlands.
| |
Collapse
|
218
|
Bongiolatti S, Mazzoni F, Gonfiotti A, Di Pierro G, Salvicchi A, Borgianni S, Ferrari K, Voltolini L. Short and mid-term outcomes of multimodal treatment for locally-advanced non-small cell lung cancer in elderly patients. Gen Thorac Cardiovasc Surg 2020; 68:1290-1297. [PMID: 32419041 DOI: 10.1007/s11748-020-01384-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 05/05/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Multimodality treatments are effective for locally advanced non-small cell lung cancer (LA-NSCLC) showing benefits in overall (OS) and disease-free survival (DFS), but these options are frequently denied to elderly patients. METHODS The objectives of this retrospective study were: to investigate mortality, morbidity and oncological outcomes of pulmonary resection after induction therapy (IT) for NSCLC in elderly patients. We divided the cohort into two: patients < 70 years (group A) and patients ≥70 years (group B). A multivariable logistic regression was built to identify factors associated with morbidity. RESULTS 77 patients underwent pulmonary resection after IT, 27 were aged ≥70 years. Type of chemotherapy, surgical procedures, pathological stages were comparable between the two groups, while the preoperative use of chemo-radiation therapy regimen was more frequent in group A (p = 0.027). In-hospital mortality was similar, while the percentage of patients with complications (38% vs 48.1%, p = 0.47) and the complication rate (50% vs 77%, p = 0.01) were higher in group B, but the severity of complications was comparable. The multivariable analysis did not identify any risk factors associated with morbidity. OS at 3 years and DFS at 2 years were not different (61% vs 48.5%, p = 0.64; 61.7% vs 44%, p = 0.393). CONCLUSIONS Lung resection for LA-NSCLC after IT can be performed safely in selected elderly patients with favourable postoperative and mid-term oncological results.
Collapse
Affiliation(s)
- Stefano Bongiolatti
- Thoracic Surgery Unit, Careggi University Hospital, Largo Brambilla, 1, 50134, Florence, Italy
| | | | - Alessandro Gonfiotti
- Thoracic Surgery Unit, Careggi University Hospital, Largo Brambilla, 1, 50134, Florence, Italy
| | - Giulia Di Pierro
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Alberto Salvicchi
- Thoracic Surgery Unit, Careggi University Hospital, Largo Brambilla, 1, 50134, Florence, Italy.
| | - Sara Borgianni
- Thoracic Surgery Unit, Careggi University Hospital, Largo Brambilla, 1, 50134, Florence, Italy
| | - Katia Ferrari
- Respiratory Medicine, Careggi University Hospital, Florence, Italy
| | - Luca Voltolini
- Thoracic Surgery Unit, Careggi University Hospital, Largo Brambilla, 1, 50134, Florence, Italy
| |
Collapse
|
219
|
Nomori H, Honma K, Shoji K, Otsuki A, Cong Y, Sugimura H, Oyama Y. Ribcage procedure after neoadjuvant chemoradiotherapy for non-small cell lung cancer involving the chest wall. Surg Today 2020; 50:1262-1271. [PMID: 32372154 DOI: 10.1007/s00595-020-02015-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/30/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Non-small cell lung cancer (NSCLC) involving the chest wall is usually treated with en bloc rib resection or parietal pleurectomy; however, the former causes chest wall deformity and the latter is associated with local recurrence. To prevent both these sequalae, we performed the "ribcage" procedure for tumors involving the chest wall after induction chemoradiotherapy. METHODS This was a single center retrospective study conducted from 2012 to 2018. The "ribcage" procedure is designed to preserve the ribs of patients with lung tumors involving chest wall and involves peeling the intercostal muscles and periosteum from the ribs, resulting in a birdcage-like appearance. Seventeen patients with NSCLC clearly involving the chest wall, but not destroying the ribs, were treated with induction chemoradiotherapy, followed by the ribcage procedure. A negative margin at the ribs was confirmed by intraoperative frozen sections in 16 of these patients, who then underwent the ribcage procedure. RESULTS Complete resection was achieved in all 16 patients, none of whom experienced major postoperative complications. After a median follow-up period of 37 months, there was no evidence of local recurrence in any of the patients. CONCLUSION Our findings suggest that the ribcage procedure is the preferable surgical option as it can prevent chest wall deformities as well as local recurrence.
Collapse
Affiliation(s)
- Hiroaki Nomori
- Department of Thoracic Surgery, Kashiwa Kousei General Hospital, 617 Shikoda, Kashiwa city, Chiba, 277-8661, Japan.
| | - Koichi Honma
- Department of Pathology, Kameda Medical Center, Chiba, Japan
| | - Kazufusa Shoji
- Department of Radiology, Kameda Medical Center, Chiba, Japan
| | - Ayumu Otsuki
- Department of Thoracic Pulmonary Medicine, Kameda Medical Center, Chiba, Japan
| | - Yue Cong
- Department of Thoracic Surgery, Kameda Medical Center, Chiba, Japan
| | - Hiroshi Sugimura
- Department of Thoracic Surgery, Kameda Medical Center, Chiba, Japan
| | - Yu Oyama
- Department of Medical Oncology, Kameda Medical Center, Chiba, Japan
| |
Collapse
|
220
|
Yamanashi K, Hamaji M, Tsunoda S, Nakanishi T, Omasa M, Nakajima N, Ohsumi A, Menju T, Chen-Yoshikawa TF, Date H. Survival outcomes of resection for pulmonary malignancies including non-small cell lung cancer and pulmonary metastasis after esophagectomy for esophageal carcinoma. Gen Thorac Cardiovasc Surg 2020; 68:1179-1186. [PMID: 32361810 DOI: 10.1007/s11748-020-01373-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 04/15/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This study investigated survival outcomes of resection for pulmonary malignancies after esophagectomy for esophageal carcinoma, comparing non-small cell lung cancer and pulmonary metastases. METHODS We retrospectively reviewed consecutive patients who underwent resection for pulmonary malignancies after esophagectomy for esophageal carcinoma between 2009 and 2018. The overall survival and relapse-free survival rate were assessed using Kaplan-Meier analysis. RESULTS Eleven patients had non-small cell lung cancer and eight patients had pulmonary metastases from esophageal carcinoma. The 5-year overall survival rate was 92.9% in all patients with a median follow-up period of 50.4 (range: 9.1-130.2) months. While the 5-year overall survival rate was 100.0% in patients with non-small cell lung cancer, it was 85.7% in patients with pulmonary metastases from esophageal carcinoma. The 5-year relapse-free survival rate was 85.7% in patients with non-small cell lung cancer. CONCLUSIONS Our data suggest that resection for pulmonary malignancies after esophagectomy for esophageal carcinoma is associated with favorable survival outcomes and should be considered in selected patients.
Collapse
Affiliation(s)
- Keiji Yamanashi
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Shigeru Tsunoda
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takao Nakanishi
- Department of Thoracic Surgery, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Mitsugu Omasa
- Department of Thoracic Surgery, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Naoki Nakajima
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Akihiro Ohsumi
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Toshi Menju
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | | | - Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| |
Collapse
|
221
|
Zhang J, Luo L, Dong J, Liu M, Zhai D, Huang D, Ling L, Jia X, Luo K, Zheng G. A prognostic 11-DNA methylation signature for lung squamous cell carcinoma. J Thorac Dis 2020; 12:2569-2582. [PMID: 32642165 PMCID: PMC7330303 DOI: 10.21037/jtd.2020.03.31] [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] [Indexed: 12/24/2022]
Abstract
Background Lung squamous cell carcinoma (LUSC), as the second frequent subtype of lung cancer, causes lots of mortalities primarily due to a lack of precise prognostic markers and timely treatment intervention. Previous studies have constructed several risk prognostic models based on DNA methylation sites in multiple tumors, whereas, DNA methylation signature of LUSC remains to be built, and its predictive value need to be evaluated. Methods The genome-wide DNA methylation data of LUSC samples was obtained from The Cancer Genome Atlas dataset. Univariate Cox analysis and the least absolute shrinkage and selection operator (LASSO) were implemented to identify DNA methylation sites related to overall survival of LUSC patients. Thus, we performed multivariate Cox regression to establish a DNA methylation signature. The Kaplan-Meier (K-M) survival curves and time-dependent receiver operating characteristic (ROC) curves were plotted to estimate the prognostic power of the signature. Comparison with other known prognostic biomarkers, our DNA methylation signature showed higher predictive specificity and sensitivity. In addition, multivariate Cox regression screened out independent prognostic factors and constructed a nomogram. Results Several statistical methods were performed to construct an 11-DNA methylation signature. LUSC patients were divided into low- and high-risk group based on risk score, and high-risk group had a shorter survival time. According to the results of K-M and ROC analyses, the 11-DNA methylation signature showed significant sensitivity and specificity in predicting the LUSC patients’ overall survival. Finally, we integrated some independent prognostic factors (risk score, metastasis stage, and tobacco smoking history) to construct a nomogram, which has excellent prognostic power and may provide guidance for the therapeutic strategies. Conclusions We constructed the first risk prognosis model based on DNA methylation site in LUSC, which showed better predictive ability. In addition, a nomogram integrating the DNA methylation signature, metastasis stage, and tobacco smoking history was developed.
