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Izaki Y, Mimae T, Kagimoto A, Handa Y, Tsutani Y, Miyata Y, Okada M, Takeshima Y. Differences in postoperative prognosis between early-stage lung adenocarcinoma and squamous cell carcinoma. Jpn J Clin Oncol 2024; 54:813-821. [PMID: 38677985 DOI: 10.1093/jjco/hyae049] [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: 01/10/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Although prognosis and treatments differ between small-cell- and nonsmall-cell carcinoma, comparisons of the histological types of NSCLC are uncommon. Thus, we investigated the oncological factors associated with the prognosis of early-stage adenocarcinoma and squamous cell carcinoma. METHODS We retrospectively compared the clinicopathological backgrounds and postoperative outcomes of patients diagnosed with pathological stage I-IIA adenocarcinoma and squamous cell carcinoma primary lung cancer completely resected at our department from January 2007 to December 2017. Multivariable Cox regression analysis for overall survival and recurrence-free survival was performed. RESULTS The median follow-up duration was 55.2 months. The cohort consisted of 532 adenocarcinoma and 96 squamous cell carcinoma patients. A significant difference in survival was observed between the two groups, with a 5-year overall survival rate of 90% (95% confidence interval 86-92%) for adenocarcinoma and 77% (95% CI 66-85%) for squamous cell carcinoma (P < 0.01) patients. Squamous cell carcinoma patients had worse outcomes compared to adenocarcinoma patients in stage IA disease, but there were no significant differences between the two groups in stage IB or IIA disease. In multivariate analysis, invasion diameter was associated with overall survival in adenocarcinoma (hazard ratio 1.76, 95% confidence interval 1.36-2.28), but there was no such association in squamous cell carcinoma (hazard ratio 0.73, 95% confidence interval 0.45-1.14). CONCLUSIONS The importance of tumor invasion diameter in postoperative outcomes was different between adenocarcinoma and squamous cell carcinoma. Thus, it is important to consider that nonsmall-cell carcinoma may have different prognoses depending on the histological type, even for the same stage.
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Affiliation(s)
- Yu Izaki
- Department of Surgical Oncology, Hiroshima University Hospital, Hiroshima, Japan
| | - Takahiro Mimae
- Department of Surgical Oncology, Hiroshima University Hospital, Hiroshima, Japan
| | - Atsushi Kagimoto
- Department of Surgical Oncology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yoshinori Handa
- Department of Surgical Oncology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yasuhiro Tsutani
- Department of Surgical Oncology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yoshihiro Miyata
- Department of Surgical Oncology, Hiroshima University Hospital, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yukio Takeshima
- Department of Pathology, , Graduate School of Biomedical and Health Sciences, Hiroshima University Hospital, Hiroshima, Japan
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Sieminska J, Miniewska K, Mroz R, Sierko E, Naumnik W, Kisluk J, Michalska-Falkowska A, Reszec J, Kozlowski M, Nowicki L, Moniuszko M, Kretowski A, Niklinski J, Ciborowski M, Godzien J. First insight about the ability of specific glycerophospholipids to discriminate non-small cell lung cancer subtypes. Front Mol Biosci 2024; 11:1379631. [PMID: 38725870 PMCID: PMC11079276 DOI: 10.3389/fmolb.2024.1379631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/05/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction: Discrimination between adenocarcinoma (ADC) and squamous cell carcinoma (SCC) subtypes in non-small cell lung cancer (NSCLC) patients is a significant challenge in oncology. Lipidomics analysis provides a promising approach for this differentiation. Methods: In an accompanying paper, we explored oxPCs levels in a cohort of 200 NSCLC patients. In this research, we utilized liquid chromatography coupled with mass spectrometry (LC-MS) to analyze the lipidomics profile of matching tissue and plasma samples from 25 NSCLC patients, comprising 11 ADC and 14 SCC cases. This study builds upon our previous findings, which highlighted the elevation of oxidised phosphatidylcholines (oxPCs) in NSCLC patients. Results: We identified eight lipid biomarkers that effectively differentiate between ADC and SCC subtypes using an untargeted approach. Notably, we observed a significant increase in plasma LPA 20:4, LPA 18:1, and LPA 18:2 levels in the ADC group compared to the SCC group. Conversely, tumour PC 16:0/18:2, PC 16:0/4:0; CHO, and plasma PC 16:0/18:2; OH, PC 18:0/20:4; OH, PC 16:0/20:4; OOH levels were significantly higher in the ADC group. Discussion: Our study is the first to report that plasma LPA levels can distinguish between ADC and SCC patients in NSCLC, suggesting a potential role for LPAs in NSCLC subtyping. This finding warrants further investigation into the mechanisms underlying these differences and their clinical implications.
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Affiliation(s)
- Julia Sieminska
- Metabolomics Laboratory, Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
| | - Katarzyna Miniewska
- Metabolomics Laboratory, Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
| | - Robert Mroz
- 2nd Department of Lung Diseases and Tuberculosis, Medical University of Bialystok, Bialystok, Poland
| | - Ewa Sierko
- Department of Oncology, Medical University of Bialystok, Bialystok, Poland
| | - Wojciech Naumnik
- 1st Department of Lung Diseases and Tuberculosis, Medical University of Bialystok, Bialystok, Poland
| | - Joanna Kisluk
- Department of Clinical Molecular Biology, Medical University of Bialystok, Bialystok, Poland
| | | | - Joanna Reszec
- Department of Medical Patomorphology, Medical University of Bialystok, Bialystok, Poland
| | - Miroslaw Kozlowski
- Department of Thoracic Surgery, Medical University of Bialystok, Bialystok, Poland
| | | | - Marcin Moniuszko
- Department of Allergology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
- Department of Regenerative Medicine and Immune Regulation, Medical University of Bialystok, Bialystok, Poland
| | - Adam Kretowski
- Metabolomics Laboratory, Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Jacek Niklinski
- Department of Clinical Molecular Biology, Medical University of Bialystok, Bialystok, Poland
| | - Michal Ciborowski
- Metabolomics Laboratory, Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
| | - Joanna Godzien
- Metabolomics Laboratory, Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
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3
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Miccio JA, Tian Z, Mahase SS, Lin C, Choi S, Zacharia BE, Sheehan JP, Brown PD, Trifiletti DM, Palmer JD, Wang M, Zaorsky NG. Estimating the risk of brain metastasis for patients newly diagnosed with cancer. COMMUNICATIONS MEDICINE 2024; 4:27. [PMID: 38388667 PMCID: PMC10883934 DOI: 10.1038/s43856-024-00445-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Brain metastases (BM) affect clinical management and prognosis but limited resources exist to estimate BM risk in newly diagnosed cancer patients. Additionally, guidelines for brain MRI screening are limited. We aimed to develop and validate models to predict risk of BM at diagnosis for the most common cancer types that spread to the brain. METHODS Breast cancer, melanoma, kidney cancer, colorectal cancer (CRC), small cell lung cancer (SCLC), and non-small cell lung cancer (NSCLC) data were extracted from the National Cancer Database to evaluate for the variables associated with the presence of BM at diagnosis. Multivariable logistic regression (LR) models were developed and performance was evaluated with Area Under the Receiver Operating Characteristic Curve (AUC) and random-split training and testing datasets. Nomograms and a Webtool were created for each cancer type. RESULTS We identify 4,828,305 patients from 2010-2018 (2,095,339 breast cancer, 472,611 melanoma, 407,627 kidney cancer, 627,090 CRC, 164,864 SCLC, and 1,060,774 NSCLC). The proportion of patients with BM at diagnosis is 0.3%, 1.5%, 1.3%, 0.3%, 16.0%, and 10.3% for breast cancer, melanoma, kidney cancer, CRC, SCLC, and NSCLC, respectively. The average AUC over 100 random splitting for the LR models is 0.9534 for breast cancer, 0.9420 for melanoma, 0.8785 for CRC, 0.9054 for kidney cancer, 0.7759 for NSCLC, and 0.6180 for SCLC. CONCLUSIONS We develop accurate models that predict the BM risk at diagnosis for multiple cancer types. The nomograms and Webtool may aid clinicians in considering brain MRI at the time of initial cancer diagnosis.
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Affiliation(s)
- Joseph A Miccio
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA
| | - Zizhong Tian
- Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Sean S Mahase
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA
| | - Christine Lin
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Serah Choi
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Brad E Zacharia
- Department of Neurosurgery, Penn State Cancer Institute, Hershey, PA, USA
| | - Jason P Sheehan
- Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Joshua D Palmer
- Department of Radiation Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
| | - Ming Wang
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve School of Medicine, Cleveland, OH, USA.
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Zhu S, Ge T, Xiong Y, Zhang J, Zhu D, Sun L, Song N, Zhang P. Surgical Options for Resectable Lung Adenosquamous Carcinoma: A Propensity Score-Matched Analysis. Front Oncol 2022; 12:878419. [PMID: 35847913 PMCID: PMC9286748 DOI: 10.3389/fonc.2022.878419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/06/2022] [Indexed: 11/19/2022] Open
Abstract
Background Surgery is the primary treatment option for Lung adenosquamous carcinoma (ASC) patients. However, no study compares the benefits of lobectomy and sublobar resection in ASC patients. Methods A total of 1379 patients in the Surveillance, epidemiology, and End Results (SEER) database and 466 patients in Shanghai Pulmonary Hospital (SPH) were enrolled. Survival benefits were evaluated after possible confounders were eliminated by propensity score matching (PSM). Results After 1:3 PSM, 463 SEER database patients and 244 SPH patients were enrolled. Lobectomy was associated with better overall survival (OS) and disease-free survival (DFS) than sublobar resection for ASC patients (5-year OS of SEER: 46.9% vs. 33.3%, P =0.017; 5-year OS of SPH: 35.0% vs. 16.4%, P =0.002; 5-year DFS of SPH: 29.5% vs. 14.8%, P =0.002). Similar results were observed in stage I patients. Univariate and multivariate Cox regression analyses showed that sublobar resection was an adverse prognostic factor independently (SEER: HR: 1.40, 95%CI: 1.08-1.81, P =0.012; SPH: HR: 1.73, 95%CI: 1.11-2.70, P =0.015). Subgroup analysis showed that all of the ASC patient subtypes tended to benefit more from lobectomy than sublobar resection. Conclusions Lobectomy remains the primary option for ASC patients compared to sublobar resection, including stage I.
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5
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Wang T, Zhou J, Wang Y, Zheng Q, Lin Z, Li G, Mei J, Liu L. Clinicopathological characteristics and prognosis of resectable lung adenosquamous carcinoma: a population-based study of the SEER database. Jpn J Clin Oncol 2022; 52:1191-1200. [PMID: 35726160 DOI: 10.1093/jjco/hyac096] [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: 11/18/2021] [Accepted: 05/25/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Adenosquamous carcinoma is a rare subtype of non-small cell lung cancer characterized by aggressive behavior, with combination of adenocarcinoma and squamous cell carcinoma components. The clinicopathological characteristics and prognosis of resectable adenosquamous carcinoma are incompletely understood and this study aimed to depict those in a large population. METHODS A total of 805 adenosquamous carcinoma, 7875 squamous cell carcinoma and 23 957 adenocarcinoma patients who underwent lobectomy or sublobectomy were queried from the Surveillance, Epidemiology, and End Results database (2010-17). Clinicopathological characteristics of adenosquamous carcinoma patients were compared with those of squamous cell carcinoma and adenocarcinoma patients. Prognostic factors were identified by univariable and multivariable Cox regression analyses. Propensity score matching was applied to reduce confounding effects. RESULTS Adenosquamous carcinoma was associated with higher pleural invasion incidence and poorer differentiation compared with squamous cell carcinoma or adenocarcinoma (P values < 0.001). The independent risk factors of cancer-specific survival of adenosquamous carcinoma patients were increasing age, male sex, invading through visceral pleura, poor differentiation and higher stage. Stage IB adenosquamous carcinoma patients whose tumor invaded through visceral pleura had significantly worse survival than those not (P = 0.003). Adenosquamous carcinoma patients had worse survival compared with squamous cell carcinoma (5-year-survival: 64.55 vs. 69.09%, P = 0.003) and adenocarcinoma (5-year-survival: 64.55 vs. 76.79%, P < 0.001) patients before match. And this difference persisted after match. CONCLUSIONS Resectable adenosquamous carcinoma patients had higher pleural invasion incidence, poorer differentiation and worse survival compared with squamous cell carcinoma and adenocarcinoma patients. Visceral pleural invasion status and differentiation grade were vital prognostic factors of adenosquamous carcinoma patients on the basis of stage.
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Affiliation(s)
- Tengyong Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Jian Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Yaxin Wang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Quan Zheng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Zhangyu Lin
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Guangchen Li
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jiandong Mei
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
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6
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Leitner BP, Givechian KB, Ospanova S, Beisenbayeva A, Politi K, Perry RJ. Multimodal analysis suggests differential immuno-metabolic crosstalk in lung squamous cell carcinoma and adenocarcinoma. NPJ Precis Oncol 2022; 6:8. [PMID: 35087143 PMCID: PMC8795406 DOI: 10.1038/s41698-021-00248-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/16/2021] [Indexed: 12/21/2022] Open
Abstract
Immunometabolism within the tumor microenvironment is an appealing target for precision therapy approaches in lung cancer. Interestingly, obesity confers an improved response to immune checkpoint inhibition in non-small cell lung cancer (NSCLC), suggesting intriguing relationships between systemic metabolism and the immunometabolic environment in lung tumors. We hypothesized that visceral fat and 18F-Fluorodeoxyglucose uptake influenced the tumor immunometabolic environment and that these bidirectional relationships differ in NSCLC subtypes, lung adenocarcinoma (LUAD) and lung squamous cell carcinoma (LUSC). By integrating 18F-FDG PET/CT imaging, bulk and single-cell RNA-sequencing, and histology, we observed that LUSC had a greater dependence on glucose than LUAD. In LUAD tumors with high glucose uptake, glutaminase was downregulated, suggesting a tradeoff between glucose and glutamine metabolism, while in LUSC tumors with high glucose uptake, genes related to fatty acid and amino acid metabolism were also increased. We found that tumor-infiltrating T cells had the highest expression of glutaminase, ribosomal protein 37, and cystathionine gamma-lyase in NSCLC, highlighting the metabolic flexibility of this cell type. Further, we demonstrate that visceral adiposity, but not body mass index (BMI), was positively associated with tumor glucose uptake in LUAD and that patients with high BMI had favorable prognostic transcriptional profiles, while tumors of patients with high visceral fat had poor prognostic gene expression. We posit that metabolic adjunct therapy may be more successful in LUSC rather than LUAD due to LUAD's metabolic flexibility and that visceral adiposity, not BMI alone, should be considered when developing precision medicine approaches for the treatment of NSCLC.
