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Lee JH, Kang Y, Kim S, Jung Y, Chung JH, Lee S, Yi E. Clinical Importance of Grading Tumor Spread through Air Spaces in Early-Stage Small-Lung Adenocarcinoma. Cancers (Basel) 2024; 16:2218. [PMID: 38927923 PMCID: PMC11201625 DOI: 10.3390/cancers16122218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
This study aimed to identify the clinical manifestation and implications according to the grading of tumor spread through air spaces in early-stage small (≤2 cm) pathological stage I non-mucinous lung adenocarcinomas. Medical records of patients with pathological stage I tumors sized ≤2 cm were retrospectively reviewed and analyzed. The furthest distance of the spread through air spaces from the tumor margin was measured on a standard-length scale (mm). Enrolled patients were categorized into spread through air spaces (STAS) (-) and STAS (+), and STAS (+) was subdivided according to its furthest distance as follows: STAS (+)-L (<2 mm) and STAS (+)-H (≥2 mm). Risk factors for STAS (+) included papillary predominant subtype (p = 0.027), presence of micropapillary patterns (p < 0.001), and EGFR (p = 0.039). The overall survival of the three groups did not differ significantly (p = 0.565). The recurrence-free survival of STAS (+)-H groups was significantly lower than those of STAS (-) and STAS (+)-L (p < 0.001 and p = 0.039, respectively). A number of alveolar spaces were definite risk factors for STAS (+)-H groups (p < 0.001), and male gender could be one (p = 0.054). In the patient group with small (≤2 cm) pathological stage I lung adenocarcinomas, the presence of STAS ≥ 2 mm was related to significantly lower recurrence-free survival. For identifying definite risk factors for the presence of farther STAS, more precise analysis from a larger study population should be undertaken.
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Affiliation(s)
- Jeong Hyeon Lee
- Department of Pathology, Korea University Anam Hospital, Seoul 02841, Republic of Korea; (J.H.L.); (Y.K.); (S.K.)
| | - Younggjn Kang
- Department of Pathology, Korea University Anam Hospital, Seoul 02841, Republic of Korea; (J.H.L.); (Y.K.); (S.K.)
| | - Seojin Kim
- Department of Pathology, Korea University Anam Hospital, Seoul 02841, Republic of Korea; (J.H.L.); (Y.K.); (S.K.)
| | - Youggi Jung
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul 02841, Republic of Korea; (Y.J.); (J.H.C.)
| | - Jae Ho Chung
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul 02841, Republic of Korea; (Y.J.); (J.H.C.)
| | - Sungho Lee
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul 02841, Republic of Korea; (Y.J.); (J.H.C.)
| | - Eunjue Yi
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul 02841, Republic of Korea; (Y.J.); (J.H.C.)
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Li T, Liu J, Zhou Y, Huang S, Wang D, Chen J, Fu Y, He P. Clinical relevance of somatic mutations in Chinese lung adenocarcinoma and their prognostic implications for survival. Cancer Med 2024; 13:e7227. [PMID: 38770632 PMCID: PMC11106684 DOI: 10.1002/cam4.7227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 04/07/2024] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND To comprehensively elucidate the genomic and mutational features of lung cancer cases, and lung adenocarcinoma (LUAD), it is imperative to conduct ongoing investigations into the genomic landscape. In this study, we aim to analyze the somatic mutation profile and assessed the significance of these informative genes utilizing a retrospective LUAD cohort. METHODS A total of 247 Chinese samples were analyzed to exhibit the tumor somatic genomic alterations in patients with LUAD. The Cox regression analysis was employed to identify prognosis-related genes and establish a predictive model for stratifying patients with LUAD. RESULTS In the Dianjiang People's Hospital (DPH) cohort, the top five frequent mutated genes were (Epidermal growth factor receptor) EGFR (68%), TP53 (30%), RBM10 (13%), LRP1B (9%), and KRAS (9%). Of which, EGFR is a mostly altered driver gene, and most mutation sites are located in tyrosine kinase regions. Oncogene pathway alteration and mutation signature analysis demonstrated the RTK-RAS pathway alteration, and smoking was the main carcinogenic factor of the DPH cohort. Furthermore, we identified 34 driver genes in the DPH cohort, including EGFR (68%), TP53 (30.4%), RBM10 (12.6%), KRAS (8.5%), LRP1B (8.5%), and so on, and 45 Clinical Characteristic-Related Genes (CCRGs) were found to closely related to the clinical high-risk factors. We developed a Multiple Parameter Gene Mutation (MPGM) risk model by integrating critical genes and oncogenic pathway alterations in LUAD patients from the DPH cohort. Based on publicly available LUAD datasets, we identified five genes, including BRCA2, Anaplastic lymphoma kinase (ALK), BRAF, EGFR, and Platelet-Derived Growth Factor Receptor Alpha (PDGFRA), according to the multivariable Cox regression analysis. The MPGM-low group showed significantly better overall survival (OS) compared to the MPGM-high group (p < 0.0001, area under the curve (AUC) = 0.754). The robust performance was validated in 55 LUAD patients from the DPH cohort and another LUAD dataset. Immune characteristics analysis revealed a higher proportion of primarily DCs and mononuclear cells in the MPGM-low risk group, while the MPGM-high risk group showed lower immune cells and higher tumor cell infiltration. CONCLUSION This study provides a comprehensive genomic landscape of Chinese LUAD patients and develops an MPGM risk model for LUAD prognosis stratification. Further follow-up will be performed for the patients in the DPH cohort consistently to explore the resistance and prognosis genetic features.