Collapse
Affiliation(s)
- Jianlei Zhang
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
| | - Liyun Luo
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
| | - Jing Dong
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
| | - Meijun Liu
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
| | - Dongfeng Zhai
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
| | - Danqing Huang
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
| | - Li Ling
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
| | - Xiaoting Jia
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
| | - Kai Luo
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
| | - Guopei Zheng
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
| |
Collapse
|
222
|
Wang W, Zhuang R, Ma H, Fang L, Wang Z, Lv W, Hu J. The diagnostic value of a seven-autoantibody panel and a nomogram with a scoring table for predicting the risk of non-small-cell lung cancer. Cancer Sci 2020; 111:1699-1710. [PMID: 32108977 PMCID: PMC7226194 DOI: 10.1111/cas.14371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/20/2020] [Accepted: 02/22/2020] [Indexed: 12/17/2022] Open
Abstract
The early detection of non-small-cell lung cancer (NSCLC) remains a common concern. The aim of our study was to validate the diagnostic value of a seven-autoantibody (7-AAB) panel compared with radiological diagnosis for NSCLC. We constructed a nomogram and a scoring table based on the 7-AAB panel's result to predict the risk of NSCLC. We prospectively enrolled 268 patients who presented with radiological lesions and underwent both the 7-AAB panel test and pathological diagnosis by surgical resection. A comparison between the 7-AAB panel and radiological diagnosis was performed. A nomogram and a scoring table based on the 7-AAB panel's result to predict the risk of NSCLC were constructed and internally validated. The 7-AAB panel test had a specificity of 90.2% and a positive predictive value (PPV) of 92.7%, which were significantly higher than those of the radiological diagnosis. The 7-AAB panel also showed a preferable sensitivity in patients with early-stage disease. Seven factors, including the 7-AAB panel results, were integrated into the nomogram. For more convenient application, we formulated a scoring table based on the nomogram. The area under the receiver operating characteristic curve was 0.840 and 0.860 in the training group and validation group, respectively, which was higher than that using the 7-AAB panel or radiological diagnosis alone. This study reveals that our 7-AAB panel has clinical value in the diagnosis of NSCLC. The utility of our nomogram and the scoring table indicated that they have the potential to assist clinicians in avoiding unnecessary treatment or needless follow-up.
Collapse
Affiliation(s)
- Weidong Wang
- Department of Thoracic SurgeryThe First Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhouChina
| | - Runzhou Zhuang
- Department of Thoracic SurgeryThe First Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhouChina
| | - Honghai Ma
- Department of Thoracic SurgeryThe First Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhouChina
| | - Likui Fang
- Department of Thoracic SurgeryThe First Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhouChina
| | - Zhitian Wang
- Department of Thoracic SurgeryThe First Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhouChina
| | - Wang Lv
- Department of Thoracic SurgeryThe First Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhouChina
| | - Jian Hu
- Department of Thoracic SurgeryThe First Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhouChina
| |
Collapse
|
223
|
Correlation between Skip N2 Metastases and SUV max, Long Diameter of Tumor, and Ki67 Expression in Patients with Non-Small-Cell Lung Cancer. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9298358. [PMID: 32420384 PMCID: PMC7201773 DOI: 10.1155/2020/9298358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 03/09/2020] [Accepted: 03/31/2020] [Indexed: 01/05/2023]
Abstract
Background We aim at investigating the correlation between skip N2 metastases (SN2) and SUVmax, long diameter of tumor mass after 18F-FDG PET/CT, and pathological Ki67 expression in patients with non-small-cell lung cancer (NSCLC). Methods and Results We retrospectively analyzed the factors that might affect the pathogenesis of SN2 in these patients. The clinical SN2 symptoms in patients with squamous carcinoma or adenocarcinoma were investigated. The work curve was utilized to analyze the optimal cutoff value for the SUVmax and long diameter of tumor. Multivariate analysis revealed that high expression of Ki67 was a risk factor for mediastinal SN2 (OR = 1.042, 95% CI: 1.009-1.076). Subgroup analysis indicated that the SUVmax of the non-SN2 group was significantly higher than that of the SN2 group in patients with squamous carcinoma (16.3 ± 6.0 vs. 10.7 ± 5.6, P = 0.026). In the patients with adenocarcinoma, the long diameter of tumor in the SN2 group was significantly longer than that of the non-SN2 group (43.8 ± 16.3 mm vs. 30.1 ± 13.8 mm, P = 0.032). The Ki67 expression in the SN2 group was significantly higher than that of the non-SN2 group (51.7 ± 24.0 vs. 30.0 ± 19.2, P = 0.028). Conclusions The differences of clinical features of the patients in the SN2 group and non-SN2 group in the NSCLC patients were associated with the pathological subtypes, which were featured by lower SUVmax in the SN2 of the squamous carcinoma, and longer diameter of SN2 in the adenocarcinoma patients.
Collapse
|
224
|
Çakir Ö, Çam I, Koç U, Çiftçi E. Evaluation of major complications associated with percutaneous CT-guided biopsy of lung nodules below 3 cm. Turk J Med Sci 2020; 50:369-374. [PMID: 31999409 PMCID: PMC7164760 DOI: 10.3906/sag-1908-73] [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: 08/13/2019] [Accepted: 01/30/2020] [Indexed: 01/05/2023] Open
Abstract
Background/aim The aim of this study was to evaluate retrospectively the incidence and risk factors for the serious complications of pneumothorax and/or parenchymal haemorrhage occurring after computed tomography (CT) guided transthoracic biopsy. Materials and methods The relation between the incidence of pneumothorax and parenchymal haemorrhage due to biopsy, age, sex, lesion localization, lesion size, duration of the procedure, depth of lesion, number of pleural insertions of the biopsy needle and pathology results were statistically evaluated. Results Between 2016 and 2017, 309 cases with lesions below 3 cm in diameter of a total of 768 (40.2%) CT-guided chest biopsy patients were selected for retrospective review. The rate of pneumothorax and parenchymal haemorrhage was 18.1% (59/309) and 51% (158/309), respectively post biopsy. The number of needle pleural insertions was correlated with the development of pneumothorax (P = 0.002). At regression analysis, for parenchymal haemorrhage, lesion depth (P < 0.001) and total procedure time (p=0.036) were determined as the most important independent risk factors. Conclusion Pneumothorax and parenchymal haemorrhage are common complications after CT-guided percutaneous biopsy. The minimum number of needle-pleural insertions, the optimal access route to the lesion and as quick as possible biopsy procedure should be selected to reduce the risk of pneumothorax and parenchymal haemorrhage.
Collapse
Affiliation(s)
- Özgür Çakir
- Department of Radiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Isa Çam
- Department of Radiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Ural Koç
- Ankara Gölbaşı Sehit Ahmet Özsoy State Hospital, Ankara, Turkey
| | - Ercüment Çiftçi
- Department of Radiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| |
Collapse
|
225
|
Gierada DS, Black WC, Chiles C, Pinsky PF, Yankelevitz DF. Low-Dose CT Screening for Lung Cancer: Evidence from 2 Decades of Study. Radiol Imaging Cancer 2020; 2:e190058. [PMID: 32300760 PMCID: PMC7135238 DOI: 10.1148/rycan.2020190058] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/15/2019] [Accepted: 11/20/2019] [Indexed: 12/17/2022]
Abstract
Lung cancer remains the overwhelmingly greatest cause of cancer death in the United States, accounting for more annual deaths than breast, prostate, and colon cancer combined. Accumulated evidence since the mid to late 1990s, however, indicates that low-dose CT screening of high-risk patients enables detection of lung cancer at an early stage and can reduce the risk of dying from lung cancer. CT screening is now a recommended clinical service in the United States, subject to guidelines and reimbursement requirements intended to standardize practice and optimize the balance of benefits and risks. In this review, the evidence on the effectiveness of CT screening will be summarized and the current guidelines and standards will be described in the context of knowledge gained from lung cancer screening studies. In addition, an overview of the potential advances that may improve CT screening will be presented, and the need to better understand the performance in clinical practice outside of the research trial setting will be discussed. © RSNA, 2020.