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Affiliation(s)
- Brooks P Leitner
- Department of Cellular & Molecular Physiology, Yale School of Medicine, New Haven, CT, USA. .,Department of Internal Medicine (Endocrinology), Yale School of Medicine, New Haven, CT, USA.
| | | | - Shyryn Ospanova
- Nazarbayev Intellectual School of Physics and Mathematics, Almaty, Kazakhstan
| | | | - Katerina Politi
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA.,Department of Internal Medicine (Oncology), Yale School of Medicine, New Haven, CT, USA.,Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Rachel J Perry
- Department of Cellular & Molecular Physiology, Yale School of Medicine, New Haven, CT, USA. .,Department of Internal Medicine (Endocrinology), Yale School of Medicine, New Haven, CT, USA.
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7
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Moreno-Rubio J, Ponce S, Álvarez R, Olmedo ME, Falagan S, Mielgo X, Navarro F, Cruz P, Cabezón-Gutiérrez L, Aguado C, Colmenarejo G, Muñoz-Fernández de Leglaria M, Enguita AB, Cebollero M, Benito A, Alemany I, Del Castillo C, Ramos R, Ramírez de Molina A, Casado E, Sereno M. Clinical-pathological and molecular characterization of long-term survivors with advanced non-small cell lung cancer. Cancer Biol Med 2021; 17:444-457. [PMID: 32587780 PMCID: PMC7309469 DOI: 10.20892/j.issn.2095-3941.2019.0363] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/17/2020] [Indexed: 01/07/2023] Open
Abstract
Objective: Long-term survivors (LS) of non-small cell lung cancer (NSCLC) without driver alterations, displaying an overall survival (OS) of more than 3 years, comprise around 10% of cases in several series treated with chemotherapy. There are classical prognosis factors for these cases [stage, Eastern Cooperative Oncology Group (ECOG), etc.], but more data are required in the literature. In this multi-center study, we focused on LS of advanced NSCLC with OS above 36 months to perform a clinical-pathological and molecular characterization. Methods: In the first step, we conducted a clinical-pathological characterization of the patients. Afterwards, we carried out a genetic analysis by comparing LS to a sample of short-term survivors (SS) (with an OS less than 9 months). We initially used whole-genome RNA-seq to identify differentiating profiles of LS and SS, and later confirmed these with reverse transcription-polymerase chain reaction (RT-PCR) for the rest of the samples. Results: A total of 94 patients were included, who were mainly men, former smokers, having adenocarcinoma (AC)-type NSCLC with an ECOG of 0–1. We obtained an initial differential transcriptome expression, displaying 5 over- and 33 under-expressed genes involved in different pathways: namely, the secretin receptor, surfactant protein, trefoil factor 1 (TFF1), serpin, Ca-channels, and Toll-like receptor (TLRs) families. Finally, RT-PCR analysis of 40 (20 LS/20 SS) samples confirmed that four genes (surfactant proteins and SFTP) were significantly down-regulated in SS compared to LS by using an analysis of covariance (ANCOVA) model: SFTPA1 (P = 0.023), SFTPA2 (P = 0.027), SFTPB (P = 0.02), and SFTPC (P = 0.047). Conclusions: We present a sequential genetic analysis of a sample of NSCLC LS with no driver alterations, obtaining a differential RNA-seq/RT-PCR profile showing an abnormal expression of SF genes.
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Affiliation(s)
| | | | - Rosa Álvarez
- Gregorio Marañón University Hospital, Madrid 28009, Spain
| | | | - Sandra Falagan
- Infanta Sofía University Hospital, San Sebastián De Los Reyes, Madrid 28702, Spain
| | - Xabier Mielgo
- Fundación Alcorcon University Hospital, Alcorcon, Madrid 28922, Spain
| | - Fátima Navarro
- Príncipe de Asturias University Hospital, Alcalá De Henares, Madrid 28805, Spain
| | | | | | - Carlos Aguado
- Clinico San Carlos University Hospital, Madrid 28040, Spain
| | | | | | | | | | - Amparo Benito
- Ramon y Cajal University Hospital, Madrid 28034, Spain
| | - Isabel Alemany
- Fundación Alcorcon University Hospital, Alcorcon, Madrid 28922, Spain
| | | | - Ricardo Ramos
- Parque Científico de Madrid Foundation, Madrid 28049, Spain
| | | | - Enrique Casado
- Infanta Sofía University Hospital, San Sebastián De Los Reyes, Madrid 28702, Spain
| | - Maria Sereno
- Infanta Sofía University Hospital, San Sebastián De Los Reyes, Madrid 28702, Spain
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Kawai H, Iguchi K, Takayashiki N, Okauchi S, Satoh H. Metachronous Isolated Contralateral Lung Metastasis from Pulmonary Adenosquamous Carcinoma with EGFR Mutation. ACTA MEDICA (HRADEC KRÁLOVÉ) 2021; 63:141-144. [PMID: 33002403 DOI: 10.14712/18059694.2020.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Lung metastasis and metachronous double primary lung cancer are both common and often present diagnostic challenges. We present a case of metachronous isolated contralateral lung metastasis from pulmonary adenosquamous carcinoma with EGFR mutation. A 75-yearold woman presented with left lung nodule on a routine follow-up chest radiograph. She had had surgery for pulmonary adenocarcinoma with EGFR Ex21 L858R mutation 6 years ago. She underwent surgical resection, and histologic findings revealed adenosquamous carcinoma with the same EGFR mutation. Re-assessment of the resected specimen of the primary tumor resected 6 years ago revealed the morphologically similarity to the left lung tumor. Based on morphological and genetic identity, final diagnosis was adenosquamous cell carcinoma and metachronous isolated contralateral lung metastasis. The diagnosis of metachronous isolated metastasis is difficult but important for appropriate management and prediction of prognosis. A careful pathological examination and evaluation of genetic abnormality are needed to make the correct diagnosis.
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Affiliation(s)
- Hitomi Kawai
- Division of Pathology, Mito Medical Center, University of Tsukuba-Mito Medical Center, Mito, Ibaraki, Japan
| | - Kesato Iguchi
- Division of Surgery, Mito Medical Center, University of Tsukuba-Mito Medical Center, Mito, Ibaraki, Japan
| | - Norio Takayashiki
- Division of Pathology, Mito Medical Center, University of Tsukuba-Mito Medical Center, Mito, Ibaraki, Japan
| | - Shinichiro Okauchi
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Ibaraki, Japan
| | - Hiroaki Satoh
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Ibaraki, Japan.
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9
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Wang Y, Qian F, Hu M, Chen Y, Yang Z, Han B. Clinical significance of visceral pleural and lymphovascular invasion in surgically resected adenosquamous lung cancer. Eur J Cardiothorac Surg 2021; 59:617-623. [PMID: 33200178 DOI: 10.1093/ejcts/ezaa353] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess the relationship between visceral pleural invasion (VPI), lymphovascular invasion (LVI) and other clinicopathological characteristics and their prognostic impact on surgically resected adenosquamous carcinoma (ASC). METHODS We retrospectively reviewed 256 patients with radically resected ASC between January 2010 and December 2015. Patients were divided into 2 groups: those with VPI and those with LVI. The effects of VPI and LVI on disease-free survival and overall survival were evaluated, further stratified by tumour size and lymph node status. RESULTS Finally, 213 patients with ASC were enrolled in our study. VPI was correlated with tumour location (P < 0.001), pT stage (P < 0.001) and pN stage (P = 0.012). LVI was related to age (P = 0.005) and pN stage (P = 0.003). Both VPI and LVI were adverse prognostic factors for disease-free survival (P = 0.008, P = 0.028) and overall survival (P = 0.005, P = 0.009) using the Kaplan-Meier method. In multivariable analysis only, VPI was an independent risk factor for disease-free survival [hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.42-0.87; false discovery rate, adjusted P = 0.020] and overall survival (HR 0.60, 95% CI 0.42-0.86; false discovery rate, adjusted P = 0.017). When the prognostic value of VPI was stratified by tumour size and lymph node status, we observed that only patients with VPI in tumours ≤4 cm and patients with N0 status had a worse prognosis than those without visceral invasion (P < 0.05). CONCLUSIONS VPI and LVI were poor prognostic factors in patients with ASC, but only VPI was an independent factor for survival, especially in patients with tumours ≤4 cm and pN0 status.
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Affiliation(s)
- Yanan Wang
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Fangfei Qian
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Minjuan Hu
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ya Chen
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhengyu Yang
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Baohui Han
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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10
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Meder L, Florin A, Ozretić L, Nill M, Koker M, Meemboor S, Radtke F, Diehl L, Ullrich RT, Odenthal M, Büttner R, Heukamp LC. Notch1 Deficiency Induces Tumor Cell Accumulation Inside the Bronchiolar Lumen and Increases TAZ Expression in an Autochthonous Kras LSL-G12V Driven Lung Cancer Mouse Model. Pathol Oncol Res 2021; 27:596522. [PMID: 34257546 PMCID: PMC8262161 DOI: 10.3389/pore.2021.596522] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 02/11/2021] [Indexed: 01/15/2023]
Abstract
Purpose: Abrogation of Notch signaling, which is pivotal for lung development and pulmonary epithelial cell fate decisions was shown to be involved in the aggressiveness and the differentiation of lung carcinomas. Additionally, the transcription factors YAP and TAZ which are involved in the Hippo pathway, were recently shown to be tightly linked with Notch signaling and to regulate the cell fate in epidermal stem cells. Thus, we aim to elucidate the effects of conditional Notch1 deficiency on carcinogenesis and TAZ expression in lung cancer. Methods: We investigated the effect of conditional Cre-recombinase mediated Notch1 knock-out on lung cancer cells in vivo using an autochthonous mouse model of lung adenocarcinomas driven by Kras LSL-G12V and comprehensive immunohistochemical analysis. In addition, we analyzed clinical samples and human lung cancer cell lines for TAZ expression and supported our findings by publicly available data from The Cancer Genome Atlas (TCGA). Results: In mice, we found induction of papillary adenocarcinomas and protrusions of tumor cells from the bronchiolar lining upon Notch1 deficiency. Moreover, the mutated Kras driven lung tumors with deleted Notch1 showed increased TAZ expression and focal nuclear translocation which was frequently observed in human pulmonary adenocarcinomas and squamous cell carcinomas of the lung, but not in small cell lung carcinomas. In addition, we used data from TCGA to show that putative inactivating NOTCH1 mutations co-occur with KRAS mutations and genomic amplifications in lung adenocarcinomas. Conclusion: Our in vivo study provides evidence that Notch1 deficiency in mutated Kras driven lung carcinomas contributes to lung carcinogenesis in a subgroup of patients by increasing TAZ expression who might benefit from TAZ signaling blockade.
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Affiliation(s)
- Lydia Meder
- Department I of Internal Medicine, University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Alexandra Florin
- Institute for Pathology, University Hospital Cologne, Cologne, Germany
| | - Luka Ozretić
- Department of Cellular Pathology, Royal Free Hospital, London, United Kingdom
| | - Marieke Nill
- Department I of Internal Medicine, University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Mirjam Koker
- Department I of Internal Medicine, University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Sonja Meemboor
- Institute for Pathology, University Hospital Cologne, Cologne, Germany
| | - Freddy Radtke
- École Polytechnique Fédérale de Lausanne, Swiss Institute for Experimental Cancer Research Lausanne, Switzerland
| | - Linda Diehl
- Institute of Experimental Immunology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland T Ullrich
- Department I of Internal Medicine, University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Margarete Odenthal
- Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany.,Institute for Pathology, University Hospital Cologne, Cologne, Germany
| | - Reinhard Büttner
- Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany.,Institute for Pathology, University Hospital Cologne, Cologne, Germany
| | - Lukas C Heukamp
- Institute for Hematopathology Hamburg, Hamburg, Germany.,Lungen Netzwerk NOWEL, Oldenburg, Germany
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11
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Krivitsky TA, Wright GM, Al Zaidi M. A predictive model for identifying candidates for adjuvant chemotherapy based on recurrence risk profile of resected, node-negative (N0) non-small cell lung cancer. J Thorac Dis 2021; 13:149-159. [PMID: 33569195 PMCID: PMC7867833 DOI: 10.21037/jtd-20-2434] [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] [Indexed: 11/17/2022]
Abstract
Background The decision for administering adjuvant chemotherapy (AC) in completely resected node-negative non-small cell lung cancer (NSCLC) is guided by likelihood of disease recurrence or death based on tumor, node, metastasis (TNM) stage. However, within each TNM stage are sub-groups of patients that are more or less likely to relapse than stage alone predicts. Methods In this retrospective cohort study, prospective data from 394 consecutive patients who underwent complete resection of node-negative NSCLC without adjuvant therapies, between 2002 and 2019 was retrospectively analyzed. Independent tumor and host risk factors for recurrence were subjected to multivariate analysis to develop a predictive risk model distributing patients into low-risk or high-risk categories. Results Recurrence risk was independently predicted by a neutrophil:lymphocyte ratio (NLR) of ≥3.5 [hazard ratio (HR), 1.9; 95% confidence interval (CI), 1.1–3.5], visceral pleural invasion (HR, 2.2; 95% CI, 1.3–3.8), histopathology other than adenocarcinoma or squamous cell (HR, 2.6; 95% CI, 1.2–5.5) and tumor size >33 mm (HR, 3.9; 95% CI, 2.3–6.7). The specific combination of risk factors contributed to a score for a risk model which classified 9% of Stage I and 69% of Stage ≥II patients as high-risk. The predicted 5-year disease-free survival (DFS) for high-risk and low-risk patients as scored by the predictive model was 30% and 85%, respectively. Conclusions Our readily reproducible, low-technology model, developed from individually validated tumor/host risk factors, identified sub-groups of resected node-negative NSCLC patients at significantly discordant risk of recurrence to their TNM stage category.
