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Li Y, Wong M, Zhan L, Corke L, Brown MC, Cheng S, Khan K, Balatnaram K, Chowdhury M, Sabouhanian A, Herman J, Walia P, Strom E, Patel D, García-Pardo M, Schmid S, Eng L, Sacher AG, Leighl N, Bradbury PA, Shepherd FA, Shultz D, Liu G. Single organ metastatic sites in non-small cell lung cancer: Patient characteristics, treatment patterns and outcomes from a large retrospective Canadian cohort. Lung Cancer 2024; 192:107823. [PMID: 38763103 DOI: 10.1016/j.lungcan.2024.107823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/17/2024] [Accepted: 05/12/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND There is a paucity of information about the characteristics, treatment patterns, and outcomes of non-small cell lung cancer (NSCLC) patients with single organ metastasis (SOM). METHODS This retrospective cohort study includes all patients with a diagnosis of stage IV NSCLC diagnosed from 2014 to 2016 and treated at Princess Margaret Cancer Centre. We compared baseline characteristics and patterns of metastatic sites between patients with SOM versus multiple (M)OM. Additionally, we identified treatment modalities and outcomes for patients with SOM. Cox multivariable models (MVA) were utilized to evaluate differences in overall survival (OS) between the SOM and MOM cohorts. RESULTS Of 893 pts analyzed, 457 (51 %) had SOM, while 436 (49 %) had MOM at initial diagnosis. Demographics were comparable between the two groups. Brain was the most common site of metastasis for SOM patients. When compared to the MOM group, the SOM group had lower percentages of liver and adrenal metastases. Amongst SOM patients, 54 % received single modality treatment, and 20 % did not receive any treatment for their SOM. In MVA, patients with liver (HR 2.4), bone (HR 1.8), and pleural (HR 1.7) metastasis as their SOM site had the worst outcomes, with median OS of 6.8 months, 12.1 months, and 13.0 months respectively. Patients with SOM had a significantly improved median OS compared to those with MOM (15.9 months vs. 10.6 months; HR 0.56, 95 % CI 0.47-0.66, p < 0.001). CONCLUSION In NSCLC patients who presented with SOM, survival correlated with the initial organ involved and was better overall compared to patients with MOM. SOM NSCLC may benefit from specific management strategies and SOM patients could be considered as a specific subgroup for survival analyses in observational and non-randomized interventional studies. In clinical trials, SOM can be considered as a stratification factor in the future.
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Affiliation(s)
- Y Li
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
| | - M Wong
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - L Zhan
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - L Corke
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - M C Brown
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - S Cheng
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - K Khan
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - K Balatnaram
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - M Chowdhury
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - A Sabouhanian
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - J Herman
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - P Walia
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - E Strom
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - D Patel
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - M García-Pardo
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - S Schmid
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - L Eng
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - A G Sacher
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - N Leighl
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - P A Bradbury
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - F A Shepherd
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - D Shultz
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - G Liu
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Medical Biophysics, Pharmacology and Toxicology, Institute of Medical Science, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Hu Y, Geng Y, Wang H, Chen H, Wang Z, Fu L, Huang B, Jiang W. Improved Prediction of Epidermal Growth Factor Receptor Status by Combined Radiomics of Primary Nonsmall-Cell Lung Cancer and Distant Metastasis. J Comput Assist Tomogr 2024:00004728-990000000-00298. [PMID: 38498926 DOI: 10.1097/rct.0000000000001591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
OBJECTIVES This study aimed to investigate radiomics based on primary nonsmall-cell lung cancer (NSCLC) and distant metastases to predict epidermal growth factor receptor (EGFR) mutation status. METHODS A total of 290 patients (mean age, 58.21 ± 9.28) diagnosed with brain (BM, n = 150) or spinal bone metastasis (SM, n = 140) from primary NSCLC were enrolled as a primary cohort. An external validation cohort, consisting of 69 patients (mean age, 59.87 ± 7.23; BM, n = 36; SM, n = 33), was enrolled from another center. Thoracic computed tomography-based features were extracted from the primary tumor and peritumoral area and selected using the least absolute shrinkage and selection operator regression to build a radiomic signature (RS-primary). Contrast-enhanced magnetic resonance imaging-based features were calculated and selected from the BM and SM to build RS-BM and RS-SM, respectively. The RS-BM-Com and RS-SM-Com were developed by integrating the most important features from the primary tumor, BM, and SM. RESULTS Six computed tomography-based features showed high association with EGFR mutation status: 3 from intratumoral and 3 from peritumoral areas. By combination of features from primary tumor and metastases, the developed RS-BM-Com and RS-SM-Com performed well with areas under curve in the training (RS-BM-Com vs RS-BM, 0.936 vs 0.885, P = 0.177; RS-SM-Com vs RS-SM, 0.929 vs 0.843, P = 0.003), internal validation (RS-BM-Com vs RS-BM, 0.920 vs 0.858, P = 0.492; RS-SM-Com vs RS-SM, 0.896 vs 0.859, P = 0.379), and external validation (RS-BM-Com vs RS-BM, 0.882 vs 0.805, P = 0.263; RS-SM-Com vs RS-SM, 0.865 vs 0.816, P = 0.312) cohorts. CONCLUSIONS This study indicates that the accuracy of detecting EGFR mutations significantly enhanced in the presence of metastases in primary NSCLC. The established radiomic signatures from this approach may be useful as new predictors for patients with distant metastases.
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Affiliation(s)
- Yue Hu
- From the Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Yikang Geng
- School of Intelligent Medicine, China Medical University, Liaoning
| | - Huan Wang
- Radiation Oncology Department of Thoracic Cancer, Cancer Hospital of Dalian University of Technology (Liaoning Cancer Hospital & Institute), Liaoning
| | - Huanhuan Chen
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang
| | - Zekun Wang
- Department of Medical Iconography, Liaoning Cancer Hospital & Institute, Liaoning
| | - Langyuan Fu
- School of Intelligent Medicine, China Medical University, Liaoning
| | - Bo Huang
- Department of Pathology, Liaoning Cancer Hospital and Institute, Liaoning
| | - Wenyan Jiang
- Department of Scientific Research and Academic, Liaoning Cancer Hospital and Institute, Liaoning, People's Republic of China
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Ladner L, Bhutada AS, Adhikari S, Cuoco JA, Entwistle JJ, Rogers CM, Marvin EA. Prognostic Indicators for Intracranial Metastases from Pancreatic Cancer: A Population-Based Retrospective Surveillance, Epidemiology, and End Results Database Analysis. World Neurosurg 2024; 182:e666-e674. [PMID: 38070735 DOI: 10.1016/j.wneu.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 12/31/2023]
Abstract
OBJECTIVE The natural history, treatment options, and clinical outcomes of pancreatic metastases to the brain remain largely unknown. Here, we seek to investigate characteristics that influence OS in pancreatic metastases to the brain. METHODS This is a population-based retrospective study of OS in 508 patients with pancreatic metastases to the brain using the SEER database. Univariate and multivariate Cox regression analyses were utilized, and a predictive nomogram was developed. RESULTS There were 508 patients identified for this study, with a median OS of 2 months. In the univariate analysis, patients older than 65 years had significantly reduced OS (P < 0.001). Patients with liver metastases (P < 0.001) and liver and lung metastases (P < 0.001) exhibited significantly reduced OS. Treatment of the primary tumor with chemotherapy only (P < 0.001), radiation only (P = 0.01), radiation and chemotherapy (P < 0.001), and surgery only (P = 0.01) were associated with increased OS. Resection of a distant metastasis site (P = 0.009) and of a brain metastasis (P = 0.03) were associated with increased OS. In the multivariable analysis, factors that remained significant included patient age (P = 0.01), liver metastases (P < 0.001), liver and lung metastases (P < 0.001), treatment with chemotherapy (P < 0.001), treatment with radiation and chemotherapy (P < 0.001), and treatment with surgery and chemotherapy (P < 0.001). The nomogram had a C-index of 0.766, suggesting congruence between the findings on the nomogram and the results in the internal verification. CONCLUSIONS Median OS is influenced by age, multiorgan metastases, and treatment of the primary tumor. These data highlight the marginal benefit of treatment, yet improved quality of life (QOL) remains to be elucidated.
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Affiliation(s)
- Liliana Ladner
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA.
| | | | - Srijan Adhikari
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; Department of Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA; School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Joshua A Cuoco
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; Department of Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA; School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - John J Entwistle
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; Department of Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA; School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Cara M Rogers
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; Department of Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA; School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Eric A Marvin
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; Department of Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA; School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
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Zhang Y, Wang Y, Zhu A, Yu N, Xia J, Li J. Dual-Targeting Biomimetic Semiconducting Polymer Nanocomposites for Amplified Theranostics of Bone Metastasis. Angew Chem Int Ed Engl 2024; 63:e202310252. [PMID: 38010197 DOI: 10.1002/anie.202310252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/03/2023] [Accepted: 11/24/2023] [Indexed: 11/29/2023]
Abstract
Bone metastasis is a type of metastatic tumors that involves the spreads of malignant tumor cells into skeleton, and its diagnosis and treatment remain a big challenge due to the unique tumor microenvironment. We herein develop osteoclast and tumor cell dual-targeting biomimetic semiconducting polymer nanocomposites (SPFeNOC ) for amplified theranostics of bone metastasis. SPFeNOC contain semiconducting polymer and iron oxide (Fe3 O4 ) nanoparticles inside core and surface camouflaged hybrid membrane of cancer cells and osteoclasts. The hybrid membrane camouflage enables their targeting to both metastatic tumor cells and osteoclasts in bone metastasis through homologous targeting mechanism, thus achieving an enhanced nanoparticle accumulation in tumors. The semiconducting polymer mediates near-infrared (NIR) fluorescence imaging and sonodynamic therapy (SDT), and Fe3 O4 nanoparticles are used for magnetic resonance (MR) imaging and chemodynamic therapy (CDT). Because both cancer cells and osteoclasts are killed synchronously via the combinational action of SDT and CDT, the vicious cycle in bone metastasis is broken to realize high antitumor efficacy. Therefore, 4T1 breast cancer-based bone metastasis can be effectively detected and cured by using SPFeNOC as dual-targeting theranostic nanoagents. This study provides an unusual biomimetic nanoplatform that simultaneously targets osteoclasts and cancer cells for amplified theranostics of bone metastasis.