Collapse
Affiliation(s)
- David S. Gierada
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St Louis, MO 63110 (D.S.G.); Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (W.C.B.); Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC (C.C.); Division of Cancer Prevention, National Cancer Institute, Bethesda, Md (P.F.P.); and Department of Radiology, Mount Sinai School of Medicine, New York, NY (D.F.Y.)
| | - William C. Black
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St Louis, MO 63110 (D.S.G.); Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (W.C.B.); Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC (C.C.); Division of Cancer Prevention, National Cancer Institute, Bethesda, Md (P.F.P.); and Department of Radiology, Mount Sinai School of Medicine, New York, NY (D.F.Y.)
| | - Caroline Chiles
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St Louis, MO 63110 (D.S.G.); Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (W.C.B.); Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC (C.C.); Division of Cancer Prevention, National Cancer Institute, Bethesda, Md (P.F.P.); and Department of Radiology, Mount Sinai School of Medicine, New York, NY (D.F.Y.)
| | - Paul F. Pinsky
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St Louis, MO 63110 (D.S.G.); Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (W.C.B.); Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC (C.C.); Division of Cancer Prevention, National Cancer Institute, Bethesda, Md (P.F.P.); and Department of Radiology, Mount Sinai School of Medicine, New York, NY (D.F.Y.)
| | - David F. Yankelevitz
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St Louis, MO 63110 (D.S.G.); Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (W.C.B.); Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC (C.C.); Division of Cancer Prevention, National Cancer Institute, Bethesda, Md (P.F.P.); and Department of Radiology, Mount Sinai School of Medicine, New York, NY (D.F.Y.)
| |
Collapse
|
226
|
Mitchell KG, Farooqi A, Ludmir EB, Corsini EM, Sepesi B, Gomez DR, Antonoff MB. Pulmonary resection is associated with long-term survival and should remain a therapeutic option in oligometastatic lung cancer. J Thorac Cardiovasc Surg 2020; 161:1497-1504.e2. [PMID: 32331820 DOI: 10.1016/j.jtcvs.2020.02.134] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Comprehensive local consolidative therapy led to improved overall survival in oligometastatic non-small cell lung cancer in a recent phase II trial, yet the role of pulmonary resection in ongoing oligometastatic trials is a matter of controversy. We sought to examine outcomes after pulmonary resection with radiotherapy used as a benchmark comparator. METHODS Patients treated at a single institution (2000-2017) with cT1-3N0-2M1 non-small cell lung cancer, 3 or less synchronous metastases, and performance status 0 to 1, and who received comprehensive local consolidative therapy were analyzed according to local consolidative therapy modality for the primary lesion. Progression was analyzed with death as a competing risk. RESULTS Of 88 patients meeting inclusion criteria, 63 (71.6%) received radiotherapy for local consolidative therapy modality for the primary lesion and 25 (28.4%) underwent surgery (lobectomy 20/25 [80.0%], pneumonectomy 3/25 [12.0%], sublobar 2/25 [8.0%]). Time from diagnosis to local consolidative therapy modality for the primary lesion was similar. Surgical patients were younger and had lower intrathoracic disease burden. Ninety-day post-treatment mortality was low (surgery 0/25 [0.0%], radiotherapy 1/63 [1.6%]). Median postoperative survival time was 55.2 months (95% confidence interval, 20.1 to not reached), with 1- and 5-year overall survivals of 95.7% and 48.0%, respectively. After radiotherapy, median postoperative survival time was 23.4 months (confidence interval, 17.2-35.9); 1- and 5-year overall survivals were 74.3% and 24.2%, respectively. No differences were observed between modalities in site of first failure, cumulative incidence of locoregional failure (P = .635), or systemic progression (P = .747). CONCLUSIONS Pulmonary resection is feasible and associated with long-term survival in selected patients with synchronous oligometastatic non-small cell lung cancer. Surgery should remain a local consolidative therapeutic option for patients with operable oligometastatic non-small cell lung cancer enrolled in ongoing and future randomized clinical trials.
Collapse
Affiliation(s)
- Kyle G Mitchell
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Ahsan Farooqi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Ethan B Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Erin M Corsini
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Daniel R Gomez
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex.
| | | |
Collapse
|
227
|
Asakura K, Kadota T, Matsuzaki J, Yoshida Y, Yamamoto Y, Nakagawa K, Takizawa S, Aoki Y, Nakamura E, Miura J, Sakamoto H, Kato K, Watanabe SI, Ochiya T. A miRNA-based diagnostic model predicts resectable lung cancer in humans with high accuracy. Commun Biol 2020; 3:134. [PMID: 32193503 PMCID: PMC7081195 DOI: 10.1038/s42003-020-0863-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 02/19/2020] [Indexed: 01/17/2023] Open
Abstract
Lung cancer, the leading cause of cancer death worldwide, is most frequently detected through imaging tests. In this study, we investigated serum microRNAs (miRNAs) as a possible early screening tool for resectable lung cancer. First, we used serum samples from participants with and without lung cancer to comprehensively create 2588 miRNAs profiles; next, we established a diagnostic model based on the combined expression levels of two miRNAs (miR-1268b and miR-6075) in the discovery set (208 lung cancer patients and 208 non-cancer participants). The model displayed a sensitivity of 99% and specificity of 99% in the validation set (1358 patients and 1970 non-cancer participants) and exhibited high sensitivity regardless of histological type and pathological TNM stage of the cancer. Moreover, the diagnostic index markedly decreased after lung cancer resection. Thus, the model we developed has the potential to markedly improve screening for resectable lung cancer. Asakura, Kadota et al. demonstrate the diagnostic potential of serum microRNAs for resectable lung cancer. Their diagnostic model based on the combined expression levels of two miRNAs predicts resectable lung cancer with 99% sensitivity, regardless of histological types and pathological stages of cancer, suggesting its promising, diagnostic utility.
Collapse
Affiliation(s)
- Keisuke Asakura
- Department of Thoracic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tsukasa Kadota
- Division of Molecular and Cellular Medicine, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Juntaro Matsuzaki
- Division of Molecular and Cellular Medicine, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yukihiro Yoshida
- Department of Thoracic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yusuke Yamamoto
- Division of Molecular and Cellular Medicine, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Kazuo Nakagawa
- Department of Thoracic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Satoko Takizawa
- Division of Molecular and Cellular Medicine, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Toray Industries, Inc. 6-10-1 Tebiro, Kamakura city, Kanagawa, 248-0036, Japan
| | - Yoshiaki Aoki
- Dynacom Co., Ltd., World Business Garden E25, 2-6-1 Nakase, Mihama-ku, Chiba city, Chiba, 261-7125, Japan
| | - Eiji Nakamura
- Dynacom Co., Ltd., World Business Garden E25, 2-6-1 Nakase, Mihama-ku, Chiba city, Chiba, 261-7125, Japan
| | - Junichiro Miura
- Dynacom Co., Ltd., World Business Garden E25, 2-6-1 Nakase, Mihama-ku, Chiba city, Chiba, 261-7125, Japan
| | - Hiromi Sakamoto
- Department of Biobank and Tissue Resources, National Cancer Center Research Institute, Tokyo, 104-0045, Japan
| | - Ken Kato
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Takahiro Ochiya
- Division of Molecular and Cellular Medicine, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. .,Institute of Medical Science, Tokyo Medical University, Tokyo, 160-0023, Japan.