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Affiliation(s)
- Timur A Krivitsky
- Department of General Medicine, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,Department of Medicine, Peninsula Health, Frankston, VIC, Australia
| | - Gavin M Wright
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,Department of Surgery, Melbourne University, VIC, Australia.,Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - Muteb Al Zaidi
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,Division of Thoracic Surgery, King Abdullah Medical City, Makkah, Saudi Arabia
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12
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Ni J, Zheng Z, Li J, Li Y, Fan M, Liu L. Risk factors of postoperative recurrence and potential candidate of adjuvant radiotherapy in lung adenosquamous carcinoma. J Thorac Dis 2020; 12:5593-5602. [PMID: 33209392 PMCID: PMC7656370 DOI: 10.21037/jtd-20-1979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Adenosquamous carcinoma (ASC) is a rare and aggressive histologic subtype of non-small cell lung cancer (NSCLC). Little is known about the prognostic significance of routine immunohistochemical (IHC) markers and clinical value of adjuvant radiotherapy in completely resected lung ASC. Methods Consecutive patients with pathologically confirmed lung ASC receiving curative resection from January 2007 to December 2017 at our center were retrospectively reviewed. The prognostic significance of 14 routine IHC markers and potential candidate of adjuvant radiotherapy were investigated. Results With a median follow up of 35 (range, 3.0–138) months, 95 out of the 176 enrolled patients had disease recurrence. The 1-, 3- and 5-year cumulative rate of recurrence was 25.8%, 55.8% and 63.1%, respectively. Using the Cox proportional hazard regression model, T stage, N stage, lymphovascular invasion (LVI), expression of CEA, expression of p53, but not EGFR mutations or expression of the other 12 IHC markers (CK20, CK5/6, PE10, ERCC1, Napsin A, RRM1, Ki67, CK7, P63, EGFR, HER2, TTF1), were significantly associated with postoperative recurrence. N stage, expression of CEA and LVI were identified as independent prognosticators of overall recurrence. Using competing risk methodology and distant recurrence chosen as a competing risk, T stage and N stage were identified as significant risk factors of loco-regional recurrence. Moreover, adjuvant radiotherapy significantly improved disease-free survival (DFS) (P=0.002) and was associated with non-significant longer overall survival (OS) (P=0.078) among 95 patients with either pathological T3–4 or N+ disease (collectively defined as pT3–4/N+ disease). Conclusions This study provides the proof of concept for using routine IHC markers, along with common clinic-pathological parameters, in predicting postoperative recurrence and identifying potential candidate for adjuvant radiotherapy in completely resected lung ASC.
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Affiliation(s)
- Jianjiao Ni
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhiqin Zheng
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center Minhang Branch Hospital, Shanghai, China
| | - Juan Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuan Li
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Pathology, Fudan University Shanghai Cancer Center, 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
| | - Liang Liu
- 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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13
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Dong Z, Wang Y, Ding V, Yan X, Lv Y, Zhong M, Zhu F, Zhao P, He C, Ding F, Shi H. GLI1 activation is a key mechanism of erlotinib resistance in human non-small cell lung cancer. Oncol Lett 2020; 20:76. [PMID: 32863909 PMCID: PMC7436900 DOI: 10.3892/ol.2020.11937] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 06/23/2020] [Indexed: 12/25/2022] Open
Abstract
Lung cancer is the leading cause of cancer-associated death worldwide. In recent years, the advancement of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) targeted therapies has provided clinical benefits for lung cancer patients with EGFR mutations. The response to EGFR-TKI varies in patients with lung cancer, and resistance typically develops during the course of the treatment. Therefore, understanding biomarkers which can predict resistance to EGFR-TKI is important. Overexpression of GLI causes activation of the Hedgehog (Hh) signaling pathway and plays a critical role in oncogenesis in numerous types of cancer. In the present study, the role of GLI1 in erlotinib resistance was investigated. GLI1 mRNA and protein expression levels were determined using reverse transcription-quantitative PCR and immunohistochemistry (IHC) in lung cancer cell lines and tumor specimens, respectively. GLI1 mRNA expression levels were found to be positively correlated with the IC50 of erlotinib in 15 non-small cell lung cancer (NSCLC) cell lines. The downregulation of GLI1 using siRNA sensitized lung cancer cells to the erlotinib treatment, whereas the overexpression of GLI1 increased the survival of lung cancer cells in the presence of erlotinib, indicating that Hh/GLI activation may play a critical role in the development of TKI resistance in lung cancer. Combined treatment with erlotinib and a GLI1 inhibitor reduced the cell viability synergistically. A retrospective study of patients with NSCLC treated with erlotinib revealed that those with a high IHC score for GLI1 protein expression had a poorer prognosis. These results indicated that GLI1 is a key regulator for TKI sensitivity, and patients with lung cancer may benefit from the combined treatment of TKI and GLI1 inhibitor.
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Affiliation(s)
- Zhouhuan Dong
- Department of Pathology, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Yun Wang
- Department of Pathology, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Vivianne Ding
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94115, USA
| | - Xiang Yan
- Department of Medical Oncology, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Yali Lv
- Department of Pathology, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Mei Zhong
- Department of Pathology, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Fengwei Zhu
- Department of Pathology, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Po Zhao
- Department of Pathology, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Charlotte He
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94115, USA
| | - Feng Ding
- Zhejiang Provincial Key Laboratory of Applied Enzymology and Precision Medicine Center, Jiaxing, Zhejiang 314006, P.R. China.,ACCB Diagnostic Laboratory, Yangze Delta Region Institute of Tsinghua University Zhejiang, Jiaxing, Zhejiang 314006, P.R. China
| | - Huaiyin Shi
- Department of Pathology, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
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14
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Jafarian AH, Kooshki Forooshani M, Reisi H, Mohamadian Roshan N. Matrix metalloproteinase-9 (MMP-9) Expression in Non-Small Cell Lung Carcinoma and Its Association with Clinicopathologic Factors. IRANIAN JOURNAL OF PATHOLOGY 2020; 15:326-333. [PMID: 32944046 PMCID: PMC7477682 DOI: 10.30699/ijp.2020.95177.1940] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 06/08/2020] [Indexed: 12/02/2022]
Abstract
Background & Objective: Matrix metalloproteinases-9 (MMP-9) is one of the most important enzymes to breakdown extracellular matrix which plays a major role in tumor invasion and metastasis. This study aimed to determine tumor MMP-9 expression in non-small-cell lung carcinoma (NSCLC) and whether it is associated with histopathologic factors and has prognostic value to affect overall survival (OS). Methods: The specimens of 92 patients with NSCLC diagnosis were included. Tumor sections were stained by immunohistochemistry method. Using scores for the percentage of cells positively stained and the intensity of staining, MMP-9 expression total score was classified as low-score (scores of 0 to 2), moderate-score (scores of 3 to 5), or high-score (scores of 6 or 7). OS was defined as the time interval since the diagnosis of NSCLC to the status at the last follow-up (dead or alive). The follow up period was up to 70 months. Results: About 74% of undifferentiated specimens (grade III tumors) showed high scores for MMP-9 expression which was significantly higher than moderately differentiated tumors (25% had high scores for MMP-9 expression) and well differentiated ones which did not have high scores (P<0.001). A total of 74 patients (80.4%) died during the follow-up period. Of this, 36% had high scores for MMP-9 expression. In contrast, none of the patients who were alive at the last follow-up had high scores for MMP-9 expression (P<0.001). Median OS was significantly lower in high score group (6 months) compared to moderate score (9 months) and high score group (15 months) (P<0.001). Conclusion: MMP-9 expression may serve as a significant prognostic factor for mortality and overall survival in NSCLC. Undifferentiated tumors significantly express higher MMP-9 immunohistochemically.
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Affiliation(s)
- Amir Hossein Jafarian
- Pathology Department, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Hossein Reisi
- Pathology Department, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nema Mohamadian Roshan
- Pathology Department, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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15
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Liang J, Sui Q, Zheng Y, Bi G, Chen Z, Li M, Huang Y, Lu T, Zhan C, Guo W. A nomogram to predict prognosis of patients with lung adenosquamous carcinoma: a population-based study. J Thorac Dis 2020; 12:2288-2303. [PMID: 32642134 PMCID: PMC7330383 DOI: 10.21037/jtd.2020.03.115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Adenosquamous carcinoma (ASC) of the lung is an infrequent variant of lung cancer. This study aimed to identify independent risk factors and to develop a predictive model for the prognosis of ASC patients. Methods Patient data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database (2004 to 2016) and database in our department (2010 to 2014). Overall survival (OS) was evaluated by the Kaplan-Meier method. Significant prognostic factors were identified by univariate analysis (UVA) and multivariate analysis (MVA) using the Cox proportional hazards regression. Competing risk model analyses were performed using cancer-specific survival outcomes. A nomogram was developed to predict patient 3-year and 5-year OS and was validated using data from the two databases. Results A total of 4,600 patients with ASC were included and divided into a training cohort (n=3,202) and two validation cohorts (n=1,372, n=26). Patients with ASC had significantly older age, lower grades of tumor differentiation or incidences of nodal, and distant invasions than adenocarcinoma and squamous cell carcinoma (SCC) of the lung (P<0.001), while the median survival time of ASC patients was intermediate [21.0 (19.3-22.7) months]. Age, sex, primary site of tumor, histological grade, T stage, N stage, M stage of the tumor, as well as surgery to the primary tumor site and chemotherapy were identified as independent factors for ASC (P<0.001). A reliable nomogram was established with a group of validation plots and concordance indices (C-indices) (internal: 0.755±0.010; external: 0.748±0.049 and 0.721±0.045). Conclusions Age, sex, primary site of tumor, histological grade, T stage, N stage, M stage of the tumor, as well as surgery to the primary site of tumors and chemotherapy were independent risk factors for ASC patients. A validated nomogram was constructed to predict the prognosis based on the patient clinical characteristics.
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Affiliation(s)
- Jiaqi Liang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Qihai Sui
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Yuansheng Zheng
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Guoshu Bi
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zhencong Chen
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ming Li
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yiwei Huang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Tao Lu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Cheng Zhan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Weigang Guo
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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16
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Wu X, Yu W, Petersen RH, Sheng H, Wang Y, Lv W, Hu J. A competing risk nomogram predicting cause-specific mortality in patients with lung adenosquamous carcinoma. BMC Cancer 2020; 20:429. [PMID: 32416716 PMCID: PMC7231424 DOI: 10.1186/s12885-020-06927-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/04/2020] [Indexed: 01/18/2023] Open
Abstract
Background Adenosquamous carcinoma (ASC) is an uncommon histological subtype of lung cancer. The purpose of this study was to assess the cumulative incidences of lung cancer-specific mortality (LC-SM) and other cause-specific mortality (OCSM) in lung ASC patients, and construct a corresponding competing risk nomogram for LC-SM. Methods Data on 2705 patients with first primary lung ASC histologically diagnosed between 2004 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The cumulative incidence function (CIF) was utilized to calculate the 3-year and 5-year probabilities of LC-SM and OCSM, and a competing risk model was built. Based on the model, we developed a competing risk nomogram to predict the 3-year and 5-year cumulative probabilities of LC-SM and the corresponding concordance indexes (C-indexes) and calibration curves were derived to assess the model performance. To evaluate the clinical usefulness of the nomogram, decision curve analysis (DCA) was conducted. Furthermore, patients were categorized into three groups according to the tertile values of the nomogram-based scores, and their survival differences were assessed using CIF curves. Results The 3-year and 5-year cumulative mortalities were 49.6 and 55.8% for LC-SM and 8.2 and 11.8% for OCSM, respectively. In multivariate analysis, increasing age, male sex, no surgery, and advanced T, N and M stages were related to a significantly higher likelihood of LC-SM. The nomogram showed good calibration, and the 3-year and 5-year C-indexes for predicting the probabilities of LC-SM in the validation cohort were both 0.79, which were almost equal to those of the ten-fold cross validation. DCA demonstrated that using the nomogram gained more benefit when the threshold probabilities were set within the ranges of 0.24–0.89 and 0.25–0.91 for 3-year and 5-year LCSM, respectively. In both the training and validation cohorts, the high-risk group had the highest probabilities of LC-SM, followed by the medium-risk and low-risk groups (both P < 0.0001). Conclusions The competing risk nomogram displayed excellent discrimination and calibration for predicting LC-SM. With the aid of this individualized predictive tool, clinicians can more expediently devise appropriate treatment protocols and follow-up schedules.
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Affiliation(s)
- Xiao Wu
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou, 310003, China
| | - Wenfeng Yu
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou, 310003, China
| | - R H Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Hongxu Sheng
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou, 310003, China
| | - Yiqing Wang
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou, 310003, China
| | - Wang Lv
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou, 310003, China
| | - Jian Hu
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou, 310003, China.
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17
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Radiographic patterns of symptomatic radiation pneumonitis in lung cancer patients: Imaging predictors for clinical severity and outcome. Lung Cancer 2020; 145:132-139. [PMID: 32447116 DOI: 10.1016/j.lungcan.2020.03.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 03/18/2020] [Accepted: 03/24/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Investigate the spectrum of radiographic patterns of radiation pneumonitis (RP) in lung cancer patients and identify imaging markers for high-grade RP and RP-related death. METHODS Eighty-two patients with lung cancer treated with conventional chest radiotherapy who had symptomatic RP were identified from the radiation oncology database. The imaging features of RP were studied for association with high-grade RP (Grade ≥3) and RP-related death (Grade 5). RESULTS RP was Grade 2 in 60 (73%), Grade 3 in 15 (18%), and Grade 5 in 7 patients (9%). Lower performance status (p = 0.04), squamous cell histology (p = 0.03), and FEV1 ≤ 2 (p = 0.009) were associated with high-grade pneumonitis. Older age (p = 0.03) and squamous cell histology (p = 0.03) were associated with RP-related death. The CT findings included ground-glass and reticular opacities in all patients, with traction bronchiectasis in 77 (94%) and consolidation in 74 (90%). The most common radiographic pattern of RP was cryptogenic organizing pneumonia (COP) pattern (n = 54), followed by acute interstitial pneumonia (AIP)/acute respiratory distress syndrome (ARDS) pattern (n = 10). Higher extent of lung involvement, diffuse distribution, and AIP/ARDS pattern were associated with high-grade pneumonitis and RP-related death. AIP/ARDS pattern was a significant factor for high-grade pneumonitis (OR:12.62, p = 0.01) in multivariable analyses adjusting for clinical variables. CONCLUSION COP pattern was the most common radiographic pattern for symptomatic RP in lung cancer patients. AIP/ARDS pattern was significantly associated with high-grade RP and RP-related deaths, and was an independent marker for high-grade RP. The recognition of the radiographic patterns of RP can help to effectively contribute to patient management.
