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Zheng Y, Li H, Zhang K, Luo Q, Ding C, Han X, Shi H. Dual-energy CT-based radiomics for predicting pathological grading of invasive lung adenocarcinoma. Clin Radiol 2024; 79:e1226-e1234. [PMID: 39098469 DOI: 10.1016/j.crad.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 06/04/2024] [Accepted: 07/09/2024] [Indexed: 08/06/2024]
Abstract
AIMS The purpose of the study was to build a radiomics model using Dual-energy CT (DECT) to predict pathological grading of invasive lung adenocarcinoma. MATERIALS AND METHODS The retrospective study enrolled 107 patients (80 low-grade and 27 high-grade) with invasive lung adenocarcinoma before surgery. Clinical features, radiographic characteristics, and quantitative parameters were measured. Virtual monoenergetic images at 50kev and 150kev were reconstructed for extracting DECT radiomics features. To select features for constructing models, Pearson's correlation analysis, intraclass correlation coefficients, and least absolute shrinkage and selection operator penalized logistic regression were performed. Four models, including the DECT radiomics model, the clinical-DECT model, the conventional CT radiomics model, and the mixed model, were established. Area under the curve (AUC) and decision curve analysis were used to measure the performance and the clinical value of the models. RESULTS The radiomics model based on DECT exhibited outstanding performance in predicting tumor differentiation, with an AUC of 0.997 and 0.743 in the training and testing sets, respectively. Incorporating tumor density, lobulation, and effective atomic number at AP, the clinical-DECT model showed a comparable performance with an AUC of 0.836 in both the training and testing sets. In comparison to the conventional CT radiomics model (AUC of 0.998 in the training and 0.529 in the testing set) and the mixed model (AUC of 0.988 in the training and 0.707 in the testing set), the DECT radiomics model demonstrated a greater AUC value and provided patients with a more significant net benefit in the testing set. CONCLUSIONS In contrast to the conventional CT radiomics model, the DECT radiomics model produced greater predictive performance in pathological grading of invasive lung adenocarcinoma.
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Affiliation(s)
- Y Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.
| | - H Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.
| | - K Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.
| | - Q Luo
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.
| | - C Ding
- Bayer Healthcare, No. 399, West Haiyang Road, Shanghai 200126, China.
| | - X Han
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.
| | - H Shi
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.
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Cheng R, Hao Z, Qiu L, Zheng X, Huang S, Xian J, Huang H, Li J, Zhang Z, Ye K, Wu W, Zhang Y, Liu J. The impact of postoperative adjuvant therapy on EGFR-mutated stage IA lung adenocarcinoma with micropapillary pathological subtypes. World J Surg Oncol 2024; 22:235. [PMID: 39232762 PMCID: PMC11375949 DOI: 10.1186/s12957-024-03429-y] [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: 11/21/2023] [Accepted: 05/27/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Micropapillary (MPP) adenocarcinoma is considered one of the most aggressive pathological types of lung adenocarcinoma (LADC). This retrospective study aimed to evaluate the prognostic significance and benefit of postoperative adjuvant therapy (PAT) in stage IA LADC patients with different proportions of MPP components. MATERIALS AND METHODS We retrospectively examined clinical stage IA LADC patients who underwent surgical resection between August 2012 and December 2019. In terms of the proportion of MPP components (TPM), the tumors were reclassified into three categories: MPP patterns absent (TPMN); low proportions of MPP components (TPML); and high proportions of MPP components (TPMH). The dates of recurrence and metastasis were identified based on physical examinations and were confirmed by histopathological examination. RESULTS Overall, 505 (TPMN, n = 375; TPML, n = 92; TPMH, n = 38) patients harboring EGFR mutations were enrolled in the study. Male sex (P = 0.044), high pathological stage (P < 0.001), and MPP pathological subtype (P < 0.001) were more frequent in the TPM-positive (TPMP) group than in the TPM-negative (TPMN) group. Five-year disease-free survival (DFS) rates were significantly lower in the TPMP group than in the TPMN group (84.5% vs. 93.4%, P = 0.006). In addition, patients with high proportions (greater than 10%) of MPP components had worse overall survival (OS) (91.0% vs. 98.9%, P = 0.025) than those with low proportions (5%≤ TPM ≤ 10%). However, postoperative EGFR tyrosine kinase inhibitors (TKIs) or adjuvant chemotherapy (ACT) cannot improve DFS and OS between EGFR-mutated patients with different proportions of MPP components. CONCLUSION MPP was related to earlier recurrence and shortened survival time, even in stage IA. Further research needs a larger sample size to clarify that EGFR-mutated stage IA patients with MPP components obtain survival benefits from adjuvant therapy.
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Affiliation(s)
- Ran Cheng
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhexue Hao
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Li Qiu
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiang Zheng
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Oncology, The First Clinical Medical College of Henan University, Kaifeng, China
| | - Sihe Huang
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianzhao Xian
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Haoyang Huang
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianfu Li
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhenhui Zhang
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kaiwen Ye
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wentao Wu
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yaowen Zhang
- Department of Radiation Oncology, Anyang Tumor Hospital, The Affiliated Anyang Tumor Hospital of Henan, Henan Medical Key Laboratory of Precise Prevention and Treatment of Esophageal Cancer, University of Science and Technology, Anyang, China.
| | - Jun Liu
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Li J, Xiong S, He P, Liang P, Li C, Zhong R, Cai X, Xie Z, Liu J, Cheng B, Chen Z, Liang H, Lao S, Chen Z, Shi J, Li F, Feng Y, Huo Z, Deng H, Yu Z, Wang H, Zhan S, Xiang Y, Wang H, Zheng Y, Lin X, He J, Liang W. Spatial whole exome sequencing reveals the genetic features of highly-aggressive components in lung adenocarcinoma. Neoplasia 2024; 54:101013. [PMID: 38850835 PMCID: PMC11208950 DOI: 10.1016/j.neo.2024.101013] [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: 01/07/2024] [Revised: 05/22/2024] [Accepted: 05/29/2024] [Indexed: 06/10/2024]
Abstract
In invasive lung adenocarcinoma (LUAD), patients with micropapillary (MIP) or solid (SOL) components had a significantly poorer prognosis than those with only lepidic (LEP), acinar (ACI) or papillary (PAP) components. It is interesting to explore the genetic features of different histologic subtypes, especially the highly aggressive components. Based on a cohort of 5,933 patients, this study observed that in different tumor size groups, LUAD with MIP/SOL components showed a different prevalence, and patients with ALK alteration or TP53 mutations had a higher probability of developing MIP/SOL components. To control individual differences, this research used spatial whole-exome sequencing (WES) via laser-capture microdissection of five patients harboring these five coexistent components and identified genetic features among different histologic components of the same tumor. In tracing the evolution of components, we found that titin (TTN) mutation might serve as a crucial intratumor potential driver for MIP/SOL components, which was validated by a cohort of 146 LUAD patients undergoing bulk WES. Functional analysis revealed that TTN mutations enriched the complement and coagulation cascades, which correlated with the pathway of cell adhesion, migration, and proliferation. Collectively, the histologic subtypes of invasive LUAD were genetically different, and certain trunk genotypes might synergize with branching TTN mutation to develop highly aggressive components.
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Affiliation(s)
- Jianfu Li
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Shan Xiong
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Ping He
- Department of pathology, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Peng Liang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Caichen Li
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Ran Zhong
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Xiuyu Cai
- Department of General Internal Medicine, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Zhanhong Xie
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China
| | - Jun Liu
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Bo Cheng
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Zhuxing Chen
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Hengrui Liang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Shen Lao
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Zisheng Chen
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jiang Shi
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Feng Li
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Yi Feng
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Zhenyu Huo
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Hongsheng Deng
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Ziwen Yu
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Haixuan Wang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Shuting Zhan
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Yang Xiang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Huiting Wang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Yongmin Zheng
- Department of pathology, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Xiaodong Lin
- Department of pathology, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China; Southern Medical University, Guangzhou 510120, China.
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.
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Xing X, Li L, Sun M, Yang J, Zhu X, Peng F, Du J, Feng Y. Deep-learning-based 3D super-resolution CT radiomics model: Predict the possibility of the micropapillary/solid component of lung adenocarcinoma. Heliyon 2024; 10:e34163. [PMID: 39071606 PMCID: PMC11279278 DOI: 10.1016/j.heliyon.2024.e34163] [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: 01/30/2024] [Revised: 07/03/2024] [Accepted: 07/04/2024] [Indexed: 07/30/2024] Open
Abstract
Objective Invasive lung adenocarcinoma(ILA) with micropapillary (MPP)/solid (SOL) components has a poor prognosis. Preoperative identification is essential for decision-making for subsequent treatment. This study aims to construct and evaluate a super-resolution(SR) enhanced radiomics model designed to predict the presence of MPP/SOL components preoperatively to provide more accurate and individualized treatment planning. Methods Between March 2018 and November 2023, patients who underwent curative intent ILA resection were included in the study. We implemented a deep transfer learning network on CT images to improve their resolution, resulting in the acquisition of preoperative super-resolution CT (SR-CT) images. Models were developed using radiomic features extracted from CT and SR-CT images. These models employed a range of classifiers, including Logistic Regression (LR), Support Vector Machines (SVM), k-Nearest Neighbors (KNN), Random Forest, Extra Trees, Extreme Gradient Boosting (XGBoost), Light Gradient Boosting Machine (LightGBM), and Multilayer Perceptron (MLP). The diagnostic performance of the models was assessed by measuring the area under the curve (AUC). Result A total of 245 patients were recruited, of which 109 (44.5 %) were diagnosed with ILA with MPP/SOL components. In the analysis of CT images, the SVM model exhibited outstanding effectiveness, recording AUC scores of 0.864 in the training group and 0.761 in the testing group. When this SVM approach was used to develop a radiomics model with SR-CT images, it recorded AUCs of 0.904 in the training and 0.819 in the test cohorts. The calibration curves indicated a high goodness of fit, while decision curve analysis (DCA) highlighted the model's clinical utility. Conclusion The study successfully constructed and evaluated a deep learning(DL)-enhanced SR-CT radiomics model. This model outperformed conventional CT radiomics models in predicting MPP/SOL patterns in ILA. Continued research and broader validation are necessary to fully harness and refine the clinical potential of radiomics when combined with SR reconstruction technology.
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Affiliation(s)
- Xiaowei Xing
- Cancer Center, Department of Radiology, Zhejiang Provincial People's Hospital, (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Liangping Li
- Department of Radiology, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Mingxia Sun
- Department of Radiology, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Jiahu Yang
- Department of Radiology, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Xinhai Zhu
- Department of Thoracic Surgery, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Fang Peng
- Department of Pathology, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Jianzong Du
- Department of Respiratory Medicine, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Yue Feng
- Cancer Center, Department of Radiology, Zhejiang Provincial People's Hospital, (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
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Zhao P, Xu L, Zhu H, Ding W, Tang H. The clinicopathological features and possible physiological mechanisms of only the EGFR-T790M primary mutation in patients with lung adenocarcinoma. Pathol Res Pract 2024; 259:155352. [PMID: 38781763 DOI: 10.1016/j.prp.2024.155352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/29/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The treatment of non-small cell lung cancer (NSCLC) patients can be complicated by the presence of the EGFR-T790M mutation. Although primary or secondary EGFR-T790M mutations have been extensively studied worldwide, there are few reports on the clinicopathological characteristics and physiological mechanisms of lung adenocarcinoma (LUAD) with only the EGFR-T790M primary mutation. METHODS The clinical data of all LUAD patients with only the EGFR-T790M primary mutation were collected. Immunohistochemical staining was performed on cell cycle-related proteins, targeted therapy indicators, and prognosis-related proteins in the specimens obtained from puncture biopsies or surgeries. OBJECTIVES The aim of this study is to analyze the clinicopathological features and possible physiological mechanisms of only the EGFR-T790M primary mutation in LUAD, and to offer recommendations for clinical management. RESULTS Two patients who have only the T790M de novo mutation were both female (2/12,928, 0.02%). β-catenin and Cyclin D1 were both highly expressed. In case 1, IHC results showed a positive Ki67 and mutant P53 and there was a significant increase in serum CYFRA 21-1. Third-generation of EGFR TKIs resulted in a partial response (PR) time of less than 8 months in case 1. In case 2, the patient underwent surgical resection and adjuvant chemotherapy, resulting in a progression-free survival (PFS) time of 25 months. CONCLUSION The results suggest that abnormal activation of the Wnt signaling pathway may be specifically associated with the EGFR-T790M primary mutation in LUAD. Furthermore, it has been observed that patients with significant Ki67, mutant P53, and CYFRA 21-1 expression tend to have a poor prognosis.
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Affiliation(s)
- Ping Zhao
- The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, People's Republic of China
| | - Liming Xu
- The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, People's Republic of China
| | - Huijuan Zhu
- The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, People's Republic of China
| | - Wei Ding
- The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, People's Republic of China
| | - Hui Tang
- The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, People's Republic of China.
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Huo J, Min X, Luo T, Lv F, Feng Y, Fan Q, Wang D, Ma D, Li Q. Computed tomography-based 3D convolutional neural network deep learning model for predicting micropapillary or solid growth pattern of invasive lung adenocarcinoma. LA RADIOLOGIA MEDICA 2024; 129:776-784. [PMID: 38512613 PMCID: PMC11088553 DOI: 10.1007/s11547-024-01800-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 02/14/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE To investigate the value of a computed tomography (CT)-based deep learning (DL) model to predict the presence of micropapillary or solid (M/S) growth pattern in invasive lung adenocarcinoma (ILADC). MATERIALS AND METHODS From June 2019 to October 2022, 617 patients with ILADC who underwent preoperative chest CT scans in our institution were randomly placed into training and internal validation sets in a 4:1 ratio, and 353 patients with ILADC from another institution were included as an external validation set. Then, a self-paced learning (SPL) 3D Net was used to establish two DL models: model 1 was used to predict the M/S growth pattern in ILADC, and model 2 was used to predict that pattern in ≤ 2-cm-diameter ILADC. RESULTS For model 1, the training cohort's area under the curve (AUC), accuracy, recall, precision, and F1-score were 0.924, 0.845, 0.851, 0.842, and 0.843; the internal validation cohort's were 0.807, 0.744, 0.756, 0.750, and 0.743; and the external validation cohort's were 0.857, 0.805, 0.804, 0.806, and 0.804, respectively. For model 2, the training cohort's AUC, accuracy, recall, precision, and F1-score were 0.946, 0.858, 0.881,0.844, and 0.851; the internal validation cohort's were 0.869, 0.809, 0.786, 0.794, and 0.790; and the external validation cohort's were 0.831, 0.792, 0.789, 0.790, and 0.790, respectively. The SPL 3D Net model performed better than the ResNet34, ResNet50, ResNeXt50, and DenseNet121 models. CONCLUSION The CT-based DL model performed well as a noninvasive screening tool capable of reliably detecting and distinguishing the subtypes of ILADC, even in small-sized tumors.
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Affiliation(s)
- Jiwen Huo
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yu Zhong District, Chongqing, 400016, China
| | - Xuhong Min
- Anhui Chest Hospital, 397 Jixi Road, Hefei, 230022, Anhui Province, China
| | - Tianyou Luo
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yu Zhong District, Chongqing, 400016, China
| | - Fajin Lv
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yu Zhong District, Chongqing, 400016, China
| | - Yibo Feng
- Institute of Research, Infervision Medical Technology Co., Ltd, 25F Building E, Yuanyang International Center, Chaoyang District, Beijing, 100025, China
| | - Qianrui Fan
- Institute of Research, Infervision Medical Technology Co., Ltd, 25F Building E, Yuanyang International Center, Chaoyang District, Beijing, 100025, China
| | - Dawei Wang
- Institute of Research, Infervision Medical Technology Co., Ltd, 25F Building E, Yuanyang International Center, Chaoyang District, Beijing, 100025, China
| | - Dongchun Ma
- Anhui Chest Hospital, 397 Jixi Road, Hefei, 230022, Anhui Province, China.
| | - Qi Li
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yu Zhong District, Chongqing, 400016, China.