| |
Collapse
|
228
|
Danti G, Berti V, Abenavoli E, Briganti V, Linguanti F, Mungai F, Pradella S, Miele V. Diagnostic imaging of typical lung carcinoids: relationship between MDCT, 111In-Octreoscan and 18F-FDG-PET imaging features with Ki-67 index. Radiol Med 2020; 125:715-729. [PMID: 32189174 DOI: 10.1007/s11547-020-01172-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/11/2020] [Indexed: 12/12/2022]
Abstract
AIMS This study analyses the capability of contrast-enhanced multi-detector computed tomography (MDCT) and spectrum of molecular imaging to characterize typical carcinoids (TCs) of lung and their relationship with Ki-67 index. MATERIALS AND METHODS We analysed 68 patients with histological diagnosis of pulmonary TC, which underwent both MDCT and nuclear molecular imaging (somatostatin receptor scintigraphy/SPECT with 111In-pentetreotide and 18F-FDG-PET/CT) at staging evaluation before surgery. The MDCT scan was reviewed for the following features: size, margins, contrast enhancement, presence of calcifications, bronchial obstruction, lymph nodes and metastases. In 111In-pentetreotide SPECT, tumour/non-tumour ratio was measured at 4- and 24-h post-injection and the per cent difference was calculated (T/NT%). FDG uptake was measured as the ratio between lesion SUVmax and liver SUVmean (SUV ratio). All imaging features were correlated between them and with Ki-67 index. RESULTS Forty-four of the 68 lesions (65%) were in the right lung. In MDCT, scan lesions appeared as a well-defined nodule in 44 patients (65%) and irregular mass in 24 patients (35%). Contrast intense enhancement was present in 53 patients (78%), calcifications in 20 patients (29%) and bronchial obstruction in 24 patients (35%). Lymph nodes and metastasis were present in 13 (19%) and 15 (22%) patients. Ki-67 index was negatively correlated with T/NT% and positively with SUV ratio; T/NT% and SUV ratio were inversely correlated. The presence of irregular margins and metastases was negatively related to T/NT%. The presence of a mass, irregular margins, bronchial obstruction, lymph nodes and metastasis was positively related to higher SUV ratio. The presence of irregular margins, bronchial obstruction, lymph nodes and metastases was significantly correlated with a higher grade of Ki-67 index. CONCLUSIONS MDCT and nuclear molecular imaging are important to characterize lung TCs. The majority of TCs appear as a well-defined nodule generally not associated with extra-thorax signs. We found a significant correlation between some MDCT aspects, nuclear medicine features and Ki-67 index. The association of MDCT and nuclear medicine imaging may be useful in predicting proliferative activity and prognosis of lung TCs.
Collapse
Affiliation(s)
- Ginevra Danti
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Valentina Berti
- Department of Nuclear Medicine, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Elisabetta Abenavoli
- Department of Nuclear Medicine, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Vittorio Briganti
- Department of Nuclear Medicine, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Flavia Linguanti
- Department of Nuclear Medicine, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Francesco Mungai
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Silvia Pradella
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy.
| | - Vittorio Miele
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| |
Collapse
|
229
|
Geraci TC, Ferrari-Light D, Wang S, Mitzman B, Chang SH, Kent A, Pass HI, Bizekis C, Zervos M, Cerfolio RJ. Robotic Sleeve Resection of the Airway: Outcomes and Technical Conduct Using Video Vignettes. Ann Thorac Surg 2020; 110:236-240. [PMID: 32151577 DOI: 10.1016/j.athoracsur.2020.01.077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/21/2020] [Accepted: 01/30/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Our objectives are to report our outcomes and to demonstrate our evolving technique for robotic sleeve resection of the airway, with or without lobectomy, using video vignettes. METHODS We retrospectively reviewed a single-surgeon prospective database from October 2010 to October 2019. RESULTS Over 9 years, of 5573 operations 1951 were planned for a robotic approach. There were 755 robotic lobectomies and 306 robotic segmentectomies, and 23 consecutive patients were scheduled for elective completely portal, robotic sleeve resection. Sleeve lobectomy was performed in 18 patients: 10 right upper lobe, 6 left upper lobe, and 2 right lower lobe. Two patients had mainstem bronchus resections and 2 underwent right bronchus intermedius resections that preserved the entire lung. One patient had a robotic pneumonectomy. One operation was converted to open thoracotomy because of concern for anastomotic tension in a patient who received neoadjuvant therapy. All patients had an R0 resection. In the last 10 operations we modified our airway anastomosis, using a running self-locking absorbable suture. The median length of hospital stay was 3 days (range, 1-11), with no 30- or 90-day mortalities. Within a median follow-up of 18 months, there were no anastomotic strictures and no recurrent cancers. CONCLUSIONS Our early and midterm results show that a completely portal robotic sleeve resection is safe and oncologically effective. Trhe technical aspects of a robotic sleeve resection of the airway are demonstrated using video vignettes.
Collapse
Affiliation(s)
- Travis C Geraci
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York.
| | | | - Simeng Wang
- Department of General Surgery, New York University Langone Health, New York, New York
| | - Brian Mitzman
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
| | - Stephanie H Chang
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
| | - Amie Kent
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
| | - Harvey I Pass
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
| | - Costas Bizekis
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
| | - Michael Zervos
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
| | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
| |
Collapse
|
230
|
Taber S, Pfannschmidt J. Validation of the 8th lung cancer TNM classification and clinical staging system in a German cohort of surgically resected patients. Innov Surg Sci 2020; 5:1-9. [PMID: 33506088 PMCID: PMC7798301 DOI: 10.1515/iss-2020-0010] [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: 03/23/2020] [Accepted: 05/20/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The updated 8th edition of the tumor, node, metastases (TNM) classification system for non-small cell lung cancer (NSCLC) attempts to improve on the previous 7th edition in predicting outcomes and guiding management decisions. This study sought to determine whether the 8th edition was more accurate in predicting long-term survival in a European population of surgically treated NSCLC patients. METHODS We scanned the archives of the Heckeshorn Lung Clinic for patients with preoperative clinical stages of IIIA or lower (based on the 7th edition), who received surgery for NSCLC between 2009 and 2014. We used pathologists' reports and data on tumor size and location to reassign tumor stages according to the 8th edition. We then analyzed stage specific survival and compared the accuracy of the two systems in predicting long-term survival. We excluded patients with neoadjuvant treatment, incomplete follow-up data, tumor histologies other than NSCLC, or death within 30 days of surgery. RESULTS The final analysis included 1,013 patients. Overall five-year survival was 47.3%. The median overall survival (OS) was 63 months (range 1-222), and the median disease-free survival (DFS) was 50 months (0-122). The median follow-up time for non-censored patients was 84 months (range 60-122). CONCLUSIONS We found significant survival differences between the newly defined stages 1A1, 1A2 and 1A3 (previously 1A). We also found that the 8th edition of TMN classification was a significantly better predictor of long-term survival, compared to the 7th edition.
Collapse
Affiliation(s)
- Samantha Taber
- Department of Thoracic Surgery, Heckeshorn Lung Clinic–HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Joachim Pfannschmidt
- Department of Thoracic Surgery, Heckeshorn Lung Clinic–HELIOS Klinikum Emil von Behring, Berlin, Germany
| |
Collapse
|
231
|
Identification of Clonality through Genomic Profile Analysis in Multiple Lung Cancers. J Clin Med 2020; 9:jcm9020573. [PMID: 32093372 PMCID: PMC7074554 DOI: 10.3390/jcm9020573] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/15/2020] [Accepted: 02/16/2020] [Indexed: 02/07/2023] Open
Abstract
In cases of multiple lung cancers, individual tumors may represent either a primary lung cancer or both primary and metastatic lung cancers. In this study, we investigated the differences between clinical/histopathological and genomic diagnoses to determine whether they are primary or metastatic. 37 patients with multiple lung cancers were enrolled in this study. Tumor cells were selected from tissue samples using laser capture microdissection. DNA was extracted from those cells and subjected to targeted deep sequencing. In multicentric primary lung cancers, the driver mutation profile was mutually exclusive among the individual tumors, while it was consistent between metastasized tumors and the primary lesion. In 11 patients (29.7%), discrepancies were observed between genomic and clinical/histopathological diagnoses. For the lymph node metastatic lesions, the mutation profile was consistent with only one of the two primary lesions. In three of five cases with lymph node metastases, the lymph node metastatic route detected by genomic diagnosis differed from the clinical and/or pathological diagnoses. In conclusion, in patients with multiple primary lung cancers, cancer-specific mutations can serve as clonal markers, affording a more accurate understanding of the pathology of multiple lung cancers and their lymphatic metastases and thus improving both the treatment selection and outcome.