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18
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Treatment for Patients With Early Stage Adenosquamous Lung Cancer. JTO Clin Res Rep 2020; 1:100021. [PMID: 34589928 PMCID: PMC8474226 DOI: 10.1016/j.jtocrr.2020.100021] [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: 01/31/2020] [Accepted: 02/08/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Adenosquamous lung cancer (ASC) is a rare type of NSCLC with poor prognosis. There is no consensus on the necessity of adjuvant chemotherapy and the selection of surgical procedures for patients with early stage lung cancer. Few studies have investigated the treatment for early stage ASC. Methods All cases of TNM stage I ASC as per the seventh edition of the American Joint Committee on Cancer staging system were identified from the Surveillance, Epidemiology, and End Results database from 2004 to 2016. The prognostic factors of the primary cohort were identified. Clinical characteristics, first-line treatments, surgical procedures, and survival data, including overall survival and cancer-specific survival, were analyzed. Results A total of 1251 patients were included. The mean age of the patients was 70 years (±9.5 y). Male and white patients accounted for larger proportions. There were 656 and 595 patients with stages IA and IB, respectively. The mean tumor size was 26.2 mm (±10.7 mm). With respect to the treatment, 139 patients who received only chemotherapy had the worst prognosis. Similar outcomes were observed in both the surgery and adjuvant therapy groups. Nevertheless, adjuvant chemotherapy could improve survival outcomes of patients with a tumor size of 4 to 5 cm. Of the 1075 patients who underwent surgery, there were 224 cases of sublobar resection, 834 cases of lobectomy, and 17 cases of extended or sleeve lobectomy. The results revealed that patients who underwent lobectomy had better prognosis. Conclusions Early stage ASC has a poor prognosis. Adjuvant chemotherapy was found to have no considerable benefit in patients with stage I disease (eighth edition). Lobectomy or other radical surgeries are recommended as they can improve overall survival of patients with ASC.
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Li Y, Wu X, Huang Y, Bian D, Jiang L. 18F-FDG PET/CT in lung adenosquamous carcinoma and its correlation with clinicopathological features and prognosis. Ann Nucl Med 2020; 34:314-321. [PMID: 32088884 DOI: 10.1007/s12149-020-01450-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 02/11/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Lung adenosquamous carcinoma (ASC) is a rare histological subtype of non-small cell lung cancer (NSCLC). Due to its rarity, the studies about 18F-FDG PET/CT in this kind of pulmonary tumor were quite limited. Thus, this study investigated 18F-FDG PET/CT findings in ASC and its correlation with clinicopathological features and clinical outcomes. METHODS Preoperative 18F-FDG PET/CT findings and parameters of maximum standard uptake value (SUVmax), metabolic tumor volume and total lesion glycolysis of primary lesion (MTV-P, TLG-P), combination of primary lesion and metastases (MTV-C, TLG-C), and clinicopathological features were retrospectively investigated in patients with ASC. Moreover, progression-free survival (PFS) was also analyzed. RESULTS All 41 patients (25 men; 16 women; age: 60 ± 7 years) had single ASC with the mean diameter of 33 ± 14 mm. Six lesions were located centrally and 35 peripherally. Serum tumor markers were abnormally increased sporadically. Twenty-two cases were at TNM stage I, 9 at II, and 10 at III. The primary tumors were FDG-avid in all cases, with the average SUVmax of 11.5 ± 6.0. SUVmax was significantly associated with tumor location, size, and TNM stage (P < 0.05). Forty-one lesions were subgrouped into 23 AC-predominant and 18 SCC-predominant lesions, and significant differences were observed for age, tumor size, and SUVmax in two groups (P < 0.05). The median PFS of 41 cases was 19 months, and 12-month and 24-month PFS rates were 72.1% and 36.1%, respectively. SUVmax, MTV-P, and TLG-C were significantly associated with PFS (P < 0.05). CONCLUSIONS ASC of the lung displayed high SUVmax on 18F-FDG PET/CT, which was associated with tumor location, size, TNM stage, and predominant histologic component. Moreover, metabolic parameters of 18F-FDG PET/CT were independent prognostic factors of this rare lung malignancy.
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Affiliation(s)
- Yuan Li
- Department of Nuclear Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China
| | - Xiaodong Wu
- Department of Nuclear Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China
- Medical College of Soochow University, Suzhou, 215123, China
| | - Yan Huang
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China
| | - Dongliang Bian
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China
| | - Lei Jiang
- Department of Nuclear Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China.
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20
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Li H, Wang Z, Yang F, Wang J. Development and validation of a nomogram for predicting cancer-specific survival of surgical resected stage I-II adenosquamous carcinoma of the lung. J Surg Oncol 2020; 121:1027-1035. [PMID: 32026478 DOI: 10.1002/jso.25858] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/16/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Primary lung adenosquamous carcinoma (ASC) is a rare cancer subtype and has a poor prognosis. The prognostic factors for resected early-stage ASC remain unclear. We aimed to develop a nomogram to predict lung cancer-specific survival (LCSS) of patients undergoing surgical resection for stage I-II ASC. METHODS Data of patients undergoing resection for stage I-II ASC and diagnosed between 2004-2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. All the included patients were randomized at a 7:3 ratio into a training and a validation cohort. We selected and integrated significant prognostic factors based on competing for risk regression to build a nomogram. The performance of the nomogram was evaluated using Harrell's concordance index (C-index) and calibration plots. RESULTS A total of 988 patients (530 men and 458 women) undergoing surgical resection for stage I-II ASC were identified and randomized into a training (692, 70%) cohort and a validation cohort (296, 30%). The baseline characteristics were similar in the training and validation cohorts. Age, T stage, N stage, and the number of examined lymph nodes were independent prognostic factors for LCSS and were used in the nomogram. The calibration plots showed that the 3- and 5-year LCSS probabilities were consistent between the nomogram prediction and the actual observation. The C-index of the nomogram was 0.671 (95%CI: 0.618-0.724) and 0.635 (95%CI: 0.557-0.713) in the training cohort and validation cohort, respectively. We developed a risk classification system based on the nomogram to stratify patients into high- and low-risk of cancer-specific death groups. Patients with a similar risk shared similar prognostic prediction regardless of the stage category and patients with the same risk shared similar prognoses despite the different stage category. CONCLUSIONS We developed a competing risk nomogram to reliably predict cancer-specific survival of patients undergoing surgical resection for stage I-II ASC. The nomogram might be a useful tool to identify patients undergoing surgical resection for ASC who could be suitable candidates for adjuvant chemotherapy.
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Affiliation(s)
- Hao Li
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| | - Zhenfan Wang
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| | - Fan Yang
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
| | - Jun Wang
- Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China
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21
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Zhu Q, Luo R, Gu J, Hou Y, Chen Z, Xu F, Wang L, Mao W, Lu C, Ge D. High CXCR4 Expression Predicts a Poor Prognosis in Resected Lung Adenosquamous Carcinoma. J Cancer 2020; 11:810-818. [PMID: 31949484 PMCID: PMC6959020 DOI: 10.7150/jca.36498] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/28/2019] [Indexed: 12/29/2022] Open
Abstract
Background: Primary adenosquamous carcinoma (ASC) is a rare malignant tumor in the lung and its biological behavior has not yet been thoroughly described. In this study, we aimed to explore the clinical and biological role of CXCR4 in patients with resected lung ASC. Methods: We retrospectively reviewed the clinical records of patients with histologically confirmed lung ASC who underwent surgical resection with systematic lymph node dissection. Immunohistochemical staining was performed to detect the expression of CXCR4 in tumor tissues. The correlation between CXCR4 expression and clinicopathological characteristics were evaluated. The association between CXCR4 expression and patients' prognosis was analyzed by Kaplan-Meier and Cox regression. Moreover, we performed in vitro studies including CCK8, transwell and cell apoptosis to explore the potential role of CXCR4 in lung ASC. Results: A total of 78 patients with resected lung ASC were reviewed. Seventy (89.7%) patient tumors expressed CXCR4, with high level of CXCR4 expression observed in 45 (57.7%) cases. In vitro, CXCR4 conferred no difference in proliferative capacity but increased invasive potential, enhanced chemoresistance and inhibited apoptosis of lung ASC. Clinically, high CXCR4 expression was significantly associated with solid ASC, lymph node metastasis and advanced TNM stage. Patients with high CXCR4 expression and solid ASC had decreased disease-free survival and overall survival.Conclusions: CXCR4 was commonly expressed in lung ASC tumors. High CXCR4 expression might be a novel marker in predicting a poor prognosis in resected lung ASC and might serve as a potential therapeutic target.
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Affiliation(s)
- Qiaoliang Zhu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
| | - Rongkui Luo
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
| | - Jie Gu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
| | - Yingyong Hou
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
| | - Zongwei Chen
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
| | - Fengkai Xu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
| | - Lin Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
| | - Wei Mao
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
| | - Chunlai Lu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
| | - Di Ge
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Shanghai Respiratory Research Institute, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
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22
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Li X, Shi G, Chu Q, Jiang W, Liu Y, Zhang S, Zhang Z, Wei Z, He F, Guo Z, Qi L. A qualitative transcriptional signature for the histological reclassification of lung squamous cell carcinomas and adenocarcinomas. BMC Genomics 2019; 20:881. [PMID: 31752667 PMCID: PMC6868745 DOI: 10.1186/s12864-019-6086-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/09/2019] [Indexed: 12/31/2022] Open
Abstract
Background Targeted therapy for non-small cell lung cancer is histology dependent. However, histological classification by routine pathological assessment with hematoxylin-eosin staining and immunostaining for poorly differentiated tumors, particularly those from small biopsies, is still challenging. Additionally, the effectiveness of immunomarkers is limited by technical inconsistencies of immunostaining and lack of standardization for staining interpretation. Results Using gene expression profiles of pathologically-determined lung adenocarcinomas and squamous cell carcinomas, denoted as pADC and pSCC respectively, we developed a qualitative transcriptional signature, based on the within-sample relative gene expression orderings (REOs) of gene pairs, to distinguish ADC from SCC. The signature consists of two genes, KRT5 and AGR2, which has the stable REO pattern of KRT5 > AGR2 in pSCC and KRT5 < AGR2 in pADC. In the two test datasets with relative unambiguous NSCLC types, the apparent accuracy of the signature were 94.44 and 98.41%, respectively. In the other integrated dataset for frozen tissues, the signature reclassified 4.22% of the 805 pADC patients as SCC and 12% of the 125 pSCC patients as ADC. Similar results were observed in the clinical challenging cases, including FFPE specimens, mixed tumors, small biopsy specimens and poorly differentiated specimens. The survival analyses showed that the pADC patients reclassified as SCC had significantly shorter overall survival than the signature-confirmed pADC patients (log-rank p = 0.0123, HR = 1.89), consisting with the knowledge that SCC patients suffer poor prognoses than ADC patients. The proliferative activity, subtype-specific marker genes and consensus clustering analyses also supported the correctness of our signature. Conclusions The non-subjective qualitative REOs signature could effectively distinguish ADC from SCC, which would be an auxiliary test for the pathological assessment of the ambiguous cases.
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Affiliation(s)
- Xin Li
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, 150086, China
| | - Gengen Shi
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, 150086, China
| | - Qingsong Chu
- Fujian Key Laboratory for Translational Research, Institute of Translational Medicine, Fujian Medical University, Fuzhou, 350001, China
| | - Wenbin Jiang
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, 150086, China
| | - Yixin Liu
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, 150086, China
| | - Sainan Zhang
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, 150086, China
| | - Zheyang Zhang
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, 150086, China
| | - Zixin Wei
- Department of Medical Oncology, Harbin Medical University Cancer hospital, Harbin, 150081, China
| | - Fei He
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, 350001, China
| | - Zheng Guo
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, 150086, China. .,Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, 350001, China. .,Key laboratory of Medical Bioinformatics, Fujian Province, Fuzhou, 350001, China.
| | - Lishuang Qi
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, 150086, China.
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23
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Ho HL, Kao HL, Yeh YC, Chou TY. The importance of EGFR mutation testing in squamous cell carcinoma or non-small cell carcinoma favor squamous cell carcinoma diagnosed from small lung biopsies. Diagn Pathol 2019; 14:59. [PMID: 31221183 PMCID: PMC6587243 DOI: 10.1186/s13000-019-0840-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/11/2019] [Indexed: 01/15/2023] Open
Abstract
Background Adenosquamous carcinoma (ADSC) of the lung, a rare but aggressive subtype of non-small cell lung cancer (NSCLC), is defined as a carcinoma containing components of adenocarcinoma (ADC) and squamous cell carcinoma (SqCC). Mutations of epidermal growth factor receptor (EGFR) are found at a frequency of 15 to 44% in Asian ADSC, and EGFR tyrosine kinase inhibitors (EGFR-TKIs) are a more effective treatment for EGFR-mutated ADSC compared to chemotherapy. However, ADSC in small lung biopsies could be misdiagnosed as SqCC or non-small cell carcinoma (NSCC) favor SqCC due to undersampling, which may result in neglecting of EGFR mutation testing and affecting patients’ clinical management, particularly in Asian patients that relatively have high prevalence of EGFR mutation. Methods A total of 148 small lung biopsy cases with pathological diagnosis of SqCC or NSCC favor SqCC were retrospectively enrolled. The frequency of EGFR mutations and the correlation between patients’ EGFR mutation status and clinicopathological characteristics were evaluated. Results EGFR mutations were found in 8.8% (13 /148) of all cases with 5.2% (7/135) in SqCC and 46.2% (6/13) in NSCC favor SqCC. There were 7 (53.8%) L858R mutation, 4 (30.8%) exon 19 deletions, and 2 (15.4%) cases with coexistent L858R and T790 M mutations. Multivariate analysis showed that EGFR mutations were more prevalent in never-smokers (83.3% versus 16.7%, p = 0.006) and patients diagnosed as NSCC favor SqCC (46.2% versus 5.2%, p = 0.001). Moreover, 75% (3/4) of EGFR mutation-positive cases with subsequent surgical resection or rebiopsy were further diagnosed as ADSC. Conclusions EGFR mutation testing should be performed in Asian patients with SqCC diagnosed from small lung biopsies, especially in never-smokers and patients with diagnosis of NSCC favor SqCC, which have a high probability of being ADSC.