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Jiang MQ, Qian LQ, Shen YJ, Fu YY, Feng W, Ding ZP, Han YC, Fu XL. Who benefit from adjuvant chemotherapy in stage I lung adenocarcinoma? A multi-dimensional model for candidate selection. Neoplasia 2024; 50:100979. [PMID: 38387107 PMCID: PMC10899011 DOI: 10.1016/j.neo.2024.100979] [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: 11/09/2023] [Accepted: 02/14/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Despite promising overall survival of stage I lung adenocarcinoma (LUAD) patients, 10-25 % of them still went through recurrence after surgery. [1] While it is still disputable whether adjuvant chemotherapy is necessary for stage I patients. [2] IASLC grading system for non-mucinous LUAD shows that minor high-grade patterns are significant indicator of poor prognosis. [3] Other risk factors, such as, pleura invasion, lympho-vascular invasion, STAS, etc. are also related to poor prognosis. [4-6] There still lack evidence whether IASLC grade itself or together with other risk factors can guide the use of adjuvant therapy in stage I patients. In this article, we tried to establish a multi-variable recurrence prediction model for stage I LUAD patients that is able to identify candidates of adjuvant chemotherapy. METHODS We retrospectively collected patients who underwent lung surgery from 2018.8.1 to 2018.12.31 at our institution and diagnosed with lung adenocarcinoma pT1-2aN0M0 (stage I). Clinical data, manifestation on CT scan, pathologic features, driver gene mutations and follow-up information were collected. Cox proportional hazards regression analyses were performed utilizing the non-adjuvant cohort to predict disease free survival (DFS) and a nomogram was constructed and applied to the total cohort. Kaplan-Meier method was used to compare DFS between groups. Statistical analysis was conducted by R version 3.6.3. FINDINGS A total of 913 stage I LUAD patients were included in this study. Median follow-up time is 48.1 months.4-year and 5-year DFS are 92.9 % and 89.6 % for the total cohort. 65 patient experienced recurrence or death. 4-year DFS are 97.0 %,94.6 % and 76.2 %, and 5-year DFS are 95.5 %, 90.0 % and 74.1 % in IASLC Grade1, 2 and 3, respectively(p < 0.0001). High-risk patients defined by single risk factors, such as, IASLC grade 3, pleura invasion, STAS, less LN resected could not benefit from adjuvant therapy. A LASSO-COX regression model was built and patients are divided into high-risk and low-risk groups. In the high-risk group, patients underwent adjuvant chemotherapy have longer DFS than those who did not (p = 0.024), while in the low-risk group, patients underwent adjuvant chemotherapy have inferior DFS than those who did not (p < 0.001). INTERPRETATION IASLC grading is a significant indicator of DFS, however it could not guide adjuvant therapy in our stage I LUAD cohort. Growth patterns and T indicators together with other risk factors could identify high-risk patients that are potential candidate of adjuvant therapy, including some stage IA LUAD patients.
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Affiliation(s)
- Meng-Qi Jiang
- Department of Radiation Oncology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li-Qiang Qian
- Department of Thoracic Surgery, Shanghai Lung Cancer Center, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Jia Shen
- Department of Radiation Oncology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuan-Yuan Fu
- Department of Radiation Oncology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen Feng
- Department of Radiation Oncology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zheng-Ping Ding
- Department of Thoracic Surgery, Shanghai Lung Cancer Center, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Chen Han
- Department of Pathology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Xiao-Long Fu
- Department of Radiation Oncology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Li X, Gao Z, Diao H, Guo C, Yu Y, Liu S, Feng Z, Peng Z. Lung adenocarcinoma: selection of surgical approaches in solid adenocarcinoma from the viewpoint of clinicopathologic features and tumor microenvironmental heterogeneity. Front Oncol 2024; 14:1326626. [PMID: 38505588 PMCID: PMC10949368 DOI: 10.3389/fonc.2024.1326626] [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: 10/23/2023] [Accepted: 02/19/2024] [Indexed: 03/21/2024] Open
Abstract
Introduction Solid adenocarcinoma represents a notably aggressive subtype of lung adenocarcinoma. Amidst the prevailing inclination towards conservative surgical interventions for diminutive lung cancer lesions, the critical evaluation of this subtype's malignancy and heterogeneity stands as imperative for the formulation of surgical approaches and the prognostication of long-term patient survival. Methods A retrospective dataset, encompassing 2406 instances of non-solid adenocarcinoma (comprising lepidic, acinar, and papillary adenocarcinoma) and 326 instances of solid adenocarcinoma, was analyzed to ascertain the risk factors concomitant with diverse histological variants of lung adenocarcinoma. Concurrently, RNA-sequencing data delineating explicit pathological subtypes were extracted from 261 cases in the TCGA database and 188 cases in the OncoSG database. This data served to illuminate the heterogeneity across lung adenocarcinoma (LUAD) specimens characterized by differential histological features. Results Solid adenocarcinoma is associated with an elevated incidence of pleural invasion, microscopic vessel invasion, and lymph node metastasis, relative to other subtypes of lung adenocarcinoma. Furthermore, the tumor microenvironment (TME) in solid pattern adenocarcinoma displayed suboptimal oxygenation and acidic conditions, concomitant with augmented tumor cell proliferation and invasion capacities. Energy and metabolic activities were significantly upregulated in tumor cells of the solid pattern subtype. This subtype manifested robust immune tolerance and capabilities for immune evasion. Conclusion This present investigation identifies multiple potential metrics for evaluating the invasive propensity, metastatic likelihood, and immune resistance of solid pattern adenocarcinoma. These insights may prove instrumental in devising surgical interventions that are tailored to patients diagnosed with disparate histological subtypes of LUAD, thereby offering valuable directional guidance.
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Affiliation(s)
- Xiao Li
- Department of Thoracic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Zhen Gao
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong First Medical University, Jinan, Shandong, China
| | - Haixiao Diao
- Department of Thoracic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Chenran Guo
- Department of Thoracic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Yue Yu
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong First Medical University, Jinan, Shandong, China
| | - Shang Liu
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong First Medical University, Jinan, Shandong, China
| | - Zhen Feng
- Department of Thoracic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Zhongmin Peng
- Department of Thoracic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
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9
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Li R, Qiu J, Li Z, Li H, Tang Z, Yu W, Tian H, Sun Z. Prognostic significance and survival benefits of postoperative adjuvant chemotherapy in patients with stage IA lung adenocarcinoma with non-predominant micropapillary components. World J Surg Oncol 2024; 22:32. [PMID: 38273367 PMCID: PMC10809442 DOI: 10.1186/s12957-024-03303-x] [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: 11/26/2023] [Accepted: 01/13/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The prognostic significance of adjuvant chemotherapy (ACT) for patients with stage IA micropapillary non-predominant (MPNP) lung adenocarcinoma (LUAD) remains unknown. This study aimed to investigate the effects of postoperative ACT in patients with stage IA MPNP-LUAD. METHODS A total of 149 patients with pathological stage IA MPNP-LUAD who underwent surgery at our center were retrospectively analyzed. Propensity score matching (PSM) analysis was conducted to reduce potential selection bias. Kaplan-Meier analyses were used to assess the impact of ACT on recurrence-free survival (RFS), overall survival (OS), and disease-specific survival (DSS). Subgroup analyses were performed for the survival outcomes based on the percentage of micropapillary components. Cox proportional hazards regression analyses were applied to identify risk factors associated with survival. RESULTS The receipt or non-receipt of postoperative ACT had no significant effect on RFS, OS, and DSS among all enrolled patients with stage IA MPNP-LUAD (P > 0.05). For patients with a micropapillary component > 5%, the 5-year rates of RFS, OS, and DSS were significantly higher in the ACT group compared to the observation group, both before and after PSM (P < 0.05). However, the differences between the two groups were not significant for patients with a micropapillary component ≤ 5% (P > 0.05). The resection range (HR = 0.071; 95% CI: 0.020-0.251; P < 0.001), tumor size (HR = 2.929; 95% CI: 1.171-7.330; P = 0.022), and ACT (HR = 0.122; 95% CI: 0.037-0.403; P = 0.001) were identified as independent prognostic factors for RFS through Cox regression analysis. CONCLUSION Patients with stage IA MPNP-LUAD who have a micropapillary component greater than 5% might benefit from postoperative ACT, while those with a micropapillary component ≤ 5% did not appear to derive the same benefit from postoperative ACT.
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Affiliation(s)
- Rongyang Li
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Jianhao Qiu
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Zhenyi Li
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Haiming Li
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Zhanpeng Tang
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Wenhao Yu
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Hui Tian
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Zhenguo Sun
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China.
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Yang Z, Dong H, Fu C, Zhang Z, Hong Y, Shan K, Ma C, Chen X, Xu J, Pang Z, Hou M, Zhang X, Zhu W, Liu L, Li W, Sun J, Zhao F. A nomogram based on CT intratumoral and peritumoral radiomics features preoperatively predicts poorly differentiated invasive pulmonary adenocarcinoma manifesting as subsolid or solid lesions: a double-center study. Front Oncol 2024; 14:1289555. [PMID: 38313797 PMCID: PMC10834705 DOI: 10.3389/fonc.2024.1289555] [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: 09/13/2023] [Accepted: 01/02/2024] [Indexed: 02/06/2024] Open
Abstract
Background The novel International Association for the Study of Lung Cancer (IASLC) grading system suggests that poorly differentiated invasive pulmonary adenocarcinoma (IPA) has a worse prognosis. Therefore, prediction of poorly differentiated IPA before treatment can provide an essential reference for therapeutic modality and personalized follow-up strategy. This study intended to train a nomogram based on CT intratumoral and peritumoral radiomics features combined with clinical semantic features, which predicted poorly differentiated IPA and was tested in independent data cohorts regarding models' generalization ability. Methods We retrospectively recruited 480 patients with IPA appearing as subsolid or solid lesions, confirmed by surgical pathology from two medical centers and collected their CT images and clinical information. Patients from the first center (n =363) were randomly assigned to the development cohort (n = 254) and internal testing cohort (n = 109) in a 7:3 ratio; patients (n = 117) from the second center served as the external testing cohort. Feature selection was performed by univariate analysis, multivariate analysis, Spearman correlation analysis, minimum redundancy maximum relevance, and least absolute shrinkage and selection operator. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate the model performance. Results The AUCs of the combined model based on intratumoral and peritumoral radiomics signatures in internal testing cohort and external testing cohort were 0.906 and 0.886, respectively. The AUCs of the nomogram that integrated clinical semantic features and combined radiomics signatures in internal testing cohort and external testing cohort were 0.921 and 0.887, respectively. The Delong test showed that the AUCs of the nomogram were significantly higher than that of the clinical semantic model in both the internal testing cohort(0.921 vs 0.789, p< 0.05) and external testing cohort(0.887 vs 0.829, p< 0.05). Conclusion The nomogram based on CT intratumoral and peritumoral radiomics signatures with clinical semantic features has the potential to predict poorly differentiated IPA manifesting as subsolid or solid lesions preoperatively.
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Affiliation(s)
- Zebin Yang
- Department of Radiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Hao Dong
- Department of Radiology, Affiliated Xiaoshan Hospital of Wenzhou Medical University, Hangzhou, China
| | - Chunlong Fu
- Department of Radiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Zening Zhang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yao Hong
- Department of Radiology, Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, China
| | - Kangfei Shan
- Department of Radiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Chijun Ma
- Department of Radiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Xiaolu Chen
- Department of Radiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Jieping Xu
- Department of Radiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Zhenzhu Pang
- Department of Radiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Min Hou
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaowei Zhang
- Department of Pathology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Weihua Zhu
- Department of Radiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Linjiang Liu
- Medical Imaging Department, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Weihua Li
- Medical Imaging Department, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Jihong Sun
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Radiology, Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, China
- Cancer Center, Zhejiang University, Hangzhou, China
| | - Fenhua Zhao
- Department of Radiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
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11
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Chen S, Yang S, Zhao Y, Zhang Y, Huang Q, Wu H, Hu H, Sun Y, Zhang Y, Xiang J, Ye T, Chen H. Value of adjuvant chemotherapy for patients with pT2N0M0 non-small cell lung cancer receiving radical resection. Thorac Cancer 2024; 15:258-265. [PMID: 38098268 PMCID: PMC10803220 DOI: 10.1111/1759-7714.15192] [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: 10/07/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Associations between adjuvant chemotherapy (ACT) and the improvement in survival for patients with pT2N0M0 non-small cell lung cancer (NSCLC) who received R0 resection remain controversial. This study aimed to evaluate the value of ACT for patients with pT2N0M0 NSCLCs, and to identify the subgroups who could benefit from ACT. METHODS Multivariable Cox proportional hazards regression models were used to estimate independent prognostic factors. High-risk factor (HRF) included visceral pleural invasion (VPI), lymphovascular invasion (LVI) and poor differentiation/undifferentiated tumors. RESULTS Of the 899 patients, 277 (30.8%) patients received ACT. More younger patients (p < 0.001) and male patients (p = 0.007) received ACT. With the increase of pathological tumor size (p < 0.001) and the number of HRFs (p < 0.001), there was a significant rise in the proportion of patients receiving ACT. For all patients, ACT could not improve recurrence-free survival (RFS) (p = 0.672) and overall survival (OS) (p = 0.306). For patients with pathological stage IIA or radiological pure-solid tumors, ACT could significantly improve the OS (p = 0.011 and p = 0.037, respectively), and multivariate analysis revealed that ACT was an independent prognostic factor for patients with pathological stage IIA (p = 0.005). ACT could improve the OS significantly in patients with pathological stage IB pure-solid lung adenocarcinoma (LUAD) (p = 0.043). CONCLUSION ACT was valuable for patients with pathological stage IIA (pT2bN0M0) and patients with radiological pure-solid LUAD of pathological stage IB. A combination of radiological features and pathological subtypes could be helpful when selecting patients with pT2N0M0 NSCLCs for ACT.