Collapse
|
232
|
Shi X, Li R, Dong X, Chen AM, Liu X, Lu D, Feng S, Wang H, Cai K. IRGS: an immune-related gene classifier for lung adenocarcinoma prognosis. J Transl Med 2020; 18:55. [PMID: 32019546 PMCID: PMC7001261 DOI: 10.1186/s12967-020-02233-y] [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: 08/16/2019] [Accepted: 01/22/2020] [Indexed: 12/20/2022] Open
Abstract
Background Tumour cells interfere with normal immune functions by affecting the expression of some immune-related genes, which play roles in the prognosis of cancer patients. In recent years, immunotherapy for tumours has been widely studied, but a practical prognostic model based on immune-related genes in lung adenocarcinoma comparable to existing model has not been established and reported. Methods We first obtained publicly accessible lung adenocarcinoma RNA expression data from The Cancer Genome Atlas (TCGA) for differential gene expression analysis and then filtered immune-related genes based on the ImmPort database. By using the lasso algorithm and multivariate Cox Proportional-Hazards (CoxPH) regression analysis, we identified candidate genes for model development and validation. The robustness of the model was further examined by comparing the model with three established gene models. Results Gene expression data from a total of 524 lung adenocarcinoma patients from TCGA were used for model development. We identified four biomarkers (MAP3K8, CCL20, VEGFC, and ANGPTL4) that could predict overall survival in lung adenocarcinoma (HR = 1.98, 95% CI 1.48 to 2.64, P = 4.19e−06) and this model could be used as a classifier for the evaluation of low-risk and high-risk groups. This model was validated with independent microarray data and was highly comparable with previously reported gene expression signatures for lung adenocarcinoma prognosis. Conclusions In this study, we identified a practical and robust four-gene prognostic model based on an immune gene dataset with cross-platform compatibility. This model has potential value in improving TNM staging for survival predictions in patients with lung adenocarcinoma. Impact The study provides a method of immune relevant gene prognosis model and the identification of immune gene classifier for the prediction of lung adenocarcinoma prognosis with RNA sequencing and microarray compatibility.
Collapse
Affiliation(s)
- Xiaoshun Shi
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, No. 1838 of North Guangzhou Avenue, Guangzhou, 510515, People's Republic of China. .,Harry Perkins Institute of Medical Research, QEII Medical Centre and Centre for Medical Research, The University of Western Australia, Nedlands, WA, 6009, Australia.
| | - Ruidong Li
- Graduate Program in Genetics, Genomics, and Bioinformatics, University of California, Riverside, CA, USA
| | - Xiaoying Dong
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, No. 1838 of North Guangzhou Avenue, Guangzhou, 510515, People's Republic of China
| | - Allen Menglin Chen
- Guangzhou Mendel Genomics and Medical Technology Co., Ltd., Guangzhou, 510535, China.,Mendel Genes Inc, Manhattan Beach, CA, 90266, USA
| | - Xiguang Liu
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, No. 1838 of North Guangzhou Avenue, Guangzhou, 510515, People's Republic of China
| | - Di Lu
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, No. 1838 of North Guangzhou Avenue, Guangzhou, 510515, People's Republic of China
| | - Siyang Feng
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, No. 1838 of North Guangzhou Avenue, Guangzhou, 510515, People's Republic of China
| | - He Wang
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, No. 1838 of North Guangzhou Avenue, Guangzhou, 510515, People's Republic of China
| | - Kaican Cai
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, No. 1838 of North Guangzhou Avenue, Guangzhou, 510515, People's Republic of China.
| |
Collapse
|
233
|
Nomori H, Shiraishi A, O’uchi T, Honma K, Shoji K, Misawa M, Sugimura H, Oyama Y. Positron Emission Tomography in T3/T4 Non-Small Cell Lung Cancer After Induction Chemoradiotherapy. Ann Thorac Surg 2020; 109:255-261. [DOI: 10.1016/j.athoracsur.2019.06.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/14/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022]
|
234
|
Hwang JK, Page BJ, Flynn D, Passmore L, McCaul E, Brady J, Yang IA, Marshall H, Windsor M, Bowman RV, Naidoo R, Guan T, Philpot S, Blake ME, Fong KM. Validation of the Eighth Edition TNM Lung Cancer Staging System. J Thorac Oncol 2019; 15:649-654. [PMID: 31863848 DOI: 10.1016/j.jtho.2019.11.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 11/18/2019] [Accepted: 11/28/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION We performed a validation study at our institution, the International Union Against Cancer (Union for International Cancer Control latest version of TNM Classification of Malignant Tumors Eighth Edition). METHODS Data were collected from the Queensland Oncology Online registry of NSCLC or SCLC cases between 2000 and 2015 and validated against the Queensland Integrated Lung Cancer Outcomes Project registry using case identification number, first name, last name, and date of birth. Where data were available, cases were classified according to the Union for International Cancer Control TNM seventh edition stage groupings and then compared with the eighth edition groupings. Kaplan-Meier curves were plotted, and the log-rank test of survival differences was performed with SPSS version 25 (IBM Corp, Armonk, NY). RESULTS Of the 3636 cases, 3352 and 1031 had complete clinical and pathologic staging, respectively. Median survival time was found to reduce with increasing clinical stage: seventh edition (IA: 88, IB: 44, IIA: 31, IIB: 18, IIIA: 15, IIIB: 8, and IV: 5 mo) versus eighth edition TNM stage (IA1: not reached, IA2: 88, IA3: 53, IB: 56, IIA: 36, IIB: 22, IIIA: 14, IIIB: 9, IIIC: 8, IVA: 6, and IVB: 3 mo). A similar overall pattern was reflected in the pathologic stage: seventh edition (IA: 124, IB: 110, IIA: 48, IIB: 42, IIIA: 26, IIIB: 31, and IV: 27 mo) versus eighth edition (IA1: not reached, IA2: 122, IA3: 125, IB: 144, IIA: 98, IIB: 57, IIIA: 31, IIIB: 24, and IVA: 7 mo). The log-rank test for survival curves was significant at p < 0.001. CONCLUSIONS Our external validation study confirms the prognostic accuracy of the eighth edition TNM lung cancer classification. Our analyses also indicated that IIIB, IIIC, and IVA stage groups had similar survival outcomes and suggest further research for refinement.
Collapse
Affiliation(s)
- Joseph K Hwang
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Chermside, Queensland, Australia.
| | - Barbara J Page
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - David Flynn
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Linda Passmore
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Elizabeth McCaul
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Jaccalyne Brady
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Ian A Yang
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Henry Marshall
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Morgan Windsor
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Rayleen V Bowman
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Rishendran Naidoo
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Tracey Guan
- Cancer Alliance, Queensland, Princess Alexandra Hospital, Metro South Health, Woolloongabba, Queensland, Australia
| | - Shoni Philpot
- Cancer Alliance, Queensland, Princess Alexandra Hospital, Metro South Health, Woolloongabba, Queensland, Australia
| | - Michael E Blake
- Cancer Alliance, Queensland, Princess Alexandra Hospital, Metro South Health, Woolloongabba, Queensland, Australia
| | - Kwun M Fong
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia
| |
Collapse
|
235
|
Haro GJ, Sheu B, Cook NR, Woodard GA, Mann MJ, Kratz JR. Comparison of Conventional TNM and Novel TNMB Staging Systems for Non-Small Cell Lung Cancer. JAMA Netw Open 2019; 2:e1917062. [PMID: 31808928 PMCID: PMC6902768 DOI: 10.1001/jamanetworkopen.2019.17062] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Improved staging for non-small cell lung cancer (NSCLC) represents a critical unmet need. External validations of the eighth edition of the TNM staging system have yielded disappointing results, with persistently high mortality observed in early-stage disease. OBJECTIVE To determine whether incorporation of a molecular prognostic classifier into conventional TNM staging for NSCLC improves estimation of disease-free survival. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted at an academic, quaternary care medical center from 2012 to 2018. A consecutive series of 238 patients underwent surgical resection of stage I to IIIC nonsquamous NSCLC and had molecular prognostic classifier testing performed. Data analysis was conducted in May 2019. EXPOSURES Patients were restaged according to the seventh and eighth editions of the TNM staging system and the novel TMMB staging system, which maintains the order and structure of the eighth edition of the TNM but downstages or upstages according to low or high molecular risk, respectively. MAIN OUTCOMES AND MEASURES The primary outcome was disease-free survival 3 years from the time of surgical resection. Reclassification statistics were then used to evaluate performance and improvement measures of the TNM seventh and eighth editions and the TNMB staging system. RESULTS Two hundred thirty-eight patients (144 [60.5%] female; median [interquartile range] age, 70 [63-75] years) were analyzed. The median (interquartile range) follow-up was 25 (14-40) months, and the disease-free survival rate was estimated to be 58.3% (95% CI, 45.7% to 69.0%). One hundred fifty-nine patients (66.8%) were reclassified by the TNMB staging system. Overall model fit remained the same for the seventh and eighth editions of the TNM staging system, whereas the R2 statistic (change from 0.22 to 0.31), concordance index (change from 0.68 to 0.73), and log-rank χ2 (change from 38 to 108) were all associated with improvements after TNMB adoption. The TNMB system, compared with the TNM eighth edition, was associated with enhanced identification of high-risk patients and better differentiation of those without recurrence from those who had recurrence (net reclassification improvement, 0.28; 95% CI, 0.08 to 0.46; P < .001), whereas the eighth edition compared with the seventh edition was not associated with improvement of this measure (net reclassification improvement, 0.02; 95% CI, -0.18 to 0.21; P = .87). CONCLUSIONS AND RELEVANCE The TNMB staging system was associated with improved estimation of disease-free survival compared with conventional TNM staging. Incorporation of a molecular prognostic classifier into staging for NSCLC may lead to better identification of high-risk patients.