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Affiliation(s)
- Yijing Zhang
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Biological Science and Medical Engineering, Donghua University, Shanghai, 201620, China
| | - Yue Wang
- Department of Radiology, Shanghai Songjiang District Central Hospital, Shanghai, 201600, China
| | - Anni Zhu
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Biological Science and Medical Engineering, Donghua University, Shanghai, 201620, China
| | - Ningyue Yu
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Biological Science and Medical Engineering, Donghua University, Shanghai, 201620, China
| | - Jindong Xia
- Department of Radiology, Shanghai Songjiang District Central Hospital, Shanghai, 201600, China
| | - Jingchao Li
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Biological Science and Medical Engineering, Donghua University, Shanghai, 201620, China
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Leonetti A, Peroni M, Agnetti V, Pratticò F, Manini M, Acunzo A, Marverti F, Sulas S, Rapacchi E, Mazzaschi G, Perrone F, Bordi P, Buti S, Tiseo M. Thirty-day mortality in hospitalised patients with lung cancer: incidence and predictors. BMJ Support Palliat Care 2023:spcare-2023-004558. [PMID: 37666650 DOI: 10.1136/spcare-2023-004558] [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: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES Patients with lung cancer experience high rates of hospitalisation, mainly due to the high risk of complications that emerge during the natural history of the disease. We designed a retrospective, single-centre, observational study aimed at defining the clinical predictors of 30-day mortality in hospitalised patients with lung cancer. METHODS Clinical records from the first admission of patients with lung cancer to the oncology ward of the University Hospital of Parma from 1 January 2017 to 1 January 2022 were collected. RESULTS 251 consecutive patients were enrolled at the time of data cut-off. In the univariate analysis, baseline clinical predictors of 30-day mortality were Eastern Cooperative Oncology Group performance status (ECOG PS) (≥2 vs 0-1: 27.5% vs 14.8%, p=0.028), high Blaylock Risk Assessment Screening Score (BRASS) (high vs intermediate-low: 34.3% vs 11.9%, p<0.001), presence of pain (yes vs no: 24.4% vs 11.7%, p=0.009), number of metastatic sites (≥3 vs <3: 26.5% vs 13.4%, p=0.017) and presence of bone metastases (yes vs no: 29.0% vs 10.8%, p=0.001). In the multivariate analysis, high BRASS remained significantly associated with increased 30-day mortality (high vs intermediate-low; OR 2.87, 95% CI 1.21 to 6.78, p=0.016). CONCLUSION Our results suggest that baseline poor ECOG PS, high BRASS, presence of pain, high tumour burden and presence of bone metastases could be used as clinical predictors of 30-day mortality in hospitalised patients with lung cancer. In particular, the BRASS scale should be used as a simple tool to predict 30-day mortality in hospitalised patients with lung cancer.
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Affiliation(s)
| | - Marianna Peroni
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Virginia Agnetti
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Fabiana Pratticò
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Martina Manini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alessandro Acunzo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Simone Sulas
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elena Rapacchi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Giulia Mazzaschi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Fabiana Perrone
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Paola Bordi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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Hao Y, Li G. Prediction of distant organ metastasis and overall survival of lung cancer patients: a SEER population-based cohort study. Front Oncol 2023; 13:1075385. [PMID: 37377915 PMCID: PMC10291234 DOI: 10.3389/fonc.2023.1075385] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
Background Distant organ metastasis is a common event in lung cancer (LC). However, the preferential metastatic pattern of different pathological types of LC and its effect on prognosis have not been comprehensively elucidated. This study aimed to explore the distant metastasis pattern and construct nomograms predicting the metastasis and survival of LC patients using the Surveillance, Epidemiology, and End Results (SEER) database. Methods LC data were downloaded from the SEER database to conduct logistic regression and investigate risk factors for developing organ metastasis. A Cox regression analysis was conducted to investigate prognostic factors of LC. A Kaplan-Meier analysis was used to estimate overall survival outcomes. Nomograms were constructed to predict the probability of organ metastasis and the 1-, 3- and 5-year survival probability of LC patients. Receiver operating characteristic curves were used to evaluate the diagnostic accuracy of the nomograms. All statistical analyses were conducted within R software. Results The liver is the most common metastatic organ of small cell carcinoma. The brain is the most likely metastasis site of large cell carcinoma, and bone is the most likely metastasis site for squamous cell carcinoma and adenocarcinoma. Patients with triple metastases (brain-bone-liver) have the worst prognosis, and for nonsquamous carcinoma with single organ metastasis, liver metastases conferred the worst prognosis. Our nomograms based on clinical factors could predict the metastasis and prognosis of LC patients. Conclusion Different pathological types of LC have different preferential metastatic sites. Our nomograms showed good performance in predicting distant metastasis and overall survival. These results will provide a reference for clinicians and contribute to clinical evaluations and individualized therapeutic strategies.
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Shen Y, Lu J, Hu F, Qian J, Zhang X, Zhong R, Zhong H, Chu T, Han B. Effect and outcomes analysis of anlotinib in non-small cell lung cancer patients with liver metastasis: results from the ALTER 0303 phase 3 randomized clinical trial. J Cancer Res Clin Oncol 2023; 149:1417-1424. [PMID: 35482076 DOI: 10.1007/s00432-022-03964-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/21/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Liver metastasis (LM) is common in non-small cell lung cancer (NSCLC), and always predicted worse outcomes with no effective therapy. We aimed to evaluate the effects and prognosis in LM patients treated with anlotinib. METHODS The present study is a post hoc analysis based on a multicenter, double-blind, phase 3 randomized clinical trial which designed to evaluate the efficacy and safety of anlotinib in patients with advanced NSCLC. A total of 437 patients were enrolled in present study, and 78 patients with LM. RESULTS Patients with LM showed a worse outcome compared to those without LM (PFS median, 2.6 vs 4.2 months), and OS (median, 5.6 vs 9.4 months, both P < 0.0001). The anlotinib was associated with longer PFS (median, 3.0 months) compared with placebo (median, 0.9 months), with a hazard ratio (HR) of 0.23 (95%CI, 0.12-0.42; P < 0.0001). Furthermore, OS was marginally significantly better in anlotinib group (median 6.6 months), compared with placebo (median 4.0 months), HR 0.61 (95%CI, 0.36-1.02; P = 0.055). Multivariate analysis confirmed normal peripheral blood LDH/TBiL level predicted better PFS and OS, lower ECOG score acted as independently prognostic factor for superior OS. Anlotinib was more associated with hand-foot syndrome (7.7% vs 0) and serum TSH level rise (7.7% vs 3.8%) and well tolerated, all AEs were no more than grade 3. CONCLUSION Patients with LM had a dismal prognosis, anlotinib could lead to a better PFS in pretreated NSCLC patients, which suggested anlotinib is a potential third-line or further therapy in these patients.
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Affiliation(s)
- Yinchen Shen
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, West Huaihai Road 241, Xuhui district, Shanghai, 230032, China
| | - Jun Lu
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, West Huaihai Road 241, Xuhui district, Shanghai, 230032, China
| | - Fang Hu
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, West Huaihai Road 241, Xuhui district, Shanghai, 230032, China
| | - Jialin Qian
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, West Huaihai Road 241, Xuhui district, Shanghai, 230032, China
| | - Xueyan Zhang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, West Huaihai Road 241, Xuhui district, Shanghai, 230032, China
| | - Runbo Zhong
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, West Huaihai Road 241, Xuhui district, Shanghai, 230032, China
| | - Hua Zhong
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, West Huaihai Road 241, Xuhui district, Shanghai, 230032, China
| | - Tianqing Chu
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, West Huaihai Road 241, Xuhui district, Shanghai, 230032, China.
| | - Baohui Han
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, West Huaihai Road 241, Xuhui district, Shanghai, 230032, China.
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Risk and prognostic factors of brain metastasis in lung cancer patients: a Surveillance, Epidemiology, and End Results population‑based cohort study. Eur J Cancer Prev 2023:00008469-990000000-00038. [PMID: 36804864 PMCID: PMC10373853 DOI: 10.1097/cej.0000000000000790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND Brain is a common metastasis site in lung cancer patients. However, homogeneous and heterogeneous risk/prognostic factors of brain metastasis for lung cancer patients have not been comprehensively elucidated. This study aimed to explore the brain metastasis risk and prognostic factors in lung cancer patients using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS Lung cancer data were downloaded from SEER database to investigate risk factors for developing brain metastasis using logistic regression analysis. Univariate and multivariate Cox analyses were used to identify potential prognostic factors. Kaplan-Meier analysis was conducted to evaluate the survival. Propensity score matching was conducted to eliminate baseline differences between two groups. RESULTS A total of 10 818 (14.1%) patients with brain metastasis were diagnosed among 76 483 lung cancer patients. For non-small-cell lung carcinoma (NSCLC), distant liver/bone/lymph node metastases, higher T, N stages were risk factors. Black race, bone metastases and distant lymph node metastases and T4 were brain metastasis risk factors for SCLC patients. Cox analysis suggested that older age, male, primary lesion at main bronchus, liver/ bone/distant lymph node metastases, T2-4, N1-3, no surgery/chemotherapy/radiotherapy were associated with worse prognosis of NSCLC-brain metastasis patients. Age older than 80, liver/bone metastases, without radiotherapy and chemotherapy were associated with worse prognosis of SCLC-brain metastasis patients. Surgery of primary site could prolong the overall survival (OS) of NSCLC patients with brain metastasis, but not SCLC. CONCLUSION In this study, we analyzed the homogeneous and heterogeneous risk/prognostic factors of brain metastasis in lung cancer patients. What is more, our results showed that surgery of primary site was associated with longer OS of NSCLC patients with brain metastasis.