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Affiliation(s)
- Shiqi Chen
- Departments of Thoracic Surgery and State Key Laboratory of Genetic EngineeringFudan University Shanghai Cancer CenterShanghaiChina
- Institute of Thoracic OncologyFudan UniversityShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Siqian Yang
- School of Life SciencesFudan UniversityShanghaiChina
| | - Yue Zhao
- Departments of Thoracic Surgery and State Key Laboratory of Genetic EngineeringFudan University Shanghai Cancer CenterShanghaiChina
- Institute of Thoracic OncologyFudan UniversityShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Yang Zhang
- Departments of Thoracic Surgery and State Key Laboratory of Genetic EngineeringFudan University Shanghai Cancer CenterShanghaiChina
- Institute of Thoracic OncologyFudan UniversityShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Qingyuan Huang
- Departments of Thoracic Surgery and State Key Laboratory of Genetic EngineeringFudan University Shanghai Cancer CenterShanghaiChina
- Institute of Thoracic OncologyFudan UniversityShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Haoxuan Wu
- Departments of Thoracic Surgery and State Key Laboratory of Genetic EngineeringFudan University Shanghai Cancer CenterShanghaiChina
- Institute of Thoracic OncologyFudan UniversityShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Hong Hu
- Departments of Thoracic Surgery and State Key Laboratory of Genetic EngineeringFudan University Shanghai Cancer CenterShanghaiChina
- Institute of Thoracic OncologyFudan UniversityShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Yihua Sun
- Departments of Thoracic Surgery and State Key Laboratory of Genetic EngineeringFudan University Shanghai Cancer CenterShanghaiChina
- Institute of Thoracic OncologyFudan UniversityShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Yawei Zhang
- Departments of Thoracic Surgery and State Key Laboratory of Genetic EngineeringFudan University Shanghai Cancer CenterShanghaiChina
- Institute of Thoracic OncologyFudan UniversityShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Jiaqing Xiang
- Departments of Thoracic Surgery and State Key Laboratory of Genetic EngineeringFudan University Shanghai Cancer CenterShanghaiChina
- Institute of Thoracic OncologyFudan UniversityShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Ting Ye
- Departments of Thoracic Surgery and State Key Laboratory of Genetic EngineeringFudan University Shanghai Cancer CenterShanghaiChina
- Institute of Thoracic OncologyFudan UniversityShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Haiquan Chen
- Departments of Thoracic Surgery and State Key Laboratory of Genetic EngineeringFudan University Shanghai Cancer CenterShanghaiChina
- Institute of Thoracic OncologyFudan UniversityShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
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12
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Xing X, Li L, Sun M, Zhu X, Feng Y. A combination of radiomic features, clinic characteristics, and serum tumor biomarkers to predict the possibility of the micropapillary/solid component of lung adenocarcinoma. Ther Adv Respir Dis 2024; 18:17534666241249168. [PMID: 38757628 PMCID: PMC11102675 DOI: 10.1177/17534666241249168] [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: 10/19/2023] [Accepted: 04/05/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Invasive lung adenocarcinoma with MPP/SOL components has a poor prognosis and often shows a tendency to recurrence and metastasis. This poor prognosis may require adjustment of treatment strategies. Preoperative identification is essential for decision-making for subsequent treatment. OBJECTIVE This study aimed to preoperatively predict the probability of MPP/SOL components in lung adenocarcinomas by a comprehensive model that includes radiomics features, clinical characteristics, and serum tumor biomarkers. DESIGN A retrospective case control, diagnostic accuracy study. METHODS This study retrospectively recruited 273 patients (males: females, 130: 143; mean age ± standard deviation, 63.29 ± 10.03 years; range 21-83 years) who underwent resection of invasive lung adenocarcinoma. Sixty-one patients (22.3%) were diagnosed with lung adenocarcinoma with MPP/SOL components. Radiomic features were extracted from CT before surgery. Clinical, radiomic, and combined models were developed using the logistic regression algorithm. The clinical and radiomic signatures were integrated into a nomogram. The diagnostic performance of the models was evaluated using the area under the curve (AUC). Studies were scored according to the Radiomics Quality Score and Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis guidelines. RESULTS The radiomics model achieved the best AUC values of 0.858 and 0.822 in the training and test cohort, respectively. Tumor size (T_size), solid tumor size (ST_size), consolidation-to-tumor ratio (CTR), years of smoking, CYFRA 21-1, and squamous cell carcinoma antigen were used to construct the clinical model. The clinical model achieved AUC values of 0.741 and 0.705 in the training and test cohort, respectively. The nomogram showed higher AUCs of 0.894 and 0.843 in the training and test cohort, respectively. CONCLUSION This study has developed and validated a combined nomogram, a visual tool that integrates CT radiomics features with clinical indicators and serum tumor biomarkers. This innovative model facilitates the differentiation of micropapillary or solid components within lung adenocarcinoma and achieves a higher AUC, indicating superior predictive accuracy.
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Affiliation(s)
- Xiaowei Xing
- Cancer Center, Department of Radiology, Zhejiang Provincial People’s Hospital, (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Liangping Li
- Department of Radiology, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Mingxia Sun
- Department of Radiology, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Xinhai Zhu
- Department of Thoracic Surgery, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Yue Feng
- Cancer Center, Department of Radiology, Zhejiang Provincial People’s Hospital, (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
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Guo C, Xu L, Li X, Fu Y, Wang H, Han R, Li G, Feng Z, Li M, Ren W, Peng Z. Computed tomography imaging and clinical characteristics of pulmonary ground-glass nodules ≤2 cm with micropapillary pattern. Thorac Cancer 2023; 14:3433-3444. [PMID: 37876115 PMCID: PMC10719660 DOI: 10.1111/1759-7714.15136] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the imaging features, lymph node metastasis, and genetic mutations in micropapillary lung adenocarcinoma (imaging with mixed ground-glass nodules) ≤2 cm, to provide a more precise and refined basis for the selection of lung segment resection. METHODS A retrospective analysis of 162 patients with surgically resected pathologically confirmed cancers ≤2.0 cm in diameter (50 cases of micropapillary mixed ground-glass nodules [mGGNs], 50 cases of nonmicropapillary mGGNs, and 62 cases of micropapillary SNs [solid nodules]) was performed. mGGNs were classified into five categories according to imaging features. The distribution of these five morphologies in micropapillary with mGGN and nonmicropapillary with mGGN was analyzed. The postoperative pathology and prognosis of lymph node metastasis were also compared between micropapillary mGGNs and micropapillary with SNs. After searching the TCGA database, we demonstrated heterogeneity, high malignancy and high risk of microcapillary lung cancer cancers. RESULTS Different pathological subtypes of mGGN differed in morphological features (p < 0.05). The rate of lymph node metastasis was significantly higher in micropapillary mGGNs than in nonmicropapillary mGGNs. In the TCGA database samples, lactate transmembrane protein activity, collagen transcription score, and fibroblast EMT score were remarkably higher in micropapillary adenocarcinoma. Other pathological subtypes had a better survival prognosis and longer disease-free survival compared with micropapillary adenocarcinoma. CONCLUSION mGGNs ≤2 cm with a micropapillary pattern have a higher risk of lymph node metastasis compared with SNs, and computed tomography (CT) imaging features can assist in their diagnosis.
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Affiliation(s)
- Chen‐ran Guo
- Department of Thoracic Surgery, Shandong Provincial HospitalShandong UniversityJinanChina
| | - Lin Xu
- Department of Thoracic Surgery, Shandong Provincial HospitalShandong UniversityJinanChina
| | - Xiao Li
- Department of Thoracic Surgery, Shandong Provincial HospitalShandong UniversityJinanChina
| | - Yi‐lin Fu
- Department of Thoracic SurgeryShandong Provincial HospitalJinanChina
| | - Hui Wang
- Department of Thoracic SurgeryShandong Provincial HospitalJinanChina
| | - Rui Han
- Peking Union Medical CollegeBeijingChina
| | - Geng‐sheng Li
- Department of AnesthesiologyShandong Provincial HospitalJinanChina
| | - Zhen Feng
- Department of Thoracic SurgeryShandong Provincial HospitalJinanChina
| | - Meng Li
- Department of Thoracic SurgeryShandong Provincial HospitalJinanChina
| | - Wan‐gang Ren
- Department of Thoracic SurgeryShandong Provincial HospitalJinanChina
| | - Zhong‐min Peng
- Department of Thoracic Surgery, Shandong Provincial HospitalShandong UniversityJinanChina
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Yang Z, Li X, Bai J, Li D, Ma Z, Deng C, Fu F, Zhang Y. Prognostic Factors for Survival of Stage IB Non-small Cell Lung Cancer Patients: A 10-Year Follow-Up Retrospective Study. Ann Surg Oncol 2023; 30:7481-7491. [PMID: 37535274 DOI: 10.1245/s10434-023-14016-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/27/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND This study aimed to determine the prognostic factors for the long-term outcome of stage IB non-small cell lung cancer (NSCLC). METHODS Surgically resected patients with stage IB NSCLC diagnosed (based on TNM 8th edition) between April 2008 and December 2013 were retrospectively reviewed. The prognosis and possible risk factors among the stage IB NSCLC patients were evaluated. RESULTS Of the 349 patients identified for the study, 80 (22.9%) received post-surgery adjuvant chemotherapy (ACT). The median follow-up time after surgery was 123.3 months. The 10-year overall survival (OS) rate was 69.6%, and the 10-year recurrence-free survival (RFS) rate was 62.8%. The patients in this cohort were divided into three groups (T1 with visceral pleural invasion [VPI], T2a without VPI, and T2a with VPI), and no significant differences in OS or RFS were found among the groups. Furthermore, survival analysis indicated that the absence of ground-glass opacity (GGO) components portends an adverse long-term OS and RFS. In a subgroup of patients with solid nodules, age older than 65 years (hazard ratio [HR] 1.987; 95% confidence interval [CI] 1.312-3.010; p = 0.001) and ACT (HR 0.392; 95% CI 0.225-0.684; p < 0.001) were independent prognostic factors for OS, whereas lymphovascular invasion (HR 1.792; 95% CI 0.995-3.227; p = 0.052) should be considered as an independent unfavorable prognostic factor for RFS. CONCLUSIONS As an upstaging factor, VPI did not further stratify prognosis for the stage IB patients in our cohort. The presence of GGO components had a notable impact on a favorable prognosis in stage IB NSCLCs.
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Affiliation(s)
- Zijiang Yang
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Human Phenome Institute, Fudan University, Shanghai, China
| | - Xiongfei Li
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jinsong Bai
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Di Li
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zelin Ma
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chaoqiang Deng
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fangqiu Fu
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.
- Institute of Thoracic Oncology, Fudan University, Shanghai, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Yang Zhang
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.
- Institute of Thoracic Oncology, Fudan University, Shanghai, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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Wang K, Liu X, Ding Y, Sun S, Li J, Geng H, Xu M, Wang M, Li X, Sun D. A pretreatment prediction model of grade 3 tumors classed by the IASLC grading system in lung adenocarcinoma. BMC Pulm Med 2023; 23:377. [PMID: 37805451 PMCID: PMC10559613 DOI: 10.1186/s12890-023-02690-3] [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: 10/06/2022] [Accepted: 09/28/2023] [Indexed: 10/09/2023] Open
Abstract
PURPOSE The new grading system for invasive nonmucinous lung adenocarcinoma (LUAD) in the 2021 World Health Organization Classification of Thoracic Tumors was based on a combination of histologically predominant subtypes and high-grade components. In this study, a model for the pretreatment prediction of grade 3 tumors was established according to new grading standards. METHODS We retrospectively collected 399 cases of clinical stage I (cStage-I) LUAD surgically treated in Tianjin Chest Hospital from 2015 to 2018 as the training cohort. Besides, the validation cohort consists of 216 patients who were collected from 2019 to 2020. These patients were also diagnosed with clinical cStage-I LUAD and underwent surgical treatment at Tianjin Chest Hospital. Univariable and multivariable logistic regression analyses were used to select independent risk factors for grade 3 adenocarcinomas in the training cohort. The nomogram prediction model of grade 3 tumors was established by R software. RESULTS In the training cohort, there were 155 grade 3 tumors (38.85%), the recurrence-free survival of which in the lobectomy subgroup was better than that in the sublobectomy subgroup (P = 0.034). After univariable and multivariable analysis, four predictors including consolidation-to-tumor ratio, CEA level, lobulation, and smoking history were incorporated into the model. A nomogram was established and internally validated by bootstrapping. The Hosmer-Lemeshow test result was χ2 = 7.052 (P = 0.531). The C-index and area under the receiver operating characteristic curve were 0.708 (95% CI: 0.6563-0.7586) for the training cohort and 0.713 (95% CI: 0.6426-0.7839) for the external validation cohort. CONCLUSIONS The nomogram prediction model of grade 3 LUAD was well fitted and can be used to assist in surgical or adjuvant treatment decision-making.
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Affiliation(s)
- Kai Wang
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Thoracic Surgery, Tianjin Chest Hospital, Jinnan District, No. 261, Taierzhuang South Road, Tianjin, 300222, China
| | - Xin Liu
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Thoracic Surgery, Tianjin Chest Hospital, Jinnan District, No. 261, Taierzhuang South Road, Tianjin, 300222, China
| | - Yun Ding
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
| | - Shuai Sun
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
| | - Jiuzhen Li
- Department of Thoracic Surgery, Tianjin Chest Hospital, Jinnan District, No. 261, Taierzhuang South Road, Tianjin, 300222, China
| | - Hua Geng
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Pathology, Tianjin Chest Hospital of Tianjin University, Tianjin, China
| | - Meilin Xu
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Pathology, Tianjin Chest Hospital of Tianjin University, Tianjin, China
| | - Meng Wang
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Thoracic Surgery, Tianjin Chest Hospital, Jinnan District, No. 261, Taierzhuang South Road, Tianjin, 300222, China
| | - Xin Li
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Thoracic Surgery, Tianjin Chest Hospital, Jinnan District, No. 261, Taierzhuang South Road, Tianjin, 300222, China
| | - Daqiang Sun
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China.
- Department of Thoracic Surgery, Tianjin Chest Hospital, Jinnan District, No. 261, Taierzhuang South Road, Tianjin, 300222, China.
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Dong H, Wang X, Qiu Y, Lou C, Ye Y, Feng H, Ye X, Chen D. Establishment and visualization of a model based on high-resolution CT qualitative and quantitative features for prediction of micropapillary or solid components in invasive lung adenocarcinoma. J Cancer Res Clin Oncol 2023; 149:10519-10530. [PMID: 37289235 DOI: 10.1007/s00432-023-04854-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/13/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To predict the existence of micropapillary or solid components in invasive adenocarcinoma, a model was constructed using qualitative and quantitative features in high-resolution computed tomography (HRCT). METHODS Through pathological examinations, 176 lesions were divided into two groups depending on the presence or absence of micropapillary and/or solid components (MP/S): MP/S- group (n = 128) and MP/S + group (n = 48). Multivariate logistic regression analyses were used to identify independent predictors of the MP/S. Artificial intelligence (AI)-assisted diagnostic software was used to automatically identify the lesions and extract corresponding quantitative parameters on CT images. The qualitative, quantitative, and combined models were constructed according to the results of multivariate logistic regression analysis. The receiver operating characteristic (ROC) analysis was conducted to evaluate the discrimination capacity of the models with the area under the curve (AUC), sensitivity, and specificity calculated. The calibration and clinical utility of the three models were determined using the calibration curve and decision curve analysis (DCA), respectively. The combined model was visualized in a nomogram. RESULTS The multivariate logistic regression analysis using both qualitative and quantitative features indicated that tumor shape (P = 0.029 OR = 4.89; 95% CI 1.175-20.379), pleural indentation (P = 0.039 OR = 1.91; 95% CI 0.791-4.631), and consolidation tumor ratios (CTR) (P < 0.001; OR = 1.05; 95% CI 1.036-1.070) were independent predictors for MP/S + . The areas under the curve (AUC) of the qualitative, quantitative, and combined models in predicting MP/S + were 0.844 (95% CI 0.778-0.909), 0.863 (95% CI 0.803-0.923), and 0.880 (95% CI 0.824-0.937). The combined model of AUC was the most superior and statistically better than qualitative model. CONCLUSION The combined model could assist doctors to evaluate patient's prognoses and devise personalized diagnostic and treatment protocols for patients.
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Affiliation(s)
- Hao Dong
- Department of Radiology, The First People's Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, No. 199 Xinnan Road, Xiaoshan, Hangzhou, Zhejiang, China
| | - Xinbin Wang
- Department of Radiology, The First People's Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, No. 199 Xinnan Road, Xiaoshan, Hangzhou, Zhejiang, China
| | - Yonggang Qiu
- Department of Radiology, The First People's Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, No. 199 Xinnan Road, Xiaoshan, Hangzhou, Zhejiang, China
| | - Cuncheng Lou
- Department of Radiology, The First People's Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, No. 199 Xinnan Road, Xiaoshan, Hangzhou, Zhejiang, China
| | - Yinfeng Ye
- Department of Radiology, The First People's Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, No. 199 Xinnan Road, Xiaoshan, Hangzhou, Zhejiang, China
| | - Han Feng
- Department of Radiology, The First People's Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, No. 199 Xinnan Road, Xiaoshan, Hangzhou, Zhejiang, China
| | - Xiaodan Ye
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
- Shanghai Institute of Medical Imaging, Shanghai, China.
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Dihong Chen
- Department of Radiology, The First People's Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, No. 199 Xinnan Road, Xiaoshan, Hangzhou, Zhejiang, China.