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Affiliation(s)
- Hsiang-Ling Ho
- Division of Molecular Pathology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Biotechnology and Laboratory Science in Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hua-Lin Kao
- Division of Molecular Pathology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Pathology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yi-Chen Yeh
- Division of Molecular Pathology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Teh-Ying Chou
- Division of Molecular Pathology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Biotechnology and Laboratory Science in Medicine, National Yang-Ming University, Taipei, Taiwan. .,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
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24
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Sakin A, Secmeler S, Arici S, Geredeli C, Yasar N, Demir C, Aksaray F, Cihan S. Prognostic Significance of Mean Platelet Volume on Local Advanced Non-Small Cell Lung Cancer Managed with Chemoradiotherapy. Sci Rep 2019; 9:3959. [PMID: 30850724 PMCID: PMC6408473 DOI: 10.1038/s41598-019-40589-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 02/19/2019] [Indexed: 11/10/2022] Open
Abstract
Mean platelet volume (MPV), the most commonly used measure of platelet size, and is altered in patients with malignancies. The aim of this study was to investigate the effect of MPV on overall survival (OS) of patients with locally advanced (Stage IIIA/B) inoperable non-small cell lung cancer (NSCLC). This retrospective study included patients who received concomitant chemoradiotherapy (CCRT) with cisplatin + etoposide regimen due to locally advanced stage IIIA/B NSCLC. The study included a total of 115 cases, consisting of 110 (95.7%) male and 5 (4.2%) female patients. The mean age of the patients was 61.3 ± 10.4 (22-82) years. ROC curve generated by MPV for OS yielded an AUC of 0.746 (95% CI 0.659-0.833), (p < 0.001). MPV was detected as >9 fL with a sensitivity of 74.4% and a specificity of 72.0%. In patients with stage IIIA, median OS was 45.0 months (95% CI 17.3-74.1) and 21 months (95% CI 10.6-31.3) in groups with MPV > 9.0 fL and ≤9.0 fL, respectively (p = 0.013). In patients with stage IIIB, median OS was 44.0 months (95% CI 13.8-60.6) and 16 months (95% CI 9.5-22.4) in groups with MPV > 9.0 fL and ≤9.0 fL, respectively (p = 0.036). ECOG performance score, total platelet count, and MPV were found as the most significant independent factors affecting survival (p < 0.001, p = 0.008, and, p = 0.034, respectively). In this study, we showed that decreased pre-treatment MPV was an independent risk factor for survival in NSCLC patients who were administered CCRT. As part of routine complete blood count panel, MPV may represent one of the easiest measuring tools as an independent prognostic marker for survival in locally advanced NSCLC.
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Affiliation(s)
- Abdullah Sakin
- Department of Medical Oncology, Yuzuncu Yil University Medical School, 65030, Van, Turkey.
| | - Saban Secmeler
- Department of Medical Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, 34384, Istanbul, Turkey
| | - Serdar Arici
- Department of Medical Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, 34384, Istanbul, Turkey
| | - Caglayan Geredeli
- Department of Medical Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, 34384, Istanbul, Turkey
| | - Nurgul Yasar
- Department of Medical Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, 34384, Istanbul, Turkey
| | - Cumhur Demir
- Department of Medical Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, 34384, Istanbul, Turkey
| | - Ferdi Aksaray
- Department of Radiation Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, 34384, Istanbul, Turkey
| | - Sener Cihan
- Department of Medical Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, 34384, Istanbul, Turkey
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25
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Clark JM, Utter GH, Nuño M, Romano PS, Brown LM, Cooke DT. ICD-10-CM/PCS: potential methodologic strengths and challenges for thoracic surgery researchers and reviewers. J Thorac Dis 2019; 11:S585-S595. [PMID: 31032077 DOI: 10.21037/jtd.2019.01.86] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The recent implementation of the International Classification of Diseases, 10th Revision, Clinical Modification and Procedure Coding System (ICD-10-CM/PCS) provides a robust classification of diagnoses and procedures for hospital systems. As researchers begin using ICD-10-CM/PCS for outcomes research from administrative datasets, it is important to understand ICD-10-CM/PCS, as well as the strengths and challenges of these new classifications. In this review, we describe the development of ICD-10-CM/PCS and summarize how it applies specifically to thoracic surgery patients undergoing pulmonary lobectomy, sublobar resection (segmentectomy or wedge resection) and esophagectomy. This myriad of ICD-10-CM/PCS codes presents challenges and questions for thoracic surgery researchers and medical journal reviewers and editors when evaluating thoracic surgical outcomes research utilizing ICD-10-CM/PCS. Additional work is needed to develop consensus guidelines and uniformity for accurate and coherent research methods to utilize ICD-10-CM/PCS in future outcomes research efforts.
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Affiliation(s)
- James M Clark
- Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento, CA, USA
| | - Garth H Utter
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery, University of California, Davis Health, Sacramento, CA, USA.,Outcomes Research Group, Department of Surgery, University of California, Davis Health, Sacramento, CA, USA
| | - Miriam Nuño
- Department of Public Health Sciences, Division of Biostatistics, University of California, Davis Health, Sacramento, CA, USA
| | - Patrick S Romano
- Center for Healthcare Policy and Research, University of California, Davis Health, Sacramento, CA, USA.,Department of Internal Medicine, University of California, Davis Health, Sacramento, CA, USA
| | - Lisa M Brown
- Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento, CA, USA.,Outcomes Research Group, Department of Surgery, University of California, Davis Health, Sacramento, CA, USA.,Thoracic Surgery Outcomes Research Network
| | - David T Cooke
- Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento, CA, USA.,Outcomes Research Group, Department of Surgery, University of California, Davis Health, Sacramento, CA, USA.,Thoracic Surgery Outcomes Research Network
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Abstract
Adenosquamous carcinoma of the lung (ASC), a relatively rare subtype of non-small-cell lung cancer, is defined as a malignancy containing components of lung adenocarcinoma (ADC) and lung squamous cell carcinoma (SCC). Although ASC has biological characteristics of ADC and SCC, it is not by any means a simple hybrid of two components above. It is extremely difficult to diagnose preoperatively; pathology of surgically resected gross specimen is the most effective means for adequate diagnosis of ASC. Platinum-based postoperative adjuvant chemotherapy for at least four cycles can significantly improve the survival in stage III patients with ASC. Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) such as erlotinib and gefitinib can be the effective therapeutic strategies for advanced EGFR-mutant ASC. The studies of crizotinib in the treatment of patients with ASC are very limited. Immune checkpoint blockade therapy may be a potential treatment choice for ASC patients.
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Affiliation(s)
- Chenghui Li
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang province, People's Republic of China.,Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China,
| | - Hongyang Lu
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China, .,Zhejiang Key Laboratory of Diagnosis & Treatment Technology on Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou, People's Republic of China,
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27
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Hlaing AM, Furusato B, Udo E, Kitamura Y, Souda M, Masutani M, Fukuoka J. Expression of phosphatase and tensin homolog and programmed cell death ligand 1 in adenosquamous carcinoma of the lung. Biochem Biophys Res Commun 2018; 503:2764-2769. [PMID: 30100056 DOI: 10.1016/j.bbrc.2018.08.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/04/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Lung adenosquamous carcinoma (ASC) is a rare variant of non-small cell lung cancer (NSCLC) with poor prognosis. Certain biological differences may exist between these tumors and other common histological types of NSCLC, including adenocarcinoma (ADC) and squamous cell carcinoma (SCC). The phosphoinositide 3-kinase (PI3K) pathway, which links oncogenes and multiple receptor classes to essential cellular functions, is activated by phosphatase and tensin homolog (PTEN) loss. The PTEN loss has been suggested to induce programmed cell death ligand 1 (PD-L1) expression in various cancer types. OBJECTIVE Here, we sought to determine the relationships between the expression of PTEN and PD-L1 in each component of ASC with ADC and SCC, and clinical parameters. MATERIAL AND METHODS Tissue microarrays of 148 cases of surgically resected lung ADC and 102 cases of SCC, as well as full sections from 28 ASC cases, were analyzed immunohistochemically for the expression of PTEN and PD-L1. RESULTS PD-L1 expression was similar between the adenocarcinoma component of ASC vs. lung ADC and between the squamous component of ASC vs. lung SCC. PTEN loss was higher in lung ADC than in the adenocarcinoma component of ASC and significantly higher in lung SCC than in the squamous component of ASC. PD-L1 expression was higher in the squamous component than in the glandular component of the 28 ASC cases, but PTEN loss was similar. Overall, PTEN loss was higher in lung SCC than in lung ADC and both components of ASC. In lung SCC and glandular portions of ASC, PD-L1 expression levels were significantly associated with those of PTEN. The loss of PTEN correlated with smoking status in patients with lung ADC. CONCLUSIONS Our results implied that both squamous and glandular components of ASC may share the same oncogenic driver pathway for carcinogenesis. However, the squamous cell components of ASC likely escape the immune surveillance better than the glandular components due to higher PD-L1 expression.
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Affiliation(s)
- Aung Myo Hlaing
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Bungo Furusato
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan; Division of Cancer Genomics, Genomic Medical Center, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan.
| | - Emiko Udo
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan; Division of Cancer Genomics, Genomic Medical Center, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Yuka Kitamura
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Masakazu Souda
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Mitsuko Masutani
- Department of Frontier Life Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Junya Fukuoka
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
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28
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Zhang C, Yang H, Lang B, Yu X, Xiao P, Zhang D, Fan L, Zhang X. Surgical significance and efficacy of epidermal growth factor receptor tyrosine kinase inhibitors in patients with primary lung adenosquamous carcinoma. Cancer Manag Res 2018; 10:2401-2407. [PMID: 30122989 PMCID: PMC6080878 DOI: 10.2147/cmar.s165660] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Primary adenosquamous carcinoma (ASC) of the lung is a rare and aggressive disease. The accurate diagnosis of ASC based on small biopsies is challenging because of the mixed components within the tumor, and this may lead to suboptimal treatment. Furthermore, information about the efficacy of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in lung ASC is limited. Patients and methods Data on a cohort of patients with lung ASC who underwent surgery between October 2008 and December 2016 at a single institution were retrospectively reviewed. Results This study analyzed 148 patients. Differences between the pre- and post-resection diagnosis were observed. Based on the results of preoperative biopsy, patients were diagnosed as having squamous cell carcinoma (n=26), adenocarcinoma (n=20), poorly differentiated carcinoma (n=20), and large cell carcinoma (n=1), and finally diagnosed as having ASC based on histopathological examination of the surgical specimens. Thirty patients (20.3%) with EGFR-sensitizing mutations (TKI group) were treated with EGFR-TKIs after surgery, whereas the remaining patients (79.7%) with unknown EGFR-mutation status received chemotherapy or chemoradiotherapy alone (non-TKI group). TKI treatment was associated with better median overall survival (OS) (HR=0.619; p=0.034). Multivariate analysis identified the presence of EGFR-TKI treatment as an independent prognostic factor for OS (HR=0.471; p=0.003). Conclusion Discrepancies between the pre- and post-operative diagnosis reflect the inadequacy of non-resection approaches to the diagnosis of ASC. ASC patients harboring EGFR-sensitizing mutations who were treated with EGFR-TKIs showed a significantly better prognosis than those receiving chemotherapy or chemoradiotherapy alone.
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Affiliation(s)
- Chao Zhang
- Department of Thoracic Surgery, The Affiliated Luoyang Central Hospital of Zhengzhou University, Luoyang, China,
| | - Haitang Yang
- Division of General Thoracic Surgery, Inselspital, Bern University Hospital, Bern, Switzerland.,Department for BioMedical Research, University of Bern, Bern, Switzerland.,Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Baoping Lang
- Department of Thoracic Surgery, The Affiliated Luoyang Central Hospital of Zhengzhou University, Luoyang, China,
| | - Xiangdong Yu
- Department of Thoracic Surgery, The Affiliated Luoyang Central Hospital of Zhengzhou University, Luoyang, China,
| | - Peng Xiao
- Department of Thoracic Surgery, The Affiliated Luoyang Central Hospital of Zhengzhou University, Luoyang, China,
| | - Dian Zhang
- Department of Thoracic Surgery, The Affiliated Luoyang Central Hospital of Zhengzhou University, Luoyang, China,
| | - Liwen Fan
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Xiao Zhang
- Department of Thoracic Surgery, The Affiliated Luoyang Central Hospital of Zhengzhou University, Luoyang, China,
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Heterogeneity of PD-L1 Expression Among the Different Histological Components and Metastatic Lymph Nodes in Patients With Resected Lung Adenosquamous Carcinoma. Clin Lung Cancer 2018; 19:e421-e430. [DOI: 10.1016/j.cllc.2018.02.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/01/2018] [Accepted: 02/11/2018] [Indexed: 02/08/2023]
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30
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Zhu L, Jiang L, Yang J, Gu W, He J. Clinical characteristics and prognosis of patients with lung adenosquamous carcinoma after surgical resection: results from two institutes. J Thorac Dis 2018; 10:2397-2402. [PMID: 29850145 DOI: 10.21037/jtd.2018.03.186] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Adenosquamous carcinoma (ASC) is a mixed glandular and squamous cell carcinoma (SCC) with more aggressive behavior than the other histologic subtypes of lung cancer. We aim to evaluate the prognosis of patients with ASC after surgical resection. Methods We reviewed records of patients who underwent surgical resection for lung cancer in two institutes between January 2010 and December 2015. Survival data were collected with a median follow-up of 59 (range from 10 to 85) months. Kaplan-Meier survival curve was determined for all patients. Results Patients with ASC accounted for 1.6% of all NSCLC patients (33 males, 25 females). The cumulative postoperative 3- and 5-year survival rates were 56% and 48%, respectively. Overall survival (OS) was significantly lower in ASC patients than in adenocarcinoma (AC) patients operated during the same period (P<0.01). Patients with ASC containing acinar predominant AC had better survival than those with non-acinar predominant ASC (P=0.03). No difference of OS was found in patients with or without visceral pleural invasion (VPI), vascular invasion (VI) or EGFR mutation status. Multivariate analysis showed gender, pathological subtype, and TNM staging to be independent prognostic factors. Conclusions We demonstrated that ASC were uncommon and aggressive lung tumors. Predominant histological subtype of AC might be an independent prognostic factor for ASC. Further prospective studies are warranted to clarify the characteristics of this rare tumor.