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Metzenmacher M, Griesinger F, Hummel HD, Elender C, Schäfer H, de Wit M, Kaiser U, Kern J, Jänicke M, Spring L, Zacharias S, Kaiser-Osterhues A, Groth A, Hipper A, Zaun G, Dörfel S, Güldenzoph B, Müller L, Uhlig J, Thomas M, Sebastian M, Eberhardt WE. Prognostic factors in nonsmall cell lung cancer: insights from the German CRISP registry. Eur Respir J 2023; 61:13993003.01336-2022. [PMID: 36180086 PMCID: PMC9892864 DOI: 10.1183/13993003.01336-2022] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/04/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Understanding prognosis, especially long-term outcome, in advanced nonsmall cell lung cancer (NSCLC) is crucial to inform patients, guide treatment and plan supportive and palliative care. METHODS Prognostic factors influencing overall survival (OS) and progression-free survival (PFS) in 2082 patients with wild-type (WT)-NSCLC (629 M1a, 249 M1b, 1204 M1c) are reported. Patients were included in the prospective German CRISP registry recruiting in >150 centres. Analysis for pre-therapeutic factors was based on results from Cox proportional hazard models. RESULTS Current M-descriptors of the Union for International Cancer Control-8 staging system were validated: M1a and M1b patients had significantly longer median time to events compared to M1c (OS/PFS 16.4/7.2 months, 17.8/6.7 months and 10.9/5.4 months, respectively). OS and PFS were influenced by number and location of metastatic organ systems. M1c and four or more metastatic organs involved had shorter OS and PFS than M1c with one to three organs (OS hazard ratio (HR) 1.69, p<0.001; PFS HR 1.81, p<0.001). M1b-liver metastases had shorter OS/PFS than M1b involving other organs (OS HR 2.70, p=0.006; PFS HR 2.48, p=0.007). Based on number of involved organs (orgsys) and liver metastases, two risk groups (low-risk: M1a, M1b-non-liver, M1c-1-3-orgsys-non-liver; high-risk: M1c-liver, M1b-liver, M1c-4+-orgsys) with significantly different prognoses could be amalgamated (median OS/PFS 14.3/6.5 months and 7.7/4.1 months, respectively). Other favourable factors were female gender and Eastern Cooperative Oncology Group stage 0, with age showing no impact. Those with T1- or N0-status were associated with longer OS than T2-4 or N2-3. CONCLUSION In this large observational dataset, we further defined factors for outcome in WT-NSCLC, including increased number of involved metastatic organ systems and liver metastases, as those with overall poorer prognosis and reduced survival chance.
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Affiliation(s)
- Martin Metzenmacher
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen – Ruhrlandklinik, Essen, Germany
| | - Frank Griesinger
- Department of Haematology and Oncology, University Dept Internal Medicine-Oncology, Pius-Hospital, University Medicine Oldenburg, Oldenburg, Germany
| | - Horst-Dieter Hummel
- Interdisziplinäres Studienzentrum mit ECTU/Translationale Onkologie, Comprehensive Cancer Center, Mainfranken, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Corinna Elender
- Pneumologie, Infektiologie, Internistische Intensivmedizin, Klinik Nord im Klinikum Dortmund, Dortmund, Germany
| | - Harald Schäfer
- Pneumologie, Thorakale Onkologie, Palliativmedizin, Infektiologie, SHG Kliniken Völklingen, Völklingen, Germany
| | - Maike de Wit
- Klinik für Innere Medizin – Hämatologie, Onkologie und Palliativmedizin, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Ulrich Kaiser
- Medizinische Klinik II, Hämatologie & Internistische Onkologie, St. Bernward Krankenhaus, Hildesheim, Germany
| | - Jens Kern
- Klinikum Würzburg Mitte – Standort Missioklinik, Med. Klinik mit Schwerpunkt Pneumologie, Würzburg, Germany
| | - Martina Jänicke
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | - Lisa Spring
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | | | | | | | | | - Gregor Zaun
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | | | - Björn Güldenzoph
- Hämatologisch-Onkologische Praxis Altona (HOPA), Hamburg, Germany
| | | | - Jens Uhlig
- Praxis Dr. med. Jens Uhlig, Naunhof, Germany
| | - Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik, University Hospital Heidelberg and Translational, Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Martin Sebastian
- Department of Hematology and Medical Oncology, University Hospital Frankfurt, Frankfurt, Germany
| | - Wilfried E.E. Eberhardt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen – Ruhrlandklinik, Essen, Germany
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10
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He J, Yang L, Zhou N, Zu L, Xu S. The role and underlying mechanisms of tumour-derived exosomes in lung cancer metastasis. Curr Opin Oncol 2023; 35:46-53. [PMID: 36321569 DOI: 10.1097/cco.0000000000000913] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Lung cancer is one of the most common malignant tumours worldwide. Metastasis is a serious influencing factor for poor treatment effect and shortened survival in lung cancer. But the complicated underlying molecular mechanisms of tumour metastasis remain unclear. In this review, we aim to further summarize and explore the underlying mechanisms of tumour-derived exosomes (TDEs) in lung cancer metastasis. RECENT FINDINGS TDEs are actively produced and released by tumour cells and carry messages from tumour cells to normal or abnormal cells residing at close or distant sites. Many studies have shown that TDEs promote lung cancer metastasis and development through multiple mechanisms, including epithelial-mesenchymal transition, immunosuppression and the formation of a premetastatic niche. TDEs regulate these mechanisms to promote metastasis by carrying DNA, proteins, miRNA, mRNA, lncRNA and ceRNA. Further exploring TDEs related to metastasis may be a promising treatment strategy and deserve further investigation. SUMMARY Overall, TDEs play a critical role in metastatic of lung cancer. Further studies are needed to explore the underlying mechanisms of TDEs in lung cancer metastasis.
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Affiliation(s)
- Jinling He
- Department of Lung Cancer Surgery
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Lingqi Yang
- Department of Lung Cancer Surgery
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Ning Zhou
- Department of Lung Cancer Surgery
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Lingling Zu
- Department of Lung Cancer Surgery
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Song Xu
- Department of Lung Cancer Surgery
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
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11
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Ma JC, Zhang JX, Wang F, Yu J, Chen D. The Effect of immunotherapy on oligometastatic non-small cell lung cancer patients by sites of metastasis. Front Immunol 2022; 13:1039157. [DOI: 10.3389/fimmu.2022.1039157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/21/2022] [Indexed: 11/16/2022] Open
Abstract
IntroductionThe efficacy of immunotherapy for treatment of patients with oligometastatic non-small cell lung cancer (NSCLC) at different metastatic sites remains controversial. We investigated the effect of different metastatic sites on immunotherapy for oligometastatic NSCLC following local treatment (LT).MethodsWe retrospectively analyzed patients with oligometastatic NSCLC from the latest 2018 registry on the SEER Stat software (8.3.9. Version) and a Chinese single-center cohort. The effects of immunotherapy on OS (overall survival) and CSS (cancer specific survival) were estimated for patients with different metastatic sites.ResultsA total of 483 patients in the SEER-18 database and 344 patients in the single-center cohort were included. Immunotherapy was significantly correlated with improved OS (SEER: Hazard ratio 0.754, 95% CI 0.609–0.932; P=0.044; China: Hazard ratio 0.697, 95% CI 0.542–0.896; P=0.005) and CSS (SEER: Hazard ratio 0.743, 95% CI 0.596–0.928; P=0.009; China: Hazard ratio 0.725, 95% CI 0.556–0.945; P=0.018). Subgroup analysis showed that OS was improved after immunotherapy in the BRM (SEER: Hazard ratio 0.565, 95% CI 0.385–0.829; P=0.004; China: Hazard ratio 0.536, 95% CI 0.312–0.920; P=0.024) and MOM (SEER: Hazard ratio 0.524, 95% CI 0.290–0.947; P=0.032; China: Hazard ratio 0.469, 95% CI 0.235–0.937; P=0.032) subgroups, but not in the BOM (SEER: P=0.334; China: P=0.441), LIM (SEER: P=0.301; China: P=0.357), or OTM (SEER: P=0.868; China: P=0.489) subgroups.ConclusionsThis study showed that immunotherapy conferred survival benefits on patients with oligometastatic NSCLC. Our subgroup analysis suggested that patients with oligometastatic NSCLC in the brain or multiple organs may particularly benefit from aggressive front-line therapies.
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Wang JF, Lu HD, Wang Y, Zhang R, Li X, Wang S. Clinical characteristics and prognosis of non-small cell lung cancer patients with liver metastasis: A population-based study. World J Clin Cases 2022; 10:10882-10895. [PMID: 36338221 PMCID: PMC9631152 DOI: 10.12998/wjcc.v10.i30.10882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/24/2022] [Accepted: 09/16/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The presence of liver metastasis (LM) is an independent prognostic factor for shorter survival in non-small cell lung cancer (NSCLC) patients. The median overall survival of patients with involvement of the liver is less than 5 mo. At present, identifying prognostic factors and constructing survival prediction nomogram for NSCLC patients with LM (NSCLC-LM) are highly desirable.
AIM To build a forecasting model to predict the survival time of NSCLC-LM patients.
METHODS Data on NSCLC-LM patients were collected from the Surveillance, Epidemiology, and End Results database between 2010 and 2018. Joinpoint analysis was used to estimate the incidence trend of NSCLC-LM. Kaplan-Meier curves were constructed to assess survival time. Cox regression was applied to select the independent prognostic predictors of cancer-specific survival (CSS). A nomogram was established and its prognostic performance was evaluated.
RESULTS The age-adjusted incidence of NSCLC-LM increased from 22.7 per 1000000 in 2010 to 25.2 in 2013, and then declined to 22.1 in 2018. According to the multivariable Cox regression analysis of the training set, age, marital status, sex, race, histological type, T stage, metastatic pattern, and whether the patient received chemotherapy or not were identified as independent prognostic factors for CSS (P < 0.05) and were further used to construct a nomogram. The C-indices of the training and validation sets were 0.726 and 0.722, respectively. The results of decision curve analyses (DCAs) and calibration curves showed that the nomogram was well-discriminated and had great clinical utility.
CONCLUSION We designed a nomogram model and further constructed a novel risk classification system based on easily accessible clinical factors which demonstrated excellent performance to predict the individual CSS of NSCLC-LM patients.