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Zhang L, Liu J, Yang D, Ni Z, Lu X, Liu Y, Liu Z, Wang H, Feng M, Zhang Y. A Nomogram Based on Consolidation Tumor Ratio Combined with Solid or Micropapillary Patterns for Postoperative Recurrence in Pathological Stage IA Lung Adenocarcinoma. Diagnostics (Basel) 2023; 13:2376. [PMID: 37510119 PMCID: PMC10378621 DOI: 10.3390/diagnostics13142376] [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: 06/18/2023] [Revised: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Patients with pathological stage IA lung adenocarcinoma (LUAD) are at risk of relapse. The value of the TNM staging system is limited in predicting recurrence. Our study aimed to develop a precise recurrence prediction model for stage IA LUAD. MATERIALS AND METHODS Patients with pathological stage IA LUAD who received surgical treatment at Zhongshan Hospital Fudan University were retrospectively analyzed. Multivariate Cox proportional hazards regression models were used to create nomograms for recurrence-free survival (RFS). The predictive performance of the model was assessed using calibration plots and the concordance index (C-index). RESULTS The multivariate Cox regression analysis revealed that CTR (0.75 < CTR ≤ 1; HR = 9.882, 95% CI: 2.036-47.959, p = 0.004) and solid/micropapillary-predominance (SMPP; >5% and the most dominant) (HR = 4.743, 95% CI: 1.506-14.933, p = 0.008) were independent prognostic factors of RFS. These risk factors were used to construct a nomogram to predict postoperative recurrence in these patients. The C-index of the nomogram for predicting RFS was higher than that of the eighth T-stage system (0.873 for the nomogram and 0.643 for the eighth T stage). The nomogram also achieved good predictive performance for RFS with a well-fitted calibration curve. CONCLUSIONS We developed and validated a nomogram based on CTR and SMP patterns for predicting postoperative recurrence in pathological stage IA LUAD. This model is simple to operate and has better predictive performance than the eighth T stage system, making it suitable for selecting further adjuvant treatment and follow-up.
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Affiliation(s)
- Longfu Zhang
- Department of Pulmonary and Critical Care Medicine, Shanghai Xuhui Central Hospital, Shanghai 200031, China
| | - Jie Liu
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Dawei Yang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital (Xiamen), Fudan University, Xiamen 361015, China
| | - Zheng Ni
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xinyuan Lu
- Key Laboratory of Public Health Safety, School of Public Health, Ministry of Education, Fudan University, Shanghai 200032, China
| | - Yalan Liu
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zilong Liu
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hao Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Mingxiang Feng
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yong Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Surgically Treated pT2aN0M0 (Stage IB) Non-Small Cell Lung Cancer: A 20-Year Single-Center Retrospective Study. J Clin Med 2023; 12:jcm12052081. [PMID: 36902867 PMCID: PMC10004231 DOI: 10.3390/jcm12052081] [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: 02/02/2023] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023] Open
Abstract
Introduction The suitability of adjuvant therapy (AT) in patients with stage IB non-small cell lung cancer (NSCLC) is still under debate considering the cost-benefit ratio between improvement in survival and side effects. We retrospectively evaluated survival and incidence of recurrence in radically resected stage IB NSCLC, to determine whether AT could significantly improve prognosis. Methods Between 1998 and 2020, 4692 consecutive patients underwent lobectomy and systematic lymphadenectomy for NSCLC. Two hundred nineteen patients were pathological T2aN0M0 (>3 and ≤4 cm) NSCLC 8th TNM. None received preoperative or AT. Overall survival (OS), cancer specific survival (CSS) and the cumulative incidence of relapse were plotted and log-rank or Gray's tests were used to assess the difference in outcome between groups. Results The most frequent histology was adenocarcinoma (66.7%). Median OS was 146 months. The 5-, 10-, and 15-year OS rates were 79%, 60%, and 47%, whereas the 5-, 10-, and 15-year CSS were 88%, 85%, and 83%, respectively. OS was significantly related to age (p < 0.001) and cardiovascular comorbidities (p = 0.04), whereas number of LNs removed was an independent prognostic factor of CSS (p = 0.02). Cumulative incidence of relapse at 5-, 10-, and 15-year were 23%, 31%, and 32%, respectively, and significantly related to the number of LNs removed (p = 0.01). Patients with more than 20 LNs removed and clinical stage I had a significantly lower relapse (p = 0.02). Conclusions Excellent CSS, up to 83% at 15-year, and relatively low risk of recurrence for stage IB NSCLC (8th TNM) patients suggested that AT for those patients could be reserved only for very selected high-risk cases.
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Impact of surgery and adjuvant chemotherapy on the survival of stage I lung adenocarcinoma patients with tumor spread through air spaces. Lung Cancer 2023; 177:51-58. [PMID: 36736075 DOI: 10.1016/j.lungcan.2023.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 12/04/2022] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Tumor spread through air spaces (STAS) is a unique mechanism of lung cancer metastasis; however, its clinical value for stage I lung adenocarcinoma (ADC) remains unclear at present. We investigated the (1) prognosis of patients after sublobar resection compared with lobectomy for stage I lung adenocarcinoma with STAS; and (2) potential benefits of adjuvant chemotherapy (ACT) for patients with stage I ADC and STAS. METHODS A total of 3328 consecutive patients with stage I ADC were retrospectively identified between 2014 and 2018 at our institution; among them, 600 were diagnosed with STAS. Kaplan-Meier analysis and Cox proportional hazard regression models were used to evaluate the impact of STAS on overall survival (OS) and recurrence-free survival (RFS). RESULTS Among stage IA patients with STAS, there was no significant difference between those who underwent sublobar resection and lobectomy in OS (P = 0.919) and RFS (P = 0.066). Multivariate analysis confirmed this result (sublobar resection versus lobectomy, OS: HR = 0.523, 95 % CI, 0.056-18.458, P = 0.714; RFS, HR = 0.360, 95 % CI, 0.115-1.565, P = 0.897). ACT did not improve the prognosis of stage IA patients but did improve the RFS of stage IB patients with high-risk recurrence factors, including poorly differentiated tumors, lymphovascular invasion and visceral pleural invasion (P = 0.046). CONCLUSIONS Sublobar and lobectomy resection provided a comparable prognosis for stage IA ADC patients with STAS. When STAS was confirmed postoperatively, ACT should be considered for patients with stage IB with high-risk recurrence factors but not for those with stage IA disease.
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E H, Wu J, Ren Y, Xia L, Xu L, Li S, Zhao Y, Li C, She Y, Su C, Wu C, Hou L, Zhao D, Chen C. The IASLC grading system for invasive pulmonary adenocarcinoma: a potential prognosticator for patients receiving neoadjuvant therapy. Ther Adv Med Oncol 2023; 15:17588359221148028. [PMID: 36643658 PMCID: PMC9837269 DOI: 10.1177/17588359221148028] [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: 05/28/2022] [Accepted: 12/12/2022] [Indexed: 01/13/2023] Open
Abstract
Background Grading system for resected invasive pulmonary adenocarcinoma proposed by the International Association for the Study of Lung Cancer (IASLC) was validated as a strong prognostic indicator. Nonetheless, the efficacy of utilizing such grading system in prognostic assessment of patients receiving neoadjuvant therapy still needs elucidating. Methods A retrospective study was conducted including patients with resected adenocarcinoma following neoadjuvant chemotherapy or targeted therapy from August 2012 to December 2020 in Shanghai Pulmonary Hospital. All the surgical specimens were re-evaluated and graded. The prognostic value of the grading system was further validated. Results Ultimately, a total of 198 patients were enrolled in this study, and subdivided into three cohorts according to the grading system. There were 13 (6.6%), 37 (18.7%), and 148 (74.7%) patients belonging to Grades 1, 2, and 3, respectively. IASLC grading system demonstrated significant power in prognosis differentiation of the entire cohort [recurrence-free survival (RFS), p < 0.001; overall survival (OS), p < 0.001] and the neoadjuvant chemotherapy and targeted therapy cohorts separately, and was further verified as a significant prognostic indicator for RFS and OS in multivariable Cox analysis. Since the majority of the patients (84.8%) did not achieve major pathologic response (MPR), representing a wide spectrum of survival, the prognostic value of grading system in non-MPR cohort was further evaluated. Similar results were also obtained that IASLC grading system was assessed significant in univariable analysis of RFS (p < 0.001) and univariable analysis of OS (p = 0.001). Conclusions The prognostic efficacy of pathological evaluation of the residual proportion of pulmonary adenocarcinoma post-neoadjuvant therapy using IASLC grading system was preliminarily verified. Such grading system might assist prognostic evaluation of neoadjuvant cohort other than traditional pathological parameters.
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Affiliation(s)
| | | | | | - Lang Xia
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Long Xu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shaoling Li
- Department of Pathology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yue Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chongwu Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chunxia Su
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chunyan Wu
- Department of Pathology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
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Dong H, Yin LK, Qiu YG, Wang XB, Yang JJ, Lou CC, Ye XD. Prediction of high-grade patterns of stage IA lung invasive adenocarcinoma based on high-resolution CT features: a bicentric study. Eur Radiol 2023; 33:3931-3940. [PMID: 36600124 DOI: 10.1007/s00330-022-09379-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES This study aims to predict the high-grade pattern (HGP) of stage IA lung invasive adenocarcinoma (IAC) based on the high-resolution CT (HRCT) features. METHODS The clinical, pathological, and HRCT imaging data of 457 patients (from bicentric) with pathologically confirmed stage IA IAC (459 lesions in total) were retrospectively analyzed. The 459 lesions were classified into high-grade pattern (HGP) (n = 101) and non-high-grade pattern (n-HGP) (n = 358) groups depending on the presence of HGP (micropapillary and solid) in pathological results. The clinical and pathological data contained age, gender, smoking history, tumor stage, pathological type, and presence or absence of tumor spread through air spaces (STAS). CT features consisted of lesion location, size, density, shape, spiculation, lobulation, vacuole, air bronchogram, and pleural indentation. The independent predictors for HGP were screened by univariable and multivariable logistic regression analyses. The clinical, CT, and clinical-CT models were constructed according to the multivariable analysis results. RESULTS The multivariate analysis suggested the independent predictors of HGP, encompassing tumor size (p = 0.001; OR = 1.090, 95% CI 1.035-1.148), density (p < 0.001; OR = 9.454, 95% CI 4.911-18.199), and lobulation (p = 0.002; OR = 2.722, 95% CI 1.438-5.154). The AUC values of clinical, CT, and clinical-CT models for predicting HGP were 0.641 (95% CI 0.583-0.699) (sensitivity = 69.3%, specificity = 79.2%), 0.851 (95% CI 0.806-0.896) (sensitivity = 79.2%, specificity = 79.6%), and 0.852 (95% CI 0.808-0.896) (sensitivity = 74.3%, specificity = 85.8%). CONCLUSION The logistic regression model based on HRCT features has a good diagnostic performance for the high-grade pattern of stage IA IAC. KEY POINTS • The AUC values of clinical, CT, and clinical-CT models for predicting high-grade patterns were 0.641 (95% CI 0.583-0.699), 0.851 (95% CI 0.806-0.896), and 0.852 (95% CI 0.808-0.896). • Tumor size, density, and lobulation were independent predictive markers for high-grade patterns. • The logistic regression model based on HRCT features has a good diagnostic performance for the high-grade patterns of invasive adenocarcinoma.
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Affiliation(s)
- Hao Dong
- Department of Radiology, First People's Hospital of Xiaoshan District, Zhejiang, Hangzhou, China
| | - Le-Kang Yin
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yong-Gang Qiu
- Department of Radiology, First People's Hospital of Xiaoshan District, Zhejiang, Hangzhou, China
| | - Xin-Bin Wang
- Department of Radiology, First People's Hospital of Xiaoshan District, Zhejiang, Hangzhou, China
| | - Jun-Jie Yang
- Department of Pathology, First People's Hospital of Xiaoshan District, Zhejiang, Hangzhou, China
| | - Cun-Cheng Lou
- Department of Radiology, First People's Hospital of Xiaoshan District, Zhejiang, Hangzhou, China
| | - Xiao-Dan Ye
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. .,Shanghai Institute of Medical Imaging, Shanghai, China. .,Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
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Liu Y, Chang Y, Zha X, Bao J, Wu Q, Dai H, Hu C. A Combination of Radiomic Features, Imaging Characteristics, and Serum Tumor Biomarkers to Predict the Possibility of the High-Grade Subtypes of Lung Adenocarcinoma. Acad Radiol 2022; 29:1792-1801. [PMID: 35351366 DOI: 10.1016/j.acra.2022.02.024] [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: 01/25/2022] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 01/26/2023]
Abstract
RATIONALE AND OBJECTIVES Lung adenocarcinomas (LADC) containing high-grade subtypes have a poorer prognosis. And some studies have shown that high-grade subtypes have been identified as an independent predictor of local recurrence in patients treated with limited resection. The aim of this study was to construct a combined model based on radiomic features, imaging characteristics and serum tumor biomarkers to predict the possibility of preoperative high-grade subtypes. MATERIALS AND METHODS 156 patients with LADC were retrospectively recruited in this study. These patients were randomly divided into training and validation cohorts. Radiomics features and imaging characteristics were extracted from plain CT images. A nomogram was developed in a training cohort by univariate and multivariate logistic analysis, and its performance was evaluated by receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) in the training and validation cohorts. RESULTS A total of 1316 radiomic features were extracted from the lesions in plain chest CT images. After applying the mRMR algorithm and the LASSO regression, 4 features were retained. Based on these radiomic features, Radiomic score (Radscore) was calculated for each patient. Spiculation, air bronchogram sign, CYFRA 21-1 and Radscore had been used in the construction of the combined model. The AUC of the combined model was respectively 0.88 (95% CI, 0.82-0.95) and 0.94 (95% CI, 0.86-1.00) in the training and validation cohorts. CONCLUSION The combined model based on CT images and serum tumor biomarkers, can predict the high-grade subtypes of LADC in a non-invasive manner, which may influence individual treatment planning, such as the choice of surgical approach and postoperative adjuvant therapy.
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Affiliation(s)
- Yuanqing Liu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, P.R. China
| | - Yue Chang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, P.R. China
| | - Xinyi Zha
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, P.R. China
| | - Jiayi Bao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, P.R. China
| | - Qian Wu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, P.R. China
| | - Hui Dai
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, P.R. China; Institute of Medical Imaging, Soochow University, Suzhou, Jiangsu Province, P.R. China; Suzhou Key Laboratory of Intelligent Medicine and Equipment, Suzhou, Jiangsu Province, P.R. China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, P.R. China; Institute of Medical Imaging, Soochow University, Suzhou, Jiangsu Province, P.R. China; Suzhou Key Laboratory of Intelligent Medicine and Equipment, Suzhou, Jiangsu Province, P.R. China.
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Woo W, Cha YJ, Kim BJ, Moon DH, Lee S. Validation Study of New IASLC Histology Grading System in Stage I Non-Mucinous Adenocarcinoma Comparing With Minimally Invasive Adenocarcinoma. Clin Lung Cancer 2022; 23:e435-e442. [PMID: 35945128 DOI: 10.1016/j.cllc.2022.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/08/2022] [Accepted: 06/06/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND A new histologic grading system for pulmonary non-mucinous invasive adenocarcinoma was proposed by the International Association for the Study of Lung Cancer (IASLC). We evaluated its clinical impact on prognosis in stage I patients, including minimally invasive adenocarcinoma (MIA). PATIENTS AND METHODS 919 patients underwent surgery for lung adenocarcinoma between 2012 and 2019. Stage I patients (n = 500) were retrospectively reviewed. They were divided into 4 categories: MIA and 3 new IASLC grades (grades 1-3). Cox proportional hazards analysis was performed to identify risk factors associated with recurrence and mortality. Furthermore, we compared the predictability of the IASLC grading system with different models that are based on the clinicopathologic characteristics (baseline model), TNM staging, and predominant histologic pattern. The area under the receiver operating characteristic curve (AUC) was calculated for comparison. RESULTS Recurrence-free survival (RFS) and overall survival (OS) were significantly stratified by the IASLC grading system in patients with stage I adenocarcinoma (P < .001 and P = .003, respectively). In multivariate analyses, IASLC grade 3 was a significant factor for RFS (hazard ratio [HR] 3.18, P < .001) and OS (HR 2.31, P = .013). The AUCs of the new IASLC model were 0.781 for recurrence and 0.770 for mortality, compared with those of the predominant pattern (0.769 for recurrence, 0.747 for death) and TNM staging (0.762 for recurrence, 0.747 for death). CONCLUSION The IASLC grading system effectively predicted the prognosis of early-stage adenocarcinoma compared with previous models. The IASLC classification appears to improve the current system; therefore, precise pathologic examination for early-stage adenocarcinoma is warranted.