Collapse
Affiliation(s)
- Greg J. Haro
- Division of Adult Cardiothoracic Surgery, University of California, San Francisco
| | - Bonnie Sheu
- Division of Adult Cardiothoracic Surgery, University of California, San Francisco
| | - Nancy R. Cook
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gavitt A. Woodard
- Division of Adult Cardiothoracic Surgery, University of California, San Francisco
| | - Michael J. Mann
- Division of Adult Cardiothoracic Surgery, University of California, San Francisco
| | - Johannes R. Kratz
- Division of Adult Cardiothoracic Surgery, University of California, San Francisco
| |
Collapse
|
236
|
Chen B, Chen X, Zhou P, Yang L, Ren J, Yang X, Li W. Primary pulmonary lymphoepithelioma-like carcinoma: a rare type of lung cancer with a favorable outcome in comparison to squamous carcinoma. Respir Res 2019; 20:262. [PMID: 31752892 PMCID: PMC6873444 DOI: 10.1186/s12931-019-1236-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 11/07/2019] [Indexed: 02/05/2023] Open
Abstract
Background Primary pulmonary lymphoepithelioma-like carcinoma (LELC) is a rare tumor and often misdiagnosed as squamous carcinoma. In the current study, clinical characteristics and outcome of primary pulmonary LELC were systematically compared with pulmonary squamous carcinoma. Methods Forty-two cases of primary pulmonary LELC and 134 squamous carcinomas were enrolled retrospectively. Characteristic and prognosis difference between the two groups was compared, and the independent prognostic factor for pulmonary LELC was identified as well. Results In comparison to squamous carcinoma, pulmonary LELC was more common in women with a younger median age and less smokers. LELC seemed to be smaller in diameter on computed tomography (CT) scans than squamous carcinoma, with scarce spiculation and vascular convergence signs. Epstein-Bar virus-encoded RNA (EBER) by in-situ hybridization was detected in 33 LELC cases, among whom 27 ones were positive in serum EBV-DNA examination. LELC patients presented a much longer median progression-free survival (PFS) than squamous carcinoma. Positive serum EBV-DNA, distant lymph node invasion, advanced clinical stage and receiving radiotherapy were correlated with the shorter PFS in LELC patients. However, only positive serum EBV-DNA was the independent PFS predictor. Conclusion Pulmonary LELC looks like distinct from squamous carcinoma. Middle-aged women and nonsmokers are comparatively predominated. CT features of pulmonary LELC are relatively less-malignant. Correspondently, the progression of pulmonary LELC is seemingly favorable than squamous carcinoma and the positive serum EBV-DNA appears to be the predictor of PFS.
Collapse
Affiliation(s)
- Bojiang Chen
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - Xuping Chen
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - Ping Zhou
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - Lan Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - Jing Ren
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - Xiaodong Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan, China.
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan, China.
| |
Collapse
|
237
|
Sihag S. Commentary: Surgery for N3 disease: Next frontier or has this ship already sailed? J Thorac Cardiovasc Surg 2019; 158:1695-1697. [PMID: 31635876 DOI: 10.1016/j.jtcvs.2019.08.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 08/30/2019] [Accepted: 08/31/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Smita Sihag
- Thoracic Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, NY.
| |
Collapse
|
238
|
Cameron LB, Hitchen N, Jordan V, Manser R, Solomon BJ. Targeted therapy for advanced anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer. Hippokratia 2019. [DOI: 10.1002/14651858.cd013453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Laird B Cameron
- Auckland District Health Board; 2 Park Road Grafton Auckland New Zealand 1023
| | - Nadia Hitchen
- Auckland District Health Board; 2 Park Road Grafton Auckland New Zealand 1023
| | - Vanessa Jordan
- University of Auckland; Department of Obstetrics and Gynaecology; Private Bag 92019 Auckland New Zealand 1003
| | - Renée Manser
- and Department of Respiratory Medicine, Royal Melbourne Hospital; Department of Haematology and Medical Oncology, Peter MacCallum Cancer Institute, St Andrew's Place, East Melbourne 3002, Victoria; 305 Grattan Street Melbourne Australia 3000
| | - Benjamin J Solomon
- Peter MacCallum Cancer Centre; Department of Medical Oncology; 305 Grattan Street Melbourne Australia 3000
| |
Collapse
|
239
|
Palmero R, Navarro-Martin A, Nadal E. Comment on an external validation of the 8th edition of the TNM classification for lung cancer staging in patients treated with chemoradiation. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S101. [PMID: 31576308 DOI: 10.21037/atm.2019.04.81] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Ramón Palmero
- Department of Medical Oncology, Catalan Institute of Oncology, L'Hospitalet, Barcelona, Spain.,Clinical Research in Solid Tumors (CReST) Group, Bellvitge Biomedical Research Institute, L'Hospitalet, Barcelona, Spain
| | - Arturo Navarro-Martin
- Department of Radiation Oncology, Catalan Institute of Oncology, L'Hospitalet, Barcelona, Spain
| | - Ernest Nadal
- Department of Medical Oncology, Catalan Institute of Oncology, L'Hospitalet, Barcelona, Spain.,Clinical Research in Solid Tumors (CReST) Group, Bellvitge Biomedical Research Institute, L'Hospitalet, Barcelona, Spain
| |
Collapse
|
240
|
Gao HJ, Jiang ZH, Gong L, Ma K, Ren P, Yu ZT, Wei YC. Video-Assisted Vs Thoracotomy Sleeve Lobectomy for Lung Cancer: A Propensity Matched Analysis. Ann Thorac Surg 2019; 108:1072-1079. [DOI: 10.1016/j.athoracsur.2019.04.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 03/14/2019] [Accepted: 04/12/2019] [Indexed: 12/20/2022]
|
241
|
Tang W, Li X, Xie X, Sun X, Liu J, Zhang J, Wang C, Yu J, Xie P. EGFR inhibitors as adjuvant therapy for resected non-small cell lung cancer harboring EGFR mutations. Lung Cancer 2019; 136:6-14. [DOI: 10.1016/j.lungcan.2019.08.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 07/27/2019] [Accepted: 08/01/2019] [Indexed: 12/30/2022]
|
242
|
Smith DE, Fernandez Aramburu J, Da Lozzo A, Montagne JA, Beveraggi E, Dietrich A. Accuracy of positron emission tomography and computed tomography (PET/CT) in detecting nodal metastasis according to histology of non-small cell lung cancer. Updates Surg 2019; 71:741-746. [PMID: 31552569 DOI: 10.1007/s13304-019-00680-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 09/16/2019] [Indexed: 11/25/2022]
Abstract
Positron emission tomography and computed tomography (PET-CT) is the non-invasive gold standard method for determining the oncological stage of patient with diagnosis of lung cancer. A correct preoperative staging is significant because only patients who do not have a history of regional or distant disease are those who will benefit from a surgical treatment. However, due to the different values of the PET-CT in terms of sensitivity and specificity to evaluate the mediastinal lymph node involvement, it is often necessary to perform a surgical mediastinal sampling through a cervical video mediastinoscopy (VM). Patient's risk factors which could modify the results of the PET scan, performing differences between non-invasive staging and the lymph node sampling due to VM are not yet clearly established in the literature. This knowledge will allow to identify in whom a surgical staging by sampling the mediastinal lymph nodes is needed. We included 234 patients with diagnosis of lung cancer who underwent a mediastinal lymph node staging by PET-CT images and histopathological results of mediastinal sampling by VM, analyzing the sensitivity and specificity of this non-invasive imaging study. We also analyzed variables that could modify the results of PET-CT, such as tumor type, location of the tumor and patient's history. We showed that those PET-CT presented an overall sensitivity and specificity of 93.8 and 62.7%, respectively, with negative and positive predictive values of 95.05 and 57.1%, respectively. The false-positive rate was 25% (57 of 234 patients). Analyzing risk factors involved in this false-positive rate (n = 57), we found that the only statistically significant factor that could explain these results was the histology of squamous carcinoma (p < 0.03). In this group of patients, it is essential to perform a mediastinal lymph node biopsy to know the real state of lymph node involvement.