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Affiliation(s)
- Jun-Feng Wang
- The First Department of Thoracic Oncology, Jilin Province Tumor Hospital, Changchun 130021, Jilin Province, China
| | - Hong-Di Lu
- The First Department of Thoracic Oncology, Jilin Province Tumor Hospital, Changchun 130021, Jilin Province, China
| | - Ying Wang
- The First Department of Thoracic Oncology, Jilin Province Tumor Hospital, Changchun 130021, Jilin Province, China
| | - Rui Zhang
- The First Department of Thoracic Oncology, Jilin Province Tumor Hospital, Changchun 130021, Jilin Province, China
| | - Xiang Li
- Big Data Center for Clinical Research, Jilin Province Tumor Hospital, Changchun 130021, Jilin Province, China
| | - Sheng Wang
- The First Department of Thoracic Oncology, Jilin Province Tumor Hospital, Changchun 130021, Jilin Province, China
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13
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Peng S, Xiao Y, Li X, Wu Z. A nomogram for predicting overall survival rate in patients with brain metastatic non-small cell lung cancer. Medicine (Baltimore) 2022; 101:e30824. [PMID: 36197226 PMCID: PMC9509136 DOI: 10.1097/md.0000000000030824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The purpose was to develop a nomogram for the prediction of the 1- and 2-year overall survival (OS) rates in patients with brain metastatic non-small cell lung cancer (BMNSCLC). Patients were collected from the Surveillance Epidemiology and End Results program (SEER) and classified into the training and validation groups. Several independent prognostic factors identified by statistical methods were incorporated to establish a predictive nomogram. The concordance index (C-index), the area under the receiver operating characteristics curve (AUC), and calibration curve were applied to estimate predictive ability of the nomogram. To compare the clinical practicability of the nomogram and TNM staging system by decision curve analysis (DCA). A total of 24,164 eligible patients were collected and assigned into the training (n = 16,916) and validation groups (n = 7248). Based on the prognostic factors, we developed a nomogram with good discriminative ability. The C-indices for training and validation group were 0.727 and 0.728. The AUCs of 1- and 2-year OS rates were both 0.8, and the calibration curves also demonstrated good performance of the nomogram. DCA illustrated that the nomogram provided clinical net benefit compared with the TNM staging system. We developed a predictive nomogram for more accurate and comprehensive prediction of OS in BMNSCLC patients, which can be a useful and convenient tool for clinicians to make proper clinical decisions, and adjust follow-up management strategies.
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Affiliation(s)
- Shanshan Peng
- The Central Hospital of Xiaogan, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Hubei, China
| | - Yu Xiao
- The Central Hospital of Xiaogan, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Hubei, China
| | - Xinjun Li
- The Central Hospital of Xiaogan, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Hubei, China
| | - Zhanling Wu
- The Central Hospital of Xiaogan, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Hubei, China
- *Correspondence: Zhanling Wu, The Central Hospital of Xiaogan, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, No. 6 People’s Square, Xiaonan District, Xiaogan City, Hubei Province, China (e-mail: )
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Organ-specific efficacy in advanced non-small cell lung cancer patients treated with first-line single-agent immune checkpoint inhibitors. Chin Med J (Engl) 2022; 135:1404-1413. [PMID: 35869859 PMCID: PMC9481449 DOI: 10.1097/cm9.0000000000002217] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Methods: Results: Conclusions:
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15
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Dong Q, Deng J, Mok TN, Chen J, Zha Z. Construction and Validation of Two Novel Nomograms for Predicting the Overall Survival and Cancer-Specific Survival of NSCLC Patients with Bone Metastasis. Int J Gen Med 2021; 14:9261-9272. [PMID: 34880665 PMCID: PMC8648091 DOI: 10.2147/ijgm.s342596] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/22/2021] [Indexed: 01/09/2023] Open
Abstract
Background Bone metastasis (BM) is the most common site of metastasis in non-small cell lung carcinoma (NSCLC). We aimed to construct and validate 2 novel nomograms predicting the 3-, 6-, and 12-months overall survival (OS) and cancer-specific survival (CSS). Methods The clinical data of 7480 patients between 2010 and 2016 were enrolled from the Surveillance, Epidemiology, and End Results database (SEER). The patients were allocated randomly to training and validation cohorts in a 7:3 ratio. Cox proportional hazards regression models were used to identify prognostic risk factors and establish 2 nomograms. The prediction accuracy of nomograms was assessed by C-index, the area under the ROC curve (AUC), and calibration curves. Results A total of 244998 NSCLC patients were identified between 2010 and 2016, with 7480 found with BM, accounting for 3.1%. Overall, 7480 patients were enrolled in the OS nomogram construction and were randomized to the training set (n = 5236) and the validation set (n = 2244). Age, sex, race, marital status, histology, grade, primary site, T stage, N stage, liver metastasis, surgery, radiotherapy, and chemotherapy were found to correlate with OS. A total of 7422 samples were included in the CSS nomogram construction, randomly grouped into training set (n = 5195) and the validation set (n = 2227). Age, sex, race, histology, grade, primary site, T stage, N stage, brain metastasis, liver metastasis, surgery, radiotherapy, and chemotherapy were associated with CSS. Two nomograms were conducted to predict the 3-, 6-, and 12-months OS and CSS. The ROC curves and exhibited good performance for predicting OS and CSS. Conclusion We established and validated 2 high-performance nomograms to assist clinical doctors in making personalized treatment decisions.
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Affiliation(s)
- Qiu Dong
- Center for Bone, Joint and Sports Medicine, The First Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, People's Republic of China
| | - Jialin Deng
- School of Medicine, Jinan University, Guangzhou, Guangdong, People's Republic of China
| | - Tsz Ngai Mok
- Center for Bone, Joint and Sports Medicine, The First Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, People's Republic of China
| | - Junyuan Chen
- Center for Bone, Joint and Sports Medicine, The First Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, People's Republic of China
| | - Zhengang Zha
- Center for Bone, Joint and Sports Medicine, The First Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, People's Republic of China
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Zhang Y, Zhang X, Wang F, Feng Y, Tang H. High quality of 58-month life in lung cancer patient with brain metastases sequentially treated with gefitinib and osimertinib. Open Med (Wars) 2021; 16:1602-1607. [PMID: 34722896 PMCID: PMC8546288 DOI: 10.1515/med-2021-0379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 11/28/2022] Open
Abstract
Brain metastases (BMs) and bone metastases seriously affect the prognosis of lung cancer patients. How to optimize the use of existing targeted drugs is an important way to address the clinical needs of the central nervous system in the individualized treatment of non-small cell lung cancer (NSCLC). In this report, we describe an NSCLC patient with BMs who survived for 58 months, which is the longest survival case among lung cancer patients with BMs. The patient was initially diagnosed with lung cancer more than 5 years ago with simultaneous brain, bone, and lung metastases. After gefitinib resistance, she received osimertinib in sequence with no progress for 58 months in total and maintained very good quality of life.
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Affiliation(s)
- Ying Zhang
- Department of Respiration Medicine, Qingdao Municipal Hospital, Qingdao, China
| | - Xiaowen Zhang
- Department of Traditional Chinese Acupuncture and Manipulation, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Fang Wang
- Department of Respiration Medicine, Qingdao Municipal Hospital, Qingdao, China
| | - Yan Feng
- Department of Respiration Medicine, Qingdao Municipal Hospital, Qingdao, China
| | - Huaping Tang
- Department of Respiration Medicine, Qingdao Municipal Hospital, Qingdao, China
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Chao C, Qian Y, Li X, Sang C, Wang B, Zhang XY. Surgical Survival Benefits With Different Metastatic Patterns for Stage IV Extrathoracic Metastatic Non-Small Cell Lung Cancer: A SEER-Based Study. Technol Cancer Res Treat 2021; 20:15330338211033064. [PMID: 34496678 PMCID: PMC8442485 DOI: 10.1177/15330338211033064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: With the knowledge of oligometastases, primary surgery plays an increasingly
vital role in metastatic non-small cell lung cancer. We aimed to evaluate
the survival benefit of primary surgery based on metastatic patterns. Materials and Methods: The selected patients with stage IV extrathoracic metastatic (m1b) non-small
cell lung cancer between 2010 and 2015 were included in a retrospective
cohort study from the Surveillance, Epidemiology, and End Results (SEER)
database. Multiple imputation was used for the missing data. Patients were
divided into 2 groups depending on whether surgery was performed. After
covariate balancing propensity score (CBPS) weighting, multivariate Cox
regression models and Kaplan-Meier survival curve were built to identify the
survival benefit of different metastatic patterns. Results: Surgery can potentially increase the overall survival (OS) (adjusted HR:
0.68, P < 0.001) of non-small cell lung cancer. The
weighted 3-year OS in the surgical group was 16.9%, compared with 7.8% in
the nonsurgical group. For single organ metastasis, surgery could improve
the survival of metastatic non-small cell lung cancer. Meanwhile, no
significant survival improvements in surgical group were observed in
patients with multiple organ metastases. Conclusion: The surgical survival benefits for extrathoracic metastatic non-small cell
lung cancer could be divided by metastatic pattern.
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Affiliation(s)
- Ce Chao
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Yongxiang Qian
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xihao Li
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Chen Sang
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Bin Wang
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xiao-Ying Zhang
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
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Zhang J, Yu Q, He Y, Hu T, Chen K, Yang Z, Zhang X, Cheng D, He Z. The Cancers-Specific Survival of Metastatic Pulmonary Carcinoids and Sites of Distant Metastasis: A Population-Based Study. Technol Cancer Res Treat 2021; 20:15330338211036528. [PMID: 34378452 PMCID: PMC8361524 DOI: 10.1177/15330338211036528] [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: 11/16/2022] Open
Abstract
Background: Lung cancer is the leading cause of cancer-related deaths and pulmonary carcinoids (PCs) account for almost 2% of all pulmonary malignancies. However, few published articles have reported prognosis and related factors of pulmonary carcinoid patients. Material and Method: The Surveillance, Epidemiology, and End Results (SEER) database was used to collect data of patients diagnosed with metastatic PCs from 2010 to 2016. The prognosis and survival of these patients were compared by employing Cox proportional hazards and the Kaplan-Meier survival analysis. Results: A total of 1763 patients were analyzed. The liver (668, 25.6%) was shown to be the most common metastatic site in the isolated organ metastasis cohort, followed by the lung (636, 24.4%), bone (562, 21.6%), and brain (460, 17.6%). Among the patients, the tumor metastasized to a single distant site included the liver, bone, lung, and brain. Cancer-specific survival (CSS) in metastatic PCs is determined by the site of metastasis and the total number of such sites. Pulmonary carcinoid patients with isolated liver metastasis manifested more favorable survival rates in comparison to patients having isolated metastasis in the lung, brain, or bone. The median CSS was 45, 7, 6, 5 months (P = 0.011). The number of distant metastatic sites and the location of distant metastasis were found to be independent risk factors for CSS. For patients with distant isolated metastasis, liver metastasis (P < 0.0001) had better CSS in comparison to those with bone metastasis. When compared to patients whose carcinoids had metastasized to the bones, patients with a brain (P = 0.273) or lung (P = 0.483) metastasis had the same CSS. Conclusion: Cancer-specific survival in metastatic PCs depends on the site of metastasis and the total number of such locations. PC patients with isolated liver metastasis manifested more favorable survival in comparison to patients with isolated metastasis in the lung, brain, or bone.