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Affiliation(s)
- Wongi Woo
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoon-Jin Cha
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bong Jun Kim
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Duk Hwan Moon
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Sungsoo Lee
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Dong H, Yin L, Chen L, Wang Q, Pan X, Li Y, Ye X, Zeng M. Establishment and validation of a radiological-radiomics model for predicting high-grade patterns of lung adenocarcinoma less than or equal to 3 cm. Front Oncol 2022; 12:964322. [PMID: 36185244 PMCID: PMC9522474 DOI: 10.3389/fonc.2022.964322] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
Objective We aimed to develop a Radiological-Radiomics (R-R) based model for predicting the high-grade pattern (HGP) of lung adenocarcinoma and evaluate its predictive performance. Methods The clinical, pathological, and imaging data of 374 patients pathologically confirmed with lung adenocarcinoma (374 lesions in total) were retrospectively analyzed. The 374 lesions were assigned to HGP (n = 81) and non-high-grade pattern (n-HGP, n = 293) groups depending on the presence or absence of high-grade components in pathological findings. The least absolute shrinkage and selection operator (LASSO) method was utilized to screen features on the United Imaging artificial intelligence scientific research platform, and logistic regression models for predicting HGP were constructed, namely, Radiological model, Radiomics model, and R-R model. Also, receiver operating curve (ROC) curves were plotted on the platform, generating corresponding area under the curve (AUC), sensitivity, specificity, and accuracy. Using the platform, nomograms for R-R models were also provided, and calibration curves and decision curves were drawn to evaluate the performance and clinical utility of the model. The statistical differences in the performance of the models were compared by the DeLong test. Results The R-R model for HGP prediction achieved an AUC value of 0.923 (95% CI: 0.891-0.948), a sensitivity of 87.0%, a specificity of 83.4%, and an accuracy of 84.2% in the training set. In the validation set, this model exhibited an AUC value of 0.920 (95% CI: 0.887-0.945), a sensitivity of 87.5%, a specificity of 83.3%, and an accuracy of 84.2%. The DeLong test demonstrated optimal performance of the R-R model among the three models, and decision curves validated the clinical utility of the R-R model. Conclusion In this study, we developed a fusion model using radiomic features combined with radiological features to predict the high-grade pattern of lung adenocarcinoma, and this model shows excellent diagnostic performance. The R-R model can provide certain guidance for clinical diagnosis and surgical treatment plans, contributing to improving the prognosis of patients.
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Affiliation(s)
- Hao Dong
- Department of Radiology, First People’s Hospital of Xiaoshan District, Hangzhou, China
| | - Lekang Yin
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lei Chen
- Department of Research, Shanghai United Imaging Intelligence Co. Ltd., Shanghai, China
| | - Qingle Wang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xianpan Pan
- Department of Research, Shanghai United Imaging Intelligence Co. Ltd., Shanghai, China
| | - Yang Li
- Department of Research, Shanghai United Imaging Intelligence Co. Ltd., Shanghai, China
| | - Xiaodan Ye
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Xiaodan Ye, ; Mengsu Zeng,
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Xiaodan Ye, ; Mengsu Zeng,
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Liu B, Qian JY, Wu LL, Zeng JQ, Xu SQ, Yuan JH, Zheng YL, Xie D, Chen X, Yu HH. A long waiting time from diagnosis to treatment decreases the survival of non-small cell lung cancer patients with stage IA1: A retrospective study. Front Surg 2022; 9:987075. [PMID: 36157427 PMCID: PMC9489994 DOI: 10.3389/fsurg.2022.987075] [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: 07/05/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe prognostic effect of delayed treatment on stage IA1 non-small cell lung cancer (NSCLC) patients is still unclear. This study aimed to explore the association between the waiting time before treatment and the prognosis in stage IA1 NSCLC patients.MethodsEligible patients diagnosed with pathological stage IA1 NSCLC were included in this study. The clinical endpoints were overall survival (OS) and cancer-specific survival (CSS). The Kaplan-Meier method, the Log-rank test, univariable, and multivariable Cox regression analyses were used in this study. Propensity score matching was used to reduce the bias of data distribution.ResultsThere were eligible 957 patients in the study. The length of waiting time before treatment stratified the survival in patients [<3 months vs. ≥3-months, unadjusted hazard ratio (HR) = 0.481, P = 0.007; <2 months vs. ≥2-months, unadjusted HR = 0.564, P = 0.006; <1 month vs. ≥1-month, unadjusted HR = 0.537, P = 0.001]. The 5-year CSS rates were 95.0% and 77.0% in patients of waiting time within 3 months and over 3 months, respectively. After adjusting for other confounders, the waiting time was identified as an independent prognostic factor.ConclusionsA long waiting time before treatment may decrease the survival of stage IA1 NSCLC patients. We propose that the waiting time for those patients preferably is less than one month and should not exceed two months.
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Affiliation(s)
- Bin Liu
- Department of Oncology, The Affiliated Hospital of Jinggangshan University, Ji’an, China
| | - Jia-Yi Qian
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lei-Lei Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jun-Quan Zeng
- Department of Oncology, The Affiliated Hospital of Jinggangshan University, Ji’an, China
| | - Shu-Quan Xu
- School of Medicine, Tongji University, Shanghai, China
| | - Jin-Hua Yuan
- Department of Oncology, The Affiliated Hospital of Jinggangshan University, Ji’an, China
| | - Yong-Liang Zheng
- Department of Oncology, The Affiliated Hospital of Jinggangshan University, Ji’an, China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
- Correspondence: Hai-Hong Yu Xiaolu Chen Dong Xie
| | - Xiaolu Chen
- Department of Respiratory and Critical Care, The Affiliated People’s Hospital of Ningbo University, Ningbo, China
- Correspondence: Hai-Hong Yu Xiaolu Chen Dong Xie
| | - Hai-Hong Yu
- School of Medicine, Tongji University, Shanghai, China
- School of Medicine, Jinggangshan University, Ji'an, China
- Correspondence: Hai-Hong Yu Xiaolu Chen Dong Xie
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Xie S, Liu Q, Han Y, Wang S, Deng H, Liu G. Adjuvant chemotherapy can benefit the survival of stage I lung adenocarcinoma patients with tumour spread through air spaces after resection: Propensity-score matched analysis. Front Oncol 2022; 12:905958. [PMID: 36052246 PMCID: PMC9424854 DOI: 10.3389/fonc.2022.905958] [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: 03/28/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background It is still unclear whether stage I lung adenocarcinoma patients with tumour spread through air spaces (STAS) can benefit from postoperative adjuvant chemotherapy (ACT) after lobectomy. This study investigated the effect of ACT on the postoperative survival of patients with stage I (STAS+) lung adenocarcinoma. Methods We retrospectively analysed the clinical data of stage I (STAS+) invasive lung adenocarcinoma patients who underwent lobectomy in the Department of Thoracic Surgery of our hospital from January 1, 2013 to January 1, 2016. Propensity score matching (PSM) was performed to group patients to investigate whether ACT could lead to better prognosis of patients. Results A total of 593 patients with stage I (STAS+) lung adenocarcinoma were enrolled. The study after PSM included 406 patients. Kaplan–Meier survival analysis showed the experimental group had a better 3-year recurrence-free survival (RFS) rate (p = 0.037) and the 5-year RFS rate (p = 0.022) than the control group. It also had higher 5-year overall survival (p = 0.017). The multivariate analysis by Cox proportional hazard regression model showed that stage I STAS+ lung adenocarcinoma patients with lymphatic vessel invasion (HR: 1.711, 95% CI: 1.052-2.784; p = 0.045), vascular invasion (HR: 5.014, 95% CI: 3.154-7.969; p < 0.001), and visceral pleural invasion (HR: 2.086, 95% CI: 1.162-3.743; p = 0.014), and without ACT (HR: 1.675, 95% CI: 1.043-2.689; p = 0.033) had a significant survival disadvantage. Conclusion ACT can boost the postoperative survival of patients with stage I (STAS+) lung adenocarcinoma.
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Affiliation(s)
- Shaonan Xie
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qingyi Liu
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Qingyi Liu,
| | - Yaqing Han
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shize Wang
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Huiyan Deng
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Guangjie Liu
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Prognostic and predictive value of the newly proposed grading system of invasive pulmonary adenocarcinoma in Chinese patients: a retrospective multicohort study. Mod Pathol 2022; 35:749-756. [PMID: 35013526 DOI: 10.1038/s41379-021-00994-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 11/08/2022]
Abstract
Our aim was to validate and analyze the prognostic impact of the novel International Association for the Study of Lung Cancer (IASLC) Pathology Committee grading system for invasive pulmonary adenocarcinomas (IPAs) in Chinese patients and to evaluate its utility in predicting a survival benefit from adjuvant chemotherapy (ACT). In this multicenter, retrospective, cohort study, we included 926 Chinese patients with completely resected stage I IPAs and classified them into three groups (Grade 1, n = 119; Grade 2, n = 431; Grade 3, n = 376) according to the new grading system proposed by the IASLC. Recurrence-free survival (RFS) and overall survival (OS) were estimated by the Kaplan-Meier method, and prognostic factors were assessed using univariable and multivariable Cox proportional hazards models. All included cohorts were well stratified in terms of RFS and OS by the novel grading system. Furthermore, the proposed grading system was found to be independently associated with recurrence and death in the multivariable analysis. Among patients with stage IB IPA (N = 490), the proposed grading system identified patients who could benefit from ACT but who were undergraded by the adenocarcinoma (ADC) classification. The novel grading system not only demonstrated prognostic significance in stage I IPA in a multicenter Chinese cohort but also offered clinical value for directing therapeutic decisions regarding adjuvant chemotherapy.
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Zhai W, Gong L, Zheng Y, Yan Q, Lai R, Liang D, Wong W, Dai S, Wang J. Ground Glass Opacity and Adjuvant Chemotherapy in Pathological Stage IB-IIA Lung Adenocarcinoma. Front Oncol 2022; 12:851276. [PMID: 35402251 PMCID: PMC8990754 DOI: 10.3389/fonc.2022.851276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background The prognostic value of ground glass opacity (GGO) in stage IA non-small cell lung cancer (NSCLC) has been widely recognized. However, studies investigating its value in the related stage IB-IIA lung adenocarcinoma (LUAD) remains lacking. The impact of adjuvant chemotherapy (ACT) on pathological stage IB-IIA LUAD is also controversial. Materials and Methods We retrospectively reviewed the clinical records of 501 patients with pathological stage IB-IIA LUAD at the Sun Yat-sen University Cancer Center from January 2008 to June 2018. We calculated and compared survival curves using the Kaplan-Meier test and log-rank test. Cox regression models were performed to determine independent prognostic factors of disease-free survival (DFS) and overall survival (OS). We established nomograms to predict the OS and DFS of LUAD patients. Calibration and receiver operator characteristic curves were conducted to assess the predictive performance of two nomograms. Based on the nomogram, we identified candidate patients that may most benefit from ACT after surgery. Results The number of patients with pure solid, part GGO, and pure GGO nodules was 240, 242, and 19, respectively, and 125 patients who received ACT. Patients with consolidation-to-tumor ratio (CTR) <0.75 had longer OS (P = 0.026) and DFS (P = 0.003). Pathological tumor size and at least 10 lymph nodes (LNs) resection were independent prognostic factors of both OS and DFS. CTR <0.75 was positively associated with DFS. The C-index of nomograms predicting individual OS and DFS was 0.660 and 0.634, respectively. Based on the nomogram for OS, ACT was found to be a positive prognostic indicator of OS (P = 0.031, HR = 0.5141, 95% CI 0.281-0.942) in patients with nomogram total points ≥5. Conclusion CTR <0.75 is associated with a better DFS in patients with stage IB-IIA LUAD. Nomograms developed by integrating pathological tumor size, at least 10 LNs resection, and CTR ≥0.75 for predicting individual OS and DFS displayed a good predictive capacity and clinical value, which were also proved to be a useful tool for selecting patients most benefiting from ACT.
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Affiliation(s)
- Wenyu Zhai
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Li Gong
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yuzhen Zheng
- Department of Thoracic Surgery, The Second Department of Surgery, Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, China
| | - Qihang Yan
- Department of Thoracic Surgery, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Renchun Lai
- Department of Anaesthesiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Dachuan Liang
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wingshing Wong
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shuqin Dai
- Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Junye Wang
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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Wang X, Chen D, Xu X, Chen Y. Comment on "clinicopathological features, survival outcomes, and appropriate surgical approaches for stage I acinar and papillary predominant lung adenocarcinoma". Cancer Med 2022; 11:2036-2037. [PMID: 35234357 DOI: 10.1002/cam4.4597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 01/06/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Xiaofan Wang
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Donglai Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Xuejun Xu
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yongbing Chen
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China
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30
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Lu D, Yang J, Liu X, Feng S, Dong X, Shi X, Zhai J, Mai S, Jiang J, Wang Z, Wu H, Cai K. Authors' response: Comment on "clinicopathological features, survival outcomes, and appropriate surgical approaches for stage I acinar and papillary predominant lung adenocarcinoma". Cancer Med 2022; 11:2038-2039. [PMID: 35142110 PMCID: PMC9089219 DOI: 10.1002/cam4.4585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/06/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Di Lu
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianjun Yang
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiguang Liu
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Siyang Feng
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoying Dong
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoshun Shi
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianxue Zhai
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shijie Mai
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianjun Jiang
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhizhi Wang
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hua Wu
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kaican Cai
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Sui Q, Liang J, Hu Z, Xu X, Chen Z, Huang Y, Zhao M, Zhan C, Wang L, Lin Z, Wang Q. The clinical prognostic factors of patients with stage IB lung adenocarcinoma. Transl Cancer Res 2022; 10:4727-4738. [PMID: 35116327 PMCID: PMC8799094 DOI: 10.21037/tcr-21-1174] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/14/2021] [Indexed: 12/24/2022]
Abstract
Background Lung adenocarcinoma (ADC) at stage IB has its own prognostic characteristics. This study aimed to investigate the clinical factors that may affect the prognosis of patients with stage IB ADC. Methods The data of ADC cases were selected from the Surveillance, Epidemiology, and End Results (SEER) database (2010–2016) and patients in Zhongshan Hospital, Fudan University (Department of Thoracic Surgery, 2015–2016). Kaplan-Meier method was used to obtain the overall survival (OS). Factors that significantly related to the prognosis were evaluated by univariate and multivariate analysis (UVA, MVA) using the Cox model. A nomogram was developed and validated to predict the 3-year OSs of those patients. Results 7,605 patients with stage IB ADC were included ultimately and were divided into two groups, a training cohort (n=5,324) and a test cohort (n=2,281). Besides, there was a validation cohort (n=272) for the verification of the nomogram model. Those with significantly older age, male, the white race, lower grades of tumor differentiation, larger tumor size (31–40 mm) without pleural layer (PL) invasion as well as receiving sublobectomy suffered from poorer survival (P<0.001), which were identified as independent factors for stage IB ADC (P<0.001), and according to which, a nomogram model was created. Conclusions Age, sex, race, histological grade, surgery to the primary site, and tumor size combined with PL invasion were independent risk factors for stage IB ADC, based on which a nomogram was constructed to predict the prognosis.
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Affiliation(s)
- Qihai Sui
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiaqi Liang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhengyang Hu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xinming Xu
- School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhencong Chen
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yiwei Huang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mengnan Zhao
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cheng Zhan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lin Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zongwu Lin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Zhao L, Bai G, Ji Y, Peng Y, Zang R, Gao S. Consolidation Tumor Ratio Combined With Pathological Features Could Predict Status of Lymph Nodes of Early-Stage Lung Adenocarcinoma. Front Oncol 2022; 11:749643. [PMID: 35096566 PMCID: PMC8794794 DOI: 10.3389/fonc.2021.749643] [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: 07/29/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Stage IA lung adenocarcinoma manifested as part-solid nodules (PSNs), has attracted immense attention owing to its unique characteristics and the definition of its invasiveness remains unclear. We sought to develop a nomogram for predicting the status of lymph nodes of this kind of nodules. METHODS A total of 2,504 patients between September 2018 to October 2020 with part-solid nodules in our center were reviewed. Their histopathological features were extracted from paraffin sections, whereas frozen sections were reviewed to confirm the consistency of frozen sections and paraffin sections. Univariate and multivariate logistic regression analyses and Akaike information criterion (AIC) variable selection were performed to assess the risk factors of lymph node metastasis and construct the nomogram. The nomogram was subjected to bootstrap internal validation and external validation. The concordance index (C-index) was applied to evaluate the predictive accuracy and discriminative ability. RESULTS We enrolled 215 and 161 eligible patients in the training cohort and validation cohort, respectively. The sensitivity between frozen and paraffin sections on the presence of micropapillary/solid subtype was 78.4%. Multivariable analysis demonstrated that MVI, the presence of micropapillary/solid subtype, and CTR >0.61 were independently associated with lymph node metastasis (p < 0.01). Five risk factors were integrated into the nomogram. The nomogram demonstrated good accuracy in estimating the risk of lymph node metastasis, with a C-index of 0.945 (95% CI: 0.916-0.974) in the training cohort and a C-index of 0.975 (95% CI: 0.954-0.995) in the validation cohort. The model's calibration was excellent in both cohorts. CONCLUSION The nomogram established showed excellent discrimination and calibration and could predict the status of lymph nodes for patients with ≤3 cm PSNs. Also, this prediction model has the prediction potential before the end of surgery.