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Affiliation(s)
- Tongxin Li
- Department of Cardiothoracic SurgeryDianjiang People's Hospital of ChongqingChongqingChina
| | - Jie Liu
- Department of Thoracic Surgery, Southwest HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Yu Zhou
- Department of Cardiothoracic SurgeryDianjiang People's Hospital of ChongqingChongqingChina
| | - Shengyuan Huang
- Department of Cardiothoracic SurgeryDianjiang People's Hospital of ChongqingChongqingChina
| | - Dong Wang
- Department of Cardiothoracic SurgeryDianjiang People's Hospital of ChongqingChongqingChina
| | - Jianrong Chen
- Department of Cardiothoracic SurgeryDianjiang People's Hospital of ChongqingChongqingChina
| | - Yong Fu
- Department of Cardiothoracic SurgeryDianjiang People's Hospital of ChongqingChongqingChina
| | - Ping He
- Department of Cardiac Surgery, Southwest HospitalArmy Medical University (Third Military Medical University)ChongqingChina
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Wang X, Dai X, Ding Q, Xu Y, Chen L, Duan S, Zhang Y, Chen Y, Chen D. Impact of CT-guided hookwire localization on tumor spread through air spaces in stage IA lung adenocarcinoma. Heliyon 2024; 10:e23705. [PMID: 38192833 PMCID: PMC10772635 DOI: 10.1016/j.heliyon.2023.e23705] [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: 08/25/2023] [Revised: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 01/10/2024] Open
Abstract
Background It remains undetermined whether preoperative computed tomography (CT)-guided hookwire localization would result in elevated risk of tumor spread through air spaces (STAS) in stage IA lung adenocarcinoma. Methods A total of 1836 patients who underwent lobectomy were included. To eliminate the potential impact of confounding factors on producing STAS, propensity score-matching (PSM) was used to create two balanced subgroups stratified by implementation of hookwire localization. We also introduced an external cohort including 1486 patients to explore the effect of hookwire localization on the incidence of STAS and patient survival after sublobar resection (SR). For proactive simulation of hookwire localization, 20 consecutive lobectomy specimens of p-stage IA lung adenocarcinoma were selected. Results Ex vivo tests revealed that mechanical artifacts presenting as spreading through a localizer surface (STALS) could be induced by hookwire localization but be distinguished by CD68 and AE1/3 antibody-based immunohistochemistry. The distance of STALS dissemination tended to be shorter compared with real STAS (P = 0.000). After PSM, implementation of hookwire localization was not associated with elevated STAS incidence, nor worse survival in p-stage IA patients undergoing lobectomy irrespective of STAS. Conclusions CT-guided hookwire localization might induce mechanical artifacts presenting as STALS which could be distinguished by immunohistochemistry, but would not affect survival in p-stage IA disease. Surgeons can be less apprehensive about performing hookwire localization in relation to STAS on stage IA disease suitable for SR.