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Affiliation(s)
- Lewei Zhu
- The First Clinical College, Southern Medical University, Guangzhou 510515, China.,Department of Thoracic Surgery, The First People's Hospital of Foshan City Guangdong Province, Foshan 528000, China
| | - Long Jiang
- Department of Thoracic Surgery, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China
| | - Jie Yang
- Department of Thoracic Surgery, The First People's Hospital of Foshan City Guangdong Province, Foshan 528000, China
| | - Weiquan Gu
- Department of Thoracic Surgery, The First People's Hospital of Foshan City Guangdong Province, Foshan 528000, China
| | - Jianxing He
- The First Clinical College, Southern Medical University, Guangzhou 510515, China.,Department of Thoracic Surgery, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China
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31
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Wang J, Lian B, Ye L, Hu J, Song Y. Clinicopathological characteristics and survival outcomes in adenosquamous carcinoma of the lung: a population-based study from the SEER database. Oncotarget 2017; 9:8133-8146. [PMID: 29487721 PMCID: PMC5814288 DOI: 10.18632/oncotarget.23550] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 10/28/2017] [Indexed: 02/07/2023] Open
Abstract
Adenosquamous carcinoma (ASC) of the lung is an unusual histology type in non-small-cell lung cancers. Due to its rarity, the clinicopathological characteristics and survival outcomes of the lung ASC are incompletely understood. We used the Surveillance, Epidemiology, and End Results (SEER) database to enroll 203,208 eligible patients, including 4,245 ASC, 124,253 adenocarcinoma (ADC) and 74,710 squamous cell carcinoma (SCC) patients. To date, this is the largest cohort in a study for ASC of the lung. With regard to age, sex, race, year of diagnosis, tumor size and SEER stage, ASC was intermediate between ADC and SCC. However, compared with ADC and SCC patients, ASC patients presented with a higher tumor grade and lower prevalence of nodal metastasis. More ASC patients underwent surgery and a lower proportion underwent radiation treatment and chemotherapy. Kaplan-Meier analysis showed that ASC patients had a better prognosis than ADC and SCC patients, but stratified analysis showed that the prognosis of ASC patients was worse than that of ADC and SCC patients in surgery and non-surgery subgroup. Multivariate analysis further confirmed that the ASC histology type was a risk factor for poor prognosis with respect to ADC and SCC. Using the propensity score matching to 1:1 match ASC with ADC or SCC, we found that ASC patients had worse survival than ADC and SCC patients. Subgroup analysis further demonstrated that ASC was a more aggressive histology type with a worse prognosis. These results provided a deep understanding of ASC, which contributed to better clinical diagnosis and treatment.
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Affiliation(s)
- Jian Wang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai 200030, China
| | - Bi Lian
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200030, China
| | - Ling Ye
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai 200030, China
| | - Jie Hu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai 200030, China
| | - Yuanlin Song
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai 200030, China
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32
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Kong M, Jin J, Cai X, Shen J, Ma D, Ye M, Zhu C, Freedman S, Walters K, Xu X, Chen B. Characteristics of lymph node metastasis in resected adenosquamous lung cancer. Medicine (Baltimore) 2017; 96:e8870. [PMID: 29310370 PMCID: PMC5728771 DOI: 10.1097/md.0000000000008870] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 10/31/2017] [Accepted: 11/04/2017] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to retrospectively analyze the clinical data of resected adenosquamous lung cancer (ASLC) and to explore the influencing factors and clinicopathological characteristics of the metastasis lymph nodes. A total of 1156 consecutive patients with surgically resected lung cancer from January 2009 to June 2014 were studied. Fifty-four previously diagnosed ASLC patients were re-evaluated by experienced pathologists. IHC and H&E staining were employed to examine the primary focus and metastasis lymph nodes. The relationship between lymph node metastasis and clinicopathological characteristics of ASLC patients was then analyzed and the pathological type of metastasis lymph node was also determined. Forty-nine cases of typical ASLC were included in the study. Of the 49 ASLC patients, 26 cases presented lymph node metastasis. Lymph node metastasis was not associated with gender, smoking, tumor distribution, histological type of primary focus, and preoperative CEA level, but was associated with age ≥ 65 (P < .05) and tumor size ≥ 3 cm (P < .05). Lymph node metastasis adenocarcinoma was the main type in ASLC patients, and was related to the age and tumor size of the primary focus. Further large sample studies are necessary to identify influencing factors and clinicopathological characteristics of metastasis lymph nodes.
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Affiliation(s)
- Min Kong
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang
| | - Jiang Jin
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang
| | - Xiuyu Cai
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center
| | - Jianfei Shen
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang
| | - Dehua Ma
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang
| | - Minhua Ye
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang
| | - Chengchu Zhu
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang
| | | | - Kelly Walters
- Rosalind Franklin University of Medicine and Science, USA
| | - Xin Xu
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Baofu Chen
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang
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Dagogo-Jack I, Saltos A, Shaw AT, Gray JE. Pathology Issues in Thoracic Oncology: Histologic Characterization and Tissue/Plasma Genotyping May Resolve Diagnostic Dilemmas. Am Soc Clin Oncol Educ Book 2017; 37:619-629. [PMID: 28561671 DOI: 10.1200/edbk_175197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Lung cancer is a heterogeneous diagnosis that encompasses a spectrum of histologic and molecular subgroups. A paradigm shift favoring selection of treatment based on histologic and molecular makeup has positively affected prognosis for patients with metastatic lung cancer, with select patients experiencing durable responses to treatment. However, prognosis remains poor for the majority of patients. Furthermore, oncologists are increasingly faced with challenging dilemmas related to histopathologic and molecular characterization of tumors, both at diagnosis and during treatment. In this review, we focus on three particular challenges: (1) management of mixed histology tumors, a particularly aggressive group of lung cancers, (2) distinguishing multiple primary lung tumors from intrapulmonary metastases, and (3) incorporation of liquid biopsies into the diagnostic algorithm and subsequent follow-up of patients with advanced lung cancer. This review will summarize the existing literature and highlight the potential for molecular genotyping to help refine approaches to each of these challenges.
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Affiliation(s)
- Ibiayi Dagogo-Jack
- From the Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Hematology/Oncology Fellowship Program, Moffitt Cancer Center, Tampa, FL; University of South Florida, Tampa, FL; Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL
| | - Andreas Saltos
- From the Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Hematology/Oncology Fellowship Program, Moffitt Cancer Center, Tampa, FL; University of South Florida, Tampa, FL; Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL
| | - Alice T Shaw
- From the Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Hematology/Oncology Fellowship Program, Moffitt Cancer Center, Tampa, FL; University of South Florida, Tampa, FL; Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL
| | - Jhanelle E Gray
- From the Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Hematology/Oncology Fellowship Program, Moffitt Cancer Center, Tampa, FL; University of South Florida, Tampa, FL; Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL
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34
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Wang Y, Hu GF, Wang ZH. The status of immunosuppression in patients with stage IIIB or IV non-small-cell lung cancer correlates with the clinical characteristics and response to chemotherapy. Onco Targets Ther 2017; 10:3557-3566. [PMID: 28790848 PMCID: PMC5530847 DOI: 10.2147/ott.s136259] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Indoleamine 2,3-dioxygenase (IDO) catalyzes the rate-limiting step of tryptophan (Trp) degradation via the kynurenine (Kyn) pathway, which inhibits the proliferation of T cells and induces the apoptosis of T cells, leading to immune tolerance. Therefore, IDO has been considered as the most important mechanism for tumor cells to escape from immune response. Previous studies suggested that IDO might be involved in the progression of tumor and resistance to chemotherapy. Several preclinical and clinical studies have proven that IDO inhibitors can regulate IDO-mediated tumor immune escape and potentiate the effect of chemotherapy. Thus, the present study investigated the correlation between the clinical parameters, responses to chemotherapy, and IDO activity to provide a theoretical basis for the clinical application of IDO inhibitors to improve the suppression status and poor prognosis in cancer patients. METHODS The serum concentrations of Trp and Kyn were measured by high-performance liquid chromatography in 252 patients with stage IIIB or IV non-small-cell lung cancer, and 55 healthy controls. The IDO activity was determined by calculating the serum Kyn-to-Trp (Kyn/Trp) ratio. RESULTS The IDO activity was significantly higher in the lung cancer patients than in the controls (median 0.0389 interquartile range [0.0178-0.0741] vs 0.0111 [0.0091-0.0133], respectively; P<0.0001). In addition, patients with adenocarcinoma had higher IDO activity than patients with nonadenocarcinoma (0.0449 [0.0189-0.0779] vs 0.0245 [0.0155-0.0563], respectively; P=0.006). Furthermore, patients with stage IIIB disease had higher IDO activity than patients with stage IV disease (0.0225 [0.0158-0.0595] vs 0.0445 [0.0190-0.0757], respectively; P=0.012). The most meaningful discovery was that there was a significant difference between the partial response (PR) patients and the stable disease (SD) and progressive disease (PD) patients (0.0240 [0.0155-0.0381] vs 0.0652 [0.0390-0.0831] vs 0.0868 [0.0209-0.0993], respectively, P<0.0001). CONCLUSION IDO activity was increased in lung cancer patients. Higher IDO activity correlated with histological types and disease stages of lung cancer patients, induced the cancer cells' resistance to chemotherapy, and decreased the efficacy of chemotherapy.
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Affiliation(s)
- Yuan Wang
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences
| | - Guo-fang Hu
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences
| | - Zhe-hai Wang
- Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, People’s Republic of China
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35
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Wu X, Li J, Chen S, Yu L, Yang B. [Clinicopathologic Features and Prognostic Implications in 72 Cases
with Lung Adenosquamous Carcinoma]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 19:653-658. [PMID: 27760593 PMCID: PMC5973411 DOI: 10.3779/j.issn.1009-3419.2016.10.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
背景与目的 肺腺鳞癌是肺癌中的一种少见类型,混合有腺癌和鳞癌两种恶性组织成分,侵袭性高、预后差。本研究旨在探讨腺鳞癌的临床病理特点和预后影响因素。 方法 对72例肺腺鳞癌患者的临床病理资料进行回顾性分析,探讨影响患者预后的因素。 结果 全组患者中位生存期位34.7个月,5年生存率为14.9%,肿瘤长径、转移(metastasis, M)分期、肿瘤-淋巴结-转移(tumor-node-metastasis, TNM)病理分期、基因突变、手术对患者预后的影响有统计学意义。 结论 肺腺鳞癌恶性程度高、预后差,应采取手术为主的综合治疗,小分子酪氨酸激酶抑制剂治疗有助于延长患者生存期。
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Affiliation(s)
- Xi Wu
- General Department, National Cancer Center/Cancer Hospital Chinese
Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Junling Li
- Internal Department, National Cancer Center/Cancer Hospital Chinese
Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shulan Chen
- Medical Record Department, National Cancer Center/Cancer Hospital Chinese
Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Lei Yu
- General Department, National Cancer Center/Cancer Hospital Chinese
Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Boyan Yang
- General Department, National Cancer Center/Cancer Hospital Chinese
Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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36
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Fan L, Yang H, Yao F, Zhao Y, Gu H, Han K, Zhao H. Clinical outcomes of epidermal growth factor receptor tyrosine kinase inhibitors in recurrent adenosquamous carcinoma of the lung after resection. Onco Targets Ther 2017; 10:239-245. [PMID: 28123305 PMCID: PMC5229167 DOI: 10.2147/ott.s114451] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The therapeutic efficacy of targeted therapy for adenosquamous carcinoma (ASC) of the lung remains unclear and the role of epidermal growth factor receptor (EGFR) testing in patients with ASC also remains controversial. We aimed to analyze the efficacy of EGFR tyrosine kinase inhibitors (EGFR-TKIs) in ASC. METHODS Clinical records of patients with ASC who received treatment with EGFR-TKIs between January 2006 and December 2014 at two institutions were retrospectively reviewed. RESULTS A total of 27 EGFR mutation-positive patients with ASC who received TKI therapy were enrolled in this study. EGFR mutations included a deletion in exon 19 in 15 cases and a point mutation at codon 858 (L858R) in exon 21 in 12 cases. Among the 27 ASC patients who received treatment with EGFR-TKIs, nine had a partial response and 11 achieved stable disease, accounting for a disease control rate of 74.1% (20/27). The median postoperative overall survival (OS) of the EGFR-mutant patients who received TKI therapy was 39 months (95% confidence interval [CI]: 25.6-52.4). The median progression-free survival for EGFR mutation-positive patients was 15 months (95% CI: 12.9-17.1), and the median relapse OS was 19 months (95% CI: 0.9-37.1). In addition, the 3- and 5-year postoperative survival rate was 51.9% and 15.3%, respectively. CONCLUSION ASC patients harboring EGFR mutations had a good response to TKI therapy. Routine EGFR testing for ASCs was recommended. Further studies on TKI therapy versus chemotherapy alone for EGFR-mutant ASCs are required.
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Affiliation(s)
- Liwen Fan
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Haitang Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- Division of General Thoracic Surgery, Inselspital University Hospital Bern, Bern, Switzerland
| | - Feng Yao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Yang Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Haiyong Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Ke Han
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Heng Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
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37
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Vassella E, Langsch S, Dettmer MS, Schlup C, Neuenschwander M, Frattini M, Gugger M, Schäfer SC. Molecular profiling of lung adenosquamous carcinoma: hybrid or genuine type? Oncotarget 2016; 6:23905-16. [PMID: 26068980 PMCID: PMC4695160 DOI: 10.18632/oncotarget.4163] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/15/2015] [Indexed: 12/20/2022] Open
Abstract
Lung adenosquamous carcinoma is a particular subtype of non-small cell lung carcinoma that is defined by the coexistence of adenocarcinoma and squamous cell carcinoma components. The aim of this study was to assess the mutational profile in each component of 16 adenosquamous carcinoma samples from a Caucasian population by a combination of next generation sequencing using the cancer hotspot panel as well as the colon and lung cancer panel and FISH. Identified mutations were confirmed by Sanger sequencing of DNA from cancer cells of each component collected by Laser Capture microdissection. Mutations typical for adenocarcinoma as well as squamous cell carcinoma were identified. Driver mutations were predominantly in the trunk suggesting a monoclonal origin of adenosquamous carcinoma. Most remarkably, EGFR mutations and mutations in the PI3K signaling pathway, which accounted for 30% and 25% of tumors respectively, were more prevalent while KRAS mutations were less prevalent than expected for a Caucasian population. Surprisingly, expression of classifier miR-205 was intermediate between that of classical adenocarcinoma and squamous cell carcinoma suggesting that adenosquamous carcinoma is a transitional stage between these tumor types. The high prevalence of therapy-relevant targets opens new options of therapeutic intervention for adenosquamous carcinoma patients.