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Affiliation(s)
- Liang Zhao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guangyu Bai
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Ji
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yue Peng
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruochuan Zang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Xu C, Zhu K, Chen D, Ruan Y, Jin Z, Qiu H, Chen B, Shen J. Efficacy and Benefit of Postoperative Chemotherapy in Micropapillray or Solid Predominant Pattern in Stage IB Lung Adenocarcinoma: A Systematic Review and Meta-Analysis. Front Surg 2022; 8:795921. [PMID: 34993229 PMCID: PMC8724201 DOI: 10.3389/fsurg.2021.795921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background: The benefit of postoperative chemotherapy remains controversial for patients with either a micropapillary or solid pattern in stage IB non-small cell lung cancer. This study is designed to explore the significance of postoperative chemotherapy in patients with either a micropapillary or solid pattern in stage IB lung adenocarcinoma. Method: To conduct the meta-analysis, PubMed, Cochrane Library, Embase and Medline were used to collect literature on long-term follow-up studies published before March, 2021, involving postoperative chemotherapy for patients with both a micropapillary or solid pattern in stage IB lung adenocarcinoma as compared to non-postoperative chemotherapy. Survival data was extracted from the literature, including the overall survival and disease-free survival. Based on overall survival and disease-free survival, hazard ratios and their 95% of confidence intervals were applied to assess the prognostic effect of postoperative chemotherapy. Review Manager software was used to merge the effect size for the meta-analysis. Result: In total, 6 papers with 956 patients were included. In terms of the prognosis of patients suffering from lung cancer when receiving postoperative chemotherapy, this study comprehensively reviews and evaluates the available evidence of micropapillary or solid patterns. After excluding the heterogeneity between the studies, we found that the pooled results from 6 studies report that postoperative chemotherapy was associated with a better overall survival rate when compared with non-postoperative chemotherapy (hazard ratio = 0.58, 95% confidence interval, 0.44–0.77; P = 0.0002). Postoperative chemotherapy also significantly improved the disease-free survival in patients with either a micropapillary or a solid pattern in stage IB lung adenocarcinoma (postoperative chemotherapy vs. non-postoperative chemotherapy, hazard ratio = 0.51, 95% confidence interval, 0.40–0.64; P < 0.001). However, a subgroup analysis showed that compared with non-postoperative chemotherapy, tumor size was unrelated to the prognosis of patients in stage IB undergoing postoperative chemotherapy (hazard ratio = 0.98, 95% confidence interval, 0.94–1.02; P = 0.27). Conclusion: Postoperative chemotherapy results in a better long-term survival rate for patients with either a solid or a micropapillary pattern in stage IB lung adenocarcinoma. Multi-center, prospective, clinical trials are needed to validate our findings.
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Affiliation(s)
- Congcong Xu
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Kanghao Zhu
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Department of Cardiothoracic Surgery, Taizhou Hospital, Zhejiang University, Linhai, China
| | - Dong Chen
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Yuhang Ruan
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Zixian Jin
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Hongbin Qiu
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Baofu Chen
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Jianfei Shen
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
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Choi J, Oh JY, Lee YS, Min KH, Shim JJ, Choi SI, Park DW, Park CK, Kang EJ, Yong HS, Shin BK, Kim HK, Lee SY. Clinical efficacy of adjuvant chemotherapy in stage IB (< 4 cm) non-small cell lung cancer patients with high-risk factors. Korean J Intern Med 2022; 37:127-136. [PMID: 32872735 PMCID: PMC8747921 DOI: 10.3904/kjim.2020.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 06/29/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Adjuvant chemotherapy is the standard of care for resected stage II-IIIA non-small cell lung cancer (NCSLC). The efficacy of adjuvant chemotherapy in stage IB (< 4 cm) NSCLC with high-risk factors is controversial. METHODS This retrospective multicenter study included 285 stage IB NSCLC patients with high-risk factors according to the 8th edition tumor, node, metastasis (TNM) classification from four academic hospitals. High-risk factors included visceral pleural invasion, vascular invasion, lymphatic invasion, lung neuroendocrine tumors, and micropapillary histology patterns. RESULTS Of the 285 patients, 127 (44.6%) were included in the adjuvant chemotherapy group and 158 (55.4%) were included in the non-adjuvant chemotherapy group. The median follow-up was 41.5 months. Patients in the adjuvant chemotherapy group had a significantly reduced recurrence rate and risk of mortality than those in the non-adjuvant chemotherapy group (hazards ratio, 0.408; 95% confidence interval, 0.221 to 0.754; p = 0.004 and hazards ratio, 0.176; 95% confidence interval, 0.057 to 0.546; p = 0.003, respectively). Adjuvant chemotherapy should be particularly considered for the high-risk factors such as visceral pleural involvement or vascular invasion. Based on the subgroup analysis, adjuvant chemotherapy should be considered when visceral pleural involvement is present, even if the tumor size is < 3 cm. CONCLUSION Adjuvant chemotherapy may be useful for patients with stage IB NSCLC with high-risk factors and is more relevant for patients with visceral pleural involvement or vascular invasion.
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Affiliation(s)
- Juwhan Choi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jee Youn Oh
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Young Seok Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Kyung Hoon Min
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jae Jeong Shim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Sue In Choi
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Dong Won Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Chan Kwon Park
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Joo Kang
- Division of Medical Oncology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Seoul, Korea
| | - Bong Kyung Shin
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Sung Yong Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
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Li M, Ruan Y, Feng Z, Sun F, Wang M, Zhang L. Preoperative CT-Based Radiomics Combined With Nodule Type to Predict the Micropapillary Pattern in Lung Adenocarcinoma of Size 2 cm or Less: A Multicenter Study. Front Oncol 2021; 11:788424. [PMID: 34926304 PMCID: PMC8674565 DOI: 10.3389/fonc.2021.788424] [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: 10/02/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose To construct an optimal radiomics model for preoperative prediction micropapillary pattern (MPP) in adenocarcinoma (ADC) of size ≤ 2 cm, nodule type was used for stratification to construct two radiomics models based on high-resolution computed tomography (HRCT) images. Materials and Methods We retrospectively analyzed patients with pathologically confirmed ADC of size ≤ 2 cm who presented to three hospitals. Patients presenting to the hospital with the greater number of patients were included in the training set (n = 2386) and those presenting to the other two hospitals were included in the external validation set (n = 119). HRCT images were used for delineation of region of interest of tumor and extraction of radiomics features; dimensionality reduction was performed for the features. Nodule type was used to stratify the data and the random forest method was used to construct two models for preoperative prediction MPP in ADC of size ≤ 2 cm. Model 1 included all nodule types and model 2 included only solid nodules. The receiver operating characteristic curve was used to assess the prediction performance of the two models and independent validation was used to assess its generalizability. Results Both models predicted ADC with MPP preoperatively. The area under the curve (AUC) of prediction performance of models 1 and 2 were 0.91 and 0.78, respectively. The prediction performance of model 2 was lower than that of model 1. The AUCs in the external validation set were 0.81 and 0.72, respectively. The DeLong test showed statistically significant differences between the training and validation sets in model 1 (p = 0.0296) with weak generalizability. There was no statistically significant difference between the training and validation sets in model 2 (p = 0.2865) with some generalizability. Conclusion Nodule type is an important factor that affects the performance of radiomics predictor model for MPP with ADC of size ≤ 2 cm. The radiomics prediction model constructed based on solid nodules alone, can be used to evaluate MPP and may contribute to proper surgical planning in patients with ADC of size ≤ 2 cm.
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Affiliation(s)
- Meirong Li
- Department of Radiology, The First Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Yachao Ruan
- Department of Radiology, The First Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Zhan Feng
- Department of Radiology, The First Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Fangyu Sun
- Department of Radiology, Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Minhong Wang
- Department of Radiology, First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Liang Zhang
- Department of Radiology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
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Huang W, Zhang H, Zhang Z, Zhang B, Sun X, Huo Y, Feng Y, Tian P, Mo H, Wang C. A prognostic nomogram based on a new classification of combined micropapillary and solid components for stage IA invasive lung adenocarcinoma. J Surg Oncol 2021; 125:796-808. [PMID: 34862621 DOI: 10.1002/jso.26760] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/06/2021] [Accepted: 11/21/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND We aimed to develop a prognostic nomogram based on a new classification of combined micropapillary and solid components in pathological stage IA invasive lung adenocarcinoma (LUAD). METHODS According to the total proportion of solid and micropapillary components (TPSM), the X-tile software was applied to classify patients into the following three groups: TPSM-low (TPSM-L), TPSM-middle (TPSM-M), and TPSM-high (TPSM-H). The postoperative survival was compared among the three groups. The multivariate Cox regression analysis was performed to identify independent prognostic factors for survival. According to these factors, a nomogram model was developed to provide a personalized prognostic evaluation. RESULTS A total of 595 patients with pathological stage IA invasive LUAD were included in our study. The 5-year disease-free survival and overall survival rates in patients with TPSM-H and TPSM-M were significantly lower than those with TPSM-L. The multivariate Cox regression analysis revealed that the TPSM classification was an independent prognostic factor for survival. According to TPSM classification, we developed a nomogram model which had good calibration and reliable discrimination ability to evaluate survival. CONCLUSIONS The nomogram based on the combination of micropapillary and solid components has good prognostic value in predicting postoperative recurrence and survival of patients with pathological stage IA invasive LUAD.
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Affiliation(s)
- Wuhao Huang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Hua Zhang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Zhiwei Zhang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thoracic Surgery, The Fifth Central Hospital of Tianjin, Tianjin, China
| | - Bin Zhang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Xiaoyan Sun
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yansong Huo
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yingnan Feng
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Pengfei Tian
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Huilan Mo
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Changli Wang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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Heldwein MB, Schlachtenberger G, Doerr F, Menghesha H, Bennink G, Schroeder KM, Schaefer SC, Wahlers T, Hekmat K. Different pulmonary adenocarcinoma growth patterns significantly affect survival. Surg Oncol 2021; 40:101674. [PMID: 34896910 DOI: 10.1016/j.suronc.2021.101674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/14/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Adenocarcinoma (AC) is the number one pathological entity of lung cancer with approximately 30-40% of cases. It is known to be heterogeneous and has 5 histopathological growth patterns. We evaluated the long-term survival rates of patients with predominant subtypes. METHODS 290 patients with AC underwent pulmonary resection between 2012 and 2017 at our institution. We excluded all patients with lymph node involvement and distant metastases. Hence, 163 patients were included for further analysis. Predominant growth pattern was defined if more than 10% of cells showed a growth pattern. 1, 3, and 5-year survival rates were evaluated. Survival was assessed by Kaplan-Meier curves and the Cox proportional hazards model was used to identify prognostic factors for overall survival. RESULTS Predominant growth patterns >10% were compared to <10% growth patterns of the same subtype. 1-year, 3-year, and 5-year overall survival rates of patients with predominant solid tumor growth >10% differed significantly from patients with <10% (88.4% vs. 97.6%, p = 0.04; 65.8% vs. 87.4% p = 0.001, 36.4% vs. 65.9% p = 0.01). Survival rates did not differ between >10% papillary and acinar growth compared to <10%. Kaplan-Meier curves showed reduced overall survival for patients with solid tumor growth >10% (log-rank 0.002). Solid tumor growth >10% was an independent prognostic factor for worse long-term survival (Hazard ratio: 3.05, p = 0.01). CONCLUSION Our study demonstrates that the presence of a predominant solid pattern in pulmonary adenocarcinoma is a factor for an unfavorable prognosis. This should be kept in mind in daily clinical practice.
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Affiliation(s)
- Matthias B Heldwein
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Faculty of Medicine and University Hospital Kerpener Strasse 62, 50937, Cologne, Germany
| | - Georg Schlachtenberger
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Faculty of Medicine and University Hospital Kerpener Strasse 62, 50937, Cologne, Germany.
| | - Fabian Doerr
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Faculty of Medicine and University Hospital Kerpener Strasse 62, 50937, Cologne, Germany
| | - Hruy Menghesha
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Faculty of Medicine and University Hospital Kerpener Strasse 62, 50937, Cologne, Germany
| | - Gerardus Bennink
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Faculty of Medicine and University Hospital Kerpener Strasse 62, 50937, Cologne, Germany
| | - Karl-Moritz Schroeder
- School of Medicine, University of Cologne, Cologne, Germany Albertus-Magnus-Platz, 50923, Cologne, Germany
| | - Stephan C Schaefer
- Institute of Pathology, University of Cologne, Faculty of Medicine and University Hospital Kerpener Strasse 62, 50937, Cologne, Germany; Institute of Pathology of the Medical Campus Bodensee Roentgen Strasse 2, 88048, Friedrichshafen, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Faculty of Medicine and University Hospital Kerpener Strasse 62, 50937, Cologne, Germany
| | - Khosro Hekmat
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Faculty of Medicine and University Hospital Kerpener Strasse 62, 50937, Cologne, Germany
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Wang X, Chen D, Wen J, Mao Y, Zhu X, Fan M, Chen Y. Benefit of adjuvant chemotherapy for patients with stage IB non-small cell lung cancer: a systematic review and meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1430. [PMID: 34733982 PMCID: PMC8506786 DOI: 10.21037/atm-21-4001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/09/2021] [Indexed: 11/06/2022]
Abstract
Background Adjuvant chemotherapy (ACT) is routinely the recommended treatment for patients with advanced non-small cell lung cancer (NSCLC) but remains a controversial option in stage IB patients. We therefore pooled the current evidence to determine the prognostic impact of ACT in stage IB NSCLC patients in the context of the eighth tumor, node, metastasis (TNM) staging system. Methods Five electronic databases were searched for eligible studies up to December 2020 without language restrictions. The primary and secondary outcomes were overall survival (OS) and disease-free survival (DFS). Search results were filtered by a set of eligibility criteria and analyzed in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The risk of bias was assessed independently using a modified set. Stata 16.0 was used for general data analysis and meta-analysis, and subgroup analyses were performed to investigate the source of interstudy heterogeneity. Results In all, 12 eligible studies were identified and 15,678 patients included. Our results demonstrated that ACT was associated with improved OS [n=11; hazard ratio (HR) =0.65; 95% confidence interval (CI): 0.60–0.70; P<0.001; I2=33.4%, P=0.131] and DFS (n=9; HR =0.73; 95% CI: 0.63–0.83; P<0.001; I2=66.7%, P=0.002) in stage IB NSCLC patients. Subgroup analysis by histology indicated that administration of ACT conferred more favorable survival to both stage IB squamous cell carcinoma (n=1; HR =0.56; 95% CI: 0.28–0.84; P<0.001) and adenocarcinoma (n=6; HR =0.59; 95% CI: 0.47–0.71; P<0.001; I2=31.0%, P=0.203). Meanwhile, both platinum-based ACT (n=7; HR =0.62; 95% CI: 0.51–0.74; P<0.001; I2=44.8%, P=0.093) and other regimens (n=2; HR =0.66; 95% CI: 0.61–0.72; P<0.001; I2=0.7%, P=0.316) could benefit patients with stage IB disease. Discussion ACT might provide survival benefits to patients with stage IB NSCLC irrespective of histology or regimens. Patient selection and time trend biases were inevitable due to the limitation of retrospective studies. More prospective studies should be initiated to investigate the optimal ACT regimens in different histologic types in stage IB NSCLC patients.