Collapse
Affiliation(s)
- David E Smith
- Thoracic Surgery and Lung Transplant Section, Hospital Italiano de Buenos Aires, Perón 4190, 1181, Buenos Aires, Argentina
| | - Julian Fernandez Aramburu
- Thoracic Surgery and Lung Transplant Section, Hospital Italiano de Buenos Aires, Perón 4190, 1181, Buenos Aires, Argentina
| | - Alejandro Da Lozzo
- Thoracic Surgery and Lung Transplant Section, Hospital Italiano de Buenos Aires, Perón 4190, 1181, Buenos Aires, Argentina
| | - Juan A Montagne
- Thoracic Surgery and Lung Transplant Section, Hospital Italiano de Buenos Aires, Perón 4190, 1181, Buenos Aires, Argentina
| | - Enrique Beveraggi
- Thoracic Surgery and Lung Transplant Section, Hospital Italiano de Buenos Aires, Perón 4190, 1181, Buenos Aires, Argentina
| | - Agustin Dietrich
- Thoracic Surgery and Lung Transplant Section, Hospital Italiano de Buenos Aires, Perón 4190, 1181, Buenos Aires, Argentina.
| |
Collapse
|
243
|
Li S, Jiang Z, Li Y, Xu Y. Prognostic significance of minichromosome maintenance mRNA expression in human lung adenocarcinoma. Oncol Rep 2019; 42:2279-2292. [PMID: 31545501 PMCID: PMC6826304 DOI: 10.3892/or.2019.7330] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 08/09/2019] [Indexed: 12/21/2022] Open
Abstract
The minichromosome maintenance (MCM) gene family plays an essential role in DNA replication and cell cycle progression. However, MCM gene expression has not been well-studied in lung adenocarcinoma (LUAD). In the present study, the expression, prognostic value and functions of MCMs in LUAD were investigated using several databases and bioinformatic tools, including Oncomine, GEPIA, cBioPortal, CancerSEA and Kaplan-Meier plotter. It was demonstrated that the mRNA expression of MCM2, MCM4 and MCM10 were significantly increased in patients with LUAD. High mRNA expression of MCM2-5, MCM8 and MCM10 were associated with poor overall survival and progression-free survival. High MCM4 expression was associated with adverse post-progression survival. In addition, the Human Protein Atlas database showed that MCM protein expression was consistent with the mRNA expression. These results demonstrate that MCM2, MCM4 and MCM10 are potential prognostic markers and therapeutic targets for LUAD.
Collapse
Affiliation(s)
- Shu Li
- Department of Hematology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Zhou Jiang
- Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Yirun Li
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, P.R. China
| | - Yang Xu
- Department of Hematology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| |
Collapse
|
244
|
Oze I, Ito H, Nishino Y, Hattori M, Nakayama T, Miyashiro I, Matsuo K, Ito Y. Trends in Small-Cell Lung Cancer Survival in 1993-2006 Based on Population-Based Cancer Registry Data in Japan. J Epidemiol 2019; 29:347-353. [PMID: 30449770 PMCID: PMC6680055 DOI: 10.2188/jea.je20180112] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/16/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Lung cancers are classified into small-cell lung cancer (SCLC) and non-small-cell lung cancer due to their different treatment and prognosis. Although many studies have reported the specific survival of SCLC patients treated at cancer hospitals, survival from population-based data has rarely been reported. METHODS We analyzed survival of SCLC cases diagnosed from 1993 through 2006 from a population-based cancer registry of six prefectures. To assess trends in SCLC survival, we defined three periods that mirrored developments in SCLC treatment: period 1, 1993-1998; period 2, 1999-2001; and period 3, 2002-2006. Assessments were based on relative survival (RS), excess hazard, and conditional survival. RESULTS A total of 10,911 SCLC patients were analyzed. Five-year RS among limited disease SCLC (LD-SCLC) in periods 1 to 3 was 16.8%, 21.1%, and 21.4%, respectively. Five-year RS among extensive disease SCLC (ED-SCLC) in periods 1 to 3 was 2.3%, 2.8%, and 2.7%, respectively. Improvement in 5-year RS in periods 2 and 3 compared with period 1 was significant among both LD- and ED-SCLC patients (all P < 0.001). Conditional 5-year RS of LD-SCLC increased from 21% at year 0 to 73% at year 5, while that of ED-SCLC was 3% at year 0 and 53% at year 5. CONCLUSIONS The prognosis of SCLC patients improved from 1999-2001 but plateaued in 2002-2006, after which no further significant improvement was seen. Continuous survey based on population-based data is helpful in monitoring the impact of developments in treatment.
Collapse
Affiliation(s)
- Isao Oze
- Division of Cancer Epidemiology and Prevention, Department of Preventive Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Hidemi Ito
- Division of Cancer Information and Control, Department of Preventive Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan
- Department of Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshikazu Nishino
- Department of Epidemiology and Public Health, Kanazawa Medical University, Ishikawa, Japan
| | - Masakazu Hattori
- Department of Cancer Therapy Center, Fukui Prefectural Hospital, Fukui, Japan
| | - Tomio Nakayama
- Division of Screening Assessment and Management, Screening Research Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Keitaro Matsuo
- Division of Cancer Epidemiology and Prevention, Department of Preventive Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan
- Department of Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuri Ito
- Department of Medical Statistics, Research & Development Center, Osaka Medical College, Takatsuki, Osaka, Japan
| |
Collapse
|
245
|
Neppl C, Keller MD, Scherz A, Dorn P, Schmid RA, Zlobec I, Berezowska S. Comparison of the 7th and 8th Edition of the UICC/AJCC TNM Staging System in Primary Resected Squamous Cell Carcinomas of the Lung-A Single Center Analysis of 354 Cases. Front Med (Lausanne) 2019; 6:196. [PMID: 31552253 PMCID: PMC6737333 DOI: 10.3389/fmed.2019.00196] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 08/21/2019] [Indexed: 12/25/2022] Open
Abstract
Background: The AJCC/UICC TNM (tumor, node, metastasis) classification is a standardized system for the description of anatomical extent and stage grouping of solid malignant tumors and is regularly updated. We aimed at testing the new 2017 8th edition of the TNM classification (TNM8) compared to the former 2009 7th edition (TNM7), in pulmonary squamous cell carcinomas (pSQCC). Methods: We analyzed a clinico-pathologically well-annotated Western single-center cohort of 354 consecutive pSQCC, resected 2000-2013, without previous neoadjuvant therapy. Patients with a clinical history of SQCC of other organs were excluded to reliably exclude lung metastases. Patients in whom TNM was unclear due to multiple tumor nodules were excluded. We reevaluated all pathological records and slides and retrospectively validated pleural invasion for all cases. Raw data of our cohort are provided as Supplementary Material. Results: The stage distribution according to TNM7 was as follows: IA (2009): 59 (16.7%), IB: 75 (21.2%), IIA: 71 (20.1%), IIB: 53 (15.0%), IIIA: 79 (22.3%), IIIB: 7 (2.0%), IV: 10 (2.8%). Staging the cases according to TNM8, 7/354 (2.0%) cases were down-staged, 154 (43.5%) were upstaged; most pronounced between stages IIA(TNM7) and IIB(TNM8), and IIB(TNM7) and IIIA(TNM8). Both staging systems showed significant prognostic impact for overall survival, disease free and disease specific survival and time to recurrence, without significant differences regarding goodness-of-fit criteria (Akaike Information Criterion and Schwarz Bayesian Criterion). Conclusion: In conclusion, we show a significant stage migration between tumors staged using TNM7 and TNM8, without benefit regarding prognostication in our cohort of primary resected pSQCC.
Collapse
Affiliation(s)
- Christina Neppl
- Institute of Pathology, University of Bern, Bern, Switzerland
| | | | - Amina Scherz
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Dorn
- Department of General Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ralph A. Schmid
- Department of General Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Inti Zlobec
- Institute of Pathology, University of Bern, Bern, Switzerland
| | | |
Collapse
|
246
|
The Prognostic Significance of the 8th Edition TNM Staging of Pulmonary Carcinoid Tumors. Am J Surg Pathol 2019; 43:1291-1296. [DOI: 10.1097/pas.0000000000001268] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
247
|
Radiomics Signature: A Biomarker for the Preoperative Distant Metastatic Prediction of Stage I Nonsmall Cell Lung Cancer. Acad Radiol 2019; 26:1253-1261. [PMID: 30527455 DOI: 10.1016/j.acra.2018.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 10/28/2018] [Accepted: 11/12/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To evaluate the predictive value of radiomics features on the distant metastasis (DM) of stage I nonsmall cell lung cancer (NSCLC) preoperatively, by comparing with clinical characteristics and CT morphological features, and to screen the important prognostic predictors. METHODS One hundred ninety-four stage I NSCLC patients were retrospectively enrolled, DM free survival (DMFS) was evaluated. The consensus clustering analysis was used to build the radiomics signatures in the primary cohort and validated in the validation cohort. The univariate survival analysis was performed in clinical characteristics, CT morphological features and radiomics signatures, respectively. Cox model was performed and C-index was calculated. RESULTS There were 25 patients (12.9%) with DM. The median DMFS was 15 months. Three hundred thirteen radiomics features were selected, then classified into five groups, two subtypes (I and II) with each group. The RS1 showed the best prognostic ability with C-index of 0.355(95% confidence interval [CI], 0.269-0.442; p < 0.001). The histological type exhibited a good prognostic ability with C-index of 0.123 (95% CI, 0.000-0.305; p < 0.001) for DMFS. Cox model showed RS1(hazard ratio [HR] 18.025, 95% CI 2.366-137.340), pleural indentation sign (HR 2.623, 95% CI 1.070-6.426) and histological type (HR 4.461, 95% CI 1.783-11.162) were the independent prognostic factors (p < 0.05). CONCLUSION Radiomics provided a new modality for the distant metastatic prediction of stage I NSCLC. Patients with type II of RS1, pleural indentation sign and nonadenocarcinoma indicated the high probability of postsurgical DM.