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Affiliation(s)
- Erik Vassella
- Institute of Pathology, University of Bern, Bern, Switzerland
| | | | | | - Cornelia Schlup
- Institute of Pathology, University of Bern, Bern, Switzerland
| | | | | | - Mathias Gugger
- Institute of Pathology, University of Bern, Bern, Switzerland.,Promed SA Laboratoire Medical, Fribourg, Switzerland
| | - Stephan C Schäfer
- Institute of Pathology, University of Bern, Bern, Switzerland.,Institute of Pathology, University Hospital of Cologne, Cologne, Germany
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Zhao H, Yang H, Yao F, Sun Y, Xu J, Gu H, Shen Z. Improved survival associated with a balanced structure between adenomatous and squamous components in patients with adenosquamous carcinoma of the lung. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2016; 42:1699-1706. [PMID: 27365198 DOI: 10.1016/j.ejso.2016.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/23/2016] [Accepted: 05/13/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Primary adenosquamous carcinoma (ASC) of the lung is rare and its biological behavior has not yet been thoroughly described. The aim of this study was to analyze the clinicopathological characteristics and prognostic factors associated with ASC. MATERIALS Clinical records of patients with ASC of the lung who underwent surgery between October 2008 and December 2014 in a single institution were retrospectively reviewed. RESULTS A total of 205 patients were identified. Patients with balanced structural components had significantly better prognosis than those with squamous (p = 0.014) or adenomatous (p < 0.001) predominance, and those with N0, N1, and N2 ASC (N0 vs. N1 [ p = 0.031] and N1 vs. N2 [p = 0.037], respectively), or stage I, II and IIIA ASC (stage I vs. II [p = 0.021] and stage II vs. IIIA [p = 0.007], respectively) had significant differences with respect to overall survival (OS). Multivariate analysis identified structural components (p = 0.011), tumor, node and metastasis (TNM) status (p < 0.001), and adjuvant chemotherapy (p = 0.008) as significantly prognostic factors for OS, and structural components (p = 0.030), TNM stage (p < 0.001) and adjuvant chemotherapy (p = 0.005) as the corresponding variables for disease-free survival. CONCLUSIONS A balanced structure between adenomatous and squamous components in patients with primary ASC of the lung was associated with better prognosis.
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Affiliation(s)
- H Zhao
- Department of Cardiovascular Surgery of 1st Affiliated Hospital of Soochow University, Suzhou, China
| | - H Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China; Division of General Thoracic Surgery, Inselspital University Hospital Bern, Bern, Switzerland
| | - F Yao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Y Sun
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - J Xu
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - H Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Z Shen
- Department of Cardiovascular Surgery of 1st Affiliated Hospital of Soochow University, Suzhou, China.
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Lian S, Huang Y, Yang H, Zhao H. Serum carbohydrate antigen 12-5 level enhances the prognostic value in primary adenosquamous carcinoma of the lung: a two-institutional experience. Interact Cardiovasc Thorac Surg 2016; 22:419-24. [DOI: 10.1093/icvts/ivv369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/12/2015] [Indexed: 02/01/2023] Open
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40
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Ito R, Iwano S, Kishimoto M, Ito S, Kato K, Naganawa S. Correlation between FDG-PET/CT findings and solid type non-small cell cancer prognostic factors: are there differences between adenocarcinoma and squamous cell carcinoma? Ann Nucl Med 2015; 29:897-905. [PMID: 26342592 DOI: 10.1007/s12149-015-1025-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/12/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The maximum standardized uptake value (SUVmax) of FDG-PET/CT is commonly used as an indicator to evaluate the invasiveness and prognosis of non-small-cell lung cancers (NSCLC). We investigated the correlation between SUVmax and tumor invasiveness or postoperative recurrence of solid type NSCLC and compared squamous cell carcinoma (SCC)/adenosquamous carcinoma (ASC) to adenocarcinoma (AC). METHODS A retrospective review of preoperative PET/CT, thin-section CT, and postoperative pathological records obtained over a 5-year period was conducted. Solid type NSCLC tumors on thin-section CT with confirmed diagnosis from surgical resection (diameter ≤3 cm) were included. Multivariate logistic regression was used to evaluate the correlation between tumor characteristics and pathological prognostic factors or postoperative recurrence. RESULTS 150 patients (111 males, 39 females; mean age 67 years; 106 cases of AC, 36 cases of SCC, and 8 cases of ASC) were included. SUVmax was significantly correlated with pleural involvement (p = 0.047), lymphatic permeation (p = 0.003), lymph node metastasis (p = 0.027), and tumor invasiveness (p < 0.001). Receiver operating characteristic analysis indicated an optimal SUVmax threshold of 5.0 for tumor invasiveness. Histopathological type was significantly correlated with pleural involvement (p = 0.042), but not with other types of invasiveness. Twenty-nine patients experienced postoperative recurrence. SUVmax was significantly correlated with tumor recurrence (p = 0.004), but size and histopathological type were not (p = 0.502 and p = 0.351, respectively). CONCLUSION SUVmax of the primary lesion in solid type NSCLC was significantly correlated with tumor invasiveness and postoperative recurrence. No differences in tumor invasiveness were observed between solid type AC and SCC/ASC. However, in solid type AC, SUVmax of the primary lesion was more significantly correlated with recurrence.
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Affiliation(s)
- Rintaro Ito
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shingo Iwano
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Mariko Kishimoto
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shinji Ito
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Katsuhiko Kato
- Department of Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya, 461-8673, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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41
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Nunes V, Santiago I, Marinho R, Pires D, Theias R, Gomes A, Pignatelli N. Duodeno-colic fistula as a rare presentation of lung cancer - surgical treatment of a stage IV oligometastatic lung disease. Int J Surg Case Rep 2015. [PMID: 26197095 PMCID: PMC4529654 DOI: 10.1016/j.ijscr.2015.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Atypical presentation of stage IV oligometastatic lung disease in a young patient. Diagnostic challenge complicated by rapid evolution to a life-threatening condition. Difficult assessment of the risk/benefit of surgery due to absence of guidelines. Importance of multidisciplinary therapeutic approach in rare clinical presentations. Successful outcome at 18 month follow-up of malignancy with rare presentation.
Introduction Rare adenosquamous carcinomas have no defined standard approach given their low incidence. They present with nonspecific imaging characteristics and are described as having worse prognosis than other lung malignancies, with greater likelihood of local invasion and early metastasis. Presentation of case Male caucasian patient, 43 years, 26 pack-year smoking history, presented with watery diarrhea, early emesis and loss of 25% body weight (20 kg) in four weeks. Colonoscopy identified a left colonic mass. Abdominal CT/ultrasound showed a large fistulous lesion between the 4th portion of the duodenum and left colon. CT showed a solid mass in the right upper lung lobe. Endoscopy and transthoracic biopsy were inconclusive. En bloc D3 and D4 duodenectomy, proximal enterectomy and left hemicolectomy were performed, with inconclusive histology of the specimen. Three months later, a right upper lung lobectomy with lymphadenectomy was performed, revealing an adenosquamous carcinoma of lung origin, R0, staged as pT2pN0pM1b. Six months later, a single dural metastasis in the left cerebellopontine angle was detected and resected, with subsequent holocranial radiotherapy and systemic adjuvant chemotherapy. Patient is currently with 18 months follow-up, in good general health and with no evidence of recurrent disease. Discussion There are no specific guidelines to treat oligometastatic adenosquamous lung carcinoma. Our approach was abdominal surgery as a life-saving procedure and, months later, oncological resection of primary lung tumor and metachronous metastasis to the brain. Conclusion A systematic, patient-oriented, patient-shared, multidisciplinary approach is particularly relevant when dealing with atypical presentations of rare diseases in young patients.
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Affiliation(s)
- Vitor Nunes
- B Surgery Department, Hospital Fernando Fonseca, 2720-276 Amadora, Portugal
| | - Inês Santiago
- Radiology Department, Hospital Fernando Fonseca, 2720-276 Amadora, Portugal
| | - Rui Marinho
- B Surgery Department, Hospital Fernando Fonseca, 2720-276 Amadora, Portugal
| | - David Pires
- B Surgery Department, Hospital Fernando Fonseca, 2720-276 Amadora, Portugal
| | - Rita Theias
- Surgical Pathology Department, Hospital Fernando Fonseca, 2720-276 Amadora, Portugal
| | - António Gomes
- B Surgery Department, Hospital Fernando Fonseca, 2720-276 Amadora, Portugal.
| | - Nuno Pignatelli
- B Surgery Department, Hospital Fernando Fonseca, 2720-276 Amadora, Portugal
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Guo Y, Jia L, Shao GG, Sun HW, Wang XX, Wang GJ, Ma KW. Clinicopathological characteristics and prognosis of patients with adenosquamous lung carcinoma. ACTA ACUST UNITED AC 2015; 35:350-355. [DOI: 10.1007/s11596-015-1436-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 12/26/2014] [Indexed: 11/28/2022]
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43
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Cheung WKC, Nguyen DX. Lineage factors and differentiation states in lung cancer progression. Oncogene 2015; 34:5771-80. [PMID: 25823023 DOI: 10.1038/onc.2015.85] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 02/13/2015] [Accepted: 02/16/2015] [Indexed: 12/30/2022]
Abstract
Lung cancer encompasses a heterogeneous group of malignancies. Here we discuss how the remarkable diversity of major lung cancer subtypes is manifested in their transforming cell of origin, oncogenic dependencies, phenotypic plasticity, metastatic competence and response to therapy. More specifically, we review the increasing evidence that links this biological heterogeneity to the deregulation of cell lineage-specific pathways and the transcription factors that ultimately control them. As determinants of pulmonary epithelial differentiation, these poorly characterized transcriptional networks may underlie the etiology and biological progression of distinct lung cancers, while providing insight into innovative therapeutic strategies.
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Affiliation(s)
- W K C Cheung
- Department of Pathology, Pathology and Cancer Center, Yale University School of Medicine, New Haven, CT, USA
| | - D X Nguyen
- Department of Pathology, Pathology and Cancer Center, Yale University School of Medicine, New Haven, CT, USA.,Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA
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44
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DU C, Li Z, Wang Z, Wang L, Tian YU. Stereotactic aspiration combined with gamma knife radiosurgery for the treatment of cystic brainstem metastasis originating from lung adenosquamous carcinoma: A case report. Oncol Lett 2015; 9:1607-1613. [PMID: 25789009 PMCID: PMC4356421 DOI: 10.3892/ol.2015.2968] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 01/22/2015] [Indexed: 11/23/2022] Open
Abstract
Brainstem metastases have a poor prognosis and are difficult to manage. The present study describes the first case of histopathologically-confirmed brainstem metastasis originating from lung adenosquamous carcinoma, and discusses the outcomes of treatment by stereotactic aspiration combined with gamma knife radiosurgery (GKRS). A 59-year-old female presented with a cystic mass (15×12×13 mm; volume, 1.3 cm3) located in the pons, two years following surgical treatment for adenosquamous carcinoma of the lung. The patient received initial GKRS for the lesion in the pons with a total dose of 54.0 Gy, however, the volume of the mass subsequently increased to 3.9 cm3 over a period of three months. Computed tomography-guided stereotactic biopsy and aspiration of the intratumoral cyst were performed, yielding 2.0 cm3 of yellow-white fluid. Histology confirmed the diagnosis of adenosquamous carcinoma. Aspiration provided immediate symptomatic relief, and was followed one week later by repeat GKRS with a dose of 12.0 Gy. The patient survived for 12 months following the repeat GKRS; however, later succumbed to the disease after lapsing into a two-week coma. The findings of this case suggest that stereotactic aspiration of cysts may improve the effects of GKRS for the treatment of cystic brainstem metastasis; the decrease in tumor volume allowed a higher radiation dose to be administered with a lower risk of radiation-induced side effects. Therefore, stereotactic aspiration combined with GKRS may be an effective treatment for brainstem metastasis originating from adenosquamous carcinoma.
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Affiliation(s)
- Chao DU
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Zhaohui Li
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Zhijia Wang
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Liping Wang
- Department of Pathology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Y U Tian
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
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Analysis of major known driver mutations and prognosis in resected adenosquamous lung carcinomas. J Thorac Oncol 2015; 9:760-8. [PMID: 24481316 DOI: 10.1097/jto.0b013e3182a406d1] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Genotyping for driver mutations is now routinely used to guide clinical care of patients with lung cancer. Adenosquamous lung carcinoma (AdSqLC) is a subtype of cancer that contains both adenocarcinoma and squamous cell carcinoma. However, the incidence, clinicopathologic characteristics, and prognostic implications of major driver mutations in AdSqLCs are not well established. METHODS Seventy-six resected AdSqLCs and 646 lung adenocarcinomas were screened for known genetic alterations involving EGFR, ERBB2, KRAS, BRAF, PIK3CA, AKT1, RET, and ALK. Tumors showing acinar, lepidic, micropapillary, or papillary growth in glandular component were classified as classical AdSqLC. RESULTS Of the 76 AdSqLCs, 43 (56.6%) harbored known mutant kinases, including 24 (31.6%) with EGFR mutations, eight (10.5%) with KRAS mutations, two (2.6%) with AKT1 (2.6%) mutations, one (1.3%) with ERBB2 insertion mutation, one (1.3%) with PIK3CA mutation, four (5.3%) with ALK fusions, and three (4%) with KIF5B-RET fusions. No mutation was found in BRAF. The mutational profiles and clinicopathologic characteristics of classical AdSqLC were strikingly similar to that of poorly differentiated adenocarcinoma. However, AdSqLCs with solid growth pattern in glandular component had high frequency of ALK or RET fusions and low EGFR mutation rate. CONCLUSIONS To our knowledge, this is the first comprehensive study investigating major oncogenic driver mutations in a large cohort of AdSqLC patients in a Chinese population. The findings suggest that it will be clinically valuable to investigate the growth pattern of glandular component in AdSqLCs.