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Affiliation(s)
- Jiandong Zhang
- Department of Thoracic Surgery, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qiongjie Yu
- Department of Chemoradiation Oncology, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yi He
- Department of Respiration, 223528Shaoxing Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Traditional Chinese Medicine, Shaoxing, Zhejiang, China
| | - Tingting Hu
- Department of Chemoradiation Oncology, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Kun Chen
- Department of Thoracic Surgery, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhihao Yang
- Department of Thoracic Surgery, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xingbo Zhang
- Department of Thoracic Surgery, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Dezhi Cheng
- Department of Thoracic Surgery, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhifeng He
- Department of Thoracic Surgery, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Shen H, Deng G, Chen Q, Qian J. The incidence, risk factors and predictive nomograms for early death of lung cancer with synchronous brain metastasis: a retrospective study in the SEER database. BMC Cancer 2021; 21:825. [PMID: 34271858 PMCID: PMC8285786 DOI: 10.1186/s12885-021-08490-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/11/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The prognosis of lung cancer with synchronous brain metastasis (LCBM) is very poor, and patients often die within a short time. However, little is known about the early mortality and related factors in patients with LCBM. METHODS Patients diagnosed with LCBM between 2010 and 2016 were enrolled from the Surveillance, Epidemiology, and End Result (SEER) database. Univariate and multivariate logistic regression analysis were used to identify significant independent prognostic factors, which were used to construct nomograms of overall and cancer-specific early death. Then, the prediction ability of the model was verified by receiver operating characteristic (ROC) curve. At last, the clinical application value of the model was tested through decision curve analysis (DCA). RESULTS A total of 29,902 patients with LCBM were enrolled in this study. Among them, 13,275 (44.4%) patients had early death, and 11,425 (38.2%) cases died of lung cancer. The significant independent risk factors for overall and cancer-specific early death included age, race, gender, Gleason grade, histological type, T stage, N stage, bone metastasis, liver metastasis and marital status, which were used to construct the nomogram. The ROC curve demonstrated good predictive ability and clinical application value. The areas under the curve (AUC) of the training group was 0.793 (95% CI: 0.788-0.799) and 0.794 (95% CI: 0.788-0.799), in the model of overall and cancer-specific early death respectively. And the AUC of the validation group were 0.803 (95% CI: 0.788-0.818) and 0.806 (95% CI: 0.791-0.821), respectively. The calibration plots of the model showed that the predicted early death is consistent with the actual value. The DCA analysis indicated a good clinical application value of this model. CONCLUSIONS We established a comprehensive nomogram to predict early death in lung cancer patients with synchronous brain metastases. Nomograms may help oncologists develop better treatment strategies, such as clinical trials and hospice care.
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Affiliation(s)
- Heng Shen
- Department of neurosurgery, Suizhou Hospital, Hubei University of Medicine, 60 Longmen Street, Suizhou, 441399, Hubei, China
- Department of Neurosurgery, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei, China
| | - Gang Deng
- Department of Neurosurgery, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei, China
| | - Qianxue Chen
- Department of Neurosurgery, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei, China.
| | - Jin Qian
- Department of neurosurgery, Suizhou Hospital, Hubei University of Medicine, 60 Longmen Street, Suizhou, 441399, Hubei, China.
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Higuera Gómez O, Moreno Paul A, Ortega Granados AL, Ros Martínez S, Pérez Parente D, Ruiz Gracia P, Sáenz Cuervo-Arango L, Vilà L. "High Tumor Burden" in Metastatic Non-Small Cell Lung Cancer: Defining the Concept. Cancer Manag Res 2021; 13:4665-4670. [PMID: 34163241 PMCID: PMC8213951 DOI: 10.2147/cmar.s302928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/31/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose Identifying patient characteristics that define a worse disease prognosis or "high tumor burden" (HTB) status is essential for clinical decision-making and treatment selection in metastatic non-small cell lung cancer (mNSCLC). We aimed to define this concept based on the experience of oncologists in clinical practice. Patients and Methods A representative sample of Spanish experts was selected and asked to complete an online survey regarding the definition of HTB according to their personal experience. Results HTB was identified by the oncologists (N = 81) as one of the principle factors influencing first-line treatment decision-making. According to the experts, HTB is mainly defined by the number of metastatic lesions (n = 45, 56%), location (n = 34, 42%), tumor size (sum of diameters of target lesions; n = 26, 32%) and liver involvement (n = 24, 30). High lactate dehydrogenase (LDH) levels were also associated with HTB. Almost half of respondents (n = 33, 41%) believed that one metastatic lesion was sufficient to consider a patient as presenting HTB, 72% (n = 58) considered that two were necessary and 99% (n = 80) three. Liver (n = 76, 100%) followed by brain (n = 65, 86%) were the main metastatic sites associated with HTB. Tumor size ranging from 6 cm to 10 cm as well as high LDH levels (three times the upper limit) defined the concept for 82% (n = 62) and 100% (n = 76) of oncologists, respectively. Conclusion In the real-world setting, according to experts, HTB is defined by the number of metastatic lesions, location of metastases, tumor size and by high LDH levels. Given the relevance of this concept, efforts should be made to unify its definition and to further explore its potential as a prognostic factor for mNSCLC patients.
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Affiliation(s)
| | - Amaia Moreno Paul
- Medical Oncology Department, Galdakao University Hospital, Galdakao, Spain
| | | | | | | | - Pedro Ruiz Gracia
- Lung Cancer, Medical Affairs Department, Roche Farma S.A, Madrid, Spain
| | | | - Laia Vilà
- Medical Oncology Department, Parc Taulí University Hospital, Sabadell, Spain
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Armutlu A, Saeed O, Saxena R. Metastatic Liver Tumors in Surgical Pathology: Impact of Contemporary Diagnostic and Therapeutic Paradigms in a Tertiary Care Center. Int J Surg Pathol 2021; 30:138-144. [PMID: 34125627 DOI: 10.1177/10668969211022708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We analyzed metastatic liver tumors received in the department of pathology in a tertiary care center over a 3-year period. There were 509 metastatic liver tumors; counterintuitively, there were as many resections (235 cases) as biopsies (274 cases). This unexpected finding reflects contemporaneous organ-specific paradigms for diagnosis and management of metastatic liver disease in oncologic practice, and the association of our practice with a National Cancer Institute-designated comprehensive cancer center with expertise and specialization in liver surgery. We receive a large number of resections for metastatic liver tumors because metastasectomy from a variety of primary tumors is associated with improved overall, and in many instances, disease-free, long-term survival. Metastatic colorectal carcinomas, metastatic neuroendocrine tumors, and metastatic gastrointestinal stromal tumors constituted 78% of resections because the largest body of literature and cumulative experience exists for these lesions. In contrast, breast carcinomas and pancreatic carcinomas, which are the next common metastatic liver tumors were biopsied but rarely resected, because metastasectomy is not the standard of care for these tumors. Immunohistochemistry was performed in less than a quarter of the total number of cases (23%), because the primary tumor site was known in the vast majority of cases. Of the 42 cases with unknown primary tumor, it was elucidated in 50% of the cases by immunohistochemical and clinical work-up. Of the cases with known primary tumor, immunohistochemistry was performed mostly in metastatic breast, colon, and lung carcinomas. In these cases, biomarker analyses provided additional information relevant to clinical management.
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Affiliation(s)
| | - Omer Saeed
- 12250Indiana University School of Medicine, Indianapolis, IN, USA
| | - Romil Saxena
- 12250Indiana University School of Medicine, Indianapolis, IN, USA
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Wang L, Shi T, Feng L, Fan Z, Xu X, Zhou X, Zhang X, Han J, Jing L, Liu J, Shan Y, Liu F, Zuo J, Wang Y. The Prognostic Value of Baseline Distant Metastasis in Icotinib-Treated Patients with EGFR-Mutated Stage IV Non-Small Cell Lung Cancer. Cancer Manag Res 2021; 13:2613-2622. [PMID: 33776479 PMCID: PMC7987279 DOI: 10.2147/cmar.s298579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/22/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Several studies have revealed the prognostic value distant metastasis in non-small-cell lung cancer (NSCLC) patients receiving first-line epidermal growth factor receptor (EGFR) inhibitors. However, the question of whether the specific metastatic site could predict survival outcomes remain elusive. This study evaluated the prognostic value of specific metastatic site at diagnosis in first-line icotinib-treated patients with EGFR-mutated advanced NSCLC. Methods A total of 216 patients with EGFR-mutated stage IV NSCLC who received first-line icotinib treatment were retrospectively enrolled. The associations between the presence of distant metastasis to certain organs at diagnosis and survival outcomes were analyzed. Patients and methods The presence of distant metastases was not associated with progression-free survival. Patients with liver metastasis showed a significantly shorter OS than those without liver metastasis (14.6m vs 33.0m, p=0.024). Patients with brain metastasis showed a marginally shorter OS than those without brain metastasis (26.5m vs 33.8m, p=0.051). Patients with lung metastasis showed a significantly longer OS than those without lung metastasis (36.0m vs 28.6m, p=0.038). Multivariable Cox regression analysis showed the presence of liver metastasis (HR [hazard ratio]: 2.265, 95% CI [confidence interval]: 1.239-4.139, p=0.008) and brain metastasis (HR: 1.493, 95% CI: 1.012-2.202, p=0.043) were independent predictors for unfavorable OS, while lung metastasis (HR: 0.669, 95% CI: 0.460-0.971, p=0.034) was an independent predictor for favorable OS. Conclusion The presence of liver and brain metastasis predicted unfavorable OS, while the presence of lung metastasis predicted favorable OS in first-line icotinib-treated patients with EGFR-mutated stage IV NSCLC.