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Affiliation(s)
- Xiaofan Wang
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Donglai Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Junmiao Wen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Yiming Mao
- Department of Surgery, Children's Hospital of Soochow University, Suzhou, China
| | - Xuejuan Zhu
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Min Fan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yongbing Chen
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China
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Xu Y, Ji W, Hou L, Lin S, Shi Y, Zhou C, Meng Y, Wang W, Chen X, Wang M, Yang H. Enhanced CT-Based Radiomics to Predict Micropapillary Pattern Within Lung Invasive Adenocarcinoma. Front Oncol 2021; 11:704994. [PMID: 34513686 PMCID: PMC8429899 DOI: 10.3389/fonc.2021.704994] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/09/2021] [Indexed: 12/25/2022] Open
Abstract
Objective We aimed to investigate whether enhanced CT-based radiomics can predict micropapillary pattern (MPP) of lung invasive adenocarcinoma (IAC) in the pre-op phase and to develop an individual diagnostic predictive model for MPP in IAC. Methods 170 patients who underwent complete resection for pathologically confirmed lung IAC were included in our study. Of these 121 were used as a training cohort and the other 49 as a test cohort. Clinical features and enhanced CT images were collected and assessed. Quantitative CT analysis was performed based on feature types including first order, shape, gray-level co-occurrence matrix-based, gray-level size zone matrix-based, gray-level run length matrix-based, gray-level dependence matrix-based, neighboring gray tone difference matrix-based features and transform types including Log, wavelet and local binary pattern. Receiver operating characteristic (ROC) and area under the curve (AUC) were used to value the ability to identify the lung IAC with MPP using these characteristics. Results Using quantitative CT analysis, one thousand three hundred and seventeen radiomics features were deciphered from R (https://www.r-project.org/). Then these radiomic features were decreased to 14 features after dimension reduction using the least absolute shrinkage and selection operator (LASSO) method in R. After correlation analysis, 5 key features were obtained and used as signatures for predicting MPP within IAC. The individualized prediction model which included age, smoking, family tumor history and radiomics signature had better identification (AUC=0.739) in comparison with the model consisting only of radiomics features (AUC=0.722). DeLong test showed that the difference in AUC between the two models was statistically significant (P<0.01). Compared with the simple radiomics model, the more comprehensive individual prediction model has better prediction performance. Conclusion The use of radiomics approach is of great value in the diagnosis of tumors by non-invasive means. The individualized prediction model in the study, when incorporated with age, smoking and radiomics signature, had effective predictive performance of lung IAC with MPP lesions. The combination of imaging features and clinical features can provide additional diagnostic value to identify the micropapillary pattern in IAC and can affect clinical diagnosis and treatment.
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Affiliation(s)
- Yunyu Xu
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Taizhou, China.,Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenbin Ji
- Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Liqiao Hou
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Taizhou, China
| | - Shuangxiang Lin
- Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Yangyang Shi
- Department of Radiation Oncology, University of Arizona, Tucson, AZ, United States
| | - Chao Zhou
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Taizhou, China
| | - Yinnan Meng
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Taizhou, China
| | - Wei Wang
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Taizhou, China
| | - Xiaofeng Chen
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IU, United States
| | - Meihao Wang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haihua Yang
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Taizhou, China
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Liang J, Wu Q, Ma S, Zhang S. [Pathological and Molecular Features of Lung Micropapillary Adenocarcinoma]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2021; 23:1007-1013. [PMID: 33203200 PMCID: PMC7679217 DOI: 10.3779/j.issn.1009-3419.2020.102.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
肺微乳头腺癌作为高级别肺腺癌,具频发转移、淋巴结浸润、复发率高和总体生存率低的临床特征。该亚型肿瘤中存在特征致癌因子通路的激活和肿瘤免疫微环境的建立。本文拟对近年来微乳头腺癌的病理学表现及分子学特征研究进展作一综述,旨在加深对微乳头型病变的认识,进而为制定特异性治疗策略奠定基础。
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Affiliation(s)
- Jiafeng Liang
- Translational Medicine Research Center, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine,
Hangzhou 310006, China
| | - Qiong Wu
- Translational Medicine Research Center, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine,
Hangzhou 310006, China
| | - Shenglin Ma
- Translational Medicine Research Center, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine,
Hangzhou 310006, China.,Department of Oncology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine,
Hangzhou 310006, China
| | - Shirong Zhang
- Translational Medicine Research Center, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine,
Hangzhou 310006, China
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Watanabe K, Sakamaki K, Ito H, Yokose T, Yamada K, Nakayama H, Masuda M. Impact of the micropapillary component on the timing of recurrence in patients with resected lung adenocarcinoma. Eur J Cardiothorac Surg 2021; 58:1010-1018. [PMID: 32386405 DOI: 10.1093/ejcts/ezaa138] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES A micropapillary (MIP) component is reported to be associated with a poor prognosis in patients with completely resected lung adenocarcinoma. The purpose of this study was to investigate the impact of an MIP component on the timing of postoperative recurrence using hazard curves. METHODS A total of 1289 patients with lung adenocarcinoma who underwent complete pulmonary resection from 2008 to 2015 were studied. Hazard curves representing the changes in hazard over time were evaluated. RESULTS The hazard curve displayed an initial wide, high peak within 1 year after surgery in patients with an MIP component, whereas some gentle peaks around the second year were noted in patients without an MIP component. The presence of an MIP component was associated with a worse recurrence-free survival and an early recurrence in stage I patients but not in advanced-stage patients. In multivariable Cox regression, the presence of an MIP component and lymph node metastasis, pleural invasion and gender were associated with a poor prognosis. CONCLUSIONS Patients with an MIP component retained a high risk of early recurrence after surgery, and the risk for recurrence persisted over the long term. Even after complete resection in stage I lung adenocarcinoma patients, an MIP component remains correlated with a poor prognosis.
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Affiliation(s)
- Katsuya Watanabe
- Department of General Thoracic Surgery, Yokohama Medical Center, Yokohama, Japan.,Department of General Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Kentaro Sakamaki
- Center for Data Science, Yokohama City University, Yokohama, Japan
| | - Hiroyuki Ito
- Department of General Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Tomoyuki Yokose
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Japan
| | - Kozo Yamada
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Haruhiko Nakayama
- Department of General Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, Yokohama, Japan
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Zhang Y, Zhao F, Wu M, Zhao Y, Liu Y, Li Q, Zhou G, Ye Z. Association of postoperative recurrence with radiological and clinicopathological features in patients with stage IA-IIA lung adenocarcinoma. Eur J Radiol 2021; 141:109802. [PMID: 34090112 DOI: 10.1016/j.ejrad.2021.109802] [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: 02/09/2021] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To retrospectively investigate whether radiological and clinicopathological characteristics were associated with the presence of stage IA-IIA lung adenocarcinoma in patients at high risk for a postoperative recurrence. MATERIALS AND METHODS Three hundred twelve patients with biopsy-proven node-negative early-stage (IA-IIA) lung adenocarcinoma met the inclusion criteria for this study. Demographics data and histopathological findings were collected from medical records. Computed tomography (CT) performed approximately 1 month before surgery was manually scored using 23 CT descriptors. Univariate analyses were applied to demonstrate an association between clinicopathological and radiological features and 2-/5-year recurrences. Multivariate logistic regression was performed to assess the ability of radiological and clinicopathological features to discriminate low and high-risk factors for recurrence. A ROC curve was used to evaluate prediction performance. RESULTS Univariate analysis revealed that the 2-year recurrence was associated with six radiological features and two clinicopathological features, while 5-year recurrence was associated with five radiological features and two clinicopathological features. A multivariate logistic regression model of combined clinicopathological and radiological features showed that stage IIA (OR = 2.87), solid texture (solid part > 50 %: OR = 4.81; solid part = 100 %: OR = 3.61), pleural attachment (OR = 3.97) and bronchovascular bundle thickening (OR = 2.16) were associated with the independent predictors of 2-year recurrence, and stage IIA (OR = 3.52), solid texture (solid part > 50 %: OR = 3.56; solid part = 100 %: OR = 2.44) and pleural attachment (OR = 4.57) were associated with 5-year recurrence. Combined radiological and clinicopathological features could be significant indicators of 2- and 5-year recurrences (AUC = 0.784 and AUC = 0.815, respectively). CONCLUSIONS The combination of radiological and clinicopathological features has the potential to help predict postoperative recurrence in patients with stage IA-IIA lung adenocarcinomas and guide oncologists and patients whether to undergo additional treatment after surgery.
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Affiliation(s)
- Yanyan Zhang
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Hexi District, Tianjin, 300060, China
| | - Fengnian Zhao
- Department of Ultrasound, Tianjin Medical University General Hospital, Anshan Road, Heping District, Tianjin, 300052, China
| | - Minghao Wu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Hexi District, Tianjin, 300060, China; Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yunqing Zhao
- Department of Radiology, Institute of Hematology, Chinese Academy of Medical Sciences, Nanjing Road, Heping District, Tianjin, 300052, China
| | - Ying Liu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Hexi District, Tianjin, 300060, China
| | - Qian Li
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Hexi District, Tianjin, 300060, China
| | - Guiming Zhou
- Department of Ultrasound, Tianjin Medical University General Hospital, Anshan Road, Heping District, Tianjin, 300052, China.
| | - Zhaoxiang Ye
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Hexi District, Tianjin, 300060, China.
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Xi J, Yin J, Liang J, Zhan C, Jiang W, Lin Z, Xu S, Wang Q. Prognostic Impact of Radiological Consolidation Tumor Ratio in Clinical Stage IA Pulmonary Ground Glass Opacities. Front Oncol 2021; 11:616149. [PMID: 33912445 PMCID: PMC8072116 DOI: 10.3389/fonc.2021.616149] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 03/16/2021] [Indexed: 01/11/2023] Open
Abstract
Objectives Our study aimed to validate pathologic findings of ground-glass nodules (GGOs) of different consolidation tumor ratios (CTRs), and to explore whether GGOs could be stratified according to CTR with an increment of 0.25 based on its prognostic role. Methods We retrospectively evaluated patients with clinical stage IA GGOs who underwent curative resection between 2011 and 2016. The patients were divided into 4 groups according to CTR step by 0.25. Cumulative survival rates were calculated by the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were conducted to obtain the risk factors on relapse-free survival (RFS). The surv_function of the R package survminer was used to determine the optimal cutoff value. Receiver operating characteristic (ROC) analysis was generated to validate optimal cutoff points of factors. Results A total of 862 patients (608 women; median age, 59y) were included, with 442 patients in group A (CTR ≤ 0.25), 210 patients in group B (0.25<CTR ≤ 0.5), 173 patients in group C (0.5<CTR ≤ 0.75), and 37 patients in group D (0.75<CTR<1). The rate of adenocarcinoma in situ (AIS) or minimally invasive adenocarcinoma (MIA) in group A (70.6%) was much higher than other three groups (p<0.001). Multivariable Cox regression revealed that CTR (HR, 1.865; 95%CI, 1.312-2.650; p = 0.001) and lymph node metastasis (HR, 10.407; 95%CI, 1.957-55.343; p = 0.006) were independent prognostic factors for recurrence free survival. In addition, CTR was the only risk factor for the presence of micropapillary or solid pattern (OR=133.9, 95%CI:32.2-556.2, P<0.001) and lymph node metastasis (OR=292498.8, 95%CI:1.2-7.4×1010, P=0.047). Paired comparison showed that rate of presence of micropapillary or solid pattern was highest in group D, followed by group C and group A/B (p<0.001). Lymph node metastasis occurred in group D only (p=0.002). Conclusions CTR is an independent prognostic factor for clinical stage IA lung adenocarcinoma manifesting as GGO in CT scan. Radiologic cutoffs of CTR 0.50 and 0.75 were able to subdivide patients with different prognosis.
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Affiliation(s)
- Junjie Xi
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiacheng Yin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiaqi Liang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cheng Zhan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Jiang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zongwu Lin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Songtao Xu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Chen D, Wang Y, Zhang X, Ding Q, Wang X, Xue Y, Wang W, Mao Y, Chen C, Chen Y. Characterization of Tumor Microenvironment in Lung Adenocarcinoma Identifies Immune Signatures to Predict Clinical Outcomes and Therapeutic Responses. Front Oncol 2021; 11:581030. [PMID: 33747907 PMCID: PMC7973234 DOI: 10.3389/fonc.2021.581030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 01/27/2021] [Indexed: 12/12/2022] Open
Abstract
Background and Objective Increasing evidence has elucidated the clinicopathological significance of individual TME component in predicting outcomes and immunotherapeutic efficacy in lung adenocarcinoma (LUAD). Therefore, we aimed to investigate whether comprehensive TME-based signatures could predict patient survival and therapeutic responses in LUAD, and to assess the associations among TME signatures, single nucleotide variations and clinicopathological characteristics. Methods In this study, we comprehensively estimated the TME infiltration patterns of 493 LUAD patients and systematically correlated the TME phenotypes with genomic characteristics and clinicopathological features of LUADs using two proposed computational algorithms. A TMEscore was then developed based on the TME signature genes, and its prognostic value was validated in different datasets. Bioinformatics analysis was used to evaluate the efficacy of the TMEscore in predicting responses to immunotherapy and chemotherapy. Results Three TME subtypes were identified with no prognostic significance exhibited. Among them, naïve B cells accounted for the majority in TMEcluster1, while M2 TAMs and M0 TAMs took the largest proportion in TMEcluster2 and TMEcluster3, respectively. A total of 3395 DEGs among the three TME clusters were determined, among which 217 TME signature genes were identified. Interestingly, these signature genes were mainly involved in T cell activation, lymphocyte proliferation and mononuclear cell proliferation. With somatic variations and tumor mutation burden (TMB) of the LUAD samples characterized, a genomic landscape of the LUADs was thereby established to visualize the relationships among the TMEscore, mutation spectra and clinicopathological profiles. In addition, the TMEscore was identified as not only a prognosticator for long-term survival in different datasets, but also a predictive biomarker for the responses to immune checkpoint blockade (ICB) and chemotherapeutic agents. Furthermore, the TMEscore exhibited greater accuracy than other conventional biomarkers including TMB and microsatellite instability in predicting immunotherapeutic response (p < 0.001). Conclusion In conclusion, our present study depicted a comprehensive landscape of the TME signatures in LUADs. Meanwhile, the TMEscore was proved to be a promising predictor of patient survival and therapeutic responses in LUADs, which might be helpful to the future administration of personalized adjuvant therapy.
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Affiliation(s)
- Donglai Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Yifei Wang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xi Zhang
- Stem Cell Translational Research Center, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Neurology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qifeng Ding
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaofan Wang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuhang Xue
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei Wang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yiming Mao
- Department of Thoracic Surgery, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Yongbing Chen
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Chen D, Wang X, Zhang F, Han R, Ding Q, Xu X, Shu J, Ye F, Shi L, Mao Y, Chen Y, Chen C. Could tumor spread through air spaces benefit from adjuvant chemotherapy in stage I lung adenocarcinoma? A multi-institutional study. Ther Adv Med Oncol 2020; 12:1758835920978147. [PMID: 33403018 PMCID: PMC7739212 DOI: 10.1177/1758835920978147] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/11/2020] [Indexed: 12/18/2022] Open
Abstract
Background: The benefit of adjuvant chemotherapy (ACT) remains unknown for patients with stage I lung adenocarcinoma (ADC) with spread through air spaces (STAS). This study investigated the effect of adjuvant chemotherapy in stage I ADC/STAS-positive patients. Methods: A total of 3346 patients with stage I ADC from five institutions in China were identified from 2009 to 2013, of whom 1082 were diagnosed with STAS (32.3%). By using the Kaplan–Meier method and Cox proportional hazard regression model, we explored the impact of STAS on prognosis, and determined if the use of adjuvant chemotherapy was associated with improved outcomes in patients with stage I ADC/STAS-positive. A validation cohort was also included in this study. Results: Patients with stage I ADC/STAS-positive in the primary cohort had unfavorable overall survival (OS) and disease-free survival (DFS). A multivariate Cox regression model confirmed the survival disadvantages of STAS in patients with stage I ADC [OS: hazards ratio (HR) = 1.877, 95% confidence interval (CI): 1.579–2.231; p < 0.001; DFS: HR = 1.895, 95% CI: 1.614–2.225; p < 0.001]. Lobectomy was associated with better OS and DFS than sublobar resection (SR) in both stage IA and IB ADC/STAS-positive. Similar results were observed in the validation cohort. For patients with stage IB ADC/STAS-positive, ACT was revealed as an independent factor for favorable survival (OS: HR = 0.604, 95% CI: 0.397–0.919; p = 0.018; DFS: HR = 0.565, 95% CI: 0.372–0.858; p = 0.007). However, among patients with stage IA ADC/STAS-positive, ACT was associated with improved outcomes only for those undergoing SR (OS: HR = 0.787, 95% CI: 0.359–0.949; p = 0.034; DFS: HR = 0.703, 95% CI: 0.330–0.904; p = 0.029). Conclusion: The presence of STAS was correlated with poor prognosis in patients with stage I ADC. Our study suggested that ACT might be considered for patients with stage IB ADC/STAS-positive and those with stage IA ADC/STAS-positive who underwent SR.