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Watanabe Y, Shiraishi K, Takahashi F, Yoshida A, Suzuki K, Asamura H, Takeuchi M, Furuta K, Tsuta K. Biomarker expression and druggable gene alterations for development of an appropriate therapeutic protocol for pulmonary adenosquamous carcinoma. Histopathology 2014; 66:939-48. [PMID: 25257380 DOI: 10.1111/his.12556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 09/19/2014] [Indexed: 11/26/2022]
Abstract
AIMS Pulmonary adenosquamous carcinoma (ASC) is more aggressive than adenocarcinoma (AC) and squamous cell carcinoma (SCC). The genetic features and biomarkers of ASC are not well known. Here, we attempted to identify potential therapeutic markers for ASC. METHODS AND RESULTS Surgically resected ASC samples from 65 patients were analysed. We examined the expression of β III-tubulin, thymidylate synthase, breast cancer susceptibility gene 1 and ribonucleotide reductase M1 (RRM1); identified mutations in epidermal growth factor receptor (EGFR), KRAS, BRAF and HER2; and detected ALK, ROS1 and RET rearrangements. Gene amplification and expression of EGFR, human epidermal growth factor receptor 2 (HER2), fibroblast growth factor receptor-1 and MET were also examined. β III-Tubulin showed the highest expression (P = 0.002), and its expression was more frequent in the AC than in the SCC component (P = 0.013). RRM1 expression was more frequent in the SCC component (P = 0.046). EGFR and KRAS mutations were detected in both components (21.5 and 10.9%, respectively). ALK and ROS1 rearrangements and MET amplification were detected in both components in one (1.5%) case. CONCLUSIONS In ASC, drug response-specific gene alterations could occur in both AC and SCC components, suggesting that patients with confirmed or suspected ASC should undergo further testing for driver gene analyses.
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Affiliation(s)
- Yukio Watanabe
- Division of Pathology, National Cancer Centre Hospital, Tokyo, Japan.,Department of Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.,Division of Thoracic Surgery, National Cancer Centre Hospital, Tokyo, Japan
| | - Kouya Shiraishi
- Division of Genome Biology, National Cancer Centre Research Institute, Tokyo, Japan
| | - Fumiaki Takahashi
- Department of Clinical Medicine (Biostatistics), School of Pharmacy, Kitasato University, Tokyo, Japan
| | - Akihiko Yoshida
- Division of Pathology, National Cancer Centre Hospital, Tokyo, Japan
| | - Kenji Suzuki
- Department of Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hisao Asamura
- Division of Thoracic Surgery, National Cancer Centre Hospital, Tokyo, Japan
| | - Masahiro Takeuchi
- Department of Clinical Medicine (Biostatistics), School of Pharmacy, Kitasato University, Tokyo, Japan
| | - Koh Furuta
- Division of Pathology, National Cancer Centre Hospital, Tokyo, Japan
| | - Koji Tsuta
- Division of Pathology, National Cancer Centre Hospital, Tokyo, Japan
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47
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Yamatani C, Abe M, Shimoji M, Maniwa T, Takahashi S, Isaka M, Ohde Y, Watanabe R, Ito I, Kondo H, Nakajima T. Pulmonary adenosquamous carcinoma with mucoepidermoid carcinoma-like component with characteristic p63 staining pattern: either a novel subtype originating from bronchial epithelium or variant mucoepidermoid carcinoma. Lung Cancer 2014; 84:45-50. [PMID: 24513264 DOI: 10.1016/j.lungcan.2014.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 01/10/2014] [Accepted: 01/15/2014] [Indexed: 01/26/2023]
Abstract
BACKGROUND Our previous study found unique adenosquamous carcinomas (ADSQs) containing a mucoepidermoid carcinoma (MEC)-like component and a characteristic p63 staining pattern. This study focused on these unique ADSQs. METHODS Thirty ADSQ cases were studied histologically and by immunohistochemistry for TTF-1 and p63. Of these 30 ADSQs, eight were selected as unique ADSQs. The clinicopathological characteristics of these ADSQs were further studied, and the gene rearrangement of mammalian mastermind-like 2 (MAML2) was investigated by fluorescence in situ hybridization (FISH) for differentiation from pulmonary MEC. RESULTS The clinicopathological characteristics between the eight ADSQs and the other ADSQ cases showed no statistically significant differences, except for serum CEA level. Histologically, the eight ADSQs contained varying degrees of the MEC-like component, which consisted of solid nests with mucin-filled cysts or a cribriform-like structure. Immunohistochemically, p63-positive nuclei characteristically encircled the tumor nests, although TTF-1 was completely negative. All unique ADSQs not only had a variable degree of squamous cell carcinoma component in addition to the MEC-like component, but also contained a small tubular adenocarcinoma component in three tumors. FISH analysis revealed no MAML2 gene rearrangement in the eight ADSQs. CONCLUSIONS Of the 30 ADSQs investigated in this study, eight contained a MEC-like component with a characteristic p63 basilar staining pattern similar to that of bronchial basal cells. These unique ADSQs shared clinical characteristics with ordinary ADSQs, but clinicopathologically differed from pulmonary ordinary MEC. Therefore, these unique ADSQs may be either a novel ADSQ subtype originating from bronchial epithelium or variant-type MEC.
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Affiliation(s)
| | - Masato Abe
- Division of Diagnostic Pathology, Shizuoka Cancer Center, Japan
| | - Masaki Shimoji
- Division of Thoracic Surgery, Shizuoka Cancer Center, Japan
| | | | | | | | - Yasuhisa Ohde
- Division of Thoracic Surgery, Shizuoka Cancer Center, Japan
| | - Reiko Watanabe
- Division of Diagnostic Pathology, Shizuoka Cancer Center, Japan
| | - Ichiro Ito
- Division of Diagnostic Pathology, Shizuoka Cancer Center, Japan
| | - Haruhiko Kondo
- Department of Surgery, Kyorin University School of Medicine, Japan
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48
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Pelosi G, Haspinger ER, Bimbatti M, Leone G, Paolini B, Fabbri A, Tamborini E, Perrone F, Testi A, Garassino M, Maisonneuve P, de Braud F, Pilotti S, Pastorino U. Does Immunohistochemistry Affect Response to Therapy and Survival of Inoperable Non–Small Cell Lung Carcinoma Patients? A Survey of 145 Stage III-IV Consecutive Cases. Int J Surg Pathol 2013; 22:136-48. [DOI: 10.1177/1066896913511527] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Whether non–small cell lung carcinoma (NSCLC) unveiled by immunohistochemistry (IHC) has the same clinical outcome as those typed by morphology is still matter of debate. A total of 145 stage III-IV, consecutive inoperable NSCLC patients treated by chemotherapy (133 cases) or EGFR tyrosine kinase inhibitor (12 cases) and including 100 biopsies, 11 surgical specimens, and 34 cytological samples had originally accounted for 120 adenocarcinomas (ADs), 19 squamous cell carcinomas (SQCs), and 6 adenosquamous carcinomas (ADSQCs) by integrating morphology and thyroid transcription factor-1 (TTF1)/p40 IHC. Thirty-two NSCLC–not otherwise specified (NSCLC-NOS) cases were identified by morphology revision of the original diagnoses, which showed solid growth pattern ( P < .001), 22 ADs, 5 SQCs, and 5 ADSQCs by IHC profiling ( P < .001), and 10 gene-altered tumors (3 EGFR, 5 KRAS, and 2 ALK). While no significant relationships were observed between response to therapy and original, morphology or IHC diagnoses, driver mutations and tumor differentiation by TTF1 expression, AD run better progression-free survival (PFS) or overall survival (OS) than other tumor types by morphology ( P = .010 and P = .047) and IHC ( P = .033 and P = .046), respectively. Furthermore, patients with NSCLC-NOS confirmed as AD by IHC tended to have poorer OS ( P = .179) and PFS ( P = .193) similar to that of ADSQC and SQC ( P = .702 and P = .540, respectively). A category of less differentiated AD with poorer prognosis on therapy could be identified by IHC, while there were no differences for SQC or ADSQC. The terminology of “NSCLC-NOS, favor by IHC” is appropriate to alert clinicians toward more aggressive tumors.
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Affiliation(s)
- Giuseppe Pelosi
- Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, Università degli Studi, Milan, Italy
| | | | | | - Giorgia Leone
- Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | - Biagio Paolini
- Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | | | - Elena Tamborini
- Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | | | - Adele Testi
- Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | | | - Patrick Maisonneuve
- Department of Medical Oncology, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | | | - Silvana Pilotti
- Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | - Ugo Pastorino
- Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
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Mather JP, Roberts PE, Pan Z, Chen F, Hooley J, Young P, Xu X, Smith DH, Easton A, Li P, Bonvini E, Koenig S, Moore PA. Isolation of cancer stem like cells from human adenosquamous carcinoma of the lung supports a monoclonal origin from a multipotential tissue stem cell. PLoS One 2013; 8:e79456. [PMID: 24324581 PMCID: PMC3850920 DOI: 10.1371/journal.pone.0079456] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 09/23/2013] [Indexed: 01/06/2023] Open
Abstract
There is increasing evidence that many solid tumors are hierarchically organized with the bulk tumor cells having limited replication potential, but are sustained by a stem-like cell that perpetuates the tumor. These cancer stem cells have been hypothesized to originate from transformation of adult tissue stem cells, or through re-acquisition of stem-like properties by progenitor cells. Adenosquamous carcinoma (ASC) is an aggressive type of lung cancer that contains a mixture of cells with squamous (cytokeratin 5+) and adenocarcinoma (cytokeratin 7+) phenotypes. The origin of these mixtures is unclear as squamous carcinomas are thought to arise from basal cells in the upper respiratory tract while adenocarcinomas are believed to form from stem cells in the bronchial alveolar junction. We have isolated and characterized cancer stem-like populations from ASC through application of selective defined culture medium initially used to grow human lung stem cells. Homogeneous cells selected from ASC tumor specimens were stably expanded in vitro. Primary xenografts and metastatic lesions derived from these cells in NSG mice fully recapitulate both the adenocarcinoma and squamous features of the patient tumor. Interestingly, while the CSLC all co-expressed cytokeratins 5 and 7, most xenograft cells expressed either one, or neither, with <10% remaining double positive. We also demonstrated the potential of the CSLC to differentiate to multi-lineage structures with branching lung morphology expressing bronchial, alveolar and neuroendocrine markers in vitro. Taken together the properties of these ASC-derived CSLC suggests that ASC may arise from a primitive lung stem cell distinct from the bronchial-alveolar or basal stem cells.
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MESH Headings
- Adult
- Adult Stem Cells/metabolism
- Adult Stem Cells/pathology
- Animals
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Bronchi/metabolism
- Bronchi/pathology
- Carcinoma, Adenosquamous/genetics
- Carcinoma, Adenosquamous/metabolism
- Carcinoma, Adenosquamous/pathology
- Carcinoma, Squamous Cell/genetics
- Carcinoma, Squamous Cell/metabolism
- Carcinoma, Squamous Cell/pathology
- Cell Differentiation
- Cell Proliferation
- Clone Cells
- Gene Expression
- Gene Expression Profiling
- Humans
- Keratin-5/genetics
- Keratin-5/metabolism
- Keratin-7/genetics
- Keratin-7/metabolism
- Lung Neoplasms/genetics
- Lung Neoplasms/metabolism
- Lung Neoplasms/pathology
- Mice
- Mice, SCID
- Neoplastic Stem Cells/metabolism
- Neoplastic Stem Cells/pathology
- Pulmonary Alveoli/metabolism
- Pulmonary Alveoli/pathology
- Transplantation, Heterologous
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Affiliation(s)
- Jennie P. Mather
- MacroGenics, Inc., South San Francisco, California, United States of America
- * E-mail:
| | - Penelope E. Roberts
- MacroGenics, Inc., South San Francisco, California, United States of America
| | - Zhuangyu Pan
- MacroGenics, Inc., South San Francisco, California, United States of America
| | - Francine Chen
- MacroGenics, Inc., South San Francisco, California, United States of America
| | - Jeffrey Hooley
- MacroGenics, Inc., South San Francisco, California, United States of America
| | - Peter Young
- MacroGenics, Inc., South San Francisco, California, United States of America
| | - Xiaolin Xu
- MacroGenics, Inc., South San Francisco, California, United States of America
| | - Douglas H. Smith
- MacroGenics, Inc., South San Francisco, California, United States of America
| | - Ann Easton
- MacroGenics, Inc., South San Francisco, California, United States of America
| | - Panjing Li
- MacroGenics, Inc., South San Francisco, California, United States of America
| | - Ezio Bonvini
- MacroGenics, Inc., Rockville, Maryland, United States of America
| | - Scott Koenig
- MacroGenics, Inc., Rockville, Maryland, United States of America
| | - Paul A. Moore
- MacroGenics, Inc., Rockville, Maryland, United States of America
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50
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Warwick R, Mediratta N, Shackcloth M, Page R, McShane J, Shaw M, Poullis M. Pneumonectomy: risk factor or innocent bystander? Asian Cardiovasc Thorac Ann 2013; 22:49-54. [DOI: 10.1177/0218492313477102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Pneumonectomy is associated with a higher operative mortality rate and worse 5-year survival after resection for non-small-cell lung cancer, compared to lobectomy. We investigated whether pneumonectomy is an independent risk factor for hospital mortality and poor long-term survival, after risk factor adjustment. Methods We analyzed a prospectively validated thoracic surgery database. Kaplan-Meier survival curves were constructed for patients who had undergone lobectomy ( n = 1484) or pneumonectomy ( n = 266). Logistic and Cox multivariate regression analysis and propensity matching were performed on hospital mortality and long-term survival data. Results Univariate analysis demonstrated that pneumonectomy was a significant risk factor for hospital death ( p = 0.02) and long-term survival ( p < 0.001). Logistic regression failed to demonstrate pneumonectomy as a risk factor for hospital mortality. Cox regression analysis failed to identify pneumonectomy as a statistically significant risk factor. Propensity analysis ( n = 266 in each group with 1:1 matching) demonstrated that pneumonectomy was not associated with hospital mortality ( p = 0.37) or poorer long-term survival ( p = 0.19) compared to lobectomy. Conclusion Pneumonectomy is not an independent risk factor for hospital mortality or long-term survival, after adjustment for confounding factors.
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Affiliation(s)
| | | | | | - Richard Page
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | - Matthew Shaw
- Liverpool Heart and Chest Hospital, Liverpool, UK
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