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Affiliation(s)
- Long Wang
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Tiantian Shi
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Li Feng
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Zhisong Fan
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Xiaoli Xu
- Department of Medical Records, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Xinliang Zhou
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Xue Zhang
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Jing Han
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Li Jing
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Jiayin Liu
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Yujie Shan
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Fengling Liu
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Jing Zuo
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
| | - Yudong Wang
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, People's Republic of China
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Li G, Xie S, Hu F, Tan M, Fan L, Wang C. Segmentectomy or Wedge Resection in Stage IA Lung Squamous Cell Carcinoma and Adenocarcinoma? J Cancer 2021; 12:1708-1714. [PMID: 33613758 PMCID: PMC7890327 DOI: 10.7150/jca.49683] [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] [Received: 06/18/2020] [Accepted: 12/24/2020] [Indexed: 11/05/2022] Open
Abstract
Objectives: We performed this study to compare survival outcomes of segmentectomy (SG) and wedge resection (WR) in stage IA lung squamous cell carcinoma (SQCC) and lung adenocarcinoma (AD). Methods: Using the Surveillance, Epidemiology, and End Results registry (SEER), we identified 1529 and 4070 patients with stage IA SQCC and AD, respectively, who had complete clinical information between 2004 and 2015. We used Kaplan-Meier analysis to determine the propensity score for patients with limited resection based on the preoperative characteristics of patients. Lung cancer-specific survival (LCSS) was compared in patients treated with WR and SG after adjusting, stratifying, or matching lung cancer patients according to propensity score. Results: Kaplan-Meier analysis demonstrated that there was a statistically significant difference in survival curves (log rank P=0.01) for patients with stage IA SQCC between SG and WR. But there was no statistically significant difference in survival curves (log rank P>0.05) in patients with stage IA AD between the two limited resections. Compared with the WR, The hazard ratios (95% confidence intervals) of SG were 0.689 (0.519-0.914) and 0.896 (0.752-1.067) in patients with stage IA SQCC and AD, respectively. Conclusion: This study suggests that SG can yield superior survival outcome compared with WR in patients with stage IA SQCC. However, the survival outcomes of SG and WR are generally equivalent in patients with stage IA AD.
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Affiliation(s)
- Guoshu Li
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Shuanshuan Xie
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Feng Hu
- Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai 200336, China
| | - Min Tan
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Lihong Fan
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Changhui Wang
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
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Campos‐Balea B, de Castro Carpeño J, Massutí B, Vicente‐Baz D, Pérez Parente D, Ruiz‐Gracia P, Crama L, Cobo Dols M. Prognostic factors for survival in patients with metastatic lung adenocarcinoma: An analysis of the SEER database. Thorac Cancer 2020; 11:3357-3364. [PMID: 32986309 PMCID: PMC7606019 DOI: 10.1111/1759-7714.13681] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/11/2020] [Accepted: 09/11/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Lung adenocarcinoma (ADC) is the main cause of death related to lung cancer. The aim of this study was to identify poor prognostic factors for overall survival (OS) in patients with stage IV lung ADC in real-world clinical practice. METHODS Patients were selected from the Surveillance Epidemiology and End Results (SEER) database. Chi-square bivariate analysis was used for the association of binary qualitative variables. A multivariate Cox regression analysis was performed to determine the impact of these prognostic factors on OS. RESULTS A total of 46 030 patients were included (51.3% men, mean age 67.03 ± 11.6), of whom 41.3% presented with metastases in bone, 28.9% in brain, 17.1% in liver and 31.8% in lung. Patients with liver metastases presented with two or more metastatic sites more frequently than patients without liver metastases (P < 0.001). Male sex (HR 0.78, 95% CI: 0.76-0.80), age ≥ 65 years (HR 1.37, 95% CI: 1.33-1.40), lack of family support (HR 0.80, 95% CI: 0.78-0.81) and presence of liver (HR 1.45, 95% CI: 1.40-1.50), bone (HR 1.21, 95% CI: 1.18-1.24) or brain metastases (HR 1.18, 95% CI: 1.15-1.21) were identified as poor prognostic factors for OS. Patients with liver metastasis showed the highest hazard ratio value (P < 0.001). CONCLUSIONS The presence of liver metastases was the worst prognostic factor for patients with metastatic lung ADC. This factor should be considered as a stratification factor for future studies evaluating new cancer treatments including immunotherapy. KEY POINTS SIGNIFICANT FINDINGS OF THE STUDY: Regression analysis identified poor prognostic factors for overall survival. Factors were male sex, age ≥ 65 years, lack of family support and presence of liver, bone and brain metastases. Patients with liver metastasis showed the highest HR (HR = 1.45 95% CI: 1.40-1.50). This study included the highest number of adenocarcinoma patients analyzed so far (N = 46 030). What this study adds The presence of liver metastases should be considered as a stratification factor for future studies evaluating new cancer treatments including immunotherapy.
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Affiliation(s)
| | | | | | | | | | | | - Leonardo Crama
- Lung Cancer. Medical Affairs Department, Roche Farma S.AMadridSpain
| | - Manuel Cobo Dols
- Medical Oncology, Unidad de Gestión Clínica Intercentros de Oncología Médica. Hospitales Universitarios Regional y Virgen de la Victoria. IBIMAMálagaSpain
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Wallrabenstein T, Del Rio J, Templeton AJ, Buess M. Much has changed in the last decade except overall survival: A Swiss single center analysis of treatment and survival in patients with stage IV non-small cell lung cancer. PLoS One 2020; 15:e0233768. [PMID: 32470017 PMCID: PMC7259780 DOI: 10.1371/journal.pone.0233768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 05/12/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Molecular therapies for cancers with targetable driver mutations and immunotherapies have revolutionized treatment of non-small cell lung cancer (NSCLC) during the last decade. International treatment guidelines began integrating targeted therapies in 2009 and immunotherapies in 2015. The aim of this study was to examine whether the benefits described for these new therapies in pivotal phase III trials have been translated to a real world patient population. PATIENTS AND METHODS Data from all consecutive patients diagnosed with stage IV NSCLC diagnosed at a community hospital in Switzerland between 2007 and 2018 were analyzed. Three groups of patients were compared, namely patients diagnosed before 2009 (group 1), between 2009 and 2015 (introduction of targeted therapies, group 2) and after 2015 (introduction of immunotherapies, group 3). The primary outcome was overall survival (OS). Time to treatment failure was a secondary outcome. Both endpoints were estimated using the Kaplan Meyer method and compared by log-rank test. RESULTS 408 patients were included. Patient characteristics were similar in the three groups. Median OS in groups 1, 2, and 3 was 9.8 (95% CI, 6.2 to 13.4), 9.9 (95% CI, 7.6 to 12.1) and 8.6 (95% CI, 6.6 to 10.5) months, respectively (p = 0.5). Across groups patients treated with targeted- and immunotherapies had a significantly better outcome than those treated with chemotherapy or best supportive care (p<0.001). Nevertheless, OS remained unchanged between groups despite adequate molecular testing and integration of targeted- and immunotherapies. Over time, the patient population got more morbid with respect to tumor burden (p = 0.02) and co-morbidities (p = 0.02). CONCLUSIONS While selected subgroups of patients may benefit from new therapies, outcome in this unselected population of patients with stage IV NSCLC treated in daily practice has not improved over the last decade.
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Affiliation(s)
- Till Wallrabenstein
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Jessica Del Rio
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Arnoud J. Templeton
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Division of Medical Oncology, St. Claraspital, Basel, Switzerland
| | - Martin Buess
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Division of Medical Oncology, St. Claraspital, Basel, Switzerland
- * E-mail:
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Machado Medeiros T, Altmayer S, Watte G, Zanon M, Basso Dias A, Henz Concatto N, Hoefel Paes J, Mattiello R, de Souza Santos F, Mohammed TL, Verma N, Hochhegger B. 18F-FDG PET/CT and whole-body MRI diagnostic performance in M staging for non-small cell lung cancer: a systematic review and meta-analysis. Eur Radiol 2020; 30:3641-3649. [PMID: 32125513 DOI: 10.1007/s00330-020-06703-1] [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: 08/19/2019] [Revised: 12/26/2019] [Accepted: 02/03/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate the diagnostic test accuracy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT), whole-body magnetic resonance imaging (WB-MRI), and whole-body diffusion-weighted imaging (WB-DWI) for the detection of metastases in patients with non-small cell lung cancer (NSCLC). METHODS MEDLINE, Embase, and Cochrane Library databases were searched up to June 2019. Studies were selected if they reported data that could be used to construct contingency tables to compare 18F-FDG PET/CT, WB-MRI, and WB-DWI. Two authors independently extracted data on study characteristics and assessed methodological quality using the Quality Assessment of Diagnostic Accuracy Studies. Forest plots were generated for sensitivity and specificity of 18F-FDG PET/CT, WB-MRI, and whole-body diffusion-weighted imaging (WB-DWI). Summary receiver operating characteristic plots were created. RESULTS The 4 studies meeting inclusion criteria had a total of 564 patients and 559 lesions, 233 of which were metastases. In studies of 18F-FDG PET/CT, the pooled estimates of sensitivity and specificity were 0.83 (95% confidence interval [CI], 0.54-0.95) and 0.93 (95% CI, 0.87-0.96), respectively. For WB-MRI, pooled sensitivity was 0.92 (95% CI, 0.18-1.00) and pooled specificity was 0.93 (95% CI, 0.85-0.95). Pooled sensitivity and specificity for WB-DWI were 0.78 (95% CI, 0.46-0.93) and 0.91 (95% CI, 0.79-0.96), respectively. There was no statistical difference between the diagnostic odds ratio of WB-MRI and WB-DWI compared with that of PET/CT (p = 0.186 for WB-DWI; p = 0.638 for WB-MRI). CONCLUSION WB-MRI and DWI are radiation-free alternatives with comparable diagnostic performance to 18F-FDG PET/CT for M staging of NSCLC. KEY POINTS • Whole-body MRI with or without diffusion-weighted imaging has a high accuracy for the diagnostic evaluation of metastases in patients with non-small cell lung cancer. • Whole-body MRI may be used as a non-invasive and radiation-free alternative to positron emission tomography with CT with similar diagnostic performance.