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Affiliation(s)
- Donglai Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Xiaofan Wang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Fuquan Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ruoshuang Han
- Department of Oncology, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Qifeng Ding
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuejun Xu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jian Shu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China Department of Thoracic Surgery, Taicang Affiliated Hospital of Soochow University, The First People's Hospital of Taicang, Taicang, China
| | - Fei Ye
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China Department of Thoracic Surgery, Hai'an Hospital Affiliated to Nantong University, Hai'an, China
| | - Li Shi
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yiming Mao
- Department of Thoracic Surgery, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, 215000, China
| | - Yongbing Chen
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gusu District, Suzhou, 215004, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, 200433, China
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Weng CF, Huang CJ, Huang SH, Wu MH, Tseng AH, Sung YC, Lee HHC, Ling TY. New International Association for the Study of Lung Cancer (IASLC) Pathology Committee Grading System for the Prognostic Outcome of Advanced Lung Adenocarcinoma. Cancers (Basel) 2020; 12:cancers12113426. [PMID: 33218158 PMCID: PMC7698816 DOI: 10.3390/cancers12113426] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/11/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022] Open
Abstract
Simple Summary This study investigated the association between survival outcome and the new grading system among advanced stage lung adenocarcinoma (LADC) (stages IIIA, IIIB and IV) patients who were diagnosed as LADC with a pathologic report according to a new grading system by the International Association for the Study of Lung Cancer (IASLC) pathology committee. The results indicate that the poorly differentiated group had a poorer prognosis in PFS, as did patients with wild-type EGFR who were treated with chemotherapy. No survival difference could be found among EGFR mutation patients. Older age and a lower body mass index also led to worse survival. Patients with poorly differentiated adenocarcinoma likewise had worse survival, especially compared to those with moderately differentiated adenocarcinoma. Our findings highlight that the therapeutic regimen should be adjusted for wild-type EGFR patients with poorly differentiated adenocarcinoma treated with chemotherapy to provide better outcomes. No survival difference could be seen among EGFR mutation patients. Abstract The impact of the new International Association for the Study of Lung Cancer pathology committee grading system for advanced lung adenocarcinoma (LADC) on survival is unclear, especially in Asian populations. In this study, we reviewed the prognostic outcomes of patients with late-stage disease according to the new grading system. We reviewed 136 LADC cases who underwent a small biopsy from 2007 to 2018. Tumors were classified according to the new grading system for LADC. Baseline characteristics (age, sex, smoking status, body mass index, and driver gene mutations) were analyzed. Kaplan–Meier and Cox regression analyses were used to determine correlations with the new grading system and prognosis. Patients with poorly differentiated adenocarcinoma were significantly correlated with a poor progression-free survival (PFS) (p = 0.013) but not overall survival (OS) (p = 0.154). Subgroup analysis showed that wild-type EGFR patients with poorly differentiated adenocarcinoma treated with chemotherapy had significantly worse PFS (p = 0.011). There was no significant difference in survival among the patients with epidermal growth factor receptor mutations who were treated with tyrosine kinase inhibitors. Patients aged >70 years and those with a BMI ≤ 25 kg/m2 and wild-type patients had significantly worse OS in both univariate (HR = 1.822, p = 0.006; HR = 2.250, p = 0.004; HR = 1.537, p = 0.046, respectively) and multivariate analyses (HR = 1.984, p = 0.002; HR = 2.383, p = 0.002; HR = 1.632, p = 0.028, respectively). Despite therapy, patients with poorly differentiated tumors still fared worse than those with better differentiated tumors. No differences were found among the EGFR mutations treated with TKI. Our findings highlight that the therapeutic regimen should be adjusted for EGFR Wild-type patients with poorly differentiated adenocarcinoma treated with chemotherapy to provide better outcomes.
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Affiliation(s)
- Ching-Fu Weng
- Division of Pulmonary Medicine, Department of Internal Medicine, Hsinchu Cathay General Hospital, Hsinchu 300, Taiwan;
- Department and Graduate Institute of Pharmacology, National Taiwan University, Taipei 100, Taiwan
| | - Chi-Jung Huang
- Medical Research Center, Cathay General Hospital, Taipei 106, Taiwan;
- Department of Biochemistry, National Defense Medical Center, Taipei 114, Taiwan
- School of Medicine, Fu Jen Catholic University, New Taipei 242, Taiwan
| | - Shih-Hung Huang
- Division of Pathology, Cathay General Hospital, Taipei 106, Taiwan;
| | - Mei-Hsuan Wu
- Teaching and Research Center, Hsinchu Cathay General Hospital, Hsinchu 300, Taiwan;
| | - Ailun Heather Tseng
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan 320, Taiwan;
| | - Yung-Chuan Sung
- Division of Hematology/Oncology, Department of Internal Medicine, Cathay General Hospital, Taipei 106, Taiwan;
| | - Henry Hsin-Chung Lee
- School of Medicine, Fu Jen Catholic University, New Taipei 242, Taiwan
- Department of Surgery, Hsinchu Cathay General Hospital, Hsinchu 300, Taiwan
- Graduate Institute of Translational and Interdisciplinary Medicine, College of Health Sciences and Technology, National Central University, Taoyuan 320, Taiwan
- Correspondence: (H.H.-C.L.); (T.-Y.L.); Tel.: +886-3-527-8999 (ext. 61346) (H.H.-C.L.); +886-2-2312-3456 (ext. 88322) (T.-Y.L.)
| | - Thai-Yen Ling
- Department and Graduate Institute of Pharmacology, National Taiwan University, Taipei 100, Taiwan
- Correspondence: (H.H.-C.L.); (T.-Y.L.); Tel.: +886-3-527-8999 (ext. 61346) (H.H.-C.L.); +886-2-2312-3456 (ext. 88322) (T.-Y.L.)
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Lam S, Bryant H, Donahoe L, Domingo A, Earle C, Finley C, Gonzalez AV, Hergott C, Hung RJ, Ireland AM, Lovas M, Manos D, Mayo J, Maziak DE, McInnis M, Myers R, Nicholson E, Politis C, Schmidt H, Sekhon HS, Soprovich M, Stewart A, Tammemagi M, Taylor JL, Tsao MS, Warkentin MT, Yasufuku K. Management of screen-detected lung nodules: A Canadian partnership against cancer guidance document. CANADIAN JOURNAL OF RESPIRATORY CRITICAL CARE AND SLEEP MEDICINE 2020. [DOI: 10.1080/24745332.2020.1819175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Stephen Lam
- British Columbia Cancer Agency & the University of British Columbia, Vancouver, British Columbia, Canada
| | - Heather Bryant
- Screening and Early Detection, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Laura Donahoe
- Division of Thoracic Surgery, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Ashleigh Domingo
- Screening and Early Detection, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Craig Earle
- Screening and Early Detection, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Christian Finley
- Department of Thoracic Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada
| | - Anne V. Gonzalez
- Division of Respiratory Medicine, McGill University, Montreal, Quebec, Canada
| | - Christopher Hergott
- Division of Respiratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rayjean J. Hung
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Anne Marie Ireland
- Patient and Family Advocate, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Michael Lovas
- Patient and Family Advocate, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Daria Manos
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John Mayo
- Department of Radiology, Vancouver Coastal Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna E. Maziak
- Surgical Oncology Division of Thoracic Surgery, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Micheal McInnis
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Renelle Myers
- British Columbia Cancer Agency & the University of British Columbia, Vancouver, British Columbia, Canada
| | - Erika Nicholson
- Screening and Early Detection, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Christopher Politis
- Screening and Early Detection, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Heidi Schmidt
- University Health Network and Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Harman S. Sekhon
- Department of Pathology and Laboratory Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Marie Soprovich
- Patient and Family Advocate, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Archie Stewart
- Patient and Family Advocate, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Martin Tammemagi
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Jana L. Taylor
- Department of Radiology, McGill University, Montreal, Quebec, Canada
| | - Ming-Sound Tsao
- Department of Laboratory Medicine and Pathobiology, University Health Network and Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Matthew T. Warkentin
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Department of Surgery and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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Zeng Q, Wang B, Li J, Zhao J, Mao Y, Gao Y, Xue Q, Gao S, Sun N, He J. Solid Nodule Appearance as a Predictor of Tumor Spread Through Air Spaces in Patients with Lung Adenocarcinoma: A Propensity Score Matching Study. Cancer Manag Res 2020; 12:8197-8207. [PMID: 32982416 PMCID: PMC7490081 DOI: 10.2147/cmar.s266750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/13/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Spread through air spaces (STAS) has been reported to be an invasive histological pattern with poor prognosis in lung cancer; however, little is known about its intrinsic risk factors. This work analyzed the correlation between pathological and radiological features and STAS in resected lung adenocarcinomas. PATIENTS AND METHODS We retrospectively reviewed 1821 consecutive surgically treated patients with histologically diagnosed lung adenocarcinoma (174 positive for STAS and 1647 negative for STAS) from December 2017 to November 2018 at our institution. Propensity score matching identified 170 well-balanced pairs of patients. The correlations between pathological and radiological features and the presence of STAS were analyzed. RESULTS Before propensity matching, the incidence rate of STAS was 9.6% in all patients. In matched cohorts, multivariate analysis showed that the presence of STAS was significantly correlated with pure solid nodules (SNs) (p = 0.001) and solid/micropapillary patterns (SMPs) (p = 0.002). The odds ratio for STAS in SN-positive and SMP-positive adenocarcinoma against that in SN-negative and SMP-negative adenocarcinoma was 10.922 (95% confidence interval, 5.826-20.475; p < 0.001). Tumor differentiation, visceral pleural invasion (VPI), lymphovascular invasion (LVI), invasive adenocarcinoma, and non-lepidic subtype were significantly associated with STAS in the univariate analysis (p < 0.05); however, the differences failed to reach a significant level in the multivariate analysis. CONCLUSION We found that STAS was significantly correlated with several invasive clinicopathological patterns. The presence of SNs and SMPs were revealed as independent predictors for STAS, which could offer clinicians clues to identify STAS-positive adenocarcinoma.
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Affiliation(s)
- Qingpeng Zeng
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Bingzhi Wang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Jiagen Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Jun Zhao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yousheng Mao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yushun Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Qi Xue
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Nan Sun
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
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Zeng J, Cui X, Cheng L, Chen Y, Du X, Sheng L. Micropapillary pattern of stage IIIA-N 2 lung adenocarcinoma is a prognostic factor after adjuvant chemoradiotherapy. Future Oncol 2020; 16:3075-3084. [PMID: 32869661 DOI: 10.2217/fon-2020-0597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aim: This study aims to investigate the significance of a micropapillary pattern in stage IIIA-N2 lung adenocarcinoma after adjuvant chemoradiotherapy. Patients & methods: A total of 257 patients with stage IIIA-N2 lung adenocarcinoma were enrolled in this study. Patients were classified into three groups based on the proportion of micropapillary components: micropapillary negative, micropapillary minor component and micropapillary predominant component. Results: The micropapillary predominant group had the shortest median disease-free survival and overall survival times compared with the micropapillary minor component and micropapillary negative groups (median overall survival time: 54 months vs 64 months vs not reached; p = 0.004). Furthermore, the micropapillary pattern was an independent prognostic factor for disease-free survival and overall survival (p < 0.05). Conclusion: The micropapillary pattern of IIIA-N2 lung adenocarcinoma is related to worse prognosis.
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Affiliation(s)
- Jian Zeng
- Department of Thoracic Surgery, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Institute of Cancer & Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China.,Department of Radiotherapy, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China
| | - Xiaoying Cui
- Institute of Cancer & Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China.,Department of Radiotherapy, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Key Laboratory Diagnosis & Treatment Technology on Thoracic Oncology, Zhejiang, China.,The Second Clinical Medical College, Zhejiang Chinese Medical University
| | - Lei Cheng
- Institute of Cancer & Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China.,Department of Radiotherapy, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Key Laboratory Diagnosis & Treatment Technology on Thoracic Oncology, Zhejiang, China
| | - Ying Chen
- Department of Thoracic Surgery, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Institute of Cancer & Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China.,Department of Radiotherapy, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Key Laboratory Diagnosis & Treatment Technology on Thoracic Oncology, Zhejiang, China
| | - Xianghui Du
- Institute of Cancer & Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China.,Department of Radiotherapy, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Key Laboratory Diagnosis & Treatment Technology on Thoracic Oncology, Zhejiang, China
| | - Liming Sheng
- Institute of Cancer & Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China.,Department of Radiotherapy, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Key Laboratory Diagnosis & Treatment Technology on Thoracic Oncology, Zhejiang, China
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50
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Xie D, Wang TT, Huang SJ, Deng JJ, Ren YJ, Yang Y, Wu JQ, Zhang L, Fei K, Sun XW, She YL, Chen C. Radiomics nomogram for prediction disease-free survival and adjuvant chemotherapy benefits in patients with resected stage I lung adenocarcinoma. Transl Lung Cancer Res 2020; 9:1112-1123. [PMID: 32953490 PMCID: PMC7481634 DOI: 10.21037/tlcr-19-577] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Robust imaging biomarkers are needed for risk stratification in stage I lung adenocarcinoma patients in order to select optimal treatment regimen. We aimed to construct and validate a radiomics nomogram for predicting the disease-free survival (DFS) of patients with resected stage I lung adenocarcinoma, and further identifying candidates benefit from adjuvant chemotherapy (ACT). Methods Using radiomics approach, we analyzed 554 patients' computed tomography (CT) images from three multicenter cohorts. Prognostic radiomics features were extracted from computed tomography (CT) images and selected using least absolute shrinkage and selection operator (LASSO) Cox regression model to build a radiomics signature for DFS stratification. The biological basis of radiomics was explored in the Radiogenomics dataset (n=79) by gene set enrichment analysis (GSEA). Then a nomogram that integrated the signature with these significant clinicopathologic factors in the multivariate analysis were constructed in the training cohort (n=238), and its prognostic accuracy was evaluated in the validation cohort (n=237). Finally, the predictive value of nomogram for ACT benefits was assessed. Results The radiomics signature with higher score was significantly associated with worse DFS in both the training and validation cohorts (P<0.001). The GSEA presented that the signature was highly correlated to characteristic metabolic process and immune system during cancer progression. Multivariable analysis revealed that age (P=0.031), pathologic TNM stage (P=0.043), histologic subtype (P=0.010) and the signature (P<0.001) were independently associated with patients' DFS. The integrated radiomics nomogram showed good discrimination performance, as well as good calibration and clinical utility, for DFS prediction in the validation cohort. We further found that the patients with high points (point ≥8.788) defined by the radiomics nomogram obtained a significant favorable response to ACT (P=0.04) while patients with low points (point <8.788) showed no survival difference (P=0.7). Conclusions The radiomics nomogram could be used for prognostic prediction and ACT benefits identification for patient with resected stage I lung adenocarcinoma.
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Affiliation(s)
- Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ting-Ting Wang
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shu-Jung Huang
- Research Institute of Oncology and Hematology, CancerCare Manitoba & University of Manitoba, Winnipeg, MB, Canada
| | - Jia-Jun Deng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yi-Jiu Ren
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yang Yang
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jun-Qi Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lei Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ke Fei
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xi-Wen Sun
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yun-Lang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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