Collapse
|
248
|
Lim WH, Au E, Krishnan A, Wong G. Assessment of kidney transplant suitability for patients with prior cancers: is it time for a rethink? Transpl Int 2019; 32:1223-1240. [PMID: 31385629 PMCID: PMC6900036 DOI: 10.1111/tri.13486] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/16/2019] [Accepted: 07/31/2019] [Indexed: 12/19/2022]
Abstract
Kidney transplant recipients have up to a 100-fold greater risk of incident cancer compared with the age/sex-matched general population, attributed largely to chronic immunosuppression. In patients with a prior history of treated cancers, the type, stage and the potential for cancer recurrence post-transplant of prior cancers are important factors when determining transplant suitability. Consequently, one of the predicaments facing transplant clinicians is to determine whether patients with prior cancers are eligible for transplantation, balancing between the accelerated risk of death on dialysis, the projected survival benefit and quality of life gains with transplantation, and the premature mortality associated with the potential risk of cancer recurrence post-transplant. The guidelines informing transplant eligibility or screening and preventive strategies against cancer recurrence for patients with prior cancers are inconsistent, underpinned by uncertain evidence on the estimates of the incidence of cancer recurrence and the lack of stage-specific outcomes data, particularly among those with multiple myeloma or immune-driven malignancies such as melanomas. With the advent of newer anti-cancer treatment options, it is unclear whether the current guidelines for those with prior cancers remain appropriate. This review will summarize the uncertainties of evidence informing the current recommendations regarding transplant eligibility of patients with prior cancers.
Collapse
Affiliation(s)
- Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Eric Au
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Anoushka Krishnan
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| |
Collapse
|
249
|
Mitchell KG, Farooqi A, Ludmir EB, Corsini EM, Zhang J, Sepesi B, Vaporciyan AA, Swisher SG, Heymach JV, Zhang J, Gomez DR, Antonoff MB. Improved Overall Survival With Comprehensive Local Consolidative Therapy in Synchronous Oligometastatic Non-Small-Cell Lung Cancer. Clin Lung Cancer 2019; 21:37-46.e7. [PMID: 31447303 DOI: 10.1016/j.cllc.2019.07.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/17/2019] [Accepted: 07/25/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Local consolidative therapy (LCT) to optimize disease control is an evolving management paradigm in non-small-cell lung cancer (NSCLC) patients who present with a limited metastatic disease burden. We hypothesized that LCT to all sites of disease would be associated with improved overall survival (OS) among patients with synchronous oligometastatic NSCLC. PATIENTS AND METHODS Patients presenting to a single institution (2000-2017) with stage IV NSCLC and ≤ 3 synchronous metastases were identified. Intrathoracic nodal disease was counted as one site. Landmark and propensity-adjusted Cox regression analyses were performed to identify factors associated with OS. RESULTS Of 194 patients, 143 (74%) had 2 or 3 sites of metastasis. LCT was delivered to all sites of disease in 121 patients (62%), to some but not all sites in 52 (27%), and were not used in 21 (11%). Comprehensive LCT was independently associated with improved OS (hazard ratio [HR] = 0.67; 95% confidence interval [CI], 0.46-0.97; P = .034), with the greatest therapeutic effect among patients without thoracic nodal disease, bone metastases, or > 1 metastatic site. Among patients who underwent comprehensive LCT, tumor histology (squamous: HR = 2.32; 95% CI, 1.28-4.22; P = .006), intrathoracic disease burden (T3-4: HR = 1.67; 95% CI, 0.97-2.86; P = .065; N3: HR = 1.90; 95% CI, 0.90-4.03; P = .093), and bone metastases (HR = 1.74; 95% CI, 1.02-3.00; P = .044) were associated with poor OS. CONCLUSION Comprehensive LCT was associated with improved OS in this large cohort of patients with synchronous oligometastatic NSCLC. These results support ongoing prospective efforts to characterize the therapeutic benefits associated with this management strategy.
Collapse
Affiliation(s)
- Kyle G Mitchell
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ahsan Farooqi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ethan B Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Erin M Corsini
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jiexin Zhang
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - John V Heymach
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jianjun Zhang
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Daniel R Gomez
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
| |
Collapse
|
250
|
Dong J, Zhu D, Tang X, Lu D, Qiu X, Li B, Lin D, Li L, Liu J, Zhou Q. Circulating tumor cells in pulmonary vein and peripheral arterial provide a metric for PD-L1 diagnosis and prognosis of patients with non-small cell lung cancer. PLoS One 2019; 14:e0220306. [PMID: 31348821 PMCID: PMC6660086 DOI: 10.1371/journal.pone.0220306] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 07/13/2019] [Indexed: 02/05/2023] Open
Abstract
Background Lung cancer is the leading cause of death caused by malignant tumors. PD-L1(programmed cell death protein-1) has shown tremendous achievement in treating NSCLC. We sought to find the relationship between CTCs in the pulmonary vein and postoperative PFS, besides we detected PD-L1 in CTCs. Method We enrolled 112 NSCLC patients. CTC tests were performed at four time points (preoperative, pulmonary vein, intraoperative and postoperative) on every NSCLC patient who received surgery. The RNA of PD-L1 was tested by FISH. The levels of the PD-L1 mRNA and protein in tissue samples were detected. Results The CTCs in the PV were the highest (P< 0.001), and CTCs in the PPA were the lowest (P< 0.001). The PFS in the group with PV CTCs≥ 16/5 ml was shorter than that in the group with PV CTCs< 16/5 ml (11.1 months vs 21.2 months, respectively; P< 0.001). The PFS in the group with PPA CTCs≥ 3/5 ml was shorter than that in the group with CTCs< 3/5 ml (14.8 months vs 20.7 months, respectively; P< 0.001). The CTCs in stage I were lower than those in stage II-IV (P = 0.025). No linear relationship was found between the CTCs and tumor size (P> 0.05) or LN metastasis (P> 0.05). In total, fifty-two (50.5%) patients had positive PD-L1 expression in CTC. In PD-L1-positive CTC patients, the value of PD-L1 tissue expression was higher than that in PD-L1-negative CTC patients (P = 0.0153). Conclusion CTCs in the pulmonary vein can be an effective prognosis indicator of NSCLC patients.
Collapse
Affiliation(s)
- Jingsi Dong
- Department of Lung Cancer Center, Sichuan University West China Hospital, Chengdu, China
| | - Daxing Zhu
- Department of Lung Cancer Center, Sichuan University West China Hospital, Chengdu, China
| | - Xiaojun Tang
- Department of Lung Cancer Center, Sichuan University West China Hospital, Chengdu, China
| | - Dan Lu
- Department of Otorhinolaryngology, Head & Neck Surgery, Sichuan University West China Hospital, Chengdu, China
| | - Xiaoming Qiu
- Department of Lung Cancer Center, Sichuan University West China Hospital, Chengdu, China
| | - Bingjie Li
- Department of Lung Cancer Center, Sichuan University West China Hospital, Chengdu, China
| | - Dan Lin
- Department of Lung Cancer Center, Sichuan University West China Hospital, Chengdu, China
| | - Lu Li
- Department of Lung Cancer Center, Sichuan University West China Hospital, Chengdu, China
| | - Jiewei Liu
- Department of Lung Cancer Center, Sichuan University West China Hospital, Chengdu, China
| | - Qinghua Zhou
- Department of Lung Cancer Center, Sichuan University West China Hospital, Chengdu, China
- * E-mail:
| |
Collapse
|