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Affiliation(s)
- Tássia Machado Medeiros
- Postgraduate Program in Medicine and Health Sciences, Pontificia Universidade Catolica do Rio Grande do Sul, Av. Ipiranga, 6690, Porto Alegre, 90619900, Brazil
| | - Stephan Altmayer
- Postgraduate Program in Medicine and Health Sciences, Pontificia Universidade Catolica do Rio Grande do Sul, Av. Ipiranga, 6690, Porto Alegre, 90619900, Brazil.,Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Av. Independência, 75, Porto Alegre, 90020160, Brazil
| | - Guilherme Watte
- Postgraduate Program in Medicine and Health Sciences, Pontificia Universidade Catolica do Rio Grande do Sul, Av. Ipiranga, 6690, Porto Alegre, 90619900, Brazil
| | - Matheus Zanon
- Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Av. Independência, 75, Porto Alegre, 90020160, Brazil.,Department of Radiology, Federal University of Health Sciences of Porto Alegre, R. Sarmento Leite, 245, Porto Alegre, 90050170, Brazil
| | - Adriano Basso Dias
- Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Av. Independência, 75, Porto Alegre, 90020160, Brazil
| | - Natália Henz Concatto
- Department of Radiology, Hospital de Clínicas de Porto Alegre, R. Ramiro Barcelos, 2350, Porto Alegre, 90035903, Brazil
| | - Julia Hoefel Paes
- Postgraduate Program in Medicine and Health Sciences, Pontificia Universidade Catolica do Rio Grande do Sul, Av. Ipiranga, 6690, Porto Alegre, 90619900, Brazil
| | - Rita Mattiello
- Postgraduate Program in Medicine and Health Sciences, Pontificia Universidade Catolica do Rio Grande do Sul, Av. Ipiranga, 6690, Porto Alegre, 90619900, Brazil
| | - Francisco de Souza Santos
- Postgraduate Program in Medicine and Health Sciences, Pontificia Universidade Catolica do Rio Grande do Sul, Av. Ipiranga, 6690, Porto Alegre, 90619900, Brazil
| | - Tan-Lucien Mohammed
- Department of Radiology, College of Medicine - University of Florida, 1600 SW Archer Rd, Gainesville, FL, 32611, USA
| | - Nupur Verma
- Department of Radiology, College of Medicine - University of Florida, 1600 SW Archer Rd, Gainesville, FL, 32611, USA
| | - Bruno Hochhegger
- Postgraduate Program in Medicine and Health Sciences, Pontificia Universidade Catolica do Rio Grande do Sul, Av. Ipiranga, 6690, Porto Alegre, 90619900, Brazil. .,Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Av. Independência, 75, Porto Alegre, 90020160, Brazil. .,Department of Radiology, Federal University of Health Sciences of Porto Alegre, R. Sarmento Leite, 245, Porto Alegre, 90050170, Brazil.
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Wen J, Chen J, Liu D, Xu X, Fan M, Zhang Z. The Eighth Edition of the American Joint Committee on Cancer Distant Metastases Stage Classification for Metastatic Pancreatic Neuroendocrine Tumors Might Be Feasible for Metastatic Pancreatic Ductal Adenocarcinomas. Neuroendocrinology 2020; 110:364-376. [PMID: 31357196 DOI: 10.1159/000502382] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/29/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Significant modifications have been made to the 8th edition of the American Joint Committee on Cancer (AJCC) distant metastases (M) stage classification for metastatic pancreatic neuroendocrine tumors (PanNETs). We aimed to validate this revised classification among metastatic PanNET patients using the Surveillance, Epidemiology, and End Results database. We further sought to evaluate the feasibility of applying this classification to metastatic pancreatic neuroendocrine carcinoma (PanNEC) and pancreatic ductal adenocarcinoma (PDAC) patients. METHODS Stage IV pancreatic neuroendocrine neoplasm (PanNEN, including G1/G2 PanNET and G3 PanNEC classified according to the World Health Organization [WHO] 2010 grading scheme) and PDAC patients with metastatic disease diagnosed between 2010 and 2015 were identified and restaged according to the revised M stage classification for PanNET. Overall survival (OS) was compared using Kaplan-Meier analysis and log-rank test. Uni- and multivariate Cox regression models were utilized to identify prognostic factors. RESULTS A total of 1,371 stage IV PanNEN and 634 PDAC patients were included. Among PanNEN patients, liver (75.0%) was the most common metastatic site, followed by distant lymph nodes (8.5%), lung (8.4%), bone (7.3%), and brain (1.0%). The 5-year OS for PanNET patients with M1a, M1b, and M1c stage was 44.15, 53.32, and 19.70%, respectively. However, survival comparison showed no significant difference between M1a and M1b stages among PanNET patients. Similar findings were noted after applying this classification to PanNEC patients. Multivariate analysis showed that the age at diagnosis and the number of distant metastatic sites were independent prognostic factors for metastatic PanNEN patients. Interestingly, excellent survival discrimination by M stage among stage IV PDAC patients was noted (M1a vs. M1b vs. M1c, 5-year OS: 5.42, 2.46, and 0%, respectively). CONCLUSION Our study is the first large sample-based validation of the AJCC 8th M stage classification for PanNET. The revised classification did not effectively stratify metastatic PanNEN patients. However, further study is warranted to validate this classification for PanNET patients according to the WHO 2017 classification. Interestingly, the revised M stage classification might be feasible for PDAC patients with metastatic disease.
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Affiliation(s)
- Junmiao Wen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiayan Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Di Liu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xinyan Xu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Min Fan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China,
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China,
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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28
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Bai SB, Liu DZ, Cheng Y, Cui H, Liu M, Cui MX, Zhang BL, Mei QB, Zhou SY. Osteoclasts and tumor cells dual targeting nanoparticle to treat bone metastases of lung cancer. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2019; 21:102054. [DOI: 10.1016/j.nano.2019.102054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/16/2019] [Accepted: 06/30/2019] [Indexed: 01/01/2023]
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29
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Wang Y, Pang Z, Chen X, Bie F, Wang Y, Wang G, Liu Q, Du J. Survival nomogram for patients with initially diagnosed metastatic non-small-cell lung cancer: a SEER-based study. Future Oncol 2019; 15:3395-3409. [PMID: 31512954 DOI: 10.2217/fon-2019-0007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aim: Prognosis of patients with metastatic non-small-cell lung cancer differ widely. Methods: All patients were randomly divided into training or validation cohort. Cox-regression analyses were conducted to select independent predictors. We built a nomogram by R code and evaluated the accuracy and the reliability of the model using C-index, calibration curves and decision curve analyses. We made a risk classification system based on the nomogram. Results: In the validation cohort, C-index was 0.729 and 0.738 for 1- and 2-year overall survival. Calibration plots and decision curve analyses presented great prognostic accuracy and clinical applicability. Its prognostic accuracy preceded the American Joint Committee on Cancer staging with evaluated integrated discrimination improvement. Conclusion: The model can be a practical tool in treatment decision and individual counseling.
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Affiliation(s)
- Yu Wang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, PR China
| | - Zhaofei Pang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, PR China
| | - Xiaowei Chen
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, PR China
| | - Fenglong Bie
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, PR China
| | - Yadong Wang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, PR China
| | - Guanghui Wang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, PR China
| | - Qi Liu
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, PR China
| | - Jiajun Du
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, PR China.,Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, PR China
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The prognostic impact of lymph node metastasis in patients with non-small cell lung cancer and distant organ metastasis. Clin Exp Metastasis 2019; 36:457-466. [PMID: 31420766 DOI: 10.1007/s10585-019-09985-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/29/2019] [Indexed: 12/29/2022]
Abstract
This study aimed to identify the prognostic value of lymph node metastasis in patients with non-small cell lung cancer (NSCLC) and distant organ metastasis. A total of 42,613 NSCLC patients with distant metastasis from the surveillance, epidemiology, and end results database between 2010 and 2013 were included for analysis. The proportion of N0 stage in M1a patients was significantly higher than that in M1b patients, 34.0% and 22.7% respectively (P < 0.001). Compared with N0 patients, patients had higher odds of experiencing multiorgan metastases (MOM) if they had higher N stage at diagnoses (P < 0.001). The Kaplan-Meier curves suggested both M1a and M1b groups patients at stage N0 had better survival than those at higher N stage (P < 0.001). Further analysis indicated that better survival was observed in N0 stage compared with N2 or N3 stage if patients had bone metastasis, brain metastasis, or MOM (P < 0.001, P < 0.001, and P = 0.002, respectively), but there was no significant difference in survival among each N stage patients with liver metastasis only. Cox regression analysis showed that compared with N0 patients, higher hazard for disease-specific mortality was observed for patients with higher N stage. Among NSCLC patients with distant organ metastasis, lymph node metastasis was associated with higher odds of experiencing MOM and a worse prognosis in terms of longer survival except patients with liver metastasis. Better understandings of the role of lymphatic metastasis in M1 NSCLC could help clinicians with better management of the disease.
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Zheng XQ, Huang JF, Lin JL, Chen L, Zhou TT, Chen D, Lin DD, Shen JF, Wu AM. Incidence, prognostic factors, and a nomogram of lung cancer with bone metastasis at initial diagnosis: a population-based study. Transl Lung Cancer Res 2019; 8:367-379. [PMID: 31555512 PMCID: PMC6749127 DOI: 10.21037/tlcr.2019.08.16] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/12/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Bone is one of the common metastatic sites of lung cancer, and its prognosis is not optimistic. We performed a study to evaluate the incidence, survival, and prognostic factors of lung cancer with bone metastasis (LCBM) at initial diagnosis, and to develop a nomogram to predict its outcomes. METHODS We conducted a retrospective study choosing 13,541 patients with LCBM from the Surveillance, Epidemiology, and End Results (SEER) 18 registry database. An X-tile analysis provided the optimal age cutoff point. The incidence, overall survival, and prognosis of bone metastasis were evaluated according to the patient information, characteristics of the tumor, and therapy. We also used multivariable Cox regression to estimate mortality hazard ratios (HRs) among patients with LCBM, while a visual nomogram was established to judge the prognosis. RESULTS The incidence of disease increased with age, but survival rates show the opposite trend. The median survival time was about 4 months. In addition, although the differences for patient race is not significant (P=0.445), White patients are prone to have bone metastases from lung cancer according to the incidence analysis. The difference for laterality is also not significant (P=0.534), while the factors of age, gender, the total number of sites, histological types, grade, tumor size, and treatment are significantly related to the outcome of patients with LCBM. Furthermore, our nomogram could predict the probability of surviving to the median survival time of the population with a c-index of 0.72. CONCLUSIONS Age, characteristics of the tumor, and therapy should be considered for prediction of prognosis for patients with lung cancer bone metastasis. Putatively, the younger patients and the patients with chemotherapy and surgery may indicate improved survival.