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Affiliation(s)
- Xiaofan Wang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Xiaoxiao Dai
- Department of Pathology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Qifeng Ding
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Yi Xu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Lei Chen
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Shanzhou Duan
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Yongsheng Zhang
- Department of Pathology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Yongbing Chen
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Donglai Chen
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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Wang J, Yao Y, Tang D, Gao W. An individualized nomogram for predicting and validating spread through air space (STAS) in surgically resected lung adenocarcinoma: a single center retrospective analysis. J Cardiothorac Surg 2023; 18:337. [PMID: 37990253 PMCID: PMC10664312 DOI: 10.1186/s13019-023-02458-0] [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: 05/13/2023] [Accepted: 11/15/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE A single-center study was conducted to explore the association between STAS and other clinical features in surgically resected adenocarcinoma to enhance our current understanding of STAS. METHODS We retrospectively enrolled patients with lung adenocarcinoma (n = 241) who underwent curative surgeries. Patients undergoing surgery in 2019 were attributed to the training group (n = 188) and those undergoing surgery in January 2022 to June 2022 were attributed to the validation (n = 53) group. Univariate and multivariate logistic regression analyses were used to identify predictive factors for STAS, which were used to construct a simple nomogram. Furthermore, ROC and calibration curves were used to evaluate the performance of the nomogram. In addition, we conducted decision curve analysis (DCA) to assess the clinical utility of this nomogram. RESULTS In our cohort, 52 patients were identified as STAS-positive (21.6%). In univariate analysis, STAS was significantly associated with age, surgical approach, CEA, CTR (Consolidation Tumor Ratio), TNM stage, tumor grade, gross tumor size, resection margin, vessel cancer embolus, pleural invasion, lymph node metastasis, high ki67 and positive PD-L1 staining (P < 0.05). Lower age, CTR > 0.75, vessel cancer embolus, high Ki67 and PD-L1 stain positive were significant predictors for STAS during multivariate logistics analysis. A simple nomogram was successfully constructed based on these five predictors. The AUC values of our nomogram for the probability of tumor STAS were 0.860 in the training group and 0.919 in the validation group. In addition, the calibration curve and DCA validated the good performance of this model. CONCLUSION A nomogram was successfully constructed to identify the presence of STAS in surgically resected lung adenocarcinoma patients.
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Affiliation(s)
- Jing Wang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, 200041, China
| | - Yuanshan Yao
- Department of Thoracic Surgery, Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, 200041, China
| | - Dongfang Tang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, 200041, China
| | - Wen Gao
- Department of Thoracic Surgery, Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, 200041, China.
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Zhang Y, Hu Y, Zhang S, Zhu M, Lu J, Hu B, Guo X, Zhang Y. Effects of pre-operative biopsy on recurrence and survival in stage I lung adenocarcinoma patients in China. ERJ Open Res 2023; 9:00675-2022. [PMID: 37583968 PMCID: PMC10423981 DOI: 10.1183/23120541.00675-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/04/2023] [Indexed: 08/17/2023] Open
Abstract
Background Whether pre-operative biopsy affects post-operative recurrence and metastasis of lung cancer patients is still controversial. Methods In order to clarify these disputes, we collected relevant literature to conduct a meta-analysis. To validate the results of the meta-analysis, we retrospectively analysed 575 patients with stage I lung adenocarcinoma who underwent surgical resection at our centre from 2010 to 2018 using propensity score matching and competing risk models. Results 5509 lung cancer patients from 11 articles were included in the meta-analysis. Summary analysis showed that the total recurrence rate of the biopsy group was higher than that of the nonbiopsy group (risk ratio 1.690, 95% CI 1.220-2.330; p=0.001). After propensity score matching, we found that there was no significant correlation between biopsy and total recurrence (risk ratio 1.070, 95% CI 0.540-2.120; p=0.850). In our cohort, of 575 stage I lung adenocarcinomas, 113 (19.7%) patients underwent pre-operative biopsy. During a median (interquartile range) follow-up of 71 (57-93) months, multivariable analyses showed pre-operative biopsy in the overall observation cohort (subdistribution hazard ratio (SHR) 1.522, 95% CI 0.997-2.320; p=0.051) and in the propensity score-matched cohort (SHR 1.134, 95% CI 0.709-1.810; p=0.600) was not significantly correlated with the risk of recurrence and metastasis. Moreover, the pre-operative biopsy did not affect disease-free survival (SHR 0.853, 95% CI 0.572-1.273; p=0.438) or overall survival (SHR 0.647, 95% CI 0.352-1.189; p=0.161). Conclusion Pre-operative biopsy might not increase the risk of recurrence and metastasis, suggesting that these procedures might be safe for patients with stage I lung adenocarcinoma whose diagnosis is difficult to determine before surgery.
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Affiliation(s)
- Yuan Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, China
- These authors contributed equally
| | - Yi Hu
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, China
- These authors contributed equally
| | - Shu Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, China
| | - Min Zhu
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, China
| | - Jun Lu
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Bin Hu
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaojuan Guo
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yuhui Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, China
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Uruga H, Mino-Kenudson M. Preoperative Biopsy Does Not Generate STAS? Chest 2022; 162:963-964. [DOI: 10.1016/j.chest.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 11/06/2022] Open
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