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Affiliation(s)
- Xuan-Qi Zheng
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou 325027, China
| | - Jin-Feng Huang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou 325027, China
| | - Jia-Liang Lin
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou 325027, China
| | - Liang Chen
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou 325027, China
| | - Ting-Ting Zhou
- Department of Thoracic Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Dong Chen
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou 325027, China
| | - Dong-Dong Lin
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Jian-Fei Shen
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, China
| | - Ai-Min Wu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou 325027, China
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Wang B, Chen L, Huang C, Lin J, Pan X, Shao Z, Hu S, Zhang X, Wang X. The homogeneous and heterogeneous risk factors for occurrence and prognosis in lung cancer patients with bone metastasis. J Bone Oncol 2019; 17:100251. [PMID: 31372332 PMCID: PMC6661364 DOI: 10.1016/j.jbo.2019.100251] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/08/2019] [Accepted: 07/08/2019] [Indexed: 01/26/2023] Open
Abstract
Purpose To analyse the homogeneous and heterogeneous risk factors for occurrence and prognosis in lung cancer patients diagnosed with bone metastasis (BM) by using the Surveillance, Epidemiology, and End Results (SEER) database. Patients and methods The medical records of lung cancer patients with or without bone metastasis were identified in the SEER database between 2010 and 2015. A multivariate logistic regression analysis was performed to identify risk factors, and a multivariate Cox regression was used to determine the prognostic effects of every variable on survival. Results In total, 34,585 eligible patients from the SEER database were included in the analysis. Male gender and metastasis to the liver were factors that were both positively associated with a risk for the development and prognosis of bone metastasis in patients with lung cancer. Younger age, poor tumour differentiation grade, higher N stage (N3), adenocarcinoma and metastasis to the brain were all positively correlated with a risk of occurrence of BM, but these factors were not correlated with an unfavourable prognosis. Age, race, marital status, tumour size and pathologic type were independent risk factors for the prognosis of bone metastasis. Conclusion The morbidity of bone metastasis in lung cancer patients is dismal, with a rate of 25.9%. The findings of this study estimate the homogeneous and heterogeneous risk factors for the occurrence and prognosis of bone metastasis in lung cancer patients, which may provide clinical guidelines for physicians.
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Affiliation(s)
- Ben Wang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, Zhejiang, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Lijie Chen
- Department of Surgical Oncology, Taizhou Hospital of Wenzhou Medical University, Taizhou 317000, Zhejiang, China
| | - Chongan Huang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, Zhejiang, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Jialiang Lin
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, Zhejiang, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Xiangxiang Pan
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, Zhejiang, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Zhenxuan Shao
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, Zhejiang, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Sunli Hu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, Zhejiang, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Xiaolei Zhang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, Zhejiang, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Chinese Orthopaedic Regenerative Medicine Society, Hangzhou, Zhejiang, China
| | - Xiangyang Wang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, Zhejiang, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
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Liao Y, Fan X, Wang X. Effects of different metastasis patterns, surgery and other factors on the prognosis of patients with stage IV non-small cell lung cancer: A Surveillance, Epidemiology, and End Results (SEER) linked database analysis. Oncol Lett 2019; 18:581-592. [PMID: 31289530 PMCID: PMC6546983 DOI: 10.3892/ol.2019.10373] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 04/10/2019] [Indexed: 12/26/2022] Open
Abstract
The surgical treatment of patients with advanced lung cancer remains controversial. The current study aimed to identify the factors affecting the prognosis of patients with stage IV non-small cell lung cancer (NSCLC) and to clarify the surgery guidelines. A total of 27,725 patients diagnosed with stage IV NSCLC were selected from the Surveillance, Epidemiology, and End Results program between 2010 and 2013. The sex, age, ethnicity, marital status, Tumor-Node-Metastasis stage, radiation therapy received and surgical status of each patient were recorded. Patients were followed up to November 2015. Survival rates were estimated by the Kaplan-Meier method. Single- and multi-factor analyses were performed using the log-rank test and multivariate Cox regression analysis respectively. In the isolated organ metastasis cohort, patients with liver metastasis alone had the worst prognosis, with a median overall survival (OS) of 4 months (liver metastasis vs. other organ metastases; P<0.001). Patients with lung metastasis only had the best prognosis, with a median OS of 8 months (lung metastasis vs. other organ metastases; P<0.001). Furthermore, patients with only one metastasis had the best prognosis, with a median OS of 6 months (single metastasis vs. multiple-organ metastases; P<0.001). The multivariate Cox regression analysis of the isolated-organ metastasis cohort and the multiple-organ metastases cohort revealed that patients who were ≤60 years, female, married, Asian, with N0 stage, had only bone metastasis, accepted wedge resection or lobectomy of the primary tumor, had surgical procedure to distant lymph node(s), and received beam radiation had an improved prognosis compared with the other patients. Age, sex, tumor type, ethnicity, N stage, number and type of metastatic lesions, surgical treatment of primary and metastatic lesions and radiation therapy are factors which influence the prognosis of patients with stage IV NSCLC. Furthermore, surgery may still benefit these patients.
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Affiliation(s)
- Yi Liao
- Department of Respiratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Xianming Fan
- Department of Respiratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Xue Wang
- Department of Respiratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
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Xu Z, Yang Q, Chen X, Zheng L, Zhang L, Yu Y, Chen M, You Q, Sun J. Clinical associations and prognostic value of site-specific metastases in non-small cell lung cancer: A population-based study. Oncol Lett 2019; 17:5590-5600. [PMID: 31186781 PMCID: PMC6507334 DOI: 10.3892/ol.2019.10225] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/25/2019] [Indexed: 02/06/2023] Open
Abstract
The prognosis of non-small cell lung cancer (NSCLC) is poor, particularly for patients with metastatic disease. Numerous efforts have been made to improve the prognosis of these patients; however, only a small number of studies have explored the occurrence rate and prognostic value of different patterns of distant metastasis (DM) in NSCLC systematically. To investigate these, information from patients diagnosed with NSCLC between 2010 and 2014 was collected from the Surveillance, Epidemiology and End Results database. Survival rate comparisons were performed using Kaplan-Meier analysis and log-rank tests. A Cox proportional hazard model was established to determine factors associated with improved overall survival (OS) and cancer-specific survival (CSS). The present study revealed that the most common site of single metastasis occurrence was bone, and the least common was the liver for NSCLC. As for multi-site metastases, the most common two-site metastasis involved bone and lung, and the most common three-site metastasis involved bone, liver and lung. As for NSCLC subtypes, large cell carcinoma (LCC) exhibited more specific metastatic features. The most common single metastatic site was the brain for patients with LCC, and the most common two-site metastatic combination was bone and liver. Patients with isolated liver metastasis exhibited the worst OS and CSS among patients with single metastasis. Furthermore, for patients with multi-site metastases, metastases involving the liver were associated with the worst OS and CSS among various combinations. To the best of our knowledge, the present study is the first to investigate the occurrence rate and prognostic value of different metastatic patterns of site-specific DM for NSCLC using a large population-based dataset. The findings of the present study may have vital implications for classifying patients with advanced NSCLC, thus laying a foundation for individualized precise treatment.
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Affiliation(s)
- Zihan Xu
- Department of Oncology, Cancer Institute of The People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
| | - Qiao Yang
- Department of Oncology, Cancer Institute of The People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
| | - Xiewan Chen
- Department of Medical English, College of Basic Medicine, Army Medical University, Chongqing 400038, P.R. China
| | - Linpeng Zheng
- Department of Oncology, Cancer Institute of The People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
| | - Luping Zhang
- Department of Oncology, Cancer Institute of The People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
| | - Yongxin Yu
- Department of Oncology, Cancer Institute of The People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
| | - Mingjing Chen
- Department of Oncology, Cancer Institute of The People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
| | - Qiai You
- Department of Oncology, Cancer Institute of The People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
| | - Jianguo Sun
- Department of Oncology, Cancer Institute of The People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
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Zhang R, Li P, Li Q, Qiao Y, Xu T, Ruan P, Song Q, Fu Z. Radiotherapy improves the survival of patients with extensive-disease small-cell lung cancer: a propensity score matched analysis of Surveillance, Epidemiology, and End Results database. Cancer Manag Res 2018; 10:6525-6535. [PMID: 30555258 PMCID: PMC6278721 DOI: 10.2147/cmar.s174801] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The survival advantage of radiotherapy for patients with extensive-disease small-cell lung cancer (ED-SCLC) has not been adequately evaluated. Methods We analyzed stage IV SCLC patients enrolled from the Surveillance, Epidemiology, and End Results (SEER) registry through January 2010 and December 2012. Propensity score analysis with 1:1 matching was performed to ensure well-balanced characteristics of all comparison groups. Kaplan-Meier and Cox proportional hazardous model were used to evaluate the overall survival (OS), cancer-specific survival (CSS), and corresponding 95% CI. Results Overall, for all metastatic ED-SCLC, receiving radiotherapy was associated with both improved OS and CSS. Radiotherapy for thoracic lesion and any metastatic sites could significantly improve the OS and CSS, except for brain metastasis. For M1a-SCLC patient, radiotherapy, most likely to the primary site, significantly improved the survival (P<0.001). Furthermore, for those ED-SCLC patients with ≥ 2 metastatic sites, that is, polymetastatic ED-SCLC patients, radiation also significantly improved the median OS from 6.0 to 8.0 months (P=0.015) and the median CSS from 7.0 to 8.0 months (P=0.020). Conclusion The large SEER results support that radiotherapy in addition to chemotherapy might improve the survival of patients with metastatic ED-SCLC.
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Affiliation(s)
- Rui Zhang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China,
| | - Ping Li
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China,
| | - Qin Li
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China,
| | - Yunfeng Qiao
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China,
| | - Tangpeng Xu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China,
| | - Peng Ruan
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China,
| | - Qibin Song
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China,
| | - Zhenming Fu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China,
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